What If ? Pandemic policy-decision-support to guide a cost-benefit-optimised, country-specific response.

BACKGROUND: After 18 months of responding to the COVID-19 pandemic, there is still no agreement on the optimal combination of mitigation strategies. The efficacy and collateral damage of pandemic policies are dependent on constantly evolving viral epidemiology as well as the volatile distribution of socioeconomic and cultural factors. This study proposes a data-driven approach to quantify the efficacy of the type, duration, and stringency of COVID-19 mitigation policies in terms of transmission control and economic loss, personalised to individual countries. METHODS: We present What If…?, a deep learning pandemic-policy-decision-support algorithm simulating pandemic scenarios to guide and evaluate policy impact in real time. It leverages a uniquely diverse live global data-stream of socioeconomic, demographic, climatic, and epidemic trends on over a year of data (04/2020-06/2021) from 116 countries. The economic damage of the policies is also evaluated on the 29 higher income countries for which data is available. The efficacy and economic damage estimates are derived from two neural networks that infer respectively the daily R-value (RE) and unemployment rate (UER). Reinforcement learning then pits these models against each other to find the optimal policies minimising both RE and UER. FINDINGS: The models made high accuracy predictions of RE and UER (average mean squared errors of 0.043 [CI95: 0.042-0.044] and 4.473% [CI95: 2.619-6.326] respectively), which allow the computation of country-specific policy efficacy in terms of cost and benefit. In the 29 countries where economic information was available, the reinforcement learning agent suggested a policy mix that is predicted to outperform those implemented in reality by over 10-fold for RE reduction (0.250 versus 0.025) and at 28-fold less cost in terms of UER (1.595% versus 0.057%). CONCLUSION: These results show that deep learning has the potential to guide evidence-based understanding and implementation of public health policies.

Electrophysiology of Muscle Fatigue in Cardiopulmonary Resuscitation on Manikin Model.

Cardiopulmonary resuscitation requires the provider to adopt positions that could be dangerous for his or her spine, specifically affecting the muscles and ligaments in the lumbar zone and the scapular spinal muscles. Increased fatigue caused by muscular activity during the resuscitation could produce a loss of quality and efficacy, resulting in compromising resuscitation. The aim of this study was to evaluate the maximum time a rescuer can perform uninterrupted chest compressions correctly without muscle fatigue. This pilot study was performed at Universidad Complutense de Madrid (Spain) with the population recruited following CONSORT 2010 guidelines. From the 25 volunteers, a total of 14 students were excluded because of kyphoscoliosis (4), lumbar muscle pain (1), anti-inflammatory treatment (3), or not reaching 80% of effective chest compressions during the test (6). Muscle activity at the high spinal and lumbar (L5) muscles was assessed using electromyography while students performed continuous chest compressions on a ResusciAnne manikin. The data from force exerted were analyzed according to side and muscle groups using Student's t test for paired samples. The influence of time, muscle group, and side was analyzed by multivariate analyses ( p ≤ .05). At 2 minutes, high spinal muscle activity (right: 50.82 ± 9.95; left: 57.27 ± 20.85 µV/ms) reached the highest values. Activity decreased at 5 and 15 minutes. At 2 minutes, L5 activity (right: 45.82 ± 9.09; left: 48.91 ± 10.02 µV/ms) reached the highest values. After 5 minutes and at 15 minutes, activity decreased. Fatigue occurred bilaterally and time was the most important factor. Fatigue began at 2 minutes. Rescuers exert muscular countervailing forces in order to maintain effective compressions. This imbalance of forces could determine the onset of poor posture, musculoskeletal pain, and long-term injuries in the rescuer.

Alternativas de seguridad de una población víctima de desplazamiento forzado: el caso de la comuna 8 de Medellín / Security choices of a population, victim of forced displacement: the case of the 8th commune in medellin

¿Es posible que poblaciones que viven en condiciones socioeconómicas precarias y en contextos violentos, puedan proveer se una seguridad diferente a la ofrecida por el Estado y por actores armados ilegales? Es la pregunta que responde este artículo, con base en la investigación realizada en Medellín, con población víctima de desplazamiento forzado de la comuna 8, que trabaja con enfoque de seguridad humana y metodología desde abajo. Analiza las políticas de seguridad del Estado, contrastándo las con las iniciativas comunitarias para enfrentar sus inseguridades mediante estrategias de acción y agendas comunitarias para proveer seguridad humana y conformarse como ciudadanos y colectivos sociales empoderados políticamente. Seña la limitaciones y potencialidades de una propuesta de seguridad aplicada por un grupo poblacional altamente vulnerado y vulnerable.

Is it possible that populations living in precarious socio-economic conditions and in violent contexts, can provide a different security from that offered by the State and illegal armed actors? It is the question that this article answers, based on a research carried out inMedellin, with victims of forced displacement of the Commune 8, which works with a focus on human security and methodology from the bottom. It analyzes the policies of the State security, contrasting them against the community initiatives in order to address their insecurities through action strategies and community agendas and thus provide human security and settle as citizens and social collectives empowered politically. It points out limitations and potentialities of a proposal of security applied by a highly violated and vulnerable population group.

Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis: a systematic review.

BACKGROUND: The use of systemic antibiotics in conjunction with scaling and root planing (SRP) may improve the clinical outcome and even could be essential for a successful treatment of periodontitis. However, the effectiveness and clinical safety of this combination of therapy remain unclear. The authors of this study reviewed the available literature related to this hypothesis, evaluating the effectiveness of the use of systemic antimicrobials in combination with SRP versus SRP alone in the treatment of chronic periodontitis (CP) or aggressive periodontitis (AgP). METHODS: The authors used 3 electronic databases and hand searched articles published from April 2001 through October 2013 in selected journals. The authors selected clinical trials with a minimum of 6 months follow-up during which patients with either CP or AgP had been treated with systemic antibiotics plus SRP in comparison with SRP alone or with placebo. The authors analyzed the gain in clinical attachment level (CAL), reduction in probing pocket depth (PPD), reduction in bleeding on probing (BOP), and patient-related variables (that is, adverse effects). RESULTS: After the selection process, the authors included 23 clinical trials in this review. Assessment of the quality of the studies revealed the risk of bias as a common finding. Overall, there was a tendency toward improvement of the measured outcomes, CAL, PPD, and BOP in studies for which systemic antibiotics were used as adjunctive therapy with SRP. CONCLUSION: Owing to the high level of heterogeneity of the studies included in this review, the authors could not establish definitive conclusions and guidelines regarding the use of adjunctive systemic antibiotics. However, within the limitations of this review, the use of systemic antibiotics with SRP may be beneficial for specific populations. Standardized clinical disease diagnostic criteria and additional randomized controlled clinical trials are necessary to verify the effectiveness of the use of adjunctive systemic antimicrobials with SRP. PRACTICAL IMPLICATIONS: Owing to methodological differences and biases among clinical trials evaluating systemic antibiotics adjunctive to SRP, clinicians should base their decisions to prescribe on the results of weighing both benefits and risks for each patient.

Medidas de inclinación de la trayectoria condílea y delángulo de bennet de lapoblación occidental, actualización y revisió nbibliográfica / Condylar path inclination and bennet angle in western population, update and literature review

Introducción: Actualmente cualquier tratamiento prostodóncico conlleva el uso de articuladores tanto para el diagnóstico como la realización de las prótesis. Aunque lo ideal sería individualizar cada caso hallando la inclinación de la trayectoria con dílea (ITC)y el ángulo de Bennet reales, se tiende a trabajar con los valores estándares establecidos. Dichos valores llevan vigentes desde que fueron instaurados sin ninguna modificación. El objetivo de este estudio fue comprobar que estos valores promedios seguían siendo validos en la actualidad. Material y método: Recopilación de valores reales de ITC y ángulo de Bennet recogidos de la bibliografía entre 1959 y 2011. Fueron seleccionados 34 estudios de grandes muestras poblacionales alcanzando un total de 2.142 valores individualizados de ITC. Resultados: Fueron encontradas grandes diferencias entre los distintos estudios revisados, desde valores medios de ITC de30,1º en 1960 hasta los 57,8º de 2009.Conclusiones: Se observó un incremento gradual de las medias de ITC a lo largo de los años, derivado por una masticación con predominio de los movimientos verticales de apertura-cierre frente a lateralidades. Estos resultados se alejan de los propuestos para los articuladores de guías fijas que son los más empleados en laboratorio. Consideramos que dichos valores estándares deben ser modificados con unas cifras mayores (AU)

Introduction: Currently any prosthodontic treatment involves the use of articulators for diagnosis and prostheses fabrication. The ideal protocol would be to individualizing each case getting the actual condylar path inclination (CPI) and Bennet angle. Although dentists used to work with the stablished standard values. Predeterminated articulator settings have been the same since they were instituted without any change. The aim of this study was to verify that these average values were still valid today. Material and methods: Collection of real CPI and Bennet angle values review from the literature between 1959 and 2011. Thirty four studies were selected from large population samples for a total of 2142 individual condylar values. Results: Large differences between the studies reviewed were found, from average values CPI of 30.1 degrees in 1960 to 57.8 º, 2009.Conclusions: It was observed a gradual increase in average CPI over the years, which indicates vertical chewing movements over lateral ones. These results are far from those proposed for semi-adjustable articulators. Therefore, these standard values must be reinstated with higher figures rather than relying on overage values (AU)

Insuficiencia renal post artroscopia de hombro / Kidney failure post shoulder arthroscopy

El manejo de fluidos post-artroscopia de hombro requiere de suficiencia cardiaca y renal. Reportamos 8 casos de insuficiencia renal post-artroscopia, en todos los casos se utilizaron soluciones hipotonicas para infusion y los pacientes utilizaron Diclofenac en tratamientos prolongados previos a la cirugia. Estas complicaciones no han sido reportadas en la bibliografía, revisamos esta y los casos a fin de alertar el riesgo de esta severa complicacion

Insuficiencia renal post artroscopia de hombro / Kidney failure post shoulder arthroscopy

El manejo de fluidos post-artroscopia de hombro requiere de suficiencia cardiaca y renal. Reportamos 8 casos de insuficiencia renal post-artroscopia, en todos los casos se utilizaron soluciones hipotonicas para infusion y los pacientes utilizaron Diclofenac en tratamientos prolongados previos a la cirugia. Estas complicaciones no han sido reportadas en la bibliografía, revisamos esta y los casos a fin de alertar el riesgo de esta severa complicacion(AU)

Insuficiencia renal post artroscopia de hombro / Kidney failure post shoulder arthroscopy

El manejo de fluidos post-artroscopia de hombro requiere de suficiencia cardiaca y renal. Reportamos 8 casos de insuficiencia renal post-artroscopia, en todos los casos se utilizaron soluciones hipotonicas para infusion y los pacientes utilizaron Diclofenac en tratamientos prolongados previos a la cirugia. Estas complicaciones no han sido reportadas en la bibliografía, revisamos esta y los casos a fin de alertar el riesgo de esta severa complicacion(AU)

El rol de la laxitud articular del hombro como causa de patologia / The role of laxity in shoulder lesions

El objetivo del trabajo es determinar cual es el rol de la laxitud como causa de patologia en jugadores de rugby. Se presentan 90 jugadores de rugby en 2 grupos: a) 25 años promedio, b) 19 años promedio. A su vez, estos grupos fueron subdivididos en 1 y 2: 1) sintomaticos, 2) asintomaticos. Los jugadores del grupo 1 padecian sintomas de inestabilidad o dolor subacromial. Ejemplo: A1 25 años sintomaticos, B2 19 años asintomaticos. Se registraron los datos, en base a los siguientes parametros: Arco de Movilidad Total (AMT): desde una Rotacion Externa (RE) y Rotacion Interna (RI) en ambos hombros, en abduccion de 90º. Se midio el Riesgo Relativo de padecer una lesion basada en el rango de movilidad de los hombros. Hemos encontrado que hay una diferencia muy significativa del rango de movilidad entre los grupos A y B: 196º versus 219º no reportada previamente en la literatura. En el Grupo A, el RR aumenta 22,18 veces con un AMT mayor a 205º y 32,84 veces con una RE mayor a 110º. En el grupo B, el RR aumenta 3,15 veces con un AMT mayor a 255º y 2,5 veces con una rotacion externa mayor a 125º. De no existir laxitud de riesgo de tener patologia en deportes de contacto disminuye a limites despreciables. La laxitud preexistente es el mayor factor generador de lesiones en deportistas de contacto. Datos relativos al AMT y a la RE en 90º de abduccion deben ser considerados como la maniobra semiologica de control.

El rol de la laxitud articular del hombro como causa de patologia / The role of laxity in shoulder lesions

El objetivo del trabajo es determinar cual es el rol de la laxitud como causa de patologia en jugadores de rugby. Se presentan 90 jugadores de rugby en 2 grupos: a) 25 años promedio, b) 19 años promedio. A su vez, estos grupos fueron subdivididos en 1 y 2: 1) sintomaticos, 2) asintomaticos. Los jugadores del grupo 1 padecian sintomas de inestabilidad o dolor subacromial. Ejemplo: A1 25 años sintomaticos, B2 19 años asintomaticos. Se registraron los datos, en base a los siguientes parametros: Arco de Movilidad Total (AMT): desde una Rotacion Externa (RE) y Rotacion Interna (RI) en ambos hombros, en abduccion de 90º. Se midio el Riesgo Relativo de padecer una lesion basada en el rango de movilidad de los hombros. Hemos encontrado que hay una diferencia muy significativa del rango de movilidad entre los grupos A y B: 196º versus 219º no reportada previamente en la li