Homeòstasi energètica. Com gestionem l’energia?

L’energia no es crea ni es destrueix; només es transforma1. Els éssers vius obeïm aquest principi i com a tal, el trànsit d’energia que ens permet viure pot descriure’s en termes de balanç energètic (figura 1). Aquest és dependent de la ingesta i l’emmagatzematge energètics, així com del seu consum. En conseqüència, la relació entre els seus elements ens permet predir si un individu mantindrà constant o no el seu pes corporal

Què caram són les biomolècules i què tenen a veure amb tu?

― Noi, si veus que t’ha de fer angúnia, mira cap a una altra banda, d’acord?I no, no ho vaig fer. Tossut i amb aires de valentia, vaig fixar la mirada en aquella agulla gegantina que, gota a gota, se m’enduia la sang. [...]La metgessa em va indicar, com si es tractés del ritual de cada dia, que pugés a la bàscula que reposava sobre el terra, que després de tentinejar va acabar marcant un 80.44 kg quadriculat. En el mateix aparell em va mesurar l’alçada, i ràpidament va anotar un 172.0 cm. Després em va convidar a seure davant de la seva cadira.― Interessant. Bé, Blai. M’he estat mirant una estona els resultats de la teva anàlisi de sang i t’hauria de comentar quatre cosetes. Primer de tot, i pel que fa a les mesures que t’acabo de prendre, vull que vegis una cosa. Saps què és l’Index de Massa Corporal? És una mesura que relaciona la massa i l’alçada d’un individu, de manera que proporciona una referència de la quantitat de massa corporal per metre quadrat― per què m’explicava aquelles coses? ―. Per si t’interessa, per la cara que fas, es calcula dividint la massa en quilograms entre l’altura al quadrat en metres. En el teu cas― va teclejar ràpidament la calculadora― em surt que el teu IMC és de 27.19 kg·m-2. Si consultem els criteris que estableix la Organització Mundial de la Salut, veiem que un IMC d’entre 25 i 30 kg·m-2 indica sobrepès. Si, a més, tenim en compte que la teva pressió arterial és de 143/92, és a dir, la pressió màxima i mínima durant la sístole i la diàstole del cor, respectivament, veiem que tens una lleugera hipertensió..

Una propuesta para el diseño de actividades que desarrollen el pensamiento crítico en el aula de ciencias

Vivimos en un mundo hiperconectado marcado por la desafiante "era de la posverdad". En este contexto urge ayudar a los jóvenes a desarrollar estrategias de pensamiento crítico y para ello se requiere instrucción, práctica y tiempo. La actividad científica escolar ofrece un escenario perfecto para promoverlo. Tras el análisis del concepto de pensamiento crítico, poniendo el foco en su enseñanza en el aula de ciencias, en este artículo se presentan dos herramientas para el diseño de actividades que pongan el foco en el desarrollo del pensamiento crítico en el aula de ciencias: el MOPC (Mapa Operativo del Pensamiento Crítico) y el EDAPC (Esquema de Diseño de Actividades de Pensamiento Crítico). A continuación, se muestra cómo se aplicaron dichas herramientas al diseño de una actividad, a modo de ejemplo, y se presentan los resultados obtenidos tras su implementación. Finalmente, se plantean algunas observaciones y consideraciones generales con relación a las herramientas presentada y al desarrollo del pensamiento crítico a lo largo de la escolaridad. Palabras clave: Pensamiento crítico, educación científica, educación secundaria obligatoria, actividades de enseñanza-aprendizaje, herramientas de diseño.We live in a hyper-connected world marked by the challenging "post-truth era". In this context, there is an urgent need to help young people develop critical thinking strategies and this requires instruction, practice and time. The school scientific activity offers a perfect setting to promote it. After analyzing the concept of critical thinking, focusing on its teaching in the science classroom, this article presents two tools made for the design of activities that focus on the development of critical thinking in the science classroom: MOPC (Critical Thinking Operational Map) and EDAPC (Scheme for the Design of Critical Thinking Activities). Next, it is shown how these tools were applied to the design of an activity, as an example, and the results obtained after their implementation are presented. Finally, some observations and general considerations are made in relation to the tools presented and the development of critical thinking throughout schooling. Keywords: Critical thinking, science education, compulsory secondary education, teaching-learning activities, design tools

Una propuesta para el diseño de actividades que desarrollen el pensamiento crítico en el aula de ciencias

Vivimos en un mundo hiperconectado marcado por la desafiante “era de la posverdad”. En este contexto urge ayudar a los jóvenes a desarrollar estrategias de pensamiento crítico y para ello se requiere instrucción, práctica y tiempo. La actividad científica escolar ofrece un escenario perfecto para promoverlo. Tras el análisis del concepto de pensamiento crítico, poniendo el foco en su enseñanza en el aula de ciencias, en este artículo se presentan dos herramientas para el diseño de actividades que pongan el foco en el desarrollo del pensamiento crítico en el aula de ciencias: el MOPC (Mapa Operativo del Pensamiento Crítico) y el EDAPC (Esquema de Diseño de Actividades de Pensamiento Crítico). A continuación, se muestra cómo se aplicaron dichas herramientas al diseño de una actividad, a modo de ejemplo, y se presentan los resultados obtenidos tras su implementación. Finalmente, se plantean algunas observaciones y consideraciones generales con relación a las herramientas presentada y al desarrollo del pensamiento crítico a lo largo de la escolaridad. Palabras clave: Pensamiento crítico, educación científica, educación secundaria obligatoria, actividades de enseñanza-aprendizaje, herramientas de diseño. A didactic proposal for the development of critical thinking in the high school science classroom Abstract: We live in a hyper-connected world marked by the challenging “post-truth era”. In this context, there is an urgent need to help young people develop critical thinking strategies and this requires instruction, practice and time. The school scientific activity offers a perfect setting to promote it. After analyzing the concept of critical thinking, focusing on its teaching in the science classroom, this article presents two tools made for the design of activities that focus on the development of critical thinking in the science classroom: MOPC (Critical Thinking Operational Map) and EDAPC (Scheme for the Design of Critical Thinking Activities). Next, it is shown how these tools were applied to the design of an activity, as an example, and the results obtained after their implementation are presented. Finally, some observations and general considerations are made in relation to the tools presented and the development of critical thinking throughout schooling. Keywords: Critical thinking, science education, compulsory secondary education, teaching-learning activities, design tools.Vivimos en un mundo hiperconectado marcado por la desafiante “era de la posverdad”. En este contexto urge ayudar a los jóvenes a desarrollar estrategias de pensamiento crítico y para ello se requiere instrucción, práctica y tiempo. La actividad científica escolar ofrece un escenario perfecto para promoverlo. Tras el análisis del concepto de pensamiento crítico, poniendo el foco en su enseñanza en el aula de ciencias, en este artículo se presentan dos herramientas para el diseño de actividades que pongan el foco en el desarrollo del pensamiento crítico en el aula de ciencias: el MOPC (Mapa Operativo del Pensamiento Crítico) y el EDAPC (Esquema de Diseño de Actividades de Pensamiento Crítico). A continuación, se muestra cómo se aplicaron dichas herramientas al diseño de una actividad, a modo de ejemplo, y se presentan los resultados obtenidos tras su implementación. Finalmente, se plantean algunas observaciones y consideraciones generales con relación a las herramientas presentada y al desarrollo del pensamiento crítico a lo largo de la escolaridad. Palabras clave: Pensamiento crítico, educación científica, educación secundaria obligatoria, actividades de enseñanza-aprendizaje, herramientas de diseño. A didactic proposal for the development of critical thinking in the high school science classroom Abstract: We live in a hyper-connected world marked by the challenging “post-truth era”. In this context, there is an urgent need to help young people develop critical thinking strategies and this requires instruction, practice and time. The school scientific activity offers a perfect setting to promote it. After analyzing the concept of critical thinking, focusing on its teaching in the science classroom, this article presents two tools made for the design of activities that focus on the development of critical thinking in the science classroom: MOPC (Critical Thinking Operational Map) and EDAPC (Scheme for the Design of Critical Thinking Activities). Next, it is shown how these tools were applied to the design of an activity, as an example, and the results obtained after their implementation are presented. Finally, some observations and general considerations are made in relation to the tools presented and the development of critical thinking throughout schooling. Keywords: Critical thinking, science education, compulsory secondary education, teaching-learning activities, design tools

Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit.

This is the peer reviewed version of the following article: group, T. E. S. o. C. c. (2018). "Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit." Colorectal Disease 20(S6): 47-57., which has been published in final form at https://doi.org/10.1111/codi.1437. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsINTRODUCTION: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. METHODS: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (> 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5). RESULTS: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83-2.79, P = 0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43-11.02, P = 0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur. CONCLUSIONS: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.

This is the peer reviewed version of the following article: The and E. S. o. C. c. groups (2018). "The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit." Colorectal Disease 20(S6): 69-89., which has been published in final form at https://doi.org/10.1111/codi.14371. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001). CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection

An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)

IntroductionTransanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally.MethodsA pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.ResultsOf 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02-2.48, P=0.04) and robotic TaTME (OR 3.05, 1.10-7.34, P=0.02) were associated with a higher risk of anastomotic leak than non-transanal laparoscopic TME. However this association was lost in the mixed-effects model controlling for patient and disease factors (OR 1.23, 0.77-1.97, P=0.39 and OR 2.11, 0.79-5.62, P=0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55-4.77, P<0.001) and male gender (OR 2.29, 1.52-3.44, P<0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%.ConclusionThis contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results

Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery

This is the peer reviewed version of the following article: , which has been published in final form at https://doi.org/10.1111/codi.14361. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland Introduction: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging. Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging. Results: Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as ‘fair’ only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively). Conclusion: The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials