A multicriteria decision analysis for selecting rainwater harvesting systems in rural areas: a tool for developing countries.

Global water provision challenges have promoted decentralized water supply alternatives such as rainwater harvesting systems (RWHS). RWHS sustainability demands involve social, technical, and economic criteria in planning. Generally, in rural areas, water provision is more complex due to multiple uses of water, scattering of households, and low economies of scale. This research proposes a multicriteria tool for selecting RWHS in rural areas, considering social, technical, and economic criteria. The tool was developed by systematically identifying subcriteria and their hierarchization through the analytical hierarchy process (AHP), the technique for order of preference by similarity to ideal solution (TOPSIS), and a case study validation. Seven subcriteria were identified. The hierarchy of criteria was social (49.7%), technical (26.4%), and economic (23.9%). The tool involved: (i) users' consultation about the perceived ease of use and availability of water sources other than rainwater; (ii) system dimensioning to establish supply size, maintenance requirements, and required water quality; and (iii) costs and benefits estimation. Tool validation in a rural area included the evaluation of the alternatives proposed: (a) alternative 1: potable domestic uses (PD) and non-potable (NPD); (b) alternative 2: PD and NPD, irrigation of crops and chicken farming for self-consumption; and alternative 3: PD and NPD and chicken farming for profit sale. The sensitivity analysis showed the tool's consistency and robustness. Tool validation highlights the importance of integrating the three dimensions in selecting RWHS. The study provides a systematic methodology to assess and prioritize RWHS, appealing to policymakers, engineers, and practitioners facilitating water management and supply processes in rural areas.

ß-Lactam allergy delabeling is safe and saves costs in Primary Care.

OBJECTIVE: To determine whether the ß-lactam allergy delabeling was safe and cost-saving in Primary Care (PC) patients. DESIGN: We have conducted a retrospective chart review of PC patients with ß-lactam allergy label evaluated in our Allergy Unit between 2017 and 2022. SITE: Allergy Department. Hospital Virgen del Rocio (Sevilla). PARTICIPANTS: A total of 391 patients labeled for ß-lactam allergy in PC were studied. MAIN MEASUREMENTS: (a) Outcome evaluation of a ß-lactam allergy delabeling procedure. (b) A ratio between the total e-prescribed antibiotic cost and the number of treatment days (the experimental daily antibiotic cost or EDAC) before and after delabeling was analyzed in delabeled and truly allergic patients. RESULTS: The results of skin testing were positive in 9.2% of the reported cases (36 of 391 patients). The reactions to oral provocation challenge (OPC) occurred in 2.14% of the patients who underwent negative skin testing to offending ß-lactam (in 15 of 699 OPC). A total of 307 patients (78.5%) were delabeled; 70 (17.9%) had a ß-lactam selective response and 14 (3.59%) reacted to both penicillin and cephalosporin. The EDAC before and after the procedure in delabeled patients was significantly lower (0.88 € vs 0.62 €, p<10-3), than that observed in truly allergic group (0.87 € vs. 0.76 €, p=not significant). CONCLUSION: To delabel ß-lactam allergy in Primary Care patients is safe in most patients, cost-saving in antibioticotherapy, and allows identify the main clinical ß-lactam allergy phenotypes that benefit from this procedure.

The influence between gestational age and postural control, a systematic review.

The central nervous system (CNS) of preterm infants might have some peculiarities which distinguish it from that of full term infants. The difficulties associated with prematurity are the main cause of deaths all over the world during the new-born period after community-acquired pneumonia, and the second cause of deaths worldwide in children under five years old. Early recognition of signs indicating fragile postural control in premature infants can support understanding and help prevent and early intervention on possible future neuromotor dysfunctions in these subjects. The purpose of this paper is to determine if there is a qualitatively different development of postural control in premature infants without neurological involvement and infants born at term. We conducted a systematic review of longitudinal and cross-sectional case-control studies published between 2010 and March 2020 on this topic. The evaluation of parameters related to postural control was also included. The methodological quality of the selected works was evaluated using the CASPe critical reading programme for cases and controls. PRISMA guidelines for systematic reviews were followed for prematurity and postural control. 16 articles were included. The total sample amounted to 3,460 participants, of which 1,860 in the preterm group, and 1,600 in the control group. All the studies found show a poorer postural control by the group of children born preterm compared to the group of children born at term and one study indicating more limited postural control with higher prematurity. Regarding the methodological quality according to CASPe, those studies exceeding half of the total score were considered of adequate quality.

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections.

Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription.

Enfermeiros em Portugal no tempo de Nightingale / Nurses in Portugal at Nightingale time / Enfermeros en Portugal en tiempos de Nightingale

Resumo Contexto: No século XIX assistimos à modernização hospitalar, à afirmação da ciência médica, e ao desenvolvimento exponencial da atividade dos enfermeiros. Objetivo: Contribuir para o conhecimento dos enfermeiros, em Portugal, no século de Nightingale. Metodologia: Histórica com análise e explicação de um passado acedido através do exame das suas marcas e da sua representação mental. Considerando não uma simples narrativa, mas uma descrição, tanto quanto possível explicativa. Resultados: Transformação ao longo de todo o século, da atividade dos enfermeiros, visível no espaço conquistado nas estruturas hospitalares, na criação do ensino, num movimento lento em direção à plena profissionalização. Conclusão: No século de Nightingale, um contínuo de profissionalização e disciplinar dos saberes, que está na origem da enfermagem como profissão e disciplina de conhecimento.

Abstract Context: In the 19th century, we witnessed hospital modernization, the affirmation of medical science, and the exponential development of nurses' activities. Objective: To know the activity of nurses in the Nightingale century. Methodology: Historical with analysis and explanation of a past accessed through the examination of its marks and mental representation. Considering not a simple narrative, but a description, as much as possible explanatory. Results: Transformation throughout the century, of the activity of nurses, visible in the space conquered in hospital structures, in the creation of teaching, in a slow movement towards full professionalization. Conclusion: In the Nightingale century, a continuation of professionalization and disciplinary knowledge, which is the origin of nursing as a profession and knowledge discipline.

Resumen Contexto: En el siglo XIX se asiste a la modernización hospitalaria, la afirmación de la ciencia médica y el desarrollo exponencial de la actividad enfermera. Objetivo: Conocer la actividad de las enfermeras en el siglo Nightingale. Metodología: Histórica con análisis y explicación de un pasado al que se accede mediante el examen de sus marcas y representación mental. No se considera una simple narración, sino una descripción lo más explicativa posible. Resultados: A lo largo del siglo se produjo una transformación de la actividad enfermera, visible en el espacio de las estructuras hospitalarias, la creación de la docencia y en un lento movimiento hacia la plena profesionalización. Conclusión: En el siglo de Nightingale, se inicia una continua profesionalización y disciplina de saberes, que es el origen de la enfermería como profesión y disciplina del conocimiento.

Un dilema actual: ¿El uso de sujeciones como técnica terapéutica garantiza la dignidad de la persona? / A current dilemma: Does the use of restraints as a therapeutic technique guarantee the dignity of the person?

Resumen Marco contextual: La sujeción como técnica terapéutica ha suscitado controversia a lo largo del tiempo. Actualmente, la contención se circunscribe a situaciones de emergencia que entrañen riesgo para la vida del paciente o para terceras personas. Objetivo: Conocer las técnicas terapéuticas de sujeción de la persona, revisar sus efectos secundarios y promover su buena praxis. Metodología: Revisión de la literatura relacionada con la contención de las personas. Análisis interpretativo de la información recopilada en documentos, artículos, libros y leyes, mediante la hermenéutica de Gadamer. Resultados: A través del tiempo se reflexiona sobre la contención de las personas por medio de la sujeción como medida terapéutica. Se indagan los aspectos éticos y se profundiza en su marco legislativo. Se analizan las implicaciones que dicha práctica puede comportar para el personal sanitario. Conclusión: Es necesario fomentar medidas terapéuticas de confort que mitiguen y limiten el uso de la sujeción de la persona con trastornos conductuales y/o necesidades especiales. Hecho que garantiza los derechos y la dignidad de la persona.

Abstract Background: Restraint as a therapeutic technique has been controversial over time. It is currently limited to emergency situations involving risk to the patient's life or third parties. Objective: To know therapeutic techniques for restraining the person, review their side effects, and promote good practice. Methodology: Literature review related to the containment of people. Interpretative analysis of information gathered from documents, articles, books, and laws, using Gadamer's hermeneutics. Results: We reflected on restraint use for containing patients as a therapeutic measure over time. We investigated the ethical aspects and examined the legislative framework in depth. The implications that this practice may have for health personnel were analyzed. Conclusion: It is necessary to promote comfort care measures that mitigate and limit the use of restraint in the person with behavioral disorders and/or special needs, thus guaranteeing their rights and dignity.

Resumo Enquadramento: A contenção como técnica terapêutica tem sido controversa ao longo do tempo. A contenção está atualmente limitada a situações de emergência que envolvem riscos para a vida do paciente ou para terceiros. Objetivo: Conhecer as técnicas terapêuticas para conter a pessoa, rever os seus efeitos secundários e promover boas práticas. Metodologia: Revisão bibliográfica, relacionada com a contenção de pessoas. Análise interpretativa da informação recolhida a partir de documentos, artigos, livros e leis, utilizando a hermenêutica de Gadamer. Resultados: Ao longo do tempo, é possível refletir sobre a contenção das pessoas por meio de contenção como medida terapêutica. Os aspetos éticos são investigados e o quadro legislativo é examinado em profundidade. As implicações que esta prática pode ter para o pessoal de saúde são analisadas. Conclusão: É necessário promover medidas de conforto terapêutico que atenuem e limitem o uso de restrições por parte da pessoa com perturbações comportamentais e/ou necessidades especiais. Isto garante os direitos e a dignidade da pessoa.

Enfermeiros em Portugal no tempo de Nightingale / Nurses in Portugal at Nightingale time / Enfermeros en Portugal en tiempos de Nightingale

Resumo Contexto: No século XIX assistimos à modernização hospitalar, à afirmação da ciência médica, e ao desenvolvimento exponencial da atividade dos enfermeiros. Objetivo: Contribuir para o conhecimento dos enfermeiros, em Portugal, no século de Nightingale. Metodologia: Histórica com análise e explicação de um passado acedido através do exame das suas marcas e da sua representação mental. Considerando não uma simples narrativa, mas uma descrição, tanto quanto possível explicativa. Resultados: Transformação ao longo de todo o século, da atividade dos enfermeiros, visível no espaço conquistado nas estruturas hospitalares, na criação do ensino, num movimento lento em direção à plena profissionalização. Conclusão: No século de Nightingale, um contínuo de profissionalização e disciplinar dos saberes, que está na origem da enfermagem como profissão e disciplina de conhecimento.

Abstract Context: In the 19th century, we witnessed hospital modernization, the affirmation of medical science, and the exponential development of nurses' activities. Objective: To know the activity of nurses in the Nightingale century. Methodology: Historical with analysis and explanation of a past accessed through the examination of its marks and mental representation. Considering not a simple narrative, but a description, as much as possible explanatory. Results: Transformation throughout the century, of the activity of nurses, visible in the space conquered in hospital structures, in the creation of teaching, in a slow movement towards full professionalization. Conclusion: In the Nightingale century, a continuation of professionalization and disciplinary knowledge, which is the origin of nursing as a profession and knowledge discipline.

Resumen Contexto: En el siglo XIX se asiste a la modernización hospitalaria, la afirmación de la ciencia médica y el desarrollo exponencial de la actividad enfermera. Objetivo: Conocer la actividad de las enfermeras en el siglo Nightingale. Metodología: Histórica con análisis y explicación de un pasado al que se accede mediante el examen de sus marcas y representación mental. No se considera una simple narración, sino una descripción lo más explicativa posible. Resultados: A lo largo del siglo se produjo una transformación de la actividad enfermera, visible en el espacio de las estructuras hospitalarias, la creación de la docencia y en un lento movimiento hacia la plena profesionalización. Conclusión: En el siglo de Nightingale, se inicia una continua profesionalización y disciplina de saberes, que es el origen de la enfermería como profesión y disciplina del conocimiento.

Un dilema actual: ¿El uso de sujeciones como técnica terapéutica garantiza la dignidad de la persona? / A current dilemma: Does the use of restraints as a therapeutic technique guarantee the dignity of the person?

Resumen Marco contextual: La sujeción como técnica terapéutica ha suscitado controversia a lo largo del tiempo. Actualmente, la contención se circunscribe a situaciones de emergencia que entrañen riesgo para la vida del paciente o para terceras personas. Objetivo: Conocer las técnicas terapéuticas de sujeción de la persona, revisar sus efectos secundarios y promover su buena praxis. Metodología: Revisión de la literatura relacionada con la contención de las personas. Análisis interpretativo de la información recopilada en documentos, artículos, libros y leyes, mediante la hermenéutica de Gadamer. Resultados: A través del tiempo se reflexiona sobre la contención de las personas por medio de la sujeción como medida terapéutica. Se indagan los aspectos éticos y se profundiza en su marco legislativo. Se analizan las implicaciones que dicha práctica puede comportar para el personal sanitario. Conclusión: Es necesario fomentar medidas terapéuticas de confort que mitiguen y limiten el uso de la sujeción de la persona con trastornos conductuales y/o necesidades especiales. Hecho que garantiza los derechos y la dignidad de la persona.

Abstract Background: Restraint as a therapeutic technique has been controversial over time. It is currently limited to emergency situations involving risk to the patient's life or third parties. Objective: To know therapeutic techniques for restraining the person, review their side effects, and promote good practice. Methodology: Literature review related to the containment of people. Interpretative analysis of information gathered from documents, articles, books, and laws, using Gadamer's hermeneutics. Results: We reflected on restraint use for containing patients as a therapeutic measure over time. We investigated the ethical aspects and examined the legislative framework in depth. The implications that this practice may have for health personnel were analyzed. Conclusion: It is necessary to promote comfort care measures that mitigate and limit the use of restraint in the person with behavioral disorders and/or special needs, thus guaranteeing their rights and dignity.

Resumo Enquadramento: A contenção como técnica terapêutica tem sido controversa ao longo do tempo. A contenção está atualmente limitada a situações de emergência que envolvem riscos para a vida do paciente ou para terceiros. Objetivo: Conhecer as técnicas terapêuticas para conter a pessoa, rever os seus efeitos secundários e promover boas práticas. Metodologia: Revisão bibliográfica, relacionada com a contenção de pessoas. Análise interpretativa da informação recolhida a partir de documentos, artigos, livros e leis, utilizando a hermenêutica de Gadamer. Resultados: Ao longo do tempo, é possível refletir sobre a contenção das pessoas por meio de contenção como medida terapêutica. Os aspetos éticos são investigados e o quadro legislativo é examinado em profundidade. As implicações que esta prática pode ter para o pessoal de saúde são analisadas. Conclusão: É necessário promover medidas de conforto terapêutico que atenuem e limitem o uso de restrições por parte da pessoa com perturbações comportamentais e/ou necessidades especiais. Isto garante os direitos e a dignidade da pessoa.

Predictive functional, statistical and structural analysis of CSNK2A1 and CSNK2B variants linked to neurodevelopmental diseases.

Okur-Chung Neurodevelopmental Syndrome (OCNDS) and Poirier-Bienvenu Neurodevelopmental Syndrome (POBINDS) were recently identified as rare neurodevelopmental disorders. OCNDS and POBINDS are associated with heterozygous mutations in the CSNK2A1 and CSNK2B genes which encode CK2α, a serine/threonine protein kinase, and CK2ß, a regulatory protein, respectively, which together can form a tetrameric enzyme called protein kinase CK2. A challenge in OCNDS and POBINDS is to understand the genetic basis of these diseases and the effect of the various CK2⍺ and CK2ß mutations. In this study we have collected all variants available to date in CSNK2A1 and CSNK2B, and identified hotspots. We have investigated CK2⍺ and CK2ß missense mutations through prediction programs which consider the evolutionary conservation, functionality and structure or these two proteins, compared these results with published experimental data on CK2α and CK2ß mutants, and suggested prediction programs that could help predict changes in functionality of CK2α mutants. We also investigated the potential effect of CK2α and CK2ß mutations on the 3D structure of the proteins and in their binding to each other. These results indicate that there are functional and structural consequences of mutation of CK2α and CK2ß, and provide a rationale for further study of OCNDS and POBINDS-associated mutations. These data contribute to understanding the genetic and functional basis of these diseases, which is needed to identify their underlying mechanisms.

Effect of agricultural activities on surface water quality from páramo ecosystems.

Páramos are high mountain ecosystems strategic for water provision in South America. Currently, páramos are under threat due to agricultural intensification that impairs surface water sources. This research analyzed the effect of agriculture (spring onion-Allium fistulosum, potato-Solanum tuberosum, and livestock farming) on water quality in páramo ecosystems. A Hydrographic Unit upstream of the Jordan river catchment (Colombia) was selected and monitored in two different rainfall regimes, following the paired catchments and upstream-downstream approaches to compare water quality from natural and anthropic areas. Twenty-two parameters related to agricultural activities were analyzed (nutrients, salts, organic matter, sediments, and pathogens). The studied agricultural activities increased loads of surface water in quality in nitrates (0.02 to 2.56 mg N-NO3/L), potassium (0.13 to 1.24 mg K/L), and Escherichia coli (63 to 2718 FCU/100 mL), generating risks on the human health and promoting eutrophication. Total nitrogen and organic matter in the rainy season were higher than dry. BOD5, COD, turbidity, and E. coli were above international standards for direct human consumption. However, water could be used for irrigation, livestock watering, and aquatic life ambient freshwater. The results show that a small land-use change of almost 15% from natural páramo vegetation to agricultural uses in these ecosystems impairs water quality, limiting its uses, and the need to harmonize small-scale livelihoods in the páramo with the sustainability of ecosystem service provision.

Preparados curativos aplicados por sanitarios al sifilítico: un recorrido histórico (s. XVI-XXI) / Preparations applied by nurses to syphilitics from 1500 to the present day

La sífilis enfermedad infecciosa, cuyo agente causal es la bacteria Treponema Pallidum, presenta una evolución tórpida, con períodos de exacerbación y latencia, siendo su transmisión por vía placentaria o contagio directo. La enfermedad posee varios estadios, denominándose el primero la sífilis primaria o primitiva, momento que comienza la infección con la aparición de un chancro, si el tratamiento es efectivo, en torno a 4-6 semanas el chancro cicatriza [Fragmento de texto] (AU)

Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review.

When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse-patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education. OBJECTIVE: To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses. DESIGN: The Campinha-Bacote model of cultural competence was used as the primary reference. METHOD: A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted. RESULTS: Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies. CONCLUSIONS: Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.

A cross-institutional analysis of the effects of broadening trainee professional development on research productivity.

PhD-trained scientists are essential contributors to the workforce in diverse employment sectors that include academia, industry, government, and nonprofit organizations. Hence, best practices for training the future biomedical workforce are of national concern. Complementing coursework and laboratory research training, many institutions now offer professional training that enables career exploration and develops a broad set of skills critical to various career paths. The National Institutes of Health (NIH) funded academic institutions to design innovative programming to enable this professional development through a mechanism known as Broadening Experiences in Scientific Training (BEST). Programming at the NIH BEST awardee institutions included career panels, skill-building workshops, job search workshops, site visits, and internships. Because doctoral training is lengthy and requires focused attention on dissertation research, an initial concern was that students participating in additional complementary training activities might exhibit an increased time to degree or diminished research productivity. Metrics were analyzed from 10 NIH BEST awardee institutions to address this concern, using time to degree and publication records as measures of efficiency and productivity. Comparing doctoral students who participated to those who did not, results revealed that across these diverse academic institutions, there were no differences in time to degree or manuscript output. Our findings support the policy that doctoral students should participate in career and professional development opportunities that are intended to prepare them for a variety of diverse and important careers in the workforce.

Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience.

In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death (p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07-0.31) and younger age (OR 8.68; IC 95% 2.66-28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05-5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.

Down-Regulation of CK2α Leads toUp-Regulation of the Cyclin-Dependent Kinase Inhibitor p27KIP1 in Conditions Unfavorable for the Growth of Myoblast Cells.

BACKGROUND/AIMS: Compelling evidence indicates that CK2α, which is one of the two catalytic isoforms of protein kinase CK2, is required for cell viability and plays an important role in cell proliferation and differentiation. While much is known on CK2 in the context of disease states, particularly cancer, its critical role in non-cancerous cell growth has not been extensively investigated. METHODS: In the present study, we have employed a cell line derived from rat heart with inducible down-regulation of CK2α and CK2α-knockout mouse tissue to identify CK2-mediated molecular mechanisms regulating cell growth. For this, we have performed Incucyte® live-cell analysis and applied flow cytometry, western blot, immunoprecipitation, immunohistochemistry, RT-qPCR and luciferase-based methods. RESULTS: Here, we show that lack of CK2α results in significantly delayed cell cycle progression through G1, inhibition of cyclin E-CDK2 complex, decreased phosphorylation of Rb protein at S795, and inactivation of E2F transcription factor. These events are accompanied by nuclear accumulation and up-regulation of the cyclin-dependent kinase inhibitor p27KIP1 in cells and CK2α-knockout mouse tissues. We found that increased levels of p27KIP1 are mainly attributable to post-translational modifications, namely phosphorylation at S10 and T197 amino acid residues catalyzed by Dyrk1B and AMPK, respectively, as silencing of FoxO3A transcription factor, which activates CDKN1B the gene coding for p27KIP1, does not result in markedly decreased expression levels of the corresponding protein. Interestingly, simultaneous silencing of CK2α and p27KIP1 significantly impairs cell cycle progression without increasing cell death. CONCLUSION: Taken together, our study sheds light on the molecular mechanisms controlling cell cycle progression through G1 phase when myoblasts proliferation potential is impaired by CK2α depletion. Our results suggest that elevated levels of p27KIP1, which follows CK2α depletion, contribute to delay the G1-to-S phase transition. Effects seen when p27KIP1 is down-regulated are independent of CK2α and reflect the protective role exerted by p27KIP1 under unfavorable cell growth conditions.

Enfermeiros entre os funcionários dos Hospitais da Universidade de Coimbra, 1779 a 1797: particularidades e implicações / Nurses in the staff of the Coimbra University Hospitals, 1779-1797: particularities and implications / Enfermeros entre el personal de los Hospitales de la Universidad de Coímbra, de 1779 a 1797: particularidades e implicaciones

Contexto: Os Hospitais da Universidade de Coimbra resultam da concentração de pequenos hospitais e são, nesta época, uma instituição de dimensões significativas. Nos finais do século XVIII, em pleno iluminismo, os hospitais vivenciaram um processo de transição para a modernidade. Objetivos: Descrever os funcionários que existiam nos Hospitais da Universidade de Coimbra nos finais do século XVIII. Analisar a evolução dos ofícios em presença e os seus posicionamentos relativos, com o foco nos enfermeiros. Metodologia: Análise histórica, partindo de fontes publicadas, considerando os contextos e as linhas evolutivas de longa duração, construindo uma síntese interpretativa. Resultados: Estamos em presença de quatro agrupamentos profissionais - cuidadores do corpo (enfermeiros, médicos e cirurgiões), cuidadores da alma (capelões e sacristãos), serviços de apoio (ajudantes, serventes, cozinheiros, roupeira, lavadeira, despenseiro), e Serviços de segurança (porteiros, guardas e tronqueiro). Conclusão: Verificou-se a presença de enfermeiros num processo de transição entre linhas de continuidade medieval, com enfermeiros-sangradores e enfermeiros-cozinheiros, e a diferenciação ascendente com enfermeira dos partos e descendente com ajudantes das enfermarias.

Context: Resulting from the integration of small hospitals, the Coimbra University Hospitals were, at this time, an institution of significant size. At the end of the 18th century, during the Age of Enlightenment, hospitals were undergoing a process of transition to modernity. Objectives: To describe the staff of the Coimbra University Hospitals in the last decades of the 18th century and analyze the evolution of the existing professions and compare their salaries and positions, while focusing on nurses. Methodology: A historical analysis based on published sources, considering the contexts and long-lasting evolutionary lines while building an interpretative summary. Results: Four professional groups were found and divided into treatment of the body - nurses, physicians, and surgeons; treatment of the soul - chaplains and sexton; support services - assistants, helpers, cooks, laundry maid, washerwoman, despenseiro; and security services - doorkeepers, guards, and tronqueiro. Conclusion: It was possible to observe the presence of nurses during the transition between medieval continuity, with the continuance of bloodletting nurses and cook nurses, and the ascending differentiation of the delivery nurse and the descending differentiation of ward assistants.

Marco contextual: Los Hospitales de la Universidad de Coímbra son el resultado de la concentración de pequeños hospitales y son, en este momento, una institución de dimensiones significativas. A finales del siglo XVIII, en plena Ilustración, los hospitales experimentaron un proceso de transición a la modernidad. Objetivos: Describir al personal que existía en los Hospitales de la Universidad de Coímbra a finales del siglo XVIII. Analizar la evolución de los oficios en presencia y sus posicionamientos relativos, centrándose en los enfermeros. Metodología: Análisis histórico, a partir de fuentes publicadas, se consideraron los contextos y las líneas evolutivas de larga duración, y se construyó una síntesis interpretativa. Resultados: Se encontraron cuatro grupos profesionales, cuidadores del cuerpo (enfermeros, médicos y cirujanos), cuidadores del alma (capellanes y sacristanes), servicios de apoyo (ayudantes, sirvientes, cocineros, guardarropa, lavandera, mayordomo) y servicios de seguridad (porteros, guardias y tronqueiro - guardia del albergue). Conclusión: Se verificó la presencia de enfermeros en un proceso de transición entre líneas de continuidad medieval, con enfermeros-sangradores y enfermeros-cocineros, y la diferenciación ascendente con el enfermero de partos y descendiente con los ayudantes de enfermería.

Un incremento exagerado de la presión arterial con el ejercicio no predice mortalidad ni eventos cardiovasculares graves en mujeres referidas a ecocardiografía de ejercicio por razones clínicas / An exaggerated increase in blood pressure with exercise does not predict mortality or severe cardiovascular events in women referred for exercise echocardiography for clinical reasons

FUNDAMENTO Y OBJETIVOS: La asociación entre un incremento exagerado de la presión arterial sistólica con el ejercicio (IEPASE) y la probabilidad de eventos cardiovasculares es controvertida y poco estudiada en población femenina. Nuestro propósito fue determinar la posible asociación de un IEPASE con mortalidad y eventos cardiovasculares en mujeres referidas a ecocardiografía de ejercicio por enfermedad coronaria conocida o sospechada. PACIENTES Y MÉTODOS: Se realizó ecocardiografía de ejercicio a 3.942 mujeres con enfermedad coronaria conocida o sospechada. El IEPASE se definió como un incremento de la presión arterial sistólica con el ejercicio ≥70mmHg. Los objetivos fueron mortalidad global y cardíaca, infarto agudo de miocardio (IM), accidente cerebrovascular (ACV) e intervenciones de revascularización coronaria. RESULTADOS: Trescientas treinta y dos mujeres desarrollaron IEPASE durante los test. En el seguimiento se registraron un total de 458 muertes (162 de origen cardíaco), 212 IM, 89 ACV y 345 intervenciones de revascularización coronaria. La tasa anual de mortalidad global y cardiaca fue inferior en el subgrupo de pacientes con IEPASE (0,15% vs. 2,3%, p = 0,02 y 0,01% vs. 0,2%, p = 0,015, respectivamente). No observamos diferencias significativas en las tasas de IM, ACV y de intervenciones de revascularización coronaria, que fueron, respectivamente, del 1,1%, 0,43% y 2,24% en pacientes con IEPASE y del 0,09%, 0,05% y 0,13% en aquellas mujeres sin IEPASE (p = 0,66; p = 0,57; p = 0,19, respectivamente), Tras un ajuste multivariante el IEPASE no resultó predictor de mortalidad ni de eventos cardiovasculares. CONCLUSIONES: El IEPASE no se asoció con mortalidad ni eventos cardiovasculares graves en mujeres con enfermedad coronaria conocida o sospechada

BACKGROUND AND OBJECTIVES: The association between an exaggerated systolic blood pressure increase with exercise (EBPIE) and the probability of cardiovascular events is controversial and poorly studied in the female population. Our aim was to determine the possible association between EBPIE on one hand and mortality and cardiovascular events on the other in women referred for exercise echocardiography due to known or suspected coronary artery disease. PATIENTS AND METHODS: A total of 3942 women with known or suspected coronary artery disease underwent exercise echocardiography. We defined EBPIE as a ≥70mm Hg increase in systolic blood pressure with exercise. The study endpoints were overall and cardiac mortality, acute myocardial infarction (MI), stroke and coronary revascularisation procedures. RESULTS: A total of 332 women developed EBPIE during the test. During the follow-up, 458 deaths (162 of cardiac origin), 212 MIs, 89 strokes and 345 coronary revascularisation procedures were recorded. The annual rates of overall and cardiac mortality were lower in the patient subgroup with EBPIE (0.15% vs. 2.3%, P=.02 and 0.01% vs. 0.2%, P=.015, respectively). There were no significant differences in the rates of MI, stroke and the need for coronary revascularisation procedures, which occurred in 1.1%, 0.43% and 2.24% of the patients with EBPIE, respectively, and occurred in 0.09%, 0.05% and 0.13% of the women without EBPIE (P=.66; P=.57; P=.19, respectively). After a multivariate adjustment, EBPIE was not a predictor of mortality or cardiovascular events. CONCLUSIONS: EBPIE is not associated with mortality or severe cardiovascular events in women with known or suspected coronary artery disease

Enfermería durante la guerra civil española y su posguerra (1936-1949): olvido e inhabilitación / Nursing during the Spanish Civil War and its post-war period (1936-1949): forgetting and disabling / Enfermagem durante a Guerra Civil Espanhola e seu período pós-guerra (1936-1949): esquecendo e incapacitando

Marco contextual: El modelo de salud en la Segunda República española (1931-1939) y las prácticas asistenciales desarrolladas por el personal enfermero transformaron las condiciones sanitarias del país. Sin embargo, durante la Guerra Civil (1936-1939), los cuidados sociosanitarios fueron desiguales. Objetivo: Analizar la influencia sanitaria durante la Guerra Civil y la posguerra española. Metodología: Investigación histórico-descriptiva, relacionada con la sanidad durante la guerra civil española y la posguerra. Recopilación de información: documentos enfermeros; análisis: periódicos, libros, leyes. Se realizó un análisis interpretativo por fechas y acontecimientos del periodo de estudio. Resultados: Entre 1939 y 1949, las leyes promulgadas revisaron el trabajo realizado por los sanitarios, lo que llevó a la represión y eliminación de funcionaros sanitarios ajenos a las ideas políticas imperantes, y supuso un proceso de purificación y descalificación. Conclusión: El Gobierno de la Segunda República española atribuyó importancia a la higiene en el ámbito sanitario y doméstico. Llegada la Guerra Civil, España sufrió carencias de cuidados sanitarios a nivel civil y militar. Durante la posguerra, la identidad de parte de la enfermería fue omitida y olvidada.

Background: The health model during the Second Spanish Republic (1931-1939) and the care practices developed by the nursing staff transformed the health conditions of the country. During the civil war (1936-1939), social and health care was unequal. Objective: Analyse the influence of health care during and after the Spanish Civil War. Methodology: Historical-descriptive research related to health care during the Civil War. Compilation of information: nursing documents, newspapers, books, laws. Interpretative analysis by dates and events of the period of study. Results: Between 1939 and 1949, the laws enacted revised the work carried out by the health workers, leading to the repression and elimination of the health workers who were alien to the prevailing political ideas, which meant a process of purification. Conclusion: The government of the Second Republic attributed importance to hygiene in the sanitary and domestic field. After the Civil War, Spain suffered from a lack of health care at both civil and military levels. During the post-war the identity of part of the nursing profession was forgotten.

Enquadramento: O modelo de saúde durante a Segunda República Espanhola (1931-1939) e as práticas assistenciais desenvolvidas pelos enfermeiros transformaram as condições de saúde do país.Durante a Guerra Civil (1936-1939), a assistência social e sanitária foi desigual. Objetivo: Analisar a influência dos cuidados de saúde durante a Guerra Civil Espanhola e período pós-guerra. Metodologia: Investigação histórico-descritiva sobre os cuidados de saúde durante a Guerra Civil. Compilação de informação: documentos de enfermagem, jornais, livros, leis. Análise interpretativa por datas e eventos do período em estudo. Resultados: Entre 1939 y 1949, as leis promulgadas reviram o trabalho realizado pelos trabalhadores da saúde, levando à repressão e eliminação de muitos que eram alheios às idéias políticas predominantes, o que implicava um processo de purificação e desqualificação. Conclusão: O Governo da Segunda República atribuiu importância à higiene no campo sanitário e doméstico. Após a Guerra Civil, a Espanha sofreu com a falta de cuidados de saúde. Durante o período pós-guerra, a identidade de parte da profissão de enfermagem foi omitida e esquecida.

Integrating the basic sciences in medical curricula: focus on the basic scientists.

Basic science educators are not trained as clinicians, yet are expected to adjust their content to mesh appropriately with its clinical application. While achievable, this is a challenge that requires intentional effort on the part of the basic science educators. A practical solution to facilitate curricular integration is to create experiential opportunities for basic scientists to observe the clinical application of their content and to pair these initiatives with training in effective medical education practices.

Developing a Practical Medical Educator Training Program: Meeting A Need in Faculty Development.

This article was migrated. The article was marked as recommended. Faculty who teach in medical schools typically do so because of their knowledge and expertise in their field, yet few receive training in best practices in teaching. Educator development programs that help faculty enhance their teaching skills while continuing to fulfill their existing professional responsibilities can help address this gap. Such programs may be developed and implemented locally by individuals within the institution. This guide is intended for individuals who are interested in developing educator training programs but who lack experience in program development. The article describes practical strategies for designing, implementing, and evaluating a collaborative program to teach skills and best practices in medical education. Key themes in program design, program implementation, and program evaluation and dissemination include appropriate goal setting, setting clear expectations, strong communication, and the benefits of diversity in collaboration. Educator training programs provide enhanced teaching skills and opportunities for career advancement for participants at all career stages, which in turn benefits the institution and the medical profession.