Machine learning methods, applications and economic analysis to predict heart failure hospitalisation risk: a scoping review protocol

INTRODUCTION

Machine learning (ML) has emerged as a powerful tool for uncovering patterns and generating new information. In cardiology, it has shown promising results in predictive outcomes risk assessment of heart failure (HF) patients, a chronic condition affecting over 64 million individuals globally.This scoping review aims to synthesise the evidence on ML methods, applications and economic analysis to predict the HF hospitalisation risk.

METHODS AND ANALYSIS

This scoping review will use the approach described by Arksey and O'Malley. This protocol will use the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Protocol, and the PRISMA extension for scoping reviews will be used to present the results. PubMed, Scopus and Web of Science are the databases that will be searched. Two reviewers will independently screen the full-text studies for inclusion and extract the data. All the studies focusing on ML models to predict the risk of hospitalisation from HF adult patients will be included.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review. The dissemination strategy includes peer-reviewed publications, conference presentations and dissemination to relevant stakeholders.

Patient-based dengue virus surveillance in Aedes aegypti from Recife, Brazil

BACKGROUND & OBJECTIVES

Dengue is currently one of the most important arthropod-borne diseases and may be caused by four different dengue virus serotypes (DENV-1 to DENV-4), transmitted mainly by Aedes aegypti (Diptera: Culicidae) mosquitoes. With the lack of a dengue vaccine, vector control strategies constitute a crucial mode to prevent or reduce disease transmission. In this context, DENV detection in natural Ae. aegypti populations may serve as a potential additional tool for early prediction systems of dengue outbreaks, leading to an intensification of vector control measures, aimed at reducing disease transmission. In Brazil, this type of surveillance has been performed sporadically by a few groups and has not been incorporated as a routine activity in control programs. This study aimed at detecting DENV in natural Ae. aegypti from Recife, Pernambuco, to check the circulating serotypes and the occurrence of transovarial transmission in local mosquito populations.

METHODS

From January 2005 to June 2006, mosquitoes (adults and eggs) were collected in houses where people with clinical suspicion of dengue infection lived at. RNA was extracted from pooled mosquitoes and RT-PCR was performed in these samples for detection of the four DENV serotypes.

RESULTS & CONCLUSION

Out of 83 pools of adult mosquitoes collected in the field, nine were positive for DENV: five for DENV-1, two for DENV-2 and two for DENV-3. From 139 pools of adult mosquitoes reared from collected eggs, there were 17 positive pools: three for DENV-1, 10 for DENV-2, and four for DENV-3. These results are discussed in the paper in regard to the local dengue epidemiological data. The conclusions clearly point to the informative power and sensitivity of DENV entomological surveillance and to the importance of including mosquito immature forms in this strategy.

Resistance to the organophosphate temephos: mechanisms, evolution and reversion in an Aedes aegypti laboratory strain from Brazil

Insecticide resistance is one of the main problems in vector control programs. Because insects have developed resistance to all classes of available chemical insecticides, a proper surveillance and management of resistance in areas where these compounds are being utilized is crucial for the success of control programs. Since the mechanisms and molecular bases of resistance are various, they must be characterized to allow efficient monitoring strategies. Here we report the establishment of an Aedes aegypti strain resistant to temephos, named RecR, selected under laboratory conditions. The parental A. aegypti population was obtained from eggs collected in an area where temephos had been used for 8 years, and presented a baseline resistance ratio (RR) of 7. After 17 generations under selective pressure, the RR has increased to 180. Biochemical assays indicate that metabolic mechanisms are involved on temephos resistance in the selected strain. These experiments showed that, compared to the susceptible colony Rockefeller, RecR present higher activity of glutathione S-transferases (GSTs), alpha- and beta-esterases, and, to a lesser degree, mixed function oxidases (MFO). At the 14th or 17th generations, there was no cross resistance of these insects to deltamethrin, cypermethrin and malathion, while a low resistance level (RR=3) was observed for pyriproxyfen, a juvenile hormone analogue. Experiments on resistance reversal, performed through three different field simulated schemes using the resistant strain, showed that temephos susceptibility can be recovered. The establishment of an A. aegypti colony resistant to temephos is extremely valuable for a deeper understanding of resistance mechanisms and thus for further improvements in control strategies against this vector. With the urgent need on improving methodologies to monitor resistance, molecular studies such as microarrays, and resistant colonies such as RecR will certainly hasten such studies.

Silencing an Anopheles gambiae catalase and sulfhydryl oxidase increases mosquito mortality after a blood meal

Catalase is a potent antioxidant, likely involved in post-blood meal homeostasis in mosquitoes. This enzyme breaks down H2O2, preventing the formation of the hydroxyl radical (HO*). Quiescins are newly classified sulfhydryl oxidases that bear a thioredoxin motif at the N-terminal and an ERV1-like portion at the C-terminal. These proteins have a major role in generating disulfides in intra- or extracellular environments, and thus participate in redox reactions. In the search for molecules to serve as targets for novel anti-mosquito strategies, we have silenced a catalase and a putative quiescin/sulfhydryl oxidase (QSOX), from the African malaria vector Anopheles gambiae, through RNA interference (RNAi) experiments. We observed that the survival of catalase- and QSOX-silenced insects was reduced over controls following blood digestion, most likely due to the compromised ability of mosquitoes to scavenge and/or prevent damage caused by blood meal-derived oxidative stress. The higher mortality effect was more accentuated in catalase-silenced mosquitoes, where catalase activity was reduced to low levels. Lipid peroxidation was higher in QSOX-silenced mosquitoes suggesting the involvement of this protein in redox homeostasis following a blood meal. This study points to the potential of molecules involved in antioxidant response and redox metabolism to serve as targets of novel anti-mosquito strategies and offers a screening methodology for finding targetable mosquito molecules.

Electrocardiographic characteristics in a population with high rates of seropositivity for Trypanosoma cruzi infection

This study was conducted in Posse, a rural community in Goiàs, Brazil. Persons were recruited into the study through house-to-house sampling of all houses in the sampled area. Blood samples were collected for seropositivity assessments for Trypanosoma cruzi and an electrocardiogram was assessed using a portable system. The results demonstrate significant differences between seropositive and seronegative persons for electrocardiographic (ECG)-derived traits. Seropositive persons had substantially longer QRS and QT intervals than seronegative persons. The PR interval was significantly different between seropositive and seronegative persons. Conduction abnormalities were observed more frequently in seropositive than seronegative persons. Right bundle branch block, an ECG abnormality typical of Chagas disease, was observed in 15% of seropositive persons compared with less than 1% of seronegative persons. Results indicate that T. cruzi infection and subsequent Chagas disease will continue to be major health problems for the foreseeable future in this typical rural area of Brazil.

[The concept of handicap]

The notion of disability appears recently in the medical and medico-legal field. It is the origin of a fundamental discussion about the health, and an ethical debate about human person. Indeed it drives to identify among the health users a particular group: disabled persons for whom the methods used with success in the field of diseases are not convenient. For ethical point of view: it is the identity of the person in a situation of disability, its dignity, its self-esteem and the respect through the regard of others which are in question. The debate was amplified when the project of a classification of handicap, as consequences of diseases, (Wood, WHO) was published, in 1980. Two tendencies were in opposition: one of them is "medicinal", following the opinion of Wood, the second is "anthropological and social", supported by scientific and disabled associations. The first proposition of Wood, after a long discussion, is abandoned. It is replaced by a "Classification of functioning, disability and health", adopted by the Mondail assembly of WHO in May 2002. This device is a compromise between the precedent tendencies. This document is heavy, confusing, imprecise and very difficult to use. We suggest a definition with dimensions, separating clearly the body modifications, the universal functional capacities for a human person and the situations of life. The subjectivity is individualised as a special dimension of assessment.

Induction of mosquitocidal activity in mice immunized with Anopheles gambiae midgut cDNA

Vaccines that induce mosquito-killing (mosquitocidal) activity could substantially reduce the transmission of certain mosquito-borne diseases, especially vaccines against African malaria vectors, such as the mosquito Anopheles gambiae. To generate and characterize antimosquito immunity we immunized groups of mice with two individual A. gambiae midgut cDNAs, Ag-Aper1 (a secreted peritrophic matrix protein) and AgMuc1 (a midgut-bound mucin), and an A. gambiae midgut cDNA library from blood-fed mosquitoes. We observed significantly increased mortality among mosquitoes that fed on either the AgMuc1- or the cDNA library-immunized mice compared to that of controls, but no differences were observed among those fed on Ag-Aper1-immunized mice. Analysis of the humoral and cellular immune responses from mice showed that the induced mosquitocidal effect was associated with immune profiles characterized by elevated tumor necrosis factor alpha and gamma interferon cytokine levels and very low antibody titers. Furthermore, an additional immunization of cDNA library-immunized mice with midgut protein shifted immunity toward a Th2-type immune response, characterized by elevated antibody titers and high interleukin-5 and interleukin-10 cytokine levels; importantly, mosquitoes feeding on these mice exhibited no undue mortality. Finally, when immune sera was ingested by mosquitoes through a membrane feeder, no effect on mosquito mortality was observed, indicating that serum factors alone were not responsible for the mosquitocidal effect. Our results demonstrate that mosquitocidal immunity in mice can be consistently generated by midgut cDNA immunization and suggest this cDNA-induced mosquitocidal immunity is cell mediated.

[The notion of health]

There has been a good deal of discussion and though on the notion of health. The most widely employed definitions can be termed "physiological", focusing on organs and normality. These definitions result from the development of medicine around the concept of disease, leading Boissier de Sauvages, author of a disease classification that continued to be used until the current classification proposed by the WHO, to state that "health, considered in its historical context, is the concourse of phenomena designating life and perfect structures". The current WHO classification goes beyond the notion of disease and introduces the very positive concept of theoretically total "well-being". In light of the evolution in the reasons why people call upon the health care system, we propose considering health as an equilibrium describing an individual's capacity to cope with the environment and taking into account the available health care resources. Thus, as proposed by René Dubos, health is a "relatively trouble-free state devoid of suffering". We integrate the notions of handicap that we have developed in a four-dimensional approach where subjectivity plays a very important role. Our proposal totally changes the notion of cure: one can be diabetic and cured, paraplegic and cured.

Handicap assessment: setting the grounds for an effective intervention in the community

Many instruments have been invented specially since the 70's to study and measure the consequences of illness and trauma; many of them simply evaluate the severity of lesions and the prediction of mortality, others evaluate morbidity. Nevertheless, none of these instruments evaluate the handicap globally. The classification of the World Health Organization, despite the fact that it contemplates the handicap in all its aspects, does not distinguish its different levels rigorously and it is not a valid instrument to quantify handicaps. The authors comment on their research and proposals for identification and quantification of the handicap. Three levels, related to "Body", "Capacities" and "Life situations", have been described and through them a useful inventory was created (published in 1998). This inventory makes it possible to establish a true medical-social and global evaluation of handicaps, providing a uniform record of the consequences of diseases, trauma or physiological features of the individual and a useful instrument for public health intervention and the promotion of human well-being.

Assessment of drug addiction. The experience of the Medico Legal Institute of Oporto

Since 1993 in Portugal, it is possible, by legal enforcement, to request forensic examination to study possible conditions of drug addiction. On the basis of examinations carried out in the Medico Legal Institute of Oporto, we present a study of 494 cases involving the relation to the demographic data of the examined individuals, their family background, legal situation, age at which drug consumption began, consumption profile at the beginning and at time of forensic examination and our conclusions.

Occupational handicap in victims of limb injuries

The authors analysed 115 victims of limb injuries due to traffic accidents, to compare the medico-legal assessment by the rate of permanent disability (PD) with a tridimensional evaluation of the damage (lesion, function and situation), from a professional aspect. There was a high correlation between PD and lesional and functional sequelae. However, in professional situations only with those who were working full-time was there a high correlation with PD. PD gives only a lesional assessment. The authors propose a professional damage evaluation which considers the handicap of the individual in her/his ordinary work besides the lesion and function, as long as the assessment is personal and it is meant to reintegrate the victim completely in her/his professional life.