Reverse left ventricular remodeling after aortic valve replacement for aortic stenosis: systematic review and meta-analysis

Introdução e objetivos: A remodelação reversa do ventrículo esquerdo (VE) após a substituição valvular aórtica (AVR), em doentes com estenose aórtica, está bem documentada como fator de prognóstico importante. No entanto, não existem valores esperados de referência. Com esta revisão sistemática e meta-análise, pretendemos caracterizar a resposta do VE após AVR. Métodos: Pesquisamos na MEDLINE/PubMed, Web of Science e Embase por estudos que relatem achados ecocardiográficos antes e pelo menos 1 mês após AVR para o tratamento de estenose aórtica. Foram identificados 5626 estudos, dos quais 4493 foram selecionados para inclusão. Os principais fatores de interesse foram as medidas estruturais e dinâmicas do VE e da válvula aórtica. Realizamos uma meta-análise de efeitos aleatórios para calcular as diferenças médias padronizadas (SMD) entre os valores de follow-up e os valores basais. Resultados: 31 estudos preencheram os critérios de elegibilidade, resultando em 2206 pacientes. AVR resultou numa redução do gradiente aórtico médio (SMD: -42.18, 95% CI: -44.39 a -39.96, I2 = 95.8%), massa do VE (para cirurgia, SMD: -84.40, CI: -103.24 a -65.57, I2 = 78.4%), massa VE indexada (SMD: -40.31, CI: -47.39 a -33.22, I2 = 78.8%), diâmetro do VE telediastólico (SMD: -2.06, CI: -3.17 a -0.94, I2 = 87.3%), volume do VE telediastólico (SMD: -13.10, CI: -18.77 a -7.43, I2 = 52.4%), espessura da parede posterior (SMD: -1.89, CI: -2.50 a -1.29, I2 = 94.1%), e espessura septal interventricular (SMD: -1.72, CI: -2.12 a -1.33, I2 = 88.1%), assim como aumento da área da válvula aórtica efetiva (SMD: 1.02, CI: 0.86 a 1.18, I2 = 96.9%) e da fração de ejeção do VE (SMD: 3.54, CI 2.22 a 4.86, I2 = 90.6%). Conclusões: A remodelação reversa ocorre após AVR e é expressa em todos os principais fatores de interesse desta revisão sistemática e meta-análise.Introduction and Objectives: Reverse Left Ventricle (LV) remodeling after Aortic Valve Replacement (AVR), in patients with aortic stenosis, is well documented as an important prognostic factor. However, there are no reference values for the expected reverse remodeling phenomenon. With this systematic review and meta-analysis, we aimed to characterize the response of the unloaded LV after AVR. Methods: We searched on MEDLINE/PubMed, Web of Science, and Embase for studies reporting echocardiographic findings before and at least 1 month after AVR for the treatment of aortic stenosis. 5626 studies were identified and 4493 were screened for inclusion. Main factors of interest were structural and dynamic measures of the LV and Aortic Valve. We performed a random-effects meta-analysis to compute standardized mean differences (SMD) between follow-up and baseline values for each outcome. Results: 31 studies met the eligibility criteria, yielding 2206 patients. AVR resulted in reduced Mean Aortic Gradient (SMD: -42.18, 95% CI: -44.39 to -39.96, I2 = 95.8%), LV Mass (for surgical AVR, SMD: -84.40, CI: -103.24 to -65.57, I2 = 78.4%), Indexed LV Mass (SMD: -40.31, CI: -47.39 to -33.22, I2 = 78.8%), End-Diastolic LV Diameter (SMD: -2.06, CI: -3.17 to -0.94, I2 = 87.3%), End-Diastolic LV Volume (SMD: -13.10, CI: -18.77 to -7.43, I2 = 52.4%), Posterior Wall Thickness (SMD: -1.89, CI: -2.50 to -1.29, I2 = 94.1%), Interventricular Septal Thickness (SMD: -1.72, CI: -2.12 to -1.33, I2 = 88.1%), and increased Effective Aortic Valve Area (SMD: 1.02, CI: 0.86 to 1.18, I2 = 96.9%), and LV Ejection Fraction (SMD: 3.54, CI 2.22 to 4.86, I2 = 90.6%). Conclusions: Reverse remodeling occurs after AVR and it is expressed in all of the main factors of interest of this systematic review and meta-analysis

ACADEMIC HELP IN A SCHOOL CONTEXT: STUDENTS OF 9 TH GRADE PERSPECTIVE

Os alunos podem auto-regular o seu aprender de forma autónoma e activa. No entanto, tal deve ser aprendido e ensinado. A iniciativa de procura de apoio e ajuda académica permite aos alunos aprender a fazê-lo e a maximizar o seu desempenho. Desta forma, visámos conhecer a concepção de procura de ajuda académica, perceber como agem perante dificuldades no seu aprender e quais as estratégias que utilizam. A amostra foi constituída por vinte alunos do 9º ano de escolaridade de ambos os géneros. A recolha de dados foi realizada através de entrevistas semi-directivas áudio- gravadas. Os dados obtidos foram tratados através de análises qualitativas e quantitativas. Os resultados revelam que a concepção de ajuda ao aprender em contexto escolar é vista como uma acção pessoal do aluno e como uma acção proveniente de outros. As situações em que o aluno considera necessitar mais de ajuda referem-se a situações de avaliação e de compreensão de conteúdos. A figura do Professor surge como a principal fonte de saber e de ajuda à qual o aluno recorre quando precisa de ajuda de âmbito escolar lato. Perante dificuldades mais específicas nas aprendizagens académicas, os alunos tentam resolvê-las maioritariamente sozinhos, ou com a ajuda da família e, só no caso de não conseguirem solucionar a sua dificuldade, procuram a ajuda do professor. Abstract Students can self-regulate their learning in an autonomous and active way. However, that should be learned and taught. The initiative to search academic help and support allows the students to learn how to do it and to maximize their performance. This way, we aim to know their perception on the search for academic help, understand how they respond to difficulties in their learning process and the strategies they choose to use. The sample consisted in twenty 9th grade students from both genders. The data collection was achieved through semi-directive audio-recorded interviews. The obtained data was treated through qualitative and quantitative analysis. The results show the perception on learning help in a school context is seen as a personal action from the students and as an action from others. The situations in which the student considers to need more help refer to assessment situations and content understanding. The Teacher’s figure appears as the man source of knowledge and help to which the student uses when help is needed in a broad school scope. Facing more specific needs with academic learning, the students try to solve them mainly alone or with the help of family members and, only when they can not solve their dificulty, they search the teacher’s help

Folk Knowledge in Maintaining Group Integration and Socio-economic Intimacy among the Arsi-Robe Peasants

The purpose of this article is to analyze the folk knowledge in maintaining folk group integration and socio-economic intimacy among the Arsi-Robe peasants. The significance of folk knowledge in folklore of the society in connection with group integration and socio-economic welfare is the case in point. This study employed a field survey research and data gathering method through the participant observation as well as direct interview. In order to obtain the substantial folkloristic data from local sources (people, occasions, or other settings), the researchers had familiarized with the social behavior and local environment of each locality. As far as the findings of this study are concerned, two points may be underscored here. People are customarily designated to take part in group-driven occupational habits like däbo and wänfä. Amongst the Arsi-Robe traditional society, if people isolate themselves from communal works, they are criticized, if not ostracized and excluded from the mainstream social and cultural roles. They also play their potential roles in kinship and kinship-like social relations. Put another way, they make interventions between their own world and a social unit in their vicinities according the collective paradigm set customarily. &nbsp

A Critical Discourse Analysis of COVID-19 in Ethiopia: Rethinking the Past and Defining the Present

The purpose of this study is to unearth the landscape of social media and analyse the contents. Contents of social media, in Ethiopia, are varying over the course of changes in politics, health, socio-economic conditions of the country. Some of the contents are reflected in the forms of narratives, comments, briefings, anecdotes, and verses to list a few. Contents changing the way people interact with each other and share information, personal messages, and opinions about situations, objects, and past experiences- rethinking the past, themes are linked to the present and define the present Ethiopia. In order to attain the stated objective, the researchers developed critical discourse analysis as a research methodology and adapted Norman Fairclough’s model of Analysis as a theoretical framework. Most social media texts are short online conversational posts or comments that do not contain enough information for a full textual analysis. Therefore, using purposive sampling six excerpts were collected from various discourses of the social media platforms, particularly Facebook, Facebook messenger, and YouTube.  Based on the contexts of the discourses, the analysis was categorized thematically. The study concluded that social media users used the platform as a means to reflect both the status quo of the past and linking to the current COVID-19 and its socio-economic impacts. COVID-19 is depicted as a disease, resulting from human wrongdoings, very dangerous which is deadly even to Satan. It is also depicted as a warrior, an extremely hungry predator looking for its prey, ready to eat up human being ravenous without a need for proper chewing

Transition to Inclusive Education Systems According to the Convention on the Rights of Persons with Disabilities

This article deals with the transition to inclusive education systems, and therefore concerns states that have built segregated education systems. Article 24 of the Convention on the Rights of Persons with Disabilities (CRPD) proclaims the right to inclusive education for disabled people. State parties that are equipped with special schools, however, face particular challenges in progressively realising the right in question. This article therefore examines what ‘inclusive education’ truly means, what steps must be taken to achieve it, and what tools can be used to ensure the transition to inclusive education systems so as to comply with the CRPD. Considering the obstacles to inclusive education, the article argues that inclusive education is a process that needs permanent efforts to adapt the general education system to disabled children. It also considers the implementation of the right to education of disabled people through the adoption of national human rights action plans and the use of human rights indicators