bluuebunny/crossref_metadata_2025 huggingface dataset:
MiR-21 mediates the protection of kaempferol against hypoxia/reoxygenation-induced cardiomyocyte injury via promoting Notch1/PTEN/AKT signaling pathway
Authors: Huang Jinxi , Qi Zhenhui
Published: November 2020

Kaempferol, a natural flavonoid compound, possesses potent myocardial protective property in ischemia/reperfusion (I/R), but the underlying mechanism is not well understood. The present study was aimed to explore whether miR-21 contributes to the cardioprotective effect of kaempferol on hypoxia/reoxygenation (H/R)-induced H9c2 cell injury via regulating Notch/phosphatase and tensin homologue (PTEN)/Akt signaling pathway. Results revealed that kaempferol obviously attenuates H/R-induced the damages of H9c2 cells as evidence by the up-regulation of cell viability, the down-regulation of lactate dehydrogenase (LDH) activity, the reduction of apoptosis rate and pro-apoptotic protein (Bax) expression, and the increases of anti-apoptotic protein (Bcl-2) expression. In addition, kaempferol enhanced miR-21 level in H9c2 cells exposed to H/R, and inhibition of miR-21 induced by transfection with miR-21 inhibitor significantly blocked the protection of kaempferol against H/R-induced H9c2 cell injury. Furthermore, kaempferol eliminated H/R-induced oxidative stress and inflammatory response as illustrated by the decreases in reactive oxygen species generation and malondialdehyde content, the increases in antioxidant enzyme superoxide dismutase and glutathione peroxidase activities, the decreases in pro-inflammatory cytokines interleukin (IL)-1β, IL-8 and tumor necrosis factor-alpha levels, and an increase in anti-inflammatory cytokine IL-10 level, while these effects of kaempferol were all reversed by miR-21 inhibitor. Moreover, results elicited that kaempferol remarkably blocks H/R-induced the down-regulation of Notch1 expression, the up-regulation of PTEN expression, and the reduction of P-Akt/Akt, indicating that kaempferol promotes Notch1/PTEN/AKT signaling pathway, and knockdown of Notch1/PTEN/AKT signaling pathway induced by Notch1 siRNA also abolished the protection of kaempferol against H/R-induced the damage of H9c2 cells. Notably, miR-21 inhibitor alleviated the promotion of kaempferol on Notch/PTEN/Akt signaling pathways in H9c2 cells exposed to H/R. Taken together, these above findings suggested thatmiR-21 mediates the protection of kaempferol against H/R-induced H9c2 cell injuryvia promoting Notch/PTEN/Akt signaling pathway.
Children with congenital heart disease exhibit seasonal variation in physical activity
Authors: Kuan Mimi T. Y. , Voss Christine , Lopez Jimmy , Hemphill Nicole M. , Harris Kevin C.
Published: November 2020

Objective

We sought to identify seasonal variation in physical activity that different physical activity measurement tools can capture in children with congenital heart disease.

Methods

Data were collected as part of a prospective cohort study at BC Children’s Hospital, Vancouver, Canada. Daily step counts of children aged 9–16 years with moderate-to-severe CHD were assessed continuously for 1-year via a commercial activity tracker (Fitbit Charge 2™). Physical activity levels were also assessed conventionally at one time-point via accelerometers (ActiGraph) and physical activity questionnaires.

Results

156 children (mean age 12.7±2.4 years; 42% female) participated in the study. Fitbit data (n = 96) over a 1-year period clearly illustrated seasonal peaks (late spring and autumn) and dips (winter and summer school holidays) in physical activity levels, with group mean values being below 12,000 steps per day throughout the year. According to conventional accelerometry data (n = 142), 26% met guidelines, which tended to differ according to season of measurement (spring: 39%, summer: 11%, fall: 20%, winter: 39%; p-value = 0.053). Questionnaire data (n = 134) identified that the most widely reported activities were walking (81%) and running (78%) with walking being the highest in summer and fall and running in winter and spring. Furthermore, regardless of overall activity levels the children exhibit similar seasonal variation.

Conclusions

We demonstrated that physical activity level changes across seasons in children with CHD. It is important to be aware of these fluctuations when assessing and interpreting physical activity levels. Season specific counselling for physical activity may be beneficial in a clinical setting.
Is the fine motor–executive functions link stronger for new compared to repeated fine motor tasks?
Authors: Maurer Michelle N. , Roebers Claudia M.
Published: November 2020

Although the motor–executive function (EF) link is actively being investigated, there remain open questions surrounding why some studies found associations between specific motor and specific EF tasks, while others did not. Furthermore, it is also yet unknown which factors impact the magnitude of the motor–EF link. Findings from neuroimaging studies have proposed that neural activity in networks that are important for motor and cognitive tasks is especially strong when a task is new. In the present behavioral study, we systematically investigated the impact that task novelty had on the motor–EF link. In our study, n = 124 kindergarten children aged five to six administered in a within-subject design three fine motor tasks of the Movement Assessment Battery for Children-2 (Posting Coins, Threading Beads, and Drawing Trail) twice in succession (new vs. repeated), and three EF tasks (adapted versions of a Flanker, a N-back, and the Advanced Dimensional Chance Card Sort task). Results not only replicated the fine motor–EF link, but also showed a significantly stronger association between EF and the new task compared to the repeated Drawing Trail task. However, for the time-based task of Posting Coins and Threading Beads, motor–EF associations did not differ between the new task and the repeated task. Future investigations of more than two repetitions will provide further insights into the assumption that the motor–EF link is mainly driven by the EF processes triggered when a task is new, demands attention, and requires fast and flexible adaptation.
Affective evaluation of images influences personality judgments through gaze perception
Authors: Shirai Risako , Ogawa Hirokazu
Published: November 2020

Faces that consistently shifted the gaze to subsequent target locations in a gaze cueing task were chosen as being more trustworthy than faces that always looked away from the target, suggesting that the validity of a gaze cue influenced the viewers’ judgments regarding the trustworthiness of human faces. We investigated whether the gaze cueing effect and judgments regarding the personality conveyed by a face would be affected by the valence of a target. A face image moved its eyes to the left or the right, and an emotional target image (positive, negative, or neutral) appeared to left or right of the face. Participants had to indicate the location of this target by pressing a key. The target image was preceded by a face that shifted its gaze to the target image (valid cue), a face that directed its gaze to the opposite side (invalid cue), or a face that did not move its eyes (no cue). The perceived trustworthiness of the face was evaluated after the gaze-cueing task. Results showed that faces that looked at positive targets were evaluated as more trustworthy than faces that looked at negative targets. However, the valence of the targets did not affect trustworthiness ratings in invalid and no-cue conditions. We suggest that integrated information about the predictability of the gaze cue and the valence of the gaze target modulates impressions about the personality of the face.
Programmatic assessment of electronic Vaccine Intelligence Network (eVIN)
Authors: Gurnani Vandana , Singh Prem , Haldar Pradeep , Aggarwal Mahesh Kumar , Agrahari Kiran , Kashyap Satabdi , Ghosh Shreeparna , Mohapatra Mrinal Kar , Bhargava Ruma , Nandi Partha , Dhalaria Pritu
Published: November 2020

eVIN is a technology system that digitizes vaccine stocks through a smartphone application and builds the capacity of program managers and cold chain handlers to integrate technology in their regular work. To effectively manage the vaccine logistics, in 2015, this technology was rolled-out in 12 states of India. This study assessed the programmatic usefulness of eVIN implementation in the areas of vaccine utilization, vaccine stock and distribution management and documentation across selected cold chain points. A pre-post study design was used, where cold chain points (CCPs) were selected using two-stage sampling technique in eVIN states. Pre-post comparative analysis was carried out on the identified indicators using both primary and secondary data sources. The vaccine utilization data reflects that the utilization had reduced from 305.3 million doses in pre-eVIN period to 215.0 million doses in post-eVIN period across 12 eVIN states, resulting into savings of approximately 90 million doses of vaccines. Number of facilities having stock-out of any vaccine showed a significant reduction by 30.4% in post-eVIN period (p<0.001). There was a 4.0% drop in facilities reporting minimum stock of any vaccine after implementation of eVIN. Facilities with maximum stock of any vaccine had increased from 37.4% in pre-eVIN to 39.2% in post-eVIN. During the pre-eVIN period, only 38.6% facilities updated vaccine stock on a daily basis, while in post-eVIN period, 53.5% facilities updated vaccine stock on daily basis. The completeness of records in the vaccine stock registers, indent form and temperature logbook have been substantially improved in the post-eVIN period (p<0.001). eVIN had helped in streamlining the vaccine flow network and ensured equity through better vaccine management practices. It is a powerful contribution to strengthen the vaccine supply chain and management. Upscaling eVIN in the remaining states of India will be crucial in improving the efficacy of vaccines and cold chain management.
Processes and outcomes of diabetes mellitus care by different types of team primary care models
Authors: Guo Fangjian , Lin Yu-Li , Raji Mukaila , Leonard Bruce , Chou Lin-Na , Kuo Yong-Fang
Published: November 2020

Background

Team care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care. This study aimed to compare the processes and outcomes of care provided to older patients with diabetes by primary care teams comprised of only primary care physicians (PCPs) versus team care that included nurse practitioners (NPs) or physician assistants (PAs).

Methods

We studied 3,524 primary care practices identified via social network analysis and 306,741 patients ≥66 years old diagnosed with diabetes in or before 2015 in Medicare data. Guideline-recommended diabetes care included eye examination, hemoglobin A1c test, and nephropathy monitoring. High-risk medications were based on recommendations from the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Preventable hospitalizations were defined as hospitalizations for a potentially preventable condition.

Results

Compared with patients in the PCP only teams, patients in the team care practices with NPs or PAs received more guideline-recommended diabetes care (annual eye exam: adjusted odds ratio (aOR): 1.04 (95% CI: 1.00–1.08), 1.08 (95% CI: 1.03–1.13), and 1.10 (95% CI: 1.05–1.15), and HbA1C test: aOR: 1.11 (95% CI: 1.04–1.18), 1.11 (95% CI: 1.02–1.20), and 1.15 (95% CI: 1.06–1.25) for PCP/NP, PCP/NP/PA, and PCP/PA teams). Patients in the PCP/NP and the PCP/PA teams had a slightly higher likelihood of being prescribed high-risk medications (aOR: 1.03 (95% CI: 1.00–1.07), and 1.06 (95% CI: 1.02–1.11), respectively). The likelihood of preventable hospitalizations was similar among patients cared for by various types of practices.

Conclusion

The team care practices with NPs or PAs were associated with better adherence to clinical practice guideline recommendations for diabetes compared to PCP only practices. Both practices had similar outcomes. Further efforts are needed to explore new and cost-effective team-based care delivery models that improve process, outcomes, and continuity of care, as well as patient care experiences.
Perception and knowledge of the effect of climate change on infectious diseases within the general public: A multinational cross-sectional survey-based study
Authors: van Wijk Max , Naing SoeYu , Diaz Franchy Silvia , Heslop Rhiannon T. , Novoa Lozano Ignacio , Vila Jordi , Ballesté-Delpierre Clara
Published: November 2020

Infectious diseases are emerging and re-emerging due to climate change. Understanding how climate variability affects the transmission of infectious diseases is important for both researchers and the general public. Yet, the widespread knowledge of the general public on this matter is unknown, and quantitative research is still lacking. A survey was designed to assess the knowledge and perception of 1) infectious diseases, 2) climate change and 3) the effect of climate change on infectious diseases. Participants were recruited via convenience sampling, and an anonymous cross-sectional survey with informed consent was distributed to each participant. Descriptive and inferential analyses were performed primarily focusing on the occupational background as well as nationality of participants. A total of 458 individuals participated in this study, and most participants were originally from Myanmar, the Netherlands, Spain, United Kingdom and the United States. Almost half (44%) had a background in natural sciences and had a higher level of knowledge on infectious diseases compared to participants with non-science background (mean score of 12.5 and 11.2 out of 20, respectively). The knowledge of the effect of climate change on infectious diseases was also significantly different between participants with and without a background in natural sciences (13.1 and 11.8 out of 20, respectively). The level of knowledge on various topics was highly correlated with nationality but not associated with age. The general population demonstrated a high awareness and strong knowledge of climate change regardless of their background in natural sciences. This study exposes a knowledge gap in the general public regarding the effect of climate change on infectious diseases, and highlights that different levels of knowledge are observed in groups with differing occupations and nationalities. These results may help to develop awareness interventions for the general public.
Transport variability over the Hawkesbury Shelf (31.5–34.5°S) driven by the East Australian Current
Authors: Ribbat Nina , Roughan Moninya , Powell Brian , Rao Shivanesh , Kerry Colette Gabrielle
Published: November 2020

The Hawkesbury Bioregion located off southeastern Australia (31.5–34.5oS) is a region of highly variable circulation. The region spans the typical separation point of the East Australian Current (EAC), the western boundary current that dominates the flow along the coast of SE Australia. It lies adjacent to a known ocean warming hotspot in the Tasman Sea, and is a region of high productivity. However, we have limited understanding of the circulation, temperature regimes and shelf transport in this region, and the drivers of variability. We configure a high resolution (750m) numerical model for the Hawkesbury Shelf region nested inside 2 data assimilating models of decreasing resolution, to obtain the best estimate of the shelf circulation and transport over a 2-yr period (2012–2013). Here we show that the transport is driven by the mesoscale EAC circulation that strengthens in summer and is related to the separation of the EAC jet from the coast. Transport estimates show strong offshore export is a maximum between 32-33oS. Median offshore transports range 2.5–8.4Sv seasonally and are a maximum during in summer driven by the separation of the EAC jet from the coast. The transport is more variable downstream of the EAC separation, driven by the EAC eddy field. Onshore transport occurs more frequently off Sydney 33.5–34.5oS; seasonal medians range -1.7 to 2.3Sv, with an onshore maximum in winter. The region is biologically productive, and it is a known white shark nursery area despite the dominance of the oligotrophic western boundary current. Hence an understanding of the drivers of circulation and cross-shelf exchange is important.
Impact of changing the surgical team for wound closure on surgical site infection: A matched case-control study
Authors: Salm Lilian , Chapalley Dimitri , Perrodin Stéphanie Fabienne , Tschan Franziska , Candinas Daniel , Beldi Guido
Published: November 2020

Background

Wound closure is performed at the end of the procedure, when the attention of the surgical team may decrease due to tiredness. The aim of this study was to assess the influence of changing the surgical team for wound closure on the rate of surgical site infection (SSI).

Methods

A two-armed observational monocentric matched case-control study was performed in a time series design. During the baseline period, closure of the abdominal wall was performed by the main surgical team. The intervention consisted of closure of the abdominal wall and skin by an independent surgical team. Matching was based on gender, BMI, length of surgery, type of surgery, elective versus emergency surgery and ASA score. The primary outcome was SSI rate 30 days after surgery.

Results

A total of 72 patients in the intervention group were matched with 72 patients in the baseline group. The SSI rate after 30 days in the intervention group was 10% (n = 7) and in the baseline group 21% (n = 15) (p = 0.064). Redo-Surgery as result of infection (e.g. opening the wound, drainage or reoperation) was significantly higher in the baseline group (19.4% vs 2.7%; p = 0.014). Mortality, length of stay, rehospitalisation and complication rates 30 days after surgery did not differ significantly.

Conclusion

Changing the surgical team for wound closure did not reduce the overall rate of SSI, but the rate of redo-surgery as a result of SSI. Despite being potentially beneficial, organizational factors are a main limiting factor of changing the surgical team for the wound closure.

Trial registration

Clinicaltrial.gov NCT04503642.
Effect of long-chain polyunsaturated fatty acids in infant formula on long-term cognitive function in childhood: A systematic review and meta-analysis of randomised controlled trials
Authors: Verfuerden Maximiliane L. , Dib Sarah , Jerrim John , Fewtrell Mary , Gilbert Ruth E.
Published: November 2020

Lack of preformed long-chain polyunsaturated fatty acids (LCPUFA) in infant formula has been hypothesised as contributing to cognitive differences between breast-fed and formula-fed infants. Previous systematic reviews found no cognitive differences between infants fed formula with LCPUFA and those fed formula without, but focused on early developmental measures, such as Bayley Scales of Infant Development, which are poorly differentiating and not predictive of cognitive ability in childhood. This systematic review examined the effect of randomising infants to formula supplemented with LCUFA vs unsupplemented formula on cognitive function ≥ age 2.5 years. We searched Medline, Embase the Cochrane Central Register of Controlled Trials without date limit, following a pre-published protocol according to PRISMA guidelines. We conducted random effects meta-analyses in RevMan v5.4 and followed GRADE and Cochrane Guidelines to evaluate strength of evidence and potential for bias. We included 8 trial cohorts which randomised participants between 1993 and 2004 and analyse 6 previously unpublished outcomes provided by various trialists. Age at the last available cognitive test ranged from 3.3 to 16 years. The pooled mean difference in Wechsler Preschool and Primary Scale of Intelligence-Revised from four trials in term-born children showed no benefit of LCPUFA: -0.04 points (95% confidence interval -5.94 to 5.85, 95% prediction interval -14.17 to 14.25). The pooled mean difference in Wechsler Abbreviated Scale of Intelligence score from two trials in preterm-born children also showed no benefit of LCPUFA: -7.71 (95% CI -24.63 to 9.22, 95% PI -97.80 to 82.38). Overall quality of evidence was low, due to substantial heterogeneity, low rates of follow-up, and indications of selective publication. The long-term effect of LCPUFA supplementation in term and preterm-born infants on cognition is highly uncertain and includes potential for large benefit as well as large harm. Based on our findings, LCPUFA supplementation of infant formula is not recommended until further robust evidence excludes long-term harm.

Study registration

PROSPERO registration numbers CRD42018105196 and CRD42018088868.
High prevalence and extended deletions in Plasmodium falciparum hrp2/3 genomic loci in Ethiopia
Authors: Golassa Lemu , Messele Alebachew , Amambua-Ngwa Alfred , Swedberg Gote
Published: November 2020

Deletions in Plasmodium falciparum histidine rich protein 2(pfhrp2) gene threaten the usefulness of the most widely used HRP2-based malaria rapid diagnostic tests (mRDTs) that cross react with its structural homologue, PfHRP3. Parasites with deleted pfhrp2/3 genes remain undetected and untreated due to ‘false-negative’ RDT results. As Ethiopia recently launched malaria elimination by 2030 in certain selected areas, the availability of RDTs and the scale of their use have rapidly increased in recent years. Thus, it is important to explore the presence and prevalence of deletion in the target genes, pfhrp2 and pfhrp3. From a total of 189 febrile patients visited Adama Malaria Diagnostic centre, sixty-four microscopically-and polymerase chain reaction (PCR)-confirmed P. falciparum clinical isolates were used to determine the frequency of pfhrp2/3 gene deletions. Established PCR assays were applied to DNA extracted from blood spotted onto filter papers to amplify across pfhrp2/3 exons and flanking regions. However, analysis of deletions in pfhrp2, pfhrp3 and flanking genomic regions was successful for 50 of the samples. The pfhrp2 gene deletion was fixed in the population with all 50(100%) isolates presenting a deletion variant. This deletion extended downstream towards the Pf3D7 0831900 (MAL7PI.230) gene in 11/50 (22%) cases. In contrast, only 2/50 (4%) of samples had deletions for the Pf3D7 0831700 (MALPI.228) gene, upstream of pfhrp2. Similarly, the pfhrp3 gene was deleted in all isolates (100%), while 40% of the isolates had an extension of the deletion to the downstream flanking region that codes for Pf3D7 13272400 (MAL13PI.485).The pfhrp3 deletion also extended upstream to Pf3D7 081372100 (MAL13PI.475) region in 49/50 (95%) of the isolates, exhibiting complete absence of the locus. Although all samples showed deletions of pfhrp2 exon regions, amplification of an intron region was successful in five cases. Two different repeat motifs in the intron regions were observed in the samples tested. Pfhrp2/3 gene deletions are fixed in Ethiopia and this will likely reduce the effectiveness of PfHRP2-based mRDTs. It will be important to determine the sensitivity PfHRP 2/3-based RDTs in these populations and conduct a countrywide survey to determine the extent of these deletions and its effect on routine RDT-based malaria diagnosis.
A simple and clinically applicable model to predict liver-related morbidity after hepatic resection for hepatocellular carcinoma
Authors: Choi Jonggi , Kim So-Hyun , Han Seungbong , Lee Danbi , Shim Ju Hyun , Lim Young-Suk , Lee Han Chu , Chung Young-Hwa , Lee Yung Sang , Lee Sung-Gyu , Kim Ki-Hun , Kim Kang Mo
Published: November 2020

Background & aim

Hepatic resection is a treatment option for patients with hepatocellular carcinoma (HCC). However, factors associated with candidacy for resection and predictive of liver-related morbidity after resection for HCC remain unclear. This study aimed to assess candidacy for liver resection in patients with HCC and to design a model predictive of liver-related morbidity after resection.

Methods

A retrospective analysis of 1,565 patients who underwent liver resection for HCC between January 2016 and December 2017 was performed. The primary outcome was liver-related morbidity, including post-hepatectomy biochemical dysfunction (PHBD), ascites, hepatic encephalopathy, rescue liver transplantation, and death from any cause within 90 days. PHBD was defined as international normalized ratio (INR) > 1.5 or hyperbilirubinemia (> 2.9 mg/dL) on postoperative day ≥ 5.

Results

The 1,565 patients included 1,258 (80.4%) males and 307 (19.6%) females with a mean age of 58.3 years. Of these patients, 646 (41.3%) and 919 (58.7%) patients underwent major and minor liver resection, respectively. Liver-related morbidity was observed in 133 (8.5%) patients, including 77 and 56 patients who underwent major and minor resection, respectively. A total of 83 (5.3%) patients developed PHBD. Multivariate analysis identified cut-off values of the platelet count, serum albumin concentration, and ICG R15 value for predicting liver-related morbidity after resection. A model predicting postoperative liver-related morbidity was developed, which included seven factors: male sex, age ≥ 55 years, ICG R15 value ≥ 15%, major resection, platelet count < 150,000/mm3, serum albumin concentration < 3.5 g/dL, and INR > 1.1.

Conclusion

Hepatic resection for HCC was safe with 90-day liver-related morbidity and mortality rates of 8.5% and 0.8%, respectively. The developed point-based scoring system with seven factors could allow the prediction of the risk of liver-related morbidity after resection for HCC.
Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants
Authors: Ho Frederick K. , Petermann-Rocha Fanny , Gray Stuart R. , Jani Bhautesh D. , Katikireddi S. Vittal , Niedzwiedz Claire L. , Foster Hamish , Hastie Claire E. , Mackay Daniel F. , Gill Jason M. R. , O'Donnell Catherine , Welsh Paul , Mair Frances , Sattar Naveed , Celis-Morales Carlos A. , Pell Jill P.
Published: November 2020

Introduction

Older people have been reported to be at higher risk of COVID-19 mortality. This study explored the factors mediating this association and whether older age was associated with increased mortality risk in the absence of other risk factors.

Methods

In UK Biobank, a population cohort study, baseline data were linked to COVID-19 deaths. Poisson regression was used to study the association between current age and COVID-19 mortality.

Results

Among eligible participants, 438 (0.09%) died of COVID-19. Current age was associated exponentially with COVID-19 mortality. Overall, participants aged ≥75 years were at 13-fold (95% CI 9.13–17.85) mortality risk compared with those <65 years. Low forced expiratory volume in 1 second, high systolic blood pressure, low handgrip strength, and multiple long-term conditions were significant mediators, and collectively explained 39.3% of their excess risk. The associations between these risk factors and COVID-19 mortality were stronger among older participants. Participants aged ≥75 without additional risk factors were at 4-fold risk (95% CI 1.57–9.96, P = 0.004) compared with all participants aged <65 years.

Conclusions

Higher COVID-19 mortality among older adults was partially explained by other risk factors. ‘Healthy’ older adults were at much lower risk. Nonetheless, older age was an independent risk factor for COVID-19 mortality.
Comparison of bispectral index-guided and fixed-gas concentration techniques in desflurane and remifentanil anesthesia: A randomized controlled trial
Authors: Yang Seong Mi , Jung Yoo Sun , Jung Chul-Woo , Kim Won Ho , Yoon Soo Bin , Lee Hyung-Chul
Published: November 2020

Anesthesia with desflurane and remifentanil can be maintained with either fixed or titrated desflurane concentration. We hypothesized that the fixed-gas concentration (FG) method would reduce the number of anesthetic titrations without hypnotic and hemodynamic instability compared to the bispectral index (BIS)-guided (BG) method. Forty-eight patients were randomly allocated to the FG or BG groups. In the FG group, desflurane vaporizer setting was fixed at 1 age-corrected minimum alveolar concentration (MAC). In the BG group, desflurane was titrated to target a BIS level at 50. Remifentanil was titrated to maintain a systolic arterial pressure (SAP) of 120 mmHg in both groups. Our primary endpoint was the hypnotic stability measured by the wobble of BIS in performance analysis, and the secondary endpoints included the wobble of SAP, mean BIS value during surgery, and the number of anesthetic titrations. The BIS in the FG group showed significantly less wobble (3.9 ± 1.1% vs 5.5 ± 1.5%, P <0.001) but lower value (33 ± 6 vs 46 ± 7, P <0.001) than BG group. The wobble of SAP showed no difference between groups [median (inter-quartile range), 5.0 (4.1–7.5)% vs 5.2 (4.2–8.3)%, P = 0.557]. The numbers of anesthetic titrations in the FG group were significantly lower than the BG group (0 ± 0 vs 8 ± 5, P<0.001 for desflurane, 13 ± 13 vs 22 ± 17, P = 0.047 for remifentanil). Less wobble in BIS and reduced anesthetic titration without hemodynamic instability during the FG technique may be practical in balanced anesthesia using desflurane and remifentanil anesthesia.

Clinical trial: This study was registered at ClinicalTrials.gov (NCT02283866).
Tiered healthcare in South Africa exposes deficiencies in management and more patients with infectious etiology of primary adrenal insufficiency
Authors: Mofokeng Thabiso Rafaki Petrus , Ndlovu Kwazi Celani Zwakele , Beshyah Salem A. , Ross Ian L.
Published: November 2020

Objective

We wished to determine the prevalence, etiology, presentation, and available management strategies for primary adrenal insufficiency (PAI) in South Africa (SA), hypothesizing a prevalence greater than the described 3.1 per million. There is great inequity in healthcare allocation, as two parallel healthcare systems exist, potentially modifying PAI patients’ clinical profiles, private being better resourced than public healthcare.

Methods

An online survey of physicians’ experience relating to PAI.

Results

The physicians were managing 811 patients, equal to a prevalence of 14.2 per million. Likely causes of PAI in public/ academic vs private settings included: AIDS-related [304 (44.8%) vs 5 (3.8%);p<0.001], tuberculosis [288 (42.5%) vs 8 (6.0%);p<0.001], autoimmune disease [50 (7.4%) vs 88 (66.2%);p<0.001], malignancy [27 (4.0%) vs 7 (5.3%);p= 0.500], genetic including adrenoleukodystrophy (ALD) [5 (0.7%) vs 16 (12.0%);p<0.001], respectively. Overall, more patients presented with nausea [101 (74.3%) and vomiting 89 (65.9%), than diarrhoea 76 (58.9%);p= 0.008 and 126 (15.5%) in adrenal crisis. Features suggestive of a crisis were hypoglycaemia [40 (78.4%) vs 42 (48.8%);p= 0.001], shock [36 (67.9%) vs 31(36.9%);p<0.001], and loss of consciousness [25 (52.1%) vs 27 (32.9%);p= 0.031]. Greater unavailability of antibody testing in the public vs. the private sector [32 (66.7%) vs 30 (32.1%);p= 0.001], [serum-ACTH 25 (52.1%) vs 16 (19.5%);p<0.001] and glucocorticoids were [26 (54.2%) vs 33 (40.2%);p= 0.015]. Many patients, 389(66.7%) were not using identification, indicating that they need steroids in an emergency.

Conclusion

A survey of South African physicians suggests a higher prevalence than previously reported. Patients presented with typical symptoms, and 15.5% presented in adrenal crisis. Significant disparities in the availability of physicians’ expertise, diagnostic resources, and management options were noted in the public versus private settings. Greater awareness among health practitioners to timeously diagnose PAI is required to prevent a life-threatening outcome.
Impact of biological education and gender on students’ connection to nature and relational values
Authors: Kleespies Matthias Winfried , Dierkes Paul Wilhelm
Published: November 2020

The new concept of relational values (RVs) is gaining more and more attention in environmental research, but empirical analyses are still rare. However, this type of research is necessary because the RVs have an influence on environmental behavior. To evaluate the impact of biological education on attributing higher importance to RVs and connectedness to nature, we compared the connection to nature scores (using the inclusion of nature scale (INS) and connectedness to nature scale (CNS)) and RV scores of biologically interested high school students (n = 417) with first year (n = 593) and advanced biology (n = 223) students. While high school students showed significant lower connection to nature scores than university students, there was no significant difference in RVs between the test groups. These results suggest that there is a lack of factors in the university study of biology that can change RVs. The gender comparison of RVs and connection to nature showed a significant higher RV score for females while INS and CNS did not show a gender difference. Thus, the study makes an important contribution to the research, as it was able to prove that gender has an influence on a person's RVs but not on their connection to nature.
“Uma Terceira Coisa”
Authors: Ferrer Diogo Falcão
Published: November 2020

Assumindo que a arquitetura e o pensamento filosófico a seu respeito são elementoes essenciais para a auto-compreensão do humano, este artigo defende três pontos acerca do papel do espaço e do tempo na arquitetura funcionalista e na sua crítica. (1) Dois exemplos significativos na História da Filosofia, nomeadamente, o conceito platónico de espaço (chōra) e o conceito kantiano de esquema (Schema) mostram que o espaço e o tempo como elementos básicos da experiência humana estão intimamente relacionados com a sensibilidade e a imaginação e não podem ser reconduzidos a uma funcionalização exclusivamente objetiva. (2) Defendo, em segundo lugar, que o funcionalismo arquitetónico não tomou deliberadamente em consideração os aspectos do espaço e do tempo que os ligam à sensibilidade e à imaginação. (3) Como resultado dos pontos precedentes, complementados por referências à posição do funcionalismo em relação ao tempo histórico e à relação de meios e fins, e considerando alguns autores importantes do séc. XX (Heidegger, Bachelard, J. Pallasmaa, G. Böhme), um terceiro ponto é defendido, a saber que as insuficiências atribuídas ao funcionalismo derivam do facto de que este ignorou o espaço e o tempo na sua relação com a sensibilidade e a imaginação. Estas teses mostrarão, finalmente, que a arquitetura pode ser entendida como um esquema sensível da auto-compreensão humana.
¿Qué es ser profesional docente?
Authors: Sarramona López Jaime , Noguera Arrom Juana , Vera Vila Julio
Published: November 2020

RESUMEN: En este trabajo se pretende repensar algunos puntos claves del debate reciente sobre la profesionalización docente, analizando en concreto las tres cuestiones siguientes: ¿Qué es una profesión? ¿Cuáles son los rasgos diferenciales de la misma? ¿En qué medida podemos afirmar que el profesorado cumple los requisitos convencionales de las profesiones? Aunque hay un acuerdo generalizado acerca de la necesidad de mejorar el status profesional de la enseñanza, no hay coincidencia en la forma de conseguirlo. Para entender las diferentes posiciones, se analizan, además, los conceptos de profesionalismo y profesionalización, y se destaca la importancia de la formación como un proceso de desarrollo personal y profesional. Por último se tratan aspectos relacionados con la salud laboral y las enfermedades profesionales.ABSTRACT: This article proposes to rethink some of the key issues of the recent debate about the teaching profession, through the analysis of three specific aspects: What is a profession? What are its distinctive features? To what extent can we say that teachers are satisfying the demands of the profession? Although there is a general agreement about the need to improve the professional quality of teaching, there doesn't seen to be a way to achieve it. In order to understand the different points of view, there will also be an analysis of the notions of professionalism and professionalization, with an emphasis on the importance of formation as professional and personal development process. To conclude, the issues of laboral health and professional illnesses will be dealt with.
Aproximación a un planteamiento sistemático de la educación no formal: la persona como centro de desarrollo
Authors: Sáez Alonso Rafael , Fernandez-salinero Miguel Carolina
Published: November 2020

RESUMEN: El significado y la utilidad de la educación no formal en el momento presente nos fuerza a investigar y reconocer sus posibilidades y a incidir en su desarrollo en virtud de las personas más que en la tipología de programas, acciones e instituciones. Es la persona la que se educa y/o es educada. Nuestra reflexión parte de la Teoría General de Sistemas. La educación es un sistema de elementos en interacción mutua y continua. La educación no formal es un sistema abierto y genera una serie de procesos de comunicación para lograr efectos educativos. Es la totalidad de la vida la que va generando el proceso de educación de la persona. Intentamos aproximarnos a un concepto de educación no formal que se define dentro de la estructura sistèmica de educación.ABSTRACT: The meaning and the usefulness of the nonformal education in the present moment force us to investigate and recognize its possibilities ant to impact in its development through the persons, more than the type of programs, actions and institutions. The person is who is educated. Our reflection parts of the General System Theory. The education is a system of elements in mutual and continuous interaction. The nonformal education is an open system and generates different communications process to achieve educational effects. The life is going to generate the personal educational process. We attempt to approximate to a nonformal education concept that it is defined within the systemic education structure.
La formación del docente en y para la complejidad
Authors: Asensio Aguilera José María
Published: November 2020

RESUMEN: Educar resulta en nuestro tiempo una actividad extremadamente compleja que requiere maestros y profesores formados en la experiencia y el dominio de unos saberes que les permitan abordar con éxito esa complejidad. Al respecto se argumenta que los enfoques interdisciplinares y sistémico-complejos, así como los conocimientos que permiten comprender mejor nuestras actividades mentales, resultan esenciales para la formación del docente y, en especial, para el desarrollo de su tacto pedagógico. Éste, aunque dependiente de aspectos profundamente enraizados de la personalidad del educador, puede verse acrecentado a partir de una adecuada reflexión sobre la práctica, que incluya, sobre todo, los elementos afectivos, epistemológicos y éticos inherentes a la misma.ABSTRACT: To educate is an extremely complex activity in our times, and it requires teachers trained in the experience and expertise of the knowledge that will help them to deal with this complexity. To this respect it is important to show up that interdisciplinary and complex systemic approaches, and also the knowledge that allows a better understanding of our mental activities are essential in teachers' training, specially in which respects to his or her pedagogical tact. This, although it depends on deeply rooted it aspects of the personality of the educator, it can turn increased mainly from an appropriate reflection on the practice that includes the affective epistemologic an ethical elements to this practice.
La cultura próxima como fuente de contenidos significativos de un diseño curricular basado en la comprensión de conceptos
Authors: Vera Vila Julio
Published: November 2020

Desde la primera infancia, el niño aprende a relacionarse con la realidad que le rodea a través de las interpretaciones con carga valorativa que le proporcionan la tradición y las personas más próximas en su microcontexto, fundamentalmente el familiar, pero también, y cada vez más, el vecinal, el local, etc. Este conjunto de claves que constituyen el primer código con el que desvelar la carga semántica de las cosas, de las personas, de los hechos, etc, se amplía y enriquece a medida que crece y acumula más experiencias relaciónales.
Evaluación cualitativa y análisis multidimensional
Authors: López-barajas Zayas Emilio
Published: November 2020

La realidad educativa que la Teoría de la Educación desea explicar, tiene un carácter complejo, holista, dinámico, abierto e interactivo. Sus dimensiones, variables y procesos se relacionan óntica y operativamente. Consideramos que una realidad como la educativa que acoge en su seno elementos de naturaleza tan diversa, y en la que la interacción entre ellos resulta especialmente significativa en cada contexto específico, propicia verificar que la introducción a posteriori, de concepción, baconiana se pierda en élla, por otra parte la posición de un racionalismo radical fundada en a priori analtítico resulta así mismo, incapaz de responder a todos los interrogantes que se suscitan a diario; también los que pretenden establecer la objetividad del conocimiento exclusivamente por la vía fenomenològica, tienen serios problemas para establecerla, al penetrar por intuición "eidètica" hacia las cosas mismas.
La intervención pedagógica como factor de equilibramiento de la personalidad del docente
Authors: García Carrasco Joaquín
Published: November 2020

Si al despacho de un psicólogo o psiquiatra llega un físico que se siente desgraciado, no es recomendable iniciar el estudio empírico de su padecimiento psíquico analizando el estado actual de la física nuclear, ni tiene por qué recluirse el terapeuta en la biblioteca de algún instituto tecnológico, antes de formular el diagnóstico o iniciar la terapia.
La construcción de esquemas: un modelo explicativo de construcción humana
Authors: Aznar Minguet Pilar
Published: November 2020

Desde el alternativismo constructivista, se ha venido enfatizando el proceso activo del sujeto en la elaboración e interpretación de información, lo cual ha llevado a establecer como postulado básico el hecho de que la construcción de la realidad es un proceso activo y personal. Esta particular explicación de la configuración humana a través de la acción surge como reacción a la explicación conductista por la grave carencia que suponía, desde ésta, el hacer depender la configuración conductual de la relación funcional entre estímulos y respuestas; en esta concepción se desdeñaba el papel que desempeñaba el organismo como conductor y difusor del estímulo
La categorización y sus implicaciones educativas
Authors: Canovas Leonhardt P.
Published: November 2020

Nuestro objetivo en este estudio es explicitar las directrices que enmarcan el relevante proceso de categorización, considerado como uno de los procesos básicos que utiliza el sujeto en el procesamiento de la información. En efecto, clasificamos o categorizamos objetos, acontecimientos, acciones, percepciones, emociones, entidades abstractas y, por supuesto, también realizamos categorizaciones sociales. Ciertamente, sin el concurso de los mencionados procesos no podríamos efectuar, ni enfrentarnos tanto a las solicitaciones y exigencias procedentes del mundo físico, como a aquellas otras elicitaciones suscitadas por la realidad social.
La Teoría de la Educación en la encrucijada
Authors: García Carrasco Joaquín , García Del Dujo Ángel
Published: November 2020

RESUMEN: El mundo parece estar en una encrucijada; también la educación y la reflexión sobre educación. Su observación y tratamiento aconsejan encontrar claves de comprensión de la estructura y patrón global de los procesos educativos.Entienden los autores que uno de los hándicaps de la Teoría de la Educación viene dado por la identificación y reducción del proceso educativo al proceso de enseñanza-aprendizaje en contextos institucionales. De esta manera no disponemos de una teoría unificada de la educación que proporcione el soporte necesario para pensar y hacer educación para el conjunto de espacios o comunidades donde se produce.Para ello proponen los autores, en vez de descomponer el proceso educativo, deconstruir los numerosos estratos que la evolución cultural ha ido creando hasta llegar al sustrato más básico del proceso educativo en la especie humana.ABSTRACT: The world resembles to be at a crossroads; the education and the reflection about the education too. Its observation and treatment advise, at the same time that they let, finding structure's comprehension keys and educational process' global pattern.The authors understand one of the Theory of Education handicap in this crossroads comes from the educational process' identification and reduction to the process of teaching-learning in the institutional context. By this way we haven't an unified theory of the education which provides the necessary support in order to think and do education to the whole of the spaces or communities where it happens.For that the authors propose, instead of breaking down the educational process, unbuild the several strata that the cultural evolution has gone creating until arrive at the most basic stratum of the educational process in the human species.
Filosofía pública y educación. La reconstrucción de la educación cívica en la democracia fuerte
Authors: Bárcena Orbe Fernando
Published: November 2020

In this paper, the author explore the relevance and significance of civic education in a «strong democracy», in the context of european community. After explore and defend the moral condition of the Europe union, the author reflect on some specifics pedagogical commitments and responsibilities in this civic matter. Talk about a strong civic education is regarded as a opportunity to conform our moral character in the public's virtues and to increase the capacity of political and civic judgment. The pervivence of democracy in a technological age, as a social way of life, require the consolidation of a new public philosophy of education.
Dekulakization and Collectivization in the Krasnoyarsk Territory: from the «Radical Fracture» to the Correction of «Kinks in the Field»
Authors: Esin R.S.
Published: November 2020

The theme of the policy of "eliminating the kulaks as a class", carried out during forced collectivization, is relevant both for historians and for modern Russian society. At the present stage of the study, the analysis of the dekulakization practice that was carried out in the beginning of 1930, both on the scale of the entire Soviet Union and within individual regions, remains relevant. The article considers the policy of "eliminating the kulaks as a class" on the territory of the districts that are currently part of the modern Krasnoyarsk territory on the basis of documents from the Krasnoyarsk state archive. The focus of attention is on forced collectivization in the in the Sukhobuzimsky, Yeniseysky, Uyarsky, Partizansky, Balakhtinsky, Abansky, novoselovsky, Pirovsky, Kazachinsky, Yeniseysky, More-Murtinsky, Kansk, Achinsky, Mansky and Krasnoyarsk districts in the period from December 1929 to April 1930. It is concluded that dekulakization in these areas allowed for a high percentage of collectivization of farms, but under the pressure of widespread peasant resistance, both the Union leadership and the leadership of the considered areas of the modern Krasnoyarsk territory were forced to temporarily suspend the process of repression and to carry out demonstrative punishment of local leaders for excesses committed during the policy of dekulakization. After the condemnation of excesses, the outflow of peasant farms from collective farms began. As a result, the article partially defines the regional specifics of the dekulakization process in December 1929 — April 1930 in the regions located on the territory of the modern Krasnoyarsk territory.