Reflexiones para optimizar el triaje en cirugía / Reflections to optimize triage in surgery

Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

A "Mean Quarrelsome Spirit:" Controversy in British Systematics, 1822-1836.

British systematics was distinctly marked by a raft of vituperative controversies around the turn of the 1830s. After the local collapse of broad consensus in the Linnaean system by 1820, the emergence of new schemes of classification-most notably, the "quinarian" system of William Sharp Macleay-brought with it an unprecedented register of public debate among zoologists in Britain, one which a young Charles Darwin would bitterly describe to his friend John Stevens Henslow in October 1836 as possessing a "mean quarrelsome spirit," conducted in "a manner anything but like that of gentlemen." This article aims to provide a social and conceptual account of the remarkable tenor of zoological discourse in Britain in the late 1820s and early 1830s, with joint attention to the philosophical and interpersonal commitments at play. In doing so, it analyzes the three of the period's most striking public controversies, each of which counted key advocates of the quinarian system as central participants.

Compositional and functional diversities of core microbial communities in wild and artificial Ophiocordyceps sinensis / Diversidades compositivas y funcionales de comunidades microbianas centrales en Ophiocordyceps sinensis silvestre y artificial

Ophiocordyceps sinensis is an entomogenous fungus, and its wildlife resource is very insufficient, as it is widely traded as a natural health product. The artificial culture of O. sinensis is a remarkably effective progress in addressing the problem. Adding microorganisms may improve the process of artificial culture. To analyse the composition and function of the microbial community, high-throughput sequencing was used to explore the microbial community inhabiting wild and artificial O. sinensis and surrounding soil. Significant differences in the microbial communities across groups were revealed by the PCoA analysis. There were 51 fungal and 598 bacterial operational taxonomic units only being assigned to the fruiting bodies of wild O. sinensis (Wf) by the Venn diagram. From the LEfSe analysis, 39 fungal taxa and 75 bacterial taxa were enriched in Wf. Enzymes that were highly abundant in the core fungi were involved in physiological metabolic processes. Metabolic pathways were dominated in the core bacteria, followed by environmental information processing. The core microorganisms, with the marked differences between Wf and the other three groups, were essential for wild O. sinensis. Functional analysis verified their involvement in the growth, development, and infection of O. sinensis. These core microorganisms may be a valuable resource for the artificial culture of O. sinensis.(AU)

Yeasts associated with mines on tree leaves in the urban areas / Levaduras asociadas a minas en hojas de árboles en zonas urbanas

Mines on tree leaves and undamaged leaves were studied to investigate yeast complexes in urban areas (Aesculus hippocastanum, miner — Cameraria ohridella; Betula verrucosa, miner — Caloptilia betulicola; Populus nigra, miner — Lithocolletis populifoliella; Quercus robur, miner — Tischeria companella; Salix caprea, miner — Trachys minuta; Syringa vulgaris, miner — Caloptilia syringella; Tilia cordata, miner — Phyllonorycter issikii; Ulmus laevis, miner — Carpatolechia fugitivella). The abundance and taxonomic structure of yeasts were studied using a surface plating method on solid media (GPY agar). Identification of yeast species was based on the ITS rDNA nucleotide sequence. The average abundance of yeasts during the first stages of mine formation in the internal tissues of leaves was 103 cfu/g. After 23–25 days, during the last stage of larval metamorphosis before mine destruction, the abundance of yeasts in the mines increased by two orders of magnitude to 105 cfu/g. No significant differences were observed in the abundance of yeasts in mines formed by different insects on different trees. A total of twelve yeast species were observed. The fast-growing ascomycetous yeasts Hanseniaspora uvarum and H. occidentalis dominated the mines. On undamaged leaves, the basidiomycetous yeasts Papiliotrema flavescens and Rhodotorula mucilaginosa, typical in the phyllosphere, dominated. The opportunistic yeast Candida parapsilosis was detected in the yeast complexes of all mines examined and was not found on the surface of leaves. Comparison of the relative abundance of yeast species between the studied mines and undamaged leaves using principal component analysis showed that all studied yeast communities in the mines were significantly different from the epiphytic yeast complexes of the undamaged leaves. Thus, miners in urban environments provoke the formation of short-lived endophytic yeast complexes with high abundance of Hanseniaspora. For leaf miners, the yeasts serve primarily as a food source for insect larvae rich in vitamins and amino acids. The adult leaf miners, in turn, contribute to the reproduction of the yeasts and create favorable conditions for their development.(AU)

Medicare and Medicaid Dual-Eligible Special Needs Plan Enrollment and Beneficiary-Reported Experiences With Care.

This cross-sectional study analyzes Medicare Advantage surveys to compare Medicare and Medicaid dual-eligible individuals' experiences with care across 3 established categories of plans.

Data-specific substitution models improve protein-based phylogenetics.

Calculating amino-acid substitution models that are specific for individual protein data sets is often difficult due to the computational burden of estimating large numbers of rate parameters. In this study, we tested the computational efficiency and accuracy of five methods used to estimate substitution models, namely Codeml, FastMG, IQ-TREE, P4 (maximum likelihood), and P4 (Bayesian inference). Data-specific substitution models were estimated from simulated alignments (with different lengths) that were generated from a known simulation model and simulation tree. Each of the resulting data-specific substitution models was used to calculate the maximum likelihood score of the simulation tree and simulated data that was used to calculate the model, and compared with the maximum likelihood scores of the known simulation model and simulation tree on the same simulated data. Additionally, the commonly-used empirical models, cpREV and WAG, were assessed similarly. Data-specific models performed better than the empirical models, which under-fitted the simulated alignments, had the highest difference to the simulation model maximum-likelihood score, clustered further from the simulation model in principal component analysis ordination, and inferred less accurate trees. Data-specific models and the simulation model shared statistically indistinguishable maximum-likelihood scores, indicating that the five methods were reasonably accurate at estimating substitution models by this measure. Nevertheless, tree statistics showed differences between optimal maximum likelihood trees. Unlike other model estimating methods, trees inferred using data-specific models generated with IQ-TREE and P4 (maximum likelihood) were not significantly different from the trees derived from the simulation model in each analysis, indicating that these two methods alone were the most accurate at estimating data-specific models. To show the benefits of using data-specific protein models several published data sets were reanalysed using IQ-TREE-estimated models. These newly estimated models were a better fit to the data than the empirical models that were used by the original authors, often inferred longer trees, and resulted in different tree topologies in more than half of the re-analysed data sets. The results of this study show that software availability and high computation burden are not limitations to generating better-fitting data-specific amino-acid substitution models for phylogenetic analyses.

What Does Sexual Behaviour Encompass? Mapping Human Sexual Repertoire / ¿Qué Conductas Componen el Comportamiento Sexual? Mapeo del Repertorio Sexual Humano

Introduction: For sciences applied to sexual behaviour, research has traditionally reported a wide variety of non-unified pools with a lack of a gold standard classification. Therefore, this work aimed to propose a comprehensivetaxonomy. Methods: A broad model was developed under expert criteria using a thematic analysis of the literature.After that, a systematic review was conducted to test and extend it within the given conditions of unification. Results:36 variables of actions and surrounding context were found and allocated in 5 groups: partner description, combinatoryvariables, objects associated, paraphilic behaviours and actual behaviours. 650 reports were screened, and 143were fully assessed. Of them, one was finally selected to add to the previous model. Discussion: A comprehensivetaxonomy was brought in, along with a method to expand and retest it if necessary. It is aimed to set a commonlyshared framework of repertoires to enable valid comparisons among samples or individuals.(AU)

Introducción: Para las ciencias del comportamiento sobre la conducta sexual, tradicionalmente, la investigación haexpuesto conjuntos no unificados de repertorios en ausencia de clasificaciones fundamentales. Por ello, este trabajotrata de exponer una propuesta de taxonomía completa y fundamentada. Métodos: Se desarrolló una propuesta delargo alcance bajo criterio de expertos haciendo un análisis temático de la literatura. Después, se llevó a cabo unarevisión sistemática para ponerla a prueba y extenderla. Resultados: Se encontraron 36 variables descriptivas delas acciones y el contexto inmediato, y se situaron en 5 grupos: pareja (descripción), combinatorio, elementos uobjetos (asociados), conductas parafílicas y conducta sexual. Se revisaron 650 estudios de los que 143 se evaluaronen profundidad. Sólo un elemento fue incluido al listado final tras la revisión sistemática. Discusión: Se obtuvo unataxonomía general del comportamiento sexual humano. El objetivo de este mapeo es facilitar mejores comparacionesentre muestras o individuos basándose en un criterio de referencia unificado.(AU)