Mexico recently launched a feminist foreign policy under the current
administration that has initiated profound transformation. This article elaborates
on the motivations behind adopting a feminist ...foreign policy and its implications
within and outside of Mexico’s borders. The outcomes of integrating a gender
perspective into areas such as climate change and public space design are touched
upon as well. While describing Mexico’s pioneering role in implementing a
feminist foreign policy in Latin America, the article argues for forging a strategic
partnership between a feminist and multilateral approach to policy-making while
addressing the crucial challenges of our time.
Background The number of people suffering from chronic diseases requiring palliative care (PC) is increasing rapidly. Therefore, PC teaching in undergraduate health science programs is necessary to ...improve primary PC based on international recommendations and available scientific evidence. Methods A descriptive cross-sectional study was conducted. Active undergraduate medical and nursing programs that were approved by the Colombian Ministry of Education and integrated PC teaching into their curricula were included in the study. The total sample consisted of 48 programs: 31 nursing and 17 medical programs. Results PC competencies are distributed throughout the curriculum in 41.67% of programs, in elective courses in 31.25%, and in mandatory courses in 27.08% of the programs. The average PC teaching hours is 81 for nursing and 57.6 for medicine. PC clinical rotations are not offered in 75% of the programs. For undergraduate nursing programs, the most frequent competencies taught are the definition and history of PC and identifying common symptoms associated with advanced disease. In undergraduate medicine, the most common competencies are pharmacological and non-pharmacological pain management and identification of PC needs. Conclusions PC teaching in undergraduate health science programs mainly addresses the conceptual and theoretical aspects of PC, which are part of the competencies present throughout the programs' curricula. Low availability of PC clinical rotations was identified. Future studies should assess whether the low availability of clinical rotations in PC limits the ability of students to develop the practical competencies necessary to provide quality PC. Trial registration Not applicable. Keywords: Undergraduate medical education, Undergraduate nursing education, Palliative care, Palliative medicine
ObjectiveManagement of reproductive health-related issues is crucial for patients with SLE, given this is a disease that primarily affects women of childbearing age. Little is known as to how the ...2020 American College of Rheumatology (ACR) Reproductive Health in Rheumatic Disease Guideline is experienced by an underserved, primarily Hispanic population and their physicians as it relates to pregnancy planning and contraception conversations. Given this population experiences high rates of unplanned pregnancies and worse SLE outcomes compared with the non-Hispanic white population, it is crucial to understand how reproductive health is discussed in this setting.MethodsA survey based on the 2020 ACR Reproductive Health Guideline was created and distributed in English and Spanish in the outpatient setting to 151 patients with SLE to determine patients’ beliefs, experiences and limitations with reproductive health discussions. Associations between categorical variables were evaluated using Pearson’s χ2 or Fisher’s exact test, as appropriate, and differences in continuous variables were assessed using Wilcoxon rank-sum test.ResultsEnglish language survey respondents were significantly more likely to report having conversations regarding contraception, pregnancy planning and peripartum medication use than the Spanish survey respondents. Two-thirds of all respondents relied on the rheumatologist as a top source of reproductive health information.ConclusionDisparities exist regarding reproductive health conversations on multiple topics between English-speaking and Spanish-speaking populations with SLE. Further understanding is needed to clarify why reproductive health conversations occur at lower frequencies in Spanish-speaking SLE populations.
Introducción. La polineuropatía, la miopatía y la polineuromiopatía son condiciones debilitantes que afectan a pacientes críticamente enfermos. Sin embargo, poco se conoce acerca de los factores ...relacionados con estos desenlaces en pacientes hospitalizados en las unidades de cuidado intensivo (UCI) y con hospitalización prolongada en el contexto clínico colombiano.
Objetivo. Evaluar los factores asociados al desarrollo de polineuropatía, miopatía y polineuromiopatía en pacientes críticos con hospitalización prolongada.
Métodos. Estudio analítico, observacional, de casos y controles apareados realizado en 192 pacientes (64 casos y 128 controles) atendidos en una clínica de tercer nivel de atención de Cali, Colombia. Se analizaron diferentes factores de riesgo como falla multiorgánica, sepsis, desnutrición, nutrición parenteral, uso de corticoides, uso de relajantes musculares, entre otros. Se evaluó si los días de estancia en UCI es un modificador del efecto de la relación entre estos factores y los desenlaces.
Resultados. Se encontró que la falla multiorgánica (OR: 6,32, IC95%: 2,15-18,58), la desnutrición (OR: 2,25, IC95%: 1,01-5,0) y el uso de relajantes musculares (OR: 2,68, IC95%: 1,04-6,87) estuvieron asociados con el desarrollo de polineuropatía y miopatía. Así mismo, se observó que la asociación entre la falla multiorgánica y estas condiciones se vio afectada por la duración de la estancia en UCI (p<0,05). En pacientes sin falla multiorgánica, el riesgo aumentó mínimamente con cada día adicional de estancia en UCI (OR: 1,004, IC95%: 0,97-1,04); sin embargo, en pacientes con falla multiorgánica, el riesgo se incrementó en un 5% por cada día adicional de estancia en UCI.
Conclusiones. Los resultados del presente estudio destacan la importancia de factores como la falla multiorgánica, la desnutrición y el uso de relajantes musculares en el desarrollo de la polineuropatía, la miopatía y la polineuromiopatía en pacientes críticos con hospitalización prolongada.
To evaluate the effect of different application modes of a recently introduced self-etching ceramic primer on the microshear bond strength (μSBS) and ceramic surface-etching pattern of two ...glass-ceramic surfaces.
Twenty-two CAD/CAM blocks of lithium disilicate (LD) and feldspathic glass ceramic (VTR) were each cut into 4 rectangular sections (n = 88 for ceramic surface). The LD and VTR specimens were divided into one control group (hydrofluoric acid + silane coupling agent HF+SII), and 10 experimental groups using Monobond Etch and Prime (MEP) applied for a combination of scrubbing times (5, 10, 20, 40, and 60 s) and reaction times (20 or 40 s). After each treatment, Tygon matrices (n = 8) were filled with a resin cement and light cured for each ceramic specimen. The specimens were stored in water at 37°C for 24 h and subjected to the μSBS test. The failure pattern and μSBS were statistically evaluated (α = 0.05). In addition, the ceramic surface etching pattern was analyzed using scanning electron microscopy.
For the LD groups, the application of MEP 60/40 resulted in a higher mean μSBS compared to HF+SI (p < 0.05). Groups 5/40, 10/40, and 20/40 resulted in mean μSBS similar to that obtained by HF+SI (p > 0.05). For VTR, no significant difference was observed among the groups (p = 0.32). Compared with MEP, HF better promoted the dissolution of glass matrix for both ceramics. However, prolonged MEP scrubbing or reaction caused significant dissolution of the glass matrix for both evaluated ceramics.
Active and prolonged application of MEP may be a viable alternative to HF+SI for increasing the bond strength to LD.
Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative ...period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed. We aimed to identify key barriers to quality perioperative care delivery for 3 "Bellwether" procedures (cesarean delivery, emergency laparotomy, and long-bone fracture fixation) in 5 low- and middle-income countries (LMICs).
Ten hospitals representing secondary and tertiary facilities from 5 LMICs were purposefully selected: 2 upper-middle income (Colombia and South Africa); 2 lower-middle income (Sri Lanka and Tanzania); and 1 lower income (Uganda). We used a rapid appraisal design (pathway mapping, ethnography, and interviews) to map out and explore the complexities of the perioperative pathway and care delivery for the Bellwether procedures. The framework approach was used for data analysis, with triangulation across different data sources to identify barriers in the country and pattern matching to identify common barriers across the 5 LMICs.
We developed 25 pathway maps, undertook >30 periods of observation, and held >40 interviews with patients and clinical staff. Although the extent and impact of the barriers varied across the LMIC settings, 4 key common barriers to safe and effective perioperative care were identified: (1) the fragmented nature of the care pathways, (2) the limited human and structural resources available for the provision of care, (3) the direct and indirect costs of care for patients (even in health systems for which care is ostensibly free of charge), and (4) patients' low expectations of care.
We identified key barriers to effective perioperative care in LMICs. Addressing these barriers is important if LMIC health systems are to provide safe, timely, and affordable provision of the Bellwether procedures.
Phylogenetics determines the evolutionary relationships between groups of species, through a phylogenetic tree. PhyML is among the main programs for the reconstruction of phylogenetic trees. ...Bootstrap is a statistical method used to measure the confidence of a given data set, which is usually applied in the analysis of inferred phylogenetic trees. In PhyML this method has two MPI parallel implementations: with point-to-point operations and collective operations. The second version is more efficient than the first, however it has a limitation on the number of bootstrap to be used due to the increase in memory consumption. In order to solve this problem, three proposals were developed. The objectives of this work were to carry out the validation of these versions together with performance tests. The validation showed that the proposed solutions present results equivalent to the point-to-point version. In the performance simulations, two solutions were shown to be superior to the point-to-point version, with the best one achieving gains of 28.46% and 39.64% for 32 and 64 processes, respectively. Therefore, the enhancements allow alternatives to the point-to-point version without limitingmemory.
Search-based reduction model for unit testing Fernández-Oliva, Perla Beatriz; Güemes-Esperón, Alejandro Miguel; Delgado-Dapena, Martha Dunia ...
Revista Facultad de Ingeniería,
10/2023
109
Journal Article
Recenzirano
Odprti dostop
Software tests are fundamental in the reliability and quality of systems, contributing to their positioning in the market. Generating test data is a critical task, as exhaustive testing is costly in ...time and effort. An adequate design of the test cases, which contemplates a selection of adequate values, can detect a high number of defects. The effectiveness of the test cases is measured according to the number of errors they managed to detect. However, the proposals that address these issues with the use of heuristic algorithms focus on the reduction of generation time and different coverage criteria.
This article presents a search-based optimization model for the generation of unit test suites that integrates different test case design techniques considering the significance of the values generated in the detection of errors. The significance of the paths is also taken into account, with the aim of obtaining test cases with greater potential to detect errors. The optimization model uses heuristic algorithms that maximize the coverage of the paths. The results of the experimentation are presented, which show that the proposal presented generates test suits with a high capacity to detect errors. For this, the effectiveness of the generated test suits to detect errors in the mutated code was evaluated.
Objetivo: determinar el factor de riesgo para desarrollar trastornos temporomandibulares (TTM) en adolescentes sometidos a rehabilitación dental. Métodos: cohorte realizada en 153 adolescentes, ...(52,9% mujeres y 47% hombres) libres de TTM. Para diagnosticar los TTM se utilizaron los Criterios Diagnósticos para la Investigación de los TTM (CDI/TTM), para determinar caries se aplicó el índice CPOD. Se formaron dos grupos, el grupo expuesto a rehabilitación dental (74), y el grupo no expuesto (79). Se realizaron seguimientos a las dos semanas, tres y seis meses de la rehabilitación dental. Se utilizó estadística descriptiva y se calculó el riesgo relativo con intervalos de confianza al 95%. Para el grupo de los expuestos, se incluyeron adolescentes libres de TTM en los que fue necesario realizar tratamiento de rehabilitación dental en órganos posteriores con caries en esmalte y dentina en fosas y fisuras. Para el grupo no expuesto, se incluyeron adolescentes pareados por edad y sexo con los expuestos, libres de TTM sin necesidades de rehabilitación dental. Resultados: la incidencia de TTM a los quince días de los expuestos (18,9%) fue superior en contraste con los no expuestos (5,0%). El riesgo relativo de desarrollar TTM en los adolescentes rehabilitados con resina a las dos semanas posteriores a la rehabilitación fue de 2.412 (I.C. 95% 1.001-5,81) veces más que en aquellos que no fueron sometidos a la rehabilitación. Conclusión: la rehabilitación dental es un factor de riesgo mínimo para desarrollar TTM a corto plazo (15 días) de realizado el procedimiento, dicho padecimiento inducido por la rehabilitación dental es agudo y auto limitante.
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