Neandertal roots: Cranial and chronological evidence from Sima de los Huesos.

Seventeen Middle Pleistocene crania from the Sima de los Huesos site (Atapuerca, Spain) are analyzed, including seven new specimens. This sample makes it possible to thoroughly characterize a Middle Pleistocene hominin paleodeme and to address hypotheses about the origin and evolution of the Neandertals. Using a variety of techniques, the hominin-bearing layer could be reassigned to a period around 430,000 years ago. The sample shows a consistent morphological pattern with derived Neandertal features present in the face and anterior vault, many of which are related to the masticatory apparatus. This suggests that facial modification was the first step in the evolution of the Neandertal lineage, pointing to a mosaic pattern of evolution, with different anatomical and functional modules evolving at different rates.

[Introducing formative portfolio as a tool for Internal Medicine residents mentoring: review of a pilot project, 2005-2006]. / Introducción del portafolio formativo como instrumento de tutorización de residentes de Medicina Interna: revisión de una experiencia piloto, 2005-2006.

Recent educational projects in our country have been trying to introduce professional portfolios as assessment/learning tools on the undergraduate and specialized post-graduate education levels. The approval of a new formative program for the Internal Medicine specialty in an effort to adapt to the present health care needs offers an opportunity to apply these formative and evaluative methodologies in the learning process of future internists. During the 2005-2006 academic year, the Formative Work Group of the Spanish Internal Medicine Society (SEMI) developed a pilot study on portfolio application as a tool for formative assessment and mentoring. This article describes the project of designing, developing, applying and assessing an electronic portfolio for first year Internal Medicine residents. It presents an analysis of the SEMI Portfolio strengths and weaknesses and finally makes suggestions for future development.

Formación del residente desde su abordaje como adulto / Resident’s education from his adult’s perspective

La formación pregrado, posgrado y la formación continuada en medicina podemos encuadrarlas dentro de la educación para adultos. Si en la formación pregrado predomina la transmisión de conocimientos, la formación posgrado debería basarse en un asentamiento de esos conocimientos y en la adquisición de habilidades. Estas tareas, en el caso de la especialización médica vía MIR, se desarrollarán en un contexto concreto donde el residente se encontrará ante la necesidad de la resolución de problemas. Como adulto podrá responsabilizarse de su propia formación, pero necesita de la guía y orientación de un tutor, pieza clave en la educación y evaluación que no sólo mide los objetivos alcanzados, sino que permite mejorar las estrategias de aprendizaje. Tanto el tutor como los posibles profesionales sanitarios que participen en la formación son de vital importancia y merecen un reconocimiento, unos recursos y una formación acorde a su labor. En el presente artículo haremos un repaso del proceso formativo desde el pregrado hasta la residencia, y también destacaremos los aspectos evaluativos como indispensables en dicho proceso (AU)

Undergraduate, postgraduate and continuing medical education must be considered as adult education. If in undergraduate medical education dominates the transmission of knowledge, postgraduate education should be based on quantitative and qualitative increase of these knowledge and on acquisition of specific skills. These tasks, in medical specialization through residency programs will be developed in a concrete context where residents will face the need to solve real problems. As adult, he/she will be able to take responsibility on its own training but, at the same time, he/she will need guidance and orientation from the tutor. Tutorial methodology is a key piece in training and its evaluation; it doesn’t only measures specific training achievements, but enhances the improving of individual learning strategies. Both tutor and other health professionals who play a role in residency program, are essential and deserve professional recognition, enough learning resources and specific c teaching skills to cope with this responsibility. In this article, a revision is presented of the formative process from undergraduate to postgraduate education level in which evaluation as an unavoidable aspect in the above mentioned process is emphasized (AU)

Feedback en educación médica / Feedback in medical education

La propuesta de un modelo centrado en la persona que aprende y el desarrollo de estrategias de aprender a aprender se persigue que los estudiantes sean más reflexivos y más autónomos en su propio proceso de aprendizaje y que se conviertan en los protagonistas de dicho proceso. Se trata, en definitiva, de dar los elementos necesarios a los estudiantes para que puedan autogestionar un proceso de aprendizaje permanente a lo largo de toda su vida profesional, una cuestión crucial en un contexto de evolución constante de los conocimientos. El feedback sería el retorno de informaicón sobre su proceso de aprendizaje de acuerdo con unos objetivos preestablecidos. El feedback presenta información y no juicio, a diferencia de la evaluación, en consecuencia siempre es formativo. El feedback no es un fin en sí mismo sino un instrumento que informa al estudiante sobre su proceso de aprendizaje y facilita los cambio necesarios. El feedback estructurado y centrado en quien aprende se caracteriza por: autoreflexivo del estudiante, centrado en quien aprende, preparación previa y relación de confianza tutor-residente (AU)

The proposal of a learner-centered model and the development of strategies for learning to learn, intends that students are more reflective and more independent in their own learning process and that they become the protagonists of this process. It really tries to give the students the necessary elements so that they can self-manage a process of permanent learning throughout their professional life, a crucial question in a context of constant evolution on the knowledge. The return of information on the process of learning, in agreement with pre-established objectives. Feedback presents/displays information and is non-judgemental, unlike the evaluation. Feedback always is formative. Feedback is not an aim in itself, but and instrument that informs the student on its process of learning and facilitates the necessary changes. Structured and centered learning feedback is characterized by: student self reflection, centered in the learning person, previously prepared and a confident relationship between tutor and student (AU)

Human hyoid bones from the middle Pleistocene site of the Sima de los Huesos (Sierra de Atapuerca, Spain).

This study describes and compares two hyoid bones from the middle Pleistocene site of the Sima de los Huesos in the Sierra de Atapuerca (Spain). The Atapuerca SH hyoids are humanlike in both their morphology and dimensions, and they clearly differ from the hyoid bones of chimpanzees and Australopithecus afarensis. Their comparison with the Neandertal specimens Kebara 2 and SDR-034 makes it possible to begin to approach the question of temporal variation and sexual dimorphism in this bone in fossil humans. The results presented here show that the degree of metric and anatomical variation in the fossil sample was similar in magnitude and kind to living humans. Modern hyoid morphology was present by at least 530 kya and appears to represent a shared derived feature of the modern human and Neandertal evolutionary lineages inherited from their last common ancestor.

New Neandertal remains from Cova Negra (Valencia, Spain).

New Neandertal fossils from the Mousterian site of Cova Negra in the Valencia region of Spain are described, and a comprehensive study of the entire human fossil sample is provided. The new specimens significantly augment the sample of human remains from this site and make Cova Negra one of the richest human paleontological sites on the Iberian Peninsula. The new specimens include cranial and postcranial elements from immature individuals and provide an opportunity to study the ontogenetic appearance of adult Neandertal characteristics in this Pleistocene population. Children younger than 10 years of age constitute four of the seven minimum number of individuals in the sample, and this relative abundance of children at Cova Negra is similar that in to other Neandertal sites in Europe and southwest Asia. The recognition of diagnostic Neandertal features in several of the specimens, as well as their western European context and late Pleistocene age, suggests that all the human remains from Cova Negra represent Neandertals. The archaeological evidence from Cova Negra indicates sporadic, short-term occupations of the site, suggesting a high degree of mobility among Neandertals.

Auditory capacities in Middle Pleistocene humans from the Sierra de Atapuerca in Spain.

Human hearing differs from that of chimpanzees and most other anthropoids in maintaining a relatively high sensitivity from 2 kHz up to 4 kHz, a region that contains relevant acoustic information in spoken language. Knowledge of the auditory capacities in human fossil ancestors could greatly enhance the understanding of when this human pattern emerged during the course of our evolutionary history. Here we use a comprehensive physical model to analyze the influence of skeletal structures on the acoustic filtering of the outer and middle ears in five fossil human specimens from the Middle Pleistocene site of the Sima de los Huesos in the Sierra de Atapuerca of Spain. Our results show that the skeletal anatomy in these hominids is compatible with a human-like pattern of sound power transmission through the outer and middle ear at frequencies up to 5 kHz, suggesting that they already had auditory capacities similar to those of living humans in this frequency range.

Aspectos comunicacionales: el reto de la competencia de la profesión médica / Aspects of communication: the challenge of competition in the medical profession

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Evaluación clínica objetiva y estructurada en geriatría. Resultados del primer proyecto realizado en España / Objetive and structured clinical evaluation in geriatrics. Results of the first project performed in Spain

OBJETIVO: Presentar los resultados de la primera prueba piloto de evaluación clínica objetiva y estructurada (ECOE) para evaluar los conocimientos y habilidades en geriatría desarrollada por la Sociedad Catalano-Balear de Geriatría y Gerontología (SCBGG) .MATERIAL Y MÉTODOS: Expertos de la SCBGG, con el asesoramiento técnico del Institut d'Estudis de la Salut (IES), diseñaron la prueba que consistió en un circuito de 22 situaciones clínicas paradigmáticas de la especialidad y en las que se utilizaron diversos instrumentos evaluativos. Participaron voluntariamente 38 médicos invitados por la SCBGG, que al finalizarla cumplimentaron un cuestionario de opinión a propósito de la misma. Para el análisis de los datos se utilizó el programa estadístico SPSS/PC+ para Windows. RESULTADOS: La puntuación media (desviación estándar [DE]) en la edición de 2000 fue de 52,6 (5,8) y en la de 2001, de 49,1 (8,6). El estadístico alfa de Cronbach (coeficiente global de fiabilidad) fue de 0,71 en la primera y de 0,84 en la segunda. En 2001 se realizó el análisis de resultados según la formación de los participantes, y obtuvieron mejores resultados aquellos formados por vía MIR. La opinión de los participantes en las dos ediciones fue muy positiva. CONCLUSIONES: La primera prueba ECOE en geriatría se presenta como un método evaluativo de la competencia profesional fiable, válido, factible y bien aceptado por los profesionales que han participado en ella (AU)

Human remains from Valdegoba Cave (Huérmeces, Burgos, Spain).

Systematic excavations, begun in 1987, at the Valdegoba cave site in northern Spain have yielded the remains of five individuals associated with a Middle Paleolithic stone tool technology and Pleistocene fauna. A fragmentary mandible of an adolescent (VB1), preserving nearly a full set of teeth, exhibits a symphyseal tubercle and slight incurvatio mandibulae anterior on the external symphysis. Both the superior and inferior transverse tori are present on the internal aspect. A second individual (VB2) is represented by a set of ten deciduous teeth consistent with an age at death of 6-9 months. A proximal manual phalanx (VB3) displays a relatively broad head, a characteristic which is found in both Neandertals, as well as European Middle Pleistocene hominids. VB4 is a fourth metatarsal that lacks the distal epiphysis, indicating it comes from an adolescent individual, and has a relatively high robusticity index. Finally, VB5 is a fifth metatarsal of an adult. The VB1 mandible shows a combination of archaic characteristics as well as more specific Neandertal morphological traits. The VB2 deciduous teeth are very small, and both the metrics and morphology seem more consistent with a modern human classification. The postcranial elements are undiagnostic, U-Th dating has provided an age of >350 ka for the base of the sequence and a date of <73.2+/-5 ka for level 7, near the top. Faunal analysis and radiometric dates from other nearby Mousterian sites suggests that the Valdegoba site is correlative with oxygen isotope stages 3-6 on the Iberian peninsula, and an Upper Pleistocene age for the Valdegoba hominids seems most reasonable.

Primeras experiencias en evaluación de la competencia clínica de los médicos de familia de Catalunya / First experiences in evaluation of the clinical competence of family doctors in catalonia

Objetivo. Construir un instrumento válido para evaluar la competencia clínica de los médicos de familia y establecer el estándar de la profesión. Diseño. Construcción de una prueba de evaluación clínica objetiva y estructurada por parte del Comité de Prueba de la Societat Catalana de Medicina Familiar i Comunitària (SCMFiC) con 27 situaciones clínicas representativas de la práctica de atención primaria, utilizando diversos instrumentos evaluativos, con una duración total de 5 horas y 30 minutos. Emplazamiento. Dos áreas básicas de salud de Barcelona para la realización de las dos ediciones de la prueba. Participantes. Médicos de familia, miembros de la SCMFiC, que participaron voluntariamente tras haber sido invitados por carta. Mediciones y resultados principales. En la primera edición de la prueba participaron 23 médicos, con una edad media de 36,6 años (DE, 6,9), siendo un 52,2 por ciento mujeres. En la segunda edición participaron 46 médicos, con una edad media de 30,9 (DE, 2,1), siendo un 76,1 mujeres. La prueba tuvo un coeficiente global de fiabilidad, alfa de Cronbach, de 0,83 en su primera edición y 0,65 en su segunda. La puntuación media global de los participantes de la primera edición fue de 56,9 (DE, 19,2), siendo 100 la puntuación máxima obtenible y la de los participantes de la segunda edición, 62,1 (DE, 4,1). Conclusiones. La experiencia de la SCMFiC es la primera por lo que refiere a la evaluación de la competencia clínica de los médicos de familia en nuestro ámbito, y se trata de una prueba fiable y válida para valorar la competencia de nuestros profesionales (AU)

Down-regulation of L-selectin expression in neutrophils by nonsteroidal anti-inflammatory drugs: role of intracellular ATP concentration.

L-selectin is an adhesion molecule that plays an essential role in the early events of the inflammatory response. Our group has recently described that several nonsteroidal anti-inflammatory drugs (NSAIDs) are able to induce both in vivo and in vitro the shedding of L-selectin in neutrophils through an unknown mechanism. In this work, we have studied potential mechanisms involved in the shedding of L-selectin induced by NSAIDs. This effect of NSAIDs did not involve any detectable intracellular calcium flux. Pretreatment of neutrophils either with Ro 31-8220 and H7, 2 specific inhibitors of protein kinase C (PKC), or with inhibitors of protein tyrosine kinases such as tyrphostin A25 or herbimycin A did not prevent the NSAID-mediated L-selectin shedding. However, the KD-IX-73-4, an inhibitor of L-selectin proteolysis was able to block the effect of NSAIDs on L-selectin expression. Remarkably, NSAIDs caused a variable reduction in the neutrophil intracellular ATP concentration that highly correlated with the differential ability of NSAIDs to trigger L-selectin shedding (r = 0.8, P <.01). In agreement with this finding, azide plus 2-deoxy-D-glucose, 2 metabolic blockers, also induced a rapid L-selectin shedding (65% +/- 8%) without affecting the neutrophil viability, activation, or expression level of other surface molecules with soluble isoforms such as CD16 and CD59. These data indicate that the maintenance of L-selectin on the neutrophil surface requires energy consumption, which suggests that L-selectin is shed in neutrophils by default. Interestingly, NSAIDs seem to cause the shedding of L-selectin, at least in part, through the reduction of the intracellular ATP concentration.

[Evaluation of clinical competence. The immediate future of nursing]. / Evaluar la competencia clínica. Futuro inmediato para enfermería.

In this article, the authors analyze the concept of professional competence and they describe some of the methods destined to be used in the evaluation of said competence in nursing professionals. The authors describe different levels of professional performance to which an evaluation may be carried out according to the conceptual model developed by Miller. Special emphasis is placed on the third level of evaluation which is based on simulations of professional practice whose protagonists are the so called simulated or role-playing/standardized sick. One type of very novel evaluation test is the Objective Structured Clinical Examination (OSCE) which makes use of, besides the simulated or role-playing/standardized sick, other mediums such as manikins, standardized tests, open-ended short answer questions, etc. This is one of the most complete clinical competence evaluation methods currently available, although one should not forget that this evaluation is carried out in a simulated, laboratory, setting.