A Comparative Study of Turbulence Methods Applied to the Design of a 3D-Printed Scaffold and the Selection of the Appropriate Numerical Scheme to Simulate the Scaffold for Tissue Engineering

Current commercial software tools implement turbulence models on computational fluid dynamics (CFD) techniques and combine them with fluid-structural interaction (FSI) techniques. There are currently a great variety of turbulence methods that are worth investigating through a comparative study in order to delineate their behavior on scaffolds used in tissue engineering and bone regeneration. Additive manufacturing (AM) offers the opportunity to obtain three-dimensional printed scaffolds (3D scaffolds) that are designed respecting morphologies and that are typically used for the fused deposition model (FDM). These are typically made using biocompatible and biodegradable materials, such as polyetherimide (PEI), ULTEM 1010 biocompatible and polylactic acid (PLA). Starting from our own geometric model, simulations were carried out applying a series of turbulence models which have been proposed due to a variety of properties, such as permeability, speed regime, pressures, depressions and stiffness, that in turn are subject to boundary conditions based on a blood torrent. The obtained results revealed that the detached eddy simulation (DES) model shows better performance for the use of 3D scaffolds in its normal operating regime. Finally, although the results do not present relevant differences between the two materials used in the comparison, the prototypes simulated in PEI ULTEM 1010 do not allow their manufacture in FDM for the required pore size. The printed 3D scaffolds of PLA reveal an elastic behavior and a rigidity that are similar to other prototypes of ceramic composition. Prototypes made of PLA reveal unpredictable variability in pore and layer size which are very similar to cell growth itself and difficult to keep constant

Rules, Standards, and the Internal Point of View

Large scale structure and cosmolog

A Comparative Study of Turbulence Methods Applied to the Design of a 3D-Printed Scaffold and the Selection of the Appropriate Numerical Scheme to Simulate the Scaffold for Tissue Engineering

Current commercial software tools implement turbulence models on computational fluid dynamics (CFD) techniques and combine them with fluid-structural interaction (FSI) techniques. There are currently a great variety of turbulence methods that are worth investigating through a comparative study in order to delineate their behavior on scaffolds used in tissue engineering and bone regeneration. Additive manufacturing (AM) offers the opportunity to obtain three-dimensional printed scaffolds (3D scaffolds) that are designed respecting morphologies and that are typically used for the fused deposition model (FDM). These are typically made using biocompatible and biodegradable materials, such as polyetherimide (PEI), ULTEM 1010 biocompatible and polylactic acid (PLA). Starting from our own geometric model, simulations were carried out applying a series of turbulence models which have been proposed due to a variety of properties, such as permeability, speed regime, pressures, depressions and stiffness, that in turn are subject to boundary conditions based on a blood torrent. The obtained results revealed that the detached eddy simulation (DES) model shows better performance for the use of 3D scaffolds in its normal operating regime. Finally, although the results do not present relevant differences between the two materials used in the comparison, the prototypes simulated in PEI ULTEM 1010 do not allow their manufacture in FDM for the required pore size. The printed 3D scaffolds of PLA reveal an elastic behavior and a rigidity that are similar to other prototypes of ceramic composition. Prototypes made of PLA reveal unpredictable variability in pore and layer size which are very similar to cell growth itself and difficult to keep constant

El efecto de la tecnología en el desarrollo del comportamiento innovador de los empleados.

La innovación es clave el desarrollo de la ventaja competitiva de lasorganizaciones. Aunque la organización propone la realizacióninnovación, los empleados son los que la llevan a cabo. Por ello, elcomportamiento de los trabajadores hacia la innovación es clave en el éxitode la innovación. Este trabajo tiene dos objetivos, el primero, analizar larelación entre el compromiso laboral y el comportamiento innovador delempleado y, el segundo, analizar el efecto de mediación del comportamientotecnológico entre el compromiso del empleado y su comportamientoinnovador. Mediante cuestionario se entrevista a una muestra de 230empleados de diversas organizaciones en España. Las hipótesis secontrastan a través de ecuaciones estructurales por medio de Partial leastsquares structural equation modeling (PLS-SEM). Los resultados ponen demanifiesto, en primer lugar, la relación directa entre el compromiso delempleado y su comportamiento innovador y, en segundo lugar, el efecto demediación del comportamiento tecnológico entre el compromiso delempleado y su comportamiento innovador. Este trabajo destaca laimportancia del compromiso del trabajador en la innovación y, también, elpapel de la tecnología en el desarrollo del comportamiento innovador de losempleados

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research