Development and Validation of a Method of Body Volume and Fat Mass Estimation Using Three-Dimensional Image Processing with a Mexican Sample.

Body composition assessment using instruments such as dual X-ray densitometry (DXA) can be complex and their use is often limited to research. This cross-sectional study aimed to develop and validate a densitometric method for fat mass (FM) estimation using 3D cameras. Using two such cameras, stereographic images, and a mesh reconstruction algorithm, 3D models were obtained. The FM estimations were compared using DXA as a reference. In total, 28 adults, with a mean BMI of 24.5 (±3.7) kg/m2 and mean FM (by DXA) of 19.6 (±5.8) kg, were enrolled. The intraclass correlation coefficient (ICC) for body volume (BV) was 0.98-0.99 (95% CI, 0.97-0.99) for intra-observer and 0.98 (95% CI, 0.96-0.99) for inter-observer reliability. The coefficient of variation for kinetic BV was 0.20 and the mean difference (bias) for BV (liter) between Bod Pod and Kinect was 0.16 (95% CI, -1.2 to 1.6), while the limits of agreement (LoA) were 7.1 to -7.5 L. The mean bias for FM (kg) between DXA and Kinect was -0.29 (95% CI, -2.7 to 2.1), and the LoA was 12.1 to -12.7 kg. The adjusted R2 obtained using an FM regression model was 0.86. The measurements of this 3D camera-based system aligned with the reference measurements, showing the system's feasibility as a simpler, more economical screening tool than current systems.

Agarose Gel Characterization for the Fabrication of Brain Tissue Phantoms for Infrared Multispectral Vision Systems.

Synthetic phantoms that recreate the characteristics of biological tissues are valuable tools for systematically studying and comprehending physiologies, pathologies, and biological processes related to tissues. The reproduction of mechanical and optical properties allows for the development and evaluation of novel systems and applications in areas such as imaging, optics, ultrasound, or dosimetry, among others. This paper proposes a methodology for manufacturing agarose-based phantoms that mimics the optical properties of healthy brain tissue within the wavelength infrared range of 800 to 820 nm. The fabrication of such phantoms enables the possibility of testing and experimentation in controlled and safe environments toward the design of new near-infrared multispectral imaging systems in neurosurgery. The results of an experimental optical characterization study indicate the validity and reliability of the proposed method for fabricating brain tissue phantoms in a cost-effective and straightforward fashion.

Development of a lumbar puncture virtual simulator for medical students training: A preliminary evaluation.

BACKGROUND: Lumbar puncture is an essential medical procedure whose objective is to obtain cerebrospinal fluid. Lumbar puncture is considered a complex procedure, mainly for novice residents who suffer from stress and low confidence, which may result in harm to the patient. METHODS: The LPVirSim, has been developed in four stages: i) requirements analysis through user-centred design; ii) prototyping of the virtual environment and the haptic component; iii) preliminary tests with Ph.D. students and physicians using two haptic devices (Omega.7 and Sigma.7); iv) a user study where physicians evaluated the usability and user experience. RESULTS: The LPVirSim integrates non-technical skills and the possibility of representing different patients for training. Usability increased from 61.76 to 68.75 in the preliminary tests to 71.43 in the user study. CONCLUSIONS: All the results showed good usability and demonstrated that the simulator arouses interest and realistically represents a Lumbar puncture, through the force and visual feedback.

A Geospatial Model to Identify Areas Associated with Late- Stage Breast Cancer: A Spatial Epidemiology Approach.

OBJECTIVE: The aim of this study was to show how a geospatial model can be used to identify areas with a higher probability for late-stage breast cancer (BC) diagnoses. METHODS: Our study considered an ecological design. Clinical records at a tertiary care hospital were reviewed in order to obtain the place of residence and stage of the disease, which was classified as early (0-IIA) and late (IIB-IV) and whose diagnoses were made during the 2013-2017 period. Then, they were geolocated to identify the distribution and spatial trend. Subsequently, the pattern of location, i.e. scattered, random and concentrated, was statistically assessed and a geospatial model was elaborated to determine the probability of late diagnoses in the state of Jalisco, Mexico. RESULT: There were 1 954 (N) geolocated BC diagnoses: 58.3% were late. During the five-year period, a southwest-northeast trend was identified, nearly 9.5% of the surface of Jalisco, where 6 out of 10 (n= 751) late- stage diagnoses were concentrated. A concentrated and statistically significant pattern was identified in the southern, central and northern Pacific area of Jalisco, where the geospatial model delimited the places with the highest probability of late clinical stages (p <0.05). CONCLUSION: The geographical differences associated with the late diagnoses of BC suggest it is necessary to adapt and focus the strategies for early detection as an alternative to create a major impact on the population. Reproducible analysis tools were used in other contexts where geolocation data are available to complement public policies and strategies aimed to control BC.

Augmented reality simulation as training model of ventricular puncture: Evidence in the improvement of the quality of punctures.

BACKGROUND: Ventricular puncture is a common procedure in neurosurgery and the first that resident must learn. Ongoing education is critical to improving patient outcomes. However, training at the expense of potential risk to patients warrants new and safer training methods for residents. METHODS: An augmented reality (AR) simulator for the practice of ventricular punctures was designed. It consists of a navigation system with a virtual 3D projection of the anatomy over a 3D-printed patient model. Forty-eight participants from neurosurgery staff performed two free-hand ventricular punctures before and after a training session. RESULTS: Participants achieved enhanced accuracy in reaching the target at the Monro foramen after practicing with the system. Additional metrics revealed significantly better trajectories after the training. CONCLUSION: The study confirms the feasibility of AR as a training tool. This motivates future work towards standardising new educative methodologies in neurosurgery.

Quantification of short-chain fatty acids in human stool samples by LC-MS/MS following derivatization with aniline analogues.

The gut microbiome produces a range of short chain fatty acids (SCFA) crucially linked with diet and nutrition, metabolism, gastrointestinal health and homeostasis. SCFA are primarily measured using gas or liquid chromatography-mass spectrometry (LC/MS) after undergoing chemical derivatization. Here we assess the merits of a derivatization protocol using aniline and two aniline analogues (3-phenoxyaniline and 4-(benzyloxy)aniline) for the targeted LC-MS/MS quantification of nine SCFA (acetic, propionic, butyric, valeric, caproic acid, isobutyric, isovaleric, 2-methylbutyric, and 2-ethylbutyric acid). Evaluation of product ion spectra and optimization of MS detection conditions, provided superior detection sensitivity for 3-phenoxyaniline and 4-(benzyloxy)aniline compared to aniline. We developed a facile SCFA derivatization method using 3-phenoxyaniline under mild reaction conditions which allows for the simultaneous quantification of these SCFA in human stool samples in under eleven minutes using multiple reaction monitoring LC-MS/MS. The method was successfully validated and demonstrates intra- and inter-day accuracy (88.5-103% and 86.0-109%) and precision (CV of 0.55-7.00% and 0.33-9.55%) with recoveries (80.1-87.2% for LLOQ, 88.5-93.0% for ULOQ) and carry-over of (2.68-17.9%). Selectivity, stability and matrix effects were also assessed and satisfied validation criteria. Method applicability was demonstrated by analysing SCFA profiles in DNA-stabilized human stool samples from newly diagnosed colorectal cancer patients prior to surgery. The development of this improved method and its compatibility to measure SCFAs from DNA-stabilized stool will facilitate studies investigating the gut microbiome in health and disease.

Force-Sensorless Identification and Classification of Tissue Biomechanical Parameters for Robot-Assisted Palpation.

The implementation of robotic systems for minimally invasive surgery and medical procedures is an active topic of research in recent years. One of the most common procedures is the palpation of soft tissues to identify their mechanical characteristics. In particular, it is very useful to identify the tissue's stiffness or equivalently its elasticity coefficient. However, this identification relies on the existence of a force sensor or a tactile sensor mounted at the tip of the robot, as well as on measuring the robot velocity. For some applications it would be desirable to identify the biomechanical characteristics of soft tissues without the need for a force/tactile nor velocity sensors. An estimation of such quantities can be obtained by a model-based state observer for which the inputs are only the robot joint positions and its commanded joint torques. The estimated velocities and forces can then be employed for closed-loop force control, force reflection, and mechanical parameters estimation. In this work, a closed-loop force control is proposed based on the estimated contact forces to avoid any tissue damage. Then, the information from the estimated forces and velocities is used in a least squares estimator of the mechanical parameters. Moreover, the estimated biomechanical parameters are employed in a Bayesian classifier to provide further help for the physician to make a diagnosis. We have found that a combination of the parameters of both linear and nonlinear viscoelastic models provide better classification results: 0% misclassifications against 50% when using a linear model, and 3.12% when using only a nonlinear model, for the case in which the samples have very similar mechanical properties.

Public Policies and Programs for the Prevention and Control of Breast Cancer in Latin American Women: Scoping Review.

BACKGROUND: Breast cancer has positioned itself worldwide as one of the main public health problems, especially in Latin America. In some countries, several programs for the prevention and control of breast cancer in women have been developed and implemented on a permanent basis, but there are no public reports on the policies that originated such programs. OBJECTIVE: A scoping review of scientific publications that identify the type, extent, and scope of policies and programs for the prevention and control of breast cancer in Latin American women was performed, and the main results were presented in this paper. METHODS: This scoping review was carried out according to the method by Arksey and O'Malley based on 3 fundamental questions about breast cancer prevention and control policies in Latin America: their type, extent and scope, and reference framework. The search period was from 2000 to 2019, and the search was carried out in the following databases: MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost), ISI Web of Science (Science Citation Index), and Scopus in English, Spanish, and Portuguese, and Scielo, Cochrane, and MEDES-MEDicina in Spanish and Portuguese. Of the 743 studies found, 20 (2.7%) were selected, which were analyzed using descriptive statistics and qualitative content analysis. RESULTS: The selected studies identified several Latin American countries that have generated policies and programs to prevent and control breast cancer in women, focusing mainly on risk communication, prevention and timely detection, effective access to health services, improvement of the screening process, and evaluation of screening programs. Evaluation criteria and greater participation of civil society in policy design and program execution are still lacking. This could undoubtedly help eliminate existing barriers to effective action. CONCLUSIONS: Although several Latin American countries have generated public policies and action programs for the prevention and control of breast cancer, a pending issue is the evaluation of the results to analyze the effectiveness and impact of their implementation given the magnitude of the public health problem it represents and because women and civil society play an important role in its prevention and control. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/12624.

Corrigendum: Genetic Regulation of Alginate Production in Azotobacter vinelandii a Bacterium of Biotechnological Interest: A Mini-Review.

[This corrects the article DOI: 10.3389/fmicb.2022.845473.].

Genetic Regulation of Alginate Production in Azotobacter vinelandii a Bacterium of Biotechnological Interest: A Mini-Review.

Alginates are a family of polymers composed of guluronate and mannuronate monomers joined by ß (1-4) links. The different types of alginates have variations in their monomer content and molecular weight, which determine the rheological properties and their applications. In industry, alginates are commonly used as additives capable of viscosifying, stabilizing, emulsifying, and gelling aqueous solutions. Recently, additional specialized biomedical uses have been reported for this polymer. Currently, the production of alginates is based on the harvesting of seaweeds; however, the composition and structure of the extracts are highly variable. The production of alginates for specialized applications requires a precise composition of monomers and molecular weight, which could be achieved using bacterial production systems such as those based on Azotobacter vinelandii, a free-living, non-pathogenic bacterium. In this mini-review, we analyze the latest advances in the regulation of alginate synthesis in this model.

HrgS (Avin_34990), a novel histidine-kinase related to GacS, regulates alginate synthesis in Azotobacter vinelandii.

Azotobacter vinelandii is a soil bacterium that produces alginates, a family of polymers of biotechnological interest. In A. vinelandii, alginate production is controlled by the two-component system GacS/GacA. GacS/GacA, in turn, regulates the Rsm post-transcriptional regulatory system establishing a cascade that regulates alginate biosynthesis by controlling the expression of the algD biosynthetic gene. In Pseudomonas aeruginosa, GacS/GacA is influenced by other histidine-kinases constituting a multicomponent signal transduction system. In this study, we explore the presence of GacS-related histidine-kinases in A. vinelandii and discover a novel histidine-kinase (Avin_34990, renamed HrgS). This histidin-kinase acts as a negative regulator of alginate synthesis by controlling the transcription of the sRNAs belonging to the Rsm post-transcriptional regulatory system, for which a functional GacS is required.

A Wearable System Based on Multiple Magnetic and Inertial Measurement Units for Spine Mobility Assessment: A Reliability Study for the Evaluation of Ankylosing Spondylitis.

Spinal mobility assessment is essential for the diagnostic of patients with ankylosing spondylitis. BASMI is a routine clinical evaluation of the spine; its measurements are made with goniometers and tape measures, implying systematic errors, subjectivity, and low sensitivity. Therefore, it is crucial to develop better mobility assessment methods. The design, implementation, and evaluation of a novel system for assessing the entire spine's motion are presented. It consists of 16 magnetic and inertial measurement units (MIMUs) communicated wirelessly with a computer. The system evaluates the patient's movements by implementing a sensor fusion of the triaxial gyroscope, accelerometer, and magnetometer signals using a Kalman filter. Fifteen healthy participants were assessed with the system through six movements involving the entire spine to calculate continuous kinematics and maximum range of motion (RoM). The intrarater reliability was computed over the observed RoM, showing excellent reliability levels (intraclass correlation >0.9) in five of the six movements. The results demonstrate the feasibility of the system for further clinical studies with patients. The system has the potential to improve the BASMI method. To the best of our knowledge, our system involves the highest number of sensors, thus providing more objective information than current similar systems.

Knowledge, Attitudes, Behavior, and Practices of Self-Breast Examination in Jalisco, Mexico.

The importance of self-breast examination to identify early signs of breast cancer has been widely discussed in scientific literature. We conducted a cross-sectional survey of women aged 18 years and over (n = 547) living in urban and rural areas in the State of Jalisco, Mexico. Survey questions included measures on knowledge, attitudes, behaviors, and practices related to self-breast examination. We compared these measures between women living in urban and rural areas and women aged 18-39 years and 40+ years. Using t-test, we tested the significance of these differentials. Our results indicate that there is no significant difference in knowledge, attitudes, behavior, and practices regarding self-breast examination between women living in urban and in rural areas of Jalisco. However, we found some difference in these measures between women in 18-39 years and 40+ years. While the State of Jalisco has taken significant steps toward promoting significance of cancer prevention, further attention to women in the older cohort is recommended.

Factores relacionados con el estrés postraumático en pacientes con alta médica por la COVID-19 / Factors related to post-traumatic stress in patients with medical discharge due to COVID-19

RESUMEN Introducción: La hospitalización a causa de la COVID-19 puede predisponer a la aparición de posibles secuelas psicológicas a largo plazo. Objetivo: Determinar la relación entre los factores hospitalarios y no hospitalarios con el estrés postraumático en pacientes con alta médica por la COVID-19. Métodos: Estudio de corte transversal y diseño correlacional. La muestra no probabilística estuvo compuesta por 126 participantes con la COVID-19, evaluados mediante un cuestionario autoadministrado y la Escala de Trauma de Davidson. Para el procesamiento de datos se aplicó la prueba ji cuadrado y la V de Cramer como medida de magnitud de efecto. Resultados: El trastorno por estrés postraumático presenta asociaciones moderadas con los factores hospitalarios: tiempo de hospitalización (p< 0,001) (V de Cramer= 0,33), tipo clínico de COVID-19 (p< 0,001) (V de Cramer= 0,49) y soporte ventilatorio invasivo (p< 0,001) (V de Cramer= 0,39); y con los factores no hospitalarios: oxigenoterapia en rehabilitación (p< 0,001) (V de Cramer= 0,33), secuelas neurológicas (p< 0,001) (V de Cramer= 0,41), dificultad respiratoria (p< 0,001) (V de Cramer= 0,53), percepción de discriminación social (p< 0,05) (V de Cramer= 0,29), dificultad para reincorporarse a las actividades diarias (p< 0,001) (V de Cramer= 0,40) y familiares infectados con la COVID-19 (p< 0,001) (V de Cramer= 0,30). Conclusiones: Existen factores, tanto intra como extrahospitalarios, que se relacionan con el trastorno por estrés postraumático luego del alta médica por la COVID-19.

ABSTRACT Introduction: Hospitalization due to COVID-19 can predispose to the appearance of possible long-term psychological sequelae. Objective: To determine the relationship between hospital and non-hospital factors with post-traumatic stress in patients discharged for COVID-19 from a hospital in Peru. Methods: Cross-sectional study and correlational design. The non-probabilistic sample consisted of 126 participants, evaluated through a self-administered questionnaire and the Davidson Trauma Scale. For data processing, the chi-square test and Cramer's V were used as measures of the magnitude of effect. Results: Post-traumatic stress disorder presents moderate associations with hospital factors: hospitalization time (p<0.001) (Cramer's V = 0.33), clinical type of COVID-19 (p<0.001) (Cramer's V = 0 .49) and invasive ventilatory support (p<0.001) (Cramer's V = 0.39); and with non-hospital factors: oxygen therapy in rehabilitation (p<0.001) (Cramer's V = 0.33), neurological sequelae (p<0.001) (Cramer's V = 0.41), respiratory distress (p<0.001) (Cramer's V = 0.53), perception of social discrimination (p<0.05) (Cramer's V = 0.29), difficulty returning to daily activities (p<0.001) (Cramer's V = 0.40) and family members infected with COVID-19 (p<0.001) (Cramer's V = 0.30). Conclusions: There are both in-hospital and out-of-hospital factors associated with post-traumatic stress disorder following discharge from COVID-19.

The GacS/A-Rsm Pathway Positively Regulates Motility and Flagella Synthesis in Azotobacter vinelandii.

Azotobacter vinelandii is a motile bacterium that possesses an unusual pattern of peritrichous flagellation for members of the Pseudomonadaceae family. Unlike what has been reported for Pseudomonas spp. FleQ is not the master regulator of motility in A. vinelandii, this role is performed by FlhDC. Other factors involved in the regulation of motility are AlgU (σE) and CydR which act as negative regulators. In some members of the Enterobacteriaceae and Pseudomonadaceae families, the GacS/A-Rsm pathway is another important factor regulating motility. In the present study, the involvement of the GacS/A-Rsm pathway in regulating the motility of A. vinelandii was explored; we found that contrary to what has been reported for most of the strains studied of Pseudomonas species, GacS/A, through the Rsm system, positively controlled swimming motility. We show that the target of this regulation is the synthesis of flagella, which most likely occurs in an FlhDC-independent manner.

[Spatio-temporal trend in detections of diabetes mellitus and systematic arterial hypertension in IMSS users, 2004-2019]. / Tendencia espacio-temporal de detecciones de diabetes mellitus e hipertensión arterial sistémica en usuarios del IMSS, 2004-2019.

Background: Diabetes Mellitus (DM) and heart diseases, which include Systemic Arterial Hypertension (SAH), have been positioned as the two main causes of mortality in Mexico, which represents important challenges for the different health institutions. Objective: To analyze the spatio-temporal trend of DM and SAH based on the detections made in first and and second level units of the Instituto Mexicano del Seguro Social, during the period 2004-2019. Material and methods: Ecological study in which detection rates of both diseases were calculated per 1,000 persons according to year, triennium and representation. The spatiotemporal trend was analyzed by spatial statistics using Geographic Information Systems. Results: During 2004-2019 therere were 9 399 889 and 11 862 069 detections on average of DM and SAH, respectively. Regarding DM, the detection rate ranged from 203.4 (2004) to 384.4 (2019) per 1000 persons, this trend increased in Tamaulipas. While SAH decreased from 1140.2 (2004) to 352 (2019) per 1000 persons in Veracruz Sur and Tamaulipas, respectively. Conclusions: The observed spatio-temporal trend can contribute to organizing and guiding, according to representation and level of care, institutional programs, integrated care protocols, clinical practice guidelines and other public policy instruments available at the Instituto Mexicano del Seguro Social to improve early detection, care, control and access to medications for DM and SAH.

Introducción: la diabetes mellitus (DM) y las enfermedades del corazón, entre las que se incluye la hipertensión arterial sistémica (HTA), se han posicionado entre las primeras causas de mortalidad en México, lo que plantea retos importantes para las diferentes instituciones de salud. Objetivo: analizar la tendencia espacio-temporal de DM e HTA con base en las detecciones realizadas en unidades de primero y segundo nivel del Instituto Mexicano del Seguro Social (IMSS), durante el periodo 2004-2019. Materiales y métodos: estudio ecológico en el que se calcularon las tasas de detección de ambos padecimientos por mil derechohabientes según año, trienio y representación. La tendencia espacio-temporal se analizó mediante estadística espacial utilizando Sistemas de Información Geográfica. Resultados: de 2004 a 2019 hubo 9 399 889 y 11 862 069 detecciones en promedio de DM e HTA, respectivamente. Referente al primer padecimiento, la tasa de deteccion osciló de 203.4 (2004) a 384.4 (2019) por mil derechohabientes, cuya tendencia aumentó en Tamaulipas. Mientras que la HTA disminuyó de 1140.2 (2004) a 352 (2019) detecciones por mil derechohabientes en Veracruz Sur y Tamaulipas, respectivamente. Conclusiones: la tendencia espacio-temporal observada puede contribuir a organizar y orientar, según su representación y nivel de atención, los programas institucionales, protocolos de atención, guías de práctica clínica y demás instrumentos de políticia pública disponibles en el IMSS para mejorar la detección oportuna, atención, control y acceso a medicamentos para DM e HTA.

Preliminary tests of an Inertial Measurement Units based System for Spine mobility assessment in patients with Ankylosing Spondylitis.

This paper presents the preliminary tests of a novel system prototype for the physical assessment of mobility in patients with Ankylosing Spondylitis (AS). The system combines multi-inertial sensors arrays with Kalman Filters-based pose estimation for monitoring spine mobility in patients with AS. This system allows detecting movements with more reliable information than the manual clinical evaluation.

Tendencia espacio-temporal de detecciones de diabetes mellitus e hipertensión arterial sistémica en usuarios del IMSS, 2004-2019 / Spatio-temporal trend in detections of diabetes mellitus and systematic arterial hypertension in IMSS users, 2004-2019

Introducción: la diabetes mellitus (DM) y las enfermedades del corazón, entre las que se incluye la hipertensión arterial sistémica (HTA), se han posicionado entre las primeras causas de mortalidad en México, lo que plantea retos importantes para las diferentes instituciones de salud. Objetivo: analizar la tendencia espacio-temporal de DM e HTA con base en las detecciones realizadas en unidades de primero y segundo nivel del Instituto Mexicano del Seguro Social (IMSS), durante el periodo 2004-2019. Material y métodos: estudio ecológico en el que se calcularon las tasas de detección de ambos padecimientos por mil derechohabientes según año, trienio y representación. La tendencia espacio-temporal se analizó mediante estadística espacial utilizando Sistemas de Información Geográfica. Resultados: de 2004 a 2019 hubo 9 399 889 y 11 862 069 detecciones en promedio de DM e HTA, respectivamente. Referente al primer padecimiento, la tasa de deteccion osciló de 203.4 (2004) a 384.4 (2019) por mil derechohabientes, cuya tendencia aumentó en Tamaulipas. Mientras que la HTA disminuyó de 1140.2 (2004) a 352 (2019) detecciones por mil derechohabientes en Veracruz Sur y Tamaulipas, respectivamente. Conclusiones: la tendencia espacio-temporal observada puede contribuir a organizar y orientar, según su representación y nivel de atención, los programas institucionales, protocolos de atención, guías de práctica clínica y demás instrumentos de políticia pública disponibles en el IMSS para mejorar la detección oportuna, atención, control y acceso a medicamentos para DM e HTA.

Background: Diabetes Mellitus (DM) and heart diseases, which include Systemic Arterial Hypertension (SAH), have been positioned as the two main causes of mortality in Mexico, which represents important challenges for the different health institutions. Objective: To analyze the spatio-temporal trend of DM and SAH based on the detections made in first and and second level units of the Instituto Mexicano del Seguro Social, during the period 2004-2019. Material and methods: Ecological study in which detection rates of both diseases were calculated per 1,000 persons according to year, triennium and representation. The spatio-temporal trend was analyzed by spatial statistics using Geographic Information Systems. Results: During 2004-2019 therere were 9 399 889 and 11 862 069 detections on average of DM and SAH, respectively. Regarding DM, the detection rate ranged from 203.4 (2004) to 384.4 (2019) per 1000 persons, this trend increased in Tamaulipas. While SAH decreased from 1140.2 (2004) to 352 (2019) per 1000 persons in Veracruz Sur and Tamaulipas, respectively. Conclusions: The observed spatio-temporal trend can contribute to organizing and guiding, according to representation and level of care, institutional programs, integrated care protocols, clinical practice guidelines and other public policy instruments available at the Instituto Mexicano del Seguro Social to improve early detection, care, control and access to medications for DM and SAH.

A Local Health Situation Room for COVID-19: Recommendations for Decision-Making From a Higher Education Institution in Mexico.

Introduction: The Situation Room is a physical or virtual space where experts systematically analyze information to characterize a health situation, especially during emergencies. Decision-making processes are made toward solving health needs and promoting collaboration among institutions and social sectors. This paper presents the context and circumstances that led the University of Guadalajara (UdeG) to install a local health situation room (HSR) to address the COVID-19 pandemic at this institution based in the state of Jalisco, Mexico, a narrative is also made of its working processes and some of its results. Methods: The design of this situation room for COVID-19 was based on the methodology established by the Pan American Health Organization (PAHO)/WHO. This local-type situation room was installed on February 12, 2020. The health problem was characterized, and strategic lines, objectives, and goals were established; the first analysis was derived from an action plan deployed at the UdeG. The strategic lines were situational diagnosis, preventive actions, and containment strategies. Results: The situation room influenced the activities of the UdeG before the epidemic cases started in the state. One of the actions with the greatest impact was developing a mathematical model for predicting COVID-19 cases. Subsequently, new models have been developed according to the epidemiological evolution of the disease, helping manage the epidemic in the state. Another important result was the early closing of face-to-face university activities, reducing contagion risks and the mobility of more than 310,000 students, faculty, and administrative personnel throughout Jalisco. Conclusions: A consequence of the closure was that the confinement generated by the pandemic was the change to virtual meetings from April 2020 to date; but at the same time, this working format was a strength, since it influenced the decision of the university board to change all the academic activities to virtual format before other educational, economic, and social activities in the state did. By April 2020, the situation room transcended its institutional boundaries and was invited to participate at the Jalisco State's Health Committee. Its recommendations have helped to maintain the state with one of Mexico's lowest COVID-19 incidence and mortality rates.

A High-Fidelity Hybrid Virtual Reality Simulator of Aneurysm Clipping Repair With Brain Sylvian Fissure Exploration for Vascular Neurosurgery Training.

INTRODUCTION: Microsurgery clipping is one of the most challenging surgical interventions in neurosurgery. The opportunities to train residents are scarce, but the need for accumulating practice is mandatory. New simulating tools are needed for skill learning. METHODS: The design, implementation, and assessment of a new hybrid aneurysm clipping simulator are presented. It consists of an ergonomic workstation with a patient head mannequin and a physics-based virtual reality simulation with bimanual haptic feedback. The simulator recreates scenarios of microsurgery from the patient fixation and the exploration of the brain lobes through Sylvian fissure and vascular structures to the aneurysm clipping. Skill metrics were introduced, including monitoring of gestures movements, exerted forces, tissue displacements, and precision in clipping. RESULTS: Two experimental conditions were tested: (1) simple clipping without brain tissue exploration and (2) clipping the aneurysm with brain Sylvian fissure exploration. Differences in the bimanual gestures were observed between both conditions. The quantitative measurements of tissue displacement of the brain lobes exhibited more tissue retrieval for the surgical gestures of neurosurgeons. Appraisal with questionnaires showed positive scores by neurosurgeons in all items evaluating the usability and realism of the simulator. CONCLUSIONS: The simulator was well accepted and feasible for training purposes. The analysis of the interactions with virtual tissues offers information to establish differential and common patterns between tested groups and thus useful metrics for skill evaluation of practitioners. Future work can lead to other tasks during the intervention and the inclusion of more clinical cases.