Repositorio Institucional
Nuestra plataforma Reúne, conserva y difunde la producción intelectual en formato digital de estudiantes, académicos e investigadores de la Universidad del Desarrollo. Es una plataforma web colaborativa diseñada y administrada por el Sistema de Bibliotecas, en el que participan las unidades académicas como proveedoras de contenido, ejerciendo el rol de editor en su respectiva “comunidad” Leer Más...
¿Qué estás buscando?
Recent Submissions
Total Outer-Independent Domination Number: Bounds and Algorithms
(2025) Bosch, Paul; Parra Inza, Ernesto; Rios Villamar, Ismael; Sánchez-Santiesteban, José Luis
In graph theory, the study of domination sets has garnered significant interest due to its applications in network design and analysis. Consider a graph G(V, E); a subset of its vertices is a total dominating set (TDS) if, for each x ∈ V(G), there exists an edge in E(G) connecting x to at least one vertex within this subset. If the subgraph induced by the vertices outside the TDS has no edges, the set is called a total outer-independent dominating set (TOIDS). The total outer-independent domination number, denoted as γoit (G), represents the smallest cardinality of such a set. Deciding if a given graph has a TOIDS with at most r vertices is an NP-complete problem. This study introduces new lowerand upper bounds for γoit (G) and presents an exact solution approach using integer linear programming (ILP). Additionally, we develop a heuristic and a procedure to efficiently obtain minimal TOIDS.
A Systematic Literature Review on the Use of Clays for Arsenic Removal
(2025) Reyes-Bozo, Lorenzo; Vyhmeister, Eduardo; Castane, Gabriel G.; Chirinos, Juan; Zárraga, Jeannette; Sandoval-Yáñez, Claudia; Valdés-González, Héctor
Arsenic contamination in water remains a critical global challenge, particularly in rural and resource-limited regions. Clays have been widely studied as cost-effective and efficient adsorbents for arsenic removal. This systematic review provides a comprehensive analysis of the application of clays in arsenic adsorption, focusing on clay types, operational units, and study methodologies. The review classifies the adsorption mechanisms, highlights key factors influencing adsorption performance—such as pH, ionic strength, and surface modifications—and examines the effectiveness of various modifications. Furthermore, the study categorizes adsorption research into kinetic, iso-thermal, thermodynamic, and efficiency studies, providing insights into the state of the art and the experimental conditions that govern arsenic removal. It also discusses the scalability and practical application of clay-based adsorption technologies, emphasizing gaps in field validation, regeneration studies, and large-scale implementation. The findings highlight the potential of natural and modified clays in arsenic remediation, while underscoring the need for further research to optimize adsorption conditions and enhance sustainability in water treatment systems.
High earnings through firm influence: the role of hierarchical structures in public procurement
(2025) Niclas Frederic Sturm,; Candia, Cristián; Damásio, Bruno; Pinheiro, Flavio L.
Public procurement, a critical but often overlooked aspect of governance, plays a pivotal role in steering the acquisition of goods, services and the commissioning of public works. Our study, analyzing over one million public procurement contracts from the Portuguese public administration, applies network science to unravel the complexities of this market. We uncover a market characterized by highly modular and hierarchical networks, with notable service specialization, regional diversity, and entity diversification. Our findings reveal a clear pattern: firms occupying influential positions within the networks consistently achieve higher earnings per bid. This disparity in earnings indicates a market where competition is constrained and entry barriers for new firms are high. Similarly, markets in the Portuguese public procurement system exhibit high levels of concentration, which raises both integrity and supplier risks that should be monitored by policymakers. The empirical framework developed in this article contributes to a growing body of literature that analyzes the levels of competition in public procurement systems. The network-based method applied here facilitates the analysis of firms’ positioning within their network of competitors and helps to quantify firm capabilities in a way that moves beyond a monolithic view of firm size and market power.
Large scale summarization using ensemble prompts and in context learning approaches
(2025) Leiva-Araos, Andrés; Gana, Bady; Allende-Cid, Héctor; García, José; Jyoti Saikia, Manob
The field of Information Assurance (IA) and Cybersecurity has seen substantial evolution, driven by advancements in technology and the increasing sophistication of threats in the digital age.
This study employs Large Language Models (LLMs), as well as other advanced NLP techniques, to conduct a comprehensive analysis of literature from 1967 to 2024. By analyzing a corpus of more than 62,000 documents extracted from Scopus, our approach involves a comprehensive methodology that includes two main phases: topic detection using BERTopic and automatic summarization with LLMs across various periods (annual and decades). By designing targeted queries to extract relevant papers, analyzing textual data, and applying advanced prompting techniques for summarization, we integrate computational models to handle large volumes of data. Our results demonstrate that an ensemble of methods (Ev2) outperforms traditional summarization and density-based approaches, with improvements ranging from 16.7% to 29.6% in keyword definition tasks. It generates summaries that outperform in 5 out of the 7 tested metrics while maintaining the logical integrity of bibliographic references. Our results illuminate the shifts in focus within Information Assurance across decades, revealing key breakthroughs and forecasting emerging areas of significance.
A framework for advancing independent air quality sensor measurements via transparent data generating process classification
(2026) Diez, Sebastian; Bannan, Thomas; Chacón, Miriam; Edwards, Pete; Ferracci, Valerio; Kılıç, Doğuşhan; Lewis, Alastair; Malings, Carl; Martin, Nicholas; Popoola, Olalekan; Rosales, Colleen; Schmitz, Sean; Schneider, Philipp; Von Schneidemesser, Erika
We propose operational definitions and a classification framework for air quality sensor-derived data, thereby aiding users in interpreting and selecting suitable data products for their applications. We focus on differentiating independent sensor measurements (ISM) from other data products, emphasizing transparency and traceability. Recommendations are provided for manufacturers, academia,andstandardizationbodiestoadoptthesedefinitions,fosteringdataproductdifferentiation and incentivizing the development of more robust, reliable sensor hardware
Open Air Quality Data Platforms for Environmental Health Research and Action
(2025) Marciel, Colleen; Bratburd, Jennifer; Diez, Sebastian; Duncan, Sara; Malings, Carl; Pant, Pallavi
PURPOSE OF REVIEW: Air pollution remains the greatest environmental threat to public health, and significantly impacts many aspects of human life. This review surveys digital platforms that provide data openly and make air quality data available for use and analysis by environmental health researchers for scientific research and to inform air quality action. RECENT FINDINGS: Successful programs that rely on different types of open air quality data have been observed and exist as models for regions that have yet to improve their air quality. However, disparities remain in the availability and granularity of generated air quality data in resource-rich and resource-poor regions. Even if air quality data are made available and open, their usability and actionability still remain challenging. Determinants of usability may include the user’s technical know-how and ability to deal with disparate data; compute capabilities; barriers in data sharing and data generation; and misuse and misclassification of data and levels and sources of exposure. However, the synthesis of different sources of data and advancements in modeling may help fill in spatiotemporal gaps in many areas of the world. In addition, the democratization of air quality data is facilitated by advancements in air quality data generation (e.g., data collection by open-source air sensors) and the ability to contribute to global, open-access, publicly available repositories that openly share data. Many open data platforms exist for sharing and accessing ground-based/in-situ data, satellite remote sensing data, and modeled or otherwise derived outputs. Online platforms that allow visualization and analysis without the need to download software are also now widely available. Despite wide availability, disparities in accessibility exist—expansion and support through interdisciplinary collaboration and continuous funding support for air quality data is essential for the continuous global benefit and community-specific action to address air quality as an environmental health issue.
Módulos itinerantes para la remediación de cuerpos de agua
(Universidad del Desarrollo. Facultad de Arquitectura y Arte, 2026) Avendaño Castillo, María Paz; Nazar Navarrete, Andrea
La génesis de esta investigación radica en la búsqueda de nuevos enfoques para la conservación y puesta en valor de áreas naturales. Esto se debe a que la contaminación ambiental es un fenómeno impulsado por la inconsciencia de actividades humanas.
Tomando como tema de investigación: Arquitectura como máquina de recuperación ambiental a causa de que, en Chile, hay problemáticas en aumento cuya evaluación no ha considerado las medidas necesarias para su resolución. Comunidades, agrupaciones y autoridades locales han tomado medidas legales para visibilizar el perjuicio al ecosistema, en concreto el foco está en los lagos y lagunas afectados por eutrofización, un fenómeno que deriva de la agricultura, industria y turismo con repercusiones en la salud de las personas, la biodiversidad y en la población de organismos vivos de un cuerpo de agua.
Como respuesta arquitectónica se toma el caso de: Módulos Itinerantes para la remediación de cuerpos de agua. Es un sistema basado en una estructura desplegable que la fitorremediación para actuar sobre cuerpos de agua. Para iniciar este proyecto se escogió el lago Villarrica, el lago más contaminado en Chile, para iniciar con un sistema de alcance nacional gradual. Estos sistemas aparte de ser itinerantes serán de carácter modular y adaptable, se trasladarán por distintos lagos y lagunas, potenciando desde la mención de innovación y emprendimiento un concepto clave: ser un proyecto que busca adaptarse y evolucionar según corresponda a su territorio y a sus usuarios. Impulsando de esta manera la recuperación de cuerpos de agua gracias a la itinerancia del sistema arquitectónico.
Instituto y Edificio Productivo Agrícola Laja
(Universidad del Desarrollo. Facultad de Arquitectura y Arte, 2026) Quezada Carrasco, Francisco Elián; Martínez, Diego
La agricultura, como actividad perteneciente al sector primario de la economía, se define por la transformación del entorno natural con el propósito de adaptarlo y optimizar su productividad. Esta práctica incide de manera directa en los sistemas ecológicos globales. En el año 2022, las emisiones derivadas de los sistemas agroalimentarios alcanzaron aproximadamente 16.200 millones de toneladas de dióxido de carbono equivalente, lo que representa un incremento del 10% en comparación con el año 2000, según la FAO1. Los principales factores que participan en este incremento son el crecimiento acelerado de la población mundial y la expansión de los centros urbanos, procesos que no solo generan una presión en los ecosistemas, sino también en la gestión de los recursos naturales asociados a su desarrollo. El crecimiento de la escasez de los recursos naturales sugiere la implementación de sistemas nuevos, prácticas y tecnologías productivas innovadoras que mejoren las limitaciones de los modelos tradicionales, promoviendo ciclos urbanos más sostenibles y resilientes.
Ante esta problemática, el objetivo de la presente investigación es analizar el potencial de las nuevas técnicas agrícolas —particularmente la agricultura vertical— como una estrategia sostenible capaz de optimizar el uso de los recursos naturales, incrementar la producción de alimentos y adaptarse a espacios reducidos dentro del tejido urbano de ciudades intermedias como Laja, Chile. Asimismo, se busca explorar su rol como catalizador de reactivación productiva local, considerando que la actividad agrícola en la zona ha disminuido desde 2018
según datos del SII, siendo desplazada por el monocultivo forestal.
Para la construcción del marco teórico atingente, se recurrirá al estudio de fuentes bibliográficas y antecedentes técnicos que permitan identificar los componentes esenciales, para el desarrollo de una propuesta arquitectónica coherente con las necesidades territoriales y ambientales del lugar.
Evacuation patterns and socioeconomic stratification in the context of wildfires
(2025) Naushirvanov, T.; Elejalde, E.; Kalimeri, K.; Omodei, E.; Karsai, M.; Ferres, Leonardo
Wildfires are becoming more frequent and intense, leading to increased evacuation events that disrupt mobility and socioeconomic structures, impacting access to resources, employment, and housing. Understanding the interplay between these factors is crucial for developing effective mitigation and adaptation strategies. We analyse evacuation patterns during the wildfires that occurred in Valparaíso, Chile, on February 2-3, 2024, using high-definition mobile phone records. Applying a causal inference approach combining regression discontinuity and difference-in-differences, we focus on socioeconomic stratification to isolate the wildfire impact on different groups. We find that many people spent nights away from home, with the lowest socioeconomic group staying away the longest. Overall, people reduced their mean and median night-to-night travel distances during the evacuation. Movements initially became irregular but later concentrated in areas of similar socioeconomic status. Finally, we demonstrate a comparability potential of the mobile phone records to the Facebook Disaster Maps, although the latter have a coarse time resolution and are generated only after the wildfire onset. Our results highlight the role of socioeconomic differences in evacuation dynamics, offering valuable insights for response planning.
Satellite quantification of methane emissions from South American countries: a high-resolution inversion of TROPOMI and GOSAT observations
(2025) Hancock, Sarah E.; Jacob, Daniel J.; Chen, Zichong; Nesser,Hannah; Davitt, Aaron; Varon, Daniel J.; Sulprizio, Melissa P.; Balasus, Nicholas; Estrada, Lucas A.; Cazorla, María; Dawidowski, Laura; Diez, Sebastián; East, James D.; Penn, Elise; Randles, Cynthia A.; Worden, John; Aben, Ilse; Parker, Robert J.; Maasakkers, Joannes D.
We use 2021 TROPOMI and GOSAT satellite observations of atmospheric methane in an analytical inversion to quantify national methane emissions from South America at up to 25km×25km resolution.
From the inversion, we derive optimal posterior estimates of methane emissions, adjusting a combination of national anthropogenic emission inventories reported by individual countries to the United Nations Framework Convention on Climate Change (UNFCCC), the UNFCCC-based Global Fuel Exploitation Inventory (GFEIv2), and the Emissions Database for Global Atmospheric Research (EDGARv7) as prior estimates. We also evaluate two alternative wetland emission inventories (WetCHARTs and LPJ-wsl) as prior estimates. Our best posterior estimates for wetland emissions are consistent with previous inventories for the Amazon but lower for the Pantanal and higher for the Paraná. Our best posterior estimate of South American anthropogenic emissions is 48 (41–56)Tga−1, where numbers in parentheses are the range from our inversion ensemble. This is 55% higher than our prior estimate and is dominated by livestock (65% of anthropogenic total). We find that TROPOMI and GOSAT observations can effectively optimize and separate national emissions by sector for 10
of the 13 countries and territories in the region, 7 of which account for 93% of continental anthropogenic emissions: Brazil (19 (16–23)Tga−1), Argentina (9.2 (7.9–11)Tga−1), Venezuela (7.0 (5.5–9.9)Tga−1), Colombia (5.0 (4.4–6.7)Tga−1), Peru (2.4 (1.6–3.9)Tga−1), Bolivia (0.96 (0.66–1.2)Tga−1), and Paraguay (0.93 (0.88 1.0) Tga−1). Our estimates align with the prior estimates for Brazil, Bolivia, and Paraguay but are significantly higher for other countries. Emissions in all countries are dominated by livestock (mainly enteric fermentation) except for oil–gas in Venezuela and landfills in Peru. Methane intensities from the oil–gas industry are high in Venezuela (33%), Colombia (6.5%), and Argentina (5.9%). The livestock sector shows the largest difference
Optimization of Water and Land Allocation in Fruit Orchards over a 20-Year Period
(2025) Quezada, Luciano; Holzapfel Eduardo; Kuschel-Otárola, Mathias; Lillo-Saavedra, Mario; Rivera, Diego; Souto, Camilo; Lagos, Octavio; Palma, Diego
This study proposes a nonlinear programming model for the optimization of water and land allocation in a 1000 ha orchard over a 20-year period to maximize farmers’ net profits. Different scenarios were evaluated, including equitable and unrestricted land allocation, and the risks associated with fruit production were considered. Additionally, a sensitivity analysis that focused on the variability of labor and water availability was conducted. The results reveal that with equitable land allocations and no constraints on the cultivated area, cherry emerges as the most profitable crop, although there are large risks associated with its price volatility. The introduction of risk and land allocation constraints highlights the importance of crop diversification in mitigating economic risks. A sensitivity analysis indicated that reductions in water and labor availability significantly affect the optimal cropping pattern of an orchard, suggesting that the efficient and adaptive management of resources is required. The proposed optimal cropping pattern maintains the economic viability of the orchard even with 70% and 24% reductions in water and labor, respectively. This approach underscores the importance of implementing resilient and sustainable agricultural strategies to ensure food security and increase economic stability in the face of changing climatic and labor conditions.
Management of Cervicofacial Necrotizing Fasciitis of Peritonsillar Origin: A Case Report
(2025) Tapia Contreras, Pedro; Matus-Miranda, Gustavo; Zeballos-Cofré, Jessica; Carvajal-Guzmán, Melissa; Jollán, Florencia; Díaz-Abarza, Sofía
Necrotizing fasciitis (NF) is a rare, rapidly progressing, and severe infection of subcutaneous tissues and muscle fascia that can be fatal. It causes rapid tissue necrosis through pathogen-induced vasoconstriction and thrombosis. While commonly found in the torso, abdomen, and limbs, it rarely affects the head and neck. Effective treatment includes early diagnosis, surgery, antibiotics, and hyperbaric oxygen therapy, though mortality remains high. A 40-year-old man with a history of uncontrolled diabetes mellitus (DM) presented with increased volume, erythema, and cramps in the cervical and upper thoracic area. The main diagnosis was NF, requiring surgical debridement of the affected tissue. Despite therapeutic efforts, the patient succumbed to sepsis and multiple organ failure. NF is a life-threatening infection with a very low incidence but a high mortality rate. Cervical NF often arises from odontogenic infections and is associated with systemic factors like diabetes and obesity. Early diagnosis is challenging, but Computed tomography (CT) and the Laboratory risk indicator score for necrotizing fasciitis (LRINEC) score are essential. Effective treatment includes surgical debridement, broad-spectrum antibiotics, and hyperbaric oxygen therapy. NF remains a critical condition with high mortality, underscoring the need for early recognition and aggressive treatment strategies to improve patient outcomes.
Surgically Treated Maxillofacial Fractures in Dr. Franco Ravera Zunino Hospital in Chile: a Retrospective Study of 5 Years Experience
(2025) Tapia Contreras, Pedro; Matus-Miranda, Gustavo; Molinare-Severino, Pablo; Zeballos-Cofré, Jessica; Moreno-Zárate, José; Matamoros-Rojo, Cristian; Sepúlveda-Quezada, Ricardo; Jollán, Florencia; Díaz-Abarza, Sofía
Maxillofacial trauma is one of the fields of surgical activity in our specialty and constitutes a relevant problem in highly complex hospitals, the presence of our specialists being essential within an interdisciplinary team for the resolution of this type of pathology. An adequate management and early treatment is essential from the moment the patient is admitted, without leaving aside the sequelae and the subsequent rehabilitation work for the work and daily reinsertion of the patients. The purpose of this work is to present the experience of the Maxillofacial Surgery team of the Rancagua Hospital in the surgical resolution of 320 maxillofacial fractures with a retrospective review of 5 years. A study was carried out with analysis of the surgical protocols of patients operated on for maxillofacial trauma, in the central pavilion, under general anesthesia, in a period of 5 years. The variables analyzed were diagnosis, age, sex, compromised facial third, type of fracture, approaches used, and type of rigid internal fixation. 368 surgical procedures were performed. The average age of the operated patients was 36 years, with a predominance of the male sex (80.4 %), the middle third was the most affected (49.1 %) followed by fractures of the lower third of the face (35.5 %). It is necessary to develop epidemiological investigations of these pathologies in order to obtain demographic conclusions and contribute to unifying diagnostic and treatment criteria, thus establishing efficient prevention and treatment policies in relation to each service and as a whole at the public health level.
Influencia vertical del contacto prematuro en la determinación de la relación oclusal de modelos articulados
(2025) Deck-Glaves, Bárbara; Belkner-Cinquemani, Mark; Casamitjana-Schiappacasse, Francisca; Buchi-Velázquez, Agustina; Herrera-Muñoz, Alisson
El estudio de la oclusión ha sido un tema de gran interés durante años y conocer los problemas relacionados es esencial para la ortodoncia.
Objetivo:
Este estudio busca cuantificar el efecto vertical y sagital interoclusal producido por un aumento de contacto prematuro de 0.5mm y 1mm en modelos de estudio y analizado según biotipo facial y clase esqueletal.
Materiales y métodos:
Fueron estudiados 30 modelos de pacientes, los cuales fueron montados en relación céntrica en articulador semiajustable. Se hicieron incrementos verticales sobre la superficie completa del contacto prematuro, mediante bloques de resina y fueron escaneados en oclusión, para luego compararlos en sentido vertical y sagital en software Blender.
Resultados:
Existe diferencia significativa en los cambios producidos tanto a nivel vertical como sagital. El mayor cambio observado fue en sentido sagital anterior en biotipo dolicofacial. No se encontró diferencia significativa al analizar el total de la muestra según biotipo facial ni clase esqueletal.
Conclusión:
Un aumento selectivo de la dimensión vertical del contacto prematuro, sí influye en la relación vertical y sagital interoclusal.
Recomendaciones chilenas para poligrafía respiratoria en pediatría. Sociedad Chilena de Neumología Pediátrica, Sociedad Chilena de Enfermedades Respiratorias y Sociedad Chilena de Medicina del Sueño
(2025) Zenteno Araos, Daniel; Brockmann Veloso, Pablo; Abara Elías, Selim; Bertrán Salinas, Katalina; Oyarzún Aguirre, Ignacio; Nayar Escobar, Stefhanie; Astudillo Maggio, Claudia; Campos Olmedo, Carolina; Escobar Adaros, Pía; Navarro Riquelme, Juan Andrés; Moya-Isammitt, Ana; Torres-Puebla, Gerardo; Moscoso Altamira, Gonzalo; Farbinger Pérez, Franz; Alarcón Grandón, Ricardo; Hernández Gómez, Alejandra
Los Trastornos Respiratorios del Sueño (TRS) son muy prevalentes y se encuentran subdiagnosticados en la población pediátrica. La prueba de referencia para el diagnóstico y su categorización es la polisomnografia (PSG), cuyo acceso es limitado en nuestro medio. Por esto, la poligrafia (PG) es una alternativa más accesible y versátil, que contribuye a disminuir la brecha diagnóstica de los TRS a nivel local. En estas recomendaciones, los autores, miembros de la Sociedad Chilena de Neumología Pediátrica (SOCHINEP), Sociedad Chilena de Enfermedades Respiratorias (SER-Chile) y la Sociedad Chilena de Medicina del Sueño (SOCHIMES) se plantearon como objetivo establecer directrices para el uso de PG en pediatría. Se profundiza sobre aspectos técnicos, aspectos prácticos e interpretación; incluyendo comentarios específicos sobre poblaciones especiales como menores de 3 meses, hospitalizados en unidades críticas, pacientes con enfermedades neuromusculares, obesidad, malformaciones craneo-faciales y ventilados crónicos. De esta forma, se establecen recomendaciones aplicables para todo Chile en el uso de la PG como una herramienta confiable y estandarizada en diferentes escenarios clínicos en pediatría.
Interpretable machine learning model for characterizing magnetic susceptibility-based biomarkers in first episode psychosis
(2025) Franco, Pamela; Montalba, Cristian; Caulier, Raúl; Milovic, Carlos; González, Alfonso; Ramirez, Juan; Undurraga, Juan; Salas, Rodrigo; Crossley, Nicolás; Tejos, Cristian; Uribe, Sergio
Background and purpose: Several studies have shown changes in neurochemicals within the deep-brain nuclei of patients with psychosis. These alterations indicate a dysfunction in dopamine within subcortical regions affected by fluctuations in iron concentrations. Quantitative Susceptibility Mapping (QSM) is a method employed to measure iron concentration, offering a potential means to identify dopamine dysfunction in these subcortical areas. This study employed a random forest algorithm to predict susceptibility features of the First-Episode Psychosis (FEP) and the response to antipsychotics using Shapley Additionality Explanation (SHAP) values.
Methods: 3D multi-echo Gradient Echo (GRE) and T1-weighted GRE were obtained in 61 healthy-volunteers (HV) and 76 FEP patients (32 % Treatment-Resistant Schizophrenia (TRS) and 68 % treatment-Responsive Schizophrenia (RS)) using a 3T Philips Ingenia MRI scanner. QSM and R2* were reconstructed and averaged in twenty-two segmented regions of interest. We used a Sequential Forward Selection as a feature selection algorithm and a Random Forest as a model to predict FEP patients and their response to antipsychotics. We further applied the SHAP framework to identify informative features and their interpretations. Finally, multiple correlation patterns from magnetic susceptibility parameters were extracted using hierarchical clustering.
Results: Our approach accurately classifies HV and FEP patients with 76.48 ± 10.73 % accuracy (using four features) and TRS vs RS patients with 76.43 ± 12.57 % accuracy (using four features), using 10-fold stratified cross-validation. The SHAP analyses indicated the top four nonlinear relationships between the selected features. Hierarchical clustering revealed two groups of correlated features for each study.
Conclusions: Early prediction of treatment response enables tailored strategies for FEP patients with treatment resistance, ensuring timely and effective interventions.
Mechanical Instability After Civilian Thoracolumbar Gunshot Injuries: A Systematic Review to Support Classification Development
(2025) Ricciardi, Guillermo; Cirillo, Ignacio; Cabrera, Juan; Alvarenga, Otávio; Neves, Emiliano; Carazzo, Charles; Dittmar, Michael; Guiroy, Alfredo; Yurac, Ratko; Schroeder, Gregory
Study DesignSystematic Review.ObjectivesIdentify risk factors for mechanical instability in thoracolumbar gunshot wounds to develop a new classification system.MethodsA systematic review following PRISMA 2020 guidelines was conducted across multiple databases from January 1, 1990, to September 12, 2024 (PROSPERO: CRD42023458804).ResultsOf 2400 records, 33 studies (3195 patients) met inclusion criteria, mostly retrospective and single-center, with varying definitions of instability. Direct comparison was limited due to clinical heterogeneity. Only 12 studies defined mechanical instability, mainly using the Denis three-column theory. Instability was reported in less than 10% of cases, except for one higher-rate outlier. The main markers included vertebral body comminution and potential ligamentous injury. Management was mainly conservative, with a low fixation rate (1.5-9.7%). Imaging relied on CT and static X-rays, with some studies advocating for dynamic radiographs.ConclusionThere is a lack of standardized definitions for mechanical instability in civilian thoracolumbar gunshot injuries. Four recurrent unstable patterns were detected, with vertebral body comminution as the most consistent marker. The need for a standardized classification system and further prospective studies is evident.
Intervenciones psicoeducativas que facilitan la adaptación del box dental y la aplicación de odontología preventiva de niños y adolescentes con Trastorno del Espectro Autista
(2025) Señor Zapata, María Fernanda; Narváez, Carmen Gloria; Hernández Reeve, María Alejandra
Actualmente Trastorno del Espectro Autista (TEA) no se define como un solo trastorno, sino un conjunto de estos. Estos individuos tienen un desarrollo atípico: alteraciones en las funciones cerebrales ejecutivas como en la interacción social, comunicación verbal-no verbal y la conducta, actividades e intereses. El especialista en odontología pediátrica debe entender el trasfondo de las características de los individuos con este trastorno y conocer las herramientas existentes para proveer una atención odontológica de calidad adaptada a las necesidades de ellos. El objetivo de este estudio fue identificar las estrategias psicoeducativas facilitadoras de la adaptación del box dental y la aplicación de odontología preventiva en niños y adolescentes con TEA. Se realizó una revisión sistemática narrativa con una búsqueda en la base de datos Pubmed, Cochrane Library, Web of Science y Wiley, de artículos relacionados publicados entre los años 2015 y 2023. De un total preliminar, después de realizado los filtros correspondientes, se llegó a un total de 19 artículos seleccionados para esta revisión. Estas intervenciones incluyen Pedagogia Visual, pictogramas, imágenes, tecnología como tablets e imágenes digitales, historias visuales, SADE, PECS y terapia Sensorial. El tratamiento con cualquiera de las técnicas facilitadoras antes mencionadas son tratamientos largos que necesitan múltiples sesiones tanto en el box odontológico como en la instrucción de técnica de cepillado para lograr el éxito. Destaca la necesidad del trabajo intersectorial entre salud y educación, especialmente en el campo de la odontología preventiva, para lograr una atención menos costosa, ya sea para el Estado o para los propios cuidadores, evitando procedimientos riesgosos de elevado costo como es la atención bajo anestesia general.
Community-Based Rehabilitation and Patient-Centered Outcomes in Survivors of Critical COVID-19 Attending an Intensive Care Recovery Clinic
(2025) González, Felipe; Haezebrouck , Evan; Fresenko, Lindsey; Sevin, Carla; Slone, Stacey; Montgomery, Ashley; Kalema, Anna; Ginoza, Lori; Martinez, Clarisa; Martinez, Clarisa; Biehl, Michelle; Kelley, Soibhan; Johnson, Joshua; Mar, Matthew; Mayer, Kirby
Objective: To examine the occurrence of physical and cognitive impairments among survivors of critical coronavirus disease of 2019 (COVID-19) who attend an intensive care unit (ICU) recovery clinic and describe their utilization of community-based rehabilitation (physical and occupational therapy).
Design: Retrospective, observational cohort study and multisite practice analysis.
Setting: ICU recovery clinics at 4 academic medical centers.
Participants: Adults (median age 56 [interquartile range, {IQR}, 47-64] years, 60% female) surviving acute respiratory failure caused by COVID-19 who required advanced respiratory support.
Main outcome measures: Six-minute walk test (6MWT) and Montreal Cognitive Assessment (MoCA).
Results: Patients attended the ICU recovery clinic (n=163) in a median of 43 (IQR, 30-60) days after discharge. Ninety-four patients (58%) participated in at least 1 community-based rehabilitation session, 52 (32%) never participated, and 17 (10%) did not have data available. Patients walked a median [IQR] of 282 [150-390] meters on the 6MWT, and the median Short Physical Performance Battery (SPPB) score was 8 [4-11] with 63% of patients classified as physically frail (score ≤9/12). The median MoCA score was 26 [22-27], with 37% at least mild cognitive impairment (score of ≤26). Among patients who were driving before ICU admission, 44% had not returned to driving after hospitalization, and an additional 21% reported driving with new limitations. Patients who participated in at least 1 community-based rehabilitation session had longer ICU lengths of stay as well as worse performance on the 6MWT and SPPB at discharge compared with individuals not receiving postdischarge rehabilitation (P<.001).
Conclusions: Survivors of acute respiratory failure caused by critical COVID-19 who attended an ICU recovery clinic are at high risk of physical and/or cognitive impairments. Two-thirds of survivors participated in physical or occupational therapy at home or an outpatient center after hospital discharge. Patients with longer lengths of stay and more physical impairments at discharge are more likely to participate in community-based rehabilitation interventions.
Therapeutic Alternatives of Buccal Mucosa Grafting in Extraoral Reconstructions: a Case of Fournier's Gangrene
(2025) Tapia Contreras, Pedro; Sarzosa Enrriquez, Marcelo; Matus-Miranda, Gustavo; Pizzi Lazo, Pablo; Díaz-Abarza, Sofía; Jollán, Florencia
Buccal mucosal grafts are versatile in medical practice, documented minimally despite potential in otolaryngology, ophthalmology, dermatology, plastic surgery and urology. They offer advantages such as being hairless, easily obtained, and infection-resistant, with a thin, highly vascularized epithelial layer aiding absorption and reducing contracture risk. Complications from oral donor sites, like pain and sensory changes, are known, relevant in conditions such as Fournier's gangrene, necessitating urgent surgical intervention and often reconstruction. We present a case report of a 45-year-old male with Fournier's gangrene treated jointly by urology and maxillofacial surgery. Buccal mucosal grafts were harvested from the inner cheek mucosa for simultaneous urethral reconstruction. The procedure preserved the parotid duct, obtaining a graft comprising mucosal, submucosal, and glandular tissues, applied to the urethral defect with bovine dermis coverage. Postoperative recovery was uneventful, with successful catheter removal in 2 weeks and complete donor site healing in 6 months. Buccal mucosal grafts prove effective in complex reconstruction, offering structural integrity and minimal morbidity. Despite challenges like graft contraction and limited tissue availability in severe cases, buccal mucosal grafts are favored for reliability and patient satisfaction in reconstructive needs, notably urethral reconstruction. The evidence shows a high success rate in most of the uses of buccal mucosal grafts, so it is recommended as an effective and safe graft for extraoral reconstructions, particularly urethral reconstruction, where the Maxillofacial Surgeon is part of the interdisciplinary team. Awareness of potential complications and procedural limitations ensures optimal outcomes and patient care.