Artículos de revistas sobre el tema "Costamagna"

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is considered one of the most technically demanding endoscopic procedures. Still, limited data are available on simulators in ERCP training. Recently, the Boškoski-Costamagna ERCP Trainer was validated as a realistic training model by our study group. As an extension to this model, a novel synthetic papilla has been designed allowing to train biliary sphincterotomy. We aimed to determine the face validity of this synthetic papilla and its didactic value for training sphincterotomy. Methods Expert participants, each with more a than 2500 ERCPs lifetime experience, were invited to perform a biliary sphincterotomy and fill out a questionnaire on the realism of the procedure and the didactic value. Results A total of 40 ERCP experts were included, originating from 16 different countries. Experts’ opinion on realism of performing a biliary sphincterotomy was rated with a median of 7 on a 10-point Likert scale, resemblance of the performed maneuvers 8 and tactile feedback 7. When asked if the cutting was perceived as realistic, experts rated a 6 and the cutting result was rated 8. The potential of the cutting papilla as a training tool for novices was rated 4 on a 4-point scale and there was a high agreement among the experts to include the papilla in the training of novices (rating 4). Conclusion This is the first synthetic papilla available for training sphincterotomy on the Boškoski-Costamagna ERCP Trainer and it demonstrates good face validity. ERCP experts highly agree on its didactic value and added value in the training curriculum of novice endoscopists.

Abstract Background and study aims Simulation-based training has become an important pillar in competence-based medicine. However, limited data are available on use of simulators in training for endoscopic retrograde cholangiopancreatography (ERCP). We aimed to determine the face and construct validity of the Boškoski-Costamagna mechanical ERCP Trainer, and to assess its didactic value, as judged by experts. Methods Participants were divided into four groups based on ERCP lifetime experience: novices, intermediate, experienced, and experts. Participants performed several standardized assignments on the simulator. Outcome parameters included times to complete the procedure, ability to cannulate both ducts, number of attempts to cannulate the common bile duct and pancreatic duct, number of inadvertent pancreatic duct cannulations, successful stent placement, and successful stone extraction. All experts filled out a questionnaire on the simulator’s realism and didactic value. Results Novices (n = 11) completed the total procedure in 21:09 (min:sec), intermediates (n = 5) in 10:58, experienced (n = 8) in 06:42 and experts (n = 22) in 06:05. Experts were significantly faster than novices (Kruskal-Wallis test P < 0.000). Experts rated the realism of the simulator 7.12 on a 10-point Likert scale. The simulator’s potential as a tool for training novices was rated 3.91 on a four-point Likert scale, and there was a high agreement among experts to include the simulator in the training of novice endoscopists (3.86 on a four-point Likert scale). Conclusions The novel Boškoski-Costamagna ERCP simulator demonstrates good face and construct validity. ERCP experts highly agree on the didactic value and added value of this simulator in the training curriculum for novice endoscopists.

Este artículo interpreta los vínculos entre espacio y memoria en la novela El sistema del tacto(2018) de Alejandra Costamagna a partir de la configuración de una geografía afectiva del Cono Sur, un imaginario de provincia argentina y un archivo familiar de la migración. La emergencia de un imaginario territorial que incluye el cruce transadino, el recorrido por la pampa y la ciudad provinciana de Campana proyecta distintas formas de vida social transformadas en el tiempo. Estos imaginarios se elaboran tanto desde una figura de infancia que despliega una percepción particular del paisaje natural como desde una subjetividad que en el presente narrativa retorna para constatar la caducidad de las formas de vivir y habitar del siglo XX. La novela integra aspectos espaciales, materiales y lingüísticos en la configuración de distintas experiencias, imágenes y percepciones de lo perecedero.

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) requires extensive hands-on training. Currently in ERCP training there are two very important problems that need attention: lack of standardized commands for communication, and misunderstanding between the trainee and the trainer. Methods A method of “blind-eye” cannulation was developed with two paired trainees using the Boškoski-Costamagna ERCP Trainer. The trainee who was holding the duodenoscope was blind-folded and the other trainee gave instructions on what maneuvers were necessary to achieve cannulation, under the supervision of a trainer. Before starting cannulation, a standard list of commands was agreed by the operators. Results The blind-eye method of cannulation teaches the operator trainee to listen and the assistant trainee to teach. Trainees use standardized commands. During the training session the two trainees swapped roles. Conclusions Currently, we do not have proof that this type of training is useful, therefore, scientific studies are needed for confirmation. However, we believe that this ERCP model may provide an entirely safe means of improving communication and technical proficiency.

Para gran parte de la crítica literaria chilena, como para el público lector en general, es elocuente la persistencia del imaginario dictatorial en la narrativa chilena de estas primeras dos décadas del siglo XXI. A pesar de que han transcurrido veinticinco años desde que se reconquistó la democracia, dicho imaginario parece seguir fortaleciéndose y reactualizándose. Esta situación adquiere particular importancia al tener en cuenta un corpus narrativo publicado entre el 2000 y 2014, conformado por escritores nacidos entre 1970 y 1990. Se está ante una producción literaria que ha sido definida como “novela de los hijos”, entendiendo por ello una novela escrita por los hijos de quienes fueron víctimas directas de la dictadura, una narrativa donde se articulan de otra manera los temas de la memoria, el duelo y el trauma.

Abstract Background and study aims Current data show that traditional training methods in endoscopic retrograde cholangiopancreatography (ERCP) fall short of producing competent trainees. We aimed to evaluate whether a novel approach to simulator-based training might improve the learning curve for novice endoscopists training in ERCP. Methods We conducted a multicenter, randomized controlled trial using a validated mechanical simulator (the Boškoski-Costamagna trainer). Trainees with no experience in ERCP received either standard cannulation training or motion training before undergoing standard cannulation training on the mechanical simulator. Trainees were timed and graded on their performance in selective cannulation of four different papilla configurations. Results Thirty-six trainees (16 in the motion training group, 20 in the standard group) performed 720 timed attempts at cannulating the bile duct on the simulator. Successful cannulation was achieved in 698 of 720 attempts (96.9 %), with no significant difference between the two study groups (P = 0.37). Trainees in the motion training group had significantly lower median cannulation times compared to the standard group (36 vs. 48 seconds, P = 0.001) and better technical performance on the first papilla type (P = 0.013). Conclusions Our findings suggest that motion training could be an innovative method aimed at accelerating the learning curve of novice trainees in the early phase of their training. Future studies are needed to establish its role in ERCP training programs.

The main goal of this work is the transient analysis of hybrid systems based on solid oxide fuel cells (SOFC). The work is divided into three parts: in the first, the fuel cell transient models are presented and discussed, whereas in the subsequent parts of the paper the anodic recirculation system (Part B: Ferrari, M.L., Traverso, A., Massardo, A.F., 2004, ASME Paper No. 2004-GT-53716) and the entire hybrid transient performance (Part C: Magistri, L., Ferrari, M.L., Traverso, A., Costamagna, P., Massardo, A.F., 2004, ASME Paper No. 2004-GT-53845) are investigated. In this paper the transient behavior of a solid oxide fuel cell is analyzed through the use of two different approaches: macroscopic and detailed SOFC models. Both models are presented in this paper, and their simulation results are compared to each other and to available experimental data. As a first step the transient response of the fuel cell was studied using a very detailed model in order to completely describe this phenomenon and to highlight the critical aspects. Subsequently, some modifications were made to this model to create an apt simulation tool (macroscopic fuel cell model) for the whole plant analysis. The reliability of this model was verified by comparing several transient responses to the results obtained with the detailed model. In the subsequent papers (Parts B and C), the integration of the macroscopic fuel cell model into the whole plant model will be described and the transient study of the hybrid plant will be presented.

Pellizas CG, Coleoni AH, Cabanillas AM, Masini-Repiso AM, Costamagna ME. Response of triiodothyronine-dependent enzyme activities to insulin-like growth factor I and growth hormone in cultured cat hepatocytes. Eur J Endocrinol 1996:134:215–20. ISSN 0804–4643 Triiodothyronine (T3) is involved in the regulation of the growth hormone-insulin-like growth factor I (GH-IGF-I) axis. In this study we investigated the effect of GH and IGF-I on the metabolic response of T3 in target tissues by evaluating the activity of two T3-dependent liver enzymes: mitochondrial α-glycerophosphate dehydrogenase (α-GPD) and cytosolic malic enzyme (ME) in rat hepatocytes in primary culture. Growth hormone (35 nmol/l) as well as IGF-I (0.5 μmol/l) reduced α-GPD and ME activities (p < 0.01) compared to the control group. Timecourse studies indicated that IGF-I 1.5 μmol/l) significantly decreased α-GPD and ME activities (p < 0.01) after 24 h, whereas the effect of GH (35 nmol/l) was recorded only after 36 h (p < 0.01). This delayed effect of GH compared to IGF-I suggested the possibility that the effect of GH could be mediated by IGF-I synthesis. To test this hypothesis, the effect of GH on the two enzyme activities was studied in the presence of anti-IGF-I antibodies. A gradual recovery of α-GPD and ME activities (p < 0.01) was observed in the presence of GH (35 nmol/l) plus increasing concentrations of anti-IGF-I antiserum. The maximal α-GPD and ME activities attained after the incubation of the liver cells with 1 μmol/l T3. a concentration high enough to fully saturate the nuclear T3 receptors for 24 h, were lowered significantly by 1.0 μmol/l IGF-I (p < 0.01). This finding suggests that the IGF-I effect might be independent of the saturation of the nuclear T3 receptors. In conclusion, in cultured rat hepatocytes, GH and IGF-I reduced the metabolic response of T3 evaluated by two liver T3-dependent enzyme activities. The effect of GH was mediated at least in part by IGF-I. Claudia G Pellizas, Dpto Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Códoba, Casilla de Correo 61, Sucursal 16, (5016) Córdoba, Argentina.

IntroduzioneIl mondo politico-culturale della destra italiana del dopoguerra è stato trascurato, per lungo tempo, dalla comunità scientifica. A parte il pionieristico lavoro di Giorgio Galli, risalente alla metà degli anni settanta, è soltanto con l'inizio di questo decennio che si sviluppa una seria linea di ricerca su alcune componenti della destra italiana. In particolare, per motivi diversi, vengono privilegiati due versanti: la Nuova Destra e l'area radicale e terrorista. L'attenzione dedicata a questi due fenomeni non è casuale ma trova spiegazione nel fatto che essi costituiscono una sorta di “novità” rispetto al filone centrale del neofascismo: da un lato, la Nuova Destra, emersa alla fine degli anni settanta sulla scia dellaNouvelle Droitefrancese, rappresenta il contributo intellettualmente piò originale e articolato di riflessione e rielaborazione delle coordinate ideologiche e politiche della destra; dall'altro, l'area radicale e terrorista costituisce per la sua intrinseca drammaticità un forte stimolo all'approfondimento delle motivazioni, del costrutto ideologico e delle articolazioni organizzative. Gli studi condotti negli anni ottanta su queste due aree forniscono importanti tasselli alla ricostruzione o alla comprensione dellaWeltanschauungdi destra. Tuttavia è rimasto escluso da questo risveglio di interesse l'espressione piò solida e corposa della destra italiana, vale a dire il Movimento Sociale Italiano.Va subito precisato, infatti, che il MSI, i movimenti di destra radicale (DR) e la Nuova Destra (ND) pur essendo contigui, si differenziano percomplessità organizzativa, strategia politicaereferenti culturali.Per quanto riguarda la complessità organizzativa, essa è:— elevata nel MSI: il partito si struttura secondo il classico modello duvergeriano del «partito di massa» e, tra l'altro, inquadra centinaia di migliaia di iscritti;— ridotta nelle formazioni della DR: i vari gruppi si strutturano o come piccole sette (i movimenti golpisti e terroristi) o come «comitati» (i movimenti di contromobilitazione moderata e reazionaria degli anni settanta);— molto bassa nella ND: essa mantiene uno stadio fluido di movimento culturale legato ad iniziative editoriali.In merito alla strategia politica, essa si articola in tre posizioni distinte:— alternativa al regime ma accettazione (e pratica) delle regole democratiche per il MSI;— abbattimento immediato e violento del sistema e rifiuto dei meccanismi democratici per la DR;— estraneità rispetto al sistema e superamento degli istituti liberaldemocratici attraverso un processo «metapolitico» di egemonizzazione culturale e di ridefinizione delle coordinate ideologiche («al di là della destra e della sinistra») per la ND.Per quanto attiene, infine, ai referenti culturali si può affermare che, nonostante tutte le componenti attingano ad un medesimo serbatoio, esse si differenziano:a)per la diversa considerazione del contributo evoliano — superficiale-strumentale nel MSI («doveroso» omaggio ad uno dei pochissimi pensatori forti della destra ma sostanziale ininfluenza dei suoi contributi), esegetico-esistenziale nella DR («il mondo delle rovine», «rapolitia», «l'uomo differenziato», «lo spirito legionario», ecc.), marginale nella ND dove viene ridimensionato per la sua impostazione anti-moderna («il mito incapacitante»);b)per l'assenza nella DR e nella ND di alcuni cardini della cultura politica missina come il pensiero giuridico (Rocco e Costamagna) e filosofico (Gentile e Spirito) fascista.Anche se la delimitazione dei confini di queste tre componenti, è stata, in certi periodi e per certi gruppi, alquanto incerta, soprattutto perché il MSI ha rappresentato sempre ilprimum mobiledi tutta Tarea di destra (di qui i frequenti passaggi di confine tra partito e organizzazioni esterne di variroutiersdella destra), esse vanno tenute adeguatamente distinte.Ciò premesso, in questo lavoro intendiamo occuparci esclusivamente del soggetto rimasto finora più in ombra, il Movimento Sociale Italiano. Più in particolare, ci soffermeremo sui tratti salienti della «cultura politica» di questo partito quale emerge, in primo luogo, dalla pubblicistica interna e dai documenti ufficiali (e quindi l'immagine che il partito proietta — e/o intende proiettare — all'esterno) e, in secondo luogo, dalle risposte ad una serie di domande di atteggiamento fornite da un campione significativo di quadri intermedi del MSI.

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