The virtual patient as a learning tool: A mixed quantitative qualitative study

Background: The use of simulation in medical education has been widely accepted. There are different types of medical simulators that vary in both accuracy to emulate the real world (fidelity) and cost of development or acquisition. There is significant evidence that supports the use of high-fidelity simulators (i.e. mannequins or dummies) to prepare students for clinical environments, less attention has been given to low-fidelity simulators. This article aims to present evidence regarding the effectiveness of a low-fidelity simulator: Virtual Patient (VP), which develops several interactive computer-based clinical scenarios, seeking to promote an alternative learning environment and the development of necessary medical skills such as clinical reasoning in students of medicine. Methods: A quasi-experimental study was designed to investigate the results on the development of history taking and clinical reasoning skills in a group of undergraduate medical students, in a course devised under the concepts of constructivism in education, which used the Virtual Patient as the fundamental teaching tool. Results were measured through a mixed, quantitative and qualitative study, triangulating the results of the students' skills evaluation when facing a clinical case represented by an actor patient before and after the course. Additionally, the description of the students' and tool's performance was measured by way of a qualitative study. Results: The comparison of the students' skills on the evaluation matrix before-and-after the course evidenced a statistically significant advance (p less than 0.01) in all aspects (interview, physical exam, clinical judgment, relevance of medical exams, and presentation of case). Students described the VP as an easy-to-use and motivating tool for learning without stress, especially at the beginning of their career. VP allowed them to create logical and structured processes, to be wrong without consequences, and to review and reassess information available. From the professor perspective, it allowed a better follow-up of the students' learning process and favored reflections on the teaching-learning process. Conclusions: VP proved to be a valuable and useful tool for the development of clinical reasoning and history taking skills in medical students, as part of a constructivist learning course. © 2018 The Author(s)

Factores de riesgo relacionados con Apgar bajo y complicaciones neonatales

Introducción: El puntaje de Apgar evalúa el estado clínico del recién nacido al momento de nacer, este estudio describe los factores de riesgo que presentaron estos pacientes y sus complicaciones durante el periodo neonatal. Objetivo: Identificar los factores de riesgo perinatales que presentaron los pacientes con puntaje APGAR bajo (menor de 7 al minuto y normal a los 5 minutos), persistentemente bajo (menor de 7 a los 5 minutos) y las complicaciones neonatales en una clínica en Barranquilla del 1-julio-2022 al 31-diciembre-2022. Metodología: Es un estudio observacional de corte transversal descriptivo a partir de historias clínicas de recién nacidos con Apgar bajo en una clínica de Barranquilla, Atlántico, los datos se registraron en una matriz de Excel y posteriormente se analizaron con el software SPSS v25. Resultados: Se revisaron 1288 historias clínicas, de las cuales 3.1% presentó APGAR bajo al minuto y 0.3% Apgar persistentemente bajo, el factor de riesgo más asociado con Apgar persistentemente bajo fue una menor edad gestacional al momento del nacimiento y la enfermedad hipertensiva asociada al embarazo con un 17.5%. Discusión y Conclusión: En este estudio se evidencio que el puntaje Apgar persistentemente bajo se relaciona a menor edad gestacional y dentro de los factores de riesgo maternos se encontró relación con hipertensión arterial asociada al embarazo.Universidad Libre Seccional Barranquilla -- Facultad de Ciencias de la Salud -- Especialización en PediatríaBackground: Apgar score is a scoring system that evaluates the clinical state of a newborn at moment of birth, this study describes the risk factors of these patients and their complications during the neonatal period. Objective: Identify the perinatal risk factors presented on patients with low Apgar score (below 7 at 1 minute and normal at 5 minutes), persistently low (below 7 at 5 minutes) and the neonatal complications at a Barranquilla clinic between July 1st 2022 and December 31st, 2022 Methodology: A descriptive cross-sectional observational study was carried out with newborns Clinical records with low Apgar at a Barranquilla city clinic, the data was registered on Excel matrix and then analyzed with SPSS v25 software. Results: 1288 clinical records were reviewed, which 3,1% presented low Apgar score at 1 minute and 0,3% persistently low Apgar score, the high-risk factor associated with persistent low Apgar was a lower gestational age at birth and hypertension disorders of pregnancy with a 17,5% Discussion and Conclussion: In this study it was evidenced that the persistently low Apgar score is related to a lower gestational age and within the maternal risk factors a relation was found with hypertension disorders of pregnancy

Predictor Model of the Supply Chain Effectiveness based on Critical Success Factors in a Commerce Retail Industry

The business environments of the globalized economy present increasing complexity under highly variable conditions of volatility, risk, and uncertainty that exert intense pressures on retailers; some of them develop programs for the improvement of the supply chain. This paper is about determining the factors of the supply chain and the development of a structural equation model. The first section presents the background, the description of the problem and a literature search of the Supply Chain factors and their classification. The Methodology section explains the development of a questionnaire as a measuring instrument based on the identified factors. The validation of the questionnaire was with the Cronbach alpha index, and then it applied to a sample of retailers in central Mexico. Using the Partial Least Squares Structural Equation Modelling Approach, the development of a structural model identified the key driver factors related to the improvement of the Supply Chain. In results report the most important factors: 1) supplier’s quality of the goods, 2) internal factors, 3) after-sale service, and 4) road infrastructure and 5) commercial environment, for commerce retail industry in México.Os ambientes de negócios da economia globalizada apresentam complexidade crescente sob condições altamente variáveis ​​de volatilidade, risco e incerteza que exercem intensa pressão sobre os varejistas; alguns deles desenvolvem programas para a melhoria da cadeia de suprimentos. Este artigo trata da determinação dos fatores da cadeia de suprimentos e do desenvolvimento de um modelo de equação estrutural. A primeira seção apresenta os antecedentes, a descrição do problema e uma pesquisa bibliográfica dos fatores da Cadeia de Suprimentos e sua classificação. A seção Metodologia explica o desenvolvimento de um questionário como instrumento de medição baseado nos fatores identificados. A validação do questionário foi com o índice alfa de Cronbach e, em seguida, aplicado a uma amostra de varejistas na região central do México. Utilizando a Abordagem de Modelagem de Equações Estruturais de Mínimos Quadrados Parciais, o desenvolvimento de um modelo estrutural identificou os principais fatores impulsionadores relacionados à melhoria da Cadeia de Suprimentos. Nos resultados relatam os fatores mais importantes: 1) qualidade do fornecedor das mercadorias, 2) fatores internos, 3) serviço pós-venda, e 4) infraestrutura rodoviária e 5) ambiente comercial, para o setor de comércio varejista no México

Proliferative papulo-nodular glossitis due to <i>Leishmania infantum</i> in a dog

Canine leishmaniosis, caused by the protozoan Leishmania infantum, is an endemic vector‐borne disease in Europe. From a diagnostic point of view, the disease can sometimes be a real challenge for the clinician, due to the variability of clinical presentations in a sick dog. These clinical signs can be classified, based on the frequency of presentation, in typical and atypical signs. In dogs is common to find different clinical presentations of cutaneous disease and systemic involvement, while clinical presentations in mucosa are not so common. A 6‐year‐old, entire, male German shepherd crossbred dog was examined for evident nodular lesions on the tongue. The most important laboratory alteration detected was hyperglobulinemia with an increase in the gamma fraction classified as polyclonal gammopathy. High anti‐Leishmania antibodies were detected by ELISA. Tongue biopsy samples were obtained from the lesions with the presence of a diffuse inflammatory infiltrate characterised by macrophages and neutrophils with no compatible forms of Leishmania parasites. However, the presence of Leishmania amastigotes was confirmed by specific immunohistochemistry. A good clinical response to the anti‐Leishmania based on meglumine antimoniate and allopurinol was observed after meglumine antimoniate administration. This clinical case describes the presentation of proliferative papulo‐nodular glossitis in an L. infantum‐positive dog as the most evident clinical finding reported

Exploring Mechanisms of Selective Directed Forgetting

While some studies have shown that providing a cue to selectively forget one subset of previously learned facts may cause specific forgetting of this information, little is known about the mechanisms underlying this memory phenomenon. In three experiments, we aimed to better understand the nature of the selective directed forgetting (SDF) effect. Participants studied a List 1 consisting of 18 sentences regarding two (or three) different characters and a List 2 consisting of sentences regarding an additional character. In Experiment 1, we explored the role of rehearsal as the mechanism producing SDF by examining the effect of articulatory suppression after List 1 and during List 2 presentation. In Experiments 2 and 3, we explored the role of attentional control mechanisms by introducing a concurrent updating task after List 1 and during List 2 (Experiment 2) and by manipulating the number of characters to be selectively forgotten (1 out of 3 vs. 2 out of 3). Results from the three experiments suggest that neither rehearsal nor context change seem to be the mechanisms underlying SDF, while the pattern of results is consistent with an inhibitory account. In addition, whatever the responsible mechanism is, SDF seems to rely on the available attentional resources and the demands of the task. Our results join other findings to show that SDF is a robust phenomenon and suggest boundary conditions for the effect to be observed.The current research was completed thanks to financial aid provided by the doctoral research grant FPI BES-2009-026811 to CA, and by grants from the Spanish Ministerio de Economía y Competitividad to MB (PSI2012-33625, PSI2015-65502, and PCIN-2015-132), and to CG-A (PSI2011-25797 and PSI2015-65502-C2-2-P), and by the Andalusian Government to MB (P12-CTS-2369-Fondos Feder)

Technological transformation in HRM through knowledge and training: Innovative business decision making

Human resource management (HRM) is a crucial aspect of the global economy, and there is a wealth of literature available on various aspects of managing human resources. There is a need to take these concepts and turn them into practical applications, and organizations and academic institutions have a vital role to play. By providing training and digital tools to enhance innovation and decision making, these entities can prepare the next generation of human resources and business leaders for the challenges they may face. This is especially relevant in light of the economic impact of pandemics and other unpredictable global events, which can have long-lasting effects on the economy. To address these challenges, a study was conducted to explore the potential use of business game simulators (BGS) as a solution. The results of the study are promising, showing that BGS can enhance pandemic preparedness, increase competitiveness, and provide a more comprehensive organizational viewpoint. To explore this hypothesis, the study used specific constructs, which were subjected to empirical processing and analysis. The results indicate that simulating past pandemics through BGS can help HRM and businesses be better prepared for future crises, and the BGS learning approach can offer a more realistic, global perspective for organization

Gobernanza en Iberoamérica: un reto para su seguridad y soberanía alimentaria

Antecedentes/Objetivos: El discurso político sobre el reto de la desnutrición ha aumentado y llevado a acuerdos nacionales e internacionales. Pero existe un nivel crucial de acción descuidado, centrado en los entornos y procesos que sustentan las políticas y su implementación. Se pretende analizar los factores de la gobernanza que influyen en el impulso de las políticas de nutrición en Iberoamérica, comparándolos con un grupo de países desarrollados, en 2012. Métodos: Estudio transversal ecológico para 2012, que utiliza el país como unidad de análisis (iberoamericanos, Canadá, nórdicos y España) sobre relación entre la gobernanza y 1. Seguridad alimentaria (SeA) y 2. Soberanía alimentaria (SoA). Fuentes información: Estadísticas de Naciones Unidas, Banco Mundial, FAO y UNICEF. Se realizo un modelo de regresión lineal simple, y ajustado por riqueza. Resultados: Controlado por la riqueza del país se detectan asociaciones entre las variables de seguridad alimentaria y soberanía alimentaria con las de gobernanza: La efectividad gubernamental se relaciona con el acceso al agua R2 = 67,4% (p = 0,002), prevalencia de subnutrición R2 = 44,9% (p = 0,02) intensidad déficit alimentario R2 = 51,5% (p = 0,03), desnutrición aguda R2 = 52,1% (p = 0,01). La voz y rendición de cuentas con el acceso al agua R2 = 66,4% (p = 0,003), desnutrición aguda R2 = 49,1% (p = 0,02). El estado de derecho con el acceso al agua R2 = 66,4% (p = 0,003), desnutrición aguda R2 = 51,1% (p = 0,01). El control de la corrupción con el acceso al agua R2 = 71,4% (p = 0,01), desnutrición aguda R2 = 49,8% (p = 0,02). La transparencia con el acceso al agua R2 = 69,5% (p = 0,001), desnutrición aguda R2 = 50,9% (p = 0,01). Y la calidad regulatoria con el acceso al agua R2 = 55,4% (p = 0,05) y desnutrición aguda R2 = 52,9% (p = 0,009). Conclusiones: La efectividad gubernamental es la condición de la gobernanza más ligada a la seguridad y soberanía alimentaria en los países Iberoamericanos. La disponibilidad de agua potable mejorada, se relaciona con todas las categorías de la gobernanza, y la desnutrición aguda con la mayoría. Siendo importante el impulso político para dar respuesta a la población vulnerable necesitada, las intervenciones para fomentar la disponibilidad, utilización y acceso a los alimentos todavía precisan mejorar y evaluar los procesos de toma de decisiones, y los procesos por los que las decisiones son implementadas, o no.Proyecto Prometeo. SENESCYT, Ecuador

¿Qué es la psicología para los estudiantes españoles de educación a distancia?

Se aplicó a los estudiantes de Psicología de la Universidad Nacional de Educación a Distancia en España (UNED) una modificación de la escala estandarizada por Thiriat (1981) y que ha sido utilizada (con más o menos cambios) en casi la totalidad de los trabajos de este tipo. En la encuesta se indaga sobre el autor, la obra y el fenómeno que considerasen como los más destacados de nuestra disciplina. También se les pedía que eligiesen entre varias definiciones de psicología y de diferentes conceptos relevantes como el pensamiento, la inteligencia o la mente. Por último, se les requería una valoración de diferentes aspectos de la psicología y de la propia psicología en su conjunto en comparación con otros campos del saber. Se concluye comparando los resultados obtenidos en este trabajo con otros similares realizados con otras poblacione

Changes in white adipose tissue metabolism induced by resveratrol in rats

Background: A remarkable range of biological functions have been ascribed to resveratrol. Recently, this polyphenol has been shown to have body fat lowering effects. The aim of the present study was to assess some of the potential underlying mechanisms of action which take place in adipose tissue. Methods: Sixteen male Sprague-Dawley rats were randomly divided into two groups: control and treated with 30 mg resveratrol/kg body weight/d. All rats were fed an obesogenic diet and after six weeks of treatment white adipose tissues were dissected. Lipoprotein lipase activity was assessed by fluorimetry, acetyl-CoA carboxylase by radiometry, and malic enzyme, glucose-6P-dehydrogenase and fatty acid synthase by spectrophotometry. Gene expression levels of acetyl-CoA carboxylase, fatty acid synthase, lipoprotein lipase, hormone-sensitive lipase, adipose triglyceride lipase, PPAR-gamma, SREBP-1c and perilipin were assessed by Real time RT-PCR. The amount of resveratrol metabolites in adipose tissue was measured by chromatography. Results: There was no difference in the final body weight of the rats; however, adipose tissues were significantly decreased in the resveratrol-treated group. Resveratrol reduced the activity of lipogenic enzymes, as well as that of heparin-releasable lipoprotein lipase. Moreover, a significant reduction was induced by this polyphenol in hormone-sensitive lipase mRNA levels. No significant changes were observed in other genes. Total amount of resveratrol metabolites in adipose tissue was 2.66 +/- 0.55 nmol/g tissue. Conclusions: It can be proposed that the body fat-lowering effect of resveratrol is mediated, at least in part, by a reduction in fatty acid uptake from circulating triacylglycerols and also in de novo lipogenesis.This study was supported by grants from the Ministerio de Ciencia e Innovacion (AGL2008-1005-ALI and partially by the AGL2006-14228-C03-02), Instituto de Salud Carlos III (RETIC PREDIMED) and the Government of Pais Vasco (IT-386-10; CTP09/R5). G. Alberdi is a recipient of a doctoral fellowship from the Ministerio de Ciencia e Innovacion. Resveratrol was a generous gift from Monteloeder (Elche, Alicante, Spain)

Muerte de neuronas colinérgicas de la región basal por necrosis y apoptosis, así como alteración de la densidad de espinas dendríticas tras la exposición aguda y a largo plazo a clorpirifos: Implicaciones legales del uso del perfil toxicogenómico como biomarcador de efectos dañinos inducidos a dosis subclínicas

Introduction: Chlorpyrifos (CPF) is an organophosphate insecticide reported to induce both after acute and repeated exposure learning and memory dysfunctions, although the mechanism is not completely known. CPF produces basal forebrain cholinergic neuronal loss, involved on learning and memory regulation, which could be the cause of such cognitive disorders. This effect was reported to be mediated through apoptotic process, although neuronal necrosis was also described after CPF exposure. Otherwise, neuronal dendritic spines were reported to be also involved on learning and memory process regulation and their alteration could also contribute to this effect. In this regard, CPF has been reported to induce an alteration in the dendritic spines density in the prefrontal cortex and hippocampus after acute and repeated exposure to subclinical doses respectively, thus their alteration in basal forebrain cholinergic neurons could also mediate cognitive disorders. Objectives and methods: Accordingly, we hypothesized that CPF induces basal forebrain cholinergic dendritic spine alteration at low concentrations and at higher concentrations produces necrotic and apoptotic cell death. We evaluated in septal SN56 basal forebrain cholinergic neurons, the CPF effect after 24 h and 14 days exposure on dendritic spines, the necrosis induction and the apoptotic and necrotic gene expression pathways. Results: This study shows that CPF induces after acute and long-term exposure an alteration of dendritic spines at lower concentrations than which induces cell death. Evaluation of cell death pathways and genes related to dendritic spine plasticity revealed that some of them are altered at lower concentrations than which produces the effects observed and below the No Observed Adverse Effect (NOAEL). Conclusions: The present finding suggest that the use of gene expression profile could be a more sensitive and accurate way to determine the NOAEL.Introducción: El clorpirifos (CPF) es un insecticida organofosforado que tras la exposición aguda y repetida, induce disfunciones de los procesos de aprendizaje y memoria, aunque el mecanismo por el cual se produce este efecto no se conoce por completo. El CPF produce en la región cerebral basal anterior la pérdida de neuronas colinérgicas, que participan en la regulación de los procesos de aprendizaje y la memoria, pudiendo ser esta la causa de tales trastornos cognitivos. Se ha observado que este efecto está mediado a través del proceso de apoptosis, aunque también se ha descrito que se produce necrosis neuronal tras la exposición a CPF. Por otra parte, también se ha demostrado que las espinas dendríticas participan en la regulación de los procesos de aprendizaje y memoria y su disrupción también podría contribuir a la alteración de dichos procesos. En este sentido, se ha descrito que el CPF altera la densidad de las espinas dendríticas en la corteza prefrontal y el hipocampo tras la exposición aguda y repetida a dosis subclínicas, respectivamente, por lo que su perturbación en las neuronas colinérgicas de la región basal anterior también podría mediar estos trastornos cognitivos. Objetivos y métodos: De acuerdo con lo expuesto, nosotros hipotetizamos que el CPF induce, en las neuronas colinérgicas de la región basal anterior, una alteración de las espinas dendríticas a bajas concentraciones y a concentraciones más altas produce muerte celular por apoptosis y necrosis. Evaluamos en neuronas colinérgicas SN56 de la región basal anterior, el efecto del CPF después de 24 horas y 14 días de exposición sobre las espinas dendríticas, la inducción de necrosis y las vías de expresión génica que median la inducción de apoptosis y necrosis. Resultados: Este estudio demuestra que el CPF induce, tras la exposición aguda y a largo plazo, una alteración de las espinas dendríticas, a concentraciones más bajas de aquellas a las que induce la muerte celular. La evaluación de las vías de muerte celular y los genes relacionados con la plasticidad de la espina dendrítica reveló que algunos de estos genes están alterados a concentraciones más bajas de aquellas a las que producen muerte celular o alteración de las espinas dendríticas y por debajo del Nivel sin efecto adverso observable (NOAEL) . Conclusiones: El presente studio sugiere que el uso del perfil de expresión génica podría ser una manera más sensible y precisa para la determinación del NOAEL