Evaluación de la competencia clínica en el posgrado de medicina familiar mediante el Examen Clínico Objetivo Estructurado

ObjetivoValorar la competencia clínica de los residentes de primer año del Curso de Especialización en Medicina Familiar aplicando un examen clínico objetivo estructurado (ECOE) para evaluar en forma simultánea las áreas cognoscitiva, afectiva y psicomotriz.DiseñoDescriptivo, observacional.EmplazamientoClínicas de medicina familiar del área metropolitana de la Ciudad de México.ParticipantesOchenta y nueve médicos en capacitación del curso de especialización en medicina familiar, de la Universidad Nacional Autónoma de México.Mediciones principalesPrevio diseño de listas de cotejo, validación de contenido por expertos, diseño de material de apoyo para la evaluación y prueba piloto, se aplicó un ECOE con 10 temas o estaciones, ocho de ellas dinámicas y dos estáticas. El criterio para considerar un nivel de desempeño competente fue de 60 puntos de un máximo de 100, tanto en cada estación como en el promedio global. El análisis estadístico fue univariado, utilizando estadística descriptiva.ResultadosEl promedio global de las calificaciones en todas las estaciones fue inferior a 60. El promedio porcentual más alto fue 73 en la estación de control de niño sano. En las cinco estaciones con mejor puntuación, la dispersión fue menor que en las cinco estaciones con la puntuación más baja. En la estación de estudio de familia se obtuvo una puntuación baja.ConclusionesEl rendimiento académico evaluado mediante ECOE para valorar la competencia clínica fue bajo. La aplicación de este tipo de examen permitió evaluar de forma más objetiva la competencia clínica. Se requiere probar escalas de evaluación de intervalo para valorar de forma más adecuada la calidad de la realización de las actividades clínicas.ObjectiveTo evaluate the clinical competence of first-year residents on the course specialising in family medicine, by applying a structured objective clinical test (SOCT) for simultaneous assessment of cognitive, affective and psychomotor areas.DesignObservational and descriptive.SettingFamily medicine clinics in the metropolitan area of Mexico City.Participants89 doctors on the specialist course in Family Medicine at the Autonomous University of Mexico (UNAM).Main measurementsAfter prior design of comparison lists, expert validation of content, and design of support material for the evaluation and pilot study, a SOCT with ten themes or sections, eight dynamic and two static, was administered. The cut-off point for competent performance was 60 out of 100, both in each section and in the overall average. The statistical analysis was univariate, using descriptive statistics.ResultsThe overall average of scores in all sections was under 60. The highest average was 73, in the section for monitoring healthy children. In the five highest-scoring sections, the scattering was lower than in the other five. There were low scores in the family study section.ConclusionsAcademic performance, as evaluated by a SOCT measuring clinical competence, was low. This kind of test enabled clinical competence to be assessed more objectively. Interval evaluation scales need to be tested so as to evaluate better the quality of the performance of clinical activities

Searching for a Cosmological Preferred Axis: Union2 Data Analysis and Comparison with Other Probes

We review, compare and extend recent studies searching for evidence for a preferred cosmological axis. We start from the Union2 SnIa dataset and use the hemisphere comparison method to search for a preferred axis in the data. We find that the hemisphere of maximum accelerating expansion rate is in the direction $(l,b)=({309^\circ}^{+23^\circ}_{-3^\circ}, {18^\circ}^{+11^\circ}_{-10^\circ})$ (\omm=0.19) while the hemisphere of minimum acceleration is in the opposite direction $(l,b)=({129^\circ}^{+23^\circ}_{-3^\circ},{-18^\circ}^{+10^\circ}_{-11^\circ})$ (\omm=0.30). The level of anisotropy is described by the normalized difference of the best fit values of \omm between the two hemispheres in the context of \lcdm fits. We find a maximum anisotropy level in the Union2 data of \frac{\Delta \ommax}{\bomm}=0.43\pm 0.06. Such a level does not necessarily correspond to statistically significant anisotropy because it is reproduced by about $30$ of simulated isotropic data mimicking the best fit Union2 dataset. However, when combined with the axes directions of other cosmological observations (bulk velocity flow axis, three axes of CMB low multipole moments and quasar optical polarization alignment axis), the statistical evidence for a cosmological anisotropy increases dramatically. We estimate the probability that the above independent six axes directions would be so close in the sky to be less than $1$. Thus either the relative coincidence of these six axes is a very large statistical fluctuation or there is an underlying physical or systematic reason that leads to their correlation.Comment: 10 pages, 7 figures. Accepted in JCAP (to appear). Extended analysis with redshift tomography of SnIa, included errorbars and increased number of axes. The Mathematica 7 files with the data used for the production of the figures along with a Powerpoint file with additional figures may be downloaded from http://leandros.physics.uoi.gr/anisotrop

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic

Low-diffusion Xe-He gas mixtures for rare-event detection: electroluminescence yield

High pressure xenon Time Projection Chambers (TPC) based on secondary scintillation (electroluminescence) signal amplification are being proposed for rare event detection such as directional dark matter, double electron capture and double beta decay detection. The discrimination of the rare event through the topological signature of primary ionisation trails is a major asset for this type of TPC when compared to single liquid or double-phase TPCs, limited mainly by the high electron diffusion in pure xenon. Helium admixtures with xenon can be an attractive solution to reduce the electron diffu- sion significantly, improving the discrimination efficiency of these optical TPCs. We have measured the electroluminescence (EL) yield of Xe–He mixtures, in the range of 0 to 30% He and demonstrated the small impact on the EL yield of the addition of helium to pure xenon. For a typical reduced electric field of 2.5 kV/cm/bar in the EL region, the EL yield is lowered by ∼ 2%, 3%, 6% and 10% for 10%, 15%, 20% and 30% of helium concentration, respectively. This decrease is less than what has been obtained from the most recent simulation framework in the literature. The impact of the addition of helium on EL statistical fluctuations is negligible, within the experimental uncertainties. The present results are an important benchmark for the simulation tools to be applied to future optical TPCs based on Xe-He mixtures. [Figure not available: see fulltext.]

Long daytime napping is associated with increased adiposity and type 2 diabetes in an elderly population with metabolic syndrome

Research examining associations between objectively-measured napping time and type 2 diabetes (T2D) is lacking. This study aimed to evaluate daytime napping in relation to T2D and adiposity measures in elderly individuals from the Mediterranean region. A cross-sectional analysis of baseline data from 2190 elderly participants with overweight/obesity and metabolic syndrome, in the PREDIMED-Plus trial, was carried out. Accelerometer-derived napping was measured. Prevalence ratios (PR) and 95% confidence intervals (CI) for T2D were obtained using multivariable-adjusted Cox regression with constant time. Linear regression models were fitted to examine associations of napping with body mass index (BMI) and waist circumference (WC). Participants napping ≥90 min had a higher prevalence of T2D (PR 1.37 (1.06, 1.78)) compared with those napping 5 to <30 min per day. Significant positive associations with BMI and WC were found in those participants napping ≥30 min as compared to those napping 5 to <30 min per day. The findings of this study suggest that longer daytime napping is associated with higher T2D prevalence and greater adiposity measures in an elderly Spanish population at high cardiovascular risk

Seasonal drought limits tree species across the Neotropics

Within the tropics, the species richness of tree communities is strongly and positively associated with precipitation. Previous research has suggested that this macroecological pattern is driven by the negative effect of water-stress on the physiological processes of most tree species. This process implies that the range limits of taxa are defined by their ability to occur under dry conditions, and thus in terms of species distributions it predicts a nested pattern of taxa distribution from wet to dry areas. However, this ‘dry-tolerance’ hypothesis has yet to be adequately tested at large spatial and taxonomic scales. Here, using a dataset of 531 inventory plots of closed canopy forest distributed across the Western Neotropics we investigated how precipitation, evaluated both as mean annual precipitation and as the maximum climatological water deficit, influences the distribution of tropical tree species, genera and families. We find that the distributions of tree taxa are indeed nested along precipitation gradients in the western Neotropics. Taxa tolerant to seasonal drought are disproportionally widespread across the precipitation gradient, with most reaching even the wettest climates sampled; however, most taxa analysed are restricted to wet areas. Our results suggest that the ‘dry tolerance’ hypothesis has broad applicability in the world's most species-rich forests. In addition, the large number of species restricted to wetter conditions strongly indicates that an increased frequency of drought could severely threaten biodiversity in this region. Overall, this study establishes a baseline for exploring how tropical forest tree composition may change in response to current and future environmental changes in this region

Identificación de riesgos geoambientales y su valoración en la zona de hundimiento del buque Prestige

Potential geological hazard assessment has been carried out in the area where the Prestige vessel was sunk using a broad database that comprises: multibeam, high and ultra-high resolution seismic profiles, gravity cores, onland seismicity stations and Ocean Bottom Seismometers (OBS). The main results of this study indicate that among the geologic factors that can be considered as potential hazards, four main categories can be differentiated based on their origin: morphologic, sedimentary, tectonic, and seismicity. Hazards of morphologic origin include steep gradients; the morphologic features suggest the occurrence of mass-wasting instabilities. Hazards of sedimentary origin also includes the occurrence of slope instability processes in form of single slides and a great variety of erosive and depositional gravity flows (debris and turbidity flows). Hazards of tectonic and seismic origin are important because the sinking area straddles the Calida Bank which is a structural seamount with a moderate tectonic activity that results in a latent seismicity of low to moderate magnitude. The interaction of these factors leads to consider to the risk as medium, and the degree of exposure of the bow and stern as high. Several general and specific recommendations are made in order to increase the geological and geophysics knowledgement in the Prestige sinking area and Spanish continental margins and deep sea areas. These recommendations also should be used to elaborate the options for reducing the hazard and loss

J-PLUS: The javalambre photometric local universe survey

ABSTRACT: TheJavalambrePhotometric Local UniverseSurvey (J-PLUS )isanongoing 12-band photometricopticalsurvey, observingthousands of squaredegrees of theNorthernHemispherefromthededicated JAST/T80 telescope at the Observatorio Astrofísico de Javalambre (OAJ). The T80Cam is a camera with a field of view of 2 deg2 mountedon a telescopewith a diameter of 83 cm, and isequippedwith a uniquesystem of filtersspanningtheentireopticalrange (3500–10 000 Å). Thisfiltersystemis a combination of broad-, medium-, and narrow-band filters, optimallydesigned to extracttherest-framespectralfeatures (the 3700–4000 Å Balmer break region, Hδ, Ca H+K, the G band, and the Mg b and Ca triplets) that are key to characterizingstellartypes and delivering a low-resolutionphotospectrumforeach pixel of theobservedsky. With a typicaldepth of AB ∼21.25 mag per band, thisfilter set thusallowsforanunbiased and accuratecharacterization of thestellarpopulation in our Galaxy, itprovidesanunprecedented 2D photospectralinformationforall resolved galaxies in the local Universe, as well as accuratephoto-z estimates (at the δ z/(1 + z)∼0.005–0.03 precisionlevel) formoderatelybright (up to r ∼ 20 mag) extragalacticsources. Whilesomenarrow-band filters are designedforthestudy of particular emissionfeatures ([O II]/λ3727, Hα/λ6563) up to z < 0.017, theyalsoprovidewell-definedwindowsfortheanalysis of otheremissionlines at higherredshifts. As a result, J-PLUS has thepotential to contribute to a widerange of fields in Astrophysics, both in thenearbyUniverse (MilkyWaystructure, globular clusters, 2D IFU-likestudies, stellarpopulations of nearby and moderate-redshiftgalaxies, clusters of galaxies) and at highredshifts (emission-line galaxies at z ≈ 0.77, 2.2, and 4.4, quasi-stellarobjects, etc.). Withthispaper, wereleasethefirst∼1000 deg2 of J-PLUS data, containingabout 4.3 millionstars and 3.0 milliongalaxies at r <  21mag. With a goal of 8500 deg2 forthe total J-PLUS footprint, thesenumbers are expected to rise to about 35 millionstars and 24 milliongalaxiesbytheend of thesurvey.Funding for the J-PLUS Project has been provided by the Governments of Spain and Aragón through the Fondo de Inversiones de Teruel, the Spanish Ministry of Economy and Competitiveness (MINECO; under grants AYA2017-86274-P, AYA2016-77846-P, AYA2016-77237-C3-1-P, AYA2015-66211-C2-1-P, AYA2015-66211-C2-2, AYA2012-30789, AGAUR grant SGR-661/2017, and ICTS-2009-14), and European FEDER funding (FCDD10-4E-867, FCDD13-4E-2685

Sensitivity of the NEXT experiment to Xe-124 double electron capture

Double electron capture by proton-rich nuclei is a second-order nuclear process analogous to double beta decay. Despite their similarities, the decay signature is quite different, potentially providing a new channel to measure the hypothesized neutrinoless mode of these decays. The Standard-Model-allowed two-neutrino double electron capture (2¿EC EC) has been predicted for a number of isotopes, but only observed in 78Kr, 130Ba and, recently, 124Xe. The sensitivity to this decay establishes a benchmark for the ultimate experimental goal, namely the potential to discover also the lepton-number-violating neutrinoless version of this process, 0¿EC EC. Here we report on the current sensitivity of the NEXT-White detector to 124Xe 2¿EC EC and on the extrapolation to NEXT-100. Using simulated data for the 2¿EC EC signal and real data from NEXT-White operated with 124Xe-depleted gas as background, we define an optimal event selection that maximizes the NEXT-White sensitivity. We estimate that, for NEXT-100 operated with xenon gas isotopically enriched with 1 kg of 124Xe and for a 5-year run, a sensitivity to the 2¿EC EC half-life of 6 × 1022 y (at 90% confidence level) or better can be reached. [Figure not available: see fulltext.

Demonstration of the event identification capabilities of the NEXT-White detector

[EN] In experiments searching for neutrinoless double-beta decay, the possibility of identifying the two emitted electrons is a powerful tool in rejecting background events and therefore improving the overall sensitivity of the experiment. In this paper we present the first measurement of the efficiency of a cut based on the different event signatures of double and single electron tracks, using the data of the NEXT-White detector, the first detector of the NEXT experiment operating underground. Using a 228Th calibration source to produce signal-like and background-like events with energies near 1.6 MeV, a signal efficiency of 71.6 ± 1.5 stat ± 0.3 sys% for a background acceptance of 20.6 ± 0.4 stat ± 0.3 sys% is found, in good agreement with Monte Carlo simulations. An extrapolation to the energy region of the neutrinoless double beta decay by means of Monte Carlo simulations is also carried out, and the results obtained show an improvement in background rejection over those obtained at lower energies.The NEXT Collaboration acknowledges support from the following agencies and institutions: the European Research Council (ERC) under the Advanced Grant 339787NEXT; the European Union's Framework Programme for Research and Innovation Horizon 2020 (2014-2020) under the Marie Sklodowska-Curie Grant Agreements No. 674896, 690575 and 740055; the Ministerio de Economia y Competitividad and the Ministerio de Ciencia, Innovacion y Universidades of Spain under grants FIS2014-53371-C04, RTI2018-095979, the Severo Ochoa Program SEV-2014-0398 and the Maria de Maetzu Program MDM-2016-0692; the GVA of Spain under grants PROMETEO/2016/120 and SEJI/2017/011; the Portuguese FCT under project PTDC/FIS-NUC/2525/2014, under project UID/FIS/04559/2013 to fund the activities of LIBPhys, and under grants PD/BD/FBD/105921/2014, SFRH/BPD/109180/2015 and SFRH/BPD/76842/2011; the U.S. Department of Energy under contracts number DE-AC02-06CH11357 (Argonne National Laboratory), DE-AC02-07CH11359 (Fermi National Accelerator Laboratory), DE-FG02-13ER42020 (Texas A&M) and DE-SC0019223/DE-SC0019054 (University of Texas at Arlington); and the University of Texas at Arlington. DGD acknowledges Ramon y Cajal program (Spain) under contract number RYC-2015-18820. We also warmly acknowledge the Laboratori Nazionali del Gran Sasso (LNGS) and the Dark Side collaboration for their help with TPB coating of various parts of the NEXT-White TPC. Finally, we are grateful to the Laboratorio Subterraneo de Canfranc for hosting and supporting the NEXT experiment.Ferrario, P.; Benlloch-Rodríguez, J.; Díaz López, G.; Hernando Morata, J.; Kekic, M.; Renner, J.; Usón, A.... (2019). Demonstration of the event identification capabilities of the NEXT-White detector. Journal of High Energy Physics (Online). (10):1-17. https://doi.org/10.1007/JHEP10(2019)052S11710M. Fukugita and T. Yanagida, Baryogenesis without grand unification, Phys. Lett.B 174 (1986) 45 [ INSPIRE ].EXO-200 collaboration, Improved measurement of the 2νββ half-life of136Xe with the EXO-200 detector, Phys. 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Gomez-Cadenas et al., Sense and sensitivity of double beta decay experiments, JCAP06 (2011) 007 [ arXiv:1010.5112 ] [ INSPIRE ].NEXT collaboration, Radiogenic backgrounds in the NEXT double beta decay experiment, arXiv:1905.13625 [ INSPIRE ].NEXT collaboration, Background rejection in NEXT using deep neural networks, 2017 JINST12 T01004 [ arXiv:1609.06202 ] [ INSPIRE ].NEXT collaboration, Application and performance of an ML-EM algorithm in NEXT, 2017 JINST12 P08009 [ arXiv:1705.10270 ] [ INSPIRE ].NEXT collaboration, Secondary scintillation yield of xenon with sub-percent levels of CO2 additive for rare-event detection, Phys. Lett.B 773 (2017) 663 [ arXiv:1704.01623 ] [ INSPIRE ].NEXT collaboration, Electroluminescence TPCs at the thermal diffusion limit, JHEP01 (2019) 027 [ arXiv:1806.05891 ] [ INSPIRE ].R. Felkai et al., Helium-xenon mixtures to improve the topological signature in high pressure gas xenon TPCs, Nucl. Instrum. 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