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This work aims to form high-performing teams, which are characterized by high cohesion, performance, confidence, a better ability to solve tasks and problems, to take risks, to act in a creative way, to resolve conflicts, to have better communication between team members. Studying groups is important for managers because the most common element of all organizations is people, and the most common technique for performing work through these people is to divide them into working groups.

Luis Cea-Calvo,1 Ignacio Marín-Jiménez,2 Javier de Toro,3 María J Fuster-RuizdeApodaca,4,5 Gonzalo Fernández,1 Nuria Sánchez-Vega,1 Domingo Orozco-Beltrán6 1Medical Affairs Department, MSD Spain, Madrid, Spain; 2IBD Unit, Gastroenterology Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón University Hospital, Madrid, Spain; 3Rheumatology Department, A Coruña University Hospital, A Coruña, Spain; 4SEISIDA (Spanish AIDS Multidisciplinary Society), Madrid, Spain; 5Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain; 6Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, SpainCorrespondence: Luis Cea-CalvoMedical Affairs Department, MSD Spain, Josefa Valcárcel 38, Madrid 28027, SpainTel +34 913210740Email luis.cea@merck.comPurpose: To investigate relationships between intentional and non-intentional non-adherence behaviors and patient experience with healthcare and beliefs in medications.Patients and Methods: This is a post hoc analysis of a cross-sectional anonymous survey distributed between May and September 2017 to patients with rheumatic disease, inflammatory bowel disease, HIV infection or diabetes mellitus from outpatient and primary care clinics in Spain. Patients answered five questions about non-adherence behaviors and completed questionnaires on their experience with healthcare (IEXPAC: Instrument to Evaluate the EXperience of PAtients with Chronic diseases) and beliefs about medicines (BMQ: Beliefs About Medicines Questionnaire).Results: Among 1530 respondents, 53% showed ≥ 1 non-adherence behavior; 35% had ≥ 1 non-intentional non-adherence behavior, and 33% had ≥ 1 intentional non-adherence behavior. Patients with HIV infection had the lowest frequency of intentional non-adherence behaviors. Non-intentional non-adherence was associated with patient beliefs (inversely with BMQ overall score) and patient experiences (inversely with IEXPAC Factor 3 sub-score, self-management). Intentional non-adherence was strongly associated with beliefs scores (directly with BMQ concerns and inversely with BMQ necessity sub-score) and inversely associated with HIV infection.Conclusion: The different associations of intentional and non-intentional non-adherence behaviors found in this study help to understand how patient experiences and beliefs influence medical non-adherence, and in the development of strategies for reducing non-adherence.Keywords: BMQ, chronic disease, IEXPAC, intentional behavior, medication adherence, patient beliefs

Milena Gobbo,1 Roberto Saldaña,2 Marcos Rodríguez,3 Javier Jiménez,4 María I García-Vega,5 José M de Pedro,6 Luis Cea-Calvo6 1Positivamente Psychology Center, Madrid, Spain; 2Confederation of Patients with Crohn’s Disease and Ulcerative Colitis, Madrid, Spain; 3General Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain; 4Anesthesiology Department, University Hospital of Getafe, Madrid, Spain; 5Anesthesiology Department, Jiménez Díaz Hospital Foundation, Madrid, Spain; 6Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, SpainCorrespondence: Milena GobboPositivamente Psychology Center, Av. del Pdte. Carmona, 10 BIS, 1º A, Madrid 28020, SpainEmail milena.gobbo@gmail.comPurpose: Information regarding patients’ needs, fears and experiences/perceptions in the perioperative setting is limited. Through two focus groups, we explored the needs, fears and experiences of patients who had recently undergone, or were scheduled for, surgery under general anaesthesia, with regard to the entire perioperative process.Materials and Methods: Adults were invited to participate in a focus group if they had (a) undergone abdominal or gynaecological surgery with general anaesthesia in the past 4 months (focus group 1) or (b) been indicated for abdominal or gynaecological surgery and were waiting for the assigned surgery date (focus group 2). Discussions were audio recorded and, through thematic analysis, patients’ needs and experiences/perceptions regarding perioperative surgical stages were obtained/coded. Analysis of code co-occurrence was performed using a codes matrix.Results: Focus groups consisted of 13 females, 1 male (50% aged > 45 years). The immediate postoperative period generated the highest number of co-occurrences, followed by the indication of surgery. The most frequent code was the need for information, especially at the indication of surgery, the pre-anaesthesia clinic and in the postoperative period. Fears were described particularly at the indication of surgery, the waiting period, the surgical room, anaesthesia induction and the postoperative period, particularly after hospital discharge; pain was cited most commonly in the postoperative period. Stress/anxiety and emotional impact were also cited in the postoperative period including home arrival.Conclusion: Information collected in these patients’ focus groups should inform future research and healthcare planning. Patients demand receiving more comprehensive and understandable information and more involvement in several steps; this could reduce fears and stress/anxiety described across the perioperative process. Importantly, findings also extend to the postoperative period and home arrival.Keywords: anaesthesia, experience, focus group, patients, perioperative care, surgery

Paciente do sexo masculino, 71 anos, natural da cidade de Cardoso/SP, portador de cardiopatia chagásica há 8 anos, realizou transplante cardíaco em abril de 2021. Em 14 de junho/2021 procurou pronto atendimento com quadro de bacteremia e febre, internou para investigação de febre persistente sendo tratado com antibioticoterapia. Paciente mantém febre e calafrios apesar do tratamento com antibióticos e persistindo com hemoculturas negativas. Foi solicitado exames laboratoriais de urgência. Em avaliação do esfregaço de sangue periférico do hemograma observou-se inúmeras formas tripomastigotas do Trypanossoma cruzi . Após 7 dias de internação paciente evoluiu com quadro de parada cardiorrespiratória sem resposta às manobras de ressuscitação cardiopulmonar. A amostra do paciente foi enviada ao setor de Biologia Molecular do nosso laboratório para padronização da técnica de detecção molecular de Trypanossoma cruzi . Foi realizada a extração do DNA a partir de sangue total e plasma coletados em EDTA, em equipamento automatizado. Seguiu-se com a amplificação do alvo pela técnica de PCR em tempo real, utilizando par de primers e sondas Taqman desenvolvidos em nosso laboratório, usando bancos de dados de referência do NCBI. Amplificamos também amostras negativas além de amostras de água (NTC – no template control), para controle da reação. Tanto na amostra de sangue quanto de plasma do paciente, a reação mostrou-se eficaz na detecção do DNA do patógeno. O desenvolvimento dessa nova técnica possibilita a detecção rápida e eficaz do Trypanossoma cruzi e poderá ser aplicado na rotina laboratorial, auxiliando no diagnóstico da Doença de Chagas.

Objetivos: A Púrpura Trombocitopênica Trombótica (PTT) é uma condição clínica de baixa prevalência (3,7 casos para cada 100.000 habitantes), caracterizada pela ocorrência de pequenos coágulos/trombos sistêmicos e espontâneos, ricos em plaquetas, associada a anemia microangiopática. A maioria dos casos decorre de um distúrbio autoimune, o qual sintetiza anticorpos direcionados à metaloprotease plasmática clivadora ADAMTS13, responsável pela segmentação dos multímeros anormalmente grandes do fator de Von Willebrand. Este estudo tem como objetivo a validação de um novo teste de determinação qualitativa do ADAMTS13 por quimiluminescência e inibidor por Bethesda em estudo comparativo com metodologia ELISA (TECHNOZYM) e exames de inibidores (Bethesda) da Mayo Clinic por metodologia FRET. Material e métodos: O estudo é um ensaio clínico não-randomizado não-cego realizado em março de 2021, no setor de Coagulação do laboratório do Hospital Israelita Albert Einstein (HIAE), onde foram realizadas as determinações qualitativas do ADAMTS13 no equipamento ACCUSTAR (Werfen, IL), e de forma não simultânea, no equipamento TECHNOZYM pela metodologia ELISA (TechnoClone). Amostras que apresentaram resultados abaixo do valor de referência por ELISA, foram enviadas ao laboratório Mayo Clinic, onde foi realizada a pesquisa de inibidor por Bethesda por metodologia FRET. Resultados: Foram testadas 21 amostras para estudo comparativo na determinação qualitativa do teste de ADAMTS13. Do total das amostras disponíveis, nenhuma amostra foi excluída e os resultados apresentaram significante concordância, sendo apenas 3 divergências (14,28%) entre as duas metodologias. No entanto, estas divergências ocorreram em uma faixa fora do diagnóstico de PTT, ou seja, acima de 30%. Adicionalmente foram testadas 6 amostras, as quais haviam sido enviadas à Mayo Clinic para uma avaliação da presença de inibidores (Bethesda), com 100% de concordância. Discussão: Nosso trabalho demonstrou que as diferentes metodologias possuem sensibilidade similar no que tange ao diagnóstico de PTT. Além disto, aventa-se a possibilidade de uma “Zona Cinza”, na qual os resultados obtidos pelo ACCUSTAR podem ser divergentes quando comparados à técnica de ELISA, principalmente em uma região de valores intermediários (entre 30 a 50%) de resultado, sem, contudo, prejudicar o raciocínio clínico e diagnóstico. Já a técnica de pesquisa de inibidor mostrou-se 100% concordante entre as metodologias utilizadas pela Mayo Clinic (FRET) e pelo HIAE (Quimioluminescência). Conclusão: Concluímos que a metodologia automatizada por quimiluminescência é capaz de ser implementada como teste diagnóstico, com maior rapidez, favorecendo um tratamento precoce e preciso aos pacientes acometidos por Purpura Trombocitopênica Trombótica.

Computer-based interventions that aim to help students endorse a growth mindset have been designed and tested in high-income countries for a number of years. However, there is no evidence of their effectiveness in middle-income nations. In those studies, students' growth mindset has traditionally been measured using surveys where students report the extent to which they believe intelligence is fixed or malleable, without linking intelligence with a more specific dimension, such as math or language. In addition, these measurements have been undertaken without distinctions being made between personal ability ("my" intelligence) and more general abilities (everyone's intelligence). Therefore, by means of a randomized experiment, this study assesses the impact of a single-session online growth-mindset intervention in Chile on distinct measurements of the growth mindset of students (general, personal, and subject-specific), as well as their propensity to seek out challenges. Accordingly, a sample of 248 students was recruited from 9 and 11th grades in three secondary schools, all of whom were randomly assigned to either a treatment or control group. The intervention was found to increase their propensity to seek out challenges and to experience an increase in growth mindset scores in all tested dimensions. No evidence of the heterogeneity of results by gender or prior growth mindset was identified.

Xavier Calvet,1–3 Federico Argüelles-Arias,4 Antonio López-Sanromán,5 Luis Cea-Calvo,6 Berta Juliá,6 Cristina Romero de Santos,6 Daniel Carpio7 1Hospital de Sabadell. Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain; 2Centro de investigación biomédica en red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; 3Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; 4UGC Digestivo Intercentros Hospitales Virgen Macarena-Rocío, Seville, Spain; 5Section of Gastroenterology, Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal, Madrid, Spain; 6Medical Affairs Department, Merck Sharp & Dohme, Madrid, Spain; 7Service of Gastroenterology Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Biomedica (IBI), Pontevedra, Spain Purpose: Ulcerative colitis (UC) may cause many patients to miss out on important personal and professional opportunities. We therefore conducted a survey (UC-LIFE) to assess patients’ perceptions of the impact of UC on social and professional lives. Patients and methods: Consecutive unselected UC patients aged ≥18 years were recruited from 38 outpatient clinics in Spain. Patients completed the survey at home, returning it by post. The survey comprised 44 multiple-choice questions, including questions about the impact of UC on social, personal, professional, and academic activities. Results: Of 585 patients invited, 436 (75%) returned the survey (mean age 46 years; 47% women). High proportions of patients considered their disease “sometimes”, “frequently” or “mostly/always” influenced leisure activities (65.1%), recreational or professional activities (57.6%), or relationships with relatives or friends (9.9%). Patients also reported that UC influenced their decision to have children (17.2%), or their ability to take care of children (40.7%); these percentages were higher in women and in younger patients. Overall, 47.0% of patients declared that UC influenced the kind of job they performed, 20.3% had rejected a job due to UC, 14.7% had lost a job due to UC, and 19.4% had had academic problems due to UC. Conclusion: Beyond symptoms alone, UC imposes an enormous additional burden on patients’ social, professional, and family lives. This extra burden clearly needs to be addressed so that the ultimate goal of IBD treatment – normalization of patient quality of life – can be attained by as many patients as possible. Keywords: disease burden, patient-reported outcomes, patients’ perceptions, quality of life, ulcerative colitis

Carlos M González,1 Loreto Carmona,2 Javier de Toro,3 Enrique Batlle-Gualda,4 Antonio I Torralba,5 María J Arteaga,6 Luis Cea-Calvo6 1Department of Rheumatology, Gregorio Marañón Hospital, 2Instituto de Salud Musculoesquelética, Madrid, 3Department of Rheumatology, Hospital Universitario A Coruña, A Coruña, 4Department of Rheumatology, Hospital Universitario de Sant Joan d’Alacant, Alicante, 5Coordinadora Nacional de Artritis, 6Medical Affairs Department, Merck Sharp & Dohme, Madrid, Spain Objective: The aim of this study was to explore perceptions of patients with rheumatic diseases treated with subcutaneous (SC) biological drugs on the impact on daily life and satisfaction with current therapy, including preferred attributes. Methods: A survey was developed ad hoc by four rheumatologists and three patients, including Likert questions on the impact of disease and treatment on daily life and preferred attributes of treatment. Rheumatologists from 50 participating centers were instructed to handout the survey to 20 consecutive patients with rheumatoid arthritis (RA), axial spondyloarthritis (ax-SpA), or psoriatic arthritis (PsA) receiving SC biological drugs. Patients responded to the survey at home and sent it to a central facility by prepaid mail. Results: A total of 592 patients returned the survey (response rate: 59.2%), 51.4% of whom had RA, 23.8% had ax-SpA, and 19.6% had PsA. Patients reported moderate-to-severe impact of their disease on their quality of life (QoL) (51.9%), work/daily activities (49.2%), emotional well-being (41.0%), personal relationships (26.0%), and close relatives’ life (32.3%); 30%–50% patients reported seldom/never being inquired about these aspects by their rheumatologists. Treatment attributes ranked as most important were the normalization of QoL (43.6%) and the relief from symptoms (35.2%). The satisfaction with their current antirheumatic therapy was high (>80% were “satisfied” or “very satisfied”), despite moderate/severe impact of disease. Conclusion: Patients with rheumatic diseases on SC biological therapy perceive a high disease impact on different aspects of daily life, despite being highly satisfied with their treatment; the perception is that physicians do not frequently address personal problems. Normalization of QoL is the most important attribute of therapies to patients. Keywords: rheumatic diseases, quality of life, emotional well-being, biological drugs, patient’s satisfaction

Technical innovation in neuroscience introduced powerful tools for measuring and manipulating neuronal activity via optical, chemogenetic, and calcium-imaging tools. These tools were initially tested primarily in male animals but are now increasingly being used in females as well. In this review, we consider how these tools may work differently in males and females. For example, we review sex differences in the metabolism of chemogenetic ligands and their downstream signaling effects. Optical tools more directly alter depolarization or hyperpolarization of neurons, but biological sex and gonadal hormones modulate synaptic inputs and intrinsic excitability. We review studies demonstrating that optogenetic manipulations are sometimes consistent across the rodent estrous cycle but within certain circuits; manipulations can vary across the ovarian cycle. Finally, calcium-imaging methods utilize genetically encoded calcium indicators to measure neuronal activity. Testosterone and estradiol can directly modulate calcium influx, and we consider these implications for interpreting the results of calcium-imaging studies. Together, our findings suggest that these neuroscientific tools may sometimes work differently in males and females and that users should be aware of these differences when applying these methods.

BackgroundIn Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations. ObjectiveThe objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates. MethodsWe conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)–based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis. ResultsFocus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates. ConclusionsThis study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations.

Perceptions of patients with rheumatic diseases on the impact on daily life and satisfaction with their medications: RHEU-LIFE, a survey to patients treated with subcutaneous biological products [Corrigendum] González CM, Carmona L, de Toro J, et al. Patient Prefer Adherence. 2017;11:1243–1252.On page 1245, Results; Response rate and sample description section, the second sentence “The mean age of the respondents was 41.7 years (SD 13.1), and 57.6% of them were females” should read “The mean age of the respondents was 51.7 years (SD 13.1), and 57.6% of them were females”.Read the original article

Six new diorganotin (IV) complexes, [Ph2Sn(Pr-ACDA)2] 1, [Bu2Sn(Pr-ACDA)2] 2, [Ph2Sn(Bz-ACDA)2] 3, [Bu2Sn(Bz-ACDA)2] 4, [Me2Sn(Bz-ACDA)2] 5, [t-Bu2Sn(Bz-ACDA)2] 6 are reported (where ACDA is the 2-amino-1-cyclopentene-1-carbodithioic anion). The diorganotin complexes were prepared from reactions between sodium N-propyl and N-benzyl-2-amino-1-cyclopentene-1-carbodithioate with R2SnCl2 (R=Ph, Bu, Me, tBu) in a 2:1 ratio. All complexes were characterized by elemental analysis, IR, multinuclear NMR (1H, 13C, and 119Sn), FAB+ mass spectrometry and in the case of 2, 3 and 5 by single-crystal X-ray diffraction. Both solution and solid state studies show that dithioacid ligands are coordinated to tin in an aniso-bidentate manner. In all complexes coordination takes place only through the carbodithioate moieties. 119Sn NMR data indicate pentacoordination of tin in solution. The tin coordination geometry, in all three structures is a highly distorted octahedral geometry, where tin is bonded to the four sulfur atoms of the two aniso-bidentate carbodithioate ligands in the equatorial plane and the organic substituents on tin atom in trans-positions. In addition, the crystal structures show the presence of N-H…S hydrogen bonding contacts.

Abaca fiber remains a vital export product that contributes primarily to the continuous economic growth of the Philippines. However, the voluminous amount of byproducts generated has consistently caused setbacks which often result to major losses to the growing abaca industry in the country. In an attempt to provide a practical solution to the emerging problem, we investigate the utilization of abaca stripping waste (ASW) as a precursor material to produce bioethanol. We test the extent of conversion of the hemicellulose-rich by product to glucose. A box-behnken experimental design was used to obtain the optimal conditions in the conversion process. Alkaline concentration (%), microwave power (W), and microwave time (min) were found to have significant influence on the glucose yield. Actual values of these independent variables were chosen on the basis of preliminary experimental results. Optimum conditions using ridge analysis were found to be: alkaline concentration 2.55%, microwave power 124.0 W, and microwave time at 1.0 min. Conversion to glucose was also performed at optimum conditions. In conclusion, a high glucose yield obtained which is suitable for bioethanol fermentation presents evidence encouraging the utilization of abaca stripping waste to produce high value products.

Discrete Trial Training (DTT) is a method of intervention for individuals with Autism Spectrum Disorder (ASD). Applications of DTT require prescribed repetitions of instruction. DTT is typically implemented via trained instructors or teachers. However, prior analysis has demonstrated the potential of parent-implemented DTT. Prior research demonstrated that DTT training can be implemented with a high degree of fidelity using a student teacher population. However, to date, no studies have evaluated the use of a DTT telehealth training with parents of children with ASD. The purpose of this study was to evaluate the feasibility of a remote parent training method to allow parents to implement DTT in home settings. To this end, three parent participants of children diagnosed with ASD were trained to implement DTT through a telehealth modality in a nonconcurrent multiple baseline design. Results suggested efficacy of this method at DTT skills acquisition.

We study the behavior across the deconfinement phase transition of the chro-moelectric flux tube generated by a static quark and a static antiquark for several distances between them. We present preliminary results for distances up to 1.33 fm and temperatures up to 1.5Tc.

IntroductionUnderstanding the adaptive capacity to current climate change of drought-sensitive tree species is mandatory, given their limited prospect of migration and adaptation as long-lived, sessile organisms. Knowledge about the molecular and eco-physiological mechanisms that control drought resilience is thus key, since water shortage appears as one of the main abiotic factors threatening forests ecosystems. However, our current background is scarce, especially in conifers, due to their huge and complex genomes.MethodsHere we investigated the eco-physiological and transcriptomic basis of drought response of the climate change-threatened conifer Cedrus atlantica. We studied C. atlantica seedlings from two locations with contrasting drought conditions to investigate a local adaptation. Seedlings were subjected to experimental drought conditions, and were monitored at immediate (24 hours) and extended (20 days) times. In addition, post-drought recovery was investigated, depicting two contrasting responses in both locations (drought resilient and non-resilient). Single nucleotide polymorphisms (SNPs) were also studied to characterize the genomic basis of drought resilience and investigate a rapid local adaptation of C. atlantica.ResultsDe novo transcriptome assembly was performed for the first time in this species, providing differences in gene expression between the immediate and extended treatments, as well as among the post-drought recovery phenotypes. Weighted gene co-expression network analysis showed a regulation of stomatal closing and photosynthetic activity during the immediate drought, consistent with an isohydric dynamic. During the extended drought, growth and flavonoid biosynthesis inhibition mechanisms prevailed, probably to increase root-to-shoot ratio and to limit the energy-intensive biosynthesis of secondary metabolites. Drought sensitive individuals failed in metabolism and photosynthesis regulation under drought stress, and in limiting secondary metabolite production. Moreover, genomic differences (SNPs) were found between drought resilient and sensitive seedlings, and between the two studied locations, which were mostly related to transposable elements.DiscussionThis work provides novel insights into the transcriptomic basis of drought response of C. atlantica, a set of candidate genes mechanistically involved in its drought sensitivity and evidence of a rapid local adaptation. Our results may help guide conservation programs for this threatened conifer, contribute to advance drought-resilience research and shed light on trees' adaptive potential to current climate change.