The Cystic Fibrosis (CF) center in Roscoff (Brittany) has been involved in therapeutic education programs (TEP) since 2006 and took part in the pilot phase of the French quality improvement program (QIP) since 2011. The aim was to improve the nutritional status of children with cystic fibrosis aged 2-12 years old in order to optimize their health status as they enter adolescence.A multidisciplinary quality team was created in order to select and address a specific health problem among our pediatric population. Following analysis of yearly indicators for our CF center, our team chose to improve quality of care concerning nutritional status of children aged 2-12 years old. Factors influencing efficacy were studied, tools were developed to implement a new nutritional program, results were analyzed on a real-time basis.N = 34; 2014: N = 44). Each patient was followed up at every clinic visit, their BMI z-score was calculated to decide their nutritional risk and personalize their follow-up program consequently. Between 1/1/2012 and 31/12/2014, the mean BMI z-score of the open cohort improved from −0.49 to −0.22.Over the 3 year period, all patients from 2 years of age, were monitored with the new follow-up program . The follow-up program aimed at improving nutritional status for children aged 2-12 years old was successfully implemented and integrated into routine practice; it was therefore extended to all children with CF (1 month - 18 years) in our center. The relationship among professional and patients and parents was strengthened. The prognosis of Cystic Fibrosis (CF) patients is mainly related to their respiratory status. It is therefore vital to maintain the best possible respiratory function over time and especially during childhood to permit normal lung growth .The direct relationship between nutritional status at the age of 2 years and FEV1 at 6 years is well established among children with CF  publication highlighting the close correlation between a good nutritional status at 2 y and subsequent pulmonary function; a color-coded BMI chart to be updated at every visit using national BMI curves for girls and boys from Ministry of health  on whichPDSA3: Intensification of our follow up program according to the child’s BMI color category including number of clinic visits, dietitian visits, calorie-intake evaluations, stool fat analysis, prescription of nutritional supplements Fig. .Therapeutic patient education  was proposed to all patients and parents according to their needs and age group: for the 0-4 year-old group, the program for parents was finalized in 2011; for the 6-10 year-old group, the program for children and parents was created and implemented during the study period; for the 10-16 year-old group, the program has been implemented since 2010.We used a tool, the Ishikawa fishbone cause and effect diagram , to deteols Fig. :PDSA1: CDifficult cases in red zone were specifically reviewed at multidisciplinary staff meetings for analysis of individual causal factors (positive and negative) and discussion of the next step to be implemented. For all patients, psycho-social support by both team psychologist and social worker was offered and early discussion concerning NG tube feeding took place systematically with all families.Satisfaction among patients and parents was assessed using a paper survey given to the patient/parent at a clinic visit (75% responded).A visual display area (poster) was set-up in the out-patient and in–patient departments so that all the patients, families and professionals could be kept up to date on progress.Staphylococcus aureus) and 9% by Burkholderia cenocepacia or Inquilinus limosus.All pediatric patients aged 2-12 years old followed up at our centre (34 patients) were enrolled in January 2012. Each child coming to a clinic visit at or after their second birthday was subsequently enrolled. All children were kept in the program for 3 years even after their 12th birthday; therefore the cohort increased to a total of 44 patients by December 2014. One child was excluded after 1 year as he was accepted on lung and liver transplant list in another centre. All except one patient had pancreatic insufficiency, 44% were girls, 88% were diagnosed by new-born screening. Eighteen percent were colonized by Pseudomonas aeruginosa, 9% by MRSA (Methicillin resistant The mean BMI z-score of the open cohort of children (34 at the start and 44 at the end of the program) progressed from −0.49  in December 2011 (just before starting the program) to −0.22  in December 2014. Comparison of our entire pediatric group of patients (0-18 years) with the national median showed a progression in median BMI z-score for our center from −0.5 to −0.26 z-score over the 3 years whereas the national figures progressed from −0.32 to −0.28 z-score [The progression is also shown in the percentage and number of patients in each color category over the 3 years Fig. . MoreoveThis new follow-up program included increased number of clinic visits for patients in red and orange zones. These were difficult to achieve as our center is in a rural area making transportation a limiting factor. For this reason, the program was adjusted and simplified in 2013 with fewer clinic and dietitian visits and increased telephone contacts Fig. .Fig. 8SiSeven patients who were not improving their BMI z-score despite close follow-up – two were stable, five were deteriorating – were screened for other diagnoses related to nutritional status such as diabetes, coeliac disease and helicobacter infection , 9. EarlThe project was well received by all the professionals involved. For the first 18 months, the pilot team met very regularly to plan and discuss progress, prepare results and presentations. Over the following 18 months, meetings were more focused with often just 2 or 3 members . The study coordinator entered all the data from the patient clinic visit on a real time basis so results were available at each meeting.The multidisciplinary team received training on patient therapeutic education at a national training Institute. The majority had already received training prior to the program, the others received training throughout the program.Patients in red zone were presented more frequently at the weekly multidisciplinary staff meetings for input by all members. Outcome of discussions was entered into their files.The quality improvement program was presented once to the hospital management/administration, twice to the multidisciplinary team, and was selected as a subject for examination by the external health authorities audit team as an example of our hospital’s improved quality of care.Patients and parents were very involved in the program and motivated to improve their position on the colored BMI curve. The patient therapeutic education program (6-10y) developed during this period was rapidly applied and was a support to the program.The process, program and results were displayed in both out-patient and In-patient Departments so all patients and parents had a simple visual summary of the program with update on results.Satisfaction among patients and parents was assessed using a paper survey given to the patient/parent at a clinic visit (75% responded): results showed that 75% were very satisfied overall especially concerning individual folder with calorie sheet (70%), information given about the program (66%), and concerning intensified follow-up of children in orange/red zones .The presentation of our work at French PHARE-M training sessions and post training sessions allowed us to share our tools, process of care and results with the other teams involved in the QI program. The tools were put on the PHARE-M website and were used by teams in other centers wishing to improve their patient BMI z-score.We took the opportunity to present our work at 2 ECFS Conferences and were selected in 2012 and 2015 for the poster session. Moreover, the pediatrician was invited to present the program at the European quality management training course held in 2015 and 2016 in the form of video sequences to illustrate the steps of the method: 5 point analysis - selection of global aim – PDSA cycles and results .CF center Roscoff succeeded in improving the nutritional status of young children with CF thereby also maintaining good respiratory function and thus giving them a better start into adolescent and adult life. We did not achieve our initial target (median: 0 z-score) but did improve the nutritional status over the 3 year period. Comparison of our entire pediatric group of patients (0-18 years) with the national median showed a progression in median BMI z-score for our center from −0.5 to −0.26 z-score over the 3 years whereas the national figures progressed from −0.32 to −0.28 z-score [Patient education played an important role in the program allowing parents and children to acquire skills and autonomy. Intensification of follow-up according to the “at risk” status of the child was instrumental and systematic screening for coeliac disease, early diabetes and helicobacter infection was implemented to identify individual causes of poor weight gain. The dietitian’s involvement was a key-role as her time was increased in order to see more children at clinic visits, to analyze calorie-intake, carry out education sessions, coordinate with the multidisciplinary team, enter data according to color zone and design new educational tools. The cohesion of the team around the physician leader ensured consistency of actions and was even enhanced throughout the project.C. McDonald  describeOur experience with 2-12 year-old patients and their families show that nutritional outcome can be optimized through close follow-up including patient and family education along a “pathway” during childhood . In CF, The cohort was heterogeneous including for example “tall thin family-pattern” children who had excellent growth in height following a curve at +2 or +3 SD with good weight gain following a median curve, good bone and lean body mass index but had however a BMI in the orange/red zone. The data for these patients explains the wide range of SD in our final results. In fact, only once these children’s growth in height flattened off at the end of puberty did we see an improvement in BMI z-score  but still in orange or red zones or presenting signs and symptoms of persistent fat-malabsorption, we combined use of 2 different pancreatic enzymes, active at different PH s  thus at different zones in the gastrointestinal tract, without increasing the total dose in order to maximize fat absorption. Our hypothesis is that it is probable that not all patients achieve a PH at 7 in the duodenum due to dysfunctional bile salt secretion in CF. For 46% of patients for whom a mix of the 2 types of pancreatic enzymes was prescribed, we noted a substantial improvement in BMI z-score (average + 0.7) within the following 12 months. This impact could lead to a further research study.The program continues after 2014 as new techniques and new-change ideas continue to be implemented.Performing continuous glucose monitoring led to early intervention with insulin therapy  following diagnosis of significant glucose intolerance or early diabetes Fig. . This moChildren’s technique for spirometry test was often quite deficient with inconsistent results depending on the child’s motivation that day. For this reason a specific module was created in the patient therapeutic program to prepare 5 year old children for the first test with the physiotherapist assisting at the examination to ensure the best possible technique. Subsequently lung function evaluation included LCI (lung clearance index) performed yearly as this test is much less dependent on technique/motivation to obtain realistic results.The team followed the framework proposed by PHARE-M; there was good cohesion and implementation as all professionals were kept up to date in the program. The follow-up indicators were updated at each visit on a real-time excel chart which motivated all actors to encourage the best possible results for their patients. The team experienced some difficulties in maintaining regular meetings which were sometimes replaced by smaller more focused discussions.We have demonstrated that the program is easily integrated into normal clinical practice and has been extended to all pediatric patients (1 month - 18 years old) as of 1/2015. This patient – centered process including individual patient therapeutic education and individual goals helped maintain the dynamic of care which continues up to now.


BCR-ABL1 fusion transcripts is necessary for the genetic confirmation of a chronic myeloid leukemia diagnosis and for the risk classification of acute lymphoblastic leukemia. BCR-ABL1 mRNAs are usually identified using a conventional RT-PCR technique according to the BIOMED-1 method. In this study, we evaluated 122 BCR-ABL1-positive samples with the Q-LAMP assay to establish if this technology may represent a valid alternative to the qualitative BIOMED-1 PCR technique usually employed for the detection and the discrimination of the common BCR-ABL1 transcripts (p190 and p210 isoforms). We found a 100% concordance rate between the two methods. Specifically, the p190- and p210-positive samples were amplified by Q-LAMP with a median threshold time (Tt) of 26.70 min (range: 24.45–31.80 min) and 20.26 min (range: 15.25-34.57 min), respectively. A median time of 19.63 was observed in samples displaying both (e13a2/e14a2) p210 isoforms. Moreover, the Q-LAMP assay allowed recognition of the BCR-ABL1 e13a2 and e14a2 isoforms . Finally, 20 samples harboring rare BCR-ABL1 isoforms  were correctly identified by the Q-LAMP assay. We conclude that the Q-LAMP assay may represent a faster and valid alternative to the qualitative BIOMED-1 RT-PCR for the diagnosis at BCR-ABL1-positive leukemias, especially when samples are analyzed in centers with restricted resources and/or limited technical expertise.Molecular detection of the  The Philadelphia (Ph) chromosome is the first cytogenetic marker associated with a malignant neoplasia as it is present in 95% of chronic myeloid leukemia (CML) cases, in 3-5% of pediatric acute lymphoblastic leukemia (ALL), and in 15%–20% of adult ALL [ABL1 oncogene juxtaposed to the breakpoint cluster region (BCR) gene on chromosome 22 [BCR-ABL1 chimeric gene encoding for an oncoprotein with constitutive tyrosine kinase (TK) activity that alters the proliferation rates, survival signaling, immunological interactions, and cytoskeleton dynamics of hematopoietic stem cells [BCR gene is most frequently located downstream of exon 13 or exon 14 , in the major cluster region (M-BCR), while the most common breakpoint in the ABL1 gene is upstream of exon 2 (a2). These breakpoints lead to the e13a2 or e14a2 BCR-ABL1 rearrangements, which encode for a 210 kDa protein called p210. In about 75% of BCR-ABL1-positive ALL, but <1% of CML patients, the breakpoint in BCR occurs between exons 1 and 2 in the microcluster region (µ-BCR), generating the e1a2 mRNA fusion that is translated into the p190 oncoprotein. In about 2–3% of CML patients, a breakpoint downstream of BCR exon 19 results in an e19a2 fusion transcript that gives rise to a 230 kDa protein (p230). Other infrequent breakpoints involve BCR exons 6 or 8 (e6a2 or e8a2) or ABL1 exon 3 (e13a3 or e14a3) [The Ph chromosome is generated by a reciprocal translocation between the long arms of chromosomes 9 and 22 t q34;q11) with the ;q11 withem cells ,6,7,8,9.r e14a3) ,13,14.BCR-ABL1-positive patients [Several studies have investigated whether the quantity or quality of the transcript type may influence the outcome of patients ,17,18,19patients ,20. Indepatients . Moreovepatients ,16,17.BCR-ABL1 transcripts is routinely performed to confirm a CML or ALL diagnosis and allow the timely assignment of an appropriate treatment regimen for each patient [Currently, identification of  patient ,22,23,24BCR-ABL1 transcripts. With the introduction of real-time quantitative polymerase chain reaction (RT-qPCR), serial measurements of BCR-ABL1 mRNA can be performed to monitor patient outcomes and, if necessary, reassess the assigned therapy. The methodology used to identify the BCR-ABL1 fusion has evolved over the years. The most common molecular diagnostic method is based on a conventional RT-PCR following the BIOMED-1 protocol, a multistep procedure that identifies the translocations and defines the breakpoints [In the last 15 years, several qualitative and quantitative molecular techniques have been developed to identify and measure akpoints .BCR-ABL1-positive leukemias may improve patient management and should ideally be feasible in clinical laboratories located outside of a specialized center, such as small hospitals or laboratories in developing countries.An easier and faster molecular assay for The loop-mediated isothermal amplification (LAMP) technology is a non-PCR-based nucleic acid amplification method that rapidly amplifies DNA or RNA targets under isothermal conditions. LAMP is performed using a strand-displacement polymerase and does not require Taq DNA polymerase or thermal cycling . The potBCR-ABL1 transcripts in Ph-positive leukemia patients. Moreover, we investigate if the Q-LAMP method is potentially able to detect rare BCR-ABL1 isoforms.In this study, we evaluate if the Q-LAMP technology may represent a valid alternative to the BIOMED-1 PCR method for the detection and the discrimination of the common BCR-ABL1-positive samples (102 positive for p210 and 30 for p190) and 50 negative samples , as previously described by Salmoiraghi et al. [GUSß control gene with a median Tt of 41.94 min (range: 38.03–51.77)  C. p < 0.001). A median time of 19.63 was observed in samples expressing both p210 isoforms (e13a2/e14a2) (p = 0.1332)   and then compared their Tts . Interes2/e14a2) . This va 0.1332) A. On the< 0.001) A. In ord< 0.001) B. BCR-ABL1 rearrangements that involve fusion of alternative exons, insertions, or breakpoints within exons such as e19a2 (the most common rearrangement), e8a2, e13a3, e14a3, e1a3, and e6a2. Approximately 5% of all CML or ALL patients are diagnosed with rare BCR-ABL1 isoforms   . Although e19a2) , probablh e19a2) .BCR-ABL1 transcripts within 50 min. The assay amplifies these different targets, including the endogenous internal control GUSβ gene [BCR-ABL1-negative cell lines [Q-LAMP is a qualitative assay for the detection and the discrimination of chromosomal translocations performing simultaneous RNA reverse transcription and DNA amplification. Previously published data generated from serial dilutions of RNA derived from ALL or CML cell lines (TOM-1 or K-562) demonstrated that the Q-LAMP assay detected and discriminated the p190 (e1a2) and p210 (e13a2 and e14a2) USβ gene , in a sill lines .BCR-ABL1-positive and 50 negative samples using the Q-LAMP assay. In our analysis, the Q-LAMP showed complete concordance with the BIOMED-1 PCR with a significantly lower time-to-results ratio, allowing the identification of BCR-ABL1-positive patients in about 30 min . A recent study by Baccarani et al. reported that the percentage of patients co-expressing both e13a2 and e14a2 isoforms ranges between 1.1% and 26.9% [The molecular detection of  and ALL . In the  and ALL ,35. Diff and ALL ,15,16,19 and ALL ,37. Thernd 26.9% . We founnd 26.9% . BCR-ABL1 rearrangement. Although the purpose of the Q-LAMP assay is the detection and discrimination of the most common BCR-ABL1 transcripts, the primer sets have been improved in order to potentially detect rare oncogenic isoforms. In this study, we observed 100% concordance rates between the Q-LAMP and the standard BIOMED-1 method when analyzing infrequent isoforms. We hypothesize that the observed delay in term of Tt of these rare isoforms might be due to the presence of additional exons, which encode for longer transcripts. Based on the results of our study, Q-LAMP might represent a valid option for the reliable and rapid detection of rare BCR-ABL1 fusion. However, further studies on larger populations should be performed in order to confirm our findings.Approximately 5% of Ph-positive patients are diagnosed with rare In conclusion, the Q-LAMP assay satisfies all the safety requirements of a validated diagnostic test coupled with being a straightforward technical approach, thanks to the pre-assembled lyophilized reagents and a one-step procedure that limits the risks of errors and optimizes laboratory workflow. This closed-tube format could easily be adopted in non-highly specialized centers for an effective diagnosis of Philadelphia-positive leukemias.BCR-ABL1 variant may be included in the calculation of baseline risk scores, it is possible to envision a scenario in which rapid and accurate determination of the BCR-ABL1 transcript will aid physicians in defining which patients will achieve greater benefit from the different available TKIs.As an increasing number of manuscripts ,15,16,19Bone marrow (BM) and peripheral blood (PB) samples were collected from 142 patients with newly diagnosed chronic phase CML and Philadelphia-positive ALL. Patients were followed in four Centers: Laboratorio di Medicina Interna ad Indirizzo Ematologico, Azienda Ospedaliera Universitaria San Luigi Gonzaga (Turin); Laboratorio di Ematologia Oncologica, Ceinge-Biotecnologie Avanzate, Università di Napoli “Federico II” (Naples); Centro di Oncologia ed Ematologia Sperimentale, Azienda Ospedaliera Universitaria “Policlinico-Vittorio Emanuele” (Catania), and the Molecular Biology Unit, University Hospital La Fe .BCR-ABL1-negative patients and 26 from healthy donors. The samples were collected from January 2016 to May 2019 and were retrospectively analyzed based on the results previously obtained with the BIOMED-1 protocol . The totInformed consent was obtained from each subject, and all procedures were performed in accordance with the Helsinki Declaration and subsequent revisions.Total RNA was extracted from PB or BM polymorphonuclear cells collected in EDTA or sodium citrate, using different methods: phenol–chloroform (N = 7), RNeasy Mini Kit, QIAGEN (N = 50), QIAsymphony, QIAGEN (N = 72), and Maxwell 16 LEV simplyRNA Kit, Promega (N = 63), according to the respective manufacturers’ instructions.Purified total RNA was quantified with a spectrophotometer  at wavelengths of 230, 260, and 280 nm. RNA integrity was then verified by running samples on 1.2% denaturing agarose gels. Total RNA samples were stored at −20 or −80 °C until their use.GUSß) that is amplified as an internal control in the same tube of the target reaction to check for the real absence of the translocation or for artifacts such as RNA degradation, reaction inhibition, or technical failure. The fluorescent signals can be monitored in real time onto the dedicated instrument LIAISON® IAM  that provides results within 60 min. At time zero, the reaction excited with appropriate wavelength UV light emits maximum fluorescence. As a consequence of the amplification, fluorescence decreases exponentially thanks to the natural quenching effect of newly synthetized amplicons  and p210  fusion transcripts in a single one-step reaction with pre-assembled lyophilized reagents (The reagents B.GUSß gene), and a no template control (nuclease-free water). During the amplification, BCR-ABL1 samples positive for p190 generate a signal in the 500 nm channel, while samples positive for p210 generate a signal in the 570 nm channel. All BCR-ABL1-negative samples were confirmed from the amplification of the GUSß control gene that produces a signal in the 530 nm channel (GUSß gene was not amplified in BCR-ABL1 p190 (e1a2) or p210  samples, due to the preferential amplification of the oncogenic isoforms. On the contrary, samples harboring the rare BCR-ABL1 p190 (e1a3) or p210  isoforms were amplified at a later time, with a positive signal for the GUSß control gene.A total of 500 ng of RNA was used for each sample in a final reaction volume of 25 μL. The assay was performed following the manufacturer’s instructions  and each analytical session included a p190/p210 double-positive control, a negative control (positive for the housekeeping  channel C. The hoAll results were expressed as threshold time (Tt) in minutes, defined as the minute at which the sample fluorescence reaches 50% of quenching .www.graphpad.com).Threshold times of the three different p210 isoform groups  were compared using the Kruskal–Wallis test followed by Dunnett’s multiple comparisons. The variance of the groups was calculated with the Bartlett test and the data distribution with the Kolmogorov–Smirnov test. The receiver operating characteristic (ROC) approach was applied to identify a possible cutoff in terms of Tt between carriers of different isoforms of the p210 fusion gene. Sensitivity and specificity were calculated, and the curve and the area under the curve (AUC) were defined. All analyses were performed using GraphPad Prism version 8.1.1 for Windows (GraphPad Software, La Jolla California USA,


Didactic lectures remain fundamental in academic medicine; however, many faculty physicians do not receive formal training in instructional delivery. In order to design a program to instill and enhance lecture skills in academic emergency medicine (EM) physicians we must first understand the gap between the current and ideal states.In 2012 the Council of Emergency Medicine Residency Directors (CORD) Academy for Scholarship designed a novel coaching program to improve teaching skills and foster career development for medical educators based on literature review and known teaching observation programs. In order to inform the refinement of the program, we performed a needs assessment of participants. Participants’ needs and prior teaching experiences were gathered from self-reflection forms completed prior to engaging in the coaching program. Two independent reviewers qualitatively analyzed data using a thematic approach.We analyzed data from 12 self-reflection forms. Thematic saturation was reached after nine forms. Overall inter-rater agreement was 91.5%. We categorized emerging themes into three domains: participant strengths and weaknesses; prior feedback with attempts to improve; and areas of desired mentorship. Several overlapping themes and subthemes emerged including factors pertaining to the lecturer, the audience/learner, and the content/delivery.This study identified several areas of need from EM educators regarding lecture skills. These results may inform faculty development efforts in this area. The authors employed a three-phase, novel, national coaching program to meet these needs. Despite multiple changes in medical education in recent years, didactic lectures remain a fundamental modality for instruction in academic medicine.9Coaching has been described as a learner-centered method of evaluating performance, clarifying the meaning of outcomes and identifying strategies for success, with the ultimate goal of fostering insight and life-long learning skills.18The Council of Emergency Medicine Residency Directors (CORD) sought to create a novel, national, faculty peer-coaching program to improve lecture skills and foster career development. The program was purposefully developed to take advantage of existing educational theories, including experiential learning, reflective learning, and deliberate practice.We conducted a needs assessment of EM educators participating in the CORD Academy for Scholarship Coaching Program. The program was made available to all CORD members presenting at national meetings. Prior to participation, presenters completed a self-assessment form regarding their teaching experience and areas of desired mentorship . ResponsAnalysis continued until thematic saturation was achieved, defined as no additional emerging themes.We analyzed data from 12 available self-reflection forms. Thematic saturation was reached after nine forms; however, we analyzed an additional three forms to ensure that no additional important themes were missed. Inter-rater agreement was 91.5%.Regarding strengths and weaknesses, as well as effective and ineffective teaching behaviors, three themes  emerged. These themes were further broken down into 10 subthemes . GeneralMany presenters (7/12) had received positive feedback in the past. It is important to note that several commented on how they were motivated to improve and strive for excellence despite receiving this positive feedback. This sentiment is captured in the following statement:This year, I won the New Speaker’s Forum at AAEM [American Academy of Emergency Medicine] and the Rising Star Award at ACEP [American College of Emergency Physicians]…However, I really do feel like there is room for improvement.Themes for improvement were in line with what presenters had previously identified as weaknesses or ineffective teaching behaviors . RegardiRegarding desired mentorship, the majority (9/12) sought assistance in improving specific teaching skills. Multiple themes emerged that were congruent with identified weaknesses . The mosI’ve given around a dozen or so national talks….I am looking for that ‘next level’ of improvement…I think I’m at the stage of being an ‘average national speaker’ and want to get to that ‘great speaker’ stage.In this study, EM educators identified multiple areas of need regarding lecture skills that were categorized into three major themes , which can be used as a framework and organizational strategy for faculty development programs in this area. Within these major themes, multiple subthemes were identified. These subthemes can serve as specific areas for skill development. Several participants remarked on their desire for excellence, hoping to distinguish themselves nationally and improve their skills. This attitude lends itself well to the coaching model in which the goal is to help one achieve his/her personal best rather than a certain level of competency. Another interesting theme was self-perception. Several participants commented on the anxiety they experienced when lecturing and their lack of confidence. This highlights that psychological factors may have an impact on teaching ability. This is another opportunity where coaching can have a meaningful impact.Based on the results of this study, the authors employed a three-phase coaching program to enhance teaching skills for medical educators involved in national speaking engagements:Pre-observation phase: The pre-observation phase serves as an opportunity for goal-setting and delineation of expectations for the presenter, coach, and the program. Presenters will complete a structured self-reflection form focusing on previous teaching experiences, feedback, and desired goals. In doing so, presenters engage in reflective practice and learning, setting the stage to build from previous experiences. Reflection has been shown in prior literature to have multiple benefits in medical education including increased learning, engagement, and comfort with difficult material.Observation phase: The observation phase is directed at data collection. The trained coach critically observes the teaching session, attending to specific needs described in this study. Data can be collected as written observations, pictures, videos, or audio recordings. Significant emphasis should be placed upon documenting specific examples. Coaches need to be inconspicuous during their observation to assure that they are not affecting the delivery of the session.Post-Observation phase: This phase consists of a debriefing session where the coach leads a discussion of the opportunities for improvement, framed within the major themes highlighted in this study. The coach targets specific, desired skill areas outlined by the subthemes elucidated and by individual participant needs identified in the pre-observation session. This meeting should be reasonably proximate to the teaching session to minimize the impact of diminished recall. The coach should analyze his/her notes and develop formative themes before the debriefing. When leading this discussion, the coach should use multiple examples, allowing the feedback to be maximally meaningful and relevant.The field of medicine embraces lifelong learning, and physician educators should strive to go beyond competency and achieve excellence. Coaching has the potential to be a valuable tool in faculty development for physicians at all stages of their careers. This novel, multi-institution, national faculty coaching program for lecture skills can address the perceived needs of EM physician educators.This was an exploratory, qualitative needs assessment and the findings must be interpreted through that lens. The sample size was small and consisted of EM educators who desired coaching to improve their lecture skills; thus, the results may not be generalizable. Additionally, while thematic saturation was achieved, it is possible that important information was not captured in the analysis. Despite these limitations, the findings of this study may serve as an important foundation from which to build upon for how to improve the lecture skills of physician educators. Future, well-designed research studies evaluating objective outcomes of the program, such as lecture evaluations, number of invited speaking engagements, audience engagement, benefits to coach and presenter, and impact on professional development, are needed.This study identified several areas of need from EM educators regarding lecture skills including factors pertaining to the lecturer, the audience or learner, and the content and delivery. These results may inform faculty development efforts in this area. The authors support a three-phase, novel, national coaching program to meet these needs.


In Nigeria, diarrhea is the second leading killer of children under five. Between 2012-2017, the Clinton Health Access Initiative, Inc. (CHAI) and the Government of Nigeria implemented a comprehensive program in eight states aimed at increasing the percentage of children under five with diarrhea who were treated with zinc and oral rehydration solution (ORS). The program addressed demand, supply, and policy barriers to ORS and zinc uptake through interventions in both public and private sectors. The interventions included: (1) policy revision and partner coordination; (2) market shaping to improve availability of affordable, high-quality ORS and zinc; (3) provider training and mentoring; and (4) caregiver demand generation.We conducted cross–sectional household surveys in program states at baseline, midline, and endline and constructed logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period.In descriptive analysis, we found 38% (95% CI = 34%-42%) received ORS at baseline and 4% (95% CI = 3%-5%) received both ORS and zinc. At endline, we found 55% (95% CI = 51%-58%) received ORS and 30% (95% CI = 27%-33%) received both ORS and zinc. Adjusting for other covariates, the odds of diarrhea being treated with ORS were 1.88  times greater at endline. The odds of diarrhea being treated with ORS and zinc combined were 15.14  times greater at endline. When we include the interaction term to investigate whether the odds ratios between the endline and baseline survey were modified by source of care, we found statistically significant results among diarrhea episodes that sought care in the public and private sector. Among cases that sought care in the public sector, the predictive probability of treatment with ORS increased from 57% (95% CI = 50%-65%) to 83% (95% CI = 79%-87%). Among cases that sought care in the private sector, the predictive probability increased from 41% (95% CI = 34%-48%) to 58% (95% CI = 54%-63%).Use of ORS and combined ORS and zinc for treatment of diarrhea significantly increased in program states during the program period. Essential Childhood Medicines Scale-up Plan: 2012-2015, the country’s first ever national roadmap for reducing child mortality by increasing access to life-saving treatments—including zinc and ORS [Essential Childhood Medicines Scale-up Plan. This program included interventions to ensure widespread availability and affordability of optimal ORS and zinc products, strengthen diagnosis and treatment practices of public and private providers, and generate demand amongst caregivers of children. The program was focused in eight states – Bauchi, Cross River, Lagos, Kaduna, Kano, Katsina, Niger, and Rivers [In Nigeria, diarrhea is the second leading killer of children under the age of five. In 2011, nearly 90 000 children under five died from diarrhea . In 2004d Rivers .The program approach aimed to address demand, supply, and policy barriers to ORS and zinc uptake in both public and private sectors. The interventions were categorized into four major areas: (1) policy revision and partner coordination; (2) market shaping to improve availability of affordable, high-quality ORS and zinc; (3) provider training and mentoring; and (4) caregiver demand generation. In Table S1 in Essential Childhood Medicines Scale-up Plan and to align and coordinate key stakeholders around the scale-up plan and updates to national treatment policies. By 2014, the NEMCM partners supported government efforts to revise to the national treatment guideline to recommend ORS and zinc for childhood diarrhea, add zinc to the national and state Essential Medicines Lists (EML), and broadly communicated the policy allowing zinc to be available over-the-counter. The NEMCM also conducted a partner mapping exercise to identify investments by non-governmental stakeholders and coordinated those investments to expand the reach of program implementation to reach underserved areas. For example, the Sustaining Health Outcomes through the Private Sector (SHOPS) program selected Benue and Kebbi state for additional investments in ORS and zinc scale-up based on the partner mapping exercise [For policy revision and partner coordination, the program partnered with the FMOH, NPHCDA, and state Ministries of Health to establish coordination mechanisms at national and state levels. Led by the government, the National Essential Medicines Coordinating Mechanism (NEMCM) consisted of various government departments, private industry, and non-governmental partner organizations . The aimexercise .For market shaping, the program engaged local manufacturers to encourage investments in production, promotion, and sales of optimal zinc and ORS products— including zinc dispersible tablets (DT), the WHO-recommended low-osmolarity ORS formulation, and co-packaged ORS and zinc. Market intelligence on Nigeria’s demand and planned orders was provided to suppliers through regular forums and reports. In addition, suppliers received one-on-one technical assistance on product registration, cost reduction, marketing, and product and packaging optimization strategies. This support led to the introduction of four new low-osmolarity ORS, six zinc DT, and seven co-packaged ORS and zinc products into the Nigerian market. Beyond the technical support to local suppliers, the program worked with Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC) to encourage suppliers to switch to a low-osmolarity ORS formulation. Prior to the program, 21 different ORS products were already available in the Nigerian market, though there was only one low-osmolarity ORS registered in the country, no zinc DT, and no co-packs. By the end of the program, there were 35 low-osmolarity ORS, 12 zinc DT, and 10 co-packs registered with NAFDAC. Furthermore, the program worked along the entire private-sector supply chain in Nigeria to expand the reach of ORS and zinc in rural areas. The program used innovative private sector strategies and streamlined distribution models targeting wholesalers, sub-distributors, and retailers. For example, the program placed brand-agnostic marketers at wholesale outlets to distribute educational materials and encourage private retailers patronizing wholesale outlets to stock ORS and zinc. The market shaping activities in the private sector led to a large increase in ORS and zinc sales by major ORS and zinc suppliers in Nigeria. The program also supported the state governments to optimize planning and procurement of ORS and zinc, including introduction of an ORS and zinc co-pack, into public facilities. The program provided technical assistance to quantify ORS and zinc demand in public facilities and advocated for inclusion of these commodities in the state procurement budgets. Additionally, the program worked with state drug management agencies to include ORS and zinc in the state drug revolving funds (DRFs) and negotiated reduced prices. By the end of the program, we observed an increasing preference by state governments for procuring co-packs. As shown in The program aimed to switch the practices of health care providers to use ORS and zinc for treatment of pediatric diarrhea through multiple interventions. The program implemented targeted activities in the public and private sector. First the program conducted diarrhea management trainings with leaders of health worker professional groups, such as the Nigerian Medical Association (NMA), Pharmaceutical Society of Nigeria (PSN), National Association of Nigerian Nurses and Midwives (NANNM), and National Association of Proprietary Patent Medicine Vendors (NAPPMED) to secure buy-in. The program subsequently rolled out state-level trainings to nearly 20 000 health care providers in the public sector. In the private sector, the program partnered with the NAPPMED and the Pharmacists Council of Nigeria (PCN) to conduct state-level trainings to nearly 19 000 patent and proprietary medicine vendors (PPMVs). Following up on the state-level trainings, the program worked with existing government supervisory structures to provide individual mentorship of public health care workers on diarrhea case management. Similarly, in the private sector, the program worked with NAPPMED and PCN to conduct shop-to-shop detailing with their network of PPMVs and pharmacists.The fourth area of intervention was to directly reach caregivers and encourage them to seek care early and provide them with education on ORS and zinc. The program worked with key influencers in the community, such as religious leaders, female vanguard associations, Islamiyah schools, and local health care workers, to incorporate messages in their communication platforms. A radio campaign was also implemented in selected states.The first half of the program focused on increasing procurement of ORS and zinc in the public sector and getting negotiated prices, mapping private sector wholesale and retail networks and implementing activities to push ORS and zinc through the private sector supply chains, and large-scale training programs for both private and public sector providers to orient them to ORS and zinc and link them to suppliers. Limited community engagement occurred during the first half of the program. In the second half of the program, the focus switched to conducting multi-contact interventions that leveraged sustainable channels, such as government supportive supervision activities and pharmaceutical detailing. The majority of community engagement activities also occurred in the second half of the program, such as utilizing key influencers, facility-based “health talks”, and radio.The purpose of this study is to evaluate the program and to present the results of the household surveys conducted at baseline, midline, and endline using analytical techniques. To estimate the potential program impact, we focused on five outcomes: 1) the change over time in care-seeking for children with diarrhea in the past two weeks; 2) the change over time in treatment with ORS for children with diarrhea in the past two weeks; 3) the change over time in treatment with combined ORS and zinc; 4) whether the change over time in treatment with ORS was modified by the source of care ; and 5) whether the change over time in treatment with combined ORS and zinc was modified by the source of care.This evaluation consisted of repeated cross-sectional, multi-stage, cluster-based household surveys carried out separately in Bauchi, Cross River, Kaduna, Kano, Katsina, Lagos, Niger, and Rivers . The sampling frame for the study was the 2006 national census. Working with Nigeria’s National Bureau of Statistics (NBS), we first stratified all EAs by state, and urban and rural areas. Next, we randomly selected EAs by using a random number generator in Microsoft Excel . Population figures were not available for census EAs so we could not conduct probability proportional to size sampling. The sizes of the EAs varied, and we incorporated sampling weights to account for differences in EA sizes which are described later in the paper. Within each EA, trained enumerators listed all households living in the EA and screened for households with at least one child under five living in the household. After completion of the listing, the interviewers conducted a systematic random sample of households with children under five. Based on our experience during piloting, we found that sampling 20 households with at least one child under five per EA was achievable even in the smallest EAs in all states except for Cross Rivers and Rivers where we reduced the number to 15. Due to security issues during data collection, we excluded certain EAs from the sample selection. A new sample was created for each wave of data collection. Independent research firms were hired to conduct the data collection: Nielsen Nigeria for the baseline and Practical Sampling International for the midline and endline. The research firms hired enumerators who were familiar with the local context, could speak the local languages in the study states, and had experience conducting household surveys. Both male and female enumerators were hired, though depending on the state context, a greater number of female enumerators were hired to comply with local norms on conducting one-on-one interviews with primarily female caregivers. Enumerators were trained for five days prior to the launch of each data collection period. Training covered background on the project, household listing procedures, review of all survey questions, research ethics, use of the electronic data collection software SurveyCTO , and a day of field practice. Teams consisting of four interviewers and one supervisor were formed.The target respondent for the household survey was the primary caregiver of children under five in the household. The household survey included questions regarding household characteristics, respondent characteristics, characteristics of the child, and if the child had diarrhea in the two weeks preceding the survey, detailed information regarding the resolution of the diarrhea, such as source of care and whether the child was given ORS and zinc. Flip charts of local ORS, zinc, and other diarrhea treatments were used to aid the respondent’s recall. The survey was translated into Hausa, Pidgin, and Yoruba, and back translated to English to ensure the question’s intent was not lost. The baseline survey was conducted on paper and double entered into CSPro . Discrepant entries were resolved by a third data entrant. The midline and endline surveys were conducted electronically using mobile devices programmed with SurveyCTO.Data collection was also organized by funding source. Activities in Kano, Lagos, and Rivers, including the program evaluation, were funded by Norad while activities in Bauchi, Cross River, Kaduna, Katsina, and Niger were funded by GAC. Due to differences in donor reporting timelines, data collection for Norad-supported states were different than GAC-supported states. Additionally, the presidential election in 2015 also affected the timing of the Norad midline survey as Nigerians often return to their home state to vote rather than vote in their usual place of residence. The program was also concerned with any potential disruptions that may have resulted from the presidential elections. To avoid effects of population movement during the elections and potential disruptions after the elections, the program decided to conduct the midline prior to the elections. Sample size calculations were designed to ensure adequate power to detect change in ORS and combined ORS and zinc coverage in each state. We used the following formula to calculate the sample size for the study:Deft is the design effect due to clustering which we assumed to be 1.5 [p1 is the 2011 state coverage estimates (the most recent coverage data available at the time) [p2 is the endline estimates necessary to see a 25% difference over time. We use a two-sided t test with 95% confidence, 80% power, and equal variances. We took into account the prevalence of diarrhea found and allowed for a 5% non-response rate [where N is the desired sample sizes of children with diarrhea in each state (assuming one child per household), o be 1.5 , p1 is tWe first appended the survey data sets from each state and survey wave into a single data set. We then merged the survey data set with the EA listing data set and constructed probability selection weights and post-stratification weights to account for unequal probability of selection. Additional information on calculations for developing the survey weights is included in Appendix S1 in To evaluate whether the five outcomes changed during the program period, we constructed models using generalized estimating equations with the logit link function and computed crude and adjusted odds ratios and 95% confidence intervals. For our fourth and fifth outcomes, we examined if the associations between the survey period and the odds of a child receiving ORS or combined ORS and zinc were modified by source of care by including an interaction between the dummy variables for survey period  and source of care .a priori knowledge; these were factors that we believe may be related to use of ORS or combined ORS and zinc as well as factors that may have changed over time. We first conducted bivariate tests between the outcome and each covariate. The final multivariable models included characteristics of the child, caregiver, and household. For child characteristics, we included the child’s sex, child’s age categorized into 1-year age intervals, and source of care for the diarrhea episode. Sources of care were categorized into 5 mutually exclusive categories: did not seek advice or care outside the home, sought care in the public sector only , sought care in the private sector only , sought care in other source only , and sought care from multiple different sources. For caregiver characteristics, we included the caregiver’s sex, caregiver’s age categorized into 10-year age intervals, and whether the caregiver had attended any level of schooling. For household characteristics, we included variables for the state the household was located in, urban or rural classification, size of the household, whether the household had access to an improved water source as defined by the Demographic and Health Survey (DHS), and the wealth status. For each survey period and state, wealth scores were independently generated using principle component analysis of survey questions on household assets and categorized into quintiles [For all models above, we identified potential confounders using uintiles .To illustrate our model results, we used the multivariable interaction models to estimate predicted probabilities and conducted contrast tests to further evaluate whether there were statistically significant differences in predicted probabilities of treatment by survey period and source of care.All results incorporated probability selection weights and post-stratification weights to account for unequal probability of selection; additionally, the modeling accounted for the clustering at the census enumeration area and household levels. All analyses were conducted in Stata 14 .The study was reviewed and approved by the National Health Research Ethics Committee of Nigeria (NHREC) (protocol number NHREC/01/01/2007). Ethical approval was also obtained from each state government research ethics committee. Written informed consent was obtained from all participating respondents.P < 0.01). We also found in our descriptive analysis a statistically significant increase in the primary study outcomes. At baseline, we found 38% (95% CI = 34%-42%) of diarrhea episodes received ORS and 4% (95% CI = 3%-5%) received both ORS and zinc. At endline, we found 55% (95% CI = 51%-58%) received ORS and 30% (95% CI = 27%-33%) received both ORS and zinc  and a greater proportion of diarrhea episodes were found in Cross River at endline compared to baseline (P = 0.03).Characteristics of diarrhea episodes in the last two weeks preceding the survey at each time period were generally similar (P = 0.24). At endline, however, the adjusted odds of care-seeking were 1.43  times greater than baseline (P < 0.01).P < 0.01).When we included the interaction term to investigate whether the odds ratios between the endline and baseline survey were modified by source of care, we found statistically significant results for treatment of ORS among diarrhea episodes that sought care in the public and private sector. For diarrhea episodes that did not seek care, the adjusted odds ratio of receiving ORS at endline compared to baseline was 0.84 . Relative to this, the odds of receiving ORS is further increased by a factor of 4.49  when seeking care in the public sector and 2.43  when seeking care in the private sector. For receipt of combined ORS and zinc, we found the odds ratio for endline was also significantly modified by seeking care in the public sector and private sectors. Among cases not seeking care, the adjusted odds ratio at endline compared to baseline was 4.24 . The adjusted odds ratio was further elevated by a factor of 3.94  times when seeking care in the public sector and 5.64  times for cases seeking care in the private sector (P = 0.64). Among cases seeking care in the public sector, the predicted probability of receiving ORS increased from 57%  to 83%  between baseline and endline (P < 0.01). The predicted probabilities also increased among cases seeking care in the private sector from 41%  to 58% . There was no statistically significant difference in the predicted probability for receiving ORS among cases seeking care from other sources or multiple sectors.To further illustrate how ORS treatment by survey period is modified by source of care, For receipt of combined ORS and zinc, there was a statistically significant increase in all sources of care. Among cases not seeking advice or care outside the home, the predicted probability increased from 2%  to 8% . Cases seeking care in the public sector saw the largest increase in predicted probability from 7%  to 51% . Among cases seeking care in the private sector, the predicted probability increased from 2%  to 29% .Use of ORS and combined ORS and zinc for treatment of diarrhea in children under five significantly increased in focal states during the program period. We also found that the increases in treatment with ORS and combined ORS and zinc treatment were modified by where treatment was sought. The results suggest that overall improvements in ORS and combined ORS and zinc usage was driven by changes in treatment found among diarrhea episodes seeking care in the public and private sector. Use of ORS and combined ORS and zinc improved the most among cases seeking care in these sectors, while diarrhea episodes that did not seek care outside the home or that sought advice or care in other sectors saw no statistically significant change in their probability of receiving ORS and limited increase for combined ORS and zinc. Care-seeking had also increased by endline, likely facilitating improved overall coverage.The program operated at a large scale and activities were implemented with high intensity. The program reached tens of thousands of health care providers in both the public and private sectors by using multiple channels and forums, such as state-level trainings, supportive supervision, detailing, continuous medical education (CME) meetings, professional associations, and SMS messages. Furthermore, the program had numerous contacts with the providers to reinforce messages. A similar multi-channel, high frequency approach was used to engage with community members. The results of the surveys, taken in context with the activities of the program, suggest that the program likely contributed to the increased uptake of ORS.This program evaluation is one of the few large-scale program evaluations of ORS and zinc scale-up. Other large-scale program evaluations include the Scaling Up of Zinc for Young Children (SUZY) program in Bangladesh and the Point-of-Use Water Disinfection and Zinc Treatment (POUZN) in Nepal. The SUZY and POUZN programs were among the first national scale-up campaigns of ORS and zinc treatment, and both program designs included government leadership, encouraging local manufacturing, partnerships with private provider associations, and caregiver-targeted demand generation. The SUZY and POUZN programs achieved 20% and 15% coverage of zinc, respectively ,15. In GNational Essential Childhood Medicines Scale-up Plan, several elements of the support were expected to affect all states, thus not allowing for a traditional control comparison. For example, the program helped to strengthen local manufacturing and distribution by providing technical support to source low-cost, high-quality pharmaceutical ingredients and product registration. Sales and distribution data provided by the manufacturers show that their ORS and zinc products were sold widely beyond the program states—and manufacturer and distributor partners actively pursued distribution channels outside focus states during program execution. Thus, a study using other states as comparators may underestimate the impact of the program. Regardless, we do believe this association between the survey period and the odds in treatment is a good representation of program change due to the rigor of the sample and analytical design.The limitations of the study are that the results are based on a pre-post evaluation design and not a traditional impact evaluation. Thus, we are unable to conclusively attribute changes in use of ORS and zinc treatment to the program. However, the regression models used to describe the associations accounted for multiple sample differences and estimated the most accurate change possible given the design limitations. Additionally, given the nature of the program to support the government to implement its As mentioned in the program description, the program was part of a larger coordinated effort to improve child health outcomes nationally. Other organizations were also collaborating with the government and CHAI through the NEMCM to invest in complementary activities in the program states as well as other states. For example, UNICEF had provided donations of ORS and zinc in Bauchi, Kaduna, and Katsina states at the start of the program. Abt Associates worked in 8 states – overlapping with CHAI in Kano, Kaduna, and Lagos – to train public and private facilities on maternal, neonatal and child health services. Society for Family Health (SFH) conducted mass media radio campaigns in Bauchi, Cross River, Lagos, Kano, and Kaduna that included messages on diarrhea treatment. Thus, the findings likely represent this collective and coordinated effort, and we cannot disentangle the program results from other partner efforts.Though several activities likely had national influence and other partners were active in some other states, the program activities in the eight states would have likely led to greater coverage than in other states with less intensive activities. We analyzed the UNICEF MICS 2016-17 data and find that combined ORS and zinc coverage in the eight program states were significantly higher than in the rest of Nigeria – 25%  compared to 14%  (Table S2 in The study relied on self-reported information by caregivers of children. We tried to limit bias from this data collection method by limiting our assessment to diarrhea episodes that occurred two weeks prior to the survey. ORS is likely distinguishable from other diarrhea medicines since it is a powder that must be mixed with water. Zinc DT may be confused with other medicines in tablet form. However, to improve the reliability of caregiver reports, data collectors were equipped with flipcharts of locally branded treatments, including ORS, zinc, antibiotics, anti-diarrheals, and home remedies, to aid in recall of the treatment used for the diarrhea episode. We also accepted “don’t know” as a response in case the respondent could not remember the medicine used. The ORS and zinc brands for which the program provided technical assistance to manufacturers are likely not distinguishable to a caregiver from other ORS and zinc brands. However, the goal of the program was not to increase utilization of any specific ORS and zinc brand but to increase overall use of ORS and zinc.The timing of the surveys could also have affected the results of the survey. As mentioned above, the surveys were timed with donor reporting periods and to avoid any disruptions due to the elections. In the Norad-supported states, the surveys occurred between December to May, while in GAC-supported states, the baseline and midline surveys were conducted between September and November and the endline in May. These months typically have lower rainfall than the summer months of June to August, which may limit any effect of seasonality on treatment rates with ORS and zinc ,25. We dLastly, we acknowledge that the authors of this study were also involved in the design and implementation of the program. We attempted to mitigate the bias by hiring an external research agency to oversee the data collection. Additionally, we have compared our survey results with independent external data sources. A DHS was conducted in 2013, approximately 6 months prior to the baseline survey . A seconThe study limitations notwithstanding, we find that the results taken together with the program context suggest that the program likely contributed to the improvement in ORS and combined ORS and zinc treatment. We encourage evaluations of other national or large-scale programs to further contribute evidence and lessons on designing and implementing large-scale programs. Further rigorous research is also needed to understand what program components and interventions are most effective at driving coverage changes.Use of ORS and combined ORS and zinc for treatment of diarrhea in children under five significantly increased in program states during the program period. Rapid scale-up of ORS and combined ORS and zinc treatment is attainable through a focused, comprehensive diarrhea management program with tailored interventions for the local context.


W ≥ 6.5) have been carefully revised for their epicentral locations and magnitudes from trusted publications. Different magnitude-conversion relationships, compatible with available local and regional ones, has been established to obtain unified moment magnitude estimates for the whole catalog. Completeness periods for the declustered catalog were estimated for the definition of appropriate seismic source models for the whole territory. The final unified Poissonian earthquake catalog spans from 1787 to 2018, covering a spatial extent of 13° to 33°N and 91° to 117°W. This catalog is compatible with other published catalogs providing basis for new analysis related to seismicity, seismotectonics and seismic hazard assessment in Mexico.Here we present a new updated and unified Poissonian earthquake catalog for Mexico. The details about the catalog compilation, the removal of duplicate events, unifying the magnitude scales, removal of dependent events through the declustering process and its completeness analysis are presented. Earthquake and focal mechanism data have been compiled from various local, regional and international sources. Large earthquake events (M Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.9933536 The occurrence of seismic events in numerous regions of the world, especially those with resultant losses in human lives, have highlighted the urgent necessity of implementing specific regulations on the seismic design codes for each specific region. Long-term earthquake hazard assessment is one of the most important tools for seismic risk mitigation and the reduction of financial and life losses related to such catastrophic events. Besides that, the construction of an early warning system together with the public awareness for natural disasters are essential complementary actions.The fundamental information necessary for any seismic hazard study is the most complete seismic record possible. This record, also termed the seismic catalog, should include at least the spatial coordinates of the epicenters, times of occurrence together with magnitudes of the earthquakes that took place in the region of interest. The quality and homogeneity of such information is reflected directly in the final seismic hazard results. Therefore, earthquake catalogs as well as focal-mechanism catalogs to provide a deep understanding of the seismotectonic setting of the area of interest are basic to develop a reliable seismic source model. A seismic source model together with a representative ground motion attenuation model considering the local site conditions are the primary components required to carry out an appropriate seismic hazard study. Instrumental earthquake catalogs show the overall seismicity of the Earth since about 1904 . However, examining and inspecting the regional historical earthquakes, in addition to the instrumental recorded events, is essential to understand the long-term seismicity.1, and articles within special issue2), while the September 8, 2017 (Mw 8.2) Tehuantepec earthquake represents the largest well-recorded recent earthquake in Mexico.Mexico is situated in one of the most active seismic belts of the planet. Its tectonic setting is highly complex. Most of the active seismic regions in and around Mexico are related to the interaction among five tectonic plates  Poissionian earthquake and focal mechanism catalogs for events ≥4.0 for the purpose of conducting seismotectonic and seismic hazard studies in Mexico. For this purpose, data were collected from a variety of sources, local , regional  and international catalogs  to achieve a unified magnitude scale. The initial compilation included all earthquakes having an assigned magnitude M ≥ 4.0 on any magnitude scale. A great effort and time have been consumed to review and revise the epicentral locations and magnitude values for the largest earthquakes (over M 6.5). For this, all previously-published peer-reviewed articles were collected to carefully check each earthquake.*) magnitude estimates. Our empirical relationships were plotted against some worldwide known ones for comparison and confirmation. With the help of such derived relationships, we assigned the Mw as the unified magnitude scale for the whole catalog, which then allows us to evaluate the completeness periods for specific magnitudes for the entire catalog. Reported magnitudes  are also included in the final database for researchers who might prefer to use different empirical relationships than those applied in the current study.Earthquake magnitudes from a variety of bulletins were reported in different magnitude scales. The initial compiled data comprised a total of about 84,000 earthquakes covering the entire previously-mentioned time period. One of the biggest challenges during this work was to build one standard format for the earthquake data. This is due to the huge number of compiled events that came from a variety of sources. The compiled catalog has been improved significantly by examining specifically the largest events (over Mw 6.5) for their locations and magnitudes, removing the duplicate events, and discernment of some missing parameters for the historical events. In addition, about 1,750 focal-mechanism solutions were compiled for the time period 1963 to 2016. They are mainly gathered from ISC and Global CMT bulletins supplemented by published solutions from international peer-reviewed papers. New empirical magnitude-conversion relationships between various reported magnitude scales  were developed from ISC and USGS bulletin values to provide the unified moment , represent the final Poissonian earthquake catalog including only main shocks with a magnitude above or equal to Mw* 4.0, covering the region with latitude ranging from 13° to 33°N and longitude ranging from 91° to 117°W. Tabulated parameters are: the origin date and time; epicentral location (longitude and latitude); depth; reported magnitudes; the final unified Mw* value; and the different codes for each parameter. Our new and updated catalog improves upon previous catalogs in terms of certainty of epicentral locations and magnitudes of the included events. This is because all original sources have been checked carefully in terms of magnitudes and locations, among other factors.Foreshocks, aftershocks and earthquake swarms, as dependent events, have been identified and removed from the catalog through a declustering process using the Gardner and KnopoffFinally, the degree of completeness for the entire catalog was evaluated for each magnitude range. The completeness analysis of the entire catalog reveals that our catalog is complete, with respect to time, for magnitudes Mw ≥ 4.0, ≥5.0 and ≥6.0 since 1990, 1990 and 1925, with activity rates of 103.3, 36.3 and 5.31 events/year, respectively. The completeness results have been interpreted in the framework of the establishment and development of the international and national seismic networks.Our unified catalog for Mexico is compatible with the well-known worldwide catalogs. Since this catalog covers some gaps and heterogeneities observed in some previous compilations, so it will present a useful guidance for upgrading it in the future. Thus, the current revised and unified catalog provides a solid basis to use in any seismotectonic and seismic hazard assessment for the whole country or for specific regions. The final version of the catalog is provided as an electronic supplement attached to this article.7, among many others). A number of local and national catalogs using different criteria and with different characteristics, time periods, data formats, and completeness intervals have been achieved. One of the major objectives of this work for Mexico is to develop a new updated and unified earthquake catalog based on the integration of international data sources, the SSN Mexican national network and any other related earthquake bulletins.During the past few decades, large efforts from many different researchers and institutions has been made in order to improve specific earthquake catalogs  for specific regions and states in Mexico  have been included. The initial compiled data included all earthquake data with magnitudes equal to or greater than 4.0. The compiled catalog  included about 84,000 events. This work implied a major struggling/challenge due to the huge number of the reported earthquakes and the major differences in the data formats and quality among the data sources. The compiled data suffered from duplication, incompleteness, and errors in both the geographic locations and the focal depths. Large effort and much time were necessary to evaluate and choose the information between the different data sources  and erase the duplicate earthquake records. For those historical events (before the year 1900) and instrumental large earthquakes (over M 6.5), a detailed inspection for the previously-available publications has been made to check both the most reliable location (latitude and longitude), depths and the magnitude sizes.In the following, we are listing the different bulletins, catalogs and sources that have been used (arranged according to priority) in the compilation of our earthquake and focal mechanism catalogs.Abe8: He presented a catalog for large shallow events (up to 60 km depth) that took place during the period from 1904 to 1980. Magnitudes from Ms and Mb by Gutenberg9 and Gutenberg and Richter10, respectively, were reported.Singhet al.11: In their research about the seismic gaps and recurrence periods of large earthquakes along the Mexican subduction zone, they presented a catalog for the largest Mexican earthquakes (Ms ≥ 7.0) that took place from 1806 to 1979. They mentioned that the epicentral locations and magnitudes of most reported events are accurate within Δ ± 0.1° for locations and M ± 0.3 for magnitudes.McNally and Minster12: During their study of the non-uniform seismic slip rates along the Middle America Trench, they included a catalog for large events (Ms ≥ 7.0) that mainly was compiled from other sources. Among these sources can be quoted the following ones: Gutenberg13, Figueroa14, Duda15, Kelleher et al.16, Miyamura17, Geller and Kanamori18, Kanamori and Abe19, and Singh et al.11.Abe and Noguchi21: A list of large shallow earthquakes spanning the time period from 1898 to 1917 was presented by the authors. Earthquake sizes have been expressed as MGR22, MD15 and Ms magnitudes. For location and origin time, they reported them from different sources, e.g., Gutenberg and Richter22, Gutenberg13 and Duda15.Singhet al.23: They presented a catalog of the largest shallow earthquakes  spanning the time period from 1900 to 1981 and covering the spatial region from 15° to 20°N in latitude, and from 94.5° to 105.5 °W in longitude. Their catalog is compiled mainly from other sources, e.g., Gutenberg and Richter22, Duda15, Rothé24, Figueroa25, Miyamura17, Abe8, Earthquake Data Report “EDR” (USGS), Uppsala and Göttingen bulletins, and Uppsala and Göttingen Wiechert seismograms.Andersonet al.26: They discussed the seismic strain release in the Mexican subduction zone , depending on the estimates of the seismic moment for a revised earthquake catalog for large events that occurred in Mexico, in the period from 1806 to 1986. Both the epicentral locations and magnitudes were compiled from previously-published sources, e.g., Gutenberg and Richter22, Singh et al.11, Yamamoto et al.27, Astiz and Kanamori28, UNAM Seismology Group29, and Nishenko and Singh30, among others.Ambraseys31and Ambraseys and Adams32: The first paper presented the results of the Ms computation of Central American earthquakes for the period from 1898 to 1930, while the second paper discussed the re-examination of macroseismic information for large earthquakes (≥Ms 7.0) for the same region and for the time period from 1898 to 1994. They mentioned that the locations of the more important earthquakes were revised using a combination of macroseismic information and instrumental readings.Santoyoet al.5: In this work, an estimation for the center of the rupture area of 24 shallow thrust earthquakes (Ms ≥ 6.9) was presented. This estimation was mainly based on their aftershock areas, or inferred from empirical relationships, e.g., Utsu and Seki33 and Wells and Coopersmith34. This useful information has been considered in the final catalog.36. In addition, other references for the largest events along the Mexican subduction zone41 were accounted. Moreover, some global and regional catalogs43 were also considered, in addition to the previously listed sources.Other references have been considered for specific regions during the compilation and revision of large earthquake events (M 6.5) in this work. For example, for those events that occurred in northwestern Mexico, in the region of Baja California44, the Zihuatanejo (Ms 7.0) November 16, 192545, the Oaxaca (Ms 8.0) January 15, 193146, the Jalisco (Ms 8.2) June 3, 193248, the Colima (M 7.5) January 30, 197349, the Orizaba (Mb 6.7) August 28, 197350, the Oaxaca  November 29, 197852, the Michoacán (Mw 8.0) September 19, 198553, the Zihuatanejo (M 6.6) December 10, 199454, the Copala (M 7.3) September 14, 199555, the Colima-Jalisco (Mw 8.0) October 9, 199556, the Chiapas (Mw 7.2) October 21, 199557, the Papanoa (Mw 7.3) April 18, 201458, the Chiapas (Mw 8.2) September 8, 201760, and the Morelos-Puebla (Mw 7.1) September 19, 201761 earthquakes, among others.Other published information about specific earthquakes was also collected from detailed works. Examples for the studied earthquakes are the (M 8.6) March 28, 1787For those historical events (before the year 1900) and instrumental large earthquakes (over M 6.5), a detailed inspection for the previously-available publications has been made to check both the most reliable location (latitude and longitude), depths and the magnitudes. The following published works have been inspected specifically for Mexican earthquakes:http://www.ssn.unam.mx/), being member of the International Seismological Association. During this period, the SSN belonged to the Mexican National Geological Institute, under the administration of the Mexican Ministry of Mining and Promotion. From 1910 to 1923, nine German-made “Wiechert” mechanical seismological stations were installed in Tacubaya, Oaxaca, Mérida, Chihuahua, Veracruz, Guadalajara, Mazatlan, Monterrey and Zacatecas  reports all earthquake data in digital format from the year 1900  until the present, and it is updated periodically. It represents one of the basic international more completed and corrected seismic bulletins, in comparison with other sources. It consists of raw and revised earthquake data collected from local and national networks (about 130 agencies) all over the world. The main earthquake parameters reported in these catalogs are: origin time, hypocenter location, phase arrival-time, magnitude, focal-mechanism solutions, etc. A number of 19,930 earthquakes (M > 4.0) 62. The Engdahl et al.62 algorithm has been used to improve routine hypocenter determinations (particularly the depth) carried out by the ISS, the ISC, and the Preliminary Determination of Epicenters (PDE) bulletins for teleseismic events. This was before the introduction of the new location algorithm of Bondár and Storchak63. Magnitude sizes are expressed in the form of Mb, Ms and Mw magnitudes. Most of Mb and Ms data were taken from the ISC bulletin, while Mw was taken from the Global CMT catalog. The number of the reported events included in the EHB-ISC bulletin for Mexico is 1,516 earthquakes . The ISC-GEM catalog was funded by the Global Earthquake Model (GEM) Foundation as part of the Global Hazard Components. Its first version is the result of a long project ended in January 201364. From November 2013 to December 2017, with the support of several public and commercial agencies, they worked on the Extension Project to include global events that took place after the year 2009, and smaller earthquakes (<M 6.2) in the period 1904–1959. In January 2018, they began working on the Advancement Project, that aimed to include additional source parameters for early earthquake events from scientific literature, which in turn improved magnitude determinations by identifying and addressing some reporting gaps of quality long-term stations, and add smaller earthquakes with Mw 5.0–5.5 in continental areas during the late instrumental period (1964 – present). A number of 765 earthquake events (Mw ≥ 5.5) were collected from the ISC-GEM catalog for Mexico , which serves directly to the requirements of the analysts who are interested in evaluating seismic hazard and seismic risk. It covers the time period from 1904 to 2014 (http://earthquake.usgs.gov/earthquakes/) which covers and includes earthquakes that occurred during the time period from 1932 until present . Magnitude sizes in this bulletin have been presented in terms of Mb, Ms, MD and Mw magnitudes. A total number of 15,055 earthquake events (over M 4.0) have been compiled from this online bulletin to be included in our compiled catalog , such as NEIC-USGS, ISC, ANF/ANFR (USArray Array Network Facility (ANF) & ANFR catalog indicates the final reviewed publication) and UofW (University of Washington) bulletin sources. For Mexico, IRIS catalog includes events covering the time period from 1960 until present. Magnitude sizes for this catalog have been expressed as Mb, Ms, MD, ML and Mw magnitudes. Most of the reported earthquakes for Mexico came from the ISC bulletin, the NEIC-USGS and the Mexican SSN seismic network. A total number of 22,865 events (over M 4.0) have been compiled from this catalog , time (hour/minute/second), geographic location , depth (in km), and reported magnitudes   reported by local and national sources  has been taken into account rather than those come from regional or international sources.The merging process has been performed following the same criteria in Sawires In terms of magnitudes Table , the com72) during the past decades. ML is the earliest magnitude scale used as an instrumentally-measured estimation of the earthquake size69. In the 1960s, the Mb was introduced to be reported in the ISC and NEIC bulletins by the USGS and the National Oceanic and Atmospheric Administration (NOAA), in conjunction with the establishment of the World-Wide Standard Seismograph Network (WWSSN). Later, the Ms was introduced by the NEIC bulletin and it was accepted later to be used by the ISC bulletin73. The main problem in the application of these scales is that they saturate for large earthquakes, which leads to the underestimation of magnitude for large earthquake events. In addition to this question, their behaviors are different over the whole magnitude range75. To overcome such problems, a new non-saturating magnitude scale (Mw) was proposed by Hanks and Kanamori71. This scale is based on the total scalar seismic moment released during the rupture of an earthquake. Seismic moment, and thus the Mw, is mainly controlled by both the fault/rupture area, the average dislocation, and the rigidity of the medium.Different magnitude scales have been considered by several researchers (e.g.78), and others by using earthquake records from different seismotectonic environments (e.g.87).In the present work, it was required to unify the magnitude scale and homogenize the earthquake catalog, as much as possible, with respect to the Mw scale. This is because the prevailing seismic hazard assessment accept only a non-saturated magnitude. A huge number of empirical relationships is presented in the literature between the Mw and other classical magnitude scales. Some of these relationships were derived from global earthquake data sets (e.g.80) in the scientific literature. In our final catalog  for Mexico”88), the initially reported magnitude scales have been included, in addition to the final equivalent Mw*. This allows interested researchers to use other type of magnitude scales to unify the catalog, or to use directly other empirical relationships to estimate the unified magnitude.In this work, a number of well-established regression relationships between the different reported magnitudes and the Mw has been specifically developed. Such relationships are those established from our database after studying and comparing with other magnitude relationships , a specific code has been included to show the fitting relationship that has been applied to obtain the final equivalent Mw* for each reported event. The temporal distribution of the unified earthquakes included in the up-to-date catalog is plotted according to their magnitude  for Mexico”91). Therefore, foreshocks, aftershocks and seismic swarms (as dependent events) should be identified and erased through out what is called a “declustering process” since they violate the assumption of independency for earthquakes92. Foreshocks and aftershocks are temporally and spatially dependent on the mainshock. However, their identification is to a large degree subjective, since there are no physical differences between the foreshocks and aftershocks, as dependent events from one side, and the mainshock from the other side. As a result, earthquake clusters are typically defined by their closeness in space and time. In the declustering process, being the earthquakes arranged in space and time, the mainshock is considered as the event having the highest magnitude in a specific seismic sequence, i.e., in a specific spatial and temporal window. This process will result in a new declustered catalog containing only independent events, i.e., mainshocks.The spatial and temporal distribution of earthquakes is in general inhomogeneous. Computations of probabilistic seismic hazard for any region is usually based on the assumption that earthquake recurrence follows an independent distribution (memory-less process) in space and time (Poissonian distribution) (e.g.95). The main difference among these statistical methods is the selection of the size of spatial and temporal windows, while the common factor among these methods is that the larger is the magnitude of the independent “mainshock” event, the larger is the defined spatial and temporal windows size. In this work, the dependent events have been identified and erased from the compiled catalog by using the same spatial and temporal windows parameters proposed by Gardner and Knopoff3. Given a certain Mw-earthquake, a full scan within a specified distance L(Mw) and time T(Mw) was performed for the whole unified catalog (e.g.97). Throughout this scan (see the uploaded compressed file entitled “FORTRAN CODES”88), the earthquake having the largest magnitude is considered to be the mainshock, and all events occurring within the L(Mw) and T(Mw) windows are declared as dependent events and erased from the catalog. Spatial and temporal window sizes of 36 km and 188 days for an Mw 4.0 event, and 100 km and 900 days for an Mw 8.0 event were used in the current declustering process. For earthquakes having in-between magnitudes, spatial (L) and temporal (T) windows sizes are computed according to the following equations:Concerning the declustering process, there are different methodologies and algorithms that have been proposed by several researchers  in the declustered catalog for Mexico, covering the spatial area between 91° and 117°W longitudes, and 13° and 33°N latitudes, during the time period from 1787 to 2018  for Mexico”88). Magnitudes below 4.0 are not considered in the current work, due to these events are usually not included in seismic hazard studies and having a very low completeness period.Applying the previously-mentioned Gardner and Knopff88) displays the most energetic (≥Mw 6.5) earthquakes taken place in Mexico throughout the catalog period (1787–2018). References has been included specifically for each event .The epicentral distribution for the mainshocks has been plotted in Fig. (101).Earthquake focal mechanisms are essential in seismotectonic studies. They are illustrating the relationship between earthquakes and their causative fault. Thus, they provide very useful information about the tectonic activity of the studied region. Focal-mechanism solutions for significant earthquakes that taken place in Mexico were collected mainly from the Global CMT catalog and the ISC online bulletin, as well as peer-reviewed articles . This catalog covers the time period from 1976 to 2014. All events included in this catalog are expressed using the Mw scale computed according to the Kanamori70 procedure. In addition, Mb and Ms magnitudes are also included for some earthquakes. A number of 784 (over Mw 4.0) solutions have been compiled from the Global CMT catalog  has been attached to this work to show the focal mechanism solutions  for the studied events that have been collected from different sources and publications and have been plotted in Fig.  have been obtained from both Global CMT and ISC sources, as well as published papers, after the removal of duplicated focal-mechanism solutions. An electronic supplement  for Mexico”104. Mc is a critical parameter in the estimation of the seismicity parameters  when using the cumulative linear Gutenberg and Richter105 relationship. Without appropriate completeness intervals for the catalog, estimated seismicity recurrence parameters would be biased, and hence will lead to skewed estimations during the assessment of probabilistic seismic hazard. It is well known that earthquake catalogs get sparser and more uncertain once looking backward in time. In fact, completeness periods vary with time. For large earthquakes, the completeness period extends back to the pre-instrumental or the historical times, while for small-magnitude earthquakes, the completeness period is achieved only within the most recent decades of the instrumental epoch. This change in the level of completeness is mainly related to the deployment and development of the seismic networks, the increasing in the sensitivity of seismographs, and also to the significant increasing in the network coverage during the recent decades.An earthquake catalog must be as complete as possible with respect to relative frequency of the earthquake occurrence with time. Threshold or cutoff magnitude, also known as completeness magnitude (Mc) is defined as the lowest magnitude value at which all earthquakes in a specific space-time domain are reported108) is used here for the estimating of the completeness periods. By applying such method, a simple graph is usually plotted between the cumulative number of earthquakes vs. time for a specific magnitude range . The catalog is considered complete (for this particular magnitude range) with respect to time when there is approximately a straight trend (constant average slope) of the plotted data. In this case, the completeness period will be the number of years from the start of this straight-slope segment until the last year of the catalog. This method is considered to be accurate and efficient even when it is applied to a small set of earthquake data.Identifying threshold magnitude and its spatial and temporal variations is a controversial task which does not has a single procedure to address it. The cumulative method  earthquakes covering the spatial region of 15° to 20°N latitudes, and 94.5° to 105.5 °W longitudes, Singh et al.4 stated that the catalog is mostly complete for earthquakes with Ms ≥ 6.5 from 1906 to 1981. Zúñiga et al.7, throughout their work about the seismotectonic regionalization of Mexico, compiled a catalog (until 2014) from the ISC bulletin, the Mexican SSN, Red Sísmica del Noroeste de México “RESNOM”, PDE, and CMT catalogs in the form of Ms magnitudes. They noticed changes during the completeness analysis of their catalog on the years 1935, 1965, 1970, 1982 and 2003. According to their work, the catalog was considered to be complete for magnitudes Mw ≥ 6.5 and 7.0 since 1935 and 1900, respectively. On the other hand, in the course of a probabilistic seismic hazard analysis for Latin America and the Caribbean, Salgado-Gálvez et al.109 assembled a catalog (from 1900 to 2015) which comes mainly from international sources110. They stated that, for Mexico and Central America, the catalog is complete for Mw 4.0, 4.5 and 5.5 since 1972, and for Mw 6.5 and 7.5 since 1934 and 1906, respectively110.The obtained completeness periods in the current work Table  appear tSome of the obtained completeness intervals directly coincide with the establishment, improvement or increase in the number of seismic stations in seismic networks locally and globally. For example, 1918 (the end of World War I), mid-1960s (the deployment and operation of the WWSSN), and mid-1990s (activation of the Comprehensive Nuclear-Test-Ban Treaty Organization). Locally, the data availability increases significantly after the large coverage of Mexican SSN on the year 1925.88): it is a Microsoft Excel™ worksheet consisting three sheets; the first two sheets are for the codes and references of the earthquakes, while the third sheet consists of 5160 rows organized into 25 columns. Each row describes a single main earthquake event, while each column describes the related parameters for this earthquake. The names of the columns mentioned in third Microsoft Excel™ sheet are the following:A: YEAR; B: MONTH; C: DAY: date type variables indicating the date of each earthquake.D: HOUR; E: MINUTE; F: SECOND: date type variables indicating the time of each earthquake.G: LONGITUDE; H: LATITUDE: double type variables  indicating the location (longitude and latitude) of each event.J: DEPTH: double type variable  indicating the depth of each individual earthquake.L: Mb; N: Ms1; P: Ms2; R: Mw; T:MD; V: ML: double type variables indicating the reported magnitudes  for the included earthquakes, they are as the following: Mb (Body-wave magnitude), Ms1 and Ms2 (Surface-wave magnitudes), Mw (Moment magnitude), MD (Duration magnitude), and ML .I, K, M, O, Q, S, U, W (Code): numbers representing the reference(s) for each previously-mentioned parameters .X: Mweq: double type variable  indicating the final/equivalent computed moment magnitude for each earthquake included in the final catalog for Mexico.V: Code: A number indicating the way of estimating the equivalent moment magnitude.The final obtained declustered and unified earthquake catalog obtained in the current study was uploaded in the figshare repository under the title  for Mexico88) contains all the codes that were used during the declustering of the unified earthquake catalog.The second uploaded compressed file at the figshare repository under the title (FORTRAN CODES88) contains all reported and checked data about the largest earthquakes (Mw ≥ 6.5) that took place in Mexico during the period from 1787 to 2018. Largest earthquakes events were described in this file by the following columns:EVENT NUMBER: Earthquakes were arranged in this file from the older to the most recent.DATE (year – month - day): Date of the event in terms of the year, month, and day.TIME (hour – minute - second): Time of the earthquake in terms of hour, minutes, and seconds.LATITUDE, LONGITUDE, LOCATION CODE: Latitude and longitude coordinates in decimal degrees, and their corresponding reference code.DEPTH, DEPTH CODE: Depth of each mentioned earthquake in kilometers, and its corresponding reference code.REPORTED MAGNITUDES (M1/M2/M3-Type-Code): Reported original magnitudes , within their original references.Mw*: Final computed equivalent moment magnitude.NOTE: Codes in this attached Microsoft Excel™ file indicate the same number of the references in the manuscript.The third uploaded supplementary Microsoft Excel™ file under the title of (Largest Earthquakes88) represents the final compiled focal mechanism solutions mentioned in the manuscript. This file consists of only one sheet; this sheet is composed for 23 columns and 1237 rows. Each row describes a single focal mechanism solution for a certain earthquake, while each column describes the related parameters for this event. The names of the columns mentioned in this Microsoft Excel™ sheet are the following:A: YEAR; B: MONTH; C: DAY: date type variables indicating the date of each earthquake.D: HOUR; E: MINUTE; F: SECOND: date type variables indicating the time of each earthquake.G: LATITUDE; H: LONGITUDE: double type variables  indicating the location (latitude and longitude) of each event.I: Mw*: double type variable  indicating the final considered moment magnitude for each earthquake included in the catalog.J: DEPTH: double type variable  indicating the depth of each individual earthquake.K: Strike 1; L: Dip 1; M: Rake 1; N: Strike 2; O: Dip 2; P: Rake 2: these columns represent the two nodal planes for the focal mechanism solution for each earthquake; each column contains a number for each mentioned individual parameter .Q: Mb; S: Mw; U: Ms: double type variables indicating other reported magnitudes  for the included earthquakes, they are as the following: Mb (Body-wave magnitude), Mw (Moment magnitude), and Ms (Surface-wave magnitude).R: Mb Reference; T: Mw Reference; V: Ms Reference; W: Bulletin: these columns mentioned the references for the Mb, Mw, Ms and the source of the focal mechanism solution, respectively.The fourth uploaded Microsoft Excel™ worksheet in the figshare repository under the title  for MexicoOriginal reported magnitudes for all earthquakes in our catalog are included in the final database as a reference for those researchers who might prefer to use other empirical relationships to unify the catalog other than those applied in the current study.88, in order to give the possibility to check them or to apply another declustering algorithm for the entire catalog.Declustering approach that has been used in the current work has been included throughout the uploaded “FORTRAN CODES” on figshareAll references used during the compilation of the earthquake catalog are included as “Codes” in the final dataset, specifically for each parameter for the largest earthquakes. This allows to check event by event from their original published references and bulletins.Supplementary Figures