Causal mediation for uncausally related mediators in the context of survival analysis.

Objective: The study of the potential intermediate effect of several variables on the association between an exposure and a time-to-event outcome is a question of interest in epidemiologic research. However, to our knowledge, no tools have been developed for the evaluation of multiple correlated mediators in a survival setting. Methods: In this work, we extended the multimediate algorithm, which conducts mediation analysis in the context of multiple uncausally correlated mediators, to a time-to-event setting using the semiparametric additive hazards model. We theoretically demonstrated that, under certain assumptions, indirect, direct and total effects can be calculated using the counterfactual framework with collapsible survival models. We also adapted the algorithm to accommodate exposure-mediator interactions. Results and conclusions: Using simulations, we demonstrated that our algorithm performs better than the product of coefficients method, even for uncorrelated mediators. The additive hazards model quantifies the effects as rate differences, which constitute a measure of impact, with applications that can be highly informative for public health. Our algorithm can be found in the R package multimediate, which is available in Github.

Omics feature selection with the extended SIS R package: identification of a body mass index epigenetic multi-marker in the Strong Heart Study.

The statistical analysis of omics data poses a great computational challenge given its ultra-high dimensional nature and frequent between-features correlation. In this work, we extended the Iterative Sure Independence Screening (ISIS) algorithm by pairing ISIS with elastic-net (Enet) and two versions of adaptive Enet (AEnet and MSAEnet) to efficiently improve feature selection and effect estimation in omics research. We subsequently used genome-wide human blood DNA methylation data from American Indians of the Strong Heart Study (N=2,235 participants), measured in 1989-1991, to compare the performance (predictive accuracy, coefficient estimation and computational efficiency) of SIS-paired regularization methods to Bayesian shrinkage and traditional linear regression to identify epigenomic multi-marker of body mass index. ISIS-AEnet outperformed the other methods in prediction. In biological pathway enrichment analysis of genes annotated to BMI-related differentially methylated positions, ISIS-AEnet captured most of the enriched pathways in common for at least two of all the evaluated methods. ISIS-AEnet can favor biological discovery because it identifies the most robust biological pathways while achieving an optimal balance between bias and efficient feature selection. In the extended SIS R package, we also implemented ISIS paired with Cox and logistic regression for time-to-event and binary endpoints, respectively, and bootstrap confidence intervals for the estimated regression coefficients.

Smoking, blood DNA methylation sites and lung cancer risk.

Altered DNA methylation (DNAm) might be a biological intermediary in the pathway from smoking to lung cancer. In this study, we investigated the contribution of differential blood DNAm to explain the association between smoking and lung cancer incidence. Blood DNAm was measured in 2321 Strong Heart Study (SHS) participants. Incident lung cancer was assessed as time to event diagnoses. We conducted mediation analysis, including validation with DNAm and paired gene expression data from the Framingham Heart Study (FHS). In the SHS, current versus never smoking and pack-years single-mediator models showed, respectively, 29 and 21 differentially methylated positions (DMPs) for lung cancer with statistically significant mediated effects (14 of 20 available, and five of 14 available, positions, replicated, respectively, in FHS). In FHS, replicated DMPs showed gene expression downregulation largely in trans, and were related to biological pathways in cancer. The multimediator model identified that DMPs annotated to the genes AHRR and IER3 jointly explained a substantial proportion of lung cancer. Thus, the association of smoking with lung cancer was partly explained by differences in baseline blood DNAm at few relevant sites. Experimental studies are needed to confirm the biological role of identified eQTMs and to evaluate potential implications for early detection and control of lung cancer.

Patterns of pharmaceutical supplies and medicines donations received during a natural disaster.

BACKGROUND: In response to emergencies, such as wildfires, donations of pharmaceuticals often occur. These donations can be given directly by governments, to non-governmental organizations as corporate donations, or by private entities that donate to individual health institutions. OBJECTIVE: This paper aimed to collect, review and analyze pharmaceutical product donations received during the natural disaster caused by wildfires in the San Luis province, Argentina, in September and October 2020. METHODS: A descriptive, cross-sectional, and retrospective study was performed. An introductory approach to good donation practices was also carried out. Medicines were classified and in the case of products that were not suitable for administration, these were discarded. RESULTS: A total of 15,593 units were segregated, of which 52.8% were over-the-counter products and 47.2% were prescription drugs. 86.3% (13,467 units) were accepted, while 13.7% (2126 units) had to be destroyed. The value of donations totaled USD 16,544. The analysis of the results showed that an important part of the donations was irrelevant in the emergency context. Donations were also received in incorrect amounts, which generated a large stock of medicines that couldn't be used. In emergencies, inappropriate donations create additional work during sorting, storage, and distribution, increasing the time professionals need to complete tasks. This extra work can easily overwhelm limited human and logistical resources. CONCLUSIONS: It is important to previously evaluate the real need for donations. In addition, the distribution of donations must be done through pre-established systems and policies. Otherwise, unsolicited and unnecessary drug donations become wasteful and should therefore be avoided.

Biopolymeric Fibrous Aerogels: The Sustainable Alternative for Water Remediation.

The increment in water pollution due to the massive development in the industrial sector is a worldwide concern due to its impact on the environment and human health. Therefore, the development of new and sustainable alternatives for water remediation is needed. In this context, aerogels present high porosity, low density, and a remarkable adsorption capacity, making them candidates for remediation applications demonstrating high efficiency in removing pollutants from the air, soil, and water. Specifically, polymer-based aerogels could be modified in their high surface area to integrate functional groups, decrease their hydrophilicity, or increase their lipophilicity, among other variations, expanding and enhancing their efficiency as adsorbents for the removal of various pollutants in water. The aerogels based on natural polymers such as cellulose, chitosan, or alginate processed by different techniques presented high adsorption capacities, efficacy in oil/water separation and dye removal, and excellent recyclability after several cycles. Although there are different reviews based on aerogels, this work gives an overview of just the natural biopolymers employed to elaborate aerogels as an eco-friendly and renewable alternative. In addition, here we show the synthesis methods and applications in water cleaning from pollutants such as dyes, oil, and pharmaceuticals, providing novel information for the future development of biopolymeric-based aerogel.

Development of melatonin-loaded, human-serum-albumin nanoparticles formulations using different methods of preparation for ophthalmic administration.

The use of proteins such as human serum albumin (HSA) to form nanometric systems seems very promising since they are non-toxic, biodegradable and have no antigenic activity. This molecule is ideal to transport insoluble drugs such as melatonin (Mel), which has antiapoptotic and antioxidant properties and appears promising for the treatment of neurodegenerative eye diseases. The objective of this study was to obtain nanoparticulate systems loaded with Mel, improving the conventional desolvation method. Systems were stabilised using two different strategies: one through the use of Eudragit S100 as a cross-linking agent and the other through thermal stabilisation. The systems thus obtained (Np-HSA-Eu-Mel and Np-HSA-Mel, respectively) were characterised and compared in terms of physicochemical and pharmacotechnical parameters. Whitish colloidal dispersions of nanometric size (≈170 nm), spherical shape, and monodisperse population were obtained. Besides, the pH was close to neutrality reaching 20 % drug encapsulation whereas the process performance was higher than 80 %. In FT-IR studies, thermal analysis and X-ray diffraction (XRD), the incorporation of the drug in the cavities of the nanoparticles could be evidenced. Regarding the physical stability of nanoparticles, for Np-HSA-Eu-Mel instability was observed at pH > 7. However, Np-HSA-Mel was able to remain stable at different pH levels. Mel release from these systems was consequently affected, where the former released faster than the active compared to the last. On the other hand, it was observed that the drying process (lyophilization in this case) applied to the nanoparticles suspensions does not affect their original properties after redispersion over a three months period. Likewise, the formulation did not produce irritation when administered topically, whereas when administered subconjunctivally, only slight irritation was observed 24 h after administration. According to the result of this study, the Np-HSA-Mel formulation could achieve advantageous properties as a vehicle for the transport of insoluble drugs for the treatment of neurodegenerative diseases at the ocular level.

Frames and rationality: Response to commentators.

The thoughtful and rewarding peer commentaries on my target article come from a broad range of disciplinary perspectives. I engage with the commentaries in three groups. First, I discuss the commentaries that apply my basic approach to new cases not considered in the target article. Second, I explore those that helpfully extend and refine my arguments. Finally, I offer replies to those that object either to the overall framework or to specific arguments.

Suprarenal Masses in Very Young Infants: Is It Safe to Watch and Wait? Report of a SIOPEN Observational Study Results.

Background: To assess whether expectant observation of infants ≤ 90 days old with small suprarenal masses (sSRMs) could avoid unnecessary surgery without impacting outcome. Methods: Infants ≤ 90 days with a ≤ 5 cm mass, without midline extension or lymph node or distant spread were registered (ClinicalTrials.org:NCT01728155). Once staging was completed, they were followed with ultrasound, MRI and urinary catecholamines. Surgical resection was only planned if there was a ≥40% mass volume increase or for a mass persisting after 48 weeks of the planned observation. Results: Over a 5-year period, 128 infants were registered. No infant had detectable MYCN amplification in the peripheral blood. Surgery was performed in 39 (30.5%) patients, in 18 during and in 21 after the planned 48-week observation, and 74% were confirmed to be neuroblastomas. Non-life-threatening surgical complications occurred in two cases. The 3-year overall survival and event-free survival were 100% and 87.1%, respectively. The 16 events observed were volume increase (N = 11) and progression to neuroblastoma stage MS (N = 5). Patients with solid masses or MIBG-positive masses had lower EFS. Conclusions: Expectant observation for infants with sSRMs with clinical follow-up and timely imaging (including MRI scan) is safe and effective, allowing surgery to be avoided in the majority of them.

Mathematical and Pharmacokinetic Approaches for the Design of New 3D Printing Inks Using Ricobendazole.

PURPOSE: 3D printing (3DP) makes it possible to obtain systems that are not achievable with current conventional methods, one of them, sustained release floating systems. Floating systems using ricobendazole (RBZ) as a model drug and a combination of polymers were designed and obtained by melt solidification printing technique (MESO-PP). METHODS: Four different MESO-PP inks were formulated based on combinations of the polymers Gelucire 43/01 and Gelucire 50/13 in different ratios. For each of the formulated inks, physicochemical characterization was performed by thermal analysis (thermogravimetric analysis [TGA] and differential scanning calorimetry [DSC]), fourier transform infrared spectrophotometer (FTIR) and X-ray diffraction (XRD). Pharmaceutical characterization was performed by in vitro assays to determine pharmaceutically relevant parameters. These parameters were calculated by applying mathematical models developed to evaluate in vitro drug release profiles. On the other hand, a physiologically based pharmacokinetic (PBPK) model was developed to predict the in vivo performance of RBZ loaded in the different inks by determining the Cmax, and the AUC0-∞. RESULTS: By increasing the proportion of Gelucire 50/13 co-surfactant in the mixtures (the proportion in Ink 1 was 33%, while the proportion in Ink 4 was 80%), the dissolution capacity of RBZ increases substantially, decreasing flotation times. CONCLUSION: MESO-PP produced ink 1 (50% Gelucire 43/01, 25% Gelucire 50/13 and 25% RBZ), which has a zero-order release (RR = 0.180%/min) and the longest flotation time (545 ± 23 min), and in turn would produce a significant increase in oral absorption of the drug, with an AUC0-∞ 2.16-fold higher than that obtained in animals treated with RBZ loaded in conventional tablets.

Functional Impairment in Borderline Personality Disorder: The Mediating Role of Perceived Social Support.

Borderline personality disorder (BPD) is characterized by instability in relationships, mood fluctuations, and erratic behavior. This study investigates the relationship between pathological personality traits and functional disability, the status of perceived social support in BPD, as well as its mediating role in this relationship. In this cross-sectional study, 192 Spanish women (BPD group, N = 97; healthy control group, N = 95) completed, through two online platforms, a battery of tests including: the Personality Inventory for DSM-5 Brief Form (PID-5-BF), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Perceived Social Support subscale of the Quality of Life Questionnaire (QLQ). The results show that perceived social support was significantly lower in the BPD group, which also presented a significantly higher disability score than the control group. Pathological personality traits affected functionality both directly and indirectly through perceived social support, as this variable was a significant mediator in both groups. We conclude that perceived social support is impaired in BPD patients, and enhancing it as a complementary therapy to evidence-based treatments could help preserve the functionality of patients while pathological traits are regulated. This study also encourages future research to delve into the relevance of other psychosocial variables on the functionality of subjects with BPD, and the need of enhancing them in therapy.

Improving 1-propanol force field: a new methodology.

A new force field for 1-propanol, in the united and all atom models, has been obtained by combining two different empirical methodologies. The first was developed by scaling atom charges and Lennard-Jones parameters to fit the dielectric constant, surface tension, and density; this methodology is named three steps systematic parameterization procedure (3SSPP), as reported by Pérez de la Luz et al. (J Chem Theory Comput 14:5949-5958, 2018). The second methodology consists of moving these parameters and together with the bond distance to obtain the liquid-vapor phase diagram of the CO2 molecule as discussed by Harris and Yung (J Phys Chem 99:12021-12024, 1995). The last methodology is used to obtain the self-diffusion coefficient, which was not consider in the 3SSPP. The 3SSPP/bond methodology is the 3SSPP plus the bond distance scaling. With this new methodology, the experimental density, dielectric constant, surface tension, and self-diffusion coefficient at ambient temperature could be achieved. Furthermore, we show the temperature dependence of the aforementioned properties. The static structure factors are in accordance with the experimental spectrum. Solubility is increased to the experimental value for the united atom (UA) model after applying this methodology and for all atom (AA) scheme, the experimental solubility value is maintained. Graphical abstract The reduction in bond distance of the 1-propanol molecule does not modify the structure factor.

Rational framing effects: A multidisciplinary case.

Frames and framing make one dimension of a decision problem particularly salient. In the simplest case, frames <i>prime</i> responses (as in, e.g., the Asian disease paradigm, where the gain frame primes risk-aversion and the loss frame primes risk-seeking). But in more complicated situations frames can function reflectively, by making salient particular reason-giving aspects of a thing, outcome, or action. For Shakespeare's Macbeth, for example, his feudal commitments are salient in one frame, while downplayed in another in favor of his personal ambition. The role of frames in reasoning can give rise to <i>rational framing effects</i>. Macbeth can prefer fulfilling his feudal duty to murdering the king, while also preferring bravely taking the throne to fulfilling his feudal duty, knowing full well that bravely taking the throne just is murdering the king. Such patterns of <i>quasi-cyclical</i> preferences can be correct and appropriate from the normative perspective of how one ought to reason. The paper explores three less dramatic types of rational framing effects: (1) Consciously framing and reframing long-term goals and short-term temptations can be important tools for self-control. (2) In the prototypical social interactions modeled by game theory, allowing for rational framing effects solves longstanding problems, such as the equilibrium selection problem and explaining the appeal of non-equilibrium solutions (e.g., the cooperative solution in the Prisoner's Dilemma). (3) Processes for resolving interpersonal conflicts and breaking discursive deadlock, because they involve internalizing multiple and incompatible ways of framing actions and outcomes, in effect create rational framing effects.

The number sense does not represent numbers, but cardinality comparisons.

Against Clarke and Beck's proposal that the approximate number system (ANS) represents natural and rational numbers, I suggest that the experimental evidence is better accommodated by the (much weaker) thesis that the ANS represents cardinality comparisons. Cardinality comparisons do not stand in arithmetical relations and being able to apply them does not involve basic arithmetical concepts and operations.

Correction: Structural and spectral properties of generative models for synthetic multilayer air transportation networks.

[This corrects the article DOI: 10.1371/journal.pone.0258666.].

Structural and spectral properties of generative models for synthetic multilayer air transportation networks.

To understand airline transportation networks (ATN) systems we can effectively represent them as multilayer networks, where layers capture different airline companies, the nodes correspond to the airports and the edges to the routes between the airports. We focus our study on the importance of leveraging synthetic generative multilayer models to support the analysis of meaningful patterns in these routes, capturing an ATN's evolution with an emphasis on measuring its resilience to random or targeted attacks and considering deliberate locations of airports. By resorting to the European ATN and the United States ATN as exemplary references, in this work, we provide a systematic analysis of major existing synthetic generation models for ATNs, specifically ANGEL, STARGEN and BINBALL. Besides a thorough study of the topological aspects of the ATNs created by the three models, our major contribution lays on an unprecedented investigation of their spectral characteristics based on Random Matrix Theory and on their resilience analysis based on both site and bond percolation approaches. Results have shown that ANGEL outperforms STARGEN and BINBALL to better capture the complexity of real-world ATNs by featuring the unique properties of building a multiplex ATN layer by layer and of replicating layers with point-to-point structures alongside hub-spoke formations.

Dissolution profiles of fenbendazole from binary solid dispersions: a mathematical approach.

Aim: Understanding a drug dissolution process from solid dispersions (SD) to develop formulations with predictable in vivo performance. Materials & methods: Dissolution data of fenbendazole released from the SDs and the control physical mixtures were analyzed using the Lumped mathematical model to estimate the parameters of pharmaceutical relevance. Results: The fit data obtained by Lumped model showed that all SDs have a unique dissolution profile with an error of ±4.1% and an initial release rate 500-times higher than the pure drug, without incidence of drug/polymer ratio or polymer type. Conclusion: The Lumped model helped to understand that the main factor influencing the fenbendazole release was the type formulation (SD or physical mixture), regardless of the type or amount of polymer used.

An appraisal of the scientific current situation and new perspectives in the treatment of cutaneous leishmaniasis.

Leishmaniasis is a Neglected Tropical Diseases caused by protozoan parasites of the genus Leishmania. It is a major health problem in many tropical and subtropical regions of the world and can produce three different clinical manifestations, among which cutaneous leishmaniasis has a higher incidence in the world than the other clinical forms. There are no recognized and reliable means of chemoprophylaxis or vaccination against infections with different forms of leishmaniasis. In addition, chemotherapy, unfortunately, remains, in many respects, unsatisfactory. Therefore, there is a continuing and urgent need for new therapies against leishmaniasis that are safe and effective in inducing a long-term cure. This review summarizes the latest advances in currently available treatments and improvements in the development of drug administration. In addition, an analysis of the in vivo assays was performed and the challenges facing promising strategies to treat CL are discussed. The treatment of leishmaniasis will most likely evolve into an approach that uses multiple therapies simultaneously to reduce the possibility of developing drug resistance. There is a continuous effort to discover new drugs to improve the treatment of leishmaniasis, but this is mainly at the level of individual researchers. Undoubtedly, more funding is needed in this area, as well as greater participation of the pharmaceutical industry to focus efforts on the development of chemotherapeutic agents and vaccines for this and other neglected tropical diseases.

[Evaluation and perspective of 20 years of neonatal screening in Galicia. Program results.] / Evaluación y perspectiva de 20 años de cribado neonatal en Galicia. Resultados del programa.

Galician newborn screening program for early detection of endocrine and metabolic diseases began in 1978 and was a pioneer in expanded newborn screening in Spain with the incorporation of mass spectrometry in July 2000. As a primary objective, 28 diseases are screened, including those recommended SNS except sickle cell anemia which is in the inclusion phase. In its 20-year history, 404,616 newborns (nb) have been analyzed, identifying 547 cases affected by the diseases included, with a global incidence of 1: 739 newborns and 1: 1.237 of the screened inborn errors of metabolism (IEM) (1:1.580 nb if excluding benign hyperphenylalaninemia-HPA), with an average participation of 99.35%, progressively higher during the analyzed period. Among the pathologies screened, congenital hypothyroidism (1:2.211 nb), cystinuria (1:4.129 nb) and HPA (1:5.699 nb), followed by phenylketonuria and cystic fibrosis (1:10,936 nb) stand out for their incidence. Sixty-six cases of false positives were identified (seventeen of them in relation to maternal pathology) and five false negatives, being the overall PPV and NPV of the program respectively of 89.2% and 99.99%, with a sensitivity of 99.09% and a specificity of 99.98%. The mortality rate of diagnosed CME patients is 1.52%, with eleven cases presenting symptoms prior to the screening result (2%). The intelligence quotient of IEM patients at risk of neurological involvement is normal in more than 95% of cases.

El Programa Gallego para la Detección Precoz de Enfermedades Endocrinas y Metabólicas se inició en 1978 y fue pionero en España en el cribado neonatal ampliado con la incorporación de la espectrometría de masas en julio de 2000. Como objetivo primario se criban veintiocho enfermedades, incluyendo las de la cartera básica del Servicio Nacional de Salud excepto la anemia de células falciformes, que está en fase de inclusión. En sus veinte años de trayectoria se analizaron 404.616 recién nacidos (RN), identificando 547 casos afectos de las enfermedades incluidas, con una incidencia global de 1:739 RN vivos y de 1:1.237 RN de las enfermedades metabólicas congénitas (EMC) cribadas (1:1.580 RN excluyendo la hiperfenilalaninemia benigna-HPA), con una participación media del 99,35%, progresivamente creciente durante el período analizado. Entre las patologías cribadas destacan por su incidencia el hipotirodismo congénito (1:2.211 RN), la cistinuria (1:4.129 RN) y la HPA (1:5.699 RN), seguida de fenilcetonuria y fibrosis quística (1:10.936 RN). Se identificaron sesenta y seis casos de falsos positivos (diecisiete de los mismos en relación con patología materna) y cinco falsos negativos, siendo el VPP (valor predictivo positivo) y el VPN (valor predictivo negativo) global del programa del 89,2% y 99,99%, respectivamente, con una sensibilidad de 99,09% y una especificidad del 99,98%. La tasa de mortalidad de los pacientes con EMC diagnosticados fue del 1,52%, presentando once casos sintomatología previa al resultado del cribado (2%). El cociente intelectual de los pacientes con EMC y riesgo de afectación neurológica es normal en más del 95% de los casos.

How self-efficacy beliefs in dealing with negative emotions are associated to negative affect and to life satisfaction across gender and age.

The present study examines the extent to which individuals' self-efficacy beliefs about their capacity to manage distinct emotions, such as anger, sadness, fear, shame and guilt, are associated with negative affect and life satisfaction in a Spanish population of diverse ages. The results attest to the validity of the Multidimensional Negative Emotions Self-Regulatory Efficacy Scale (MNESRES) and show that self-efficacy beliefs related to basic and self-conscious/moral emotions are associated differently with negative affect and life satisfaction. These findings corroborate previous findings from American and Italian populations, and they support the view that discrete emotions deserve distinct attention, either regarding their management or their association with individuals' well-being and adjustment.

Sustained-release hydrogels of ivermectin as alternative systems to improve the treatment of cutaneous leishmaniasis.

Background: Leishmaniasis is a neglected tropical disease and its cutaneous form manifests as ulcers or nodules, generally in exposed parts of the body. This work aimed to develop ivermectin (IVM) thermosensitive hydrogels as topical formulations to improve cutaneous leishmaniasis treatment. Materials & methods: Hydrogels based on poloxamers 407 and 188 with different concentrations of IVM were prepared and rheologically characterized. The IVM release profiles were obtained and mathematically analyzed using the Lumped model. Results: The formulation containing 1.5% w/w of IVM presented an adequate gelling temperature, an optimal complex viscosity and elastic modulus. Hydrogels allowed to modulate the release of IVM. Conclusion: IVM thermosensitive hydrogels can be considered a valuable alternative to improve the treatment of cutaneous leishmaniasis.