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PURPOSE: This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC). METHODS: A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators. RESULTS: We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment. CONCLUSIONS: We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes.

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Renal cancer is the seventh most common cancer in men and the tenth in women. The aim of this article is to review the diagnosis, treatment, and follow-up of renal carcinoma accompanied by recommendations with new evidence and treatment algorithms. A new pathologic classification of RCC by the World Health Organization (WHO) was published in 2022 and this classification would be considered a "bridge" to a future molecular classification. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. Adjuvant treatment with pembrolizumab is an option for intermediate-or high-risk cases, as well as patients after complete resection of metastatic disease. More data are needed in the future, including positive overall survival data. Clinical prognostic classification, preferably IMDC, should be used for treatment decision making in mRCC. Cytoreductive nephrectomy should not be deemed mandatory in individuals with intermediate-poor IMDC/MSKCC risk who require systemic therapy. Metastasectomy can be contemplated in selected subjects with a limited number of metastases or long metachronous disease-free interval. For the population of patients with metastatic ccRCC as a whole, the combination of pembrolizumab-axitinib, nivolumab-cabozantinib, or pembrolizumab-lenvatinib can be considered as the first option based on the benefit obtained in OS versus sunitinib. In cases that have an intermediate IMDC and poor prognosis, the combination of ipilimumab and nivolumab has demonstrated superior OS compared to sunitinib. As for individuals with advanced RCC previously treated with one or two antiangiogenic tyrosine-kinase inhibitors, nivolumab and cabozantinib are the options of choice. When there is progression following initial immunotherapy-based treatment, we recommend treatment with an antiangiogenic tyrosine-kinase inhibitor. While no clear sequence can be advocated, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in the setting of metastatic RC.

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Misconceptions about the brain (neuromyths) among educators have been found across different countries, but little has been done to dispel them. The present study assessed the effect of a one-year Science of Learning (SoL) course on neuroscience literacy and beliefs in neuromyths in a sample of Chilean pre-service teachers. An experimental group of pre-service teachers, who took the SoL course as part of their university training, and a control group were needed for the study. Participants in both groups completed an online survey three times during the year (beginning, middle and end of year). The results showed that participants in both groups responded correctly to most assertions but held major misconceptions about the brain (Time 1), in line with previous studies. Regarding neuroscience literacy, participants in the experimental and control groups did not differ significantly at Time 1, but the experimental group showed significantly better performance than the control group at Time 2 and Time 3. Unlike neuroscience literacy, the results in neuromyth beliefs did not differ significantly by group at Time 1 and Time 2; however, at Time 3, the experimental group showed a significant decline in neuromyth beliefs. Overall, these results suggest that the SoL course significantly improved overall neuroscience literacy and reduced neuromyth belief among pre-service teachers, but the effect of the intervention was small.

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Animal vocalizations convey important information about the emitter, including sex, age, biological quality, and emotional state. Early on, Darwin proposed that sex differences in auditory signals and vocalizations were driven by sexual selection mechanisms. In humans, studies on the association between male voice attributes and physical formidability have thus far reported mixed results. Hence, with a view to furthering our understanding of the role of human voice in advertising physical formidability, we sought to identify acoustic attributes of male voices associated with physical formidability proxies. Mean fundamental frequency (F 0), formant dispersion (D f ), formant position (P f ), and vocal tract length (VTL) data from a sample of 101 male voices was analyzed for potential associations with height, weight, and maximal handgrip strength (HGS). F 0 correlated negatively with HGS; P f showed negative correlations with HGS, height and weight, whereas VTL positively correlated with HGS, height and weight. All zero-order correlations remained significant after controlling for false discovery rate (FDR) with the Benjamini-Hochberg method. After controlling for height and weight-and controlling for FDR-the correlation between F 0 and HGS remained significant. In addition, to evaluate the ability of human male voices to advertise physical formidability to potential mates, 151 heterosexual female participants rated the voices of the 10 strongest and the 10 weakest males from the original sample for perceived physical strength, and given that physical strength is a desirable attribute in male partners, perceived attractiveness. Generalized linear mixed model analyses-which allow for generalization of inferences to other samples of both raters and targets-failed to support a significant association of perceived strength or attractiveness from voices alone and actual physical strength. These results add to the growing body of work on the role of human voices in conveying relevant biological information.

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Stevia (Stevia rebaudiana [Bertoni] Bertoni) is a perennial plant originating in Paraguay. Stevia is primarily cultivated for the production of non-caloric sweeteners. In December 2018, wilted stevia cv. 'PC4' were recovered from two separate fields of 0.3 ha (24.66 S 56.46 W) and 0.5 ha (24.69 S 56.44 W), both with 3 years history of stevia production in San Estanislao County, San Pedro, Paraguay. The wilted plants were randomly distributed in beds covered with plastic mulch and a 30% disease incidence was recorded. Dark brown septate hyphae and microsclerotia were observed on stem bases and black necrotic roots of the wilted plants. Root and crown regions were washed, cut into 0.5 to 1.0 cm pieces, and then surface-disinfested with 0.6% NaOCl before placing them in Petri dishes containing acidified potato-dextrose-agar. Plates were incubated for one week at 25 ± 5°C under fluorescent light with a 12 h photoperiod yielding five isolates SP1PY, SP2PY, SP3PY, SP4PY and SP5PY with gray-black colonies without conidia but showing numerous microsclerotia. Twenty microsclerotia from pure cultures of five isolates were measured, with mean width 38.8 ± 4.7 µm and length 68.8 ± 15.5 µm. Fungal DNA was extracted from mycelia of five isolates for PCR amplification of the internal transcribed spacer (ITS) and translation elongation factor 1-alpha (TEF1-α) using ITS4/ITS5 and EF1-728F/EF-2 primers (Machado et al. 2019). The resultant amplicons were sequenced at Eton Bioscience (Research Triangle Park, NC) and deposited in the NCBI GenBank database (ITS: MT645815, OM956150, OM956151, OM956152, OM956153; and TEF1-α: MT659121, OM959505, OM959506, OM959507, OM959508). Sequences were aligned with several isolates of Macrophomina spp. previously reported (Huda-Shakirah et al. 2019; Machado et al. 2019; Santos et al. 2020; Poudel et al. 2021) using ClustalW. Alignments (ITS and TEF-1α) were concatenated to generate a maximum likelihood tree using MEGA7. The novel isolates grouped into the M. euphorbiicola clade with 95% of bootstrap support. Stevia plants cv. 'Katupyry' were grown in 10 cm-diameter nursery bags containing autoclaved sandy soil and kept under greenhouse conditions (28 ± 5°C; 16 h photoperiod). Fifteen plants per isolate (n=75) were inoculated by adding 20 g of rice infested with M. euphorbiicola to each plant. Infested grains were distributed around the crown of the plant at a depth of 0.5 cm; non-infested rice was added to four control plants. Lower-stem lesions and microsclerotia of M. euphorbiicola developed on all inoculated plants. No lesions or microsclerotia were observed on control plants. The M. euphoribiicola fungus was re-isolated from inoculated stevia plants but not from the non-infested rice treated plants. Koch's postulates were repeated twice with similar results. Previously, M. phaseolina was reported causing charcoal rot on stevia in Egypt (Hilal and Baiuomy 2000), and in North Carolina, USA (Koehler and Shew 2017). However, Paraguayan isolates grouped with isolates of M. euphorbiicola based on the combined sequences of the ITS and TEF-1α regions. Machado et al. (2019) reported M. euphorbiicola causing charcoal rot on castor bean (Ricinus communis) and bellyache bush (Jatropha gossypifolia) in Brazil, which borders northeast Paraguay, a major stevia production area. This pathogen has a significant impact on stevia production during hot, dry weather by reducing the number of harvestable plants and increasing replanting costs in perennial production systems.

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PURPOSE: To review current measures for renal cancer care and develop a comprehensive and updated list of measures for their practical use in Spain. METHODS: The study was developed by Fundación ECO, a Spanish foundation aiming to improve oncology quality of care. A systematic literature review was carried out to identify measures and knowledge gaps. A scientific committee composed of nine experts reviewed the literature findings and added measures. A preliminary list of 42 measures was evaluated with the Delphi method to gather feedback from 47 medical oncology experts in Spain. Experts scored the appropriateness of the measures and ranked their priority in two consecutive online surveys. The scientific committee reviewed the Delphi results and developed the measures. A technical group from Universidad Francisco de Vitoria conducted and oversaw the Delphi method. RESULTS: The Delphi method led to consensus on all 42 measures. The scientific committee used a prioritisation matrix to select 25 of these measures for evaluating quality of care in renal cancer. These measures regarded structure, process, and outcome and covered general management, diagnosis, treatment, follow-up, and evaluation of health outcomes. Easy-to-use index cards were developed for all 25 measures, including their definition, formula, acceptable level of attainment, and rationale. CONCLUSIONS: This manuscript aims to provide healthcare professionals with expert- and evidence-based measures that are useful for evaluating quality of care in renal cancer in Spain and cover all aspects and stages.

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Introduction: Number sense has been systematically measured using dot comparison tasks. However, recent studies have reported that performance on dot comparison might be influenced inhibitory control and visual properties of dot arrays. In the present study, we analysed the influence of continuous magnitude, inhibitory control, and numerical ratio on the dot comparison performance of preschool children. Methods: Participants were 517 preschool children from 13 different schools in Chile. Children completed a dot comparison and two inhibitory control tasks. Gebuis and Reynvoet method was used to create well-controlled dot arrays for use in the dot comparison task. A logistic mixed effects model was conducted to predict participants' dot comparison accuracy. Continuous magnitude and ratio were entered as level-1 predictors and inhibitory control as level-2 predictors. Results: The results showed that all predictors made a significant contribution to dot comparison accuracy. Furthermore, a significant double interaction (inhibitory control x continuous magnitude) and a triple interaction (inhibitory control x continuous magnitude x ratio) showed that the contribution of inhibitory control skills in dot comparison accuracy depends on the continuous properties of dot arrays and ratio. Discussion: These findings suggest that preschool children rely more on continuous magnitudes than numerosity in dot comparison tasks. They also indicate that the greater children's inhibitory control, the more able they are to respond based on numerosity in fully incongruent trials, particularly when ratio is low (easiest items). Taken together, the above findings support the competing processes account provided that both ANS and inhibitory control skills influence performance on dot comparison tasks.

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Background: Traumatic brain injuries (TBI) are a leading cause of death and disability worldwide. Violence is the leading cause of mortality in Honduras. However, the incidence and impact of TBI in this low-middle income country (LMIC) is unknown. The aim of this study is to describe the epidemiology of TBI in Honduras, as captured by an injury surveillance tool in the country's major referral center. Methods: A cross sectional review of all TBI-related emergency department visits at the main referral hospital in Honduras from January to December 2013 was conducted. The calculation of descriptive statistics from Injury Surveillance System (InSS) data was performed. Results: Of 17,971 total injuries seen in 2013, 20% were traumatic brain injuries (n=3,588). The main mechanisms of injury were falls (41.11%), road traffic accidents (23.91%), blunt trauma (20.82%), penetrating knife injuries (5.85%), and firearm injuries (2.26%). Most TBI were classified as mild; 99.69% (Glasgow Coma Scale=15). Emergency room mortality was low (1.11%). The modified Kampala Trauma Score median was 8 (interquartile range 7-8). Conclusion: Mild TBI accounts for a significant percentage of all injuries presenting to a high-volume referral center in Honduras in 2013. Despite the high incidence of violence in this country, most TBI were accidental, secondary to road traffic accidents and falls. Further research is required with more recent data as well as with prospective data collection methods.

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Matrix metalloproteinases (MMPs) not only play a relevant role in homeostatic processes but are also involved in several pathological mechanisms associated with infectious diseases. As their clinical relevance in Chagas disease has recently been highlighted, we studied the modulation of circulating MMPs by Trypanosoma cruzi infection. We found that virulent parasites from Discrete Typing Units (DTU) VI induced higher proMMP-2 and MMP-2 activity in blood, whereas both low (DTU I) and high virulence parasites induced a significant decrease in proMMP-9 plasma activity. Moreover, trans-sialidase, a relevant T. cruzi virulence factor, is involved in MMP-2 activity modulation both in vivo and in vitro. It removes α2,3-linked sialyl residues from cell surface glycoconjugates, which then triggers the PKC/MEK/ERK signaling pathway. Additionally, bacterial sialidases specific for this sialyl residue linkage displayed similar MMP modulation profiles and triggered the same signaling pathways. This novel pathogenic mechanism, dependent on sialic acid removal by the neuraminidase activity of trans-sialidase, can be exploited by different pathogens expressing sialidases with similar specificity. Thus, here we present a new pathogen strategy through the regulation of the MMP network.

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Diversas técnicas convencionales han sido utilizadas con gran eficacia; sin embargo, la no aceptación de algunas de ellas por los padres, ciertos condicionamientos éticos y legales así como cambios en la educación actual y el avance en nuevas tecnologías, obligan al odontólogo a un replanteamiento de actitudes. Objetivo: El objetivo del presente trabajo es identificar qué técnicas alternativas son empleadas en la clínica dental por los profesionales para el manejo de la conducta de pacientes infantiles. Material y métodos: Se realizó un cuestionario en la plataforma de Google, remitido vía email a 190 odonto/estomatólogos que tratasen pacientes infantiles, obteniendo una participación de 132 encuestas adecuadas para el análisis de 6 técnicas alternativas de manejo de la conducta. El estudio estadístico se realizó en el programa SPSS aplicando el test de ANOVA para una significación de p= 0,05. Resultados: Un 35,1% de los encuestados utilizaban medios audiovisuales para el tratamiento dental, siendo la televisión el más frecuentemente empleado. La musicoterapia fue la técnica más utilizada (70,5% de los participantes) con mayor frecuencia del sexo femenino, aunque sin diferencias significativas, siendo la música moderna la de mayor aceptación. Un 32,8% utilizaron la ludoterapia como técnica de manejo seguida del empleo de técnicas de relajación con un 25%, ambas con mayor porcentaje femenino. Las dos técnicas menos utilizadas fueron la aromaterapia (6,8%) y la hipnosis (2,3%). Conclusiones: A pesar del incremento en la utilización de técnicas alternativas en el manejo de la conducta, todavía su empleo es escaso por los odonto/estomatólogos.

Várias técnicas convencionais têm sido usadas com grande eficácia; contudo, a não aceitação de algumas delas pelos pais, certas condições éticas e legais, assim como as mudanças na educação atual e o avanço das novas tecnologias, forçam o dentista a repensar as atitudes. Objetivo: O objetivo do presente estudo é identificar quais técnicas alternativas são utilizadas na clínica odontológica por profissionais para gerenciar o comportamento de pacientes infantis. Material e métodos: Foi realizado um questionário na plataforma Google, enviado por e-mail a 190 dentistas/stomatologistas que trataram crianças, obtendo 132 pesquisas adequadas para a análise de 6 técnicas alternativas de gestão comportamental. O estudo estatístico foi realizado no programa SPSS aplicando o teste ANOVA para uma significância de p= 0,05. Resultados: 35,1% dos inquiridos utilizaram meios audiovisuais para tratamento dentário, sendo a televisão a mais frequentemente utilizada. A musicoterapia foi a técnica mais utilizada (70,5% dos participantes) pelo sexo feminino, embora sem diferenças significativas, sendo a música moderna a mais amplamente aceita. 32,8% utilizaram a terapia lúdica como técnica de gestão seguida do uso de técnicas de relaxamento com 25%, ambas com uma percentagem maior de mulheres. As duas técnicas menos utilizadas foram a aromaterapia (6,8%) e a hipnose (2,3%). Conclusões: Apesar do aumento do uso de técnicas alternativas na gestão do comportamento, o seu uso ainda é escasso pelos odontologistas/estomatologistas.

Various conventional techniques have been used with great efficiency; nevertheless, the non-acceptance of some of them by the parents, certain ethical and legal conditions as well as changes in the current education and the advance in new technologies, force the dentist to a rethinking of attitudes. Aim: The aim of this paper is to identify what alternative techniques are used by professionals for the behavior's management of pediatric patients in the dental clinic. Material and methods: A questionnaire was carried out on the Google platform, sent via email to 190 odonto / stomatologists who treated pediatric patients, obtaining a participation of 132 appropriate surveys for the analysis of 6 alternative behavior management techniques. The statistical study was carried out in the SPSS program, applying the ANOVA test for a significance of p = 0.05. Results: 35.1% of respondents used audiovisual media for dental treatment, being television the most frequently used. Music therapy was the most applied technique (70.5% of the participants) with the highest frequency of female sex, without significant differences though, being modern music the most widely accepted. 32.8% used play therapy as a management technique followed by the use of relaxation techniques with 25%, both with a higher female percentage. The two least used techniques were aromatherapy (6.8%) and hypnosis (2.3%). Conclusions: Despite the increase in the use of alternative techniques in behavior management, their use is still scarce by dentists / stomatologists.

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