An explainable machine learning approach for hospital emergency department visits forecasting using continuous training and multi-model regression.

BACKGROUND AND OBJECTIVE: In the last years, the Emergency Department (ED) has become an important source of admissions for hospitals. Since late 90s, the number of ED visits has been steadily increasing, and since Covid19 pandemic this trend has been much stronger. Accurate prediction of ED visits, even for moderate forecasting time-horizons, can definitively improve operational efficiency, quality of care, and patient outcomes in hospitals. METHODS: In this paper we propose two different interpretable approaches, based on Machine Learning algorithms, to accurately forecast hospital emergency visits. The proposed approaches involve a first step of data segmentation based on two different criteria, depending on the approach considered: first, a threshold-based strategy is adopted, where data is divided depending on the value of specific predictor variables. In a second approach, a cluster-based ensemble learning is proposed, in such a way that a clustering algorithm is applied to the training dataset, and ML models are then trained for each cluster. RESULTS: The two proposed methodologies have been evaluated in real data from two hospital ED visits datasets in Spain. We have shown that the proposed approaches are able to obtain accurate ED visits forecasting, in short-term and also long-term prediction time-horizons up to one week, improving the efficiency of alternative prediction methods for this problem. CONCLUSIONS: The proposed forecasting approaches have a strong emphasis on providing explainability to the problem. An analysis on which variables govern the problem and are pivotal for obtaining accurate predictions is finally carried out and included in the discussion of the paper.

Enfoque radiológico en el diagnostic de la enfermedad por reflujo gastroesofágico en niños: test de sifonaje / Radiological diagnostic approach of gastroesophageal reflux disease in children: test siphoning

El diagnóstico de la enfermedad por reflujo gastroesofágico (ERGE) en la edad pediátrica es, en ocasiones, complicado dado el gran número de manifestaciones clínicas, muchas de ellas inespecíficas, y a la dificultad de los niños más pequeños para expresar la sintomatología. Tras una minuciosa historia clínica y según la respuesta al tratamiento empírico, se valora la necesidad de realizar pruebas complementarias. Dado el amplio espectro de técnicas diagnósticas y la ausencia de unanimidad ante cuál debe ser la técnica de elección, es controvertido seleccionar la exploración más rentable para el estudio del RGE. Siempre se ha de valorar el riesgo-beneficio, evitando someter al niño, en la medida de lo posible, a exploraciones invasivas. El objetivo de este trabajo es describir la utilidad del test de sifón de agua o test de sifonaje (TS) como método de despistaje de la ERGE a partir del año de vida, en pacientes sintomáticos. Es una técnica radiológica con elevada sensibilidad, sencilla, rápida y con buena tolerancia por parte de la población infantil, que permite realizar un estudio anatómico y funcional del tracto digestivo superior, con una irradiación mínima (AU)

The diagnosis of gastroesophageal reflux disease (GORD) in children is often difficult due to the large variability of symptoms and the poor linguistic skills of Young infants. The need of additional test is evaluated after an exhaustive check on the patient´s clinical history and depending on the response to empirical treatment. The choice of the ideal test to study gastroesophangeal reflux is controversial due to the lack of an unanimous technique. It´s important to evaluate the risk and benefits and to avoid exposing children to unnecessary and invasive tests if possible. The aim is to describe the use of the water siphon test (WST) for the initial diagnosis of GORD in symptomatic children over the age of one. The WST is a simple and fast radiological technique, with high sensibility and good tolerance by young patients that allows us to study the anatomy and function of the superior digestive tract with minimal radiation thanks to the use of an intermittent fluoroscopy (AU)

Ro60 and La ribonucleoproteins become self-aggregated by cell stress.

Ro and La antigens are of clinical interest in subacute cutaneous lupus erythematosus because skin lesions appear after UV irradiation, which induces the translocation of intracellular Ro and La ribonucleoproteins and trigger autoantibody production. Present studies address the question whether cellular stressors modify molecular characteristics and distribution of Ro60 and La proteins. To accomplish our goal HEp-2 cells were stressed by heat and UV irradiation and Ro and La expression was studied by indirect immunofluorescence and Western blot and crossed-immunoprecipitation using monoclonal anti-Ro/La or anti-HSP70 linked to CNBr-Sepharose 4B. Results of present studies confirm that Ro60 and La were located in the nuclei of non stressed cells; however under stress, both ribonucleoproteins were redistributed within cytoplasm and nucleoplasm, interestingly the stress induces self aggregation of both ribonucleoproteins, as demonstrated the Western blot assays. Ro and La proteins interact with the cytoskeleton protein via HSP70. In conclusion, the cell stress redistributes Ro and La proteins whiting nucleo-cytoplasmic compartments. This redistribution is accompanied by self aggregation of Ro and La which became associated with HSP70. Finally, the cell stress is an important factor for antigenic redistribution.

[Cardiorespiratory depression in 8 newborn infants whose mothers took "yucuyahui" (Zoapatle-Montanoa tomentosa) during labor]. / Depresión cardiorrespiratoria en ocho recién nacidos cuyas madres ingirieron infusiones de yucuyahui (zoapatle-Montanoa tomentosa) durante el trabajo de parto.

Yucuyahui (zoapatle-Montanoa tomentosa), is a wild herb used as a folk oxytocic-remedy. Eight pregnant women drank infusions of the herb during the labor and their newborns showed cardiorespiratory depression that needs basic or advanced life support to recover. They improved during the first minutes with an average Apgar score at one minute of 4.5, and 7.4 at ten minutes (p < 0.05). A negative correlation was found between the number of ingested infusions and the Apgar score at the one minute (r = -0.65). Simultaneous administration of alcoholic beverages in three of the pregnant woman did not contribute to deep depression in their neonates. The mechanism of M Tomentosa action is still unknown, but it is possible that it is similar to other oxytocic-drugs, as oxytocin or ergot alkaloids, with which Montanoa shares uterine and systemic effects.