Methodology for Virtual Education of Clinical Engineering through the Implementation of Digital Tools for Simulated Scenarios and International Collaboration

The Covid-19 global pandemic has represented a challenge for education, which had to migrate to virtual environments. Universities adopted different teaching methods to keep contributing to the growth of the professionals in various fields. In this context, the Biomedical Engineering program of the Pontificia Universidad Catolica del Peru and the Universidad Peruana Cayetano Heredia had to change or adapt the methodology of the courses included in its curriculum in order to reach the learning objectives. This paper presents a methodology for an innovative approach of simulated scenarios using digital tools for the virtual teaching of Clinical Engineering. The learning results achieved in two semesters of implementation of the methodology, during 2020 and 2021, were measured by means of a survey applied to the students at the end of the course. Obtaining achievement results above 76 % and improvement opportunities that would be useful for the next version of this course and for the replication of the methodology in other universities. © 2023 IEEE.

Digital Financial Culture and Inclusion of Emerging Entrepreneurs in a Zonal Market – Peru

The covid-19 brought great difficulties, making it impossible to have resources to cover the basic needs of the family, so the population has had to look for possible alternatives to cope with the situation, such as creating businesses to cover the basic family basket. However, there is uncertainty as to whether these entrepreneurs understand the financial culture to better manage their businesses and at the same time whether they have the digital financial inclusion in their ventures that will allow them to continue in the market. Therefore, the objective of this study is to determine the relationship between financial culture and digital financial inclusion of emerging entrepreneurs in a market. In this research with a quantitative approach, correlational scope and non-experimental design, a survey was applied to a sample of 108 entrepreneurs in a zonal market. The results showed that the financial culture variable and the digital financial inclusion variable have a significant relationship according to Spearman's Rho test. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

Exploring the pandemic from feminist research: social scientists, covid and university

This research aims to understand the impact of the COVID-19 pandemic on the research processes of women social scientists at the University of Granada from a gender perspectivep. We have also explored strategies that the researchers have developed to continue their studies. Some of these strategies have been conceived as care practices in research. On the other hand, we have collected proposals aimed at improving research practice in times of pandemic. In order to address these objectives, we have implemented a qualitative methodology based on in-depth interviews and feminist epistemological and methodological perspectives. © GKA Ediciones, authors.

Access to hospitalization for patients with severe COVID-19 during the first wave of the pandemic in Caracas, Venezuela

Background. The COVID-19 pandemic has overwhelmed health systems around the world, causing access problems. The patient referral system in Caracas, Venezuela has no interinstitutional coordination, patients are given a note by the referring center and thereafter seeking care relies on themselves. We studied primarily to what extent the Caracas healthcare system satisfied the demand for hospitalization of severe COVID-19 during periods of congestion, measured in proportion of patients not hospitalized;and secondly how difficult it was for patients with severe COVID-19 to meet their need of hospitalization, measured in number of days and visits made to health centers until hospitalization or desisting from further searching. Methods. This study was approved by national bioethics committee. We included all symptomatic patients who attended the University Hospital of Caracas COVID-19 testing center, whose nasopharyngeal swab PCR was positive for SARS-CoV-2, and whose SpO2 was 93% or less between 07/01/2020 and 07/24/2020, the period in which we referred patients due to unavailability of beds in our center. Results. Ninety-four patients were included, 66 (70%) were men, the mean age was 58 years (range, 25-87 years), the median number of comorbidities was 1 (range, 0-3), and the median SpO2 was 90% (range, 30%-93%). Fourty-three (46%) patients were never admitted following referral from our center. Referred patients required a median of 1 day (range, 1-15 days) and 2 visits (range, 1-41 visits) to being admitted, or a median of 2 days (range, 1-17 days) and 5 visits (range, 1-31 visits) to desisting from further searching for admission. Conclusion. These data show that the healthcare system did not meet the hospitalization needs of half of the patientswith severe COVID-19 during the peak of the first wave of the pandemic in Caracas. The data also show that referred patientsfaced a major delay in being hospitalized, and that referred patients had to perform multiple visits to healthcare centers accross the city as a consequence of insufficient system capacity, increasing their urban mobility and therefore their probabilities of transmitting SARS-CoV-2 to others.

Identifying Urban Agriculture Needs and Challenges for the Implementation of Green Labeling in Xochimilco, Mexico

The current global situation with a dominant economic development model producing social inequality, increment and intensification of urbanization has generated severe environmental degradation and an associated increase in the likelihood of pandemics. New strategies that strengthen sustainable food production are urgent in highly unequal countries as Mexico. In Mexico City, the most populated city of the country, a wetland system, named Xochimilco, still holds chinampas, a unique and ingenious food system dating from pre-Hispanic times. These days chinampas are the best example of urban sustainable agriculture production. Unfortunately, this system is under threat due to urbanization and industrial land-use changes. Among the strategies to promote sustainable modes of production and consumption is eco or green labeling, consisting of a voluntary environmental certification approach, and marketing and advertising tool, that can change producers' and consumers' behavior toward long-term sustainability. Although widely used, the benefits of green labels for producers are not always realized. This study aimed to learn more about the agro-ecological production process and commercialization challenges in Xochimilco and San Gregorio Atlapulco in Southern Mexico City to understand chinampa producers' needs and determine whether a green label can offer solutions in this vulnerable socio-ecological system, particularly suffering the effects of the COVID-19 pandemics. For this, a literature review and producers' mental model analysis based on network theory, were developed. Results show that non-resolved issues such as commercialization problems, consumers' unwillingness to pay a fair price, loss of healthy soil, and degraded water quality used for irrigation persist and can affect the benefits of a green label including to improve chinampa production and farmers' income. Farmers' current necessities comprised increasing profits, receiving financial advice to set prices of agro-ecological vegetables and production costs, among others. Under the current production and commercialization scenarios complying with the assessment cost of certification will be difficult for most producers;then, implementing the green label would probably fail to fulfill the benefits. Attending to former and persistent conflicts and satisfying chinampa producers' neglected necessities are essential before implementing any program. Copyright © 2022 Arroyo-Lambaer, Zambrano, Rivas, Vázquez-Mendoza, Figueroa, Puente-Uribe, Espinosa-García, Tapia-Palacios, Mazari-Hiriart, Revollo-Fernández, Jiménez-Serna, Covarrubias and Sumano.

Quality and User Satisfaction of the Telemedicine Service in Cardiology During COVID-19

The objective of this study was to determine the relationship between the quality of telemedicine service in cardiology and user satisfaction during COVID-19 at the Victor Lazarte Echegaray Hospital - Trujillo, Peru, in 2021. The research methodology used is the hypothetical method deductive with a non-experimental quantitative approach and descriptive correlational analysis with cross-sectional design. For this study, a total of n = 96 patients (100%) were surveyed and received care in the telemedicine services in cardiology. Two types of survey instruments were used, the first SERVQHOS is to evaluate the quality of the telemedicine service, and the Second SERVQUAL is for user satisfaction and its dimensions such as reliability, responsiveness, security, empathy, and tangibility. We used the Spearman correlation coefficient to determine the association between telemedicine service quality versus user satisfaction and its dimensions. The results show a significant relationship of p < 0.05 between the two variables and a moderate positive correlation of Rho = 0.525. In addition, most of the patients surveyed (41.7%) during the COVID-19 pandemic indicated that the telemedicine service is regular and safety is acceptable. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The cost of care during times of COVID: Case study of TDABC and minimum utilization cost analysis in a medicare advantage population

The COVID-19 pandemic has obligated us to rethink the use of telemedicine in healthcare. During Covid-19 telemedicine has been essential to maintain patient access and provide continuity of care. Historically, cost calculations in healthcare have not been transparent and accurate enough to project cost-effective strategies. This is particularly relevant when attempting to use value-based costing. The Medicare Advantage Care service model offers great opportunity to evaluate the cost of care for research and financial reasons. Based on a capitated reimbursement model, a TDABC (Time Driven Activity Based Costing) methodology provides an accurate analysis to determine a MUC (Minimum Utilization Cost), contributing to better alignment and projection of an MLR (Medical Loss Ratio) that helps keep the balance between quality of care and financial responsibility.

Awake prone positioning in nonintubated spontaneous breathing ICU patients with acute hypoxemic respiratory failure (PRONELIFE)-protocol for a randomized clinical trial.

BACKGROUND: It is uncertain whether awake prone positioning can prevent intubation for invasive ventilation in spontaneous breathing critically ill patients with acute hypoxemic respiratory failure. Awake prone positioning could benefit these patients for various reasons, including a reduction in direct harm to lung tissue, and prevention of tracheal intubation-related complications. DESIGN AND METHODS: The PRONELIFE study is an investigator-initiated, international, multicenter, randomized clinical trial in patients who may need invasive ventilation because of acute hypoxemic respiratory failure. Consecutive patients admitted to participating ICUs are randomly assigned to standard care with awake prone positioning, versus standard care without awake prone positioning. The primary endpoint is a composite of tracheal intubation and all-cause mortality in the first 14 days after enrolment. Secondary endpoints include time to tracheal intubation and effects of awake prone positioning on oxygenation parameters, dyspnea sensation, and complications. Other endpoints are the number of days free from ventilation and alive at 28 days, total duration of use of noninvasive respiratory support, total duration of invasive ventilation, length of stay in ICU and hospital, and mortality in ICU and hospital, and at 28, 60, and 90 days. We will also collect data regarding the tolerance of prone positioning. DISCUSSION: The PRONELIFE study is among the first randomized clinical trials investigating the effect of awake prone positioning on intubation rate in ICU patients with acute hypoxemic failure from any cause. The PRONELIFE study is sufficiently sized to determine the effect of awake prone positioning on intubation for invasive ventilation-patients are eligible in case of acute hypoxemic respiratory failure without restrictions regarding etiology. The PRONELIFE study is a pragmatic trial in which blinding is impossible-however, as around 35 ICUs worldwide will participate in this study, its findings will be highly generalizable. The findings of the PRONELIFE study have the potential to change clinical management of patients who may need invasive ventilation because of acute hypoxemic respiratory failure. TRIAL REGISTRATION: ISRCTN ISRCTN11536318 . Registered on 17 September 2021. The PRONELIFE study is registered at clinicaltrials.gov with reference number NCT04142736 (October, 2019).

Effect of a health education program on students in the Peruvian highlands during COVID-19

Introduction: To reduce childhood obesity, advertising warnings, based on octagons, and programs to strengthen and promote physical activity have been developed. Objective: To determine the association of the healthy lifestyle of elementary school students, the use of nutritional octagons and educational programs in the Peruvian highlands. Methodology: Analytical cross-sectional study, based on a virtual survey of primary school children in a region of the Peruvian highlands. Results: Of the 5041 schoolchildren surveyed, the majority can clearly recognize octagons in food, enjoy the physical activities of the educational program "Aprendo en casa" and recognize that products with octagons are harmful. Living in Huancayo was associated with liking the physical activities of the "Aprendo en casa" program more (p<0.001), clearly recognizing nutritional octagons (p<0.001), a higher frequency of reviewing octagons (p<0.001) and their influence prior to consumption (p<0.001). Women (p=0.034) and those in higher grades (p<0.001) did less physical activity with their family members. Students in higher grades had more consumption of candy (p=0.004), salty snacks (p=0.013) and fatty food (0.029). Women (p=0.007) and those living in Huancayo (p<0.001) consumed more yogurt, while women consumed less carbonated beverages (p=0.028). Conclusion: Significant frequencies and associations were found with the use of nutritional markers, the "I learn at home" program and consumption of unhealthy foods, which should be useful for intervention programs and another research. © 2021 Sociedad espanola de dietetica. All rights reserved.

Febrile crisis as initial manifestation of COVID-19

Introduction: COVID-19 is a disease that has shown low morbidity and mortality in pediatrics. Febrile crises are one of the most common causes of admission to emergency services and consultations with the neuropediatrician. Objective: Interpret the presence of simple febrile crisis in patients admitted to pediatric emergency services as an initial manifestation of COVID-19. Case presentation: One-year-old female patient, with a previous health history, who is attended in the emergency service with a fever of 38 ℃ and motor crisis, of widespread onset, with tonic-clonic seizures, which yielded with antypiretic measures. By protocol, lumbar puncture is performed which is negative. She was admitted, and 24 hours later there is an onset of catarrhal manifestations;an otoscopy is performed and acute otitis media is diagnosed, so antibiotic treatment is initiated. The polymerase chain reaction test for COVID-19 (PCR) is performed with a positive result, so, the patient is referred to the "San Miguel del Padrón" Pediatric Hospital. Conclusions: COVID-19 should be suspected in patients who attend to the emergency services due to a febrile crisis as the only health problem. COVID-19 is a disease that has been shown to occur in a variety of ways. © 2021, Editorial Ciencias Medicas. All rights reserved.

Implementation of telemedicine in rheumatology: Virtual consultation as a tool for direct communication with primary care

Background: Virtual consultation is defined as the provision of a healthcare service when there is a distance between the subjects and information and communication technologies are used to carry out the consultation. This tool has been successfully implemented in different specialties. It is useful for providing quick solutions, improving the overload of the medical care and for the early detection of inflammatory diseases1. In our centre, virtual consultation from Primary Care (PC) to Hospital Care (HC) has been implemented. Objectives: The main objective is to describe our experience with the use of virtual consultation and its value as a new modality of specialised medical care. The second aim is to identify the most frequent reasons for consultation and diagnoses, to assess the concordance between the two and to analyse the trend over time of the number of virtual consultations and their relationship with the different waves of the COVID 19 pandemic. Methods: Retrospective observational study. The virtual consultations made from PC (47 centres) to Rheumatology during 2020 were analysed. They were carried out through a computer programme, using the “Andalusian Health Service Virtual Consultation Platform” tool. A specific agenda was established for virtual consultations. The reason for the referral and the rheumatologist's diagnosis were collected. The response given to the PC was divided into four models: NON-TRIBUTARY (not related to the speciality), DISCHARGE (a diagnosis and therapeutic response is concluded), APPOINTMENT FOR CONSULTATION and FOLLOW-UP (new contact is requested, completing the information). The reasons for consultation, diagnoses, time and type of response were analysed. Results: 47 virtual consultations were carried out. 54.5% (n 298) were closed as DISCHARGE. 27.4% (n 150) were APPOINTMENT FOR CONSULTATION, and 17.7% (n 97) indicated FOLLOW-UP. Only 0.4% (n 2) were NOT TRIBUTARY. The average response time was 2 days 15 hours and 56 min. The most frequent reason for consultation was polyarthralgias (26.7%, n 146) and after the rheumatologist's assessment a diagnosis was established in 89% of them. Inflammatory arthropathy accounted for 30.8% (n 45), osteoarthritis for 19.9% (n 29), fibromyalgia for 12.3% (n 18), polymyalgia rheumatica (PMR) for 6.9% (n 10), osteoporosis for 2.7% (n 4) and connective tissue disease for 2.1% (n 3). Another frequent reason for consultation was osteoporosis (13.5% n 74), of which 85.1% (n 63) had a confirmed diagnosis and/or need for revision. A diagnosis could be made via telematics in 89.6% of the consultations. 15.5% were osteoporosis (n 85), 14.9% osteoarthritis (n 81), 10.5% soft tissue injuries, 8.8% mechanical/ nonspecific pain (n 47), 7.1% rheumatoid arthritis (n 39), 6.5% fibromyalgia (n 34), 6.2% connective tissue disease (n 34), 5.7% PMR (n 31), 4.9% suspected spondyloarthritis (n 26), 4.2% psoriatic arthritis (n 23) and 4.2% microcrystalline arthritis (n 23). 27.4% (n 150) of the virtual consultations were required for assessment in a face-to-face appointment. We analysed the distribution over time (Figure 1). In the COVID 19 confinement phase (14 March -21 June), the number of consultations increased, peaking in June, a behaviour that has persisted in the other mobility phases (October/November). Conclusion: More than half of the virtual consultations carried out were resolved without face-to-face assessment, with a diagnosis being established in almost 90%. It is an effective tool for rapid access to Rheumatology, detecting pathology requiring preferential attention, with a face-to-face appointment, as well as for the early diagnosis of inflammatory arthropathy, which was detected in a quarter of the consultations, as well as for the diagnosis and follow-up of osteoporosis. Virtual consultation facilitates a quick response, playing an even more relevant role in the current SARS CoV-2 pandemic situation. (Figure Presented).

Post-COVID seizure: A new feature of "long-COVID"

Novel coronavirus SARS-CoV-2 has created unprecedented healthcare challenges. Neurologic deficits are often an important presenting symptom. To date, the only reported post-infectious COVID-19 manifestations of neurologic disease include cognitive deficits and dysfunction of the peripheral nervous system. Here we report that seizure can also be a post-COVID-19 or "long-COVID" complication. We present a 71-year-old man with hypertension, diabetes mellitus, and COVID-19 diagnosed by RT-PCR who initially presented with posterior circulation stroke-like symptoms, which completely resolved after emergent thrombolysis. Six days later, the patient returned with seizure activity, supported by radiographic and electroencephalographic studies. Notably, he was negative for SARS-CoV-2, and no other provoking factor was uncovered after a comprehensive work-up. To our knowledge, this is the first report of post-infectious seizures after a case of COVID-19, highlighting the potential importance of monitoring for neurologic symptoms in COVID-19 patients, even after convalescence.

ANXIETY AS A PREVAILING FACTOR OF PERFORMANCE OF UNIVERSITY MATHEMATICS STUDENTS DURING THE COVID-19 PANDEMIC

Introduction. Anxiety is characterised by feelings of tension, apprehension or fear. It arises from concern about student performance at university, with an emphasis on exact science subjects. It is not only students, who suffer from mathematical anxiety. However, anxiety is a predominant factor in student performance at all levels. Aim. The aim of the research was to describe the levels of anxiety also known as distress manifested by university mathematics students studying at the Universidad Nacional de Chimborazo (UNACH) during the 2020-1 academic semester. Methodology and research methods. The current study was carried out applying the quantitative paradigm. It is of a descriptive exploratory design. The total sample consisted of 120 students, who are preparing at their university level, and, who are studying the subject of mathematics at different levels and careers at UNACH. The selection of the sample was of an intentional non-probabilistic type and having as inclusion criteria not having been diagnosed with an anxiety disorder. As a measurement instrument, the Short Inventory of Anxiety Situations and Responses-ISRA-B was applied. ISRA-B was sent to students by email to facilitate data collection. Results. The results were analysed by means of the two-factor ANOVA calculation (mathematics and understanding). The results showed that there are statistically significant differences in the understanding of the contents presented by the teachers in a virtual way. During the COVID-19 pandemic the levels of mathematical anxiety increased. Teaching mathematics at university in online format requires the assessment of digital connection and time limited submission of assignments. These factors limit understanding and generate mathematical anxiety. Scientific novelty. In face-to-face education, mathematical anxiety is common. But because of the pandemic, mathematics education has had to migrate to the virtual environment. The present research reflects the impact of anxiety not only on mathematics education and academic performance but also on the emotions of students. The data collection instruments ISRA-B-C, ISRA-B-F and ISRA-B-M are innovative and adaptable to all levels of education. Practical significance. The importance of mathematics and the overestimation of its difficulties cause great concern for the learning of this subject in studies at a higher university level. The current studies of virtual mathematical anxiety are important because they allow the detection and analysis of possible educational failures in online learning. The failures of online education have a direct impact not only on performance and learning, but on an emotional state of students.

Severity of Chest Imaging is Correlated with Risk of Acute Neuroimaging Findings among Patients with COVID-19.

BACKGROUND AND PURPOSE: Severe respiratory distress in patients with COVID-19 has been associated with higher rate of neurologic manifestations. Our aim was to investigate whether the severity of chest imaging findings among patients with coronavirus disease 2019 (COVID-19) correlates with the risk of acute neuroimaging findings. MATERIALS AND METHODS: This retrospective study included all patients with COVID-19 who received care at our hospital between March 3, 2020, and May 6, 2020, and underwent chest imaging within 10 days of neuroimaging. Chest radiographs were assessed using a previously validated automated neural network algorithm for COVID-19 (Pulmonary X-ray Severity score). Chest CTs were graded using a Chest CT Severity scoring system based on involvement of each lobe. Associations between chest imaging severity scores and acute neuroimaging findings were assessed using multivariable logistic regression. RESULTS: Twenty-four of 93 patients (26%) included in the study had positive acute neuroimaging findings, including intracranial hemorrhage (n = 7), infarction (n = 7), leukoencephalopathy (n = 6), or a combination of findings (n = 4). The average length of hospitalization, prevalence of intensive care unit admission, and proportion of patients requiring intubation were significantly greater in patients with acute neuroimaging findings than in patients without them (P < .05 for all). Compared with patients without acute neuroimaging findings, patients with acute neuroimaging findings had significantly higher mean Pulmonary X-ray Severity scores (5.0 [SD, 2.9] versus 9.2 [SD, 3.4], P < .001) and mean Chest CT Severity scores (9.0 [SD, 5.1] versus 12.1 [SD, 5.0], P = .041). The pulmonary x-ray severity score was a significant predictor of acute neuroimaging findings in patients with COVID-19. CONCLUSIONS: Patients with COVID-19 and acute neuroimaging findings had more severe findings on chest imaging on both radiographs and CT compared with patients with COVID-19 without acute neuroimaging findings. The severity of findings on chest radiography was a strong predictor of acute neuroimaging findings in patients with COVID-19.

Linear Sintonization of Two Cascade Vectorial Controllers from the Numerical Prediction of a Mechanical Ventilator System

With the increasing number of COVID-19 cases, the demand of ventilators has increased to such an extent that there is not enough supply of equipment available. For this reason, this research is based on an open source project presented by the Massachusetts Institute of Technology which involves the conditioning of an Artificial Manual Breathing Unit (AMBU bag), that acts as an aid for patients to maintain a constant respiratory cycle. This document presents the calculation of the control matrix for the mechatronic and bio pneumatic systems of the ventilator by implementing a Space-State Model that allows to obtain the control gains that may reduce the error concerning the open loop operation of the ventilator;furthermore, this paper also presents the SIMULINK simulations that demonstrate the efficiency of the calculated control matrixes. Due to these graphic demonstrations, it was observed that the implemented controllers provided an increase in the response time and reduced the error, thus, theoretically, both controllers must provide stability and a higher performance to the ventilator prompting an appropriate assistance to the hospitalized victims of the COVID-19;however, currently, this project is not viable, as it has not been tested in real life and it does not meet the quality and medical requirements for its use in emergencies. © 2020 IEEE.