Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

La publicidad emocional como estrategia de mercadotecnia: Oportunidad para las compañías

Emotions impact on social interactions, attention, perception and memory of the human (Strack, F, Martin, L., Stepper, S., 1988). Due to its relationship with facial expressions, it is possible to identify, analyze and code them based on voluntary and involuntary changes in the keypoints of the face, such as eyes, eyebrows, eyelids, nostrils and lips and interpreting the impact on internal or external stimuli. Based on the Discrete of Emotions Theory of Ekman and Friesen (1976), the FaceCoding Analysys -FCA, measures facial expressions to infer about the emotional behavior of human beings and their decision-making. For the qualitative research, an advertisement was exposed to n = 35 participants, via on-line. The information was processed in SPSS version 22 for Mac using descriptive statistics. The results indicate that the emotion that occurs with the highest proportion is in accordance with the advertising campaignLas emociones impactan en las interacciones sociales, la atención, percepción y memoria del ser humano (Strack, F, Martin, L., Stepper, S., 1988). Por su relación con las expresiones faciales, es posible identificarlas, codificarlas y analizarlas en función de los cambios voluntarios e involuntarios en los puntos clave de la cara, como ojos, cejas, párpados, fosas nasales y labios e interpretar el impacto a los estímulos internos o externos. Con base en la Teoría Discreta de las Emociones de Ekman y Friesen (1976), el FaceCoding Analysys – FCA, mide las expresiones faciales para inferir a cerca del comportamiento emocional del ser humano y su toma de decisiones. Para la investigación de corte cualitativo, se expuso una anuncio publicitario a n=35 participantes, vía on-line. La información fue procesada en SPSS versión 22 para Mac, utilizando estadística descriptiva. Los resultados indican que la emoción que se presenta con mayor proporción está en concordancia con la campaña publicitaria

Bienestar financiero, una reflexión desde la ficción neoliberal en un contexto local

La globalización financiera leída, como un proceso donde los corporativos están afincados en países centrales, que poseen un mayor grado de industrialización, marcan las reglas del juego económico hacia las economías de países periféricos, llamados también emergentes o en vías de industrialización. Las cadenas productivas diferenciadas son una de las consecuencias de este modelo, ya que se focaliza en regiones en donde lideran aquellos procesos estratégicos. Este fenómeno en América Latina, se traduce en la desigualdad en los sistemas económicos de quienes participan en decisiones estratégicas por la influencia de las políticas públicas que se diseñan en beneficio de corporativos transnacionales con mayor poderío. Esto se debe, en gran medida, por influencia de los movimientos de flujos internacionales de capital, los cuales son controlados por inversionistas ubicados en un reducido grupo de países centrales; quienes ven beneficiado su desarrollo económico a costa de distintos recursos que proveen los países periféricos. Las políticas educativas de los países de América Latina deberían acentuar en el modelo capitalista neoliberal, un objetivo de educación financiera, en la búsqueda de un mejor bienestar en la calidad de vida de la población económicamente activa. El presente artículo pretende responder al interrogante del impacto que tiene el modelo neoliberal en el bienestar financiero en una comunidad, el cual, desde el argumento teórico, se diseña para implementar políticas públicas en beneficio del bienestar social

A Survey of Empirical Results on Program Slicing

International audienceBACKGROUND:Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.METHODS:This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.FINDINGS:Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).INTERPRETATION:Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding