Escala para la identificación del paciente pediátrico crónico complejo (Escala PedCom). Estudio piloto / A scale for the identification of the complex chronic pediatric patient (PedCom Scale): A pilot study

Introducción y objetivos: La condición crónica compleja (CCC) es una realidad cada vez más prevalente en pediatría. Sin embargo, padecer una CCC no supone necesariamente ser un paciente crónico complejo (PCC). Desde esta perspectiva, nos propusimos el desarrollo de un instrumento (Escala PedCom) que facilitase la identificación del PCC. Material y métodos: Inicialmente se definieron aspectos generales para la clasificación de un paciente como PCC. Posteriormente se desarrollaron los ítems de la escala puntuándolos de 0,5 a 4 puntos. Se realizó análisis factorial confirmatorio (AFC) y se estudió la consistencia interna mediante alfa de Cronbach. La concordancia se evaluó mediante estudio intra- e interobservador. El gold standard fue la clasificación realizada por 2 evaluadores tras valoración de la historia clínica del paciente. El punto de corte para considerar al paciente como PCC se estableció mediante curva ROC. Resultados: La versión inicial incluyó 43 ítems con índice de validez de contenido global (IVC) de 0,94. Para el estudio se incluyeron 180 pacientes. Tras el AFC se eliminó un ítem, por lo que la versión final consta de 42 ítems con IVC de 0,95. El valor alfa de Cronbach fue 0,723. El índice de correlación intraclase del análisis test-retest fue de 0,998 y 0,996 para el estudio interobservador. El punto de corte para considerar a un paciente como PCC se estableció en 6,5 puntos, con el que se obtuvo una sensibilidad del 98% y especificidad del 94%. Conclusiones: La Escala PedCom es una herramienta de fácil uso enfocada a la identificación del PCC. En nuestra muestra, presentó adecuada consistencia interna y niveles adecuados de concordancia intra- e interobservador; con buenos resultados de sensibilidad y especificidad para la identificación del PCC. (AU)

Introduction and objectives: The complex chronic condition (CCC) is an increasingly prevalent reality in pediatrics. However, having a CCC does not necessarily mean being a complex chronic patient (CCP). From this perspective, we developed an instrument (PedCom Scale) that would facilitate the identification of the PCC. Material and methods: Initially, general aspects for the classification of patients as CCP were defined. Subsequently, the items of the scale were developed, scoring them from 0.5 to 4 points. We performed a confirmatory factor analysis (CFA) and the internal consistency was studied using alpha-Cronbach. Concordance was evaluated by intra- and inter-observer study. The gold standard was the classification performed by two evaluators after assessing the patient's medical history. The cut-off point for considering the patient as a CCP was established using the ROC curve. Results: The initial version included 43 items with a global content validity index (CVI) of 0.94. A total of 180 patients were included. After the CFA, one item was eliminated, so the final version consists of 42 items with an CVI of 0.95. The alpha-Cronbach value was 0.723. The intraclass correlation coefficient of the test–retest analysis was 0.998 and 0.996 for the inter-observer study. The cut-off point for considering a patient as a CCP was established at 6.5 points, with these results we obtained a sensitivity of 98% and specificity of 94%. Conclusions: The PedCom Scale is an easy-to-use tool focused on the identification of the CCP. In our sample, it presented satisfactory levels of internal consistency and adequate levels of intra- and inter-observer agreement, with good sensitivity and specificity for the identification of the PCC. (AU)

A scale for the identification of the complex chronic pediatric patient (PedCom Scale): A pilot study.

INTRODUCTION AND OBJECTIVES: The complex chronic condition (CCC) is an increasingly prevalent reality in pediatrics. However, having a CCC does not necessarily mean being a complex chronic patient (CCP). From this perspective, we developed an instrument (PedCom Scale) that would facilitate the identification of the CCP. MATERIAL AND METHODS: Initially, general aspects for the classification of patients as CCP were defined. Subsequently, the items of the scale were developed, scoring them from 0.5 to 4 points. We performed a confirmatory factor analysis (CFA) and the internal consistency was studied using alpha-Cronbach. Concordance was evaluated by intra- and inter-observer study. The gold standard was the classification performed by two evaluators after assessing the patient's medical history. The cut-off point for considering the patient as a CCP was established using the ROC curve. RESULTS: The initial version included 43 items with a global content validity index (CVI) of 0.94. A total of 180 patients were included. After the CFA, one item was eliminated, so the final version consists of 42 items with an CVI of 0.95. The alpha-Cronbach value was 0.723. The intraclass correlation coefficient of the test-retest analysis was 0.998 and 0.996 for the inter-observer study. The cut-off point for considering a patient as a CCP was established at 6.5 points, with this results we obtained a sensitivity of 98% and specificity of 94%. CONCLUSIONS: The PedCom Scale is an easy-to-use tool focused on the identification of the CCP. In our sample, it presented satisfactory levels of internal consistency and adequate levels of intra- and inter-observer agreement, with good sensitivity and specificity for the identification of the CCP.

Efficient informatics-based source and mask optimization for optical lithography.

Source and mask optimization (SMO) is a widely used computational lithography technology that greatly improves the image fidelity of lithography systems. This paper develops an efficient informatics-based SMO (EISMO) method to improve the image fidelity of lithography systems. First, a communication channel model is established to depict the mechanism of information transmission in the SMO framework, where the source is obtained from the gradient-based SMO algorithm. The manufacturing-aware mask distribution is then optimized to achieve the best mutual information, and the theoretical lower bound of lithography patterning error is obtained. Subsequently, an efficient informatics-based method is proposed to refine the mask optimization result in SMO, further reducing the lithography patterning error. It is shown that the proposed EISMO method is computationally efficient and can achieve superior imaging performance over the conventional SMO method.

Effects of music therapy as an adjunct to chest physiotherapy in children with cystic fibrosis: A randomized controlled trial.

Airway clearance therapy (ACT) is considered an important approach to improve airway clearance in children with cystic fibrosis (CF). Daily ACT administration requires substantial commitments of time and energy that complicate ACT and reduce its benefits. It is crucial to establish ACT as a positive routine. Music therapy (MT) is an aspect of integrative strategies to ameliorate the psycho-emotional consequences of chronic diseases, and a MT intervention could help children with CF between the ages of 2 and 17 develop a positive response. The aim of this randomized controlled trial was to evaluate the effects of specifically composed and recorded instrumental music as an adjunct to ACT. We compared the use of specifically composed music (Treated Group, TG), music that the patient liked (Placebo Group, PG), and no music (Control Group, CG) during the usual ACT routine in children with CF aged from 2 to 17. The primary outcomes, i.e., enjoyment and perception of time, were evaluated via validated questionnaires. The secondary outcome, i.e., efficiency, was evaluated in terms of avoided healthcare resources. Enjoyment increased after the use of the specifically composed music (children +0.9 units/parents +1.7 units; p<0.05) compared to enjoyment with no music (0 units) and familiar music (+0.5 units). Perception of time was 11.1 min (±3.9) less than the actual time in the TG (p<0.05), 3.9 min (±4.2) more than the actual time in the PG and unchanged in the CG. The potential cost saving related to respiratory exacerbations was €6,704.87, while the cost increased to €33,524.35 in the CG and to €13,409.74 in the PG. In conclusion, the specifically composed, played and compiled instrumental recorded music is an effective adjunct to ACT to establish a positive response and is an efficient option in terms of avoided costs. Trial registered as ISRCTN11161411. ISRCTN registry (www.isrctn.com).

Influence of pneumococcal vaccination on the hospitalization of healthy pediatric patients due to typical Community-Acquired Pneumonia.

INTRODUCTION: Community-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP. METHOD: From 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months-14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records. RESULTS: A total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children. CONCLUSIONS: The increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).

Broncoscopias en unidades de cuidados intensivos neonatales / Bronchoscopies in Neonatal Intensive Care Units

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Recurrent wheezing during the first 3 years of life in a birth cohort of moderate-to-late preterm infants.

BACKGROUND: Data addressing short- and long-term respiratory morbidity in moderate-late preterm infants are limited. We aim to determine the incidence of recurrent wheezing and associated risk and protective factors in these infants during the first 3 years of life. METHODS: Prospective, multicenter birth cohort study of infants born at 32+0 to 35+0  weeks' gestation and followed for 3 years to assess the incidence of physician-diagnosed recurrent wheezing. Allergen sensitization and pulmonary function were also studied. We used multivariate mixed-effects models to identify risk factors associated with recurrent wheezing. RESULTS: A total of 977 preterm infants were enrolled. Rates of recurrent wheezing during year (Y)1 and Y2 were similar (19%) but decreased to 13.3% in Y3. Related hospitalizations significantly declined from 6.3% in Y1 to 0.75% in Y3. Independent risk factors for recurrent wheezing during Y2 and Y3 included the following: day care attendance, acetaminophen use during pregnancy, and need for mechanical ventilation. Atopic dermatitis on Y2 and male sex on Y3 were also independently associated with recurrent wheezing. Palivizumab prophylaxis for RSV during the first year of life decreased the risk or recurrent wheezing on Y3. While there were no differences in rates of allergen sensitization, pulmonary function tests (FEV0.5 ) were significantly lower in children who developed recurrent wheezing. CONCLUSIONS: In moderate-to-late premature infants, respiratory symptoms were associated with lung morbidity persisted during the first 3 years of life and were associated with abnormal pulmonary function tests. Only anti-RSV prophylaxis exerted a protective effect in the development of recurrent wheezing.

Amino Acid Transport Defects in Human Inherited Metabolic Disorders.

Amino acid transporters play very important roles in nutrient uptake, neurotransmitter recycling, protein synthesis, gene expression, cell redox balance, cell signaling, and regulation of cell volume. With regard to transporters that are closely connected to metabolism, amino acid transporter-associated diseases are linked to metabolic disorders, particularly when they involve different organs, cell types, or cell compartments. To date, 65 different human solute carrier (SLC) families and more than 400 transporter genes have been identified, including 11 that are known to include amino acid transporters. This review intends to summarize and update all the conditions in which a strong association has been found between an amino acid transporter and an inherited metabolic disorder. Many of these inherited disorders have been identified in recent years. In this work, the physiological functions of amino acid transporters will be described by the inherited diseases that arise from transporter impairment. The pathogenesis, clinical phenotype, laboratory findings, diagnosis, genetics, and treatment of these disorders are also briefly described. Appropriate clinical and diagnostic characterization of the underlying molecular defect may give patients the opportunity to avail themselves of appropriate therapeutic options in the future.

On the Performance of Interleavers for Quantum Turbo Codes.

Quantum turbo codes (QTC) have shown excellent error correction capabilities in the setting of quantum communication, achieving a performance less than 1 dB away from their corresponding hashing bounds. Existing QTCs have been constructed using uniform random interleavers. However, interleaver design plays an important role in the optimization of classical turbo codes. Consequently, inspired by the widely used classical-to-quantum isomorphism, this paper studies the integration of classical interleaving design methods into the paradigm of quantum turbo coding. Simulations results demonstrate that error floors in QTCs can be lowered significantly, while decreasing memory consumption, by proper interleaving design without increasing the overall decoding complexity of the system.

Initial Evaluation of Prospective and Parallel Assessments of Cystic Fibrosis Newborn Screening Protocols in Eastern Andalusia: IRT/IRT versus IRT/PAP/IRT.

Identifying newborns at risk for cystic fibrosis (CF) by newborn screening (NBS) using dried blood spot (DBS) specimens provides an opportunity for presymptomatic detection. All NBS strategies for CF begin with measuring immunoreactive trypsinogen (IRT). Pancreatitis-associated protein (PAP) has been suggested as second-tier testing. The main objective of this study was to evaluate the analytical performance of an IRT/PAP/IRT strategy versus the current IRT/IRT strategy over a two-year pilot study including 68,502 newborns. The design of the study, carried out in a prospective and parallel manner, allowed us to compare four different CF-NBS protocols after performing a post hoc analysis. The best PAP cutoff point and the potential sources of PAP false positive results in our non-CF newborn population were also studied. 14 CF newborns were detected, resulting in an overall CF prevalence of 1/4, 893 newborns. The IRT/IRT algorithm detected all CF cases, but the IRT/PAP/IRT algorithm failed to detect one case of CF. The IRT/PAP/IRT with an IRT-dependent safety net protocol was a good alternative to improve sensitivity to 100%. The IRT × PAP/IRT strategy clearly performed better, with a sensitivity of 100% and a positive predictive value (PPV) of 39%. Our calculated optimal cutoffs were 2.31 µg/L for PAP and 167.4 µg2/L2 for IRT × PAP. PAP levels were higher in females and newborns with low birth weight. PAP false positive results were found mainly in newborns with conditions such as prematurity, sepsis, and hypoxic-ischemic encephalopathy.

Combining the Burrows-Wheeler Transform and RCM-LDGM Codes for the Transmission of Sources with Memory at High Spectral Efficiencies.

In this paper, we look at the problem of implementing high-throughput Joint Source- Channel (JSC) coding schemes for the transmission of binary sources with memory over AWGN channels. The sources are modeled either by a Markov chain (MC) or a hidden Markov model (HMM). We propose a coding scheme based on the Burrows-Wheeler Transform (BWT) and the parallel concatenation of Rate-Compatible Modulation and Low-Density Generator Matrix (RCM-LDGM) codes. The proposed scheme uses the BWT to convert the original source with memory into a set of independent non-uniform Discrete Memoryless (DMS) binary sources, which are then separately encoded, with optimal rates, using RCM-LDGM codes.

Information theoretical approaches in computational lithography.

Computational lithography is nowadays playing an indispensible role in improving the imaging performance of optical lithography systems. This paper develops a new and powerful approach to computational lithography by introducing an information theoretical channel modeling in partially coherent lithography systems. A statistical model is built up based on the lithography imaging model to characterize the information transfer between the mask and print images. Then, this paper calculates the optimal information transfer (OIT) in partially coherent lithography systems, and derives the theoretical limit of image fidelity for optical proximity correction (OPC), which is used extensively in computational lithography. Finally, the proposed information theoretical approaches are applied to improve the OPC solutions obtained by the gradient-based algorithm. A set of simulations are provided to verify the proposed information theoretical model and approaches.

Fast optical proximity correction method based on nonlinear compressive sensing.

Optical proximity correction (OPC) is an extensively used resolution enhancement technique (RET) in optical lithography. To date, the computational efficiency has become a big issue for pixelated OPC techniques due to the increasing complexity of lithographic masks in modern integrated circuits. This paper is the first to apply nonlinear compressive sensing (CS) theory to break through the computational efficiency of gradient-based pixelated OPC methods. The proposed method reduces the dimensionality of the OPC problem by downsampling the layout pattern. Then, a nonlinear cost function is established to guarantee the lithography imaging performance on the downsampled layout. Under the sparsity assumption of the mask, the OPC problem is formulated as an inverse nonlinear CS reconstruction problem. The iterative hard thresholding (IHT) algorithm is then used to solve for the OPC problem. The proposed method proves to improve the computational efficiency of traditional gradient-based OPC methods, while improving the process windows of the lithography systems. Benefiting from the sparse property of the mask patterns, the mask manufacturability can also be improved compared to traditional methods.

Tracheal bronchus diagnosed in children undergoing flexible bronchoscopy.

This paper describes the clinical features of paediatric patients with tracheal bronchus (TB) identified with flexible bronchoscopy (FB) in a tertiary care hospital. A retrospective review of every FB with diagnosis of TB carried out in our centre since 1990 was performed which considered specifically: age at diagnosis, gender, semiology, somatic anomalies, tracheal bronchus type, other bronchoscopic findings and clinical progress. Out of 1665 FB in 1337 patients, TB was found in 26 (1.9%). The median age was 15 months (age range 1 month-13 years), with no gender differences. Of 26 patients, a total of 24 had associated congenital pathologies (92.3%) (heart disease 69%, chromosomal abnormality 35% and spinal fusion defect 11%). FB was performed for a number of reasons including: recurrent or persistent wheezing, pneumonia or atelectasis, persistent stridor and refractory cough. The type of TB identified was primarily ectopic lobar of the right upper lobe (73%) and the apical supernumerary (11.5%). In addition to TB, other defects were found by FB in 90% of cases, such as tracheomalacia, bronchomalacia or tracheal stenosis. The review confirmed a higher prevalence of TB than expected in previous series and highlighted its association with other airway or somatic malformations, notably congenital cardiac defects and spinal fusion defects. All patients were managed conservatively for the TB.

Atelectasia masiva: ¿siempre cuerpo extraño? / Massive pulmonary atelectasis: Is it always a foreign body?

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Bronquitis plástica en pediatría: manejo y tratamiento / Management and Treatment of Pediatric Plastic Bronchitis

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