Oral anticoagulation in octogenarians with atrial fibrillation

Vitamin K antagonists (VKAs) are still largely employed, even in nonvalvular atrial fibrillation (AF). Our aim was to study the clinical profile of octogenarians treated with oral anticoagulation and to study the effect of age on the quality of VKAs anticoagulation. Data are from a prospective national registry in an adult Spanish population of nonvalvular AF. We included 1637 patients who had been receiving VKAs for at least 6 months before enrolment. Mean age was 73.8 ± 9.4 years. Patients aged > 80 years (N = 429) had a high risk profile with higher risk of stroke and bleeding than younger patients; CHA2DS2-VASc (Cardiac failure, Hypertension, Age > 74, Diabetes, Stroke, Vascular disease, Age 65–74 years, and Sex category) 4.5 ± 1.3 vs. 3.5 ± 1.6, p < 0.001, HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 64 years), Drugs/alcohol concomitantly) 2.4 ± 0.9 vs. 1.9 ± 1.1, p < 0.001. Creatinine clearance was lower in octogenarians than in younger patients (54.3 ± 16.1 ml/min vs. 69.5 ± 23.7 ml/min, p < 0.001) and severe renal disease with creatinine clearance < 30 ml/min was more frequent in octogenarians (5.2% vs. 2.2%, p < 0.001). In patients treated with VKAs (N = 1637), the international normalized ratio values of the 6 months previous to enrollment were similar in all age quartiles, as was the time in the therapeutic range. In this large registry octogenarians with nonvalvular AF had high risk of stroke and bleeding and frequent renal disease. VKAs anticoagulation quality was similar in octogenarians and in younger patients.

Apprendre avec la technologie : l'impact sur l'enseignement et l'apprentissage de l’utilisation de la technologie numérique (SMARTBOARD) dans les classes

This research was devoted to gaining information on teachers? use of technology, specifically SMARTBOARD technology, for teaching and promoting learning in the classroom. Research has suggested that use of technology can enhance learning and classroom practices. This has resulted in administrators encouraging the use of SMARTBOARDS, installing them in classrooms and providing training and support for teachers to use this technology. Adoption of new technology, however, is not simple. It is even more challenging because making the best use of new technologies requires more than training; it requires a paradigm shift in teachers? pedagogical approach. Thus, while it may be reasonable to believe that all we need to do is show teachers the benefits of using the SMARTBOARD; research tells us that changing paradigms is difficult for a variety of reasons. This research had two main objectives. First, to discover what factors might positively or negatively affect teachers? decisions to take up this technology. Second, to investigate how the SMARTBOARD is used by teachers who have embraced it and how this impacts participation in classrooms. The project was divided into two parts; the first was a survey research (Part 1), and the second was an ethnographic study (Part 2). A thirty-nine item questionnaire was designed to obtain information on teachers? use of technology and the SMARTBOARD. The questionnaire was distributed to fifty teachers at two EMSB schools: James Lyng Adult Centre (JLAC) and the High School of Montreal (HSM). Part 2 was an ethnographic qualitative study of two classes (Class A, Class B) at JLAC. Class A was taught by a male teacher, an early-adopter of technology and a high-level user of the SMARTBOARD; Class B was taught by a female teacher who was more traditional and a low-level user. These teachers were selected because they had similar years of experience and general competence in their subject matter but differed in their use of the technology. The enrollment in Class A and Class B were twenty-three and twenty-four adult students, respectively. Each class was observed for 90 minutes on three consecutive days in April 2010. Data collection consisted of videotapes of the entire period, and observational field notes with a graphical recording of participatory actions. Information from the graphical recording was converted to sociograms, a graphic representation of social links among individuals involved in joint action. The sociogram data was tabulated as quantified data. The survey results suggest that although most teachers are interested in and use some form of technology in their teaching, there is a tendency for factors of gender and years of experience to influence the use of and opinions on using technology. A Chi Square analysis of the data revealed (a) a significant difference (2 = 6.031, p < .049) for gender in that male teachers are more likely to be interested in the latest pedagogic innovation compared to female teachers; and, (b) a significant difference for years of experience (2 = 10.945, p < .004), showing that teachers with ?6 years experience were more likely to use the SMARTBOARD, compared to those with more experience (>6 years). All other items from the survey data produced no statistical difference. General trends show that (a) male teachers are more willing to say yes to using the SMARTBOARD compared to female teachers, and (b) teachers with less teaching experience were more likely to have positive opinions about using the SMARTBOARD compared to teachers with more experience. The ethnographic study results showed differences in students? response patterns in the two classrooms. Even though both teachers are experienced and competent, Teacher A elicited more participation from his students than Teacher B. This was so partly because he used the SMARTBOARD to present visual materials that the students could easily respond to. By comparison, Teacher B used traditional media or methods to present most of her course material. While these methods also used visual materials, students were not able to easily relate to these smaller, static images and did not readily engage with the material. This research demonstrates a generally positive attitude by teachers towards use of the SMARTBOARD and a generally positive role of this technology in enhancing students? learning and engagement in the classroom. However, there are many issues related to the SMARTBOARD use that still need to be examined. A particular point is whether teachers feel adequately trained to integrate SMARTBOARD technology into their curricula. And, whether the gender difference revealed is related to other factors like a need for more support, other responsibilities, or a general sense of anxiety when it comes to technology. Greater opportunity for training and ongoing support may be one way to increase teacher use of the SMARTBOARD; particularly for teachers with more experience (>6 years) and possibly also for female teachers.

Impacto del Programa de Alimentación Escolar en el Trabajo Infantil: Una aproximación desde la toma de decisiones familiares

Esta investigación analiza el impacto del Programa de Alimentación Escolar en el trabajo infantil en Colombia a través de varias técnicas de evaluación de impacto que incluyen emparejamiento simple, emparejamiento genético y emparejamiento con reducción de sesgo. En particular, se encuentra que este programa disminuye la probabilidad de que los escolares trabajen alrededor de un 4%. Además, se explora que el trabajo infantil se reduce gracias a que el programa aumenta la seguridad alimentaria, lo que consecuentemente cambia las decisiones de los hogares y anula la carga laboral en los infantes. Son numerosos los avances en primera infancia llevados a cabo por el Estado, sin embargo, estos resultados sirven de base para construir un marco conceptual en el que se deben rescatar y promover las políticas públicas alimentarias en toda la edad escolar.

Clase Invertida

En este segundo número de reflexiones pedagógicas se presenta una revisión de la denominada clase invertida (flipped classroom). Este texto presentan los componentes que caracterizan esta estrategia. Se comparan igualmente los elementos que la diferencian de la clase tradicional y se destacan los pasos para adelantar esta innovación y su forma de funcionamiento. De igual manera se muestran algunos indicadores que pueden llevar a una reflexión de la pacífica pedagógica y se concluye con estudios que muestran sus aportes e investigaciones que la soportan.