Quality control of B-lines analysis in stress Echo 2020

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio

Competencias para la capacidad gerencial de las personas directivas y su vinculación con las juntas: módulo de aprendizaje

El modulo busca fortalecer las capacidades gerenciales de las personas directoras del sistema educativo de Costa Rica a través de las varias competencias identificadas por ellas mismas para el trabajo efectivo con las Juntas, las cuales versan en el liderazgo, la comunicación, la negociación, el trabajo en equipo y la delegación,Centro de Investigaciones en Educación y Docencia (CIDE)División de Educación para el Trabaj

The needs of teenage mothers in the educational context: a case study in an institution of public education

Introducción. El embarazo en la adolescencia es un problema de salud pública que debe ser subsanado en las generaciones presentes a partir de la educación en salud. La Enfermería no debe mostrarse ajena a este proceso, sino que debe ser sensible a las necesidades tanto de las adolescentes en riesgo como de las adolescentes embarazadas, motivo por el que en  esta investigación se planteó como pregunta ¿cuáles son las necesidades surgidas en el ámbito educativo en las adolescentes embarazadas?Método. Se diseñó un estudio cualitativo, fenomenológico. Los datos fueron recolectados mediante la técnica de grupo focal en el que participaron tres adolescentes madres. El análisis se realizó desde una perspectiva interpretativa.Resultados. Los principales resultados evidenciaron necesidades personales como uniformes que se ajusten a sus cambios físicos, necesidades de infraestructura como sillas y pupitres adecuados, un espacio específico para la lactancia, tiempo para ver a su hijo o hija y adecuación de los horarios de clase.Conclusión. Se concluye que la implementación de las políticas públicas favorecerá el respeto de los derechos de las adolescentes madres en aspectos personales, académicos y de infraestructura.Introduction. The teenage pregnancy is a public health problem that should be remedied in the present generation from health education. Nursing cannot ignore this process but must be sensitive to the needs of at-risk adolescents and pregnant teenagers. Therefore, this research was to answer what are the needs arising in the field of education in pregnant teens?Method.  We designed a qualitative, phenomenological study. Data were collected by the technique of focus group involving three teenage mothers. The analysis was carried out from an interpretive perspective.Results. The main results showed personal needs like uniforms that meet their physical, infrastructure needs such as adequate chairs and desks, a specific space for breastfeeding, time to see your child and adequacy of class schedules.Conclusion. It is concluded that the implementation of public policies promotes respect for the rights of teenage mothers in personal, academic and infrastructural aspects

Quality control of regional wall motion analysis in stress Echo 2020

Background: The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria.Methods: One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE videoclips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31 years (mean value 18 years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (&gt;= 90%).Results: Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7 +/- 13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r = -0.161, p = 0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p &lt; 0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt.Conclusions: In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit. (C) 2017 Elsevier B.V. All rights reserved

A Coffee Berry Borer (Coleoptera: Curculionidae: Scolytinae) Bibliography

Native to Africa, the coffee berry borer, Hypothenemus hampei (Ferrari) (Coleoptera: Curculionidae: Scolytinae), has gradually invaded most coffee-growing areas worldwide. Adult females colonize the coffee berry and oviposit within galleries in the coffee seeds. Larvae and adults consume the seeds, resulting in drastic reductions in yields and quality, negatively affecting the income of approximately 20 million coffee-growing families (~100 million people) in ~80 countries, with losses surpassing more than $500 million annually (Vega et al. 2015). It has become evident that the coffee berry borer scientific community could greatly benefit from having access to a bibliography of the literature related to the insect. Such an information source would allow scientists to find out what research areas have been explored throughout the many coffee berry borer-infested countries after more than 100 years of research on the topic. It could also help to direct lead future research efforts into novel areas, and away from topics and ideas that have been thoroughly investigated in the past

CTA contributions to the 33rd International Cosmic Ray Conference (ICRC2013)

Compilation of CTA contributions to the proceedings of the 33rd International Cosmic Ray Conference (ICRC2013), which took place in 2-9 July, 2013, in Rio de Janeiro, BrazilComment: Index of CTA conference proceedings at the ICRC2013, Rio de Janeiro (Brazil). v1: placeholder with no arXiv links yet, to be replaced once individual contributions have been all submitted. v2: final with arXiv links to all CTA contributions and full author lis