Covid-19 should be considered as a differential diagnosis for an ‘Acute Abdomen

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Mercados educacionais e a comunidade Education markets and the community

Os defensores de abordagens baseadas no mercado para a educação invocam, às vezes, a necessidade de "empoderamento" (empowerment) das comunidades nas tomadas de decisão educacionais para justificar a reforma dos sistemas educacionais públicos convencionais. Com base em exemplos da Austrália, da Inglaterra e do País de Gales, da Nova Zelândia e dos eua, este artigo explora as maneiras complexas e contraditórias como as políticas educacionais contemporâneas usam o conceito de envolvimento das comunidades. Ele demonstra mais ainda que o papel e o impacto do envolvimento das comunidades nas escolas nada têm de simples. O artigo conclui que, se o envolvimento das comunidades quer ter efeitos progressistas, ele deve ser articulado com uma política de educação democrática mais ampla.<br>The proponents of market-based approaches to education have sometimes invoked the need for community empowerment in educational decision-making to justify the reform of conventional state educational systems. Drawing upon examples from Australia, England and Wales, New Zealand and the usa, this paper explores the complex and contradictory ways in which the concept of community involvement is used in contemporary education policy. It further demonstrates that the role and impact of community involvement in schools are by no means straightforward. The paper concludes that, if community involvement is to be progressive in its effects, it will need to be articulated with a broader democratic politics of education

Enhanced performance in fusion plasmas through turbulence suppression by megaelectronvolt ions

© 2022, The Author(s), under exclusive licence to Springer Nature Limited.Alpha particles with energies on the order of megaelectronvolts will be the main source of plasma heating in future magnetic confinement fusion reactors. Instead of heating fuel ions, most of the energy of alpha particles is transferred to electrons in the plasma. Furthermore, alpha particles can also excite Alfvénic instabilities, which were previously considered to be detrimental to the performance of the fusion device. Here we report improved thermal ion confinement in the presence of megaelectronvolts ions and strong fast ion-driven Alfvénic instabilities in recent experiments on the Joint European Torus. Detailed transport analysis of these experiments reveals turbulence suppression through a complex multi-scale mechanism that generates large-scale zonal flows. This holds promise for more economical operation of fusion reactors with dominant alpha particle heating and ultimately cheaper fusion electricity.N

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease