Using EMR to Implement and Track Compliance of a Unique Colon Bundle That Reduced Surgical Site Infection in Colorectal Surgery: A Single Institution Review

Background: Surgical site infections (SSI) remain a common complication of colorectal surgery and are associated with an increase in cost, hospital LOS and an increased risk of postoperative morbidity and mortality. It is well studied that surgical care bundles reduce infection, there is no established consensus on the optimal amalgamation of variables. Increasing the number of measures within the bundle is associated with a stepwise reduction in SSI. This review presents the efficacy and implementation of a detailed surgical bundle to reduce SSIs in patients undergoing colorectal surgery. We illustrate how the use of EMR aids in implementation and the ability to easily record and track compliance, leading to dramatic reductions in SSIs during colon surgery. Methods: Our 700+ bed tertiary care center performs over 25,000 surgeries per year and approximately 280 colon cases. In 2015 our institution had a rise in the rate of SSI in colorectal surgeries prompting our institution to reevaluate their practices and initiate a Colon Bundle. A multidisciplinary team evaluated the current process and reviewed best practice guidelines and prevention bundles at other high performing institutions. The current Colon Bundle consists of various features including; standardized preoperative bowel prep, hair removal outside of OR, CHG prep, intraop wound protectors and an incision closing protocol . The benefit of this bundle focuses on continued surveillance of compliance with the incorporation directly into the EMR system. Intraop nursing staff are required to document key components of the bundle as part of their intraop paperwork, generating monthly reports that track surgeon specific compliance and fallouts. Results: The rate of SSI prior to implementation of the Colon Bundle, was 7.82% for 243 colon cases with a SIR of 2.431. The bundle was implemented in 2015 and the rate of SSI dropped to 3.52% with a SIR of 1.25 in 2016. The SSI rate continued to drop, in 2017 to 1.96% with a decrease in SIR to 0.68. When compliance was evaluated for specific components, most showed an increase between July 2017 and September 2018. Adherence to the intraop closure went from an average of 93% to 97%, wound protector use went from 85% to 90%. Preop CHG wipes went from 89% to 92%. A few areas had a decrease in compliance, including changing of gown and gloves intraop at the initiation of closing bundle from 99% to 97% and use of new instruments intraop when closing went from 98% to 96%. Conclusions: The implementation of a unique colon bundle at hospital dramatically reduced the incidence of SSI. Ongoing surveillance of compliance is tracked through the EMR allowing for immediate recognition of fall outs, reporting of SSI directly to the surgeons and a way to quickly address issues with compliance. We show that EMR is a helpful tool to track compliance and can be used effectively to improve adherence to aspects of a Colon Bundle in order to effectively reduce SSI

Estudio de alternativas ERNC para optimizar el suministro eléctrico del caserío Los ángeles, Magdalena de Cao, Ascope, La Libertad

La presente investigación tiene como propuesta el Estudio de Alternativas ERNC para Optimizar el Suministro Eléctrico del Caserío Los Ángeles, Magdalena de Cao, Ascope, La Liberta, contando con 30 viviendas que no cuentan aún con energía eléctrica. Para llevar a cabo su desarrollo, se realizó una encuesta a la población a fin de lograr determinar la máxima demanda y la energía consumida de lugar; con los datos obtenidos y haciendo uso de las fuentes de datos meteorológicas se logró obtener valores de la radiación solar y velocidad del viento de la zona, para posteriormente evaluar la existencia del potencial del recurso estudiado. Con los datos evaluados, se seleccionó a la energia solar por tener mayor potencial, posteriormente se realizó el dimensionamiento de los sistemas Off Grid o aislado y el sistema On Grid o interconectado, lográndose a través de cálculos y softwares, establecer sus componentes y el presupuesto económico. Posteriormente se realizó los análisis de viabilidad económica VAN y TIR de las alternativas elegidas, para evaluar la alternativa más optima a desarrollar para la electrificación del caserío. Con los resultados del análisis de viabilidad económica se concluyó que la inversión social es más conveniente para ambos sistemas en: Off Grid con un VAN positivo de S/ 40,654.5 y un TIR de un 12%, un B/C de 1.2; a una tasa social de descuento del 9% y para el sistema On Grid con un VAN positivo de S/ 197,799.7 y un TIR de un 43%, un B/C de 3.95; a una tasa social de descuento del 9%, siendo económicamente viable ambos sistemas

Influence of successive heat waves on the thermoregulatory responses of pregnant and non-pregnant ewes

The frequency of heat waves has increased over the last years, with an impact on animal production and health, including the death of animals. Therefore, the aim of this study was to evaluate the dynamics of thermoregulation and hormonal responses in non-pregnant and pregnant ewes exposed to successive heat waves. Twentyfour non-pregnant and 18 pregnant Santa Ines ewes with black coat color (live weight: 55 ± 9.03 kg; age: 60 months) were used. Weather variables such air temperature, relative humidity, and solar radiation were continuously recorded. The rectal and tympanic temperatures and respiratory rate were measured daily. Serum triiodothyronine (T3) and prolactin were evaluated during the heat wave and thermoneutral periods. The physiological variables were higher under the heat wave conditions and were related to the activation of the thermoregulatory system for maintaining homeothermy (P < 0.05). The core body temperature was higher during successive heat waves (P < 0.05), as was the tympanic temperature, which are both affected by changes in air temperature (P < 0.05). T3 and prolactin levels were not influenced by successive heat waves (P < 0.05) and rectal temperature and respiratory rate were highest in non-pregnant ewes (P < 0.05). Prolactin was not affected by temperature. The results indicate that the Santa Ines breed overcomes the thermal challenge during a heat wave without showing severe signs of thermal stress regardless of being pregnant or not

Could Physical Fitness Be Considered as a Protective Social Factor Associated with Bridging the Cognitive Gap Related to School Vulnerability in Adolescents? The Cogni-Action Project

Carlos Cristi-Montero received funding for the Cogni-Action Project from the National Commission for Scientific and Technological Research CONICYT/FONDECYT INICIACION 2016 grant No. 11160703 (Chile), and the National Research and Development Agency (ANID) from Chile-2019, Postdoctoral Grant No. 74200071.The first aim was to compare differences between school vulnerability groups, fitness levels, and their combination in adolescent cognitive performance. The second aim was to determine the mediation role of fitness in the association between school vulnerability and cognitive performance. A total of 912 Chilean adolescents aged 10–14 years participated in this study. The school vulnerability index (SVI) assigned by the Chilean Government was categorized into high-, mid-, or low-SVI. Adolescents were classified as fit or unfit according to their global fitness z-score computed from their cardiorespiratory (CRF), muscular (MF), and speed/agility fitness (SAF) adjusted for age and sex. A global cognitive scorewas estimated through eight tasks based on a neurocognitive battery. Covariance and mediation analyses were performed, adjusted for sex, schools, body mass index, and peak high velocity. Independent analyses showed that the higher SVI, the lower the cognitive performance (F(6,905) = 18.5; p < 0.001). Conversely, fit adolescents presented a higher cognitive performance than their unfit peers (F(5,906) = 8.93; p < 0.001). The combined analysis found cognitive differences between fit and unfit adolescents in both the high- and mid-SVI levels (Cohen’s d = 0.32). No differences were found between fit participants belonging to higher SVI groups and unfit participants belonging to lower SVI groups. Mediation percentages of 9.0%, 5.6%, 7.1%, and 2.8% were observed for the global fitness score, CRF, MF, and SAF, respectively. The mediation effect was significant between lowwith mid-high-SVI levels but not between mid- and high-SVI levels. These findings suggest that an adequate physical fitness level should be deemed a protective social factor associated with bridging the cognitive gap linked to school vulnerability in adolescents. This favourable influence seems to be most significant in adolescents belonging to a more adverse social background.National Commission for Scientific and Technological Research CONICYT/FONDECYT INICIACION (Chile) 11160703National Research and Development Agency (ANID) from Chile 7420007

Conducta infiel y adicción a redes sociales en adultos de la selva peruana

Addiction to social networks increases the chances of partner infidelity. This research aimed to determine the relationship between unfaithful behavior and addiction to social networks in adults from the commercial areas of Tarapoto, Lamas, San José de Sisa, Moyobamba, and Naranjos, in the Peruvian Amazon region, during the first four-month period of 2021. Thus, a study with a non-experimental design and correlational research type was developed in a sample of 318 individuals between 20 and 40 years old. The Multidimensional Infidelity Inventory and the Social Networks Addiction Questionnaire were applied. 62.3% of the participants were male, 57.5% were between 30 and 59 years old, 66.7% lived with their partners without marriage, and 51.6% were in the second stage of the couple relationship. There were significant differences between men and women regarding unfaithful behavior (U=6387,500; p&lt;0.000). In this context, a predominance of the medium level of addiction to social networks in the participants and the low level in the dimensions of infidelity behavior were observed, establishing a statistically significant correlation between both variables.La adicción a las redes sociales potencia las probabilidades de infidelidad de pareja. Esta investigación tuvo el objetivo de determinar la relación entre conducta infiel y adicción a redes sociales en adultos de las áreas comerciales de Tarapoto, Lamas, San José de Sisa, Moyobamba y Naranjos, región de la Amazonía Peruana, durante el primer cuatrimestre de 2021. Así, se desarrolló un estudio con diseño no experimental y tipo de investigación correlacional, en una muestra de 318 individuos con edades entre 20 y 40 años, a los que se aplicó el Inventario Multidimensional de Infidelidad y el Cuestionario de Adicción a Redes Sociales. El 62,3% de los participantes perteneció al sexo masculino, el 57,5% tenía edades entre 30 y 59 años, el 66,7% convivía con sus parejas sin estar casados y el 51,6% se encontraban en la segunda etapa de la relación de pareja. Existieron diferencias significativas entre hombres y mujeres en cuanto a la conducta infiel (U=6387,500; p&lt;0,000). En este contexto, se observó un predominio del nivel medio de la adición a las redes sociales en los participantes y del bajo en las dimensiones de la conducta de infidelidad, estableciéndose correlación estadísticamente significativa entre ambas variables

Corporate Security Responsibility: Towards a Conceptual Framework for a Comparative Research Agenda

The political debate about the role of business in armed conflicts has increasingly raised expectations as to governance contributions by private corporations in the fields of conflict prevention, peace-keeping and postconflict peace-building. This political agenda seems far ahead of the research agenda, in which the negative image of business in conflicts, seen as fuelling, prolonging and taking commercial advantage of violent conflicts,still prevails. So far the scientific community has been reluctant to extend the scope of research on ‘corporate social responsibility’ to the area of security in general and to intra-state armed conflicts in particular. As a consequence, there is no basis from which systematic knowledge can be generated about the conditions and the extent to which private corporations can fulfil the role expected of them in the political discourse. The research on positive contributions of private corporations to security amounts to unconnected in-depth case studies of specific corporations in specific conflict settings. Given this state of research, we develop a framework for a comparative research agenda to address the question: Under which circumstances and to what extent can private corporations be expected to contribute to public security

Cuantificación y valoración económica del conflicto humano-puma en San Onofre, departamento de Sucre, Colombia

The puma (Puma concolor) is a feline native to America that is occasionally responsible for opportunistic attacks and predation of domestic animals of productive interest in Colombia, which is why it is considered an animal that generates conflicts. However, it is also a key species in the dynamics and balance of its ecosystems, for which the maintenance of its populations is transcendental. In this study, we present the first characterization and economic valuation of damage caused by P. concolor in the Colombian ecoregion of Montes de María. Specifically, we report a quantification of the losses of sheep and pigs in some rural localities of the municipality of San Onofre, department of Sucre, carried out through a semi-structured interview that was applied to producers between 2018 and 2020. Additionally, we present a bibliographic review of the evidence on the human-puma conflict in the Colombian Caribbean region. We found that the human-puma conflict situation is underrepresented in studies for the Caribbean region. Puma attacks in San Onofre were mainly linked to the vulnerability of the prey and the management of the enclosures. Losses for sheep producers ranged from $540.000 to$2.465.000, while for hog producers they ranged from $292.500 to$1.560.000. Given the importance of the region for the persistence of the species and the dependence of local producers on agricultural activities to support their families, interdisciplinary efforts must be combined to better understand this problem and propose viable and comprehensive solutions.El puma (Puma concolor) es un felino nativo de América que, ocasionalmente, es responsable de ataques y depredación oportunista de animales domésticos de interés productivo en Colombia, razón por la que es considerado como un animal que genera conflictos. Sin embargo, es también una especie clave en la dinámica y el equilibrio de sus ecosistemas, por lo que el mantenimiento de sus poblaciones es trascendental. En este estudio presentamos la primera caracterización y valoración económica de daños ocasionados por P. concolor en la ecorregión colombiana de Montes de María. Específicamente, reportamos una cuantificación de las pérdidas de ovinos y porcinos en algunas localidades rurales del municipio de San Onofre, departamento de Sucre, realizada por medio de una entrevista semiestructurada que se aplicó a productores entre 2018 y 2020. Adicionalmente, presentamos una revisión bibliográfica de la evidencia sobre el conflicto humano-puma en la región del Caribe colombiano. Encontramos que la situación del conflicto humano-puma está subrepresentada en los estudios para la región Caribe. Los ataques de puma en San Onofre se vincularon principalmente a la vulnerabilidad de las presas y el manejo de los encierros. Las pérdidas para los productores de ovinos oscilaron entre $540,000 y$2,465,000, mientras que para los productores de porcinos estuvieron entre $29,500 y$1,560,000. Dada la importancia de la región para la persistencia de la especie y la dependencia de los productores locales de las actividades agropecuarias para el sostenimiento de sus familias, se deben aunar esfuerzos interdisciplinares que permitan comprender mejor esta problemática y proponer soluciones viables e integrales

Behavioral Improvement and Regulation of Molecules Related to Neuroplasticity in Ischemic Rat Spinal Cord Treated with PEDF

Pigment epithelium derived factor (PEDF) exerts trophic actions to motoneurons and modulates nonneuronal restorative events, but its effects on neuroplasticity responses after spinal cord (SC) injury are unknown. Rats received a low thoracic SC photothrombotic ischemia and local injection of PEDF and were evaluated behaviorally six weeks later. PEDF actions were detailed in SC ventral horn (motor) in the levels of the lumbar central pattern generator (CPG), far from the injury site. Molecules related to neuroplasticity (MAP-2), those that are able to modulate such event, for instance, neurotrophic factors (NT-3, GDNF, BDNF, and FGF-2), chondroitin sulfate proteoglycans (CSPG), and those associated with angiogenesis and antiapoptosis (laminin and Bcl-2) and Eph (receptor)/ephrin system were evaluated at cellular or molecular levels. PEDF injection improved motor behavioral performance and increased MAP-2 levels and dendritic processes in the region of lumbar CPG. Treatment also elevated GDNF and decreased NT-3, laminin, and CSPG. Injury elevated EphA4 and ephrin-B1 levels, and PEDF treatment increased ephrin A2 and ephrins B1, B2, and B3. Eph receptors and ephrins were found in specific populations of neurons and astrocytes. PEDF treatment to SC injury triggered neuroplasticity in lumbar CPG and regulation of neurotrophic factors, extracellular matrix molecules, and ephrins

Comparative untargeted metabolome analysis of ruminal fuid and feces of Nelore steers (Bos indicus).

We conducted a study to identify the fecal metabolite profle and its proximity to the ruminal metabolism of Nelore steers based on an untargeted metabolomic approach. Twenty-six Nelore were feedlot with same diet during 105 d. Feces and rumen fuid were collected before and at slaughter, respectively. The metabolomics analysis indicated 49 common polar metabolites in the rumen and feces. Acetate, propionate, and butyrate were the most abundant polar metabolites in both bio-samples. The rumen presented signifcantly higher concentrations of the polar compounds when compared to feces (P< 0.05); even though, fecal metabolites presented an accentuated representability of the ruminal fuid metabolites. All fatty acids present in the ruminal fuid were also observed in the feces, except for C20:2n6 and C20:4n6. The identifed metabolites ofer information on the main metabolic pathways (higher impact factor and P< 0.05), as synthesis and degradation of ketone bodies; the alanine, aspartate and glutamate metabolisms, the glycine, serine; and threonine metabolism and the pyruvate metabolism. The fndings reported herein on the close relationship between the ruminal fuid and feces metabolic profles may ofer new metabolic information, in addition to facilitating the sampling for metabolism investigation in animal production and health routines

Durvalumab Plus Carboplatin/Paclitaxel Followed by Maintenance Durvalumab With or Without Olaparib as First-Line Treatment for Advanced Endometrial Cancer: The Phase III DUO-E Trial

PURPOSE Immunotherapy and chemotherapy combinations have shown activity in endometrial cancer, with greater benefit in mismatch repair (MMR)-deficient (dMMR) than MMR-proficient (pMMR) disease. Adding a poly(ADP-ribose) polymerase inhibitor may improve outcomes, especially in pMMR disease. METHODS This phase III, global, double-blind, placebo-controlled trial randomly assigned eligible patients with newly diagnosed advanced or recurrent endometrial cancer 1:1:1 to: carboplatin/paclitaxel plus durvalumab placebo followed by placebo maintenance (control arm); carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib placebo (durvalumab arm); or carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib (durvalumab + olaparib arm). The primary end points were progression-free survival (PFS) in the durvalumab arm versus control and the durvalumab + olaparib arm versus control. RESULTS Seven hundred eighteen patients were randomly assigned. In the intention-to-treat population, statistically significant PFS benefit was observed in the durvalumab (hazard ratio [HR], 0.71 [95% CI, 0.57 to 0.89]; P = .003) and durvalumab + olaparib arms (HR, 0.55 [95% CI, 0.43 to 0.69]; P < .0001) versus control. Prespecified, exploratory subgroup analyses showed PFS benefit in dMMR (HR [durvalumab v control], 0.42 [95% CI, 0.22 to 0.80]; HR [durvalumab + olaparib v control], 0.41 [95% CI, 0.21 to 0.75]) and pMMR subgroups (HR [durvalumab v control], 0.77 [95% CI, 0.60 to 0.97]; HR [durvalumab + olaparib v control] 0.57; [95% CI, 0.44 to 0.73]); and in PD-L1-positive subgroups (HR [durvalumab v control], 0.63 [95% CI, 0.48 to 0.83]; HR [durvalumab + olaparib v control], 0.42 [95% CI, 0.31 to 0.57]). Interim overall survival results (maturity approximately 28%) were supportive of the primary outcomes (durvalumab v control: HR, 0.77 [95% CI, 0.56 to 1.07]; P = .120; durvalumab + olaparib v control: HR, 0.59 [95% CI, 0.42 to 0.83]; P = .003). The safety profiles of the experimental arms were generally consistent with individual agents. CONCLUSION Carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab with or without olaparib demonstrated a statistically significant and clinically meaningful PFS benefit in patients with advanced or recurrent endometrial cancer