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Abstract Introduction Self‐expanding Y‐metal stents (SEMS) are best suited lesions with involvement of the carina and proximal main bronchi; however, Y‐stents can be difficult to place. These difficulties guided us to develop a modification of the classic technique that addresses some of the challenges during positioning. We present the Y reverse technique for Y stent insertion using a combination of rigid and flexible bronchoscopy. Materials and Methods This retrospective study included 15 consecutive patients, suffering from tracheal‐carina‐lower main bronchi complex, hospitalized at the Thoracic Surgery Unit of the Vanvitelli University of Naples between October 2021 and October 2023. Inclusion criteria: patients in which the length of the stenosis of the right bronchi was greater than that of the left bronchi, advanced oncological conditions, severe respiratory failure; exclusion criteria: Karnofsky scale with

Abstract Objective Self‐management interventions may enhance health‐related quality of life (HRQoL) in epilepsy. However, several barriers often impair their implementation in the real world. Digital interventions may help to overcome some of these barriers. Considering this, the Helpilepsy Plus Prototype was developed as a prototype smartphone‐delivered self‐care treatment program for adults with epilepsy. Methods The 12‐week Helpilepsy Plus Prototype was evaluated through a randomized controlled feasibility trial with a waiting‐list control (WLC) group. Outcome measurement at baseline and at 12 weeks assessed adherence to the prototype intervention and changes in epilepsy‐related outcomes. The primary endpoint was patient autonomy measured with EASE, and secondary endpoints included HRQoL measured with QOLIE‐31, health literacy measured with HLQ, anxiety, and depression symptoms measured with HADS. Semi‐structured interviews were conducted with a heterogeneous sample of participants to assess user‐friendliness and usefulness. The prototype program was delivered through the Neuroventis Platform (Neuroventis, BV, Overijse, Belgium), a certified medical device (under EU/MDD Class I, and EU/MDR grace period). Results Ninety‐two patients were included (46 in the intervention group, 46 in WLC). Most participants (63%, 58/92 women, median age 30 years) had pharmacoresistant epilepsy (61%, 56/92). Only 22% of participants (10/46) in the intervention group completed at least half of all intervention sessions. No significant differences between the intervention group and WLC were observed. Although there was a larger proportion of patients in the intervention group with meaningful improvements in HRQoL compared to WLC (19/46 versus 11/46), the difference was not significant (p = 0.119). Qualitative feedback showed that participants would appreciate more personalization, such as adaptation of the content to their current epilepsy knowledge level, a more interactive interface, shorter text sections, and interaction through reminders and notifications. Significance Digital interventions should allow sufficient scope for personalization and interaction to increase patient engagement and enable benefits from self‐care apps. Feedback loops allow the participatory development of tailored interventions. Plain Language Summary In this study, we investigated the effectiveness of an app‐based self‐help intervention. Study participants were either randomly assigned to a group that had access to the app or a group that received access to the app after the end of the study. Although a larger proportion of participants in the intervention group showed a relevant improvement in quality of life, the difference between the two groups was not statistically significant. Less than one‐fifth of participants in the intervention group attended at least half of all intervention sessions; patient feedback showed that patients required more personalization and interactive options.

Innovation in services is a necessary requirement to improve the competitiveness of organizations, espe-cially in a globally growing sector like healthcare. However, it is a complex process since services are intangible and co-created with users and other actors who interact through different roles, interests, and capabilities. Additionally, the outcome of the innovation process is expected to be a new or improved ex-perience for the patient and their family, as it is a key indicator in healthcare systems that determines user satisfaction and service quality. Many studies suggest the application of approaches and tools to innovate in services, but the literature is scarce in linking the innovation process with patient experience and individuals' skills to achieve successful innovation outcomes. This literature review aims to identify the relationship between three theoretical con-structs: the service innovation process, innovation competence, and patient experience, which will establish a theoretical framework for understanding the innovation competence of those involved in the healthcare service innovation process to contribute to collaborative work among ecosystem actors. This article presents the protocol for the systematic literature review considering previous works related to process improvement in the healthcare sector, attempting to address questions related to research topics and considering future lines outlined in previous reviews. The methodological design of this systematic review is based on recommendations made by authors in the healthcare field, and the recommendations of the PRISMA 2020 statement were also followed.

Abstract The error of estimated glomerular filtration rate (eGFR) and its consequences in predialysis are unknown. In this prospective multicentre study, 315 predialysis patients underwent measured GFR (mGFR) by the clearance of iohexol and eGFR by 52 formulas. Agreement between eGFR and mGFR was evaluated by concordance correlation coefficient (CCC), total deviation index (TDI) and coverage probability (CP). In a sub-analysis we assessed the impact of eGFR error on decision-making as (i) initiating dialysis, (ii) preparation for renal replacement therapy (RRT) and (iii) continuing clinical follow-up. For this sub-analysis, patients who started RRT due to clinical indications (uremia, fluid overload, etc.) were excluded. eGFR had scarce precision and accuracy in reflecting mGFR (average CCC 0.6, TDI 70% and cp 22%) both in creatinine- and cystatin-based formulas. Variations -larger than 10 ml/min- between mGFR and eGFR were frequent. The error of formulas would have suggested (a) premature preparation for RTT in 14% of stable patients evaluated by mGFR; (b) to continue clinical follow-up in 59% of subjects with indication for RTT preparation due to low GFRm and (c) to delay dialysis in all asymptomatic patients (n = 6) in whom RRT was indicated based on very low mGFR. The error of formulas in predialysis was frequent and large and may have consequences in clinical care.

Globally, intron 22 inversions (Inv22s) of the factor VIII gene (F8) are the most frequent pathogenic variants and account for 45–50% of severe hemophilia A (SHA) cases, while intron 1 inversion (Inv1) explains 1–5% of SHA cases. The detection of both inversions by an inverse shifting-polymerase chain reaction (IS-PCR) is the first choice worldwide for the diagnosis of patients and carriers of SHA. To improve its sensitivity and reproducibility in the visualization of PCR products, we approached the IS-PCR with fluorescent capillary electrophoresis instead of agarose electrophoresis. Based on the original protocol, we modified two primers by 5’-end labeling with FAM™ fluorescent dye for the detection of the PCR products by capillary electrophoresis. Additionally, the “fast enzymes” BclI and T4-Ligase were incorporated for work saving in the genomic digestion and ligation reactions, respectively. Once we accomplished the standardization and verified the reproducibility of the modified IS-PCR method, we applied it for the diagnosis of a cohort of SHA patients and carriers. The modified IS-PCR by fluorescent capillary electrophoresis for PCR product detection is more sensitive than agarose electrophoresis. The method was also improved by using the new rapid enzymes to save time in the whole process.

Background & Aims: In clinical practice, the diagnosis of alcohol-associated hepatitis (AH) is mostly based on non-invasive criteria, which were defined at a consensus conference by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). These criteria were recently modified by adding C-reactive protein (CRP) and termed NIAAAm-CRP criteria, which showed superior diagnostic accuracy for presence of alcohol-associated steatohepatitis (ASH) on liver histology. The aim of our study was to validate the diagnostic accuracy of both original NIAAA criteria and NIAAAm-CRP criteria for presence of ASH on liver histology in an independent cohort. Methods: Data from a large multinational cohort of 445 patients with alcohol-associated liver disease (ALD) that served to establish a novel grading and staging system of alcohol-associated liver disease were analyzed retrospectively. Diagnosis of ASH was based on presence of hepatocyte ballooning plus lobular neutrophil infiltration and established in virtual consensus meetings of multiple expert liver pathologists. Results: Complete data including CRP values were available in 346 patients. Overall diagnostic accuracy for prediction of ASH was 73% for NIAAA criteria and 77% for NIAAAm-CRP criteria. In a subgroup with suspected severe AH (MELD >20, n = 123), overall diagnostic accuracy for prediction of ASH was 69% for NIAAA criteria and 74% for NIAAAm-CRP criteria. Conclusion: Our findings confirm recent data on suboptimal diagnostic accuracy of original NIAAA criteria and validate slightly better but still suboptimal performance of NIAAAm-CRP criteria for presence of ASH. Impact and Implications: Alcohol-associated steatohepatitis (ASH) is diagnosed on liver histology but liver biopsy is not always feasible. Non-invasive diagnosis based on clinical findings has been proposed using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria and recently improved using NIAAAm-CRP criteria. Our findings validate slightly better but still suboptimal performance of NIAAAm-CRP criteria for the presence of histological ASH. Clinical trials of novel drugs should focus on histologically proven ASH.

Abstract Background The localization of lung nodules is challenging during thoracoscopy. In this study, we evaluated the use of three‐dimensional (3D) lung reconstruction for use in the operating room to guide the identification of lung nodules during thoracoscopy. Methods This was a single‐center retrospective study. All consecutive patients undergoing thoracoscopic resection of lung nodules were included in the study. Patients were retrospectively divided into two groups based upon whether the thoracoscopic resection was performed with the assistance (3D group) or not (standard group) of 3D lung reconstruction. The operative time (minutes) to detect lung nodules was statistically compared between the two study groups in relation to the characteristics of lung nodules as size, localization, and distance from the visceral pleura. Results Our study population consisted of 170 patients: 85 in the 3D group and 85 in the standard group. No intergroup difference differences were found regarding the characteristics and histological diagnosis of lesions. The standard group compared to the 3D group was associated with a significantly longer operative time for the detection of lesions

Abstract Background Video‐assisted thoracoscopic surgery (VATS) resection of deep‐seated lung nodules smaller than 1 cm is extremely challenging. Several methods have been proposed to overcome this limitation but with not neglectable complications. Intraoperative lung ultrasound (ILU) is the latest minimally invasive proposed technique. The aim of the current study was to analyze the accuracy and efficacy of ILU associated with VATS to visualize solitary and deep‐seated pulmonary nodules smaller than 1 cm. Methods Patients with subcentimetric solitary and deep‐seated pulmonary nodules were included in this retrospective study from November 2020 to December 2022. Patients who received VATS aided with ILU were considered as group A and patients who received conventional VATS as group B (control group). The rate of nodule identification and the time for localization with VATS alone and with VATS aided with ILU in each group were analyzed. Results A total of 43 patients received VATS aided with ILU (group A) and 31 patients received conventional VATS (group B). Mean operative time was lower in group A (p

Objetivo: Analizar el concepto de probabilidad que se describe en las Normas Internacionales de Información Financiera (NIIF). Método: El enfoque fue cualitativo, parcialmente descriptivo, enfocado en el análisis de contenido de los antecedentes y el marco normativo de las NIIF. La unidad de estudio comprendió el concepto de probabilidad. Resultados: Los resultados muestran la importancia del uso de probabilidades en el marco normativo de las NIIF, donde destaca el análisis de diversos escenarios acerca del futuro, así como un conocimiento suficiente de teoría de probabilidades a fin de contar con una concepción clara del término “probabilidad” y su adecuada interpretación. Conclusión: Es necesario analizar los diversos escenarios acerca del futuro desde el enfoque bayesiano y comprender adecuadamente su interpretación. Asimismo, es importante examinar la ausencia de precisiones en el término “probabilidad” y cómo afecta su aplicación en la preparación de estados financieros.

Abstract Background Intrathoracic neurogenic tumors (INTs) are derived from nerve tissue and grow within the chest. Preoperative diagnosis can be challenging and only complete surgical exeresis enables confirmation of the suspected diagnosis. Here, we analyzed our experience on management of paravertebral lesions with solid and cystic patterns. Methods A monocentric retrospective study was conducted, which included 25 consecutive cases of ITNs in the period from 2010 to 2022. These cases had been surgically treated by thoracoscopic resection alone, or in combination with neurosurgery in the case of dumbbell tumors. The demographic and operative data along with complications were recorded and analyzed. Results Twenty‐five patients were diagnosed with a paravertebral lesion of which 19 (76%) had solid features and six (24%) had cystic features. The most common diagnosis was schwannoma (72%), followed by neurofibroma (20%) and malignant schwannoma (8%). In four cases (12%) the tumor showed an intraspinal extension. None of the patients had recurrence until 6 months of follow‐up. Comparison between the VATS and thoracotomy procedures showed that outcome of discharge on the postoperative day, on average, was 2.61 ± 0.5 versus 3.51 ± 0.53, respectively (p‐value

IntroductionIt is well-known that circulating microRNAs (miRNAs) play a relevant role in many kinds of diseases by regulating the expression of genes involved in various pathophysiologic processes, including erectile dysfunction (ED) and cardiovascular diseases (CVD).PurposeThis study aimed to identify the miRNA-21 profile in the blood samples of patients with ED, CVD, and the combination of both pathologies to elucidate the potential function of miRNA-21.MethodsA total of 45 patients with CVD and/or who underwent the erectile function test were included and divided into the following categories: CVD with ED (cases, n = 29) and controls (n = 16) with either ED or CVD. Real-time polymerase chain reaction analysis verified the results. miRNA-21 expression was quantified, and informatics analysis was applied to predict the functions of this differentially expressed miRNA-21.ResultsA total of 64% of cases (63 ± 9 years, 66% with severe ED, 56% with CV ejection fraction) first presented ED as the sentinel clinical manifestation. Serum miRNA-21 levels in the control ED were significant, up to 10-fold higher than in the CVD controls and cases. A significant inverse (p = 0.0368, β = −2.046) correlation was found between erectile function and miRNA-21 levels.ConclusionsOur study provides comprehensive insights into the functional interaction between miRNA-21 and ED in CVD patients. Its relevance lies in the potential of miRNA as a biomarker to be applied in the cardiovascular predictive medicine field.

OBJECTIVES:. We aimed to assess the feasibility and reliability of sequential ultrasonographic and elastographic monitoring in acute liver failure (ALF). DESIGN:. Observational study. SETTING:. ALF is a rare, life-threatening disease that requires intensive care admission and often liver transplant, where the accurate selection of patients is crucial. Liver elastography is a noninvasive tool that can measure hepatic stiffness, but previous results have been inconclusive in ALF. PATIENTS:. Patients admitted between October 2021 and March 2023 to the Liver Intensive Therapy Unit at King’s College Hospital with ALF were recruited, with healthy control (HC) individuals and acute-on-chronic liver failure (ACLF) used as controls. INTERVENTION:. None. MEASUREMENTS:. Average shear wave velocity was recorded with ElastPQ on the right and left liver lobes and the spleen. Portal vein flow, hepatic artery resistive index, and peak systolic velocity were also recorded. Physiologic and histologic data were used for comparison. MAIN RESULTS:. Forty patients with ALF, 22 patients with ACLF, and 9 HC individuals were included in the study. At admission, liver stiffness measurement (LSM) of the right lobe was statistically different between HC individuals (5.6 ± 2 kPa), ALF (31.7 ± 17 kPa), and ACLF (76.3 ± 71 kPa) patients (ALF vs. ACLF, p = 0.0301). Spleen size and stiffness discriminated between ALF (10.4 ± 2 cm and 21.4 ± 16.6 kPa) and ACLF (14 ± 2.3 cm and 42.6 ± 26 kPa). At admission, LSM was not different between ALF patients who spontaneously survived versus patients who died or were transplanted in the following 90 days. However, the trend over the first 10 days of admission was different with a peak of LSM at day 5 in spontaneous survivors followed by reduction during the recovery phase. ALF patients with poor prognosis showed a persistently increased LSM. CONCLUSIONS:. In ALF stiffness peaks at day 5 of admission with subsequent reduction in patients spontaneously surviving, showing significant difference according to the prognosis at day 7 of admission. LSM might be useful in distinguishing acute from acute-on-chronic liver failure together with spleen volume and stiffness.

[This corrects the article DOI: 10.1371/journal.pone.0264689.].

Abstract Background Persistent air leak (PAL) is a common complication after video‐assisted thoracoscopic surgery (VATS) lobectomy. We aimed to evaluate whether the intraoperative quantitative measurement of air leaks using a mechanical ventilation test could predict PAL and identify those patients needing additional treatment for the prevention of PAL. Methods This was an observational, retrospective, single‐center study that included 82 patients who underwent VATS lobectomy with a mechanical ventilation test for VL. Only 2% of patients who underwent lobectomy surgery had persistent air leaks. Results At the end of lobectomy performed in patients with non‐small cell lung cancer, the lung was reinflated at a 25–30 mmH2O pressure and ventilatory leaks (VL) were calculated and in relation to the entity of the air leaks, we evaluated the most suitable intraoperative treatment to prevent persistent air leaks. Conclusion VL is an independent predictor of PAL after VATS lobectomy; it provides a real‐time intraoperative guidance to identify those patients who can benefit from additional intraoperative preventive interventions to reduce PAL.

Agricultural systems are currently facing significant issues, primarily due to population growth rates in the context of global climate change. Rising temperatures cause plant heat stress and impact crop yield, which in turn compromises global food production and safety. Climate change is also having a significant impact on water availability around the world, and droughts are becoming more frequent and severe in many regions. The combined effect of both heat and drought stresses increases plant damage, resulting in reduced plant development and productivity loss. Therefore, developing heat–drought-tolerant crop varieties is crucial for enhancing yield under these challenging conditions. Tomato (Solanum lycopersicum L.), a major vegetable crop highly appreciated for its nutritional qualities, is particularly sensitive to extreme temperatures, which have a significant negative impact on tomato fruit setting and cause male gametophyte abortion. In this work, a classical genetic approach was employed to identify tomato genotypes showing a resilient response to combined heat and drought stress conditions. A phenotype screening of a natural germplasm collection and an ethyl methanesulfonate (EMS) mutagenized population resulted in the identification of a significant number of tomato lines tolerant to combined heat and drought conditions, specifically 161 EMS lines and 24 natural accessions as tolerant. In addition, TILLING and Eco-TILLING analyses were used as proof-of-concept to isolate new genetic variants of genes previously reported as key regulators of abiotic stress responses in different species. The identification of these variants holds the potential to provide suitable plant material for breeding programs focused on enhancing tomato resilience to adverse climate conditions.

Este trabajo centra el interés en el “cuerpo vestido” que somos, para acercarnos a los significados y sentidos que asignan los enfermos a la exposición de su cuerpo y a su identificación genérica al ser sometidos al uso de una “bata de hospital”. Es una aproximación a las experiencias que vive el “cuerpo doliente” a través de la interpretación del lenguaje corporal (expresiones motoras y verbales) de un grupo de varones y mujeres (adultos jóvenes, medios y mayores), en el momento de su admisión en un hospital de la Ciudad de Cuenca (Ecuador). Cuarenta enfermos admitidos fueron sujetos de observación participante y el mismo número de enfermeras, con experiencia en admisión y cuidado, ofrecieron testimonios acerca del tema. Las vivencias corresponden a un cuerpo incomodado físicamente, limitado en su movimiento, intimidad y pudor, e ignorado en su identidad.

El objetivo del estudio fue evaluar el efecto de tres alimentos (T1=AQUATECH32, T2= CORINA28 y T3= AQUAPRO32) en el crecimiento, asimilación alimenticia e índices de bienestar de juveniles de paco, Piaractus brachypomus (25.2 ± 0.55 g) cultivados durante 46 días. El experimento se realizó en el Fundo El Gavilán, ubicado en el km 7 de la carretera Yurimaguas- Munichis. Noventa peces fueron asignados equitativa y aleatoriamente en nueve jaulas de 1 m3 y cada alimento fue asignado aleatoriamente y evaluados por triplicado. Los peces fueron alimentados dos veces al día con una tasa de alimentación inicial de 8% en los primeros 32 días, luego de la cual se reajustó a 7% hasta el final del experimento. Se realizaron monitoreos biométricos cada 15 días para evaluar el crecimiento y reajustar las raciones. Al final del experimento AQUATECH32 y AQUAPRO32 produjeron mayores índices de crecimiento (GP, GPD, TCE y TCR) que la dieta de la línea CORINA28, sin embargo, de acuerdo al ANOVA, no hubo diferencias significativas (P>0.05), como tampoco las hubo para los índices de asimilación alimenticia y de bienestar. De acuerdo a los resultados, se podría utilizar cualquiera de los tres alimentos ya que el rendimiento productivo es similar.

Introduction: The professional dedicated to respiratory health has an exemplary role in tobacco control, promoting smoking cessation in their patients. However, multiple circumstances cause a low implementation. Therefore, the objective of the study is to identify the consumption, knowledge and perception of tobacco and its emerging products in a representative sample of professionals involved in the treatment of respiratory patients integrated into the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Material and methods: Descriptive analysis of a structured online interview addressed to 5340 SEPAR members. Results: In a sample of 802 respondents, more than 33% have smoked at some time and 6.6% continue to smoke. More than 66% consider smoking as a chronic disease. More than 90% consider their role model important and advise their patients to quit smoking, but less than half carry out a smoking intervention. Only 35% of them believe that the ban on smoking in health centers is always complied. More than 75% do not consider nicotine delivery devices an option for smoking cessation or harm reduction. 22% are unaware of water pipes and 29% of heated tobacco. Conclusions: Professionals specialized in respiratory diseases are highly sensitized to smoking. Despite this, there are still weak points such as the insufficient implementation of smoking cessation interventions or the scant training in smoking and in new emerging products. Resumen: Introducción: El profesional dedicado a la salud respiratoria tiene un papel ejemplar en el control del tabaquismo, promoviendo el abandono del hábito tabáquico en sus pacientes. Sin embargo, múltiples circunstancias provocan una baja implementación. Por tanto, el objetivo del estudio es identificar el consumo, el conocimiento y la percepción sobre el tabaco y sus productos emergentes en una muestra representativa de profesionales implicados en el tratamiento de pacientes respiratorios integrados en la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Material y métodos: Análisis descriptivo de una entrevista estructurada en línea dirigida a 5.340 miembros de la SEPAR. Resultados: En una muestra de 802 encuestados, más del 33% ha fumado alguna vez y el 6.6% sigue fumando. Más del 66% considera el tabaquismo como una enfermedad crónica. Más del 90% considera importante su modelo a seguir y aconseja a sus pacientes que dejen de fumar, pero menos de la mitad realiza una intervención para dejar de fumar. Solo el 35% de ellos cree que la prohibición de fumar en los centros de salud se cumple siempre. Más del 75% no considera que los dispositivos de suministro de nicotina sean una opción para dejar de fumar o reducir los daños. El 22% desconoce las pipas de agua y el 29% el tabaco calentado. Conclusiones: Los profesionales especialistas en enfermedades respiratorias están altamente sensibilizados al tabaquismo. A pesar de ello, aún existen puntos débiles como la insuficiente implantación de intervenciones para dejar de fumar o la escasa formación en tabaquismo y en nuevos productos emergentes.

Abstract Introduction Staging of the mediastinum lymph nodes involvement in patients with non–small cell lung cancer (NSCLC) is an important prognostic factor determining the most appropriate multimodality treatment plan. The objective of this study is to assess ultrasound characteristics of mediastinal lymph nodes metastasis and effectiveness of intraoperative ultrasound‐guided mediastinal nodal dissection in patients with resected NSCLC. Materials and Methods All patients undergoing video‐assisted thoracoscopic surgery lobectomy and pulmonary lymphadenectomy from November 2020 to March 2022 at the thoracic surgery department of the Vanvitelli University of Naples underwent intraoperative ultrasound‐guided mediastinal lymph nodal dissection. Results This study evaluates whether individual B‐mode features and a compounding thereof can be used to accurately and reproducibly predict lymph node malignancy. Discussion Intraoperative ultrasound, during systematic mediastinal lymph node dissection, is helpful in preventing lesion to mediastinal structures. Pathological nodal sonographic characteristics are round shape, short‐axis diameter, echogenicity, margin, the absence or presence of coagulation necrosis sign, and the absence or presence of central hilar structure, increased color Doppler flow, the absence or presence of calcification, and nodal conglomeration. Operating time was not substantially prolonged. The procedure is simple, safe and highly accurate. Conclusions Ultrasonic techniques allow surgeons to detect the relationship between lymph nodes and surrounding large blood vessels during biopsy, improving the safety and simplicity of the operation, increasing the number of harvested lymph nodes, and reducing the risk of intraoperative injury; it is a fast, easily reproducible, and inexpensive method.

Abstract Variants in ATP8B1, ABCB11, and ABCB4 underlie the most prevalent forms of progressive familial intrahepatic cholestasis. We aim to describe variants in these genes in a cohort of patients with adult‐onset liver disease, and explore a genotype–phenotype correlation. Patients with onset of liver disease aged above 18 who underwent sequencing of cholestasis genes for clinical purposes over a 5‐year period were identified. Bioinformatic analysis of variants was performed. Liver histology was evaluated in patients with variants. Of the 356 patients tested, at least one variant was identified in 101 (28.4%): 46 ABCB4, 35 ABCB11, and 28 ATP8B1. Patients with ABCB4 variants had chronic liver disease (71.7%) and pregnancy‐associated liver dysfunction (75%), with a younger age of onset in more severe genotypes (p = 0.046). ABCB11 variants presented with pregnancy‐associated liver dysfunction (82.4%) and acute/episodic cholestasis (40%), with no association between age of onset and genotype severity. ATP8B1 variants were associated with chronic liver disease (75%); however, they were commonly seen in patients with an alternate etiology of liver disease and variants were of low predicted pathogenicity. In adults with suspected genetic cholestasis, variants in cholestasis genes were frequently identified and were likely to contribute to the development of liver disease, particularly ABCB4 and ABCB11. Variants were often in heterozygous state, and they should no longer be considered recessive Mendelian traits. Sequencing cholestasis genes in selected patients with adult‐onset disease should be considered, with interpretation in close collaboration with histopathologists and geneticists.

El habitar contiene una serie de cambios que se manifiestan en las prácticas cotidianas donde se toman decisiones voluntarias y condicionadas a factores externos, como pueden ser económicos, políticos, sociales y culturales. El propósito de analizar el habitar como proceso de hacerse presente en un espacio, es entender la homogeneidad y heterogeneidad de las formas de vida, a fin de reflexionar sobre las ventajas y desventajas, particularmente en este artículo que observa el habitar de la mujer a través de la vivienda contemporánea latinoamericana, como metodología se plantea la identificación de patrones de comportamiento que se manifiestan en la realidad de la vida cotidiana, sirviendo de guía para analizar, entender, proponer y proyectar de mejor manera diseños de vivienda que integren las necesidades actuales de la mujer latinoamericana.

Introduction: Fever stands out as the predominant clinical indicator in infancy. Pediatricians encounter fever routinely in their daily practice, playing a crucial role in their interactions with children and families. Objective: The aim is to examine pediatricians’ viewpoints, understanding, and approaches regarding childhood fever in two healthcare settings: pediatric hospitalization (emergency and inpatient ward) and primary care. Methods: A qualitative study was conducted using an ethnomethodological approach. Pediatricians working in the specified pediatric settings participated in in-depth interviews where theoretical clinical cases were presented for analysis. Results: Following the examination of the discourses, the codes were organized into eight categories: Understanding of fever, Significance ascribed to fever, Therapeutic strategies, Engagement with the evidence, Family apprehensions regarding fever, Influence of the COVID-19 Pandemic, Inter- and intra-professional relationships, and Suggestions for change: Conclusions: Pediatricians acknowledge the importance of addressing discomfort in the treatment of fever, but express challenges in implementing these recommendations. Pediatricians in inpatient settings emphasize the need for enhanced parental education from primary care, while those in primary care recognize the potential for improvement. Inpatient pediatricians are open to implementing changes in their daily practices, particularly concerning the administration of antipyretics.

Abstract Objective: To analyze the epidemiological and clinical profile of patients with developmental disabilities followed in a university clinic in Brazil. Methods: Descriptive, retrospective study, based on medical records. Children aged zero to 18 years with developmental problems, firstly evaluated between 2009 and 2018, were included. Patients with missing data or out of the age and time period established were excluded. There were nine losses and 374 patients constituted the final sample. Linear regression models were performed. Results: The mean age at the first assessment was 52.2±39.7 months and the age when the parents perceived the symptoms was 20.9±23.8 months. The most common impairment was motor associated with language delay (28.3%). The interval between the parents’ perception and the first consultation was associated with the mothers’ education and number of pregnancies. The age at first assessment was associated with the disability type. The number of pregnancies was associated with the child's age when the parents noticed the symptoms and at the first consultation. Conclusions: Parents’ recognition of the symptoms occurred early, however, there was a delay until the arrival at the clinic. Higher maternal education was associated with a shorter gap between perception of the developmental disability and consultation. A greater number of pregnancies was associated with a later perception of the developmental delay by the parents as well as a delay in the assessment and a wider interval between them. Motor problems were the most common in younger children, and language complaints in older ones.

La comprensión lectora es una de las principales preocupaciones del sistema escolar, dado su impacto en el aprendizaje de las demás áreas escolares. El objetivo de la investigación fue describir la influencia de una estrategia didáctica mediada por juegos digitales y no digitales en el desarrollo de la comprensión lectora a nivel inferencial en estudiantes de quinto grado. La metodología tuvo un enfoque cualitativo, con diseño de investigación-acción. La implementación se realizó con 18 estudiantes, con edades entre 9 y 12 años, de estrato socioeconómico bajo y medio, de una institución pública colombiana ubicada en zona urbana. Las categorías observadas fueron comprensión lectora, motivación, vinculación de los padres, estrategias de juego digital y no digital. Se utilizaron como instrumentos: pruebas pretest y postest de comprensión lectora, RIMMS para la motivación, una guía de observación, entrevista a los padres de familia y un grupo focal. La estrategia didáctica consistió en dos cápsulas educativas, un juego no digital basado en un tablero similar al juego de escaleras y serpientes, otras dos cápsulas educativas y un juego digital en Scratch. Se usó WhatsApp para la comunica-ción con estudiantes y padres. Se obtuvieron mejoras significativas en la comprensión lectora, la motivación mostró niveles mayores en el juego no digital. En conclusión, la estrategia didáctica implementada mejoró significativamente la comprensión lectora, resaltando una mayor motivación hacia el juego no digital, por la implementación de avatares y una mayor participación del entorno familiar.

Objetivo: Identificar si existe una revelación diferenciada de los juicios de las empresas mineras peruanas para el año 2020 en relación con las Normas Internacionales de Información Financiera (NIIF), y describir si se presenta un suficiente nivel de detalle de los supuestos asumidos en las empresas mineras peruanas en el año 2020 en relación con las NIIF. Método: Enfoque cualitativo, parcialmente descriptivo, no experimental, transversal y un análisis de contenido del marco normativo de las NIIF y de los estados financieros de las empresas mineras peruanas. Resultados: Cuatro de las once empresas mineras peruanas no efectúan una revelación diferenciada de los juicios y, por otro lado, los supuestos asumidos son genéricos y no proporcionan mayor detalle. Conclusión: Existe una apertura de criterios en la revelación de juicios y una carencia de revelación suficiente de los supuestos asumidos.

As of the introduction of anesthesia on the Island, on March 11, 1847 there was a progressive advance in the development of surgery. In Cienfuegos it would be a milestone when the surgeon Alfredo Méndez introduced it between 1901 and 1902; and its use has increased at present. The main actions that have been developed by the Anesthesiology and Resuscitation specialty in the general hospitals in Cienfuegos were described. The book of the Clinical Anesthesiology, in its first and second editions, was revised. Interviews were conducted with protagonists who were part of the development of the specialty in Cienfuegos. The main facts that were developing the specialty of Anesthesiology and Resuscitation in the province were found since the beginning of the 20th century with the application of chloroform and ether by Alfredo Méndez surgeon and how it continues its development with doctors dedicated to anesthesia in the beginning of the second half of the 1950s; the development in the Civil Hospital and private clinics, until the triumph of the Revolution and until nowadays in the XXI century. Anesthesia in Cienfuegos was introduced at the beginning of the 20th century, having a constant task in the development of this discipline, as well as the integration of the specialty to the Anesthesiology Resuscitation and Pain Cuban Society, being its provincial group and chapter.

Byrnes et al. reconstruct the developing mesentery from digitized embryonic datasets and human and animal cadavers using 3D digital and printed models. They confirm the mesentery remains a continuous organ in and on which all abdominal digestive organs develop and that at the foundation level, the abdomen comprises a mesenteric and non-mesenteric domain.

Neuroendocrine liver metastases (LM-NEN) develop in a considerable proportion of patients with gastroenteropancreatic neuroendocrine neoplasms. There is a paucity of experimental models that accurately recapitulate this complex metastatic human liver microenvironment precluding scientific and clinical advancements. Here, we describe the development of a novel personalised immunocompetent precision cut tumour slice (PCTS) model for LM-NEN using resected human liver tissue. The histological assessment throughout the culture demonstrated that slices maintain viability for at least 7 days and retain the cellular heterogeneity of the original tumour. Essential clinical features, such as patient-specific histoarchitecture, tumour grade, neuroendocrine differentiation and metabolic capacity, are preserved in the slices. The PCTS also replicate the tumor-specific immunological profile as shown by the innate and adaptive immunity markers analysis. Furthermore, the study of soluble immune checkpoint receptors in the culture supernatants proves that these immunomodulators are actively produced by LM-NEN and suggests that this process is epithelium-dependent. This model can be employed to investigate these pathways and provides a powerful platform for mechanistic, immunological and pre-clinical studies.

Objetivo: Describir los conceptos de pasivos, provisiones y pasivos contingentes a partir de aspectos relevantes de la Teoría de Probabilidades. Método: La investigación fue cualitativa, descriptiva, no experimental con el uso del método deductivo-inductivo, sobre la base del análisis de contenido de las Normas Internacionales de Información Financiera (NIIF) y la Teoría de Probabilidades. Resultados: Los resultados muestran discrepancias sobre los conceptos de pasivos, provisiones y pasivos contingentes, entre lo planteado por la NIC 37 y el Marco Conceptual para la Información Financiera, considerando además aspectos relevantes de la Teoría de Probabilidades. Conclusión: Existen divergencias conceptuales entre la NIC 37 y el Marco Conceptual para la Información Financiera respecto a la definición de pasivos, provisiones o pasivos contingentes, lo cual podría producir un impacto relevante en los estados financieros, así como su inadecuada interpretación.

Summary Objectives The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers’ current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients. Methods A voluntary 27‐item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists. Results Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents’ patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%). Significance The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.

El presente artículo tiene como objetivo analizar los factores organizacionales que, desde la gestión educativa, garantizan la eficacia escolar en una institución privada del Callao. A través de la revisión de la bibliografía se contextualiza y define a la eficacia escolar, se recogen sus características y se identifican los factores organizacionales propios de esta. Asimismo, se definieron los temas preliminares. En base a estas categorías se estableció la guía de entrevista semiestructurada la cual fue aplicada a docentes de la institución previamente descrita. La información recogida y organizada como producto de la revisión bibliográfica fue contrastada con la información resultante de las entrevistas aplicadas. Fruto de la discusión e interpretación de los resultados se identificaron nueve factores organizacionales presentes en la institución analizada. Al final de la investigación se concluye que existe presencia de factores organizacionales en la institución, además se asume que la eficacia escolar no se logra siguiendo una fórmula o lista de cotejo, pues su logro depende de variables propias de cada escuela.

Abstract The poor prognosis of pancreatic ductal adenocarcinoma (PDAC) is attributed to the highly fibrotic stroma and complex multi-cellular microenvironment that is difficult to fully recapitulate in pre-clinical models. To fast-track translation of therapies and to inform personalised medicine, we aimed to develop a whole-tissue ex vivo explant model that maintains viability, 3D multicellular architecture, and microenvironmental cues of human pancreatic tumours. Patient-derived surgically-resected PDAC tissue was cut into 1–2 mm explants and cultured on gelatin sponges for 12 days. Immunohistochemistry revealed that human PDAC explants were viable for 12 days and maintained their original tumour, stromal and extracellular matrix architecture. As proof-of-principle, human PDAC explants were treated with Abraxane and we observed different levels of response between patients. PDAC explants were also transfected with polymeric nanoparticles + Cy5-siRNA and we observed abundant cytoplasmic distribution of Cy5-siRNA throughout the PDAC explants. Overall, our novel model retains the 3D architecture of human PDAC and has advantages over standard organoids: presence of functional multi-cellular stroma and fibrosis, and no tissue manipulation, digestion, or artificial propagation of organoids. This provides unprecedented opportunity to study PDAC biology including tumour-stromal interactions and rapidly assess therapeutic response to drive personalised treatment.

Recent research has shown that cultural, linguistic, and sociodemographic peculiarities influence the measurement of trait emotional intelligence (trait EI). Assessing trait EI in different populations fosters cross-cultural research and expands the construct’s nomological network. In mental health, the trait EI of clinical populations has been scarcely researched. Accordingly, the present study examined the relationship between trait EI and key sociodemographic variables on Trait Emotional Intelligence Questionnaire (TEIQue-SF) datasets with mental healthcare patients from three different Spanish-speaking countries. Collectively, these datasets comprised 528 participants, 23% from Chile (120), 28% from Peru (150), and 49% from Spain (258). The sociodemographic variables we used for trait EI comparisons were gender, age, educational level, civil status, and occupational status. Analyses involved Multigroup Exploratory Structural Equation Modelling (to test measurement invariance) and analysis of covariance (ANCOVA). Our results revealed significant between-country differences in trait EI across the studied sociodemographic variables and interactions between these variables. Measurement invariance across the datasets was attained up to the scalar level regarding gender and education (i.e., strong invariance), although analyses on age, civil status, and occupation displayed non-invariance. The resultant psychometric evidence supports the suitability of the TEIQue-SF for the accurate cross-cultural assessment of trait EI in mental health settings. It also highlights the importance of incorporating trait EI into extant psychotherapeutic frameworks to enhance non-pharmacological treatment efficacy.

Parental burnout is a unique and context-specific syndrome resulting from a chronic imbalance of risks over resources in the parenting domain. The current research aims to evaluate the psychometric properties of the Spanish version of the Parental Burnout Assessment (PBA) across Spanish-speaking countries with two consecutive studies. In Study 1, we analyzed the data through a bifactor model within an Exploratory Structural Equation Modeling (ESEM) on the pooled sample of participants (N = 1,979) obtaining good fit indices. We then attained measurement invariance across both gender and countries in a set of nested models with gradually increasing parameter constraints. Latent means comparisons across countries showed that among the participants’ countries, Chile had the highest parental burnout score, likewise, comparisons across gender evidenced that mothers displayed higher scores than fathers, as shown in previous studies. Reliability coefficients were high. In Study 2 (N = 1,171), we tested the relations between parental burnout and three specific consequences, i.e., escape and suicidal ideations, parental neglect, and parental violence toward one’s children. The medium to large associations found provided support for the PBA’s predictive validity. Overall, we concluded that the Spanish version of the PBA has good psychometric properties. The results support its relevance for the assessment of parental burnout among Spanish-speaking parents, offering new opportunities for cross-cultural research in the parenting domain.

Objetivo: Comprender las definiciones y propiedades de la Teoría de Probabilidades a fin de considerarlas en la evaluación de la información financiera sobre contingencias, enfatizando el concepto de probabilidad. Método: La investigación es de enfoque cualitativo, de tipo exploratorio y parcialmente descriptivo, de diseño no experimental y transversal, con supuestos hipotéticos, sobre la base del análisis de información, estudio de casos y entrevistas semiestructuradas. Resultados: Las contingencias son reveladas en las notas más que ser reconocidas en los estados financieros. El nivel de revelación no es suficiente en cuanto a los juicios aplicados en las estimaciones, así como en la impracticabilidad de los mismos y su racionalidad. Conclusiones: El concepto de probabilidad en las Normas Internacionales de Información Financiera difiere del concepto establecido en la Teoría de Probabilidades. La estimación de las probabilidades debe considerar la naturaleza y características de la contingencia y la probabilidad de ocurrencia del evento, traducido en ganar o perder un litigio, considerando el enfoque bayesiano, puesto que mide la creencia sobre la ocurrencia de un evento.

Abstract Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can have insidious symptoms which may lead to acute liver failure and death. Prompt recognition, stopping offending drug, and initiating corticosteroid are the mainstay of treatment. Early involvement of a specialist liver unit is vital.

BackgroundTuberculosis (TB) is a disease associated with poverty. Moreover, a significant proportion of TB patients face a substantial financial burden before and during TB care. One of the top targets in the End TB strategy was to achieve zero catastrophic costs due to TB by 2020. To assess patient costs related to TB care and the proportion of TB-affected households that faced catastrophic costs, the Philippines National TB Programme (NTP) conducted a national TB patient cost survey in 2016-2017.MethodsA cross-sectional survey of 1,912 TB patients taking treatment in health facilities engaged with the NTP. The sample consists of 786 drug-sensitive TB (DS-TB) patients in urban facilities, 806 DS-TB patients in rural facilities, and 320 drug-resistant TB (DR-TB) patients. Catastrophic cost due to TB is defined as total costs, consisting of direct medical and non-medical costs and indirect costs net of social assistance, exceeding 20% of annual household income.ResultsThe overall mean total cost including pre- and post-diagnostic costs was US$601. The mean total cost was five times higher among DR-TB patients than DS-TB patients. Direct non-medical costs and income loss accounted for 42.7% and 40.4% of the total cost of TB, respectively. More than 40% of households had to rely on dissaving, taking loans, or selling their assets to cope with the costs. Overall, 42.4% (95% confidence interval (95% CI): 40.2-44.6) of TB-affected households faced catastrophic costs due to TB, and it was significantly higher among DR-TB patients (89.7%, 95%CI: 86.3-93.0). A TB enabler package, which 70% of DR-TB patients received, reduced catastrophic costs by 13.1 percentage points (89.7% to 76.6%) among DR-TB patients, but only by 0.4 percentage points (42.4% to 42.0%), overall.ConclusionsTB patients in the Philippines face a substantial financial burden due to TB despite free TB services provided by the National TB Programme. The TB enabler package mitigated catastrophic costs to some extent, but only for DR-TB patients. Enhancing the current social and welfare support through multisectoral collaboration is urgently required to achieve zero catastrophic costs due to TB.

Early childhood is a sensitive period for development, and it is important to use psychometrically sound instruments to assess the child's developmental abilities. The International Development and Early Learning Assessment (IDELA) represents an innovative, feasible and low-cost assessment tool for preschool children that evaluates motor development, pre-numeracy, pre-literacy, and socioemotional development. These areas of development represent “key” skills for early development and school readiness. The objectives of this study were to translate the IDELA to Brazilian Portuguese, to conduct its cultural adaptation to the Brazilian population, to analyze its content validity, to assess its inter-rater reliability, to analyze the internal consistency of its sub-domains and to investigate associations between the child's IDELA scores and sociodemographic characteristics of the family. This was a descriptive, cross-sectional study, in which a sample of 565 preschool children were assessed with the IDELA in the city of Embu das Artes, São Paulo. Results indicated that the IDELA was successfully translated and culturally adapted to the Brazilian population, presenting adequate content validity, good internal consistency of its sub-domains and very high inter-rater reliability. Among the evaluated children, the girls' mean scores were higher than the boys' mean scores; 5-year-old children had higher scores than 4-year-old children; a positive correlation was observed between maternal education and the children's mean scores in the total IDELA, the pre-mathematics and the socioemotional subdomains. In conclusion, the Brazilian version of the IDELA proved to be feasible, adequate and reliable to assess early childhood development and school readiness of preschool age children in Brazil. Future studies could use the IDELA to provide relevant data about the children's development and school readiness in other Brazilian regions that will be useful in the planning of public health and education policies to improve children's integral development and their academic achievement.

The dopamine transporter (DAT) regulates the dimension and duration of dopamine transmission. DAT expression, its trafficking, protein–protein interactions, and its activity are conventionally studied in the CNS and within the context of neurological diseases such as Parkinson’s Diseases and neuropsychiatric diseases such as drug addiction, attention deficit hyperactivity and autism. However, DAT is also expressed at the plasma membrane of peripheral immune cells such as monocytes, macrophages, T-cells, and B-cells. DAT activity via an autocrine/paracrine signaling loop regulates macrophage responses to immune stimulation. In a recent study, we identified an immunosuppressive function for DAT, where blockade of DAT activity enhanced LPS-mediated production of IL-6, TNF-α, and mitochondrial superoxide levels, demonstrating that DAT activity regulates macrophage immune responses. In the current study, we tested the hypothesis that in the DAT knockout mice, innate and adaptive immunity are perturbed. We found that genetic deletion of DAT (DAT−/−) results in an exaggerated baseline inflammatory phenotype in peripheral circulating myeloid cells. In peritoneal macrophages obtained from DAT−/− mice, we identified increased MHC-II expression and exaggerated phagocytic response to LPS-induced immune stimulation, suppressed T-cell populations at baseline and following systemic endotoxemia and exaggerated memory B cell expansion. In DAT−/− mice, norepinephrine and dopamine levels are increased in spleen and thymus, but not in circulating serum. These findings in conjunction with spleen hypoplasia, increased splenic myeloid cells, and elevated MHC-II expression, in DAT−/− mice further support a critical role for DAT activity in peripheral immunity. While the current study is only focused on identifying the role of DAT in peripheral immunity, our data point to a much broader implication of DAT activity than previously thought. This study is dedicated to the memory of Dr. Marc Caron who has left an indelible mark in the dopamine transporter field.

Este artículo está orientado a analizar la forma en la que se han estructurado territorialmente algunas ciudades grandes, en especial Bogotá, para el cumplimiento de propósitos de desconcentración y fortalecimiento de la democracia local. Mediante una revisión normativa y bibliográfica se pudo identificar las similitudes y diferencias existentes entre la estructura propia de Bogotá y otras ciudades capitales como Quito, Ciudad de México, Buenos Aires, Brasilia y Madrid. Lo anterior con el propósito de demostrar que, aunque las normas más importantes que rigen para Bogotá le otorgaron un estatus especial a las localidades, como sucede con las divisiones territoriales de algunas de las otras ciudades analizadas, en la práctica, su diseño las orientó al cumplimiento de funciones de gestión y de apoyo a los organismos centrales, restringiendo su rol en el cumplimiento de funciones propias orientadas a la gestión de los asuntos propios de sus comunidades.

Background: Anxiety and depression remain underdiagnosed in routine clinical practice in up to two thirds of epilepsy patients despite significant impact on medical and psychosocial outcome. Barriers to adequate mental health care for epilepsy and/or psychogenic non-epileptic seizures (PNES) include a lack of integrated mental health specialists and standardized procedures. This naturalistic study outlines the procedures and outcome of a recently established psychotherapeutic service.Methods: Routine screening included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, cut-off value > 13) and Generalized Anxiety Disorder scale (GAD-7, cut-off value > 5). Positively (above cut-off in at least one questionnaire) screened patients were seen for a standardized interview for mental health disorders and the development of a personalized treatment plan. PNES patients were seen irrespective of their screening score. Resources were provided to support self-help and access to psychotherapy. Patients were contacted 1 month after discharge to evaluate adherence to therapeutic recommendations.Results: 120 patients were screened. Overall, 56 of 77 positively screened patients (77%) were found to have a psychiatric diagnosis through standardized interview. More epilepsy patients with an anxiety disorder had previously been undiagnosed compared to those with a depressive episode (63% vs. 30%); 24 epilepsy patients (62%) with a psychiatric comorbidity and 10 PNES patients (59%) were not receiving any mental health care. At follow-up, 16/17 (94%) epilepsy patients and 7/7 PNES patients without prior psychiatric treatment were adhering to therapeutic recommendations.Conclusion: Integrating mental health specialists and establishing standardized screening and follow-up procedures improve adherence to mental health care recommendations in epilepsy and PNES patients.

Positive psychology and positive organizational behavior studies recognize that leadership is extremely important for generating positive well-being. Despite the frequently reported significant positive correlations, the causal long-term relationship between leadership, positive high intense affect, and employee results remains unclear. The main objective of this study was to analyze the long-term (longitudinal) relation of transformational leadership and positive high-intensity emotions with employee group satisfaction, commitment, and proactive behavior. We built a longitudinal structural equation model to test a mediation model with two time points; 2,480 workers from 166 work units completed questionnaires at both time points. Our results reveal that positive high-intensity emotions mediate the relation between transformational leadership and proactive behavior of workers, the bidirectional relations between the variables were also analyzed. The present study is, to our knowledge, the first analyzing the long-term effect of TFL and collective high-intensity emotions on worker’s results longitudinally. Our findings reflect the great complexity of affect and affect-related results in organizations and highlight the need for more longitudinal research to clarify emotional processes at work.

En la actualidad la arquitectura enfrenta un proceso de globalización con patrones que están cambiando las estructuras urbanas, sociales, económicas y culturales hacia el paradigma de la complejidad, con dinámicas en constante interacción, resultando para los estudios urbanos un conjunto intrincado y difícil de comprender. Este cambio requiere una visión sistémica para reconocer tanto las propiedades del objeto, como el comportamiento de los sujetos en torno a un sistema arquitectónico, que en conjunto suman más que el todo. Es importante la reflexión desde la academia, asumiendo una enseñanza interdisciplinar y con una visión epistemológica desde el sur global.

Los valores de un programa son los postulados éticos que deben regir los currículos y todas las actividades de los directivos, docentes y estudiantes. Se hace una reflexión acerca de los valores de Facultad de Medicina de la Universidad de Cartagena, se explicita su significado y se hace énfasis en la importancia de su interiorización y aplicación en los diversos procesos de la vida del programa, en especial en el quehacer de los individuos que la representan. Rev.cienc.biomed. 2011; 2(1): 154-157

Las micro y pequeñas empresas representan un 85 % en la industria del software. Se les caracteriza por el uso de los modelos de calidad tanto del proceso como del producto. En una investigación descriptiva con 80 mypes se observa mayor uso de modelos de calidad de proceso y menor uso para calidad de producto, aunque muestran un conocimiento de los factores de calidad.

O Núcleo de Apoio à Saúde da Família (NASF) foi criado pelo Ministério da Saúde em 2008 e implantado em vários municípios do país buscando fortalecer a Estratégia de Saúde da Família (ESF), proposta central da atenção primária à saúde. Diante da incipiente proposta da política de saúde, com objetivo de conhecer o tra-balho desenvolvido pelo NASF, buscamos compreender o funcionamento de uma equipe de um município da região da grande Belo Horizonte. O estudo focou a realização do apoio matricial na relação dos profissionais do NASF com os profissionais das equipes de saúde da família. Foi utilizado como método, a observação partici-pante e o diário de campo numa abordagem qualitativa de aproximação da temática. Verificou-se que o apoio matricial desenvolvido por essa equipe ainda está em construção. Nota-se dificuldades como a pouca compre-ensão de gestores, usuários, profissionais de saúde, inclusive os próprios integrantes do NASF, sobre a proposta de trabalho, além da organização e das condições de trabalho, por vezes, apresentarem-se desfavoráveis para a realização do apoio.

The liver parenchyma consists of several cell types, but the origin of this tissue in humans is unclear. Here, the authors perform single cell RNA sequencing of human fetal and adult liver to identify a hepatobiliary hybrid progenitor population of cells, which have a similar gene signature to mouse oval cells.

Patients with autoimmune liver disease frequently fit diagnostic criteria for more than one condition. Up to 12.5% of autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC) cohorts have a label of AIH/PSC overlap. There can be an interval of many years between the diagnoses of the two conditions, and the sequence in which they are made is unpredictable. Issues exist with the use of diagnostic criteria validated for AIH in patients with AIH/PSC overlap. There are no agreed criteria for the diagnosis of AIH/PSC overlap, it is based on a combination of biochemistry, autoantibody profile, cholangiogram, and liver histology. A positive diagnosis of AIH/PSC overlap impacts therapeutic options and prognosis. There is a beneficial role for immunosuppression, albeit with a higher relapse rate and evidence of progressive liver disease despite immunosuppression in some cases. Liver related outcomes sit somewhere between the constituent diseases, with better outcomes than PSC but poorer outcomes than AIH. There is an increasing body of data for patients with AIH/PSC overlap undergoing liver transplantation for end-stage disease. Nearly half of patients with autoantibody positive liver disease in childhood have autoimmune sclerosing cholangitis (ASC). ASC patients are differentiated from those with AIH by having abnormal cholangiograms. Histological analysis shows chronic hepatitis in