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Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a damage control tool with a potential role in the hemodynamic resuscitation of severely ill patients in the civilian pre-hospital setting. REBOA ensures blood flow to vital organs by early proximal control of the source of bleeding. However, there is no consensus on the use of REBOA in the pre-hospital setting. This article aims to perform a systematic review of the literature about the feasibility, survival, indications, complications, and potential candidates for civilian pre-hospital REBOA. Methods A literature search was conducted using Medline, EMBASE, LILACS and Web of Science databases. Primary outcome variables included overall survival and feasibility. Secondary outcome variables included complications and potential candidates for endovascular occlusion. Results The search identified 8 articles. Five studies described the use of REBOA in pre-hospital settings, reporting a total of 47 patients in whom the procedure was attempted. Pre-hospital REBOA was feasible in 68–100% of trauma patients and 100% of non-traumatic patients with cardiac arrest. Survival rates and complications varied widely. Pre-hospital REBOA requires a coordinated and integrated emergency health care system with a well-trained and equipped team. The remaining three studies performed a retrospective analysis identifying 784 potential REBOA candidates. Conclusions Pre-hospital REBOA could be a feasible intervention for a significant portion of severely ill patients in the civilian setting. However, the evidence is limited. The impact of pre-hospital REBOA should be assessed in future studies.

Abstract Background The native potatoes (Solanum tuberosum subsp. tuberosum L.) grown in Chile (Chiloé) represent a new, unexplored source of endophytes to find potential biological control agents for the prevention of bacterial diseases, like blackleg and soft rot, in potato crops. Result The objective of this study was the selection of endophytic actinobacteria from native potatoes for antagonistic activity against Pectobacterium carotovorum subsp. carotovorum and Pectobacterium atrosepticum, and their potential to suppress tissue maceration symptoms in potato tubers. This potential was determined through the quorum quenching activity using a Chromobacterium violaceaum ATCC 12472 Wild type (WT) bioassay and its colonization behavior of the potato plant root system (S. tuberosum) by means of the Double labeling of oligonucleotide probes for fluorescence in situ hybridization (DOPE-FISH) targeting technique. The results showed that although Streptomyces sp. TP199 and Streptomyces sp. A2R31 were able to inhibit the growth of the pathogens, only the Streptomyces sp. TP199 isolate inhibited Pectobacterium sp. growth and diminished tissue maceration in tubers (p ≤ 0.05). Streptomyces sp. TP199 had metal-dependent acyl homoserine lactones (AHL) quorum quenching activity in vitro and was able to colonize the root endosphere 10 days after inoculation. Conclusions We concluded that native potatoes from southern Chile possess endophyte actinobacteria that are potential agents for the disease management of soft rot and blackleg.

Open Education (OE) opens up learning opportunities to, potentially, every person in the world. Additionally, it allows teachers, researchers, and practitioners to find, share, reuse, and improve existing resources under a dependable legal framework. Aiming to spread and foster the introduction of open policies in Higher Education (HE) institutions, the gamified interactive learning experience Catch the Open! was developed. Catch the Open! targets HE educators who wish to learn, or who wish to deepen their existing knowledge, about OE and Open Educational Practices (OEP). Within the gamified learning experience, the user becomes an educator, Alex, the game character, who receives a task from the Rector: to investigate how to best include OE and OEP in teaching and learning practice within the institution. Alex proceeds to explore and gather information in a web-based 2D virtual HE institution where students, colleagues, and guest researchers will help her to develop a comprehensive understanding of OE and the practical application of OEP. The educational content within Catch the Open! is underpinned by an OE competences framework for HE educators, developed in a previous phase of the Erasmus+ OpenGame project. In this paper, the design process to link pedagogical and technological approaches, which results in the Catch the Open! gamified web-based interactive application, is presented as well as the application itself. Moreover, two phases of piloting with 153 HE educators from six different HE institutions are presented. The obtained findings showed that the gamified environment helped in learning about OE. On the other hand, learners also suggested several improvement aspects of the gamified environment, such as the length of finishing a learning mission while playing.

The design, implementation, and outcome of game-based learning for learners with disabilities have not been sufficiently examined systematically. Particularly, learner-based and contextual factors, as well as the essential roles played by various stakeholders, have not been addressed when game-based learning applications are used in special education. Therefore, a systematic literature review using the Activity Theory (AT) was conducted to analyse studies about game-based learning for learners with disabilities. Content analysis of 96 studies reported relevant information with respect to each activity component—(a) subject (learners with disabilities), (b) technology (game-based learning applications), (c) object (target skills or behaviours), (d) rules (implementation procedure and performance measures), (e) community (learners with disabilities, special education professionals, and parents), (f) division of labour (among learners, professionals, and parents) and (g) outcome (performance of target skills or behaviours). Furthermore, this study identified existing gaps from the reviewed studies, including occasional lack of parental engagement, difficulty of standardising performance measures due to the heterogeneity of learner profiles and contradictions (e.g., opposing views among experts on the role of educational games in social interactions). Finally, recommendations were made under each activity component. The study concluded that both general and domain-specific guidelines should be created for each disability category proposed in this review to assist practitioners who wish to use game-based learning with learners with disabilities.

Long-term unemployment is a persistent problem in Europe, following the economic crisis suffered in 2008. This situation reveals self-employment as a good option for becoming re-involved in the working life. In this context, this paper presents a gamified educational platform to empower social economy entrepreneurship skills in long-term unemployed people. In particular, we present the training approach underpinning the motivational process supported by gamification, which has been developed using the ADDIE model. The learning path is developed according to a story that guides the work throughout the training process. It is based on the premises of alignment with reality, instruction from didactic material and real-life stories, in-game practice, work in groups and assistance from a facilitator. This approach covers the competence needs identified in a previous study and includes gamification techniques to improve motivation and engagement. Therefore, the training program comprises: (1) a set of materials and real social economy enterprise experiences, which are the basis for learning and getting inspiration; (2) activities to develop a business plan based on concepts learned from the learning materials and from real-life stories, as well as the help of a facilitator who walks with trainees during the process; (3) a set of individual and group, mandatory and optional assessment activities to evaluate the learning achieved; and (4) a three-views scoring system that shows learning progress for individuals and groups, and gives players the opportunity to exchange gamification points for benefits in the game. The results presented in this paper are based on a sample of two pilots run in Italy and Spain and involving five facilitators working with around 60 learners. About 60% of participants indicated their intention to apply knowledge obtained in a real-life entrepreneurship initiative.

Introducción. La miastenia grave es una enfermedad autoinmunitaria con una prevalencia mundial de 150 a 250 casos por 1´000.000 de habitantes. El tratamiento recomendado para la miastenia grave sin timoma es la timectomía total, la cual es la única alternativa de curación. Métodos. Se llevó a cabo un estudio descriptivo y retrospectivo de una serie de casos de pacientes adultos con miastenia grave sin timoma sometidos a timectomía, durante el periodo de 2010 a 2017. En el análisis estadístico descriptivo, se utilizaron frecuencias absolutas y porcentajes para las variables cualitativas y, para las variables cuantitativas, se utilizaron la mediana y el rango intercuartílico. Resultados. Veintiocho pacientes con miastenia grave sin timoma se sometieron a timectomía desde el año 2010 hasta el 2017. Se categorizaron según la clasificación del estado posterior a la intervención de la Myasthenia Gravis Foundation of America y se evidenció que 4 (14,3 %) pacientes presentaban remisión completa y el grado 3 de manifestaciones clínicas mínimas fue el más frecuente en 19 (67,9 %); 26 (92,9 %) tuvieron mejoría con respecto al cambio del estado clínico, en 2 (7,1 %) no se documentaron cambios y en ningún paciente hubo empeoramiento, exacerbación o muerte secundaria a la enfermedad. Conclusiones. A lo largo de siete años se practicó timectomía a 28 pacientes con diagnóstico de miastenia grave sin timoma, aproximadamente, en el 15 % de los pacientes hubo remisión completa, el grado 3 de manifestaciones mínimas fue el más frecuente y el 93 % presentó mejoría de su estatus clínico.

Introducción. La tomografía corporal (TC) total en la evaluación de pacientes con trauma grave, puede ser una herramienta eficaz y segura para decidir entre un tratamiento quirúrgico y uno no quirúrgico, pero aún no son claras las implicaciones diagnósticas y los riesgos asociados con esta técnica. Métodos. Se incluyeron pacientes mayores de 15 años con trauma grave que fueron sometidos a TC total. Se evaluaron la seguridad, la efectividad y la eficiencia por medio de los parámetros de incidencia de nefropatía inducida por los medios de contraste, dosis total de radiación por paciente, proporción de casos en los que la TC total cambió el manejo, y el retraso en el diagnóstico. Resultados. Se incluyeron 263 pacientes, 83 % sufrieron trauma cerrado y 17 % sufrieron trauma penetrante. La gravedad de la lesión fue mayor en estos últimos y, sin embargo, el trauma cerrado con inestabilidad hemodinámica se presentó con mayores grados de choque. El 65 % de los pacientes recibió tratamiento selectivo no operatorio. Entre los subgrupos, no hubo diferencias significativas en el tiempo entre el ingreso a la sala de urgencias y la toma de la TC total (p=0,96) y, en la mayoría de los casos, el tiempo entre la práctica de la TC total y el diagnóstico de presencia o ausencia de heridas fue menor de 25 minutos. La mediana de radiación total estuvo por debajo de 20 mSv en todos los grupos. No hubo diferencias significativas en la mortalidad (p=0,17). Conclusión. La TC total es una herramienta segura y eficiente para decidir entre un tratamiento quirúrgico y uno no quirúrgico en los casos de trauma grave, independientemente del mecanismo de la lesión o la estabilidad hemodinámica al ingreso.

Abstract Morbidly adherent placenta (MAP), which includes accreta, increta, and percreta, is a condition characterized by the invasion of the uterine wall by placental tissue. The condition is associated with higher odds of massive post-partum hemorrhage. Several interventions have been developed to improve hemorrhage-related outcomes in these patients; however, there is no evidence to prefer any intervention over another. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular intervention that may be useful and effective to reduce hemorrhage and transfusions in MAP patients. The objective of this narrative review is to summarize the evidence for REBOA in patients with MAP. We posit that acute care surgeons can perform REBOA for patients with MAP.

Actualmente, los juegos pervasivos son uno de los tipos de experiencia de juego que causan el mayor impacto en los jugadores, pues rompen el entorno usual del juego en su dimensión espacial, temporal o social. Este documento tiene el objetivo de proponer, en esos juegos, una integración de la narrativa con la interactividad y la geolocalización. Esta integración requiere un modelo que represente y estructure la historia y su fusión con el resto de elementos del juego. Además, ese modelo debe permitir analizar la efectividad de la historia y cómo ésta ayuda a crear una buena experiencia de usuario. En este trabajo, proponemos una fuerte estructuración de la narrativa que incluye soporte a la geolocalización. A través de un ejemplo de diseño de una historia interactiva geolocalizada, se explican las diferentes características del modelo que hacen posible la creación de buena narrativa interactiva.

El uso de un método de desarrollo específico para videojuegos e ducativos que facilite la definición de objetivos pedagógicos y lúdicos podría mejorar la eficiencia inst ructiva de este tipo de aplica ciones, sin perder su jugabilidad. Con esta intención, en este trabajo se presenta un proceso de diseño incremental que aplica principios de Ingen iería del Software par a generar videojuegos educativos con acti vidades colaborativas. Siguiendo dicho pr oceso, la especificación y dis eño de contenidos educativos y de juego es más sencilla y permi te garantizar el equilibrio entre los component es educativos y de juego. Comp lementariamente, se presenta un prototipo de una herramienta de autor que implementa la met odología propuesta.

En este artículo se presenta el uso de video juegos multijugador que manejan actividades colaborativas como un instrumento educativo acorde con la era digital que vivimos, así como las bases que soportan dicha iniciativa. Este tipo de aplicaciones que se denomina Video Games–Supported Collaborative Learning (vgscl), pretende obtener las ventajas que se derivan de los tres pilares sobre los cuales se apoya la utilización de estas aplicaciones: el uso de videojuegos como elemento atractivo y motivador para un amplio porcentaje de la población en edad escolar, el aprendizaje implícito de conceptos ocultos en los retos y actividades del propio videojuego, y la aplicación de técnicas de aprendizaje colaborativo que permiten a los estudiantes desarrollar sus habilidades sociales mientras aprenden y obtienen un aprendizaje más efectivo.

With the rapid evolution of mobile technology, the adoption of mobile learning in education has also increased. Several studies have conducted various systematic literature reviews to discuss mobile learning from different perspectives, such as its advantages and limitations. However, limited attention has been paid to pedagogy in mobile learning. To address this gap, this study conducts a systematic review of 165 empirical studies on mobile learning to investigate the changing landscape of mobile learning pedagogy. The findings reveal that, despite the ubiquity and flexibility of mobile technologies, most mobile learning studies were conducted in formal settings. The findings also reveal that game-based learning and collaborative learning were the most frequently used pedagogical approaches. Furthermore, redefinition is the most frequently used pedagogical functionality of technology in mobile learning, based on the Substitution Augmentation Modification Redefinition (SAMR) model. The findings of this systematic literature review could be beneficial to both researchers and practitioners in highlighting how mobile learning is designed and implemented, and what gaps should be focused on to enhance pedagogical experiences on mobile devices and thus achieve better mobile learning outcomes.