Machine learning models' assessment: trust and performance.

The common black box nature of machine learning models is an obstacle to their application in health care context. Their widespread application is limited by a significant "lack of trust." So, the main goal of this work is the development of an evaluation approach that can assess, simultaneously, trust and performance. Trust assessment is based on (i) model robustness (stability assessment), (ii) confidence (95% CI of geometric mean), and (iii) interpretability (comparison of respective features ranking with clinical evidence). Performance is assessed through geometric mean. For validation, in patients' stratification in cardiovascular risk assessment, a Portuguese dataset (N=1544) was applied. Five different models were compared: (i) GRACE score, the most common risk assessment tool in Portugal for patients with acute coronary syndrome; (ii) logistic regression; (iii) Naïve Bayes; (iv) decision trees; and (v) rule-based approach, previously developed by this team. The obtained results confirm that the simultaneous assessment of trust and performance can be successfully implemented. The rule-based approach seems to have potential for clinical application. It provides a high level of trust in the respective operation while outperformed the GRACE model's performance, enhancing the required physicians' acceptance. This may increase the possibility to effectively aid the clinical decision.

Impact of annual TB screening on stone quarry workers in high-incidence Portuguese municipalities.

The Portuguese municipalities of Penafiel and Marco de Canaveses are high TB incidence areas, where stone quarry workers represent a vulnerable population.To assess the annual rate of TB infection (ARI) in stone quarry workers and to compare it with the TB notification rate in the general community.An annual TB infection screening strategy using interferon-gamma release assay (IGRA) was implemented in 2018 for workers from high-risk stone quarries. A prospective cohort was enrolled and workers screened in periods of 2 years were included. IGRA-positive workers were referred for preventive treatment. ARI was calculated as the proportion of workers with IGRA conversion.Of the 232 IGRA-negative workers in 2018, 20 tested positive in 2019 (8.6% ARI). Of 171 IGRA-negative workers in 2019, eight tested positive in 2021 (4.7% in 2 years). Two of the 150 IGRA-negative workers in 2021 tested positive in 2022 (1.3% ARI). ARI decreased by 84.9% between 2019 and 2022. In the two municipalities, the TB notification rate declined 23.9% between 2018 and 2021.A more pronounced reduction in ARI was observed among stone quarry workers regularly screened for TB infection compared to the notification rate among the general population in high-incidence municipalities. A screening strategy for high-risk populations, together with enforced community measures, could foster risk reduction in the community..

Sorghum hybrids grown in hydroponics contrast for phosphorus use efficiency / Híbridos de sorgo crescidos em hidroponia contrastam para eficiência de uso de fósforo

Phosphorus (P) use efficiency is crucial for sorghum production. P acquisition efficiency is the most important component of P use efficiency. The early-stage evaluation of plant development is a useful tool for identifying P-efficient genotypes. This study aimed to identify sorghum hybrids that are efficient in P use efficiency and assess the genetic diversity among hybrids based on traits related to P acquisition efficiency. Thus, 38 sorghum hybrids and two inbred lines (checks) were evaluated under low and high P in a paper pouch system with nutrient solution. Biomass and root traits related to P efficiency were measured. There was no interaction between genotypes and P levels concerning all evaluated traits. The biomass and root traits, except root diameter, presented smaller means under low P than high P. Efficient and inefficient hybrids under each P level were identified. The genetic diversity assessment grouped these genotypes in different clusters. The hybrids AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540, and DKB 590 were superior under low-P and high-P. Hybrids SC121, 1236020 e 1167017 presented the lowest means than all other hybrids, under both conditions. The evaluated hybrids showed phenotypic diversity for traits related to P acquisition, such as root length and root surface area, which can be useful for establishing selection strategies for sorghum breeding programs and increasing P use efficiency.

A eficiência do uso do fósforo (P) é fundamental para a produção de sorgo. A avaliação no estágio inicial do desenvolvimento da planta é uma ferramenta útil para a identificação de genótipos eficientes de P. Este trabalho teve como objetivo identificar híbridos de sorgo que sejam eficientes ao uso de P e avaliar a diversidade genética entre os híbridos com base em características relacionadas à eficiência de aquisição de P. Assim, 38 híbridos de sorgo e duas linhagens (testemunhas) foram avaliados sob baixo e alto P em sistema de pastas de papel com solução nutritiva. Características de biomassa e de raiz relacionadas à eficiência de P foram mensuradas. Não houve interação entre genótipos e níveis de P em todas as características avaliadas. As características de biomassa e raiz, exceto o diâmetro da raiz, apresentaram médias menores sob baixo P em comparação com alto P. Híbridos eficientes e ineficientes sob cada nível de P foram identificados e agrupados quanto à diversidade genética. Os híbridos AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540 e DKB 590 foram superiores sob baixo-P e alto-P. Os híbridos SC121, 1236020 e 1167017 apresentaram as menores médias que todos os outros híbridos, em ambas condições. Os híbridos avaliados apresentaram diversidade fenotípica para características relacionadas à aquisição de P, como comprimento e área superficial da raiz, o que pode ser útil para estabelecer estratégias de seleção para programas de melhoramento de sorgo e aumentar a eficiência de uso do P.

Sorghum hybrids grown in hydroponics contrast for phosphorus use efficiency

Abstract Phosphorus (P) use efficiency is crucial for sorghum production. P acquisition efficiency is the most important component of P use efficiency. The early-stage evaluation of plant development is a useful tool for identifying P-efficient genotypes. This study aimed to identify sorghum hybrids that are efficient in P use efficiency and assess the genetic diversity among hybrids based on traits related to P acquisition efficiency. Thus, 38 sorghum hybrids and two inbred lines (checks) were evaluated under low and high P in a paper pouch system with nutrient solution. Biomass and root traits related to P efficiency were measured. There was no interaction between genotypes and P levels concerning all evaluated traits. The biomass and root traits, except root diameter, presented smaller means under low P than high P. Efficient and inefficient hybrids under each P level were identified. The genetic diversity assessment grouped these genotypes in different clusters. The hybrids AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540, and DKB 590 were superior under low-P and high-P. Hybrids SC121, 1236020 e 1167017 presented the lowest means than all other hybrids, under both conditions. The evaluated hybrids showed phenotypic diversity for traits related to P acquisition, such as root length and root surface area, which can be useful for establishing selection strategies for sorghum breeding programs and increasing P use efficiency.

Resumo A eficiência do uso do fósforo (P) é fundamental para a produção de sorgo. A avaliação no estágio inicial do desenvolvimento da planta é uma ferramenta útil para a identificação de genótipos eficientes de P. Este trabalho teve como objetivo identificar híbridos de sorgo que sejam eficientes ao uso de P e avaliar a diversidade genética entre os híbridos com base em características relacionadas à eficiência de aquisição de P. Assim, 38 híbridos de sorgo e duas linhagens (testemunhas) foram avaliados sob baixo e alto P em sistema de pastas de papel com solução nutritiva. Características de biomassa e de raiz relacionadas à eficiência de P foram mensuradas. Não houve interação entre genótipos e níveis de P em todas as características avaliadas. As características de biomassa e raiz, exceto o diâmetro da raiz, apresentaram médias menores sob baixo P em comparação com alto P. Híbridos eficientes e ineficientes sob cada nível de P foram identificados e agrupados quanto à diversidade genética. Os híbridos AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540 e DKB 590 foram superiores sob baixo-P e alto-P. Os híbridos SC121, 1236020 e 1167017 apresentaram as menores médias que todos os outros híbridos, em ambas condições. Os híbridos avaliados apresentaram diversidade fenotípica para características relacionadas à aquisição de P, como comprimento e área superficial da raiz, o que pode ser útil para estabelecer estratégias de seleção para programas de melhoramento de sorgo e aumentar a eficiência de uso do P.

Modulation of the functional interfaces between retroviral intasomes and the human nucleosome.

Infection by retroviruses as HIV-1 requires the stable integration of their genome into the host cells. This process needs the formation of integrase (IN)-viral DNA complexes, called intasomes, and their interaction with the target DNA wrapped around nucleosomes within cell chromatin. To provide new tools to analyze this association and select drugs, we applied the AlphaLISA technology to the complex formed between the prototype foamy virus (PFV) intasome and nucleosome reconstituted on 601 Widom sequence. This system allowed us to monitor the association between both partners and select small molecules that could modulate the intasome/nucleosome association. Using this approach, drugs acting either on the DNA topology within the nucleosome or on the IN/histone tail interactions have been selected. Within these compounds, doxorubicin and histone binders calixarenes were characterized using biochemical, in silico molecular simulations and cellular approaches. These drugs were shown to inhibit both PFV and HIV-1 integration in vitro. Treatment of HIV-1-infected PBMCs with the selected molecules induces a decrease in viral infectivity and blocks the integration process. Thus, in addition to providing new information about intasome-nucleosome interaction determinants, our work also paves the way for further unedited antiviral strategies that target the final step of intasome/chromatin anchoring. IMPORTANCE In this work, we report the first monitoring of retroviral intasome/nucleosome interaction by AlphaLISA. This is the first description of the AlphaLISA application for large nucleoprotein complexes (>200 kDa) proving that this technology is suitable for molecular characterization and bimolecular inhibitor screening assays using such large complexes. Using this system, we have identified new drugs disrupting or preventing the intasome/nucleosome complex and inhibiting HIV-1 integration both in vitro and in infected cells. This first monitoring of the retroviral/intasome complex should allow the development of multiple applications including the analyses of the influence of cellular partners, the study of additional retroviral intasomes, and the determination of specific interfaces. Our work also provides the technical bases for the screening of larger libraries of drugs targeting specifically these functional nucleoprotein complexes, or additional nucleosome-partner complexes, as well as for their characterization.

Two step calibration method for ozone low-cost sensor: Field experiences with the UrbanSense DCUs.

Urban air pollution is a global concern impairing citizens' health, thus monitoring is a pressing need for city managers. City-wide networks for air pollution monitoring based on low-cost sensors are promising to provide real-time data with detail and scale never before possible. However, they still present limitations preventing their ubiquitous use. Thus, this study aimed to perform a post-deployment validation and calibration based on two step methods for ozone low-cost sensor of a city-wide network for air pollution and meteorology monitoring using low-cost sensors focusing on the main challenges. Four of the 23 data collection units (DCUs) of the UrbanSense network installed in Porto city (Portugal) with low-cost sensors for particulate matter (PM), carbon monoxide (CO), ozone (O3), and meteorological variables (temperature, relative humidity, luminosity, precipitation, and wind speed and direction) were evaluated. This study identified post-deployment challenges related to their validation and calibration. The preliminary validation showed that PM, CO and precipitation sensors recorded only unreliable data, and other sensors (wind speed and direction) very few data. A multi-step calibration strategy was implemented: inter-DCU calibration (1st step, for O3, temperature and relative humidity) and calibration with a reference-grade instrument (2nd step, for O3). In the 1st step, multivariate linear regression (MLR) resulted in models with better performance than non-linear models such as artificial neural networks (errors almost zero and R2 > 0.80). In the 2nd step, the calibration models using non-linear machine learning boosting algorithms, namely Stochastic Gradient Boosting Regressor (both with the default and post-tuning hyper-parameters), performed better than artificial neural networks and linear regression approaches. The calibrated O3 data resulted in a marginal improvement from the raw data, with error values close to zero, with low predictability (R2 ∼ 0.32). The lessons learned with the present study evidenced the need to redesign the calibration strategy. Thus, a novel multi-step calibration strategy is proposed, based on two steps (pre and post-deployment calibration). When performed cyclically and continuously, this strategy reduces the need for reference instruments, while probably minimising data drifts over time. More experimental campaigns are needed to collect more data and further improve calibration models.

Home administration of biological treatment in severe asthma in real-life experience: impact on asthma control and quality of life.

Summary: Introduction. Several biological agents for the treatment of severe asthma have been approved for self-administration on an outpatient basis in the last years. However, data on the impact of home administration in outcomes such as asthma control and quality of life in real-life settings are sparse. Being this knowledge crucial for clinical practice, this study aimed to assess asthma control and quality of life in patients who transitioned from day hospital administration of biological therapy to home administration. Methods. A single-center prospective analysis of 33 patients treated with biologics for severe asthma, who switched from hospital to home treatment was performed. Asthma Control Test (ACT), Control of Allergic Rhinitis and Asthma Test (CARAT), Asthma Life Quality (ALQ) and the number of exacerbations were assessed 3 months before and 3 and 6 months after of home-use. Results. ACT and CARAT did not show statistical differences comparing to the baseline values (21.8 ± 2.7 and 23.8 ± 5.5) within 3 months (22.1 ± 2.4, p = 0.609; 23.2 ± 5.3, p = 0.572) or 6 months (23.4 ± 0.9, p = 0.553; 23.7 ± 6.2, p = 0.149) of home administration. Also, ALQ score did not show meaningful variations between baseline (9.5 ± 3.2) and after 3 months (11.2 ± 4.4, p = 0.275) and 6 months (10.3 ± 3.8, p = 0.209) of home-use. Regarding asthma exacerbations, we did not record a significant difference comparing to the baseline values of 3 months/patient exacerbations (0.2 ± 0.4) and after 3 months (0.2 ± 0.5, p = 0.786) or 6 months (0.2 ± 0.4, p = 1.000) of change in modality treatment. There was no cases of anaphylaxis or other serious adverse effects in those patients treated at home. Conclusions. Transition of day hospital administration of biologic treatment for severe asthma to home administration did not lead to any deterioration of asthma control or quality of life. Our results emphasized the efficacy and safety of home administration of biologic treatment and provide support on changing the paradigm of the administration of biological treatment in severe asthma.

Decline of tuberculosis notification rate in different populations and regions in Portugal, 2010-2017.

BACKGROUND: Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes. METHODS: We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010-2017, disaggregated by region, age group, nationality and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models. RESULTS: The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive). CONCLUSIONS: The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.

Diagnostic and therapeutic approach of central sleep apnea in heart failure - the role of adaptive servo-ventilation. A statement of the Portuguese society of pulmonology and the Portuguese sleep association.

It is known that patients with heart failure (HF) have an increased risk of developing central sleep apnoea (CSA), with Cheyne-Stokes respiration. The development of servo-ventilation aimed to treat CSA and improve the quality of life (QoL) of these patients. A large randomized clinical study, SERVE-HF, was conducted in order to test this theory in patients with HF and reduced ejection fraction (HFrEF). The results from this trial seemed to indicate that, in these patients, there was no beneficial effect of the assisted ventilation in CSA treatment. More surprisingly, an increased rate of all-cause or cardiovascular mortality was observed. This has led to dramatic changes in clinical practice, with decreased frequency of servo-ventilation prescription across Europe, including Portugal, due to changes in the guidelines. However, SERVE-HF was conducted only in severe systolic HF patients with CSA, and caution must be taken when extrapolating these results to HF patients with preserved ejection fraction or CSA patients without HF. The study also showed poor adherence, methodological and statistical gaps, including study design, patient selection, data collection and analysis, treatment adherence, and group crossovers, which have not been discussed in the trial as potential confounding factors and raise several concerns. Moreover, the adaptive servo-ventilation (ASV) device used in SERVE-HF was unable to lower the minimum support pressure below 3 mm H20, and this has been suggested as one of the probable contributing reasons to the excess mortality observed in this study. This limitation has since been solved, and this ASV device is no longer used. This paper describes the results of a Portuguese Task Force on the treatment of central sleep apnoea in patients with chronic HF.

Teleconsultation in respiratory medicine - A position paper of the Portuguese Pulmonology Society.

The COVID-19 pandemic crisis, among so many social, economic and health problems, also brought new opportunities. The potential of telemedicine to improve health outcomes had already been recognised in the last decades, but the pandemic crisis has accelerated the digital revolution. In 2020, a rapid increase in the use of remote consultations occurred due to the need to reduce attendance and overcrowding in outpatient clinics. However, the benefit of their use extends beyond the pandemic crisis, as an important tool to improve both the efficiency and capacity of future healthcare systems. This article reviews the literature regarding telemedicine and teleconsultation standards and recommendations, collects opinions of Portuguese experts in respiratory medicine and provides guidance in teleconsultation practices for Pulmonologists.

Sorghum hybrids grown in hydroponics contrast for phosphorus use efficiency.

Phosphorus (P) use efficiency is crucial for sorghum production. P acquisition efficiency is the most important component of P use efficiency. The early-stage evaluation of plant development is a useful tool for identifying P-efficient genotypes. This study aimed to identify sorghum hybrids that are efficient in P use efficiency and assess the genetic diversity among hybrids based on traits related to P acquisition efficiency. Thus, 38 sorghum hybrids and two inbred lines (checks) were evaluated under low and high P in a paper pouch system with nutrient solution. Biomass and root traits related to P efficiency were measured. There was no interaction between genotypes and P levels concerning all evaluated traits. The biomass and root traits, except root diameter, presented smaller means under low P than high P. Efficient and inefficient hybrids under each P level were identified. The genetic diversity assessment grouped these genotypes in different clusters. The hybrids AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540, and DKB 590 were superior under low-P and high-P. Hybrids SC121, 1236020 e 1167017 presented the lowest means than all other hybrids, under both conditions. The evaluated hybrids showed phenotypic diversity for traits related to P acquisition, such as root length and root surface area, which can be useful for establishing selection strategies for sorghum breeding programs and increasing P use efficiency.

COPD phenotypes by computed tomography and ventilatory response to exercise.

INTRODUCTION: Computed tomographic (CT) phenotypic patterns of chronic obstructive pulmonary disease (COPD) identify different clinical features of disease. The impact of these variables on the physiological response to exercise has been the focus of a great deal of research as it allows more individualized clinical approaches. The aim of our study was to evaluate the relationships between CT phenotyping of subjects with COPD and the ventilatory response during cardiopulmonary exercise testing (CPET). METHODS: Subjects with COPD were classified into four phenotypes based on CT metrics of emphysema (low attenuation area less than a threshold of -950 Hounsfield [%LAA-950]) and airwall thickness (bronchial wall area percentage [%WA]). RESULTS: Eighty COPD patients (78.8% males, median age 65±11.3 years) were enrolled in the study. Based on CT phenotype, 25 (31.3%) patients were classified as normal, 27 (33.8%) air dominant, 17 (21.3%) emphysema dominant and 11 (13.8%) mixed type. The emphysema and mixed phenotypes showed the highest ventilatory equivalent for carbon dioxide (VE/VCO2) and VE/VCO2 slope (p<0,05). In all phenotypes, %LAA was positive correlated with VE/VCO2 and VE/VCO2 slope (r = 0.437, p = 0.006 and r = 0.503, p<0.001, respectively). %WA also showed a positive correlation with VE/VCO2 and VE/VCO2 slope (r = 0.541, p<0.001 and r = 0.299, p = 0.033, respectively). In multivariate regression models, after adjustment for age, BMI, sex and FEV1, %LAA was the only independent predictor of VE/VCO2 and VE/VCO2 slope (ß 0.343, SE 0.147, 95% CI 0.009/0.610, p = 0.044 and ß 0.496, SE 0.081, 95% CI 0.130/0.455, p = 0.001, respectively). CONCLUSION: Emphysema (%LAA) and airways metrics (%WA) had strong relationships with the different characteristics of ventilatory response to exercise in subjects with mild to moderate COPD. In particular, %LAA seemed to play an important role as an independent predictor of VE/VCO2 and VE/VCO2 slope. These results suggested that CT phenotyping may help predicting ventilatory response to exercise in subjects with COPD.

Effect of dietary buriti oil on the quality, fatty acid profile and sensorial attributes of lamb meat.

Forty crossbred (Santa Ines × Dorper) male lambs were used to investigate the effect of dietary buriti oil (BOIL) intake on meat quality, fatty acid (FA) composition and sensory attributes. A completely randomized design with five BOIL intake levels (0, 12, 24, 36 and 48 g/kg DM) was used. Increasing dietary BOIL intake linearly reduced the DMI, slaughter weight, cooking loss, shear force, yellowness, 16:0, c9-18:1 FA concentrations, and the delta-9-desaturase activity index computed using c9-16:1 and 16:0 as product and substrate pair, cis-MUFA and Æ©MUFA/Æ©SFA ratio of lamb meat (P ≤ 0.05); however, increasing dietary BOIL intake quadratically increased the energy intake, lipid content and linearly increased the total FA intake, chroma, collagen, total BI, 18:0, 20:3n-6 concentration and sensory attributes of lamb meat (P ≤ 0.05), without affecting health indexes regarding fat consumption. BOIL addition at levels above 24 g/kg DM in lamb diet reduces growth, however, improves tenderness, flavor and "goat" aroma intensity and slightly changes meat FA levels, promoting better acceptance by panelists.

Assessing the effects of PMM2 variants on protein stability.

Phosphomannomutase 2 deficiency, PMM2-CDG, is the most frequent disorder of protein N-glycosylation. It is an autosomal recessive disease with a broad clinical and biochemical phenotype. Trying to predict the impact of novel variants is often a challenge due to the high number of variants and the difficulty to establish solid genotype-phenotype correlations. A potential useful strategy is to use computational chemistry calculations as a tool from which relevant information on the structural impact of novel variants may be deduced. Here we present our analyses based on four well-known PMM2 deleterious variants (p.(Leu32Arg), p.(Asp65Tyr), p.(Phe119Leu), p.(Arg141His)) and the polymorphic p.(Glu197Ala) for which we have predicted the effect on protein stability. Our work predicts the effect of different amino acid residues on the conformation and stability of PMM2. These computational simulations are, therefore, an extremely useful methodology which, in combination with routinely used in silico methods of pathogenicity prediction, may help to reveal the structural impact of novel variants at the protein level, potentially leading to a better understanding of target biological molecules.

[Effects of inspiratory muscle training on respiratory function and balance in stroke survivors: a randomized controlled trial]. / Efectos del entrenamiento muscular inspiratorio sobre la función respiratoria y el equilibrio en supervivientes de ictus: un ensayo clínico controlado aleatorizado.

INTRODUCTION: After a stroke, patients with hemiparesis and / or hemiplegia will present a notable asymmetry of the trunk and pelvis, and decreased postural stability and balance, affecting, consequently, respiratory function. OBJECTIVE: The objective of this study is to analyze the effects of inspiratory muscle training (IMT) on lung function, inspiratory muscle strength, postural and trunk control and balance in stroke survivors in the subacute phase. MATERIALS AND METHODS: 16 survivors of stroke in the subacute phase participated in RCT (experimental = 8; placebo = 8). The experimental group received IMT program, 5 days a week, once a day, for 8 weeks, with a progressive intensity from 15% to 60% of the PImax. The placebo group performed the same program, but with a fixed load of 7cmH20. Inspiratory muscle strength (PImax), lung function (FVC, FEV1, PEF, VMV), trunk control (TCT), and postural control and balance (PASS and Berg Scale) were evaluated. RESULTS: Experimental and placebo groups showed significant increases in PImax, with a difference between groups. There was a moderate and negative correlation between the initial PImax value and the percentage change (?PImax) (r = -0.572; p = 0.021). Significant increases in VMV (l/m) were observed in the experimental group, and increases in PASS in both groups, but without significant differences between groups. CONCLUSIONS: Inspiratory muscle training, although low intensity, is effective in improving inspiratory muscle strength in stroke survivors. However, the effects on postural control and balance remain uncertain.

TITLE: Efectos del entrenamiento muscular inspiratorio sobre la función respiratoria y el equilibrio en supervivientes de ictus: un ensayo clínico controlado aleatorizado.Introducción. Tras un ictus, los pacientes con hemiparesia y/o hemiplejía van a presentar una asimetría notable del tronco y la pelvis, y una disminución de la estabilidad postural y el equilibrio, lo que afecta, como consecuencia, a la función respiratoria. Objetivo. Analizar los efectos del entrenamiento muscular inspiratorio (EMI) sobre la función pulmonar, la fuerza muscular inspiratoria, el control postural y del tronco y el equilibrio en supervivientes de ictus. Materiales y métodos. Dieciséis pacientes supervivientes de ictus en fase subaguda participaron en un ensayo clínico controlado aleatorizado (experimental = 8; placebo = 8). El grupo experimental recibió un programa de EMI, cinco días a la semana, una vez al día, durante ocho semanas, con una intensidad progresiva del 15 al 60% de la PImáx. El grupo placebo realizó el mismo programa, pero con una carga fija de 7 cmH2O. Se evaluaron la fuerza muscular inspiratoria ­presión inspiratoria máxima (PImáx)­, la función pulmonar (capacidad vital forzada, volumen espirado en el primer segundo, flujo espiratorio máximo y ventilación voluntaria máxima), el control del tronco (test de control del tronco), y el control postural y el equilibrio ­Postural Scale for Stroke Patients (PASS) y escala de Berg­. Resultados. Los grupos experimental y placebo presentaron incrementos significativos en la PImáx, con diferencia entre grupos. Existió una correlación negativa y moderada entre el valor de la PImáx inicial y el porcentaje de cambio (?PImáx) (r = ­0,572; p = 0,021). Se observaron incrementos significativos en la ventilación voluntaria máxima (L/m) en el grupo experimental, e incrementos en la PASS en ambos grupos, pero sin diferencias significativas entre grupos. Conclusiones. El entrenamiento muscular inspiratorio, aunque de baja intensidad, es efectivo para mejorar la fuerza muscular inspiratoria en pacientes supervivientes de ictus. Sin embargo, los efectos sobre el control postural y el equilibrio permanecen inciertos.

Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation.

OBJECTIVE: Substance use disorders (SUD) are frequently comorbid with other psychiatric conditions, but a comprehensive diagnostic assessment is often not feasible clinically. Efficient psychometrically-validated screening tools exist for commonly comorbid conditions, but cutoff accuracies have typically not been evaluated in addiction treatment settings. This study examined the performance of several widely-used screening measures in relation to diagnostic status from a clinical interview to identify and validate cutoff scores in an inpatient SUD treatment setting. METHOD: Participants were 99 patients in a large residential SUD treatment program in Ontario, Canada. Participants completed a screening battery, including the Patient Health Questionnaire - 9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), and Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and underwent a semi-structured diagnostic clinical interview. Receiver operating characteristic curves were used to determine optimal cutoff scores on the screening tool against the interview-based diagnosis. RESULTS: Area under the curve (AUC) was statistically significant for all screens and were as follows: PHQ-9 = 0.70 (95% CI = 0.59-0.80), GAD-7 = 0.74 (95% CI = 0.63-0.84), and PCL-5 = 0.79 (95% CI = 0.66-0.91). The optimal accuracy cutoff scores based on sensitivity and specificity were: PHQ-9 ≥ 16, GAD-7 ≥ 9, the PCL-5 ≥ 42. CONCLUSIONS: In general, the candidate screeners performed acceptably in this population. However, the optimal cutoff scores were notably higher than existing guidelines for depression and PTSD, potentially due to the general elevations in negative affectivity among individuals initiating SUD treatment. Further validation of these cutoff values is warranted. PUBLIC HEALTH SIGNIFICANCE: This study provides modified screening cutoff scores for major depression, anxiety disorders, and post-traumatic stress disorder in addiction treatment settings.

The incidence of severe oral mucositis and its occurrence sites in pediatric oncologic patients.

BACKGROUND: Childhood cancer is one of the main causes of child mortality and its treatment has debilitating effects on the oral cavity. Several oral mucositis (SOM) is one of the most common and may cause undesirable symptoms such as pain and risk of systemic infection. MATERIAL AND METHODS: This was a longitudinal, retrospective, and observational study determining the incidence of severe oral mucositis (SOM) and its occurrence sites in pediatric oncologic patients, in João Pessoa, Brazil, between 2013 and 2018. Data from 56 patients aged 1 to 18 years were collected from their medical records and through an oral mucosa examination, from the 1st to 5th week of chemotherapy treatment (CT) using the modified Oral Assessment Guide, by previously calibrated examiners (Kappa index > 0.7). The data were analyzed by the Chi-square test, and Odds Ratios were calculated. RESULTS: Most patients were females (54.5%), aged 8.8 years (± 4.8), with hematologic tumors (73.2%), predominantly Acute Lymphoid Leukemia (50.0%). An increase in the occurrence of SOM was observed throughout the CT (P = 0.05), ranging from 12.5% in the 1st to 35.7% in the 5th CT week. In the 1st CT week, there was a predominance of alterations in the lips (5.5%) and saliva (5.5%), while in the 5th, the jugal / palate mucosa (21.4%) remained the most affected site by SOM. Differences in the severity of SOM in the jugal / palate mucosa (P = 0.01) and labial mucosa (P = 0.04) were observed over time. In the 5th CT week, the likelihood of developing SOM was 13.3-fold higher (95% CI: 1.5 - 105.6) in patients with hematologic tumors. CONCLUSIONS: The incidence of SOM was higher in the 5th CT week, most commonly affecting the jugal / palate mucosa, and patients with hematologic tumors were more prone to develop SOM.

Trend of hospitalized cases of oral cancer in Brazil and its relationship with oral health coverage in public health system between 2009 and 2017.

BACKGROUND: This study aimed to analyze the trend in the number of hospitalized cases of oral cancer in Brazil, according to the coverage of oral health services in public health system, and also investigate the influence of healthcare and clinical characteristics on the severity of oral cancer cases. MATERIAL AND METHODS: This retrospective study considered the period between 2009 and 2017. Data from the Hospital Registry of Cancer from the National Cancer Institute were used, considering the primary locations C00 to C06. Detailed information including sex, age, alcohol and tobacco use, year of first consultation, and the clinical stage of the cases were also collected. The frequency of hospitalized cases was correlated with the coverage of Primary Care Oral Health Teams (ESB) and the number of Dental Specialty Centers (CEO). It was also estimated the chance of advanced oral cancer cases, according to healthcare and clinical characteristics. Data were analyzed using Tweedie's multiple regression and multiple binary logistic regression (α<0.05). RESULTS: There was an increasing trend in the number of hospitalized cases of oral cancer in Brazil between 2009 and 2017 (B=0.043, p<0.001, PR=1.044). The increase in ESB coverage was associated with small increase in the number of hospitalized cases of oral cancer (B=0.001, p=0.003, PR=1.001). The increase in the number of CEO was associated with decrease in the number of hospitalized cases of oral cancer (B=-0.085, p<0.001, PR =0.918). The increase of ESB (OR=0.998) and CEO (OR=0.974) contributed for reducing the number of stage IV cases, whilst the history of alcohol and tobacco use (OR=1.574) was associated with an increase in the number of stage IV cases. CONCLUSIONS: Although an increasing trend was detected, the expansion of the public health system reduced the number of hospitalized cases and the frequency of advanced oral cancer cases in Brazil.