Resultados de la Vigilancia Epidemiológica de las enfermedades transmisibles. Informe anual. Año 2015

El objetivo final de la vigilancia de las enfermedades transmisibles es reducir su incidencia en la comunidad. La Red Nacional de Vigilancia Epidemiológica (RENAVE) tiene entre sus funciones la recogida sistemática de la información epidemiológica, su análisis e interpretación y la difusión de los resultados. Este informe presenta los resultados de la vigilancia de las enfermedades transmisibles para el año 2015 realizada por los servicios de vigilancia de las comunidades autónomas y el Centro Nacional de Epidemiología (CNE) de acuerdo a los protocolos de la RENAVE.N

Diverse mechanisms in proton knockout reactions from the Borromean nucleus 17Ne

Nucleon knockout experiments using beryllium or carbon targets reveal a strong dependence of the quenching factors, i.e., the ratio (R s) of theoretical to the experimental spectroscopic factors (C 2S), on the proton-neutron asymmetry in the nucleus under study. However, this dependence is greatly reduced when a hydrogen target is used. To understand this phenomenon, exclusive 1H (17Ne , 2p16F) and inclusive 12C(17Ne,2p16F)X , 12C (17Ne , 16F) X as well as 1H (17Ne , 16F) X (X-denotes undetected reaction products) reactions with 16F in the ground and excited states were analysed. The longitudinal momentum distribution of 16F and the correlations between the detached protons were studied. In the case of the carbon target, there is a significant deviation from the predictions of the eikonal model. The eikonal approximation was used to extract spectroscopic factor values C 2S . The experimental C 2S value obtained with C target is markedly lower than that for H target. This is interpreted as rescattering due to simultaneous nucleon knockout from both reaction partners, 17Ne and 12C

Coulomb dissociation of N 20,21

Neutron-rich light nuclei and their reactions play an important role in the creation of chemical elements. Here, data from a Coulomb dissociation experiment on N20,21 are reported. Relativistic N20,21 ions impinged on a lead target and the Coulomb dissociation cross section was determined in a kinematically complete experiment. Using the detailed balance theorem, the N19(n,γ)N20 and N20(n,γ)N21 excitation functions and thermonuclear reaction rates have been determined. The N19(n,γ)N20 rate is up to a factor of 5 higher at

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Using data analytics to accelerate biopharmaceutical process scale-up

In the biopharmaceutical industry, the selection of high-quality cell lines characterized by high productivity and stability over time plays a critical role for the development of processes meeting the desired quality and manufacturability criteria. Cell line selection involves their testing through subsequent stages at different process scales to progressively recreate the conditions of an industrial-scale bioreactor, from static micro-well plates, to shake flasks to reactors of increasing volumes and complexity. In this context both scale-up and scale-down are challenging due to the variety and quantity of data to mine and the scarcity of first-principles understanding on cells culture dynamics. This paper illustrates the use of advanced data-driven modeling where patterns across multiple scales are identified and interpreted to aid the cell line selection scale-up process. Methods such as multiway principal components analysis, Procrustes analysis and joint-Y projection to latent structures are used to characterize cell lines cross correlation and their dynamic behavior over time, and to carry out performance predictions across different scales. The approach has the potential to mature into a general framework to aid scale-up for cell-line selection and so drive acceleration in the development cycle of biopharmaceuticals through an optimal use of the available data acquisition platforms

MICA2 : Modelling Interaction between Cyclists and Automobiles 2

FFI-projektet MICA (180401-191231) visade hur förarmodeller kan hjälpa automatiska bromssystem att bli smartare och aktiveras mer effektivt utan att kompromissa med föraracceptans. MICA2 har haft ett brett fokus på hela omkörningen då både aktiva och passiva säkerhetssystem har utvecklats och testats i projektet: Försäkringsdata och olycksdatabaser har analyserats för att identifiera olycksscenarion och olycksmekanismer för alla faser i omkörningen. Flera beteendemodeller har utvecklats för att hantera hela omkörningsmanövern vid simuleringar. Modellerna tar hänsyn till både förarens objektiva säkerhet, cyklistens perspektiv på situationen och den upplevda säkerheten för alla involverade trafikanter. Modellerna har använts för att utveckla och analysera aktivering av automatisk bromsning och -styrning i kritiska omkörningssituationer. Externa krockkuddar och expanderbara metallstrukturer för personbilar som kan lindra skadeutfallet hos cyklister har utvecklats och testats. En effektanalys av systemen har genomförts som visade att expanderbar metallstruktur på en bil kan minska risken för moderata/svåra huvudskador från 69% till 9%. Dessutom bedömdes att ett AEB-system med MICA2-modeller skulle kunna undvika 20% av omkörningsolyckorna helt. Nya metoder för datainsamling har utvecklats - som ger helt nya möjligheter att generera och verifiera beteendemodeller och att jämföra olika testmiljöer. Data har samlats in i både cykel- och körsimulatorer. Vidare har virtual realtity använts i ett experiment på provbana utan att äventyra deltagarnas säkerhet. Dessutom, genom att väva ihop indata från olika kamerasystem, har unika naturalistiska data samlats in med motorfordonsförare som kör om cyklister i verklig trafik. Resultaten från MICA2 gör det möjligt att utveckla nya säkerhetssystem, ger ny input till utveckling av experimentella procedurer i Euro NCAP och främjar säker interaktion mellan automatiserade fordon och cyklister.While the FFI-project MICA (180401-191231) showed how driver models can help automated emergency braking systems become smarter and activate more effectively without compromising acceptability, the MICA2 project addressed the safety of the whole overtaking manoeuvre by developing and testing prototypical active and passive safety systems. Insurance claims databases and crash databases were analysed to determine the crash scenarios and crash-causation mechanisms for each overtaking phase. Several behavioural models were developed to address the whole overtaking manoeuvre. These models were not limited to the driver’s objective safety but also considered the cyclist’s perspective and the perceived safety of the different road-users. The models were used for the activation of automated emergency braking and automated emergency steering. In addition, external airbags and expandable metal structures were developed and tested in the project. The project also performed a safety assessment on the systems. For instance, the expandable metal structure from Autoliv reduced the AIS2+ head injury risk from 69% to 9%. In addition, an AEB system using MICA2 models, was able to avoid 20% of the crashes. New methodologies for data collection were developed in the project, providing unprecedented data that was used to generate and verify the behavioural models as well as to compare different test-environments. Data was collected from riding and driving simulators. Further, virtual reality was employed in a test-track experiment to warrant the repeatability and safety of critical overtaking manoeuvres. Finally, by stitching several camera systems together, we collected unique naturalistic data showing how drivers overtake cyclists in the real world. The results from MICA2 not only enabled new safety systems, but they also provided a fresh input for the development of experimental protocols in Euro NCAP and the promotion of a safe interaction between automated vehicle and cyclists. Two PhD students graduated within MICA2. Further, the project produced more than 15 journal papers and conference contributions. Dissemination also included events in the SAFER network and a final even where the prototypical active and passive safety systems were demonstrated on the airfield in Vårgårda

Integrating metabolome dynamics and process data to guide cell line selection in biopharmaceutical process development

The successful development of mammalian cell culture for the production of therapeutic antibodies is a resource-intensive and multistage process which requires the selection of high performing and stable cell lines at different scale-up stages. Accordingly, science-based approaches exploiting biological information, such as metabolomics, can support and accelerate the selection of promising cell lines to progress. In fact, the integration of dynamic biological information with process data can provide valuable insights on the cell physiological changes as a consequence of the cultivation process. This work studies the industrial development of monoclonal antibodies at micro-bioreactor scale (Ambr®15) and aims at accelerating the selection of the better performing cell lines. To that end, we apply a machine learning approach to integrate time-varying process and biological information (i.e., metabolomics), explicitly exploiting their dynamics. Strikingly, cell line performance during the cultivation can be predicted from early process timepoints by exploiting the gradual temporal evolution of metabolic phenotypes. Furthermore, product titer is estimated with good accuracy at late process timepoints, providing insights into its relationship with underlying metabolic mechanisms and enabling the identification of biomarkers to be further investigated. The biological insights obtained through the proposed machine learning approach provide data-driven metabolic understanding allowing early identification of high performing cell lines. Additionally, this analysis offers the opportunity to identify key metabolites which could be used as biomarkers for industrially relevant phenotypes and onward fit into our commercial manufacturing platforms

Impacto de la pandemia de COVID-19 sobre la utilización de la medición de la HbA1c y sus resultados en pacientes ambulatorios adultos y pediátricos con diabetes

La diabetes mellitus incrementa los riesgos y complicaciones asociadas a la COVID-19. Una de las principales consecuencias de la pandemia ha sido la drástica reducción de las consultas presenciales. El objetivo de este estudio es evaluar el impacto que ha tenido la pandemia de COVID-19 en la gestión de la determinación de HbA1c y sus resultados en pacientes ambulatorios adultos y pediátricos con diabetes, teniendo en cuenta tanto la medición realizada en el laboratorio como las pruebas de laboratorio en el lugar de asistencia o point-of-care testing (POCT)

Impact of COVID-19 pandemic on HbA1c management and results in pediatric and adult outpatients with diabetes

Diabetes mellitus intensify the risks and complications related to COVID-19 infection. A major effect of the pandemic has been a drastic reduction of in-person visits. The aim of this study was to evaluate the impact of the COVID-19 pandemic on HbA1c management and results among pediatric and adult outpatients with diabetes, considering the laboratory and point-of-care testing (POCT) HbA1c measurements