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Voice disorders, such as dysphonia, are common among the general population. These pathologies often remain untreated until they reach a high level of severity. Assisting the detection of voice disorders could facilitate early diagnosis and subsequent treatment. In this study, we address the practical aspects of automatic voice disorders detection (AVDD). In real-world scenarios, data annotated for voice disorders is usually scarce due to various challenges involved in the collection and annotation of such data. However, some relatively large datasets are available for a reduced number of domains. In this context, we propose the use of a combination of out-of-domain and in-domain data for training a deep neural network-based AVDD system, and offer guidance on the minimum amount of in-domain data required to achieve acceptable performance. Further, we propose the use of a cost-based metric, the normalized expected cost (EC), to evaluate performance of AVDD systems in a way that closely reflects the needs of the application. As an added benefit, optimal decisions for the EC can be made in a principled way given by Bayes decision theory. Finally, we argue that for medical applications like AVDD, the categorical decisions need to be accompanied by interpretable scores that reflect the confidence of the system. Even very accurate models often produce scores that are not suited for interpretation. Here, we show that such models can be easily improved by adding a calibration stage-trained with just a few minutes of in-domain data. The outputs of the resulting calibrated system can then better support practitioners in their decision-making process.

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BACKGROUND: Human error and violation of rules are perceived as deviations from some desired behavior, appearing variably in literature as either similar or opposing concepts. Behavioral deviations may be linked to accidents or considered a protective factor against them. OBJECTIVE: This article aims to explore definitions, characteristics, classifications, and management approaches for behavioral deviations, specifically human error and violation of rules. METHODS: A systematic literature review was conducted. RESULTS: The authors differ in defining and classifying error and violation, associating them with generation of accidents or their prevention. The management proposals for deviations highlighted by the authors were emphasized. CONCLUSION: The findings of this article reinforce the prominence of authors Jens Rasmussen and James Reason in the field. They assert that deviations are a natural aspect of the work process and even serve as a preventive factor against accidents, although their frequent association with accidents remains common in organizations. This study contributes to theoretical understanding by systematizing prevalent perspectives on deviation, human error, and violation of rules. It proposes a taxonomy and emphasizing the need for managing deviations, rather than combating them, especially in an organizational context.

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Objective: People with different cultural backgrounds can evaluate the appropriateness of direct and indirect support seeking differently. In this study we explored how direct and indirect communication rules for verbal support seeking by patients with diabetes were perceived among Dutch and Surinamese female participants, and whether the appropriateness differed for the ingroup, outgroup and intercultural support seeker-support provider interactions. Methods: The study applied a 2 (direct versus indirect support seeking) X 2 (Surinamese patient versus Dutch patient) X 2 (Surinamese support provider versus Dutch support provider)-design. Dutch and Surinamese participants (N = 686) were randomly assigned to one of the eight conditions in which they were provided with a depiction of the patient, the direct or indirect request for help, and the help provider. The main outcome was the rated appropriateness of the help-seeking request in the specific context. Results: The results revealed a significant main effect of communication style: both, Surinamese and Dutch participants evaluated the direct help-seeking as more appropriate compared to indirect help-seeking, independent of patient or provider culture. This effect was particularly strong in participants who scored high on the individual difference in independent self, as shown by a significant interaction. Discussion: Literature usually identifies that Surinamese and Dutch populations have different cultural backgrounds and values that express themselves in different attitudes, in general more collectivistic and more individualistic, respectively. However, with regard to help seeking preferences the study results did not verify this expectation. These findings underscore the importance of the support providers' role in assessing and understanding the individuals' communication style with regard to help-seeking, rather than assuming communication preferences on the basis of cultural background.

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PURPOSE: To link the concepts measured by the Grocery Shelving Task Test (GST) to the codes and qualifiers of the activity and participation component of the International Classification of Functioning, Disability and Health (ICF). METHODS: The linkage was performed by two professionals who applied the 10 standardized binding rules. The linking process was performed through the model of extraction and identification of the concepts that were found in each item of the GST Test. RESULTS: The GST test includes 1 domain of the activity and participation component (d4 mobility). The link with the qualifiers allowed quantifying the impairment of the limitations of activities in the postoperative period, being observed that 21.27% of the sample did not present any problem, 61.70% presented the qualifier "0.1" (mild problem), 8.50% had a moderate problem (qualifier '0.2') and 8.50% had a severe problem (qualifier '0.3'). No complete impairment was observed in any study participant. DISCUSSION: The linking of the GST to the ICF codes and qualifiers allowed quantifying the functional impairment in the postoperative period of breast cancer, allowing a comprehensive and standardized view, and being a guiding tool for treatment plans.

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BACKGROUND AND OBJECTIVE: Pediatric readmissions are a burden on patients, families, and the healthcare system. In order to identify patients at higher readmission risk, more accurate techniques, as machine learning (ML), could be a good strategy to expand the knowledge in this area. The aim of this study was to develop predictive models capable of identifying children and adolescents at high risk of potentially avoidable 30-day readmission using ML. METHODS: Retrospective cohort study was carried out with 9,080 patients under 18 years old admitted to a tertiary university hospital. Demographic, clinical, and biochemical data were collected from electronic databases. We randomly divided the dataset into training (75 %) and testing (25 %), applied downsampling, repeated cross-validation with five folds and ten repetitions, and the hyperparameter was optimized of each technique using a grid search via racing with ANOVA models. We applied six ML classification algorithms to build the predictive models, including classification and regression tree (CART), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), decision tree and logistic regression (LR). The area under the receiver operating curve (AUC), sensitivity, specificity, Youden's J-index and accuracy were used to evaluate the performance of each model. RESULTS: The avoidable 30-day hospital readmissions rate was 9.5 %. Some algorithms presented similar AUC, both in the dataset training and in the dataset testing, such as XGBoost, RF, GBM and CART. Considering the Youden's J-index, the algorithm that presented the best index was XGBoost with bagging imputation, with AUC of 0.814 (J-index of 0.484). Cancer diagnosis, age, red blood cells, leukocytes, red cell distribution width and sodium levels, elective admission, and multimorbidity were the most important characteristics to classify between readmission and non-readmission groups. CONCLUSION: Machine learning approaches, especially XGBoost, can predict potentially avoidable 30-day pediatric hospital readmission into tertiary assistance. If implemented in the computer hospital system, our model can help in the early and more accurate identification of patients at readmission risk, targeting health strategic interventions.

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INTRODUCCIÓN: Las prácticas de crianza en alimentación y la conducta alimentaria han sido ampliamente estudiadas en niños, sin embargo, es necesario proporcionar información sobre su impacto en adultos. La evidencia sugiere que las prácticas de crianza en alimentación pueden tener un impacto en la conducta alimentarias emocional, descontrolada, restrictiva y desordenada, las cuales están asociadas con el incremento del Índice de masa corporal (IMC), el sobrepeso y la obesidad, mismos que se encuentran como principal factor de riesgo para el desarrollo de DT2. OBJETIVO: analizar través de una revisión sistemática la evidencia existente acerca de la relación entre las prácticas de crianza en alimentación, la conducta alimentaria y el riesgo de diabetes en adultos. METODOLOGÍA: Se realizó una búsqueda de literatura publicada de 2013 a 2023 en las bases de datos Pubmed, Scopus, EBSCOhost, Clarivate Science Citation Index Expanded y SpringerLink. Se identificaron 459 estudios, luego de aplicar los criterios de exclusión, se revisaron 15 estudios en total. RESULTADOS: Las subescalas de las prácticas de crianza en alimentación más empleadas fueron: preocupación, control, presión para comer y restricción. Se encontró asociación entre las prácticas de crianza en alimentación, la conducta alimentaria y el incremento del IMC. CONCLUSIÓN: Se consideran insuficientes las investigaciones que muestran el impacto de las prácticas de crianza en alimentación sobre la conducta alimentaria y si estas a su vez tienen efectos en el riesgo de diabetes en la etapa adulta.

INTRODUCTION: Parenting practices in feeding and eating behavior have been widely studied in children, however, it is necessary to provide information on their impact on adults. The evidence suggests that parenting practices in feeding can have an impact on emotional, uncontrolled, restrictive and disordered eating behavior, which are associated with an increase in BMI, overweight and obesity, which are found as the main factor of risk for the development of T2D. OBJECTIVE: To analyze, through a systematic review, the existing evidence about the relationship between parenting feeding practices, eating behavior and the risk of diabetes in adults. METHODOLOGY: A search of literature published from 2013 to 2023 was carried out in the Pubmed, Scopus, EBSCOhost, Clarivate Science Citation Index Expanded and SpringerLink databases. 459 studies were identified, after applying the exclusion criteria, 15 studies in total were reviewed. RESULTS: The subscales of the most frequently used parenting practices in feeding were: concern, control, pressure to eat and restriction. An association was found between parenting feeding practices, eating behavior and increased BMI. CONCLUSION: Research showing the impact of parenting feeding practices on eating behavior and whether these in turn have effects on the risk of diabetes in adulthood are considered insufficient.

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Virtual small molecule libraries are valuable resources for identifying bioactive compounds in virtual screening campaigns and improving the quality of libraries in terms of physicochemical properties, complexity, and structural diversity. In this context, the computational-aided design of libraries focused against antidiabetic targets can provide novel alternatives for treating type II diabetes mellitus (T2DM). In this work, we integrated the information generated to date on compounds with antidiabetic activity, advances in computational methods, and knowledge of chemical transformations available in the literature to design multi-target compound libraries focused on T2DM. We evaluated the novelty and diversity of the newly generated library by comparing it with antidiabetic compounds approved for clinical use, natural products, and multi-target compounds tested in vivo in experimental antidiabetic models. The designed libraries are freely available and are a valuable starting point for drug design, chemical synthesis, and biological evaluation or further computational filtering. Also, the compendium of 280 transformation rules identified in a medicinal chemistry context is made available in the linear notation SMIRKS for use in other chemical library enumeration or hit optimization approaches.

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An instrumental discovery in comparative and developmental biology is the existence of assembly archetypes that synthesize the vast diversity of organisms' body plans-from legs and wings to human arms-into simple, interpretable and general design principles. Here, we combine a novel mathematical formalism based on category theory with experimental data to show that similar 'assembly archetypes' exist at the larger organization scale of ecological communities when assembling a species pool across diverse environmental contexts, particularly when species interactions are highly structured. We applied our formalism to clinical data discovering two assembly archetypes that differentiate between healthy and unhealthy human gut microbiota. The concept of assembly archetypes and the methods to synthesize them can pave the way to discovering the general assembly principles of the ecological communities we observe in nature.

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This study examines how two popular drug-likeness concepts used in early development, Lipinski Rule of Five (Ro5) and Veber's Rules, possibly affected drug profiles of FDA approved drugs since 1997. Our findings suggest that when all criteria are applied, relevant compounds may be excluded, addressing the harmfulness of blindly employing these rules. Of all oral drugs in the period used for this analysis, around 66 % conform to the RO5 and 85 % to Veber's Rules. Molecular Weight and calculated LogP showed low consistent values over time, apart from being the two least followed rules, challenging their relevance. On the other hand, hydrogen bond related rules and the number of rotatable bonds are amongst the most followed criteria and show exceptional consistency over time. Furthermore, our analysis indicates that topological polar surface area and total count of hydrogen bonds cannot be used as interchangeable parameters, contrary to the original proposal. This research enhances the comprehension of drug profiles that were FDA approved in the post-Lipinski period. Medicinal chemists could utilize these heuristics as a limited guide to direct their exploration of the oral bioavailability chemical space, but they must also steer the wheel to break these rules and explore different regions when necessary.

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This research aimed to find out the relationship between informality and the internalization of the rules of behavior required for complexity in the economic system, as better knowledge is required for formalization policy to have a greater impact. We use the economic complexity index (ECI) for 2018 at the regional level in Colombia, which combines the country's productive structure with the amount of knowledge and know-how embodied in the goods it produces. The informality measure we use is the individual's affiliation to social security (in particular health insurance), and we use a proxy of civic rule's internalization as an inverse relation with traffic tickets. This research aimed to shed new light on public policy to improve formalization and its economic impact. First, we include a theory that includes both intrinsic and extrinsic motivation types. The self-determination theory or organismic integration theory proposes this theory. Second, we have argued that the motivation to formalize is intrinsic to greater cultural capacity. Individuals gradually internalize rules of behavior that have repercussions on social dynamics. Third, the composition and characteristics of the families in the study sample seem to show that some factors increase the propensity for informality. Our empirical analysis reveals that group of people with a lower educational level are the ones who are more likely to belong to the informal labor market. These results are consistent with the literature. Multivariate Probit regression was used to examine these factors.

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The dispersal-body mass association has been highlighted as a main determinant of biodiversity patterns in metacommunities. However, less attention has been devoted to other well-recognized determinants of metacommunity diversity: the scaling in density and regional richness with body size. Among active dispersers, the increase in movement with body size may enhance local richness and decrease ß-diversity. Nevertheless, the reduction of population size and regional richness with body mass may determine a negative diversity-body size association. Consequently, metacommunity assembly probably emerges from a balance between the effect of these scalings. We formalize this hypothesis by relating the exponents of size-scaling rules with simulated trends in α-, ß- and γ-diversity with body size. Our results highlight that the diversity-body size relationship in metacommunities may be driven by the combined effect of different scaling rules. Given their ubiquity in most terrestrial and aquatic biotas, these scaling rules may represent the basic determinants-backbone-of biodiversity, over which other mechanisms operate determining metacommunity assembly. Further studies are needed, aimed at explaining biodiversity patterns from functional relationships between biological rates and body size, as well as their association with environmental conditions and species interactions.

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This study investigates the relation between exposure to critical air pollution events with multipollutant (CO, PM10, PM2.5, NO2, O3, and SO2) and hospitalizations for respiratory diseases in the metropolitan area of São Paulo (RMSP) and in the countryside and coastline, from 2017 to 2021. Data mining analysis by temporal association rules searched for frequent patterns of respiratory diseases and multipollutants associated with time intervals. In the results, pollutants PM10, PM2.5, and O3 showed high concentration values in the three regions, SO2 on the coast, and NO2 in the RMSP. Seasonality was similar between pollutants and between cities and concentrations significantly higher in winter, except for O3, which was present in warm seasons. Hospitalizations were recurrent during the transition from summer to colder periods. In approximately 35% of the total days with hospitalization greater than the annual average, one or more pollutants had a high concentration. The rules showed that PM2.5, PM10, and O3 pollutants are strongly associated with increased hospitalizations in the RMSP (PM2.5 and PM10 with 38.5% support and 77% confidence) and in Campinas (PM2.5 with 66.1% support and 94% confidence) and the pollutant O3 with maximum support of 17.5%. On the coast, SO2 was related to high hospitalizations (43.85% support and 80% confidence). The pollutants CO and NO2 were not associated with the increase in hospitalizations. The ratio delay indicates the pollutants that were associated with hospitalizations, having concentration remained above the limit for three days, oscillating in smaller hospitalizations on the 1st day and again higher on the 2nd and 3rd days of delay, in a decreasing way. In conclusion, high pollutant exposure is significantly associated with daily hospitalization for respiratory problems. The cumulative effect of air pollutants increased hospitalization in the following days, in addition to identifying the pollutants and which pollutant combinations are most harmful to health in each region.

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Background: Diagnosis of pulmonary embolism (PE) constitutes a challenge for practitioners. Current practice involves use of pre-test probability prediction rules. Several strategies to optimize this process have been explored. Objectives: To explore whether application of the pulmonary embolism rule-out criteria (PERC rule) and age-adjusted D-dimer (DD) would have reduced the number of computed tomography pulmonary angiography (CTPA) examinations performed in patients with suspected PE. Methods: A retrospective cross-sectional study of adult patients taken for CTPA under suspicion of PE in 2018 and 2020. The PERC rule and age-adjusted DD were applied. The number of cases without indications for imaging studies was estimated and the operational characteristics for diagnosis of PE were calculated. Results: 302 patients were included. PE was diagnosed in 29.8%. Only 27.2% of 'not probable' cases according to the Wells criteria had D-dimer assays. Age adjustment would have reduced tomography use by 11.1%, with an AUC of 0.5. The PERC rule would have reduced use by 7%, with an AUC of 0.72. Conclusions: Application of age-adjusted D-dimer and the PERC rule to patients taken for CTPA because of suspected PE seems to reduce the number of indications for the procedure.

Contexto: O diagnóstico de embolia pulmonar (EP) representa um desafio para o profissional. A prática atual envolve o uso de modelos de previsão de probabilidade pré-teste e, para otimizar esse processo, várias estratégias têm sido exploradas. Objetivos: Investigar se a aplicação dos critérios de exclusão de EP (pulmonary embolism rule-out criteria, PERC) e do D-dímero (DD) ajustado para idade diminui o número de angiografias computadorizadas (ATCs) pulmonares realizadas em pacientes com suspeita de EP. Métodos: Estudo transversal retrospectivo com pacientes adultos submetidos a ATC pulmonar com suspeita de EP em 2018 e 2020. Foram aplicados os critérios PERC e o DD ajustado para idade. Foi estimado o número de casos não indicados para exames de imagem, e foram calculadas as características operacionais para o diagnóstico de EP. Resultados: Foram incluídos 302 pacientes, dos quais 29,8% apresentaram diagnóstico de EP. Apenas 27,2% dos casos não prováveis ​​de acordo com os critérios de Wells apresentaram DD; o ajuste implicou em uma diminuição de ACTs de 11,1%, com área sob a curva de 0,5. Os critérios PERC diminuiriam em 7%, com área sob a curva de 0,72. Conclusões: A aplicação do DD ajustado para idade e dos critérios PERC em pacientes submetidos a ATC pulmonar por suspeita de EP parece diminuir a indicação para tais exames.

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Objective: To evaluate and validate the medically necessary and time sensitive score by testing the variables, in order to create a surgical preoperative score for procedure prioritization in COVID-19 pandemic in Colombia. Methods: A multicenter retrospective cross-sectional study of instrument validation with a cultural adaptation and translation into the Spanish language was carried out in Bogota, Colombia. Patients over 18 years of age who had undergone elective procedures of general surgery and subspecialties were included. The translation of the medically necessary and time sensitive score into Spanish was performed independently by two bilingual surgeons fluent in both English and Spanish. A final version of the Spanish questionnaire (MeNTS Col) for testing was then produced by an expert committee. After translation and cultural adaptation, it was submitted to evaluate the psychometric properties of the medically necessary and time sensitive score. Cronbach's α was used to represent and evaluate the internal consistency and assess reliability. Results: A total of 172 patients were included, with a median age of 54 years; of which 96 (55.8%) patients were females. The vast majority of patients were treated for general surgery (n = 60) and colon and rectal surgery (n = 31). The evaluation of the internal consistency of the scale items in Spanish version was measured, and values of 0.5 for 0.8 were obtained. In the reliability and validation process, Cronbach's α values in all items remained higher than 0.7. The new MeNTS Col model was analyzed, and a result of 0.91 was obtained. Conclusions: The Spanish version of the medically necessary and time sensitive, the MeNTS Col score, and its respective Spanish translation perform similarly to the original version. Therefore, they can be useful and reproducible in Latin American countries.

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INTRODUCTION: The genomic-based 21-gene recurrence score assay (21-GRSA) allows to determine the usefulness of adjuvant chemotherapy in patients with luminal-type early breast cancer (LTEBC). Additional predictive models have also been developed, such as Magee equations (ME), the Predict model (PM), and the Tennessee nomogram score (TNS). OBJECTIVE: To evaluate the concordance between 21-GRSA, ME, PM and TNS. METHODS: Patients with unifocal LTEBC and 21-GRSA, ME, PM and TNS results were included. A subgroup analysis of women older than 50 years was carried out. Concordance between the models and 21-GRSA was evaluated using Cohen's kappa index (KI). RESULTS: One-hundred and twenty-two women were included. Concordance between 21-GRSA and ME (KI = 0.35) and PM (KI = 0.24) was fair (p < 0.001). Concordance between 21-GRSA and TNS was inferior (KI = 0.16, p = 0.04). Eighty patients older than 50 years with sufficient data to calculate all three predictive models were included. Concordance was found between the low-risk classification on 21-GRSA and all three combined models in 36/37 patients (negative predictive value of 97.3%). CONCLUSION: 21-GRSA can be omitted in women older than 50 years with LTEBC classified with low risk scores on all three predictive models.

INTRODUCCIÓN: La prueba genómica de recurrencia de 21 genes (PGR21) permite determinar la utilidad de la quimioterapia adyuvante en pacientes con cáncer de mama temprano luminal (CMTL). Se han desarrollado modelos predictivos adicionales, como las ecuaciones de Magee (EM), el modelo Predict (MP) y la puntuación del nomograma de la Universidad de Tennessee (NT). OBJETIVO: Evaluar la concordancia entre PGR21, EM, MP y NT. MÉTODOS: Se incluyeron pacientes con CMTL unifocal y con resultados de PGR21, EM, MP y NT. Se efectuó subanálisis de mujeres mayores de 50 años. La concordancia se evaluó mediante índice kappa de Cohen (IK). RESULTADOS: Se incluyeron 122 mujeres. La concordancia entre PGR21 y EM (IK = 0.35) y MP (IK = 0.24) fue aceptable (p < 0.001); entre PGR21 y NT fue inferior (IK = 0.16, p = 0.04). Se incluyeron 80 pacientes mayores de 50 años con datos suficientes para calcular los tres modelos. Se encontró concordancia entre la clasificación de bajo riesgo mediante PGR21 y los tres modelos combinados en 36/37 pacientes (valor predictivo negativo de 97.3 %). CONCLUSIÓN: Se puede omitir la PGR21 en las mujeres mayores de 50 años con CMTL que se clasifica de bajo riesgo en los tres modelos predictivos.

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OBJECTIVE: To evaluate the value of positron emission tomography/computed tomography (PET/CT) in predicting no residual disease (NRD) after secondary cytoreductive surgery (SCS) compared with MSK criteria, the iMODEL, and the AGO score. METHODS: We analyzed 112 patients with platinum-sensitive ovarian carcinoma who underwent SCS. We excluded patients for whom PET/CT was not performed, those without sufficient data, and who received chemotherapy before SCS. Ultimately, 69 patients were included. RESULTS: Variables that correlated with NRD were peritoneal carcinomatosis index (odds ratio [OR]=0.91; 95% confidence interval [CI]=0.83-0.99; p=0.044), European Cooperative Oncology Group Performance Status (ECOG) 0 (OR=8.0; 95% CI=1.34-47.5; p=0.022), and ≤2 lesions by PET/CT (OR=4.36; 95% CI=1.07-17.7; p=0.039). Of the patients with ≤2 lesions by PET/CT, 48 (92.3%) underwent complete SCS. The sensitivity, positive predictive value, negative predictive value, and accuracy of PET/CT for NRD were 85.7%, 92.3%, 33.3%, and 81.2%, respectively. NRD was achieved after fulfilling the MSK criteria, iMODEL and AGO Score in 89.1%, 88.1% and 85.9%, respectively. The accuracy of the MSK criteria, iMODEL, and AGO score in predicting NRD was 87%, 83.3%, and 77.3%, respectively. The PET/CT findings agreed well with the AGO score and iMODEL. The addition of PET/CT to these models increased the NRD rates (92.2%, 91.8%, and 89.4% for MSK+PET/CT, iMODEL+PET/CT, and AGO+PET/CT, respectively), but lowered their accuracy. CONCLUSION: We observed NRD in 92.3% of patients with ≤2 lesions by PET/CT, with an accuracy of 81.2%. PET/CT did not increase the accuracy of the MSK criteria, iMODEL, or AGO score models.

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On September 4, 2022, Chilean voters massively turned down a constitutional proposal that responded to widely shared criticisms of the 1980 constitution and emerged from a consensual and participatory process. This result is paradoxical because ex ante, the odds seemed largely in favor of changing the status quo. We argue that three factors, which derived from the interaction between rules and political contingency, explain the outcome: a Convention under the control of party-less independents, the exceptional underrepresentation of the political right, and a highly decentralized and public writing process. We extract some lessons from the failed experience that can be useful for countries seeking to deepen democratization through constitutional change and for a future constitution-making process in Chile.

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Climate change is reshaping biological communities, as species track environmental temperature. Assemblage reorganization is underpinned by shifts in species abundance and distribution, but studies often focus on documenting compositional turnover. As a consequence, phenomena such as the tropicalization of temperate communities have been widely associated with increased occupancy of warm-affinity species. Abundance-weighted change in thermal affinity can be tracked with the Community Temperature Index (CTI), and decomposed into four processes: tropicalization (increasing warm-affinity), borealization (increasing cold-affinity), deborealization (decreasing cold-affinity), and detropicalization (decreasing warm-affinity). Further evaluation of these processes according to species persistence (i.e., immigrant, emigrant, and resident) may provide insights on whether novel communities emerge primarily from local shifts in species abundance or distribution. Using long-term data on fish assemblages undergoing climate change's effects across 19 temperate estuaries surveyed for at least 20 years, we hypothesized (1) deborealization is the main process reshaping communities under climate change, and (2) the contribution of resident species to processes reshaping communities surpass the ones from immigrants and emigrants. Community dissimilarity was calculated through the Temporal Beta Index (TBI), which was further decomposed into species and individual losses and gains. These values were then used as effect sizes in the meta-analyses performed to detect systematic trends in assemblage reorganization in response to climate change. We also calculated CTI and the strength of temperature-related processes for resident, immigrant and emigrant species. Species and individual gains outweighed losses in estuaries. Temperature was correlated with changes in species abundance, but not occurrence. Fish abundance decreased with warming, and initially cooler estuaries gained more fish than warmer ones. Novel communities were shaped by a variety of processes, but mainly tropicalization. Assemblage reorganization was primarily driven by shifts in abundance of resident species with distinct thermal affinities, while contributions of arriving and exiting species played a secondary role. These findings reveal that novel communities are drawn primarily from the local species pool, due to changes in climate-related drivers that favor distinct resident species.

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Resumen Introducción: La prueba genómica de recurrencia de 21 genes (PGR21) permite determinar la utilidad de la quimioterapia adyuvante en pacientes con cáncer de mama temprano luminal (CMTL). Se han desarrollado modelos predictivos adicionales, como las ecuaciones de Magee (EM), el modelo Predict (MP) y la puntuación del nomograma de la Universidad de Tennessee (NT). Objetivo: Evaluar la concordancia entre PGR21, EM, MP y NT. Métodos: Se incluyeron pacientes con CMTL unifocal y con resultados de PGR21, EM, MP y NT. Se efectuó subanálisis de mujeres mayores de 50 años. La concordancia se evaluó mediante índice kappa de Cohen (IK). Resultados: Se incluyeron 122 mujeres. La concordancia entre PGR21 y EM (IK = 0.35) y MP (IK = 0.24) fue aceptable (p < 0.001); entre PGR21 y NT fue inferior (IK = 0.16, p = 0.04). Se incluyeron 80 pacientes mayores de 50 años con datos suficientes para calcular los tres modelos. Se encontró concordancia entre la clasificación de bajo riesgo mediante PGR21 y los tres modelos combinados en 36/37 pacientes (valor predictivo negativo de 97.3 %). Conclusión: Se puede omitir la PGR21 en las mujeres mayores de 50 años con CMTL que se clasifica de bajo riesgo en los tres modelos predictivos.

Abstract Introduction: The genomic-based 21-gene recurrence score assay (21-GRSA) allows to determine the usefulness of adjuvant chemotherapy in patients with luminal-type early breast cancer (LTEBC). Additional predictive models have also been developed, such as Magee equations (ME), the Predict model (PM), and the Tennessee nomogram score (TNS). Objective: To evaluate the concordance between 21-GRSA, ME, PM and TNS. Methods: Patients with unifocal LTEBC and 21-GRSA, ME, PM and TNS results were included. A subgroup analysis of women older than 50 years was carried out. Concordance between the models and 21-GRSA was evaluated using Cohen's kappa index (KI). Results: One-hundred and twenty-two women were included. Concordance between 21-GRSA and ME (KI = 0.35) and PM (KI = 0.24) was fair (p < 0.001). Concordance between 21-GRSA and TNS was inferior (KI = 0.16, p = 0.04). Eighty patients older than 50 years with sufficient data to calculate all three predictive models were included. Concordance was found between the low-risk classification on 21-GRSA and all three combined models in 36/37 patients (negative predictive value of 97.3%). Conclusion: 21-GRSA can be omitted in women older than 50 years with LTEBC classified with low risk scores on all three predictive models.

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BACKGROUND: The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died. METHODS: This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score. RESULTS: From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641-0.944) and 0.704 (95% IC: 0.617-0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001). CONCLUSIONS: The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.

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