The Impact of a Specialized Hernia Center and Standardized Practices on Surgical Outcomes in Hernia Surgery: A Systematic Review and Meta-Analysis.

Aim: Hernia registries report that guidelines are not always implemented by general surgeons and suggest that the success rate of this procedure is higher in hernia specialty centers. There are many definitions of hernia centers, but their objectives consist of improving healthcare by homogenizing the clinical practice. We performed a systematic review and meta-analysis to analyze hernia centers' definitions and compare hernia centers with non-specialized centers. Material and Methods: Cochrane Central, Scopus, Scielo, and PubMed were systematically searched for studies defining a hernia center or comparing hernia centers and non-specialized centers. Outcomes assessed were recurrence, surgical site events, hospital length of stay (LOS), and operative time. We performed subgroup analyses of hernia type. Statistical analysis was performed with R Studio. Results: 3,260 studies were screened and 88 were thoroughly reviewed. Thirteen studies were included. Five studies defined a hernia center and eight studies, comprising 141,366 patients, compared a hernia center with a non-specialized center. Generally, the definitions were similar in decision-making and educational requirements but differed in structural aspects and the steps required for the certification. We found lower recurrence rates for hernia centers for both inguinal (1.08% versus 5.11%; RR 0.21; 95% CI 0.19 to 0.23; p < 0.001) and ventral hernia (3.2% vs. 8.9%; RR 0.425; 95% CI 0.28 to 0.64; p < 0.001). Hernia centers also presented lower surgical site infection for both ventral (4.3% vs. 11.9%; RR 0.435; 95% CI 0.21 to 0.90; p = 0.026) and inguinal (0.1% vs. 0.52%; RR 0.15; 95% CI 0.02 to 0.99; p = 0.49) repair. Conclusion: Our systematic review and meta-analysis support that a hernia center establishment improves postoperative outcomes data. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024522263, PROSPERO CRD42024522263.

Nesting Biology of Megachile (Chrysosarus) jenseni (Hymenoptera: Megachilidae) in Two Contrasting Pampean Agroecosystems: A Potential Pollinator for Alfalfa?

Several crops depend on both managed and wild bees to produce fruits and/or seeds, and the efficiency of numerous wild bees is higher than that of some managed species. Therefore, knowing and understanding the required resources for wild bees could enabled the establishment of management practices to increase their populations. Here, we provide information about the nesting biology of Megachile (Chrysosarus) jenseni, a Faboideae-specialist bee species. Based on observations from two populations occurring in contrasting agroecosystems, this bivoltine species showed common behavioral features shared with other species of subgenus Chrysosarus, such as the use of petal pieces and mud as nesting materials and the utilization of pre-existing cavities. Both studied populations showed a bivoltine life cycle with a rapid early-summer generation and a second generation, with most individuals overwintering. Main causes of mortality were unknown diseases (or other factors), causing the death of preimaginal stages. Moreover, this species was attacked by a cleptoparasite megachilid (Coelioxys remissa), a parasitic eulophid wasp (Melittobia sp.), and a bee fly (Anthrax oedipus). Finally, we discussed the potential use of this leaf-cutter bee species for alfalfa pollination.

[Low back pain and referral to the spine specialist: situation and resources in Buenos Aires]. / Lumbalgia y derivación al especialista de columna: situación y recursos en hospitales públicos de la Ciudad Autónoma de Buenos Aires.

INTRODUCTION: 90% of cases of acute low back pain have no specific underlying cause. International guidelines are available to help identify those individuals who require specialized care. However, in our country, there is a limited emphasis on primary healthcare, with the primary focus on hospital-based care. The aim of this study is to provide an overview of the diagnostic and therapeutic resources utilized in the initial care of patients experiencing low back pain at their first consultation with a specialist physician. METHODS: Descriptive and cross-sectional study, with prospective data collection through a questionnaire administered to patients experiencing low back pain during their first visit to a specialist's office. RESULTS: A total of 44 patients were included, with an average age of 53 years; 50% sought medical attention for chronic pain. Informal referrals were associated with the referring physician's specialty (non-orthopedic), patients with a higher number of emergency department visits, and longer waiting times to obtain the consultation; 52% of patients arrived with at least one complementary study. CONCLUSION: Most of the referrals were appropriate; however, informal referrals were more common. Only 1/5 of the patients underwent an physical examination, and less than 30% of those with red flag symptoms presented with suitable complementary studies. The median waiting time for the consultation was 24 days.

Introducción: El 90% de las lumbalgias agudas son de causa inespecífica. Existen guías internacionales que permiten identificar a aquellos pacientes que requieren atención especializada. En nuestro país la orientación a la atención primaria de la salud es escasa, centrada principalmente en la atención en los hospitales. El objetivo del presente estudio fue describir los recursos de salud, diagnósticos y terapéuticos, utilizados en la atención inicial de pacientes con dolor lumbar que acuden a la consulta del médico especialista Métodos: Estudio descriptivo y transversal, con recolección prospectiva de los datos a través de un cuestionario destinado a pacientes con dolor lumbar que acuden por primera vez a la consulta especializada. Resultados: Se incluyeron 44 pacientes, edad media 53 años; 50% concurrió por dolor crónico. La derivación informal se asoció con: especialidad de derivación (no traumatólogo), pacientes con mayor número de consultas a guardia y mayor demora en obtener la consulta. El 52% concurrió con al menos un estudio complementario. Conclusión: La mayor parte de las derivaciones fueron correctas, sin embargo, predominó la derivación informal. Solo 1/5 de los pacientes fue examinado y menos del 30% de los pacientes con banderas rojas acudió con estudios complementarios adecuados. La mediana del tiempo de espera para la consulta fue 24 días.

Understanding different dominance patterns in western Amazonian forests.

Dominance of neotropical tree communities by a few species is widely documented, but dominant trees show a variety of distributional patterns still poorly understood. Here, we used 503 forest inventory plots (93,719 individuals ≥2.5 cm diameter, 2609 species) to explore the relationships between local abundance, regional frequency and spatial aggregation of dominant species in four main habitat types in western Amazonia. Although the abundance-occupancy relationship is positive for the full dataset, we found that among dominant Amazonian tree species, there is a strong negative relationship between local abundance and regional frequency and/or spatial aggregation across habitat types. Our findings suggest an ecological trade-off whereby dominant species can be locally abundant (local dominants) or regionally widespread (widespread dominants), but rarely both (oligarchs). Given the importance of dominant species as drivers of diversity and ecosystem functioning, unravelling different dominance patterns is a research priority to direct conservation efforts in Amazonian forests.

Insuficiente aplicación de Medicina Natural y Tradicional en afecciones relacionadas con la ortopedia y la traumatología / Unsatisfactory Application of Natural and Traditional Medicine in Conditions Related with Orthopedics and Traumatology

La Medicina Natural y Tradicional aplica sus diferentes modalidades en la práctica médica moderna, segura, económica, inocua y simple; y con pocos efectos colaterales resuelve grandes problemas de salud en situaciones especiales o de desastres con recursos limitados. De ahí que el egresado de programas de especialización de las ciencias médicas cuenta con sólidos conocimientos para su aplicación, especialmente en las afecciones osteomioarticulares, donde la especialidad de ortopedia y traumatología tiene un papel primordial para identificar las causas y consecuencias de la insuficiencia de su aplicación en pacientes portadores de afecciones relacionadas con esta especialidad. A través de un estudio crítico reflexivo basado en el análisis y la síntesis, así como de la constatación de la validez de los puntos de vista asumidos como referentes en el proceso de superación del especialista de ortopedia y traumatología, se pudo mostrar cómo se ha concebido la superación profesional en el Hospital General Dr. Juan Bruno Zayas Alfonso, al integrar adecuadamente los conocimientos y las competencias. Esto se expresó en la elaboración e implementación de una estrategia de superación profesional, que permitió la actualización de relevantes conocimientos necesarios en el campo de la MNT para el desempeño de este profesional. Se concluyó que era insuficiente el nivel de conocimiento de los contenidos, como también los cursos ofertados para su desarrollo, lo que trajo como consecuencia una atención médica sin calidad(AU)

Natural and traditional medicine applies its different modalities in modern, safe, economical, innocuous and simple medical practice; with few collateral effects, it solves major health problems in special or disaster situations with limited resources. Hence, the graduate of specialization programs in medical sciences possesses solid knowledge for its application, especially in osteomyoarticular conditions, in which the specialty of orthopedics and traumatology has a key role in identifying the causes and consequences of its unsatisfactory application in patients with conditions related to this specialty. Through a reflexive and critical study based on analysis and synthesis, as well as the verification of the validity of the viewpoints assumed as referents in the process of improvement of the orthopedics and traumatology specialist, it was possible to show how professional improvement has been conceived at Hospital General Dr. Juan Bruno Zayas Alfonso, by adequately integrating knowledge and competences. This was expressed through the elaboration and implementation of a professional improvement strategy, which allowed updating relevant knowledge necessary in the field of natural and traditional medicine for the performance of this professional. The level of knowledge about the contents was concluded to be insufficient, while the courses offered for its development were so, which resulted in a medical care without quality(AU)

Formación, desarrollo y evaluación de competencias profesionales en especialistas en cirugía general

Introducción: La formación, el desarrollo, la evaluación de competencias y el desempeño de los profesionales de la salud han sido una preocupación permanente en las últimas décadas, para incrementar la calidad de los servicios. Asimismo, las universidades médicas trabajan en pro de aportar un profesional con capacidad y modo de actuación adecuados. Objetivo: Evaluar, desde la formación permanente y continuada, las competencias profesionales de especialistas en cirugía general, a partir de la elaboración de la ficha del perfil de competencias. Materiales y métodos: Se realizó un estudio de desarrollo, descriptivo, exploratorio, en el período de enero de 2022 a enero de 2023, en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. En la investigación participaron los 28 especialistas en cirugía general que laboran en el centro, y se analizó la variable "competencias profesionales". Se utilizaron como métodos teóricos: análisis documental, analítico-sintético, sistematización, inducción-deducción y modelación; y como empíricos: consulta a expertos con el método Delphi por rondas, y para la evaluación, el método 360 grados. Resultados: Se evaluaron las competencias profesionales del especialista en cirugía general según la ficha del perfil elaborada, y se identificaron las limitaciones, y la necesidad de superación desde la formación permanente y continuada. Conclusiones: La evaluación de los especialistas en cirugía general a partir del perfil de competencias profesionales, es el punto de partida para un adecuado desempeño profesional, y el enriquecimiento de las ciencias de la educación médica desde el principio de la formación permanente y continuada.

Introduction: The training, development, evaluation of skills and performance of the health professionals has been a concern in the last decades, to increase the quality of the services. Likewise, medical universities work in favor of providing professionals with adequate skills and mode of action. Objective: To evaluate, from the permanent and continuous training, the professional skills of specialist in general surgery, starting from the preparation of the skill profile file. Materials and methods: A development, descriptive, exploratory study was carried out in the period from January 2022 to January 2023 at the Clinical Surgical University Hospital Comandante Faustino Pérez Hernández, of Matanzas. The 28 specialists in general surgery who work in the hospital participated in the research, and the variable "professional skills" was analyzed. The following theoretical methods were used: documentary analysis, analytic-synthetic, systematization; induction-deduction and modeling; and as empirical: experts' consultation with the Delphi method by rounds, and for evaluation, the 360 degrees method. Results: The professional skills of the specialist in general surgery were evaluated according to the profile elaborated; the limitations and the need to improve from permanent and continuous training were identified. Conclusions: The evaluation of the specialist in general surgery from the profile of professional skills, is the start point for an adequate professional performance, and the enrichment of medical education sciences from the principle of the permanent and continuous training.

Guía para la confección del informe de tesis de especialistas de primer grado / Guide for preparing the thesis report of first-degree specialists i: en

Contar con una guía que establezca un formato único para la elaboración del informe correspondiente a las tesis de las especialidades de las ciencias médicas ha sido, hasta el momento, una necesidad de los tribunales y residentes. Por ello, en la Universidad de Ciencias Médicas de Santiago de Cuba se propuso confeccionar una guía a tal efecto, en la cual se mantienen los aspectos formales y científicos establecidos previamente, pero se añaden elementos en el formato en cuanto a la escritura y la extensión general y por secciones. En este artículo se expone dicha guía, que se constituye en un instrumento de utilidad tanto para los especialistas de primer grado, al facilitar y perfeccionar la confección del trabajo de tesis, como para los tribunales estatales que tienen a su cargo la evaluación de estos informes.

Having a guide that establishes a single format for preparing the report corresponding to theses in medical science specialties has been, until now, a need for courts and residents. For this reason, at the University of Medical Sciences from Santiago de Cuba it was proposed to prepare a guide for this purpose, in which the formal and scientific aspects previously established are maintained, but elements are added in the format in terms of writing and general extension and by parts. This article presents this guide, which constitutes a useful instrument both for first-degree specialists, by facilitating and perfecting the preparation of the thesis work, and for the state courts that are in charge of evaluating these reports.

Especialización de enfermería en anestesiología y reanimación como necesidad formativa en Cuba / Nursing specialization in anesthesiology and resuscitation as a training need in Cuba

Introducción: Las especialidades de posgrado constituyen la formación académica que le proporciona al profesional la actualización, profundización, perfeccionamiento o ampliación de las competencias laborales para el desempeño asistencial que requiere. Objetivo: Explorar la percepción de los enfermeros certificados para la práctica de la anestesiología sobre la necesidad de la formación de enfermeros especialistas en anestesiología y reanimación. Métodos: Se realizó un estudio cualitativo, de tipo Investigación Convergente Asistencial en el Departamento de Docencia e Investigación del Hospital Provincial Pediátrico Universitario de Villa Clara, Cuba, entre los meses de enero y marzo del año 2022. El universo estuvo compuesto por 100 profesionales de enfermería certificados en anestesiología, y la muestra seleccionada a través de un muestreo teórico quedó constituida por 80. Se realizaron entrevistas informales y ocho grupos de discusión en el proceso investigativo. Resultados: Los participantes perciben como necesaria la formación de enfermeros especialistas en anestesiología, reanimación y alivio del dolor. Las estrategias para lograr esta formación deben estar dirigidas a su aprobación por parte de las instancias de posgrado del Ministerio de Salud Pública y el Ministerio de Educación Superior. Conclusiones: Perciben como perentorio la formación de enfermeros especialistas en anestesiología y reanimación, ya que permitirá garantizar la adecuada renovación de este recurso humano, contar con enfermeras capacitadas y capaces de brindar atención anestesiológica óptima, alcanzar un nivel profesional superior que los coloque paralelos a otras áreas del cuidado y formar recursos humanos más jóvenes que tengan un nivel de preparación superior en esta especialidad.

Introduction: Postgraduate specialties constitute the academic training that provides the professional with the updating, deepening, improvement or expansion of labor competencies for the care performance that is required. Objective: to explore the perception of certified nurses for the practice of anesthesiology on the need to train specialist nurses in anesthesiology and resuscitation. Methods: A qualitative study of the Convergent Care Research type was carried out in the Teaching and Research Department of The Provincial Pediatric University Hospital of Villa Clara, Cuba between the months of January and March of the year 2022. The universe was composed of 100 nursing professionals. certificates in anesthesiology and the sample selected through a proven theory was made up of 80. Informal interviews and discussion groups were conducted as instruments in the investigative process. Results: the participants will perceive as necessary the training of specialist nurses in anesthesiology, resuscitation and pain relief. The strategies to achieve this training must be directed to its approval by the postgraduate instances of the Ministry of Public Health and the Ministry of Higher Education. Conclusions: the training of nurses specialized in anesthesiology and resuscitation is imperative, as it will guarantee the adequate renewal of this human resource, have trained nurses capable of providing optimal anesthesiological care, reach a higher professional level than place them parallel to other areas. of care and train younger human resources that have a higher level of preparation in this specialty.

Effect of Plant Defenses and Plant Nutrients on the Performance of Specialist and Generalist Herbivores of Datura: A Macroevolutionary Study.

Macroevolutionary patterns in the association between plant species and their herbivores result from ecological divergence promoted by, among other factors, plants' defenses and nutritional quality, and herbivore adaptations. Here, we assessed the performance of the herbivores Lema trilineata daturaphila, a trophic specialist on Datura, and Spodoptera frugiperda, a polyphagous pest herbivore, when fed with species of Datura. We used comparative phylogenetics and multivariate methods to examine the effects of Datura species' tropane alkaloids, leaf trichomes, and plant macronutrients on the two herbivores´ performances (amount of food consumed, number of damaged leaves, larval biomass increment, and larval growth efficiency). The results indicate that species of Datura do vary in their general suitability as food host for the two herbivores. Overall, the specialist performs better than the generalist herbivore across Datura species, and performance of both herbivores is associated with suites of plant defenses and nutrient characteristics. Leaf trichomes and major alkaloids of the Datura species are strongly related to herbivores' food consumption and biomass increase. Although hyoscyamine better predicts the key components of the performance of the specialist herbivore, scopolamine better predicts the performance of the generalist; however, only leaf trichomes are implicated in most performance components of the two herbivores. Nutrient quality more widely predicts the performance of the generalist herbivore. The contrasting effects of plant traits and the performances of herbivores could be related to adaptive differences to cope with plant toxins and achieve nutrient balance and evolutionary trade-offs and synergisms between plant traits to deal with a diverse community of herbivores.

Variables, indicadores y criterios de evaluación del servicio médico como escenario de formación de especialistas

La calidad de la educación de posgrado concebida estratégicamente como la integración de la pertinencia social y la excelencia académica, deviene esencial en la gestión de las instituciones docente-asistenciales del sector salud. Sus múltiples dimensiones deben ser contextualizadas y son susceptibles de análisis y perfeccionamiento en cada servicio médico donde se desarrolla el proceso de formación de especialistas. Se utilizaron métodos teóricos y empíricos, para la identificación de las dificultades y la elaboración de la nueva propuesta. Se obtuvieron criterios sobre los servicios médicos como escenarios de formación, en los que se identificaron los problemas relativos a la actividad de posgrado. La propuesta consideró las directrices estratégicas, la población objeto de atención y los diferentes ámbitos temporales y espaciales identificados, con lo que pretende el fortalecimiento y desarrollo de la formación de posgrado en las Universidades de Ciencias Médicas en Cuba.

The quality of postgraduate education, strategically conceived as the integration of social relevance and academic excellence, becomes essential in the management of teaching-assistance institutions in the health sector. Its multiple dimensions must be contextualized and are susceptible to analysis and improvement in each medical service where the specialist formation process takes place. Theoretical and empirical methods were used, for the identification of the difficulties and the elaboration of the new proposal. Criteria on medical services were obtained as training scenarios, in which problems related to postgraduate activity were identified. The objective of the work is to expose a proposal of variables, indicators and evaluation criteria in the service as a scenario the specialist's formation. The proposal was considered the strategic guidelines, the target population and the different temporal and spatial areas identified, with which it intends to strengthen and develop postgraduate training in the Medical Sciences Universities in Cuba.

Understanding the Geographic Patterns of Closely-Related Species of Paspalum (Poaceae) Using Distribution Modelling and Seed Germination Traits.

The sexual species of the Dilatata complex (Paspalum dasypleurum, P. flavescens, P. plurinerve, P. vacarianum, and P. urvillei) are closely related phylogenetically and show allopatric distributions, except P. urvillei. These species show microhabitat similarities and differences in germination traits. We integrated species distribution models (SDMs) and seed germination assays to determine whether germination divergences explain their biogeographic pattern. We trained SDMs in South America using species' presence-absence data and environmental variables. Additionally, populations sampled from highly favourable areas in the SDMs of these species were grown together, and their seeds germinated at different temperatures and dormancy-breaking conditions. Differences among species in seed dormancy and germination niche breadth were tested, and linear regressions between seed dormancy and climatic variables were explored. SDMs correctly classified both the observed presences and absences. Spatial factors and anthropogenic activities were the main factors explaining these distributions. Both SDMs and germination analyses confirmed that the niche of P. urvillei was broader than the other species which showed restricted distributions, narrower germination niches, and high correlations between seed dormancy and precipitation regimes. Both approaches provided evidence about the generalist-specialist status of each species. Divergences in seed dormancy between the specialist species could explain these allopatric distributions.

Estimación de brechas de geriatras en Chile / Estimation of geriatrician gaps in Chile

Antecedentes: el envejecimiento de la población chilena y la transición epidemiológica que atraviesa el país, ha incrementado la necesidad de formar, entre otros especialistas, a médicos geriatras. Objetivo: estimar la brecha de geriatras en Chile de acuerdo con necesidades epidemiológicas de la población de 65 años y más. Método: se realizó una estimación de brecha de horas de geriatra para la red de salud, a partir de una consulta a 57 geriatras de laboralmente activos de un total de 156 geriatras registrados a enero del 2021. En dicha consulta se indagó sobre tiempo de duración de consulta y frecuencia de consultas ideales de acuerdo con la capacidad funcional de las personas mayores a nivel nacional y por región obtenida de la encuesta Casen 2017. Resultados: a febrero del 2022 existe un total de 162 geriatras en Chile, cifra que equivale a un geriatra por cada 15.806 personas de 65 años y más. De acuerdo con la estimación realizada, se requeriría en Chile, un total de 1.244.689 horas de geriatra anual, equivalentes a la existencia de 589 geriatras a nivel nacional. Conclusión: según los resultados del estudio, a nivel nacional se necesitarían de un total de 589 geriatras para cubrir las necesidades de atención de las personas mayores con algún nivel de dependencia. De acuerdo con estas cifras, al primer trimestre del 2022 el país presentaría una brecha de 427 geriatras. Ante lo elevada de esta brecha, se cree necesario avanzar en estrategias de formación general en geriatría y gerontología en los equipos de salud y socio-sanitarios.

Background:The ageing between the Chilean population and the epidemiological transition that the country is going through has increased the need to train, among other specialists, geriatric doctors.Objective: To estimate the gap between geriatricians in Chile according to the epidemiological needs of the population aged 65 years and over. Method:An estimate of the gap in geriatrician hours was made for the health network based on a consultation of 57 active geriatricians out of 156 registered as of January 2021. In this consultation, the duration and frequency of ideal consultations were inquired according to the functional capacity of the elderly at the national level and by region obtained from the Casen 2017 survey.Results: as of February 2022, there are 162 geriatricians in Chile, equivalent to one geriatrician for every 15,806 people aged 65 years and over. According to the estimate, a total of 1,244,689 hours of annual geriatrician would be required in Chile, equivalent to 589 geriatricians nationwide. Conclusion:According to the study's results, at the national level, a total of 589 geriatricians would be needed to cover the care needs of older people with some level of dependen-ce. According to these figures, in the first quarter of 2022, the country would present a gap of 427 geriatricians. Given the highness of this gap, it is believed necessary to advance general training strategies in geriatrics and gerontology in health and socio-health teams

Contrasting the population genetic structure of a specialist (Hexaglandula corynosoma: Acanthocephala: Polymorphidae) and a generalist parasite (Southwellina hispida) distributed sympatrically in Mexico.

Polymorphidae is a monophyletic group of acanthocephalans distributed worldwide. Within this family, Hexaglandula corynosoma is a specialist species that uses a single bird species as a definitive host. Southwellina hispida is a generalist species that uses a broad spectrum of definitive hosts to complete its life cycle. In the current research, sequences of cytochrome c oxidase subunit 1 (cox1) from mitochondrial DNA were generated from 44 specimens of H. corynosoma and 76 of S. hispida distributed sympatrically in 6 biogeographic provinces of Mexico with the objective of characterizing and comparing the population genetic structure of 2 acanthocephalan species with opposing life strategies. The phylogeographic studies indicated that the populations of both species lacked a phylogeographic structure and exhibited high haplotype diversity, low nucleotide diversity and low Fst values among the biogeographic provinces; in combination with negative values on the neutrality test, this suggests that the populations of acanthocephalans are expanding. Paratenic hosts are key for the transmission from intermediate to definitive hosts in the generalist species. However, the inclusion of paratenic hosts does not play a principal role in the population genetic structure of S. hispida within its distribution along the coasts of Mexico.

Mechanical properties of the California sea lion (Zalophus californianus) and northern elephant seal (Mirounga angustirostris) lower jaws explain trophic plasticity.

The fossil record of pinnipeds documents a suite of morphological changes that facilitate their ecological transition from a terrestrial to an aquatic lifestyle. Among these is the loss of the tribosphenic molar and the behavior typically associated with it in mammals: mastication. Instead, modern pinnipeds exhibit a broad range of feeding strategies that facilitate their distinct aquatic ecologies. Here, we examine the feeding morphology of two species of pinnipeds with disparate feeding ecologies: Zalophus californianus, a specialized raptorial biter, and Mirounga angustirostris, a suction specialist. Specifically, we test whether the morphology of the lower jaws facilitates trophic plasticity in feeding for either of these species. We used finite element analysis (FEA) to simulate the stresses during the opening and closing of the lower jaws in these species to explore the mechanical limits of their feeding ecology. Our simulations demonstrate that both jaws are highly resistant to the tensile stresses experienced during feeding. The lower jaws of Z. californianus experienced the maximum stress at the articular condyle and the base of the coronoid process. The lower jaws of M. angustirostris experienced the maximum stress at the angular process and were more evenly distributed throughout the body of the mandible. Surprisingly, the lower jaws of M. angustirostris were even more resistant to the stresses experienced during feeding than those of Z. californianus. Thus, we conclude that the superlative trophic plasticity of Z. californianus is driven by other factors unrelated to the mandible's tensile resistance to stress during feeding.

La Enfermería de Práctica Avanzada en la educación de posgrado para las enfermeras especialistas / Advanced Practice Nursing in Postgraduate Education for Specialist Nurses

Introducción: El término Enfermería de Práctica Avanzada tiene sus orígenes en la misma historia del desarrollo de la enfermería moderna, existe evidencia de que aumenta a nivel internacional, pero persiste la incertidumbre sobre la claridad del rol y la necesidad de progresar de manera coordinada. En la literatura revisada no se encuentra claridad acerca de la Enfermería de Práctica Avanzada para la educación y el desarrollo profesional de las enfermeras especialistas para considerarlas de práctica avanzada a pesar del conocimiento teórico y práctico que poseen. Objetivo: Identificar cómo se aborda desde la literatura científica, la Enfermería de Práctica Avanzada en la educación de posgrado para enfermeras especialistas. Métodos: Se realizó metarrevisión conocida como revisión paraguas o revisión de revisiones entre enero y abril de 2022. Búsqueda en bases de datos: BVS, SciELO y PubMed, con las palabras clave "enfermería de práctica avanzada" AND "enfermeras especialistas" AND "educación de postgrado en enfermería". Criterios de inclusión: estudios de revisión, disponibles a texto completo, publicados en los idiomas inglés, español o portugués. Criterios de exclusión: textos repetidos, los que solo se puede leer el resumen y aquellos que no se ajustaron al tema de estudio. Conclusiones: Varios de los estudios revisados describen el valor de la Enfermería de Práctica Avanzada para el desarrollo profesional y la mejora en la calidad de los servicios; no obstante, su valía aún no es bien reconocida en todos los contextos y se precisa avanzar en la consolidación de las especialistas para considerarlas de práctica avanzada(AU)

Introduction: The term advanced practice nursing has its origins in the very history of modern nursing development. Evidence shows that it is increasing internationally, but uncertainty persists about the clarity of the role and the need to progress in a coordinated way. In the reviewed literature, there is no clarity about advanced practice nursing for the education and professional development of specialist nurses to consider them of advanced practice, despite the theoretical and practical knowledge that they possess. Objective: To identify how advanced practice nursing is approached from the scientific literature in postgraduate education for specialist nurses. Methods: A meta-review known as umbrella review or review of reviews was conducted between January and April 2022. A search was conducted in the BVS, SciELO and PubMed databases, with the keywords enfermería de práctica avanzada [advanced practice nursing] AND enfermeras especialistas [nurse specialists] AND educación de postgrado en enfermería [postgraduate nursing education]. The following inclusion criteria were considered: review studies; available in full text; and published in English, Spanish or Portuguese. The following exclusion criteria were considered: repeated texts; those for which only the abstract could be read; and those that did not fit the study topic. Conclusions: Several of the reviewed studies describe the value of advanced practice nursing for professional development and the improvement in the quality of services; however, its value is still not well recognized in all contexts and progress is needed towards the consolidation of specialists to be considered of advanced practice(AU)

Evolutionary transitions in diet influence the exceptional diversification of a lizard adaptive radiation.

BACKGROUND: Diet is a key component of a species ecological niche and plays critical roles in guiding the trajectories of evolutionary change. Previous studies suggest that dietary evolution can influence the rates and patterns of species diversification, with omnivorous (animal and plant, 'generalist') diets slowing down diversification compared to more restricted ('specialist') herbivorous and carnivorous diets. This hypothesis, here termed the "dietary macroevolutionary sink" hypothesis (DMS), predicts that transitions to omnivorous diets occur at higher rates than into any specialist diet, and omnivores are expected to have the lowest diversification rates, causing an evolutionary sink into a single type of diet. However, evidence for the DMS hypothesis remains conflicting. Here, we present the first test of the DMS hypothesis in a lineage of ectothermic tetrapods-the prolific Liolaemidae lizard radiation from South America. RESULTS: Ancestral reconstructions suggest that the stem ancestor was probably insectivorous. The best supported trait model is a diet-dependent speciation rate, with independent extinction rates. Herbivory has the highest net diversification rate, omnivory ranks second, and insectivory has the lowest. The extinction rate is the same for all three diet types and is much lower than the speciation rates. The highest transition rate was from omnivory to insectivory, and the lowest transition rates were between insectivory and herbivory. CONCLUSIONS: Our findings challenge the core prediction of the DMS hypothesis that generalist diets represent an 'evolutionary sink'. Interestingly, liolaemid lizards have rapidly and successfully proliferated across some of the world's coldest climates (at high elevations and latitudes), where species have evolved mixed arthropod-plant (omnivore) or predominantly herbivore diets. This longstanding observation is consistent with the higher net diversification rates found in both herbivory and omnivory. Collectively, just like the evolution of viviparity has been regarded as a 'key adaptation' during the liolaemid radiation across cold climates, our findings suggest that transitions from insectivory to herbivory (bridged by omnivory) are likely to have played a role as an additional key adaptation underlying the exceptional diversification of these reptiles across extreme climates.

Validación por especialistas a grupo de ejercicios de resistencia aeróbica para futbolistas Categoría Sub-14

La resistencia aeróbica en el fútbol se considera una capacidad determinante, para lo cual su potenciación es parte indispensable del contenido de la preparación deportiva, siendo útil diseñar modelos especializados para su mejora, los cuales deben someterse en primera instancia a su validación teórica. En tal sentido, se plantea como objetivo de la investigación validar teóricamente a través de expertos nacionales y extranjeros una propuesta sobre un grupo de ejercicios para desarrollar la resistencia aeróbica en futbolistas de la categoría Sub-14. La Investigación es descriptiva-explicativa de orden correlacional, se valida una propuesta de intervención con un grupo de ejercicios de resistencia aeróbica para futbolistas Sub-14 en dos momentos del diseño. Se consultan 5 indicadores evaluativos a 25 especialistas (Nacionales: 14, Extranjeros: 11), se valida teóricamente la futura propuesta de intervención. Entre grupos independientes no se presentaron evaluaciones significativamente diferentes en ninguno de los 5 indicadores. Entre grupos relacionados, se evidenciaron diferencias significativas a favor del postest, tanto en los especialistas nacionales (Integralidad: r=0.001; Asequibilidad: r=0.002; Progresión: p=0.001; Variedad: p=0.001; Especialización Progresiva: p=0.001), como en los extranjeros (Integralidad: r=0.006; Asequibilidad: r=0.004; Progresión: p=0.002; Variedad: p=0.003; Especialización Progresiva: p=0.004). La futura propuesta de intervención presentó una adecuada Integralidad, Asequibilidad, Progresión, Variedad y Especialización Progresiva, mejorando significativamente las evaluaciones de la propuesta en su segundo momento de diseñada. Por otra parte, existe un grado de concordancia adecuado independientemente de las concepciones teóricas y metodológicas de cada grupo independiente, un valor adicional de la propuesta presentada por el autor.

A resistência aeróbica no futebol é considerada uma capacidade determinante, para a qual a sua valorização é uma parte indispensável do conteúdo da preparação desportiva, sendo útil para conceber modelos especializados para o seu aperfeiçoamento, os quais devem ser submetidos, em primeira instância, a uma validação teórica. Neste sentido, o objectivo da investigação é validar teoricamente, através de peritos nacionais e estrangeiros, uma proposta de um grupo de exercícios para desenvolver a resistência aeróbica em jogadores de futebol da categoria sub-14. A investigação é descritiva-explicativa de ordem correlacional, uma proposta de intervenção é validada com um grupo de exercícios de resistência aeróbica para jogadores de futebol sub-14 em dois momentos da concepção. Cinco indicadores de avaliação foram consultados com 25 especialistas (Nacionais: 14, Estrangeiros: 11), e a futura proposta de intervenção foi teoricamente validada. Entre grupos independentes, não houve avaliações significativamente diferentes em nenhum dos 5 indicadores. Entre grupos relacionados, foram evidenciadas diferenças significativas a favor do pós-teste, tanto nos especialistas nacionais (Compreensibilidade: r=0,001; Acessibilidade de preços: r=0,002; Progressão: p=0,001; Variedade: p=0,001; Especialização Progressiva: p=0,001), como nos especialistas estrangeiros (Compreensibilidade: r=0,006; Acessibilidade de preços: r=0,004; Progressão: p=0,002; Variedade: p=0,003; Especialização Progressiva: p=0,004). A futura proposta de intervenção apresentou uma Compreensibilidade, Acessibilidade, Progressão, Variedade e Especialização Progressiva adequadas, melhorando significativamente as avaliações da proposta no seu segundo momento de concepção. Por outro lado, existe um grau de acordo adequado independentemente das concepções teóricas e metodológicas de cada grupo independente, um valor adicional da proposta apresentada pelo autor.

Aerobic endurance in soccer is considered a determining capacity, for which its enhancement is an indispensable part of the content of sports training, being useful to design specialized models for its improvement, which must first be submitted to theoretical validation. In this sense, the objective of the research is to theoretically validate, through national and foreign experts, a proposal on a group of exercises to develop aerobic endurance in soccer players of the U-14 category. The research is descriptive-explanatory of correlational order, an intervention proposal is validated with a group of aerobic endurance exercises for U-14 soccer players in two moments of the design. Five evaluative indicators were consulted to 25 specialists (Nationals: 14, Foreigners: 11), and the future intervention proposal was theoretically validated. Between independent groups, there were no significantly different evaluations in any of the indicators5. Between related groups, significant differences in favor of the posttest were evidenced, both in the national specialists (Comprehensiveness: r=0.001; Affordability: r=0.002; Progression: p=0.001; Variety: p=0.001; Progressive Specialization: p=0.001), and in the foreign specialists (Comprehensiveness: r=0.006; Affordability: r=0.004; Progression: p=0.002; Variety: p=0.003; Progressive Specialization: p=0.004). The future intervention proposal presented adequate Comprehensiveness, Affordability, Progression, Variety and Progressive Specialization, significantly improving the evaluations of the proposal in its second moment of design. On the other hand, there is an adequate degree of agreement regardless of the theoretical and methodological conceptions of each independent group, an additional value of the proposal presented by the author.

Prevalencia del síndrome de agotamiento profesional (burnout) y variables asociadas en médicos especialistas / Prevalence of Burnout Syndrome and Associated Variables in Mexican Medical Specialists

RESUMEN Objetivo: Determinar la prevalencia del síndrome de agotamiento profesional (burnout) y las variables asociadas en médicos especialistas. Métodos: Estudio observacional, descriptivo y transversal, mediante censo de médicos especialistas de 3 hospitales regionales (n = 540), ficha de identificación y Maslach Burnout Inventory-Human Services Survey autoaplicado. Se realizaron estadísticas descriptivas y el análisis inferencial con SPSS 15.0 y Epi-infoV6.1. Resultados: Un 90,0% de los especialistas estudiados respondieron. Se detectó burnout en el 45,9%. Hubo diferencias significativas en las variables: ser mujer; la edad <40 arios; no tener pareja estable o llevar menos de 15 años con ella; que la pareja trabaje; no tener hijos; especialidad clínica; menos de 10 años de antigüedad profesional y en el puesto actual de trabajo, y laborar jornada acumulada. Correlación negativa: burnout con agotamiento emocional y con despersonalización. Positiva con la falta de realización personal en el trabajo. Conclusiones: El burnout es frecuente (45,9%) entre los médicos especialistas. Los niveles medios de las subescalas se encuentran cerca de la normalidad. La afección por el agotamiento emocional y la despersonalización se comportan inversamente proporcionales con la puntuación total del síndrome, y directamente proporcionales con la falta de realización personal en el trabajo con burnout.

ABSTRACT Objective: To determine the prevalence of burnout syndrome and the associated variables in medical specialists in Mexico. Methods: Observational, descriptive and cross-sectional study, by means of a census of 540 medical specialists from three Regional Hospitals. Using their identification card and self-administered Maslach Burnout Inventory-Human Services questionnaire, descriptive statistics and inferential analysis were performed using SPSS 15.0 and Epi-infoV6.1. Results: There was a 90.0% response in the specialists studied. Burnout was detected in 45.9%. There were significant differences in variables: being female; under 40 years of age; without a stable partner, and less than 15 years together; a working couple; childless; clinical specialty; less than 10 years of professional and current employment, and accumulated work day. A negative correlation was found in burnout with emotional exhaustion, and with depersonalisation. It was positive with a lack of personal fulfilment at work. Conclusions: Burnout is common (45.9%) in specialist physicians. The average levels of the subscales are close to normal. Emotional exhaustion and depersonalisation behave inversely proportional to the total score of the syndrome, and directly proportional to the lack of personal fulfilment in the work with burnout.

El rol del tutor en la formación del especialista de Medicina General Integral / The Tutor's Role in the Training of the Specialist in Family and Community Medicine

Introducción: La figura del tutor tiene vital importancia en la formación del especialista de Medicina General Integral. Objetivo: Valorar los antecedentes de la función del tutor en la formación del especialista de MGI en Cuba. Métodos: Se realizó un análisis documental, a partir de una búsqueda de literatura relevante sobre el tema de enero de 2019 a enero de 2020. Se utilizaron los buscadores de información científica Pubmed, Scielo y Google Académico. Se evaluaron artículos de revisión, de investigación y páginas web que tenían menos de 10 años de publicados, en idioma español, portugués e inglés, y que hicieran referencia al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 83 referencias bibliográficas, de las cuales 34 se citaron en el presente artículo. Conclusiones: La labor del tutor en la formación del especialista de Medicina General Integral constituye un eje primordial para la formación de los residentes como regulador de la estrategia y ritmo del sistema de enseñanza y aprendizaje, acorde al contexto histórico en el que se han desarrollado y evolucionado los diferentes planes de estudio de la especialidad(AU)

Introduction: The tutor's role is of vital importance in the training of the specialist in family and community medicine. Objective: To assess the background about the tutor's role in the training of the specialist in family and community medicine in Cuba. Method: A document analysis was carried out, based on a search of relevant literature about the subject from January 2019 to January 2020. The scientific information search engines Pubmed, Scielo and Google Scholar were used. Review articles, research articles and web pages were assessed, of the were published within the last ten years old, in Spanish, Portuguese and English, and that made reference to the topic of study through the title. Articles that did not meet these conditions were excluded. These criteria allowed the study of 83 bibliographic references, of which 34 were cited in the present article. Conclusions: The tutor's work is a cornerstone in the training of the specialist in family and community medicine, as far as it is a regulator of the strategy and rhythm of the teaching and learning system, according to the historical context in which the different programs of studies for the specialty have been developed and evolved(AU)

Prevalence of Burnout Syndrome and Associated Variables in Mexican Medical Specialists.

OBJECTIVE: To determine the prevalence of burnout syndrome and the associated variables in medical specialists in Mexico. METHODS: Observational, descriptive and cross-sectional study, by means of a census of 540 medical specialists from three Regional Hospitals. Using their identification card and self-administered Maslach Burnout Inventory-Human Services questionnaire, descriptive statistics and inferential analysis were performed using SPSS 15.0 and Epi-infoV6.1. RESULTS: There was a 90.0% response in the specialists studied. Burnout was detected in 45.9%. There were significant differences in variables: being female; under 40 years of age; without a stable partner, and less than 15 years together; a working couple; childless; clinical specialty; less than 10 years of professional and current employment, and accumulated work day. A negative correlation was found in burnout with emotional exhaustion, and with depersonalisation. It was positive with a lack of personal fulfilment at work. CONCLUSIONS: Burnout is common (45.9%) in specialist physicians. The average levels of the subscales are close to normal. Emotional exhaustion and depersonalisation behave inversely proportional to the total score of the syndrome, and directly proportional to the lack of personal fulfilment in the work with burnout.