AbstractObjectiveTo provide focused evaluation of predictive modeling of electronic medical record (EMR) data to predict 30 day hospital readmission.DesignSystematic review.Data sourceOvid Medline, ...Ovid Embase, CINAHL, Web of Science, and Scopus from January 2015 to January 2019.Eligibility criteria for selecting studiesAll studies of predictive models for 28 day or 30 day hospital readmission that used EMR data.Outcome measuresCharacteristics of included studies, methods of prediction, predictive features, and performance of predictive models.ResultsOf 4442 citations reviewed, 41 studies met the inclusion criteria. Seventeen models predicted risk of readmission for all patients and 24 developed predictions for patient specific populations, with 13 of those being developed for patients with heart conditions. Except for two studies from the UK and Israel, all were from the US. The total sample size for each model ranged between 349 and 1 195 640. Twenty five models used a split sample validation technique. Seventeen of 41 studies reported C statistics of 0.75 or greater. Fifteen models used calibration techniques to further refine the model. Using EMR data enabled final predictive models to use a wide variety of clinical measures such as laboratory results and vital signs; however, use of socioeconomic features or functional status was rare. Using natural language processing, three models were able to extract relevant psychosocial features, which substantially improved their predictions. Twenty six studies used logistic or Cox regression models, and the rest used machine learning methods. No statistically significant difference (difference 0.03, 95% confidence interval −0.0 to 0.07) was found between average C statistics of models developed using regression methods (0.71, 0.68 to 0.73) and machine learning (0.74, 0.71 to 0.77).ConclusionsOn average, prediction models using EMR data have better predictive performance than those using administrative data. However, this improvement remains modest. Most of the studies examined lacked inclusion of socioeconomic features, failed to calibrate the models, neglected to conduct rigorous diagnostic testing, and did not discuss clinical impact.
OBJECTIVE
To examine the association between hearing aids (HAs) and time to diagnosis of Alzheimer disease (AD) or dementia, anxiety or depression, and injurious falls among adults, aged 66 years and ...older, within 3 years of hearing loss (HL) diagnosis.
DESIGN
Retrospective cohort study.
SETTING
We used 2008 to 2016 national longitudinal claims data (based on office visit, inpatient, or outpatient healthcare encounters) from a large private payer. We used Kaplan‐Meier curves to examine unadjusted disease‐free survival and crude and adjusted Cox regression models to examine associations between HAs and time to diagnosis of three age‐related/HL‐associated conditions within 3 years of HL diagnosis. All models were adjusted for age, sex, race/ethnicity, census divisions, and prior diagnosis of cardiovascular conditions, hypertension, hypercholesterolemia, obesity, and diabetes.
PARTICIPANTS
The participants included 114 862 adults, aged 66 years and older, diagnosed with HL.
MEASUREMENT
Diagnosis of (1) AD or dementia; (2) depression or anxiety; and (3) injurious falls.
INTERVENTION
Use of HAs.
RESULTS
Large sex and racial/ethnic differences exist in HA use. Approximately 11.3% of women vs 13.3% of men used HAs (95% confidence interval CI difference = −0.024 to −0.016). Approximately 13.6% of whites (95% CI = 0.13‐0.14) vs 9.8% of blacks (95% CI = 0.09‐0.11) and 6.5% of Hispanics (95% CI = 0.06‐0.07) used HAs. The risk‐adjusted hazard ratios of being diagnosed with AD/dementia, anxiety/depression, and injurious falls within 3 years after HL diagnosis, for those who used HAs vs those who did not, were 0.82 (95% CI = 0.76‐0.89), 0.89 (95% CI = 0.86‐0.93), and 0.87 (95% CI = 0.80‐0.95), respectively.
CONCLUSIONS
Use of HAs is associated with delayed diagnosis of AD, dementia, depression, anxiety, and injurious falls among older adults with HL. Although we have shown an association between use of HAs and reduced risk of physical and mental decline, randomized trials are needed to determine whether, and to what extent, the relationship is causal. J Am Geriatr Soc 67:2362–2369, 2019
Purpose Thumb carpometacarpal (CMC) arthritis contributes considerably to functional disability in the aging adult United States (US) population. Owing to the increasing growth in this segment of our ...population, its burden on health care resources will increase in the future. Variations exist in the degree of complexity and cost among different surgical treatments. We examined the national trends of the surgical treatment of thumb CMC arthritis and hypothesized that current practice patterns are not supported by evidence favoring the simpler trapeziectomy-only procedure. Methods Using a random 5%, nationally representative, sample of Medicare fee-for-service beneficiaries diagnosed with thumb CMC arthritis between 2001 and 2010, we used a multinomial logistic regression model to assess the association between patients’ characteristics and the surgical treatment. Furthermore, we used surgeons’ unique identifiers to examine how their practice preferences have changed over time. Results Our findings demonstrated an increasing trend in the utilization of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) from 84% in 2001 to 90% in 2010. Ninety-five percent of surgeons performed only 1 type of surgical procedure, and among those, 93% of surgeons performed only trapeziectomy with LRTI. Compared with 2001, the odds of a patient undergoing thumb CMC arthrodesis or prosthetic arthroplasty slightly increased between 2007 and 2010. Conclusions The majority of hand surgeons in the US use trapeziectomy with LRTI as the surgical treatment of choice for thumb CMC arthritis. Although clinical trials from the United Kingdom support the use of the less complex trapeziectomy-only procedure, US surgeons are still reticent to change their practice, which favors LRTI. National comparative studies are still needed to examine the effectiveness of various surgical options for the treatment of thumb CMC joint arthritis. Type of study/level of evidence Prognostic II.
Tumor infiltrating lymphocytes (TILs) usually become exhausted and dysfunctional owing to chronic contact with tumor cells and overexpression of multiple inhibitor receptors. Activation of TILs by ...targeting the inhibitory and stimulatory checkpoints has emerged as one of the most promising immunotherapy prospectively. We investigated whether triggering of CD28, 4-1BB, and PD-1 checkpoints simultaneously or alone could enhance the immune response capacity of lymphocytes. In this regard, anti-PD-1, CD80-Fc, and 4-1BBL-Fc proteins were designed and produced in CHO-K1 cells as an expression host. Following confirmation of the Fc fusion proteins' ability to bind to native targets expressed on engineered CHO-K1 cells (CHO-K1/hPD-1, CHO-K1/hCD28, CHO-K1/hCTLA4, and CHO-K1/h4-1BB), the effects of each protein, on its own and in various combinations, were assessed in vitro on T cell proliferation, cytotoxicity, and cytokines secretion using the Mixed lymphocyte reaction (MLR) assay, 7-AAD/CFSE cell-mediated cytotoxicity assay, and a LEGENDplex™ Human Th Cytokine Panel, respectively. MLR results demonstrated that T cell proliferation in the presence of the combinations of anti-PD-1/CD80-Fc, CD80-Fc/4-1BBL-Fc, and anti-PD-1/CD80-Fc/4-1BBL-Fc proteins was significantly higher than in the untreated condition (1.83-, 1.91-, and 2.02-fold respectively). Furthermore, anti-PD-1 (17%), 4-1BBL-Fc (19.2%), anti-PD-1/CD80-Fc (18.6%), anti-PD-1/4-1BBL-Fc (21%), CD80-Fc/4-1BBL-Fc (18.5%), and anti-PD-1/CD80-Fc/4-1BBL-Fc (17.3%) significantly enhanced cytotoxicity activity compared to untreated condition (7.8%). However, concerning the cytokine production, CD80-Fc and 4-1BBL-Fc alone or in combination significantly increased the secretion of IFN-γ, TNF-α, and IL-2 compared with the untreated conditions. In conclusion, this research establishes that the various combinations of produced anti-PD-1, CD80-Fc, and 4-1BBL-Fc proteins can noticeably induce the immune response in vitro. Each of these combinations may be effective in killing or destroying cancer cells depending on the type and stage of cancer.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The Experimental Design was applied to optimize the electrocatalytic activity of La0.8Ba0.2CoO3 perovskite oxide/Active Carbon composite material in the alkaline solution for the Oxygen Evolution ...Reaction. After the preparation of La0.8Ba0.2CoO3, and structural characterizations, the experimental design was utilized to determine the optimal amount of the composite material and testing conditions. The overpotential was defined as the response variable, and the mass ratio of perovskite/active carbon, Potassium hydroxide (KOH) concentration, and Poly(vinylidene fluoride) (PVDF) amount were considered effective parameters. The significance of model terms is demonstrated by P-values less than 0.0500. The proposed prediction model determined the optimal amounts of 0.665 mg of PVDF, a KOH concentration of 0.609 M, and A perovskite/Active Carbon mass ratio of 2.81 with 308.22 mV overpotential (2.27% greater than the actual overpotential). The stability test of the optimized electrode material over 24 h suggests that it could be a good candidate electrocatalyst for OER with reusability potential.
Background
There is a paucity of evidence regarding the association between family physicians’ panel size and health outcomes of patients with hypertension in China.
Objective
To examine the ...association between family physicians’ panel size and health outcomes of patients with hypertension in urban China.
Design
This retrospective cohort study during 1 contract year from July 1, 2018, to June 31, 2019, was set in four community health centers (CHCs) in Xiamen City, China.
Participants
A total of 18,119 adult patients (18+) diagnosed with hypertension and their 61 family physicians were included.
Main Measures
Family physicians’ panel size was measured by the number of registered patients in the preceding 6 months. The outcome measures included blood pressure (BP) control rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) measured at each follow-up visit.
Key Results
Every additional 100 patients to the panel size were associated with an average of 17% increase in BP control rate (95% confidence interval CI = 1.15 to 1.19), and decrease in SBP (− 0.3 mmHg, 95% CI: − 0.38 to − 0.30), DBP (− 0.4 mmHg, 95% CI: − 0.39 to − 0.34), and MAP (− 0.4 mmHg, 95% CI: − 0.38 to − 0.33). After entering the quadratic term of panel size in the model, the panel size was negatively associated with BP control rate and positively associated with SBP, DBP, and MAP, while for the quadratic term, the odds ratio for BP control rate was positive and the coefficients for SBP, DBP, and MAP were negative. A U-shape association was found between panel size and health outcomes of patients with hypertension, and the turning point was about 600 patients.
Conclusions
The panel size of family physicians was curvilinearly associated with health outcomes of patients with hypertension in urban China.
Tumor infiltrating lymphocytes (TILs) usually become exhausted and dysfunctional owing to chronic contact with tumor cells and overexpression of multiple inhibitor receptors. Activation of TILs by ...targeting the inhibitory and stimulatory checkpoints has emerged as one of the most promising immunotherapy prospectively. We investigated whether triggering of CD28, 4-1BB, and PD-1 checkpoints simultaneously or alone could enhance the immune response capacity of lymphocytes. In this regard, anti-PD-1, CD80-Fc, and 4-1BBL-Fc proteins were designed and produced in CHO-K1 cells as an expression host. Following confirmation of the Fc fusion proteins’ ability to bind to native targets expressed on engineered CHO-K1 cells (CHO-K1/hPD-1, CHO-K1/hCD28, CHO-K1/hCTLA4, and CHO-K1/h4-1BB), the effects of each protein, on its own and in various combinations, were assessed in vitro on T cell proliferation, cytotoxicity, and cytokines secretion using the Mixed lymphocyte reaction (MLR) assay, 7-AAD/CFSE cell-mediated cytotoxicity assay, and a LEGENDplex™ Human Th Cytokine Panel, respectively. MLR results demonstrated that T cell proliferation in the presence of the combinations of anti-PD-1/CD80-Fc, CD80-Fc/4-1BBL-Fc, and anti-PD-1/CD80-Fc/4-1BBL-Fc proteins was significantly higher than in the untreated condition (1.83-, 1.91-, and 2.02-fold respectively). Furthermore, anti-PD-1 (17%), 4-1BBL-Fc (19.2%), anti-PD-1/CD80-Fc (18.6%), anti-PD-1/4-1BBL-Fc (21%), CD80-Fc/4-1BBL-Fc (18.5%), and anti-PD-1/CD80-Fc/4-1BBL-Fc (17.3%) significantly enhanced cytotoxicity activity compared to untreated condition (7.8%). However, concerning the cytokine production, CD80-Fc and 4-1BBL-Fc alone or in combination significantly increased the secretion of IFN‐γ, TNF-α, and IL-2 compared with the untreated conditions. In conclusion, this research establishes that the various combinations of produced anti-PD-1, CD80-Fc, and 4-1BBL-Fc proteins can noticeably induce the immune response in vitro. Each of these combinations may be effective in killing or destroying cancer cells depending on the type and stage of cancer.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The optimal use of material and energy by different industries has recently become an issue of great importance due to limited energy resources around the world. Material flow cost accounting (MFCA) ...has been suggested as a novel management system that can enhance waste management and provide an estimation of actual values of losses. This research aims to apply MFCA to the wastewater treatment unit of the Tabriz Oil Refining Company. In order to establish MFCA, the amount of input and output material, material costs, system costs and energy costs were studied. Using mass balance in all sections of wastewater treatment unit, losses were identified and costs and benefits were established. Results from MFCA calculation indicated that the annual cost of the unit is 28.14 million USD. This study also investigated the effect of changing the type of microorganisms in the biological treatment section that are able to digest high levels of ammonia and hydrogen sulfide and addition of reverse osmosis to the cooling drain section. It was found that the positive product's value increased from 58.92% to 90.76% and negative product's cost reduced from 41.08% to 9.23%. In addition to economic issues, use of these modifications considerably reduces environmental issues due to the release of NH3 and H2S to the environment and contamination of ground water through evaporation ponds.
•MFCA was established in wastewater unit of Tabriz Oil Refining Company.•Physical treatment step had the most contribution to amount of negative products.•Increase in positive product and decrease in negative product's value was achieved.
Purpose
People aging with disability may be limited in their ability to engage in healthy behaviors to maintain cardiometabolic health. We investigated the role of health promoting features in the ...neighborhood environment for incident cardiometabolic disease in adults aging with physical disability in the United States.
Design
Retrospective cohort study.
Setting
Optum’s Clinformatics® Data Mart Database (2007-2018) of administrative health claims.
Subjects
ICD-9-CM codes were used to identify 15 467 individuals with a diagnosis of Cerebral Palsy, Spina Bifida, Multiple Sclerosis, or Spinal Cord Injury.
Measures
Cardiometabolic disease was identified using ICD-9-CM/ICD-10-CM codes over 3 years of follow-up. Measures of the neighborhood environment came from the National Neighborhood Data Archive and linked to individual residential ZIP codes over time. Covariates included age, sex, and comorbid health conditions.
Analysis
Cox regression models estimated hazard ratios (HR) for incident cardiometabolic disease. Using a 1-year lookback period, individuals with pre-existing cardiometabolic disease were excluded from the analysis.
Results
Net of individual risk factors, residing in neighborhoods with a greater density of broadband Internet connections (HR = .88, 95% CI: .81, .97), public transit stops (HR = .89, 95% CI: .83, .95), recreational establishments (HR = .89, 95% CI: .83, .96), and parks (HR = .88, 95% CI: .82, .94), was associated with reduced risk of 3-year incident cardiometabolic disease.
Conclusion
Findings identify health-promoting resources that may mitigate health disparities in adults aging with disability.
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