Una propuesta metodológica para la construcción de videojuegos

Este artículo presenta una propuesta metodológica llamada CASCRUM para el desarrollo de videojuegos en 2d como una herramienta para la construcción de este tipo de software. Esta propuesta se fundamenta en las etapas del ciclo de vida de la metodología de Cascada y como método de seguimiento de las etapas de CASCRUM integramos de la metodología Scrum el ciclo de reuniones Daily Scrum con una variante de la misma semanal la cual llamamos Week Meeting Planning. Para la evaluación de la propuesta tomamos como escenario a la Facultad de Ingeniería en Sistemas Computacionales de la Universidad Tecnológica de Panamá Campus Central. El tiempo de experimentación fue durante los años 2013 al 2014. En el periodo académico del 2013 los estudiantes recibían la guía de un instructor con conocimientos avanzados en videojuegos en 2d, para el año 2014 algunos de los estudiantes del periodo anterior fueron los monitores de los grupos. Con el fin de evaluar si CASCRUM era eficiente para la construcción de videojuegos en 2d, se formaron tres grupos en ambos periodos y cada grupo se le asignaba una única metodología de desarrollo a lo largo del periodo de experimentación, las metodologías que se implementaron fueron (Cascada, Scrum y CASCRUM), para homologar los resultados se utilizaron las métricas del ciclo de vida de videojuegos

Review of In vitro Toxicity of Nanoparticles and Nanorods: Part 1

The specific use of engineered nanostructures in biomedical applications has become very attractive, due to their ability to interface and target specific cells and tissues to execute their functions. Additionally, there is continuous progress in research on new nanostructures with unique optical, magnetic, catalytic, and electrochemical properties that can be exploited for therapeutic or diagnostic methods. On the other hand, as nanostructures become widely used in many different applications, the unspecific exposure of humans to them is also unavoidable. Therefore, studying and understanding the toxicity of such materials is of increasing importance. Previously published reviews regarding the toxicological effects of nanostructures focuses mostly on the cytotoxicity of nanoparticles and their internalization, activated signaling pathways, and cellular response. Here, the most recent studies on the in vitro cytotoxicity of NPs, nanowires, and nanorods for biomedical applications are reviewed and divided into two parts. The first part considers nonmagnetic metallic and magnetic nanostructures. While part 2 covers carbon structures and semiconductors. The factors influencing the toxicity of these nanostructures are elaborated, to help elucidating the effects of these nanomaterials on cells, which is a prerequisite for their save clinical use

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Una propuesta metodológica para la construcción de videojuegos

Este artículo presenta una propuesta metodológica llamada CASCRUM para el desarrollo de videojuegos en 2d como una herramienta para la construcción de este tipo de software. Esta propuesta se fundamenta en las etapas del ciclo de vida de la metodología de Cascada y como método de seguimiento de las etapas de CASCRUM integramos de la metodología Scrum el ciclo de reuniones Daily Scrum con una variante de la misma semanal la cual llamamos Week Meeting Planning. Para la evaluación de la propuesta tomamos como escenario a la Facultad de Ingeniería en Sistemas Computacionales de la Universidad Tecnológica de Panamá Campus Central. El tiempo de experimentación fue durante los años 2013 al 2014. En el periodo académico del 2013 los estudiantes recibían la guía de un instructor con conocimientos avanzados en videojuegos en 2d, para el año 2014 algunos de los estudiantes del periodo anterior fueron los monitores de los grupos. Con el fin de evaluar si CASCRUM era eficiente para la construcción de videojuegos en 2d, se formaron tres grupos en ambos periodos y cada grupo se le asignaba una única metodología de desarrollo a lo largo del periodo de experimentación, las metodologías que se implementaron fueron (Cascada, Scrum y CASCRUM), para homologar los resultados se utilizaron las métricas del ciclo de vida de videojuegos

Multiorgan Failure and Refractory Lactic Acidosis due to Pasteurella multocida Septicemia in a Patient with No Animal Exposure

Introduction. Pasteurella multocida is a gram-negative coccobacillus pathogenic to animals. It can cause infection in humans by a bite, scratch, or lick from a cat or dog. P. multocida can cause a variety of infections in humans, including cellulitis, osteomyelitis, endocarditis, peritonitis, and septic shock. Case Presentation. A 56-year-old male presented to our hospital with a 2-day history of fever, abdominal pain, nausea, and vomiting. He denied exposure to cats, dogs or other pets. He had severe respiratory distress requiring ventilator support, profound septic shock requiring multiple vasopressors, severe lactic acidosis, and renal failure requiring emergent hemodialysis. Blood cultures confirmed the presence of P. multocida. The patient subsequently died of cardiopulmonary arrest due to multiorgan failure with refractory shock. Conclusion. P. multocida septicemia can lead to septic shock. Early identification of this organism may decrease mortality. Although our patient had no known cat or dog exposure, physicians should enquire about a history of animal exposure when a patient presents with an infection with no obvious cause

Magnetic Compression of Tumor Spheroids Increases Cell Proliferation In Vitro and Cancer Progression In Vivo

International audienceA growing tumor is submitted to ever-evolving mechanical stress. Endoscopic procedures add additional constraints. However, the impact of mechanical forces on cancer progression is still debated. Herein, a set of magnetic methods is proposed to form tumor spheroids and to subject them to remote deformation, mimicking stent-imposed compression. Upon application of a permanent magnet, the magnetic tumor spheroids (formed from colon cancer cells or from glioblastoma cells) are compressed by 50% of their initial diameters. Such significant deformation triggers an increase in the spheroid proliferation for both cell lines, correlated with an increase in the number of proliferating cells toward its center and associated with an overexpression of the matrix metalloproteinase−9 (MMP−9). In vivo peritoneal injection of the spheroids made from colon cancer cells confirmed the increased aggressiveness of the compressed spheroids, with almost a doubling of the peritoneal cancer index (PCI), as compared with non-stimulated spheroids. Moreover, liver metastasis of labeled cells was observed only in animals grafted with stimulated spheroids. Altogether, these results demonstrate that a large compression of tumor spheroids enhances cancer proliferation and metastatic process and could have implications in clinical procedures where tumor compression plays a role

Effect of chili flour (Capsicumm Annuum Var. Bremisculum) on the productive indices of chickens

El objetivo del estudio fue evaluar el comportamiento productivo de pollitos Cobb 500 en etapa 1-21 días (d) de edad en las condiciones andinas del Ecuador. Se emplearon un total de 315 pollos, con un d de edad, distribuidos en tres grupos de 105 animales cada uno: T1, Control (dieta basal sin aditivo); T2, dieta basal más 10 partes por millón (ppm) de ají (Capsicumm annuum Car. bremisculum) y T3, dieta basal más 50 ppm de ají. Se utilizó un diseño completamente aleatorizado donde se evaluó: grado de aceptabilidad, ganancia de peso (GP), ganancia media diaria (GMD), conversión alimenticia (CA), ocurrencia de diarreas, mortalidad y peso relativo de órganos linfoides. El grado de aceptabilidad fue superior (P0,05) no variaron entre tratamientos; la ocurrencia de diarrea fue menor (P<0,05) en el grupo T3, en este mismo tratamiento (T3) no hubo mortalidad; el tamaño del timo y la bolsa de Fabricio fue superior (P<0,05) en los tratados con ají, de éstos el T3 tuvo mejor comportamiento. Se concluye que el uso de la harina de ají en pollos de 1-21 d de edad no mejora la GP ni la CA. El peso relativo de timo, bazo y bolsa de Fabricio no variaron entre tratamientos, mientras que el tamaño del timo y bolsa de Fabricio fue mejor en el tratamiento T3. Asimismo, se logró disminuir los trastornos diarreicos y la mortalidad