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"Trigo, M."
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Teaching and learning of calculus
\"This survey focuses on the main trends in the field of calculus education. Despite their variety, the findings reveal a cornerstone issue that is strongly linked to the formalism of calculus concepts and to the difficulties it generates in the learning and teaching process. As a complement to the main text, an extended bibliography with some of the most important references on this topic is included. Since the diversity of the research in the field makes it difficult to produce an exhaustive state-of-the-art summary, the authors discuss recent developments that go beyond this survey and put forward new research questions.\"--Back cover.
Book
Postpartum depression: How it differs from the “baby blues”
IntroductionDespite many signs and symptoms of depression get dismissed as normal physiologic changes associated with childbirth, depressive disorders are a common complication of pregnancy and postpartum period. The so-called “baby blues” have a minor functional impact and respond well to social support, whilst postpartum depression causes significant functional compromise, requiring more aggressive therapy. There is an extreme type of postpartum depressive disorder, postpartum psychosis, when patients present psychosis, mania, or thoughts of infanticide. It is imperative to promptly recognize and differentiate these entities, in order to minimize its impact on both mother and child. Antidepressant treatment may be necessary for some women, but risks and benefits should always be considered prior to institute pharmacotherapy.ObjectivesTo identify current approaches and evidence-based treatment options for postpartum depression.MethodsReview of the most recent literature regarding postpartum depression. The research was carried out through the Cochrane, UptoDate, PubMed, MedLine, LILACS and SciELO databases, using the terms “postpartum depression”, “baby blues” and “postpartum psychosis”, until December 2020.ResultsSince both depression and antidepressant medications confer risk upon the infant, when postpartum depression develops, psychotherapy is usually the first-line treatment. Antidepressant treatment may be necessary, but its use during pregnancy and postpartum must be weighed carefully.ConclusionsIn order to better prevent postpartum depression, recommendations include the use of screening instruments as a routine clinical practice during pregnancy and referral when necessary. Maternal depression has a severe impact on both mother and child, so mental health professionals have a very important role in reducing postnatal emotional complications.DisclosureNo significant relationships.
Journal Article
Psychiatric aspects of the end of life in oncologic patients
IntroductionPatients with life-limiting oncologic conditions should be approached by multidisciplinary teams that contribute to improve their quality of life, including support from mental health dedicated professionals. It is the role of the psychiatrist to understand the relationship between mental health and general health outcomes, specific of this type of patients. Terminally ill and dying patients benefit from psychiatric support, and it seems to have real effects in terms of patient care and medical staff education.ObjectivesTo identify approaches and mental health professionals’ practices regarding end-of-life issues in terminally ill cancer patients.MethodsReview of the most recent literature regarding end-of-life issues in terminally ill cancer patients. The research was carried out through the Cochrane, UptoDate, PubMed, MedLine, LILACS and SciELO databases, using the terms “oncology”, “psychiatry” and “end of life”, until December 2020.ResultsWhile symptoms of anxiety and depression are common in palliative care settings, generally related to feelings of helplessness and fear of death, they should not be assumed to be an inevitable part of it. For terminally ill patients, anxiety and trauma-related disorders can manifest in various ways and it is important to establish personalized treatment approaches, based on a supportive clinical team, and, if necessary, psychotherapy and psychopharmacologic or complementary treatments.ConclusionsIt is extremely important to assess terminally ill patients from the mental health point of view. It is required that psychiatrists take part in clinical care and research on the treatment of these patients with severe medical conditions, in order to increase their quality of life.DisclosureNo significant relationships.
Journal Article
Internet addiction disorder: When technology becomes a problem
IntroductionInternet addiction disorder (IAD) is the compulsive and problematic use of the internet, resulting in significant functional impairment in several life domains. This happens when an individual engages in online activities disregarding daily responsibilities or other interests, and not realizing its negative consequences. Although not officially recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), the relationships between digital media use and mental health has been under debate and discussion amongst experts due to presenting some features of excessive use, withdrawal phenomena, tolerance, and negative repercussions typical of many substance abuse disorders.ObjectivesTo present an overview of theoretical considerations on IAD and its eventual inclusion in the next version of the DSM.MethodsReview of the most recent literature regarding internet addiction disorder. The research was carried out through the PubMed, MedLine, SpringerLink and LILACS databases, using the terms “internet addiction”, “addiction disorders” and “social media”, until December 2020.ResultsThere is controversy around the diagnosis of internet addiction, including whether it is a unique clinical entity or a manifestation of other underlying psychiatric disorders, raising complex questions of causality. Since there are no standardized definition, there is lack of evidence-based recommendations to its approach.ConclusionsResearch suggests that some individuals dealing with internet addiction are at significant risk, therefore merit professional care. Further research is needed, with carefully controlled studies, emphasizing incapacity, prognosis and response to treatment, in order to consider internet addiction as a disease, and include it in DSM’s next edition.DisclosureNo significant relationships.
Journal Article
The role of the gut-brain axis in depression and anxiety disorders
IntroductionThere is a bi-directional biochemical communication pathway between the gastrointestinal tract and the central nervous system, referred to as the “gut–brain axis”. Studies show that bacteria in the gastrointestinal tract, including commensal, probiotic, or pathogenic, can affect brain’s function. Since there is a symbiotic relationship between gut microbiota and the brain, changes in its composition can lead to dysbiosis, which plays a role in many psychiatric disorders, such as depression and anxiety, and therefore becomes a potential therapeutic target.ObjectivesTo examine data from recent studies regarding the gut-brain axis and its relationship with psychiatric disorders, such as depression and anxiety.MethodsReview of the most recent literature regarding the gut-brain axis and its relationship with depression and anxiety disorders. The research was carried out through the MedLine, PubMed, UptoDate, ScienceDirect, SciELO and SpringerLink databases, using the terms “gut-brain axis”, “depression” and “anxiety”, until December 2020.ResultsThere is a relationship between dysbiosis of microbiota and some psychiatric disorders, particularly depression. Symbiosis may be restored by purposefully manipulate the gut microbiota using therapies such as probiotics, therefore enhancing beneficial bacteria in the gastrointestinal tract and improving symptoms of depression.ConclusionsAlthough probiotics can be used in the treatment of depression, further research is needed in order to carefully determine parameters such as the duration of treatment, dosage and drug interactions. Nonetheless, a better understanding of the gut-brain axis may arise new approaches on how we prevent and treat mental illnesses.DisclosureNo significant relationships.
Journal Article
Therapeutic use of psychedelic drugs in depression disorders
IntroductionDepression is one of the most prevalent mental illnesses, leading to important personal distress and economic consequences. Treatment is long, often involving psychotherapy and pharmacological treatment, and relapses are frequent. Used mostly for treatment of mood disorders and alcohol dependence, drugs such as lysergic acid diethylamide (LSD) were studied in the 1950’s and showed therapeutic promise in attenuating depressive symptoms. However, in the 1960s all major psychedelic research programs were ended. Recently, there is a renewed research interest in these drugs, considering its antidepressant potential.ObjectivesTo review current knowledge on the therapeutic uses of psychedelic drugs such as LSD in depression disorders.MethodsReview of the most recent literature regarding the therapeutical potential of psychedelic drugs such as LSD in depression disorders. The research was carried out through the UptoDate, PubMed, MedLine, ScienceDirect and SpringerLink databases, using the terms “LSD”, “psychedelic drugs” and “depression disorders”, until December 2020.ResultsAs in past scientific studies, data of recent clinical research shows that the use of LSD relieves distress concerning death, particularly in terminally ill oncologic patients, and addictions including alcoholism and nicotine. There is more limited data concerning the use of classic hallucinogens to treat depression and anxiety disorders.ConclusionsAlthough research has shown many of the neurobiological and psychological effects of classic hallucinogens on humans, the studies that have been completed to date are not sufficient to establish clinically relevant effects. Despite further research is needed, the outcomes are encouraging, and larger, well-designed, placebo-controlled trials are now underway or being planned.DisclosureNo significant relationships.
Journal Article
Targeting stromal remodeling and cancer stem cell plasticity overcomes chemoresistance in triple negative breast cancer
The cellular and molecular basis of stromal cell recruitment, activation and crosstalk in carcinomas is poorly understood, limiting the development of targeted anti-stromal therapies. In mouse models of triple negative breast cancer (TNBC), Hedgehog ligand produced by neoplastic cells reprograms cancer-associated fibroblasts (CAFs) to provide a supportive niche for the acquisition of a chemo-resistant, cancer stem cell (CSC) phenotype via FGF5 expression and production of fibrillar collagen. Stromal treatment of patient-derived xenografts with smoothened inhibitors (SMOi) downregulates CSC markers expression and sensitizes tumors to docetaxel, leading to markedly improved survival and reduced metastatic burden. In the phase I clinical trial EDALINE, 3 of 12 patients with metastatic TNBC derived clinical benefit from combination therapy with the SMOi Sonidegib and docetaxel chemotherapy, with one patient experiencing a complete response. These studies identify Hedgehog signaling to CAFs as a novel mediator of CSC plasticity and an exciting new therapeutic target in TNBC.
Stromal cell recruitment, activation and crosstalk with cancer cells is poorly understood. Here, the authors demonstrate that cancer cell-derived Hedgehog ligand triggers stromal remodeling that in turn induces a cancer-stem-cell like, drug-resistant phenotype of nearby cancer cells while treatment with smoothened inhibitors reverses these phenotypes.
Journal Article
On the key role of droughts in the dynamics of summer fires in Mediterranean Europe
Summer fires frequently rage across Mediterranean Europe, often intensified by high temperatures and droughts. According to the state-of-the-art regional fire risk projections, in forthcoming decades climate effects are expected to become stronger and possibly overcome fire prevention efforts. However, significant uncertainties exist and the direct effect of climate change in regulating fuel moisture (e.g. warmer conditions increasing fuel dryness) could be counterbalanced by the indirect effects on fuel structure (e.g. warmer conditions limiting fuel amount), affecting the transition between climate-driven and fuel-limited fire regimes as temperatures increase. Here we analyse and model the impact of coincident drought and antecedent wet conditions (proxy for the climatic factor influencing total fuel and fine fuel structure) on the summer Burned Area (BA) across all eco-regions in Mediterranean Europe. This approach allows BA to be linked to the key drivers of fire in the region. We show a statistically significant relationship between fire and same-summer droughts in most regions, while antecedent climate conditions play a relatively minor role, except in few specific eco-regions. The presented models for individual eco-regions provide insights on the impacts of climate variability on BA, and appear to be promising for developing a seasonal forecast system supporting fire management strategies.
Journal Article
The Hot Summer of 2010: Redrawing the Temperature Record Map of Europe
The summer of 2010 was exceptionally warm in eastern Europe and large parts of Russia. We provide evidence that the anomalous 2010 warmth that caused adverse impacts exceeded the amplitude and spatial extent of the previous hottest summer of 2003. \"Mega-heatwaves\" such as the 2003 and 2010 events likely broke the 500-year-long seasonal temperature records over approximately 50% of Europe. According to regional multi-model experiments, the probability of a summer experiencing mega-heatwaves will increase by a factor of 5 to 10 within the next 40 years. However, the magnitude of the 2010 event was so extreme that despite this increase, the likelihood of an analog over the same region remains fairly low until the second half of the 21st century.
Journal Article
Significant increase of global anomalous moisture uptake feeding landfalling Atmospheric Rivers
One of the most robust signals of climate change is the relentless rise in global mean surface temperature, which is linked closely with the water-holding capacity of the atmosphere. A more humid atmosphere will lead to enhanced moisture transport due to, among other factors, an intensification of atmospheric rivers (ARs) activity, which are an important mechanism of moisture advection from subtropical to extra-tropical regions. Here we show an enhanced evapotranspiration rates in association with landfalling atmospheric river events. These anomalous moisture uptake (AMU) locations are identified on a global scale. The interannual variability of AMU displays a significant increase over the period 1980-2017, close to the Clausius-Clapeyron (CC) scaling, at 7 % per degree of surface temperature rise. These findings are consistent with an intensification of AR predicted by future projections. Our results also reveal generalized significant increases in AMU at the regional scale and an asymmetric supply of oceanic moisture, in which the maximum values are located over the region known as the Western Hemisphere Warm Pool (WHWP) centred on the Gulf of Mexico and the Caribbean Sea.
Increasing atmospheric temperatures are expected to have various impacts on the global water cycle. Here, the authors show that there is an intensification of atmospheric rivers, that causes enhanced evapotranspiration and thus atmospheric moisture uptake in many regions of the world.
Journal Article