Reflexiones para optimizar el triaje en cirugía / Reflections to optimize triage in surgery

Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

A "Mean Quarrelsome Spirit:" Controversy in British Systematics, 1822-1836.

British systematics was distinctly marked by a raft of vituperative controversies around the turn of the 1830s. After the local collapse of broad consensus in the Linnaean system by 1820, the emergence of new schemes of classification-most notably, the "quinarian" system of William Sharp Macleay-brought with it an unprecedented register of public debate among zoologists in Britain, one which a young Charles Darwin would bitterly describe to his friend John Stevens Henslow in October 1836 as possessing a "mean quarrelsome spirit," conducted in "a manner anything but like that of gentlemen." This article aims to provide a social and conceptual account of the remarkable tenor of zoological discourse in Britain in the late 1820s and early 1830s, with joint attention to the philosophical and interpersonal commitments at play. In doing so, it analyzes the three of the period's most striking public controversies, each of which counted key advocates of the quinarian system as central participants.

Medicare and Medicaid Dual-Eligible Special Needs Plan Enrollment and Beneficiary-Reported Experiences With Care.

This cross-sectional study analyzes Medicare Advantage surveys to compare Medicare and Medicaid dual-eligible individuals' experiences with care across 3 established categories of plans.

Data-specific substitution models improve protein-based phylogenetics.

Calculating amino-acid substitution models that are specific for individual protein data sets is often difficult due to the computational burden of estimating large numbers of rate parameters. In this study, we tested the computational efficiency and accuracy of five methods used to estimate substitution models, namely Codeml, FastMG, IQ-TREE, P4 (maximum likelihood), and P4 (Bayesian inference). Data-specific substitution models were estimated from simulated alignments (with different lengths) that were generated from a known simulation model and simulation tree. Each of the resulting data-specific substitution models was used to calculate the maximum likelihood score of the simulation tree and simulated data that was used to calculate the model, and compared with the maximum likelihood scores of the known simulation model and simulation tree on the same simulated data. Additionally, the commonly-used empirical models, cpREV and WAG, were assessed similarly. Data-specific models performed better than the empirical models, which under-fitted the simulated alignments, had the highest difference to the simulation model maximum-likelihood score, clustered further from the simulation model in principal component analysis ordination, and inferred less accurate trees. Data-specific models and the simulation model shared statistically indistinguishable maximum-likelihood scores, indicating that the five methods were reasonably accurate at estimating substitution models by this measure. Nevertheless, tree statistics showed differences between optimal maximum likelihood trees. Unlike other model estimating methods, trees inferred using data-specific models generated with IQ-TREE and P4 (maximum likelihood) were not significantly different from the trees derived from the simulation model in each analysis, indicating that these two methods alone were the most accurate at estimating data-specific models. To show the benefits of using data-specific protein models several published data sets were reanalysed using IQ-TREE-estimated models. These newly estimated models were a better fit to the data than the empirical models that were used by the original authors, often inferred longer trees, and resulted in different tree topologies in more than half of the re-analysed data sets. The results of this study show that software availability and high computation burden are not limitations to generating better-fitting data-specific amino-acid substitution models for phylogenetic analyses.

New heterodont odontocetes from the Oligocene Pysht Formation in Washington State, U.S.A., and a reevaluation of Simocetidae (Cetacea, Odontoceti).

Odontocetes first appeared in the fossil record by the early Oligocene, and their early evolutionary history can provide clues as to how some of their unique adaptations, such as echolocation, evolved. Here, three new specimens from the early to late Oligocene Pysht Formation are described further increasing our understanding of the richness and diversity of early odontocetes, particularly for the North Pacific. Phylogenetic analysis shows that the new specimens are part of a more inclusive, redefined Simocetidae, which now includes Simocetus rayi, Olympicetus sp. 1, Olympicetus avitus, O. thalassodon sp. nov., and a large unnamed taxon (Simocetidae gen. et sp. A), all part of a North Pacific clade that represents one of the earliest diverging groups of odontocetes. Amongst these, Olympicetus thalassodon sp. nov. represents one of the best known simocetids, offering new information on the cranial and dental morphology of early odontocetes. Furthermore, the inclusion of CCNHM 1000, here considered to represent a neonate of Olympicetus sp., as part of the Simocetidae, suggests that members of this group may not have had the capability of ultrasonic hearing, at least during their early ontogenetic stages. Based on the new specimens, the dentition of simocetids is interpreted as being plesiomorphic, with a tooth count more akin to that of basilosaurids and early toothed mysticetes, while other features of the skull and hyoid suggest various forms of prey acquisition, including raptorial or combined feeding in Olympicetus spp., and suction feeding in Simocetus. Finally, body size estimates show that small to moderately large taxa are present in Simocetidae, with the largest taxon represented by Simocetidae gen. et sp. A with an estimated body length of 3 m, which places it as the largest known simocetid, and amongst the largest Oligocene odontocetes. The new specimens described here add to a growing list of Oligocene marine tetrapods from the North Pacific, further promoting faunistic comparisons across other contemporaneous and younger assemblages, that will allow for an improved understanding of the evolution of marine faunas in the region.

Maxillary Molar Root Canal Morphology Using Cone-Beam Computed Tomography: An Epidemiological Study from Shandong Province, China / Morfología del Conducto Radicular del Molar Maxilar Mediante Tomografía Computarizada de Haz Cónico: Un Estudio Epidemiológico de la Provincia de Shandong, China

SUMMARY: The objective of this study was to evaluate the maxillary molar root canal morphology in individuals from the Shandong province, China, using cone-beam computed tomography (CBCT) and classify it based on Ahmed et al. (2017) classification system to obtain a reference for clinical diagnosis and treatment. From December 2020 to June 2021, we screened CBCT data of 1,619 patients at the Jinan Stomatological Hospital who had been indicated for CBCT because of various oral abnormalities. The root and root canal morphologies of all teeth were statistically analyzed, and the root canal morphology was classified based on Ahmed et al. (2017) classification system. In the maxillary molars, three roots were the most common, accounting for 99.24 % and 74.61 % of all maxillary first and second molars, respectively. Two roots were the second most common, accounting for 0.66 % and 17.29 % of all maxillary first and second molars, respectively. Root morphology variation, e.g., fusion or furcation defect, was present in 22 (0.76 %) maxillary first molars and 765 (25.39 %) maxillary second molars, with the most common being mesiobuccal and distobuccal root fusion. Detection rates of a second mesiobuccal canal (MB2) in the maxillary first and second molars were 48.5 % and 26.5 %, respectively. Among age groups, the frequency of MB2 was the highest in the 15-24-year-old group and lowest in the 55-64-year-old group. Bilateral MB2 root canals were present in 64.8 % and 48.4 % of the maxillary first and second molars, respectively. Men and women accounted for 60.6 % and 67.8 % of the maxillary first molars, respectively, and 51.7 % and 45.6 % of the maxillary second molars, respectively. According to Ahmed et al. (2017) classification of root canal morphology, 18 and 22 root canal configurations were found in 1,453 right maxillary first molars and 1,444 left maxillary first molars, respectively. The right maxillary first molars showed three two-rooted, 14 three-rooted, and one four-rooted type. The left maxillary first molars showed two one-rooted, six two-rooted, and 14 three-rooted types. According to Ahmed et al. (2017) classification of root canal morphology, 43 and 45 root canal configurations were found in 1,507 right maxillary second molars and 1,506 left maxillary second molars, respectively. The right maxillary second molars showed 17 one-rooted, 16 two- rooted, eight three-rooted, and two four-rooted types. The left maxillary second molars showed 19 one-rooted, 13 two-rooted, 12 three- rooted, and one four-rooted type. This study showed that the maxillary molar root canal morphology is diverse in the Shandong province. Ahmed et al. (2017) classification system provides a clear description of the root canal morphology. CBCT can be used to study complex root and root canal morphologies.

El objetivo de este estudio fue evaluar la morfología del conducto radicular del molar superior en individuos de la provincia de Shandong, China, utilizando tomografía computarizada de haz cónico (CBCT) y clasificarla con base en el sistema de clasificación de Ahmed et al. (2017) para obtener una referencia para diagnóstico clínico y tratamiento. Desde diciembre de 2020 hasta junio de 2021, analizamos los datos de CBCT de 1619 pacientes en el Hospital Estomatológico de Jinan a quienes se les indicó CBCT debido a diversas anomalías orales. Las morfologías de la raíz y del conducto radicular de todos los dientes se analizaron estadísticamente, y la morfología del conducto radicular se clasificó según el sistema de clasificación de Ahmed et al. (2017). En los molares superiores, tres raíces fueron las más comunes, representando el 99,24 % y el 74,61 % de todos los primeros y segundos molares superiores, respectivamente. Dos raíces fueron las segundas más comunes, representando el 0,66 % y el 17,29 % de todos los primeros y segundos molares superiores, respectivamente. La variación de la morfología de la raíz, por ejemplo, fusión o defecto de furcación, estuvo presente en 22 (0,76 %) primeros molares superiores y 765 (25,39 %) segundos molares superiores, siendo la fusión radicular mesiovestibular y distovestibular la más común. Las tasas de detección de un segundo canal mesiovestibular (MB2) en los primeros y segundos molares superiores fueron del 48,5 % y 26,5 %, respectivamente. Entre los grupos de edad, la frecuencia de MB2 fue más alta en el grupo de 15 a 24 años y más baja en el grupo de 55 a 64 años. Los conductos radiculares MB2 bilaterales estaban presentes en el 64,8 % y el 48,4 % de los primeros y segundos molares superiores, respectivamente. En los hombres y en las mujeres representaron el 60,6 % y el 67,8 % de los primeros molares superiores, respectivamente, y el 51,7 % y el 45,6 % de los segundos molares superiores, respec- tivamente. Según la clasificación de la morfología del conducto radicular de Ahmed et al. (2017) se encontraron configuraciones de conducto radicular 18 y 22 en 1453 primeros molares superiores derechos y 1444 primeros molares superiores izquierdos, respectivamente. Los primeros molares superiores derechos mostraron tres tipos de dos raíces, 14 de tres raíces y uno de cuatro raíces. Los primeros molares superiores izquierdos mostraron dos tipos de una raíz, seis de dos raíces y 14 de tres raíces. Según la clasificación de la morfología del conducto radicular de Ahmed et al. (2017) se encontraron configuraciones de conducto radicular 43 y 45 en 1507 segundos molares superiores derechos y 1506 segundos molares superiores izquierdos, respectivamente. Los segundos molares superiores derechos mostraron 17 tipos de una raíz, 16 de dos raíces, ocho de tres raíces y dos de cuatro raíces. Los segundos molares superiores izquierdos mostraron 19 de una raíz, 13 de dos raíces, 12 de tres raíces y uno de cuatro raíces. Este estudio mostró que la morfología del conducto radicular del molar superior es diversa en la provincia de Shandong. El sistema de clasificación de Ahmed y colaboradores proporciona una descripción clara de la morfología del conducto radicular. CBCT se puede utilizar para estudiar morfologías complejas de raíces y conductos radiculares.

Tree Visualization By One Table (tvBOT): a web application for visualizing, modifying and annotating phylogenetic trees.

tvBOT is a user-friendly and efficient web application for visualizing, modifying, and annotating phylogenetic trees. It is highly efficient in data preparation without requiring redundant style and syntax data. Tree annotations are powered by a data-driven engine that only requires practical data organized in uniform formats and saved as one table file. A layer manager is developed to manage annotation dataset layers, allowing the addition of a specific layer by selecting the columns of a corresponding annotation data file. Furthermore, tvBOT renders style adjustments in real-time and diversified ways. All style adjustments can be made on a highly interactive user interface and are available for mobile devices. The display engine allows the changes to be updated and rendered in real-time. In addition, tvBOT supports the combination display of 26 annotation dataset types to achieve multiple formats for tree annotations with reusable phylogenetic data. Besides several publication-ready graphics formats, JSON format can be exported to save the final drawing state and all related data, which can be shared with other users, uploaded to restore the final drawing state for re-editing or used as a style template for quickly retouching a new tree file. tvBOT is freely available at: https://www.chiplot.online/tvbot.html.

Virus taxonomy and the role of the International Committee on Taxonomy of Viruses (ICTV).

The taxonomy of viruses is developed and overseen by the International Committee on Taxonomy of Viruses (ICTV), which scrutinizes, approves and ratifies taxonomic proposals, and maintains a list of virus taxa with approved names (https://ictv.global). The ICTV has approximately 180 members who vote by simple majority. Taxon-specific Study Groups established by the ICTV have a combined membership of over 600 scientists from the wider virology community; they provide comprehensive expertise across the range of known viruses and are major contributors to the creation and evaluation of taxonomic proposals. Proposals can be submitted by anyone and will be considered by the ICTV irrespective of Study Group support. Thus, virus taxonomy is developed from within the virology community and realized by a democratic decision-making process. The ICTV upholds the distinction between a virus or replicating genetic element as a physical entity and the taxon category to which it is assigned. This is reflected by the nomenclature of the virus species taxon, which is now mandated by the ICTV to be in a binomial format (genus + species epithet) and is typographically distinct from the names of viruses. Classification of viruses below the rank of species (such as, genotypes or strains) is not within the remit of the ICTV. This article, authored by the ICTV Executive Committee, explains the principles of virus taxonomy and the organization, function, processes and resources of the ICTV, with the aim of encouraging greater understanding and interaction among the wider virology community.