Experiential-sensorial adaptive system model for hospitality based on 360° VR videos and case-based reasoning.

In this work, an adaptive software architecture is proposed for the generation of experiences for hotel promotion and marketing, based on Case-based Reasoning (CBR) that uses the attributes and user characteristics and immersive 360° videos. Considering that immersion in virtual reality (VR) environments can trigger responses in various dimensions, such as affective, cognitive, attitudinal, and behavioral dimensions, these dimensions are evaluated in immersive environments with 360° videos. To validate the results obtained with the software architecture, a quasi-experimental study was conducted through the evaluation of the experience, consisting in the visualization of the environments of a boutique hotel, with a sample of a randomly selected group of young people. The contribution of this work lies in the use of 360° VR videos, for the visualization of the hotel characteristics and environments according the user profiles, to evaluate the affective, cognitive and attitudinal and behavioral responses and their influence on the booking intention and attitude. Finally, conclusions and recommendations for future work have been established.

Coronary Flow Reserve and Myocardial Resistance Reserve Changes After Transcatheter Aortic Valve Implantation in Aortic Stenosis.

Aortic valve stenosis (AS) induces an alteration in hemodynamic conditions that are responsible for coronary microvasculature impairment. Relief of AS by transcatheter aortic valve implantation (TAVI) is expected to improve the coronary artery hemodynamic. We aimed to assess the midterm effects of TAVI in coronary flow reserve (CFR) and myocardial resistance reserve (MRR) by a continuous intracoronary thermodilution technique. At-rest and hyperemic coronary flow was measured by a continuous thermodilution technique in 23 patients with AS and compared with that in 17 matched controls, and repeated 6 ± 3 months after TAVI in 11 of the patients with AS. In patients with AS, absolute coronary flow at rest was significantly greater, and absolute resistance at rest was significantly less, than in controls (p <0.01 for both), causing less CFR and MRR (1.73 ± 0.4 vs 2.85 ± 1.1, p <0.01 and 1.95 ± 0.4 vs 3.22 ± 1.4, p <0.01, respectively). TAVI implantation yielded a significant 35% increase in CFR (p >0.01) and a 39% increase in MRR (p <0.01) driven by absolute coronary flow at rest reduction (p = 0.03). In patients with AS, CFR and MRR determined by continuous thermodilution are significantly impaired. At 6-month follow-up, TAVI improves these indexes and partially relieves the pathophysiologic alterations, leading to a partial restoration of CFR and MRR.

Development of an accurate and rapid method for whole genome characterization of canine parvovirus.

Canine parvovirus is a highly contagious pathogen affecting domestic dogs and other carnivores globally. Monitoring CPV through continuous genomic surveillance is crucial for mapping variability and developing effective control measures. Here, we developed a method using multiplex-PCR-next-generation sequencing to obtain full-length CPV genomes directly from clinical samples. This approach utilizes tiling and tailed amplicons to amplify overlapping fragments of roughly 250 base pairs. This enables the creation of Illumina libraries by conducting two PCR reaction runs. We tested the assay in 10 fecal samples from dogs diagnosed with CPV and one CPV-2 vaccine strain. Furthermore, we applied it to a feline sample previously diagnosed with the feline panleukopenia virus. The assay provided 100 % genome coverage and high sequencing depth across all 12 samples. It successfully provided the sequence of the coding regions and the left and right non-translated regions, including tandem and terminal repeats. The assay effectively amplified viral variants from divergent evolutionary groups, including the antigenic variants (2a, 2b, and 2c) and the ancestral CPV-2 strain included in vaccine formulations. Moreover, it successfully amplified the entire genome of the feline panleukopenia virus found in cat feces. This method is cost-effective, time-efficient, and does not require lab expertise in Illumina library preparation. The multiplex-PCR-next-generation methodology facilitates large-scale genomic sequencing, expanding the limited number of complete genomes currently available in databases and enabling real-time genomic surveillance. Furthermore, the method helps identify and track emerging CPV viral variants, facilitating molecular epidemiology and control. Adopting this approach can enhance our understanding of the evolution and genetic diversity of Protoparvovirus carnivoran1.

Outcomes of rapid deployment aortic valve replacement with concomitant cardiac procedures.

Background: Rapid deployment aortic valve replacement (RD-AVR) has been recently introduced with encouraging results. Outcomes of isolated RD-AVR include good hemodynamic profile, facilitation of minimally invasive techniques, and reduction of surgical times. However, role of this prosthesis in concomitant surgery is not well known. Methods: In 2016, we formed a registry to monitor the introduction of this prosthesis, RApid Deployment Aortic Replacement (RADAR). We aim to report mid-term outcomes focusing on patients who had RD-AVR combined with other surgical procedures. Results: Between July 2012 and February 2021, 370 patients were included in this registry (mean age, 75.8±8.0 years; 64.32% male; mean EuroSCORE II, 3.5±2.8). Of these, 128 (34.59%) had concomitant procedures including myocardial revascularization surgery in 69 patients (53.91%), surgery on the ascending aorta in 34 (26.56%), and procedures on other valves in 10 patients (7.81%). There were no significant differences between the isolated AVR and concomitant AVR groups in postoperative complications, in-hospital mortality (4.72% vs. 3.32%, P=0.524), or hemodynamic behavior of these prostheses. Three-year survival was 83.73% and 89.89% in the isolated and concomitant AVR group respectively. There was no difference in survival between the two groups (log-rank test, P=0.4124). Conclusions: Our results support the safety and efficacy of the Edwards INTUITY valve system even in complex aortic valve disease with additional cardiac procedures. RD-AVR could become a useful tool for concomitant surgeries where surgical times are expected to be prolonged.

Transcatheter aortic valve implantation in patients with extra-small aortic annuli.

BACKGROUND: A small aortic annulus (SAA) is a risk factor for prosthesis-patient mismatch (PPM) in patients undergoing surgical or transcatheter aortic valve implantation (TAVI). Data regarding TAVI in patients with extra-SAA are scarce. AIMS: The aim of this study was to analyse the safety and efficacy of TAVI in patients with extra-SAA. METHODS: A multicentre registry study including patients with extra-SAA (defined as an aortic annulus area <280 mm2 and/or perimeter <60 mm) undergoing TAVI was established. Primary efficacy and safety endpoints were defined as device success and early safety at 30 days, respectively, using the Valve Academic Research Consortium-3 criteria, and were analysed according to valve type: self-expanding (SEV) versus balloon-expandable (BEV). RESULTS: A total of 150 patients were included, of which 139 (92.7%) were women, and 110 (73.3%) received an SEV. Intraprocedural technical success was 91.3%, with a higher rate in patients receiving an SEV (96.4% vs 77.5% with BEV; p=0.001). Overall, 30-day device success was 81.3%, (85.5% with SEV vs 70.0% with BEV; p=0.032). The primary safety endpoint occurred in 72.0% of patients (with no difference between groups; p=0.118). Severe PPM occurred in 12% (9.0% with SEV and 24.0% with BEV; p=0.039), with no impact on all-cause mortality, cardiovascular mortality, or heart failure readmission at 2-year follow-up. CONCLUSIONS: TAVI is a safe and feasible treatment in patients with extra-SAA with a high rate of technical success. The use of SEV was associated with a lower rate of intraprocedural complications, higher device success at 30 days and better haemodynamic outcomes compared to BEV.

Significados de la humanización en cuidado crítico. Vivencias y acciones de profesionales sanitarios en Unidades de Cuidado Intensivo en Bogotá y Cartagena (Colombia) / Significats de la humanització en cura crítica. Vivències i accions de professionals sanitaris a Unitats de Cura Intensiva a Bogotà i Cartagena (Colòmbia) / Meanings of humanization in critical care. Experiences and actions of health professionals in Intensive Care Units in Bogota and Cartagena (Colombia)

La humanización en la prestación de servicios de salud es un imperativo ético, incluso para las Unidades de Cuidado Intensivo (UCI), donde brindar atención integral centrada en pacientes y familiares, y no en lo tecnológico, es un reto. Se presenta un estudio cualitativo que utilizó entrevistas semiestructuradas en línea, observación participante y diario de campo. Participaron 10 trabajadores de UCI privadas y 10 en UCI públicas: 6 fisioterapeutas, 5 médicos, 4 sanitarios de enfermería y 5 enfermeras. Para analizar la información se realizó codificación, categorización y hermenéutica de ideas. Se descubrieron dos posturas frente a la humanización: como obligación (deontología) o como acto respeto (profesionalismo). Se comprende y practica la humanización como: 1) buen trato y cordialidad al realizar intervenciones; 2) ponerse en el lugar del paciente reconociendo que tiene familia; 3) cuidados que garantizan confort al paciente mediante acciones sobre el cuerpo;4) cumplir con objetivos terapéuticos evitando sufrimiento o daño; 5) reconocer la dignidad del paciente; 6) atención a la vulnerabilidad del paciente, especialmente oncológico. Existen barreras para la humanización: la pandemia, los insumos de la UCI, las normas institucionales rígidas, entre otras. En conclusión, los significados otorgados a la humanización en cuidado crítico están mediadas por prácticas con énfasis en aspectos biológicos e ideas relacionadas con el respeto por la dignidad humana (intimidad), el buen trato y evitar sufrimiento al paciente. La pandemia generó crisis en la atención humanizada expresada, entre otras, en ausencia de apoyo psicosocial al personal que trabaja en UCI.(AU)

La humanització en la prestació de serveis de salut és un imperatiu ètic, fins i tot per a les Unitats de Cura Intensiva (UCI), on brindar atenció integral centrada en pacients i familiars, i no en l’aspecte tecnològic, és un repte. Es presenta un estudi qualitatiu que va utilitzar entrevistes semi-estructurades en línia, observació participant i diari de camp. Van participar 10 treballadors d'UCI privades i 10 en UCI públiques: 6 fisioterapeutes, 5 metges, 4 sanitaris d'infermeria i 5 infermeres. Per a analitzar la informació es va realitzar codificació, categorització i hermenèutica d'idees. Es van descobrir dues postures enfront de la humanització: com a obligació (deontologia)o com a acte respecto (professionalisme). Es comprèn i practica la humanització com: 1) bon tracte i cordialitat en realitzar intervencions; 2) posar-se en el lloc del pacient reconeixent que té família; 3) cures que garanteixen confort al pacient mitjançant accions sobre el cos; 4) complir amb objectius terapèutics evitant sofriment o mal; 5) reconèixer la dignitat del pacient; 6) atenció a la vulnerabilitat del pacient, especialment oncològic. Existeixen barreres per a la humanització: la pandèmia, els inputs de l'UCI, les normes institucionals rígides, entre altres. En conclusió, els significats atorgats a la humanització en cura crítica estan mediades per pràctiques amb èmfasis en aspectes biològics i idees relacionades amb el respecte per la dignitat humana (intimitat), el bon tracte i evitar sofriment al pacient. La pandèmia va generar crisi en l'atenció humanitzada expressada, entre altres, en absència de suport psicosocial al personal que treballa en UCI.(AU)

Humanization in the provision of health services is an ethical imperative; even for Intensive Care Units (ICU), where achieving comprehensive care focused on patients and families and not on technology is a challenge. A qualitative study is presented that used semi-structured online interviews, participant observation, and field diary. 10 private ICU workers and 10 public ICU workers participated: 6 physiotherapists, 5 doctors, 4 nursing assistants and 5 nurses. To analyse the information, ideas were codified, categorized and hermeneutics performed. Two positions were found regarding humanization, as an obligation (deontology) or as an act of respect (professionalism). Humanization is understood and practiced as: 1) good treatment and cordiality when carrying out interventions; 2) put yourself in the patient's shoes, recognizing that you have a family; 3) care that guarantees comfort to the patient through actions on the body; 4) meet therapeutic objectives avoiding suffering or harm; 5) recognize the dignity of the patient; 6) attention to the vulnerability of the patient, especially cancer. There are barriers to humanization: the pandemic, ICU supplies, rigid institutional regulations, and others. In conclusions the meanings given to humanization in critical care are mediated by practices with an emphasis on biological aspects and ideas related to respect for human dignity (privacy), good treatment and avoiding suffering to the patient. The pandemic generated a crisis for humanized care, expressed, among others, in the absence of psychosocial support for personnel working in the ICU.(AU)

Valproate-associated hyperammonemic encephalopathy in subarachnoid hemorrhage: a diagnosis to consider. / Encefalopatia hiperamonêmica associada ao valproato na hemorragia subaracnóidea: um diagnóstico a considerar.

OBJECTIVE: Subarachnoid hemorrhage is a prevalent disease with high morbidity and mortality. Numerous complications contribute to brain injury and defy the clinical practitioner on diagnosis and management. Valproate-associated hyperammonemic encephalopathy is a rare, underdiagnosed, serious and important entity to consider. We present a case of a patient with subarachnoid hemorrhage who received anticonvulsant prophylaxis with valproate and developed neuroworsening associated with high levels of ammoniemia and periodic discharge electroencephalographic patterns without other identifiable causes. Discontinuing valproic acid treatment and normalization of ammoniemia resulted in improvement in clinical and electroencephalographic neurological status.

OBJETIVO: A hemorragia subaracnóidea é uma doença prevalente com alta morbidade e mortalidade. Inúmeras complicações contribuem para a lesão cerebral e desafiam o médico no diagnóstico e tratamento. A encefalopatia hiperamonêmica associada ao valproato é uma entidade rara, subdiagnosticada, grave e importante a ser considerada. Apresentamos o caso de um paciente com hemorragia subaracnóidea que recebeu profilaxia anticonvulsivante com valproato e evoluiu com piora neurológica associada a níveis plasmáticos elevados de amônia e descargas periódicas no eletroencefalograma, sem outras causas identificáveis. A interrupção do tratamento com ácido valproico e a normalização dos níveis plasmáticos de amônia resultaram em melhora do quadro neurológico e eletroencefalográfico.

Encefalopatia hiperamonêmica associada ao valproato na hemorragia subaracnóidea: um diagnóstico a considerar / Valproate-associated hyperammonemic encephalopathy in subarachnoid hemorrhage: a diagnosis to consider

RESUMO Objetivo: A hemorragia subaracnóidea é uma doença prevalente com alta morbidade e mortalidade. Inúmeras complicações contribuem para a lesão cerebral e desafiam o médico no diagnóstico e tratamento. A encefalopatia hiperamonêmica associada ao valproato é uma entidade rara, subdiagnosticada, grave e importante a ser considerada. Apresentamos o caso de um paciente com hemorragia subaracnóidea que recebeu profilaxia anticonvulsivante com valproato e evoluiu com piora neurológica associada a níveis plasmáticos elevados de amônia e descargas periódicas no eletroencefalograma, sem outras causas identificáveis. A interrupção do tratamento com ácido valproico e a normalização dos níveis plasmáticos de amônia resultaram em melhora do quadro neurológico e eletroencefalográfico.

ABSTRACT Objective: Subarachnoid hemorrhage is a prevalent disease with high morbidity and mortality. Numerous complications contribute to brain injury and defy the clinical practitioner on diagnosis and management. Valproate-associated hyperammonemic encephalopathy is a rare, underdiagnosed, serious and important entity to consider. We present a case of a patient with subarachnoid hemorrhage who received anticonvulsant prophylaxis with valproate and developed neuroworsening associated with high levels of ammoniemia and periodic discharge electroencephalographic patterns without other identifiable causes. Discontinuing valproic acid treatment and normalization of ammoniemia resulted in improvement in clinical and electroencephalographic neurological status.

Principios bioéticos y virtudes éticas en la toma de decisiones fisioterapéuticas en una unidad de cuidado intensivo (UCI) de Bogotá

Objetivo: analizar los principios bioéticos y las virtudes éticas en la toma de decisiones de fisioterapeutas de una unidad de cuidado intensivo (UCI) en Bogotá. Metodología: estudio cualitativo en el que participaron fisioterapeutas especialistas en cuidado crítico, trabajadores de una UCI en Bogotá. Herramientas de recolección de información: observación participante, diario de campo y entrevista semiestructurada. Se realizó análisis categorial de tipo hermenéutico. Resultados: las principales discusiones bioéticas en la UCI remiten a los principios de autonomía, beneficencia, no maleficencia y justicia, tangencialmente a los principios de dignidad humana y derechos humanos, igualdad, justicia y equidad, y respeto de la vulnerabilidad humana y la integridad personal. Algunas virtudes expresadas fueron benevolencia, compasión, cuidado y prudencia. Conclusiones: de acuerdo con los participantes, los principios de respeto por la autonomía, beneficencia, no maleficencia y justicia son herramientas para analizar, reflexionar y solucionar conflictos que día a día ocurren en las UCI; la virtud de la prudencia es la más difícil de cultivar, especialmente por el contexto de gravedad del paciente en la UCI o al informar sobre su estado a familiares. En la UCI se debe fomentar la discusión sobre principios bioéticos basados en derechos humanos y en virtudes éticas del personal asistencial, en aras de prácticas humanizadas y de calidad.

Objective: to analyze the bioethical principles and ethical virtues in the decision-making of physiotherapists in an intensive care unit (ICU) in Bogotá. Methodology: a qualitative study with the participation of physiotherapists specialized in critical care and workers of an ICU in Bogota. Data collection tools: participant observation, field diary, and semi-structured interview. A hermeneutic categorical analysis was performed. Results: the main bioethical discussions in the ICU refer to the principles of autonomy, beneficence, non-maleficence, and justice, tangentially to the principles of human dignity and human rights, equality, justice and equity, and respect for human vulnerability and personal integrity. Some virtues expressed were benevolence, compassion, care, and prudence. Conclusions: according to the participants, the principles of respect for autonomy, beneficence, non-maleficence, and justice are tools for analyzing, reflecting, and solving conflicts that occur on a daily basis in the ICU; the virtue of prudence is the most difficult to cultivate, especially in the context of the seriousness of the patient in the ICU or when informing relatives about his condition. In the ICU, discussion of bioethical principles based on human rights and ethical virtues should be encouraged in the ICU, for the sake of humanized and quality practices.

Objetivo: analisar os princípios bioéticos e as virtudes éticas na tomada de decisões de fisioterapeutas de unidades de terapia intensiva (UTI) em Bogotá, Colômbia. Metodologia: estudo qualitativo do qual participaram fisioterapeutas especializados em cuidado crítico, trabalhadores de uma UTI em Bogotá. Ferramentas de coleta de informações foram observação participante, diário de campo e entrevista semiestruturada. Foi realizada análise categorial de tipo hermenêutico. Resultados: as principais discussões bioéticas na UTI remetem aos princípios de autonomia, beneficência, não maleficência e justiça, de forma tangencial aos princípios de dignidade humana e direitos humanos, igualdade, justiça e equidade, e respeito à vulnerabilidade humana e à integridade pessoal. Algumas virtudes expressas foram benevolência, compaixão, cuidado e prudência. Conclusões: de acordo com os participantes, os princípios de respeito pela autonomia, pela beneficência, pela não maleficência e pela justiça são ferramentas para analisar, refletir e solucionar conflitos que dia a dia ocorrem nas UTIs; a virtude da prudência é a mais difícil de cultivar, especialmente pelo contexto de gravidade do paciente na UTI ou ao informar sobre seu estado a familiares. Na UTI, deve ser fomentada a discussão sobre princípios bioéticos baseados em direitos humanos e em virtudes éticas do pessoal assistencial, em termos de práticas humanizadas e de qualidade.

Reconstrucción secuencial de ruptura bilateral del ligamento cruzado anterior. Reporte de un caso / Sequential reconstruction of bilateral anterior cruciate ligament rupture. Case report

Cuando se presentan pacientes con ruptura bilateral del ligamento cruzado anterior y requieren cirugía reconstructiva, se puede optar por procedimientos de reconstrucción unilateral a la vez. Este tipo de abordaje terapéutico ha sido descripto en la literatura, sin embargo, existe muy poca evidencia acerca de la reconstrucción simultánea o secuencial de ambas rodillas en el mismo acto quirúrgico. En este trabajo se presenta un caso de reconstrucción secuencial en el mismo acto quirúrgico, con un solo tiempo anestésico, realizado por un solo equipo quirúrgico en un paciente con ruptura bilateral de ligamento cruzado anterior. Además, se desarrolla una actualización del tema y se compara este procedimiento con aquellos efectuados en dos actos quirúrgicos, desde el punto de vista económico, clínico y funcional, el plan de fisioterapia adoptado y los resultados a mediano plazo mediante la escala de Lysholm. Tipo de Estudio: Reporte de caso y actualización. Nivel de Evidencia: IV

When we face a patient with bilateral anterior cruciate ligament rupture and requires a ligament reconstruction, we can suggest a unilateral reconstruction procedure. This type of surgical management has been described in the literature; however, very scant evidence is published about simultaneous or sequential ACL reconstruction at one stage procedure.This paper presents a case report of a sequential ACL reconstruction made in a one-stage surgical procedure for the same surgical team in a patient with bilateral ACL rupture. A revision of the literature is made, a comparison with those made in two separate procedures is also reported, from a clinical, functional, and economic view, the rehabilitation program and the medium-term outcome by the score of Lysholm. Type of study: Case report and literature review. Level of Evidence: IV

Can the setup of a patch modulate finder's advantage?

According to the Rate Maximization Model the finder's advantage is an environmental factor modulating social foraging strategies. One factor that can influence the finder's advantage is the patches' setup. We analyzed the strategies of Wistar rats foraging in groups n = 4 in a 4 × 3 array of deposits where only four of them were baited (patches) with different configurations on each trial. Specifically, the goal was to assess whether the finder's advantage varied according to the distribution (Square vs. Zig-zag) and distance (Small vs. Large) between patches. Foraging responses were classified as production (seeking for food) or scrounging (tracking conspecifics) to calculate the frequency of use of each strategy in each group and estimate the induced finder's advantage in each situation. In patch-setups with short distances, production was more common and the finder's advantage higher. Results can be explained by the combined effect of a local enhancing and simultaneous patch exploitation on small setups.

Biological characteristics of a sub-population of cancer stem cells from two triple-negative breast tumour cell lines.

Triple-negative breast tumours (TNBTs) make up 15-20% of all breast tumours. There is no treatment for them, and the role that cancer stem cells (CSCs) have in carcinogenesis is still unclear, so finding markers and therapeutic targets in CSC exosomes requires these cells to exist as a homogeneous cell population. The objective of this work was to determine differences in ultrastructural morphology, proliferative capacity, and mouse-xenotransplantation characteristics of the MDA-MB-231 and MDA-MB-436 TNBT cell lines with the CD44 high /CD24 low phenotype in order to study their exosomes. The results show that the CD44 high /CD24 low MBA-MB-231 cells had a population doubling time of 41.56 h, compared to 44.79 h in the MDA-MB-436 cell line. After magnetic immunoseparation, 18.75% and 14.56% of the stem cell population of the MDA-MB-231 and MDA-MB-436 cell lines, respectively, were of the CD44 high /CD24 low phenotype, which were expanded to reach purities of 80.4% and 87.6%. The same expanded lineage in both cell lines was shown to possess the pluripotency markers Nanog and Oct4. Under a scanning electron microscope, the CD44 high /CD24 low lineage of the MBA-MD-231 cell line formed groups of more interconnected cells than this lineage of the MBA-MD-436 line. A total of 16% of the mice inoculated with the CD44 high /CD24 low lineage of either cell line presented tumours of the breast, lung, and submandibular ganglia, in whose tissues variable numbers of inoculated cells were found 30 days post-inoculation. By magnetic immunoselection, it was possible to isolate in similar quantities and characterize, expand, and xenotransplant the CD44 high /CD24 low lineage of the MDA-MB-231 and MDA-MB-436 cell lines. The former cell line has greater proliferative capacity, the two lines differ under scanning electron microscopy in how they intercommunicate, and both cell lines induce new tumours in mice and persist at least 30 days post-inoculation in the transplanted animal so their exosomes would also be different.

Environmental and anthropogenic factors synergistically affect space use of jaguars.

Large terrestrial carnivores have undergone some of the largest population declines and range reductions of any species, which is of concern as they can have large effects on ecosystem dynamics and function.1-4 The jaguar (Panthera onca) is the apex predator throughout the majority of the Neotropics; however, its distribution has been reduced by >50% and it survives in increasingly isolated populations.5 Consequently, the range-wide management of the jaguar depends upon maintaining core populations connected through multi-national, transboundary cooperation, which requires understanding the movement ecology and space use of jaguars throughout their range.6-8 Using GPS telemetry data for 111 jaguars from 13 ecoregions within the four biomes that constitute the majority of jaguar habitat, we examined the landscape-level environmental and anthropogenic factors related to jaguar home range size and movement parameters. Home range size decreased with increasing net productivity and forest cover and increased with increasing road density. Speed decreased with increasing forest cover with no sexual differences, while males had more directional movements, but tortuosity in movements was not related to any landscape factors. We demonstrated a synergistic relationship between landscape-scale environmental and anthropogenic factors and jaguars' spatial needs, which has applications to the conservation strategy for the species throughout the Neotropics. Using large-scale collaboration, we overcame limitations from small sample sizes typical in large carnivore research to provide a mechanism to evaluate habitat quality for jaguars and an inferential modeling framework adaptable to the conservation of other large terrestrial carnivores.

Effect of group size on producer-scrounger strategies of Wistar rats.

In a collective foraging situation, we assessed the distribution of search responses of Wistar rats relative to the size of the group. For both, small and large groups, the number of production opportunities per capita was equal. Foraging strategies were classified as either production (opening gates with food) or scrounging (following conspecifics). Small groups showed a higher proportion of producers than large groups and required less time to deplete the food. The proportion of producing and scrounging responses yields to equilibrium between their payoffs. Producing and scrounging were highly correlated with different prior responses. Also, the relative frequency of producing and scrounging associated activities correlated with the time spent consuming food procured by each activity. It is possible that a simple outcome-strategy feedback mechanism mediates the choice of prior activities and procurement responses.

Ruptura inveterada del tendón patelar. Reconstrucción con tendones semitendinoso y recto interno / Neglected rupture of patellar tendon. Reconstruction with semitendinosus and gracilis tendon autografts

Introducción: La ruptura inveterada del tendón patelar es una patología poco común y significa un reto para su resolución quirúrgica. El ascenso de la patela, la fibrosis en el lugar de la ruptura y la imposibilidad de afrontar los extremos del tendón hacen que su reparación primaria sea imposible, teniendo que recurrir a su reconstrucción con injerto. En este trabajo se describe la reconstrucción del tendón patelar con la utilización de injerto autólogo de semitendinoso - recto interno, técnica quirúrgica basada en los trabajos de Ecker y col.1 y Van der Zwaal y col.,2 con algunas modificaciones.Materiales y métodos: se intervinieron ocho pacientes, todos de sexo masculino, con una edad promedio de treinta y ocho años (22-50). El lapso entre la ruptura y el procedimiento quirúrgico fue en promedio de sesenta días (87­40). El tiempo de seguimiento postoperatorio fue en promedio de once meses (7­18). Resultados: todos lograron extensión completa de la rodilla y una flexión activa promedio de 130° (125-140°). El resultado fue excelente en seis de ellos y bueno en dos pacientes. El score postoperatorio de Lysholm fue de 92 (90-96). En la evaluación radiográfica presentaron un índice de Insall Salvati promedio de 1.16 (1.1­1.3). Estos dos últimos resultados fueron estadísticamente significativos (p <0.005) comparados con el preoperatorio.Conclusión: la ruptura inveterada del tendón patelar es una patología poco frecuente, cuya resolución quirúrgica es un reto para el cirujano ortopedista, la técnica descripta en este trabajo ofrece seguridad en su reconstrucción, y ofrece una recuperación íntegra del aparato extensor. Tipo de estudio: Serie de casos, retrospectivo. Nivel de evidencia: IV

Introduction: Neglected rupture of the patellar tendon is a rare pathology and is a challenge for its surgical resolution. The migration of the patela, fibrosis at the site of rupture and the impossibility of facing the ends of the tendon make its first repair impossible having to resort to its reconstruction with graft. This work describes the reconstruction of the patellar tendon semitendinosus and gracilis autograft, surgical technique based on the work of Ecker and col.1 and Van der Zwaal and col.2 with some modifications.Materials and methods: eight patients, all male, were involved with an average age of thirty-eight years (22-50). Whose time lapse between the rupture and the surgical procedure was on average sixty days (87­40). The postoperative follow-up was on average eleven months (7­18).Results: all achieved full knee extension and an average active flexion of 130° (125-140°). The result was excellent in six of them and good in two patients. Lysholm's post-operative score was 92 (90-96). In the radiographic evaluation they had an average Insall Salvati index of 1.16 (1.1 ­ 1.3). These last two results were statistically significant (p <0.005) compared to preoperative.Conclusions: the neglected rupture of the patellar tendon is a rare pathology, whose surgical resolution is a challenge for the orthopedic surgeon, the technique described in this work offers safety in the reconstruction of this ligament and offers a complete recovery of the extensor mechanism. Type of study: Case series, retrospective. Level of Evidence: IV

Dentiseñas-Colombia, prototipo de una App para facilitar la comunicación Odontólogo- Persona con Discapacidad Auditiva* / Dentiseñas-Colombia, mock-up for App to facilitate communication between Dentist and Hearing-Impaired Person / Dentiseñas-Colômbia, protótipo de um aplicativo para facilitar a comunicação entre Dentista e Pessoa com Deficiência Auditiva

Resumen Introducción y objetivo: En Colombia existen barreras de acceso a la consulta odontológica relacionadas con el no reconocimiento de las Personas con Discapacidad Auditiva como sujetos con otra modalidad comunicativa; por tanto, se propuso diseñar el prototipo de una App en Lengua de Señas Colombiana para facilitar la comunicación entre Odontólogo y Personas con Discapacidad Auditiva en la consulta de primera vez, el consentimiento informado y la fase de prevención y promoción en salud oral. Materiales y métodos: Estudio con dos componentes: uno cualitativo, donde se realizaron entrevistas semiestructuradas a 23 participantes e identificaron las frases facilitadoras para la comunicación Odontólogo-Personas con Discapacidad Auditiva. Y otro tecnológico que propone el diseño del prototipo de la App, el cual junto a sus videos fue valorado por los participantes. Resultados: Se presenta el sustento teórico relacionado con la App para favorecer la comunicación asertiva entre Odontólogo y Personas con Discapacidad Auditiva a partir de 6 categorías: empatía, proceso de comunicación, herramientas de comunicación, ética del cuidado, interculturalidad y barreras de acceso. Se muestra el prototipo de la App con 20 frases en LSC y subtituladas para identificar la usabilidad de esta. Conclusión: El prototipo de la App diseñado facilita la interacción entre Odontólogo y Personas con Discapacidad Auditiva, mejora la experiencia odontológica durante los proceso de atención e incentiva la inclusión de las Personas con Discapacidad Auditiva en la toma de decisiones.

Abstract Introduction and objective: In Colombia there are healthcare-related barriers to access to dental consultation related to the non-recognition of Hearing-Impaired Person as a subject with another communicative modality; therefore, it was proposed to design the mock-up for an App in Colombian Sign Language to facilitate communication between the Dentist and Hearing-Impaired Person in the first-time consultation, informed consent and the phase of prevention and oral health promotion. Materials and methods: Study with two components: a qualitative one, where semi-structured interviews were carried out with 23 participants and identified the phrases facilitating communication between Dentist and Hearing-Impaired Person. And another technological one that proposes the design of the prototype of the App, which along with its videos was valued by the participants. Results: Is presented the theoretical support related to the App, to promote assertive communication between Dentist and Hearing-Impaired Person, based on 6 categories: empathy, communication process, communication tools, ethics of care, interculturality and healthcare-related barriers. The mock-up for the App is shown with 20 phrases in LSC and subtitled to identify its usability. Conclusion: The mock-up of the App designed facilitates the interaction between Dentist and Hearing-Impaired Person, improves the dental experience during the attention process and encourages the inclusion of Hearing-Impaired Person in decision-making.

Resumo Introdução e objetivo: Na Colômbia existem barreiras no acesso à consulta odontológica relacionadas ao não reconhecimento de as Pessoas com Deficiência Auditiva como sujeito de outra modalidade comunicativa; portanto, foi proposto desenhar o protótipo de um aplicativo em Línguas de Sinais Colombiana para facilitar a comunicação assertiva entre o Dentista e as Pessoa com Deficiência Auditiva na primeira consulta, consentimento informado e a fase de prevenção e promoção em saúde bucal. Materiais e métodos: Estudo com dois componentes: um qualitativo, onde foram realizadas entrevistas semiestruturadas com 23 participantes e identificadas as frases que facilitam a comunicação entre Dentista e Pessoa com Deficiência Auditiva. E outra tecnológica que propõe o design do protótipo do aplicativo, que, juntamente com seus vídeos, foi valorizado pelos participantes. Resultados: É apresentado o suporte teórico relacionado ao aplicativo para promover a comunicação assertiva entre dentistas e pessoas com deficiência auditiva, com base em 6 categorias: empatia, processo de comunicação, ferramentas de comunicação, ética do cuidado, interculturalidade e barreiras de acesso. É mostrado o protótipo do aplicativo com 20 frases no LSC e legendado para identificar sua usabilidade. Conclusão: O protótipo do aplicativo projetado facilita a interação entre Dentista e Pessoa com Deficiência Auditiva, melhora a experiência odontológica durante o processo de atendimento e incentiva a inclusão de Pessoa com Deficiência Auditiva na tomada de decisão.

Autonomía profesional del odontólogo en instituciones prestadoras de servicios de salud públicas y privadas de Bogotá en el marco del sistema de salud colombiano / Professional Autonomy of Dentists in Public and Private Healthcare Providing Institutions (IPS) in Bogotá in the Framework of the Colombian Health System / Autonomia profissional do dentista em instituições prestadoras de serviços públicos e privados de saúde, em Bogotá, no âmbito do sistema de saúde colombiano

Resumen: Objetivo: Identificar la influencia del sistema de salud colombiano sobre la autonomía profesional de odontólogos que ejercen en IPS públicas y privadas de Bogotá. Metodología: Estudio cualitativo comprensivo, llevado a cabo con herramientas etnográficas como la entrevista semiestructurada. Las categorías de análisis fueron: autonomía profesional, modelos de atención, toma de decisiones y sistema contractual. La información se analizó de manera categorial, contextual y de contenido. Resultados: Se evidenció que la autonomía profesional está limitada por el tiempo de atención para los pacientes (veinte minutos). Otra limitante es la restricción en la realización de procedimientos y, en ocasiones, los protocolos de atención. Por estas limitaciones, el odontólogo pierde habilidades y conocimientos adquiridos en la academia, sus habilidades y la seguridad en sí mismo. Discusión: El sistema de salud colombiano limita la autonomía profesional de los odontólogos que ejercen en IPS públicas y privadas. La autonomía profesional, relacionada con la toma de decisiones, es un eje importante del ejercicio asistencial. Ejercer la autonomía profesional permite lograr razonamientos ético-clínicos, desarrollar destrezas y promover el bienestar de los pacientes, es decir, el compromiso bioético (beneficencia, no maleficencia y justicia), y el respeto.

Abstract: Objective: To identify the influence of the Colombian health system on the professional autonomy of dentists who practice in public and private IPS (healthcare providing institutions) in Bogotá. Methodology: Comprehensive qualitative study, carried out with ethnographic tools such as the semi-structured interview. The analysis categories were: professional autonomy, health care models, decision making and contract system. The information was analyzed according to its category, context and content. Results: It was found that professional autonomy is limited due to the time given per patient (twenty minutes). Another limitation is the restriction to carry out procedures and, sometimes, the care protocols. Due to these limitations, dentists lose the skills and knowledge acquired in the academia, their abilities and self-confidence. Discussion: The Colombian health system limits the professional autonomy of dentists who work in public and private IPS. Professional autonomy, related to decision making, is an important axis in the healthcare practice. Exercising professional autonomy allows achieving ethical-clinical reasonings, developing skills and promoting the patients' well-being, that is, the bioethical commitment (beneficence, non-maleficence and justice), and respect.

Resumo: Objetivo: Identificar a influência do sistema de saúde colombiano na autonomia profissional dos dentistas que atuam nas instituições prestadoras de serviços de saúde (IPS) públicas e privadas, em Bogotá. Metodologia: Estudo qualitativo compreensivo, realizado com ferramentas etnográficas, como a entrevista semiestruturada. As categorias de análise foram: autonomia profissional, modelos de atenção, tomada de decisão e sistema contratual. As informações foram analisadas de forma categórica, contextual e de conteúdo. Resultados: Evidenciou-se que a autonomia profissional é limitada pelo tempo de atendimento aos pacientes (vinte minutos). Outra limitação é a restrição na execução de procedimentos e, às vezes, nos protocolos de atenção. Devido a essas limitações, o dentista perde as habilidades e os conhecimentos acadêmicos que foram adquiridos, além de suas próprias habilidades e sua autoconfiança. Discussão: O sistema de saúde colombiano limita a autonomia profissional dos dentistas que atuam nas IPS públicas e privadas. A autonomia profissional, relacionada à tomada de decisão, é um importante eixo de atenção à saúde. O exercício da autonomia profissional nos permite alcançar o raciocínio ético-clínico, desenvolver habilidades e promover o bem-estar dos pacientes, ou seja, o compromisso bioético (beneficência, não maleficência e justiça) e o respeito.