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Este estudio aborda la problemática en torno a la relación de las teorías y modelos pedagógicos, centrándose en su vínculo con la investigación educativa y la práctica en el aula. En este sentido, el objetivo principal es analizar el rol del método inductivo en la relación entre las teorías y modelos pedagógicos desde la praxis en el aula, utilizando la metainvestigación y la crítica reflexiva basada en la teoría fundamentada. De este modo, se exploran las definiciones de teorías y modelos pedagógicos, el rol histórico del método inductivo en la investigación educativa, la relación entre el razonamiento inductivo, las principales teorías y modelos pedagógicos, y las implicaciones prácticas de estos enfoques en la enseñanza y el aprendizaje. Los resultados revelan que el método inductivo es esencial para formular hipótesis, teorías y modelos a partir de observaciones empíricas, proporcionando una base sólida para la investigación educativa. Además, ha influido significativamente en el desarrollo de diversos modelos pedagógicos, facilitando la integración de teoría y práctica, lo cual es vital para una enseñanza efectiva. En conclusión, el estudio destaca la relevancia continua del método inductivo en la investigación educativa y su potencial para mejorar las prácticas pedagógicas, especialmente con el avance de la tecnología, que ofrece nuevas oportunidades para mejorar la recopilación y el análisis de datos.

Background and Purpose The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of intravenous thrombolysis (IVT) plus mechanical thrombectomy (MT) versus IVT alone. This study aimed to evaluate the safety and efficacy in DMVO patients treated with either MT-IVT or IVT alone. Methods This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage. Results The study involved 1,057 patients before matching, and 640 patients post-matching. Functional outcomes at 90 days showed no significant difference between groups in achieving good functional recovery (modified Rankin Scale 0–1 and 0–2), with adjusted odds ratios (OR) of 1.21 (95% confidence interval [CI] 0.81 to 1.79; P=0.35) and 1.00 (95% CI 0.66 to 1.51; P>0.99), respectively. Mortality rates at 90 days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; P=0.30). The incidence of symptomatic intracerebral hemorrhage was comparable, but any type of intracranial hemorrhage was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63; P

Background: Application time and viscosity are factors that can significantly affect the properties of bone cement and implant fixation. The aim of this study was to investigate the influence of different application times of 2 different cements on mechanical parameters, cement interdigitation, and cement distribution. Methods: P.F.C. Sigma tibial trays were cemented with high-viscous Palacos R and medium- to low-viscous Simplex P in an open-cell model. The application was performed at different times within the manufacturer’s specifications. Cement interdigitation and micromotion were measured with computed tomography scan using a novel method. Results: Significant differences of insertion forces were found at all times of cement application. Cement penetration decreased with increasing pressure and viscosity. No significant differences were shown for micromotion between Palacos R and Simplex P except for an increase for Simplex P from 3 to 7 minutes at the bone-cement interface. Simplex P appeared to trap air at the implant-cement interface at 3 minutes and increased at 7 minutes. Conclusions: Cement distribution and intrusion of Palacos R and Simplex P decreased with time. Simplex P trapped air at the implant-cement interface, decreasing the amount of contact at the implant-cement interface, which is worrisome for long-term implant fixation. Given the significant changes in cement properties after mixing, it is necessary for surgeons to understand the viscosity and timing of cement application to achieve optimal cement penetration and surface contact area to potentially decrease implant loosening. High-viscous Palacos R should be applicated immediately with doughing time and medium-viscous Simplex P for about 4 minutes considering a threshold of minimum pressure.

Background Acute ischemic stroke arising from medium vessel occlusions (MeVO) poses substantial challenges in treatment and management. This study aims to elucidate the outcomes and factors contributing to achieving excellent recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2c–3) versus successful recanalization (mTICI 2b) in patients with MeVO stroke undergoing mechanical thrombectomy (MT). Methods We conducted a multinational study analyzing data from the MAD‐MT (Multicenter Analysis of Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy) registry, encompassing 37 centers across North America, Asia, and Europe, collected between September 2017 and July 2023. The study included acute ischemic stroke patients with MeVO treated with MT, with or without intravenous thrombolysis, who achieved mTICI 2b–3 post‐MT. Results Among 1463 patients with successful recanalization (mTICI 2b–3), 523 achieved mTICI 2b recanalization, and 940 achieved mTICI 2c–3. Distal occlusions exhibited higher odds of excellent recanalization compared with proximal MeVO vessel occlusions (odds ratio, 1.58; 95% CI, 1.17–2.15; P = 0.003). Cardioembolic stroke pathogenesis was associated with a higher likelihood of excellent recanalization (1.67; 95% CI, 1.07–2.59; P = 0.018). Patients achieving mTICI 2c–3 recanalization demonstrated lower initial National Institutes of Health Stroke Scale scores, significant improvements in postprocedural National Institutes of Health Stroke Scale shift, and a higher percentage of favorable 90‐day outcomes compared with those with mTICI 2b. However, no significant difference in 90‐day mortality rates was observed. Conclusion This study underscores that among patients with MeVO stroke with successful recanalization (mTICI 2b–3) there is higher likelihood of achieving excellent recanalization (mTICI 2c–3) in distal occlusions and cardioembolic pathogenesis. mTICI 2c–3 scores post‐MT correlate with improved clinical outcomes compared with mTICI 2b, affirming the superiority of excellent recanalization over successful recanalization in patients with MeVO stroke. Further prospective studies and randomized controlled trials are warranted for validation.

Purpose: This study aims to investigates the perceptions of 3rd-year accountancy students concerning the passing rates of the Licensure Examination for Certified Public Accountants (LECPA). Design/methodology/approach: This study utilized a qualitative research design with a multiple case study approach, the researchers employed in-depth interviews, observations, and data mining to explore students’ decisions to persist in pursuing CPA licensure or reconsider their career paths. Research Findings: The results of the study indicated that some participants exhibited strong determination fueled by personal commitment, while others expressed hesitancy due to concerns about exam difficulty and the risk of failure. These insights emphasize the importance of robust support systems for aspiring Certified Public Accountants. Contribution/Originality/Novelty: The findings contribute valuable insights for academic institutions and educators to tailor effective support systems and interventions, advancing the understanding of career choices, educational motivation, and dynamics within the field of accountancy for 3rd-year students. Tujuan Penelitian: Penelitian ini bertujuan untuk mengetahui persepsi mahasiswa akuntansi tahun ke-3 mengenai tingkat kelulusan Ujian Lisensi Akuntan Publik Bersertifikat (LECPA). Desain / metodologi / pendekatan: Penelitian ini memanfaatkan desain penelitian kualitatif dengan pendekatan studi kasus ganda, para peneliti menggunakan wawancara mendalam, observasi, dan penggalian data untuk mengeksplorasi keputusan siswa untuk tetap mengejar lisensi CPA atau mempertimbangkan kembali jalur karir mereka. Temuan Penelitian: Hasil penelitian menunjukkan bahwa beberapa peserta menunjukkan tekad yang kuat yang dipicu oleh komitmen pribadi, sementara yang lain menyatakan keraguan karena kekhawatiran akan kesulitan ujian dan risiko kegagalan. Wawasan ini menekankan pentingnya sistem pendukung yang kuat bagi calon Akuntan Publik Bersertifikat. Kontribusi / Orisinalitas / Kebaruan: Temuan ini memberikan kontribusi wawasan berharga bagi institusi akademis dan pendidik untuk menyesuaikan sistem pendukung dan intervensi yang efektif, memajukan pemahaman tentang pilihan karir, motivasi pendidikan, dan dinamika dalam bidang akuntansi untuk siswa tahun ke-3.

This study unraveled the challenges of a teenage mother while studying as a senior high school student amidst the tremors of the pandemic. In doing so, a qualitative narrative research design was used in gathering the data, and an unstructured interview was done with the main participant. The listed responses were scrutinized to formulate a general conclusion regarding the overall condition of the teenage mother. Based on the findings, it was revealed that the teenage student-mother is prone to conflicts, and to combat these conflicts, perseverance along with hard work is a must. For the most part, it has been established that the amount of support received by the teenage student-mother is one of the major reasons that contribute to their overall state because in every aspect of life they are involved in, their children will always be a part of them because they are the utmost priority of these teenage student-mothers. In general, the researchers concluded that in the participant’s time in distance learning, her parenting was not affected that much by her school work. With this being said, her positive attitude towards her grueling circumstance led to her overall success in both her motherly and academic duties. She was able to continue her studies and take care of her child all at once because of the new learning environment brought out by distance learning.

El escrito realiza una breve revisión de la adaptación de las ideas del liberalismo clásico en América Latina a partir de los procesos de emancipación hasta la segunda mitad del siglo XIX. Se parte del marco conceptual de las ideas liberales surgidas en la Ilustración y en los eventos revolucionario en Francia y Estados Unidos. El objetivo principal del artículo es analizar la adaptación de estas ideas en dos áreas, a saber: política y económica. En el área política se considera la ambivalencia entre democracia y monarquía, la influencia de la religión en el quehacer político, las discusiones sobre la esclavitud y su abolición, y las ideas sobre la nación. En el área económica se examina la influencia teórica de las ideas liberales en América Latina, y las políticas económicas de libre mercado que se implementaron a finales de siglo. Con este propósito, se realiza una revisión histórico-analítica, con base en documentos primarios, como las cartas de Thomas Jefferson y las de Abraham Lincoln, y con base en estudios previos. Esta revisión se enmarca conceptualmente en el Liberalismo Clásico. Se concluye que las ideas del liberalismo sirvieron para la construcción de democracias endebles en la región, las cuales mantenían ciertos beneficios a la Iglesia Católica y, al mismo tiempo, se fortalecían a partir de la apertura al mercado externo como respuesta a la necesidad de materias primas que provenía del incremente industrial en Europa y Estados Unidos.

ObjectiveMechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). First-pass (FP) reperfusion of the occluded vessel and fewer passes with stent retrievers show improvement in functional outcomes in stroke patients, while higher numbers of passes are associated with higher complication rates and worse outcomes. Studies indicate that a larger size of the stent-retriever is associated with a higher rate of first-pass reperfusion and improved clinical outcomes. In this retrospective study, we investigated the clinical performance of a recently developed and one of the largest stent-retrievers available in the treatment of LVO (pRESET 6-50, phenox GmbH, Bochum).Materials and methodsAll consecutive patients with ischemic stroke due to proximal large vessel occlusion treated with MT using the pRESET 6-50 stent-retriever in two tertiary stroke centers between 09/2021 and 07/2022 were included in this study. The reperfusion rate after MT was quantified by the modified thrombolysis in cerebral infarction (mTICI) score, and functional neurological outcome was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score and the major early neurological recovery (mENR) rate after 24 h. Successful FP reperfusion was defined as mTICI ≥ 2b. Successful and complete reperfusion were defined as mTICI ≥ 2b and mTICI ≥ 2c, respectively.ResultsIn total, 98 patients (52 men and 46 women) with a median age of 75 (range 25–95 years) were included. A total of 70 (72%) patients presented with an occlusion of the middle cerebral artery (MCA) in the M1 segment, 6 (6%) patients with an occlusion of the M2 segment, 17 (17%) patients with an occlusion of the internal carotid artery (ICA), and 5 (5%) patients with an occlusion of the obstructed basilar artery (BA). Successful FP reperfusion was achieved in 58 patients (62%). Successful and complete reperfusion were achieved in 95 (97%) and 82 (83%) patients, respectively. The median National Institutes of Health Stroke Scale (NIHSS) in all treated patients improved from 17 to 7.5. Major early neurological recovery (mENR) was observed in 34 patients (35.1%).ConclusionMT with the pRESET 6-50 stent-retriever achieves high successful first-pass and final reperfusion rates in patients with AIS and LVO. The results of this study support the thesis to use large-format stent-retriever in proximal vessel occlusion MT whenever feasible in order to improve high FP and final reperfusion rate, which are known predictors of good clinical outcome.

Objetivo. Analizar el rol de los factores socioeconómicos y culturales en la vulnerabilidad a la obesidad en madres y sus hijos menores de dos años, en localidades del Sur de Morelos, México. Material y métodos. Se realizó trabajo de campo y observación no participativa. Durante 2019, se aplicaron 17 entrevistas semiestructuradas a una submuestra de una cohorte. Los datos fueron ordenados y analizados con apoyo del software Atlas-Ti v. 7, usando 18 códigos libres. Resultados. Factores sociales como los ingresos del hogar y los roles de género, combinados con la influencia de la parentela y las creencias sobre la preferencia de la niñez por productos ultraprocesados, predisponen la disponibilidad de bebidas y alimentos calóricos que generan vulnerabilidad a la obesidad durante la infancia temprana. La actividad eco­nómica de las madres, la participación de los padres y evitar influencia de parientes puede predisponer una mejor calidad de los alimentos y mayor actividad física. Conclusiones. La baja disponibilidad de alimentos saludables, los riesgos de inseguridad alimentaria y los factores familiares y culturales, que se presentan en contextos de vulnerabilidad económica y social, incrementan la vulnerabilidad del binomio madre-hijo a la obesidad.

Soccer is a sport of various motor actions, where the reception of the ball is classified as a control action at different heights, speeds and angles. The player must have the ability to receive the ball in order to generate a different action: a pass, shot or dribble; its optimization implies greater probabilities of technical-tactical performance. In this sense, the objective of the research was to biomechanically analyze the mid-height reception technique in professional and amateur soccer players using video analysis as a measurement method. The research was descriptive-explanatory of correlational order, four variables of the motor movement (D: distance covered; AM: maximum acceleration; VM: maximum speed and AF: amplitude of the femorotibial joint) are analyzed through video-analysis with Kinovea . Five professional players (group 1) and 15 amateur players (group 2) were studied. The amateur soccer players presented a higher mean in all the variables studied, “D” (group 1: 72.17cm; group 2: 101.27cm; p=0.001), “AM” (group 1: 61.84m/s 2 ; group 2: 101.73m/s 2 ; p=0.000), “VM” (group 1: 8.18m/s; group 2: 12.55m/s; p=0.000) and “AF” (group 1: 62.6°; group 2 : 75.2°; p=0.002), which behaves significantly different in all cases. The biomechanical analysis carried out on professional and amateur soccer players, in the technique of receiving the ball at mid-height, concludes that amateur players require greater technical improvement, regardless of their experience in competitions.

Abstract Objectives: to evaluate feeding practices in the first year of life and their association with the development of overweight and obesity in children in Mexico. Methods: the association between overweight and obesity with different feeding practices were evaluated. The data was processed using the statistical package Stata version 14 using logistic regression models. Results: 396 children were evaluated; the prevalence of overweight and obesity was 6% and 7.7% presented a possible risk of overweight. 6.9% had exclusive breastfeeding in the first 6 months of life and 71.7% were fed infant formula. The variables significantly associated with the development of overweight and obesity in the first year of life were the age of the child (p =0.043, RR=0.57), the introduction of fluids in the first three days of life (p=0.02, RR=2.90), consumption of foods with a high sugar content (p =0.01, RR=0.25), consumption of milk other than breast (p =0.02, RR3.25) and egg consumption (p =0.05; RR=0.28). Conclusions: our results show that it is essential to attend complementary feeding practices and reinforce exclusive breastfeeding in the first year of life, as measures to prevent overweight and obesity to improve health in childhood.

The growth of the aquaculture sector leads to a demand for sustainable feed ingredients. Prebiotics are potential sustainable feed ingredients that can promote the improved performance of aquaculture species without the use of antimicrobials. This study investigated the potential of Azolla pinnata as a candidate prebiotic source. Prebiotic characteristics and dietary effect of commercial diet (CD) with varying pulverised azolla (PA) inclusion was evaluated. Results showed that PA (9.40% moisture) constitutes around 16.1% ash, 22.3% crude fibre, 20.9% crude protein, 1.7% crude fat and 29.6% nitrogen-free extract. Crude xylan and cellulose content of PA were 13.7% and 12.6% dry matter (DM) respectively. Growth of Lactobacillus rhamnosus in PA-supplemented MRS broth remarkably improved after 4 to 6 hours of incubation. Feeding trials results revealed that PA inclusion had no adverse effect on average survival of milkfish fingerlings, albeit significant improvement (p < 0.01) was noted in group fed with 2% PA-replaced CD in terms of the total weight gain (119.9%), specific growth rate (2.62% day–1) and feed efficiency (79.9%). The present study demonstrated the prebiotic activity of PA, as well as its potential use as dietary feed component for improved growth and feed efficiency of cultured milkfish.

The industrialization models of ECLAC, developed during the 1950s, 1960s and 1970s, and those of Ecuador, implemented by the 21st-century socialist government, are similar in their attempt to industrialize through the substitution of imports and government expenditure. In both cases, the economic policies focused on a closed economy, with high tariff barriers, and a strong role of the state as the main actor in the economy. The article uses a comparative method of analysis which emphasizes the outcomes of both of the periods studied. The results show that the models applied brought the same problems; imbalance in external trade and rising public debt. An alternative premise is suggested, that the models applied are the main causes of the debt crisis in the 1980s and the increasing public debt in the government of Rafael Correa.

Parabolic flights are one of the most important pillars for research, development, and applications in space. Accordingly, we developed the world’s first non-governmental parabolic flight program using Novespace’s Airbus A310 ZERO-G. Through the flexible combination of academic research with industrial experiments, as well as with the support of private persons and low administrative efforts, we achieved a highly cost-efficient small-scale campaign concept, which is located at the Air Base Dübendorf in Switzerland. The program was very successful, and it resulted in 31 experiments and tests conducted by Universities and organizations in the industry in microgravity, culminating in many scientific publications and in larger subsequent projects for all users. We describe here how we designed, developed, tested, and built up this program. We also discuss the difficulties, problems, and success factors of a project that—for the first time—was successfully built from the “bottom-up”, and which was a large-scale flight research platform by scientists for scientists on a voluntary, non-governmental, and non-commercial basis.

Objective: In rare cases, Lyme neuroborreliosis (LNB) can induce cerebral vasculitis leading to severe stenosis of the cerebral vasculature and consecutive ischemia. Therapy is based on anti-biotic treatment of the tick-borne disease, whereas interventional therapeutic options have not been assessed yet. Material and Methods: We report on a patient with LNB and concomitant stenoses and progressive and fatal vasculitis of the cerebral vessels despite all therapeutic efforts by the departments of neurology and interventional neuroradiology. In this context, we also conducted a literature review on endovascular treatment of LNB-associated cerebral ischemia. Results: A 52-year-old female presented with transient neglect and psychomotor slowdown (initial NIHSS = 0). MRI and serology led to the diagnosis of basal meningitis due to LNB with vasculitis of cerebral arteries. Despite immediate treatment with antibiotics and steroids, neurologic deterioration (NIHSS 8) led to an emergency angiography on day 2 after admission. Hemodynamically relevant stenoses of the MCA were treated via spasmolysis and PTA, leading to almost complete neurological recovery. Despite intensified medical treatment, the vasculitis progressed and could only be transiently ameliorated via repetitive spasmolysis. On day 19, she again presented with significant neurologic deterioration (NIHSS 9), and PTA and stenting of the nearly occluded MCA were performed with a patent vessel, initially without hemorrhagic complications. Despite all therapeutic efforts and preserved stent perfusion, vasculitis worsened and the concurrent occurrence of subdural hemorrhage led to the death of the patient. Conclusion: Neuroradiological interventions, i.e., spasmolysis, PTA, and, if necessary, stenting, can and should be considered in cases of LNB-induced vasculitis and stroke that are refractory to best medical treatment alone. Key point: Neuroradiological interventions can be considered in patients with vascular complications of Lyme neuroborreliosis as an additional extension of the primary drug therapy.

Abstract Acute myocardial infarction (MI) resulting from coronary ischemia is a major cause of disability and death worldwide. Transplantation of human embryonic stem cell (hESC)‐derived cardiovascular progenitor cells (hCVPCs) promotes the healing of infarcted hearts by secreted factors. However, the hCVPC‐secreted proteins contributing to cardiac repair remain largely unidentified. In this study, we investigated protective effects of neurotrophin (NT)‐3 secreted from hCVPCs in hearts against myocardial ischemia/reperfusion (I/R) injury and explored the underlying mechanisms to determine the potential of using hCVPC products as a new therapeutic strategy. The implantation of hCVPCs into infarcted myocardium at the beginning of reperfusion following 1 hour of ischemia improved cardiac function and scar formation of mouse hearts. These beneficial effects were concomitant with reduced cardiomyocyte death and increased angiogenesis. Moreover, hCVPCs secreted a rich abundance of NT‐3. The cardioreparative effect of hCVPCs in the I/R hearts was mimicked by human recombinant NT‐3 (hNT‐3) but canceled by NT‐3 neutralizing antibody (NT‐3‐Ab). Furthermore, endogenous NT‐3 was detected in mouse adult cardiomyocytes and its level was enhanced in I/R hearts. Adenovirus‐mediated NT‐3 knockdown exacerbated myocardial I/R injury. Mechanistically, hNT‐3 and endogenous NT‐3 inhibited I/R‐induced cardiomyocyte apoptosis through activating the extracellular signal‐regulated kinase (ERK) and reducing the Bim level, resulting in the cardioreparative effects of infarcted hearts together with their effects in the improvement of angiogenesis. These results demonstrate for the first time that NT‐3 is a cardioprotective factor secreted by hCVPCs and exists in adult cardiomyocytes that reduces I/R‐induced cardiomyocyte apoptosis via the ERK‐Bim signaling pathway and promotes angiogenesis. As a cell product, NT‐3 may represent as a noncell approach for the treatment of myocardial I/R injury.

Objective. To present the results of a stakeholder analysis used to construct a map of the actors involved in the delib­eration of a proposal to increase the tax on sugar-sweetened beverages (SSB) in Mexico from 10 to 20 percent per liter. Materials and methods. A literature review and in­terviews to key actors were implemented. The analysis of the actors’ power and position was made using Policymaker. Results. There was concern for the obesity epidemic among all stakeholders, but little consensus on the way to solve it. Researchers and non-governmental organizations (NGO) support an increase in the tax on SSB, while government officials and industry representatives oppose this measure. Conclusion. Supporters of an increase to the tax on SSB need to build a coalition in order to force government officials to support this policy and successfully confront the soda industry, which has a solid opposing strategy and enormous financial resources to influence public opinion and congressmen.

La filosofía de la no violencia se construye a través de cuatro ideas indispensables: la existencia del opresor; existencia del oprimido; métodos no violentos; y, la idea de justicia. Estas ideas son contextualizadas dentro de una revisión bíblica de la no violencia, intentando construir un fundamento teológico sobre el cual se fundamente la filosofía de la no violencia. La revisión bíblica se desarrollará analizando los diálogos de Jesús con Poncio Pilatos, la carta de Pablo a los Romanos, y el libro de Daniel, de esta forma se podrá generar una estructura interpretativa coherente del espacio interpretativo de la desobediencia civil.

Abstract. Objectives:. In view of the increased attention to reverse shoulder arthroplasty (rTSA) as a treatment for complex proximal humeral fractures in the elderly, the present study analyzes in-hospital complications and the postoperative management of rTSA versus open reduction and internal fixation (ORIF). Methods:. We retrospectively reviewed patients hospitalized from 2016 to 2018 for proximal humeral fractures (ICD-9 codes: S42.21), III- and IV-part, who underwent an ORIF with locking plates, rTSA or nonoperative treatment. In-hospital complications and postoperative management in both groups were included in the analysis. Results:. We included n 190 patients (ORIF 90, rTSA 71, nonoperative 29), more likely to be female (82.1% vs 17.9%; P

BackgroundNeonatal stroke remains a rare condition that has not yet been assessed in the field of endovascular treatment.CaseWe present the first case report of a successful mechanical thrombectomy in a newborn with a basilar occlusion the treatment was 14 hours after birth. Complete reperfusion of the basilar artery was achieved after the two thrombectomy maneuvers with stent retrievers. Imaging follow-up proved patency of the target vessel and at day 30, the patient showed no neurologic deficits.ConclusionsMechanical thrombectomy appears to be technically feasible and can be an individual option in selected cases to treat stroke in neonates with proven persistent proximal cerebral artery occlusion.

El objetivo de este estudio transversal cuantitativo-descriptivo fue describir las estrategias de afrontamiento en adultos después del período de duelo debido a la muerte de su padre y / o madre. Los participantes fueron 45, 28 mujeres y 17 hombres que recibieron asistencia psicológica en "El Centro de Apoyo al Duelo" (CAD), Cuenca-Ecuador. Se utilizaron el Registro sociodemográfico, el Inventario de Duelo Complicado (IDC) y el Inventario de Estrategias de Afrontamiento (CSI) para la recopilación de datos. Los resultados indican que la retirada social es la estrategia de afrontamiento más utilizada seguida por la evitación del problema. La resolución de problemas es la estrategia menos utilizada. Después del análisis de IDC, los resultados podrían clasificarse por la ausencia y la intensidad del duelo complicado. Se identificó que nueve personas tienen una presencia seria de la misma; 25 moderado; 10 ligero; 1 no lo presenta. Como conclusión, los participantes que utilizan menos resolución de problemas como estrategia de afrontamiento muestran una presencia moderada de duelo complicado (DC). El DC en la población estudiada podría deberse al hecho de que la estrategia de afrontamiento más utilizada es su predictor. Entre la población estudiada, el luto complicado es evidente en casi todos los participantes.

Continuous loss of cardiomyocytes (CMs) is one of the fundamental characteristics of many heart diseases, which eventually can lead to heart failure. Due to the limited proliferation ability of human adult CMs, treatment efficacy has been limited in terms of fully repairing damaged hearts. It has been shown that cell lineage conversion can be achieved by using cell reprogramming approaches, including human induced pluripotent stem cells (hiPSCs), providing a promising therapeutic for regenerative heart medicine. Recent studies using advanced cellular reprogramming-based techniques have also contributed some new strategies for regenerative heart repair. In this review, hiPSC-derived cell therapeutic methods are introduced, and the clinical setting challenges (maturation, engraftment, immune response, scalability, and tumorigenicity), with potential solutions, are discussed. Inspired by the iPSC reprogramming, the approaches of direct cell lineage conversion are merging, such as induced cardiomyocyte-like cells (iCMs) and induced cardiac progenitor cells (iCPCs) derived from fibroblasts, without induction of pluripotency. The studies of cellular and molecular pathways also reveal that epigenetic resetting is the essential mechanism of reprogramming and lineage conversion. Therefore, CRISPR techniques that can be repurposed for genomic or epigenetic editing become attractive approaches for cellular reprogramming. In addition, viral and non-viral delivery strategies that are utilized to achieve CM reprogramming will be introduced, and the therapeutic effects of iCMs or iCPCs on myocardial infarction will be compared. After the improvement of reprogramming efficiency by developing new techniques, reprogrammed iCPCs or iCMs will provide an alternative to hiPSC-based approaches for regenerative heart therapies, heart disease modeling, and new drug screening.

Las ideas de revolución en América Latina se han construido a través de la estructura de héroe, víctima y victimario y se contextualizan dentro de las ideas de fin de la historia, de romanticismo y libertad. Pensar en revolución nos lleva también a pensar que su contenido ha sido monopolizado hacia cierta forma de ver la realidad. Visualizar y entender la estructura de pensamiento alrededor de la idea de revolución es el principal objetivo de este escrito, el cual termina preguntándose sobre el débil desarrollo regional de ideas que propongan nuevos contenidos para llenar el concepto de revolución. Este texto se basa en las ideas de revolución construidas alrededor de cuatro sucesos históricos en la región, a saber: la Revolución mexicana, iniciada en 1910; la Revolución boliviana, de abril de 1952; la Revolución cubana, de comienzos de 1959; y, la Revolución nicaragüense, de finales de la década de 1970.

During early postnatal development in mammals, cardiomyocytes exit the cell cycle, losing their regenerative capacity. Here the authors show that, following myocardial infarction, loss of microRNA-128 promotes cardiomyocyte proliferation and cardiac regeneration in adult mice partly via enhancing the expression of the chromatin modifier SUZ12.

Abstract Alzheimer’s disease (AD) is the most common cause of dementia among older adults. Accumulation of amyloid-β (Aβ) in the brain is considered central in AD pathogenesis and its understanding crucial for developing new diagnostic and therapeutic approaches. Recent literature suggests that ageing may induce post translational modifications in Aβ, in the form of spontaneous amino acid modifications, which enhance its pathogenic properties, contributing to its aggregation. In this study, we have investigated whether the isoaspartate (IsoD-Aβ) and pyroglutamate (pE3-Aβ) modified forms of Aβ are significantly associated with AD pathology or represent markers of ageing. Cerebral neocortex of 27 AD cases, 32 old controls (OC) and 11 young controls (YC) was immunostained for pE3-Aβ and IsoD-Aβ, quantified as protein load and correlated with other Aβ forms and p-TAU. IsoD-Aβ and pE3-Aβ were detected at low levels in non-demented controls, and significantly increased in AD (p ≤ 0.001), with a characteristic deposition of IsoD-Aβ in blood vessel walls and pE3-Aβ within neurons. Both AD and OC showed positive associations between IsoD-Aβ and Aβ (p = 0.003 in AD and p = 0.001 in OC) and between IsoD-Aβ and pE3-Aβ (p = 0.001 in AD and OC). This last association was the only significant pE3-Aβ correlation identified in AD, whereas in the control cohorts pE3-Aβ also correlated with Aβ and AβPP (p = 0.001 in OC and p = 0.010 in YC). Our analyses suggest that IsoD-Aβ accumulation starts with ageing; whereas pE3-Aβ deposition is more closely linked to AD. Our findings support the importance of age-related modifications of Aβ in AD pathogenesis.

A complete and prompt cardiac arrest using a cold cardioplegic solution is routinely used in heart transplantation to protect the graft function. However, warm ischemic time is still inevitable during the procedure to isolate donor hearts in the clinical setting. Our knowledge of the mechanism changes prevented by cold storage, and how warm ischemia damages donor hearts, is extremely poor. The potential consequences of this inevitable warm ischemic time to grafts, and the underlying potential protective mechanism of prompt graft cooling, have been studied in order to explore an advanced graft protection strategy. To this end, a surgical procedure, including 10–15 min warm ischemic time during procurement, was performed in mouse models to mimic the clinical situation (Group I), and compared to a group of mice that had the procurement performed with prompt cooling procedures (Group II). The myocardial morphologic changes (including ultrastructure) were then assessed by electron and optical microscopy after 6 h of cold preservation. Furthermore, syngeneic heart transplantation was performed after 6 h of cold preservation to measure the graft heart function. An electron microscopy showed extensive damage, including hypercontracted myofibers with contraction bands, and damaged mitochondria that released mitochondrial contents in Group I mice, while similar patterns of damage were not observed in the mice from Group II. The results from both the electron microscopy and immunoblotting verified that cardiac mitophagy (protective mitochondrial autophagy) was present in the mice from Group II, but was absent in the mice from Group I. Moreover, the mice from Group II demonstrated faster rebeating times and higher beating scores, as compared to the mice from Group I. The pressure catheter system results indicated that the graft heart function was significantly more improved in the mice from Group II than in those from Group I, as demonstrated by the left ventricle systolic pressure (31.96 ± 6.54 vs. 26.12 ± 8.87 mmHg), the +dp/dt (815.6 ± 215.4 vs. 693.9 ± 153.8 mmHg/s), and the -dp/dt: (492.4 ± 92.98 vs. 418.5 ± 118.9 mmHg/s). In conclusion, the warm ischemic time during the procedure impaired the graft function and destroyed the activation of mitophagy. Thus, appropriate mitophagy activation has emerged as a promising therapeutic target that may be essential for graft protection and functional improvement during heart transplantation.

Background Stent‐retriever thrombectomy is the first‐line therapy in acute stroke with intracranial large vessel occlusion. In case of failure of stent‐retriever thrombectomy, rescue stent angioplasty might be the only treatment option to achieve permanent recanalization. This study aims at identifying predictors for poor outcome and complications in a large, multicenter cohort receiving rescue stent angioplasty. Methods and Results We performed a retrospective analysis of patients with large vessel occlusion who were treated with rescue stent angioplasty after stent‐retriever thrombectomy between 2012 and 2018 in 7 neurovascular centers. We defined 2 binary outcomes: (1) functional clinical outcome (good modified Rankin Scale, 0–2; and poor modified Rankin Scale, 4–6) and (2) early symptomatic intracerebral hemorrhage. Impacts of clinical, radiological, and interventional parameters on outcomewere assessed in uni‐ and multivariable logistic regression models. Two hundred ten patients were included with target vessels located within the anterior circulation (136 of 210; 64.8%) and posterior circulation (74 of 210; 35.2%). Symptomatic intracerebral hemorrhage occured in 22 patients, 86.4% (19 of 22) after anterior and 13.6% (3 of 22) after posterior circulation large vessel occlusion. Good functional outcome was observed in 44.8% (73 of 163). A higher National Institutes of Health Stroke Scale on admission (adjusted odds ratio, 1.10; P=0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; P=0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; P

Background and Purpose: Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy. However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy.Methods: We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS.Results: Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1–4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5–8) on admission to 2.5 (IQR 0–8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41).Conclusion: ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

El cuerpo es el lugar en donde se inscribe la subjetividad. No existe subjetividad sin cuerpo. Más allá de las teorías políticas, los estudios sobre esta categoría se abren también a perspectivas que lo conectan con la vida y el deseo. El cuerpo erótico constituye así una deriva que dialoga con las Políticas del Afecto y los Estudios Culturales. Nuestro trabajo parte de un fenómeno, pensado como “artefacto cultural”, que se origina en la música y estalla hacia otros campos generando una productividad. El objetivo del presente artículo es analizar categorías como cuerpo y erotismo y su relación con el bolero, a partir de una figura que constituye una “personalidad de excepción” en quien vida y obra se mezclan para dar lugar a un artefacto cultural: La Lupe. Nuestro corpus está conformado por formatos que permitirán leer esta productividad que representa La Lupe en Latinoamérica durante el siglo XX. Partiremos de las propuestas teóricas de Roger Dadoun sobre erotismo, cuerpo y deseo, y de las discusiones sobre “originalidad” de Gilles Deleuze, en diálogo con diferentes lecturas sobre el bolero que permitirán comprender las categorías anteriores, tomando en cuenta la especificidad que tienen dentro del imaginario latinoamericano.

The aim of this contribution is to design and test the lightning protection of an aircraft radome exposed to direct lightning strikes. The influencing parameters are investigated on different radome wall samples equipped with solid and segmented diverter strips. The effectiveness of the lightning interception and protection measures is tested with different high-voltage waveforms and representative high-current pulses. The tests show that reliable radome lightning protection can be achieved by an optimized arrangement of solid and segmented diverter strips, even if the aircraft radome has a huge size, with dimensions up to several meters.

Aim: The objective of this study was to evaluate the potential of Gabing San Fernando (Xanthosoma spp.) corms as partial carbohydrate replacement for maize in finisher broiler production. Materials and Methods: The completely randomized design was utilized to investigate the effects of three finisher poultry diets prepared in varying amounts of cocoyam-corm meal set at 0% (control), 25%, and 50% (experimental) replacement levels. Results: There were no significant differences (p≥0.05) as to mortality and body weight measurements between control and experimental groups. Similarly, the mean weights of selected internal organs and condemnable carcasses among treatment groups did not show any significant differences (p≥0.05). In terms of the average feed intakes, birds from 50%-cocoyam group had the highest mean value and were found to be statistically different (p≥0.01) from both control and 25%-cocoyam groups. However, feed conversion ratio did not significantly differ (p≥0.05) among three groups. Higher feed costs were associated with the 50%-cocoyam treatment diet, which was only consistent with higher feed inputs. Thus, the group fed with 50%-cocoyam meal had significantly higher total mean production costs (p

Background and Purpose: A tandem occlusion of the intracranial circulation and the extracranial carotid artery (ICA) occurs in 10–20% of all strokes based on large vessel occlusion (LVO). The optimal treatment strategy for those patients is unknown. We report our management strategy and the outcome in these patients in a large single-center cohort.Materials and Methods: We retrospectively identified and analyzed all patients treated by Mechanical Thrombectomy (MT) for an intracranial LVO associated with an occlusion of the extracranial ICA between April 2009 and May 2016 (163/1,645, 9.9%). The following data was collected: Recanalization rate, occurrence of symptomatic intracranial hemorrhage (sICH), clinical result according to the early neurological improvement (ENI, NIHSS score improvement of ≥8 points after 24 h or NIHSS score of 0 or 1 after 3 days) and functional outcome and mortality during long term follow up. Secondary endpoints were the patency of the internal carotid artery at 24 h. Patient demographics and anti-aggregation regimen were recorded as co-variables.Results: 163/1,645 (9.9%) MT patients had a tandem occlusion. All thrombectomy procedures were performed with stent retrievers. PTA with or without additional placement of a stent was performed in 149 vs. 14 patients. The overall rate of TICI IIB/III recanalization was 91.4%. An early neurological improvement was found in 79 of 163 patients (48.4%), 51% (76/149) in the stent group and 21% (3/14) in the non stent group. 120/163 patients (73.6%) had a long term favorable outcome (mRS 0–2). The ICA re-occlusion rate at 24 h was 5.4% (8/149) in the stent group and 42% (6/14) in the non stent group. The rate of symptomatic hemorrhage was 4.9%.The regression analysis showed that only younger age (p = 0.002) and shorter recanalization times (p = 0.017) were associated with good outcome.Conclusion: Stent-PTA of the ICA in addition to MT with a stent retriever was safe and effective in tandem occlusion of the anterior brain circulation. PTA and MT without stenting in tandem lesions showed a higher early re-occlusion rate and lower rate of early neurological improvement. The technical approach should aim for the fastest possible recanalization of the intracranial vessels, either with stenting first or last.

Cardiac regeneration is a homeostatic cardiogenic process by which the sections of malfunctioning adult cardiovascular tissues are repaired and renewed employing a combination of both cardiomyogenesis and angiogenesis. Unfortunately, while high-quality regeneration can be performed in amphibians and zebrafish hearts, mammalian hearts do not respond in kind. Indeed, a long-term loss of proliferative capacity in mammalian adult cardiomyocytes in combination with dysregulated induction of tissue fibrosis impairs mammalian endogenous heart regenerative capacity, leading to deleterious cardiac remodeling at the end stage of heart failure. Interestingly, several studies have demonstrated that cardiomyocyte proliferation capacity is retained in mammals very soon after birth, and cardiac regeneration potential is correspondingly preserved in some preadolescent vertebrates after myocardial infarction. There is therefore great interest in uncovering the molecular mechanisms that may allow heart regeneration during adult stages. This review will summarize recent findings on cardiac regenerative regulatory mechanisms, especially with respect to extracellular signals and intracellular pathways that may provide novel therapeutics for heart diseases. Particularly, both in vitro and in vivo experimental evidences will be presented to highlight the functional role of these signaling cascades in regulating cardiomyocyte proliferation, cardiomyocyte growth, and maturation, with special emphasis on their responses to heart tissue injury.

Dominant optic neuropathies causing fiber loss in the optic nerve are among the most frequent inherited mitochondrial diseases. In most genetically resolved cases, the disease is associated to a mutation in OPA1, which encodes an inner mitochondrial dynamin involved in network fusion, cristae structure and mitochondrial genome maintenance. OPA1 cleavage is regulated by two m-AAA proteases, SPG7 and AFG3L2, which are respectively involved in Spastic Paraplegia 7 and Spino-Cerebellar Ataxia 28. Here, we identified a novel mutation c.1402C>T in AFG3L2, modifying the arginine 468 in cysteine in an evolutionary highly conserved arginine-finger motif, in a family with optic atrophy and mild intellectual disability. Ophthalmic examinations disclosed a loss of retinal nerve fibers on the temporal and nasal sides of the optic disk and a red-green dyschromatopsia. Thus, our results suggest that neuro-ophthalmological symptom as optic atrophy might be associated with AFG3L2 mutations, and should prompt the screening of this gene in patients with isolated and syndromic inherited optic neuropathies.

IntroductionTreatment with short hairpin RNA (shRNA) interference therapy targeting phosphodiesterase 5a after myocardial infarction (MI) has been shown to mitigate post-MI heart failure. We investigated the mechanisms that underpin the beneficial effects of PDE5a inhibition through shRNA on post-MI heart failure.MethodsAn adenoviral vector with an shRNA sequence inserted was adopted for the inhibition of phosphodiesterase 5a (Ad-shPDE5a) in vivo and in vitro. Myocardial infarction (MI) was induced in male C57BL/6J mice by left coronary artery ligation, and immediately after that, the Ad-shPDE5a was injected intramyocardially around the MI region and border areas.ResultsFour weeks post-MI, the Ad-shPDE5a-treated mice showed significant mitigation of the left ventricular (LV) dilatation and dysfunction compared to control mice. Infarction size and fibrosis were also significantly reduced in Ad-shPDE5a-treated mice. Additionally, Ad-shPDE5a treatment decreased the MI-induced inflammatory cytokines interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and transforming growth factor-β1, which was confirmed in vitro in Ad-shPDE5a transfected myofibroblasts cultured under oxygen glucose deprivation. Finally, Ad-shPDE5a treatment was found to activate the myocardial Akt signaling pathway in both in vivo and in vitro experiments.ConclusionThese findings indicate that PDE5a inhibition by Ad-shPDE5a via the Akt signal pathway could be of significant value in the design of future therapeutics for post-MI heart failure.

Background and Objective. Exosomes secreted from mesenchymal stem cells (MSC) have demonstrated cardioprotective effects. This study examined the role of exosomes derived from MSC overexpressing CXCR4 for recovery of cardiac functions after myocardial infarction (MI). Methods. In vitro, exosomes from MSC transduced with lentiviral CXCR4 (ExoCR4) encoding a silencing sequence or null vector were isolated and characterized by transmission electron microscopy and dynamic light scattering. Gene expression was then analyzed by qPCR and Western blotting. Cytoprotective effects on cardiomyocytes were evaluated and effects of exosomes on angiogenesis analyzed. In vivo, an exosome-pretreated MSC-sheet was implanted into a region of scarred myocardium in a rat MI model. Angiogenesis, infarct size, and cardiac functions were then analyzed. Results. In vitro, ExoCR4 significantly upregulated IGF-1α and pAkt levels and downregulated active caspase 3 level in cardiomyocytes. ExoCR4 also enhanced VEGF expression and vessel formation. However, effects of ExoCR4 were abolished by an Akt inhibitor or CXCR4 knockdown. In vivo, ExoCR4 treated MSC-sheet implantation promoted cardiac functional restoration by increasing angiogenesis, reducing infarct size, and improving cardiac remodeling. Conclusions. This study reveals a novel role of exosomes derived from MSCCR4 and highlights a new mechanism of intercellular mediation of stem cells for MI treatment.

Implantation of cell-sheets into damaged regions of the heart after myocardial infarction (MI) has been shown to improve heart function. However, the tissue morphology following application of induced pluripotent stem cell (iPSC)-derived cardiomyocytes (CM) has not been studied in detail at the level afforded by electron microscopy. We hypothesized that increasing the number of CM derived from iPSC would increase the effectiveness of cell-sheets used to treat ischemic cardiomyopathy. We report here on the ultrastructural features after application of a bio-membrane 'cell patch'.iPSC-derived progenitor cells were transduced using lentivirus vectors with or without NCX1 promoter. iPSC-CM sheets were transplanted over the transmural MI region in a mouse model of regional ischemic cardiomyopathy. Mice were divided into four groups, 1) Sham; 2) MI; 3) MI + iPSC without NCX1 treated cells (MI + iPSCNull) and 4) MI + iPSC receiving NCX1 promoter treated cells (MI + iPSCNCX1). Echocardiography was performed 4 weeks after cell patch application, followed by histological and transmission electron microscopy (TEM) analysis.Large numbers of transplanted CM were observed with significant improvements in left ventricular performance and remodeling in group 4 as compared with group 3. No teratoma formation was detected in any of the treatment groups.Manipulation of iPSC yields large numbers of iPSC-CM and favorable morphological and ultrastructural tissue changes. These changes have the potential to enhance current methods used for restoration of cardiac function after MI.

Abstract Background Model-independent analysis with B-spline regularization has been used to quantify myocardial blood flow (perfusion) in dynamic contrast-enhanced cardiovascular magnetic resonance (CMR) studies. However, the model-independent approach has not been extensively evaluated to determine how the contrast-to-noise ratio between blood and tissue enhancement affects estimates of myocardial perfusion and the degree to which the regularization is dependent on the noise in the measured enhancement data. We investigated these questions with a model-independent analysis method that uses iterative minimization and a temporal smoothness regularizer. Perfusion estimates using this method were compared to results from dynamic 13N-ammonia PET. Results An iterative model-independent analysis method was developed and tested to estimate regional and pixelwise myocardial perfusion in five normal subjects imaged with a saturation recovery turboFLASH sequence at 3 T CMR. Estimates of myocardial perfusion using model-independent analysis are dependent on the choice of the regularization weight parameter, which increases nonlinearly to handle large decreases in the contrast-to-noise ratio of the measured tissue enhancement data. Quantitative perfusion estimates in five subjects imaged with 3 T CMR were 1.1 ± 0.8 ml/min/g at rest and 3.1 ± 1.7 ml/min/g at adenosine stress. The perfusion estimates correlated with dynamic 13N-ammonia PET (y = 0.90x + 0.24, r = 0.85) and were similar to results from other validated CMR studies. Conclusion This work shows that a model-independent analysis method that uses iterative minimization and temporal regularization can be used to quantify myocardial perfusion with dynamic contrast-enhanced perfusion CMR. Results from this method are robust to choices in the regularization weight parameter over relatively large ranges in the contrast-to-noise ratio of the tissue enhancement data.

My name is Paul Christian. I am a Black British man with learning disabilities. The lives and experiences of Black people with learning disabilities are underrepresented in the UK history of learning disability. This article explains my involvement in activism to change this and shares the learning from these projects. It discusses the process of co-writing and why research is needed to record and share the experiences of Black people admitted to the former institutions and the importance of accessible information about Black history, race and racism.

Background: History starts from where we are now - it is not just things that happened a long time ago. The global pandemic began in 2019. It has changed the lives of people with learning disabilities. We began our project during the first lockdown in April 2020. We came together to set up a website to collect stories and support and learn from each other about how to survive and keep strong. Storytelling is very important because it helps us understand what is going on. It is also a way to capture the history of people with learning disabilities at a very difficult time. We know that thousands of people with learning disabilities became ill and died in the flu epidemic of 1918. But nobody recorded their stories in their own words. We want to make sure this does not happen again, so we created an archive to help us remember. Methods: The project was managed with an advisory group of people with and without learning disabilities who met monthly to monitor the collection and analysis of stories on the site. A site audit was performed regularly to determine the themes in the stories and who had submitted. The article describes the progress of the project, the stories we have shared, and the challenges we have faced. Conclusions: We discuss how people with learning disabilities have been presented in the media and our views about the way we are not heard, or always shown as vulnerable victims. We have found many sad stories, but also positive ones about people being creative and supportive. We look forward to the future and share our ideas about how society could be different and more inclusive. Being part of this project has given us confidence to know we are not alone, and shown us how we can help with the recovery.