Clinical Outcomes in 3343 Children and Adults with Rheumatic Heart Disease from 14 Low and Middle Income Countries: 2-Year Follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study)

BACKGROUND: -There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease (RHD) or information on their predictors. We report the two year follow-up of individuals with RHD from 14 low and middle income countries in Africa and Asia.

METHODS: -Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for two years to assess mortality, congestive heart failure (CHF), stroke or transient ischemic attack (TIA), recurrent acute rheumatic fever (ARF), and infective endocarditis (IE).

RESULTS: -Vital status at 24 months was known for 2960 (88.5%) patients. Two thirds were female. Although patients were young (median age 28 years, interquartile range 18 to 40), the two year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio (HR) 2.36, 95% confidence interval (CI) 1.80-3.11), CHF (HR 2.16, 95% CI 1.70-2.72), New York Heart Association functional class III/IV (HR 1.67, 95% CI 1.32-2.10), atrial fibrillation (AF) (HR 1.40, 95% CI 1.10-1.78) and older age (HR 1.02, 95% CI 1.01-1.02 per year increase) at enrolment. Post-primary education (HR 0.67, 95% CI 0.54-0.85) and female sex (HR 0.65, 95%CI 0.52-0.80) were associated with lower risk of death. 204 (6.9%) had new CHF (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or TIA (8.45/1000 patient-years), 19 (0.6%) had ARF (3.49/1000 patient-years), and 20 (0.7%) had IE (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/TIA or systemic embolism. Patients from low and lower-middle income countries had significantly higher age- and sex-adjusted mortality compared to patients from upper-middle income countries. Valve surgery was significantly more common in upper-middle income than in lower-middle- or low-income countries.

CONCLUSIONS: -Patients with clinical RHD have high mortality and morbidity despite being young; those from low and lower-middle income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and treatment of clinical RHD are required to improve outcomes.

Towards Night

Sixty artists explore the nocturnal. Curated by Tom Hammick. The evening hour too gives us the irresponsibility which darkness and lamplight bestow. We are no longer quite ourselves. – Virginia Woolf, Street Haunting: A London Adventure, 1930 Towards Night is an exhibition exploring the nocturnal through paintings, prints and drawings by over sixty artists. Drawing on the nineteenth century European Romantic tradition, the show surveys contemporary and historical connections to wonderment and dystopia at dusk, twilight, night and dawn. Towards Night juxtaposes key paintings and prints by Constable, Friedrich, Munch, Nolde, Palmer and Turner, some of the best known visionaries of the Romantic tradition with contemporary artists who work with the transformative aspects of nightfall to convey emotional responses of awe, anxiety and solitude, love and loss, revelry, insomnia, and journey’s end. The exhibition opens with direct and positive responses to the natural world; Marc Chagall’s exotic dreamlike evening in The Poet Reclining (1915) sits close to eighteenth century Indian miniatures depicting brightly painted figures offset against darkening monsoon clouds, and William Crozier’s Balcony at Night, Antibes (2007), of a plant, blue and iridescent against the cool night sky. As the exhibition progresses, the dystopias become darker and more disturbing, and the connections between artists and works intensify: Emma Stibbon’s Rome Aqueduct (2011) takes on a heightened sense of pathos alongside Caspar David Friedrich’s Winter Landscape (1811); Peter Doig’s cinematic Echo Lake (1998) conjures up an increased sense of contemporary angst; and Prunella Clough’s False Flower (1993), a magical tree defying brutalism by growing out of concrete, becomes more miraculous near Night Shift (2015) Nick Carrick’s tomblike high rise. Tom Hammick’s Violetta Alone (2015) and Michael Craig Martin’s Ash Tray (2015), reinforce hedonistic aspects of night-time revelry alongside Four AM, Betsy Dadd’s young woman drinking in the early hours of the morning and L.S. Lowry’s drunken people in a pub in The Crowd (1922). In the final room, a cluster of works explores dreams and insomnia, from Louise Bourgeois’ Spirals (2010) to Munch’s lovers embracing in The Kiss (1902). Tom Hammick, curator of the show said “This exhibition has grown way beyond its original conception, to become a magnificent survey of painting and printmaking from over two hundred years based around the central tenet of night. The exhibition is a kind of painterly response to the way figurative artists use their artistic heroes as starting points for their own work, both compositionally and emotionally.” Artists featured in Towards Night: Christiane Baumgarter, Michael Craig-Martin, Julian Opie, Will Gill, Merlin James, Howard Hodgkin, WillIam Scott, Patrick Caulfield, George Shaw, Stephen Chambers, Basil Beattie, Betsy Dadd, Christopher Le Brun, L.S Lowry, Andrew Cranston, David Willetts, James Fisher, Emma Stibbon, Vija Celmins, William Blake, William Crozier, Tom Hammick, Georgia Keeling, Helen Turner, Humphrey Ocean, Julian Bell, Craigie Aitchison, Mark Wright, Ken Kiff, Matthew Burrows, Andrzej Jackowski, Sarah Raphael, Nick Bodimeade, Nick Carrick, Mary Newcomb, Hurvin Anderson, Peter Doig, Phoebe Unwin, Danny Markey, Sara Lee, Simon Burton, Susie Hamilton, Marc Chagall, Alfred Wallis, Emil Nolde, J.M.W. Turner, Prunella Clough, Samuel Palmer, Louise Bourgeois, Caspar David Friedrich, Alex Katz, Ewan Gibbs, Susie Hamilton, Andrzej Jackowski, Amanda Vesey, Edward Stott, Gertrude Hermes, Rose Wylie, Sidney Nolan, John Constable, J.M.W. Turner, Emil Nolde, Hiroshige, Edvard Munch, Samuel Palmer, Eileen Cooper, Charles Neame-Spencer, Samantha Cary.

Toimijuuden sosiokulttuuriset ulottuvuudet. Tapaustutkimus ammatti- ja yliopisto-opiskelijoiden juomisaiheisissa ryhmäkeskusteluissa ilmenevistä toimijuuden malleista

Tässä pro gradu -tutkielmassa tarkastellaan suomalaisten opiskelijanuorten ryhmäeroja heidän tavoissaan muodostaa yhteisymmärrys. Tutkielmassa käsitellään aihetta kahdesta suunnasta; metodologisesta ja empiirisestä. Metodologisessa osiossa esitellään uusi tapa tulkita yhteiskuntaluokkaan kytkeytyviä elämäntapaan ja kulttuuriin liittyviä eroja. Tutkielman empiirisessä osassa puolestaan vertaillaan ryhmäkohtaisia eroja ammatti- ja yliopistoryhmien käymistä juomisaiheisista ryhmäkeskusteluista heidän käyttämänsä vuorovaikutustavan pohjalta. Tutkielman teoreettisena näkökulmana on lähestyä ryhmäkeskusteluita toimijuuden näkökulmasta. Tällöin ryhmäkeskusteluissa ilmenevää toimintaa ei irroteta kontekstistaan, vaan sen nähdään ilmentävän osaltaan toimijoiden tapaa jäsentää maailmaa ja toimia siellä. Toimijuuden näkökulma ottaa huomioon toiminnan moraaliset, kognitiiviset ja sosiaaliset ulottuvuudet. Näkökulman muodostamisen pohjana käytetään pohjoisamerikkalaisten kulttuuripsykologien viimeaikaisia toimijuuteen liittyviä tutkimuksia, joita täydennetään Basil Bernsteinin sosiolingvistisillä teorioilla (1964 ja 2003) ja Jukka Törrösen kehittelemillä analyysikäsitteillä (2010 ja 2014). Aineisto koostuu 35 ryhmähaastattelusta, joissa eri koulutusasteen (ammattiopisto- ja yliopisto-) opiskelijat eri koulutusaloilta (liiketalous- ja sosiaaliala) ja eri sukupuolista muodostavat 3–6 hengen ryhmissä tarinan mielestään hauskimmasta ja inhottavimmasta juomiskertomuksesta. Tutkielmassa lähestytään aineistoa kysyen, ovatko aikaisemmin havaitut ryhmäerot tulkittavissa ja myös nähtävissä ryhmän henkilöiden keskinäisessä vuorovaikutuksessa ilmenevinä erilaisina toimijuuden malleina. Aineiston analyysin tuloksena erottui kolme erilaista ryhmien yhteisymmärryksen muodostamista kuvaavaa toimijuuden mallia, jotka olivat yhteydessä ryhmien koulutustasoon; hiljaiseen tietoon nojautuvat (ammattiopistoryhmät), ihmiskeskeisesti neuvottelevat (yliopiston sosiaalialaa opiskelevat) ja ”konservatiivisesti” järkeilevät (yliopiston liiketalousalaa opiskelevat). Tulokset ovat rinnastettavissa aikaisemmin kulttuurisesta näkökulmasta yhteiskuntaluokkaa tarkastelleisiin tutkimuksiin. Tämän pohjalta toimijuuden näkökulmaa voidaan pitää varteenotettavana lähestymistapana kulttuuristen erojen tulkinnassa.

Uma experiência de ensino integrado dos fundamentos matemáticos da ciência da computação

Este trabalho tem por objetivo relatar os resultados preliminares de uma experiência de integração curricular, em andamento na Escola de Informática da UCPel, na área de fundamentos matemáticos da Ciência da Computação. A concepção curricular da experiência está baseada nas idéias de Basil Bernstein sobre currículos de coleção e/ou integração, na idéia de desenvolvimento autônomo do aluno e na organização do ensino em forma semi-presencial (com apoio da Internet) e cooperativa (com apoio de softwares matemáticos).

Sistema de gestión basado en las normas ISO 9000 como estrategia para el mejoramiento continuo de la calidad en las estaciones de servicio ALBA petróleos de El Salvador

Propuesta de un sistema de gestión de calidad que aporta a la mejora de los procesos en las estaciones de servicio con el respaldo de la normas internacionales ISO 9000 en las que se encuentran los apartados para estructurar el sistema de gestión. En el estudio se aplicaron conocimientos técnicos y uso de herramientas de recolección de datos con el fin de proponer estrategias de mejora para lograr un aumento en la satisfacción de los consumidores de combustible y/o tienda de conveniencia de las estaciones de servicio ALBA petróleos de El Salvador

What does VET bring to higher education that is distinctive?

Australian higher education is in a state of flux. One sign of this flux is the entry of new providers, including those with a track record in VET. Are these providers offering similar qualifications to universities or do they bring something new and distinctive? This paper draws on Pierre Bourdieu’s theory of distinction to argue that the entry of qualifications by new providers trouble some of the boundaries between the VET and higher education fields. VET provider degrees emerge as a new point of distinction in the higher education field, offering benefits that resonate with changes in the market for degrees. VET provider degrees potentially alter the structure of the higher education field, disturbing the established order and changing the rules of the game. Basil Bernstein’s concept of ‘message systems’ is drawn on to nuance the theory of distinction in the context of the Australian tertiary landscape. Attention is thus drawn to messages associated with teaching, curriculum and assessment in VET providers that help us to examine the action of these providers in reconfiguring distinction. The analysis presented here hints at a redefinition of what makes a degree distinctive.

Argumentos duales: el principio de dualidad como una estructura argumentativa

El objetivo de la tesis es identificar una familia de argumentos que comparten una estructura con el principio de dualidad de la geometría proyectiva. Esta familia la denomino "argumentos duales". Para lograr este objetivo, tomo cuatro argumentos importantes de la filosofía analítica e identifico en ellos la estructura que comparten. Los cuatro argumentos son: (i) el acertijo de la inducción de Goodman; (ii) la indeterminación de la referencia Putnam; (iii) la indeterminación de la traducción de Quine; (iv) la paradoja del seguimiento de reglas de Wittgenstein.

Inteligencia territorial para la recuperación de las dinámicas socio-productivas en la subregión de Lengupá (Boyacá, Colombia)

Este documento corresponde al ejercicio preliminar de la línea de investigación en dinámicas territoriales, y es uno de los artículos científicos propuestos como resultado del Proyecto de investigación “Inteligencia territorial para la recuperación de las dinámicas socio-productivas de la subregión de Lengupá”. Por lo tanto, presenta los resultados de la fase exploratoria, correspondiente al diagnóstico regional en el marco de los enfoques teóricos desde los cuales la región es estudiada. A continuación, se presentarán los dos pilares fundamentales de ésta investigación: el territorio y la Inteligencia Territorial. En el caso del territorio, este proceso de investigación parte de un diferenciación previa respecto al lugar y al espacio, debido a que en el territorio se dan relaciones históricas y de poder en una relación dialéctica, entre los atributos ecológicos y culturales, teniendo en cuenta el planteamiento de Sasquet, (2015) cuando menciona que para comprender el territorio es necesario comprender el espacio geográfico, territorialidad humana, en escala subregional y a través del tiempo.

USO Y COBERTURA DE LA TIERRA EN COSTA RICA PARA 1992: UNA APLICACIÓN DE TELEDETECCIÓN ESPACIAL Y SISTEMAS DE INFORMACION GEOGRÁFICA

En el presente artículo se describe el procedimiento utilizado para actualizar el mapa de uso y cobertura de la tierra de Costa Rica para el año 1992. En el proceso se integró la cartografía análoga existente para 1985 a escala 1:200.000 e imágenes digitales del Mapeador Temático de LANDSAT para los años 1991 y 1993. Para comprobar la exactitud de la clasificación se usaron 1.372 puntos obtenidos de fotos aéreas de 1992 y trabajo de campo empleando un Sistema de Posicionamiento Global (SPG). Los resultados obtenidos indican que existe un 46.6% del país bajo pastos, un 32,9 bajo bosques y un 8,5% bajo uso agrícola. Un 7,8% del área se incluyó en una categoría denominada <<no clasificada, usos mezclados, deforestada>>. La exactitud global de la clasificación fue de un 74%; con una confusión entre pasto y bosque de un 19%.  SUMMARY The objective of this paper is to describe the process used by the authors to update the preliminary 1985 land use-land cover map of Costa Rica. Paper maps of 1985 at scale 1:200.000 we digitized, rasterized and use to label the output of a nonsupervised classification carried out using 1991-93 digital data from LANDSAT 5 (Thematic Mapper). Aerial photography and field work aided by a Global Positional System (GPS) was used to gather ground-truth data. A total of 1372 stratified points were used to test the accuracy of the final map. Our results showed that 46,6% of the country is under pasture, 32,9% under forest and 8.5% under agriculture. The nonclassified areas were lumped into one category that accounted for 7,8% of the country. Global accuracy of the classification was 74% with the confusion between forest and pasture accounting for 19% of this error.