La gestión eficaz del docente en el aula. Un estudio de caso.

The quality of education is one of the purposes of our educational system, struggled to achieve effective schools where the figure of the teacher acquires rightful role in classroom management and educational improvement. These is a research focused on teaching management of new teachers and experts and learns about and compare different ways of managing the classroom teachers employed by these groups and classrooms with similar characteristics. After the statistical treatments of the data have been checked three of the hypotheses, two were rejected and partially confirmed.La dirección direction calidad educativa es uno de los Propósitos de Nuestro Sistema Educativo, lidiado Por CONSEGUIR Escuelas Eficaces Donde la Figura del Docente Adquiera el papel Que le corresponde en la Gestión del aula y en la Mejora Educativa. En Esta Investigación se Analiza la Gestión Docente de noveles y Expertos, en Grupos y aulas de SIMILARES Características, a través de dos Instrumentos:. Uno de Observación Directa Y OTRO indirecta Tras el Tratamiento Estadístico de los Datos se han comprobado tres de las hipótesis planteadas, dos fueron rechazadas y uña parcialmente confirmada

The timing of the deglaciation in the Atlantic Iberian mountains:Insights from the stratigraphic analysis of a lake sequence in Serra da Estrela (Portugal)

Understanding the environmental response to the last glacial termination in regions located in transitional climate zones such as the Atlantic Iberian mountains is crucial to estimate potential changes in regions affected by current glacial melting. We present an 8.5 m-long, solid last deglaciation and Holocene chronostratigraphic record including detailed sediment analysis from Lake Peixão, a pro-glacial lake in the Serra da Estrela (Central Portugal). The age–depth model relies on a Bayesian approach that includes 16 AMS 14C dates and 210Pb–137CS measurements, robustly dating the lake formation at 14.7 ± 0.32 cal. ka BP. This chronological reconstruction shows an average sedimentation rate of ca. 0.07 cm yr−1 (15 yr cm−1), enabling proxy analyses at decadal timescales. The sediment sequence is composed of five lithological units: (U1) coarse and unsorted fluvioglacial lacustrine deposits; (U2) massive fluvioglacial lacustrine deposits (863–790 cm below surface [bsf]; 14.7 ± 0.32–13.8 ± 0.12 cal. ka BP); (U3) water current fluvioglacial lacustrine deposits (790–766 cm bsf; 13.8 ± 0.12–12.9 ± 0.29 cal. ka BP); (U4) laminated/banded lacustrine deposits characterized by terrigenous deposits from ice-covered lake periods and episodic events of ice and snow melting (766–752 cm bsf; 12.9 ± 0.29–11.7 ± 0.15 cal. ka BP); and (U5) massive muddy lacustrine deposits (752–0 cm bsf; 11.7 ± 0.15 cal. ka BP–present). The occurrence of U2 to U4 deposits defines the transition from glacial cold (U1) to net warm postglacial conditions (U5). These climate transitions are marked by changes in sediments and the presence of very low sedimentation rate periods, possibly related to the Intra-Allerød Cold Period and the coldest phase of the Younger Dryas. Our results support the previously proposed timing of the retreat of the Serra da Estrela glaciers ca. 13.8 ± 0.12 cal. ka BP. The robust chronology of Lake Peixão highlights the potential of Iberian pro-glacial lakes for dating deglaciation processes and will lead to unprecedented decadal-to-centennial timescale palaeoclimate reconstructions in this region since the last glacial–interglacial transition

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Environmental effects of ozone depletion, UV radiation and interactions with climate change : UNEP Environmental Effects Assessment Panel, update 2017

Peer reviewe

Integrin-Alpha IIb Identifies Murine Lymph Node Lymphatic Endothelial Cells Responsive to RANKL

Microenvironment and activation signals likely imprint heterogeneity in the lymphatic endothelial cell (LEC) population. Particularly LECs of secondary lymphoid organs are exposed to different cell types and immune stimuli. However, our understanding of the nature of LEC activation signals and their cell source within the secondary lymphoid organ in the steady state remains incomplete. Here we show that integrin alpha 2b (ITGA2b), known to be carried by platelets, megakaryocytes and hematopoietic progenitors, is expressed by a lymph node subset of LECs, residing in medullary, cortical and subcapsular sinuses. In the subcapsular sinus, the floor but not the ceiling layer expresses the integrin, being excluded from ACKR4+LECs but overlapping with MAdCAM-1 expression. ITGA2b expression increases in response to immunization, raising the possibility that heterogeneous ITGA2b levels reflect variation in exposure to activation signals. We show that alterations of the level of receptor activator of NF-κB ligand (RANKL), by overexpression, neutralization or deletion from stromal marginal reticular cells, affected the proportion of ITGA2b+LECs. Lymph node LECs but not peripheral LECs express RANK. In addition, we found that lymphotoxin-β receptor signaling likewise regulated the proportion of ITGA2b+LECs. These findings demonstrate that stromal reticular cells activate LECs via RANKL and support the action of hematopoietic cell-derived lymphotoxin

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Pre-symptomatic transcriptome changes during cold storage of chilling sensitive and resistant peach cultivars to elucidate chilling injury mechanisms

Background: Cold storage induces chilling injury (CI) disorders in peach fruit (woolliness/mealiness, flesh browning and reddening/bleeding) manifested when ripened at shelf life. To gain insight into the mechanisms underlying CI, we analyzed the transcriptome of 'Oded' (high tolerant) and 'Hermoza' (relatively tolerant to woolliness, but sensitive to browning and bleeding) peach cultivars at pre-symptomatic stages. The expression profiles were compared and validated with two previously analyzed pools (high and low sensitive to woolliness) from the Pop-DG population. The four fruit types cover a wide range of sensitivity to CI. The four fruit types were also investigated with the ROSMETER that provides information on the specificity of the transcriptomic response to oxidative stress. Results: We identified quantitative differences in a subset of core cold responsive genes that correlated with sensitivity or tolerance to CI at harvest and during cold storage, and also subsets of genes correlating specifically with high sensitivity to woolliness and browning. Functional analysis indicated that elevated levels, at harvest and during cold storage, of genes related to antioxidant systems and the biosynthesis of metabolites with antioxidant activity correlates with tolerance. Consistent with these results, ROSMETER analysis revealed oxidative stress in 'Hermoza' and the progeny pools, but not in the cold resistant 'Oded'. By contrast, cold storage induced, in sensitivity to woolliness dependant manner, a gene expression program involving the biosynthesis of secondary cell wall and pectins. Furthermore, our results indicated that while ethylene is related to CI tolerance, differential auxin subcellular accumulation and signaling may play a role in determining chilling sensitivity/tolerance. In addition, sugar partitioning and demand during cold storage may also play a role in the tolerance/sensitive mechanism. The analysis also indicates that vesicle trafficking, membrane dynamics and cytoskeleton organization could have a role in the tolerance/sensitive mechanism. In the case of browning, our results suggest that elevated acetaldehyde related genes together with the core cold responses may increase sensitivity to browning in shelf life. Conclusions: Our data suggest that in sensitive fruit a cold response program is activated and regulated by auxin distribution and ethylene and these hormones have a role in sensitivity to CI even before fruit are cold stored.This research was funded by US-Israel Binational Agriculture Research and Development Fund (BARD) Grant no. US-4027-07. We thank the European Science Foundation for Short Term Scientific Mission grants to A. Dagar (COST Action 924, reference codes COST-STSM-924-04254 and Quality Fruit COST FA1106 for networking.Pons Puig, C.; Dagar, A.; Martí Ibáñez, MC.; Singh, V.; Crisosto, CH.; Friedman, H.; Lurie, S.... (2015). Pre-symptomatic transcriptome changes during cold storage of chilling sensitive and resistant peach cultivars to elucidate chilling injury mechanisms. BMC Genomics. 16:1-35. https://doi.org/10.1186/s12864-015-1395-6S13516Crisosto C, Mitchell F, Ju Z. Susceptibility to chilling injury of peach, nectarine, and plum cultivars grown in California. Hort Sci. 1999;34:1116–8.Lurie S, Crisosto C. Chilling injury in peach and nectarine. Postharvest Biol Technol. 2005;37:195–208.Crisosto C, Mitchell F, Johnson S. Factors in fresh market stone fruit quality. Postharvest News Inform. 1995;6(2):17–21.Dawson DM, Melton LD, Watkins CB. Cell wall changes in nectarines (Prunus persica): solubilization and depolymerization of pectic and neutral polymers during ripening and in mealy fruit. Plant Physiol. 1992;100(3):1203–10.Zhou H, Sonego L, Khalchitski A, Ben Arie R, Lers A, Lurie A. Cell wall enzymes and cell wall changes in ‘Flavortop’ nectarines: mRNA abundance, enzyme activity, and changes in pectic and neutral polymers during ripening and in woolly fruit. J Am Soc Hort Sci. 2000;125:630–7.Jarvis MC, Briggs SPH, Knox JP. Intercellular adhesion and cell separation in plants. Plant Cell Environ. 2003;26(7):977–89.Zhou H, Ben-Arie R, Lurie S. Pectin esterase, polygalacturonase and gel formation in peach pectin fractions. Phytochemistry. 2000;55(3):191–5.Brummell DA, Dal Cin V, Lurie S, Crisosto CH, Labavitch JM. Cell wall metabolism during the development of chilling injury in cold-stored peach fruit: association of mealiness with arrested disassembly of cell wall pectins. J Exp Bot. 2004;55(405):2041–52.Kader AA, Chordas A. Evaluating the browning potential of peaches. Calif Agric. 1984;38:14–5.Cevallos-Casals BA, Byrne D, Okie WR, Cisneros-Zevallos L. Selecting new peach and plum genotypes rich in phenolic compounds and enhanced functional properties. Food Chem. 2006;96(2):273–80.Rojas G, Méndez MA, Muñoz C, Lemus G, Hinrichsen P. Identification of a minimal microsatellite marker panel for the fingerprinting of peach and nectarine cultivars. Electron J Biotechnol. 2008;11:4–5.Scorza R, Sherman WB, Lightner GW. Inbreeding and co-ancestry of low chill short fruit development period freestone peaches and nectarines produced by the University of Florida breeding program. Fruit Varieties J. 1988;43:79–85.Brooks R, Olmo HP. Register of New Fruit and Nut Varieties, 2nd edition edn: Univ of California Press; 1972.Okie WR, Service USAR. Handbook of peach and nectarine varieties: performance in the southeastern United States and index of names: U.S. Dept. of Agriculture, Agricultural Research Service; 1998Martínez-García P, Peace C, Parfitt D, Ogundiwin E, Fresnedo-Ramírez J, Dandekar A, et al. Influence of year and genetic factors on chilling injury susceptibility in peach (Prunus persica (L.) Batsch). Euphytica. 2012;185(2):267–80.Ogundiwin E, Martí C, Forment J, Pons C, Granell A, Gradziel T, et al. Development of ChillPeach genomic tools and identification of cold-responsive genes in peach fruit. Plant Mol Biol. 2008;68(4–5):379–97.Pons C, Martí C, Forment J, Crisosto CH, Dandekar AM, Granell A. A Bulk Segregant Gene Expression Analysis of a Peach Population Reveals Components of the Underlying Mechanism of the Fruit Cold Response. PLoS ONE. 2014;9(3):e90706.Rosenwasser S, Fluhr R, Joshi JR, Leviatan N, Sela N, Hetzroni A, et al. ROSMETER: A Bioinformatic Tool for the Identification of Transcriptomic Imprints Related to Reactive Oxygen Species Type and Origin Provides New Insights into Stress Responses. Plant Physiol. 2013;163(2):1071–83.Kader AA, Mitchell FG. Maturity and quality. In: James H. LaRue RSJ, vol. Publication No. 3331, editor. Peaches, Plums, and Nectarines: Growing and Handling for Fresh Market. Oakland, Calif: Cooperative Extension, University of California, Division of Agriculture and Natural Resources; 1989. p. 191–6.Dagar A, Friedman H, Lurie S. Thaumatin-like proteins and their possible role in protection against chilling injury in peach fruit. Postharvest Biol Technol. 2010;57(2):77–85.Lill RE, Van Der Mespel GJ. A method for measuring the juice content of mealy nectarines. Sci Hortic. 1988;36(3–4):267–71.Tusher VG, Tibshirani R, Chu G. Significance analysis of microarrays applied to the ionizing radiation response. Proc Natl Acad Sci. 2001;98(9):5116–21.Pavlidis P, Noble WS. Matrix2png: a utility for visualizing matrix data. Bioinformatics. 2003;1-9(2):295–6.Dagar A, Pons Puig C, Marti Ibanez C, Ziliotto F, Bonghi CH, Crisosto C, et al. Comparative transcript profiling of a peach and its nectarine mutant at harvest reveals differences in gene expression related to storability. Tree Genet Genomes. 2013;9(1):223–35.Doherty CJ, Van Buskirk HA, Myers SJ, Thomashow MF. Roles for Arabidopsis CAMTA transcription factors in cold-regulated gene expression and freezing tolerance. Plant Cell. 2009;21(3):972–84.Gilmour S, Zarka D, Stockinger E, Salazar M, Houghton J, Thomashow M. Low temperature regulation of the Arabidopsis CBF family of AP2 transcriptional activators as an early step in cold-induced COR gene expression. Plant J. 1998;16(4):433–42.Dong L, Zhou H-W, Sonego L, Lers A, Lurie S. Ethylene involvement in the cold storage disorder of ‘Flavortop’ nectarine. Postharvest Biol Technol. 2001;23(2):105–15.Zhou H-W, Dong L, Ben-Arie R, Lurie S. The role of ethylene in the prevention of chilling injury in nectarines. J Plant Physiol. 2001;158(1):55–61.Kilian J, Whitehead D, Horak J, Wanke D, Weinl S, Batistic O, et al. The AtGenExpress global stress expression data set: protocols, evaluation and model data analysis of UV-B light, drought and cold stress responses. Plant J. 2007;50(2):347–63.Giraldo E, Díaz A, Corral JM, García A. Applicability of 2-DE to assess differences in the protein profile between cold storage and not cold storage in nectarine fruits. J Proteome. 2012;75(18):5774–82.Obenland D, Vensel W, Hurkman Ii W. Alterations in protein expression associated with the development of mealiness in peaches. J Hortic Sci Biotechnol. 2008;83(1):85–93.Vizoso P, Meisel L, Tittarelli A, Latorre M, Saba J, Caroca R, et al. Comparative EST transcript profiling of peach fruits under different post-harvest conditions reveals candidate genes associated with peach fruit quality. BMC Genomics. 2009;10(1):423.Hannah M, Heyer A, Hincha D. A Global Survey of Gene Regulation during Cold Acclimation in Arabidopsis thaliana. PLoS Genet. 2005;1(2):e26.Walia H, Wilson C, Condamine P, Liu X, Ismail AM, Zeng L, et al. Comparative Transcriptional Profiling of Two Contrasting Rice Genotypes under Salinity Stress during the Vegetative Growth Stage. Plant Physiol. 2005;139(2):822–35.Lurie S, Zhou H-W, Lers A, Sonego L, Alexandrov S, Shomer I. Study of pectin esterase and changes in pectin methylation during normal and abnormal peach ripening. Physiol Plant. 2003;119(2):287–94.Peace C, Crisosto C, Gradziel T. Endopolygalacturonase: A candidate gene for Freestone and Melting flesh in peach. Mol Breed. 2005;16(1):21–31.Luza JG, van Gorsel R, Polito VS, Kader AA. Chilling Injury in Peaches: A Cytochemical and Ultrastructural Cell Wall Study. J Am Soc Hortic Sci. 1992;117(1):114–8.Masia A, Zanchin A, Rascio N, Ramina A. Some Biochemical and Ultrastructural Aspects of Peach Fruit Development. J Am Soc Hortic Sci. 1992;117(5):808–15.Dean GH, Zheng H, Tewari J, Huang J, Young DS, Hwang YT, et al. The Arabidopsis MUM2 Gene Encodes a β-Galactosidase Required for the Production of Seed Coat Mucilage with Correct Hydration Properties. Plant Cell Online. 2007;19(12):4007–21.Johnson CS, Kolevski B, Smyth DR. TRANSPARENT TESTA GLABRA2, a Trichome and Seed Coat Development Gene of Arabidopsis, Encodes a WRKY Transcription Factor. Plant Cell Online. 2002;14(6):1359–75.Karssen CM, der Swan DLC B-v, Breekland AE, Koornneef M. Induction of dormancy during seed development by endogenous abscisic acid: studies on abscisic acid deficient genotypes of Arabidopsis thaliana (L.) Heynh. Planta. 1983;157(2):158–65.Bui M, Lim N, Sijacic P, Liu Z. LEUNIG_HOMOLOG and LEUNIG Regulate Seed Mucilage Extrusion in ArabidopsisF. J Integr Plant Biol. 2011;53(5):399–408.Hussey S, Mizrachi E, Spokevicius A, Bossinger G, Berger D, Myburg A. SND2, a NAC transcription factor gene, regulates genes involved in secondary cell wall development in Arabidopsis fibres and increases fibre cell area in Eucalyptus. BMC Plant Biol. 2011;11(1):173.Jin H, Cominelli E, Bailey P, Parr A, Mehrtens F, Jones J, et al. Transcriptional repression by AtMYB4 controls production of UV‐protecting sunscreens in Arabidopsis. EMBO J. 2000;19(22):6150–61.Romera-Branchat M, Ripoll JJ, Yanofsky MF, Pelaz S. The WOX13 homeobox gene promotes replum formation in the Arabidopsis thaliana fruit. Plant J. 2013;73(1):37–49.Itkin M, Seybold H, Breitel D, Rogachev I, Meir S, Aharoni A. TOMATO AGAMOUS-LIKE 1 is a component of the fruit ripening regulatory network. Plant J. 2009;60(6):1081–95.Bemer M, Karlova R, Ballester AR, Tikunov YM, Bovy AG, Wolters-Arts M, et al. The Tomato FRUITFULL Homologs TDR4/FUL1 and MBP7/FUL2 Regulate Ethylene-Independent Aspects of Fruit Ripening. Plant Cell Online. 2012;24(11):4437–51.Jaakola L, Poole M, Jones MO, Kämäräinen-Karppinen T, Koskimäki JJ, Hohtola A, et al. A SQUAMOSA MADS Box Gene Involved in the Regulation of Anthocyanin Accumulation in Bilberry Fruits. Plant Physiol. 2010;153(4):1619–29.Ogundiwin EA, Peace CP, Nicolet CM, Rashbrook VK, Gradziel TM, Bliss FA, et al. Leucoanthocyanidin dioxygenase gene (PpLDOX): a potential functional marker for cold storage browning in peach. Tree Genetics Genomes. 2008;4(3):543–54.Baxter IR, Young JC, Armstrong G, Foster N, Bogenschutz N, Cordova T, et al. A plasma membrane H + −ATPase is required for the formation of proanthocyanidins in the seed coat endothelium of Arabidopsis thaliana. Proc Natl Acad Sci U S A. 2005;102(7):2649–54.Cheng GW, Crisosto CH. Browning Potential, Phenolic Composition, and Polyphenoloxidase Activity of Buffer Extracts of Peach and Nectarine Skin Tissue. J Am Soc Hortic Sci. 1995;120(5):835–8.Wang Y-S, Tian S-P, Xu Y. Effects of high oxygen concentration on pro- and anti-oxidant enzymes in peach fruits during postharvest periods. Food Chem. 2005;91(1):99–104.Sevillano L, Sanchez-Ballesta MT, Romojaro F, Flores FB. Physiological, hormonal and molecular mechanisms regulating chilling injury in horticultural species. Postharvest technologies applied to reduce its impact. J Sci Food Agric. 2009;89(4):555–73.Provart NJ, Gil P, Chen W, Han B, Chang HS, Wang X, et al. Gene expression phenotypes of Arabidopsis associated with sensitivity to low temperatures. Plant Physiol. 2003;132(2):893–906.Prasad T, Anderson M, Stewart C. Acclimation, Hydrogen Peroxide, and Abscisic Acid Protect Mitochondria against Irreversible Chilling Injury in Maize Seedlings. Plant Physiol. 1994;105(2):619–27.Mhamdi A, Queval G, Chaouch S, Vanderauwera S, Van Breusegem F, Noctor G. Catalase function in plants: a focus on Arabidopsis mutants as stress-mimic models. J Exp Bot. 2010;61(15):4197–220.Ulmasov T, Murfett J, Hagen G, Guilfoyle TJ. Aux/IAA proteins repress expression of reporter genes containing natural and highly active synthetic auxin response elements. Plant Cell Online. 1997;9(11):1963–71.Schepetilnikov M, Dimitrova M, Mancera E, Martínez AG, Keller M, Ryabova LA. TOR and S6K1 promote translation reinitiation of uORF containing mRNAs via phosphorylation of eIF3h. EMBO J. 2013;32(8):1087–102.Xiong Y, Sheen J. The Role of Target of Rapamycin Signaling Networks in Plant Growth and Metabolism. Plant Physiol. 2014;164(2):499–512.Murray JAH, Jones A, Godin C, Traas J. Systems Analysis of Shoot Apical Meristem Growth and Development: Integrating Hormonal and Mechanical Signaling. Plant Cell Online. 2012;24(10):3907–19.Leiber R-M, John F, Verhertbruggen Y, Diet A, Knox JP, Ringli C. The TOR Pathway Modulates the Structure of Cell Walls in Arabidopsis. Plant Cell Online. 2010;22(6):1898–908.Garcia-Hernandez M, Davies E, Baskin TI, Staswick PE. Association of Plant p40 Protein with Ribosomes Is Enhanced When Polyribosomes Form during Periods of Active Tissue Growth. Plant Physiol. 1996;111(2):559–68.Cunningham JT, Rodgers JT, Arlow DH, Vazquez F, Mootha VK, Puigserver P. mTOR controls mitochondrial oxidative function through a YY1-PGC-1[agr] transcriptional complex. Nature. 2007;450(7170):736–40.Baur AH, Yang SF. Methionine metabolism in apple tissue in relation to ethylene biosynthesis. Phytochemistry. 1972;11(11):3207–14.Peiser GD, Wang T-T, Hoffman NE, Yang SF, Liu H-w, Walsh CT. Formation of cyanide from carbon 1 of 1-aminocyclopropane-1-carboxylic acid during its conversion to ethylene. Proc Natl Acad Sci. 1984;81(10):3059–63.Begheldo M, Manganaris GA, Bonghi C, Tonutti P. Different postharvest conditions modulate ripening and ethylene biosynthetic and signal transduction pathways in Stony Hard peaches. Postharvest Biol Technol. 2008;48(1):8–8.Shi Y, Tian S, Hou L, Huang X, Zhang X, Guo H, et al. Ethylene signaling negatively regulates freezing tolerance by repressing expression of CBF and type-A ARR genes in Arabidopsis. Plant Cell. 2012;24(6):2578–95.Thain SC, Vandenbussche F, Laarhoven LJJ, Dowson-Day MJ, Wang Z-Y, Tobin EM, et al. Circadian Rhythms of Ethylene Emission in Arabidopsis. Plant Physiol. 2004;136(3):3751–61.Wang KLC, Yoshida H, Lurin C, Ecker JR. Regulation of ethylene gas biosynthesis by the Arabidopsis ETO1 protein. Nature. 2004;428(6986):945–50.Zheng Z, Guo Y, Novák O, Dai X, Zhao Y, Ljung K, et al. Coordination of auxin and ethylene biosynthesis by the aminotransferase VAS1. Nat Chem Biol. 2013;9(4):244–6.Poschet G, Hannich B, Raab S, Jungkunz I, Klemens PAW, Krueger S, et al. A Novel Arabidopsis Vacuolar Glucose Exporter is involved in cellular Sugar Homeostasis and affects Composition of Seed Storage Compounds. Plant Physiol. 2011;157(4):1664–76.Wang K, Shao X, Gong Y, Zhu Y, Wang H, Zhang X, et al. The metabolism of soluble carbohydrates related to chilling injury in peach fruit exposed to cold stress. Postharvest Biol Technol. 2013;86:53–61.Liu Y-H, Offler CE, Ruan Y-L. Regulation of fruit and seed response to heat and drought by sugars as nutrients and signals. Frontiers Plant Sci. 2013;4:282.Coello P, Hey SJ, Halford NG. The sucrose non-fermenting-1-related (SnRK) family of protein kinases: potential for manipulation to improve stress tolerance and increase yield. J Exp Bot. 2011;62(3):883–93.Baena-González E, Sheen J. Convergent energy and stress signaling. Trends Plant Sci. 2008;13(9):474–82.Baena-González E. Energy Signaling in the Regulation of Gene Expression during Stress. Mol Plant. 2010;3(2):300–13.Robaglia C, Thomas M, Meyer C. Sensing nutrient and energy status by SnRK1 and TOR kinases. Curr Opin Plant Biol. 2012;15(3):301–7.Uemura M, Joseph RA, Steponkus PL. Cold Acclimation of Arabidopsis thaliana (Effect on Plasma Membrane Lipid Composition and Freeze-Induced Lesions). Plant Physiol. 1995;109(1):15–30.Zhang C, Tian S. Crucial contribution of membrane lipids’ unsaturation to acquisition of chilling-tolerance in peach fruit stored at 0°c. Food Chem. 2009;115(2):405–11.Abdrakhamanova A, Wang QY, Khokhlova L, Nick P. Is Microtubule Disassembly a Trigger for Cold Acclimation? Plant Cell Physiol. 2003;44(7):676–86.Baluška F, Hlavacka A, Šamaj J, Palme K, Robinson DG, Matoh T, et al. F-Actin-Dependent Endocytosis of Cell Wall Pectins in Meristematic Root Cells. Insights from Brefeldin A-Induced Compartments. Plant Physiology. 2002;130(1):422–31.Baluška F, Liners F, Hlavačka A, Schlicht M, Van Cutsem P, McCurdy DW, et al. Cell wall pectins and xyloglucans are internalized into dividing root cells and accumulate within cell plates during cytokinesis. Protoplasma. 2005;225(3–4):141–55.Gonzalez-Aguero M, Pavez L, Ibanez F, Pacheco I, Campos-Vargas R, Meisel L, et al. Identification of woolliness response genes in peach fruit after post-harvest treatments. J Exp Bot. 2008;59(8):1973–86.Bashline L, Lei L, Li S, Gu Y. Cell Wall, Cytoskeleton, and Cell Expansion in Higher Plants. Mol Plant. 2014;4:586–600.Dhonukshe P, Grigoriev I, Fischer R, Tominaga M, Robinson DG, Hašek J, et al. Auxin transport inhibitors impair vesicle motility and actin cytoskeleton dynamics in diverse eukaryotes. Proc Natl Acad Sci. 2008;105(11):4489–94.Fischer U, Men S, Grebe M. Lipid function in plant cell polarity. Curr Opin Plant Biol. 2004;7(6):670–6.Schrick K, Fujioka S, Takatsuto S, Stierhof Y-D, Stransky H, Yoshida S, et al. A link between sterol biosynthesis, the cell wall, and cellulose in Arabidopsis. Plant J. 2004;38(2):227–43.Cheng GW, Crisosto CH. Iron—Polyphenol Complex Formation and Skin Discoloration in Peaches and Nectarines. J Am Soc Hortic Sci. 1997;122(1):95–9.Bouché N, Fait A, Zik M, Fromm H. The root-specific glutamate decarboxylase (GAD1) is essential for sustaining GABA levels in Arabidopsis. Plant Mol Biol. 2004;55(3):315–25.Pedreschi R, Franck C, Lammertyn J, Erban A, Kopka J, Hertog M, et al. Metabolic profiling of ‘Conference’ pears under low oxygen stress. Postharvest Biol Technol. 2009;51(2):123–30

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

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

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