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As institutions continuously strive to align with the standards set forth within competency-based medical education, there is an increased need to produce evidence of learner achievement in the form of observable behaviors. However, the complexity of healthcare education and clinical environments make it challenging to generate valid and reliable behavioral assessments. In this article, we utilize our interdisciplinary knowledge from the perspectives of experts in medical education, assessment, and academic administration to provide tips to successfully incorporate behavioral assessments into instructional designs. These include tips for identifying the best assessment methods fit for purpose, guiding instructors in establishing boundaries of assessment, managing instructors, selecting raters, generating behavioral assessment guides, training raters, ensuring logistics support assessment strategies, and fostering capacity for iteration. These can be used by institutions to improve planning and implementation for longitudinal behavioral assessments.
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The electronic structure and related electronic properties of two novel isostructural octacyanometallates Cd2(H2O)4[MoIV(CN)8]·2H2O and Cd2(H2O)4[WIV(CN)8]·2H2O are described from a combined experimental and computational approach. The impact that the octacoordinated heavy metals W and Mo have on the electronic structure and optical response of isostructural materials whose electronic properties strongly depend on the crystal structure is discussed. It is found that the effect of the polarization power of the metal centers, combined with the ligand field of cyanos, produces considerable changes in the electronic structure and, consequently, in the band gap energy. The ab initio calculations, which were performed with generalized gradient PBE and hybrid HSE06 density functionals, accurately reproduce the electronic structure of [Mo(CN)8]4- and [W(CN)8]4- building units, revealing that the electronic transitions associated with the band gap energy have an origin in the charge transfer phenomena of metal to ligand nature. Moreover, the optical band gap transitions have an allowed indirect behavior in the Γ â M â D direction which is associated with the (x2 - y2) â π* transition. The allowed direct and indirect (experimental and theoretical) band gap energies together with the exciton effective masses are reported.
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In pigs, meat quality depends markedly on the fatty acid (FA) content and composition of the intramuscular fat, which is partly determined by the gene expression in this tissue. The aim of this work was to identify the link between muscle gene expression and its FA composition. In an (Iberian × Duroc) × Duroc backcrossed pig population, we identified modules of co-expressed genes, and correlation analyses were performed for each of them versus the phenotypes, finding four relevant modules. Two of the modules were positively correlated with saturated FAs (SFAs) and monounsaturated FAs (MUFAs), while negatively correlated with polyunsaturated FAs (PUFAs) and the omega-6/omega-3 ratio. The gene-enrichment analysis showed that these modules had over-representation of pathways related with the biosynthesis of unsaturated FAs, the Peroxisome proliferator-activated receptor signalling pathway and FA elongation. The two other relevant modules were positively correlated with PUFA and the n-6/n-3 ratio, but negatively correlated with SFA and MUFA. In this case, they had an over-representation of pathways related with fatty and amino acid degradation, and with oxidative phosphorylation. Using a graphical Gaussian model, we inferred a network of connections between the genes within each module. The first module had 52 genes with 87 connections, and the most connected genes were ADIPOQ, which is related with FA oxidation, and ELOVL6 and FABP4, both involved in FA metabolism. The second module showed 196 genes connected by 263 edges, being FN1 and MAP3K11 the most connected genes. On the other hand, the third module had 161 genes connected by 251 edges and ATG13 was the top neighbouring gene, while the fourth module had 224 genes and 655 connections, and its most connected genes were related with mitochondrial pathways. Overall, this work successfully identified relevant muscle gene networks and modules linked with FA composition, providing further insights on how the physiology of the pigs influences FA composition.
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Metaparasitylenchus hypothenemi is an endoparasitic nematode of the coffee berry borer Hypothenemus hampei. The nematode has only been recorded across a limited geographical range in coffee-growing areas of southeastern Mexico. Because of its confined geographical distribution, the effect of altitude, temperature, and mean annual precipitation on M. hypothenemi's presence/absence in the Soconusco region of Mexico was investigated. The geographical distribution of this parasite was predicted based on current data, using geographical information systems (GIS), the MaxEnt algorithm, and historical data to improve the prediction accuracy for other Neotropical regions. In Soconusco, the presence of this parasite is directly related to annual precipitation, especially in the areas with the highest annual rainfall (4000 - 4700 mm/year). Four species distribution models were generated for the Neotropical region with environmental variables for sites with parasite presence data, predicting a range of possible distribution with a high probability of occurrence in southeastern Mexico and southwestern Guatemala and a low probability in areas of Central and South America. Characterization of the abiotic habitat conditions suitable for M. hypothenemi development allows us to predict its distribution in the Neotropics and contributes to our understanding of its ecological relationship with environmental variables.
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Diet habits and nutrition quality significantly impact health and disease. Here is delve into the intricate relationship between diet habits, nutrition quality, and their direct impact on health and homeostasis. Focusing on (-)-Epicatechin, a natural flavanol found in various foods like green tea and cocoa, known for its positive effects on cardiovascular health and diabetes prevention. The investigation encompasses the absorption, metabolism, and distribution of (-)-Epicatechin in the human body, revealing a diverse array of metabolites in the circulatory system. Notably, (-)-Epicatechin demonstrates an ability to activate nitric oxide synthase (eNOS) through the G protein-coupled estrogen receptor (GPER). While the precise role of GPER and its interaction with classical estrogen receptors (ERs) remains under scrutiny, the study employs computational methods, including density functional theory, molecular docking, and molecular dynamics simulations, to assess the physicochemical properties and binding affinities of key (-)-Epicatechin metabolites with GPER. DFT analysis revealed distinct physicochemical properties among metabolites, influencing their reactivity and stability. Rigid and flexible molecular docking demonstrated varying binding affinities, with some metabolites surpassing (-)-Epicatechin. Molecular dynamics simulations highlighted potential binding pose variations, while MMGBSA analysis provided insights into the energetics of GPER-metabolite interactions. The outcomes elucidate distinct interactions, providing insights into potential molecular mechanisms underlying the effects of (-)-Epicatechin across varied biological contexts.
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In the last few years, there has been an increasing interest in solutions for sustainable agriculture to reduce negative impacts on the environment resulting from modern agricultural practices. The use of environmentally beneficial bacteria, like Pseudomonas, which can increase plant productivity by reducing growth time, is a promising opportunity for sustainable agriculture. Pseudomonas is a gram-negative bacterium genus, commonly present in soils, plants, and irrigation water. Pseudomonas has a wide range of metabolic routes that could benefit agriculture, such as nutrient uptake, pathogen suppression, heavy metal solubilization, drought tolerance, and high salt concentration tolerance. Pseudomonas may even be proposed as a potential tool for future agriculture on other planets, where the use of microorganisms would be essential for crop development in hostile and inhospitable environments. Hence, the present review discusses the potential use of Pseudomonas in sustainable agriculture on planet Earth and potentially on Mars, highlighting its role in plant growth enhancement and plant protection from pathogenic microorganisms.
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Agricultura , Pseudomonas , Pseudomonas/fisiología , Microbiología del Suelo , Desarrollo de la Planta/fisiologíaRESUMEN
Population genetics theory predicts a relationship between fitness, genetic diversity (H0) and effective population size (Ne), which is often tested through heterozygosity-fitness correlations (HFCs). We tested whether population and individual fertility and heterozygosity are correlated in two endangered Mexican spruces (Picea martinezii and Picea mexicana) by combining genomic, demographic and reproductive data (seed development and germination traits). For both species, there was a positive correlation between population size and seed development traits, but not germination rate. Individual genome-wide heterozygosity and seed traits were only correlated in P. martinezii (general-effects HFC), and none of the candidate single nucleotide polymorphisms (SNPs) associated with individual fertility showed heterozygote advantage in any species (no local-effects HFC). We observed a single and recent (c. 30 thousand years ago (ka)) population decline for P. martinezii; the collapse of P. mexicana occurred in two phases separated by a long period of stability (c. 800 ka). Recruitment always contributed more to total population census than adult trees in P. mexicana, while this was only the case in the largest populations of P. martinezii. Equating fitness to either H0 or Ne, as traditionally proposed in conservation biology, might not always be adequate, as species-specific evolutionary factors can decouple the expected correlation between these parameters.
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In celiac disease (CD) there is a state of hypercoagulability and multiple factors have been found that may be involved. Cases of association of CD and antiphospholipid síndrome (APS) have been described and several observational studies have found an increase in antiphospolipid antibodies (AAF) in patients with CD, so both entities may be interrelated, increasing the risk of thrombotic events. A descriptive case of a patient who is simultaneusly diagnosed with CD and APS is presented.
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The electronic structure and derived optical properties of five synthesized metal-dicyanoaurate(I), (K)M[Au(CN)2], (M = Mn, Co, Ni, Zn and Cd), coordination polymers are described from a combined experimental analysis and theoretical study based on density functional theory. In this sense, the topological features that influence the electronic structure, which in turn give rise to electronic transitions associated with the band gap energy, are studied from first principles calculations (with hybrid HSE06 and GGA-PBE density functionals) and electronic spectroscopy. The impact of gold (through spin-orbit coupling) and aurophilic interactions on the electronic transitions that gives rise to optical properties is described. The calculated projected density of states and band dispersion diagrams shed light on the molecular orbital distribution and the role of a dicyanoaurate(I) molecular block as the origin of the optical properties. Infrared, Raman and ultraviolet-visible spectroscopic analyses reveal the effect that charge transfer interactions, of a metal â ligand and metal â metal nature, have on the electronic behavior within the solids through association with the polarizing power of transition metals and gold atoms.
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INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.
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Cirrosis Hepática , Atención Perioperativa , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Atención Perioperativa/métodos , Atención Perioperativa/normas , México , Complicaciones Posoperatorias/prevención & controlRESUMEN
BACKGROUND: Pediatric iliofemoral venous thromboembolism that is resistant to conventional treatments poses significant management challenges. Stent placement represents a potentially underutilized strategy in children when stenosis or thrombosis persists intraprocedurally or recurs postoperatively, despite treatments such as venoplasty, lysis, and thrombectomy. OBJECTIVE: This study aims to report our institutional experience with iliofemoral stenting in 17 pediatric patients with recurrent iliofemoral venous thromboembolism or stenosis. MATERIALS AND METHODS: We performed an IRB-approved retrospective review of pediatric patients (<18 years of age) who underwent iliofemoral venous stenting for recurrent stenosis or thrombosis between January 2012 and December 2022 at a single tertiary care institution. Patient demographics, risk factors for venous thromboembolism, presenting symptoms, and procedural characteristics were recorded. The primary outcome was stent patency rates at interval imaging follow-up. RESULTS: Seventeen patients with mean age of 14.6 years (range 7-17) and mean BMI of 27.7 were stented during the study period. Sixteen of 17 patients presented with evidence of May-Thurner anatomy. 14/17 patients presented with acute iliofemoral venous thromboembolism, 2/17 with chronic venous thromboembolism, and 1/17 with left lower extremity swelling without thrombosis. Seventy-three total angiographic procedures were performed, which included angioplasty, lysis, and thrombectomy, and 23 stent placements. Patients underwent an average of 3 procedures (range 1-9) over a mean of 2.8 months (range 0-17 months) prior to undergoing stent placement. Stents were deployed successfully in all patients. The median follow-up was 18 months (range, 1-77 months). Primary and secondary patency rates were 13/17 (76%) and 14/14 (100%) at 12 months and 12/17 (71%) and 14/14 (100%) at 24 months, respectively. CONCLUSION: In our experience of 17 patients, stent placement appears to be a durable option for children with iliofemoral venous thromboembolism following failure to establish vessel patency or development of recurrent thrombosis/stenosis postoperatively.
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Vena Femoral , Vena Ilíaca , Stents , Humanos , Niño , Femenino , Masculino , Adolescente , Estudios Retrospectivos , Vena Femoral/cirugía , Vena Femoral/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/cirugía , Tromboembolia Venosa/diagnóstico por imagen , Resultado del Tratamiento , RecurrenciaRESUMEN
INTRODUCTION: Transfontanellar brain ultrasound is an essential tool for monitoring the size of the ventricles in preterm neonates and has many advantages over other alternative diagnostic techniques, including its accessibility and non-use of ionizing radiation. When considering the normal ventricular size, it is essential to have reference measurements based on age-matched populations. The objective of this article is to present our reference measures, based on a sample of preterm infants that we have studied. METHODS: A retrospective observational study was conducted. Measurements of the Levene index, frontal horn thickness, and Evans index were obtained in preterm neonates from 25 to 45 weeks, over a period of 5 years, between January 2016 and December 2020. After applying the exclusion criteria, a sample of 199 patients and 350 ultrasound scans were obtained. The independent samples t-test and the Mann-Whitney test were used for the comparison of samples. RESULTS: The distribution of the right and left Levene indices was normal (Shapiro-Wilk test with pâ¯=â¯0.16 and 0.05, respectively), unlike the thickness distribution of the frontal horns (pâ¯<â¯0.05 on both sides). No significant differences were detected between the sexes (pâ¯=â¯0.08). A linear correlation was found between the biparietal diameter and the Levene index. CONCLUSION: From the results obtained in our study, we present reference tables for ventricular size, with the 3rd, 25th, 50th, 75th, and 97th, being the first ones made in our country.
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Ventrículos Cerebrales , Recien Nacido Prematuro , Nomogramas , Humanos , Estudios Retrospectivos , Femenino , Masculino , Recién Nacido , Ventrículos Cerebrales/diagnóstico por imagen , Ventrículos Cerebrales/anatomía & histología , Valores de Referencia , Tamaño de los Órganos , Ultrasonografía/métodosRESUMEN
Limited English proficiency poses a significant barrier to health care, particularly in US border states, exacerbated by a nationwide shortage of interpreters. This growing disparity in language-concordant care underscores the need for solutions like integrating Medical Spanish Certification (MSC) into medical school curricula, a topic of considerable debate. Various arguments exist for and against including MSC in medical education, especially considering the increasing Hispanic/Latino patient population. This paper aims to present a balanced perspective on officially including MSC in medical school curricula. After discussing the various arguments, the authors suggest a balanced approach that addresses the challenges while leveraging the potential benefits of MSC in medical education.
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The generation of self-focusing beams of extreme ultraviolet (XUV) radiation using the focal cone high harmonic generation (FCHHG) technique is examined for high energy lasers. The FCHHG geometry is created by passing a focusing laser beam through a gas sheet prior to reaching focus and thus creating a converging beam of high harmonic radiation. This leads to a larger interaction area that increases the total area of XUV emission while not exceeding the saturation intensity of the target atoms or increasing the density of the atoms. Such a method allows for scaling of HHG to any incident laser power. An experiment was conducted demonstrating such scaling to incident 400 TW pulses, showing both the expected spectral signature of HHG and the converging cone of XUV radiation. It was found that this technique is very sensitive to spatial non-uniformity in the driving laser, which has become more prevalent in high energy laser systems.
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Foam targets have gained considerable importance over the last decade in laser-matter interaction. They find widespread applications such as in inertial confinement fusion and secondary sources for particles and radiation. At the same time, the advent of high repetition-rate laser systems, be they short-pulse in the tens of femtosecond regime or in the kilo-Joule nanosecond regime, calls for equally high repetition rate targetry systems. A well-established repetition-rate targetry system is the tape target. In this article, we present the successful marriage of a tape target delivery system with 3D-printed foam targets produced by two photon polymerization.
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Background: Rathke's cleft cyst (RCC) is a benign lesion in the sellar and suprasellar compartments. Similarly, pituitary adenomas can present with cystic morphology, making it a differential diagnosis when evaluating a patient with a cystic lesion in the sellar region. Surgical goals differ between RCCs and pituitary adenomas as the first can achieve remission of symptoms with cyst decompression in contrast to pituitary adenomas where complete resection would be the main goal. Imaging analysis alone may not be sufficient to define a preoperative surgical plan. The combination of imaging and conjoined use of validated tools may provide valuable insights to the clinician when defining a surgical approach. Case Description: We present a case of a 27-year-old male with a 3-month history of visual disturbances and headaches. Magnetic resonance imaging showed a cystic lesion in the sellar compartment with compression of nearby structures. The authors were able to accurately diagnose this sellar lesion as an RCC with the conjoined aid of two classifications proposed in the literature. Cyst evacuation was performed with relief of symptoms and improved visual outcomes at follow-up. Conclusion: While cystic adenomas can require total resection for cure, RCCs can show marked improvement with partial resection and evacuation of its contents. An accurate preoperative diagnosis can lead the surgeon to opt for the best surgical approach.
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OBJECTIVES: The aims of this study were to investigate the prevalence of dose reduction in patients with SLE treated with belimumab (BEL) in Spain, analyze treatment modalities, and determine impact on control of disease activity. METHODS: Retrospective longitudinal and multicentre study of SLE patients treated with BEL. Data on disease activity, treatments and outcomes were recorded before and after reduction (6-12 months), and they were compared. RESULTS: A total of 324 patients were included. The dose was reduced in 29 patients (8.9%). The dosing interval was increased in 9 patients receiving subcutaneous BEL and in 6 patients receiving intravenous BEL. The dose per administration was reduced in 16 patients.Pre-reduction status was remission (2021 DORIS) in 15/26 patients (57.7%) and LLDAS in 23/26 patients (88.5%). After reduction, 2/24 patients (8.3%) and 3/22 patients (13.6%) lost remission at 6 months and 12 months, respectively (not statistically significant [NS]). As for LLDAS, 2/23 patients (8.7%) and 2/21 patients (9.5%) lost their status at 6 and 12 months, respectively (NS). Significantly fewer patients were taking glucocorticoids (GCs) at their 12-month visit, although the median dose of GCs was higher at the 12-month visit (5 [0.62-8.75] vs 2.5 [0-5] at baseline). CONCLUSION: Doses of BEL can be reduced with no relevant changes in disease activity-at least in the short term-in a significant percentage of patients, and most maintain the reduced dose. However, increased clinical or serologic activity may be observed in some patients. Consequently, tighter post-reduction follow-up is advisable.
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INTRODUCTION: There are no defined criteria for deciding to remove a non-functioning indwelling pleural catheter (IPC) when lung re-expansion on chest X-ray is incomplete. Chest computed tomography (chest CT) is usually used. The objective of this work is to validate the usefulness of chest ultrasound performed by a pulmonologist and by a radiologist compared to chest CT. PATIENTS AND METHODS: Prospective, descriptive, multidisciplinary and multicenter study including patients with malignant pleural effusion and non-functioning IPC without lung reexpansion. Decisions made on the basis of chest ultrasound performed by a pulmonologist, and performed by a radiologist, were compared with chest CT as the gold standard. RESULTS: 18 patients were analyzed, all of them underwent ultrasound by a pulmonologist and chest CT and in 11 of them also ultrasound by a radiologist. The ultrasound performed by the pulmonologist presents a sensitivity of 60%, specificity of 100%, PPV 100% and NPV 66% in the decision of the correct removal of the IPC. The concordance of both ultrasounds (pulmonologist and radiologist) was 100%, with a kappa index of 1. The 4 discordant cases were those in which the IPC was not located on the ultrasound. CONCLUSIONS: Thoracic ultrasound performed by an expert pulmonologist is a valid and simple tool to determine spontaneous pleurodesis and remove a non-functioning IPC, which would make it possible to avoid chest CT in those cases in which lung reexpansion is observed with ultrasonography.
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Derrame Pleural Maligno , Humanos , Derrame Pleural Maligno/diagnóstico por imagen , Derrame Pleural Maligno/terapia , Derrame Pleural Maligno/patología , Estudios Prospectivos , Cateterismo , Catéteres de Permanencia , UltrasonografíaRESUMEN
Coagulation management in the patient with cirrhosis has undergone a significant transformation since the beginning of this century, with the concept of a rebalancing between procoagulant and anticoagulant factors. The paradigm that patients with cirrhosis have a greater bleeding tendency has changed, as a result of this rebalancing. In addition, it has brought to light the presence of complications related to thrombotic events in this group of patients. These guidelines detail aspects related to pathophysiologic mechanisms that intervene in the maintenance of hemostasis in the patient with cirrhosis, the relevance of portal hypertension, mechanical factors for the development of bleeding, modifications in the hepatic synthesis of coagulation factors, and the changes in the reticuloendothelial system in acute hepatic decompensation and acute-on-chronic liver failure. They address new aspects related to the hemorrhagic complications in patients with cirrhosis, considering the risk for bleeding during diagnostic or therapeutic procedures, as well as the usefulness of different tools for diagnosing coagulation and recommendations on the pharmacologic treatment and blood-product transfusion in the context of hemorrhage. These guidelines also update the knowledge regarding hypercoagulability in the patient with cirrhosis, as well as the efficacy and safety of treatment with the different anticoagulation regimens. Lastly, they provide recommendations on coagulation management in the context of acute-on-chronic liver failure, acute liver decompensation, and specific aspects related to the patient undergoing liver transplantation.