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This study presents a methodology for predicting the duration of surgical procedures using Machine Learning (ML). The methodology incorporates a new set of predictors emphasizing the significance of surgical team dynamics and composition, including experience, familiarity, social behavior, and gender diversity. By applying ML techniques to a comprehensive dataset of over 77,000 surgeries, we achieved a 24% improvement in the mean absolute error (MAE) over a model that mimics the current approach of the decision maker. Our results also underscore the critical role of surgeon experience and team composition dynamics in enhancing prediction accuracy. These advancements can lead to more efficient operational planning and resource allocation in hospitals, potentially reducing downtime in operating rooms and improving healthcare delivery.

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The aim of this observational, cross-sectional study is to evaluate potential differences in kinematics, specifically range of motion (ROM) and velocity, during planar cervical movements between patients with non-traumatic chronic neck pain and disability and asymptomatic controls, while accounting for potential influencing variables of age, sex and fear of movement. The influence of pain intensity, neck disability, age, sex or fear of motion on kinematics was analyzed through robust multivariate Bayesian regression models fitted using the brms library in R. Forty-three patients with neck pain (aged 36.70 ± 13.75 years; 10 men and 33 women) and 42 asymptomatic participants (aged 32.74 ± 13.24 years; 25 men and 17 women) completed the study protocol. The presence of neck pain/disability was associated with lower ROM and peak velocity during all planar movements when considering the influence of age, sex or fear of motion, with standardized regression coefficients that had a small effect size (ranged from 0.11 to 0.28) and estimated differences of less than 2.21° in ROM and 25.61°/s in peak velocity. Although patients with chronic mechanical neck pain showed reduced ROM and peak velocity, the small effect sizes and the low estimated differences between groups question the relevance and clinical usefulness of kinematic analysis of planar movements in samples of patients similar to those included in our study. It is probable that there are differences between the groups, but it is insufficient to rely solely on kinematic variables for patient discrimination. This limitation likely arises from the substantial variability in patient kinematics.

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Low-density lipoprotein cholesterol (LDL-C), which makes up about 70% of the cholesterol in the blood, is critical in the formation of arteriosclerotic plaques, increasing the risk of heart disease. LDL-C levels are estimated using Friedewald, Martin and Sampson equations, though they have limitations with high triglycerides. Our aim is to compare the effectiveness of these equations versus the ultracentrifugation technique in individuals with and without dyslipidemia and identify precision. There were 113 participants, 59 healthy controls and 54 dyslipidemic patients. Samples were collected after fasting. LDL-C was estimated using the Friedewald, Martin and Sampson equations. The purified LDL-C, ultracentrifugated and dialysized control group without dyslipidemia vs. patients with coronary artery disease (CAD) showed differences in age, HDL-C, triglycerides and glucose non-HDL-C (p = 0.001 in all). There were correlations in CGWD between ultracentrifugation and Sampson R-squared (R2) = 0.791. In the dyslipidemia control group, ultracentrifugation and Friedewald R2 = 0.911. In patients with CAD, correlation between ultracentrifugation and Sampson R2 = 0.892; Bland-Altman confirmed agreement in controls without dyslipidemia. The Martin and Sampson equations are interchangeable with ultracentrifugation. Conclusion: The role of LDL analysis using precise techniques is necessary to obtain better control of disease outcomes after the use of precise therapies and suggests verifying its importance through clinical trials.

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Neutrophils, which constitute the most abundant leukocytes in human blood, emerge as crucial players in the induction of endothelial cell death and the modulation of endothelial cell responses under both physiological and pathological conditions. The hallmark of preeclampsia is endothelial dysfunction induced by systemic inflammation, in which neutrophils, particularly through the formation of neutrophil extracellular traps (NETs), play a pivotal role in the development and perpetuation of endothelial dysfunction and the hypertensive state. Considering the potential of numerous pharmaceutical agents to attenuate NET formation (NETosis) in preeclampsia, a comprehensive assessment of the extensively studied candidates becomes imperative. This review aims to identify mechanisms associated with the induction and negative regulation of NETs in the context of preeclampsia. We discuss potential drugs to modulate NETosis, such as NF-κß inhibitors, vitamin D, and aspirin, and their association with mutagenicity and genotoxicity. Strong evidence supports the notion that molecules involved in the activation of NETs could serve as promising targets for the treatment of preeclampsia.

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This paper examines advances in ultra-high concentration photovoltaics (UHCPV), focusing specifically on vertical multijunction (VMJ) solar cells. The use of gallium arsenide (GaAs) in these cells increases their efficiency in a range of applications, including terrestrial and space settings. Several multijunction structures are designed to maximize conversion efficiency, including a vertical tunnel junction, which minimizes resistive losses at high concentration levels compared with standard designs. Therefore, careful optimization of interconnect layers in terms of thickness and doping concentration is needed. Homo-multijunction GaAs solar cells have been simulated and analyzed by using ATLAS Silvaco 5.36 R, a sophisticated technology computer-aided design (TCAD) tool aimed to ensure the reliability of simulation by targeting a high conversion efficiency and a good fill factor for our proposed structure model. Several design parameters, such as the dimensional cell structure, doping density, and sun concentrations, have been analyzed to improve device performance under direct air mass conditions AM1.5D. The optimized conversion efficiency of 30.2% has been achieved with investigated GaAs solar cell configuration at maximum concentration levels.

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Maërl habitats are composed of coralline red algae species that can live freely rolling on the seabed and forming nodules, the so-called rhodoliths, or incrusted forming coralligenous habitats. Maërl habitats are generally distributed in the Mediterranean at a depth of between 30 m and 70 m and are considered one of the most emblematic Mediterranean seabeds. In the present study, the complex structure of maërl habitats was investigated to i) characterise the relief features and classify the different sediments, ii) to estimate the abundance of the coralline red algae (both rhodoliths and encrusting ones) and iii) to analyse the biodiversity of the species inhabiting the habitat. Data were obtained from an approximately 11 km-long transect, using non-intrusive sampling methods, integrating information from video images collected using the Remotely Operated Vehicle LIROPUS (IEO_CSIC), and multibeam bathymetry and backscatter data. Video images were used to reconstruct (using GIS) the habitat structure and characteristics. Throughout the transect, a strong relationship between habitat characteristics and the effect of trawling activity and the geomorphology of the studied area was observed. The closed area to fishing activity showed a high abundance of rhodoliths in well-structured megaripples reliefs. Contrarily, the areas affected by fishing showed an important destructuring of the relief with a low density of rhodoliths. Last, the muddy bottoms showed areas with no characteristic features and no rhodoliths. All this information has allowed to reconstruct the maërl habitat in the Blanes continental shelf (NW Mediterranean) and analyse the fragmentation of the assemblages seen in the video to assess its good environmental status (GES), and finally to identify the level of ecological integrity of this vulnerable habitat.

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Patients experiencing mental health crises often seek help through messaging-based platforms, but may face long wait times due to limited message triage capacity. Here we build and deploy a machine-learning-enabled system to improve response times to crisis messages in a large, national telehealth provider network. We train a two-stage natural language processing (NLP) system with key word filtering followed by logistic regression on 721 electronic medical record chat messages, of which 32% are potential crises (suicidal/homicidal ideation, domestic violence, or non-suicidal self-injury). Model performance is evaluated on a retrospective test set (4/1/21-4/1/22, N = 481) and a prospective test set (10/1/22-10/31/22, N = 102,471). In the retrospective test set, the model has an AUC of 0.82 (95% CI: 0.78-0.86), sensitivity of 0.99 (95% CI: 0.96-1.00), and PPV of 0.35 (95% CI: 0.309-0.4). In the prospective test set, the model has an AUC of 0.98 (95% CI: 0.966-0.984), sensitivity of 0.98 (95% CI: 0.96-0.99), and PPV of 0.66 (95% CI: 0.626-0.692). The daily median time from message receipt to crisis specialist triage ranges from 8 to 13 min, compared to 9 h before the deployment of the system. We demonstrate that a NLP-based machine learning model can reliably identify potential crisis chat messages in a telehealth setting. Our system integrates into existing clinical workflows, suggesting that with appropriate training, humans can successfully leverage ML systems to facilitate triage of crisis messages.

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The elbow is one of the most commonly dislocated joints. While conservative management is frequently performed for simple elbow dislocations, the importance of primary surgical treatment is still undetermined. However, promising results have been reached after surgical repair. We propose an arthroscopic surgical repair of the lateral ligament complex (LCL), performed with a horizontal suture and 2 Fibertak Knotless implants (Arthrex) placed on the LCL origin, one anterior and the other posterior. Operative treatment should be performed in patients with moderate and gross elbow laxity to avoid post-traumatic sequelae and decrease revision rates. Arthroscopic techniques create fewer complications. This procedure allows one to address intra-articular elbow joint pathology with less chance of wound complications and the ability to use bone anchors if desired.

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Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.

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BACKGROUND: Aortic stenosis is the most common valvulopathy in Western countries. The treatment of choice had been surgery aortic valve replacement (SAVR), but the improvement in endovascular approaches as transcatheter aortic valve implantation (TAVI), initially reserved for patients with very high surgical risk, has been extended to high and intermediate, and recently also to low-risk patients. Stroke and vascular cognitive impairment are the most important complications. It is not entirely clear which technique is best to avoid these complications as well as their impact. Our goal is to evaluate changes in cognitive performance in the early (1-month) and late (1-year) postoperative period in patients undergoing SAVR or TAVI, by extensive neuropsychological study (NRP) and advanced Magnetic Resonance Imaging (MRI). Specifically, to compare early and late cognitive changes after the intervention between both groups, the occurrence of stroke during follow-up and to compare the appearance of silent vascular lesions and changes in brain activity and functional connectivity with functional MRI during follow-up between both groups. METHODS/DESIGN: Prospective longitudinal cohort study. A non-selected representative sample of 80 subjects, 40 SAVR and 40 TAVI to obtain a final sample of 36 eligible subjects in each group, ranging from 70 to 85 years old, with indication for aortic replacement and intermediate or high surgical risk will be studied. At baseline, within one month before the treatment, all individuals will undergo an extensive NRP and advanced MRI study. These studies will also be performed 1-month and 1-year after treatment, to assess the appearance of new vascular lesions, as well as changes in cognitive performance with respect to baseline. DISCUSSION: This study aims to evaluate changes in cognitive performance as well as both clinical and silent vascular events occurring in the early (1-month) and late (1-year) periods after SAVR and TAVI. We will also analyze the correlation between neuropsychological and neuroimaging approaches in order to evaluate cognition. Therefore, it may provide high-quality data of cognitive changes and vascular events for both techniques, and be useful to tailor interventions to individual characteristics and ultimately aiding in decision-making. TRIAL REGISTRATION: This study is register in Clinicaltrials.gov (NCT05235529) on 11th February 2022.

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PURPOSE: To explore the efficacy and safety of individualized follitropin delta dosing, based on serum anti-Müllerian hormone (AMH) concentration and bodyweight, in a long gonadotropin-releasing hormone (GnRH) agonist protocol. METHODS: Clinical outcomes after one treatment cycle are reported in women with AMH: 5-35 pmol/L. Oocytes were inseminated by intracytoplasmic sperm injection, blastocyst transfer was on Day 5 and remaining blastocysts were cryopreserved. Data collection included live births and neonatal health follow-up for all fresh/frozen transfers performed within one year after treatment allocation. RESULTS: In total, 104 women started stimulation, of whom 101 had oocyte recovery and 92 had blastocyst transfer. The average daily dose of follitropin delta was 11.0 ± 1.6 µg and the duration of stimulation was 10.3 ± 1.6 days. The mean number of oocytes was 12.5 ± 6.4, the mean number of blastocysts was 5.1 ± 3.4, and 85% had at least one good-quality blastocyst. Following mostly single blastocyst transfer (95%), the ongoing pregnancy rate was 43%, the live-birth rate was 43%, and the cumulative live-birth rate was 58% per started stimulation. There were 6 cases of early OHSS (5.8%) graded as mild (n = 3) and moderate (n = 3) and 6 cases of late OHSS (5.8%) graded as moderate (n = 3) and severe (n = 3). CONCLUSION: In this first evaluation of the individualized follitropin delta dosing in a long GnRH agonist protocol, the cumulative live-birth rate was high. A randomized trial comparing follitropin delta in a long GnRH agonist protocol versus in a GnRH antagonist protocol should provide further insight into the efficacy and safety of this treatment option. TRIAL REGISTRATION NUMBER: NCT03564509; June 21, 2018.

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Pose estimation of C. elegans in image sequences is challenging and even more difficult in low-resolution images. Problems range from occlusions, loss of worm identity, and overlaps to aggregations that are too complex or difficult to resolve, even for the human eye. Neural networks, on the other hand, have shown good results in both low-resolution and high-resolution images. However, training in a neural network model requires a very large and balanced dataset, which is sometimes impossible or too expensive to obtain. In this article, a novel method for predicting C. elegans poses in cases of multi-worm aggregation and aggregation with noise is proposed. To solve this problem we use an improved U-Net model capable of obtaining images of the next aggregated worm posture. This neural network model was trained/validated using a custom-generated dataset with a synthetic image simulator. Subsequently, tested with a dataset of real images. The results obtained were greater than 75% in precision and 0.65 with Intersection over Union (IoU) values.

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Thrombophilia is a group of inherited or acquired coagulation disorders that have been associated with reproductive failure. However, there are still no clear recommendations on whether its inclusion in the initial study of the infertile couple or patients with recurrent implantation failure is necessary. In this discussion paper, based on a SWOT (strengths, weaknesses, opportunities, threats) analysis, the different aspects of the repercussions of thrombophilia screening and treatment in reproduction are evaluated. To avoid possible subjectivity in the analysis and results of this study, researchers followed Oxford criteria for the evaluation of evidence. The results from the evaluation of the reviewed bibliography seem to indicate that, pending new evidence, it would be advisable not to include thrombophilia screening in the initial baseline study of the infertile couple. There is no evidence to support a clear association between thrombophilia and implantation failure or infertility. Thrombophilia testing in this setting may increase cost, with minimal potential benefit and lead to inappropriate use of anticoagulants with possible deleterious adverse effects. Future well-designed studies are needed to assess the possible benefit of anticoagulant therapy in infertile thrombophilic patients with implantation failure.

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Background: Occipital encephalocele is a congenital defect of the neural tube at the level of the cranial midline, which results in herniation of meninges and brain tissue. The results of the management of myelomeningocele study determine the maternal and fetal risks for an open fetal surgery and have motivated the constant review of the concepts and strategies which the pediatric neurosurgeon can employ for the treatment of neural tube defects in the prenatal period. Case Description: We present a case of a female patient in utero of 26 gestational weeks with the diagnosis of an occipital encephalocele treated by open fetal surgery. During week 20 of gestation, the diagnosis of occipital encephalocele was made by ultrasound, which was corroborated by fetal magnetic resonance that showed cranial protrusion of neural and meningeal content in the occipital region, measuring 1.6 × 2.8 × 3.3 cm with an approximate volume of 7.7 cc through a bone defect of 6 mm. The closure of the defect was performed by the postnatal surgical technique adapted to the open fetal surgery. Later, the patient was born transabdominal with a 2.8 cm occipital wound, with suture points and approximated borders, normocephalic, without clinical signs of sepsis, hydrocephalus, or overt neurologic compromise. Conclusion: Open fetal surgery is a therapeutic option in the face of an isolated occipital encephalocele. This case report demonstrates the viability of the surgical procedure by the adaptation of a postnatal surgical technique to a prenatal surgery. Further studies are needed to evaluate the long-term functional results, comparing them with those seen in patients who undergo a postnatal procedure.

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BACKGROUND: Heart transplant (HT) from controlled donation after circulatory death (cDCD) is an emerging strategy that is rapidly expanding and may help increase the heart donor pool. MATERIALS AND METHODS: The use of thoracoabdominal normothermic regional perfusion with extracorporeal membrane oxygenation device has allowed to perform HT after cDCD in our country. We present a successful case of heart transplantation using a graft from cDCD with 201 min cold ischemia time. DISCUSSION AND CONCLUSION: HT from cDCD could be a good alternative to brain dead donation. This experience suggests than nonlocal cardiac from cDCD could tolerate long periods of cold ischemia time and break the main barriers with this technique.

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Adrenergic ß2-agonists represent a mainstay in asthma management. Their chronic use has been associated with decreased bronchoprotection and rebound hyperresponsiveness. Here we investigate on the possible therapeutic advantage of a pharmacological association of ß2-agonists with montelukast, a highly selective leukotriene receptor antagonist, in modulating bronchial reactivity and controlling asthma features. The study has been conducted in vitro and in vivo and also takes advantage of the synthesis of a salt that gave us the possibility to simultaneously administer in vivo formoterol and montelukast (MFS). In vitro studies demonstrate that montelukast (1) preserves ß2-agonist response in isolated bronchi by preventing homologous ß2-adrenoceptor desensitization; (2) reduces desensitization by modulating ß2-receptor translocation in bronchial epithelial cells. In vivo studies demonstrate that sensitized mice receiving formoterol or montelukast display a significant reduction in airway hyperresponsiveness, but the ß2-agonist relaxing response is still impaired. Allergen challenge causes ß2 heterologous desensitization that is further increased by treatment in vivo with formoterol. Conversely MFS not only inhibits airway hyperresponsiveness but it rescues the ß2-agonist response. Histological analysis confirms the functional data, demonstrating an enhanced therapeutic efficiency of MSF in controlling also pulmonary metaplasia and lung inflammation. MFS is efficacious also when sensitized mice received the drug by local administration. In conclusion, the data obtained evidenced a therapeutic advantage in the association of ß2-agonists with montelukast in the control of asthma-like features and a better rescue bronchodilation response to ß2-agonists.

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The high consumption rate of vegetables stimulates the cultivation and increases the demand regarding the adequacy of the production processes. The attack of the pest Plutella xylostella causes high losses by reducing product quality, typifying a phytosanitary problem. This study aimed to verify the bioactivity of aqueous extracts of leaves of Jacaranda decurrens and Jacaranda mimosifolia at concentrations of 5, 10, and 15% on the insect. The choice test was carried out at the laboratory to determine the food effect of plant extracts and evaluate changes in the life cycle of insects exposed to active compounds through the analysis of biological parameters. Plant extracts of J. decurrens and J. mimosifolia presented with phagodeterrent classification in the choice experiments. The three J. decurrens extract concentrations promoted a prolongation of larval and pupal duration, while the duration of individuals treated with J. mimosifolia at 10% was significantly reduced. Occurred reduction in larval survival of individuals treated with aqueous extracts of J. decurrens and J. mimosifolia. Eggs from treatments with aqueous extract of J. decurrens and J. mimosifolia had reduced survival. Pupal survival of individuals treated with extract at 15% showed a significant reduction compared to the treatments at 5% and 10%. Pupae from the treatment with aqueous extract of Jacaranda mimosifolia showed a reduction in biomass in the treatment at 15% differing from the control e 5%. Thus, the aqueous extracts of the species J. decurrens and J. mimosifolia show insecticidal potential in the tests performed on P. xylostella.

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Plants produce a wide variety of bioactive compounds with insecticidal properties, such as secondary metabolites capable of interfering with the nutrition and reproduction of pest species such as Plutella xylostella. Thus, the objective of this study was to evaluate the effects of aqueous and ethanolic extracts of Ludwigia spp. (Onagraceae) on the feeding and oviposition of P. xylostella. Choice bioassays were performed using aqueous and ethanolic extracts. The aqueous extract of L. tomentosa resulted in an approximately 81% reduction in larval feeding compared to that in the control, with an antifeedant index (AI) of 52%. The aqueous and ethanolic extract of L. nervosa acted by stimulating larval feeding. The oviposition was significantly reduced in the kale leaves treated with aqueous and ethanolic extracts of Ludwigia spp. The aqueous extracts promoted an average 90% reduction in oviposition when compared to that in the control, and an oviposition deterrent index (ODI) above 61% was classified as an oviposition deterrent. In addition, ethanolic extracts affected 81% of oviposition, with an ODI above 41%. Bioassays should be performed to clarify the use of aqueous and ethanolic extracts of L. nervosa as they acted as phagostimulants in the feeding tests and as deterrents in the oviposition tests. The phenolic compounds-flavonoids, condensed tannins, and alkaloids-were more abundant in L. nervosa, L. tomentosa, L. sericea, and L. longifolia. The extracts of L. longifolia and L. tomentosa showed the best results, interfering with the host choice for feeding and oviposition in P. xylostella and representing an alternative for the control of diamondback moths.

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The Philippine government significantly raised cigarette excise taxes in 2013, following passage of the landmark Sin Tax Reform Act of 2012. As a result, cigarette prices increased substantially. Given varying smokers' responses to the price increase, we examined underlying typologies of Filipino smokers and assessed how these typologies determine smoking intensity. We used cross-sectional data from the 2015 wave of the Philippine Global Adult Tobacco Survey (N = 1,651). To uncover typologies, random effects latent class modelling was used on six individual smoker responses (attempting to stop, thinking about quitting, decreasing sticks smoked, switching to cheaper brands, buying in bulk, and asking from others). Bivariate and multivariate analyses were employed to uncover determinants of typologies and smoking intensity. We found two typologies based on smokers' response. The first group, called "potential quitters" (62.62%), is composed of smokers who are more likely to consider quitting and decrease sticks smoked. The second group, called "unlikely to quit" (37.38%), have smokers who opt for price-minimization strategies like switching to cheaper brands, buying in bulk, or asking cigarettes from others. Potential quitters tend to be female, a student, and less nicotine dependent. They smoke up to three fewer sticks than those unlikely to quit, controlling for other factors. Nicotine dependence stood out as the most important predictor of being in the unlikely to quit group. The dominant role of nicotine dependence in determining a smoker's typology points to the need for non-price based measures, such as those targeted towards highly-nicotine dependent smokers, to complement tax-induced price increases and comprehensively address the smoking problem.

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BACKGROUND: Multiple health-risk behaviours such as physical inactivity, excessive recreational screen time, and insufficient sleep have been independently and positively associated with poor adherence to the Mediterranean diet in adolescents. However, little is known about the combined association between 24-Hour Movement Guidelines (i.e., physical activity, screen time, and sleep duration) and adherence to the Mediterranean diet. OBJECTIVE: The aim of the present study was to examine whether adolescents who meet all three 24-Hour Movement Guidelines report greater adherence to the Mediterranean diet, and the different foods that comprise it, compared to those who do not meet the three recommendations. METHODS: In this cross-sectional study, 1391 Spanish adolescents (13.08 ± 0.85, 44.82% girls), aged 11-16 years, completed self-reported questionnaires on physical activity, recreational screen time, sleep duration and adherence to the Mediterranean diet. A binary logistic regression analysis was used to predict the likelihood of having an optimal adherence to the Mediterranean diet, as well as different food items, according to the meeting of the three 24-Hour Movement Guidelines. Covariates included were age, sex, socioeconomic status, and body mass index (z-score). RESULTS: Adolescents who met all three 24-Hour Movement Guidelines obtained higher adherence to the Mediterranean diet than those who did not meet with the three recommendations (ß = 1.33, 95% confidence interval [CI]: 0.81, 1.85, p < 0.001). In addition, those who met all three 24-Hour Movement Guidelines were more likely to consume a fruit and vegetables once a day, consume fish regularly, and eat cereal or grains for breakfast (all, p < 0.05), and less likely to consume commercially baked goods or pastries for breakfast and to eat sweets and candies several times a day (all, p < 0.001), compared to those who did not comply with the three 24-Hour Movement Guidelines. CONCLUSION: Since meeting the three 24-Hour Movement Guidelines seems to be associated with Mediterranean diet eating patterns in adolescents, it seems necessary to promote these movement behaviours from the early stages of life.

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