Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality

<p>Abstract</p> <p>Background</p> <p>Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients undergoing primary total hip arthroplasty (THA) over an 8-year study period in Spain.</p> <p>Methods</p> <p>We selected all surgical admissions in individuals aged ≥40 years who had received a primary THA (ICD-9-CM procedure code 81.51) between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index.</p> <p>Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM.</p> <p>Results</p> <p>We identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p < 0.001). In 2001, 81% of patients had a Charlson Index of 0, 18.4% of 1-2, and 0.6% > 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p < 0.001). The mean LOHS was 13 days in 2001 and decreased to 10.45 days in 2008 (p < 0.001). During the period studied, the mean cost per patient increased from 6,634 to 9,474 Euros. Multivariate analysis shows that from 2001 to 2008 the incidence of THA hospitalizations has significantly increased for both sexes and only men showed a significant reduction in IHM after THA.</p> <p>Conclusions</p> <p>The current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.</p

Borehole water level response to barometric pressure as an indicator of aquifer vulnerability

The response of borehole water levels to barometric pressure changes in semiconfined aquifers can be used to determine barometric response functions from which aquifer and confining layer properties can be obtained. Following earlier work on barometric response functions and aquifer confinement, we explore the barometric response function as a tool to improve the assessment of groundwater vulnerability in semiconfined aquifers, illustrated through records from two contrasting boreholes in the semiconfined Chalk Aquifer, East Yorkshire, UK. After removal of recharge and Earth tide influences on the water level signal, barometric response functions were estimated and aquifer and confining layer properties determined through an analytical model of borehole water level response to barometric pressure. A link between the thickness and vertical diffusivity of the confining layer determined from the barometric response function, and groundwater vulnerability is proposed. The amplitude spectrum for barometric pressure and instrument resolution favor determination of the barometric response function at frequencies to which confining layer diffusivities are most sensitive. Numerical modeling indicates that while the high frequency response reflects confining layer properties in the immediate vicinity of the borehole, the low frequency response reflects vertical, high diffusivity pathways though the confining layer some hundreds of meters distant. A characteristic time scale parameter, based on vertical diffusivities and thicknesses of the saturated and unsaturated confining layer, is introduced as a measure of semiconfined aquifer vulnerability. The study demonstrates that the barometric response function has potential as a tool for quantitative aquifer vulnerability assessment in semiconfined aquifers

Trends in incidence and outcomes of revision total hip arthroplasty in Spain: A population based study

<p>Abstract</p> <p>Background</p> <p>To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain.</p> <p>Methods</p> <p>We selected all surgical admissions in individuals aged ≥ 40 years who underwent RTHA (ICD-9-CM procedure code 81.53) between 2001 and 2008 from the Spanish National Hospital Discharge Database. Age- and sex-specific incidence rates, Charlson co-morbidity index, length of stay (LOS), costs and in-hospital mortality (IHM) were estimated for each year. Multivariate analyses were conducted to asses time trends.</p> <p>Results</p> <p>32, 280 discharges of patients (13, 391 men/18, 889 women) having undergone RTHA were identified. Overall crude incidence showed a small but significant increase from 20.2 to 21.8 RTHA per 100, 000 inhabitants from 2001 to 2008 (p < 0.01).</p> <p>The incidence increased for men (17.7 to 19.8 in 2008) but did not vary for women (22.3 in 2001 and 22.2 in 2008). Greater increments were observed in patients older than 84 years and in the age group 75-84. In 2001, 19% of RTHA patients had a Charlson Index ≥ 1 and this proportion rose to 24.6% in 2008 (p < 0.001). The ratio RTHA/THA remained stable and around 20% in Spain along the entire period</p> <p>The crude overall in-hospital mortality (IHM) increased from 1.16% in 2001 to 1.77% (p = 0.025) in 2008. For both sexes the risk of death was higher with age, with the highest mortality rates found among those aged 85 or over. After multivariate analysis no change was observed in IHM over time. The mean inflation adjusted cost per patient increased by 78.3%, from 9, 375 to 16, 715 Euros from 2001 to 2008.</p> <p>After controlling for possible confounders using Poisson regression models, we observed that the incidence of RTHA hospitalizations significantly increased for men and women over the period 2001 to 2008 (IRR 1.10, 95% CI 1.03-1.18 and 1.08, 95% CI 1.02-1.14 respectively).</p> <p>Conclusions</p> <p>The crude incidence of RTHA in Spain showed a small but significant increase from 2001 to 2008 with concomitant reductions in LOS, significant increase in co-morbidities and cost per patient.</p

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Multiobjective Evolutionary Feature Selection for Fuzzy Classification

The interpretability of classification systems refers to the ability of these to express their behaviour in a way that is easily understandable by a user. Interpretable classification models allow for external validation by an expert and, in certain disciplines such as medicine or business, providing information about decision making is essential for ethical and human reasons. Fuzzy rule-based classification systems are consolidated powerful classification tools based on fuzzy logic and designed to produce interpretable models; however, in presence of a large number of attributes, even rule-based models tend to be too complex to be easily interpreted. In this work, we propose a novel multivariate feature selection method in which both search strategy and classifier are based on multi-objective evolutionary computation. We designed a set of experiments to establish an acceptable setting with respect to the number of evaluations required by the search strategy and by the classifier, and we tested our strategy on a real-life dataset. Then, we compared our results against a wide range of feature selection methods that includes filter, wrapper, multivariate and univariate methods, with deterministic and probabilistic search strategies, and with evaluators of diverse nature. Finally, the fuzzy rule-based classification model obtained with the proposed method has been evaluated with standard performance metrics and compared with other wellknown fuzzy rule-based classifiers. We have used two real-life datasets extracted from a contact center; in one case, with the proposed method we obtained an accuracy of 0.7857 with 8 rules, while the best fuzzy classifier compared obtained 0.7679 with 8 rules, and in the second case, we obtained an accuracy of 0.7403 with 5 rules, while the best fuzzy classifier compared obtained 0.6364 with 4 rules

CONSULTORIAS EMPRESARIALES Y NEGOCIOS INTERNACIONALES

The purpose of this document is to present the analysis of the negotiating profileof the employees of the sales area of a hardware store in the city of Valledupar inwhich 31 salespeople were surveyed according to the criteria of the profile of thenegotiator of the Marrero and Ortiz model. It was possible to identify through anexploratory and confirmatory factorial analysis that the orientation of the employeesof the company was directed to the collaboration and satisfaction of the collectiveneeds of the individuals involved, in the same way it was established that in theemployees of this union the Compliance with duty with responsibility and ethicsplays a very important role when it comes to establishing negotiations.El prop´osito del presente documento es el de exponer el an´alisis del perfil negociadorde los empleados del ´area de ventas de una ferreter´ıa en la ciudad de Valleduparen la que se encuestaron a 31 vendedores de acuerdo a los criterios del perfil delnegociador del modelo de Marrero y Ortiz (2016). Se logr´o identificar mediante unan´alisis factorial exploratorio y confirmatorio que la orientaci´on de los empleadosde la empresa estaba dirigida a la colaboraci´on y a la satisfacci´on de las necesidadescolectivas de los individuos involucrados, de la misma manera se estableci´o que enlos empleados de este gremio el cumplimiento del deber con responsabilidad y ´eticajuega un papel muy importante a la hora de establecer negociaciones