Abstract Solar Heat Gain Coefficient (SHGC) is a thermal property of glass and transparent elements, defined as the ratio between the amount of solar energy that passes through the glass and the amount of solar energy that reaches it. SHGC can be determined using mathematical models, computer simulations, or field and laboratory measurements. This paper compares the methods for obtaining the SHGC, which include laboratory measurements using a portable calorimeter, computer simulation using the WINDOW software and calculated according to ISO 9050 standard. Two solar control glasses and one clear glass, used as a reference, were selected. The SHGCs obtained using laboratory measurements were lower than those obtained using the other methods due to the solar simulator and equipment limitations. Despite this, there was a good approximation of the behaviour of the glasses regarding the increase in air velocity. The heat transfer coefficient on the exterior surface was fixed, so the SHGC obtained for each glass based on ISO 9050 remains the same, regardless of the air velocity. The SHGC results based on ISO 9050 were similar to those measured by means of a portable calorimeter under conditions of higher air velocities. (SHGC elements it models simulations 905 standard reference selected limitations this velocity fixed same velocities 90 9

Resumo O fator solar é uma propriedade térmica de vidros e elementos transparentes, definida como a razão entre a quantidade de energia solar que atravessa o vidro e a quantidade de energia solar que nele incide. O fator solar pode ser determinado por meio de modelos de cálculo, simulações computacionais ou medições em campo ou laboratório. Este artigo compara métodos de obtenção do fator solar, que incluem medições em laboratório com um calorímetro portátil, simulação computacional no software WINDOW e cálculo conforme procedimentos da norma ISO 9050. Foram selecionados dois vidros de controle solar e um vidro comum como referência. Devido a limitações do simulador solar e do equipamento, os valores de fator solar obtidos nas medições em laboratório foram menores que os calculados pelos outros dois métodos. Apesar disso, houve boa aproximação do comportamento dos vidros quanto ao aumento da velocidade do ar. Os valores calculados por meio da ISO 9050 permaneceram iguais para cada tipo de vidro, independentemente da velocidade do ar, devido ao coeficiente de transferência de calor superficial externo ser fixo. Os valores de fator solar calculados pela norma apresentaram maior proximidade com os valores medidos pelo calorímetro portátil em condições de velocidades do ar mais elevadas. transparentes incide referência equipamento disso 905 fixo elevadas 90 9

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 Introduction. Knotting is one of the essential surgical skills and vitally important processes that depends on its correct execution. The acquisition of these skills requires motor work, friendly and realistic environments. A strategy to facilitate learning the knotting technique is to generate accessible simulation instruments. Methods. A surgical knot simulator is presented, built with low-budget materials and affordable for the general population, with a budget of approximately $5,000 COP (US$ 1.23). Results. A surgical knot simulator has been developed in a way that, when attached to the thigh of a lower extremity from a seated position, provides a stable surface to effectively perform knot tying practice. Conclusion. Modern surgery considers patient safety as the top priority, so it is no longer appropriate to adopt a “see one, do one, teach one” training method. Constant practice using simulators is the most appropriate method. This work presents an alternative for uninterrupted learning of surgical techniques related to knots.

Resumen Introducción. Anudar es una de las habilidades quirúrgicas esenciales y de su correcta ejecución dependen procesos de vital importancia. La adquisición de estas competencias requiere trabajo motor, entornos amigables y realistas. Una estrategia para facilitar el aprendizaje de la técnica de anudado es generar instrumentos de simulación accesibles. Métodos. Se presenta un simulador de nudos quirúrgicos, construido con materiales de bajo costo y asequibles para la población en general, con un presupuesto de aproximadamente $5.000 COP (US$ 1,23). Resultados. Se desarrolló un simulador de nudos quirúrgicos que, al fijarse a la extremidad inferior desde una posición sentada, proporciona una superficie estable para llevar a cabo la práctica de anudado de manera efectiva. Conclusión. La cirugía moderna considera la seguridad del paciente como la principal prioridad, por lo que ya no es apropiado adoptar un método de formación de “ver uno, hacer uno, enseñar uno”. Es la práctica constante mediante simuladores, el método más adecuado. Este trabajo presenta una alternativa de aprendizaje ininterrumpido de las técnicas quirúrgicas relacionadas con los nudos.

ABSTRACT: The precise account of biodiversity in the tropics has prompted the need for extended and accurate forest inventories in mountainous landscapes, where satellite imagery and radiative transfer modeling of forests have acquired much relevance. Last-generation classification algorithms (i.e. machine learning) using terrain information have proven useful for mapping forest types, however, the accuracy of classifications is measured on average over a large extent, and little emphasis has been placed on predicting which illumination configurations could in fact cause high uncertainty in the classification results. This paper presents a 3D modeling approach adapted to the Discrete Anisotropic Radiative Transfer (DART) image simulator, which indicates whether forest types are distinguishable in a set of steep terrain configurations. The approach also describes a comparison of simulated and real forest scenes on slopes at high (4 m) spatial resolution. This method was applied to estimate the spectral separability of three forest types (oak, pine, and high tropical forests) on steep terrain in Mexico. For extreme (low or high) solar incidence angles, the pine and high tropical forests were indistinguishable, and by contrast, they were distinguishable on slopes near to the solar perpendicular plane. As a consequence, to maximize favourable slope configurations, we recommend to incorporate images acquired in the morning and in the afternoon for machine learning classification algorithms.

RESUMEN: El registro preciso de la biodiversidad tropical ha llevado a la necesidad de inventarios forestales extensos y precisos en zonas montañosas, donde las imágenes satelitales y la modelización de transferencia radiativa de los bosques han adquirido mucha relevancia. Los algoritmos de clasificación de imágenes de última generación (i.e. aprendizaje automático), aplicados con información auxiliar del relieve, se han revelado relativamente exitosos para el mapeo de tipos de bosques, sin embargo, la exactitud de la clasificación se mide solamente en promedio sobre áreas extensas, y poca atención se ha vertido en predecir las configuraciones de iluminación que en realidad causan alta incertidumbre en los resultados de la clasificación. En este artículo, se presenta una metodología basada en el simulador de imágenes Discrete Anisotropic Radiative Transfer (DART), para determinar si los tipos de bosque son distinguibles o no en configuraciones de terreno escarpado. Este trabajo describe la comparación de escenas forestales simuladas y reales en imágenes de alta resolución espacial (4 m). El método se aplicó para la estimación de la separabilidad espectral de tres tipos de bosques (encino, pino y selva alta perennifolia) en terrenos escarpados en México. Para ángulos de incidencia solar extremos (muy pequeños o muy grandes), el bosque de pino y la selva alta resultaron indistinguibles, y en contraste, fueron distinguibles en laderas cercanas al plano perpendicular solar. En consecuencia, para incluir un máximo de configuraciones favorables de laderas, recomendamos incorporar imágenes adquiridas en la mañana y en la tarde en el entrenamiento de los algoritmos de aprendizaje automático.

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.

Abstract: This research presents a novel trajectory generation algorithm and the design of a prescribed time controller for trajectory tracking tasks for autonomous vehicles. The trajectory generation algorithm uses a hybrid combination of computer vision techniques and intelligent rail detection methods using an on-board camera. Based on the previous information, a possible trajectory is then generated that the vehicle should follow. A time-prescribed controller is then developed and implemented to track the trajectory generated by the proposed methodology. The controller uses a hybrid structure in which a time-varying feedback controller transitions into a fixed-time controller. This approach achieves stabilization in the prescribed time despite the initial conditions. To address the trajectory design, a scaled autonomous vehicle simulator was used to then evaluate the prescribed time controller compared to a finite time controller and a dynamic feedback controller. The simulation results demonstrate the effectiveness of trajectory generation and trajectory tracking control algorithms in addressing these challenges in real-world scenarios by examining two situations: unperturbed and perturbed cases.

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 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 Actualmente, el número de cursos en línea y la demanda de e-learning están creciendo, lo que a menudo se debe a la flexibilidad que ofrece este formato de formación y al coste relativamente bajo de la formación. Al mismo tiempo, solo entre el 10 y el 15% de los estudiantes completan con éxito el curso. Hay una serie de factores externos e internos que influyen en la finalización exitosa de un curso en línea. Hemos desarrollado 3 cursos de ESP en línea para estudiantes de posgrado (con mención en Farmacia Industrial, Psicología, Salud Pública y Salud) y un curso de ESP en línea para estudiantes de pregrado de facultades clínicas. Los cursos para estudiantes de posgrado se implementaron como parte de su especialización para programas de maestría, mientras que el curso para estudiantes de pregrado se ofreció como menor. Todos los cursos se desarrollaron de acuerdo con el esquema del curso aprobado, se alojaron en la plataforma Moodle, contenían elementos de interactividad (conferencias interactivas, simulador interactivo), el control se llevó a cabo mediante pruebas MCQ y a los estudiantes también se les ofrecieron tareas creativas (se verificaron manualmente por los profesores). Todos los cursos en línea se han sometido a un examen de tres etapas, lo que garantiza la calidad del curso en términos de contenido e implementación técnica. A pesar de una serie de similitudes entre estos cursos (desde el punto de vista de la organización), el desempeño en los cursos para estudiantes de posgrado y en el curso para estudiantes universitarios fue significativamente diferente (95,5% de los estudiantes de posgrado y 13% de los estudiantes universitarios completaron con éxito sus estudios). Dominar un curso en línea requiere un alto grado de autoorganización, por lo que este formato de trabajo probablemente sea apropiado para graduados y estudiantes de doctorado. En este estudio se construyó un modelo matemático que permite predecir con un alto grado de confianza (96%) si un estudiante completará exitosamente el curso en línea.

ABSTRACT Currently, the number of online courses and the demand for e-learning are growing, which is often due to the flexibility this training format provides and the relatively low cost of training. At the same time, only 10-15% of students successfully complete the course. There are a number of external and internal factors that influence the successful completion of an online course. We have developed 3 online ESP courses for graduate students (majoring in Industrial Pharmacy, Psychology, Public Health and Healthcare) and an online ESP course for undergraduate students of clinical faculties. Courses for graduate students were implemented as part of their major for master's programs while the course for undergraduate students was offered as a minor. All courses were developed in accordance with the approved course outline, hosted on the Moodle platform, contained elements of interactivity (interactive lectures, interactive simulator), control was carried out using MCQ tests, and students were also offered creative assignments (they were checked manually by teachers). All online courses have undergone a three-stage examination, which guarantees the quality of the course in terms of content and technical implementation. Despite a number of similarities between these courses (from the point of view of organization), performance in the courses for graduate students and the course for undergraduates was significantly different (95.5% of graduate students and 13% of undergraduates successfully completed their studies). Mastering an online course requires a high degree of self-organization, so this format of work is most likely appropriate for graduates and PhD students. In this study, a mathematical model was built that makes it possible to predict with a high degree of confidence (96%) whether a student will successfully complete the online course.

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 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.

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.