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BACKGROUND: No-show to medical appointments has significant adverse effects on healthcare systems and their clients. Using machine learning to predict no-shows allows managers to implement strategies such as overbooking and reminders targeting patients most likely to miss appointments, optimizing the use of resources. METHODS: In this study, we proposed a detailed analytical framework for predicting no-shows while addressing imbalanced datasets. The framework includes a novel use of z-fold cross-validation performed twice during the modeling process to improve model robustness and generalization. We also introduce Symbolic Regression (SR) as a classification algorithm and Instance Hardness Threshold (IHT) as a resampling technique and compared their performance with that of other classification algorithms, such as K-Nearest Neighbors (KNN) and Support Vector Machine (SVM), and resampling techniques, such as Random under Sampling (RUS), Synthetic Minority Oversampling Technique (SMOTE) and NearMiss-1. We validated the framework using two attendance datasets from Brazilian hospitals with no-show rates of 6.65% and 19.03%. RESULTS: From the academic perspective, our study is the first to propose using SR and IHT to predict the no-show of patients. Our findings indicate that SR and IHT presented superior performances compared to other techniques, particularly IHT, which excelled when combined with all classification algorithms and led to low variability in performance metrics results. Our results also outperformed sensitivity outcomes reported in the literature, with values above 0.94 for both datasets. CONCLUSION: This is the first study to use SR and IHT methods to predict patient no-shows and the first to propose performing z-fold cross-validation twice. Our study highlights the importance of avoiding relying on few validation runs for imbalanced datasets as it may lead to biased results and inadequate analysis of the generalization and stability of the models obtained during the training stage.

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The comprehensive composition of phenolic compounds (PC) from seven genotypes of guabiju were analyzed by high-performance liquid chromatography coupled to a diode array detector and mass spectrometry (HPLC-ESI-qTOF-MS/MS), and a targeted metabolomic approach was utilized to explore the PC-related similarities among the genotypes. Sixty-seven phenolic compounds were annotated and twenty-four were quantified in all genotypes of guabiju. The phenolic acids and anthocyanins were the major PC, representing more than 63% (w/w) of the total PC. Di-O-galloylquinic and tri-O-galloylquinic acids and ellagitannins were reported for the first time in guabiju. The results of hierarchical clustering and principal components analysis (PCA) suggested seven groups as suitable clusters to be formed according to phenolic composition. Eleven PC were selected as relevant for sample clustering, and six of them were highlighted as the most informative (in decreasing order of importance): epicatechin, catechin, (epi)gallocatechin gallate II, di-O-galloylquinic acid I, tri-O-galloylquinic acid and delphinidin 3-O-glucoside. To the best of our knowledge, this study contributes to the literature with the most complete phenolic profile of guabiju genotypes up to date. Moreover, guabiju susceptibility to fungal infestation related to PC composition was briefly discussed based on a parallel study using the same genotypes.

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Several approaches to assess the authenticity of food products have been developed, given that fraudulent products may impact consumers' confidence, affect commercial trades and lead to health risks. This paper proposes an approach to identify the chemical elements that optimally discriminate rice samples according to their producing region in the South of Brazil, the largest rice producer outside Asia. A combinatorial procedure on the concentration of 26 elements determined using inductively coupled mass spectrometry (ICP-MS) and liquid chromatography hyphenated with ICP-MS from 640 rice samples was coupled with Support Vector Machine. The assessed elements included nonmetal and metal elements of 3 types of rice collected from 5 rice-producing regions. The framework selected Mn, Fe, Cu, Zn, Ni, Mo, Cd, Cs, As, Rb, Se, and iAs as the most informative elements for tracking samples' origin. The concentration of such elements is strongly affected by fertilization procedures and soil composition.

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PURPOSE: There are no criteria to establish priority for bariatric surgery candidates in the public health system in several countries. The aim of this study is to identify preoperative characteristics that allow predicting the success after bariatric surgery. MATERIALS AND METHODS: Four hundred and sixty-one patients submitted to Roux-en-Y gastric bypass were included. Success of the surgery was defined as the sum of five outcome variables, assessed at baseline and 12 months after the surgery: excess weight loss, use of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) as a treatment for obstructive sleep apnea (OSA), daily number of antidiabetics, daily number of antihypertensive drugs, and all-cause mortality. Partial least squares (PLS) regression and multiple linear regression were performed to identify preoperative predictors. We performed a 90/10 split of the dataset in train and test sets and ran a leave-one-out cross-validation on the train set and the best PLS model was chosen based on goodness-of-fit criteria. RESULTS: The preoperative predictors of success after bariatric surgery included lower age, presence of non-alcoholic fatty liver disease and OSA, more years of CPAP/BiPAP use, negative history of cardiovascular disease, and lower number of antihypertensive drugs. The PLS model displayed a mean absolute percent error of 0.1121 in the test portion of the dataset, leading to accurate predictions of postoperative outcomes. CONCLUSION: This success index allows prioritizing patients with the best indication for the procedure and could be incorporated in the public health system as a support tool in the decision-making process.

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BACKGROUND: Surgical theater (ST) operations planning is a key subject in the healthcare management literature, particularly the scheduling of procedures in operating rooms (ORs). The OR scheduling problem is usually approached using mathematical modeling and made available to ST managers through dedicated software. Regardless of the large body of knowledge on the subject, OR scheduling models rarely consider the integration of OR downstream and upstream facilities and resources or validate their propositions in real life, rather using simulated scenarios. We propose a heuristic to sequence surgeries that considers both upstream and downstream resources required to perform them, such as surgical kits, post anesthesia care unit (PACU) beds, and surgical teams (surgeons, nurses and anesthetists). METHODS: Using hybrid flow shop (HFS) techniques and the break-in-moment (BIM) concept, the goal is to find a sequence that maximizes the number of procedures assigned to the ORs while minimizing the variance of intervals between surgeries' completions, smoothing the demand for downstream resources such as PACU beds and OR sanitizing teams. There are five steps to the proposed heuristic: listing of priorities, local scheduling, global scheduling, feasibility check and identification of best scheduling. RESULTS: Our propositions were validated in a high complexity tertiary University hospital in two ways: first, applying the heuristic to historical data from five typical ST days and comparing the performance of our proposed sequences to the ones actually implemented; second, pilot testing the heuristic during ten days in the ORs, allowing a full rotation of surgical specialties. Results displayed an average increase of 37.2% in OR occupancy, allowing an average increase of 4.5 in the number of surgeries performed daily, and reducing the variance of intervals between surgeries' completions by 55.5%. A more uniform distribution of patients' arrivals at the PACU was also observed. CONCLUSIONS: Our proposed heuristic is particularly useful to plan the operation of STs in which resources are constrained, a situation that is common in hospital from developing countries. Our propositions were validated through a pilot implementation in a large hospital, contributing to the scarce literature on actual OR scheduling implementation.

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Several statistical-based approaches have been developed to support medical personnel in early breast cancer detection. This article presents a method for feature selection aimed at classifying cases into categories based on patients' breast tissue measures and protein microarray. The effectiveness of this feature selection strategy was evaluated against the commonly used Wisconsin Breast Cancer Database-WBCD (with several patients and fewer features) and a new protein microarray data set (with several features and fewer patients). Features were ranked according to a feature importance index that combines parameters emerging from the unsupervised method of principal component analysis and the supervised method of Bhattacharyya distance. Observations of a training set were iteratively categorized into malignant and benign cases through 3 classification techniques: k-Nearest Neighbor, linear discriminant analysis, and probabilistic neural network. After each classification, the feature with the smallest importance index was removed, and a new categorization was carried out until there was only one feature left. The subset yielding maximum accuracy was used to classify observations in the testing set. Our method yielded average 99.17% accurate classifications in the testing set while retaining average 4.61 out of 9 features in the WBCD, which is comparable to the best results reported by the literature on that data set, with the advantage of relying on simple and widely available multivariate techniques. When applied to the microarray data, the method yielded average accuracy of 98.30% while retaining average 2.17% of the original features. Our results can aid health-care professionals during early diagnosis of breast cancer.

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In this paper, we propose a novel framework to select the most relevant X-Ray Fluorescence (XRF) energy values (i.e., features) to enhance the clustering (grouping) of counterfeit and illicit medical tablets. The framework is based on the integration of multidimensional scaling (MDS) and Procrustes analysis (PA) multivariate techniques. MDS provides a projection of the original data into a lower dimension, while PA finds a projection matrix from the original data. Such outputs give rise to a feature importance index that guides an iterative feature selection process; after each feature is inserted in the subset, an optimization procedure based on a greedy search method is carried out to maximize the clustering quality assessed through the Silhouette Index (SI). The inorganic chemical fingerprinting of 41 commercial samples (Viagra®, Cialis®, Lazar®, Libiden®, Maxfil®, Plenovit®, Potent 75®, Rigix®, V-50®, Vimax® and Pramil®) and 56 seized counterfeit samples (Viagra and Cialis) was used to validate the proposed framework. From the original 2048 data points in the full spectra, we identified a subset comprised of 41 energy values that substantially improved clustering quality; the obtained groups were assessed by visual inspection of the PCA plots.

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Phenolic and nitrogenous compounds from different styles craft beers were identified by high performance liquid chromatography and mass spectrometry in order to stratify beer samples according to their style. For this, an exploratory assessment relying on Linear Discriminant Analysis was performed. Fifty-seven phenolic compounds were reported and twelve of them were found for the first time in beer: benzoic acids, 2,4-dihydroxybenzoic acid, 2,3-dihydroxybenzoic acid, dimethoxybenzoic acid; phenolic acid conjugates, 3-p-coumaroylquinic acid, 4-p-coumaroylquinic acid, 3-feruloylquinic acid, 4-feruloylquinic acid, 5-feruloylquinic acid; flavonoids, taxifolin hexoside, quercetin dihexoside, apigenin-6,8-dipentoside, and isofraxidin hexoside. Additionally, 11 nitrogenous compounds belonging to the phenolamide class were found. Two discriminant functions were generated and allowed a satisfactory separation among all beer styles. 3-Caffeoylquinic acid, 3-p-coumaroylquinic acid, 4-p-coumaroylquinic acid, 5-caffeoylquinic acid, coumaric acid, kaempferol-3-O-rutinoside, proanthocyanidin B dimer III and proanthocyanidin B dimer V were the compounds that showed the highest capacity of discriminate the beer styles (IPA, Lager and Weiss).

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Erectile dysfunction medicines such as Cialis and Viagra are very popular worldwide and are between the most prevalent counterfeit medicines in Brazil. A range of analytical methods has been used to analyze Cialis and Viagra, such as ATR-FTIR, GCMS and UPLC-MS. Until now, there are no data available of DSC methods for analysis of counterfeit medicines of Cialis and Viagra. DSC is a thermal analysis that provides useful information of physico-chemical events, and however is almost not used for forensic purposes. In this study, thermal analysis of 25 counterfeit Viagra and Cialis seized by Brazilian Federal Police were performed by DSC and compared to their authentic medicines and analytical standards, along with chemometric tools. Authentic samples of Viagra displayed a similar thermal profile with the API, while Cialis were different with additional endothermic peaks, that could be related to excipients interference. Thermograms of Viagra counterfeit samples were similar to authentic samples, while Cialis showed an enlargement and displacement of endothermic peaks. Also, some Cialis counterfeit samples showed melting peaks attributed to sildenafil, the API of Viagra, instead tadalafil, confirming previous results obtained by UPLC-MS. Multivariate analysis with application of Hierarchical Cluster Analysis classified different groups of samples, including a cluster with counterfeit Cialis and Viagra, indicating the use of same API for both counterfeit medicines and possibly the same illicit production; and a cluster with authentic Viagra and counterfeit Cialis, confirming the addition of sildenafil instead tadalafil to Cialis counterfeit samples. Here for the first time we described the use of DSC for chemical profiling of Cialis and Viagra and showed that even when applied to a small group of samples, DSC along with chemometric tools can be considered as a good auxiliary method in forensic casework samples. DSC provided useful data to perform the identification of counterfeit and authentic medicines, with low cost and a simple method.

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BACKGROUND: In this article, we propose a method that integrates systematic layout planning techniques to lean health care practices aided by multicriteria decision analysis that could be applied to reformulate the layout of health care facilities. METHODS: We analyze a high-variety sterilization unit of a large public hospital located in Brazil. The unit is currently implementing lean practices, and layout changes are required to provide more efficient materials and information flows. RESULTS: Traditional design of health care facilities is not aligned with lean implementation and its underlying practices and principles. We propose the integration of such approaches to enhance their benefits. To rank and select the best layout alternative, a multicriteria decision analysis method (analytic hierarchy process) is adopted. CONCLUSIONS: There are 3 contributions here: the integration of lean principles into traditional health care facility design practices, the use of multicriteria decision analysis to refine the determination of the best layout solution, and the application of our propositions in a real case study.

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In forensic and pharmaceutical scenarios, the application of chemometrics and optimization techniques has unveiled common and peculiar features of seized medicine and drug samples, helping investigative forces to track illegal operations. This paper proposes a novel framework aimed at identifying relevant subsets of attenuated total reflectance Fourier transform infrared (ATR-FTIR) wavelengths for classifying samples into two classes, for example authentic or forged categories in case of medicines, or salt or base form in cocaine analysis. In the first step of the framework, the ATR-FTIR spectra were partitioned into equidistant intervals and the k-nearest neighbour (KNN) classification technique was applied to each interval to insert samples into proper classes. In the next step, selected intervals were refined through the genetic algorithm (GA) by identifying a limited number of wavelengths from the intervals previously selected aimed at maximizing classification accuracy. When applied to Cialis®, Viagra®, and cocaine ATR-FTIR datasets, the proposed method substantially decreased the number of wavelengths needed to categorize, and increased the classification accuracy. From a practical perspective, the proposed method provides investigative forces with valuable information towards monitoring illegal production of drugs and medicines. In addition, focusing on a reduced subset of wavelengths allows the development of portable devices capable of testing the authenticity of samples during police checking events, avoiding the need for later laboratorial analyses and reducing equipment expenses. Theoretically, the proposed GA-based approach yields more refined solutions than the current methods relying on interval approaches, which tend to insert irrelevant wavelengths in the retained intervals. Copyright © 2016 John Wiley & Sons, Ltd.

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Attenuated total reflectance (ATR), a sampling technique by Fourier transform infrared (FTIR) spectroscopy, has been adopted as an analytical tool for detecting fraudulent medicines. The spectrum generated by FTIR-ATR typically relies on hundreds of equally spaced wavenumbers which may reduce the performance of techniques tailored to classify samples into classes, i.e., authentic or fraudulent. This paper proposes a novel method for selecting subsets of wavenumbers (variables) that better classify samples into such classes. For that matter, principal components analysis (PCA) is integrated to the k-nearest neighbor (KNN) classification technique. PCA is applied to FTIR-ATR data, and a variable importance index is built on the PCA outputs. An iterative backward variable elimination is started guided by that index; after each variable removal, samples are categorized into authentic or fraudulent classes using KNN, and the classification accuracy is measured. The wavenumber subset compromising high accuracy and reduced percent of retained variables is chosen. When applied to Cialis FTIR-ATR data, the proposed approach retained only average 1.84% of the original variables and increased the classification accuracy average 2.1%, to 0.9897 from 0.9689; as for Viagra data, the method increased average classification accuracy 1.56%, from 0.9135 to 0.9278, using only 7.72% of the original variables.

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This paper proposes a direct and efficient method to discriminate between counterfeit and authentic Cialis and Viagra samples by combining attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy with multivariate techniques. The chemical profile of 53 commercial samples (Viagra(®), Cialis(®)) and 104 counterfeit samples (Viagra and Cialis) from distinct seizures were obtained from ATR-FTIR data derived from 10mg of crushed core tablets. Principal component analysis (PCA) technique was employed to classify samples based on the fingerprint region mid-infrared spectra (1800-525 cm(-1)) using OMNIC v.7.2 software; PCA enabled categorizing samples in groups with different chemical profiles, successfully distinguishing between authentic and counterfeits samples in forensic routine. The existence of active pharmaceutical ingredients (API) and technological adjuvant others than specified on the medicine package were also detected in counterfeit samples. In addition, we applied the similarity match (SM) method to demonstrate that a mixture of pharmaceutical powders deriving from a common origin may have been used to manufacture both counterfeit Cialis and Viagra tablets from distinct seizures.