Does Standing on a Cycle-ergometer, Towards the Conclusion of a Graded Exercise Test, Yield Cardiorespiratory Values Equivalent to Treadmill Testing?

Graded exercise testing (GXT), per a cycle-ergometer (CE), offers safety and monitoring advantages over treadmill (TM) GXT. Unfortunately, CE-VO2max and some other cardiorespiratory (CR) variables are frequently lower than TM-GXT values. It has been difficult to compare TM and CE-GXT values. However, it was hypothesized that standing towards the conclusion of the CE-GXT (Stand-CE) might increase CE values to those equal to TM-GXT. If Stand-CE and TM-GXT CR values were equal, Stand-CE-GXT could become the method of choice for GXT for the general population. The purpose of this investigation was to investigate the effect of Stand-CE on CR variables. An intentionally diverse sample (N = 34, 24 males and 10 females, aged 18-54 y, with VO2max values 25-76 ml/kg/min) representing the general population participated. Volunteers completed two GXT trials, one per TM (Bruce protocol) and the other per a MET-TM-matched CE-GXT where initially-seated participants stood and pedaled after their respiratory exchange ratio (RER) reached 1.0. Eighteen participants underwent a third MET-TM-matched trial where they remained seated throughout GXT (Sit-CE). Trials were counter-balanced with at least 48 h between GXT. There were significant statistical differences (p \u3c 0.05) between TM and Stand-CE per matched-samples T-test (N = 34) on the following variables: VEmax (TM = 115 + 24.4 l/min, Stand-CE = 99.4 + 28.1), VCO2max (TM = 4.26 + 0.9 l/min, Stand-CE = 3.56 + 0.84), VO2max (TM = 44.9 + 9.1 ml/kg/min, Stand-CE = 39.3 + 9.0), METSmax (TM = 12.8 + 2.6 METS, Stand-CE = 11.2 + 2.5), and HRmax (TM = 175 + 13 bpm, Stand-CE = 166 + 12). One-way repeated measures ANOVA (N = 18) demonstrated no statistical differences between all trials: VEmax (TM = 112.8 + 25.3 l/min, Stand-CE = 102.3 + 25.2, Sit-CE = 107.3 + 33.1), VCO2max (TM = 4.17 + 0.99 l/min, Stand-CE = 3.62 + 0.80, Sit-CE = 3.55 + 0.83), VO2max (TM = 47.1 + 9.8 ml/kg/min, Stand-CE = 42.0 + 9.0, Sit-CE = 43.3 + 8.9), METSmax (TM = 13.5 + 2.8 METS, Stand-CE = 12.0 + 2.6, Sit-CE = 12.4 + 2.5), and HRmax (TM = 176 + 13 bpm, Stand-CE = 171 + 12, Sit-CE = 173 + 11). Results of this investigation suggest that TM-GXT CR values are larger than Stand-CE, and Stand-CE values are not different from Sit-CE. Future studies will test validity of these findings per gender, aerobic training status, in populations that are highly-skilled with TM and CE (tri-athletes), children, the elderly, and diseased populations

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

Mentored Open Online Communities (MOOCs) as a Third Space for Teaching and Learning in Higher Education

Online learning environments have been promoted as educational innovations with tremendous potential. Originally framed as massive open online courses (MOOCs), large-scale, open, online learning experiences have gained significant attention under the dichotomised umbrellas of either revolutionising education or failing the schools. To provide a third space for teaching and learning in higher education institutions, modified the original framing of MOOC to develop our own mentored open online community (MooC). This chapter explores a case study of a social media project that evolved around the hashtag #WalkMyWorld and developed into this alternative type of online learning experience. A group of university teacher educators sought to break through dichotomous perspectives by experimenting with a hybrid environment \u27removed\u27 but still embedded within face-to-face classes, allowing participants to communicate, socialise and learn in a flexible, open environment. #WalkMyWorld was conceived as a third space to support learners in online spaces, offering a new organisational structure within face-to-face undergraduate and graduate-level education courses

“Facebook Me”: The Potential of Student Teachers’ Online Communities of Practice in Learning to Teach

This study examined the ways in which early childhood pre-service student teachers (PSTs) used an online community for discussions related to teaching. Using the lenses of communities of practice, our goal was to understand what happens when the PSTs begin to share new learnings about teaching through ongoing practice in online communities. We investigated characteristics of the conversations of PSTs and their professors when using Facebook. This study was based on the postings of seven early childhood PSTs and five university faculty members. PSTs were interviewed at the conclusion of the semester to share their experiences from posting on Facebook. Two categories from the data include PSTs’ views of the viability of Facebook and the kinds of talk that surfaced within the Facebook group conversations. Findings suggested that Facebook has the potential to sustain informal dialogues. However, PSTs require strong faculty support to solve issues related to complexities of practice

“Facebook Me”: The Potential of Student Teachers’ Online Communities of Practice in Learning to Teach

This study examined the ways in which early childhood pre-service student teachers (PSTs) used an online community for discussions related to teaching. Using the lenses of communities of practice, our goal was to understand what happens when the PSTs begin to share new learnings about teaching through ongoing practice in online communities. We investigated characteristics of the conversations of PSTs and their professors when using Facebook. This study was based on the postings of seven early childhood PSTs and five university faculty members. PSTs were interviewed at the conclusion of the semester to share their experiences from posting on Facebook. Two categories from the data include PSTs’ views of the viability of Facebook and the kinds of talk that surfaced within the Facebook group conversations. Findings suggested that Facebook has the potential to sustain informal dialogues. However, PSTs require strong faculty support to solve issues related to complexities of practice

Renal Phenotype in Lowe Syndrome: A Selective Proximal Tubular Dysfunction

Background and objectives: Lowe syndrome is defined by congenital cataracts, mental retardation, and proximal tubulopathy and is due to mutations in OCRL. Recently, mutations in OCRL were found to underlie some patients with Dent disease, characterized by low molecular weight proteinuria, hypercalciuria, and nephrocalcinosis. This phenotypic heterogeneity is poorly understood