14 research outputs found
Evaluation of a modified reynolds stress model for turbulent dispersed two-phase flows including two-way coupling
No full textApplied Science
Free serum cortisol during the postoperative acute phase response determined by equilibrium dialysis liquid chromatography-tandem mass spectrometry
No full textIn severely ill patients low concentrations of the corticosteroid binding globulin are typically found; the aim of this study was to quantify directly free bioactive cortisol concentrations in the sera of postoperative cardiosurgical patients. Serum samples of 12 consecutive patients undergoing aortocoronary bypass surgery taken preoperatively and on the postoperative days 1 to 4 were analyzed. Total serum cortisol was quantified using liquid chromatographytandem mass spectrometry with an online sample extraction system and trideuterated cortisol as the internal standard, and free serum cortisol was measured after overnight equilibrium dialysis. Whereas on the first postoperative day, the median total serum cortisol concentration was approximately twofold increased compared to preoperative samples (preoperatively, 245 nmol/l (interquartile range (IQR) 203293 nmol/l); first postoperative day, 512 nmol/l (IQR 410611 nmol/l)), median dialyzable free cortisol concentration was almost sevenfold increased (preoperatively, 14.2 nmol/l (IQR 10.920.7 nmol/l); first postoperative day, 98.3 nmol/l (IQR 81.3134 nmol/l)). On the fourth postoperative day, median free cortisol was still significantly increased compared to baseline sampling (p < 0.05), whereas median total cortisol was not. A median of 5.7% (IQR 5.47.0%) of total cortisol was found as free cortisol on the preoperative day, 21.2% (IQR 18.9 23.5%) on the first postoperative day and 10.5% (IQR 9.814.0%) on the fourth postoperative day. It is concluded that during the postoperative period the freeto bound ratio of cortisol is highly variable and that during the acute phase response direct quantification of free bioactive cortisol concentrations seems to be biologically more appropriate than the measurement of total cortisol concentrations
Disfunção cardíaca na sepse experimental avaliada em coração isolado e perfundido de camundongo
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências Biológicas, Programa de Pós-Graduação em Farmacologia, Florianópolis, 2010A síndrome da resposta inflamatória sistêmica (SIRS), quando associada a uma infecção pode evoluir para sepse e choque séptico, que são importantes causas de morte nas UTIs. Em geral, a morte é causada por um colapso cardiovascular e hipotensão refratária, que aparecem logo no início da sepse. A disfunção vascular é mais estudada e compreendida que a disfunção cardíaca, contudo a última é reconhecida como um importante mediador da disfunção de múltiplos órgãos na sepse. O objetivo do presente trabalho foi caracterizar a disfunção cardíaca na sepse experimental induzida pela ligadura e perfuração do ceco (CLP) em camundongos, utilizando a metodologia de coração isolado e perfundido (preparação de Langendorff), e também, avaliar a participação do óxido nítrico nesse processo. Os parâmetros cardíacos avaliados foram: Tensão sistólica e diastólica, +dT/dt (velocidade de contração), -dT/dt (velocidade de relaxamento), AUC (área sob a curva), pressão de perfusão das coronárias e frequência cardíaca. Observamos que durante a sepse severa (índice de mortalidade de 100% quarenta e oito horas após a CLP) o perfil de atividade apresentado pelos corações sépticos, apesar de variado, mostra que a sepse causa importantes alterações na funcionalidade cardíaca. O parâmetro tensão sistólica, três horas após os animais serem submetidos à CLP, mostrou que 38% dos corações apresentaram valores superiores aos apresentados pelos corações controle (e por isso denominados de suprafuncionais), 12% apresentaram valores inferiores (subfuncionais) e 50% apresentaram valores semelhantes aos apresentados pelos corações controle (normofuncionais). Seis horas após a CLP o subgrupo suprafuncional correspondeu a apenas 21% do total de corações avaliados, enquanto o subgrupo subfuncional correspondeu a 29%. Doze horas após a CLP o subgrupo normofuncional foi o mais numeroso, correspondendo a 77% do total de corações avaliados. Por fim, vinte e quatro horas após a CLP houve um aumento substancial no número de corações subfuncionais, representando 40% dos corações avaliados. Perfil semelhante foi encontrado em relação aos parâmetros velocidade de contração, velocidade de relaxamento e AUC. Quando estimulados com isoprenalina para avaliação da capacidade contrátil e capacidade cronotrópica positiva, os corações dos animais submetidos à CLP vinte e quatro horas antes apresentaram importante redução no funcionamento das células auto-rítmicas do nodo sino-atrial, alterações no sistema de condução dos estímulos e ainda, o sistema contrátil destes corações encontrou-se parcialmente reduzido. Tanto os corações suprafuncionais avaliados três horas após a CLP quanto os corações suprafuncionais avaliados vinte e quatro horas após, apresentaram tensão sistólica superior à apresentada pelos corações controle em resposta à isoprenalina. A resposta cronotrópica e inotrópica positiva dos demais corações avaliados (subfuncionais três horas após a CLP, normofuncionais três e vinte e quatro horas após a CLP) foi semelhante à resposta apresentada pelos corações controle, sugerindo que a atividade beta-adrenérgica, atividade contrátil e o aspecto elétrico da frequência cardíaca estão preservados nestes corações. Observamos ainda que os níveis plasmáticos de NOx encontram-se elevados a partir de três horas após o procedimento cirúrgico, permanecendo assim até pelo menos quarenta e oito horas após a CLP. A infusão de um inibidor não-seletivo das enzimas NOS (L-NAME) não alterou a atividade basal dos corações controle e dos corações sépticos avaliados vinte e quatro horas após a CLP. Por outro lado, quando estimulados com isoprenalina, os corações controle infundidos com L-NAME apresentaram resposta cronotrópica e inotrópica positiva inferior à apresentada pelos corações controle que receberam apenas Krebs. Os corações sépticos que receberam L-NAME quando estimulados com isoprenalina apresentaram resposta concentração-dependente à isoprenalina, tanto no parâmetro tensão sistólica quanto no parâmetro frequência cardíaca, efeito este que não foi observado nos corações sépticos que receberam apenas Krebs. O substrato L-arginina não é um fator limitante para a produção de óxido nítrico, visto que não foram observadas diferenças em corações controle e corações sépticos avaliados vinte e quatro horas após a CLP e que tiveram arginina adicionada à solução de perfusão. Assim, nosso trabalho mostra que ocorrem importantes alterações cardíacas durante a sepse, as quais acometem tanto a maquinaria contrátil quanto as células auto-rítmicas, tendo início logo nas primeiras horas de instalação do quadro e perdurando até horários mais tardios. Demonstramos ainda, que o óxido nítrico parece estar envolvido nas alterações observadas
Large health disparities in cardiovascular death in men and women, by ethnicity and socioeconomic status in an urban based population cohort
No full textBackground: Socioeconomic status and ethnicity are not incorporated as predictors in country-level cardiovascular risk charts on mainland Europe. The aim of this study was to quantify the sex-specific cardiovascular death rates stratified by ethnicity and socioeconomic factors in an urban population in a universal healthcare system. Methods: Age-standardized death rates (ASDR) were estimated in a dynamic population, aged 45–75 in the city of The Hague, the Netherlands, over the period 2007–2018, using data of Statistics Netherlands. Results were stratified by sex, ethnicity (country of birth) and socioeconomic status (prosperity) and compared with a European cut-off for high-risk countries (ASDR men 225/100,000 and women 175/100,000). Findings: In total, 3073 CVD deaths occurred during 1·76 million person years follow-up. Estimated ASDRs (selected countries of birth) ranged from 126 (95%CI 89–174) in Moroccan men to 379 (95%CI 272–518) in Antillean men, and from 86 (95%CI 50–138) in Moroccan women to 170 (95%CI 142–202) in Surinamese women. ASDRs in the highest and lowest prosperity quintiles were 94 (95%CI 90–98) and 343 (95%CI 334–351) for men, and 43 (95%CI 41–46) and 140 (95%CI 135–145), for women, respectively. Interpretation: In a diverse urban population, large health disparities in cardiovascular ASDRs exists across ethnic and socioeconomic subgroups. Identifying these high-risk subgroups followed by targeted preventive efforts, might provide a basis for improving cardiovascular health equity within communities. Instead of classifying countries as high-risk or low-risk, a shift towards focusing on these subgroups within countries might be needed. Funding: Leiden University Medical Center and Leiden Universit
Data Resource Profile: Extramural Leiden University Medical Center Academic Network (ELAN)
No full textEffect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: A patient-level meta-analysis of randomized trials
No full textpeer reviewedBackground: The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection. Methods: For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only. We used individual patient data from 11 trials that randomly assigned patients to receive antibiotics based on procalcitonin levels (the "procalcitonin-guided" group) or the current standard of care (the "controls"). The primary endpoint was mortality within 30 days. Secondary endpoints were duration of antibiotic treatment and length of stay. Results: Mortality in the 2252 procalcitonin-guided patients was significantly lower compared with the 2230 control group patients (21.1% vs 23.7%; adjusted odds ratio 0.89, 95% confidence interval (CI) 0.8 to 0.99; p = 0.03). These effects on mortality persisted in a subgroup of patients meeting the sepsis 3 definition and based on the severity of sepsis (assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score, occurrence of septic shock or renal failure, and need for vasopressor or ventilatory support) and on the type of infection (respiratory, urinary tract, abdominal, skin, or central nervous system), with interaction for each analysis being > 0.05. Procalcitonin guidance also facilitated earlier discontinuation of antibiotics, with a reduction in treatment duration (9.3 vs 10.4 days; adjusted coefficient -1.19 days, 95% CI -1.73 to -0.66; p < 0.001). Conclusion: Procalcitonin-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and lower antibiotic treatment duration. © 2018 The Author(s)
Thoracic outlet syndrome (TROTS) registry:A study protocol for the primary upper extremity deep venous thrombosis section
No full textIntroduction There is a lack of comprehensive and uniform data on primary upper extremity deep venous thrombosis (pUEDVT). pUEDVT includes venous thoracic outlet syndrome related upper extremity deep venous thrombosis (UEDVT) and idiopathic UEDVT. Research on these conditions has been hampered by their rarity, lack of uniform diagnostic criteria, and heterogeneity in therapeutic strategies. To improve current research data collection using input of all various pUEDVT treating medical specialists, we initiated the ThoRacic OuTlet Syndrome (TROTS) registry. The aim of the TROTS registry is to a) collect extensive data on all pUEDVT patients through a predefined protocol, b) give insight in the long term outcome using patient reported outcome measures, c) create guidance in the diagnostic and clinical management of these conditions, and thereby d) help provide content for future research. Methods and analysis The TROTS registry was designed as an international prospective longitudinal observational registry for data collection on pUEDVT patients. All pUEDVT patients, regardless of treatment received, can be included in the registry after informed consent is obtained. All relevant data regarding the initial presentation, diagnostics, treatment, and follow-up will be collected prospectively in an electronic case report form. In addition, a survey containing general questions, a Health-related Quality of Life questionnaire (EQ-5D-5L), and Functional Disability questionnaire (Quick-DASH) will be sent periodically (at the time of inclusion, one and two years after inclusion, and every five years after inclusion) to the participant. The registry protocol was approved by the Medical Ethical Review Board and registered in the Netherlands Trial Register under Trial-ID NL9680. The data generated by the registry will be used for future research on pUEDVT and published in peer reviewed journals. Conclusion TROTS registry data will be used to further establish the optimal management of pUEDVT and lay the foundation for future research and guidelines
Психологические аспекты дидактической коммуникации в контексте новой парадигмы образования
No full textThe paper explores students» reflexive ideas about such aspects of didactic communication with a teacher as space and time of educational interaction (temporal-topological aspect), educational content, organizational model of communication, means and methods of interaction (interactive aspect), individual-personal features of communicators, relevant for educational interaction. The author compares students» opinions about ideal educational communication and their real estimation. The research aims at theoretical and empirical modeling of the construct «didactic communication». Research methods are seen as follows: theoretical and empirical modeling of the construct «didactic communication». The author applied inventory Psychological structure of the educational communication and the Constructivist test. The research was carried out with the secondand third-year students of Tsiolkovski Kaluga State University (Pedagogical Faculty). The author highlights that there are conjugate (coherent) statements on the sample of students» opinions on the preferred parameters of didactic communication with the teacher. The most desirable characteristics are seen as spatial-temporal, content and individual-personal aspects arranged in compliance with students» expectations. In their subjective assessments of real learning interaction, the subjects most highly noted the group modus of didactic communication, which is fully confirmed by an external criterion: the student community is actually a communicative network, and their communications are not confined to the student, on the contrary, are more addressed to fellow students. At the same time to assessing the real interactions our probationers have pointed to the feeling of low contribution and estrangement in communicative process control. Deficient activity in the educational interactions is partially compensated with the activity in the non-formal student communication. Работа посвящена исследованию рефлексивных представлений обучаемого о таких аспектах дидактической коммуникации с обучающим, как пространство и время учебного взаимодействия (темпорально-топологический аспект), учебное содержание, организационная модель коммуникации, средства и приемы взаимодействия (интерактивный аспект), индивидуально-личностные особенности коммуникантов, актуальные для учебного взаимодействия. Цель исследования – теоретико-эмпирическое моделирование конструкта «дидактической коммуникации». Метод исследования: теоретико-эмпирическое моделирование конструкта «дидактической коммуникации». В ходе исследования сопоставлены представления обучаемых об оптимальной по их субъективным оценкам структуре дидактической коммуникации с теми оценками, которые испытуемые дали реальному учебному взаимодействию. Эмпирические данные получены на основе авторской методики «Психологическая структура дидактической коммуникации» и конструктивистского теста. В исследовании приняли участие студенты 2–3 курсов Института педагогики Калужского государственного университета имени К. Э. Циолковского. По итогам исследования можно констатировать довольно сопряженные (когерентные) по выборке обучаемых суждения относительно предпочитаемых параметров дидактической коммуникации с обучающим. А именно: триаду наиболее желательных характеристик составили выстроенные в соответствии с ожиданиями обучаемого пространственно-временные, содержательные и индивидуально-личностные аспекты. В своих субъективных оценках реального учебного взаимодействия испытуемые наиболее высоко отметили групповой модус дидактической коммуникации, что вполне подтверждается внешним критерием: сообщество обучаемых фактически представляет собой коммуникативную сеть, а их коммуникации не замыкаются на обучающем, напротив, в большей степени адресованы сокурсникам. В то же время, давая оценку реальному учебному взаимодействию, наши респонденты отметили ощущение низкой вовлеченности в процесс дидактической коммуникации на паритетной основе, чувство психологической отчужденности от контроля коммуникативного процесса, психологической трудности его критической рефлексии. Недостаточная психологическая вовлеченность обучаемых находит частичную компенсацию в активности неформальных сетей коммуникации.
At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods
No full textBy September 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Early recognition can help provide life-saving targeted anti-coagulation therapy right at admission. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Age, overall presence of symptoms, shortness of breath, and hypertension were found to be key predictors for PE using our extreme gradient boosted model. This analysis based on the, until now, largest global dataset for this set of problems can inform hospital prioritisation policy and guide long term clinical research and decision-making for COVID-19 patients globally. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients. © The Author(s) 2024
Digital platforms for enhancing english eearning: exploring the effectiveness of Canva and TikTok in Improving english oral communication, creativity, and collaborative learning
No full textEste informe explora la efectividad de las plataformas digitales, específicamente Canva y TikTok, para mejorar el aprendizaje del inglés entre estudiantes en contextos socioeconómicos vulnerables en Colombia. Se enfatiza la importancia del Aprendizaje Basado en Tareas (TBL) como una metodología que fomenta el aprendizaje colaborativo y la creatividad, permitiendo a los estudiantes mejorar sus habilidades de comunicación oral. La iniciativa "Bilingüismo para la Paz," lanzada por la Universidad de Córdoba, busca cerrar la brecha educativa que enfrentan los niños de las escuelas públicas en el aprendizaje del inglés. A través de una experiencia de prácticas en la Institución Educativa Ribera, el autor reflexiona sobre los desafíos y éxitos encontrados al implementar estrategias de enseñanza innovadoras. La narrativa destaca la importancia de la participación estudiantil, la retroalimentación y la creación de un ambiente de aprendizaje de apoyo, mostrando en última instancia el impacto transformador de la educación tanto en los estudiantes como en los educadores.This report explores the effectiveness of digital platforms, specifically Canva and TikTok, in enhancing English learning among students in vulnerable socioeconomic contexts in Colombia. It emphasizes the importance of Task-Based Learning (TBL) as a methodology that fosters collaborative learning and creativity, enabling students to improve their oral communication skills. The initiative, "Bilingualism for Peace," launched by the University of Córdoba, aims to bridge the educational gap faced by children from public schools in English learning. Through an internship experience at the Ribera Educational Institution, the author reflects on the challenges and successes encountered in implementing innovative teaching strategies. The narrative highlights the significance of student engagement, feedback, and the creation of a supportive learning environment, ultimately showcasing the transformative impact of education on both students and educators.Introduction ..........5Underlying Theories ..........72.1 ENGLISH AS A FOREIGN LANGUAGE ..........72.2 COLLABORATIVE LEARNING ..........82.3 TASK BASED LEARNING .........92.3.1 TASK-BASED LEARNING IN ENGLISH TEACHING. ..........92.3.2 TASK-BASED LEARNING IMPLEMENTATION ..........102.4 DIGITAL PLATFORM IN ENGLISH AS A FOREIGN LANGUAGE (EFL) TEACHING ..........102.5 CANVA ..........112.5.1 CANVA IN EDUCATION ..........122.6 TIKTOK ..........12Teaching Methods And Strategies ..........133.1 Duties Chart ..........16Gains ..........194.1 Duties Chart ..........24Conclusions ..........27Limitations ..........28REFERENCES ..........30APPENDIX. ..........32PregradoLicenciado(a) en Lenguas Extranjeras con Énfasis en InglésPasantía
