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The study aimed to explore the research and approaches of internal control and corporate governance applied in family businesses in Latin America. For this, a literary review was carried out through the compilation of bibliographic sources of various studies carried out in Peru, Chile, Colombia, Argentina and Ecuador related to the research topic. The results indicate that, if a family business intends to grow and maintain its validity over time, passing on to the following generations, it must develop internal control and corporate governance structures. In conclusion, the study highlights the importance of contributing to the establishment, internal control structures and corporate governance, through different mechanisms, mainly in first and second-generation family businesses, considering the mortality they suffer in different countries. region of.

Key message The current status of molecular regulation of nitrogen assimilation and recent advances made in gymnosperms are reviewed. Abstract Gymnosperms are a heterogeneous and ancient group of seed plants that includes conifers, ginkgos, cycads and gnetophytes. Molecular studies on extant gymnosperms have been constrained by some discouraging features for experimental research such as their long life cycles, large sizes, complex megagenomes and abundant phenolic compounds in their woody tissues. However, the development of high-throughput sequencing and refined multiomics technologies in the last few years has allowed to explore the molecular basis of essential processes in this ancient lineage of plants. Nitrogen is one of the main limiting factors determining vascular development and biomass production in woody plants. Therefore, nitrogen uptake, metabolism, storage and recycling are essential processes for fundamental gymnosperm biology. Here, recent progress in the molecular regulation of nitrogen assimilation in gymnosperms is reviewed and some future perspectives on this topic are outlined.

Background Pain is one of the most common and most difficult symptoms to manage in adult burn patients in the Intensive Care Unit (ICU). Insufficient or unsuccessful pain management can negatively affect physiological, psychological and social health in burn patients, both during and after hospitalization. Music therapy and music medicine interventions have been shown to positively affect pain and mental health in this population. This systematic review and meta-analysis provide an update of Randomized Controlled Trials (RCTs) using music therapy or music medicine interventions in adult burn patients. Methods A variety of databases were searched from their beginning to June 2020, including PsycINFO and PsycArticles (via APAsycNET), PubMed and MEDLINE (via OvidSP), Scopus, Web of Science, and the Cochrane Library. Data of all articles meeting the inclusion criteria were extracted, organized and processed according to the PRISMA guidelines. Statistical analysis was performed using Q-test and I2 statistics. Results 10 RCTs with a total of 1,061 participants were included. The results of the meta-analysis showed a statistically significant reduction of pain (I2 = 96.03%, P Conclusions This review provides preliminary evidence for the effectiveness of music interventions for adult burn patients. However, more high-quality RCTs are needed to safely establish guidelines for music therapists and other health care professionals in using music for health purposes with this population.

Resumen Los procesos de internacionalización de los centros superiores de estudio han tenido en esta parte del continente una etapa de crecimiento casi lento, pero en la presente década las asociaciones en la formación o fortalecimiento de redes se han multiplicado. El uso de las nuevas tecnologías fue el instrumento para sortear la falta presencialidad en las aulas de parte de los docentes y discentes por la pandemia sanitaria, para primero garantizar el dictado virtual de las materias, capacitar a los profesores y estudiantes adecuarse aceleradamente al uso de las plataformas y aulas virtuales, para luego trabajar en reactivación vía redes y programas virtualizados. Las redes de universidades en la América latina comenzaron a utilizarse intensamente apelando a las plataformas y a las aulas virtuales, a fin de restablecer las convocatorias de los programas de movilidad estudiantil y docente, así mismo incorporar los mecanismos para que los estudiantes y profesores elegidos puedan movilizarse virtualmente. El proceso de internacionalización exige un trabajo comprometido y concertado entre los estados, universidades y las diferentes redes, los cuales pueden y deben mejorar, para ello la digitalización e innovación de los canales sistemas de comunicación pueden ser un medio de integración real y rápida.

The study corresponds to the analysis of 126 female university students at the Bosa facilities of the Universidad Distrital Francisco José de Caldas in Bogotá, aged between 17 and 33 years. The perceived stress scale (EEP-14) was used; To evaluate emotional regulation, the emotional regulation questionnaire (ERQ) was used where it was evaluated (CR = 44%) (cognitive reevaluation) and (SE = 37%) (emotional suppression); the results showed that on average perceived stress is moderate (40.2%).

Tofacitinib is approved for the treatment of moderate to severe active rheumatoid arthritis (RA) in adult patients who do not respond adequately or are intolerant to one or more disease-modifying anti-rheumatic drugs. The tofacitinib RA clinical development program included randomized controlled trials of 6–24-month duration and long-term extension studies with > 7061 patients and 22,875 patient-years of exposure. To date, there are no data from other randomized studies in patients with cardiovascular risk factors comparing the long-term safety of a JAK inhibitor versus an anti-TNF. Real-world studies are necessary to complete the body of evidence supporting the effectiveness and safety of a therapeutic agent. In the case of tofacitinib, real-world data derive from health insurance claims databases, registries (US Corrona Registry, Swiss Registry, and others), national pharmacovigilance programs, and hospital databases (case series). The present article provides complete and up-to-date information on the safety profile of tofacitinib in RA, from clinical trials to real-world studies. Tofacitinib has demonstrated a consistent safety profile during up to 9.5 years of experience in randomized controlled trials and long-term extension studies. Real-world evidence has not added new safety issues with respect to those found in the clinical program. In general, the safety profile of tofacitinib is consistent with that of biologic disease-modifying anti-rheumatic drugs, with an increased risk of herpes zoster that seems to be a class effect of Janus kinase inhibitors. The continuous follow-up of therapeutic agents to treat rheumatoid arthritis is needed to adequately establish the safety profile for new mechanisms of action and potential risks associated with their longer term use.

To identify recommendations on the diagnosis and management of rheumatoid arthritis (RA) supported by low recommendation grades, to study the causes of this low grading, and to propose solutions. A group of six rheumatologists, with extensive experience in the development of systematic reviews, reviewed national and international RA recommendations and practice guidelines. They identified all recommendations with a low level of evidence or recommendation grade (levels equivalent to 4, 5, or grades C or D of the Oxford Levels of Evidence), classified them by areas (diagnosis, follow-up, treatment, others), and analyzed plausible causes of low graduation. A Delphi was used to select 10 recommendations where it was most important to obtain quality evidence to support them. Subsequently, actions were proposed to improve evidence and recommendation grading. Fourteen documents were analyzed, in which 192 recommendations with low evidence/grade of recommendation were identified, most of which were on treatment. The two most frequent causes of this low level are the absence of studies and the discrepancy between the wording of the recommendation and the evidence used. Finally, the proposed solution to the critical recommendations is a list of unanswered research questions and possible designs to answer them. We propose to design and promote research that truly supports or rectifies clinical practice and, thus, bridges the gap between existing evidence and critical recommendations.

To evaluate and detail the management of a difficult, long-term, open abdomen in a resource constraint setting with the use of Hydrocolloid dressing. An observational retrospective study was conducted at a single level-1 trauma center. Over a 5-year period, all the open abdomen patients were evaluated and the cohorts who were treated with Hydrocolloid dressings were described in detail from their admission to their discharge. During this period, there were 147 open abdomens. 7.5% (11) patients required long-term open abdomen management, in which Hydrocolloid dressing was utilized. Of this group, there were no entero/colonic-atmospheric fistulas, and there was either de-novo complete skin coverage, successful skin graft placement, or definitive abdominal wall repair in all the patients. De-novo complete skin coverage took an average of 7.4 months. All the patients were discharged home after an average of 107 days hospitalized. Despite not being an optimal management of an open abdomen, there are always a small group of these patients who lose abdominal domain, are critically ill or injured, and have prolonged hospitalization with an open abdomen. In this cohort, and especially in resource constraint settings, Hydrocolloid dressing is a cost-efficient, simple, and effective method to treat the ‘long-term’ open abdomens.

Objective To assess the cost-effectiveness of tofacitinib-containing treatment sequences versus sequences containing only standard biological therapies in patients with moderate-to-severe rheumatoid arthritis (RA) after the failure of conventional synthetic disease-modifying antirheumatic drugs (csDMARD-IR population) and in patients previously treated with methotrexate (MTX) who show an inadequate response to second-line therapy with any tumour necrosis factor inhibitor (TNFi-IR population). Methods A patient-level microsimulation model estimated, from the perspective of the Spanish Public NHS, lifetime costs and quality-adjusted life years (QALY) for treatment sequences starting with tofacitinib (5 mg twice daily) followed by biological therapies versus sequences of biological treatments only. Concomitant treatment with MTX was considered. Model’s parameters comprised demographic and clinical inputs (initial Health Assessment Questionnaire [HAQ] score and clinical response to short- and long-term treatment). Efficacy was measured by means of HAQ score changes using mixed treatment comparisons and data from long-term extension (LTE) trials. Serious adverse events (SAEs) data were derived from the literature. Total cost estimation (€, 2018) included drug acquisition, parenteral administration, disease progression and SAE management. Results In the csDMARD-IR population, sequences starting with tofacitinib proved dominant options (more QALYs and lower costs) versus the corresponding sequences without tofacitinib. In the TNFi-IR population, first-line treatment with tofacitinib+MTX followed by scAbatacept+MTX➔rituximab+MTX➔certolizumab+MTX proved dominant versus scTocilizumab+MTX➔scAbatacept+MTX➔rituximab+MTX➔certolizumab+MTX; and tofacitinib+MTX➔scTocilizumab+MTX➔scAbatacept+MTX➔rituximab+MTX versus scTocilizumab+MTX➔scAbatacept+MTX➔rituximab+MTX➔certolizumab+MTX was less effective but remained a cost-saving option. Conclusions Inclusion of tofacitinib seems a dominant strategy in moderate-to-severe RA patients after csDMARDs failure. Tofacitinib, as initial third-line therapy, proved a cost-saving strategy (€− 337,489/QALY foregone) in moderate-to-severe TNFi-IR RA patients. Key points• Therapeutical approach in rheumatoid arthritis (RA) consisted in sequences of several therapies during patient lifetime.• Treatment sequences initiating with tofacitinib followed by biological drugs provided higher health effects in csDMARDs-IR population, compared with sequences containing only biological drugs.• In both csDMARD-IR and TNFi-IR RA populations, initiating treatment with tofacitinib was associated to lower treatment costs for the Spanish National Health System.

El desarrollo “del trabajo de investigación estuvo enfocado a la relación que existe entre la participación en ferias comerciales de las empresas asociadas en Pro Olivo y su desempeño, periodo 2016 - 2017, lo que permite establecer cómo la participación en ferias comerciales se relaciona con el desempeño, promoción del producto, nivel competitivo y el logro de objetivos empresariales; el presente trabajo de investigación es no experimental de nivel explicativa, porque se obtienen datos directamente de la realidad objeto de estudio de acuerdo a la finalidad de” la investigación. El área de “investigación está enmarcada en el comercio exterior, relacionado a las ferias internacionales en el departamento de Tacna considerada como una región que tiene vocación exportadora desarrollada las misma que son impulsadas por los organismos estatales y principalmente por el Ministerio de la Producción quien viene implementando políticas públicas de promoción de” exportaciones. Así mismo “se viene observando que falta mejorar el desempeño de las empresas asociadas a Pro Olivo, lo que va a permitir mejorar su productividad, la calidad de sus productos y por lo tanto tengan una mejor oferta frente a los” mercados, internacionales. Se concluye que existe relación directa entre la participación en ferias comerciales de las empresas asociadas en Pro Olivo y su” desempeño.

To evaluate and detail the management of a difficult, long-term, open abdomen in a resource constraint setting with the use of Hydrocolloid dressing.An observational retrospective study was conducted at a single level-1 trauma center. Over a 5-year period, all the open abdomen patients were evaluated and the cohorts who were treated with Hydrocolloid dressings were described in detail from their admission to their discharge.During this period, there were 147 open abdomens. 7.5% (11) patients required long-term open abdomen management, in which Hydrocolloid dressing was utilized. Of this group, there were no entero/colonic-atmospheric fistulas, and there was either de-novo complete skin coverage, successful skin graft placement, or definitive abdominal wall repair in all the patients. De-novo complete skin coverage took an average of 7.4 months. All the patients were discharged home after an average of 107 days hospitalized.Despite not being an optimal management of an open abdomen, there are always a small group of these patients who lose abdominal domain, are critically ill or injured, and have prolonged hospitalization with an open abdomen. In this cohort, and especially in resource constraint settings, Hydrocolloid dressing is a cost-efficient, simple, and effective method to treat the 'long-term' open abdomens.

AIM Rheumatic manifestations are common in patients with Hashimoto's thyroiditis (HT). Since previous reports on the prevalence of arthritis in this disease may have a rheumatology referral bias, we sought to establish the prevalence of undifferentiated inflammatory arthropathy (UIA) in unselected HT patients as seen in an endocrinology clinic. METHODS Cross-sectional study of 92 consecutive HT patients and no definite rheumatic disease from the Endocrinology Division, Hospital Universitario de Caracas diagnosed by the presence of anti-thyroid peroxidase antibodies (n = 68) or typical ultrasonographic findings (n = 24). Undifferentiated inflammatory arthropathy was defined as combination of morning stiffness and joint pain with ≥2 characteristics of inflammatory joint pain. The study was revised and approved by the Ethics Committee of our hospital and all patients signed an informed consent form. RESULTS Twenty-three patients (25%; 95% CI 16-34) met the criteria for UIA. Joints most commonly affected were the knees, hands and ankles and the most common pattern was oligoarticular (82.6%). In the multivariate analysis, variables associated to the presence of UIA were the presence of myalgia (odds ratio [OR] = 19.41; 95% CI = 2.38-158.38) and Raynaud's phenomenon (OR = 4.32; 95% CI = 1.01-18.60). No association was found with demographics, duration of disease, comorbidities or thyroid function status. CONCLUSIONS Almost 1 in 4 patients with HT had no definite rheumatic disease present with UIA. An early identification of concurrent arthritis in HT patients is necessary for thorough differential diagnosis and prompt treatment initiation to halt potential joint damage and disability.

Background: The availability of oral janus kinase inhibitors, as tofacitinib, has extended the treatment pathways for management of patients with rheumatoid arthritis (RA) Objectives: To assess the cost-effectiveness of tofacitinib as second-line treatment compared to treatment sequences containing standard biological-therapies in patients with moderate to severe RA after failure to disease-modifying antirheumatic drugs (DMARDs) from the Spanish National Health System perspective. Methods: A patient-level microsimulation model was used to compare the lifetime cost and quality-adjusted life-years (QALY) for treatment sequences initiating with tofacitinib (5mg BID) followed by biological therapies versus sequences of biological treatments excluding tofacitinib. The sequences were selected by a panel of experts based on clinical practice in Spain. Concomitant treatment with methotrexate (MTX) was considered along all the therapies in the treatment sequences. Model parameters included age, weight, initial Health Assessment Questionnaire (HAQ) score and clinical response to short and long treatment. Efficacy was measured by means of HAQ score changes using mixed-treatment-comparisons (for the first 6 months) and data from long-term extension trials (for later periods). Serious adverse event (SAE) information derived from literature. The estimation of total cost for sequences included: drugs acquisition (public ex-factory prices with mandatory deduction or reference prices) and parenteral administration, disease progression and SAE management. Local unitary costs (€, 2018) were applied. Additional comparisons were explored testing other potential sequences. Results: The base case results showed that sequences initiating with tofacitinib provided greater outcomes than the correspondent sequences excluding tofacitinib. In scenario 1 tofacitinib+MTX→Rituximab+MTX→sc Tocilizumab+MTX→Etanercept+MTX→Certolizumab+MTX provided 13.99 QALYs versus 13.92 QALYs for adalimumab+MTX→Rituximab+MTX→sc Tocilizumab+MTX→Etanercept+MTX→Certolizumab+MTX. In scenario 2 tofacitinib+MTX→Adalimumab+MTX→Rituximab+MTX→sc Tocilizumab+MTX→Etanercept+MTX provided 13.75 QALYs versus 13.62 QALYs for Baricitinib+MTX→Adalimumab+MTX→Rituximab+MTX→sc Tocilizumab+MTX→Etanercept+MTX. Tofacitinib-containing sequences provided lower total costs than the alternative sequences (-€5,783 and -€13,975 for the pairwise comparisons previously described), resulting, therefore, dominant options versus sequences excluding tofacitinib. On the probabilistic sensitivity analyses, sequences initiating with tofacitinib resulted cost-effective in 64.0% (scenario 1) and 56.9% (scenario 2) of the 1,000 iterations performed, because incremental cost-effectiveness ratio fell below a €25,000/QALY gained willingness to pay threshold. Conclusion: These results suggest that the inclusion of tofacitinib could be a dominant strategy for treatment of moderate to severe RA patients after DMARDs failure in Spain. Disclosure of Interests: Carmen Peral Shareholder of: Carmen Peral is employee of and shareholder in Pfizer, Employee of: Carmen Peral is employee of and shareholder in Pfizer, Alejandro Balsa Grant/research support from: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Consultant for: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Sandoz, Lilly, Paid instructor for: Pfizer, Speakers bureau: Pfizer, Novartis, UCB, Nordic, Sanofi, Sandoz, Lilly, Federico Navarro Grant/research support from: Pfizer, Consultant for: Pfizer, Jose Luis Pablos: None declared, Jose Manuel Martinez Sesmero Consultant for: Pfizer, Susana Gomez Employee of: I am a current employee of Pfizer., Monica Valderrama Shareholder of: Have received shares from Pfizer, Employee of: employee in Pfizer, Itziar Oyaguez Consultant for: I am employee of PORIB a consultant company which has received financial support from Grunenthal for development of this project, Miguel Angel Casado Grant/research support from: Pfizer, Consultant for: Pfizer, Fernando De Andres Grant/research support from: Pfizer, Employee of: Pfizer, Maria Montoro Shareholder of: Maria Montoro is employee of and shareholder in Pfizer, Employee of: Maria Montoro is employee of and shareholder in Pfizer

Background:Depression and anxiety are highly prevalent in patients (pts) with psoriatic arthritis (PsA),1 with inflammation a key pathogenic feature of depression in these pts.2 Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA. It acts by modulating immune and inflammatory responses. The link between major depressive disorder/generalised anxiety disorder (MDD/GAD), inflammation and tofacitinib effectiveness has not been fully explored.Objectives:Analyse the prevalence of probable MDD/GAD in pts with PsA initiating tofacitinib treatment and the impact of baseline (BL) probable MDD/GAD status on tofacitinib efficacy in these pts.Methods:This was a post hoc analysis of data from pts who received tofacitinib 5 or 10 mg twice daily (BID), or placebo (PBO), pooled from two Phase 3 trials (12-month OPAL Broaden [NCT01877668];3 6-month OPAL Beyond [NCT01882439]4). Pts with BL probable MDD and/or GAD were identified by a Short Form-36 Health Survey (SF-36) Mental Component Summary score (MCS) ≤38. Pt demographics/BL characteristics and outcomes were stratified by the presence (SF-36 MCS ≤38) or absence (SF-36 MCS >38) of BL probable MDD/GAD. At Months (M)3/6/9/12, changes from BL in SF-36 MCS were evaluated, and efficacy assessed by the proportions of pts who achieved: Psoriatic Arthritis Disease Activity Score (PASDAS) ≤3.2, Health Assessment Questionnaire-Disability Index (HAQ-DI) improvement ≥0.35 and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) improvement ≥4. BL global pain was measured via visual analogue scale.Results:Of the 706 pts included in this analysis, BL probable MDD/GAD was identified in 46.2%, 44.9% and 46.2% of pts in the tofacitinib 5 mg BID (108/234), tofacitinib 10 mg BID (106/236) and PBO (109/236) groups, respectively. BL disease activity was similar across the three treatment groups, independent of probable MDD/GAD status (mean PASDAS: 6.1–6.4 in pts with vs 5.8–6.1 in pts without probable MDD/GAD). In the tofacitinib 5 mg BID group, mean BL scores for HAQ-DI (1.4 vs 1.0), FACIT-F total score (20.5 vs 32.4) and global pain (61.3 vs 51.5) indicated worse disability, fatigue and pain, respectively, for pts with vs without BL probable MDD/GAD. Similar findings were seen in the tofacitinib 10 mg BID and PBO groups. At M3, improvements from BL in SF-36 MCS in pts with probable MDD/GAD were numerically, but not significantly, greater with tofacitinib 5 and 10 mg BID vs PBO, and these changes were largely sustained to M12 (Figure 1a). At M3, numerically greater proportions of pts achieved improvements in PASDAS, HAQ-DI and FACIT-F with tofacitinib 5 or 10 mg BID vs PBO, regardless of BL probable MDD/GAD status (Figure 1b–d). Through M3–12, the proportions of pts who achieved PASDAS ≤3.2 with tofacitinib 5 or 10 mg BID were generally significantly greater in pts without vs with probable MDD/GAD (Figure 1b). At all timepoints, rates of improvement in HAQ-DI with tofacitinib 5 mg BID were numerically greater in pts with vs without probable MDD/GAD, whereas the opposite was true for tofacitinib 10 mg BID (Figure 1c). FACIT-F improvement rates with tofacitinib 10 mg BID were consistently numerically greater in pts with vs without probable MDD/GAD, while findings were mixed for tofacitinib 5 mg BID (Figure 1d).Conclusion:Around 46% of pts with PsA treated with tofacitinib had BL probable MDD/GAD (SF-36 MCS ≤38). Pts with BL probable MDD/GAD treated with tofacitinib had sustained changes in SF-36 MCS. Rates of clinical improvement with tofacitinib were generally greater in pts without vs with probable MDD/GAD, whereas findings for disability and fatigue improvements varied between tofacitinib doses. Further research is required to evaluate the relationship between PsA and depression, to improve treatment targets and the quality of life of pts with PsA.References:[1]Zhao et al. Clin Rheumatol 2020; 39: 217-225.[2]Mathew & Chandran. Rheumatol Ther 2020; 7: 287-300.[3]Mease et al. N Engl J Med 2017; 377: 1537-1550.[4]Gladman et al. N Engl J Med 2017; 377: 1525-1536.Acknowledgements:Study sponsored by Pfizer Inc. Medical writing support was provided by Emma Deeks, CMC Connect, and funded by Pfizer Inc.Disclosure of Interests:Laure Gossec Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, Pfizer Inc, Roche, UCB, Gustavo Citera Consultant of: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis, Pfizer Inc, Sanofi Genzyme, Grant/research support from: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis, Pfizer Inc, Sanofi Genzyme, Agustí Sellas-Fernández: None declared, David C Gruben Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Monica Valderrama Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Susana Gómez Shareholder of: Pfizer Inc, Employee of: Pfizer Inc.

A adubação tem proporcionado grandes avanços na produtividade e qualidade de pastagens, e entre os nutrientes, o nitrogênio (N) merece destaque por sua grande extração e aumento da produtividade das pastagens, porém, após sua aplicação ao solo, sofre influência do meio e pode ser perdido, quando mal manejado. Para minimizar tal problema, uma alternativa promissora é o uso de fertilizantes de eficiência aumentada, buscando-se reduzir tais perdas e proporcionar aumento de produtividade. Dessa forma, avaliou-se o efeito de fontes e doses de N na implantação de Urochloa brizantha cv. Xaraés (capim-xaraés) na produtividade e nos valores bromatológicos, em cultivo em condições do Cerrado. O experimento foi conduzido em área experimental no município de Rio Verde - GO, distribuídos em blocos ao acaso com quatro repetições, em esquema fatorial de 3x4. O primeiro fator foram três fontes de N (ureia convencional, ureia de eficiência aumentada e nitrato de amônio); o segundo fator foram quatro doses de N (0, 20, 40 e 80 kg N ha-1 corte-1). O uso da ureia convencional fez-se como a melhor alternativa para a cultura do capim-xaraés (P ≥ 0,05). A dose de nitrogênio recomendada é de 80 kg ha-1 por corte (P < 0,05), em vista do aumento da produtividade de massa seca, e à melhoria da qualidade bromatológica do capim-xaraés.

Entre os fatores agrícolas, a adubação tem proporcionado grandes avanços na produtividade e qualidade de pastagens, sendo que o nitrogênio (N) merece destaque por sua grande extração e aumento da produtividade de gramíneas, entretanto, sofre influência do meio e pode ser perdido se mal manejado. Para minimizar tal problema, uma alternativa apontada como promissora é o uso de fertilizantes de eficiência aumentada. Dessa forma, objetivou-se com o trabalho avaliar o efeito de fontes e doses de N na implantação do Urochloa brizantha cv. Xaraés (capim-xaraés), em cultivo nas condições do Cerrado. O experimento foi conduzido em área experimental no município de Rio Verde – GO, Brasil, com delineamento em blocos ao acaso com quatro repetições, em esquema fatorial de 3x4. Sendo três fontes de N (ureia convencional, ureia de eficiência aumentada e nitrato de amônio); e quatro doses de N (0, 20, 40 e 80 kg N ha-1 corte-1). O uso da ureia convencional fez-se como a melhor alternativa para a cultura do capim-xaraés, a ureia revestida não foi considerada de maior eficiência. A dose de nitrogênio recomendada é de 80 kg ha-1 por corte, em vista da melhoria nutricional da matéria seca da parte aérea.

Entre os fatores agrícolas, a adubação tem proporcionado grandes avanços na produtividade e qualidade de pastagens, sendo que o nitrogênio (N) merece destaque por sua grande extração e aumento da produtividade de gramíneas, entretanto, sofre influência do meio e pode ser perdido se mal manejado. Para minimizar tal problema, uma alternativa apontada como promissora é o uso de fertilizantes de eficiência aumentada. Dessa forma, objetivou-se com o trabalho avaliar o efeito de fontes e doses de N na implantação do Urochloa brizantha cv. Xaraés (capim-xaraés), em cultivo nas condições do Cerrado. O experimento foi conduzido em área experimental no município de Rio Verde – GO, Brasil, com delineamento em blocos ao acaso com quatro repetições, em esquema fatorial de 3x4. Sendo três fontes de N (ureia convencional, ureia de eficiência aumentada e nitrato de amônio); e quatro doses de N (0, 20, 40 e 80 kg N ha-1 corte-1). O uso da ureia convencional fez-se como a melhor alternativa para a cultura do capim-xaraés, a ureia revestida não foi considerada de maior eficiência. A dose de nitrogênio recomendada é de 80 kg ha-1 por corte, em vista da melhoria nutricional da matéria seca da parte aérea.

Background There is a continued interest in global emergency medicine (EM) training, research, and clinical program development. There are many opportunities for “voluntourism” in medicine, but many of these experiences do not have standard goals and objectives. Objective This article describes a rotation for EM residents from the United States to have a structured learning experience focusing on emergency medical settings in the prehospital phase (something often lacking in U.S. programs). Discussion The authors discuss the structure of the training program, including goals, objectives, and core competencies. First-hand accounts of the training experience are also presented. Conclusions Global training experiences can have clear benefits. Students go to places to “learn,” but can also “teach” at the same time. Setting goals and objectives helps to assure that students are gaining specific core competencies as part of the experience. Other global rotations would benefit from having a defined structure.

Background:Although ideally Recommendations for the management of rheumatoid arthritis (RA) should be supported by the highest level of evidence, many of which are based on “expert opinion”. This means that there are knowledge gaps to which a part of the research efforts in this disease should be directed.Objectives:1.- Analyze the causes of the low level of evidence in some of the recommendations on diagnosis and management of RA in the main published documents2.- Identify the knowledge gaps that justify said low level of evidence3.- Design actions to respond to the knowledge gaps identified.Methods:Qualitative study. A group of six experts in systematic review of the literature was selected. Fourteen documents of national and international recommendations on RA (EULAR, ACR and SER) of the last 5 years were analyzed by a peer review. They selected recommendations with low level of evidence (Oxford 4 and 5) / grade of recommendation (C and D), and classified by areas (diagnosis, monitoring, treatment, others) and then possible causes of low level of evidence were analyzed. These were submitted to a Delphi to select the 10 recommendations in which participants considered it more critical to obtain quality evidence. Subsequently, actions were proposed to improve the levels of evidence in general and, through the PICOS structure (population, intervention, comparator, study design) specific studies were proposed to respond to the issues raised in these 10 recommendationsResults:185 recommendations were found that had a low level of evidence / grade of recommendation, most related to the treatment of RA. The two most frequent causes of this low level of evidence and / or the degree of recommendation were the absence of studies and an incorrect classification of the level of evidence and / or degree of recommendation. In addition, other reasons and methodological barriers were found for which nine critical recommendations were finally selected for which new PICOs were developed with which to propose targeted research projectsConclusion:It is necessary to improve the methodological approach in the RA recommendations guidelines to correct errors and fill gaps with appropriate studies.Table 1.Actions to increase the level of evidence / recommendation.#Action1Prioritization of research towards knowledge gaps with the design and development of specific studies2Increase knowledge of experts in the methodology of consensus documents (including RSL, formulation of recommendations, etc.)3Supervision of the entire process by expert methodologists, to ensure a correct allocation of the levels of evidence and degree of recommendation4Review and select those topics that are really of interest and should be reviewed and can be answered5Expert opinion should never become a recommendation, but will be included in the text that accompanies that recommendation.6Clear syntax will be used and short recommendations will be made7Establishment and application of homogeneous criteria to formulate recommendationsKey words: Rheumatoid arthritis, recommendations, data gapsDisclosure of Interests:gloria candelas: None declared, Lucía Silva-Fernández: None declared, Maria Montoro Employee of: Pfizer employee, Abad Hernández: None declared, Jose Ramón Maneiro: None declared, Virginia Villaverde: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Estíbaliz Loza Grant/research support from: Roche, Pfizer, Abbvie, MSD, Novartis, Gebro, Adacap, Astellas, BMS, Lylly, Sanofi, Eisai, Leo, Sobi, Susana Gómez Employee of: Pfizer employee, Monica Valderrama Consultant of: Pfizer employee, Ana Ortiz: None declared

Falls are a major cause of disability, morbidity, institutionalization, and mortality in older adults. The purpose of the study was to examine the risk factors for falls among Mexican older adults aged 60 years and older. This study included 6247 participants and their spouse or partner aged 60 years and older from the Mexican Health and Aging Study, an ongoing longitudinal study (2001–2012) conducted in Mexico. Measures included socio-demographics, falls, physical activity, comorbid conditions, pain, vertigo, vision and hearing impairments, urinary incontinence, lower extremity functional limitation, activities of daily living (ADLs), cognitive function, and depressive symptoms. Mean age was 69.6 years (standard error = 0.18) and 51.8% were female. Forty percent reported one or more falls at baseline. Older age, being female, obesity, arthritis, fractures, stroke, suffering pain, vertigo, lower extremity functional limitations, physical activity, depressive symptoms, urinary incontinence, and ADL disability were significant factors associated with one or more falls over time. Early detection and treatment of the risk factors for falls in this population will help improve the quality of life and reduce medical complications and health care costs.

Resumen Objetivos Estudiar el grado de cultura de seguridad (CS) de los profesionales en el ambito de un servicio de urgencias extrahospitalarias. Analizar las dimensiones que reciben puntuaciones inferiores, con el fin de establecer futuras estrategias de actuacion. Material y metodos Estudio observacional, descriptivo, transversal en el que se distribuyo el cuestionario de la Agency for Healthcare Research and Quality (AHRQ) al universo muestral de los profesionales sanitarios que trabajan en las unidades de soporte vital avanzado del 061 de Aragon, durante el mes de agosto de 2013. Resultados Se analizaron 80 cuestionarios (tasa de respuesta 55,55%). Principales fortalezas: adecuada dotacion de personal (96%), buen clima laboral (89%), apoyo de superiores inmediatos (77%), trabajo en equipo (74%) y ambiente no punitivo hacia los eventos adversos (68%). Areas de mejora: insuficiente formacion en seguridad del paciente (53%), ausencia de feedback (50%). Conclusiones Las oportunidades de mejora detectadas se centran en la formacion de los profesionales, con el fin de procurar una asistencia mas segura, extendiendo al mismo tiempo la cultura de seguridad. Asi mismo se considera necesaria la puesta en marcha de un sistema de notificacion y registro de eventos adversos en nuestro servicio.

Resumen Objetivo Describir la evolucion de la mortalidad reducible por accion de los servicios sanitarios (MRASS) en Espana y evaluar si las transferencias sanitarias han supuesto algun cambio significativo. Metodos La MRASS se definio a partir de una lista de causas utilizada en otros estudios. Se analizan tasas de MRASS ajustadas por edad y sexo en los periodos 1999-2001 y 2006-2008, justo antes y 5 anos tras culminar el proceso de transferencias. Resultados La MRASS represento el 24% de las defunciones en personas de 0-74 anos. Descendio entre ambos periodos en mayor medida (19,4%) que el resto de causas (14,5%). El grupo de causas que mas descendieron fueron: cardiopatia isquemica (28,0%), resto de enfermedades vasculares (26,8%), enfermedades quirurgicas y errores medico-quirurgicos (25,9%) y diabetes (22,5%). Aunque existieron diferencias entre comunidades autonomas (CCAA), no se aprecio que estas diferencias ni la evolucion de la MRASS se relacionaran con las transferencias. Navarra y Madrid presentaron las menores tasas de MRASS y Canarias, Asturias, Andalucia, Ceuta y Melilla, las mayores. Baleares fue la CCAA donde mas disminuyo la MRASS. Conclusiones La MRASS representa una importante proporcion de la experiencia de mortalidad de personas de 0-74 anos. Ha descendido en todas las CCAA, y aunque hay grandes diferencias entre ellas, no parece que el proceso de transferencias sanitarias influyera en su evolucion en el periodo estudiado. Pese a limitaciones, la MRASS es un indicador que se debe considerar para monitorizar y detectar debilidades en la efectividad de los sistemas asistenciales.

Arthritis and vitamin D insufficiency are prevalent in older adults and are risk factors for disability. The objective of this study was to examine the effect of co-occurring arthritis and vitamin D deficiency on upper–lower extremity functional limitations and disability in older adults. We examined 1533 participants aged ≥50 years from a subsample of the Mexican Health and Aging Study. Measures included sociodemographics, body mass index, comorbid conditions, falls, physical activity, physical function tests, functional limitations, activities of daily living (ADL), and vitamin D. Participants were categorized into four groups according to arthritis and vitamin D status: no vitamin D insufficiency and no arthritis (58.80%), vitamin D insufficiency only (27.49%), arthritis only (8.47%), and arthritis and vitamin D insufficiency (5.24%). Fourteen percent reported arthritis, and 31.2% had vitamin D insufficiency. The arthritis and vitamin D insufficiency group was associated with upper–lower extremity functional limitations [odds ratio (OR) 1.82, 95% confidence interval (CI) 1.06–3.15, and OR 1.90, 95% CI 1.00–3.62, respectively] and ADL disability (OR 3.00, 95% CI 1.63–5.51) when compared with the no vitamin D insufficiency and no arthritis group (reference group). The arthritis only group was three times more likely to report upper–lower extremity functional limitations and ADL disability. The vitamin D insufficiency only group was not significantly associated with functional limitations nor ADL disability. Arthritis and vitamin D insufficiency increased the risk of ADL disability in this population. However, the effect of arthritis and vitamin D insufficiency on upper–lower extremity functional limitations was not higher than the effect of arthritis only, but higher than the effect on vitamin D insufficiency alone.

To assess the status of coral formations dominated by A c ro p o r a palmata (APF) and A. cervicornis (ACF) in the Tayrona National Natural Park (TNNP), Colombian Caribbean, a study was conducted at the bays of Chengue, Gayraca, Nenguange and Cinto between May- December 2001. The distribution and extension of the formations in the study area were evaluated by swimming along the coast and using draft maps, a GPS and a calibrated flow-meter, and their living cover were estimated in quadrat-belt transects (1x10 m). Atotal of 29 APF (119320 m2) and 12 ACF (21760 m2) were assessed. Almost all the APF exhibited living colonies of A. palmata, but the mean cover by this species reached only about 10%, representing about 14000 m2 of living area and a live: dead tissue proportion of 1: 8. Only four ACF had living colonies of A. cerv i c o r n i s, and the mean live cover by this species was near 5%, corresponding to only 1200 m2 and a live: dead tissue proportion of 1: 15. Algae was the dominant category at both types of formation, covering about 80% of the substrate, followed by stony corals (17% in APF and 12% in ACF) and in less proportion by sand, zoanthids, octocorals and sponges. The hard coral assemblage was composed by 21 species in both formations, but, despite the extensive mortality of acroporids, it continued dominated by A. palmata (60%) in the APF and by A. cer v i c o r n i s (40%) in the A C F. M i l l e p o r a c o m p l a n a t a was the only other stony coral species that reached important cover values (19% in APF and 24% in ACF); this is an opportunist coral that may have been gaining dominance following the decline of acroporid species. The results of our study indicate that acroporid populations of the PNNT have not recovered after 15 years of their mass mortality, and on the contrary, suggest that their status is now more dramatic. This is coincident with the general scenario that was diagnosed recently for the status of these corals in the Wider Caribbean. However, the current condition of acroporids in the PNNT seems better than in other reef areas of the Colombian Caribbean, so that, its remnant surviving populations can represent important reserves for conservation of both species and for future restoration programs.

Sprague-Dawley rats 10-12 weeks of age were entrained to a standard light-dark cycle with lights turned on at 6 am and off at 6 pm. Variations of 24-hour aqueous humor protein concentration were determined. Samples were taken every 4 hours (N = 10-14) under the standard light-dark condition at 8 pm, midnight, 4 am, 8 am, noon, and 4 pm. Under an acute constant dark condition, when lights were not turned on at 6 am, samples were collected at 8 am, noon, 4 pm, and 8 pm. Aqueous humor protein concentrations under the standard light-dark condition were found in the range of 0.305 ± 0.115 mg/ml (mean ± SD, N = 10) at midnight to 1.505 ± 0.342 mg/ml (N = 14) at noon. The 3 light-phase protein concentrations were each higher than the 3 dark-phase concentrations. Aqueous humor protein concentrations at 8 am, noon, and 4 pm under the acute constant dark condition were each higher than the concentrations at 8 pm (after both 2 hours and 26 hours in the dark), midnight, and 4 am, demonstrating an endogenously driven 24-hour pattern. At 8 am, noon, and 4 pm, protein concentrations were 56-147% higher when exposed to light. Intraocular pressure (IOP) was monitored using telemetry in separate groups of light-dark entrained rats under the standard light-dark condition and the acute constant dark condition. The 24-hour IOP pattern was inverse to the 24-hour pattern of aqueous humor protein concentration under the standard light-dark condition, and this IOP pattern was not altered by the acute constant dark condition. In conclusion, an endogenously driven 24-hour variation of aqueous humor protein concentration occurred in Sprague-Dawley rats with higher concentrations during the light-phase than the dark-phase. This endogenous pattern of protein concentration was accentuated by a direct effect of light, which was unrelated to the 24-hour pattern of IOP.

The celiac trunk (CT) is a vascular structure of the upper abdomen which gives off the left gastric artery (LGA), the splenic artery and the common hepatic artery. This study aims to compare the vascular patterns of the CT of two different samples (cadaveric and radiological) and to propose a simple classification of CT variations based on previous studies and our results. To perform this study we examined 43 adult cadavers, 24 males and 19 females, ages ranged from 69 to 92. In addition, we analysed 596 MDCT (multidetector computed tomographic) angiography examinations of 430 males and 166 females, ages ranged from 42 to 82. According to the classification proposed, results were divided into Type I or complete CT (578/639 cases, 90.5 %), Type II or incomplete CT (61/639 cases, 9.5 %), Type III or absence of CT and Type IV or celiacomesenteric trunk with no cases reported. Type I was divided into Type Ia or bifurcated trunk with LGA arising first (368/639 cases, 57.6 %), Type Ib or trifurcated trunk (205/639 cases, 32.1 %) and Type Ic or tetrafurcated trunk with an extra branch (5/639 cases, 0.8 %). Type II included hepatosplenic (29/639 cases, 4.5 %), gastroplenic (32/639, 5 %) and hepatogastric trunks (0/639, 0 %) which represented Types IIa, IIb and IIc respectively. No significant differences were found between the cadaveric and radiological samples. Gender did not appear to be related to any variability of the structures either. A new, simple and complete classification of the anatomical variations of the CT is proposed.

Genetic variability of 95 isolates of Beauveria bassiana from different geographical regions and hosts was assessed using RAPDs and ITS-RFLP molecular markers in order to characterize its genetic variability. Clusterings were obtained using UPGMA and Principal Coordinates Analysis. Four groups were identified with RAPDs. A 930 bp fragment was amplified with primers ITS1 and PN16, and polymorphisms were observed with Alu I and Msp I, generating two main clusters. Results indicate low genetic variability present in the Colombian B. bassiana population, no association to host type or geographic locality, and a population structure that is not clonal. This characterization sets criteria for determination of bio-insecticide potentiality, introduction of foreign strains and improvement of entomopathogens within an IPM program.

The aim of this study is to measure the degree of safety culture (CS) among healthcare professional workers of an out-of-hospital Emergency Medical Service. Most patient safety studies have been conducted in relation to the hospital rather than pre-hospital Emergency Medical Services. The objective is to analyze the dimensions with lower scores in order to plan futures strategies.A descriptive study using the AHRQ (Agency for Healthcare Research and Quality) questionnaire. The questionnaire was delivered to all healthcare professionals workers of 061 Advanced Life Support Units of Aragón, during the month of August 2013.The response rate was 55%. Main strengths detected: an adequate number of staff (96%), good working conditions (89%), tasks supported from immediate superior (77%), teamwork climate (74%), and non-punitive environment to report adverse events (68%). Areas for improvement: insufficient training in patient safety (53%) and lack of feedback of incidents reported (50%).The opportunities for improvement identified focus on the training of professionals in order to ensure safer care, while extending the safety culture. Also, the implementation of a system of notification and registration of adverse events in the service is deemed necessary.

Resumen Los estudios de poblacion adulta, que incluian cierto numero de personas mayores, demostraron una inexistente o debil correlacion en el binomio colesterol-enfermedad cardiovascular en la tercera edad. Aquellos que incluyeron un considerable volumen de personas en esas franjas de edad si encontraban una importante relacion; incluso al considerar el riesgo absoluto, no el relativo, este era mayor en este grupo de poblacion. Hay estudios que indican que la relacion desaparece por encima de los 85 anos de edad, y algunos dudan si se mantiene por encima de los 75 anos. Los grandes estudios prospectivos de intervencion farmacologica indican que el tratamiento hipolipemiante en la tercera edad es tan eficaz como en los adultos mas jovenes. Sin embargo, y dado que el analisis de esta franja de edad se hizo retrospectivamente, y con un numero pequeno de personas, hay en marcha varios estudios con distintas estatinas para establecer la eficacia y la oportunidad de tratar la hiperlipemia en la tercera edad. Los analisis costo-beneficio post-hoc disponibles con estatinas referidos a la tercera edad, indican que su uso estaria justificado. Finalmente se revisan las opciones farmacologicas disponibles en la actualidad: estatinas, resinas y fibratos. La mayor potencia hipolipemiante de las primeras, y su tolerancia, hacen que sean de eleccion en el tratamiento de las hipercolesterolemias puras o asociadas con hipertrigliceridemias moderadas. En las hipertrigliceridemias puras o asociadas con una hipercolesterolemia leve, los fibratos son la primera eleccion. Se recuerda la importancia de ajustar las dosis de los farmacos en funcion de la funcion renal y/o hepatica en esta edad, en la que es frecuente una insuficiencia real o funcional de los sistemas corporales de eliminacion.

Cyclic peptides containing even numbers of alternating d- and l-amino acids adopt a symmetric ring structure with NH and CO amide functions approximately perpendicular to the average plane of the ring. This results in hydrogen-bonded, β-sheet like tubular ensembles by coaxial stacking of rings in which adjacent strands are oriented antiparallel to one another. Starting from a molecular mechanics minimum energy configuration having the C4 symmetry reported for similar structures, an optimized monomer geometry which retained that symmetry was obtained using density functional theory (DFT). The geometry of the monomer is quite similar to that of stable polypeptides and proteins and the calculated gas-phase harmonic vibrational frequencies are quantitatively reasonable. Two monomers were then brought together coaxially, with adjacent strands arranged antiparallel, creating a dimer of D4 symmetry. Dimer energy was then minimized with respect to ring separation along, and relative rotation of one ring with resp...

This short communication proposes a new method to translate human EEG recordings into music. The sonification method is based on the relation of primary concepts of musical composition to different time-frequency characteristics of electrical signals from the brain that give information about the mental states. In general terms, normalization and thresholding procedures were applied to wavelet transforms of analyzed signals in order to extract amplitude and frequency parameters that were mapped to several synthetic or natural sounds following basic musical composition structures. The method seeks to provide a new perspective about the brain activity by means of an auditory feedback which not only facilitates the long term monitoring in clinical contexts like polysomnographics studies or epilepsy but also offers a new tool for a self-understating of the different human body processes modulated by the brain.

To describe the evolution of amenable mortality (MRASS) in Spain and to evaluate differences in trend patterns before and after health care services were transferred to local authorities.MRASS was defined from a list of causes of death used in other studies. We analyzed the change in sex-age-standardized death rates of MRASS in two periods: 1999-2001 and 2006-2008, just before, and five years after, the health care transfers were completed.MRASS represented 24% of deaths in persons from 0 to 74 years old. MRASS has seen a reduction (19.4%) between the two periods over and above other causes of mortality (14.5%). The group of causes of mortality which showed most reduction: ischemic heart disease (28%), other vascular disease (27%), surgical conditions and surgical-medical errors (26%), and diabetes (22.5%). Although there were differences between the districts, health care transfers have not created significant variations in MRASS. Navarra and Madrid showed lower rates of MRASS, and the Canary Islands, Asturias, Andalusia, Ceuta and Melilla had higher rates. The Balearic Islands showed the greatest reduction in MRASS.MRASS constitutes an important proportion of trends of mortality in persons between 0-74 years. It has declined in all districts. Even though there were large differences between districts, there does not appear to be any direct influence due to health care transfer in amenable mortality trends. In spite of limitations, MRASS is an indicator to be considered when monitoring and detecting weaknesses in the effectiveness of health care systems.

Obesity has been identified as a limitation of extracorporeal shockwave lithotripsy (SWL). The obesity metrics of body mass index (BMI) and skin-to-stone distance (SSD) have been evaluated as predictors of SWL success. While SSD has demonstrated a strong correlation with success, BMI has not. Bioimpedance analysis (BIA) is an accurate way of determining body adiposity. We evaluated fat mass percentage (FMP) as measured by BIA as a predictor of SWL success.We prospectively collected body composition data using the Imp-DF50 Body Impedance Analyzer on consecutive patients undergoing SWL. All generated variables, including FMP, along with demographics, BMI, stone size, and stone composition, were analyzed. Patients were evaluated for success, defined as no evidence of stones on radiography of the kidneys, ureters, and bladder at follow-up.Fifty-two consecutive patients were enrolled in the study, of which 37 had the necessary metrics to be included in the analysis. Twenty-three (62.2%) patients were stone free while 14 (37.8%) were found to have residual stone at follow-up. There was no difference in sex, stone laterality, mean age, and stone size between the groups. For the success and failure groups, the mean BMI was 25.8 kg/m(2) and 29.8 kg/m(2) (P=0.0091), and mean FMP 24.6% and 32.2% (P=0.0034). On mirrored multivariable analysis, both BMI (OR=0.735, P=0.026) and FMP (OR=0.806, P=0.010) were associated with success. Patients with a FMP ≥35% had a reduced success rate compared with those with a FMP35% (14% vs 73%, respectively, P=0.0028).Both BMI and FMP both appear to be independent predictors of success. Based on these findings, a large study examining the relationship between BMI, FMP, SSD, and SWL success is warranted. A preoperative FMP ≥35% is associated with a 14% success rate, and alternative treatment strategies for urolithiasis should be considered.

Objective To evaluate the effect that a safety wire (SW) had on insertion force and direct ureteral trauma using ureteral access sheaths (UAS) in an ex vivo porcine model. Material and Methods UASs were advance into 20 fresh ex vivo porcine kidney-ureters, either with or without SWs. The average and max force of insertion were recorded. Retrograde saline injection was used to identify the presence of lacerations. Results For SW vs no SW, the mean insertion force (1.79 vs 0.67, P = .0003, respectively) and max insertion force (2.29 kg vs 1.00, P = .0007) was greater in the SW group. There were 9 lacerations, 6 of which were partial and 3 complete. Of the partial injuries, 2 were in the no SW group and 4 were in the SW group. Of the complete lacerations, 2 occurred in the no SW group and 1 in the SW group. However, there was no significant difference in the total number of lacerations ( P = 1.00), the number of partial lacerations ( P = .628), or the number of complete lacerations ( P = 1.00) between the 2 groups. Conclusions The use of an SW significantly increases the force required to insert a UAS; however, it does not appear to affect the force or the degree of ureteral injury.