Conflict Dynamics in Scale-Free Networks with Degree Correlations and Hierarchical Structure.

We present a study of the dynamic interactions between actors located on complex networks with scale-free and hierarchical scale-free topologies with assortative mixing, that is, correlations between the degree distributions of the actors. The actor's state evolves according to a model that considers its previous state, the inertia to change, and the influence of its neighborhood. We show that the time evolution of the system depends on the percentage of cooperative or competitive interactions. For scale-free networks, we find that the dispersion between actors is higher when all interactions are either cooperative or competitive, while a balanced presence of interactions leads to a lower separation. Moreover, positive assortative mixing leads to greater divergence between the states, while negative assortative mixing reduces this dispersion. We also find that hierarchical scale-free networks have both similarities and differences when compared with scale-free networks. Hierarchical scale-free networks, like scale-free networks, show the least divergence for an equal mix of cooperative and competitive interactions between actors. On the other hand, hierarchical scale-free networks, unlike scale-free networks, show much greater divergence when dominated by cooperative rather than competitive actors, and while the formation of a rich club (adding links between hubs) with cooperative interactions leads to greater divergence, the divergence is much less when they are fully competitive. Our findings highlight the importance of the topology where the interaction dynamics take place, and the fact that a balanced presence of cooperators and competitors makes the system more cohesive, compared to the case where one strategy dominates.

Prevalence and risk factors for serositis in patients with systemic lupus erythematosus: A case-control study.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease with a wide variety of clinical manifestations. One of its symptoms, associated to high morbidity, is serositis. Its prevalence ranges between 11% and 54%, and little is known about factors associated to this manifestation. The aim of this study is to determine the prevalence of serositis in SLE patients visited at the outpatient Lupus Unit of the Hospital del Mar and identify risk factors that can be used as predictors of this manifestation. METHODS: A retrospective case-control study was performed based on the review of 297 medical records of SLE patients. Twenty-eight patients were identified to have suffered serositis (cases) and were age- and sex-matched with 2 controls with SLE without serositis. RESULTS: The overall prevalence of serositis in our cohort was 9.42%, being higher in men than in women, 30% versus 7.9% (p = 0.001, 95% CI: 1.7-42.4%). In 40.7%, it was the first manifestation of the disease. When looking for serositis-associated factors, an association was found with anti-dsDNA antibodies measured by the Crithidia method (p = 0.016), and different measures of corticosteroids, where cases had required higher maximum doses and more pulses than controls throughout the disease, although this last correlation was lost when adjusting for confounding variables as nephritis and arthritis. Cases also received more mycophenolic acid (p = 0.021) and, marginally, more belimumab (p = 0.056). CONCLUSION: The overall prevalence of serositis was 9.42%, being significantly higher in men (30%). Therefore, male gender constitutes a risk factor for serositis, and almost one third of men will develop this manifestation, so greater awareness is required in SLE men. CrithidiaDNA+ was also identified as a risk factor, and it should be determined in all SLE patients. Cases significantly received more corticosteroid pulses and higher maximum doses in relation to other SLE severe manifestations, which could imply a more aggressive form of SLE in patients with serositis.

Exposure to virtual reality as a tool to reduce peri-operative anxiety in patients undergoing colorectal cancer surgery: a single-center prospective randomized clinical trial.

BACKGROUND: More than 60% of patients who undergo surgery for colorectal cancer experience anxiety at some point during the perioperative period. In addition to the obvious impact on the experience of the therapeutic process, the presence of anxiety has also been associated with the appearance of complications. Virtual reality could reduce it by simulating the controlled exposure of the patient to the conscious part of the surgical process. METHODS: Single-center randomized clinical trial (NCT04058600) in which patients who were to undergo surgery for colorectal cancer and who had not previously undergone surgery as adults were exposed, prior to hospital admission, to virtual reality software in which all perioperative phases in which the patient is awake, from admission to discharge, were recreated. The main objective was to determine the presence of pre- and post-exposure anxiety using the validated State-Trait Anxiety Inventory Scale (STAI-S) and Hospital Anxiety and Depression Scale (HADS). RESULTS: A total of 126 patients were recruited (58 exposed, 68 unexposed). There were no differences between the groups in terms of age, gender, anesthetic risk, type of surgery. or levels of preoperative anxiety or depression. After exposure, all anxiety/depression rating scales decreased significantly. CONCLUSIONS: The use of simulation using virtual reality can reduce perioperative anxiety in patients undergoing surgery for colorectal cancer.

Use of HPV testing in cervical cancer screening services in Mexico, 2008-2018: a nationwide database study.

OBJECTIVE: To describe the methods of a study aimed at evaluating high risk-HPV (hrHPV)-based screening and cervical cytology as triage compared to conventional cervical cytology as primary screening in the detection of grade 2+ cervical intraepithelial neoplasia in the National Cancer Screening Program (NCSP) of Mexico. MATERIALS AND METHODS: We will use information originated from the Womens Cancer Information System of Mexico regarding cervical cancer from 2008 to 2018. The database includes cytology results, diagnostic confirmation by histopathology and/or treatment colposcopy. We will then carry out statistical analyses on approximately 15 million hrHPV. RESULTS: We will evaluate the overall performance of hrHPV-based screening as part of the NCSP and compare hrHPV-based to cytology-based screening under real-life conditions. To guarantee an unbiased comparison between hrHPV with cytology triage and conventional cytology we will use propensity score matching. CONCLUSIONS: ytology we will use propensity score matching. Conclusion. Decision makers may use our results to identify areas of opportunity for improvement in NCSP processe.

OBJETIVO: Describir los métodos de un estudio que busca comparar el beneficio de la introducción de la prueba de VPH de alto riesgo como prueba primaria frente a la citología convencional para la detección de la neoplasia intraepitelial cervical grado 2 o mayor, dentro del Programa de Prevención y Control del Cáncer de la Mujer, para el periodo de 2008 a 2018. MATERIAL Y MÉTODOS: Se utilizarán los registros del Sistema de Información de Cáncer de la Mujer, se realizarán los análisis estadísticos con aproximadamente 15 millones de resultados de VPH-alto riesgo, además se utilizarán los resultados de citología, colposcopia, histología y los casos referenciados al centro oncológico para tratamiento. Para comparar ambos grupos usaremos "propensity score matching". RESULTADOS: Se evaluará el desempeño general de la prueba de VPH-alto riesgo, en condiciones reales dentro del Programa Nacional de Prevención y Control de la Mujer y su tendencia en el tiempo. CONCLUSIONES: Los resultados de estudio ayudarán a los tomadores de decisiones a identificar áreas de oportunidad para mejorar el programa en México.

Association between Altered Cortisol Profiles and Neurobehavioral Impairment after Mild Traumatic Brain Injury in College Students.

Mild traumatic brain injury (mTBI) is the most common form of TBI, with more than 2.5 million TBI cases in the United States annually. Identification of easily obtainable biomarkers that track strongly with mTBI symptoms may improve our understanding of biological factors that contribute to mTBI symptom profiles and long-term outcomes. Notably, some individuals with mTBI exhibit circadian disruptions and elevated stress sensitivity, which in other clinical groups often correlate with disrupted secretion of cortisol, a glucocorticoid hormone that coordinates circadian and stress physiology. Here, we examined whether cortisol profiles could serve as a biomarker to complement the assessment of neurobehavioral sequelae after mTBI. We partnered with our on-campus health clinic to recruit college students seeking medical care after mTBI (n = 46) and compared this population to a well-matched non-injured student control group (n = 44). We collected data at an initial visit (shortly after injury in mTBI subjects) and one week later. At each visit, we evaluated neurobehavioral function using the Automated Neuropsychological Assessment Metric (ANAM). The subjects also provided cortisol samples through at-home saliva collection. We observed strong coherence between ANAM subjective and objective measures, indicating significant multi-dimensional impairment in subjects with mTBI. Further, female mTBI subjects exhibited diminished neurobehavioral function compared with males. Regardless of sex, decreased amplitude of diurnal cortisol and a blunted cortisol awakening response were associated with mTBI symptom severity and neurobehavioral impairment. Taken together, these findings suggest that salivary cortisol profiles may be a sensitive biomarker for studying underlying biological factors that impact mTBI symptoms and outcomes.

Nuevos Recursos Tecnológicos para la Enseñanza de Anatomía Durante la Crisis por Pandemia COVID-19. Desde el B-learn hacia el E-learn en una Nueva Escuela de Medicina de Chile / New Technological Resources for Anatomy Teaching During the COVID-19 Pandemic Crisis. From B-learn to E-Learn at a New Medical School, in Chile

Para iniciar la enseñanza de anatomía la nueva Escuela de Medicina de la Universidad de Tarapacá (UTA) adquirió innovadores recursos tecnológicos según el estado del arte en medios digitales y 3D. La primera cohorte de estudiantes de medicina utilizó estos recursos tecnológicos el año 2016, valoró positivamente la asignatura cursada y su metodología didáctica mediante un enfoque combinado (B-Learn). Estos resultados fueron publicados el año 2018, siendo un exitoso modelo local de enseñanza hasta el año 2019. La pandemia COVID-19 golpeó fuertemente a Chile desde el inicio del año 2020 y las universidades debieron adaptar su modelo de enseñanza. En nuestro caso se realizó impartiendo las asignaturas mediante un enfoque de total aprendizaje en línea a través de internet (E-Learn). Se impartió el primer y segundo semestre de anatomía a 36 estudiantes del primer año de medicina 2020. Además de los recursos tradicionales como textos de estudio y guías de laboratorio, para migrar a un modelo de curso E-Learn totalmente en línea, se utilizaron los recursos digitales y 3D almacenados en la base de datos local de la mesa de disección digital SECTRA® y su plataforma RIS/PACS portal IDS7 SECTRA®, para ser enseñados mediante internet vía Zoom® en tiempo real y vía plataformas Intranet-UTA en conjunto con Moodle® para las tareas y posteriores evaluaciones. La transición desde un modelo B-Learn a uno E-Learn se realizó en forma exitosa gracias a la experiencia conseguida los años anteriores en cuanto a diseño y uso de recursos didácticos, además de la base de datos local con recursos anatómicos previamente almacenados en formato digital. El rendimiento de los alumnos fue sobresaliente durante la pandemia, mostrando la versatilidad y adaptación de los nuevos estudiantes nativos digitales a las emergentes condiciones de aprendizaje.

SUMMARY: To start teaching anatomy, the recently established medical school of the University of Tarapacá (UTA) acquired innovative and state of the art technological resources in digital and 3D media. The first cohort of medical students used these resources in 2016 and positively assessed the subject studied and its didactic methodology through a combined approach (B- Learn). These results were published in 2018, and it was deemed a successful local teaching model until 2019. Since the beginning of 2020 the COVID-19 pandemic impacted Chile particularly hard, and universities had to adapt their teaching model. In our case, we carried it out by teaching the subjects using a comprehensive online learning approach through the Internet (E-Learn). The first and second semester of anatomy were taught to 36 students in the first year of medicine 2020. In addition to traditional resources such as study texts and laboratory guides, to migrate to a fully online E- Learn course model, the digital and 3D resources stored in the local database of the SECTRA® digital dissection table and its RIS/ PACS portal IDS7 SECTRA® platform were used to be taught via the internet through Zoom® in real-time and via Intranet UTA platforms in conjunction with Moodle® for the tasks and subsequent evaluations. The transition from a B-Learn model to an E-Learn model was carried out successfully thanks to the experience gained in previous years in terms of design and use of teaching resources, in addition to the local database with previously stored anatomical resources in digital format. Student performance was outstanding during the pandemic, showing the versatility and adaptation of new digital native students to emerging learning conditions.

Nuevos Recursos Digitales y 3D en la Enseñanza de Anatomía. Experiencia Internacional Reportada en el "Sectra Users Meeting 2019", Karolinska Institutet, Suecia, antes de la Pandemia de COVID-19 / New Digital and 3D Resources in the Teaching of Anatomy. International Experience Reported in the "Sectra Users Meeting 2019", Karolinska Institutet, Sweden, Before the Pandemic COVID-19

El uso de nuevos recursos tecnológicos en la enseñanza de anatomía ha impulsado la necesidad de adaptar el modelo educativo haciéndolo más centrado en el estudiante, dinámico y participativo mediante herramientas digitales y 3D; orientando los conocimientos hacia su aplicación clínica, pero bajo un ajuste curricular que tiende a cursar menos horas presenciales en aula o laboratorio. Este trabajo describe la experiencia local de una nueva Escuela de Medicina en Chile, reportada el año 2018, además y otros trabajos de centros formadores presentados en el "SECTRA Users Meeting 2019 Estocolmo", Karolinska Institutet, Suecia. Este trabajo describe los reportes orales sobre la aplicación de nuevos recursos digitales como; la mesa de disección digital táctil SECTRA® y modelos anatómicos cadavéricos impresos en 3D Erler-Zimmer®, bases de datos sobre anatomía digital, además, su impacto en el desempeño académico, reportado por usuarios de diferentes países, tales como: Australia, Canadá, Chile, China, Colombia, Estados Unidos de Norteamérica (EUA) y Suecia. Los datos fueron recopilados y analizados a partir de la información reportada en las presentaciones orales y resúmenes entregados por los expositores. La gran mayoría de los países expositores declararon el uso combinado de recursos digitales y 3D sumados a los tradicionales para la enseñanza de anatomía. Sólo el representante de EUA declaró usar exclusivamente recursos digitales (en laboratorio y en línea), experiencia correspondiente a una joven e innovadora escuela de medicina. La mayoría de los centros docentes declaró utilizar la mesa de disección digital en una amplia proporción de sus contenidos curriculares, en asociación a plataformas tipo RIS/PACS como IDS7 portal de SECTRA o las utilizadas por el centro formador. El uso de nuevas tecnologías digitales y 3D ha ganado un importante espacio en el currículum de la enseñanza de anatomía, complementando el uso de los recursos tradicionales.

SUMMARY: The use of new technological resources in the teaching of anatomy has promoted the need to adapt the educational model, making it more student-centered, dynamic, and participatory through digital and 3D tools, directing the knowledge towards its clinical application, but under a curricular adjustment that tends to take fewer contact hours in the classroom or laboratory. This work describes the local experience of a new School of Medicine in Chile, reported in 2018, and other work from training centers presented at the "SECTRA Users Meeting 2019 Stockholm", Karolinska Institutet, Sweden. This work describes the oral reports on the application of new digital resources such as; the SECTRA® digital tactile dissection table and Erler- Zimmer® 3D printed cadaveric anatomical models, databases on digital anatomy, in addition, its impact on academic performance, reported by users from different countries, such as Australia, Canada, Chile, China, Colombia, United States of America (USA) and Sweden. The data was collected and analyzed from the information reported in the oral presentations and summaries delivered by the speakers.The vast majority of the exhibiting countries declared the combined use of digital and 3D resources added to the traditional ones for teaching anatomy. Only the representative from the USA stated that they exclusively used digital resources (in the laboratory and online), an experience corresponding to a young and innovative medical school. Most of the educational centers stated that they used the digital dissection table in a large proportion of their curricular contents, in association with RIS/PACS-type platforms such as the IDS7 SECTRA portal or those used by the training center. The use of new digital and 3D technologies has gained an important space in the anatomy teaching curriculum, complementing the use of traditional resources.

Use of HPV testing in cervical cancer screening services in Mexico, 2008-2018: a nationwide database study / Uso de la prueba de VPH para la detección de cáncer cervical en México, 2008-2018: estudio de una base de datos nacional

Abstract: Objective: To describe the methods of a study aimed at evaluating high risk-HPV (hrHPV)-based screening and cervical cytology as triage compared to conventional cervical cytology as primary screening in the detection of grade 2+ cervical intraepithelial neoplasia in the National Cancer Screening Program (NCSP) of Mexico. Materials and methods: We will use information originated from the Womens Cancer Information System of Mexico regarding cervical cancer from 2008 to 2018. The database includes cytology results, diagnostic confirmation by histopathology and/or treatment colposcopy. We will then carry out statistical analyses on approximately 15 million hrHPV. Results: We will evaluate the overall performance of hrHPV-based screening as part of the NCSP and compare hrHPV-based to cytology-based screening under real-life conditions. To guarantee an unbiased comparison between hrHPV with cytology triage and conventional cytology we will use propensity score matching. Conclusion: Decision makers may use our results to identify areas of opportunity for improvement in NCSP processes.

Resumen: Objetivo: Describir los métodos de un estudio que busca comparar el beneficio de la introducción de la prueba de VPH de alto riesgo como prueba primaria frente a la citología convencional para la detección de la neoplasia intraepitelial cervical grado 2 o mayor, dentro del Programa de Prevención y Control del Cáncer de la Mujer, para el periodo de 2008 a 2018. Material y métodos: Se utilizarán los registros del Sistema de Información de Cáncer de la Mujer, se realizarán los análisis estadísticos con aproximadamente 15 millones de resultados de VPH-alto riesgo, además se utilizarán los resultados de citología, colposcopia, histología y los casos referenciados al centro oncológico para tratamiento. Para comparar ambos grupos usaremos "propensity score matching". Resultados: Se evaluará el desempeño general de la prueba de VPH-alto riesgo, en condiciones reales dentro del Programa Nacional de Prevención y Control de la Mujer y su tendencia en el tiempo. Conclusiones: Los resultados de estudio ayudarán a los tomadores de decisiones a identificar áreas de oportunidad para mejorar el programa en México.