Explore the vast range of titles available.

Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. However, in patients with terminal illnesses, these devices may disrupt the dying process. This study was undertaken to review our current strategies surrounding device deactivation. A retrospective chart review was performed at Kingston Health Sciences Centre of patients with an ICD who died from 2015 to 2018. Data collected included patient demographics, clinical details surrounding device implantation, patient co-morbidities leading to deactivation, time to deactivation, physical place of deactivation, and device programming information. Ethics approval was obtained from the Queen's University Health Sciences Research Ethics Board. A total of 49 patients were included for analysis. Mean age at the time of death was 77.5 years (range: 57 to 94 years) and 12.2% (6/49) were women. The indications for ICD implantation were primary prevention of sudden cardiac death in 69.4% (34/49) and secondary prevention in 30.6% (15/49). Deactivation as part of end-of-life care was performed in 32.7% of patients (16/49). Deactivations occurred in clinic in 6.1% (3/49) of patients, on hospital inpatient wards in 12.2% (6/49) of patients, and in critical care settings in 14.2% (7/49) of patients. The remaining 67.3% (33/49) of patients died with fully functioning devices in place. The most prevalent terminal diagnoses were metastatic cancer (22.4%) and end-stage congestive heart failure (20.4%). On average, patients had their devices deactivated 13 months (range: 0 to 62 months) after their terminal diagnosis was established. Once a patient was documented as Do Not Resuscitate (DNR), deactivation was discussed and carried out within a mean time of 38 days (range: 0 to 400 days). Seven patients had their device active for more than 1 month after being documented as DNR. Ten patients (20.4%) received ICD shocks after their terminal diagnosis, 9 received shocks in the month before death, and 2 received shocks after formal DNR orders were in place. Approximately one-third of patients with ICDs received deactivation of their cardioversion/defibrillation therapies as part of their end-of-life care plan. A relatively high proportion of patients (20%) received an ICD shock in the last month of life. In conclusion, addressing device programming needs, including deactivation of cardioversion/defibrillation therapies, should be considered in the context of a patient's goals of care in every patient with an ICD who has a co-existing life-limiting diagnosis.

Diabetes has become a global noninfectious pandemic with rates rapidly rising around the globe. The major drivers of this increase in type 2 diabetes are obesity, an increase in processed foods, and a decrease in physical activity. In the United States, the National Diabetes Prevention Program (NDPP) has proven to be an effective lifestyle intervention to delay or prevent new-onset type 2 diabetes. However, there is limited evidence that such a lifestyle program will work in a South American community. This pilot program aims to determine if a modified version of the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) would be feasible in an Ecuadorian population. The goals of this pilot program were a 7% weight loss, >150 min of physical activity per week, and a reduction of fat calories to yield a reduced risk of type 2 diabetes. This program was led by family medicine physicians and was offered to people with prediabetes in Quito, Ecuador. The program was modified to include only the first half of the DPP curriculum, which included a schedule of 16 classes in the first 6 months. Further, the program was provided in Spanish and modified to be more culturally specific to this population. Participants were recruited from the faculty and staff of Pontifical Catholic University of Ecuador (Pontificia Universidad Católica del Ecuador [PUCE]) in Quito. Outcomes measured included A1c reduction, weight loss, increase in physical activity minutes, and progression to type 2 diabetes mellitus (T2DM). The sample included 33 people with prediabetes. The mean age of the participants was 52 years (range, 41-66 years), the mean body mass index (BMI) was 27.6 kg/m (range, 21.0-40.3 kg/m ), and the mean HbA1C was 6.2% (range, 5.7-6.4%). The attendance was 97.8% at 6 months. The mean weight loss was 3.4 kg per participant (range, 1.5 kg weight gain to 8.3 kg weight loss); in percentage points, this was a mean weight loss of 3.6% (range, 2.3% gain to 11.8% weight loss). Three-fourths of the participants lost weight (78.3%). The majority of participants (75.8%) met the target physical activity level of 150 min per week, and all participants increased their physical activity levels from baseline. No participants progressed to type 2 diabetes during this study. The DPP 6 month pilot was effective in this population with prediabetes in Ecuador. The largest changes were made in physical activity time. Holding the program at worksites and providing lunch were key factors in the very high retention rate in this study.

The development of biofuels aligned with the circular economy has gained increasing attention as a sustainable alternative to non-renewable energy sources. This study aims to evaluate the physical and thermal properties of biomass briquettes derived from potato stalk residues to assess their potential as biofuels. For this, dried potato stalk residues were subjected to pyrolysis for carbonization, followed by grinding and mixing with potato and achira binders in proportions of 10% and 20%, respectively. The briquetting process was performed at a pressure of 10 MPa with compaction times of 30 and 60 s. Scanning electron microscopy (SEM) revealed a porous structure with uniform binder distribution, while Raman spectroscopy confirmed the presence of D and G bands, indicative of amorphous carbon structures with graphite-like imperfections. Thermogravimetric analysis (TGA) determined a moisture content of 10%, which ensures stability. Non-carbonized briquettes exhibited higher compressive strength, withstanding forces in excess of 400 N at 20% deformation. The average calorific value of both briquette types was 15 MJ/kg, comparable to biofuels derived from sugarcane bagasse and rice hulls, with samples exceeding the 12 MJ/kg threshold for biomass fuel classification. These results indicate that potato stalk briquettes could be a viable biofuel alternative to support renewable energy diversification.

Este texto desenvolve com precisão os conceitos de inteligência artificial e neurotecnologia, e sua aplicação no mercado de trabalho e na mente do consumidor. Este comunica a crescente preocupaçãocom o deslocamento de mão de obra da IA nas organizações e elabora uma defesa tanto do trabalhador quanto do consumidor nas organizações e na governança corporativa atuais.O livro descreve com dedicação os primórdios da inteligência artificial e da neurotecnologia. Em seguida, desenvolve em profundidade as implicações dessas ferramentas em cada setor econômicoem que seu poder iminente de sucesso está conquistando novas necessidades dos consumidores.Além disso, ele investiga e analisa o papel da inteligência artificial e da neurotecnologia em quatro frentes decisivas do setor, como medicina, educação, tecnologia veicular e defesa militar. Destinado a estudantes de Marketing, Psicologia, Engenharia de Sistemas, Administração de Empresas, Administração de Negócios e Direito.Inlcui:Uma explicação precisa do que é inteligência artificial e neurotecnologia.Radiografia do poder das máquinas em face do deslocamento de mão de obra.Um caso forte para defender o cérebro e a mente do consumidor.Estratégias para sobreviver em um mundo dominado pela inteligência artificial nas organizações.

NOABSTRACTPatient-ventilator asynchrony (PVA) is frequent in intensive care. Its presence is associated with prolonged days of mechanical ventilation and may lead to increased mortality in the intensive care unit (ICU) and hospital. Little is known about the ability of Colombian intensive care professionals to identify asynchronies, and the factors associated with their correct identification are not apparent.To describe the ability of Colombian intensive care professionals to identify patient-ventilator asynchronies (PVA) using waveform analysis. In addition, to define the characteristics associated with correctly detecting PVA.We conducted a multicenter, cross-sectional, national survey-based study between January and August 2024. Colombian physiotherapists, respiratory therapists, nurses and intensive care physicians from 24 departments participated in the study. An online survey was used. They were asked to identify six different PVAs presented as videos. The videos were displayed using pressure/time and flow/time waveform of a Puritan Bennett 840 ventilator.We recruited 900 participants, 60% female, most of whom were physiotherapists (53%). Most professionals had specialty training in critical care (42%), and 32% reported having specific PVA training. Double triggering was the most frequently identified PVA (75%). However, only 3.67% of participants recognized all six PVAs. According to multiple logistic regression analysis, working in a mixed unit (OR 2.59; 95% CI 1.19 – 5.54), caring for neonates (OR 5.19; 95% CI 1.77 – 15.20), and having specific training (OR 2.38; 95% CI 1.16 – 4.76) increases the chance of correctly recognizing all PVAs.In Colombia, a low percentage of professionals recognize all PVAs. Having specific training in this topic, working in mixed ICUs and neonatal intensive care was significantly associated with identifying all PVAs.

Chagas cardiomyopathy is an endemic disease in Latin America. A significant proportion of patients develop atrial fibrillation (AF), which may result in stroke and increased morbidity or mortality. Interatrial block (IAB) has been associated with the development of AF in different clinical scenarios. The aim of our study was to determine whether IAB can predict new-onset AF in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators (ICDs). We conducted a retrospective study of patients with Chagas cardiomyopathy and ICDs from 14 centers in Latin America. Demographics, clinical, and device follow-up were collected. Surface electrocardiograms were scanned at 300 dpi and maximized ×8. Semiautomatic calipers were used to determine P-wave onset and offset. Partial IAB was defined as a P wave of >120 ms and advanced IAB as a P wave of >120 ms with biphasic morphology (±) in inferior leads. AF events and ICD therapies were reviewed during follow-up by 2 independent investigators. A total of 80 patients were analyzed. Mean age was 54.6 ± 10.4 years, and 52 (65%) were male. Mean left ventricular ejection fraction was 40 ± 12%. IAB was detected in 15 patients (18.8%), with 8 (10.0%) partial and 7 (8.8%) advanced. During a follow-up of 33 ± 20 months, 11 patients (13.8%) presented with new AF. IAB (partial + advanced) was strongly associated with new AF (p <0.0001) and inappropriate therapy by the ICD (p = 0.014). In conclusion, IAB (partial + advanced) predicted new-onset AF in patients with Chagas cardiomyopathy and ICDs.

The autonomous control of landing procedures can provide the efficiency and precision that are vital for the successful, safe completion of space operations missions. Controlling a lander with this precision is challenging because the propellants, which will be expended during the operations, represent a significant fraction of the lander’s mass. The mass variation of each tank profoundly influences the inertia and mass characteristics as thrust is generated and complicates the precise control of the lander state. This factor is a crucial consideration in our research and methodology. The dynamics model for our lander was developed where the mass, inertia, and center of mass (COM) vary with time. A feed-forward neural network (NN) is incorporated into the dynamics to capture the time-varying inertia tensor and COM. Moreover, the propellant takes time to travel through the feed lines from the storage tanks to the engine; also, the solenoid valves require time to open and close. Therefore, there are time delays between the actuator and the engine response. To take into account these sources of variations, a combined time delay is also included in the control loop to evaluate the effect of delays by fluid and mechanisms on the performance of the controller. The time delay is estimated numerically by a Computational Fluid Dynamics (CFD) model. As part of the lander’s control mechanism, a thrust vector control (TVC) with two rotational gimbals and a reaction control system (RCS) are incorporated into the dynamics. Simple proportional, integral, and derivative (PID) controllers are designed to control the thrust, the gimbal angles of the TVC, and the torque required by the RCS to manipulate the lander’s rotation and altitude. A complex mission with several numerical examples is presented to verify the hover and rotational motion control.

Purpose of the Review Successful catheter ablation of ventricular arrhythmias depends on identifying the critical tissues that sustain the arrhythmia. Increasingly, the intramural space is being recognized as an important source of idiopathic and reentrant ventricular arrhythmias, representing a common cause of ablation failure. A systematic approach to mapping and ablating these arrhythmias is key to optimize outcomes. Recent Findings Intramural ventricular arrhythmias are common in certain anatomical locations such as the left ventricular ostium or the interventricular septum. In these cases, mapping of the septal coronary veins provides an opportunity to explore the intramural compartment of the septum to perform activation mapping, entrainment and/or pace mapping. When an intramural arrhythmia is identified, ablation may require radiofrequency application from multiple sites, prolonged lesions, or special ablation techniques such as bipolar ablation or transvenous ethanol injection. Summary Identification of intramural ventricular arrhythmias depends on comprehensive mapping that should include the coronary venous system, and ablation often requires advanced techniques. This paper provides a guide on when to suspect an intramural ventricular arrhythmia in the electrophysiology laboratory and how to approach mapping and ablation in these challenging cases.

La Agencia Nabón de la Empresa Eléctrica Regional Centro Sur C.A. (CENTROSUR) enfrenta desafíos logísticos y climáticos al llevar a cabo lecturas presenciales de medidores de energía eléctrica en la parroquia El Progreso del cantón Nabón. Este estudio de investigación se enfoca en la viabilidad y los beneficios de implementar sistemas de medición remota de energía eléctrica en la Agencia Nabón de CENTROSUR. La gestión eficiente de la energía eléctrica es esencial tanto entornos urbanos como rurales, y la adopción de tecnologías de medición remota puede desempeñar un papel crucial en la optimización de su uso. Esta iniciativa tiene como objetivo optimizar recursos, reducir costos y mejorar la calidad del servicio eléctrico al proporcionar datos precisos y en tiempo real sobre el consumo de energía. El estudio se basa en un análisis exhaustivo que combina métodos cuantitativos, descriptivos, explicativo – causal, de corte transversal y no experimental, incluyendo revisión de literatura y evaluación de datos específicos de la Agencia Nabón de CENTROSUR. Se viabiliza la aplicación de la investigación al obtener resultados positivos en los índices financieros PIR de 78.84 meses y VAN 11.115,84, además destaca la necesidad de modernizar la infraestructura de los sistemas de medición que cumplieron su vida útil. En conclusión, dentro de la parroquia El Progreso se requiere una modernización de los sistemas de medición, aunque demanda una inversión inicial considerable, promete beneficios a largo plazo como facturación precisa, gestión eficiente del consumo y mayor satisfacción del cliente, respaldada por análisis económicos positivos.