High-Sensitivity Cardiac Troponin and the Universal Definition of Myocardial Infarction.

Background: The introduction of more sensitive cardiac troponin assays has led to increased recognition of myocardial injury in acute illnesses other than acute coronary syndrome. The Universal Definition of Myocardial Infarction recommends high-sensitivity cardiac troponin (hs-cTn) testing and classification of patients with myocardial injury based on aetiology, but the clinical implications of implementing this guideline are not well understood. Methods: In a stepped-wedge cluster randomized controlled trial, we implemented a hs-cTn assay and the recommendations of the Universal Definition in 48,282 consecutive patients with suspected acute coronary syndrome. In a pre-specified secondary analysis, we compared the primary outcome of myocardial infarction or cardiovascular death and secondary outcome of non-cardiovascular death at one year across diagnostic categories. Results: Implementation increased the diagnosis of type 1 myocardial infarction by 11% (510/4,471), type 2 myocardial infarction by 22% (205/916), and acute and chronic myocardial injury by 36% (443/1,233) and 43% (389/898), respectively. Compared to those without myocardial injury, the rate of the primary outcome was highest in those with type 1 myocardial infarction (cause-specific hazard ratio [csHR] 5.64, 95% confidence interval [CI] 5.12 to 6.22), but was similar across diagnostic categories, whereas non-cardiovascular deaths were highest in those with acute myocardial injury (csHR 2.65, 95%CI 2.33 to 3.01). Despite modest increases in anti-platelet therapy and coronary revascularization after implementation in patients with type 1 myocardial infarction, the primary outcome was unchanged (csHR 1.00, 95%CI 0.82 to 1.21). Increased recognition of type 2 myocardial infarction and myocardial injury did not lead to changes in investigation, treatment or outcomes. Conclusions: Implementation of high-sensitivity cardiac troponin and the recommendations of the Universal Definition of Myocardial Infarction identified patients at high-risk of cardiovascular and non-cardiovascular events, but was not associated with consistent increases in treatment or improved outcomes. Trials of secondary prevention are urgently required to determine whether this risk is modifiable in patients without type 1 myocardial infarction. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT0185212

Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome.

BACKGROUND: Major disparities between women and men in the diagnosis, management, and outcomes of acute coronary syndrome are well recognized. OBJECTIVES: The aim of this study was to evaluate the impact of implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial infarction in women and men with suspected acute coronary syndrome. METHODS: Consecutive patients with suspected acute coronary syndrome were enrolled in a stepped-wedge, cluster-randomized controlled trial across 10 hospitals. Myocardial injury was defined as high-sensitivity cardiac troponin I concentration >99th centile of 16 ng/l in women and 34 ng/l in men. The primary outcome was recurrent myocardial infarction or cardiovascular death at 1 year. RESULTS: A total of 48,282 patients (47% women) were included. Use of the high-sensitivity cardiac troponin I assay with sex-specific thresholds increased myocardial injury in women by 42% and in men by 6%. Following implementation, women with myocardial injury remained less likely than men to undergo coronary revascularization (15% vs. 34%) and to receive dual antiplatelet (26% vs. 43%), statin (16% vs. 26%), or other preventive therapies (p < 0.001 for all). The primary outcome occurred in 18% (369 of 2,072) and 17% (488 of 2,919) of women with myocardial injury before and after implementation, respectively (adjusted hazard ratio: 1.11; 95% confidence interval: 0.92 to 1.33), compared with 18% (370 of 2,044) and 15% (513 of 3,325) of men (adjusted hazard ratio: 0.85; 95% confidence interval: 0.71 to 1.01). CONCLUSIONS: Use of sex-specific thresholds identified 5 times more additional women than men with myocardial injury. Despite this increase, women received approximately one-half the number of treatments for coronary artery disease as men, and outcomes were not improved. (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]; NCT01852123)

Relações de classe e de gênero e modificações no processo do trabalho docente

Um exame da composição de classe ao longo das duas últimas décadas aponta para algo bastante dramático. O processo de proletarização tem tido um efeito tanto amplo quanto consistente. Dada a crise fiscal do estado, esse impacto será sentido mais diretamente entre empregados do estado, tal como o professorado. O processo de trabalho docente tem se tornado sujeito aos mesmos processos que têm levado à proletarização de muitos outros empregos. Contudo, o professorado não é constituído somente de pessoas situadas numa determinada classe. São pessoas também situadas num determinado gênero. Há uma evidente conclusão a ser tirada das análises da proletarização. Em toda categoria ocupacional, as mulheres estão mais sujeitas ao processo de proletarização que os homens. Este padrão é, naturalmente, amplamente reproduzido dentro da educação. Embora a imensa maioria do professorado nos Estados Unidos seja constituída de mulheres, a maioria dos cargos de direção nas escolas elementares é mantido por homens. Eu argumento que, a menos que vejamos as conexões entre essas duas dinâmicas - classe e gênero - não poderemos entender a história e os tentativos presentes para racionalizar a educação ou as raízes e os efeitos da proletarização sobre o próprio ato docente. É na intersecção dessas duas dinâmicas que se pode começar a deslindar algumas das razões pelas quais os procedimentos para racionalizar o trabalho docente têm se desenvolvido.An examination of changes in class composition over the past two decades points out something quite dramatically. The process of proletarianization has had both a large and consistent effect. Given the fiscal crisis of the state, this impact will be felt more directly among state employees such as teachers. The labor process of teaching was becoming susceptible to similar processes that had led to the proletarianization of many other jobs. Yet, teachrs are not only classed actors. They are gendered actors as well. A striking conclusion is evident from the analyses of proletarianization. In every occupational category, women are more apt to be proletariannized than men. This pattern is, of course, largely reproduced within education. While the overwhelming majority of school teachers in the United States are women, many more men are principals of elementary schools. I want to claim that unless we see the connections between these two dynamics - class and gender - we cannot understand the history of and current attempts at rationalizing education or the roots and effects of proletarianization of teaching itself. It is at the intersection of these two dynamics that one can begin to unravel some of the reasons why produceres for rationalizing the work of teachers have evolved. The ultimate effects of these procedures, with the loss of control that accompanies them, can bear in important ways on how we think about the "reform" of teaching and curriculum and the state's role in it

Sulforaphane promotes ER stress, autophagy and cell death: implications for cataract surgery

Posterior capsule opacification (PCO) commonly develops following cataract surgery and is a wound-healing response that can ultimately lead to secondary visual loss. Improved management of this problem is required. The isothiocyanate, sulforaphane (SFN) is reported to exert cytoprotective and cytotoxic actions and the latter may be exploited to treat/prevent PCO. SFN concentrations of 10µM and above significantly impaired wound-healing in a human lens capsular bag model. A similar pattern of response was also seen with a human lens cell line, FHL124. SFN treatment promoted increased expression of ER stress genes, which also corresponded with protein expression. Evidence of autophagy was observed in response to SFN as determined by increased LC3-II levels and detection of autophagic vesicles. This response was disrupted by established autophagy inhibitors chloroquine and 3-MA. SFN was found to promote MAPK signaling and inhibition of ERK activation using U0126 prevented SFN induced LC3-II elevation and vesicle formation. SFN also significantly increased levels of reactive oxygen species. Taken together, our findings suggest that SFN is capable of reducing lens cell growth and viability and thus could serve as a putative therapeutic agent for PCO

Enhanced multiclass SVM with thresholding fusion for speech-based emotion classification

As an essential approach to understanding human interactions, emotion classification is a vital component of behavioral studies as well as being important in the design of context-aware systems. Recent studies have shown that speech contains rich information about emotion, and numerous speech-based emotion classification methods have been proposed. However, the classification performance is still short of what is desired for the algorithms to be used in real systems. We present an emotion classification system using several one-against-all support vector machines with a thresholding fusion mechanism to combine the individual outputs, which provides the functionality to effectively increase the emotion classification accuracy at the expense of rejecting some samples as unclassified. Results show that the proposed system outperforms three state-of-the-art methods and that the thresholding fusion mechanism can effectively improve the emotion classification, which is important for applications that require very high accuracy but do not require that all samples be classified. We evaluate the system performance for several challenging scenarios including speaker-independent tests, tests on noisy speech signals, and tests using non-professional acted recordings, in order to demonstrate the performance of the system and the effectiveness of the thresholding fusion mechanism in real scenarios.Peer ReviewedPreprin

Para a noção de transformação curricular

Neste artigo é evidenciada a relação entre currículo e conhecimento, abordando-se o conhecimento escolar na sua seleção, organização e transformação, a partir de uma revisão do conceito de transposição didática e da proposição dos conceitos de transformação curricular e transformação didática. Qualquer debate sobre o currículo exige a dilucidação do conhecimento e uma reflexão sobre os seus diversos significados, sobretudo quando a educação se torna num projeto amplo de questionamento da realidade social. Para além de várias questões colocadas acerca do conhecimento escolar e do modo como a sua organização pode ser realizada, procura-se centrar o debate numa reflexão sobre as fronteiras entre conhecimentos e esclarecer que, sobre essa temática, jamais poderão existir respostas fechadas.This article highlights the link between curriculum and knowledge, the approach of school knowledge’s selection, organization and transformation is based on a revision of the concept of didactic transposition and on the proposal of the concepts of curriculum and didactic transformation. Debates on curriculum demand an explanation and a reflection on the multiple meanings of knowledge mainly when education aims to be a broad project to contest social reality. It aims to focus the discussion on a reflection regarding the borders between knowledges and to show that in this subject there are never closed answers.Dans cet article est mis en évidence le rapport entre le curriculum et la connaissance, en abordant la connaissance scolaire dans sa sélection, son organisation et sa transformation à partir d’une révision du concept de transposition didactique et de la proposition des concepts de transformation du curriculum et de transformation didactique. Toute discussion sur le curriculum exige la dilucidation de la connaissance et une réflexion sur ses plusieurs signifiés, surtout quand l’éducation devient un projet plus large de mise en question de la réalité sociale. Au delà des plusieurs questions posées autour de la connaissance scolaire et de la manière comme son organisation peut être réalisée, on cherche á fixer le débat dans une réflexion sur les frontières entre connaissances et éclaircir que, sur cette thématique jamais ne pourront exister des réponses absolues.En este trabajo se pone en evidencia la relación entre el currículum y el conocimiento, abordándose el conocimiento escolar en su selección, organización y transformación desde una revisión del concepto de transposición didáctica y de la proposición de los conceptos de transformación curricular y transformación didáctica. Cualquier discusión sobre el currículum requiere la aclaración del conocimiento y una reflexión sobre sus diversos significados, especialmente cuando la educación se convierte en un proyecto más amplio de cuestionamiento de la realidad social. Además de varias preguntas sobre el conocimiento escolar y el modo en el que su organización puede tener lugar, se intenta centrar el debate en una reflexión sobre las fronteras entre conocimientos y aclarar que en esta temática jamás podrán existir respuestas cerradas.(undefined

Reframing professional development through understanding authentic professional learning

Continuing to learn is universally accepted and expected by professionals and other stakeholders across all professions. However, despite changes in response to research findings about how professionals learn, many professional development practices still focus on delivering content rather than enhancing learning. In exploring reasons for the continuation of didactic practices in professional development, this article critiques the usual conceptualization of professional development through a review of recent literature across professions. An alternative conceptualization is proposed, based on philosophical assumptions congruent with evidence about professional learning from seminal educational research of the past two decades. An argument is presented for a shift in discourse and focus from delivering and evaluating professional development programs to understanding and supporting authentic professional learning

Vendo a educação de forma relacional : classe e cultura na sociologia do conhecimento escolar

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