Mesoamerican University

Introduction: Esophageal prosthesis is crucial in managing end-stage esophageal diseases, relieving patients with obstructive conditions. However, the accessibility of esophageal prostheses in Guatemala remains a topic of concern due to the country's healthcare infrastructure and regional disparities. Handmade prostheses in Latin America have shown acceptability and the ability to resolve dysphagia, although they are not without complications, such as perforations, bleeding, infection, and a more invasive surgical approach. This case aims to report the experience of using a handmade prosthesis in an environment where self-expanding esophageal devices are not affordable due to their high cost. Case Description/Methods: A 71-year-old man patient, originally from Totonicapán, Guatemala, CA, presented to a third-level public hospital in the West with a chief complaint of dysphagia and progressive weight loss over the past 2 years. Paraneoplastic syndrome was observed during the physical examination. Diagnostic procedures, including endoscopy with biopsy and thoracoabdominal CT scan (Figure 1A), led to a diagnosis of end-stage adenocarcinoma of the lower esophagus with lung and liver metastasis. Given the palliative nature of the disease, surgical intervention was planned, and an esophageal endoprosthesis with an orotracheal tube (Figure 1B) was placed. The procedure was uneventful, and the patient tolerated it well. A progressive liquid diet was initiated 24 hours postoperatively, with occasional episodes of emesis. The patient was discharged on the fourth day after surgery, showing good clinical evolution and tolerating a soft diet, with outpatient follow-up provided by a multidisciplinary team. Discussion: Esophageal cancer in Guatemala is frequently diagnosed at advanced stages. In this case, the handmade esophageal prosthesis was successfully placed using 2 basic techniques: Pulsion (Figure 1C), involving peroral tube insertion, and traction (Figure 1D), involving pulling the tube through the tumor from below via a high gastrotomy. Traction intubation is preferred for tumors in the lower esophagus, requiring laparotomy and gastrotomy. The alternative use of these handmade esophageal prostheses improves terminal patients' quality of life, as it resolves dysphagia and enables them to eat. However, the main post-surgical adverse effect is gastroesophageal reflux, resulting from the physiological alteration of the esophageal sphincter. Therefore, the implementation of an adequate educational plan is essential.Figure 1.: Handmade esophageal prosthesis placement: (a) bird peak sign, (b) handmade prothesis made with an endotracheal tube, (c) Pulsion technique, (d) traction technique.

The risk of climate change impacts occurring is a function of a socioecological system's exposure and vulnerability to climate-related hazards. Vulnerability itself is the result of a system's sensitivity and adaptive capacity. The potential climate change driven biophysical impacts on the municipality Totonicapn in the western highlands of Guatemala are well documented in outcome vulnerability studies and projected to be severe. They include droughts, frosts, forest fires and life zone changes which also represent important hazards to the municipality's population. Yet, recent detailed socioeconomic information on the municipality's contextual vulnerability is scarce. Moreover, social capital which is central to the yet successful management of the unique communal coniferous forests is poorly understood. The present study evaluates the contextual vulnerability of the municipality's population and communal forests using 5 interviews and 167 household surveys from 3 communities for 15 socioeconomic indicators. Qualitative analysis of the interviews urges for further investigation into the link between emigration to the USA, the loss of social capital and communal forest management. Quantitative analysis of the indicators and their aggregation into a vulnerability index by Principal Component Analysis demonstrates that education is the most important vulnerability factor, followed by income which was negatively related to natural resource dependency. An overarching theme was gender inequality. The study is a plea for location and population specific research and adaptation strategies as it identifies significant differences even between communities of the same municipality.

La restauración ecológica se percibe por muchos conservacionistas, y por la mayoría de los economistas, como una diversión, una ilusión, y mucho peor, como una pérdida de tiempo y dinero. En este trabajo se señala que la restauración, de hecho, complementa no sólo a la conservación de la naturaleza sino que también es útil para lograr un desarrollo socio-económicamente sostenible y equitativo. Esto se debe a que restaurar y aumentar la base del capital natural es la mejor vía para generar puestos de trabajo, y mejorar los medios de supervivencia y de calidad de vida para todos, lo mismo que para la economía.

Le racisme contemporain et la violence au Guatemala sont des phénomènes complexes et persistants intimement liés au processus de modernisation capitaliste et de formation de l’État aux 19 e et 20 e siècles. L’expansion coloniale européenne, l’immigration allemande, l’essor des plantations caféières ont institutionnalisé les discriminations, légitimé le racisme et instrumentalisé en particulier l’opposition entre « Indiens » et « Ladinos ».

In this paper, the interaction control schemes suitable for implementation on industrial robot units are presented. In particular, the focus is on impedance control and parallel control, which are conceived to manage the interaction with a more or less compliant environment without requiring an accurate model thereof. All the considered schemes are based on an inner motion control loop, which can be the usual independent joint control of PID type or an advanced model-based motion control law with superior tracking performance. The inner motion control loop is in charge of tracking the reference trajectory computed by the outer interaction control loop. Special emphasis is given to controlling 6-degrees-of-freedom (DOF) interaction tasks involving the end-effector position and orientation when a contact force and moment are applied.