Pediatric Tele-Home Care Compared to Usual Care: Cost-Minimization Analysis.

BACKGROUND: Although home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. OBJECTIVE: The aim of this study is to compare the average cost of a discharge by tele-home care with the usual care and to analyze the main drivers of the differential costs of both care models. METHODS: A cost-minimization analysis is conducted under a hospital's perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. RESULTS: A 24-hour stay at the hospital costs US $574.19, while the in-home hospitalization costs US $301.71 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main saving drivers were the personnel costs (US $102.83/US $284.53, 35.5% of the total), intermediate noncare costs (US $6.09/US $284.53, 33.17%), and structural costs (US $55.16/US $284.53, 19.04%). Home hospitalization involves a total stay 27.61% longer, but at almost half the daily cost, and thus represents a saving of US $176.70 (9.01%) per 24-hour stay. CONCLUSIONS: The cost analysis conducted under a hospital perspective shows that pediatric tele-home care is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction.

Estudio del consenso en la nosología y la terminología del trastorno específico del lenguaje (TEL) en lengua catalana (Cataluña y Mallorca) con metodología Delphi / Study of the consensus on the nosology and terminology of specific language impairment (SLI) in the Catalan language (Catalonia and Majorca) using the Delphi methodology

La nosología y la terminología del trastorno específico del lenguaje (TEL) es confusa para los profesionales y los familiares de las personas que lo padecen, así como desajustada ante los conocimientos y datos actuales. Para clarificar y evaluar esta situación en el ámbito de habla catalana se ha realizado la primera fase de un estudio tipo Delphi con 24 participantes experimentados en el TEL. Se ha empleado un cuestionario con 40 preguntas acerca de la situación, la caracterización nosológica y sus términos actuales.La propuesta de nosología (descriptiva) de un nuevo esquema de caracterización diagnóstica de los trastornos se ha aceptado parcialmente. Se ha alcanzado un consenso en su descripción externa: nivel alto de gravedad, mejoría en comunicación y dificultades estructurales persistentes de lenguaje, con consecuencias funcionales graves de tipo social y educativo en la adaptación. Ha habido un acuerdo para cada tipología nosológica particular: El TEL como específico y principal, ya sea asilado o asociado con la presencia de alguna diferenciación biomédica (causal), o con comorbilidades (correlacionadas) o con factores de riesgo (relacionados de forma individual). El consenso no se alcanzó para el conjunto de ellas como marco para situar los trastornos del lenguaje.Los resultados han mostrado que no hay acuerdo en diversas propuestas terminológicas presentadas, pero tampoco hay oposición a un cambio progresivo para otra denominación como la del trastorno del desarrollo del lenguaje (TDL).Se ha llegado a obtener un consenso sobre la mayoría de las cuestiones relativas a las situaciones de detección, evaluación e intervención logopédica.(AU)

The nosology and terminology of specific language impairment (SLI) has been considered by many professionals not only confused, but also out of step with current available knowledge and data. This impression is shared by many families and social institutions. To help clarify SLI in the Catalan speaking population we undertook a Delphi project. Ten known experts in the field set up the project, and there were 24 participants. Forty propositions were presented on the situation (diagnosis and management), characterization and nosology, together with the terminology in use.The proposal of (descriptive) nosology for a new diagnostic characteristics scheme was accepted but consensus was not reached. Consensus was reached on its symptomatic description: high level of severity, improvement in communication, but persistent structural difficulties of language, with serious functional, social and educational consequences in adaptation. The most important result was the consensus for each particular nosological specification, although not for the whole as an expression of language disorders: SLI as specific and principal, either isolated or associated with the presence of some biomedical (causal) differentiation, or with co-morbidities (correlated) or with the presence of risk factors (individually associated). The results show no consensus on the terminology proposals; however, there was no opposition to a progressive change to another name such as developmental language disorders (DLD). Consensus was also reached on most issues related to situations of detection, evaluation and speech and language therapy intervention.(AU)

Aln2tbl: building a mitochondrial features table from a assembly alignment in fasta format.

The sequencing, annotation and analysis of complete mitochondrial genomes is an important research tool in phylogeny and evolution. Starting with the primary sequence, genes/features are generally annotated automatically to obtain preliminary annotations in the form of a feature table. Further manual curation in a graphic alignment editor is nevertheless necessary to revise annotations. As such, the automatically generated feature table is invalidated and has to be modified manually before submission to data banks. We developed aln2tbl.py, a python script that recreates a feature table from a manually refined alignment of genes mapped on the mitochondrial genome in fasta format. The feature table is populated with notes and annotations specific to mitochondrial genomes. The table can be used to create a sqn file to be submitted directly to data banks. In summary, our scripts fills one gap in the available toolbox and, combined with other software, allows the automation of the entire process, from primary sequence to annotated genome submission, even if a manual curation step is conducted in a visual sequence editor.

Sociodemographic and Pre-Linguistic Factors in Early Vocabulary Acquisition.

Here, we studied the beginnings of language development, jointly assessing two groups of precursors, sociodemographic and pre-linguistic, that have previously been studied separately. Thus, the general objective of this study was to explore which factors best explained the acquisition of initial expressive vocabulary. The sample consisted of 504 participants from Catalan-speaking homes with ages ranging between 10 and 18 months. The data were obtained through the MacArthur-Bates Communicative Development Inventories (MCB-CDIs). Vocabulary development shows a lexical spurt at 17 months. Regression analyses show that pre-linguistic factors have more explanatory power of than sociodemographic ones. Within the sociodemographic variables, age, birth order and birth weight explain part of the vocabulary variance. With respect to pre-linguistic variables, imitation, late gestures and phrase comprehension are predictors of the initial vocabulary acquisition. Specifically, imitation and late gestures were the pre-linguistic behaviours that made it possible to distinguish between children with higher and lower levels of vocabulary. We discussed these findings in relation to their relevance for language acquisition and for the early assessment of linguistic competence.

Endpoints and design of clinical trials in patients with decompensated cirrhosis: Position paper of the LiverHope Consortium.

Management of decompensated cirrhosis is currently geared towards the treatment of complications once they occur. To date there is no established disease-modifying therapy aimed at halting progression of the disease and preventing the development of complications in patients with decompensated cirrhosis. The design of clinical trials to investigate new therapies for patients with decompensated cirrhosis is complex. The population of patients with decompensated cirrhosis is heterogeneous (i.e., different etiologies, comorbidities and disease severity), leading to the inclusion of diverse populations in clinical trials. In addition, primary endpoints selected for trials that include patients with decompensated cirrhosis are not homogeneous and at times may not be appropriate. This leads to difficulties in comparing results obtained from different trials. Against this background, the LiverHope Consortium organized a meeting of experts, the goal of which was to develop recommendations for the design of clinical trials and to define appropriate endpoints, both for trials aimed at modifying the natural history and preventing progression of decompensated cirrhosis, as well as for trials aimed at managing the individual complications of cirrhosis.

Predicting risk of dyslexia with an online gamified test.

Dyslexia is a specific learning disorder related to school failure. Detection is both crucial and challenging, especially in languages with transparent orthographies, such as Spanish. To make detecting dyslexia easier, we designed an online gamified test and a predictive machine learning model. In a study with more than 3,600 participants, our model correctly detected over 80% of the participants with dyslexia. To check the robustness of the method we tested our method using a new data set with over 1,300 participants with age customized tests in a different environment -a tablet instead of a desktop computer- reaching a recall of over 78% for the class with dyslexia for children 12 years old or older. Our work shows that dyslexia can be screened using a machine learning approach. An online screening tool in Spanish based on our methods has already been used by more than 200,000 people.

High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study.

BACKGROUND & AIMS: Liver fibrosis is the main determinant of long-term outcome in chronic liver diseases. Little is known about the prevalence of liver fibrosis in the general population. The aim of the study was to investigate the prevalence of liver fibrosis in the general adult population with unknown liver disease. METHODS: This was a population-based, cross-sectional study performed in the Barcelona metropolitan area. Subjects aged 18 to 75 years old were identified randomly from citizens included in the primary health care registry. Of 4866 subjects invited, 3076 participated (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS. RESULTS: Prevalence estimates of increased LS (≥6.8, ≥8.0, and ≥9.0 kPa) were 9.0%, 5.8%, and 3.6%, respectively. The etiology of liver disease was mainly nonalcoholic fatty liver disease (NAFLD), followed by alcohol risk consumption (consumption of ≥21 standard drinking units/wk in men and ≥14 standard drinking units/wk in women). Factors independently associated with increased LS were male sex, abdominal obesity, type 2 diabetes, serum glucose, high-density lipoprotein, and triglyceride levels. Subjects without risk factors for NAFLD or without alcohol risk consumption had a very low prevalence of increased LS. The best cut-off value of LS for significant liver fibrosis (F2-F4) was 9.2 kPa, with high sensitivity and specificity. TE was more accurate than alanine aminotransferase, NAFLD fibrosis score, or Fibrosis 4. An algorithm for screening for liver fibrosis using TE in the community setting is proposed. CONCLUSIONS: These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes.

Comparative efficacy and safety of antibiotics used to treat acute bacterial skin and skin structure infections: Results of a network meta-analysis.

OBJECTIVE: This NMA compared the efficacy and safety between IV antibiotics that are used in the current standard of care for managing adult patients (≥18 years of age) with ABSSSI. METHODS: Comparators were chosen on the basis that both direct and indirect comparisons between the interventions of interest could be performed. Outcomes of the analysis were selected on the basis that they are frequently measured and reported in trials involving ABSSSI patients, and only published randomised control trials of any size and duration and with any blinding status were eligible for inclusion in the analysis. The NMA was performed using both a fixed-effect and random-effect model. Efficacy-related endpoints were (1) clinical treatment success and (2) microbiological success at TOC visit. Safety-related endpoints were (1) number of discontinuations due to AEs/SAEs, (2) patients experiencing AEs, (3) patients experiencing SAEs and (4) all-cause mortality. RESULTS: Study interventions included daptomycin, dalbavancin, linezolid and tigecycline. Vancomycin was the comparator in all studies, except in two where it was linezolid and teicoplanin. The NMA showed that irrespective of patient subgroup, the likelihood of clinical and microbiological success with dalbavancin was statistically similar to the comparators studied. No statistically significant differences were observed between dalbavancin and any of the comparators in the discontinuation rate due to AEs/SAEs. In contrast, dalbavancin was associated with a significantly lower likelihood of experiencing an AE than linezolid, a significantly lower likelihood of experiencing a SAE than vancomycin and daptomycin, and a significantly lower risk of all-cause mortality than vancomycin, linezolid and tigecycline. CONCLUSION: Dalbavancin affords a promising, new alternative IV antimicrobial agent which is as effective as traditional therapies, but with the added benefit of enabling clinicians to treat patients with ABSSSI in different organisational settings. Notwithstanding, any introduction of an effective treatment with a differential mode of administration into healthcare systems must be followed by a change in clinical practice and patient management in order to fully achieve desirable economic outcomes.

La memoria de trabajo, capacidad y procedimientos, en el trastorno específico del lenguaje: análisis visual de eventos y su expresión oral / Working memory, ability and procedures in specific language impairment: visual analysis of events and their oral expression

Objetivo. Este estudio se enmarca en la perspectiva teórica de considerar las habilidades cognitivas como factores contribuyentes al trastorno específico del lenguaje (TEL). El propósito de la investigación es clarificar si se dan diferencias en los procedimientos empleados en la memoria de trabajo (MdT) de los TEL. El experimento comparativo realizado concierne a la percepción visual, la representación y la descripción de unas imágenes que ilustran eventos de tipo mental. Método. Se estudian 2 grupos de 13 niños y niñas, de entre 5 y 8 años, uno con TEL y otro de desarrollo normal (DN) de control. La tarea experimental, registrada con eye tracker y vídeo, consiste en el análisis visual de las áreas de interés de las imágenes mentales y su descripción oral, que requiere 2 verbos. Resultados. Las diferencias esperadas en el análisis visual no se han confirmado en su conjunto. Sí lo han sido para la fluidez, la velocidad en el inicio de la descripción, el desorden de los constituyentes y el tiempo empleado hasta el inicio de los verbos. Todos ellos son informativos de diferencias en los procesos de la MdT. Entre los TEL menores las diferencias han sido más amplias que entre los mayores. Conclusión. Las diferencias halladas apuntan a la existencia de múltiples procesamientos diferenciados en el grado de habilidad (datos temporales) y solo alguno, como la planificación y el orden de los constituyentes, son distintos. Estas diferencias son mucho más claras para los TEL menores (AU)

Purpose. This study is grounded on the perspective which holds that cognitive abilities contribute to the specific language impairment (SLI). The goal of this research is to find out if distinct procedures can be measures and identified in their working memory (WM). The task employed in the comparative experiment involves the visual analysis and perception of events, its representations and description of images depicting mental events. Method. Two groups of 13 children from 5 to 8 years old, SLI and a normal developing group (ND) conform the sample. The study comprises the eye tracked visual analysis of images illustrating mental events, and their video registered oral description that requires 2 verbs. Results. The results of the visual analysis have not supported the majority of predictions. They validated only the predictions about fluency, readiness in the beginning of the oral description, the clutter of constituents, and the time elapsed until uttering the verbs. All of them are informative about the processes hold in the WM. The differences with young SLI have been much more important than those found in the older groups. Conclusion. The results reflect some differences in the non verbal WM procedures, mainly in their level of cognitive proficiency (temporal data), and only some, like planning and constituent order have been found diverse. The differences are much more evident for the young SLI group (AU)

Study of the Specific Language Impairment in a three-generation family / Estudio del trastorno específico del lenguaje en tres generaciones de una familia

Purpose. Three members of a family, one of each generation, are studied in order to obtain their SLI language profile, together with motor and cognitive data. Additional information on the absence of FOXP2 mutations is also provided. Method. The language profile is twofold: natural conversation and language tests, and an evaluation of their cognitive abilities, oral-motor praxis, and laterality. Results. Cognitive abilities (short term and procedural working memory, perception, conceptual and coherence strategies) are not at the average level. General oral fine mobility (not the speech apraxia), fluency and auditory phonetic discrimination are impaired at different degrees. The language phenotype exhibits lexical as well as syntactic processing difficulties as the main impairments. The language competence of the adult members is simple but sufficient for everyday communication. Conclusions. The long-standing language competence results of SLI show an adaptation in terms of simplicity, high frequency strategies, and pragmatic resources. Language profile, sensory-motor abilities and cognition favour a non-specific approach to the language acquisition impairment (AU)

Objetivo. Estudiar tres miembros de una familia con Trastorno Específico del Lenguaje (TEL), uno de cada generación, para obtener su perfil de lenguaje, junto a otros datos de tipo motriz y cognitivo. Se aporta información adicional sobre la ausencia de mutaciones en el gen FOXP2. Método. El perfil del lenguaje que se presenta es doble: Los datos provienen de conversaciones naturales y de tests de lenguaje. También son evaluadas sus habilidades cognitivas, sus praxias oro- motrices y su lateralidad. Resultados. Las habilidades cognitivas de las memorias a corto termino y procedimental de trabajo, la percepción, la conceptuación y las estrategias de construcción de coherencia (texto), no alcanzan un nivel de normalidad. La movilidad fina oral general (no la apraxia de habla), la fluidez, y la fonética auditiva son deficientes en grados diversos. El fenotipo del lenguaje manifiesta sus máximas dificultades de procesamiento en los niveles léxico y sintáctico. Los adultos tienen un lenguaje coloquial muy simple pero normal. Conclusiones. La competencia lingüística de los miembros mayores muestra una buena adaptación, resaltando sus estrategias de simplicidad, usos de alta frecuencia y buena pragmática comunicativa. El perfil del lenguaje, las habilidades sensorio - motrices y las cognitivas favorecen una aproximación no especifica al TEL (AU)

Relationships between serotonergic and cannabinoid system in depressive-like behavior: a PET study with [11C]-DASB.

Chronic stress represents a major environmental risk factor for mood disorders in vulnerable individuals. The neurobiological mechanisms underlying these disorders involve serotonergic and endocannabinoid systems. In this study, we have investigated the relationships between these two neurochemical systems in emotional control using genetic and imaging tools. CB1 cannabinoid receptor knockout mice (KO) and wild-type littermates (WT) were exposed to chronic restraint stress. Depressive-like symptoms (anhedonia and helplessness) were produced by chronic stress exposure in WT mice. CB1 KO mice already showed these depressive-like manifestations in non-stress conditions and the same phenotype was observed after chronic restraint stress. Chronic stress similarly impaired long-term memory in both genotypes. In addition, brain levels of serotonin transporter (5-HTT) were assessed using positron emission tomography. Decreased brain 5-HTT levels were revealed in CB1 KO mice under basal conditions, as well as in WT mice after chronic stress. Our results show that chronic restraint stress induced depressive-like behavioral alterations and brain changes in 5-HTT levels similarly to those revealed in CB1 KO mice in non-stressed conditions. These results underline the relevance of chronic environmental stress on serotonergic and endocannabinoid transmission for the development of depressive symptoms. Chronic restraint stress induces depressive-like behavior and reduced 5-HTT levels in WT mice similar to those revealed in non-stressed CB1-KO mice. Reduced 5-HTT in both genotypes increases synaptic 5-HT concentration. The 5-HT release is modulated through CB1 receptors and the absence of inhibitory CB1 receptor causes decreased inhibition of 5-HT release resulting in high synaptic 5-HT concentration that are not further enhanced by stress.

Positron emission tomographic imaging of the cannabinoid type 1 receptor system with [¹¹C]OMAR ([¹¹C]JHU75528): improvements in image quantification using wild-type and knockout mice.

In this study, we assessed the feasibility of using positron emission tomography (PET) and the tracer [¹¹C]OMAR ([¹¹C]JHU75528), an analogue of rimonabant, to study the brain cannabinoid type 1 (CB1) receptor system. Wild-type (WT) and CB1 knockout (KO) animals were imaged at baseline and after pretreatment with blocking doses of rimonabant. Brain uptake in WT animals was higher (50%) than in KO animals in baseline conditions. After pretreatment with rimonabant, WT uptake lowered to the level of KO animals. The results of this study support the feasibility of using PET with the radiotracer [¹¹C]JHU75528 to image the brain CB1 receptor system in mice. In addition, this methodology can be used to assess the effect of new drugs in preclinical studies using genetically manipulated animals.

Genes differentially expressed in CB1 knockout mice: involvement in the depressive-like phenotype.

Recent hypotheses to explain the neurobiology of depression underline the role played by stress in mood disorders. The endocannabinoid system is one of the major physiological substrates involved in emotional responses and stress. Thus, mice lacking CB(1) receptor exhibit a depressive-like phenotype and an increased vulnerability to deleterious effects of stress. In order to identify possible molecular pathways contributing to this phenotype, we have examined the gene expression profile of mutants at basal conditions and after the exposure to repeated stress. Several genes coding for neurotransmitter receptors, neurotrophic factors, neuropeptides and hormones receptors were differentially expressed in CB(1) knockout mice.

Verb morphology in Catalan and Spanish in children with specific language impairment: a developmental study.

In this article we examine language processing and development in Catalan or Spanish-speaking children with SLI, focusing on the study of the verb. We analyse the key initial phase of its process of acquisition and aim to define common features of the SLI group that distinguish them from children with normal language development. We intend to identify more precisely the kind of delay shown by these children in a language with a rich verb morphology, in terms of both structure and chronology. The sample comprised 18 Catalan-Spanish bilingual pre-school children, assigned to three groups of six; an SLI group and two control groups, one matched for age and the other matched for MLU-w. Developmental data were obtained by recording situations of spontaneous speech at two different time points. Certain differences were found between groups in verb production. Production of verb inflection by children with SLI was only partial at the first evaluation; they maintained the same percentage of errors after a year. The patterns of correct and incorrect verb forms found in Catalan and Spanish do not corroborate the EOI hypothesis, but they support the Surface Hypothesis, given that the number of errors is not particularly high. This suggests the presence of limitations in subjects' processing ability, linked to the typological characteristics of the specific language being learnt.

Paciente con artritis por cuerpo extraño: púa de erizo de mar / A case of arthritis produced by a foreing body: sea urchin spines

La artritis por cuerpo extraño está producida por la penetración de partículas en el interior o proximidad de articulaciones, bolsas serosas o vainas tendinosas.Presentamos un caso de sinovitis por púa de erizo de mar, en el que se producía clínica en forma de tumefacción, dolor e impotencia funcional de articulaciones, y que presentaba exacerbaciones de los síntomas con las nuevas punciones. Las técnicas de imagen como la radiografía simple, la tomografía axial computarizada o la resonancia magnética nuclear pueden ayudar en el diagnóstico y localización del cuerpo extraño. Los datos analíticos y microbiológicos enfocarán el tratamiento médico que en algunos casos sólo será complementario al tratamiento quirúrgico. La anatomía patológica puede identificar cuerpo extraño, y en la mayoría de los casos puede aparecer una reacción granulomatosa similar a una enfermedad tipo sarcoidosis o tuberculosis. En el caso que nos ocupa los cultivos microbiológicos siempre fueron negativos, por lo que no fue necesario tratamiento antibiótico (AU)

Flúor: un viejo y buen amigo / Fluor: and old and gold friend

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