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Falls are a severe problem in older adults, often resulting in severe consequences such as injuries or loss of consciousness. It is crucial to screen fall risk in order to prescribe appropriate therapies that can potentially prevent falls. Identifying individuals who have experienced falls in the past, commonly known as fallers, is used to evaluate fall risk, as a prior fall indicates a higher likelihood of future falls. The methods that have the most support from evidence are Gait Speed (GS) and Time Up and Go (TUG), which use specific cut-off values to evaluate the fall risk. There have been proposals for alternative methods that use wearable sensor technology to improve fall risk assessment. Although these technological alternatives are promising, further research is necessary to validate their use in clinical settings. In this study, we propose a method for identifying fallers based on a Support Vector Machine (SVM) classifier. The inputs for the classifier are the gait parameters obtained from a 30-minute walk recorded using an Inertial Measurement Unit (IMU) placed at the foot of patients. We validated our proposed method using a sample of 157 patients aged over 70 years. Our findings indicate significant differences (p< 0.05) in stride speed, clearance, angular velocity, acceleration, and coefficient of variability among steps between fallers and non-fallers. The proposed method demonstrates the its potential to classify fallers with an accuracy of [79.6]%, slightly outperforming the GS method which provides an accuracy of [77.0]%, and also overcomes its dependency on the cut-off speed to determine fallers. This method could be valuable in detecting fallers during long-term monitoring that does not require periodic evaluations in a clinical setting.

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Multiple large-scale genomic profiling efforts have been undertaken in osteosarcoma to define the genomic drivers of tumorigenesis, therapeutic response, and disease recurrence. The spatial and temporal intratumor heterogeneity could also play a role in promoting tumor growth and treatment resistance. We conducted longitudinal whole-genome sequencing of 37 tumor samples from 8 patients with relapsed or refractory osteosarcoma. Each patient had at least one sample from a primary site and a metastatic or relapse site. Subclonal copy-number alterations were identified in all patients except one. In 5 patients, subclones from the primary tumor emerged and dominated at subsequent relapses. MYC gain/amplification was enriched in the treatment-resistant clones in 6 of 7 patients with multiple clones. Amplifications in other potential driver genes, such as CCNE1, RAD21, VEGFA, and IGF1R, were also observed in the resistant copy-number clones. A chromosomal duplication timing analysis revealed that complex genomic rearrangements typically occurred prior to diagnosis, supporting a macroevolutionary model of evolution, where a large number of genomic aberrations are acquired over a short period of time followed by clonal selection, as opposed to ongoing evolution. A mutational signature analysis of recurrent tumors revealed that homologous repair deficiency (HRD)-related SBS3 increases at each time point in patients with recurrent disease, suggesting that HRD continues to be an active mutagenic process after diagnosis. Overall, by examining the clonal relationships between temporally and spatially separated samples from patients with relapsed/refractory osteosarcoma, this study sheds light on the intratumor heterogeneity and potential drivers of treatment resistance in this disease. SIGNIFICANCE: The chemoresistant population in recurrent osteosarcoma is subclonal at diagnosis, emerges at the time of primary resection due to selective pressure from neoadjuvant chemotherapy, and is characterized by unique oncogenic amplifications.

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The key issues in any fire emergency are recognising fire hotspots, locating the emergency intervention team (EI), following the evolution of the fire, and selecting the evacuation path. This leads to the study and development of HelpResponder, a solution capable of detecting the focus of interest in hostile spaces derived from fire due to high temperatures without visibility. A study is conducted to determine which model best predicts measured [Formula: see text] levels. The variables used are temperature, humidity, and air quality, obtained from sensors installed in a fire tower. The statistical methods applied, namely ARIMAX, KNN, SVM, and TBATS, allow the adjustment and modelling of the variables. Explanatory variables with temporal structure are incorporated into SVM, a new improvement proposal. Moreover, combining different models showed the best efficiency in forecasting. In fact, another contribution of our work lies in offering a small-scale prediction system that is specifically designed to save batteries. The system has been tested and validated in a hostile environment (building), simulating real emergency situations. The system has been tested and validated in several hostile environments, simulating real emergency situations. It can help firefighters respond faster in an emergency. This reduces the risks associated with the lack of information and improves the time for tactical operations, which could save lives.

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Multiple large-scale tumor genomic profiling efforts have been undertaken in osteosarcoma, however, little is known about the spatial and temporal intratumor heterogeneity and how it may drive treatment resistance. We performed whole-genome sequencing of 37 tumor samples from eight patients with relapsed or refractory osteosarcoma. Each patient had at least one sample from a primary site and a metastatic or relapse site. We identified subclonal copy number alterations in all but one patient. We observed that in five patients, a subclonal copy number clone from the primary tumor emerged and dominated at subsequent relapses. MYC gain/amplification was enriched in the treatment-resistant clone in 6 out of 7 patients with more than one clone. Amplifications in other potential driver genes, such as CCNE1, RAD21, VEGFA, and IGF1R, were also observed in the resistant copy number clones. Our study sheds light on intratumor heterogeneity and the potential drivers of treatment resistance in osteosarcoma.

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The utility of cancer whole genome and transcriptome sequencing (cWGTS) in oncology is increasingly recognized. However, implementation of cWGTS is challenged by the need to deliver results within clinically relevant timeframes, concerns about assay sensitivity, reporting and prioritization of findings. In a prospective research study we develop a workflow that reports comprehensive cWGTS results in 9 days. Comparison of cWGTS to diagnostic panel assays demonstrates the potential of cWGTS to capture all clinically reported mutations with comparable sensitivity in a single workflow. Benchmarking identifies a minimum of 80× as optimal depth for clinical WGS sequencing. Integration of germline, somatic DNA and RNA-seq data enable data-driven variant prioritization and reporting, with oncogenic findings reported in 54% more patients than standard of care. These results establish key technical considerations for the implementation of cWGTS as an integrated test in clinical oncology.

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The high impact of air quality on environmental and human health justifies the increasing research activity regarding its measurement, modelling, forecasting and anomaly detection. Raw data offered by sensors usually makes the mentioned time series disciplines difficult. This is why the application of techniques to improve time series processing is a challenge. In this work, Singular Spectral Analysis (SSA) is applied to air quality analysis from real recorded data as part of the Help Responder research project. Authors evaluate the benefits of working with SSA processed data instead of raw data for modelling and estimation of the resulting time series. However, what is more relevant is the proposal to detect indoor air quality anomalies based on the analysis of the time derivative SSA signal when the time derivative of the noisy original data is useless. A dual methodology, evaluating level and dynamics of the SSA signal variation, contributes to identifying risk situations derived from air quality degradation.

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BACKGROUND: Safe sampling of central nervous system tumor tissue for diagnostic purposes may be difficult if not impossible, especially in pediatric patients, and an unmet need exists to develop less invasive diagnostic tests. METHODS: We report our clinical experience with minimally invasive molecular diagnostics using a clinically validated assay for sequencing of cerebrospinal fluid (CSF) cell-free DNA (cfDNA). All CSF samples were collected as part of clinical care, and results reported to both clinicians and patients/families. RESULTS: We analyzed 64 CSF samples from 45 pediatric, adolescent and young adult (AYA) patients (pediatric = 25; AYA = 20) with primary and recurrent brain tumors across 12 histopathological subtypes including high-grade glioma (n = 10), medulloblastoma (n = 10), pineoblastoma (n = 5), low-grade glioma (n = 4), diffuse leptomeningeal glioneuronal tumor (DLGNT) (n = 4), retinoblastoma (n = 4), ependymoma (n = 3), and other (n = 5). Somatic alterations were detected in 30/64 samples (46.9%) and in at least one sample per unique patient in 21/45 patients (46.6%). CSF cfDNA positivity was strongly associated with the presence of disseminated disease at the time of collection (81.5% of samples from patients with disseminated disease were positive). No association was seen between CSF cfDNA positivity and the timing of CSF collection during the patient's disease course. CONCLUSIONS: We identified three general categories where CSF cfDNA testing provided additional relevant diagnostic, prognostic, and/or therapeutic information, impacting clinical assessment and decision making: (1) diagnosis and/or identification of actionable alterations; (2) monitor response to therapy; and (3) tracking tumor evolution. Our findings support broader implementation of clinical CSF cfDNA testing in this population to improve care.

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BACKGROUND AIMS: Cytomegalovirus (CMV) reactivation is a significant complication following allogeneic hematopoietic stem cell transplant (HSCT) and affects upwards of 40% of pediatric HSCT patients. Pre-emptive therapy remains the only effective treatment strategy available for pediatric patients following CMV reactivation. Little is known about how the timing of induction treatment following CMV reactivation impacts outcomes in pediatric patients, especially following ex vivo T-cell-depleted (TCD) HSCT. METHODS: The authors evaluated how the timing of induction treatment after CMV reactivation impacts overall survival (OS) and CMV disease in pediatric patients undergoing TCD HSCT at a single institution. The authors retrospectively analyzed patients treated on the pediatric service who received an initial ex vivo TCD HSCT at Memorial Sloan Kettering Cancer Center (MSKCC) from January 2010 to June 2018. CMV reactivation was defined as ≥1 CMV polymerase chain reaction >500 copies/mL in whole blood or >137 IU/mL in plasma within the first 180 days after allogeneic HSCT. To analyze the impact of the timing of induction treatment, the authors' primary study outcome was OS and secondary outcome was CMV disease. RESULTS: A total of 169 patients who underwent an initial allogeneic TCD HSCT on the pediatric service at MSKCC from January 2010 to June 2018 were included in the analysis. Thirty-seven (22%) patients reactivated CMV during the first 180 days following HSCT. Of those patients who reactivated CMV, CMV donor/recipient (D/R) serostatus was as follows: D+/R+ n = 28 (76%) and D-/R+ n = 9 (24%). There was no CMV reactivation observed among recipients who were CMV-seronegative irrespective of donor serostatus. In those patients who reactivated CMV, the median time from HSCT to CMV reactivation was 24 days (interquartile range, 20-31). Eleven patients ultimately developed CMV disease in addition to CMV viremia, whereas the remaining patients had only CMV viremia. The cumulative incidence of CMV reactivation at 60 days was 45.2% (95% confidence interval [CI], 32.8-57.5) in the D+/R+ subgroup and 31% (95% CI, 14.2-47.9) in the D-/R+ subgroup. For those patients who reactivated CMV, 30 (81%) received induction treatment with ganciclovir or foscarnet. To analyze the impact of the timing of induction treatment on clinical outcomes, the authors restricted the analysis to those patients who reactivated CMV and received induction treatment (n = 30). The timing of induction treatment was significantly associated with OS, with optimal timing of initiation within a week of CMV reactivation (P = 0.02). There was no significant impact on the timing of induction treatment and risk of CMV disease (P = 0.30). CONCLUSIONS: In ex vivo TCD HSCT in pediatric patients, early initiation of induction treatment after CMV reactivation is associated with improved OS.

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PURPOSE: The tyrosine kinase receptor anaplastic lymphoma kinase (ALK) can be abnormally activated in neuroblastoma, and somatic ALK mutations occur in 6%-10% of patients. The differential clinical impact of these mutations has not been clearly elucidated. METHODS: Data on patients with neuroblastoma harboring ALK mutations were retrospectively analyzed. ALK sequencing was performed by whole-genome sequencing, hybrid-based capture of targeted exomes, or hotspot ALK mutation profiling. The differential impact of ALK mutation site on clinical characteristics, response to treatment, and survival was analyzed. In a subgroup of patients with locoregional neuroblastoma diagnosed after 2014, the impact of all ALK mutations was compared with wild-type ALK. RESULTS: Of 641 patients with neuroblastoma with ALK status analyzed on at least one tumor sample, 103 (16%) had tumors harboring ALK mutations. Mutations existed across all ages (birth to 67.8 years), stages (30% locoregional and 70% metastatic), and risk groups (20%, 11%, and 69% with low-, intermediate-, and high-risk disease, respectively). Mutation sites included F1174 (51%), R1275 (29%), R1245 (10%), and others (10%). Mutation site was not prognostic for progression-free survival or overall survival in the entire cohort, high-risk subgroup, or locoregional subgroup. Locoregional tumors with any ALK mutation were generally invasive: L2 by International Neuroblastoma Research Group staging in 30/31 patients with a 2-year progression-free survival (59%, 95% CI, 37.4 to 80.5) that was inferior to historical controls. This observation was corroborated in the post-2014 subgroup in which gross total resection was less likely for ALK-mutated tumors. CONCLUSION: Somatic ALK mutations are present across all stages and risk groups of neuroblastoma. No specific mutation carries differential prognostic significance. Locoregional neuroblastoma has an invasive phenotype when harboring somatic ALK mutations in this population.

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Some lipoprotein disorders related to the residual risk of premature cardiovascular disease (PCVD) are not detected by the conventional lipid profile. In this case-control study, the predictive power of PCVD of serum sdLDL-C, measured using a lipoprotein precipitation method, and of the physicochemical properties of serum lipoproteins, analyzed by nuclear magnetic resonance (NMR) techniques, were evaluated. We studied a group of patients with a first PCVD event (n = 125) and a group of control subjects (n = 190). Conventional lipid profile, the size and number of Very Low Density Lipoproteins (VLDL), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL) particles, and the number of particles of their subclasses (large, medium, and small) were measured. Compared to controls, PCVD patients had lower concentrations of all LDL particles, and smaller and larger diameter of LDL and HDL particles, respectively. PCVD patients also showed higher concentrations of small dense LDL-cholesterol (sdLDL), and triglycerides (Tg) in LDL and HDL particles (HDL-Tg), and higher concentrations of large VLDL particles. Multivariate logistic regression showed that sdLDL-C, HDL-Tg, and large concentrations of LDL particles were the most powerful predictors of PCVD. A strong relationship was observed between increased HDL-Tg concentrations and PCVD. This study demonstrates that beyond the conventional lipid profile, PCVD patients have other atherogenic lipoprotein alterations that are detected by magnetic resonance imaging (MRI) analysis.

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Myeloid/lymphoid neoplasm with eosinophilia (MLN-Eo) is a World Health Organization (WHO) established category of hematologic malignancies primarily arising in adults. We discuss an 8-month-old infant who presented with clinical features similar to those of juvenile myelomonocytic leukemia (JMML) but who was diagnosed with MLN-Eo driven by an ETV6-FLT3 fusion. Results of patient-derived leukemia ex vivo studies demonstrated increased sensitivity to type I FLT3 inhibitors as compared with type II inhibitors. Treatment with the type I inhibitor gilteritinib resulted in complete immunophenotypic and cytogenetic remission. This patient subsequently underwent a hematopoietic stem cell transplant and remains in complete remission 1 year later. This is the youngest patient reported with an ETV6-FLT3 fusion and adds to the mounting reports of FLT3-rearranged MLN-Eo, supporting its addition to the WHO classification. Furthermore, this case highlights the clinical utility of ex vivo drug testing of targeted therapies.

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Firefighter's interventions under dense smoke and flames are hazardous and ideally need an efficient in-advance geo-located actuation plan. The existing communication and sensing technologies should be customized, optimized, and integrated to better know the conditions (flame locations, air condition) before and during the rescue team's interventions. In this paper, we propose a firefighter intervention architecture, which consists of several sensing devices (flame detectors, carbon dioxide air content) a navigation platform (an autonomous ground wheeled robot), and a communication/localization network (BLE IoT network) that can be used before and during an intervention in rescue or fire extinguishing missions even for indoor or confined spaces. The paper's key novelty presents our integrated solution, giving some key implementation details and an intensive experimentation campaign in two real firefighter scenarios with real controlled fires. Results carried out in these real indoor scenarios are presented to demonstrate the feasibility of the system. A fire detection system is proposed to improve fire focus in real time and moving in confined spaces with no visibility and physical references. The results obtained in the experimentation show the proposal's effectiveness in locating the fire focus's position and orientation reducing time and risk exposure. This kind of location-aware fire integrated systems would significantly impact the speed and security of first responder interventions.

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Adoptive cell therapy using cytomegalovirus (CMV)-specific cytotoxic T lymphocytes (CMV-CTLs) has demonstrated efficacy posttransplant. Despite the predicted limited engraftment of CMV-CTLs derived from third-party donors, partially matched third-party donor-derived CMV-CTLs have demonstrated similar response rates to those derived from primary hematopoietic cell transplantation donors. Little is known about the mechanisms through which adoptive cellular therapies mediate durable responses. We performed a retrospective analysis of patients receiving CMV-CTLs for treatment of CMV viremia and/or disease after allogeneic transplant between September of 2009 and January of 2018. We evaluated whether response to adoptively transferred CMV-CTLs correlated with immune reconstitution (IR), using validated CD4+ IR milestones of 50 × 106/L and 200 × 106/L. In this analysis, a cohort of 104 patients received CMV-CTLs derived from a primary transplant donor (n = 25), a third-party donor (n = 76), or both (n = 3). Response to therapy did not increase the likelihood of achieving CD4+ IR milestones at 1 (P = .53 and P > .99) or 2 months (P = .12 and P = .33). The origin of CMV-CTLs did not impact subsequent CD4+ IR. CMV-CTLs appeared to interact with host immunity in mediating responses. Recipients with a baseline CD4 >50 × 106/L had higher response to therapy (P = .02), improved overall survival (P < .001), and protection from CMV-related death (P = .002). Baseline endogenous immunity appears to improve CMV-related and overall survival in this cohort and can be an important marker at the initiation of therapy.

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Physiological sensors can be used to detect changes in the emotional state of users with affective computing. This has lately been applied in the educational domain, aimed to better support learners during the learning process. For this purpose, we have developed the AICARP (Ambient Intelligence Context-aware Affective Recommender Platform) infrastructure, which detects changes in the emotional state of the user and provides personalized multisensorial support to help manage the emotional state by taking advantage of ambient intelligence features. We have developed a third version of this infrastructure, AICARP.V3, which addresses several problems detected in the data acquisition stage of the second version, (i.e., intrusion of the pulse sensor, poor resolution and low signal to noise ratio in the galvanic skin response sensor and slow response time of the temperature sensor) and extends the capabilities to integrate new actuators. This improved incorporates a new acquisition platform (shield) called PhyAS (Physiological Acquisition Shield), which reduces the number of control units to only one, and supports both gathering physiological signals with better precision and delivering multisensory feedback with more flexibility, by means of new actuators that can be added/discarded on top of just that single shield. The improvements in the quality of the acquired signals allow better recognition of the emotional states. Thereof, AICARP.V3 gives a more accurate personalized emotional support to the user, based on a rule-based approach that triggers multisensorial feedback, if necessary. This represents progress in solving an open problem: develop systems that perform as effectively as a human expert in a complex task such as the recognition of emotional states.

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OBJECTIVES: A burn patient is a challenge for any anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. The victim may have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population. MATERIALS AND METHODS: It was a prospectively descriptive study, including 4 patients, and all of them were considered major burn patients, who underwent escharotomy with general anesthesia and neuromuscular relaxation. The main variable was the time for recovery of a TOF higher than 0.9 after the administration of sugammadex before extubation. RESULTS: Mean time of recovery from a TOF ratio higher than 0.9 following the administration of Sugammadex was of 4.95min 95% CI (3.25-6.64, p=.53). CONCLUSIONS: The reversion of neuromuscular relaxation with sugammadex appears to be effective and safe in the burn patient. More analytical, comparative studies of larger populations would be necessary to confirm these data.

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OBJECTIVES: The burn patient is a challenge for the anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. They have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population. MATERIAL AND METHODS: Prospectively descriptive study including four patients, all of them considered major burn patients, who underwent escharotomy with general anesthesia and neuromuscular relaxation. The main variable was the time for recovery of a TOF higher than 0.9 after the administration of sugammadex before extubation. RESULTS: Mean time of recovery from a TOF ratio higher than 0.9 following the administration of Sugammadex was of 4.95minutes 95% CI (3.25-6.64, p=.53); CONCLUSIONS: The reversion of neuromuscular relaxation with sugammadex appears to be effective and safe in the burn patient. More analytical, comparative studies, of larger populations would be necessary to confirm this data.

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Introducción: Las premisas teóricas de la recuperación cuestionan el concepto kraepeliniano de la psicosis. Asumir la reversibilidad de esta condición favorece la incorporación de tratamientos integrados con el fin de abordar de forma eficiente las distintas dimensiones que la conforman. Objetivos del estudio: Describir la puesta en marcha de intervenciones grupales desde el punto de vista de la recuperación en personas con psicosis en un dispositivo comunitario de la red pública. Confirmar la eficacia de dichas intervenciones identificando los factores clínicos mejorados. Analizar el efecto de las intervenciones terapéuticas prolongadas en la evolución clínica. Pacientes: 28 personas con diagnósticos incluidos en los códigos CIE-10 (F20-25, F31, F60.0 y F60.1), tradicionalmente relacionados con la psicosis. Método: Se describe la estructura y el contenido del grupo, que han sido adaptados al contexto de trabajo: Grupo abierto en cuanto a pacientes y profesionales, sesiones quincenales, incorporación de técnicas corporales, evolución hacia la ayuda mutua etc... Se evalúa la situación clínica mediante las escalas PANSS y GAF. Resultados: Se objetiva una mejoría significativa a nivel de los síntomas negativos y sociales que se mantiene e incrementa entre los pacientes que continúan en seguimiento a lo largo del tiempo. Discusión: Dichos hallazgos resultan especialmente valiosos dada la resistencia de las dimensiones emocionales y sociales a los abordajes exclusivamente farmacológicos. Se plantean líneas de trabajo futuras, las dificultades en la generalización de los logros obtenidos en el contexto terapéutico a las actividades de la vida cotidiana y los ensayos que se han puesto en marcha para vencer dichas trabas. Asimismo se considera la posibilidad de incluir otros instrumentos de evaluación de naturaleza cualitativa que incluyan la visión subjetiva de los pacientes en su propio proceso (AU)

Introduction: Theoretical background in recovery confronts the kraepelian concept of psychosis. Considering this condition as reversible in volves looking for more efficient therapies for some of the dimensions. Objectives: Description of the process to start a group with people with psychosis under the recovery paradigm in a public health team. Confirmation of the efficacy of group intervention and treated symptoms. Analysis of effect of long-term group intervention. Patients: This work is based on a recovery group therapy experience in a community mental health team from a public health service in Spain. 28 subjects were diagnosed of disorders included in ICD- 10: F20-25, F31, F60.0 and F60.1 related to psychosis. Method: The study describes structure and contents of the group and clinical assessment trough PANSS and GAF scales. Results: Negative and social symptoms remarkably improved in a progressive way trough the two years course. Discussion: These facts are considered especially worthy given their traditionally resistant condition to an isolated pharmacological assessment. Future lines of study are drawn. Difficulties in generalization of results in real framework are discussed. We are considering new measurement tools including subjective and qualitative instruments (AU)

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INTRODUCTION: One of the risks of using endonasal tubes (ET) is the appearance of pressure ulcers (PU). OBJECTIVE: To ascertain the proportion of patients with nasal PU, study the risk factors of appearance, and find predictive variables. MATERIAL AND METHODS: A six-month prospective, observational study of intensive care unit patients with ET. VARIABLES: Variable response: "the appearance of pu as a result of the use of ET". Explanatory variables: age, duration of stay, length of time with ET, gender, sedation, norepinephrine perfusion, mechanical ventilation, anemia, nutritional state. ANALYSIS: multivariate statistical techniques (multiple logistical regression). Statistics program g-stat 2.0. Significance level p < 0.05. RESULTS: Sample of 48 patients. Proportion of patients with PU: 29.2%. Those patients with PU had similar ages, duration of stay and longer length of time with ET. Results of the Logistic Regression model: only the variable "time with ET" was statistically significant (p = 0.03; odds ratio: 1.047). CONCLUSIONS: The length of time the patient is using an ET influences the appearance of nasal PU (risk increases 1.047 for each day with ET). None of the variables dealt with could be used as a predictive factor in the appearance of PU.

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Desde una perspectiva personal, basada en su experiencia, la autora explica diversos «trucos» y habilidades a poner en práctica ante variadas situaciones de emergencia y urgencia. En esta ocasión, sus recomendaciones se aplican al ámbito del paciente politraumatizado(AU)

From a personal perspective based on her experience, the author explains various «tricks» and skills which can be used when facing different emergency situations. In this article, the author’s recommendations deal with poly-traumatic cases(AU)

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