Assessment of sustainable livelihoods and the application of community capitals: Case study of cattle families from El Doncello, Caquetá-Colombia / Evaluación de los medios de vida sostenibles y la aplicación de los capitales de la comunidad: estudio de caso de familias ganaderas de el doncello, caquetá-colombia

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ABSTRACT Introduction: Bovine cattle raising is the most important line of the economy of Caquetá department and El Doncello municipality, according to the figures given by the Departmental Committee of Cattlemen there is a herd of2,175,065 cattle heads in the region, many of the rural families depend on said economic activity to generate their income; To do this, the life analysis methodology examines the assets that communities have which are called community capital, and the approach they use to meet their fundamental human needs. Objective: To assess sustainable means and the application of community capital in cattle rancher families in the municipality of El Doncello, Caquetá (Colombia). Materials and methods: For the collection of information the producer families of the municipality of El Doncello were assessed; based on the sources of the Departmental Committee of Cattlemen, for this purposefamilies were surveyed and participatory workshops were carried out using the livelihood methodology framing the community capitals (human, natural, financial, physical and social) using 36 variables for the assessment of them, and the fundamental human needs (basic of the person, the environment and of action) that grouped 15 analysis variables; Subsequently, the interpretation and analysis of the data was made through aprincipal component analysis-PCA relating the typologies and each of the variables assessed in this study; all the data were run in the InfoStat Program. Results: It was found that 939 families base their economy on livestock production in the municipality of El Doncello, the human capital of these families was distributed in 72 men representing 15.55 %, 81 women (17.49 %), 143 boys (30.89 %)and 167 girls (36.07%), finding three types of families: Typology 1: families with <50 bovines on theirfarms; Typology 2: between 51 and 100 bovines, and Typology 3: >101 bovines, where financial capital is the one that represents the greatest contribution given its characteristics of income generation and well-beingfor families. The principal component analysis-ACP carried out for social capital divided according to the first principal component-PC1 with a contribution of 62.3 % to Family Typology 1 (families with <50 head of cattle) to the positive end of said component strongly associated with the variables greater participation in projects and organizations to which they belong, with the particularity of having a greater number of members at home; from Typology 3 to the negative end of said component associated with the variables greater number of shared spaces in which they participate and greater level of family participation. In the same way, for natural capital, a separation was observed between Family Typology 1, associated with the variables greater number of water sources, mainly due to the fact that a large part of these producers were in the mountain range zone, greater area in stubble, greater number of spaces used and more activities for consumption, such as plantations of plantain, cocoa, cassava and other subsistence crops and Family Typology 2 strongly associated with the variables greater number of trees in pastures and greater percentage of natural products. One of the most important capitals within the producers is the financial one, for which the following was observed: the first principal component-PC1, with a contribution of 43.7%, separates Typology 1 from the positive end of said component associated with the variable income from daily wages and income from subsidies, these families are the ones that generate the least amount of assets and through which they diversify their income that are not only dependent on livestockproduction as such, but also on other types of economic activities, of the Typology 2 to the negative extreme associated with the variables income from transfers, credits, income from formal employment and income from the sale ofprocessed products, such as cheese. The second main component-PC2, with a contribution of 24.4 %, groups Family Typology 3 strongly associated with the highest income from the sale of space-use products, These families, by owning a greater number of cattle heads, base a large part of their economy in said activity, but they diversify it with other types of income such as rubber crops, cocoa, pineapple, plantain, cassava, among others. Finally, the fundamental human needs-FHN can be defined as very similar for the three types of families studied, with slight adjustments in the basic needs for Typology 1, where food, health, shelter and security are classified as bad and regular. Although the situation does not vary much for Typology 2, but it does look better for Typology 3 in which satisfaction is good, except for security, everyone has the same perception, this is mainly due to the presence of certain illegal armed groups in the region. Regarding the needs of the person, the environment and action, there are no variations between the different types. Conclusions: Finally, it was possible to observe a high cultural tie that cattle ranchers have for this economic activity that is evidenced in human capital, where we see the number of people who directly depend on livestock and its derivatives. Also, in terms of financial capital, it can be observed that there is a great diversification of the income of families that not only depend on livestock, but also on income from formal employment, daily wages, loans and sales of other crops such as plantain, cassava, rubber and cocoa; In terms of social and natural capital, a good sustainable appropriation of environmental care and the participation of rural communities are observed. Finally, a low contribution to the fundamental human needs of the producing communities is denoted, this mainly due to the social and economic conditions of the region; In this sense, this study has repercussions as a first diagnosis in the management of the livelihoods of rural cattle-raising communities in the department of Caquetá.

Características Fonoaudiológicas de Pacientes Atendidos por um Serviço de Genética Clínica / Speech-language Pathology Characteristics of Patients Assisted by a Clinical Genetics Service / Características de patología del habla y lenguaje de Pacientes Atendidos por un Servicio de Genética Clínica

Introdução: O trabalho conjunto da genética médica e da fonoaudiologia é essencial, contribuindo para o desenvolvimento de procedimentos que auxiliam no tratamento de pacientes com distúrbios da comunicação. Objetivo: Analisar as características fonoaudiológicas de pacientes pediátricos atendidos por um serviço de genética clínica. Método: Estudo transversal observacional, realizado com pacientes atendidos pelo serviço de genética de um hospital em Porto Alegre. Para a coleta de dados, aplicou-se um questionário relacionado as áreas de audição, deglutição, motricidade orofacial, voz e linguagem. Resultados: A amostra foi constituída por 54 participantes com idades entre 8 meses e 17 anos (média de idade 6 anos e 5 meses). 24,07% (n=13) dos pacientes apresentaram diagnóstico de síndrome, e 59,26% (n=32) tinham atraso no desenvolvimento neuropsicomotor. Com relação ao perfil fonoaudiológico, 81,48% (n=44) apresentaram algum hábito oral deletério durante a infância. 16,67% (n=9) percebiam alguma dificuldade para ouvir e 29,62% (n=16) para deglutir. 85,19% (n=46) dos participantes manifestaram a linguagem oral desenvolvida e, destes, 71,74% (n=33) apresentavam trocas na fala. 33,33% (n=18) já estavam em atendimento fonoaudiológico, e outros 24,07% (n=13) estavam na fila de espera para este atendimento. Conclusões: Uma parte significativa dos pacientes apresentou queixas e/ou manifestações nas áreas da comunicação humana, principalmente em relação à linguagem, à fala e aos hábitos orais deletérios. Esses dados destacam a importância do encaminhamento para a equipe de fonoaudiologia. (AU)

Introduction: The collaborative efforts of medical genetics and speech therapy are essential, contributing to the development of procedures that assist in treating patients with communication disorders. Objective: To analyze the speech therapy characteristics of pediatric patients seen by a clinical genetics service. Methods: Observational cross-sectional study conducted with patients seen at the genetics service of a hospital in Porto Alegre. A questionnaire related to hearing, swallowing, orofacial motricity, voice, and language areas was used for data collection. Results: The sample consisted of 54 participants aged between 8 months and 17 years, with an average age of 6 years and 5 months. 24.07% (n=13) of the patients had a diagnosis of syndrome, and 59.26% (n=32) had delayed neuropsychomotor development. Regarding the speech therapy profile, 81.48% (n=44) had some harmful oral habit during childhood. 16.67% (n=9) reported some difficulty in hearing, and 29.62% (n=16) in swallowing. 85.19% (n=46) of the participants showed developed oral language, and of these, 71.74% (n=33) made speech substitutions. 33.33% (n=18) of the patients were already undergoing speech therapy, and another 24.07% (n=13) were on the waiting list for this treatment. Conclusions: A significant portion of the patients presented complaints and/or manifestations in the areas of human communication, especially regarding language, speech, and harmful oral habits. These data highlight the importance of referral to the speech therapy team. (AU)

Introducción: La colaboración entre genética médica y foniatría es esencial para desarrollar procedimientos que ayuden en el tratamiento de pacientes con trastornos de la comunicación. Objetivo:Analizar las características de patología del habla y lenguaje de pacientes pediátricos atendidos por un servicio de genética clínica. Método: Estudio transversal observacional con pacientes atendidos por el servicio de genética de un hospital en Porto Alegre. Se aplicó un cuestionario sobre audición, deglución, motricidad orofacial, voz y lenguaje. Resultados: La muestra consistió en 54 participantes con edades comprendidas entre 8 meses y 17 años (media: 6 años y 5 meses). El 24,07% (n=13) de los pacientes tenían un diagnóstico de síndrome, y el 59,26% (n=32) presentaron retraso en el desarrollo neuropsicomotor. En cuanto al perfil foniatra, el 81,48% (n=44) presentaron algún hábito oral perjudicial durante la infancia. El 16,67% (n=9) reportaron dificultades para oír, y el 29,62% (n=16) para tragar. El 85,19% (n=46) manifestaron lenguaje oral desarrollado y, de ellos, el 71,74% (n=33) realizaban intercambios en el habla. El 33,33% (n=18) de los pacientes ya estaban en tratamiento foniatra y el 24,07% (n=13) estaban en lista de espera para este tratamiento. Conclusiones: Una parte significativa de los pacientes presentó quejas y/o manifestaciones en las áreas de la comunicación humana, especialmente en relación con el lenguaje, el habla y los hábitos orales perjudiciales, enfatizando la importancia de la derivación al equipo de foniatría. (AU)

Early determination of potential critical quality attributes of therapeutic antibodies in developability studies through surface plasmon resonance-based relative binding activity assessment.

Precise measurement of the binding activity changes of therapeutic antibodies is important to determine the potential critical quality attributes (CQAs) in developability assessment at the early stage of antibody development. Here, we report a surface plasmon resonance (SPR)-based relative binding activity method, which incorporates both binding affinity and binding response and allows us to determine relative binding activity of antibodies with high accuracy and precision. We applied the SPR-based relative binding activity method in multiple forced degradation studies of antibody developability assessment. The current developability assessment strategy provided comprehensive, precise characterization of antibody binding activity in the stability studies, enabling us to perform correlation analysis and establish the structure-function relationship between relative binding activity and quality attributes. The impact of a given quality attribute on binding activity could be confidently determined without isolating antibody variants. We identified several potential CQAs, including Asp isomerization, Asn deamidation, and fragmentation. Some potential CQAs affected binding affinity of antibody and resulted in a reduction of binding activity. Certain potential CQAs impaired antibody binding to antigen and led to a loss of binding activity. A few potential CQAs could influence both binding affinity and binding response and cause a substantial decrease in antibody binding activity. Specifically, we identified low abundance Asn33 deamidation in the light chain complementarity-determining region as a potential CQA, in which all the stressed antibody samples showed Asn33 deamidation abundances ranging from 4.2% to 27.5% and a mild binding affinity change from 1.76 nM to 2.16 nM.

Private management of African protected areas improves wildlife and tourism outcomes but with security concerns in conflict regions.

Protected areas can conserve wildlife and benefit people when managed effectively. African governments increasingly delegate the management of protected areas to private, nongovernmental organizations, hoping that private organizations' significant resources and technical capacities actualize protected areas' potential. Does private sector management improve outcomes compared to a counterfactual of government management? We leverage the transfer of management authority from governments to African Parks (AP)-the largest private manager of protected areas in Africa-to show that private management significantly improves wildlife outcomes via reduced elephant poaching and increased bird abundances. Our results also suggest that AP's management augments tourism, while the effect on rural wealth is inconclusive. However, AP's management increases the risk of armed groups targeting civilians, which could be an unintended outcome of AP's improved monitoring and enforcement systems. These findings reveal an intricate interplay between conservation, economic development, and security under privately managed protected areas in Africa.

Attentional Bias, Pupillometry, and Spontaneous Blink Rate: Eye Characteristic Assessment Within a Translatable Nicotine Cue Virtual Reality Paradigm.

Background: Incentive salience processes are important for the development and maintenance of addiction. Eye characteristics such as gaze fixation time, pupil diameter, and spontaneous eyeblink rate (EBR) are theorized to reflect incentive salience and may serve as useful biomarkers. However, conventional cue exposure paradigms have limitations that may impede accurate assessment of these markers. Objective: This study sought to evaluate the validity of these eye-tracking metrics as indicators of incentive salience within a virtual reality (VR) environment replicating real-world situations of nicotine and tobacco product (NTP) use. Methods: NTP users from the community were recruited and grouped by NTP use patterns: nondaily (n=33) and daily (n=75) use. Participants underwent the NTP cue VR paradigm and completed measures of nicotine craving, NTP use history, and VR-related assessments. Eye-gaze fixation time (attentional bias) and pupillometry in response to NTP versus control cues and EBR during the active and neutral VR scenes were recorded and analyzed using ANOVA and analysis of covariance models. Results: Greater subjective craving, as measured by the Tobacco Craving Questionnaire-Short Form, following active versus neutral scenes was observed (F1,106=47.95; P<.001). Greater mean eye-gaze fixation time (F1,106=48.34; P<.001) and pupil diameter (F1,102=5.99; P=.02) in response to NTP versus control cues were also detected. Evidence of NTP use group effects was observed in fixation time and pupillometry analyses, as well as correlations between these metrics, NTP use history, and nicotine craving. No significant associations were observed with EBR. Conclusions: This study provides additional evidence for attentional bias, as measured via eye-gaze fixation time, and pupillometry as useful biomarkers of incentive salience, and partially supports theories suggesting that incentive salience diminishes as nicotine dependence severity increases.

The trend of the quality of cause-of-death data and its association with socio-economic indicators in Serbia in the period 2005-19.

This study aims to evaluate the temporal trend in the quality of cause-of-death data and garbage code profiles and to determine its association with socio-economic status in Serbia. A longitudinal study was assessed using data from mortality registers from 2005 to 2019. Computer application Analysis of Causes of National Deaths for Action (ANACONDA) calculates the distribution of garbage codes by severity and composite quality indicator: Vital Statistics Performance Index for Quality (VSPI(Q)). A relationship between VSPI(Q) and country development was estimated by analysing two socio-economic indicators: the Socio-demographic Index and the Human Development Index (HDI). Serbia indicates progress in strengthening cause-of-death statistics. The steady upward trend of the VSPI(Q) index has risen from 55.6 (medium quality) to 70.2 (high quality) over the examined years. Significant reduction of 'Insufficiently specified causes with limited impact' (Level 4) and an increase in the trend of 'High-impact garbage codes' (Levels 1 to 3) were evident. Decreased deaths of no policy value (annual percentage change of -1.41%) have manifested since 2014. A strong positive association between VSPI(Q) and socio-economic indicators was assessed, where the HDI has shown a stronger association with VSPI(Q). Improved socio-economic conditions on the national level are followed by enhanced cause-of-death data quality. Upcoming actions to improve quality should be directed at high-impact garbage codes. The study underlines the need to prioritise the education and training of physicians with a crucial role in death certification to overcome many cause-of-death quality issues identified in this assessment.

Quantitative assessment of preoperative brain development in pediatric congenital heart disease patients by synthetic MRI.

OBJECTIVES: This study investigated the quantitative assessment and application of Synthetic MRI (SyMRI) for preoperative brain development in children with congenital heart disease (CHD). METHODS: Forty-three CHD patients aged 2-24 months were prospectively included in the observation group, and 43 healthy infants were included in the control group. The SyMRI scans were processed by postprocessing software to obtain T1, T2, and PD maps. The values of T1, T2, and PD in different brain regions were compared with the scores of the five ability areas of the Gesell Development Scale by Pearson correlation analysis. RESULTS: In the observation group, the T1 values of the posterior limb of the internal capsule (PLIC), Optic radiation (PTR), cerebral peduncle, centrum semiovale, occipital white matter, temporal white matter, and dentate nucleus were greater than those in the control group. In the observation group, the T2 values of the PLIC, PTR, frontal white matter, occipital white matter, temporal white matter, and dentate nucleus were greater than those in the control group. Pearson correlation analysis revealed that the observation group had significantly lower Development Scale scores. In the observation group, the T2 value of the splenium of the corpus callosum was significantly positively correlated with the personal social behavior score. The AUCs for diagnosing preoperative brain developmental abnormalities in children with CHD using T1 values of the temporal white matter and dentate nucleus were both greater than 0.60. CONCLUSIONS: Quantitative assessment using SyMRI can aid in the early detection of preoperative brain development abnormalities in children with CHD. CRITICAL RELEVANCE STATEMENT: T1 and T2 relaxation values from SyMRI can be considered as a quantitative imaging marker to detect abnormalities, allowing for early clinical evaluation and timely intervention, thereby reducing neurodevelopmental disorders in these children. KEY POINTS: T1 and T2 relaxation values by SyMRI are related to myelin development. Evaluated development quotient markers were lower in the observation compared to the control group. SyMRI can act as a reference indicator for brain development in CHD children.

From Rhetoric to Action: Justice, Equity, Diversity, and Inclusion in Coordinated Specialty Care for Early Psychosis.

Attention to inclusivity and equity in health research and clinical practice has grown in recent years; however, coordinated specialty care (CSC) for early psychosis lags in efforts to improve equity despite evidence of ongoing disparities and inequities in CSC care. This Open Forum argues that marginalization and disparities in early psychosis research and clinical care are interrelated, and the authors provide suggestions for paths forward. Commitment to equity and justice demands recentering the perspectives of those most affected by early psychosis services and investing in the integration of historically excluded perspectives across all aspects of practice, policy, and research.

Mapping sustainability: A comparative analysis proposal across EU countries and regions.

This paper addresses the need to understand the structure of sustainability change in the face of the unpredictability of modern civilization. The aim of the paper is to examine the structure of sustainability change in relation to smaller spatial units such as the regions of the European Union and to compare these results with those achieved at the country level. For this purpose, the sustainable development indicators available in the Eurostat database were analyzed. Studies published to date have tended to focus on the performance of national economies or selected regions. In this article, the available data on regions are also analyzed. The study aims to compare the level of sustainable development achieved at the level of EU countries and regions located within them. Methodologically, the study uses advanced methods of comparative analysis, and the synthesis of the data enables the construction of a synthetic measure using taxonomic methods, facilitating the classification of EU countries and regions into clusters. The results highlight significant divergences in sustainability achievements between EU countries and regions. The study reveals the importance of studying sustainable development in smaller geographical cross-sections. The results highlight the need to expand access to data at the regional level (sustainability indicators) to facilitate more comprehensive analyses and inform targeted policy interventions. Looking to the future, the study recommends further research into the inter-linkages between sustainability and other critical areas in EU regions, such as innovation and competitiveness.

An Overview of Continuing Medical Education/Continuing Professional Development Systems in China: A Mixed Methods Assessment.

Aims of this assessment were to describe requirements for physicians to engage in CME/CPD; explore perceptions of In-Country SMEs of their CME/CPD systems; describe perceptions of In-Country physicians about interprofessional continuing education (IPCE) and independent CME/CPD; and provide recommendations that may be adopted to improve quality and effectiveness. This assessment used a mixed-methods approach that included 1:1 interviews with in-country subject matter experts and an electronic survey capturing qualitative and quantitative data from practicing in-country physicians. This assessment reflects a country invested in the education of its physician workforce. CME/CPD systems have embedded governance structures, organizations authorized to provide education, and a recognized credit system. Governing bodies have implemented regulations to limit influence from commercial interest organizations on CME/CPD, and there is opportunity to expand delivery systems to reach physicians across diverse geographic regions, better align content to individual physicians' gaps and learning needs, and reduce cost. There is opportunity to invest in IPCE within a country with a strong professional hierarchy system. This assessment reflects CME/CPD systems that are relatively mature and identifies several opportunities to expand and enhance systems to better meet educational needs of physicians and to positively impact practice and patient outcomes.

Vigilancia científica y tecnológica en procesos de modificación físico-enzimática en gránulos de almidón / Scientific and technological watch on physical-enzymatic modification processes in starch granules

RESUMEN Las demandas actuales de las industrias hacen necesario recurrir a nuevas herramientas para la generación de desarrollo e innovación tecnológica, por lo cual, se ha identificado la necesidad de implementar tecnologías en la búsqueda de tendencias en el campo de los procesos de modificación de los materiales amiláceos. Este estudio tuvo por objetivo determinar la dinámica de producción científica, por medio de herramientas de innovación, como la vigilancia científica en la modificación de almidones por hidrólisis enzimática, asistida por tecnologías emergentes. Para ello, se realizó un análisis cuantitativo de los resultados, a partir de recopilaciones de datos derivados de bases científicas, reportados en clústeres y mapas de tendencias, con información sobre las principales revistas, autores, línea de tiempo, entidades y áreas de conocimiento en la modificación físico-enzimática del almidón. Esta vigilancia permitió identificar que las investigaciones se están orientando a las modificaciones duales y la aplicación de tecnologías emergentes (campos eléctricos, ultrasonido y microondas), como métodos alternativos en la modificación del almidón de cereales y tubérculos.

ABSTRACT The current demands of the industries make it necessary to resort to new tools for the generation of technological development and innovation, therefore, the need to implement technologies in the search for trends in the field of starch modification processes has been identified. The objective of this study was to determine the dynamics of scientific production by means of innovation tools such as scientific surveillance in starch modification by enzymatic hydrolysis assisted by emerging technologies. For this purpose, a quantitative analysis of the results was carried out based on compilations of data derived from scientific databases reported in clusters and trend maps with information on the main journals, authors, timelines, entities, and areas of knowledge in starch physico-enzymatic modification. This monitoring allowed the identification that research is being oriented to dual modifications and the application of emerging technologies (electric fields, ultrasound, and microwaves) as alternative methods in the modification of cereal and tuber starch.

El progreso en medicina y la inteligencia artificial / Progress in medicine and artificial intelligence

Resumen Este ensayo cuestiona, a propósito de la medicina, la idea de progreso como desarrollo tecnológico al centrarlo en las personas y no en las cosas. Se analiza cómo el predominio de tal idea de progreso convierte a las sociedades actuales al tecno-fetichismo que degrada la vida comunitaria y la práctica médica contribuyendo a la medicalización de la vida social. Se argumenta que la realización de las potencialidades tecnológicas depende de sus formas de uso, que el móvil principal del desarrollo tecnológico es el lucro sin límites, y que los desarrollos prioritarios son los que potencian el control social que mantiene el statu quo. Se critica la idea de inteligencia como cociente intelectual al proponerla como atributo del ser humano como un todo, manifiesto en las formas pensar y proceder de las personas en sus circunstancias, donde la afectividad y el pensamiento crítico son imprescindibles para su desarrollo. Se destaca que su antecedente es el concierto armónico de la vida planetaria contrastante con la disarmonía humana imperante. Se plantea que la inteligencia artificial es la más reciente hechura del tecno-fetichismo que deposita en la tecnología atributos vitales, y que sus formas de uso acentuarán la degradación de la vida humana y planetaria. Se propone otra idea de progreso médico basado en formas de organización propicias para el desarrollo de aptitudes inquisitivas, críticas y colaborativas que impulsen la superación permanente, cuyo horizonte lejano es el progreso dignificante: sublimación espiritual, intelectual, moral y convivencial de las colectividades en armonía con el ecosistema planetario.

Abstract This essay questions, with regard to medicine, the idea of progress as technological development by focusing on people rather than things. It analyzes how the predominance of such an idea of progress converts today’s societies to techno-fetishism that degrades community life and medical practice, contributing to the medicalization of social life. It is argued that the realization of technological potentialities depends on their forms of use; that the main motive of technological development is unlimited profit and that priority developments are those that enhance the social control that maintains the status quo. The intelligence as an intelligence quotient is criticized by proposing it as an attribute of the human being as a whole, manifested in the ways of thinking and proceeding of people in their circumstances, where affectivity and critical thinking are essential for their development; it is emphasized that its antecedent is the harmonic concert of planetary life that contrasts with the prevailing human disharmony. It is proposed that artificial intelligence is the most recent creation of techno-fetishism that deposits vital attributes in technology and that its forms of use will accentuate the degradation of human and planetary life. Another idea of medical progress is proposed, based on forms of organization conducive to the development of inquisitive, critical and collaborative skills that promote permanent improvement, whose distant horizon is dignifying progress: spiritual, intellectual, moral and convivial sublimation of collectivities in harmony with the planetary ecosystem.

A comprehensive analysis of leadership attributes, discrepancies, and implications for gender equity in vascular surgery.

OBJECTIVE: Well-developed leadership skills have been associated with a better understanding of health care context, increased team performance, and improved patient outcomes. Surgeons, in particular, stand to benefit from leadership development. Although studies have focused on investigating knowledge gaps and needs of surgeons in leadership roles, there is a noticeable gap in the literature concerning leadership in vascular surgery. The goal of this study was to characterize current leadership attributes of vascular surgeons and understand demographic influences on leadership patterns. METHODS: This retrospective cohort study was a descriptive analysis of vascular surgeons and their observers who took the Leadership Practices Inventory (LPI) from 2020 to 2023. The LPI is a 30-question inventory that measures the frequency of specific leadership behaviors across five practices of leadership. RESULTS: A total of 110 vascular surgeons completed the LPI. The majority of participants were White (56%) and identified as male (60%). Vascular surgeons most frequently observed the "enabling others to act" leadership practice style (8.90 ± 0.74) by all evaluators. Vascular surgeons were most frequently above the 70th percentile in the "challenge the process" leadership practice style (49%) compared with the average of other leaders worldwide. Observers rated vascular surgeons as displaying significantly more frequent leadership behaviors than vascular surgeons rated themselves in every leadership practice style (P < .01). The only demographic variable associated with a significantly increased occurrence of achieving 70th percentile across all five leadership practice styles was the male gender: a multivariable model adjusting for objective experience showed that men were at least 3.5 times more likely to be rated above the 70th percentile than women. CONCLUSIONS: Vascular surgeons under-report the frequency at which they practice leadership skills across all five leadership practice styles and should recognize their strengths of enabling others to act and challenging the process. Men are recognized as exhibiting all five leadership practices more frequently than women, regardless of current position or experience level. This observation may reflect the limited leadership positions available for women, thereby restricting their opportunities to demonstrate leadership practices as frequently or recognizably as their male counterparts.

Quantitative Evaluation of the Real-World Harmonization Status of Laboratory Test Items Using External Quality Assessment Data.

Background: In recent decades, the analytical quality of clinical laboratory results has substantially increased because of collaborative efforts. To effectively utilize laboratory results in applications, such as machine learning through big data, understanding the level of harmonization for each test would be beneficial. We aimed to develop a quantitative harmonization index that reflects the harmonization status of real-world laboratory tests. Methods: We collected 2021-2022 external quality assessment (EQA) results for eight tests (HbA1c, creatinine, total cholesterol, HDL-cholesterol, triglyceride, alpha-fetoprotein [AFP], carcinoembryonic antigen [CEA], and prostate-specific antigen [PSA]). This EQA was conducted by the Korean Association of External Quality Assessment Service, using commutable materials. The total analytical error of each test was determined according to the bias% and CV% within peer groups. The values were divided by the total allowable error from biological variation (minimum, desirable, and optimal) to establish a real-world harmonization index (RWHI) at each level (minimum, desirable, and optimal). Good harmonization was arbitrarily defined as an RWHI value ≤ 1 for the three levels. Results: Total cholesterol, triglyceride, and CEA had an optimal RWHI of ≤ 1, indicating an optimal harmonization level. Tests with a desirable harmonization level included HDL-cholesterol, AFP, and PSA. Creatinine had a minimum harmonization level, and HbA1c did not reach the minimum harmonization level. Conclusions: We developed a quantitative RWHI using regional EQA data. This index may help reflect the actual harmonization level of laboratory tests in the field.

Cost, Usability, Credibility, Fairness, Accountability, Transparency, and Explainability Framework for Safe and Effective Large Language Models in Medical Education: Narrative Review and Qualitative Study.

BACKGROUND: The world has witnessed increased adoption of large language models (LLMs) in the last year. Although the products developed using LLMs have the potential to solve accessibility and efficiency problems in health care, there is a lack of available guidelines for developing LLMs for health care, especially for medical education. OBJECTIVE: The aim of this study was to identify and prioritize the enablers for developing successful LLMs for medical education. We further evaluated the relationships among these identified enablers. METHODS: A narrative review of the extant literature was first performed to identify the key enablers for LLM development. We additionally gathered the opinions of LLM users to determine the relative importance of these enablers using an analytical hierarchy process (AHP), which is a multicriteria decision-making method. Further, total interpretive structural modeling (TISM) was used to analyze the perspectives of product developers and ascertain the relationships and hierarchy among these enablers. Finally, the cross-impact matrix-based multiplication applied to a classification (MICMAC) approach was used to determine the relative driving and dependence powers of these enablers. A nonprobabilistic purposive sampling approach was used for recruitment of focus groups. RESULTS: The AHP demonstrated that the most important enabler for LLMs was credibility, with a priority weight of 0.37, followed by accountability (0.27642) and fairness (0.10572). In contrast, usability, with a priority weight of 0.04, showed negligible importance. The results of TISM concurred with the findings of the AHP. The only striking difference between expert perspectives and user preference evaluation was that the product developers indicated that cost has the least importance as a potential enabler. The MICMAC analysis suggested that cost has a strong influence on other enablers. The inputs of the focus group were found to be reliable, with a consistency ratio less than 0.1 (0.084). CONCLUSIONS: This study is the first to identify, prioritize, and analyze the relationships of enablers of effective LLMs for medical education. Based on the results of this study, we developed a comprehendible prescriptive framework, named CUC-FATE (Cost, Usability, Credibility, Fairness, Accountability, Transparency, and Explainability), for evaluating the enablers of LLMs in medical education. The study findings are useful for health care professionals, health technology experts, medical technology regulators, and policy makers.

Household-level data on well-being, inequalities, and social capital in Western Province, Zambia.

This article presents survey data from households from the Muoyo-Mukukutu area in Western Province, Zambia based on stratified sampling. Data from 411 households were collected using a questionnaire survey from 2022. Understanding the complexities of well-being is crucial for informing policies to enhance the quality of life and reduce multidimensional poverty in developing countries. Hence, the survey focuses on subjective and objective well-being and their determinants. Survey data contains details on various dimensions of objective well-being, such as living standards, health, and nutrition. It also covers the issue of subjective well-being (life satisfaction), including the related concept of freedom of choice. Moreover, we collected detailed information about diverse forms of inequalities and deprivations at the societal and intra-household level, paying particular attention to the areas of social capital and decision-making power. Additionally, the data contain details about the relationships with and attitudes to traditional leaders and statutory government representatives, respondents' economic activities and aspirations (with a special focus on agriculture), and their various socio-demographic characteristics. Individual survey results can be compared with a robust set of data as we intentionally used questions applied in other international surveys when possible.

Development of a postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract: a reliability and validity study.

OBJECTIVE: To develop a comprehensive compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts and to assess its reliability and validity. METHOD: Drawing on the Interactive Model of Health Behavior, we conducted a literature review and semi-structured interviews to create a pool of 36 items. The items underwent rigorous evaluation through the Delphi method, face validity checks, and item analysis, leading to a reduction to 18 items. To assess the scale's reliability and validity, we collected data from 225 parents of children with congenital cataracts. We employed SPSS version 25.0 for data analysis and evaluated construct validity using exploratory factor analysis, content validity, internal consistency reliability, and test-retest reliability. RESULTS: The compliance scale for postoperative visual function rehabilitation in children with congenital cataracts comprises 5 dimensions and 18 items. Exploratory factor analysis extracted 5 common factors, with a cumulative variance contribution rate of 68.178%. Item-level content validity index ranged from 0.730 to 1.000, and the content validity index of the scale was 0.963. The total Cronbach's alpha coefficient, split-half reliability, and test-retest reliability of the scale were 0.855, 0.778, and 0.859, respectively. CONCLUSIONS: The compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts demonstrates acceptable reliability and validity. It serves as a valuable reference for developing standardized nursing programs for these children in clinical practice.

Assessment of Neonatal Mortality and Associated Hospital-Related Factors in Healthcare Facilities Within Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana.

Objectives: Ghana's quest to reduce neonatal mortality, in hospital facilities and communities, continues to be a nightmare. The pursuit of achieving healthy lives and well-being for neonates as enshrined in Sustainable Development Goal three lingered in challenging hospital facilities and communities. Notwithstanding that, there have been increasing efforts in that direction. This study examines the contributing factors that hinder the fight against neonatal mortality in all hospital facilities in the Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana. Methods: The study utilized neonatal mortality data consisting of neonatal deaths, structural facility related variables, medical human resources, types of hospital facilities and natal care. The data was collected longitudinally from 2014 to 2019. These variables were analysed using the negative binomial hurdle regression (NBH) model to determine factors that contribute to this menace at the facility level. Cause-specific deaths were obtained to determine the leading causes of neonatal deaths within health facilities in the two municipal assemblies. Results: The study established that the leading causes of neonatal mortality in these districts are birth asphyxia (46%), premature birth (33%), neonatal sepsis (11%) and neonatal jaundice (7%). The NBH showed that neonatal mortality in hospital facilities depend on the number of incubators, monitoring equipment, hand washing facilities, CPAPb machines, radiant warmers, physiotherapy machines, midwives, paediatric doctors and paediatric nurses in the hospital facility. Conclusions: Early management of neonatal sepsis, birth asphyxia, premature birth and neonatal infections is required to reduce neonatal deaths. The government and all stakeholders in the health sector should provide all hospital facilities with the essential equipment and the medical human resources necessary to eradicate the menace. This will make the realization of Sustainable Development Goal three, which calls for healthy lives and well-being for all, a reality.

Influence of socio-family variables on parental assessment of the pragmatic development of children under 4 years of age.

Introduction: Interest in pragmatic development and its assessment has increased in recent years, not only because of the predictive value of pragmatic impairments as warning signs in the detection of multiple developmental disorders, but also because of the consideration that pragmatics has received in the field of mental disorders. Current contexts of child development assessment require pragmatic assessment instruments that accurately define profiles and take into account the immediate context in which they develop. Parents' knowledge of their children's abilities is supported by exhaustive observation over time of regularities in their behavior. But it is true that the way a caregiver interprets behavior is mediated by multiple variables. The aim of the present study, therefore, is to shed light on the possible influence of parental belief systems on the assessment of children's pragmatic development by analyzing the relationship between sociofamilial variables and the assessment of pragmatic competence. Method: A total of 215 educational centers across Spain participated in the study. The final sample was of 262 parents of boys and girls between 6 and 48 months of age. The parental questionnaire for the evaluation of pragmatic development, The Pragmatics Profile, in an adapted Spanish version, was applied along with a number of items for the evaluation of parental beliefs. Results: Analyses confirm the existence of an effect of child development conceptions and other socio-familial variables on the assessment of pragmatic development between 6 and 48 months of age. Furthermore, the results indicate that better scores on pragmatic development are associated with parents with higher socioeconomic and educational levels, greater number of children and more interactionist conceptions and realistic. Conclusion: The effect of parental conceptions on the evaluation of pragmatics points to the need to obtain convergent measures in an area as complex as that of communicative development in early childhood, especially taking into account that an evaluation which is neutral and free from context is not possible or indeed desirable. Pragmatic development must be evaluated within this contextual framework and should take into account each of the variables present therein. Hence the complementarity between parental reports and performance-based test.