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Tres son los aspectos que reavivan la sinodalidad: en primer lugar, la escucha, es decir, la sensibilidad y la apertura a las opiniones de los otros; escuchar es tanto más importante cuanto más se asciende en la jerarquía. El segundo aspecto es la corresponsabilidad, porque el caminar juntos no puede acaecer sin la corrección fraterna que purifica a la Iglesia de los errores y la hace avanzar. El tercer aspecto es la participación de los laicos que, como miembros de pleno derecho de la Iglesia, están llamados a expresarse y a hacer sugerencias. No solo deben ser acogidos, también deber ser escuchados. Este es el rumbo marcado por el Concilio Vaticano II, pero todavía poco seguido.

Little attention has been paid to how medication management technologies, designed for older adults, modify the participation of family caregivers. We developed a tablet-based ambient display that provides external cues to remind and motivate older adults to take their medications. This study aimed to understand the effect of ambient displays on the involvement of family members in the elderly's medication management. We conducted a 10-week study consisting of interviews administered weekly to nine elderly-caregivers. We identify that new involvement patterns of the family caregivers were provoked through external cues, which made them aware of older adults' medication adherence and encouraged younger relatives to help older adults.

“El camino de la sinodalidad es el camino que Dios espera de la Iglesia del tercer milenio” (papa Francisco). No es un camino fácil, sino exigente y costoso. Ser Iglesia es ser comunidad que camina junta. No es suficiente tener un sínodo, hay que ser sínodo. Para ello es necesario un intenso diálogo e intercambios, un diálogo vivo entre los pastores y los fieles. La sinodalidad requiere la participación de los laicos que, como miembros de pleno derecho de la Iglesia, están llamados a expresarse y hacer sugerencias. No solo deben ser acogidos, también deben ser escuchados. Este es el rumbo marcado por el Concilio Vaticano II, pero todavía poco seguido.

Piscirickettsia salmonis is the aetiological agent of piscirickettsiosis, a bacterial disease that affects farmed salmonids, causing high mortalities and significant economic losses in the Chilean salmon farm industry. Given the Chilean native fish species Patagonian blenny, Eleginops maclovinus, lives in the vicinity of salmon farms, it is relevant to clarify the epidemiological role that this species could play in the transmission and/or dissemination of this pathogen. This study aimed to evaluate the bidirectional transmission of P. salmonis between the Patagonian blenny and Oncorhynchus mykiss (rainbow trout), via a cohabitation challenge model. The results of this study demonstrated the transmission of the bacteria from Patagonian blennies to rainbow trout, considering the specific mortality in cohabitant rainbow trout, reaching 46%: the necropsy of these specimens, evidencing the characteristic pathological lesions of the disease and the positive results of the qPCR analysis for P. salmonis, in the same individuals. In contrast, no mortalities of Patagonian blenny specimens were recorded in the challenged experimental groups. This study is the first report showing the horizontal transmission of P. salmonis from a native non-salmonid species, such as the Patagonian blenny, to a salmonid species, generating the disease and specific mortality in rainbow trout, using a cohabitation challenge.

Hombre de 61 años de edad referido al servicio de neurocirugía de un segundo nivel de atención, por presentar alteraciones en la sensibilidad de la región abdominal y de miembros pélvicos, junto con una disminución en la fuerza de los mismos aunado a fallas ocasionales para el control de esfínter vesical, se realizaron estudios de diagnóstico, en las imágenes de resonancia magnética (RMN) se observa una lesión ocupante de espacio en la región torácica relacionada a un probable meningioma espinal en T6. Se efectuó laminoplastía y se resecó la lesión tumoral quitando la compresión medular, el resultado de patología confirmo un meningioma transicional, la sintomatología remitió, ha ido recuperando el déficit neurológico y la fuerza muscular.

Introduction: Although primary immune thrombocytopenia (ITP) is rare in childhood, it is the most frequent cause of thrombocytopenia. There have been attempts to establish risk factors to predict the progression of the disease in order to optimise its management, which has changed in recent years due to, among other reasons, specialised care. Material and methods: A retrospective, observational and analytical study was conducted on patients diagnosed with ITP over a 3-year period in a Paediatric Haematology specialist clinic. Results: From the epidemiological, clinical and analytical point of view, the characteristics of this group are similar to others. Most of the patients (23/31, 74.2 %) had ITP for less than 12 months, with there being no serious complications related to the disease or the treatment received. It was established that risk factors were related to being slowly evolving (lower event-free survival (EFS)) with no statistical significance, female gender, age over 10 years, leukopenia absence of initial severe thrombocytopenia, and non-specialised care. The absence of a history of infection was significantly related to a lower EFS. Conclusions: The epidemiological and analytical risk factors for a slowly evolving ITP are the same that described in the literature. Patients treated before the beginning of specialised care also had a lower EFS. These data seem to support the current recommendation that rare diseases should be managed in specialised units. Resumen: Introducción: La trombopenia inmune primaria (PTI) es poco frecuente en la infancia, pero es la causa más habitual de trombopenia. Se han intentado establecer factores de riesgo para predecir su evolución, con el objetivo de poder optimizar su manejo, que se ha modificado en los últimos años, debido entre otros factores, a una atención más especializada. Material y métodos: Estudio retrospectivo, observacional y analítico de los pacientes con PTI, en un periodo de 3 años, en una consulta especializada en Hematología Pediátrica. Resultados: Desde el punto de vista epidemiológico, clínico y analítico, las características de esta serie son similares a las de otros grupos. La mayoría de los pacientes (23/31; 74.2 %) presentaron una PTI de duración menor de 12 meses, sin complicaciones graves relacionadas con la enfermedad ni con el tratamiento. Se establecieron como factores de riesgo relacionados con una evolución tórpida (supervivencia libre de eventos (SLE) menor), sin alcanzar la significación estadística, el sexo femenino, la edad mayor de 10 años, la leucopenia, la ausencia de trombopenia grave inicial y la atención no especializada. La ausencia de antecedente de infección se relacionó significativamente con una SLE menor. Conclusiones: Los factores de riesgo de evolución tórpida de PTI epidemiológicos y analíticos de este estudio coinciden con los descritos en la literatura. Presentaron una SLE menor los pacientes tratados antes del inicio de la atención especializada. Estos datos parecen apoyar la recomendación actual de que las enfermedades poco frecuentes, como ésta, se controlen en unidades especializadas.

Introducción: la multimorbilidad, polifarmacia, y los problemas relacionados con la medicación son frecuentes tanto en las personas que envejecen con VIH como en los que se diagnostica en edades avanzadas. Objetivo: describir las características demográficas, clínicas y los problemas relacionados con la medicación en pacientes ≥ 50 años con nuevo diagnóstico de infección por VIH. Métodos: estudio transversal descriptivo. Se incluyen pacientes ≥ 50 años con nuevo diagnóstico de infección por VIH, quienes ingresan a cuatro centros de atención de VIH de la ciudad de Medellín, Colombia, entre enero 2013 y diciembre 2016. Resultados: se analizaron 493 pacientes. 62,7 % (n=309) de pacientes se encontraban en estadio 3 de la OMS y 49,5 % (n=244) tenían alguna condición definitoria de SIDA, siendo las más frecuente el síndrome de desgaste 23,7 % (n=117) y la tuberculosis 16,8 % (n=82). Al momento del diagnóstico, la mediana de CD4 fue 176 células/mL (RIQ 59-352) y carga viral 117.323 copias/mL (RIQ, 28.237- 411.139). Un 59 % (n=291) tenían comorbilidades no infecciosas, las más comunes hipertensión arterial 22,3% (n=110) y dislipidemia 14,2 % (n=70). Se encontraron 66,1 % (n=326) pacientes con problemas relacionados con la medicación, siendo los más frecuentes: interacciones medicamentosas 61,1 % (301), polifarmacia con ARV 53,1 % (262), medicación potencialmente inapropiada 7,9 % (39), y alto riesgo anticolinérgico en el 2,4 % (12). Conclusión: al momento del diagnóstico, los adultos mayores VIH positivos presentan de manera frecuente multimorbilidad, polifarmacia e interacciones medicamentosas. El diagnóstico de VIH en esta población es más tardío y la presencia de enfermedades oportunistas es frecuente.

Resumen La sepsis neonatal constituye una de las principales causas de mortalidad neonatal en los países en desarrollo. Los neonatos, en particular los prematuros, tienen un mayor riesgo de infecciones bacterianas, por lo que el manejo con antibióticos constituye la terapia más frecuente en la Unidad de Cuidado Intensivo Neonatal (UCIN), estimándose en hasta un 70%. La presentación clínica de la sepsis neonatal es inespecífica en muchas ocasiones, lo que hace que la antibioticoterapia empírica se inicie tempranamente para evitar consecuencias deletéreas para los pacientes; su inespecificidad la caracteriza como un reto diagnóstico, por lo que diferentes autores han diseñado estrategias para determinar neonatos candidatos a terapia antimicrobiana. La microbiología permanece en contacto estrecho con la clínica ya que conocer los gérmenes frecuentemente asociados a la sepsis neonatal ayuda a determinar el espectro antibiótico a usar. De igual forma, el conocimiento de la farmacología antibiótica es clave puesto que el tratamiento antibiótico no es inocuo y puede asociarse a aumento de morbilidad o mortalidad. El tiempo de evolución y los factores de riesgo maternos están asociados a los gérmenes responsables esperados, ya descritos por múltiples estudios descriptivos a nivel mundial. El uso indiscriminado de antibióticos de amplio espectro para el manejo de infecciones en los recién nacidos ha generado un aumento en la resistencia antibiótica, lo que a su vez lleva a tasas más altas de fallo terapéutico con el uso de las terapias antibióticas empíricas. A razón de lo anterior, los Programas de Vigilancia de Uso de Antibióticos juegan un papel determinante para monitorear el cambio en la resistencia a nivel local para ajustar y homogeneizar la práctica médica que logre regular el uso de antibióticos y mitigar la emergente resistencia bacteriana. Abstract Neonatal sepsis constitutes one of the main causes of neonatal mortality in developing countries. Newborns, particularly premature newborns, have a higher risk of bacterial infections that result in frequent administration of antibiotics in the Neonatal Intensive Care Units (NICU), which is estimated to be as high as 70%. The clinical presentation of neonatal sepsis is nonspecific, prompting the early use of empirical antibiotic prescription to avoid adverse consequences in the patients. Its non-specificity characterizes it as a challenging diagnostic, this aspect led several authors to design strategies to determine which newborns are true candidates for antimicrobial therapy. Microbiology is closely linked to clinical practice. Thus, knowing the most frequent bacteria associated with neonatal sepsis will be closely related to the antibiotic spectrum that should be used to treat it. Furthermore, knowledge on basic pharmacology is key inasmuch as the antimicrobial treatment is not innocuous and can be related to an increase in mortality and morbidity. Clinical course and maternal risk factors are associated with the expected responsible germs that are already described in multiple descriptive studies worldwide. Indiscriminate use of broad-spectrum antibiotics for the management of newborn infections is leading to antibiotic resistance increase. At the same time, this is related to even higher rates of therapeutic failure with empiric antimicrobial treatment. Based on this, Antimicrobial Stewardship Programs play a determinant role to monitor the changes in local resistance to adjust and homogenize medical practice to regulate the use of antibiotics and mitigate the emergent and threatening antimicrobial bacterial resistance.

Decision-making is a process that allows adapting behavior in response to feedback to achieve a goal. Previous studies have suggested that the cerebral cortex shows different activation patterns in response to feedback. However, the effects of reward and punishment on learning contexts and decision-making are not clear. Thus, this experiment compared the effects of reward and punishment on behavior and the electroencephalographic activity of cortical areas related to decision-making in a no-risk context. Twenty healthy males were asked to perform a decision-making task under two conditions in which the goal was to finish in the shortest time possible. In the reward condition, the more points the participant accumulated the sooner the task ended, while in the punishment condition, the more points accumulated the longer the task lasted. Lower reaction times were found in the reward condition, characterized by a higher absolute power of the slow bands in almost all the cortices recorded. Changes in the interhemispheric correlation were also obtained in the comparison of the two feedback conditions. Results suggest that changes in the type of feedback affect cortical functionality and behavioral execution during decision-making, with the reward being related to a quick emotional response strategy and punishment associated with slower and, likely, more reasoned responses.

The coronavirus disease 2019 (COVID-19) produced by SARS-CoV-2 has taken on great importance in recent months, and is under constant investigation by different areas of medicine, including rheumatology, in search of the best evidence scientific. In the case of the paediatric population, it is particularly important as it was first thought that the impact of the pandemic in this population would be less due to the low presence of severe cases. Evidence is now being reported of clinical pictures in children with a diagnosis of COVID-19 who are characterised by an altered inflammatory state consisting of a storm of pro-inflammatory cytokines that produces manifestations similar to those presented in autoimmune diseases, such as Kawasaki disease. It has been called Multisystemic Inflammatory Syndrome in children, temporarily associated with SARS-CoV-2 which, in many cases requires hospitalisation in paediatric intensive care units and multidisciplinary management by various specialties. Resumen La enfermedad por coronavirus 2019 (COVID-19) producida por el SARS-CoV-2 ha tomado una gran importancia en los ultimos meses y se encuentra bajo constante investigacion por distintas areas de la medicina, incluida la reumatologia, en la busqueda de la mejor evidencia cientifica. En el caso de la poblacion pediatrica cobra especial importancia puesto que en un principio se pensaba que el impacto de la pandemia en esta poblacion seria menor, debido a la baja presencia de casos severos, pero la evidencia actual reporta la existencia de cuadros clinicos en ninos con diagnostico de COVID-19 que se caracterizan por un estado inflamatorio alterado consistente en una tormenta de citocinas proinflamatorias que produce manifestaciones similares a las presentadas en enfermedades autoinmunes como la enfermedad de Kawasaki. Se le ha denominado sindrome inflamatorio multisistemico en ninos asociado temporalmente con SARS-CoV-2, el cual en muchos casos precisa internacion en unidades de cuidados intensivos pediatricos y el manejo multidisciplinario por diversas especialidades.

Resumen Introduccion El sindrome antifosfolipido es una trombofilia autoinmune adquirida que se caracteriza por una serie de fenomenos consistentes en trombosis (venosa y/o arterial o microvascular) y/o la perdida del embarazo o complicaciones en asociacion con anticuerpos antifosfolipido positivos persistentes. Esta patologia comprende otras manifestaciones sistemicas, y existen multiples causas que conllevan complicaciones hemorragicas en tal contexto. En este articulo se revisan las principales caracteristicas del compromiso hemorragico de sindrome antifosfolipido y se ofrece asesoramiento en relacion con el manejo de estas manifestaciones. Materiales y metodos Se realizo una revision narrativa de la literatura mediante la busqueda en las bases de datos PubMed, el motor de busqueda de Medline, y Embase hasta noviembre del 2020. En dicha revision se caracterizaron las complicaciones hemorragicas en el contexto de sindrome antifosfolipido. Resultados Se encontraron 290 articulos. Al excluir los que no cumplian con el objetivo del estudio, duplicados y cartas al editor, quedaron un total de 55, que fueron incluidos para el desarrollo del presente articulo. Conclusion El sindrome antifosfolipido clasicamente se ha descrito como un trastorno protrombotico y asociado a comorbilidad obstetrica. Sin embargo, por su fisiopatologia se presumen muchas otras manifestaciones, entre ellas las hemorragicas. Debido a la escasa evidencia cientifica sobre este tipo de manifestaciones, es necesario continuar con estudios mas profundos y reportes de casos que aporten informacion acerca de las manifestaciones hemorragicas como complicaciones del sindrome antifosfolipido.

Montelukast is widely used in recurrent wheezing and/or asthma treatment. Several adverse drug reactions (ADRs) have been described in children related to montelukast. Neuropsychiatric reactions are one of the most important. We designed an observational, retrospective, descriptive study on ADRs related to montelukast in the Pediatric Pulmonology Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain. Between January 2012 and December 2017, in the Pediatric Pulmonology Unit, 348 patients were treated with Montelukast; of them, 20 presented RAM. The main symptoms described Reacciones adversas a montelukast: de la teoria a la practica. Serie de casos Adverse drug reactions of montelukast: from theory to practice. Case report were insomnia (n = 7), hyperactivity (n = 4), nightmares (n = 3), abdominal pain (n = 2) and paraesthesia in extremities (n = 2). They appeared from the first days to months after the start of treatment and disappeared after stopping it. Two patients presented limb paresthesia, not described previously in children. The 5.7 % of our patients treated with montelukast had ADRs that required treatment discontinuation. Sleep disorders were the most frequent.

RESUMEN: El uso de medios auxiliares como es el caso de los adhesivos dentales permitirá que la adhesión entre la prótesis y la mucosa sea mejor y se logre una mejor retención, estabilidad y eficiencia masticatoria. Se realizó una búsqueda en internet en las siguientes bases de datos, Pubmed, EBSCO, BEIC, Cochrane y Epistemonikos. Para la búsqueda electrónica se utilizaron las palabras “denture adhesive”, “dental adhesive”, “complete denture wearers”, “retention”, “support”, “stability”, “masticatory performance”, “Candida albicans” y “quality of life” relacionadas con el operador booleano AND. Al aplicar los criterios de inclusión y exclusión terminando con 14 artículos. Finalmente, quedaron 5 ensayos clínicos aleatorizados, 3 ensayos clínicos no aleatorizados, 2 estudios observacionales de cohorte prospectivos, 3 artículos in vivo y 1 estudio in vitro. Los adhesivos dentales han demostrado un mejoramiento en la retención, adhesión, estabilidad y eficiencia masticatoria en los portadores de prótesis totales, independiente de su presentación, sea en forma de polvo, crema, tiras o almohadillas. Por medio de su uso, se ha demostrado que los portadores de prótesis totales han podido mejorar su calidad de vida, tanto en la seguridad del manejo de su aparato protésico como en el aspecto nutricional, pues permite que se alimenten de mejor forma, esto incluso es posible observar cuando se prescriben en aquellos pacientes con prótesis recién instaladas.

Bis(indolyl)methane derivatives (BIMs) were synthesized in moderate to good yields by (thio)urea catalyzed electrophilic substitution of indole (2) with various aldehydes 1. Reactions were performed under conventional and microwave (MW) heating, either using 1,2-dichloroetane as solvent or without solvent. The procedure using microwave heating was also applied to the synthesis of the natural products vibrindole A (3n), arsindoline A (3i), arundine (3o) and tris(1H-indol-3-yl)methane (3j). Additionally, the synthesis of streptindole was carried out via intermediate 3g. This methodology is well suited for the synthesis of bis(indolyl)methanes: it offers good yields of products, low sensitivity to moisture and oxygen, high tolerance to different functional groups on the aldehydes such as alkynes and trimethylsilane, and simplicity in operation

Objetivo: Evaluar el nivel de independencia funcional de los pacientes sometidos a cirugía cardiaca durante su proceso de recuperación. Materiales y Método: Investigación con enfoque cuantitativo y estudio de tipo analítico longitudinal prospectivo. La población de estudio estuvo conformada por personas mayores de 18 años, sometidas a cirugía cardiaca programada, en una institución de salud de la ciudad de Medellín, Colombia. Se aplicó un cuestionario para las variables sociodemográficas y el procedimiento quirúrgico, además se utilizó el instrumento de independencia funcional de Granger y Hamilton traducido al español por Paolinelli. Se realizó un análisis univariado, bivariado y se usó la regresión de la mediana como prueba multivariada no paramétrica. Resultados: El total de participantes fue de 33. El 50% tenía 64 años. El 66.7% fueron hombres. Se encontró que el 57.6% eran hipertensos y el 12.1% diabéticos. El 54.5% se sometió a bypass coronario. Se evidencia una diferencia estadísticamente significativa entre cada una de las mediciones de la independencia funcional (p

espanolIntroduccion: El pie diabetico una de las complicaciones mas frecuentes de la Diabetes mellitus con impacto funcional, economico y elevada morbimortalidad, pudiendo ser evitado hasta en 75% de casos con modificacion sus factores de riesgo; en la literatura mundial la frecuencia de los factores de riesgo cardiovascular en el Pie Diabetico son referidos en pocas veces de manera individual, por lo que su correcta identificacion daria una base mas sistematica para su abordaje. Objetivo: Identificar los Factores cardiovasculares en pacientes con Diabetes mellitus que estan asociados a pie diabetico. Material y metodos: El estudio es observacional, analitico con diseno trasversal, en pacientes adultos en area de urgencias con diagnostico de Diabetes mellitus. Se estudiaron las variables: presencia o ausencia de pie diabetico, edad, genero, hipertension, sobrepeso, tabaquismo, Dislipidemia. Mediante R Studio 1.0.153, se determino normalidad, se realizaron correlaciones y comparaciones entre variables. Analisis estadistico: Se obtuvieron 201 pacientes, media de edad: 59.4±15.3 anos, 48.76% de genero masculino y 51.24% femenino; prevalencia de pie Diabetico de 31.34% (63 pacientes). Se analizo cada variable, siendo no estadisticamente significativas: edad (p=0.2172), Sexo (p= 0.8796), sobrepeso u Obesidad (p= 0.1423), Tabaquismo (p= 0.4993) y dislipidemia (p=0.8699). Existio una asociacion estadisticamente significativa para hipertension mediante Prueba Exacta de Fisher (p: 0.001156), con intervalo de confianza de 95% (1.556-9.603) y Odds Ratio de 3.6456. Conclusiones: De las variables senaladas como factores de riesgo cardiovascular solo la hipertension arterial sistemica presento correlacion estadisticamente significativa con el pie diabetico. EnglishIntroduction: Diabetic foot is one of the most frequent complications of Diabetes mellitus with functional impact and high morbidity and mortality, being able to be avoided in up to 75% of cases with modification of risk factors; In the world literature, the frequency of cardiovascular risk factors in the Diabetic Foot are referred in a few times individually, so that their correct identification would give a more systematic basis for their approach. Objective: To identify the cardiovascular factors in patients with diabetes mellitus that are associated with diabetic foot. Material and methods: The study is observational, analytical with transversal design, in adult patients in emergency area diagnosed with Diabetes mellitus. The variables were studied: presence or absence of diabetic foot, age, gender, hypertension, overweight, smoking, dyslipidemia. Using R Studio 1.0.153, normality was determined, correlations and comparisons between variables were made. Statistical analysis: 201 patients were obtained, mean age: 59.4 ± 15.3 years, 48.76% male and 51.24% female; Diabetic foot prevalence of 31.34% (63 patients). Each variable was analyzed, being not statistically significant: age (p = 0.2172), Sex (p = 0.8796), overweight or Obesity (p = 0.1423), Smoking (p = 0.4993) and dyslipidemia (p = 0.8699). There was a statistically significant association for hypertension by Fisher's Exact Test (p: 0.001156), with 95% confidence interval (1556-9.603) and Odds Ratio of 3.6456. Conclusions: Of the variables indicated as cardiovascular risk factors, only systemic arterial hypertension showed a statistically significant correlation with diabetic foot.

Interoperability is defined as the ability of a system or device to communicate between different technologies and software applications. This allows the exchange and use of data in an efficient, precise, and robust way. The present article gives researchers and healthcare information systems developers a qualitative and quantitative synthesis of the state of knowledge related to data formats and data standards proposed for mHealth devices interoperability in healthcare information systems that retrieve and store ECG data. We carry out a scoping review to answer to following questions: (1) What digital data formats or data standards have been proposed for the interoperability of electrocardiograph data between traditional healthcare information systems and mobile healthcare information systems? (2) What are the advantages and disadvantages of these data formats or data standards? The scoping review was conducted in four databases in accordance with the JBI methodology for scoping reviews, and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A total of 4018 studies were identified of which 30 studies met the inclusion criteria. Based on our findings, we identify four standards and nine formats for capturing and storing streaming ECG data in mobile health applications. The standards used were HL7, SCP-ECG, x73-PHD, and PDF/A. Formats include CSV, PDF-ECG, and seven XML-based formats. These are ECG-XML, HL7-XML, mPCG-XML, mECGML, JSON, SaECG, and CDA R2.

The evaluation of external and internal stimuli permits the ongoing actualization of choice-related information and, thus, the association between stimuli and outcomes. This process is essential to decision-making as it allows constant adaptation to environmental changes in order to maximize gains and minimize losses. Reversal learning paradigms are used to study this process, which has been associated with prefrontal cortex activity (frontopolar, dorsolateral) in conjunction with posterior areas (parietal, temporal), due to their participation in integrating and processing the stimuli-reward relation. The aim of this study was to assess the cortical functionality associated with reversal learning during the decision-making process. The EEG activity of 22 young men was recorded while performing a decision-making task in a reversal learning condition compared to an initial learning condition. EEG data were analyzed during evaluation of the stimuli, before motor execution (formation of preferences), and during task feedback (outcome evaluation). The formation of preferences stage was characterized by a higher correlation of the alpha2 band between the parietal cortices. In the feedback stage of the reversal learning condition, a higher absolute power of the theta band in the left dorsolateral (F3), and a lower correlation of the alpha1 band between the right frontopolar and dorsolateral (Fp2-F4), as well as between the right frontopolar and temporal (Fp2-T4), were observed. The data obtained show that the EEG activity of the areas recorded changed in the evaluation of the stimuli information in the reversal learning condition during a decision-making task.

Little attention has been paid to how medication management technologies, designed for older adults, modify the participation of family caregivers. We developed a tablet-based ambient display that provides external cues to remind and motivate older adults to take their medications. This study aimed to understand the effect of ambient displays on the involvement of family members in the elderly's medication management. We conducted a 10-week study consisting of interviews administered weekly to nine elderly-caregivers. We identify that new involvement patterns of the family caregivers were provoked through external cues, which made them aware of older adults' medication adherence and encouraged younger relatives to help older adults.

El nervio radial es un nervio comúnmente lesionado; el tratamiento de elección actual es la transferencia de tendón, sin embargo, el objetivo de este estudio es proponer la transferencia de nervio mediano como tratamiento quirúrgico de preferencia para la recuperación de extensión de la muñeca y movilidad individual de los dedos posterior a la lesión del nervio radial. Se realizó una revisión de la literatura usando terminología MESH como: nervio radial, transferencia de nervio y lesión de nervio periférico para la búsqueda de reportes de caso, artículos de revisión, estudios descriptivos y cohortes publicados desde el año 1990 hasta el 2020. Se excluyeron artículos escritos en idiomas diferentes a inglés o español y estudios realizados en animales. Se encontraron 22 artículos de técnica quirúrgica de transferencia nerviosa, 11 de lesiones nerviosas, 4 de anatomía del nervio radial y mediano, 4 reportes de caso, 6 revisiones sistemáticas en donde se describe el recorrido anatómico de los nervios comúnmente utilizados, la técnica quirúrgica, las ventajas y complicaciones de la intervención. La transferencia de nervio mediano a radial tiene potencial para ser el tratamiento quirúrgico de elección en lesiones distales de nervio radial con pérdida de función generando buenos resultados funcionales.

Resumen Este artículo analiza los avances y desafíos con respecto a la implementación de los Programas de Desarrollo con Enfoque Territorial (PDET), que son componentes transversales de la Reforma Rural Integral (RRI), punto 1 del Acuerdo Final para la Paz firmado entre las FARC-EP y el Estado colombiano en el año 2016. Para esto, se consideran los desarrollos normativos y la política pública que tiene el Estado colombiano en el marco de la implementación de los PDET, con el fin de evaluar cuáles son los desafíos y avances de dichos instrumentos de planeación y su relación con la construcción de paz territorial. De esta forma, se encuentra que los PDET sufren unos retrasos importantes en su implementación, debido a las fallas en la articulación entre los entes estatales y las políticas públicas a nivel nacional y territorial, a los problemas de disponibilidad presupuestal yala sostenibilidad fiscal que no permiten su adecuada implementación. Este trabajo se desarrolló con una metodología de corte cualitativo con un enfoque exploratorio-descriptivo, en el cual se hizo uso de la revisión documental como técnica metodológica principal a través de la implementación de una matriz de revisión documental. Abstract This paper analyzes the progress and challenges regarding the implementation of the Programas de Desarrollo con Enfoque Territorial (PDET), which are transversal components of the Reforma Rural Integral (RRI) (Comprehensive Rural Reform), chapter 1 of the Acuerdo Final para la Paz (Final Peace Agreement) signed between FARC -EP and Colombia in 2016. To this end, Colombia's legal developments and public policy are considered in the context of the implementation of the PDET, in order to assess what are the contributions and challenges of these instruments and their relationship with territorial peace building. In this way, it was found that the PDET suffer significant delays in their implementation as a result of failures in the articulation between state entities and public policies of national and territorial level, and problems in terms of budget availability and fiscal sustainability that do not allow their proper implementation. This paper employs a qualitative methodology with an exploratory-descriptive approach, using record-keeping as the main research method through the implementation of a record-keeping matrix.

Date palm pollen (DPP) plays a very important role in the fertilization process, since its viability and the pollination method influence on the quality, development, and yield of the fruit. In the present study, a broad review of its main characteristics, consumption, and DPP production are presented, as well as a description of its extraction methods and viability tests. The evolution of the pollination methods used in the date palm is also presented, from its natural pollination to the use of specialized mechanical and electrical devices, as well as the use of dry DPP and the current trend towards the use of DPP in liquid suspension. Likewise, the efficiency of the methods of natural pollination (wind); traditional (strands placement); dusting hand; dusting with manual, mechanical, or electric pollinator; and liquid pollination were evaluated from the fruit set percentage (FSP). Finally, starting from a scientometric analysis, the pollination methods were widely discussed, concluding that the dusting spraying of pollen suspension with liquid DPP is the pollination method that commonly presents the highest FSP, followed by dusting dry DPP with a motorized pollinator.

Decision-making is a process that allows individuals to choose an option or alternative in order to maximize a subjective gain or achieve a set goal by evaluating and establishing a preference based on contextual and internal information. Ernst and Paulus proposed a three-stage temporal division of this process: 1) the assessment and formation of preferences among possible options; 2) the selection and execution of an action; and 3) the experience or evaluation of an outcome. Each stage involves the participation of several brain regions, including the prefrontal, parietal, and temporal cortices. There are reports of distinct functionalities of these cortices for each stage of decision-making, but those studies focus on individual stages and do not provide any direct comparisons among them. Therefore, using a task that allows the clear temporal separation of the three stages of decision-making, we characterized the electroencephalographic activity (EEG) of those cortices in 30 healthy right-handed men during preference changes that occurred while performing a decision-making task. As the trials progressed, the preference for the stimulus shifted towards maximizing gains on the task. Forty trials sufficed to maintain these behavioral changes. Specific EEG patterns for each stage of decision-making were obtained, and it was possible to associate them with the cognitive processes involved in each one. These EEG data support the temporal division of the decision-making process proposed by Ernest and Paulus and show that the task designed could be a useful tool for determining behavioral and cerebral changes associated with stimuli preference during decision-making.

Resumen La enfermedad por coronavirus (COVID-19) producida por el SARS-CoV-2 ha sido un reto para los servicios de salud en todo el mundo. La pandemia se ha extendido ampliamente con mas de 80 millones de casos confirmados y mas de un millon de muertes a nivel mundial, por lo que ha estado bajo constante investigacion para entender todos los aspectos de la enfermedad. Recientemente se han reportado varios casos de pacientes con sindrome de Guillain-Barre asociado a COVID-19 como manifestacion principal, convirtiendola en la primera enfermedad neurologica autoinmune desencadenada por SARS-CoV-2; sin embargo, es necesario obtener mas informacion para entender completamente los mecanismos inmunopatogenicos implicados en esta asociacion.

Convolutional neural networks (CNNs) have proven their efficiency in various applications in agriculture. In crops such as date, they have been mainly used in the identification and sorting of ripe fruits. The aim of this study was the performance evaluation of eight different CNNs, considering transfer learning for their training, as well as five hyperparameters. The CNN architectures evaluated were VGG-16, VGG-19, ResNet-50, ResNet-101, ResNet-152, AlexNet, Inception V3, and CNN from scratch. Likewise, the hyperparameters analyzed were the number of layers, the number of epochs, the batch size, optimizer, and learning rate. The accuracy and processing time were considered to determine the performance of CNN architectures, in the classification of mature dates’ cultivar Medjool. The model obtained from VGG-19 architecture with a batch of 128 and Adam optimizer with a learning rate of 0.01 presented the best performance with an accuracy of 99.32%. We concluded that the VGG-19 model can be used to build computer vision systems that help producers improve their sorting process to detect the Tamar stage of a Medjool date.

La hemicorea inducida por hiperglicemia no cetósica es una complicación poco frecuente de la diabetes mellitus. Se caracteriza por la tríada de movimientos coreiformes involuntarios unilaterales, hiperglucemia sin cetosis e hiperintensidad de ganglios basales contralaterales en imágenes de resonancia magnética nuclear principalmente en T1 o alta densidad en tomografía computarizada. Tiene un alto potencial de recuperabilidad total o parcial de su expresión clínica, por esta razón el diagnóstico y tratamiento oportuno es indispensable para evitar secuelas neurológicas irreversibles. Se presentan dos casos clínicos de este síndrome en los cuales es llamativo la incongruencia de los hallazgos imagenológicos con los clínicos.

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

Background Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases. Methods We present a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. Results A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 (range, 6–62), 1 (2%) case of clinical recurrence was registered. In addition, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative compared with the preoperative scores. Conclusion Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients’ reported outcomes. pre-print 371 KB