"The journey of a thousand miles begins with one step": An Asian American perspective on mentoring in neuropsychology.

OBJECTIVE: The Asian Neuropsychological Association (ANA) is a recently established cultural identity-based organization with the mission to ensure accessibility and provision of culturally sensitive neuropsychological services for individuals of Asian descent. One of ANA's programmatic goals has been to foster a pipeline of neuropsychologists through mentoring and networking. In this paper, we aim to understand the historical context as well as unique considerations that are relevant for mentoring in the Asian American community. METHODS: A search of the existing literature in psychology and allied fields such as counseling and sociology was conducted to identify and formulate suggestions for mentoring culturally diverse communities, with a specific focus on Asian Americans. Firsthand narrative descriptions of effective examples of mentoring experiences in the context of shared values are discussed. FINDINGS AND IMPLICATIONS: This paper reviews the historical context and establishes an initial contextual foundation for increasing knowledge about best practices that can be used to establish effective mentoring relationships for Asian Americans. Six key considerations were identified: model minority myth, acculturation and enculturation, ethno-racial status and gender, the context of communication, quantity and quality of mentorship, and unique values specific to the Asian American community. Our findings identify the value of cultural identity-based organizations in creating communities that can support the professional development of future neuropsychologists at various career stages. Overall, findings have implications for maintaining the relevance of the field of neuropsychology in adequately serving an increasingly culturally diverse national and international population.

Depression and suicidal ideation in Mexican medical students during COVID-19 outbreak. A longitudinal study.

INTRODUCTION: The COVID-19 pandemic has been particularly difficult for populations at risk for mental health problems, such as healthcare professionals and medical students. In the present study, we evaluated the effect of the pandemic on mental health in a sample of Mexican medical students with and without a mental health diagnosis. METHOD: Longitudinal and descriptive study based on scales of suicidal ideation, depressive symptoms and risk of alcohol consumption, conducted in April and December 2020. RESULTS: Sample includes 247 medical students, 64.4% are women. Prevalence of depression increased between April and December from 19.84% to 40.08%. In the case of women from 23.67% to 42.60% (χ2 = 0.000) and in men from 11.54% to 34.62% (χ2 = 0.001). In April 16.92% of healthy students presented some sign of depression and in December the percentage increased to 40.80% (χ2 = 0.000). Regarding medicated students, the prevalence in April was 32.61% and in December it was 36.96% (χ2 = 0.662). In April, the medicated students with risk of suicidal ideation were 17 out of 46 (36.96%), compared to the students without a diagnosis of psychiatric illness were 29 out of 201 (13.43%) (χ2 = 0.000). For December, the non-medicated students at risk of suicidal ideation were 34 out of 201 (16.91%), and the medicated students were 12 out of 46 (26.09%) (χ2 = 0.149). CONCLUSIONS: The pandemic has increase the rate of depression in medical students, being more severe in women. Students under psychiatric treatment showed a higher prevalence of depression; however, the fact of being under treatment resulted in a protective factor for the increase in the prevalence of depression. It is important to deepen the understanding of the causes of depression and to disseminate among the university community the benefits of early detection and treatment of people with socio-emotional disorders.

Implementation of a clinical pharmacist-driven comprehensive medication management program in an outpatient wound healing center.

BACKGROUND: The role of the pharmacist in wound healing management among patients with diabetic and nondiabetic foot ulcers (DFU) is unclear. We sought to implement and evaluate an integrated pharmacist-driven comprehensive medication management (CMM) program in a multidisciplinary podiatrist-led wound healing center (WHC). OBJECTIVES: The objectives were to determine the role of the clinical pharmacist in a WHC and evaluate the impact of CMM interventions on prescribing rates and wound healing rates. METHODS: A pharmacist-driven CMM program was implemented in a podiatrist-led WHC, and an evaluation spanning 6 years was conducted. RESULTS: Overall, 1018 patients were treated over 6 years, and 515 received wound treatment after the CMM period, of which, 309 received CMM services. A total of 441 medication related problems (MRPs) were identified; most were related to medication safety (35.1%) and inappropriate or ineffective therapy (31.3%), and problems with adherence accounted for 22.5% of documented MRPs. An average of 3.41 interventions per patient were documented, and most were related to patient education (40.8%). Only metformin (20.3 vs. 34.2%; P < 0.001) and insulin prescription (57.3 vs. 73.8%; P < 0.001) prevalence increased after CMM implementation. Other prescriptions were not significantly different among patients presenting in the pre- and post-CMM periods, respectively. Wound healing rates among patients with DFU were similar before and after implementation (55 vs. 52%; P = 0.49). Likewise, wound healing rates among those with non-DFUs were similar before- and after implementation (56 vs. 53%; P = 0.56). CONCLUSION: The implementation of a novel pharmacist-driven CMM program embedded within a multidisciplinary podiatrist-managed WHC provided the initial evidence of the potential benefits of providing pharmacist-driven CMM services to patients with lower extremity ulcers. Prospective studies of CMM in this patient population are needed.

Effect of calcium hydroxide mixed with preservatives on physicochemical characteristics and sensory shelf-life of corn tortilla.

BACKGROUND: The objective of the study was to evaluate the physicochemical characteristics and shelf-life of corn tortilla stored at room temperature (25 °C) using aw modifiers (propylene glycol and glycerol) and pH modifiers (fumaric acid and sodium benzoate) as preservatives combined with calcium hydroxide. Detection thresholds were used to determine the maximum preservative concentration and calcium hydroxide. Physicochemical characterization and sensory evaluation were used to determine the stability and sensory shelf-life of tortillas. RESULTS: Control, calcium hydroxide, calcium hydroxide + fumaric acid, calcium hydroxide + glycerol, calcium hydroxide + propylene glycol, and calcium hydroxide + sodium benzoate treatments had rounded half-lives of 1, 2, 1, 2, 2, and 2 days respectively. Glycerol combined with calcium hydroxide resulted in tortillas with lower pH variations over time. Mold presence was the critical attribute causing tortilla rejection. CONCLUSION: The use of aw modifiers had a better effect in preserving corn tortilla, as the concentration of pH modifiers at detection threshold levels was not able to reach an optimum performance when combined with calcium hydroxide. © 2021 Society of Chemical Industry.

Mechanochemical ablation for great and small saphenous veins insufficiency in patients with type III shunt.

OBJECTIVE: the aim of this study was to assess the results of mechanochemical endovenous ablation either in the primary or recurrent saphenous vein insufficiency, including only patients with veno-venous shunt type III. METHODS: retrospective analysis of a prospective study of patients with symptomatic chronic venous insufficiency who underwent ClariVein® technique. A total of 134 saphenous veins were included between August 2017 and August 2018. Follow-up was performed by Duplex ultrasound at 1, 6 and 12 months. Primary endpoints were technical and anatomical success. Secondary endpoints were the need for further treatment of varicose collateral veins by sclerotherapy, outcomes regarding recurrent insufficiency and clinical success. RESULTS: A total of 111 great saphenous veins and 23 small saphenous veins were treated with a technical success of 95.6%. The overall anatomical success rates at 1, 6 and 12 month were 96.2%, 88.8% and 84.4%, respectively, without differences between primary and recurrent insufficiency. Deferred sclerotherapy over varicose collaterals was carried out in 28% of the patients with anatomical success. Clinical improvement was achieved in 87.3%. CONCLUSIONS: MOCA technique has proven to be an effective technique, although additional treatment over varicose collaterals could be necessary in up to one-third. Atrophy of the saphenous vein and the lack of persistent varicose collateral veins during follow-up seem to be indicators of successful therapy.

Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry.

Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24-48 hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03-2.4]) and DOAC-free time longer than 6 days (OR: 5.42 [1.18-26]). Minor bleeding events were described in 76 (8.4%) patients, with higher incidence for dabigatran (12.7%) versus other DOACs (6.6%). Major bleeding events occurred in 17 (1.9%) patients. Bridging therapy was used in 315 (35%) patients. It was associated with minor (OR: 2.57 [1.3-5.07]) and major (OR: 4.2 [1.4-12.3]) bleeding events, without decreasing thrombotic events. Conclusion This study offers real-world data on perioperative DOAC management and outcomes in a large prospective sample size to date with a high percentage of major surgery. Short-term preprocedural DOAC interruption depending on the drug, hemorrhagic risk, and renal function, without bridging therapy and a reduced DOAC-free time, seems the safest practice.

Need for risk-adapted therapy for malignant ovarian germ cell tumors: A large multicenter analysis of germ cell tumors' patients from French TMRG network.

BACKGROUND: Malignant ovarian germ cell tumors are rare tumors, affecting young women with a generally favorable prognosis. The French reference network for Rare Malignant Gynecological Tumors (TMRG) aims to improve their management. The purpose of this study is to report clinicopathological features and long-term outcomes, to explore prognostic parameters and to help in considering adjuvant strategy for stage I patients. PATIENTS AND METHODS: Data from patients with MOGCT registered among 13 of the largest centers of the TMRG network were analyzed. We report clinicopathological features, estimated 5-year event-free survival (5y-EFS) and 5-year overall survival (5y-OS) of MOGCT patients. RESULTS: We collected data from 147 patients including 101 (68.7%) FIGO stage I patients. Histology identifies 40 dysgerminomas, 52 immature teratomas, 32 yolk sac tumors, 2 choriocarcinomas and 21 mixed tumors. Surgery was performed in 140 (95.2%) patients and 106 (72.1%) received first line chemotherapy. Twenty-two stage I patients did not receive chemotherapy. Relapse occurred in 24 patients: 13 were exclusively treated with upfront surgery and 11 received surgery and chemotherapy. 5y-EFS was 82% and 5y-OS was 92.4%. Stage I patients who underwent surgery alone had an estimated 5y-EFS of 54.6% and patients receiving adjuvant chemotherapy 94.4% (P < .001). However, no impact on estimated 5y-OS was observed: 96.3% versus 97.8% respectively (P = .62). FIGO stage, complete primary surgery and post-operative alpha fetoprotein level significantly correlated with survival. CONCLUSION: Adjuvant chemotherapy does not seem to improve survival in stage I patients. Active surveillance can be proposed for selected patients with a complete surgical staging.

The French national network dedicated to rare gynecological cancers diagnosis and management could improve the quality of surgery in daily practice of granulosa cell tumors. A TMRG and GINECO group Study.

OBJECTIVE: The French national rare gynecological tumor network has been established to improve the quality of care through offering expertise in double reading histological diagnosis, reviewing cases and guiding management of these tumors through specialized multidisciplinary tumor boards and online clinical guidelines (www.ovaire-rare.com). The aim of this study is to evaluate the impact of the development and implementation of this network by assessing the conformity of medical practice with the guidelines concerning the granulosa cell tumors (GCTs). METHODS: This is a French nationwide study, including 463 patients (out of the 639 identified patients) with a definitive diagnosis of GCT between 2011 and 2016. Surgical practices were analyzed for conformity with the current guidelines (www.ovaire-rare.org). Medical records, surgical and pathological reports were systematically analyzed. Total conformity was defined by a conservative (unilateral salpingo-oophorectomy) or radical surgery (hysterectomy and bilateral salpingo-oophorectomy) including surgical staging (omentectomy, peritoneal biopsies and peritoneal cytology) according to the FIGO stage. Partial conformity referred to a conservative or radical surgery without surgical staging and non-conformity was defined as a non-optimal surgery as recommended by the guidelines. RESULTS: Median age at diagnosis was 49 years old (range 10-89). The median size of tumor was 94 mm (range 5-400). Radical surgery was performed in 240 patients (52%); while a fertility-sparing surgery was performed in 98 cases (21%). A surgical staging was performed in 76 cases (16%) and an evaluation of the endometrium in 289 cases (62%). Surgery was fully compliant with the guidelines in 65 patients (14%), partially compliant in 213 patients (46%), non-compliant in 137 patients (30%) and not assessable in 48 cases (10%). A statistically significant difference for compliance was observed in restaging surgery (p < 0,001), radical surgery (p = 0,017) and the period (before or after) of the implementation of the network (p < 0,001). Survival analyses did not allow us to demonstrate a significant difference in overall survival nor in PFS although there was a trend in favor of optimal surgery compared to incomplete/non optimal surgery. CONCLUSION: Surgical management's conformity to the guidelines increases over time from 2011 to 2016. According to this study, the implementation of a national network dedicated to rare gynecologic tumors seems to significantly improve the surgical management of the patients with ovarian granulosa cell tumors.

Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer.

PURPOSE: The aim of our study was to comprehensively evaluate the most valuable metabolic parameters of cervical tumours and pelvic lymph nodes (PLN) by FDG-PET/CT to predict para-aortic lymph node (PALN) metastasis and stratify patients for surgical staging. METHODS: The study included patients with locally advanced cervical cancer, negative PALN uptake on preoperative FDG-PET/CT, and para-aortic lymphadenectomy. Two senior nuclear medicine physicians expert in gynaecologic oncology reviewed all PET/CT exams, and extracted tumour SUVmax, MTV, and TLG, as well as PLN. Prognostic parameters of PALN involvement were identified using ROC curves and logistic regression analysis. RESULTS: One hundred and twenty-five consecutive locally advanced cervical cancer patients were included. The FDG-PET/CT false-negative rate was, respectively, 27.7% (13/47) and 5.1% (4/78) in patients with and without FDG-PET/CT PLN uptake. The AUC of cervical tumour size, SUVmax, MTV, and TLG was, respectively, 0.75 (0.62-0.87), 0.59 (0.44-0.76), 0.75 (0.60-0.90), and 0.71 (0.56-0.86). The AUC of PLN size, SUVmax, SUVmean, PLN SUVmax/Tumour SUVmax ratio, MTV, and TLG was, respectively, 0.57 (0.37-0.78), 0.82 (0.68-0.95), 0.77 (0.61-0.94), 0.85 (0.72-0.98), 0.69 (0.51-0.87), and 0.74 (0.57-0.91). The metabolic parameter showing the best trade-off between sensitivity and specificity to predict PALN involvement was the ratio between PLN and tumour SUVmax. CONCLUSION: The risk of PALN metastasis in FDG-PET/CT negative PLN patients is very low, so para-aortic lymphadenectomy does not seem justified. In patients with preoperative PLN uptake on FDG-PET/CT, surgical staging led to treatment modification in more than 25% of cases and should therefore be performed. Patients with more than one positive PLN and high PLN metabolic activity are at high risk of para-aortic extension and recurrence. Further prospective evaluation is required to consider intensified treatment modalities without prior PALN dissection.

Deleterious alleles in the context of domestication, inbreeding, and selection.

Each individual has a certain number of harmful mutations in its genome. These mutations can lower the fitness of the individual carrying them, dependent on their dominance and selection coefficient. Effective population size, selection, and admixture are known to affect the occurrence of such mutations in a population. The relative roles of demography and selection are a key in understanding the process of adaptation. These are factors that are potentially influenced and confounded in domestic animals. Here, we hypothesize that the series of events of bottlenecks, introgression, and strong artificial selection associated with domestication increased mutational load in domestic species. Yet, mutational load is hard to quantify, so there are very few studies available revealing the relevance of evolutionary processes. The precise role of artificial selection, bottlenecks, and introgression in further increasing the load of deleterious variants in animals in breeding and conservation programmes remains unclear. In this paper, we review the effects of domestication and selection on mutational load in domestic species. Moreover, we test some hypotheses on higher mutational load due to domestication and selective sweeps using sequence data from commercial pig and chicken lines. Overall, we argue that domestication by itself is not a prerequisite for genetic erosion, indicating that fitness potential does not need to decline. Rather, mutational load in domestic species can be influenced by many factors, but consistent or strong trends are not yet clear. However, methods emerging from molecular genetics allow discrimination of hypotheses about the determinants of mutational load, such as effective population size, inbreeding, and selection, in domestic systems. These findings make us rethink the effect of our current breeding schemes on fitness of populations.

Cervical consistency index and risk of Cesarean delivery after induction of labor at term.

OBJECTIVE: To evaluate the association between the cervical consistency index (CCI) and the risk of Cesarean delivery after planned induction of labor (IOL) at term. METHODS: This was a prospective observational study of women with a term singleton pregnancy admitted for IOL due to maternal or fetal indication. Ultrasonographic images were obtained before IOL and CCI was calculated offline once recruitment was completed. The main outcome was defined as Cesarean delivery due to failed IOL or arrest of labor. Cesarean deliveries indicated due to maternal or fetal compromise (Van Dillen's grade 1 or 2) were excluded from analysis. Univariate statistical analysis was performed using Fisher's exact test and Student's t-test for categorical and continuous variables, respectively. Multivariate analysis was performed using logistic regression, including CCI and other variables related to the main outcome. Intraclass correlation coefficients were used to estimate intra- and interobserver agreement. RESULTS: Of 510 women admitted for IOL during the study period and for whom image quality was adequate, 46 were excluded due to emergency Cesarean delivery leaving 464 pregnancies for analysis. Cesarean section due to failed IOL or arrest of labor was performed in 100/464 (21.6%) pregnancies. The mean CCI of women who underwent Cesarean delivery was not significantly different from that in those who had vaginal delivery after IOL (70.1 ± 12.3% vs 70.0 ± 13.1%; P = 0.94). Multivariate analysis also showed absence of statistical association between CCI and Cesarean delivery for failed IOL or arrest of labor. Intraclass correlation coefficients for intra- and interobserver agreement were 0.81 (95% CI, 0.66-0.89) and 0.86 (95% CI, 0.75-0.92), respectively. CONCLUSION: CCI does not seem to be associated with the risk of Cesarean delivery after IOL. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Características hematológicas y bioquímicas en pacientes con y sin diabetes mellitus tipo 2 (DM2) sometidos a hemodiálisis durante un año de seguimiento / Hematologic and biochemical characteristics in patients with and without type 2 diabetes mellitus undergoing hemodialysis during a one-year follow-up period

Objetivo: Reportar si existen diferencias hematológicas y bioquímicas entre los pacientes con y sin diabetes mellitus tipo 2 (DM2) bajo tratamiento de hemodiálisis (HD). Materiales y métodos: Estudio observacional de cohorte retrospectiva de pacientes atendidos por el Programa de Salud renal en el Centro de Prevención de Enfermedad Renal S.A.C (CENPER) de Lima, Perú. Se compararon los parámetros hematológicos y bioquímicos de 3 pacientes con DM2 y 3 pacientes sin DM2 sometidos a HD. Resultados: Se encontraron diferencias significativas (p<0,05) en el porcentaje de linfocitos, el cociente linfocito/ monocito (LMR), la concentración de hemoglobina y hematocrito (menor en pacientes diabéticos), en el porcentaje de monocitos y en el cociente neutrófilo/ linfocitos (NLR) (mayor en pacientes diabéticos). En los parámetros bioquímicos solo se encontró diferencia significativa en la transaminasa TGO que está más elevada en pacientes diabéticos comparados con pacientes no diabéticos (p<0.005). Conclusiones: Diabetes es un factor importante asociado con inflamación, anemia, linfopenia y monocitosis en pacientes sometidos a HD. LMR fue el marcador más potente de inflamación en esta serie de pacientes. Estudios a mayor escala son requeridos para corroborar esta evidencia.

Objective: To report if there are hematologic and biochemical differences among patients with and without type 2 diabetes mellitus (T2DM) undergoing hemodialysis (HD). Materials and methods: An observational, retrospective, cohort study of patients treated in the Renal Health Program at the Centro de Prevención de Enfermedad Renal S.A.C. (CENPER) in Lima, Peru. The hematologic and biochemical parameters of 3 patients with T2DM and 3 patients without T2DM undergoing HD were compared. Results: Significant differences (p < 0.05) were found in the lymphocyte percentage, lymphocyte/monocyte ratio (LMR), hemoglobin and hematocrit concentration (lower in diabetic patients), monocyte percentage, and neutrophil/ lymphocyte ratio (NLR) (higher in diabetic patients). In the biochemical parameters, the only significant difference was found in the glutamic-oxaloacetic transaminase (GOT) value, which was higher in the diabetic patients compared with the non-diabetic patients (p < 0.005). Conclusions: Diabetes is an important factor linked to inflammation, anemia, lymphopenia and monocytosis in patients undergoing HD. The LMR was the most powerful marker of inflammation in this patient series. Larger-scale studies are required to verify this evidence.

A multi-center, open-label trial to compare the efficacy and pharmacokinetics of Artemether-Lumefantrine in children with severe acute malnutrition versus children without severe acute malnutrition: study protocol for the MAL-NUT study.

BACKGROUND: Malnutrition and malaria frequently coexist in sub-Saharan African countries. Studies on efficacy of antimalarial treatments usually follow the WHO standardized protocol in which severely malnourished children are systematically excluded. Few studies have assessed the efficacy of chloroquine, sulfadoxine-pyrimethamine and quinine in severe acute malnourished children. Overall, efficacy of these treatments appeared to be reduced, attributed to lower immunity and for some antimalarials altered pharmacokinetic profiles and lower drug concentrations. However, similar research on the efficacy and pharmacokinetic profiles of artemisinin-combination therapies (ACTs) and especially artemether-lumefantrine in malnourished children is currently lacking. The main objective of this study is to assess whether artemether-lumefantrine is less efficacious in children suffering from severe acute malnutrition (SAM) compared to non-SAM children, and if so, to what extent this can be attributed to a sub-optimal pharmacokinetic profile. METHODS/DESIGN: In two sites, Ouelessebougou, Mali and Maradi, Niger, children with uncomplicated microscopically-confirmed P. falciparum malaria aged between 6 and 59 months will be enrolled. Two non-SAM children will be enrolled after the enrolment of each SAM case. Children with severe manifestations of malaria or complications of acute malnutrition needing intensive treatment will be excluded. Treatment intakes will be supervised and children will be followed-up for 42 days, according to WHO guidance for surveillance of antimalarial drug efficacy. Polymerase Chain Reaction genotyping will be used to distinguish recrudescence from re-infection. SAM children will also benefit from the national nutritional rehabilitation program. Outcomes will be compared between the SAM and non-SAM populations. The primary outcome will be adequate clinical and parasitological response at day 28 after PCR correction, estimated by Kaplan-Meier analysis. To assess the pharmacokinetic profile of lumefantrine, a sparse sampling approach will be used with randomized allocation of sampling times (5 per child). A total of 180 SAM children and 360 non-SAM children will be recruited during the 2013 and 2014 malaria seasons. DISCUSSION: This study will provide important information that is currently lacking on the effect of SAM on therapeutic efficacy and pharmacokinetic profile of artemether-lumefantrine. If it shows lower therapeutic efficacy and decreased lumefantrine concentrations, it would inform dose optimization studies in SAM children. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01958905.

Addition of a worm leachate as source of humic substances in the drinking water of broiler chickens.

The objective of this research was to evaluate the growth performance, the apparent ileal digestibility of nitrogen and energy, the retention of nutrients and the apparent metabolizable energy corrected to zero nitrogen retention (AMEn) in broiler chickens supplemented with increasing doses of a worm leachate (WL) as a source of humic substances (HS) in the drinking water. In Exp. 1, 140 male broilers were penned individually and assigned to four WL levels (0%, 10%, 20%, and 30%) mixed in the drinking water from 21 to 49 days of age. Water was offered in plastic bottles tied to the cage. In Exp. 2, 600 male broilers from 21 to 49 days of age housed in floor pens were assigned to three levels of WL (0%, 10%, and 20%) mixed in the drinking water. The WL was mixed with tap water in plastic containers connected by plastic tubing to bell drinkers. The results of both experiments were subjected to analysis of variance and polynomial contrasts. In Exp. 1, the daily water consumption was similar among treatments but the consumption of humic, fulvic, and total humic acids increased linearly (p<0.01) as the WL increased in the drinking water. The feed conversion (p<0.01) and the ileal digestibility of energy, the excretion of dry matter and energy, the retention of dry matter, ash and nitrogen and the AMEn showed quadratic responses (p<0.05) relative to the WL levels in drinking water. In Exp. 2, the increasing level of WL in the drinking water had quadratic effects on the final body weight, daily weight gain and feed conversion ratio (p<0.05). The addition of WL as a source of HS in the drinking water had beneficial effects on the growth performance, ileal digestibility of energy, the retention of nutrients as well on the AMEn in broiler chickens; the best results were observed when the WL was mixed at levels of 20% to 30% in the drinking water.

Nutrient intake and food habits of soccer players: analyzing the correlates of eating practice.

Despite the impact and popularity of soccer, and the growing field of soccer-related scientific research, little attention has been devoted to the nutritional intake and eating habits of soccer players. Moreover, the few studies that have addressed this issue suggest that the nutritional intake of soccer players is inadequate, underscoring the need for better adherence to nutritional recommendations and the development and implementation of nutrition education programs. The objective of these programs would be to promote healthy eating habits for male and female soccer players of all ages to optimize performance and provide health benefits that last beyond the end of a player's career. To date, no well-designed nutrition education program has been implemented for soccer players. The design and implementation of such an intervention requires a priori knowledge of nutritional intake and other correlates of food selection, such as food preferences and the influence of field position on nutrient intake, as well as detailed analysis of nutritional intake on match days, on which little data is available. Our aim is to provide an up-to-date overview of the nutritional intake, eating habits, and correlates of eating practice of soccer players.

Fatty acids intake and immune parameters in the elderly.

INTRODUCTION: The rapid increase on life-expectancy represents a major challenge and economic burden for modern societies. Several studies have focused on the effects of polyunsaturated fatty acids (PUFA) upon the immune system; however less attention has been paid to the effects of monounsaturated fatty acids (MUFA). In this work we investigated the relationship of habitual consumption of different types of fatty acids with different immune parameters in the elderly. SUBJECTS AND METHODS: 40 institutionalized elderly (76-95 y) and 35 home-living middle-age subjects (57-65 y) were recruited. Dietary intakes of macronutrients, fiber and fatty acids, as well as immune parameters such as serum cytokines levels (IL-10, TNF-α, IL-8, IL-17, TGF-ß and IL-12), phagocytic activity and cytotoxic NK activity, were determined. RESULTS: Elderly subjects had a lower intake of total lipids. MUFA intake was significantly lower in the elderly group than in middle-age adults whilst the contrary was true for PUFA. MUFA intake in the elderly was found to be positively associated with IL-12 (ß = 0.879) and TNF-α (ß = 0.789) serum concentrations, whilst PUFA intake was inversely related to levels of IL-12 (ß = -0.534). These associations were not observed in the middle-age group. CONCLUSION: MUFA intake may contribute to the pro-inflammatory status present in the elderly. It may be advisable to develop future nutrient recommendations specific for elderly taking into account immune parameters.

Introducción: El rápido aumento de la esperanza de vida en las sociedades desarrolladas representa un gran desafío y supone una elevada carga económica. Numerosos trabajos han estudiado los efectos de los ácidos grasos poliinsaturados (AGP) sobre el sistema inmune, sin embargo los efectos de los ácidos grasos monoinsaturados (AGM) han recibido mucha menos atención. En este trabajo se investigó la relación del consumo habitual de los diferentes tipos de ácidos grasos con diversos parámetros inmunológicos en ancianos. Individuos y métodos: Se reclutaron 40 ancianos institucionalizados (79-95 AÑOs) y 35 individuos de mediana edad (57-65 AÑOs) que residían en sus hogares. Se determinó la ingesta diaria de macronutrientes, fibra y ácidos grasos, así como diversos parámetros inmunes; niveles séricos de citoquinas (IL-10, TNF-α, IL-8, IL-17, TGF-ß e IL-12), actividad fagocítica y actividad citotóxica de células NK. Resultados: Los voluntarios ancianos presentaron una menor ingesta de lípidos totales. La ingesta de AGM fue significativamente menor en el grupo de ancianos que en los adultos de mediana edad, mientras que lo contrario fue cierto para los AGP. La ingesta de AGM en ancianos se asoció positivamente con las concentraciones de IL-12 (ß = 0,879) y TNF-α (ß = 0,789), mientras que la ingesta de AGP mostró una relación inversa con los niveles de IL-12 (ß = -0,534). Estas asociaciones no fueron observadas en el grupo de mediana edad. Conclusión: La ingesta de AGM podría contribuir al estado pro-inflamatorio presente en los ancianos. Sería aconsejable desarrollar recomendaciones nutricionales específicas para ancianos teniendo en cuenta parámetros inmunológicos.

Microbial targets for the development of functional foods accordingly with nutritional and immune parameters altered in the elderly.

OBJECTIVE: The development of functional foods for microbiota modulation in the elderly constitutes an interesting strategy. However, for such development, specific targets, not just in terms of microbiota but also considering immune and nutritional parameters, should be identified in this population. METHODS: We analyzed the intestinal microbiota and immune parameters in 38 institutionalized elderly (mean 84 years old) and a group of 38 elderly adults (mean 62 years old). Nutritional assessments were also carried out. RESULTS: The elderly people in this study presented reduced levels of Faecalibacterium genus and Bacteroides and Blautia coccoides groups and increased Lactobacillus group, as well as reduced levels of fecal short-chain fatty acids (SCFA) when compared to younger adults. Moreover, they showed higher levels of the proinflammatory cytokines tumor necrosis factor (TNF)-α and interleukin (IL)-12 as well as the chemokine IL-8. Significant nutritional deficiencies were also observed in the elderly group. CONCLUSION: The results obtained in this study suggest potential targets for the development of functional foods for the elderly population.

Experience with using second life for medical education in a family and community medicine education unit.

BACKGROUND: The application of new technologies to the education of health professionals is both a challenge and a necessity. Virtual worlds are increasingly being explored as a support for education. AIM: The aim of this work is to study the suitability of Second Life (SL) as an educational tool for primary healthcare professionals. DESIGN: Qualitative study of accredited clinical sessions in SL included in a continuing professional development (CPD) programme for primary healthcare professionals. LOCATION: Zaragoza I Zone Family and Community Medicine Education Unit (EU) and 9 health centres operated by the Aragonese Health Service, Aragon, Spain. METHOD: The EU held two training workshops in SL for 16 healthcare professionals from 9 health centres by means of two workshops, and requested them to facilitate clinical sessions in SL. Attendance was open to all personnel from the EU and the 9 health centres. After a trail period of clinical sessions held at 5 health centres between May and November 2010, the CPD-accredited clinical sessions were held at 9 health centres between February and April 2011. PARTICIPANTS: 76 healthcare professionals attended the CPD-accredited clinical sessions in SL. MAIN MEASUREMENTS: Questionnaire on completion of the clinical sessions. RESULTS: Response rate: 42-100%. Questionnaire completed by each health centre on completion of the CPD-accredited clinical sessions: Access to SL: 2 centres were unable to gain access. Sound problems: 0% (0/9). Image problems: 0% (0/9). Voice/text chat: used in 100% (10/9); 0 incidents. Questionnaire completed by participants in the CPD-accredited clinical sessions: Preference for SL as a tool: 100% (76/76). Strengths of this method: 74% (56/76) considered it eliminated the need to travel; 68% (52/76) believed it made more effective use of educational resources; and 47% (36/76) considered it improved accessibility. Weaknesses: 91% (69/76) experienced technical problems, while; 9% (7/76) thought it was impersonal and with little interaction. 65.79% (50/76) believed it was better than other distance learning methods and 38.16% (29/76) believed it was better than face-to-face learning. CONCLUSIONS: SL is a tool that allows educational activities to be designed that involve a number of health centres in different geographical locations, consequently eliminating the need to travel and making more effective use of educational resources.

Is there a relationship between the playing position of soccer players and their food and macronutrient intake?

Many authors have proposed the necessity of the design and implementation of dietary and nutrition education programs for soccer players, although little information is available about the determinants of food selection and nutrient intake. The aim of this study was to evaluate the nutritional intake and eating patterns of soccer players according to their playing position in the team. Eighty-seven young male soccer players (aged 16-21 years) were recruited from the junior teams of a Spanish First Division Soccer League Club and divided into 6 positional categories (goalkeepers, full-backs, centre-backs, midfielders, wingers, and forwards). Body composition (height, weight, and body fat), performance in soccer-specific tests (jumping, sprinting, and intermittent endurance), and dietary intake (weighed food intake method) were assessed. A spontaneous higher carbohydrate intake was observed for full-backs, midfielders, and wingers (g·kg(-1) body mass: 4.9 ± 1.0, 4.9 ± 1.3, 4.9 ± 0.8; % of energy intake: 47 ± 5, 46 ± 6, 46 ± 4), compared with goalkeepers and centre-backs (g·kg(-1) of body mass: 3.9 ± 1.0, 4.3 ± 1.1; % of energy intake: 44 ± 3, 42 ± 4). These differences were related to food selection patterns, and a higher contribution to daily energy intake of cereals, derivatives, and potatoes was observed between full-backs compared with goalkeepers and centre-backs (33% vs. 27% and 25%). The magnitude of these differences is limited considering the whole diet, and an inadequate nutrient intake were observed in most individuals of every group. The design and implementation of nutrition intervention programs, taking into consideration positional differences in nutritional intake, would be useful for these players.

Combination of an Enzymatically Hydrolyzed Yeast and Yeast Culture with a Direct-fed Microbial in the Feeds of Broiler Chickens.

A balance trial experiment was carried out to evaluate the potential relationship between an enzymatically hydrolyzed yeast (EHY) and yeast culture combined with a live Bacillus subtilis (Bs) on the productive parameters, ileal digestibility, retention of nutrient and energy and villus morphology in broilers. Seventy two 28 d old, Ross B308 male broilers were assigned to a factorial combination of 2 levels of EHY (0 and 1 kg/ton of feed) and 2 levels of Bs (0 and 125 g/ton of feed). The experiment lasted 2 weeks. Several treatment interactions were observed. EHY-fed broilers showed the lowest feed intake and feed conversion ratio whereas Bs-fed broilers showed the highest feed intake and intermediate feed conversion ratio (EHY and BS interaction, p<0.05). Also, EHY-fed broilers had greater ileal digestibility of dry matter (EHY and BS interaction, p<0.01) and energy (EHY and BS interaction, p<0.05) but these responses were counterbalanced by the combination of EHY and Bs. The thickness of the mucosa was similar between the control and EHY-fed broilers, but was lowest when Bs was added alone (EHY and BS interaction, p<0.01). The thickness of the villus was greater in EHY plus Bs-fed broilers, intermediate for the control and lower for Bs or EHY-fed broilers (EHY and BS interaction, p<0.05). The area of the villus was greater in the control and EHY plus Bs-fed broilers (EHY and BS interaction, p<0.05). In addition, EHY-fed broilers showed greater breast yield and nitrogen retention (p<0.01) and ashes digestibility (p<0.05). On the other hand, Bs-fed broilers had greater carcass and breast weight, nitrogen retention, energy excretion and villus height (p<0.05). In summary, EHY and Bs enhanced some growth, carcass and nutrient retention responses, but did not show any synergic relationship in these responses. Opposite to this, the results suggest that the positive effect of EHY on the feed conversion and digestibility of nutrients were counterbalanced by the addition of Bs.