Adaptaciones cardiacas hemodinámicas, estructurales y funcionales a un programa de ejercicio físico supervisado durante el embarazo: ensayo clínico aleatorizado = Hemodynamic, structural and functional cardiac adaptations in a supervised physical exercise program during pregnancy: a randomized controlled trial

Introducción: Diversos cambios ocurren en el sistema cardiovascular materno durante el embarazo, lo que genera un gran estrés sobre este sistema especialmente durante el tercer trimestre, pudiendo acentuarse en presencia de determinados factores de riesgo. Los objetivos de este estudio fueron, valorar las adaptaciones cardiovasculares producidas por un programa específico de ejercicio físico; su seguridad sobre el sistema cardiovascular materno y los resultados del embarazo; y su eficacia en el control de los factores de riesgo cardiovascular. Material y métodos: El diseño del estudio fue un ensayo clínico aleatorizado. 151 gestantes sanas fueron evaluadas mediante un ecocardiograma y un electrocardiograma en la semana 20 y 34 de gestación. Un total de 89 gestantes participaron en un programa de ejercicio físico (GE) desde el primer hasta el tercer trimestre de embarazo, constituido principalmente por 25-30 minutos de trabajo aeróbico (55-60% de la frecuencia cardiaca de reserva), trabajo de fortalecimiento general y específico, y un trabajo de tonificación del suelo pélvico; desarrollado 3 días a la semana con una duración de 55-60 minutos cada sesión. Las gestantes aleatoriamente asignadas al grupo de control (GC; n=62) permanecieron sedentarias durante el embarazo. El estudio fue aprobado por el Comité Ético de investigación clínica del Hospital Universitario de Fuenlabrada. Resultados: Las características basales fueron similares entre ambos grupos. A diferencia del GC, las gestantes del GE evitaron el descenso significativo del gasto cardiaco indexado, entre el 2º y 3ºT de embarazo, y conservaron el patrón geométrico normal del ventrículo izquierdo; mientras que en el GC cambió hacia un patrón de remodelado concéntrico. En la semana 20, las gestantes del GE presentaron valores significativamente menores de frecuencia cardiaca (GC: 79,56±10,76 vs. GE: 76,05±9,34; p=0,04), tensión arterial sistólica (GC: 110,19±10,23 vs. GE: 106,04±12,06; p=0,03); tensión arterial diastólica (GC: 64,56±7,88 vs. GE: 61,81±7,15; p=0,03); tiempo de relajación isovolumétrica (GC: 72,94±14,71 vs. GE: 67,05±16,48; p=0,04); y un mayor tiempo de deceleración de la onda E (GC: 142,09±39,11 vs. GE: 162,10±48,59; p=0,01). En la semana 34, el GE presentó valores significativamente superiores de volumen sistólico (GC: 51,13±11,85 vs. GE: 56,21±12,79 p=0,04), de llenado temprano del ventrículo izquierdo (E) (GC: 78,38±14,07 vs. GE: 85,30±16,62; p=0,02) y de tiempo de deceleración de la onda E (GC: 130,35±37,11 vs. GE: 146,61±43,40; p=0,04). Conclusión: La práctica regular de ejercicio físico durante el embarazo puede producir adaptaciones positivas sobre el sistema cardiovascular materno durante el tercer trimestre de embarazo, además de ayudar en el control de sus factores de riesgo, sin alterar la salud materno-fetal. ABSTRACT Background: Several changes occur in the maternal cardiovascular system during pregnancy. These changes produce a considerable stress in this system, especially during the third trimester, which can be increased in presence of some risk factors. The aims of this study were, to assess the maternal cardiac adaptations in a specific exercise program; its safety on the maternal cardiovascular system and pregnancy outcomes; and its effectiveness in the control of cardiovascular risk factors. Material and methods: A randomized controlled trial was designed. 151 healthy pregnant women were assessed by an echocardiography and electrocardiography at 20 and 34 weeks of gestation. A total of 89 pregnant women participated in a physical exercise program (EG) from the first to the third trimester of pregnancy. It consisted of 25-30 minutes of aerobic conditioning (55-60% of their heart rate reserve), general and specific strength exercises, and a pelvic floor muscles training; 3 times per weeks during 55-60 minutes per session. Pregnant women randomized allocated to the control group (CG) remained sedentary during pregnancy. The study was approved by the Research Ethics Committee of Hospital Universitario de Fuenlabrada. Results: Baseline characteristics were similar between groups. Difference from the CG, pregnant women from the EG prevented the significant decrease of the cardiac output index, between the 2nd and 3rd trimester of pregnancy, and preserved the normal left ventricular pattern; whereas in the CG shifted to concentric remodeling pattern. At 20 weeks, women in the EG had significant lower heart rate (CG: 79,56±10,76 vs. EG: 76,05±9,34; p=0,04), systolic blood pressure (CG: 110,19±10,23 vs. EG: 106,04±12,06; p=0,03); diastolic blood pressure (CG: 64,56±7,88 vs. EG: 61,81±7,15; p=0,03); isovolumetric relaxation time (GC: 72,94±14,71 vs. GE: 67,05±16,48; p=0,04); and a higher deceleration time of E Wave (GC: 142,09±39,11 vs. GE: 162,10±48,59; p=0,01). At 34 weeks, the EG had a significant higher stroke volume (CG: 51,13±11,85 vs. EG: 56,21±12,79 p=0,04), early filling of left ventricular (E) (CG: 78,38±14,07 vs. EG: 85,30±16,62; p=0,02) and deceleration time of E wave (CG: 130,35±37,11 vs. EG:146,61±43,40; p=0,04). Conclusion: Physical regular exercise program during pregnancy may produce positive maternal cardiovascular adaptations during the third trimester of pregnancy. In addition, it helps to control the cardiovascular risk factors without altering maternal and fetus health.

A language exchange program: sustainability innovation in language and culture engagement

Spanish Educational Laws have been promoting the widespread use of English; as a result, Spanish Uni versities are looking for ways to give students more international training in order to prepare them for a future that will increasingly involve global problems and partnerships. Therefore, the Polytechnic University of Madrid, Spain (UPM), and the University of British Columbia, Okanagan, Canada (UBCO) have come together to offer opportunities for international collaboration and learning, thus facilitating virtual encounters among Spanish and Canadian students. The Language Exchange Program between the UPM and UBCO acts as a model for sustainability innovation in language and culture engagement as the students can interact with native speakers in communication tasks. This interdisciplinary initiative supports the latest methodological principles observed in the Common European Framework for Languages, such as autonomous and life-long learning, self-assessment and peer-assessment as well as the incorporation of new technologies to the learning process. Additionally the ‘virtual’ mobility is provided at no extra cost. This article presents the preliminary results of two virtual exchange programs that have been offering varied forms of study which are venue-independent, and have clearly expanded the range of scenarios for the students on both sides by promoting collaborative work and cultural exchange.

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.

Modified Dialectical Behavior Therapy Program Applied Within a Time-Limited Corrections Setting

Dialectical Behavioral Therapy (DBT) is an empirically supported therapy developed to treat individuals with Borderline Personality Disorder that has sustained efficacy following completion of the treatment (Linehan, 1993; Van Den Bosch et al., 2005). The core concepts of DBT include mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance, which seek to foster more functional ways of interacting with others, coping with distress, and managing difficult emotions. Using a standard DBT format in a corrections setting can be difficult due to the population's multifaceted composition. The Denver County Jail is a unique corrections setting because it contains a unit specifically developed for male inmates with mental health issues. A corrections modified, time-limited DBT curriculum was developed to fit the needs of this unique population. During the course of the group, staff appeared to be accepting of the group material and initial feedback from inmates and officers was positive.