Redefining the Lines of Expertise: Educational Pathways Through the Communities Together Advocacy Project

The profiles of American communities are among the most dynamic in recent history. This qualitative study examines collaboration between an urban community and The University of Utah. The Communities Together Advocacy Project illustrates parents’ perspectives on the effectiveness of an advocacy training program and their subsequent leadership roles within a community. Findings speak to parent advocates as critical stakeholders in community-university partnerships

Community-Centered School Leadership: Radical Care and \u3ci\u3eAperturas\u3c/i\u3e During COVID-19

We share school leaders’ perspectives on Zoom videos concerning the needs of immigrant and refugee families in Title I schools. In these videos, participants crafted and shared personal narratives about their leadership experiences during the COVID-19 era of education. Rooted in participatory design research methods, the process of designing these videos were both a research project and an intervention to assist families and school leaders to better understand each other. We present a close analysis of administrators’ perspectives and describe how our codesigned video methodology enabled participants to coconstruct new meanings of school-community relationships during the pandemic through a radical care framework. We conceptualize these reimaginings as aperturas—cracks in the dominant family engagement paradigm that allow us to collectively work towards transformative ends which we term community-centered school leadership. We conclude the article with recommendations for how both school leadership and research can approach and reimagine family engagement postpandemic

Families and Educators Co-Designing: Critical Education Research as Participatory Public Scholarship

For the past six years, we—members of the Family-School Collaboration Design Research Project—have been working to understand and transform family-school relationships in Salt Lake City, Utah. Our group includes an evolving cast of scholars, family leaders, professional educators, graduate students, and organizers. We are trying to create spaces where culturally and linguistically diverse (CLD) families-families whose language and culture differ from the dominant school culture-have real voice in schools and can partner equitably with educators. We are a part of a national network of scholars, practitioners, and family and community leaders called the Family Leadership Design Collaborative (FLDC). Since 2016, we have been working and learning alongside colleagues across the country, with support from the network\u27s central organizers, Drs. Ann Ishimaru and Megan Bang. The FLDC is carving out new aperturas (openings) for research and social change, based on a vision of community wellbeing and educational justice (Ishimaru et al., 2019). You can read more about the FLDC framework, methods, and projects at https://familydesigncollab.org . In the FLDC, we use a form of design-based research we call solidarity-driven co-design (Ishimaru et al., 2019). Design-based research advances educational theory by designing, piloting, studying, and revising educational interventions in real-life learning situations (Cobb et al., 2003; Collins et al., 2004). Solidarity-driven co-design takes design-based research and integrates aspects of community-based research and decolonizing methodologies (Bhattacharya, 2009; Beckman & Long, 2016; Strand et al., 2003; Tuhiwai Smith, 2013). The result is a critical, participatory process that centers the knowledge, leadership, and creativity of families that are usually kept out of research and decision-making spaces (Bang & Vossoughi, 2016; Philip et al., 2018). Solidarity-driven co-design follows an iterative, four-step cycle. In step one, families, educators, organizers, and researchers come together to build relationships, share stories, and theorize together about a topic of concern. In step two, the team designs possible solutions, which are then piloted in step three. In step four, the team analyzes data from the pilot and refines solutions for another cycle. Throughout the process, close attention is paid to critical questions of identity and power in terms of both the topic of study and internal dynamics among the co-designers (Ishimaru et al., 2019). This process shares features with other community-based methods, such as critical participatory action research (Fine & Torre, 2021; Torre et al., 2012). For example, it positions people who are usually the subjects of research as co-researchers, it goes through iterative cycles that include both research and action, and it is committed to social transformation. At the same time, the process of co-design makes much less of a distinction between the stages of research and action, instead merging the two into an ongoing process of creation. It emphasizes the tools of both reflection (looking at the past and the present) and imagination (envisioning and beginning to craft more just futures for our schools and communities) . In this chapter, we share a bit about our work in Salt Lake City-our goals and our methods, our challenges and our successes. We discuss how the project emerged, how we facilitated the co-design process, and the products we created in order to reach beyond the academy. We explore some of the tensions we faced and how the project evolved over time as COVID-19 changed the landscape of schooling

Respuesta inmune desregulada en pacientes obesos como agravante por COVID-19

La obesidad, enfermedad caracterizada por acumulación excesiva de tejido adiposo, es el factor asociado al mayor índice de severidad en la infección por SARS-CoV-2. Durante la pandemia, tanto investigaciones independientes como del Ministerio de Salud (MINSA-Perú) mostraron correlación entre obesidad y COVID-19. La investigación tiene como objetivo analizar de qué manera la respuesta inmune desregulada en pacientes obesos actúa como agravante de COVID-19. Para ello, se revisó evidencia científica disponible en diferentes bases de datos, tras lo cual se encontró que la respuesta inmune desregulada causada por la obesidad se amplifica al asociarse con COVID-19, ya que potencia la creación de un microambiente inflamatorio local de bajo grado inducido por secreciones de adipocitos disfuncionales. Asimismo, los pacientes obesos presentan mayor susceptibilidad a la infección por SARS-CoV-2 debido a la pérdida gradual de ASC funcionales que perjudica la ciliogénesis, reduciendo así su eliminación; además, el tejido adiposo alterado propicia la sobreexpresión de receptores de proteasas que facilitarán su entrada. El agravamiento del cuadro clínico de COVID-19 se desencadenará en consecuencia de los procesos de disfunción endotelial y disminución de la angiogénesis puesto que, en conjunto, producirán hipoxia, fibrosis e insuficiencia funcional pulmonar. Se concluye que la respuesta inmune desregulada en pacientes obesos está estrechamente relacionada con la morbimortalidad a nivel cardio-metabólico, que conlleva al cuadro clínico severo y en algunos casos, al deceso del paciente infectado. Palabras clave: Obesidad (DeCS), COVID-19 (DeCS), respuesta inmune (DeCS).   DOI: http://dx.doi.org/10.17268/rmt.2021.v16i03.1

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

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

¡Ya basta con la ciudadanía restrictiva!: Undocumented Latina/o Young People and Their Families’ Participatory Citizenship

This article describes a community-based participatory action research project (PAR), “Voces Diversas e Importantes” [Diverse and Important Voices] that the intergenerational Family School Partnership (FSP) collective enacted to support citizenship participation and increase the possibilities undocumented Latina/o students and families have for transforming practices and perspectives within the school context and community. In this PAR project undocumented young people and their families challenge the notion that legal citizenship alone provides educational rights and equity. Central to this study is how participants troubled and disrupted the racialization and gendered components of citizenship as well transformed their participation into leadership practices that leveraged organizational changes and heightened positive educational pathways for young undocumented students in the high school.

La Compraventa internacional de mercaderías bajo la convención de las Naciones Unidas, Viena 1980

Tesis (Licenciatura en Derecho)--Universidad Americana, Managua, 1998El estudio siguiente aborda lo relacionado a la compraventa internacional de mercaderías, tratando primero aspectos generales del comercio internacional, segundo los actores y las transacciones comerciales internacionales, también aborda los principios que rigen a los contratos y las normas que regulan el contrato de compraventa internacional de mercaderías que se encuentran contenidas en las diferentes convenciones; finalmente presenta un análisis de forma detenida sobre las disposiciones que establece la convención de Viena de 1980, sobre la formación del contrato, que abarca la oferta, aceptación y el perfeccionamiento del contrato, los derechos y obligaciones del comprador y vendedor, la distribución de riesgos, así como también la resolución de conflictos en materia de compraventa internacional de mercaderías