Relationship between endothelial nitric oxide synthase gene polymorphisms and the risk of myocardial infarction in the Algerian population

Introduction: Endothelial nitric oxide synthase (eNOS), the enzyme in charge of nitric oxide production, plays a crucial role in vascular biology. However, the impact of single nucleotide polymorphisms (SNPs) affecting the gene encoding for eNOS (eNOS) on coronary artery diseases remains under debate and no data were available at present in populations originating from Mahghreb.Aim of the Study: Our purpose was to evaluate the association between the eNOS -786T/C and +894G/T SNPs and (i) the risk of myocardial infarction (MI) and (ii) variations in systolic (SBP) and diastolic (DBP) blood pressure values.Patients and Methods: Concerning MI, the SNPs were characterised in a casecontrol study (70 cases vs 68 controls) based on the male population originating from Oran, Algeria.Results: The associations with blood pressure values were assessed in anenlarged control group including 115 male subjects. Since the -786T/CSNP could not be associated to MI, the genotype distribution of the+894G/T genotypes signifi cantly differed between MI cases and controls(p=0.025). The risk of MI (odds ratio) associated to the +894G/T SNP wasestimated to 1.2 (95%CI=[1.03;1.32]). The haplotype analysis confi rmedthis association and the absence of impact of the -786T/C SNP. On the other hand, no consistent association was shown between the two SNPs and SBP or DBP.Conclusion: As observed in other populations, the eNOS +894G/T SNPwas associated with MI in the Algerian population but the mechanismunderlying the effect could not be related to variations in blood pressure.Keywords: Endothelial nitric oxide synthase, myocardial infarction, blood pressure, genetic epidemiology

Justifications-on-demand as a device to promote shifts of attention associated with relational thinking in elementary arithmetic

Student responses to arithmetical questions that can be solved by using arithmetical structure can serve to reveal the extent and nature of relational, as opposed to computational thinking. Here, student responses to probes which require them to justify-on-demand are analysed using a conceptual framework which highlights distinctions between different forms of attention. We analyse a number of actions observed in students in terms of forms of attention and shifts between them: in the short-term (in the moment), medium-term (over several tasks), and long-term (over a year). The main factors conditioning students´ attention and its movement are identified and some didactical consequences are proposed

Mutualism between ribbed mussels and cordgrass enhances salt marsh nitrogen removal

Salt marsh ecosystems have declined globally and are increasingly threatened by erosion, sea level rise, and urban development. These highly productive, physically demanding ecosystems are populated by core species groups that often have strong trophic interactions with implications for ecosystem function and service provision. Positive interactions occur between ribbed mussels (Geukensia demissa) and cordgrass (Spartina alterniflora). Mussels transfer particulate nitrogen from the water column to the marsh sediments, which stimulates cordgrass growth, and cordgrass provides predator and/or heat stress refuge for mussels. Here, we test mussel facilitation of two functions in salt marshes that relate to N removal: microbial denitrification and water filtration. Microcosm experiments revealed that the highest rates of N-2 production and nitrification occurred when mussels were present with marsh vegetation, suggesting that mussels enhanced coupling of the nitrification-denitrification. Surveys spanning the York River Estuary, Chesapeake Bay, showed that the highest densities of mussels occurred in the first meter for all marsh types with mainstem fringing (1207 +/- 265 mussels/m(2)) being the most densely populated. The mussel population was estimated to be similar to 197 million animals with a water filtration potential of 90-135 million L/hr. Erosion simulation models demonstrated that suitable marsh habitat for ribbed mussels along the York River Estuary would be reduced by 11.8% after 50 years. This reduction in mussel habitat resulted in a projected 15% reduction in ribbed mussel abundance and filtration capacity. Denitrification potential was reduced in conjunction with projected marsh loss (35,536 m(2)) by 205 g N/hr, a 16% reduction. Because of the predominant occurrence of ribbed mussels at the marsh seaward edge and because the highest proportional loss will occur for fringing marshes (20%), shoreline management practices that restore or create fringing marsh may help offset these projected losses

Effects on nurses' quality of working life and on patients' quality of life of an educational intervention to strengthen humanistic practice among hemodialysis nurses in Switzerland: a protocol for a mixed-methods cluster randomized controlled trial.

Humanistic nursing practice constitutes the cornerstone of the nursing profession. However, according to some authors, such practice tends to fade over time in favour of non-humanistic behaviours. To contrast this tendency, an educational intervention (EI) based on Watson's Theory of Human Caring was developed and tested in two pilot studies involving, respectively, rehabilitation nurses in Quebec (Canada) and haemodialysis (HD) nurses in Switzerland. In light of the positive results obtained in these, another study is being undertaken to examine more in depth the EI's effects on both HD nurses and patients in French Switzerland. The EI is expected to have positive effects on quality of nurse-patient relationship (NPR), team cohesion, nurse quality of working life (QoWL), and patient quality of life (QoL). The study described in this protocol will use a mixed-method cluster randomised controlled trial design. For the quantitative component, nurse and patient data will be collected through questionnaires. The accessible population of 135 nurses and 430 patients will be clustered into 10 HD units. These units will be randomised into an experimental group (EG) and a waiting-list control group (WLCG). Measurements will be taken at baseline (pre-intervention) and repeatedly over time (post-intervention): immediately at EI completion and six and 12 months thereafter. For the qualitative portion of the study, 18 semi-structured interviews will be conducted with EG nurses picked at random two months after EI completion to explore perceived changes in nurse humanistic practice. Qualitative data will be analysed through the relational caring inquiry method, a phenomenological approach. Descriptive and inferential statistics will be computed from the quantitative data. The study described in this protocol will determine if and how the proposed EI promotes humanistic nursing practice and how this practice affects quality of NPR, nurse QoWL, and patient QoL. Moreover, it will lay the groundwork for offering the EI to nurses in other healthcare sectors. This clinical study was registered with ClinicalTrials.gov [NCT03283891, 14/09/2017]

Diabetic foot complications among Indigenous peoples in Canada: A scoping review through the PROGRESS-PLUS equity lens

Introduction Indigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications (DRFC), such as foot ulcers, lower extremity amputations (LEA), and peripheral arterial disease. This scoping review aimed to provide a comprehensive understanding of DRFC among First Nations, Métis, and Inuit peoples in Canada, incorporating an equity lens Methods A scoping review was conducted based on Arksey and O’Malley refined by the Joanna Briggs Institute. The PROGRESS-Plus framework was utilized to extract data and incorporate an equity lens. A critical appraisal was performed, and Indigenous stakeholders were consulted for feedback. We identified the incorporation of patient-oriented/centered research (POR). Results Of 5,323 records identified, 40 studies were included in the review. The majority of studies focused on First Nations (92%), while representation of the Inuit population was very limited populations (< 3% of studies). LEA was the most studied outcome (76%). Age, gender, ethnicity, and place of residence were the most commonly included variables. Patient-oriented/centered research was mainly included in recent studies (16%). The overall quality of the studies was average. Data synthesis showed a high burden of DRFC among Indigenous populations compared to non-Indigenous populations. Indigenous identity and rural/remote communities were associated with the worse outcomes, particularly major LEA. Discussion This study provides a comprehensive understanding of DRFC in Indigenous peoples in Canada of published studies in database. It not only incorporates an equity lens and patient-oriented/centered research but also demonstrates that we need to change our approach. More data is needed to fully understand the burden of DRFC among Indigenous peoples, particularly in the Northern region in Canada where no data are previously available. Western research methods are insufficient to understand the unique situation of Indigenous peoples and it is essential to promote culturally safe and quality healthcare. Conclusion Efforts have been made to manage DRFC, but continued attention and support are necessary to address this population’s needs and ensure equitable prevention, access and care that embraces their ways of knowing, being and acting

Bridging knowing and proving in mathematics An essay from a didactical perspective

Text of a talk at the conference "Explanation and Proof in Mathematics: Philosophical and Educational Perspective" held in Essen in November 2006International audienceThe learning of mathematics starts early but remains far from any theoretical considerations: pupils' mathematical knowledge is first rooted in pragmatic evidence or conforms to procedures taught. However, learners develop a knowledge which they can apply in significant problem situations, and which is amenable to falsification and argumentation. They can validate what they claim to be true but using means generally not conforming to mathematical standards. Here, I analyze how this situation underlies the epistemological and didactical complexities of teaching mathematical proof. I show that the evolution of the learners' understanding of what counts as proof in mathematics implies an evolution of their knowing of mathematical concepts. The key didactical point is not to persuade learners to accept a new formalism but to have them understand how mathematical proof and statements are tightly related within a common framework; that is, a mathematical theory. I address this aim by modeling the learners' way of knowing in terms of a dynamic, homeostatic system. I discuss the roles of different semiotic systems, of the types of actions the learners perform and of the controls they implement in constructing or validating knowledge. Particularly with modern technological aids, this model provides a basis designing didactical situations to help learners bridge the gap between pragmatics and theory

Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

<p>Abstract</p> <p>Background</p> <p>Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland.</p> <p>Methods</p> <p>The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital). A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse). The introduction of this triage system was combined with information to the public on the "correct" use of emergency services.</p> <p>Results</p> <p>After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month) as compared to the three previous years in the EDs. The Number of visits to public sector GPs during office hours did not alter. Implementation of ABCDE-triage combined with public guidance was associated with decreased total number of doctor visits in public health care. During same period, the number of patient visits in the private health care increased. Simultaneously, the number of doctor visits in secondary health care ED did not alter.</p> <p>Conclusions</p> <p>The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the secondary health care EDs. Limiting the access of less urgent patients to ED may redirect the demands of patients to private sector rather than office hours GP services.</p

New technologies and firm organization : the case of electronic traceability systems in French agribusiness

This paper considers the relationship between the adoption of electronic traceability systems (ETSs) and the organization of firms. More precisely, it analyzes the respective roles of a firm's organizational structure, and organizational changes, in the process of ETS adoption in agribusiness. We use data from the French "Organizational Changes and Computerization" survey from 2006. We test a probit model to demonstrate the organizational structure and organizational changes underlying the firm's ETS adoption choice. Results show that ETS adoption is strongly favored by organizations with heavy hierarchical structures, standardized managerial practices and contractual mechanisms with external partners. This adoption process seems to coevolve with the organization: firms that implemented an ETS during the observed period (2003-2006) have experienced the most important organizational changes in terms of managerial practices, information systems and contractual relations, as well as the strengthening of the intermediate levels in the hierarchy

Teaching and Learning of Calculus

This survey focuses on the main trends in the field of calculus education. Despite their variety, the findings reveal a cornerstone issue that is strongly linked to the formalism of calculus concepts and to the difficulties it generates in the learning and teaching process. As a complement to the main text, an extended bibliography with some of the most important references on this topic is included. Since the diversity of the research in the field makes it difficult to produce an exhaustive state-of-the-art summary, the authors discuss recent developments that go beyond this survey and put forward new research questions