Pediatric ocular rosacea, a misdiagnosed disease with high morbidity: Proposed diagnostic criteria

Ocular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children. A clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola/chalazions and conjunctival/corneal phlyctenules evolving to neovascularization and scarring may occur. Visual impairment and consequent amblyopia are frequent and corneal perforation although rare is the most feared complication. Ocular manifestations usually precede cutaneous lesions. Although few cases of pediatric ocular rosacea (POR) have been reported in the literature, many cases must have been underdiagnosed or misdiagnosed. The delay in diagnosis is greater than one year in the large majority of cases and may lead to serious ocular sequelae. This review aims to highlight the clinical features of POR, its epidemiology, easy diagnosis and effective treatment. We also propose new diagnostic criteria, in which at least three of the five clinical criteria must be present: (1) Chronic or recurrent keratoconjunctivitis and/or red eye and/or photophobia; (2) Chronic or recurrent blepharitis and/or chalazia/ hordeola; (3) Eyelid telangiectasia documented by an ophthalmologist; (4) Primary periorificial dermatitis and/ or primary features of rosacea; and (5) Positive familial history of cutaneous and/or ocular rosacea

Innocent heart murmurs

Innocent heart murmur is a frequent auscultatory finding in children. The diagnosis is essentially clinical, without need for further investigation. However, excluding heart disease can be a difficult task. This review article describes some features of medical history and physical examination that help in this differentiation. The role of diagnostic tests is also examined

Student perspectives on the relationship between a curve and its tangent in the transition from Euclidean Geometry to Analysis

The tangent line is a central concept in many mathematics and science courses. In this paper we describe a model of students’ thinking – concept images as well as ability in symbolic manipulation – about the tangent line of a curve as it has developed through students’ experiences in Euclidean Geometry and Analysis courses. Data was collected through a questionnaire administered to 196 Year 12 students. Through Latent Class Analysis, the participants were classified in three hierarchical groups representing the transition from a Geometrical Global perspective on the tangent line to an Analytical Local perspective. In the light of this classification, and through qualitative explanations of the students’ responses, we describe students’ thinking about tangents in terms of seven factors. We confirm the model constituted by these seven factors through Confirmatory Factor Analysis

A introdução de competências de gestão na formação médica: uma avaliação multidimensional das expectativas

In the last decades, the organizational dynamics has shown the imperative need to rule the management competences mainly relevant in the health sector. Has this reality been perceived and included in the medical curriculum? Once there is a reformist impulse in the way how the health units are managed, why haven’t most of the Medicine Faculties integrated this domain in their curricular reforms? Hence, there seems to be a strong search for these additional competences, only in a post-graduate phase, above all justified by a better qualification in the medical praxis, in which the doctors are called to decide in scenarios with limited resources and budget constraints. With this work we wish to research the perceptions and eventual motivations of the students in the Medicine Faculties of Portugal to introduce management competences in the ir medical pre-graduate curriculum. Focusing on the medicine students and on the change occurred in the doctors’ behaviour, before and after contacting with this new competence, we aspired to qualify and understand the future graduates’ expectations in what regards this objective. Thus, the use of the Non Linear Canonical Correlation Analysis has allowed not only the multidimensional description of topologies and /or typologies of individuals, but it has also analysed the relations among the various answers, arranged in optimal scales, thus determining similarities / dissimilarities among the shown opinions along the medical training process. From the results it was concluded that there isn’t a majority group expressing a tendency clearly, but rather a distribution of the respondents in the various typologies in every sample, which indicates to the decision-makers a perspective of the curriculum flexible approach, in a different model from the one predominating in the present Medical Education institutions, that still don’t work with the concept of curricular attractors.A dinâmica organizacional que se tem manifestado nas últimas décadas tornou imperativo o domínio de competências de gestão, particularmente relevantes no sector da saúde. Terá sido esta realidade percepcionada e incluída no currículo médico? Existindo um impulso reformista na forma de encarar a gestão de unidades de saúde, por que razão a maioria das Faculdades de Medicina não integrou este domínio nas suas reformas curriculares? Não obstante, parece existir uma forte procura na aquisição destas competências complementares, apenas numa fase pós-graduada, fundamentalmente justificada por uma melhor qualificação na prática médica, na qual os médicos são chamados a decidir em cenários com recursos limitados e constrangimentos orçamentais. Pretendemos com este trabalho, investigar as motivações das Faculdades de Medicina em Portugal para a introdução de competências de gestão no currículo pré e pós-graduado médico. Centrando-nos nos alunos de medicina e na mudança operada no comportamento dos médicos, antes e após contacto com esta nova competência, aspirámos qualificar e entender as expectativas dos futuros licenciados em relação a este objectivo. Assim, o recurso à Análise de Correlações Canónicas Não Lineares permitiu, não só uma descrição multidimensional de topologias e/ou tipologias de indivíduos, como também analisou as relações entre as várias respostas, acomodadas em escalas óptimas, determinando, deste modo, similitudes/dissimilitudes entre as opiniões manifestadas, no decurso do processo de formação médica

Students’ Evolving Meaning About Tangent Line with the Mediation of a Dynamic Geometry Environment and an Instructional Example Space

In this paper I report a lengthy episode from a teaching experiment in which fifteen Year 12 Greek students negotiated their definitions of tangent line to a function graph. The experiment was designed for the purpose of introducing students to the notion of derivative and to the general case of tangent to a function graph. Its design was based on previous research results on students’ perspectives on tangency, especially in their transition from Geometry to Analysis. In this experiment an instructional example space of functions was used in an electronic environment utilising Dynamic Geometry software with Function Grapher tools. Following the Vygotskian approach according to which students’ knowledge develops in specific social and cultural contexts, students’ construction of the meaning of tangent line was observed in the classroom throughout the experiment. The analysis of the classroom data collected during the experiment focused on the evolution of students’ personal meanings about tangent line of function graph in relation to: the electronic environment; the pre-prepared as well as spontaneous examples; students’ engagement in classroom discussion; and, the role of researcher as a teacher. The analysis indicated that the evolution of students’ meanings towards a more sophisticated understanding of tangency was not linear. Also it was interrelated with the evolution of the meaning they had about the inscriptions in the electronic environment; the instructional example space; the classroom discussion; and, the role of the teacher

‘Warrant’ revisited: Integrating mathematics teachers’ pedagogical and epistemological considerations into Toulmin’s model for argumentation

In this paper, we propose an approach to analysing teacher arguments that takes into account field dependence—namely, in Toulmin’s sense, the dependence of warrants deployed in an argument on the field of activity to which the argument relates. Freeman, to circumvent issues that emerge when we attempt to determine the field(s) that an argument relates to, proposed a classification of warrants (a priori, empirical, institutional and evaluative). Our approach to analysing teacher arguments proposes an adaptation of Freeman’s classification that distinguishes between: epistemological and pedagogical a priori warrants, professional and personal empirical warrants, epistemological and curricular institutional warrants, and evaluative warrants. Our proposition emerged from analyses conducted in the course of a written response and interview study that engages secondary mathematics teachers with classroom scenarios from the mathematical areas of analysis and algebra. The scenarios are hypothetical, grounded on seminal learning and teaching issues, and likely to occur in actual practice. To illustrate our proposed approach to analysing teacher arguments here, we draw on the data we collected through the use of one such scenario, the Tangent Task. We demonstrate how teacher arguments, not analysed for their mathematical accuracy only, can be reconsidered, arguably more productively, in the light of other teacher considerations and priorities: pedagogical, curricular, professional and personal

Sensing polymer inhomogeneity in coated metals during the early stages of coating degradation

Negative-feedback scanning electrochemical microscopy (SECM) is successfully applied to visualize spatially-resolved differences in the topography of coated metal samples upon exposure to aqueous electrolyte solutions of different composition. This method allows the investigation of the uptake of reactants from the electrolyte phase through the polymeric matrix to the metal/polymer interface to be performed even at early exposures. Yet, the method must be carefully checked to discard transport processes from the organic matrix into the solution phase, such as those related to lixiviation. In this later case, the topography of the polymer layer may evolve with time accordingly, not longer exclusively responding to the uptake by the polymer matrix of components from the electrolyte phase. Furthermore, lixiviated species may also react with the SECM tip, eventually leading to the continuous modification of the active surface area of the electrode during the measurements. In this work, the effect of lixiviation from a nickel foil coated with plasticized PVC (PVC Plastisol) on its topographic characterization by SECM was investigate

The French Didactic Tradition in Mathematics

This chapter presents the French didactic tradition. It first describes theemergence and development of this tradition according to four key features (role ofmathematics and mathematicians, role of theories, role of design of teaching andlearning environments, and role of empirical research), and illustrates it through two case studies respectively devoted to research carried out within this traditionon algebra and on line symmetry-reflection. It then questions the influence of thistradition through the contributions of four researchers from Germany, Italy, Mexicoand Tunisia, before ending with a short epilogue

Changes in Microbiota Profile in the Proximal Remnant Intestine in Infants Undergoing Surgery Requiring Enterostomy

Early-life gut dysbiosis has been associated with an increased risk of inflammatory, metabolic, and immune diseases later in life. Data on gut microbiota changes in infants undergoing intestinal surgery requiring enterostomy are scarce. This prospective cohort study examined the enterostomy effluent of 29 infants who underwent intestinal surgery due to congenital malformations of the gastrointestinal tract, necrotizing enterocolitis, or spontaneous intestinal perforation. Initial effluent samples were collected immediately after surgery and final effluent samples were collected three weeks later. Gut microbiota composition was analysed using real-time PCR and 16S rRNA gene sequencing. Three weeks after surgery, an increase in total bacteria number (+21%, p = 0.026), a decrease in Staphylococcus (-21%, p = 0.002) and Candida spp. (-16%, p = 0.045), and an increase in Lactobacillus (+3%, p = 0.045) and in less abundant genera belonging to the Enterobacteriales family were found. An increase in alpha diversity (Shannon's and Simpson's indexes) and significant alterations in beta diversity were observed. A correlation of necrotizing enterocolitis with higher Staphylococcus abundance and higher alpha diversity was also observed. H2-blockers and/or proton pump inhibitor therapy were positively correlated with a higher total bacteria number. In conclusion, these results suggest that positive changes occur in the gut microbiota profile of infants three weeks after intestinal surgery.info:eu-repo/semantics/publishedVersio