Prognostic importance of anaemia in patients with acute pulmonary embolism.

Although associated with adverse outcomes in other cardiopulmonary diseases, limited evidence exists on the prognostic value of anaemia in patients with acute pulmonary embolism (PE). We sought to examine the associations between anaemia and mortality and length of hospital stay in patients with PE. We evaluated 14,276 patients with a primary diagnosis of PE from 186 hospitals in Pennsylvania, USA. We used random-intercept logistic regression to assess the association between anaemia at the time of presentation and 30-day mortality and discrete-time logistic hazard models to assess the association between anaemia and time to hospital discharge, adjusting for patient (age, gender, race, insurance type, clinical and laboratory variables) and hospital (region, size, teaching status) factors. Anaemia was present in 38.7% of patients at admission. Patients with anaemia had a higher 30-day mortality (13.7% vs. 6.3%; p <0.001) and a longer length of stay (geometric mean, 6.9 vs. 6.6 days; p <0.001) compared to patients without anaemia. In multivariable analyses, anaemia remained associated with an increased odds of death (OR 1.82, 95% CI: 1.60-2.06) and a decreased odds of discharge (OR 0.85, 95% CI: 0.82-0.89). Anaemia is very common in patients presenting with PE and is independently associated with an increased short-term mortality and length of stay.

Research and teaching: a holy or an unholy alliance?

Much of the self-image of the Western university hangs on the idea that research and teaching are intimately connected. The central axiom here is that research and teaching are mutually supportive of each other. An institution lacking such a set of relationships between research and teaching falls short of what it means to be a university. This set of beliefs raises certain questions: Is it the case that the presence of such a mutually supportive set of relationships between research and teaching is a necessary condition of the fulfilment of the idea of the university? (A conceptual question). And is it true that, in practice today, such a mutually supportive set of relationships between research and teaching characterises universities? (An empirical question). In my talk, I want to explore these matters in a critical vein. I shall suggest that: a) In practice today, such a mutually supportive set of relationships between research and teaching is in jeopardy. Far from supporting each other, very often research and teaching contend against each other. Research and teaching are becoming two separate ideologies, with their own interest structures. b) Historically, the supposed tight link between research and teaching is both of recent origin and far from universally achieved in universities. Institutional separateness between research and teaching is and has been evident, both across institutions and even across departments in the same institution. c) Conceptually, research and teaching are different activities: each is complex and neither is reducible to the other. In theory, therefore, research and teaching may be said to constitute a holy alliance but in practice, we see more of an unholy alliance. If, then, in an ideal world, a positive relationship between research and teaching is still a worthwhile goal, how might it be construed and worked for? Seeing research and teaching as two discrete and unified sets of activity is now inadequate. Much better is a construal of research and teaching as themselves complexes, as intermingling pools of activity helping to form the liquid university that is emerging today. On this view, research and teaching are fluid spaces, ever on the move, taking up new shapes, and themselves dividing and reforming, as the university reworks its own destiny in modern society. On such a perspective, working out a productive relationship between research and teaching is a complex project. This is an alliance that is neither holy nor unholy. It is an uneasy alliance, with temporary accommodations and continuous new possibilities.

Aprender investigando. Una experiencia formativa en el ámbito de la enfermería = Research teaching processes used as a methodological strategy in the education of healthcare professionals

Este trabajo tiene como propósito presentar y valorar, desde la perspectiva del alumnado participante, un proyecto de investigación-formación puesto en marcha durante el curso 2003-2004 en la elaboración del trabajo de tesina, fin de carrera, en la Escuela de Enfermería de Vitoria, dentro del programa de Licenciatura Europea de Enfermería. Constituye el punto de partida de un proyecto a largo plazo, iniciado con la intención de desarrollar principios teóricos y procedimientos prácticos que nos permitan sistematizar procesos formativos que, centrados en la investigación, articulen la teoría y la práctica e integren una perspectiva comunicativa y cooperativa.

Desenvolupament d'eines per l'apliació de l'aprenentatge basat en projectes a l'enginyeria tècnica de telecomunicacions

El projecte d'innovació docent s'emmarca dintre de la línia de treball de l'Escola Politècnica Superior de Castelldefels. Aquesta escola, des de els seus inicis ha destacat per la seva aposta per la innovació docent i l'aplicació de mètodes pedagògics pioners arreu d'Espanya. El sistema d'ensenyament basat en el seguiment individualitzat de l'estudiant, facilitat per una bona relació professor/nombre d'estudiants (grups de 40 o 20 estudiants), l'avaluació continuada, que parteix de les activitats acadèmiques realitzades en una matèria, i l'avaluació curricular, que atén el rendiment global de l'estudiant, fan que el sistema fomenti el treball regular al mateix temps que l'informa en tot moment del seu progrés acadèmic. Per un altre banda, dintre del sistema educatiu de la nostra escola podem destacar l'aplicació de l'Aprenentatge Basat en Projectes (PBL), aplicat inicialment als estudis de Segon Cicle. D'acord amb aquest model, els alumnes aprenen realitzant projectes en grup. Les intervencions del professorat i els materials del curs estan orientats a donar suport a les necessitats dels projectes que es desenvolupen a cada moment. Tot seguint la línia de treball de l'escola i la seva adequació als criteris determinats en el Espai Europeu d'Educació Superior, aquest projecte segueix tres línies d’actuació: (1) incideix en l'aplicació del PBL dintre d'assignatures Optatives i en assignatures de primers cursos de la Titulació d'Enginyeria de Telecomunicacions, (2) estimular l’alumnat, a través de treballs interdisciplinaris i la utilització de les noves tecnologies, (3) generació de documentació adaptada als nous plans d’estudi. Aquestes línies d’actuació es desenvolupen per motivar els alumnes en els estudis d'enginyeria que estan cursant i fer-los veure l'aplicabilitat, en el camp de la recerca, de gran quantitat dels coneixements que van adquirint durant la seva formació dintre de la Universitat.

dEICbian: una distribució GNU/LINUX personalitzada per laboratoris de docència

En aquest projecte es desenvolupa una distribució GNU/Linux adaptada als laboratoris de docència del departament d’enginyeria de la informació i de les comunicacions. Partint de una anàlisi exhaustiu de les necessitats del departament i gràcies a la col·laboració dels seus membres s’ha realitzat la distribució dEICbian, un sistema que permetrà facilitar les tasques docents als laboratoris del departament. Amb l’objectiu de mantenir el sistema actualitzat també s’ha desenvolupat un generador de noves versions de la distribució dEICbian per tal de garantir tenir, sempre, un sistema modern i lliure d’errors als laboratoris del departament. L’opinió dels usuaris, expressada mitjançant enquestes, ha estat favorable i ara només resta el darrer pas: la seva implementació als laboratoris.

Teaching foreign languages through translation: considering multiple intelligences

Aquest treball de recerca tracta de la relació existent entre pedagogia, traducció, llengües estrangeres i intel•ligències múltiples. El debat sobre si la traducció és una eina útil a la classe de llengües estrangeres és un tema actual sobre el qual molts investigadors encara indaguen. Estudis recents, però, han demostrat que qualsevol tasca de traducció -en la qual s’hi poden incloure treballs amb les diferents habilitats- és profitosa si la considerem un mitjà, no una finalitat en ella mateixa. Evidentment, l’ús de la traducció dins l’aula és avantatjosa, però també hem de tenir presents certs desavantatges d’aquesta aplicació. Un possible desavantatge podria ser la creença que, al principi, molta gent té referent a l’equivalència, paraula per paraula, d’una llengua vers una altra. Però després de presentar vàries tasques de traducció als estudiants, aquests poden arribar a controlar, fins i tot, les traduccions inconscients i poden assolir un cert nivell de precisió i flexibilitat que val la pena mencionar. Però l’avantatge principal és que s’enfronten a una activitat molt estesa dins la societat actual que combina dues llengües, la llengua materna i la llengua objecte d’estudi, per exemple. De tot això en podem deduir que utilitzar la llengua materna a la classe no s’ha de considerar un crim, com fins ara, sinó una virtut, evidentment si és emprada correctament. En aquest treball de recerca s’hi pot trobar una síntesi tant de les principals teories d’adquisició i aprenentatge de llengües com de les teories de traducció. A la pregunta de si les teories, tant de traducció com de llengües estrangeres, s’haurien d’ensenyar implícita o explícitament, es pot inferir que segons el nivell d’estudis on estiguin els aprenents els convindrà aprendre les teories explícitament o les aprendran, de totes maneres, implícitament. Com que qualsevol grup d’estudiants és heterogeni -és a dir que cada individu té un ritme i un nivell d’aprenentatge concret i sobretot cadascú té diferents estils de percepció (visual, auditiu, gustatiu, olfactiu, de moviment) i per tant diferents intel•ligències-, els professors ho han de tenir en compte a l’hora de planificar qualsevol programa d’actuació vers els alumnes. Per tant, podem concloure que les tasques o projectes de traducció poden ajudar als alumnes a aprendre millor, més eficaçment i a aconseguir un aprenentatge més significatiu.

Enteral nutrition in critically ill patients with severe hemodynamic failure after cardiopulmonary bypass.

BACKGROUND & AIMS: The study was designed to investigate and quantify nutritional support, and particularly enteral nutrition (EN), in critically ill patients with severe hemodynamic failure. METHODS: Prospective, descriptive study in a surgical intensive care unit (ICU) in a university teaching hospital: patients aged 67+/-13 yrs (mean+/-SD) admitted after cardiac surgery with extracorporeal circulation, staying 5 days in the ICU with acute cardiovascular failure. Severity of disease was assessed with SAPS II, and SOFA scores. Variables were energy delivery and balance, nutrition route, vasopressor doses, and infectious complications. Artificial feeding delivered according to ICU protocol. EN was considered from day 2-3. Energy target was set 25 kcal/kg/day to be reached stepwise over 5 days. RESULTS: Seventy out of 1114 consecutive patients were studied, aged 67+/-17 years, and staying 10+/-7 days in the ICU. Median SAPS II was 43. Nine patients died (13%). All patients had circulatory failure: 18 patients required intra-aortic balloon-pump support (IABP). Norepinephrine was required in 58 patients (83%). Forty patients required artificial nutrition. Energy delivery was very variable. There was no abdominal complication related to EN. As a mean, 1360+/-620 kcal/kg/day could be delivered enterally during the first 2 weeks, corresponding to 70+/-35% of energy target. Enteral nutrient delivery was negatively influenced by increasing dopamine and norepinephrine doses, but not by the use of IABP. CONCLUSION: EN is possible in the majority of patients with severe hemodynamic failure, but usually results in hypocaloric feeding. EN should be considered in patients with careful abdominal and energy monitoring.

Susceptibility of Biomphalaria straminea (Dunker, 1848) from Serra da Mesa Dam, Goiás, Brazil to infection with three strains of Schistosoma mansoni Sambon, 1907

Ecological changes from water resources development projects often affect the epidemiology of water-associated diseases. In order to investigate the occurrence and distribution of freshwater snails of medical and veterinary importance in the area of influence of the Serra da Mesa Hydroelectric a survey has been performed since 1997 and revealed the occurrence of well-established populations of Biomphalaria straminea (Dunker, 1848) in the 8 municipalities surrounding the lake. Areas of epidemiologic risk for schistosomiasis were selected and studies of parasite-mollusc compatibility were undertaken using specimens from 19 populations of B. straminea and 3 strains (CM, EC and PB) originally isolated from B. straminea. Among 1,135 specimens used 15 became infected (infection index of 1.3%) and 8 populations were susceptible to the schistosome strains: B. straminea from Campinorte (Castelão, susceptible to CM and EC strains, and Planeta Água, EC strain), Colinas (Tocantinzinho river, CM and EC strains), Minaçu (Canabrava river, EC strain), Niquelândia (Codemin, CM and PB strains, and Almas river, CM strain), Uruaçu (touristic area, PB strain) and Santa Rita do Novo Destino (Maranhão river, CM and EC strains). These results, associated with marked social and ecological changes occurred, strongly suggest the possibility of B. straminea coming to act as a vector of schistosomiasis in the studied area.

The interaction of human pathogenic arena viruses with the host cell

SummaryResearch projects presented in this thesis aimed to investigate two major aspects of the arenaviruses life cycle in the host cell: viral entry and the biosynthesis of the viral envelope glycoprotein.Old World arenaviruses (OWAV), such as Lassa virus (LASV) and lymphocytic choriomeningitis virus (LCMV), attach to the cell by binding to their receptor, alpha-dystroglycan. Virions are then internalized by a largely unknown pathway of endocytosis and delivered to the late endosome/lysosome where fusion occurs at low pH. In the major project of my thesis, we sought to identify cellular factors involved in OWAV cell entry. Our work indicates that OWAV cell entry requires microtubular transport and a functional multivesicular body (MVB) compartment. Infection indeed depends on phosphatidyl inositol 3-kinase (PI3K) activity and lysobisphosphatidic acid (LBPA), a lipid found in membranes of intraluminal vesicles (ILVs) of the MVB. We further found a requirement of factors that are part of the endosomal sorting complex required for transport (ESCRT), involved in the formation of ILVs. This suggests an ESCRT-mediated sorting of virus- receptor complex during the entry process.During viral replication, biosynthesis of viral glycoprotein takes place in the endoplasmic reticulum (ER) of the host cell. When protein load exceeds the folding capacity of the ER, the accumulation of unfolded proteins is sensed by three ER resident proteins, activating transcription factor 6 (ATF6), inositol-requiring enzyme 1 (IRE1) and PKR-like ER kinase (PERK), whose signaling induces the cellular unfolded protein response (UPR). Our results indicate that acute LCMV infection transiently induces the activation of the ATF6 branch of the UPR, whereas the PERK, and IRE1 axis of UPR are neither triggered nor blocked during infection. Our data also demonstrate that activation of ATF6 pathway is required for optimal viral replication during acute infection.The formation of the mature, fusion-active form of arenaviruses glycoproteins requires proteolytic cleavage mediated by the cellular protease subtilisin kexin isozyme-1 (SKI-l)/site-l protease (SIP). We show that targeting the SKI-1/S1P enzymatic activity with specific inhibitors is a powerful strategy to block arenaviruses productive infection. Moreover, characterization of protease function highlights differences in processing between cellular and viral substrates, opening new possibilities in term of drug development against human pathogenic arenaviruses.RésuméLes projets de recherche présentés dans cette thèse visaient à étudier deux aspects du cycle de vie des arenavirus: l'entrée du virus dans la cellule hôte et la biosynthèse de la glycoprotéine durant la réplication virale.Les arenavirus du vieux monde (OWAV), tels que le virus de Lassa (LASV) et le virus de la chorioméningite lymphocytaire (LCMV) s'attachent à la cellule hôte en se liant à leur récepteur, l'alpha-dystroglycane. Les virions sont ensuite intemalisés par une voie d'endocytose inconnue et livrés à l'endosome tardif/lysosome, où le pH acide permet la fusion entre l'enveloppe virale et la membrane du compartiment. Le projet principal de ma thèse consistait à identifier les facteurs cellulaires impliqués dans l'entrée des OWAV dans la cellule hôte. Nos résultats indiquent que l'entrée des OWAV nécessite le transport microtubulaire et la présence d'un corps multivésiculaire (MVB) fonctionnel. L'infection dépend en effet de l'activité de phosphatidyl inositol 3-kinase (PI3K) et de lysobisphosphatidic acid (LBPA), un lipide présent dans les membranes des vésicules intraluminales (ILVs) du MVB. Nous avons également trouvé l'implication de facteurs constituant l'endosomal sorting complex required for sorting (ESCRT) qui joue un rôle dans la formation des ILVs. Ces donnés suggèrent l'incorporation du complexe virus-récepteur dans des ILVs durant le processus d'entrée.Lors de la réplication virale, la biosynthèse de la glycoprotéine virale a lieu dans le réticulum endoplasmique (ER) de la cellule hôte. Lorsque la charge de protéines nouvellement synthétisées excède la capacité de pliage des protéines dans le ER, l'accumulation de protéines mal pliées est détectée par trois facteurs: activating transcription factor 6 (ATF6), inositol-requiring enzyme 1 (IRE1) et PKR-like ER kinase (PERK). Leur signalisation constitue la réponse cellulaire face aux protéines mal pliées (UPR). Nos résultats montrent que l'infection aiguë avec LCMV induit transitoirement l'activation de la voie de signalisation ATF6 alors que les axes PERK et IRE1 de l'UPR ne sont ni induits ni bloqués pendant l'infection. Nos données prouvent également que l'activation de la voie ATF6 est nécessaire à une réplication virale optimale lors de l'infection aiguë avec LCMV.La maturation des glycoprotéines des arenavirus nécessite un clivage protéolytique par la protéase cellulaire subtilisin kexin isozyme-1 (SKI-l)/site-l protease (SIP). Nous avons démontré que le ciblage de l'activité enzymatique de SKI-1/SIΡ avec des inhibiteurs spécifiques est une stratégie prometteuse pour bloquer l'infection par les arenavirus. La caractérisation du mécanisme d'action de la protéase a, par ailleurs, révélé des différences au niveau du clivage entre les substrats cellulaires et viraux, ce qui ouvre de nouvelles perspectives en terme de développement de médicaments contre les arenavirus pathogènes pour l'homme.

The Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+): rationale and methodology.

Venous thromboembolism (VTE) is common and has a high impact on morbidity, mortality, and costs of care. Although most of the patients with VTE are aged ≥65 years, there is little data about the medical outcomes in the elderly with VTE. The Swiss Cohort of Elderly Patients with VTE (SWITCO65+) is a prospective multicenter cohort study of in- and outpatients aged ≥65 years with acute VTE from all five Swiss university and four high-volume non-university hospitals. The goal is to examine which clinical and biological factors and processes of care drive short- and long-term medical outcomes, health-related quality of life, and medical resource utilization in elderly patients with acute VTE. The cohort also includes a large biobank with biological material from each participant. From September 2009 to March 2012, 1,863 elderly patients with VTE were screened and 1003 (53.8 %) were enrolled in the cohort. Overall, 51.7 % of patients were aged ≥75 years and 52.7 % were men. By October 16, 2012, after an average follow-up time of 512 days, 799 (79.7 %) patients were still actively participating. SWITCO65+ is a unique opportunity to study short- and long-term outcomes in elderly patients with VTE. The Steering Committee encourages national and international collaborative research projects related to SWITCO65+, including sharing anonymized data and biological samples.

CRNINI workshop: Ethics in Research with children

Guidance for ethical research projects   •Good practice in children’s research •Building on knowledge gained in GUI •Initiated by DCYA   •Produced by Working Group with research, legal, policy and child protection expertise   Patricia's presentation is an analysis of at data from the Growing Up in Ireland study:  The relationship between family tranisitions and children's well being.

Factors associated with schistosomiasis mansoni in a population from the municipality of Jaboticatubas, State of Minas Gerais, Brazil

Jaboticatubas is a municipality in the metropolitan region of Belo Horizonte which has been a target of a wide media release as "the capital of schistosomiasis" since the 1960's. In order to give support to a work based on an integrated control, we sought to identify the disease determinants at the site. A transversal study was carried out aimed at identifying prevalence rates of the disease and factors associated with the infection in the district of São José de Almeida, and two close localities, Cipó Velho and São José da Serra, all of them located in the municipality of Jaboticatubas. A parasitological survey was performed, applying the Kato-Katz method with two slides per sample in 1186 schoolchildren which represents 77% of all registered pupils in four public schools in 2001. Among these schoolchildren a number of 101 (8.6%) prooved positive for Schistosoma mansoni eggs in their stool samples. A total of 64 families, whose schoolchildren had shown to be positive for schistosomiasis, also undertook examinations. As negative control, a random sample was collected from the 206 families, whose children had proven negative for schistosomiasis. The prevalence among 270 families (1304 people) was 12%. To assess those who continued to have contact with possibly contaminated water, 1061 (81.4%) people of the 270 families were interviewed. A multivariate analysis identified the following factors associated with the infection: time of residence in the area (short period), garbage disposal (use of deserted areas), gender (male), age (from 10 to 29 years), and water contact (daily and weekly). Further analysis of these factors revealed a close correlation between water contact and the disease, with a positive significant frequency concerning almost all those items. Depending on gender and age significant variations of water contact patterns associated with leisure and professional activities were found. A malacological survey on water collections in the area identified snails of the species Biomphalaria straminea and B. glabrata. The latter showed 17 (0.6%) specimens positive for S. mansoni. Qualitative studies have complemented such evidences, which allowed us to design a reference picture and specific indicators of the disease for the local population. Those data provided the essential information to continue the development of an already ongoing educative process, as well as projects on environmental improvements.

Cloughmills Incredible Edibles Project

Cloughmills Incredible Edibles Project aims to reconnect people with each other, their community and the natural world by developing a sustainable, fair and healthy food system in Cloughmills. They aim to teach people where food comes from, appreciate seasonal diversity and environmental impacts of food, be confident in cooking and celebrate the role of food in our lives. They will improve diet related health, reduce impacts of food poverty, make their community more resilient, increase choices available to and skills within their community, maximise the impacts of every pound spent locally and develop a shared food vision.   Food growing skills, communal and domestic using containers and permaculture/organic techniques; Foodscape the community – grow food in public spaces; Recruit ‘Fruit and Veg’ champions to support growing at home; ‘Share the Surplus’ – encourage and connect people with surplus produce to share. Cookery classes for all ages; Shared learning events on food skills & techniques; ‘Bake Your Lawn’ in schools – growing, harvesting, milling and baking breads; Develop mushroom growing project as a social enterprise for young people; Teaching lost skills related to food; Host pizza & movie nights where all ages make their own pizzas; promote a lovefoodhatewaste campaign with community and businesses. Totally Local campaign promoting local/seasonal produce; mystery market stall every month showcasing local produce, cooking tips; facilitate development of more food businesses; establish food hub. Part of theCFI Programme 2013-2015 Initiative Type Community Food Growing Projects Nutrition Education and Training Programmes Location Antrim Partner Agencies safefood

A Rapid Mapping Study of Smoking Projects and Services Targeted at People Living on Low Income and/or Minority Ethnic Groups

This is a study concerned with community based services aimed at smokers living on a low income and/or black and minority ethnic groups.

La visite médicale en pratique hospitalière: entre soins et apprentissage [Conducting ward rounds: a balance between care and teaching].

Every day, hospital doctors spend time at conducting ward rounds. Rounds are a core clinical activity during which doctors interact with patients, synthetise a whole set of informations and make many decisions. In addition, rounds can become a crucial teaching moment, when a trainee gets supervised by an attending physician. However, litterature on the topic of rounds is scarce. This paper summarizes the results of the few key studies focusing on ward rounds. The results are presented in four sections, each one being dedicated to one of the round stakeholders: the trainee or resident, the trainer, the patient and the nurse. An emphasis is put on ward rounds involving both a trainee and a trainer, since such rounds always mean striking a balance between care and teaching.