Pedagogías decoloniales caminando y preguntando: notas a Paulo Freire desde Abya Yala

En unas notas personales, comprometidas y profundas, Catherine Walsh retoma sus diálogos con Paulo Freire. Recupera, desafía y pone en tensión sus propuestas a la luz de una (re)existencia decolonial que impone y reclama la concepción de pedagogías otras, próximas al Freire en el sentido revolucionario, pero ajenas por su distanciamiento de la modernidad occidental y opciones epistemologicas eurocéntricas. A través del diálogo, la autora presenta sus posturas con contundencia,  pensándolas como movimiento que se afecta con el caminar y el preguntar.Este trabajo es publicado en su versión en español con el consentimiento de su autora. Pertenece en la versión original en idioma inglés al International Journal of Lifelong Education, Vol. 34, No. 2, Special Issue on Education and Decolonization, 2015, en prensa. La traducción al español rioplatense fue realizada por María Marta Yedaide y Carlos Rafael Domínguez

Co-design and user validation of the MedFit App: a focus group analysis

This abstract details the development phase of the formative research process outlined by the Medical Research Council, used to develop a theoretically informed Android App, named MedFit, to enhance disease self-management and quality of life in adults with cardiovascular disease (CVD). The overall aim of the app is to increase physical activity minutes of adults with CVD. A key part of the development phase, which is the focus of this abstract, is the co-design and user validation of the MedFit app

Behavior Change Techniques in Physical Activity eHealth Interventions for People With Cardiovascular Disease: Systematic Review

Background: Cardiovascular disease (CVD) is the leading cause of premature death and disability in Europe, accounting for 4 million deaths per year and costing the European Union economy almost €196 billion annually. There is strong evidence to suggest that exercise-based secondary rehabilitation programs can decrease the mortality risk and improve health among patients with CVD. Theory-informed use of behavior change techniques (BCTs) is important in the design of cardiac rehabilitation programs aimed at changing cardiovascular risk factors. Electronic health (eHealth) is the use of information and communication technologies (ICTs) for health. This emerging area of health care has the ability to enhance self-management of chronic disease by making health care more accessible, affordable, and available to the public. However, evidence-based information on the use of BCTs in eHealth interventions is limited, and particularly so, for individuals living with CVD. Objective: The aim of this systematic review was to assess the application of BCTs in eHealth interventions designed to increase physical activity (PA) in CVD populations. Methods: A total of 7 electronic databases, including EBSCOhost (MEDLINE, PsycINFO, Academic Search Complete, SPORTDiscus with Full Text, and CINAHL Complete), Scopus, and Web of Science (Core Collection) were searched. Two authors independently reviewed references using the software package Covidence (Veritas Health Innovation). The reviewers met to resolve any discrepancies, with a third independent reviewer acting as an arbitrator when required. Following this, data were extracted from the papers that met the inclusion criteria. Bias assessment of the studies was carried out using the Cochrane Collaboration’s tool for assessing the risk of bias within Covidence; this was followed by a narrative synthesis. Results: Out of the 987 studies that were identified, 14 were included in the review. An additional 9 studies were added following a hand search of review paper references. The average number of BCTs used across the 23 studies was 7.2 (range 1-19). The top three most frequently used BCTs included information about health consequences (78%, 18/23), goal setting (behavior; 74%, 17/23), and joint third, self-monitoring of behavior and social support (practical) were included in 11 studies (48%, 11/23) each. Conclusions: This systematic review is the first to investigate the use of BCTs in PA eHealth interventions specifically designed for people with CVD. This research will have clear implications for health care policy and research by outlining the BCTs used in eHealth interventions for chronic illnesses, in particular CVD, thereby providing clear foundations for further research and developments in the area

MedFit: The development of a mobile-application to enhance participant self-management of their cardiovascular disease

Background: Cardiovascular disease (CVD) is the leading cause of premature death and disability in Europe. Cardiac Rehabilitation (CR) can reduce the impact of CVD by lowering mortality and morbidity rates and promoting healthy active lifestyles. Yet adherence within CR is low. Research suggests that mHealth interventions are useful in supporting the self-management of chronic disease. The purpose of this research is to report on the development of an mHealth intervention. Methods: For the intervention development the Medical Research Council’s formative process consisting of 4 stages; i) development, ii) feasibility/piloting, iii) evaluation and iv) implementation will be used to develop a theoretically informed Android App to enhance disease self-management and quality of life in CVD. Like CR it will use exercise as its main modality, and provide advice on other health behaviours. Results: A systematic review of the use of behaviour change techniques (BCTs) in physical activity eHealth interventions for CVD patients has been conducted. Seven electronic databases yielded 987 articles, 97 of which met the inclusion criteria for full text review. A multidisciplinary team comprised of exercise scientists, health behaviour change and technology specialists are using this information to develop the intervention prototype. Stage one will be followed by qualitative research, where end-users will be asked to examine the intervention in order to determine its feasibility and acceptability, to ultimately improve its efficacy through a co-design process. Conclusion: Preliminary findings and systematic review protocol will be reported as per the PRISMA guidelines, ultimately aiding the development of the MedFit app

The gas-phase reaction of NH2 with formaldehyde (CH2O) is not a source of formamide (NH2CHO) in interstellar environments

The first experimental study of the low-temperature kinetics of the gas-phase reaction of NH2 with formaldehyde (CH2O) has been performed. This reaction has previously been suggested as a source of formamide (NH2CHO) in interstellar environments. A pulsed Laval nozzle equipped with laser-flash photolysis and laser-induced fluorescence spectroscopy was used to create and monitor the temporal decay of NH2 in the presence of CH2O. No loss of NH2 could be observed via reaction with CH2O and we place an upper-limit on the rate coefficient of <6x10-12 cm3 molecule-1 s-1 at 34K. Ab initio calculations of the potential energy surface were combined with RRKM calculations to predict a rate coefficient of 6.2x10-14 cm3 molecule-1 s-1 at 35K, consistent with the experimental results. The presence of a significant barrier, 18 kJ mol-1, for the formation of formamide as a product, means that only the H-abstraction channel producing NH3 + CHO, in which the transfer of an H-atom can occur by quantum mechanical tunnelling through a 23 kJ mol-1 barrier, is open at low temperatures. These results are in contrast with a recent theoretical study which suggested that the reaction could proceed without a barrier and was therefore a viable route to gas-phase formamide formation. The calculated rate coefficients were used in an astrochemical model which demonstrated that this reaction produces only negligible amounts of gas-phase formamide under interstellar and circumstellar conditions. The reaction of NH2 with CH2O is therefore not an important source of formamide at low temperatures in interstellar environments.Comment: Manuscript, 14 pages, 4 figures. Supporting Information, 8 pages, 2 figures. Accepted for publication in The Astrophysical Journal Letter

MedFit: a mobile application for recovering CVD patients

The third phase of the recovery from cardiovascular disease (CVD) is an exercise-based rehabilitation programme. However, adherence to an exercise regime is typically not maintained by the patient for a variety of reasons such as lack of time, financial constraints, etc. In order to facilitate patients to perform their exercises from the comfort of their home and at their own convenience, we have developed a mobile application, termed MedFit. It provides access to a tailored suite of exercises along with easy to understand guidance from audio and video instructions. Two types of wearable sensors are utilized to allow motivational feedback to be provided to the user for self monitoring and to provide near real-time feedback. Fitbit, a commercially available activity and fitness tracker, is used to provide in-depth feedback for self-monitoring over longer periods of time (e.g. day, week, month), whereas the Shimmer wireless sensing platform provides the data for near real-time feedback on the quality of the exercises performed. MedFit is a simple and intuitive mobile application designed to provide the motivation and tools for patients to help ensure faster recovery from the trauma caused by CVD. In this paper we describe the MedFit application as a demo submission to the 2nd MMHealth Workshop at ACM MM 2017

Identification of key residues that confer Rhodobacter sphaeroides LPS activity at horse TLR4/MD-2.

The molecular determinants underpinning how hexaacylated lipid A and tetraacylated precursor lipid IVa activate Toll-like receptor 4 (TLR4) are well understood, but how activation is induced by other lipid A species is less clear. Species specificity studies have clarified how TLR4/MD-2 recognises different lipid A structures, for example tetraacylated lipid IVa requires direct electrostatic interactions for agonism. In this study, we examine how pentaacylated lipopolysaccharide from Rhodobacter sphaeroides (RSLPS) antagonises human TLR4/MD-2 and activates the horse receptor complex using a computational approach and cross-species mutagenesis. At a functional level, we show that RSLPS is a partial agonist at horse TLR4/MD-2 with greater efficacy than lipid IVa. These data suggest the importance of the additional acyl chain in RSLPS signalling. Based on docking analysis, we propose a model for positioning of the RSLPS lipid A moiety (RSLA) within the MD-2 cavity at the TLR4 dimer interface, which allows activity at the horse receptor complex. As for lipid IVa, RSLPS agonism requires species-specific contacts with MD-2 and TLR4, but the R2 chain of RSLA protrudes from the MD-2 pocket to contact the TLR4 dimer in the vicinity of proline 442. Our model explains why RSLPS is only partially dependent on horse TLR4 residue R385, unlike lipid IVa. Mutagenesis of proline 442 into a serine residue, as found in human TLR4, uncovers the importance of this site in RSLPS signalling; horse TLR4 R385G/P442S double mutation completely abolishes RSLPS activity without its counterpart, human TLR4 G384R/S441P, being able to restore it. Our data highlight the importance of subtle changes in ligand positioning, and suggest that TLR4 and MD-2 residues that may not participate directly in ligand binding can determine the signalling outcome of a given ligand. This indicates a cooperative binding mechanism within the receptor complex, which is becoming increasingly important in TLR signalling.This work was supported by a project grant from the Horserace Betting Levy Board to CEB and a Horserace Betting Levy Board Veterinary Research Training Scholarship to KLI. This work was also supported by a Wellcome Trust program grant to NJG and CEB. CEB is a BBSRC Research Development Fellow.This is the final version of the article. It first appeared from PLOS at http://dx.doi.org/10.1371/journal.pone.0098776

Technology use among patients with cardiovascular disease: an assessment of patient need for a technology enabled behavioural change intervention.

Effective Cardiac Rehabilitation (CR) can significantly improve mortality and morbidity rates in relation to cardiovascular disease; however, uptake of traditional community-based long-term is very low. PATHway (Physical Activity Towards Health) will provide individualized rehabilitation programs, through an internet-enabled sensor-based home exercise platform that allows remote participation. The purpose of this study was to assess the level of interest and use of technology by individuals living with CVD in order to inform the design of a technology-enabled CR programme. Method: A technology usage questionnaire based on a previous study investigating the role of technology and mHealth in a CVD population was used (Dale et al., 2014) to ascertain the current level of technology use. All patients attending the Phase Four community cardiac rehabilitation HeartSmart programme (MedEx) were recruited (N=67; 66.2 years, SD= 8.55, Males =76.1%, Females=20.9%). Results: Technology usage was high with 60% of participants owning a smartphone and 85% accessing the internet (54% of whom access it everyday). Participants endorsed the idea of technology enabled cardiac rehabilitation, indicating that they found the idea ‘ appealing’. 79% were interested in receiving ongoing CR support via their smartphones, 79% were interested in receiving CR via the internet. It was found that 52% of patients found the idea of a virtual rehabilitation class appealing. Conclusion: This study provides support for the patient need for a technology enabled behavioural change intervention, specifically through the provision of an internet-enabled sensor-based home exercise platform that allows remote participation in CR exercise programs

Protocolised non-invasive compared with invasive weaning from mechanical ventilation for adults in intensive care : the Breathe RCT

Background: Invasive mechanical ventilation (IMV) is a life-saving intervention. Following resolution of the condition that necessitated IMV, a spontaneous breathing trial (SBT) is used to determine patient readiness for IMV discontinuation. In patients who fail one or more SBTs, there is uncertainty as to the optimum management strategy. Objective: To evaluate the clinical effectiveness and cost-effectiveness of using non-invasive ventilation (NIV) as an intermediate step in the protocolised weaning of patients from IMV. Design: Pragmatic, open-label, parallel-group randomised controlled trial, with cost-effectiveness analysis. Setting: A total of 51 critical care units across the UK. Participants: Adult intensive care patients who had received IMV for at least 48 hours, who were categorised as ready to wean from ventilation, and who failed a SBT. Interventions: Control group (invasive weaning): patients continued to receive IMV with daily SBTs. A weaning protocol was used to wean pressure support based on the patient’s condition. Intervention group (non-invasive weaning): patients were extubated to NIV. A weaning protocol was used to wean inspiratory positive airway pressure, based on the patient’s condition. Main outcome measures: The primary outcome measure was time to liberation from ventilation. Secondary outcome measures included mortality, duration of IMV, proportion of patients receiving antibiotics for a presumed respiratory infection and health-related quality of life. Results: A total of 364 patients (invasive weaning, n = 182; non-invasive weaning, n = 182) were randomised. Groups were well matched at baseline. There was no difference between the invasive weaning and non-invasive weaning groups in median time to liberation from ventilation {invasive weaning 108 hours [interquartile range (IQR) 57–351 hours] vs. non-invasive weaning 104.3 hours [IQR 34.5–297 hours]; hazard ratio 1.1, 95% confidence interval [CI] 0.89 to 1.39; p = 0.352}. There was also no difference in mortality between groups at any time point. Patients in the non-invasive weaning group had fewer IMV days [invasive weaning 4 days (IQR 2–11 days) vs. non-invasive weaning 1 day (IQR 0–7 days); adjusted mean difference –3.1 days, 95% CI –5.75 to –0.51 days]. In addition, fewer non-invasive weaning patients required antibiotics for a respiratory infection [odds ratio (OR) 0.60, 95% CI 0.41 to 1.00; p = 0.048]. A higher proportion of non-invasive weaning patients required reintubation than those in the invasive weaning group (OR 2.00, 95% CI 1.27 to 3.24). The within-trial economic evaluation showed that NIV was associated with a lower net cost and a higher net effect, and was dominant in health economic terms. The probability that NIV was cost-effective was estimated at 0.58 at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year. Conclusions: A protocolised non-invasive weaning strategy did not reduce time to liberation from ventilation. However, patients who underwent non-invasive weaning had fewer days requiring IMV and required fewer antibiotics for respiratory infections. Future work: In patients who fail a SBT, which factors predict an adverse outcome (reintubation, tracheostomy, death) if extubated and weaned using NIV? Trial registration: Current Controlled Trials ISRCTN15635197. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 48. See the NIHR Journals Library website for further project information