Evaluation of a Diagnostic Decision Support System for the Triage of Patients in a Hospital Emergency Department

One of the biggest challenges for the management of the emergency department (ED) is to expedite the management of patients since their arrival for those with low priority pathologies selected by the classification systems, generating unnecessary saturation of the ED. Diagnostic decision support systems (DDSS) can be a powerful tool to guide diagnosis, facilitate correct classification and improve patient safety. Patients who attended the ED of a tertiary hospital with the preconditions of Manchester Triage system level of low priority (levels 3, 4 and 5), and with one of the five most frequent causes for consultation: dyspnea, chest pain, gastrointestinal bleeding, general discomfort and abdominal pain, were interviewed by an independent researcher with a DDSS, the Mediktor system. After the interview, we compare the Manchester triage and the final diagnoses made by the ED with the triage and diagnostic possibilities ordered by probability obtained by the Mediktor system, respectively. In a final sample of 214 patients, the urgency assignment made by both systems does not match exactly, which could indicate a different classification model, but there were no statistically significant differences between the assigned levels (S = 0.059, p = 0.442). The diagnostic accuracy between the final diagnosis and any of the first 10 Mediktor diagnoses was of 76.5%, for the first five diagnoses was 65.4%, for the first three diagnoses was 58%, and the exact match with the first diagnosis was 37.9%. The classification of Mediktor in this segment of patients shows that a higher level of severity corresponds to a greater number of hospital admissions, hospital readmissions and emergency screenings at 30 days, although without statistical significance. It is expected that this type of applications may be useful as a complement to the triage, to accelerate the diagnostic approach, to improve the request for appropriate complementary tests in a protocolized action model and to reduce waiting times in the ED

Municipal mortality due to thyroid cancer in Spain

BACKGROUND: Thyroid cancer is a tumor with a low but growing incidence in Spain. This study sought to depict its spatial municipal mortality pattern, using the classic model proposed by Besag, York and Mollié. METHODS: It was possible to compile and ascertain the posterior distribution of relative risk on the basis of a single Bayesian spatial model covering all of Spain's 8077 municipal areas. Maps were plotted depicting standardized mortality ratios, smoothed relative risk (RR) estimates, and the posterior probability that RR > 1. RESULTS: From 1989 to 1998 a total of 2,538 thyroid cancer deaths were registered in 1,041 municipalities. The highest relative risks were mostly situated in the Canary Islands, the province of Lugo, the east of La Coruña (Corunna) and western areas of Asturias and Orense. CONCLUSION: The observed mortality pattern coincides with areas in Spain where goiter has been declared endemic. The higher frequency in these same areas of undifferentiated, more aggressive carcinomas could be reflected in the mortality figures. Other unknown genetic or environmental factors could also play a role in the etiology of this tumor

A super-Earth and a sub-Neptune orbiting the bright, quiet M3 dwarf TOI-1266

We report the discovery and characterisation of a super-Earth and a sub-Neptune transiting the bright ($K=8.8$), quiet, and nearby (37 pc) M3V dwarf TOI-1266. We validate the planetary nature of TOI-1266 b and c using four sectors of TESS photometry and data from the newly-commissioned 1-m SAINT-EX telescope located in San Pedro M\'artir (Mexico). We also include additional ground-based follow-up photometry as well as high-resolution spectroscopy and high-angular imaging observations. The inner, larger planet has a radius of $R=2.37_{-0.12}^{+0.16}$ R$_{\oplus}$ and an orbital period of 10.9 days. The outer, smaller planet has a radius of $R=1.56_{-0.13}^{+0.15}$ R$_{\oplus}$ on an 18.8-day orbit. The data are found to be consistent with circular, co-planar and stable orbits that are weakly influenced by the 2:1 mean motion resonance. Our TTV analysis of the combined dataset enables model-independent constraints on the masses and eccentricities of the planets. We find planetary masses of $M_\mathrm{p}$ = $13.5_{-9.0}^{+11.0}$ $\mathrm{M_{\oplus}}$ ($<36.8$ $\mathrm{M_{\oplus}}$ at 2-$\sigma$) for TOI-1266 b and $2.2_{-1.5}^{+2.0}$ $\mathrm{M_{\oplus}}$ ($<5.7$ $\mathrm{M_{\oplus}}$ at 2-$\sigma$) for TOI-1266 c. We find small but non-zero orbital eccentricities of $0.09_{-0.05}^{+0.06}$ ($<0.21$ at 2-$\sigma$) for TOI-1266 b and $0.04\pm0.03$ ($<0.10$ at 2-$\sigma$) for TOI-1266 c. The equilibrium temperatures of both planets are of $413\pm20$ K and $344\pm16$ K, respectively, assuming a null Bond albedo and uniform heat redistribution from the day-side to the night-side hemisphere. The host brightness and negligible activity combined with the planetary system architecture and favourable planet-to-star radii ratios makes TOI-1266 an exquisite system for a detailed characterisation

Contemporary management of cancer of the oral cavity

Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers

Advanced glycoxidation and lipoxidation end products (AGEs and ALEs): an overview of their mechanisms of formation

Advanced lipoxidation end products (ALEs) and advanced glycation end products (AGEs) have a pathogenetic role in the development and progression of different oxidative-based diseases including diabetes, atherosclerosis, and neurological disorders. AGEs and ALEs represent a quite complex class of compounds that are formed by different mechanisms, by heterogeneous precursors and that can be formed either exogenously or endogenously. There is a wide interest in AGEs and ALEs involving different aspects of research which are essentially focused on set-up and application of analytical strategies (1) to identify, characterize, and quantify AGEs and ALEs in different pathophysiological conditions ; (2) to elucidate the molecular basis of their biological effects ; and (3) to discover compounds able to inhibit AGEs/ALEs damaging effects not only as biological tools aimed at validating AGEs/ALEs as drug target, but also as promising drugs. All the above-mentioned research stages require a clear picture of the chemical formation of AGEs/ALEs but this is not simple, due to the complex and heterogeneous pathways, involving different precursors and mechanisms. In view of this intricate scenario, the aim of the present review is to group the main AGEs and ALEs and to describe, for each of them, the precursors and mechanisms of formation

Impact of volatile phenols and their precursors on wine quality and control measures of Brettanomyces/Dekkera yeasts

Volatile phenols are aromatic compounds and one of the key molecules responsible for olfactory defects in wine. The yeast genus Brettanomyces is the only major microorganism that has the ability to covert hydroxycinnamic acids into important levels of these compounds, especially 4-ethylphenol and 4-ethylguaiacol, in red wine. When 4-ethylphenols reach concentrations greater than the sensory threshold, all wine’s organoleptic characteristics might be influenced or damaged. The aim of this literature review is to provide a better understanding of the physicochemical, biochemical, and metabolic factors that are related to the levels of p-coumaric acid and volatile phenols in wine. Then, this work summarizes the different methods used for controlling the presence of Brettanomyces in wine and the production of ethylphenols