Advancements in Home-Based Devices for Detecting Obstructive Sleep Apnea: A Comprehensive Study.

Obstructive Sleep Apnea (OSA) is a respiratory disorder characterized by frequent breathing pauses during sleep. The apnea-hypopnea index is a measure used to assess the severity of sleep apnea and the hourly rate of respiratory events. Despite numerous commercial devices available for apnea diagnosis and early detection, accessibility remains challenging for the general population, leading to lengthy wait times in sleep clinics. Consequently, research on monitoring and predicting OSA has surged. This comprehensive paper reviews devices, emphasizing distinctions among representative apnea devices and technologies for home detection of OSA. The collected articles are analyzed to present a clear discussion. Each article is evaluated according to diagnostic elements, the implemented automation level, and the derived level of evidence and quality rating. The findings indicate that the critical variables for monitoring sleep behavior include oxygen saturation (oximetry), body position, respiratory effort, and respiratory flow. Also, the prevalent trend is the development of level IV devices, measuring one or two signals and supported by prediction software. Noteworthy methods showcasing optimal results involve neural networks, deep learning, and regression modeling, achieving an accuracy of approximately 99%.

Análisis factorial de la Escala Situacional de Empatia Emocional en una muestra universitaria chilena

La preocupación empática y angustia personal son los componentes emocionales de la empatía según los modelos más utilizados. Estos componentes pueden conceptualizarse en forma disposicional o situacional. Los análisis previos tienden a considerar escalas disposicionales con escasa evidencia para las situacionales. El presente estudio analizó la estructura factorial de la Escala Situacional de la Empatía Emocional, compuesta por la preocupación empática y angustia personal. En una muestra a conveniencia de estudiantes universitarias/os chilenos/as (N = 539), se analizó el ajuste de primer y segundo orden de la escala mediante análisis factorial. Los resultados indicaron un buen (X2/gl = 4.189, CFI = .964, ТЫ = .932, sRMR = .042, RMSEA = .086, AIC = 12041.418, BIC = 12097.185) y mejor ajuste del modelo de segundo orden Cfdiferenda(1) = 16.689,p .01, -ΔAIC- = 211.633 > 10, y -ΔBIC- = 207.342 > 10), mientras que el de un orden no mostró un buen ajuste (X2/gl = 20.878, CFI = .727, ты = .544, SRMR = .118, RMSEA = .224, AIC = 12253.051, BIC = 12304.527). Los resultados fueron consistentes con la literatura. Se discute la necesidad de nuevas evidencias de validez y el uso de muestras más representativas.

Empathic concern and personal distress are the emotional components of empathy according to most utilized models. These components can be conceptualized in a dispositional or situational form. Previous analyzes tend to consider dispositional scales, with little evidence for situational ones. The present study analyzed the factor structure of a situational scale of emotional empathy, composed of empathic concern and personal distress. In a convenience sample of Chilean university students (N = 539), the one-order and second-order fit of the scale was analyzed using factor analysis. The results indicated a good (X2/gl = 4.189, CFI = .964, ТЫ = .932, SRMR = .042, RMSEA = .086, AIC = 12041.418, BIC = 12097.185) and better Ct2 difference(1) = 16.689, p .01, -ΔAIC- = 211.633 > 10, y -ΔBIC- = 207.342 > 10) second-order fit while one-order did not show a good fit (X2/gl = 20.878, CFI = .727, ты = .544, SRMR = .118, RMSEA = .224, AIC = 12253.051, BIC = 12304.527). The results were consistent with the literature. The need for new types of validity and the use of more representative samples was discussed.

Condom use and drug consumption in migrants: a systematic review.

OBJECTIVE: To identify condom use and drug consumption in migrants, as well as the association between these variables. METHOD: A systematic search was carried out for articles published in Spanish and English (2017-2022), in PubMed, EBSCO, WEB of SCIENCE, Elsevier, Scielo, Redalyc, with eligible studies reporting on condom use and drug consumption, and their association. RESULTS: The search strategy found 147 articles with the combination of terms and other sources. After excluding articles by title, abstract, and finding that they had the study variables, eight articles were included for qualitative analysis and only three met the criteria for quantitative analysis. CONCLUSION: Drug consumption favors inconsistent condom use, increasing the risk of acquiring an STI, and can lead to other mental health issues derived from the use of these substances.

Current research trends on cognition, integrative complexity, and decision-making: a systematic literature review using activity theory and neuroscience.

Introduction: This article presents a systematic literature review that follows the PRISMA and PICOS guidelines to analyze current research trends on cognition, integrative complexity (IC) (a cognitive feature focusing on information processing in a person's response rather than its quantity or quality), and decision-making from the perspectives of activity theory and neuroscience. Methods: The study examines 31 papers published between 2012 and 2022 and 19 articles specifically related to neuroscience. We performed a content analysis using six categories within activity theory: subjects, objects, rules, community, division of labor, and outcomes. Results: The study investigates the relationship between decision-making outcomes and IC as a cognitive feature in various contexts. Additionally, content analysis on neuroscience and IC revealed significant research gaps, including understanding the nature of IC, challenges related to its measurement, and differentiation from other cognitive features. We also identify opportunities for investigating the brain's activity during decision-making in relation to IC. Discussion: We address the need for a more precise categorization of IC in studies of cognition, IC, and decision-making. We discuss the implications of our analysis for understanding the cognitive nature of IC and the potential of neuroscience methods for studying this attribute.

Cognitive modeling for understanding interactions between people and decision support tools in complex and uncertain environments: A study protocol.

BACKGROUND: Recent advances in Computational Intelligence Tools and the escalating need for decision-making in the face of complex and uncertain phenomena like pandemics, climate change, and geopolitics necessitate understanding the interaction between these tools and human behavior. It is crucial to efficiently utilize the decision-makers cognitive resources in addressing specific problems. METHODS: The main goal of this present protocol is to describe the effect that CITs (Computational Intelligence Tools) have on decisions made during complex and uncertain situations. It is an exploratory study with a mixed methodology. Solomon's group experiment design includes a narrative analysis of cognitive features such as integrative complexity (IC), cognitive flexibility (CF), and fluid intelligence (FI). Additionally, measures of neural activity (NA), physiological measures (PM), and eye-tracking data (ET) will be collected during the experimental session to examine the marginal impact of these processes on decision outcomes (DO) and their relation to CIT capabilities. To achieve this objective, 120 undergraduate and graduate students involved in decision-making will participate as subjects. The approximate duration of the study will be 2 years. Strict adherence to the relevant ethical considerations will be maintained during the performance of the experimental tasks. DISCUSSION: The study will provide valuable information on CITs' effect on decision-making under complex and uncertain contexts. This will help to better understand the link between technology and human behavior, which has important implications. CIT designers can use future results and at the same time, it will be possible to understand cognitive, behavioral, physiological processes, and even the subjective assessment of individuals when they use technological tools to solve a problem.

Implications of Artificial Intelligence Algorithms in the Diagnosis and Treatment of Motor Neuron Diseases-A Review.

Motor neuron diseases (MNDs) are a group of chronic neurological disorders characterized by the progressive failure of the motor system. Currently, these disorders do not have a definitive treatment; therefore, it is of huge importance to propose new and more advanced diagnoses and treatment options for MNDs. Nowadays, artificial intelligence is being applied to solve several real-life problems in different areas, including healthcare. It has shown great potential to accelerate the understanding and management of many health disorders, including neurological ones. Therefore, the main objective of this work is to offer a review of the most important research that has been done on the application of artificial intelligence models for analyzing motor disorders. This review includes a general description of the most commonly used AI algorithms and their usage in MND diagnosis, prognosis, and treatment. Finally, we highlight the main issues that must be overcome to take full advantage of what AI can offer us when dealing with MNDs.

Inhibition of the Human Neuronal Sodium Channel Nav1.9 by Arachidonyl-2-Chloroethylamide, An Analogue of Anandamide in a hNav1.9/rNav1.4 Chimera, An Experimental and in Silico Study.

Cannabinoids regulate analgesia, which has aroused much interest in identifying new pharmacological therapies in the management of refractory pain. Voltage-gated Na+ channels (Navs) play an important role in inflammatory and neuropathic pain. In particular, Nav1.9 is involved in nociception and the understanding of its pharmacology has lagged behind because it is difficult to express in heterologous systems. Here, we utilized the chimeric channel hNav1.9_C4, that comprises the extracellular and transmembrane domains of hNav1.9, co-expressed with the ß1 subunit on CHO-K1 cells to characterize the electrophysiological effects of ACEA, a synthetic surrogate of the endogenous cannabinoid anandamide. ACEA induced a tonic block, decelerated the fast inactivation, markedly shifted steady-state inactivation in the hyperpolarized direction, decreasing the window current and showed use-dependent block, with a high affinity for the inactivated state (ki = 0.84 µM). Thus, we argue that ACEA possess a local anaesthetic-like profile. To provide a mechanistic understanding of its mode of action at the molecular level, we combined induced fit docking with Monte Carlo simulations and electrostatic complementarity. In agreement with the experimental evidence, our computer simulations revealed that ACEA binds Tyr1599 of the local anaesthetics binding site of the hNav1.9, contacting residues that bind cannabinol (CBD) in the NavMs channel. ACEA adopted a conformation remarkably similar to the crystallographic conformation of anandamide on a non-homologous protein, obstructing the Na+ permeation pathway below the selectivity filter to occupy a highly conserved binding pocket at the intracellular side. These results describe a mechanism of action, possibly involved in cannabinoid analgesia.

Condom use and drug consumption in migrants: a systematic review / Uso de preservativo e consumo de drogas em migrantes: revisão sistemática / Uso de condón y consumo de drogas en migrantes: revisión sistemática

ABSTRACT Objective: To identify condom use and drug consumption in migrants, as well as the association between these variables. Method: A systematic search was carried out for articles published in Spanish and English (2017-2022), in PubMed, EBSCO, WEB of SCIENCE, Elsevier, Scielo, Redalyc, with eligible studies reporting on condom use and drug consumption, and their association. Results: The search strategy found 147 articles with the combination of terms and other sources. After excluding articles by title, abstract, and finding that they had the study variables, eight articles were included for qualitative analysis and only three met the criteria for quantitative analysis. Conclusion: Drug consumption favors inconsistent condom use, increasing the risk of acquiring an STI, and can lead to other mental health issues derived from the use of these substances.

RESUMO Objetivo: Identificar o uso de preservativo e o consumo de drogas em migrantes, bem como a associação entre essas variáveis. Método: Foi realizada uma busca sistemática de artigos publicados em espanhol e inglês (2017-2022), em PubMed, EBSCO, WEB of SCIENCE, Elsevier, Scielo, Redalyc, com estudos elegíveis relatando o uso de preservativos e consumo de drogas, e sua associação. Resultados: Com a estratégia de busca foram identificados 147 artigos com a combinação de termos e outras fontes. Após eliminar os artigos por título, resumo e identificar que continham as variáveis do estudo, oito artigos foram incluídos para análise qualitativa e apenas três atenderam aos critérios para análise quantitativa. Conclusão: O consumo de drogas estimula o uso inconsistente do preservativo, o que aumenta o risco de aquisição de uma IST, além de outros problemas de saúde mental decorrentes do consumo dessas substâncias.

RESUMEN Objetivo: Identificar el uso del condón y el consumo de drogas en migrantes, así como la asociación entre estas variables. Método: Se realizó una búsqueda sistemática de artículos publicados en español e inglés (2017-2022), en PubMed, EBSCO, WEB of SCIENCE, Elsevier, Scielo, Redalyc, siendo que los estudios elegibles informaron sobre el uso del condón y el consumo de drogas, y su asociación Resultados: Con la estrategia de búsqueda se identificaron 147 artículos con la combinación de términos y de otras fuentes. Después de la eliminación de artículos por título, resumen, identificar que cuenten con las variables de estudio, se incluyeron ocho artículos para el análisis cualitativo y únicamente tres cumplieron con los criterios para el análisis cuantitativo. Conclusión: El consumo de drogas favorece el uso inconstante del condón, y esto incrementa el riesgo de adquirir alguna ITS, además de otras cuestiones de salud mental derivadas del consumo de estas sustancias.

Análisis factorial confirmatorio de la Escala verbal de fusión de identidad en una muestra chilena / Confirmatory factor analysis of the Verbal Identity Fusion Scale in a Chilean sample

Resumen La fusión de identidad consiste en un sentimiento de unión con un grupo, en el que el individuo experimenta una mezcla entre su identidad personal y la social; y es un buen predictor de la conducta extrema progrupo. El presente estudio analizó la estructura factorial de la Escala verbal de fusión de identidad elaborada por Gómez et al. (2011), en una muestra chilena. Se utilizó una muestra universitaria seleccionada por conveniencia de 411 participantes (66% mujeres) con una edad media de 24.45 años (DT = 5.89). Se analizó el ajuste unifactorial y bifactorial de la Escala a través del análisis factorial, y las respectivas confiabilidades. Los resultados indicaron un buen y mejor ajuste del modelo bifactorial (χ 2/gl = 3.34, p < .001, CFI = .975, TLI = .957, SRMR = .030, y RMSEA = .085), por sobre el unifactorial, que no mostró un buen ajuste (χ 2/gl = 5.26, p < .001, CFI = .946, TLI = .919, SRMR = .042, y RMSEA = .116). Ambos modelos contaron con altas confiabilidades (> .800). Se discutió sobre el mejor ajuste de la estructura bifactorial en relación con estudios realizados en Estados Unidos, España y población inmigrante en Chile. Se proyecta la necesidad de futuros estudios que incorporen otros análisis de validez y superen la limitación del presente estudio asociada al uso de una muestra no representativa.

Abstract Identity fusion consists in a form alignment with a group and is a significant predictor of extreme pro-group behavior. The present study analyzed the factor structure of the verbal scale of identity fusion developed by Gómez et al. (2011), in a Chilean sample. A Chilean university sample by convenience of 411 participants (66% women) with a mean age of 24.45 years (SD = 5.89) was used. One-factor and two-factor fit of the scale was analyzed through factor analysis, and the respective reliabilities. The results indicated a good and better fit of the two-factor (χ2/gl = 3.34, p < .001, CFI = .975, TLI = .957, SRMR = .030, and RMSEA = .085), than the one-factor model, which did not show a good fit (χ2/gl = 5.26, p < .001, CFI = .946, TLI = .919, SRMR = .042, and RMSEA = .116). Both models had high reliabilities (> .800). The better fit of the two-factor structure was discussed in relation to studies conducted in the United States, Spain, and an immigrant population in Chile. The need for future studies incorporating other validity analyses and overcoming the limitation of the present study associated with the use of a non-representative sample is projected.

Development of a Sensing Platform Based on Hands-Free Interfaces for Controlling Electronic Devices.

Hands-free interfaces are essential to people with limited mobility for interacting with biomedical or electronic devices. However, there are not enough sensing platforms that quickly tailor the interface to these users with disabilities. Thus, this article proposes to create a sensing platform that could be used by patients with mobility impairments to manipulate electronic devices, thereby their independence will be increased. Hence, a new sensing scheme is developed by using three hands-free signals as inputs: voice commands, head movements, and eye gestures. These signals are obtained by using non-invasive sensors: a microphone for the speech commands, an accelerometer to detect inertial head movements, and an infrared oculography to register eye gestures. These signals are processed and received as the user's commands by an output unit, which provides several communication ports for sending control signals to other devices. The interaction methods are intuitive and could extend boundaries for people with disabilities to manipulate local or remote digital systems. As a study case, two volunteers with severe disabilities used the sensing platform to steer a power wheelchair. Participants performed 15 common skills for wheelchair users and their capacities were evaluated according to a standard test. By using the head control they obtained 93.3 and 86.6%, respectively for volunteers A and B; meanwhile, by using the voice control they obtained 63.3 and 66.6%, respectively. These results show that the end-users achieved high performance by developing most of the skills by using the head movements interface. On the contrary, the users were not able to develop most of the skills by using voice control. These results showed valuable information for tailoring the sensing platform according to the end-user needs.

Complex Congenital Heart Disease and Neurodevelopment. A Case Study of Fraternal Twins.

Congenital heart defects have been associated with adverse neurodevelopmental outcomes due to factors that result in a hypoxic-ischemic cerebral cumulative effect. We present a pair of fraternal twins: the first twin was healthy, and the second was born with a complex congenital heart defect (CCHD). They were followed for growth and neurodevelopmental outcomes to determine the comparative effect of exposure to a CCHD. Results show that exposure to a CCHD could be related to a persistent motor deficiency with hypotonia and concurrent height for age delay. CCHD requires a comprehensive neurodevelopmental approach; the pathophysiology and the surrounding stimuli are influential.

Diagnosis and management of cardiopulmonary events in very low birth weight infants close to discharge: a quality improvement initiative.

BACKGROUND: Cardiopulmonary events (CPE) have a central, obstructive, or mixed etiology. Lack of standardized diagnosis and management of CPE may prolong the length of stay (LOS). OBJECTIVE: To increase the accuracy of CPE diagnosis and decrease LOS by 10% for preterm infants over a 12-month period. METHODS: Develop an evidence-based algorithm to identify type of CPE, determine management approach, and evaluate cardio-respiratory monitors output. Apply model for improvement and statistical process control charts to determine special cause variation. RESULTS: Identification of central apnea increased from 15 to 39% (p < 0.01). LOS decreased 26% from 52.6 days to 39.2 days, with an estimated cost savings of $13,119 per each of the 225 infants in the initiative. CONCLUSION: After implementing an evidence-based algorithm for management of neonatal CPE, a significant increase in the accuracy of the diagnosis of central apnea and cost savings associated with a decrease in LOS were observed.

Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women.

An epidemic of Zika virus (ZIKV) infection began in Colombia in October 2015. Previous studies have identified a cause-effect relationship between fetal exposure to the ZIKV and the development of microcephaly and other central nervous system (CNS) anomalies with variable degrees of neurodevelopmental delay. Less is known about the neurodevelopmental outcome of infants without CNS anomalies born to symptomatic ZIKV RT-PCR-positive women. We aimed to compare the neurodevelopmental outcome of these infants to a control group of infants without CNS anomalies born to asymptomatic ZIKV RT-PCR negative women who did not seroconvert during pregnancy. Participating infants were categorized according to ZIKV maternal exposure. Women with symptomatology suggestive of ZIKV infection and a positive RT-PCR for ZIKV were categorized as ZIKV-exposed. Maternal controls (ZIKV unexposed) from the same geographic area were subsequently captured during the tail end of the epidemic through a partner project, the ZIKAlliance, whose aim was to determine the prevalence of ZIKV in pregnant women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). The ZIKV-exposed women were found to be older, had less subsidized health care, had a higher percentage of women in middle-class socioeconomic strata, had higher technical and university education, were less likely to be living with a partner, and had higher rates of pregnancy comorbidity and premature births than ZIKV unexposed women. Compared to infants born to ZIKV unexposed women (unexposed), infants born to ZIKV exposed women (exposed) were of lower gestational age and required more speech and occupational therapy services. No differences between groups were observed in the proportion of cut-off scores <70 on the Bayley-III Scale at 12, 18, and 24 months for motor, language, and cognitive domains. When a cut-off of <85 was used, a higher percentage of motor and cognitive impairment was observed in unexposed infants at 12 and 24 months CA, respectively. Median and IQR score on the Bayley-III scale showed higher scores in favor of exposed infants for motor development at 12 and 18 months CA, language at 12 months, and cognitive domain at 12, 18, and 24 months. The adjusted median and IQR compound score of the difference between exposed and unexposed was higher in favor of exposed infants at 12 to 24 months CA for motor (3.8 [95% CI 1.0 to 6.7]) and cognitive domains (10.6 [95% CI 7.3 to 13.9]). We observed no differences in the language domain (1.9 [95% CI -1.2 to 5.0]). We conclude that infants with no evidence of microcephaly or other CNS anomalies born to ZIKV-exposed women had normal neurodevelopment up to 24 months of CA, supporting an all-or-nothing effect with maternal ZIKV exposure. Long-term follow-up to evaluate school performance is required. Clinical Trial Registration: www.clinicaltrials.gov, NCT02943304.

Clinical Features and Neurodevelopmental Outcomes for Infants with Perinatal Vertical Transmission of Zika Virus, Colombia.

Transplacental transmission of Zika virus has been reported during all trimesters of pregnancy and might lead to central nervous system anomalies, including microcephaly. We report 3 cases of perinatal Zika infection identified during the epidemic in Colombia and provide detailed descriptions of clinical features, diagnosis, and neurodevelopmental outcome at 18 months of age (corrected).

Fecal Microbial Transplant in Individuals With Immune-Mediated Dry Eye.

PURPOSE: To evaluate the safety of the Fecal Microbial Transplant for Sjogren Syndrome (FMT) trial in individuals with immune-mediated dry eye (DE). DESIGN: Open-label, nonrandomized clinical trial. METHODS: The study population included 10 individuals with DE symptoms and signs meeting criteria for Sjögren or positive early Sjögren markers. Procedures were 2 FMTs from a single healthy donor delivered via enema, 1 week apart. The primary outcome measure was safety. In addition, gut microbiome profiles, DE metrics, and T-cell profiles in blood were examined at baseline before FMT, and at 1 week, 1 month, and 3 months after FMT. RESULTS: The mean age of the population was 60.4 years; 30% were male; 50% were white; and 50% were Hispanic. At baseline, all subjects had significantly different gut microbiome profiles from the donor, including higher mean diversity indices. Subjects had a decreased abundance of genera Faecalibacterium, Prevotella, and Ruminococcus and an increased abundance of genera Alistipes, Streptococcus, and Blautia compared to the donor. Effector and regulatory T-cell profiles were positively correlated with each other and with DE symptom severity (T helper 1 cells [Th1]; r = .76; P = .01; Th17: r = 0.83; P = .003; CD25: r = 0.66; P = .04; FoxP3: r = 0.68; P = .03). No adverse events were noted with FMT. After FMT, gut microbiome profiles in 8 subjects moved closer to the donor's profile. As a group, gut microbiome profiles at all follow-up time points were more similar to the original recipients' than the donor's microbiome; however, certain phyla, classes, and genera operational taxonomic unit (OTU) numbers remained closer to the donor vs recipients' baseline profiles out to 3 months. Five individuals subjectively reported improved dry eye symptoms 3 months after FMT. CONCLUSIONS: FMT was safely performed in individuals with immune-mediated DE, with certain bacterial profiles resembling the donor out to 3 months after FMT. One-half the subjects reported improved DE symptoms. The most effective FMT administration method has yet to be determined.

Fetal central nervous system anomalies according to RT-PCR and trimester of maternal infection with Zika virus: A prospective cohort study.

INTRODUCTION: In October 2015, an epidemic of Zika began in Colombia's geographic areas with a high population of mosquitoes of the genus Aedes. We aimed to describe the fetal brain ultrasound findings in pregnant women with active symptoms or a history of symptoms suggestive of Zika virus (ZIKV) infection. MATERIAL AND METHODS: Eligible pregnant women were tested with reverse transcriptase-polymerase chain reaction (RT-PCR) for ZIKV and followed prospectively using detailed anatomic ultrasound and transvaginal neurosonography to detect structural anomalies of the fetal central nervous system (CNS). RESULTS: A total of 115 symptomatic women with a positive ZIKV RT-PCR and 55 with a negative ZIKV RT-PCR were enrolled in the study; CNS compromise of the fetus occurred in 22% and 17%, respectively (p = 0.255). Callosal dysgenesis (14.5%) was the most frequent anomaly of the CNS, followed by microcephaly (13.6%) and neuronal migration disorders (8.3%). When symptomatic ZIKV RT-PCR-positive women were categorized by trimester of infection, CNS anomalies were present in 40% of first-trimester infections, compared with 21% and 7% in second- and third-trimester infections (p = 0.002). CNS anomalies were also more severe in first-trimester-infected fetuses than in second- and third-trimester-infected fetuses. The high prevalence of CNS anomalies in fetuses of symptomatic ZIKV RT-PCR negative women suggests a high rate of false-negative cases and an even higher prevalence of CNS anomalies than observed in this study. CONCLUSIONS: The prevalence of fetal CNS anomalies was higher than previously reported in the literature for both symptomatic RT-PCR-positive and -negative pregnant women. Corpus callosum anomalies, microcephaly, neuronal migration disorders, and brain parenchymal hyperechogenicities were the most frequent CNS anomalies detected. In addition, CNS anomalies were more frequent and severe in infected fetuses during the first trimester of pregnancy than during the second or third trimester.

Project Baby Bear: Rapid precision care incorporating rWGS in 5 California children's hospitals demonstrates improved clinical outcomes and reduced costs of care.

Genetic disorders are a leading contributor to mortality in neonatal and pediatric intensive care units (ICUs). Rapid whole-genome sequencing (rWGS)-based rapid precision medicine (RPM) is an intervention that has demonstrated improved clinical outcomes and reduced costs of care. However, the feasibility of broad clinical deployment has not been established. The objective of this study was to implement RPM based on rWGS and evaluate the clinical and economic impact of this implementation as a first line diagnostic test in the California Medicaid (Medi-Cal) program. Project Baby Bear was a payor funded, prospective, real-world quality improvement project in the regional ICUs of five tertiary care children's hospitals. Participation was limited to acutely ill Medi-Cal beneficiaries who were admitted November 2018 to May 2020, were <1 year old and within one week of hospitalization, or had just developed an abnormal response to therapy. The whole cohort received RPM. There were two prespecified primary outcomes-changes in medical care reported by physicians and changes in the cost of care. The majority of infants were from underserved populations. Of 184 infants enrolled, 74 (40%) received a diagnosis by rWGS that explained their admission in a median time of 3 days. In 58 (32%) affected individuals, rWGS led to changes in medical care. Testing and precision medicine cost $1.7 million and led to $2.2-2.9 million cost savings. rWGS-based RPM had clinical utility and reduced net health care expenditures for infants in regional ICUs. rWGS should be considered early in ICU admission when the underlying etiology is unclear.

The Burden of Dengue in Children by Calculating Spatial Temperature: A Methodological Approach Using Remote Sensing Techniques.

BACKGROUND: Dengue fever is one of the most important arboviral diseases. Surface temperature versus dengue burden in tropical environments can provide valuable information that can be adapted in future measurements to improve health policies. METHODS: A methodological approach using Daymet-V3 provided estimates of daily weather parameters. A Python code developed by us extracted the median temperature from the urban regions of Colima State (207.3 km2) in Mexico. JointPoint regression models computed the mean temperature-adjusted average annual percentage of change (AAPC) in disability-adjusted life years (DALY) rates (per 100,000) due to dengue in Colima State among school-aged (5-14 years old) children. RESULTS: Primary outcomes were average temperature in urban areas and cumulative dengue burden in DALYs in the school-aged population. A model from 1990 to 2017 medium surface temperature with DALY rates was performed. The increase in DALYs rate was 64% (95% CI, 44-87%), and it seemed to depend on the 2000-2009 estimates (AAPC = 185%, 95% CI 18-588). CONCLUSION: From our knowledge, this is the first study to evaluate surface temperature and to model it through an extensive period with health economics calculations in a specific subset of the Latin-American endemic population for dengue epidemics.

Refining the resolution of craniofacial dysmorphology in bipolar disorder as an index of brain dysmorphogenesis.

As understanding of the genetics of bipolar disorder increases, controversy endures regarding whether the origins of this illness include early maldevelopment. Clarification would be facilitated by a 'hard' biological index of fetal developmental abnormality, among which craniofacial dysmorphology bears the closest embryological relationship to brain dysmorphogenesis. Therefore, 3D laser surface imaging was used to capture the facial surface of 21 patients with bipolar disorder and 45 control subjects; 21 patients with schizophrenia were also studied. Surface images were subjected to geometric morphometric analysis in non-affine space for more incisive resolution of subtle, localised dysmorphologies that might distinguish patients from controls. Complex and more biologically informative, non-linear changes distinguished bipolar patients from control subjects. On a background of minor dysmorphology of the upper face, maxilla, midface and periorbital regions, bipolar disorder was characterised primarily by the following dysmorphologies: (a) retrusion and shortening of the premaxilla, nose, philtrum, lips and mouth (the frontonasal prominences), with (b) some protrusion and widening of the mandible-chin. The topography of facial dysmorphology in bipolar disorder indicates disruption to early development in the frontonasal process and, on embryological grounds, cerebral dysmorphogenesis in the forebrain, most likely between the 10th and 15th week of fetal life.

Construcción y validación de un instrumento para medir la percepción de exclusión social en jóvenes / Development and validation of an instrument to measure social exclusion perception in young people

Resumen Introducción: La exclusión social es un fenómeno multifactorial que expone a las personas a desventajas económicas, institucionales y sociales. Frecuentemente los jóvenes padecen exclusión social que les genera amplias consecuencias negativas. Objetivo: Desarrollar y validar un instrumento para evaluar la percepción de exclusión social en jóvenes mexicanos. Método: Estudio centrado en la psicometría. En una primera fase se creó una versión preliminar del instrumento a partir de reactivos derivados de la literatura. La calidad de los reactivos fue evaluada por expertos y por un grupo de jóvenes de la población objetivo. En una segunda fase se incluyeron 415 jóvenes y se obtuvo la confiabilidad, validez y normas del instrumento. Resultados: La primera versión del instrumento contempló 60 reactivos evaluados en la segunda fase. La versión final del instrumento incluyó 35 reactivos agrupados en nueve factores que explicaron el 62,30 % de la varianza total. Esta estructura factorial mostró una consistencia interna alta (α= ,863). El análisis factorial confirmatorio indicó un adecuado ajuste (x2= 1,71; CFI= ,926; RMSEA= ,042) que brinda evidencia sobre la validez empírica del instrumento. Conclusión: El instrumento tiene adecuadas propiedades psicométricas para evaluar la percepción de exclusión social en jóvenes mexicanos, el cual puede ser empleado en la investigación psicosocial. El estudio de la exclusión social se lleva a cabo desde las ciencias políticas, la economía y la sociología; pero hasta el conocimiento de los autores, este estudio representa una de las primeras propuestas de su abordaje desde la psicología social considerando central la visión de los individuos y sus interacciones sociales con otros grupos.

Abstract Introduction: Social exclusion is a multifactorial phenomenon that involves economic, institutional and social disadvantages for diverse groups of people. Frequently, young people face social exclusion that causes them negative consequences. Objective: To develop and validate an instrument to evaluate social exclusion perception in young people from Mexico. Method: This is an article research result, which is based on psychometric principles. During the first phase, a preliminary instrument version was developed on the base of a literature review. Experts and a group of young Mexican people evaluate items' quality. During the second phase, 415 participants were enrolled and the instrument psychometric properties (reliability, validity, and interpretation) were estimated. Results: The first version instrument included 60 items which were evaluated in the second phase. The final version of the instrument has 35 items grouped in nine factors that explained 62,30 % of the total variance. This instrument's factorial structure showed high internal consistency (α=.863). The confirmatory factorial analysis indicated an acceptable fit (x2=1.71; CFI=.926; RMSEA=.042) which gave evidence of the instrument empirical validity. Conclusion: Instrument has good psychometric properties to evaluate social exclusion perception; therefore it can be used in the psychosocial investigation. Social exclusion phenomenon has been studied on base the politics, economic and sociology sciences; however until author knowledge, this is a pioneer proposal to study social exclusion based on the social psychology. This science is focused in the subject vision and their group social interactions.