Uncovering the neurological effects of West Nile virus during a record-breaking southern Spain outbreak in 2020-2021.

The 2020-21 West Nile Virus (WNV) outbreak in Andalusia, Spain, was the largest reported in the country, with eight cases of West Nile Neuroinvasive Disease (WNND) diagnosed in a tertiary hospital. Diagnosis of WNND is based on detecting WNV RNA, viral isolation, or demonstrating a specific immune response against the virus, with additional tests used to support the diagnosis. Treatment remains supportive, with variable outcomes. The potential efficacy of plasma exchange (PLEX) in select cases raises the possibility of an autoimmune component secondary to infectious pathology of the central nervous system. The influence of climate change on the expansion of WNV into new regions is a significant concern. It is crucial for physicians practicing in high-risk areas to be knowledgeable about the disease for early prevention and effective control measures.

Extracting body function information using rule-based methods: Highlighting structure and formatting challenges in clinical text.

This paper describes the identification of body function (BF) mentions within the clinical text within a large, national, heterogeneous corpus to highlight structural challenges presented by the clinical text. BF in clinical documents provides information on dysfunction or impairments in the function or structure of organ systems or organs. BF mentions are embedded in highly formatted structures where the formats include implied scoping boundaries that confound existing natural language processing segmentation and document decomposition techniques. This paper describes follow-up work to adapt a rule-based system created using National Institutes of Health records to a larger, more challenging corpus of Social Security Administration data. Results of these systems provide a baseline for future work to improve document decomposition techniques.

Linking Free Text Documentation of Functioning and Disability to the ICF With Natural Language Processing.

Background: Invaluable information on patient functioning and the complex interactions that define it is recorded in free text portions of the Electronic Health Record (EHR). Leveraging this information to improve clinical decision-making and conduct research requires natural language processing (NLP) technologies to identify and organize the information recorded in clinical documentation. Methods: We used natural language processing methods to analyze information about patient functioning recorded in two collections of clinical documents pertaining to claims for federal disability benefits from the U.S. Social Security Administration (SSA). We grounded our analysis in the International Classification of Functioning, Disability, and Health (ICF), and used the Activities and Participation domain of the ICF to classify information about functioning in three key areas: mobility, self-care, and domestic life. After annotating functional status information in our datasets through expert clinical review, we trained machine learning-based NLP models to automatically assign ICF categories to mentions of functional activity. Results: We found that rich and diverse information on patient functioning was documented in the free text records. Annotation of 289 documents for Mobility information yielded 2,455 mentions of Mobility activities and 3,176 specific actions corresponding to 13 ICF-based categories. Annotation of 329 documents for Self-Care and Domestic Life information yielded 3,990 activity mentions and 4,665 specific actions corresponding to 16 ICF-based categories. NLP systems for automated ICF coding achieved over 80% macro-averaged F-measure on both datasets, indicating strong performance across all ICF categories used. Conclusions: Natural language processing can help to navigate the tradeoff between flexible and expressive clinical documentation of functioning and standardizable data for comparability and learning. The ICF has practical limitations for classifying functional status information in clinical documentation but presents a valuable framework for organizing the information recorded in health records about patient functioning. This study advances the development of robust, ICF-based NLP technologies to analyze information on patient functioning and has significant implications for NLP-powered analysis of functional status information in disability benefits management, clinical care, and research.

Effect of a Mobile-based Intervention on Mental Health in Frontline Healthcare Workers Against COVID-19: Protocol for a Randomized Controlled Trial

AimTo evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness-based approaches on the mental health of healthcare workers at the frontline against COVID-19 in Spain. DesignWe will carry out a two-week, individually randomised, parallel group, controlled trial. Participants will be individually randomised to receive the PsyCovidApp intervention or control App intervention. MethodsThe PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended COVID-19 patients will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the two weeks intervention period. Measures will include stress, depression and anxiety (DASS-21 questionnaire - primary endpoint), insomnia (ISI), burnout (MBI-HSS), post-traumatic stress disorder (DTS), and self-efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation. DiscussionDespite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence regarding the effectiveness of this type of intervention on this specific population and context. ImpactDespite the lack of solid evidence about their effectiveness, mobile-based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits. Clinical trial registrationNCT04393818 (ClinicalTrials.gov identifier)

Adaptive laboratory evolution of Pseudomonas putida KT2440 improves p-coumaric and ferulic acid catabolism and tolerance.

Pseudomonas putida KT2440 is a promising bacterial chassis for the conversion of lignin-derived aromatic compound mixtures to biofuels and bioproducts. Despite the inherent robustness of this strain, further improvements to aromatic catabolism and toxicity tolerance of P. putida will be required to achieve industrial relevance. Here, tolerance adaptive laboratory evolution (TALE) was employed with increasing concentrations of the hydroxycinnamic acids p-coumaric acid (pCA) and ferulic acid (FA) individually and in combination (pCA â€‹+ â€‹FA). The TALE experiments led to evolved P. putida strains with increased tolerance to the targeted acids as compared to wild type. Specifically, a 37 â€‹h decrease in lag phase in 20 â€‹g/L pCA and a 2.4-fold increase in growth rate in 30 â€‹g/L FA was observed. Whole genome sequencing of intermediate and endpoint evolved P. putida populations revealed several expected and non-intuitive genetic targets underlying these aromatic catabolic and toxicity tolerance enhancements. PP_3350 and ttgB were among the most frequently mutated genes, and the beneficial contributions of these mutations were verified via gene knockouts. Deletion of PP_3350, encoding a hypothetical protein, recapitulated improved toxicity tolerance to high concentrations of pCA, but not an improved growth rate in high concentrations of FA. Deletion of ttgB, part of the TtgABC efflux pump, severely inhibited growth in pCA â€‹+ â€‹FA TALE-derived strains but did not affect growth in pCA â€‹+ â€‹FA in a wild type background, suggesting epistatic interactions. Genes involved in flagellar movement and transcriptional regulation were often mutated in the TALE experiments on multiple substrates, reinforcing ideas of a minimal and deregulated cell as optimal for domesticated growth. Overall, this work demonstrates increased tolerance towards and growth rate at the expense of hydroxycinnamic acids and presents new targets for improving P. putida for microbial lignin valorization.

Abdominal obesity is strongly associated to blood pressure in young Mexicans / La obesidad abdominal está fuertemente asociada a hipertensión arterial en jóvenes mexicanos

Objective: The objective of this study was to determine associations between abdominal obesity (AOb) and the other components of metabolic syndrome (MetS) in young Mexicans in a cross-sectional survey completed during a 4 year period. Methods: This cross-sectional study reports on components and prevalence of MetS by using Alberti et al. (16) criteria, as well as association between AOb and elevated blood pressure (BP) of 2,993 Mexican university students, ages 17 to 25 years (66% women) from central and northern Mexico, over a 4-year survey (2010-2013). Results: The most prevalent MetS components in the total sample were low HDL-C concentration (43.6%) and AOb (41.1%). MetS prevalence was 11.8%, more men than women were classified with MetS (14.3% vs. 10.5%, p < 0.01). BP was the MetS component with the lowest prevalence (8.6%). A strong association between AOb and altered BP with in both men and women was found (OR 4.3, IC95% 2.5-7.4). Conclusions: Even BP was the component with the lowest prevalence, AOb was more strongly associated with it. This fact, could explain the prevalence of hypertension among young Mexican adults (AU)

Objetivo: el objetivo de este estudio fue determinar la asociación entre la obesidad abdominal (OAb) y los otros componentes del síndrome metabólico (SMet) en jóvenes mexicanos a través de una encuesta transversal completada durante un período de 4 años. Métodos: este estudio transversal informa sobre los componentes y la prevalencia del SMet usando los criterios de Alberti y cols. (16), así como la asociación entre OAb y la presión arterial (PA) elevada de 2.993 estudiantes universitarios mexicanos, con edades de 17 a 25 años (66% mujeres), procedentes del centro y norte de México, a través de una encuesta de 4 años (2010-2013). Resultados: los componentes del SMet de mayor prevalencia en la muestra total fueron baja concentración de HDL-C (43,6%) y OAb (41,1%). La prevalencia de SMet fue del 11,8%, mayor en hombres que en mujeres (14,3% vs. 10,5%; p < 0,01). La PA elevada fue el componente del SMet con la prevalencia más baja (8,6%). Se encontró una fuerte asociación entre OAb y PA elevada, tanto en hombres como en mujeres (OR 4,3; IC 95% 2,5 a 7,4). Conclusiones: a pesar de que la PA elevada fue el componente con menor prevalencia, la OAb estuvo más fuertemente asociada con esta, hecho que podría explicar la prevalencia de hipertensión entre los adultos jóvenes mexicanos (AU)

Health insurance or subsidy has universal advantage for management of hospital malnutrition unrelated to GDP.

BACKGROUND AND OBJECTIVES: Protein-energy and micronutrient malnutrition are global public health problems which, when not prevented and severe, require medical management by clinicians with nutrition expertise, preferably as a collectively skilled team, especially when disease-related. This study aimed to investigate barriers and facilitators of clinical nutrition services (CNS), especially the use of oral, enteral (EN) and parenteral (PN) nutrition in institutional and home settings. METHODS AND STUDY DESIGN: An international survey was performed between January and December 2014 in twenty-six countries from all continents. Electronic questionnaires were distributed to 28 representatives of clinical nutrition (PEN) societies, 27 of whom responded. The questionnaire comprised questions regarding a country's economy, reimbursement for CNS, education about and the use of EN and PN. RESULTS: The prevalence of malnutrition was not related to gross domestic product (GDP) at purchasing power parity (PPP) per capita (p=0.186). EN and PN were used in all countries surveyed (100%), but to different extents. Reimbursement of neither EN nor PN use depended on GDP, but was associated with increased use of EN and PN in hospitals (p=0.035), although not evident for home or chronic care facilities. The size of GDP did not affect the use of EN (p=0.256), but it mattered for PN (p=0.019). CONCLUSIONS: A worldwide survey by nutrition support societies did not find a link between national economic performance and the implementation of medical nutrition services. Reimbursement for CNS, available through health insurance systems, is a factor in effective nutrition management.

phase instability and molecular kinetics provoked by repeated crossing of the demixing transition of PNIPAM solutions.

The demixing process of aqueous poly(N-isopropylacrylamide) (PNIPAM) solutions can occur either via a nucleation and growth process or via spinodal decomposition. The ensuing self-assembly, leading to heterogeneous morphologies within the PNIPAM solution, is codetermined by kinetic processes caused by molecular transport. By subjecting PNIPAM solutions to cyclic changes in temperature leading to repeated crossing of the demixing transition, we are able to assess the importance of kinetics as well as of overheating and supercooling of the phase transition within the metastable range delimited by the binodal and spinodal lines. First indications about the location of these stability limits for the low- and high-temperature phases, separated by about 1.6 K, could be gained by detailed kinetic studies of the refractive index. These investigations are made possible due to the novel technique of temperature-modulated optical refractometry.

Study of the factors associated with substance use in adolescence using Association Rules.

The aim of this study is to analyse the factors related to the use of addictive substances in adolescence using association rules, descriptive tools included in Data Mining. Thus, we have a database referring to the consumption of addictive substances in adolescence, and use the free distribution program in the R arules package (version 2.10.0). The sample was made up of 9,300 students between the ages of 14 and 18 (47.1% boys and 52.9% girls) with an average age of 15.6 (SE=1.2). The adolescents answered an anonymous questionnaire on personal, family and environmental risk factors related to substance use. The best rules obtained with regard to substance use relate the consumption of alcohol to perceived parenting style and peer consumption (confidence = 0.8528), the use of tobacco (smoking), cannabis and cocaine to perceived parental action and illegal behaviour (confidence = 0.8032, 0.8718 and 1.0000, respectively), and the use of ecstasy to peer consumption (confidence = 1.0000). In general, the association rules show in a simple manner the relationship between certain patterns of perceived parental action, behaviours that deviate from social behavioural norms, peer consumption and the use of different legal and illegal drugs of abuse in adolescence. The implications of the results obtained are described, together with the usefulness of this new methodology of analysis.

Video-assisted thoracic surgery (VATS) lobectomy: 13 years' experience.

BACKGROUND: Major lung resection by video-assisted thoracic surgery (VATS) has been proven to be both safe and technically feasible, but is not routinely performed in most hospitals. The aim of this paper is to show our technique for VATS lobectomy and our experience and outcomes obtained. METHODS: We have performed a retrospective review included all patients undergoing major pulmonary resection by VATS at the General and Thoracic Surgery Unit, Virgen Macarena University Hospital, Seville (Spain) since 1992. The clinical records of all patients were drawn from the hospital archive and data for the following variables were recorded for analysis: age, sex, clinical diagnosis, clinical status, date of surgery, type of surgery, inoperability, conversion to conventional surgery and reasons, duration of surgery and intraoperative complications, postoperative and long-term complications, postoperative stay, diagnosis, definitive status, and mortality. We also describe our surgical technique for each lobectomy. RESULTS: A total of 237 major pulmonary resections were performed, on 203 males and 34 males, with a mean age of 61.43 years (non-small-cell bronchogenic carcinoma: 204, benign processes: 24, carcinoid tumors: 4, and lobectomy due to metastases: 5). The overall conversion rate was 14.01%. Mean duration of lobectomy was 153 min, with a median of 98 min, and mean postoperative stay was 4.2 days. The morbidity rate was 15.18%, mostly involving minor complications. Perioperative mortality was 3.7%. The actuarial 5-year survival rate was 77.7%. CONCLUSIONS: VATS lobectomy is a viable safe procedure that meets oncological criteria for lung cancer surgery. In our experience, VATS is currently to be considered ideally indicated for certain benign processes and for T1-T2 N0 M0 bronchogenic carcinomas.

Anaplasma marginale field challenge: protection by an inactivated immunogen that shares partial sequence of msp1alpha variable region with the challenge strain.

Twenty four Hereford heifers free of anaplasmosis were allotted into three groups of eight animals each and inoculated three times with adjuvant in Puck saline as control or 50 microg and 100 microg of total protein of Anaplasma marginale initial bodies from three Mexican strains which share the same variable region of msp1alpha and msp4. Inoculation with the adjuvant or the immunogen at either of the two protein doses did not induce any undesirable changes attributable to inoculation in vaccinates or controls. On day 78 post vaccination animals were released in a ranch where bovine Anaplasmosis is endemic. The A. marginale strain prevalent in this ranch shares some of the msp1alpha tandem repeats with and the strains used in the vaccine. After release, all animals became infested with Boophilus microplus ticks and flies. During the challenge period, between days 279 and 300, loss of PCV due to clinical anaplasmosis in control animals was statistically higher from vaccinated animals. Likewise, controls mean peak rickettsemia was also significantly higher (p< or =0.01) than vaccinates' rickettsemias. The antibody responses of all vaccinates after the third vaccination reached OD values above 2.0 on day 49 and were different from controls (p<0.01). IgG(2) responses from both groups of vaccinates were different from controls (p<0.01). Vaccinates which required treatment, also showed the lowest IgG(2) and substantial IgG(1) responses. After contact with the rickettsia, controls developed clinical disease and 7 out of 8 required treatment, while vaccinates in general showed no substantial changes in hematocrit or rickettsemia and only one animal in each group required treatment. Our present results show that vaccination with either 50 microg or 100 microg of protein from purified IB derived from three strains induced protection to resist the challenge with the a field strain that shares some of the tandem repeats of MSP1a.

Antenatal glucocorticoid treatment decreases mortality and chronic lung disease in survivors among 23- to 28-week gestational age preterm infants.

The purpose of this study was to analyze the influence of antenatal glucocorticoid therapy (AGT) on mortality and chronic lung disease (CLD) in surviving preterm infants 23 to 28 weeks gestational age (WGA). This was a multicenter, prospective, observational study. A total of 2448 infants 23 to 28 WGA were born in 2002 to 2003; 27.7% did not receive AGT, 18.8% were exposed to partial AGT, and 53.5% were exposed to complete AGT. A total of 883 died and 22.9% of 1537 survivors were affected by CLD. Unadjusted univariate analysis showed AGT was associated with a reduction in mortality (p<0.001), either with partial or complete AGT courses, and also with a reduction in CLD in survivors (p<0.001), but only with complete AGT courses. In logistic regression analysis adjusted for confounding factors and a propensity score for AGT, AGT was significant and independently associated with a reduction of mortality, but only for complete AGT course (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.47 to 0.87; p=0.004), and with a decrease in CLD if a complete AGT course was administered (OR, 0.63; 95% CI, 0.45 to 0.89; p=0.009). A complete course of AGT in 23 to 28 WGA pregnancies is associated with decreased rates of neonatal mortality and CLD disease in surviving infants.