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In several studies, the fear of public speaking acts like pathology. However, giving a lecture or presenting a project are daily tasks that stir the nerves, even the non-phobic person. The article intends to show the pedagogical vision about the influence of virtual environments’ aid in public speaking practice.Two studies were conducted. A scoping review debated the use of the virtual reality programs for public speaking skills training and has proved, in this context, is still a recent procedure, and so lacks solid evidence. Second, exploratory research detected and compared nine virtual reality applications for public speaking practice.

The wristbands are very popular among the population due to factors such as their low cost, ease of use, designs and the feedback they provide to the consumer. These wearables track activity, heart rate and sleep-wake patterns. However, few studies have analysed the reliability of the data collected by these activity devices.The validation of sleep data should be carried out by comparing it with Polysomnog- raphy (PSG), which is the standard test for measuring sleep parameters in the clinical setting. Thus, the aim of this project is the validation of the data quality of the Xiaomi Mi Band 5 wristband, when compared with the data by the hospital sleep unit devices during the performance of the polysomnography test.In order to achieve this objective, an Epoch by Epoch (EBE) analysis will be performed to analyse how similar the results obtained by the two methods are. This analysis will use data from 45 people who underwent a PSG test and wore a Xiaomi Mi Band 5 bracelet for one night in a sleep unit of a hospital in A Corun ̃a. For this analysis, raw data from the PSG device and data from the Xiaomi Mi Band 5 wristband were used. In addition, different sleep variables were determined with the data extracted from both devices and following the guidelines of the American Academy of Sleep Medicine (AASM) manual.

The fear of public speaking is one of the most common social phobias causing anxiety problems in many people.In this context, this project focuses on developing a tool capable of helping mental health professionals using virtual reality as a controlled environment in expository therapies, in this case applied to Glossophobia.To enhance the creation of self-control mechanisms in these patients, the use of virtual reality is explored with the aid of Neuro and Biofeedback, allowing the visualization in real time of the physiological response to the stimuli of the virtual environment.

We live in an era daily inundated with information, and the economy of attention makes us far from the truth. The present study has its core to study the creation, use and sharing of videos originated by artificial intelligence that can make it appear that a person says or does something, although he has never said or done anything of the kind. This content is called deepfake. The problem is the way this content is propagated, which for the untrained eye it can be seen as authentic. Quantitative research was carried out, through an inquiry and a literature review.

Schizophrenia is considered a complex syndrome, with multifactorial neurodevelopmental alterations. Empathy is a complex fundamental component of human emotional experience, which influences one's emotions and behavior. On the Electroencephalogram, an activation of the dorsolateral prefrontal cortex is characterized by a decrease in alpha activity. The main objective of this work is to understand if the immersive tools of Virtual Reality influence the electrical activity of the brain and the heart. The two immersive tools were able to increase empathy, mainly by altering prefrontal brain activity as well as heart rate.

Virtual Reality, Augmented Reality and Mixed Reality all have useful applications in the field of medicine, but Mixed reality has great potential because it allows for interaction with both real and digital Objects.Based on a previous literature review, a preliminary Delphi study was performed to obtain the opinion of a panel of 22 experts from several hospitals on the use of Mixed Reality tools, such as the HoLoLens 2, in surgeries.After data collection, a consensus letter was signed. According to experts, the most useful areas are medical education and surgical planning.

In recent years Machine Learning (ML) strategies have proven to be useful to automate numerous classification and pattern detection tasks in diverse fields thanks to the increase of computational power in hardware. One of such fields is the Automatic Speech Recog- nition (ASR), which can use ML architectures to transcribe human speech into readable text. The Word Error Rate (WER) obtained with ML strategies can become relatively low while providing quick responses, reaching accuracy levels that approach human tran- scription accuracy. However, one of the main drawbacks in traditional architectures is the high demand of transcribed data to obtain a low WER in training. This kind of data is particularly hard to be achieved due to the high dependency on human processing. Luckily, a new framework proposed in 2020 (wav2vec2), considerably reduces the need for audio labelling thanks to the use of a Convolutional Neural Network (CNN) with self-supervised training on cross-lingual unlabelled audios of multiple languages and the ability to fine- tune the obtained results with labelled audios of a specific language. Thus, the framework can obtain results that outperform previous architectures by using much smaller audio datasets with transcriptions. This paper presents an ASR system based on wav2vec 2.0 that is fine-tuned for Galician, a language which currently only has small audio datasets available. Such a system is evaluated with a spontaneous speech dataset of approximately 1 hour from the Galicia Parliament, showing a relatively low WER (18.61%).

There is a profile of patient with eosinophilic oesophagitis and atopic background, marked by the existence of IgE-mediated sensitizations. Our aim is to report the observed sensitivities to environmental and food allergens and panallergens in patients with eosinophilic oesophagitis with atopic background as well as characterizing other markers or analytical parameters. We suspect that the prevalence of sensitization to panallergens will be high and this will probably be relevant in terms of the onset and clinical course of the disease. We collated clinical and analytical data from 160 adult patients with a reported diagnosis of eosinophilic oesophagitis. These patients were studied between 1 January 2012 and 31 December 2020. During an initial visit skin tests were performed with full batteries of routine aero-allergens and foodstuffs. Patients were subsequently referred for blood test and determination of specific IgE, blood count and total IgE (in all cases), as well as eosinophilic cation protein and IMMUNOISAC in the centres in which this was available. We were able to detect a broad spectrum of sensitizations to environmental, foodstuffs and panallergens. The most common allergic disease was rhinoconjuntivitis. The sensitizations observed to foodstuffs were atypical for the adult population and were not responsible for manifestations compatible with immediate allergy. An important percentage of patients presented seasonal worsening of choking symptoms. We should be able to identify patients with eosinophilic oesophagitis and atopic background. Identifying this phenomenon would enable giving dietary and environmental recommendations as well as more specific and effective treatments to our patients.

SummaryAnimals moving through landscapes need to strike a balance between finding sufficient resources to grow and reproduce while minimizing encounters with predators1,2. Because encounter rates are determined by the average distance over which directed motion persists1,3–5, this trade-off should be apparent in individuals’ movement. Using GPS data from 1,396 individuals across 62 species of terrestrial mammals, we show how predators maintained directed motion ~7 times longer than for similarly-sized prey, revealing how prey species must trade off search efficiency against predator encounter rates. Individual search strategies were also modulated by resource abundance, with prey species forced to risk higher predator encounter rates when resources were scarce. These findings highlight the interplay between encounter rates and resource availability in shaping broad patterns mammalian movement strategies.

La elección del formato es un aspecto fundamental a tener en cuenta a la hora de lle- var a cabo una ilustración. Antes siquiera de dibujar un solo trazo, y de hacer uso de otras herramientas -como el color, la línea o la composición-, el tamaño y proporción del soporte sobre el que la obra se realiza son capaces de expresar ciertas sensacio- nes y empezar a comunicar conceptos de una manera eficaz.En este artículo se presenta un proyecto de dibujo al que se ha denominado El Entra- mado, un proyecto vivo y en continua expansión cuyo objetivo es mostrar una amplia variedad de escenarios, y donde cada pieza es la parte de un todo en el afán de pre- sentar un “macroespacio” interconectado entre sí, mostrando una geografía única. Este proyecto pretende experimentar e investigar con el uso de diversos formatos para materializar todos esos distintos escenarios de una manera comunicativamente efectiva, con el fin de crear ilustraciones cuyo concepto de espacio sea el que deter- mine el formato a utilizar, plegándose este a las necesidades comunicativas de cada imagen, y desprendiéndose de los formatos estandarizados que normalmente son utilizados.

BACKGROUND Polysomnography is the gold standard for measuring and detecting sleep patterns. In recent years, activity wristbands have become popular because they record continuous data in real time. Hence, comprehensive validation studies are needed to analyze the performance and reliability of these devices in the recording of sleep parameters. OBJECTIVE This study compared the performance of one of the best-selling activity wristbands, the Xiaomi Mi Band 5, against polysomnography in measuring sleep stages. METHODS This study was carried out at a hospital in A Coruña, Spain. People who were participating in a polysomnography study at a sleep unit were recruited to wear a Xiaomi Mi Band 5 simultaneously for 1 night. The total sample consisted of 45 adults, 25 (56%) with sleep disorders (SDis) and 20 (44%) without SDis. RESULTS Overall, the Xiaomi Mi Band 5 displayed 78% accuracy, 89% sensitivity, 35% specificity, and a Cohen κ value of 0.22. It significantly overestimated polysomnography total sleep time (P=.09), light sleep (N1+N2 stages of non–rapid eye movement [REM] sleep; P=.005), and deep sleep (N3 stage of non-REM sleep; P=.01). In addition, it underestimated polysomnography wake after sleep onset and REM sleep. Moreover, the Xiaomi Mi Band 5 performed better in people without sleep problems than in those with sleep problems, specifically in detecting total sleep time and deep sleep. CONCLUSIONS The Xiaomi Mi Band 5 can be potentially used to monitor sleep and to detect changes in sleep patterns, especially for people without sleep problems. However, additional studies are necessary with this activity wristband in people with different types of SDis. CLINICALTRIAL ClinicalTrials.gov NCT04568408; https://clinicaltrials.gov/ct2/show/NCT04568408 INTERNATIONAL REGISTERED REPORT RR2-10.3390/ijerph18031106

We study determinants of financial inclusion for individuals with a refugee background (refugees) from over 30 countries residing in Utica, New York. We find that greater financial inclusion is associated with refugees who are male, more educated, employed, richer, older at time of migration, have better language skills, and have lived in the country longer. Financial inclusion also increases with the degree to which refugees trust financial institutions and decreases with the degree to which refugees' close friends are from the same ethnic group. Country of origin, religious affiliation, and religiosity are strong predictors in many specifications.

Background Polysomnography is the gold standard for measuring and detecting sleep patterns. In recent years, activity wristbands have become popular because they record continuous data in real time. Hence, comprehensive validation studies are needed to analyze the performance and reliability of these devices in the recording of sleep parameters. Objective This study compared the performance of one of the best-selling activity wristbands, the Xiaomi Mi Band 5, against polysomnography in measuring sleep stages. Methods This study was carried out at a hospital in A Coruña, Spain. People who were participating in a polysomnography study at a sleep unit were recruited to wear a Xiaomi Mi Band 5 simultaneously for 1 night. The total sample consisted of 45 adults, 25 (56%) with sleep disorders (SDis) and 20 (44%) without SDis. Results Overall, the Xiaomi Mi Band 5 displayed 78% accuracy, 89% sensitivity, 35% specificity, and a Cohen κ value of 0.22. It significantly overestimated polysomnography total sleep time (P=.09), light sleep (N1+N2 stages of non–rapid eye movement [REM] sleep; P=.005), and deep sleep (N3 stage of non-REM sleep; P=.01). In addition, it underestimated polysomnography wake after sleep onset and REM sleep. Moreover, the Xiaomi Mi Band 5 performed better in people without sleep problems than in those with sleep problems, specifically in detecting total sleep time and deep sleep. Conclusions The Xiaomi Mi Band 5 can be potentially used to monitor sleep and to detect changes in sleep patterns, especially for people without sleep problems. However, additional studies are necessary with this activity wristband in people with different types of SDis. Trial Registration ClinicalTrials.gov NCT04568408; https://clinicaltrials.gov/ct2/show/NCT04568408 International Registered Report Identifier (IRRID) RR2-10.3390/ijerph18031106

The analysis of the impacts on residential housing in the city of Seville by tourist rental has been the main objective that has guided the carrying out of this work. To achieve this the behavior of the rental of housing for tourist purposes, the evolution of the rental cost and the prices of the houses were characterized. The effects of tourist rental experienced by Sevillian residents were also examined. Organized resistance against the impact of intensive tourism in Seville is recent. The Collective Assembly against the Touristization of Seville (CACTUS) began to take its first steps a few years ago. Its members consider that the migration from residential to tourist-type rental not only expels the resident population, but that with the emptying of the neighborhoods, the solidarity networks that have been typical of Sevillian neighborhoods also disappear.

Traditional techniques to evaluate the efficiency to innovate of economic sectors face two difficulties: heterogeneous sectors, and uncertain and imprecise information. In this article, a methodolo...

Aim: The aim of this study is to evaluate long-term durability and effectiveness of the adjustable transobturator male system (ATOMS). Materials and methods: The retrospective multicenter Iberian ATOMS study (n = 215) was updated to evaluate long-term continence status, complications, explants, and secondary treatments. Mean follow-up from surgery to March 2020 was 60.6 ± 18.4 months (range, 39-91). Eleven patients deceased of an unrelated causes. Kaplan-Meier curves were performed to evaluate device durability and incontinence free of recurrence interval. The multivariate analysis defined the population at risk of device explant. Results: A total of 155 patients were dry at the last follow-up visit (72.1%); 99 (46%) used no pads and 56 (26%) used a security pad/day with urine loss less than 10 mL; 96% of dry patients after adjustment remained free of incontinence 1 year later, 93.6% 2 years later, 91.1% 3 years later, 89.2% 5 years later, and 86.7% 8 years later. Complications during follow-up occurred in 43 of 215 (20%). In total, 25 (11.6%) devices were explanted and causes were inefficacy 11 (44%), inefficacy and pain 3 (12%), port erosion 10 (40%), and wound infection 1 (4%). The secondary implant was performed in 11 (5.1%) cases, 6 artificial urinary sphincter and 5 repeated ATOMS. Time to explant was associated to complications (P < .0001), baseline stress urinary incontinence (SUI) severity (P = .01), and former irradiation (P = .03). Multivariate analysis revealed complications (hazard ratio [HR] = 8.71; 3.83-19.82), baseline SUI severity (>5 compared to 1-2 pads/day; HR = 14.9; 1.87-125), and irradiation before ATOMS (HR = 2.26; 1.02-5.18) predicted earlier ATOMS explant. Three cases received radiation after implant without complication. Conclusions: ATOMS device is efficacious and safe in the long term. Determinants for device explant include complications, baseline severity of incontinence, and previous irradiation. Currently, the durability of the device after 5 years is reassuring. Sin financiación 2.696 JCR (2020) Q3, 50/89 Urology & Nephrology 0.918 SJR (2020) Q1, 27/107 Urology No data IDR 2020 UEM

14 páginas, 3 figuras, 8 tablas., Background: Lower quantity and poorer sleep quality are common in most older adults, especially for those who live in a nursing home. The use of wearable devices, which measure some parameters such as the sleep stages, could help to determine the influence of sleep quality in daily activity among nursing home residents. Therefore, this study aims to analyse the influence of sleep and its changes concerning the health status and daily activity of older people who lived in a nursing home, by monitoring the participants for a year with Xiaomi Mi Band 2. Methods: This is a longitudinal study set in a nursing home in [Details omitted for double-anonymized peer reviewed]. The Xiaomi Mi Band 2 will be used to measure biomedical parameters and different assessment tools will be administered to participants for evaluating their quality of life, sleep quality, cognitive state, and daily functioning. Results: A total of 21 nursing home residents participated in the study, with a mean age of 86.38 ± 9.26. The main outcomes were that sleep may influence daily activity, cognitive state, quality of life, and level of dependence in activities of daily life. Moreover, environmental factors and the passage of time could also impact sleep. Conclusions: Xiaomi Mi Band 2 could be an objective tool to assess the sleep of older adults and know its impact on some factors related to health status and quality of life of older nursing homes residents. Trial Registration: NCT04592796 (Registered 16 October 2020) Available on: https://clinicaltrials.gov/ct2/show/NCT04592796, The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the CITIC by the European Regional Development Fund – Galicia 2014–2020 Program, Handytronic chair (grant number 523/2017) Scholarships to develop a PhD thesis by the European Social Fund, National Program of R+D+i oriented to the Challenges of Society 2019 (grant numbers ED431G-2019/01, ED481A-2019/069, PRE2020-094308, PID2019-104323RB-C33)

Advances achieved in recent decades regarding cardiac surgery have revealed a new risk that goes beyond surgeons’ dexterity; post-operative hours are crucial in these patients and are usually spent at intensive care units (ICUs), where they need to be continuously monitored to adjust the treatments. Clinical decision support systems (CDSS) have been developed to take this real-time information and provide clinical suggestions to physicians, so as to reduce medical errors and increase patient recovery ratio. In this review, an initial total of 666 papers were considered, finishing with 23 of them after the researchers’ filter, which included the deletion of duplications and exclusion if the title and abstract were not of real interest. The review of these papers concludes the applicability and extends the CDSS offer to both doctors and patients. Better prognosis and recovery rate are achieved by using this technology, which also has high acceptance among most physicians. However, despite the evidence that well-designed CDSS are effective, they still need to be refined to offer the best assistance as possible, which may still take time, despite the promising models that have already been applied in real ICUs.

[EN]: [Introduction]: Methicillin-resistant Staphylococcus aureus (MRSA) is considered a major cause of healthcare-associated (HA) and community-acquired (CA) infections. Considering non-β-lactam susceptibility as a potential marker for mecC-MRSA and CA-MRSA, the aim of this study was to determine the frequency and the associated genetic lineages of non-beta-lactam-antibiotic susceptible MRSA (NBLS-MRSA) strains in a multicenter study in Spain. [Methods]: A collection of 45 NBLS-MRSA strains recovered in the period from January to June 2016 from 12 Spanish hospitals was analyzed. Molecular typing through spa-type characterization, agr group and multi-locus-sequence typing was performed. Methicillin-resistant genes (mecA and mecC) as well as immune evasion cluster (scn-chp-sak-sea-sep, considering scn gene as the marker of IEC system) and Panton-Valentine leukocidin (PVL) genes were determined with PCR/sequencing. [Results]: The NBLS-MRSA phenotype was uncommon in the 12 hospitals analyzed (NBLS-MRSA/MRSA frequency: 0.3%-7.7%). All strains contained the mecA gene (and none contained mecC). Twenty-two different spa-types were detected among NBLS-MRSA strains, with spa-t008/agr-I the most prevalent (27%). The main clonal complexes were (CC/%): CC8/42.2%, CC5/33.3% and CC30/4.4%, with ST8 and ST5 as the main sequence types. The PVL toxin was present in 38% of strains (with spa-types t008, t024, t019, t044, t068, t318 and t3060). The IEC genes were detected in 78% of strains: IEC type-B (n = 17), type-F (n = 16), type-A (n = 1) and type-E (n = 1); 10 MRSA isolates were scn-negative. [Conclusion]: The NBLS-MRSA phenotype is uncommon in the analyzed hospitals; although no mecC-positive strains were detected, it could be a good marker for MRSA PVL-positive isolates (38%), frequently associated with CA-MRSA infections. [ES]: [Introducción]: Staphylococcus aureus resistente a meticilina (SARM) es una de las principales causas de infecciones tanto relacionadas con la asistencia sanitaria como asociadas a la comunidad (AC). Considerando la sensibilidad a antibióticos no-β-lactámicos como marcador potencial de SARM-mecC y SARM-AC, el objetivo de este estudio fue determinar la frecuencia y líneas genéticas de cepas SARM sensibles a antibióticos no-β-lactámicos (SARM-SNBL) en un estudio multicéntrico en España. [Métodos]: Se analizaron 45 cepas SARM-SNBL procedentes de 12 hospitales obtenidas durante enero-junio de 2016. El tipado molecular se realizó mediante caracterización del spa-tipo, grupo agr y multi-locus-sequence typing. Mediante PCR/secuenciación se determinaron los genes: de resistencia a meticilina (mecA y mecC), del sistema de evasión inmune humano (scn-chp-sak-sea-sep, usando scn como marcador del sistema IEC) y de la leucocidina de Panton-Valentine (LPV). [Resultados]: El fenotipo SARM-SNBL fue infrecuente en los 12 hospitales analizados (frecuencia SARM-SNBL/SARM: 0,3-7,7%). Todas las cepas fueron mecA-positivas (ninguna mecC). Se detectaron 22 spa-tipos diferentes, siendo el spa-t008/agr-I el prevalente (27%). Los principales complejos clonales fueron (CC/%): CC8/42,2%, CC5/33,3% y CC30/4,4%, destacando las secuencias tipo ST8 y ST5 como mayoritarias. El 38% de las cepas fue LPV-positiva (spa-tipos t008, t024, t019, t044, t068, t318 y t3060). El 78% de las cepas fue IEC-positivo: tipo-B (n = 17), tipo-F (n = 16), tipo-A (n = 1) y tipo-E (n = 1); 10 aislados fueron scn-negativos. [Conclusión]: El fenotipo SARM-SNBL es poco frecuente en los hospitales analizados; aunque no se detectaron cepas mecC-positivas, este fenotipo puede ser un buen marcador de aislados SARM LPV-positivos, frecuentemente asociados a infecciones por SARM-AC.

We study determinants of happiness—a subjective measure of wellbeing—for roughly 600 refugees from over 30 different countries currently residing in Utica, NY. For refugees from the former Soviet Union, the former Yugoslavia and Southeast Asia, having many friends from one’s own ethnic group is strongly positively correlated with happiness in Utica, while, for African refugees, English-language skills are a strong determinant of happiness with living in their local area. Income is only modestly related to the happiness of refugees in general, though the results vary by group. We do find strong evidence that those with children are happier than those without. These last two results represent departures from much of the broader literature on happiness in the United States.

Backgrounds Patient-reported outcome measurements are important for urinary incontinence. We analyze self-assessed patient satisfaction and defne the clinical profle of patient with highest satisfaction with the adjustable transobturator male system (ATOMS). Methods Patient perception of results was evaluated in a series of 181 patients after ATOMS adjustment. Baseline incontinence severity was defned in pads-per-day (PPD) as mild (2), moderate (3–5) or severe (≥6), and dryness as use of none or one security PPD. Post-operative pain at discharge was evaluated by 0–10 visual analogue scale and complications by Clavien–Dindo classifcation. Multivariate analysis was performed to anticipate “very much better” than baseline perception on patient global impression of improvement and a predictive nomogram was developed. Results Dryness was achieved in 80.7% (94.9% mild, 80.8% moderate and 65.8% severe groups). Mean pad-test and padcount decrease with respect to baseline was 458±330 ml and 3.2±1.9 PPD, respectively (both p

This paper explores the risk and return characteristics of a large and diverse cross section of 254 cryptocurrencies that differ in traded volume and main usage. First, we find long memory, volatility clustering, heavy tails, and negative leverage effects to be common features of cryptocurrencies’ return behavior. Second, GARCH models accounting for these features provide the best goodness-of-fit properties. About 80% of cryptocurrencies are well described by Student's t (stud) GARCH specifications with the TGARCH-stud chosen for about 20% of the sample. We then compare out-of-sample 1%-Value-at-Risk (VaR) forecasts under 48 specifications using standard backtesting procedures. Heavy-tailed VaR specifications outperform all normally distributed alternatives. Throughout the analysis, differences emerge when results are broken down by traded volume and usage categories. Overall, our findings have important implications for investors, policymakers, and regulators for the understanding and measuring of market risk in the cryptocurrency market.

BACKGROUND This paper has shown the results derived from the implementation of two editions of a Massive Online Open Course (MOOC) that focused on the use and application of technology resources, most of which were free, to promote participation and intervention amongst people with disabilities. That is the only one MOOC focused on providing information to professionals about different tools to promote technology’s participation of people with disabilities. The study provides initial evidence of the rates for a MOOC with blended learning and tips to motivate the participants. OBJECTIVE The goals were (a) to describe the profile of person enrolled on a MOOC based on promoting the participation of people with disabilities, and (b) to analyse the behavior and progression of participants in the MOOC and their satisfaction with the educational resources provided. METHODS The MOOC was implemented using the tools of the MIRIADAX platform. This allowed the incorporation of plain text, multimedia resources (self-recording videos), links to complementary information, and an evaluation process. The study design was based on quantitative and qualitative data. The quantitative data from the two questionnaires and from MIRIADAX were analysed using various statistical methods. As has been noted, the MOOC had two editions. RESULTS Both editions had 1440 persons enrolled, but the course was completed by 254 participants in the first edition and 195 in the second one. The rates of completion were high relative to other courses, with 42.83%, and 51.31%. The general participant profile was that of a woman between the ages of 25 and 34, living in Spain, and studying at university. High quality of learning resources, blended learning and weekly challenges to promote participation were the main factors for the success of this MOOC. CONCLUSIONS Features of an Effective MOOC were identified: Topic of interest, Quality multimedia resources, Complementary documentation, Promotion of student participation, Straightforward ways to evaluate the participants, Duration of the MOOC. The analysis of results and comparison with previous research have enabled some key conclusions to be drawn and considered when designing, editing, and implementing successful MOOCs in the future.

Proceeding paper [Abstract] This study explores the potential of music as a therapy element in digital therapy programs to improve mental health and well-being. Music induces an emotional component in the individual that translates into changes in their brain activity, which can be monitored through electroencephalography. A scoping review was conducted to identify the most recent relevant publications related to the effect of music on brain activity and emotional state in digital therapy programs. From 585 identified publications, six relevant publications were selected that meet all the requirements defined in the study.

[Abstract] Background: Presently the use of technological devices such as wearable devices has emerged. Physical activity monitoring with wearable sensors is an easy and non-intrusive approach to encourage preventive care for older adults. It may be useful to follow a continuous assessment of the risk of falling. The objective is to explore the relationship between the daily activity measured by Xiaomi Mi Band 2 and the risk of falling of older adults residing in or attending care facilities. Methods: A cross-sectional study was conducted on three different institutions located in Galicia (autonomous community) (Spain). Results: A total of 31 older adults were included in the study, with a mean age of 84 ± 8.71 years old. The main findings obtained were that a greater number of steps and distance could be related to a lower probability of falling, of dependency in basic activities of daily living, or of mobility problems. Conclusions: The importance of focusing on daily steps, intrinsically related to the objective assessment of daily physical activity, is that it is a modifiable factor that impacts different aspects of health and quality of life. Xunta de Galicia; IN852A 2016/10 GERIA-TIC project co-funded by the Galician Innovation Agency (GAIN) through the Connect P.E.M.E. Program (third edition) (IN852A 2016/10) and European Union F.E.D.E.R. funds.

The interactivity of an immersive environment comes up from the relationship that is established between the user and the system. This relationship results in a set of data exchanges between human and technological actors. The real-time biofeedback devices allow to collect in real time the biodata generated by the user during the exhibition. The analysis, processing and conversion of these biodata into multimodal data allows to relate the stimuli with the emotions they trigger. This work describes an adaptive model for biofeedback data flows management used in the design of interactive immersive systems. The use of an affective algorithm allows to identify the types of emotions felt by the user and the respective intensities. The mapping between stimuli and emotions creates a set of biodata that can be used as elements of interaction that will readjust the stimuli generated by the system. The real-time interaction generated by the evolution of the user’s emotional state and the stimuli generated by the system allows him to adapt attitudes and behaviors to the situations he faces.

[Abstract] Background: Work stress is one of the most relevant issues in public health. It has a significant impact on health, especially the development of mental disorders, causing occupational imbalance. There is a growing interest in the development of tools with a positive effect on workers. To this end, wearable technology is becoming increasingly popular, as it measures biometric variables like heartbeat, activity, and sleep. This information may be used to assess the stress a person is suffering, which could allow the development of stress coping strategies, both at a professional and personal level. (2) Methods: This paper describes an observational, analytical, and longitudinal study which will be set at a research center in A Coruña, Spain. Various scales and questionnaires will be filled in by the participants throughout the study. For the statistical analysis, specific methods will be used to evaluate the association between numerical and categorical variables. (3) Discussion: This study will lay the foundation for a bigger, more complete study to assess occupational stress in different work environments. This will allow us to begin to understand how occupational stress influences daily life activity and occupational balance, which could directly enhance the quality of life of workers if the necessary measures are taken. This work is supported in part by some grants from the European Social Fund 2014–2020. CITIC (Research Centre of the Galician University System) and the Galician University System (SUG) obtained funds through the Regional Development Fund (ERDF) to cover 80% of the Operational Program ERDF Galicia 2014–2020, and the remaining 20% was obtained by the Secretaría Xeral de Universidades of the Galician University System (SUG). Specifically, the author P.C.M. obtained a scholarship (Ref. ED481A-2019/069), and the author M.D.C.M.-D. (Ref. ED481A 2018/205) to develop the Ph.D. thesis. Furthermore, the diffusion and publication of this research are funded by the CITIC, as the Research Centre by Galician University System, with the support previously mentioned (Ref ED431G 2019/01). In addition, this work is also supported in part by the Ministerio de Ciencia e Innovación R+D+I projects in the framework of the national programs of knowledge generation and scientific and technological strengthening of the R+D+I system, and challenges of society’s oriented R+D+I 2019 call (PID2019-104323RB-C33)

[Abstract] The advances achieved in recent decades regarding cardiac surgery have led to a new risk that goes beyond surgeons’ dexterity; postoperative hours are crucial for cardiac surgery patients and are usually spent in intensive care units (ICUs), where the patients need to be continuously monitored to adjust their treatment. Clinical decision support systems (CDSSs) have been developed to take this real-time information and provide clinical suggestions to physicians in order to reduce medical errors and to improve patient recovery. In this review, an initial total of 499 papers were considered after identification using PubMed, Web of Science, and CINAHL. Twenty-two studies were included after filtering, which included the deletion of duplications and the exclusion of titles or abstracts that were not of real interest. A review of these papers concluded the applicability and advances that CDSSs offer for both doctors and patients. Better prognosis and recovery rates are achieved by using this technology, which has also received high acceptance among most physicians. However, despite the evidence that well-designed CDSSs are effective, they still need to be refined to offer the best assistance possible, which may still take time, despite the promising models that have already been applied in real ICUs. Xunta de Galicia; ED431C 2018/49

Background: Assistive Technology (AT) refers to “assistive products and related systems and services developed for people to maintain or improve functioning and thereby to promote well-being”. Improving the process of design and creation of assistive products is an important step towards strengthening AT provision. Purpose: (1) to present a framework for designing and creating Low-Cost AT, (2) to display the preliminary results and evidence derived from applying the framework. Methodology: First, an evidence-based process was applied to develop and conceptualize the framework. Then, a pilot project to validate the framework was carried out. The sample was formed by 11 people with disabilities. The measure instruments were specific questionnaire, several forms of the Matching Person-Technology model, the Psychosocial Impact of Assistive Device Scale, and a tool to assess the usability and universal design of AT. Results: The framework integrates three phases: Identification (Design), Creation (Making the prototype), and Implementation (Outcome Measures), based on the principles of Design Thinking, and with a user-centered perspective. The preliminary results showed the coherence of the entire process and its applicability. The matching between person and device was high, representing the importance of involving the user in the design and selection of AT. Conclusions: The framework is a guide for professionals and users to apply a Low-Cost and Do-It-Yourself perspective to the provision of AT. It highlights the importance of monitoring the entire procedure and measuring the effects, by applying the outcome measures.

In this article, a multi-criteria approach is proposed to prioritize user-stories in an Agile Software Development environment. User-stories are characterized by their interdependencies and the effort of development. The PROMETHEE II multi-criteria method is proposed as a technique to find a ranking of user-stories, but it needs information about preference thresholds and criteria weights. These parameters are considered stochastic variables and a simulation process is performed to explore robustness of the user-stories prioritization. We show that the information provided by the approach reveals zones of ambiguity in which some user-stories cannot be ranked. An example illustrates this approach and its utility is analyzed. Limitations of the approach are discussed and future research is proposed.

[Resumo] Neste capítulo, preséntase a experiencia de creación e dinamización do MOOC “Tecnoloxías para a Participación Activa na Diversidade Funcional”, impartido a través de Miríadax entre Xaneiro e Febreiro de 2019, e orientado á transferencia de coñecemento á sociedade sobre as potencialidades ofrecidas pola tecnoloxía para facilitar a participación e a autonomía das persoas con diversidade funcional. O curso estruturouse en catro módulos centrais, conformados por textos, vídeos, test de autoavaliación e outros materiais complementarios con información de referencia sobre a temática. Para a dinamización do curso, empregáronse: correos masivos, foro, retos semanais e comunidade en Google+. Os resultados superaron as expectativas iniciais do equipo docente, acadando cotas elevadas de participación e satisfacción entre o alumnado, e finalizando con éxito a formación máis de 250 persoas. Destacou especialmente a participación voluntaria nos retos semanais e na comunidade de Google+, na que se publicaron máis de 80 materiais orixinais elaborados polo alumnado. Así, nesta primeira experiencia púidose cumprir co obxectivo de transferencia de coñecemento á sociedade, e facelo a través dunha ferramenta gratuíta e interactiva. Os resultados obtidos permiten concluír que tanto os contidos abordados como as metodoloxías e materiais empregados, foron axeitados para favorecer a aprendizaxe e a motivación do alumnado. [Abstract] This chapter presents the experience of creation and dynamization of the MOOC "Technologies for Active Participation in Functional Diversity", developed through Miríadax between January and February 2019, and oriented to the transfer of knowledge to society about the potentialities offered by technology to facilitate the participation and autonomy of people with functional diversity. The course was structured in four central modules, made up of texts, videos, self-assessment tests and other complementary materials with reference information on the subject. For the dynamization of the course, the following were used: mass mailings, forum, weekly challenges and community on Google+. The results exceeded the initial expectations of the teaching team, achieving high levels of participation and satisfaction among the students; more than 250 people successfully completed the training. The voluntary participation in the weekly challenges and in the Google+ community was particularly noteworthy, with more than 80 publications with original materials produced by the students. Thus, in this first experience it was possible to meet the objective of transferring knowledge to society, through a free and interactive tool. The results obtained allow concluding that both the contents approached and the methodologies and materials used were adequate to promote learning and motivation of students.

Art has a power different from all other human actions; it can produce a variety of human emotions like nothing else. The main purpose of this chapter is to study the relation between media arts and emotions. Virtual environments are increasingly being used by artists; the use of immersive environments allows the media art artist to go further than express himself, allows that through contemplation and interaction the participant also becomes part of the artistic artefact. Immersive environments can induce emotional changes capable of generating states of empathy. Considering an immersive environment as a socio-technical system, where human and non-human elements interact, establishing strong relationships, the authors used actor-network theory as an approach to design an immersive artifact of digital media art. The use of neurofeedback mechanisms during the participant's exposure to immersive environments opens doors to new types of interaction, allowing to explore emotional states to generate empathy.

Importance: The Developmental Coordination Disorder Questionnaire (DCDQ) is the most widely used measure of difficulties with activities of daily living and academic performance in children with developmental coordination disorder, but this tool has not been adapted for use in Spain. Objective: To translate and cross-culturally adapt the DCDQ into European Spanish (DCDQ–ES) for use in assessing motor coordination in Spanish children. Design: Cross-cultural adaptation and preliminary validation study. Setting: Community and mainstream schools in Spain. Participants: A committee of five experts oversaw the cross-cultural adaptation process. A community-based convenience sample of 31 parents of children ages 5–14 yr was used to test the comprehensibility of the DCDQ–ES. Preliminary reliability was tested with 35 randomly selected parents of children ages 6–12 yr. Outcomes and Measures: The DCDQ was translated into European Spanish and cross-culturally adapted following international guidelines. Comprehensibility was assessed using cognitive debriefing interviews. The final version of the DCDQ–ES was used for the reliability analysis. Results: Cultural relevance and equivalence and idiomatic differences between the DCDQ and DCDQ–ES were evaluated. Comprehensibility analysis led to minor modifications that facilitated comprehension and interpretation. Internal consistency and homogeneity of the DCDQ–ES were good (Cronbach’s α = .857, corrected item–total correlations = .268–.692). Conclusions and Relevance: The DCDQ–ES is conceptually and semantically equivalent to DCDQ and was successfully cross-culturally adapted for the European Spanish context. Preliminary data suggest that the DCDQ–ES is a reliable measure of motor coordination in Spanish children. What This Article Adds: This study provides evidence of the cultural equivalence of the DCDQ–ES for use with Spanish children. Occupational therapists in Spain can use the DCDQ–ES to evaluate children’s motor coordination difficulties in everyday activities.

[Abstract] The exploitation of electronic health records (EHRs) has multiple utilities, from predictive tasks and clinical decision support to pattern recognition. Artificial Intelligence (AI) allows to extract knowledge from EHR data in a practical way. In this study, we aim to construct a Machine Learning model from EHR data to make predictions about patients. Specifically, we will focus our analysis on patients suffering from respiratory problems. Then, we will try to predict whether those patients will have a relapse in less than 6, 12 or 18 months. The main objective is to identify the characteristics that seem to increase the relapse risk. At the same time, we propose an exploratory analysis in search of hidden patterns among data. These patterns will help us to classify patients according to their specific conditions for some clinical variables. Centro de Investigación de Galicia CITIC is funded by Consellería de Educación, Universidades e Formación Profesional from Xunta de Galicia and European Union (European Regional Development Fund—FEDER Galicia 2014-2020 Program) by grant ED431G 2019/01. Partially supported by the Spanish Ministry of Science (Challenges of Society 2019) PID2019-104323RB-C33 Xunta de Galicia; ED431G 2019/01

[Resumen] La presente propuesta consiste en un estudio comparativo de una selección de herramientas tecnológicas destinadas a la creación de actividades interactivas, basadas en la gamificación, mediante las cuales se favorece la implementación de metodologías activas y participativas en las aulas, con diferentes grupos de estudiantes. Por lo tanto, se establece como objetivo principal potenciar la implementación de estas herramientas interactivas en las aulas, comparando sus principales características y dando a conocer los puntos fuertes de cada una, en función de las necesidades existentes en el aula. En cuanto a la metodología empleada, se realizó un análisis comparativo de un total de 10 herramientas. Las variables a analizar fueron: registro, coste, idioma, perfil de acceso, dificultad de uso, guía de uso y asistente virtual, accesibilidad, modalidad de funcionamiento de las actividades, modalidad de acceso a las actividades, inserción de material multimedia, visualización previa de actividades, gestión de respuestas, análisis de respuestas, compatibilidad con otras herramientas, y afinidad con distintos dispositivos y sistemas operativos. En base a los resultados obtenidos, se establece como conclusión que el profesorado dispone de una gran variedad de recursos tecnológicos que le permiten crear múltiples tipos de actividades interactivas e implementarlas de forma fácil en el aula. [Abstract] The present proposal consists of a comparative study of a technological tools selection aimed at creating interactive activities, based on gamification, through which is favoured the implementation of active and participatory methodologies in the classroom, with different groups of students. Therefore, the main objective is to promote the implementation of these interactive tools in the classroom, comparing their main characteristics and advertising the strengths of each one, according to the existing needs in the classroom. Regarding the methodology used, a comparative analysis of a total of 10 tools was carried out. The variables were: registration, cost, language, access profile, difficulty of use, user's guide and virtual assistant, accessibility, functioning mode of the activities, access mode to the activities, insertion of multimedia material, previous visualisation of activities, answers management, answers analysis, compatibility with other tools, and affinity with different devices and operating systems. Based on the results obtained, it is established as a conclusion that professors have a great variety of technological resources that allow them to create multiple types of interactive activities and implement them easily in the classroom.

The Developmental Coordination Disorder Questionnaire (DCDQ) is a widely used and well-validated tool that contributes to the diagnosis of Developmental Coordination Disorder (DCD). The aim of this study was to further analyze the psychometric properties of the European Spanish cross-culturally adapted version of the Developmental Coordination Disorder Questionnaire (DCDQ-ES) in a sample of Spanish children aged 6&ndash, 11 years and to establish reference norms with respect to age groups. Parents of 540 typically developing children completed the DCDQ-ES. A second sample of 30 children with probable DCD (pDCD) was used to test its discriminant validity. Confirmatory factor analysis supported the original three-factor structure and the internal consistency was excellent (Cronbach&rsquo, s &alpha, = 0.907). Significant differences between age groups were found. The pDCD group scored significantly lower than the reference sample in the three subscales and DCDQ-ES total score (p &lt, 0.001, AUC = 0.872). The DCDQ-ES is a reliable and valid tool for screening motor coordination difficulties in Spanish children and for identifying children with probable DCD. The findings of this research suggest that context-specific cut-off scores should be systematically utilized when using cross-cultural adaptations of the DCDQ. Age-specific cut-off scores for Spanish children are provided.

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Developmental Coordination Disorder (DCD) is one of the most prevalent neurodevelopmental disorders in school-aged children, with major consequences in psychosocial and physical health. Adequate identification of this disorder is necessary to prompt effective interventions. The aims of this study were to develop the Spanish adjusted reference norms for the DCDDaily-Q and to test the correlation and agreement between the Spanish versions of the DCDDaily-Q (DCDDaily-Q-ES) and the Developmental Coordination Disorder Questionnaire (DCDQ-ES), two reliable instruments to assess motor performance and DCD. Clinically relevant percentiles were calculated for the DCDDaily-Q-ES using a representative sample of Spanish children aged 5 to 10 years (n = 356, M = 7.3 years, SD = 1.8, boys = 50%). Pearson&rsquo, s correlation coefficient and intraclass correlation coefficient (ICC) were used to determine correlation and agreement between questionnaires, respectively. A moderate and significant correlation and agreement between DCDDaily-Q-ES and DCDQ-ES was found (r = 0.406, ICC = 0.381, p &lt, 0.001). Differences in daily participation and performance were found between age groups, but not between boys and girls. Spanish age-adjusted percentiles and cutoff scores for DCDDaily-Q-ES are provided. This study offers further validation and relevant information regarding assessment of DCD and has practical implications for clinical practice and research.

Selection of a retail location is a strategic decision-making problem that involves the long-term commitment of resources. However, very often managers look for several candidate locations that can be incorporated in a business plan. In this article, a case study developed in a large Brazilian company is presented where managers required to identify a set of interesting locations in a context of imprecise and qualitative information. ELECTRE TRI-C is applied, a multi-criteria decision analysis sorting method in which representative reference alternatives are used to model preference ordered categories, a priori. Trapezoidal fuzzy numbers (TrFNs) are used as input in ELECTRE TRI-C, which allows: (1) imprecision and uncertainty parameters to be set in a very transparent way; (2) in the case of qualitative criteria, to define a category by providing information about reference alternatives in the form of the membership degree of verbal values, a feature that was not available so far in this method; (3) the outranking indices to be calculated such that the rationale of assignment rules is preserved; (4) the proliferation of fuzzy numbers to evaluate alternatives to be avoided, thus reducing the cognitive effort of the decision maker. TrFNs obtained in a previous analysis are used in the case study, thereby showing the advantages of the approach.

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galegoEste traballo xestouse no Grupo de Innovacion Educativa “Gamificacion e interactividade nas aulas” da Universidade da Coruna. Como principal obxectivo planeouse determinar o potencial da creacion de contidos interactivos dentro das presentacions de diferentes materias mediante tecnoloxias coma os clickers on-line e ferramentas de gamificacion para captar a atencion do alumnado. A comunicacion presenta os resultados do emprego das enquisas online e en tempo real, a traves de diversas aplicacions, coma AnswerGarden, Kahoot e Mentimeter. A metodoloxia interactiva aplicouse en materias do Grao en Terapia Ocupacional e na Universidade Senior da Universidade da Coruna. Os participantes activos incluen aos propios docentes, estudantes xoves (entre 19 e 25 anos) e persoas maiores de 50 anos (Universidade Senior). Os estudantes de 2o e 3o de Terapia Ocupacional (n=105) participaron nas enquisas (media de 6 consultas online por materia). Na Universidade Senior, 30 estudantes reflectiron as suas percepcions sobre diferentes tematicas como saude, benestar e envecellemento e manifestaron os conecementos acadados sobre o uso das TIC. Nesta primeira experiencia, comprobouse que a gamificacion pode ser aplicada nos contornos universitarios con diferentes grupos de estudantes. A participacion e visualizacion dos resultados producese en tempo real, ofrecendo unha retroalimentacion inmediata e contribuindo a aprendizaxe de contidos especificos. EnglishThe present work was created by Group of Educative Innovation “Gamification and interactivity in classrooms” of Universidade da Coruna. The main proposal was to determine the potential derivate from the creation of interactive contains on presentation of few subjects through technologies. One example of that is the use of clickers online and tools for gamification to get the attention from students. The paper presents the results from the use of online and on time enquires through diverse applications, like AnswerGarden, Kahoot and Mentimeter. The interactive methodology was applied in subjects of Degree in Occupational Therapy and of Senior University. The active participants were the own teachers, young students (19 – 25 years old) and people with more than 50 years (Senior University). The students from 2 and 3 course of Occupational Therapy (n=105) participated on enquires (main of 6 consults by subject). In Senior University, 30 students reflected their perceptions about different subjects, as health, wellbeing and aging, and exposed their own knowledge about ICT. In that first experience, authors checked that gamification can be applied along universities contexts with different groups of students. The participation and display of results occur in real time, offering an immediate feedback and contributing to the knowledge of specific contains.

We consider the effect of adaptive model selection and regularization by agents on price volatility and market stability in a simple agent-based model of a financial market. The agents base their trading behavior on forecasts of future returns, which they update adaptively and asynchronously through a process of model selection, estimation, and prediction. The addition of model selection and regularization methods to the traders' learning algorithm is shown to reduce but not eliminate overfitting and resulting excess volatility. Our results suggest that even a high degree of attention to overfitting on the part of traders who are engaged in data mining is unlikely to entirely eliminate destabilizing speculation. They also accord well with the empirical ``sparse signals" and ``pockets of predictability" findings of Chinco, Clark-Joseph and Ye (2019) and Farmer, Schmidt and Timmermann (2019).

(1) Background: The study is focused on the implementation of outcome measurement tools to assess the impact of an assistive device from a loan bank in the lives of people with Amyotrophic Lateral Sclerosis and Neuromuscular Diseases. The secondary purpose is to analyse the correct matching between the person and technology, derived from the counselling of an occupational therapist. (2) Methods: Cross-sectional study. The sample was formed by 28 people with rare neurodegenerative disorders. A specific questionnaire, the Psychosocial Impact of Assistive Device Scale (PIADS), and the Matching Person and Technology (MPT) tool were applied to collect the data. (3) Results: The dimension of the PIADS with the best score was competence, and the variations according to gender were not remarkable. The three dimensions of the PIADS (competence, adaptability, and self-esteem) were correlated positively between them and with the mean score of the MPT tool (p &lt, 0.01). The type of assistive technology (AT), diagnosis, and correct match between person&ndash, technology are the main factors that condition a positive impact. (4) Conclusions: The results noted the importance of assessing the needs, demands, and contexts of people with rare neurodegenerative diseases to prescribe the best AT. Loan banks of AT have to be considered a valid service that complements their lack in public health services.

The electrophysiological alterations in nerves due to diabetes are classically studied in relation to their instantaneous frequency, conduction velocity and amplitude. However, analysis of amplitude variability may reflect the occurrence of feedback loop mechanisms that adjust the output as a function of its previous activity could indicate fractal dynamics. We assume that a peripheral neuropathy, such as that evoked by diabetes, the inability to maintain a steady flow of sensory information is reflected as a breakdown of the long range power-law correlation of CAP area fluctuation from cutaneous nerves. To test this, we first explored in normal rats whether fluctuations in the trial-to-trial CAP area showed a self-similar behavior or fractal structure by means of detrended fluctuations analysis (DFA), and Poincare plots. In addition, we determine whether such CAP fluctuations varied by diabetes induction. Results showed that CAP area fluctuation of SU nerves evoked in normal rats present a long term correlation and self-similar organization (fractal behavior) from trial to trial stimulation as evidenced by DFA of CAP areas. However, CAPs recorded in diabetic nerves exhibited significant reductions in area, larger duration and increased area variability and different Poincare plots than control nerves. The Hurst exponent value determined with the DFA method from a series of 2000 CAPs evoked in diabetic SU nerves was smaller than in control nerves. It is proposed that in cutaneous nerves of normal rats variability of the CAP area present a long term correlation and self-similar organization (fractal behavior), and reflect the ability to maintain a steady flow of sensory information through cutaneous nerves. Nevertheless, this is not the case for sural nerves of diabetic rats which is reflected as a breakdown of the long range power-law correlation of CAP area fluctuation. Nonlinear time series analysis of CAP area fluctuations is a valuable new insight tool that can be used for the study of alterations in transmission of sensory information in humans suffering diabetes or under other demyelination diseases.

espanolLa sifilis es una infeccion bacteriana causada por Treponema pallidum, se transmite principalmente por via sexual. La enfermedad tiene importancia no solo clinica sino tambien de salud publica, debido a su frecuencia. Las manifestaciones clinicas son muy variadas y van desde una ulcera o chancro hasta lesiones cutaneas diseminadas, cardiovasculares, neurologicas, oftalmologicas o articulares. Sin tratamiento, la enfermedad progresa durante anos y puede provocar complicaciones neurologicas y cardiacas. El diagnostico se basa principalmente en las manifestaciones clinicas e interpretacion de pruebas serologicas. A pesar de su antiguedad, los principios del tratamiento han permanecido estables hasta la actualidad. La penicilina es el tratamiento de eleccion. La respuesta al tratamiento se determina en base a los cambios de los titulos de anticuerpos durante meses tras el tratamiento. EnglishSyphilis is a bacterial infection caused by Treponema pallidum, it is mainly transmitted sexually. The disease is important not only clinical but also of public health, due to its frequency. The clinical manifestations are varied and range from an ulcer or chancre to disseminated skin lesions, cardiovascular, neurological, ophthalmological or joint. Without treatment, the disease progresses for years and can cause neurological and cardiac complications. The diagnosis is mainly based on clinical manifestations and interpretation of serological tests. Despite its age, the principles of treatment have remained stable until today. Penicillin is the treatment of choice. The response to treatment is determined based on changes in antibody titers for months after treatment.