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Los sistemas sanitarios se enfrentan al desafío de atender adecuadamente las necesidades de poblaciones culturalmente heterogéneas (Mendonza et al., 2019). La pandemia ha resaltado la necesidad de garantizar el acceso a la atención sanitaria y de promover un servicio de calidad para todas las personas sin excepción (Perna y Moreno, 2021). En este escenario, la mediación intercultural sanitaria instaura un entorno de respeto mutuo y trabaja paliando las distintas barreras y factores negativos que determinan la salud de las poblaciones más vulnerables, como las poblaciones migrantes (Verrept, 2019). Así mismo, ocupa un papel esencial al prevenir y promover una atención integral sobre las diferentes necesidades sociales de los colectivos más vulnerables (Silva, 2020), garantizando la accesibilidad y la equidad del sistema sanitario (Rubio y Rubio, 2020). Este trabajo tiene como objetivos identificar el valor que aporta la mediación intercultural a la atención sanitaria y conocer cuáles son las funciones y experiencias realizadas en el ámbito. Para averiguarlo se ha elaborado una revisión narrativa, haciendo hincapié en la literatura de los últimos ocho años. Los resultados muestran la necesidad de definir la figura profesional del/la mediador/a intercultural sanitario/a dados los beneficios que aporta, al mejorar la calidad en la atención sanitaria y al promover un sistema de salud más accesible y equitativo. Más aún en situaciones de crisis sanitaria, donde se han visto acentuadas las vulnerabilidades de las poblaciones migrantes. Se refleja un largo recorrido para lograrlo lleno de desafíos y nuevos retos dada la naturaleza cambiante de nuestra sociedad.

PurposeManufacturing firms (MFs) nowadays are struggling to design and maintain an integrated product-service offer. This paper aims to explore the role of the supply chain (SC) in the design of the Product-Service System (PSS). In particular, the study focuses on the Design for Supply Chain (DfSC) approach in order to understand its role and contribution to the Design for Product Service Supportability (DfPSSu) approach in supporting PSS design.Design/methodology/approachBased on the multiple-case study approach, this paper used in-depth-interviews method to collect primary data from four multinational car manufacturers and two academic researchers.FindingsThe study reveals how a better design of the SC is required for the development of a service supportability approach that, in turn, facilitates the design of the PSS. Additionally, Internet of Things (IoT) technologies support MFs to analyse the ongoing development of the PSS business model. Finally, a better design of PSS is essential for strengthening the integration of Product and Service Offerings.Practical implicationsThis study suggests that MFs can build dynamic SC capabilities to deal with fundamental changes that occurred when adopting servitization.Originality/valueThis paper is among the first attempts to study the design process of the PSS business model in a real business context taking into account different design strategies.

Two applications of cryogenic protocols are cryotherapy and cryopreservation for virus cleaning and germplasm storage. They are based on exposing explants to ultra-low temperature (−196°C) in liqui...

The decrease in female enrollment at the Higher Secondary Education level in Mexico is a problem that is influenced by different factors that intervene in the interpersonal relationships of women in every facet of their lives. This academic dropout has its origin in causes dependent on the student's gender. The objective of this article is to demonstrate that the speech received at home and at school establishes the gender difference, as well as to expose the influence that this has on school dropout. To achieve this, the method of critical discourse analysis was used, which made it possible to label, catalog and analyze the speeches of the speakers. From the results obtained, it can be concluded that the dropout students of this academic level dropped out of school especially during the first semesters of high school. Among the main reasons are economic, family and cultural factors.

BACKGROUND Within the hematopoietic compartment, fibromodulin (FMOD) is almost exclusively expressed in chronic lymphocytic leukemia (CLL) lymphocytes. We set out to determine whether FMOD could be of help in diagnosing borderline lymphoproliferative disorders (LPD). METHODS We established 3 flow cytometry-defined groups (CLL [n = 65], borderline LPD [n = 28], broadly defined as those with CLLflow score between 35 and -20 or discordant CD43 and CLLflow, and non-CLL LPD [n = 40]). FMOD expression levels were determined by standard RT-PCR in whole-blood samples. Patients were included regardless of lymphocyte count but with tumor burden ≥40%. RESULTS FMOD expression levels distinguished between CLL (median 98.5, interquartile range [IQR] 37.8-195.1) and non-CLL LPD (median 0.012, IQR 0.003-0.033) with a sensitivity and specificity of 1. Most borderline LPDs were CD5/CD23/CD200-positive with no loss of B-cell antigens and negative or partial expression of CD43. 16/22 patients with available cytogenetic analysis showed trisomy 12. In 25/28 (89%) of these patients, FMOD expression levels fell between CLL and non-CLL (median 3.58, IQR 1.06-6.21). DISCUSSION This study could suggest that borderline LPDs may constitute a distinct group laying in the biological spectrum of chronic leukemic LPDs. Future studies will have to confirm these results with other biological data. Quantification of FMOD can potentially be of help in the diagnosis of phenotypically complex LPDs.

Backgroundnon-pharmacological interventions to prevent delirium are useful in hospitalised older adults. However, they are poorly implemented in clinical practice. We aimed to develop a software for bedside use by hospitalised older adults and to improve their access to these interventions.Methodsa transdisciplinary team composed of healthcare professionals, designers, engineers and older adults participated in the development of the software. Scrum methodology was used to coordinate the work of the team, and the software was evaluated in a feasibility study.Resultsa software for touchscreen mobile devices that supports Android 5.0 or later was produced, including modules for time-spatial re-orientation, cognitive stimulation, early mobilisation, sensorial support use promotion, sleep hygiene and pain management optimisation. Horizontal disposition, use of colour contrast and large interaction areas were used to improve accessibility. The software’s usability and accessibility were evaluated in 34 older adults (average age 73.2 ± 9.1 years) showing that 91.1% of them got access to all the software functions without previous instructions. The clinical feasibility assessment showed that 83.3% of the 30 enrolled hospitalised patients (76 ± 8 years) completed the 5-day protocol of software usage during hospitalisation. Software use was associated with a decreased trend in delirium incidence of 5 of 32 (15.6%) at baseline to 2 of 30 (6.6%) after its implementation.Conclusiona highly accessible and implementable software, designed to improve access to non-pharmacological interventions to prevent delirium in hospitalised older adults, was developed. The effectiveness of the software will be evaluated in a randomised clinical trial.

Un problema común en los procesos criogénicos es la supervivencia a temperatura ultra baja (-196 °C). Con base a los efectos fisiológicos del ácido salicílico (AS) en la señalización de respuestas de tolerancia a estrés, el objetivo fue evaluar el efecto de AS en el incremento de la supervivencia y en el crecimiento de yemas de papa sometidas a criogenia. Microplantas del clon avanzado 06-27 del Banco de Germoplasma in vitro del Programa de Papa en Metepec Estado de México, México, fueron incubadas por 28 días en AS (0, 10-6 y 10-5 M) y sometidas posteriormente a proceso criogénico. Efecto de AS en regeneración de plantas: se observó un incremento significativo en la supervivencia en plantas pretratadas con AS 10-5 y 10-6 M con respecto al testigo (1.66-2.04 veces respectivamente). El peso fresco, longitud de tallo y raíz incrementaron significativamente en microplantas pretratadas con AS con respecto al testigo. Criogenia: ambas concentraciones de AS 10-5 y 10-6 M indujeron significativamente mayor supervivencia (2.17-3.21 veces respectivamente) de explantes a criogenia. Plantas preincubadas en AS y regeneradas después de ser sometidas 1 h a criogenia incrementaron significativamente la longitud de raíz. El testigo presentó formación de callo, ausente en las plantas tratadas con AS. La combinación AS-criogenia favoreció el desarrollo de plantas sometidas a métodos que emplean temperaturas ultra bajas en papa con fines de criopreservación de germoplasma o en crioterapia para la obtención de materiales libres de virus.

Background The study of stool microbiota has taken great relevance in the last years, given its role in the maintenance of the intestinal metabolic, physiological, and immunological homeostasis, as well as, its effect over HIV biomarkers levels such as CD4/CD8 ratio, high sensitivity C-Reactive Protein (hs-CRP), related to poor outcomes (rapid progression to AIDS). Several efforts have been made to characterize the gut microbiome. In HIV infection, most of the studies report the presence of a dysbiotic pattern; however, few of them have made an approach in elderly HIV-positive subjects despite the fact that nowadays this subgroup is rising. In this study, we compared the composition of faecal microbiota, Short Chain Fatty Acids (SCFAs), and systemic biomarkers between elderly HIV-positive and HIV-negative subjects. Methods A cross-sectional study with 18 HIV-negative controls and 20 HIV-positive patients. The quantification of Bacteroidetes, Firmicutes, Proteobacteria, Actinobacteria, Lactobacillus, Enterobacteriaceae, Bifidobacterium, Escherichia coli, Clostridium leptum, Clostridium coccoides was performed in faecal samples by qPCR. The analysis was performed by calculating the ΔCq of each microorganism using 16S rDNA as a reference gene. Faecal SCFAs were measured by HPLC. The hs-CRP and sCD14 were performed by ELISA. Results An increase in the Firmicutes/Bacteroidetes ratio, coupled with a significant increase in the proteobacteria phylum was detected in HIV-positive subjects. In contrast, a decrease in the Clostridium leptum group was observed. Nevertheless, these elderly HIV-positive patients showed higher levels of total SCFAs mainly by an augmented propionic acid values, compared to HIV-negative subjects. Whereas high levels of hs-CRP were positively correlated with sCD14 in the HIV-positive group. Conclusions Alterations in bacterial communities reveals a dysbiotic state related to an unbalance of faecal SCFAs. Therefore, these intestinal conditions might drive an increase of poor prognostic biomarkers in elderly HIV-positive subjects.

Background HIV infection is characterized by CD4+ T-cells depletion related to gut damage, microbial translocation, immune activation and intestinal and systemic low-grade inflammation. With the use of antiretroviral treatment, these alterations in HIV+ patients reach similar levels to HIV- controls. However, almost 20% patients have deficient immune reconstitution of CD4+ T-cells, which make them more susceptible to develop non-AIDS and AIDS comorbidities. Methods HIV+ patients on ART, with sustained virologic control were grouped according to their immune reconstitution as: immunological responders (n = 18) and immunological non-responders (n = 18); also, HIV- controls were enrolled (n = 14). CD4+ and CD8+ T-cell activation (HLA-DR+ and CD38+ single and co-expression) were measured by flow cytometry. Serum levels of sCD14, sCD163, lipopolysaccharide, I-FABP, sST2, as well as fecal levels of calprotectin, lactoferrin and secretory IgA were evaluated by ELISA. Levels of C-reactive protein were determined by a high sensibility singleplex bead-based immunoassay. Serum and fecal concentrations of proinflammatory cytokines were quantified by multiplex bead-based immunoassay. Results HLA-DR+ and CD38+ co-expression, as well as median fluorescence intensity in CD4+ and CD8+ T-cells subpopulations was greater in immunological non-responders group, after normalization and fold change calculation. Similarly, this group presented higher levels of sCD14, C-reactive protein, as well as fecal calprotectin and lactoferrin. Furthermore, both HIV+ groups showed elevated levels of proinflammatory cytokines in stool. Conclusions Our data suggests that despite the virologic control, HIV+ patients under treatment with deficient immune reconstitution showed elevation of both innate and T-cells immune activation, as well as intestinal and systemic inflammation. However, some patients with CD4+ T-cells count above 350 cells/μL also presented these alterations. Future studies are necessary to evaluate the dynamics of multiple systemic and intestinal biomarkers in diverse types of HIV+ patients, as such as their clinical impact.

HIV infects its target cell and integrates into its genome as an essential step in its replication cycle. Proviral DNA is also subjected to the same transcriptional regulation as the host cell genome by its own transcriptional factors, with activating or repressive activity. There is a clear interaction between the presence of transcriptional repressors and a decrease in the rate of HIV replication, promoting gene silencing in infected cells, which serve as viral reservoirs. This represents a major obstacle for HIV eradication. The ZBTB gene family comprises 49 genes that encode transcription factors that have a repressor function in differentiation and development of cells of the lymphopoietic lineage, including the main target cells of HIV, CD4+ T cells. In this cross-sectional study, we evaluated the expression profile of ZBTB genes in CD4+ T cells of HIV-positive individuals with different levels of infection control. We found upregulation of gene expression of ZBTB4 (p < 0.01), ZBTB7B (p < 0.001), and ZBTB38 (p < 0.05) and downregulation of ZBTB16 (p < 0.01) in HIV-positive patients compared to HIV-negative individuals. Interestingly, in a deeper analysis, we observed that elite controllers had the highest levels of expression of the ZBTB38, ZBTB2, HIC1, ZBTB7A, ZBTB7B (ThPOK) and ZBTB4 genes, showing 2.56- to 7.60-fold upregulation compare to the ART-naive group. These results suggest a possible contribution of these ZBTB transcriptional repressors in HIV-positive patients and a possible new molecular mechanism of viral control.

Potato virus S (PVS) is one of the most difficult viruses to eliminate by thermotherapy due to its thermal deactivation point. Pre-treatment methods involving salicylic acid (SA) have been successfully carried in conjugation with cryogenic methods to reduce oxidative damage and eliminate viruses. In the present investigation, the effect of SA to protect Solanum tuberosum plants infected with PVS from oxidative damage from subsequent cryotherapy was studied. Vulnerable genotypes to cryogenic protocol were selected, with two SA treatments examined. Potato clones were pretreated with SA (0, 10−5, and 10−6 M), plant development was evaluated and then exposed to cryotherapy. This was followed up by a plant development evaluation and virus testing. After the initial treatment with SA, the plants exhibited an increase in the variables evaluated before cryotherapy. After cryotherapy, between 66.6% and 100% of the treated plants were found to be virus-free compared to control plants which exhibited 0% survival. Thus, the SA-cryotherapy treatment combination described appears to enhance plant survival and eliminate PVS from potato plants.