Constrained numerical deconvolution using orthogonal polynomials.

In this article, we present an enhanced version of Cutler's deconvolution method to address the limitations of the original algorithm in estimating realistic input and output parameters. Cutler's method, based on orthogonal polynomials, suffers from unconstrained solutions, leading to the lack of realism in the deconvolved signals in some applications. Our proposed approach incorporates constraints using a ridge factor and Lagrangian multipliers in an iterative fashion, maintaining Cutler's iterative projection-based nature. This extension avoids the need for external optimization solvers, making it particularly suitable for applications requiring constraints on inputs and outputs. We demonstrate the effectiveness of the proposed method through two practical applications: the estimation of COVID-19 curves and the study of mavoglurant, an experimental drug. Our results show that the extended method presents a sum of squared residuals in the same order of magnitude of that of the original Cutler's method and other widely known unconstrained deconvolution techniques, but obtains instead physically plausible solutions, correcting the errors introduced by the alternative methods considered, as illustrated in our case studies.

Space-time analysis of COVID-19 cases and SARS-CoV-2 wastewater loading: A geodemographic perspective.

Severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) continues to effect communities across the world. One way to combat these effects is to enhance our collective ability to remotely monitor community spread. Monitoring SARS-CoV-2 in wastewater is one approach that enables researchers to estimate the total number of infected people in a region; however, estimates are often made at the sewershed level which may mask the geographic nuance required for targeted interdiction efforts. In this work, we utilize an apportioning method to compare the spatial and temporal trends of daily case count with the temporal pattern of viral load in the wastewater at smaller units of analysis within Austin, TX. We find different lag-times between wastewater loading and case reports. Daily case reports for some locations follow the temporal trend of viral load more closely than others. These findings are then compared to socio-demographic characteristics across the study area.

[Patient simulation for hand therapy in an anesthesiologist after an occupational injury: A case study]. / Simulación clínica para la rehabilitación de la mano en un anestesiólogo después de una lesión ocupacional: un estudio de caso.

We described the use of clinical simulation for hand therapy in an anesthesiologist that accidentally suffered from entrapment with the surgical table in the right thumb and underwent a partial toe-to-hand autograft. At week 14 after surgery, the patient practiced anesthetic tasks and clinical scenarios using a patient simulator instead undergoing a regular occupational therapy regimen. Quantifiable physical, functional and psychological measures improved during and after the simulation intervention, and there was no decline one month after the patient returned to work. The use of clinical simulation as part of the rehabilitation process of an anesthesiologist after hand injury contributed to improving the range of motion, strength, sensibility, and functional tests. Overall, it played an important role in determining the worker's potential to withstand the demands of anesthesia practice.

Sequence subtyping of Trichomonas gallinae from Bonelli's eagle (Aquila fasciata) during four years (2014-2017) reveals that MLS type is associated with lesions.

Avian trichomonosis is a parasitic disease that affects wild birds. The objective of this work was to determine the importance of avian trichomonosis in Bonelli's eagles to improve conservation measures in this population. One hundred and eighty-eight birds were studied: 181 chicks, two juveniles, one subadult and four adults. The birds were externally examined and gross lesions at the oropharynx registered. Samples from the oropharyngeal cavity were obtained for Trichomonas spp. detection by culture and PCR, and positive samples were subjected to a multilocus sequence typing approach, including the ITS1/5.8S/ITS2 region (ITS), ribosomal RNA small subunit (18S) and Fe-hydrogenase gene (FeHyd). Global prevalence of T. gallinae infection was 37.8% in total, 45.5% in nestlings. Thirty-three percent of the birds developed lesions that ranged from mild (n = 41) to moderate (n = 14) or severe (n = 7). Multilocus sequence typing analysis showed five different MLS types, ITS-A/18S-VI/FeHyd-A1 and ITS-D/18S-II/Fe-C4 being the most frequent. An association between ITS-A/18S-VI/FeHyd-A1 and moderate or severe lesions was observed, but birds with type ITS-A/18S-VI/FeHyd-A2 also developed lesions. On the contrary, birds with MLS type ITS-D/18S-II/FeHyd-C4 displayed only a low proportion of mild lesions. Chicks raised in nests were at higher risk for T. gallinae infection and development of lesions than chicks raised in captivity. Discordances between samples cultured in TYM and samples subjected to PCR from oropharyngeal swabs were observed, swab-ITS-PCR being more sensitive.RESEARCH HIGHLIGHTS 45.5% of Bonelli's eagles in the nest carried T. gallinae and 39.4% showed lesions.PCR from oral swabs showed higher sensitivity than culture in TYM for detection of T. gallinae.MLS types ITS-A/18S-VI/Fe-A1 (and A2) are a risk factor for the development of lesions.

Role of 3D printing for the protection of surgical and critical care professionals in the COVID-19 pandemic. / Papel de la impresión 3D para la protección de los profesionales del área quirúrgica y críticos en la pandemia de COVID-19.

BACKGROUND AND OBJECTIVE: There is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment. METHODS: A working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution. RESULTS: The following supplies are produced: 1) devices that help protect providers: face protection screens (2,400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1,200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7,500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas. CONCLUSIONS: 3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic.

Oral trichomonosis: Description and severity of lesions in birds in Spain.

Avian trichomonosis is a parasitic disease caused by the flagellated protozoan Trichomonas gallinae. Columbiformes are the reservoir host of the parasite, with high levels of infection, but also other domestic and wild birds from a variety of orders are susceptible to the infection and development of gross lesions. In this paper we describe the type and severity of lesions in wild birds in four avian orders (Accipitriformes, Falconiformes, Strigiformes and Columbiformes). A total of 94 clinical cases diagnosed of trichomonosis were selected for the categorization of their lesions in the upper digestive tract. The affected birds were classified into three different categories (mild, moderate and severe) based on size (in relation to the tracheal opening), depth and location of the lesions. Mild cases are those with small and superficial lesions far from the oropharyngeal opening; moderate cases possess larger and deeper lesions, and severe cases very large and deep lesions that impede swallowing or affect the skull. Mild lesions were found in 10.6 % of cases; moderate lesions were observed in 18.1 % of the birds and severe lesions in 71.3 %. Treatment outcomes in birds with either mild or moderate lesions were favorable, while severe lesions were related to poor body score, leading to death or euthanasia in most cases. A relationship between severe lesions and avian order was found, with a higher percentage of birds with this type in Falconiformes, Columbiformes and Strigiformes. Multifocal lesions were more frequent in Columbiformes and Falconiformes. In Strigiformes, 93.3 % of birds showed lesions in the upper jaw. This study seeks to further understanding of avian trichomonosis and to provide information that will be useful to veterinarians and related professionals for assessment, prognosis and treatment choice for these birds.

[Simulation as a tool to facilitate change in healthcare organisations]. / La simulación como herramienta para facilitar el cambio en las organizaciones sanitarias.

OBJECTIVE: To describe the use of simulation as a tool to support the strategic management of change in the Cantabrian Regional Health Service in Spain. METHODS: A working group was created to: 1) define the strategic areas of innovation and change; 2) establish criteria for the selection of proposals that can be addressed with simulation; 3) analyse and select the proposals; 4) design and implement the simulation programs, and 5) evaluate results. RESULTS: The constantly changing needs of the regional health system enabled 6 strategic areas to be identified during 2017-208: 1) efficient use of resources; 2) implementation of health plans of interest in the community; 3) patient safety improvement; 4) management of health personnel; 5) development of new professional skills, and 6) selection and implementation of new technology. CONCLUSIONS: Clinical simulation is a useful tool to promote innovation strategies in healthcare, facilitating the adaptation of professionals and patients to change.

Emotional response to a high-fidelity trauma simulation: An observational study. / Respuesta emocional a una simulación de alta fidelidad en trauma: Un estudio observacional.

INTRODUCTION: The emotional environment created during a simulation session can influence learning. Positive emotions improve perceptual processing and facilitate learning, while negative emotions can reduce working memory, resulting in poorer learning outcomes. OBJECTIVES: The aim of this study was to investigate the impact of simulation training on emotions during all phases of a high-fidelity simulation using standard prebriefing and «good judgement debriefing ¼ techniques. METHODS: This was an observational study that included 74 anesthesiologists participating in a simulation-based training. A standardized prebriefing was followed by «good judgement debriefing¼. In order to assess emotions, we used the circumplex model of emotion, and asked participants to complete the affect grid scale before prebriefing (Stage 1), before starting the simulation (Stage 2), before debriefing (Stage 3) and following debriefing (Stage 4). RESULTS: The affect grid scores obtained from 67 participants were analyzed. Following debriefing, the experience of the polytrauma patient simulation was significantly more pleasant compared to previous stages (P<0.01). In addition, participants perceived the activity as becoming increasingly active as it progressed (P<0.01). CONCLUSIONS: High-fidelity trauma simulation creating a safe environment using a standardized prebriefing and «good judgement debriefing¼ is experienced as a pleasant and active activity at all stages of the simulation. Further investigation is needed to assess the impact of these results on learning.

Desarrollo y optimización de un modelo animal para el estudio de las células ganglionares en enfermedad degenerativa de la retina y nervio óptico / Development and optimisation of an animal model for the study of ganglion cells in degenerative diseases of the retina and optic nerve

Introducción: La esclerosis múltiple es una enfermedad autoinmune, crónica e inflamatoria del sistema nervioso central con desmielinización axonal, gliosis y neurodegeneración. Considerada una causa frecuente de discapacidad neurológica en adultos jóvenes. En este trabajo, se ha optimizado un modelo de encefalomielitis autoinmune experimental (EAE), mediante la inyección de glicoproteína mielínica de los oligodendrocitos (MOG35-55), se han estudiado las repercusiones oftalmológicas, y se plantea su uso como modelo de experimentación en otros estudios de degeneración de las células ganglionares (CGR) y del nervio óptico (NO). Material y métodos: Dieciséis ratones de 10 semanas en 2 grupos de estudio: grupo control 10 animales y grupo con EAE 6 animales. Al grupo EAE se le inyectó MOG35-55. Los animales del modelo EAE, fueron monitorizados mediante escalas de discapacidad motora. Las retinas y los nervios ópticos se procesaron para examen morfológico a microscopia óptica y estudio ultraestructural. Resultados: Los modelos animales presentaron clínica motora de lesión medular, apareciendo los primeros síntomas entre el 7.°-19.° día postinyección. Con un promedio de discapacidad máxima de 3,5puntos. En retina, el promedio de CGR en el grupo EAE fue de 0,0891μm frente a 0,1678μm del grupo control (p = 0,0003). El NO se vio intensamente afectado con una gliosis reactiva, aumento del daño axonal y disminución de la densidad axonal (grupo control 0,38038 axones/μm2 frente al grupo EAE 0,16 axones/μm2; p = 0,00032). Conclusiones: En este trabajo hemos caracterizado y detallado un modelo animal de EAE para el estudio de alteraciones desmielinizantes en retina y NO. Sus características lo convierten en un magnífico instrumento para el estudio de las enfermedades oftalmológicas neurodegenerativas

Introduction: Multiple sclerosis is an autoimmune, chronic and inflammatory disease of the central nervous system with axonal demyelination, gliosis and neurodegeneration. It is considered a frequent cause of neurological disability in young adults. In this work, an Experimental Autoimmune Encephalomyelitis (EAE) model was optimised by injecting a myelin oligodendrocyte glycoprotein (MOG35-55). The ophthalmological effects were studied, as well as its use as an experimental model in other studies of retinal ganglion cell degeneration (RGC) and optic nerve (ON). Material and methods: The study included 16 mice of 10 weeks that were placed into 2 study groups: a control group of 10 animals and another group of 6 animals with EAE that were injected with MOG35-55. The animals of the EAE model were monitored using motor disability scales. The retinas and optic nerves were processed for morphological examination by optical microscopy and ultrastructure studies. Results: The animal models presented with motor symptoms of spinal cord injury, with the first symptoms appearing between the 7 th and 19 th day post-injection, with a maximum disability mean of 3.5 points. In the retina, the mean RGC in the EAE group was 0.0891 μm, compared with 0.1678 μm of the control group (p = .0003). The ON was strongly affected with reactive gliosis, increased axonal damage and decreased density axonal (control group 0.38038 axons/μm2 versus EAE group 0.16 axons/μm2, p = .00032). Conclusions: In this work an animal model of EAE has been characterised and detailed for the study of demyelinating alterations in the retina and the ON. Its characteristics make it an excellent tool for the study of neurodegenerative ophthalmic diseases

Development and optimisation of an animal model for the study of ganglion cells in degenerative diseases of the retina and optic nerve. / Desarrollo y optimización de un modelo animal para el estudio de las células ganglionares en enfermedad degenerativa de la retina y nervio óptico.

INTRODUCTION: Multiple sclerosis is an autoimmune, chronic and inflammatory disease of the central nervous system with axonal demyelination, gliosis and neurodegeneration. It is considered a frequent cause of neurological disability in young adults. In this work, an Experimental Autoimmune Encephalomyelitis (EAE) model was optimised by injecting a myelin oligodendrocyte glycoprotein (MOG35-55). The ophthalmological effects were studied, as well as its use as an experimental model in other studies of retinal ganglion cell degeneration (RGC) and optic nerve (ON). MATERIAL AND METHODS: The study included 16 mice of 10 weeks that were placed into 2 study groups: a control group of 10 animals and another group of 6 animals with EAE that were injected with MOG35-55. The animals of the EAE model were monitored using motor disability scales. The retinas and optic nerves were processed for morphological examination by optical microscopy and ultrastructure studies. RESULTS: The animal models presented with motor symptoms of spinal cord injury, with the first symptoms appearing between the 7th and 19th day post-injection, with a maximum disability mean of 3.5 points. In the retina, the mean RGC in the EAE group was 0.0891µm, compared with 0.1678µm of the control group (p=.0003). The ON was strongly affected with reactive gliosis, increased axonal damage and decreased density axonal (control group 0.38038 axons/µm2 versus EAE group 0.16 axons/µm2, p=.00032). CONCLUSIONS: In this work an animal model of EAE has been characterised and detailed for the study of demyelinating alterations in the retina and the ON. Its characteristics make it an excellent tool for the study of neurodegenerative ophthalmic diseases.

Droplet distribution and airborne bacteria in an experimental shower unit.

Although human exposure to water aerosols is common in residential showers, the droplet distribution patterns generated in showers are not well understood nor is the bacteria released during shower operation. In this study, a two-phase flow Particle Tracking Velocimetry (PTV) algorithm was successfully used to characterize the spatial spray pattern and velocity field in two experimental showers (one low-flow and one high-flow). In addition, the airborne bacteria present in the shower over nearly 5 months of controlled operation was determined for both showers. The results indicate that the droplet velocity out of the low-flow showerhead (which had fewer orifices) was significantly higher than that out of the high-flow showerhead resulting in a higher aerosol number concentration in the low-flow shower and more consistent wetting of the shower wall. Both showerheads generated droplets in the respirable range and genera of potential health concern were observed in the shower aerosols measured both prior to and following shower operation. The study provides one of the first visualizations of droplet spray patterns in residential showers and provides insight into the airborne bacteria present in showers.

Learning outcomes evaluation of a simulation-based introductory course to anaesthesia. / Evaluación de los resultados de aprendizaje de un curso de introducción a la anestesiología basado en simulación clínica.

OBJECTIVE: An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. MATERIAL AND METHOD: Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed. RESULTS: Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues. CONCLUSIONS: A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization.

Guía de actuación clínica en la hemorragia subaracnoidea. Sistemática diagnóstica y tratamiento / Clinical practice guidelines for subarachnoid haemorrhage. Diagnosis and treatment

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[Innovation in healthcare processes and patient safety using clinical simulation]. / Innovando en procesos asistenciales y seguridad del paciente mediante simulación clínica.

OBJECTIVE: Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. MATERIAL AND METHODS: The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. RESULTS: Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. CONCLUSION: Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering.

Stock management in hospital pharmacy using chance-constrained model predictive control.

One of the most important problems in the pharmacy department of a hospital is stock management. The clinical need for drugs must be satisfied with limited work labor while minimizing the use of economic resources. The complexity of the problem resides in the random nature of the drug demand and the multiple constraints that must be taken into account in every decision. In this article, chance-constrained model predictive control is proposed to deal with this problem. The flexibility of model predictive control allows taking into account explicitly the different objectives and constraints involved in the problem while the use of chance constraints provides a trade-off between conservativeness and efficiency. The solution proposed is assessed to study its implementation in two Spanish hospitals.

Characterizing the bacterial communities in retail stores in the United States.

The microorganisms present in retail environments have not been studied in detail despite the fact that these environments represent a potentially important location for exposure. In this study, HVAC filter dust samples in 13 US retail stores were collected and analyzed via pyrosequencing to characterize the indoor bacterial communities and to explore potential relationships between these communities and building and environmental parameters. Although retail stores contained a diverse bacterial community of 788 unique genera, over half of the nearly 118K sequences were attributed to the Proteobacteria phylum. Streptophyta, Bacillus, Corynebacterium, Pseudomonas, and Acinetobacter were the most prevalent genera detected. The recovered indoor airborne microbial community was statistically associated with both human oral and skin microbiota, indicating occupants are important contributors, despite a relatively low occupant density per unit volume in retail stores. Bacteria generally associated with outdoor environments were present in the indoor communities with no obvious association with air exchange rate, even when considering relative abundance. No significant association was observed between the indoor bacterial community recovered and store location, store type, or season. However, predictive functional gene profiling showed significant associations between the indoor community and season. The microbiome recovered from multiple samples collected months apart from the same building varied significantly indicating that caution is warranted when trying to characterize the bacterial community with a single sampling event.