A low-cost portable simulator of a domestic cat larynx for teaching endotracheal intubation

Objective: To design and construct an affordable simulator of the cat larynx for training intubation maneuvers and to share the designs for its fabrication. Study design: Research and development study. Animals: A domestic cat. Methods: The cadaver of a cat, dead by natural causes, was frozen in sternal recumbency with the neck extended and the mouth wide open. A computed tomography image was acquired and used to construct a digital three-dimensional (3D) model of the pharynx and trachea. A digitally adapted model was 3D-printed and used to generate a silicone model of these structures, which was placed within a wooden container. The quality of the simulator was assessed by 46 veterinary anesthesiologists and veterinarians with experience in tracheal intubation maneuvers, and their opinions were obtained through an anonymous questionnaire. Results: Several preliminary prototypes were assessed regarding stability, texture and cost. Finally, a silicone model of a cat larynx (LaryngoCUBE) was produced and encased in a wooden container. Results from the questionnaire showed high scores regarding anatomy, tissue texture and intubation maneuver realism, compared with the real procedure. Conclusions: and clinical relevance Use of LaryngoCUBE as a training tool may improve the skills of students and reduce the use of animals for teaching endotracheal intubation. Blueprints and computational models are provided online so that the simulator can be fully reproduced.Fil: Clausse, María. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigación Veterinaria de Tandil. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigación Veterinaria de Tandil. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Centro de Investigación Veterinaria de Tandil; ArgentinaFil: Nejamkin, Pablo. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Veterinarias. Departamento de Fisiopatología. Laboratorio de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; ArgentinaFil: Bulant, Carlos Alberto. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; ArgentinaFil: Genaro, Ariel. Instituto de Profesorado de Arte Tandil; ArgentinaFil: Landivar, Florencia. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Veterinarias; ArgentinaFil: del Sole, Maria Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigación Veterinaria de Tandil. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigación Veterinaria de Tandil. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Centro de Investigación Veterinaria de Tandil; ArgentinaFil: Clausse, Alejandro. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentin

Modelos de avaliação de desempenho para terminais intermodais de transbordo de grãos

Agribusiness grows in economic importance as well as grain production in the country, but the flow of this production suffers from numerous barriers to efficient transport system in virtue of the structural problems present logistics. Intermodal terminals arise as optimizers this bottleneck and the present study are to verify that the contributions of operational model sand managers engaged in the study of intermodal terminals. To this end, we describe some empirical studies developed in the industry and used the two dimensions of performance and it is concluded that the contributions of operational performance and management working together provide a more accurate understanding and systemic levels of efficiency of intermodal terminals transshipment of grain.Agroindustria crece en importancia económica, así como la producción de granos en el país, pero el flujo de esta producción sufre de numerosas barreras para sistema de transporte eficiente, en virtud de los problemas estructurales de logística presentes. Terminales intermodales surgen como optimizadores de este cuello de botella y este estudio tiene como objetivo determinar cuáles son las aportaciones de los modelos operativos y directivos que participan en el estudio de rendimiento en las terminales intermodales. Para ello, realizó algunos estudios empíricos desarrollados en la industria y utiliza las dos dimensiones del desempeño y se concluye que las contribuciones de rendimiento operativo y de gestión de trabajo en conjunto proporcionan una comprensión más precisa y los niveles sistémicos de la eficiencia de las terminales intermodales transbordo de granos.O agronegócio cresce em importância econômica assim como a produção de grãos no país, mas o escoamento dessa produção sofre inúmeras barreiras à eficiência do sistema de transporte em virtudes dos problemas estruturais logísticos presentes. Terminais intermodais surgem como otimizadores desse gargalo, e o presente estudo têm como objetivo verificar quais as contribuições dos modelos operacionais e gerencias exercem no estudo de desempenho em terminais intermodais. Para tanto, apresentou-se alguns trabalhos empíricos desenvolvidos no setor e que utilizaram as duas dimensões do desempenho e conclui-se que, as contribuições do desempenho operacional e gerenciais atuando juntas fornecem uma compreensão mais apurada e sistêmica dos níveis de eficiência de terminais intermodais de transbordo de grãos

Static, Dynamic, and High Cycle Fatigue Analysis of Crossed Spherical Gearing for Robotic Arm Ball Joint: A Finite Element Analysis Approach

Crossed spherical gearing is used in the joints of robotic arm prostheses and allows mobility in 3 degrees of freedom. This paper aims to evaluate the design of a cross-spherical gear with three different materials, PEEK, AISI 304L, and Ti-6Al-4V, for a robotic arm prosthesis by finite element analysis. ANSYS mechanical software (version 2021 R1) was used to perform the static analysis and evaluate the deformations and stresses, modal analysis of natural frequencies and vibration modes, and high cycle fatigue analysis to determine fatigue resistance. The results obtained in the static analysis show that the maximum stresses are in the same zones for the three materials and have similar values. However, the Ti-6Al-4V and ASI 304L materials have a higher safety factor than PEEK, with a value of 5.17. In conclusion, the crossed spherical gearing is numerically validated using the finite element analysis so that the prototype can be later manufactured at an experimental level, and the values obtained for the crossed spherical gearing of the robotic arm prosthesis can be verified

Alternative low doses and routes of administering a prostaglandin F2α analogue to induce luteolysis in Nelore cows

The present study was conducted in order to verify the efficacy of lower doses and alternative routes of a prostaglandin F2α analogue, luprostiol (PGF), for the induction of luteolysis and the precipitation of estrus in nonlactating Nelore cows (Bos taurus indicus). A conventional dose (15 mg) of PGF was compared to doses lower than the conventional dose, which ranges from 10 to 50%, that were administered intramuscularly (IM), intravulvosubmucosally (IVSM), or in the Bai-hui acupuncture site located within the lumbosacral area. The cows were administered PGF 8 day after estrus in the presence of a corpus luteum, and randomly assigned to the following groups: G1 (positive control), 15 mg, IM (n = 23); G2, 7.5 mg, IM (n = 23); G3, 3.75 mg, IM (n = 24); G4, 7.5 mg, IVSM (n = 25); G5, 3.75 mg, Bai-hui acupoint (n = 24); and G6, 1.5 mg, Bai-hui acupoint (n = 25). The results indicated that 50% of a conventional dose of PGF (7.5 mg) resulted in a complete luteal regression (plasma progesterone <1 ng/ml) at Hour 48, and hastened estrus, regardless of whether or not PGF was administered IM or IVSM. Comparatively, 10 or 25% of the conventional dose, even when administered to the Bai-hui acupoint, resulted in an initial reduction in the concentration of progesterone at Hour 24, followed by an increase observed at Hour 48. In conclusion, 25% of a conventional PGF dose administered via the Bai-hui acupoint proved inadequate to induce a complete luteal regression, whereas 50% of a conventional dose administered IM or IVSM was found to be the minimal dose required to induce effectively a complete luteal regression, and to precipitate the onset of estrus in nonlactating Nelore cows

Lineage Analysis of Circulating Trypanosoma cruzi Parasites and Their Association with Clinical Forms of Chagas Disease in Bolivia

Around 30–50% of Trypanosoma cruzi infections in Latin America cause chronic Chagas disease 10–30 years after the primary infection due to lack of effective treatment. The major clinical complications associated with chronic Chagas disease are cardiac myositis (leading to cardiac failure), and autonomous neuroplexus degeneration of the digestive tract that can cause megacolon or megaesophagus. Therefore, there are three major clinical forms of Chagas disease; cardiac, digestive and indeterminate (asymptomatic). The parasites, which can infect humans as well as other mammals, are transmitted by species of triatomines commonly found in the Americas. The parasite is divided in at least six discrete typing units: TcI, TcIIa–e. In humans, the TcI is mainly observed in Central America and northern parts of South America while the TcIIb/d/e is confined mainly to the southern cone of Latin America. We determined which DTU were prevalent in chronic patients in Bolivia, where the three clinical forms and several DTUs of the parasites are present, in order to determine whether there was a link between a particular parasite DTU and a particular clinical outcome. We found a vast majority of TcIId but its kDNA polymorphism showed no association with any of the clinical manifestations of chronic Chagas

Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort

Background: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. Methods: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. Results: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p&lt;0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). Conclusions: In our global cohort, death was the outcome in &gt;10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Is a 7-day Helicobater pylori treatment enough for eradication and inactivation of gastric inflammatory activity?

AIM: To compare the efficacy of a 7-d vs 10-d triple therapy regarding H pylori eradication, endoscopic findings and histological gastric inflammatory inactivation in the Ecuadorian population

Proyecto de creación de una empresa de asesoria en mercadeo de base de datos y su aplicación en empresas comerciales de Guayaquil

PARA ALCANZAR SU OBJETIVO DE VENTAS SE OFRECE UN SERVICIO DIRIGIDO CON ASESORIA EN MERCADEO EN BASE DE DATOS, DE ESA FORMA AMBAS PARTES TANTO CLIENTE COMO VENDEDOR OBTIENEN BENEFICIOS EN LOS AMBITOS FINANCIEROS ECONOMICO Y DE MERCADEO PARA LOS COMERCIOS PEQUEÑOS DE LA CIUDAD DE GUAYAQUIL