Challenges and solutions for Latin American-trained international medical graduates in psychiatry residency

Objective: Latin American-trained international medical graduates (IMGs) in psychiatry residency face multiple challenges that go beyond their medical training. These challenges call for innovative problem-solving. Although the professional development of IMGs has been discussed in the professional literature, little is written about their experiences. In this report, a group of IMGs reflect on their experiences and describe how they solved challenges. Method: Using cogenerative ethnography, four IMGs trained in Colombia, the Dominican Republic, and Mexico provided insights on their challenges and solutions while adapting to psychiatric residency training. Individual interviews, focused discussion, and written reports were analyzed using data reduction, data display, and conclusion-drawing techniques. Results: We illustrate the challenges of IMG training in psychiatry using their reflections and stories. We categorize these challenges into three domains: immigration and acculturation, social adjustment, and medical training. Quotes were selected to illustrate IMGs’ challenges and coping strategies. Conclusion: Some of the combined cultural, social, and academic challenges of Latin American-trained IMGs in psychiatry residency are described. Recognizing and planning for the personal challenges of IMGs in psychiatry can enhance the transition into psychiatric training. Ultimately, improvements in IMG training converts into improved healthcare for all patients

Challenges and solutions for Latin American-trained international medical graduates in psychiatry residency

Objective: Latin American-trained international medical graduates (IMGs) in psychiatry residency face multiple challenges that go beyond their medical training. These challenges call for innovative problem-solving. Although the professional development of IMGs has been discussed in the professional literature, little is written about their experiences. In this report, a group of IMGs reflect on their experiences and describe how they solved challenges. Method: Using cogenerative ethnography, four IMGs trained in Colombia, the Dominican Republic, and Mexico provided insights on their challenges and solutions while adapting to psychiatric residency training. Individual interviews, focused discussion, and written reports were analyzed using data reduction, data display, and conclusion-drawing techniques. Results: We illustrate the challenges of IMG training in psychiatry using their reflections and stories. We categorize these challenges into three domains: immigration and acculturation, social adjustment, and medical training. Quotes were selected to illustrate IMGs’ challenges and coping strategies. Conclusion: Some of the combined cultural, social, and academic challenges of Latin American-trained IMGs in psychiatry residency are described. Recognizing and planning for the personal challenges of IMGs in psychiatry can enhance the transition into psychiatric training. Ultimately, improvements in IMG training converts into improved healthcare for all patients

BRAF and TERT mutations in papillary thyroid cancer patients of Latino ancestry.

Papillary thyroid cancer (PTC) is the second most commonly diagnosed malignancy in U.S. Latinas and in Colombian women. Studies in non-Latinos indicate that BRAF and TERT mutations are PTC prognostic markers. This study aimed to determine the prevalence and clinical associations of BRAF and TERT mutations in PTC Latino patients from Colombia. We analyzed mutations of BRAF (V600E) and TERT promoter (C228T, C250T) in tumor DNA from 141 patients (75 with classical variant PTC, CVPTC; 66 with follicular variant PTC, FVPTC) recruited through a multi-center study. Associations between mutations and clinical variables were evaluated with Fisher exact tests. Survival was evaluated with Kaplan-Meier plots. Double-mutant tumors (BRAF+/TERT+, n = 14 patients) were more common in CVPTC (P = 0.02). Relative to patients without mutations (n = 48), double mutations were more common in patients with large tumors (P = 0.03), lymph node metastasis (P = 0.01), extra-thyroid extension (P = 0.03), and advanced stage (P = 6.0 × 10-5). In older patients, TERT mutations were more frequent (mean age 51 years vs 45 years for wild type TERT, P = 0.04) and survival was lower (HR = 1.20; P = 0.017); however, given the small sample size, the decrease in survival was not statically significant between genotypes. Comparisons with published data in US whites revealed that Colombian patients had a higher prevalence of severe pathological features and of double-mutant tumors (10 vs 6%, P = 0.001). Mutations in both oncogenes show prognostic associations in Latinos from Colombia. Our study is important to advance Latino PTC precision medicine and replicates previous prognostic associations between BRAF and TERT in this population

Approach of Passive Filters using NSGA II in industrial installations: Part I

The optimization of passive filters in industrial systems has been presented by different computational methods. The objective of this paper is to develop a computational algorithm with NSGA II to select the configuration and design parameters of a set of passive filters for industrial installations. As a methodology, the optimization problem was addressed using three independent objective functions of innovative character for compensation of harmonics through passive filters as a multiobjective problem. The results were the computational solution to this problem that determines a set of Pareto optimal solutions (Frontier). In addition, the computational tool has several new features such as: calculates the parameters that characterize the filters, but also selects the type of configuration and the number of branches of the filter in each candidate bar according to a set of pre-established configurations according to PRODIST-M8 (Brazilian Standard) and IEEE 519-2014. Also determine solutions with good power quality indicators (THD, TDD and NPV) for several characteristic and non-characteristic scenarios of the system that allow to represent: daily variations of the load, and variations of system parameters and filters. It evaluates the cost of energy bills in an industrial power grid that has different operating conditions (characteristic scenarios) and evaluates the economic effect of harmonic filters as reactive power compensators

APORTE DE LOS MODELOS DE ASOCIATIVIDAD EMPRESARIAL EN ACTIVIDADES ECONÓMICAS SENSIBLES. ESTUDIO Y APLICACIÓN PARA EL SECTOR DE JUEGOS, SUERTE Y AZAR DE BOGOTÁ (COLOMBIA).

En este artículo se analizan las posibilidades de la asociatividad empresarial como respuesta a laproblemática que enfrentan un grupo de empresas involucradas del sector de juegos, suerte y azar dela ciudad de Bogotá y Cundinamarca, que son generadoras de empleo para muchas familiasindependientes. Se presenta una propuesta para que los colocadores independientes (promotores) deapuestas puedan conservar su actividad en el mercado, a través de una estrategia de asociatividad conla empresa que tiene la concesión para el aprovechamiento de la actividad económica mencionada. Através de una metodología exploratoria se hace un acercamiento conceptual a la asociatividadempresarial, realizando un trabajo interpretativo sobre los modelos más utilizados actualmente, asícomo de las experiencia exitosas en otros contextos geográcos

Construcción: temas y reflexiones

IlustracionesEEl presente volumen se estructura a partir de las diversas facetas que involucran lo construido, mediante las cuales el lector que se aproxime a este libro percibirá que sus autores actúan responsablemente al alertar a la sociedad sobre puntos críticos que deben ser tenidos en cuenta, si de lo que se trata es de advertir sobre los riesgos que para la sociedad implica desconocer, entre otras cosas, que lo construido es no solamente el ámbito en el 10 / Juan Pablo Duque Cañas que se establecen nuestros recuerdos, colectiva y frágilmente compartidos, sino también un factor de impacto prioritario cuyos peligros deben escudriñarse en búsqueda de nuevas posibilidades que nos permitan superar los graves problemas que el mismo espacio construido detona como resultado de equivocadas prácticas y concepciones

La gestión integral del territorio rural en la localidad de Ciudad Bolívar de Bogotá

Para contribuir a la solución de la problemática social y agroambiental, se formuló y ejecutó el proyecto ¨Asistencia agroambiental rural en la localidad de Ciudad Bolívar, articulada a la generación de proyectos temáticos integrales (PTI)¨, el cual articuló iniciativas de la comunidad aprobadas por la Alcaldía local con propuestas concertadas, fomuladas y desarrolladas participativamente (PTI), por diferentes grupos de gestión de productores de las nueve veredas de la localidad

Megalin/LRP2 Expression Is Induced by Peroxisome Proliferator-Activated Receptor -Alpha and -Gamma: Implications for PPARs' Roles in Renal Function

BACKGROUND: Megalin is a large endocytic receptor with relevant functions during development and adult life. It is expressed at the apical surface of several epithelial cell types, including proximal tubule cells (PTCs) in the kidney, where it internalizes apolipoproteins, vitamins and hormones with their corresponding carrier proteins and signaling molecules. Despite the important physiological roles of megalin little is known about the regulation of its expression. By analyzing the human megalin promoter, we found three response elements for the peroxisomal proliferator-activated receptor (PPAR). The objective of this study was to test whether megalin expression is regulated by the PPARs. METHODOLOGY/PRINCIPAL FINDINGS: Treatment of epithelial cell lines with PPARα or PPARγ ligands increased megalin mRNA and protein expression. The stimulation of megalin mRNA expression was blocked by the addition of specific PPARα or PPARγ antagonists. Furthermore, PPAR bound to three PPAR response elements located in the megalin promoter, as shown by EMSA, and PPARα and its agonist activated a luciferase construct containing a portion of the megalin promoter and the first response element. Accordingly, the activation of PPARα and PPARγ enhanced megalin expression in mouse kidney. As previously observed, high concentrations of bovine serum albumin (BSA) decreased megalin in PTCs in vitro; however, PTCs pretreated with PPARα and PPARγ agonists avoided this BSA-mediated reduction of megalin expression. Finally, we found that megalin expression was significantly inhibited in the PTCs of rats that were injected with BSA to induce tubulointerstitial damage and proteinuria. Treatment of these rats with PPARγ agonists counteracted the reduction in megalin expression and the proteinuria induced by BSA. CONCLUSIONS: PPARα/γ and their agonists positively control megalin expression. This regulation could have an important impact on several megalin-mediated physiological processes and on pathophysiologies such as chronic kidney disease associated with diabetes and hypertension, in which megalin expression is impaired