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Periprosthetic joint infection (PJI) continues to challenge the orthopedic community. As the need for total knee arthroplasty (TKA) continues to increase and is more frequently being performed in younger patients, the absolute number of infected patients is expected to increase. Currently, infection after TKA is the leading reason for early readmission and the main cause of revision arthroplasty within the first two years after surgery. There is no perfect treatment option; rather, there are a variety of alternatives that carry their own set of benefits and flaws. Moreover, clinical results of these treatment options are always expected to be lower than the outcomes achieved after a primary TKA. The accuracy in selecting the appropriated treatment option for each patient is key for achieving positive results. Each case should be considered with all available evidence to successfully eradicate the infection and prevent reinfection. This chapter describes the different treatment options, their indications, steps, and the available up-to-date results for treating PJI after TKA.

Periprosthetic joint infection (PJI) is the most feared and challenging complication after total knee arthroplasty (TKA) due to the difficulty in diagnosis and treatment. The patient is exposed to multiple procedures, increasing the risk of complications, and finally compromising functional outcome. Currently, there is no gold standard test for PJI, and the final diagnosis is accomplished by combining clinical suspicion with inflammatory marker results. Two-stage exchange arthroplasty remains the preferred method of treatment for chronic PJI in TKA, with a high rate of success reported in literature. However, failures and complications in two-stage exchange can occur. There are no clarified guidelines to treat complications or treatment failures. Thus, each case should be individualized to offer options that match the patient’s expectations with what is achievable. The case report in this chapter represents the worst case scenario after a TKA, and is a reminder that the gold standard is far from perfect, while it outlines multiple instances a surgeon could encounter.

El trabajo analiza la influencia de las exportaciones sobre el crecimiento del PBI, asimismo analiza su influencia indirecta sobre los otros componentes del gasto autónomo. Como una ampliación del modelo de Harrod y del Supermultiplicador de Hicks, se introduce la variable importaciones, con el propósito de comprobar que también es influenciada por el aumento de las exportaciones. El tratamiento de la data es econométrico, con la inclusión de modelos VAR y MCE. Los resultados obtenidos evidencian una influencia directa e indirecta de las exportaciones en el crecimiento económico, con lo que se confirma la hipótesis formulada.

El objetivo del presente trabajo de investigación ha sido, determinar el nivel de articipaciónde los gobiernos municipales provinciales de Ancash, en la generación del desarrollo local, usando para tal fin el indicador de Calidad de Desempeño Local. El tipo de investigación usado para tal fin es cuantitativa, el diseño de investigación es no experimental, de corte transversal y descriptivo. La medición del desempeño municipal se ha realizado con el índice de calidad de desempeño local propuesto por Huther y Anwar (2006) cuyos índices compuestos son: a) asegurar la transparencia y la vocería de todos los ciudadanos; b) ofrecer servicios públicos y eficientes; c) promover la salud y el bienestar de los ciudadanos y d) crear un clima favorable para el crecimiento económico estable. Los resultados muestran que el Índice de calidad de desempeño municipal de los concejos provinciales de Ancash está en el rango de 27 a 40, indicando que los gobiernos locales provinciales, no contribuyen actualmente a la generación de desarrollo local.

La complejidad en los usos y relaciones de los humanos con la tecnología, revela hoy nuevas habilidades y comportamientos tanto en el consumo como en la producción de contenidos en un mundo altamente interconectado. De aquí surge la necesidad de entender la Competencia Mediática en la educación como el espacio que trasciende el uso instrumental de la tecnología insertándose en el consumo crítico de información y la posibilidad de producir contenidos con responsabilidad y sentido ciudadano. Para estudiar la Competencia Mediática es importante conocer su evolución desde el concepto chomskiano de competencia hasta llegar al campo de la Comunicación/Educación donde adquiere dimensiones, ámbitos e indicadores que hacen posible su medición en distintos grupos poblacionales. Investigadores de la Universidad Santiago de Cali, la Pontificia Universidad Javeriana de Cali y la Universidad de Huelva, desarrollaron una discusión conceptual y metodológica acerca de cómo ponderar la Competencia Mediática en jóvenes de 14 a 17años pertenecientes a instituciones educativas públicas de los municipios de Cali, Roldanillo, Jamundí, Candelaria y Buenaventura, pertenecientes al departamento del Valle del Cauca, Colombia. De este ejercicio investigativo quedan aproximaciones conceptuales y algunas propuestas metodológicas para la medición de la Competencia Mediática que se esbozan en este artículo a manera de marco para un diagnóstico de la misma en el campo educativo.

El objetivo de este estudio es determinar en qué medida el gasto público ha contribuido a reducir la pobreza en el departamento de Ancash: 2007- 2012. La teoría refiere que el gasto público es una herramienta efectiva de los gobiernos, no sólo para estimular la ecpnomía, sino también como una herramienta de combate de la pobreza, si es que está bien orientada. El análisis se basa en el método de Mínimos Cuadrados Ordinarios (MCO), se estiman cuatro modelos que involucran las variables: pobreza, medida según el método de "línea de pobreza" y el método de "Necesidades Básicas Insatisfechas"; además, se analiza el gasto público del gobierno regional y provincial y cómo este ha sido distribuido principalmente en los sectores salud, educación e infraestructura. Se concluye que la inversión pública en los sectores educación, salud e infraestructura ha contribuido a la reducción de la pobreza en el departamento de Ancash, la inversión en infraestructura muestra mayor incidencia en la reducción de la pobreza. Asimismo se llega establecer que la atomización del gasto no conduce a resultados óptimos en la reducción de la pobreza.

Stiffness after total knee arthroplasty (TKA) adversely affects outcome and impacts patient function. Various risk factors for stiffness after TKA have been identified, including reduced preoperative knee range of motion, history of prior knee surgery, etiology of arthritis, incorrect positioning or oversizing of components, and incorrect gap balancing. Mechanical and associated causes, such as infection, arthrofibrosis, complex regional pain syndrome, and heterotopic ossification, secondary gain issues have also been identified. Management of stiffness following TKA can be challenging. The condition needs to be assessed and treated in a staged manner. A nonsurgical approach is the first step. Manipulation under anesthesia may be considered within the first 3 months after the index TKA, if physical therapy fails to improve the range of motion. Beyond this point, consideration should be given to surgical intervention such as lysis of adhesions, either arthroscopically or by open arthrotomy. If the cause of stiffness is deemed to be surgical error, such as component malpositioning, revision arthroplasty is indicated. The purpose of this article is to evaluate the various aspects of management of stiffness after TKA.

Surgical equipment can become contaminated during surgery. It is unknown if electrocautery tips can become contaminated in clean orthopedic procedures despite the produced heat. Therefore, we conducted a prospective study to address this concern. The tips from 25 primary and 25 aseptic revision THAs were collected and an additional 5 sterile tips served as negative controls. Aerobic and anaerobic cultures were incubated for a minimum of 3 days. There were 3 positive cultures (6%); one in primary THA (4%) with Lactobacillus and Enterococcus faecalis; two among revisions (8%), one with E. faecalis and another one with alpha hemolytic streptococci and coagulase negative Staphylococcus. The mean exposure time of the contaminated tips was 132.3 minutes. Patients were followed for 90 days postoperatively and none of them developed surgical site infection. This is the first study to demonstrate that electrosurgical devices can become contaminated during THA in laminar flow equipped operating rooms.

Revision total hip arthroplasty (THA) can be successfully performed through the direct anterior (DA) approach. Patient positioning, the surgical approach and specific instruments are important for obtaining adequate exposure. Acetabular exposure can be facilitated by capsular release and correct placement of retractors. Distal and proximal extension of the incision, as well as a femoral extended trochanteric osteotomy (ETO) can be performed to increase femoral exposure. The purposes of this article are to describe the DA approach, provide surgical techniques for revision THA through this approach, and describe the indications, contraindications and complications of this approach.

The majority (60 %) of the soils in the Venezuelan Andes are Inceptisols, a large percentage of which are classified as Dystrustepts by the US Soil Taxonomy, Second Edition of 1999. Some of these soils were classified as Humitropepts (high organic - C-OC-soils) and Dystropepts by the Soil Taxonomy prior to 1999, but no equivalent large group was created for high-OC soils in the new Ustepts suborder. Dystrusepts developed on different materials, relief and vegetation. Their properties are closely related with the parent material. Soils developed on transported deposits or sediments have darker and thicker A horizons, a slightly acid reaction, greater CEC and OC contents than upland slope soils. Based on the previous classification into large groups (Humitropepts and Dystropepts) we found that: Humitropepts have a slightly less acid and higher values of CEC than Dystropepts. These properties or characteristics seem to be related to the fact that Humitropepts have a higher clay and OC content than the Dystropepts. Canonical discrimination analysis showed that the variables that discriminate the two great soil groups from each other are OC and silt. Data for Humitropepts are grouped around the OC vector (defining axis 3, principal component analysis), while Dystropepts are associated with the clay and sand vectors, with significant correlation. Given the importance of OC for soil properties, we propose the creation of a new large group named Humustepts for the order Inceptisol, suborder Ustepts.

A key factor for the successful adoption of Model-Driven Development (MDD) techniques is the ability to verify models, which can be achieved by model simulation and testing. This is already a reality for UML models, due mainly to the UML action language. However, this action language is purely object-oriented, which implies it needs to be extended to model applications of new software development paradigms, such as aspect-oriented applications. These extensions also require modifying the tools that execute the UML models, which, with the currently available tools, is often not possible. Furthermore, at the current time, there are no tools fully compliant with the UML action language. In order to overcome this limitation, this paper presents Populo, an extensible UML model debugger, which interprets the UML action language, compliant with the standard, and that can be customised for executing profiled (i.e. extended) UML models.

El estudio se realizó en el distrito de Tamburco (Abancay, Apurímac, Perú), con el objetivo de comparar la interpretación de los resultados de la prueba «California Mastitis Test» (CMT) en el diagnóstico de la mastitis subclínica en bovinos. Se trabajó con 209 vacas de una población de 459 en ordeño manual, pertenecientes a 95 criadores, donde se evaluaron 828 cuartos mamarios funcionales y se estimaron los principales criterios de interpretación de la CMT. La prevalencia de mastitis subclínica fue de 72.3 y 65.6% en las vacas y de 48.7 y 42.3% en el total de cuartos mamarios, considerando y sin considerar trazas como positivos, respectivamente, y sin diferencia significativa. La prevalencia de mastitis subclínica en los cuartos mamarios individuales varió entre 48.3 y 49.3% y de 40.0 y 45.5%, según el cuarto, considerando y sin considerar trazas, respectivamente (p

A single subcutaneous injection of amphenone to pyloric ligated rats produced a significant decrease in gastric secretory volume, free acid and potassium content, with an increase in pH, gastric juice sodium and pepsin concentration. Cortisone, corticosterone, DCA or ACTH administered with amphenone did not alter the amphenone effect. Aldosterone alone produced a reduction in gastric juice sodium. When amphenone was injected with aldosterone, the amphenone effects, including an increased sodium, were again observed. When amphenone was administered with histamine, the amphenone effects relating to pH and free acid concentration were not observed. Adrenalectomy produced a decrease in gastric secretory volume, acidity and pepsin secretion, and an increase in sodium and pH. In previously adrenalectomized rats the amphenone inhibitory effects on gastric secretion were absent. An increase in adrenal gland weight was observed 4 hours after amphenone administration, but was not seen when cortisone, corticosterone, DCA, aldosterone or histamine were administered with amphenone. ACTH alone or with amphenone produced an increase in adrenal weight. Amphenone caused a considerable increase in thymus weight, which could be prevented by the simultaneous injection of corticosterone, aldosterone or histamine, but not by DCA or adrenalectomy. ACTH or cortisone alone or in combination with amphenone decreased thymus weight.

In recent years biomedical scientific community has been working towards the development of high-throughput devices that allow a reliable, rapid and parallel detection of several strains of virus or microparticles simultaneously. One of the complexities of this problem lies on the rapid prototyping of new devices and wireless rapid detection of small particles and virus alike. By reducing the complexity of microfluidics microfabrication and using economic materials along with makerspace tools (Avra Kundu, Ausaf, and Rajaraman 2018) it is possible to provide an affordable solution to both the problems of high-throughput devices and detection technologies. We present the development of a wireless, standalone device and disposable microfluidics chips that rapidly generate parallel readouts for selected, possible virus variants from a nasal or saliva sample, based on motorized and non-motorized microbeads detection, and imaging processing of the motion tracks of these beads in micrometers. Microbeads and SARS-CoV-2 COVID-19 Delta variant were tested as proof-of-concept for testing the microfluidic cartridges and wireless imaging module. The Microbead Assay (MA) system kit consists of a WiFi readout module, a microfluidic chip, and a sample collection/processing sub-system. Here, we focus on the fabrication and characterization of the microfluidic chip to multiplex various micrometer-sized beads for economic, disposable, and simultaneous detection of up to six different viruses, microparticles or variants in a single test, and data collection using a commercially available, WiFi-capable, and camera integrated device (Fig. 1).