The reconstructed cranium of Pierolapithecus and the evolution of the great ape face.

Pierolapithecus catalaunicus (~12 million years ago, northeastern Spain) is key to understanding the mosaic nature of hominid (great ape and human) evolution. Notably, its skeleton indicates that an orthograde (upright) body plan preceded suspensory adaptations in hominid evolution. However, there is ongoing debate about this species, partly because the sole known cranium, preserving a nearly complete face, suffers from taphonomic damage. We 1) carried out a micro computerized tomography (CT) based virtual reconstruction of the Pierolapithecus cranium, 2) assessed its morphological affinities using a series of two-dimensional (2D) and three-dimensional (3D) morphometric analyses, and 3) modeled the evolution of key aspects of ape face form. The reconstruction clarifies many aspects of the facial morphology of Pierolapithecus. Our results indicate that it is most similar to great apes (fossil and extant) in overall face shape and size and is morphologically distinct from other Middle Miocene apes. Crown great apes can be distinguished from other taxa in several facial metrics (e.g., low midfacial prognathism, relatively tall faces) and only some of these features are found in Pierolapithecus, which is most consistent with a stem (basal) hominid position. The inferred morphology at all ancestral nodes within the hominoid (ape and human) tree is closer to great apes than to hylobatids (gibbons and siamangs), which are convergent with other smaller anthropoids. Our analyses support a hominid ancestor that was distinct from all extant and fossil hominids in overall facial shape and shared many features with Pierolapithecus. This reconstructed ancestral morphotype represents a testable hypothesis that can be reevaluated as new fossils are discovered.

How to Advance Palliative Care Research in South America? Findings From a Delphi Study.

CONTEXT: Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved. OBJECTIVES: To develop a set of recommendations to advance PC research in SA. METHODS: Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of ≥75%. RESULTS: 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public policies, education and prognosis were defined as the most relevant. CONCLUSION: Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resources and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region.

Competencies for quality spiritual care in palliative care in Latin America: from the Spirituality Commission of the Latin American Association for Palliative Care.

Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.

Assessment of bullet holes through the analysis of mushroom-shaped morphology in synthetic fibres: analysis of six cases.

Textiles damage analysis is a very valuable tool in forensic investigations. However, to date, very little research has been carried out to understand the impact of bullet causing damages to clothing. According to the review of the most recent scientific papers, the frictional heating and crushing action of a bullet passing through synthetic fibres cause a unique transformation in their ends called mushroom-shaped morphology. In this study, the textile remains of six individuals executed during the first decade of the Chilean military dictatorship period (1973-1990) were analysed. The purpose was to examine their clothing in order to describe the fibre defects in the bullet holes. The fibres were directly observed using two different models of stereomicroscopy (MZ16A and EZ4D, Leica Microsystem Ltd., Wetzlar, Germany) and through a combination of transmitted, oblique and co-axial illumination (with Leica DFC500 Digital Camera), at × 230 and at a resolution of up to 840 Lp/mm. The mushroom-shaped morphology, along with rupturing of yarns, fibrillation or splitting of fibres, was observed in the bullet holes. Although the mushroom-shaped is a useful pattern for bullet hole identification in synthetic fibres, further research needs to be performed for developing a sounder interpretational framework of this type of forensic evidence.

Investigación en Medicina Familiar y Comunitaria en Iberoamérica / Research in Family and Community Medicine in Ibero-America / Pesquisa em Medicina de Família e Comunidade na Ibero-América

El grupo de trabajo # 4 de la VI Cumbre Iberoamericana de Medicina Familiar en San José, Costa Rica, 2016 se conformó para lograr contribuir al desarrollo de la investigación en Medicina Familiar y Atención Primaria en Iberoamérica, así como para consolidar la Red IBIMEFA. Estuvo integrado por 54 médicos de 21 países. Se nombraron 2 coordinadores generales y 10 coordinadores para dirigir los cinco subgrupos. El trabajo realizado por este grupo durante ocho meses, obtuvo como resultado la identificación de líneas activas y prioritarias de investigación en medicina familiar, la necesidad de realizar estrategias para promover la producción científica, tales como: a) desarrollo de pasantías de investigación en diferentes regiones; b) identificación de fuentes de financiamiento; c) lograr una plataforma virtual, soporte para asesorías y foros de investigación coordinados por IBIMEFA.

In order to contribute to the development of research in Family Medicine and Primary Care in Ibero-America and the consolidation of the IBIMEFA Network, the Work Group #4 was created for the VI Ibero-American Summit of Family Medicine in San José, Costa Rica, 2016, which was composed by a group of 54 family physicians from 21 countries. Two general coordinators and 10 subgroup coordinators were designated. The work developed by this group throughout an 8-month period has resulted in the identification of both active and priority research lines in Family Medicine and the need to develop strategies for the promotion of scientific production, such as: a) the development of research internships across the different regions, b) the identification of sources of financing; c) the design of a virtual platform with support for consultancy and research forums coordinated by IBIMEFA

O grupo de trabalho nº 4 da VI Cúpula Ibero-Americana de Medicina Familiar em San Jose, Costa Rica de 2016 se organizou para colaborar com o desenvolvimento da pesquisa em Medicina de Família e Atenção Primaria na Ibero-América, assim como consolidar a Rede IBIMEFA. Foi composto por 54 médicos de 21 países. Dois coordenadores gerais e 10 sub-coordenadores foram nomeados para organizar os cinco subgrupos. O trabalho realizado durante oito meses por este grupo obteve como resultado a identificação de linhas ativas e prioritárias de pesquisa em Medicina de Família e a necessidade de serem estabelecidas estratégias para promover a produção científica tais como: a) implementação de estágios de pesquisa em diferentes regiões; b) identificação de fontes de financiamento; c) desenvolver uma plataforma virtual, dar suporte para consultoria e realizar fóruns de pesquisa coordenados pela IBIMEFA.

Miocene small-bodied ape from Eurasia sheds light on hominoid evolution.

Miocene small-bodied anthropoid primates from Africa and Eurasia are generally considered to precede the divergence between the two groups of extant catarrhines­hominoids (apes and humans) and Old World monkeys­and are thus viewed as more primitive than the stem ape Proconsul. Here we describe Pliobates cataloniae gen. et sp. nov., a small-bodied (4 to 5 kilograms) primate from the Iberian Miocene (11.6 million years ago) that displays a mosaic of primitive characteristics coupled with multiple cranial and postcranial shared derived features of extant hominoids. Our cladistic analyses show that Pliobates is a stem hominoid that is more derived than previously described small catarrhines and Proconsul. This forces us to reevaluate the role played by small-bodied catarrhines in ape evolution and provides key insight into the last common ancestor of hylobatids (gibbons) and hominids (great apes and humans).

New dental remains of Anoiapithecus and the first appearance datum of hominoids in the Iberian Peninsula.

New dental remains of the fossil great ape Anoiapithecus brevirostris are described from the Middle Miocene local stratigraphic series of Abocador de Can Mata (ACM) in els Hostalets de Pierola (Vallès-Penedès Basin, NE Iberian Peninsula). These specimens correspond to maxillary fragments with upper teeth from two female individuals from two different localities: left P(3)-M(1) (IPS41712) from ACM/C3-Aj (type locality; 11.9 Ma [millions of years ago]); and right M(1)-M(2) and left P(4)-M(2) (IPS35027) from ACM/C1-E* (12.3-12.2 Ma). Relative enamel thickness is also computed in the latter individual and re-evaluated in other Middle Miocene hominoids from ACM, in order to better assess their taxonomic affinities. With regard to maxillary sinus development, occlusal morphology, molar proportions and enamel thickness, the new specimens show greater resemblances with the (male) holotype specimen of A. brevirostris. They differ from Pierolapithecus catalaunicus in displaying less inflated crests, a more lingually-located hypocone, and relatively lower-crowned molars; from Dryopithecus fontani, in the relatively thicker enamel and lower-crowned molars; from Hispanopithecus spp., in the more inflated crown bases, less peripheral cusps and more restricted maxillary sinus; and from Hispanopithecus laietanus also in the thicker crests, more restricted occlusal foveae, and relatively lower-crowned molars. The new specimens of A. brevirostris show some slight differences compared with the holotype of this species: smaller size (presumably due to sexual size dimorphism), and less distally-tapering M(2) occlusal contour (which is highly variable in both extant and extinct hominoids). The reported remains provide valuable new evidence on dental intraspecific variation and sexual dimorphism in Anoiapithecus. From a taxonomic viewpoint, they support the distinction of this taxon from both Dryopithecus and Pierolapithecus. From a chronostratigraphic perspective, IPS35027 from ACM/C1-E* enlarges the known temporal distribution of Anoiapithecus, further representing the oldest record (first appearance datum) of hominoids in the Iberian Peninsula.

Taxonomic attribution of the La Grive hominoid teeth.

The two hominoid teeth--a central upper incisor (NMB G.a.9.) and an upper molar (FSL 213981)--from the Middle Miocene site of La Grive-Saint-Alban (France) have been traditionally attributed to Dryopithecus fontani (Hominidae: Dryopithecinae). However, during the last decade discoveries in the Vallès-Penedès Basin (Spain) have shown that several hominoid genera were present in Western Europe during the late Middle Miocene. As a result, the attribution of the dryopithecine teeth from La Grive is not as straightforward as previously thought. In fact, similarities with the upper incisor of Pierolapithecus have led to suggestions that either the latter taxon is present at La Grive, or that it is a junior synonym of Dryopithecus. Here, we re-describe the La Grive teeth and critically revise their taxonomic assignment based on metrical and morphological comparisons with other Middle to Late Miocene hominoids from Europe and Turkey, with particular emphasis on those from the Vallès-Penedès Basin. Our results suggest that the I(1) differs in several respects from those of Pierolapithecus and Hispanopithecus, so that an attribution to either Dryopithecus or Anoiapithecus (for which this tooth is unknown) seems more likely. The molar, in turn, most likely corresponds to the M(1) of a female individual. Compared to other Middle Miocene taxa, its occlusal morphology enables its distinction from Pierolapithecus, whereas relative crown height agrees well with Dryopithecus. Therefore, based on available evidence, we support the traditional attribution of the La Grive hominoid to D. fontani.

The nasal and paranasal architecture of the Middle Miocene ape Pierolapithecus catalaunicus (primates: Hominidae): phylogenetic implications.

The internal (nasal and paranasal) cranial anatomy of the Middle Miocene (11.9 Ma [millions of years ago]) great ape Pierolapithecus catalaunicus (Hominidae: Dryopithecini) is described on the basis of computed-tomography scans of the holotype specimen (IPS21350), with particular emphasis on its phylogenetic implications. Pierolapithecus displays the following characters: an anteriorly-restricted maxillary sinus that posteriorly spreads towards the ethmoidal area (thus resembling the pongine condition), although being situated well above the molar roots (as in kenyapithecins, other dryopithecins and pongines); lack of frontal sinus (a synapomorphy of derived pongines, independently acquired by both cercopithecoids and hylobatids); posteriorly-situated turbinals (as in Pongo); anteriorly-projecting nasolacrimal canal (as in Pongo); and probably stepped nasal floor with non-overlapping premaxillary-maxillary contact (as in dryopithecines and stem hominoids, although it cannot be conclusively shown due to bone damage). Overall, Pierolapithecus displays a mosaic of primitive hominid and derived pongine features that are inconsistent with this taxon being a hominine (as previously suggested). Two alternative phylogenetic interpretations are possible: Pierolapithecus may be a stem member of the Hominidae as previously suggested in its original description, or alternatively this taxon may be a stem member of the Ponginae s.l. (with the European dryopithecines being the sister taxon to the Asian pongines).

Curso virtual de educación continuada para los profesionales de la salud vinculados a los ensayos clínicos / Virtual course of continuing education for health professors linked to clinical assays

Se realizó un estudio cuasi-experimental para elevar la competencia y desempeño de profesionales de la salud vinculados a ensayos clínicos. El estudio contó de 3 fases: diagnóstico de las necesidades de información sobre la temática e identificación de las dificultades en el desempeño de la actividad; diseño y valoración de un curso virtual de ensayos clínicos; y aplicación y evaluación de la efectividad del curso. En el diagnóstico el 92,0 por ciento de los evaluados presentaron altas necesidades de información y el 52 por ciento fueron evaluados con un desempeño malo. En función de estos resultados se diseñó un curso virtual de ensayos clínicos a través de un sitio Web. La implementación del curso fue aprobada por los expertos con un porcentaje de aceptación general del 95 por ciento. Una vez finalizado, el curso fue evaluado como efectivo pues más del 80 % de los profesionales fueron evaluados sin necesidades de información y un desempeño bueno.

We made a quasi-experimental study to increase competence and performance of health professionals involved in clinical assays. Study had three phases: diagnosis of information needs on topic and identification of difficulties of activity performance; design and valuation of a virtual course of clinical assays, and application and assessment of course effectiveness. In diagnosis 92,0 percent of assessed had a high rate of information needs, and 52 percent were assessed as a poor performance. According to these results we designed a virtual course of clinical assays be means of a website. The course's put into practice was approved by experts with a general acceptation percentage of 95 percent. Once concluded, course was assessed as effective since more than 80 percent of professionals were assessed without information needs and with a good performance.

Curso virtual de educación continuada para los profesionales de la salud vinculados a los ensayos clínicos / Virtual course of continuing education for health professors linked to clinical assays

Se realizó un estudio cuasi-experimental para elevar la competencia y desempeño de profesionales de la salud vinculados a ensayos clínicos. El estudio contó de 3 fases: diagnóstico de las necesidades de información sobre la temática e identificación de las dificultades en el desempeño de la actividad; diseño y valoración de un curso virtual de ensayos clínicos; y aplicación y evaluación de la efectividad del curso. En el diagnóstico el 92,0 por ciento de los evaluados presentaron altas necesidades de información y el 52 por ciento fueron evaluados con un desempeño malo. En función de estos resultados se diseñó un curso virtual de ensayos clínicos a través de un sitio Web. La implementación del curso fue aprobada por los expertos con un porcentaje de aceptación general del 95 por ciento. Una vez finalizado, el curso fue evaluado como efectivo pues más del 80 % de los profesionales fueron evaluados sin necesidades de información y un desempeño bueno(AU)

We made a quasi-experimental study to increase competence and performance of health professionals involved in clinical assays. Study had three phases: diagnosis of information needs on topic and identification of difficulties of activity performance; design and valuation of a virtual course of clinical assays, and application and assessment of course effectiveness. In diagnosis 92,0 percent of assessed had a high rate of information needs, and 52 percent were assessed as a poor performance. According to these results we designed a virtual course of clinical assays be means of a website. The course's put into practice was approved by experts with a general acceptation percentage of 95 percent. Once concluded, course was assessed as effective since more than 80 percent of professionals were assessed without information needs and with a good performance(AU)

Diseño y validación de una forma novedosa de aprendizaje en la formación de evaluadores clínicos de medicamentos / I design and validation in a novel way of learning in the formation of clinical appraisers of medications

El Subcentro de Ensayos Clínicos de Villa Clara, evolucionando en la tendencia internacional de educación a distancia; propicia la inserción de esta nueva modalidad en sus cursos de postgrado. Nos propusimos diseñar un curso a distancia de ensayos clínicos que permita ampliar las oportunidades en la información y actualización de profesionales relacionados con esta rama del conocimiento; a partir de un estudio observacional descriptivo, donde se diagnosticaron las necesidades de información en investigación clínica en tres hospitales de la provincia de Villa Clara. El estudio contó con dos fases: una de diagnóstico y otra de diseño y validación del sitio Web según el criterio de los expertos. Se identificaron altas necesidades de información en los profesionales de la salud respecto a la investigación clínica, hecho que justificó la confección del sitio Web. El mismo se consideró aprobado por presentar un 100% de aceptación por los expertos

The Subcenter of Clinical Trials of Villa Clara keeping up with the international tendency of distance education provides this new modality in its post-graduate courses. Starting from observational descriptive study in which the needs for information in clinical investigation of tree hospitals in Villa Clara province were assessed we sought to design a clinical trial distance course. That might give further opportunities in the information and update formation of professionals in this branch of knowledge. The course had two stages, one of diagnosis and another of design and validation of the Website according to the experts opinion. A Strong Informations necessity among health professionals regarding clinical investigation was identified. This fact justified the creation of the Web site which was approved for having a 100% of the experts acceptance

Un entorno virtual de aprendizaje como herramienta para la formación de los recursos humanos en la evaluación clínica de medicamentos / Virtual enviroment for learging as a tool in the formation of human resources for clinical assessment of drugs

Nos propusimos diseñar un curso a distancia de ensayos clínicos que permita ampliar las oportunidades en la información y actualización de profesionales relacionados con esta rama del conocimiento; a partir de un estudio observacional descriptivo, donde se diagnosticaron las necesidades de información en investigación clínica en tres hospitales de la provincia de Villa Clara. El estudio contó con dos fases: una de diagnóstico y otra de diseño y valoración del sitio Web según el criterio de los expertos. Se identificaron altas necesidades de información en los profesionales de la salud respecto a la investigación clínica, hecho que justificó la confección del sitio Web. El mismo se consideró aprobado por presentar un 100 por ciento de aceptación por los expertos(AU)

Necesidades de aprendizaje sobre evaluación clínica de medicamentos en la provincia de Villa Clara, Cuba / Learning needs on drug clinical assessment in Villa Clara province, Cuba

Uno de los principales retos que enfrenta el Sistema Nacional de Salud de Cuba, es dar respuesta a la elevada demanda de evaluación clínica de productos de la Biotecnología e Industria Médico Farmacéutica Cubana, a través de ensayos clínicos que cumplan estándares de calidad internacionales. El Subcentro de Ensayos Clínicos de Villa Clara posee dentro de su misión garantiza el éxito de estas evaluaciones, por lo que se ha propuesto elevar el nivel de conocimiento de los profesionales de la Atención Secundaria de Salud y afines al sistema, en el dominio y aplicación del método científico aplicado a la evaluación clínica de productos médicos. Se realizó un estudio de intervención en 20 profesionales pertenecientes a tres hospitales de la provincia Villa Clara desde enero hasta marzo de 2004. El estudio contó con tres fases: diagnóstico, diseño de una estrategia curricular de intervención e intervención y aplicación de la estrategia. Se llevó a cabo además una valoración de la efectividad de la misma. El diagnóstico de las necesidades de aprendizaje se realizó a través de un examen inicial donde el 95 por ciento de los profesionales resultaron tener altas necesidades de aprendizaje, fundamentalmente relacionadas con las "Buenas Practicas Clínicas" y la "Bioética". La estrategia elaborada contó con 5 temas básicos fundamentales para la investigación clínica. La aplicación de la misma resultó ser efectiva, pues permitió solucionar la mayoría de las necesidades de aprendizaje identificadas(AU)

Farmacovigilancia intensiva del factor estimulante de Colonias Granulocíticas Cubano (ior-Leukocim) en pacientes oncohematológicos pediátricos / Intensive drug surveillance of the cuban granulocyte colony-stimulating factor (ior-leukocim) in pediatric oncohematologic patients

Con el objetivo de describir y evaluar los efectos adversos relacionados con la administración del Factor Estimulante de Colonias Granulocíticas Cubano (ior-Leukocim), se analizaron las historias clínicas de cincuenta (50) pacientes incluídos, con edades comprendidas entre 1-18 años de edad, en el ensayo clínico realizado en el Servicio de Hematología del Hospital Infantil "José Luis Miranda" de Villa Clara, donde se evalúa el impacto del producto. Se incluyeron los pacientes que reportaron reacciones adversas, tipo de reacción y grado de intensidad. Se aplicó el algoritmo de Karsh y Lasagna para evaluar la fuerza de la relación de causalidad. Se observó que las reacciones adversas más frecuentes fueron: fiebre y dolores osteomusculares, en su mayoría clasificadas como efectos colaterales moderados de relación probable con la administración del producto(AU)