Role of secretory immunoglobulin A and secretory component in the protection of mucosal surfaces.

The contribution of secretory immunoglobulin A (SIgA) antibodies in the defense of mucosal epithelia plays an important role in preventing pathogen adhesion to host cells, therefore blocking dissemination and further infection. This mechanism, referred to as immune exclusion, represents the dominant mode of action of the antibody. However, SIgA antibodies combine multiple facets, which together confer properties extending from intracellular and serosal neutralization of antigens, activation of non-inflammatory pathways and homeostatic control of the endogenous microbiota. The sum of these features suggests that future opportunities for translational application from research-based knowledge to clinics include the mucosal delivery of bioactive antibodies capable of preserving immunoreactivity in the lung, gastrointestinal tract, the genito-urinary tract for the treatment of infections. This article covers topics dealing with the structure of SIgA, the dissection of its mode of action in epithelia lining different mucosal surfaces and its potential in immunotherapy against infectious pathogens.

Traditional Chinese materia medica: a retrospect and prospect

For thousands of years, traditional medicine and remedies have been practed and used in the fight against disease in China. They have proved to be valuable and the distillate of vast historical experience based on field-tested human experiments, long-term observations and clinical trials. The Chinese people belive that traditional medicine is consistent with theirown culture. Endowed with a unique theoretical system and provided outstanding clinical results, traditional Chinese medicine continues to play an important role in helping the Chinese nation flourish. The recent study of traditional medicinal plants in Chine has given us confidence that what was recorded in ancient medical literature through empirical observations is indeed still coindicent with the concepts of modern chemistry, pharmacology and medicine. The task of revealing what is valid and efficacious should be retained, and what is mythic and invalid should be discarded in traditional Chinese medicine may require scientific research lasting for several generations. Therfore, multidisciplinary cooperation and international collaboration in this field would be essential. Systematic coordination of work in traditional medicine by word organizations, national governments, private foundations and individual scientists is a requisite as well.

Educación ambiental como factor de cambio: conocer, interpretar y aprender para mejorar desde lo glocal

Primero comenzamos por describir la situación global histórica de la transformación del entorno. Luego se describe cómo evoluciona la Educación Ambiental bajo el concepto del desarrollo, constituyéndose como la Educación Ambiental para el Desarrollo Sustentable. Continuamos describiendo la situación de la EA a nivel internacional; se pasa luego al ámbito nacional, teniendo como escenario a México, aquí se hace un análisis del estado que guarda la EA en el país. Después se continua con el ámbito estatal, para lo cual se analiza la situación de la EA en el estado de Zacatecas, en este plano se toca el tema de la participación de las instituciones de educación superior en el intercambio de experiencias y conocimientos para el fortalecimiento de programas de EADS. Luego pasamos a un ámbito municipal, el caso a tratar es el municipio de Monte Escobedo Zacatecas, se hace una descripción general del municipio y se tratan los antecedentes que han motivado este proyecto, para luego pasar a describir el caso específico de la Sierra de Monte Escobedo; a partir de las características de ésta y retomando una propuesta previa de integrar la Sierra al sistema de Áreas Naturales Protegidas de México, se hacen dos propuestas: La primera es sobre el diseño de un Centro de Interpretación y Educación Ambiental; la segunda es para la realización de un Sendero de interpretación. Ambas propuestas pretenden contribuir al aprovechamiento sustentable de los recursos y desarrollo de la comunidad.

Unhealthy Consequences: Energy Costs and Child Health

Substantial and compelling medical and public health evidence indicated that non-medical factors, such as home energy costs, profoundly influence child health and well-being. Child Health Impact Assessment offered an evidence- and experience-based method through which to evaluate the implications of policy, regulations, and legislation for children's health and well-being. Our Child Health Impact Assessment of home energy costs revealed that unaffordable home energy has important and preventable adverse consequences for children's health. The available evidence showed that unaffordable home energy has preventable, potential consequences on the health and well-being of the more than 400,000 Massachusetts children living in low-income households. Low-income families are caught in the gap between rising energy prices and available energy assistance. Energy assistance falls far short of the need, especially when there is a spike in energy prices, such as following Hurricane Katrina in 2005. In addition to the exceedingly high housing costs in Massachusetts, our climate means low-income families spend more of their income on home energy (energy burden) to keep warm than families in other regions of the U.S.

La consulta de terapia antitrombótica: progresando hacia la Enfermería de Práctica Avanzada.

There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges.

An investment social network beside the Banco de Barcelona, an unusual case?

[cat] L’extensió de les activitats bancàries al segle XIX va ser liderat per alguns grups socials connectats amb el comerç, que van treure profit de la seva experiència i coneixement per estendre la seva influència al voltant del món del crèdit. A la historiografia espanyola, hi ha un conjunt de treballs que s’han centrat en aquesta gent, però en molts pocs casos s’ha fet una classificació que permeti detectar el conjunt de grups econòmics que han liderat el procés de modernització financera de l’Espanya de mitjans del segle XIX. El principal objectiu del treball és l’anàlisi dels grups socials que van formar el Banco de Barcelona entre 1844 i 1854. Aquesta institució va ser important per a la història financera i bancària d’Espanya per ser pionera en la seva activitat creditícia i d’emissió: a més, la seva experiència va servir com a base en la constitució d’un sistema financer modern a Espanya. En una societat com la catalana de mitjans del segle XIX, la confiança era un factor important per explicar la decisió d’invertir. L’aparició de noves companyies i les seves necessitats d’inversió van transformar el comportaments previs. Quin va ser el comportament dels inversors potencials? Va ser el grup que hi havia al voltant del banc el que va ascendir econòmicament en els anys centrals del segle XIX? La resposta és prou clara, els membres del consell d’administració del Banc de Barcelona formaven un grup apart dins dels grups que sorgeixen a l’economia catalana en el seu conjunt.

An investment social network beside the Banco de Barcelona, an unusual case?

[cat] L’extensió de les activitats bancàries al segle XIX va ser liderat per alguns grups socials connectats amb el comerç, que van treure profit de la seva experiència i coneixement per estendre la seva influència al voltant del món del crèdit. A la historiografia espanyola, hi ha un conjunt de treballs que s’han centrat en aquesta gent, però en molts pocs casos s’ha fet una classificació que permeti detectar el conjunt de grups econòmics que han liderat el procés de modernització financera de l’Espanya de mitjans del segle XIX. El principal objectiu del treball és l’anàlisi dels grups socials que van formar el Banco de Barcelona entre 1844 i 1854. Aquesta institució va ser important per a la història financera i bancària d’Espanya per ser pionera en la seva activitat creditícia i d’emissió: a més, la seva experiència va servir com a base en la constitució d’un sistema financer modern a Espanya. En una societat com la catalana de mitjans del segle XIX, la confiança era un factor important per explicar la decisió d’invertir. L’aparició de noves companyies i les seves necessitats d’inversió van transformar el comportaments previs. Quin va ser el comportament dels inversors potencials? Va ser el grup que hi havia al voltant del banc el que va ascendir econòmicament en els anys centrals del segle XIX? La resposta és prou clara, els membres del consell d’administració del Banc de Barcelona formaven un grup apart dins dels grups que sorgeixen a l’economia catalana en el seu conjunt.

Online teaching of inflammatory skin pathology by a French-speaking international university network

Introduction: Developments in technology, webbased teaching and whole slide imaging have broadened the teaching horizon in anatomic pathology. Creating online learning material including many types of media like radiologic images, videos, clinical and macroscopic photographs and whole slides imaging is now accessible to almost every university. Unfortunately, a major limiting factor to maintain and update the learning material is the amount of work, time and resources needed. In this perspective, a French national university network was initiated in 2011 to build mutualised online teaching pathology modules with clinical cases and tests. This network has been extended to an international level in 2012-2014 (Quebec, Switzerland and Ivory Coast). Method: One of the first steps of the international project was to build a learning module on inflammatory skin pathology intended for interns and residents of pathology and dermatology. A pathology resident from Quebec spent 6 weeks in France and Switzerland to develop the contents and build the module on an e-learning Moodle platform (http: //moodle.sorbonne-paris-cite.fr) under the supervision of two dermatopathologists (BV, MB). The learning module contains text, interactive clinical cases, tests with feedback, whole slides images (WSI), images and clinical photographs. For that module, the virtual slides are decentralized in 2 universities (Bordeaux and Paris 7). Each university is responsible of its own slide scanning, image storage and online display with virtual slide viewers. Results: The module on inflammatory skin pathology includes more than 50 web pages with French original content, tests and clinical cases, links to over 45 WSI and more than 50 micro and clinical photographs. The whole learning module is currently being revised by four dermatopathologists and two senior pathologists. It will be accessible to interns and residents in spring 2014. The experience and knowledge gained from that work will be transferred to the next international fellowship intern whose work will be aimed at creating lung and breast pathology learning modules. Conclusion: The challenges of sustaining a project of this scope are numerous. The technical aspect of whole-slide imaging and storage needs to be developed by each university or group. The content needs to be regularly updated, completed and its use and existence needs to be promoted by the different actors in pathology. Of the great benefits of that kind of project are the international partnerships and connections that have been established between numerous Frenchspeaking universities and pathologists with the common goals of promoting education in pathology and the use of technology including whole slide imaging. * The Moodle website is hosted by PRES Sorbonne Paris Cité, and financial supports for hardware have been obtained from UNF3S (http://www.unf3s.org/) and PRES Sorbonne Paris Cité. Financial support for international fellowships has been obtained from CFQCU (http://www.cfqcu.org/).

El portafoli electrònic com a procediment avaluador de l'aprenentatge per a la comprensió als centres de secundària de la xarxa school+

[cat] El projecte que s'ha dut a terme sota el nom "El portafoli electrònic com a procediment avaluador de l'aprenentatge per a la comprensió als centres de secundària de la Xarxa School +", s'ha desenvolupat a partir de tres eixos prioritaris que sintetitzen els objectius que ens havíem plantejat:1. Desenvolupar una experiència pedagògica que impliqués la perspectiva educativa delsprojectes de treball, i la utilització del sistema d¿ensenyament i aprenentatge virtualSchool+Microcosmos. 2. Afavorir una experiència de col·laboració entre el professorat de cada centre i entre elprofessorat dels diferents centres participants. 3. Realitzar una recerca sistemàtica, a partir de la utilització de diferents procediments de recollida d'evidències (observacions, entrevistes, anàlisis de materials, actes de reunió delgrup, informes finals,...) al voltant de les formes de comprensió que es poden produir per part dels estudiants, i com a camí per un replantejament de l'aprenentatge a l'educació secundària. La recerca desenvolupada ens ha mostrat com les possibilitats de promoure la comprensió des de la perspectiva educativa adoptada -els projectes de treball- són manifestes, però es troben limitades per les constriccions organitzatives -sobretot temporals i espacials- i curriculars que actualmentmediatitzen la capacitat innovadora dels centres de secundària. Aquest informe recull els processos i els resultats de la recerca i la innovació educativa realitzades, així com algunes de les seves conseqüències per a plantejar canvis en l'educació secundària.

El portafoli electrònic com a procediment avaluador de l'aprenentatge per a la comprensió als centres de secundària de la xarxa school+

[cat] El projecte que s'ha dut a terme sota el nom "El portafoli electrònic com a procediment avaluador de l'aprenentatge per a la comprensió als centres de secundària de la Xarxa School +", s'ha desenvolupat a partir de tres eixos prioritaris que sintetitzen els objectius que ens havíem plantejat:1. Desenvolupar una experiència pedagògica que impliqués la perspectiva educativa delsprojectes de treball, i la utilització del sistema d¿ensenyament i aprenentatge virtualSchool+Microcosmos. 2. Afavorir una experiència de col·laboració entre el professorat de cada centre i entre elprofessorat dels diferents centres participants. 3. Realitzar una recerca sistemàtica, a partir de la utilització de diferents procediments de recollida d'evidències (observacions, entrevistes, anàlisis de materials, actes de reunió delgrup, informes finals,...) al voltant de les formes de comprensió que es poden produir per part dels estudiants, i com a camí per un replantejament de l'aprenentatge a l'educació secundària. La recerca desenvolupada ens ha mostrat com les possibilitats de promoure la comprensió des de la perspectiva educativa adoptada -els projectes de treball- són manifestes, però es troben limitades per les constriccions organitzatives -sobretot temporals i espacials- i curriculars que actualmentmediatitzen la capacitat innovadora dels centres de secundària. Aquest informe recull els processos i els resultats de la recerca i la innovació educativa realitzades, així com algunes de les seves conseqüències per a plantejar canvis en l'educació secundària.

Collaborative quality improvement to manage pain in acute care hospitals.

Objective. Collaborative quality improvement programs have been successfully used to manage chronic diseases in adults and acute lung complications in premature infants. Their effectiveness to improve pain management in acute care hospitals is currently unknown. The purpose of this study was to determine whether a collaborative quality improvement program implemented at hospital level could improve pain management and overall pain relief. Design.To assess the effectiveness of the program, we performed a before-after trial comparing patient's self-reported pain management and experience before and after program implementation. We included all adult patients hospitalized for more than 24 hours and discharged either to their home or to a nursing facility, between March 1, 2001 and March 31, 2001 (before program implementation) and between September 15, 2005 and October 15, 2005 (after program implementation). Setting.A teaching hospital of 2,096 beds in Geneva, Switzerland. Patients.All adult patients hospitalized for more than 24 hours and discharged between 1 to 31 March 2001 (before program) and 15 September to 15 October 2005 (after program implementation). Interventions.Implementation of a collaborative quality improvement program using multifaceted interventions (staff education, opinion leaders, patient education, audit, and feedback) to improve pain management at hospital level. Outcome Measures.Patient-reported pain experience, pain management, and overall hospital experience based on the Picker Patient Experience questionnaire, perceived health (SF-36 Health survey). Results.After implementation of the program only 2.3% of the patients reported having no pain relief during their hospital stay (vs 4.5% in 2001, P = 0.05). Among nonsurgical patients, improvements were observed for pain assessment (42.3% vs 27.9% of the patients had pain intensity measured with a visual analog scale, P = 0.012), pain management (staff did everything they could to help in 78.9% vs 67.9% of cases P = 0.003), and pain relief (70.4% vs 57.3% of patients reported full pain relief P = 0.008). In surgical patients, pain assessment also improved (53.7.3% vs 37.6%) as well as pain treatment. More patients received treatments to relieve pain regularly or intermittently after program implementation (95.1% vs 91.9% P = 0.046). Conclusion.Implementation of a collaborative quality improvement program at hospital level improved both pain management and pain relief in patients. Further studies are needed to determine the overall cost-effectiveness of such programs.

Quantitative Guidelines for Thin Maintenance Surfaces, TR-435, 2003

What follows are the refined guidelines from the Thin Maintenance Surface: Phase II Report. For that report, test sections were created and monitored along with some existing test sections. From the monitoring and evaluation of these test sections, literature reviews, and the experience and knowledge of the authors, the following guidelines were created. More information about thin maintenance surfaces and their uses can be found in the above-mentioned report.

Teatterivaellus : elämyspedagoginen lähestymistapa näyttelijäntyöhön

Toiminta ja fyysisyys ovat näyttelijäntyön tukipilarit. Niiden kautta syntyy ajatus, läsnäolo, kontakti ja tarjoaminen. Ne ovat työn perusta. Näyttelijän tehtävänä on tehdä tarjouksia vastanäyttelijälle ja ohjaajalle sekä ottaa tarjouksia vastaan. Näytelmät ja roolit vaihtuvat. On tärkeää, että myös näyttelijä vaihtaa omaa lähestymistapaansa aina tehtävän mukaan. Tällöin on mahdollisuus uudistua ja kehittyä ammatissaan. Tässä opinnäytetyössä tutkin vaellusta näyttelijäntyön lähestymistapana. Tutkielmani pääkysymys on, kuinka vaeltaen löydetty näyttelijäilmaisu pystytään siirtämään näyttämöllä tapahtuvaan kohtaukseen? Alakysymyksinä selvitin mitä menetelmiä teatterivaellus tarjoaa näyttelijäntyöhön, miten teatterivaellus toimii elämyspedagogisesti ja kuinka luonnon esteettinen kokemus siirtyy näyttämön estetiikkaan. Tein tutkielmani hankkeistettuna toimintatutkimuksena Pohjois-Karjalan Opiston teatterilinjalla keväällä 2005. Olen opettanut teatterivaellusta vuodesta 1999 lähtien. Tutkielmaani sisältyvänä käytännön projektina ohjasin linjan pääteoksen, Coline Serreaun näytelmän Kani Kani. Käytännössä tuo tutkiminen tapahtui siten, että yksittäistä kohtausta ja jopa yksittäistä repliikkiä harjoiteltiin ensin ulkona erilaisissa maaston kohdissa hakien parasta maastoa ja toimintaa tekstin ajatuksen ja sisällön tuottamiselle; sellaista fyysistä vastusta ja väsymyksen tilaa, jolloin näyttelemisen este olisi mahdollisimman pieni. Löydetty ilmaisu pyrittiin paikallistamaan niin fyysisesti kehoon kuin ajatteluunkin. Tämän ulkoharjoituksen jälkeen tultiin sisälle harjoittelemaan samoja kohtauksia, pyrkien säilyttämään tuo ulkona löydetty ilmaisu. Harjoiteltiin ja tehtiin muistiinpanoja työpäiväkirjoihin. Tutkimusmenetelminä olivat kyselyt oppilailta ja omat päiväkirjamuistiinpanot. Tutkielmani yhteenvetona totean, että ulkoa löydetyn ilmaisun siirrossa onnistuttiin silloin, kun toiminta tai tapahtuma siirtyi ulkoa sellaisenaan, samankaltaisina tekoina sisälle; tai silloin kun näyttämöllä käytettiin samankaltaista liikettä ja esineistöä kuin maastossa. Teatterivaellus toi mukanaan koko esityksen estetiikan, tavan olla ja esittää. Itselleni tämä tutkielma antoi varmuuden siitä, että teatterivaellus on oikeasti yksi mahdollinen tapa lähestyä näyttelijäntyötä ja esityksen ohjaamista.

Educational resources offered by the European Board of Physical and Rehabilitation Medicine (EBPRM)

Background .- Physical and Rehabilitation Medicine (PRM) is a very demanding medical speciality. To ensure high standard of research and care in PRM all across Europe, it is crucial to attract gifted trainees and offer them high quality education. At undergraduate level, many medical schools in Europe omit to offer teaching on disabled persons and on basic PRM knowledge. Thus PRM is hardly known to medical students. For postgraduate trainees access to evidence-based knowledge as well as teaching of research methodology specific to PRM, rehabilitation methodology, disability management and team building also need to be strengthened to increase the visibility of PRM. Action .- To address these issues the EBPRM proposes presently a specific undergraduate curriculum in PRM including the issues of disability, participation and handicap as a basis for general medical practice and postgraduate rehabilitation training. For PRM trainees many educational documents are now available on the EBPRM website. A growing number of educational sessions for PRM trainees take place during international and national PRM Congresses which can be accessed at low cost. Educational papers published regularly in European rehabilitation journals and European PRM Schools are offered free or at very low cost to trainees.

El desarrollo personal y profesional mediante el aprendizaje reflexivo : una experiencia en el grado de Educación Social

In the last years, an increase of the interest to develop educational practices in higher education, based on the approach of the reflective learning, is observed. Nevertheless, we scarcely find in our context researches or experiences that allow knowing students’ perceptions about this teaching and learning approach. We have developed an experience in the bachelor of Social Education at the University of Girona with the aim to contribute to the personal and professional development of future social educators in their initial training, using reflective learning methodology. In this article we present an evaluation of the experience based on students’ perceptions. They assessed the usefulness they think the module has for their training, the methodology and the activities. This evaluation has been carried out through in-depth interviews to 17 students who participated in the module in 2010-11 academic year. The results show that students assess positively the experience, either its general usefulness or the methodology of reflective learning, although they acknowledge some difficulties to carry out such a process which involves a high degree of introspection and a difficulty to set the boundaries in the narration of personal questions. The study also shows some challenges related on the need, but also the difficulty, to include personal and professional development as a powerful axis in the higher education curriculum, as well as elements linked to reflective learning assessment