tbuckley/cabot-search huggingface dataset:
ME/CFS: Exercise goals should be set by patients and not driven by treatment plan, says NICE
Authors: Ingrid Torjesen
Journal: BMJ (2021)

Graded exercise therapy (GET) should no longer be used to treat patients with myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome (ME/CFS), says the National Institute for Health and Care Excellence in long awaited updated guidance.1

Patients may still be offered exercise programmes provided they are not based on fixed incremental increases in physical activity or exercise. Instead, programmes should be based around person centred energy management, which is a self-management strategy led by the patient with support from a healthcare professional in an ME/CFS specialist team, the guideline advises.

Energy management should consider all types of activity (cognitive, physical, emotional, and social) that help patients learn to use the amount of energy they have, while reducing their risk of post-exertional malaise or worsening their symptoms by exceeding their limits.

Cognitive behavioural therapy has sometimes been assumed to be a cure for ME/CFS, the guideline acknowledges. Now it should be offered only to help people manage their symptoms, improve their functioning, and reduce the distress associated with having a chronic illness.

The final 2021 guideline shows a real change of emphasis from the previous guideline published in 2007, which said that cognitive behavioural therapy …
Presurgical Somatostatin Analogue Versus Direct Surgery for Newly-Diagnosed Acromegaly Patients: A Systematic Review and Meta-Analysis, Assessing Clinical Evidence Using the GRADE System
Authors: Vania Santos Nunes, Julia Martins Simoes Correa, Maria Eduarda Silva Puga, Edina Mariko Koga Silva, Cesar Luiz Boguszewski
Journal: Endocrine Reviews (2014)
TCT-431 Alcohol Septal Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy: 17-Year Experience in Chile
Authors: Pabla Cataldo, Fernando Verdugo, Christian Dauvergne, Manuel Mendez, Fernando Pineda, Polentzi Uriarte, Jorge Sandoval Berrocal
Journal: Journal of the American College of Cardiology (2021)
Miscommunication About Low-Dose Aspirin for Preeclampsia Prevention—Further Support for Universal Prophylaxis
Authors: Adam K. Lewkowitz, Dwight J. Rouse
Journal: JAMA Network Open (2021)

Tamar Krishnamurti, PhD; Alexander L. Davis, PhD; Samantha Rodriguez, MS; Laila Hayani, MS; Miriam Bernard, BA; Hyagriv N. Simhan, MD
춘계학술대회 : 포스터발표 ; C형 간염에 의한 간경변증 환자에서 간암 표지자로서의 혈청 알파태아단백
Authors: 김경아, 박경일, 정은숙, 이준성, 양전호, 문영수
Journal: Clinical and Molecular Hepatology (2005)

배경: 혈청 알파 태아 단백은 만성 간질환자에서 간암 진단을 위한 표지자로 널리 이용되고 있다. 그러나, 검사의 민감도가 낮고, 간세포 손상이 심할 경우 특이도가 낮아지며 만성 간질환의 원인에 따라 진단적 의의가 달라질 수 있다. 우리나라에서는 B형 간염과 연관된 간암이 가장 많아 혈청 알파태아단백에 대한 연구는 대부분 B형 간염과 연관된 간질환을 대상으로 하고 있다. 본 연구에서는 C형 간염의 의한 간경변증 환자에서 혈청 알파태아단백의 간암 표지자로서
Does your dermatology classifier know what it doesn’t know? Detecting the long-tail of unseen conditions
Authors: Abhijit Guha Roy, Jie Ren, Shekoofeh Azizi, Aaron Loh, Vivek Natarajan, Basil Mustafa, Nick Pawlowski, Jan Freyberg, Yuan Liu, Zach Beaver, Nam Vo, Peggy Bui, Samantha Winter, Patricia MacWilliams, Greg S. Corrado, Umesh Telang, Yun Liu, Taylan Cemgil, Alan Karthikesalingam, Balaji Lakshminarayanan, Jim Winkens
Journal: Medical Image Analysis (2021)
Restoring activity in the thalamic reticular nucleus improves sleep architecture and reduces Aβ accumulation in mice
Authors: Rohan Jagirdar, Chia-Hsuan Fu, Jin Park, Brian F. Corbett, Frederik M. Seibt, Michael Beierlein, Jeannie Chin
Journal: Science Translational Medicine (2021)

Chemogenetic stimulation of the thalamic reticular nucleus increases slow-wave sleep and reduces Aβ accumulation in rodents.
An organoid-based screen for epigenetic inhibitors that stimulate antigen presentation and potentiate T-cell-mediated cytotoxicity
Authors: Zhuolong Zhou, Kevin Van der Jeught, Yuanzhang Fang, Tao Yu, Yujing Li, Zheng Ao, Sheng Liu, Lu Zhang, Yang Yang, Haniyeh Eyvani, Mary L. Cox, Xiyu Wang, Xiaoming He, Guang Ji, Bryan P. Schneider, Feng Guo, Jun Wan, Xinna Zhang, Xiongbin Lu
Journal: Nature Biomedical Engineering (2021)
Risk Factors for In-Hospital Mortality Among Patients Hospitalized with COVID-19 and ESKD
Authors: Jackson Heilbronn, Amir Abdi Pour, Giv Heidari-Bateni, Lida Gharibvand, Kwame B. Agyeman, Sahib D. Grewal, Mohammad Sharif, Sergio Infante, Mita Zahra E. Co, Sayna Norouzi
Journal: Journal of the American Society of Nephrology (2021)

Heilbronn, Jackson; Pour, Amir Abdi; Heidari-Bateni, Giv; Gharibvand, Lida; Agyeman, Kwame B.; Grewal, Sahib D.; Sharif, Mohammad; Infante, Sergio; Co, Mita Zahra E.; Norouzi, Sayna; Loma Linda Medical Center Author Information
Questions About a Risk Prediction Model of Mortality After Esophagectomy for Cancer
Authors: Zachary R. McCaw, Lee-Jen Wei
Journal: JAMA Surgery (2021)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
TCT-102 Assessing the Risk of Neo-Left Ventricular Outflow Tract Obstruction in Transcatheter Mitral Valve Replacement: Are We Treating All the Patients Who Can Be Treated?
Authors: Keshav Kohli, Yinghan Xu, Zhenglun Alan Wei, Tiffany Netto, Adam Greenbaum, Vasilis Babaliaros, Philipp Blanke, Ajit Yoganathan, John Oshinski
Journal: Journal of the American College of Cardiology (2021)
Perturbed NK-cell homeostasis associated with disease severity in chronic neutropenia
Authors: Ebba Sohlberg, Aline Pfefferle, Eivind Heggernes Ask, Astrid Tschan-Plessl, Benedikt Jacobs, Herman Netskar, Susanne Lorenz, Minoru Kanaya, Mizuha Kosugi-Kanaya, Stephan Meinke, Anette Mörtberg, Petter Höglund, Mikael Sundin, Göran Carlsson, Jan Palmblad, Karl-Johan Malmberg
Journal: Blood (2021)

Neutrophils have been thought to play a critical role in terminal differentiation of NK cells. Whether this effect is direct or a consequence of global immune changes with effects on NK-cell homeostasis remains unknown. In this study, we used high-resolution flow and mass cytometry to examine NK-cell repertoires in 64 patients with neutropenia and 27 healthy age- and sex-matched donors. A subgroup of patients with chronic neutropenia showed severely disrupted NK-cell homeostasis manifesting as increased frequencies of CD56bright NK cells and a lack of mature CD56dim NK cells. These immature NK-cell repertoires were characterized by expression of the proliferation/exhaustion markers Ki-67, Tim-3, and TIGIT and displayed blunted tumor target cell responses. Systems-level immune mapping revealed that the changes in immunophenotypes were confined to NK cells, leaving T-cell differentiation intact. RNA sequencing of NK cells from these patients showed upregulation of a network of genes, including TNFSF9, CENPF, MKI67, and TOP2A, associated with apoptosis and the cell cycle, but different from the conventional CD56bright signatures. Profiling of 249 plasma proteins showed a coordinated enrichment of pathways related to apoptosis and cell turnover, which correlated with immature NK-cell repertoires. Notably, most of these patients exhibited severe-grade neutropenia, suggesting that the profoundly altered NK-cell homeostasis was connected to the severity of their underlying etiology. Hence, although our data suggest that neutrophils are dispensable for NK-cell development and differentiation, some patients displayed a specific gap in the NK repertoire, associated with poor cytotoxic function and more severe disease manifestations.
Depressive Symptom Assessment in Medically Ill Patients
Authors: Steven R. Hahn
Journal: JAMA (2021)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Patient-Reported Testing Burden of Breast Magnetic Resonance Imaging Among Women With Ductal Carcinoma In Situ
Authors: Soudabeh Fazeli, Bradley S. Snyder, Ilana F. Gareen, Constance D. Lehman, Seema A. Khan, Justin Romanoff, Constantine A. Gatsonis, Kathy D. Miller, Joseph A. Sparano, Christopher E. Comstock, Lynne I. Wagner, Ruth C. Carlos
Journal: JAMA Network Open (2021)

<h3>Importance</h3> The use of magnetic resonance imaging (MRI) in pretreatment planning of ductal carcinoma in situ (DCIS) remains controversial. Understanding changes in short-term health-related quality of life associated with breast MRI would allow for a more complete comparative effectiveness assessment. <h3>Objective</h3> To assess whether there are changes in patient-reported quality of life associated with breast MRI among women diagnosed with DCIS. <h3>Design, Setting, and Participants</h3> This cohort study was a substudy of a nonrandomized clinical trial conducted at 75 participating US institutions from March 2015 to April 2016. Women recently diagnosed with unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. A total of 355 women met the eligibility criteria and underwent the study MRI. Data analysis was performed from June 3, 2020, to July 1, 2021. <h3>Exposures</h3> Participants underwent bilateral breast MRI within 30 days of study registration and before surgery. Information on patient-reported testing burden for breast MRI was collected after MRI and before surgery. <h3>Main Outcomes and Measures</h3> The primary outcome of this substudy was the patient-reported testing burden of breast MRI, measured by the Testing Morbidities Index (TMI) summated scale score. The TMI is a 7-item instrument that evaluates the temporary changes in quality of life associated with imaging before, during, and after the test (0 represents the worst possible, 100 the hypothetical ideal test experience). <h3>Results</h3> Of the 355 women who met the eligibility criteria, 244 (69%) completed both questionnaires and were included in this analysis. The median age was 59 years (range, 34-85 years). The mean MRI TMI summated scale score was 85.9 (95% CI, 84.6-87.3). Of the 244 women, 142 (58%) experienced at least some fear and anxiety before the examination, and 120 women (49%) experienced fear and anxiety during the examination. A total of 156 women (64%) experienced pain or discomfort during the examination. In multivariable analyses, greater test-related burden was associated with higher levels of cancer worry (regression coefficient, −2.75; SE, 0.94;<i>P</i> = .004). <h3>Conclusions and Relevance</h3> In this cohort study, a clinically meaningful breast MRI testing burden among women with DCIS was revealed that was significantly associated with cancer worry. Understanding the potential quality-of-life reduction associated with MRI, especially when used in combination with mammography, may allow development of targeted interventions to improve the patient experience.
Pembrolizumab (PEM) Added to ICE Chemotherapy Results in High Complete Metabolic Response Rates in Relapsed/Refractory Classic Hodgkin Lymphoma (cHL): A Multi-Institutional Phase II Trial
Authors: Locke J. Bryan, Carla Casulo, Pamela Allen, Scott E. Smith, Hatice Savas, Reem Karmali, Barbara Pro, Kaitlyn O'Shea, Joan Chmiel, Brett Alan Palmer, Jayesh Mehta, Leo I. Gordon, Jane N. Winter
Journal: Blood (2021)
CRTC3, a sensor and key regulator for melanogenesis, as a tunable therapeutic target for pigmentary disorders
Authors: Hanju Yoo, Ha-Ri Lee, Ki-Hyun Kim, Min-Ah Kim, Seunghyun Bang, Young-Ho Kang, Woo-Hyung Kim, Youngsup Song, Sung Eun Chang
Journal: Theranostics (2021)

Background: Although CREB phosphorylation is known to be essential in UVB/cAMP-stimulated melanogenesis, CREB null mice did not show identifiable pigmentation phenotypes. Here, we show that CREB-regulated transcription co-activator 3 (CRTC3) quantitatively regulates and orchestrates melanogenesis by directly targeting microphthalmia-associated transcription factor (MITF) and regulating the expression of most key melanogenesis-related genes. Methods: We analyzed CRTC3-null, KRT14-SCF transgenic, and their crossover mice. The molecular basis of CRTC3 effects on pigmentation was investigated by histology, melanin/tyrosinase assay, immunoblotting, shRNA, promoter assay, qRT-PCR, and subcellular localization. These analyses were carried out in primary cultured melanocytes, mouse cell lines, normal human cells, co-cultures, and ex vivo human skin. CRTC/CREB activity screening was performed to identify candidate agents for the regulation of melanogenesis. Results: The coat and skin color of CRTC3-null mice was paler due to a reduction in melanin deposition. Melanogenesis-related genes were reduced in CRTC3-deficient cultured melanocytes and tail skin of CRTC3-null mice. Notably, basal levels of MITF present in CRTC3-null mice were sufficient for melanocytic differentiation/survival. Thus CRTC3-null mice showed a comparable number of epidermal melanocytes compared to control mice. Stem cell factor (SCF) introduction by crossing with KRT14-SCF mice increased epidermal melanocytes and melanin deposition in control and CRTC3-null mice, but the skin color remained still light on the CRTC3-null background. Furthermore, we identified the therapeutic potential of altiratinib to inhibit melanogenesis in human melanocytes and human skin effectively and safely. Conclusion: CRTC3 appears to be a key sensor for melanogenesis and can be used as a reversible and tunable tool for selectively regulating melanogenesis without affecting melanocyte integrity. Thus, CRTC3 can also serve as a screening tool for the discovery of ideal melanogenesis-modulating small molecules.
Bernard Helmut “Ury” Baruch
Authors: Anne Baruch, John Baruch
Journal: BMJ (2021)

Bernard Helmut Baruch (“Ury”), who was of Jewish heritage, came to the UK with his family from Germany in 1930. He was dissuaded from studying classics by his parents, who feared for his career prospects. Instead he took medicine and was studying at Liverpool Medical School in 1940 when, with his brother, Walter (who became an anaesthetist), he was interned as an enemy alien and sent to Canada. On release he was sponsored to complete his medical training in Canada, …
Abstract 15048: Outcomes Following Left Atrial Appendage Occlusion in Patients With Cerebral Amyloid Angiopathy and Prior Intracerebral Hemorrhage
Authors: Majd A El-Harasis, Shiva P Ponamgi, Robert Ward, Stephen English, Christopher V Desimone, Jonathan Graff-Radford, Alejandro A Rabinstein, Thomas M Munger, Samuel Asirvatham, David R Holmes
Journal: Circulation (2019)

Introduction: Left atrial appendage occlusion (LAAO) is a method of preventing embolic strokes in patients with atrial fibrillation (AF), as an alternative to oral anticoagulation. This is an attra...
TCT-184 Diagnostic Concordance and Discordance Between Angiography-Based Quantitative Flow Ratio and Fractional Flow Reserve Derived From Computed Tomography in Complex Coronary Artery Disease
Authors: Hideyuki Kawashima, Norihiro Kogame, Masafumi Ono, Patrick Serruys, Yoshinobu Onuma
Journal: Journal of the American College of Cardiology (2021)
Trials Test Mushrooms and Herbs as Anti–COVID-19 Agents
Authors: Anita Slomski
Journal: JAMA (2021)

in frustration as desperate patients infected with the novel coronavirus tried one ineffective remedy after another."People were taking increasingly toxic drugs, and nothing was working," Shubov said in an interview.Missing from those early hit-or-miss therapeutics, however, were traditional medicines such as Chinese herbs and medicinal mushrooms.
Options for Endocrine-Refractory, Hormone Receptor–Positive Breast Cancer: Which Target and When?
Authors: Virginia F. Borges
Journal: Journal of Clinical Oncology (2021)

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
Treatment with an Allogeneic Leukemia-Derived Dendritic Cell Vaccine in AML Patients Shows MRD Conversion and Improved Survival
Authors: Arjan A. Van de Loosdrecht, Jacqueline Cloos, Eva Maria Wagner, Uwe Platzbecker, Tobias A. W. Holderried, Janine van Elssen, Aristoteles Giagounidis, Soren Lehmann, Hester van Zeeburg, Jeroen Rovers, Bjorn T. Gjertsen
Journal: Blood (2021)
Impact of COVID-19-Associated AKI on Subsequent Development of CKD
Authors: Muner Mohamed, Ashraf Dwal, Juan Carlos Q. Velez
Journal: Journal of the American Society of Nephrology (2021)

Background: There is paucity of data about post-hospital discharge kidney-related outcomes in individuals with COVID-19-associated acute kidney injury (CoV-AKI) during the pandemic. We hypothesized that patients who survive a hospital admission due to COVID-19 and AKI are at risk for acquiring residual chronic kidney disease (CKD) thereafter. Methods: We conducted a retrospective observational study examining records of patients hospitalized at Ochsner Medical Center over a 3-month period (March-May 2020) with COVID-19 and diagnosis of AKI by KDIGO. We examined the rate of full recovery of AKI (serum creatinine value back to within 10% of baseline or < 1.2 mg/dL) at 9 months post-hospital discharge. Factors associated with recovery were assessed. Results: Among 916 admissions due to COVID-19 within the study [220 (24%) to an intensive care unit], there were 226 (26%) cases of AKI, 98 of them (43%) with AKIrequiring dialysis (AKI-RRT). Patients with CoV-AKI had a median age of 67 (34-99) and 58% were men. Self-identified black race accounted for 65% of the cohort. Among those with CoV-AKI, there were 111 in-hospital deaths (49%). Of 115 patients with CoVAKI who were discharged alive, 9-month follow-up data were retrieved in 97 (missing data in 18). Full recovery of kidney function was achieved by 76 (78%). Among those who progressed to residual CKD, 11 (11%) patients were declared to have end-stage kidney disease (ESKD) requiring dialysis. Baseline CKD stages 3-5 was associated with lower rate of full renal recovery [23/76 (30%) vs. 14/23 (61%);RR: 2.01, p=0.004)]. Conclusions: Full recovery from CoV-AKI was observed in of those who remain alive post-hospital discharge. About 1/10th of patients with CoV-AKI reached ESKD at intermediate-term follow-up. Preexisting CKD is associated with lower rate of recovery in CoV-AKI. These data do not seem to suggest that CoV-AKI is associated with greater risk for development of CKD compared to other forms of in-hospital AKI.
CircRNF220, not its linear cognate gene RNF220, regulates cell growth and is associated with relapse in pediatric acute myeloid leukemia
Authors: Xiaodan Liu, Xiaoping Liu, Mansi Cai, Ailing Luo, Yingyi He, Sha Liu, Xiaohong Zhang, Xu Yang, Ling Xu, Hua Jiang
Journal: Molecular Cancer (2021)

Circular RNAs (circRNAs) constitute a family of transcripts with unique structures and have been confirmed to be critical in tumorigenesis and to be potential biomarkers or therapeutic targets. However, only a few circRNAs have been functionally characterized in pediatric acute myeloid leukemia (AML).Here, we investigated the expression pattern of circRNAs in pediatric AML using a circRNA microarray. The characteristics, potential diagnostic value, and prognostic significance of circRNF220 were evaluated. A series of functional experiments were performed to investigate the role of circRNF220 in primary pediatric AML cells. Then we investigated the aberrant transcriptional networks regulated by circRNF220 in primary AML cells by RNA-seq. Furthermore, biotin RNA pulldown assays were implemented to verify the relationship between circRNF220 and miR-30a.We identified a circRNA, circRNF220, which was specifically abundant in and accumulated in the peripheral blood and bone marrow of pediatric patients with AML. It could distinguish AML from ALL and other hematological malignancies with high sensitivity and specificity. Significantly, circRNF220 expression independently predicted prognosis, while high expression of circRNF220 was an unfavorable prognostic marker for relapse. Furthermore, we characterized the function of circRNF220 and found that circRNF220 knockdown specifically inhibited proliferation and promoted apoptosis in AML cell lines and primary cells. Mechanistically, circRNF220 may act as an endogenous sponge of miR-30a to sequester miR-30a and inhibit its activity, which increases the expression of its targets MYSM1 and IER2 and implicated in AML relapse.Collectively, these findings demonstrated that circRNF220 could be highly efficient and specific for the accurate diagnosis of pediatric AML, with implications for relapse prediction.
IL1RAP Pulls a Double Shift in the Cysteine Factory
Authors: Sang Jun Yoon, Gina M. DeNicola
Journal: Cancer Discovery (2021)

Abstract Summary: Anoikis is a critical barrier to cancer cell metastasis. In this issue of Cancer Discovery, Zhang and colleagues identify that IL1 receptor accessory protein suppresses anoikis in Ewing sarcoma by promoting both the activity of the system Xc− cystine/glutamate antiporter and cystathionine γ-lyase (CTH) transcription to sustain cysteine levels for reactive oxygen species detoxification. See related article by Zhang et al., p. 2884.
Detection of SARS-CoV-2 in Dialysis Effluent on a Peritoneal Dialysis Program in Mexico City: Four Cases
Authors: Diana P. Morales, Daniel Rodriguez, Elva Arellano Escalante, Andreé M. Tirado Hernández, Joaquin Gonzalez Monroy, Maria Guadalupe Suarez
Journal: Journal of the American Society of Nephrology (2021)

Morales, Diana P.; Rodriguez, Daniel; Escalante, Elva Arellano; Tirado Hernández, Andreé M.; Monroy, Joaquin Gonzalez; Suarez, Maria Guadalupe Author Information