Background Pediatric critical care physician attitudes about withdrawal of ventricular assist devices and extracorporeal membrane oxygenation in cases of medical futility are poorly defined. Our aim was to define current attitudes regarding the withdrawal of these devices. Methods IRB-approved, cross-sectional observational survey conducted among pediatric critical care attending physicians and fellow physicians in the United States between 2016 and 2017. Data was collected anonymously and statistically analyzed. Results A total of 158 physicians responded with 67% being attending physicians. Compared to (...) a VAD, a higher percentage had taken care of a patient on ECMO where the device was turned off because care was believed to be futile, including currently. Nearly all reported that it can be ethically permissible to withdraw support from a patient with a VAD and on ECMO, but varied opinions existed as to who should ultimately make this decision if the patient/their family disagrees. More respondents agreed that a patient/their family should agree to withdrawal of VAD or ECMO support prior to initiation if futility is later determined and that protocols should be created for VAD and ECMO withdrawal. Conclusion Most pediatric critical care physicians felt that it can be ethically permissible to withdraw VAD and ECMO support. Our study indicates that pediatric VAD and ECMO withdrawal protocols are desired, but further investigation is needed to determine how to best design protocols that would incorporate multiple stakeholders. (shrink)

Entre 2010 et 2011, une fouille d’urgence a été menée sur la pente Sud de la colline de Viklèsà l’Est de l’acropole d’Amathonte, et a révélé un type de réservoir d’eau alimenté depuis la surface ; découverte à ce jour unique à Chypre. Ce dispositif est constitué d’une citerne creusée dans le rocher et partiellement construite, reliée, par un passage voûté, à un puits d’accès servant également pour puiser. Ce réservoir, d’une capacité de 30 m 3environ, devait desservir les besoins (...) en eau non pas d’un habitat, comme c’est souvent le cas, mais des espaces funéraire, cultuel ou économique implantés sur la colline de Viklèsdans l’Antiquité. Dans cette étude est présenté le mobilier archéologique mis au jour — céramique, lithique, figurines de terre cuite et ossements — qui atteste une occupation continue du lieu, allant de la fin de l’époque archaïque à la fin de l’époque protobyzantine, date d’abandon définitif de l’utilisation de la citerne. (shrink)