In a crowded harbor water area, it is a major concern to control ship traffic for assuring safety and maximizing the efficiency of port operations. Vessel Traffic Service (VTS) operators pay much ...attention to caution areas like ship route intersections or traffic congestion area in which there are some risks of ship collision. They want to control the traffic of the caution area at a proper level to lessen risk. Inertial ship movement makes swift changes in direction and speed difficult. It is hence important to predict future traffic of the caution area earlier on so as to get enough time for control actions on ship movements. In the harbor area, VTS stations collect a large volume of Automatic Identification Service (AIS) sensor data, which contain information about ship movement and ship attributes. This paper proposes a new deep neural network model called Ship Traffic Extraction Network (STENet) to predict the medium-term traffic and long-term traffic of the caution area. The STENet model is trained with AIS sensor data. The STENet model is organized into a hierarchical architecture in which the outputs of the movement and contextual feature extraction modules are concatenated and fed into a prediction module. The movement module extracts the features of overall ship movements with a convolutional neural network. The contextual modules consist of five separated fully-connected neural networks, each of which receives an associated attribute. The separation of feature extraction modules at the front phase helps extract the effective features by preventing unrelated attributes from crosstalking. To evaluate the performance of the proposed model, the developed model is applied to a real AIS sensor dataset, which has been collected over two years at a Korean port called Yeosu. In the experiments, four methods have been compared including two new methods: STENet and VGGNet-based models. For the real AIS sensor dataset, the proposed model has shown 50.65% relative performance improvement on average for the medium-term predictions and 57.65% improvement on average for the long-term predictions over the benchmark method, i.e., the SVR-based method.
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Recently, the interplay between autophagy and apoptosis has become an important factor in chemotherapy for cancer treatment. Inhibition of autophagy may be an effective strategy to improve the ...treatment of chemo-resistant cancer by consistent exposure to chemotherapeutic drugs. However, no reports have clearly elucidated the underlying mechanisms. Therefore, in this study, we assessed whether salinomycin, a promising anticancer drug, induces apoptosis and elucidated potential antitumor mechanisms in chemo-resistant prostate cancer cells. Cell viability assay, Western blot, annexin V/propidium iodide assay, acridine orange (AO) staining, caspase-3 activity assay, reactive oxygen species (ROS) production, and mitochondrial membrane potential were assayed. Our data showed that salinomycin alters the sensitivity of prostate cancer cells to autophagy. Pretreatment with 3-methyladenine (3-MA), an autophagy inhibitor, enhanced the salinomycin-induced apoptosis. Notably, salinomycin decreased phosphorylated of AKT and phosphorylated mammalian target of rapamycin (mTOR) in prostate cancer cells. Pretreatment with LY294002, an autophagy and PI3K inhibitor, enhanced the salinomycin-induced apoptosis by decreasing the AKT and mTOR activities and suppressing autophagy. However, pretreatment with PD98059 and SB203580, an extracellular signal-regulated kinases (ERK), and p38 inhibitors, suppressed the salinomycin-induced autophagy by reversing the upregulation of ERK and p38. In addition, pretreatment with
-acetyl-l-cysteine (NAC), an antioxidant, inhibited salinomycin-induced autophagy by suppressing ROS production. Our results suggested that salinomycin induces apoptosis, which was related to ROS-mediated autophagy through regulation of the PI3K/AKT/mTOR and ERK/p38 MAPK signaling pathways.
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IMPORTANCE The number of geriatric patients who undergo surgery has been increasing, but there are insufficient tools to predict postoperative outcomes in the elderly. OBJECTIVE To design a ...predictive model for adverse outcomes in older surgical patients. DESIGN, SETTING, AND PARTICIPANTS From October 19, 2011, to July 31, 2012, a single tertiary care center enrolled 275 consecutive elderly patients (aged ≥65 years) undergoing intermediate-risk or high-risk elective operations in the Department of Surgery. MAIN OUTCOMES AND MEASURES The primary outcome was the 1-year all-cause mortality rate. The secondary outcomes were postoperative complications (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission), length of hospital stay, and discharge to nursing facility. RESULTS Twenty-five patients (9.1%) died during the follow-up period (median interquartile range, 13.3 11.5-16.1 months), including 4 in-hospital deaths after surgery. Twenty-nine patients (10.5%) experienced at least 1 complication after surgery and 24 (8.7%) were discharged to nursing facilities. Malignant disease and low serum albumin levels were more common in the patients who died. Among the geriatric assessment domains, Charlson Comorbidity Index, dependence in activities of daily living, dependence in instrumental activities of daily living, dementia, risk of delirium, short midarm circumference, and malnutrition were associated with increased mortality rates. A multidimensional frailty score model composed of the above items predicted all-cause mortality rates more accurately than the American Society of Anesthesiologists classification (area under the receiver operating characteristic curve, 0.821 vs 0.647; P = .01). The sensitivity and specificity for predicting all-cause mortality rates were 84.0% and 69.2%, respectively, according to the model’s cutoff point (>5 vs ≤5). High-risk patients (multidimensional frailty score >5) showed increased postoperative mortality risk (hazard ratio, 9.01; 95% CI, 2.15-37.78; P = .003) and longer hospital stays after surgery (median interquartile range, 9 5-15 vs 6 3-9 days; P < .001). CONCLUSIONS AND RELEVANCE The multidimensional frailty score based on comprehensive geriatric assessment is more useful than conventional methods for predicting outcomes in geriatric patients undergoing surgery.
Frailty is related to adverse outcomes in the elderly. However, current status and clinical significance of frailty have not been evaluated for the Korean elderly population. We aimed to investigate ...the usefulness of established frailty criteria for community-dwelling Korean elderly. We also tried to develop and validate a new frailty index based on a multidimensional model.
We studied 693 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA). We developed a new frailty index (KLoSHA Frailty Index, KFI) and compared predictability of it with the established frailty indexes from the Cardiovascular Health Study (CHS) and Study of Osteoporotic Fracture (SOF). Mortality, hospitalization, and functional decline were evaluated.
The prevalence of frailty was 9.2% (SOF index), 13.2% (CHS index), and 15.6% (KFI). The criteria from CHS and KFI correlated with each other, but SOF did not correlate with KFI. During the follow-up period (5.6 ± 0.9 years), 97 participants (14.0%) died. Frailty defined by KFI predicted mortality better than CHS index (c-index: 0.713 and 0.596, respectively; p<0.001, better for KFI). In contrast, frailty by SOF index was not related to mortality. The KFI showed better predictability for following functional decline than CHS index (area under the receiver-operating characteristic curve was 0.937 for KFI and 0.704 for CHS index, p = 0.001). However, the SOF index could not predict subsequent functional decline. Frailty by the KFI (OR = 2.13, 95% CI 1.04-4.35) and CHS index (OR = 2.24, 95% CI 1.05-4.76) were associated with hospitalization. In contrast, frailty by the SOF index was not correlated with hospitalization (OR = 1.43, 95% CI 0.68-3.01).
Prevalence of frailty was higher in Korea compared to previous studies in other countries. A novel frailty index (KFI), which includes domains of comprehensive geriatric assessment, is a valid criterion for the evaluation and prediction of frailty in the Korean elderly population.
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With evaluation for physical performance, measuring muscle mass is an important step in detecting sarcopenia. However, there are no methods to estimate muscle mass from blood sampling.
To develop a ...new equation to estimate total-body muscle mass with serum creatinine and cystatin C level, we designed a cross-sectional study with separate derivation and validation cohorts. Total body muscle mass and fat mass were measured using dual-energy x-ray absorptiometry (DXA) in 214 adults aged 25 to 84 years who underwent physical checkups from 2010 to 2013 in a single tertiary hospital. Serum creatinine and cystatin C levels were also examined.
Serum creatinine was correlated with muscle mass (P < .001), and serum cystatin C was correlated with body fat mass (P < .001) after adjusting glomerular filtration rate (GFR). After eliminating GFR, an equation to estimate total-body muscle mass was generated and coefficients were calculated in the derivation cohort. There was an agreement between muscle mass calculated by the novel equation and measured by DXA in both the derivation and validation cohort (P < .001, adjusted R2 = 0.829, β = 0.95, P < .001, adjusted R2 = 0.856, β = 1.03, respectively).
The new equation based on serum creatinine and cystatin C levels can be used to estimate total-body muscle mass.
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Digital technology to enable aging in place Kim, Kwang-il; Gollamudi, Shreya S.; Steinhubl, Steven
Experimental gerontology,
February 2017, 2017-02-00, 20170201, Volume:
88
Journal Article
Peer reviewed
Aging, both of individuals and populations, presents challenges and opportunities. The multitude of morbidities and disabilities that are a too common component of aging represent significant ...challenges to individuals, their families and to healthcare systems. Aging in place is the ability to safely and comfortably maintain an independent and high quality of life in one's own home and community and is a highly desirable goal of most individuals with the additional benefit of significantly impacting the impending enormous healthcare burden. In order to make this possible, new care models that take advantage of novel technologies for tracking important physiologic and safety parameters need to be developed and implemented. By thoughtfully doing so, it can be possible to seamlessly provide preventative interventions when and as needed, detect the earliest signs of aggravation of chronic conditions, or identify and respond to any emergency situations, such as falls or cardiac arrest. In contrast to current approaches, caring for elderly individuals in their homes based on a digital technology infrastructure could be effective and cost-saving. In this review, we provide an overview of the characteristics of potential digital solutions applicable to creative aging along with the existing evidence supporting their ability to improve care, increase quality of life, and substantially decrease the emotional and financial costs associated with aging.
•Aging in place is the ability to maintain an independent and high quality of life in one’s own home and community.•It would be facilitated by innovations in digital technologies on diagnosis, prevention, monitor, and treatment of chronic medical conditions.•Technological advancements and redesigning of systems of care are required to overcome challenges such as privacy issue, overloading data.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Vessel traffic volume and vessel traffic service (VTS) operator workloads are increasing with the expansion of global maritime trade, contributing to marine accidents by causing difficulties in ...providing timely services. Therefore, it is essential to have sufficient VTS operators considering the vessel traffic volume and near-miss cases. However, no quantitative method for determining the optimal number of workstations, which is necessary for calculating the VTS operator staffing level, has yet been proposed. This paper proposes a new, microscopic approach for calculating the number of workstations from vessel trajectories and voice recording communication data between VTS operators and navigators. The vessel trajectory data are preprocessed to interpolate different intervals. The proposed method consists of three modules: Information services, navigational assistance services, and traffic organization service. The developed model was applied to the Yeosu VTS in Korea. Another workstation should be added to the current workstation based on the proposed method. The results showed that even without annual statistical data, a reasonable VTS operator staffing level could be calculated. The proposed approach helps prevent vessel accidents by providing timely services even if the vessel traffic is congested if VTS operators are deployed to a sufficient number of workstations.
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The rock core test is the most direct and reliable way to measure fundamental physical, hydraulic, and mechanical properties for underground reservoir characterization. A 10-cm diameter and ...3.6-m-long granodiorite core was retrieved from a 4.2-km-deep geothermal well at the Pohang Enhanced Geothermal System (EGS) site in Korea. Numerous natural fractures were detected in the core and induced core disks were observed. We optimized the sample preparation with this limited core for various tests based on the scanned X-ray CT images that visualized all the fractures in the core. We measured the basic mechanical—the deformation and strength properties of intact rock—and thermal properties of intact samples. In particular, fracture deformation and strength properties were directly measured by conducting direct shear tests on pre-existing natural fractures. The seismic velocity and normal fracture stiffness were compared with the wireline logging and injection test measurements, respectively. The discrepancies between the in situ data and laboratory experiment are due to the stress dependency of properties. The measurements presented in this paper provide essential inputs for the EGS reservoir modelling and a dataset of properties for the fractured granite reservoir at a great depth from which few samples have been retrieved thus far.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Polypharmacy is an important issue in the care of older patients with cancer, as it increases the risk of unfavorable outcomes. We estimated the prevalence of polypharmacy, potentially ...inappropriate medication (PIM) use, and drug–drug interactions (DDIs) in older patients with cancer in Korea and their associations with clinical outcomes.
Subjects, Materials, and Methods
This was a secondary analysis of a prospective observational study of geriatric patients with cancer undergoing first‐line palliative chemotherapy. Eligible patients were older adults (≥70 years) with histologically diagnosed solid cancer who were candidates for first‐line palliative chemotherapy. All patients enrolled in this study received a geriatric assessment (GA) at baseline. We reviewed the daily medications taken by patients at the time of GA before starting chemotherapy. PIMs were assessed according to the 2015 Beers criteria, and DDIs were assessed by a clinical pharmacist using Lexi‐comp Drug Interactions. We evaluated the association between polypharmacy and clinical outcomes including treatment‐related toxicity, and hospitalization using logistic regression and Cox regression analyses.
Results
In total, 301 patients (median age 75 years; range, 70–93) were enrolled; the most common cancer types were colorectal cancer (28.9%) and lung cancer (24.6%). Mean number of daily medications was 4.7 (±3.1; range, 0–14). The prevalence of polypharmacy (≥5 medications) was 45.2% and that of excessive polypharmacy (≥10 medications) was 8.6%. PIM use was detected in 137 (45.5%) patients. Clinically significant DDIs were detected in 92 (30.6%) patients. Polypharmacy was significantly associated with hospitalization or emergency room (ER) visits (odds ratio: 1.73 1.18–2.55, p < .01). Neither polypharmacy nor PIM use showed association with treatment‐related toxicity.
Conclusion
Polypharmacy, PIM use, and potential major DDIs were prevalent in Korean geriatric patients with cancer. Polypharmacy was associated with a higher risk of hospitalization or ER visits during the chemotherapy period.
Implications for Practice
This study, which included 301 older Korean patients with cancer, highlights the increased prevalence of polypharmacy in this population planning to receive palliative chemotherapy. The prevalence of polypharmacy and excessive polypharmacy was 45.2% and 8.6%, respectively. The prescription of potentially inappropriate medications (PIMs) was detected in 45.5% and clinically significant drug–drug interaction in 30.6% of patients. Given the association of polypharmacy with increased hospitalization or emergency room visits, this study points to the need for increased awareness and intervention to minimize polypharmacy in the geriatric cancer population undergoing chemotherapy. Moreover, specific criteria for establishing PIMs should be adopted for the treatment of older adults with cancer.
There is limited information on polypharmacy in Asian older adults with metastatic cancer, especially for those undergoing palliative chemotherapy. This article reports on the prevalence of polypharmacy, potentially inappropriate medication use, and potential drug‐drug interactions in older patients with cancer in Korea.
Frailty is a common geriatric syndrome characterized by increased risk of disability, hospitalization, and mortality. Hypertension (HTN) is one of the most common chronic medical conditions in the ...elderly. However, there have been few studies regarding the association between frailty and HTN prevalence, treatment, and control rates. We analyzed data of 4,352 older adults (age ≥ 65 years) from the fifth Korea National Health and Nutrition Examination Survey. We constructed a frailty index based on 42 items and classified participants as robust, pre-frail, or frail. Of the subjects, 2,697 (62.0%) had HTN and 926 (21.3%) had pre-HTN. Regarding frailty status, 721 (16.6%), 1,707 (39.2%), and 1,924 (44.2%) individuals were classified as robust, pre-frail and frail, respectively. HTN prevalence was higher in frail elderly (67.8%) than pre-frail (60.8%) or robust elderly (49.2%) (P < 0.001). Among hypertensive patients, frail elderly were more likely to be treated than pre-frail or robust elderly (P < 0.001), but the proportion of patients whose blood pressure was under control ( < 150/90 mmHg) was lower in frail elderly (P = 0.005). Considering the adverse cardiovascular outcomes associated with frailty, more attention should be paid to the blood pressure control of the frail elderly.
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