Abstract The Galapagos Islands, a natural heritage of humanity, have meticulous control of wildlife and strict inspection of the number and frequency of visitors. The increase in tourists, apart from positive aspects, and the increase in population generates a greater demand for electrical energy. In this sense, Galapagos seeks a boost to comprehensive energy sustainability, replacing thermal energy with environmentally friendly Non-Conventional Renewable Energy (NCRE), through the optimal energy management project through the Conolophus microgrid project. This document analyzes the optimal management of electrical energy (short-term economic dispatch) considering the stochasticity presented by the high insertion of NCRE in the Santa Cruz-Baltra electrical system. For it. The free simulation software called “SimSEE” (Electric Energy Systems Simulator) is used, where operational scenarios are modeled with and without the Conolophus project in order to analyze its impact on the planning of the operation of the Santa Cruz-Baltra system.

Resumen: Las islas Galápagos, patrimonio natural de la humanidad, cuentan con un control minucioso de la vida silvestre y ejercen estricta inspección del número y frecuencia de visitantes. El incremento de turistas, aparte de aspectos positivos, y el incremento de la población genera una mayor demanda de energía eléctrica. En este sentido, Galápagos busca un impulso a la sostenibilidad energética integral, reemplazando la energía térmica con Energías Renovables No Convencionales (ERNC), amigables con el medio ambiente, a través del proyecto de gestión óptima de la energía mediante el proyecto de microrred Conolophus. En el presente documento se analiza la gestión óptima de la energía eléctrica (despacho económico de corto plazo) considerando la estocasticidad que presenta la alta inserción de ERNC en el sistema eléctrico Santa Cruz-Baltra. Para ello. se usa el software libre de simulación denominado “SimSEE” (Simulador de Sistemas de Energía Eléctrica), donde se modelan escenarios operativos con y sin el proyecto Conolophus con la finalidad de analiza su impacto en la planificación de la operación del sistema Santa Cruz-Baltra.

Abstract Vulvar leiomyosarcoma is a malignant tumor with a very rare presentation; there are about 50 cases published in the literature. Its prognosis is poor due to its local recurrence and hematogenous dissemination, with mainly lung and liver involvement. We present the case of a 30-year-old patient with a rapidly growing palpable tumor on the right labia majora, which, due to its size and vascular component, was embolized by interventional radiology before surgical removal, with good clinical evolution.

Resumen El leiomiosarcoma vulvar es un tumor maligno de presentación muy rara, existen publicados cerca 50 casos en la literatura. Su pronóstico es malo, por su recidiva local y diseminación por vía hematógena con principal afección pulmonar y hepática. Se presenta el caso de una paciente de 30 años con tumoración palpable de rápido crecimiento en labio mayor derecho, el cual debido a su tamaño y componente vascular fue embolizado por radiología intervencionista previo a extirpación quirúrgica, con buena evolución clínica.

Abstract Objective To evaluate surgeons’ performance in resecting CAM-type deformities using a realistic arthroscopic surgery simulator. Methods An arthroscopic simulator was created using low-cost materials with the help of a GTMax Core A1 3D printer and the programs Invesalius and Meshmixer 2017, which were used to develop femoral head parts in ABS material, with the presence of a CAM-type deformity, to mimic a femoroacetabular impact situation. After the operations were performed by 16 surgeons, the femurs were compared to a previous model with deformity and another without, using Cloudcompare, and parameters such as the volumetric difference between the operated femurs, with and without deformity, the minimum and maximum distance between them, the percentage of the deformity resected, the estimated time for total resection of the deformity, as well as a qualitative analysis based on the images and graphs provided by the program representing the areas of the parts resected, were evaluated at the end. Results The average resection speed was 34.66 mm3/min (SD = 46 mm3/min, max = 147.33; min = −2.66). The average resection rate was 26.2% (SD = 34.7%, max = 111; min = −2). Qualitative analysis showed hyporesection of deformities and sometimes hyperresection of nondeformed areas. The simulator was highly rated by the surgeons, with a tactile sensation very similar to real surgery, according to them. Conclusion Arthroscopic simulators have proved very useful in training less experienced surgeons. surgeons CAMtype CAM type lowcost low cost A D 2017 material situation 1 Cloudcompare them resected end 3466 34 66 34.6 mm3min mmmin mm3 mm SD 4 147.33 14733 147 33 −2.66. 266 −2.66 . 2 −2.66) 262 26 26.2 347 7 34.7% 111 −2. −2 −2) 201 346 3 6 34. 147.3 1473 14 −2.6 26. 34.7 11 − 20 147.

Resumo Objetivo Avaliar o desempenho de cirurgiões na ressecção de deformidades tipo CAME fazendo uso de um simulador realista de cirurgia artroscópica. Métodos Um simulador artroscópico foi criado a partir de materiais de baixo custo com auxílio de uma impressora 3D GTMax Core A1 e dos programas Invesalius e Meshmixer 2017, que foram utilizados para criar peças de cabeça de fêmur em material ABS, com a presença de uma deformidade tipo CAME, a fim de mimetizar uma situação de impacto femoroacetabular. Após as operações serem realizadas por 16 cirurgiões, os fêmures foram comparados a um modelo prévio com e outro sem deformidade pelo programa Cloudcompare, sendo avaliados ao final parâmetros como diferença volumétrica entre os fêmures operados, com e sem deformidade, distância mínima e máxima entre eles, porcentagem da deformidade ressecada, tempo estimado para ressecção total da deformidade, além de uma análise qualitativa feita com base nas imagens e gráficos fornecidos pelo programa representando as áreas das peças efetivamente ressecadas. Resultados A velocidade média de resseção foi de 34,66mm3/minuto (DP = 46 mm3/min, max = 147,33 mm3/min; min = −2,66 mm3/min). A média de ressecção obtida foi de 26,2% (DP = 34,7%, max = 111%; min = −2%). A análise qualitativa demonstrou uma hiporresecção das deformidades e, por vezes, hiperresecção de áreas não deformadas. O simulador foi muito bem avaliado pelos cirurgiões, tendo uma sensação tátil bem semelhante à cirurgia real segundo os mesmos. Conclusão Simuladores artroscópicos se mostraram muito úteis no treinamento de cirurgiões menos experientes. artroscópica D 2017 ABS femoroacetabular 1 Cloudcompare operados eles ressecada ressecadas 3466mm3minuto mmminuto 34 66mm3 minuto mm DP 4 mm3min mmmin mm3 mm3/min 14733 147 33 147,3 266 2 66 −2,6 mm3/min. . mm3/min) 262 26 26,2 347 7 34,7% 111% 111 −2%. −2% −2%) vezes deformadas mesmos experientes 201 3 66mm 1473 14 147, 6 −2, 26, 34,7 11 −2 20 34, −

Abstract: This paper introduces the Distributed Utility Function Algorithm (D-AFU) as a notable progression in managing and optimizing network traffic within distributed settings. Based on the utility function principle, D-AFU dynamically adjusts data rate in response to ever-changing network demands, with optimal performance and a higher user experience. Contrary to the centralized model, D-AFU employs a distributed, scalable and resilient against failures and system overloads mechanism. Its efficiency was validated using the NS-3 simulator. Three main metrics were used: the data rate allocation, utility per session, and fairness (quantified by the Gini coefficient). D-AFU displays exceptional performance and low latency, particularly vital for real-time applications with high Quality of Service (QoS) requirements.

Resumen: El artículo presenta el Algoritmo de Función de Utilidad Distribuida (D-AFU) como una notable evolución en la gestión y optimización del tráfico de red en entornos distribuidos. Basado en el principio de función de utilidad, D-AFU ajusta dinámicamente la velocidad de datos en respuesta a las demandas cambiantes de la red, con un rendimiento óptimo y una mejor experiencia para el usuario. A diferencia del modelo centralizado, D-AFU emplea un mecanismo distribuido escalable y con mayor resistencia contra fallos y sobrecargas del sistema. Su eficiencia fue validada utilizando el simulador NS-3. Se utilizaron tres métricas principales: la tasa de asignación de transmisión, la utilidad por sesión y la equidad (cuantificada por el coeficiente de Gini). D-AFU mostró un rendimiento excepcional, especialmente vital para aplicaciones en tiempo real que exigen alta Calidad de Servicio (QoS) y baja latencia.

Introdução: O ensino em cirurgia deve acompanhar a evolução das técnicas, procedimentos e tecnologia. Desde a década de 90 a videocirurgia vem se desenvolvendo e hoje é a primeira escolha para muitos procedimentos em cirugia geral. Com características diferentes da cirurgia convencional, os residentes treinaram em simuladores para adaptação. A literatura médica mundial já apresenta programas consagrados para treinamento entre eles os Fundamentos da Cirurgia Laparoscópica (FLS). A avaliação das habilidades técnicas cirúrgicas é uma ferramenta importante em programas de residência médica. Objetivo: Avaliar o impacto do treinamento através de aquisição de habilidades dos médicos residentes em cirurgia geral antes e após treinamento teórico-prático em videocirurgia utilizando um simulador de baixa fidelidade baseado em exercícios do FLS. Método: Estudar de modo prospectivo a aquisição de habilidades de médicos residentes em cirurgia geral de primeiro e segundo ano (R1 e R2), antes e após realização de treinamento teórico-prático pré-definido. Conclusão: Houve melhora significativa com o treinamento atingindo níveis de conhecimento e aprimoramento semelhantes aos trabalhos da literatura mundial. A melhoria no desempenho dos residentes foi evidente em ambos os grupos da amostra. Aqueles do primeiro ano atingiram a concentração de conhecimento após o treinamento semelhante ao desempenho dos residentes de segundo ano na avaliação inicial, destacando que o treinamento sequenciado realizado equivale a um ano de prática no programa de residência geral de cirurgia

Introduction: Teaching in surgery must follow the evolution of medical techniques, procedures and technology. Since the 90s videosurgery has been developing and nowadays is the gold standard for many procedures in general surgery. As there are different characteristics from conventional surgery, residents need to practice in order to adapt to simulators. The world medical literature has established many training programs among them the Fundaments of laparoscopic Surgery (FLS). Evaluation of surgical technical abilities is a major tool for the residency programs. Objectives: To assess the effect of training acquiring skills of residents at first and second postgraduated level year (PGY1 and PGY2) before and after practice using low fidelity simulator based on tasks from FLS. Methods: A prospective study was conducted to determinate skills acquisition of residents at first and second postgraduated level year l (PGY1 and PGY2) before and after standardized practice using low fidelity simulator. Conclusions: There was a significant improve of the technical abilities reaching levels of improvement. Resident’s performance was evident in the sample groups. First year residents (PGY1) achieved knowledge retention after training similar to the performance of second in the initial assessment, suggesting that the sequenced training carried out is equivalent to one year of practice in the general surgery residency program

Introdução: O ensino em cirurgia convencional foi tradicionalmente baseado no modelo halstediano do “see one, do one and teach one” (veja um, faça um e ensine um); porém, com a bem sucedida propagação da cirurgia videolaparoscópica precisou ser adaptado para um novo modelo do “do many, mentored always” (fazer vários, sempre supervisionado). A nova era da cirurgia demanda treinamento sequencial, com crescente complexidade e repetição supervisionada para adquirir habilidades especificas prévias ao primeiro ato operatório. Objetivo: Desenvolver modelo para ensino e treinamento em videocirurgia com plataforma de baixo custo, fácil execução e baixa fidelidade com tarefas que utilizam materiais sintéticos. Método: Construiu-se com materiais de baixo custo plataforma utilizando apenas placa de madeira, poucos materiais de ferragem (parafuso simples, parafuso com porca tipo borboleta, gancho com rosca), folha de EVA (etileno acetato de vinila), tinta branca para artesanato e caneta hidrográfica. A amostra-teste foi composta por 15 cirurgiões gerais com mais de 10 anos de experiência em videolaparoscopia. Iniciou-se a avaliação com um vídeo explicativo com duração de 20 min. A seguir, cada cirurgião executou 5 tarefas gravadas para posterior análise e pontuação. Mediu-se as habilidades de acordo com a pontuação. Resultados: A plataforma foi útil e eficaz em reproduzir as atividades utilizadas para replicação do programa comparativo do Fundaments of Laparoscopic Surgery. A amostra de cirurgiões atingiu o tempo alvo definido como padrão pelo programa. Conclusão: A plataforma elaborada com materiais de baixo custo é de fácil aquisição, mostrou-se modelo eficaz para treinamento em videocirurgia, de fácil replicabilidade e construção, adaptável a vários modelos de tarefas, e feita com materiais sintéticos.

Introduction: Teaching in conventional surgery has traditionally been based on the Halstedian model of “see one, do one, and teach one”. However, with the widespread success of videolaparoscopic surgery, the teaching method needed to be adapted to a novel “Do many, always mentored” model. The modern era of surgery demands sequential training with progressively increasing complexity and supervised repetition, in order to acquire specific skills prior to the first surgical procedure. Objective: To develop a new experimental teaching and training with low cost and low fidelity platform for laparoscopic surgery using synthetic materials, and simple manufacturing. Method: A platform was built using low-cost materials easily found in hardware stores, consisting of a wooden board and a few hardware materials (threaded bolt, wing nut and bolt, threaded hooks), EVA sheet (ethylene vinylacetat), white crafting paint, and felt-tip pen. The sample consisted of 15 general surgeons with more than 10 years of experience in videolaparoscopy. The evaluation began with an explanatory video lasting 20 min. Next, each surgeon performed 5 recorded tasks for later analysis and scoring. Skills were measured according to the stablished score. Results: The developed platform was useful and capable of reproducing the tasks performed based on the program of Fundaments of Laparoscopic Surgery. All the surgeons of the sample group achieved the target time proposed for the program. Conclusion: Was shown that the proposed platform can be built using easily obtainable and low-cost materials, and it proved to be an effective model for training in laparoscopic surgery, being easy to replicate and construct. Additionally, this platform can be easily adapted to various models of tasks using materials similar to those found in other training programs, that are widely practiced and have been globally validated.

Abstract Objective: The aim of this study was to evaluate the effect of three training methodologies on the acquisition of psychomotor skills for laparoendoscopic single-site surgery (LESS), using straight and articulating instruments. Methods: A prospective study was conducted with subjects randomly divided into three groups, who performed a specific training for 12 days using three laparoscopic tasks in a laparoscopic simulator. Group-A trained in conventional laparoscopy setting using straight instruments and in LESS setting using both straight and articulating instruments. Group-B trained in LESS setting using straight and articulating instruments, whereas Group-C trained in LESS setting using articulating instruments. Participants´ performance was recorded with a video-tracking system and evaluated with 12 motion analysis parameters (MAPs). Results: All groups obtained significant differences in their performance in most of the MAPs. Group-C showed an improvement in nine MAPs, with a high level of technical competence. Group-A presented a marked improvement in bimanual dexterity skills. Conclusions: Training in LESS surgery using articulating laparoscopic instruments improves the quality of skills and allows smoother learning curves.

Resumen Objetivo: Evaluar el efecto de tres métodos de entrenamiento en la adquisición de habilidades psicomotrices para la cirugía laparoendoscópica por puerto único (LESS, laparoendoscopic single-site surgery) utilizando instrumental recto y articulado. Método: Se realizó un estudio prospectivo con sujetos divididos aleatoriamente en tres grupos, quienes realizaron un entrenamiento específico durante 12 días utilizando tres tareas laparoscópicas en un simulador laparoscópico. El grupo A entrenó en el entorno laparoscópico convencional con instrumentos rectos, y en el entorno LESS con instrumentos rectos y articulados. El grupo B entrenó en el entorno LESS con instrumentos rectos y articulados. El Grupo C entrenó en el entorno LESS con instrumentos articulados. El desempeño de los participantes se registró con un sistema de seguimiento en video y fue evaluado con 12 parámetros de análisis de movimiento (MAP, motion analysis parameters). Resultados: Todos los grupos obtuvieron diferencias significativas en su desempeño para la mayoría de los MAP. El grupo C mostró una mejora en nueve MAP, con un alto nivel de competencia técnica. El grupo A mostró una marcada mejora en la habilidad de destreza bimanual. Conclusiones: El entrenamiento en cirugía LESS con instrumentos articulados mejora la calidad de las habilidades adquiridas y permite curvas de aprendizaje más suaves.

ABSTRACT The development of the conceptual design of a technology for obtaining concentrated nitric acid at 99 % by weight from conventional nitric acid is presented through the analysis of 2 production alternatives, using a process simulator. For the conceptual design, process analysis techniques such as mathematical modeling, process simulation, optimization, economic analysis and Pinch analysis were used, among others. The process flow diagrams of both alternatives are also presented, as well as the validation of the mathematical model used to calculate the vapor - liquid balance in the water - nitric acid - magnesium nitrate system, as well as the sizing of the main equipment, optimizing the 2 feed and solvent inlet plates, as well as the heat transfer area of the heat exchange equipment. Finally, a summary of the economic analysis carried out for the two alternatives studied and the selection of the best one is presented.

RESUMEN Se presenta el desarrollo del diseño conceptual de una tecnología para la obtención del ácido nítrico concentrado al 99 % en peso a partir del ácido nítrico convencional mediante el análisis de 2 alternativas de producción, haciendo uso de un simulador de procesos. Para el diseño conceptual se utilizaron técnicas del análisis de proceso tales como la modelación matemática, la simulación de procesos, la optimización, análisis económico y análisis Pinch entre otras. Se presentan, además, los diagramas de flujo de procesos de ambas alternativas, la validación del modelo matemático empleado para el cálculo del equilibrio vapor - líquido en el sistema agua - ácido nítrico - nitrato de magnesio, así como el dimensionamiento de los equipos principales, optimizando los 2 platos de entrada de la alimentación y del solvente, así como el área de transferencia de calor de los equipos de intercambio térmico. Finalmente se expone un resumen del análisis económico realizado para las dos alternativas estudiadas y la selección de la mejor.

RESUMEN Introducción: el embarazo ectópico es en la actualidad un problema de salud a nivel mundial. El aumento de su incidencia se atribuye a las dificultades en el diagnóstico que muchas veces se presentan y a la morbilidad y la mortalidad que de él se derivan. Es una de las primeras causas de muerte en el primer trimestre de la gestación. Objetivo: valorar el embarazo ectópico como un dilema clínico para el diagnóstico. Métodos: se realizó una revisión bibliográfica narrativa que incluyó diversos textos, artículos, materiales impresos y digitales relacionados con el embarazo ectópico. Se consultaron las bases de datos y directorios SciELO, LILACS, Latindex, Medline y Scopus, mediante las palabras clave en español y operadores boléanos para ampliar los resultados: “hemorragias” AND “embarazo ectópico”. Fueron seleccionados 22 artículos originales y de revisión, en el contexto nacional e internacional, publicados entre 2000 y 2020. Desarrollo: en toda enfermedad nosológica un buen interrogatorio y un examen físico favorecen el diagnóstico, por muy difícil que este sea. Seguir los pasos del método clínico ayuda a obtener un diagnóstico certero y oportuno. Es de trascendental importancia que el médico conozca la fisiopatología y los elementos clínicos en el embarazo ectópico, lo que puede ir a buscar en un interrogatorio exquisito y un examen físico detallado. Conclusiones: la diversidad de presentaciones clínicas posibles ha llevado a considerarlo “el gran simulador de la Ginecología”, por lo que constituye un dilema clínico su diagnóstico en los diferentes niveles de atención de salud.

ABSTRACT Introduction: ectopic pregnancy is currently a world of health problem. The increase in its incidence is attributed to the difficulties in the diagnosis that are often presented and to the morbidity and mortality that derive from it. It is one of the first causes of death in the first quarter of pregnancy. Objective: assess ectopic pregnancy as a clinical dilemma for diagnosis. Methods: a narrative bibliographic review was carried out that included various texts, articles, printed and digital materials related to ectopic pregnancy. The databases and directories Scielo, Lilacs, Latindex, Medline and Scopus were consulted, through the keywords in Spanish and Bollean operators to expand the results: “Hemorrhages” and “Ectopic pregnancy”. 22 original and review articles were selected, in the national and international context, published between 2000 and 2020. Development: in every nosological illness a good interrogation and a physical examination favor the diagnosis, however difficult it may be. Following the steps of the clinical method helps to obtain an appropriate and timely diagnosis. It is transcendental that the doctor knows the pathophysiology and the clinical elements in ectopic pregnancy, which can go to look in an exquisite interrogation and a detailed physical examination. Conclusions: the diversity of possible clinical presentations has led to "the great simulator of gynecology", so it constitutes a clinical dilemma its diagnosis in the different levels of health care.

ABSTRACT Purpose: To assess the effect of the Coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency. Methods: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated. Results: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator’s cataract challenges (p<0.696). Conclusion: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic. Purpose 201 COVID19 COVID 19 (COVID-19 Methods retrospective study (201 prepandemic 202 (202 COVID-1 compared evaluated Results 127 256 respectively 502 50 2 50.2 4.2% 42 4 (4.2 49 9 4.9 p=0.314. p0314 p p=0.314 . 0 314 p=0.314) simulators s p<0.696. p0696 p<0.696 696 (p<0.696) Conclusion increase 20 COVID1 1 (COVID-1 (20 COVID- 12 25 5 50. 4.2 (4. 4. p031 p=0.31 31 p069 p<0.69 69 (p<0.696 (COVID- (2 (4 p03 p=0.3 3 p06 p<0.6 6 (p<0.69 (COVID ( p0 p=0. p<0. (p<0.6 p=0 p<0 (p<0. p= p< (p<0 (p< (p

ABSTRACT Understanding of various aerodynamic factors involved in flight trajectories is fundamental to design launch vehicles. First and foremost, computer simulation is an efficient way of predicting its behavior in the movement across the atmosphere. Considering that the available Brazilian version of Analysis, Simulation and Trajectory Optimization Software for Space Applications (Astos) does not simulate a controlled vehicle in six degrees of freedom (DoF), the aim of this article is to complement the Astos outcomes, particularly evaluating the trajectory of a controlled launch vehicle from liftoff to orbit injection, considering the model of rigid body dynamics with a six DoF. This approach carried out with an in-house developed simulator called Scott that simulated a multistage launcher with three flight configurations. In the Scott computer program, a launcher was modeled with differential equations in six DoF, coupled axes attitude control system, and aerodynamic coefficients that changed as a function of Mach number. These features improved the results generated by Astos software for the same configurations and the same initial conditions. Additionally, the results provided by Scott were close to actual vehicle in terms of attitude change and Mach number reached. vehicles foremost atmosphere Analysis (Astos DoF , (DoF) outcomes injection inhouse house program system conditions Additionally reached (DoF

ABSTRACT Purpose: To assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency. Methods: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated. Results: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator’s cataract challenges (p<0.696). Conclusion: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic. Purpose 201 COVID19 COVID 19 (COVID-19 Methods retrospective study (201 prepandemic 202 (202 COVID-1 compared evaluated Results 127 256 respectively 502 50 2 50.2 4.2% 42 4 (4.2 49 9 4.9 p=0.314. p0314 p p=0.314 . 0 314 p=0.314) simulators s p<0.696. p0696 p<0.696 696 (p<0.696) Conclusion increase 20 COVID1 1 (COVID-1 (20 COVID- 12 25 5 50. 4.2 (4. 4. p031 p=0.31 31 p069 p<0.69 69 (p<0.696 (COVID- (2 (4 p03 p=0.3 3 p06 p<0.6 6 (p<0.69 (COVID ( p0 p=0. p<0. (p<0.6 p=0 p<0 (p<0. p= p< (p<0 (p< (p

ABSTRACT The research relevance is predefined by the air travel number growth. Accordingly, the relevance of this issue is increasing, especially concerning air travel safety. Also, due to the increasing demand for international flights, it becomes essential to harmonize the standards and methodology of training aviation personnel. The research aims to consider the parameters of flight safety and the impact of the unification of training programs for aviation personnel. The conclusion that unification can significantly affect safety was made with the help of scientific and special methods, including analysis, synthesis, concretization, and generalization. An analysis of existing unification methods was conducted. The multi-crew pilot training program proved to be one of the most advanced compared to standard flight crew training programs. The method was determined to be a specialized training program tailored to the needs of the aviation industry and focused on training pilots for multi-crew and jet operations. The program is more challenging, intensive and dynamic, and includes a significant amount of simulator training. Traditional flight training programs, such as Private Pilot Licenses (PPL), Commercial Pilot Licenses (CPL), instrument qualification, and multi-engine rating, have a broader scope and provide pilots with more career opportunities. Simulator training has been identified as a critical component of many flight training programs and plays a vital role in flight safety. The study may be of interest to a range of readers concerned with the issue of standardizing aviation training and improving safety in aviation, including researchers, faculty, and students of higher education institutions in the aviation field. growth Accordingly Also flights personnel synthesis concretization generalization conducted multicrew multi operations challenging dynamic PPL, PPL , (PPL) CPL, CPL (CPL) qualification multiengine engine rating opportunities researchers faculty field (PPL (CPL

Abstract Background The application of botulinum toxin (BoNT) in the treatment of blepharospasm and hemifacial spasm (HS) is a well-established practice. However, neurology residency programs often rely on real patients for training, which has limitations in terms of patient availability and skill acquisition. Objective Assess the efficacy of a new facial phantom model for acquiring motor skills in BoNT application. Methods An anthropomorphic facial phantom model was developed in collaboration with a medical training simulator start-up. A group of seven neurologists and one ophthalmologist with expertise in BoNT application evaluated the model using an adapted learning object review instrument (LORI). The instrument assessed aspects such as: content quality, alignment of learning objectives, feedback and adaptation, motivation, presentation design, and accessibility. Results The facial phantom model received high scores in the LORI evaluation, with the highest ratings given to alignment with learning objectives and motivation. The model also scored well in terms of accessibility, content quality, and presentation design. However, feedback and adaptation received a lower score due to the static nature of the model. Conclusion The facial phantom model shows promise as a valuable tool for teaching and developing competence in BoNT application for HS and blepharospasm. The model reduces the reliance on real patients for training, providing a broader and safer learning experience for neurology residents. It also provides a realistic learning experience and offers portability, cost-effectiveness, and ease of manufacturing for use in various medical training scenarios. It is an effective and accessible tool for teaching BoNT application. (BoNT (HS wellestablished established practice However acquisition startup. startup start up. up start-up LORI. . (LORI) quality motivation design accessibility evaluation residents portability costeffectiveness, costeffectiveness cost effectiveness, effectiveness cost-effectiveness scenarios (LORI

Resumo Antecedentes A aplicação de toxina botulínica (TxB) no tratamento do blefaroespasmo e do espasmo hemifacial (EH) é uma prática bem estabelecida. No entanto, os programas de residência em neurologia frequentemente dependem de pacientes reais para treinamento, o que apresenta limitações em termos de disponibilidade de pacientes e aquisição de habilidades. Objetivo Avaliar a eficácia de um novo modelo de manequim facial para aquisição de habilidades motoras na aplicação de TxB. Métodos Foi desenvolvido um modelo antropomórfico de manequim facial em coloboração com uma empresa de simuladores de treinamento médico. Um grupo constituído por sete neurologistas e um oftalmologista com experiência em aplicação de TxB avaliou o modelo utilizando um instrumento adaptado de revisão de objeto de aprendizagem (LORI). O instrumento analisou aspectos como: qualidade do conteúdo, alinhamento dos objetivos de aprendizagem, feedback e adaptação, motivação, concepção da apresentação e acessibilidade. Resultados O modelo de manequim facial obteve pontuações altas na avaliação do LORI com os maiores escores em alinhamento com os objetivos de aprendizagem e motivação. O modelo também obteve boas pontuações em termos de acessibilidade, qualidade do conteúdo e concepção da apresentação. No entanto, o item feedback e adaptação recebeu uma pontuação média mais baixa, devido à natureza estática. Conclusão O modelo manequim facial mostra-se promissor como uma EH e blefaroespasmo. O modelo reduz a dependência de pacientes reais para treinamento portátil, de baixo custo e de fácil fabricação para uso em diversos cenários de treinamento, proporcionando uma experiência de aprendizagem mais ampla e segura para residentes de neurologia. Além disso, fornece uma experiência de aprendizagem realista e oferece portabilidade, economia e facilidade de fabricação para uso em vários cenários de treinamento médico. É uma ferramenta eficaz e acessível para o ensino da aplicação de TxB. (TxB (EH estabelecida entanto médico LORI. . (LORI) motivação acessibilidade baixa estática mostrase mostra se portátil disso portabilidade (LORI