Alterations of left ventricular myocardial characteristics associated with obesity

Background-Obesity is associated with heart failure, but an effect of weight, independent of comorbidities, on cardiac structure and function is not well established. We sought whether body mass index (BMI) and insulin levels were associated with subclinical myocardial disturbances. Methods and Results-Transthoracic echocardiography, myocardial Doppler-derived systolic (sm) and early diastolic velocity ( em), strain and strain rate imaging and tissue characterization with cyclic variation (CVIB), and calibrated integrated backscatter (cIB) were obtained in 109 overweight or obese subjects and 33 referents (BMI35) and the referent patients (P

Climate change and construction sector SMEs:vulnerability, consequences and resilience

Climate change has become one of the prime challenges the society has to face in the future. As far as businesses are concerned, it also has added one other important issue that they have to consider as part of their business planning. Climate change is of significant importance particularly to the Small and Medium-sized enterprises (SMEs), which are considered as the most vulnerable among the business community to the effects of climate change. This paper presents the findings of a literature review conducted with the aim of identifying the specific importance of climate change to the construction sector SMEs. The objectives of the paper are to identify the vulnerability of construction sector SMEs to the effects of climate change, their consequences and also to identify the importance of improving resilience and implementing adaptive measures to manage these issues. The paper also outlines the directions of a study undertaken to address these issues as part of an EPSRC funded research project titled “Community Resilience to Extreme Weather Events – CREW”. The paper concludes by stressing the importance of improving the resilience of construction sector SMEs to climate change effects and also the importance of collective action in this regard.

Utilising Intranet technologies in construction sector SMEs:building up knowledge bases for extreme weather event risk management

Intranet technologies accessible through a web based platform are used to share and build knowledge bases in many industries. Previous research suggests that intranets are capable of providing a useful means to share, collaborate and transact information within an organization. To compete and survive successfully, business organisations are required to effectively manage various risks affecting their businesses. In the construction industry too this is increasingly becoming an important element in business planning. The ability of businesses, especially of SMEs which represent a significant portion in most economies, to manage various risks is often hindered by fragmented knowledge across a large number of businesses. As a solution, this paper argues that Intranet technologies can be used as an effective means of building and sharing knowledge and building up effective knowledge bases for risk management in SMEs, by specifically considering the risks of extreme weather events. The paper discusses and evaluates relevant literature in this regard and identifies the potential for further research to explore this concept.

Coping with extreme weather:strategies of construction SMEs

Weather extremes have created a considerable impact on Small and Medium-sized Enterprises (SMEs) in the UK during the recent years, especially on SMEs in the construction sector. Evidence in relation to the recent weather extremes have demonstrated that SMEs are some of the worst impacted by the Extreme Weather Events (EWEs) and have confirmed them as a highly vulnerable section of the UK economy to the impact of extreme weather. This is of particular importance to the construction industry, as an overarching majority of construction companies are SMEs who account for the majority of employment and income generation within the industry. Whilst construction has been perceived as a sector significantly vulnerable to the impacts of EWEs, there is scant evidence of how construction SMEs respond to such events and cope with their impact. Based on the evidence emerged from case studies of construction SMEs, current coping strategies of construction SMEs were identified. Some of the strategies identified were focused at organisational level whereas others were focused at project level. Further, some of the strategies were general risk management / business continuity strategies whereas others have been specifically developed to address the risk of EWEs. Accordingly, coping strategies can be broadly categorised based on their focus; i.e. those focused at project or organisational level, and based on the risks that they seek to address; i.e. business / continuity risks in general or EWE risk specifically. By overlapping these two aspects; their focus and risks that they seek to address, four categories of coping strategies can be devised. There are; general risk management strategies focused at business level, general risk management strategies focused at project level, EWE specific strategies focused at business level, and EWE specific strategies focused at project level. It is proposed that for a construction SME to effectively cope with the impact of EWEs and develop their resilience against EWEs a rich mix of these coping strategies are required to suite the particular requirements of the business.

The impact of a family home-learning program on levels of parental/caregiver efficacy

This study sought to determine if participation in a home education learning program would impact the perceived levels of parental self-efficacy of parents/caregivers who participate in the completion of home-learning assignments and increase their levels of home-learning involvement practices. Also, the study examined the relationship between the parental involvement practice of completing interactive home-learning assignments and the reading comprehension achievement of first grade students. A total of 146 students and their parents/caregivers representing a convenience sample of eight first grade classes participated in the study. Four classes (n=74) were selected as the experimental group and four classes (n=72) served as the control group. There were 72 girls in the sample and 74 boys and the median age was 6 years 6 months. The study employed a quasi-experimental research design utilizing eight existing first grade classes. It examined the effects of a home-learning support intervention program on the perceived efficacy levels of the participating parents/caregivers, as measured by the Parent Perceptions of Parent Efficacy Scale (Hoover-Dempsey, Bassler, & Brissie, 1992) administered on a pre/post basis. The amount and type of parent involvement in the completion of home assignments was determined by means of a locally developed instrument, the H.E.L.P. Parent Involvement Home-learning Scale, administered on a pre/post basis. Student achievement in reading comprehension was measured via the reading subtest of the Brigance, CIB-S pre and post. The elementary students and their parents/caregivers participated in an interactive home-learning intervention program for 12 weeks that required parent/caregiver assistance. Results revealed the experimental group of parents/caregivers had a significant increase in their levels of perceived self-efficacy, p<.001, from the pre to post, and also had significantly increased levels of parental involvement in seven home-learning activities, p<.001, than the control group parents/caregivers. The experimental group students demonstrated significantly higher reading levels than the control group students, p<.001. This study provided evidence that interactive home-learning activities improved the levels of parental self-efficacy and parental involvement in home-learning activities, and improved the reading comprehension of the experimental group in comparison to the control.

The Impact of a Family Home-learning Program on levels of Parental/Caregiver Efficacy

This study sought to determine if participation in a home education learning program would impact the perceived levels of parental self-efficacy of parents/caregivers who participate in the completion of home-learning assignments and increase their levels of home-learning involvement practices. Also, the study examined the relationship between the parental involvement practice of completing interactive home-learning assignments and the reading comprehension achievement of first grade students. A total of 146 students and their parents/caregivers representing a convenience sample of eight first grade classes participated in the study. Four classes (n=74) were selected as the experimental group and four classes (n=72) served as the control group. . There were 72 girls in the sample and 74 boys and the median age was 6 years 6 months. The study employed a quasi-experimental research design utilizing eight existing first grade classes. It examined the effects of a home-learning support intervention program on the perceived efficacy levels of the participating parents/care¬givers, as measured by the Parent Perceptions of Parent Efficacy Scale (Hoover-Dempsey, Bassler, & Brissie, 1992) administered on a pre/post basis. The amount and type of parent involvement in the completion of home assignments was determined by means of a locally developed instrument, the H.E.L.P. Parent Involvement Home-learning Scale, administered on a pre/post basis. Student achievement in reading comprehension was measured via the reading subtest of the Brigance, CIB-S pre and post. The elementary students and their parents/caregivers participated in an interactive home-learning intervention program for 12 weeks that required parent/caregiver assistance. Results revealed the experimental group of parents/caregivers had a significant increase in their levels of perceived self-efficacy, p<.001, from the pre to post, and also had significantly increased levels of parental involvement in seven home-learning activities, p<.001, than the control group parents/caregivers. The experimental group students demonstrated significantly higher reading levels than the control group students, p<.001. This study provided evidence that interactive home-learning activities improved the levels of parental self-efficacy and parental involvement in home-learning activities, and improved the reading comprehension of the experimental group in comparison to the control.

Cooperative or collaborative learning: Is there a difference in university students’ perceptions?

The hypothesis that the same educational objective, raised as cooperative or collaborative learning in university teaching does not affect students’ perceptions of the learning model, leads this study. It analyses the reflections of two students groups of engineering that shared the same educational goals implemented through two different methodological active learning strategies: Simulation as cooperative learning strategy and Problem-based Learning as a collaborative one. The different number of participants per group (eighty-five and sixty-five, respectively) as well as the use of two active learning strategies, either collaborative or cooperative, did not show differences in the results from a qualitative perspective.

Impacto de la resiliencia en pacientes con Artritis Reumatoide

Introducción: La artritis reumatoide (AR) es una enfermedad autoinmune-inflamatoria, que compromete las articulaciones diartrodiales. Tiene una importante repercusión sistémica que incluye la depresión; por lo tanto, tiene un severo impacto sobre la calidad de vida. Es posible que mecanismos de defensa, tales como la resiliencia, puedan amortiguar dicho impacto. Metodología: estudio de corte transversal, multicéntrico (análisis inicial dentro del grupo AR, con muestra no probabilística de 66 pacientes, posterior selección aleatoria simple de 16 pacientes de la muestra inicial y selección de 16 individuos sanos pareados). Posteriormente, se comparó la resiliencia entre sujetos con AR y sujetos sanos, mediante las escalas RS y CD-RISC25. Adicionalmente, se aplicaron las escalas EEAE, EADZ, SF-36 y PANAS. Los datos fueron evaluados mediante el coeficiente de correlación de Spearman, las pruebas U Mann-Whitney, Kruskall-Wallis, T de Student y análisis de varianza. Resultados: se encontraron diferencias significativas en las estrategias de afrontamiento no espirituales en grupos de resiliencia baja, media y alta; diferencias en las medianas de resiliencia en los grupos de depresión por EAZD en los pacientes. No se encontraron resultados significativos en las variables clínicas de la AR ni en la comparación con sujetos sanos. Conclusiones: el uso de estrategias de afrontamiento no espirituales y la ausencia de depresión, se asoció a mayores niveles de resiliencia en los pacientes con AR, por lo cual, los componentes emocionales y cognitivos se asocian a la resiliencia.

Uso de dexmedetomidina como tratamiento coadyuvante de síndrome de abstinencia alcohólica: revisión sistemática

El objetivo de este estudio es establecer si la dexmedetomidina (DEX) es segura y efectiva para el manejo coadyuvante de síndrome de abstinencia a alcohol (SAA) a través de la búsqueda de evidencia científica. Metodología: se realiza una revisión sistemática de literatura publicada y no publicada desde enero de 1989 hasta febrero 2016 en PubMed, Embase, Scopus, Bireme, Cochrane library y en otras bases de datos y portales. Los criterios de inclusión fueron ensayos clínicos aleatorizados y no aleatorizados, estudios cuasi-experimentales, estudios de cohorte, y estudios de casos y controles; que incluyeron pacientes mayores de 18 años hospitalizados con diagnóstico de SAA y donde se usó DEX como terapia coadyuvante. Resultados: 7 estudios, 477 pacientes, se incluyeron en el análisis final. Se encontraron dos ensayos clínicos aleatorizados, tres estudios de casos y controles y dos estudios de cohorte retrospectivo. Solo uno de los estudios fue doble ciego y utilizó placebo como comparador. Análisis y conclusiones: en los estudios experimentales se determinan que el uso de DEX como terapia coadyuvante en el manejo de SAA tiene significancia clínica y estadística para disminuir dosis de BZD en las primeras 24 horas de tratamiento; pero no demostraron tener otros beneficios clínicos. En los estudios no aleatorizados existe consenso que relaciona el uso de DEX con menores dosis de BZD de forma temprana. Recomendaciones: no se recomienda el uso de DEX en SAA de forma rutinaria. Se recomienda usar DEX solo en casos en el que exista evidencia fallo terapéutico a BZD.

Ketamina para el tratamiento de la hiperalgesia causada por remifentanil en cirugía: revisión sistemática de literatura

La hiperalgesia secundaria a la administración de remifentanil se ha documentado tanto en estudios animales como en estudios experimentales en humanos y ha aumentado su incidencia dado su uso cada vez más frecuente para el mantenimiento durante diferentes procedimientos anestésicos, anestesia general balanceada, anestesia total intravenosa y sedaciones. La hiperalgesia secundaria al uso de remifentanil es un proceso pro-nociceptivo relacionado pero que difiere de la tolerancia aguda, en el que los neurotransmisores excitatorios de N- metil D aspartato (NMDA) juegan un rol central. Por tanto la ketamina se ha utilizado en diferentes dosis para la prevención de dicha hiperalgesia sin que se haya establecido su efectividad para la prevención y tratamiento de esta condición. Se encontraron 8 estudios publicados en los últimos 10 años que proponen a la ketamina como una estrategia útil y efectiva el tratamiento de la hiperalgesia inducida por el uso de remifentanil. Los resultados demuestran que la ketamina es un tratamiento costo efectivo para el tratamiento de la hiperalgesia en diferentes poblaciones sometidas a diversos procedimientos quirúrgicos y anestésicos que incluyan la administración de remifentanil tanto en la inducción como en el mantenimiento anestésico sin generar efectos secundarios adicionales, así como que logra disminuir el consumo de opioides y la EVA en el posoperatorio.

PRISM (Polarized Radiation Imaging and Spectroscopy Mission): an extended white paper

PRISM (Polarized Radiation Imaging and Spectroscopy Mission) was proposed to ESA in May 2013 as a large-class mission for investigating within the framework of the ESA Cosmic Vision program a set of important scientific questions that require high res- olution, high sensitivity, full-sky observations of the sky emission at wavelengths ranging from millimeter-wave to the far-infrared. PRISM’s main objective is to explore the distant universe, probing cosmic history from very early times until now as well as the structures, distribution of matter, and velocity flows throughout our Hubble volume. PRISM will survey the full sky in a large number of frequency bands in both intensity and polarization and will measure the absolute spectrum of sky emission more than three orders of magnitude bet- ter than COBE FIRAS. The data obtained will allow us to precisely measure the absolute sky brightness and polarization of all the components of the sky emission in the observed frequency range, separating the primordial and extragalactic components cleanly from the galactic and zodiacal light emissions. The aim of this Extended White Paper is to provide a more detailed overview of the highlights of the new science that will be made possible by PRISM, which include: (1) the ultimate galaxy cluster survey using the Sunyaev-Zeldovich (SZ) e↵ect, detecting approximately 106 clusters extending to large redshift, including a char- acterization of the gas temperature of the brightest ones (through the relativistic corrections to the classic SZ template) as well as a peculiar velocity survey using the kinetic SZ e↵ect that comprises our entire Hubble volume; (2) a detailed characterization of the properties and evolution of dusty galaxies, where the most of the star formation in the universe took place, the faintest population of which constitute the di↵use CIB (Cosmic Infrared Background); (3) a characterization of the B modes from primordial gravity waves generated during inflation and from gravitational lensing, as well as the ultimate search for primordial non-Gaussianity using CMB polarization, which is less contaminated by foregrounds on small scales than thetemperature anisotropies; (4) a search for distortions from a perfect blackbody spectrum, which include some nearly certain signals and others that are more speculative but more informative; and (5) a study of the role of the magnetic field in star formation and its inter- action with other components of the interstellar medium of our Galaxy. These are but a few of the highlights presented here along with a description of the proposed instrument.

SUS: estrutura, competências e serviços

Em SUS: Estrutura, Competências e Serviços, analisa-se o Sistema Único de Saúde (SUS) e sua estrutura abrangendo a organização em regiões de saúde, a hierarquização, em níveis de complexidade de serviços, a competência constitucional e as desigualdades entre os entes federativos e as instâncias de decisão – CIT, CIB e CIR. Por fim, trata-se da integralidade da assistência à saúde atendida pelo SUS por meio do rol de ações, serviços e medicamentos previstos na RENASES e RENAME.