Síndrome de Burnout en personal de salud de emergencia del Hospital Central de la Fuerza Aérea del Perú. Febrero-julio 2014

El documento digital no refiere asesor.Establece el grado de presentación del síndrome de Burnout en el personal de salud que labora en el Servicio de Emergencia del Hospital Central de la Fuerza Aérea del Perú en el 2014. El síndrome de Burnout es una afección que consiste en un estrés crónico caracterizado por síntomas de despersonalización, cansancio emocional, abandono de la realización personal; que sufren los profesionales que tienen una atención intensa y prolongada con personas que están en situación de necesidad o dependencia. En esta situación por la naturaleza de su labor, se encuentran los médicos, enfermeras, policías, profesores, asistentes sociales, etc. El personal de salud de emergencia está en contacto con personas que acuden por alguna urgencia o emergencia, estas preocupaciones son transmitidas al personal que labora en esta área y pueden desarrollar el síndrome de Burnout. La presentación de este síndrome se puede ver reflejado en la disminución del rendimiento y motivación en el trabajo, así como un distanciamiento con los pacientes y sus familiares.Trabajo académic

The Semantic Typology of Visually Grounded Paraphrases

Visually grounded paraphrases (VGPs) are different phrasal expressions describing the same visual concept in an image. Previous studies treat VGP identification as a binary classification task, which ignores various phenomena behind VGPs (i.e., different linguistic interpretation of the same visual concept) such as linguistic paraphrases and VGPs from different aspects. In this paper, we propose semantic typology for VGPs, aiming to elucidate the VGP phenomena and deepen the understanding about how human beings interpret vision with language. We construct a large VGP dataset that annotates the class to which each VGP pair belongs according to our typology. In addition, we present a classification model that fuses language and visual features for VGP classification on our dataset. Experiments indicate that joint language and vision representation learning is important for VGP classification. We further demonstrate that our VGP typology can boost the performance of visually grounded textual entailment

Wnt Signaling in Zebrafish Fin Regeneration: Chemical Biology Using GSK3b Inhibitors

poster abstractBone growth can be impaired due to disease, such as osteoporosis, and Wnt signaling pathways regulate bone growth. The parathyroid hormone (PTH) is therapeutic for anabolic bone growth (bone building), which activates Wnt signaling, leading to bone growth. GSK3b (glycogen synthetase kinase 3 beta) protein inhibitors activate Wnt signaling, including in bone growth models. Our study utilized a zebrafish model system to study Wnt activated fin regeneration and bone growth. Wnt signaling is the first genetically identified step in fin regeneration, and bony rays are the main differentiated cell type in fins. Thus, zebrafish fin regeneration may be a useful model to study Wnt signaling mediated bone growth. Fin regeneration experiments were conducted using various concentrations of GSK3b inhibitor compound for different treatment periods and regenerative outgrowth was measured at 4 and 7 days post amputation. Experiments revealed continuous low concentration (5-6 nM) treatment to be most effective at increasing regeneration. Higher concentrations inhibited fin growth, perhaps by excessive stimulation of differentiation programs. In situ hybridization experiments were performed to examine effects of Gsk3b inhibitor on Wnt responsive gene expression. Initial experiments show temporal and spatial changes on individual gene markers following GSK3b inhibitor treatment. Additionally, confocal microscopy and immunofluorescence labeling data indicated that the Wnt signaling intracellular signal transducer, betacatenin, accumulates throughout Gsk3b inhibitor treated tissues. Finally, experiments are underway to quantify phosphohistone-3 staining in regenerating tissue to measure effects of Gsk3b inhibitor on cell proliferation. Together, these data indicate that bone growth in zebrafish fin regeneration is improved by activating Wnt signaling. Zebrafish Wnt signaling experiments provide good model to study bone growth and bone repair mechanisms, and may provide an efficient drug discovery platform

NGC 346 in The Small Magellanic Cloud. IV. Triggered Star Formation in the HII Region N66

Stellar feedback, expanding HII regions, wind-blown bubbles, and supernovae are thought to be important triggering mechanisms of star formation. Stellar associations, being hosts of significant numbers of early-type stars, are the loci where these mechanisms act. In this part of our photometric study of the star-forming region NGC346/N66 in the Small Magellanic Cloud, we present evidence based on previous and recent detailed studies, that it hosts at least two different events of triggered star formation and we reveal the complexity of its recent star formation history. In our earlier studies of this region (Papers I, III) we find that besides the central part of N66, where the bright OB stellar content of the association NGC346 is concentrated, an arc-like nebular feature, north of the association, hosts recent star formation. This feature is characterized by a high concentration of emission-line stars and Young Stellar Objects, as well as embedded sources seen as IR-emission peaks that coincide with young compact clusters of low-mass pre-main sequence stars. All these objects indicate that the northern arc of N66 encompasses the most current star formation event in the region. We present evidence that this star formation is the product of a different mechanism than that in the general area of the association, and that it is triggered by a wind-driven expanding HII region (or bubble) blown by a massive supernova progenitor, and possibly other bright stars, a few Myr ago. We propose a scenario according to which this mechanism triggered star formation away from the bar of N66, while in the bar of N66 star formation is introduced by the photo-ionizing OB stars of the association itself.Comment: Astrophysical Journal, In Press. 10 pages, 4 figures, emulateapj LaTeX style. Figures with Scaled-down resolution. Related Press Releases: http://www.nasa.gov/mission_pages/spitzer/news/spitzer-20081008.html and http://www.eso.org/public/outreach/press-rel/pr-2008/pr-34-08.htm

Corticothalamic feedback sculpts visual spatial integration in mouse thalamus

En route from retina to cortex, visual information travels through the dorsolateral geniculate nucleus of the thalamus (dLGN), where extensive cortico-thalamic (CT) feedback has been suggested to modulate spatial processing. How this modulation arises from direct excitatory and indirect inhibitory CT feedback components remains enigmatic. We show that in awake mice topographically organized cortical feedback modulates spatial integration in dLGN by sharpening receptive fields (RFs) and increasing surround suppression. Guided by a network model revealing wide-scale inhibitory CT feedback necessary to reproduce these effects, we targeted the visual sector of the thalamic reticular nucleus (visTRN) for recordings. We found that visTRN neurons have large receptive fields, show little surround suppression, and have strong feedback-dependent responses to large stimuli, making them an ideal candidate for mediating feedback-enhanced surround suppression in dLGN. We conclude that cortical feedback sculpts spatial integration in dLGN, likely via recruitment of neurons in visTRN

Virtual reality training versus blended learning of laparoscopic cholecystectomy:a randomized controlled trial with laparoscopic novices

This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program. Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires. The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group. VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches

HER3-targeted protein chimera forms endosomolytic capsomeres and self-assembles into stealth nucleocapsids for systemic tumor homing of RNA interference in vivo.

RNA interference represents a potent intervention for cancer treatment but requires a robust delivery agent for transporting gene-modulating molecules, such as small interfering RNAs (siRNAs). Although numerous molecular approaches for siRNA delivery are adequate in vitro, delivery to therapeutic targets in vivo is limited by payload integrity, cell targeting, efficient cell uptake, and membrane penetration. We constructed nonviral biomaterials to transport small nucleic acids to cell targets, including tumor cells, on the basis of the self-assembling and cell-penetrating activities of the adenovirus capsid penton base. Our recombinant penton base chimera contains polypeptide domains designed for noncovalent assembly with anionic molecules and tumor homing. Here, structural modeling, molecular dynamics simulations, and functional assays suggest that it forms pentameric units resembling viral capsomeres that assemble into larger capsid-like structures when combined with siRNA cargo. Pentamerization forms a barrel lined with charged residues mediating pH-responsive dissociation and exposing masked domains, providing insight on the endosomolytic mechanism. The therapeutic impact was examined on tumors expressing high levels of HER3/ErbB3 that are resistant to clinical inhibitors. Our findings suggest that our construct may utilize ligand mimicry to avoid host attack and target the siRNA to HER3+ tumors by forming multivalent capsid-like structures

The impact of heavy-quark loops on LHC dark matter searches

If only tree-level processes are included in the analysis, LHC monojet searches give weak constraints on the dark matter-proton scattering cross section arising from the exchange of a new heavy scalar or pseudoscalar mediator with Yukawa-like couplings to quarks. In this letter we calculate the constraints on these interactions from the CMS 5.0/fb and ATLAS 4.7/fb searches for jets with missing energy including the effects of heavy-quark loops. We find that the inclusion of such contributions leads to a dramatic increase in the predicted cross section and therefore a significant improvement of the bounds from LHC searches.Comment: 12 pages, 1 table, 3 figures, v2: extended discussion and improved relic density calculation - matches published versio

Bouveret's syndrome: presentation of two cases with review of the literature and development of a surgical treatment strategy

BACKGROUND Bouveret's syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. It is a rare condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnostic and treatment strategies are required for optimal management and outcome. The purpose of this paper is to develop a surgical strategy for optimized individual treatment of Bouveret's syndrome based on the available literature and motivated by our own experience. CASE PRESENTATION Two cases of Bouveret's syndrome are presented with individual management and restrictive surgical approaches tailored to the condition of the patients and intraoperative findings. CONCLUSIONS Improved diagnostics and restrictive individual surgical approaches have shown to lower the mortality rates of Bouveret's syndrome. For optimized outcome of the individual patient: The medical and perioperative management and time of surgery are tailored to the condition of the patient. CT-scan is most often required to secure the diagnosis. The surgical approach includes enterolithotomy alone or in combination with simultaneous or subsequent cholecystectomy and fistula repair. Lower overall morbidity and mortality are in favor of restrictive surgical approaches. The surgical strategy is adapted to the intraoperative findings and to the risk for secondary complications vs. the age and comorbidities of the patient