91 research outputs found
reimagining stem education and training with e real 3d and holographic visualization immersive and interactive learning for an effective flipped classroom
While the 19th and the 20th centuries were, in education, mainly about standardization, the 21st century is about visualization, interaction, customization, gamification and flipped teaching. What today we know about learning from cognitive psychology is that people learn by practicing, with feedback to tell them what they're doing right and wrong and how to get better. For STEM education, that means they need to practice thinking like a scientist in the field. So e-REAL is a cornerstone: developed as workplace learning system in a number of fields (from medical simulation to soft skills development within the continuing education), it's an ideal solution to root a practical â but not simplicistic - approach for STEM education.</p
Virtual worlds and augmented reality: The enhanced reality lab as a best practice for advanced simulation and immersive learning
e-REAL is enhanced reality for immersive simulation. It is a system where physical and digital objects co-exist and interact in real time, in a real place and not within a headset. e-REAL allows for an advanced simulation within a multisensory scenario, based on challenging situations developed by visual storytelling techniques. The e-REAL immersive setting is fully interactive with 3D holographic visualization, talking avatars, electronically writable surfaces and more: people can take notes, cluster key-concepts or fill questionnaires directly on the projected surfaces. Learners rapidly circle between deliberate practice and direct feedback within a simulation scenario until mastery is achieved. So far, the early findings show that visualization, if linked in interactive ways to the learners, allows for better neural processes related to learning and behavior change. Mondi virtuali e realtĂ aumentata: lâEnhanced Reality Lab come best practice per la simulazione avanzata e lâapprendimento immersivoe-REAL Ăš realtĂ potenziata per la simulazione immersiva. Eâ un sistema dove oggetti fisici e virtuali coesistono e interagiscono in tempo reale, in un luogo reale e non allâinterno di un visore. e-REAL consente una simulazione avanzata allâinterno di uno scenario multisensoriale, basato su situazioni sfidanti progettate attraverso tecniche di storytelling visuale. Il setting immersivo di e-REAL Ăš pienamente interattivo con visualizzazioni olografiche in 3D, avatars parlanti, superfici sulle quali Ăš possibile scrivere elettronicamente e altro ancora: le persone possono prendere note, raggruppare concetti-chiave, compilare questionari direttamente sulle superfici proiettate. Lâapplicazione della tecnica denominate Rapid Cicle Deliberate Practice (RCDP), basata su feedback diretti e mirati, consente di migliorare le performance giĂ nel corso della simulazione. I primi risultati mostrano che la visualizzazione interattiva potenzia i processi neurali associati allâapprendimento e al cambiamento comportamentale
Estimulaçao VDD com Cabo Unico
Com o objetivo de avaliar a eficiĂȘncia da estimulaçao sincrĂŽnica VDD com cabo Ășnico, sao analisados 30 pacientes, 18 do sexo feminino e 12 do masculino, com idades entre 43 e 83 anos. Todos apresentavam funçao sinusal normal com bloqueio atrioventricular de 2Âș grau (5 casos) ou total (25 casos), sendo utilizados marcapassos VDD com cabos Ășnicos quadripolares, num seguimento mĂ©dio de 17,2 ± 8,5 meses. Avaliou-se a confiabilidade do procedimento pela captaçao da atividade atrial e pela mensuraçao da onda P em 8 posiçoes e/ou decĂșbitos, e a sua eficiĂȘncia pela verificaçao da elevaçao da freqĂŒĂȘncia de estimulaçao constatada no Holter. A estimulaçao VDD foi inefetiva em apenas um paciente (3,3%), tendo nos demais confiabilidade de 96,1%, e elevado a freqĂŒĂȘncia de 68 a 130%, com manutençao do sincronismo atrioventricular. Por ser confiĂĄvel, eficiente e apresentar resposta de freqĂŒĂȘncia com manutençao do sincronismo AV, a estimulaçao VDD deve ser recomendada, nos pacientes com funçao sinusal nornal, em substituiçao Ă VVI e VVI.R
Estimulaçao VDD com Cabo Unico
Com o objetivo de avaliar a eficiĂȘncia da estimulaçao sincrĂŽnica VDD com cabo Ășnico, sao analisados 30 pacientes, 18 do sexo feminino e 12 do masculino, com idades entre 43 e 83 anos. Todos apresentavam funçao sinusal normal com bloqueio atrioventricular de 2Âș grau (5 casos) ou total (25 casos), sendo utilizados marcapassos VDD com cabos Ășnicos quadripolares, num seguimento mĂ©dio de 17,2 ± 8,5 meses. Avaliou-se a confiabilidade do procedimento pela captaçao da atividade atrial e pela mensuraçao da onda P em 8 posiçoes e/ou decĂșbitos, e a sua eficiĂȘncia pela verificaçao da elevaçao da freqĂŒĂȘncia de estimulaçao constatada no Holter. A estimulaçao VDD foi inefetiva em apenas um paciente (3,3%), tendo nos demais confiabilidade de 96,1%, e elevado a freqĂŒĂȘncia de 68 a 130%, com manutençao do sincronismo atrioventricular. Por ser confiĂĄvel, eficiente e apresentar resposta de freqĂŒĂȘncia com manutençao do sincronismo AV, a estimulaçao VDD deve ser recomendada, nos pacientes com funçao sinusal nornal, em substituiçao Ă VVI e VVI.R
Servicios de acompañamiento y asistencia psicológica desarrollados durante la pandemia (COVID-19) en Argentina y Chile
La pandemia de COVID-19 provocĂł que los estados adopten, entre otras medidas, el aislamiento como modo de prevenir el esparcimiento del virus. Esto generĂł que los ciudadanos deban aprender a vincularse de un modo alternativo con los sistemas de educaciĂłn y salud. Por otra parte, esta nueva condiciĂłn de funcionamiento cĂvico impactĂł directamente sobre la subjetividad y la salud mental de la poblaciĂłn. Como respuesta a la emergencia generada por la pandemia y las estrategias de asilamiento, surgieron diferentes espacios dirigidos a orientar, contener, acompañar y asistir a diferentes segmentos de la poblaciĂłn: contagiados, familiares, trabajadores de la salud, trabajadores esenciales, etcĂ©tera. La construcciĂłn de estos dispositivos tuvo como desafĂos definir un encuadre de trabajo eficaz para la situaciĂłn descripta y establecer un modo de contacto y asistencia adecuado a la situaciĂłn de aislamiento social. Objetivos: Presentar y discutir las experiencias de trabajo de diferentes servicios y dispositivos de asistencia vinculados a salud mental construidos en respuesta a la pandemia de COVID-19 en las ciudades de CĂłrdoba y Catamarca (Argentina) y en la ciudad de ChillĂĄn, en la regiĂłn del BĂo-BĂo (Chile). Exponer datos e informaciĂłn en relaciĂłn a las caracterĂsticas de consultantes, motivos de consulta, modos de intervenciĂłn y principales fortalezas y debilidades de los dispositivos. Contribuciones: Desde las diferentes perspectivas teĂłrico-metodolĂłgicas y considerando las distintas poblaciones a las cuales se dirigieron los dispositivos, los modos de abordar el padecimiento subjetivo durante la pandemia aportan informaciĂłn relevante y reflexiones sobre la forma en la cual se responde a las emergencias en salud mental. Por otra parte, abren la discusiĂłn sobre modos novedosos de definir los encuadres de intervenciĂłn e incluir la tecnologĂa como un aliado en la asistencia psicolĂłgica en general.Fil: Rossi, Alejandra NoemĂ. Universidad Nacional de CĂłrdoba. Facultad de PsicologĂa; Argentina.Fil: Rossi, Alejandra NoemĂ. Ministerio de Salud de la Provincia de CĂłrdoba, Argentina.Fil: GonzĂĄlez, MarĂa Cristina. Universidad Nacional de CĂłrdoba. Facultad de PsicologĂa; Argentina.Fil: Ponce, Luciano Federico. Universidad Nacional de CĂłrdoba. Facultad de PsicologĂa; Argentina.Fil: Ferrero, Cecilia. Universidad Nacional de CĂłrdoba. Facultad de PsicologĂa; Argentina.Fil: Barrera Scholtis; Mariana. Universidad Nacional de CĂłrdoba. Facultad de PsicologĂa; Argentina.Fil: Salvetti, Marcela Alejandra. Universidad Nacional de CĂłrdoba. Facultad de PsicologĂa. Servicio Cuidando a Quienes Cuidan: Servicio de ContenciĂłn Virtual para Efectores/as de la Salud, Docentes y No docentes; Argentina.Fil: ChĂĄvez Lorena. Universidad Nacional de CĂłrdoba. Facultad de PsicologĂa; Argentina.Fil: Moreno FrĂas, Ana Virginia. Universidad Nacional de CĂłrdoba. Facultad de PsicologĂa. Servicio Cuidando a Quienes Cuidan: Servicio de ContenciĂłn Virtual para Efectores/as de la Salud, Docentes y No docentes; Argentina.Fil: SuĂĄrez, Coral. SalugĂ©nica; Argentina.Fil: RoldĂĄn, Fernando. SalugĂ©nica; Argentina.Fil: Reyes, Ana MarĂa. Universidad del BĂo-BĂo; Chile.Fil: Rey, Ricardo. Universidad del BĂo-BĂo; Chile.Fil: Zicavo MartĂnez, Nelson. Universidad del BĂo-BĂo; Chile
Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)
Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild-moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild-moderate IC were reported such malignancy (753-100%), diabetes (103-13.7%), malnutrition (26-3.5%) and uremia (1-0.1%), while severe IC causes were steroids treatment (14-16.3%); neutropenia (7-8.1%), malignancy on chemotherapy (71-82.6%). Preoperative risk classification were reported as follow: mild-moderate: ASA 1-14 (1.9%); ASA 2-202 (26.8%); ASA 3-341 (45.3%); ASA 4-84 (11.2%); ASA 5-7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2-16 patients (18.6%); ASA 3-41 patients (47.7%); ASA 4-19 patients (22.1%); ASA 5-3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild-moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild-moderate and severe groups. Long-term survival data: in mild-moderate disease-free survival (median, IQR) is 28 (10-91) and in severe IC, it is 21 (10-94). Overall survival (median, IQR) is 44 (18-99) and 26 (20-90) in mild-moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16-81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild-moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients
National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio : a pooled analysis of 458 population-based studies in Asian and Western countries
Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and nonHDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries. Methods: We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group. Results: Since similar to 1980, mean TC increased in Asian countries. In Japan and South Korea, the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at similar to 0.4 mmol/L per decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as similar to 0.7 per decade in Swiss men (equivalent to similar to 26% decline in coronary heart disease risk per decade). The ratio increased in China. Conclusions: HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.Peer reviewe
Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study
: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (pâ=â0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (pâ=â0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (pâ=â0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (pâ=â0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (pâ=â0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (pâ=â0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (pâ=â0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (pâ<â0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (pâ=â0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (pâ=â0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)
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Liver trauma: WSES 2020 guidelines
Abstract: Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines
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