Nutritional status of schoolchildren before and after confinement by COVID-19 (2019-2021) in Jujuy, Argentina.

An increase in the prevalence of obesity due to lockdown and confinement linked to COVID-19 is observed. Variations in the nutritional status of schoolchildren from Jujuy are analyzed in relation to confinement due to COVID-19 (2019-2021) and its relationship with socio-demographic variables and the school environment. This is an observational, descriptive study. Data from 56,695 schoolchildren aged 6-18 years old is analyzed based on two temporary cuts (2019 pre-confinement and 2021 post-confinement). The nutritional status of schoolchildren (underweight, overweight, and obese) was established using the IOTF (International Obesity Task Force) criterion. The prevalence of each nutritional phenotype was estimated by sex and age group, considering the following independent variables: setting (rural/urban), school management system (public/private), geographic altitude, and percentage of households with unmet basic needs (UBN) in the place where they attend school. Multiple proportions contrast was performed using Fisher's test, a transition matrix ws produced and a statistical model of proportional odds was fitted. It was observed that between 2019 and 2021, the prevalence of underweight decreased and the prevalence of overweight and obesity increased significantly. In 2021, 67% of schoolchildren maintained the same nutritional category that they had in 2019, 21% gained weight and 12% lost weight. The model explains about 52% of the total variability observed. The factors that are significantly correlated in the model are school cycle, age, geographic altitude, school setting, and % of households with UBN. The results indicate that during the COVID-19 pandemic, there was a shift to the right in the distribution of the nutritional status categories of the schoolchildren population in Jujuy, with a decrease in the prevalence of underweight and an increase in the prevalence of overweight and obesity with variations related to age, school location, geographic altitude, and socioeconomic characteristics of the households in the place where the children attended school.

Algorithm for predicting valvular heart disease from heart sounds in an unselected cohort.

Objective: This study aims to assess the ability of state-of-the-art machine learning algorithms to detect valvular heart disease (VHD) from digital heart sound recordings in a general population that includes asymptomatic cases and intermediate stages of disease progression. Methods: We trained a recurrent neural network to predict murmurs from heart sound audio using annotated recordings collected with digital stethoscopes from four auscultation positions in 2,124 participants from the Tromsø7 study. The predicted murmurs were used to predict VHD as determined by echocardiography. Results: The presence of aortic stenosis (AS) was detected with a sensitivity of 90.9%, a specificity of 94.5%, and an area under the curve (AUC) of 0.979 (CI: 0.963-0.995). At least moderate AS was detected with an AUC of 0.993 (CI: 0.989-0.997). Moderate or greater aortic and mitral regurgitation (AR and MR) were predicted with AUC values of 0.634 (CI: 0.565-703) and 0.549 (CI: 0.506-0.593), respectively, which increased to 0.766 and 0.677 when clinical variables were added as predictors. The AUC for predicting symptomatic cases was higher for AR and MR, 0.756 and 0.711, respectively. Screening jointly for symptomatic regurgitation or presence of stenosis resulted in an AUC of 0.86, with 97.7% of AS cases (n = 44) and all 12 MS cases detected. Conclusions: The algorithm demonstrated excellent performance in detecting AS in a general cohort, surpassing observations from similar studies on selected cohorts. The detection of AR and MR based on HS audio was poor, but accuracy was considerably higher for symptomatic cases, and the inclusion of clinical variables improved the performance of the model significantly.

Endophytic Fungal Terpenoids: Natural Role and Bioactivities.

Endophytic fungi are a highly diverse group of fungi that intermittently colonize all plants without causing symptoms of the disease. They sense and respond to physiological and environmental changes of their host plant and microbiome. The inter-organism interactions are largely driven by chemical networks mediated by specialized metabolites. The balance of these complex interactions leads to healthy and strong host plants. Endophytic strains have particular machinery to produce a plethora of secondary metabolites with a variety of bioactivities and unknown functions in an ecological niche. Terpenoids play a key role in endophytism and represent an important source of bioactive molecules for human health and agriculture. In this review, we describe the role of endophytic fungi in plant health, fungal terpenoids in multiple interactions, and bioactive fungal terpenoids recently reported from endophytes, mainly from plants used in traditional medicine, as well as from algae and mangroves. Additionally, we highlight endophytic fungi as producers of important chemotherapeutic terpenoids, initially discovered in plants. Despite advances in understanding endophytism, we still have much to learn in this field. The study of the role, the evolution of interactions of endophytic fungi and their terpenoids provide an opportunity for better applications in human health and agriculture.

An efficient synthesis of cis-4-hydroxyphosphonic and cis-4-hydroxyphosphinic analogs of pipecolic acid from cyclic enaminones.

An expedient synthetic entry to cis-4-hydroxyphosphonic and cis-4-hydroxyphosphinic analogs of cis-4-hydroxypipecolic acid is presented in this paper. The main feature of this methodology is the highly regioselective addition of silyl phosphites or phosphonites to cyclic 1-benzyloxycarbonyl enaminones. Interestingly, the hydride reduction of the resulting 2-phospho-4-oxopiperidine proceeds with high diastereofacial preference using NaBH4. In the last step, the cleavage of N-Cbz group under hydrogenolysis followed by the hydrolysis of the phosphonate or phosphinate functionalities, led to the target cis-4-hydroxyphosphonic and cis-4-hydroxyphosphinic acids, respectively.

Interrater and intrarater agreement on heart murmurs.

OBJECTIVE: To investigate interrater and intrarater agreement between physicians and medical students on heart sound classification from audio recordings, and factors predicting agreement with a reference classification. DESIGN: Intra- and interrater agreement study. SUBJECTS: Seventeen GPs and eight cardiologists from Norway and the Netherlands, eight medical students from Norway. MAIN OUTCOME MEASURES: Proportion of agreement and kappa coefficients for intrarater agreement and agreement with a reference classification. RESULTS: The proportion of intrarater agreement on the presence of any murmur was 83% on average, with a median kappa of 0.64 (range k = 0.09-0.86) for all raters, and 0.65, 0.69, and 0.61 for GPs, cardiologist, and medical students, respectively.The proportion of agreement with the reference on any murmur was 81% on average, with a median kappa of 0.67 (range 0.29-0.90) for all raters, and 0.65, 0.69, and 0.51 for GPs, cardiologists, and medical students, respectively.Distinct murmur, more than five years of clinical practice, and cardiology specialty were most strongly associated with the agreement, with ORs of 2.41 (95% CI 1.63-3.58), 2.19 (1.58-3.04), and 2.53 (1.46-4.41), respectively. CONCLUSION: We observed fair but variable agreement with a reference on heart murmurs, and physician experience and specialty, as well as murmur intensity, were the factors most strongly associated with agreement.Key points:Heart auscultation is the main physical examination of the heart, but we lack knowledge of inter- and intrarater agreement on heart sounds.• Physicians identified heart murmurs from heart sound recordings fairly reliably compared with a reference classification, and with fair intrarater agreement.• Both intrarater agreement and agreement with the reference showed considerable variation between doctors• Murmur intensity, more than five years in clinical practice, and cardiology specialty were most strongly linked to agreement with the reference.

The process for recognizing of foreign medical degrees in Costa Rica: a statistical survey for the past 15 years.

This article presents the most important developments in the recognition process of foreign medical degrees in Costa Rica over the past fifteen years. Most applicants received their medical degrees in Cuba, Venezuela, Nicaragua and Mexico. By far the most numerous group completed their studies in Cuba, followed by graduates from Venezuelan and Nicaraguan universities, the number of which has increased in the last five years. The pass rate of the written examination used in the recognition process is 23.9% with relatively large fluctuations between graduates of the individual countries, especially between the countries with the lowest numbers of graduates. The main goal of the recognition process is to ensure that graduates from different study conditions and curricula as well as from diverging areas of specialization of the faculties abroad have competencies and knowledge comparable to those of medical graduates in Costa Rica. The focus is on the safety of the patient, as is the case with state exams in many countries.

Inspiratory crackles-early and late-revisited: identifying COPD by crackle characteristics.

BACKGROUND: The significance of pulmonary crackles, by their timing during inspiration, was described by Nath and Capel in 1974, with early crackles associated with bronchial obstruction and late crackles with restrictive defects. Crackles are also described as 'fine' or 'coarse'. We aimed to evaluate the usefulness of crackle characteristics in the diagnosis of chronic obstructive pulmonary disease (COPD). METHODS: In a population-based study, lung sounds were recorded at six auscultation sites and classified in participants aged 40 years or older. Inspiratory crackles were classified as 'early' or 'late and into the types' 'coarse' and 'fine' by two observers. A diagnosis of COPD was based on respiratory symptoms and forced expiratory volume in 1 s/forced inspiratory vital capacity below lower limit of normal, based on Global Lung Function Initiative 2012 reference. Associations between crackle characteristics and COPD were analysed by logistic regression. Kappa statistics was applied for evaluating interobserver agreement. RESULTS: Of 3684 subjects included in the analysis, 52.9% were female, 50.1% were ≥65 years and 204 (5.5%) had COPD. Basal inspiratory crackles were heard in 306 participants by observer 1 and in 323 by observer 2. When heard bilaterally COPD could be predicted with ORs of 2.59 (95% CI 1.36 to 4.91) and 3.20 (95% CI 1.71 to 5.98), annotated by observer 1 and 2, respectively, adjusted for sex and age. If bilateral crackles were coarse the corresponding ORs were 2.65 (95% CI 1.28 to 5.49) and 3.67 (95% CI 1.58 to 8.52) and when heard early during inspiration the ORs were 6.88 (95% CI 2.59 to 18.29) and 7.63 (95%CI 3.73 to 15.62). The positive predictive value for COPD was 23% when early crackles were heard over one or both lungs. We observed higher kappa values when classifying timing than type. CONCLUSIONS: 'Early' inspiratory crackles predicted COPD more strongly than 'coarse' inspiratory crackles. Identification of early crackles at the lung bases should imply a strong attention to the possibility of COPD.

Intoxicaciones agudas con pesticidas para fines suicidas en Costa Rica durante la década de 2010-2020 / SuicideSuicide attempts due to pesticide poisoning in Costa Rica during the 2010-2020 decade

Resumen Introducción: La intoxicación con plaguicidas es de los métodos más utilizados por los suicidas, especialmente en países agrícolas de ingreso medio-bajo. El objetivo de la investigación fue describir y analizar la situación epidemiológica de la intoxicación aguda por plaguicidas con fines suicidas en Costa Rica durante los años 2010-2020. Materiales y métodos: Se recopilaron datos del Centro Nacional para el Control de Intoxicaciones (CNCI) de las intoxicaciones agudas con plaguicidas para fines suicidas durante el 2010-octubre 2020 y datos del Instituto Nacional de Estadística y Censos (INEC) de las defunciones por suicidios con plaguicidas durante los años 2010-2019. Los datos se analizaron por sexo, edad, provincia, agente tóxico, ruta de absorción, severidad del cuadro clínico y mortalidad. Resultados: De las 3240 intoxicaciones agudas totales con plaguicidas para fines suicidas durante los años 2010-octubre 2020, el 64.7% eran hombres y 35.3% mujeres; 31.9% de las intoxicaciones ocurrieron en personas en edades entre los 20-29 años y 21% entre 30-39 años; 23.4% de los incidentes ocurrieron en la provincia de Alajuela y 19.7% en San José; el 75% de los plaguicidas utilizados eran de uso agrícola; en el 17.2% de las intoxicaciones utilizaron Glifosato y 15.9% Paraquat; en 98.3% de los casos la ruta de absorción fue por ingestión; 65.3% de los casos fueron reportados con sintomatología leve según el CNCI. Durante el 2010-2019, 432 personas murieron por suicidio utilizando plaguicidas, lo que significa una mortalidad anual promedio de 13.3% de las intoxicaciones agudas con plaguicidas para fines suicidas Conclusiones: La epidemiología de los intentos suicidas utilizando pesticidas en CR es muy similar a los patrones internacionales predominando hombres jóvenes en zonas agrícolas y que tienen acceso a los pesticidas. Es necesario fortalecer medidas e implementar políticas para la regulación, almacenaje y manejo adecuado de los plaguicidas.

Abstract Introduction: Pesticides self-poisoning is one of the most popular suicide methods especially in lower middle class income agricultural countries. The objective of this research is to describe and analyze the epidemiological situation of suicide attempts due to pesticide poisoning in Costa Rica during the last decade. Materials and methods: Data of pesticides self-poisoning goes all the way from 2010 until October 2020. That information was collected from the National Center for Poisoning Control (CNCI, stands for the initials in spanish) database and National Institute for Statistics and Census (INEC in spanish) data of pesticides self-poisoning deaths from 2010-2019. All data was analyzed by sex, age, province, toxic agent, route of absorption, clinical severity and mortality. Results: There were 3240 total cases of suicide attempts due to pesticides during 2010-october 2020; 64.7% of this poisoning were in men and 35.3% in women, 31.9% of the poisoning persons were in age with a range between 20-29 years and 21% between 30-39 years old; 23.4% of cases were reported in Alajuela and 19.7% in San José; 75% of the cases used agricultural pesticide; 17.2% of the poisonings occurred due to Glifosato and 15.9% due to Paraquat; ingestion was the route of absorption in 98.3% of the cases; and 65.3% reported mild clinical severity. During 2010-2019, 432 people died due to suicide using pesticides as a weapon, which means an average mortality of 13.3% of all the suicide attempts with pesticides in this period. Conclusions: Costa Rica´s epidemiology of suicide attempts using pesticides is very similar to international epidemiology, where most of the cases are young men that have access to pesticides and lived-in agricultural areas. It´s necessary to implement policies for the regulations, storage and proper management of pesticides in order to prevent suicide.

Time Series Complexities and Their Relationship to Forecasting Performance.

Entropy is a key concept in the characterization of uncertainty for any given signal, and its extensions such as Spectral Entropy and Permutation Entropy. They have been used to measure the complexity of time series. However, these measures are subject to the discretization employed to study the states of the system, and identifying the relationship between complexity measures and the expected performance of the four selected forecasting methods that participate in the M4 Competition. This relationship allows the decision, in advance, of which algorithm is adequate. Therefore, in this paper, we found the relationships between entropy-based complexity framework and the forecasting error of four selected methods (Smyl, Theta, ARIMA, and ETS). Moreover, we present a framework extension based on the Emergence, Self-Organization, and Complexity paradigm. The experimentation with both synthetic and M4 Competition time series show that the feature space induced by complexities, visually constrains the forecasting method performance to specific regions; where the logarithm of its metric error is poorer, the Complexity based on the emergence and self-organization is maximal.

Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study.

AIMS: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are main causes of dyspnoea, and echocardiography and spirometry are essential investigations for these diagnoses. Our aim was to determine the prevalence of HF and COPD in a general population, also how the diseases may be identified, and to what extent their clinical characteristics differ. METHODS AND RESULTS: In the seventh survey of Tromsø study (2015-16), subjects aged 40 years or more were examined with echocardiography, spirometry, lung sound recordings, questionnaires, including the modified Medical Research Council (mMRC) questionnaire on dyspnoea, and N-terminal pro-brain natriuretic peptide analysis. A diagnosis of HF (HF with reduced ejection fraction, HF with mid-range ejection fraction, or HF with preserved ejection fraction) or COPD was established according to current guidelines. Predictors of HF and COPD were evaluated by logistic regression and receiver operating characteristic curve analysis. A total of 7110 participants could be evaluated for COPD, 1624 for HF, and 1538 for both diseases. Age-standardized prevalence of HF was 6.8% for women and 6.1% for men; the respective figures for COPD were 5.2% and 5.1%. Among the 1538 evaluated for both diseases, 139 subjects fulfilled the HF criteria, but only 17.1% reported to have the disease. Of those fulfilling the COPD criteria, 31.6% reported to have the disease. Shortness of breath at exertion was a frequent finding in HF; 59% of those with mMRC ≥2 had HF, while such shortness of breath was found in 24% among those with COPD. Reporting mMRC ≥2 had an odds ratio for HF of 19.5 (95% confidence interval 11.3-33.7), whereas the odds ratio for COPD was 6.3 (95% confidence interval 3.5-11.6). Current smoking was the strongest predictor of COPD but did not predict HF. Basal inspiratory crackles were significant predictors of HF in multivariable analysis. Among the subtypes of HF, an age <70 years was most frequently found in HF with reduced ejection fraction, in 51.7%. Clinical scores based on the predictive value in multivariable analysis of history, symptoms, and signs predicted HF and COPD with areas under the curve of 0.833 and 0.829, respectively. CONCLUSIONS: Study participants with HF and COPD were in most cases not aware of their condition. In general practice, when an elderly patient present with shortness of breath, both diseases should be considered. Previous cardiovascular disease points at HF, while a history of smoking points at COPD. The threshold should be low for ordering echocardiography or spirometry for verifying the suspected cause of dyspnoea.

Results of an anaemia treatment protocol complementary to blood transfusion in elderly patients with hip fracture.

BACKGROUND: Anaemia is a very common condition in elderly patients with hip fracture. The side effects of blood transfusions are well known, and further research on potential alternative therapies is needed. OBJECTIVES AND DESIGN: A non-controlled descriptive study, conducted on 138 patients admitted for hip fracture, aimed at analysing the effects of an anaemia treatment protocol adjunctive to transfusion, based on the use of supra-physiological doses of intravenous iron and erythropoietin (IS/EPOS). The variables collected were, medical history, physical and cognitive status prior to fracture, as well as the need of blood products, medical complications during admission and their functional outcome at three and six months after the fracture were evaluated. Transfusion rates were compared with a historical control group when the only treatment for acute anaemia was transfusion (2011). RESULTS: Almost half (63, 48%) of the patients received blood transfusion, with (91,70%) IS/EPOD. Intravenous iron did not reduce the percentage of transfused patients (56% vs. 44%), but it did reduce the number of blood units required (0.7 units less in IS/EPO group). Patients who required transfusion had a longer hospital stay, (1.7 days; 13.2 vs. 11.5; p<0.005). Patients who received IS had better functional recovery assessed with Barthel index and the Functional Ambulation Categories (FAC scale) at 3 and 6 months after the fracture. Patients with malnutrition or subtrochanteric fracture needed more tabletransfusions (p<0.005). Functional recovery at 3 and 6 months after fracture was better in patients who received intravenous iron. Neither blood transfusions nor intravenous iron were associated with infectious complications or increased mortality. The patient series of this study was compared with a group of patients with hip fracture and similar characteristics seen in 2011, before intravenous iron was available, revealing a 17% reduction in blood transfusion needs (p<0.005). CONCLUSION: The use of intravenous iron in elderly patients with hip fracture may help to reduce the number of blood units needed for the treatment of anaemia, although a causal relationship cannot be established due to not having a control group. Transfusions were associated with longer hospital stay in elderly patients with hip fracture.

Melting Temperature Estimation of Imidazole Ionic Liquids with Clustering Methods.

Ionic liquids (ILs) are ionic compounds with low melting points that can be designed to be used in an extensive set of commercial and industrial applications. However, the design of ILs is limited by the quantity and quality of the available data in the literature; therefore, the estimation of physicochemical properties of ILs by computational methods is a promising way of solving this problem, since it provides approximations of the real values, resulting in savings in both time and money. We studied two data sets of 281 and 134 liquids based on the molecule imidazole that were analyzed with QSPR techniques. This paper presents a software architecture that uses clustering techniques to improve the robustness of estimation models of the melting point of ILs. These results indicate an error of 6.25% in the previously unmodeled data set and an error of 4.43% in the second data set. We have an improvement with the second data set of 1.81% over the last results previously found.

Convolutional Neural Network for Breathing Phase Detection in Lung Sounds.

We applied deep learning to create an algorithm for breathing phase detection in lung sound recordings, and we compared the breathing phases detected by the algorithm and manually annotated by two experienced lung sound researchers. Our algorithm uses a convolutional neural network with spectrograms as the features, removing the need to specify features explicitly. We trained and evaluated the algorithm using three subsets that are larger than previously seen in the literature. We evaluated the performance of the method using two methods. First, discrete count of agreed breathing phases (using 50% overlap between a pair of boxes), shows a mean agreement with lung sound experts of 97% for inspiration and 87% for expiration. Second, the fraction of time of agreement (in seconds) gives higher pseudo-kappa values for inspiration (0.73-0.88) than expiration (0.63-0.84), showing an average sensitivity of 97% and an average specificity of 84%. With both evaluation methods, the agreement between the annotators and the algorithm shows human level performance for the algorithm. The developed algorithm is valid for detecting breathing phases in lung sound recordings.

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study.

We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. PURPOSE: To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. METHODS: Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. RESULTS: A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. CONCLUSIONS: Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis.

Adventitious and Normal Lung Sounds in the General Population: Comparison of Standardized and Spontaneous Breathing.

BACKGROUND: For clinical practice and research, it would be easier to auscultate lung sounds without simultaneously measuring air flow. This study evaluated whether the presence of adventitious lung sounds and the characteristics of normal lung sounds differ between spontaneous and standardized breathing in a general population. METHODS: A cross-sectional study was conducted with 116 subjects (53.4% female, mean age 59.2 ± 11.6 y). The subjects reported heart/lung diseases and the degree of dyspnea, and spirometry was carried out. Lung sounds were recorded at 6 chest locations, first during spontaneous breathing and then during breathing with a standardized air flow of 1.5 L/s. Crackles and wheezes were identified by 4 observers. Intensity and frequency of normal lung sounds in the 100-2,000 Hz band were determined. RESULTS: Inspiratory crackles were heard in 19 subjects (16.4%) during spontaneous breathing and in 18 subjects during standardized breathing (15.5%). Only 5 subjects were identified with both methods (kappa = 0.13). Expiratory wheezes were heard in 18 subjects (15.5%) during spontaneous breathing and in 23 subjects during standardized breathing (19.8%). Nine subjects were identified with both methods (kappa = 0.32). The mean intensity and median frequency of normal lung sounds were significantly higher during standardized breathing than during spontaneous breathing, both at inspiration (23.1 dB vs 20.1 dB and 391.6 Hz vs 367.3 Hz) and expiration (20 dB vs17.6 dB and 376.3 Hz vs 355 Hz). Dyspnea was more frequently reported when expiratory wheezes were present, but this association was only statistically significant during standardized breathing (P = .03). During spontaneous breathing, increased mean intensity and median frequency during expiration were associated with an increased reporting of heart/lung diseases (P = .02 and P = .01, respectively). CONCLUSIONS: The mode of breathing had an impact on both adventitious and normal lung sounds. Although adventitious sounds were found with similar frequency between the modes of breathing, less than half of these subjects were identified with both methods. Spontaneous breathing was not inferior to standardized breathing in reflecting lung disease.

Combining multivariate statistics and the think-aloud protocol to assess Human-Computer Interaction barriers in symptom checkers.

Symptom checkers are software tools that allow users to submit a set of symptoms and receive advice related to them in the form of a diagnosis list, health information or triage. The heterogeneity of their potential users and the number of different components in their user interfaces can make testing with end-users unaffordable. We designed and executed a two-phase method to test the respiratory diseases module of the symptom checker Erdusyk. Phase I consisted of an online test with a large sample of users (n=53). In Phase I, users evaluated the system remotely and completed a questionnaire based on the Technology Acceptance Model. Principal Component Analysis was used to correlate each section of the interface with the questionnaire responses, thus identifying which areas of the user interface presented significant contributions to the technology acceptance. In the second phase, the think-aloud procedure was executed with a small number of samples (n=15), focusing on the areas with significant contributions to analyze the reasons for such contributions. Our method was used effectively to optimize the testing of symptom checker user interfaces. The method allowed kept the cost of testing at reasonable levels by restricting the use of the think-aloud procedure while still assuring a high amount of coverage. The main barriers detected in Erdusyk were related to problems understanding time repetition patterns, the selection of levels in scales to record intensities, navigation, the quantification of some symptom attributes, and the characteristics of the symptoms.

A Predictive Model for Guillain-Barré Syndrome Based on Single Learning Algorithms.

Background. Guillain-Barré Syndrome (GBS) is a potentially fatal autoimmune neurological disorder. The severity varies among the four main subtypes, named as Acute Inflammatory Demyelinating Polyneuropathy (AIDP), Acute Motor Axonal Neuropathy (AMAN), Acute Motor Sensory Axonal Neuropathy (AMSAN), and Miller-Fisher Syndrome (MF). A proper subtype identification may help to promptly carry out adequate treatment in patients. Method. We perform experiments with 15 single classifiers in two scenarios: four subtypes' classification and One versus All (OvA) classification. We used a dataset with the 16 relevant features identified in a previous phase. Performance evaluation is made by 10-fold cross validation (10-FCV). Typical classification performance measures are used. A statistical test is conducted in order to identify the top five classifiers for each case. Results. In four GBS subtypes' classification, half of the classifiers investigated in this study obtained an average accuracy above 0.90. In OvA classification, the two subtypes with the largest number of instances resulted in the best classification results. Conclusions. This study represents a comprehensive effort on creating a predictive model for Guillain-Barré Syndrome subtypes. Also, the analysis performed in this work provides insight about the best single classifiers for each classification case.

[Geriatric intervention in elderly hip fracture patients admitted to University Hospital of Guadalajara: Clincal, healthcare and economical repercussions]. / Intervención geriátrica en el anciano ingresado por fractura de cadera en el Hospital Universitario de Guadalajara: repercusión clínica, asistencial y económica.

OBJECTIVE: To evaluate the healthcare outcomes and economic impact of geriatric intervention in patients over 75 years old with hip fracture in acute phase. MATERIAL AND METHODS: Retrospective study of patients admitted to the University Hospital of Guadalajara (HUGU) due to hip fracture. An analysis was made of the number of cases per year, preoperative period, hospital stay, and mortality of all the patients over 75 years admitted to the HUGU due to hip fracture between 2002 and 2013. RESULTS: A total of 2942 patients were included. Comparing the activity of 2013 to that of 2006, the mean hospital stay fell from 18.5 to 11.2 days (-39.2%), and mortality from 8.9% to 6.8% (-23%). In contrast, the mean preoperative stay remained at a mean of 2.7 days versus 2.4 in previous years in the early post-intervention period. Hospital stay decreased, despite a progressive annual increase in the daily cost of hospitalisation due to hip fracture surgery, the reduced stay led to a reduction of the total cost by more than 900,000 euros each year. Geriatric intervention has gradually reduced mean hospital stay and mortality, although with a tendency to increase mean preoperative stay. CONCLUSIONS: Geriatric intervention in patients with hip fracture reduces mortality and length of hospital stay, and decreasing costs.

International perception of lung sounds: a comparison of classification across some European borders.

INTRODUCTION: Lung auscultation is helpful in the diagnosis of lung and heart diseases; however, the diagnostic value of lung sounds may be questioned due to interobserver variation. This situation may also impair clinical research in this area to generate evidence-based knowledge about the role that chest auscultation has in a modern clinical setting. The recording and visual display of lung sounds is a method that is both repeatable and feasible to use in large samples, and the aim of this study was to evaluate interobserver agreement using this method. METHODS: With a microphone in a stethoscope tube, we collected digital recordings of lung sounds from six sites on the chest surface in 20 subjects aged 40 years or older with and without lung and heart diseases. A total of 120 recordings and their spectrograms were independently classified by 28 observers from seven different countries. We employed absolute agreement and kappa coefficients to explore interobserver agreement in classifying crackles and wheezes within and between subgroups of four observers. RESULTS: When evaluating agreement on crackles (inspiratory or expiratory) in each subgroup, observers agreed on between 65% and 87% of the cases. Conger's kappa ranged from 0.20 to 0.58 and four out of seven groups reached a kappa of ≥0.49. In the classification of wheezes, we observed a probability of agreement between 69% and 99.6% and kappa values from 0.09 to 0.97. Four out of seven groups reached a kappa ≥0.62. CONCLUSIONS: The kappa values we observed in our study ranged widely but, when addressing its limitations, we find the method of recording and presenting lung sounds with spectrograms sufficient for both clinic and research. Standardisation of terminology across countries would improve international communication on lung auscultation findings.