Qualitative Study of Barriers and Facilitators to Care Among Children in Immigrant Families.

OBJECTIVES: Children in immigrant families comprise ∼25% of US children and live in families with high levels of poverty and food insecurity. Studies suggest a decline in public benefit enrollment among children in immigrant families. We aimed to explore perspectives on barriers and facilitators in accessing care among immigrant caregivers of hospitalized children. METHODS: With a general qualitative descriptive design, we developed a semistructured interview guide using an iterative process informed by literature and content expertise. Using purposive sampling, we recruited immigrant caregivers of hospitalized children in March 2020 and conducted interviews in English or Spanish. Interviews were recorded, transcribed, and translated to English. Three authors coded transcripts using Dedoose and identified themes via thematic analysis. RESULTS: Analysis of 12 caregiver interviews revealed barriers and facilitators in accessing healthcare and public benefit use. Barriers included healthcare system barriers, immigration-related fear, and racism and discrimination. Within healthcare system barriers, subthemes included language barriers, cost, complexity of resource application, and lack of guidance on available benefits. Within immigration-related fear, subthemes included fear of familial separation, fear of deportation, fear that benefit use affects immigration status, and provider distrust. Healthcare system facilitators of resource use included recruiting diverse workforces, utilizing language interpretation, guidance on benefit enrollment, legal services, and mental health services. Participants also recommended hospital partnership with trusted information sources, including media stations and low-cost clinics. CONCLUSIONS: Immigrant caregivers of hospitalized children identified barriers and facilitators in access to care. Further research is needed to assess the efficacy of caregiver-suggested interventions.

Clinical Findings and Genetic Analysis of Nine Mexican Families with Bartter Syndrome.

BACKGROUND: Bartter's syndrome (BS) is a group of salt-wasting tubulopathies characterized by hypokalemia, metabolic alkalosis, hypercalciuria, secondary hyperaldosteronism, and low or normal blood pressure. Loss-of-function variants in genes encoding for five proteins expressed in the thick ascending limb of Henle in the nephron, produced different genetic types of BS. AIM: Clinical and genetic analysis of families with Antenatal Bartter syndrome (ABS) and with Classic Bartter syndrome (CBS). METHODS: Nine patients from unrelated non-consanguineous Mexican families were studied. Massive parallel sequencing of a gene panel or whole-exome sequencing was used to identify the causative gene. RESULTS: Proband 1 was homozygous for the pathogenic variant p.Arg302Gln in the SLC12A1 gene encoding for the sodium-potassium-chloride NKCC2 cotransporter. Proband 3 was homozygous for the nonsense variant p.Cys308* in the KCNJ1 gene encoding for the ROMK potassium channel. Probands 7, 8, and 9 showed variants in the CLCKNB gene encoding the chloride channel ClC-Kb: proband 7 was compound heterozygous for the deletion of the entire gene and the missense change p.Arg438Cys; proband 8 presented a homozygous deletion of the whole gene and proband 9 was homozygous for the nonsense mutation p.Arg595*. A heterozygous variant of unknown significance was detected in the SLC12A1 gene in proband 2, and no variants were found in SLC12A1, KCNJ1, BSND, CLCNKA, CLCNKB, and MAGED2 genes in probands 4, 5, and 6. CONCLUSIONS: Genetic analysis identified loss-of-function variants in the SLC12A1, KCNJ1, and CLCNKB genes in four patients with ABS and in the CLCNKB gene in two patients with CBS.

Recent Advances in the Microencapsulation of Essential Oils, Lipids, and Compound Lipids through Spray Drying: A Review.

In recent decades, the microcapsules of lipids, compound lipids, and essential oils, have found numerous potential practical applications in food, textiles, agricultural products, as well as pharmaceuticals. This article discusses the encapsulation of fat-soluble vitamins, essential oils, polyunsaturated fatty acids, and structured lipids. Consequently, the compiled information establishes the criteria to better select encapsulating agents as well as combinations of encapsulating agents best suited to the types of active ingredient to be encapsulated. This review shows a trend towards applications in food and pharmacology as well as the increase in research related to microencapsulation by the spray drying of vitamins A and E, as well as fish oil, thanks to its contribution of omega 3 and omega 6. There is also an increase in articles in which spray drying is combined with other encapsulation techniques, or modifications to the conventional spray drying system.

Diagnostic Performance of Airway Ultrasound for the Assessment of Difficult Laryngoscopy: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aimed to review and appraise the evidence regarding airway ultrasound assessment in predicting difficult laryngoscopy in adult patients. DESIGN: A systematic review of the literature was conducted according to the Cochrane collaboration guidelines and the recommendations for the systematic review and meta-analysis of diagnostic studies. Observational studies that evaluated the diagnostic performance of airway ultrasound for the prediction of difficult laryngoscopy were included for consideration. SETTING: Literature searches were performed in 4 databases (PubMed [Medline], Embase, Clinical Trials, and Google Scholar) to identify all observational studies using any ultrasound technique to assess difficult laryngoscopy. The search terms included "sonography," "ultrasound," "airway," "difficult airway," "difficult laryngoscopy," "Cormack," "risk factors," "ultrasound at the point of care," "difficult ventilation," "difficult intubation" and others, combined with sensitive filters. The search was done for studies performed in the last 20 years in English or Spanish. PARTICIPANTS: Adult patients older than 18 years old under general anesthesia for an elective procedure. Evident anatomic airway abnormalities, obstetric populations, those using an alternative imaging method besides ultrasound, and animal studies were excluded. INTERVENTIONS: Preoperative bedside ultrasound measuring distances and ratios from the skin to different reference points, such as the ratio of the hyomental distance in a neutral position (HMDN) and hyomental distance in extension (HMDR), HMDN, and the skin-to-epiglottis distance (SED), the preepiglottic area, and tongue thickness, among others. MEASUREMENTS AND MAIN RESULTS: A total of 24 studies evaluated the prediction of a difficult laryngoscopy using airway ultrasound. The diagnostic performance and the number of ultrasound parameters reported in the studies were variable. Meta-analysis was performed for 3 measurements consistently included in most studies. The SED and the HMDR ratio presented a sensitivity of 75% and 61%, respectively, and a specificity of 86% and 88%, respectively. The ratio of the preepiglottic distance to the epiglottic distance at the midpoint of the vocal cords (pre-E/E-VC) presented the best performance for predicting a difficult laryngoscopy (sensitivity: 82%, specificity: 83%, diagnostic odds ratio: 22.2). CONCLUSION: With the currently available evidence, the 3 commonly used point-of-care ultrasound measures used to identify difficult laryngoscopy, (SED, HMDR, and pre-E/E-VC), showed better sensitivity and similar specificity to clinical measures. Future studies and more data may change the authors' confidence in these conclusions, given the wide variability of measurements noted in studies.

Primary open-angle glaucoma in patients with obstructive sleep apnoea in a Colombian population: a cross-sectional study.

OBJECTIVE: Determine the prevalence, functional and structural alterations of primary open-angle glaucoma (POAG) in patients with obstructive sleep apnoea (OSA). DESIGN: Cross-sectional. SETTING: Tertiary hospital associated with specialised center in ophthalmologic images in Bogota, Colombia. PARTICIPANTS: 150 patients, for a sample of 300 eyes, 64 women (42.7%) and 84 men (57.3%) between 40 and 91 years old with a mean age of 66.8 (±12.1) years. INTERVENTIONS: Visual acuity, biomicroscopy, intraocular pressure, indirect gonioscopy and direct ophthalmoscopy. Patients classified as glaucoma suspects underwent automated perimetry (AP) and optical coherence tomography of the optic nerve OUTCOME MEASURE: The primary outcomes are the determination of prevalence of glaucoma suspects and POAG in patients with OSA. Secondary outcomes are the description of functional and structural alterations in computerised exams of patients with OSA. RESULTS: The prevalence of glaucoma suspect was 12.6%, and for POAG was 17.3%. No alterations in the appearance of the optic nerve was seen in 74.6%, focal or diffuse thinning of the neuroretinal rim (16.6%) was the most frequently finding, followed by asymmetry of the disc>0.2 mm (8.6%) (p=0.005). In the AP, 41% showed arcuate, nasal step and paracentral focal defects. The mean retinal nerve fiber layer (RNFL) was normal (>80 µM) in 74% of the mild OSA group, 93.8% of the moderate group and 17.1% of the severe group. Similarly, normal (P5-90) ganglion cell complex (GCC) in 60%, 68% and 75%, respectively. Abnormal results in the mean RNFL was seen in 25.9%, 6.3% and 23.4% of the mild, moderate and severe groups, respectively. In the GCC, 39.7%, 33.3% and 25% of the patients in the aforementioned groups. CONCLUSION: It was possible to determine the relationship between structural changes in the optic nerve and the severity of OSA. No relationship with any of the other studied variables was identified.

Video Analysis of 26 Cases of Second ACL Injury Events in Collegiate and Professional Athletes.

Background: Significant effort has gone into the identification and quantification of the underlying mechanisms of primary ACL injury. Secondary ACL injury is observed in approximately 1/4 to 1/3 of athletes who return to sport following ACL reconstruction. However, little has been done to evaluate the mechanisms and playing circumstances surrounding these repeat injuries. Hypothesis/Purpose: The purpose of this study was to characterize the mechanisms of non-contact secondary ACL injuries using video analysis. It was hypothesized that in video recordings of secondary ACL injury, athletes would exhibit greater frontal plane hip and knee angles, but not greater hip and knee flexion, at 66 ms following initial contact (IC) as compared to at IC and 33ms following IC. Study Design: Cross-Sectional Study. Methods: Twenty-six video recordings of competitive athletes experiencing secondary ACL ruptures via noncontact mechanisms were analyzed for lower extremity joint kinematics, playing situation, and player attention. Kinematics were assessed at IC as well as 33 ms (1 broadcast frame) and 66 ms (2 broadcast frames) following IC. Results: Knee flexion and knee frontal plane angles were greater at 66 ms than IC (p ≤ 0.03). Hip, trunk, and ankle frontal plane angles were not greater at 66 ms than IC (p ≥ 0.22). Injuries were distributed between attacking play (n=14) and defending (n=8). Player attention was most commonly focused on the ball (n=12) or an opponent (n=7). A single-leg landing accounted for just over half of the injuries (54%), while a cutting motion accounted for the remainder of the injuries (46%). Conclusion: Secondary ACL injury was most likely to occur during landing or a sidestep cut with player attention external to their own body. Knee valgus collapse combined with limited hip motion was identified in the majority of secondary injuries. Level of Evidence: Level IIIb.

A glyco-engineering approach for site-specific conjugation to Fab glycans.

Effective processes for synthesizing antibody-drug conjugates (ADCs) require: 1) site-specific incorporation of the payload to avoid interference with binding to the target epitope, 2) optimal drug/antibody ratio to achieve sufficient potency while avoiding aggregation or solubility problems, and 3) a homogeneous product to facilitate approval by regulatory agencies. In conventional ADCs, the drug molecules are chemically attached randomly to antibody surface residues (typically Lys or Cys), which can interfere with epitope binding and targeting, and lead to overall product heterogeneity, long-term colloidal instability and unfavorable pharmacokinetics. Here, we present a more controlled process for generating ADCs where drug is specifically conjugated to only Fab N-linked glycans in a narrow ratio range through functionalized sialic acids. Using a bacterial sialytransferase, we incorporated N-azidoacetylneuraminic acid (Neu5NAz) into the Fab glycan of cetuximab. Since only about 20% of human IgG1 have a Fab glycan, we extended the application of this approach by using molecular modeling to introduce N-glycosylation sites in the Fab constant region of other therapeutic monoclonal antibodies. We used trastuzumab as a model for the incorporation of Neu5NAz in the novel Fab glycans that we designed. ADCs were generated by clicking the incorporated Neu5NAz with monomethyl auristatin E (MMAE) attached to a self-immolative linker terminated with dibenzocyclooctyne (DBCO). Through this process, we obtained cetuximab-MMAE and trastuzumab-MMAE with drug/antibody ratios in the range of 1.3 to 2.5. We confirmed that these ADCs still bind their targets efficiently and are as potent in cytotoxicity assays as control ADCs obtained by standard conjugation protocols. The site-directed conjugation to Fab glycans has the additional benefit of avoiding potential interference with effector functions that depend on Fc glycan structure.

El amor como sujeto perenne. Una interpretación sobre las concepciones del amor de pareja en el último quinquenio / Love as a perennial subject. An interpretation of conceptions of couple love in the last five years

El amor es un tema que transversaliza al ser humano en todas sus experiencias vitales; es por ello por lo que constantemente está expuesto a contextos colmados de significados, los cuales, de una u otra manera, forjan una idea sobre término, misma que influye directamente en las relaciones de pareja. El presente artículo surge de una investigación reflexiva acerca de las concepciones del amor de pareja en el último quinquenio del siglo XXI y su relación con las formas de amar, lo cual permitió esclarecer, desde lo documental inicialmente, los modos y maneras de relacionamiento en la actualidad. La reflexión transita desde la idea del amor como problema que interesa, pasando por el camino que conduce al sí mismo del amor, entendiendo que este es el problema perenne; finaliza el artículo con la idea de que absolutizar el amor es negarlo

Love is a theme that transverses and crosses human beings in all their life experiences; that is why it is constantly exposed to contexts full of meanings, which, in one way or another, forge an idea about it, which directly influences couple relationships. This article reflects on the conceptions of couple love in the last five years of the 21st century and its relationship with the ways of loving, which allowed us to clarify, initially at a documentary level, the modes, and ways of relating at present. The reflection moves from the idea of love as a problem of interest, passing through the path that leads to love itself, understanding that this is the perennial problem; the article ends with the idea that to absolutize love is to deny it.

Bienestar psicológico y consumo de sustancias psicoactivas en adultos jóvenes del Quindío / Psychological well-being and consumption of psychoactive substances in young adults from Quindío

El consumo de Sustancias Psicoactivas (SPA) es una problemática que por años ha generado afectaciones en los ámbitos individual y colectivo, contribuyendo al aumento en las cifras de problemáticas psicosociales y de salud. El objetivo del estudio fue establecer la relación entre el bienestar psicológico y el consumo de SPA en 97 personas de 18 a 25 años del departamento del Quindío. Para ello, se implementó un diseño transversal con alcance correlacional. Los datos se recolectaron mediante la Prueba de Detección de Consumo de Alcohol, Tabaco y otras Sustancias y la Escala del Bienestar Psicológico de Ryff. Se identificó que la mayoría de los participantes se ubicaron en un nivel alto en la mayoría de las dimensiones de la escala de bienestar. El 91,75% de los participantes consumieron alguna sustancia, a lo largo de su vida. Finalmente, se encontró una relación entre la preocupación por otros por el consumo de tabaco y el bajo nivel de autonomía (-0,3144, p < 0,01), y el intento por dejar el consumo alcohol y bajo nivel del dominio del entorno (-0,3275, p < 0,01).

The consumption of psychoactive substances (PAS) generates affectations in the individual and collective spheres, contributing to the increase in the figures of psychosocial and health problems. The objective of the study was to establish the relationship between the consumption of PAS and psychological well-being in 97 people between 18 and 25 years of age in the department of Quindío. For this, a cross-sectional design with correlational scope was implemented. Data were collected using the Alcohol, Tobacco, and Other Substance Use Screening Test and the Ryff Psychological Well-Being Scale. It was identified that the majority of those evaluated were located at a high level in most of the dimensions of the well-being scale. 91,75% of the participants consumed some substance throughout their lives. Finally, a relationship was found between concern for others about tobacco consumption and low level of autonomy (-0,3144, p < 0.01), and the attempt to quit alcohol consumption and low level of mastery of environment (-0,3275, p < 0.01).

Protection of Mono and Polyunsaturated Fatty Acids from Grapeseed Oil by Spray Drying Using Green Biopolymers as Wall Material.

One of the most common ways to protect oils is microencapsulation, which includes the use of encapsulating agents. Due to the environmental problems facing humanity, this study seeks to combine green biopolymers (microcrystalline cellulose and whey protein isolate) that function as encapsulating agents for grapeseed oil. Grapeseed oil that is obtained from agro-industrial waste has shown health benefits, including cardioprotective, anticancer, antimicrobial, and anti-inflammatory properties. These health benefits have been mainly associated with monounsaturated (MUFA) and polyunsaturated (PUFA) fatty acids. In this sense, it has been observed that grapeseed oil can be easily modified by environmental factors such as oxygen, high temperatures, and light, showing the instability and easy degradation of grapeseed oil. In this study, grapeseed oil was encapsulated using the spray-drying technique to conserve its lipidic profile. Powder recovery of the grapeseed oil microcapsules ranged from 65% to 70%. The encapsulation efficiency of the microcapsules varied between 80% and 85%. The FTIR analysis showed chemical interactions that demonstrate chemisorption between the grapeseed oil and the encapsulating material, while the SEM micrographs showed a correct encapsulation in a spherical shape. Gas chromatography showed that the lipid profile of grapeseed oil is preserved thanks to microencapsulation. Release tests showed 80% desorption within the first three hours at pH 5.8. Overall, whey protein and microcrystalline cellulose could be used as a wall material to protect grapeseed oil with the potential application of controlled delivery of fatty acids microcapsules.

Influencia de un programa recreativo en la disminución de la ansiedad en estudiantes de bachillerato / Influência de um programa recreativo sobre a redução da ansiedade nos estudantes do ensino secundário / Influence of a recreational program in reducing anxiety in high school students

RESUMEN Las actividades recreativas poseen numerosos efectos positivos en el comportamiento humano, esto puede favorecer a indicadores psicológicos de relevancia como la ansiedad percibida. En tal sentido, se planteó como propósito de la investigación determinar cómo influye un programa recreativo en la disminución de los niveles de ansiedad en estudiantes de bachillerato. La investigación es descriptiva-explicativa, de orden correlacional; se diagnostican intencionalmente a 30 estudiantes de bachillerato a través del test de Beck, antes y después de implementada una propuesta recreativa por ocho semanas. Los porcentajes de ansiedad disminuyeron a medida que se implementa la propuesta de intervención, tanto de forma general como en el análisis por género, al ser significativa la disminución (p=0.003). El presente estudio evidencia que las actividades recreativas pueden contribuir a la disminución de la ansiedad en adolescentes de bachiller, tanto para el género femenino como para el masculino. Se recomienda tres acciones a futuro: ampliar el tiempo de implementación de la propuesta de intervención, realizar estudios por género y direccionar la futura investigación a un nivel cuasiexperimental.

RESUMO As atividades recreativas têm numerosos efeitos positivos no comportamento humano, o que pode favorecer indicadores psicológicos relevantes, tais como a percepção de ansiedade. Neste sentido, o objectivo da investigação era determinar como um programa recreativo influencia a redução dos níveis de ansiedade dos estudantes do ensino secundário. A investigação é descritiva-explicativa, de ordem correlacional; 30 estudantes do ensino secundário foram intencionalmente diagnosticados através do teste Beck, antes e depois da implementação de uma proposta recreativa durante oito semanas. As percentagens de ansiedade diminuíram à medida que a proposta de intervenção foi sendo implementada, tanto em geral como na análise por género, uma vez que a diminuição foi significativa (p=0,003). O presente estudo mostra que as atividades recreativas podem contribuir para a redução da ansiedade nos adolescentes do ensino secundário, tanto para raparigas como para rapazes. Três ações futuras são recomendadas: prolongar o tempo de implementação da proposta de intervenção, realizar estudos por género e orientar a investigação futura para um nível quase experimental.

ABSTRACT Recreational activities have numerous positive effects on human behavior, this can favor relevant psychological indicators such as perceived anxiety. In this sense, the purpose of the research was to determine how a recreational program influences the reduction of anxiety levels in high school students. The research is descriptive-explanatory, correlational; 30 high school students are intentionally diagnosed through the Beck test, before and after implementing a recreational proposal for eight weeks. The percentages of anxiety decreased as the intervention proposal was implemented, both in general and in the analysis by gender, as the decrease was significant (p=0.003). The present study shows that recreational activities can contribute to the reduction of anxiety in high school adolescents, both for the female gender and for the male gender. Three future actions are recommended: extend the implementation time of the intervention proposal, carry out studies by gender and direct future research at a quasi-experimental level.

Estrategia de actividades físico-recreativas para el uso adecuado del tiempo libre en adolescentes / Estratégia de atividades físico-recreativas para o uso adequado do tempo livre nos adolescentes / Strategy of physical recreational activities for the adequate use of the free time in teenagers

RESUMEN En la estrategia con actividades físico-recreativas, en el uso del tiempo libre por adolescentes, se asume una concepción metodológica desde la vinculación de los enfoques cuantitativos y cualitativos, con la articulación de métodos y técnicas que posibilitaron el estudio de los antecedentes y criterios teóricos acerca de los enfoques actuales de ese fenómeno. El objetivo de este trabajo consistió en implementar una estrategia con actividades físico-recreativas que contribuirán al uso adecuado del tiempo libre por los adolescentes de las unidades particulares laicas de Sangolquí. Los resultados avalan la realización de un diagnóstico de necesidades que facilitó la concepción de la estrategia sobre una base científica, en una estructura que se consolidó en etapas y acciones con las vías de control, lo cual permitió una organicidad lógica y coherente en el uso adecuado del tiempo libre por los adolescentes. Este estudio favoreció la modificación del estado inicial del uso del tiempo libre por los adolescentes, al otorgarles un rol protagónico en la búsqueda de sus intereses y la satisfacción de sus necesidades. Esto conduce a arribar al estado deseado y el cumplimiento de los objetivos previstos, al considerar la articulación y la naturaleza cognoscitiva, práctica y axiológica de las actividades. La valoración de los expertos consideró que la estrategia es muy adecuada y ratificaron el valor de la misma, al expresar que puede ser implementada, pues tiene un marco legal y metodológico que avala la pertinencia, la factibilidad y la aplicabilidad de la misma.

RESUMO Na estratégia com atividades físico-recreativas na utilização do tempo livre pelos adolescentes, assume-se uma concepção metodológica a partir da ligação de abordagens quantitativas e qualitativas, com a articulação de métodos e técnicas que tornaram possível o estudo dos antecedentes e critérios teóricos sobre as atuais abordagens a este fenómeno. O objectivo deste trabalho consistiu em implementar uma estratégia com atividades físico-recreativas que contribuam para a utilização adequada do tempo livre pelos adolescentes nas unidades privadas leigas de Sangolquí. Os resultados apoiam a realização de um diagnóstico de necessidades que facilitou a concepção da estratégia numa base científica, numa estrutura que foi consolidada em fases e ações com os meios de controlo, o que permitiu uma organicidade lógica e coerente na utilização adequada do tempo livre pelos adolescentes. Este estudo favoreceu a modificação do estado inicial de utilização do tempo livre pelos adolescentes, dando-lhes um papel de liderança na prossecução dos seus interesses e na satisfação das suas necessidades. Isto leva a chegar ao estado desejado e ao cumprimento dos objectivos planeados, considerando a articulação e a natureza cognitiva, prática e axiológica das atividades. A avaliação dos peritos considerou a Estratégia Muito Adequada e ratificou o seu valor, expressando que pode ser implementada, uma vez que possui um quadro legal e metodológico que endossa a sua pertinência, viabilidade e aplicabilidade.

ABSTRACT In the strategy with physical-recreational activities, in the use of free time by teenagers, a methodological conception is assumed from the linking of quantitative and qualitative approaches, with the articulation of methods and techniques that made it possible to study the background and theoretical criteria about current approaches to this phenomenon. The objective of this work was to implement a strategy with physical-recreational activities that will contribute to the adequate use of free time by adolescents from the private lay units of Sangolquí. The results support the realization of a diagnosis of needs that facilitated the conception of the strategy on a scientific basis, in a structure that was consolidated in stages and actions with the control channels, which allowed a logical and coherent organization in the appropriate use. Free time for teenagers. This study favored the modification of the initial state of the use of free time by adolescents, by giving them a leading role in the pursuit of their interests and the satisfaction of their needs. This leads to arriving at the desired state and the fulfillment of the planned objectives, when considering the articulation and the cognitive, practical and axiological nature of the activities. The experts' assessment considered that the Strategy is Very Appropriate and ratified its value, expressing that it can be implemented, since it has a legal and methodological framework that supports its relevance, feasibility and applicability.

Incidencia del entrenamiento funcional para potencializar la fuerza en nadadores semilleros del club Varadero / Incidência de treino funcional para potenciar a força dos nadadores do clube Varadero / Incidence of functional training to potentiate strength in beginner swimmers of the Varadero club

RESUMEN El entrenamiento funcional ayuda a potencializar la fuerza en ciertos grupos musculares; de esta manera, el deportista mejora la postura corporal, gana fuerza y resistencia muscular y, por ende, puede incrementar indicadores relacionados con la capacidad física y el rendimiento final. En tal sentido, se planteó como objetivo de la investigación, aplicar un programa de entrenamiento funcional enfocado en el mejoramiento de la fuerza en nadadores semilleros del Club Varadero. La investigación es de tipo descriptiva-explicativa de orden correlacional; se diagnostica una población de 17 nadadores (ambos géneros; 14-16 años) del Club referido. Se aplica un entrenamiento funcional adaptado al nadador sobre la base de cuatro indicadores físicos en dos momentos de aplicado dicho entrenamiento. Se logran diferencias significativas a favor del postest en todas las pruebas físicas, tanto en el test de flexión de codo (p=0.001), como el test de abdominales (p=0.001). Además, se incluyen el salto horizontal (p=0.005) y el salto vertical (p=0.001). Es primordial potencializar el entrenamiento de la capacidad física de la fuerza en nadadores mediante una correcta planificación de entrenamiento funcional, dado el fortalecimiento de los músculos que intervienen en el gesto técnico. Se recomiendan cuatro acciones que influyen en ampliar la muestra de estudio; se hace énfasis en el género femenino; se comparan los resultados de la investigación con otros estudios en otros rangos etarios y se realiza una investigación de tipo cuasiexperimental.

RESUMO O treino funcional ajuda a potenciar a força em certos grupos musculares; desta forma, o atleta melhora a postura corporal, ganha força e resistência muscular e, portanto, pode aumentar os indicadores relacionados com a capacidade física e o desempenho final. Neste sentido, o objectivo da investigação era aplicar um programa de treino funcional centrado na melhoria da força dos nadadores do Clube Varadero. A investigação é do tipo descritivo-explicativo de ordem correlativa; é diagnosticada uma população de 17 nadadores (ambos os sexos; 14-16 anos de idade) do Clube. O treino funcional adaptado ao nadador foi aplicado com base em quatro indicadores físicos em dois momentos após a aplicação do treino. Foram conseguidas diferenças significativas a favor do pós-teste em todos os testes físicos, tanto no teste de flexão do cotovelo (p=0,001) como no teste abdominal (p=0,001). Além disso, o salto horizontal (p=0,005) e o salto vertical (p=0,001) estão incluídos. É essencial melhorar o treino da capacidade física de força dos nadadores através de um planeamento correto do treino funcional, dado o reforço dos músculos envolvidos no gesto técnico. São recomendadas quatro ações que influenciam o alargamento da amostra do estudo; é dada ênfase ao sexo feminino; os resultados da investigação são comparados com outros estudos noutras faixas etárias e é realizado um tipo de investigação quase-experimental.

ABSTRACT Functional training helps to enhance strength in certain muscle groups; in this way, the athlete improves body posture, gains muscle strength and endurance and, therefore, can increase indicators related to physical capacity and final performance. In this sense, the objective of the research was to apply a functional training program focused on the improvement of strength in beginner swimmers of the Varadero Club. The research is of descriptive-explanatory type of correlational order; a population of 17 swimmers (both genders; 14-16 years old) of the referred Club is diagnosed. A functional training adapted to the swimmer is applied on the basis of four physical indicators in two moments of applying said training. Significant differences are achieved in favor of the post- test in all the physical tests, both in the elbow flexion test (p=0.001) and in the abdominal test (p=0.001). In addition, the horizontal jump (p=0.005) and the vertical jump (p=0.001) are included. It is essential to potentiate the training of the physical capacity of strength in swimmers through a correct planning of functional training, given the strengthening of the muscles that intervene in the technical gesture. Four actions are recommended that influence the expansion of the study sample; emphasis is placed on the female gender; The results of the research are compared with other studies in other age ranges and a quasi-experimental type of research is carried out.

Becoming a Doctor During a Pandemic: Impact on Medical Student Social Identity Formation.

The COVID-19 pandemic required modifications to undergraduate medical education that likely affected medical students' social identity formation (SIF). SIF is shaped by experiences throughout the medical education continuum. This commentary explores factors potentially affecting medical student SIF during the COVID-19 pandemic focusing on students' perceptions of being part of the healthcare team, their role in medicine, and their engagement during the pandemic. Based on such considerations, we propose that educators should aim to design effective learning environments to support a full educational experience that encompasses acquiring medical knowledge and building strong social identities even during a pandemic.

Manejo conservador de lesión aerodigestiva: reporte de un caso y revisión de la literatura / Conservative management of aerodigestive injury: A case report andreview of the literature

Introducción. El trauma penetrante de cuello representa un evento desafortunado de baja incidencia y alta complejidad diagnóstica y terapéutica, lo que supone un reto para el cirujano general.Caso clínico. Paciente femenina de 20 años de edad, quien sufrió una herida cervical por proyectil de arma de fuego, desarrollando de forma secundaria una lesión aerodigestiva. Se realizó un tratamiento expectante en un hospital de alta complejidad, con una evolución favorable. Discusión. En la literatura existe un claro debate en cuanto al manejo de las lesiones penetrantes en cuello y la sospecha de lesión orgánica oculta. En nuestro paciente la lesión aerodigestiva fue tratada mediante observación y seguimiento clínico. Conclusiones. El manejo de un paciente con lesión aerodigestiva se puede corroborar mediante las imágenes diagnósticas y se puede tratar de forma expectante con un resultado exitoso, sin agregar morbilidad y con un impacto adecuado en el buen uso de los recursos disponibles

Introduction. Penetrating neck trauma represents an unfortunate event with a low incidence and high diagnostic and therapeutic complexity, which represents a challenge for the general surgeon. Clinical case. A 20-year-old female patient, who suffered a cervical wound from a firearm projectile, secondarily developing an aerodigestive lesion. An expectant treatment was carried out in a high complexity hospital, with a favorable evolution.Discussion. In the literature there is a clear debate regarding the management of penetrating neck injuries and suspected occult organic injury. In our patient, the aerodigestive injury was treated by observation and clinical follow-up.Conclusions. The management of a patient with aerodigestive injury can be corroborated by diagnostic images and can be treated expectantly with a successful result, without adding morbidity and with an adequate impact on the proper use of available resources

Robust Descriptor of Pancreatic Tissue for Automatic Detection of Pancreatic Cancer in Endoscopic Ultrasonography.

Pancreatic cancer (PC) has a reported mortality of 98% and a 5-y survival rate of 6.7%. Experienced gastroenterologists detect 80% of those with early-stage PC by endoscopic ultrasonography (EUS). Here we propose an automatic second reader strategy to detect PC in an entire EUS procedure, rather than focusing on pre-selected frames, as the state-of-the-art methods do. The method unmasks echo tumoral patterns in frames with a high probability of tumor. First, speeded up robust features define a set of interest points with correlated heterogeneities among different filtering scales. Afterward, intensity gradients of each interest point are summarized by 64 features at certain locations and scales. A frame feature vector is built by concatenating statistics of each feature of the 15 groups of scales. Then, binary classification is performed by Support Vector Machine and Adaboost models. Evaluation was performed using a data set comprising 55 participants, 18 of PC class (16,585 frames) and 37 subjects of non-PC class (49,664 frames), randomly splitting 10 times. The proposed method reached an accuracy of 92.1%, sensitivity of 96.3% and specificity of 87.8.3%. The observed results are also stable in noisy experiments while deep learning approaches fail to maintain similar performance.

Human-Origin iPSC-Based Recellularization of Decellularized Whole Rat Livers.

End-stage liver diseases lead to mortality of millions of patients, as the only treatment available is liver transplantation and donor scarcity means that patients have to wait long periods before receiving a new liver. In order to minimize donor organ scarcity, a promising bioengineering approach is to decellularize livers that do not qualify for transplantation. Through decellularization, these organs can be used as scaffolds for developing new functional organs. In this process, the original cells of the organ are removed and ideally should be replaced by patient-specific cells to eliminate the risk of immune rejection. Induced pluripotent stem cells (iPSCs) are ideal candidates for developing patient-specific organs, yet the maturity and functionality of iPSC-derived cells do not match those of primary cells. In this study, we introduced iPSCs into decellularized rat liver scaffolds prior to the start of differentiation into hepatic lineages to maximize the exposure of iPSCs to native liver matrices. Through exposure to the unique composition and native 3D organization of the liver microenvironment, as well as the more efficient perfusion culture throughout the differentiation process, iPSC differentiation into hepatocyte-like cells was enhanced. The resulting cells showed significantly higher expression of mature hepatocyte markers, including important CYP450 enzymes, along with lower expression of fetal markers, such as AFP. Importantly, the gene expression profile throughout the different stages of differentiation was more similar to native development. Our study shows that the native 3D liver microenvironment has a pivotal role to play in the development of human-origin hepatocyte-like cells with more mature characteristics.

Seizure exacerbation with anti-seizure medications in adult patients with epilepsy.

There are numerous reports of seizure exacerbation related to specific anti-seizure medications (ASMs); however, a quantitative analysis with clearly defined parameters for seizure exacerbation in an outpatient setting is lacking. This retrospective study examines adult patients starting a single ASM and follows patient outcomes over the course of treatment, with quantitative evaluation of the incidence of paradoxical seizure exacerbation. In this study, outpatient encounters with five epileptologists at the Baylor College of Medicine Comprehensive Epilepsy Center were evaluated over a 10-month period. Seizure exacerbation was defined as an increase in seizure frequency at least 2 times greater than the baseline seizure frequency after initiation of an ASM, with return to baseline after ASM discontinuation. Patients were stratified into four categories: (1) probable ASM-induced seizure exacerbation; (2) possible ASM-induced seizure exacerbation; (3) non-ASM induced seizure exacerbation; or (4) no seizure exacerbation. Out of a total of 236 encounters where an ASM was initiated, we found that 5.5% of patients experienced some form of seizure exacerbation. However, only 1.3% of patients had probable ASM-induced seizure exacerbation. Consistent with prior studies, our data indicate seizure exacerbation in adults is rare with the initiation of ASMs. However, further studies with a larger sample size are necessary to better understand what factors may predispose patients to potential medication-induced seizure exacerbation.

Patterns in reporting and participant inclusion related to race and ethnicity in autism intervention literature: Data from a large-scale systematic review of evidence-based practices.

LAY ABSTRACT: Researchers who study autism-related interventions do a poor job reporting data related to the race and ethnicity of autistic individuals who participate in their studies, and of those who do report these data, the participants are overwhelmingly White. This is problematic for many reasons, as we know little about how interventions are meeting the needs of culturally and linguistically diverse populations, and we assume that interventions are effective for all when they have been developed and validated primarily with and for White children. This study examined the reporting patterns of autism intervention researchers whose work was included in a large-scale systematic review of the intervention literature published between 1990 and 2017. We found that only 25% of studies (out of 1,013 included in the review) included data related to the race and ethnicity of their participants, with minimal change in reporting patterns across the years. In studies with reported data, White participants had the highest rate of participation, with a large gap between the next highest rates of participation among Hispanic/Latino, Black, and Asian participants. Other race and ethnicity groups had very low representation. This study includes additional analyses which examine how the reporting patterns and the inclusion of racially and ethnically diverse participants varies across study types, interventions, and outcome areas. Reporting this data is merely a starting point to begin to address the many disparities in autism-related healthcare, education, and research practices, and this article includes broader implications and next steps to ensure the field becomes more equitable and inclusive.

[Conjunctival mass as the first manifestation of Epstein Barr virus infection]. / Masa conjuntival como primera manifestación de infección por virus del Epstein Barr.

The Epstein Barr virus is an infectious disease with a high worldwide prevalence, which can present multiple systemic manifestations. The ophthalmological findings are the least frequent and nonspe cific and, therefore, its diagnosis is complicated and delayed; however, it should always be considered as a diagnostic possibility in the presence of atypical ocular and periocular inflammatory clinical pictures. OBJECTIVE: To describe the clinical case of a patient with the presence of a conjunctival mass as the first finding in Epstein Barr virus infection. CLINICAL CASE: A 4-year-old boy with a 4-day history of left upper eyelid edema and ptosis associated with a large, fast-growing, elevated, painful, and salmon-colored upper bulbar conjunctival mass with extension to the upper fornix associated with bilateral cervical and inguinal lymphadenopathy. Initially, a lymphoproliferative disorder was suspected, with blood count with lymphocytosis and atypical lymphocytes, elevated lactate dehydro genase, peripheral blood smear with an increase in white blood cells and some atypical lymphocytes, bone marrow aspirate with a predominance of granulocytes and predominantly CD8-positive T lym phocytes and an increase in Gamma-Delta T lymphocytes. The orbit CT scan showed thickening of the left upper eyelid with peripheral enhancement and the abdominal CT scan showed splenomegaly. Biopsy confirmed chronic Epstein Barr virus infection with positive IgM and indeterminate IgG anti bodies. Symptomatic management was indicated with satisfactory evolution and complete resolution of the conjunctival lesion and lymphadenopathy. CONCLUSION: Epstein Barr virus infection should be considered as a possible diagnosis in atypical ocular and periocular inflammatory manifestations in the pediatric population.