A new rolling forecasting framework using Microsoft Power BI for data visualization: A case study in a pharmaceutical industry.

CONTEXT AND OBJECTIVES: Demand forecasting is a vital step for production planning and consequently, for supply chain efficiency, especially for the pharmaceutical (pharma) supply chain due to its unique characteristics. Numerous models and techniques that are proposed in the literature but little in concrete and generic framework to forecasting process, mainly for pharmaceutical supply chain. Unlike studies in the literature, this study not only perfectly predict the sales of a pharma manufacturer, but also visualize the results via a developed dashboard using modern information technology and business intelligence. MATERIAL AND METHODS: In this research, a rolling forecasting framework comprising of different steps and specialized tools is proposed that can assist supply chain managers to perform an accurate sales forecasting and consequently a better performance and specifically patient satisfaction. The proposed generic framework combines the use of Visual studio C++ software to extract optimal forecasting and the Power BI software to monitor the accuracy of the obtained sales forecasts. Three exponential smoothing methods are integrated in the proposed framework, which is open to adding more new forecasting methods. RESULTS: The proposed framework is tested for many data sets from a pharmaceutical manufacturer company, and the results obtained show superior performance, especially a clear decline in both forecast errors, which can reach 75% and a drop of stock level to 50%. Therefore, the company is currently using it and a future integration with their ERP is being carried out. CONCLUSION: The proposed rolling forecasting framework contributes to insightful decision-making through the visualization of accurate future sales and turnover, and consequently, an efficient stock management and effective production planning.

Impacto del manejo multidisciplinar digestivo-quirúrgico en los pacientes con atresia de esófago / Impact of digestive-surgical cross-disciplinary management in patients with esophageal atresia

Objetivos: El objetivo de este estudio es analizar si los pacientesintervenidos de atresia de esófago (AE) se benefician de un programade seguimiento multidisciplinar, basado en las guías clínicas actuales,implantado en nuestro centro. Material y métodos: Estudio retrospectivo, observacional y analí-tico incluyendo los pacientes intervenidos de AE entre 2012 y 2022. Seanalizaron los resultados de la implantación en 2018 de un programa deconsultas conjuntas de gastroenterología y cirugía pediátrica aplicandoun protocolo basado en las nuevas guías ESPGHAN-NASPGHAN. Sedividieron a los pacientes tratados antes y después de 2018 y se compararon las variables cuantitativas: pérdidas de seguimiento, inicio y duracióndel tratamiento antirreflujo e inicio de nutrición enteral, y cualitativas:prevalencia de reflujo gastroesfoágico, realización de cirugía antirreflujo,infecciones respiratorias, estenosis de la anastomosis, refistulizaciones,disfagia, episodios de impactación, necesidad de gastrostomía y resul-tados de las endoscopias. Resultados: Se incluyeron 38 pacientes. Un 63,2% presentaronreflujo gastroesofágico. El 97,4% tomaron tratamiento antirreflujo el primer año de vida que posteriormente se retiró en el 47,4%. El tiempo deretirada se redujo una media de 24 meses tras la aplicación del programa(p< 0,05). Se realizaron 4,6 veces más pHmetrías tras la implantacióndel programa. El protocolo estandarizó la realización de endoscopiasen pacientes asintomáticos al cumplir 5 y 10 años. Se realizaron 25endoscopias con tomas de biopsia después de 2018, detectando alteraciones histológicas en un 28%. El número de pérdidas de seguimiento seredujo de forma significativa tras la implantación del protocolo (p< 0,05). Conclusiones: El seguimiento multidisciplinar digestivo-quirúrgicode los pacientes con AE genera un impacto positivo en su evolución.(AU)

Objective: The objective of this study was to analyze whether patients undergoing esophageal atresia (EA) surgery benefit from a cross-disciplinary follow-up program, based on current clinical guidelines,implemented in our institution. Materials and methods: An observational, analytical, retrospectivestudy of patients undergoing EA surgery from 2012 to 2022 was carriedout. The results of a joint pediatric surgery and gastroenterology consultation program –which was implemented in 2018 and applies a protocolbased on the new ESPGHAN-NASPGHAN guidelines– were analyzed.Patients were divided according to whether they had been treated before or after 2018. Quantitative variables –follow-up losses, anti-refluxtreatment initiation and duration, and enteral nutrition initiation– andqualitative variables –prevalence of gastroesophageal reflux, anti-refluxsurgery, respiratory infections, anastomotic stenosis, re-fistulizations,dysphagia, impaction episodes, need for gastrostomy, and endoscopicresults– were compared. Results: 38 patients were included. 63.2% had gastroesophagealreflux. 97.4% received anti-reflux treatment in the first year of life, withtreatment being subsequently discontinued in 47.4%. Discontinuationtime decreased by a mean of 24 months following program implementation (p< 0.05). A 4.6-fold increase in the frequency of pH-metries wasnoted following program implementation. The protocol standardizedendoscopies in asymptomatic patients when they turn 5 and 10 years old. 25 endoscopies with biopsy were carried out after 2018, with histologicaldisorders being detected in 28% of them. The number of follow-up lossessignificantly decreased following protocol implementation (p< 0.05). Conclusions: Digestive-surgical cross-disciplinary follow-up of EApatients has a positive impact on patient progression. Applying the guidelines helps optimize treatment and early diagnosis of complications.(AU)

Machine Learning as a Strategic Tool for Helping Cocoa Farmers in Côte D'Ivoire.

Machine learning can be used for social good. The employment of artificial intelligence in smart agriculture has many benefits for the environment: it helps small farmers (at a local scale) and policymakers and cooperatives (at regional scale) to take valid and coordinated countermeasures to combat climate change. This article discusses how artificial intelligence in agriculture can help to reduce costs, especially in developing countries such as Côte d'Ivoire, employing only low-cost or open-source tools, from hardware to software and open data. We developed machine learning models for two tasks: the first is improving agricultural farming cultivation, and the second is water management. For the first task, we used deep neural networks (YOLOv5m) to detect healthy plants and pods of cocoa and damaged ones only using mobile phone images. The results confirm it is possible to distinguish well the healthy from damaged ones. For actions at a larger scale, the second task proposes the analysis of remote sensors, coming from the GRACE NASA Mission and ERA5, produced by the Copernicus climate change service. A new deep neural network architecture (CIWA-net) is proposed with a U-Net-like architecture, aiming to forecast the total water storage anomalies. The model quality is compared to a vanilla convolutional neural network.

Systems of Precision: Coherent Probabilities on Pre-Dynkin Systems and Coherent Previsions on Linear Subspaces.

In the literature on imprecise probability, little attention is paid to the fact that imprecise probabilities are precise on a set of events. We call these sets systems of precision. We show that, under mild assumptions, the system of precision of a lower and upper probability form a so-called (pre-)Dynkin system. Interestingly, there are several settings, ranging from machine learning on partial data over frequential probability theory to quantum probability theory and decision making under uncertainty, in which, a priori, the probabilities are only desired to be precise on a specific underlying set system. Here, (pre-)Dynkin systems have been adopted as systems of precision, too. We show that, under extendability conditions, those pre-Dynkin systems equipped with probabilities can be embedded into algebras of sets. Surprisingly, the extendability conditions elaborated in a strand of work in quantum probability are equivalent to coherence from the imprecise probability literature. On this basis, we spell out a lattice duality which relates systems of precision to credal sets of probabilities. We conclude the presentation with a generalization of the framework to expectation-type counterparts of imprecise probabilities. The analogue of pre-Dynkin systems turns out to be (sets of) linear subspaces in the space of bounded, real-valued functions. We introduce partial expectations, natural generalizations of probabilities defined on pre-Dynkin systems. Again, coherence and extendability are equivalent. A related but more general lattice duality preserves the relation between systems of precision and credal sets of probabilities.

Prévision de la séroprévalence de l'hépatite A dans la Wilaya de Setif en 2024 / Forecast of hepatitis a seroprevalence in the Wilaya of Setif in 2024

La séroprévalence des anticorps anti hépatite A (correspondant au taux d'immunisation) était de 100% à Sétif (Algérie), chez les personnes âgées entre 10 et 14 ans en 1986. Elle est passée à 70,4% en 2011. Partant de ce fait, les auteurs se proposent de prévoir cette séroprévalence, dans la même wilaya en 2024, à travers le modèle 'Logit binaire multiple', sur la base des données d'une enquête réalisée en 2011. La séroprévalence globale chez les sujets âgés entre 5 et 19 ans serait, selon les résultats de ce modèle, de 67% en 2024; les principaux facteurs associés à cette séroprévalence seraient l'âge, l'habitat, la taille des ménageset l'antécédent d'ictère. En conséquence, un programme de vaccination pourrait s'imposer comme une nouvelle stratégie de lutte contre la maladie dans la wilaya de Sétif.

The seroprevalence of anti-hepatitis A antibodies (corresponding to the immunization rate) was 100% in Sétif, in people aged between 10 and 14 years in 1986. It has declined to 70.4% in 2011. Starting from this fact, the authors propose to predict this seroprevalence, in the same wilaya (district) in 2024, through the 'multiple binary logit' model, based on data from a survey carried out in 2011. The overall seroprevalence in subjects aged between 5 and 19 years would be, according to the results of this model, 67% in 2024; the main factors associated with this seroprevalence would be age, habitat, household size and a history of jaundice. As a result, a vaccination program could establish itself as a new disease control strategy in Sétif.

Frecuencia de y cesáreas en establecimientos públicos y privados de la Provincia de Concepción, Chile, 2001-2019 / Caesareans section frequency in public and private establishments of the Province of Concepción, Chile, 2001-2019

Introducción: El porcentaje nacional de cesárea supera las recomendaciones internacionales, alcanzando altos niveles, con consecuencias significativas en la salud de la mujer. Por esta razón es un problema necesario de analizar. Objetivo: Describir la situación epidemiológica de las cesáreas en la Provincia de Concepción, periodo 2001-2019, según establecimiento y previsión. Material y métodos: Estudio observacional, descriptivo, ecológico, transversal. Incluye universo de partos en la Provincia de Concepción 2001-2019, datos del Departamento de Estadísticas e Información de Salud (DEIS). Recopilación y análisis según técnicas descriptivas en Microsoft Excel® Resultados: En establecimientos públicos, el número de partos disminuyó un 60.6%. En establecimientos privados aumentó 4.8 veces, junto al 39% de incremento en las cesáreas. Las pacientes pertenecientes al grupo A de menores ingresos de la aseguradora de salud pública, Fondo Nacional de Salud (FONASA), presentaron un porcentaje estable de cesáreas, en torno al 25%, mientras que el grupo D (de mayores ingresos) aumentó un 47.8% entre los años 2005 y 2009. Entre 2002 y 2019 el porcentaje promedio de cesáreas de pacientes pertenecientes a las aseguradoras privadas, Instituciones de Salud Previsional (ISAPRE), fue del 66.5%. Conclusiones: Se observó un aumento de cesáreas muy especialmente en recintos privados. La previsión de salud es un factor que considerar, particularmente el grupo FONASA-D, que presentó la mayor alza en las cesáreas, incluso más que las gestantes de ISAPRE. El porcentaje alarmante de cesáreas, especialmente en establecimientos privados, debe ser preocupación prioritaria para nuestro sistema de salud.

Introduction: The national caesarean section rate exceeds international recommendations, reaching elevated levels, with significant consequences on women's health. For this reason it is a necessary problem to analyze. Objective: To describe the epidemiological situation of caesarean sections in the Province of Concepción, period 2001-2019, according to establishment and forecast. Material and methods: Observational, descriptive, ecological, longitudinal study. Includes universe of births in the Province of Concepción 2001-2019, data from the Department of Statistics and Health Information (DEIS). Collection and analysis according to descriptive techniques in Microsoft Excel®. Results: In public establishments, the number of deliveries decreased by 60.6%. In private establishments it increased 4.8 times, together with the 39% increase in cesarean sections. Patients belonging to group A with the lowest income of the public health insurer, National Health Fund (FONASA), presented a stable percentage of caesarean sections, around 25%, while group D (with the highest income) increased 47.8% between 2005 and 2009. Between 2002 and 2019, the average percentage of caesarean sections of patients belonging to private insurers, Institutions of Social Security (ISAPRE), was 66.5%. Conclusions: An increase in caesarean sections was observed, especially in private facilities. Health insurance is a factor to consider, particularly the FONASA-D group, which presented the highest increase in cesarean sections, even more than ISAPRE pregnant women. The alarming percentage of caesarean sections, especially in private establishments, should be a priority concern for our health system.

COVID-19, cisnes negros y anticipación de desastres sanitarios: problemas futuros y el futuro como problema en la ética de la Salud Pública / COVID-19, black swans and the anticipation of health disasters: future problems and the future as a problem in Public Health ethics

La pandemia de la COVID-19 ha recordado la importancia de prevenir y planificarse ante eventos altamente desastrosos para lasalud comunitaria. Varios fenómenos emergentes suponen amenazas prospectivas para la Salud Pública. Sin embargo, el caráctermayormente futuro de problemas como la resistencia antibiótica, el impacto del cambio climático en la salud o la bioingeniería depatógenos genera dificultades de análisis. ¿Cuáles son los desafíos éticos y epistemológicos que suscitan los problemas futurospara la Salud Pública? ¿Cómo deben abordarse los problemas morales de escenarios futuros, potencialmente catastróficos? Eneste artículo se defiende la necesidad de adoptar enfoques éticos anticipativos desde la ética de la Salud Pública. En primer lugar,se argumentará que el abordaje de estos problemas futuros requiere reflexionar sobre el futuro como problema ético y epistémico.En segundo lugar, se analizarán las características de la incipienteética anticipatoria en los ámbitos de la ética de la tecnología y labioética. En tercer lugar, se defenderá la aplicación de metodologías de previsión y anticipación en debates sobre la ética de la SaludPública. Finalmente, se ofrecerán algunas reflexiones para fortalecer los análisis normativos anticipativos a fin de prevenir y atajar deantemano los efectos adversos de las futuras crisis sanitarias.(AU)

The COVID-19 pandemic has recalled the importance of prevention and preparedness for highly disastrous events in communityhealth. Several emerging phenomena pose prospective threats to public health. However, the largely future-oriented character ofproblems, for instance, such as antibiotic resistance, the impact of climate change on health, or the bioengineering of pathogensgenerates difficulties of analysis. What are the ethical and epistemological challenges raised by future public health problems? Howshould the moral problems of potentially catastrophic future scenarios be addressed? This article argues in favour of adopting antici-patory ethical approaches from public health ethics. First, it will be argued that addressing these future problems requires reflectionon the future as an ethical and epistemic problem. Second, the characteristics of the emerginganticipatory ethics in the fields ofethics of technology and bioethics will be clarified. Third, the application of foresight and anticipatory methodologies in public healthethics debates will be defended. Finally, some reflections will be offered to strengthen anticipatory normative analyses to prevent andaddress in advance the adverse effects of future health crises.(AU)

Perceived exertion and dyspnea while cycling during a hypoxic and hyperoxic placebo.

Rating of perceived exertion (RPE) is used to subjectively quantify the perception of physical activity, breathlessness or dyspnea, and leg discomfort (RPElegs) during exercise. However, it is unknown how dyspnea or RPElegs can be influenced by expectations. Thirty healthy, active participants (19 males, 11 females) completed five, 5-minute submaximal cycling trials at 60% peak work rate. We deceived participants by telling them they were inspiring different hypoxic and hyperoxic gases, when in fact they breathed room air. Cardiorespiratory variables were similar between the trials, however, dyspnea and RPElegs evaluated with a Borg scale changed in a dose-response manner. When participants believed they were breathing 15% O2, they significantly increased dyspnea +0.70 ± 0.2 units (p = 0.03) compared to room air, whereas RPElegs was unchanged +0.35 ± 0.1 units (p = 0.70). When participants believed they were breathing 15% O2, they significantly increased dyspnea +1.05 ± 0.4 units (p = 0.003) compared to 23% hyperoxic condition, whereas RPElegs was unchanged +0.35 ± 0.1 units (p = 0.70). We found that dyspnea during exercise is susceptible to expectancy, without any accompanying physiological changes. Given coaches and clinicians use perceived exertion to prescribe exercise intensity and evaluate treatments, our findings show that the effect of expectations must be considered when interpreting sensations of breathlessness.

Obtención de nueva información sobre el síndrome urémico hemolítico mediante minería de texto / Obtaining new information on hemolytic uremic syndrome by text mining

Resumen El síndrome urémico hemolítico (SUH) está caracterizado por microangiopatía trombótica, anemia hemolítica, trombocitopenia e insuficiencia renal aguda. Puede causar desde secuelas permanentes hasta muerte, principalmente en niños. En este trabajo, utilizando minería de textos (MT), se analizó el texto explícito e implícito de 16 192 artículos científicos originales sobre SUH indexados en la base de datos de Europe PMC. Los objetivos fueron examinar comportamientos, realizar seguimiento de tendencias, hacer predicciones y cruzar datos con otras fuentes de información. Para el análisis se utilizaron -entre otras herramientas infor máticas- flujos de trabajo (FT) especialmente desarrollados en la plataforma KNIME. La MT sobre las palabras de los resúmenes de las publicaciones permitió: detectar asociaciones no descritas entre eventos relacionados con SUH; extraer información subyacente; hacer agrupamientos temáticos mediante algoritmos no supervisados; realizar predicciones sobre el curso de las investigaciones asociadas al tema. Tanto el abordaje como los FT desarrollados para realizar Ciencia de Datos sobre SUH pueden aplicarse a otros temas biomédicos y a otras bases de datos científicos, permitiendo analizar aspectos relevantes en el campo de la salud humana para me jorar la investigación, la prevención y el tratamiento de múltiples enfermedades.

Abstract Hemolytic uremic syndrome (HUS) is characterized by thrombotic microangiopathy, hemolytic anemia, thrombocytopenia and acute renal failure. It can cause from permanent sequelae to death, mainly in children. In this work, using text mining (TM), we analyzed the explicit and implicit text of 16 192 original scientific articles on HUS indexed in the Europe PMC database. The objectives were to examine behaviors, track trends, and make predictions and cross-check data with other sources of information. For the analysis we used -among other computational tools- specially developed workflows (WF) in the KNIME platform. The TM on the words of the abstracts of the publications made it possible to: detect undescribed associations between events related to HUS; extract underly ing information; make thematic clustering using unsupervised algorithms; make forecasting about the course of research associated with the topic. Both the approach and the WFs developed to perform Data Science on HUS can be applied to other biomedical topics and other scientific databases, making it possible to analyze relevant aspects in the field of human health to improve research, prevention and treatment of multiples diseases.

Role of diagnostic imaging technologists during the COVID-19 pandemic: the importance of organization and planning in the first line. / Papel del personal técnico superior en imagen para el diagnóstico durante la pandemia COVID-19: importancia de la organización y planificación en la primera línea.

The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception. In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.

Contribución de las Mutuas de Previsión Social al Sistema Hospitalario español: el caso de La Alianza / Contribution of the Mutual Insurance Societies to the Spanish Hospital System: the case of La Alianza

Las sociedades de ayuda o apoyo mutuos fueron un conjunto variado de insti-tuciones de carácter social, de naturaleza privada y sin ánimo de lucro, que proporcionaron prestaciones socio-asistenciales también en caso de enfermedad, a buena parte de la población, entre la segunda mitad del siglo XIX y primera del XX. En España, fueron escasos los hospitales promovidos por estas instituciones, quizá porque la mayoría no llegaron a tener suficiente número de socios para hacerlo. Los hospitales de este tipo se encontraban, mayoritariamente, en Cataluña, donde las sociedades obreras de ayuda mutua tuvieron un mayor desarrollo. A través del caso paradigmático de los hospitales de La Alianza, el estudio muestra que estos hospitales estuvieron abiertos a diversos tipos de pacientes (privados o derivados por otras instituciones) y tuvieron una dependencia económica múltiple. También se analizan los cam-bios que más influyeron en los hospitales de las mutuas, en la segunda mitad del siglo XX: el proceso de federación de las mutuas de previsión social y el itinerario de concertación pública. Estos hospitales participaron en el desarrollo de nuevas especialidades médico-quirúrgicas hospitalarias. Se advierte que fueron precisamente los hospitales de La Alianza los que llevaron a un mayor desarrollo de esta entidad. (AU)

Physiotherapists' Perspectives on the Threats Facing Their Profession in the Areas of Leadership, Burnout, and Branding: A Pan-Canadian Perspective from the Physio Moves Canada Project, Part 3.

Purpose: Physiotherapist is the professional designation of those who provide physiotherapy (PT). Physiotherapists have earned a reputation as important providers of medical and non-medical rehabilitation for Canadians after injury, illness, or surgery. Despite the fact that physiotherapy has a nearly 100-year presence in Canada, some would suggest that practitioners arguably remain under-recognized for the value they offer to the spectrum of health care. Method: In the latter half of 2017, a cross-Canada qualitative study was conducted through which a subgroup of physiotherapists in every Canadian province and in Yukon Territory volunteered to share their perspectives on the threats facing the current practice of physiotherapy in the next 5-15 years. The data were collected from a series of nominal-group-technique-based focus groups and one-on-one interviews and then analyzed to condense the ideas generated into themes. A total of 117 physiotherapy professionals participated in focus sessions or one-on-one interviews as part of the Physio Moves Canada project, which was set up to explore, capture, and synthesize the perspectives of academics, front-line clinicians, and administrators on the future of the profession. Results: This article, the third in a series, describes the results of the descriptive thematic analysis of three identified threats: issues pertaining to professional leadership and direction, clinician burnout, and clarity of the physiotherapy brand. Informed by 11 sub-themes, the results suggest that participants were concerned about the ability of the professional body to mobilize toward shared and common goals while simultaneously defending against external pressures and internal disagreements on what exactly physiotherapy as a discipline is meant to be. Many respondents also identified reasons for optimism if the professional community is able to work together as a large and motivated single entity. Conclusions: The findings are described in terms of possible directions for priority investment of resources or critical reflection by professional leadership, educators, and regulators.

Objectif : physiothérapeute est la désignation professionnelle des personnes qui offrent des services de physiothérapie. Les physiothérapeutes ont acquis une réputation d'importants prestataires de services de réadaptation médicale et non médicale auprès des Canadiens après une blessure, une maladie ou une opération. Même si la physiothérapie existe depuis près de cent ans au Canada, certains avancent que les praticiens sont sous-reconnus par rapport à la valeur qu'ils apportent au spectre des soins. Méthodologie : pendant la deuxième moitié de 2017, les chercheurs ont procédé à une analyse qualitative en vertu de laquelle un sous-groupe de physiothérapeutes de chaque province canadienne et du Yukon se sont portés volontaires pour donner leur point de vue sur les menaces qu'affrontera la pratique actuelle de la physiothérapie d'ici cinq à quinze ans. Les chercheurs ont colligé les données à partir d'une série de groupes de travail nominaux portant sur les techniques et à partir d'entrevues individuelles, puis les ont analysées pour condenser les idées en thèmes. Au total, 117 professionnels de la physiothérapie ont participé aux groupes de travail ou aux entrevues individuelles dans le cadre du projet Physio Moves Canada, créé pour explorer, saisir et synthétiser les points de vue d'universitaires, de cliniciens de première ligne et de leurs clients au sujet de l'avenir de la profession. Résultats : ce troisième article d'une série décrit les résultats de l'analyse thématique descriptive de trois menaces qui ont été dégagées : les enjeux relatifs au leadership et à l'orientation professionnels, l'épuisement professionnel des cliniciens et la clarté de la « marque ¼ de la physiothérapie. Éclairés par 11 sous-thèmes, les résultats indiquent que les participants s'inquiétaient de la capacité du corps professionnel de se mobiliser vers des objectifs communs tout en se défendant contre les pressions externes et les mésententes internes sur ce que la discipline de la « physiothérapie ¼ doit être au juste. De nombreux répondants ont également souligné des raisons d'être optimistes si le milieu professionnel réussit à travailler de concert, comme une seule vaste entité motivée. Conclusions : les observations sont décrites sous forme d'orientations possibles des investissements prioritaires des ressources ou de réflexion critique entamée par les leaders, les professeurs et les régulateurs.

Quem perde e quem ganha com a PEC 287/2016? Uma análise pela variação da riqueza atuarial do segurado urbano brasileiro do Regime Geral de Previdência Social / ¿Quién pierde y quién gana con la PEC 287/2016? Un análisis por la variación de la riqueza actuarial del beneficiario urbano del Sistema Brasileño de Seguridad Social / Who loses and who wins with the PEC 287/2016? An analysis of the pension wealth variation for the urban beneficiary of Brazilian Social Security System

Resumo Este estudo mensura a alteração de riqueza do segurado pela reforma da Proposta de Emenda à Constituição n. 287/2016 (PEC 287, 2016), com a criação do pedágio e alterações na idade mínima, fatores de reposição, média dos salários de contribuição e percentual de reversão das pensões. Propõe-se o uso do indicador valor presente líquido atuarial aplicado ao fluxo de caixa esperado das contribuições e benefícios de aposentadoria programada, por invalidez e pensão por morte, além da reversão a cônjuge com continuidade a filhos menores. Os mais atingidos negativamente são aqueles com idade próxima à aposentadoria por idade e pouco tempo de contribuição. Porém, para grupos com grande tempo de contribuição (mais de 29 anos para homens e 21 para mulheres) e idades entre 45 e 55 anos, para homens, e entre 40 e 54 anos, para mulheres, há um surpreendente ganho de riqueza atuarial.

Resumen Este estudio mensura la alteración de riqueza del asegurado por la reforma de la Propuesta de Enmienda a la Constitución (PEC) 287/2016, con la creación del peaje fiscal y alteraciones en el tiempo mínimo de contribución, factores de reposición, media de las contribuciones y porcentual de reversión de las pensiones. Se propone uso del indicador valor presente neto actuarial aplicado al flujo de caja esperado de las contribuciones y beneficios de jubilación programada, por invalidez y pensión por muerte, además de la reversión al cónyuge con continuidad a hijos menores. Los más afectados negativamente son aquellos con edad próxima a la jubilación por edad y poco tiempo de contribución. Sin embargo, para grupos con gran tiempo de contribución (más de 29 años para hombres y de 21 para mujeres) y edades entre 45 y 55 años para hombres y entre 40 y 54 para mujeres hay un sorprendente beneficio de riqueza actuarial.

Abstract This study calculates the impact of the changes in the individual pension wealth due to the proposed constitutional amendment 287/2016 that provides on the retirement eligibility age, benefit replacement rate, benefit accrual formula, and reduced percentage of family benefits. It uses the expected cash flow in actuarial net present value for the contributions and benefits of voluntary retirement, disability retirement, and death pension, in addition to family benefits. The results show that the most affected, are those of almost full retirement age with little contribution time. However, surprisingly, for groups with a high contribution period (more than 29 years for men and 21 for women) and aged between 45 and 55 years for men and between 40 and 54 for women there is an actuarial wealth gain.

Excess Weight in Spain: Current Situation, Projections for 2030, and Estimated Direct Extra Cost for the Spanish Health System.

INTRODUCTION AND OBJECTIVES: Excess weight promotes the development of several chronic diseases and decreases quality of life. Its prevalence is increasing globally. Our aim was to estimate the trend in excess weight between 1987 and 2014 in Spanish adults, calculate cases of excess weight and its direct extra costs in 2006 and 2016, and project its trend to 2030. METHODS: We selected 47 articles in a systematic literature search to determine the progression of the prevalence of overweight, nonmorbid obesity, and morbid obesity and average body mass index between 1987 and 2014. We projected the expected number of cases in 2006, 2016, and 2030 and the associated direct extra medical costs. RESULTS: Between 1987 and 2014, the prevalence of overweight, obesity, and morbid obesity increased by 0.28%/y (P=.004), 0.50%/y (P <.001) and 0.030%/y (P=.006) in men, and by 0.10%/y (P=.123), 0.25%/y (P=.078), and 0.042%/y (P=.251) in women. The mean body mass index increased by 0.10 kg/m2/y in men (P <.001) and 0.26 kg/m2/y in women (significantly only between 1987 and 2002, P <.001). We estimated 23 500 000 patients with excess weight in 2016, generating 1.95 billion €/y in direct extra medical costs. If the current trend continues, between 2016 and 2030, there will be 3 100 000 new cases of excess weight, leading to 3.0 billion €/y of direct extra medical costs in 2030. CONCLUSIONS: Excess weight in Spanish adults has risen since the creation of population registries, generating direct extra medical costs that represent 2% of the 2016 health budget. If this trend continues, we expect 16% more cases in 2030 and 58% more direct extra medical costs.

Validity and reliability of methods to microscopically detect and quantify malaria parasitaemia.

OBJECTIVES: The recommended microscopy method by WHO to quantify malaria parasitaemia yields inaccurate results when individual leucocyte (WBC) counts deviate from 8000 leucocytes/µl. A method avoiding WBC count assumptions is the Lambaréné method (LAMBA). Thus, this study compared validity and reliability of the LAMBA and the WHO method. METHODS: Three methods for counting parasitaemia were applied in parallel in a blinded assessment: the LAMBA, the WHO method using a standard factor of 8000 leucocytes/µl ['simple WHO method' (sWHO)] and the WHO method using measured WBC counts ['accurate WHO method' (aWHO)]. Validity was assessed by comparing LAMBA and sWHO to the gold standard measurement of aWHO. Reliability was ascertained by computation of intraclass correlation coefficients (ICCs). RESULTS: 787 malaria-positive thick smears were analysed. Parasitaemia as determined by LAMBA and sWHO increasingly deviated from aWHO the more patients' WBCs diverged from 8000/µl. Equations of linear regression models assessing method deviation in percent from gold standard as function of WBC count were y = -0.00608x (95% CI -0.00693 to -0.00524) + 47.8 for LAMBA and y = -0.0125x (95% CI -0.01253 to -0.01247) + 100.1 for sWHO. Comparison of regression slopes showed that the deviation was twice as high for sWHO as for LAMBA (P < 0.001). ICCs were excellent (>90%) for both methods. CONCLUSIONS: The LAMBA has higher validity than the sWHO and may therefore be preferable in resource-limited settings without access to routine WBC-evaluation.

Forecasting zoonotic cutaneous leishmaniasis using meteorological factors in eastern Fars province, Iran: a SARIMA analysis.

OBJECTIVES: To predict the occurrence of zoonotic cutaneous leishmaniasis (ZCL) and evaluate the effect of climatic variables on disease incidence in the east of Fars province, Iran using the Seasonal Autoregressive Integrated Moving Average (SARIMA) model. METHODS: The Box-Jenkins approach was applied to fit the SARIMA model for ZCL incidence from 2004 to 2015. Then the model was used to predict the number of ZCL cases for the year 2016. Finally, we assessed the relation of meteorological variables (rainfall, rainy days, temperature, hours of sunshine and relative humidity) with ZCL incidence. RESULTS: SARIMA(2,0,0) (2,1,0)12 was the preferred model for predicting ZCL incidence in the east of Fars province (validation Root Mean Square Error, RMSE = 0.27). It showed that ZCL incidence in a given month can be estimated by the number of cases occurring 1 and 2 months, as well as 12 and 24 months earlier. The predictive power of SARIMA models was improved by the inclusion of rainfall at a lag of 2 months (ß = -0.02), rainy days at a lag of 2 months (ß = -0.09) and relative humidity at a lag of 8 months (ß = 0.13) as external regressors (P-values < 0.05). The latter was the best climatic variable for predicting ZCL cases (validation RMSE = 0.26). CONCLUSIONS: Time series models can be useful tools to predict the trend of ZCL in Fars province, Iran; thus, they can be used in the planning of public health programmes. Introducing meteorological variables into the models may improve their precision.

The Duality of Entropy/Extropy, and Completion of the Kullback Information Complex.

The refinement axiom for entropy has been provocative in providing foundations of information theory, recognised as thoughtworthy in the writings of both Shannon and Jaynes. A resolution to their concerns has been provided recently by the discovery that the entropy measure of a probability distribution has a dual measure, a complementary companion designated as "extropy". We report here the main results that identify this fact, specifying the dual equations and exhibiting some of their structure. The duality extends beyond a simple assessment of entropy, to the formulation of relative entropy and the Kullback symmetric distance between two forecasting distributions. This is defined by the sum of a pair of directed divergences. Examining the defining equation, we notice that this symmetric measure can be generated by two other explicable pairs of functions as well, neither of which is a Bregman divergence. The Kullback information complex is constituted by the symmetric measure of entropy/extropy along with one of each of these three function pairs. It is intimately related to the total logarithmic score of two distinct forecasting distributions for a quantity under consideration, this being a complete proper score. The information complex is isomorphic to the expectations that the two forecasting distributions assess for their achieved scores, each for its own score and for the score achieved by the other. Analysis of the scoring problem exposes a Pareto optimal exchange of the forecasters' scores that both are willing to engage. Both would support its evaluation for assessing the relative quality of the information they provide regarding the observation of an unknown quantity of interest. We present our results without proofs, as these appear in source articles that are referenced. The focus here is on their content, unhindered. The mathematical syntax of probability we employ relies upon the operational subjective constructions of Bruno de Finetti.

[Medical human resources planning in Europe: A literature review of the forecasting models]. / La planification des médecins en Europe : une revue de la littérature des modèles de projection.

BACKGROUND: Healthcare is a labor-intensive sector in which half of the expenses are dedicated to human resources. Therefore, policy makers, at national and internal levels, attend to the number of practicing professionals and the skill mix. This paper aims to analyze the European forecasting model for supply and demand of physicians. METHODS: To describe the forecasting tools used for physician planning in Europe, a grey literature search was done in the OECD, WHO, and European Union libraries. Electronic databases such as Pubmed, Medine, Embase and Econlit were also searched. RESULTS: Quantitative methods for forecasting medical supply rely mainly on stock-and-flow simulations and less often on systemic dynamics. Parameters included in forecasting models exhibit wide variability for data availability and quality. The forecasting of physician needs is limited to healthcare consumption and rarely considers overall needs and service targets. Besides quantitative methods, horizon scanning enables an evaluation of the changes in supply and demand in an uncertain future based on qualitative techniques such as semi-structured interviews, Delphi Panels, or focus groups. Finally, supply and demand forecasting models should be regularly updated. Moreover, post-hoc analyze is also needed but too rarely implemented. CONCLUSION: Medical human resource planning in Europe is inconsistent. Political implementation of the results of forecasting projections is essential to insure efficient planning. However, crucial elements such as mobility data between Member States are poorly understood, impairing medical supply regulation policies. These policies are commonly limited to training regulations, while horizontal and vertical substitution is less frequently taken into consideration.

Association of Biomarkers of Inflammation and Endothelial Dysfunction with Fasting and Postload Glucose Metabolism: A Population-Based Prospective Cohort Study Among Inner Mongolians in China.

OBJECTIVE: To examine the associations between elevated levels of C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble E-selectin (sE-selectin) with fasting and 2-hour postload glucometabolic status among Inner Mongolians in China. METHODS: Based on a cross-sectional survey of patients during 2003, 2260 participants were reinvestigated between 2013 and 2014. We categorized the participants into 3 subgroups according to fasting and postload glucose levels, respectively. The associations between biomarkers of inflammation and endothelial dysfunction and deterioration of fasting and postload glucometabolic status were examined by ordinal logistic regression analysis. RESULTS: We found 142 and 49 persons who had impaired fasting glucose (IFG) levels and type 2 diabetes in the fasting state and 335 and 50 persons who had impaired glucose tolerance (IGT) and type 2 diabetes in the postload state. After multivariable adjustment, elevated CRP and sICAM-1 levels were associated with deterioration of fasting glucometabolic status from normal fasting glucose to IFG and type 2 diabetes (odds ratio [OR] 1.73 [95% CI 1.18 to 2.54] for elevated CRP levels, OR 1.86 [95% CI 1.30 to 2.66] for elevated sICAM-1 levels). Elevated sE-selectin levels were associated with deterioration of postload glucometabolic status from normal glucose tolerance to IGT and type 2 diabetes (OR 1.34 [95% CI 1.01 to 1.77]) in the multivariable-adjusted model. CONCLUSIONS: Biomarkers of inflammation and endothelial dysfunction were separately associated with fasting and postload glucose metabolism among Inner Mongolians.