Síndrome cardiorrenal tipo 4 en paciente revascularizado percutáneamente

Introducción: el síndrome cardiorrenal es una patología dada por la disfunción en la interdependencia de estos órganos por interacciones bidireccionales (agudas o crónicas), los cuales pueden afectar indistintamente la función renal o ventricular. Objetivo: presentar y justificar la enfermedad renal crónica como desencadenante de cuadros congestivos por falla cardiaca de novo. Presentación del caso: se reporta el caso de un paciente masculino de 69 años revascularizado percutáneamente hace tres años con múltiples comorbilidades que ingresa en el contexto de una falla cardiaca de novo, secundaria a su enfermedad renal crónica estadio V de base, en manejo con hemodiálisis y en quien se descartó enfermedad coronaria aguda y miocardiopatía infiltrativa. Se logró estabilizar la injuria renal y cardiaca dando egreso y continuando manejo ambulatorio de sus patologías, al llevar un control adecuado de las mismas con Nefrología y Cardiología. Discusión y conclusión: la enfermedad cardiovascular generada por antecedentes renales tiene una gran repercusión en la función ventricular izquierda, causando hipertrofia, lo que lleva a una congestión con posterior sobrecarga debido a la caída del filtrado glomerular y que resulta en la disminución de la fracción de eyección. La enfermedad renal crónica predispone a alteraciones en la función cardiaca, lo que aumenta el riesgo cardiovascular.

Background: Cardiorenal syndrome is a pathology caused by dysfunction in the interdependence of these organs due to bidirectional interactions (acute or chronic), which can affect either renal or ventricular function. Purpose: To present and justify chronic kidney disease as a trigger of congestive conditions due to de novo heart failure. Case presentation: We report the case of a 69-year-old male patient percutaneously revascularized 3 years ago with multiple comorbidities who was admitted in the context of de novo heart failure secondary to his stage V chronic kidney disease on hemodialysis, in whom acute coronary artery disease and infiltrative cardiomyopathy were ruled out. The renal and cardiac injury was stabilized and the patient was discharged and continued outpatient management of his pathologies with adequate control of the same with nephrology and cardiology. Discussion and conclusion: Cardiovascular disease generated by renal history has great repercussion in left ventricular function causing hypertrophy that leads to congestion with subsequent overload due to the fall of glomerular filtration resulting in a decrease of the ejection fraction. Chronic kidney disease predisposes to alterations in cardiac function increasing cardiovascular risk.

Alterations in Circulating Monocytes Predict COVID-19 Severity and Include Chromatin Modifications Still Detectable Six Months after Recovery.

An early analysis of circulating monocytes may be critical for predicting COVID-19 course and its sequelae. In 131 untreated, acute COVID-19 patients at emergency room arrival, monocytes showed decreased surface molecule expression, including low HLA-DR, in association with an inflammatory cytokine status and limited anti-SARS-CoV-2-specific T cell response. Most of these alterations had normalized in post-COVID-19 patients 6 months after discharge. Acute COVID-19 monocytes transcriptome showed upregulation of anti-inflammatory tissue repair genes such as BCL6, AREG and IL-10 and increased accessibility of chromatin. Some of these transcriptomic and epigenetic features still remained in post-COVID-19 monocytes. Importantly, a poorer expression of surface molecules and low IRF1 gene transcription in circulating monocytes at admission defined a COVID-19 patient group with impaired SARS-CoV-2-specific T cell response and increased risk of requiring intensive care or dying. An early analysis of monocytes may be useful for COVID-19 patient stratification and for designing innate immunity-focused therapies.

In situ Grazing Incidence Small Angle X-ray Scattering on Roll-To-Roll Coating of Organic Solar Cells with Laboratory X-ray Instrumentation.

We present an in-house, in situ Grazing Incidence Small Angle X-ray Scattering (GISAXS) experiment, developed to probe the drying kinetics of roll-to-roll slot-die coating of the active layer in organic photovoltaics (OPVs), during deposition. For this demonstration, the focus is on the combination of P3HT:O-IDTBR and P3HT:EH-IDTBR, which have different drying kinetics and device performance, despite their chemical structure only varying slightly by the sidechain of the small molecule acceptor. This article provides a step-by-step guide to perform an in situ GISAXS experiment and demonstrates how to analyze and interpret the results. Usually, performing this type of in situ X-ray experiments to investigate the drying kinetics of the active layer in OPVs relies on access to synchrotrons. However, by using and further developing the method described in this paper, it is possible to perform experiments with a coarse temporal and spatial resolution, on a day-to-day basis to gain fundamental insight in the morphology of drying inks.

Energy band alignment at the heterointerface between CdS and Ag-alloyed CZTS.

Energy band alignment at the heterointerface between CdS and kesterite Cu2ZnSnS4 (CZTS) and its alloys plays a crucial role in determining the efficiency of the solar cells. Whereas Ag alloying of CZTS has been shown to reduce anti-site defects in the bulk and thus rise the efficiency, the electronic properties at the interface with the CdS buffer layer have not been extensively investigated. In this work, we present a detailed study on the band alignment between n-CdS and p-CZTS upon Ag alloying by depth-profiling ultraviolet photoelectron spectroscopy (UPS) and X-ray photoelectron spectroscopy (XPS). Our findings indicate that core-level peaks and the valence band edge of CdS exhibit a significant shift to a lower energy (larger than 0.4 eV) upon the etching of the CdS layer, which can be assigned due to band bending and chemical shift induced by a change in the chemical composition across the interface. Using a simplified model based on charge depletion layer conservation, a significantly larger total charge region depletion width was determined in Ag-alloyed CZTS as compared to its undoped counterpart. Our findings reveal a cliff-like band alignment at both CdS/CZTS and CdS/Ag-CZTS heterointerfaces. However, the conduction-band offset decreases by more than 0.1 eV upon Ag alloying of CZTS. The approach demonstrated here enables nanometer-scale depth profiling of the electronic structure of the p-n junction and can be universally applied to study entirely new platforms of oxide/chalcogenide heterostructures for next-generation optoelectronic devices.

Persistent Double-Layer Formation in Kesterite Solar Cells: A Critical Review.

In kesterite Cu2ZnSn(S,Se)4 (CZTSSe) solar cell research, an asymmetric crystallization profile is often obtained after annealing, resulting in a bilayered - or double-layered - CZTSSe absorber. So far, only segregated pieces of research exist to characterize the appearance of this double layer, its formation dynamics, and its effect on the performances of devices. In this work, we review the existing research on double-layered kesterites and evaluate the different mechanisms proposed. Using a cosputtering-based approach, we show that the two layers can differ significantly in morphology, composition, and optoelectronic properties and complement the results with a large statistical data set of over 850 individual CZTS solar cells. By reducing the absorber thickness from above 1000 to 300 nm, we show that the double-layer segregation is alleviated. In turn, we see a progressive improvement in the device performance for lower thickness, which alone would be inconsistent with the well-known case of ultrathin CIGS solar cells. We therefore attribute the improvements to the reduced double-layer occurrence and find that the double layer limits the efficiency of our devices to below 7%. By comparing the results with CZTS grown on monocrystalline Si substrates, without a native Na supply, we show that the alkali metal supply does not determine the double-layer formation but merely reduces the threshold for its occurrence. Instead, we propose that the main formation mechanism is the early migration of Cu to the surface during annealing and formation of Cu2-xS phases in a self-regulating process akin to the Kirkendall effect. Finally, we comment on the generality of the mechanism proposed by comparing our results to other synthesis routes, including our own in-house results from solution processing and pulsed laser deposition of sulfide- and oxide-based targets. We find that although the double-layer occurrence largely depends on the kesterite synthesis route, the common factors determining the double-layer occurrence appear to be the presence of metallic Cu and/or a chalcogen deficiency in the precursor matrix. We suggest that understanding the limitations imposed by the double-layer dynamics could prove useful to pave the way for breaking the 13% efficiency barrier for this technology.

Transition-Metal Oxides for Kesterite Solar Cells Developed on Transparent Substrates.

Fabrication on transparent soda-lime glass/fluorine-doped tin oxide (FTO) substrates opens the way to advanced applications for kesterite solar cells such as semitransparent, bifacial, and tandem devices, which are key to the future of the PV market. However, the complex behavior of the p-kesterite/n-FTO back-interface potentially limits the power conversion efficiency of such devices. Overcoming this issue requires careful interface engineering. This work empirically explores the use of transition-metal oxides (TMOs) and Mo-based nanolayers to improve the back-interface of Cu2ZnSnSe4, Cu2ZnSnS4, and Cu2ZnSn(S,Se)4 solar cells fabricated on transparent glass/FTO substrates. Although the use of TMOs alone is found to be highly detrimental to the devices inducing complex current-blocking behaviors, the use of Mo:Na nanolayers and their combination with n-type TMOs TiO2 and V2O5 are shown to be a very promising strategy to improve the limited performance of kesterite devices fabricated on transparent substrates. The optoelectronic, morphological, structural, and in-depth compositional characterization performed on the devices suggests that the improvements observed are related to a combination of shunt insulation and recombination reduction. This way, record efficiencies of 6.1, 6.2, and 7.9% are obtained for Cu2ZnSnSe4, Cu2ZnSnS4, and Cu2ZnSn(S,Se)4 devices, respectively, giving proof of the potential of TMOs for the development of kesterite solar cells on transparent substrates.

COVID-19: A pandemic in the era of digital health / COVID-19: Una pandemia en la era de la salud digital / COVID-19: Uma pandemica na era da saúde digital

Coronavirus disease 2019 (COVID-19) has been declared a pandemic due to its rapid spread, generating a high number of deaths worldwide. This phenomenon takes place in a context of digital health, which uses emerging information technologies. In this article, we describe how these tools have been used to confront COVID-19, providing benefits at several levels, including clinical (such as best clinical record of cases, remote care or diagnostic assistance using artificial intelligence), epidemiological (systems geographic information), academic (e-learning) and personal level (use of mobile applications or search for information through social networks). Reviewing the use of these tools around the world allow us to replicate best practices in order to improve the management of COVID-19 by governments.

La enfermedad por coronavirus 2019 (COVID-19) ha sido declarada como una pandemia por su rápida propagación, generando una elevada cantidad de muertes en todo el mundo. Este fenómeno se desarrolla en un contexto de salud digital, la cual utiliza las tecnologías de la información emergentes. En este artículo buscamos describir cómo han sido utilizadas estas herramientas para hacer frente al COVID-19, las cuales brindan beneficios a nivel clínico (como el mejor registro clínico de los casos, la atención remota o asistencia diagnóstica mediante inteligencia artificial), epidemiológico (sistemas de información geográfica), académico (e-aprendizaje) y personal (uso de aplicaciones móviles o búsqueda de información mediante redes sociales). Revisar el uso de estas herramientas en el mundo podría permitirnos replicar las mejores prácticas con el fin de mejorar el manejo del COVID-19 por parte de los gobiernos.

A doença de coronavírus 2019 (COVID-19) foi declarada uma pandemia devido à sua rápida disseminação, gerando um alto número de mortes em todo o mundo. Esse fenômeno ocorre em um contexto de saúde digital, que utiliza tecnologias de informação emergentes. Neste artigo, procuramos descrever como essas ferramentas foram usadas para lidar com o COVID-19, que fornecem benefícios em nível clínico (como o melhor registro clínico de casos, cuidados remotos ou assistência diagnóstica usando inteligência artificial), epidemiológicos (sistemas informações geográficas), acadêmicas (e-learning) e pessoais (uso de aplicativos móveis ou busca de informações através de redes sociais). A revisão do uso dessas ferramentas em todo o mundo pode nos permitir replicar as melhores práticas para melhorar o gerenciamento do COVID-19 pelos governos.

DAQUA-MASS: An ISO 8000-61 Based Data Quality Management Methodology for Sensor Data.

The Internet-of-Things (IoT) introduces several technical and managerial challenges when it comes to the use of data generated and exchanged by and between various Smart, Connected Products (SCPs) that are part of an IoT system (i.e., physical, intelligent devices with sensors and actuators). Added to the volume and the heterogeneous exchange and consumption of data, it is paramount to assure that data quality levels are maintained in every step of the data chain/lifecycle. Otherwise, the system may fail to meet its expected function. While Data Quality (DQ) is a mature field, existing solutions are highly heterogeneous. Therefore, we propose that companies, developers and vendors should align their data quality management mechanisms and artefacts with well-known best practices and standards, as for example, those provided by ISO 8000-61. This standard enables a process-approach to data quality management, overcoming the difficulties of isolated data quality activities. This paper introduces DAQUA-MASS, a methodology based on ISO 8000-61 for data quality management in sensor networks. The methodology consists of four steps according to the Plan-Do-Check-Act cycle by Deming.

Diaphanous 1 (DIAPH1) is Highly Expressed in the Aged Human Medial Temporal Cortex and Upregulated in Myeloid Cells During Alzheimer's Disease.

BACKGROUND: The receptor for advanced glycation end products (RAGE) is linked to cellular stress and inflammation during Alzheimer's disease (AD). RAGE signals through Diaphanous-1 (DIAPH1); however, the expression of DIAPH1 in the healthy and AD human brain has yet to be methodically addressed. OBJECTIVE: To delineate the cell- and disease-state specific expression of DIAPH1 in the human medial temporal cortex during healthy aging and AD. METHODS: We used semi-quantitative immunohistochemistry in the human medial temporal cortex paired with widefield and confocal microscopy and automated analyses to determine colocalization and relative expression of DIAPH1 with key cell markers and molecules in the brains of subjects with AD versus age-matched controls. RESULTS: We report robust colocalization of DIAPH1 with myeloid cells and increased expression during AD, which strongly correlated to increased neutral lipids and morphology of inflamed myeloid cells. DIAPH1 moderately colocalized with markers of endothelial cells, astrocytes, neurons, and oligodendrocytes. DISCUSSION: Our findings localize DIAPH1 particularly to myeloid cells in the CNS, especially in AD in the locations of lipid droplet accumulation, thereby implicating RAGE-DIAPH1 signaling in dysregulated lipid metabolism and morphological changes of inflamed myeloid cells in this disorder.

Correction: Lifestyle factors and oncogenic papillomavirus infection in a high-risk male population.

[This corrects the article DOI: 10.1371/journal.pone.0184492.].

Lifestyle factors and oncogenic papillomavirus infection in a high-risk male population.

BACKGROUND: High risk human papillomavirus (HR-HPV) infection in males is a health issue with implications for HPV-related lesions in their partners. The identification of risk factors for male infection may improve our understanding of HR-HPV transmission and prevention. The aim of this study was to evaluate the relationships between lifestyle, genital warts and HR-HPV infection. The study was focused on men with an increased risk of HR-HPV infection: male sexual partners of women diagnosed with high-grade squamous intraepithelial cervical lesions. METHODS: Men were enrolled and prospectively recruited within the first six months after diagnosis of cervical lesions in their female partners (n = 175, 2013-2016). Epidemiological and sexual behaviour data were obtained. The presence of genital warts was established by visual inspection. Detection and genotyping of HR-HPV infection in genital samples were performed with a Linear Array HPV Genotyping Test. All HR-HPV positive men were offered a follow-up exam at 12 months. SPSS version 19 was used for statistical analysis. RESULTS AND DISCUSSION: The prevalence of HR-HPV infection in men was 45.1% (79/175). Genital warts were observed in 10.3% (18/175) of the subjects. Detection of genital warts (OR 3.5, p = 0.015), smoking habits (OR 2.3, p = 0.006) and sexual debut before 16 years old (OR 2, p = 0.035) were associated with an increased risk for HR-HPV infection (univariate analysis). This association was also observed for genital warts and smoking status in a multivariate analysis. The same genotype was found after one year in 71.4% (20/28) of subjects. CONCLUSIONS: The presence of genital warts and smoking habits seem to be associated with a higher risk of HR-HPV infection in males. Earlier sexual debut may increase this risk. Extensive knowledge of the natural history of HR-HPV infection in males is an absolute requirement for the design and implementation of prevention strategies for the general population as well as for specific populations such as couples after treatment for high-grade cervical lesions.

Evaluación de la competencia en cuidados paliativos en estudiantes de medicina / Evaluation of palliative care competency in medical students

Introducción. Por los cambios sociodemográficos de la población, los cuidados paliativos son una herramienta indispensable en el profesional de la salud. La simulación clínica permite reproducir situaciones reales, siendo una herramienta útil para la integración de los dominios que componen la competencia en cuidados paliativos. El objetivo es evaluar la atención al paciente en situación terminal a través de la simulación clínica. Sujetos y métodos. Estudio descriptivo con médicos internos de pregrado (sexto año) de la Facultad de Medicina de la Universidad Autónoma de Yucatan. Se evaluaron tres dominios de la competencia en cuidados paliativos mediante escenarios de simulación y una lista de verificación con un alfa de Cronbach de 0,928 y un CCI de 0,562. Resultados. Siete estudiantes (5,11%) mostraron competencia para la atención en cuidados paliativos, cumpliendo el 100% de los indicadores de la lista de verificación. Por otro lado, 47 participantes (34,3%) mostraron desarrollo de la competencia con un desempeño ≥ 80% de los indicadores. Sin embargo, 83 estudiantes (60%) obtuvieron < 80% de los indicadores, por lo que mostraron deficiencia en la competencia. El dominio con mayor desempeño fue ‘dar malas noticias’ (≥ 80% de cumplimiento de los indicadores), y el menor, ‘manejar el contagio emocional’ (< 80%). Conclusiones. La evaluación por medio de simulación de la competencia en cuidados paliativos permite integrar en un mismo escenario los elementos de la competencia, favoreciendo el análisis y la retroalimentación del estudiante de medicina, por lo que se recomienda su empleo en procesos de evaluación (AU)

Introduction. Due to sociodemographic changes in the population, palliative care is an indispensable tool to the health professionals. The clinical simulation reproduces real situations, allowing to integrate the areas or domains that compose the competency in palliative care. The objective is to evaluate the care of the patient in a terminal situation through clinical simulation. Subjects and methods. Descriptive study with undergraduate medical interns (sixth year) of the School of Medicine of the Universidad of Yucatan. Three domains of the competency in palliative care were evaluated with a checklist with a Cronbach’s alpha of 0.928 and a CCI of 0.562. Results. Seven students (5.11%) showed competency for the attention in palliative care with a 100% of the items of the checklist, otherwise, 47 participants (34.3%) showed developing competency in palliative care with a performance greater or equal to 80% of the items, thus, 83 students (60%) obtain less than 80% of the items, showing deficiency in the competency. The domain with best performance was ‘breaking bad news’, with all elements above 80%, and the worst performance was ‘managing emotional contagion’, with no-item above 80%. Conclusions. Evaluation through clinical simulation of the competency in palliative care allows to integrate in one scenario the elements of the competency, facilitating the analysis and the medical student’s feedback, for its use is strongly recommended during the evaluation process (AU)

Prevalence and concordance of high-risk papillomavirus infection in male sexual partners of women diagnosed with high grade cervical lesions / Prevalencia y concordancia de infección por papilomavirus de alto riesgo en las parejas sexuales masculinas de mujeres diagnosticadas de lesiones cervicales de alto grado

BACKGROUND: Little is known about the characteristics of high-risk papillomavirus (HR-HPV) infection in men. The aims of this cross-sectional study were: (a) to investigate HR-HPV prevalence and genotype distribution in men, sexual partners of women presenting with high-grade cervical intraepithelial neoplasia (HG-CIN), according to epidemiological characteristics, and (b) to assess type-specific concordance between partners. METHODS: A total of 125 men were recruited within the first 6 months after HG-CIN diagnosis of their partner. Samples from the coronal sulcus, glans penis shaft, and scrotum were tested with linear array HPV genotyping assay (Roche Diagnostics, Mannheim, Germany). Type-specific concordance within 120 couples was studied. Epidemiological factors were evaluated by multivariate logistic regression analysis. SPSS 19 (IBM, Chicago, USA). RESULTS: The prevalence of HR-HPV infection in males was 50.4% (63/125). HPV16/53/52/51/66/31 were the most frequent genotypes (24/10.4/9.6/8.8/8/7.2%, respectively). Current smoking was associated with an increased risk for HR-HPV infection in men (38.2% (21/55) vs 60% (42/70), OR 2.4, p = 0.025). Among 60 infected couples, 62% shared at least one genotype: 41.7% couples were concordantly HPV16 positive and 18.3% were HPV16 negative (kappa value: 0.21). The proportion of women with the same genotype as their male partner was higher than the proportion of men sharing the same genotype as their female partner: 58.7% (37/63) vs 30.8% (37/120), p < 0.0001. CONCLUSIONS: Sexual partners of women with HG-CIN are a significant reservoir and vector of HPV infection, a fact that could contribute to making viral clearance more difficult to achieve in their partners after treatment of their HG-CIN lesions

INTRODUCCIÓN: Las características de la infección por papilomavirus de alto riesgo (VPH-AR) en el varón apenas se conocen. Los objetivos de este estudio transversal fueron: (a) investigar la prevalencia de VPH-AR y la distribución de genotipos en varón pareja sexual de mujer con neoplasia intraepitelial cervical de alto grado (CIN-AG) y su epidemiología, y (b) evaluar la concordancia tipo-específica entre parejas. MÉTODOS: Se seleccionaron hombres (n=125) en los primeros 6 meses tras el diagnóstico de CIN-AG de su pareja. Se genotiparon muestras del surco coronario, base del glande y escroto (Linear Array, Roche Diagnostics, Mannheim, Alemania). Se estudió la concordancia tipo-específica entre parejas (n=120). Los factores epidemiológicos se evaluaron mediante regresión logística multivariante, SPSS 19 (IBM, Chicago, USA). RESULTADOS: La prevalencia de VPH-AR en el hombre fue del 50,4% (63/125). VPH16/53/52/51/66/31 fueron los genotipos más frecuentes (24/10,4/9,6/8,8/8/7,2%, respectivamente). El tabaquismo se asoció con un mayor riesgo de infección por VPH-AR en el hombre (38,2% [21/55] vs 60% [42/70], OR 2,4, p = 0,025). Entre 60 parejas infectadas, el 62% compartieron al menos un genotipo: el 41,7% fueron concordantes VPH16 positivas y el 18,3% VPH16 negativas (valor kappa: 0,21). La proporción de mujeres con el mismo genotipo que su pareja fue mayor que la de hombres con el mismo genotipo que su pareja: 58,7% (37/63) vs 30,8% (37/120), p < 0,0001. CONCLUSIONES: Las parejas sexuales de mujeres con CIN-AG constituyen un importante reservorio y vector de infección por VPH; esto podría contribuir a que el aclaramiento viral de sus parejas tras el tratamiento de CIN-AG fuese más difícil de alcanzar

Prevalence and concordance of high-risk papillomavirus infection in male sexual partners of women diagnosed with high grade cervical lesions.

BACKGROUND: Little is known about the characteristics of high-risk papillomavirus (HR-HPV) infection in men. The aims of this cross-sectional study were: (a) to investigate HR-HPV prevalence and genotype distribution in men, sexual partners of women presenting with high-grade cervical intraepithelial neoplasia (HG-CIN), according to epidemiological characteristics, and (b) to assess type-specific concordance between partners. METHODS: A total of 125 men were recruited within the first 6 months after HG-CIN diagnosis of their partner. Samples from the coronal sulcus, glans penis shaft, and scrotum were tested with linear array HPV genotyping assay (Roche Diagnostics, Mannheim, Germany). Type-specific concordance within 120 couples was studied. Epidemiological factors were evaluated by multivariate logistic regression analysis. SPSS 19 (IBM, Chicago, USA). RESULTS: The prevalence of HR-HPV infection in males was 50.4% (63/125). HPV16/53/52/51/66/31 were the most frequent genotypes (24/10.4/9.6/8.8/8/7.2%, respectively). Current smoking was associated with an increased risk for HR-HPV infection in men (38.2% (21/55) vs 60% (42/70), OR 2.4, p=0.025). Among 60 infected couples, 62% shared at least one genotype: 41.7% couples were concordantly HPV16 positive and 18.3% were HPV16 negative (kappa value: 0.21). The proportion of women with the same genotype as their male partner was higher than the proportion of men sharing the same genotype as their female partner: 58.7% (37/63) vs 30.8% (37/120), p<0.0001. CONCLUSIONS: Sexual partners of women with HG-CIN are a significant reservoir and vector of HPV infection, a fact that could contribute to making viral clearance more difficult to achieve in their partners after treatment of their HG-CIN lesions.

Retroalimentación integral (debriefing) oral y asistida por video en simulación de reanimación cardiopulmonar avanzada: estudio piloto / Oral and video-assisted debriefing in advanced cardiopulmonary resuscitation simulation: a pilot study

Introducción: En los cursos de soporte vital básico y avanzado con simuladores, parte del proceso de aprendizaje incluye la retroalimentación integral (debriefing), que consiste en un momento de reflexión individual o en equipo acerca de lo que sucedió durante el escenario de simulación y lo que significó para cada miembro. Objetivo: Comparar debriefing oral con o sin video en el logro de la competencia de reanimación cardiopulmonar (RCP) en modelos de simulación. Sujetos y métodos: Estudio piloto experimental (antes y después) con 30 estudiantes del quinto curso de la licenciatura de médico cirujano de la Facultad de Medicina de la Universidad Autónoma de Yucatán, aleatorizados en dos grupos: 15 alumnos que recibieron debriefing oral (grupo I) y 15 que recibieron debriefing asistido por video (grupo II) de la sesión de simulación. Cada sesión de retroalimentación tuvo una duración aproximada de 20 minutos. Resultados: Los resultados mostraron mejoría de los pasos de RCP: intervenciones y abordaje grupo I, 3 (20%); liderazgo, 4 (27%); manejo del ritmo inicial del paro, 3 (20%); calidad de la RCP avanzada, 11 (73%); cuidados posparada, 5 (33%); logro de la competencia, 5 (33%); grupo II: 7 (47%), 14 (93%), 12 (80%), 13 (87%), 14 (93%) y 13 (87%), respectivamente, con una diferencia significativa (prueba exacta de Fisher) en liderazgo, manejo del ritmo inicial, cuidados posparada y logro de la competencia. Conclusiones: Hay ventaja del debriefing asistido por video en las habilidades no técnicas y en el dominio de la competencia de RCP avanzada

Introduction: Part of the learning process of the simulator courses of basic and advanced life support includes debriefing, which is a time for individual, or team reflection, about what happened during the simulation scenario, and what it meant for each member. Aim: To compare the oral debriefing, with or without video, in achieving competence in cardiopulmonary resuscitation (CPR) on simulation models. Subjects and methods: Experimental study. A group of 30 students in the fifth year of the School of Medicine of Universidad Autónoma de Yucatán, were selected. Participants were randomly divided into two groups: 15 students who received oral debriefing (OD) and 15 students who received video-assisted debriefing training (VD), each session lasting 20 minutes. Results: Results showed improvement in the following steps: interventions and approach OD 3 (20%) and VD 7 (47%), leadership OD 4 (27%) and VD 14 (93%), initial rhythm handling OD 3 (20%) and VD 12 (80%), advanced CPR quality OD 11 (73%) and VD 13 (87%), post-cardiac arrest care OD 5 (33%) and VD 14 (93%), and achieving competition OD 5 (33%) and VD 13 (87%). Significant differences using Fisher’s exact test were found in leadership, initial rhythm handling, postcardiac arrest care and achieving competition. Conclusions: Students achieve better skills on advanced CPR after simulation model training with video-assisted debriefing

Impact of Sn(S,Se) secondary phases in Cu2ZnSn(S,Se)4 solar cells: a chemical route for their selective removal and absorber surface passivation.

The control and removal of secondary phases is one of the major challenges for the development of Cu2ZnSn(S,Se)4 (CZTSSe)-based solar cells. Although etching processes have been developed for Cu(S,Se), Zn(S,Se), and CuSn(S,Se) secondary phases, so far very little attention has been given to the role of Sn(S,Se). In this paper, we report a chemical route using a yellow (NH4)2S solution to effectively remove Sn(S,Se). We found that Sn(S,Se) can form on the surface either because of stoichiometric deviation or by condensation. After etching, the efficiency of devices typically increases between 20 and 65% relative to the before etch efficiencies. We achieved a maximum 5.9% efficiency in Se-rich CZTSSe-based devices. It is confirmed that this feature is related not only to the removal of Sn(S,Se) but also to the unexpected passivation of the surface. We propose a phenomenological model for this passivation, which may open new perspectives for the development of CZTSSe-based solar cells.

ZnSe etching of Zn-rich Cu2ZnSnSe4: an oxidation route for improved solar-cell efficiency.

Cu2ZnSnSe4 kesterite compounds are some of the most promising materials for low-cost thin-film photovoltaics. However, the synthesis of absorbers for high-performing devices is still a complex issue. So far, the best devices rely on absorbers grown in a Zn-rich and Cu-poor environment. These off-stoichiometric conditions favor the presence of a ZnSe secondary phase, which has been proved to be highly detrimental for device performance. Therefore, an effective method for the selective removal of this phase is important. Previous attempts to remove this phase by using acidic etching or highly toxic organic compounds have been reported but so far with moderate impact on device performance. Herein, a new oxidizing route to ensure efficient removal of ZnSe is presented based on treatment with a mixture of an oxidizing agent and a mineral acid followed by treatment in an aqueous Na2S solution. Three different oxidizing agents were tested: H2O2, KMnO4, and K2Cr2O7, combined with different concentrations of H2SO4. With all of these agents Se(2-) from the ZnSe surface phase is selectively oxidized to Se(0), forming an elemental Se phase, which is removed with the subsequent etching in Na2S. Using KMnO4 in a H2SO4-based medium, a large improvement on the conversion efficiency of the devices is observed, related to an improvement of all the optoelectronic parameters of the cells. Improvement of short-circuit current density (J(sc)) and series resistance is directly related to the selective etching of the ZnSe surface phase, which has a demonstrated current-blocking effect. In addition, a significant improvement of open-circuit voltage (V(oc)), shunt resistance (R(sh)), and fill factor (FF) are attributed to a passivation effect of the kesterite absorber surface resulting from the chemical processes, an effect that likely leads to a reduction of nonradiative-recombination states density and a subsequent improvement of the p-n junction.

Patients with cardiac disease: Changes observed through last decade in out-patient clinics.

AIM: To describe current profile of patients with cardiovascular disease (CVD) and assessing changes through last decade. METHODS: Comparison of patients with established CVD from two similar cross-sectional registries performed in 1999 (n = 6194) and 2009 (n = 4639). The types of CVD were coronary heart disease (CHD), heart failure (HF) and atrial fibrillation (AF). Patients were collected from outpatient clinics. Investigators were 80% cardiologist and 20% primary care practitioners. Clinical antecedents, major diagnosis, blood test results and medical treatments were collected from all patients. RESULTS: An increase in all risk factors, except for smoking, was observed; a 54.4% relative increase in BP control was noted. CHD was the most prevalent CVD but HF and AF increased significantly, 41.5% and 33.7%, respectively. A significant reduction in serum lipid levels was observed. The use of statins increased by 141.1% as did all cardiovascular treatments. Moreover, the use of angiotensin-renin system inhibitors in patients with HF, beta-blockers in CHD patients or oral anticoagulants in AF patients increased by 83.0%, 80.3% and 156.0%, respectively (P < 0.01). CONCLUSION: The prevalence of all cardiovascular risk factors has increased in patients with CVD through last decade. HF and AF have experienced the largest increases.

Single-step sulfo-selenization method to synthesize Cu2ZnSn(S(y)Se(1-y))4 absorbers from metallic stack precursors.

Pentenary Cu2ZnSn(S(y)Se(1-y))4 (kesterite) photovoltaic absorbers are synthesized by a one-step annealing process from copper-poor and zinc-rich precursor metallic stacks prepared by direct-current magnetron sputtering deposition. Depending on the chalcogen source--mixtures of sulfur and selenium powders, or selenium disulfide--as well as the annealing temperature and pressure, this simple methodology permits the tuning of the absorber composition from sulfur-rich to selenium-rich in one single annealing process. The impact of the thermal treatment variables on chalcogenide incorporation is investigated. The effect of the S/(S+Se) compositional ratio on the structural and morphological properties of the as-grown films, and the optoelectronic parameters of solar cells fabricated using these absorber films is studied. Using this single-step sulfo-selenization method, pentenary kesterite-based devices with conversion efficiencies up to 4.4 % are obtained.