Reinforcement learning for decision-making under deep uncertainty.

Planning under complex uncertainty often asks for plans that can adapt to changing future conditions. To inform plan development during this process, exploration methods have been used to explore the performance of candidate policies given uncertainties. Nevertheless, these methods hardly enable adaptation by themselves, so extra efforts are required to develop the final adaptive plans, hence compromising the overall decision-making efficiency. This paper introduces Reinforcement Learning (RL) that employs closed-loop control as a new exploration method that enables automated adaptive policy-making for planning under uncertainty. To investigate its performance, we compare RL with a widely-used exploration method, Multi-Objective Evolutionary Algorithm (MOEA), in two hypothetical problems via computational experiments. Our results indicate the complementarity of the two methods. RL makes better use of its exploration history, hence always providing higher efficiency and providing better policy robustness in the presence of parameter uncertainty. MOEA quantifies objective uncertainty in a more intuitive way, hence providing better robustness to objective uncertainty. These findings will help researchers choose appropriate methods in different applications.

Effect of two preservation methods on the viability and enzyme production of a recombinant Komagataella phaffii (Pichia pastoris) strain.

The methylotrophic yeast Komagataella phaffii, previously known as Pichia pastoris, has been reported as a host for producing human recombinant lysosomal enzymes intended for enzyme replacement therapy. K. phaffii has advantages such as easy genetic handling, rapid growth, cost-effective mediums, and the ability to develop mammalian-like post-translational modifications. To maintain cell viability and enzyme activity over time, it is important to consider the bioprocess optimization and the proper selection and preservation of clones. In this study, we evaluated the effect of glycerol and skim milk in cryopreservation at -80 °C, as well as the use of skim milk or its combination with NaCl, disaccharides or sorbitol in freeze-drying on the cell viability and activity of a recombinant lysosomal enzyme (i.e., human ß-hexosaminidase-A) produced in K. phaffii GS115 strain. The results showed that cryopreservation with glycerol and skim milk, as well as freeze-drying using disaccharides and sorbitol with skim milk, maintained the viability above 80%. Although variations in enzyme activity among treatments were found, the use of disaccharides had a positive effect on the enzymatic activity levels. This is the first report of the evaluation of two suitable methods to preserve a recombinant K. phaffii strain, preventing the loss of viability and maintaining the activity of the recombinant protein.

Una respuesta ética en la atención a residencias de ancianos en la pandemia Covid-19 / An ethical response in the care of nursing homes in the covid-19 pandemic

La llegada de la pandemia COVID-19 puso en evidencia el riesgo de una posible falta de atención de los ancianos de las residencias de mayores. Aportamos la experiencia de un equipo multidisciplinar con profesionales voluntarios de diferentes especialidades que realizó una labor de apoyo a los profesionales sanitarios de las residencias. Este equipo se implementó desde las gerencias de atención primaria y de atención especializada. La sistemática de trabajo se inspiraba en el de hospitalización a domicilio e incluía la atención directa de los pacientes más complejos y el asesoramiento en las medidas de prevención, aislamiento e higiene dentro de la residencia. De este modo fue posible que los ancianos de las residencias con sospecha o diagnóstico de COVID-19 recibieran una atención adecuada por parte de un equipo interdisciplinar, que se descargara parte de la presión de los profesionales de las residencias y que los familiares percibieran que no existía abandono terapéutico. El compromiso desde diversos niveles asistenciales en una labor coordinada ha conseguido evitar que una población vulnerable pudiera quedar desatendido durante la pandemia

With the arrival of the COVID-19 pandemic, the risk of a possible lack of care for the elderly in nursing homes became evident. We summarize the experience of a multidisciplinary team with volunteer professionals from different specialties who carried out support for healthcare professionals in nursing homes. This team was implemented from both Primary and Specialty Care managements. Its work paradigm was proposed by our home hospitalization team, which included direct care of the most complex patients and general counselling on isolation, hygiene and preventive measures within the nursing homes. Thanks to this support, the elderly population placed there, with suspected or diagnosed COVID-19, received adequate care from an interdisciplinary team, which led part of the pressure to be released from their professional workers, and many family members were aware that there was no neglect of the elderly. Commitment from various levels of care in a coordinated effort has prevented a vulnerable population from being left unattended during the pandemic

De rotura fibrilar a linfoma del manto / From muscle tear to mantle cell lymphoma

Presentamos el caso de un varón que, mientras realizaba ejercicio en la playa, presentó un fuerte dolor en la pantorrilla. Después de varios días apareció un dolor en el costado izquierdo que aumentaba con los movimientos respiratorios. Acudió a nuestra consulta porque a su regreso presentaba inflamación de la pierna. Fue diagnosticado en urgencias de trombosis venosa profunda y tratado con heparina de bajo peso molecular. En nuestra consulta se le detectaron adenopatías inguinales bilaterales. Considerando pudiera tratarse de un síndrome paraneoplásico, se inició la búsqueda de tumores

We present the case of a man who, while exercising on the beach, presented severe calf pain. After several days, a pain appeared on his left side that increased with respiratory movements. He came to our clinic because on his return he developed leg swelling. He was diagnosed in the emergency department with deep vein thrombosis and treated with low molecular weight heparin. In our clinic, bilateral inguinal adenopathies were detected. Considering it might be a paraneoplastic syndrome, a search for tumors was made