Learning about informal fallacies and the detection of fake news: An experimental intervention.

The philosophical concept of informal fallacies-arguments that fail to provide sufficient support for a claim-is introduced and connected to the topic of fake news detection. We assumed that the ability to identify informal fallacies can be trained and that this ability enables individuals to better distinguish between fake news and real news. We tested these assumptions in a two-group between-participants experiment (N = 116). The two groups participated in a 30-minute-long text-based learning intervention: either about informal fallacies or about fake news. Learning about informal fallacies enhanced participants' ability to identify fallacious arguments one week later. Furthermore, the ability to identify fallacious arguments was associated with a better discernment between real news and fake news. Participants in the informal fallacy intervention group and the fake news intervention group performed equally well on the news discernment task. The contribution of (identifying) informal fallacies for research and practice is discussed.

Ileosigmoid Knotting: A Case Series.

Ileosigmoid knotting is a rare case of intestinal obstruction that later leads to bowel necrosis. This is more common in males than females and seen more in areas with increased rates of sigmoid volvulus. The main clinical presentations are abdominal distention, abdominal pain and tenderness, vomiting, and obstipation. Definitive diagnosis is challenging due to its rarity and overlapping symptoms with other more common abdominal conditions. Delay in diagnosis and management can lead to peritonitis, necrosis of the bowel, sepsis, and eventually septic shock. Surgeons should consider ileosigmoid knotting in cases of acute abdomen, as it requires fast decision-making and intervention for a good prognosis. We present two cases of ileosigmoid knotting presenting with acute abdomen requiring emergent laparotomy with resection of necrotic bowel.

The use of oximetry and a questionnaire in primary care enables exclusion of a subsequent obstructive sleep apnea diagnosis.

PURPOSE: The study aims to prospectively validate the prognostic value of oximetry alone or combined in a two-step strategy with a questionnaire for the exclusion of obstructive sleep apnea (OSA) in primary care. METHODS: A total of 140 subjects with suspected OSA were included from 54 participating primary care practices. All subjects completed the Philips questionnaire and underwent one night of oximetry prior to referral to a sleep center. The prognostic value of two strategies was evaluated against the diagnosis of the sleep center as the gold standard: (1) assume OSA and subsequently refer to a sleep center if the oxygen desaturation index (ODI) is ≥ 5 and (2) assume OSA and refer to a sleep center if the Philips questionnaire score is ≥ 55% (regardless of the ODI) or if the Philips questionnaire score is < 55% and the ODI is ≥ 5. RESULTS: OSA was diagnosed in the sleep centers in 100 (71%) of the included subjects. Using ODI ≥ 5 alone resulted in a sensitivity of 99.0%, a specificity of 50.0%, a negative predictive value of 95.2%, and a positive predictive value 83.2%. Using the two-step strategy, oximetry would be performed on 39% of the subjects. This strategy resulted in a sensitivity of 100%, a specificity of 35.0%, a negative predictive value of 100%, and a positive predictive value of 79.4%. CONCLUSIONS: In a Dutch primary care population with a clinical suspicion of OSA and low frequency of cardiovascular comorbidities, the use of oximetry alone or combined in a two-step strategy with a questionnaire enables exclusion of a sleep center diagnosis of OSA.

Validation of the oxygen desaturation index in the diagnostic workup of obstructive sleep apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is common, and diagnosis requires expensive and laborious testing to assess the apnea hypopnea index (AHI). We performed an analysis to explore the relationship between the oxygen desaturation index (ODI) as measured with pulse oximetry and the AHI in our large portable monitoring (PM) database to find an optimal cutoff value for the ODI in order to be able to exclude AHI ≥ 5 on PM. METHODS: Three thousand four hundred thirteen PM recordings were randomly divided into a training set (N = 2281) and a test set (N = 1132). The optimal cutoff for the ODI to exclude an AHI ≥ 5 on PM was determined in the training set and subsequently validated in the test set. RESULTS: Area under the curve of the ODI to exclude an AHI ≥ 5 on PM was 0.997 in the training set and 0.996 in the test set. In the training set, the optimal cutoff to predict an AHI < 5 was an ODI < 5. Using this cutoff in the test set provided a sensitivity of 97.7%, a specificity of 97.0%, a positive predictive value of 99.2%, and a negative predictive value of 91.4%. CONCLUSION: An ODI < 5 predicts an AHI < 5 with high sensitivity and specificity when measured simultaneously using the same oximeter during PM recording.

Retrospective validation of a new volumetric capnography parameter for the exclusion of pulmonary embolism at the emergency department.

Volumetric capnography might be used to exclude pulmonary embolism (PE) without the need for computed tomography pulmonary angiography. In a pilot study, a new parameter (CapNoPE) combining the amount of carbon dioxide exhaled per breath (carbon dioxide production (V CO2 )), the slope of phase 3 of the volumetric capnogram (slope 3) and respiratory rate (RR) showed promising diagnostic accuracy (where CapNoPE=(V CO2 ×slope 3)/RR). To retrospectively validate CapNoPE for the exclusion of PE, the volumetric capnograms of 205 subjects (68 with PE) were analysed, based on a large multicentre dataset of volumetric capnograms from subjects with suspected PE at the emergency department. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and diagnostic accuracy of the in-pilot established threshold (1.90 Pa·min) were calculated. CapNoPE was 1.56±0.97 Pa·min in subjects with PE versus 2.51±1.67 Pa·min in those without PE (p<0.001). The AUC of the ROC curve was 0.714 (95% CI 0.64-0.79). For the cut-off of ≥1.90 Pa·min, sensitivity was 64.7%, specificity was 59.9%, the negative predictive value was 77.4% and the positive predictive value was 44.4%. The CapNoPE parameter is decreased in patients with PE but its diagnostic accuracy seems too low to use in clinical practice.

Reproducibility of hypercapnic ventilatory response measurements with steady-state and rebreathing methods.

In this study, the hypercapnic ventilatory response (HCVR) was measured, defined as the ventilation response to carbon dioxide tension (PCO2 ). We investigated which method, rebreathing or steady-state, is most suitable for measurement of the HCVR in healthy subjects, primarily based on reproducibility. Secondary outcome parameters were subject experience and duration. 20 healthy adults performed a rebreathing and steady-state HCVR measurement on two separate days. Subject experience was assessed using numeric rating scales (NRS). The intraclass correlation coefficient (ICCs) of the sensitivity to carbon dioxide above the ventilatory recruitment threshold and the projected apnoea threshold were calculated to determine the reproducibility of both methods. The ICCs of sensitivity were 0.89 (rebreathing) and 0.56 (steady-state). The ICCs of the projected apnoea threshold were 0.84 (rebreathing) and 0.25 (steady-state). The steady-state measurement was preferred by 16 out of 20 subjects; the differences in NRS scores were small. The hypercapnic ventilatory response measured using the rebreathing setup provided reproducible results, while the steady-state method did not. This may be explained by high variability in end-tidal PCO2 . Differences in subject experience between the methods are small.

Challenges in the implementation of EAACI guidelines on allergen immunotherapy: A global perspective on the regulation of allergen products.

Regulatory approaches for allergen immunotherapy (AIT) products and the availability of high-quality AIT products are inherently linked to each other. While allergen products are available in many countries across the globe, their regulation is very heterogeneous. First, we describe the regulatory systems applicable for AIT products in the European Union (EU) and in the United States (US). For Europe, a depiction of the different types of relevant procedures, as well as the committees involved, is provided and the fundamental role of national agencies of the EU member states in this complex and unique network is highlighted. Furthermore, the regulatory agencies from Australia, Canada, Japan, Russia, and Switzerland provided information on the system implemented in their countries for the regulation of allergen products. While AIT products are commonly classified as biological medicinal products, they are made available by varying types of procedures, most commonly either by obtaining a marketing authorization or by being distributed as named patient products. Exemptions from marketing authorizations in exceptional cases, as well as import of allergen products from other countries, are additional tools applied by countries to ensure availability of needed AIT products. Several challenges for AIT products are apparent from this analysis and will require further consideration.

Allergen manufacturing and quality aspects for allergen immunotherapy in Europe and the United States: An analysis from the EAACI AIT Guidelines Project.

Adequate quality is essential for any medicinal product to be eligible for marketing. Quality includes verification of the identity, content and purity of a medicinal product in combination with a specified production process and its control. Allergen products derived from natural sources require particular considerations to ensure adequate quality. Here, we describe key aspects of the documentation on manufacturing and quality aspects for allergen immunotherapy products in the European Union and the United States. In some key parts, requirements in these areas are harmonized while other fields are regulated separately between both regions. Essential differences are found in the use of Reference Preparations, or the requirement to apply standardized assays for potency determination. As the types of products available are different in specific regions, regulatory guidance for such products may also be available in one specific region only, such as for allergoids in the European Union. Region-specific issues and priorities are a result of this. As allergen products derived from natural sources are inherently variable in their qualitative and quantitative composition, these products present special challenges to balance the variability and ensuring batch-to-batch consistency. Advancements in scientific knowledge on specific allergens and their role in allergic disease will consequentially find representation in future regulatory guidelines.

Proposals for harmonization of allergens regulation in the European Union

Allergen medicinal products in the European Union are regulated differently across the different Member States. Thus, whereas in some countries strict quality, safety and efficacy requirements are in place, in others, most allergens are on the market as Named Patient Products, without any regulatory oversight. This situation results on European allergic patients being exposed to totally different standards depending on where they live. Initiatives to correct this situation are needed (AU)

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Proposals for harmonization of allergens regulation in the European Union.

Allergen medicinal products in the European Union are regulated differently across the different Member States. Thus, whereas in some countries strict quality, safety and efficacy requirements are in place, in others, most allergens are on the market as Named Patient Products, without any regulatory oversight. This situation results on European allergic patients being exposed to totally different standards depending on where they live. Initiatives to correct this situation are needed.

Food by-products as potential antioxidant and antimicrobial additives in chill stored raw lamb patties.

The aim of this work was to study the in vitro antioxidant potential of aqueous extracts obtained from tomato (TOM), red grape (GRA), olive (OLI) and pomegranate (POM) by-products as well as to evaluate the effect of their addition into lamb meat patties (1000mg/kg) in order to improve shelf life. A negative (CON) and a positive control (sodium ascorbate, ASC) were also included in the experiment. Results for radical scavenging activity, metal chelating activity and reducing power indicated that GRA and OLI extracts could inhibit oxidation more efficiently than POM and TOM extracts (P<0.01). Consistently, GRA and OLI treatments showed the highest redness (a*) (P<0.01) and antioxidant activity, both for lipids and proteins, throughout storage (P<0.001). Furthermore, in general, microbial counts were reduced by the addition of by-products extracts. These results suggest that the extracts obtained from grape and olive pomaces could be effectively used to replace sodium ascorbate in lamb meat products.

The TL,NO /TL,CO ratio cannot be used to exclude pulmonary embolism.

BACKGROUND: The existing screening modalities for pulmonary embolism (PE), such as D-dimer and clinical prediction rules, have low positive predictive values. With its capability to indicate pulmonary vascular abnormalities, the ratio of the transfer factor of the lungs for nitric oxide and the transfer factor of the lungs for carbon monoxide (TL,NO /TL,CO ) might be an additional discriminating parameter. METHODS: Carbon monoxide/Nitric oxide diffusion measurements were performed on unselected patients seen on the emergency department for which due to suspected PE a computed tomography pulmonary angiogram (CTPA) was ordered. RESULTS: A total of 28 patients were included, PE was found in 12 on CTPA. Median TL,NO /TL,CO ratio was 4·09 (interquartile range (IQR) 3·83-4·40) in the no PE group versus 4·00 (IQR 3·78-4·32) in the PE group (P = 0·959). Median alveolar volume was 77·1% of predicted in the no PE group versus 71·0% of predicted in the PE group (P = 0·353). Median TL,CO was 75·8% of predicted in the no PE group versus 68·8% of predicted in the PE group (P = 0·120). Median TL,NO was 69·3% of predicted in the no PE group versus 60·5% of predicted in the PE group (P = 0·078). CONCLUSION: The presented data indicate that the TL,NO /TL,CO ratio cannot be used to exclude PE.

Volumetric capnography in the exclusion of pulmonary embolism at the emergency department: a pilot study.

The analysis of the [Formula: see text] in expired air as a function of the exhaled volume (volumetric capnography) might result in a more specific exclusion tool for pulmonary embolism (PE) in addition to the Wells-score and D-dimer. A novel combination of volumetric capnography parameters ([Formula: see text]) should be decreased in PE and could possibly be used to decrease the number of requested computed tomography pulmonary angiograms (CTPA). Volumetric capnography measurements were performed on consecutive patients seen in the emergency department for which, due to suspected PE (due to increased D-dimer level or Wells-score), a CTPA was ordered. A total of 30 subjects were included, of which in 13 PE was seen on CTPA. Median [Formula: see text] was 4.36 kPa (IQR 3.92-4.88) in the no PE group versus 4.07 kPa (IQR 3.37-4.39) in the PE group (p = 0.086). Median of the novel parameter [Formula: see text] was 1.85 min.kPa dl-1 (IQR 1.21-3.00) in the no PE group versus 1.18 min.kPa dl-1 (IQR 0.61-1.38) in the PE group (p = 0.006). Using a threshold for the new parameter of 1.90 min.kPa dl-1 or higher to exclude PE resulted in a negative predictive value of 100% (95% CI: 77%-100%) and would have potentially excluded PE in 47% (95% CI: 26%-69%) of the no PE group without the need for CTPA. This pilot study introduces a novel parameter [Formula: see text] which is significantly decreased in PE subjects. Future studies regarding validation and addressing aspects such as reproducibility and normalization after treatment are needed to confirm its usability in excluding PE in the emergency department.

Isolation and identification of low molecular weight antioxidant compounds from fermented "chorizo" sausages.

This work is focused on the determination of low molecular weight compounds extracted from samples of fermented sausages. The antioxidant activity of fractions isolated from chorizo extracts was tested by their ability to quench free radicals by the DPPH-radical scavenging assay. Natural dipeptides and metabolites characteristic of meat were abundant in the fractions isolated by RP-HPLC from chorizo extracts. Due to extensive degradation during the ripening of chorizo, the extracts did not contain many peptides in a concentration that allowed identification. However, many free amino acids were identified by LC-MS/MS and HILIC-MS/MS. The fractions with the most hydrophilic compounds showed the highest antioxidant activity.

Evaluation of two natural extracts (Rosmarinus officinalis L. and Melissa officinalis L.) as antioxidants in cooked pork patties packed in MAP.

Two natural extracts, from rosemary (Rosmarinus officinalis L.; Nutrox) and lemon balm (Melissa officinalis L.; Meliox) showing a potential antioxidant activity, have been evaluated and compared with a synthetic antioxidant (Butylated hydroxytoluene; BHT) and a control batch. Pork meat patties were made by addition of the mentioned compounds, cooked and packed in modified atmosphere and stored under illumination for 6 days. A descriptive sensory analysis was also conducted. The patties with natural extracts showed higher a*-values (P<0.001) than control and BHT samples. Cooked pork hardness was the lowest for Meliox batch after 0 and 3 days of storage in comparison with the rest of the batches. Nutrox batch showed the lowest TBARS values and hexanal content (P<0.05) throughout the storage period. The batches with natural antioxidants produced the highest concentrations of free thiol groups after 0 and 3 days. Differences in sensory attributes among batches were not detected by the judge panel.

Effect of different cooking methods on lipid oxidation and formation of free cholesterol oxidation products (COPs) in Latissimus dorsi muscle of Iberian pigs.

The aim of this work was to study the influence of different cooking methods (grilled (GR), fried (FP), microwave (MW) and roasted (RO)) on lipid oxidation and formation of free cholesterol oxidation products (COPs) of meat from Iberian pigs that have been fed on an intensive system. Moisture and total lipid content, TBARs, hexanal and COPs were measured in Latissimus dorsi muscle samples. Cooking did not produce changes in total lipid content in meat but induced significantly higher lipid oxidation (TBARs and hexanal values) (p<0.001) and cholesterol oxidation (COPs) (p<0.01). When the different cooking methods were studied, the grilled method was the least affected by lipid oxidation (TBARs and hexanal) compared to the others. There were no significant differences among different cooking methods on COPs values. The most abundant cholesterol oxides were both 7α-hydroxycholesterol and 7ß-hydroxycholesterol in all groups studied.

Longitudinal analysis of cytokine gene expression and parasite load in PBMC in Leishmania infantum experimentally infected dogs.

Canine visceral leishmaniasis (CVL) is caused by Leishmania infantum, an intracellular protozoan parasite that causes a severe infectious disease. To evaluate the gene expression profile associated to CVL in vivo, we have measured monthly by real-time PCR over one year the IL-4, IL-10, IL-12, IL-13, IFN-gamma, TGF-beta and TNF-alpha mRNA levels in peripheral blood mononuclear cells in 6 experimentally infected dogs that exhibited different progressions of the illness. While in two dogs no parasite, or a very low number of parasites, was detected and the two dogs did not show any clinico-pathological abnormalities at the end of the study (L dogs), for the remaining dogs high parasite loads were detected and they developed clinical leishmaniasis (H dogs). The L dogs have null expression of both IL-4 and IL-13 for the first 4 months after the infection, whereas an early IL-4 and IL-13 expression occurs in this period of infection in most of the dogs that developed clinical leishmaniasis (H dogs). Furthermore, a higher IFN-gamma expression was associated with the increase of parasite load and clinical status in these dogs. Moreover, the high variability of expression at the pre-infection stage causes us to reject the possibility that the basal levels of these cytokines indicate the prognosis of the subsequent response against infection.

DNA immunisation with minimalistic expression constructs.

The low efficacy obtained in large animals makes plasmid-based DNA vaccines commercially unviable. Another concern is the presence of antibiotic resistance markers on virtually all conventional plasmids. Here we describe the use of minimalistic, immunogenically defined gene expression (MIDGE) vectors for DNA vaccination. MIDGE are linear, covalently-closed vectors containing all the essential information for gene expression and none of the non-essential and potentially dangerous plasmid backbone sequences. MIDGE vectors can also be chemically modified on both ends at defined positions allowing targeting of the DNA to specific cell types or cellular compartments. Immunisation of mice with simple and end-modified MIDGE vectors showed that they are efficacious tools to generate and/or manipulate antigen-specific immune responses.

Vacunación con DNA: una perspectiva inmunológica / DNA vaccination: an immunological perspective

La vacunación con DNA es una nueva y prometedora estrategia para la prevención y el tratamiento de muchas enfermedades debido a su habilidad para inducir una respuesta inmunitaria tanto humoral como celular, frente al antígeno codificado por el DNA recombinante. Una vez inoculado en el huésped, el DNA se introduce en las células, donde el antígeno se expresa y se procesa para ser después reconocido por el sistema inmunitario como si se tratase de una infección natural. Esta tecnología presenta grandes esperanzas para ser usada en la inmunoterapia del cáncer y se espera que llegue a ser el método preferido para la próxima generación de vacunas, particularmente adecuadas contra infecciones intracelulares para las que no hay vacunas efectivas. Esta revisión se centra en los mecanismos por los cuales la vacunación con DNA es capaz de inducir una respuesta inmunitaria y los abordajes que se están llevando a cabo para su optimización. También se ofrece una visión general sobre las aplicaciones de la vacunación con DNA (AU)

Fatty acids and triacylglycerols profiles from different types of Iberian dry-cured hams.

Thirty hams were allotted into four groups according to fattening diet ("Montanera" - acorns and pasture; and "Pienso" - concentrated diet) and genotype of pigs (Iberian and Iberian×Duroc pigs). Total lipids, triacylglycerol composition and fatty acids from neutral lipids fraction were measured in biceps femoris muscle. Fattening diet largely affected lipid composition of hams. Total intramuscular lipids and triacylglycerols content were higher in Montanera hams than in Pienso hams. In Montanera hams, triacylglycerols contained more oleic acid (C18:1) and less stearic (C18:0) and palmitic (C16:0) acids (p<0.001) and accordingly less PSO, PPL, PPO, PPS, SSO (p<0.001) and more OLL, OOL, OOO triacylglycerols compared to Pienso hams (p<0.001). Genotype of pigs has an important effect in triacylglycerols composition but only a limited effect on their fatty acids composition. So, Iberian hams contained more of PLLn, PLL, POLn and POL+SLL compared to Iberian×Duroc hams (p<0.001) and POO and SOO were present in a higher quantity in Iberian×Duroc hams (p<0.01).