A Method for Systematic Adaptation and Synchronization of Healthcare Processes

International organizations, as the World Health Organization (WHO) and national governments are constantly defining (or modifying) new healthcare protocols and procedures. Those changes have a significant impact, on one side, on the organizational concerns of a great number of healthcare institutions and centers, and on the other side, on their health information systems that need to be adapted according to the new (or modified) procedures. Administrative workflows are commonly defined by a high level entity and they must then be applied on different institutions ruled by this high level entity. Those workflows must then be adapted to the particular circumstances of each institution, complying with the general regulations of the process established at the top level. This problem, called Hierarchical Adaptation Problem, also implies establishing the methods to evolve together the high level regulation. Such methods must maintain the consistency among the different levels by means of the propagation of the changes to all the different adaptations of the original workflow. To solve this problem, this work introduces the Hierarchical Adaptation Method. A method based on ontologies to define the rules that must be satisfied by a generic workflow to be considered adaptable to different application cases and the rules that must be satisfied by its adapted versions. Moreover, it provides the operations to facilitate both adaptation of administrative workflows and propagation of changes

CompareML: A Novel Approach to Supporting Preliminary Data Analysis Decision Making

There are a large number of machine learning algorithms as well as a wide range of libraries and services that allow one to create predictive models. With machine learning and artificial intelligence playing a major role in dealing with engineering problems, practising engineers often come to the machine learning field so overwhelmed with the multitude of possibilities that they find themselves needing to address difficulties before actually starting on carrying out any work. Datasets have intrinsic properties that make it hard to select the algorithm that is best suited to some specific objective, and the ever-increasing number of providers together make this selection even harder. These were the reasons underlying the design of CompareML, an approach to supporting the evaluation and comparison of machine learning libraries and services without deep machine learning knowledge. CompareML makes it easy to compare the performance of different models by using well-known classification and regression algorithms already made available by some of the most widely used providers. It facilitates the practical application of methods and techniques of artificial intelligence that let a practising engineer decide whether they might be used to resolve hitherto intractable problems. Thus, researchers and engineering practitioners can uncover the potential of their datasets for the inference of new knowledge by selecting the most appropriate machine learning algorithm and determining the provider best suited to their data

Desempeño del sistema de vigilancia colombiano durante la pandemia de COVID-19: evaluación rápida de los primeros 50 días

Introduction: The COVID pandemic is a challenge for public health surveillance and an opportunity to assess its strengths and weaknesses to improve the response.Objective: To evaluate the performance of the Colombian public health surveillance system during the first 50 days of the COVID-19 pandemic in the country.Materials and methods: We analyzed the data published between March 6 and April 24, 2020, by the Instituto Nacional de Salud and the World Health Organization (WHO).We evaluated: i) the quality of the data according to the fulfillment of Benford’s law, and ii) the timeliness of the information measured as the difference in dates between the data generated by the Instituto Nacional de Salud and WHO’s situational reports. We assessed the fulfillment of Benford’s law using the p values of the log-likelihood ratio, the chi square or Moreno’s exact tests.Results: Until April 24 there were 4,881 cases of COVID-19 in Colombia. During most of the first 50 days of the pandemic, Benford’s law was fulfilled except the first days of the epidemic. The difference between Instituto Nacional de Salud and WHO reports largely depends on the different reporting times.Conclusion: In general, the Colombian public health surveillance system fulfilled Benford’s law suggesting that there was quality in the data. Future studies comparing the performance of the departments and districts will improve the diagnosis of the Colombian surveillance system.Introducción. La pandemia de COVID es un desafío para la vigilancia en salud pública y una oportunidad para evaluar sus fortalezas y debilidades en aras de mejorar la respuesta.Objetivo. Evaluar el desempeño del sistema de vigilancia en salud pública colombiano durante los primeros 50 días de la pandemia de COVID-19 en el país.Materiales y métodos. Se analizaron los datos publicados entre el 6 de marzo y el 24 de abril de 2020 por el Instituto Nacional de Salud y la Organización Mundial de Salud (OMS). Se consideraron en la evaluación: i) la calidad de los datos según la ley de Benford y ii) la oportunidad de la información, medida como la diferencia en fechas entre los datos generados en el Instituto Nacional de Salud y los recogidos en el informe situacional de la OMS. La variabilidad en el cumplimiento de la ley de Benford se evaluó con los valores de p en las pruebas de razón del logaritmo de la verosimilitud, ji al cuadrado o exacta de Moreno.Resultados. Hasta el 24 de abril hubo 4.881 casos de COVID-19 en Colombia. En la mayoría de los primeros 50 días se cumplió la ley de Benford, excepto en los primeros días de la epidemia. La diferencia entre los informes del Instituto Nacional de Salud y la OMS ha dependido, en gran medida, de la diferencia en los horarios de cierre de la información.Conclusión. En general, el sistema de vigilancia en salud pública colombiano cumplió con la ley de Benford, lo cual sugiere que hubo calidad en los datos. En futuros estudios que comparen el desempeño de los departamentos y distritos se podrá mejorar el diagnóstico de la vigilancia en salud pública del país

Optogenetic delivery of trophic signals in a genetic model of Parkinson's disease

Optogenetics has been harnessed to shed new mechanistic light on current and future therapeutic strategies. This has been to date achieved by the regulation of ion flow and electrical signals in neuronal cells and neural circuits that are known to be affected by disease. In contrast, the optogenetic delivery of trophic biochemical signals, which support cell survival and are implicated in degenerative disorders, has never been demonstrated in an animal model of disease. Here, we reengineered the human and Drosophila melanogaster REarranged during Transfection (hRET and dRET) receptors to be activated by light, creating one-component optogenetic tools termed Opto-hRET and Opto-dRET. Upon blue light stimulation, these receptors robustly induced the MAPK/ERK proliferative signaling pathway in cultured cells. In PINK1B9 flies that exhibit loss of PTEN-induced putative kinase 1 (PINK1), a kinase associated with familial Parkinson’s disease (PD), light activation of Opto-dRET suppressed mitochondrial defects, tissue degeneration and behavioral deficits. In human cells with PINK1 loss-of-function, mitochondrial fragmentation was rescued using Opto-dRET via the PI3K/NF-кB pathway. Our results demonstrate that a light-activated receptor can ameliorate disease hallmarks in a genetic model of PD. The optogenetic delivery of trophic signals is cell type-specific and reversible and thus has the potential to inspire novel strategies towards a spatio-temporal regulation of tissue repair

Análisis de la morfometría ósea en ratas sometidas a diferentes situaciones de hipoxia

El hueso es uno de los tejidos metabólicamente más activos, metabolismo que requiere de un aporte suficiente de oxígeno. En este sentido, se han publicado resultados contradictorios de cómo la hipoxia podría modificar el remodelado óseo y con ello la estructura del hueso. El objetivo del estudio fue valorar el efecto de la hipoxia sobre la morfometría ósea y la densidad mineral ósea medidas por tomografía axil computarizada de alta resolución (HR-pQTc ). Se analizaron 61 ratas wistar a las que se les sometió a diferentes condiciones experimentales: ratas control (sometidas a condiciones de normoxia), ratas sometidas a hipoxia crónica constante y ratas sometidas a hipoxia crónica intermitente. Los animales se sacrificaron por una sobredosis cardiaca de fenobarbital. A continuación, se procedió a la extracción de los huesos, fémur y tibia. Posteriormente se fijaron en etanol al 70% para su posterior análisis. Se utilizó un micro-TAC modelo escáner SKYSCAN 1172 de la marca BRUKER y un software de captación de datos skyscan1172 µCT. La reconstrucción de las imágenes se realizó mediante un software Nrecon utilizándose posterio mente el software de análisis de imagen "CTAN". Se utilizó el SPSS v22 para el análisis estadístico. Nuestros resultados mostraron que las ratas sometidas a condiciones de hipoxia tenían una menor densidad mineral de tejido (TMD) en fémur cortical y un menor grosor trabecular de la tibia. Por otra parte, analizando las ratas sometidas a hipoxia crónica permanente en referencia a las ratas control, se observó que la hipoxia se asoció con un menor espesor cortical de la tibia, menor densidad mineral ósea (BMD) en fémur trabecular y con menor volumen óseo porcentual (BV/TV) del fémur trabecular. Diferenciando por sexos, las ratas hembras sometidas a hipoxia crónica permanente presentaron un menor espesor de la tibia cortical, menor grosor de las trabéculas de la tibia y el fémur y menores valores de BMD en las trabéculas de la tibia y el fémur. Las ratas macho sometidas a hipoxia crónica permanente, tenían un menor número de trabéculas en la tibia. También se observó como las ratas sometidas a hipoxia permanente intermitente, tenían un menor TMD que las ratas control. Nuestros resultados mostraron que en diferentes condiciones de hipoxia se observó un deterioro de la morfometría ósea, probablemente debido a que se produce una alteración del remodelado óseo promovido por la hipoxia tisular

HORuS transmission spectroscopy and revised planetary parameters of KELT-7 b

We report on the high-resolution spectroscopic observations of two planetary transits of the hot Jupiter KELT-7b (Mp = 1.28 +/- 0.17Mjup, Teq=2028 K) observed with the High Optical Resolution Spectrograph (HORuS) mounted on the 10.4-m Gran Telescopio Canarias (GTC). A new set of stellar parameters are obtained for the rapidly rotating parent star from the analysis of the spectra. Using the newly derived stellar mass and radius, and the planetary transit data of the Transiting Exoplanet Survey Satellite (TESS) together with the HORuS velocities and the photometric and spectroscopic data available in the literature, we update and improve the ephemeris of KELT-7b. Our results indicate that KELT-7 has an angle Lamda = -10.55 +/- 0.27 deg between the sky projections of the star’s spin axis and the planet’s orbital axis. By combining this angle and our newly derived stellar rotation period of 1.38 +/- 0.05 d, we obtained a 3D obliquity Psi = 12.4 +/- 11.7 deg (or 167.6 deg), thus reinforcing that KELT-7 is a well-aligned planetary system. We search for the presence of Halfa, Li i, Na i, Mg i, and Ca ii features in the transmission spectrum of KELT-7b but we are only able to determine upper limits of 0.08–1.4 % on their presence after accounting for the contribution of the stellar variability to the extracted planetary spectrum. We also discuss the impact of stellar variability in the planetary data. Our results reinforce the importance of monitoring the parent star when performing high-resolution transmission spectroscopy of the planetary atmosphere in the presence of stellar activity

An Objective Scatter Index Based on Double-Pass Retinal Images of a Point Source to Classify Cataracts

PURPOSE: To propose a new objective scatter index (OSI) based in the analysis of double-pass images of a point source to rank and classify cataract patients. This classification scheme is compared with a current subjective system. METHODS: We selected a population including a group of normal young eyes as control and patients diagnosed with cataract (grades NO2, NO3 and NO4) according to the Lens Opacities Classification System (LOCS III). For each eye, we recorded double-pass retinal images of a point source. In each patient, we determined an objective scatter index (OSI) as the ratio of the intensity at an eccentric location in the image and the central part. This index provides information on the relevant forward scatter affecting vision. Since the double-pass retinal images are affected by both ocular aberrations and intraocular scattering, an analysis was performed to show the ranges of contributions of aberrations to the OSI. RESULTS: We used the OSI values to classify each eye according to the degree of scatter. The young normal eyes of the control group had OSI values below 1, while the OSI for subjects in LOCS grade II were around 1 to 2. The use of the objective index showed some of the weakness of subjective classification schemes. In particular, several subjects initially classified independently as grade NO2 or NO3 had similar OSI values, and in some cases even higher than subjects classified as grade NO4. A new classification scheme based in OSI is proposed. CONCLUSIONS: We introduced an objective index based in the analysis of double-pass retinal images to classify cataract patients. The method is robust and fully based in objective measurements; i.e., not depending on subjective decisions. This procedure could be used in combination with standard current methods to improve cataract patient surgery scheduling

Six hundred years of South American tree rings reveal an increase in severe hydroclimatic events since mid-20th century

South American (SA) societies are highly vulnerable to droughts and pluvials, but lack of long-term climate observations severely limits our understanding of the global processes driving climatic variability in the region. The number and quality of SA climate-sensitive tree ring chronologies have significantly increased in recent decades, now providing a robust network of 286 records for characterizing hydroclimate variability since 1400 CE. We combine this network with a self-calibrated Palmer Drought Severity Index (scPDSI) dataset to derive the South American Drought Atlas (SADA) over the continent south of 12°S. The gridded annual reconstruction of austral summer scPDSI is the most spatially complete estimate of SA hydroclimate to date, and well matches past historical dry/wet events. Relating the SADA to the Australia–New Zealand Drought Atlas, sea surface temperatures and atmospheric pressure fields, we determine that the El Niño–Southern Oscillation (ENSO) and the Southern Annular Mode (SAM) are strongly associated with spatially extended droughts and pluvials over the SADA domain during the past several centuries. SADA also exhibits more extended severe droughts and extreme pluvials since the mid-20th century. Extensive droughts are consistent with the observed 20th-century trend toward positive SAM anomalies concomitant with the weakening of midlatitude Westerlies, while low-level moisture transport intensified by global warming has favored extreme rainfall across the subtropics. The SADA thus provides a long-term context for observed hydroclimatic changes and for 21st-century Intergovernmental Panel on Climate Change (IPCC) projections that suggest SA will experience more frequent/severe droughts and rainfall events as a consequence of increasing greenhouse gas emissions

Association of a single nucleotide polymorphism combination pattern of the Klotho gene with non-cardiovascular death in patients with chronic kidney disease

Chronic kidney disease (CKD) is associated with an elevated risk of all-cause mortality, with cardiovascular death being extensively investigated. However, non-cardiovascular mortality represents the biggest percentage, showing an evident increase in recent years. Klotho is a gene highly expressed in the kidney, with a clear influence on lifespan. Low levels of Klotho have been linked to CKD progression and adverse outcomes. Single nucleotide polymorphisms (SNPs) of the Klotho gene have been associated with several diseases, but studies investigating the association of Klotho SNPs with noncardiovascular death in CKD populations are lacking. The main aim of this study was to assess whether 11 Klotho SNPs were associated with non-cardiovascular death in a subpopulation of the National Observatory of Atherosclerosis in Nephrology (NEFRONA) study (n ¼ 2185 CKD patients). After 48 months of follow-up, 62 cardiovascular deaths and 108 non-cardiovascular deaths were recorded. We identified a high non-cardiovascular death risk combination of SNPs corresponding to individuals carrying the most frequent allele (G) at rs562020, the rare allele (C) at rs2283368 and homozygotes for the rare allele (G) at rs2320762 (rs562020 GG/AG þ rs2283368 CC/CT þ rs2320762 GG). Among the patients with the three SNPs genotyped (n ¼ 1016), 75 (7.4%) showed this combination. Furthermore, 95 (9.3%) patients showed a low-risk combination carrying all the opposite genotypes (rs562020 AA þ rs2283368 TT þ rs2320762 GT/TT). All the other combinations [n ¼ 846 (83.3%)] were considered as normal risk. Using competing risk regression analysis, we confirmed that the proposed combinations are independently associated with a higher fhazard ratio [HR] 3.28 [confidence interval (CI) 1.51-7.12]g and lower [HR 6 × 10- (95% CI 3.3 × 10--1.1 × 10-)] risk of suffering a non-cardiovascular death in the CKD population of the NEFRONA cohort compared with patients with the normal-risk combination. Determination of three SNPs of the Klotho gene could help in the prediction of non-cardiovascular death in CKD