European experience with the second-generation Edwards SAPIEN XT transcatheter heart valve in patients with severe aortic stenosis: 1-year outcomes from the SOURCE XT Registry

OBJECTIVES The SOURCE XT Registry (Edwards SAPIEN XT Aortic Bioprosthesis Multi-Region Outcome Registry) assessed the use and clinical outcomes with the SAPIEN XT (Edwards Lifesciences, Irvine, California) valve in the real-world setting. BACKGROUND Transcatheter aortic valve replacement is an established treatment for high-risk/inoperable patients with severe aortic stenosis. The SAPIEN XT is a balloon-expandable valve with enhanced features allowing delivery via a lower profile sheath. METHODS The SOURCE XT Registry is a prospective, multicenter, post-approval study. Data from 2,688 patients at 99 sites were analyzed. The main outcome measures were all-cause mortality, stroke, major vascular complications, bleeding, and pacemaker implantations at 30-days and 1 year post-procedure. RESULTS The mean age was 81.4 ± 6.6 years, 42.3% were male, and the mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 20.4 ± 12.4%. Patients had a high burden of coronary disease (44.2%), diabetes (29.4%), renal insufficiency (28.9%), atrial fibrillation (25.6%), and peripheral vascular disease (21.2%). Survival was 93.7% at 30 days and 80.6% at 1 year. At 30-day follow-up, the stroke rate was 3.6%, the rate of major vascular complications was 6.5%, the rate of life-threatening bleeding was 5.5%, the rate of new pacemakers was 9.5%, and the rate of moderate/severe paravalvular leak was 5.5%. Multivariable analysis identified nontransfemoral approach (hazard ratio [HR]: 1.84; p < 0.0001), renal insufficiency (HR: 1.53; p < 0.0001), liver disease (HR: 1.67; p = 0.0453), moderate/severe tricuspid regurgitation (HR: 1.47; p = 0.0019), porcelain aorta (HR: 1.47; p = 0.0352), and atrial fibrillation (HR: 1.41; p = 0.0014), with the highest HRs for 1-year mortality. Major vascular complications and major/life-threatening bleeding were the most frequently seen complications associated with a significant increase in 1-year mortality. CONCLUSIONS The SOURCE XT Registry demonstrated appropriate use of the SAPIEN XT THV in the first year post-commercialization in Europe. The safety profile is sustained, and clinical benefits have been established in the real-world setting. (SOURCE XT Registry; NCT01238497).

Retention in care during the first 3 years of antiretroviral therapy for women in Malawi's option B+ programme: an observational cohort study

Background Studies of Malawi's option B+ programme for HIV-positive pregnant and breastfeeding women have reported high loss to follow-up during pregnancy and at the start of antiretroviral therapy (ART), but few data exist about retention during breastfeeding and after weaning. We examined loss to follow-up and retention in care in patients in the option B+ programme during their first 3 years on ART. Methods We analysed two data sources: aggregated facility-level data about patients in option B+ who started ART between Oct 1, 2011, and June 30, 2012, at 546 health facilities; and patient-level data from 20 large facilities with electronic medical record system for HIV-positive women who started ART between Sept 1, 2011, and Dec 31, 2013, under option B+ or because they had WHO clinical stages 3 or 4 disease or had CD4 counts of less than 350 cells per μL. We used facility-level data to calculate representative estimates of retention and loss to follow-up. We used patient-level data to study temporal trends in retention, timing of loss to follow-up, and predictors of no follow-up and loss to follow-up. We defined patients who were more than 60 days late for their first follow-up visit as having no follow-up and patients who were more than 60 days late for a subsequent visit as being lost to follow-up. We calculated proportions and cumulative probabilities of patients who had died, stopped ART, had no follow-up, were lost to follow-up, or were retained alive on ART for 36 months. We calculated odds ratios and hazard ratios to examine predictors of no follow-up and loss to follow-up. Findings Analysis of facility-level data about patients in option B+ who had not transferred to a different facility showed retention in care to be 76·8% (20 475 of 26 658 patients) after 12 months, 70·8% (18 306 of 25 849 patients) after 24 months, and 69·7% (17 787 of 25 535 patients) after 36 months. Patient-level data included 29 145 patients. 14 630 (50·2%) began treatment under option B+. Patients in option B+ had a higher risk of having no follow-up and, for the first 2 years of ART, higher risk of loss to follow-up than did patients who started ART because they had CD4 counts less than 350 cells per μL or WHO clinical stage 3 or 4 disease. Risk of loss to follow-up during the third year was low and similar for patients retained for 2 years. Retention rates did not change as the option B+ programme matured. Interpretation Our data suggest that pregnant and breastfeeding women who start ART immediately after they are diagnosed with HIV can be retained on ART through the option B+ programme, even after many have stopped breastfeeding. Interventions might be needed to improve retention in the first year on ART in option B+. Funding Bill & Melinda Gates Foundation, Partnerships for Enhanced Engagement in Research Health, and National Institute of Allergy and Infectious Diseases.

Incidence and predictors of cutaneous manifestations during the early course of systemic sclerosis: a 10-year longitudinal study from the EUSTAR database.

OBJECTIVES To longitudinally map the onset and identify risk factors for skin sclerosis and digital ulcers (DUs) in patients with systemic sclerosis (SSc) from an early time point after the onset of Raynaud's phenomenon (RP) in the European Scleroderma Trials and Research (EUSTAR) cohort. METHODS 695 patients with SSc with a baseline visit within 1 year after RP onset were followed in the prospective multinational EUSTAR database. During the 10-year observation period, cumulative probabilities of cutaneous lesions were assessed with the Kaplan-Meier method. Cox proportional hazards regression analysis was used to evaluate risk factors. RESULTS The median modified Rodnan skin score (mRSS) peaked 1 year after RP onset, and was 15 points. The 1-year probability to develop an mRSS ≥2 in at least one area of the arms and legs was 69% and 25%, respectively. Twenty-five per cent of patients developed diffuse cutaneous involvement in the first year after RP onset. This probability increased to 36% during the subsequent 2 years. Only 6% of patients developed diffuse cutaneous SSc thereafter. The probability to develop DUs increased to a maximum of 70% at the end of the 10-year observation. The main factors associated with diffuse cutaneous SSc were the presence of anti-RNA polymerase III autoantibodies, followed by antitopoisomerase autoantibodies and male sex. The main factor associated with incident DUs was the presence of antitopoisomerase autoantibodies. CONCLUSION Early after RP onset, cutaneous manifestations exhibit rapid kinetics in SSc. This should be accounted for in clinical trials aiming to prevent skin worsening.

Freshman Friendship and University Connection

The purpose of this study is to understand better the support systems available to freshmen students at the University of Connecticut and how those support systems impact their connection to the university. The study involves two questionnaires, one distributed at the beginning of their first semester and a second follow-up questionnaire at the end of that same semester. Two main research questions are the focus of this study. The first question is whether freshmen who make friends on campus feel more connected than freshmen who report having fewer friends. The second question concerns whether freshmen who feel more connected to the university report stronger feelings of support than freshmen who do not feel connected to the university. This study has found that support at the university level needs to be more focused on individual students because freshmen who make friends at the university report experiencing greater levels of support. Parents, faculty, and counselors need to reexamine the way in which they provide support in order to reach those students who are not connecting with friends. The First Year Experience Program could better serve freshmen students by focusing on the relationship between students, instructor, and mentor to build friendships within the FYE class, which will foster friendships and support.

The Relationship between AP English Language Performance and College Outcomes

This study focused on the relationship between students’ Advanced Placement (AP) English language performance and their subsequent college success. Targeted students were divided into three groups according to their AP English Language performance. Subsequent college success was measured by students’ first-year college GPA, retention to the second year, and institutional selectivity. The demographic characteristics of the three AP performance groups with regard to gender, ethnicity, and best language spoken are provided. Results indicated that, after controlling for students’ SAT scores as a measure of prior academic performance, AP English Language performance was positively related to all three measures of college success.

Caring Minds

Greetings Pacesetter Grads Feel Boost in Entry to Nursing Workforce UTHealth-UH Dual Bachelors Program for First-Time Students UTHealth School of Nursing – By the Numbers 2012 PARTNERS Spring Luncheon – honored “Generations of Nurses” – guest speaker Naomi Judd UT Health Services Expands Care for Patients When I Grow Up, – A UTHealth Nursing Student’s Story Donors Support Start of New Accelerated Family Nurse Practitioner Program Giuseppe Colasurdo, M.D. – Appointed Sixth President in U THealth’s 40-Year History Dean Starck Named to UT Academy of Health Science Education, Marcus Honored by Regents for Outstanding Teaching Students Select Two for 2012 McGovern Awards Endowed scholarships Former home of School of Nursing for 30 years disappears in dust cloud Ruppert Named 2012 FAAN

A new way of teaching different subjects in a foreign language in the Building Engineering Degree at the Universidad Politécnica.

The European Union has been promoting linguistic diversity for many years as one of its main educational goals. This is an element that facilitates student mobility and student exchanges between different universities and countries and enriches the education of young undergraduates. In particular, a higher degree of competence in the English language is becoming essential for engineers, architects and researchers in general, as English has become the lingua franca that opens up horizons to internationalisation and the transfer of knowledge in today’s world. Many experts point to the Integrated Approach to Contents and Foreign Languages System as being an option that has certain benefits over the traditional method of teaching a second language that is exclusively based on specific subjects. This system advocates teaching the different subjects in the syllabus in a language other than one’s mother tongue, without prioritising knowledge of the language over the subject. This was the idea that in the 2009/10 academic year gave rise to the Second Language Integration Programme (SLI Programme) at the Escuela Arquitectura Técnica in the Universidad Politécnica Madrid (EUATM-UPM), just at the beginning of the tuition of the new Building Engineering Degree, which had been adapted to the European Higher Education Area (EHEA) model. This programme is an interdisciplinary initiative for the set of subjects taught during the semester and is coordinated through the Assistant Director Office for Educational Innovation. The SLI Programme has a dual goal; to familiarise students with the specific English terminology of the subject being taught, and at the same time improve their communication skills in English. A total of thirty lecturers are taking part in the teaching of eleven first year subjects and twelve in the second year, with around 120 students who have voluntarily enrolled in a special group in each semester. During the 2010/2011 academic year the degree of acceptance and the results of the SLI Programme have been monitored. Tools have been designed to aid interdisciplinary coordination and to analyse satisfaction, such as coordination records and surveys. The results currently available refer to the first and second year and are divided into specific aspects of the different subjects involved and into general aspects of the ongoing experience.

Project-based learning experience on Data Structures course

This paper presents the innovations in the practical work of the Data Structures subject carried out in the last five years, including a transition period and a first year of implantation of the European Higher Education Area. The practical coursework is inspired by a project-based methodology and from 2008/2009 additional laboratory sessions are included in the subject schedule. We will present the academic results and ratios of the mentioned time period which imply a significant improvement on students' performance.

Could it be possible to replace DERIVE with MAXIMA?

In recent years, a considerable number of teachers in Spain have been using DERIVE to teach math subjects in High Schools and Universities. This software has been used by the authors of this work as a support tool in Mathematics courses for Engineering. Since Texas Instruments does not support DERIVE, we were faced with finding an alternative software product, and considering the possibility of using a public-domain software such as MAXIMA. Here we make a comparative study of DERIVE and MAXIMA as support tools for a Calculus course for first year Engineering students.

Modelos predictivos para el estudio del abandono en centros universitarios

El abandono universitario es un problema que siempre ha afectado a las distintas universidades públicas. La Universidad Politécnica de Madrid, en concreto la Escuela Técnica Superior de Ingenieros Informáticos, pretende reducir dicho abandono aplicando técnicas de Data Mining para detectar aquellos alumnos que abandonan antes de que lo hagan. Este proyecto, a través de la metodología CRISP-DM (CRoss Industry Standard Process for Data Mining) y con los datos obtenidos del SIIU (Sistema Integrado de Información Universitaria), tiene como fin identificar a los alumnos que abandonan el primer añoo para poder aplicar distintas políticas en ellos y así evitarlo. ---ABSTRACT---Early university abandonment is a problem which has affected different public universities. The Universidad Polit´ecnica de Madrid (Polytechnic University of Madrid), inparticular the Escuela Técnica Superior de Ingenieros Informáticos (Computer Science Engineering School), wants to reduce this abandonment rate using Data Mining techniques to find students who are likely to leave before they do. The purpose of this project, through CRISP-DM (CRoss Industry Standard Process for Data Mining) methodology and using the data from SIIU (Sistema Integrado de Informaci´on Universitaria), is to identify those students who leave the first year in order to apply different policies and avoid it.

Integrating Generic Competences into Engineering Curricula

The new degrees in Spanish universities generated as a result of the Bologna process, stress a new dimension: the generic competencies to be acquired by university students (leadership, problem solving, respect for the environment, etc.). At Universidad Polite¿cnica de Madrid a teaching model was defined for two degrees: Graduate in Computer Engineering and Graduate in Software Engineering. Such model incorporates the training, development and assessment of generic competencies planned in these curricula. The aim of this paper is to describe how this model was implemented in both degrees. The model has three components. The first refers to a set of seven activities for introducing mechanisms for training, development and assessment of generic competencies. The second component aims to coordinate actions that implement the competencies across courses (in space and time). The third component consists of a series of activities to perform quality control. The implementation of generic competencies was carried out in first year courses (first and second semesters), together with the planning for second year courses (third and fourth semesters). We managed to involve a high percentage of first-year courses (80%) and the contacts that have been initiated suggest a high percentage in the second year as well.

Integrated approach to foreign language in the building engineering degree at the Universidad Politécnica Madrid

The European Union has been promoting linguistic diversity for many years as one of its main educational goals. This is an element that facilitates student mobility and student exchanges between different universities and countries and enriches the education of young undergraduates. In particular,a higher degree of competence in the English language is becoming essential for engineers, architects and researchers in general, as English has become the lingua franca that opens up horizons to internationalisation and the transfer of knowledge in today’s world. Many experts point to the Integrated Approach to Contents and Foreign Languages System as being an option that has certain benefits over the traditional method of teaching a second language that is exclusively based on specific subjects. This system advocates teaching the different subjects in the syllabus in a language other than one’s mother tongue, without prioritising knowledge of the language over the subject. This was the idea that in the 2009/10 academic year gave rise to the Second Language Integration Programme (SLI Programme) at the Escuela Arquitectura Tecnica in the Universidad Politecnica Madrid (EUATM-UPM), just at the beginning of the tuition of the new Building Engineering Degree, which had been adapted to the European Higher Education Area (EHEA) model. This programme is an interdisciplinary initiative for the set of subjects taught during the semester and is coordinated through the Assistant Director Office for Educational Innovation. The SLI Programme has a dual goal; to familiarise students with the specific English terminology of the subject being taught, and at the same time improve their communication skills in English. A total of thirty lecturers are taking part in the teaching of eleven first year subjects and twelve in the second year, with around 120 students who have voluntarily enrolled in a special group in each semester. During the 2010/2011 academic year the degree of acceptance and the results of the SLI Programme are being monitored. Tools have been designed to aid interdisciplinary coordination and to analyse satisfaction, such as coordination records and surveys. The results currently available refer to the first semester of the year and are divided into specific aspects of the different subjects involved and into general aspects of the ongoing experience.

Contemplative Education CenterStage: Training the Mindful Performer

In the late 20th century and early 21st century, contemplative education/studies courses, concentrations, and initiatives have emerged in the academy. Although there has been significant discussion of postsecondary courses and programs that have integrated contemplative views and practices in the literature, there have been few studies of contemplative curricula and pedagogy in higher education. Additionally, there have been even fewer inquiries of the influence of contemplative education on performing arts training within conservatories and college and university departments. The aim of this qualitative study was two-fold: (1) to describe, interpret, and appraise the impact of contemplative education on the curricula of an interdisciplinary conservatory level performing arts program, MFA Contemporary Performance, at Naropa University; and (2) to disclose, compare, and analyze MFA student perceptions of the influence of contemplative education on their professional and personal development. The following questions guided this study: (1) How do faculty and students characterize contemplative education within the MFA in Theater: Contemporary Performance Program? (2) How does contemplative education impact the intended and operational curricula of courses within the MFA Contemporary Performance Program? (3) How do graduate students perceive the effects of contemplative education, offered by the MFA Contemporary Performance Program, on the development of their communication abilities, presence-in-performance, sociolinguistic perspectives, and aesthetic perspectives? Based on the research methodology of educational criticism and connoisseurship, this investigation provides a vivid description and interpretation of the intended and operational curricula of three core courses within the MFA program. These curricula were examined through five dimensions: intentional, curricular, pedagogical, structural, and evaluative. In order to shape our understanding of the contemplative and performative nature of the curricula, the significant and subtle qualities of the courses were further captured by preparation, context-building, reflective, showing, and closing conventions. Since the courses were grounded in postmodern view, they were evaluated according to Doll's criteria of richness, recursion, relations, and rigor for the evaluation of postmodern curricula. MFA first- and second-year students primarily characterized contemplative education as body/mind training for performance and personal development, sitting meditation, and cultivation of mindfulness and awareness. Student perceptions of the impact of contemplative education on the development of their communication abilities, presence-in-performance, sociolinguistic perspectives, and aesthetic perspectives, throughout the course of their two-year training, are presented in a dimensional analysis. The research reveals eight different themes that intersect the three core curricula and interviews with MFA students and faculty. These thematics include inclusivity, nowness, silence, improvisation, goodness, heart, training, and space. The beginning letter of each theme combines to form the acronym, insights. The framework of insights connects and illuminates the most potent aspects of MFA Contemporary Performance values and training.

Estudo de uma proposta de ensino de física para o primeiro ano do ensino médio inspirada na teoria do pensamento complexo de Morin

O mundo está passando por uma mudança paradigmática. O paradigma moderno baseado nas ideias de René Descartes e Isaac Newton está sendo substituído por um novo paradigma chamado de pós-moderno ou complexo. Essa mudança tem gerado uma crise em toda a sociedade, e essa crise pode ser muito bem percebida na escola. Enquanto o mundo passa a valorizar a criatividade, a autonomia e habilidades como o trabalho em equipe e a capacidade de resolução de problemas complexos, a escola procura se fechar em torno de si mesma, exigindo a memorização e reprodução de conteúdos prontos, visando a solução de problemas artificiais que em nada se relaciona com o cotidiano e os interesses dessa nova sociedade. Nessa perspectiva, esse trabalho propõe uma metodologia para o ensino do conteúdo de Física do primeiro ano do Ensino Médio inspirada na teoria do pensamento complexo de Edgar Morin. Para isso, desenvolvemos uma sequência didática com atividades que visam não só abordar os conteúdos previstos pelo Currículo Oficial do Estado de São Paulo de maneira contextualizada e motivadora, mas abordá-los com o objetivo de procurar iniciar o desenvolvimento do pensamento complexo dos alunos. Assim, para alcançar esse objetivo, na elaboração de cada atividade, levamos em consideração \"Os Sete Saberes Necessários à Educação do Futuro\" de Morin assim como as competências e habilidades que estão previstas nos Parâmetros Curriculares Nacionais (PCN). Sabemos que o pensamento complexo não se desenvolve do dia para noite, pois é um processo que se estende por toda a vida. Entretanto esperamos que com esse trabalho, possamos dar uma contribuição nesse sentido, e vislumbrar durante o ano letivo o princípio do desenvolvimento desse modo de pensar nos alunos.

A structural model of cognitive-motivational variables as explanatory factors of academic achievement in Spanish Language and Mathematics

In recent years, several explanatory models have been developed which attempt to analyse the predictive worth of various factors in relation to academic achievement, as well as the direct and indirect effects that they produce. The aim of this study was to examine a structural model incorporating various cognitive and motivational variables which influence student achievement in the two basic core skills in the Spanish curriculum: Spanish Language and Mathematics. These variables included differential aptitudes, specific self-concept, goal orientations, effort and learning strategies. The sample comprised 341 Spanish students in their first year of Compulsory Secondary Education. Various tests and questionnaires were used to assess each student, and Structural Equation Modelling (SEM) was employed to study the relationships in the initial model. The proposed model obtained a satisfactory fit for the two subjects studied, and all the relationships hypothesised were significant. The variable with the most explanatory power regarding academic achievement was mathematical and verbal aptitude. Also notable was the direct influence of specific self-concept on achievement, goal-orientation and effort, as was the mediatory effect that effort and learning strategies had between academic goals and final achievement.