Identification of high-risk patients for referral through machine learning assisting the decision making to manage minor ailments in community pharmacies

Background: Data analysis techniques such as machine learning have been used for assisting in triage and the diagnosis of health problems. Nevertheless, it has not been used yet to assist community pharmacists with services such as the Minor Ailment Services These services have been implemented to reduce the burden of primary care consultations in general medical practitioners (GPs) and to allow a better utilization of community pharmacists’ skills. However, there is a need to refer high-risk patients to GPs. Aim: To develop a predictive model for high-risk patients that need referral assisting community pharmacists’ triage through a minor ailment service. Method: An ongoing pragmatic type 3 effectiveness-implementation hybrid study was undertaken at a national level in Spanish community pharmacies since October 2020. Pharmacists recruited patients presenting with minor ailments and followed them 10 days after the consultation. The main outcome measured was appropriate medical referral (in accordance with previously co-designed protocols). Nine machine learning models were tested (three statistical, three black box and three tree models) to assist pharmacists in the detection of high-risk individuals in need of referral. Results: Over 14′000 patients were included in the study. Most patients were female (68.1%). With no previous treatment for the specific minor ailment (68.0%) presented. A percentage of patients had referral criteria (13.8%) however, not all of these patients were referred by the pharmacist to the GP (8.5%). The pharmacists were using their clinical expertise not to refer these patients. The primary prediction model was the radial support vector machine (RSVM) with an accuracy of 0.934 (CI95 = [0.926,0.942]), Cohen’s kappa of 0.630, recall equal to 0.975 and an area under the curve of 0.897. Twenty variables (out of 61 evaluated) were included in the model. radial support vector machine could predict 95.2% of the true negatives and 74.8% of the true positives. When evaluating the performance for the 25 patient’s profiles most frequent in the study, the model was considered appropriate for 56% of them. Conclusion: A RSVM model was obtained to assist in the differentiation of patients that can be managed in community pharmacy from those who are at risk and should be evaluated by GPs. This tool potentially increases patients’ safety by increasing pharmacists’ ability to differentiate minor ailments from other medical conditionsSpanish Society of Clinical, Family and Community Pharmacy and the Pharmaceutical Associations of Valencia, Madrid, Gipuzkoa, Malaga, Castellon and ValladolidUniversity of GranadaOpen access funding by University of Lausanne

Field Trials for the Empirical Characterization of the Low Voltage Grid Access Impedance From 35 kHz to 500 kHz

The access impedance of low-voltage (LV) power networks is a major factor related to the performance of the narrow-band power line communications (NB-PLCs) and, in a wider sense, to electromagnetic compatibility (EMC) performance. Up to date, there is still a lack of knowledge about the frequency-dependent access impedance for frequencies above 9 kHz and up to 500 kHz, which is the band where the NB-PLC operates. The access impedance affects the transmission of the NB-PLC signal, and it determines the propagation of the non-intentional emissions that may disturb other electrical devices, including malfunctioning or reduced lifetime of equipment. This paper presents the results of field measurements of the LV access impedance up to 500 kHz in different scenarios, with measurement locations close to end users and near transformers. The results provide useful information to analyze the characteristics of the LV access impedance, including variation with frequency, ranges of values for different frequency bands, and analysis of specific phenomena. Moreover, the results reveal a diverse frequency-dependent behavior of the access impedance in different scenarios, depending on the grid topology, the number of end users (that is, number and type of connected loads), and the type of transformation center. Overall, the results of this paper offer a better understanding of the transmission of NB-PLC signals and EMC-related phenomena.The authors would like to thank Iberdrola for the availability and the collaboration of authorized staff for carrying out the field trials

Ferroelectric and anomalous quantum Hall states in bare rhombohedral trilayer graphene

Nontrivial interacting phases can emerge in elementary materials. As a prime example, continuing advances in device quality have facilitated the observation of a variety of spontaneous quantum Hall-like states, a cascade of Stoner-like magnets, and an unconventional superconductor in bilayer graphene. Its natural extension, rhombohedral trilayer graphene is predicted to be even more susceptible to interactions given its even flatter low-energy bands and larger winding number. Theoretically, five spontaneous quantum Hall phases have been proposed to be candidate ground states. Here, we provide transport evidence for observing four of the five competing ordered states in interaction-maximized, dually-gated, rhombohedral trilayer graphene. In particular, at vanishing but finite magnetic fields, two states with Chern numbers 3 and 6 can be stabilized at elevated and low electric fields, respectively, and both exhibit clear magnetic hysteresis. We also reveal that the quantum Hall ferromagnets of the zeroth Landau level are ferroelectrics with spontaneous layer polarizations even at zero electric field, as evidenced by electric hysteresis. Our findings exemplify the possible birth of rich interacting electron physics in a simple elementary material

Resultados de los potenciales evocados miogénicos vestibulares en el vértigo posicional paroxístico benigno

Objective: Benign paroxysmal positional vertigo (BPPV) seems to occur because of otoconia migration into the semicircular canals or their adherence to the cupula. Although the origin of these otoconia lies in the macula of the utricle, vestibular evoked myogenic potentials (VEMPs) can be used assess saccular function. The aim of this study is to assess the saccular function in patients diagnosed with BPPV. Patients and method: Nineteen patients diagnosed with BPPV of the posterior semicircular canal were included in this study. Their auditory function and their caloric, rotatory chair, and VEMP responses were tested. Ipsilateral and contralateral VEMP thresholds, ipsilateral and contralateral p13 and n23 latencies at 100 dB, inter-peak amplitude and the interaural amplitude difference were determined. Results: We found a lack of VEMP response in 52 % of the ears with BPPV. When adjusted for bilateral absence, VEMP response was absent in 20.3 % of ears. Conclusions: Some patients with idiopathic BPPV show a degree of saccular dysfunction

New Sequence Variations in Spermatogenesis Candidates Genes

The aim of this paper was to estimate the frequency and types of mutations in key candidate genes involved in spermatogenesis, and its potential value as a cause of azoospermia / cryptozoospermia.Patients and Methods: the sequencing of the coding region of the genes DBY, RBMY, DAZ, CDY and BPY2, excluding the promoter region was performed in a series of 25 patients with azoospeermia or severe oligozoospermia without AZF microdeletions. Exon 3 of DAZL gene (DAL3) was also sequenced. The sequences obtained were analyzed by ProSeq, DnaSP v5 and compared with the database through Blastn and tblastx.Results and conclusions: 16 of the 25 patients showed some type of variants, such as transversions, transitions, deletions and / or insertions in the DAZ, DAZL, CDY and RBMY genes. The mutated sequences presented between 97 and 99% homology with the specific protein of every gene, except in DAZL (73%) and DAZ (94%) proteins. The variants found have not been described previously, suggesting they could be mutations that might affect protein function.Fil: Poli, María Noelia. Universidad Nacional de Mar del Plata; Argentina. Asociación de Genética Humana; Argentina. Universidad Nacional de Mar del Plata; ArgentinaFil: Fernandez Iriarte, Pedro Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Iudica, Celia Estela. Universidad Nacional de Mar del Plata; Argentina. Asociación de Genética Humana; ArgentinaFil: Zanier, Justo Hector Mario. Asociación de Genética Humana; ArgentinaFil: Coco, Roberto. Fecunditas Instituto de Medicina Reproductiva; Argentin

Fatty Liver Is Associated with Transcriptional Downregulation of Stearoyl-CoA Desaturase and Impaired Protein Dimerization

AIMS AND METHODS: We evaluated the modulation of liver stearoyl-CoA desaturase-1 (Scd1) by dietary factors and insulin resistance (IR) in two experimental models of high-fat diet (HFD)-induced nonalcoholic fatty liver disease (NAFLD). The first model included Sprague Dawley (SD) rats that developed NAFLD without IR, and the second one included a rat model of genetic IR and cardiovascular disease, the spontaneously hypertensive rats (SHR) and its normotensive, insulin-sensitive control Wistar-Kyoto (WKY). The adult rats were given standard chow diet (CD) or HFD for 10 weeks. In all the animals, we explored the hepatic Scd1 transcriptional activity and protein levels. RESULTS: HFD-fed rats of both strains developed severe NAFLD. Liver abundance of Scd1 mRNA was significantly decreased in HFD-fed rats regardless of the strain; SD-CD: 235±195 vs. SD-HFD 4.5±2.9, p<0.0004, and SHR-CD: 75.6±10.8 vs. SHR-HFD: 4.48±17.4, and WKY-CD: 168.7±17.4 vs. WKY-HFD: 12.9±17.4, p<0.000001 (mean±SE, ANCOVA adjusted by HOMA). Analysis of liver Scd1 protein expression showed a particular pattern in the HFD groups, characterized by the presence of high levels of a monomeric protein band (32.2-36.6 Kda, p<0.003) and decreased levels of a dimeric protein band (61.9-66.1 Kda, p<0.02) regardless of the rat strain. Pharmacologic intervention with the peroxisome proliferator-activated receptor α agonist clofibrate reverted the liver phenotype and significantly modified the hepatic Scd1 transcriptional activity and protein expression. CONCLUSION: Diet-induced fatty liver is associated with the downregulation of hepatic Scd1 transcript and de-dimerization of the protein, and these changes were not much affected by the status of peripheral IR.Fil: Fernandez Gianotti T.Fil: Burgueño A.Fil: Gonzales Mansilla Nl.Fil: Pirola Cj.Fil: Sookoian S

Estudio comparativo de los clones de aislamientos de Staphylococcus aureus resistentes a meticilina prevalentes en la Argentina

Fil: Gardella, Noella. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Fernandez, Silvina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Di Gregorio, Sabrina Noelia. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Cuirolo, Arabela Ximena. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Gutkind, Gabriel Osvaldo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Mollerach, Marta Eugenia. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

Efecto de la densidad de siembra y dosis nitrogenada en maíz (Zea mays L.) en ensayos conducidos bajo agricultura de precisión

Trabajo Final Integrador (Área de Consolidación Métodos Cuantitativos para la Investigación Agropecuaria - Ingeniería Agronómica) -- UNC- Facultad de Ciencias Agropecuarias, 2018La agricultura de precisión permite optimizar la gestión tanto económica como productiva de una empresa agropecuaria. A partir de esta herramienta se analizaron tres bases de datos provenientes de ensayos de dosificación variable en el cultivo de maíz en campos de productores en Illinois, Estados Unidos. Se evaluaron los rendimientos promedios en relación a distintas densidades de siembra y diferentes dosis de nitrógeno, con el objetivo de poder determinar las dosis adecuadas para mejorar los rendimientos, preservando la sustentabilidad. Los resultados que se observaron fueron que los máximos rendimientos se logran con las mayores dosis de nitrógeno pero no así con las mayores densidades de siembra

Factores y estrategias en la implantación del Servicio de Indicación Farmacéutica en farmacia comunitaria

El Servicio de Indicación Farmacéutica (SIF) es el servicio profesional a través del cual el farmacéutico atiende la consulta de los pacientes sobre un síntoma menor con el fin de obtener un remedio adecuado. Requiere de una actuación protocolizada y conlleva una elevada responsabilidad por parte del farmacéutico. INDICA+PRO es un proyecto realizado desde 2017 para evaluar el impacto y la implantación del SIF en la farmacia comunitaria española. Este artículo evalúa la implantación del SIF en una única farmacia. En la etapa de implantación del SIF a través de INDICA+PRO se detectaron factores de implantación (barreras y facilitadores) para los que se utilizaron una serie de estrategias. Como parte de la implementación se propusieron estrategias como destacar las ventajas del SIF para la farmacia, realizar incentivos por la prestación del servicio o la distribución de tareas dentro del equipo. Entre los facilitadores se encontró la disponibilidad de la zona de atención personalizada, la buena relación con los centros de salud cercanos y la realización de otros servicios profesionales en la farmacia. Las ventajas obtenidas por la realización del SIF obtenidas siguiendo el procedimiento protocolizado, dentro del programa SEFAC eXPERT®, establecido fueron, entre otras, la mejora en el seguimiento del paciente, el incremento en la comunicación del equipo y con el paciente facilitado por el historial farmacoterapéutico de la farmacia y la elaboración de informes estandarizados.Minor ailment service (MAS) is a professional pharmacy service assisting patients to manage minor ailments. MAS involves a structured consultation process with protocols which delineate professional practice. INDICA+PRO is a project, started in 2017, which evaluates the impact and subsequently implementation of MAS in Spanish community pharmacies. This paper reports on the experience of implementing the service in a single pharmacy. Implementation factors (barriers and facilitators) were detected and a series of strategies were developed and used as part of the implementation program of MAS through a practice program, INDICA+PRO. The implementation strategies, such as highlighting the advantages of MAS for the pharmacy, incentives for the provision of the service and/or the distribution of tasks within the team were used to overcome barriers. Facilitators included the availability of a consultation room in the pharmacy, good relationships with nearby health centers and the provision of other professional services in the pharmacy. The advantages obtained from MAS, following the inclusion in the software (SEFAC eXPERT®) of the agreed protocols and clinical information, were improved patient follow-up, increased communication within the team and with patients, the pharmacy having a clinical history of the minor ailments and the ability of being able to prepare standardized report

Enlightening the Universe behind the Milky Way Bulge

Context. The location of the Solar System constrains the detection of extragalactic sources beyond the Milky Way(MW) plane. The optical observations are hampered in the so--called Zone of Avoidance (ZOA) where stellar crowding and Galactic absorption are severe. Observations at longer wavelengths are needed to discover new background galaxies and complete the census in the ZOA. Aims. The goal of this work is to identify galaxies behind the MW Bulge using near-infrared (NIR) data from the VISTA Variables in V\'ia L\'actea (VVV) survey. Methods. To this end we made use of different VISTA Science Archive (VSA) tools in order to extract relevant information from more than 32 billion catalogued sources in the VVV Bulge region. We find that initial photometric restriction on sources from VSA \texttt{vvvSource} table combined with restrictions on star--galaxy separation parameters obtained from Source Extractor is a successful strategy to achieve acceptable levels of contamination (60\%) and a high completeness (75\%) in the construction of a galaxy target sample. To decontaminate the initial target sample from Galactic sources our methodology also incorporates the visual inspection of false colour RGB images, a crucial quality control which was carried out following a specifically defined procedure. Results. Under this methodology we find 14480 galaxy candidates in the VVV Bulge region making this sample the largest catalogue to date in the ZOA. Moreover these new sources provide a \textbf{fresh} picture of the Universe hidden behind the curtain of stars, dust and gas in the unexplored MW Bulge region. Conclusions. The results from this work further demonstrate the potential of the VVV/VVVX survey to find and study a large number of galaxies and extragalactic structures obscured by the MW, enlightening our knowledge of the Universe in this challenging and impressive region of the sky