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•Thrombosis is a common complication in COVID-19 patients.•A new consideration of higher prophylactic doses has been recomended.•Therapeutic anticoagulation in COVID-19 patients seems ...to be asociated with lower death rates.•Compared with the standard dose group, higher doses had a higher frequency of bleeding.
Este estudio tiene como objetivo desarrollar, por medio de un entorno virtual, un espacio para la construcción de significados que se asocien con los conceptos básicos de estadística, como parte del ...proyecto de Comunidades de Aprendizaje Matemático de la Universidad de Costa Rica y los cursos libres que imparte. Para ello, desde el enfoque socio-epistemológico, se desarrollan las etapas de la ingeniería didáctica para implementar en un grupo de 30 estudiantes (entre 14 y 15 años) el ciclo de investigación estadística propuesto por (Wild y Pfannkuch, 1999). En los resultados se muestran dos organizaciones de prácticas asociadas al actuar del estudiantado cuando comprenden comportamientos de naturaleza estocástica. Además, esta investigación reporta el papel del cambio en la muestra estadística, para asegurar una representatividad de la población de estudio. Se concluye con algunas características de la práctica de inferencia y su relación con una forma de pensar ante comportamientos no deterministas.
Resumen: El asesoramiento psicoeducativo es un proceso que busca la mejora de las prácticas educativas y el desarrollo de la autonomía de los agentes educativos implicados. Este proceso se constituye ...como una conversación en la que los usos del lenguaje del asesor juegan un rol crítico. El artículo presenta una revisión de alcance de la evidencia científica publicada entre 2000 y 2020 en relación con los recursos discursivos del asesor, es decir, con sus usos del lenguaje en procesos de asesoramiento psicoeducativo, con el doble objetivo de mapear dicha evidencia e identificar algunas implicaciones prácticas que se derivan de ella. Los resultados se han organizado en torno a tres cuestiones: las posiciones comunicativas de asesores y asesorados en términos de control, los principales recursos discursivos que usan los asesores, y los efectos sobre el proceso de asesoramiento del uso de determinados recursos discursivos por parte de los asesores. La revisión ha permitido identificar una importante base de recursos y orientaciones para la práctica y revela que el área de estudio tiene un carácter plural a nivel conceptual y metodológico, y una naturaleza emergente y no consolidada.
Robust evidence exists regarding initiation, intensification or modification of treatments. Recommendations to de-escalate therapy are lacking, specifically in diabetes. A successful treatment ...de-intensification reduces overtreatment, polypharmacy, and risk of adverse effects.
To encompass current recommendations for deprescribing common drugs and create a consensus among health professionals.
We reviewed four databases for deprescribing approaches published between 2010 and 2022. Articles were divided into different groups of drugs (for uric-acid, hypoglycemic, lipid-lowering, and psychotropic drugs).
Hypoglycemic agents: strategies were limited to newer agents and insulin regimens for elderly individuals. Reducing insulin was associated with 1.1% reduction of A1c over time. SGLT2i and GLP-1RAs dose reduction depends on adverse events. Lipid-lowering agents: studies show that patients with very low cholesterol have fewer cardiovascular events without associated increased risk. Antihypertensive agents: Younger patients, lower systolic blood pressure, and few comorbidities are ideal characteristics for discontinuation. Uric acid therapy: we found no recommendation for dose de-escalation. Poor treatment adherence is associated with episodes of gout and deforming arthritis in the long term.
Deprescribing hypoglycemic, statins, antihypertensives, and urate-lowering agents may be feasible in selected patients, but periodic surveillance is important. More evidence is necessary to support this decision entirely.
Background. Although the mortality burden of the devastating 1918 influenza pandemic has been carefully quantified in the United States, Japan, and European countries, little is known about the ...pandemic experience elsewhere. Here, we compiled extensive archival records to quantify the pandemic mortality patterns in 2 Mexican cities, Mexico City and Toluca. Methods. We applied seasonal excess mortality models to age-specific respiratory mortality rates for 1915–1920 and quantified the reproduction number from daily data. Results. We identified 3 pandemic waves in Mexico City in spring 1918, autumn 1918, and winter 1920, which were characterized by unusual excess mortality among people 25–44 years old. Toluca experienced 2-fold higher excess mortality rates than Mexico City but did not experience a substantial third wave. All age groups, including that of people ⩾65 years old, experienced excess mortality during 1918–1920. Reproduction number estimates were <2.5, assuming a 3-d generation interval. Conclusion. Mexico experienced a herald pandemic wave with elevated young adult mortality in spring 1918, similar to the United States and Europe. In contrast to the United States and Europe, there was no mortality sparing among Mexican seniors ⩾65 years old, highlighting potential geographical differences in preexisting immunity to the 1918 virus. We discuss the relevance of our findings to the 2009 pandemic mortality patterns.
Purpose
To evaluate CCL2, CXCL8, and CXCL10 in the tears of patients with Primary Sjögren’s syndrome (PSS) and correlate them with ocular symptoms/discomfort and objective ocular tests.
Methods
We ...studied 21 patients with PSS. A single ophthalmologist, expert in dry eye, examined the patients and assessed tear film breakup time, Schirmer I test, tear meniscus height, Van Bijsterveld staining score and SICCA Ocular Staining Score. We also assessed the ESSPRI and ocular dryness VAS and the Ocular Surface Disease Index (OSDI), a 12-item scale assessing symptoms associated with dry eye disease and their impact on vision (ocular symptoms/discomfort). Tear samples collected with sterile tear flow strips were frozen at -86 °C until testing. After thawing, tears were extracted from the strips. We tested CCL2, CXCL8, and CXCL10 by luminometry. We also included 21 healthy control subjects without a dry eye.
Results
CXCL8 levels were similar in patients and controls. PSS patients had lower levels of CXCL10 (472.8 vs. 1652 pg/μL,
p
= 0.009) and CCL2 (1.08 vs. 9 pg/μL,
p
= 0.0001) than controls. Patients with worse ocular sicca symptoms/discomfort had the lowest CXCL10 levels (239.3 vs. 646.2 pg/μL,
p
= 0.02). CCL2 correlated with tear meniscus height (
τ
= 0.37,
p
= 0.02) and with OSS (
τ
= -0.3,
p
= 0.05).
Conclusions
We found lower levels of CXCL10 and CCL2 in the tears of patients with PSS, associating the former with worse ocular symptoms and the latter with positive ocular target tests.
The clinical demand of plasmid DNA (pDNA) has been increasing constantly. An exponential‐fed perfusion (EFP) culture is a new mode for plasmid production for clinical trials and commercialization. ...However, the culture conditions may lead to cell filamentation and growth cessation. In this study, the variation of the physiological state and the plasmid contents of Escherichia coli DH5α hosting pVAX1‐NH36 in an EFP culture for application as a Leishmaniasis vaccine was investigated. The culture performance was monitored using flow cytometry (FC) and real‐time quantitative PCR. The FC studies showed a high viability of cell population and a constant distribution of complexity and size. A high homogeneity of pDNA (>95 % of supercoiled) was obtained, which might be attributed to a better culture environment. The obtained plasmid specific and volumetric yields of 1.8 mg/g dcw and 36.5 mg/L represent typical values for laboratory‐scale plasmid production in a defined medium. A segregated kinetic model of the perfusion system was developed and fitted to the experimental data (R2 > 0.96). A practical conclusion of this work is that a space–time yield analysis of a bioprocess requires a viability evaluation. This new strategy of culture operation might help in the efficient production of pDNA for therapeutic use.
El presente artículo reflexiona sobre los procesos de descentralización impulsados en la educación escolar chilena a partir de la creación de un subsidio focalizado en grupos socioeconómicos bajos, ...denominado Subvención Escolar Preferencial (SEP). Para ello, se ilustra dicha política pública mediante una Matriz de Marco Lógico (MML) y se revisan resultados del periodo 2009-2016 correspondientes a escuelas municipales de dos comunas adscritas a la SEP. El trabajo deriva en dos conjeturas. Primeramente, este subsidio no estaría induciendo mejoras en el desempeño académico a pesar del alza sostenida de sus recursos. En segundo lugar, se aprecia una concentración creciente de alumnos prioritarios en los contextos analizados, lo que concuerda con la marcada segregación escolar registrada en Chile.
The 1918 influenza pandemic was a major epidemiological event of the twentieth century resulting in at least twenty million deaths worldwide; however, despite its historical, epidemiological, and ...biological relevance, it remains poorly understood. Here we examine the relationship between annual pneumonia and influenza death rates in the pre-pandemic (1910-17) and pandemic (1918-20) periods and the scaling of mortality with latitude, longitude and population size, using data from 66 large cities of the United States. The mean pre-pandemic pneumonia death rates were highly associated with pneumonia death rates during the pandemic period (Spearman ρ = 0.64-0.72; P<0.001). By contrast, there was a weak correlation between pre-pandemic and pandemic influenza mortality rates. Pneumonia mortality rates partially explained influenza mortality rates in 1918 (ρ = 0.34, P = 0.005) but not during any other year. Pneumonia death counts followed a linear relationship with population size in all study years, suggesting that pneumonia death rates were homogeneous across the range of population sizes studied. By contrast, influenza death counts followed a power law relationship with a scaling exponent of ∼0.81 (95%CI: 0.71, 0.91) in 1918, suggesting that smaller cities experienced worst outcomes during the pandemic. A linear relationship was observed for all other years. Our study suggests that mortality associated with the 1918-20 influenza pandemic was in part predetermined by pre-pandemic pneumonia death rates in 66 large US cities, perhaps through the impact of the physical and social structure of each city. Smaller cities suffered a disproportionately high per capita influenza mortality burden than larger ones in 1918, while city size did not affect pneumonia mortality rates in the pre-pandemic and pandemic periods.
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