Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Voluntariado en Acción Catálogo de iniciativas de voluntariado Centros de Educación para el Desarrollo.

Este catálogo compila todas las iniciativas de voluntariado que enmarcan y orientan las acciones de más de dos mil voluntarios anuales que aportan con su tiempo y conocimiento al fortalecimiento de las comunidades, sus organizaciones sociales y comunitarias que trabajan decididamente para construir una mejor sociedad. Durante los últimos tres años hemos apostado por el fortalecimiento de esta estrategia generando nuevas modalidades, diversos escenarios para el desarrollo del voluntariado, capacitando a los 19 líderes y los voluntarios en las sedes, siempre bajo la profunda convicción de que el mundo se puede cambiar cuando mucha gente pequeña, en lugares pequeños, haciendo cosas pequeñas, logran tocar la vida de las personas que más lo necesitan

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.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

The pertinence of addressing the affective filter in EFL Costa Rican classrooms and strategies to lower it

This paper explains the relevance that the affective filter has on students’ learning processes and the different approaches that can be implemented to reduce its negative effects. At this time, several studies have confirmed the role that the affective spectrum plays on students’ proficiency in a foreign language and how necessary it is to address this issue. In order to collect information about the negative impact of the affective filter and the strategies that can be used, an exhaustive analysis of different studies was carried out. This analysis shows that when students’ affective filter is ‘high’—e.g. feeling anxious, frustrated, stressed—students eventually become uninterested and unmotivated about the subject matter and the activities carried out in class. Also, they could become apathetic to the relationships that could be built with other classmates due to the fear of being criticized, and as a result, students’ learning process would be hindered. Moreover, some effective methods are discussed as well, such as using humor as a tool in the class, having discussions about the topics that are to be introduced, using English captions, applying relevant topics to teach, implementing songs and games, introducing self-soothing strategies, and creating teacher-student rapport to encourage a healthy and comfortable environment within the classroom. Overall, it is concluded that students having a ‘high’ affective filter leads to a learning process being negatively affected. Then, the importance of examining possible procedures to help students succeed is emphasized as well.Universidad Nacional, Costa RicaDivisión de Educologí

English language teaching in Costa Rica: Facing challenges

Undoubtedly, it is every teacher's life quest to find the best way to teach; there are no universal formulas to accomplish that. A committed teacher is a life-long learner, which shows why being an educator is not an easy career. A teacher is indeed like a candle that lights the students' path as it consumes itself. Such abnegation comes at a high price. Particularly, English teachers in a Country such as Costa Rica are faced with various challenges, ranging from deeply ingrained negative attitudes towards teachers and the education system itself, their own well-being which tends to be neglected a little too often, unequal access to resources and teaching materials, heterogeneous student populations, emotional factors in the classroom, among many others. An English teacher in a developing country (and probably elsewhere) has to be prepared to deal with the unexpected, learn, relearn, and unlearn, and whenever something new is learned, it is every (English) teacher's duty to share it using different means; getting published is but one way to do so. This ebook comprises a collection of essays written by students from the Master's Program in Education with an Emphasis on English Learning from Universidad Nacional, Costa Rica as part of their graduation project. In each of the manuscripts contained here, a Costa Rican English teacher reflects on some of his or her educational experiences and encountered challenges and proposes strategies to tackle them so that any English teachers out there facing similar situations may benefit from these ideas.Universidad Nacional, Costa RicaDivisión de Educologí

Escalando innovaciones rurales

¿Cómo conseguir que las inventivas locales e individuales tengan repercusiones en contextos más amplios? ¿Cómo lograr saltos de escala, que hagan posible articular unas innovaciones con otras y diseminar los alcances a otros potenciales beneficiarios fuera de su núcleo inicial? Estas son las preguntas centrales del «Seminario Internacional sobre Escalamiento de Innovaciones Rurales», llevado a cabo en Lima en mayo de 2012, en el marco del Programa de Escalamiento de Innovaciones Rurales (PEIR). Este evento buscó reunir a especialistas, académicos y actores de diferentes partes del mundo, para reflexionar durante tres días en torno a la potencialidad y los retos del escalamiento de innovaciones rurales en los países en desarrollo. Este libro recoge los principales aportes y contribuciones al debate

First Assessment of the Impacts of the COVID-19 Pandemic on Global Marine Recreational Fisheries

This work is the result of an international research effort to determine the main impacts of the COVID-19 pandemic on marine recreational fishing. Changes were assessed on (1) access to fishing, derived from lockdowns and other mobility restrictions; (2) ecosystems, because of alterations in fishing intensity and human presence; (3) the blue economy, derived from alterations in the investments and expenses of the fishers; and (4) society, in relation to variations in fishers’ health and well-being. For this, a consultation with experts from 16 countries was carried out, as well as an international online survey aimed at recreational fishers, that included specific questions designed to capture fishers’ heterogeneity in relation to behavior, skills and know-how, and vital involvement. Fishers’ participation in the online survey (5,998 recreational fishers in 15 countries) was promoted through a marketing campaign. The sensitivity of the fishers’ clustering procedure, based on the captured heterogeneity, was evaluated by SIMPER analysis and by generalized linear models. Results from the expert consultation highlighted a worldwide reduction in marine recreational fishing activity. Lower human-driven pressures are expected to generate some benefits for marine ecosystems. However, experts also identified high negative impacts on the blue economy, as well as on fisher health and well-being because of the loss of recreational fishing opportunities. Most (98%) of the fishers who participated in the online survey were identified as advanced, showing a much higher degree of commitment to recreational fishing than basic fishers (2%). Advanced fishers were, in general, more pessimistic about the impacts of COVID-19, reporting higher reductions in physical activity and fish consumption, as well as poorer quality of night rest, foul mood, and raised more concerns about their health status. Controlled and safe access to marine recreational fisheries during pandemics would provide benefits to the health and well-being of people and reduce negative socioeconomic impacts, especially for vulnerable social groups

First Assessment of the Impacts of the COVID-19 Pandemic on Global Marine Recreational Fisheries

This work is the result of an international research effort to determine the main impacts of the COVID-19 pandemic on marine recreational fishing. Changes were assessed on (1) access to fishing, derived from lockdowns and other mobility restrictions; (2) ecosystems, because of alterations in fishing intensity and human presence; (3) the blue economy, derived from alterations in the investments and expenses of the fishers; and (4) society, in relation to variations in fishers? health and well-being. For this, a consultation with experts from 16 countries was carried out, as well as an international online survey aimed at recreational fishers, that included specific questions designed to capture fishers? heterogeneity in relation to behavior, skills and know-how, and vital involvement. Fishers? participation in the online survey (5,998 recreational fishers in 15 countries) was promoted through a marketing campaign. The sensitivity of the fishers? clustering procedure, based on the captured heterogeneity, was evaluated by SIMPER analysis and by generalized linear models. Results from the expert consultation highlighted a worldwide reduction in marine recreational fishing activity. Lower human-driven pressures are expected to generate some benefits for marine ecosystems. However, experts also identified high negative impacts on the blue economy, as well as on fisher health and well-being because of the loss of recreational fishing opportunities. Most (98%) of the fishers who participated in the online survey were identified as advanced, showing a much higher degree of commitment to recreational fishing than basic fishers (2%). Advanced fishers were, in general, more pessimistic about the impacts of COVID-19, reporting higher reductions in physical activity and fish consumption, as well as poorer quality of night rest, foul mood, and raised more concerns about their health status. Controlled and safe access to marine recreational fisheries during pandemics would provide benefits to the health and well-being of people and reduce negative socioeconomic impacts, especially for vulnerable social groups.Fil: Pita, Pablo. Universidad de Santiago de Compostela; EspañaFil: Ainsworth, Gillian B.. Universidad de Santiago de Compostela; EspañaFil: Alba, Bernardino. Alianza de Pesca Española Recreativa Responsable; EspañaFil: Anderson, Antônio B.. Universidade Federal do Espírito Santo; BrasilFil: Antelo, Manel. Universidad de Santiago de Compostela; EspañaFil: Alós, Josep. Consejo Superior de Investigaciones Científicas. Instituto Mediterráneo de Estudios Avanzados; EspañaFil: Artetxe, Iñaki. No especifíca;Fil: Baudrier, Jérôme. Institut Français de Recherche Pour l’Exploitation de la Mer; FranciaFil: Castro, José J.. Universidad de Las Palmas de Gran Canaria; EspañaFil: Chicharro, Belén. No especifíca;Fil: Erzini, Karim. Universidad de Algarve; PortugalFil: Ferter, Keno. No especifíca;Fil: Freitas, Mafalda. No especifíca;Fil: García-de-la-Fuente, Laura. Universidad de Oviedo; EspañaFil: García Charton, José A.. Universidad de Murcia; EspañaFil: Giménez Casalduero, María. Universidad de Murcia; EspañaFil: Grau, Antoni M.. No especifíca;Fil: Diogo, Hugo. Universidade Dos Açores; Portugal. Direção de Serviços de Recursos; PortugalFil: Gordoa, Ana. No especifíca;Fil: Henriques, Filipe. Universidad de Algarve; Portugal. Universidad de Coimbra; PortugalFil: Hyder, Kieran. University of East Anglia; Reino UnidoFil: Jiménez Alvarado, David. Universidad de Las Palmas de Gran Canaria; EspañaFil: Karachle, Paraskevi K.. No especifíca;Fil: Lloret, Josep. Universidad de Girona; EspañaFil: Laporta, Martin. No especifíca;Fil: Lejk, Adam M.. No especifíca;Fil: Dedeu, Arnau L.. Consejo Superior de Investigaciones Científicas. Instituto de Ciencias del Mar; EspañaFil: Sosa, Martín Pablo. No especifíca;Fil: Martínez, Lllibori. No especifíca;Fil: Mira, Antoni M.. No especifíca;Fil: Morales Nin, Beatriz. Consejo Superior de Investigaciones Científicas. Instituto Mediterráneo de Estudios Avanzados; EspañaFil: Mugerza, Estanis. No especifíca;Fil: Olesen, Hans J.. Technical University of Denmark; DinamarcaFil: Papadopoulos, Anastasios. No especifíca;Fil: Pontes, João. Universidad de Algarve; PortugalFil: Pascual Fernández, José J.. Universidad de La Laguna; EspañaFil: Purroy, Ariadna. Consejo Superior de Investigaciones Científicas. Instituto de Ciencias del Mar; EspañaFil: Ramires, Milena. Santa Cecília University; BrasilFil: Rangel, Mafalda. Universidad de Algarve; PortugalFil: Reis Filho, José Amorim. Universidade Federal do Pará; BrasilFil: Sánchez Lizaso, Jose L.. Universidad de Alicante; EspañaFil: Sandoval, Virginia. Universidad de Murcia; EspañaFil: Sbragaglia, Valerio. Consejo Superior de Investigaciones Científicas. Instituto de Ciencias del Mar; EspañaFil: Silva, Luis. No especifíca;Fil: Skov, Christian. Technical University of Denmark; DinamarcaFil: Sola, Iván Daniel. Universidad de Alicante; España. Universidad de Playa Ancha; ChileFil: Strehlow, Harry V.. No especifíca;Fil: Torres, María A.. No especifíca;Fil: Ustups, Didzis. No especifíca;Fil: van der Hammen, Tessa. No especifíca;Fil: Veiga, Pedro. Universidad de Algarve; PortugalFil: Venerus, Leonardo Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Centro para el Estudio de Sistemas Marinos; ArgentinaFil: Verleye, Thomas. No especifíca;Fil: Villasante, Sebastián. Universidad de Santiago de Compostela; EspañaFil: Weltersbach, Marc Simon. No especifíca;Fil: Zarauz, Lucía. No especifíca