Sildenafil associated AION with optic nerve enhancement in brain MRI and pleocytosis in CSF, a case report

A document by Montasser BEN DHIA. Click on the document to view its contents.

Tariff exemptions are fundamental to attracting Foreign Direct Investment (FDI) into the manufacturing sector, though the associated administrative processes present areas for optimization for both investing entities and the national tax authority. This paper proposes a conceptual framework to empower tax administration by leveraging a synergistic integration of Optical Character Recognition (OCR) and Large Language Model (LLM) technologies. The proposed system is designed to first utilize OCR for intelligent digitization, precisely extracting data from diverse application documents and key regulatory texts such as tariff orders. Subsequently, the LLM would enhance the capabilities of administrative officers by automating the critical and time-intensive task of verifying submitted HS Tariff Codes for machinery, equipment, and raw materials against official exemption lists. By enhancing the speed and precision of these initial assessments, this AI-driven approach systematically reduces potential for non-alignment and non-optimized exemption utilization, thereby streamlining the investment journey for FDI companies. For the national administration, the benefits include a significant boost in operational capacity, reduced administrative load, and a strengthened control environment, ultimately improving the ease of doing business and solidifying the nation's appeal as a premier destination for high-value manufacturing FDI. .

Thermal Limitations on Lignin Biosynthesis: Revisiting Treeline Dynamics Through High-Altitude Plant AdaptationLingyu Ma1, Yaning Cui21Research Institute of Wood Industry, Chinese Academy of Forestry, Dongxiaofu No.1, Beijing, 100091, China2 State Key Laboratory of Tree Genetics and Breeding, College of Biological Sciences and Technology, Beijing Forestry University, Beijing 100083, ChinaCorrespondence Yaning Cui, State Key Laboratory of Tree Genetics and Breeding, College of Biological Sciences and Technology, Beijing Forestry University, Beijing 100083, ChinaEmail address : cuiyaning@bjfu.edu.cnThe adaptation of plants to extreme high-altitude environments has long been a central focus in ecological research. While low temperatures are known to influence plant distribution through multiple pathways including limitations on photosynthesis, respiratory efficiency, and indirect effects on resource allocation. A particularly emerging hypothesis proposed that cold temperatures may directly interfere with the biochemical process of cell wall lignification, thereby fundamentally affecting mechanical support, water transport capacity, and stress resistance in plants (Gričar et al., 2024; Kumari & Kumar, 2024). While this hypothesis finds support in distinctive wood anatomical features such as “Blue Rings”-cellular anomalies characterized by incomplete lignification within annual growth rings-the precise mechanisms through which cryogenic conditions influence the biosynthesis, polymerization, and spatial deposition of critical xylem wall components remain experimentally unverified (Piermattei et al., 2015). Furthermore, the reasons for the absence of trees above the treeline cannot be found in trees below the treeline, which requires further validation through comprehensive in-depth investigations on adaptation strategies employed by alpine plants.Recently, wood anatomy combined with environmental factors was developed to provide a new perspective for understanding the mechanism of treeline formation (Fig. 1a) (Büntgen et al., 2025). The pioneering work of Büntgen et al. (Büntgen et al., 2025) employed Safranin-Astra Blue double-staining technique coupled with microscopic imaging to quantitatively analyze the degree of cell wall lignification (DCWL) in stem tissues of P. pamirica across elevational gradients, thereby establishing a robust negative correlation between elevation and lignification capacity while controlling for temperature variation.The degree of plant lignification exhibits a strong elevational dependence, as demonstrated by recent findings (Büntgen, 2023) (Fig. 1a). Quantitative analysis of P. pamirica specimens across the 5550-5850 m altitudinal gradient in Ladakh revealed a significant negative correlation between elevation and the degree of cell wall lignification. DCWL decreased from 69% at 5550 m to 34% at 5850 m, showing a strong negative correlation with elevation (r = −0.73; p < 0.01; Fig. 1b). This altitudinal trend was visually confirmed through Safranin-Astra Blue double-staining and microscopic imaging, which clearly showed reduced lignification in high-elevation specimens. The observed pattern corresponds to substantial thermal declines along the gradient, with annual mean root-zone temperature decrease of 5.6°C and a surface air temperature by 1.4°C between the lowest and highest sampling sites, providing compelling evidence for temperatures-mediated inhibition of lignin biosynthesis pathways under extreme cold conditions (Büntgen et al., 2025).Recent studies have established that temperature influences lignin biosynthesis and elevation gradients establish a well-defined negative correlation with temperature (Palosse et al., 2024). At 5550 m, the mean root zone and surface air temperatures remained above 5°C for 52 and 41 days respectively, while at the higher elevation of 5850 m, these durations decreased significantly to 15 and 25 days for root zone and surface air temperatures accordingly. Thus, structural equation modeling (SEM) reflected the direct effect of temperature on DCWL (r = -0.73) (Fig. 1b). Although plant age and size varied across altitudes, these variations showed no significant association with elevation. For instance, the largest specimens occurred at mid-altitude of 5800 m, while the smallest plants were distributed at low altitude of 5550 m. Structural equation modeling revealed that plant age and size had no significant effect on DCWL (p > 0.05), eliminating their confounding effects on lignification changes, thereby further highlighting the dominant role of temperature (Fig. 1b) (Büntgen et al., 2025).Beyond temperature constraints, the observed non-linear patterns in plant size and age suggest that Allee effects may further contribute to distributional limits at habitat edges. Recent research has demonstrated that Allee effect may contribute to distributional stasis at habitat edges, as evidenced by non-linear elevational patterns observed in plant size and age parameters-with minimum values clustered at the base elevation (5550 m) while maxima occurred at intermediate and upper sampling zones (Büntgen et al., 2025). This underutilized ecological concept offers a novel biochemical perspective for understanding treeline formation mechanisms, complementing traditional physiological explanationsIn summary, Büntgen et al. (2025) conclusively link thermal constraints to lignification suppression in high-altitude plants, advancing a biochemical paradigm for treeline formation. Future studies could build on this work by employing in situ chemical imaging (e.g., Raman spectroscopy) to resolve spatial lignin distribution patterns, or using Arabidopsis mutants to identify cold-responsive transcriptional regulators (e.g., MYB factors) in lignin pathways (Li et al., 2024; Wang et al., 2023).

Objectives:To characterise UK otolaryngologists’ use of middle-meatal antrostomy (MMA) and pre-operative computed tomography (CT) during endoscopic sphenopalatine-artery (SPA) ligation, and to explore perceived safety and medicolegal risk. Design:National cross-sectional survey. A 14-item e-questionnaire was circulated December 2024–April 2025. Setting/Participants:Twenty-five ENT surgeons with varied experience responded. Results: Fifteen out of 25 surgeons (60 %) reported always performing a middle meatal antrostomy (MMA), with a 95 % confidence interval (CI) of 39–79 %. The same number (15/25, 60 %; 95 % CI: 39–79 %) reported never obtaining a preoperative CT scan, while 4 out of 25 (16 %; 95 % CI: 5–36 %) said they always obtained one. Surgeons with more than 10 years’ experience were less likely to request CT compared to those with 10 years or less (28 % vs 67 %), an absolute difference of 39 % (95 % CI: 7–71 %). SPA caseload showed no clear association with MMA or CT use. Conclusions:UK SPA-ligation practice is heterogeneous. Most surgeons deem the procedure safe without routine MMA or CT, yet a sizeable minority favour MMA even when imaging is unavailable and remain wary of medicolegal scrutiny. Clearer national guidance distinguishing emergency from elective scenarios may harmonise practice and reassure clinicians.

Particularly in dry and semi-arid areas, soil salinity and phosphorus deficiency are major factors limiting agricultural productivity (Rhoades and Loveday, 1990). For possible application in saline soil management, the current work sought to separate and describe salt-tolerant phosphate-solubilizing bacteria (PSB) from rhizospheric soil samples. Soil samples were collected from saline-affected agricultural fields, and serial dilutions were plated on Pikovskaya’s agar to screen for PSB based on halo zone formation. Selected isolates were further evaluated for quantitative phosphate solubilization in liquid media and tested for salt tolerance on media supplemented with increasing concentrations of NaCl (0–10%). Several isolates demonstrated efficient phosphate solubilization and sustained growth at NaCl concentrations of up to 7%, indicating moderate to high salt tolerance. These strains hold promise as bioinoculants for improving phosphorus availability and promoting plant growth in saline environments. Further studies, including molecular identification and greenhouse trials, are recommended to assess their efficacy under field conditions.

A document by Suresh Kumar. Click on the document to view its contents.

A document by Rafael Castellanos - Bueno . Click on the document to view its contents.

Metformin for the Prevention of Hyperemesis Gravidarum: Cautious Enthusiasm*Cathy Nelson-Piercy - catherine.nelson-piercy@nhs.netMelanie Nana, Catherine Williamson, Rebecca PainterHyperemesis gravidarum (HG), the most severe form of nausea and vomiting in pregnancy (NVP), affects around 3% of pregnant women, and can result in both maternal and fetal morbidity and mortality (Nana M et al. Lancet. 2025 in press). It is the commonest reason for hospital admission in the first trimester of pregnancy. With appropriate antiemetics and intravenous fluids symptoms can be ameliorated in most women (Nelson-Piercy et al. 2024;131(7):e1-e30). However, the short- and long-term consequences on maternal mental health and offspring physical and neurocognitive development (Nijsten K et al. Am J Obstet Gynecol. 2022;227(3):414-429) as well as the significant financial burden on health services make prevention of HG desirable.GDF15, a hormone present in non-pregnant people, in particular after tissue damage and starvation, is secreted by trophoblast, rising rapidly in early pregnancy. It causes taste aversion, nausea, and vomiting. Genome-wide association studies of women with HG and/or NVP identified mutations and genetic variation in GDF15 and its receptor, GFRAL, associated with severe HG. Experimental studies have shown that chronic low serum GDF15 increases the effects of subsequent high GDF15 in pregnancy, and that ‘pre-conditioning’ with GDF15 can ameliorate the symptoms caused by high GDF15 exposure. It was therefore hypothesised that preconception ‘pre-conditioning’ with GDF15 raising agents could protect against HG.Metformin, a cheap and widely accessible medication safely used in pregnancy for gestational and pre-gestational diabetes mellitus (DM), and polycystic ovarian syndrome, has been shown to increase levels of GDF15, and could render women less sensitive to fetally derived GDF15. Metformin may therefore be a safe and attractive candidate for HG-prevention.Sillis et al. (Sillis et al. BJOG 2025) compared rates of HG and NVP in 80 women exposed to metformin pre-pregnancy with 4411 unexposed women. Their finding of a reduction of rates of HG (n=1/80; 1.25% vs. n=97/4,411; 2.20%) in the metformin group, albeit non-significant, is exciting, as it could have immediate clinical applicability in contrast to the lengthy development and safety testing of specific GDF15 blockers for use in pregnancy.Overweight, pre-gestational medical conditions, and assisted reproductive techniques (ART) are all HG-risk factors. The authors acknowledge adjusting for important confounders, including indication for metformin and ART would have further strengthened the study, but was not within the methodological scope. Additionally, the study was unable to establish a dose-effect relation, defining optimal pre-pregnancy metformin dose or duration and timing in relation to conception. Further, symptom severity was minimally recorded, making it impossible to comment on whether HG-severity improved alongside reduction in prevalence.   We agree with the authors that large multicentre studies including diverse populations are needed. Most importantly, prospective randomized controlled trials will ensure control for potential confounders. Studies suggest only a small proportion of women carry GDF15 mutations; while providing promise for some women it isn’t the story for all. This may have contributed to the lack of statistical significance in Sillis et al’s study. While the results offer hope, metformin to prevent HG must not be allowed to enter routine clinical practice before appropriate clinical studies have been performed to confirm its efficacy and to inform optimal dose and duration of treatment.The authors declare no conflict of interest.

The mechanical state of Arctic landfast sea ice remains poorly constrained due to limited observations. This study investigates interactions between drifting sea ice and the coastal landfast ice near Utqiaġvik, Alaska by integrating data from broadband seismometer, Distributed Acoustic Sensing (DAS), and marine radar. We find that decreases in sea ice velocity, marking transitions from drift to compressive contact, coincide with increased seismic energy. Tremor characteristics vary seasonally with ice conditions. In January, dense ice packs produced sustained harmonic tremors with gliding and U-shaped spectral features, consistent with repetitive stick-slip motion at the ice–ice or ice–ground interface under velocity-weakening friction. In April, smaller fragmented floes generated short-lived, chaotic tremors linked to brittle failure and spatially dispersed impacts. These findings demonstrate that seismic tremors encode the mechanical properties of interacting ice, offering a new tool to distinguish ice regimes and monitor evolving Arctic coastal dynamics under climate change.

Hydrological systems in the tropical Andes are characterized by a pronounced climatic and biophysical variability yet remain understudied, particularly in Peru, where diverse natural and anthropogenic factors challenge sustainable water management. Using a paired‑catchment design under similar climatic conditions, this study introduces a novel methodology for analyzing data-limited catchments by comparing two adjacent headwater catchments in the humid Peruvian puna of around 3 km2, named HUA_01 and HUA_02. High-resolution rainfall and streamflow data, combined with key biophysical indicators, were used to assess how variations in factors such as bofedal extent and connectivity influence hydrological functioning. Our analysis shows that HUA_01 exhibits higher event-scale runoff coefficients with a delayed, buffered response, whereas HUA_02 demonstrates a “flashier” behavior with faster recession dynamics and enhanced percolation –effects that are exacerbated by overgrazing. Furthermore, we identify a dual reservoir system, consisting of a rapidly responsive shallow component and a slower, deeper reservoir, which underscores the complex interplay between surface processes and subsurface storage. These findings not only advance our conceptual understanding of headwater hydrology in the Andean Puna but also highlight the critical need for comprehensive research to guide adaptive water management strategies amid climate change and increasing land-use pressures in high-Andean headwaters.

The intricate role of sleep in sustaining critical physiological functions and preserving cognitive integrity is well-established. Inadequate sleep, whether in duration or quality, profoundly impairs fundamental cognitive functions, including memory consolidation, sustained attention, executive decision-making, and temporal perception. This study endeavors to explore the effects of short-term sleep restriction on subjective time perception employing both retrospective and prospective paradigms to unveil how acute sleep restriction reshapes temporal cognition in healthy adults. Following ethical approval, 31 healthy volunteers aged between 18 and 35 years participated. The experimental protocol which included assessments conducted under two conditions: after four consecutive nights of regular sleep and following three-night of sleep restriction, during which participants’ sleep duration was reduced by two hours per night. Subjective time perception was evaluated using both retrospective and prospective time generation tasks (RTP and PTP). To assess cognitive performance, participants completed the Stroop test, which measures selective attention and cognitive flexibility, and the Wechsler Memory Scale-III (WMS-III), a validated instrument for evaluating short-term and working memory functions. The RTP after sleep restriction showed a significant prolongation compared to regular sleep duration (20.2±8.8 vs 26.6±12.3 sec, respectively; ANOVA p=0.01). Short-term and working memory performances decreased after sleep restriction (10.8±1.9 vs 10.0±2.1 sec and 12.3±2.1 vs 11.4±2.3 sec respectively; ANOVA p0.01 for both). Even moderate sleep restriction (e.g., a two-hour reduction) disrupts temporal cognition and memory, underscoring the critical need for sufficient sleep to sustain optimal cognitive performance in high-demand scenarios.

Human consciousness, though often described in abstract terms, is grounded in identifiable physiological mechanisms that can be analysed and measured via empirical methods. Drawing on interdisciplinary evidence from neuroscience, physiology and systems biology, we propose a provisional framework aimed at characterizing the physical and biophysical features that may underlie human consciousness. We review current methods for quantifying these biophysical correlates, highlighting the potential roles of electrical activity, metabolic thresholds, thermodynamic constraints, ionic regulation and network dynamics in sustaining conscious states. We also consider the contributions of non-neuronal cells such as astrocytes and microglia, alongside the modulatory influences of peripheral inputs, including gut-brain interactions and cardiovascular and respiratory rhythms. We then examine the physiological dynamics underlying shifts in consciousness by integrating clinical data from anaesthesia, coma and sleep with neurophysiological and biochemical measurements. This synthesis allows us to identify a set of quantifiable parameters that characterize the conscious brain, including oscillatory coherence, cerebral metabolic rate, spike timing precision and ionic stability. We emphasize the importance of methodological convergence, whereby the integration of neuroimaging, electrophysiology and computational modelling enhances analytical robustness, improves interpretability and enables cross-validation of findings. Next, we conceptualize consciousness within a multidimensional threshold space, where varying degrees of awareness emerge from biophysical and physiological interactions. Overall, our approach proposes an operational definition of consciousness based on identifiable thresholds and interdependent physical parameters, aiming to support the integration of diverse findings within a coherent systems-level framework grounded in empirical evidence and clinical observations.

Currently, polymeric foams are widely utilized in the creation of passive support surfaces such as mattresses, cushions, and seating. However, these materials encounter challenges in prolonged use, including diminished performance, permanent deformation, reduction in thickness, and nonuniform pressure distribution. These issues can lead to pressure concentration in sensitive bodily areas, particularly the gluteal region, thereby increasing the risk of pressure ulcers. Advances in additive manufacturing technology, alongside the capability to design engineered structures with controllable mechanical properties, have directed researchers’ attention toward employing this method as an alternative to traditional foams. Among these, auxetic structures have garnered interest for applications related to skin wound healing due to their unique mechanical characteristics. In this study, re-entrant auxetic structure samples were numerically designed using the finite element method and subsequently fabricated via the fused deposition modeling (FDM[1](#fn-0002)) additive manufacturing process, utilizing thermoplastic polyurethane (TPU[2](#fn-0003)). The mechanical performance of these structures was assessed through compression testing, in accordance with ISO 3386-1, and fatigue testing. These analyses investigated the impact of parameters such as unit cell dimensions and cell angle on the compressive stress and resilience of the structure. The results indicated that the designed auxetic structure, when utilizing TPU with A95 hardness, could achieve a compressive stress between 7 and 8 kPa at 40% compression. Furthermore, fatigue tests demonstrated that the structure’s resilience is dependent on the amount of strain, whereas the loading duration did not significantly affect its rebound behavior. These findings underscore the high potential of auxetic structures in designing support surfaces with customizable mechanical performance, tailored to the biomechanical needs of the body.

In this paper, we discuss the definition of measurable value solution for quasilinear degenerate parabolic equation ∂ t u + ∂ x f ( u )= ∂ xx A ( u ) , ( x , t ) ∈ R + 2 = R × ( 0 , + ∞ ) , u ( x , 0 ) = u 0 ( x ) , x ∈ R . It is shown that if the equation is with the weak degeneracy, than there exists a L 2 -entropy solution .

Soil carbon sequestration, including organic (SOC) and inorganic carbon (SIC), between shelterbelt and croplands may exhibit divergent responses to edaphic factors as the consequences of soil acidification caused by agricultural fertilization for the latter. In this regard, the aim of this study was to determine the variations and determinants of SOC and SIC content in the top 100 cm for shelterbelt forest (SF) and crop fields (CF) in drylands. In total, 480 soil samples (30×4×4) were collected from 30 paired SF and CF within different distance (CF_0.25H, CF_0.5H, CF_1H) at four depths (0–10, 10–30, 30–50, and 50–100 cm) in the middle reaches of the Heihe River Basin, NW China. The results showed that there were no significant ( P > 0.05) differences in the content of soil total carbon (STC), SOC, SIC, and the ratio of SIC to SOC between SF and CF. Meanwhile, there was a significant ( P < 0.01) linear relationship between SOC and STC at varied depths, and SOC and the ratio of SOC to STC were deceased as soil depths increase, suggesting SIC play a dominant role in the subsoil. Variance partitioning analysis showed edaphic factors can explained 78.19 % and 70.10% variation of SOC, and 45.10% and 49.70% variation of SIC for SF and CF, respectively. Pearson’s correction analysis, random forest, linear mixed effects model and structural equation model consistently indicated that soil nutrient play a significant role in determining SOC, while physicochemical properties contribute to SIC. In conclusion, our study demonstrates the contrasting response of SOC and SIC to edaphic factors, but the consistency of abiotic factors in determining soil carbon for shelterbelt and croplands. Our findings provide an improved understanding between soil carbon sequestration and abiotic factors for agroforestry in drylands.

Accreditation is an approach to assessing the quality of hospital services. In most of the world, accreditation is carried out with the same standards, regardless of the size and type of hospital. We aim to develop specific accreditation modules for small and special hospitals. The research was conducted in three phases: review, qualitative, and quantitative. In the first phase, a scoping review was conducted to identify the accreditation axes of the target hospitals. In the second phase, and during a descriptive qualitative study, through in-depth semi-structured interviews with key informants in the field of accreditation, the accreditation modules of the target hospitals were identified. The initial model, including the modules obtained from the first and second phases, entered the third phase, a modified classical Delphi. The final accreditation modules of small and special hospitals were extracted using descriptive statistics (median). India, Australia, and the Joint Accreditation Commission of the United States have taken steps to develop accreditation standards for small hospitals and special hospitals, respectively. The specific modules for small and special hospitals were finalized under the following headings: leadership and management, continuous quality improvement, inpatient care (small hospitals), specialized care (special hospitals), patient safety and infection control, outpatient and para-clinical services, patient engagement, and medication management. The general framework for accreditation at the module level is more or less the same for all hospitals. Nevertheless, by systematically developing and implementing specific standards, this approach is expected to improve accreditation processes further and elevate healthcare delivery in small and specialty hospitals.

The second Trump administration’s centrepiece legislation, the modestly-named Big Beautiful Bill, offers an opportunity to reflect upon how the U.S. state affects health policy and the prospects for equitable access to affordable healthcare. Is the U.S. still an outlier (by comparison with Europe and much of the world), in that its many of its citizens are either uncovered, poorly covered or tenuously and only temporarily covered by health insurance? The answer is yes. And the chipping away at Obamacare and Medicaid by Trump 2.0 (learning from his failure to repeal Obamacare in 2017) as part of the Big Beautiful Bill, shows us that it is easier for the Right to dismantle progressive social legislation than it is for the Liberal-Left to assemble it. To understand why, we have to understand the effect of the U.S. state ( i.e. political structure) upon public policy. This article revisits the nature of that state, to depict the underlying causes of ‘American exceptionalism’ which is partly ideological, but more significantly institutional than often realised.

Blinatumomab along with Combined Antifungal Agents for Refractory adult acute lymphoblastic leukemia with invasive aspergillosis: a case report

Turning solar energy into chemical resources by photocatalysts is severely retarded by low efficiency. But, plasmonic photocatalysts, as a kind of photocatalysts, have shown some promising practical applications from the points of view of improving visible-Near Infrared (Vis-NIR) light absorption and charge separation. Especially, important progresses on plasmon enhancement mechanism, such as NIR light absorption, hot charge carriers’ utilization, quantifying the role of plasmon, have been made. In this review, those plasmonic photocatalysts achieving near-IR light absorption, being identified to generate hot charge carriers and being applied to emerging new reactions, are concentrated. The most recent applications, particularly for medical drugs waste, microplastics, and microbiological inactivation, are outlined. The challenges and future trends of plasmonic photocatalysts are concluded in the end.

AbstractThe need to make curricular adaptations became evident after co-designing the course English III: Exchanging Information and Ideas for Inclusion  (García Villeda et al., 2024) and implementing it in the fifth semester of the Educational Inclusion degree program. These adaptations aimed to reduce the difficulty of the activities and increase student engagement through playful and technological strategies such as hand-clapping games and Karaoke Mornings.  To assess the impact of this pedagogical intervention, a diagnostic test (pretest) was administered at the beginning and a final test (posttest) at the end of the course, following a quasi-experimental design without a control group. One of the strategies included was the monitored use of Duolingo Classroom . The results showed a general improvement in student performance; however, no statistically significant correlation was found between this improvement and the number of lessons completed on Duolingo. ResumenTras co-diseñar el curso Inglés III: Intercambio de información e ideas para la inclusión  (García Villeda et al., 2024) para su implementación en el quinto semestre de la Licenciatura en Inclusión Educativa, se identificó la necesidad de realizar adaptaciones curriculares con el fin de reducir la dificultad de las actividades y aumentar su atractivo con actividades de juego y tecnología (Hand-clapping games y Karaoke Mornings). Para evaluar el impacto de esta intervención pedagógica, se aplicó una prueba diagnóstica (pretest) y otra al final del curso (posttest), siguiendo un diseño cuasiexperimental sin grupo de control. Una de las estrategias incluidas fue el uso monitoreado de Duolingo Classroom. Los resultados arrojaron un avance general en el desempeño de los estudiantes; sin embargo, no se encontró una correlación estadística entre dichos avances y el número de lecciones completadas en Duolingo. Introducción En el contexto actual de globalización y diversidad cultural, el dominio del idioma inglés se ha convertido en una competencia esencial para los futuros docentes en formación inicial. Sin embargo, México ocupa el lugar 89 de 113 países en dominio del idioma inglés, según el estudio realizado por Education First (\cite{mxico}). Este bajo nivel de proficiencia representa un reto importante para las instituciones encargadas de la formación docente, especialmente considerando que el plan de estudios de 2018 contemplaba, para algunos programas de formación docente, la dedicación de seis horas a la semana de lengua extranjera, con el objetivo de que “un alumno de escuela normal pública alcance un nivel B2 en inglés en 3.5 años de su carrera (lo que) no es tarea fácil” (Rebollo Sánchez, 2019). Las Escuelas Normales Superiores enfrentan el reto de integrar esta lengua extranjera en los planes de estudio no solo como una herramienta comunicativa, sino también como un medio para promover el desarrollo integral del estudiante. Particularmente, en programas formativos como la Licenciatura en Inclusión Educativa, la enseñanza del inglés debe responder a principios pedagógicos que reconozcan la diversidad y fomenten la equidad educativa. No obstante, esto se ve complicado por el bajo nivel de dominio del idioma entre el alumnado y por las dificultades estructurales del sistema educativo. Ante este panorama, la autoridad educativa emprendió la contratación de expertos en inglés. Se apuntó hacia la certificación CEFR A1 como meta mínima para las y los estudiantes normalistas. El programa institucional de Lengua Extranjera del BINE ha enfrentado una serie de dificultades, que van desde la calificación alta en Control Escolar a estudiantes que después tienen resultados muy bajos en el examen de certificación CEFR A1, hasta aquello que la Academia de Inglés refiere como “un desfase entre los ambiciosos programas de curso y la modesta realidad del nivel de inglés de las estudiantes normalistas”. Este contexto nos lleva a reflexionar sobre la importancia de ajustar los objetivos curriculares a las capacidades reales del alumnado, particularmente en contextos inclusivos donde la heterogeneidad es la norma. El conocimiento del inglés se considera hoy en día un componente fundamental dentro del perfil profesional del docente. No solo permite el acceso a información científica, tecnológica y pedagógica internacional, sino que también posibilita la participación en redes de colaboración académica y el intercambio de buenas prácticas educativas. En este sentido, las Escuelas Normales tienen la responsabilidad de diseñar estrategias didácticas que desarrollen competencias comunicativas en inglés alineadas con las necesidades específicas de los futuros maestros, particularmente aquellos destinados a trabajar en contextos diversos e inclusivos. La Licenciatura en Inclusión Educativa tiene como finalidad formar profesionales capaces de atender la diversidad en los contextos educativos, promoviendo ambienktes de aprendizaje accesibles, equitativos y respetuosos. Este enfoque implica reconocer que cada estudiante presenta diferencias individuales en cuanto a ritmos de aprendizaje, estilos cognitivos, capacidades sensoriales y necesidades particulares. Por lo tanto, la enseñanza del inglés en esta licenciatura no puede limitarse a un modelo homogéneo; por el contrario, debe adaptarse a la heterogeneidad del grupo escolar mediante metodologías inclusivas que favorezcan el acceso equitativo al conocimiento de la lengua extranjera. Uno de los principales desafíos que enfrentan las Escuelas Normales es la diversidad de niveles lingüísticos entre los estudiantes normalistas, algunos de los cuales pueden presentar barreras en su propio proceso de aprendizaje del inglés. Además, existen limitaciones relacionadas con los recursos didácticos, la infraestructura tecnológica y la formación continua del docente frente a nuevas demandas educativas. Otro aspecto crítico es la percepción negativa que muchos estudiantes tienen hacia el aprendizaje de lenguas extranjeras, lo cual puede verse exacerbado en aquellos con dificultades específicas de aprendizaje. En este sentido, es necesario implementar estrategias motivacionales y personalizadas que favorezcan la autoconfianza y la autonomía en el proceso de aprendizaje. Para superar estos retos, se requiere un enfoque pedagógico basado en la inclusión, la flexibilidad curricular y el uso de tecnologías accesibles. Es importante incorporar materiales multimodales y multilingües, ya que estos permiten atender distintos canales de aprendizaje y ofrecer apoyo en la lengua materna del estudiante. Asimismo, es necesario diseñar actividades diferenciadas según las características del alumnado, sin perder de vista los objetivos comunes del curso, lo que implica llevar a cabo adaptaciones curriculares razonables. Otra estrategia efectiva consiste en promover el trabajo colaborativo y cooperativo, dinamizando el aula mediante actividades grupales donde los estudiantes puedan aprender unos de otros, fortaleciendo valores como la solidaridad y la empatía. Un ejemplo de lo complejo que puede ser el proceso de aprendizaje se dio cuando le pedí a una estudiante que realizara una actividad en inglés: “Ua, you are not doing anything, please copy the text”. Con cara de no entenderme nada me respondió “Os cors, teacher”. Cuando vio mi cara de sorpresa, ante no saber si era un error de pronunciación o una broma, Ua. volteó con su amiga y le preguntó “¿Sí se dice así, no?”. Esta anécdota muestra de forma clara la brecha entre el discurso oficial que establece metas ambiciosas y la realidad del aula.   Desde la perspectiva de la Nueva Escuela Mexicana, la Unidad de Aprendizaje Curricular Inglés se basa en el enfoque comunicativo, que “enfatiza las habilidades orales y escritas, incluyendo las nociones gramaticales. Otro pilar de nuestro programa es el Marco Común Europeo de Referencia (MCER), en el cual el vocabulario, los elementos gramaticales y la gradualidad de las progresiones son determinados por las necesidades comunicativas comprendidas entre el nivel A1 y B1”, lo cual lleva al estudiante de manera gradual al desarrollo de las cuatro habilidades del idioma: comprensión auditiva (listening ), producción oral (speaking ), comprensión lectora (reading ) y producción escrita (writing ), para comunicarse en inglés en distintos contextos, siguiendo una lógica progresiva (de lo simple a lo complejo) (SEP, 2023, p. 21). Este enfoque ha sido aplicado con anterioridad en diferentes modalidades educativas. Por ejemplo, durante el ciclo escolar 2013-2014, en la licenciatura en Educación Secundaria, se utilizó la plataforma Duolingo como herramienta complementaria para el aprendizaje del inglés. Esta experiencia resultó provechosa, especialmente para estudiantes que tenían intereses laborales o personales en el idioma, como aquellos dedicados al marketing telefónico, quienes buscaban mejorar su pronunciación y comprensión auditiva, o bien, quienes planeaban emigrar a Estados Unidos y requerían habilidades comunicativas básicas. También fue útil para quienes posteriormente impartieron clases de inglés y necesitaban consolidar sus propias competencias lingüísticas. La implementación paralela de actividades en Duolingo (Ramos, 2014) demostró ser una estrategia flexible, motivadora y adaptable a las necesidades individuales de los estudiantes, lo cual respalda su posible uso en la Licenciatura en Inclusión Educativa. La enseñanza del inglés en las Escuelas Normales, especialmente en programas orientados hacia la inclusión educativa, debe trascender la mera transmisión de conocimientos gramaticales o léxicos. Se trata de un proceso pedagógico que busca empoderar a los futuros docentes para que sean agentes de cambio en contextos diversos y plurales. Para ello, es indispensable replantear las prácticas educativas en torno a valores de equidad, accesibilidad y respeto a la diferencia, garantizando que todos los estudiantes, sin excepción, puedan acceder a una educación bilingüe e inclusiva. Las políticas educativas deben estar alineadas con la realidad del aula, y no solo con metas idealizadas, si queremos que el aprendizaje del inglés sea realmente significativo y transformador. Marco teórico Por su parte, Duolingo es una plataforma digital gratuita disponible en formato web y móvil, diseñada para enseñar diversos idiomas a través de actividades interactivas basadas en ejercicios de gramática, vocabulario, pronunciación y comprensión auditiva. Su enfoque lúdico, combinado con técnicas de aprendizaje basadas en la repetición espaciada y la gamificación, permite a los usuarios avanzar a su propio ritmo, lo cual resulta especialmente útil en contextos donde el acceso a recursos educativos tradicionales puede ser limitado. Entre las ventajas del uso de Duolingo en este contexto se encuentran su accesibilidad ya que al ser gratuito y estar disponible en dispositivos móviles puede ser utilizado por estudiantes de distintos niveles socioeconómicos. También ofrece flexibilidad horaria permitiendo a los estudiantes practicar inglés en cualquier momento y lugar lo cual favorece la autonomía en el aprendizaje. La motivación mediante gamificación con acumulación de puntos medallas y competencia amigable con otros usuarios fomenta la constancia y el compromiso. Además los ejercicios ofrecen retroalimentación inmediata permitiendo identificar errores y aprender de forma autónoma.Las licenciaturas en Educación tienen como finalidad formar profesionales capaces de diseñar e implementar estrategias pedagógicas innovadoras y efectivas. El conocimiento del inglés no solo les permite acceder a literatura académica internacional, sino también desarrollar competencias comunicativas que pueden transferir a sus futuros alumnos. En este sentido, Duolingo puede funcionar como una herramienta de autoaprendizaje que apoya al currículo formal sin sustituirlo. Metodología e intervención El grupo de 5o semestre está conformado por 19 personas. En el diseño del programa de curso nuestra participación tomó en cuenta la posición en la malla curricular del curso de Inglés III, su intención de tocar el tema de la inclusión educativa, el propósito del curso “Inglés III. Intercambio de información e ideas para la inclusión es utilizar el inglés como un medio para desenvolverse en el mundo, considerando tres aspectos fundamentales: En primer lugar, cultivar la competencia en el uso del inglés para la comunicación personal y social, facilitando relaciones, transacciones e interacciones diarias; en segundo lugar, fomentar la participación en actividades culturales e interculturales realizadas en inglés, promoviendo una comprensión más profunda tanto de la cultura propia como de la diversidad social y escolar; y en tercer lugar, proveer a futuros educadores con las herramientas de una segunda lengua que les permita acceder a materiales educativos y avances científicos relevantes para su desarrollo profesional”. (García Villeda et al, 2024).   Se realizan ajustes según acuerdo con el programa institucional de lengua extranjera, por el nivel básico de Inglés que refieren las estudiantes (Ejemplo: El instructivo de juego se convierte en “Juego de manos”. El sentido es, además de ajustar el nivel hacia algo más elemental, se trata de enfocar los esfuerzos hacia la certificación A1, puesto que éste es el último curso de Inglés del programa de LIE (2022). En particular se destinan dos horas por semana a la plataforma Duolingo, para práctica en clase, lo que se refleja en asignarle 40% de la evaluación. Se agregan los temas de la certificación CEFR A1 como referencia, pero pueden cambiar por el avance individual de cada persona.

Objectives: To evaluate the clinical outcomes of patients with cardiac sarcoidosis (CS) undergoing cardiac resynchronization therapy (CRT) among a cohort of patients with CS and cardiac implantable electronic devices. Background: CS manifests with conduction abnormalities, ventricular arrhythmias (VA), and heart failure (HF). While CRT improves outcomes in select nonischemic cardiomyopathies, its specific role in CS-related cardiomyopathy remains unclear. Methods: This retrospective cohort study included patients from the Johns Hopkins Cardiac Sarcoidosis Program (2004–2024) with a clinical or histological CS diagnosis who underwent ICD or pacemaker implantation, with or without CRT. Outcomes assessed included HF hospitalizations, appropriate anti-tachycardia pacing (ATP) or ICD shocks, heart transplantation, all-cause mortality, and a composite of these measures. Results: Among 212 patients (40.1% female, mean age 52.8 ± 11.1 years), 85 received CRT (82 CRT-D, 3 CRT-P). CRT recipients had significantly lower baseline left ventricular ejection fraction (LVEF) than non-CRT patients (mean difference: 11%; P < .01) but demonstrated greater LVEF improvement over time (1.43%; P = .03). During a follow-up of 6.15 ± 4.43 years, HF hospitalizations occurred in 12.7%, ATP/ICD shocks in 40.6%, and death in 8.0%. Composite outcomes occurred in 48.5% with no significant differences between CRT and non-CRT groups ( P = .50). CRT patients had lower freedom from HF hospitalizations ( P = .01) but similar arrhythmia treatment rates ( P = .70). Conclusions: CRT in CS was associated with improved LVEF but higher HF hospitalization rates and comparable VA treatment outcomes. These findings highlight the need for further research to optimize CRT utilization in this population.

Climate change increases the frequency and severity of heatwaves that negatively affect plant survival and productivity. To investigate the possibility that heat stress primes plants and their offspring for future exposure, we exposed successive generations of Arabidopsis thaliana to severe heatwave conditions. Heat-primed offspring had a higher seed production after exposure to heat stress. DNA methylation mutants were more sensitive and showed no priming effect, whereas demethylation mutants showed the opposite response, confirming the involvement of DNA methylation in the response to the treatments. Consistently, bisulfite sequencing showed a global hypermethylation of genomic, conversely mitochondrial DNA revealed hypomethylation in response to heat. mRNA sequencing indicated that priming particularly affected genes related to the mitochondrial energy system and oxidative stress responses. Consistently, under heat conditions respiration rates and antioxidant enzymes activities (APX, POX, CAT, DHAR and MDHAR) were less increased, whereas soluble sugar and tocopherol levels were higher in primed plants. Under heat conditions membrane peroxidation (MDA) and protein carbonylation levels of primed plants were significantly lower, correlating with a lower increase of electrolyte leakage. These results demonstrate that heat stress induces heritable epigenetic changes involving DNA methylation affecting respiration and antioxidant activities enhancing the protection from oxidative damage. This increases the resilience of the plant and its progeny and affects our predictions of climate change responses of plants.

Background: High-dose corticosteroids (HDS) are an established treatment for non-COVID-19 acute respiratory distress syndrome (ARDS) because of their anti-inflammatory effects. In COVID-19 patients requiring oxygen therapy or invasive mechanical ventilation, 6mg dexamethasone daily reduces mortality. This study evaluated the effect of HDS compared to standard-dose dexamethasone on IC mortality and superinfection rates in ICU patients with COVID-19 in Suriname. Methods: This retrospective cohort study included patients with PCR-confirmed severe COVID-19 pneumonia admitted to ICUs in Suriname, between June 2020 and October 2021. Patients received standard-dose corticosteroids (SDS) and/or HDS (dexamethasone >6 mg daily or equivalent). Treatment with HDS was analyzed as a time-dependent exposure. Predictors of mortality were identified through logistic regression and incorporated as covariates in a time-updated Cox survival model. Chi-square test compared bacterial superinfections between treatment groups. Results: Of 103 included patients, 36(35%) received HDS. In multivariable analysis, only age (OR 1.10 per year, p=0.022) and invasive mechanical ventilation (OR 8.28, p=0.046) were associated with mortality. Time-updated survival analysis showed no significant harm or benefit with HDS (HR 1.99, 95% CI:0.78-5.09, p=0.15) and no increased superinfection rates (p=1.00). Conclusion: This first Surinamese study of HDS in severe COVID-19 pneumonia found no improved outcomes compared to SDS, nor increased bacterial superinfections. These findings do not support corticosteroid dose escalation beyond standard dexamethasone therapy in severe COVID-19 pneumonia.