High Specialty Research Articles

Inter-regional Hospital Patients’ mobility: Is co-operation better than competition?

Abstract Background According to Italian law, citizens are free to choose their preferred place of care across the national territory. This study aims to analyze the associations between patients’ mobility between Tuscany (Italy) and other Italian regions and the complexity of Diagnosis Related Groups (DRGs) provided for these hospitalizations. Methods A retrospective study was conducted using 2019 Hospital Discharge Cards data of Tuscany provided by the Italian Ministry of Health. The surgical DRGs of each Major Diagnostic Categories (MDCs) were considered according to high specialty (HS) and non-high specialty (N-HS). For each MDCs, patients’ attractions, and escapes to bordering and non-bordering regions with Tuscany were associated with HS and N-HS surgical discharge DRGs by using the Odds Ratio. The analysis was performed using STATA software, and the significance level was set at 95%. Results For Digestive Diseases, patients from non-border regions were more likely to be attracted to Tuscan hospitals for HS DRGs (OR: 1.37 95%CI: 1.08-1.74; p < 0,05), while for Musculoskeletal Diseases those from non-border regions were less likely to be attracted for HS DRGs (OR: 0.51 95%CI: 0.47-0.56; p < 0,05). For Nervous Diseases (OR: 3.08 95%CI: 2.18-4.37; p < 0,05), for Ear, Nose, Mouth And Throat Diseases (OR: 2.41 95%CI: 1.52-5.03; p < 0,05) and for Hepatobiliary And Pancreas Diseases (OR: 4.55 95%CI: 2.71-7.68; p < 0,05), Tuscan patients were more likely to escape to non-border regions for HS DRGs, while for Musculoskeletal Diseases (OR: 0.76 95%CI: 0.68-0.84; p < 0,05) they were less likely to be admitted to non-border regions for HS DRGs. Conclusions The results suggest the necessity of establishing mobility agreements between regions, particularly for high-specialty DRGs. In fact, the provision of mobility care economically benefits the receiving (creditor) region, which provides the medical service, but is not advantageous to the patient’s region of residence (debtor). Key messages • Monitoring mobility flows is critical to improve identify possible lack of supply of resources. • There is a need to develop interregional mobility agreements to ensure better cooperation between different regional health systems.

Neonatal screening for hearing loss and its associated factors: A pediatric hospital experience

Abstract Introduction Hearing impairment affects 0.6% of children worldwide, with 60% of cases being preventable. Identifying risk factors for hearing impairment would facilitate early detection and better patient prognosis. Objectives To identify factors associated with abnormalities in auditory screening in a pediatric hospital. Methods A cross-sectional study was conducted on patients assessed in the early hearing detection program at the Pediatric Tower of the High Specialty Hospital of Veracruz, Mexico, between June 2022 and 2023. Screening was performed using otoacoustic emissions initially. Those with abnormalities underwent two retests, and those positive in all three evaluations underwent confirmatory testing. Newborn screening was conducted at discharge for healthy neonates and after reaching a weight of over 1.8 kg and more than 34 gestational weeks for preterm infants. For term and low-birth-weight babies, screening occurred when they reached 2 kg, considering positive results in any of the three tests indicative of altered screening and probable hearing impairment. Results A total of 2731 patients were fully evaluated, with 1416 (51.8%) being male, and a median Apgar score of 9 at 5 minutes. The incidence of hearing impairment was 0.7%, comprising 19 patients. Evaluation of sex, 5-minute Apgar score, weight, gestational age, congenital malformations, history of neonatal asphyxia, hyperbilirubinemia, sepsis, TORCH infections, family history of hearing impairment, maternal exposure to ototoxic drugs, substances, COVID-19, gestational diabetes, or maternal hypertension obtaining values of p > 0.05 in each of them. Conclusions The prevalence of hearing loss is similar to that reported in the literature. In our population, auditory screening abnormalities are not associated with classic perinatal factors, indicating the complexity of contributors to neonatal hearing impairment. Key messages • The neonatal screening program plays a fundamental role in identifying patients with hearing loss even without any clinical factor that arouses suspicion of hearing loss. • Early diagnosis will favor timely care for patients with hearing loss, favoring their development with adequate care to improve their quality of life.

The impact of the current medico-legal and regulatory culture in Ireland on the decision of graduate entry medical school students to pursue a career in obstetrics and gynecology

ObjectivesMedico-legal and regulatory culture has a significant impact on medical practitioners, including the decision of graduates to enter high-risk specialties. This study explores the impact of the current medico-legal and regulatory culture in Ireland on the decision of graduate entry medical students to enter one high risk specialty, obstetrics and gynecology. Study DesignWe conducted a survey of 146 final-year, graduate-entry medical students pre- and post- a 6-week rotation in obstetrics and gynecology in Ireland. Participants were asked to rate the influence (on a four-point scale) of factors such as fear of being sued, being reported to the regulatory body or criminal prosecution on their decision to pursue a career in obstetrics or gynaecology. Data were matched pre- and post-rotation and McNemar-Bowker’s test was used to test for differences in related data. All analysis was conducted using SPSS for Windows version 25. ResultsThe responses of 72 students to both questionnaires could be matched (response rate 49.3%). The majority of participants pre-rotation reported that fear of being sued (74%), fear of being reported to the regulatory body (70%) and fear of criminal prosecution (55%) were factors influencing their decision (somewhat or to a great extent) to pursue a career in obstetrics. There were no significant changes post-rotation. Compared to obstetrics, lower proportions of participants pre-rotation considered fear of being sued (54%), fear of being reported to the regulatory body (50%) and fear of criminal prosecution (40%) as factors influencing their decision to pursue a career in gynecology. There were no significant changes post-rotation. ConclusionsMedico-legal and regulatory culture is shaping the perceptions of graduate entry medical students of obstetrics and gynecology and influencing their decision to pursue a career in the speciality. Understanding the impact of medico-legal culture on career choices including a high-risk specialty such as obstetrics and gynecology is important from both a policy and reform context, and if the healthcare service is to recruit and retain adequate numbers to ensure the safe provision of healthcare.

Implementing a letter template to expedite specialty medication appeal letter submission

BackgroundPrior authorizations (PAs) for biologic medications, used to treat inflammatory bowel disease (IBD), are often denied by pharmacy benefits managers and can require a complex appeal process for patients to gain access to medication. ObjectiveThis quality improvement project evaluated the impact of implementing a standardized appeal letter template and customizable clinical rationale letter content on specialty pharmacist workflow and workload in an integrated hospital health system specialty pharmacy (HSSP) IBD clinic. Practice descriptionThis initiative was conducted in an IBD outpatient clinic at a tertiary academic medical center with an integrated HSSP whose specialty pharmacists work collaboratively with providers to manage specialty medications. Practice innovationA letter template was created in the electronic health record (EHR) for pharmacists to use when submitting appeal letters. The template automatically populates patient results from recent labs, imaging, and clinic visit notes as part of the appeal documentation. Clinical rationale letter content was developed for the most common appeal reasons using EHR functionality that allows the creation of standardized notes that can be shared among team members and customized at time of use. Evaluation methodAn analysis of 2 months of data preimplementation/postimplementation was conducted using descriptive statistics to report the number of appeals submitted, time from PA denial to appeal submission, and appeal approval rate. A pharmacist postimplementation satisfaction score was also collected. ResultsThe number of appeals submitted preimplementation (n = 73) and postimplementation (n = 73) was the same. Postimplementation, 89% of appeals were submitted within 3 days of PA denial compared to 29% preimplementation. PA approval rate was high (93%) preimplementation and postimplementation. Overall pharmacist satisfaction was 9.7 out of 10. ConclusionImplementation of an appeal letter template and standardized clinical rationale letter content in the EHR led to decreased time to appeal submission and high specialty pharmacist satisfaction.

Mortality-Associated Factors in a Traumatic Brain Injury Population in Mexico.

Traumatic brain injury (TBI) is a major cause of death and disability, with a rising incidence in recent years. Factors such as age, sex, hypotension, low score on the Glasgow Coma Scale, use of invasive mechanical ventilation and vasopressors, etc., have been associated with mortality caused by TBI. The aim of this study was to identify the clinical and sociodemographic characteristics that influence the mortality or survival of patients with TBI in a tertiary care hospital in Mexico. A sample of 94 patients aged 18 years or older, from both sexes, with an admitting diagnosis of mild-to-severe head trauma, with initial prehospital treatment, was taken. Data were extracted from the Single Registry of Patients with TBI at the Ixtapaluca Regional High Specialty Hospital (HRAEI). Normality tests were used to decide on the corresponding statistical analysis. No factors associated with mortality were found; however, survival analysis showed that the presence of seizures, aggregate limb trauma, and subjects with diabetes mellitus, heart disease or patients with four concomitant comorbidities had 100% mortality. In addition, having seizures in the prehospital setting increased the risk of mortality four times. Although they did not have a direct association with mortality, they significantly decreased survival. A larger sample size is probably required to obtain an association with mortality. These results reflect the severity of the clinical situation in this population and, although no risk factors were identified, they enlighten us about the conditions presented by patients who died.

Breastfeeding When the Mother and the Baby Are Hospitalized Together or Separately

Objective:At the Regional High Specialty Hospital of Ixtapaluca, a lactation unit was implemented to promote breast milk feeding. This report aimed to describe the experience of breastfeeding in scenarios where the mother and the baby were hospitalized together or separately.Methods:This is a clinical practice article that describes situations where direct infant feeding was not an option. Lactation nursing staff provided educational support to mothers for breast milk expression with therapeutic self-care measures to promote exclusive breastfeeding.Results:Supplementation of breast milk was carried out in four scenarios: (1) mother and baby hospitalized together, (2) hospitalized separately, (3) the mother at home and the infant hospitalized, and (4) the mother hospitalized and the infant at home.Conclusions:The lactation unit of a non-obstetric hospital contributed to the promotion and training of exclusive breastfeeding techniques in situations where the mother or the baby was hospitalized.

Association of hTERT expression, Her2Neu, estrogen receptors, progesterone receptors, with telomere length before and at the end of treatment in breast cancer patients.

Breast cancer shows significant clinical, morphologic, and molecular variation. Telomeres are nucleoprotein complexes composed of hexanucleotide repeat DNA sequence, TTAGGG, and numerous telomere-associated proteins. The maintenance of telomere length is carried out by a ribonucleoprotein called telomerase, which consists of two main components: a catalytic subunit called hTERT (human telomerase reverse transcriptase) and an RNA template called hTR (human telomerase RNA). The importance of evaluating hTERT expression lies in its potential therapeutic application, being an attractive target due to its almost non-existent expression in normal somatic cells. It is also expected that the anti-neoplastic effect would appear earlier in neoplastic cells with shorter telomeres. Additionally, a significant relationship has been observed between Her2-Neu overexpression and Her2-Neu positivity, which could suggest new combined therapies.The aim of this study was to detect the expression of hTERT, estrogen receptor (ER), progesterone receptor (PR), and HER2-Neu in neoplastic breast tissue embedded in paraffin before treatment and to investigate the relationship between them and with baseline and post-treatment telomere length, as well as with various clinicopathological parameters. A cross-sectional-correlational, 21 women diagnosed with breast cancer at the Oncology Service of the High Specialty Medical Unit No. 1 of Bajio of the Mexican Institute of Social Security. The study complies with the Helsinki Declaration and was approved by the Institutional Ethical Committee of the Mexican Institute of Social Security (R-2019-1001-127). A peripheral blood sample was obtained before oncological treatment and at the end of oncological treatment for the measurement of telomere length by extracting DNA from leukocytes, was performed by the quantitative polymerase chain reaction (PCR) method described by Cawthon. Tumor samples were collected from each patient at the oncology department for immunohistochemical determination of biomarker expression (ER, PR, Her2/neu) and hTERT. Of the 21 cases included in the study, the median age was 57.57 years. Eighteen cases were classified as invasive ductal carcinoma NOS (85.71%), 10 were histologic grade 2 (47.61%), 16 cases were hormone receptor positive (76.19%), 7 were Her2Neu positive (33.33%), and only 2 cases were triple negative (9.52%). Positive hTERT expression was detected in 11 cases (52.38%) and was negative in the remaining cases. A significant association was identified between hTERT-positive cases and Her2-Neu positive cases (p = 0.04). Baseline and post-treatment telomere lengths showed a significant difference using the non-parametric Wilcoxon t-test (p = 0.002). In hTERT-positive cases, there was significant telomere shortening at the end of oncological treatment (6.14 ± 1.54 vs. 4.75 ± 1.96 Kb, p = 0.007). Positive hTERT immunostaining cases were associated with poor prognostic factors, such as Her2-Neu overexpression and post-treatment telomere shortening. In the future, hTERT immunostaining could be used to select patients for therapies with antagonistic effects on hTERT, as well as in the selection of more appropriate chemotherapy regimens for patients who express it.

An Examination of the Original Knowledge and Inheritance of Putu Xian Opera Among Putian Citizens

The purpose of this study is to investigate how the age and educational level of Putian citizens affect their attitudes towards the original perception and transmission of Putu Xian opera. Putu Xian Opera, with its distinct art form and rich cultural legacy, holds a significant place in the history of Chinese opera as one of the first batch of national intangible cultural heritages in China. The original preservation and transmission of Putu Xian Opera are vital to Putian inhabitants, as Putian is the cradle of this traditional art form. According to the findings of an extensive survey of Putian residents, the age group of 46 55 has the largest proportion of citizens, followed by that of 36 45. Regarding the awareness and transmission of Putu Xian opera, citizens between the ages of 26 and 35 and 18 and 25 have the most positive opinions, whilst those under the age of 18 and those 56 and older have the lowest awareness. The survey population is somewhat more male than female, with a more balanced ratio of male to female. The data does not indicate any discernible variations in opinions regarding the understanding and legacy of Putu Xian Opera. The respondents greatest degree of education was a bachelor s degree (23.2%), which was followed by secondary or high school (23%), specialty or college (22.2%), and high school (22%). The group places greater value on preserving the unique qualities of Putu Xian opera and fostering a positive outlook on its dissemination the more educated they are. Research indicates that individuals with higher levels of education have a stronger feeling of responsibility and initiative towards the preservation of cultural heritage. They are also better able to strike a balance between tradition and modernity, which helps to effectively preserve and advance Putu Xian Opera. In addition, this study highlights the critical role that people educational attainment plays in the preservation of intangible cultural assets and offers insightful experience and theoretical references for the preservation and transmission of traditional culture in other countries.

Terapia psicológica grupal y su efecto en ansiedad, depresión y niveles de BDNF en candidatos a trasplante renal

The objective of the present study is to describe the effect of a group intervention on the levels of anxiety and depression associated with the level of BDNF and cognitive impairment of patients who are candidates for kidney transplantationthrough a pre-experimental study. 25 adult patients of both gendersof a High Specialty Medical Unitparticipated in the study. The Beck depression and Golberg anxiety inventories and the Folstein Mini Mental State Exam were applied. At the beginning and end of the intervention, blood and urine samples were taken to analyze BDNF levels. A group intervention with a brief orientation cognitive behavioral approach was carried out. The results in the variables of anxiety (p = 0.002) and depression (p = 0.04) show significant differences before and after the interventionreducing the levels of these variables considerably; Regarding BDNF levels and cognitive impairment, no significant differences were found.This study shows the usefulness of group psychological therapies for the benefit of these patients as well as the need to carry out more studies that evaluate biological markers related to the pathologies presented.

Health Regulation in High Specialty Medical Units of the IMSS

In accordance with the Sustainable Development Goals (SDG) of the 2030 Agenda of the United Nations General Assembly, the National Development Plan (PND) 2019-2024 includes in its Guiding Principles, "Leave no one behind; leave no one out", and for its part, the Mexican Social Security Institute (IMSS) implements strategies to guarantee access to universal health through the granting of economic, social and medical benefits, whose objective is to promote, maintain and recover . health care, however, to be carried out with effectiveness, quality and safety, these activities require Health Care Institutions authorization. In this work, the Operational Plan for Health Security in Medical Units of the IMSS (POSSUM IMSS) is disclosed, all the Licenses in all Third Level Care hospitals, whose objective was to comply with the instructions of the General Directorate (DG). on February 2, 2023, within the framework of the Safe Hospital program, to process 100% of Licenses in High Specialty Medical Units (UMAE). After its implementation, on November 10, 2023, the entire UMAE reached 100% Global Compliance in Licenses. The POSSUM IMSS contributes to regulatory certainty to achieve the transformation towards a more modern, inclusive, safe and efficient IMSS for the user and worker population and is susceptible to being implemented in other public and private sector institutions.

Single Effective Complex Loading into Zero-Mode Waveguides Optimized with Fluorescence Evaluation at Quenching and Accumulation Checkpoints.

Single-molecule detection with high accuracy and specialty plays an important role in biomedical diagnosis and screening. Zero-mode waveguides (ZMWs) enable the possibility of single biological molecule detection in real time. Nevertheless, the absence of a reliable assessment for single effective complex loading has constrained further applications of ZMWs in complex interaction. Both the quantity and activity of the complex loaded into ZMWs have a critical effect on the efficiency of detection. Herein, a fluorescence evaluation at quenching and accumulation checkpoints was established to assess and optimize single effective complex loading into ZMWs. A primer-template-enzyme ternary complex was designed, and then an evaluation for quantity statistics at the quenching checkpoint and functional activity at the accumulation checkpoint was used to validate the effectiveness of complexes loaded into ZMWs. By optimizing the parameters such as loading time, procedures, and enzyme amount, the single-molecule effective occupancy was increased to 25.48%, achieving 68.86% of the theoretical maximum value (37%) according to Poisson statistics. It is of great significance to provide effective complex-loading validation for improving the sample-loading efficiency of single-molecule assays or sequencing in the future.

Perception of the Quality of Care by the Users in the Gynecology and Obstetric Service of a Public Hospital of High Speciality From Veracruz

Background: It is known that measuring the perception of the quality of care in a hospital has become a growing and important indicator of the efficiency of the health system; however, so far, Mexico has not set a precedent for it. Objective: To report the results obtained in order to evaluate its importance and impact. Material and Methods: A qualitative cohort, prospective longitudinal study was carried out in the High Specialty Hospital of the Secretary of Health and Assistance (SSA) of the state of Veracruz, in the different areas of the gynecology and obstetrics service (GYO), using the surveys provided by the official website of the State Government: http://www.calidad.salud.gob.mx/site/calidad/encuesta_satisfaccion_trato_digno.html as a measurement instrument. Unit of Analysis: 450 people following pertinent inclusion and exclusion criteria, with a confidence level of 99% and a confidence limit of 1.7%. Discussion: Given the growing demand for health services by users, it is imperative that both public and private institutions are up to the task, both in terms of quantity and quality of human capital. Conclusions: we consider it necessary to generate analysis and reflection devices that redefine the model of relationship between professionals and patients, considering the political, social and cultural variables in which this relationship is formed.

Wellens Syndrome the Previous Room to A Large Previous Myocardial Infarction. Report of A Case.

Wellens syndrome or also called anterior descending T wave syndrome, described for the first time in 1982 by Wellens and Zwaan, as a subtype of high-risk unstable angina that progresses to myocardial infarction in the anterior face, which can be massive and fatal; Documentation of this pattern on the ECG would be essential to initiate pharmacological treatment and priority referral to the hemodynamics room; A case of a 74-year-old male patient is described who begins symptoms in the early morning with typical chest pain and adrenergic discharge that progressively disappears. The patient is sent to a High Specialty Medical Center for Catheterization, which correlates injury in a rare anatomical site of the middle segment of the anterior descending artery. Knowledge of Wellens Syndrome in the emergency room is of utmost importance to reduce morbidity in patients and avoid its consequences, as well as the importance of primary referral for cardiac catheterization.

Prognostic Factors for Residual Lithiasis in Patients With Staghorn Calculi Undergoing Percutaneous Nephrolithotomy in the Maya Region of Yucatan, Mexico: A Case-Control Study.

Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico,placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient's collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula. A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate. A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100).A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001). Guy's Score Grade IV showed a higher incidence of residual lithiasis,seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.

Interaction Effects of FTO and MC4R Polymorphisms on Total Body Weight Loss, Post-Surgery Weight, and Post-Body Mass Index after Bariatric Surgery.

Bariatric surgery (BS) is considered the most effective intervention for patients with severe obesity and is used to maintain long-term weight loss and glycemic control. The aim of this study was to analyze the effects of genotypes and haplotypes of the fat mass and obesity-associated (FTO) and melanocortin 4 receptor (MC4R) genes on total body weight loss (TBWL), post-surgery weight, and post-BMI after bariatric surgery. We retrospectively selected 101 patients from Bajio High Specialty Regional Hospital, León Guanajuato, México, who underwent Roux-en-Y gastric bypass (RYGB) to determine their body mass index (BMI), blood pressure, biochemical characteristics, and comorbidities. Post-surgery, patients were referred for registered anthropometry and blood pressure. Glucose, lipid and hepatic profiles, and insulin, leptin, and ghrelin levels were measured, and rs9939609, rs9930506, and rs1421085 FTO and rs17782313 MC4R polymorphisms were genotyped. Six (4-8) years after BS, post-surgery weight was greater in carriers of the rs9939609 and rs1421085 risk genotypes. TBWL was lower for the rs9930506 and rs1421085 risk genotypes. Insulin and HOMA-IR were greater in patients with the three FTO polymorphisms. There were significant interaction effects of the rs9930506 and rs1421085 FTO risk genotypes on weight and BMI in response to BS. No association was found with the MC4R polymorphism. The genotypes and haplotypes of the FTO gene influence post-surgery weight, TBWL, insulin levels, and HOMA-IR.

MESS Scale in Peripheral Vascular Trauma of the Lower Extremities: Experience at the High Specialty Regional Hospital Dr Gustavo A Rovirosa Perez

MESS Scale in Peripheral Vascular Trauma of the Lower Extremities: Experience at the High Specialty Regional Hospital Dr Gustavo A Rovirosa Perez

Colorimetric microneedle sensor using deep learning algorithm for meat freshness monitoring

Currently, the developed testing methods determining meat freshness are time-consuming, inconvenient, or have high specialty requirements. Herein, we proposed a colorimetric microneedle sensor (CMS) using a deep learning algorithm for visualized meat freshness monitoring. The CMS was obtained by molding edible hydrogels containing pH-responsive anthocyanins, which change colors because of the structure change of anthocyanins in response to pH. When attached to meat, the CMS was capable of penetrating the meat and extracting tissue fluids by capillary action. With meat spoilage, the pH of the tissue fluid gradually rose, leading to a change in CMS from pink to purple and finally to dark blue. Thus, according to variations of CMS colors, in situ and visualized detection of meat freshness was achieved. Further, a deep learning algorithm was applied to integrate with CMS to form a smartphone application (App), allowing for more convenient and accurate freshness detection. Images of CMS attached to the meat with different freshness were collected to form a training source as the input of the convolutional neural network (CNN). Through convolving CMS color features, the meat freshness classified as “fresh”, “less fresh”, and “spoiled” was finally outputted. With the incorporation of CNN, the App enabled users to identify the freshness of meat from stored photos or real-time images of CMS-labeled meats in a fast, accurate, portable, and universal way. This visualized detection strategy of CMS combined with an algorithm-integrated App has a promising potential for wide applications such as food safety, health monitoring, and environmental protection.

The early determinants of career choices for medical students following an obstetrics and gynaecology placement: Mixed methods study.

To explore the impact of attending a clinical placement in considering a career in obstetrics and gynaecology. Mixed methods study. London Medical School. Fifth year medical students attending a clinical placement in obstetrics and gynaecology. Between January 2021 and January 2022, questionnaires were used and semi-structured focus groups conducted, which were audio-recorded. Descriptive statistics were conducted and a framework analysis on transcribed focus groups. The impact of the clinical placement on career choice. Six main themes were identified from the analysis; three contributing to considering a career in obstetrics and gynaecology; pregnancy is not an illness, extraordinary experience of observing childbirth and variable specialty and three themes emerged contributing to not considering a career; lack of work-life balance, high stakes specialty and the emotional toll. Even at an undergraduate level, medical students exhibited concerns about the long-term feasibility of achieving work-life balance and avoiding professional burnout, which was partly attributed to the responsibility of looking after both the woman and their baby. Obstetrics and gynaecology is perceived as an exciting and variable speciality by medical students. Students' experiences on the labour ward during a clinical placement appear to contribute to the consideration of a career in obstetrics and gynaecology. Students should be given opportunities to discuss their concerns about obstetrics, particularly over the potential psychological impact of adverse/traumatic birth events. It is crucial to provide a realistic introduction to obstetrics, to recruit enthusiastic junior doctors who will be resilient to the pressures of the speciality, to avoid burnout and minimise attrition rates.

Automatic image processing to identify post-COVID conditions by using deep learning

In the present research, a supervised learning classification methodology is proposed to identify post-COVID conditions. Image processing and deep learning methods were employed to analyze a data set provided by the High Specialty Medical Unit No.1 of the Mexican Institute of Social Security (T1-IMSS) of Leon, Guanajuato, Mexico, of Mexican patients infected with COVID-19. The dataset is classified into post-COVID findings and no post-COVID findings. A deep neural network of 50 hidden layers is used to extract regions of interest, with properties that can potentially be related to computer-aided medical diagnosis. Different patterns were found in the post-COVID computed tomography scans: pulmonary fibrosis, ground glass pattern, etc. The efficiency of the proposed method was 97% precision using the cross-validation classification scenario. This result allows to provide an auxiliary tool in medical diagnosis, through computer-aided diagnosis. This model provides an automatic and objective estimation of post-COVID conditions of Mexican patients, facilitating the expert interpretation during the COVID-19 pandemic.

Climate change impacts on insect pests for high value specialty crops in California

California is a global leader in production and supply of walnuts and almonds, and the state is the largest producer of peaches in the U.S. These crops have an important contribution to the California's agricultural economy. Damages to these crops from lepidopteran pests, mainly from Codling moth (Cydia pomonella) (family: Tortricidae), Peach twig borer (Anarsia lineatella) (family: Gelechiidae) and Oriental fruit moth (Grapholita molesta) (family: Tortricidae), are still high, despite the improvement in pest management activities. Given that temperature increase can directly impact the rate of growth and development of these pests, it is important to understand to what extent dynamics of these pests will change in future in California. The objective of this study was to quantify changes in the biofix, lifecycle length, and number of generations for these pests for the entire Central Valley of California. Using a well-established growing-degree days (GDD) model calibrated and validated using observations from orchards of California, and climate change projections from the Coupled Model Intercomparison Project phases 5 and 6 (CMIP5 and CMIP6) General Circulation Models, we found that biofix dates of these pests are expected to shift earlier by up to 28 days, and length of generations is expected to be shortened by up to 19 days, and up to 1.4 extra generations of these pests can be added by the end of the century depending on the scenario. Results from this work would enable industries to prioritize development of practices that are more effective in the long run, such as developing better cultural and biological pest solutions and insect tolerant varieties. Growers and researchers can take proactive actions to minimize future risks associated with these damaging pests. This work can be scalable to other pests and regions to understand regional dynamics of damaging agricultural pests under climate change.