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This paper presents a framework forteaching English in synchronous computer-mediated environments. This research shows the components of the framework, how it materializes in the teachers' pedagogical practices, and in the students' perceptions of lessons designed using the framework. The sources of data for this investigation are a questionnaire for students, in-depth interviews with teachers, and an analysis of the transcripts of synchronous sessions that were planned and executed using the framework. This investigation presents suitable guidelines to plan, carry out, and close lessons delivered synchronously. This study shows that when the framework is used, it helps teachers plan activities, and it supports the creation of a suitable environment for learning English online. This investigation also shows that when the framework is employed, it promotes a risk-free environment. It encourages collaboration, and it fosters the linking of ideas and the comprehension of fundamental concepts.

When people from different backgrounds offer products and services to the general public without complying with the legal parameters that a business requires, they generate a phenomenon known as the Informal Trade. In the “Mariscal de Puyo” market, there has been a flourishing of the informal trade for the commercialization of basic needs, which is gaining space in the internal supply chain of Ecuador. Quantifying its impact on society represents a task little tackled by science. This research proposes a solution to the posed problem by developing a method to evaluate the impact of informal trade. The proposed method bases its operation on a neutrosophic multi-criteria approach. A case study is implemented with the purpose of measuring the impact of informal trade on the “Mariscal de Puyo” market.

The objective of this study was to apply neutrosophic logic in the context of the DEMATEL method to evaluate the variables involved in the eligibility of individuals in asylum requests and immigration processes. To achieve this, information acquisition methods were employed to gather the variables necessary for inclusion in the study. An expert panel was engaged to assess these variables, taking into account the inherent indeterminacy and uncertainties associated with decision-making. The study's results highlighted variables such as "Persecution in the country of origin" and "Reasons for the application" as highly influential elements in the eligibility process. This information provided decision-makers with a clearer understanding of which aspects should be prioritized in the evaluation of asylum and immigration requests. The combination of neutrosophic logic and the DEMATEL method proved to be an effective tool in addressing the complexity of this process and provided a more robust framework for decision-making. [ABSTRACT FROM AUTHOR]

Background and Aims: Endoscopic band legation (EBL) is an effective method for the prophylaxis of acute variceal bleeding (AVB). This procedure may be associated with several complications, particularly bleeding. Our analysis aimed to evaluate the risk of complications due to EBL in a cohort of patients who underwent EBL for the prophylaxis of variceal bleeding and the eventual presence of risk predictors. Patients and Methods: We retrospectively analysed data from consecutive patients who underwent EBL in a primary prophylaxis regimen. For all patients, simultaneously with EBL, we recorded the Child–Pugh and MELD score, platelet count and US features of portal hypertension. Results: We collected data from 431 patients who performed a total of 1028 EBLs. We recorded 86 events (8.4% of all procedures). Bleeding after EBL occurred 64 times (6.2% of all procedures), with the following distribution: intraprocedural bleeding in 4%; hematocystis formation in 17 cases (1.7%); 6 events (0.6%) of AVB due to post-EBL ulcers. None of these events presented a correlation with platelet count (84,235 ± 54,175 × 103/mL vs. 77,804 ± 75,949 × 103/mL; p = 0.70) or with the condition of severe thrombocitopenia established at PLT < 50,000/mmc (22.7% with PLT ≤ 50,000/mmc vs. 15.9% with PLT ≥ 50,000/mmc; p = 0.39). Our results showed a relationship between cumulative complications of EBL and Child–Pugh score (6.9 ± 1.6 vs. 6.5 ± 1.3; p = 0.043). Conclusions: EBL in cirrhotic patients is a safe procedure. The risk of adverse events depends on the severity of liver disease, without a relationship with platelet count. [ABSTRACT FROM AUTHOR]

The application of indigenous justice in Ecuador is a topic of interest given its implications for the social life of the nation. The problem focuses on the fact that this constitutes a part of the country's cultural heritage, but in turn, sometimes contradicts the so-called ordinary justice. Due to the, it is proposed as the objective of the investigation to propose the most appropriate actions to mitigate the limitations of the application of indigenous justice in Ecuador. Empirical methods such as the interview, the cause-effect diagram, and multi-criteria decision methods such as Promethee and Vikor were used for this. It was obtained as a result that the main actions must strengthen the communication system through dialogues and conferences of judicial institutions, with the objective of Indigenous Justice, to increase the knowledge on that topic among the members of the society, and encourage the protection of the ethnical minorities and, in turn, set the necessary limits in each territory, to prevent the violation of rights and impunity, and to achieve that the indigenous communities comply with all the stipulated on the Constitution, the international treaties that Ecuador has signed, considering the indigenous justice as an immediate source of right. [ABSTRACT FROM AUTHOR]

Venezuelan migration to neighboring countries in the area is a phenomenon that has been growing in recent years. Ecuador is one of the main countries where migrants who leave Venezuela have gone to reside.They initially arrived in the country as a transit to reach other countries, however, over time many of them decided to settle in Ecuador permanently. Venezuelan migration in our country presents certain characteristics, such as the youth of those who arrive, the high educational level, and the motivation for economic improvement that prompted them to emigrate at first and in a second wave for family reunification. This research aims to apply a survey to know more precisely the economic, social, labor, and humanitarian situation of this sector of migration in the country. We selected a model that uses NeutroAlgebra and is generated by the PROSPECTOR function. PROSPECTOR function is the well-known function used in the classic medical expert system MYCIN, while NeutroAlgebra is an algebra that has at least one NeutroOperation or one NeutroAxiom, where some cases are indeterminate. This model has previously been used in the evaluation of medical care of migrants in Chile. However, unlike the model we are inspired on, here input data are linguistic terms associated with Single-Valued Neutrosophic Numbers, which allows respondents to express more reliably what they want to say. [ABSTRACT FROM AUTHOR]

This paper presents a multicriteria method, solved by means of a method which is based on the ideal distance using neutrosophic numbers, which is convenient to evaluate the development of the investigative competencies of graduates in the UNIANDES Ibarra Law School, their competences and functions, for which we used theoretical samples that address the followup programs for higher education graduates, the analysis of their competencies and their impact on labor markets. The descriptive field research with a quantitative approach was applied. The sample covered a total of 122 Law professionals. The results obtained showed a similarity in the decisions obtained in practice. [ABSTRACT FROM AUTHOR]

Copyright of Dilemas Contemporáneos: Educación, Política y Valores is the property of Dilemas Contemporaneos: Educacion, Politica y Valores and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Dilemas Contemporáneos: Educación, Política y Valores is the property of Dilemas Contemporaneos: Educacion, Politica y Valores and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Radio-frequency ablation (RFA) has been employed in the treatment of Barcelona Clinic Liver Cancer (BCLC) early stage hepatocellular carcinoma (HCC) as curative treatments. Aim: To assess the effectiveness and the safety of RFA in patients with early HCC and compensated cirrhosis. Methods: A cohort of 151 consecutive patients with early stage HCC (122 Child-Pugh class A and 29 class B patients) treated with RFA were enrolled. Clinical, laboratory and radiological follow-up data were collected from the time of first RFA. A single lesion was observed in 113/151 (74.8%), two lesions in 32/151 (21.2%), and three lesions in 6/151 (4%) of patients. Results: The overall survival rates were 94%, 80%, 64%, 49%, and 41% at 12, 24, 36, 48 and 60 months, respectively. Complete response (CR) at 1 month (p<0.0001) and serum albumin levels (p = 0.0004) were the only variables indipendently linked to survival by multivariate Cox model. By multivariate analysis, tumor size (p = 0.01) is the only variable associated with an increased likehood of CR. The proportion of major complications after treatment was 4%. Conclusions: RFA is safe and effective for managing HCC with cirrhosis, especially for patients with HCC ≤3 cm and higher baseline albumin levels. Complete response after RFA significantly increases survival. [ABSTRACT FROM AUTHOR]

Background and study aims  The therapeutic role of endoscopic ultrasound (EUS) evolved in recent decade,s opening a new chapter in the field of endoscopic biliary drainage (BD). EUS-BD has emerged as a new mini-invasive technique for neoplastic jaundice not amenable to endoscopic retrograde cholangiopancreatography (ERCP). The primary study aims were to assess the clinical efficacy of EUS-BD using an electrocautery-enhanced lumen apposing metal stent (ECE-LAMS) in patients with malignant biliary obstruction with failed\unfeasible ERCP and the adverse event (AE) rate. The secondary aims were to evaluate the technical success and incidence of jaundice recurrence. Patients and methods  Data from All patients referred to our tertiary-care Institute with obstructive jaundice due to unresectable malignant distal biliary stricture and unfeasible\failed ERCP, were prospectively recorded from January 2015 to February 2018. The procedures were performed by a single-step ECE-LAMS (AXIOS-EC, Boston Scientific) placement, from the upper gut lumen to the biliary tree, for definitive biliary decompression. Results  Twenty-one patients were consecutively enrolled. Mean pre-procedure common bile duct diameter was 16 mm and the bilirubin level was 13.9 mg/dL (range 3.8-29.5). LAMS was positioned from the duodenal bulb (n = 19) to gastric antrum (n = 2). We registered a 100 % of technical and clinical success. No AEs occurred. We observed a single case of delayed AE consisting of a buried LAMS, which was successfully resolved endoscopically. Conclusions  Despite the limits of being non-comparative, our study shows outcomes in a homogeneous population in terms of indications and technique. EUS-BD with dedicated ECE-LAMS is associated with extremely good clinical efficacy and safety and can be considered as an alternative in cases of failed/unfeasible ERCP., Competing Interests: Competing interests The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objectives: To investigate the in vitro and ex-vivo effect of IL-6 inhibition on the balance between Th1, Th2, Th17 and Treg cells., Methods: Ten consecutive adult patients with active early rheumatoid arthritis (ERA) and ten healthy volunteers were included in the study. The percentages of Th1, Th2, Th17 and Treg cells were analysed by flow cytometry in the peripheral blood mononuclear cells obtained from controls and from RA patients at the time of first evaluation and just before the third TCZ infusion. The in vitro effect of TCZ on the different subsets of CD4+ T cells and the expression levels of Th1, Th2, Th17 and Treg-related cytokines was also assessed., Results: Treatment with TCZ, both ex vivo and in vitro, resulted in a significant reduction of the percentage of Th1, Th17 and Treg cells with a concomitant significant increase of Th2 cell subsets. The reduction of the different subsets of T lymphocytes was associated with an intense staining with Annexin V, suggesting an apoptotic-related cell reduction. A significant decrease of Th1, Th17 and Treg cytokines and a concomitant increase of IL-4 was also observed after TCZ treatment in PBMC isolated from RA patients., Conclusions: TCZ could modify the immune imbalance in RA inducing apoptosis of Th1, Th17 and Treg cells and promoting the appearance of a Th2 response.

Aim: To investigate the clinical course of untreatable hepatocellular carcinoma (HCC) identified at any stage and to identify factors associated with mortality., Methods: From January 1999 to December 2010, 320 out of 825 consecutive patients with a diagnosis of HCC and not appropriate for curative or palliative treatments were followed and managed with supportive therapy. Cirrhosis was diagnosed by histological or clinical features and liver function was evaluated according to Child-Pugh score. The diagnosis of HCC was performed by Ultra-Sound guided biopsy or by multiphasic contrast-enhanced computed tomography or gadolinium-enhanced magnetic resonance imaging. Data were collected for each patient including all clinical, laboratory and imaging variables necessary for the outcome prediction staging systems considered. HCC staging was performed according Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program scores. Follow-up time was defined as the number of months from the diagnosis of HCC to death. Prognostic baseline variables were analyzed by multivariate Cox analysis to identify the independent predictors of survival., Results: Seventy-five per cent of patients had hepatitis C. Ascites was present in 169 patients (53%), while hepatic encephalopathy was present in 49 patients (15%). The Child-Pugh score was class A in 105 patients (33%), class B in 142 patients (44%), and class C in 73 patients (23%). One hundred patients (31%) had macroscopic vascular invasion and/or extra-hepatic spread of the tumor. A single lesion > 10 cm was observed in 34 patients (11%), while multinodular HCC was present in 189 patients (59%). Thirty nine patients (12%) were BCLC early (A) stage, 55 (17%) were BCLC intermediate (B) stage, 124 (39%) were BCLC advanced (C) stage, and 102 (32%) were end-stage BCLC (D). At the time of this analysis (July 2011), 28 (9%) patients were still alive. Six (2%) patients who were lost during follow-up were censored at the last visit. The overall median survival was 6.8 mo, and the 1-year survival was 32%. The 1-year survival according to BCLC classes was 100%, 79%, 12% and 0%, for BCLC A, B, C and D, respectively. There was a significant difference in survival between each BCLC class. The median survival of patients of BCLC stages A, B, C and D was 33, 17.4, 6.9, and 1.8 mo, respectively (P < 0.05 for comparison between stages). The median survival of Child-Pugh A, B and C classes were 9.8 mo (range 6.4-13), 6.1 (range 4.9-7.3), and 3.7 (range 1.5-6), respectively (P < 0.05 for comparison between stages). By univariate analysis, the variables significantly associated to an increased liklihood of mortality were Eastern Cooperative Oncology Group performance status (PS), presence of ascites, low level of albumin, elevated level of bilirubin, international normalized ratio (INR) and Log-[(α fetoprotein (AFP)]. At multivariate analysis, mortality was independently predicted by bad PS (P < 0.0001), high INR values (P = 0.0001) and elevated Log-(AFP) levels (P = 0.009)., Conclusion: This study confirms the heterogeneous behavior of untreated HCC. BCLC staging remains an important prognostic guide and may be important in decision-making for palliative treatment.