Solitary pulmonary nodule malignancy predictive models applicable to routine clinical practice: a systematic review

Background: Solitary pulmonary nodule (SPN) is a common finding in routine clinical practice when performing chest imaging tests. The vast majority of these nodules are benign, and only a small proportion are malignant. The application of predictive models of nodule malignancy in routine clinical practice would help to achieve better diagnostic management of SPN. The present systematic review was carried out with the purpose of critically assessing studies aimed at developing predictive models of solitary pulmonary nodule (SPN) malignancy from SPN incidentally detected in routine clinical practice. Methods: We performed a search of available scientific literature until October 2020 in Pubmed, SCOPUS and Cochrane Central databases. The inclusion criteria were observational studies carried out in low-risk population from 35 years old onwards aimed at constructing predictive models of malignancy of pulmonary solitary nodule detected incidentally in routine clinical practice. Studies had to be published in peer-reviewed journals, either in Spanish, Portuguese or English. Exclusion criteria were non-human studies, or predictive models based in high-risk populations, or models based on computational approaches. Exclusion criteria were non-human studies, or predictive models based in high-risk populations, or models based on computational approaches (such as radiomics). We used The Transparent Reporting of a multivariable Prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement, to describe the type of predictive model included in each study, and The Prediction model Risk Of Bias ASsessment Tool (PROBAST) to evaluate the quality of the selected articles. Results: A total of 186 references were retrieved, and after applying the exclusion/inclusion criteria, 15 articles remained for the final review. All studies analysed clinical and radiological variables. The most frequent independent predictors of SPN malignancy were, in order of frequency, age, diameter, spiculated edge, calcification and smoking history. Variables such as race, SPN growth rate, emphysema, fibrosis, apical scarring and exposure to asbestos, uranium and radon were not analysed by the majority of the studies. All studies were classified as high risk of bias due to inadequate study designs, selection bias, insufficient population follow-up and lack of external validation, compromising their applicability for clinical practice. Conclusions: The studies included have been shown to have methodological weaknesses compromising the clinical applicability of the evaluated SPN malignancy predictive models and their potential influence on clinical decisionmaking for the SPN diagnostic managemen

Flame filtering and perimeter localization of wildfires using aerial thermal imagery

Airborne thermal infrared (TIR) imaging systems are being increasingly used for wild fire tactical monitoring since they show important advantages over spaceborne platforms and visible sensors while becoming much more affordable and much lighter than multispectral cameras. However, the analysis of aerial TIR images entails a number of difficulties which have thus far prevented monitoring tasks from being totally automated. One of these issues that needs to be addressed is the appearance of flame projections during the geo-correction of off-nadir images. Filtering these flames is essential in order to accurately estimate the geographical location of the fuel burning interface. Therefore, we present a methodology which allows the automatic localisation of the active fire contour free of flame projections. The actively burning area is detected in TIR georeferenced images through a combination of intensity thresholding techniques, morphological processing and active contours. Subsequently, flame projections are filtered out by the temporal frequency analysis of the appropriate contour descriptors. The proposed algorithm was tested on footages acquired during three large-scale field experimental burns. Results suggest this methodology may be suitable to automatise the acquisition of quantitative data about the fire evolution. As future work, a revision of the low-pass filter implemented for the temporal analysis (currently a median filter) was recommended. The availability of up-to-date information about the fire state would improve situational awareness during an emergency response and may be used to calibrate data-driven simulators capable of emitting short-term accurate forecasts of the subsequent fire evolution.Postprint (author's final draft

Years of sunlight exposure and cataract: a case-control study in a Mediterranean population.

BACKGROUND: We aimed to investigate the relation between sunlight exposure and risk of cataract. METHODS: We carried out a frequency-matched case-control study of 343 cases and 334 controls attending an ophthalmology outpatient clinic at a primary health-care center in a small town near Valencia, Spain. All cases were diagnosed as having a cataract in at least one eye based on the Lens Opacification Classification system (LOCS II). Controls had no opacities in either eye. All cases and controls were interviewed for information on outdoor exposure, "usual" diet, history of severe episodes of diarrhea illness, life-style factors and medical and socio-demographic variables. Blood antioxidant vitamin levels were also analyzed. We used logistic regression models to estimate sex and age-adjusted odds ratios (ORs) by quintiles of years of occupational outdoor exposure, adjusting for potential confounders such as smoking, alcohol consumption, serum antioxidants and education. RESULTS: No association was found between years of outdoor exposure and risk of cataract. However, exploratory analyses suggested a positive association between years of outdoor exposure at younger ages and risk of nuclear cataract later in life. CONCLUSION: Our study does not support an association with cataract and sunlight exposure over adult life

Short-term fire front spread prediction using inverse modelling and airborne infrared images

A wildfire forecasting tool capable of estimating the fire perimeter position sufficiently in advance of the actual fire arrival will assist firefighting operations and optimise available resources. However, owing to limited knowledge of fire event characteristics (e.g. fuel distribution and characteristics, weather variability) and the short time available to deliver a forecast, most of the current models only provide a rough approximation of the forthcoming fire positions and dynamics. The problem can be tackled by coupling data assimilation and inverse modelling techniques. We present an inverse modelling-based algorithm that uses infrared airborne images to forecast short-term wildfire dynamics with a positive lead time. The algorithm is applied to two real-scale mallee-heath shrubland fire experiments, of 9 and 25 ha, successfully forecasting the fire perimeter shape and position in the short term. Forecast dependency on the assimilation windows is explored to prepare the system to meet real scenario constraints. It is envisaged the system will be applied at larger time and space scales.Peer ReviewedPostprint (author's final draft

The role of education and ethnicity on amenable mortality due to five leading non-communicable diseases among Blacks and Whites in the United States, 1990-2015

Background General mortality consistently declined in the United States (US) from 1969 to 2013. During the same period, a decrease has been described in the percentage of deaths attributed to main non-communicable diseases (NCD) including heart disease, cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), cerebrovascular diseases and diabetes. Amenable mortality trend and pace has been proposed as a good indicator of health care performance. We aimed to measure the impact of attained education and ethnicity on amenable mortality caused by cancer, CVD, COPD, cerebrovascular disease and diabetes among Non-Hispanic Whites (NHW) and Non-Hispanic Blacks (NHB) in the US from 1990 to 2015. Methods We analyzed data from death certificates downloaded from the US National Center for Health Statistics using a modified version of the Nolte’s list of amenable mortality causes related to appropriate health care. The US Population estimates (1990 to 2015) by age, gender and ethnicity came from the US Census Bureau. We analyzed annual percentage changes in age-standardized mortality rates for cancer, CVD, COPD, cerebrovascular disease and diabetes for the period 1990-2015. Results Between the time periods of 1990 and 2015, age-adjusted amenable mortality rates due to the five studied causes of death increased among the uneducated, while it decreased among the most educated in both sexes and races. Age-standardized NCD amenable mortality rates were higher among the least educated NHB and NHW males, compared to NHB and NHW females respectively during the entire period. The least educated NHW men and women born in the 1980’s presented cancer amenable mortality rates almost 3 times higher than those NHW men and women born in 1955; however, among the most educated NHW individuals, no significant differences were found in amenable mortality across birth cohorts. No notable variation was observed among NHB born before or after 1955, a finding that was consistent for all five studied diseases as well as the combined adjusted-amenable mortality rate. NHW men and women showed the greatest gap between the most and the least educated. Findings also demonstrated that a disparate cohort and year of death effect between the most and the least educated groups widened the gap in cause specific amenable mortality risk and ratio among NHW. Conclusions Our analysis showed a strong effect of attained education as a key factor for developing and directing health programs aiming to decrease NCD mortality among predominant US races. This reality calls for interventions targeting disadvantaged groups, to remove barriers to quality healthcare, and a healthy longer life. Assertive policy efforts should be made in the US to implement universal healthcare that includes quality curative medicine and innovative preventive services for all, thereby reducing the growing disparities in segments of the population and leading to a more efficient use of available resources

Análisis de la extracción y validación bilingüe de terminología con el programa informático Multiterm Extract

Catorzenes Jornades de Foment de la Investigació de la FCHS (Any 2008-2009

“You knew you had to be there, it had to be done”: Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain

IntroductionThe COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned.MethodsWe carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi’s 7-step data analysis method.ResultsDuring the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic.ConclusionIn the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemic

Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews

Introduction and hypothesis In recent years the number of caesarean sections has increased worldwide for different reasons. to review the scientific evidence relating to the impact of the type of delivery on pelvic floor disorders (PFDs) such as urinary and faecal incontinence and pelvic organ prolapse. Methods A review of systematic reviews and meta-analysis, drawn from the following databases: MEDLINE (via PubMed), Scopus,Web of Science, The Cochrane Library and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud/ Latin American and Caribbean Health Sciences Literature) prior to January 2019. The directives of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in assessing article quality. Results Eleven systematic reviews were evaluated, 6 of which found a significantly decreased risk of urinary incontinence associated with caesarean section and 3 meta-analyses showed a significant reduction in POP for caesarean section, compared with vaginal delivery. Of 5 reviews that examined delivery type and faecal incontinence, only one indicated a lower incidence of faecal incontinence associated with caesarean delivery. However, most of the studies included in these reviews were not adjusted for important confounding factors and the risk of PFDs was not analysed by category of caesarean delivery (elective or urgent). Conclusion When compared with vaginal delivery, caesarean is associated with a reduced risk of urinary incontinence and pelvic organ prolapse. These results should be interpreted with caution and do not help to address the question of whether elective caesareans are protective of the maternal pelvic floo

“You knew you had to be there, it had to be done”: Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain

Introduction: The COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned. Methods: We carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi’s 7-step data analysis method. Results: During the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic. Conclusion: In the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemi