Automated Pain Assessment in Children Using Electrodermal Activity and Video Data Fusion via Machine Learning.

OBJECTIVE: Pain assessment in children continues to challenge clinicians and researchers, as subjective experiences of pain require inference through observable behaviors, both involuntary and deliberate. The presented approach supplements the subjective self-report-based method by fusing electrodermal activity (EDA) recordings with video facial expressions to develop an objective pain assessment metric. Such an approach is specifically important for assessing pain in children who are not capable of providing accurate self-pain reports, requiring nonverbal pain assessment. We demonstrate the performance of our approach using data recorded from children in post-operative recovery following laparoscopic appendectomy. We examined separately and combined the usefulness of EDA and video facial expression data as predictors of children's self-reports of pain following surgery through recovery. Findings indicate that EDA and facial expression data independently provide above chance sensitivities and specificities, but their fusion for classifying clinically significant pain vs. clinically nonsignificant pain achieved substantial improvement, yielding 90.91% accuracy, with 100% sensitivity and 81.82% specificity. The multimodal measures capitalize upon different features of the complex pain response. Thus, this paper presents both evidence for the utility of a weighted maximum likelihood algorithm as a novel feature selection method for EDA and video facial expression data and an accurate and objective automated classification algorithm capable ofdiscriminating clinically significant pain from clinically nonsignificant pain in children.

Consumo de antibióticos en dos servicios hospitalarios / Antibiotic consumption in two hospital services

Introducción: El uso excesivo e inadecuado de los antibióticos ha contribuido al incremento de la resistencia antimicrobiana y al aumento en los costos hospitalarios, lo que atenta contra la calidadasistencial.Objetivo: Determinar el consumo, el costo global y total de antibióticos en dos servicios hospitalarios.Métodos: Se realizó un estudio exploratorio, observacional, transversal, en el Hospital Clínico Quirúrgico Aleida Fernández Chardiet del municipio de Güines, provincia Mayabeque, en el períodocomprendido de enero a abril de 2019. La información primaria se obtuvo del reporte de consumo de antibióticos y se trabajó con el universo de antibióticos controlados registrados0que se prescribieron en los servicios de Medicina Interna y Cirugía. Las variablesse expresaron en frecuencias absolutas y relativas. Los resultados se mostraron en tablas y gráficos.Resultados: Los antibióticos más utilizados fueron: en un 25.6 % el Cefatoxime, 15.1 por ciento la Cefuroxima y en Facultad de Ciencias Médicas de Mayabeque 473 Consumo de antibióticos en dos servicios hospitalarios un 11.2 por ciento la Ceftriaxona. El mayor gasto por concepto de antibióticos controlados consumidos en esas salas correspondió en un 28.21 por ciento al mes de marzo, seguido por 27.57 por ciento en el mes de enero y un 24.41 % en el mes de febrero.Conclusiones: Las cefalosporinas constituyen el grupo farmacológico más empleado, el costo global de antibióticos consumidos en ambos servicios corresponden a las prescripciones de Ciprofloxacina y Ceftriaxona y el costo total de antibióticos incide en los meses de enero y marzo.(AU)

Introduction: The excessive and inadequate use of antibiotics has contributed to the increasing of the antimicrobial resistance and the hospital costs, which affects the assistance quality.Objective: To determine the consumption, the global cost and the total of antibiotics in two hospital services.Methods: An exploratory, observational, cross-sectional study was performed at Aleida Fernández Chardiet teaching Clinical Surgical hospital from Güines municipality, Mayabeque province,from January to April, 2019. The primary information was obtained from the report of antibiotics consumption and the research was based on the controlled universe of registered antibiotics that were prescribed in the Internal Medicine and Surgery Services The variableswere expressed in absolute and relative frequencies. The results were shown in tables and graphs.Results: The most used antibiotics were: in a 25.6 per cent Cefatoxime, 15.1 % Cefuroxime and in a 11.2 per cent laCeftriaxone. The highest expense for consumed controlled antibiotics in those wards corresponded in a 28.21 % to March, followed by 27.57 per cent in January and a 24.41 per cent in February.Conclusions: Cephalosporin constitute the most used pharmacological group, the global cost of consumed antibiotics in both services corresponded to the prescriptions of Ciprofloxacin and Ceftriaxoneand the total cost of antibiotics prevails in January and March.(AU)

Indicadores para evaluar la correspondencia entre pertinencia y calidad en los egresados de Ciencias Médicas / Indicators to assess the correspondence between relevance and quality in graduates of Medical Sciences

Introducción:El reto que la sociedad actual propone a las universidades consiste en formar profesionales capaces de afrontar demandas laborales, desarrollar habilidades que les permita solucionar eficazmente las necesidades sociales, combinando conocimiento y habilidades intelectuales, manuales, sociales, actitudes para afrontar un problema profesional. Objetivo: Identificar los indicadores que permitan evaluar la correspondencia entre pertinencia del egresado de las Ciencias Médicas y la calidad de los servicios prestados en las instituciones de Atención Secundaria de Salud, provincia Mayabeque.Métodos: Se realizó un estudio descriptivo, transversal de abril 2018 a abril 2019 en las entidades de Atención Secundaria de Salud. El universo estuvo constituido por 250 graduados de las carreras de Ciencias Médicas, 100 estudiantes de Medicina, 50 de Estomatología y 100 de Indicadores para evaluar la correspondencia entre pertinencia y calidad en los egresados Tecnología de la Salud vinculados a las instituciones objeto de estudio y 100 pacientes que acudieron solicitando atención en el periodo estudiado. Resultados: Se identificaron 12 Indicadores para evaluar la pertinencia del egresado de las carreras de Ciencias Médicas, 26 Indicadores para caracterizar la calidad de los servicios brindados en las instituciones de Atención Secundaria de Salud y la correspondencia entre los indicadores de pertinencia y calidad Conclusiones: Existe correspondencia entre pertinencia del egresado de las carreras de Ciencias Médicas y la calidad de los servicios brindados en las instituciones de Atención Secundaria de Salud de la provincia Mayabeque. La correspondencia entre pertinencia y calidad será más eficiente en la medida en que se logre que los profesionales apliquen conocimientos y habilidades para solucionar.(AU)

Introduction:The challenge that today's society proposes to universities is to train professionals capable of facing job demands, developing skills that allow them to effectively solve social needs, combining knowledge and intellectual, manual, social skills, attitudes to face a professional problem. Objective: To identify the indicators that allow evaluating the correspondence between the relevance of the graduate of Medical Sciences and the quality of the services provided in the Secondary Health Care institutions, Mayabeque province. Methods: A descriptive, cross-sectional study was performed from April 2018 to April 2019 in the entities of Secondary Health Care. The universe was made up of 250 graduates from Medical Sciences careers, 100 Medicine, 50 Stomatology and 100 Health Technology students linked to the institutions under study and 100 patients who came seeking care in the period studied.Results:Twelve Indicators were identified to assess the relevance of the graduate of Medical Sciences careers, 26 indicators to characterize the quality of the services provided in the Secondary Health Care institutions and the correspondence between the indicators of relevance and quality. Conclusions: There is a correspondence between the relevance of the graduate of Medical Sciences careers and the quality of the services provided in the Secondary Health Care institutions of Mayabeque province. The correspondence between relevance and quality will be more efficient to the extent that professionals apply knowledge and skills to solve the population's health needs.(AU)

Youth and Parent Appraisals of Participation in a Study of Spontaneous and Induced Pediatric Clinical Pain.

The current study examined youths' and their parents' perceptions concerning participation in an investigation of spontaneous and induced pain during recovery from laparoscopic appendectomy. Youth (age range 5-17 years) and their parents independently completed surveys about their study participation. On a 0 (very negative) -to-10 (very positive) scale, both parents 9.4(1.3) [mean(SD)] and youth 7.9(2.4) rated their experience as positive. Among youth, experience ratings did not differ by pain severity and survey responses did not differ by age. Most youth (83%) reported they would tell another youth to participate. Ethical issues regarding instigation of pain in youth for research purposes are examined.

Human Eosinophils Express a Distinct Gene Expression Program in Response to IL-3 Compared with Common ß-Chain Cytokines IL-5 and GM-CSF.

Despite recent advances in asthma management with anti-IL-5 therapies, many patients have eosinophilic asthma that remains poorly controlled. IL-3 shares a common ß subunit receptor with both IL-5 and GM-CSF but, through α-subunit-specific properties, uniquely influences eosinophil biology and may serve as a potential therapeutic target. We aimed to globally characterize the transcriptomic profiles of GM-CSF, IL-3, and IL-5 stimulation on human circulating eosinophils and identify differences in gene expression using advanced statistical modeling. Human eosinophils were isolated from the peripheral blood of healthy volunteers and stimulated with either GM-CSF, IL-3, or IL-5 for 48 h. RNA was then extracted and bulk sequencing performed. DESeq analysis identified differentially expressed genes and weighted gene coexpression network analysis independently defined modules of genes that are highly coexpressed. GM-CSF, IL-3, and IL-5 commonly upregulated 252 genes and downregulated 553 genes, producing a proinflammatory and survival phenotype that was predominantly mediated through TWEAK signaling. IL-3 stimulation yielded the most numbers of differentially expressed genes that were also highly coexpressed (n = 119). These genes were enriched in pathways involving JAK/STAT signaling. GM-CSF and IL-5 stimulation demonstrated redundancy in eosinophil gene expression. In conclusion, IL-3 produces a distinct eosinophil gene expression program among the ß-chain receptor cytokines. IL-3-upregulated genes may provide a foundation for research into therapeutics for patients with eosinophilic asthma who do not respond to anti-IL-5 therapies.

Resultados alcanzados en los subsistemas de Ciencia e Innovación Tecnológica provincia Mayabeque año 2018 / Obtained results in the subsystems of Science and Technological Innovation in Mayabeque, 2018

Introducción: la ciencia constituye un complejo fenómeno social que tiene como propósito la producción, difusión y aplicación de conocimientos. En la universidad cubana, el proceso de ciencia e innovación tecnológica promueve la introducción y generalización de resultados científicos que garanticen impactos sostenibles.Objetivo: describir el comportamiento de algunos de los subsistemas de Ciencia e Innovación Tecnológica en la provincia Mayabeque como resultado de la implementación de la Carpeta Metodológica de Ciencia y Técnica.Métodos: se realizó un estudio descriptivo, transversal en el departamento de Ciencia e Innovación Tecnológica de la Facultad de Ciencias Médicas de Mayabeque, de enero a diciembre del 2018. El universo estuvo constituido por los subsistemas que conduce la dirección de Ciencia y Técnica. Para la selección de la muestra se utilizó un método no probabilístico, intencional, quedando conformada por cuatro subsistemas: proyectos, resultados científicos técnicos, producción científica, y categoría científica.Resultados: predominaron los proyectos de Tesis de Terminación de Residencia (91.06 %), de los resultados científicos el 33.33 % correspondieron a los problemas de grupos especiales, se incrementaron las publicaciones en un 50,6 % con respecto al año 2017, se aprobaron nueve expedientes de investigadores, se obtuvieron dos premios Joven Investigador, un premio del Ministerio de Ciencia Tecnología y Medio Ambiente y tres Premios Anuales de Salud.Conclusiones: la implementación de la Carpeta Metodológica de Ciencia e Innovación Tecnológica en Sedes Universitarias y entidades de Atención Primaria y Secundaria de Salud logra resultados relevantes en alguno de los subsistemas de Ciencia y Técnica en la provincia Mayabeque.(AU)

Introduction: science constitutes a complex social phenomenon with the purpose of production, diffusion and application of knowledge. In the Cuban Universities, the process of science and technological innovation promotes the promotion and generalization of scientific results that garantee sustainable impacts.Objective: to describe the behavior of some subsystems of science and technological innovation in Mayabeque as a result of the implementation of Science and Technics Methodological dossier.Methods: a descriptive, transversal study was carried out in the department of science and technological innovation of Mayabeque Faculty of Medical Sciences, from January to December, 2018. The Universe was composed by the subsystems under the Science and Technics direction. For the selection of the sample a non-probabilistic, intentional method was used, and it was formed by four subsystems: projects, scientific and technical results, scientific production, and scientific category.Results: projects related to residence final theses prevailed (91.06 %), related to the Scientific results the 33.33 % corresponded problems of special groups, publications were increased in a 96.5 % taking into account 2017, nine investigators records were approved , two “Young Investigator” prizes were obtained, A prize of the Ministry of Science , Technology and Environment and three Annual Health Prize.Conclusions: the implementation of the Science and Technological Innovation dossier in University centers, Primary and Secondary Health Care Institutions obtained relevant results in one of the subsystems of Science and Technics in Mayabeque province.(AU)

Automated Pain Assessment using Electrodermal Activity Data and Machine Learning.

Objective pain assessment is required for appropriate pain management in the clinical setting. However, clinical gold standard pain assessment is based on subjective methods. Automated pain detection from physiological data may provide important objective information to better standardize pain assessment. Specifically, electrodermal activity (EDA) can identify features of stress and anxiety induced by varying pain levels. However, notable variability in EDA measurement exists and research to date has demonstrated sensitivity but lack of specificity in pain assessment. In this paper, we use timescale decomposition (TSD) to extract salient features from EDA signals to identify an accurate and automated EDA pain detection algorithm to sensitively and specifically distinguish pain from no-pain conditions.

Automated Pain Detection in Facial Videos of Children using Human-Assisted Transfer Learning.

Accurately determining pain levels in children is difficult, even for trained professionals and parents. Facial activity provides sensitive and specific information about pain, and computer vision algorithms have been developed to automatically detect Facial Action Units (AUs) defined by the Facial Action Coding System (FACS). Our prior work utilized information from computer vision, i.e., automatically detected facial AUs, to develop classifiers to distinguish between pain and no-pain conditions. However, application of pain/no-pain classifiers based on automated AU codings across different environmental domains results in diminished performance. In contrast, classifiers based on manually coded AUs demonstrate reduced environmentally-based variability in performance. In this paper, we train a machine learning model to recognize pain using AUs coded by a computer vision system embedded in a software package called iMotions. We also study the relationship between iMotions (automatically) and human (manually) coded AUs. We find that AUs coded automatically are different from those coded by a human trained in the FACS system, and that the human coder is less sensitive to environmental changes. To improve classification performance in the current work, we applied transfer learning by training another machine learning model to map automated AU codings to a subspace of manual AU codings to enable more robust pain recognition performance when only automatically coded AUs are available for the test data. With this transfer learning method, we improved the Area Under the ROC Curve (AUC) on independent data from new participants in our target domain from 0.67 to 0.72.

Towards Automated Pain Detection in Children using Facial and Electrodermal Activity.

Accurately determining pain levels in children is difficult, even for trained professionals and parents. Facial activity and electro- dermal activity (EDA) provide rich information about pain, and both have been used in automated pain detection. In this paper, we discuss preliminary steps towards fusing models trained on video and EDA features respectively. We compare fusion models using original video features and those using transferred video features which are less sensitive to environmental changes. We demonstrate the benefit of the fusion and the transferred video features with a special test case involving domain adaptation and improved performance relative to using EDA and video features alone.

Comportamiento de algunos subsistemas de ciencia y técnica en la provincia Mayabeque / Behavior of some subsystems in Science and Technics in Mayabeque province

Introducción: la investigación es una acción planificada con la finalidad de resolver un problema científico, propiciando el desarrollo de habilidades investigativas en la superación profesional. Objetivo: describir el comportamiento de algunos de los subsistemas de Ciencia y Técnica en la; provincia Mayabeque. Método: Estudio descriptivo de corte transversal en la Facultad de Ciencias Médicas Mayabeque en el periodo comprendido de enero del año 2012 hasta junio del 2016, el universo de estudio estuvo constituido por los ocho subsistemas de Ciencia y Técnica. La muestra de carácter intencional conformado por cinco subsistemas: investigación, resultados científicos técnicos, producción científica, generalización de resultados y categoría científica, analizándose los indicadores de Ciencia y Técnica oficiales enviados al MINSAP, mediante el análisis porcentual. Resultados: los proyectos de investigación protagonizados por profesionales fueron insuficientes, el número de resultados científicos introducidos se incrementó, el 67,39 por ciento de la producción científica correspondió a artículos publicados en revistas, capítulos de libros e ISBN. Se contaba con 56 investigadores hasta el 2016. Se identificaron 180 resultados a generalizar. Conclusiones: el incremento en el número de profesionales con categoría científica en la provincia Mayabeque refleja el despertar científico y motivación de estos por exponer soluciones alternativas a los problemas de salud de la población aunque el número de proyectos institucionales fue insuficiente en relación al potencial científico de la provincia(AU)

Introduction: investigation is a planned action with the purpose of solving a scientific problem, providing the development of scientific skills in the professional performance.Objective: to describe the behavior of some subsystems in Science and technics in Mayabeque province. Method: a descriptive transversal study was carried about at Mayabeque Faculty of Medical Sciences from January, 2012 to June, 2016, the universe was constituted by the five subsystems in Science and technics. The intentional sample was composed by five subsystems: investigation, scientific and technical results, scientific production, generalization of the results and the scientific category, the official indicators of Science and Technics were analyzed and sent to MINSAP, by perceptual analysis.Results: the investigation projects performed by professionals were insufficient, the number of introduced scientific results was increased, the 67, 39 per cent of the scientific production corresponded to articles published in scientific magazines, book chapters and ISBN. There were 56 investigators until 2016. 180 results to be generalized were identified. Conclusions: the increasing of the number of professionals with scientific category in Mayabeque province shows a scientific and stimulating movement for reporting alternative solutions to the health problems of the population although the number of institutional projects was insufficient in relation to the scientific potential of the province(AU)

La xerostomía y su relación con el consumo de medicamentos, cigarro y alcohol / Xerostomy and its relation with medications, cigarettes and alcohol

Introducción: la xerostomía, es el resultado de alteraciones localizadas en las glándulas productoras de saliva o un desequilibrio de índole sistémica Objetivo: determinar la prevalencia de xerostomía según sexo y grupo de edades en relación con el uso de medicamentos, consumo de bebidas alcohólicas o cigarro en pacientes mayores de 30 años de edad de un consultorio médico. Método: se realizó un estudio descriptivo transversal en el consultorio médico número 1 área sur del municipio Güines, en el periodo comprendido de enero del 2015 a enero del 2016. El universo de estudio constituido por 836 pacientes mayores de 30 años que acudieron a consulta en el periodo estudiado. La muestra 231 pacientes fumadores, consumidores de medicamentos o bebidas alcohólicas, seleccionados intencionalmente, teniéndose en cuenta criterios de inclusión y exclusión. Se aplicó una encuesta, los resultados se presentan en tablas de distribución de frecuencia. Resultados: la xerostomía tiene mayor incidencia en el sexo masculino mayor de 40 años. Los síntomas se presentan en 76.2 por ciento de fumadores, 39.8 por ciento consumidores de alcohol y en un 59.2 por ciento en consumidores de medicamentos. Conclusión: los síntomas más frecuentes asociados a la xerostomía fueron dolor en la boca y dientes, ardor en mucosa bucal, resequedad en labios y sensación de boca seca al momento de la comida, incidiendo más frecuentemente en hombres a partir de los 50 años. Los pacientes consumidores de cigarro y alcohol presentan síntomas asociados a la xerostomía, con mayor incidencia en relación al consumo de medicamentos(AU)

Introduction: systemic xerostomy is the result of localized disorders in the saliva glands production orofa disequilibriumObjective: to determine the prevalence of xerostomy according to sex and age groups in relation to the use of medications, cigarette or alcohol consumption in patients older than 30 years old in a doctors office.Method: a descriptive, transversal study was carried out in the doctor office number 1 in the southern area in Güines, from January, 2015 to January, 2016. The studied universe was formed by 836 patients older than 30 years old who attended the consultation during that period. The sample was 231 smoker patients, medication or alcoholic consumers, selected intentionally , taking into account the inclusion and exclusion criteria. A survey was applied, the results were presented in tables of frequency distribution.Results: xerostomy has the highest incidence in the male sex and older than mayor de 40 years old. The symptoms are presented in 76.2 percent of smokers, 39.8 percent of alcohol consumers and in a 59.2 percent in medication consumers. Conclusion: the most frequent symptoms associated to xerostomy pain in the mouth and teeth, burning in the oral mucosa, dryness in lips and sensation of dry mouth when eating, with a higher incidence in men of 50 years old and older. Smoker patients and alcohol consumer present symptoms associated to xerostomy, with the highest incidence in medication consumers(AU)

Discovery of LX2761, a Sodium-Dependent Glucose Cotransporter 1 (SGLT1) Inhibitor Restricted to the Intestinal Lumen, for the Treatment of Diabetes.

The increasing number of people afflicted with diabetes throughout the world is a major health issue. Inhibitors of the sodium-dependent glucose cotransporters (SGLT) have appeared as viable therapeutics to control blood glucose levels in diabetic patents. Herein we report the discovery of LX2761, a locally acting SGLT1 inhibitor that is highly potent in vitro and delays intestinal glucose absorption in vivo to improve glycemic control.

Terminologías económicas necesarias para incrementar la eficiencia y la calidad en salud / Necessary economic terminologies to increase the efficiency and quality in health

Eficiencia y calidad son conceptos polémicos y debatidos con la inclusión de la normalización y metrología como complemento para lograr la eficacia de los procesos. La relación economía - salud permite tomar decisiones, es la vía que logra la mejor relación entre recursos y resultados. El desconocimiento existente entre los profesionales de la salud, directivos y demás trabajadores sobre terminologías económicas impide el logro de mejores resultados en las instituciones y aplicar las técnicas económicas en la toma de decisiones certeras para la organización. Se presentan definiciones económicas e interrelaciones entre economía y salud con el objetivo de ampliar el conocimiento sobre temas económicos entre los profesionales y directivos del sector. Este artículo puede funcionar como importante material de estudio, facilitando la toma de decisiones en aras de incrementar la eficiencia y la calidad de los servicios brindados en el sector de la salud. Para su elaboración se consultaron fuentes bibliográficas actualizadas en formato digital y literatura clásica sobre Economía. Tomando como premisa fundamental que la preparación y superación de los profesionales del sector es un proceso sistémico y continúo, orientado a desarrollar colectivos cohesionados, eficientes y competentes (AU)

Efficiency and quality are polemic and debated concepts with the inclusion of the normalization and metrology as a complement to get the efficiency of the processes. The relation economy-health allows to take decisions, it is the way to obtain a better relation between the resources and the results. There is an ungratefulness between health professionals, directors and other workers about economic terminology that obstructs the achievement of the best results in the institutions to apply the economic techniques in taking adequate decisions for organization. Economic definitions and interrelations between economy and health are presented with the objective to increase knowledge about economic topics between professionals and directors of health. This article may be an important study material, easing the taking of decisions to rise the efficiency and quality of services of health. For its elaboration updated bibliographic resources in digital format and classic literature about economy were consulted. Taking as a main condition that preparation and education of health professionals is a systemic and continuous process oriented to develop efficient and competent collectives (AU)

Potent benzoazepinone γ-secretase modulators with improved bioavailability.

The triazolyl amide γ-secretase modulators are potent alternatives to the cinnamyl amides that have entered the clinic for the treatment of Alzheimer's disease. Herein we build on the lead benzoazepinones described in our prior communication with imidazomethoxyarene moiety alternatives that offer opportunities to fine tune physical properties as well as address hERG binding and PK. Both half-life and bioavailability were significantly improved, especially in dog, with robust brain Aß42 lowering maintained in both transgenic mouse and rat.

Discovery of novel triazolobenzazepinones as γ-secretase modulators with central Aß42 lowering in rodents and rhesus monkeys.

Synthesis and SAR studies of novel triazolobenzazepinones as gamma secretase modulators (GSMs) are presented in this communication. Starting from our azepinone leads, optimization studies toward improving central lowering of Aß42 led to the discovery of novel benzo-fused azepinones. Several benzazepinones were profiled in vivo and found to lower brain Aß42 levels in Sprague Dawley rats and transgenic APP-YAC mice in a dose-dependent manner after a single oral dose. Compound 34 was further progressed into a pilot study in our cisterna-magna-ported rhesus monkey model, where we observed robust lowering of CSF Aß42 levels.

Automated Assessment of Children's Postoperative Pain Using Computer Vision.

BACKGROUND: Current pain assessment methods in youth are suboptimal and vulnerable to bias and underrecognition of clinical pain. Facial expressions are a sensitive, specific biomarker of the presence and severity of pain, and computer vision (CV) and machine-learning (ML) techniques enable reliable, valid measurement of pain-related facial expressions from video. We developed and evaluated a CVML approach to measure pain-related facial expressions for automated pain assessment in youth. METHODS: A CVML-based model for assessment of pediatric postoperative pain was developed from videos of 50 neurotypical youth 5 to 18 years old in both endogenous/ongoing and exogenous/transient pain conditions after laparoscopic appendectomy. Model accuracy was assessed for self-reported pain ratings in children and time since surgery, and compared with by-proxy parent and nurse estimates of observed pain in youth. RESULTS: Model detection of pain versus no-pain demonstrated good-to-excellent accuracy (Area under the receiver operating characteristic curve 0.84-0.94) in both ongoing and transient pain conditions. Model detection of pain severity demonstrated moderate-to-strong correlations (r = 0.65-0.86 within; r = 0.47-0.61 across subjects) for both pain conditions. The model performed equivalently to nurses but not as well as parents in detecting pain versus no-pain conditions, but performed equivalently to parents in estimating pain severity. Nurses were more likely than the model to underestimate youth self-reported pain ratings. Demographic factors did not affect model performance. CONCLUSIONS: CVML pain assessment models derived from automatic facial expression measurements demonstrated good-to-excellent accuracy in binary pain classifications, strong correlations with patient self-reported pain ratings, and parent-equivalent estimation of children's pain levels over typical pain trajectories in youth after appendectomy.

LP-925219 maximizes urinary glucose excretion in mice by inhibiting both renal SGLT1 and SGLT2.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of oral anti-diabetic agents that improve glycemic control by inhibiting SGLT2-mediated renal glucose reabsorption. Currently available agents increase urinary glucose excretion (UGE) to <50% of maximal values because they do not inhibit SGLT1, which reabsorbs >50% of filtered glucose when SGLT2 is completely inhibited. This led us to test whether LP-925219, a small molecule dual SGLT1/SGLT2 inhibitor, increases UGE to maximal values in wild-type (WT) mice. We first tested LP-925219 inhibition of glucose transport by HEK293 cells expressing SGLT1 or SGLT2, and then characterized LP-925219 pharmacokinetics. We found that LP-925219 was a potent inhibitor of mouse SGLT1 (IC50 = 22.6 nmol/L) and SGLT2 (IC50 = 0.5 nmol/L), and that a 10 mg/kg oral dose was bioavailable (87%) with a long half-life (7 h). We next delivered LP-925219 by oral gavage to WT, SGLT1 knockout (KO), SGLT2 KO, and SGLT1/SGLT2 double KO (DKO) mice and measured their 24-h UGE. We found that, in vehicle-treated mice, DKO UGE was maximal and SGLT2 KO, SGLT1 KO, and WT UGEs were 30%, 2%, and 0.2% of maximal, respectively; we also found that LP-925219 dosed at 60 mg/kg twice daily increased UGE of SGLT1 KO, SGLT2 KO, and WT mice to DKO UGE levels. These findings show that orally available dual SGLT1/SGLT2 inhibitors can maximize 24-h UGE in mammals, and suggest that such agents merit further evaluation for their potential, in diabetic patients, to achieve better glycemic control than is achieved using selective SGLT2 inhibitors.

El costo y la toma de decisiones en las investigaciones de salud / The cost and decision making in health research

Se realizó un tema de actualidad con el objetivo de argumentar como la aplicación de la clasificación de los costos en las investigaciones en salud permiten lograr una mayor exactitud en los resultados obtenidos. Permite valorar lo relacionado con la utilización de recursos disponibles en el proceso de producción, consumo, distribución y financiamiento de la salud. Los costos son una importante herramienta que posibilita la toma de decisiones en la práctica asistencial diaria y en la elección de la mejor alternativa investigativa que permite valorar desde la pérdida social generada por la salud hasta el impacto económico, social y organizativo que implica sobre el individuo o sociedad la investigación. Sin dudas la aplicación del estudio de los costos garantiza la mayor eficiencia en los servicios prestados. Su correcta utilización logra el éxito del binomio calidad-eficiencia (AU)

A current topic was developed in order to explain how the application of the classification of costs in health research allows a greater accuracy in the obtained results. It allows assessing everything concerning the use of available resources in the process of production, consumption, distribution and health financing. Costs are an important tool that enables decision making in daily clinical practice and in choosing the best reseach alternative which allows to assess from either the social loss generated by health care or the economic, social and organizational impact that research implies for the individual or society. There is no doubt that the application of the study of the costs ensures greater efficiency in the services provided. Its proper use success in achieving the equality-efficiency binomial (AU)

El costo y la toma de decisiones en las investigaciones de salud / The cost and decision making in health research

Se realizó un tema de actualidad con el objetivo de argumentar como la aplicación de la clasificación de los costos en las investigaciones en salud permiten lograr una mayor exactitud en los resultados obtenidos. Permite valorar lo relacionado con la utilización de recursos disponibles en el proceso de producción, consumo, distribución y financiamiento de la salud. Los costos son una importante herramienta que posibilita la toma de decisiones en la práctica asistencial diaria y en la elección de la mejor alternativa investigativa que permite valorar desde la pérdida social generada por la salud hasta el impacto económico, social y organizativo que implica sobre el individuo o sociedad la investigación. Sin dudas la aplicación del estudio de los costos garantiza la mayor eficiencia en los servicios prestados. Su correcta utilización logra el éxito del binomio calidad-eficiencia

A current topic was developed in order to explain how the application of the classification of costs in health research allows a greater accuracy in the obtained results. It allows assessing everything concerning the use of available resources in the process of production, consumption, distribution and health financing. Costs are an important tool that enables decision making in daily clinical practice and in choosing the best reseach alternative which allows to assess from either the social loss generated by health care or the economic, social and organizational impact that research implies for the individual or society. There is no doubt that the application of the study of the costs ensures greater efficiency in the services provided. Its proper use success in achieving the equality-efficiency binomial

Variación de la neutralidad del PH salival a cinco minutos de ingesta de alimentos derivados del maíz en universitarios de 17 a 22 años / Variation of salivary pH neutrality at five minutes of ingestion of foods derived from corn in university students aged 17 to 22 years old

Objetivo: establecer la variación de la neutralidad en el pH salival a cinco minutos de la ingesta de alimentos derivados del maíz. Metodología: el diseño corresponde a un estudio observacional, transversal comparativo. El universo de estudio fue conformado por 125 universitarios, de los cuales se seleccionó la muestra por conveniencia, aplicando criterios de inclusión y exclusión, obteniendo una muestra de 60 estudiantes que fueron distribuidos al azar por medio de una tabla aleatoria en cuatro grupos correspondientes a cada uno de los tres alimentos seleccionados para el estudio y parafina. Previo a la recolección de muestras se indicó: no lavarse los dientes, comer o beber (excepto agua) no realizar ejercicio extenuante mínimo una hora antes de la recolección de saliva. Los datos se recolectaron en cuatro días, en un horario de 8:00 a 10:00 am, haciendo dos tomas de muestra de saliva, una antes de la ingesta de alimentos y masticación de parafina y otra a cinco minutos de la ingesta. Posteriormente ambas muestras de saliva fueron medidas por medio de un pH metro (METROHM 632 PH-METER) para determinar el pH salival que presentaban, se registraron los valores en cuatro tablas, una por cada grupo; conformadas por tres columnas que correspondían al número correlativo del estudiante, pH inicial y pH a cinco minutos de ingesta del alimento. Para el análisis de datos se empleó el paquete estadístico SPSS. Se realizó prueba t y análisis de varianza ANOVA, el nivel de significancia fue de 5%. Resultados: se encontró que las variaciones producidas por los alimentos derivados del maíz investigados no son significativas a los cinco minutos de ingesta (p 0,68), existiendo diferencias significativa entre los grupos de alimento (p 0,000). La única variación no significativa estadísticamente entre pH inicial y pH a cinco minutos de ingesta, fue para el grupo C (tamal de elote) (p 0,123). Las comparaciones entre grupo mostraron que no existen diferencias significativas estadísticamente entre los grupos A y D (p 0,797), B y C (p 0,359) y entre C y D (p 0,109). Conclusiones: los resultados evidencian que a 5 minutos de la ingesta, los alimentos derivados del maíz investigados no producen una variación del pH salival fuera del rango de neutralidad.

Objective: to establish the variation of neutrality in salivary pH five minutes after the ingestion of foods derived from corn. Methodology: the design corresponds to an observational, cross-sectional comparative study. The study universe was made up of 125 university students, of which the sample was selected for convenience, applying inclusion and exclusion criteria, obtaining a sample of 60 students who were randomly distributed through a random table into four groups corresponding to each one of the three foods selected for the study and paraffin. Before collecting samples, it was indicated: do not brush teeth, eat or drink (except water) do not perform strenuous exercise at least one hour before collecting saliva. The data was collected in four days, from 8:00 to 10:00 am, taking two saliva samples, one before eating food and chewing paraffin and another five minutes after ingestion. Subsequently, both saliva samples were measured by means of a pH meter (METROHM 632 PH-METER) to determine the salivary pH they presented, the values were recorded in four tables, one for each group; made up of three columns that corresponded to the correlative number of the student, initial pH and pH at five minutes of food intake. The SPSS statistical package was used for data analysis. T-test and ANOVA analysis of variance were performed; the level of significance was 5%. Results: it was found that the variations produced by the foods derived from the investigated corn are not significant after five minutes of ingestion (p 0.68), with significant differences between the food groups (p 0.000). The only statistically non-significant variation between initial pH and pH at five minutes of ingestion was for group C (corn tamale) (p 0.123). Comparisons between groups showed that there are no statistically significant differences between groups A and D (p 0.797), B and C (p 0.359) and between C and D (p 0.109). Conclusions: the results show that 5 minutes after ingestion, the foods derived from corn investigated do not produce a variation in salivary pH outside the neutrality range.