Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Glacier and climate evolution in the Pariacacá Mountains: Peru

Glaciers in Peru play a major role in water availability and they also have direct implications on natural hazards such as glacial lake outburst floods (GLOFs) and/or ice avalanches, which have caused a high number of fatalities and damage to infrastructure in the last decades. Despite a noticeable effort to quantify and understand the shrinking and thawing of glaciers in Peru, there are still regions where detailed assessment is still missing. In this work, a set of remote sensing images were used to map, for the first time, the evolution of the glaciated area (from 1970 to 2018) in the Pariacacá Mountains (11º5’ S, 76º0’ W) in the Cordillera Central of Peru. The results evidenced a marked decrease of the glaciated surface, with 55.3% shrinkage since 1970 and 40% since 1987. Faster glacier retreat occurred between 1985 and the end of the 1990s, and this period was followed by a significant slowdown in shrinking rates. The differential loss of ice, depending on elevation and exposure to incoming radiation, has led to changes in spatial distribution of the glaciers. Currently, they have almost completely thawed below 5000 m a.s.l. They are mostly located in south- to west-facing aspects. Ice melting in the last decades has even affected the summit areas. Finally, the development of ablation hollows has been identified as an important driver of glacier thaw. These features are formed mainly in gentle slopes and highly irradiated zones between 5000 and 5400 m a.s.l.Los glaciares en Perú juegan un papel fundamental en la disponibilidad de agua y también poseen claras implicaciones en la ocurrencia de riesgos naturales como desbordamientos de lagos (GLOFs) y/o avalanchas de hielo que han causado un gran número de víctimas y daños a infraestructuras en las últimas décadas. A pesar del gran esfuerzo que se ha realizado para cuantificar y comprender el retroceso de los glaciares en Perú, aún existen regiones donde se carece de un estudio detallado. En este trabajo, se utilizan imágenes de satélite para cartografiar por primera vez la evolución de la superficie cubierta por glaciares (durante el periodo 1970-2018) en las montañas de Pariacacá (11º5’ S, 76º0’ W) en la Cordillera Central de Perú. Los resultados evidencian un marcado retroceso glaciar, afectando al 55.3% desde 1970 y al 40% desde 1987. El periodo de mayor retroceso sucedió entre 1985 y el final de los años 90, periodo seguido por una ralentización en los ratios de fusión. Las diferencias en desaparición de hielo según altura y orientación han llevado a claros cambios en la distribución espacial de los glaciares. Actualmente, se encuentran mayoritariamente en caras sur y este. La desaparición de hielo ha llegado a afectar en los últimos años a los sectores cimeros. Finalmente, también se ha analizado la evolución de grandes depresiones de fusión sobre los glaciares que han sido identificados como un elemento significativo para acelerar la degradación de los glaciares. Estas formas aparecen fundamentalmente en zonas con elevada radiación, entre los 5000 y 5400 m s.n.m

Thermostability and in vitro digestibility of a purified major allergen 2S albumin (Ses i 1) from white sesame seeds (Sesamum indicum)

A major 2S albumin allergen, Ses i 1, from white sesame seeds was purified to homogeneity, characterized and identified using proteomic techniques. Ses i 1 exhibited a molecular weight of 12062 Da, although an extensive C-terminal clipping of the small subunit was observed. In addition, the N-terminal glutamine of the small subunit had been converted to pyroglutamate and a variant of the large subunit which had lost the N-terminal glutamine was also detected. The protein was thermo-stable up to 90°C at neutral and acid pH, retaining its monomeric state and showing minimal alterations, which were reversible on cooling, in a predominantly α-helical secondary structure, as shown by circular dichroism and Fourier transform-infrared spectroscopy. Ses i 1 was also highly resistant to digestion using a physiologically relevant in vitro gastrointestinal model system. After 2 h of gastric digestion, the allergen remained completely intact and only the small subunit was cleaved during 2 h of subsequent duodenal digestion, leaving a major IgE epitope region of this protein intact. Neither prior heating of the Ses i 1 nor the presence of the physiological surfactant phosphatidylcholine affected the pattern of proteolysis. These findings are consistent with those found for the 2S albumin allergen from Brazil nut, Ber e 1, and suggest that Ses i 1 may preserve its structure from the degradation in the gastrointestinal tract, a property thought to be crucial for both a protein to sensitise the mucosal immune system and provoke an allergic reaction in a sensitised individual.We gratefully acknowledge Dr. Mike Naldrett for his help in acquiring the MALDI-MS spectral data and the support of the BBSRC competitive strategic grant for IFR. F. Javier Moreno was supported by a Marie Curie Fellowship of the European Community programme ‘‘Quality of Life and Management of Living Resources’’ under contract number QLK1-CT-2001-51997.Peer Reviewe

Variational Benchmarks for Quantum Many-Body Problems

International audienceThe continued development of novel many-body approaches to ground-state problems in physics and chemistry calls for a consistent way to assess its overall progress. Here we introduce a metric of variational accuracy, the V-score, obtained from the variational energy and its variance. We provide the most extensive curated dataset of variational calculations of many-body quantum systems to date, identifying cases where state-of-the-art numerical approaches show limited accuracy, and novel algorithms or computational platforms, such as quantum computing, could provide improved accuracy. The V-score can be used as a metric to assess the progress of quantum variational methods towards quantum advantage for ground-state problems, especially in regimes where classical verifiability is impossible

Variational Benchmarks for Quantum Many-Body Problems

International audienceThe continued development of novel many-body approaches to ground-state problems in physics and chemistry calls for a consistent way to assess its overall progress. Here we introduce a metric of variational accuracy, the V-score, obtained from the variational energy and its variance. We provide the most extensive curated dataset of variational calculations of many-body quantum systems to date, identifying cases where state-of-the-art numerical approaches show limited accuracy, and novel algorithms or computational platforms, such as quantum computing, could provide improved accuracy. The V-score can be used as a metric to assess the progress of quantum variational methods towards quantum advantage for ground-state problems, especially in regimes where classical verifiability is impossible

Considerations and consequences of allowing DNA sequence data as types of fungal taxa

Nomenclatural type definitions are one of the most important concepts in biological nomenclature. Being physical objects that can be re-studied by other researchers, types permanently link taxonomy (an artificial agreement to classify biological diversity) with nomenclature (an artificial agreement to name biological diversity). Two proposals to amend the International Code of Nomenclature for algae, fungi, and plants (ICN), allowing DNA sequences alone (of any region and extent) to serve as types of taxon names for voucherless fungi (mainly putative taxa from environmental DNA sequences), have been submitted to be voted on at the 11th International Mycological Congress (Puerto Rico, July 2018). We consider various genetic processes affecting the distribution of alleles among taxa and find that alleles may not consistently and uniquely represent the species within which they are contained. Should the proposals be accepted, the meaning of nomenclatural types would change in a fundamental way from physical objects as sources of data to the data themselves. Such changes are conducive to irreproducible science, the potential typification on artefactual data, and massive creation of names with low information content, ultimately causing nomenclatural instability and unnecessary work for future researchers that would stall future explorations of fungal diversity. We conclude that the acceptance of DNA sequences alone as types of names of taxa, under the terms used in the current proposals, is unnecessary and would not solve the problem of naming putative taxa known only from DNA sequences in a scientifically defensible way. As an alternative, we highlight the use of formulas for naming putative taxa (candidate taxa) that do not require any modification of the ICN.Peer reviewe