A Method for Systematic Adaptation and Synchronization of Healthcare Processes

International organizations, as the World Health Organization (WHO) and national governments are constantly defining (or modifying) new healthcare protocols and procedures. Those changes have a significant impact, on one side, on the organizational concerns of a great number of healthcare institutions and centers, and on the other side, on their health information systems that need to be adapted according to the new (or modified) procedures. Administrative workflows are commonly defined by a high level entity and they must then be applied on different institutions ruled by this high level entity. Those workflows must then be adapted to the particular circumstances of each institution, complying with the general regulations of the process established at the top level. This problem, called Hierarchical Adaptation Problem, also implies establishing the methods to evolve together the high level regulation. Such methods must maintain the consistency among the different levels by means of the propagation of the changes to all the different adaptations of the original workflow. To solve this problem, this work introduces the Hierarchical Adaptation Method. A method based on ontologies to define the rules that must be satisfied by a generic workflow to be considered adaptable to different application cases and the rules that must be satisfied by its adapted versions. Moreover, it provides the operations to facilitate both adaptation of administrative workflows and propagation of changes

CompareML: A Novel Approach to Supporting Preliminary Data Analysis Decision Making

There are a large number of machine learning algorithms as well as a wide range of libraries and services that allow one to create predictive models. With machine learning and artificial intelligence playing a major role in dealing with engineering problems, practising engineers often come to the machine learning field so overwhelmed with the multitude of possibilities that they find themselves needing to address difficulties before actually starting on carrying out any work. Datasets have intrinsic properties that make it hard to select the algorithm that is best suited to some specific objective, and the ever-increasing number of providers together make this selection even harder. These were the reasons underlying the design of CompareML, an approach to supporting the evaluation and comparison of machine learning libraries and services without deep machine learning knowledge. CompareML makes it easy to compare the performance of different models by using well-known classification and regression algorithms already made available by some of the most widely used providers. It facilitates the practical application of methods and techniques of artificial intelligence that let a practising engineer decide whether they might be used to resolve hitherto intractable problems. Thus, researchers and engineering practitioners can uncover the potential of their datasets for the inference of new knowledge by selecting the most appropriate machine learning algorithm and determining the provider best suited to their data

Nuevos usos residenciales en el espacio rural de Castilla y León

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Evaluation of the national vaccination day in bogotá, d.c., 2001

Objectives: A national immunization day-NID, aimed at improving vaccination coverage, was carried out in Colombia in November 2001. The main objective of the study was to measure the proportion of children under 2 years either completing their immunization schedule or advancing through it by receiving doses during the NID. Besides, we also evaluated the proportion of lost opportunities for vaccination during the NID and the impact of the media (TV, radio, newspapers, etc.) in advertising the NID. Methods: In order to evaluate the impact of immunization a cross sectional survey was carried out in Bogotá in the waiting rows of the 30 randomly selected vaccination posts; 623 participants were systematically chosen. The outcomes were analyzed by age, socioeconomic level and type of health insurance-SSS. Only children holding a vaccination card were considered eligible for the study. Results: Most people become aware about NID through TV, 81 %, followed by radio advertisements, 22 %. After attending NID the proportion of fully vaccinated children, according to PAHO scheme, raised from 46 % to 66 %, a 43 % increase. This increase was even higher among children aged less than 6 months (140 % increment). There were no differences in the increment by social stratum or affiliation to the SSS. Among the children studied we identified a 24 % of loss opportunities for vaccination that did not differ by socioeconomic level or SSS groups. Conclusions: Our results suggest that, despite its high costs, NID might be useful to transiently overcome barriers for adequate access to health services.Objetivos: Durante Noviembre de 2001 se realizó una jornada de vacunación en Bogotá con el fin de mejorar coberturas. El objetivo principal era medir la proporción de niños menores de 2 años que finalizaban el esquema o que avanzaban en el esquema por dosis recibidas durante la jornada. Adicionalmente se midió la proporción de oportunidades perdidas de vacunación-OPV durante la jornada y el impacto de los diferentes medios de comunicación usados para anunciar la realización de la jornada. Métodos: Se diseñó un estudio transversal con encuesta rápida en las filas de espera de los puestos de vacunación. Todos los indicadores fueron relacionados con variables socioeconómicas como la edad del niño, el estrato socioeconómico y el tipo de afiliación al sistema de salud-SGSS. Fueron seleccionados al azar 30 puestos de vacunación y se escogieron 623 participantes con carné de vacunación. Resultados: El medio masivo con mayor impacto fue la televisión, 81 %, seguido por la radio con 22 %. El porcentaje de niños con esquema completo de OPS pasó de 46 a 63 %, incremento de 43 %, siendo mayor en los menores de 6 meses (incremento de 140 %). No hubo diferencias en el incremento por estrato socioeconómico o tipo de afiliación al SGSS. Se registró un 24 % de OPV que tampoco fue diferente por estrato socioeconómico o afiliación al SGSS. Conclusiones: Los resultados sugieren que, pese a su alto costo, las jornadas de vacunación pueden ser útiles para remover transitoriamente las barreras de acceso a los servicios de salud

Strontium hexaferrite platelets: a comprehensive soft X-ray absorption and Mössbauer spectroscopy study

IBERMÖSS-2019, Bilbao, 30-31 may 2019. --https://www.ehu.eus/es/web/ibermossmeetingStrontium ferrite (SFO, SrFe12O19) is a ferrite employed for permanent magnets due to its high magnetocrystalline anisotropy. Since its discovery in the mid-20th century, this hexagonal ferrite has become an increasingly important material both commercially and technologically, finding a variety of uses and applications. Its structure can be considered a sequence of alternating spinel (S) and rocksalt (R) blocks. All the iron cations are in the Fe3+ oxidation state and it has a ferrimagnetic configuration with five different cationic environments for the iron (three octahedral sites, a tetraedrical site and a bipiramidal site)[1,2]. We have studied the properties of SrFe 12O19 in the shape of platelets, up to several micrometers in width, and tens of nanometers thick, synthesized by a hydrothermal method. We have characterized the structural and magnetic properties of these platelets by Mössbauer spectroscopy, x-ray transmission microscopy (TMX), transmission electron microscopy (TEM), x-ray diffraction (XRD), vibrating-sample magnetometry (VSM), x-ray absorption spectroscopy (XAS), x-ray circular magnetic dichroism (XMCD) and photoemission electron microscopy (PEEM). To the best of our knowledge this is the first time that the x-ray absorption spectra at the Fe L 2,3 edges of this material in its pure form have been reported. The Mössbauer results recorded from these platelets both in the electron detection and transmission modes have helped to understand the iron magnetic moments determined by XMCD (Fig.1). The experimental results have been complemented with multiplet calculations aimed at reproducing the observed XAS and XMCD spectra at the Fe L 2,3 absorption edge, and by density functional theory (DFT) calculations to reproduce the oxygen K- absorption edge. Finally the domain pattern measured in remanence is in good agreement with micromagnetic simulations [3]

Phenylalanine Hydroxylase (PAH) Genotyping in PKU Argentine Patients

Phenylketonuria (PKU, OMIM 261600) is predominantly caused by mutations in the PAH gene. One hundred and three Argentine PKU patients were studied by Sanger sequencing; 101 were completely characterized (90.3% were compound heterozygotes). Fifty-four different pathogenic variants were identified. Mutations were distributed all along the PAH gene but concentrated in exon 7 (26%), 12 (12%), 11 (10%), and 6 (10%). 77% were missense, and 77% affected the enzyme catalytic domain, nine mutations accounted for 57% of 179 studied alleles: p.Arg261Gln (Allele frequency(AF):10.6%), c.1066-11G>A (AF:9,5%), p.Arg408Trp (AF:8,3%), p.Tyr414Cys (AF:5,5%), p.Ala403Val, p.Val388Met, and p.Arg158Gln (AF: 5% each), p.Leu48Ser, and p.Ile65Thr (AF:4% each). The predicted phenotype was assigned by Guldberg´s arbitrary value (AV) and compared with the clinical phenotype based in tolerance to Phe intake. 29.1% (n:30) were hyperphenylalaninemias, 18.5% (n:19) mild-PKU, 27.2% (n:28) moderate-PKU and 25.2 % (n:26) classical-PKU. Genotype/phenotype correlation was statistically significant (p<0.001) Overall concordance was 62,5%: 93.3% in hyperphenylalaninemia, 64.7% in mild-PKU and 65.4% in classical patients. The moderate-PKU showed a weak concordance (17%) with milder AV prediction than clinical assessment. 74% of discordant moderate patients harbored p.Arg261Gln, and p.Val388Met. Our cohort is highly heterogeneous, with predominant Mediterranean influence (mainly Spanish), but with differences with other Latin-American countries.Fil: Enacán, Rosa E.. Fundacion de Endocrinologia Infantil.; ArgentinaFil: Miñana, Mariana Nuñez. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Fernandez, Luis. Universidad Autónoma de Madrid; EspañaFil: Valle, María Gabriela. Fundacion de Endocrinologia Infantil.; ArgentinaFil: Salerno, Mercedes. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Fraga, Claudia I.. Fundacion de Endocrinologia Infantil.; ArgentinaFil: Santos Simarro, Fernando. Universidad Autónoma de Madrid; EspañaFil: Prieto, Laura. Fundacion de Endocrinologia Infantil.; ArgentinaFil: Lapunzina, Pablo. Universidad Autónoma de Madrid; EspañaFil: Specola, Norma. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Chiesa, Ana Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; Argentina. Fundacion de Endocrinologia Infantil.; Argentin

Methylthioadenosine phosphorylase gene expression is impaired in human liver cirrhosis and hepatocarcinoma

Methylthioadenosine phosphorylase (MTAP) is a key enzyme in the methionine and adenine salvage pathways. In mammals, the liver plays a central role in methionine metabolism, and this essential function is lost in the progression from liver cirrhosis to hepatocarcinoma. Deficient MTAP gene expression has been recognized in many transformed cell lines and tissues. In the present work, we have studied the expression of MTAP in human and experimental liver cirrhosis and hepatocarcinoma. We observe that MTAP gene expression is significantly reduced in human hepatocarcinoma tissues and cell lines. Interestingly, MTAP gene expression was also impaired in the liver of CCl4-cirrhotic rats and cirrhotic patients. We provide evidence indicating that epigenetic mechanisms, involving DNA methylation and histone deacetylation, may play a role in the silencing of MTAP gene expression in hepatocarcinoma. Given the recently proposed tumor suppressor activity of MTAP, our observations can be relevant to the elucidation of the molecular mechanisms of multistep hepatocarcinogenesis

Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study

Background: Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area. Methods: A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006–2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression. Results: 341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found. Conclusion: HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI

GATA2 Promotes Hematopoietic Development and Represses Cardiac Differentiation of Human Mesoderm.

In vertebrates, GATA2 is a master regulator of hematopoiesis and is expressed throughout embryo development and in adult life. Although the essential role of GATA2 in mouse hematopoiesis is well established, its involvement during early human hematopoietic development is not clear. By combining time-controlled overexpression of GATA2 with genetic knockout experiments, we found that GATA2, at the mesoderm specification stage, promotes the generation of hemogenic endothelial progenitors and their further differentiation to hematopoietic progenitor cells, and negatively regulates cardiac differentiation. Surprisingly, genome-wide transcriptional and chromatin immunoprecipitation analysis showed that GATA2 bound to regulatory regions, and repressed the expression of cardiac development-related genes. Moreover, genes important for hematopoietic differentiation were upregulated by GATA2 in a mostly indirect manner. Collectively, our data reveal a hitherto unrecognized role of GATA2 as a repressor of cardiac fates, and highlight the importance of coordinating the specification and repression of alternative cell fates.Ramón y Cajal Program, Spanish Ministry of Economy, Industry, and Competitiveness, Spanish Cancer Association, FERO, Instituto de Salud Carlos III, European Social Fund, MINECO, PERIS Program of the Generalitat de Catalunya, Obra Social la Caixa-Fundacion Josep Carreras, Spanish Institute of Health Carlos III, Wellcome Trust, MRC, CRUK, NIH-NIDD

Selenium and impaired physical function in US and Spanish older adults

Background: Selenium (Se) is a trace element with a narrow safety margin. Objectives: To evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults. Design: NHANES 2011–2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017–2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lowerextremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis. Results: Meta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 μg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 μg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations. Discussion: In US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms.Instituto de Salud Carlos III European Commission PI18/287 16/609State Secretary of R + D + I PID2019-108973RB-C21/C22European Social Fund (ESF) European Commissio