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Heart failure with improved ejection fraction (HFimpEF) has better outcomes than HF with reduced EF (HFrEF). However, factors contributing to HFimpEF remain unclear. This study aimed to evaluate clinical and longitudinal characteristics associated with subsequent HFimpEF. This was a single-center retrospective HFrEF cohort study. Data were collected from 2014 to 2022. Patients with HFrEF were identified using International Classification of Diseases codes, echocardiographic data, and natriuretic peptide levels. The main end points were HFimpEF (defined as EF >40% at ≥3 months with ≥10% increase) and mortality. Cox proportional hazards and mixed effects models were used for analyses. The study included 1,307 patients with HFrEF with a median follow-up of 16.3 months (interquartile range 8.0 to 30.6). The median age was 65 years; 68% were male whereas 57% were White. On follow-up, 38.7% (n = 506) developed HFimpEF, whereas 61.3% (n = 801) had persistent HFrEF. A multivariate Cox regression model identified gender, race, co-morbidities, echocardiographic, and natriuretic peptide as significant covariates of HFimpEF (p

Pedagogical knowledge has been identified as an essential factor for impacting the learning, behavioral, and social emotional outcomes for children with disabilities, particularly students with emotional disturbances (ED). There are many professionals in and out of the school environment who work with children with ED. Oftentimes, these professionals are required to have specialized knowledge and skills. Unfortunately, they acquire these skills and knowledge separate from each other. Therefore, this 5-year interdisciplinary project funded by the U.S. Department of Education, Office of Special Education Programs (USDOE, OSEP) was designed to enhance the skills and knowledge of special education teachers and social workers regarding students with ED. The purpose of this study was to explore participants' perceptions of interdisciplinary teacher preparation. The study adopted a basic qualitative (i.e., content analysis) design. Each question was analyzed to capture the emerging categories. The results for each question are discussed in detail. Some recommendations for teacher educators and practitioners are provided.

Abstract Background DNA methylation in the form of 5-methylcytosine (5mC) is the most abundant base modification in animals. However, 5mC levels vary widely across taxa. While vertebrate genomes are hypermethylated, in most invertebrates, 5mC concentrates on constantly and highly transcribed genes (gene body methylation; GbM) and, in some species, on transposable elements (TEs), a pattern known as “mosaic”. Yet, the role and developmental dynamics of 5mC and how these explain interspecies differences in DNA methylation patterns remain poorly understood, especially in Spiralia, a large clade of invertebrates comprising nearly half of the animal phyla. Results Here, we generate base-resolution methylomes for three species with distinct genomic features and phylogenetic positions in Annelida, a major spiralian phylum. All possible 5mC patterns occur in annelids, from typical invertebrate intermediate levels in a mosaic distribution to hypermethylation and methylation loss. GbM is common to annelids with 5mC, and methylation differences across species are explained by taxon-specific transcriptional dynamics or the presence of intronic TEs. Notably, the link between GbM and transcription decays during development, alongside a gradual and global, age-dependent demethylation in adult stages. Additionally, reducing 5mC levels with cytidine analogs during early development impairs normal embryogenesis and reactivates TEs in the annelid Owenia fusiformis. Conclusions Our study indicates that global epigenetic erosion during development and aging is an ancestral feature of bilateral animals. However, the tight link between transcription and gene body methylation is likely more important in early embryonic stages, and 5mC-mediated TE silencing probably emerged convergently across animal lineages.

The goal of this work was to characterize potential biological agents responsible for biodeterioration in heritage buildings identified as Costa Rican Caribbean architecture using a multidisciplinary approach. First, an inventory of buildings of Caribbean architecture from Limón City was elaborated. Then, a multi-criteria evaluation system was used to define priority scores to select buildings for sampling and analysis. Selected buildings were sampled for potential biological agents responsible for biodeterioration. Wood samples were taken from sections showing visual damage and fungi were isolated and characterized using Sanger sequencing. A basic profile of Costa Rican Caribbean architecture was established. A preliminary identification of 101 buildings that satisfied the basic profile of characteristics was con-ducted. Subsequently, these buildings were classified into 4 typologies from which 23 buildings belonging to Typologies 1 and 2 were chosen for the collection and registration of data. Applying the multi-criteria evaluation, 6 buildings with final scores higher than 60 points were selected from which the 1st (Casa Misionera Bautista) and 3rd (Antigua Capitanía de Puerto) in the classification were selected for further characterization of biological agents. From the sampling conducted on these two buildings. A total of 36 fungi were isolated. All fungi identified belonged to the fungal group Ascomycota phylum, the most common genera being Trichoderma, Fusarium, and Penicillium. The study shows how multidisciplinary studies can improve the process of decision-making in the preservation of heritage with the use of a ranking obtained for each building in the multi-criteria evaluation and the use of advanced techniques for the identification of biological agents.

Este estudio examinó la aplicación del aprendizaje activo en la carrera de Derecho, en la Sede de Guanacaste, Universidad de Costa Rica, durante el 2022; tuvo un alcance exploratorio y se enmarcó en el paradigma cualitativo. Entre los principales resultados, se identificó la utilización de diez tipos de métodos activos en los cursos. El profesorado estima que este enfoque contribuye a fomentar un aprendizaje integral y profundo del derecho; también, permite una mejor vinculación entre teoría y práctica, lo cual estimula el desarrollo de habilidades disciplinares y blandas. El estudiantado mostró una percepción favorable acerca de métodos activos, enfatizando que estos propician mejores condiciones para el aprendizaje. Se concluye que el uso frecuente de metodologías activas en los cursos muestra que este enfoque se está integrando notablemente en la cultura pedagógica de la carrera. Las personas docentes y estudiantes consideran el proceso educativo como un fenómeno complejo que involucra elementos conceptuales, prácticos y emocionales, por lo que valoran esta clase de métodos como instrumentos didácticos idóneos. Por tanto, se aprecia que la implementación del aprendizaje activo en la carrera es congruente con los fundamentos teóricos sobre el tema y responde a los requerimientos formativos actuales.

Introduction: Tranexamic acid (TXA) has been used to improve bleeding outcomes in many surgical procedures. However, its blood-sparing effect in liposuction is not well established. Methods: A systematic literature search was performed using PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, ClinicalTrials.gov, and WorldWideScience.org databases from their inception to October 8, 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors focused on 3 main topics: 1) TXA, 2) liposuction, and 3) complications. We included articles evaluating the potential blood-sparing effects of TXA in liposuction. Studies were excluded if they were systematic review articles or protocol papers, animal studies, conference abstracts, survey studies, or non-English publications. Results: A total of 711 articles were identified, with 1 retrospective and 4 prospective (3 randomized) studies meeting our inclusion criteria. TXA was used in various forms: administered intravenously either on induction or after the procedure, mixed into the tumescent solution, or infiltrated into the liposuction sites after lipoaspiration. A significantly smaller reduction in hematocrit was noted in the TXA group compared with that in the non-TXA group (p

Virtual learning is attracting more students with disabilities as it may offer unique learning opportunities in online environments. However, virtual instruction may not effectively meet the needs of students with emotional and behavioral disorders (EBD). We highlight ways that special education teachers can develop culturally relevant behavioral expectations and increase parent engagement to improve the likelihood of obtaining more positive virtual learning outcomes for students with EBD. Each component includes an explanation and accompanying examples.

AbstractWaste management (WM) is fundamental for sustainable development; however, practices and approaches vary between developed and developing countries. Costa Rica belongs to the latter group, and although the country has shown a steady commitment toward sustainability, WM and food waste (FW) interventions are still one major challenge. There is a research gap regarding household FW-related behavior and local governments’ performance in terms of sustainability. Therefore, our study aims to address this gap by analyzing the behavior of household FW generators, linking it to the WM actions of municipalities, and contributing to local policies. The study considered a sample of households in the Greater Metropolitan Area of the country to determine consumer drivers for waste, specifically regarding their intention to avoid FW, and conducted a structural equation model based on behavioral constructs. An expert consultation with the local government’s environmental managers was also performed to address their WM policy approach. The findings indicate household FW management is driven by values, perceived behavioral control, social norms, and socioeconomic characteristics but mainly by external aspects, such as local government enabling (or disabling) actions toward FW reduction. Opportunities and policy interventions could arise when local governments recognize the potential of sound WM alternatives, beginning with options for separate organic waste collection, and following with treatments to generate value and appropriate WM approaches.

There is significant variability in methods used to perform neurological examination in poorlyresponsive patients. Inconsistent and poor inter-examiner reliability may lead to poor,consequential clinical decision-making and care. Noxious stimuli are routinely administered to elicit motoric responses to determine the depth of unresponsiveness in comatose patients. However, no study has tested the reliability of noxious stimuli delivery (NSD) method or quantified applied force that elicit motor responses in patients with coma.

Heart failure (HF) with reduced ejection fraction (HFrEF) remains a leading cause of morbidity and mortality. Heart failure withimproved ejection fraction (HFimpEF) has better prognosis and outcomes. However, improvement only occurs in a subpopulationof HFrEF.

A 49-year-old female patient, asymptomatic, presented to the cardiology office for a right atrial mass, identified incidentally in a non-electrocardiogram (ECG)-gated contrast-enhanced computed tomography, performed for follow-up of pulmonary tuberculosis. Echocardiography, surprisingly, showed an anechogenic ovoid mass in the right atrium measuring 40 × 40 mm2, implanted in the interatrial septum without affecting the tricuspid valve. ECG-gated computed tomography angiography (CTA), confirmed the dimensions of the mass, which presented homogeneous content, calcified areas, and a 12-mm pedicle implanted near the ostium of the coronary sinus. Additionally, contrast uptake and infiltration of adjacent structures were ruled out. In the surgical field, an encapsulated mass with blood content was found, which pathology reported as a hematic endocardial cyst (HEC). These are rare cardiac masses, constituting 1.5% of all primary cardiac tumors. It is usually an incidental finding, and its clinical presentation will depend on its dimensions and the intracardiac hemodynamic impact. A highlighting feature is its anechogenic content on ultrasound, however, multimodality imaging allows for making diagnostic assumptions, discerning between primary cardiac tumors, and provides morphological and hemodynamic information useful for therapeutic decision making. The age of the patient, the large size of the HEC, and its location in the interatrial septum make up a completely atypical presentation of this rare disease, which motivated this report.

Durante siglos, la universidad ha sido referente humanístico, dedicada a la universalización del saber, a la generación de nuevos conocimientos, pero también a garantizar la libertad, el pensamiento crítico y los derechos de los ciudadanos. En tal sentido, la presente investigación, desarrollada bajo un enfoque hermenéutico-documental, analiza la trascendencia de la universidad en la formación y defensa de los Derechos Humanos en el siglo XXI. Para alcanzar este objetivo, se toman en consideración los siguientes aspectos: 1. Los fundamentos filosóficos que sustentan los Derechos Humanos. 2. La tergiversación de los Derechos Humanos en los escenarios sociales. 3. La incidencia de la universidad en la enseñanza crítica en Derechos Humanos. Se concluye que la universidad juega un papel relevante en la defensa, promoción y protección de los Derechos Humanos, lo que deja en evidencia que la articulación universidad- Derechos Humanos, no es un interés netamente académico, sino que lleva a la interacción con lo político, lo social, lo económico y con los diversos actores que hacen vida en los espacios universitarios y sociales.

Abstract Background The evolutionary origins of animal nervous systems remain contentious because we still have a limited understanding of neural development in most major animal clades. Annelids — a species-rich group with centralised nervous systems — have played central roles in hypotheses about the origins of animal nervous systems. However, most studies have focused on adults of deeply nested species in the annelid tree. Recently, Owenia fusiformis has emerged as an informative species to reconstruct ancestral traits in Annelida, given its phylogenetic position within the sister clade to all remaining annelids. Methods Combining immunohistochemistry of the conserved neuropeptides FVamide-lir, RYamide-lir, RGWamide-lir and MIP-lir with gene expression, we comprehensively characterise neural development from larva to adulthood in Owenia fusiformis. Results The early larval nervous system comprises a neuropeptide-rich apical organ connected through peripheral nerves to a prototroch ring and the chaetal sac. There are seven sensory neurons in the prototroch. A bilobed brain forms below the apical organ and connects to the ventral nerve cord of the developing juvenile. During metamorphosis, the brain compresses, becoming ring-shaped, and the trunk nervous system develops several longitudinal cords and segmented lateral nerves. Conclusions Our findings reveal the formation and reorganisation of the nervous system during the life cycle of O. fusiformis, an early-branching annelid. Despite its apparent neuroanatomical simplicity, this species has a diverse peptidergic nervous system, exhibiting morphological similarities with other annelids, particularly at the larval stages. Our work supports the importance of neuropeptides in animal nervous systems and highlights how neuropeptides are differentially used throughout development.

Este trabajo de investigación realiza un análisis de los factores que inciden en el correcto desempeño de una institución de educación superior pública en Latinoamérica. Dicho análisis nace bajo el argumento de que los aspectos de la cultura organización de las universidades de la región latinoamericana mejoran el desempeño institucional y fomentan una educación de calidad. En este sentido, la educación superior debería ser un derecho al que un individuo en edad de ejercerla pueda acceder de manera igualitaria y de calidad. Esta investigación se desarrolló mediante un enfoque y metodología cualitativa utilizando la entrevista como método exploratorio de la problemática y para crear una propuesta a partir de la opinión de expertos en gestión educativa sobre los factores que influyen en el desempeño de una universidad. Con esta propuesta mejorarían los procesos inmersos en el mundo académico, la investigación científica, y de infraestructura. En consecuencia, se proponen la cultura organizacional, la gestión del conocimiento, la cultura de autoevaluación y el presupuesto como elementos fundamentales para mejorar el desempeño institucional.

Tuberculosis consistently causes more deaths worldwide annually than any other single pathogen, making new effective vaccines an urgent priority for global public health. Among potential adjuvants, STING-activating cyclic dinucleotides (CDNs) uniquely stimulate a cytosolic sensing pathway activated only by pathogens. Recently, we demonstrated that a CDN-adjuvanted protein subunit vaccine robustly protects against tuberculosis infection in mice. In this study, we delineate the mechanistic basis underlying the efficacy of CDN vaccines for tuberculosis. CDN vaccines elicit CD4 T cells that home to lung parenchyma and penetrate into macrophage lesions in the lung. Although CDNs, like other mucosal vaccines, generate B cell-containing lymphoid structures in the lungs, protection is independent of B cells. Mucosal vaccination with a CDN vaccine induces Th1, Th17, and Th1-Th17 cells, and protection is dependent upon both IL-17 and IFN-γ. Single-cell RNA sequencing experiments reveal that vaccination enhances a metabolic state in Th17 cells reflective of activated effector function and implicate expression of Tnfsf8 (CD153) in vaccine-induced protection. Finally, we demonstrate that simply eliciting Th17 cells via mucosal vaccination with any adjuvant is not sufficient for protection. A vaccine adjuvanted with deacylated monophosphoryl lipid A (MPLA) failed to protect against tuberculosis infection when delivered mucosally, despite eliciting Th17 cells, highlighting the unique promise of CDNs as adjuvants for tuberculosis vaccines.

La emergencia sanitaria nacional producto de la pandemia por COVID-19 ha llevado a las distintas instancias educativas a cambiar la forma en la cual evalúan a las personas estudiantes, al pasar de un formato presencial a uno virtual. De manera general, se desconoce la opinión del estudiantado de ingeniería civil sobre la aplicación de los exámenes en línea, por lo que esta investigación tiene como objetivo brindar información al profesorado sobre la aplicabilidad del examen en línea como una posible herramienta de evaluación de aprendizajes en ingeniería civil. Se presentan los resultados de encuestar a tres grupos de estudiantes de la carrera de ingeniería civil en tres momentos temporales distintos, uno antes de la emergencia sanitaria y dos durante esta, para así, en un marco comparativo del antes y durante la pandemia, dar cuenta de sus opiniones mediante la aplicación de la misma encuesta y si estas han cambiado a lo largo del tiempo. Se encuentra que la opinión con respecto a la aplicación de exámenes en línea de una muestra de los cursos Mecánica de Suelos I y II de la Universidad de Costa Rica y del Tecnológico de Costa Rica se ha vuelto más favorable durante la emergencia sanitaria.

La novela Mamita Yunai publicada en 1941 por Carlos Luis Fallas, se aborda desde el análisis crítico del discurso, por lo que se toma en cuenta el contexto social y su relación con los derechos humanos; desde la categoría lingüística identifico los adjetivos que caracterizan a los personajes con el propósito de analizar los diferentes grupos sociales y su acceso a la justicia social; en lo que respecta a los interdiscursos se analiza si se reproducen o reivindican los derechos humanos de los grupos sociales que segmentaron. Dialogar sobre las desigualdades sociales en la cultura costarricense me permitió observar: la violencia de género, marginalización, desprecio, así como el racismo hacia los hombres y mujeres de manera más específica según su género, clase social y étnica.

En el presente artículo, se documentan los resultados de la aplicación del análisis guiado de sentencias como estrategia para el aprendizaje colaborativo, en el curso de Razonamiento Jurídico II de la Universidad de Costa Rica, Sede de Guanacaste, durante el II ciclo de 2021. A fin de promover una visión crítica y situada del fenómeno jurídico, se examina cualitativamente la pertinencia de esta táctica para fomentar el aprendizaje de los elementos sobre la interpretación y argumentación jurídica mediante la colaboración entre pares. Se concluye que esta última incidió positivamente en el aprendizaje de cada participante. La estrategia propicia un abordaje integral de las temáticas que permite vincular la teoría, la práctica y el contexto, para la construcción significativa de conocimientos. También, fomenta el desarrollo de diversas habilidades y actitudes relacionadas propiamente con los contenidos, así como con la investigación, el aprendizaje continuo, entre otros. Por tanto, como corolario de la experiencia, puede concluirse que se trata de un mecanismo idóneo para propiciar el aprendizaje activo y crítico del razonamiento jurídico.

Takotsubo syndrome (TTS) is a rare cardiomyopathy, but its prevalence is increasing due to the greater availability of diagnostic tools, whose pathophysiology is unknown; however, the evidence points to an excess of catecholamines that ends up generating cardiac stunning. The cause of excessive sympathetic discharge is multifactorial, and some tumors may be related to their origin. In this case report, we present a female patient with TTS whose only identified triggering factor was an atrial myxoma, which generated an unusual clinical presentation. Current multimodal diagnostic tools together with the multidisciplinary evaluation of the HeartTeam allowed an accurate diagnosis and an adequate management of the clinical picture.

Abstract BackgroundAutologous fat grafting (AFG) is a widely used surgical technique that involves extracting a patient's own adipose tissue and transferring it to different areas of the body. This practice is still evolving. Guidelines for antibiotic prophylaxis and use of adjuncts in plastic surgery are currently limited, with a notable absence of standardized guidelines for AFG. ObjectivesIn this survey, we assess contemporary antibiotic practices and adjuncts in AFG procedures. MethodsA 52-question survey was emailed to 3106 active members of The Aesthetic Society. Two hundred and ninety-three responses were recorded, representing a 9% response rate. ResultsWe analyzed 288 responses. The most common AFG procedures were facial (38%), gluteal (34%), and breast (27%) augmentation. Preoperative antibiotics were used by 84.0% overall, with rates of 74.3%, 88.0%, and 92.7% in face, breast, and gluteal AFG, respectively. Lipoaspirate–antibiotic mixing was reported by 19.8%, mainly during gluteal AFG (46.9%), and less so in face (2.8%) and breast (8%) AFG. Notably, 46.9% of surgeons administered prolonged prophylaxis for 72 h or more. Tranexamic acid was utilized by 39.9% of the surveyed surgeons. Platelet-rich plasma was used by 5.6%. Doppler ultrasound was incorporated by 16.7% in AFG, with 21.5% in gluteal AFG, 14% in the face, and 19% in breast procedures. ConclusionsIn this survey, we offer insights into antibiotic practices and adjunct therapies in AFG, especially intraoperative antibiotic mixing. Practices among members of The Aesthetic Society vary from guidelines. It is crucial to standardize practices and conduct further research to pave the way for evidence-based guidelines in AFG. Level of Evidence: 5

Objetivo: Describir las características clínicas y epidemiológicas de la viruela símica (Mpox) en la población asegurada de La Libertad del Seguro Social de Salud (EsSalud). Materiales y métodos: Estudio descriptivo, cuyos datos se recolectaron de las fichas clínico-epidemiológicas e historias clínicas; se consideró casos según la sintomatología y el resultado positivo de la prueba PCR. Las variables de estudio fueron síntomas y signos, duración de la enfermedad, antecedentes clínicos, sexo, edad, orientación sexual, lugar de contacto con la persona con la Mpox. Se calcularon frecuencias absolutas y relativas e intervalos de confianza. Resultados: La Mpox se presentó en la población asegurada entre el 15 de julio y el 31 de diciembre del 2022, y se notificaron 48 casos. Las características clínicas fueron fiebre (54,17 %), astenia y linfadenopatía (52,08 %) (cuya localización fue inguinal en el 25 %, cervical en el 12 % y axilar en el 5 %), mialgia y dolor de espalda (43,75 %), dolor de garganta (37,50 %) y escalofríos (5 %), exantema polimórfico y de forma centrífuga (100 %); además, existieron complicaciones (6,25 %) y hubo una persona fallecida (letalidad de 6,25 %). Se presentó inmunodepresión por VIH en 23 casos (47,92 %); antecedente de sífilis, 4 casos (8,33 %); herpes genital, 3 casos (6,25 %); verrugas genitales, 2 casos (4,17 %). Afectó a 47 hombres (97,92 %), entre ellos a homosexuales (58,33 %), 13 heterosexuales (27,08 %) y 7 bisexuales (14,58 %). Diez de ellos tuvieron contacto con personas con la Mpox (20,83 %) en su domicilio, 7 (14,59 %) en el trabajo, 5 (10,42 %) en una fiesta y 2 (4,17 %) en un bar. Conclusiones: La Mpox se manifestó principalmente en hombres homosexuales y bisexuales no vacunados contra la viruela humana. Los principales síntomas fueron fiebre, astenia y linfadenopatía con predominio inguinal. Además, el exantema fue polimórfico en todos los casos, la enfermedad duró de 17 a 45 días, las complicaciones fueron excepcionales, el 50 % de casos tuvieron inmunodepresión por VIH y la letalidad fue de 6,25 %.

The emergence of additive manufacturing technologies for fiber-reinforced thermoset composites has greatly bolstered their utilization, particularly within the aerospace industry. However, the ability to precisely measure the interface strength between the fiber and thermoset matrix in additively manufactured composites has been constrained by the cumbersome nature of single-fiber pull-out experiments and the need for costly instrumentation. This study aims to introduce a novel methodology for conducting single-fiber pull-out tests aimed at quantifying interface shear strength in additively manufactured thermoset composites. Our findings substantiate the viability of this approach, showcasing successful fiber embedding within composite test specimens and precise characterization of fiber pull-out strength using a conventional mechanical testing system. The test outcome revealed an average interfacial strength value of 2.4 MPa between carbon fiber and the thermoset epoxy matrix, aligning with similar studies in the existing literature. The outcome of this study offers an affordable and versatile test methodology to revolutionize composite material fabrication for superior mechanical performance.

Introduction Flow diverters (FD) are stent‐type devices that enable the exclusion of intracranial aneurysms in clinical scenarios where coil‐type devices exhibit high failure rates. However, its effectiveness hasn't been examined in countries with low and middle incomes, like Mexico. Methods Longitudinal, retrospective study of the patients who received care at a tertiary center between November 2020 and April 2022. Adults older than 18 with non‐ruptured intracranial aneurysms were included. After treatment with FD, post‐procedure control angiograms were performed between three and six months later. The occlusion rate was evaluated using the O'Kelly‐Marotta scale. Results There were 23 patients —2 of whom had double aneurisms—, 20 women, with an average age of 51.4 years (±13.3). 19 saccular aneurysms, 4 fusiform aneurysms, and 2 dissecting aneurysms were treated. Neck measurements were in the range of 1.9 to 19 mm. Angioplasties were performed as part of the procedure on four patients, and successful liberation was achieved in all procedures. Between three and six months of follow up, total occlusion was observed in 14 aneurisms, and three had less than 5% residuals. Only three late procedural related complications were found. Conclusion The patients treated with FD at our reference center had complex aneurysms. Complete occlusion was achieved in 56% of the treated aneurysms during follow up. The use of the FD appears to be safe and to have a high level of effectiveness, similar to what has been described in international reports.

Background: Although postoperative complications of paramedian forehead flap (PMFF) are generally low, surgical site complications and unplanned reoperation can still occur. Recent literature suggests infection to be the most common complication following PMFF reconstruction. This study sought to determine the patient and preoperative factors associated with surgical site complications and unplanned reoperations at a national level. Methods: Patients who underwent PMFF reconstruction from the ACS-NSQIP 2007 – 2019 database were analyzed to determine composite surgical site morbidity and unplanned return to the operating room. Patient and operative factors were also analyzed to assess independent risk factors for surgical site morbidity and unplanned reoperation in the first 30 postoperative days. Results: A total of 1,592 PMFF were analyzed between 2007 and 2019. Of these, 2.7% (43/1592) developed a composite surgical site complication in the first 30 postoperative days. Risk factors for composite surgical site complication included >10% weight loss in the previous 6 months (p

This article presents the results of a descriptive phenomenological study with mixed approach carried out to identify the pedagogical, curricular and didactic elements involved in the creation of an e-learning environment for the students of the course Directed Research I at the State Distance University in Costa Rica (UNED). As for the method, it is guided by a process of concurrent triangulation where there is a preeminence of data of a quantitative nature that are complemented and validated with qualitative data. Questionnaires were applied to all 60 students enrolled in Directed Research I and interviews were carried out with three tutors. Findings show that most students are satisfied with the pedagogical, curricular and didactic elements of UNED's educational model. However, both tutors and students agree on the need to strengthen actions that promote meaningful learning. The conclusions point the need to orient the teachers' work to the students' necessities using the potential offered by ICT for the generation of educational proposals in the form of e-learning.

A nivel mundial, la Organización Mundial de la Salud estima que más de 346 millones de personas tienen diabetes, y se estima que el dato se duplicará para el año 2030 si la tendencia actual continúa. El objetivo de esta investigación fue analizar los factores psicosociales relacionados con los hábitos alimenticios y el estilo de vida en pacientes diabéticos del municipio de Achuapa, León Nicaragua, enero- febrero 2023. Se aplicó la metodología de diseño analítico de corte transversal. Para la recolección de los datos fue empleado la entrevista, que también incluyó examen físico, exámenes de laboratorio (Glucemia en ayunas, perfil lipídico, creatinina) e instrumentos como la Escala multidimensional de apoyo social percibido (EMAS) y la Escala evaluativa de estrés para diabéticos (EED) (Polonsky) entre otros. Se pretende precisar los factores psicosociales como estrés, apoyo social percibido, depresión y adherencia al tratamiento. Los datos fueron analizados con el software SPSS V25 utilizando herramientas estadísticas como frecuencias y Odds Ratio. Los resultados demuestran que la prevalencia de depresión es alta en particular depresión moderada con una relación bidireccional con la glucemia alterada, apoyo social percibido en el cual prevaleció el apoyo moderado. Igualmente, con los niveles de estrés encontrados; prevaleció alto consumo de carbohidratos y frituras y un bajo consumo de frutas, verduras y agua, lo cual afecta el control de la diabetes. Se logró asociar la glucemia alterada con depresión mediante la herramienta Odds Ratio, logrando significancia estadística constituyendo un riesgo al igual que con dislipidemia.

The electrochemical co-deposition of Cr-Co oxide coatings at room temperature on 304 stainless steel (SS) was studied using an electrolyte composed of a mixture of ethylene glycol (EG), hydrated metal chloride salts (MCln∙YH2O), and water as a secondary hydrogen donor (HBD). Metallic Cu and Ni undercoats were applied to improve the adhesion of a posterior Cr-Co metallic and oxide layer. The electroactive events that took place during both electrodeposition processes were studied using cyclic voltammetry (CV) and chronoamperometry. The microstructure and composition of the surface layers were studied using scanning electron microscopy (SEM/EDS), X-ray diffraction (XRD) and cross-sectional elemental mapping via transmission electron microscopy (TEM). The surface of steel with the Cr-Co:EG-H2O coating showed greater resistance to pitting corrosion (123.93 mV) compared to untreated stainless steel (62.3 mV). This sample showed a large hystere-sis area, which is associated with high resistance to pitting corrosion by the occurrence of a re-passivation of the sample at a Erep value of 24.31 mV. After the cyclic potentiodynamic polariza-tion (CPP) test, the lowest specific mass loss (0.001 mg/cm2) was achieved for the AISI 304 SS sample coated using EG-water solvents (Cr-Co:EG-H2O), while the untreated AISI 304 SS reached a higher specific mass loss (0.01 mg/cm2). The Electrochemical Impedance Spectroscopy (EIS) tests showed that the uniform corrosion resistance varied significantly from the untreated AISI 304 SS (35 kΩ) to the coated sample (57 kΩ), which is attributed to the protection provided by the chromium and cobalt oxides coating. The best corrosion resistance achieved was correlated with a superhydrophobic character (with a contact angle of 158.41°) of the Cr-Co coatings. This was in turn a consequence of a needle-like morphology characteristic of these oxides.

Según diversas críticas a la pedagogía tradicional y su impacto en la formación de profesionales en Derecho, han surgido recomendaciones como adoptar enfoques pedagógicos alternativos, implementar cambios en los planes de estudio, nuevas estrategias didácticas y de evaluación, entre otras. No obstante, se estima oportuno analizar si acciones de esta naturaleza, por sí mismas, son suficientes para trascender el modelo pedagógico tradicional. En este ensayo, se pretende discurrir sobre las posibilidades de un nuevo modelo pedagógico para la enseñanza y aprendizaje del Derecho, al considerar otros factores como el ejercicio de la autoridad pedagógica y la capacidad del docente para reflexionar sobre su propia praxis. Por tanto, se sugiere que remozar sustancialmente el modelo pedagógico conlleva un abordaje integral desde sus diferentes dimensiones, especialmente la epistemológica y política, antes de ocuparse de aquellos aspectos formales o metodológicos.

How invertebrates with spiral cleavage establish their body plans is unclear. Here the authors show that, like molluscs, a basal annelid uses ERK1/2 to instruct body patterning, suggesting that this is a deep ancestral trait in animal embryogenesis.

El seguimiento a las personas egresadas y graduadas de carreras a nivel universitario está poco desarrollado en Latinoamérica, pero día a día toma más fuerza con otros procesos como lo son la autoevaluación y acreditación. Más allá de eso, la mejora continua en la educación superior surge como un nuevo paradigma que busca responder al cambio constante de la realidad laboral a la que se insertan los y las nuevas profesionales, en el que la retroalimentación que pueden dar quienes se han egresado y graduado de las carreras se convierte en insumo esencial para tal objetivo. Por ello, este artículo plantea, a partir de la experiencia de las Carreras de Psicología y Enseñanza de la Psicología de la Universidad de Costa Rica, una serie de consideraciones y recomendaciones que deberían tomarse en cuenta para la adecuada gestión del seguimiento a esta población. El presente artículo busca ser una guía para las carreras en proceso de mejora continua que deben realizar seguimiento a personas graduadas y egresadas; presentando desde las principales variables que deberían de tomar en cuenta para su adecuado desarrollo hasta las precauciones a considerar para que el proceso tenga un buen curso.

Sexual (and gender)-dimorphism in tolerance to hypobaric hypoxia increasingly matters for a differential surveillance of human activities at high altitude (HA). At low altitudes, the prevalence of anxiety and depression in women has already been found to double when compared with men; it could be expected to even increase on exposure to HA. In purposefully caring for the health of women at HA, the present work explores the potential involvement of the tryptophan (Trp)–melatonin axis in mood changes on exposure to hypobaric hypoxia. The present work highlights some already known anxiogenic effects of HA exposure. Hypoxia and insomnia reduce serotonin (5-HT) availability; the latter defect being expressed as failure of brown adipose tissue (BAT) activation and mood disorders. Rapid eye movement (REM) sleep organization and synapsis restoration that are additionally affected by hypoxia impair memory consolidation. Affective complaints may thus surge, evolving into anxiety and depression. Sex-related differences in neural network organization and hormonal changes during the menstrual cycle, and certainly also during the life cycle, underscore the possibility of 5-HT–related mood alterations, particularly in women on HA exposure. The mean brain rate of 5-HT synthesis at sea level is already 1.5-fold higher in males than in females. sexual dimorphism also evidences the overexpression effects of SERT, a 5-HT transporter protein. Gonadal and thyroid hormones, as influenced by HA exposure, further modulate 5-HT availability and its effects in women. Besides caring for adequate oxygenation and maintenance of one’s body core temperature, special precautions concerning women sojourning at HA should include close observations of hormonal cycles and, perhaps, also trials with targeted antidepressants.

Objective. This paper assesses the availability and quality of death certificate data in Latin America and the feasibility of using these data to study place of death and associated factors. Methods. In this comparative study, we collected examples of current official death certificates and digital data files containing information about all deaths that occurred during 1 year in 19 Latin American countries. Data were collected from June 2019 to May 2020. The records for place of death and associated variables were studied. The criteria for data quality were completeness, number of ill-defined causes of death and timeliness. Results. All 19 countries provided copies of current official death certificates and 18 of these registered the place of death. Distinguishing among hospital or other health care institution, home and other was possible for all countries. Digital data files with death certificate data were available from 12 countries and 1 region. Three countries had data considered to be of high quality and seven had data considered to be of medium quality. Categories for place of death and most of the predetermined factors possibly associated with place of death were included in the data files. Conclusions. The quality of data sets was rated medium to high in 10 countries. Hence, death certificate data make it feasible to conduct an international comparative study on place of death and the associated factors in Latin America.

Objetivos. Durante la infección aguda por el virus SARS-CoV-2 se ha demostrado una afectación miocárdica, se desconoce si existen secuelas cardiovasculares en pacientes recuperados de esta infección y si estas se asocian a un incremento en la morbilidad y mortalidad global. El objetivo de este estudio fue comparar la deformación miocárdica en pacientes recuperados de infección leve por SARS-CoV-2 con controles sanos. Materiales y métodos. Estudio observacional transversal que incluyó 33 sujetos recuperados de infección leve por SARS-CoV-2, quienes fueron diagnosticados en los tres a seis meses previos, y 31 voluntarios sanos, ambos grupos libres de factores de riesgo cardiovascular. El estudio de deformación miocárdica se realizó mediante ecocardiografía con modalidad speckle tracking. Se compararon variables clínicas y antropométricas. Resultados. El strain longitudinal global 2D del ventrículo izquierdo fue menor en los sujetos recuperados de infección leve de SARS-CoV-2 que los controles (-20,2%±2,6 vs. -21,6%±2,4; p=0,036). Ambos grupos presentaron diferencias en los tres niveles ventriculares, siendo significativa a nivel apical (-21,2±4,0 vs. -23,4%±4,2; p=0,044). La afectación por niveles evidencia un patrón Takotsubo reverso. La fracción de eyección del ventrículo izquierdo se encontró preservada en ambos grupos (p=0,153). Conclusiones. La deformación miocárdica del ventrículo izquierdo está afectada en sujetos recuperados de infección leve de SARS-CoV-2, mientras que la fracción de eyección se encontró en rangos de normalidad. Nuestro estudio muestra un potencial rol del strain longitudinal global en la detección de alteraciones miocárdicas subclínicas en pacientes que tuvieron infección por SARS-CoV-2.

Water scarcity is a growing problem in many regions worldwide. According to the United Nations, around one-fifth of the world’s population lives in areas where water is scarce. Another one-quarter of the world’s population has to face water supply cuts, mainly because this proportion of the population lacks the necessary infrastructure to acquire water from rivers and aquifers (UN, 2005). Water is a resource that is essential to human survival and is also present in all productive processes in the economy. Therefore, we are challenged to adequately manage water to ensure the population’s well-being and to achieve socioeconomic development. Specifically, this paper analyzes the situation present in the summer of 2022 at Riudecanyes (a village in Catalonia, Spain), where a drought problem exists. We propose applying the conflicting claims problem theory to give possible solutions to distribute the water. We propose to use this theory to describe the distribution of the available irrigation hours in 2022, considering the demand made by the farmers in the previous year, when there was regular irrigation.