Jugendliche mit Gehörlosigkeit oder Schwerhörigkeit in der Transition von der Schule zur Arbeit : Ergotherapeutische Unterstützungsmöglichkeiten zur erfolgreichen Bewältigung der Herausforderungen während der Transition

Thema: Hörbeeinträchtigungen nehmen stetig zu. Betroffene Menschen sind mit unterschiedlichsten Herausforderungen konfrontiert. Die Arbeitslosenquote von Menschen mit Hörbeeinträchtigung ist deutlich höher als die der Allgemeinbevölkerung. Es ist deshalb wichtig, die Betroffenen beim Einstieg ins Berufsleben zu unterstützen. Fragestellung: Auf welche Herausforderungen stossen Jugendliche mit Gehörlosigkeit oder Schwerhörigkeit im Übergang von der Schule zur Arbeit und wie kann die Ergotherapie sie in diesem Übergangsprozess unterstützen? Methode: Mittels einer systematischen Literaturrecherche in sieben Datenbanken wurden vier Hauptstudien zur Bearbeitung der Fragestellung ausgewählt. Die Hauptstudien wurden kritisch beurteilt und diskutiert. Die relevanten Ergebnisse wurden ins KAWA-Modell eingebettet, um Schlussfolgerungen für die Ergotherapie ziehen zu können. Ergebnisse: Der Übergang von der Schule ins Berufsleben stellte sich als einer der schwierigsten heraus. Herausforderungen treten sowohl bei der Arbeitsfindung wie auch am Arbeitsplatz selbst auf. Mögliche Aufgabenbereiche für die Ergotherapie sind die Förderung des Selbstmanagements der Betroffenen, die Edukation aller am Transitionsprozess beteiligten Personen sowie die Arbeitsplatzanpassung. Schlussfolgerung: Eine enge Zusammenarbeit aller Beteiligten bei der Unterstützung der Jugendlichen mit einer Hörbeeinträchtigung ist zentral. Die Ergotherapie besitzt mit ihrer ganzheitlichen Sichtweise eine wichtige Expertise, um den Übergang von der Schule zur Arbeit begleiten zu können

Gut microbiota-dependent metabolite trimethylamine N-oxide (TMAO) and cardiovascular risk in patients with suspected functionally relevant coronary artery disease (fCAD)

Trimethylamine N-oxide (TMAO) has been associated with cardiovascular outcomes. However, the diagnostic value of TMAO and its precursors have not been assessed for functionally relevant coronary artery disease (fCAD) and its prognostic potential in this setting needs to be evaluated.; Among 1726 patients with suspected fCAD serum TMAO, and its precursors betaine, choline and carnitine, were quantified using liquid chromatography tandem mass spectrometry. Diagnosis of fCAD was performed by myocardial perfusion single photon emission tomography (MPI-SPECT) and coronary angiography blinded to marker concentrations. Incident all-cause death, cardiovascular death (CVD) and myocardial infarction (MI) were assessed during 5-years follow-up.; Concentrations of TMAO, betaine, choline and carnitine were significantly higher in patients with fCAD versus those without (TMAO 5.33 μM vs 4.66 μM, p < 0.001); however, diagnostic accuracy was low (TMAO area under the receiver operating curve [AUC]: 0.56, 95% CI [0.53-0.59], p < 0.001). In prognostic analyses, TMAO, choline and carnitine above the median were associated with significantly (p < 0.001 for all) higher cumulative events for death and CVD during 5-years follow-up. TMAO remained a significant predictor for death and CVD even in full models adjusted for renal function (HR = 1.58 (1.16, 2.14), p = 0.003; HR = 1.66 [1.07, 2.59], p = 0.025). Prognostic discriminative accuracy for TMAO was good and robust for death and CVD (2-years AUC for CVD 0.73, 95% CI [0.65-0.80]).; TMAO and its precursors, betaine, choline and carnitine were significantly associated with fCAD, but with limited diagnostic value. TMAO was a strong predictor for incident death and CVD in patients with suspected fCAD.; NCT01838148

External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction

Background: The early non-invasive discrimination of Type 2 versus Type 1 Myocardial Infarction (T2MI, T1MI) is a major unmet clinical need. We aimed to externally validate a recently derived clinical score (Neumann) combing female sex, no radiating chest pain, and high-sensitivity cardiac troponin I (hs-cTnI) concentration ≤40.8 ng/L. Methods: Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. The final diagnoses of T2MI and T1MI were centrally adjudicated by two independent cardiologists using all information including cardiac imaging and serial measurements of hs-cTnT/I according to the fourth universal definition of MI. Model performance for T2MI diagnosis was assessed by formal tests and graphical means of discrimination and calibration. Results: Among 6684 enrolled patients, MI was the adjudicated final diagnosis in 1079 (19%) patients, of which 242 (22%) had T2MI. External validation of the Neumann Score showed a moderate discrimination (C-statistic 0.67 (95%CI 0.64–0.71)). Model calibration showed underestimation of the predicted probabilities of having T2MI for low point scores. Model extension by adding the binary variable heart rate >120/min significantly improved model performance (C-statistic 0.73 (95% CI 0.70–0.76, p 120/min improved the model’s performance

Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome

Aims The utility of clinical risk scores regarding the prediction of major adverse cardiac events (MACE) is uncertain. We aimed to directly compare the prognostic performance of five established clinical risk scores as well as an unstructured integrated clinical judgement (ICJ) of the treating emergency department (ED) physician. Methods and results Thirty-day MACE including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the ED with acute chest discomfort in an international multicentre study. We compared the prognostic performance of the HEART score, GRACE score, T-MACS, TIMI score, and EDACS, as well as the unstructured ICJ of the treating ED physician (visual analogue scale to estimate the probability of acute coronary syndrome, ranging from 0 to 100). Among 4551 eligible patients, 1110/4551 patients (24.4%) had at least one MACE within 30 days. Prognostic accuracy was high and comparable for the HEART score, GRACE score, T-MACS, and ICJ [area under the receiver operating characteristic curve (AUC) 0.85–0.87] but significantly lower and only moderate for the TIMI score (AUC 0.79, P &lt; 0.001) and EDACS (AUC 0.74, P &lt; 0.001), resulting in sensitivities for the rule-out of 30-day MACE of 93–96, 87 (P &lt; 0.001), and 72% (P &lt; 0.001), respectively. Conclusion The HEART score, GRACE score, T-MACS, and unstructured ICJ of the treating physician, not the TIMI score or EDACS, performed well for the prediction of 30-day MACE and may be considered for routine clinical use. Trial registration ClinicalTrials.gov number NCT0047058

Cardiovascular imaging following perioperative myocardial infarction/injury

Patients developing perioperative myocardial infarction/injury (PMI) have a high mortality. PMI work-up and therapy remain poorly defined. This prospective multicenter study included high-risk patients undergoing major non-cardiac surgery within a systematic PMI screening and clinical response program. The frequency of cardiovascular imaging during PMI work-up and its yield for possible type 1 myocardial infarction (T1MI) was assessed. Automated PMI detection triggered evaluation by the treating physician/cardiologist, who determined selection/timing of cardiovascular imaging. T1M1 was considered with the presence of a new wall motion abnormality within 30 days in transthoracic echocardiography (TTE), a new scar or ischemia within 90 days in myocardial perfusion imaging (MPI), and Ambrose-Type II or complex lesions within 7 days of PMI in coronary angiography (CA). In patients with PMI, 21% (268/1269) underwent at least one cardiac imaging modality. TTE was used in 13% (163/1269), MPI in 3% (37/1269), and CA in 5% (68/1269). Cardiology consultation was associated with higher use of cardiovascular imaging (27% versus 13%). Signs indicative of T1MI were found in 8% of TTE, 46% of MPI, and 63% of CA. Most patients with PMI did not undergo any cardiovascular imaging within their PMI work-up. If performed, MPI and CA showed high yield for signs indicative of T1MI.Trial registration: https://clinicaltrials.gov/ct2/show/NCT02573532

Degradability of cross-linked polyurethanes based on synthetic polyhydroxybutyrate and modified with polylactide

In many areas of application of conventional non-degradable cross-linked polyurethanes (PUR), there is a need for their degradation under the influence of specific environmental factors. It is practiced by incorporation of sensitive to degradation compounds (usually of natural origin) into the polyurethane structure, or by mixing them with polyurethanes. Cross-linked polyurethanes (with 10 and 30%wt amount of synthetic poly([R,S]-3-hydroxybutyrate) (R,S-PHB) in soft segments) and their physical blends with poly([d,l]-lactide) (PDLLA) were investigated and then degraded under hydrolytic (phosphate buffer solution) and oxidative (CoCl2/H2O2) conditions. The rate of degradation was monitored by changes of samples mass, morphology of surface and their thermal properties. Despite the small weight losses of samples, the changes of thermal properties of polymers and topography of their surface indicated that they were susceptible to gradual degradation under oxidative and hydrolytic conditions. Blends of PDLLA and polyurethane with 30 wt% of R,S-PHB in soft segments and PUR/PDLLA blends absorbed more water and degraded faster than polyurethane with low amount of R,S-PHB

La Biblioteca de Catalunya: una difusió del patrimoni amb visió de futur

Màster Oficial en Estudis Avançats en Història de l'Art. Curs: 2008-2009. Directora: Imma SociasL'acumulació de llibres en si mateixa, deia Sèneca, no és sinònim de saviesa. Els llibres tan sols són instruments de coneixement que, agrupats en una biblioteca, esdevenen col·leccions inerts que requereixen de la voluntat humana per cobrar vida i sentit. D'aquesta manera, les biblioteques són receptacles que, durant segles, han custodiat el saber, l'han conservat i han ajudat a construir la identitat social tal com l'entenem avui. Actualment, però, sembla que el paper de les biblioteques ha estat revisat per tal que la seva funció camini en paral·lel amb les necessitats dels seus usuaris. En termes de modernitat, ja no s'entén una biblioteca que presti exclusivament els serveis que havia prestat fins aleshores, sinó que se li exigeix un compromís amb l'actualitat que ha d'anar lligat a les darreres tendències culturals d'una ciutat, una regió o un país. Amb tot, l'actitud de les biblioteques nacionals en termes generals i de la Biblioteca de Catalunya (BC) en particular, hauria de ser d'obertura a les persones. Si d¿entrada, aquestes encara no conceben la biblioteca com un espai de diàleg -sinó més aviat de silenci-, cal que la biblioteca hi arribi a través de diversos mitjans. La múltiple naturalesa d'aquests canals de difusió dependrà, doncs, de la programació, que s¿hauria de situar en un mateix nivell que la resta de propostes culturals i didàctiques de la zona on la biblioteca opera. Al llarg de les pàgines que segueixen, s'intentaran mostrar diversos paradigmes internacionals de biblioteques nacionals que semblen estar acomplint aquesta funció alhora educativa i cultural. Seguidament, es presentaran els canals de difusió de la Biblioteca de Catalunya per tal de conèixer de prop com aquesta fa partícip el ciutadà, tot palesant algunes de les bonances i mancances del seu sistema. Tot seguit, a partir dels objectius estratègics de la BC per als propers anys, s'intentarà comprendre el rumb que aquesta vol prendre, i caldrà avaluar si les mesures proposades són prou arriscades. En darrer terme, un seguit de conclusions tancaran el cercle, que es completarà amb algunes propostes que podrien ajudar al posicionament de la Biblioteca de Catalunya en l'àmbit metropolità, nacional i, per què no, internacional

Le commentaire de Tankuang sur l’Eveil à la Foi dans le Grand Véhicule: la probable influence de Wonhyo

Tankuang was a Chinese monk active during the eighth century. His texts were found in Dunhuang at the beginning of the twentieth century, and only then included in the Taishō canon. Tankuang wrote several commentaries on numerous Mahāyāna sutras, and two of these texts are commentaries on the Dasheng qixin lun. This paper focuses on the influence of two Korean monks, Wonch’uk and Wonhyo, on Tankuang’s commentaries. Whereas it seems clear that Tankuang was affiliated to the Ximing lineage of Wonch’uk, there is no such evidence concerning the influence of Wonhyo. But it appears that Tankuang is taking over some of the concepts introduced by Wonhyo, and there are some clear cases of textual and doctrinal evidence of this influence that I will present in this paper