Stochastic logistic fuzzy maps for the construction of integrated multirates scenarios in the financing of infrastructure projects

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.In general, the development of economic infrastructure systems requires a behavioural comprehensive analysis of different financial variables or rates to establish its long-term success with regards to the Equity Internal Rate of Return (EIRR) expectation. For this reason, several financial organizations have developed economic scenarios supported by computational techniques and models to identify the evolution of these financial rates. However, these models and techniques have shown a series of limitations with regard to the financial management process and its impact on EIRR over time. To address these limitations in an inclusive way, researchers have developed different approaches and methodologies focused on the development of financial models using stochastic simulation methods and computational intelligence techniques. This paper proposes a Stochastic Fuzzy Logistic Model (S-FLM) inspired by a Fuzzy Cognitive Map (FCM) structure to model financial scenarios. Where the input consists in financial rates that are characterized as linguistic rates through a series of adaptive logistic functions. The stochastic process that explains the behaviour of the financial rates over time and their partial effects on EIRR is based on a Monte Carlo sampling process carried out on the fuzzy sets that characterize each linguistic rate. The S-FLM was evaluated by applying three financing scenarios to an airport infrastructure system (pessimistic, moderate/base, optimistic), where it was possible to show the impact of different linguistic rates on the EIRR. The behaviour of the S-FLM was validated using three different models: (1) a financial management tool; (2) a general FCM without pre-loaded causalities among the variables; and (3) a Statistical S-FLM model (S-FLMS), where the causalities between the concepts or rates were obtained as a result of an independent effects analysis applying a cross modelling between variables and by using a statistical multi-linear model (statistical significance level) and a multi-linear neural model (MADALINE). The results achieved by the S-FLM show a higher EIRR than expected for each scenario. This was possible due to the incorporation of an adaptive multi-linear causality matrix and a fuzzy credibility matrix into its structure. This allowed to stabilize the effects of the financial variables or rates on the EIRR throughout a financing period. Thus, the S-FLM can be considered as a tool to model dynamic financial scenarios in different knowledge areas in a comprehensive manner. This way, overcoming the limitations imposed by the traditional computational models used to design these financial scenarios

Cost analysis of universal neonatal screening for inborn errors of metabolism with tandem mass spectrometry in Colombia

Antecedentes: La espectrometría de masas en tándem permite procesar muchas muestras de sangre seca, enviadas por correo ordinario, para detectar anomalías congénitas. En varios países, estas pruebas se hacen de manera rutinaria. En este trabajo se estudia la posibilidad de instaurar un programa nacional de tamización neonatal de cobertura universal.Objetivos: Estimar los costos y el empleo de recursos involucrados en un programa de tamización universal y, así, estimar el costo por caso detectado en Colombia.Materiales y métodos: Se realizó una búsqueda de la literatura junto con una evaluación de costos de la tamización en neonatos de fenilcetonuria, galactosemia, deficiencia de biotini-dasa, hiperplasia suprarrenal congénita, deficiencia de acil-CoA deshidrogenasa de cadena media y acidemias orgánicas mediante espectrometría de masas en tándem. Los costos se encuentran en pesos colombianos de 2012.Resultados: Los costos de los equipos de espectrometría se estimaron entre $700 y$ 1.100 millo-nes y pueden realizar hasta 4.000 pruebas por mes con una vida útil de 8 años. El costo de los insumos y el transporte de las muestras totalizaron en $21.600 por prueba. Si se asumen 12 máquinas con una productividad inicial del 50$ 33.459 (incluyendo pruebas confirmatorias), y con una cobertura del 75% de los neonatos, se lograría obtener utilidades a partir del segundo año, y se recuperaría el valor de la inversión en el cuarto año.Conclusiones: Al tamizar anualmente 518.400 neonatos, se podrían detectar unos 50 casos a un costo aproximado de $330 millones por caso correctamente detectado.Q4Artículo original68-73Background: The tandem mass spectrometry method allows the processing of dry blood samples, and can be sent by regular mail, in order to detect several congenital abnormalities. In many countries these tests are routine practice. This article studies the possibility of establishing a nationwide universal coverage neonatal screening program.Objectives: To estimate the costs and resource use involved in a tandem mass spectrometry universal screening program, and to estimate the cost per detected case in Colombia.Materials and methods: A literature search was performed looking for the economic analysis for neonatal screening of phenylketonuria, galactosemia, biotinidase deficiency, congenital adrenal hyperplasia, medium chain acyl-CoA dehydrogenase deficiency, and organic acidemia. Costs are shown in US dollars (1 USD = 1880 COP).Results: The costs of tandem mass spectrometry equipment were estimated between USD$ 373,000 and USD$585,000, with a monthly capacity of 4,000 tests and an eight-year useful life. The costs for supplies and transport of tests were USD$ 11.50 per test. If an initial productivity of 50% for 12 machines in the first year, 80% for the second, and 90% for the third, with a cost of USD$17.81 per test (including confirmatory test), and a 75$ 176,000 per case detected

Cost-effectiveness of AQP4 antibody detection with cell-based assay compared with elisa for devic disease diagnosis in Colombia

Q1Q1A44Objectives Neuromyelitis optica (NMO) or Devic disease is a rare chronic condition characterized by demyelinating lesions in the central nervous system. The aim of this study was to evaluate cost-effectiveness of the detection of antibodies against the protein aquaporin water channel 4 (AQP4) with cell-based assay (CBA), compared with ELISA, for the diagnosis of NMO in Colombia. Methods A decision tree model was constructed to compare costs, correctly diagnosed cases and relapses averted in patients with clinical suspicion of NMO, that were subjected to diagnostic tests for the detection of AQP4 antibodies. The analysis was undertaken from a third-party payer perspective, one year time horizon (first year with the disease) taking all costs for treatment and relapses, in 2014 Colombian pesos, from official published prices (1 USD = 2,033 COP). Since the CBA kit is not available in Colombia (currently samples are processed abroad), the price was obtained from the manufacturer and set in a national laboratory. Clinical variables were from a systematic literature review. Univariate and probabilistic sensitivity analyses (a Monte Carlo simulating a cohort of 1000 patients) were conducted. Results Identification of AQP4 antibodies with CBA is a dominant strategy: more effective (855 correctly diagnosed patients compared with 765 detected by ELISA, and 130 avoided relapses), and less costly, with expected yearly costs per correctly diagnosed Devic patient of USD $14,658 compared with$15,614 for ELISA. Using CBA may represent savings in terms of reduced costs of treating disease and relapse with hospitalization. Conclusions AQP4 antibody identification by the CBA method is a cost-saving diagnostic test, dominant over the ELISA method

Human Papillomavirus Infection and Lung Cancer

Lung cancer continues to be the most common neoplasia and represents the leading cause of cancer-related death in the world. Nonetheless, contrary to expected projections, the decrease in incidence expected by decrease in tobacco exposure has been partially halted due to an increasing amount of lung cancer cases in nonsmokers, particularly in female patients. This led to the development of new hypotheses in terms of lung cancer etiology, including the involvement of oncogenic viruses such as the human papillomavirus (HPV). HPV role in the pathophysiology of lung cancer, including adenocarcinoma and squamous cell carcinoma, is currently under research. Exposure to HPV, and the resulting infection, can occur in several possible ways, including sexual transmission and airborne fomites. Main pathogenic occurrences include alterations in inhibition of p53 and retinoblastoma. This chapter presents the current evidence as to the role of HPV in the development of lung cancer, methods to establish HPV infection, and also explores the role of predisposing factors, as well as immunological and inflammatory factors in nonsmokers. Additionally, the role of other molecular factors, such as EGFR, interleukins 6 and 10, and others, is discussed. Finally, future perspectives in this new paradigm of lung cancer in nonsmokers are broadly reviewed

Cost-utility analysis of genomic profiling in early breast cancer in Colombia

Antecedentes: En Colombia, la mejor estrategia para establecer la indicación de quimioterapia adyuvante en cáncer de mama temprano (CMT) sigue siendo desconocida. Este estudio tuvo como objetivo identificar la costo-utilidad de las pruebas Oncotype DX™ (ODX) o Mammaprint™ (MMP) para establecer la necesidad de quimioterapia adyuvante. Métodos: Este estudio utilizó un modelo de análisis de decisiones adaptado para comparar el costo y los resultados de la atención entre las pruebas ODX o MMP y la atención de rutina sin pruebas ODX o MMP (quimioterapia adyuvante para todas las pacientes) en un horizonte temporal de 5 años desde la perspectiva del Sistema Nacional de Salud de Colombia (SNS; pagador). Los insumos se obtuvieron de las tarifas nacionales de costos unitarios, la literatura publicada y la base de datos de ensayos clínicos. La población de estudio incluyó mujeres con CBE con receptores hormonales positivos (HR +), HER2 negativo, ganglios linfáticos negativos (LN0) con criterios clínicos de alto riesgo de recurrencia. Las medidas de resultado fueron el cociente coste-utilidad incremental descontado (ICUR; 2021 dólares estadounidenses por año de vida ajustado por calidad [AVAC] ganado) y el beneficio monetario neto (MBN). Se realizaron análisis de sensibilidad probabilísticos (APS) y determinísticos (ASD). Resultados: ODX aumenta los AVAC en 0,05 y MMP en 0,03 con un ahorro de 2374 $y 554$ en comparación con la estrategia estándar, respectivamente, y supusieron un ahorro en el plano coste-utilidad. El NMB para ODX fue de 2203 dólares y para MMP de 416. Ambas pruebas dominan a la estrategia estándar. El análisis de sensibilidad reveló que con un umbral de 1 producto interior bruto per cápita, ODX sería rentable en el 95,5% de los casos, frente al 70,2% de casos en los que se aplicó MMP.DSA mostró que la variable con influencia significativa era el coste mensual de la quimioterapia adyuvante. El PSA reveló que ODX era una estrategia sistemáticamente superior. Conclusiones: El perfil genómico mediante pruebas ODX o MMP para definir la necesidad de tratamiento quimioterapéutico adyuvante en pacientes con HR + y HER2 -EBC es una estrategia costo-efectiva que permite al SNS colombiano mantener el presupuesto. 2023, El Autor (es).Background: In Colombia, the best strategy to establish indication for adjuvant chemotherapy in early breast cancer (EBC) remains unknown. This study aimed to identify the cost-utility of Oncotype DX™ (ODX) or Mammaprint™ (MMP) tests to establish the necessity of adjuvant chemotherapy. Methods: This study used an adapted decision-analytic model to compare cost and outcomes of care between ODX or MMP tests and routine care without ODX or MMP tests (adjuvant chemotherapy for all patients) over a 5-year time horizon from the perspective of the Colombian National Health System (NHS; payer). Inputs were obtained from national unit cost tariffs, published literature, and clinical trial database. The study population comprised women with hormone-receptor-positive (HR +), HER2-negative, lymph-node-negative (LN0) EBC with high-risk clinical criteria for recurrence. The outcome measures were discounted incremental cost-utility ratio (ICUR; 2021 United States dollar per quality-adjusted life-year [QALY] gained) and net monetary benefit (NMB). Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were performed. Results: ODX increases QALYs by 0.05 and MMP by 0.03 with savings of $2374 and$554 compared with the standard strategy, respectively, and were cost-saving in cost-utility plane. NMB for ODX was $2203 and for MMP was$416. Both tests dominate the standard strategy. Sensitivity analysis revealed that with a threshold of 1 gross domestic product per capita, ODX will be cost-effective in 95.5% of the cases compared with 70.2% cases involving MMP.DSA showed that the variable with significant influence was the monthly cost of adjuvant chemotherapy. PSA revealed that ODX was a consistently superior strategy. Conclusions: Genomic profiling using ODX or MMP tests to define the need of adjuvant chemotherapy treatment in patients with HR + and HER2 −EBC is a cost-effective strategy that allows Colombian NHS to maintain budget. © 2023, The Author(s)

Síndrome Miller Fisher: un reporte de caso y diagnósticos diferenciales

Las polineuropatías de origen inmunológico como el Síndrome de Guillain-Barré(SGB) y su variante, el Síndrome Miller-Fisher (SMF), tienen una incidencia de 0.6 a 2.4 casos por cada 100.000 habitantes al año, mayor frecuencia en hombres y con tendencia incrementarse en Colombia por infección con el virus del Zika. A continuación, se presenta un caso clínico de un paciente de 66 años que es llevado por su familiar al servicio de urgencias por presentar un cuadro clínico consistente en disartria, adiadococinesia, debilidad y parestesia en miembros inferiores, no tolera la bipedestación, y asocia antecedente de cuadro gripal. Se decide hospitalizar, con diagnósticos probables de un Síndrome cerebeloso, Hemiplejia alterna o Evento Cerebro vascular cerebeloso isquémico en curso. Ingresa a UCI al empeorar neurológicamente y entrar en falla respiratoria; asocia hipertensión arterial, síndrome taquibradi, hiperglicemia, alteración de oxigenación y ventilación; se reciben pruebas diagnósticas que permiten descartar neroinfección o enfermedad neurodegenerativa, se controlaron patologías asociadas en paralelo a la recuperación de su estado neurológico inicial, y en el día 19 se traslada nuevamente a hospitalización en pisos de medicina interna con traqueostomía y gastrostomía percutánea. Estando en pisos, se toma Resonancia Nuclear Magnética (RNM) cuyos resultados y la evolución neurológica del paciente llevan a solicitar electromiografía de miembros superiores con hallazgos normales por lo que se decide realizar el manejo diagnóstico para enfermedades de origen inmunológico. Se solicita perfi l inmunológico obteniéndose resultados positivos para ANAS y para Anticuerpos anticélulas parietales. Ante estos hallazgos y dada la respuesta favorable del paciente al manejo con corticoide, se considera, como diagnóstico posible, una enfermedad neuropática infl amatoria aguda de origen inmunológico del tipo SMF o Miastenia Gravis. Se inicia manejo con inmunoglobulina intravenosa a lo cual el paciente responde con evolución adecuada. Con reporte negativo para anticuerpos anti receptor de acetilcolina, se descarta Miastenia gravis y ante la condición estable y evolución neurológica favorable del paciente se da salida para hospitalización domiciliaria con diagnóstico de neuropatía infl amatoria aguda del tipo SMF. Conclusión: el diagnóstico de las polineuropatía resulta confuso y exige médico tratante el conocer los diagnósticos diferenciales asociados a sintomatología clínica de polineuropatía aguda, para hacer el abordaje diagnóstico y terapéutico correcto del paciente y favorecer su evolución con desenlaces favorables

Dispositivo para la exploración y/o reparación de tuberías, con dispositivos de detección de imágenes y/o mecanismo de desbaste o pulido y/o mecánismo de reparación

Un dispositivo de exploración y reparación de tuberías, caracterizado porque comprende: un mecanismo de tracción que le permite al dispositivo desplazarse en el interior de la tubería; un mecanismo de apertura el cual comprende sistemas que permiten transmitir un movimiento rotacional hacia el mecanismo de tracción, ajustando la inclinación del mecanismo de tracción y permitiéndole al dispositivo adaptarse a tuberías de distintos diámetros; un sensor de distancia que permite determinar la ubicación del dispositivo al interior de la tubería; uno o más dispositivos de detección de imágenes; uno o más mecanismos de elevación y posicionamiento que permiten mover los uno o más dispositivos de detección de imágenes; un mecanismo de fijación que comprende dos o más cabezales de fijación ubicados alrededor del mecanismo de fijación, permitiendo anclar el dispositivo a la tubería durante las operaciones de reparación; un mecanismo de desbaste que comprende una herramienta de pulido y el cual prepara la superficie a reparar cambiando la rugosidad de ésta mediante un proceso de pulido o desbaste; un mecanismo de reparación instalado sobre la misma estructura que soporta el mecanismo de desbaste que fija un material de reparación sobre la superficie a reparar; y un módulo de comunicaciones inalámbrico que le permite comunicarse con una estación base

Mortality and Advanced Support Requirement for Patients With Cancer With COVID-19 : A Mathematical Dynamic Model for Latin America

PURPOSE: In the midst of a global pandemic, evidence suggests that similar to other severe respiratory viral infections, patients with cancer are at higher risk of becoming infected by COVID-19 and have a poorer prognosis. METHODS: We have modeled the mortality and the intensive care unit (ICU) requirement for the care of patients with cancer infected with COVID-19 in Latin America. A dynamic multistate Markov model was constructed. Transition probabilities were estimated on the basis of published reports for cumulative probability of complications. Basic reproductive number (R0) values were modeled with R using the EpiEstim package. Estimations of days of ICU requirement and absolute mortality were calculated by imputing number of cumulative cases in the Markov model. RESULTS: Estimated median time of ICU requirement was 12.7 days, median time to mortality was 16.3 days after infection, and median time to severe event was 8.1 days. Peak ICU occupancy for patients with cancer was calculated at 16 days after infection. Deterministic sensitivity analysis revealed an interval for mortality between 18.5% and 30.4%. With the actual incidence tendency, Latin America would be expected to lose approximately 111,725 patients with cancer to SARS-CoV-2 (range, 87,116-143,154 patients) by the 60th day since the start of the outbreak. Losses calculated vary between < 1% to 17.6% of all patients with cancer in the region. CONCLUSION: Cancer-related cases and deaths attributable to SARS-CoV-2 will put a great strain on health care systems in Latin America. Early implementation of interventions on the basis of data given by disease modeling could mitigate both infections and deaths among patients with cancer

The clinical and molecular cardiometabolic fingerprint of an exploratory psoriatic arthritis cohort is associated with the disease activity and differentially modulated by methotrexate and apremilast

Objectives: (1) To evaluate clinical and molecular cardiovascular disease (CVD) signs and their relationship with psoriatic arthritis (PsA) features and (2) to identify a clinical patient profile susceptible to benefit from methotrexate (MTX) and/or apremilast regarding CVD risk. Methods: This cross-sectional study included 100 patients with PsA and 100 age-matched healthy donors. In addition, an exploratory cohort of 45 biologically naïve patients treated for 6 months with apremilast, MTX or combined therapy according to routine clinical practice was recruited. Extensive clinical and metabolic profiles were obtained. Ninety-nine surrogate CVD-related molecules were analysed in plasma and peripheral blood mononuclear cells (PBMCs). Hard cluster analysis was performed to identify the clinical and molecular phenotypes. Mechanistic studies were performed on adipocytes. Results: Cardiometabolic comorbidities were associated with disease activity and long-term inflammatory status. Thirty-five CVD-related proteins were altered in the plasma and PBMCs of PsA patients and were associated with the key clinical features of the disease. Plasma levels of some of the CVD-related molecules might distinguish insulin-resistant patients (MMP-3, CD163, FABP-4), high disease activity (GAL-3 and FABP-4) and poor therapy outcomes (CD-163, LTBR and CNTN-1). Hard cluster analysis identified two phenotypes of patients according to the rates of cardiometabolic comorbidities with distinctive clinical and molecular responses to each treatment. Conclusions: (1) Novel CVD-related proteins associated with clinical features could be emerging therapeutic targets in the context of PsA and (2) the pleiotropic action of apremilast could make it an excellent choice for the management of PsA patients with high CVD risk, targeting metabolic alterations and CVD-related molecules

Una mirada interdisciplinaria

Las enfermedades crónicas no transmisibles son, en la actualidad, uno de los temas de salud de mayor interés alrededor del mundo, dado el rápido crecimiento que han experimentado en las últimas décadas en países desarrollados y en vía de desarrollo y el alto impacto, no solo biológico, sino económico, sanitario y social que generan para el individuo y la sociedad. De acuerdo con la OMS, las enfermedades crónicas (patologías cardiovasculares, diabetes mellitus, todos los tipos de cáncer y las enfermedades respiratorias), son las principales causas de mortalidad en el mundo, ya que se les asigna un peso del 63% de las muertes a nivel global, con más de 36 millones de defunciones (71% en mayores de 60 años). Así las cosas, la diabetes mellitus se ha ido convirtiendo progresivamente en un problema de salud pública a nivel mundial, dada la estrecha relación que tiene con el sobrepeso y con el sedentarismo, fenómenos característicos del estilo de vida de gran parte de la población a nivel mundial. Este libro presenta de manera ordenada y didáctica información actualizada y práctica acerca de esta enfermedad, de tal forma que pueda ser utilizado como material de consulta y referencia por estudiantes y profesionales de la salud en el ejercicio académico y asistencial, desde una perspectiva práctica de naturaleza interdisciplinaria.Acciones mundiales, regionales y locales para reducir el impacto de la diabetes – Diabetes mellitus en la adolescencia – Alteraciones visuales y oculares en pacientes diabéticos – Diabetes mellitus tipo 2, obesidad y síndrome de apnea obstructiva del sueño – Pie diabético: una mirada desde las imágenes diagnosticas – Diabetes mellitus en el paciente quirúrgico – Diabetes mellitus: una mirada desde la medicina tradicional china – prevención de la diabetes mellitus: reflexiones desde la medicina familiar – Diabetes mellitus: prescripción de ejercicio y actividad física – Meta análisis y revisiones sistemáticas aplicadas en el campo de la diabetes melitus