ECMO for Respiratory Failure in the Patient with Advance Lung Disease: A Bridge to Recovery or Decision

Extracorporeal membrane oxygenation (ECMO) has clear benefits in patients with acute cardiopulmonary failure. However, selecting patients who will benefit from extracorporeal membrane oxygenation can be a challenge and remains a hurdle for clinicians today. An increased concern when considering ECMO therapy is whether the patient will recover enough function and be able to be weaned from ECMO support and survive to discharge or undergo lung transplantation and specially on whether to extend extracorporeal membrane oxygenation as a bridge to recovery in those with concerns of a meaningful recovery or as a bridge-to-decision (BTD) for patients whose criteria for lung transplantation are unknown. In addition, ECMO is a resource-intensive form of lung support that requires significant institutional commitment and a well-trained team to ensure good outcomes. The critical factors in the decision-making process when there are concerns regarding the initiation, continuation, or withdrawal of ECMO include early transfer to a specialized lung transplant center and a multidisciplinary consensus among lung transplant pulmonologists, lung transplant surgeons, and ECMO critical care intensivists to expedited transplant evaluation and to clearly defined the goals of care and selecting the appropriate candidates who will benefit from ECMO as a BTD for patients not listed yet for lung transplantation

Comparison of Natural Feature Descriptors for Rigid-Object Tracking for Real-Time Augmented Reality

This paper presents a comparison of natural feature descrip- tors for rigid object tracking for augmented reality (AR) applica- tions. AR relies on object tracking in order to identify a physical object and to superimpose virtual object on an object. Natu- ral feature tracking (NFT) is one approach for computer vision- based object tracking. NFT utilizes interest points of a physcial object, represents them as descriptors, and matches the descrip- tors against reference descriptors in order to identify a phsical object to track. In this research, we investigate four different nat- ural feature descriptors (SIFT, SURF, FREAK, ORB) and their capability to track rigid objects. Rigid objects need robust de- scriptors since they need to describe the objects in a 3D space. AR applications are also real-time application, thus, fast feature matching is mandatory. FREAK and ORB are binary descriptors, which promise a higher performance in comparison to SIFT and SURF. We deployed a test in which we match feature descriptors to artificial rigid objects. The results indicate that the SIFT de- scriptor is the most promising solution in our addressed domain, AR-based assembly training

Surgical outcomes after cardiac surgery in liver transplant recipients

ObjectiveThis was a single-center retrospective study to assess the surgical outcomes and predictors of mortality of liver transplant recipients undergoing cardiac surgery.MethodsFrom 2000 to 2010, 61 patients with a functioning liver allograft underwent cardiac surgery. The mean interval between liver transplantation and cardiac surgery was 5.4 ± 4.4 years. Of the 61 patients, 33 (54%) were in Child-Pugh class A and 28 in class B. The preoperative and postoperative data were reviewed.ResultsThe overall in-hospital mortality was 6.6%. The survival rate was 82.4% ± 5.1% at 1 year and 50.2% ± 8.2% at 5 years. Cox regression analysis identified preoperative encephalopathy (odds ratio, 5.2; 95% confidence interval, 1.8-15.5; P = .003) and pulmonary hypertension (odds ratio, 3.5; 95% confidence interval, 1.3-9.4; P = .045) as independent predictors of late mortality. The preoperative Model for End-Stage Liver Disease (MELD) scores of patients who died in-hospital or late postoperatively were significantly greater statistically than the scores of the others (in-hospital death, 23.7 ± 7.8 vs 13.1 ± 4.5, P < .001; late death, 15.2 ± 6.1 vs 12.3 ± 4.1, P = .038). The Youden index identified an optimal MELD score cutoff value of 13.5 (sensitivity, 56.0%; specificity, 67.6%). Kaplan-Meier survival analysis successfully demonstrated that the survival rate of the MELD score less than 13.5 (MELD <13.5) group was significantly greater than that of the MELD >13.5 group (MELD <13.5 group, 93.8% ± 4.2% at 1 year and 52.4% ± 11.8% at 5 years; MELD >13.5 group, 66.9% ± 9.6% at 1 year and 46.1% ± 11.1% at 5 years; P = .027). In contrast, the survival rate when stratified by Child-Pugh class (class A vs B) was not significantly different.ConclusionsCardiac surgery in the liver allograft recipients was associated with acceptable surgical outcomes. Preoperative encephalopathy and pulmonary hypertension were independent predictors of late mortality. The cutoff value of 13.5 in the MELD score might be useful for predicting surgical mortality in cardiac surgery

Calidad del servicio y el impacto financiero de Inversiones Trini ENFM EIRL, Huarmey - Áncash

En la presente investigación titulada “Calidad del servicio y el impacto financiero de Inversiones Trini ENFM EIRL, Huarmey – Áncash”, el objetivo general fue determinar el impacto de la calidad del servicio en el ámbito financiero de Inversiones Trini ENFM EIRL. La investigación se realizó con el enfoque cuantitativo, de tipo básica, en el estudio la población estuvo constituida por el número de clientes que en promedio asisten en una semana a la empresa (80) y la muestra fue 67. La técnica empleada fue la encuesta, como instrumento el cuestionario. Como resultado de la investigación, el 58% de participantes respondió Nunca, Casi nunca 24%, A veces 11% y Casi siempre 7%, estos datos nos muestran los puntos a mejorar en cuanto a la calidad de servicio que brinda la empresa, como lo es: ofrecer sus servicios con información actualizada, redes sociales, un sistema de reservación e intercomunicadores en las habitaciones. Se concluyó que, si bien es cierto, la empresa cuenta con una calidad de servicio deseada por los clientes, se deben implementar o mejorar algunas opiniones rescatadas por los hospedados con el propósito de seguir creciendo como empresa y obtener una mejor liquidez y rentabilida

Caracterización e identificación de riesgos ergonómicos en trabajadores del área de servicios generales en la Universidad ECCI.

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La transgresión a la norma 0459 de atención integral en salud con enfoque forense

Introduction. A high-quality and timely medical forensic examination can potentially validate and address the crime to restore victims’ rights, minimize the trauma they may experience, and promote healing. Aim. To evaluate compliance with the forensic criteria of the comprehensive health care protocol for victims of sexual assault according to resolution 0459 of 2012 in four hospitals in southwestern Colombia. Methods. Retrospective descriptive study, a checklist based on Resolution 0459 of 2012 was used to evaluate the process of care for victims of sexual assault in hospital institutions of low and medium complexity. Descriptive analysis of the data was performed. Categorical variables were presented as absolute and relative frequencies, a Z score test was used with a value of p &lt; 0.05 as statistical significance. Results. 131 cases of sexual assault treated in the emergency services of low and medium complexity institutions were documented. 87% of the cases occurred in women and 50.4% in people under 14 years of age. In most cases, the standard of comprehensive care for victims of sexual violence was not met. Conclusion. The comprehensive care process with a forensic approach in Colombia is deficient; It violates the rights of victims, transgresses the gender equity policy and resolution 0459 of 2012. These situations could be having a significant impact on the administration of justice, the restitution of victims’ rights and the impunity of the crime.&nbsp;Introducción. Un examen médico forense oportuno y de alta calidad puede potencialmente validar y abordar el delito. Objetivos. Evaluar el cumplimiento de los criterios forenses del protocolo y modelo de atención integral en salud para víctimas de agresión sexual según la Resolución 0459 de 2012 en cuatro hospitales del suroccidente de Colombia. Metodología. Estudio descriptivo retrospectivo, se diseñó una lista de chequeo con base en la Resolución 0459 de 2012 para evaluar los criterios forenses del proceso de atención de las víctimas de agresión sexual en instituciones hospitalarias de baja y mediana complejidad. Se realizó un análisis descriptivo de los datos. Las variables categóricas se presentaron como frecuencias absolutas y relativas, se utilizó Z score test con un valor de p &lt; 0,05 como significancia estadística. Resultados. Se documentaron 131 casos de agresión sexual atendidos en los servicios de urgencias de instituciones de baja y mediana complejidad. El 87% de los casos ocurrieron en mujeres y el 50,4% en personas menores de 14 años. En la mayoría de los casos no se cumplieron criterios de interés forense de la norma de atenciónintegral a víctimas de agresión sexual. Conclusiones. El proceso de atención integral con enfoque forense en Colombia es deficiente; vulnera los derechos de las víctimas, transgrede la política de equidad de género y la resolución 0459 de 2012. Estas situaciones podrían estar impactando de manera significativa en la administración de justicia, la restitución de derechos de las víctimas y la impunidad del delito

Patterns of belowground overyielding and fine-root biomass in native and exotic angiosperms and gymnosperms

Mixing tree species can lead to more productive forests, but how belowground productivity is affected by mixtures of trees of diverse phylogenetic and eco-evolutionary histories is unclear. Here, we examine how species origin and phylogeny affect belowground productivity in tree communities of varied richness and functional diversity. We measured standing fine-root biomass and annual fine-root production across 41 assemblages of 12 tree species, representing both angiosperms and gymnosperms originating from North America and Europe. Increasing functional diversity of mixtures stimulated overyielding of annual production but did not affect standing biomass. In general, annual productivity of mixtures of species that were less productive in monoculture had neutral (angiosperms) to positive (North American species: +16%) responses to mixing, whereas annual productivity of mixtures of species that were more productive in monoculture had neutral (European species) to negative (gymnosperms: −6%) responses to mixing. These differences translated into angiosperm mixtures overyielding in standing biomass by 16% but no effects of mixing on gymnosperm mixtures. The trends we observed between North American and European species annual production were reversed when considering standing biomass. European mixtures had 14% more standing biomass and North American mixtures had 10% less standing biomass than expected from monocultures. Our study offers a rare examination of the combined roles of origin and phylogeny in forest fine-root productivity, and suggests varied consequences of biodiversity change for forest belowground productivity based on composition. In North America, belowground productivity of young forests composed of angiosperms and native tree species may be more tightly linked to diversity than that of forests dominated by gymnosperms or European species. This suggests that increased diversity may lead to the greatest enhancement of belowground productivity in native, North American forests dominated by angiosperms, but also that declines in diversity may be felt most strongly in these forests as well

Control de un convoy robótico mediante planificación de rutas y estrategias de orientación

This paper presents an overview about control methods implemented on robotic convoy systems or cooperative systems on mobile platforms which can be used for path planning, orientation, environment perception, route tracking and control systems in which involve the measurement, analysis, and interpretation of different variables for further implementation. A review was made of investigation articles on bibliographic indexes and databases about control methods used in convoy systems to evidence progress, trends and application methods.Este artículo presenta un estado del arte relacionado con métodos de control implementados en sistemas de convoy robóticos en plataformas móviles que pueden ser utilizados para la planificación de rutas o trayectorias, orientación, percepción de entornos y sistemas de control en el que se involucra la medición, análisis e interpretación de diversas variables y su posterior implementación. Se realizó una revisión de artículos de investigación en índices bibliográficos y bases de datos sobre métodos de control aplicados en sistemas de convoy para de esta forma evidenciar avances, tendencias y métodos de aplicación.

Disruption of early visual processing in amyloid-positive healthy individuals and mild cognitive impairment

Background Amyloid deposition is a primary predictor of Alzheimer’s disease (AD) and related neurodegenerative disorders. Retinal changes involving the structure and function of the ganglion cell layer are increasingly documented in both established and prodromal AD. Visual event-related potentials (vERP) are sensitive to dysfunction in the magno- and parvocellular visual systems, which originate within the retinal ganglion cell layer. The present study evaluates vERP as a function of amyloid deposition in aging, and in mild cognitive impairment (MCI). Methods vERP to stimulus-onset, motion-onset, and alpha-frequency steady-state (ssVEP) stimuli were obtained from 16 amyloid-positive and 41 amyloid-negative healthy elders and 15 MCI individuals and analyzed using time–frequency approaches. Social cognition was assessed in a subset of individuals using The Awareness of Social Inference Test (TASIT). Results Neurocognitively intact but amyloid-positive participants and MCI individuals showed significant deficits in stimulus-onset (theta) and motion-onset (delta) vERP generation relative to amyloid-negative participants (all p  70%. Discussion vERP may assist in the early detection of amyloid deposition among older individuals without observable neurocognitive impairments and in linking previously documented retinal deficits in both prodromal AD and MCI to behavioral impairments in social cognition

Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant

RATIONALE: Primary graft dysfunction (PGD) is a form of acute lung injury that occurs after lung transplantation. The definition of PGD was standardized in 2005. Since that time, clinical practice has evolved, and this definition is increasingly used as a primary endpoint for clinical trials; therefore, validation is warranted. OBJECTIVES: We sought to determine whether refinements to the 2005 consensus definition could further improve construct validity. METHODS: Data from the Lung Transplant Outcomes Group multicenter cohort were used to compare variations on the PGD definition, including alternate oxygenation thresholds, inclusion of additional severity groups, and effects of procedure type and mechanical ventilation. Convergent and divergent validity were compared for mortality prediction and concurrent lung injury biomarker discrimination. MEASUREMENTS AND MAIN RESULTS: A total of 1,179 subjects from 10 centers were enrolled from 2007 to 2012. Median length of follow-up was 4 years (interquartile range = 2.4-5.9). No mortality differences were noted between no PGD (grade 0) and mild PGD (grade 1). Significantly better mortality discrimination was evident for all definitions using later time points (48, 72, or 48-72 hours; P < 0.001). Biomarker divergent discrimination was superior when collapsing grades 0 and 1. Additional severity grades, use of mechanical ventilation, and transplant procedure type had minimal or no effect on mortality or biomarker discrimination. CONCLUSIONS: The PGD consensus definition can be simplified by combining lower PGD grades. Construct validity of grading was present regardless of transplant procedure type or use of mechanical ventilation. Additional severity categories had minimal impact on mortality or biomarker discrimination