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Background: The COVID-19 pandemic in Latin America generated the need to develop low-cost, fast-manufacturing mechanical ventilators. The Universidad de La Sabana and the Fundacion Neumologica Colombiana designed and manufactured the Unisabana-HERONS (USH) ventilator. Here, we present the preclinical and clinical study results to evaluate its effectiveness and safety characteristics in an animal model (Yorkshire Sow) and five patients with acute respiratory failure receiving mechanical ventilatory support for 24 h. Methods: The effectiveness and safety outcomes included maintaining arterial blood gases and pulse oximetry saturation (SpO2), respiratory pressures and volumes (during continuous monitoring) in the range of ARDS and lung-protective strategy goals, and the occurrence of barotrauma. A significance level of 0.05 was used for statistical tests. This clinical trial was registered on Clinicaltrials.gov (NCT04497623) and approved by the ethics committee. Results: Among patients treated with the Unisabana-HERONS, the most frequent causes of acute respiratory failure were pneumonia in 3/5 (60 %) and ARDS in 2/5 (40 %). During the treatment, the ventilatory parameters related to lung protection protocols were kept within the safety range, and vital signs and blood gas were stable. The percentage of time that the respiratory pressures or volumes were out of safety range were plateau pressure >30 cm H2O: 0.00 %; driving pressure >15 cm H2O: 0.06 %; mechanical power >15 J/min: 0.00 %; and Tidal volume >8 mL/kg: 0.00 %. There were no adverse events related to the ventilator. The usability questionnaire retrieved a median score for all items between 9 and 10 (best score: 10), indicating great ease of use. Conclusion: The Unisabana-HERONS ventilator effectively provided adequate gas exchange and maintained the ventilatory parameters in the range of lung protection strategies in humans and an animal model. Furthermore, it is straightforward to use and is a low-cost medical device.
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BACKGROUND: Patient-ventilator asynchrony is common in patients undergoing mechanical ventilation. The proportion of health-care professionals capable of identifying and effectively managing different types of patient-ventilator asynchronies is limited. A few studies have developed specific training programs, but they mainly focused on improving patient-ventilator asynchrony detection without assessing the ability of health-care professionals to determine the possible causes. METHODS: We conducted a 36-h training program focused on patient-ventilator asynchrony detection and management for health-care professionals from 20 hospitals in Latin America and Spain. The training program included 6 h of a live online lesson during which 120 patient-ventilator asynchrony cases were presented. After the 6-h training lesson, health-care professionals were required to complete a 1-h training session per day for the subsequent 30 d. A 30-question assessment tool was developed and used to assess health-care professionals before training, immediately after the 6-h training lecture, and after the 30 d of training (1-month follow-up). RESULTS: One hundred sixteen health-care professionals participated in the study. The median (interquartile range) of the total number of correct answers in the pre-training, post-training, and 1-month follow-up were significantly different (12 [8.75-15], 18 [13.75-22], and 18.5 [14-23], respectively). The percentages of correct answers also differed significantly between the time assessments. Study participants significantly improved their performance between pre-training and post-training (P < .001). This performance was maintained after a 1-month follow-up (P = .95) for the questions related to the detection, determination of cause, and management of patient-ventilator asynchrony. CONCLUSIONS: A specific 36-h training program significantly improved the ability of health-care professionals to detect patient-ventilator asynchrony, determine the possible causes of patient-ventilator asynchrony, and properly manage different types of patient-ventilator asynchrony.
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Health Personnel , Patient-Ventilator Asynchrony , Humans , Hospitals , Respiration, Artificial , SpainABSTRACT
OBJETIVO: Sistematizar, evaluar y sintetizar la investigación original específica en México sobre la zoonosis por Trypano-soma cruzi, los vectores (Triatominae: Hemiptera: Reduviidae) y la enfermedad de Chagas (EC). Material y métodos. La investigación original fue identificada con PRISMA mediante cuatro sistemas de búsqueda, usando criterios de inclusión, se realizó la asignación a 14 áreas temáticas y fue evaluada mediante criterios técnicos. RESULTADOS: De un total de 1 410 registros, fueron elegidos 659 (46.7%) para la valoración técnica, de los cuales, 221 (15.7%) fueron incluidos como las evidencias de mayor calidad. El buscador PubMed contribuyó con 95% de los registros, mientras que los buscadores BibTri, Lilacs y Scielo aportaron 5%. La tasa de publicación fue constante de 1950 a 1990, con un incremento exponencial de 1995 a 2020. La alta calidad de publicaciones incrementó de 5.3% en 1990 hasta 49.8% en 2020. Los temas de aspectos sistémicos, económicos, antropológicos y sociales de la EC en México fueron los menos representados (8%). CONCLUSIONES: En las dos últimas décadas en México ha incrementado la investigación científica. Sin embargo, son notables las caren- cias en las áreas para poder fundamentar la política pública sanitaria en cuanto a la atención, la prevención y el control de la EC en el país.
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BACKGROUND: Internal redistribution of gas, referred to as pendelluft, is a new potential mechanism of effort-dependent lung injury. Neurally-adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV +) follow the patient's respiratory effort and improve synchrony compared with pressure support ventilation (PSV). Whether these modes could prevent the development of pendelluft compared with PSV is unknown. We aimed to compare pendelluft magnitude during PAV + and NAVA versus PSV in patients with resolving acute respiratory distress syndrome (ARDS). METHODS: Patients received either NAVA, PAV + , or PSV in a crossover trial for 20-min using comparable assistance levels after controlled ventilation (> 72 h). We assessed pendelluft (the percentage of lost volume from the non-dependent lung region displaced to the dependent region during inspiration), drive (as the delta esophageal swing of the first 100 ms [ΔPes 100 ms]) and inspiratory effort (as the esophageal pressure-time product per minute [PTPmin]). We performed repeated measures analysis with post-hoc tests and mixed-effects models. RESULTS: Twenty patients mechanically ventilated for 9 [5-14] days were monitored. Despite matching for a similar tidal volume, respiratory drive and inspiratory effort were slightly higher with NAVA and PAV + compared with PSV (ΔPes 100 ms of -2.8 [-3.8--1.9] cm H2O, -3.6 [-3.9--2.4] cm H2O and -2.1 [-2.5--1.1] cm H2O, respectively, p < 0.001 for both comparisons; PTPmin of 155 [118-209] cm H2O s/min, 197 [145-269] cm H2O s/min, and 134 [93-169] cm H2O s/min, respectively, p < 0.001 for both comparisons). Pendelluft magnitude was higher in NAVA (12 ± 7%) and PAV + (13 ± 7%) compared with PSV (8 ± 6%), p < 0.001. Pendelluft magnitude was strongly associated with respiratory drive (ß = -2.771, p-value < 0.001) and inspiratory effort (ß = 0.026, p < 0.001), independent of the ventilatory mode. A higher magnitude of pendelluft in proportional modes compared with PSV existed after adjusting for PTPmin (ß = 2.606, p = 0.010 for NAVA, and ß = 3.360, p = 0.004 for PAV +), and only for PAV + when adjusted for respiratory drive (ß = 2.643, p = 0.009 for PAV +). CONCLUSIONS: Pendelluft magnitude is associated with respiratory drive and inspiratory effort. Proportional modes do not prevent its occurrence in resolving ARDS compared with PSV.
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The energetic demands of modern society for clean energy vectors, such as H2, have caused a surge in research associated with homogeneous and immobilized electrocatalysts that may replace Pt. In particular, clathrochelates have shown excellent electrocatalytic properties for the hydrogen evolution reaction (HER). However, the actual mechanism for the HER catalyzed by these d-metal complexes remains an open debate, which may be addressed via Operando spectroelectrochemistry. The prediction of electrochemical properties via density functional theory (DFT) needs access to thermodynamic functions, which are only available after Hessian calculations. Unfortunately, there is a notable lack in the current literature regarding the precise evaluation of vibrational spectra of such complexes, given their structural complexity and the associated tangled IR spectra. In this work, we have performed a detailed theoretical and experimental analysis in a family of Co(II) clathrochelates, in order to establish univocally their IR pattern, and also the calculation methodology that is adequate for such predictions. In summary, we have observed the presence of multiple common bands shared by this clathrochelate family, using the B3LYP functional, the LANL2DZ basis, and effective core potentials (ECP) for heavy atoms. The most important issue addressed in this article was therefore related to the detailed assignment of the fingerprint associated with cobalt(II) clathrochelates, which is a challenging endeavor due to the crowded nature of their spectra.
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Background: Peritoneal dialysis (PD) is a frequent method for renal replacement therapy in pediatric population. However, PD is associated with a high incidence of early and late complications. Thus, this study aims to evaluate the perioperative factors associated with these complications. Methods: Clinical records of patients who had peritoneal dialysis catheter (PDC) placement between January 2013 and June 2016 were retrospectively analyzed. Sociodemographic and perioperative variables were recorded and analyzed. Results: A total of 92 patients required PDC insertion. Primary PDC failure occurred in 21.74% of cases, and 17.39% required reoperation. The most common complication was occlusion (13.04%), followed by leak (8.7%). Age younger than 1 year and weight less than 10 kg were significant risk factors for catheter dysfunction, reoperation, leak, PDC occlusion, hernia, and death. The open technique was associated with higher risks of operation, leak, and peritonitis than the laparoscopic technique. Placement of the catheter by the laparoscopic technique reduced the odds of occlusion by 38%. Conclusions: Patients younger than 1 year and weighing less than 10 kg have an increased risk of complications and death, regardless of the technique used. The most frequent complication is catheter failure; however, the laparoscopic technique appears to reduce this complication.
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Laparoscopy , Peritoneal Dialysis , Humans , Child , Retrospective Studies , Catheters, Indwelling/adverse effects , Peritoneum/surgery , Peritoneal Dialysis/adverse effects , Peritoneal Dialysis/methods , Laparoscopy/methods , Risk FactorsABSTRACT
The density of states (DOS) is fundamentally important for understanding physical processes in organic disordered semiconductors, yet hard to determine experimentally. We evaluated the DOS by considering recombination via tail states and using the temperature and open-circuit voltage (V_{oc}) dependence of the ideality factor. By performing Suns-V_{oc} measurements, we find that the energetic disorder increases deeper into the band gap, which is not expected for a Gaussian or exponential DOS. The linear dependence of the disorder on energy reveals the power-law DOS in organic solar cells.
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Normal Distribution , TemperatureABSTRACT
OBJECTIVE: In this study, we aim to identify social typologies of pedestrian crashes considering demographics, health impacts, involved vehicle, temporality of the collision, and place of impact in Hermosillo, Mexico. METHODS: A socio-spatial analysis was performed by using local urban planning information and vehicles-pedestrian crashes records collected by the police department (N = 950) between 2014 and 2017. Multiple Correspondence Analysis and Hierarchical Cluster Analysis were used to determine typologies. Geographical distribution of typologies was obtained with spatial analysis techniques. RESULTS: The results suggest there are four typologies, which portray the physical vulnerability of pedestrians, which reflect the vulnerability to collisions associated to the variables age, gender, and street speed limits. Findings show that children are more likely to be injured during weekends in residential zones (Typology 1), while older females are more likely to be injured during the first three days of the week (Monday - Wednesday) in the downtown area (Typology 2). Injured males during the afternoon in arterial streets represented the most frequent cluster (Typology 3). Also, males were likely to be severely injured by heavy trucks during nighttime in peri-urban areas (Typology 4). These findings indicate that vulnerability and risk exposure vary according to the type of pedestrian involved in the crash, which are linked to the types of places they visit. CONCLUSIONS: The design of the built environment plays a major role in the number of pedestrian injuries particularly when it favors motor vehicles over pedestrians or non-motorized vehicles. Because traffic crashes are considered preventable events, cities must embrace a diversity of mobility modes and incorporate the appropriate infrastructures that safeguard the lives of all their travelers, especially pedestrians.
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Pedestrians , Wounds and Injuries , Male , Child , Female , Humans , Accidents, Traffic , Cities , Mexico/epidemiology , Motor Vehicles , Wounds and Injuries/epidemiologyABSTRACT
This study explores the nuclear magnetic shielding, chemical shifts, and the optoelectronic properties of the BiMnVO5 compound using the full-potential linearized augmented plane wave method within the generalized gradient approximation by employing the Hubbard model (GGA + U). The 209Bi and 51V chemical shifts and bandgap values of the BiMnVO5 compound in a triclinic crystal structure are found to be directly related to Hubbard potential. The relationship between the isotropic nuclear magnetic shielding σiso and chemical shift δiso is obtained with a slope of 1.0231 and - 0.00188 for 209Bi and 51V atoms, respectively. It is also observed that the bandgap, isotropic nuclear magnetic shielding, and chemical shifts increase with the change in Hubbard potentials (U) of 3, 4, 5, 6, and 7.
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Recent low-temperature infrared-based experimental studies provided information about the effects of aqueous microsolvation on the intramolecular hydrogen bond of protonated glycine and ß-alanine [J. Phys. Chem. A 2019, 123, 3355]. Here we address the temperature-dependent entropic effects on the aqueous microsolvation patterns of these protonated amino acids using the AAH+(H2O)n (n = 1-8) cluster model at 50 K and room temperature with Born-Oppenheimer molecular dynamics using a calibrated hybrid density functional. The CCOOH-Ow, N-Ow, and center-of-mass-Ow radial distribution functions provide accurate structural data and temperature-dependent water coordination numbers vs. solvation degree. The solvation patterns for protonated glycine at 50 K show structural features in agreement with previous static optimizations. However, entropic effects at room temperature play a crucial role in the evolution of the intramolecular HB strength vs. solvation degree for both protonated amino acids. With increasing hydration entropic effects favor the making of solvent hydrogen bond networks over full solvation of protonated glycine. At room temperature four water molecules are needed to build the first solvation shell for protonated glycine while five are required for protonated ß-alanine. A new statistical Cumulative Percentage of Structures (CPS) scheme is proposed; when the CPS data are analyzed in light of the empirical formula of Rozenberg et al. [Phys. Chem. Chem. Phys. 2000, 2, 2699] and the hydrogen bond relative strength (HBRS) criteria of Jeffrey [An Introduction to Hydrogen Bonding; Oxford University: 1997] we can provide a detailed molecular mechanism for the weakening of the intramolecular hydrogen bond based on the average dynamical structures, which clearly reveals the temperature dependence of this process. The new CPS-HBRS scheme proposed here can be utilized using any type of molecular dynamics trajectory (classical, BOMD, CPMD, etc.).
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[This corrects the article DOI: 10.1039/D2RA03850A.].
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PURPOSE: To describe demographic, clinical, diagnostic and therapeutic aspects of pediatric patients with benign adipocytic tumors admitted to a high complexity teaching hospital from 2007 to 2021. METHODS: Retrospective observational descriptive study. Patient information was retrieved from clinical records. A descriptive analysis was carried out for qualitative data and frequencies were calculated for quantitative data. RESULTS: 76 patients were included with a mean age of 7.5 years old where 60.5% were boys. The main symptom was a mass (73.7%) mostly found in the lower limbs (23.6%). Congenital birth defects were identified in 48.6% of the cases. Preoperative imaging was available in 78.9% of the patients allowing characterization of lesions or differential diagnosis. The therapeutic goal was resection with negative margins, which was feasible in all cases except for one case. The histopathological diagnosis was lipoma in 68.4% of the cases followed by lipoblastoma in 13.1%. The mean follow-up period was 17.9 months. 79.7% of the patients were asymptomatic at their last out-patient visit. CONCLUSION: Benign adipocytic tumors constitute a wide spectrum of lesions, which involve diverse anatomic segments from the neural axis to the inguinoscrotal region. The present work contributes to the general understanding of the clinical presentation and differential diagnosis for these infrequent neoplasms.
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Lipoblastoma , Male , Child , Humans , Female , Retrospective Studies , Diagnosis, Differential , Hospitalization , Hospitals, TeachingABSTRACT
The structural and optoelectronic characteristics of Zn1-x Cd x S (x = 0, 0.25, 0.50, 0.75, 1) semiconductors are reported using density functional theory within GGA, EV-GGA, and mBJ functionals. These semiconductors are observed in cubic symmetry at all Cd-concentrations and the lattice constant increases linearly with Cd-concentration while the bulk modulus shows a reverse behavior. These materials are direct bandgap semiconductors at all Cd-concentrations and their bandgap energy decreases from 3.67 eV to 2.59 eV. The isotropic optical properties of these direct bandgap semiconductors vary with Cd concentration as well, with absorption coefficients decreasing and absorbed near-UV light converting to visible blue light. Optical properties like refractive index, dielectric constant, conductivity, extinction coefficient, and reflectance are also displayed and discussed. These results provide useful theoretical understanding for the application of CdZnS semiconductors in photonic, photovoltaic, and optoelectronic devices.
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INTRODUCTION: The SARS-CoV-2 virus, which causes COVID-19, has spread quickly worldwide, causing millions of cases and thousands of deaths. Some risk factors in the general population are related to the development of severe COVID-19 or death, but in pregnant women and neonates, the information is limited. OBJECTIVE: To determine the epidemiological and clinical characteristics of pregnant women and neonates diagnosed with COVID-19 by RT-PCR and serological tests, and analyze the relationship between the influenza vaccination and COVID-19 symptoms in infected pregnant women in Sinaloa state. METHODS: We collected samples from 116 pregnant women and 84 neonates from the Women´s Hospital of Sinaloa. They were diagnosed with COVID-19 by RT-PCR and serological tests (IgG), and sociodemographic, clinical and laboratory parameters were recorded. RESULTS: A total of 11.2% (13/116) of the pregnant women were RT-PCR+, 25% (29/116) were IgG+ and 4.3% (5/116) were positive for both tests. Symptoms such as rhinorrhea (P = .04), cough (P = .02) and polypnea (P = .04) in pregnant women were related to COVID-19, also leukocyte index was higher in pregnant women with COVID-19 (P = .03), but the associations were lost after the Bonferroni correction. No laboratory parameters or underlying diseases were associated with COVID-19, and most infected pregnant women had mild cases. We found an association between the influenza vaccine and less common COVID-19 symptoms in pregnant women who were infected (P = .01). A total of 7.2% (6/84) of neonates were RT-PCR+, 35.7% (30/84) were IgG+, and there were no symptoms or underlying diseases associated with neonates who were infected. In conclusion, this work demonstrated that some symptoms were related to COVID-19, most pregnant women and neonates had mild cases, and the influenza vaccine could decrease the severity of COVID-19 cases in pregnant women.
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COVID-19 , Influenza Vaccines , Pregnancy Complications, Infectious , COVID-19/epidemiology , Female , Humans , Immunoglobulin G , Infant, Newborn , Mexico/epidemiology , Pregnancy , Pregnant Women , SARS-CoV-2ABSTRACT
Background: Preeclampsia (PE) and COVID-19 share a common vascular-endothelial physiopathological pathway that may aggravate or worsen women's outcomes when both coexist. This study aims to evaluate the association of sFlt-1 levels and adverse maternal outcomes among positive SARS-CoV-2 pregnant women with and without hypertensive disorders of pregnancy (HDP). Methods: We performed a multicenter retrospective cohort study of pregnant women with confirmed SARS-CoV-2 infection that required hospital admission. The exposed cohort comprised women with a diagnosis of an HDP. The primary outcome was a composite definition of adverse maternal outcome. The association between predictors and the main and secondary outcomes was assessed using an elastic-net regression which comprised a Lasso and Ridge regression method for automatic variable selection and penalization of non-statistically significant coefficients using a 10-fold cross-validation where the best model if automatically chosen by the lowest Akaike information criterion (AIC) and Bayesian information criteria (BIC). Results: Among 148 pregnant women with COVID-19, the best predictive model comprised sFlt-1 MoMs [odds ratio (OR): 5.13; 95% CI: 2.19-12.05], and HDP (OR: 32.76; 95% CI: 5.24-205). sFlt-1 MoMs were independently associated with an increased probability of an adverse maternal outcome despite adjusting for HDP. Conclusions: Our study shows that sFlt-1 is an independent predictor of adverse outcomes in women with SARS-CoV-2 despite hypertension status.
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The COVID-19 pandemic has drawn greater attention to social determinants of health and associated health inequities, which disproportionately affect vulnerable populations and places in the U.S. In this study, we explored geographic patterns of local-level COVID-19 vulnerability and associations with social and health determinants across Colorado. To conceptualize social and health determinants and how together they generate risk and exposure, we integrated the concepts of social vulnerability and syndemic to situate COVID-19 vulnerability within a broader hazards of place framework. Using geospatial statistics and GIS, we estimated census tract-level rates of COVID-19, which are not yet available in Colorado, and mapped areas of high and low incidence risk. We also developed composite indices that characterized social and health vulnerabilities to measure multivariate associations with COVID-19 rates. The findings revealed hotspots of persistent risk in mountain communities since the pandemic emerged in Colorado, as well as clusters of risk in the Urban Front Range's central and southern counties, and across many parts of eastern Colorado. Vulnerability analyses indicate that COVID-19 rates were associated with mental health and chronic conditions along with social determinants that represent inequities in education, income, healthcare access, and race/ethnicity (minority percent of population), which may have disproportionately exposed some communities more than others to infection and severe health outcomes. Overall, the findings provide geographic health information about COVID-19 and vulnerability context, which may better inform local decision-making for interventions and policies that support equity of social determinants of health.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2021382 .
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COVID-19 , Social Determinants of Health , COVID-19/epidemiology , Colorado/epidemiology , Geography , Humans , PandemicsABSTRACT
This study examined the spatial effects of El Niño and vulnerability on cholera in Peru across the epidemic period of 1991 to 1998. Using Wavelet and GIS analyses, relationships between sea surface temperatures and department-level cholera rates were estimated. In addition, we constructed composite indices to assess spatial vulnerability during the 1997-98 extreme El Niño. The findings demonstrated strong temporal connections in 1997-98, most evident in northern Peru, and less clear connections from 1991-93. Spatially, we found patterns of difference, greater cholera risk in northern coastal Peru in 1997-98, compared to greater risk in central and southern coastal Peru in 1991-92. Overall, the spatial vulnerability analysis suggested preexisting social conditions and disaster impacts increased cholera exposure and infection in 1998. Our study supports the notion that the spatial nature of El Niño's impacts on cholera rates exacerbated cholera vulnerability following the emergence, rather than triggered the epidemic's onset in 1991.