Raising patient voices in medical education: an assessment of patient perceived effect of social determinants of health conversations and the patient-physician relationship on quality of obstetric care, to inform the development of patient driven medical education curricula.

Background: Conventional medical education lacks the lived experiences of patients which may authentically convey the social determinants of health (SDOH) and resulting health disparities. Videos of first-person patient narratives may prove a valuable education tool in this regard. The objective of this study is to investigate how patient demographics, satisfaction with care, and patient-physician relationships influence obstetric patient interest and willingness to contribute to a SDOH video curriculum by sharing their lived experiences through first-person narratives. Methods: Study design included an anonymous, cross-sectional survey and an optional semi-structured telephone interview. Participants were 18 years old with a live-birth delivery <8 weeks prior to recruitment and received care during their pregnancy at Los Angeles General Medical Center (LAGMC). Variables surveyed included demographics, satisfaction with care, aspects of the patient-physician relationship, perceived utility, and personal interest in contributing to an educational SDOH video. A bivariate analysis was conducted to compare participants' characteristics and responses on interest in contributing and perceived helpfulness of first-person patient SDOH videos. Results: 72.43% of participants (N = 70) believed a patient's first-person video on SDOH would be "Helpful" in preparing physicians to provide competent medical care; however, 71.43% responded "No" to "Interest" in sharing with physicians their experiences with SDOH. English preference and being U.S. born were factors significantly associated with viewing first-person SDOH video as "Helpful" (P > 0.001). Major themes from telephone interviews reflected enthusiasm for first-person patient narratives and perceived benefits of using patient experiences to educate physicians on SDOH. However, participants cited barriers to disclosing SDOH including brief and strictly clinical interactions with physicians, lack of continuity of care, and fear of being judged by physicians. Conclusion: While most participants recognized the utility of addressing social needs in medical education and reported satisfaction with their obstetricians and care, these factors did not uniformly translate into willingness to contribute first-person patient narratives. To improve the representation of patients from racial, ethnic, gender, linguistic, and sexual minorities into medical curricula, further research and strategies are needed to overcome the barriers discouraging patient disclosure of social needs to physicians.

Safety window for the transsphenoidal approach for pituitary tumours: a computed tomographic angiography study.

BACKGROUND: The aims are to evaluate the morphometry of the sellar region and propose a safety window on the floor of the sella turcica for the transsphenoidal approach in a Hispanic population. MATERIALS AND METHODS: We retrospectively analysed 150 computed tomographic angiography sellar region images from asymptomatic patients. The images were evaluated intraobservatory by an expert radiologist. We measured: intercarotid distance of cavernous segment; depth of sella turcica; skull base angle; anterior distance, the distance between anterior spinal nasal and floor of the sella turcica; posterior distance, the distance between anterior spinal nasal and posterior wall of the sella turcica; anterior surgical angle, formed between the floor of the nostril and superior limit of the anterior wall of the sella turcica; and posterior angle, formed between the floor of the nostril and the inferior limit of the posterior wall of the sella turcica. RESULTS: Safety window was based on two measures: the intercarotid distance and depth. The mean of the safety window is 151.13 mm² and 147.60 mm² for men and women, respectively. The intercarotid distance was 17.83 mm. The depth of the sella turcica was 8.46 mm. The skull base angle was 112.13 grades. The anterior distance was 76.34 mm. The posterior distance was 87.59 mm. The anterior surgical angle was 32.76 grades. The posterior surgical angle was 87.59 grades. CONCLUSIONS: The surgical approach space is smaller in females. It could significate a more complicated surgery in this population. Anatomical understanding could reduce complications in hospitals without a neuronavigation system.

Exposure to the COVID-19 pandemic environment and generosity.

We report data from an online experiment which allows us to study how generosity changed over a 6-day period during the initial explosive growth of the COVID-19 pandemic in Andalusia, Spain, while the country was under a strict lockdown. Participants (n = 969) could donate a fraction of a €100 prize to an unknown charity. Our data are particularly rich in the age distribution and we complement them with daily public information about COVID-19-related deaths, infections and hospital admissions. We find correlational evidence that donations decreased in the period under study, particularly among older individuals. Our analysis of the mechanisms behind the detected decrease in generosity suggests that expectations about others' behaviour, perceived mortality risk and (alarming) information play a key-but independent-role for behavioural adaptation. These results indicate that social behaviour is quickly adjusted in response to the pandemic environment, possibly reflecting some form of selective prosociality.

Propuesta teórica para el cambio de conducta en el consumo excesivo de alcohol en adolescentes / Theory-based proposal for changing the behavior of adolescents consuming alcohol in excess / Proposta teórica para mudança de comportamento no consumo excessivo de álcool em adolescentes

RESUMEN Introducción El consumo de alcohol en los adolescentes es un problema cada vez más frecuente y va en aumento debido a que el consumo episódico excesivo es una tendencia cada vez más común en esta población. Para el profesional de enfermería de primer nivel de atención, se vuelve necesario implementar herramientas sustentadas en evidencia científica como una alternativa factible que responda a las necesidades actuales. Objetivo Desarrollar una propuesta de aplicación a partir de la Teoría de Situación Específica del Modelo de Intención de Cambio (I-Change) enfocada al cambio de conducta del consumo excesivo de bebidas alcohólicas en adolescentes. Desarrollo Se utilizó la metodología de tres pasos propuesta por Fawcett. Para la revisión de literatura sobre consumo excesivo de bebidas alcohólicas, se emplearon términos en inglés y español, así como los operadores booleanos AND y OR en diversas bases de datos, posteriormente se construyó una estructura conceptual teórico-empírica de la propuesta de la Teoría de Situación Específica para el consumo excesivo de bebidas alcohólicas. Conclusiones La presente propuesta supone una alternativa para lograr el cambio de conducta del consumo excesivo de bebidas alcohólicas a través de un proceso motivacional de tres fases (premotivacional, motivacional y postmotivacional). Implementar esta propuesta, busca dar solución a una problemática que genera una carga importante de salud en una población vulnerable. Los hallazgos derivados de su aplicación pueden aportar evidencia para la labor del profesional de enfermería en el campo de la prevención del consumo de alcohol.

ABSTRACT Introduction Alcohol consumption among adolescents is a growing and frequent problem. Moreover, the episodic but excessive consumption of alcohol is becoming more common among the population. This situation makes it necessary for the nursing professional practicing in primary care to implement strategies and tools based on scientific evidence to address this problem. Objective Based on the Change Intention Model Specific Situation Theory (I-Change), to develop a proposal aimed at changing the behaviors of adolescents who binge drinking. Development The three steps methodology proposed by Fawcett was used. Using both English and Spanish terms, as well as the boolean operators AND and OR, diverse databases, were consulted regarding the literature on binge drinking. The conceptual theoretical- empirical structure of the proposal based on the Specific Situation Theory (binge drinking) was then constituted. Conclusions The present proposal offers an alternative to achieve a behavior change regarding binge drinking through a motivational process of three phases: pre-motivational, motivational, and post-motivational. This proposal can be implemented in order to address the problem of binge drinking among adolescents. The findings derived from this application can further provide evidence to the nursing professionals practicing alcohol consumption prevention.

RESUMO Introdução O consumo de álcool em adolescentes é um problema cada vez mais frequente e está aumentando, pois o consumo episódico excessivo é uma tendência cada vez mais comum nessa população. Para o profissional de enfermagem de atenção básica, torna-se necessária a implementação de ferramentas baseadas em evidências científicas como uma alternativa viável que responda às necessidades atuais. Objetivo Desenvolver uma proposta de aplicação baseada na Teoria da Situação Específica do Modelo de Intenção de Mudança (I-Change) focada na mudança comportamental no consumo excessivo episódico de álcool em adolescentes. Desenvolvimento Foi utilizada a metodologia de três etapas proposta por Fawcett. Para a revisão da literatura sobre o consumo episódico excessivo de álcool, foram utilizados termos em inglês e espanhol, bem como os operadores booleanos AND e OR em diversas bases de dados, posteriormente foi construída uma estrutura conceitual teórico-empírica da Teoria proposta. para o consumo episódico excessivo de álcool. Conclusões A presente proposta supõe uma alternativa para alcançar a mudança de comportamento do consumo episódico excessivo de álcool através de um processo motivacional de três fases (pré-motivacional, motivacional e pós-motivacional). A implementação desta proposta busca responder a um problema que gera uma carga significativa de saúde em uma população vulnerável. Os achados derivados de sua aplicação podem fornecer evidências para a atuação do profissional de enfermagem no campo da prevenção do consumo de álcool.

Registered Replication Report: Rand, Greene, and Nowak (2012).

In an anonymous 4-person economic game, participants contributed more money to a common project (i.e., cooperated) when required to decide quickly than when forced to delay their decision (Rand, Greene & Nowak, 2012), a pattern consistent with the social heuristics hypothesis proposed by Rand and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned to conditions and who met the protocol inclusion criteria (an intent-to-treat approach that included the 65.9% of participants in the time-pressure condition and 7.5% in the forced-delay condition who did not adhere to the time constraints), and we observed a difference in contributions of -0.37 percentage points compared with an 8.6 percentage point difference calculated from the original data. Analyzing the data as the original article did, including data only for participants who complied with the time constraints, the RRR observed a 10.37 percentage point difference in contributions compared with a 15.31 percentage point difference in the original study. In combination, the results of the intent-to-treat analysis and the compliant-only analysis are consistent with the presence of selection biases and the absence of a causal effect of time pressure on cooperation.

Immunophenotyping of peripheral blood, ranges of serum chemistries and clinical hematology values of healthy chimpanzees (Pan troglodytes).

This paper presents clinical chemistry, hematology and immunophenotyping data from 102 chimpanzees over a 2-year period. The groupings were: 3 years or less, 4-7 years, and 8 + years. These data are intended to augment formerly published information on these parameters and to serve as a concise reference guide for primate veterinarians and researchers for whom these data may be useful. This study has larger samplings than previously published data and more panel constituents by immunophenotyping.

Double or bifid zygomaticus major muscle: anatomy, incidence, and clinical correlation.

The anatomy of the double or bifid zygomaticus major muscle is investigated in a series of 50 hemifacial cadaver dissections. The double zygomaticus major muscle represents an anatomical variation of this muscle of facial expression. This bifid muscle originates as a single structure from the zygomatic bone. As it travels anteriorly, it then divides at the sub-zygomatic hollow into superior and inferior muscle bundles. The superior bundle inserts at the usual position above the comer of the mouth. The inferior bundle inserts into the modiolus below the corner of the mouth. The incidence of the double zygomaticus major muscle was 34% in the present study, as it was found to be present in 17 of 50 cadaver dissections. This study shows that variation in the individual morphology of the mimetic muscles can be a common finding. Clinically, the double or bifid zygomaticus major muscle may explain the formation of cheek "dimples." The inferior bundle was observed in several specimens to have a dermal attachment along its mid-portion, which tethers the overlying skin. When an individual with this anatomy smiles, traction on the skin may create a dimple due to this dermal tethering effect.

The anatomy of the labiomandibular fold.

The anatomy of the labiomandibular fold was evaluated in a series of 12 fresh hemifacial cadaver dissections. The techniques of methylene blue dye injection, histologic evaluation, and gross dissection all confirm that the labiomandibular fold has distinct anatomic boundaries. The superior boundary is formed by the cutaneous insertion of the depressor anguli oris muscle at the labiomandibular crease. The inferior boundary is determined by the mandibular ligament, which has been previously described. The cutaneous insertion of the depressor muscle and the mandibular ligament act as relative points of fixation. The dynamic forces of both aging and facial animation act about these two points to create the typical appearance of the labiomandibular fold. This anatomy is consistent with that seen in other areas of the face such as the nasolabial and nasojugal folds, where the dermal insertion of muscle and/or fascia defines an anatomically distinct region. Clinically, this anatomy may suggest that a subcutaneous plane of dissection during the face lift procedure may allow manipulation and reduction of the fat that was noted lateral to the dermal insertion of the depressor anguli muscle. Subcutaneous dissection also avoids lateral pull on the platysma muscle, which may tend to accentuate and distort the labiomandibular crease due to its intimate association with the overlying depressor muscle.

Brain and liver targeted overexpression of O6-methylguanine DNA methyltransferase in transgenic mice.

O6-Methylguanine DNA methyltransferase (MGMT; EC 2.1.1.63) is an unusual DNA repair protein in that it directly and specifically repairs a premutagenic DNA lesion without involving other proteins. MGMT removes the alkyl group from O6-alkylguanine in DNA in a unique stoichiometric reaction by accepting the alkyl group on a cysteine residue. The intracellular level of MGMT varies among tissues and appears to be inversely correlated to tissue-specific tumorigenesis induced by monofunctional alkylating agents. Because MGMT acts in solo, genetic manipulation of its expression may provide valuable insight into its contribution to cellular resistance to alkylation toxicity and to tumor induction. The human MGMT full length cDNA has been fused with a portion of the human transferrin (TF) 5'-flanking region (TF/MGMT). Transgenic founder mice were produced carrying the TF/MGMT transgene and then bred to establish stable transgenic lines. Human MGMT transcripts were specifically expressed in abundance in transgenic brain and liver tissues. In vitro MGMT assays revealed approximately 150-fold and approximately 25-fold increases in MGMT activity in transgenic brain and liver extracts respectively. Western blot analysis confirmed that human MGMT protein is specifically synthesized in transgenic brain and liver tissues.

[The primary outcome in transluminal coronary angioplasty: the recent experience of the Instituto Nacional de Cardiología (1991-1992)]. / Exito primario en angioplastía coronaria transluminal: experiencia reciente del Instituto Nacional de Cardiología (1991-1992).

Percutaneous balloon coronary angioplasty had a slow start in Mexico, and until recently only a relatively small number of procedures have been performed. Since March 1991, the Instituto Nacional de Cardiología has state-of-the-art fluoroscopic imaging and easy access to a variety of balloon coronary angioplasty catheters and accessories. Under these conditions, an increasing number of PTCAs have been performed (221 procedures in an initial 15 month period). The primary results of PTCA in this patient population is presented as a reference source for results of PTCA in our population. Indication for PTCA was stable angina in 31%, unstable angina in 64% and AMI in 5%. Forty-two percent of the procedures were for multivessel PTCA, with a total of 355 lesions approached (1.6 segments per patient). There were 34% type A, 51% type B and 15% type C lesions. Mean percent stenosis was reduced from 81% to 29% (p < 0.001). There was a 94% success rate in type A lesions, 89% in type B and 77% in type C lesions. Six patients required urgent CABG (2.7%), thirteen had a myocardial infarction (5.9%) and mortality was 1.35% (including one patient with cardiogenic shock who had a noncomplicated failure and had a late in-hospital death). We conclude that with adequate support and equipment, angioplasty results compare favorably to those reported by more experienced groups in developed nations. Also, the necessary number of procedures for the maintenance of competence in PTCA can be done in our country.

[Granulosa cell tumor with liver metastasis treated with partial hepatectomy and chemotherapy. Report of a case]. / Tumor de células de la granulosa metastásico a hígado tratado con hepatectomía parcial y quimioterapia. Reporte de un caso.

A patient with granulosa cell tumor recurrence 14 years after primary resection, was treated with partial hepatectomy and adjuvant chemotherapy (vinblastine, cisplatin and bleomycin). She achieved complete remission and is free of disease 18 months after treatment.

Mesenteric lymphadenectomy prevents postburn systemic spread of translocated bacteria.

We investigated the role of mesenteric lymph nodes in postburn systemic spread of intestinal bacteria. Group 1 minipigs (n=8) had a 40% third-degree burn. Group 2 minipigs (n=7) had the same burn injury, but their mesenteric lymph nodes were removed immediately after burn. Group 3 minipigs (n=8) had sham burn, and group 4 minipigs (n=6) had mesenteric lymph node removal under anesthesia. All minipigs were killed at 48 hours, and tissues were harvested for bacteriological culture. Group 1 showed a large number of positive cultures from several of the systemic organs. Group 2 demonstrated no positive cultures in any of the tissues except the peritoneal fluid. These data suggest that bacterial translocation occurs mainly via mesenteric lymphatics to mesenteric lymph nodes and, thence, into other systemic tissue. After major burns, mesenteric lymph nodes may become an additional focus of infection.

Case report: occupational therapy with a traumatic bilateral shoulder disarticulation amputee.

This report describes the application of occupational therapy to a patient with traumatic bilateral shoulder disarticulation. Treatment goals and methods for acute care, preprosthetic training, and prosthetic training are described and illustrated.