Machine learning techniques for classification problems related to therapies in diabetes patients

The growing use of technology and cyber tools has been embraced by the healthcare sector in many ways. An interesting and currently not completely exploited field of application is "patient engagement" . This thesis tackles the problem of classifying diabetes patients, with the use of machine learning, based on the therapy they are following in: patients that are following the correct therapy and patients that are not following the therapy, or for which the therapy is not correct.ope

As diretrizes avançadas na américa latina. Um análise ético de caso da Argentina

In recent years, advance directives (ADs) have been increasingly incorporated into Latin American societies as an instrument that allows patients to specify how they would like to be treated in the event that they are no longer competent. Their main goal is, therefore, to increase respect towards the autonomy of patients. However, learning from the experience yielded by ADs in other countries, in order to work out the best way to implement them is important to achieve this end. Identifying potential facilitators and barriers to carry out such a project that can be found in the Latin American context is also important. In this article, we will analyze the evolution of ADs in the U.S., focusing especially on the difficulties faced during this process which arise mainly from an overly individualistic approach to the process of decision-making. In contrast, we will argue that the role usually played by families or other people close to the patient, in Latin American societies offers favorable conditions to implement a more relational approach, able to overcome the problems encountered by the individualistic model. Nevertheless, we will also argue that significant efforts are needed to improve the quality of the physicianpatient-family relationship. In particular, overcoming the paternalistic actions still exerted by some physicians, often concerning relatives, constitutes a necessary condition for the implementation of ADsEn años recientes, las directivas anticipadas (DAs) han sido incorporadas de manera creciente en las sociedades latinoamericanas como un instrumento que permite a los pacientes especificar el modo en que desearían ser tratados en caso de que no sean competentes. El objetivo principal de estos instrumentos es, por lo tanto, incrementar el respeto por la autonomía de los pacientes. No obstante, es importante para ello conocer la experiencia que arrojaron las DAs en otros países, para poder diseñar así la mejor manera de implementarlas. Igualmente importante es identificar posibles facilitadores y barreras que pudiera ofrecer el contexto latinoamericano para llevar a cabo dicho proyecto. En este artículo se analiza la evolución de las DAs en los Estados Unidos, se concentra especialmente en las dificultades que surgieron a lo largo de este proceso, y que se deben fundamentalmente a un abordaje excesivamente individualista del proceso de toma de decisiones. En contraste con ello, se argumenta que el rol importante que desempeñan generalmente las familias, u otras personas cercanas al paciente, en las sociedades Latinoamericanas ofrece condiciones favorables para lograr un abordaje más relacional, capaz de superar los problemas del modelo individualista. Sin embargo, se argumenta también que se necesitan esfuerzos importantes para mejorar la calidad de la relación médico-paciente-familia. En particular, la superación de las acciones paternalistas todavía ejercidas por algunos médicos, frecuentemente en conjunto con los familiares, constituye una condición necesaria para la implementación de las DAs.Nos últimos anos, as directivas de avanço foram incorporadas cada vez mais nas sociedades latino-americanas como um instrumento que permite aos pacientes especificar o modo em que gostaria de ser tratado quando eles não são competentes. O principal objectivo destes instrumentos é então aumentar o respeito pela autonomia dos pacientes. No entanto, é importante conhecer a experiência de avanço de políticas em outros países, para projetar a melhor maneira de implementá-las também. É importante também identificar potenciais facilitadores e barreiras que poderiam ofrecer o contexto latino-americano para realizar este projeto. Este artigo discute a evolução do avanço de políticas nos Estados Unidos, especialmente focando as dificuldades que surgiram durante o processo, e que é devido primeiramente a uma abordagem excessivamente individualista do processo decisório. Em contrapartida, defendemos que o papel importante que as famílias, ou outras pessoas próximas do paciente nas sociedades latino-americanas, geralmente oferece condições favoráveis para alcançar uma abordagem mais relacional, capaz de superar os problemas do modelo individualista. Também discutimos a grande necessidade de esforços para melhorar a qualidade da relação médico-paciente-família. Em particular, a superação das ações paternalistas exercidas por alguns médicos, muitas vezes em conjunto com membros da família, constitui uma condição necessária para a aplicação das directivas de avanço

Spatially-resolved spectroscopy of narrow-line Seyfert 1 host galaxies

We present optical integral field spectroscopy for five $z<0.062$ narrow-line Seyfert 1 galaxies (NLS1s) host galaxies, probing their host galaxies at $\gtrsim 2-3$ kpc scales. Emission lines in the nuclear AGN spectra and the large-scale host galaxy are analyzed separately, based on an AGN-host decomposition technique. The host galaxy gas kinematics indicates large-scale gas rotation in all five sources. At the probed scales of $\gtrsim 2-3$ kpc, the host galaxy gas is found to be predominantly ionized by star formation without any evidence of a strong AGN contribution. None of the five objects shows specific star formation rates exceeding the main sequence of low-redshift star forming galaxies. The specific star formation rates for MCG-05-01-013 and WPVS 007 are roughly consistent with the main sequence, while ESO 399-IG20, MS 22549-3712, and TON S180 show lower specific star formation rates, intermediate to the main sequence and red quiescent galaxies. The host galaxy metallicities, derived for the two sources with sufficient data quality (ESO 399-IG20 and MCG-05-01-013), indicate central oxygen abundances just below the low-redshift mass-metallicity relation. Based on this initial case study, we outline a comparison of AGN and host galaxy parameters as a starting point for future extended NLS1 studies with similar methods.Comment: 25 pages, 8 figures, accepted for publication in ApJ on 3 September 201

The Machine Paradigm and Alternative Approaches in Cognitive Science

In a recent paper called To think human out of the machine paradigm, it is stated that psychological science operates within a machine paradigm that is committed to mechanical causality. In addition, it is emphasizes the epistemological and methodological limitations of explanations based in deterministic mechanics and instead argues for the need of an 'organic paradigm' that takes into consideration psychological processes such as subjectivity, inter-subjectivity, and agency. Although there is no doubt that much psychological science has operated under a machine paradigm, we argue that recent psychological research is pursued using a wide variety of approaches and with an absence of a partially integrated meta-theoretical corpus. The present situation looks more like a Tower of Babel of epistemological approaches and empirical programs. The reconsideration of the organic paradigm and an explicitly addressed epistemological framework could constitute a step forward and lead to an explanatory pluralism built on greater dialogue within the psychological sciences.Fil: Barutta, Joaquin. Hospital Italiano. Instituto Universitario. Escuela de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Aravena, Pía. Universidad Diego Portales; ChileFil: Ibañez, Agustin Mariano. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentina. Universidad Diego Portales; Chil

Diabetic kidney disease. new clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on "the natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function"

Recent epidemiological studies have disclosed heterogeneity in diabetic kidney disease (DKD). In addition to the classical albuminuric phenotype, two new phenotypes have emerged, i.e., “nonalbuminuric renal impairment” and “progressive renal decline”, suggesting that DKD progression toward end-stage kidney disease in diabetic patients may occur through two distinct pathways heralded by a progressive increase in albuminuria and decline in renal function independent of albuminuria, respectively. Besides the natural history of DKD, also the management of hyperglycemia in patients with type 2 diabetes and reduced renal function has profoundly changed in the last two decades. New anti-hyperglycemic drugs have become available for treatment of these individuals and the lowest estimated glomerular filtration rate safety thresholds for some of the old agents have been reconsidered. This joint document of the Italian Diabetes Society (SID) and the Italian Society of Nephrology (SIN) reviews the natural history of DKD in the light of the recent epidemiological literature and provides updated recommendations on anti-hyperglycemic treatment with non-insulin agents in DKD patients

Novel Insight into the Mechanisms of the Bidirectional Relationship between Diabetes and Periodontitis

Periodontitis and diabetes are two major global health problems despite their prevalence being significantly underreported and underestimated. Both epidemiological and intervention studies show a bidirectional relationship between periodontitis and diabetes. The hypothesis of a potential causal link between the two diseases is corroborated by recent studies in experimental animals that identified mechanisms whereby periodontitis and diabetes can adversely affect each other. Herein, we will review clinical data on the existence of a two-way relationship between periodontitis and diabetes and discuss possible mechanistic interactions in both directions, focusing in particular on new data highlighting the importance of the host response. Moreover, we will address the hypothesis that trained immunity may represent the unifying mechanism explaining the intertwined association between diabetes and periodontitis. Achieving a better mechanistic insight on clustering of infectious, inflammatory, and metabolic diseases may provide new therapeutic options to reduce the risk of diabetes and diabetes-associated comorbidities

Theories and Theorizers: A Contextual Approach to Theories of Cognition

An undisputable characteristic of cognitive science is its enormous diversity of theories. Not surprisingly, these often belong to different paradigms that focus on different processes and levels of analysis. A related problem is that researchers of cognition frequently seem to ascribe to incompatible approaches to research, creating a Tower of Babel of cognitive knowledge. This text presents a pragmatic model of meta-theoretical analysis, a theory conceived of to examine other theories, which allows cognitive theories to be described, integrated and compared. After a brief introduction to meta-theoretical analysis in cognitive science, the dynamic and structural components of a theory are described. The analysis of conceptual mappings between components and explanation strategies is also described, as well as the processes of intra-theory generalization and inter-theory comparison. The various components of the meta-theoretical model are presented with examples of different cognitive theories, mainly focusing on two current approaches to research: The dynamical approach to cognition and the computer metaphor of mind. Finally, two potential counter arguments to the model are presented and discussed.Fil: Barutta, Joaquin. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentina. Hospital Italiano; ArgentinaFil: Cornejo, Carlos. Pontificia Universidad Católica de Chile; ChileFil: Ibañez, Agustin Mariano. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentin

Role of the endocannabinoid system in diabetes and diabetic complications

Increasing evidence suggests that an overactive endocannabinoid system (ECS) may contribute to the development of diabetes by promoting energy intake and storage, impairing both glucose and lipid metabolism, by exerting pro‐apoptotic effects in pancreatic beta cells and by facilitating inflammation in pancreatic islets. Furthermore, hyperglycaemia associated with diabetes has also been implicated in triggering perturbations of the ECS amplifying the pathological processes mentioned above, eventually culminating in a vicious circle. Compelling evidence from preclinical studies indicates that the ECS also influences diabetes‐induced oxidative stress, inflammation, fibrosis and subsequent tissue injury in target organs for diabetic complications. In this review, we provide an update on the contribution of the ECS to the pathogenesis of diabetes and diabetic microvascular (retinopathy, nephropathy and neuropathy) and cardiovascular complications. The therapeutic potential of targeting the ECS is also discussed. LINKED ARTICLES: This article is part of a themed section on Endocannabinoids. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v173.7/issueto