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Development of digital resources is difficult due to their particular complexity relying on pedagogical aspects. Another aspect is the lack of well-defined development processes, experiences documented, and standard methodologies to guide and organize game development. Added to this, there is no documented technique to ensure correct implementation of a competency in a videogame. This research proposes a Short Serious Game Development Process founded in Software Engineering paradigms and complemented by previous efforts on large scale development of digital learning resources. This paper focuses in a technique called Competency-Based Decomposition that achieves implementing a formal competency into a short serious game, with which the formal learning process will be complemented to improve the way students learn. Through a case study will be demonstrated its utility by implementing the process and the technique in the whole of mathematics competencies for sixth grade of elementary school in Mexico. The result of applying the proposed process for study case is a collection of video games that satisfactorily implements the competencies and its contents, its expected learning and its knowledge areas specified for sixth grade of elementary school in Mexico by the Ministry of Public Education.

Olivia Sánchez-Cabral,1 Dina Martínez-Mendoza,1,2 Ángel Paul Flores-Bello,3 José Arturo Martínez-Orozco,4 Rosa María Rivera-Rosales,5 César Luna-Rivero,5 Patricio Santillán-Doherty,6 Gustavo Reyes-Terán7 1Interventional Pulmonology Unit, 2Hospital Epidemiology Surveillance Unit, 3Clinic of Tuberculosis and Pleural Diseases, 4Department of Infectious Diseases and Clinical Microbiology, 5Anatomic Pathology Service, 6Medical Direction, 7Department of Research in Infectious Diseases, National Institute of Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico Background: The key diagnostic method for the evaluation of lung diseases associated with HIV infection is bronchoscopy, with bronchoalveolar lavage (BAL) being the most commonly used sampling technique. Transbronchial biopsy (TBB) is often complementary. Setting: This is a retrospective cross-sectional study to determine the diagnostic usefulness of bronchoscopy with simultaneous samples obtained through BAL and TBB in HIV-infected patients with pneumonia at the National Institute of Respiratory Diseases Ismael Cosío Villegas. Methods: In this cross-sectional study (January 2014–December 2015), the diagnostic yield of bronchoscopic samples from all HIV-positive patients with pneumonia aged >18 years, from procedures performed in the Interventional Pulmonology Unit, was analyzed and recorded in its database. The diagnostic yield concordance between BAL and TBB samples was evaluated by kappa index calculation. Results: A total of 198 procedures on 189 HIV-infected patients with pneumonia were performed. A total of 167/189 (88.4%) patients were male, and the mean age was 34.7 years (SD ±9.0). Overall, the diagnostic yield for either technique was 87.9% (174/198), but it was higher for TBB, its yield being 78.8% (156/198). In contrast, that of BAL was 62.1% (123/198) (P=0.001). The overall diagnostic yield concordance between TBB and BAL was insignificant (κ=0.213, P

A trend (factors used for multivariate analysis, I p i < 0.20) was observed for females ( I p i = 0.09), younger age ( I p i = 0.11), history of psoriatic arthritis ( I p i = 0.12) and use of systemic treatments ( I p i = 0.07), including use of biologic therapies ( I p i = 0.17) (Table 1). Flares were defined as exacerbation of psoriasis within 1 month after the onset of SARS-CoV-2 infection. Psoriasis worsened within 1 month of infection in 25 (17.7%) children and 26 (17.5%) SARS-CoV-2-infections (Table 1). 1 TABLE Risk factors for psoriasis flares after SARS-CoV-2 infection. [Extracted from the article]

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The Agroforestry Support Program for Empowering Communities Towards Self-Reliance (ASPECTS) was conceived to develop a model of two-stage approach in agroforestry promotion by capacitating the upland communities to establish community-managed agroforestry extension services, while strengthening the agroforestry education programs of the three collaborating agroforestry schools in the Philippines. ASPECTS convened a multisectoral collaboration in building the physical and social infrastructure of the partner communities (i.e. training of farmer-trainers and establishing training facilities and community demonstration plots and nursery); improving schools' capacities in implementing agroforestry programs (i.e. improving library resources, field facilities, and staff development); promoting farm-based research; and establishing institutional linkages. The school-led multisectoral collaboration intensified agroforestry promotion in the three partner upland communities; intensified farmer-to-farmer training activities; enhanced delivery of agroforestry education programs of the three collaborating schools; and enabled the local development organizations to recognize the importance of agroforestry by integrating agroforestry-related activities in their annual development programs. This action research has proven that the educational institutions have the potentials and the capacity to enforce empowerment of upland communities. This model also affirms the viability of partnership and collaboration in enhancing upland development endeavors. This model harnessed the potentials and developed synergy among people and institutions represented in the multisectoral convergence. This project has developed a model of scaling-up agroforestry promotion using a two-stage approach--capacitating the farming communities, while strengthening the collaborating schools' agroforestry programs. (Contains 2 figures and 3 tables.)

Evaluates four modules, created by the Society for Industrial and Organizational Psychology, for educating students about industrial/organizational (I/O) psychology. Reports that students' knowledge about I/O increased, and their interest in taking an I/O psychology course also increased. (CMK)

Physical therapy for patients in the ICU is advanced practice demanding specialized knowledge and skills. However, ICU physical therapy competency standards lack uniformity or defined processes. To describe the development process of the Perme ICU Physical Therapy Competency and to assess its face and content validity. Quantitative research study for the content validation of the Perme ICU Physical Therapy Competency using a panel of experts. The face validity assessment consisted of two informal surveys and discussions with clinicians representing various disciplines in ICU. A content validation survey included analysis of sufficiency, clarity, coherence, and relevance for items in the Perme ICU Physical Therapy Competency. For the quantitative analysis of content validity, the item-level content validity index (I-CVI) was used. Scale-level content validity index based on the universal agreement method (S-CVI/UA) was calculated as the proportion of items on the scale that achieve a relevance scale of 3 or 4 by all experts. Scale-level content validity index was calculated based on the average method (S-CVI/Ave). The sufficiency, clarity, coherence, and relevance of the Perme ICU Physical Therapy Competency items presented S-CVI/Ave greater than 80 % (97 %, 97 %, 99 %, 95 %, respectively). This study establishes that the Perme ICU Physical Therapy Competency has a satisfactory level of face and content validity. The Perme ICU Physical Therapy Competency, with its solid framework, is a valuable assessment tool applicable for integration in any ICU competency program. It can be utilized as a self-assessment tool by individual therapists or in collaboration with mentors and evaluators to evaluate knowledge and skills effectively. This innovative tool not only enhances clinical practice but also presents an opportunity for advancing the physical therapy profession within the ICU setting. [ABSTRACT FROM AUTHOR]

Background: There is conflicting evidence about the use of biomarkers to diagnose left atrial thrombus in patients with atrial fibrillation.Objective: The purpose of this study was to assess the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation.Methods: We searched 4 electronic databases from inception to December 16, 2020. The reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. We used a bivariate model to calculate the pooled sensitivity and specificity with their 95% confidence intervals (CIs). The optimal cutoff and predictive values were also estimated.Results: Eleven cross-sectional studies involving 4380 patients were included. The median prevalence of left atrial thrombus was 12%. In 7 studies, the pooled sensitivity of D-dimer at 500 ng/mL was 50% (95% CI 26%-74%) and the pooled specificity was 88% (95% CI 76%-95%). The pooled sensitivity of age-adjusted D-dimer was 36% (95% CI 14%-66%) and the pooled specificity was 99% (95% CI 96%-99%) in 2 studies. The optimal cutoff of D-dimer was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI 44%-85%) and a pooled specificity of 73% (95% CI 54%-86%). The positive and negative predictive values were 21.8% and 95.4%, respectively. The risk of bias was low or unclear for all domains. Concerns about applicability were low for almost all studies.Conclusion: Our meta-analysis suggests that D-dimer has the potential to be useful to rule out left atrial thrombus in patients with atrial fibrillation. [ABSTRACT FROM AUTHOR]

Abstract Background Osteoarthritis (OA) is characterized by degeneration of articular cartilage. Animal models of OA induced are a widely used tool in the study of the pathogenesis of disease. Several proteomic techniques for selective extraction of proteins have provided protein profiles of chondrocytes and secretory patterns in normal and osteoarthritic cartilage, including the discovery of new and promising biomarkers. In this proteomic analysis to study several proteins from rat normal articular cartilage, two-dimensional electrophoresis and mass spectrometry (MS) were used. Interestingly, latexin (LXN) was found. Using an immunohistochemical technique, it was possible to determine its localization within the chondrocytes from normal and osteoarthritic articular cartilage. Results In this study, 147 proteins were visualized, and 47 proteins were identified by MS. A significant proportion of proteins are involved in metabolic processes and energy (32%), as well as participating in different biological functions including structural organization (19%), signal transduction and molecular signaling (11%), redox homeostasis (9%), transcription and protein synthesis (6%), and transport (6%). The identified proteins were assigned to one or more subcellular compartments. Among the identified proteins, we found some proteins already recognized in other studies such as OA-associated proteins. Interestingly, we identified LXN, an inhibitor of mammalian carboxypeptidases, which had not been described in articular cartilage. Immunolabeling assays for LXN showed a granular distribution pattern in the cytoplasm of most chondrocytes of the middle, deep and calcified zones of normal articular cartilage as well as in subchondral bone. In osteoarthritic cartilage, LXN was observed in superficial and deep zones. Conclusions This study provides the first proteomic analysis of normal articular cartilage of rat. We identified LXN, whose location was demonstrated by immunolabeling in the chondrocytes from the middle, deep and calcified zones of normal articular cartilage, and superficial and deep zones of osteoarthritic cartilage.

Abstract Background The implementation of gene therapy for the treatment of pituitary tumors emerges as a promising complement to surgery and may have distinct advantages over radiotherapy for this type of tumors. Up to now, suicide gene therapy has been the main experimental approach explored to treat experimental pituitary tumors. In the present study we assessed the effectiveness of insulin-like growth factor I (IGF-I) gene therapy for the treatment of estrogen-induced prolactinomas in rats. Results Female Sprague Dawley rats were subcutaneously implanted with silastic capsules filled with 17-β estradiol (E2) in order to induce pituitary prolactinomas. Blood samples were taken at regular intervals in order to measure serum prolactin (PRL). As expected, serum PRL increased progressively and 23 days after implanting the E2 capsules (Experimental day 0), circulating PRL had undergone a 3–4 fold increase. On Experimental day 0 part of the E2-implanted animals received a bilateral intrapituitary injection of either an adenoviral vector expressing the gene for rat IGF-I (RAd-IGFI), or a vector (RAd-GFP) expressing the gene for green fluorescent protein (GFP). Seven days post vector injection all animals were sacrificed and their pituitaries morphometrically analyzed to evaluate changes in the lactotroph population. RAd-IGFI but not RAd-GFP, induced a significant fall in serum PRL. Furthermore, RAd-IGFI but not RAd-GFP significantly reversed the increase in lactotroph size (CS) and volume density (VD) induced by E2 treatment. Conclusion We conclude that IGF-I gene therapy constitutes a potentially useful intervention for the treatment of prolactinomas and that bioactive peptide gene delivery may open novel therapeutic avenues for the treatment of pituitary tumors.

Objectives: The purpose of this article was to determine the change in the volume of pacemaker implantations with the COVID‐2019 pandemic and to assess the change in the number of pacemaker implants according to etiology during the pandemic. Background: The establishment of a mandatory social isolation have generated a decrease in activities in cardiology units. Methods: Descriptive, cross‐sectional study that used a database of a Peruvian Hospital. Time was divided into three categories: Before COVID period and COVID period including Previous to Social isolation (SI) and Social Isolation. The number of pacemaker implantations were compared per the same amount of time. Results: A reduction in the pacemaker implant of 73% (95% CI: 33‐113; P <.001) was observed during the COVID‐19 pandemic period, and a reduction of 78% of patients with the diagnosis of complete or high‐grade atrioventricular block and a reduction in the de‐novo pacemaker implant was observed, regardless of the etiology. Conclusions: Our results indicate a very significant reduction (73%) in de‐novo pacemaker implantation during the months of the COVID‐19 pandemic. The reduction in the number of de‐novo pacemaker occurred independent of the etiology. [ABSTRACT FROM AUTHOR]