Assessment of fit of the time-varying dynamic partial credit model using the posterior predictive model checking method.

Several new models based on item response theory have recently been suggested to analyse intensive longitudinal data. One of these new models is the time-varying dynamic partial credit model (TV-DPCM; Castro-Alvarez et al., Multivariate Behavioral Research, 2023, 1), which is a combination of the partial credit model and the time-varying autoregressive model. The model allows the study of the psychometric properties of the items and the modelling of nonlinear trends at the latent state level. However, there is a severe lack of tools to assess the fit of the TV-DPCM. In this paper, we propose and develop several test statistics and discrepancy measures based on the posterior predictive model checking (PPMC) method (PPMC; Rubin, The Annals of Statistics, 1984, 12, 1151) to assess the fit of the TV-DPCM. Simulated and empirical data are used to study the performance of and illustrate the effectiveness of the PPMC method.

A Time-Varying Dynamic Partial Credit Model to Analyze Polytomous and Multivariate Time Series Data.

The accessibility to electronic devices and the novel statistical methodologies available have allowed researchers to comprehend psychological processes at the individual level. However, there are still great challenges to overcome as, in many cases, collected data are more complex than the available models are able to handle. For example, most methods assume that the variables in the time series are measured on an interval scale, which is not the case when Likert-scale items were used. Ignoring the scale of the variables can be problematic and bias the results. Additionally, most methods also assume that the time series are stationary, which is rarely the case. To tackle these disadvantages, we propose a model that combines the partial credit model (PCM) of the item response theory framework and the time-varying autoregressive model (TV-AR), which is a popular model used to study psychological dynamics. The proposed model is referred to as the time-varying dynamic partial credit model (TV-DPCM), which allows to appropriately analyze multivariate polytomous data and nonstationary time series. We test the performance and accuracy of the TV-DPCM in a simulation study. Lastly, by means of an example, we show how to fit the model to empirical data and interpret the results.

The Comorbidities, Radiographic Findings, Age, and Lymphopenia (CORAL) Tool: A Diagnostic Ally for Emergency Physicians Created for the COVID-19 Crisis and Beyond.

BACKGROUND: This study aimed to develop a novel clinical approach to predict intensive care unit (ICU) admission and mortality among coronavirus disease 2019 (COVID-19) patients in the emergency department (ED). METHODS: A retrospective cohort study was conducted including adults ≥ 18 years diagnosed with COVID-19 in the emergency department and admitted to the ICU between March and July 2020 in an academic hospital. The outcome variables were mortality and ICU admission. Additional variables that were collected included sex, age, comorbidities, symptom phenotype, and laboratory (lymphopenia) and imaging findings. A logistic regression model was used to construct and validate the risk models. RESULTS: A total of 808 patients were included in the study; 61.9% were men. The mean age was 57.8 ± 15.9 years, and high blood pressure (HBP) was the most prevalent comorbidity (31.8%). Seventy-six (9.4%) patients were admitted to the ICU. Age ≥ 60 years, chronic obstructive pulmonary disease (COPD), lymphopenia, and imaging findings correlated with mortality. Age ≥ 60 years, lymphopenia (<1,000 cells per microliter), and hypothyroidism correlated with ICU admission. These variables were incorporated into a scoring system (Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool) to predict mortality and ICU admission. CONCLUSIONS: Our Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool is a practical tool for different clinical settings independent of access to advanced medical resources or technologies. CORAL is suitable for emergency physicians in low- and middle-income countries.

Cirugía de alargamiento y engrosamiento de pene. Técnica NEF: resultados en 750 pacientes / Penis enlargement and thickening surgery. NEF technique: results in 750 patients

Introducción y objetivo: La cirugía de alargamiento y engrosamiento de pene supone un reto técnico para el cirujano, puesto que las técnicas clásicas han demostrado resultados insuficientes para los pacientes. Nuestro objetivo es presentar nuestra experiencia con una técnica reproducible que permite evitar el empleo de extensores y las complicaciones de la infiltración de grasa. Material y método: Analizamos de forma retrospectiva 750 casos de alargamiento y engrosamiento de pene primarios realizados con la técnica NEF (No Extenders No Fat) - No Extensores No Grasa), analizando la técnica quirúrgica, sus resultados y complicaciones. Esta técnica se basa en la creación de un colgajo de avance cutáneo junto con un colgajo de fascia de Scarpa y un nanofat infiltrado en las fascias profundas del pene. Resultados: La ganancia media en longitud en el grupo de pacientes estudiados fue de 4.8cm en reposo, con un espectro de 2 hasta 8.1cm. En el engrosamiento, se alcanzó un incremento medio de 1.17 cm (mínimo de 0.5 y máximo de 1.8 cm). Conclusiones: La tasa de satisfacción de pacientes, de complicaciones y retoques en nuestro grupo de estudio nos hablan de una cirugía que mejora las técnicas previas, más invasivas y con mayor tasa de complicaciones. El apoyo psicológico y la ayuda profesional preoperatoria es imperativa, y se debe ofrecer especialmente en casos de dismorfofobia. El trabajo pre y postoperatorio es esencial en estos pacientes. Conseguir pacientes con expectativas reales es la primera barrera que debemos franquear. Solo cuando el paciente haya entendido la cirugía y sus resultados, debemos avanzar hacia ella. (AU)

Background and objective: Penis lengthening and thickening surgery is a technical challenge for the surgeon, since classical techniques have shown insufficient results for patients. Our objective is to present our experience in the develop of a a reproducible technique that avoids the use of extensors and the complications of fat infiltration. Methods: Retrospectiv análisis of 750 cases of primary penis enlargement and thickening performed with the NEF (No Extenders No Fat) technique, analyzing the surgical technique, its results and complications. This technique is based on the creation of a skin advancement flap, together with a Scarpa fascia flap and a nanofat infiltrated at the deep fascia of the penis. Results: Mean gain in length in the group of patients studied was 4.8 cm at rest with a spectrum from 2 to 8.1 cm. In thickening, the measurement reached an average increase of 1.17 cm (minimum of 0.5 and a maximum of 1.8 cm). Conclusions: Rates of patient satisfaction, complications and retouching in our group tell us about a surgery that improves previous more invasive techniques with a higher rate of complications. Psychological support and professional pre-surgery help is imperative and should be offered especially in those cases of dysmorphophobia. Pre and postoperative work is essential in these patients. Getting patients with real expectations is the first barrier we must overcome. Only when the patient has understood the surgery and its results, should we move towards it. (AU)

Racial and ethnic variation in referral times for thoracic oncologic surgery in a major metropolitan area.

OBJECTIVE: The study objective was to understand the impact of race/ethnicity on access to thoracic surgical care for patients undergoing lung resection for cancer. METHODS: We performed a retrospective analysis on 206 consecutive patients who underwent lung resection for cancer (120 female, 86 male; median age 66 years), with respect to how race and ethnicity impact time to referral for thoracic surgery to a major healthcare center. Time between initial radiographic appearance of a lung nodule/mass 1 cm or greater to surgical referral and time from surgical referral to operation were evaluated for 121 White, 30 Asian, 26 Hispanic, 12 African American, and 17 mixed or other race patients. The impact of age, sex, median income of patient's household, national and state Area Deprivation Indices, insurance type, and distance between the patient's domicile and our hospital was evaluated. The influence of the referring physician's practice (hospital-based, hospital-affiliated, or private), internal or external referral, race/ethnicity, and level of specialization was also studied. RESULTS: African American, Asian, Hispanic, and mixed/other race patients had significantly longer wait times between initial radiographic finding of a lung nodule/mass 1 cm or greater and surgical referral compared with White individuals (median days: African American, 78; Asian, 95; Hispanic, 92; mixed or other, 65; White, 35). Multiple linear regression analysis demonstrated that race/ethnicity was the only significant predictor of prolonged time to surgical referral when adjusted for age, sex, median household income level, national and state Area Deprivation Indices, insurance type, and distance between patient's home and our hospital. The referring physician's type of practice and internal versus external referral were not significant. However, the physician's race/ethnicity and level of specialization had an impact on referral times, with nonspecialists referring patients sooner to thoracic surgery compared with specialists who ordered more workup tests. For all patient races/ethnicities, there was no difference in time between surgical referral and day of operation. CONCLUSIONS: Race and ethnicity have a major impact on the time from initial radiographic appearance of a lung nodule/mass 1 cm or greater to referral for surgical resection for cancer. This study suggests the need to develop strategies to reduce minority wait times and improve timely access to surgery for patients with thoracic malignancies. VIDEO ABSTRACT: Discussion of how race and ethnicity impact referral time to thoracic surgery discussed by Dr Moises Hernandez.

Lesión penetrante intracraneana transorbitaria, con compromiso de seno cavernoso en paciente pediátrico / Transorbital penetrating intracranial injury, with cavernous sinus involvement

Las lesiones traumáticas penetrantes transorbitarias-intracraneanas son infrecuentes en población pediátrica, pudiendo ocurrir en el contexto de accidentes domésticos, deportivos o escolares. Pueden extenderse a la base del cráneo y comprometer estructuras vasculares como el seno cavernoso y carótida interna. Se presenta el caso de una niña de 6 años de edad, que sufre lesión penetrante transorbitaria intracraneal con un lápiz de madera, con trayecto cruzado desde borde medial de órbita izquierda, transetmoidal y transesfenoidal, ingresando a región selar derecha e improntando a arteria carótida derecha (porción cavernosa). Luego de los estudios prequirúrgicos, se realizó extirpación de cuerpo extraño con cirugía endoscópica+control endovascular en caso de lesión carotidea. Posterior a resecar cuerpo extraño, se reparó fístula de LCR evidenciada intraoperatoriamente. La paciente se recuperó adecuadamente, sin déficit neurológico, sin fístula postoperatoria de LCR, sin infección del SNC ni alteración oculomotora (AU)

Transorbitary intracranial penetrating traumatic injuries are uncommon in the pediatric population, and may occur in the context of domestic, sporting or school accidents. They can extend to skull base and compromise vascular structures such as cavernous sinus and internal carotid. We present a case of 6 years-old girl that suffered an intracranial transorbital penetrating injury with a wooden pencil that crossed from the medial edge of left orbit, transetmoidal and trans-sphenoidal, entering the right sellar region and leaving its end in contact with carotid artery (cavernous segment). After pre-surgical studies, foreign body removal was performed with endoscopic surgery+endovascular control in case of carotid injury. After removing the foreign body, a CSF fistula occurred and was repaired. Patient recovered adequately, without neurological deficit, without postoperative CSF fistula, without CNS infection or oculomotor alteration (AU)

JAGGED-NOTCH3 signaling in vascular remodeling in pulmonary arterial hypertension.

Within the pulmonary arterial tree, the NOTCH3 pathway is crucial in controlling vascular smooth muscle cell proliferation and maintaining smooth muscle cells in an undifferentiated state. Pulmonary arterial hypertension (PAH) is a fatal disease without cure, characterized by elevated pulmonary vascular resistance due to vascular smooth muscle cell proliferation in precapillary arteries, perivascular inflammation, and asymmetric neointimal hyperplasia. Here, we show that human PAH is characterized by overexpression of the NOTCH ligand JAGGED-1 (JAG-1) in small pulmonary artery smooth muscle cells and that JAG-1 selectively controls NOTCH3 signaling and cellular proliferation in an autocrine fashion. In contrast, the NOTCH ligand DELTA-LIKE 4 is minimally expressed in small pulmonary artery smooth muscle cells from individuals with PAH, inhibits NOTCH3 cleavage and signaling, and retards vascular smooth muscle cell proliferation. A new monoclonal antibody for the treatment of PAH, which blocks JAG-1 cis- and trans-induced cleavage of the NOTCH3 receptor in the pulmonary vasculature, was developed. Inhibition of JAG-1-induced NOTCH3 signaling in the lung reverses clinical and pathologic pulmonary hypertension in two rodent models of disease, without toxic side effects associated with nonspecific NOTCH inhibitors. Our data suggest opposing roles of NOTCH ligands in the pulmonary vasculature in pulmonary hypertension. We propose that selectively targeting JAG-1 activation of NOTCH3 may be an effective, safe strategy to treat PAH.

Transorbital penetrating intracranial injury, with cavernous sinus involvement.

Transorbitary intracranial penetrating traumatic injuries are uncommon in the paediatric population, and may occur in the context of domestic, sporting or school accidents. They can extend to skull base and compromise vascular structures such as cavernous sinus and internal carotid. We present a case of 6 years-old girl that suffered an intracranial transorbital penetrating injury with a wooden pencil that crossed from the medial edge of left orbit, transetmoidal and trans-sphenoidal, entering the right sellar region and leaving its end in contact with carotid artery (cavernous segment). After pre-surgical studies, foreign body removal was performed with endoscopic surgery + endovascular control in case of carotid injury. After removing the foreign body, a CSF fistula occurred and was repaired. Patient recovered adequately, without neurological deficit, without postoperative CSF fistula, without CNS infection or oculomotor alteration.

Evidence of bovine leukemia virus circulating in sheep and buffaloes in Colombia: insights into multispecies infection.

Bovine leukemia virus (BLV) is the causative agent of leukemia/lymphoma in cattle. However, previous evidence has shown its presence in other species of livestock as well as in humans, suggesting that other species can be accidental hosts of the virus. In viral infections, receptors that are common to different animal species are proposed to be involved in cross-species infections. For BLV, AP3D1 has been proposed to be its receptor, and this protein is conserved in most mammalian species. In Colombia, BLV has been reported in cattle with high prevalence rates, but there has been no evidence of BLV infections in other animal species. In this study, we tested for the virus in sheep (n = 44) and buffaloes (n = 61) from different regions of Colombia by nested PCR, using peripheral blood samples collected from the animals. BLV was found in 25.7% of the animals tested (12 buffaloes and 15 sheep), and the results were confirmed by Sanger sequencing. In addition, to gain more information about the capacity of the virus to infect these species, the predicted interactions of AP3D1 of sheep and buffaloes with the BLV-gp51 protein were analyzed in silico. Conserved amino acids in the binding domains of the proteins were identified. The detection of BLV in sheep and buffaloes suggests circulation of the virus in multiple species, which could be involved in dissemination of the virus in mixed livestock production settings. Due to the presence of the virus in multiple species and the high prevalence rates observed, integrated prevention and control strategies in the livestock industry should be considered to decrease the spread of BLV.

Using structural equation modeling to study traits and states in intensive longitudinal data.

Traditionally, researchers have used time series and multilevel models to analyze intensive longitudinal data. However, these models do not directly address traits and states which conceptualize the stability and variability implicit in longitudinal research, and they do not explicitly take into account measurement error. An alternative to overcome these drawbacks is to consider structural equation models (state-trait SEMs) for longitudinal data that represent traits and states as latent variables. Most of these models are encompassed in the latent state-trait (LST) theory. These state-trait SEMs can be problematic when the number of measurement occasions increases. As they require the data to be in wide format, these models quickly become overparameterized and lead to nonconvergence issues. For these reasons, multilevel versions of state-trait SEMs have been proposed, which require the data in long format. To study how suitable state-trait SEMs are for intensive longitudinal data, we carried out a simulation study. We compared the traditional single level to the multilevel version of three state-trait SEMs. The selected models were the multistate-singletrait (MSST) model, the common and unique trait-state (CUTS) model, and the trait-state-occasion (TSO) model. Furthermore, we also included an empirical application. Our results indicated that the TSO model performed best in both the simulated and the empirical data. To conclude, we highlight the usefulness of state-trait SEMs to study the psychometric properties of the questionnaires used in intensive longitudinal data. Yet, these models still have multiple limitations, some of which might be overcome by extending them to more general frameworks. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Does Functional Somatic Symptoms Measurement Differ Across Sex and Age? Differential Item Functioning in Somatic Symptoms Measured With the CIDI.

Functional Somatic Symptoms (FSS) are physical symptoms that cannot be attributed to underlying pathology. Their severity is often measured with sum scores on questionnaires; however, this may not adequately reflect FSS severity in subgroups of patients. We aimed to identify the items of the somatization section of the Composite International Diagnostic Interview that best discriminate FSS severity levels, and to assess their functioning in sex and age subgroups. We applied the two-parameter logistic model to 19 items in a population-representative cohort of 962 participants. Subsequently, we examined differential item functioning (DIF). "Localized (muscle) weakness" was the most discriminative item of FSS severity. "Abdominal pain" consistently showed DIF by sex, with males reporting it at higher FSS severity. There was no consistent DIF by age, however, "Joint pain" showed poor discrimination of FSS severity in older adults. These findings could be helpful for the development of better assessment instruments for FSS, which can improve both future research and clinical care.

Analysis of COVID-19 Mortality and Survival in Colombia: A prospective Cohort Study / Análisis de la mortalidad y supervivencia para COVID-19 en Colombia: Un estudio de cohorte prospectiva

Abstract Objective: To determine the mortality and survival of COVID-19 cases in Colombia between March and July 2020. Materials and methods: A retrospective cohort study in the Colombian population between March 6 to July 8, 2020, with the data reported to the National Institute of Health. Survival analysis was performed considering the real-time PCR results, died or recovered, the onset of symptoms until the date of death, or the final time of the cohort. The actuarial variation and Long-Rank test were applied for survival. Risk factors were determined by Cox regression. Results: The overall survival rate was 100%, 98%, 97%, and 95% for day 1, 10, 20 and 30, respectively. Differences were found in survival in age, sex, region, and hospitaliza tion time spending (p <0.01), the 30-day survival rate was 96% and 95% for females and males, respectively. The region with the highest survival was Antioquia with 99% and the lower Barranquilla with 93%. The age group with the lowest survival was ≥80 years of age with 60%, and being hospitalized represented a survival rate of 68%. Conclusions: This study is one of the first to estimate survival in the Colombian population diagnosed with COVID-19.

Resumen Objetivo: determinar la mortalidad y supervivencia de casos de COVID-19 en Colombia entre marzo y julio de 2020. Materiales y métodos: Estudio de cohorte retrospectivo en población colombiana entre el 6 de marzo al 8 de julio de 2020, con los datos reportados al Instituto Nacional de Salud. El análisis de supervivencia se realizó considerando los resultados de la PCR en tiempo real, fallecido o recuperado, el inicio de los síntomas hasta la fecha del fallecimiento o el momento final de la cohorte. Para la supervivencia se aplicó la variación actuarial y la prueba de rango largo. Los factores de riesgo se determinaron mediante regresión de Cox. Resultados: La tasa de supervivencia general fue del 100%, 98%, 97% y 95% para los días 1, 10, 20 y 30, respectivamente. Se encontraron diferencias en la su pervivencia en cuanto a edad, sexo, región y tiempo de hospitalización (p <0,01), la tasa de supervivencia a 30 días fue del 96% y 95% para mujeres y hombres, respectivamente. La región con mayor supervivencia fue Antioquia con 99% y la Baja Barranquilla con 93%. El grupo de edad con menor supervivencia fue el ≥80 años con 60%, y la hospitalización representó una tasa de supervivencia del 68%. Conclusiones: Este estudio es uno de los primeros en estimar la supervivencia en la población colombiana diagnosticada con COVID-19.

Co-Circulation of Bovine Leukemia Virus Haplotypes among Humans, Animals, and Food Products: New Insights of Its Zoonotic Potential.

Bovine leukemia virus (BLV) is the causative agent of leukemia/lymphoma in cattle. It has been found in humans and cattle-derived food products. In humans, it is described as a potential risk factor for breast cancer development. However, the transmission path remains unclear. Here, a molecular epidemiology analysis was performed to identify signatures of genetic flux of BLV among humans, animals, and food products. Sequences obtained from these sources in Colombia were used (n = 183) and compared with reference sequences available in GenBank. Phylogenetic reconstruction was performed in IQ-TREE software with the maximum likelihood algorithm. Haplotype (hap) distribution among the population was carried out with a median-joining model in Network5.0. Recombination events were inferred using SplitsTree4 software. In the phylogenetic analysis, no specific branches were identified for the Colombian sequences or for the different sources. A total of 31 haps were found, with Hap 1, 4, 5 and 7 being shared among the three sources of the study. Reticulation events among the different sources were also detected during the recombination analysis. These results show new insights about the zoonotic potential of BLV, showing evidence of genetic flux between cattle and humans. Prevention and control strategies should be considered to avoid viral dissemination as part of the One Health program policies.

Quiste esplénico. Esplenectomía parcial con exclusión vascular laparoscópica / Splenic cyst. Laparoscopic partial splenectomy with vascular exclusion

RESUMEN Antecedentes: la esplenectomía conlleva peligro de infecciones de distinta naturaleza. El riesgo de sepsis fluctúa entre 4,25 y 18,2%. El tratamiento quirúrgico corriente en las afecciones del bazo es la esplenectomía; la resección parcial, cuando es posible, es la mejor opción. Objetivo: evaluar los resultados a partir de la resección parcial del bazo y oclusión vascular en porta dores de quistes esplénicos. Material y métodos: en un período de 3 años se realizó esplenectomía parcial en 4 pacientes con quiste esplénico, en dos de los cuales se empleó exclusión vascular. Femenino, 3; edad, 30,5 años; IMC, 26,1. Resultados: tiempo operatorio,120,75 minutos; de clampeo,12 minutos. Pérdida sanguínea sin clam peo, 700 y 200 mL; con clampeo, 50 y 30 mL. Un paciente fue reintervenido, completando la esplenec tomía por vía convencional. Tiempo de internación, 3,5 días. Conclusiones: la resección parcial del bazo con clampeo vascular transitorio es una opción factible y asegura, con escaso sangrado.

ABSTRACT Background: Background: Spleen resection is associated with high risk of infections. The risk of sepsis ranges between 4.25% and 18.2%. Splenectomy is the usual surgical practice in spleen diseases, and partial resection is the best option, when possible. Objective: The aim of this study was to evaluate the outcomes of partial splenectomy with vascular occlusion in patients with splenic cysts. Material and methods: Over a 3-year period, 4 patients with splenic cysts underwent partial splenec tomy; vascular exclusion was used in 2 of them. Three patients were women; age, 30.5 years; BMI: 36.1 Results: Operative time. 120.75 minute; clamping time, 12 minutes. Blood loss without vascular clam ping, 700 and 200 mL; with vascular clamp, 50 and 30 mL. One patient was reoperated with total splenectomy via the conventional approach. Length of hospital stay, 3.5 days. Conclusions: Partial splenectomy with temporary vascular clamping is a feasible and safe option with minor intraoperative bleeding.

Efecto placebo y estimulación sonora binaural de ondas beta y theta en el rendimiento de una tarea de memoria de trabajo / Placebo Effect and Binaural Sound Stimulation of Beta Wave and Theta Wave in a Working Memory Task Performance

Resumen En el presente trabajo se realizó un estudio cuasi experimental de medidas repetidas con grupos caso y control, cuyo objetivo fue medir el efecto de los sonidos binaurales de onda beta y theta, y de la información placebo relacionada a ellos, sobre el rendimiento de una tarea de memoria de trabajo computarizada, versión libre del Automated Operation Span Task -AOSPAN-de Unsworth, Heitz, Schrock y Engle (2005). Dicha tarea se repitió en dos sesiones separadas por un lapso mínimo de dos semanas, una de las cuales se resolvía mientras se escuchaba una estimulación sonora binaural de onda beta o theta que, dependiendo del grupo, se acompañaba o no de información placebo. Se evaluaron 98 personas con distinto nivel de escolaridad divididas en seis grupos experimentales y uno de control. Se encontraron diferencias significativas en el tiempo de presentación de la tarea experimental asociada a información placebo, mostrando una mejoría en la segunda aplicación de la tarea. Debido a ambigüedades en los resultados, a pesar de encontrar diferencias significativas asociadas a la estimulación binaural de onda beta, no pudieron establecerse relaciones concretas entre la mejoría en el recuerdo de conjuntos de hasta cuatro elementos con la presencia de dicha variable. No se encontraron diferencias significativas en las variables de recuerdo global, lo cual puede explicarse por el tipo de tarea de memoria utilizado.

Abstract In this work, a quasi-experimental study of repeated measures with case and control groups was carried out, whose objective was to measure the effect of binaural sounds of beta and theta waves, and the placebo informa tion related to them, on the performance of a computerized working memory task, Automated Operation Span Task -AOSPAN- free version of Unsworth, Heitz, Schrock and Engle (2005). This task was repeated in two sessions separated by an interval of two weeks, one of which was resolved while listening to a binaural sound stimulation of beta wave or theta that, depending on the group, was supported or not by placebo information. 98 people with different levels of schooling were tested twice, divided into six experimental groups and one control group. Significant differences were found related to time duration in performing the experimental task associated with placebo information; it was showed an improvement the second time the task was administered. Due to ambiguities in the results, despite finding significant differences associated with binaural stimulation of beta wave, it was not possible to establish concrete relations between the improvement in the memory of sets up four elements with the presence of this variable. No significant differences were found in the global recall variables, which can be explained by the type of memory task performed.

GGUM: An R Package for Fitting the Generalized Graded Unfolding Model.

In this article, the newly created GGUM R package is presented. This package finally brings the generalized graded unfolding model (GGUM) to the front stage for practitioners and researchers. It expands the possibilities of fitting this type of item response theory (IRT) model to settings that, up to now, were not possible (thus, beyond the limitations imposed by the widespread GGUM2004 software). The outcome is therefore a unique software, not limited by the dimensions of the data matrix or the operating system used. It includes various routines that allow fitting the model, checking model fit, plotting the results, and also interacting with GGUM2004 for those interested. The software should be of interest to all those who are interested in IRT in general or to ideal point models in particular.

Diagnóstico y tratamiento de la pancreatitis aguda en la Argentina. Resultados de un estudio prospectivo en 23 centros.

In Argentina there are no multicenter studies evaluating the management of patients with acute pancreatitis (AP) nationwide. OBJECTIVES: The main objective of this study is to know how the patients with AP are treated in Argentina. The secondary objective is to assess whether the results comply with the recommendation of the American College of Gastroenterology Guide. MATERIAL AND METHODS: Twenty three center participated in the study. They include in a database hosted online consecutive patients with acute pancreatitis from june 2010 to june 2013. RESULTS: 854 patients entered the study. The average age was 46.6 years and 495 (58%) belonged to the female sex. The most common cause (88.2%) of AP was biliary. Some prognostic system was used in 99 % of patients and the most used was Ranson (74.5%). Were classified as mild 714 (83.6%) patients and severe 140 (16.4%). Systemic complications occurred in 43 patients and local complications in 21. 86 patients underwent dynamic CT scans and 73 patients had pancreatic and / or peripancreatic necrosis. Mortality was 1.5%. There was no difference in mortality in relation to the size, complexity or affiliation of the center. The comply of key recommendations of the American College of Gastroenterology Guide was over 80%. CONCLUSIONS: The diagnosis and treatment of patients with AP in 23 health centers located throughout the country was optimal. The management complied with most of the recommendations of the American College of Gastroenterology Guide.

Diagnóstico y tratamiento de la pancreatitis aguda en la Argentina. Resultados de un estudio prospectivo en 23 centros.

In Argentina there are no multicenter studies evaluating the management of patients with acute pancreatitis (AP) nationwide. OBJECTIVES: The main objective of this study is to know how the patients with AP are treated in Argentina. The secondary objective is to assess whether the results comply with the recommendation of the American College of Gastroenterology Guide. MATERIAL AND METHODS: Twenty three center participated in the study. They include in a database hosted online consecutive patients with acute pancreatitis from june 2010 to june 2013. RESULTS: 854 patients entered the study. The average age was 46.6 years and 495 (58%) belonged to the female sex. The most common cause (88.2%) of AP was biliary. Some prognostic system was used in 99 % of patients and the most used was Ranson (74.5%). Were classified as mild 714 (83.6%) patients and severe 140 (16.4%). Systemic complications occurred in 43 patients and local complications in 21. 86 patients underwent dynamic CT scans and 73 patients had pancreatic and / or peripancreatic necrosis. Mortality was 1.5%. There was no difference in mortality in relation to the size, complexity or affiliation of the center. The comply of key recommendations of the American College of Gastroenterology Guide was over 80%. CONCLUSIONS: The diagnosis and treatment of patients with AP in 23 health centers located throughout the country was optimal. The management complied with most of the recommendations of the American College of Gastroenterology Guide.

Structure and antimicrobial activity of phloroglucinol derivatives from Achyrocline satureioides.

The new prenylated phloroglucinol α-pyrones 1-3 and the new dibenzofuran 4, together with the known 23-methyl-6-O-demethylauricepyrone (5), achyrofuran (6), and 5,7-dihydroxy-3,8-dimethoxyflavone (gnaphaliin A), were isolated from the aerial parts of Achyrocline satureioides. Their structures were determined by 1D and 2D NMR spectroscopic studies, while the absolute configuration of the sole stereogenic center of 1 was established by vibrational circular dichroism measurements in comparison to density functional theory calculated data. The same (S) absolute configuration of the α-methylbutyryl chain attached to the phloroglucinol nucleus was assumed for compounds 2-6 based on biogenetic considerations. Derivatives 7-16 were prepared from 1 and 5, and the antimicrobial activities of the isolated metabolites and some of the semisynthetic derivatives against a selected panel of Gram-positive and Gram-negative bacteria, as well as a set of yeast molds, were determined.