Improving and maintaining cooperation are fundamental issues for any project to be time-persistent, and sanctioning free riders may be the most applied method to achieve it. However, the application ...of sanctions differs from one group (project or institution) to another. We propose an optional, public good game model where a randomly selected set of the free riders is punished. To this end, we introduce a parameter that establishes the portion of free riders sanctioned with the purpose to control the population state evolution in the game. This parameter modifies the phase portrait of the system, and we show that, when the parameter surpasses a threshold, the full cooperation equilibrium point becomes a stable global attractor. Hence, we demonstrate that the fractional approach improves cooperation while reducing the sanctioning cost.
This article presents an argument for re-reading Jean Baudrillard's ideas considering their potential contribution to the sociology of higher education, particularly in relation to contemporary ...debates about 'world-class' universities. In order to apply Baudrillard's ideas, China's commitment to the development of 'world-class' universities is presented as a case study. Radical thinking, as understood by Baudrillard, relies on ambivalence and fascination - instead of critique - and seeks to push a logic to its limits rather than opposing it. Critiques of world-class universities have not stopped the totalizing effects of rankings and world-class status seeking; on the contrary, these phenomena and their effects continue to accelerate. A non-deterministic approach to thinking is set into motion around the paroxystic state that prevails in the pursuit of 'world-class' status among contemporary higher education systems.
Metformin is the broadly accepted the first-line medication for diabetes. Its use, however, is limited by gastrointestinal side effects present in approximately 25% of patients. This study aimed to ...better understand the interplay between metformin intolerance and gut microbiota among Black individuals with diabetes.
We performed a cross-sectional study among 29 Black individuals living with diabetes with or without metformin intolerance. Participants with mean age 59±11, 58% female, were stratified into three groups: 1)intolerant: metformin intolerance in the past, not on metformin; 2)partially intolerant: mild to moderate gastrointestinal symptoms, currently taking metformin 3)tolerant: using metformin without symptoms. We collected and analyzed rectal swabs and analyzed microbiota composition using V3–V4 regions of the 16s rRNA.
Metformin intolerant subjects trended towards having greatest alpha diversity, followed by tolerant and partially tolerant (Intolerant:4.9; Tolerant:4.2; Partially tolerant:3.9). Mean difference in alpha diversity for intolerant versus partially tolerant was 1.0 (95% CI-0.1,2.1) and intolerant versus tolerant were 0.7 (95% CI -0.4,1.8).
This was the first study to evaluate the role of microbiota and metformin intolerance among Black individuals. We report on differences in alpha diversity as well as microbiota composition.
•Metformin is the most used antidiabetic medication globally with a favorable safety and efficacy profile.•Metformin use is limited in patients who develop intolerance with gastrointestinal side effects.•We explored the gut microbiome patterns of Black individuals with and without metformin intolerance.•Individuals with partial tolerance (on therapy experiencing symptoms) tended to have the lowest gut microbiota diversity.•People taking metformin had lower microbial diversity than those not on metformin.
Amidst global competition in higher education, colleges and universities adopt strategies that mimic and adapt business practices. Branding is now a widespread practice in higher education; ...multimodal advertisement is a manifestation of emerging branding strategies for universities. While the visibility of brands in higher education has grown substantially in recent years, its empirical study has lagged. This article reports on the findings from a study that employed social semiotic and multimodal analysis to explore text and visual rhetoric as brand construction strategies in publicly displayed university advertisements. After analyzing photographs representing advertising campaigns from 16 different universities displayed in an urban public transportation system, I suggest that universities construct their brand identity through messages that emphasize multiple choices and convenience, but construct success primarily according to corporate standards and values.
Accidental ingestion of caustics in pediatrics continues to be a frequent problem that can lead to severe injuries and permanent sequelae that require esophageal rehabilitation programs. This study ...aimed to describe the medical care experience of children who ingested caustic substances in a tertiary hospital in Mexico City.
We conducted a descriptive and analytical study. We described age, sex, type of caustics, clinical and endoscopic findings, and the radiological evolution of 284 patients who arrived during the acute phase.
The records of 336 children with a history of caustic ingestion were reviewed. The median age was 1.7 years, and the predominant sex was male. Caustic soda was the most accidentally ingested substance. We found an association between the severity of the esophageal injury with the presence of more than four symptoms at diagnosis (χ², p < 0.001) and with the finding of oral lesions, sialorrhea, and vomiting (χ², p < 0.05). Forty percent (n = 114) showed normal gastrointestinal endoscopy.
In children with caustic ingestion, upper gastrointestinal endoscopy should be performed within 72 hours to evaluate the extent of the lesions. In this study, we found that more than four symptoms at admission, and oral lesions, sialorrhea, and vomiting are associated with the severity of the esophageal injury.
In this article, we explore commodities and consumption, two concepts that are central to critiques of the neoliberal university. By engaging with these concepts, we explore the limits of neoliberal ...logic. We ground this conceptual entanglement in Marxist and post-Marxist traditions given our understanding of neoliberalism both as an extension of and as a meaningfully different form of capitalism. As colleges and universities enact neoliberal economic assumptions by focusing on revenue generation, understanding students as customers, and construing their faculty as temporary service providers, the terms commodity and consumption have become commonplace in critical higher education literature. When critiques concerning the commodification and consumption of higher education are connected with these theoretical and conceptual foundations, they not only become more effective but also provide a more meaningful guide upon which current and future scholars can build.
The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate.
We performed a prospective nationwide study including a consecutive cohort of ...liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe COVID-19 among hospitalised patients were analysed using multivariate Cox regression.
A total of 111 liver transplant patients were diagnosed with COVID-19 (SIR = 191.2 95% CI 190.3–192.2). The epidemiological curve and geographic distribution overlapped widely between the liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. A total of 12 patients were admitted to the ICU (10.8%). The mortality rate was 18%, which was lower than in the matched general population (SMR = 95.5 95% CI 94.2–96.8). Overall, 35 patients (31.5%) met criteria of severe COVID-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe COVID-19 (relative risk = 3.94; 95% CI 1.59–9.74; p = 0.003), particularly at doses higher than 1,000 mg/day (p = 0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit.
Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring COVID-19 but their mortality rates are lower than the matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe COVID-19. However, complete immunosuppression withdrawal should be discouraged.
In liver transplant patients, chronic immunosuppression increases the risk of acquiring COVID-19 but it could reduce disease severity. Complete immunosuppression withdrawal may not be justified. However, mycophenolate withdrawal or temporary conversion to calcineurin inhibitors or everolimus until disease resolution could be beneficial in hospitalised patients.
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•The incidence of coronavirus disease 2019 (COVID-19) is higher in liver transplant patients.•Mortality rates are lower than those observed in the matched general population.•Immunosuppression withdrawal may not be justified.•Mycophenolate may increase the risk of severe COVID-19 in a dose-dependent manner.•Calcineurin inhibitors and everolimus are not deleterious for COVID-19.
Social media sites and other contemporary technologies open the possibility for the construction of online identities that are loosely connected to physical bodies; this construction allows ...individuals to edit their identities constantly, in a continuous process of self-recreation. In parallel, universities utilise printed and electronic media to present themselves in the best light possible through the process of branding, which - it is argued here - constitutes an instance of hyper-real identity assemblage. This article explores the ethical implications of researching brand construction in university advertisements. The authors reflect upon the ethical implications of conducting educational research on university identities when such identities rely on the representations of racially minoritised students. Online identity construction through technology invites a discussion of postmodern notions of self and reality; this article presents an exploration of a postmodern ethics for educational research.
Background
Surgical hemostasis has become one of the key principles in the advancement of surgery. Hemostatic agents are commonly administered in many surgical specialties, although the lack of ...consensus on the definition of intraoperative bleeding or of a standardized system for its classification means that often the most suitable agent is not selected. The recommendations of international organizations highlight the need for a bleeding severity scale, validated in clinical studies, that would allow the selection of the best hemostatic agent in each case. The primary objective of this study is to evaluate the VIBe scale (Validated Intraoperative Bleeding Scale) in humans. Secondary objectives are to evaluate the scale's usefulness in liver surgery; to determine the relationship between the extent of bleeding and the hemostatic agent used; and to assess the relationship between the grade of bleeding and postoperative complications.
Methods
Prospective multicenter observational study including 259 liver resections that meet the inclusion criteria: patients scheduled for liver surgery at one of 10 medium-high volume Spanish HPB centers using an open or minimally invasive approach (robotic/laparoscopic/hybrid), regardless of diagnosis, ASA score <4, age ≥18, and who provide signed informed consent during the study period (September 2023 until the required sample size has been recruited). The participating researchers will be responsible for collecting the data and for reporting them to the study coordinators.
Discussion
This study will allow us to evaluate the VIBe scale for intraoperative bleeding in humans, with a view to its subsequent incorporation in daily clinical practice.
Clinical Trial Registration
https://clinicaltrials.gov/ct2/show/NCT05369988?term = serradilla&draw = 2&rank = 3
, NCT0536998.
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