QUALITY AND PERFORMANCE IN ACADEMIC EDUCATION FROM THE PERSPECTIVE OF STRATEGIC MARKETING

Knowledge is a long-term process which consists in acquiring information throughout life. We live in an era of technologic dynamism, where information means power. The organizations which are strategically oriented towards the individual knowledge of their customers, of their needs, the large analysis of the market phenomena, of the ongoing transformations, as well as the intelligent use of innovating techniques will have the decisive competitive upper hand.strategic marketing, student-oriented learning, performance, quality

Long-term outcome in new onset refractory status epilepticus: a retrospective study

BACKGROUND: New onset refractory status epilepticus (NORSE) is a neurologic emergency without an immediately identifiable cause. The complicated and long ICU stay of the patients can lead to perceiving a prolongation of therapies as futile. However, a recovery is possible even in severe cases. This retrospective study investigates ICU treatments, short- and long-term outcome and ethical decisions of a case series of patients with NORSE. METHODS: Overall, 283 adults were admitted with status epilepticus (SE) to the Neurocritical Care Unit of the University Hospital Zurich, Switzerland, between 01.2010 and 12.2022. Of them, 25 had a NORSE. We collected demographic, clinical, therapeutic and outcome data. Descriptive statistics was performed. RESULTS: Most patients were female (68%), previously healthy (Charlson comorbidity index 1 [0-4]) and relatively young (54 ± 17 years). 96% presented with super-refractory SE. Despite extensive workup, the majority (68%) of cases remained cryptogenic. Most patients had a long and complicated ICU stay. The in-hospital mortality was 36% (n = 9). The mortality at last available follow-up was 56% (n = 14) on average 30 months after ICU admission. The cause of in-hospital death for 89% (n = 8) of the patients was the withholding/withdrawing of therapies. Medical staff except for one patient triggered the decision. The end of life (EOL) decision was taken 29 [12-51] days after the ICU admission. Death occurred on day 6 [1-8.5] after the decision was taken. The functional outcome improved over time for 13/16 (81%) hospital survivors (median mRS at hospital discharge 4 [3.75-5] vs. median mRS at last available follow-up 2 [1.75-3], p < 0.001). CONCLUSIONS: Our data suggest that the long-term outcome can still be favorable in NORSE survivors, despite a prolonged and complicated ICU stay. Clinicians should be careful in taking EOL decisions to avoid the risk of a self-fulfilling prophecy. Our results encourage clinicians to continue treatment even in initially refractory cases

Management of brainstem haemorrhages

Among spontaneous intracranial haemorrhages, primary non-traumatic brainstem haemorrhages are associated with the highest mortality rate. Patients classically present with rapid neurological deterioration. Previous studies have found that the severity of initial neurological symptoms and hydrocephalus are predictors of poor outcomes. In addition, radiological parameters aim to classify brainstem haematomas according to volume, extension and impact on prognosis. However, previous studies have failed to agree on a differentiated radiological classification for outcome and functional recovery. Electrophysiology, including motor, auditory and somatosensory evoked potentials, is used to estimate the extent of the initial injury and predict functional recovery. The current management of brainstem haematomas remains conservative, focusing on initial close neurocritical care monitoring. Surgical treatment concepts exist, but similarly to general intracranial haemorrhage management, they continue to be controversial and have not been sufficiently investigated. This is especially the case for haematomas in the posterior fossa, as these are excluded from most current clinical trials. Existing studies were mostly carried out before the present millennium began, and limitations are evident in the adaptation of those results and recommendations to current management, with today&rsquo;s technological and diagnostic possibilities. We therefore recommend the re-evaluation of brainstem haemorrhages in the modern neurosurgical and intensive care environment

Tackling the translational challenges of multi-omics research in the realm of European personalised medicine : A workshop report

Personalised medicine (PM) presents a great opportunity to improve the future of individualised healthcare. Recent advances in -omics technologies have led to unprecedented efforts characterising the biology and molecular mechanisms that underlie the development and progression of a wide array of complex human diseases, supporting further development of PM. This article reflects the outcome of the 2021 EATRIS-Plus Multi-omics Stakeholder Group workshop organised to 1) outline a global overview of common promises and challenges that key European stakeholders are facing in the field of multi-omics research, 2) assess the potential of new technologies, such as artificial intelligence (AI), and 3) establish an initial dialogue between key initiatives in this space. Our focus is on the alignment of agendas of European initiatives in multi-omics research and the centrality of patients in designing solutions that have the potential to advance PM in long-term healthcare strategies.Peer reviewe

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Measurement of exhaled nitric oxide in healthy adults.

BACKGROUND AND AIM: Measurement of exhaled nitric oxide (NO) is useful in the diagnosis and management of asthma. The aims of this study were to investigate the effects of physiologic confounders on levels of fractional exhaled NO (FE(NO)) in healthy adults and to establish reference values of FE(NO) measured according to American Thoracic Society (ATS) guidelines. METHODS: FE(NO) was measured in 122 healthy nonsmoking subjects of 20 to 65 years with a chemiluminescence analyser using the single breath online technique and an exhalation flow of 50 mL/s. RESULTS: The geometric mean [SE] FE(NO) was 21.6[1.06] ppb in males and 16.3[1.07] ppb in females (p < 0.01). FE(NO) increased significantly with body size and spirometric indices. In a stepwise regression analysis, body weight was the only variable included in the model (r = 0.36, p < 0.0001) and explained gender differences in FE(NO). When weight-related variables, including BMI, BSA and dead space volume, were analysed in a stepwise regression model, dead space volume gave the best correlation with FE(NO) (R = 0.39; p < 0.0001). CONCLUSION: The present study estimated that mean FE(NO) in healthy Caucasian subjects of 20 to 65 years, measured according to ATS guidelines with the online single breath technique, ranges from 15 to 24 ppb depending on the body weight. We suggest that the volume of dead space may explain the effect of weight on exhaled NO. However, a substantial part of FE(NO) variability in normal subjects remains unexplained

La diffusione del primo Aurignaziano a sud dell\u2019arco alpino

RIASSUNTO - La diffusione del primo Aurignaziano a sud dell\u2019arco alpino - I siti protoaurignaziani del Riparo Mochi e del Riparo Bombrini (Balzi Rossi, Alpi Marittime) e della Grotta di Fumane (Prealpi Venete) vengono confrontati sulla base dei seguenti aspetti: cronologia, aree di approvvigionamento dei materiali litici, lavorazione della selce (catene operative, prodotti, tipologia), manufatti in materie dure animali e provenienza delle conchiglie marine usate come parures. La comparsa del Protoaurignaziano nelle serie stratigrafiche dei tre siti avviene nel medesimo intervallo cronologico. Le industrie ricadono nella tradizione tecnologica del Protoaurignaziano, ma si differenziano per quanto riguarda aree di approvvigionamento della selce e tipologia delle armature. Le ricerche sinora condotte su scala europea attribuiscono al medesimo gruppo \u201citalo-greco\u201d le conchiglie marine dei tre siti; per la collezione di Fumane non vi sono dati sufficienti per stabilire la provenienza adriatica o tirrenica, anche se quest\u2019ultima pare pi\uf9 probabile. Rapporti tra Fumane e spiagge liguri sono suggeriti anche da alcuni ciottoli utilizzati nel sito veneto. In conclusione: allo stato delle ricerche non pare possibile indicare, per l\u2019Italia settentrionale, un modello di diffusione del Protoaurignaziano da est verso ovest o viceversa. I siti dei Balzi Rossi e di Fumane potrebbero essere espressione della migrazione di due gruppi di Uomini Moderni diversi, anche se legati da una medesima tradizione culturale.SUMMARY - The diffusion of the earliest Aurignacian south of the Alpine mountain range - The protoaurignacian assemblages of Mochi and Bombrini Shelters (Balzi Rossi, Maritime Alps) and Fumane Cave (Venetian Prealps) are compared on the basis of the following aspects: chronology, provenance of lithic raw material, techno-typological features of both lithic and bone industries and provenance of the marine shells used as personal ornaments. The Protoaurignacian is dated to the same chronological interval in the stratigraphic sequence of the three sites. The lithic industries belong to the technological tradition of the Protoaurignacian, but a difference between sites is observed in the provisioning areas of lithic raw material and in the typology of armatures. Analysis of aurignacian bead-types across Europe, attributes the marine shells of the three sites to an \u201citalian-greek\u201d group. Present data do not allow establishing the Adriatic or Tyrrhenian provenance of the Fumane marine shell-bead collection, although the latter seems more probable. A link between Fumane and the ligurian shores is also suggested by some pebbles used in the former site. The current state of knowledge does not favour a Protoaurignacian spreading model from east to west or vice versa. The Balzi Rossi and Fumane sites could have been the expressions of the migrations of different human groups, even if linked by a common cultural tradition

La diffusione del primo aurignaziano a sud dell'arco alpino

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