Heparin-induced thrombocytopenia (HIT) is a life-threatening complication associated with high medical costs. Factor Xa inhibitors gradually replace approved treatment with intravenous direct ...thrombin inhibitors despite their off-label indication, because of easier management and favorable economic profile. Whether they are cost-effective remains unclear. We evaluated the cost-effectiveness of approved and off-label anticoagulants in patients with suspected HIT, based on census data from the largest Swiss hospital between 2015 and 2018. We constructed a decision tree model that reflects important clinical events associated with HIT. Relevant cost data were obtained from the finance department or estimated based on the Swiss-wide cost tariff. We estimated averted adverse events (AEs) and incremental cost-effectiveness ratio as primary outcome parameters. We performed deterministic and probabilistic sensitivity analyses with 2000 simulations to assess the robustness of our results. In the base-case analysis, the total cost of averting 1 AE was 49 565 Swiss francs (CHF) for argatroban, 30 380 CHF for fondaparinux, and 30 610 CHF for rivaroxaban; after adjusting for 4Ts score: 41 152 CHF (argatroban), 27 710 CHF (fondaparinux), and 37 699 CHF (rivaroxaban). Fondaparinux and rivaroxaban were more clinically effective than argatroban, with AEs averted of 0.820, 0.834, and 0.917 for argatroban, fondaparinux, and rivaroxaban, respectively. Treatment with fondaparinux resulted in less cost and more AEs averted, hence dominating argatroban. Results were most sensitive to AE rates and prolongation of stay. Monte Carlo simulations affirmed our base-case analysis. This is the first cost-effectiveness analysis comparing argatroban with fondaparinux and rivaroxaban using primary data. Fondaparinux and rivaroxaban resulted in more averted AEs, but fondaparinux had greater cost savings. Fondaparinux could be a viable alternative to argatroban.
•Fondaparinux costs less and confers more benefits than argatroban in patients with suspected heparin-induced thrombocytopenia.
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The edge, the fog, the cloud, and even the end-user's devices play a key role in the management of the health sensitive content/data lifecycle. However, the creation and management of solutions ...including multiple applications executed by multiple users in multiple environments (edge, the fog, and the cloud) to process multiple health repositories that, at the same time, fulfilling non-functional requirements (NFRs) represents a complex challenge for health care organizations. This paper presents the design, development, and implementation of an architectural model to create, on-demand, edge-fog-cloud processing structures to continuously handle big health data and, at the same time, to execute services for fulfilling NFRs. In this model, constructive and modular blocks , implemented as microservices and nanoservices, are recursively interconnected to create edge-fog-cloud processing structures as infrastructure-agnostic services. Continuity schemes create dataflows through the blocks of edge-fog-cloud structures and enforce, in an implicit manner, the fulfillment of NFRs for data arriving and departing to/from each block of each edge-fog-cloud structure. To show the feasibility of this model, a prototype was built using this model, which was evaluated in a case study based on the processing of health data for supporting critical decision-making procedures in remote patient monitoring. This study considered scenarios where end-users and medical staff received insights discovered when processing electrocardiograms (ECGs) produced by sensors in wireless IoT devices as well as where physicians received patient records (spirometry studies, ECGs and tomography images) and warnings raised when online analyzing and identifying anomalies in the analyzed ECG data. A scenario where organizations manage multiple simultaneous each edge-fog-cloud structure for processing of health data and contents delivered to internal and external staff was also studied. The evaluation of these scenarios showed the feasibility of applying this model to the building of solutions interconnecting multiple services/applications managing big health data through different environments.
The interruption of vector-borne transmission of Chagas disease was certified in Chile in 1999. Our goal was to determine the effects of the interruption of vector transmission on the age and spatial ...distributions of the risk of Chagas disease. We analyzed cases of Chagas disease by age and sex between 1989 and 2017, from notified disease reports of the Ministry of Health. Bayesian risk maps were constructed using the Besag-York-Mollie model. The reported cases of Chagas disease had a mean age of 45.9 ± 17.6 years. Small changes in the age distribution were found among different periods (χ
= 602.4,
< 0.001). These were explained mainly by numbers lower than those expected in age groups 0-39 years in the 2011-2017 period. Part of the observed reduction in the proportion of individuals in the lower strata could be explained by the aging of the Chilean population. An increase of reported cases was detected after the interruption of vector-borne transmission (
= 4.24,
< 0.04), with regional differences (
= 4.35,
< 0.001). The regions of the north-central area that have the highest burden of Chagas tended to decrease the relative risk, while the regions of the south tended to increase and small risk areas appear in zones where there are no insect vectors. There is still no clear evidence of a reduction in the reported cases in Chile. This could be explained mainly by an improvement in the detection of cases, but it cannot be ruled out that vector transmission still exists. The changes in distribution suggest potential impact from human internal migration and blood transfusion. This study provides strong evidence supporting the idea that entomological surveillance and long-term follow-up of Chagas disease need to be maintained after certification of interruption in endemic countries.
Terahertz time-domain spectroscopy has been used to probe the properties of four carbon allotropes with a sequenced c-axis stacking order: single-layer reduced graphene oxide, few-layer graphene ...oxide, disordered needle coke and highly organized graphite. The results obtained demonstrate a very high sensitivity to the structural characteristics of the tested samples. The multi-layer materials show the same type of spectral response with strong variations in the attenuation in the whole terahertz band depending on their constructural organization. The single-layer sample shows a distinct response where conductive effects dominate. The results obtained are consistent with theoretical investigations using semi-empirical quantum chemistry methods.
Pulmonary embolism has a high incidence and mortality, especially if undiagnosed. The examination of choice for diagnosing the disease is computed tomography pulmonary angiography. As many factors ...can lead to misinterpretations and diagnostic errors, different groups are utilizing deep learning methods to help improve this process. The diagnostic accuracy of these methods tends to increase by augmenting the training dataset. Deep learning methods can potentially benefit from the use of images acquired with devices from different vendors. To the best of our knowledge, we have developed the first public dataset annotated at the pixel and image levels and the first pixel-level annotated dataset to contain examinations performed with equipment from Toshiba and GE. This dataset includes 40 examinations, half performed with each piece of equipment, representing samples from two medical services. We also included measurements related to the cardiac and circulatory consequences of pulmonary embolism. We encourage the use of this dataset to develop, evaluate and compare the performance of new AI algorithms designed to diagnose PE.
Reproductive number (R0)-maps estimate risk zones of vector-borne diseases and geographical distribution changes under climate change.
To map R0 aiming to estimate the epidemiological risk of Chagas ...disease in Chile, its distribution and possible changes due to the global climate change.
We used a relationship between R0 and entomological parameters of vectors as function of environmental variables, to map the risk of Chagas disease in Chile, under current and projected future environmental conditions.
We obtained a geographical R0 estimation of Chagas disease in Chile. The highest R0averages correspond to the Central-Northern regions of Chile. T. cruzi transmission area could increase in the future due to climate changes. Independent of the future condition, both for optimistic and pessimistic climate change scenarios, the area of potential risk for Chagas disease transmission would increase. The estimated R0 values suggest that, if a control of T. infestans is not maintained, Chagas disease endemic status will persist or increase, independently of the climate change scenarios.
Mapping R0 values is an effective method to assess the risk of Chagas disease. The eventual increase in the transmission area of the disease is worrisome.
Abstract Objective: To test the performance of ChatGPT on radiology questions formulated by the Colégio Brasileiro de Radiologia (CBR, Brazilian College of Radiology), evaluating its failures and ...successes. Materials and Methods: 165 questions from the CBR annual resident assessment (2018, 2019, and 2022) were presented to ChatGPT. For statistical analysis, the questions were divided by the type of cognitive skills assessed (lower or higher order), by topic (physics or clinical), by subspecialty, by style (description of a clinical finding or sign, clinical management of a case, application of a concept, calculation/classification of findings, correlations between diseases, or anatomy), and by target academic year (all, second/third year, or third year only). Results: ChatGPT answered 88 (53.3%) of the questions correctly. It performed significantly better on the questions assessing lower-order cognitive skills than on those assessing higher-order cognitive skills, providing the correct answer on 38 (64.4%) of 59 questions and on only 50 (47.2%) of 106 questions, respectively (p = 0.01). The accuracy rate was significantly higher for physics questions than for clinical questions, correct answers being provided for 18 (90.0%) of 20 physics questions and for 70 (48.3%) of 145 clinical questions (p = 0.02). There was no significant difference in performance among the subspecialties or among the academic years (p > 0.05). Conclusion: Even without dedicated training in this field, ChatGPT demonstrates reasonable performance, albeit still insufficient for approval, on radiology questions formulated by the CBR.
Resumo Objetivo: Testar o desempenho do ChatGPT em questões de radiologia formuladas pelo Colégio Brasileiro de Radiologia (CBR), avaliando seus erros e acertos. Materiais e Métodos: 165 questões da avaliação anual dos residentes do CBR (2018, 2019 e 2022) foram apresentadas ao ChatGPT. Elas foram divididas, para análise estatística, em questões que avaliavam habilidades cognitivas de ordem superior ou inferior e de acordo com a subespecialidade, o tipo da questão (descrição de um achado clínico ou sinal, manejo clínico de um doente, aplicação de um conceito, cálculo ou classificação dos achados descritos, associação entre doenças ou anatomia) e o ano da residência (R1, R2 ou R3). Resultados: O ChatGPT acertou 53,3% das questões (88/165). Houve diferença estatística entre o desempenho em questões de ordem cognitiva inferior (64,4%; 38/59) e superior (47,2%; 50/106) (p = 0,01). Houve maior índice de acertos em física (90,0%; 18/20) do que em questões clínicas (48,3%; 70/145) (p = 0,02). Não houve diferença significativa de desempenho entre subespecialidades ou ano de residência (p > 0,05). Conclusão: Mesmo sem treinamento dedicado a essa área, o ChatGPT apresenta desempenho razoável, mas ainda insuficiente para aprovação, em questões de radiologia formuladas pelo CBR.
Pain is not a trivial issue for hidradenitis suppurativa (HS) patients and has been considered a domain in the Core Outcome Set. To date, there is no evidence about pain caused by the ultrasound ...examinations.
The aim of the study was to assess the presence of pain generated by the ultrasound examinations of HS patients.
A multicentric cross-sectional study for detecting pain during the ultrasound examinations of HS patients using a validated verbal questionnaire immediately after the imaging studies. Statistical analysis included demographic data and possible associations with sex, age, location, clinical (Hurley), and ultrasonographic scoring (SOS-HS). The statistical tests were two proportions Z test, χ2 test, Student's t test, and ANOVA. A p < 0.05 was considered significant.
317 patients met the criteria. 77.3% of them did not present pain. Of cases with pain, 59.8% were mild, 16.7% moderate, and 23.6% severe. No significant association was found with sex, age, staging, location, or the number of affected regions. Although nonsignificant, severe pain cases were more frequent in the clinical Hurley III and ultrasonographic SOS-HS III stages.
Pain generated by the ultrasound examination of HS patients is infrequent.
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