A Patient Portal Intervention to Promote Adolescent and Young Adult Self-Management Skills.

OBJECTIVE: Failure to transfer care to adult medicine is associated with gaps in health care access and poor health outcomes among young adults. We examined whether a patient portal educational intervention is acceptable and can improve adolescent and young adult (AYA) self-management skills toward transition readiness to adult care. METHODS: We conducted a single site feasibility study using a mixed research method consisting of 1) a patient portal one-on-one educational intervention with pre- and postsurveys adapted from the Transition Readiness Assessment Questionnaire to assess participant self-management skills and portal user activity; 2) portal user experience was assessed through semistructured interviews until thematic saturation was reached. Study participants were 13 to 25 years old and received care at an academic-affiliated community pediatric clinic. Descriptive statistics were used to describe participant characteristics, paired t tests, or Wilcoxon signed-rank tests to assess outcomes of survey response changes pre- versus postintervention. RESULTS: Sixty percent of enrolled participants (N = 78) completed the surveys. Following the educational intervention, we observed an increase in participants self-reporting knowing how to access their protected health information P < .0001, (95%, confidence interval [CI], 1-2) and in the proportion of participants self-reporting to strongly agree to know their medication P = .025 (95%, CI 0-1). We also observed an increase in portal user access at 3 weeks; the median number of logins was 2 per participant (range 1-36, P < .0001). The Portal user experience was strongly positive. CONCLUSION: Our patient portal educational intervention suggests that AYAs welcome a patient portal to access protected health information and is associated with an increase in the proportion of participants self-reporting to strongly agree with knowing their medication. While these results are encouraging, this is a quasiexperimental study designed on the frame of feasibility. Our study was not adequately powered, limiting our findings' significance. Future interventions would benefit from a larger sample size with a comparison group to ascertain the effect of a patient portal on self-management skills in a diverse AYA population and inform best practices.

Imprinted antibody responses against SARS-CoV-2 Omicron sublineages.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron sublineages carry distinct spike mutations resulting in escape from antibodies induced by previous infection or vaccination. We show that hybrid immunity or vaccine boosters elicit plasma-neutralizing antibodies against Omicron BA.1, BA.2, BA.2.12.1, and BA.4/5, and that breakthrough infections, but not vaccination alone, induce neutralizing antibodies in the nasal mucosa. Consistent with immunological imprinting, most antibodies derived from memory B cells or plasma cells of Omicron breakthrough cases cross-react with the Wuhan-Hu-1, BA.1, BA.2, and BA.4/5 receptor-binding domains, whereas Omicron primary infections elicit B cells of narrow specificity up to 6 months after infection. Although most clinical antibodies have reduced neutralization of Omicron, we identified an ultrapotent pan-variant-neutralizing antibody that is a strong candidate for clinical development.

Imprinted antibody responses against SARS-CoV-2 Omicron sublineages.

SARS-CoV-2 Omicron sublineages carry distinct spike mutations and represent an antigenic shift resulting in escape from antibodies induced by previous infection or vaccination. We show that hybrid immunity or vaccine boosters result in potent plasma neutralizing activity against Omicron BA.1 and BA.2 and that breakthrough infections, but not vaccination-only, induce neutralizing activity in the nasal mucosa. Consistent with immunological imprinting, most antibodies derived from memory B cells or plasma cells of Omicron breakthrough cases cross-react with the Wuhan-Hu-1, BA.1 and BA.2 receptor-binding domains whereas Omicron primary infections elicit B cells of narrow specificity. While most clinical antibodies have reduced neutralization of Omicron, we identified an ultrapotent pan-variant antibody, that is unaffected by any Omicron lineage spike mutations and is a strong candidate for clinical development.

API Content and Blend Uniformity Using Quantum Cascade Laser Spectroscopy Coupled with Multivariate Analysis.

The process analytical technology (PAT) initiative proposed by the US Food and Drug Administration (FDA) suggests innovative methods to better understand pharmaceutical processes. The development of analytical methods that quantify active pharmaceutical ingredients (APIs) in powders and tablets is fundamental to monitoring and controlling a drug product's quality. Analytical methods based on vibrational spectroscopy do not require sample preparation and can be implemented during in-line manufacturing to maintain quality at each stage of operations. In this study, a mid-infrared (MIR) quantum cascade laser (QCL) spectroscopy-based protocol was performed to quantify ibuprofen in formulations of powder blends and tablets. Fourteen blends were prepared with varying concentrations from 0.0% to 21.0% (w/w) API. MIR laser spectra were collected in the spectral range of 990 to 1600 cm-1. Partial least squares (PLS) models were developed to correlate the intensities of vibrational signals with API concentrations in powder blends and tablets. PLS models were evaluated based on the following figures of merit: correlation coefficient (R2), root mean square error of calibration, root mean square error of prediction, root mean square error of cross-validation, and relative standard error of prediction. QCL assisted by multivariate analysis was demonstrated to be accurate and robust for analysis of the content and blend uniformity of pharmaceutical compounds.

Distinguishing patients with laboratory-confirmed chikungunya from dengue and other acute febrile illnesses, Puerto Rico, 2012-2015.

Chikungunya, a mosquito-borne viral, acute febrile illness (AFI) is associated with polyarthralgia and polyarthritis. Differentiation from other AFI is difficult due to the non-specific presentation and limited availability of diagnostics. This 3-year study identified independent clinical predictors by day post-illness onset (DPO) at presentation and age-group that distinguish chikungunya cases from two groups: other AFI and dengue. Specimens collected from participants with fever ≤7 days were tested for chikungunya, dengue viruses 1-4, and 20 other pathogens. Of 8,996 participants, 18.2% had chikungunya, and 10.8% had dengue. Chikungunya cases were more likely than other groups to be older, report a chronic condition, and present <3 DPO. Regardless of timing of presentation, significant positive predictors for chikungunya versus other AFI were: joint pain, muscle, bone or back pain, skin rash, and red conjunctiva; with dengue as the comparator, red swollen joints (arthritis), joint pain, skin rash, any bleeding, and irritability were predictors. Chikungunya cases were less likely than AFI and dengue to present with thrombocytopenia, signs of poor circulation, diarrhea, headache, and cough. Among participants presenting <3 DPO, predictors for chikungunya versus other AFI included: joint pain, skin rash, and muscle, bone or back pain, and absence of thrombocytopenia, poor circulation and respiratory or gastrointestinal symptoms; when the comparator was dengue, joint pain and arthritis, and absence of thrombocytopenia, leukopenia, and nausea were early predictors. Among all groups presenting 3-5 DPO, pruritic skin became a predictor for chikungunya, joint, muscle, bone or back pain were no longer predictive, while arthritis became predictive in all age-groups. Absence of thrombocytopenia was a significant predictor regardless of DPO or comparison group. This study identified robust clinical indicators such as joint pain, skin rash and absence of thrombocytopenia that can allow early identification of and accurate differentiation between patients with chikungunya and other common causes of AFI.

Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015.

Identifying etiologies of acute febrile illnesses (AFI) is challenging due to non-specific presentation and limited availability of diagnostics. Prospective AFI studies provide a methodology to describe the syndrome by age and etiology, findings that can be used to develop case definitions and multiplexed diagnostics to optimize management. We conducted a 3-year prospective AFI study in Puerto Rico. Patients with fever ≤7 days were offered enrollment, and clinical data and specimens were collected at enrollment and upon discharge or follow-up. Blood and oro-nasopharyngeal specimens were tested by RT-PCR and immunodiagnostic methods for infection with dengue viruses (DENV) 1-4, chikungunya virus (CHIKV), influenza A and B viruses (FLU A/B), 12 other respiratory viruses (ORV), enterovirus, Leptospira spp., and Burkholderia pseudomallei. Clinical presentation and laboratory findings of participants infected with DENV were compared to those infected with CHIKV, FLU A/B, and ORV. Clinical predictors of laboratory-positive dengue compared to all other AFI etiologies were determined by age and day post-illness onset (DPO) at presentation. Of 8,996 participants enrolled from May 7, 2012 through May 6, 2015, more than half (54.8%, 4,930) had a pathogen detected. Pathogens most frequently detected were CHIKV (1,635, 18.2%), FLU A/B (1,074, 11.9%), DENV 1-4 (970, 10.8%), and ORV (904, 10.3%). Participants with DENV infection presented later and a higher proportion were hospitalized than those with other diagnoses (46.7% versus 27.3% with ORV, 18.8% with FLU A/B, and 11.2% with CHIKV). Predictors of dengue in participants presenting <3 DPO included leukopenia, thrombocytopenia, headache, eye pain, nausea, and dizziness, while negative predictors were irritability and rhinorrhea. Predictors of dengue in participants presenting 3-5 DPO were leukopenia, thrombocytopenia, facial/neck erythema, nausea, eye pain, signs of poor circulation, and diarrhea; presence of rhinorrhea, cough, and red conjunctiva predicted non-dengue AFI. By enrolling febrile patients at clinical presentation, we identified unbiased predictors of laboratory-positive dengue as compared to other common causes of AFI. These findings can be used to assist in early identification of dengue patients, as well as direct anticipatory guidance and timely initiation of correct clinical management.

Vocación quirúrgica / Surgical vocation

Describir y delimitar el proceso de vocación quirúrgica y las variables que se le asocian. Diseño. Estudio cuali-cuantitativo, transversal, de casos seleccionados, analizados con propósito descriptivo. Metodología. Previo consentimiento informado se realizaron entrevistas en profundidad, audio-grabadas, a un grupo de 40 cirujanos en ejercicio. Principales medidas de resultados. Vocación quirúrgica. Resultados. Fueron de sexo masculino 95 por ciento, edad promedio 65 años (41 a 86 años), promedio de años de experiencia médica 35,4 (10 a 68), promedio de experiencia quirúrgica 30,2 años (3 a 59). De la formación profesional, 85 por ciento correspondió al sistema de residentado quirúrgico universitario y 15 por ciento al de especialidad no escolarizada. La vocación quirúrgica es un proceso que puede iniciarse en diferentes etapas de la vida. Cuando ocurre previo a los estudios universitarios (17,5 por ciento de la muestra estudiada) se asocia a alta influencia familiar (padre o tíos cirujanos). Más frecuentemente (80 por ciento) emerge durante el pregrado, al influjo de diversos estímulos formativos que provee la propia escuela de formación médica y/o docentes paradigmáticos. En un caso (2,5 por ciento), la vocación había nacido muy temprana, sin que el entrevistado pudiera explicar su origen. Conclusiones: La vocación quirúrgica se sustenta en una sólida vocación de servicio. El cirujano con real vocación experimenta placer en la realización de las actividades quirúrgicas, a la par que visualiza el manejo del paciente y su familia de manera integral y ética. Finalmente, se discuten nuevas hipótesis de investigación en esta área surgidas del estudio y se dan recomendaciones para la enseñanza profesional de la cirugía incluyendo la ética como una necesidad básica de ella...

To describe and delimit the surgical vocation process and associated factors. Design. Selected cases cross-sectional study qualitatively and quantitatively analyzed withdescriptive purpose. Methods. Previous informed consent in depth audio-recorded interviews was carried out in 40 surgeons in current professional practice. Main outcome measures. Surgical vocation. Results. Males represented 95 per cent; mean age was 65 years (41-86), mean medical experience 35.4 years (10-68), surgical experience 30.2 years (03-59). Training centers: 85 per cent had university surgical training and 15 per cent non-university training. Surgical vocation is a process that can begin in different periods of the life's cycle. When it does before university studies (17.5 per cent of the studied sample) it is mainly associated to strong family influence (parents or uncles surgeons). More frequently (80 per cent) it emerges during medical undergraduate studies, under the influence of diverse formative stimuli provided by the medical school and/or paradigmatic professors. In one case (2.5 per cent) surgical vocation had emerged at an early age whose origin the interviewed could not explain. Conclusions. Surgical vocation is based on solid service vocation. The surgeon with substantive vocation experiences real pleasure in doing surgical activities being oriented to a comprehensive and ethical management of patient and family. Finally, new research hypothesis produced by this study in this area are discussed and recommendations are given for professional teaching of surgery including Ethics as a basic need in surgeon's training...

MRI safety: a report of current practice and advancements in patient preparation and screening.

MRI offers detailed diagnostic images without ionizing radiation; however, there are considerable safety concerns associated with high electromagnetic field strength. With increasing use of high and ultra high (7T) magnetic field strength, adequate patient preparation and screening for ferrous material is increasingly important. We review current safety standards for patient screening and preparation and how they are implemented at our institution. In addition, we describe a novel supplemental screening technique wherein the lights are dimmed in response to detected ferrous metal at the threshold of Zone IV.

Vocación psiquiátrica / Psychiatry as a vocation

Describir y delimitar el proceso de vocación psiquiátrica y las variables que se le asocian. Diseño: Estudio de casos, transversal, cualitativo, descriptivo y comparativo. Metodología: Previo consentimiento informado se realizaron entrevistas en profundidad, audio-grabadas, en dos grupos seleccionados por criterios de heterogeneidad: 45 psiquiatras en ejercicio actual y 61 médicos residentes de psiquiatría. Resultados y conclusiones: La vocación psiquiátrica comprende varias dimensiones. En ella destaca la consideración integral de la persona, el interés por el aspecto psíquico del paciente y el deseo de aliviar el sufrimiento que causa la enfermedad mental. En el grupo de psiquiatras en ejercicio, la vocación psiquiátrica se aprecia más consolidada y genuina. En el grupo de residentes, ella impresiona más debilitada y, en algunos casos, inexistente. Varios de los residentes entrevistados escogieron la psiquiatría como especialidad por motivos de conveniencia personal, al no haber alcanzado una vacante en la de su preferencia...

To describe and delimit the psychiatric vocation process and its associated factors. Design: Transversal, qualitative, descriptive and comparative study of cases. Methodology: Previous informed consent in depth audio-recorded interviews were carried out in two groups selected by criteria of heterogeneity, 45 psychiatrists currently in practice and 61 residents in psychiatry. Results and conclusions: Psychiatric vocation includes several dimensions. It considers the person as an integral being, showing strong interest on the psychological part of the patient and a need to reduce the suffering caused by mental illness. In the group of psychiatrists, the psychiatric vocation showed itself as more consolidated and genuine. In the group of residents, psychiatric vocation appeared as a weak and in some cases inexistent process. Several residents chose psychiatry as a career on account of personal convenience because they did not reach vacancy in their preferred specialty...

Surface-enhanced Raman scattering (SERS) characterization of trace organoarsenic antimicrobials using silver/polydimethylsiloxane nanocomposites.

Organoarsenic drugs such as roxarsone and 4-arsanilic acid are poultry feed additives widely used in US broilers to prevent coccidosis and to enhance growth and pigmentation. Despite their veterinary benefits there has been growing concern about their use because over 90% of these drugs are released intact into litter, which is often sold as a fertilizing supplement. The biochemical degradation of these antimicrobials in the litter matrix can release significant amounts of soluble As(III) and As(V) to the environment, representing a potential environmental risk. Silver/polydimethylsiloxane (Ag/PDMS) nanocomposites are a class of surfaceenhanced Raman scattering (SERS) substrates that have proven effective for the sensitive, reproducible, and field-adaptable detection of aromatic acids in water. The work presented herein uses for the first time Ag/PDMS nanocomposites as substrates for the detection and characterization of trace amounts of roxarsone, 4-arsanilic acid, and acetarsone in water. The results gathered in this study show that organoarsenic species are distributed into the PDMS surface where the arsonic acid binds onto the embedded silver nanoparticles, enhancing its characteristic 792 cm(-1) stretching band. The chemisorption of the drugs to the metal facilitates its detection and characterization in the parts per million to parts per billion range. An extensive analysis of the distinct spectroscopic features of each drug is presented with emphasis on the interactions of the arsonic acid, amino, and nitro groups with the metal surface. The benefits of SERS based methods for the study of arsenic drugs are also discussed.

Preoperative cardiac risk stratification and management.

Perioperative myocardial infarction carries an increased short and long-term morbidity and mortality. The perioperative cardiac evaluation should focus on obtaining critical data such as type of surgery, patient co-morbidities, functional capacity of the patient, medications used and exclusion of active cardiac conditions. With this information the physician should stratify the patient according to the latest American College of Cardiology/American Heart Association guidelines and recommend interventions to decrease myocardial infarct risk. The interventions include: coronary revascularization (e.g. angioplasty, coronary artery bypass graft) and/ or pharmacological therapy (e.g. Beta-blockers, statins, etc.). All this information should be documented and discussed among the perioperative physicians (surgeon, anesthesia, primary physician, cardiologist) in order to provide the optimal care of the patient. The management of other cardiac conditions such as valvular disease, hypertension, heart failure, cardiac arrhythmias and cardiac devices are not contemplated in this narrative review.

Vibrational spectroscopy standoff detection of explosives.

Standoff infrared and Raman spectroscopy (SIRS and SRS) detection systems were designed from commercial instrumentation and successfully tested in remote detection of high explosives (HE). The SIRS system was configured by coupling a Fourier-transform infrared interferometer to a gold mirror and detector. The SRS instrument was built by fiber coupling a spectrograph to a reflective telescope. HE samples were detected on stainless steel surfaces as thin films (2-30 microg/cm(2)) for SIRS experiments and as particles (3-85 mg) for SRS measurements. Nitroaromatic HEs: TNT, DNT, RDX, C4, and Semtex-H and TATP cyclic peroxide homemade explosive were used as targets. For the SIRS experiments, samples were placed at increasing distances and an infrared beam was reflected from the stainless steel surfaces coated with the target chemicals at an angle of approximately 180 degrees from surface normal. Stainless steel plates containing TNT and RDX were first characterized for coverage distribution and surface concentration by reflection-absorption infrared spectroscopy. Targets were then placed at the standoff distance and SIRS spectra were collected in active reflectance mode. Limits of detection (LOD) were determined for all distances measured for the target HE. LOD values of 18 and 20 microg/cm(2) were obtained for TNT and RDX, respectively, for the SIR longest standoff distance measured. For SRS experiments, as low as 3 mg of TNT and RDX were detected at 7 m source-target distance employing 488 and 514.5 nm excitation wavelengths. The first detection and quantification study of the important formulation C4 is reported. Detection limits as function of laser powers and acquisition times and at a standoff distance of 7 m were obtained.

Cultivo experimental de Octopus mimus, Gould 1852 en el Perú / Experimental culture of Octopus mimus, Gould 1852 in Peru

Octopus mimus Gould, 1852 es un recurso bentónico muy importante en la pesquería artesanal peruana y de gran demanda en el mercado internacional. Actualmente no existen antecedentes sobre el cultivo de esta especie en el pacífico Sudeste, salvo los realizados por Zuñiga (1995-1996 a,b) y Baltazar et. al (1999). Las experiencias de cultivo se realizaron en las intalaciones del Centro De Acuicultura La Arena, Casma, Perú, empleándose tanques de fibra de vidrio y lon-line en el mar. La alimentación fue a base de peces, crustáceos y moluscos, se ensayó con pienso húmedo que fue aceptado tras un período de inanición. La cópula se realizó con ejemplares mayores a 1, 5 Kg. Se observó diferencias en el crecimiento, en los tanques 8185 y 369 g/mes) fue mayor que en las líneas de cultivo (120,6 g/mes). Se obtuvieron para larvas con una supervivencia máxima de 17 días a temperatura de 21 a 22°C, las que fueron alimentadas con nauplios de artemia (camarón de salmuera).

Apoptosis en psiquiatría / Apoptosis in psychatry

Se presenta las bases neurobiológicas de la apoptosis, su evolución histórica, los tipos de muerte celular programada diferenciándolos de la muerte por necrosis desde el punto de vista Bioquímico, genético, epigenético y morfológico de las células. La vida y la muerte tienen su propia maquinaria biológica que las preserva y estas se encuentran en un equilibrio dinámico representadas por el fenómeno de la mitosis (vida) y la apoptosis (muerte); un desequilibrio entre ellas derivara en el origen de determinadas enfermedades. Se postula dentro de la teoría de neurodesarrollo para la esquizofrenia como una enfermedad neurodegenerativa; de cómo la apoptosis podría explicar el origen de la esquizofrenia y depresiones refractarias, la probable relación entre apoptosis y HIV, suicidio y depresión recurrente.