Training in the Primary Education Teacher Degree in STEM disciplines: Analysis before its reform in Spain

La nueva Ley de Educación, conocida como LOMLOE, incluye entre otros cambios y por vez primera la competencia STEM con entidad propia. En consonancia, se propone una reforma de los planes de estudio de los Grados de Magisterio en Educación Primaria, para lo cual resulta indispensable un análisis profundo y global de dicha formación inicial. En este estudio se abordan los siguientes objetivos: i) comparar la distribución de créditos en las disciplinas STEM y sus didácticas; ii) comprobar si predominan los contenidos científico-matemáticos o los didácticos; iii) analizar los contenidos de Tecnología e Ingeniería; iv) comparar estos aspectos entre universidades públicas y privadas. Para ello, se revisan los planes de estudios de las 37 universidades públicas y 22 privadas que ofertan el Grado de Magisterio en Educación Primaria en el curso 2020-2021. Se analizan las guías docentes de las 342 asignaturas obligatorias de las disciplinas relacionadas, atendiendo a sus contenidos y a su temporalización, y se realiza un estudio descriptivo e inferencial. Los resultados muestran que las universidades públicas dedican más créditos a la formación en las disciplinas STEM, especialmente a los contenidos disciplinares de matemáticas y ciencias, existiendo una importante dispersión en los datos. En las universidades públicas, los contenidos disciplinares predominan sobre los didácticos, especialmente en ciencias. En cuanto a la tecnología, los contenidos son propios de las llamadas Tecnologías de la Información y la Comunicación, y no de la Tecnología entendida desde STEM. Por su parte, la Ingeniería y el propio enfoque global STEM están ausentes. Este análisis revela la necesidad de renovar los planes de estudio con contenidos adaptados a lo que demanda la LOMLOE, fundamentalmente, incluyendo aspectos de Tecnología e Ingeniería desde una perspectiva STEM.The new Law of Education in Spain, known as LOMLOE, includes for the first time the STEM competence with its own entity, among other changes. Accordingly, a reform of the curricula of the Primary Education Teaching Degrees is proposed, for which a deep and global analysis of this initial training is essential. Thus, the objectives that guided this study included the following: i) to compare the distribution of credits among STEM disciplines and their didactics; ii) to check whether scientific-mathematical or didactic content predominates; iii) to analyse the contents of Technology and Engineering; and iv) to compare these aspects between public and private universities. To that end, the study plans of the 37 public and 22 private universities that offered the Primary Education Teaching Degree in the 2020-2021 academic year were analysed. The teaching guides of the 342 compulsory subjects of the associated disciplines were evaluated, considering their contents and their timing, and a descriptive and inferential study were carried out. The results show that public universities allocate more credits to training in STEM disciplines, especially to the disciplinary content of mathematics and science, while there is a significant dispersion in the data. In public universities there is a major focus on disciplinary content, especially in science. Regarding technology, the contents are specific to Information and Communication Technologies, and not to technology understood from the STEM perspective. In addition, engineering and the global STEM approach itself are absent. This analysis reveals the need to renew the curricula with contents that are more adapted to what the LOMLOE demands and, above all, explicitly including aspects of technology and engineering with a STEM approach

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

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

Innovar en la enseñanza universitaria

Se recogen experiencias docentes innovadoras desarrolladas en la Universidad de Alcalá con el objetivo de indagar en las posibilidades y obstáculos surgidos en los procesos de cambio e innovación. En dichas experiencias docentes se han implementado nuevas metodologías, experiencias piloto y Proyectos de Innovación, que han contribuido a clarificar el proceso y a indagar en propuestas de acción contextualizadas. Las experiencias de dividen en cuatro bloques: estrategias de aprendizaje activo; estrategias de integración curricular; innovación en la educación; y uso de las nuevas tecnologías.MadridBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)