Prediction of Waiting Times in A&E.

Predicting waiting times in A&E is a critical tool for controlling the flow of patients in the department. The most used method (rolling average) does not account for the complex context of the A&E. Using retrospective data of patients visiting an A&E service from 2017 to 2019 (pre-pandemic). An AI-enabled method is used to predict waiting times in this study. A random forest and XGBoost regression methods were trained and tested to predict the time to discharge before the patient arrived at the hospital. When applying the final models to the 68,321 observations and using the complete set of features, the random forest algorithm's performance measurements are RMSE=85.31 and MAE=66.71. The XGBoost model obtained a performance of RMSE=82.66 and MAE=64.31. The approach might be a more dynamic method to predict waiting times.

Exploring facial expressions and action unit domains for Parkinson detection.

BACKGROUND AND OBJECTIVE: Patients suffering from Parkinson's disease (PD) present a reduction in facial movements called hypomimia. In this work, we propose to use machine learning facial expression analysis from face images based on action unit domains to improve PD detection. We propose different domain adaptation techniques to exploit the latest advances in automatic face analysis and face action unit detection. METHODS: Three different approaches are explored to model facial expressions of PD patients: (i) face analysis using single frame images and also using sequences of images, (ii) transfer learning from face analysis to action units recognition, and (iii) triplet-loss functions to improve the automatic classification between patients and healthy subjects. RESULTS: Real face images from PD patients show that it is possible to properly model elicited facial expressions using image sequences (neutral, onset-transition, apex, offset-transition, and neutral) with accuracy improvements of up to 5.5% (from 72.9% to 78.4%) with respect to single-image PD detection. We also show that our proposed action unit domain adaptation provides improvements of up to 8.9% (from 78.4% to 87.3%) with respect to face analysis. Finally, we also show that triplet-loss functions provide improvements of up to 3.6% (from 78.8% to 82.4%) with respect to action unit domain adaptation applied upon models created from scratch. The code of the experiments is available at https://github.com/luisf-gomez/Explorer-FE-AU-in-PD. CONCLUSIONS: Domain adaptation via transfer learning methods seem to be a promising strategy to model hypomimia in PD patients. Considering the good results and also the fact that only up to five images per participant are considered in each sequence, we believe that this work is a step forward in the development of inexpensive computational systems suitable to model and quantify problems of PD patients in their facial expressions.

Monoamine oxidase binding not expected to significantly affect [18F]flortaucipir PET interpretation.

PURPOSE: [18F]-labeled positron emission tomography (PET) radioligands permit in vivo assessment of Alzheimer's disease biomarkers, including aggregated neurofibrillary tau (NFT) with [18F]flortaucipir. Due to structural similarities of flortaucipir with some monoamine oxidase A (MAO-A) inhibitors, this study aimed to evaluate flortaucipir binding to MAO-A and MAO-B and any potential impact on PET interpretation. METHODS: [18F]Flortaucipir autoradiography was performed on frozen human brain tissue slices, and PET imaging was conducted in rats. Dissociation constants were determined by saturation binding, association and dissociation rates were measured by kinetic binding experiments, and IC50 values were determined by competition binding. RESULTS: Under stringent wash conditions, specific [18F]flortaucipir binding was observed on tau NFT-rich Alzheimer's disease tissue and not control tissue. In vivo PET experiments in rats revealed no evidence of [18F]flortaucipir binding to MAO-A; pre-treatment with MAO inhibitor pargyline did not impact uptake or wash-out of [18F]flortaucipir. [18F]Flortaucipir bound with low nanomolar affinity to human MAO-A in a microsomal preparation in vitro but with a fast dissociation rate relative to MAO-A ligand fluoroethyl-harmol, consistent with no observed in vivo binding in rats of [18F]flortaucipir to MAO-A. Direct binding of flortaucipir to human MAO-B was not detected in a microsomal preparation. A high concentration of flortaucipir (IC50 of 1.3 µM) was found to block binding of the MAO-B ligand safinamide to MAO-B on microsomes suggesting that, at micromolar concentrations, flortaucipir weakly binds to MAO-B in vitro. CONCLUSION: These data suggest neither MAO-A nor MAO-B binding will contribute significantly to the PET signal in cortical target areas relevant to the interpretation of [18F]flortaucipir.

Sizes of pure and doped helium droplets from single shot x-ray imaging.

Advancements in x-ray free-electron lasers on producing ultrashort, ultrabright, and coherent x-ray pulses enable single-shot imaging of fragile nanostructures, such as superfluid helium droplets. This imaging technique gives unique access to the sizes and shapes of individual droplets. In the past, such droplet characteristics have only been indirectly inferred by ensemble averaging techniques. Here, we report on the size distributions of both pure and doped droplets collected from single-shot x-ray imaging and produced from the free-jet expansion of helium through a 5 µm diameter nozzle at 20 bars and nozzle temperatures ranging from 4.2 to 9 K. This work extends the measurement of large helium nanodroplets containing 109-1011 atoms, which are shown to follow an exponential size distribution. Additionally, we demonstrate that the size distributions of the doped droplets follow those of the pure droplets at the same stagnation condition but with smaller average sizes.

Claims on Ready-to-Eat Cereals: Are Those With Claims Healthier?

Background: The use of advertising content strategies that suggest consuming a product will confer nutrient- and health-related benefits influences household food purchasing decisions, which increases consumption of energy-dense, nutrient-poor products. We examined the presence of marketing claims regarding nutrient content, health and nature in ready-to-eat (RTE) cereal packages in relation to the products' nutritional quality. Methods: A cross-sectional content analysis was conducted on 178 RTE cereal packages available in the six largest supermarket chains in four Colombian cities from August to November 2018. The nutritional quality of products was assessed through the nutrient profile model established by the Chilean Law of Food Labeling and Advertising law. Results: All products sampled exceeded the regulation threshold for at least one nutrient of concern (e.g., high-in calories and/or sugar). The majority (66.3%) of packages had claims related to nature, 57.3% had nutrient-content claims, and 15.7% had health benefit or risk avoidance claims. Most products with nature, nutrient-content, and health claims were high in energy (99.2, 98.0, and 92.9%, respectively) and sugar (88.1, 87.3, and 92.9%, respectively). Conclusion: RTE cereal products offered in major Colombian supermarket chains are heavily marketed using nutrition- and nature-related claims. Nearly all products with claims are high in energy and sugar, despite the messages conveyed by the claims to consumers. Results support the implementation of mandatory regulations restricting claims on food and beverage products high in nutrients of concern.

Geographic Distribution of the Ciclovia and Recreovia Programs by Neighborhood SES in Bogotá: How Unequal is the Geographic Access Assessed Via Distance-based Measures?

Ciclovia, also known as Open Streets initiatives in other countries, are city streets that are closed to motorized traffic and opened during certain times to residents for engaging in physical activity (PA). These initiatives are viewed by policy makers and health and community advocates as being beneficial to social, environmental, and community health. This study explores the geographic distribution of Ciclovia and Recreovia and the differences in geographic access assessed via distance-based measures, based on the socioeconomic status (SES) of the area. Results from this study show that the median distance to the Ciclovia according to SES ranges from 2930 m for SES 1 (most disadvantaged) to 482 m for SES 6 (wealthiest). The median distance to the Recreovia sites ranges from 5173 m for SES 1 to 3869 m for SES 6. This study found revealing urban inequities in the distribution of Ciclovia, whereas there was less inequalities within the Recreovia sites. This study shows that urban interventions are needed to promote recreational activity and reduce health disparities in under resourced, low SES areas.

Open bilateral common femoral and popliteal vein aneurysm repair.

Although venous aneurysms are rare, typically asymptomatic, and most commonly found incidentally on imaging studies, patients with this pathology can develop pulmonary emboli owing to these aneurysms acting as a nidus for thrombus formation. There is no clear consensus regarding conservative management with anticoagulation vs operative intervention as the best treatment of deep venous aneurysms. We report the clinical course and surgical treatment of a patient presenting with both bilateral common femoral vein and bilateral popliteal venous aneurysms who had a known history of prior symptomatic pulmonary emboli.

Scoping review of studies on food marketing in Latin America: Summary of existing evidence and research gaps.

OBJECTIVE: To document the evidence about marketing of ultra-processed foods and "non-alcoholic" beverages in Latin America. METHODS: We performed a structured search of quantitative and qualitative studies in PubMed, SciELO and LILACS, published between January 2000 and May 2017 and conducted in Latin America. We conducted a quality assessment following a standardized tool and a thematic analysis to identify key typologies of marketing across studies. RESULTS: Out of 521 studies screened by title and abstract, we included 36 in this review; 27 of them analyzed television advertisement. Other marketing channels studied were food packaging, point of sale and outdoor advertisement. Studies found television advertises foods and beverages that are mostly ultraprocessed foods and have low nutritional value, particularly those promoted during children's programming. We also observed children have a literal interpretation of images printed on food packaging, so this can be deceiving. Several studies also found proximity to unhealthy foods may increase their consumption. Finally, the thematic analysis identified the following typologies of food marketing: a) television advertisement, b) food packaging marketing, c) marketing strategies at points of sale and d) other marketing strategies. We found almost no advertisements for unprocessed or minimally processed foods such as fruits and vegetables. We did not find any studies on digital marketing conducted in the region. CONCLUSIONS: This review found that the main channel of food marketing was television advertising. This synthesis provides insights to the challenges unhealthy eating represents to the public health of Latin America and identifies knowledge gaps to guide future research.

Impact of Cardiac Cycle on Thoracic Aortic Geometry-Morphometric Analysis of Ecg Gated Computed Tomography.

BACKGROUND: Understanding morphological changes of ascending aorta, aortic arch and descending aorta with cardiac and respiratory motion is critical for planning of endovascular repair of thoracic aorta. The aim of this study was to determine the impact of the cardiac cycle on thoracic aortic geometry. METHODS: In this retrospective study, electrocardiogram-gated cardiac computed tomography from 116 patients who were evaluated for transcatheter aortic valve replacement were reviewed. A protocol for measurements of maximal diameters and lengths of the thoracic aorta and supra-aortic vessels was established. Measurements were made in multiplanar views perpendicular to the semiautomatically created centerline on both systolic and diastolic phases. RESULTS: Mean age was 77 ± 11 years of our study cohort. Mean systolic and diastolic diameter were 31.6 ± 0.42 and 30.1 ± 4.4 mm at the sinotubular junction (STJ), 35.6 ± 4.8 and 34.8 ± 4.7 mm in the ascending aorta, 29.1 ± 3.3 and 28.5 ± 3.3 mm in the aortic arch (distal left common carotid artery), and 26.7 ± 5.4 and 25.8 ± 5.4 mm in the descending aorta. Mean diameter change was 1.5 ± 0.9 mm at the STJ, 0.8 ± 0.9 mm in the ascending aorta, 0.6 ± 0.8 mm in the aortic arch, and 0.9 ± 1.2 mm in the descending aorta. Mean arterial strain was 5.0 ± 3.2% at the level of the STJ, 2.4 ± 2.7% in the ascending aorta, 2.0 ± 2.9% in the aortic arch, and 3.9 ± 5.7% in the descending aorta. CONCLUSIONS: Our results demonstrated that small but significant circumferential and longitudinal strain was present at every aortic level. These findings may have implications for endovascular thoracic aortic repair and may provide reference values for future comparison.

Neighborhood environment, self-rated health and quality of life in Latin America.

To conduct a systematic review examining the associations between neighborhood environments and self-rated health (SRH) and health-related quality of life (HR-QOL) in the urban context of Latin America. We conducted a structured search of quantitative studies in three bibliographic databases published in Spanish, English, Portuguese and French from January 1990 to December 2015. We restricted the search to studies conducted in Latin-American cities with one million and more inhabitants. Eleven studies were finally included in the analysis. Ten were cross-sectional studies and one was a cohort follow-up study. Two studies found positive associations between accessibility to parks and HR-QOL. One study found that high neighborhood social capital was positively associated with SRH. Neighborhood socioeconomic status was positively associated with both HR-QOL and SRH in two studies. A walkable neighborhood was positively associated with SRH in two studies. Three studies included attributes related with neighborhood security perception and road safety, with higher scores of HR-QOL, both in the physical and mental dimensions, while high levels of street noise were negatively associated. Narrowness and slope of streets were negatively associated with SRH. No association was found between the perception of neighborhood security and SRH. The results of this systematic review show that several studies conducted in Latin America have found significant associations between neighborhood environment and SRH and HRQOL. However, the relatively small number of studies and the heterogeneity among them require further studies to better understand this topic in the region.

Nutrition Quality of Packaged Foods in Bogotá, Colombia: A Comparison of Two Nutrient Profile Models.

BACKGROUND: Front-of-package warning labels are an increasingly common policy and have been implemented to inform consumers of the nutritional quality of ultra-processed foods. This study examined the proportion of Colombian products that could be subjected to such regulations. METHODS: Two nutrition profile models were compared: the Pan American Health Organization (PAHO) model, and the nutrient profile established under the Chilean food labeling and advertising law (Chilean model). Products (n = 6708) exceeding nutrient criteria based on each model were identified as subject to regulation. RESULTS: A total of 80.2% (PAHO model) to 66.4% (Chilean model) of foods met the criteria for regulation. The categories with the highest proportion of regulated products were meats (97.3% PAHO model; 87.5% Chilean model), sweets (95.6% PAHO) and snacks (Chilean model). The category with the lowest proportions of regulated products were cereals (47.3% PAHO model) and miscellaneous foods and fish/seafood (39.0% and 39.5%, respectively, Chilean model). CONCLUSIONS: Under both the PAHO and Chilean nutrient profile models, the majority of packaged foods available in Bogotá would be eligible to receive front-of-package warning labels. These results suggest a warning label law could have a major impact on the Colombian food supply, especially in the context of the growing prevalence of diet-related chronic diseases in Colombia.

Scoping review of studies on food marketing in Latin America: Summary of existing evidence and research gaps

ABSTRACT OBJECTIVE To document the evidence about marketing of ultra-processed foods and "non-alcoholic" beverages in Latin America. METHODS We performed a structured search of quantitative and qualitative studies in PubMed, SciELO and LILACS, published between January 2000 and May 2017 and conducted in Latin America. We conducted a quality assessment following a standardized tool and a thematic analysis to identify key typologies of marketing across studies RESULTS Out of 521 studies screened by title and abstract, we included 36 in this review; 27 of them analyzed television advertisement. Other marketing channels studied were food packaging, point of sale and outdoor advertisement. Studies found television advertises foods and beverages that are mostly ultraprocessed foods and have low nutritional value, particularly those promoted during children's programming. We also observed children have a literal interpretation of images printed on food packaging, so this can be deceiving. Several studies also found proximity to unhealthy foods may increase their consumption. Finally, the thematic analysis identified the following typologies of food marketing: a) television advertisement, b) food packaging marketing, c) marketing strategies at points of sale and d) other marketing strategies. We found almost no advertisements for unprocessed or minimally processed foods such as fruits and vegetables. We did not find any studies on digital marketing conducted in the region. CONCLUSIONS This review found that the main channel of food marketing was television advertising. This synthesis provides insights to the challenges unhealthy eating represents to the public health of Latin America and identifies knowledge gaps to guide future research.

Synthesis, radiosynthesis, in vitro and first in vivo evaluation of a new matrix metalloproteinase inhibitor based on γ-fluorinated α-sulfonylaminohydroxamic acid.

BACKGROUND: To study MMP activity in vivo in disease, several radiolabeled MMP inhibitors functioning as radiotracers have been evaluated by means of SPECT and PET. Unfortunately, most of them suffer from metabolic instability, mainly hepatobiliary clearance and insufficient target binding. The introduction of a fluorine atom into MMPIs could contribute to target binding, enhance the metabolic stability and might shift the clearance towards more renal elimination. Recently developed α-sulfonylaminohydroxamic acid based γ-fluorinated inhibitors of MMP-2 and -9 provide promising fluorine interactions with the enzyme active site and high MMP inhibition potencies. The aim of this study is the (radio)synthesis of a γ-fluorinated MMP-2 and -9 inhibitor to evaluate its potential as a radiotracer to image MMP activity in vivo. RESULTS: Two new fluorine-containing, enantiomerically pure inhibitors for MMP-2 and -9 were synthesized in a six step sequence. Both enantiomers exhibited equal inhibition potencies in the low nanomolar and subnanomolar range. LogD value indicated better water solubility compared to the CGS 25966 based analog. The most potent inhibitor was successfully radiofluorinated. In vivo biodistribution in wild type mice revealed predominantly hepatobiliary clearance. Two major radioactive metabolites were found in different organs. Defluorination of the radiotracer was not observed. CONCLUSION: (Radio)synthesis of a CGS based γ-fluorinated MMP inhibitor was successfully accomplished. The (S)-enantiomer, which normally shows no biological activity, also exhibited high MMP inhibition potencies, which may be attributed to additional interactions of fluorine with enzyme's active site. Despite higher hydrophilicity no significant differences in the clearance characteristics compared to non-fluorinated MMPIs was observed. Metabolically stabilizing effect of the fluorine was not monitored in vivo in wild type mice.

Maternal and familial correlates of anthropometric typologies in the nutrition transition of Colombia, 2000-2010.

OBJECTIVE: We aimed to assess the maternal and family determinants of four anthropometric typologies at the household level in Colombia for the years 2000, 2005 and 2010. DESIGN: We classified children 2) to assess stunting and overweight/obesity, respectively; mothers were categorized according to BMI to assess underweight (<18·5 kg/m2) and overweight/obesity (≥25·0 kg/m2). At the household level, we established four final anthropometric typologies: normal, underweight, overweight and dual-burden households. Separate polytomous logistic regression models for each of the surveyed years were developed to examine several maternal and familial determinants of the different anthropometric typologies. SETTING: National and sub-regional (urban and rural) representative samples from Colombia, South America. SUBJECTS: Drawing on data from three waves of Colombia's Demographic and Health Survey/Encuesta Nacional de Salud (DHS/ENDS), we examined individual and household information from mothers (18-49 years) and their children (birth-5 years). RESULTS: Higher parity was associated with an increased likelihood of overweight and dual burden. Higher levels of maternal education were correlated with lower prevalence of overweight, underweight and dual burden of malnutrition in all data collection waves. In 2010, participation in nutrition programmes for children <5 years, being an indigenous household, food purchase decisions by the mother and food security classification were also associated with the four anthropometric typologies. CONCLUSIONS: Results suggest that maternal and family correlates of certain anthropometric typologies at the household level may be used to better frame policies aimed at improving social conditions and nutrition outcomes.

HPV genotypes detected by linear array and next-generation sequencing in anal samples from HIV positive men who have sex with men in Mexico.

The incidence of anal cancer has been rising, especially in HIV+ patients and has been associated with HPV infection. HIV+ patients are more at risk of HPV coinfection and are seven times more likely to have persistent HPV infection; moreover, HIV+ men have an increased risk of developing anal cancer compared to HIV+ women. The development of screening strategies for the detection of HPV in HIV+ men is of major importance; however, there is not enough information about the HPV genotypes and variants that are colonizing the anal epithelia of HIV+ men in diverse geographical regions. Therefore, this work was aimed at identifying HPV genotypes present in the anal epithelium of HIV+ men who have sex with men (MSM), with or without anal lesions (n = 75). For HPV genotyping, two approaches were performed: Linear Array HPV Genotyping Test and next-generation sequencing (NGS). In general, the six most frequent HPV genotypes found by Linear Array were HPV6, 62, 61, 81, 16 and 51. On the other hand, employing NGS, a total of 36 HPV genotypes belonging to both alpha and beta genera were found. The genotypes with the greatest number of reads, according to the diagnostic group, were: HPV81, 45, 6, 51 and 61 in MSM without anal lesions (WAIN); HPV6, 61, 70, 62 and 66 in MSM with atypical lesions (AAL); HPV6, 11, 66, 81 and 61 in MSM with anal intraepithelial neoplasia grade I (AIN I); and HPV16, 81, 58, 61 and 52 with AIN III. Additionally, a great diversity of L1 variants was observed, especially in genotypes HPV16, 58, 61, 52, 45 and 59.

Formation of Core-Shell Ethane-Silver Clusters in He Droplets.

Ethane core-silver shell clusters consisting of several thousand particles have been assembled in helium droplets upon capture of ethane molecules followed by Ag atoms. The composite clusters were studied via infrared laser spectroscopy in the range of the C-H stretching vibrations of ethane. The spectra reveal a splitting of the vibrational bands, which is ascribed to interaction with Ag. A rigorous analysis of band intensities for a varying number of trapped ethane molecules and Ag atoms indicates that the composite clusters consist of a core of ethane that is covered by relatively small Ag clusters. This metastable structure is stabilized due to fast dissipation in superfluid helium droplets of the cohesion energy of the clusters.

Description and early outcomes of the hybrid graft for dialysis.

INTRODUCTION: Long-term dialysis access has become more challenging as patient survival has improved in end-stage renal disease. The GORE® Hybrid Vascular Graft (GHVG) has been designed to improve dialysis access outcomes and provide additional access options for challenging patients. In this article, we will review the design of the graft, unique properties and reported outcomes. METHODS: We reviewed data available at our institution and performed a Pubmed search on GORE® Hybrid Vascular graft. We found two more studies besides the data published by our department. RESULTS: To date, there have been three papers showing early results of these grafts. All studies report successful placement of the grafts with no unexpected complications. Limb edema has not been a common problem, despite concerns of placing a stent graft into the axillary vein. The papers have shown 70% cumulative patency of the GHVG at 12 months. The comparative studies showed no significant benefit compared to conventional grafts. We see this as an option of continuing with arm access rather than going to more complex access creation such as a chest wall access or going to access creation in the legs. CONCLUSIONS: The GHVG has been shown to have comparable performance to standard arteriovenous graft techniques and can expand access options for some patients with challenging anatomy.

Results From Colombia's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Physical activity (PA) is vital to the holistic development of young people. Regular participation in PA is associated with substantial benefits for health, cognitive function, and social inclusion. Recognizing the potential of PA in the context of the current peace process in Colombia, the purpose of this article is to present the methodology and results of Colombia's second Report Card on PA for children and youth. METHODS: A group of experts on PA graded 14 PA indicators based on data from national surveys and policy documents. RESULTS: National and departmental policy indicators received a grade of B, while organized sport participation, overweight, obesity, community influence, and nongovernment initiatives indicators received a grade of C. Overall PA levels, active transportation, sedentary behaviors, and school influence received a grade of D. Active play, low physical fitness, and family influence received an Incomplete grade. CONCLUSIONS: PA levels are low and sedentary behaviors are high in Colombian children and youth, with notable geographic differences. A broad policy framework translated into specific actions could provide unique opportunities to bridge the gap between knowledge and practice, and contribute to social integration goals in a postconflict setting.

Formation of Large Ag Clusters with Shells of Methane, Ethylene, and Acetylene in He Droplets.

Helium droplets were used to assemble composite metal-molecular clusters. Produced clusters have several hundreds of silver atoms in the core, immersed in a shell consisting of methane, ethylene, or acetylene molecules. The structure of the clusters was studied via infrared spectra of the C-H stretches of the hydrocarbon molecules. The spectra of the clusters containing methane and acetylene show two distinct features due to molecules on the interface with silver core and those in the volume of the neat molecular part of the clusters. The relative intensities of the peaks are in good agreement with the estimates based on the number of the captured particles. Experiments also suggest that selection rules for infrared transitions for molecules adsorbed on metal surfaces are also valid for silver clusters as small as 300 atoms.