Improving quality in systems of care: solving complicated challenges with simulation-based continuing professional development.

The delivery of quality health care depends on the successful interactions of practitioners, teams, and systems of care comprising culture. Designing educational programs to improve these interactions is a major goal of continuing professional development, and one approach for educational planners to effect desired changes is simulation-based education. Because simulation-based education affords an opportunity for educators to train health care professionals in environments that resemble clinical practice, this instructional method allows planners to integrate overarching priorities for improvement in health care practice with the training goals of individuals.

Undernutrition upregulates fumarate hydratase in the rat nucleus accumbens.

Previous comparative studies of fumarate hydratase (FH) protein density revealed that the enzyme was overexpressed in the striatum of rodents that are less influenced by rewarding stimuli, from cocaine to food. Therefore, we recently proposed FH as a potential striatal biomarker of brain reward deficiency and addiction vulnerability. This work has been focused to investigate FH activity in the Nucleus Accumbens (NAc) of undernourished rats, taking into account that malnutrition has been related to increased responsiveness to food and drug reward.

Differential regulation of CDK5 and c-Fos expression by morphine in the brain of Lewis and Fischer 344 rat strains.

The aim of this study was to comparatively study cyclin-dependent kinase 5 (CDK5) and c-Fos regulation by morphine in the brains of Lewis and Fischer 344 (F344) rats, which are known to differ in their behavioral sensitivities to several drugs of abuse. Two hours after an acute i.p.

[Epidemiological profile of late mortality in severe polytraumatisms].

Objective: A study is made of the epidemiology, chronogramand causes of late mortality in traumatized patients.

Design: A prospective, observational cohort study of adult trauma patients was carried out.

Settings: Province of Guipúzcoa (Basque Country, Spain).

Social indicators of deception.

Objective: This study addresses a practical homeland security issue of considerable current concern: In a situation in which the opportunity exists to question or interview concurrently two or more suspects, how does one determine truth or deception at a social level?

Background: Recent world events have led to an increased emphasis on the capacity to detect deception, especially in military, security, and law enforcement settings. In many screening or checkpoint situations, the opportunity exists to question two or more suspects regarding their involvement in some activity, yet investigators know very little regarding characteristics of speech or behavior that are exhibited between two suspects that indicate truth or deception.

Method: We conducted an empirical study in which pairs of police officers and firefighters who had served together as partners took part.

Delivery of gold nanoparticles to the brain by conjugation with a peptide that recognizes the transferrin receptor.

The treatment of Alzheimer's disease and many other brain-related disorders is limited because of the presence of the blood-brain barrier, which highly regulate the crossing of drugs. Metal nanoparticles have unique features that could contribute to the development of new therapies for these diseases. Nanoparticles have the capacity to carry several molecules of a drug; furthermore, their unique physico-chemical properties allow, for example, photothermal therapy to produce molecular surgery to destroy tumor cells and toxic structures.

The Play Experience Scale: development and validation of a measure of play.

Objective: A measure of play experience in video games was developed through literature review and two empirical validation studies.

Background: Despite the considerable attention given to games in the behavioral sciences, play experience remains empirically underexamined. One reason for this gap is the absence of a scale that measures play experience.

Clinical utility of LC3 and p62 immunohistochemistry in diagnosis of drug-induced autophagic vacuolar myopathies: a case-control study.

Background: Some patients treated with chloroquine, hydroxychloroquine, or colchicine develop autophagic vacuolar myopathy, the diagnosis of which currently requires electron microscopy. The goal of the current study was to develop an immunohistochemical diagnostic marker for this pathologic entity.

Methodology: Microtubule-associated protein light chain 3 (LC3) has emerged as a robust marker of autophagosomes.

Assessment of the value of a genetic risk score in improving the estimation of coronary risk.

Background: The American Heart Association has established criteria for the evaluation of novel markers of cardiovascular risk. In accordance with these criteria, we assessed the association between a multi-locus genetic risk score (GRS) and incident coronary heart disease (CHD), and evaluated whether this GRS improves the predictive capacity of the Framingham risk function.

Methods And Results: Using eight genetic variants associated with CHD but not with classical cardiovascular risk factors (CVRFs), we generated a multi-locus GRS, and found it to be linearly associated with CHD in two population based cohorts: The REGICOR Study (n=2351) and The Framingham Heart Study (n=3537) (meta-analyzed HR [95%CI]: ~1.

Costa Rica's Marine Protected Areas: status and perspectives.

With 51 100km2 of terrestrial area and 589 000km2 of national waters, Costa Rica is considered one of the countries with the greatest biodiversity. It has approximately 3.5% of the world marine species.

Team knowledge research: emerging trends and critical needs.

Objective: This article provides a systematic review of the team knowledge literature and guidance for further research.

Background: Recent research has called attention to the need for the improved study and understanding of team knowledge. Team knowledge refers to the higher level knowledge structures that emerge from the interactions of individual team members.

Conceptualization and measurement of team workload: a critical need.

Objective: The purpose of this article is to present and expand on current theories and measurement techniques for assessing team workload.

Background: To date, little research has been conducted on the workload experienced by teams. A validated theory describing team workload, which includes an account of its relation to individual workload, has not been articulated.

Pregnancy outcome in women exposed to leflunomide before or during pregnancy.

Objective: Findings from animal studies have suggested that leflunomide may be a human teratogen. In the only human cohort study published to date, an increase in adverse outcomes in pregnancies after exposure to leflunomide was not detected. The aim of the present analysis was to expand on the previously published data with a description of birth outcomes among women who did not meet the previous cohort study criteria but who were exposed to leflunomide either during pregnancy or prior to conception.

Effect of production environment, genotype and process on the mineral content of native bitter potato cultivars converted into white chuño.

Background: Variables and interaction effects affecting the mineral concentration of Andean bitter potatoes converted into so-called white chuño are unknown. We report on the effect of three contrasting production environments (E) on the dry matter (DM), zinc, iron, calcium, potassium, magnesium, phosphorus and sodium concentration of four potato native bitter genotypes (G) processed (P) into two different 'types' of white chuño.

Results: The DM content and iron, calcium, magnesium and sodium concentration of white chuño are significantly dependent on E, G, P, and E × G × P interaction (predominantly at P < 0.

[A prospective, observational severe sepsis/septic shock registry in a tertiary hospital in the province of Guipuzcoa (Spain)].

Objective: To determine the epidemiological and clinical characteristics of the patients with severe sepsis/septic shock admitted to the ICU of Donostia Hospital (Guipuzcoa, Spain), analyzing the prognostic factors and comparing them with the existing data at national level.

Design: A prospective observational study was carried out during a consecutive 3-year period (1 Feb. 2008-31 Dec.

Measuring teamwork and conflict among emergency medical technician personnel.

Objective: We sought to develop a reliable and valid tool for measuring teamwork among emergency medical technician (EMT) partnerships.

Methods: We adapted existing scales and developed new items to measure components of teamwork. After recruiting a convenience sample of 39 agencies, we tested a 122-item draft survey tool (EMT-TEAMWORK).

[Management of the patient with a high risk of fracture in clinical practice. Results from a survey of 174 Spanish Rheumatologists (OSTEOPAR project)].

Objective: To collect information about diagnosis, classification and treatment of patients at high risk of fracture in the rheumatologist's practice.

Material And Methods: A survey was conducted among Spanish rheumatologists. The survey was aimed at gathering data on the physician's healthcare activity, the osteoporosis (OP) and fracture risk factors considered as most relevant, the diagnostic used tests and the treatment indication according to the presence of different risk factors.

LIF, a Novel STAT5-Regulated Gene, Is Aberrantly Expressed in Myeloproliferative Neoplasms.

A search for genes potentially regulated by STAT5 identified leukemia inhibitory factor (LIF) as a good candidate. Using various experimental approaches, we have validated LIF as a direct transcriptional target of STAT5 in myeloid cell lines: STAT5 binds to LIF promoter, and LIF expression is increased after activation of the JAK2/STAT5 pathway. We also found that LIF expression is significantly increased in patients with chronic myeloproliferative neoplasms with and without activating mutations of the pathway, indicating that LIF might play an important role in STAT5-mediated oncogenesis.

Twelve best practices for team training evaluation in health care.

Background: Evaluation and measurement are the building blocks of effective skill development, transfer of training, maintenance and sustainment of effective team performance, and continuous improvement. Evaluation efforts have varied in their methods, time frame, measures, and design. On the basis of the existing body of work, 12 best practice principles were extrapolated from the science of evaluation and measurement into the practice of team training evaluation.

Getting ready for simulation-based training: a checklist for nurse educators.

Nurse educators are incorporating computerized patient simulators into curricula with increasing frequency. Although several studies have focused on implementation and a framework for designing simulation using patient simulation, discussion of pre-training planning for simulation is limited. This article highlights some of the seminal literature from the science of training and discusses principles most applicable to nursing education.