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Abstract Background Despite the prevalence of non-English languages in the US population, existing medical training to teach communication with linguistically diverse communities is limited to electives or solely focuses on medical interpreting. Language-appropriate communication skills are seldom comprehensively integrated in medical education. This study describes the development and evaluation of an intervention to teach foundational language equity concepts. Methods The authors implemented a pre-clinical language equity course at three medical school campuses between August 2020 and March 2022. Sessions focused on the impact of language in health, physician language proficiency standards, and working with medical interpreters. The study sought to (1) understand students’ language skills and prior clinical experiences with patients with non-English language preference and (2) evaluate the curriculum’s impact. Students self-reported their language skills and experiences as part of a voluntary pre-questionnaire. Pre and post-questionnaires evaluated knowledge, attitudes, and intent to apply language equity concepts. Descriptive statistics and chi-squared tests were used to examine trends; themes were identified from free-text responses. Results Overall, 301 students completed the course, 252 (83%) completed at least one questionnaire; for each session, between 35% and 46% of learners completed both pre and post-questionnaires. Three quarters (189/252) reported non-English languages. Over half (138/252) reported previous non-English language patient care, and 28% (62/224) had served as ad hoc (untrained) interpreters. Only two students (

Introduction Medical Spanish courses in US medical schools aim to teach patient-centered communication, yet many existing resources focus on technical vocabulary and may inadvertently increase jargon use with patients. Graphic medicine presents an opportunity for interactive learning that centers the patient experience, yet it has never been explored in medical Spanish education. Methods We developed a Medical Spanish Graphic Activity (MeGA) for medical student deliberate practice of patient-centered verbal communication focused on three aspects: diagnosis, treatment, and follow-up care. Each 30-minute activity included a comics handout depicting a patient with a common problem. Students used voice-to-text technology to record their explanations in response to prompts. Transcripts were analyzed for jargon use, including total jargon, unexplained jargon, and problem words (non-Spanish words plus unexplained jargon), utilizing a previously published, reliable protocol for Spanish medical jargon classification. Participants voluntarily provided postactivity feedback. Results Twenty-nine fourth-year students with intermediate or greater Spanish skills participated in a series of 10 MeGA activities between January and April 2022. Unexplained jargon use and problem words progressively decreased for all transcripts (diagnosis, treatment, and follow-up; all ps < .001). Total jargon use also decreased, but this was not significant in follow-up transcripts (p = .38). All students agreed that MeGA helped them enhance communication skills applicable to patient care and self-identify strengths and limitations. Discussion MeGA is realistic to implement, engages students' active participation in the speaking domain, and reduces unexplained jargon use. Future studies should explore the broader application of this model and engage patient perspectives.

Abstract This study aimed to assess pulmonary and muscle dysfunction by analyzing the slow component of oxygen uptake (VO2SC), and mechanical and ventilatory efficiency in adult women recovered from the severe acute respiratory syndrome coronavirus type II (SARS-CoV-2) during a constant load test. 32 women (N = 17 patients with SARS-CoV-2; N = 15 control group) performed two cardiopulmonary exercise tests (CPX) on a cycle ergometer. In the first test, the participants performed incremental CPX until extenuation. In the second test the participants performed a 10-min CPX at a constant load intensity (watts) corresponding to the first ventilatory threshold. There was a 48–72 h rest period between the two tests. There was a significant increase in the VO2SC in the patients recovered from SARS-CoV-2 (160.4 ± 60 mL min−1) in comparison with the healthy participants (59.6 ± 65 mL min−1) (P

Lobular glandular endocervical hyperplasia is an uncommon benign entity within the spectrum of gastric-type endocervical lesions. We report a case of a 48-year-old woman who presented with a palpable mass and watery vaginal discharge. Ultrasound revealed an 8 cm × 4 cm × 3 cm multicystic mass affecting the cervix, and hysterectomy was performed. The well-delimited multicystic, mucinous mass distorted the entire cervix. Microscopically, endocervical glandular proliferation with a lobular architecture was observed. The glands were lined with a single layer of tall, mucin-rich, columnar cells with basal and bland nuclei. The lesion was positive for MUC6 marker and hormonal receptors were negative, while P53 expression was normal. Three years later, the patient remained disease free. Here, we discuss the differential diagnosis between lobular glandular endocervical hyperplasia and similar conditions, particularly gastric-type endocervical adenocarcinoma, and review the literature focusing on the molecular pathways underlying gastric-type endocervical lesions. This case highlights the importance of accurate diagnosis to ensure favorable outcomes.

Abstract Background There is limited information about the impact of coronavirus disease (COVID‐19) on the muscular dysfunction, despite the generalized weakness and fatigue that patients report after overcoming the acute phase of the infection. This study aimed to detect impaired muscle efficiency by evaluating delta efficiency (DE) in patients with COVID‐19 compared with subjects with chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), and control group (CG). Methods A total of 60 participants were assigned to four experimental groups: COVID‐19, COPD, IHD, and CG (n = 15 each group). Incremental exercise tests in a cycle ergometer were performed to obtain peak oxygen uptake (VO2peak). DE was obtained from the end of the first workload to the power output where the respiratory exchange ratio was 1. Results A lower DE was detected in patients with COVID‐19 and COPD compared with those in CG (P ≤ 0.033). However, no significant differences were observed among the experimental groups with diseases (P > 0.05). Lower VO2peak, peak ventilation, peak power output, and total exercise time were observed in the groups with diseases than in the CG (P

Colitis-associated colorectal carcinoma (CAC) occurs in inflammatory bowel disease (IBD) because of the “chronic inflammation-dysplasia-cancer” carcinogenesis pathway characterized by p53 alterations in the early stages. Recently, gastric metaplasia (GM) has been described as the initial event of the serrated colorectal cancer (CRC) process, resulting from chronic stress on the colon mucosa. The aim of the study is to characterize CAC analyzing p53 alterations and microsatellite instability (MSI) to explore their relationship with GM using a series of CRC and the adjacent intestinal mucosa. Immunohistochemistry was performed to assess p53 alterations, MSI and MUC5AC expression as a surrogate for GM. The p53 mut-pattern was found in more than half of the CAC, most frequently stable (MSS) and MUC5AC negative. Only six tumors were unstable (MSI-H), being with p53 wt-pattern (p = 0.010) and MUC5AC positive (p = 0.005). MUC5AC staining was more frequently observed in intestinal mucosa, inflamed or with chronic changes, than in CAC, especially in those with p53 wt-pattern and MSS. Based on our results, we conclude that, as in the serrated pathway of CRC, in IBD GM occurs in inflamed mucosa, persists in those with chronic changes and disappears with the acquisition of p53 mutations.

Introduction Hispanic/Latinx patients experience health disparities in endocrine disease, such as higher rates of mortality due to diabetes mellitus, worse outcomes in the surgical treatment of thyroid cancer, and lack of knowledge about bone health and osteoporotic fracture prevention. Educational strategies to teach cultural and linguistic medical Spanish knowledge to medical students have the potential to improve Hispanic/Latinx endocrine health. Methods We created an 8-hour medical Spanish endocrine module targeting language and cultural skills acquisition. Specifically, students practiced obtaining a past medical history, obtaining a medications history, providing and explaining a diagnosis, explaining discharge instructions, and discussing sociocultural aspects of endocrine health. We divided the module into four 2-hour sessions: (1) preclass self-study, (2) class period, (3) role-play/interviewing practice session, and (4) case/cultural activity assignment. Participants completed a pre- and postassessment to measure student confidence level and knowledge. Results We implemented the module four times at one medical school, with 47 fourth-year medical students with intermediate or higher general Spanish skills. Confidence increased for all learners in the endocrine-focused interview and exam in Spanish. Heritage Spanish learners, who were exposed to Spanish at home as children, reported higher postmodule confidence in eliciting the past medical history of endocrine problems. Discussion The medical Spanish endocrine module improved the communication skills of medical students with intermediate through advanced Spanish proficiency. Future study should evaluate learner clinical performance metrics and applications to other groups of learners, such as resident physicians or health professions involved in the care of patients with endocrine disease.

Introduction While many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts. Methods An 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels. Results Students demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups. Discussion An intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).

Community-onset bloodstream infections (CO-BSI) caused by gram-negative bacilli are common and associated with significant mortality; those caused by Pseudomonas aeruginosa are associated with worse prognosis and higher rates of inadequateempirical antibiotic treatment. The aims of this study were to describe the characteristics of patients with CO-BSI caused by P. aeruginosa, to identify predictors, and to develop a predictive score for P. aeruginosa CO-BSI. Materials/methods: PROBAC is a prospective cohort including patients >14 years with BSI from 26 Spanish hospitals between October 2016 and May 2017. Patients with monomicrobial P. aeruginosa CO-BSI and monomicrobial Enterobacterales CO-BSI were included. Variables of interest were collected. Independent predictors of Pseudomonas aeruginosa CO-BSI were identified by logistic regression and a prediction score was developed. Results: A total of 78patients with P. aeruginosa CO-BSI and 2572 with Enterobacterales CO-BSI were included. Patients with P. aeruginosa had a median age of 70 years (IQR 60–79), 68.8% were male, median Charlson score was 5 (IQR 3–7), and 30-daymortality was 18.5%. Multivariate analysis identified the following predictors of CO-BSI-PA [adjusted OR (95% CI)]: male gender [1.89 (1.14–3.12)], haematological malignancy [2.45 (1.20–4.99)], obstructive uropathy [2.86 (1.13–3.02)], source of infection other than urinary tract, biliary tract or intra-abdominal [6.69 (4.10–10.92)] and healthcare-associated BSI [1.85 (1.13–3.02)]. Anindex predictive of CO-BSI-PA was developed; scores ≥ 3.5 showed a negative predictive value of 89% and an area under the receiver operator curve (ROC) of 0.66. Conclusions: We did not find a good predictive score of P. aeruginosa CO-BSI due to its relatively low incidence in the overall population. Our model includes variables that are easy to collect in real clinical practice and could be useful to detect patients with very low risk of P. aeruginosa CO-BSI.

The COVID-19 pandemic prompted the rapid incorporation of telemedicine into healthcare systems, resulting in increased access challenges for patients in the United States with limited English proficiency (LEP). Non-English-language speakers face challenges with telemedicine that magnify pre-existing barriers to language-appropriate care, such as difficulty accessing professional medical interpreters and navigating both electronic health information and online patient portals. Improved medical education on telehealth would increase equitable care for linguistic minorities. Medical education targeting telehealth care delivery should include clinician instruction on working with interpreters in telehealth contexts, increasing patient access to telehealth resources, and addressing patients’ language needs for telemedicine.

Protected urban green spaces (PUGS) are exposed to numerous disturbances and threats since they are immersed in highly dynamic socio-ecological systems. PUGS in highly urbanized cities require particular conservation strategies. Here, we propose an approach for PUGS management which integrates three components: (i) scientific knowledge (monitoring/restoration), (ii) community interaction with the environment, and (iii) management decision. Based on the perception of stakeholders, we searched for evidence that these components are well-integrated in PUGS management and decision-making. The intersection of these components should produce a solid management program, provided that the obtained multidisciplinary knowledge meets the needs of information required by the community and decision makers. We tested this in a small PUGS located within Mexico City at the National Autonomous University of Mexico campus that holds the Ecological Reserve of Pedregal de San Ángel. Through a participatory approach we elicited mental models and represented group beliefs using Fuzzy Cognitive Mapping (FCM). This, in turn, produced evidence of effective integration of the three components in terms of management and decision-making. Our findings provide insight into the actors' perceptions and concerns and suggest that the interactions among the three components, although important, are not self-generated and must be constructed. The findings also suggest that one of the management problems is the mismatch between scientific knowledge and conservation programs. It is paramount to include generated knowledge into management and monitoring programs. The complexity of the PUGS requires an active collaboration among actors and monitoring the development of management strategies using the three components while taking the conservation goals into account.

In addition to the increase in fungal infections that has been observed in the last few decades, it has been reported that severe clinical COVID-19 can increase the risk of invasive fungal infections. The main objective of this study was to evaluate if there had been an increase in candidaemia and invasive pulmonary aspergillosis (IPA) cases since the onset of the SARS-CoV-2 pandemic. Data were retrospectively collected from April 2019 to March 2021, from patients admitted to Consorcio Hospital General Universitario de Valencia (Spain). A total of 152 candidaemia cases (56 of which were due to Candida auris) and 108 possible IPA cases were detected. A great increase in candidaemia cases was produced during the first and the third epidemic waves of the SARS-CoV-2 pandemic (June 2020, and January 2021, respectively), while an increase in IPA cases was produced during the third wave. The 28-day mortality rates in patients affected by candidaemia and IPA increased in 2020 and 2021. C. auris has displaced the other Candida species, becoming the most isolated Candida species in blood cultures since the onset of the SARS-CoV-2 pandemic. Antifungal consumption increased in 2020 when compared to 2019, especially echinocandins, voriconazole and isavuconazole.

The Education Act of 2006 (LOE) orders the compulsory assessment of headmasters of public schools at the end of their management period. The result of this evaluation will have, at least, economical consequences. This Act also states that the regional education authorities will be in charge of the development of such assessments. So has been done, and, as a result, nowadays there are as many evaluation programmes as autonomous communities. This article researches and compares the legal regulations in force that rule these evaluations in every autonomous community and finally shows that, in spite of its common origin and purpose, the systems, methods and evaluation processes which are used by the regional authorities differ greatly from each others. This analysis also draws some conclusions that could be taken into account to improve the evaluation process of headmasters.

Urban geosites are an important resource for science, geoeducation and geotourism that may provide multiple benefits for local communities. The gigantic Mexico City is settled in a paleolake basin sur- rounded by Quaternary volcanic ranges. The SW corner of the city has spread over two of these ranges, Sierra Chichinautzin and the Sierra de las Cruces, leaving few outcrops in the dense urban network that are preserved in public parks. We present here the results of our study of the geological characteristics of two parks managed by local communities. We found surprisingly high geodiversity in these parks and their directly surrounding areas which, along with their accessibility, give them elevated geoeducation and geotourism values. This geodiversity is combined with biodiversity, creating a geo-bio-heritage that is, however, threatened by anthropic activities. We designed geopaths and, as a first approach to the communities, we organized field excursions along them which were highly successful in raising the knowledge and interest of local people on their geo-bio-heritage and also contributed to their aware- ness of anthropic threats that need to be addressed in order to achieve sustainable management for their conservation. Our project hence represents the first step of a strategy to promote the natural heritage to local communities, contribute to its conservation, and reduce the gap between science and society.

IntroductionCarbapenemase-Producing Escherichia coli (CP-Eco) isolates, though less prevalent than other CP-Enterobacterales, have the capacity to rapidly disseminate antibiotic resistance genes (ARGs) and cause serious difficult-to-treat infections. The aim of this study is phenotypically and genotypically characterizing CP-Eco isolates collected from Spain to better understand their resistance mechanisms and population structure.MethodsNinety representative isolates received from 2015 to 2020 from 25 provinces and 59 hospitals Spanish hospitals were included. Antibiotic susceptibility was determined according to EUCAST guidelines and whole-genome sequencing was performed. Antibiotic resistance and virulence-associated genes, phylogeny and population structure, and carbapenemase genes-carrying plasmids were analyzed.Results and discussionThe 90 CP-Eco isolates were highly polyclonal, where the most prevalent was ST131, detected in 14 (15.6%) of the isolates. The carbapenemase genes detected were blaOXA-48 (45.6%), blaVIM-1 (23.3%), blaNDM-1 (7.8%), blaKPC-3 (6.7%), and blaNDM-5 (6.7%). Forty (44.4%) were resistant to 6 or more antibiotic groups and the most active antibiotics were colistin (98.9%), plazomicin (92.2%) and cefiderocol (92.2%). Four of the seven cefiderocol-resistant isolates belonged to ST167 and six harbored blaNDM. Five of the plazomicin-resistant isolates harbored rmt. IncL plasmids were the most frequent (45.7%) and eight of these harbored blaVIM-1. blaOXA-48 was found in IncF plasmids in eight isolates. Metallo-β-lactamases were more frequent in isolates with resistance to six or more antibiotic groups, with their genes often present on the same plasmid/integron. ST131 isolates were associated with sat and pap virulence genes. This study highlights the genetic versatility of CP-Eco and its potential to disseminate ARGs and cause community and nosocomial infections.

Summary: Background: Pseudomonas aeruginosa healthcare-associated infections are one of the top antimicrobial resistance threats world-wide. In order to analyze the current trends, we performed a Spanish nation-wide high-resolution analysis of the susceptibility profiles, the genomic epidemiology and the resistome of P. aeruginosa over a five-year time lapse. Methods: A total of 3.180 nonduplicated P. aeruginosa clinical isolates from two Spanish nation-wide surveys performed in October 2017 and 2022 were analyzed. MICs of 13 antipseudomonals were determined by ISO-EUCAST. Multidrug resistance (MDR)/extensively drug resistance (XDR)/difficult to treat resistance (DTR)/pandrug resistance (PDR) profiles were defined following established criteria. All XDR/DTR isolates were subjected to whole genome sequencing (WGS). Findings: A decrease in resistance to all tested antibiotics, including older and newer antimicrobials, was observed in 2022 vs 2017. Likewise, a major reduction of XDR (15.2% vs 5.9%) and DTR (4.2 vs 2.1%) profiles was evidenced, and even more patent among ICU isolates [XDR (26.0% vs 6.0%) and DTR (8.9% vs 2.6%)] (p

IntroductionInfections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.MethodsA national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.ResultsA total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.DiscussionData from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.

El artículo presenta las principales características metodológicas y los resultados de 15 artículos científicos y una tesis, los que fueron seleccionados después de una búsqueda inicial en torno a investigaciones recientes sobre temas de comunicación institucional en museos, derechos humanos culturales y políticas públicas. La indagación forma parte del proceso para conformar el estado del arte —estado de la cuestión—, de una investigación en curso que analiza la relación entre la comunicación institucional de museos de arte y los derechos humanos culturales de la juventud, en el marco de las políticas públicas en México. Los artículos se identificaron y seleccionaron a partir de la búsqueda en bases de datos como EBSCO host, ProQuest, Latindex, Dialnet y Scielo, los que fueron publicados en revistas arbitradas entre el 2018 y el 2022.

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3.

La presente investigación ofrece una visión sobre la situación de las aulas de Educación Secundaria de la provincia de Valencia en relación con la homofobia. Se trata de una investigación descriptiva que ha utilizado como principal instrumento una encuesta creada ad hoc y cumplimentada manualmente por el alumnado participante. Este estudio es fruto del análisis de 7.365 encuestas cumplimentadas por estudiantes, aplicada previamente a la intervención del colectivo LAMBDA en las aulas durante el período de 2015 al 2018. A través de estas, se recopiló información sobre la percepción del alumnado con relación a la diversidad afectivo-sexual y de género en los centros educativos. Los resultados identifican en general una actitud positiva hacia las personas LGBTI. Sin embargo, también se halla homofobia cognitiva, afectiva, conductual e institucional en el alumnado. Existen diferencias entre géneros, de forma que las mujeres muestran una actitud más positiva hacia la diversidad sexual y de género que los hombres. A partir de estos resultados consideramos importante tener en cuenta la variable género en la formación del alumnado para hacer frente a todo tipo de homofobia y a la intolerancia por género.

La resiliencia es una capacidad de las localidades turísticas por medio de la cual lidian con el cambio y las perturbaciones que ponen en peligro los recursos de vida. Los objetivos de este artículo son analizar los aportes teórico-metodológicos de la resiliencia en el turismo y diseñar un marco analítico, integral y flexible con el propósito de estimar la resiliencia de forma cualitativa en comunidades locales turísticas. Además, intenta servir de guía a investigadores que necesitan dar precisión a sus experiencias empíricas. Metodológicamente, se recurre a la revisión de la literatura especializada, con ello se examina el aporte recíproco de los sistemas socio-ecológicos y la resiliencia en el turismo. Enseguida se utiliza el método de análisis-síntesis, con la intención de identificar la importancia y el alcance de los elementos de un marco teórico-metodológico. Luego, se unifican criterios semejantes, a fin de conectar relaciones y formar un todo como aporte al conocimiento científico. De acuerdo con los resultados, la capacidad de análisis de los marcos teórico-metodológicos se sustenta en las características de los sistemas socio-ecológicos, el uso de factores de resiliencia y el empleo de medidas operacionales de resiliencia.

In the valuable orchid genus Cypripedium, the section Irapeana consists of a distinctive group of Mesoamerican species that is formed by Cypripedium dickinsonianum Hágsater, C. irapeanum Lex., and C. molle Lindl. All lady slipper orchids exhibit different distributions and abundances. Data analysis that used herbarium accessions and field investigations indicated that the habitats of these three species have been dramatically reduced. Prospecting for suitable habitats based on climatic, vegetation, and soil parameters allows us to predict potential distributions. Conservation strategies, such as ex situ propagation by asymbiotic and symbiotic approaches, have indicated that the culture media used are a determining factor for seedling development. Mycorrhizal isolates play a main role in the compatibility and further development of germinated seeds. The fungi isolated from adult plants belong to two different families, which makes it possible that widely distributed C. irapeanum populations will be fungal-specific as well as restricted for C. molle. Root mycorrhization patterns occur high on the secondary roots. In contrast with other species of the genus, in situ germination can occur over a short period of two months, but we have documented periods as long as ten years. Cypripedium is a highly problematic genus for ex situ conservation because the germination requirements and cultures are poorly documented, and there is great urgency for in situ conservation to develop strategies for identifying hotspot habitats and actualize the protection status to avoid extinction of this genus.

La presente investigación estudia la manera en que el modelo de aprendizaje combinado, llamado blended learning, constituye una alternativa para fomentar la adquisición de competencias, optimizar el uso de las instalaciones escolares y aumentar el alcance educativo en bachillerato, de acuerdo con los planteamientos de la Reforma Integral de Educación Media Superior, en México. Se realizaron observaciones a alumnos de bachillerato en la asignatura de Informática, quienes interactuaron en actividades colaborativas mediante foros virtuales y de manera presencial, posteriormente se aplicó un cuestionario para conocer sus experiencias y percepciones. Los resultados muestran que la calidad de la interacción y comunicación en el trabajo colaborativo presenta áreas de oportunidad; sin embargo, se mostró que el modelo de aprendizaje combinado propicia el desarrollo de competencias generales y el uso de tecnología. Recibido: 17 de febrero de 2014 Aceptado: 18 de septiembre de 2014 Abstract This research studies how the blended learning model promotes the acquisition of competences, enhances the use of school facilities and increases the educational offering in High School, as established in the Integral Reform of Higher Secondary Education in the Mexican system. Observations to students were carried out in the subject of Computer Sciences, they performed collaborative activities on virtual forums and in the classroom, and afterwards a questionnaire was administrated to know their experiences and opinions about the use of this model. The results show that the quality of the interaction and communication in teamwork can be improve, however the blended learning model showed to encourage the development of general competences and the use of technology, however. Recibido: 17 de febrero de 2014 Aceptado: 18 de septiembre de 2014