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Pulmonary aspiration is the passage of food, gastroesophageal reflux and/or saliva to the airway in a manner sufficient to cause chronic or recurrent respiratory symptoms. It is an important cause of recurrent pneumonia, progressive lung disease, bronchiectasis and even death. Aspiration is intermittent and often occurs in children with underlying medical conditions or syndromes that cause respiratory symptoms similar to chronic pulmonary aspiration, so diagnosis of aspiration is often delayed until there is a significant lung injury. The available diagnostic methods and their limitations, and treatment options of chronic pulmonary aspiration in the pediatric population are described., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

(Series Information) European Papers - A Journal on Law and Integration, 2021 6(2), 1193-1228 | Article | (Table of Contents) I. Preliminary remarks. - II. The increasing attractiveness of cartels in the age of big data analytics. - III. Collusion between rational algorithms: the relation between market transparency and artificial intelligence in a world of big data. - IV. Existing vs created market conditions: tacit collusion or algorithmic concerted practices? - V. The limited role played by intent and imputability in the antitrust realm: the case of parent company liability and its applicability by analogy to the relation undertakings vis-à-vis algorithms. - VI. Big data analytics does create competitive concerns: should the Commission and national competition authorities commit to tackling algorithmic collusion? - VII. Conclusions. | (Abstract) Due to digital markets' transparency, algorithmic collusion may occur even if algorithms are designed to maximize profits rather than to conspire. The literature suggests that competition rules may not cover algorithmic collusion, being the latter an example of tacit collusion: by monitoring market conditions, each algorithm unilaterally and rationally decides to maintain supra-competitive prices. Data analytics ease the monitoring and reaction to competitors' behaviours, increasing the number of markets subject to tacit collusion. Yet, intention to conspire seems absent. In this Article, it is submitted that algorithmic collusion is different from tacit collusion and can be tackled under EU competition law. In the traditional scenario, undertakings base their rational decisions on the existing markets conditions. While designing their algorithms to maximize profits, undertakings are contributing to create the conditions allowing "tacit" collusion to occur. Moreover, a quasi-strict liability regime applies to antitrust offences, so that intention and imputability play limited roles. As a consequence, if algorithms programmed to maximize profits end up colluding, a rebuttable presumption of the existence of a concerted practice should apply. The practice should be prohibited unless undertakings can prove that, in the specific case, a concerted practice did not occur or that art. 101(3) TFEU applies. Moreover, competition rules may be enforced even without ascertaining any antitrust infringement. Competitive concerns are enough to adopt commitment decisions. Here, the Commission (or a National Competition Authority) may negotiate with the concerned undertakings technical remedies to prevent algorithmic collusion by intervening on the way the algorithms work.

Objectives: Unilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management., Material and Methods: We conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017., Results: Of the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p=0.02) and older patients (56±18 years vs. 38±18, p<.01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund-Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k=.883, p<.001)., Conclusion: A sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen., (Copyright © 2019 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: This paper presents a methodology to optimize, using Altman's Z-Score for private companies, the prediction of private companies of the Spanish health sector entering a situation of bankruptcy., Method: The proposed method consists of the application of genetic algorithms (GA) to find the coefficients of the formula of the chain of ratios proposed by Altman in the version of the score for private companies which optimize the prediction for Spanish private health companies, maximizing sensitivity and specificity, and thereby reducing type I and type II errors. For this purpose, a sample of 5,903 companies from the Spanish private health sector obtained from the database of the Iberian Balance Analysis System (SABI) between 2007 and 2015 was used., Results: The results show that the predictive model obtained with the AG presents greater accuracy, sensitivity and specificity than that proposed by Altman for private companies with both test data and all sample data., Conclusions: The most important finding of this study was to establish a methodology that can identify the optimized coefficients for the Altman Z-Score, which allows a more accurate prediction of bankruptcy in Spanish private healthcare companies., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Prostate Cancer (PCa) represents the most common malignant tumor in men but according to the European Association of Urology (EAU) guidelines, a mass screening for PCa diagnosis should not be performed due to over-diagnosis and over-treatment related problems. An early clinical diagnosis is possible, mainly based on digital rectal examination and Prostatic Specific Agent (PSA) testing. However, the only mandatory test to define the presence of PCa is ultrasound guided-biopsy, obtained on multiple samples, which has also a high prognostic value. In this context, diagnostic imaging plays an important role as confirmed by EAU that in a 2016 update of their guidelines on PCa stated the importance of Positron Emission Tomography (PET) with 11 C- or 18 F-choline combined with computed tomography (CT) to identify local relapse, lymph node involvement and metastatic spread at all stages. Consequently, in 2017, the European Association of Nuclear Medicine (EANM) together with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published new guidelines for 68 Ga-Prostate Specific Membrane Antigen (PSMA) PET/CT to help physicians in the recommendation, execution and interpretation of PET/CT scans in patients with PCa. Thus, the aim of this 'evidence paper' is to define the current diagnostic algorithm in PCa in order to increase the general level of confidence in approaching such a crucial topic., (Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)

The challenges introduced by AI for the EU anti-discrimination legal framework have been a widely discussed topic among the doctrine. In the light of the 20th anniversary of the EU Charter of Fundamental Rights, the Commission released a regulatory proposal to tackle AI. This paper seeks to determine whether the proposal successfully addresses the existent pitfalls of the EU framework. First, this paper explores the functioning of AI systems that employ machine learning techniques and determines how discrimination takes place. Second, the article examines intellectual property rights as one of the main barriers for accountability and redressal of violations committed by an AI system. Third, the state of the discussion concerning the pitfalls of the existent EU approach towards non-discrimination is addressed. The available academic literature suggests that discriminatory outputs produced by an AI will amount to indirect discrimination in most scenarios. In this sense, cases of indirect proxy discrimination will likely pass the proportionality test, therefore justifying the discriminatory output. The last section of this article studies the Commission’s regulatory proposal. Although the document seems to effectively tackle discrimination caused by biased training data sets, this paper concludes that intellectual property rights and proxy discrimination still constitute significant barriers for the enforcement of anti-discrimination law.

In the modern world, among the different clinical presentations of osteoarthritis, gonarthrosis and coxarthrosis exhibit the highest prevalence. In this paper, the characteristics of osteoarthritis and the different scales of assessment and classification of this pathology are exposed, to provide an exhibition of current evidence generated around diagnostic algorithms and treatment of osteoarthritis, with emphasis set out in the knee and hip, as these are the most frequent; a rational procedure for monitoring patients with osteoarthritis based on characteristic symptoms and the severity of the condition is also set. Finally, reference is made to the therapeutic benefits of the recent introduction of viscosupplementation with Hylan GF-20.

The symptoms related to the presence of arachnoid cysts in the Central Nervous System depend on the size of the cyst and its growth rate, its location and, in some cases, the associated CSF dynamic disorder. Sometimes there is acute clinical presentation due to cyst rupture or acute bleeding. Although it is generally accepted that asymptomatic or paucisymptomatic cysts do not require surgical treatment, there is no consensus on the therapeutic approach of choice in symptomatic cases. The aim of this paper is to review the literature, analyzing the pros and cons of the three main surgical options (microsurgery, neuroendoscopy, and CSF shunt) based primarily on the location of the cyst. Although treatment must be always individualized, basic management recommendations may be offered., (Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.)

Objective: Re-evaluate the effective dose (E) of typical nuclear medicine procedures using the new ICRP-103 weighting factors and the latest dosimetry data and relate E with Background Equivalent Radiation Time (BERT)., Material and Methods: Effective dose associated with radiopharmaceuticals and nuclear medicine procedures has been calculated for the following ages: adult, 15, 10, 5 and 1 year. Dosimetry data have been extracted from ICRP-106, ICRP-80, ICRP-53 and/or manufacturer's brochure., Results: The relationship of the data of effective dose associated with radiopharmaceuticals and explorations is shown. The new tissue weighting factors result in a decreased value of the effective dose, except in cases that particularly affect the breast, in which it increases. The effective dose associated with nuclear medicine procedures is in the range 0.1-60 mSv. BERT ranges from a few days to 20 years. The effective dose associated to tests in children is generally higher than the effective dose for an adult., Conclusions: The results shown in this paper are an updated collection of effective dose values for commonly used radiopharmaceuticals in nuclear medicine. Expressing the effective dose equivalent time in units of natural radiation helps to explain issues associated with radiation exposure to patients and healthcare personnel., (2009 Elsevier España, S.L. y SEMNIM. All rights reserved.)

Purpose: The main purpose of the paper is to evaluate an automated method for blood vessels segmentation in color fundus images, due to its important role in the diagnosis of several pathologies such as diabetes. The final objective is to introduce the algorithm into a Computer Aided Diagnosis (CAD) tool that would be available in those local medical centers without specialists., Method: An automated method for blood vessels segmentation in color fundus images was implemented and tested. The algorithm starts with the extraction of vessel centerlines, which are used as guidelines for the subsequent vessel filling phase. The outputs of four directional differential operators are processed in order to select connected sets of candidate points to be further classified as centerline pixels using vessel derived features. The final segmentation is obtained using an iterative region growing method that integrates the contents of several binary images, resulting from vessel width dependent morphological filters. The method was evaluated using the images of two publicly available databases (STARE and DRIVE) and a database with 24 images., Results: The algorithm outperforms other published algorithms and approximates the average accuracy of a human observer without a significant degradation of sensitivity and specificity. In addition, results have been subject to the experts' valuation that they think that retinal vessels remain represented with valuable accuracy on having analyzed the test's images., Conclusion: Due to the good segmentation results, the algorithm proposed could be implemented as part of a complete CAD tool in the local medical centers. This would reduce cost and diagnosis time.

Mental retardation affects 1-3% of the population. Its etiology is heterogeneous and approximately 47% of cases are caused by genetic factors. The aim of this paper is to report on etiologies of mental retardation, to present updates on new technologies of molecular diagnosis, and to analyze their limitations for the appropriate and rational use of them. Finally, an algorithm based on genetics is suggested for the study of mental retardation by reporting on the techniques available in Argentina and in developed countries. A well-defined etiology will lead to the proper management of children with mental retardation, and suitable family counseling.

Dementia is a chronic progressive mental disorder, which adversely affects different domains as memory, thinking, comprehension, judgment, orientation, calculation or language. People with dementia eventually lose the ability to carry out routine daily activities such as dressing, toileting, traveling and handling money. Memory impairment and dementia are commonly seen by physicians in multiple disciplines including primary care, geriatrics, neurology, and psychiatry. We discuss the pros and cons of brief cognitive tests such as the Mini-mental State Examination (MMSE) and test for executive functions to detect cognitive impairment in community patients. Diagnosis must meet standard diagnostic criteria, including tests of cognitive, global and behavioral functioning and activities of daily living. Preliminary diagnosis often takes place in primary care, usually followed by specialist assessment. In this paper we discuss operational criteria for diagnosis in primary care. An algorithm for practical physicians is proposed.

Objectives: Patient movement during SPECT acquisition of images is a frequent cause of artefacts in myocardial perfusion SPECT studies. In this paper we propose an algorithm for the correction of longitudinal movements., Materials and Methods: The method is based on the calculation of the correlation between unidimensional functions obtained from successive projections with a window obtained automatically to eliminate unwanted data points before calculating the correlation. The algorithm was assessed on studies obtained from a cardiac phantom and from those corresponding to ten patients. Seven of these patients had significant movement during SPECT acquisition and those corresponding to the other three studies, in which no movement was observed, were used as a control., Results: In the phantom studies obtained, the mean error of the calculated displacements was less than 0.5 pixels when the window proposed was employed. The error reached 2.8 pixels when the length of the window increased. In patient studies, the method succeeded in reducing the patient motion in all cases and the three control studies remained unchanged. When no window was used to limit the correlation, three out of the seven studies that originally presented movements did not improve and one control study got worse., Conclusion: The results obtained indicate the utility of the algorithm and demonstrate the need to window the data before calculating the correlation.

Over the past decade, concern has grown regarding the risks generated by the use of artificial intelligence systems. One of the main problems associated with the use of these systems is the harm they have been proven to cause to the fundamental right to equality and non-discrimination. In this context, it is vital that we examine existing and proposed regulatory instruments that aim to address this particular issue, especially taking into consideration the difficulties of applying the abstract nature that typically characterises legal instruments and, in particular, the equality and non-discrimination legal framework, to the specific instructions that are needed when coding an artificial intelligence instrument that aims to be non-discriminatory. This paper focuses on examining how article 10 of the new EU Artificial Intelligence Act proposal may be the starting point for a new form of regulation that adapts to the needs of algorithmic systems.