44,031 research outputs found

    Accuracy of the Logistic EuroSCORE in Predicting Long-Term Survival Following Isolated Aortic Valve Replacement

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    Objective: To assess the ability of the logistic EuroSCORE to predict long- term mortality of patients undergoing isolated Surgical Aortic Valve Replacement (SAVR). Methods: A retrospective review of all patients undergoing SAVR between September 1999, and March 2018 was done. Results: 2018 patients were eligible for inclusion in the study. Patients were grouped according to risk: low (n = 506), intermediate (n = 609), and high-risk (n = 903) depending on their logistic EuroSCORE values. The 30-day mortality of the low- risk group was 0.47%. The one-, five-, 10-, 15-, and 20-year mortality was 1.66%, 4.9%, 14.9%, 24.3%, and 43.8%, respectively. Intermediate-risk group 30-day mortality was 0.66%. The one-, five-, 10-, 15-, and 20-year mortality was 3.28%, 11.9%, 32%, 54.8%, and 82.6%, respectively. The 30-day mortality of the high- risk group was 3.99%. The one-, five-, 10-, 15-, and 20-year mortality was 8.2%, 27%, 55.4%, 78.6%, and 87%, respectively. Conclusion: Our results confirm that the lES is accurate in predicting long-term mortality outcomes of SAVR. This real-world data provides evidence of the potential usefulness of the EuroSCORE to help the heart team and patients decide on appropriate interventions for aortic stenosis

    Gamification in E-Learning: game factors to strengthen specific English pronunciation features in undergraduate students at UPTC Sogamoso

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    Appendix A Characterization survey (104), Appendix B. EFL Students’ questionnaire (109), Appendix C. Characterization survey: data treatment question (113), Appendix D. Informed consent letter, English version (114), Appendix E. Carta de consentimiento informado, versión en español (117), Appendix F. Time Schedule (120), Appendix G. Sample Challenges at Moodle (126), Appendix H. Participants’ questionnaire results (128).La gamificación es un término que suele denotar el uso de componentes del juego en situaciones no relacionadas con el juego en sí para crear experiencias de aprendizaje agradables, divertidas y motivadoras para los estudiantes (Werbach y Hunter, 2012). Por lo tanto, el análisis de los factores básicos de los juegos se convierte en algo esencial a la hora de definir y utilizar la gamificación como estrategia de mediación del inglés como lengua extranjera para fortalecer rasgos específicos de pronunciación en los estudiantes de pregrado de la UPTC Sogamoso. El procedimiento de estudio se basa en la investigación acción mediante la implementación de la estrategia de gamificación para la mediación en la pronunciación del inglés, orientada a treinta estudiantes de diferentes programas de ingeniería, administración y tecnología con niveles heterogéneos de dominio del inglés. Las actividades se centran principalmente en la producción de sonidos, el ritmo, el acento y la entonación, los rasgos de pronunciación segmental y suprasegmental. Los resultados arrojaron una evidente mejora en las características segméntales y suprasegmentales de la percepción en la pronunciación de los participantes así como la contribución del objetivo de los juegos a la instrucción fonética y fonológica, la sensación en el juego a la motivación para mejorar la pronunciación, el reto establecido en los juegos a la actitud positiva de los participantes, y la sociabilidad a la exposición practica de la pronunciación inglesa.Gamification is a relatively new term that often denotes the use of game components in situations unrelated to the game itself to create enjoyable, fun, and motivating learning experiences for students (Werbach and Hunter, 2012). Therefore, analyzing the games' basic factors becomes essential when defining and using gamification as a strategy for English as Foreign Language mediation to strengthen specific pronunciation features in UPTC Sogamoso undergraduate students. The study procedure is based on action research by implementing the gamification strategy for mediation in English pronunciation, oriented to thirty students from different engineering, management, and technology programs at heterogeneous levels of English proficiency. The activities mainly focus on sound production, rhythm, stress, and intonation, segmental and suprasegmental pronunciation features. The results showed an evident improvement in the segmental and suprasegmental features of the participants' pronunciation perception as well as the contribution of game goals to phonetics and phonological instruction, the game sensation to the motivation for pronunciation improvement, the game challenge to the participants' positive attitude, and the sociality to the English pronunciation exposure practice

    Metaphors of London fog, smoke and mist in Victorian and Edwardian Art and Literature

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    Julian Wolfreys has argued that after 1850 writers employed stock images of the city without allowing them to transform their texts. This thesis argues, on the contrary, that metaphorical uses of London fog were complex and subtle during the Victorian and Edwardian periods, at least until 1914. Fog represented, in particular, formlessness and the dissolution of boundaries. Examining the idea of fog in literature, verse, newspaper accounts and journal articles, as well as in the visual arts, as part of a common discourse about London and the state of its inhabitants, this thesis charts how the metaphorical appropriation of this idea changed over time. Four of Dickens's novels are used to track his use of fog as part of a discourse of the natural and unnatural in individual and society, identifying it with London in progressively more negative terms. Visual representations of fog by Constable, Turner, Whistler, Monet, Markino, O'Connor, Roberts and Wyllie and Coburn showed an increasing readiness to engage with this discourse. Social tensions in the city in the 1880s were articulated in art as well as in fiction. Authors like Hay and Barr showed the destruction of London by its fog because of its inhabitants' supposed degeneracy. As the social threat receded, apocalyptic scenarios gave way to a more optimistic view in the work of Owen and others. Henry James used fog as a metaphorical representation of the boundaries of gendered behaviour in public, and the problems faced by women who crossed them. The dissertation also examines fog and individual transgression, in novels and short stories by Lowndes, Stevenson, Conan Doyle and Joseph Conrad. After 1914, fog was no more than a crude signifier of Victorian London in literature, film and, later, television, deployed as a cliche instead of the subtle metaphorical idea discussed in this thesis

    Building body identities - exploring the world of female bodybuilders

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    This thesis explores how female bodybuilders seek to develop and maintain a viable sense of self despite being stigmatized by the gendered foundations of what Erving Goffman (1983) refers to as the 'interaction order'; the unavoidable presentational context in which identities are forged during the course of social life. Placed in the context of an overview of the historical treatment of women's bodies, and a concern with the development of bodybuilding as a specific form of body modification, the research draws upon a unique two year ethnographic study based in the South of England, complemented by interviews with twenty-six female bodybuilders, all of whom live in the U.K. By mapping these extraordinary women's lives, the research illuminates the pivotal spaces and essential lived experiences that make up the female bodybuilder. Whilst the women appear to be embarking on an 'empowering' radical body project for themselves, the consequences of their activity remains culturally ambivalent. This research exposes the 'Janus-faced' nature of female bodybuilding, exploring the ways in which the women negotiate, accommodate and resist pressures to engage in more orthodox and feminine activities and appearances

    The temporality of rhetoric: the spatialization of time in modern criticism

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    Every conception of criticism conceals a notion of time which informs the manner in which the critic conceives of history, representation and criticism itself. This thesis reveals the philosophies of time inherent in certain key modern critical concepts: allegory, irony and the sublime. Each concept opens a breach in time, a disruption of chronology. In each case this gap or aporia is emphatically closed, elided or denied. Taking the philosophy of time elaborated by Giorgio Agamben as an introductory proposition, my argument turns in Chapter One to the allegorical temporality which Walter Benjamin sees as the time of photography. The second chapter examines the aesthetics of the sublime as melancholic or mournful untimeliness. In Chapter Three, Paul de Man's conception of irony provides an exemplary instance of the denial of this troubling temporal predicament. In opposition to the foreclosure of the disturbing temporalities of criticism, history and representation, the thesis proposes a fundamental rethinking of the philosophy of time as it relates to these categories of reflection. In a reading of an inaugural meditation on the nature of time, and in examining certain key contemporary philosophical and critical texts, I argue for a critical attendance to that which eludes those modes of thought that attempt to map time as a recognizable and essentially spatial field. The Confessions of Augustine provide, in the fourth chapter, a model for thinking through the problems set up earlier: Augustine affords us, precisely, a means of conceiving of the gap or the interim. In the final chapter, this concept is developed with reference to the criticism of Arnold and Eliot, the fiction of Virginia Woolf and the philosophy of cinema derived from Deleuze and Lyotard. In conclusion, the philosophical implications of the thesis are placed in relation to a conception of the untimeliness of death

    Metabolic and nutritional triggers associated with increased risk of liver complications in SARS-CoV-2

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    Obesity, diabetes, cardiovascular and respiratory diseases, cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can quickly induce severe respiratory failure in 5% of cases. Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease, and damage to the liver parenchyma can be caused by infection of hepatocytes. Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction. Furthermore, pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage. In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients. As guidelines for SARS-CoV-2 in intensive care (IC) specifically are not yet available, strategies for management of sepsis and SARS are suggested in SARS-CoV-2. Early enteral nutrition (EN) should be started soon after IC admission, preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day. Monitoring is necessary to identify signs of intolerance, hemodynamic instability and metabolic disorders, and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. Nutrients including vitamins A, C, D, E, B6, B12, folic acid, zinc, selenium and ω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation. Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients
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