Antibrush Border Antibody Disease: A Case Series.

Antibrush border antibody (ABBA) disease is a rare cause of kidney disease characterized by progressive renal tubular injury associated with immune complex deposition along the basement membranes of the proximal tubule and circulating autoantibodies to brush border antigens. Several antigens have been identified as targets of autoantibodies in this disease, including low-density lipoprotein receptor related protein 2 (LRP2), cubilin, and amnionless proteins. We present 9 patients from 2 academic medical centers and describe the clinicopathologic characteristics and outcome data. All patients presented with acute kidney injury and proteinuria. Pathology confirmed immune complex deposition along proximal tubular basement membranes in all patients, but the majority (6/8) also showed segmental glomerular subepithelial immune complexes. Two of 3 patients treated with rituximab demonstrated stabilization of kidney function; 1 of these patients had mantle cell lymphoma. One patient with lung cancer showed stabilization of disease after treatment of the malignancy. The remaining patients progressed to end-stage kidney disease with either conservative therapy (3 patients) or immunosuppression with glucocorticoids (2 patients). This series highlights the poor prognosis of ABBA disease, but a potential benefit of anti-B cell therapy or treatment of an underlying malignancy in some cases.

Lupus IgA1 autoantibodies synergize with IgG to enhance plasmacytoid dendritic cell responses to RNA-containing immune complexes.

Autoantibodies to nuclear antigens are hallmarks of systemic lupus erythematosus (SLE) where they contribute to pathogenesis. However, there remains a gap in our knowledge regarding how different isotypes of autoantibodies contribute to this autoimmune disease, including the production of the critical type I interferon (IFN) cytokines by plasmacytoid dendritic cells (pDCs) in response to immune complexes (ICs). We focused on IgA, which is the second-most prevalent isotype in serum and, along with IgG, is deposited in glomeruli in individuals with lupus nephritis. We show that individuals with SLE have serum IgA autoantibodies against most nuclear antigens, correlating with IgG against the same antigen. We investigated whether IgA autoantibodies against a major SLE autoantigen, Smith ribonucleoprotein (Sm/RNP), played a role in IC activation of pDCs. We found that pDCs expressed the IgA-specific Fc receptor, FcαR, and IgA1 autoantibodies synergized with IgG in RNA-containing ICs to generate robust primary blood pDC IFN-α responses in vitro. pDC responses to these ICs required both FcαR and FcγRIIa, showing synergy between these Fc receptors. Sm/RNP IC binding to and internalization by pDCs were greater when ICs contained both IgA1 and IgG. Circulating pDCs from individuals with SLE had higher binding of IgA1-containing ICs and higher expression of FcαR than pDCs from healthy control individuals. Although pDC FcαR expression correlated with the blood IFN-stimulated gene signature in SLE, Toll-like receptor 7 agonists, but not IFN-α, up-regulated pDC FcαR expression in vitro. Together, we show a mechanism by which IgA1 autoantibodies contribute to SLE pathogenesis.

Rapid automatized naming: what it is, what it is not, and why it matters.

Rapid automatized naming (RAN) has surged in popularity recently as an important indicator of reading difficulties, including dyslexia. Despite an extensive history of research on RAN, including recent meta-analyses indicating a unique contribution of RAN to reading above and beyond phonemic awareness, questions remain regarding RAN's relationship to reading. Specific questions exist regarding how PA mediates that relationship and how best to use data from RAN measures to identify risk for reading failure. Through multiple studies, we demonstrate that RAN is not merely subsumed by skills typically assessed when conducting universal screening for reading difficulties (i.e., phonemic segmentation fluency and letter naming fluency), but contributes unique information above and beyond these measures. Additionally, we discuss the process for the development of cut points for risk for Acadience RAN, along with guidance regarding how educators can interpret RAN scores as an indicator of risk for future reading difficulties. The results presented here support the idea that difficulties associated with RAN are not merely reflections of difficulties with other early literacy skills typically assessed during universal screening, but constitute separate and distinct difficulties that may precipitate later reading problems.

Interferon-γ induces combined pyroptotic angiopathy and APOL1 expression in human kidney disease.

Elevated interferon (IFN) signaling is associated with kidney diseases including COVID-19, HIV, and apolipoprotein-L1 (APOL1) nephropathy, but whether IFNs directly contribute to nephrotoxicity remains unclear. Using human kidney organoids, primary endothelial cells, and patient samples, we demonstrate that IFN-γ induces pyroptotic angiopathy in combination with APOL1 expression. Single-cell RNA sequencing, immunoblotting, and quantitative fluorescence-based assays reveal that IFN-γ-mediated expression of APOL1 is accompanied by pyroptotic endothelial network degradation in organoids. Pharmacological blockade of IFN-γ signaling inhibits APOL1 expression, prevents upregulation of pyroptosis-associated genes, and rescues vascular networks. Multiomic analyses in patients with COVID-19, proteinuric kidney disease, and collapsing glomerulopathy similarly demonstrate increased IFN signaling and pyroptosis-associated gene expression correlating with accelerated renal disease progression. Our results reveal that IFN-γ signaling simultaneously induces endothelial injury and primes renal cells for pyroptosis, suggesting a combinatorial mechanism for APOL1-mediated collapsing glomerulopathy, which can be targeted therapeutically.

Commentary: Engagement for Research and Quality Improvement - More Than Just Words.

We reflect on the paper from Hahn-Goldberg et al. (2024) who shared key learnings from a pan-Canadian quality improvement (QI) and patient engagement care transition initiative called Bridge-to-Home. In considering the approach and outcomes presented in their paper, we have generated reflections and practical suggestions on how to amplify engagement work even further: (1) patient engagement and QI are about relationships; (2) seamlessly implementing complex interventions across siloed organizations continues to be a challenge, which engagement alone cannot solve; (3) it is time for a paradigm shift; (4) QI is about human behaviour change and is inherently messy; and (5) embedding fulsome evaluation of engagement is essential.

How do people with intellectual disabilities understand friendship? A systematic meta-synthesis.

BACKGROUND: Previous systematic reviews of the relationships of people with intellectual disabilities have included consideration of intimate relationships. In this paper, we report a systematic review of papers describing friendship only. METHOD: A systematic qualitative meta-synthesis of the research exploring experiences of friendship as reported by people with intellectual disabilities. RESULTS: Seven papers met the inclusion criteria for analysis. Three superordinate themes were identified. (1) Reciprocity, 'Someone who helps me, and I help them'. (2) The building blocks of friendships, 'I can tell her some secrets'. (3) Managing friendship difficulties, 'In real life it's much harder'. CONCLUSION: People with intellectual disabilities value friendship and actively engage in reciprocal exchanges. We explore the strengths and limitations of current research, clinical implications, and directions for future research.

Establishment of a Biorepository for Down Syndrome: Experience of the Inter-Institutional Multidisciplinary BioBank - BioBIM.

BACKGROUND: Down syndrome, or Trisomy 21, is the leading genetic cause of cognitive disability in children and is associated with a high risk of several comorbidities, particularly congenital heart defects, early onset Alzheimer's disease, leukaemia, and autoimmune disorders. OBJECTIVE: This study describes the design, methods, and operational procedures employed to establish a biobank dedicated to Down syndrome that can support research projects investigating the effects of various genetic and environmental factors on this complex disease. METHODS: Blood was collected from all recruited subjects, processed, aliquoted and immediately frozen at -80 °C in the Interinstitutional Multidisciplinary BioBank (BioBIM) facilities. A small aliquot of the sample was used to perform blood tests for which analysis would not be feasible at a later date, such as blood cell counts. Each biological sample was coded, assigned a Standard PREanalytical Code, and registered in the oloBIOBANK software connected to a medical card containing all the donor's anamnestic data. All samples were stored under continuous real-time temperature recording using a freezer connected to a T-GUARD alarm system. In addition, a radiofrequency identification tracking system strictly monitored each cryopreservation operation performed throughout the sample lifecycle. RESULTS: Biological samples were collected from 454 individuals with Down syndrome from 2007 to 2023. A total of 2233 biological samples were available for research purposes, including whole blood in different anticoagulants, serum, plasma, and frozen peripheral blood mononuclear cells. The quality of the nucleic acids obtained through specific standard operating procedures demonstrated that these samples were appropriate for clinical and basic research. CONCLUSION: By establishing this biobank, we have gathered a significant number of biological samples and clinical data from individuals with Down syndrome, thereby fostering collaboration between different research groups in an open and transparent manner. Sharing expertise and resources among scientists will ultimately facilitate the transfer of knowledge to clinical practice, leading to the development of more effective therapeutic treatments to improve the outcomes and quality of life of patients with Down syndrome.

Challenges and Opportunities for the Clinical Translation of Spatial Transcriptomics Technologies.

Background: The first spatially resolved transcriptomics platforms, GeoMx (Nanostring) and Visium (10x Genomics) were launched in 2019 and were recognized as the method of the year by Nature Methods in 2020. The subsequent refinement and expansion of these and other technologies to increase -plex, work with formalin-fixed paraffin-embedded tissue, and analyze protein in addition to gene expression have only added to their significance and impact on the biomedical sciences. In this perspective, we focus on two platforms for spatial transcriptomics, GeoMx and Visium, and how these platforms have been used to provide novel insight into kidney disease. The choice of platform will depend largely on experimental questions and design. The application of these technologies to clinically sourced biopsies presents the opportunity to identify specific tissue biomarkers that help define disease etiology and more precisely target therapeutic interventions in the future. Summary: In this review, we provide a description of the existing and emerging technologies that can be used to capture spatially resolved gene and protein expression data from tissue. These technologies have provided new insight into the spatial heterogeneity of diseases, how reactions to disease are distributed within a tissue, which cells are affected, and molecular pathways that predict disease and response to therapy. Key Message: The upcoming years will see intense use of spatial transcriptomics technologies to better define the pathophysiology of kidney diseases and develop novel diagnostic tests to guide personalized treatments for patients.

Can behaviorally inhibited preschoolers make friends?

Preschoolers who display extremely inhibited behavior are at risk for the development of anxiety disorders. However, behavioral inhibition (BI) is a multifaceted characteristic. Some children with BI are fearful when confronted by unfamiliar adults, peers, and objects; others are fearful when separated from their parents. In the present study, we examined specific features of BI that predicted observed friendship formation among preschoolers who are behaviorally inhibited. We also examined whether teacher ratings of classroom behaviors predicted friendship formation. Sixty highly inhibited children (35 female, Mage = 52.57 months) were observed during eight weekly free-play sessions with initially unfamiliar inhibited peers. Free-play periods occurred before weekly intervention sessions for children with BI and their parents. An observational protocol was developed to identify children who made a friend during the eight weekly sessions. Before the first session, different subtypes of BI were assessed by parents; preschool teachers assessed the children's classroom behaviors with familiar peers. Twenty-six children met the criteria for having made and kept a friend. Probit regression analyses revealed that parent ratings of BI among unfamiliar peers and teacher ratings of children's social anxiety before the intervention were associated with a decreased probability of making a friend. No evidence was found linking children's responses to the intervention and friendship formation. Results suggest that extremelyinhibited preschoolers are capable of making friends. Implications for future research and intervention efforts that focus on individual differences of children with BI are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Flagellin-modulated inflammasome pathways characterize the human alveolar macrophage response to Burkholderia pseudomallei, a lung-tropic pathogen.

Melioidosis is an emerging tropical infection caused by inhalation, inoculation, or ingestion of the flagellated, facultatively intracellular pathogen Burkholderia pseudomallei. The melioidosis case fatality rate is often high, and pneumonia, the most common presentation, doubles the risk of death. The alveolar macrophage is a sentinel pulmonary host defense cell, but the human alveolar macrophage in B. pseudomallei infection has never been studied. The objective of this study was to investigate the host-pathogen interaction of B. pseudomallei infection with the human alveolar macrophage and to determine the role of flagellin in modulating inflammasome-mediated pathways. We found that B. pseudomallei infects primary human alveolar macrophages but is gradually restricted in the setting of concurrent cell death. Electron microscopy revealed cytosolic bacteria undergoing division, indicating that B. pseudomallei likely escapes the alveolar macrophage phagosome and may replicate in the cytosol, where it triggers immune responses. In paired human blood monocytes, uptake and intracellular restriction of B. pseudomallei are similar to those observed in alveolar macrophages, but cell death is reduced. The alveolar macrophage cytokine response to B. pseudomallei is characterized by marked interleukin (IL)-18 secretion compared to monocytes. Both cytotoxicity and IL-18 secretion in alveolar macrophages are partially flagellin dependent. However, the proportion of IL-18 release that is driven by flagellin is greater in alveolar macrophages than in monocytes. These findings suggest differential flagellin-mediated inflammasome pathway activation in the human alveolar macrophage response to B. pseudomallei infection and expand our understanding of intracellular pathogen recognition by this unique innate immune lung cell.

The functional and anatomical characterization of three spinal output pathways of the anterolateral tract.

The nature of spinal output pathways that convey nociceptive information to the brain has been the subject of controversy. Here, we provide anatomical, molecular, and functional characterizations of two distinct anterolateral pathways: one, ascending in the lateral spinal cord, triggers nociceptive behaviors, and the other one, ascending in the ventral spinal cord, when inhibited, leads to sensorimotor deficits. Moreover, the lateral pathway consists of at least two subtypes. The first is a contralateral pathway that extends to the periaqueductal gray (PAG) and thalamus; the second is a bilateral pathway that projects to the bilateral parabrachial nucleus (PBN). Finally, we present evidence showing that activation of the contralateral pathway is sufficient for defensive behaviors such as running and freezing, whereas the bilateral pathway is sufficient for attending behaviors such as licking and guarding. This work offers insight into the complex organizational logic of the anterolateral system in the mouse.

AA amyloidosis With Ig-Dominant Staining and Diagnostically Unusual Features.

Introduction: Although serum amyloid A (AA) amyloid may occasionally show nonspecific staining by immunofluorescence (IF), the correct diagnosis can usually be determined by integrating pathologic features and clinical scenario, and using AA amyloid immunohistochemistry (IHC) and/or mass spectrometry. A recent mass spectrometry-based study described false-positive Ig IF staining in a subset of AA amyloid cases. Methods: We sought to delineate clinicopathologic features of AA amyloid with Ig-dominant staining by using a retrospective review. Results: AA amyloid with Ig-dominant staining was identified in 10 patients from 5 institutions, representing 1.2% to 4% of AA amyloid kidney biopsies. Evidence of a monoclonal protein was documented in 0% to 2.7% of patients with AA amyloid screened for inclusion, but 30% of those with Ig-dominant staining. The patient population had equal sex distribution and presented at median age of 68.5 years with nephrotic proteinuria and kidney impairment. Etiologies of AA amyloid included injection drug use (30%), autoimmune disease (20%), and chronic infection (10%); 40% had no identified clinical association. On biopsy, heavy chain (co)dominant staining by IF (in 80%), discordant distribution in Ig staining (in 20%), tubulointerstitial nephritis (in 30%), and/or crescents (in 10%) were present. Two of 3 patients with paraproteinemia had concordant heavy and/or light chain dominant staining within the AA amyloid. Two cases were initially misdiagnosed as Ig-associated amyloidosis. Conclusion: We describe the morphologic spectrum of AA amyloidosis with Ig-dominant staining which may have clinical, laboratory, and pathologic overlap with amyloid light chain (AL), amyloid heavy chain, and heavy and light chain (AHL) amyloidosis.

Co-Design with Patients for Improving Patient Safety: Strategies, Barriers and pitfalls.

What happens when "frontline" workers are patients and family members performing health-related tasks? As more and more complex healthcare tasks are performed by patients and family members, and more emphasis is placed on patient- and family-centered care, strategies are needed to engage patients and family members in co-design "work systems" and patient-professional collaborative work. Human factors professionals are well-equipped to apply participatory ergonomics to patient and collaborative tasks. However, there are a number of barriers and pitfalls in engaging patients in design. Moving from tokenism to meaningful engagement in research requires patience, constant reflection, and a commitment to codesign. Our panel will explore the continuum of engagement and strategies to move from tokenism to partnership to cocreation in patient safety research, ranging from ambulatory medication safety to diagnosis in the emergency department. Strategies and barriers are presented as a starting point to discuss how to achieve effective work system designs.

Predictors and Moderators of Parent Engagement in Early Interventions for Behaviorally Inhibited Preschool-Aged Children.

Behavioral inhibition (BI) is a temperamental style that poses risk for later anxiety. Efficacious interventions have been developed for inhibited children, but their success depends on parent engagement. However, little is known regarding predictors of parent engagement in early interventions for BI. This study examined parent-, child- and treatment-level (i.e., parent-only or parent-child) factors as independent and interactive predictors of parent engagement (attendance, and parent-reported homework completion and treatment satisfaction) in a randomized-controlled trial comparing two interventions for inhibited preschoolers: Cool Little Kids (CLK) and the Turtle Program ("Turtle"). We also explored predictors of co-parent (CP) attendance. The sample comprised 151 primary parents (PPs) and their 45-64-month-old children. Attendance was greater in Turtle and homework completion was slightly greater in CLK, with no group difference in satisfaction. In Turtle, child anxiety predicted greater PP attendance and PP depression predicted lower satisfaction. In CLK, the interaction between child and PP anxiety significantly predicted satisfaction. Across groups, child anxiety predicted greater homework completion and CP anxiety predicted greater CP attendance. Results suggest that child anxiety may motivate parent engagement, particularly when children receive concurrent treatment and/or in-vivo coaching. However, intensive treatment may be too burdensome for depressed parents, whereas less intensive treatments may be more acceptable to non-anxious parents of anxious children. These findings can inform approaches to improve parent engagement in early interventions targeting BI.

Propuesta de guía de observación para el ejercicio práctico estatal de la Licenciatura en enfermería / Proposal of guide of observation for the exercise practical State of the Bachelor's degree in Nursing

Introducción: el examen práctico estatal forma parte del proceso de fundamentar el título de licenciado en enfermería en muchas universidades, este debe evaluar la adquisición de las diferentes habilidades y actitudes en correspondencia con el diseño curricular en una forma homogénea. Objetivo: diseñar una guía de observación para el ejercicio de examen práctico estatal de la carrera de Licenciatura en enfermería. Métodos: se realizó una investigación educativa de desarrollo, entre enero y agosto del 2016 en la carrera de Licenciatura en Enfermería del Instituto Superior Politécnico "Sol Naciente" de Huambo, Angola. En la primera fase fue revisada la literatura, aplicado un instrumento de recolección de datos al currículo y aplicado la técnica de grupo focal, en la segunda fase fue construida la propuesta de guía de observación y en la tercera fase está fue valorada por especialistas. En la primera y tercera fase se utilizaron herramientas de estadística descriptiva. Resultados: la mayor parte de las asignaturas contribuyen a la formación asistencial seguida por la formación en ciencias básicas y naturales con 36,2 por ciento y 21,3 por ciento respectivamente. El instrumento elaborado verifica valores, actitudes y habilidades docentes-asistenciales-administrativas. Fue valorado el instrumento por los especialistas con la condición de excelente, para los aspectos de validez, confiabilidad e integralidad de esté con el 100 por ciento, 63,6 por ciento, 81,8 por ciento respectivamente. Conclusiones: el análisis de los resultados de la consulta a especialistas hace que se concluya que el instrumento elaborado es fácil de aplicar y permite evaluar con objetividad, validez y confiabilidad las competencias profesionales adquiridas(AU)

Introduction: The state practical exam is part of the process of founding a bachelor's degree in nursing in many universities, which must evaluate the acquisition of different skills and attitudes, in accordance with the curriculum design in a homogeneous way. Objective: Design an observation guide for the exercise of state practical examination of the Bachelor in Nursing. Methodical: Held an educational development research, between January and August of 2016, in degree in nursing of the Institute Superior Polytechnic Sol Nascente in Huambo, Angola. In the first phase, the literature was revised, a data collection instrument was applied to the curriculum and the focal group technique was applied. In the second phase the proposal for an observation guide was constructed and in the third phase it was evaluated by specialists. In the first and third phase, descriptive statistics tools were used. Results: Most of the subjects contribute to classroom training followed by training in basic and natural sciences with 36.2 percent and 21.3 percent respectively. The instrument checks drawn values, attitudes and teachers-care and administrative skills. It was the instrument valued by experts with excellent condition, for aspects of validity, reliability and integrity of this with 100 percent, 63.6 percent, 81.8 percent respectively. Conclusions: The analysis of the results of the consultation of specialists makes it possible to conclude that the instrument elaborated is easy to apply and allows to evaluate with objectivity, validity and reliability the acquired professional competences(AU)

Propuesta de guía de observación para el ejercicio práctico estatal de la Licenciatura en enfermería / Proposal of guide of observation for the exercise practical State of the Bachelor's degree in Nursing

Introducción: el examen práctico estatal forma parte del proceso de fundamentar el título de licenciado en enfermería en muchas universidades, este debe evaluar la adquisición de las diferentes habilidades y actitudes en correspondencia con el diseño curricular en una forma homogénea. Objetivo: diseñar una guía de observación para el ejercicio de examen práctico estatal de la carrera de Licenciatura en enfermería. Métodos: se realizó una investigación educativa de desarrollo, entre enero y agosto del 2016 en la carrera de Licenciatura en Enfermería del Instituto Superior Politécnico "Sol Naciente" de Huambo, Angola. En la primera fase fue revisada la literatura, aplicado un instrumento de recolección de datos al currículo y aplicado la técnica de grupo focal, en la segunda fase fue construida la propuesta de guía de observación y en la tercera fase está fue valorada por especialistas. En la primera y tercera fase se utilizaron herramientas de estadística descriptiva. Resultados: la mayor parte de las asignaturas contribuyen a la formación asistencial seguida por la formación en ciencias básicas y naturales con 36,2 por ciento y 21,3 por ciento respectivamente. El instrumento elaborado verifica valores, actitudes y habilidades docentes-asistenciales-administrativas. Fue valorado el instrumento por los especialistas con la condición de excelente, para los aspectos de validez, confiabilidad e integralidad de esté con el 100 por ciento, 63,6 por ciento, 81,8 por ciento respectivamente. Conclusiones: el análisis de los resultados de la consulta a especialistas hace que se concluya que el instrumento elaborado es fácil de aplicar y permite evaluar con objetividad, validez y confiabilidad las competencias profesionales adquiridas(AU)

Introduction: The state practical exam is part of the process of founding a bachelor's degree in nursing in many universities, which must evaluate the acquisition of different skills and attitudes, in accordance with the curriculum design in a homogeneous way. Objective: Design an observation guide for the exercise of state practical examination of the Bachelor in Nursing. Methodical: Held an educational development research, between January and August of 2016, in degree in nursing of the Institute Superior Polytechnic Sol Nascente in Huambo, Angola. In the first phase, the literature was revised, a data collection instrument was applied to the curriculum and the focal group technique was applied. In the second phase the proposal for an observation guide was constructed and in the third phase it was evaluated by specialists. In the first and third phase, descriptive statistics tools were used. Results: Most of the subjects contribute to classroom training followed by training in basic and natural sciences with 36.2 percent and 21.3 percent respectively. The instrument checks drawn values, attitudes and teachers-care and administrative skills. It was the instrument valued by experts with excellent condition, for aspects of validity, reliability and integrity of this with 100 percent, 63.6 percent, 81.8 percent respectively. Conclusions: The analysis of the results of the consultation of specialists makes it possible to conclude that the instrument elaborated is easy to apply and allows to evaluate with objectivity, validity and reliability the acquired professional competences(AU)

Propuesta para el diseño de una guía didáctica en la disciplina Bioquímica / Proposal for the design of a study guide in the Biochemistry discipline

INTRODUCCIÓN: Este trabajo aporta una estructura y metodología de construcción de guía didáctica que permite dirigir el trabajo independiente en función de una enseñanza integral. OBJETIVO: Diseñar una guía didáctica desarrolladora en la disciplina Bioquímica capaz de sustentar una enseñanza integral. MÉTODOS: Se realizó una investigación educativa de desarrollo, entre enero de 2014 y julio de 2015 en la carrera de Licenciatura en Enfermería del Instituto Superior Politécnico Sol Nascente de Huambo, Angola. Fue revisada la literatura y aplicado un instrumento de recolección de datos al currículo, también se aplicó un cuestionario a 153 estudiantes y fueron entrevistados 6 expertos. En una primera fase fueron realizadas las actividades antes mencionadas, posteriormente con los aporte de los métodos teóricos y empíricos utilizados así como la experiencia de los autores fue construida la estructura y metodología de la guía didáctica. RESULTADOS: La disciplina tiene 19 temas, con 2,9 h presenciales por semana y la literatura a revisar tiene como promedio 870,4 páginas. Los estudiantes estudian 4,3h semanales, el 40,5% tiene condiciones de estudio regular y el 36,6% refiere que son malas. El 66,7% de los expertos consideran útil la implementación de guías didácticas el 50% habló de atender las diferencias individuales a través de este medio de enseñanza. CONCLUSIONES: Se obtuvo una guía didáctica con un enfoque sistemático donde el profesor va dosificando actividades docentes teniendo en cuenta los estilos de aprendizaje del grupo y dejando claro las condiciones de estudio y la ruta crítica para la revisión bibliográfica

INTRODUCTION: This paper provides a structure and methodology for constructing a study guide that will allow students to work independently to achieve a comprehensive education. OBJECTIVE: To design a study guide in the Biochemistry discipline able to provide a comprehensive education. METHODS: An educational development study was conducted between January 2014 and July 2015 in the Nursing Degree course of the Sol Nascente Polytechnic Institute of Huambo, Angola. A literature review was performed and a data collection tool was used to extract data from the curriculum. A questionnaire was completed by 153 students, and there were also interviews by 6 experts. These activities were carried out in the first phase, then the contribution of theoretical and empirical methods used and the experience of the authors were built into the structure and methodology of the guide. RESULTS: Discipline has 19 topics, with 2.9 hours per week, and the literature to revise has a mean of 870.4 pages. Students study 4.3hours per week; 40.5% have normal study conditions, and 36.6% say they are bad. Two-thirds (66.7%) of experts consider implementing useful tutorials and 50% seek to address individual differences through this instruction medium. CONCLUSIONS: A tutorial guide with a systemic approach, where the teacher is dosing the teaching activities taking into account group learning styles, and making sure that the study conditions and the critical path for the review of the literature review are obtained

Maximizing the Shadowing Experience: A Guidance Document.

Job shadowing is an excellent way to learn more about the pharmacy profession. The shadowing individuals gain a greater sense of the role pharmacists play in the health care team and are exposed to the variety of roles that are filled by pharmacists. Job shadowing is also an important way for pharmacists to demonstrate the value of the profession and recruit talented individuals to their institution. However, there are several important considerations to ensure that the shadowing experience is beneficial for the individual, is a positive experience for the sponsor, and is compliant with the host institution's policies and procedures. The goal of this article is to prepare a potential host site for developing and maintaining a successful job shadow experience.