Propuesta para la creación de Centros Autosuficientes de Imágenes Médicas para establecimientos de la Caja Costarricense del Seguro Social

The Public Health System of Costa Rica faces a problem of concentration and misdistribution of resources, specifically in the imaging centers (IC) and therefore in the auxiliary diagnostic studies of its kind. For that reason, this work presents a methodology for health technology management that proposes a solution that helps the System to decentralize and optimize the service offered by the State. The first stage of this work consisted in the identification of the IC concentration problem. For that a general analysis was performed, in the Costa Rican Social Security (institution responsible for the provision of health services), its health care centers and the technological capacity of their IC. Then, a study was carried out to characterize the actual demand of the diagnostic imaging services, through a demographic and an epidemiological analysis. Subsequently, a solution model was proposed to solve the problem of resource concentration: first, a method was generated to estimate quantitatively the level of the access to the IC that the inhabitants have in a particular geographical region; second, the concept of a Self-sufficient Medical Imaging Center (SMIC) was defined and with that, several procedures and criteria to estimate theoretically, the number of resources that a IC needs to achieve the self-sufficiency in the provision of the service; third, an additional method was created to perform a qualitative analysis of the viability to convert a IC in to a SMIC. In the final stage of the work, the solution model was validated under real conditions of the Social Security. For that, eight medical centers networks were selected (corresponding to different geographical regions of the country) and for each region the estimation of the level of access to the IC was performed, that allowed the classification in networks with “good”, “regular” and “bad” access. Afterward, to evaluate the current technological, human and infrastructural resource capacity, an assessment to the IC of each network was performed; followed by a theoretical estimation of the number of resources that each network should have in order to supply the people’s demands. Finally, a multivariate analysis was completed, to find the relationship between the investment, the benefit to the people and priority of a region, to perform a conversion of an IC to an SMIC. That way and supported by the obtained results, we can assert that the proposed methodology for health technology management, works to achieve the objectives of this workEn Costa Rica, el Sistema de Salud Público padece de un problema de concentración y mala distribución de sus recursos, particularmente de los servicios de imaginología y por tanto de este tipo de estudios de diagnóstico auxiliar. Por tal motivo, en este trabajo se desarrolló una metodología de gestión tecnológica, en la que se propuso una solución que coadyuvaría a descentralizar y optimizar el servicio ofrecido por el Estado. La primera etapa del trabajo consistió en la identificación del problema de concentración de los servicios de imaginología (SI). Para ello se realizó un análisis general de la Caja Costarricense del Seguro Social (institución encargada de la prestación de los servicios de salud), de su red de establecimientos y de la capacidad tecnológica que tienen sus SI. Luego a través de un análisis demográfico y otro epidemiológico, se llevó a cabo un estudio para caracterizar la demanda real de la población de los servicios de diagnóstico por imágenes. Posteriormente se propuso un modelo de solución al problema de concentración: primero, se generó un método para estimar de manera cuantitativa el nivel de acceso a los SI que tienen los habitantes de una región geográfica particular; segundo, se definió el concepto de un Centro Autosuficiente de Imágenes Médicas (CAIM) y se generaron una serie de procedimientos y criterios para realizar una estimación teórica de los recursos que tiene que tener un SI para lograr la autosuficiencia en la prestación del servicio; tercero, se generó un método para realizar un análisis cualitativo sobre la viabilidad que existe para que un SI logre convertirse en un CAIM. En la etapa final del trabajo, el modelo de solución fue validado bajo condiciones reales del Seguro Social. Se seleccionaron 8 Subredes de establecimientos (que corresponden a regiones geográficas independientes) y en cada una de ellas se realizó la estimación del acceso a los servicios de imagenología que tienen sus habitantes, esto permitió clasificar a las Subredes según su nivel de acceso en bueno, regular o malo. Posteriormente, se llevó a cabo una evaluación in situ a un SI de cada Subred, para conocer su capacidad de atención en función del número de recursos (tecnológicos, humanos y de infraestructura) con los que dispone actualmente. A continuación, se realizó una estimación teórica de los recursos que debería tener cada Subred, para satisfacer la demanda que su población genera. Y por último, se realizó un análisis multivariado entre la inversión, el beneficio y la prioridad que tiene cada Subred para realizar una conversión de un SI a un CAIM. De tal manera, y soportado por los resultados obtenidos, es posible afirmar que la metodología de gestión tecnológica propuesta, funcionó para cumplir con los objetivos del trabajo

Metal-Semiconductor Interfaces in Thin-Film Transistors

The metal-semiconductor interface in thin-film transistors (TFTs) is one of the bottlenecks on the development of these devices. Although this interface does not play an active role in the transistor operation, a low-quality interface can be responsible for a low performance operation. In a-Si TFTs, a doped film can be used to improve this interface, however, in other TFT technologies, there is no doped film to be used. In this chapter, some alternatives to improve this interface are analysed. Also, the influence of this interface on the electrical stability of these devices is presented

The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Binational Border Surveillance

In 1997, the Centers for Disease Control and Prevention, the Mexican Secretariat of Health, and border health officials began the development of the Border Infectious Disease Surveillance (BIDS) project, a surveillance system for infectious diseases along the U.S.-Mexico border. During a 3-year period, a binational team implemented an active, sentinel surveillance system for hepatitis and febrile exanthems at 13 clinical sites. The network developed surveillance protocols, trained nine surveillance coordinators, established serologic testing at four Mexican border laboratories, and created agreements for data sharing and notification of selected diseases and outbreaks. BIDS facilitated investigations of dengue fever in Texas-Tamaulipas and measles in California–Baja California. BIDS demonstrates that a binational effort with local, state, and federal participation can create a regional surveillance system that crosses an international border. Reducing administrative, infrastructure, and political barriers to cross-border public health collaboration will enhance the effectiveness of disease prevention projects such as BIDS

The dynamic DNA methylomes of double-stranded DNA viruses associated with human cancer

The natural history of cancers associated with virus exposure is intriguing, since only a minority of human tissues infected with these viruses inevitably progress to cancer. However, the molecular reasons why the infection is controlled or instead progresses to subsequent stages of tumorigenesis are largely unknown. In this article, we provide the first complete DNA methylomes of double-stranded DNA viruses associated with human cancer that might provide important clues to help us understand the described process. Using bisulfite genomic sequencing of multiple clones, we have obtained the DNA methylation status of every CpG dinucleotide in the genome of the Human Papilloma Viruses 16 and 18 and Human Hepatitis B Virus, and in all the transcription start sites of the Epstein-Barr Virus. These viruses are associated with infectious diseases (such as hepatitis B and infectious mononucleosis) and the development of human tumors (cervical, hepatic, and nasopharyngeal cancers, and lymphoma), and are responsible for 1 million deaths worldwide every year. The DNA methylomes presented provide evidence of the dynamic nature of the epigenome in contrast to the genome. We observed that the DNA methylome of these viruses evolves from an unmethylated to a highly methylated genome in association with the progression of the disease, from asymptomatic healthy carriers, through chronically infected tissues and pre-malignant lesions, to the full-blown invasive tumor. The observed DNA methylation changes have a major functional impact on the biological behavior of the viruses

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Test of lepton universality in b→sℓ+ℓ−b \rightarrow s \ell^+ \ell^- decays

The first simultaneous test of muon-electron universality using $B^{+}\rightarrow K^{+}\ell^{+}\ell^{-}$ and $B^{0}\rightarrow K^{*0}\ell^{+}\ell^{-}$ decays is performed, in two ranges of the dilepton invariant-mass squared, $q^{2}$. The analysis uses beauty mesons produced in proton-proton collisions collected with the LHCb detector between 2011 and 2018, corresponding to an integrated luminosity of 9 $\mathrm{fb}^{-1}$. Each of the four lepton universality measurements reported is either the first in the given $q^{2}$ interval or supersedes previous LHCb measurements. The results are compatible with the predictions of the Standard Model.Comment: All figures and tables, along with any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2022-046.html (LHCb public pages

Measurement of lepton universality parameters in B+→K+ℓ+ℓ−B^+\to K^+\ell^+\ell^- and B0→K∗0ℓ+ℓ−B^0\to K^{*0}\ell^+\ell^- decays

A simultaneous analysis of the $B^+\to K^+\ell^+\ell^-$ and $B^0\to K^{*0}\ell^+\ell^-$ decays is performed to test muon-electron universality in two ranges of the square of the dilepton invariant mass, $q^2$. The measurement uses a sample of beauty meson decays produced in proton-proton collisions collected with the LHCb detector between 2011 and 2018, corresponding to an integrated luminosity of $9$ $\text{fb}^{-1}$. A sequence of multivariate selections and strict particle identification requirements produce a higher signal purity and a better statistical sensitivity per unit luminosity than previous LHCb lepton universality tests using the same decay modes. Residual backgrounds due to misidentified hadronic decays are studied using data and included in the fit model. Each of the four lepton universality measurements reported is either the first in the given $q^2$ interval or supersedes previous LHCb measurements. The results are compatible with the predictions of the Standard Model.Comment: All figures and tables, along with any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2022-045.html (LHCb public pages

Study of charmonium and charmonium-like contributions in B+ → J/ψηK+ decays

A study of B+→ J/ψηK+ decays, followed by J/ψ → μ+μ− and η → γγ, is performed using a dataset collected with the LHCb detector in proton-proton collisions at centre-of-mass energies of 7, 8 and 13 TeV, corresponding to an integrated luminosity of 9 fb−1. The J/ψη mass spectrum is investigated for contributions from charmonia and charmonium-like states. Evidence is found for the B+→ (ψ2(3823) → J/ψη)K+ and B+→ (ψ(4040) → J/ψη)K+ decays with significance of 3.4 and 4.7 standard deviations, respectively. This constitutes the first evidence for the ψ2(3823) → J/ψη decay