Comparison of students' use and acceptance of emergency online learning due to COVID-19 in the USA, Mexico, Peru, and Turkey.

Due to the COVID-19 pandemic, and pursuant to the governments' order of citizens remaining at home, several countries were required to transition from face-to-face instruction to an online model to provide higher education to their students. While factors affecting the use of online learning are diverse and have been studied by models of use and acceptance of technology, this cross-sectional study explores the factors unique to the current emergency situation that influence students' use and acceptance of emergency online learning. Moreover, it proposes a model to predict a student's cognitive engagement in Mexico, Peru, Turkey, and the USA. This is a quantitative study with an exploratory and descriptive scope and cross-sectional design. Data was collected from 1009 students from the four countries, who completed surveys anonymously. The factors analyzed were attitude, affect, and motivation, perceived behavioral control (ease of use, self-efficacy, and accessibility), and cognitive engagement. The data was analyzed using descriptive, correlation, and regression analysis. The predictive model shows that students' attitude toward online learning impacts their cognitive engagement in Mexico, Peru, and the USA. Furthermore, self-efficacy is a significant moderator for cognitive engagement in all four countries. The model also shows that each country has different determinants for cognitive engagement. Understanding the factors that affect the use of emergency online learning is essential for the success and/or achievement of its maximum benefits in situations like a global pandemic. Limitations of this study have been identified as use of convenience sampling, and an inability to explore factors related to instruction and system attributes. Professors who did not teach online learning lacked knowledge about online educational strategies and used the technological resources that were immediately available to them. Therefore, research that explores the use of instructional strategies and the use of technological systems during emergency online learning is necessary. This study includes suggestions to incorporate open educational resources that use microlearning and emphasizes the importance of student self-efficacy; because it was predictor of cognitive engagement in all four countries. Faculty and higher education institutions can and should develop strategies to increase students' sense of self-efficacy.

College students' use and acceptance of emergency online learning due to COVID-19.

Due to COVID-19, higher education institutions transitioned to online learning. This study explored college students' perceptions of their adoption, use, and acceptance of emergency online learning. The factors analyzed were attitude, affect, and motivation; perceived behavioral control (ease of use of technology, self-efficacy, and accessibility), and cognitive engagement. Quantitative and qualitative data were collected from 270 students. The findings present how attitude, motivation, self-efficacy, and use of technology play a significant role in the cognitive engagement and academic performance of students. Also, participants preferred face-to-face learning over online learning. This study presents suggestions on how to improve the acceptance of emergency online learning.

A western route of prehistoric human migration from Africa into the Iberian Peninsula.

Being at the western fringe of Europe, Iberia had a peculiar prehistory and a complex pattern of Neolithization. A few studies, all based on modern populations, reported the presence of DNA of likely African origin in this region, generally concluding it was the result of recent gene flow, probably during the Islamic period. Here, we provide evidence of much older gene flow from Africa to Iberia by sequencing whole genomes from four human remains from northern Portugal and southern Spain dated around 4000 years BP (from the Middle Neolithic to the Bronze Age). We found one of them to carry an unequivocal sub-Saharan mitogenome of most probably West or West-Central African origin, to our knowledge never reported before in prehistoric remains outside Africa. Our analyses of ancient nuclear genomes show small but significant levels of sub-Saharan African affinity in several ancient Iberian samples, which indicates that what we detected was not an occasional individual phenomenon, but an admixture event recognizable at the population level. We interpret this result as evidence of an early migration process from Africa into the Iberian Peninsula through a western route, possibly across the Strait of Gibraltar.

Hydra: A web-based system for cardiovascular analysis, diagnosis and treatment.

BACKGROUND AND OBJECTIVE: Cardiovascular (CV) risk stratification is a highly complex process involving an extensive set of clinical trials to support the clinical decision-making process. There are many clinical conditions (e.g. diabetes, obesity, stress, etc.) that can lead to the early diagnosis or establishment of cardiovascular disease. In order to determine all these clinical conditions, a complete set of clinical patient analyses is typically performed, including a physical examination, blood analysis, electrocardiogram, blood pressure (BP) analysis, etc. This article presents a web-based system, called Hydra, which integrates a full and detailed set of services and functionalities for clinical decision support in order to help and improve the work of clinicians in cardiovascular patient diagnosis, risk assessment, treatment and monitoring over time. METHODS: Hydra integrates a number of different services: a service for inputting all the information gathered by specialists (physical examination, habits, BP, blood analysis, electrocardiogram, etc.); a tool to automatically determine the CV risk stratification, including well-known standard risk stratification tables; and, finally, various tools to incorporate, analyze and graphically present the records of the ambulatory BP monitoring that provides BP analysis over a given period of time (24 or 48 hours). In addition, the platform presents a set of reports derived from all the information gathered from the patient in order to support physicians in their clinical decisions. RESULTS: Hydra was tested and validated in a real domain. In particular, internal medicine specialists at the Hypertension Unit of the Santiago de Compostela University Hospital (CHUS) validated the platform and used it in different clinical studies to demonstrate its utility. It was observed that the platform increased productivity and accuracy in the assessment of patient data yielding a cost reduction in clinical practice. CONCLUSIONS: This paper proposes a complete platform that includes different services for cardiovascular clinical decision support. It was also run as a web-based application to facilitate its use by clinicians, who can access the platform from any remote computer with Internet access. Hydra also includes different automated methods to facilitate the physicians' work and avoid potential errors in the analysis of patient data.

mtDNA haplogroups and osteoarthritis in different geographic populations.

OBJECTIVE: To compare the frequency distribution of the mtDNA haplogroups in OA patients and healthy controls between the United Kingdom (UK) and Spain. METHODS: We used the single base extension (SBE) assay to obtain the European mtDNA haplogroups in 1471 OA patients and 406 healthy controls from Spain, and 453 OA patients and 280 healthy controls from the UK. Some differential haplogroup J-related single nucleotide polymorphisms (SNPs) between both populations were analyzed. The whole data was analyzed with SPSS software (v.18) following appropriate approaches that included chi-square contingency tables and logistic regression models adjusting by gender and age. RESULTS: The haplogroup J appeared underrepresented in OA patients from Spain when compared with healthy controls (OR=0.636; 95% CI: 0.444-0.911; p=0.013). Individuals from the UK carrying the haplogroup T showed a decreased risk of OA (OR=0.574; 95% CI: 0.350-0.939; p=0.027). The comparison of the frequency distribution of the haplogroup J between the UK and Spain showed a decreased presence of this haplogroup in healthy controls from the UK when compared with healthy controls from Spain that is in borderline of the statistical significance (p=0.06). The analysis of some haplogroup J-related SNPs in OA patients and healthy controls from Spain and the UK showed that the SNP m.3394t>c appeared underrepresented in the UK cohort (p=0.038). CONCLUSIONS: The proposed mitochondrial uncoupling mechanism derived from the mtDNA haplogroups J and T could be behind their protective role against OA. The different association found in Spain and the UK could reflect the adaptation of the mtDNA haplogroups to different climatic patterns. The genetic composition of the haplogroup J between the UK and Spain seems to be slightly different, being the m.3394t>c SNP one of the differentially expressed haplogroup J-related polymorphisms.

Enfermedad de Kikuchi-Fujimoto en una portadora del VIH / Kikuchi-Fujimoto disease in an HIV carrier

No disponible

Common variations in estrogen-related genes are associated with severe large-joint osteoarthritis: a multicenter genetic and functional study.

OBJECTIVE: Several lines of evidence suggest that estrogens influence the development of osteoarthritis (OA). The aim of this study was to explore the association of two common polymorphisms within the aromatase (CYP19A1) and estrogen receptor (ER) alpha (ESR1) genes with severe OA of the lower limbs. METHODS: The rs1062033 (CYP19A1) and rs2234693 (ESR1) single nucleotide polymorphisms were genotyped in 5528 individuals (3147 patients with severe hip or knee OA, and 2381 controls) from four centres in Spain and the United Kingdom. Gene expression was measured in femoral bone samples from a group of patients. RESULTS: In the global analysis, both polymorphisms were associated with OA, but there was a significant sex interaction. The GG genotype at rs1062033 was associated with an increased risk of knee OA in women [odds ratio (OR) 1.23; P=0.04]. The CC genotype at rs2234693 tended to be associated with reduced OA risk in women (OR 0.76, P=0.028, for knee OA; OR=0.84, P=0.076 for hip OA), but with increased risk of hip OA in men (OR 1.28; P=0.029). Women with unfavourable genotypes at both loci had an OR of 1.61 for knee OA (P=0.006). The rs1062033 genotype associated with higher OA risk was also associated with reduced expression of the aromatase gene in bone. CONCLUSIONS: Common genetic variations of the aromatase and ER genes are associated with the risk of severe OA of the large joints of the lower limb in a sex-specific manner. These results are consistent with the hypothesis that estrogen activity may influence the development of large-joint OA.

Tratamiento de las fracturas periprotésicas de rodilla de fémur distal mediante clavo intramedular retrógrado / Treatment of periprosthetic knee fractures in the distal femur by means of retrograde intramedullary nailing

Objetivos. Valorar nuestros resultados radiológicos y funcionales tras la estabilización de fracturas periprotésicas de rodilla en fémur distal mediante clavo intramedular acerrojado retrógrado. Material y método. Estudio retrospectivo de 12 pacientes afectados de fractura supracondílea periprotésica de fémur distal. El seguimiento medio fue de 14 meses (6-24 meses). Resultados. Entre las posibles causas de la fractura periprotésica encontramos la existencia de una osteotomía femoral anterior excesiva en cinco de los doce pacientes de nuestro estudio. Se consiguió la consolidación clínica y radiológica en todos los pacientes, tras un período medio de 15 semanas. Como complicaciones cabe señalar la consolidación en mala posición en 3 de los 12 pacientes por falta de reducción durante la cirugía; ninguna precisó tratamiento secundario. Conclusiones. La existencia de una osteotomía anterior excesiva que debilita la cortical femoral podría ser una de las causas de fractura periprotésica, por lo que debe ser evitada. El enclavado intramedular retrógrado para el tratamiento de fracturas periprotésicas de fémur distal es una técnica que proporciona buenos resultados con un índice bajo de complicaciones

Purpose. To assess the radiological and functional results obtained after stabilization of periprosthetic knee fractures in the distal femur by means of a retrograde locked intramedullary nail. Materials and methods. Retrospective study of 12 patients that sustained a periprosthetic supracondylar distal femoral fracture. Mean follow-up was 14 months (range: 6-24 months). Results. Clinical and radiological healing was achieved in all patients over a mean period of 15 weeks. As regards complications, the presence of a malunion in 3 out of the 12 patients was probable related the fact that the fracture was not reduced intraoperatively; however, these did not require secondary treatment. Among the possible causes for the periprosthetic fracture, we could mention the existence of an excessive previous femoral osteotomy in five of the 12 patients in our study. Conclusions. Retrograde intramedullary nailing for the treatment of periprosthetic distal femoral fractures is a technique that has afforded us good results with a low complications rate. The presence of an overly aggressive previous osteotomy that weakened the femoral cortex could be construed to be a likely cause for the periprosthetic fracture; therefore these should be avoided (AU)

Remission of HIV-associated myelopathy after highly active antiretroviral therapy.

HIV-associated myelopathy is the leading cause of spinal cord disease in HIV-infected patients. Typically, it affects individuals with low CD4 T cell counts, presenting with slowly progressive spastic paraparesis associated with dorsal column sensory loss as well as urinary disturbances. Other aetiologies must be first ruled out before establishing the diagnosis. We report here the case of a 37-year-old woman with advanced HIV disease, who developed HIV-associated myelopathy. The patient showed a gradual improvement after beginning with highly active antiretroviral therapy and, finally, she achieved a complete functional recovery. In addition, neuroimaging and neurophysiological tests normalized.

Accidentes de tráfico atendidos por una unidad de soporte vital avanzado. Análisis de factores pronósticos / Road traffic accidents assisted by an advanced vital support unit. Analysis of prognostic factors

Objetivos: Describir los accidentes de tráfico atendidos por una Unidad de Soporte Vital Avanzado (USVA), la magnitud que éstos representan en nuestra actividad así como determinar aquellos factores que permitan predecir la mortalidad. Métodos: Estudio observacional descriptivo en el que se han recogido de forma prospectiva los accidentes de tráfico que han requerido la atención de la USVA de A Coruña (España) durante el período de un año. Resultados: Se encontraron diferencias significativas entre profundidad del coma, medido con la escala de Glasgow (GCS), y la mortalidad. Las variables asociadas estadísticamente con la mortalidad al realizar el análisis de regresión logística fueron el GCS (OR= 0,77) y el traumatismo torácico (OR= 3,37). Conclusiones: Bajos valores en la escala de Glasgow y tener traumatismo torácico se muestran como los factores relacionados con una mayor mortalidad (AU)

Quantitative and functional neutrophil deficiencies.

Neutrophil is a cell involved in the maintenance of homeostasis of the organism. It plays an important role in the elimination and control of certain pathogenic microorganisms. Deficiency in function and quantity of neutrophils, either due to congenital or secondary etiological extrinsic factors, lead to recurrent infectious processes of variable severity. The most frequent oral complications in these patients are ulcers, periodontal disease and candidiasis. Due to their high susceptibility to infections and the risk implied in undergoing surgical procedures, actions leading to a higher degree of prophylaxis must be carried out on these patients (oral hygiene habits, fluoridation, dietary advise, etc.). The use of granulocyte colony-stimulating factors (G-CSF) allows, in some cases, the fullfillment of some, until recently considered controversial dental procedures. Its administration demands an adequate selection of patients and a close collaboration between physician and dental practitioner. Despite G-CSF effectiveness, dental treatment in severe neutropenic patients must be carried out in a hospital and, in some cases, regardless of adequate care, the progress of periodontal disease cannot be avoided.

[Paronychia in patients infected with HIV treated with indinavir]. / Paroniquia en pacientes infectados por el VIH tratados con indinavir.

A retrospective study of cases of paronychia associated with anti-retroviral therapy diagnosed in two general hospitals is here reported. Lesions appeared from 3 and 48 months after institution of therapy. At diagnosis, 84.6% of patients were on indinavir therapy. CD4 values ranged from 120 and 1,332 cells/mm3 and viral load was lower than 200 copies/ml in 92.3 of cases. Conservative therapy was applied in 7 patients and surgery in 6. In all patients indinavir therapy was discontinued, and cure was achieved 16 weeks later. The "retinoid" effect of indinavir is discussed as likely pathogenic explanation for this complications. We advocate for topic therapy and change of anti-retroviral therapy, reserving surgery for patients not responding to therapy. Pain and functional limitation caused by this non uncommon complication (1.6% of our patients treated with anti-retroviral agents) makes its knowledge necessary and an active search by clinicians in patients receiving indinavir therapy.

Paroniquia en pacientes infectados por el VIH tratados con indinavir / Paronychia in HIV-positive patients treated with indinavir

Presentamos un estudio retrospectivo de los casos de paroniquia, asociados a terapia antirretrovírica, diagnosticados en dos hospitales generales. Las lesiones aparecieron entre 3 y 48 meses desde el inicio de la terapia. El 84,6 por ciento de los pacientes se encontraban en tratamiento con indinavir en el momento del diagnóstico. La cifra de CD4 varió entre 120 y 1.332 cél/mm3 y la carga vírica fue inferior a 200 cop/ml en el 92,3 por ciento de los casos. Se realizó terapia médica conservadora en 7 pacientes y en 6 cirugía; en todos los casos se suspendió la terapia con indinavir, con lo que tras 16 semanas se consiguió la curación.Se discute el probable efecto retinoide-like del indinavir como probable explicación patogénica de esta complicación. Se preconiza la realización de terapia tópica y la modificación del tratamiento antirretrovírico, reservando la terapia quirúrgica para los casos refractarios. El dolor y la limitación funcional que produce esta complicación, no infrecuente (1,6 por ciento de nuestros pacientes tratados con antirretrovíricos), hace necesario su conocimiento y búsqueda activa por parte de los clínicos en los pacientes que reciben tratamiento con indinavir (AU)

Response to standard syphilis treatment in patients infected with the human immunodeficiency virus.

In a study designed to evaluate the efficacy of penicillin in HIV-infected patients with syphilis and to determine the clinical and laboratory responses after treatment, 13 patients with HIV infection and syphilis were assessed at enrollment and at the last follow-up examination (median time of 21 months). The Venereal Diseases Research Laboratory (VDRL) test, the Treponema pallidum hemaglutination test, and leukocyte counts in cerebrospinal fluid were evaluated both at enrollment and at the last follow-up visit, and the polymerase chain reaction for Treponema pallidum DNA and the rabbit infectivity test were performed on cerebrospinal fluid samples at the last follow-up visit. Primary syphilis was confirmed in four patients, latent syphilis in five, and neurosyphilis in four. After penicillin treatment, all patients were asymptomatic. The serum rapid plasma reagin test became negative in five patients, and titers declined in eight. The VDRL test, Treponema pallidum DNA, and the rabbit infectivity test were negative in all 13 patients. Except for one patient whose serological titer was slow to decline, all patients had good clinical and serological responses to penicillin. In certain settings, factors other than penicillin treatment failure should be considered in HIV-infected patients with suspected relapse of syphilis.