Effects of a Hybrid Program of Active Breaks and Responsibility on the Behaviour of Primary Students: A Mixed Methods Study

Schools are ideal environments to promote healthy lifestyles and teach values among students. In this sense, the present study aims to verify the result of an Active Break program (AB) within the Teaching Personal and Social Responsibility (TPSR) Model in the school environment. The sample consisted of two teachers/tutors from the sixth year of Primary Education and 51 pupils, aged between 11 and 13 years, who were divided into an experimental group (n = 26) and a control group (n = 25). The intervention program lasted 3 months, in which the hybridised methodology was applied during 100% of the weekly classes, computing a total of 156 sessions by the end of the study. It was a quasi-experimental study design that used a mixed methodology combining a systematic observational analysis with semi-structured interviews. The results showed an evolution in the behaviour of the teacher from the experimental group from a controlling style to one centred on the transfer of autonomy, while the teacher from the control group primarily used strategies based on the imposition of tasks and the establishment of organisation, which caused an increase in disruptive behaviours among students. We conclude that the program is adaptable to Primary Education and can be extended to any educational environment to improve the classroom climate and attract the attention of students and, finally, allows for the promotion of new teaching strategies.We are grateful for the support of the National Institute of Physical Education of Catalonia (INEFC); the Spanish government subprojects integration ways between qualitative and quantitative data, multiple case development, and synthesis review as main axis for an innovative future in physical activity and sports research (PGC2018-098742-B-C31) and mixed method approach on performance analysis (in training and competition) in elite and academy sport (PGC2018-098742-B-C33) (2019–2021) (Ministry of Science, Innovation and Universities/State Research Agency/European Regional Development Fund), which are part of the coordinated project’s new approach to research in physical activity and sport from mixed methods perspective (NARPAS_MM) (SPGC201800X098742CV0); the Generalitat de Catalunya Research Group [Research group and in novation in designs] (GRID); Technology and multimedia and digital application to observational designs (Grant number 2017 SGR 1405). All individuals included in this section have consented to the acknowledgement

Whole-Blood Mitochondrial DNA Copies Are Associated With the Prognosis of Acute Respiratory Distress Syndrome After Sepsis.

https://pubmed.ncbi.nlm.nih.gov/34557198/#:~:text=Resumen-,El%20s%C3%ADndrome%20de%20dificultad%20respiratoria%20aguda%20(SDRA)%20es%20un%20proceso,v%C3%ADnculos%20mec%C3%A1nicos%20de%20esta%20observaci%C3%B3n%20con%20la%20patogenia%20del%20SDRA.,-Palabras%20clave%3A%20SDR

Clinical relevance of timing of assessment of ICU mortality in patients with moderate-to-severe Acute Respiratory Distress Syndrome

Mortality is a frequently reported outcome in clinical studies of acute respiratory distress syndrome (ARDS). However, timing of mortality assessment has not been well characterized. We aimed to identify a crossing-point between cumulative survival and death in the intensive care unit (ICU) of patients with moderate-to-severe ARDS, beyond which the number of survivors would exceed the number of deaths. We hypothesized that this intersection would occur earlier in a successful clinical trial vs. observational studies of moderate/severe ARDS and predict treatment response. We conducted an ancillary study of 1580 patients with moderate-to-severe ARDS managed with lung-protective ventilation to assess the relevance and timing of measuring ICU mortality rates at different time-points during ICU stay. First, we analyzed 1303 patients from four multicenter, observational cohorts enrolling consecutive patients with moderate/severe ARDS. We assessed cumulative ICU survival from the time of moderate/severe ARDS diagnosis to ventilatory support discontinuation within 7-days, 28-days, 60-days, and at ICU discharge. Then, we compared these findings to those of a successful randomized trial of 277 moderate/severe ARDS patients. In the observational cohorts, ICU mortality (487/1303, 37.4%) and 28-day mortality (425/1102, 38.6%) were similar (p = 0.549). Cumulative proportion of ICU survivors and non-survivors crossed at day-7; after day-7, the number of ICU survivors was progressively higher compared to non-survivors. Measures of oxygenation, lung mechanics, and severity scores were different between survivors and non-survivors at each point-in-time (p < 0.001). In the trial cohort, the cumulative proportion of survivors and non-survivors in the treatment group crossed before day-3 after diagnosis of moderate/severe ARDS. In clinical ARDS studies, 28-day mortality closely approximates and may be used as a surrogate for ICU mortality. For patients with moderate-to-severe ARDS, ICU mortality assessment within the first week of a trial might be an early predictor of treatment response

Predicting the length of mechanical ventilation in acute respiratory disease syndrome using machine learning: The PIONEER Study

Background: The ability to predict a long duration of mechanical ventilation (MV) by clinicians is very limited. We assessed the value of machine learning (ML) for early prediction of the duration of MV > 14 days in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Methods: This is a development, testing, and external validation study using data from 1173 patients on MV ≥ 3 days with moderate-to-severe ARDS. We first developed and tested prediction models in 920 ARDS patients using relevant features captured at the time of moderate/severe ARDS diagnosis, at 24 h and 72 h after diagnosis with logistic regression, and Multilayer Perceptron, Support Vector Machine, and Random Forest ML techniques. For external validation, we used an independent cohort of 253 patients on MV ≥ 3 days with moderate/severe ARDS. Results: A total of 441 patients (48%) from the derivation cohort (n = 920) and 100 patients (40%) from the validation cohort (n = 253) were mechanically ventilated for >14 days [median 14 days (IQR 8–25) vs. 13 days (IQR 7–21), respectively]. The best early prediction model was obtained with data collected at 72 h after moderate/severe ARDS diagnosis. Multilayer Perceptron risk modeling identified major prognostic factors for the duration of MV > 14 days, including PaO2/FiO2, PaCO2, pH, and positive end-expiratory pressure. Predictions of the duration of MV > 14 days showed modest discrimination [AUC 0.71 (95%CI 0.65–0.76)]. Conclusions: Prolonged MV duration in moderate/severe ARDS patients remains difficult to predict early even with ML techniques such as Multilayer Perceptron and using data at 72 h of diagnosis. More research is needed to identify markers for predicting the length of MV. This study was registered on 14 August 2023 at ClinicalTrials.gov (NCT NCT05993377)

The sepsis six

La sepsis es la segunda causa de muerte en los países industrializados, llevando asociado un importante gasto sanitario. En el año 2004, conscientes del problema, la European Society of Intensive Care Medicine, Society of Critical Care Medicine y el International Sepsis Forum, en el marco de la Surviving Sepsis Campaign publicaron unas recomendaciones, que se actualizaron en 2008, cuyo objetivo era protocolizar el tratamiento de la sepsis. Con ello, se ha conseguido disminuir la mortalidad en 6 puntos. El objetivo de este manuscrito es difundir las recomendaciones de las sociedades científicas y concienciar a los profesionales del Hospital General Universitario de Ciudad Real de la importancia del diagnóstico y tratamiento de la sepsis, animando a aplicar estos paquetes de medidas recomendados precozmente, para evitar complicaciones mayores. Nos limitamos a las medidas recomendadas en las 6 primeras horas por su sencillez, su precio y su eficacia, sin entrar en aquellas reservadas a los pacientes críticos y de aplicación en unidades especializadas. Objetivo: Realizar una revisión de las recomendaciones vigentes que facilite concienciar a los profesionales del Hospital General Universitario de Ciudad Real, de la importancia y necesidad del diagnóstico y tratamiento precoces de la sepsis, animando a aplicar estos paquetes de medidas desde cualquier nivel asistencial, para evitar complicaciones mayores y gastos evitables. Estrategia de Búsqueda: Bases de datos bibliográficas (Medline), Revistas científicas, webs científicas , fuentes propias. Selección de Estudios: Basada principalmente en la relevancia científica de las fuentes de información

Preferential accumulation of severe variants of Citrus tristeza virus in plants co-inoculated with mild and severe variants

The viral population in sweet orange plants, either healthy or pre-inoculated with the asymptomatic isolate of Citrus tristeza virus (CTV) T32, and then graft- or aphid-inoculated with the stem-pitting isolate T318, was characterized with respect to symptom expression, reaction with monoclonal antibody MCA13, single-strand conformation polymorphism (SSCP) of genes p18 and p20, bi-directional RT-PCR, and dot-blot hybridisation. All plants inoculated with T318, with or without pre-inoculation, showed stem pitting, reacted with MCA13, had the SSCP profile characteristic of this isolate, and in bi-directional RT-PCR yielded a 450-bp DNA product associated with severe isolates, indicating that T32 afforded no protection against T318. The latter isolate had two main sequence variants, the minor one of which was indistinguishable from the main T32 sequence, and both were detected in most plants that were graft-inoculated with T318. However, the T32 variant was not detected in plants that were aphid-inoculated only with T318 and also showed stem pitting. This suggested an association of symptoms with the major T318 sequence and preferential transmission of this variant by aphids. The T318-specific variant accumulated more than the T32 variant in plants in which both were replicating, suggesting a higher fitness of the former. Our results clearly emphasize the potential threat of severe CTV variants in areas where mild isolates are presently predominant

Efficacy of dexamethasone treatment for patients with the acute respiratory distress syndrome caused by COVID-19: study protocol for a randomized controlled superiority trial

Abstract Background There are no specific generally accepted therapies for the coronavirus disease 2019 (COVID-19). The full spectrum of COVID-19 ranges from asymptomatic disease to mild respiratory tract illness to severe pneumonia, acute respiratory distress syndrome (ARDS), multisystem organ failure, and death. The efficacy of corticosteroids in viral ARDS remains unknown. We postulated that adjunctive treatment of established ARDS caused by COVID-19 with intravenous dexamethasone might change the pulmonary and systemic inflammatory response and thereby reduce morbidity, leading to a decrease in duration of mechanical ventilation and in mortality. Methods/design This is a multicenter, randomized, controlled, parallel, open-label, superiority trial testing dexamethasone in 200 mechanically ventilated adult patients with established moderate-to-severe ARDS caused by confirmed SARS-CoV-2 infection. Established ARDS is defined as maintaining a PaO2/FiO2 ≤ 200 mmHg on PEEP ≥ 10 cmH2O and FiO2 ≥ 0.5 after 12 ± 3 h of routine intensive care. Eligible patients will be randomly assigned to receive either dexamethasone plus standard intensive care or standard intensive care alone. Patients in the dexamethasone group will receive an intravenous dose of 20 mg once daily from day 1 to day 5, followed by 10 mg once daily from day 6 to day 10. The primary outcome is 60-day mortality. The secondary outcome is the number of ventilator-free days, defined as days alive and free from mechanical ventilation at day 28 after randomization. All analyses will be done according to the intention-to-treat principle. Discussion This study will assess the role of dexamethasone in patients with established moderate-to-severe ARDS caused by SARS-CoV-2. Trial registration ClinicalTrials.gov NCT04325061 . Registered on 25 March 2020 as DEXA-COVID19