Relationships Between Chemoreflex Responses, Sleep Quality, and Hematocrit in Andean Men and Women.

Andean highlanders are challenged by chronic hypoxia and many exhibit elevated hematocrit (Hct) and blunted ventilation compared to other high-altitude populations. While many Andeans develop Chronic Mountain Sickness (CMS) and excessive erythrocytosis, Hct varies markedly within Andean men and women and may be driven by individual differences in ventilatory control and/or sleep events which exacerbate hypoxemia. To test this hypothesis, we quantified relationships between resting ventilation and ventilatory chemoreflexes, sleep desaturation, breathing disturbance, and Hct in Andean men and women. Ventilatory measures were made in 109 individuals (n = 63 men; n = 46 women), and sleep measures in 45 of these participants (n = 22 men; n = 23 women). In both men and women, high Hct was associated with low daytime SpO2 (p < 0.001 and p < 0.002, respectively) and decreased sleep SpO2 (mean, nadir, and time <80%; all p < 0.02). In men, high Hct was also associated with increased end-tidal PCO2 (p < 0.009). While ventilatory responses to hypoxia and hypercapnia did not predict Hct, decreased hypoxic ventilatory responses were associated with lower daytime SpO2 in men (p < 0.01) and women (p < 0.009) and with lower nadir sleep SpO2 in women (p < 0.02). Decreased ventilatory responses to CO2 were associated with more time below 80% SpO2 during sleep in men (p < 0.05). The obstructive apnea index and apnea-hypopnea index also predicted Hct and CMS scores in men after accounting for age, BMI, and SpO2 during sleep. Finally, heart rate response to hypoxia was lower in men with higher Hct (p < 0.0001). These data support the idea that hypoventilation and decreased ventilatory sensitivity to hypoxia are associated with decreased day time and nighttime SpO2 levels that may exacerbate the stimulus for erythropoiesis in Andean men and women. However, interventional and longitudinal studies are required to establish the causal relationships between these associations

Twisting gauged non-linear sigma-models

We consider gauged sigma-models from a Riemann surface into a Kaehler and hamiltonian G-manifold X. The supersymmetric N=2 theory can always be twisted to produce a gauged A-model. This model localizes to the moduli space of solutions of the vortex equations and computes the Hamiltonian Gromov-Witten invariants. When the target is equivariantly Calabi-Yau, i.e. when its first G-equivariant Chern class vanishes, the supersymmetric theory can also be twisted into a gauged B-model. This model localizes to the Kaehler quotient X//G.Comment: 33 pages; v2: small additions, published versio

Start of SPIDER operation towards ITER neutral beams

Heating Neutral Beam (HNB) Injectors will constitute the main plasma heating and current drive tool both in ITER and JT60-SA, which are the next major experimental steps for demonstrating nuclear fusion as viable energy source. In ITER, in order to achieve the required thermonuclear fusion power gain Q=10 for short pulse operation and Q=5 for long pulse operation (up to 3600s), two HNB injectors will be needed [1], each delivering a total power of about 16.5 MW into the magnetically-confined plasma, by means of neutral hydrogen or deuterium particles having a specific energy of about 1 MeV. Since only negatively charged particles can be efficiently neutralized at such energy, the ITER HNB injectors [2] will be based on negative ions, generated by caesium-catalysed surface conversion of atoms in a radio-frequency driven plasma source. A negative deuterium ion current of more than 40 A will be extracted, accelerated and focused in a multi-aperture, multi-stage electrostatic accelerator, having 1280 apertures (~ 14 mm diam.) and 5 acceleration stages (~200 kV each) [3]. After passing through a narrow gas-cell neutralizer, the residual ions will be deflected and discarded, whereas the neutralized particles will continue their trajectory through a duct into the tokamak vessels to deliver the required heating power to the ITER plasma for a pulse duration of about 3600 s. Although the operating principles and the implementation of the most critical parts of the injector have been tested in different experiments, the ITER NBI requirements have never been simultaneously attained. In order to reduce the risks and to optimize the design and operating procedures of the HNB for ITER, a dedicated Neutral Beam Test Facility (NBTF) [4] has been promoted by the ITER Organization with the contribution of the European Union\u2019s Joint Undertaking for ITER and of the Italian Government, with the participation of the Japanese and Indian Domestic Agencies (JADA and INDA) and of several European laboratories, such as IPP-Garching, KIT-Karlsruhe, CCFE-Culham, CEA-Cadarache. The NBTF, nicknamed PRIMA, has been set up at Consorzio RFX in Padova, Italy [5]. The planned experiments will verify continuous HNB operation for one hour, under stringent requirements for beam divergence (< 7 mrad) and aiming (within 2 mrad). To study and optimise HNB performances, the NBTF includes two experiments: MITICA, full-scale NBI prototype with 1 MeV particle energy and SPIDER, with 100 keV particle energy and 40 A current, aiming at testing and optimizing the full-scale ion source. SPIDER will focus on source uniformity, negative ion current density and beam optics. In June 2018 the experimental operation of SPIDER has started

The Effect of Spironolactone on the Pathogenesis of Ligatureinduced Alveolar Bone Loss in Wistar Rats

Tumor necrosis factor (TNF) is a pro-inflammatory cytokine that has a straight relationship with tissue  destruction in the pathogenesis of periodontitis. Inhibitory effects of TNF production have been attributed  to spironolactone. The aim of this study was to evaluate the effect of spironolactone on the pathogenesis of  ligature-induced alveolar bone loss in rats. Experimental periodontitis was induced in 38 Wistar rats by ligature  placement in the left second maxillary molar. The contra-lateral maxillary molar served as intragroup  control. Animals were randomly divided into 4 groups and treated with spironolactone (50, 100, 200  mg·kg-1) or saline. Morphometrical registration of maxillary alveolar bone was performed after 28 days of  experimental periodontitis. Intra-group comparisons showed significantly higher alveolar bone loss mean  values in maxillary sides with ligature (paired sample t test, p&lt;0.05). Mean alveolar bone loss was not significantly  different between groups, independently of the dosage (range: 0.63 – 0.66 mm, one-way  ANOVA, p&gt;0.05). Although spironolactone has recognized TNF-inhibitory properties, the possibility of its  use on modulation of host immune-inflammatory response in periodontal disease was not confirmed.

From interruption to experimentation and transformation: pedagogical training of higher education teachers in Portugal

In this article, we discuss the plurality of meanings that may characterize pedagogy and teaching in higher education, exploring the possible effects of a particular higher education teacher training provided in Portugal. By recognizing that pedagogy cannot be understood as a merely technical issue, requiring a more general and broader reflection on higher education, we understand teaching in its ethical, political and aesthetic sense, exploring the meaning (or the lack thereof) of what happens in education if we move away from an explanatory and normative vision. In the analysis of the individual portfolios developed by the trainees during the course, we identified two axes that were configured as fundamental to think about how the training proposal had impacted its participants with regard to pedagogical issues: transformation movements at the level of conceptions and practices; and the creation of experimental dynamics both within the scope of training and in the context of practices taking place in the institutions and in the professional daily lives of each participant. It is worth highlighting that one of the most interesting aspects of reading and analyzing the writing exercises found in the portfolios lies precisely in the possibility of following these movements of transformation and experimentation, as well as understanding the way through which a space for collective study is formed, a study community. From the analysis of the two axes mentioned above, we understand how this collective dimension of the training proposal emerges from the reports of its participants.Neste artigo, apresentamos uma pesquisa que discute a pluralidade de significados que podem caracterizar a pedagogia e o trabalho docente no ensino superior, explorando os possíveis efeitos de uma modalidade específica de formação de professores de ensino superior em Portugal. Ao reconhecer que a pedagogia não pode ser entendida como uma questão meramente técnica, implicando uma reflexão mais geral e ampla sobre o ensino superior, entendemos a ação docente no seu sentido ético, político e estético, explorando o sentido (ou falta dele) do que acontece em educação em detrimento de uma visão explicativa e normativa. Na análise dos portfólios individuais desenvolvidos pelos formandos no decorrer do curso, identificamos dois eixos que foram se configurando como fundamentais para pensar a forma como a proposta de formação impactou nos seus participantes no que diz respeito às questões pedagógicas: movimentos de transformação ao nível das concepções e das práticas; e a criação de dinâmicas de experimentação tanto no âmbito da formação como no contexto das práticas desenvolvidas nas instituições e nos quotidianos profissionais de cada um dos participantes. Cabe destacar que um dos aspectos mais interessantes da leitura e análise dos exercícios de escrita presentes nos portfólios reside, precisamente, na possibilidade de acompanhar esses movimentos de transformação e experimentação, e ainda o modo como a partir deles se constitui um espaço de estudo coletivo, uma comunidade de estudo. A partir da análise dos dois eixos referidos, damos conta da forma como essa dimensão coletiva da proposta de formação emerge dos relatos dos seus participantes

Desenvolvimento Profissional Docente: Perceções dos Professores em Diferentes Períodos ao Longo da Vida

Nowadays, given the broad consensus assumption that professional development is a learning process throughout life, this article summarizes the results of a doctoral research in which the main objective is the characterization of the perceptions ofnon-higher education teachers of their own professional development processes.Conceptually, it is argued that teachers’ professional development comprises formal and informal types of learning in different periods of their life. This empirical study is based on a qualitative methodology, with data collected through FocusGroups, involving teachers of all grade levels, from preschool to secondary, and in different stages of their professional life cycle. The obtained results highlight some differences between the teachers’ perceptions, according to the period of working life in which they are, and the teaching grade they currently teach.Desde el amplio consenso supuesto de hoy en día que el desarrollo profesional es un proceso de aprendizaje durante toda la vida, en este artículo se resumen los resultados de una investigación doctoral cuyo principal objetivo es caracterizarlas percepciones de los docentes de enseñanza no superior con relación a sus propios procesos de desarrollo profesional. Conceptualmente, se argumenta que el desarrollo profesional de los maestros incluye aprendizaje formal e informal de en diferentes períodos de la vida. El estudio empírico es parte de una metodología cualitativa y los datos fueron recogidos a través de grupos focales en los que han participado profesores de todos los grados de enseñanza, desde preescolar hasta secundaria, en diferentes etapas del ciclo de vida profesional.Los resultados obtenidos ponen de manifiesto algunas diferencias entre las percepciones de los profesores, de acuerdo con el período de la vida laboral en que se encuentran, y el grado de la enseñanza que imparten actualmente.Partindo do pressuposto amplamente consensual na contemporaneidade de que o desenvolvimento profissional é um processo de aprendizagem ao longo da vida, este artigo sintetiza os resultados de uma pesquisa doutoral cujo principalobjetivo é caracterizar as perceções dos docentes do ensino não-superior sobre os seus próprios processos de desenvolvimento profissional. No plano conceptual, argumenta-se que o desenvolvimento profissional docente engloba aprendizagens formais e informais existentes em diferentes períodos ao longo da vida. O estudo empírico enquadra-se numa metodologia qualitativa, tendo os dados sido recolhidos através de Focus Groups em que participaram docentes dos vários níveis de escolaridade, desde o pré-escolar ao secundário, que se encontravam em distintos períodos do ciclo de vida profissional. Os resultados alcançados permitem evidenciar algumas diferenças entre as perceções dos docentes, consoante quer o período da vida profissional em que se encontram, quer os níveis de escolaridade em que os docentes lecionam

Burnout syndrome and coping strategies in Portuguese oncology health care providers

Background Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. Objective The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. Methods Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory “Inventário de Resolução de Problemas” were administered. Descriptive, correlational, and linear regression analyses were performed. Results The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. Discussion Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology

Burnout syndrome and coping strategies in Portuguese oncology health care providers

Background: Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. Objective: The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. Methods: Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory "Inventario de Resolucao de Problemas" were administered. Descriptive, correlational, and linear regression analyses were performed. Results: The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. Discussion: Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology.Department of Mental Health - Ministry of Health in Mozambique (MISAU)Sofala Prov Hlth Directorate, Dept Mental Hlth, Minist Hlth, Beira, MozambiqueBeira Cent Hosp, Dept Med Psychiat, Beira, MozambiqueUniv Fed São Paulo, Paulista Sch Med, Dept Psychiat, São Paulo, SP, BrazilColumbia Univ, Coll Phys & Surg, Dept Psychiat, New York, NY USAUniv Porto, Psychiat & Mental Hlth, FMUP, Fac Med, Oporto, PortugalWorld Psychiat Assoc, Geneva, SwitzerlandPortuguese Soc Psychiat & Mental Hlth, Oporto, PortugalUniv Porto, FCUP, Dept Math, Fac Sci, Oporto, PortugalUniv Porto, Ctr Math, CMUP, Oporto, PortugalUniv Fed São Paulo, Paulista Sch Med, Dept Psychiat, São Paulo, SP, BrazilWeb of Scienc

Indirect calibration between clinical observers - application to the New York Heart Association functional classification system

<p>Abstract</p> <p>Background</p> <p>Previous studies showed an inter-observer agreement for the NYHA classification of approximately 55%. The aim of this study was to calibrate the New York Heart Association (NYHA) classification system between observers, increasing its reliability.</p> <p>Results</p> <p>Among 1136 community-dwellers in Porto, Portugal, aged ≥ 45 years, 265 reporting breathlessness answered a 4-item questionnaire to characterize symptom severity. The questionnaire was administered by 7 physicians who also classified the subject's functional capacity according to NYHA. Each subject was assessed by one physician. We calibrated NYHA classifications by the concurrent method, using 1-parameter logistic graded response model. Discrepancies between observers were assessed by differences in ability thresholds between NYHA classes I-II and II-III. The ability estimated by the model was used to predict the NYHA classification for each observer.</p> <p>Estimates of the first and second thresholds for each observer ranged from -1.92 to 0.46 and from 1.42 to 2.30, respectively. The agreement between estimated ability and the observers' NYHA classification was 88% (kappa = 0.61).</p> <p>Conclusions</p> <p>The study objectively indicates the main reason why several studies have reported low inter-observer is the existence of discrepant thresholds between observers in the definition of NYHA classes. The concurrent method can be used to minimize the reliability problem of NYHA classification.</p

Primary and Secondary Prophylaxis of Gastrointestinal Bleeding in Children with Portal Hypertension: A Multicenter National Study by SIGENP

Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in Italy. Methods: A questionnaire was sent to 21 major pediatric hepatology centers. It included 34 questions referring to the medical, endoscopic, radiological, and surgical management of GI varices. Results: Out of 21 centers, 16 returned a completed questionnaire (survey response rate 76%) with a high level of completeness. A total of 1206 children with PH were under follow-up. Splenomegaly associated with hypersplenism was the main indication for endoscopic surveillance in all centers (100%). Primary prophylaxis was performed with endoscopy plus non-selective beta-blockers (NSBBs) in 50%, endoscopy alone in 38%, and NSBBs alone in 12%. All centers managed acute variceal bleeding with endoscopy within 24 h, acid suppression, and octreotide infusion. Secondary prophylaxis of variceal bleeding was conducted using endoscopy (100%) and NSBBs (87%). Transjugular intrahepatic portosystemic shunt (TIPS) was considered a good option when endoscopic treatment failed in 94% of centers. Conclusions: In Italy, there is broad consensus among centers regarding the management of gastrointestinal varices in children with portal hypertension. All participating centers endorsed the use of endoscopic screening for children presenting with clinical signs of portal hypertension. Nonetheless, further research is essential to establish evidence-based guidelines and to improve overall quality of care