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Storylines of Family Medicine is a 12-part series of thematically linked essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'V: ways of thinking-honing the therapeutic self', authors present the following sections: 'Reflective practice in action', 'The doctor as drug-Balint groups', 'Cultivating compassion', 'Towards a humanistic approach to doctoring', 'Intimacy in family medicine', 'The many faces of suffering', 'Transcending suffering' and 'The power of listening to stories.' May readers feel a deeper sense of their own therapeutic agency by reflecting on these essays.

Social networking sites are a new ecosystem of social relations in which adolescents follow public figures or influencers: instagrammers, tweeters and youtubers. Their behaviour in the posts they publish become a trend and a model for the new generations. In order to explore these behaviours and their consequences, it is useful to study the behaviour of the 10 instagramers, 10 tweeters and 10 youtubers with the largest number of followers in the world. A mixed method was employed, combining: social media analysis (SNA) methodology executed by monitoring Twitter, Instagram and YouTube accounts and their publications (300 posts with the highest number of likes). The FanapageKarma tool was used to capture data by applying data mining techniques. Subsequently, sentiment analysis was performed using Meaning Cloud software, determining sentiment polarity analysis quantitatively. Finally, a semantic analysis of the content was performed using Nvivo. The results of multi-regression and sentiment's analysis show clear differences between social networking sites. Twitter is a space for critical analysis of information and social movements, especially climate change. In this space adolescents defend their values and ideology. Instagram is a showcase for fashion and beauty, where brands support an idealised and desirable lifestyle. YouTube is a space for entertainment and comedy. It concludes that despite their differences there is one univocal feature, the effort of influencers to capture audiences and establish parasocial relationships.

Western Eurasia witnessed several large-scale human migrations during the Holocene1-5. Here, to investigate the cross-continental effects of these migrations, we shotgun-sequenced 317 genomes-mainly from the Mesolithic and Neolithic periods-from across northern and western Eurasia. These were imputed alongside published data to obtain diploid genotypes from more than 1,600 ancient humans. Our analyses revealed a 'great divide' genomic boundary extending from the Black Sea to the Baltic. Mesolithic hunter-gatherers were highly genetically differentiated east and west of this zone, and the effect of the neolithization was equally disparate. Large-scale ancestry shifts occurred in the west as farming was introduced, including near-total replacement of hunter-gatherers in many areas, whereas no substantial ancestry shifts happened east of the zone during the same period. Similarly, relatedness decreased in the west from the Neolithic transition onwards, whereas, east of the Urals, relatedness remained high until around 4,000 BP, consistent with the persistence of localized groups of hunter-gatherers. The boundary dissolved when Yamnaya-related ancestry spread across western Eurasia around 5,000 BP, resulting in a second major turnover that reached most parts of Europe within a 1,000-year span. The genetic origin and fate of the Yamnaya have remained elusive, but we show that hunter-gatherers from the Middle Don region contributed ancestry to them. Yamnaya groups later admixed with individuals associated with the Globular Amphora culture before expanding into Europe. Similar turnovers occurred in western Siberia, where we report new genomic data from a 'Neolithic steppe' cline spanning the Siberian forest steppe to Lake Baikal. These prehistoric migrations had profound and lasting effects on the genetic diversity of Eurasian populations.

Neuropsychological assessment is essential in patients with cognitive impairment and could be coupled with psychophysiological techniques. Specifically, quantitative electroencephalography may complement data from neuroimage, neurophysiology, and neuropsychology providing relevant information about brain functioning and dynamics. A 77-year-old male consulted for expressive language difficulties that began at age 65. Neuroimaging findings revealed atrophy and hypometabolism of the left temporal and frontal lobe, with cerebral microlesions. Quantitative electroencephalography findings showed decreased absolute and relative power, low alpha peak frequency, and marked inter- and intrahemispheric frontal and temporal asymmetries. The neuropsychological profile showed alteration in executive and expressive language domains, consistent with neuroimaging and psychophysiological findings. A diagnosis of primary progressive aphasia, a form of frontotemporal dementia, as well as a small vessel disease and mild cognitive impairment was concluded. Neuropsychological and quantitative electroencephalography data contribute to the diagnosis and would help determine the disease progression.

Abstract Digital well-being, which refers to a balanced individual experience of digital consumption, has been gaining attention recently in the study of the effects of digital technology use. Social networks are central in debates over digital well-being, as social media overuse is often identified as a primary issue. Teenagers who spend an average of three hours daily on social media especially draw the attention of researchers. Based on statistical evidence, TikTok is the most popular network among young users worldwide. However, there are not many platform-specific studies on its effects on adolescent well-being. One of the most consistent gaps is the lack of research on how different aspects involved in TikTok use impact adolescents’ digital well-being on the app. In light of this, the study aimed to explore the relationship between time spent on TikTok, content consumption, and self-perception of digital well-being. Given the scientific consensus on social media’s greater impact on girls, this study also sought to examine gender differences. For that purpose, a quantitative cross-sectional study was conducted with 737 Spanish adolescents aged 12 to 18, who completed an online questionnaire with validated scales and items on daily usage time, type of content consumption, and digital well-being. Results showed significant gender differences in TikTok usage and content consumption: girls spent more time on TikTok and notably engaged more with beauty and fashion content, while boys with video games and sports content, suggesting that traditional gender roles are still present in their choices of content consumption. Beyond that, a rather positive self-perception of digital well-being on TikTok by teenagers was observed. Despite this, an increased TikTok usage was associated with a reduced ability to set boundaries and limit their time on the app. These findings highlight the need for measures to limit the time adolescents spend on TikTok, such as mandatory parental controls on electronic devices and educational programs aimed at promoting healthy digital habits.

Abstract In recent years, research has progressively increased the importance of considering sex differences in stress and fear memory studies. Many studies have traditionally focused on male subjects, potentially overlooking critical differences with females. Emerging evidence suggests that males and females can exhibit distinct behavioral and neurophysiological responses to stress and fear conditioning. These differences may be attributable to variations in hormone levels, brain structure, and neural circuitry, particularly in regions such as the prefrontal cortex (PFC). In the present study, we explored sex differences in prelimbic cortex (PL) calcium activity in animals submitted to immobilization stress (IMO), fear conditioning (FC), and fear extinction (FE). While no significant sex differences were found in behavioral responses, we did observe differences in several PL calcium activity parameters. To determine whether these results were related to behaviors beyond stress and fear memory, we conducted correlation studies between the movement of the animals and PL activity during IMO and freezing behavior during FC and FE. Our findings revealed a clear correlation between PL calcium activity with movement during stress exposure and freezing behavior, with no sex differences observed in these correlations. These results suggest a significant role for the PL in movement and locomotion, in addition to its involvement in fear-related processes. The inclusion of both female and male subjects is crucial for studies like this to fully understand the role of the PFC and other brain areas in stress and fear responses. Recognizing sex differences enhances our comprehension of brain function and can lead to more personalized and effective approaches in the study and treatment of stress and fear-related conditions.

The Lean Management had its origin in the 50s in the Japanese automobile industry, and is currently used in different production processes, included those related to pharmaceutical production, for which has raised its application in the manufacture of loperamide HCl-orodispersible tablets (HCl-ODT) under the coordination of the Pharmaceutical Quality System (PQS). A theoretical proposal for process reengineering has been carried out both incorporating and applying the different Lean tools in the industrial manufacturing process of HCl-ODT, and their subsequent integration into the PQS, through each one of the processes stages, such as: weighing, screening, mixing, compression, and packaging, under the compliance of the current legislation of the pharmaceutical industry and in compatibility with what is established in the ICHs within the Quality System, in order to increase the effectiveness and efficiency of the process and its profitability. Lean Management under the coordination of the Pharmaceutical Quality System (PQS), is an excellent strategy for manufacturing loperamide HCl-orodispersible tablets since it improves its Quality System, as well as facilitates compliance with the national and international guides, standards and legislation that are suitable to it.

The Antarctic Ice Sheet (AIS) has experienced accelerated loss of ice over the last decades and could become the main contributor to sea level rise in the coming centuries. However, the associated uncertainty is very large. The main sources of this uncertainty lie in the future scenarios, the climatic forcing and, most notably, the structural uncertainty due to our lack of understanding of ice–ocean interaction processes, in particular, the representation of subshelf basal melt. In this study, we use a higher-order ice sheet model to investigate the impact of these three sources of uncertainty on the contribution of the AIS to sea level in the coming centuries in the context of the Ice Sheet Model Intercomparison Project for CMIP6 (ISMIP6) but extending the projections to 2500. We test the sensitivity of the model to basal melting parameters using several forcings and scenarios simulated in the CMIP5 and CMIP6 ensembles. Results show a strong dependency on the values of the parameter that controls the heat exchange velocity between ice and ocean as well as the forcing and scenario. Higher values of the heat exchange parameter lead to higher sea level rise, with the contribution depending on the forcing–scenario configuration and reaching in some cases more than 3 m in sea level equivalent by the end of 2500. Idealized simulations considering the individual effects of the atmospheric and the oceanic forcing have been performed, demonstrating that the oceanic forcing plays a dominant role over the western sector of the AIS, while the atmospheric forcing is more important for the eastern sector and the interior.

Background and purpose: Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. Methods: Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. Results: A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05 ± 3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. Conclusion: The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. Level of evidence: Systematic review of Level 2–4 evidence studies. Resumen: Antecedentes y objetivo: La reducción abierta rara vez es necesaria en las fracturas supracondíleas de húmero pediátrica. Sin embargo, falta evidencia sobre cuál es el abordaje óptimo para obtener resultados satisfactorios. El abordaje anterior facilita una visión directa de la fractura y una excelente exposición de las estructuras neurovasculares, aunque su uso es poco común. El objetivo de este estudio fue revisar las indicaciones, resultados y complicaciones asociadas con el abordaje anterior para la reducción abierta de estas fracturas. Métodos: Nuestro protocolo se registró en PROSPERO: CRD42023446923. La búsqueda se realizó en MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov y Cochrane Library, desde inicios hasta diciembre de 2023. Se realizó screening por duplicado. Se recogieron datos demográficos, indicaciones para el abordaje abierto, puntuación de Flynn funcional y estética y complicaciones. La calidad de los estudios se evaluó con Methodological Index for Non-Randomized Studies Criteria (MINORS). Resultados: Se incluyeron 19 estudios que agrupaban a 483 pacientes. Un estudio se clasificó con nivel de evidencia 2, 10 con nivel 3, y 8 con nivel 4. La puntuación media MINORS fue 13,05 ± 3,47. La indicación principal para el abordaje abierto fue el fracaso de la reducción cerrada, reportada en 46% de pacientes. El 97,7% y 98,6% de los pacientes lograron un Flynn funcional y cosmético satisfactorio, respectivamente. La tasa de lesiones neurovasculares postquirúrgicas fue 1,4%. Un paciente fue reintervenido. Conclusiones: El abordaje anterior es seguro y efectivo en el maneco de fracturas supracondíleas de húmero pediátricas cuando se requiera un abordaje abierto. Nivel de evidencia: Revisión sistemática de estudios con nivel de evidencia 2-4.

Tipping elements, including the Antarctic Ice Sheet (AIS), are Earth system components that could reach critical thresholds due to anthropogenic emissions. Increasing our understanding of past warm climates can help to elucidate the future contribution of the AIS to emissions. The mid-Pliocene Warm Period (mPWP; ∼ 3.3–3.0 million years ago) serves as an ideal benchmark experiment. During this period, CO2 levels were similar to the present day (PD; 350–450 ppmv), but global mean temperatures were 2.5–4.0 K higher. Sea level reconstructions from that time indicate a rise of 5–25 m compared to the present, highlighting the potential crossing of tipping points in Antarctica. In order to achieve a sea level contribution far beyond 10 m, not only the West Antarctic Ice Sheet (WAIS) needs to largely decrease, but a significant response in the East Antarctic Ice Sheet (EAIS) is also required. A key question in reconstructions and simulations is therefore which of the AIS basins retreated during the mPWP. In this study, we investigate how the AIS responds to climatic and bedrock conditions during the mPWP. To this end, we use the Pliocene Model Intercomparison Project, Phase 2 (PlioMIP2), general circulation model ensemble to force a higher-order ice sheet model. Our simulations reveal that the WAIS experiences collapse with a 0.5 K oceanic warming. The Wilkes Basin shows retreat at 3 K oceanic warming, although higher precipitation rates could mitigate such a retreat. Totten Glacier shows slight signs of retreats only under high-oceanic warming conditions (greater than 4 K oceanic anomaly). If only the WAIS collapses, we simulate a mean contribution of 2.7 to 7.0 ms.l.e. (metres of sea level equivalent). If, in addition, the Wilkes Basin retreats, our simulations suggest a mean contribution of 6.0 to 8.9 ms.l.e. Besides uncertainties related to the climate forcing, we also examine other sources of uncertainty related to initial ice thickness and ice dynamics. We find that the climatologies yield a higher uncertainty than the dynamical configuration if parameters are constrained with PD observations and that starting from Pliocene reconstructions leads to smaller ice sheet configurations due to the hysteresis behaviour of marine bedrocks. Ultimately, our study concludes that marine ice cliff instability is not a prerequisite for the retreat of the Wilkes Basin. Instead, a significant rise in oceanic temperatures can initiate such a retreat.

Abstract B cell chronic lymphocytic leukaemia (B‐CLL) presenting with cutaneous infiltration is rare, and when it occurs, it presents most commonly on the head and neck. We present the case of an 80‐year‐old woman with a 2‐month history of erythema, swelling and pain affecting all her toes. She had a history of B‐CLL diagnosed 20 years previously that had remained stable under observation without treatment. A toe skin biopsy showed a diffuse infiltrate of lymphoid cells occupying the dermis composed of small mature lymphoid cells with a monotonous appearance. On immunohistochemistry, the neoplastic lymphoid cells stained positive for the B‐cell marker CD20. Overall, the morphology and immunophenotype were consistent with cutaneous involvement by chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL). We concluded that her symptoms were directly caused by skin infiltration of B‐CLL.

Background: The treatment of psoriasis in patients with a personal history of cancer is a matter of debate and limited evidence is available to guide clinicians. Objectives: To report a multicenter real-life experience of a group of patients with psoriasis undergoing treatment with guselkumab and a history of cancer. Methods: We conducted a multicenter retrospective Spanish study enrolling patients with moderate-to-severe plaque psoriasis and neoplasia being treated with guselkumab for their psoriasis. Results: Twenty patients with moderate-to-severe psoriasis and at least 12 weeks of ongoing treatment were included. For the analysis, a 52 week follow-up period was evaluated in terms of efficacy and safety. Most of the malignancies in these patients were solid tumors. The percentage of patients achieving psoriasis area and severity index ≤3 at week 12 and week 52 was 80% and 87.5%, respectively, whereas 68.8% of patients achieved psoriasis area and severity index ≤1. A 52-week survival rate of 100% in the study population was observed (n = 20), including those patients with concomitant active cancers (n = 14). No adverse effects or dropouts related to guselkumab safety profile were detected. Limitations: Modest sample size and the retrospective nature of the study. Conclusion: Guselkumab not only demonstrates high effectiveness in treating psoriasis but also exhibits a favorable safety profile in patients with neoplasms.

Genito-Pelvic Pain/Penetration Disorder is a common sexual disorder that affects an individual's sexual health and overall well-being. Education is a therapeutic resource that presents several advantages, and it can potentially generate improvements both in pain and sexual functioning-related outcomes in patients suffering from this affliction. The objective of this study was to assess if a therapeutic educational program produced improvements in the different domains of the Female Sexual Function Index in participants suffering from Genito-Pelvic Pain Penetration Disorder. Participants were randomized into a group that received a face-to-face therapeutic educational program, a group that received the same program but online, or a control group. The Female Sexual Function Index was assessed, and analysis of the change in the domains for every group was performed using multiple t-tests. Improvements were found in the face-to-face intervention group, but only the "Pain" domain showed significant improvements (-1.1 points, p < 0.05). Improvements were also found in the online group, but they were only significant in the "Pain" and "Satisfaction" domains (-0.8 points, p < 0.05 for both). A therapeutic educational program improves pain-related outcomes, and it shows a positive tendency to also improve sexual functioning-related outcomes in patients suffering from Genito-Pelvic Pain/Penetration Disorder. Registration: Clinical Trials (NCT05114473).

Intergenerational games to be played by grandparents and their grandchildren can be mutually beneficial for both age groups: breaking with age stereotypes, linking the learning and leisure needs of both generations and encouraging communication, solidarity, and social connectedness between generations. Due to the COVID-19 pandemic, it was necessary to switch from colocated physical intergenerational play to online experiences. This type of experience, in which grandparents connect from their own houses to participate, represents a challenge in terms of recruiting participants and carrying out the online sessions, due to grandparents' technological insecurities and their reluctance to play videogames. Besides, intergenerational games have to be carefully designed to promote symmetrical interactions, fun, and engagement on the part of both age groups as well as to develop easy to use interfaces. In this work, we present an online storytelling game designed to be played by family teams formed by grandparents and their grandchildren. The guidelines followed, the assessment tools designed to evaluate the intergenerational dynamics and the emotions that arise during the experience are also presented. Results of the three online sessions carried out are presented and discussed.