Recomendaciones para desarrollar un programa de formación en simulación quirúrgica laparoscópica. Perspectivas obtenidas tras 12 años de formación de cirujanos

Introduction. The use of simulation in surgery has made it possible to shorten learning curves through deliberate practice. Although it has been incorporated long ago, there are still no clear recommendations to standardize its development and implementation. This manuscript aims to share recommendations based on our experience of more than twelve years of employing and improving a methodology in laparoscopic surgical simulation. Topics for Reflection. To transfer surgical skills to a trainee, we base our methodology on a three-pillar framework: The hardware and infrastructure (tools to train with), the training program itself (what to do), and the feedback (how to improve). Implementing a cost-effective program is feasible: the hardware does not need to be high fidelity to transfer skills, but the program needs to be validated. These pillars have evolved over time by incorporating technology: the on-site guidance from experts has changed to a remote and asynchronous modality by video recording the trainee’s execution, and by enabling remote and asynchronous feedback. The feedback provider does not necessarily have to be an expert clinician in the subject, but a person previously trained to be a trainer. This allows for deliberate practice until mastery has been reached and learning curves are consolidated. Conclusions. Recommendations based on the experience of our center have been presented, explaining the framework of our strategy. Considering these suggestions, it is hoped that our simulation methodology can aid the development and implementation of effective simulation-based programs for other groups and institutions.Introducción. El uso de la simulación en cirugía ha permitido acortar las curvas de aprendizaje mediante la práctica deliberada. A pesar de que se ha incorporado previamente, aún no existen recomendaciones claras para estandarizar su desarrollo e implementación. Este manuscrito pretende compartir recomendaciones basadas en nuestra experiencia, con más de doce años empleando y mejorando una metodología en la simulación quirúrgica laparoscópica. Temas de reflexión. Para transferir las habilidades quirúrgicas a un aprendiz, basamos nuestra metodología en un marco de tres pilares: El hardware y la infraestructura (herramientas con las que entrenar), el programa de entrenamiento (qué hacer), y la retroalimentación (cómo mejorar). La implementación de un programa rentable es factible: el hardware no necesita ser de alta fidelidad para transferir las habilidades, pero el programa necesita ser validado. Estos pilares han evolucionado a lo largo del tiempo incorporando tecnología: la presencia de expertos ha evolucionado a una modalidad remota y asincrónica mediante la grabación en vídeo de la ejecución del alumno, y permitiendo su retroalimentación. Aquel que entrega retroalimentación no tiene que ser necesariamente un clínico experto en la materia, sino una persona previamente formada como instructor. Esto permite una práctica deliberada hasta dominar la habilidad y establecer curvas de aprendizaje. Conclusiones. Se han presentado recomendaciones basadas en la experiencia de nuestro centro, explicando el marco de nuestra estrategia. Teniendo en cuenta estas sugerencias, se espera que nuestra metodología de simulación pueda ayudar al desarrollo e implementación de programas efectivos basados en la simulación a otros grupos e instituciones

Dinámica espacial y temporal de las ocupaciones prehispánicas en la cuenca hidrográfica del rio Limari (30° Lat. S.).

Este trabajo discute la secuencia de desarrollo histórico prehispánico en el Norte Semiárido de Chile a partir del estudio de las dinámicas espaciales y temporales de las ocupaciones humanas en la cuenca hidrográfica del río Limarí. A partir del estudio de asentamientos, materiales depositados en colecciones y arte rupestre se observa una secuencia de transformaciones y desarrollo desde el Arcaico Temprano hasta el período Incaico que diverge de lo tradicionalmente planteado para la región, reconociéndose ritmos de cambios sociales diferenciales dentro de la misma zona, especialmente en relación con la tradicional asociación entre incorporación de cerámica y la constitución de un modo de vida agrícola. La incorporación del arte rupestre permite articular sus características espaciales y representacionales con procesos más amplios, discutiéndose las relaciones establecidas entre dinámicas y cambios sociales con los flujos de información que producen las representaciones rupestres y sus respectivas audiencias.This paper discusses the pre-Hispanic sequence of historical development in the semiarid north of Chile through the study of spatial and temporal dynamics of human occupation in the Limari valley. Based on the study of settlements, museum collections and rock art, a sequence of transformations and development between the Early Archaic and Inca Period is observed that differs from what is traditionally known of the area. In this time frame, social changes such as the adoption of pottery and the constitution of an agrarian way of life, occur at different paces in both time and space within the same Limari valley. We discuss spatial and representational characteristics of rock art in relation to pre-hispanic social processes, emphasizing the links between audiences, flows of information and the dynamics of social life.Fil: Troncoso, Andrés. Universidad de Chile; ChileFil: Vergara, Francisco. No especifica;Fil: Pavlovic, Daniel. Universidad de Chile; ChileFil: González, Paola. No especifica;Fil: Pino, Mariela. No especifica;Fil: Larach, Pablo. No especifica;Fil: Escudero, Antonia. No especifica;Fil: La Mura, Natalia. No especifica;Fil: Moya, Francisca. No especifica;Fil: Pérez, Isidora. No especifica;Fil: Gutiérrez, Renata. No especifica;Fil: Pascual, Daniel. No especifica;Fil: Belmar, Carolina. No especifica;Fil: Basile, Mara Valeria. Universidad de Buenos Aires. Facultad de Filosofía y Letras. Museo Etnográfico "Juan B. Ambrosetti"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: López, Patricio. Universidad de Chile; ChileFil: Dávila, Cristian. No especifica;Fil: Vásquez, María José. No especifica;Fil: Urzúa, Paula. No especifica

Natural disasters and territoriality: the case of the lafkenche de Saavedra

Natural disasters are very common in our country. Earthquakes, tsunamis, volcanic eruptions and floods are phenomena that happens quite frequently, often altering the way local groups interact with nature. This because they are able to modify cultural, social and economic practices reorienting the future of a specific territory, as happened in Saavedra with the 9.5 degrees earthquake and subsequent tsunami of 1960. From a political ecology of disasters; and through focus groups, semi-structured interviews and participatory mappings; this article analyses the way local authorities with competence in disasters have recognized the relevance of the lafkenche's territoriality, generating an intercultural dialogue between actors that have diff erent epistemologies and ontologies about disasters

Study of structural capacity and serviceability affecting the obstruction of residential door

The last Chilean earthquake, occurred on February 27, 2010, allowed establishing important patterns of structural failures in reinforced concrete residential buildings; however, limited progress has been made in the study of basic standards of serviceability, such as obstruction of doors. Thus, this study focused on measuring the influence of design specifications and construction criteria of lintels and columns, in terms of obstruction of doors, considering capacity thresholds for certain levels of displacement. The study consisted of the design and construction of a full-scale prototype of a reinforced concrete frame, designed in accordance with all the ACI-318-08 requirements, taking into account typical aspects of geometry and materiality widely used by the real estate industry, for location and size of doors. In order to quantify the structural capacity of the prototype and to study the serviceability of the door, a quasi-static cyclic test was conducted, according to load and displacement protocols specified in FEMA 356 and FEMA 461, which was adjusted by using virtual models based on a static nonlinear analysis called "Pushover". This research verified that, for displacement levels even five times higher than those established by codes considered, the cracking degree was minimal and fully recoverable. It was also found the door evidenced malfunction when the displacements were greater than those specified by design only, validating a high degree of accomplishment of current codes, in terms of capacity and serviceability, when dealing with obstruction of residential doors

Plan piloto para un catastro de tierras adquiridas por CONADI: estudio exploratorio.

El actual informe tiene su génesis en una aproximación de la territorialidad en la condición y estado actual de las tierras comunitarias indígenas que la Corporación Nacional Indígena (CONADI) ha adquirido en La Región de la Araucanía. Ante este planteamiento la Fundación de Desarrollo Social y Cultural AITUÉ, contacta a la Facultad de Ciencias Agronómicas de la Universidad de Chile para ver la factibilidad de realizar un estudio exploratorio sobre estos temas y otras materias desconocidas sobre la propiedad entregadas por CONADI desde 1994, que son de interés nacional

Contribution of −Omics Technologies in the Study of <i>Porphyromonas gingivalis</i> during Periodontitis Pathogenesis: A Minireview

Periodontitis is a non-communicable chronic inflammatory disease characterized by the progressive and irreversible breakdown of the soft periodontal tissues and resorption of teeth-supporting alveolar bone. The etiology of periodontitis involves dysbiotic shifts in the diversity of microbial communities inhabiting the subgingival crevice, which is dominated by anaerobic Gram-negative bacteria, including Porphyromonas gingivalis. Indeed, P. gingivalis is a keystone pathogen with a repertoire of attributes that allow it to colonize periodontal tissues and influence the metabolism, growth rate, and virulence of other periodontal bacteria. The pathogenic potential of P. gingivalis has been traditionally analyzed using classical biochemical and molecular approaches. However, the arrival of new techniques, such as whole-genome sequencing, metagenomics, metatranscriptomics, proteomics, and metabolomics, allowed the generation of high-throughput data, offering a suitable option for bacterial analysis, allowing a deeper understanding of the pathogenic properties of P. gingivalis and its interaction with the host. In the present review, we revise the use of the different −omics technologies and techniques used to analyze bacteria and discuss their potential in studying the pathogenic potential of P. gingivalis

EL DIAGNÓSTICO PRENATAL DE CARDIOPATÍAS CONGÉNITAS MEJORA EL PRONÓSTICO NEONATAL

Las malformaciones congénitas son la principal causa de muerte neonatal precoz en nuestro medio; en la mayoría de los casos corresponden a cardiopatías congénitas mayores. Las cardiopatías congénitas tienen una incidencia de 8/1.000 recién nacidos vivos, correspondiendo la mitad de ellas a cardiopatías congénitas mayores. Una de las intervenciones recomendadas para reducir la mortalidad de este grupo de niños es evaluar rutinariamente la anatomía del corazón fetal mediante ecografía obstétrica, para planificar la atención neonatal, de aquellos fetos con cardiopatías congénitas, en el momento y lugar más oportuno. En objetivo de la presente revisión es comprobar si el diagnóstico prenatal de una cardiopatía congénita mejora el pronóstico perinatal respecto de aquellos casos que son diagnosticados post parto. Observamos que el diagnóstico antenatal de cardiopatía congénita, no mejora la sobrevida neonatal, excepto en ciertas cardiopatías congénitas ductus dependientes (transposición de grandes arterias, hipoplasia del corazón izquierdo y coartación de aorta), en que si se ha reportado una mayor probabilidad de sobrevida en el grupo de recién nacidos en los cuales se realizó el diagnóstico en el período prenatal. Recomendamos la evaluación rutinaria del corazón fetal en la ecografía obstétrica habitual, y efectuar ecocardiografía fetal especializada ante la sospecha de alteraciones o en aquellos grupos de mayor riesg

Immobilised chiral inducer on Pt-based mesoporous titanate nanotubes as heterogeneous catalysts for enantioselective hydrogenation

A new series of chiral porous titanate nanotubes (TNTs) containing (−)-11-trimethoxysilyl-cinchonidine (TMS-CD) moieties were synthesized via direct surface anchorage. These hybrid solids were used as supports for Pt (1 wt%) catalysts and evaluated in heterogeneous enantioselective hydrogenation of 1-phenyl-1,2-propanodione. The supports and catalysts were characterized by a variety of techniques including TGA, N2 adsorption isotherms, solid state NMR (13C and 29Si), XRD, HR-TEM, DRIFTs and XPS. For the best system the hydrogen pressure, solvent effects and recycles were studied. The maximum enantiomeric excess (ee) and the turnover frequency obtained under optimized conditions with 1% Pt/TNT-CD were 37% (at 15 wt% nominal content of TMS-CD) and 165 min−1 (at 10 wt% nominal content of TMS-CD), respectively. The variation of H2 pressure and solvent affects both the activity and enantioselectivity due to the substrate adsorption on the metal active sites. Additionally, these heterogeneous catalysts can also be easily recycled and reused for three times without the loss of activity and enantioselectivity. After the 3rd cycle, catalyst deactivation due to the leaching of Pt nanoparticles and modifier hydrogenation in the feed was detected.The authors thank CONICYT for the financial support (FONDECYT GRANT 1061001, FONDECYT Initiation GRANT 11121631, FONDECYT postdoctoral 3140130 and 3140157) and REDOC.CTA doctoral network. P.A. Osorio-Vargas thanks MECESUP for doctoral fellowship.Peer Reviewe

Fetal ECG: A Novel Predictor of Atrioventricular Block in Anti-Ro Positive Pregnancies

OBJECTIVE: Approximately 2.8% of pregnancies are Ro/La antibody positive. 3–15% of fetuses develop complete heart block (CHB). First‐degree atrioventricular heart block (1° AVB) is reported in a third of Ro/La fetuses but as most have a normal postnatal ECG this may reflect inadequacies of Doppler measurement techniques. METHODS: Comparison was made between mechanical (mPR) and electrical (ePR) intervals obtained prospectively using Doppler and non‐invasive fetal ECG (fECG) in 52 consecutive Ro/La pregnancies in 46 women carrying 54 fetuses in an observational study at a fetal medicine unit. 121 mPR and 37 ePR intervals were recorded in 49 Ro/La fetuses. Five were referred with CHB and excluded. ePR was measured successfully in 35/37 (94%) and mPR was measured in all cases. 1° AVB was defined as PR >95% CI. Logistic regression predicted abnormal final fetal rhythm from first mPR or ePR. RESULTS: The ePR model gave 66.7% sensitivity (6 of 8 final abnormal fetal rhythm cases were predicted correctly in fetuses >20 weeks) and 96.2% specificity. mPR gave 44.4% sensitivity (4 of 9 cases) and 88.5% specificity. Z scores for ePR (zPR) were calculated from 199 normal fetuses. The area under the receiver operator characteristic (ROC) curve was 0.88 (95% CI, 0.754 to 1.007). A cut‐off of 1.65 gave a sensitivity of 87.5% and specificity of 95% for those with prolonged and normal ePR intervals, respectively. CONCLUSION: zPR is better than mPR at differentiating between normal and prolonged PR intervals, suggesting that fECG is the diagnostic tool of choice to investigate the natural history and therapy of conduction abnormalities in Ro/La pregnancies

A new non-cinchona chiral modifier immobilized on Pt/SiO2 catalysts for enantioselective heterogeneous hydrogenation

Pt heterogeneous catalysts were prepared by the covalent immobilization of (4′R,5′S)-4′,5′-dihydro-4′,5′-diphenyl-2-(6-cyanopyridyl)imidazoline (PyIm) as the asymmetric modifier. These novel series of catalysts were studied in the 1-phenyl-1,2-propanodione (PPD) hydrogenation. The effects of the PyIm surface concentration, hydrogen pressure, solvent nature and recycles on the reaction were studied. These modified catalysts represent the first effective immobilized chiral non-Cinchona-type modifier of Pt for the enantioselective hydrogenation. The enantio-differentiation was attributed to the substrate–modifier interactions involving hydrogen bonding between the keto-carbonyl O atom and the NH moiety PyIm. The results confirmed that the variations in the H2 pressure and the solvent affect the activity and the enantioselectivity due to the substrate adsorption on the active sites of the metal. Additionally, this heterogeneous catalyst can be conveniently reused at least five times without loss of its catalytic efficiency, but the enantioselectivity decreased, which may be due to the leaching of the modifier.The authors would like to thank CONICYT for their financial support (FONDECYT GRANT 1061001, FONDECYT Initiation GRANT 11121631, FONDECYT postdoctoral 3140130 and 3140157) and the REDOC.CTA doctoral network.Peer Reviewe