Orbital stability analysis and photometric characterization of the second Earth Trojan asteroid 2020 XL5.

Trojan asteroids are small bodies orbiting around the L4 or L5 Lagrangian points of a Sun-planet system. Due to their peculiar orbits, they provide key constraints to the Solar System evolution models. Despite numerous dedicated observational efforts in the last decade, asteroid 2010 TK7 has been the only known Earth Trojan thus far. Here we confirm that the recently discovered 2020 XL5 is the second transient Earth Trojan known. To study its orbit, we used archival data from 2012 to 2019 and observed the object in 2021 from three ground-based observatories. Our study of its orbital stability shows that 2020 XL5 will remain in L4 for at least 4 000 years. With a photometric analysis we estimate its absolute magnitude to be [Formula: see text], and color indices suggestive of a C-complex taxonomy. Assuming an albedo of 0.06 ± 0.03, we obtain a diameter of 1.18 ± 0.08 km, larger than the first known Earth Trojan asteroid.

A SEER analysis of survival and prognostic factors in merkel cell carcinoma of the head and neck region.

While Merkel cell carcinoma (MCC) of the head and neck is highly malignant, it remains poorly characterized due to its rarity. The purpose of this study was to examine prognostic factors for overall survival (OS) and disease-specific survival (DSS) in patients with MCC of the head and neck region. The Surveillance, Epidemiology and End Results registry was reviewed for patients diagnosed between 1984 and 2016 with histologically confirmed, primary MCC of the head and neck region. A total of 2818 patients met the inclusion criteria, with a median age at diagnosis of 77 years. At five and 10 years, respectively, the OS was 42.4% and 25.1% and the DSS was 67.9% and 64.1%. Multivariate Cox analysis indicated that predictors of decreased DSS included age at diagnosis ≥75 years, white race, increasing tumor spread, lymph node involvement and either the lip or the scalp/neck as a primary site. When adjusting for the aforementioned factors, tumor depth was not found to be a prognostic factor for DSS. We anticipate these results will help clinicians to counsel patients regarding expectations and potential prognosis.

Inflammatory biomarkers in dentinal fluid as an approach to molecular diagnostics in pulpitis.

AIM: To explore a set of inflammatory biomarkers obtained from dentinal fluid (DF) from patients with symptomatic irreversible pulpitis (IP), reversible pulpitis (RP) and normal pulp (NP). METHODOLOGY: A cross-sectional exploratory study was performed, recruiting 64 patients on the basis of their respective pulp condition. DF samples were obtained from all patients (23, from IP patients; 20, from RP patients; and 21, from NP patients). Quantification of biomarkers was performed using a Luminex® MAGPIX platform system and multiplex assay kits. The Kruskal-Wallis test was used for comparisons with regard to pulp state. A simple logistic regression model and the odds ratio (OR) with a 95% level of confidence (P = 0.05) were used to evaluate associations between biomarker levels and pulpal diagnosis. The performance discrimination of the biomarkers was evaluated through the construction of a receiver operating characteristic (ROC) curve by calculating the area under the curve (AUC) for IP versus RP after logistic regression modelling. Youden criteria were used to establish cut-off points for biomarkers alone with AUC > 70 and P-value < 0.05, or estimated probabilities from the multivariable logistic model. RESULTS: The biomarkers that had significantly higher values in participants with IP versus RP were IL-1α, VEGF-α and FGF acid (P < 0.05). FGF acid (OR: 12.62; P = 0.0085; CI 95% 1.91-83.29) and VEGF-α (OR: 2.61; P = 0.0252; CI 95% 1.13-6.03) were associated with pulp diagnoses of IP versus RP. The AUC-ROC curve for FGF acid was 0.79. The model containing FGF acid, IL-1α, IL-6 and TIMP-1 had an AUC-ROC of 0.92 for IP versus RP with a significant difference from the FGF acid ROC curve (P = 0.0231). CONCLUSIONS: Dentinal fluid could be used to assay pulpal mediators in the molecular diagnosis of pulpitis. Despite the limitation of the clinical diagnostics used in the present study, it was possible to detect a difference between irreversible symptomatic pulpitis and reversible pulpitis associated with the following combined biomarkers: FGF acid + IL-6 + IL-1α, +TIMP-1.

Single-laboratory validation of an LC-MS/MS method for determining florfenicol (FF) and florfenicol amine (FFA) residues in chicken feathers and application to a residue-depletion study.

A suitable analytical method is required to study the behaviour of florfenicol (FF) and its metabolite florfenicol amine (FFA) in broiler's feathers. An LC-MS/MS method was developed, assessed and intra-laboratory-validated for FF and FFA analyses. We chose cloramphenicol-d5 as an internal standard, acetone as a solvent for the extraction of the analytes and dichloromethane for the clean-up. Through LC-MS/MS analysis, we established a detection limit of 20 µg kg-1, as well as calculated quantification limits of 24.4 and 24.5 µg kg-1 for FF and FFA, respectively. Validation parameters such as linearity, recovery and precision were calculated following Commission Decision 2002/657/EC. For linearity, all standard curves showed a standard coefficient greater than 0.99. Recoveries ranged from 99% to 102% for all studied concentrations. The results show that this analytical method is precise and reliable. For the depletion study, 64 Ross 308 broilers were treated with a therapeutic dosage of 10% FF during 5 consecutive days and their feathers were then analysed. Samples were drawn on days 5, 10, 15, 20, 25, 30, 35 and 40 post-treatments. As for the control group, 16 broiler chickens were raised under the same regime. Throughout the whole study, the detected concentrations of FF and FFA in feather samples were above 100 µg kg-1. In fact, even on day 30 post-treatment we detected concentrations of 221.8 and 28.8 µg kg-1 for FF and FFA, respectively. Based on these results, we conclude that these analytes will persist for a long time and will deplete slowly in feathers of treated broiler chickens.

Residue depletion of oxytetracycline (OTC) and 4-epi-oxytetracycline (4-epi-OTC) in broiler chicken's claws by liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Antibiotics are widely used in poultry production for the treatment of bacterial diseases. However, residues may remain in products and by-products destined for human consumption or animal feeding. The claws of chickens, which are a by-product of the poultry industry, can directly or indirectly enter the food chain as meals destined to feed other productive animals. Thus, it becomes necessary to determine and quantify antimicrobial residues present in this matrix. The objective of the study was to assess the depletion of oxytetracycline (OTC) and its metabolite 4-epi-OTC in broiler chicken's claws. Claws of 32 broilers treated with a therapeutic dosage of 10% OTC during 7 days were analysed. Samples were taken at days 3, 9, 15 and 19 post-treatment. As for the control group, eight broiler chickens were raised under the same conditions. Extraction was carried out through EDTA-McIlvaine buffer, and clean-up employed a SPE C-18 Sep-Pak®. Instrumental analysis was performed through LC-MS/MS. The concentrations of both analytes were determined in claw samples until day 19 post-treatment. Average concentrations were within the LOD (20 µg kg-1) and LOQ (22 µg kg-1) for OTC and 84 µg kg-1 for 4-epi-OTC. Withdrawal times (WDTs) of 39 days for OTC and 54 days for 4-epi-OTC were established in claws based on 95% confidence. These findings demonstrate that claws can be a source of antimicrobial residue entry into the food chain, since the results showed that OTC and its metabolite can be found in chicken's claws for long periods, even exceeding the average lifespan of a broiler chicken.

Experiencia de diez años en resecciones hepáticas / Ten years experience in hepatic resections

Revisamos experiencia reciente y resultados obtenidos con resecciones hepáticas mayores en pacientes referidos a nuestra institución. Revisión retrospectiva de historias clínicas de pacientes entre agosto de 1998 y agosto de 2008, con el objetivo de precisar el tipo de cirugía efectuada, indicaciones principales, complicaciones y morbimortalidad operatoria. 22 pacientes cuyas historias estuvieron disponibles para revisión. La principal indicación de cirugía fueron neoplasias malignas 86,4% de los casos, las metástasis de carcinoma colorrectal (7) la primera indicación seguida de hepatocarcinoma (4). Otras indicaciones incluyeron: colangiocarcinomas perifericos (2), metástasis de tumores neuroendocrinos (2), diversas lesiones benignas (3) otros tumores (4). La hepatectomía derecha y segmentectomías anatómicas fueron los más frecuentes con un 27,3 % cada uno, seguidos de segmentectomía lateral izquierda (II y III) en 19%. El tiempo operatorio promedio fue 270,4 min (rango: 180-560 min). El promedio de estancia hospitalaria fue 7,7 días (rango:4-30). El 8% de nuestros pacientes no requirió estancia posoperatoria inmediata en UTI. La tasa de complicaciones fue 44,5% siendo el derrame pleural reactivo y el sangrado posoperatorio más frecuentes. La tasa de reintervención fue 18,2%. La mortalidad global fue 9% (2/22), y la inherente al procedimiento quirúrgico 4,5% (1/22). Las resecciones hepáticas mayores son un procedimiento relevante en el armamento del cirujano oncólogo dedicado al tratamiento de neoplasias digestivas, la morbimortalidad operatoria en nuestra institución es similar a otros centros de mayor volumen a nivel internacional.

Review the recent experience and results of major hepatic resections of patients treated at our institution. Retrospective review of clinical records patients submitted to major hepatic resection inten years, between August 1998 to August 2008, with descriptive statistics of type of surgery, indications, complications and surgical related morbimortality. Twenty two patients with complete clinical records for review were included. The main indication for surgery were malignant neoplasms in 86,4% of the cases,being colorectal liver metastasis (7) the first one followed by hepatocarcinomas (4). Other indications included:The periferic colanghiocarcinomas (2), metastasis from neuroendocrine tumors (2), varied beningn lesions (3)and other tumors (4). Right hepatectomy and anatomical segmentectomies were the most frequent procedures 27.3% each, followed by left lateral segmentectomy (II - III) in19% of the cases. Medium operative time was 270.4 min (range: 180-560 min). Mean hospital stay was 7.7 days (range: 4-30). 8% of the patients did not required post operative ICU care. Complications rate was 44.5% being reactive pleural effusion and postoperative bleedingthe most frecuent ones. Reintervention rate was 18.2%, global mortality 9% (2/22), and surgical related mortality was 4.5% (1/22). Major hepatic resections are a relevant procedure in the armament of surgical oncologists dedicated to treatment of digestive neoplasms, the number of such procedures done at public institutions are limited. Operative morbimortality in our institution is similar to other major volume centers.

Nuevas especies del genero prevotella y su importancia en el área odontológica: Revisión de la literatura

De los diversos procesos infecciosos que se suscitan en la cavidad bucal humana, las enfermedades periodontales tienen especial importancia ya que cada día que pasa son más las personas que se ven afectadas por estas patologías. Su etiología y desarrollo se ha relacionado desde muchos años con la presencia de microorganismos periodontopatógenos, destacándose entre estos los pertenecientes a la Familia Bacteroidaeceae, representados por los Géneros Porphyromonas y Prevotella. Constantemente surgen nuevas especies del Género Prevotella, las cuales están implicadas en mayor o menor grado en causar daño al periodonto y es por ello que resulta de vital importancia para el Odontólogo el hecho de conocer las especies de este Género que han sido reclasificadas, así como la detección e identificación de nuevas especies a los fines de aplicar el tratamiento antimicrobiano más adecuado y garantizar resultados exitosos luego de la implementación del mismo.

Periodontal diseases are one of the most important oral pathologies occurred in the human oral cavity. There are more people who have been affected by periodontal pathogens. Some of the microorganisms that are related with periodontal diseases belong to the Family Bacteroidaceae, represented by Genus Porphyromonas and Prevotella. In recient years, it can found new species of the Genus Prevotella and the dentist should know about them like resident microflora of the oral cavity and their implications in periodontal diseases, in order to establish the most convenient antimicrobial treatment for these pathologies.

Resección colorrectal laparoscópica experiencia inicial / Laparoscopic colorectal resection initial experience

Evaluar factibilidad resultados a corto plazo de la resección colorrectal laparoscópica en pacientes con patologías benignas y malignas de colon y recto. Estudio retrospectivo, descriptivo incluyó pacientes programados para resección colorrectal laparoscópica durante 6 años, entre noviembre 2000 marzo de 2006. Se analizaron: edad, sexo, diagnóstico de ingreso, distribución anatómica, procedimiento quirúrgico, tiempo quirúrgico, complicaciones intraoperatorias, tasa de conversión, morbilidad posoperatoria y estancia hospitalaria. En caso de patología oncológica, se evaluó: estadiaje patológico, número de ganglios disecados, tamaño, negatividad de márgenes quirúrgicos, recurrencia local a distancia. Se incluyeron 26 pacientes con patología colorrectal diversa programados para resección laparoscópica. Edad promedio fue 56,3 años. 20 pacientes tenían diagnóstico de adenocarcinoma colorrectal (76,92 por ciento). El 46,15 por ciento de los adenocarcinomas estaban localizados en recto. Se realizaron 10 hemicolectomías radicales derechas (38,46 por ciento), 8 resecciones anteriores bajas de recto (30,76 por ciento), 4 resecciones abdomino-perineales (15,38 por ciento), 3 sigmoidectomías (11,58 por ciento) una colectomía total (3,84 por ciento). La tasa de conversión fue 38,46 por ciento. Tiempo quirúrgico promedio 324 minutos. La morbilidad a los 30 días de posoperatorio fue 23,27 por ciento. No hubo mortalidad. Tiempo promedio de hospitalización fue 6,7 días. En los casos oncológicos, el promedio de ganglios disecados fue 12. Los márgenes fueron negativos en todos los casos. La resección colorrectal laparoscópica es factible. Ofrece buenos resultados a corto plazo, aunque a expensas de un tiempo quirúrgico mayor. En patología maligna, los criterios oncológicos de radicalidad no se ven comprometidos.

Resección endometrial histeroscópica más inserción de DIU-LNG en el sangrado uterino anormal refractario a tratamiento médico / Hysteroscopic endometrial resection plus LNG-IUD insertion in abnormal uterine bleeding refractory to medical treatment

OBJETIVO: Evaluar los resultados del tratamiento del sangrado uterino anormal (SUA) refractario a tratamiento médico, con resección endometrial histeroscópica asociado a la inserción de un sistema intrauterino de liberación de levonorgestrel. MÉTODO: Estudio prospectivo de 24 pacientes con SUA tratadas con resección endometrial histeroscópica seguida de inserción de un dispositivo intrauterino que libera 20 microgramos diarios de levonorgestrel. RESULTADOS: En 23 de las 24 pacientes tratadas se obtuvo un resultado favorable en término de control del SUA, con un período de seguimiento promedio de 18,3 meses. Una paciente requirió histerectomía por persistencia de dolor pélvico. CONCLUSIÓN: Asociar a la resección endometrial histeroscópica la inserción de un sistema intrauterino de liberación de levonorgestrel mejora los resultados de la cirugía conservadora pudiendo evitar la histerectomía en el 95,9% de las mujeres con SUA de causa benigna.

OBJECTIVE: To evaluate hysteroscopic endometrial resection associated to levonorgestrel intrauterine device insertion as a treatment of abnormal uterine bleeding of benign cause. METHOD: 24 patients with abnormal uterine bleeding, were treated with hysteroscopic endometrial resection followed by the insertion of a intrauterine levonorgestrel device. RESULTS: 23 of 24 patients no report symptoms after 18.3 months follow up. One hysterectomy was performed for persistent chronic pelvic pain. CONCLUSIONS: Endometrial ablations with diathermic loop followed by the insertion of intrauterine levonorgestrel device improve the results of the conservative surgeries, avoiding 95.9% of hysterectomies in patients with abnormal uterine bleeding.

Metformin plus low glimepiride doses improve significantly HOMAIR and HOMAbCELL without hyperinsulinemia in patients with type 2 diabetes

Type 2 Diabetes mellitus is characterized by insulin resistance and defects in insulin secretion. These variables have been studied by the euglycemic/hyperinsulinemic clamp and MinMod, which difficult the insulin resistance and b cell failure study in clinical practice. The aim of this study was to evaluate three different anti-diabetic therapeutic options using a mathematical model (Homeostasis model assessment, HOMA). Seventy type 2 diabetic patients were randomly assigned one of the next therapeutic options: A) Metformin + ADA Diet + Physical activity (Walk, 60 minutes/day). B) Metformin + Glimepiride + ADA Diet + Physical activity. C) Only ADA diet + Physical activity. A blood sample was taken before and after the treatment to determine basal and post-prandial blood glucose, basal insulin and HbA1c and to calculate HOMAbcell and HOMAIR. Before treatment basal and post-prandial levels of glucose, HbA1c, basal insulin and HOMAIR and HOMAbcell were significantly different when compared to after treatment levels for each group (p<0.01). Significant differences were also found when comparing basal blood glucose reduction (51.8 per cent; p<0.01), post-prandial blood glucose (55.0 per cent; p<0.05), and HOMAIR (65.3 per cent; p<0.01) of group B (Metformin + low glimepiride dose) with the other therapeutic options. We conclude that metformin plus glimepiride at a low dose is a more effective treatment for type 2 diabetes than other therapeutic options. HOMAIR and HOMAbcell are inexpensive and reliable methods to study IR and b cell function in DM2

Pancreatitis aguda: índice de severidad en TC: evaluación de complicaciones y hospitalización / Acute pancreatitis: severity index in CT: evaluation of complications and hospitalization

Objetivos. Analizar los criterios tomográficos clásicos de Balthazar y el índice de severidad (Balthazar clásico más necrosis), en pancreatitis aguda, como factores predictivos del desarrollo de complicaciones y tiempo de hospitalización en nuestra experiencia. Material y método. Estudio retrospectivo en 61 pacientes con diagnóstico clínico de Pancreatitis aguda a quienes se les realizó TC abdominal con contraste endovenoso. Estas exploraciones se analizaron según los criterios de Balthazar, grado de necrosis pancreática e índice de severidad en TC. Posteriormente se realizó una correlación con la presencia de complicaciones y tiempo de hospitalización. Resultado. Los hallazgos fueron similares a otros estudios en la predicción de complicaciones y tiempo de estadía hospitalaria, pero en nuestra serie hubo menos días promedio de hospitalización y no tuvimos mortalidad. Conclusión. El factor de necrosis pancreática y el índice de severidad en el estudio tomográfico mejora la evaluación pronóstica de la pancreatitis aguda.

The CIDA-QUEST large-scale survey of Orion OB1: evidence for rapid disk dissipation in a dispersed stellar population.

We are conducting a large-scale, multiepoch, optical photometric survey [Centro de Investigaciones de Astronomia-Quasar Equatorial Survey Team (CIDA-QUEST)] covering about 120 square degrees to identify the young low-mass stars in the Orion OB1 association. We present results for an area of 34 square degrees. Using photometric variability as our main selection criterion, as well as follow-up spectroscopy, we confirmed 168 previously unidentified pre-main sequence stars that are about 0.6 to 0.9 times the mass of the sun (Mo), with ages of about 1 million to 3 million years (Ori OB1b) and about 3 million to 10 million years (Ori OB1a). The low-mass stars are spatially coincident with the high-mass (at least 3 Mo) members of the associations. Indicators of disk accretion such as Halpha emission and near-infrared emission from dusty disks fall sharply from Ori OB1b to Ori OB1a, indicating that the time scale for disk dissipation and possibly the onset of planet formation is a few million years.

Disk Accretion in the 10 Myr Old T Tauri Stars TW Hydrae and Hen 3-600A.

We have found that two members of the TW Hydrae association, TW Hydrae and Hen 3-600A, are still actively accreting, based on the ballistic infall signature of their broad Halpha emission profiles. We present the first quantitative analysis of accretion in these objects and conclude that the same accretion mechanisms which operate in the well-studied 1 Myr old T Tauri stars can and do occur in older (10 Myr) stars. We derive the first estimates of the disk mass accretion rate in TW Hya and Hen 3-600A, which are 1-2 orders of magnitude lower than the average rates in 1 Myr old objects. The decrease in accretion rates over 10 Myr, as well as the low fraction of TW Hya association objects still accreting, points to significant disk evolution, possibly linked to planet formation. Given the multiplicity of the Hen 3-600 system and the large UV excess of TW Hya, our results show that accretion disks can be surprisingly long lived in spite of the presence of companions and significant UV ionizing flux.

Systemically administered interleukin-10 reduces tumor necrosis factor-alpha production and significantly improves functional recovery following traumatic spinal cord injury in rats.

In these studies, we examined the neuroprotective effects of the potent antiinflammatory cytokine interleukin-10 (IL-10) following spinal cord injury (SCI). Neuroprotection was assessed by using behavioral and morphological end points. We hypothesized that injury-induced inflammation contributes to the resulting neuropathology and subsequent loss of function. Therefore, by attenuating injury-induced inflammation, we should promote functional recovery. The New York University device was used to induce moderate SCI and study the resulting inflammatory response and functional consequences of inhibiting this response in rats. We determined that SCI induces the expression of tumor necrosis factor-alpha (TNF-alpha) in the spinal cord and by SCI-activated monocytes isolated from the peripheral circulation. IL-10 (5.0 microg) administered 30 minutes after-injury significantly reduced the expression of TNF-alpha protein in the spinal cord and in vitro by SCI-activated monocytes. Next, we investigated whether IL-10 would improve functional recovery after SCI. Randomized, double-blinded studies demonstrated that a single injection of IL-10 significantly improves hind limb motor function 2 months after injury, as determined by the Basso, Beattie and Bresnahan (BBB) open-field behavioral test. IL-10-treated animals had a mean BBB score of 18.0+/-0.5 (SEM, n = 9) compared with a score of 12.9+/-0.6 (SEM, n = 9) for the saline-treated controls. Morphological analysis demonstrated that IL-10 reduces lesion volume by approximately 49% 2 months after injury. These data suggest that acute administration of IL-10 reduces TNF-alpha synthesis in the spinal cord and by activated macrophages, is neuroprotective, and promotes functional recovery following SCI.

Anatomía de la región de la cadera: abordaje lateral directo / Anatomy of the hip: direct lateral approach

El abordaje lateral directo de la cadera, consiste en una aproximación a la cápsula articular, mediante una incisión longitudinal descrita sobre el trocánter mayor del fémur a traves de fascia lata y una disección conjunta del músculo glúteo medio y vasto lateral para su posterior retracción hacia anterior. Esta técnica puede traer consigo un daño neurológico a nivel del nervio glúteo superior, que inerva los músculos abductores del musculo. El objetivo de esta investigación es destacar las razones anatómicas de la posible lesión del nervio

Pseudohermafroditismo femenino de etiología rara / Female pseudohermaphroditism of rare etiology

En el presente trabajo se expone y discute el caso clínico-quirúrgico de una escolar de ocho años de edad, referida a nuestra consulta con el diagnóstico de Pseudohermafroditismo femenino de etiología a precisar. Al finalizar su evaluación, se concluye el diagnóstico de pseudohermafroditismo femenino por hiperplasia estromal e hipertecosis estromal

Pseudohermafroditismo masculino por hipoplasia de las células de leyding / Male pseudohermaphroditism by hypoplasia of the leyding

En el presente trabajo se resumen los hallazgos clínicos, de laboratorio endocrinológico e histopatológico de un niño con cariotipo masculino (46 XY) y genitales externos e identificación social femeninos, catalogado como un caso raro de Pseudohermafroditismo masculino por hipoplasia de las células de leydig

Assessment of family cancer history collection and utilization in patient care.

OBJECTIVES: This study was conducted to determine whether patients and accompanying persons visiting the Gynecologic Oncology Clinic were aware if a family cancer history was recorded and utilized in their medical care; whether they were aware of the importance of a family cancer history, and whether they would like to learn more about familial cancer. METHODS: Sixteen- and 17-item self-report questionnaires were administered to patients and their accompanying persons, respectively, who were visiting the Gynecologic Oncology Clinic. All responses were anonymous. RESULTS: Two hundred forty-four patient questionnaires and 114 accompanying person questionnaires were completed. Seventy-eight percent of the patients and 70% of the accompanying persons replied that a physician had inquired about their family history of cancer. Only 40% of those patients and 70% of those accompanying persons (31 and 49% of total patients and accompanying persons, respectively) replied that the inquiry was by their family physician. Sixty-seven percent of these patients and 63% of these accompanying persons reported that a written record was made of the family history. Thirty-one percent of the patients and 28% of accompanying persons knew that their family cancer history information had been used to aid in their medical care. Eighty-eight percent of the patients and 83% of the accompanying persons reported the occurrence of at least one relative with cancer; however, only 44% of the patients and 35% of the accompanying persons replied that a health care provider had ever provided teaching about the importance of a family cancer history. Seventy-five percent of the patients and 73% of the accompanying persons indicated that they would like to learn more about hereditary cancer and cancer genetics. CONCLUSIONS: This study demonstrates that patients desire information about cancer genetics and hereditary cancer. Therefore, health care providers should provide better education and information to their patients as well as improve their family history-taking skills.