Decision-making support systems on extended hospital length of stay: validation and recalibration of a model for patients with AMI

Copyright © 2023 Xavier, Seringa, Pinto and Magalhães. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: Cardiovascular diseases are still a significant cause of death and hospitalization. In 2019, circulatory diseases were responsible for 29.9% of deaths in Portugal. These diseases have a significant impact on the hospital length of stay. Length of stay predictive models is an efficient way to aid decision-making in health. This study aimed to validate a predictive model on the extended length of stay in patients with acute myocardial infarction at the time of admission. Methods: An analysis was conducted to test and recalibrate a previously developed model in the prediction of prolonged length of stay, for a new set of population. The study was conducted based on administrative and laboratory data of patients admitted for acute myocardial infarction events from a public hospital in Portugal from 2013 to 2015. Results: Comparable performance measures were observed upon the validation and recalibration of the predictive model of extended length of stay. Comorbidities such as shock, diabetes with complications, dysrhythmia, pulmonary edema, and respiratory infections were the common variables found between the previous model and the validated and recalibrated model for acute myocardial infarction. Conclusion: Predictive models for the extended length of stay can be applied in clinical practice since they are recalibrated and modeled to the relevant population characteristics.This study was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).info:eu-repo/semantics/publishedVersio

Machine learning prediction of mortality in acute myocardial infarction

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Acute Myocardial Infarction (AMI) is the leading cause of death in Portugal and globally. The present investigation created a model based on machine learning for predictive analysis of mortality in patients with AMI upon admission, using different variables to analyse their impact on predictive models. Methods: Three experiments were built for mortality in AMI in a Portuguese hospital between 2013 and 2015 using various machine learning techniques. The three experiments differed in the number and type of variables used. We used a discharged patients' episodes database, including administrative data, laboratory data, and cardiac and physiologic test results, whose primary diagnosis was AMI. Results: Results show that for Experiment 1, Stochastic Gradient Descent was more suitable than the other classification models, with a classification accuracy of 80%, a recall of 77%, and a discriminatory capacity with an AUC of 79%. Adding new variables to the models increased AUC in Experiment 2 to 81% for the Support Vector Machine method. In Experiment 3, we obtained an AUC, in Stochastic Gradient Descent, of 88% and a recall of 80%. These results were obtained when applying feature selection and the SMOTE technique to overcome imbalanced data. Conclusions: Our results show that the introduction of new variables, namely laboratory data, impacts the performance of the methods, reinforcing the premise that no single approach is adapted to all situations regarding AMI mortality prediction. Instead, they must be selected, considering the context and the information available. Integrating Artificial Intelligence (AI) and machine learning with clinical decision-making can transform care, making clinical practice more efficient, faster, personalised, and effective. AI emerges as an alternative to traditional models since it has the potential to explore large amounts of information automatically and systematically.The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).info:eu-repo/semantics/publishedVersio

Synthesis and characterization of sensitive hydrogels based on semi- interpenetrated networks of poly 2-ethyl-(2-pyrrolidone) methacrylate and hyaluronic acid

Sensitive hydrogels attract interest due to their soft wet appearance and shape response to environmental variations. The synthesis and characterization of semi-interpenetrated hydrogels obtained by radical-induced polymerization of 2-ethyl-(2-pyrrolidone)methacrylate (EPM) in the presence of different concentrations of hyaluronic acid (HA) using N,N′-methylene-bisacrylamide or triethylene glycol dimethacrylate as crosslinker, followed by freeze-drying, are described. Polymeric systems were characterized by NMR, FTIR, SEM, TGA, and DMA. PEPMHA hydrogels' mechanical properties and swelling were found to be intimately related to HA concentration and crosslinker. The swelling response was assessed for temperature and pH variation in order to study the behavior of the hydrogels. We found that the presence of HA in PEPM polymeric systems induced a sensitivity to pH variation rather than temperature. Finally, the biocompatibility profile of the hydrogels was evaluated, using mesenchymal stem cells. Cell adhesion and proliferation results revealed the non-cytotoxicity of the systems. We estimate that PEPMHA hydrogels can be used for applications in tissue engineering and for the controlled release of bioactive compounds.Contract grant sponsor: Marie Curie Early Stage Training Alea Jacta Est; contract grant number: MEST-CT-2004-8104The authors thank David Gomez, Sofia Caridade, and Justyna Chojnacka for their technical support and BIOIBERICA for the supply of hyaluronic acid. This work was carried out under the scope of the European NoE EXPERTISSUES, projects MAT 2007-63355, PTDC/QUI/68804/2006 (FCT), CIBER-BBN and Plan-E 2009-0144. In the memory of Prof. Roberto Sastre

Diaqua­(6-bromo­picolinato-κ2 N,O)(nitrato-κ2 O,O)copper(II)

In the monomeric title complex, [Cu(C6H3BrNO2)(NO3)(H2O)2], the CuII ion is coordinated by a bidentate 6-bromo­picolinate ion, one nitrate ion and two water mol­ecules in a geometry inter­mediate between five- and six-coordinate. Conventional O—H⋯O hydrogen bonds link the complex mol­ecules, forming layers parallel to the ab plane

Development, validation and comparative study with no-apnea, STOP-bang, and NoSAS

Background: Obstructive sleep apnea (OSA) is a very prevalent disorder. Here, we aimed to develop and validate a practical questionnaire with yes-or-no answers, and to compare its performance with other well-validated instruments: No-Apnea, STOP-Bang, and NoSAS. Methods: A cross-sectional study containing consecutively selected sleep-lab subjects underwent full polysomnography. A 4-item model, named GOAL questionnaire (gender, obesity, age, and loud snoring), was developed and subsequently validated, with item-scoring of 0–4 points (≥2 points indicating high risk for OSA). Discrimination was assessed by area under the curve (AUC), while predictive parameters were calculated using contingency tables. OSA severity was classified based on conventionally accepted apnea/hypopnea index thresholds: ≥5.0/h (OSA≥5), ≥15.0/h (OSA≥15), and ≥30.0/h (OSA≥30). Results: Overall, 7377 adults were grouped into two large and independent cohorts: derivation (n = 3771) and validation (n = 3606). In the derivation cohort, screening of OSA≥5, OSA≥15, and OSA≥30 revealed that GOAL questionnaire achieved sensitivity ranging from 83.3% to 94.0% and specificity ranging from 62.4% to 38.5%. In the validation cohort, screening of OSA≥5, OSA≥15, and OSA≥30, corroborated validation steps with sensitivity ranging from 83.7% to 94.2% and specificity from 63.4% to 37.7%. In both cohorts, discriminatory ability of GOAL questionnaire for screening of OSA≥5, OSA≥15, and OSA≥30 was similar to No-Apnea, STOP-Bang or NoSAS. Conclusion: All four instruments had similar performance, leading to a possible greater practical implementation of the GOAL questionnaire, a simple instrument with only four parameters easily obtained during clinical evaluation.publishersversionpublishe

Preparation of robust polyamide microcapsules by interfacial polycondensation of p-phenylenediamine and sebacoyl chloride and plasticization with oleic acid

Microcapsules produced by interfacial polycondensation of p-phenylenediamine (PPD) and sebacoyl chloride (SC) were studied. The products were characterized in terms of morphology, mean diameter and effectiveness of dodecane encapsulation. The use of Tween 20 as dispersion stabilizer, in comparison with polyvinyl alcohol (PVA), reduced considerably the mean diameter of the microcapsules and originated smoother wall surfaces. When compared to ethylenediamine (EDA), microcapsules produced with PPD monomer were more rigid and brittle, prone to fracture during processing and ineffective retention of the core liquid. The use of diethylenetriamine (DETA) cross-linker in combination with PPD did not decrease capsule fragility. On the other hand, addition of a small fraction of oleic acid to the organic phase remarkably improved wall toughness and lead to successful encapsulation of the core-oil. Oleic acid is believed to act as a plasticizer. Its incorporation in the polymeric wall was demonstrated by FTIR and (1)H-NMR.This work was funded by FEDER funds through the Operational Programme for Competitiveness Factors (COMPETE), ON.2 – O Novo Norte – North Portugal Regional Operational Programme and National Funds through Foundation for Science and Technology (FCT) under the projects: PEst-C/EQB/UI0511, NORTE-07-0124-FEDER-000026 – RL1_ Energy and PTDC/CTM-NAN/119979/2010. The Bruker Avance III 400 spectrometer is part of the National NMR network and was purchased under the framework of the National Programme for Scientific Reequipment, REDE/1517/RMN/2005, with funds from POCI 2010 (FEDER) and (FCT). Joana R. Góis acknowledges FCT-MCTES for her PhD scholarship (SFRH/BD/69635/2010)

E Depois de um Aborto Espontâneo? Uma Reflexão de Cariz Psicodinâmico sobre a Importância da Vinculação e dos Afetos

Introdução: A Organização Mundial de Saúde define interrupção espontânea da gravidez (IEG) como a suspensão de uma gravidez antes que o feto seja capaz de vida extra-uterina independente. Embora uma IEG continue a ser vista como um evento que não terá qualquer impacto no funcionamento psicológico da mulher, constitui um evento traumático que se relaciona com incertezas relacionadas com a competência para conceber um filho. Objetivos: Propor uma reflexão sobre o impacto das IEG na vinculação numa gravidez seguinte e possível relação com os afetos e relação mãe-filho após o nascimento e na vida. Metodologia: Revisão seletiva da literatura no PubMed e B-On com as palavras “spontaneous abortion”, “prenatal attachment”, “mother-child relationship”. Resultados: As teorias da vinculação baseiam-se no conceito de que é um processo individual que ocorre não só após o nascimento, como também, na experiência pré-natal. Numa gravidez subsequente à morte de um filho, o bebé imaginário coincide em certa parte com o bebé perdido. A mãe apresenta desejos contraditórios de dar à luz um filho vivo ou de continuar unida a outro falecido. Mulheres com história de IEG parecem apresentar sintomatologia depressiva e ansiedade. Algumas mulheres, esquivam-se do investimento emocional com o feto, outras reagem com sobrenvolvimento, sem espaço. O luto deve ser realizado de modo a que o novo filho não seja confundido com o precedente e que não seja reparador da ferida narcísica dos pais, tão frequentemente com dificuldades de adaptação social e familiar. Conclusão: Parecem existir evidências de que após uma IEG há uma vinculação pré-natal mais baixa na gravidez seguinte. Este facto torna clara a importância de haver apoio psicológico após uma IEG de forma a que seja feito o luto do filho e a preparação psicológica para acolher o filho seguinte.info:eu-repo/semantics/publishedVersio

Amentadione from the Alga Cystoseira usneoides as a Novel Osteoarthritis Protective Agent in an Ex Vivo Co-Culture OA Model

Osteoarthritis (OA) remains a prevalent chronic disease without effective prevention and treatment. Amentadione (YP), a meroditerpenoid purified from the alga Cystoseira usneoides, has demonstrated anti-inflammatory activity. Here, we investigated the YP anti-osteoarthritic potential, by using a novel OA preclinical drug development pipeline designed to evaluate the anti-inflammatory and anti-mineralizing activities of potential OA-protective compounds. The workflow was based on in vitro primary cell cultures followed by human cartilage explants assays and a new OA co-culture model, combining cartilage explants with synoviocytes under interleukin-1 beta (IL-1 beta) or hydroxyapatite (HAP) stimulation. A combination of gene expression analysis and measurement of inflammatory mediators showed that the proposed model mimicked early disease stages, while YP counteracted inflammatory responses by downregulation of COX-2 and IL-6, improved cartilage homeostasis by downregulation of MMP3 and the chondrocytes hypertrophic differentiation factors Col10 and Runx2. Importantly, YP downregulated NF-kappa B gene expression and decreased phosphorylated IkB alpha/total IkB alpha ratio in chondrocytes. These results indicate the co-culture as a relevant pre-clinical OA model, and strongly suggest YP as a cartilage protective factor by inhibiting inflammatory, mineralizing, catabolic and differentiation processes during OA development, through inhibition of NF-kappa B signaling pathways, with high therapeutic potential

Antiepileptogenesis after Stroke - Trials and Tribulations: Methodological Challenges and Recruitment Results of a Phase II Study with Eslicarbazepine Acetate.

There is currently no evidence to support the use of antiseizure medications to prevent unprovoked seizures following stroke. Experimental animal models suggested a potential antiepileptogenic effect for eslicarbazepine acetate (ESL), and a Phase II, multicentre, randomised, double-blind, placebo-controlled study was designed to test this hypothesis and assess whether ESL treatment for 1 month can prevent unprovoked seizures following stroke. We outline the design and status of this antiepileptogenesis study, and discuss the challenges encountered in its execution to date. Patients at high risk of developing unprovoked seizures after acute intracerebral haemorrhage or acute ischaemic stroke were randomised to receive ESL 800 mg/day or placebo, initiated within 120 hours after primary stroke occurrence. Treatment continued until Day 30, then tapered off. Patients could receive all necessary therapies for stroke treatment according to clinical practice guidelines and standard of care, and are being followed up for 18 months. The primary efficacy endpoint is occurrence of a first unprovoked seizure within 6 months after randomisation ('failure rate'). Secondary efficacy assessments include occurrence of a first unprovoked seizure during 12 months after randomisation and during the entire study; functional outcomes (Barthel Index original 10-item version; National Institutes of Health Stroke Scale); post-stroke depression (Patient Health Questionnaire-9; PHQ-9); and overall survival. Safety assessments include evaluation of treatment-emergent adverse events; laboratory parameters; vital signs; electrocardiogram; suicidal ideation and behaviour (PHQ-9 question 9). The protocol aimed to randomise approximately 200 patients (1:1), recruited from 21 sites in seven European countries and Israel. Despite the challenges encountered, particularly during the COVID-19 pandemic, the study progressed and included a remarkable number of patients, with 129 screened and 125 randomised. Recruitment was stopped after 30 months, the first patient entered in May 2019, and the study is ongoing and following up on patients according to the Clinical Trial Protocol

Pulegone and Eugenol Oral Supplementation in Laboratory Animals: Results from Acute and Chronic Studies

Essential oils are natural compounds used by humans for scientific purposes due to their wide range of properties. Eugenol is mostly present in clove oil, while pulegone is the main constituent of pennyroyal oil. To guarantee the safe use of eugenol and pulegone for both humans and animals, this study addressed, for the first time, the effects of these compounds, at low doses (chronic toxicity) and high doses (acute toxicity), in laboratory animals. Thirty-five FVB/n female mice were randomly assigned to seven groups (n = 5): group I (control, non-additive diet); group II (2.6 mg of eugenol + 2.6 mg of pulegone); group III (5.2 mg of eugenol + 5.2 mg of pulegone); group IV (7.8 mg of eugenol + 7.8 mg of pulegone); group V (7.8 mg of eugenol); group VI (7.8 mg of pulegone); and group VII (1000 mg of eugenol + 1000 mg of pulegone). The compounds were administered in the food. Groups I to VI were integrated into the chronic toxicity study, lasting 28 days, and group VII was used in the acute toxicity study, lasting 7 days. Animals were monitored to assess their general welfare. Water and food intake, as well as body weight, were recorded. On the 29th day, all animals were euthanized by an overdose of ketamine and xylazine, and a complete necropsy was performed. Blood samples were collected directly from the heart for microhematocrit and serum analysis, as well as for comet assay. Organs were collected, weighed, and fixed in formaldehyde for further histological analysis and enzymatic assay. Eugenol and pulegone induced behavioral changes in the animals, namely in the posture, hair appearance and grooming, and in mental status. These compounds also caused a decrease in the animals' body weight, as well as in the food and water consumption. A mortality rate of 20% was registered in the acute toxicity group. Both compounds modulated the serum levels of triglycerides and alanine aminotransferase. Eugenol and pulegone induced genetic damage in all animals. Eugenol increased the activity of the CAT enzyme. Both compounds increased the GR enzyme at the highest dose. Moreover, pulegone administered as a single compound increased the activity of the GST enzyme. Histopathological analysis revealed inflammatory infiltrates in the lungs of groups II, III, and IV. The results suggest that eugenol and pulegone may exert beneficial or harmful effects, depending on the dose, and if applied alone or in combination