Literacy in Lockdown: Learning and Teaching During COVID-19 School Closures.

Across the globe, students have been away from schools and their teachers, but literacy learning has continued. In many countries, students' literacy proficiency is often measured via high-stakes assessment tests. However, such tests do not make visible students' literacy lives away from formal learning settings, so students are positioned as task responders, rather than as agentive readers and writers. The authors explore the fluidity and diversity of literacy events and practices for students and their teachers observed during the recent period of COVID-19 lockdown restrictions.

Management of aortic valve bypass surgery.

The 3 leading causes of aortic stenosis (AS) in adults are calcific degeneration of a normal trileaflet aortic valve (AV), calcific degeneration of a congenital bicuspid AV, and rheumatic AS. Therapeutic options in patients with severe AS include aortic valve replacement (AVR), transcatheter aortic valve implantation (TAVI), or aortic valve bypass (AVB). An AVB involves the placement of a valved conduit between the apex of the left ventricle and the descending thoracic aorta. AVB serves as a useful alternative to treat severe AS in patients deemed high risk for conventional AVR (ie, porcelain aorta, previous cardiac surgery) or TAVI (ie, severe aorto-iliac disease, limited experience, lack of hybrid operating room). Advantages of on-pump AVB include the avoidance of aortic cannulation, cross-clamping, and cardioplegic cardiac arrest. The procedure can also be performed without cardiopulmonary bypass. In this article, the authors review the circulatory physiology, perioperative anesthetic management, the role of intraoperative transesophageal echocardiography, and surgical considerations of AVB surgery through 3 cases.

My hearing disability is no barrier to work.

I applaud the recent correspondence urging deaf students not to give up their studies (letters September 13). There are many hard of hearing and deaf nurses, doctors, physiotherapists, radiologists and audiologists in the NHS. I am profoundly deaf and work on an acute medical/respiratory ward. Disability is not a barrier to nursing.

Dynamic and differential changes in myocardial and plasma endothelin in patients undergoing cardiopulmonary bypass.

OBJECTIVE: The bioactive peptide endothelin modulates left ventricular function by changing afterload, coronary vascular tone, and myocardial contractility. However, whether increased plasma endothelin levels observed in patients during and after coronary revascularization and cardiopulmonary bypass reflect actual myocardial interstitial levels are unknown. METHODS: A microdialysis probe (outer diameter: 0.77 mm; length: 4 mm) was placed in the left ventricular apical midmyocardium in 20 patients and myocardial interstitial fluid was collected (2.5 microL/min) at baseline and up to 30 minutes after cardiopulmonary bypass. Myocardial interstitial and systemic arterial endothelin were measured by radioimmunoassay. RESULTS: Baseline myocardial interstitial endothelin was over 6-fold higher than plasma (20.11 +/- 2.07 vs 3.19 +/- 0.25 fmol/mL, P < .05). Plasma endothelin increased by 23% +/- 12% at 60 minutes of cardiopulmonary bypass whereas myocardial interstitial endothelin increased by 105% +/- 24%, P < .05), and this change was higher than in the plasma ( P < .05). Although no further change in plasma endothelin occurred during cardiopulmonary bypass, myocardial interstitial levels increased further after crossclamp removal (400% +/- 75%) and remained significantly higher than plasma at separation from cardiopulmonary bypass. CONCLUSION: The unique findings of this study were 2-fold: First, significant compartmentalization of endothelin exists within the human myocardium. Second, a significantly higher and temporally disparate change in myocardial interstitial endothelin occurs during and after cardiopulmonary bypass when compared with systemic levels. These dynamic changes in myocardial endothelin likely influence coronary vascular tone and contractility.

A prospective, randomized study of endothelin and postoperative recovery in off-pump versus conventional coronary artery bypass surgery.

OBJECTIVE: The objectives are 2-fold: (1). to serially determine endothelin (ET) levels in arterial vascular compartments in patients undergoing coronary artery bypass surgery using either cardiopulmonary bypass or off-pump techniques, and (2). to define potential relationships between endothelial levels and specific perioperative parameters of patient recovery. METHODS: In a prospective, randomized study, endothelin plasma content was measured from patients undergoing coronary artery bypass grafting using either off-pump techniques (OPCAB group, n = 25) or conventional cardiopulmonary bypass (CPB group, n = 25) before surgery, before and after coronary artery anastomosis, and 6 and 24 hours postoperatively. Specific indices of patient recovery including pulmonary artery pressures, ventilation requirement, and hospital stay were documented for patients in both study groups. RESULTS: Postoperative systemic arterial ET levels were significantly increased by 200% in the CPB group and 50% in the OPCAB group. ET levels remained significantly higher in the CPB group relative to the OPCAB group throughout the postoperative period of observation (p < 0.05). Pulmonary artery pressures, ventilation requirement, and hospital stay were significantly increased in patients in the CPB group. CONCLUSIONS: Postoperative ET levels were higher in patients who underwent CPB for coronary artery bypass surgery. Increased ET in the postoperative period may contribute to a more complex recovery from coronary artery bypass surgery in patients undergoing cardiopulmonary bypass.

The Antimicrobial Activity of Phenolic Compounds Against Listeria monocytogenes and Their Effectiveness in a Model Milk System.

The minimum inhibitory concentration (MIC) of several phenolic compounds against eight strains of Listeria monocytogenes in tryptose phosphate agar (TPA) was determined. Based upon concentration, the most effective compound was the phenolic antioxidant tertiary butylhydroquinone (TBHQ) which had a MIC of 64 µg/ml. Among the FDA approved food antimicrobials, the most effective was propyl paraben with a MIC of 512 µg/ml. Propyl paraben and TBHQ were then compared to potassium sorbate, a commonly used food antimicrobial, in a model milk system containing 10% nonfat milk solids. In this study, only one strain of the test microorganisms, Scott A, was used and two levels of inoculum, 10 and 1000 CFU/ml, were tested. As expected with the basic pH of the model system, both phenolic compounds were significantly more effective than potassium sorbate against L. monocytogenes at 35°C. Both compounds caused a noticeable increase in lag phase of this microorganism. There was about a three log difference in viable cell counts between propyl paraben and TBHQ and the control. The TBHQ was inconsistent in its activity. The inhibitory action of propyl paraben was not affected by the level of inoculum and had consistent activity throughout testing.