Two-Stage Control Design of a Buck Converter/DC Motor System without Velocity Measurements via a Σ

This paper presents a two-stage control design for the “Buck power converter/DC motor” system, which allows to perform the sensorless angular velocity trajectory tracking task. The differential flatness property of the DC-motor model is exploited in order to propose a first-stage controller, which is designed to achieve the desired angular velocity trajectory. This controller provides the voltage profiles that must be tracked by the Buck converter. Then, a second-stage controller is meant to assure the aforementioned. This controller is based on flatness property of the Buck power converter model, which provides the input voltage to the DC motor. Due to the fact that the two-stage controller proposed uses the average model of the system, as a practical and effective implementation of this controller, a Σ − Δ-modulator is employed. Finally, in order to verify the control performance of this approach, numerical simulations are included

Función del profesional en enfermería en la atención del acoso escolar en niños, niñas y adolescentes

Actualmente se ha incrementado y visualizado el fenómeno del acoso escolar o bullying(por su traducción al inglés); sin embargo, llama la atención que esta práctica ha  existido durante mucho tiempo, pero es hasta ahora donde se evidencian las consecuencias que genera en los niños, niñas y adolescentes que, según diversos estudios, puede generar suicidios en esta población. Diversas profesiones han profundizado en el tema; a pesar de ello, no se ha visto avance en el manejo y prevención del acoso y se ha incrementado el número de casos que llegan a instituciones de salud relacionados con los daños físicos y psicológicos que se ocasionan en el niño víctima de acoso escolar. Es un reto para enfermería poder abordar esta situación y plantear posibles estrategias de intervención para su manejo y prevención, no solo en la víctima y victimario sino también en la familia, escuelas e instituciones de salud en los diferentes niveles de atención, ya que cuenta con las herramientas para diseñar intervenciones en el manejo de la comunidad y del paciente institucionalizado. &nbsp

Active commuting to and from university, obesity and metabolic syndrome among Colombian university students

Background: There is limited evidence concerning how active commuting (AC) is associated with health benefits in young. The aim of the study was to analyze the relationship between AC to and from campus (walking) and obesity and metabolic syndrome (MetS) in a sample of Colombian university students. Methods: A total of 784 university students (78.6% women, mean age = 20.1 ± 2.6 years old) participated in the study. The exposure variable was categorized into AC (active walker to campus) and non-AC (non/infrequent active walker to campus: car, motorcycle, or bus) to and from the university on a typical day. MetS was defined in accordance with the updated harmonized criteria of the International Diabetes Federation criteria. Results: The overall prevalence of MetS was 8.7%, and it was higher in non-AC than AC to campus. The percentage of AC was 65.3%. The commuting distances in this AC from/to university were 83.1%, 13.4% and 3.5% for < 2 km, 2- 5 km and > 5 km, respectively. Multiple logistic regressions for predicting unhealthy profile showed that male walking commuters had a lower probability of having obesity [OR = 0.45 (CI 95% 0.25–0.93)], high blood pressure [OR = 0.26 (CI 95% 0.13–0.55)] and low HDL cholesterol [OR = 0.29 (CI 95% 0.14–0.59)] than did passive commuters. Conclusions: Our results suggest that in young adulthood, a key life-stage for the development of obesity and MetS, AC could be associated with and increasing of daily physical activity levels, thereby promoting better cardiometabolic health.This study was part of the project entitled “Body Adiposity Index and Biomarkers of Endothelial and Cardiovascular Health in Adults”, which was funded by Centre for Studies on Measurement of Physical Activity, School of Medicine and Health Sciences, Universidad del Rosario (Code N° FIUR DNBG001) and Universidad de Boyacá (Code N° RECT 60)

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Formin Homology 2 Domain Containing 3 (FHOD3) Is a Genetic Basis for Hypertrophic Cardiomyopathy

BACKGROUND: The genetic cause of hypertrophic cardiomyopathy remains unexplained in a substantial proportion of cases. Formin homology 2 domain containing 3 (FHOD3) may have a role in the pathogenesis of cardiac hypertrophy but has not been implicated in hypertrophic cardiomyopathy. OBJECTIVES: This study sought to investigate the relation between FHOD3 mutations and the development of hypertrophic cardiomyopathy. METHODS: FHOD3 was sequenced by massive parallel sequencing in 3,189 hypertrophic cardiomyopathy unrelated probands and 2,777 patients with no evidence of cardiomyopathy (disease control subjects). The authors evaluated protein-altering candidate variants in FHOD3 for cosegregation, clinical characteristics, and outcomes. RESULTS: The authors identified 94 candidate variants in 132 probands. The variants' frequencies were significantly higher in patients with hypertrophic cardiomyopathy (74 of 3,189 [2.32%]) than in disease control subjects (18 of 2,777 [0.65%]; p < 0.001) or in the gnomAD database (1,049 of 138,606 [0.76%]; p < 0.001). FHOD3 mutations cosegregated with hypertrophic cardiomyopathy in 17 families, with a combined logarithm of the odds score of 7.92, indicative of very strong segregation. One-half of the disease-causing variants were clustered in a small conserved coiled-coil domain (amino acids 622 to 655); odds ratio for hypertrophic cardiomyopathy was 21.8 versus disease control subjects (95% confidence interval: 1.3 to 37.9; p < 0.001) and 14.1 against gnomAD (95% confidence interval: 6.9 to 28.7; p < 0.001). Hypertrophic cardiomyopathy patients carrying (likely) pathogenic mutations in FHOD3 (n = 70) were diagnosed after age 30 years (mean 46.1 ± 18.7 years), and two-thirds (66%) were males. Of the patients, 82% had asymmetric septal hypertrophy (mean 18.8 ± 5 mm); left ventricular ejection fraction <50% was present in 14% and hypertrabeculation in 16%. Events were rare before age 30 years, with an annual cardiovascular death incidence of 1% during follow-up. CONCLUSIONS: FHOD3 is a novel disease gene in hypertrophic cardiomyopathy, accounting for approximately 1% to 2% of cases. The phenotype and the rate of cardiovascular events are similar to those reported in unselected cohorts. The FHOD3 gene should be routinely included in hypertrophic cardiomyopathy genetic testing panels

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Solving the dynamic equations of a 3-<span style="text-decoration:underline; " class="text">P</span>RS Parallel Manipulator for efficient model-based designs

Introduction of parallel manipulator systems for different applications areas has influenced many researchers to develop techniques for obtaining accurate and computational efficient inverse dynamic models. Some subject areas make use of these models, such as, optimal design, parameter identification, model based control and even actuation redundancy approaches. In this context, by revisiting some of the current computationally-efficient solutions for obtaining the inverse dynamic model of parallel manipulators, this paper compares three different methods for inverse dynamic modelling of a general, lower mobility, 3-PRS parallel manipulator. The first method obtains the inverse dynamic model by describing the manipulator as three open kinematic chains. Then, vector-loop closure constraints are introduced for obtaining the relationship between the dynamics of the open kinematic chains (such as a serial robot) and the closed chains (such as a parallel robot). The second method exploits certain characteristics of parallel manipulators such that the platform and the links are considered as independent subsystems. The proposed third method is similar to the second method but it uses a different Jacobian matrix formulation in order to reduce computational complexity. Analysis of these numerical formulations will provide fundamental software support for efficient model-based designs. In addition, computational cost reduction presented in this paper can also be an effective guideline for optimal design of this type of manipulator and for real-time embedded control

Role of the nursing professional in the attention of bullying in children and adolescents

Actualmente se ha incrementado y visualizado el fenómeno del acoso escolar o bullying(por su traducción al inglés); sin embargo, llama la atención que esta práctica ha&nbsp; existido durante mucho tiempo, pero es hasta ahora donde se evidencian las consecuencias que genera en los niños, niñas y adolescentes que, según diversos estudios, puede generar suicidios en esta población. Diversas profesiones han profundizado en el tema; a pesar de ello, no se ha visto avance en el manejo y prevención del acoso y se ha incrementado el número de casos que llegan a instituciones de salud relacionados con los daños físicos y psicológicos que se ocasionan en el niño víctima de acoso escolar. Es un reto para enfermería poder abordar esta situación y plantear posibles estrategias de intervención para su manejo y prevención, no solo en la víctima y victimario sino también en la familia, escuelas e instituciones de salud en los diferentes niveles de atención, ya que cuenta con las herramientas para diseñar intervenciones en el manejo de la comunidad y del paciente institucionalizado. &nbsp;Currently the phenomenon of bullying has increased and visualized, however, it is striking that this practice has existed for a long time, but it is up until now where the consequences that it generates in the children and adolescents are shown, where, according to various studies, can generate suicides in this population. Various professions have deepened the issue; despite this, there has not been progress in the management and prevention of harassment and it has increased the number of cases that reach health institutions related to physical and psychological damage that are caused in the child victim of bullying. It is a challenge for nursing to tackle this situation and propose possible intervention strategies for its management and prevention, not only in the victim and victimizer, but also in the family, schools, and health institutions in the different levels of care, since it has the tools to design interventions in the management of the community and the institutionalized patien