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Background The use of artificial intelligence (AI) is not a recent phenomenon, but the latest advancements in this technology are making a significant impact across various fields of human knowledge. In medicine, this trend is no different, although it has developed at a slower pace. ChatGPT is an example of an AI-based algorithm capable of answering questions, interpreting phrases, and synthesizing complex information, potentially aiding and even replacing humans in various areas of social interest. Some studies have compared its performance in solving medical knowledge exams with medical students and professionals to verify AI accuracy. This study aimed to measure the performance of ChatGPT in answering questions from the Progress Test from 2021 to 2023. Methodology An observational study was conducted in which questions from the 2021 Progress Test and the regional tests (Southern Institutional Pedagogical Support Center II) of 2022 and 2023 were presented to ChatGPT 3.5. The results obtained were compared with the scores of first- to sixth-year medical students from over 120 Brazilian universities. All questions were presented sequentially, without any modification to their structure. After each question was presented, the platform's history was cleared, and the site was restarted. Results The platform achieved an average accuracy rate in 2021, 2022, and 2023 of 69.7%, 68.3%, and 67.2%, respectively, surpassing students from all medical years in the three tests evaluated, reinforcing findings in the current literature. The subject with the best score for the AI was Public Health, with a mean grade of 77.8%. Conclusions ChatGPT demonstrated the ability to answer medical questions with higher accuracy than humans, including students from the last year of medical school.

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INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

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Background: The vocational guidance process in educational institutions faces important challenges in managing trials and errors in diagnoses. Technological tools are identified as an effective solution to address these problems. This research seeks to improve career guidance in educational institutions through the implementation of an expert system. The main objective is to reduce test processing time and achieve greater efficiency in students' self-knowledge regarding their interests, based on the personalities of the Holland Test. Methods: The development of the expert system followed a six-model approach. First, an organisational model was created to assess the scope and feasibility of the project. Next, a task and agent model was developed to investigate the impact and look for improvements. A knowledge model was then developed to analyse the relevant knowledge bases. A communication model was also developed to evaluate the communication interface of the system. Next, a design model was created to provide guidelines for the implementation of the system. Finally, the implementation of the knowledge system was carried out to ensure its correct functioning. Results: The implementation of the expert system has shown significant improvements in the vocational guidance process. It was possible to reduce the time needed to apply the test, thus optimising the psychologist's time and allowing a greater capacity for analysis. In addition, an improvement in the effectiveness of the students' self-knowledge in relation to their vocational interests based on the personalities of the Holland Test was observed. Conclusions: This study contributes to career guidance in educational institutions by introducing an innovative expert system. This technological solution optimizes the career guidance process, benefiting psychologists administering tests and students seeking self-knowledge about their career interests.

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Mexicans in the United States have been reported to maintain practices of Mexican traditional medicine at comparably higher rates than most other populations, including other Latino sub-groups. In this cross-sectional study, we examined the pre- and post-migration traditional medicine practices of first-generation immigrants from Mexico living in southern Arizona. Our objective was to assess how migration affected Mexican immigrants' ethnomedical practices and to better understand the mechanisms and motivating factors for the post-migration maintenance of practice. We designed a survey instrument based off prior qualitative data on traditional medicine practices and translated it into Spanish. The survey measured the rates and frequency of six domains of lay healing practices: herbal medicine, healing foods, self-medication with over-the-counter medicine, and three types of specialty healers (curandero/a, and sobador/a, or partero/a), and asked questions about knowledge sources, reasons for maintaining practice post-migration, and to what extent participants believed the remedies were effective. The research team fielded the telephone-based survey from April 2022 to February 2023 to 300 first-generation adult Mexican immigrants residing in southern Arizona. A series of proportions tests were conducted to examine differences in reliance on lay healing pre- and post-migration as well as to assess differences between women's and men's lay practices. The data indicate a general, but moderated decline in lay medical practices post-migration, with the usage of expert healers declining at much higher rates than the three self-care domains. Women tend to use herbal medicine and healing foods at higher rates than men post-migration. This cross-sectional quantitative study confirms prior research indicating that traditional medicine practices are heavily relied upon by Mexican origin people both pre- and post-migration. These findings suggest that public health messaging and medical providers should better address and harness Mexican immigrants' lay medical practices in order to optimize health in this population.

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Abstract Currently, the percentage of traffic accidents has increased, and according to statistics, this percentage will continue to increase every year, so it is necessary to develop new technologies to prevent this kind of accidents. This paper presents a drowsiness detection system based on electroencephalogram (EEG) signals using a pair of channels (Fp1 and Fp2) applied to drivers before entering their vehicles. First, this model detects the relationship between the area under the curve (AUC) of alpha brain waves, an effective parameter for detecting drowsiness. Then, the extracted information is passed to a fuzzy expert system (FES) that classifies the subject's state as "alert" or "sleepy"; the criterion used was a threshold and training with subjective levels. The proposed system was compared with neural network models, such as support vector machine (SVM), K nearest neighbors (KNN), and random forest (RF). Measurements of one hundred and twenty minutes were performed on each of the ten drivers for two days to test the system. The tests confirm that this system is suitable for preventive measures and that the fuzzy system is superior to traditional neural network methods.

Resumen Actualmente, el porcentaje de accidentes de tráfico ha aumentado, y según las estadísticas, este porcentaje seguirá aumentando cada año, por lo que es necesario desarrollar nuevas tecnologías para prevenir este tipo de accidentes. Este trabajo presenta un sistema de detección de somnolencia basado en señales de electroencefalograma (EEG) utilizando un par de canales (Fp1 y Fp2) aplicado a los conductores antes de entrar en sus vehículos. En primer lugar, este modelo detecta la relación entre el área bajo la curva (AUC) de las ondas cerebrales alfa, un parámetro eficaz para detectar la somnolencia. A continuación, la información extraída se pasa a un sistema experto difuso (FES) que clasifica el estado del sujeto como "alerta" o "somnoliento"; el criterio utilizado fue un umbral y el entrenamiento con niveles subjetivos. El sistema propuesto se comparó con modelos de redes neuronales, como la máquina de vectores de soporte (SVM), K vecinos más cercanos (KNN) y el bosque aleatorio (RF). Se realizaron mediciones de ciento veinte minutos en cada uno de los diez conductores durante dos días para probar el sistema. Las pruebas confirman que este sistema es adecuado para las medidas preventivas y que el sistema difuso es superior a los métodos tradicionales de redes neuronales.

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El objetivo del presente estudio fue analizar las características sociodemográficas, metodológicas y diagnósticas de los informes periciales en psiquiatría y psicología realizados en el Centro de Estudios en Derecho y Salud entre 2011 y 2020. Se optó por un enfoque cuantitativo, descriptivo con intención analítica, transversal, con diseño retrospectivo. Se analizó la información obtenida en 145 peritajes. Se adelantó un análisis univariado para todas las variables sociodemográficas, metodológicas y diagnósticas de los informes periciales, según su naturaleza cualitativa o cuantitativa, y un análisis bivariado a través de tablas de contingencia para las variables mencionadas, con intervalos de confianza del 95 % para cada una de las medidas de prevalencia. Se encontró que la mayoría de peritajes fueron solicitados por el área del derecho contencioso-administrativo. Los diagnósticos más prevalentes fueron el trastorno adaptativo, el trastorno por estrés postraumático y el trastorno depresivo. Si bien los informes revisados cumplen con los lineamientos mínimos de ley, se encontraron algunas falencias relacionadas con la ausencia de información. Se espera que estos hallazgos permitan la reflexión por parte de los auxiliares de la justicia sobre los requerimientos de los informes periciales con miras a la humanización de la justicia y el apoyo a la toma de decisiones legales.

The aim of this study was to analyse the socio-demographic, methodological and diagnostic characteristics of the expert reports in psychiatry and psychology carried out at the Centre for Law and Health Studies between 2011 and 2020. We opted for a quantitative, descriptive approach with analytical, cross-sectional, retrospective design. The information obtained from 145 expert opinions was analysed. A univariate analysis was carried out for all sociodemographic, methodological and diagnostic variables in the expert reports, according to their qualitative or quantitative nature, and a bivariate analysis through contingency tables for the aforementioned variables, with confidence intervals of 95 % for each of the prevalence measures. It was found that the majority of expert opinions were requested by the area of contentious-administrative law. The most prevalent diagnoses were adjustment disorder, post-traumatic stress disorder and depressive disorder. Although the reports reviewed comply with the minimum legal guidelines, there were some shortcomings related to the absence of information. It is hoped that these findings will allow for reflection on the part of justice officials on the requirements of expert reports with a view to the humanisation of justice and support for legal decision-making.

O objetivo deste estudo foi analisar as características sociodemográficas, metodológicas e diagnósticas dos laudos periciais em psiquiatria e psicologia realizados no Centro de Estudos em Direito e Saúde entre 2011 e 2020. Optou-se por uma abordagem quantitativa e descritiva com desenho analítico, transversal e retrospectivo. Foram analisadas as informações obtidas de 145 pareceres de especialistas. Foi realizada uma análise univariada para todas as variáveis sociodemográficas, metodológicas e diagnósticas dos laudos periciais, de acordo com sua natureza qualitativa ou quantitativa, e uma análise bivariada por meio de tabelas de contingência para as variáveis mencionadas, com intervalos de confiança de 95 % para cada uma das medidas de prevalência. Verificou-se que a maioria dos pareceres foi solicitada pela área de direito contencioso-administrativo. Os diagnósticos mais prevalentes foram transtorno de ajustamento, transtorno de estresse pós-traumático e transtorno depressivo. Embora os relatórios analisados estejam em conformidade com as diretrizes legais mínimas, houve algumas deficiências relacionadas à ausência de informações. Espera-se que esses resultados permitam uma reflexão por parte dos envolvidos no sistema judiciário sobre os requisitos dos laudos periciais, com vistas à humanização da justiça e ao apoio à tomada de decisões legais.

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INTRODUCTION: Recent advances in the treatment of locally advanced NSCLC have led to changes in the standard of care for this disease. For the selection of the best approach strategy for each patient, it is necessary the homogenization of diagnostic and therapeutic interventions, as well as the promotion of the evaluation of patients by a multidisciplinary oncology team. OBJECTIVE: Development of an expert consensus document with suggestions for the approach and treatment of locally advanced NSCLC leaded by Spanish Lung Cancer Group GECP. METHODS: Between March and July 2023, a panel of 28 experts was formed. Using a mixed technique (Delphi/nominal group) under the guidance of a coordinating group, consensus was reached in 4 phases: 1. Literature review and definition of discussion topics 2. First round of voting 3. Communicating the results and second round of voting 4. Definition of conclusions in nominal group meeting. Responses were consolidated using medians and interquartile ranges. The threshold for agreement was defined as 85% of the votes. RESULTS: New and controversial situations regarding the diagnosis and management of locally advanced NSCLC were analyzed and reconciled based on evidence and clinical experience. Discussion issues included: molecular diagnosis and biomarkers, radiologic and surgical diagnosis, mediastinal staging, role of the multidisciplinary thoracic committee, neoadjuvant treatment indications, evaluation of response to neoadjuvant treatment, postoperative evaluation, and follow-up. CONCLUSIONS: Consensus clinical suggestions were generated on the most relevant scenarios such as diagnosis, staging and treatment of locally advanced lung cancer, which will serve to support decision-making in daily practice.

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Metacognition is essential in the musical learning process as it involves understanding the purpose of each task, its planning, execution and evaluation. Considering the relevance of metacognitive processes, our objective in this study was to investigate how expert and beginner musicians manifest and verbalize their metacognitive processes in the context of preparing repertoire for a performance. The method used was a multi-case study carried out in two different contexts: with the five members of a brass quintet made up of professional musicians and with three beginner university violin students. The results obtained indicated that even at different levels of expertise, metacognitive processes were present in the musical practices of participants in the two contexts investigated. It was found that in both cases time management is a component of the preparation process in metacognitive regulation, however, for the beginner violinists in our sample it was a significantly more complex task than for the professional brass players. Regarding the learning monitoring and evaluation processes, it was possible to verify that beginner instrumentalists as well as professional musicians used declarative, conditional and procedural knowledge to carry out and reflect on their musical practices. These results have implications for both the individual and collective study process and for teaching processes. It is also observed that reflective thinking must accompany the processes of individual and collective interpretative-musical practices, considering that the musical results desired by musicians are related to the quality of cognitive, behavioral, affective and motivational undertakings pertinent to control and regulation of metacognitive processes.

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The use of herbal medicine to treat various diseases is becoming increasingly important as an alternative therapy. Numerous plants have been traditionally used for different purposes, including antiparasitic in humans and animals. Diseases caused by gastrointestinal parasites in ruminants, especially by the nematode Haemonchus contortus, cause large economic losses to the producers, whether by complications of the diseases or the cost of treatment. The main way of handling nematodiasis is by administering anthelmintic drugs, but their excessive use has the disadvantage of causing drug resistance; therefore, an alternative is the use of herbal medicine for this purpose. Mesquite (Prosopis spp.) has been used in Mexico to treat gastrointestinal diseases attributed to helminths. The present study aimed to characterize the rheological properties of mesquite flour using the SeDeM Expert System to determine its suitability for tablet production by direct compression. Direct compression technology facilitates the tableting process by reducing manufacturing costs. The results of the present study indicate that mesquite flour can be processed by direct compression. The latter could allow the manufacturing of economic tablets to treat infections by H. contortus in ruminants.

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RESUMEN A partir de una revisión bibliográfica de la literatura se ha planeado y desarrollado un consenso de expertos internacionales sobre la utilización de las vitaminas B1, B6, B12 en sus déficits y en la neuropatía periférica que puede estar asociada a la misma, como tema que precia de esa aproximación aclaratoria para optimizar su manejo. Se plantearon varias cuestiones de discusión que se consideraron importantes y dignas de ser abordadas y aclaradas, conservando nueve de ellas para su discusión ulterior buscando el consenso en tres rondas consecutivas. Se han propuesto 41 recomendaciones sobre el manejo de estas condiciones, con unanimidad por parte de los participantes en el consenso. Con ellas se ha intentado aclarar puntos oscuros o controvertidos, facilitando la actitud del clínico ante ellos en la práctica médica actual.

ABSTRACT Based on a bibliographic review of the literature, a consensus of international experts has been carried out on the use of vitamins B1, B6, B12, in their deficiencies, and in the peripheral neuropathy that may be associated with them, to optimize the management of these conditions. Several questions considered important and worthy of being addressed and clarified were raised, retaining nine of them for further discussion to achieve consensus. Forty one recommendations on the management of these conditions have been proposed, with unanimity of the participants in the consensus. This has been an attempt to clarify controversial points, assisting the clinician's attitude in current medical practice.

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Este estudo descritivo parte de pesquisa bibliográfica e documental, visando esboçar uma gênese e constituição das Perícias Médico-Previdenciárias (PMP) no país e buscando ressaltar seu conteúdo crítico. Foi empreendida então a Análise de Conteúdo para categorizar os núcleos temáticos em periodizações históricas que, a partir do método dialético, nos possibilitaram conjugar uma análise diacrônica e sincrônica do papel, do lugar e da função social das PMP. Desvela-se de sua institucionalização legal uma postura historicamente conservadora e antitrabalhadora, que sustenta a ação pericial no âmbito do Instituto Nacional do Seguro Social (INSS) e nos permite afirmar que sequer tal campo de poder têm relação com qualquer resolução dos problemas em Saúde do Trabalhador (ST), pois o paradigma da causalidade dos agravos à saúde se dá pela precedência das condições de trabalho em uma visão (a)histórica e descontextualizada das relações econômicas, políticas, ideológicas e sociais que influem nos nexos entre trabalho e saúde/doença

The descriptive study, based on bibliographic and documentary research, outlines the genesis and institutionalization of Social Security Medical Experts (PMP) in Brazil, highlight its critical content. Content Analysis categorized the thematic cores into historical periods that, based on the dialectical method, allowed us to combine a diachronic and synchronic analysis of the role, place, and social function of PMP. Their legal institutionalization reveals a historically conservative and anti-worker(s) stance that supports the expert action within the National Institute of Social Security (INSS), allowing us to affirm that such a field of power has no intention to solve occupational health issues, for the causality paradigm of health problems is given a priori by the working conditions under an ahistorical and decontextualized view of economic, political, ideological and social relations that influence the link between work and health/disease

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Resumo A esfera das perícias comumente reduz a questão do estabelecimento do nexo de causalidade entre trabalho e saúde/doença apenas ao binômio trabalho/vida pessoal. Partindo dos pressupostos dos campos Saúde do Trabalhador (ST) e Saúde Mental Relacionada ao Trabalho (SMRT), este ensaio visa problematizar o resultado da questão, que reside na existência de dificuldades enfrentadas por trabalhadores na obtenção do nexo causal entre seus agravos/adoecimentos, cuja causalidade mais complexa se explica a partir de várias mediações pouco consideradas nos atos periciais circunscritos apenas às anamneses clínicas de cunho biomédicas pautadas nos pressupostos da Medicina do Trabalho, Higiene e Saúde Ocupacional. As formas de superação à ideia de causa-efeito passam pelo entendimento de que o processo de adoecimento é social e histórico e de que é preciso buscar mediações entre trabalho e adoecimento para elucidar sintomatologias singulares a partir da experiência do desgaste coletivo. Tal averiguação deve, ao mesmo tempo, problematizar os próprios processos de trabalho dos atores sociais envolvidos nas investigações periciais e partir das prioridades definidas pelos próprios trabalhadores que atuam como sujeitos da análise da nocividade do trabalho para a saúde.

Abstract Expert testimonies commonly reduce the establishment of causal links between work and health/illness solely to the dichotomy of work/personal life. Based on the assumptions from the fields of Workers Health and Work-Related Mental Health, this essay problematizes the results of this issue, namely the difficulties faced by workers in establishing the causal link between their ailments/illnesses, whose more complex causality is explained through several mediations that are often overlooked by the limited expert acts restricted only to clinical anamneses based on Occupational Medicine, Hygiene, and Occupational Health. Overcoming the idea of cause and effect involves understanding that the process of falling ill is social and historical, and requires exploring the mediations between work and illness to elucidate singular symptomatology based on the collective wear and tear experience. Such an investigation should simultaneously problematize the very work processes of the social actors involved in the expert investigations, starting from the priorities defined by the workers themselves who act as subjects in the analysis of work-related harm to health.

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Resumen Este trabajo analiza el programa de asistencia técnica a la investigación y el desarrollo pesquero, implementado por la Food and Agriculture Organization (FAO) en Brasil, entre 1955 y 1978. Nos interrogamos cuáles son las motivaciones de los países desarrollados, de la FAO y de Brasil para movilizar ese conocimiento y cómo se construyó el soporte socio-institucional para su afincamiento. Siguiendo el itinerario de los expertos y atendiendo a las características del campo de la biología pesquera, mostramos cómo se construyeron, de manera simultánea, el campo de investigación, la política y la actividad pesquera brasileñas. Para eso, recurrimos a los informes de varios expertos de la FAO y de organismos públicos brasileños.

Abstract This paper analyzes the technical assistance program for research and fishery development, implemented by the Food and Agriculture Organization (FAO) in Brazil, between 1955 and 1978. We argue what were the motivations of the developed countries, the FAO and Brazil to mobilize this knowledge and how the socio-institutional support for its achievement was built. Following the itinerary of experts and attending to the characteristics of the field of fishing biology, we show how the Brazilian field of research, policies and fishing activity were built simultaneously. For this purpose, we used reports from several experts from the FAO and Brazilian public bodies.

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Introducción: una nueva metodología para el empleo del análisis estadístico implicativo contextualizado a las investigaciones médicas de causalidad brinda reglas y meta-reglas que deben corresponderse con la práctica médica, lo cual se desconoce. Objetivo: evaluar la calidad de las reglas derivadas de la aplicación del análisis estadístico implicativo en las investigaciones médicas de causalidad. Métodos: se realizó un estudio observacional con la aplicación de técnicas cualitativas de tipo criterio de expertos. Los 33 expertos de mayor puntuación emitieron su juicio, mediante una escala Likert de cinco puntos, acerca de la frecuencia con que se cumplen en la práctica médica 23 reglas derivadas de la aplicación del análisis estadístico implicativo en tres estudios para la identificación de factores pronósticos en cáncer de mama. Las opiniones se procesaron mediante el método Delphi en dos rondas y se trianguló con la validez racional de estas reglas. Resultados: los expertos consideraron que cerca del 74 % de las reglas se cumplen en la práctica médica siempre o frecuentemente y sólo una regla resultó absurda. En la segunda ronda se trataron las tres reglas en las que no existió un acuerdo perfecto, en la cual se ratificó una regla como absurda y aumentó el nivel de acuerdo. La triangulación permitió encontrar contradicciones literatura-experto que facilitaron la identificación de problemas en la redacción de la interpretación de las reglas. Conclusiones: las reglas evaluadas reflejan, en general, lo que ocurre en la práctica médica y aquellas que resultan absurdas alertan al investigador sobre un posible sesgo de confusión.

Introduction: A new methodology for the use of contextualized statistical implicative analysis in causality medical research provides rules and meta-rules that must correspond to medical practice, which is unknown. Objective: To evaluate the quality of the rules derived from the application of the statistical implicative analysis in causality medical research. Methods: An observational study was carried out applying qualitative techniques based on expert judgement. Using a five-point Likert scale, the 33 experts with the highest score expressed their judgment about the frequency of the fulfilment of the 23 rules derived from the application of the statistical implicative analysis in three studies in order to identify prognostic factors for breast cancer. Opinions were processed using the two-round Delphi method, and the rational validity of these rules was triangulated. Results: The experts considered that about 74% of the rules are always or frequently followed in medical practice; only one rule was absurd. In the second round, the three rules in which there was no perfect agreement were discussed; one rule was ratified as absurd and there was an increase in the level of agreement. The triangulation allowed us to find contradictions between literature and experts, which facilitated the identification of problems in the drafting of the interpretation of the rules. Conclusions: The rules evaluated generally reflect what happens in medical practice and those that are absurd warn the researcher about the possibility of a confusion bias.

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This study sought to analyze whether an accurate diagnosis of the type and subtype of hepatic Glycogen Storage Diseases (GSDs) could be performed based on general clinical and biochemical aspects via comparing the proposed diagnostic hypotheses with the molecular results. Twelve physicians with experience in hepatic GSDs reviewed 45 real cases comprising a standardized summary of clinical and laboratory data. There was no relation between the hit rate and the time since graduation, the time of experience in GSD, and the number of patients treated during their careers. The average assertiveness was 47%, with GSD Ia and Ib being the best-identified types, while no expert correctly identified GSD IXc. Underage investigation for later manifestations, incomplete clinical description, and complementary analysis, the overvaluation of a specific clinical finding ("false positive") or the discarding of the diagnosis in the absence of it ("false negative"), as well as the lack of knowledge of the rarest GSD types, may have impacted the accuracy of the assessment. This study emphasized that characteristics considered as determinants in identifying the specific types or subtypes of GSD are not exclusive, thus becoming factors that may have induced the evaluators to misdiagnose.

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Objectives: The study was aimed at measuring the impact of training on forensic case formulation in mental health and to provide more evidence on the reliability of the TEC-F. Method: Nine psychiatrists and six psychologists from various Latin American countries participated in a quasi-pedagogical experiment. The quality of formulations was independently and blindly measured pre- and post-intervention with the TEC-F and the assignment of two standard vignettes was also randomly manipulated. Quality mean differences and instrument reliability indicators were calculated. Results: The values of intraclass correlation coefficients were 0.92; 0.94; 0.83; 0.93 and 0.95 and the values of Cronbach's alpha coefficient were 0.83; 0.94; 0.63; 0.77 and 0.93, for the dimensions transparency, specificity, communication, reasoning and for the total TEC-F respectively. The results of the 19-day test-retest were excellent. The mean TEC-F total quality pre-course was 31.4 and the mean post-course, 38.4 (p = 0.003 and p = 0.001 for group test and paired test respectively). Conclusions: The pedagogical intervention produced a significant improvement in the quality of the expert's formulations. The study added evidence supporting the TEC-F reliability.

OBJETIVOS: El estudio se propuso medir el impacto de un entrenamiento sobre formulación pericial del caso forense en salud mental y extender evidencias relacionadas con la confiabilidad de la TEC-F. MÉTODO: Nueve psiquiatras y seis psicólogos de diversos países latinoamericanos participaron de un cuasi-experimento pedagógico. Se midió independientemente y a ciegas la calidad de las formulaciones con la TEC-F pre y post intervención y también se manipuló aleatoriamente la asignación de dos viñetas estándares. Se calcularon diferencias de medias e indicadores de confiabilidad del instrumento. RESULTADOS: Los valores de coeficientes de correlación intraclase fueron 0,92; 0,94; 0,83; 0,93 y 0,95 y los valores del coeficiente Alfa de Cronbach fueron 0,83; 0,94; 0,63; 0,77 y 0,93, para las dimensiones transparencia, especificidad, comunicación, fundamentación y para el total TEC-F respectivamente. Los resultados del test-retest a 19 días fueron excelentes. La media de calidad total TEC-F precurso fue 31,4 y la media post curso, 38,4 (p = 0,003 y p = 0,001 para prueba grupal y para prueba apareada respectivamente). CONCLUSIONES: La intervención pedagógica produjo una significativa mejoría en la calidad de las formulaciones periciales. El estudio adicionó evidencias sosteniendo la confiabilidad de la TEC-F.

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An analytical method for quantification of seventeen pharmaceuticals and one metabolite was validated and applied in the analysis of hospital effluent samples. Two different sampling strategies were used: seasonal sampling, with 7 samples collected bimonthly; and hourly sampling, with 12 samples collected during 12 h. Thus, the variability was both seasonal and within the same day. High variability was observed in the measured concentrations of the pharmaceuticals and the metabolite. The quantification method, performed using weighted linear regression model, demonstrated results of average concentrations in seasonal samples ranged between 0.19 µgL-1 (carbamazepine) and higher than 61.56 µgL-1 (acetaminophen), while the hourly samples showed average concentrations between 0.07 µgL-1 (diazepam) and higher than 54.91 µgL-1 (acetaminophen). It is described as higher because the maximum concentration of the calibration curve took into account the dilution factor provided by DLLME. The diurnal results showed a trend towards higher concentrations in the first and last hours of sampling. The risk quotient (RQ) was calculated using organisms from three different trophic levels, for all the analytes quantified in the samples. Additionally, in order to understand the level of importance of each RQ, an expert panel was established, with contributions from 23 specialists in the area. The results were analyzed using a hybrid decision-making approach based on a Fuzzy Analytic Hierarchy Process (FAHP) and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method, in order to rank the compounds by environmental risk priority. The compounds of greatest concern were losartan, acetaminophen, 4-aminoantipyrine, sulfamethoxazole, and metoclopramide. Comparison of the environmental risk priority ranking with the potential human health risk was performed by applying the same multicriteria approach, with the prediction of endpoints using in silico (Q)SAR models. The results obtained suggested that sulfamethoxazole and acetaminophen were the most important analytes to be considered for monitoring.

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Purpose: To evaluate patterns and opinion from international experts with respect to dry eye disease (DED) diagnosis in clinical practice. Methods: An online survey was distributed to worldwide DED experts. The use of diagnosis tests was evaluated including: symptoms questionnaires, functional tests, tear stability, tear volume, tear composition, surface damage and inflammation, and eyelid assessment. After the subjective importance of symptoms, tear break up time (TBUT), non-invasive TBUT, Schirmer's test, tear meniscus height, tear osmolarity, tear metalloproteinase 9, blepharitis assessment and non-contact meibography was evaluated according to likert scale. Results: The survey was sent to 109 experts, and 77 completed the questionnaire (rate of response = 70.6%). Most of the participants were from North America (27%) and Europe (40%). A majority of respondents (73%) diagnose DED using clinical signs and symptoms, but not fulfilling a specific criteria. Seventy-six participants (98.7%) use symptoms questionnaires. All participants evaluate damage to ocular surface, and fluorescein staining is the most frequent method used (92%). Also, all the respondents perform meibomian gland and blepharitis assessment. On the other hand, only 69.8% evaluate tear composition, being osmolarity the most common test used (66.2%). Regarding to the importance of tests, TBUT (p = 0.002) and Schirmer's (p = 0.021) were found to be more important to experts from Europe than North America. No differences were found in any other test (p > 0.05). Conclusions: This survey offers updated and day-to-day diagnostic clinical practice by DED worldwide experts. The results highlight the importance of symptoms and clinical signs, but not necessarily following a strict criteria.

RESUMO

En Cuba, el acceso a los servicios farmacéuticos por parte de la población se ve afectado por la no disponibilidad de medicamentos y la lejanía de las farmacias. La falta de información acerca de la existencia de los medicamentos y la cantidad de estos en la red de farmacias cercanas a una ubicación geográfica, aparejados al poco suministro de medicamentos y la calidad de la prestación del servicio, genera descontento e inconformidad en la población. En la presente investigación se realiza un diseño para mejorar la problemática planteada a partir de un sistema basado en reglas como ayuda a la toma de decisiones para la obtención de los medicamentos por parte de la población. Se aplica un estudio de caso mediante el cual es posible sugerir al usuario las 5 farmacias más cercanas donde el paciente puede adquirir los medicamentos sobre las decisiones asumidas.

In Cuba, access to pharmaceutical services by the population is affected by the non-availability of medicines and the remoteness of pharmacies. The lack of information about the existence of medicines and the quantity of these in the network of pharmacies close to a geographical location, coupled with the low supply of medicines and the quality of service provision, generates discontent and nonconformity in the population. In the present investigation, a design is carried out to improve the problem raised from a system based on rules as an aid to decision-making to obtain medicines by the population. A case study is applied through which it is possible to suggest to the user the 5 closest pharmacies where the patient can acquire the medicines on the decisions made.

RESUMO

Ghosting has become a way to end abruptly short/casual relationships. It is the practice of ending a personal relationship suddenly and without explanation withdrawing from all communication. Nowadays at family courts, the quality of psychology expert witness reports is limited to transcribe the interviewed person words, without applying any professional method tending to elaborate a diagnosis.On the other side, usually the formal procedures mandated by the law are not followed, may be due to the excessive amount of work. These two reasons lead to impose home exclusion or different kind of restrictions to see one or more members of the family, measures that facilitate de abrupt termination of the family bond, developing serious psychological consequences to the excluded person. Attempts are made to warn about the need for real expert reports that help judges to improve decision-making, to not facilitate long term family relationships ending.

El ghosting (fantasmeo o desaparición) se estableció como una forma de terminación de relaciones breves y sin compromiso. Consiste simplemente en cortar todo tipo de comunicación y no dar señales de vida de forma abrupta. Por otro lado, los informes psicológicos en los tribunales de familia, habitualmente se limitan a transcribir los dichos de las partes entrevistadas, sin efectuar ningún otro acto profesional que no sea el mero relato. Esto, sumado al no seguimiento de los procedimientos de la ley, terminan facilitando el cese abrupto no de relaciones cortas, sino parejas de larga data, o hasta inclusive matrimonios, mediante exclusiones de hogares o imposición de perímetros de exclusión, con las innumerables consecuencias para la persona ghosteada y la familia. Se intenta advertir, sobre la necesidad de la realización de verdaderos informes periciales, que ayuden a los magistrados a mejorar la toma de decisiones, que no faciliten la finalización abrupta de relaciones familiares de larga data.