La actividad experimental en educación primaria : restricciones y retos

Es un estudio que aporta pruebas empíricas sobre las condiciones y las restricciones de las actividades experimentales en Educación Primaria en Navarra (Spain), basadas en una encuesta distribuida a toda la población objeto de estudio. La encuesta está confeccionada mediante respuestas abiertas y objetivas con escala Likert. El objetivo del trabajo es el diagnóstico actual de la situación y uso de los laboratorios escolares, que servirá para adecuar y mejorar las condiciones de los centros y de los profesores en su actividad docente

¿Qué opinan los futuros maestros sobre el aprendizaje de las ciencias a través de la indagación y sobre sus necesidades formativas?

The application of an open-ended questionnaire allows us to detect some ideas about inquiry in preservice Primary teachers. A first analysis allows us to categorize the type of answers. In general, the majority of students ask for more theoretical contents about science, since they are not confidence in being involved in science teaching without this background. A great scattering of answers appears when students are asked for inquiry in the Primary classrooms. Finally, no coherent answers are detected when students declare that they want to learn “more scientific contents” (90%), whereas less than 50% of them would like to be taught about this issue

The Mexican consensus on non-cardiac chest pain

Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by ret-rosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced byesophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology,pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options forthose patients. Methods Three general coordinators carried out a literature review of all articles published inEnglish and Spanish on the theme and formulated 38 initial statements, dividing them into 3 maincategories: 1) definitions, epidemiology, and pathophysiology, 2) diagnosis, and 3) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statementswere those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions The final consensus included 29 statements. All patients presentingwith chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initialapproach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagiaor alarm symptoms are present, endoscopy is recommended. High-resolution manometry isthe best method for ruling out spastic motor disorders and achalasia and pH monitoring aidsin demonstrating abnormal esophageal acid exposure. Treatment should be directed at thepathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/orsmooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionallysurgery or endoscopic therapy

Consenso mexicano sobre dolor torácico no cardiaco

Introducción: Dolor torácico no cardíaco (DTNC) se define como un síndrome clínico caracte-rizado por dolor retroesternal semejante a la angina de pecho, pero de origen no cardiaco ygenerado por enfermedades esofágicas, osteomusculares, pulmonares o psiquiátricas.Objetivo: Presentar una revisión consensuada basada en evidencias sobre definición, epidemio-logía, fisiopatología, diagnóstico y opciones terapéuticas para pacientes con DTNC.Métodos: Tres coordinadores generales realizaron una revisión bibliográfica de todas las publi-caciones en inglés y espa˜nol sobre el tema y elaboraron 38 enunciados iniciales divididosen tres categorías principales: 1) definiciones, epidemiología y fisiopatología; 2) diagnóstico,y 3) tratamiento. Los enunciados fueron votados (3 rondas) utilizando el sistema Delphi, y losque alcanzaron un acuerdo > 75% fueron considerados y calificados de acuerdo con el sistemaGRADE. Resultados y conclusiones: El consenso final incluyó 29 enunciados Todo paciente que debutacon dolor torácico debe ser inicialmente evaluado por un cardiólogo. La causa más común deDTNC es la enfermedad por reflujo gastroesofágico (ERGE). Como abordaje inicial, si no existensíntomas de alarma, se puede dar una prueba terapéutica con inhibidor de bomba de pro-tones (IBP) por 2-4 semanas. Si hay disfagia o síntomas de alarma, se recomienda hacer unaendoscopia. La manometría de alta resolución es el mejor método para descartar trastornosmotores espásticos y acalasia. La pHmetría ayuda a demostrar exposición esofágica anormal alácido. El tratamiento debe ser dirigido al mecanismo fisiopatológico, y puede incluir IBP, neu-romoduladores y/o relajantes de músculo liso, intervención psicológica y/o terapia cognitiva,y ocasionalmente cirugía o terapia endoscópica. ABSTRACT Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by retros-ternal pain similar to that of angina pectoris, but of non-cardiac origin and produced byesophageal, musculoskeletal, pulmonary, or psychiatric diseases.Aim: To present a consensus review based on evidence regarding the definition, epidemiology,pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options forthose patients. Methods: Three general coordinators carried out a literature review of all articles published inEnglish and Spanish on the theme and formulated 38 initial statements, dividing them into 3 maincategories: (i) definitions, epidemiology, and pathophysiology; (ii) diagnosis, and (iii) treatment.The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statementswere those that reached > 75% agreement, and they were rated utilizing the GRADE system.Results and conclusions: The final consensus included 29 statements. All patients presentingwith chest pain should initially be evaluated by a cardiologist. The most common cause ofnon-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. Ifdysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution mano-metry is the best method for ruling out spastic motor disorders and achalasia and pH monitoringaids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at thepathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/orsmooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionallysurgery or endoscopic therapy

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

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

High-temperature dolomite in the Lower Cretaceous Cupido Formation, Bustamante Canyon, northeast Mexico: petrologic, geochemical and microthermometric constraints

The Lower Cretaceous Cupido Formation, a carbonate system developed in northeastern Mexico, like many ancient carbonate platforms contains numerous dolomite bodies. These diagenetic features are particularly well exposed at Bustamante Canyon (Nuevo Leon State) where the Cupido Formation crops out from base to top along 6 km. Dolomitization affected practically all facies and crosscuts bedding planes; dolomite bodies are irregular in outer and margin platform facies and tabular/subhorizontal in inner platform facies. Most dolomite is replacive and also occurs as cement in small amounts. Crystal shape of replacement dolomite varies from nonplanar, planar-s to planar-e, whereas the dolomite cement consists mostly of saddle dolomite. Dolomite is non ferroan and shows dull red luminescence, its ¿Â18OPDB varies from -4.2 to -6.4¿ñ and its ¿Â13CPDB from 1.8 to 3.4¿ñ. 87Sr/86Sr ratios of replacement dolomite vary from 0.70754 to 0.70770. Homogenization temperatures in dolomite from fl uid inclusion analysis range from 190 oC to 200 oC and are interpreted as the minimum temperatures for the dolomite formation. Petrographic data, geometries and distribution of dolomite bodies, microthermometric results from fl uid inclusions and geochemical information suggest that the dolomitization occurred under deep-burial diagenetic conditions. Similar homogenization temperatures were determined in dolomite and postdolomite calcite cement of the Cupido Formation from southern locations including Potrero Chico and Potrero Minas Viejas. The high temperatures recorded in the Cupido Formation dolomites are the result of a regional thermal anomaly developed probably around salt structures. 87Sr/86Sr values, oxygen stable isotopes, and trace element composition of dolomite suggest that the dolomitizing fl uid was perhaps a hot mixture of formation water (modifi ed sea water) of the Cupido Formation and brines derived from the updip La Virgen Formation, a carbonate-evaporite succession equivalent in age to the Cupido Formation. Dolomite distribution was apparently not controlled by major tectonic features (e.g., faults or fractures); the dolomitizing fl uid seems to have followed subhorizontal or lateral fl owing circulating patterns controlled by the former porosity and permeability of the calcareous facies.La Formación Cupido del Cretácico Inferior, un sistema carbonatado desarrollado en el noreste de México, como muchas de las plataformas carbonatadas antiguas contiene numerosos cuerpos de dolomita. Estas rasgos diageneticos estan particularmente bien expuestas en el Canon de Bustamante (Estado de Nuevo Leon), donde la Formacion Cupido afl ora desde su base hasta su cima a lo largo de 6 km. La dolomitizacion afecto practicamente todas las facies cruzando los planos de estratifi cacion; los cuerpos de dolomita son irregulares en las facies de plataforma externa y margen de plataforma y tabulares a subhorizontales en las facies de interior de plataforma. La mayoria de la dolomita es de reemplazamiento y tambien ocurre como cemento en cantidades menores. Las formas de los cristales de la dolomita de reemplazamiento varian de no-planar, a planar-s y a planar-e; la dolomita de cemento es en su mayoria dolomita barroca. La dolomita es no ferrosa y exhibe luminiscencia opaca de color rojo, su ¿Â18OPDB varia de -4.2 a -6.4¿ñ y su ¿Â13CPDB de 1.8 a 3.4¿ñ. La relacion 87Sr/86Sr de la dolomita de reemplazamiento varia de 0.70754 a 0.70770. Las temperaturas de homogeneizacion de la dolomita medidas en inclusiones fl uidas varian de 190 a 200 ¿¿C y se interpretan como las temperaturas minimas de formacion de la dolomita. Los datos petrografi cos, la geometria y la distribucion de los cuerpos de dolomita, los resultados microtermometricos de inclusiones fl uidas y la informacion geoquimica sugieren que la dolomitizacion ocurrio bajo condiciones diageneticas de sepultamiento profundo. Temperaturas de homogeneizacion similares fueron determinadas en dolomita y cemento de calcita post-dolomita de la Formacion Cupido de localidades mas al sur, incluyendo Potrero Chico y Potrero Minas Viejas. Las altas temperaturas registradas en las dolomitas de la Formacion Cupido son el resultado de una anomalia termica regional desarrollada probablemente alrededor de estructuras salinas. Las relaciones de 87Sr/86Sr, los isotopos de oxigeno y la composicion de los elementos traza de la dolomita sugieren que el fl uido dolomitizante fue posiblemente una mezcla caliente de agua de formacion (agua marina modifi cada) de la Formacion Cupido y salmueras derivadas de la Formacion La Virgen, una sucesion carbonatada-evaporitica equivalente en edad a la Formacion Cupido. La distribucion de la dolomita no estuvo aparentemente controlada por rasgos tectonicos mayores (e.g., fallas o fracturas); los fl uidos dolomitizantes parecen haber seguido patrones de circulacion de fl ujo subhorizontal o lateral, controlados por la porosidad y permeabilidad originales de las facies calcareas

Serial real-time RT-PCR and serology measurements substantially improve Zika and Dengue virus infection classification in a co-circulation area

International audienceBackgroundReal-time RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) is considered the gold standard for Zika virus (ZIKV) infection diagnosis, despite its low sensitivity. Diagnosis using recommended serologic cutoffs in co-circulating Flaviviruses areas maybe inadequate due to in-vitro cross-reactivities of Flaviviruses-specific antibodies. We evaluated Zika diagnosis in symptomatic patients using serial RT-PCR and develop a classification model using serial Dengue virus (DENV) and ZIKV serologies.MethodsA prospective longitudinal multicentric study in Southern Mexico (NCT02831699) enrolled symptomatic and non-symptomatic participants. In the classification model, true positives were symptomatic (using a modified World Health Organization/Pan American Health Organization definition) with RT-PCR positive for ZIKV or DENV. True negatives were non-symptomatic with negative RT-PCR. Serial serology measurements were used to predict disease status.ResultsAnalyzing ZIKV and DENV RT-PCR at 3 timepoints between days 3 and 13 of symptom onset detected 25% more cases than a single RT-PCR analysis between day 0 and 6. When considering sensitivity and specificity together, the serial serology model predicted all categories of disease and negatives better than manufactures cutoffs. Their cutoffs optimized sensitivity or specificity but not both.ConclusionsWe demonstrated the importance of serial RT-PCR and antibody measurements to diagnose arbovirus infection in symptomatic patients living in regions with co-circulating flaviviruses