Using machine learning methods to determine a typology of patients with HIV-HCV infection to be treated with antivirals

Several European countries have established criteria for prioritising initiation of treatment in patients infected with the hepatitis C virus (HCV) by grouping patients according to clinical characteristics. Based on neural network techniques, our objective was to identify those factors for HIV/HCV co-infected patients (to which clinicians have given careful consideration before treatment uptake) that have not being included among the prioritisation criteria. This study was based on the Spanish HERACLES cohort (NCT02511496) (April-September 2015, 2940 patients) and involved application of different neural network models with different basis functions (product-unit, sigmoid unit and radial basis function neural networks) for automatic classification of patients for treatment. An evolutionary algorithm was used to determine the architecture and estimate the coefficients of the model. This machine learning methodology found that radial basis neural networks provided a very simple model in terms of the number of patient characteristics to be considered by the classifier (in this case, six), returning a good overall classification accuracy of 0.767 and a minimum sensitivity (for the classification of the minority class, untreated patients) of 0.550. Finally, the area under the ROC curve was 0.802, which proved to be exceptional. The parsimony of the model makes it especially attractive, using just eight connections. The independent variable "recent PWID" is compulsory due to its importance. The simplicity of the model means that it is possible to analyse the relationship between patient characteristics and the probability of belonging to the treated group

El Mecanismo Tutelar del Sistema Interamericano como Garantía de los Derechos de los Pueblos Indígenas

This article has as general objective to describe the guardianship decisions of the two organs that protect human rights in the inter-American system. The result is achieved through the development of a qualitative, simple, and legal investigation, which uses the deductive and inductive analytical method, and focuses its analysis on the international practice of the Inter-American Commission and Court, obtaining that both the precautionary and provisional mechanism has been focused on the protection of indigenous people from their rights to life, integrity, freedom, property and free movement, in their individual and collective dimension; in addition, that the requestor adoption of measures is character- ized by being general, specific or concerted.El artículo tiene como objetivo general describir las decisiones tutelares de los dos órganos que protegen los Derechos Humanos en el Sistema Interamericano. El resultado se consigue mediante el desarrollo de una investigación cualitativa, básica y jurídica, que utiliza el método analítico deduc- tivo e inductivo, y centra su análisis en la práctica internacional de la Comisión y Corte Interamericana, obteniendo que tanto el mecanismo cautelar como provisional se ha centrado en la protección a los indígenas de sus Derechos a la Vida, Integridad, Libertad, Propiedad y Libre Circulación, en su dimen- sión individual y colectiva; además, que la solicitud o adopción de medidas se caracterizan por ser generales, específicas o concertadas

Use of frontal flap for reconstruction of malar region following arteriovenous malformation resection: a case report

Arteriovenous malformations (AVMs) are rare congenital vascular anomalies characterized by abnormal artery-vein connections. These malformations often occur intracranially but can be found in extracranial regions, presenting unique clinical challenges. Diagnosis and staging, typically using the Schobinger clinical classification, are essential, and various imaging techniques aid in the process. Treatment of AVMs is a multidisciplinary effort, with minimally invasive endovascular procedures being preferred, and surgical resection considered for extensive cases. In this case report, a 52-year-old male with an AVM in the malar region underwent successful treatment. The procedure involved preoperative marking, anesthesia, flap division, AVM resection, and flap placement, followed by suturing and a second surgical stage. The successful utilization of a contralateral frontal flap for reconstruction following AVM resection is highlighted. This case underscores the importance of a multi-stage surgical approach and careful flap preservation in AVM treatment, emphasizing the skills of surgeons. Collaboration among various medical specialties is crucial for effectively managing AVMs, combining embolization, resection, and reconstruction for tailored treatment that improves both function and aesthetics

What makes Input-Output Tables of Trade of Raw Material Goods Peculiar Networks? The World and Mexican Cases

(¿Qué hace que las tablas insumo-producto del comercio de mercancías de materia prima sean redes peculiares? Los casos mundial y mexicano)Objetivo: se examinan varias peculiaridades de las tablas de input-output (IOT) del comercio de materias primas cuando se tratan como redes. Metodología: dos IOTs de comercio de materias primas (mundial y México) se comparan con una red con distribución de escala y organización jerárquica (una base de datos de correos electrónicos) utilizando distintas centralidades y estadísticas de la teoría de grafos. Resultados: las IOTs son un tipo de gráfico muy particular debido a su idiosincrasia, para las cuales las medidas de estándar de gráficas no proporcionan resultados satisfactorios, y que deben adaptarse para dar un retrato fragmentado de toda la red. Recomendaciones: las herramientas analíticas de redes aplicadas a las IOTs mejoran la comprensión del comercio de materias primas, a nivel nacional como mundial, lo cual es útil en el diseño de la política comercial. Limitaciones: no se incluye la centralidad de caminata aleatoria ni cambios de régimen por shocks externos. Originalidad: es una contribución novedosa que resalta particularidades de las IOTs, vistas como redes, para México. Conclusiones: se encuentran importantes particularidades de las IOTs al compararlas con otras redes.Objective: This paper examines several peculiarities of Input-Output Tables (IOTs) of trade of raw material goods when treated as networks. Methodology: two IOTs of trade of raw material goods (World and Mexico) are compared with a network with a scale free distribution and hierarchical organization (an email database) by using distinct centralities and statistics from graph theory. Results: IOTs are a very particular type of graph due to their idiosyncrasies, for which standard graph measures cannot provide satisfactory results, and which have to be adapted to give a fragmented picture of the whole network. Recommendations: analytical tools of network theory applied to IOTs substantially improve the understanding of trade of raw material goods, both at the national and the global level, which is useful in the design of trade policy. Limitations: this research does not include random walk centrality and regime switching from external shocks. Originality: this is a novel research that enlightens the particularities of the IOTs, seen as networks, for the Mexican case. Conclusions: this investigation finds important particularities of IOTs when compared with other networks

Concurrent validity of supraclavicular skin temperature measured with iButtons and infrared thermography as a surrogate marker of brown adipose tissue

We are grateful to Ms. Carmen Sainz-Quinn for assistance with the English language. We are grateful to Alberto Quesada-Aranda for helping with the development of the Temperatus software (Free trial in http://profth.ugr.es/temperatus).This study is part of a Ph.D. Thesis conducted in the Biomedicine Doctoral Studies of the University of Granada, Spain.Brown adipose tissue (BAT) thermogenic activity is commonly assessed with a positron emission tomography with computed tomography scan (PET/CT). This technique has several limitations and alternative techniques are needed. Supraclavicular skin temperature measured with iButtons and infrared thermography (IRT) has been proposed as an indirect marker of BAT activity. We studied the concurrent validity of skin temperature measured with iButtons vs. IRT and the association of supraclavicular skin temperature measured with iButtons and IRT with BAT. We measured skin temperature upon a shivering threshold test with iButtons and IRT in 6 different regions in 12 participants (n = 2 men). On a separate day, we determined supraclavicular skin temperature with an iButton and IRT after 2 h of a personalized cooling protocol. Thereafter, we quantified BAT volume and activity by PET/CT. We observed that the absolute differences between the devices were statistically different from 0 (all P < 0.05) after the shivering threshold test. Moreover, we did not find any association between supraclavicular skin temperature measured with iButtons or IRT and BAT 18F-FDG activity (r = −0.213; P = 0.530 and r = −0.079; P = 0.817). However, we observed a negative association of supraclavicular skin temperature measured by IRT with BAT 18F-FDG volume (r = −0.764; P = 0.006), but not with supraclavicular skin temperature measured with iButtons (r = −0.546; P = 0.082). In light of these results, we concluded that the measurement of skin temperature obtained by iButtons and IRT are not comparable. Furthermore, it seems that supraclavicular skin temperature is not associated with BAT 18F-FDG activity, but it appears to be negatively associated with BAT 18F-FDG volume in the case of IRT.This study was supported by the Spanish Ministry of Economy and Competitiveness via the Fondo de Investigación Sanitaria del Instituto de Salud Carlos III (PI13/01393), Retos de la Sociedad (DEP2016-79512-R), PTA 12264-I, and European Regional Development Fund (ERDF), the Spanish Ministry of Education (FPU 13/04365, FPU14/04172, FPU15/05337, and FPU15/04059), by the Spanish Ministry of Science and Innovation-MINECO (RYC-2014-16938), the Fundación Iberoamericana de Nutrición (FINUT), the Redes Temáticas de Investigación Cooperativa RETIC (Red SAMID RD16/0022), the AstraZeneca HealthCare Foundation, the University of Granada Plan Propio de Investigación 2016 -Excellence actions: Unit of Excellence on Exercise and Health (UCEES) - and Plan Propio de Investigación 2018 - Programa Contratos-Puente, and the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades (ERDF, ref. SOMM17/6107/UGR). This study is part of a Ph.D

UN MODELO PEDAGÓGICO PARA LA FORMACIÓN PERMANENTE DEL PROFESORADO UNIVERSITARIO

This investigation has as an objective the establishment of a socio-educative syllabus for the sociological, psychological, and pedagogical permanent teleformation of teachers. It responds to the problem: insufficiencies that the teachers from the meso-universities (a revolutionary pedagogy whereby there is a representation of the university in all the boroughs of the province) in the boroughs in Las Tunas province manifest in the development of tasks as teachers in correspondence to the pedagogical model of universalizing the higher education, this affects the work they do. From practice point of view, it is offered a socio-educative syllabus, for permanent teleformation of teachers form the meso-universities according to the pedagogical model, which articulates the modalities of distance and week postgraduate education though the negotiation of knowledge and the usage of ICT. This model is based on the relations of structuring, constructing, collaborating, and feedback that are established among the components: guidance-teacher and virtual context for pedagogical teleformation; this will allow the active and responsible participation of the students in the construction of the content and in the formation of a curriculum in accordance to their needs, interests, and potentialities.El trabajo parte de una investigación, cuyo objetivo lo constituye el establecimiento de un programa socio educativo para la teleformación permanente sociológica, psicológica y pedagógica de los docentes, responde al problema de las insuficiencias que manifiestan los profesores de las Sedes Universitarias Municipales (SUM) de Las Tunas en el desarrollo de las tareas como docentes en correspondencia con el modelo pedagógico de la universalización, lo que afecta su desempeño. En la práctica se aporta un programa socio educativo, para la teleformación permanente de los docentes de la SUM, sobre la base de un modelo pedagógico, que articula las modalidades a distancia y presencial de la educación de posgrado mediante la gestión del conocimiento y el uso de las TIC. El modelo pedagógico para la teleformación permanente, cuya esencia está en las relaciones de estructuración, construcción, colaboración y retroalimentación que se establecen entre los componentes: relación orientador - docente y contexto virtual de teleformación pedagógica, permitirá la participación activa y responsable de los cursistas en la construcción del contenido, la conformación de un currículum acorde con sus necesidades, intereses y potencialidades

Physical fitness reference standards for preschool children: the PREFIT project

Objectives: Reference values are necessary for classifying children, for health screening, and for early prevention as many non-communicable diseases aggravate during growth and development. While physical fitness reference standards are available in children aged 6 and older, such information is lacking in preschool children. Therefore, the purposes of this study were (1) to provide sex-and age-specific physical fitness reference standards for Spanish preschool children; and (2) to study sex differences across this age period and to characterise fitness performance throughout the preschool period. Design: Cross-sectional. Methods: A total of 3179 preschool children (1678 boys) aged 2.8–6.4 years old from Spain were included in the present study. Physical fitness was measured using the PREFIT battery. Results: Age- and sex-specific percentiles for the physical fitness components are provided. Boys performed better than girls in the cardiorespiratory fitness, muscular strength, and speed-agility tests over the whole preschool period studied and for the different percentiles. In contrast, girls performed slightly better than boys in the balance test. Older children had better performance in all fitness tests than their younger counterparts. Conclusions: Our study provides age- and sex-specific physical fitness reference standards in preschool children allowing interpretation of fitness assessment. Sexual dimorphism in fitness tests exists already at preschool age, and these differences become larger with age. These findings will help health, sport, and school professionals to identify preschool children with a high/very low fitness level, to examine changes in fitness over time, and to analyse those changes obtained due to intervention effects.The PREFIT project takes place thanks to the funding linked to the Ramón y Cajal grant held by FBO (RYC-2011-09011). CC-S is supported by a grant from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). JRR and FBO are supported by grants from the Spanish Ministry of Science and Innovation (RYC-2010-05957 and RYC-2011-09011, respectively). In addition, this study was further supported by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). Additional funding from the SAMID III network, RETICS, funded by the PNI+D+I 2017-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (ERDF) (Ref. RD16/0022), the EXERNET Research Network on Exercise and Health in Special Populations (DEP2005-00046/ACTI), the University of the Basque Country (GIU14/21), and the University of Zaragoza (JIUZ-2014-BIO-08)

Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions

[Background and Aims]: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models.[Methods]: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies.[Results]: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets.[Conclusions]: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT 03050333.)Research support for this study was received from “La Caixa/Caja Navarra” Foundation (ID 100010434;project PR15/11100006)

SARS-CoV-2 Infection in Multiple Sclerosis

To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal diseas

Recicland, demostration on the management of organic and inorganic waste from agriculture

La agricultura protegida que se desarrolla principalmente en el litoral oriental andaluz es una actividad de gran importancia económica y social para Andalucía. Sin embargo, el crecimiento exponencial de la superficie de invernadero ha dado lugar a un incremento del volumen de residuos agrarios. Además, este sistema agrícola está evolucionando hacia nuevas técnicas de cultivo que implican, no sólo la generación de residuos, sino también una mayor diversificación que hace más complicada su gestión. El principal problema para la gestión de estos residuos agrarios no está sólo en su dispersión geográfica, sino también en su estacionalidad, ya que se genera gran cantidad en determinados periodos anuales, coincidiendo con la finalización de las campañas agrícolas. Por este motivo, la capacidad máxima de recogida y almacenamiento y el proceso de gestión están condicionados por el volumen generado al finalizar los ciclos de cultivo. En este contexto, surge el proyecto RECICLAND que pretende palear dichos problemas y contribuir a la gestión sostenible de los residuos generados en los procesos productivos. Concretamente, el objetivo general de este proyecto es desarrollar actividades demostrativas piloto, informando de modo práctico sobre diferentes técnicas para la gestión específica de residuos inorgánicos y restos vegetales. Para ello, se ha establecido un área de reciclaje, junto con actividades de transferencia (jornadas prácticas, visitas, vídeos demostrativos y publicaciones) en el Centro IFAPA La Mojonera (Almería).Protected agriculture, which takes place mainly on the eastern coast of Andalusia, constitutes the major economic and social activity for this region. However, greenhouse area exponential growth has led to an increase in the volume of agricultural waste. In addition, this agricultural system is evolving towards new cultivation techniques that not only involve the generation of waste, but also a greater diversification that makes its management hard to tackle. The main issue regarding management of this agricultural waste is not only its geographical dispersion, but also its seasonality, as a large quantity is generated during certain periods of the year, coinciding with the end of agricultural campaigns. Indeed, the maximum collection and storage capacity and the management process itself are conditioned by the volume generated at the end of cropping cycles. In this context, the RECICLAND project arises, which aims to alleviate these problems and contribute to the sustainable management of the waste generated in the production processes. Specifically, the general objective of project is to develop pilot demonstration activities, providing practical information on different techniques for the specific management of inorganic waste and plant debris. For this purpose, a recycling area has been set up, where transference activities such as practical workshops, guide visits, demonstration, videos, and publications are being carried out in IFAPA La Mojonera (Almería)