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BACKGROUND Creating credible and engaging health communication materials is knowledge- and labor-intensive. OBJECTIVE We propose a low-cost alternative by classifying lay health articles by relevance and topic using natural language processing (NLP). METHODS With postpartum depression as a case study, we conducted a manual review of online lay articles to classify articles on their relevance to pregnancy and topics. To scale the classification process on relevance and topics, we built models using Bidirectional Encoder Representations from Transformers (BERT), Generative Pre-trained Transformer model (ChatGPT), and Random Forest. RESULTS The gold standard corpus included 392 articles. A BERT-based model performed best (F1= 0.974) in an end-to-end classification of relevance and topics. In a two-step approach, given articles already classified as related to pregnancy, ChatGPT was best (F1 = 0.972) in classifying topics. CONCLUSIONS With NLP, we may repurpose lay reading materials as low-cost and easily accessible health education and communication sources.

Introduction Many health providers and communicators who are concerned that patients will not understand numbers instead use verbal probabilities (e.g., terms such as “rare” or “common”) to convey the gist of a health message. Objective To assess patient interpretation of and preferences for verbal probability information in health contexts. Methods We conducted a systematic review of literature published through September 2020. Original studies conducted in English with samples representative of lay populations were included if they assessed health-related information and elicited either (a) numerical estimates of verbal probability terms or (b) preferences for verbal vs. quantitative risk information. Results We identified 33 original studies that referenced 145 verbal probability terms, 45 of which were included in at least two studies and 19 in three or more. Numerical interpretations of each verbal term were extremely variable. For example, average interpretations of the term “rare” ranged from 7 to 21%, and for “common,” the range was 34 to 71%. In a subset of 9 studies, lay estimates of verbal probability terms were far higher than the standard interpretations established by the European Commission for drug labels. In 10 of 12 samples where preferences were elicited, most participants preferred numerical information, alone or in combination with verbal labels. Conclusion Numerical interpretation of verbal probabilities is extremely variable and does not correspond well to the numerical probabilities established by expert panels. Most patients appear to prefer quantitative risk information, alone or in combination with verbal labels. Health professionals should be aware that avoiding numeric information to describe risks may not match patient preferences, and that patients interpret verbal risk terms in a highly variable way.

BACKGROUND Home health aides (HHAs) provide necessary hands-on care to older adults and those with chronic conditions in their homes. Despite their integral role, HHAs experience numerous challenges on the job, including their ability to communicate with other healthcare professionals about patient care while caring for patients and accessing educational resources. While technological interventions have the potential to address these challenges, little is known about the technological landscape and existing tech-based interventions designed for and used by this workforce. OBJECTIVE We conducted a scoping review of the scientific literature to identify existing studies which have described, designed, deployed, and/or tested technology-based tools and apps intended for use by HHAs to care for patients in the home. To complement our literature review, we conducted a landscape analysis of existing mobile apps intended for HHAs providing in home care. METHODS We searched the following databases from inception to October 2020: Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and CINAHL (EBSCO). Three researchers screened the yield using pre-specified inclusion and exclusion criteria. Four researchers then independently reviewed these articles and a fifth arbitrated when needed. Among studies that met the inclusion criteria, data were extracted and summarized narratively. An analysis of mHealth apps designed for HHAs was performed using a predefined set of terms to search the Google Play Store and Apple App Store. Two researchers independently screened the resulting apps and those that met the inclusion criteria were categorized according to their intended purpose and functionality. RESULTS Of the 8,643 studies retrieved, 182 underwent full-text review, and 9 met our inclusion criteria. Half (n=4) were descriptive in nature, proposing technology-based systems (e.g., web-portal, dashboard) and/or prototypes without a technical or user-based evaluation of the technology. In most papers (n=7), HHAs were just one of several users and not the sole/primary intended user of the technology. Our review of mobile apps yielded 166 Android and iOS apps, of which 48 met the inclusion criteria. These apps provided HHAs with one or more of the following functions: electronic visit verification (29), clocking in and out (23), documentation (22), task checklist (19), communication between HHA and agency (14), patient information (6), resources (5), and communication between HHA and clients (4). Overall, of the 48 apps, 25 performed monitoring functions, 4 supporting functions, and 19 did both. CONCLUSIONS A limited number of studies and mobile apps are designed to support HHAs on the job. Further research and rigorous evaluation of technology-based tools are needed to assess their impact on the work HHAs provide in patient’s homes.

Technology advances and collaborations with information technology and computer science groups have enabled library services to expand into new domains. Listening to user needs, eliminating administrative burden and saving users time remain strong foundations on which to build new library services enabled by technology. Examples of what is now possible is described, including service to user groups, successes, failures and challenges. Although technology advances have enabled library service enhancements to all user groups, special emphasis on new library services in support of the research enterprise is discussed. As Lindberg and Humphreys predicted in 2015, the research enterprise's need for responsible curation of research data has created new opportunities for library services and examples of those services are discussed. As technology continues to advance, new library services are expected to emerge. These may include regulatory and compliance services. By developing these services with user feedback to save users time and expedite their work, and in collaboration with technology experts, libraries can expect to offer sustainable and valued services for years to come.

Background The objective of this study was to assess the overall quality of study-level meta-analyses in high-ranking journals using commonly employed guidelines and standards for systematic reviews and meta-analyses. Methods 100 randomly selected study-level meta-analyses published in ten highest-ranking clinical journals in 2016–2017 were evaluated by medical librarians against 4 assessments using a scale of 0–100: the Peer Review of Electronic Search Strategies (PRESS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Institute of Medicine’s (IOM) Standards for Systematic Reviews, and quality items from the Cochrane Handbook. Multiple regression was performed to assess meta-analyses characteristics’ associated with quality scores. Results The overall median (interquartile range) scores were: PRESS 62.5(45.8–75.0), PRISMA 92.6(88.9–96.3), IOM 81.3(76.6–85.9), and Cochrane 66.7(50.0–83.3). Involvement of librarians was associated with higher PRESS and IOM scores on multiple regression. Compliance with journal guidelines was associated with higher PRISMA and IOM scores. Conclusion This study raises concerns regarding the reporting and methodological quality of published MAs in high impact journals Early involvement of information specialists, stipulation of detailed author guidelines, and strict adherence to them may improve quality of published meta-analyses.

Tropical dry forests experience pronounced seasonal changes in precipitation manifested in varied plant phenologies. At landscape scales, geologic substrate—one of the least understood abiotic factors interacting with precipitation—maymodulate phenological responses in these forests through a combination of mechanisms regulating water and nutrient use. We leveraged a phenological dataset from the semiarid island of Curaçao to examine the extent to which plant phenology at multiple levels of biological organization diverge under different geologies. Monthly observations over a 30-month period of leaves, flowers, and fruits of 69 plant species of different life forms at three nearby sites differing in their underlaying geology were used to examine intra-and inter-annual plant responses at species, community, and system levels. The integration of leaf, flower, and fruit observations at intra-annual scales revealed diverse phenological strategies among species, broad associations with geologic substrate, and the extent of intra-specific variation as a function of geology. The community-andsystem-level analyses at inter-annual scales showed a reduction inmean leaf scores during the 30-month period, a weak and strong leafless period in 1993 and 1994, respectively, and differences among geologic substrates. Finally, we observed significant and positive relationships between precipitation and the phenophase scores; the strength of the relationships varied with phenophase and geologic substrate. Results of this work emphasize the importance of geologic substrate, and more broadly speaking landscape heterogeneity, in modulating plant phenological responses in tropical dry forests. Ultimately, this information will become important to understand and mitigate global climate change impacts.Abstract in Spanish is available with online material.

Writing from affects as a research methodology. In this article I propose Suely Rolnik's notion of vibrant body and Walter Benjamin's approach to the figure ofthe storyteller as coordinates to organize an arts research writing practice. The sensitive, corporeal, sensory, imaginative and reflective impressions that emerge from the exchange with artistic practice have the potential to produce amicropolitical action space. This territory can be traced as a situated and singular knowledge from writing, and more specifically from narration as an approximation to sensible experience. The starting point is my position as a spectator-researcher of contemporary performing art practices. From this position I focus to the seed of subjective transformation that could appear after the encounter with an artistic practice. From this interaction arises a storyteller-researcher becoming. Writing becomes a practice that seeks to resonate the power of micropolitical transformation that the work of artists is able to produce.; Escribir desde los afectos como metodología de investigación. En este artículo planteo la noción de cuerpo vibrátil de Suely Rolnik y la aproximación que hace Walter Benjamin a la figura del narrador como coordenadas para organizar una práctica de escritura para la investigación en artes. Las impresiones sensibles, corporales, sensoriales, imaginativas y reflexivas que emergen del intercambio con la práctica artística tienen la potencia de producir un campo de acción micropolítica. Este territorio se puede rastrear como un conocimiento situado y singular desde la escritura, y más en concreto desde la narración como aproximación a la experiencia sensible. El punto de partida es mi posición como espectadora-investigadora en prácticas escénicas contemporáneas. Desde esta posición situada llamo la atención sobre el germen de transformación subjetiva que es capaz de generar el encuentro con una práctica artística. De esa interacción emerge un devenir narradora-investigadora donde la escritura se transforma en una práctica que intenta hacer resonar la potencia de transformación micropolítica que el trabajo de les artistas es capaz de promover.

Increasingly, a critical eye has been placed on the methodological quality of consensus statements. As expert systematic review (SR) methodologists, librarians are often called on to support consensus statement work. Using the Weill Cornell Medicine Samuel J. Wood Library's SR Service experience as a guide, the aim of this paper is to answer three main questions regarding librarians supporting consensus statement work: (1) What is a consensus statement? (2) What is consensus statement methodology and how does this compare to practice guidelines? (3) What are important and practical points to consider when supporting this kind of request?

El objetivo fue caracterizar los sistemas de producción de cuyes. Se llevó a cabo una encuesta de abril a julio de 2019 a 187 familias criadoras de cuyes en el distrito de San Andrés de Tupicocha - Huarochirí, Lima - Perú. Los datos obtenidos fueron procesados con el programa IBM SPSS Statistics v.23, realizando un análisis estadístico descriptivo. La actividad cuyícola está ampliamente distribuida y realizada sobre todo en lugares alejados de la ciudad, esta especie tiene una importancia como fuente de ingresos mediatos y de seguridad alimentaria. Este estudio describe la variable agrícola y animal; en este último la población, alimentación, instalaciones, sanidad, manejo, comercialización y factores limitantes en la crianza de cuyes que tiene esta zona. Los resultados mostraron que tienen un sistema crianza semicomercial (62.5 %) y una alimentación a base de forraje (91.2 %), sin embargo, no tienen un manejo técnico adecuado, La crianza se realiza en un solo grupo sin distinción de clase, sexo y edad; en cocinas - cuartos (78.4 %). Se encontró 61.5 cuyes en promedio por familia, y productores que tienen por encima de 500 cuyes (2.1 %). Las principales enfermedades reportadas fueron ectoparásitos (48.4 %), neumonía (38.6 %) y salmonelosis (24.6 %). Las instalaciones de crianza son cocinas y cuartos (78.4 %) mientras que los que crían en galpones son a base de adobe y materiales de la zona. El 94.7 % de los encuestados declararon problemas de enfermedades, asistencia técnica, mejoramiento genético, instalaciones y pastos, en ese orden de prioridad. Esto conlleva a un bajo nivel tecnológico y de índices productivos, recomendándose asistencia técnica y promover mecanismo de asociatividad para la inversión, además de sistemas de extensión para su desarrollo, con el fin de mejorar su crianza.

Background and Purpose— The clinical utility of positron emission tomography (PET) imaging in evaluating carotid artery plaque vulnerability remains unclear. Two tracers of recent interest for carotid plaque imaging are 18 F-fluorodeoxyglucose ( 18 F-FDG) and 18 F-sodium fluoride ( 18 F-NaF). We performed a systematic review and meta-analysis evaluating the association between carotid artery 18 F-FDG or 18 F-NaF uptake and recent or future cerebral ischemic events. Methods— A systematic review of Ovid MEDLINE, Ovid EMBASE, and the Cochrane library was conducted from inception to December 2017 for articles evaluating PET tracer uptake in recently symptomatic versus asymptomatic carotid arteries, and articles evaluating carotid uptake in relation to future ischemic events. Cerebral ischemic events were defined as ipsilateral strokes, transient ischemic attacks, or amaurosis fugax. We quantitatively pooled studies by a random-effects model when 3 or more studies were amenable for analysis. We assessed the standardized mean difference between tracer uptake in the symptomatic versus asymptomatic carotid artery using Cohen’s d metric. Results— After screening 4144 unique articles, 13 prospective cohort studies assessing carotid artery 18 F-FDG uptake in patients with recent cerebral ischemia were eligible for review. Eleven cohorts of 290 subjects scanned with 18 F-FDG were eligible for meta-analysis. We found that carotid arteries ipsilateral to recent ischemic events had significantly higher 18 F-FDG uptake than asymptomatic arteries (Cohen’s d =0.492; CI=0.130–0.855; P =0.008) as well as significant heterogeneity (Cochran’s Q =31.5; P =0.0005; I 2 =68.3%). Meta-regression was not performed due to the limited number of studies in the analysis. Only 2 studies investigating 18 F-NaF PET imaging, and another 2 articles investigating ischemic event recurrence were found. Conclusions— Recent ipsilateral cerebral ischemia may be associated with increased carotid 18 F-FDG uptake on PET imaging regardless of degree of carotid stenosis, although significant heterogeneity was found, and these results should be interpreted with caution. Emerging evidence suggests a similar association may be present with 18 F-NaF plaque uptake. More studies are warranted to provide definitive conclusions on the utility of 18 F-FDG or 18 F-NaF in carotid plaque evaluation before investigating carotid PET as a diagnostic tool for cerebral ischemic events.

En este artículo se plantea una lectura de la obra Hacia (2019) como dispositivo coreográfico crítico frente al problema del desencantamiento del mundo derivado de la separación entre naturaleza y cultura heredada de la Modernidad/colonialidad. Se presentan nociones del perspectivismo amerindio como la de agencia relacional de todos los entes del mundo; y la del conocimiento como proceso de subjetivación que implica indefectiblemente la dimensión corporal, sensorial e imaginativa. El análisis contribuye al acercamiento entre la antropología y la creación escénica contemporánea en Brasil.

Female athletes are at a greater risk for anterior cruciate ligament (ACL) injuries than males. Current training programs for ACL injury reduction focus on muscle strengthening, appropriate movement patterns, and balance training. However, there is limited research on effective strategies to teach youth female soccer athletes how to properly perform desired movements associated with a decreased risk of ACL injuries. Behavioral skills training (BST) programs have been shown to be effective in teaching a wide variety of skills, but research on applications to sports is limited. This study evaluated a BST package for teaching a stepwise agility program to 3 youth female soccer athletes that consisted of verbal instructions, modeling, rehearsal, and feedback, which included video replay. Results showed a significant improvement in the number of steps the participants performed correctly relative to baseline, as well as maintenance of skills at follow-up. Implications for coaches and athletes, as well as limitations and directions for future research, are discussed.

The current study examined the collateral effects of an antecedent intervention for decreasing speech volume on vocal stereotypy. After teaching the participant to use a conversational voice level by providing visual feedback from a decibel meter app, conversational voice levels were differentially reinforced in the presence of a green card. Differential effects in voice magnitude during a green-card condition and a no-card condition were demonstrated using an alternating-treatments design. Results showed a decrease in volume of speech during the green-card condition, an overall decrease in vocal stereotypy, and a decrease to zero levels in loud stereotypical vocalizations. The implications of these findings on the treatment of vocal stereotypy are discussed.

Trança es una exploración de la alteridad constitutiva del ser a partir de prácticas corporales que buscan a esos otros que son parte de quien soy. Granato se propone convocar a dos coreógrafos contemporáneos a través de su cuerpo. Esta iniciativa, en apariencia imposible, funciona como desencadenante de una serie de prácticas corporales que articulan las condiciones para el encuentro con el otro a partir de la escucha activa y la insistencia en la exploración, el tanteo y la búsqueda, hechas explícitas en la acción paradójica de tocar sin tocar, un gesto que deliberadamente evita la apropiación instrumental y la captura de sentido propias del sentido del tacto. Se trata aquí de ir un poco antes, pensar la alteridad que hay en mí a partir de contemplar al otro en su misterio esencial y desde ahí generar las condiciones que hagan posible la aparición de ese lugar entre, de ese espacio donde el encuentro es posible. Este artículo reflexiona sobre los diferentes modos en que la construcción imaginaria de alteridad se materializa en una pieza escénica. En Trança, la fabulación del otro permite explorar una diversidad de formas de relación que nos sitúan como audiencia en lugares desde donde experimentar y hacer visibles las sutiles relaciones que emergen de la invención del otro. La escena contiene esta potencia de imaginar alteridad. La aproximación que propone este artículo analiza los procedimientos estéticos que construyen esos otros imaginarios en la escena y señalan las formas de relación posibles que se derivan de estas distintas fabricaciones de alteridad.

Although experts have identified benefits to replacing paper with electronic consent (eConsent) for research, a comprehensive understanding of strategies to overcome barriers to adoption is unknown. To address this gap, we performed a scoping review of the literature describing eConsent in academic medical centers. Of 69 studies that met inclusion criteria, 81% (n=56) addressed ethical, legal, and social issues; 67% (n=46) described user interface/user experience considerations; 39% (n=27) compared electronic versus paper approaches; 33% (n=23) discussed approaches to enterprise scalability; and 25% (n=17) described changes to consent elections. Findings indicate a lack of a leading commercial eConsent vendor, as articles described a myriad of homegrown systems and extensions of vendor EHR patient portals. Opportunities appear to exist for researchers and commercial software vendors to develop eConsent approaches that address the five critical areas identified in this review.

Background Suicide risk screening is recommended in pediatric care. To date, no previous studies illustrate the implementation of suicide risk screening in pediatric subspecialty care, even though chronic medical conditions are associated with a higher risk of suicide. Methods A large multidivision pediatric ambulatory clinic implemented annual suicide risk screening. Patients ages 9-21 years participated in suicide risk screening using the Ask Suicide-Screening Questions during the project. A multidisciplinary team employed quality improvement methods and survey-research design methods to evaluate the feasibility and acceptability of the screening process for patients, families, and medical providers. Results During the quality improvement project period, 1,934 patients were offered screening; 1,301 (67.3%) patients completed screening; 82 patients (6.3% of 1,301 patients) screened positive. The monthly compliance rate held steady at 86% following several Plan-Do-Study-Act cycles of improvement. The survey results demonstrate that providers rated the suicide risk screening process positively; however, a subset of providers indicated that the screening process was out of their scope of practice or impeded their workflow. Conclusions Suicide risk screening is feasible in pediatric specialty care and can identify at-risk patients. Continued efforts are needed to standardize suicide risk screening practices. Future directions include identifying factors associated with suicide risk in patients in pediatric subspecialty care settings.

BACKGROUND: CTA is a widely available imaging examination that may allow the evaluation of high-risk carotid plaque features. PURPOSE: Our aim was to evaluate the association between specific carotid plaque features on CTA and ipsilateral cerebrovascular ischemia. DATA SOURCES: We performed a systematic review of Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library from inception to March 2016 for articles that evaluated the relationship between CTA-detected carotid plaque features and ischemic events, defined as ipsilateral ischemic stroke or transient ischemic attack. STUDY SELECTION: Sixteen studies were ultimately included after screening 12,557. DATA ANALYSIS: Two readers recorded data from each study and assessed the study quality with all disagreements resolved by a third reader. A random-effects OR was used to evaluate the association between cerebrovascular ischemia and each of the evaluated plaque features. DATA SYNTHESIS: We found significant positive relationships with cerebrovascular ischemia for the presence of soft plaque (OR, 2.9; 95% CI, 1.4–6.0), plaque ulceration (OR, 2.2; 95% CI, 1.4–3.4), and increased common carotid artery wall thickness (OR, 6.2; 95% CI, 2.5–15.6). We found a significant negative relationship between calcified plaque and ipsilateral ischemia (OR, 0.5; 95% CI, 0.4–0.7). LIMITATIONS: We found heterogeneity in the existing literature secondary to lack of standardized plaque features and clinical definitions. CONCLUSIONS: Soft plaque, plaque ulceration, and increased common carotid artery wall thickness on CTA are associated with ipsilateral cerebrovascular ischemia, while calcified plaque is negatively associated with downstream ischemic events.

Carotid atherosclerosis is responsible for ~20% of ischemic strokes, but it is unclear whether carotid disease is associated with the presence of downstream silent brain infarction (SBI). We performed a systematic review and meta-analysis to study the relationship between SBI and 2 separate manifestations of carotid atherosclerosis, carotid intima-media thickening (IMT) and luminal stenosis.Ovid MEDLINE, Ovid Embase, and the Cochrane Library Database were searched with an additional search of references and citing articles of target studies. Articles were included if they reported an association between carotid IMT or stenosis and magnetic resonance imaging-defined SBI, excluding SBIs found after carotid intervention.We pooled 7 studies of carotid IMT reporting on 1469 subjects with SBI and 5102 subjects without SBI. Subjects with SBI had a larger mean IMT than subjects without SBI (pooled standardized mean difference, .37; 95% confidence interval [CI], .23-.51; P .0001). We pooled 11 studies of carotid stenosis reporting on 12,347 subjects (2110 subjects with carotid stenosis and 10,237 subjects without carotid stenosis). We found a higher prevalence of SBI among subjects with carotid stenosis (30.4% versus 17.4%). Our pooled random-effects analysis showed a significant positive relationship between carotid stenosis and SBI (odds ratio, 2.78; 95% CI, 2.19-3.52; P .0001).Two forms of atherosclerotic disease, carotid IMT and stenosis, are both significantly associated with SBI. This review highlights a lack of consistent definitions for carotid disease measures and little evidence evaluating SBI prevalence downstream from carotid stenosis.

Background and Purpose: Numerous stroke scales have been developed to predict functional outcomes following acute ischemic stroke. The goal of this study was to summarize functional outcome scores in stroke that incorporate neuroimaging with those that don’t incorporate neuroimaging. Methods: Searches were conducted in Ovid MEDLINE, Ovid Embase, and the Cochrane Library Database from inception to January 23, 2015. Additional records were identified by employing the “Cited by” and “View References” features in Scopus. We included studies that described stroke prognosis models or scoring systems that predict functional outcome based on clinical and/or imaging data available on presentation. Score performance was evaluated based on area under the receiver operating characteristic curve (AUC). Results: A total of 3300 articles were screened, yielding 14 scores that met inclusion criteria. Half (7) of the scores included neuroimaging as a predictor variable. Neuroimaging parameters included infarct size on magnetic resonance diffusion-weighted imaging, infarct size defined by computed tomography hypodensity, and hemodynamic abnormality on perfusion imaging. The modified Rankin Scale at 3 months poststroke was the most common functional outcome reported (13 of 14 scores). The AUCs ranged from 0.64 to 0.84 for scores that included neuroimaging as a predictor and 0.64 to 0.94 for scores that did not include neuroimaging. External validation has been performed for 7 scores. Conclusions: Due to the marked heterogeneity in the scores and populations in which they were applied, it is unclear whether current imaging-based scores offer advantages over simpler approaches for predicting poststroke function.

Clinical Medical Librarians at Weill Cornell Medicine (WCM), Samuel J. Wood Library provide unique health literacy services for patients, families, and caregivers on the Phyllis and David Komansky Center for Children’s Health pediatric floors of New York-Presbyterian Hospital (NYPH) by conducting twice weekly patient rounds and bringing consumer health information and services to bedsides. Although in its infancy, the Pediatric Consumer Librarian Service (PCLS) generates statements of appreciation from patients and parents, enthusiasm among stakeholders, and reports of increased job satisfaction by librarians. We report on experiences, methods, feedback from users, and plans for the future.

Workplace harassment is a social phenomenon that manifests the oppression that one person produces to another to denote the power that is held over this and that is reflected in offenses, criticism and insults, these practices are also known as mobbing, this is considered a crime, from the labor point of view, but also of criminal law, despite this there is judicial lack of authority in the country, leaving this type of case unimportant. There are various characteristics that lead to identify this type of behavior within the work environment, however, the world legislation, citing as an example the Spanish law, still does not articulate in a concrete way the behaviors that generate mobbing, clearly preventing the intervention of the system judicial to these practices, clearly preventing the intervention of the judicial system to these practices. Mobbing in Ecuador is a common problem in public and private companies, which constitute a legal vacuum in the Ecuadorian positive law, for this reason in order to have a first approach to the subject, interviewed Multicompetent Judges of the city of Babahoyo, who agreed that the issue is not addressed in local legislation and that greater efforts are needed to typify the characteristics and sanctions that this type of aggression must have., El acoso laboral es un fenómeno social en que se manifiesta la opresión que produce una persona a otra para denotar el poder que se tiene sobre ésta y que se refleja en ofensas, críticas e insultos, estas prácticas también son conocidas con el término de mobbing, el cual es considerado como delito, desde el punto de vista laboral y de derecho penal, pese a esto existe impericia judicial en el país dejando sin importancia este tipo de situaciones. Son diversas las características que conllevan a identificar conductas anómalas dentro del entorno laboral, sin embargo, la legislación mundial, citando como ejemplo la ley española, aun no articula de manera concreta las conductas que generan el mobbing, impidiendo claramente la intervención del sistema judicial a estas prácticas. El mobbing en Ecuador es un problema común en las empresas públicas y privadas, que constituyen un vacío legal en el derecho positivo ecuatoriano, por tal razón con el fin de tener un primer acercamiento del tema, se entrevistó a Jueces Multicompetentes de la ciudad de Babahoyo, quienes coincidieron que el tema no es tratado en la legislación local y que hacen falta mayores esfuerzos por tipificar las características y las sanciones que este tipo de agresión debe de tener.

Objective: The goal of this scoping review was to collect data on patient- and family-centered care (PFCC) programs and initiatives that have included the direct involvement of librarians and information professionals to determine how librarians are involved in PFCC and highlight opportunities for librarians to support PFCC programs.Methods: Systematic literature searches were conducted in seven scholarly databases in the information, medical, and social sciences. Studies were included if they (1) described initiatives presented explicitly as PFCC programs and (2) involved an information professional or librarian in the PFCC initiative or program. Based on the definition of PFCC provided by the Institute for Patient- and Family-Centered Care, the authors developed a custom code sheet to organize data elements into PFCC categories or initiatives and outcomes. Other extracted data elements included how the information professional became involved in the program and a narrative description of the initiatives or programs.Results: All included studies (n=12) identified patient education or information-sharing as an integral component of their PFCC initiatives. Librarians were noted to contribute to shared decision-making through direct patient consultation, provision of health literacy education, and information delivery to both provider and patient with the goal of fostering collaborative communication.Conclusions: The synthesis of available evidence to date suggests that librarians and information professionals should focus on patient education and information-sharing to support both patients or caregivers and clinical staff. The burgeoning efforts in participatory care and inclusion of patients in the decision-making process pose a unique opportunity for librarians and information professionals to offer more personalized information services.

BACKGROUND Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones. OBJECTIVE To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation. DESIGN Systematic review. SETTING Ovid MEDLINE, Ovid EMBASE, Cochrane Library, PsycINFO Elton B. Stephens Co. (EBSCO), AgeLine, CINAHL. MEASUREMENTS We abstracted key information about each program and categorized programs into 14 types and 9 subtypes. For programs that reported an impact evaluation, we systematically assessed the study quality. We also systematically examined the potential for programs to be successfully implemented in environments with limited resources available. RESULTS We found 116 articles describing 115 elder mistreatment programs. Of these articles, 43% focused on improving prevention, 50% focused on identification, and 95% focused on intervention, with 66% having multiple foci. The most common types of program were: educational (53%), multidisciplinary team (MDT) (21%), psychoeducation/therapy/counseling (15%), and legal services/support (8%). Of the programs, 13% integrated an acute-care hospital, 43% had high potential to work in low-resource environments, and 57% reported an attempt to evaluate program impact, but only 2% used a high-quality study design. CONCLUSION Many programs to combat elder mistreatment have been developed and implemented, with the majority focusing on education and MDT development. Though more than half reported evaluation of program impact, few used high-quality study design. Many have the potential to work in low-resource environments. Acute-care hospitals were infrequently integrated into programs.

OBJECTIVE The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies. DATA SOURCES We performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020. METHODS OF STUDY SELECTION There were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709). TABULATION, INTEGRATION, AND RESULTS Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p = .85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p = .59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p = .03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; p = .31 and OR 0.95; 95% CI, 0.47-1.89; p = .88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p