Una educación para la vida: resignificación de proyectos educativos integrales / integralesAn Education for Life: Re-meaning of Integral Education ProjectsUma / Uma educação para a vida: ressignificação de projetos educativos complementares

El proyecto de resignificación educativa busca la forma-ción permanente del docente que piensa en la educación como proceso, para transformar el espacio educativo tradicional en un espacio democrático y participativo, con proyectos cooperativos e interdisciplinarios. Duran-te seis meses se trabajó desde la Investigación Acción Educativa (iae) (Elliot, 1998), por lo que los temas del programa se establecieron de acuerdo con los intereses y necesidades de los profesores y directores de la escuela. La implementación se realizó con la comunidad edu-cativa de una institución rural de São Paulo, en la cual se desarrollaron talleres semanales alrededor de las preguntas: ¿Cuáles serían las propuestas de trabajo di-recto con los estudiantes?, ¿qué cambios afectarían las concepciones y prácticas pedagógicas de los maestros y las relaciones entre todos los miembros de la comuni-dad escolar (estudiantes, maestros, empleados, familia, etc.)? Con los 217 estudiantes, de 4 a 11 años de esta institución, se trabajaron guiones de estudio basados en sus intereses. Los resultados preliminares de estos proyectos han demostrado que es posible construir la educación para la ciudadanía y la conciencia ambiental a través de acciones que tengan sentido para la comu-nidad escolar

The Educational Resignification Project seeks the per-manent training of the teacher who thinks of education as a process, to transform the traditional educational space into a democratic and participatory space, with cooperative and interdisciplinary projects. Work was carried out for six months using the Educational Action Research-iae (Elliot, 1998); therefore, the topics of the program were established according to the interests and needs of the teachers and school directors. The implemen-tation was conducted with the educational community of a rural institution in São Paulo, where weekly workshops were developed around the questions: What would be the proposals for direct work with students? and What changes would affect pedagogical conceptions and practices of teachers and the relationships between all members of the school community (students, teachers, employees, family, etc.)? With the 217 students from 04 to 11 years old at this school, study scripts were developed based on their interests. The preliminary projects' results showed it is possible to build education for citizenship and environmental awareness through actions that make sense for the school community.

O Projeto de Ressignificação Educacional busca a for-mação permanente do professor que pensa a educação como um processo, para transformar o espaço educa-cional tradicional em um espaço democrático e partici-pativo, com projetos cooperativos e interdisciplinares. Trabalhamos por seis meses a partir da Pesquisa-Ação Educacional (pae) (Elliot, 1998), de modo que os te-mas do programa foram estabelecidos de acordo com os interesses e necessidades dos professores e direto-res escolares. A implementação foi realizada com a comunidade educativa de uma instituição rural de São Paulo, onde foram desenvolvidas oficinas semanais em torno das questões: "Quais seriam as propostas de tra-balho direto com os alunos?"; "Que mudanças afetariam as concepções e práticas pedagógicas dos professores e as relações entre todos os membros da comunidade escolar (alunos, professores, funcionários, família, etc.)?". Com os 217 alunos de 04 a 11 anos desta escola, foram trabalhados roteiros de estudo baseados em seus in-teresses. Os resultados preliminares desses projetos mostraram que é possível construir educação para a cidadania e consciência ambiental por meio de ações que façam sentido para a comunidade escolar.

Clinical Efficacy of Modified Banxia Xiexintang Combined with Vedolizumab in Treatment of Crohn's Disease with Syndrome of Cold and Heat in Complexity / 中国实验方剂学杂志

ObjectiveTo evaluate the clinical efficacy of modified Banxia Xiexintang combined with vedolizumab （VDZ） in the treatment of active moderate to severe Crohn's disease （CD） with the syndrome of cold and heat in complexity and the effect of the therapy on intestinal flora. MethodEighty patients were randomized based on the random number table method into a control group （40 cases） and an observation group （40 cases）. The control group was treated with VDZ， and the observation group was treated with modified Banxia Xiexintang （1 bag per day） combined with VDZ. The treatment in both groups lasted for 14 weeks and the follow-up lasted until the 52th weeks. The CD activity index （CDAI）， CD simplified endoscopic score （SES-CD）， inflammatory bowel disease questionnaire （IBDQ） score， and syndrome score of cold and heat in complexity were assessed before treatment， after treatment， and at the end of follow-up. The levels of hemoglobin （HGB）， hematocrit （HCT）， albumin （ALB）， C-reactive protein （CRP）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， interleukin-17 （IL-17）， and fecal calprotectin （FC） were measured before and after treatment. Intestinal flora was examined before and after treatment. The safety of the therapy was evaluated. ResultCompared with those before treatment， the scores of CDAI， SES-CD， and the syndrome of cold and heat in complexity decreased （P<0.05） and the IBDQ score increased after treatment （P<0.05）. Compared with those before treatment， the scores of CDAI， SES-CD， and the syndrome of cold and heat in complexity increased （P<0.05） and the IBDQ score decreased （P<0.05） at the end of follow-up. After treatment and at the end of follow-up， the observation group had lower scores of CDAI， SES-CD， and syndrome of cold and heat （P<0.05） and higher IBDQ score （P<0.05） than the control group. Moreover， the observation group had higher clinical remission rate（χ2=4.381，3.962） and response rate（χ2=5.541，4.306） and lower non-response rate（χ2=6.646，4.306） than the control group at the two time points （P<0.05）. The endoscopic remission rate（χ2=4.072，3.985） and response rate（χ2=4.528，5.161） in the observation group were higher than those in the control group （P<0.05）. After treatment， the HGB， HCT， and ALB levels in both groups elevated， and the observation group had higher levels than the control group （P<0.05）. The treatment in both groups lowered the levels of CRP， IL-6， TNF-α， IL-17， and FC （P<0.05）， and the observation group had lower levels of CRP， IL-6， TNF-α， IL-17， and FC than the control group after treatment （P<0.05）. The relative abundance of Bifidobacterium， Lactobacillus， and Prevotella increased （P<0.05）， while that of Proteus， Klebsiella， and Enterococcus decreased （P<0.05） in the two groups after treatment. Moreover， the changes in the relative abundance of these bacteria in the observation group were more obvious than those in the control group （P<0.05）. No adverse reactions related to the modified Modified Banxia Xiexintang were observed during the study period. ConclusionModified Banxia Xiexintang combined with VDZ can play a synergistic role and has good short-term and long-term efficacy. This therapy can improve the nutritional status， regulate intestinal flora， and reduce inflammatory injury in the treatment of moderate to severe active CD patients with the syndrome of cold and heat in complexity without causing severe adverse reactions.

Metacognición desde las bases del pensamiento complejo / Metacognition from the bases of complex knowlegde

Introducción: La metacognición es el proceso mediante el cual el estudiante toma conciencia de lo que aprende, pero como podemos ampliar este concepto desde el paradigma emergente de la complejidad, si religamos la conciencia a la aplicación del pensamiento complejo. La metacognición aplicada con elementos de pensamiento complejo le llamamos metacomplejidad, que es un proceso superior donde tomamos conciencia desde la complejidad para aprender y enseñar, implicara niveles de realidad y formas de aplicar la complejidad en los procesos educativos. Objetivo: Revisar teóricamente el concepto de metacognición a fin de profundizar en el tema tomando en consideración el concepto de aula mente social en la Educación. Método: Revisión teórica de publicaciones del autor, es un estudio transversal, retro-prospectivo no experimental Discusiones: El proceso de continuidad de la metacomplejidad será pues el aula mente social como el proceso más creativo que puede desarrollar un estudiante para poder resolver problemas educativos o de la vida cotidiana. Conclusión: La metacognición es el proceso mental más sensible en el proceso educativo que trasciende aplicando el pensamiento complejo.

Introduction: Metacognition is the process through which the student becomes aware of what he learns, but how can we expand this concept from the emerging paradigm of complexity, if we relink awareness to the application of complex thinking. Metacognition applied with elements of complex thinking is called metacomplexity, which is a superior process where we become aware of complexity to learn and teach, it will imply levels of reality and ways of applying complexity in educational processes. Objective: To theoretically review the concept of metacognition in order to deepen the subject taking into consideration the concept of classroom social mind in Education. Method: Theoretical review of the author's publications, it is a cross-sectional, retro-prospective, non-experimental study. Discussions: The process of continuity of metacomplexity will therefore be the social mind classroom as the most creative process that a student can develop in order to solve educational or daily life problems. Conclusion: Metacognition is the most sensitive mental process in the educational process that transcends by applying complex thinking.

Inductores de ferroptosis para el tratamiento del cáncer

Introducción: La ferroptosis es un proceso no apoptótico de muerte celular regulada que depende de la presencia de iones hierro en el medio intracelular. Se caracterizada por la acumulación de especies reactivas de lípidos oxidados y radicales libres en las membranas celulares. Los inductores e inhibidores de este proceso inciden de manera circunstancial en él, con cuya respuesta celular se trabaja en función de elaborar modelos para el tratamiento del cáncer. Objetivo: Profundizar en el proceso de ferroptosis con un enfoque hacia los inductores e inhibidores, el establecimiento de modelos biofisicoquímicos y las estrategias terapéuticas para el tratamiento del cáncer. Métodos: Se realizó una revisión de los estudios más significativos sobre el tema, publicados en la Web of Science, PubMed, EBSCO, y Scopus. Resultados: Gracias al novedoso descubrimiento de la ferroptosis como impulsor de la muerte de células tumorales para tratar el cáncer, se han comenzado a desarrollar modelos teóricos que simulan el comportamiento de estas células y la complejidad en sistemas biológicos; que permiten encontrar procedimientos alternativos y menos invasivos contra esta y otras enfermedades. Conclusiones: Los inductores e inhibidores tienen una función primordial a la hora de predecir la influencia en la sensibilidad a la ferroptosis; por lo que se indagó en los mecanismos de funcionamiento de estos, que facilitará la forma de inducir en mayor o menor grado la muerte celular y disminuir la población de células cancerígenas.

Introduction: Ferroptosis is a non-apoptotic process of regulated cell death that depends on the presence of iron ions in the intracellular medium. It is characterized by the accumulation of reactive species of oxidized lipids and free radicals in cell membranes. The inducers and inhibitors of this process circumstantially affect it, whose cellular response is used to develop models for cancer treatment. Objective: To deepen the ferroptosis process focusing on inducers and inhibitors, the establishment of biophysiochemical models and therapeutic strategies for cancer treatment. Methods: A review was carried out of the most significant studies on the subject, published in the Web of Science, PubMed, EBSCO and Scopus. Results: Thanks to the novel discovery of ferroptosis as a conductor of tumor cell death to treat cancer, theoretical models have begun to be developed that simulate the behavior of these cells and the complexity in biological systems; that allow finding alternative and less invasive procedures against this and other diseases. Conclusions: Inductors and inhibitors have a primary role in predicting the influence on sensitivity to ferroptosis; therefore, the mechanisms of operation of these were investigated, which will facilitate the way to induce cell death to a greater or lesser degree and reduce the population of cancer cells.

O pensamento complexo da comunicação organizacional: sobre identidade, imagem-conceito e gestão de imagem da ciência e do SUS / The complex thinking of organizational communication: on identity, concept-image and image management of science and of SUS / El pensamiento complejo de la comunicación organizacional: sobre identidad, imagen-concepto e gestión de la imagen de la ciencia y del SUS

A vivência num caminho de empregado de 'chão de fábrica' de grande empresa a gestor de uma pequena empresa, junto às teorias de comunicação, contribuíram para as reflexões acadêmicas no campo da comunicação organizacional do cientista e professor Rudimar Baldissera. Em entrevista à Reciis, o professor mobiliza termos frequentemente associados à comunicação e às organizações, tais como imagem-conceito, identidade e públicos, e problematiza o prisma das decisões e dos objetivos da gestão em perspectiva da comunicação para a partilha, o diálogo, a ação/retroação e as perturbações geradas pelos diversos públicos que são constitutivos das organizações. Por meio de reflexões a partir do paradigma da complexidade, Baldissera discorre sobre o 'tecer' e 'retecer'da imagem das instituições de saúde, da ciência, das universidades públicas e do SUS, no contexto contemporâneo marcado pela emergência sanitária da covid-19. Destaca a comunicação organizacional como um campo consolidado na construção da crítica e do conhecimento na área da comunicação e informação. Rudimar Baldissera é professor associado do Departamento de Comunicação ­ Faculdade de Biblioteconomia e Comunicação (Fabico), e professor e pesquisador do PPGCOM/UFRGS

Along with communication theories, the experience acquired during the path from 'factory floor' employee to manager of a small business contributed to the academic reflections done by scientist and professor Rudimar Baldissera in the organizational communication field. In an interview to Reciis, the professor mobilizes terms frequently associated with communication and organizations, such as concept-image, identity and audience, and problematizes the prism of decisions and objectives of management in perspective of communication for sharing, dialogue, action/feedback and disturbances generated by the different publics that are constitutive of organizations. Through reflections from the paradigm of complexity, Baldissera discusses the 'weaving' and 'reweaving' of the image of health institutions, science, public universities and SUS, in the contemporary context marked by the health emergency of covid-19. He highlights organizational communication as a consolidated field in the construction of criticism and knowledge in communication and information field. Rudimar Baldissera is an associate professor at the Department of Communication ­ Faculty of Library Science and Communication (Fabico), and professor and researcher at PPGCOM/UFRGS

La experiencia en un camino de empleado en el 'piso de fábrica' de una gran empresa a gerente de una pequeña, junto con las teorías de la comunicación, contribuyó a las reflexiones académicas en el campo de la comunicación organizacional del científico y profesor Rudimar Baldissera. En entrevista con Reciis, el profesor moviliza términos frecuentemente asociados con la comunicación y las organizaciones, como ima-gen-concepto, identidad y públicos, y problematiza el prisma de las decisiones y objetivos de la gestión en la perspectiva de la comunicación para compartir, el diálogo, la acción/retroalimentación y las perturbaciones generadas por los diversos públicos que son constitutivos de las organizaciones. A través de reflexiones desde el paradigma de la complejidad, Baldissera discute el 'tejer' y 'retejer' de la imagen de las institucio-nes de salud, la ciencia, las universidades públicas y el SUS, en el contexto contemporáneo marcado por la emergencia sanitaria de la covid-19. Destaca la comunicación organizacional como un campo consolidado en la construcción de la crítica y el conocimiento en el campo de la comunicación y información. Rudimar Baldissera es profesor asociado del Departamento de Comunicación de la Facultad de Biblioteconomía y Comunicación (Fabico) y docente e investigador del PPGCOM/UFRGS

Teoría de la complejidad y los sistemas de salud / Complexity theory and health systems

En la investigación en salud es todavía poco frecuente el uso de la Teoría de la Complejidad y de la Fractalidad (más aún en tópicos no relacionados directamente con la biología molecular o con la clínica). La complejidad nos propone complementar con propuestas desde nuevas perspectivas el pensamiento lineal y cuantitativo predominante todavía en la metodología de producción del conocimiento científico. El estudio de los sistemas de salud necesita un enfoque que se aparte de la linealidad, lo rígido y lo direccional, dado que los mismos son sistemas complejos en los que el todo es más que la simple suma de sus partes. La crisis global generada ante la pandemia por COVID-19 nos puso frente a la oportunidad (y a la obligación) de repensar tanto nuestra praxis cotidiana como nuestra forma de producir conocimiento (AU)

In health research, the use of the Complexity and Fractality Theory is still infrequent (even more so in topics not directly related to molecular or clinical biology). The complexity proposes us to complement with proposals from new perspectives the linear and quantitative thinking still predominant in the methodology of production of scientific knowledge. The study of health systems needs an approach that moves away from linearity, rigidity and direction, since they are complex systems in which the whole is more than the simple sum of its parts. The global crisis generated by the COVID-19 pandemic presented us with the opportunity (and the obligation) to rethink both our daily praxis and our way of producing knowledge (AU)

A Ventricular Fibrillation Recognition Method Based on Random Forest and BP Neural Network / 中国医疗器械杂志

Ventricular fibrillation is the most common pathophysiological mechanism leading to cardiac arrest. If cardiac arrest can be rescued in time, the survival rate of patients can be greatly improved. Therefore, rapid and accurate identification of ventricular fibrillation is extremely important. This paper proposes an automatic detection algorithm for ventricular fibrillation based on random forest and BP (back propagation) neural network. Pass the ECG signal through a 6 s moving window, calculate 6 kinds of characteristic parameters according to the time-frequency domain information of the signal, use these 6 kinds of characteristic parameters as the input of the classifier, carry out classification and test, and give the authoritative experts in the database. A total of 44 cases of related data were used to evaluate the method. The results show that using the ten-fold cross-validation method, the accuracy of classification of ventricular fibrillation in the CU database (Creighton University Ventricular Tachyarrhythmia Database) and the AHA database (the American Heart Association Database) has reached 96.38% and 99.45%, which has certain applicability.

Intervención ambulatoria basada en categorización por complejidad en neurorehabilitación

Introducción: Existen múltiples factores que dificultan el acceso a la terapia de alta intensidad y pocos estudios han considerado la efectividad de la Neurorehabilitación motora ambulatoria basada en atención directa al paciente, ejercicios guiados por el cuidador y entrenamiento de autogestión en rehabilitación. Objetivo: Evaluar el efecto en los resultados funcionales, de movilidad y equilibrio en los pacientes atendidos por un programa de Neurorehabilitación motora ambulatoria categorizados por complejidad en rehabilitación en el Hospital Carlos van Buren de Valparaíso. Material y Método: Estudio de cohorte retrospectivo. Se analizaron los registros de los pacientes atendidos en 2018 en el policlínico de Neurorehabilitación del Hospital Carlos van Buren, se recopilaron los datos desde las historias clínicas, se categorizaron en tres niveles de complejidad en rehabilitación y se hizo el análisis estadístico. Resultados: Se estudiaron 34 usuarios, el diagnóstico más recurrente fue el accidente cerebro vascular en el 82,3%. En las escalas funcionales, todos los valores cambiaron de mayor a menor severidad, luego de la rehabilitación (Rankin modificado, índice de Barthel, el nivel funcional y velocidad de marcha). En relación con la recuperación proporcional, los pacientes de baja complejidad lograron un 13,5%, los de mediana el 83% y los de alta un 25%. Conclusiones: Los resultados indican que un programa de Neurorehabilitación motora ambulatorio proporciona cambios funcionales favorables a los pacientes de mediana complejidad en rehabilitación. El uso de una categorización de rehabilitación basada en la complejidad es una opción útil en el entorno clínico, pero se requiere de mayores investigaciones.

Background: There are multiple factors that hinder access to high intensity therapies. Few studies have considered the effectiveness of outpatient motor neurorehabilitation based on direct patient care, caregiver-mediated exercises and self-directed exercises. Objetive: Evaluate the effect of an categorized outpatient motor neurorehabilitation program in a Public Hospital with respect to functionality, mobility and balance. Material and Method: Retrospective cohort study. The patients seen in 2018 at the Neurorehabilitation polyclinic of the Carlos Van Buren Hospital were analyzed, the data was collected from the medical records, they were categorized into three levels of complexity in rehabilitation and the statistical analysis was performed. Results: A total of 34 users were studied, the most recurrent diagnosis was stroke in 82.3%. On the functional scales, all values changed from highest to lowest severity post intervention (modified Rankin, Barthel index, functional level and walking speed). In relation to proportional recovery, low complexity patients achieved 13.5%, median 83% and high 25%. Conclusions: The results indicate that an outpatient motor Neurorehabilitation program provides favorable functional changes for patients of medium complexity in rehabilitation. The use of a complexity-based categorization of rehabilitation is a useful option in the clinical setting, but further research is required.

Comprehensive comparison between Halcyon 2.0 and Truebeam VMAT plans for different treatment sites: dosimetric quality and plan complexity / 中华放射肿瘤学杂志

Objective:To analyze the differences in dosimetric quality and plan complexity of volumetric modulated arc therapy (VMAT) plans based on Halcyon 2.0 and Truebeam for different treatment sites of the patients.Methods:Halcyon 2.0 VMAT plans in head & neck, chest, abdomen, and pelvis treatment sites of 49 cases were retrospectively selected and the VMAT plans were re-designed based on Truebeam with the same optimization parameters. The differences in dosimetric metrics and plan complexity between the two types of plans were compared and analyzed. P<0.05 was considered as statistically significant. Results:In terms of PTV, Halcyon 2.0 plans showed better homogeneity index (HI), conformal index (CI) in the head & neck and chest. Besides, Halcyon 2.0 plans yielded better D 98% and CI in the abdomen and better D 2% in the pelvis. For organs at risk (OAR), the D 20% and D mean of bilateral lungs, and D meanof heart for Halcyon 2.0 plans in the chest were lower than those for Truebeam plans (all P<0.05). For the complexity metrics, the median average aperture area variability (AAV) of Halcyon 2.0 plans in the head & neck, abdomen and pelvis were 0.414, 0.425 and 0.432, which were better than 0.385, 0.368 and 0.361 of Truebeam plans in the corresponding sites, respectively. In the abdomen and pelvis, Halcyon 2.0 plans showed better median modulation complexity score (MCS) than Truebeam plans (0.320 vs. 0.268, 0.303 vs. 0.282; both P<0.05). The median small aperture score (SAS) for all plans of Halcyon 2.0 were better than that of Truebeam plans (all P<0.05), and the median plan average beam area (PA) of all plans of Halcyon 2.0 were larger than that of Truebeam plans (all P<0.05). Conclusions:Compared with conventional fractionated VMAT plans based on Halcyon 2.0 and Truebeam, Halcyon 2.0 plans have similar or even better dosimetric quality. However, Halcyon 2.0 plans have lower plan complexity, which makes it an advantage in clinical application.

The design and practice of high complexity blended teaching mode in regional anatomy teaching / 中华医学教育探索杂志

This study combines self-learning with a set of online and offline teaching and learning methods such as lecture teaching, case discussion and experimental method. In addition, this study designs a five-step blended teaching mode as well as a multi-tool and multi-dimensional comprehensive evaluation system of the whole process. Both the blended teaching mode and the comprehensive evaluation system have achieved good results after the implementation. The chapter test results show that the students' test scores applying this kind of blended teaching mode are significantly higher than that applying the traditional teaching mode; the ability test results show that under the high complexity blended teaching mode, the students' ability has been improved more effectively, which is more conducive to the realization of the core competence goals in the professional training objectives and teaching objectives.

Discussion on the factors influencing the curative effect of Tuina (Chinese massage) / 国际中医中药杂志

Tuina (Chinese massage) is an important part of Traditional Chinese Medicine. It is a simple and inexpensive technique, and has shown effectiveness for muscle and bone diseases, visceral diseases, gynecological diseases, and common diseases in children. This paper aims to analyze the factors influencing the effects of Tuina. The factors included the aspects of diagnosis, treatment, prognosis, patient factors and doctor-patient communication. During the treatment of Tuina, doctors should carry out good doctor-patient communication, properly evaluate and exam patients, and clarify diagnosis, take appropriate Tuina techniques according to the patients' constitution, health condition, and comorbidity. Only in such way, could Tuina achieve effectiveness and safety.

Research on the Optimization of Traditional Chinese Medicine Governance System from the Perspective of Complexity / 中国医学伦理学

The complexity of the development history, culture and system of Traditional Chinese Medicine (TCM) deeply affect its inheritance, innovation and development. From the perspective of complexity, and based on the framework of "situation-theory-tool", this paper analyzed the complexity and dilemma of TCM governance. The complexity of TCM governance requires continuous adjustment of the governance system. On the one hand, the optimization of the government governance system should clarify the relationship between power and responsibility, and stimulate the endogenous power of local governments. On the other hand, the concept of "collaborative governance" should be used to realize the resource integration and functional synergy of different subjects in the horizontal structure of TCM governance, and enhance the capability of joint action.

Wearable devices: Perspectives on assessing and monitoring human physiological status / 生物医学工程学杂志

This review article aims to explore the major challenges that the healthcare system is currently facing and propose a new paradigm shift that harnesses the potential of wearable devices and novel theoretical frameworks on health and disease. Lifestyle-induced diseases currently account for a significant portion of all healthcare spending, with this proportion projected to increase with population aging. Wearable devices have emerged as a key technology for implementing large-scale healthcare systems focused on disease prevention and management. Advancements in miniaturized sensors, system integration, the Internet of Things, artificial intelligence, 5G, and other technologies have enabled wearable devices to perform high-quality measurements comparable to medical devices. Through various physical, chemical, and biological sensors, wearable devices can continuously monitor physiological status information in a non-invasive or minimally invasive way, including electrocardiography, electroencephalography, respiration, blood oxygen, blood pressure, blood glucose, activity, and more. Furthermore, by combining concepts and methods from complex systems and nonlinear dynamics, we developed a novel theory of continuous dynamic physiological signal analysis-dynamical complexity. The results of dynamic signal analyses can provide crucial information for disease prevention, diagnosis, treatment, and management. Wearable devices can also serve as an important bridge connecting doctors and patients by tracking, storing, and sharing patient data with medical institutions, enabling remote or real-time health assessments of patients, and providing a basis for precision medicine and personalized treatment. Wearable devices have a promising future in the healthcare field and will be an important driving force for the transformation of the healthcare system, while also improving the health experience for individuals.

Decreasing complexity of glucose time series derived from continuous glucose monitoring is correlated with deteriorating glucose regulation / 医学前沿

Most information used to evaluate diabetic statuses is collected at a special time-point, such as taking fasting plasma glucose test and providing a limited view of individual's health and disease risk. As a new parameter for continuously evaluating personal clinical statuses, the newly developed technique "continuous glucose monitoring" (CGM) can characterize glucose dynamics. By calculating the complexity of glucose time series index (CGI) with refined composite multi-scale entropy analysis of the CGM data, the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes (P for trend < 0.01). Furthermore, CGI was significantly associated with various parameters such as insulin sensitivity/secretion (all P < 0.01), and multiple linear stepwise regression showed that the disposition index, which reflects β-cell function after adjusting for insulin sensitivity, was the only independent factor correlated with CGI (P < 0.01). Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.

Consultorio de Salud Ambiental en un Hospital Privado de Comunidad de la Ciudad de Buenos Aires / Environmental Health consulting office in a Private Community Hospital of the Buenos Aires City

En los últimos años surge el concepto de Una Sola Salud que reconoce la interdependencia sistémica al observar que los cambios en la salud humana se expresan de manera sincrónica e indivisible de la salud del ambiente. Nuevas enfermedades y daños crónicos inespecíficos ocurren a la par de la pérdida de biodiversidad y vitalidad. En las últimas décadas venimos observando el surgimiento de "adaptaciones sistémicas" que requieren un abordaje desde la clínica y la toxicología a nivel individual y desde la epidemiología de la complejidad a nivel poblacional. Luego de un largo recorrido de investigaciones, el Hospital Italiano formalizó el consultorio de Salud Ambiental con la intención de brindar respuesta a la demanda de pacientes que atribuyen síntomas y signos a la polución ambiental. (AU)

In recent years, the concept of One Health has emerged, recognizing the systemic interdependence and the changes in human health that are expressed synchronously and indivisible from the environment. New diseases and nonspecific chronic damage are occuring in parallel with the loss of biodiversity and vitality.In recent decades we have observed the appearance of "systemic adaptations" that require a clinical and toxicological approach at the individual level, and address the population level from an epidemiological and complexity science paradigm. After many years of research, the Hospital Italiano de Buenos Aires formalized the Environmental Health consulting office and the measurement of glyphosate levels, giving answer to the demand of patients who associate their signs and symptoms to environmental pollution. (AU)

Complexity theory in the management of patients with pain

Nonlinear systems are not susceptible to being investigated with reductionist methods. In this sense, complexity theory offers an alternative approach to quantify the importance of contextual factors (CFs) in the patient with pain. The result of the positive (placebo) or negative (nocebo) use of CFs in the therapeutic setting could be responsible for a large part of a non-specific component of the efficacy of the treatment, directly affecting the quality of the results related to the patient's health (for example, pain, disability, or satisfaction). In recent years, understanding of the value of these effects has increased. Despite growing interest, knowledge, and awareness of them is currently limited and heterogeneous among health professionals, reducing their translational value in the field of health.Keywords: complexity, contextual factors, pain, health professionals, placebo, nocebo.

Los sistemas no lineales no son susceptibles de ser investigados con métodos reduccionistas. En este sentido, la teoría de la complejidad ofrece un enfoque alternativo para cuantificar la importancia de los factores contextuales (FCs) en el paciente con dolor. El resultado del uso positivo (placebo) o negativo (nocebo) de FCs en el tratamiento podría ser responsable de gran parte de un componente no específico de la eficacia del tratamiento, afectando directamente la calidad de los resultados relacionados con la salud del paciente (por ejemplo, dolor, funcionalidad o satisfacción).En los últimos años se ha incrementado la comprensión del valor de estos efectos. A pesar del creciente interés, el conocimiento y la conciencia de ellos es actualmente limitado y heterogéneo entre profesionales de la salud, lo que reduce su valor traslacional en el campo de la salud.Palabras clave: complejidad; factores contextuales; profesionales de la salud; dolor; placebo; nocebo.

Epistemologia e formação do psicólogo: discussões contemporâneas / Epistemology and psychologist formation: contemporary discussions

Este ensaio teórico discute a formação do psicólogo a partir de seu campo epistemológico e de seus desafios contemporâneos. O tema é problematizado a partir da constituição histórica e teórica da psicologia até as complexas demandas da formação e da atuação profissional, considerando as diretrizes da graduação e da pós-graduação. Para isso, são apresentados aspectos relativos à constituição epistemológica da psicologia - a sua história, a associação de seus pressupostos teóricos e a configuração atual, cujos limites são determinados nos espaços de intersecção com outras áreas da ciência -, bem como relativos à formação profissional. Aspectos históricos e políticos, abordagens, ênfases, áreas, interfaces, objetos, teorias, pressupostos, prática, complexidade, disciplinaridade, paradigmas e interdisciplinas são elementos que atravessam essa discussão. A psicologia se caracteriza como uma ciência de epistemologia plural, de currículo integrador, que visa a formar um profissional generalista. Espera-se que as provocações apresentadas subsidiem outras pesquisas sobre as conexões entre a formação e as formas de pensamento emergentes nas ciências.(AU)

This theoretical essay discusses the psychologist formation from its epistemological field and its contemporary challenges. The theme is problematized from the historical and theoretical constitution of psychology to the complex demands of training and professional performance, considering the graduation and postgraduate guidelines. For this, aspects related to the epistemological constitution of psychology are presented - its history, the association of its theoretical assumptions and the current configuration, whose limits are determined in the spaces of intersection with other areas of Science - as well as those related to professional training. Historical and political aspects, approaches, emphases, areas, interfaces, objects, theories, assumptions, practice, complexity, disciplinarity, paradigms and interdisciplines are elements that cross this discussion. Psychology is characterized as a science of plural epistemology with an integrative curriculum that aims to train a generalist professional. It is expected that the provocations presented will support other researchs on the connections between training and emerging forms of thinking in the sciences.(AU)

Este ensayo teórico discute la formación del psicólogo desde su campo epistemológico y sus desafíos contemporáneos. El tema es problematizado desde la constitución histórica y teórica de la psicología hasta las complejas demandas de formación y actuación profesional, considerando las orientaciones de los estudios de pregrado y posgrado. Para eso, se presentan aspectos relacionados con la constitución epistemológica de la psicología - su historia, la asociación de sus presupuestos teóricos y la configuración actual en la que se determinan los límites de su campo en los espacios de intercambio con otras áreas de la ciência -, así como la constitución y el estado de la formación de este profesional. Aspectos históricos y políticos, enfoques, énfasis, ámbitos, interfaces, objetos, teorías, presupuestos, práctica, complejidad, disciplinaridad, paradigmas e interdisciplinas son elementos que atraviesan esta discusión. La psicología se caracteriza como una ciencia de epistemología plural, con un currículo integrador, que tiene como objetivo formar un profesional generalista. Se espera que las provocaciones presentadas apoyen futuras investigaciones sobre las conexiones entre la formación en psicología y las formas emergentes de se pensar en las ciencias.(AU)

O idadismo no contexto do trabalho da Estratégia Saúde da Família: projeção de saberes ao tetragrama dialógico de Morin / El edadismo en el contexto del trabajo de la estrategia salud de la familia: proyección de saberes al tetragrama dialógico de Morin / Ageism in the work context of the family health strategy: projection of knowledge on Morin's dialogic tetragrammaton

Trata-se de um estudo teórico com o objetivo de aproximar aportes sobre o idadismo ao tetragrama dialógico de interações, proposto por Morin, no contexto do trabalho na Estratégia Saúde da Família e na Atenção Primária à Saúde. Para isso, foi realizada uma projeção simbólica de saberes sobre o etarismo organizada em quatro atos: ordem, dispersão, interação e religação. Conclui-se que esse exercício teórico pode ser transmutado para o cotidiano de trabalho na Saúde, no qual a compreensão da existência do tetragrama dialógico, atuando simultaneamente na vida de forma antagônica, concorrente e complementar, pode incitar um pensar crítico, criativo e complexo em prol de saberes e de práticas frente à complexidade do idadismo.(AU)

Se trata de un estudio teórico con el objetivo de aproximar contribuciones sobre el edadismo al tetragrama dialógico de interacciones, propuesto por Morin, en el contexto del trabajo en la Estrategia Salud de la Familia y de la Atención Primaria de la Salud. Para ello, se realizó una proyección simbólica de saberes sobre el edadismo organizada en cuatro actos: orden, dispersión, interacción y reconexión. Se concluyó que este ejercicio teórico pueda transmutarse para el cotidiano de trabajo en la salud, en donde la comprensión de la existencia del tetragrama dialógico, actuando simultáneamente en la vida de forma antagónica, competidora y complementaria, pueda incitar un pensar crítico, creativo y complejo en pro de saberes y de prácticas ante la complejidad del edadismo.(AU)

This is a theoretical study that aims to articulate contributions on ageism with the dialogic tetragrammaton of interactions, proposed by Morin, in the context of work in the Family Health Strategy and Primary Health Care. To accomplish this, a symbolic projection of knowledge about ageism was carried out, organized in four acts: order, dispersion, interaction, and reconnection. We concluded that this theoretical exercise can be transmuted to the daily work in health care, and that understanding the existence of the dialogic tetragrammaton, which acts in life simultaneously in antagonistic, concurrent and complementary ways, can stimulate critical, creative and complex thinking in favor of knowledge and practices that take the complexity of ageism into account.(AU)

Development of the modified medication regimen complexity index of Chinese version(mMRCI-C)and its validation in elderly diabetic patients / 中华全科医师杂志

Objective:To develop the modified medication regimen complexity index of Chinese version (mMRCI-C)and test its reliability and validity.Method:The Chinese version of MRCI was developed by modification,translation and back translation. The MRCI was interculturally adapted by 2-rounds of expert consultation and pilot study to ensure the semantics, content and conceptual equivalence. The validation of the mMRCI-C scale was tested among 420 community-dwelling elderly patients with type 2 diabetes mellitus(T2DM) in Shanghai Changfeng Community Health Service Center from October to December 2020. SPSS 23.0 was used to analyze the reliability and validity of the scale.Results:The mMRCI-C scale included 3 dimensions, namely drug dosage form (14 entries), medication frequency (5 entries), and additional instructions (6 entries), with a total of 25 entries. Among 420 valid questionnaires collected,the respondents were 212 males (50.4%) and 208 females (49.6%) with a mean age of (71.4±8.1) years. The test-retest reliability was 0.999 and internal consistency reliability was 0.849. The content validity exceeded 0.80,the convergent validity was 0.932; and discriminant validity P<0.001. Conclusion:The preliminary testing results show that the reliability and validity of the mMRCI-C scale are satisfactory.

Complexity score-based plan quality control of VMAT / 中华放射肿瘤学杂志

Objective:To explore the difference in the complexity of different treatment planning systems, multi-leaf collimator (MLC) types and treatment sites of volume-modulated arc therapy (VMAT), and propose a complexity score for plan quality control.Methods:Statistical analysis of 12 complexity metrics including Monaco and Eclipse, Agility, Millennium and High-definition MLC, nasopharyngeal, lung and cervical cancer was performed. Spearman correlation coefficient between complexity metrics was calculated. Principal component analysis was conducted to reduce the dimensionality of the original data set to the first two principal components and explain its physical meaning. Complexity score based on the principal components was calculated to establish warning and action thresholds for plan quality control. The correlation between complexity metrics and γ pass rate was analyzed.Results:Except cervical cancer aperture sub-regions metric, other metrics had significant differences between Monaco and Eclipse. Monaco MLC had a more regular field but higher MU, smaller leaf gap, and longer leaf travel distance. High-definition MLC with smaller leaf width significantly added MLC aperture-related metrics. The first two principal components explained over 80% of the total variance of the original dataset, complexity score was weighted average of first two principal components. The distribution of complexity score for different equipment and sites was different. The warning threshold was expressed as the average plus standard deviation, and the action threshold was expressed as the average plus 2 standard deviations. Complexity metrics and complexity scores had small correlation with γ pass rate, showing weak or irrelevant but statistically significant. Conclusions:Different planning systems, MLC types, and treatment site complexity metrics are significantly different. The complexity score is a useful tool for plan quality control.