Global Health System Resilience during Encounters with Stressors - Lessons Learnt from Cancer Services during the COVID-19 Pandemic.

AIMS: The protracted COVID-19 pandemic has overwhelmed health systems globally, including many aspects of cancer control. This has underscored the multidimensional nature of cancer control, which requires a more comprehensive approach involving taking a wider perspective of health systems. Here, we investigated aspects of health system resilience in maintaining cancer services globally during the COVID-19 pandemic. This will allow for health systems to be resilient to different types of system stressors/shocks in the future, to allow cancer care to be maintained optimally. MATERIALS AND METHODS: Using the World Health Organization health system framework (capturing aspects of service delivery, health workforce, information, medical products, vaccines and technologies, financing and governance and leadership), we carried out a comparative analysis of the impact of COVID-19 and the synthesis of the findings in responses in cancer care in 10 countries/jurisdictions across four continents comprising a wide diversity of health systems, geographical regions and socioeconomic status (China, Colombia, Egypt, Hong Kong SAR, Indonesia, India, Singapore, Sri Lanka, UK and Zambia). A combination of literature and document reviews and interviews with experts was used. RESULTS: Our study revealed that: (i) underlying weaknesses of health systems before the pandemic were exacerbated by the pandemic (e.g. economic issues in low- and middle-income countries led to greater shortage of medication and resource constraints compounded by inadequacies of public financing and issues of engagement with stakeholders and leadership/governance); (ii) no universal adaptive strategies were applicable to all the systems, highlighting the need for health systems to design emergency plans based on local context; (iii) despite the many differences between health systems, common issues were identified, such as the lack of contingency plan for pandemics, inadequate financial policies for cancer patients and lack of evidence-based approaches for competing priorities of cancer care/pandemic control. CONCLUSION: We identified four key points/recommendations to enhance the resilient capacity of cancer care during the COVID-19 pandemic and other system stressors: (i) effective pandemic control approaches in general are essential to maintain the continuity of cancer care during the emergency health crises; (ii) strong health systems (with sufficient cancer care resources, e.g. health workforce, and universal health coverage) are fundamental to maintain quality care; (iii) the ability to develop response strategies and adapt to evolving evidence/circumstances is critical for health system resilience (including introducing systematic, consistent and evidence-based changes, national support and guidance in policy development and implementation); (iv) preparedness and contingency plans for future public health emergencies, engaging the whole of society, to achieve health system resilience for future crises and to transform healthcare delivery beyond the pandemic.

Effect and associated factors of a clinical pharmacy model in the incidence of medication errors (EACPharModel) in the Hospital Pablo Tobón Uribe: study protocol for a stepped wedge randomized controlled trial (NCT03338725).

BACKGROUND: According to WHO, medication error (ME) is a subject that requires attention at all levels of care to reduce severe and preventable damage related to medication use. Clinical pharmacy practice standards have been proposed around the world so that the pharmacist, as part of a multidisciplinary health team, can help improve patient safety; however, further evidence derived from adequate studies is needed to demonstrate this. This study aims to assess the effect of a clinical pharmacy practice model (CPPM) in preventing MEs associated with the medication use process. METHODS: A prospective, stepped-wedge, cluster-randomized, controlled trial with a duration of 14 months will be performed to compare the effect of a CPPM along with the usual care process of patients in the Pablo Tobón Uribe Hospital (Medellin, Colombia). The study is designed as a cluster-randomized controlled trial, involving five hospital wards (clusters) and 720 patients. Medical wards are allocated to interventions using a stepped-wedge design. Clusters are initially assigned to the control group. After a 2-month observation period, hospital clusters were randomly allocated to the intervention group. Study outcomes will be assessed at baseline and at 2, 4, 6, 8, 10, and 12 months after randomization. The primary outcome will be to assess the effect of a CPPM on the incidence of medication errors associated with the medication use process. Drug-related problems and factors that contribute to the occurrence of MEs will be assessed as secondary outcomes. Statistical analyses will be performed using a mixed model, with the treatment group and time as fixed effects and the clustering structure as a random effect. Statistical analysis will be performed using Pearson chi-square tests and Student's t-tests, and a P value < 0.05 will be considered statistically significant. DISCUSSION: As far as we know, this is the first stepped-wedge, cluster-randomized, controlled trial designed to assess the change of a CPPM on the incidence of medication errors in a hospital in Colombia, and it could generate valuable information about a standardized and patient-centered clinical pharmacy model to improve the safety of inpatient care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03338725. Registered on 9 November 2017. The first patient was randomized on 2 February 2018. PROTOCOL VERSION: 0010112018JG.

Tensor-product kernel-based representation encoding joint MRI view similarity.

To support 3D magnetic resonance image (MRI) analysis, a marginal image similarity (MIS) matrix holding MR inter-slice relationship along every axis view (Axial, Coronal, and Sagittal) can be estimated. However, mutual inference from MIS view information poses a difficult task since relationships between axes are nonlinear. To overcome this issue, we introduce a Tensor-Product Kernel-based Representation (TKR) that allows encoding brain structure patterns due to patient differences, gathering all MIS matrices into a single joint image similarity framework. The TKR training strategy is carried out into a low dimensional projected space to get less influence of voxel-derived noise. Obtained results for classifying the considered patient categories (gender and age) on real MRI database shows that the proposed TKR training approach outperforms the conventional voxel-wise sum of squared differences. The proposed approach may be useful to support MRI clustering and similarity inference tasks, which are required on template-based image segmentation and atlas construction.

Novel heuristic search for ventricular arrhythmia detection using normalized cut clustering.

Processing of the long-term ECG Holter recordings for accurate arrhythmia detection is a problem that has been addressed in several approaches. However, there is not an outright method for heartbeat classification able to handle problems such as the large amount of data and highly unbalanced classes. This work introduces a heuristic-search-based clustering to discriminate among ventricular cardiac arrhythmias in Holter recordings. The proposed method is posed under the normalized cut criterion, which iteratively seeks for the nodes to be grouped into the same cluster. Searching procedure is carried out in accordance to the introduced maximum similarity value. Since our approach is unsupervised, a procedure for setting the initial algorithm parameters is proposed by fixing the initial nodes using a kernel density estimator. Results are obtained from MIT/BIH arrhythmia database providing heartbeat labelling. As a result, proposed heuristic-search-based clustering shows an adequate performance, even in the presence of strong unbalanced classes.

Evaluation of quick tests for phosphorus determination in dairy manures.

Nutrients in animal manure are valuable inputs in agronomic crop production. Rapid and timely information about manure nutrient content are needed to minimize the risks of phosphorus (P) over-application and losses of dissolved P (DP) in runoff from fields treated with manure. We evaluated the suitability of a commercial hand-held reflectometer, a hydrometer, and an electrical conductivity (EC) meter for determining DP and total P (TP) in dairy manures. Bulk samples (n = 107) collected from farms across CT, MD, NY, PA, and VA were highly variable in total solids (TS) concentration, ranging from 11 to 213gL(-1), in suspensions' pH (6.3-9.2), and EC (6.2-53.3 dS m(-1)). Manure DP concentrations measured using the RQFlex reflectometer (RQFlex-DP(s)) were related to molybdate-reactive P (MRP(s)) concentrations as follows: RQFlex-DP(s) = 0.471 x MRP(s) + 1102 (r2 = 0.29). Inclusion of pH and squared-pH terms improved the prediction of manure DP from RQFlex results (r2 = 0.66). Excluding five outlier samples that had pH < or = 6.9 the coefficient of determination (r2) for the MRP(s) and RQFlex-DP(s) relationship was 0.83 for 95% of the samples. Manure TS were related to hydrometer specific gravity readings (r2 = 0.53) that were in turn related to TP (r2 = 0.34), but not to either RQFlex-DP or MRP. Relationships between suspensions' EC and DP or TP were non-significant. Therefore, the RQFlex method is the only viable option for on-site quick estimates of DP that can be made more robust when complemented with TS and pH measurements. The DP quick test can provide near real-time information on soluble manure nutrient content across a wide range of handling and storage conditions on dairy farms and quick estimates of potential soluble P losses in runoff following land applications of manure.

Interacciones hospedero-parásito / Interaction host-parasite

La interacción hospedero-parásito juega un papel importante en la evolución de las enfermedades infecciosas. En este articulo se analiza esta interacción desde el punto de vista del hospedero, es decir de la respuesta inmune incluyendo los conceptos de la respuesta T1 y T2 frente al microorganismo. En infecciones con lepra cada vez es más claro el papel de la respuesta T1/T2 y su relación con la evolución de la enfermedad, pero falta por esclarecer como un individuo responde con una u otra lo que se traduce en curación ó enfermedad. En las infecciones por Herpes simplex aunque no es tan claro el papel de la respuesta T1/T2 si lo es el de algunas citocinas tanto en la primoinfección, latencia y reactivación. Finalmente en las infecciones por Criptococcus neoformans, aunque las características propias del microorganismo se relacionan con la evolución de la infección, la respuesta inmune con perfil T1 se asocia con el control de la infección

An association study of bipolar mood disorder (type I) with the 5-HTTLPR serotonin transporter polymorphism in a human population isolate from Colombia.

The short variant of a functional length polymorphism in the promoter region of the serotonin transporter has been associated with several behavioural and psychiatric traits, including bipolar mood disorder. The same short allele has also been implicated as a modifier of the bipolar phenotype. Here we evaluate the etiologic/modifier role of this polymorphism in a case (N=103) / control (N=112) sample for bipolar mood disorder (type I) collected from an isolated South American population. We did not detect an association between bipolar disorder and the 5-HTT promoter polymorphism in this sample. However, an excess of the short allele was seen in younger cases and in cases with psychotic symptoms. When combined with data from the literature, the increased frequency of the short allele in patients with psychotic symptoms was statistically significant.

Otitis media aguda: un reto diagnóstico y terapéutico / Acute middle otitis: a diagnostic and therapeutic challenge

La otitis media es una de las entidades más comunes de la infancia. Es de origen multifactorial, siendo la infección respiratoria el principal factor asociado. La patogénesis de esta enfermedad incluye la interacción entre disfunción de la tuba timpánica, inmunodeficiencia, infección, atopia y la respuesta inmune del huésped. El diagnóstico es clínico, el examen del oído medio debe realizarse idealmente con un otoscopio neumático que permita evaluar la membrana timpánica y su movilidad. Las pruebas audiológicas como la impedanciometría y la audiometría, deben hacer parte del seguimiento de todo paciente porque confirman la presencia de líquido en el oído medio y descartan alteraciones conductivas y neurosensoriales. Todas las OM deben tratarse, el manejo debe fundamentarse en el conocimiento de los principios farmacológicos de los medicamentos existentes, para poder elegir el más adecuado. Para los casos de otitis media con efusión el uso de corticoides ha demostrado ser efectivo. En algunos casos puede ser necesaria la intervención quirúrgica, la inserción de tubos de timpanostomía, para facilitar el drenaje de efusiones no resueltas. Lo más importante es el conocimiento de la patogénesis de la OM, para realizar un acertado manejo médico y disminuir la aparición de complicaciones y secuelas que puedan comprometer el desarrollo normal de los niños que padecen o han padecido la infeccion

Phylogeography of the West Indian manatee (Trichechus manatus): how many populations and how many taxa?

To resolve the population genetic structure and phylogeography of the West Indian manatee (Trichechus manatus), mitochondrial (mt) DNA control region sequences were compared among eight locations across the western Atlantic region. Fifteen haplotypes were identified among 86 individuals from Florida, Puerto Rico, the Dominican Republic, Mexico, Columbia, Venezuela, Guyana and Brazil. Despite the manatee's ability to move thousands of kilometers along continental margins, strong population separations between most locations were demonstrated with significant haplotype frequency shifts. These findings are consistent with tagging studies which indicate that stretches of open water and unsuitable coastal habitats constitute substantial barriers to gene flow and colonization. Low levels of genetic diversity within Florida and Brazilian samples might be explained by recent colonization into high latitudes or bottleneck effects. Three distinctive mtDNA lineages were observed in an intraspecific phylogeny of T. manatus, corresponding approximately to: (i) Florida and the West Indies; (ii) the Gulf of Mexico to the Caribbean rivers of South America; and (iii) the northeast Atlantic coast of South America. These lineages, which are not concordant with previous subspecies designations, are separated by sequence divergence estimates of d = 0.04-0.07, approximately the same level of divergence observed between T. manatus and the Amazonian manatee (T. inunguis, n = 16). Three individuals from Guyana, identified as T. manatus, had mtDNA haplotypes which are affiliated with the endemic Amazon form T. inunguis. The three primary T. manatus lineages and the T. inunguis lineage may represent relatively deep phylogeographic partitions which have been bridged recently due to changes in habitat availability (after the Wisconsin glacial period, 10 000 B P), natural colonization, and human-mediated transplantation.