How to ... be a reflective practitioner.

미국의 “전국 수학 교사 협의회”(National Council of Teachers of Mathematics, NCTM)는 1989년부터 〈학교 수학의 교육과정과 평가 규준〉(1989), 〈수학 가르침(교수)의 전문성 규준〉(1991), 〈학교 수학의 평가(시험) 규준〉(NCTM, 1995), 〈학교 수학의 원리와 규준〉(2000)을 출판하여 미국의 수학 교육 의 전망(목표, 나아갈 길)과 규준(실행 지침)을 제시하였다. 수학 교사들로 구성된 미국의 NCTM은 학생, 학부모, 학교 행정가 등 많은 사람들과 힘을 합하여 모든 학생들에게 수준 높은 수학 교육을 받을 수 있는 여건(환경, 기회)을 조성하는 데 구심점의 역할을 하였다. 한편 많은 관련 단체들은 여러 배경과 능력을 가진 학생들이 전문성을 지닌 교사(특수 교사를 일컫는 밀이 아니다. 수학 교과를 이해하고 수학의 전문성과 특수성을 가르칠 수 있는 일반 교사를 일컫는 말이다.)로부터 미래를 대비해 평등하고, 진취적이며, 지원이 잘 이루어지고, 공학 도구(IT)가 잘 갖춰진 환경에서 중요한 수학적 아이디어를 이해하면서 학습할 수 있는 수학 교실(미국에서는 우리나라처럼 수학 교사가 수학 시간에 학생의 방(교실: Homeroom)에 찾아가지 않고 학생들이 선생의 방(수학 교실: Classroom)을 찾아온다. 전형적인 수학 교실의 사진은 2쪽에 나와 있다.)을 만들기 위해 함께 힘썼다. NCTM에서 출간한 여러 규준들은 우리나라의 제6차와 제7차 교육과정에도 큰 영향을 미쳤다. 이 글에서는 NCTM(2000)에서 제시한 학습 원리를 간단히 살펴본 다음 이를 중심으로 현재 미국 수학 교육의 교수ㆍ학습 이론의 동향을 살펴본다.

미국 NCTM의 Principles and Standards for School Mathematics에 나타난 수학과 교수,학습의 이론

Objective: The aim was to formulate clinical practice guidelines for pheochromocytoma and paraganglioma (PPGL). Participants: The Task Force included a chair selected by the Endocrine Society Clinical Guidelines Subcommittee (CGS), seven experts in the field, and a methodologist. The authors received no corporate funding or remuneration. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. The Task Force reviewed primary evidence and commissioned two additional systematic reviews. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, European Society of Endocrinology, and Americal Association for Clinical Chemistry reviewed drafts of the guidelines. Conclusions: The Task Force recommends that initial biochemical testing for PPGLs shou...

/pdf/pheochromocytoma-and-paraganglioma-an-endocrine-society-4ij7m1t7fo.pdf

Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline

ContextDiagnosis of pheochromocytoma depends on biochemical evidence of catecholamine
production by the tumor. However, the best test to establish the diagnosis
has not been determined.ObjectiveTo determine the biochemical test or combination of tests that provides
the best method for diagnosis of pheochromocytoma.Design, Setting, and ParticipantsMulticenter cohort study of patients tested for pheochromocytoma at
4 referral centers between 1994 and 2001. The analysis included 214 patients
in whom the diagnosis of pheochromocytoma was confirmed and 644 patients who
were determined to not have the tumor.Main Outcome MeasuresTest sensitivity and specificity, receiver operating characteristic
curves, and positive and negative predictive values at different pretest prevalences
using plasma free metanephrines, plasma catecholamines, urinary catecholamines,
urinary total and fractionated metanephrines, and urinary vanillylmandelic
acid.ResultsSensitivities of plasma free metanephrines (99% [95% confidence interval
{CI}, 96%-100%]) and urinary fractionated metanephrines (97% [95% CI, 92%-99%])
were higher than those for plasma catecholamines (84% [95% CI, 78%-89%]),
urinary catecholamines (86% [95% CI, 80%-91%]), urinary total metanephrines
(77% [95% CI, 68%-85%]), and urinary vanillylmandelic acid (64% [95% CI, 55%-71%]).
Specificity was highest for urinary vanillylmandelic acid (95% [95% CI, 93%-97%])
and urinary total metanephrines (93% [95% CI, 89%-97%]); intermediate for
plasma free metanephrines (89% [95% CI, 87%-92%]), urinary catecholamines
(88% [95% CI, 85%-91%]), and plasma catecholamines (81% [95% CI, 78%-84%]);
and lowest for urinary fractionated metanephrines (69% [95% CI, 64%-72%]).
Sensitivity and specificity values at different upper reference limits were
highest for plasma free metanephrines using receiver operating characteristic
curves. Combining different tests did not improve the diagnostic yield beyond
that of a single test of plasma free metanephrines.ConclusionPlasma free metanephrines provide the best test for excluding or confirming
pheochromocytoma and should be the test of first choice for diagnosis of the
tumor.

https://jamanetwork.com/journals/jama/articlepdf/194752/JTO10005.pdf

Biochemical diagnosis of pheochromocytoma: which test is best?

El articulo ofreece una presentacion comentada del Informe presentado a la
UNESCO por la Comision lnternacional sobre la Educacion para el siglo XXI,
presidida por Jacques Delors. Se trata de una obra de obligada lrctura para aquellos
que ejercen su labor docente o se preparan para ella a las puertas del proximo
milenio.

La educación encierra un tesoro

The polyamines putrescine, spermidine, and spermine and ornithine decarboxylase (ODC), the rate-limiting enzyme in their biosynthetic pathway, play an important role in cell proliferation, differentiation, and transformation. In the present study, we have analyzed polyamine concentrations and ODC activity in samples from benign breast diseases (n = 36), benign breast tissue adjacent to the primary carcinoma (n = 19), and breast carcinoma (n = 104). ODC activity in primary carcinoma was significantly higher (2.42 +/- 0.22 nmol CO2/h g; P < 0.001) than that found in benign breast (0.62 +/- 0.15 nmol CO2/h g) or in breast tissue adjacent to the primary carcinoma (0.52 +/- 0.16 nmol CO2/h g). The total polyamine content of breast cancer tissues was higher than in benign breast diseases (704.3 +/- 38.3 nmol/g wet weight versus 295.8 +/- 27.4 nmol/g wet weight) and correlated well with ODC activity (Pearson, r = 0.42; P < 0.001). ODC activity correlated with histological grade, peritumoral lymphatic or blood vessel invasion, S-phase fraction, and cathepsin D. Total polyamine concentration increased with S-phase fraction, cathepsin D, and aneuploidy. No significant correlation was found between ODC or polyamines and tumor size, lymph node involvement, or steroid receptor status. A major finding in our study was that ODC activity was an independent prognostic factor for recurrence and death. The results indicate that the estimation of ODC activity and polyamines in human breast carcinoma might be useful to determine tumor aggressiveness and suggest that ODC may have a potential value as both a prognostic factor and a chemoprevention target in human breast cancer.

/pdf/prognostic-value-of-ornithine-decarboxylase-and-polyamines-vy8nrwzix9.pdf

Prognostic value of ornithine decarboxylase and polyamines in human breast cancer: correlation with clinicopathologic parameters.

Mycosis fungoides is usually an indolent disease that, after a variable period of time in a stable phase, evolves into a tumoral form with aggressive behavior. The molecular events that mark this progression remain essentially unknown to date, and this prompted us to investigate the hypothetical role of p16INK4a silencing in mycosis fungoides progression. We analyzed the three most frequent mechanisms of inactivation of the p16INK4a gene (deletion, promoter hypermethylation, and mutation) in nine cases with patch/plaque and tumoral lesions of mycosis fungoides. The existence of alterations was investigated by microsatellite analysis, methylation-specific polymerase chain reaction, and direct sequencing. Alterations of the p16INK4a gene were found in four of nine of the plaque lesions (hypermethylation in three samples and allelic loss in one sample) and seven of nine in the tumor lesions (hypermethylation in five samples and allelic loss in three samples). No case presented point mutations. Although a higher incidence of p16INK4a hypermethylation was observed in the cases that failed to achieve a complete remission, the limited size of our series prompted us to evaluate this finding cautiously. The results of this study therefore showed a common genetic alteration that is found more frequently in tumoral lesions than it is in plaque lesions of mycosis fungoides. It also offers data that could suggest a relationship between p16INK4a hypermethylation and unfavorable clinical outcome. Broader studies are needed to confirm both relationships.

p16INK4a Gene Alterations Are Frequent in Lesions of Mycosis Fungoides

Serum Levels of High-Sensitivity Troponin T: A Novel Marker for Cardiac Remodeling in Hypertrophic Cardiomyopathy

La evaluación en el proceso de enseñanza y aprendizaje de las Ciencias Sociales

Aims To study the relative prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) monitoring in addition to clinical disease severity scores (CDSSs) in outpatients with destabilized heart failure (HF).

Methods and results Seventy-one outpatients with recently destabilized HF were recruited. At baseline, and at all following visits, a CDSS based on Framingham criteria was obtained, and NT-proBNP levels were measured in a blind fashion. CDSS did not correlate with NT-proBNP levels at any time ( P > 0.1), although their relative changes correlated during follow-up ( P 0.1 for all visits), whereas changes in NT-proBNP levels were predictive at several time points: week 2 ( P = 0.005), week 3 ( P = 0.037), week 4 ( P = 0.015), and 6 months ( P = 0.026). A change in NT-proBNP levels at follow-up week 2 (%) added independent prognostic information ( P < 0.001, HR 0.982, 95% CI 0.972–0.992) to baseline CDSS ( P = 0.002, HR 2.05, 95% CI 1.290–3.266), age ( P = 0.007, HR 1.034, 95% CI 1.009–1.059), and left ventricular ejection fraction ( P = 0.013, HR 0.942, 95% CI 0.898–0.987).

Conclusion Serial monitoring for per cent change in NT-proBNP concentrations offers superior prognostic information to clinical assessment among outpatients with recent destabilized HF.

/pdf/usefulness-of-clinical-and-nt-probnp-monitoring-for-3486dwvfvg.pdf

Pedro Miralles Martínez

Papers

Prognostic value of ornithine decarboxylase and polyamines in human breast cancer: correlation with clinicopathologic parameters.

p16INK4a Gene Alterations Are Frequent in Lesions of Mycosis Fungoides

Serum Levels of High-Sensitivity Troponin T: A Novel Marker for Cardiac Remodeling in Hypertrophic Cardiomyopathy

La evaluación en el proceso de enseñanza y aprendizaje de las Ciencias Sociales

Usefulness of clinical and NT-proBNP Monitoring for prognostic guidance in destabilized heart failure outpatients