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Resumo Os agonistas do receptor de GLP1 (GLP1-RAs) são medicamentos que imitam os efeitos do hormônio incretínico GLP1. Eles foram inicialmente introduzidos na medicina para o tratamento do diabetes em 2005 e para a obesidade em 2014. Com o passar do tempo, dados provenientes de objetivos secundários e exploratórios de amplos ensaios clínicos randomizados sugeriram que os GLP1-RAs também poderiam exercer ação renal ao retardar a progressão da doença renal em pacientes com e sem diabetes. Com base nesse raciocínio, o estudo Flow (semaglutida 1 mg vs. placebo) foi desenhado e o recrutamento começou em 2019, estendendo-se até maio de 2021. Os resultados publicados recentemente confirmaram o efeito da semaglutida na redução do desfecho renal composto. No entanto, assim como os inibidores do SGLT2, os mecanismos potenciais por trás dos efeitos renais dos GLP1-RAs ainda precisam ser elucidados. O objetivo desta revisão é abordar os diferentes mecanismos fisiológicos dos GLP1-RAs em nível renal, utilizando evidências de estudos experimentais e da literatura científica atual. GLP GLP1RAs GLPRAs RAs (GLP1-RAs 200 2014 tempo raciocínio vs placebo 2019 estendendose estendendo se 2021 composto entanto SGLT2 SGLT elucidados atual 20 201 202 2

Abstract GLP1 receptor agonists (GLP1-RAs) are drugs that mimic the effects of the incretin hormone GLP1 and were initially introduced in medicine for the treatment of diabetes in 2005 and for obesity in 2014. Over time, data from secondary and exploratory objectives of large randomized controlled-trials suggested that GLP1-RAs could also exert renal action by slowing the progression of kidney disease in patients with and without diabetes. Based on this rationale, the Flow study (1 mg semaglutide vs placebo) was designed and recruitment began in 2019 until May 2021. The recently published results confirmed the effect of semaglutide in reducing the composite renal outcome. However, similar to SGLT2 inhibitors, the potential mechanisms behind the renal effects of GLP1-RAs still need to be elucidated. The aim of this review is to address the different physiological mechanisms of GLP1-RAs at the renal level, using evidence from experimental studies and current scientific literature. GLP GLP1RAs GLPRAs RAs (GLP1-RAs 200 2014 time controlledtrials controlled trials rationale 1 ( placebo 201 2021 outcome However SGLT inhibitors elucidated level literature 20 202 2

https://doi.org/10.1590/2175-8239-jbn-2024-0101en

Transdisciplinary curriculum design for sustainability transitions: A reflective dialogue
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Olvitt, Lausanne

; Davies, Megan

; Ebrahim, A'ishah

; Cockburn, Jessica

South African Journal of Science

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Oct 2024, Volumen 120 Nº 9-10 Paginas 1 - 8

Resumen: En | Texto: En | PDF: En

Inter- and transdisciplinary curricula can potentially develop an integrated understanding of an increasingly interconnected, complex world and develop students' agency, empathy, creativity and critical thinking skills. Within the South African qualification landscape, the Postgraduate Diploma (PGDip) is identified as a multi-or interdisciplinary qualification that allows working professionals 'to undertake advanced reflection and development by means of a systematic survey of current thinking, practice and research methods in an area of specialisation'. In this paper, four academics reflexively share their experiences of (re)developing and piloting transdisciplinary curricula for the PGDip in Sustainable Development (at Stellenbosch University) and the PGDip in Sustainability Learning (at Rhodes University). Reflections centre around the rationale, context and emergence of the two programmes, their structure and intended learning outcomes, and principles guiding the overall curriculum design. We highlight the appropriateness of transdisciplinary approaches to curricula focused on the sustainability field, and it distils three broad features of the two PGDip programmes that seem important - even necessary - for developing students' competencies as sustainability practitioners. These are ontological groundedness, epistemological openness and ethical attentiveness. SIGNIFICANCE: This paper provides a rationale for pursuing transdisciplinary curricula that are oriented to sustainability. It shares reflections from two postgraduate diploma curriculum design processes and provides summative insights into broad features of transdisciplinary curriculum design that may enhance sustainability transitions. These features may help to guide other university curriculum developers wanting to design similar programmes to support sustainability transitions.

https://doi.org/10.17159/sajs.2024/17884

Academic exclusion of Health Sciences students in South African higher education institutions - A rationale for institutional policy and processes
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Nalla, S

; Vincent-Lambert, C

African Journal of Health Professions Education

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Sep 2024, Volumen 16 Nº 3 Paginas 2 - 8

Resumen: En | Texto: En | PDF: En

BACKGROUND: Academic exclusion is practised in many national and international higher education institutions (HEIs), significantly impacting students' futures. Associated stress and anxiety remain a source of conflict between all role players. Reasons for, and the rationale behind, academic exclusion are complex and multifactorial OBJECTIVES: To investigate and describe contemporary practices and core themes relating to academic exclusion by reviewing the academic policies and procedures in a sample of six South African HEIs within a health professions education context METHODS: A prospective, pragmatic design was followed. This involved simple content analysis of source documents to identify similarities and differences in approach to academic exclusion, including the rationale and potential implications thereof RESULTS: The rationale for exclusion remains multifactorial. The majority of institutions linked exclusion to continued poor performance and failure to complete qualifications within the maximum time. All institutions allowed for an appeal process; however, this differed significantly between institutions CONCLUSION: There is a clear, defendable rationale for the exclusion, and practices that seek to prevent students from continuing should be guided by policies and procedures that are clear and contextually relevant. While the right to appeal exclusion is supported, arbitrary support for such appeals in the absence of merit defeats the aims, objectives and rationale for exclusion

https://doi.org/10.7196/ajhpe.2024.v16i4.805

Efectos de la pandemia del COVID-19 en las exportaciones manufactureras mexicanas: un análisis por subsectores
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Cuevas Ahumada, Víctor Manuel

; Jaime Camacho, Daniel David

Análisis económico

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Ago 2024, Volumen 39 Nº 101 Paginas 5 - 21

Resumen: Es En | Texto: Es En | PDF: Es | PDF: En

Resumen En este trabajo se emplea un modelo de datos en panel para estudiar el impacto de seis variables clave, tres de ellas relacionadas con la pandemia del COVID-19, sobre las exportaciones manufactureras mexicanas. El panel comprende los 21 subsectores de la industria manufacturera y observaciones mensuales para el período enero de 2020 - diciembre de 2022. Para estimar el modelo, que incluye tanto variables de demanda como de oferta, se utilizan dos métodos: mínimos cuadrados ordinarios y mínimos cuadrados en dos etapas. El segundo método corrige problemas de endogeneidad y se complementa con medidas para acrecentar la eficiencia. La evidencia obtenida indica que las exportaciones manufactureras responden positivamente frente a un incremento en la demanda externa, una depreciación real del peso, un descenso en los costos laborales unitarios (CLU), una mayor cobertura de los programas de vacunación, y un relajamiento de las medidas de distanciamiento social. Dado que los CLU descienden conforme aumenta la productividad laboral, procede concluir que una mayor inversión en educación formal de calidad, en capacitación y adiestramiento es una medida efectiva para exportar más. Asimismo, los efectos de los esfuerzos de vacunación subrayan la importancia de coordinar la política económica con la política de salud.

Abstract This paper employs a panel data model to study the impact of six key variables, three of them directly related to the COVID-19 pandemic, on Mexican manufacturing exports. The panel comprises the 21 manufacturing subsectors and monthly data during the January 2020-December 2022 period. Moreover, the model specification entails supply- as well as demand-side variables. The two estimation techniques are ordinary least squares and two- stage least squares. The second estimation procedure corrects for endogeneity problems and is complemented by remedial measures to achieve more efficient parameter estimates. Along these lines, the evidence is robust in showing that manufacturing exports respond positively to an increase in external demand, a real currency depreciation, a drop in unit labor costs (ULC), a wider coverage of vaccination campaigns, and a relaxation of social distancing measures. Given that ULC fall as labor productivity rises, there is a valid rationale to conclude that investing in high- quality formal education, training and skill development could be an effective measure to raise exports. Likewise, the effects of the vaccination efforts highlights the relevance of coordinating economic policy with health policy.

https://doi.org/10.24275/uam/azc/dcsh/ae/2024v39n101/cuevas

Pharmaco-phytochemistry of esters isolated from leaf extracts of Spondias mombin as potential antiviral agents
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Boadu, Akwasi

; Karpoormath, Rajshekhar

; Nlooto, Manimbulu

South African Journal of Science

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Ago 2024, Volumen 120 Nº 7-8 Paginas 1 - 11

Resumen: En | Texto: En | PDF: En

The present work reports on the isolation and characterisation of two novel antiviral ester compounds from dichloromethane leaf extracts of Spondias mombin (SM). The characterisation and structural elucidation were established from spectroscopic evidence of nuclear magnetic resonance, Fourier transform infrared and mass spectroscopy. The compounds identified were 6-methylheptyl pentadecanoate and 6-methylheptyl-15-(1,2,3,4,4a,8a-hexahydronaphthalen-1-yl)pentadecanoate. The novel isolated ester compounds were reported to have anti-rhino virus activity in silico against a known biological target (HsNMT1) that plays a key role in developing therapeutics against the common cold. Molecular docking analysis revealed the binding affinity across all targets within the range of -4.6 to -8.2 kcal/mol, whilst molecular dynamic simulation showed that systems attained good stability due to the maintenance of mean root-mean-square deviation values within the acceptable range of 1.5-2.5 Å. It can be concluded that the novel compounds are potential inhibitory candidates against rhinovirus protein target HsNMT1. However, in vitro and in vivo experiments are further required to validate the possible inhibitory candidates against rhinovirus disease (common cold). SIGNIFICANCE: The significance of this study contributes to the scientific rationale for using SM leaf extracts to treat viral diseases. Two novel compounds, 6-methylheptyl pentadecanoate and 6-methylheptyl-15-(1,2,3,4,4a,8a-hexahydronaphthalen-1-yl)pentadecanoate, were predicted through computer-aided techniques to possess anti-rhinovirus properties.

https://doi.org/10.17159/sajs.2024/14913

El Ambiente Físico de la Sala de Clases: Un Ámbito de Prácticas Inclusivas
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Angulo De la Fuente, Verónica

Revista latinoamericana de educación inclusiva

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Jun 2024, Volumen 18 Nº 1 Paginas 213 - 226

Resumen: En Es | Texto: En Es | PDF: En | PDF: Es

ABSTRACT: The objective of this essay is to highlight the importance of recognizing the physical environment of the classroom as a central element to move towards inclusive education. Through the development of the argument, the aim is to address the following question: Why should educational communities consider the physical dimension of classrooms to advance the implementation of an inclusive framework in their schools? Drawing on the concept of "inclusive practices" (Booth and Ainscow, 2015), a rationale is presented for why it is relevant for educational institutions and their various stakeholders to reflect on the organization and arrangement of school furniture, the place that students occupy in the classroom, and the environmental conditions that characterize that space (lighting, acoustics, visibility). The modification, diversification, and/or flexibility of the physical environment of classrooms can be considered an inclusive practice in schools, as long as it takes into account the needs and voices of students and promotes their participation.

RESUMEN: El presente ensayo tiene por objetivo relevar la importancia de reconocer el ambiente físico de la sala de clases como un elemento central para avanzar hacia una educación inclusiva. A través del desarrollo del argumento se pretende responder a la siguiente pregunta: ¿Por qué las comunidades educativas deberían considerar la dimensión física del aula para avanzar en la implementación de un enfoque inclusivo en sus escuelas? Tomando como referencia el concepto de “prácticas inclusivas” (Booth y Ainscow, 2015) se expone por qué resulta relevante que las instituciones educativas y sus diferentes actores reflexionen acerca de la organización y disposición del mobiliario escolar, la ubicación de las y los estudiantes en la sala de clases y las condiciones ambientales que caracterizan ese espacio (iluminación, acústica, visibilidad). La apropiación, diversificación y flexibilización del ambiente físico pueden ser consideradas prácticas inclusivas en las escuelas, en tanto consideren las necesidades y voces de las y los estudiantes y promuevan su participación.

https://doi.org/10.4067/s0718-73782024000100213

Concepción teórico-metodológica de identificación y detección de talentos en el fútbol de base
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Sarracén Legrá, Ronald

; Noa Cuadro, Héctor

; Milán Leyva, Eudis

Ciencia y Deporte

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Abr 2024, Volumen 9 Nº 1 Paginas 112 - 127

Resumen: Pt Es En | Texto: Pt Es En | PDF: Pt | PDF: Es | PDF: En

RESUMO Introdução: o processo de seleção de talentos no esporte é atualmente uma prioridade em Cuba, porém, na pirâmide esportiva, especificamente na base, persistem limitações no futebol de base, notadamente na etapa de identificação e detecção., o que demonstra sua relevância e importância. Objetivo: desenvolver uma concepção teórico-metodológica com abordagem integrativa que se concretize em uma metodologia de identificação e detecção de talentos no futebol de base com abordagem integrativa. Materiais e métodos: para o desenvolvimento da pesquisa foram utilizados métodos teóricos, empíricos e matemáticos e/ou estatísticos para determinar os elementos teóricos sobre a identificação e detecção de talentos no futebol de base. Foram aplicados a uma população composta por 16 professores de futebol das equipes esportivas de Imías. Resultados: são sintetizadas novas relações que se revelam na inter-relação sistêmica entre os componentes da concepção teórico-metodológica, são oferecidas definições da concepção teórico-metodológica, seus componentes, a metodologia, bem como a identificação e detecção de talentos contextualizados. No futebol de base, tudo isso nos permite oferecer meios e procedimentos aos professores como uma ferramenta pedagógica necessária, que se distingue pela sua abordagem integradora. Conclusões: a concepção teórico-metodológica que se especifica em uma metodologia é portadora de novos componentes e relações essenciais entre os subsistemas que revelam a dinâmica de identificação e detecção de talentos a partir de uma abordagem integrativa, que responda às particularidades, contextualização e demandas do futebol de base.

RESUMEN Introducción: el proceso de selección de talentos en los deportes constituye una prioridad en la actualidad en Cuba, sin embargo, en la pirámide deportiva, específicamente en la base persisten limitaciones en el fútbol de base, de forma notoria en la etapa de identificación y detección, lo cual se demuestra su actualidad e importancia. Objetivo: elaborar una concepción teórico-metodológica con enfoque integrador que se concreta en una metodología de identificación y detección de talentos en el fútbol de base con un enfoque integrador. Materiales y métodos: para el desarrollo de la investigación se utilizaron métodos teóricos, empíricos y matemáticos y/o estadísticos para la determinación de los elementos teóricos acerca de la identificación y detección de talentos en el fútbol de base. Los mismos se aplicaron a una población conformada por 16 profesores de fútbol de los Combinados deportivos en Imías. Resultados: se sintetizan nuevas relaciones que se develan en la interrelación sistémica entre los componentes de la concepción teórico-metodológica, se ofrecen definiciones de la concepción teórico-metodológica, sus componentes, de la metodología, así como de la identificación y detección de talentos contextualizadas en el fútbol de base, todo ello, permite ofrecer vías y procedimientos a los profesores como una herramienta didáctica necesaria, la cual se distingue por su enfoque integrador. Conclusiones: la concepción teórico metodológica que se concreta en una metodología, es portadora de nuevos componentes y relaciones esenciales entre los subsistemas que revelan la dinámica de la identificación y detección de talentos a partir de un enfoque integrador, los cuales responden a las particularidades, contextualización y exigencias del fútbol de base.

ABSTRACT Introduction: Sports talent selection is a priority in present-day Cuba; however, in the sports structure, particularly at lower levels, there are striking shortcomings during the talent detection stage. Aim: To design a theoretical-methodological rationale based on a comprehensive approach for the detection of local soccer talents. Materials and methods: this study relied on theoretical, empirical, and mathematical-statistical methods for the detection of local soccer talents. The population of the study consisted of 16 soccer teachers from Imias Sports Complexes. Results: New relations were identified through a systemic interrelation among the components of the theoretical-methodological rationale. The study offers a definition of its components, the method, and the detection of local soccer talents, which provided teachers with the necessary ways and procedures that can be used as didactic tools, based on a comprehensive approach. Conclusions: The theoretical-methodological rationale bears new components and essential relationships among the subsystems that reveal the dynamic of talent spotting based on a comprehensive approach, which focuses in the specifics, contextualization, and demands of local soccer practice.

https://doi.org/10.34982/2223.1773.2024.v9.no1.008

Oportunidades perdidas en la prevención de la sífilis congénita en México
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Hernández-Muñoz, Eduardo A.

; Gil-Lozada, Jessica

; Díaz-Ramírez, Jorge B.

; Zavala-Sánchez, Eugenio V.

; Lara-Lona, Elia

Gaceta médica de México

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Abr 2024, Volumen 160 Nº 2 Paginas 187 - 194

Resumen: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Background: The WHO presented the initiative: "Global elimination of congenital syphilis (CS): rationale and strategies for action". It establishes that CS is a preventable disease that can be eliminated. Objective: To estimate the proportion of missed opportunities for prevention (MOP) of (CS). Material and methods: Cross-sectional study. We studied women with children with confirmed diagnosis of CS (NOM-039-SSA2-2002) in the Mexican Social Security Institute in Jalisco from 01/01/2016 to 08/01/2022. The clinical records of the mother, the newborn and the epidemiological study (ES) were reviewed. Each case was classified into one of the MOP categories. Results: 52 cases were reported: 46.2 % (n = 24) were ruled out, 34.6 % (n = 18) confirmed, 15.4 % (n = 8) unknown and 3.8 % (n = 2) probable cases. The HIV test was performed in 61.1 % (n = 11) and syphilis in 72.2 % (n = 13) of the mothers. The MOP in 27.8 % (n = 5) was inadequate treatment or omission of maternal treatment despite a timely diagnosis of syphilis. Treatment was inadequate in 63.6 % (n = 7) of the women who received it. Conclusion: The classification of MOP identifies gaps in CS prevention and can guide stakeholders, policy makers and public health prevention programs to reduce the incidence of CS.

Resumen Antecedentes: La Organización Mundial de la Salud estableció que la sífilis congénita es una enfermedad prevenible que puede eliminarse. Objetivo: Estimar la proporción de oportunidades perdidas en la prevención (OPP) de la sífilis congénita. Material y métodos: Estudio transversal descriptivo. Se eligieron mujeres en cuyos hijos recién nacidos se identificó sífilis congénita entre 2016 y 2022. Se revisaron los expedientes clínicos de la madre, el recién nacido y el estudio epidemiológico. Cada caso se clasificó en una de las categorías de las OPP. Resultados: Se notificaron 52 casos: 46.2 % (n = 24) fue descartado, 34.6 % (n = 18) confirmado, 15.4 % (n = 8) desconocido y 3.8 % (n = 2) probable. Las pruebas para identificar infección por VIH y sífilis se realizaron en 61.1 % (n = 11) y 72.2 % de las madres (n = 13). La OPP en 27.8 % (n = 5) consistió en tratamiento inadecuado u omisión de tratamiento materno a pesar de diagnóstico oportuno de la sífilis. De quienes recibieron tratamiento, en 63.6 % fue inadecuado (n = 7). Conclusión: La clasificación de OPP de sífilis congénita permite identificar brechas en la prevención y dirigir intervenciones de salud pública hacia las principales causas para reducir la incidencia.

https://doi.org/10.24875/gmm.24000037

Violence Exposure and Disability in Colombian Female Survivors of Intimate Partner Violence: the Mediating Role of Depressive Symptoms
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Sandoval, Lina Marcela

; Siprian Castro, Elvis

; Fandiño-Losada, Andrés

; Pacichana-Quinayaz, Sara Gabriela

; Lennon, Shirley Evelyn

; Gutiérrez-Martínez, María Isabel

Revista Colombiana de Psiquiatría

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Mar 2024, Volumen 53 Nº 1 Paginas 55 - 62

Resumen: Es En | Texto: Es En | PDF: Es | PDF: En

RESUMEN Introducción: La violencia es un importante problema de salud pública y una de las principales causas de muerte en todo el mundo. Las consecuencias para la salud mental de sobrevivir a la violencia de la pareja íntima incluyen depresión, ansiedad y trastorno de estrés postraumático. Estudios previos han identificado que existe una relación entre la depresión y el nivel de discapacidad en mujeres sobrevivientes a violencia de pareja íntima. La estimación del efecto directo, indirecto o total de una exposición en un resultado permite identificar efectos mediadores en un grupo de variables. La detección de los efectos de la mediación es útil para identificar vías causales que generan un resultado final y proporciona una justificación para diseñar intervenciones dirigidas al mediador, lo que a su vez afecta positivamente al resultado. El objetivo es identificar el efecto mediador de los síntomas de depresión en la relación entre gravedad de la violencia y el nivel de discapacidad de las mujeres víctimas de violencia de pareja. Métodos: Estudio transversal que incluyó a 94 mujeres de 18 o más años víctimas de violencia de pareja, identificadas en 2 instituciones públicas de salud de Cali y Tuluá, en el suroccidente de Colombia. Se realizó un análisis de rutas causales mediante un modelo de ecuaciones estructurales (SEM), en Stata® 14. Resultados: El efecto directo de la gravedad de la violencia en la discapacidad no es significativo ((3 = 0,09; p = 0,63); sin embargo, el efecto indirecto mediado por los síntomas de depresión incrementa su magnitud y es significativo (3 = 0,39; p <0,01). El efecto total es mayor y significativo (3 = 0,48; p = 0,01). Conclusiones: Existe un papel mediador de los síntomas depresivos entre la exposición a violencia de pareja y el nivel de discapacidad en las mujeres del suroccidente colombiano. Así, tratar los síntomas de depresión es fundamental para mejorar la funcionalidad de las mujeres víctimas de la violencia de pareja. Los resultados de esta investigación contribuyen a definir estrategias para prevenir y abordar la violencia de pareja, los síntomas depresivos y la discapacidad en esta población.

ABSTRACT Background: Violence is an important public health problem and one of the main causes of deaths worldwide. The mental health consequences of surviving intimate partner violence (IPV) include depression, anxiety and post-traumatic stress disorder. Previous studies have identified that there is a relationship between depression and level of disability in female survivors of IPV. Estimating the direct, indirect or total effect of an exposure on an outcome makes it possible to identify mediating effects between a group of variables. Detecting mediation effects is useful for identifying casual pathways that generate a final outcome and provides a rationale for designing interventions to target the mediator, which in turn positively affects the outcome. The objective was to identify the mediating role of depressive symptoms on the relationship between IPV and disability. Methods: This was a cross-sectional study of 94 women over the age of 18 who were survivors of IPV by men. They were recruited from two public hospitals in Cali and Tuluá in southwest Colombia. An analysis of casual relationships was performed using structural equation modelling that was made up of: four exogenous observed variables (age, current relationship status [in a relationship or single], level of schooling, and history of an impairment), intermediate endogenous variables (violence and depressive symptoms), and the main endogenous variable (disability). The analyses were carried out in Stata14.2. Results: The direct effect of IPV severity on the level of disability was not statistically significant ((3 = 0.09; P = 0.63). However, the indirect effect of IPV severity on disability mediated by depressive symptoms was ((3 = 0.39; P <0.01). The total effect of IPV severity on the level of disability was even greater ((3 = 0.48; P = 0.01). Conclusions: This study found a complete mediating role of depressive symptoms on the relationship between the severity of IPV and the level of disability for the female participants in this study. The results of this research contribute to defining strategies to prevent and address intimate partner violence, depressive symptoms and disability in this population.

https://doi.org/10.1016/j.rcp.2021.11.009

10.

Obstacles to critical thinking: A qualitative study on secondary school learners in Masvingo, Zimbabwe
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Wekwete, Prayers

; Higgs, Leonie

South African Journal of Education

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Feb 2024, Volumen 44 Nº 1 Paginas 1 - 11

Resumen: En | Texto: En | PDF: En

The research reported on in this article was mainly undertaken to determine the obstacles to the enhancement of critical thinking in the learning of history at Form 3 level in secondary schools in the Masvingo urban area of Zimbabwe, in terms of the rationale of developing the learners' critical thinking. The promotion of critical thinking abilities is vital in education, since doing so helps to improve the learners' academic performance, as well as aiding in producing graduates with a multiplicity of skills that are required in the 21st century job market and in society as a whole. We used semi-structured interviews and lesson observations to reach conclusions on what recommendations to make in addressing the research problem. Several factors were identified as hindering the learners' acquisition of critical thinking, including the learners' and teachers' lack of self-efficacy, motivation and the poor learning environment. In addition to reflecting on the possibility of improving the learning and teaching of critical thinking, we recommend that the Ministry of Primary and Secondary Education, Zimbabwe's Schools Examination Council, teacher training colleges and teachers should all work together to develop the learners' critical thinking skills within the parameters of the Zimbabwean education system.

https://doi.org/10.15700/saje.v44n1a2261

11.

HEARTS en las Américas: impulsar el cambio en el sistema de salud para mejorar el control de la hipertensión en la población
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Ordunez, Pedro

; Campbell, Norm R. C.

; DiPette, Donald J.

; Jaffe, Marc G.

; Rosende, Andrés

; Martínez, Ramón

; Gamarra, Angelo

; Lombardi, Cintia

; Parra, Natalia

; Rodríguez, Libardo

; Rodríguez, Yenny

; Brettler, Jeffrey

Revista Panamericana de Salud Pública

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2024, Volumen 48 elocation e17

Resumen: Es En Pt | Texto: Es En Pt | PDF: Es | PDF: En | PDF: Pt

RESUMEN Propósito de la revisión. HEARTS en las Américas es la adaptación regional de la iniciativa mundial HEARTS, de la Organización Mundial de la Salud, para la prevención y el control de las enfermedades cardiovasculares (ECV). Su objetivo general es impulsar el cambio de la práctica clínica y de la gestión en los entornos de atención primaria, por parte de los servicios de salud, a fin de mejorar el control de la hipertensión y reducir el riesgo de ECV. En esta revisión se describe la iniciativa HEARTS en las Américas. En primer lugar, se resume la situación epidemiológica regional en cuanto a la mortalidad por ECV y las tendencias en el control de la hipertensión a nivel poblacional; a continuación, se explica la razón de ser de los principales componentes de la intervención: el sistema de manejo orientado a la atención primaria y la vía clínica de HEARTS. Por último, se examinan los factores clave para acelerar la expansión de HEARTS: los medicamentos, la atención basada en el trabajo en equipo y un sistema de monitoreo y evaluación. Resultados recientes. Hasta el momento, 33 países y territorios de América Latina y el Caribe se han comprometido a integrar este programa en toda su red de atención primaria de salud para el 2025. El aumento de la cobertura y del control de la hipertensión en los entornos de atención primaria de salud (en comparación con el modelo tradicional) es prometedor y confirma que las intervenciones que se promueven como parte de HEARTS son factibles y resultan aceptables para las comunidades, los pacientes, los prestadores de servicios de salud, los responsables de la toma de decisiones y los financiadores. En esta revisión se destacan algunos casos de implementación satisfactoria. Conclusiones. Ampliar el uso de un tratamiento eficaz de la hipertensión y optimizar el control del riesgo de ECV es una forma pragmática de acelerar la reducción de la mortalidad por ECV y, al mismo tiempo, de fortalecer los sistemas de atención primaria de salud para responder con calidad y de manera eficaz y equitativa al desafío que entrañan las enfermedades no transmisibles, no solo en los países de ingresos bajos o medianos, sino en todas las comunidades a nivel mundial.

ABSTRACT Purpose of review. HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. Recent findings. Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Summary. Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.

RESUMO Propósito da revisão. HEARTS nas Américas é uma adaptação regional da iniciativa mundial HEARTS, da Organização Mundial da Saúde, voltada para prevenção e controle das doenças cardiovasculares (DCV) na Região das Américas. Seu objetivo geral é promover mudanças na prática clínica e na gestão da atenção primária pelos serviços de saúde a fim de melhorar o controle da hipertensão arterial e reduzir o risco de DCV. Esta revisão descreve a iniciativa HEARTS nas Américas. Primeiro, é apresentado um resumo da situação epidemiológica regional relativa à mortalidade por DCV e das tendências no controle da hipertensão arterial em nível populacional. Em seguida, são explicados os motivos por trás dos principais componentes da intervenção: o sistema de manejo focado na atenção primária e o componente clínico da HEARTS. Por fim, são examinados os principais fatores para acelerar a ampliação da HEARTS: medicamentos, atenção baseada no trabalho em equipe e um sistema de monitoramento e avaliação. Resultados recentes. Até o momento, 33 países e territórios da América Latina e do Caribe se comprometeram a integrar esse programa em toda sua rede de atenção primária à saúde até 2025. Comparado com o modelo tradicional, o aumento da cobertura e do controle da hipertensão arterial nos ambientes de atenção primária à saúde é promissor e confirma que as intervenções promovidas pela HEARTS são exequíveis e aceitas por comunidades, pacientes, prestadores de serviços de saúde, tomadores de decisão e financiadores. Nesta revisão, destacamos alguns casos nos quais a implementação foi satisfatória. Conclusões. Ampliar a aplicação de um tratamento eficaz contra a hipertensão arterial e otimizar o controle do risco de DCV são medidas pragmáticas para acelerar a redução da mortalidade por DCV e, ao mesmo tempo, fortalecer os sistemas de atenção primária à saúde para responder com qualidade, eficácia e equidade ao desafio apresentado pelas doenças não transmissíveis, não apenas nos países de baixa ou média renda, mas no mundo todo.

https://doi.org/10.26633/rpsp.2024.17

12.

Dissociation and re-imagination: the publicity of Chinese marriage law and divorce narrative in the 1950s reimagination re imagination re-imagination s
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Luo, Yingyu

; Han, Chao

Trans/Form/Ação

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2024, Volumen 47 Nº 4 elocation e0240056

Resumen: Fr En | Texto: Fr En | PDF: Fr | PDF: En

Résumé: Après la promulgation de la loi sur le mariage de la République populaire de Chine en 1950, les œuvres littéraires dérivées du besoin de publicité ont des implications politiques et une signification disciplinaire distinctes. Parce que le problème du divorce a la rationalité des “droits libres” et la sensibilité de l’agitation sociale, le récit du “divorce” à cette époque se situe dans une certaine mesure entre la politique et la réalité. D’une part, les œuvres littéraires doivent promouvoir positivement le concept juridique de “liberté de divorce” et, d’autre part, elles doivent être soumises à un traitement narratif insensible. Les récits de divorce sont donc vagues et capricieux. Toutefois, la littérature a comblé dans une certaine mesure le fossé entre la loi et la réalité en réimaginant les problèmes réels causés par le divorce. Résumé 1950 distinctes droits libres lagitation l agitation sociale “divorce Dune D part liberté dautre d autre insensible capricieux Toutefois 195 19 1

Abstract: After the promulgation of the Marriage Law of the People’s Republic of China in 1950, literary works engendered from the exigencies of publicity held distinct policy implications and disciplinary significance. Given that the issue of divorce encapsulates both the rationale of “free rights” and the sensibility of social disorder, the narrative of “divorce” during this period is, to some extent, situated between politics and reality. On the one hand, literary works must positively advocate the legal concept of “divorce freedom”, while, on the other hand, they must also undergo a delicately nuanced narrative processing to circumvent sensitivities. Consequently, the depiction of divorce narratives is characterized by ambiguity and capriciousness. Nonetheless, literature has to some extent bridged the gap between law and reality by reimagining the genuine predicaments triggered by divorce. Abstract Peoples People s 1950 significance free rights disorder hand freedom, freedom , freedom” while sensitivities Consequently capriciousness Nonetheless 195 19 1

https://doi.org/10.1590/0101-3173.2024.v47.n4.e0240056

13.

Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan Prospective randomized pressurelimiting pressure limiting communityacquired community acquired STAMINA trial)
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Maia, Israel Silva

; Medrado Jr, Fernando Azevedo

; Tramujas, Lucas

; Tomazini, Bruno Martins

; Oliveira, Júlia Souza

; Sady, Erica Regina Ribeiro

; Barbante, Letícia Galvão

; Nicola, Marina Lazzari

; Gurgel, Rodrigo Magalhães

; Damiani, Lucas Petri

; Negrelli, Karina Leal

; Miranda, Tamiris Abait

; Santucci, Eliana

; Valeis, Nanci

; Laranjeira, Ligia Nasi

; Westphal, Glauco Adrieno

; Fernandes, Ruthy Perotto

; Zandonai, Cássio Luis

; Pincelli, Mariangela Pimentel

; Figueiredo, Rodrigo Cruvinel

; Bustamante, Cíntia Loss Sartori

; Norbin, Luiz Fernando

; Boschi, Emerson

; Lessa, Rafael

; Romano, Marcelo Pereira

; Miura, Mieko Cláudia

; Alencar Filho, Meton Soares de

; Dantas, Vicente Cés de Souza

; Barreto, Priscilla Alves

; Hernandes, Mauro Esteves

; Grion, Cintia Magalhães Carvalho

; Laranjeira, Alexandre Sanches

; Mezzaroba, Ana Luiza

; Bahl, Marina

; Starke, Ana Carolina

; Biondi, Rodrigo Santos

; Dal-Pizzol, Felipe

; Caser, Eliana Bernadete

; Thompson, Marlus Muri

; Padial, Andrea Allegrini

; Veiga, Viviane Cordeiro

; Leite, Rodrigo Thot

; Araújo, Gustavo

; Guimarães, Mário

; Martins, Priscilla de Aquino

; Lacerda, Fábio Holanda

; Hoffmann Filho, Conrado Roberto

; Melro, Livia

; Pacheco, Eduardo

; Ospina-Táscon, Gustavo Adolfo

; Ferreira, Juliana Carvalho

; Freires, Fabricio Jocundo Calado

; Machado, Flávia Ribeiro

; Cavalcanti, Alexandre Biasi

; Zampieri, Fernando Godinho

Critical Care Science

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2024, Volumen 36 elocation e20240210en

Resumen: En Pt | Texto: En Pt | PDF: En | PDF: Pt

ABSTRACT Background: Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear. Objective: To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia. Methods: The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance. Outcomes: The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide. Conclusion: STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial. Background ventilatorinduced induced pressurelimiting limiting unclear Objective endexpiratory end expiratory lowpositive low ventilatorfree free communityacquired community Methods (STAMINA multicenter openlabel open label moderatetosevere moderate severe units 50 Outcomes inhospital hospital support oxide Conclusion Here rationale 5

RESUMO Contexto: Em estudos observacionais sobre a síndrome do desconforto respiratório agudo, sugeriu-se que a driving pressure é o principal fator de lesão pulmonar induzida por ventilador e de mortalidade. Não está claro se uma estratégia de limitação da driving pressure pode melhorar os desfechos clínicos. Objetivo: Descrever o protocolo e o plano de análise estatística que serão usados para testar se uma estratégia de limitação da driving pressure envolvendo a titulação da pressão positiva expiratória final de acordo com a melhor complacência respiratória e a redução do volume corrente é superior a uma estratégia padrão envolvendo o uso da tabela de pressão positiva expiratória final baixa do protocolo ARDSNet, em termos de aumento do número de dias sem ventilador em pacientes com síndrome do desconforto respiratório agudo devido à pneumonia adquirida na comunidade. Métodos: O estudo STAMINA (ventilator STrAtegy for coMmunIty acquired pNeumoniA) é randomizado, multicêntrico e aberto e compara uma estratégia de limitação da driving pressure com a tabela de pressão positiva expiratória final baixa do protocolo ARDSnet em pacientes com síndrome do desconforto respiratório agudo moderada a grave devido à pneumonia adquirida na comunidade internados em unidades de terapia intensiva. Esperamos recrutar 500 pacientes de 20 unidades de terapia intensiva brasileiras e duas colombianas. Eles serão randomizados para um grupo da estratégia de limitação da driving pressure ou para um grupo de estratégia padrão usando a tabela de pressão positiva expiratória final baixa do protocolo ARDSnet. No grupo da estratégia de limitação da driving pressure, a pressão positiva expiratória final será titulada de acordo com a melhor complacência do sistema respiratório. Desfechos: O desfecho primário é o número de dias sem ventilador em 28 dias. Os desfechos secundários são a mortalidade hospitalar e na unidade de terapia intensiva e a necessidade de terapias de resgate, como suporte de vida extracorpóreo, manobras de recrutamento e óxido nítrico inalado. Conclusão: O STAMINA foi projetado para fornecer evidências sobre se uma estratégia de limitação da driving pressure é superior à estratégia da tabela de pressão positiva expiratória final baixa do protocolo ARDSnet para aumentar o número de dias sem ventilador em 28 dias em pacientes com síndrome do desconforto respiratório agudo moderada a grave. Aqui, descrevemos a justificativa, o desenho e o status do estudo. Contexto sugeriuse sugeriu clínicos Objetivo ARDSNet Métodos ventilator pNeumoniA randomizado 50 2 colombianas Desfechos resgate extracorpóreo inalado Conclusão Aqui justificativa 5

https://doi.org/10.62675/2965-2774.20240210-en

14.

Is the neutrophil-to-lymphocyte "ratio"nale from head and neck to thyroidology for thyroidologists?: promise or passé? neutrophiltolymphocyte neutrophil lymphocyte rationale ratio nale thyroidologists thyroidologists? passé
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Sengul, Ilker

; Sengul, Demet

; Kesicioglu, Tugrul

; Cinar, Esma

; Detanac, Dzemail

; Pelikán, Anton

; Kudlova, Pavla

Revista da Associação Médica Brasileira

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2024, Volumen 70 Nº 5 elocation e20231617

Resumen: En | Texto: En | PDF: En

https://doi.org/10.1590/1806-9282.20231617

15.

“A rua me abraçou, mas eu não vou perder meu filho para ninguém estranho”: Carolina e os sentidos da maternidade no contexto da situação de rua
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Santos, Gilney Costa

; Constantino, Patrícia

; Baptista, Tatiana Wargas de Faria

Physis: Revista de Saúde Coletiva

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2024, Volumen 34 elocation e34060

Resumen: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Slavery is a critical event in the establishment of Brazilian society, and in particular, how Black women were (and still are) integrated into it. Black women were the mainstay of Brazilian social formation. So, today, they start from the place of someone who carries four centuries of enslavement. This ethnography seeks to recognize in the voice of Carolina, a Black woman living on the streets in Little Africa in Rio de Janeiro, the meanings of being a woman, motherhood in the context of homelessness, and its relationships with public policies. Carolina’s story helps us understand the space in which being a woman acquires meanings from the reproductive capacity and what it forges in negotiations toward mothering possibilities. She experiences the street as a space of freedom but also of insecurity and precariousness. “Handing over” the child to the legal adoption system has different meanings than those constructed by State agents. Carolina believes that “handing over” a child means breaking with any possibility of “becoming a woman” and “mother”. There is an urgent need to have an anti-racist State agenda that guides the dramatic reality of women living on the streets and their descendants under the reparatory rationale.

Resumo A escravidão é um evento crítico na formação da sociedade brasileira e, em particular, no modo como a mulher negra foi (e ainda é) a ela integrada. As mulheres negras foram o esteio da formação social brasileira, de modo que, hoje, partem do lugar de quem carrega quatro séculos de escravização. Nesta etnografia, buscamos reconhecer na voz de Carolina, mulher preta, em situação de rua, na Pequena África do Rio de Janeiro, sentidos sobre ser mulher, a maternidade no contexto da situação de rua e suas relações com as políticas públicas. A história de Carolina ajuda a compreender o espaço em que ser mulher ganha sentidos a partir da capacidade reprodutiva e o que forja de negociações para ter possibilidades de maternar. A rua é vivida por ela como espaço de liberdade, mas também de insegurança e precariedade. “Entregar” o filho para o sistema de adoção legal tem sentidos diferentes daqueles construídos por agentes de Estado. Para Carolina, a “entrega" de um filho significa a ruptura com qualquer possibilidade de “tornar-se mulher” e “mãe”. É urgente uma agenda de Estado antirracista que paute, na lógica da reparação, a dramática realidade de mulheres em situação de rua e seus descendentes.

https://doi.org/10.1590/s0103-7331202434060pt

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