Search

MRSA enterocolitis is under-recognized in the setting of PCR testing. In this case report, we describe risk factors, the importance of stool culture, and the third published case of MRSA enterocolitis in a patient with leukemia. In addition, we performed a retrospective analysis of all stool cultures at our institution that have grown Staphylococcus aureus, and we describe an additional five cases. We also report the diagnostic yield of organisms detected by culture, but not on the FilmArray panel. While rare, these cases demonstrate that MRSA in stool may indicate a severe and potentially life-threatening infection, particularly in immunocompromised persons.

IntroductionIn the digital era, the evolving demands of professional fields, especially in higher education, have accentuated the need for advanced digital competencies among faculty members. Digital competencies are now considered essential for effective teaching, necessitating an in-depth understanding of how these skills are distributed across different demographics, including gender and academic level. This study aims to explore the digital competencies of faculty members at the State University of Milagro, focusing on how these competencies vary by gender and academic level.MethodsThis study employed a quantitative approach within the positivist paradigm to assess the digital competencies of 279 faculty members at the State University of Milagro. Data were collected using the Higher Education Digital Competence Assessment Questionnaire, a validated instrument designed to measure various dimensions of digital skills. Descriptive statistical analysis was conducted using SPSS to evaluate the internal consistency of the competencies and to identify correlations among them, as well as to assess the influence of gender and academic level on these competencies.ResultsThe analysis revealed significant correlations among the different dimensions of digital competencies, indicating that proficiency in one area often contributes to the development of skills in other areas. The integrative nature of digital technologies within the academic environment was evident, with a high level of internal consistency observed across the competencies assessed. Notably, differences were found based on gender and academic level, suggesting that these demographic factors influence technological exposure and training, with certain groups displaying higher competency levels in specific areas.DiscussionThe findings highlight the importance of promoting integrative educational strategies that consider the diverse backgrounds of faculty members to ensure equitable development of digital competencies. The observed gender and academic level disparities underline the need for targeted interventions that address the specific needs of different faculty groups. By fostering a more balanced development of digital skills, institutions can enhance overall teaching effectiveness and better prepare faculty to meet the demands of modern educational environments. These results contribute to the ongoing discourse on digital competency development in higher education and suggest avenues for further research on how to bridge existing gaps in digital skills among faculty.

Hidradenitis suppurativa is a chronic inflammatory skin disease that usually presents in young adults with painful abscesses in intertriginous areas. We present a case of severe hidradenitis suppurativa (Hidradenitis Suppurativa Investigator Global Assessment (HS-IGA) = 5; Hurley stage III) investigated by cardiology and respirology specialists for dyspnea. The patient’s symptoms required right-sided cardiac catheterization via the right femoral vein in the inguinal area. The patient was able to undergo this invasive cardiac procedure without infectious complications using multidisciplinary management (dermatology, cardiology, respirology, internal medicine, and infectious diseases specialists), intravenous ertapenem 1 g/day for 6 weeks perioperatively, biologic therapy, and treatment of diabetes with semaglutide. The administration of ertapenem preoperatively and postoperatively of an invasive procedure can be beneficial, particularly when the upcoming intervention requires access to skin areas severely affected by hidradenitis suppurativa. Comorbidities such as obesity and diabetes should be addressed as their treatment might contribute to improve hidradenitis suppurativa.

BackgroundPatient safety is a fundamental aspect of health care practice across global health systems. Safe practices, which include incident reporting systems, have proven valuable in preventing the recurrence of safety incidents. However, the accessibility of this tool for health care discipline students is not consistent, limiting their acquisition of competencies. In addition, there is no tools to familiarize students with analyzing safety incidents. Gamification has emerged as an effective strategy in health care education. ObjectiveThis study aims to develop an incident reporting system tailored to the specific needs of health care discipline students, named Safety Incident Report System for Students. Secondary objectives included studying the performance of different groups of students in the use of the platform and training them on the correct procedures for reporting. MethodsThis was an observational study carried out in 3 phases. Phase 1 consisted of the development of the web-based platform and the incident registration form. For this purpose, systems already developed and in use in Spain were taken as a basis. During phase 2, a total of 223 students in medicine and nursing with clinical internships from universities in Argentina, Brazil, Colombia, Ecuador, and Spain received an introductory seminar and were given access to the platform. Phase 3 ran in parallel and involved evaluation and feedback of the reports received as well as the opportunity to submit the students’ opinion on the process. Descriptive statistics were obtained to gain information about the incidents, and mean comparisons by groups were performed to analyze the scores obtained. ResultsThe final form was divided into 9 sections and consisted of 48 questions that allowed for introducing data about the incident, its causes, and proposals for an improvement plan. The platform included a personal dashboard displaying submitted reports, average scores, progression, and score rankings. A total of 105 students participated, submitting 147 reports. Incidents were mainly reported in the hospital setting, with complications of care (87/346, 25.1%) and effects of medication or medical products (82/346, 23.7%) being predominant. The most repeated causes were related confusion, oversight, or distractions (49/147, 33.3%) and absence of process verification (44/147, 29.9%). Statistically significant differences were observed between the mean final scores received by country (P

Abstract Textile grade polyacrylonitrile (PAN) was used as a precursor material for carbon fiber preparation. E-beam irradiated polyacrylonitrile grafted carbon nanofibers were dispersed in polyacrylonitrile solution (dissolved in dimethyl formamide). Carbon nanofibers (CNF) infused polyacrylonitrile solution was wet spun on a lab-scale wet-spinning setup to form 50 to 70 µm diameter fibers with 3.2 wt.% CNF-PAN, 6.4 wt.% CNF-PAN, and neat PAN. Precursor fibers were characterized for thermal, mechanical and morphological properties using various techniques. Drawing the precursor fibers further enhanced polymer chain orientation and coalesced the voids, enhancing tensile strength and modulus by more than 150% compared to those of the undrawn fibers. Precursor composite fibers on carbonization showed enhanced strength, compared to that of pristine PAN fibers, by four times and stiffness by 14 times. The carbon–carbon composite fibers were further characterized with SEM/FIB, XRD and tensile strength. The property improvements were dependent on the uniform distribution of carbon nanofibers, and surface modification of carbon nanofibers further enabled their dispersion in the composite fibers. Furthermore, 3.2 wt.% CNFs in PAN fibers showed maximum improvement in properties compared to 6.4 wt.% CNF in PAN fibers, indicating that the property enhancements go through a maximum and then drop off due to challenge in getting uniform distribution of nanofibers.

Liver and heart disease are major causes of death worldwide. It is known that metabolic alteration causing type 2 diabetes (T2D) and Nonalcoholic fatty liver (NAFLD) coupled with a derangement in lipid homeostasis, may exacerbate hepatic and cardiovascular diseases. Some pharmacological treatments can mitigate organ dysfunctions but the important side effects limit their efficacy leading often to deterioration of the tissues. It needs to develop new personalized treatment approaches and recent progresses of engineered RNA molecules are becoming increasingly viable as alternative treatments. This review outlines the current use of antisense oligonucleotides (ASOs), RNA interference (RNAi) and RNA genome editing as treatment for rare metabolic disorders. However, the potential for small non-coding RNAs to serve as therapeutic agents for liver and heart diseases is yet to be fully explored. Although miRNAs are recognized as biomarkers for many diseases, they are also capable of serving as drugs for medical intervention; several clinical trials are testing miRNAs as therapeutics for type 2 diabetes, nonalcoholic fatty liver as well as cardiac diseases. Recent advances in RNA-based therapeutics may potentially facilitate a novel application of miRNAs as agents and as druggable targets. In this work, we sought to summarize the advancement and advantages of miRNA selective therapy when compared to conventional drugs. In particular, we sought to emphasise druggable miRNAs, over ASOs or other RNA therapeutics or conventional drugs. Finally, we sought to address research questions related to efficacy, side-effects, and range of use of RNA therapeutics. Additionally, we covered hurdles and examined recent advances in the use of miRNA-based RNA therapy in metabolic disorders such as diabetes, liver, and heart diseases.

BackgroundThe psychological impact of the COVID-19 pandemic on healthcare professionals has been widely studied, along with different strategies to minimize it. However, professionals’ assessment of the social support received and the factors that mitigated their fear of contagion have not been described. This study aimed to assess healthcare professionals’ satisfaction with the social support and information received and their efforts to self-isolate to avoid infecting loved ones in Chile, Colombia, and Ecuador.MethodsA cross-sectional online survey, conducted from July to September 2020 in three Latin American countries, elicited healthcare professionals’ satisfaction with social support from colleagues, their community, the media, and scientific societies; as well as the information received about the evolution of the pandemic and measures to avoid contagion. The EASE scale was used to measure acute stress.ResultsSurvey responses were received from 700 professionals. The response rate per country exceeded the estimated sample size except in the case of Colombia, which was 81.4%. In general, peer support was highly valued, though satisfaction was lower in high-risk units (p

BackgroundThe COVID-19 pandemic has generated immense health care pressure, forcing critical decisions to be made in a socially alarmed environment. Adverse conditions have led to acute stress reactions, affective pathologies, and psychosomatic reactions among health personnel, which have been exacerbated by the successive waves of the pandemic. The recovery of the entire health system and its professionals has been hindered, making it essential to increase their resilience. ObjectiveThis study aimed to achieve 2 primary objectives. First, it sought to identify coping strategies, both individual and organizational, used by health care workers in Ecuador to navigate the acute stress during the early waves of the pandemic. Second, it aimed to develop training materials to enhance team leaders' capabilities in effectively managing high-stress situations. MethodsThe study used qualitative research techniques to collect information on institutional and personal coping strategies, as well as consensus-building techniques to develop a multimedia psychological tool that reinforces the resilience of professionals and teams in facing future crises. ResultsThe findings from the actions taken by health care workers in Ecuador were categorized into 4 types of coping strategies based on Lazarus' theories on coping strategies. As a result of this study, a new audiovisual tool was created, comprising a series of podcasts, designed to disseminate these strategies globally within the Spanish-speaking world. The tool features testimonials from health care professionals in Ecuador, narrating their experiences under the pressures of providing care during the pandemic, with a particular emphasis on the coping strategies used. ConclusionsEnsuring the preparedness of health professionals for potential future outbreaks is imperative to maintain quality and patient safety. Interventions such as this one offer valuable insights and generate new tools for health professionals, serving as a case study approach to train leaders and improve the resilience capacity and skills of their teams.

El presente trabajo tiene como objetivo caracterizar el ordenamiento territorial del desarrollo rural en el cantón Tosagua, provincia de Manabí, mediante la recolección de datos y análisis de atributos de la cartografía shape representada en mapas temáticos. La investigación desarrollada fue de tipo descriptivo, con un diseño no experimental y un enfoque metodológico mixto. Para caracterizar el territorio y sus potencialidades, se analizó el Plan de Desarrollo y Ordenamiento Territorial del cantón Tosagua, se aplicó la técnica de observación de campo directa para la malla rural, y se analizó la variada cartografía satelital shape disponible por el Instituto Geográfico Militar del Ecuador. Para determinar las potencialidades del desarrollo agropecuario se recolectó información en la Unidad de Ordenamiento Territorial del Departamento de Planificación del Gobierno Autónomo Descentralizado Municipal del Cantón Tosagua, y se analizaron las bases de datos de las imágenes cartográficas, así como los archivos shape proporcionados. Los resultados obtenidos permiten concluir sobre la necesidad de implementar estrategias dentro del marco legal del ordenamiento territorial para regular el uso y gestión de suelo en el cantón Tosagua.

Abstract Introduction Diabetes is the second leading cause of death in Ecuador, as 79% of the indigenous population live in rural areas that are difficult to access and have below‐average health resources. The objective of this study was to define person‐centred indicators to monitor the care received by patients with diabetes in the indigenous population. Method Qualitative research combining three focus groups (with the participation of 10 patients and 18 professionals) to capture relevant information and Delphi to reach a consensus on the pertinence, relevance, and feasibility of a set of indicators was conducted. Two rounds of the Delphi technique were performed, with the participation of 64 professionals in the first round (90% response rate) and 34 in the second round (53% response rate). Results A total of 23 indicators were identified which were distributed in the previously identified six dimensions (cosmovision, accessibility, adaptability to cosmovision, resources, equipment, community care, quality culture and results). Conclusions The consensus on the set of indicators among all the participants in this study strengthened the results obtained. These indicators have considered the feasibility and relevance and aimed to achieve comprehensive person‐centred care for diabetes among the indigenous population in Ecuador and possibly the Andean community. Patient or Public Contribution These indicators’ development included patients and caregivers since its conception. During the qualitative phase of this research, relevant information on cultural and social beliefs was gathered directly from the study population to achieve patient‐centred indicators for adequate diabetes care.

Abstract Introduction The global prevalence of diabetes in 2019 in adults was estimated to be 9.3%. This study developed in Ecuador, for the first time, instruments to assess patient‐reported outcomes and experiences. Methods The Experiences of the Person with Diabetes (EPD) Questionnaire is a diabetes‐specific instrument. A mixed‐methods study was conducted. First, a qualitative item development phase that included four focus groups and six semi‐structured interviews with patients was conducted in different rural and urban areas of Ecuador to obtain information on culture, beliefs, demographics, diet and social perspectives. A second quantitative phase for psychometric validation was carried out in primary care settings of rural and urban areas of Ecuador. Results Forty‐two and four hundred and eighty‐nine participants were included in each phase, respectively. The item development phase resulted in a questionnaire of 44 items (23 for perceived outcomes and 21 for experiences). In the validation study, most participants were women (58%) and from urban areas (57%). Exploratory factor analysis revealed three dimensions for each instrument. Outcomes instrument dimensions were symptoms and burnout, worries and fears and social limitations. Experiences instrument dimensions were information, patient‐centred care and care delivery. Cronbach's α values of the total score and dimensions were high, ranging between .81 and .93 in both instruments. Confirmatory factor analysis showed an acceptable fit of the data. Conclusion The EPD Questionnaire is probably the first instrument developed to assess patient‐reported experiences and perceived outcomes in a middle‐income country that included patients to capture all dimensions relevant for the intended population. Its psychometric properties are robust and could provide valuable information for clinicians and policymakers in the region. Patient or Public Contribution The development of these instruments has taken into consideration patients and the public since their conception. A qualitative approach gathered relevant information related to the cultural, social and economic burden of different populations in Ecuador. Before validation, a pilot test was carried out with users of the National Health Services to obtain their perspectives and insights of the developed instrument. Finally, during the data analysis, we have given special consideration to social variables such as rural and urban populations.

Implant-supported prostheses could serve as a reliable restorative option for partial edentulism. Various restorative materials have been utilized in fabricating these prostheses, impacting both esthetics and peri-implant health. The present systematic review aimed to assess the survival rate and mechanical complications of zirconia ceramic compared to metal-ceramic implant-supported multiunit fixed dental prostheses (FDPs). We conducted searches in online databases such as MEDLINE (PubMed), Scopus, and Cochrane up until December 2022. A risk-of-bias assessment was done for all the included studies. Data extraction was performed based on the following parameters: author, year, study design, number of implants, abutment material, age range, observation period, incidence of mechanical complications, and survival rate. This systematic review included six studies (four randomized controlled trials and two retrospective studies). The meta-analysis significantly favored metal-ceramic restorations regarding mechanical complications with a risk ratio (RR) value of 1.64 and P = 0.001. Meta-analysis showed no difference in metal-ceramic FDPs in prostheses survival rate (P = 0.63; RR: 1.27, 95% confidence interval: 0.52–3.37; heterogeneity: P = 0.65; I2: 0%). While metal-ceramic multiunit implant-supported prostheses exhibited fewer mechanical complications compared to zirconia-ceramic prostheses, there was no significant difference in terms of prosthesis survival rate between the two. Hence, both treatments appear to be viable options for long-term implant-supported prostheses.

Chemotherapy and radiotherapy resistance are major obstacles in the long-term efficacy of head and neck squamous cell carcinoma (HNSCC) treatment. Secondhand smoke (SHS) exposure is common and has been proposed as an independent predictor of HNSCC recurrence and disease-free survival. However, the underlying mechanisms responsible for these negative patient outcomes are unknown. To assess the effects of SHS exposure on cisplatin efficacy in cancer cells, three distinct HNSCC cell lines were exposed to sidestream (SS) smoke, the main component of SHS, at concentrations mimicking the nicotine level seen in passive smokers’ saliva and treated with cisplatin (0.01–100 µM) for 48 h. Compared to cisplatin treatment alone, cancer cells exposed to both cisplatin and SS smoke extract showed significantly lower cisplatin-induced cell death and higher cell viability, IC50, and indefinite survival capacity. However, SS smoke extract exposure alone did not change cancer cell viability, cell death, or cell proliferation compared to unexposed control cancer cells. Mechanistically, exposure to SS smoke extract significantly reduced the expression of cisplatin influx transporter CTR1, and increased the expression of multidrug-resistant proteins ABCG2 and ATP7A. Our study is the first to document that exposure to SHS can increase cisplatin resistance by altering the expression of several proteins involved in multidrug resistance, thus increasing the cells’ capability to evade cisplatin-induced cell death. These findings emphasize the urgent need for clinicians to consider the potential role of SHS on treatment outcomes and to advise cancer patients and caregivers on the potential benefits of avoiding SHS exposure.

Abstract This study analyzed the frequency and intensity of acute stress among health professionals caring for COVID-19 patients in four Latin American Spanish-speaking countries during the outbreak. A cross-sectional study involved a non-probability sample of healthcare professionals in four Latin American countries. Participants from each country were invited using a platform and mobile application designed for this study. Hospital and primary care workers from different services caring for COVID-19 patients were included. The EASE Scale (SARS-CoV-2 Emotional Overload Scale, in Spanish named Escala Auto-aplicada de Sobrecarga Emocional) was a previously validated measure of acute stress. EASE scores were described overall by age, sex, work area, and experience of being ill with COVID-19. Using the Mann–Whitney U test, the EASE scores were compared according to the most critical moments of the pandemic. Univariate and multivariate analysis was performed to investigate associations between these factors and the outcome ‘acute stress’. Finally, the Kruskal–Wallis was used to compare EASE scores and the experience of being ill. A total of 1372 professionals responded to all the items in the EASE scale: 375 (27.3%) Argentines, 365 (26.6%) Colombians, 345 (25.1%) Chileans, 209 (15.2%) Ecuadorians, and 78 (5.7%) from other countries. 27% of providers suffered middle-higher acute stress due to the outbreak. Worse results were observed in moments of peak incidence of cases (14.3 ± 5.3 vs. 6.9 ± 1.7, p

La gestión de proyectos abarca una variedad de metodologías adaptables. La innovación tecnológica en salud es trascendental, su éxito depende del método para implementar, adquirir o desarrollar los servicios hospitalarios. La investigación tuvo como objetivo desarrollar un modelo de gestión de proyectos para el área de imagenología de los hospitales generales de Manabí del Instituto Ecuatoriano de Seguridad Social. Se aplicó un enfoque mixto, cuantitativo-cualitativo. Se realizó un análisis bibliográfico documental sobre proyectos de imagenología, metodologías y buenas prácticas; para analizar producción y tiempos; con un diseño descriptivo y explicativo de tipo no experimental, transversal. La población y muestra seleccionada fue de doce funcionarios, encargados de la administración de sistemas e imagenología de los hospitales, se utilizaron métodos teóricos, empíricos, estadísticos y técnicas de investigación como encuesta, entrevista y validación a expertos a través del método Delphi. Se analizaron metodologías ágiles y tradicionales, características, factores de aplicación y costos, lo que permitió desarrollar una propuesta de modelo de gestión de proyectos basado en una metodología híbrida que da importancia a la empatía, y se basa en grupos de trabajo, recursos y resultados esperados una vez que se lleve a cabo la implementación.

Abstract We present how altering the chain flexibility affects the nanoscale organization of polymer‐grafted nanoparticles (PGNPs) and its ultimate impact on macroscale thermal properties. To isolate the role of chain flexibility on wetting behavior in athermal polymer nanocomposites (PNC), the graft and matrix chemistry is kept identical by utilizing 1,3‐cyclohexadiene‐based polymer materials. Increasing the rigidity and molecular weight of both the graft and matrix is found to favor mixing of poly(1,3‐cyclohexadiene) PCHD‐grafted silica NPs with the matrix, supported by a concomitant increase in glass transition temperatures of the PNCs. Further, the associated entropic factors that drive wetting behavior and dispersion of PGNPs are discussed, emphasizing the dominant role‐played by chain flexibility. Alterations in graft flexibility had the strongest impact on dispersion and Tg values of the PNC, while molecular weight (MW) plays a secondary role. This investigation is a unique demonstration of how chain flexibility alteration in athermal semiflexible systems can be used to alter NP organization by altering filler‐matrix wettability which also impacts thermal properties.

La sociedad ecuatoriana demanda a las instituciones del bachillerato y de la educación superior desde la articulación con el desarrollo nacional, donde el estudiante sea el artífice fundamental del proceso. El objetivo seguido con el presente material documental es el abordaje sobre los elementos a tener en cuenta con la actitud emprendedora, las fases sobre el proceso de creación de empresas viables, así como para el desarrollo de acciones que conforman una estrategia en el trabajo con las principales habilidades, aptitudes y actitudes en el logro de metas sobre emprendedurismo. La metódica utilizada fue descriptiva, bibliográfica y documental. Se concluye que existe una necesidad latente de trabajar con los elementos relacionados con la capacitación y preparación en emprededurismo en jóvenes en la etapa del bachiller técnico y universitaria en la cual se utilicen acciones estratégicas, para dotar a los mismos con las competencias para la capitalización de los conocimientos en su plan de vida, con la creación de su propia empresa y en alcanzar la superación de las fronteras tradicionales. PALABRAS CLAVE: Emprededurismo; Actitud emprendedora; Estrategia. Strategic aspects to encourage the entrepreneurial attitude in third-year students of the Agricultural Technical High School ABSTRACT Ecuadorian society demands high school and higher education institutions from the articulation with national development, where the student is the fundamental architect of the process. The objective followed with this documentary material is the approach on the elements to consider with the entrepreneurial attitude, the phases on the process of creating viable companies, as well as for the development of actions that make up a strategy in the work with the companies. main skills, aptitudes, and attitudes in the achievement of goals on entrepreneurship. The method used was descriptive, bibliographic and documentary. It is concluded that there is a latent need to work with the elements related to training and preparation in entrepreneurship in young people in the stage of technical and university bachelor in which strategic actions are used, to equip them with the skills to capitalize on the knowledge in their life plan, with the creation of their own company and in reaching the overcoming of the traditional borders. KEYWORDS: Entrepreneurship; Entrepreneurial attitude; Strategy.

Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers.Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

El artículo describe los resultados de una investigación que tiene el propósito de elaborar una guía didáctica para el desarrollo del lenguaje en niños de 4 años de la escuela “José de Vasconcellos”. Los referentes teóricos están enmarcados en los postulados de las teorías constructivistas Piagetiana y Vigotskyana, en lo que respecta al desarrollo del lenguaje. Metodológicamente, la investigación se enmarcó en un enfoque cualitativo, con el método de Investigación Acción según el modelo de Elliot (2000). Para la recolección de información se pusieron en práctica la revisión documental y la observación participante, con el uso de las notas de campo para el registro de datos. El grupo objeto de estudio estuvo conformado por 18 estudiantes, 18 padres de familia, 1 docente y la directora del plantel. El estudio se desarrolló en tres fases, la fase uno permitió descubrir algunas debilidades en el desarrollo del lenguaje de los niños; la fase dos sirvió para activar la participación de los involucrados para el diseño de la guía didáctica, asumida según Hernández (2015). En la fase tres se validó la guía mediante expertos y se aplicó en prueba a un grupo de niños. Sometido el proceso a la discusión cooperativa, se concluye que la investigación es pertinente, siendo recomendable su aplicación a niños de cuatro años de edad.

Este artículo sintetiza el trabajo de investigación desarrollado en la Escuela “José de Vasconcellos”, el cual tuvo como objetivo establecer la incidencia de la formación de emociones en la inestabilidad motriz en 19 niños de 4 a 5. A tal efecto, se diseñó una investigación con método mixto con la aplicación del test TEPSI (Haeusler y Marchant), una encuesta dirigida a 25 padres y madres y entrevistas abiertas a la docente y a la autoridad escolar. Los resultados del test y de la encuesta revelan la existencia de considerables disfunciones en las áreas de desarrollo denominadas Coordinación, Motricidad y Lenguaje, siendo esta última la de niveles disfuncionales más altos, resultados éstos que llevan a concluir sobre la existencia de inestabilidad motriz entre los niños. Por otra parte, se corroboró la aplicación de estrategias didácticas en el aula para la formación de emociones que se consideraron eficientes por su incidencia en la regulación emocional de los niños.

A partir del escenario marcado por el Covid-19, el mundo ha tenido que asumir trasformaciones en la forma de realizar sus diferentes actividades. Ecuador ha realizado ajustes estratégicos en el área de salud, ciencia, tecnología y educación; como los pilares básicos para la toma de las decisiones fundamentadas del país. Con la declaración de emergencia sanitaria en todo el territorio nacional, garantizar la eficiencia en los diferentes procesos representa una tarea de vital importancia. Las Instituciones de la Educación Superior, fueron pioneras en la adopción de las medidas preventivas asociadas a la Covid-19, y en la implementación del teletrabajo. En este escenario, cuantificar el comportamiento del talento humano ayudaría a garantizar los objetivos planteados y fomentar su crecimiento. La presente investigación tiene como objetivo implementar un modelo para la evaluación del desempeño. El modelo fue aplicado en trabajadores de la Universidad Estatal del Sur de Manabí. Como resultado se aplicó la técnica de Iadov para evaluar el nivel de satisfacción de los usuarios finales. La propuesta fue valorada de 0.94 representando alta satisfacción.

Abstract In response to muscle injury, muscle stem cells integrate environmental cues in the damaged tissue to mediate regeneration. These environmental cues are tightly regulated to ensure expansion of muscle stem cell population to repair the damaged myofibers while allowing repopulation of the stem cell niche. These changes in muscle stem cell fate result from changes in gene expression that occur in response to cell signaling from the muscle environment. Integration of signals from the muscle environment leads to changes in gene expression through epigenetic mechanisms. Such mechanisms, including post-translational modification of chromatin and nucleosome repositioning, act to make specific gene loci more, or less, accessible to the transcriptional machinery. In youth, the muscle environment is ideally structured to allow for coordinated signaling that mediates efficient regeneration. Both age and disease alter the muscle environment such that the signaling pathways that shape the healthy muscle stem cell epigenome are altered. Altered epigenome reduces the efficiency of cell fate transitions required for muscle repair and contributes to muscle pathology. However, the reversible nature of epigenetic changes holds out potential for restoring cell fate potential to improve muscle repair in myopathies. In this review, we will describe the current knowledge of the mechanisms allowing muscle stem cell fate transitions during regeneration and how it is altered in muscle disease. In addition, we provide some examples of how epigenetics could be harnessed therapeutically to improve regeneration in various muscle pathologies.

Abstract Tobacco smoking is the leading preventable cause of cancer. Moreover, continued smoking during cancer therapy reduces overall survival. Aware of the negative consequences of tobacco smoking and the challenges of smoking cessation, cancer patients are inquiring whether they should switch to electronic cigarettes (e-cigarettes). To obtain evidence-based data to inform this decision, we examined the effects of e-cigarette aerosol exposure on cisplatin resistance in head and neck cancer cells. Our results show that cancer cells exposed to e-cigarette aerosol extracts and treated with cisplatin have a significant decrease in cell death, increase in viability, and increase in clonogenic survival when compared to non-exposed cells. Moreover, exposure to e-cigarette aerosol extracts increased the concentration of cisplatin needed to induce a 50% reduction in cell growth (IC50) in a nicotine-independent manner. Tobacco smoke extracts induced similar increases in cisplatin resistance. Changes in the expression of drug influx and efflux transporters, rather than activation of cell growth-promoting pathways or DNA damage repair, contribute to e-cigarette induced cisplatin resistance. These results suggest that like combustible tobacco, e-cigarette use might increase chemotherapy resistance, and emphasize the urgent need for rigorous evaluation of e-cigarettes health effects to ensure evidence-based public health policies.

Abstract Background Headache is one of the most prevalent diseases. The Global Burden of Disease Study ranks it as the seventh most common disease overall and the second largest neurological cause of disability in the world. The “Do Not Do” recommendations are a strategy for increasing the quality of care and reducing the cost of care for headache. This study aimed to identify specific low-value practices in headache care, determine their frequency, and estimate the cost overrun that they represent, in order to establish “Do not Do” recommendations specifically for headache by consensus and according to scientific evidence. Methods This was a mixed methods research study that combined qualitative consensus-building techniques, involving a multidisciplinary panel of experts to define the “Do Not Do” recommendations in headache care, and a retrospective observational study with review of a randomized set of patient records from the past 6 months in four hospitals, to quantify the frequency of these “Do Not Do” practices. We calculated the sum of direct costs of medical consultations, medicines, and unnecessary diagnostic tests. Results Seven “Do Not Do” recommendations were established for headache. In total, 3507 medical records were randomly reviewed. Low-value practices had a highly variable occurrence, depending on the hospital and type of headache. Overall, 34.1% of low-value practices were related to treatment, 21% were related to overuse of imaging in consultation, and 19% were related to emergency care. The estimated cost of low-value practices in the four hospitals was 203,520.47 euros per 1000 patients. Conclusions This study identified low-value headache practices that need to be eradicated and provided data on their frequency and cost overruns.

Organ donation after brain stem death is quite common in the west. In India, the procedure is still gaining acceptance. The surgical steps for multi-organ retrieval have evolved in different centers with significant variations, and the scientific evidence levels for each technique are low. Organ retrieval requires a fairly rapid surgical technique to avoid ischemic injury to the target organs yet avoid iatrogenic injuries. This article offers and outline of the multi-organ donation procedure. It details the abdominal organ retrieval techniques and touches on thoracic organs and composite tissue grafts as well. It also briefly touches upon machine perfusion of organs.

Background: Microvascular flap reconstruction (MFR) of medium–large tongue defects following ablative surgery is the standard of care. The decision for MFR is often made prior to surgery or intraoperatively depending on the extent of the defect and the volume of remnant tongue. However, there exists no objective technique to predict this requirement preoperatively. This knowledge is crucial for counseling and planning. We aimed to identify an objective magnetic resonance imaging (MRI) measurement tool to predict the need for MFR of tongue tumors. Materials and Methods: This was a retrospective analysis of patients undergoing surgery (with or without reconstruction) for squamous cell carcinoma of the tongue. Patients had a preoperative MRI as part of their assessment. As per our institution protocol, the decision for the requirement of MFR was made by a consensus of two experienced reconstructive surgeons intraoperatively. This decision was correlated with the ratio of tumor volume to the total tongue volume (tv) as observed in the MRI. Results: A total of 47 patients were identified. Twenty-eight patients underwent reconstruction, while 19 did not. The ratio of tumor thickness to tongue thickness (Tt/tt) was calculated, and a cutoff of >0.395 (sensitivity 89.3% and specificity 89.5%) was found to significantly correlate with the decision for MFR (P < 0.001). The volume of a tumor to total tv ratio was calculated from the data of 22 cases, and a cutoff of >4.2 (sensitivity 83.3 and specificity 90) was found to be correlated significantly with the decision for MFR (P < 0.001). Conclusion: Tt/tt ratio is a useful tool to determine the need for MFR of tongue tumor excision defects in the preoperative setting and can help guide counseling.

Introduction: Microsurgical tissue transfer in the pediatric population is challenging for several reasons– small vessel diameter, flap size, difficulties with postoperative flap monitoring, and difficulty in anticipating tissue growth and remodeling. In addition, head-and-neck reconstruction is uniquely difficult due to the functional deficits after ablative surgery. We present our series of microvascular reconstruction for tumors of the head and neck in the pediatric population. Materials and Methods: Retrospective review of microvascular reconstruction performed in our institution for benign and malignant tumors of the head and neck for patients aged

This study analyses the bycatch composition of an artisanal shrimp trawl fleet operating between Cabo Blanco and Máncora in Northern Peru between April 2019 and March 2020. A total of 300 hauls were analysed with respect to target catch and bycatch (consisting of other commercial species, discards, and macroalgae). A total of 277 species were recorded including 111 species of fish, 65 species of molluscs, 51 species of crustaceans, 22 species of algae, 12 species of cnidarian, 9 species of echinoderms, 4 species of Bryozoa and 3 species of polychaeta. Capture per unit effort (CPUE, kg.h-1) was highest for fish, followed by crustaceans, algae and molluscs. The target species Penaeus californiensis coffee shrimp constituted 17.8% of the overall catch,82.2% represented bycatch, and 50.6% represented discards. Coffee shrimps were more abundant in June and November 2019 and in January and February 2020. Highest bycatch CPUE occurred in May, June and December 2019. The most abundant species in the bycatch throughout the study period were sand perch (Diplectrum conceptione, 16% weight of the total catch), the macroalgae caulerpa (Caulerpa filiformis, 13%), sole flounder (Etropus ectenes, 6.4%), Pacific drum (Larimus pacificus, 5.7%), and lumptail searobin (Prionotus stephanophrys, 5.1%). Overall, the contribution of sand perch and flounder, exceeded the weight of coffee shrimp, therefore the interpretation that shrimp is the sole target species needs to be revised. The number of discarded species per month increased towards the spring months with the highest value in November. This study represents the first characterisation of bycatch in the artisanal trawling fishery in the Piura region in northern Peru and reveals a high proportion of bycatch in the fishery but also hints at potential temporal management measures that could be imposed to reduce the levels of bycatch. For example, the months of May and December had the greatest bycatch to shrimp ratios and the fishery could potentially be closed to avoid high bycatch risk, however, longer term information is needed to assess if the trends observed in bycatch are similar over longer periods of time. The species characterisation of bycatch also provides information for the design of modified nets which would target the reduction of small fish present in the catch.

Introduction Vascularized composite allotransplantation (VCA) has added another step to the reconstructive ladder, leading to a paradigm shift in the approach toward management of cases of upper limb amputations. In this article, we discuss in detail the technical aspects of proximal forearm level transplantation, as well as the immediate posttransplant monitoring and immunosuppression protocols. Materials and Methods A 24-year-old male victim of an electric injury presented with a bilateral proximal forearm level amputation. After the mandatory preoperative psychiatric and immunological evaluation, the patient underwent a proximal forearm level double upper extremity transplantation. He was then put on a stringent immunosuppression and physical rehabilitative regime. Discussion Conceptually, the proximal forearm level transplantation is significantly different from distal forearm level transplant. This transplant “reestablishes” the “donor extremity length,” maintains the normal functional length of the donor muscles, and the functional return happens only after the newly transplanted donor muscles are reinnervated over a period of time. Conclusion As the sequence of surgical repair and associated decision making could be quite confusing for this level of transplantation, it is highly advisable to do mock cadaver surgical dissections in order to standardize the procedure and make the team familiar with it.

Introduction This is the first case of supracondylar level transplant from the Indian subcontinent, performed for a bilateral below elbow amputee. It has a completely different set of challenges for the transplant team, with a relatively shorter ischemia time window. The technical considerations for the same have been discussed in detail in this article. Materials and Methods The patient was a 19-year-old female who lost her both upper limbs at proximal forearm level due to severe crush injury following a road traffic accident. Insufficient bone length on either side necessitated a supracondylar level transplant. The preoperative workup included detailed clinical evaluation, biochemical, and psychological evaluation. The donor was a young brain-dead, male patient from a hospital, 30 minutes away. The donor and recipient preparations in this case were unique. The recipient’s own elbow flexors and extensors were used while the elbow joint was from the donor. The specific challenges we faced during this procedure have been described in detail. Results The transplantation has been a complete technical success, with the patient rehabilitated back to her independent life style. This article describes only the technical considerations. The functional recovery aspect is part of an another soon to be published manuscript. Conclusion Supracondylar level arm-transplant requires a highly coordinated team effort with precise preoperative planning, along with meticulous attention to detail to achieve a successful outcome. In properly selected patients, it could be a life-changing procedure, worth all the effort.

El presente artículo científico tiene como fin proponer la orientación psicosocial y psicoeducativa a las familias de pacientes que padecen cáncer, para esto primeramente se ha procurado una revisión documental en relación al tema de estudio, se ha investigado sobre el rol acompañador y de apoyo que la familia en momentos de crisis cumple, partiendo en la certeza de los múltiples cambios que la sociedad moderna impone a ese rol. Posteriormente se realizó un recorrido por los aspectos teóricos más relevantes sobre funcionamiento familiar ante un diagnóstico de cáncer, desde el punto de vista de los cambios en el paciente y en la familia, impacto e intervención psicosocial señalando que el paciente debe contar con asistencia multiprofesional, la orientación psicoeducativa desde el punto de vista de las actividades complementarias en el tratamiento, la importancia de la orientación psicosocial y psicoeducativa tanto para el paciente como para sus familias, y finalmente la descripción del sistema de actividades para la orientación psicosocial y psicoeducativa, seguidas de las conclusiones extraídas del tema desarrollado. PALABRAS CLAVE: Orientación; psicosocial; psicoeducativo; familias; cáncer. PSYCHOSOCIAL AND PSYCHOEDUCTIVE ORIENTATION TO FAMILIES OF PATIENTS WHO HAVE CANCER ABSTRACT The purpose of this scientific article is to propose psychosocial and psychoeducational guidance to families of patients suffering from cancer. Firs to fall, a documentary review has been sought in relation to the subject to the study, and research has been carried out on the accompanying and supportive role that the Family in times of crisis meets, departing from the certainty of the multiple changes that modern society imposes on that role. Subsequently, are view was made of the most relevant theoretical aspects of family functioning in the face of a cancer diagnosis, from the point of view of changes in the patient and the family, impact and psychosocial intervention indicating that the patient must have multi-professional assistance, the psychoeducational orientation from the point of view of the complementary activities in the treatment, the importance of the psychosocial and psychoeducational orientation for both the patient and their families, and finally the description of the system of activities for the psychosocial and psychoeducational orientation, followed by the conclusions drawn from the theme developed. KEYWORDS: Guidance; psychosocial; psychoeducational; families; cancer.

This paper assesses the need for fourth level training in the area of environmental engineering in the province of Manabí, Ecuador, based on the objectives proposed in the National Development Plan (2017-2021). The analysis was carried out through the application of a survey aimed at 1,000 professionals linked to environmental activities in the public and private sectors. The results obtained demonstrate the pertinence in the development of a research master's degree that responds to the needs and demands of the region and the country, which must develop scientific research in the fields of environmental and health engineering; conduct environmental feasibility studies of processes and projects; design, direct and execute water and wastewater sampling processes; as well as new technologies for the treatment of solid and liquid waste and the optimization of inputs, products and processes.

Purpose: To survive, organizations must have a competitive advantage in order to stay ahead of the competition. Market innovation has remained the driving force behind most market expansions and stability in the turbulent nature of global economies. This study sought to establish the influence of market innovation on the competitive advantage of telecommunication companies in Kenya. Design/Method/Approach: Using the philosophy of positivism, the study adopted an explanatory research design in testing the hypothesis. The main data collection instrument was a structured questionnaire using both physical conduct and online interactions to return 247 responses from mid and top level managers in a total of 26 active telecommunications companies in Kenya. The study used both descriptive and inferential statistics using SPSS computer application to analyze the data. Findings: From the study findings, it was established that innovative distribution channels significantly influenced the competitive advantage while advertising and promotions did not have a significant influence. This led to the conclusion that market innovation has a significant influence on the competitive advantage of telecommunication companies in Kenya. Practical implications: The study recommends that telecommunication companies need to form collaborations and partnerships for ease of establishing market distribution channels that have indicated to bring influence onto the competitive advantage of the companies. Other recommendations include a wider coverage of the East African market for the telecommunications sector. The study provides insights into new companies with interest in the region. Originality/Value: From the results marketing and promotions are not the only major contributing factor in the competitive advantage but the channels of distribution. Research limitations/Future research: The study faced limitations on having to visit the field during the COVID-19 pandemic period thus encountering the restrictions of entry into premises. All protocols were observed to overcome that obstacle. Some of the telecommunications companies were facing difficulties in operations and hence could not participate. Paper type: empirical

Objectives To determine the volume of health professionals who suffered distress due to their care of patients with COVID-19 and to analyse the direction in which the response capacity of the professionals to face future waves of COVID-19 is evolving.Design A cross-sectional study.Setting Primary care and hospitals in Spain.Participants A non-randomised sample of 685 professionals (physicians, nurses and other health staff).Primary and secondary outcome measures Frequency and intensity of stress responses measured by the Acute Stress of Health Professionals Caring COVID-19 Scale (EASE). Variation of stress responses according to the number of deaths per day per territory and the evolutionary stage of the COVID-19 outbreak measured by the Kruskal-Wallis and the Mann-Whitney U tests.Results The average score on the EASE Scale was 11.1 (SD 6.7) out of 30. Among the participants, 44.2% presented a good emotional adjustment, 27.4% a tolerable level of distress, 23.9% medium–high emotional load and 4.5% extreme acute stress. The stress responses were more intense in the most affected territories (12.1 vs 9.3, p=0.003) and during the disillusionment phase (12.7 vs 8.5 impact, 10.2 heroic and 9.8 honeymoon, p=0.000).Conclusions The pandemic has affected the mental health of a significant proportion of health professionals which may reduce their resilience in the face of future waves of COVID-19. The institutional approaches to support the psychological needs of health professionals are essential to ensure optimal care considering these results.

La aplicación de las ontologías en el aprendizaje adaptativo contribuyen implementar alternativas tecno – pedagógicas con un profundo fundamento computacional. Para proyectar investigaciones de innovaciones educativas es importante determinar cuáles son los principales pares de variables dependiente (VD) y independiente (VI) que se han estudiado en el último lustro (2015-2019). En esta década, diversos estudios teóricos están presentes en Scopus hasta el 2018 pero no logran identificar por cada publicación la relación VD-VI. Ello motivó a realizar un mapeo sistemático empleando criterios establecidos en el protocolo PRISMA. Se seleccionaron 289 trabajos (ACM Digital Library (94), IEEE Xplorer (100) y Scopus (95)). Al aplicarse rigurosos criterios de inclusión y exclusión se escogieron 53 publicaciones. Se observa que existen resultados en esta área del conocimiento aun así, la aplicación de métodos híbridos que logre integrar sistemas de recomendación de objetos de aprendizaje adaptativos con diversas técnicas de recomendación, por ejemplo: basados por contenido, filtrado colaborativo y en ontologías, es aún incipiente. Se concluye que los pares de variables que mayor frecuencia evidenciaron fueron: VD: sistema de aprendizaje adaptativo – VI: modelo basado en ontologías difusas; VD: evaluación de habilidades – VI: modelo basado en ontologías difusas; VD: objetos de aprendizaje – VI: modelo basado en ontologías; VD: estilos de aprendizaje – VI: modelo basado en ontologías; VD: repositorios de recursos educativos digitales – VI: máquinas de soporte vectorial; VD: clasificación y agrupación de estudiantes – VI: modelo basado en ontologías.

Many affected counties have had experienced a shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. We aimed to investigate the needs of healthcare professionals and the technical difficulties faced by them during the initial outbreak. A cross-sectional web-based survey was conducted among the healthcare workforce in the most populous cities from three Latin American countries in April 2020. In total, 1,082 participants were included. Of these, 534 (49.4%), 263 (24.3%), and 114 (10.5%) were physicians, nurses, and other professionals, respectively. At least 70% of participants reported a lack of PPE. The most common shortages were shortages in gown coverall suits (643, 59.4%), N95 masks (600, 55.5%), and face shields (569, 52.6%). Professionals who performed procedures that generated aerosols reported shortages more frequently (p

Background: Pharyngeal reconstruction is a challenging aspect of reconstruction after resections for head-and-neck cancer. The goals of reconstruction are to restore the continuity of the pharyngeal passage to enable oral alimentation and rehabilitation of speech wherever possible. This study was performed to determine the outcomes following pharyngeal reconstruction in total laryngectomy (TL) using different reconstructive options and to determine the predictors of pharyngocutaneous fistula (PCF) and swallowing dysfunction. Materials and Methods: Retrospective analysis of patient data between 2003 and 2010 of patients undergoing TL with partial or total pharyngectomy. Demographic and treatment details were collected and analysed. Univariate analysis was performed to determine predictors of PCF and swallowing dysfunction. Results: Fifty-seven patients underwent pharyngeal reconstruction following TL, 31 of whom had received prior treatment. Following tumour resection, 31 patients had circumferential defects and 26 patients had partial pharyngeal defects. The flaps used include pectoralis major myocutaneous flap (n = 29), anterolateral thigh flap (n = 8), gastric pull-up (n = 13) and free jejunal flap (n = 7). PCF was seen in 20 patients, of which 15 (75%) were managed conservatively and 5 required another surgery. At last follow-up, 99 patients (68%) were on full oral alimentation. Tracheo-oesophageal puncture and prosthesis insertion was done in 20 patients, of whom 17 (85%) developed satisfactory speech. Partial pharyngeal defects were associated with a higher risk of PCF on univariate analysis (P = 0.006) but were not significant on multivariate analysis. Post-operative swallowing dysfunction was significantly higher with hypopharyngeal involvement by tumour (P = 0.003). Conclusion: Pharyngeal reconstruction in TL is feasible with good results. Majority of the patients swallow and regain acceptable swallowing function within 3 months.

La superación pedagógica está dirigida a mejorar el desempeño profesional de los docentes, así como a desarrollar competencias que le permitan incidir positivamente en el perfeccionamiento continuo del proceso de enseñanza aprendizaje en las universidades. Sin embargo aún persisten dificultades en los docentes en cuento al dominio de métodos didácticos y educativos, así como procedimientos que limitan la función metodológica, orientadora y educativa que debe desempeñar el docente universitario. Es por ello que este trabajo propone como objetivo fundamentar la necesidad de potenciar el desarrollo de las competencias pedagógicas de los docentes universitarios sustentada en el papel orientador que desempeña el docente como mediador del proceso de enseñanza - aprendizaje. A través del mismo se revela la importancia del papel que desempeña la superación pedagógica en la elevación de la calidad del aprendizaje y la formación integral del estudiante universitario, así como la necesidad de formar a los profesionales de la Educación Superior en herramientas didácticas y educativas encaminadas que les permita desde la dirección del proceso docente educativo modificar modos de comportamientos y actitudes ante el estudio de los estudiantes. Se propone una alternativa pedagógica que favorezca la orientación profesional de los docentes de la Universidad Técnica de Manabí. PALABRAS CLAVE: Superación pedagógica; desempeño profesional; superación profesional; competencias pedagógicas; orientación profesional. THE PEDAGOGICAL EDUCATION OF THE UNIVERSITY TEACHER: A NEED FOR POSTGRADUATE OVERCOMING ABSTRACT Pedagogical improvement is aimed at improving the professional performance of teachers, as well as developing competencies that allow them to positively influence the continuous improvement of the teaching-learning process in universities. However, there are still difficulties in teachers regarding the mastery of didactic and educational methods, as well as procedures that limit the methodological, guiding and educational function that should be performed by university teachers. For this reason, this paper proposes to support the development of the pedagogical competences of university teachers based on the guiding role of the teacher as mediator of the teaching - learning process. It reveals the importance of the role played by pedagogical improvement in raising the quality of learning and the integral training of university students, as well as the need to train Higher Education professionals in educational and educational tools aimed at That allows them from the direction of the educational process to modify modes of behavior and attitudes to the study of students. It proposes a pedagogical alternative that favors the professional orientation of the teachers of the Technical University of Manabí. KEYWORDS: Pedagogical improvement; professional performance; Advanced professional; pedagogical competences; professional orientation.

Carbon nanotube (CNT) yarns exhibit low tensile strength compared to conventional high-performance carbon fibers due to the facile sliding of CNTs past one another. Electron beam (e-beam) irradiation was employed for in a single-step surface modification of CNTs to improve the mechanical properties of this material. To this end, CNT yarns were simultaneously functionalized and crosslinked using acrylic acid (AA) and acrylonitrile (AN) in an e-beam irradiation process. The chemical modification of CNT yarns was confirmed by X-ray photoelectron spectroscopy (XPS), Raman spectroscopy and scanning electron microscopy (SEM). The best improvement in mechanical properties was achieved on a sample treated with an aqueous solution of AA and subsequent irradiation. CNT yarn treatment with AA enhanced the strength (444.5 ± 68.4 MPa) by more than 75% and the modulus (21.5 ± 0.6 GPa) by more than 144% as compared to untreated CNT yarn (strength 251 ± 26.5 MPa and modulus 8.8 ± 1.2 GPa).

Abstract Background Increased availability of maternal health services alone does not lead to better outcomes for maternal health.The services need to be utilized first.One way to increase service utilization is to plan responsive health care services by taking into account the community’s views or expressed needs. Burundi has a high maternal mortality ratio, and despite improvements in health infrastructure, skilled staff and the abolition of user fees for pregnant women,utilization of maternal health services remains low. Possible reasons for this include a lack of responsive healthcare services. An exploratory study was conducted in 2013 in two provinces of Burundi (Makamba and Kayanza), with the aim to collect the experiences of women and men with the maternal health services,their views regarding those services, channels used to express these experiences, and the providers’ reaction. Methods Semi-structured interviews were used to collect data from men and women and key informants, including community health workers, health committee members, health providers, local authorities, religious leaders and managers of non-governmental organizations. Data analysis was facilitated by MAXQDA 11 software. Results Negative experiences with maternal health services were reported and included poor staff behavior towards women and a lack of medicine. Health committees and suggestion boxes were introduced by the government to channel the community’s views. However, they are not used by the community members, who prefer to use community health workers as intermediaries. Fear of expressing oneself linked to the post-war context of Burundi, social and gender norms, and religious norms limit the expression of community members’ views, especially those of women. The limited appreciation of community health workers by the providers further hampers communication and acceptance of the community’s views by health providers. Conclusion In Burundi, the community voice to express views on maternal health services is encountering obstacles and needs to be strengthened,especially the women’s voice. Community mobilization in the form of a mass immunization campaign day organized by women fora, and community empowerment using participatory approaches could contribute towards community voice strengthening.

Introduction: Ameloblastomas are benign but aggressive odontogenic tumors with have a high propensity for bony destruction. They require to be excised completely to avoid local recurrence, and these resections involve significant functional and esthetic disturbances. With the advent of microvascular reconstruction, they can be excised, and defects are reconstructed with preservation of form and function. This paper presents our experience with wide excision and microvascular reconstruction for maxillomandibular ameloblastomas, and to describe the planning, resection, microvascular reconstruction, and rehabilitation of these patients. Materials and Methods: A retrospective review of records for patients treated with wide excision and microvascular reconstruction for maxillomandibular ameloblastomas at Amrita Institute of Medical Sciences Kochi between 2003 and 2015 was performed. Clinical and pathological features were described, and a literature review was performed. Results: A total of 48 patients were identified with equal sex distribution and mean age at presentation of 35 (range 16–71) years. Half of these patients had primary lesions, and the remaining half had the recurrent disease (range 1–4 previous surgeries). Forty patients (83%) had mandibular lesions and the remaining had the maxillary disease. All patients had wide excision with a gross bony margin of 1 cm and reconstruction with microvascular flaps (fibula free flap = 41, distal circumflex iliac artery flap = 3 and scapular free flap = 2, anterolateral thigh flap = 1 and radial forearm free flap = 1). Mean tumor size was 4.73 (2–14) cm. At a median follow-up of 21 months, all patients were free of recurrence. Successful dental rehabilitation was achieved in 40 patients (83%). Conclusion: This approach leads to results in excellent local control, functional, and esthetic outcomes. Although managing these patients is challenging, multidisciplinary expertise and planning are crucial for successful management.

With the aim of decreasing the number of experiments to obtain a perovskite solar cell (PSC) with maximum theoretical efficiency, in this paper, PSC performance was studied using the program solar cell capacitance simulator (SCAPS-1D). The PSC with the architecture ITO/TiO2/perovskite/spiro-MeOTAD/Au was investigated, while the selected perovskite was mixed cation Rb0.05Cs0.1FA0.85PbI3. The analysis was based on an experimentally prepared solar cell with a power conversion efficiency of ~7%. The PSC performance, verified by short-circuit current density (Jsc), open-circuit voltage (Voc), fill factor (FF) and power conversion efficiency (PCE), was studied by optimization of the simulation parameters responsible for improvement of the cell operation. The optimized parameters were absorber layer thickness, doping, defect concentration and the influence of the resistivity (the net effect of ohmic loss, Rs and the leakage current loss represented by the resistivity, Rshunt). The results of SCAPS-1D simulations estimated the theoretical power conversion efficiency of 15% for our material. We have showed that the main contribution to improvement of solar cell efficiency comes with lowering ohmic resistivity of the cell as well as doping and defect concentration, because their concentration is proportional to recombination rate.

Network data consisting of recorded historical events can be represented as hyper-graphs where the ties or events can connect any number of nodes or event related attributes. In this paper, we perform a centrality analysis of a directed hypergraph representing attacks by indigenous peoples from the Lesser Antilles on European colonial settlements, 1509–1700. The results of central attacks with respect to at- tacked colonial force, member of attack alliances, and year and location of attack are discussed and compared to a non-relational exploratory analysis of the data. This comparison points to the importance of a mixed methods approach to enhance the analysis and to obtain a complementary understanding of a network study.

Individual carbon nanotubes (CNTs) exhibit excellent mechanical, electrical and thermal properties, leading to development of a new generation of advanced lightweight materials and spacecraft electronics substituting the electronics based on silicon. The direct assembly of CNTs into macroscopic fibers or sheets has been a way to overcome their dispersion and processing challenges. Because of a wide range of applications of this material, we investigate effectively the defects on CNT yarns structures created by electron beam and gamma sources and their impact on the morphology and mechanical properties. The irradiated samples with electron beam at doses of 400, 600 and 800 kGy had a decrease in the strength from 219.60 ± 18.90 MPa for pristine yarn to 108.86 ± 23.77, 153.15 ± 21.63, 170.50 ± 25.78 MPa, respectively. The sample irradiated with gamma in air at dose of 100 kGy had the strength increased slightly as compared with the pristine sample and an increase in the elasticity modulus from 8.79 ± 1.19 to 19.63 ± 2.02 GPa as compared to CNT pristine yarn. The quality of the CNT yarns that was gamma irradiated in air with absorbed dose of 100 kGy was not affected by the radiation process with improvement of 123% of the Young’s modulus.

Abstract Background Oxylipins and endocannabinoids are low molecular weight bioactive lipids that are crucial for initiation and resolution of inflammation during microbial infections. Metabolic complications in malaria are recognized contributors to severe and fatal malaria, but the impact of malaria infection on the production of small lipid derived signalling molecules is unknown. Knowledge of immunoregulatory patterns of these molecules in malaria is of great value for better understanding of the disease and improvement of treatment regimes, since the action of these classes of molecules is directly connected to the inflammatory response of the organism. Methods Detection of oxylipins and endocannabinoids from plasma samples from forty children with uncomplicated and severe malaria as well as twenty controls was done after solid phase extraction followed by chromatography mass spectrometry analysis. The stable isotope dilution method was used for compound quantification. Data analysis was done with multivariate (principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA®) and univariate approaches (receiver operating characteristic (ROC) curves, t tests, correlation analysis). Results Forty different oxylipin and thirteen endocannabinoid metabolites were detected in the studied samples, with one oxylipin (thromboxane B2, TXB2) in significantly lower levels and four endocannabinoids (OEA, PEA, DEA and EPEA) at significantly higher levels in infected individuals as compared to controls according to t test analysis with Bonferroni correction. Three oxylipins (13-HODE, 9-HODE and 13-oxo-ODE) were higher in severe compared to uncomplicated malaria cases according to the results from multivariate analysis. Observed changes in oxylipin levels can be connected to activation of cytochrome P450 (CYP) and 5-lipoxygenase (5-LOX) metabolic pathways in malaria infected individuals compared to controls, and related to increased levels of all linoleic acid oxylipins in severe patients compared to uncomplicated ones. The endocannabinoids were extremely responsive to malaria infection with majority of this class of molecules found at higher levels in infected individuals compared to controls. Conclusions It was possible to detect oxylipin and endocannabinoid molecules that can be potential biomarkers for differentiation between malaria infected individuals and controls and between different classes of malaria. Metabolic pathways that could be targeted towards an adjunctive therapy in the treatment of malaria were also pinpointed.

Introduction: Vascularized composite tissue allotransplantation is a relatively new concept, which was unavailable in the Indian subcontinent till a bilateral hand transplant was carried out successfully in January 2015. Materials and Methods: The setting up of the transplant programme involved obtaining legal clearances, creating public awareness, harnessing the institutional facilities, drawing up protocols, assembling the surgical team, managing immunological issues, rehabilitation and preparing the ancillary services. Results: Both, the first and second bilateral hand transplants were resounding successes with both the recipients getting back to their original daily routines. Conclusions: The organisation of the hand transplant programme was a large task, which necessitated intensive planning, and cooperation from various teams within and outside the institution. Exemplary team-work was the key to the phenomenal success of these path breaking endeavors in the subcontinent.

Introduction: This report covers the strategies adopted for rehabilitation for the first and second dual hand transplants performed in India. Materials and Methods: The team, under a trained physiatrist, including physiotherapy and occupational therapy personnel, was involved in the management of both these patients. The management protocol was developed considering previous reports as well as our management strategies in the rehabilitation of the replanted hands. The involvement of the team with the patients started in the 1st week itself and continued on a daily basis for the entire year. Results: Outcome analysis was performed at 6 months and 1 year using the disability of shoulder and hand evaluation and hand transplant scoring system. Functional magnetic resonance imaging was done at the end of 1 year to assess the cortical integration of the transplanted hand. Conclusion: Despite more than 110 hands being transplanted worldwide, hand transplant remains an experimental procedure. It is still not considered the “standard of care” for hand amputees. Outcome analyses performed worldwide do indicate that the procedure can provide a substantial improvement in the quality of life for the hand amputee, especially the bilateral amputees.

Introduction: Being able to counter immune-mediated rejection has for decades been the single largest obstacle for the progress of vascular composite allotransplantation (VCA). The human immune system performs the key role of differentiating the ‘self’ from the ‘non-self’. This, although is quintessential to eliminate or resist infections, also resists the acceptance of an allograft which it promptly recognises as ‘non-self’. Materials and Methods: Pre-operative evaluation of the recipient evaluation included immunological assessment in the form of panel reactive antibodies (PRA), human leucocyte antigen (HLA) typing, donor-specific antibody detection assays (DSA) and complement-dependent cytotoxicity assays (CDC). Induction immunosuppression was by thymoglobulin and the maintenance by the standard triple-drug therapy. Results: Both the recipients were managed by the standard triple drug therapy and have had only minor episodes of rejections thus far which have been managed appropriately. Discussion: Induction immunosuppression was by thymoglobulin and the maintenance by the standard triple-drug therapy. Various groups have tried various other formulations and regimes as well. Conclusion: A comprehensive plan has to be drawn up for immunological screening, selection and the post-operative immunosuppressant usage. The ultimate goal of these immunosuppression modalities is to achieve a state of donor-specific tolerance.

Introduction: This article deals with two patients who underwent bilateral hand transplantation following amputation of both upper limbs at the distal third of the foream. Materials and Methods: The first patient had a history of loss of hands in a train accident, with possiblity of a run over element during the injury. The second patient lost his both hands in a mine blast. The preoperative work up included detailed clinical and psychological evaluation. The donor retrieval was similar in both the cases and the donors were housed in our own instittution. The donor preparation, recipient preparation and the transplant procedure was similar except for the need of primary tendon transfers in the left hand of the first patient. Results: The first patient needed a free flap transfer to cover compromised skin flap on the left hand on the second day. The second hand transplant was uneventful. Both the recipients are now back to their normal daily routines. Conclusions: Hand transplantation is a potentially life altering procedure, but to optimise the results, it is imperative that there is a meticulous planning and diligent execution with utmost importance to the detail coupled with a synchronised team effort.