Resilient Structural Sparsity in the Design of Consensus Networks.

The consensus problem is relevant to different areas ranging from biology, social psychology, and physics to power systems and robotics. Two crucial aspects of the design of a consensus system are the implementation issues that arise in densely connected networks and the presence of malicious agents that try to cause a deviation from a synchronization state. In this article, we introduce a formulation to design the topology of a consensus network to improve its resilience to attacks while remaining sparse and consistent with the a priori structural relations between the agents. Through mathematical analysis and simulations on artificial and real-world cases, we show the benefits and usefulness of using this strategy to design resilient and structurally sparse consensus networks.

The impact of climate change on photovoltaic power potential in Southwestern Colombia.

In this paper, we present the first study of the long-term climate-change impact on photovoltaic power potential in Nariño, Colombia. In this region, more than half of the territory does not have a constant electricity supply, but it has great potential for solutions with renewable energy sources. Based on the Coordinated Regional Downscaling Experiment (CORDEX), we assess the change in photovoltaic power potential towards the end of this century, considering two climate change scenarios, one optimistic and the other pessimistic. Our results suggest that changes in photovoltaic power potential, by the end of the century, will have a maximum decrease of around 2.49% in the central zone of Nariño, with some non-affected areas, and a maximum increase of 2.52% on the southeastern side with respect to the pessimistic climate change scenario.

Guía de Práctica Clínica para el diagnóstico temprano y la referencia oportuna del cáncer de pulmón.

OBJETIVO: Proporcionar recomendaciones para la detección temprana de pacientes con alto riesgo de desarrollar cáncer de pulmón (CP) en el primer nivel de atención y su referencia oportuna. Material y métodos. Se realizó una búsqueda detallada de la evidencia científica disponible para responder las preguntas de investigación clínica y se utilizó el Panel Delphi modificado para lograr un consenso entre expertos. RESULTADOS: Se generaron 14 recomendaciones siguiendo los estándares de una GPC. Conclusión. El CP representa un problema de salud pública en México; por ello, esta guía establece recomendaciones que apoyan la toma de decisiones sobre la detección precoz y la referencia de pacientes con sospecha de CP en el primer nivel de atención.

Guía de práctica clínica para el diagnóstico y el tratamiento de la otitis media aguda en niños.

BACKGROUND: Acute otitis media (AOM) is one of the most prevalent acute conditions in the pediatric population worldwide. This work aimed to elaborate a Clinical Practice Guideline with clinical recommendations systematically developed to assist decision-making of specialists, patients, caregivers, and public policymakers involved in managing patients with AOM in children. METHODS: This document was developed by the College of Pediatric Otorhinolaryngology and Head, and Neck Surgery of Mexico (COPEME) in compliance with international standards. The SIGN quality of evidence classification was used. On behalf of the COPEME, the Guideline Development Group (GDG) was integrated, including otolaryngologists, infectologists, pediatricians, general practitioners, and methodologists with experience in systematic literature reviews and the development of clinical practice guidelines. RESULTS: A consensus was reached on 18 clinical questions, covering what was previously established by the GDG in the scope document of the guidelines. Scientific evidence answering each of these clinical questions was identified and critically evaluated. The GDG agreed on the final wording of the clinical recommendations using the modified Delphi panel technique. Specialists and patient representatives conducted an external validation. CONCLUSIONS: This Clinical Practice Guideline presents clinical recommendations for the prevention, diagnosis, and management of AOM to assist shared decision-making among physicians, patients, and caregivers and improve the quality of clinical care.

INTRODUCCIÓN: La otitis media aguda (OMA) es uno de los padecimientos agudos más prevalentes en la población pediátrica a escala global. El objetivo de este trabajo fue elaborar una guía de práctica clínica con recomendaciones para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el manejo de la OMA en niños. MÉTODOS: El documento ha sido desarrollado por parte del Colegio de Otorrinolaringología y Cirugía de Cabeza y Cuello Pediátricas de México (COPEME) en cumplimiento con los estándares internacionales. Se empleó la clasificación de calidad de la evidencia de SIGN. En representación del COPEME, se integró el Grupo de Desarrollo de la Guía (GDG), que incluyó otorrinolaringólogos, infectólogos, pediatras, médicos generales y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. RESULTADOS: Se consensuaron 18 preguntas clínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente. El GDG acordó la redacción final de las recomendaciones clínicas mediante la técnica Delphi de panel. Se llevó a cabo una validación externa por colegas especialistas y representantes de pacientes. CONCLUSIONES: En esta Guía de Práctica Clínica se presentan recomendaciones clínicas para la prevención, el diagnóstico y el manejo de la OMA, con el fin de asistir la toma de decisiones compartidas entre médicos, pacientes y cuidadores con la intención de contribuir a mejorar la calidad de la atención clínica.

Guía de práctica clínica para el diagnóstico y el tratamiento de la otitis media aguda en niños / Clinical practice guidelines for diagnosis and management of acute otitis media in children

Resumen Introducción: La otitis media aguda (OMA) es uno de los padecimientos agudos más prevalentes en la población pediátrica a escala global. El objetivo de este trabajo fue elaborar una guía de práctica clínica con recomendaciones para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el manejo de la OMA en niños. Métodos: El documento ha sido desarrollado por parte del Colegio de Otorrinolaringología y Cirugía de Cabeza y Cuello Pediátricas de México (COPEME) en cumplimiento con los estándares internacionales. Se empleó la clasificación de calidad de la evidencia de SIGN. En representación del COPEME, se integró el Grupo de Desarrollo de la Guía (GDG), que incluyó otorrinolaringólogos, infectólogos, pediatras, médicos generales y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Resultados: Se consensuaron 18 preguntas clínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente. El GDG acordó la redacción final de las recomendaciones clínicas mediante la técnica Delphi de panel. Se llevó a cabo una validación externa por colegas especialistas y representantes de pacientes. Conclusiones: En esta Guía de Práctica Clínica se presentan recomendaciones clínicas para la prevención, el diagnóstico y el manejo de la OMA, con el fin de asistir la toma de decisiones compartidas entre médicos, pacientes y cuidadores con la intención de contribuir a mejorar la calidad de la atención clínica.

Abstract Background: Acute otitis media (AOM) is one of the most prevalent acute conditions in the pediatric population worldwide. This work aimed to elaborate a Clinical Practice Guideline with clinical recommendations systematically developed to assist decision-making of specialists, patients, caregivers, and public policymakers involved in managing patients with AOM in children. Methods: This document was developed by the College of Pediatric Otorhinolaryngology and Head, and Neck Surgery of Mexico (COPEME) in compliance with international standards. The SIGN quality of evidence classification was used. On behalf of the COPEME, the Guideline Development Group (GDG) was integrated, including otolaryngologists, infectologists, pediatricians, general practitioners, and methodologists with experience in systematic literature reviews and the development of clinical practice guidelines. Results: A consensus was reached on 18 clinical questions, covering what was previously established by the GDG in the scope document of the guidelines. Scientific evidence answering each of these clinical questions was identified and critically evaluated. The GDG agreed on the final wording of the clinical recommendations using the modified Delphi panel technique. Specialists and patient representatives conducted an external validation. Conclusions: This Clinical Practice Guideline presents clinical recommendations for the prevention, diagnosis, and management of AOM to assist shared decision-making among physicians, patients, and caregivers and improve the quality of clinical care.

A four-year follow-up survey of antimicrobial resistance among Acinetobacter baumannii complex from inpatients in Southern Brazil.

OBJECTIVES: To determine the trends of antimicrobial resistance for Acinetobacter baumannii complex isolates recovered from inpatients over a 4-year follow-up survey. METHODS: A total of 659 A baumannii complex isolates were recovered from hospitalized patients in Porto Alegre and its metropolitan area, Southern Brazil, from 2017 to 2020. Susceptibility profile was determined for ampicillin/sulbactam, amikacin, gentamicin, imipenem, meropenem, minocycline, polymyxin B and tigecycline. RESULTS: Overall, PMB was the most active agent against the set of A baumannii isolates over the period. Although stable, a high resistance rate was observed. CONCLUSIONS: Our results shown the presence of an extensively-drug resistant A baumannii complex isolates over the past four years. Polymyxin B has been the only antimicrobial agent that remain with a good in vitro activity. Strict surveillance and infection control measures are mandatory.

Impact of the blue-carba rapid test for carbapenemase detection on turnaround time for an early therapy against Pseudomonas aeruginosa.

BACKGROUND: To determine the turnaround time from a blue-carba result until a final microbiological report (bacterial identification plus antimicrobial susceptibility profile) and to infer the impact of an early therapeutic intervention based on the blue-carba results. METHODS: Pseudomonas aeruginosa isolates were recovered from hospitalized patients from Porto Alegre, Brazil, and tested by blue-carba test. Time required for a blue-carba result, right after the sample processing, was compared with those required to get final report (specie identification and antimicrobial susceptibility profile) Isolates blue-carba positive were tested by phenotypically and genotypically for Klebsiella pneumoniae carbapenemase and metallo-ß-lactamase genes. RESULTS: A total of 199 isolates were analyzed and 23 (11.6%) were blue-carba positive and harboring the blaSPM-1-like gene. Fifty-two (26.1%) isolates were blue-carba negative but resistant to meropenem and/or imipenem. Polymyxin B and ceftolozane/tazobactam (this latter except for SPM-1 producers) were 100% active for all P. aeruginosa isolates, a blue-carba test allow an earlier intervention or adequacy of therapy. CONCLUSIONS: Early adequacy can be promoted by blue-carba test for 11.6% of SPM-1-producing P. aeruginosa isolates, polymyxin B could be prior associated and ceftolozane/tazobactam withdrawn from therapy. For the remaining isolates, empirical therapy involving ceftolozane/tazobactam can be maintained with greater likelihood of adequacy. An active communication between laboratory and clinical services is necessary to better explore these earlier blue-carba results, significantly reducing the time for a first intervention.

Prediction of site-specific solar diffuse horizontal irradiance from two input variables in Colombia.

Accurate measurements of diffuse irradiance are essential to design a solar photovoltaic system. However, in-situ radiation measurements in Colombia, South America, can be limited by the costs of the implementation of meteorological stations equipped with a pyranometer mounted on a sun tracker with a shading device, which is required to measure diffuse irradiance. Furthermore, the databases found in Colombia contain missing data, which raises the need for implementing models that are trained with very few features. In this paper, we introduce a methodology based on simple angle calculations and a regression model to predict half-hourly diffuse horizontal solar irradiance from only the measure of global horizontal irradiance and a geographic coordinate as inputs. Using measurements taken from the national solar radiation database for 6 different sites in Colombia and state-of-the-art machine learning models for regression, we validated the accuracy prediction of the proposed methodology. The results showed a prediction error ranging from 5.86 to 9.36 [W/m 2], and a coefficient of determination ranging from 0.9974 to 0.9983. The data-set used along with the feature engineering process and the deep neural network model created can be found in a Github repository referenced in the paper.

Evaluation of a polymyxin drop test for polymyxin resistance detection among non-fermentative gram-negative rods and enterobacterales resistant to carbapenems.

To assess the performance of the drop test for polymyxin B resistance detection among Enterobacterales and non-fermentative gram-negative rods resistant to carbapenems. Seven hundred and fifteen carbapenem-resistant isolates were tested: 628 Enterobacterales species and 87 non-fermentative gram-negative rods. For the polymyxin drop test, concentrations range from 0.25 to 8.0 µg/mL. Broth microdilution, as gold standard, was performed using in-house-prepared panels and interpreted according to the CLSI guidelines. Results were interpreted in terms of categorical agreements and discrepancies. Accuracy for a drop of polymyxin B at 2.0, 4.0 and 8.0 was calculated as better cutoff for resistance determination. No very major error was observed among all isolates, and 95.5% of agreement was observed among Enterobacterales, particularly for Klebsiella pneumoniae. A higher accuracy (95.1%) was obtained when a single drop of polymyxin B at 4.0 µg/mL was applied. Polymyxin drop test presented >95% of categorical agreement, without very major errors, for KPC-producing K. pneumoniae isolates. An accuracy of 95.1% was obtained with a single drop at 4.0 µg/mL polymyxin B. Polymyxin B drop is an easy and feasible test and may allow a reduction on the turnaround time for polymyxin resistance detection and impacting on early implementation of accurate therapeutic interventions.

Pediatric asthma treatment: What to do when international guideline recommendations do not agree.

BACKGROUND: There was a need for a solid asthma guideline in Mexico to update and unify asthma management. Because high-quality asthma guidelines exist worldwide, in which the latest evidence on asthma management is summarized, the ADAPTE approach allows for the development of a national asthma guideline based on evidence from already existing guidelines, adapted to national needs. OBJECTIVE: To fuse evidence from the best asthma guidelines and adapt it to local needs with the ADAPTE approach. METHODS: The Appraisal of Guidelines for Research and Evaluation (AGREE) II asthma guidelines were evaluated by a core group to select 3 primary guidelines. For each step of asthma management, clinical questions were formulated and replied according to (1) evidence in the primary guidelines, (2) safety, (3) Cost, and (4) patient preference. The Guidelines Development Group, composed of a broad range of experts from medical specialties, primary care physicians, and methodologists, adjusted the draft questions and replies in several rounds of a Delphi process and 3 face-to-face meetings, taking into account the reality of the situation in Mexico. We present the results of the pediatric asthma treatment part. RESULTS: Selected primary guidelines are from the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN), Global Initiative for Asthma (GINA), and Spanish Guidelines on the Management of Asthma (GEMA) 2015, with 2016 updates. Recommendations or suggestions were made for asthma treatment in Mexico. In this article, the detailed analysis of the evidence present in the BTS/SIGN, GINA, and GEMA sections on the (non) pharmacologic treatment of pediatric asthma, education, and devices are presented for 2 age groups: children 5 years or younger and children 6 to 11 years old with asthma. CONCLUSION: For the pediatric treatment and patient education sections, applying the AGREE II and Delphi methods is useful to develop a scientifically sustained document, adjusted to the Mexican situation, as is the Mexican Guideline on Asthma.

Saccharomyces cerevisiae var. boulardii fungemia following probiotic treatment.

Probiotics are commonly prescribed as an adjuvant in the treatment of antibiotic-associated diarrhea caused by Clostridium difficile. We report the case of an immunocompromised 73-year-old patient on chemotherapy who developed Saccharomyces cerevisiae var. boulardii fungemia in a central venous catheter during treatment of antibiotic-associated pseudomembranous colitis with the probiotic Saccharomyces cerevisiae var. boulardii. Fungemia was resolved after interruption of probiotic administration without the need to replace the central venous line.

[Mexican Asthma Guidelines: GUIMA 2017]. / Guía Mexicana del Asma: GUIMA 2017.

BACKGROUND: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. METHODS: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. RESULTS: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. CONCLUSIONS: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.

Implantação de antissepsia cirúrgica alcoólica das mãos: relato de experiência / Implementation of alcohol-based surgical hand antisepsis: experience report / Implantación de uma antissepsia quirúrgica alcohólica de las manos: relato de experiencia

Objetivos: Relatar a experiência de implantação do antisséptico alcoólico para o preparo das mãos da equipe cirúrgica.Método: Relato de experiência de implantação de solução alcoólica para antissepsia cirúrgica das mãos em substituição a escovação, durante os meses de dezembro de 2014 a julho de 2015. Resultados: A escolha do produto baseou-se na análise de documentação e testes de utilização. O antisséptico alcoólico foi oferecido como alternativa à utilização das escovas impregnadas com antisséptico. Foram disponibilizados artigos científicos e cartazes para os profissionais. Observou-se 282 procedimentos. A taxa de adesão à solução alcoólica variou de 33% no mês da implantação a 54% e a adesão à técnica correta foi observada em apenas 35,8% das oportunidades.Conclusão: Houve considerável adesão à solução alcoólica e observou-se impacto econômico e demanda de capacitações para a técnica correta. Há necessidade de identificar fatores mobilizadores e barreiras para a implantação dessa tecnologia.

Objectives: To describe the experience of surgical alcohol-based antisepsis on hand preparation of the surgical team. Methods: Reporting the experience on deployment of alcohol solution for surgical hand antisepsis to replace brushing, during December 2014­July 2015. Results: Product was selected upon documentation analysis and application trial. Alcohol-based antisepsis was offered as alternative to the use of brushes impregnated with antiseptic. Scientific papers and advertising posters were available to the professionals. A total of 282 procedures were observed. The adherence rate to the alcohol solution ranged from 33% in the month of implementation to 54%, and compliance to the proper technique was observed in only 35.8% of cases. Conclusion: There was considerable adherence to the alcohol-based solution; it was observed as well economic impact and increasing of training demand for the right technique. There is a need to identify motivation factors and barriers for the successful implementation of this technology.

Objetivos: Relatar la experiencia de implantación del antiséptico alcohólico para la preparación de las manos del equipo quirúrgico. Método: Relato de la experiencia de implantaçión de la solución alcohólica para la antisepsia quirúrgica de las manos en reemplazo del cepillaje, entre diciembre de 2014 a julio de 2015. Resultados: La elección del producto se fundamentó en el análisis de la documentación y ensayos. El antisséptico fue ofrecido como alternativa a los cepillos. Fueron disponible artículos científicos y carteles para los profesionales. Fueron vistos 282 procedimientos. La adhesion a la solución alcohólica varió del 33% en el mes de la implantación al 54% y la adhesión a la técnica correcta fue observada en 35,8%. Conclusión: Hubo considerable adhesión a la solución alcohólica y se observó un impacto económico y demanda de capacitaciones para la técnica correcta. Hay necesidad de identificar los factores mobilisadores y barreras para la implantación de esta tecnologia.

[ARIA Mexico 2014. Adaptation of the Clinical Practice Guide ARIA 2010 for Mexico. Methodology ADAPTE]. / ARIA México 2014. Adaptación de la Guía de Práctica Clínica ARIA 2010 para México. Metodología ADAPTE.

BACKGROUND: The global prevalence of allergic rhinitis is high. International Study of Asthma and Allergies in Childhood (ISAAC) Phase III reports a total estimated prevalence of 4.6% in Mexico. There is evidence based on allergic rhinitis Clinical Practice Guidelines (CPG), but its promotion, acceptance and application is not optimal or adequate in Mexico. OBJECTIVE: To generate a guideline for the treatment of allergic rhinitis and its impact on asthma by adaptating the 2010 ARIA Guideline to Mexican reality, through a transculturation process applying the ADAPTE methodology. PATIENTS AND METHOD: Using the ADAPTE Methodology, the original 2010 ARIA CPG recommendations were evaluated by the guideline development group (GDG) into which multiple medical specialities managing patients with allergic rhinitis were incoorporated. The GDG valorated the quality of 2010 ARIA, checked and translated key clinical questions. Moreover, the GDG adjusted recommendations, patient preferences and included comments in the context of the Mexican reality (safety, costs and cultural issues). To accomplish this, we ran Delphi panels with as many rounds as necessary to reach agreement. One extra question, not included in the original 2010 ARIA, on the use of Nasal Lavages for AR was created sustained by a systematic literature review. RESULTS: A total of 45 questions from the original 2010 ARIA were included and divided into six groups covering prevention, medical treatment, immunotherapy and alternative medicine to treat patients with allergic rhinitis with or without asthma. Most of the questions reached agreement in one or two rounds; one question required three rounds. CONCLUSIONS: An easy-to-use, adaptated, up-to-date and applicable allergic rhinitis guideline for Mexico is now available.

ANTECEDENTES: la prevalencia de rinitis alérgica en todo el mundo es alta. El Estudio Internacional de Asma y Alergias en la Niñez (ISAAC de International Study of Asthma and Allergies in Childhood) Fase III reporta una prevalencia estimada total en México de 4.6%. Existen guías de práctica clínica basadas en evidencia de rinitis alérgica, pero su promoción, aceptación y validez no son óptimas ni adecuadas para México. OBJETIVO: generar una guía de tratamiento de la rinitis alérgica y su repercusión en el asma adaptando la guía ARIA 2010 a la realidad mexicana mediante un proceso de transculturización, por medio de la metodología ADAPTE. MATERIAL Y MÉTODO: a través de la metodología ADAPTE un grupo de desarrollo de la guía, integrado por múltiples especialistas que tratan pacientes con rinitis alérgica, valoró la calidad de la guía ARIA 2010, revisó y tradujo las preguntas clínicas clave y ajustó las recomendaciones, preferencias del paciente y comentarios a la realidad mexicana (seguridad, costos y aspectos culturales). Para lograrlo se corrieron páneles Delphi, con tantas rondas como fuera necesario hasta lograr un acuerdo. Por medio de una revisión sistemática de la bibliografía se creó una pregunta especial no incluida en ARIA 2010 de la utilidad de realizar lavados nasales en pacientes con rinitis alérgica. RESULTADOS: se incluyeron 45 preguntas de la guía original ARIA 2010, divididas en seis bloques que abarcan prevención, tratamiento médico, inmunoterapia y terapias alternativas de pacientes con rinitis alérgica con o sin asma. La mayor parte de las preguntas alcanzaron acuerdo en una a dos rondas, sólo una requirió tres para ello. CONCLUSIONES: se cuenta ahora con una guía de rinitis alérgica de usosencillo, adaptada, actualizada y válida para México.