The Egyptian Cardiothoracic Surgeon (ECTS - E-Journal)
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Distance teacher preparation
No full textThis article explores the nature and development of distance teacher preparation in the field of TESOL. It explores the origins of the practice and links it to general distance development. It uses two frames: a general TESOL frame offered by Freeman and Johnson, which includes the domains of teacher–learner, the social context, and the pedagogical process and places this alongside the work of Moore's domains of distance education: technology, pedagogy, organization, and policy. It shows where we are today and gives advice for the practitioner
Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus
No full textBackground: Foot wounds in people with diabetes mellitus (DM) are a common and serious global health issue. People with DM are prone to developing foot ulcers and, if these do not heal, they may also undergo foot amputation surgery resulting in postoperative wounds. Negative pressure wound therapy (NPWT) is a technology that is currently used widely in wound care. NPWT involves the application of a wound dressing attached to a vacuum suction machine. A carefully controlled negative pressure (or vacuum) sucks wound and tissue fluid away from the treated area into a canister. A clear and current overview of current evidence is required to facilitate decision-making regarding its use. Objectives: To assess the effects of negative pressure wound therapy compared with standard care or other therapies in the treatment of foot wounds in people with DM in any care setting. Search methods: In January 2018, for this first update of this review, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We identified six additional studies for inclusion in the review. Selection criteria: Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of any brand of NPWT in the treatment of foot wounds in people with DM, irrespective of date or language of publication. Particular effort was made to identify unpublished studies. Data collection and analysis: Two review authors independently performed study selection, risk of bias assessment and data extraction. Initial disagreements were resolved by discussion, or by including a third review author when necessary. We presented and analysed data separately for foot ulcers and postoperative wounds. Main results: Eleven RCTs (972 participants) met the inclusion criteria. Study sample sizes ranged from 15 to 341 participants. One study had three arms, which were all included in the review. The remaining 10 studies had two arms. Two studies focused on postamputation wounds and all other studies included foot ulcers in people with DM. Ten studies compared NPWT with dressings; and one study compared NPWT delivered at 75 mmHg with NPWT delivered at 125 mmHg. Our primary outcome measures were the number of wounds healed and time to wound healing. NPWT compared with dressings for postoperative wounds Two studies (292 participants) compared NPWT with moist wound dressings in postoperative wounds (postamputation wounds). Only one study specified a follow-up time, which was 16 weeks. This study (162 participants) reported an increased number of healed wounds in the NPWT group compared with the dressings group (risk ratio (RR) 1.44, 95% confidence interval (CI) 1.03 to 2.01; low-certainty evidence, downgraded for risk of bias and imprecision). This study also reported that median time to healing was 21 days shorter with NPWT compared with moist dressings (hazard ratio (HR) calculated by review authors 1.91, 95% CI 1.21 to 2.99; low-certainty evidence, downgraded for risk of bias and imprecision). Data from the two studies suggest that it is uncertain whether there is a difference between groups in amputation risk (RR 0.38, 95% CI 0.14 to 1.02; 292 participants; very low-certainty evidence, downgraded once for risk of bias and twice for imprecision). NPWT compared with dressings for foot ulcers There were eight studies (640 participants) in this analysis and follow-up times varied between studies. Six studies (513 participants) reported the proportion of wounds healed and data could be pooled for five studies. Pooled data (486 participants) suggest that NPWT may increase the number of healed wounds compared with dressings (RR 1.40, 95% CI 1.14 to 1.72; I2 = 0%; low-certainty evidence, downgraded once for risk of bias and once for imprecision). Three studies assessed time to healing, but only one study reported usable data. This study reported that NPWT reduced the time to healing compared with dressings (hazard ratio (HR) calculated by review authors 1.82, 95% CI 1.27 to 2.60; 341 participants; low-certainty evidence, downgraded once for risk of bias and once for imprecision). Data from three studies (441 participants) suggest that people allocated to NPWT may be at reduced risk of amputation compared with people allocated to dressings (RR 0.33, 95% CI 0.15 to 0.70; I2 = 0%; low-certainty evidence; downgraded once for risk of bias and once for imprecision). Low-pressure compared with high-pressure NPWT for foot ulcers One study (40 participants) compared NPWT 75 mmHg and NPWT 125 mmHg. Follow-up time was four weeks. There were no data on primary outcomes. There was no clear difference in the number of wounds closed or covered with surgery between groups (RR 0.83, 95% CI 0.47 to 1.47; very low-certainty evidence, downgraded once for risk of bias and twice for serious imprecision) and adverse events (RR 1.50, 95% CI 0.28 to 8.04; very low-certainty evidence, downgraded once for risk of bias and twice for serious imprecision). Authors' conclusions: There is low-certainty evidence to suggest that NPWT, when compared with wound dressings, may increase the proportion of wounds healed and reduce the time to healing for postoperative foot wounds and ulcers of the foot in people with DM. For the comparisons of different pressures of NPWT for treating foot ulcers in people with DM, it is uncertain whether there is a difference in the number of wounds closed or covered with surgery, and adverse events. None of the included studies provided evidence on time to closure or coverage surgery, health-related quality of life or cost-effectiveness. The limitations in current RCT evidence suggest that further trials are required to reduce uncertainty around decision-making regarding the use of NPWT to treat foot wounds in people with DM.</p
Outcome Prediction After Open Heart Surgery
Full text linkoai:oai.journals.escts.net:article/6Abstract:
Background: Mortality is the most commonly used outcome measure after cardiac surgery. Various risk scores were developed to predict mortality after cardiac surgery with many differences among these scores. We evaluated the accuracy of Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score and Cardiac Surgery Score (CASUS) in predicting mortality in our patient population.
Methods: Between October 2015 and December 2017, 103 adult patients who underwent open heart surgery were evaluated. The clinical characteristics, outcomes and risk scores data of the patients were collected. Accuracy of the scores was assessed using receiver operating curve (ROC) and the multivariate logistic regression analysis.
Results: 103 patients were enrolled with mortality rate of 10.3%. The non-survivors group showed statistically significant lower E.F, higher platelet count, higher bilirubin level and lower Po2 level (P value: 0.015, 0.020, 0.038, 0.006) respectively. Both APACHE II and SOFA scores performed better than CASUS score in predicting mortality in this study. However, APACHE II score (Area Under Curve “AUC”:0.878, sensitivity: 80%, specificity: 78.5%) and the preoperative platelet count independently predicted mortality after cardiac surgery.
Conclusion: Both APACHE II and SOFA scores showed a high power in predicting mortality after cardiac surgery but APACHE II score rises as the best tool for risk stratification in our patient population.
Keywords: Mortality; Cardiac surgery; Risk scores
Discordant Notes:Marginality and Social Control in Madrid, 1850-1930
No full textScholarship on urban culture and the senses has traditionally focused on the study of literature and the visual arts. Recent decades have seen a surge of interest on the effects of sound the urban space and its population. These studies analyse how sound generates identities that are often fragmentary and mutually conflicting. They also explore the ways in which sound triggers campaigns against the negative effects of noise on the nerves and health of the population. Little research has been carried out about the impact of sound and music in areas of broader social and political concern such as social aid, hygiene and social control. Based on a detailed study of Madrid from the 1850s to the 1930s, Discordant Notes argues that sound and music have played a key role in structuring the transition to modernity by helping to negotiate social attitudes and legal responses to problems such as poverty, insalubrity, and crime. Attempts to control the social groups that own unwanted musical practices such as organ grinding and flamenco performances in taverns raised awareness about public hygiene, alcoholism and crime, and triggered legal reform in these areas. In addition to scapegoating, marginalising and persecuting these musical practices, the authorities and the media used workhouse bands as instruments of social control to spread "aural hygiene" across the city
What factors are associated with the prevalence of atopic symptoms amongst adolescents in Greater Manchester?
No full textINTRODUCTION: Atopy commonly manifests itself as atopic diseases (ADs), namely asthma, eczema and hay fever. The prevalence of AD is rising worldwide, and it is widely accepted as a major public health issue, due to the significant burden of AD on health care systems. METHOD: Data were obtained from the youth survey of the European Urban Health Indicator System 2 project. The study participants were students aged 14-16 years from Greater Manchester. The main outcomes measured were the prevalence of atopic symptoms and the factors associated with the development of atopy. RESULTS: Of the sample studied, 70% reported having had an AD during their lifetime. The lifetime prevalence of ever having asthma, eczema or hay fever was 33.4%, 28.1% and 49.0%, respectively. Gender, family affluence, body mass index, diet, smoking and worrying were all significantly associated with atopic symptoms. Smoking was the only variable to be significantly associated with all three ADs. Season of birth and pollution were not shown to be associated with atopic symptoms. CONCLUSION: This study demonstrates that the prevalence of AD in Greater Manchester was high amongst adolescents. Several environmental, demographic and social factors were found to be significantly associated with the development of atopic symptoms. This study provides a baseline for future studies to further investigate the factors that are associated with AD and allow for the implementation of preventative public health policy
Quaternary glaciations
No full textThe Quaternary is synonymous with extensive glaciation of Earth's mid- and high latitudes. Although there were local precursors, significant glaciation began in the Oligocene in eastern Antarctica. It was followed by glaciation in mountain areas through the Miocene (in Alaska, Greenland, Iceland, and Patagonia), later in the Pliocene (e.g., in the Alps, the Bolivian Andes, and possibly in Tasmania), and in the earliest Pleistocene (New Zealand, Iceland, and Greenland). Today, evidence from both the land and the ocean floors demonstrates that the major continental glaciations, outside the polar regions, rather than occurring throughout the 2.6 Ma of the Quaternary, were markedly restricted to the last 1 Ma–800 Ka or less. Marine Isotope Stage (MIS) 22 (ca. 870–880 Ma) included the first of the “major” worldwide events with substantial ice volumes that typify the later Pleistocene glaciations (i.e., MIS 16, 12, 10, 6, 4–2)
A longitudinal study of the relationship between dental caries and obesity in late childhood and adolescence
No full textOBJECTIVES: To determine whether caries experience in late childhood (aged 7-9 years) was predictive of adolescent obesity (ages 12-16 years) to inform the use of a common risk factor approach (CRFA) for prevention.METHODS: A cohort study was conducted in an area of North West England. Clinical assessment of caries took place using the same methodology at ages 7-9 years and 12-16 years. Body mass index (BMI) category was calculated from height and weight measurements using age and gender specific cut-offs at 12-16 years only. The association between dependent variable (BMI category dichotomized as underweight/normal and overweight/obese) and explanatory variables (baseline and follow-up dental caries and sociodemographic status) adjusted for age, was assessed.RESULTS: At baseline, 5,470 (96.8 percent) participants took part and information was available for 2,958 (54.1 percent) participants at follow-up. Univariate analysis indicated that BMI category in adolescence was not shown to be significantly associated with: the presence or absence of caries in late childhood (P = 0.61); in adolescence (P = 0.06); gender (P = 0.91); or deprivation (P = 0.35). Multivariate logistic regression indicated that BMI category in adolescence was not predicted by caries in late childhood or adolescence, after adjusting for sociodemographic variables.CONCLUSION: Caries and obesity were highly prevalent in this population. Caries in childhood was not shown to be associated with obesity in adolescence and there was no cross-sectional association between the two diseases in adolescence. A CRFA is not precluded, however, the results suggest that additional interventions, specific for each disease, are required to prevent obesity and caries.</p
Fully analytical integration over the 3D volume bounded by the β sphere in topological atoms
No full textAtomic multipole moments associated with a spherical volume fully residing within a topological atom (i.e. the β sphere) can be obtained analytically. Such an integration is thus free of quadrature grids. A general formula for an arbitrary rank spherical harmonic multipole moment is derived, for an electron densitycomprising Gaussian primitives of arbitrary angular momentum. The closed expressions derived here are also sufficient to calculate the electrostatic potential, the two types of kinetic energy, as well as the potential energy between atoms. Some integrals have not been solved explicitly before but through recursion and substitution are broken down to more elementary listed integrals. The proposed method is based on a central formula that shifts Gaussian primitives from one centre to another, which can be derived from the well-known plane-wave expansion (or Rayleigh equation)
Do marketing and alcohol treatment/ public health experts think televised alcohol advertisements abide by regulatory guidelines?
No full textTelevised alcohol advertisements in the UK must abide by the BCAP Code, which provides guidelines concerning advertisements not implying, condoning or encouraging immoderate, irresponsible or anti-social drinking. Previously, 75% of 373 general public respondents shown one of seven advertisements rated a breach of at least one guideline. The present study assessed whether experts in marketing (n=25) and alcohol treatment/ public health (n=25) perceived the same seven television alcohol advertisements as complying with the BCAP Code. Overall, 83% of advertisements were rated as breaching at least one guideline. This provides further proof that self-regulatory alcohol guidelines are not fit for purpose