Bidirectional Energy Flow in the Photosystem II Supercomplex.

The water-splitting capability of Photosystem II (PSII) of plants and green algae requires the system to balance efficient light harvesting along with effective photoprotection against excitation in excess of the photosynthetic capacity, particularly under the naturally fluctuating sunlight intensity. The comparatively flat energy landscape of the multicomponent structure, inferred from the spectra of the individual pigment-protein complexes and the rather narrow and featureless absorption spectrum, is well known. However, how the combination of the required functions emerges from the interactions among the multiple components of the PSII supercomplex (PSII-SC) cannot be inferred from the individual pigment-protein complexes. In this work, we investigate the energy transfer dynamics of the C2S2-type PSII-SC with a combined spectroscopic and modeling approach. Specifically, two-dimensional electronic-vibrational (2DEV) spectroscopy provides enhanced spectral resolution and the ability to map energy evolution in real space, while the quantum dynamical simulation allows complete kinetic modeling of the 210 chromophores. We demonstrate that additional pathways emerge within the supercomplex. In particular, we show that excitation energy can leave the vicinity of the charge separation components, the reaction center (RC), faster than it can transfer to it. This enables activatable quenching centers in the periphery of the PSII-SC to be effective in removing excessive energy in cases of overexcitation. Overall, we provide a quantitative description of how the seemingly contradictory functions of PSII-SC arise from the combination of its individual components. This provides a fundamental understanding that will allow further improvement of artificial solar energy devices and bioengineering processes for increasing crop yield.

Plasma infrared fingerprinting with machine learning enables single-measurement multi-phenotype health screening.

Infrared spectroscopy is a powerful technique for probing the molecular profiles of complex biofluids, offering a promising avenue for high-throughput in vitro diagnostics. While several studies showcased its potential in detecting health conditions, a large-scale analysis of a naturally heterogeneous potential patient population has not been attempted. Using a population-based cohort, here we analyze 5,184 blood plasma samples from 3,169 individuals using Fourier transform infrared (FTIR) spectroscopy. Applying a multi-task classification to distinguish between dyslipidemia, hypertension, prediabetes, type 2 diabetes, and healthy states, we find that the approach can accurately single out healthy individuals and characterize chronic multimorbid states. We further identify the capacity to forecast the development of metabolic syndrome years in advance of onset. Dataset-independent testing confirms the robustness of infrared signatures against variations in sample handling, storage time, and measurement regimes. This study provides the framework that establishes infrared molecular fingerprinting as an efficient modality for populational health diagnostics.

Promocionando la Promoción de la Salud: percepciones de estudiantes de medicina sobre un programa educativo para cambio de conductas en atención primaria / Promoting Health Promotion: Medical students perceptions about an educational program on behavioral change in primary care

Objetivo: Valorar si un programa formativo ofrecido por médicos de familia en el currículum oficial de medicina sobre principios y estrategias para ayudar a los pacientes a cambiar conductas de riesgo (APCCR) produce cambios en sus percepciones, opiniones y actitudes con relación a este tipo de intervenciones. Diseño: Estudio cuasiexperimental antes-después. Emplazamiento: Una facultad de medicina. Participantes: Todos los alumnos de 4.o curso de medicina (n = 110). Intervenciones: Formación experiencial sobre estrategias comunicativas para APCCR. Mediciones: Opiniones y percepciones evaluadas antes y después del curso mediante cuestionario ad hoc. Resultados: Tras el curso, los estudiantes (n = 103) cambiaron sus ideas sobre la motivación como factor «interno» (15, 13%) a "interno-externo" (71, 61%) (p = 0,003), reforzando sus opiniones sobre la capacidad del médico para APCCR (alta: 72, 62%; baja: 10, 12%; p = 0,008). Los alumnos se consideraron más capaces de respetar la autonomía de los pacientes cuando estos toman decisiones o siguen conductas consideradas perjudiciales (fácil: 58, 50%; difícil: 28, 24%; p = 0,001) e incrementaron su percepción sobre su capacidad para afrontar este tipo de entrevistas (83, 72% vs. 1, 1%; p < 0,001). Conclusiones: Esta formación parece contribuir a crear en estudiantes percepciones y actitudes positivas relacionadas con aspectos claves a la hora de afrontar una entrevista para APCCR, lo cual supone un aspecto preliminar clave para implementar este tipo de estrategias

Objective: To evaluate whether a training program offered by family physicians in the official medical curriculum on principles and strategies to help patients change risk behaviours (HPCRB), produces changes in perceptions, opinions, and attitudes regarding this type of intervention. Design: Quasi-experimental before-after study. Setting: A School of Medicine. Participants: All students in their 4th year (n = 110). Interventions: Experiential training course on communicative strategies for HPCRB. Measurements: Opinions and perceptions were evaluated before and after the course using an ad hoc survey. Results: After the course, students (n = 103) changed their ideas about motivation as an "internal" (15, 13%) to ‘internal-external’ factor (71, 61%) (P = .003), reinforcing their opinions about the clinician's ability for HPCRB (high: 72, 62%; low: 10, 12%; P = .008). They considered themselves more capable to respect patient autonomy when they make decisions or follow harmful behaviours (easy: 58, 50%; difficult: 28, 24%; P = .001), and increased their perception of their ability to cope with this type of interview (83, 72% vs. 1, 1%; P < .001). Conclusions: This training course seems to contribute to creating positive perceptions and attitudes in students, as regards key aspects when conducting an interview for HPCRB. This is a key preliminary aspect to implement this type of strategy

Enseñar y aprender habilidades de comunicación clínica en la Facultad de Medicina. La experiencia de la Francisco de Vitoria (Madrid) / Teaching and learning clinical communication skills in Francisco de Vitoria medical school (Madrid)

La comunicación clínica ha sido aceptada como un contenido importante de los planes de estudio de medicina y reconocida como una competencia esencial por los organismos de acreditación y las organizaciones internacionales de educación médica. La formación en habilidades de «comunicación clínica» requiere que el estudiante ensaye con «pacientes simulados» bajo supervisión y observación directa y reciba un feedback específico y personalizado. Ello exige un programa de enseñanza en grupos pequeños, a través de un aprendizaje experiencial, impartido por profesores médicos especializados en la materia, de forma integrada con el resto de habilidades clínicas, esto es, no mediante intervenciones puntuales, sino a lo largo de todo el currículum. Se describen las características generales, organizativas y pedagógicas de un programa transversal dirigido a los estudiantes de medicina para su formación en habilidades de «comunicación clínica» basado en la experiencia desarrollada en la facultad de medicina en la Universidad Francisco de Vitoria durante los últimos 6 años, la cual puede servir de ejemplo en el contexto de los estudios de medicina en España o de otros entornos educativos

Clinical communication has been accepted as an important content of medical curricula and recognized as an essential competence by accreditation bodies and international medical education organizations. "Clinical Communication" skills training requires the student to practice with "standardized patients" under direct supervision and observation and receive specific and personalized feedback. This task requires a small group teaching, through an experiential learning, given by medical teachers specialized in this subject, in an integrated way with other clinical skills, that is, not through aisolate interventions, but throughout the curriculum. We describes the general, managerial, educational features and main educational results of an integrated "Clinical Communication Skills Curriculum" for medical students, implemented at the Universidad Francisco de Vitoria school of medicine during the last six years. Some useful and practical messages for improving teaching and learning these skills in universitary medical education in Spain are extracted

Sensibilidad de los alumnos admitidos en una facultad de medicina en aspectos relacionales, organizativos y éticos de la práctica clínica / Sensitivity of students admitted in a medical school regarding relational, managerial and ethical aspects of clinical practice

ANTECEDENTES: A pesar de que la sensibilidad humana y ética se considera atributo clave en los médicos, estos no son considerados para la selección de alumnos en las escuelas de medicina. OBJETIVO: Estudio exploratorio para valorar la sensibilidad de los estudiantes que inician sus estudios de medicina en aspectos relacionales, organizativos, personales y éticos que supone el ejercicio de la medicina. METODOLOGÍA: Estudio cualitativo sobre comentarios basados en la observación. En la primera sesión del curso se presentó a los alumnos un vídeo de un encuentro clínico simulado que ponía de manifiesto diferentes conductas y acontecimientos que incidían negativamente en su calidad. Se les pidió a los alumnos que destacaran al menos un par de aspectos/conductas que podrían mejorarse. Dos observadores externos categorizaron estos comentarios. Resultados y CONCLUSIONES: Participaron 105 alumnos (30 varones, 75 mujeres) que realizaron 251 comentarios (media: 2,3). Se identificaron 47 (21%) comentarios de tipo exclusivamente evaluativos o conceptuales y 177 (79%) de tipo descriptivo de los que la mayoría ofrecían algún comentario evaluativo. Los alumnos detectaron conductas comunicativas entre las que destacan contenidos del lenguaje verbal y no verbal del médico que interpretaron como pérdida del interés profesional y de respeto por el paciente, actitudes de prepotencia y de insensibilidad, falta de solidaridad emocional con los pacientes así como falta de privacidad y confidencialidad. Estos resultados son útiles para conocer la sensibilidad del recién ingresado sobre estos temas y para orientar intervenciones educativas al respecto. Su carácter exploratorio exige realizar estudios más exhaustivos sobre este tema

BACKGROUND: Although human sensitivity and ethics is considered a key attribute doctors, usually these are not considered in candidates to be admitted in medical schools. AIM: An exploratory study to assess the sensitivity of students admitted in medical school in relational, organizational, personal and ethical issues involved in clinical practice. METHODOLOGY: A qualitative study on comments based on the observation of a clinical situation. In the first session of the course students watched a video of a clinical encounter who highlighted different behaviors and events that contributed negatively on its quality. Students were asked to stand out at least a couple of aspects/behaviors that could be improved. Two external observers categorized these comments. Results and CONCLUSIONS: A total of 105 students (30 men and 75 women) made 251 comments (average: 2.3). Exclusively evaluative or conceptual comments: 47 (21%); descriptive comments (most with evaluative remarks also): 177 (79%). Students detected a wide range of communicative behaviors: physician verbal and nonverbal behaviours that were interpreted as loss of professional interest and respect for the patient, attitudes of arrogance and insensitivity, lack of emotional solidarity with the patients as well as lack of privacy and confidentiality. These results are useful to know the sensitivity of the students admitted to medical school on these issues and to guide and planing educational INTERVENTIONS: Further studies on this topic will be needed

Comunicación clínica: por qué, cómo, cuándo y qué (núcleo curricular) enseñar / Clinical communication: why, how, when and what ("Curricular nucleus") to teach

La comunicación clínica (CC) es hoy en día reconocida como una competencia fundamental que debe poseer el médico, y no solamente por ser la más utilizada por el clínico, sino porque en su contexto se despliegan el resto de competencias clínicas. Además, las evidencias científicas muestran que una CC de calidad se relaciona con importantes resultados en la asistencia y hoy en día supone un fin en sí misma. La CC no es algo que se adquiera por la simple experiencia, sino que debe y puede enseñarse. Para ello los métodos docentes que se han mostrado más eficaces son los denominados experienciales, que incorporan el feedback, la repetición y la reflexión tras encuentros con pacientes reales o simulados, con profesores preparados y de manera continuada a lo largo de todo el currículum. El consenso LAPS_CCC sobre un "núcleo curricular de habilidades comunicativas" recientemente alcanzado por 46 expertos de Iberoamérica, España y Portugal representa una propuesta sobre los contenidos a enseñar en los estudios de Medicina para estos países y es útil para orientar la incorporación de la CC en sus facultades de medicina de una forma homogénea y realista

Clinical Communication (CC) is nowadays recognized as a key competence that every physician should have and not only because it is the most used by the clinician but because other clinical skills are practiced through it. We also have enough evidence showing that a communication of quality is related to important outcomes of care and, at present, the western society considers good communication an end by itself. The CC is not something that is acquired only by experience but should and can be taught. Teaching methods that have proven to be most effective are those "experientials", i. e. , incorporating feedback, rehearsal and reflection after encounters with actual or simulated patients, with trained teachers and throughout the entire curriculum. The LAPS_CCC consensus on a "core curriculum of communication skills" recently reached among 46 experts from Latin America, Spain and Portugal, represents a proposal on contents to be taught in medical studies in the context of these countries and it is useful to guide the incorporation of the CC in their medical schools in a homogeneous and realistic way