External interaction management of VRML scenes for e-learning applications

This is an electronic version of the paper presenten at the International conference on International Workshop on Web3D Technologies in Learning, Education and Training (LET-Web3D 2004) held in Udine (Italy) on 2004This paper describes an innovative approach to solve some of the problems that arise when integrating virtual reality capabilities into e-learning environments. The VRML representation of a scene includes, along with its geometric description, a full specification of the student-scene interaction logic. This representation is rendered by a browser, which also orchestrates the interaction according to the logic. Such a mechanism implies reprogramming and/or replicating partly the logic when modifying the interaction scheme of a single scene for different students. It also prevents any external access to student’s actions or scene reactions, which is necessary for on-line evaluation or instruction. We propose to expand the standard interaction mechanism of VRML so that both the specification of the scene logic and the interaction flow are managed by an external and centralized entity following a clientserver approach, hence solving the identified problems, while additionally increasing design efficiency and content protection.This work has been partly supported by the Plan Nacional de Ciencia y Tecnología of the Spanish Government under project TIC2001-306

Surfactant Protein C Deficiency in a Puerto Rican Adolescent With a Rare SFTPC Genetic Variant

Surfactant protein C (SP-C) is a hydrophobic lipoprotein necessary for lowering alveolar surface tension and lung defense mechanisms. Defects in its function due to genetic mutations in the SFTPC gene have been increasingly identified in patients presenting with childhood interstitial lung disease. SFTPC mutations are inherited in an autosomal dominant pattern with reduced penetration and variable expressivity, although de novo mutations have also been documented. In this article, we present the case of an oxygen-dependent 13-year-old male with interstitial lung disease and severe pulmonary hypertension. Genetic analysis and lung biopsy confirmed the diagnosis of SP-C deficiency with the rare heterozygous mutation IVS4+2. To our knowledge, this is the first documented case of SP-C deficiency in the Puerto Rican population and the second worldwide with the IVS4+2 genetic mutation

Alfabetización en salud y COVID-19 en mayores: aproximación desde la Farmacia Comunitaria

Introducción: La alfabetización en salud son las habilidades cognitivas y sociales que determinan que los individuos puedan acceder, entender y usar la información para promover y mantener su salud. La necesidad de estas habilidades ha sido notable en la pandemia.  Método: Se realiza un cuestionario específico a los pacientes mayores de 60 años. Este consta de tres partes: el instrumento HLS-EU-Q16 adaptado a COVID-19, preguntas sobre la actuación del farmacéutico y la herramienta SAHLSA. Resultados: La población era mayoritariamente femenina (75,4%) y su edad era de 79,2±9,4 años. El nivel educativo mayoritario fue de educación primaria (34,4%), predominando éste y el sin estudios en mayores de 80 años. El cuestionario HLS-EU-Q16 reveló que la alfabetización en salud sobre COVID-19 era deficiente (23%), insuficiente (70,5%) y suficiente (6,6%). El cuestionario SAHLSA mostró alfabetización suficiente en el 80%. Mientras que el primer cuestionario no mostró relación con el nivel educativo, ningún bachiller o universitario presentó valores insuficientes en el cuestionario SAHLSA. Por último, los entrevistados consideraron como primer sanitario al que acudir para obtener información fiable al médico (77%), seguido por el farmacéutico (13%). El 75% consideró que el farmacéutico le había ayudado a comprender las precauciones frente a la COVID-19.  Conclusiones: Los pacientes presentan dificultades para identificar la información fiable y para encontrar información de tratamientos frente a la COVID. Esta necesidad no está relacionada con el nivel educativo ni con la alfabetización en salud en otras áreas. El farmacéutico puede ser un agente clave en resolver esta necesidad

Alfabetización en salud y COVID-19 en mayores: aproximación desde la Farmacia Comunitaria

Introducción: La alfabetización en salud son las habilidades cognitivas y sociales que determinan que los individuos puedan acceder, entender y usar la información para promover y mantener su salud. La necesidad de estas habilidades ha sido notable en la pandemia.  Método: Se realiza un cuestionario específico a los pacientes mayores de 60 años. Este consta de tres partes: el instrumento HLS-EU-Q16 adaptado a COVID-19, preguntas sobre la actuación del farmacéutico y la herramienta SAHLSA. Resultados: La población era mayoritariamente femenina (75,4%) y su edad era de 79,2±9,4 años. El nivel educativo mayoritario fue de educación primaria (34,4%), predominando éste y el sin estudios en mayores de 80 años. El cuestionario HLS-EU-Q16 reveló que la alfabetización en salud sobre COVID-19 era deficiente (23%), insuficiente (70,5%) y suficiente (6,6%). El cuestionario SAHLSA mostró alfabetización suficiente en el 80%. Mientras que el primer cuestionario no mostró relación con el nivel educativo, ningún bachiller o universitario presentó valores insuficientes en el cuestionario SAHLSA. Por último, los entrevistados consideraron como primer sanitario al que acudir para obtener información fiable al médico (77%), seguido por el farmacéutico (13%). El 75% consideró que el farmacéutico le había ayudado a comprender las precauciones frente a la COVID-19.  Conclusiones: Los pacientes presentan dificultades para identificar la información fiable y para encontrar información de tratamientos frente a la COVID. Esta necesidad no está relacionada con el nivel educativo ni con la alfabetización en salud en otras áreas. El farmacéutico puede ser un agente clave en resolver esta necesidad

Resultados oncológicos en enfermedad N1 posterior a la prostatectomía radical

ResumenAntecedentesLa prostatectomía radical+linfadenectomía pélvica puede mejorar la supervivencia libre de progresión y supervivencia cáncer-específica en la enfermedad ganglionar.ObjetivoAnalizar las características de los pacientes con enfermedad ganglionar en el análisis histopatológico de la prostatectomía radical.Material y métodosEstudio retrospectivo de pacientes sometidos a prostatectomía radical con enfermedad ganglionar metastásica de 1988 a 2015.ResultadosSe incluyeron 25 pacientes, de 66.5 años (DE±6.5); antígeno prostático específico medio de 20.17ng/dL (RIC: 18); con una mediana de seguimiento en 63 meses (RIC: 86). Clasificación de riesgo por D’Amico, 15 (60%) pacientes de alto, 8 (32%) intermedio y 2 (8%) de riesgo bajo. Se encontraron márgenes positivos en 15 casos (60%); estadio tumoral T2 en 4 (16%), T3A en 3 (12%), T3B en 17 (68%) y T4 en 1 (4%); cantidad de ganglios positivos, uno en 14 (56%), 2 en 3 (12%) y más de 2 en 8 (32%) casos. Recibieron radioterapia 3 pacientes (16%) y bloqueo hormonal 24 (96%). La supervivencia libre de progresión fue de 105 meses y la supervivencia cáncer-específica fue del 86 y 45% a 5 y 10 años respectivamente. El HR para progresión bioquímica fue significativo en márgenes positivos (HR: 9.5, IC95%: 0.99-91.5, p=0.50) y ≥2 ganglios positivos (HR: 8.5, IC95%: 1.1-61.9, p=0.34). La afectación≥2 ganglios predijo progresión con una OR de 7.2 (IC95% 1.06-48.6, p=0.043).ConclusionesLa supervivencia media a 5 años es superior al 80%. El número de ganglios positivos podría ser un factor predictor de progresión bioquímica.AbstractBackgroundRadical prostatectomy+pelvic lymph node dissection can improve progression-free survival and cancer-specific survival in lymph node disease.AimTo analyze the characteristics of patients with lymph node disease in the histopathologic findings of the radical prostatectomy and lymph node dissection.Material and methodsA retrospective study was carried out on patients that underwent radical prostatectomy with metastatic lymph node disease within the time frame of 1988 to 2015.ResultsThe study included 25 patients with a mean 66.5 years of age (SD±6.5), a mean prostate-specific antigen of 20.17ng/dl (IQR: 18), and a median follow-up period of 63 months (IQR: 86). According to the D’Amico classification, 15 (60%) patients were high-risk, 8 (32%) were intermediate-risk, and 2 (8%) were low-risk. Positive margins were found in 15 cases (60%); 4 (16%) patients had T2 tumor stage, 3 (12%) had T3A, 17 (68%) had T3B, and one patient (4%) had T4. Fourteen (56%) patients had one positive lymph node, 3 (12%) patients had 2 positive lymph nodes, and 8 (32%) patients had more than 2 positive lymph nodes. Three (16%) patients received radiotherapy and 24 (96%) underwent hormone blockade. Progression-free survival was 105 months and cancer-specific survival was 86% at 5 years and 45% at ten years. The HR for biochemical progression was significant in positive margins (HR: 9.5, 95% CI: 0.99-91.5, P=.50) and when there were≥2 positive lymph nodes (HR: 8.5, 95% CI: 1.1-61.9, P=0.34). Involvement of≥2 lymph nodes predicted progression with an odds ratio of 7.2 (95% CI: 1.06-48.6, P=.043).ConclusionsThe average 5-year survival was above 80%. The number of positive lymph nodes could be a predictive factor for biochemical progression

Therapeutical interest of statins in the treatment of atherosclerosis

Los inhibidores de la HMG-Co A reductasa o estatinas, son fármacos muy utilizados en el tratamiento de la hipercolesterolemia, ya que consiguen disminuir la concentración plamática de lipoproteína de baja densidad (LDL) regulando la síntesis endógena de colesterol y por tanto, de receptores para LDL. Recientemente se ha comprobado como el tratamiento prolongado con estos fármacos disminuyen la mortalidad y morbilidad cardiovascular. Este fenómeno puede explicarse por los efectos beneficiosos directos de las estatinas en el desarrollo de la placa de ateroma. Las estatinas disminuyen la proliferación y migración de células de musculatura lisa vascular e inducen apoptosis de estas células. También previenen la oxidación de LDL y la formación de células espumosas, reducen la respuesta inflamatoria asociada a la aterosclerosis, normalizan los fenómenos de coagulación y fibrinolisis y por último mejoran significativamente la función endotelial. Todas estas propiedades parecen estar mediadas compuestos isoprenoides intermediarios de la ruta metabólica de la HMG-Co A reductasa, y son independientes de la concentración de colesterol en el medio. Por tanto, las estatinas también podrían ser utilizadas en enfermedades asociadas a disfunción endotelial independientemente de las cifras analíticas de LDL, tal y como sucede en la hipertensión.HMG-Co A reductase inhibitors or statins, are widely used drugs in the treatment of hypercholesterolemia. They lower plasmatic concentration of low density lipoprotein (LDL) by regulating cholesterol synthesis and consequently synthesis of LDL receptors. Chronic treatment with these drugs has recently shown to be able to reduce cardiovascular-related morbidity and mortality. This fact could be explained by a direct benefic effect of statins in development of atherosclerotic plaque. Statins reduce vascular smooth muscle cell proliferation and migration , as well as they induce apoptosis of these cells. They also prevent LDL oxidation and foam cell formation, reducing inflammatory response associated to atherosclerosis, normalising coagulation and fibronolysis and improving endothelial function. All these properties seem to be mediated by intermediary isoprenoid compounds from HMG-Co A reductase metabolic pathway and do not depend of cholesterol concentration in the medium. Thus, statins could also be used in the treatment of some diseases associated to endothelial disfunction, independently of analytical LDL values, like hypertension

Interés terapéutico de las estatinas en el tratamiento de la aterosclerosis

Los inhibidores de la HMG-Co A reductasa o estatinas, son fármacos muy utilizados en el tratamiento de lahipercolesterolemia, ya que consiguen disminuir la concentración plamática de lipoproteína de baja densidad (LDL)regulando la síntesis endógena de colesterol y por tanto, de receptores para LDL.Recientemente se ha comprobado como el tratamiento prolongado con estos fármacos disminuyen la mortalidad ymorbilidad cardiovascular. Este fenómeno puede explicarse por los efectos beneficiosos directos de las estatinas enel desarrollo de la placa de ateroma. Las estatinas disminuyen la proliferación y migración de células de musculaturalisa vascular e inducen apoptosis de estas células. También previenen la oxidación de LDL y la formación de célulasespumosas, reducen la respuesta inflamatoria asociada a la aterosclerosis, normalizan los fenómenos de coagulacióny fibrinolisis y por último mejoran significativamente la función endotelial. Todas estas propiedades parecen estarmediadas compuestos isoprenoides intermediarios de la ruta metabólica de la HMG-Co A reductasa, y son independientesde la concentración de colesterol en el medio.Por tanto, las estatinas también podrían ser utilizadas en enfermedades asociadas a disfunción endotelial independientementede las cifras analíticas de LDL, tal y como sucede en la hipertensión

Bottom-up development of nanoimprinted PLLA composite films with enhanced antibacterial properties for smart packaging applications

Altres ajuts: ICN2 is supported by the CERCA Program/Generalitat de Catalunya.In this work, polymer nanocomposite films based on poly(L-lactic acid) (PLLA) were reinforced with mesoporous silica nanoparticles, mesoporous cellular foam (MCF) and Santa Barbara amorphous-15 (SBA). PLLA is a biobased aliphatic polyester, that possesses excellent thermomechanical properties, and has already been commercialized for packaging applications. The aim was to utilize nanoparticles that have already been established as nanocarriers to enhance the mechanical and thermal properties of PLLA. Since the introduction of antibacterial properties has become an emerging trend in packaging applications, to achieve an effective antimicrobial activity, micro/nano 3D micropillars decorated with cone- and needle-shaped nanostructures were implemented on the surface of the films by means of thermal nanoimprint lithography (t-NIL), a novel and feasible fabrication technique with multiple industrial applications. The materials were characterized regarding their composition and crystallinity using Fourier transform infrared spectroscopy (FT-IR) and X-ray diffraction (XRD), respectively, and their thermal properties using differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA). Their mechanical properties were examined by the nanoindentation technique, while the films' antimicrobial activity against the bacteria Escherichia coli and Staphylococcus aureus strains was tested in vitro. The results demonstrated the successful production of nanocomposite PLLA films, which exhibited improved mechanical and thermal properties compared to the pristine material, as well as notable antibacterial activity, setting new groundwork for the potential development of biobased smart packaging materials

Burden of disease in young population of a colombian health insurance company

To estimate the burden of disease of population between 10-24 years old enrolled in the SER JOVEN program of a Colombian insurance company using disability-adjusted life-years (DALYs). Incidences were estimated from the administrative claims data of Mutual SER EPS. The ICD-10 codes of the main diagnosis were identified and regrouped according to the categories of diseases reported in the global burden of disease (GBD) study. To estimate the years of life lost (YLL), the difference between the age of death and the life expectancy at that age was obtained in a reference mortality population. The years lived with disability (YLD) were obtained by multiplying the estimated morbidity and the disability weights of the GBD 2017. DALYs were calculated by adding YLD and YLLs. We used the information of 512 patients insured to Mutual SER-EPS between 10-24 years, who died during January 2015 to December 2017 from all causes, and the healthcare registers of young people aged 10-24 years residing in 21 municipalities where Mutual SER EPS has presence. In the studied population, premature deaths and disability produced 5,355 DALYs, for 2017. Of these, 67.1% (3,591) of the burden of disease was due to non-communicable causes; followed by communicable, maternal, neonatal, and nutritional diseases (15.9%). The remaining 17% were due to unintentional and vital injuries and unclassified causes. The specific causes with the highest reported burden were substance use disorders and mental disorders, and this relationship remained constant between 2015-2017. In both sexes the first cause was non-communicable diseases; in men, injuries; and in women, communicable, maternal, neonatal diseases. In the analyzed population there was a considerable burden of disease associated with mental disorders and substance use. It is recommended to implement effective strategies that allow prioritizing the diseases that generate the greatest burden

Impact in hospitalization costs of a cardiovascular risk management program in Colombia: a propensity score matching model

Cardiovascular diseases (CVD) are the leading cause of death and burden of disease in Colombia and globally. In 2017, CVD represented the 12% of total DALYs. CVD is a costly disease from patient, family and societal perspectives. Effective prevention and risk management programs reduces the incidence of CVD by as much as 80%. We aimed to estimate the impact of direct medical hospitalization costs related to adherence in a risk management program in Colombia, 2018. We retrospectively collected data from 6,243 patients with data of enrollment in a cardiovascular risk management program (DTC, in Spanish) of a subsidized insurer, who presented arterial hypertension (AH) or AH+ type 2 diabetes mellitus (DM2). 1,065 were identified adherent to the program (treated) and 5.178 non adherent (controls). We designed a propensity score matching model adjusted with confounding variables to estimate the effect of treatment (program adherence) over hospitalization cost. Costs were calculated based on hospitalization invoices and expressed in Colombian pesos (COP) 2018. DTC has an average negative effect on cost of treated population. Being treated avoids hospitalization costs; these results were statistically significant at the 5% and 10% level (with 95%CI that goes through zero). Hence, being in the DTC program reduces hospital costs that ranges from COP-$11,346,372 to -$ 799,259 (95%CI) compared to the average cost. The overall impact on program costs is a significant saving of COP583,670 per event-year. If all members of the DTC program fulfilled its activities by more than 80%, the savings generated by the program would be close to COP$ 6.85 billion. DTC risk management program reduces direct hospitalization costs of events associated to CVD. Our results are important to design policies focused on the cost and risk management of patients with CVD in poor population