El clima de aula según becarios 18 y alumnos regulares de una universidad privada de Lima

The admission of poor students sponsored by the Beca 18 social program into Lima universities is a recent phenomenon that requires studies on their adjustment and academic performance. This research targeted Beca 18 students at USIL and compared their responses to a questionnaire on perceptions of classroom climate with those from regular students. Both were participating in the course on math analysis offered to engineering students. In the general context of positive perceptions of classroom climate, Beca 18 students slightly differed from regular students, showing more positive perceptions of professor’s behavior in terms of creation of a working environment, class pace, interest in the student, and promotion of cooperation and group work. A greater difference was observed in regard of the avoidance of a climate of competition, which should be studied in greater depth. On the other hand, Beca 18 students complained more about the lack of solidarity, which can be explained by their adaptation to the more co lectivistic culture observed in Peruvian provinces.La inserción de beneficiarios pobres del programa social Beca 18 en universidades limeñas es un fenómeno reciente que amerita estudios relativos a su adaptación y desempeño académico. En la presente investigación se analizaron las respuestas de becarios 18 en USIL a un cuestionario de percepciones del clima de aula, y se les comparó con las de alumnos regulares para establecer si había diferencias. Ambos participaban en el Curso de Análisis Matemático que se imparte a estudiantes de ingeniería. En el contexto general de climas de aula bastante positivos, los becarios se diferenciaron ligeramente de los alumnos regulares por una percepción más positiva del comportamiento del profesor en términos del ambiente de trabajo creado, el ritmo de la clase, el interés por el estudiante y el fomento de la cooperación y trabajo grupal. Mayor diferencia se observó respecto a la evitación de un clima de competición; esto debería investigarse a mayor profundidad. De otro lado, los becarios se quejaron más de la falta de ayu da por parte de otros alumnos, lo cual se explica por la mayor solidaridad existente en provincias, cuya población es más colectivista que la de Lima.La inserción de beneficiarios pobres del programa social Beca 18 en universidades limeñas es un fenómeno reciente que amerita estudios relativos a su adaptación y desempeño académico. En la presente investigación se analizaron las respuestas de becarios 18 en USIL a un cuestionario de percepciones del clima de aula, y se les comparó con las de alumnos regulares para establecer si había diferencias. Ambos participaban en el Curso de Análisis Matemático que se imparte a estudiantes de ingeniería. En el contexto general de climas de aula bastante positivos, los becarios se diferenciaron ligeramente de los alumnos regulares por una percepción más positiva del comportamiento del profesor en términos del ambiente de trabajo creado, el ritmo de la clase, el interés por el estudiante y el fomento de la cooperación y trabajo grupal. Mayor diferencia se observó respecto a la evitación de un clima de competición; esto debería investigarse a mayor profundidad. De otro lado, los becarios se quejaron más de la falta de ayu da por parte de otros alumnos, lo cual se explica por la mayor solidaridad existente en provincias, cuya población es más colectivista que la de Lima

El clima de aula según becarios 18 y alumnos regulares de una universidad privada de Lima

The admission of poor students sponsored by the Beca 18 social program into Lima universities is a recent phenomenon that requires studies on their adjustment and academic performance. This research targeted Beca 18 students at USIL and compared their responses to a questionnaire on perceptions of classroom climate with those from regular students. Both were participating in the course on math analysis offered to engineering students. In the general context of positive perceptions of classroom climate, Beca 18 students slightly differed from regular students, showing more positive perceptions of professor’s behavior in terms of creation of a working environment, class pace, interest in the student, and promotion of cooperation and group work. A greater difference was observed in regard of the avoidance of a climate of competition, which should be studied in greater depth. On the other hand, Beca 18 students complained more about the lack of solidarity, which can be explained by their adaptation to the more co lectivistic culture observed in Peruvian provinces.La inserción de beneficiarios pobres del programa social Beca 18 en universidades limeñas es un fenómeno reciente que amerita estudios relativos a su adaptación y desempeño académico. En la presente investigación se analizaron las respuestas de becarios 18 en USIL a un cuestionario de percepciones del clima de aula, y se les comparó con las de alumnos regulares para establecer si había diferencias. Ambos participaban en el Curso de Análisis Matemático que se imparte a estudiantes de ingeniería. En el contexto general de climas de aula bastante positivos, los becarios se diferenciaron ligeramente de los alumnos regulares por una percepción más positiva del comportamiento del profesor en términos del ambiente de trabajo creado, el ritmo de la clase, el interés por el estudiante y el fomento de la cooperación y trabajo grupal. Mayor diferencia se observó respecto a la evitación de un clima de competición; esto debería investigarse a mayor profundidad. De otro lado, los becarios se quejaron más de la falta de ayu da por parte de otros alumnos, lo cual se explica por la mayor solidaridad existente en provincias, cuya población es más colectivista que la de Lima.La inserción de beneficiarios pobres del programa social Beca 18 en universidades limeñas es un fenómeno reciente que amerita estudios relativos a su adaptación y desempeño académico. En la presente investigación se analizaron las respuestas de becarios 18 en USIL a un cuestionario de percepciones del clima de aula, y se les comparó con las de alumnos regulares para establecer si había diferencias. Ambos participaban en el Curso de Análisis Matemático que se imparte a estudiantes de ingeniería. En el contexto general de climas de aula bastante positivos, los becarios se diferenciaron ligeramente de los alumnos regulares por una percepción más positiva del comportamiento del profesor en términos del ambiente de trabajo creado, el ritmo de la clase, el interés por el estudiante y el fomento de la cooperación y trabajo grupal. Mayor diferencia se observó respecto a la evitación de un clima de competición; esto debería investigarse a mayor profundidad. De otro lado, los becarios se quejaron más de la falta de ayu da por parte de otros alumnos, lo cual se explica por la mayor solidaridad existente en provincias, cuya población es más colectivista que la de Lima

Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study

Producción CientíficaBackground. To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient’s age. Methods. The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000–2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient’s age: Group A: 60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids. Results. Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40–60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients 1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups. Conclusions. Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory

Renal transplantation in the modern immunosuppressive era in Spain: four-year results from a multicenter database focus on post-transplant cardiovascular disease

Producción CientíficaTo evaluate cardiovascular disease (CVD) after renal transplantation we established a CVD database (no-intervention) including all patients transplanted among 2000–2002 in 14 hospitals from Spain (Renal Forum Group) (n¼2600). They were prospective followed annually thereafter and we present herein the most important results concerning survival figures and CVD at four years. Mean recipient age was 49.7±13.7 years: 16% retransplanted and 12.5% hyperimmunized. Tacrolimus, mycophenolate mofetil, and steroids was used in 63%. Acute rejection (AR) rate at 1 year was 14.8%. Graft and patient survival at 48 months were 85.6% (death censored) and 91.7% respectively. The first cause of graft loss was vascular in the first year, death with function during the 2–3 years, and chronic allograft nephropathy at the 4th year. Donor age, time on dialysis, acute tubular necrosis (ATN), AR, SCr at 6 months, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in the first year, and systolic blood pressure at 24 months were independent risk factors for graft loss at 4th year. The first cause of death was CVD (predominantly ischemic heart disease (IHD) in the first year). Recipient age, ATN, and SCr at 6 months were independent predictors of mortality. Despite worsening of donor age, comorbidity, and advanced age of recipients, survival figures at four years are considered good in our Spanish non-selected population. Cardiovascular mortality is the most important cause of death and graft loss particularly, IHD in the first year. Therefore, to decrease post-transplant mortality a careful cardiovascular evaluation and treatment in the waiting list and a close follow-up of patients after transplantation is mandatory

Sequencing three crocodilian genomes to illuminate the evolution of archosaurs and amniotes

The International Crocodilian Genomes Working Group (ICGWG) will sequence and assemble the American alligator (Alligator mississippiensis), saltwater crocodile (Crocodylus porosus) and Indian gharial (Gavialis gangeticus) genomes. The status of these projects and our planned analyses are described

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections

Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries