Purpose
Early clinical recognition of sepsis can be challenging. With the advancement of machine learning, promising real-time models to predict sepsis have emerged. We assessed their performance by ...carrying out a systematic review and meta-analysis.
Methods
A systematic search was performed in PubMed, Embase.com and Scopus. Studies targeting sepsis, severe sepsis or septic shock in any hospital setting were eligible for inclusion. The index test was any supervised machine learning model for real-time prediction of these conditions. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, with a tailored Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist to evaluate risk of bias. Models with a reported area under the curve of the receiver operating characteristic (AUROC) metric were meta-analyzed to identify strongest contributors to model performance.
Results
After screening, a total of 28 papers were eligible for synthesis, from which 130 models were extracted. The majority of papers were developed in the intensive care unit (ICU,
n
= 15; 54%), followed by hospital wards (
n
= 7; 25%), the emergency department (ED,
n
= 4; 14%) and all of these settings (
n
= 2; 7%). For the prediction of sepsis, diagnostic test accuracy assessed by the AUROC ranged from 0.68–0.99 in the ICU, to 0.96–0.98 in-hospital and 0.87 to 0.97 in the ED. Varying sepsis definitions limit pooling of the performance across studies. Only three papers clinically implemented models with mixed results. In the multivariate analysis, temperature, lab values, and model type contributed most to model performance.
Conclusion
This systematic review and meta-analysis show that on retrospective data, individual machine learning models can accurately predict sepsis onset ahead of time. Although they present alternatives to traditional scoring systems, between-study heterogeneity limits the assessment of pooled results. Systematic reporting and clinical implementation studies are needed to bridge the gap between bytes and bedside.
Quantum biology revisited Cao, Jianshu; Cogdell, Richard J; Coker, David F ...
Science advances,
04/2020, Letnik:
6, Številka:
14
Journal Article
Recenzirano
Odprti dostop
Photosynthesis is a highly optimized process from which valuable lessons can be learned about the operating principles in nature. Its primary steps involve energy transport operating near theoretical ...quantum limits in efficiency. Recently, extensive research was motivated by the hypothesis that nature used quantum coherences to direct energy transfer. This body of work, a cornerstone for the field of quantum biology, rests on the interpretation of small-amplitude oscillations in two-dimensional electronic spectra of photosynthetic complexes. This Review discusses recent work reexamining these claims and demonstrates that interexciton coherences are too short lived to have any functional significance in photosynthetic energy transfer. Instead, the observed long-lived coherences originate from impulsively excited vibrations, generally observed in femtosecond spectroscopy. These efforts, collectively, lead to a more detailed understanding of the quantum aspects of dissipation. Nature, rather than trying to avoid dissipation, exploits it via engineering of exciton-bath interaction to create efficient energy flow.
Food security concerns and the scarcity of new productive land have put productivity enhancement of degraded lands back on the political agenda. In such a context, salt‐affected lands are a valuable ...resource that cannot be neglected nor easily abandoned even with their lower crop yields, especially in areas where significant investments have already been made in irrigation and drainage infrastructure. A review of previous studies shows a very limited number of highly variable estimates of the costs of salt‐induced land degradation combined with methodological and contextual differences. Simple extrapolation suggests that the global annual cost of salt‐induced land degradation in irrigated areas could be US$ 27.3 billion because of lost crop production. We present selected case studies that highlight the potential for economic and environmental benefits of taking action to remediate salt‐affected lands. The findings indicate that it can be cost‐effective to invest in sustainable land management in countries confronting salt‐induced land degradation. Such investments in effective remediation of salt‐affected lands should form part of a broader strategy for food security and be defined in national action plans. This broader strategy is required to ensure the identification and effective removal of barriers to the adoption of sustainable land management, such as perverse subsidies. Whereas reversing salt‐induced land degradation would require several years, interim salinity management strategies could provide a pathway for effective remediation and further showcase the importance of reversing land degradation and the rewards of investing in sustainable land management.
Starting from the zygote, all cells in the human body continuously acquire mutations. Mutations shared between different cells imply a common progenitor and are thus naturally occurring markers for ...lineage tracing
. Here we reconstruct extensive phylogenies of normal tissues from three adult individuals using whole-genome sequencing of 511 laser capture microdissections. Reconstructed embryonic progenitors in the same generation of a phylogeny often contribute to different extents to the adult body. The degree of this asymmetry varies between individuals, with ratios between the two reconstructed daughter cells of the zygote ranging from 60:40 to 93:7. Asymmetries pervade subsequent generations and can differ between tissues in the same individual. The phylogenies resolve the spatial embryonic patterning of tissues, revealing contiguous patches of, on average, 301 crypts in the adult colonic epithelium derived from a most recent embryonic cell and also a spatial effect in brain development. Using data from ten additional men, we investigated the developmental split between soma and germline, with results suggesting an extraembryonic contribution to primordial germ cells. This research demonstrates that, despite reaching the same ultimate tissue patterns, early bottlenecks and lineage commitments lead to substantial variation in embryonic patterns both within and between individuals.
Highlights ► Morphologically activated microglia seen up to 28 days after diffuse brain injury. ► Inflammatory genes acutely elevated in thalamus & cortex after diffuse TBI. ► Anti-inflammatory genes ...acutely elevated after diffuse TBI. ► Translocator protein 18 kDa receptor binding validated qPCR results. ► Acute ibuprofen administration attenuated classical inflammatory genes in the VPM.
The British Society of Gastroenterology (BSG) and the Association of Coloproctology for Great Britain and Ireland (ACPGBI) commissioned this update of the 2002 guidance. The aim, as before, is to ...provide guidance on the appropriateness, method and frequency of screening for people at moderate and high risk from colorectal cancer. This guidance provides some new recommendations for those with inflammatory bowel disease and for those at moderate risk resulting from a family history of colorectal cancer. In other areas guidance is relatively unchanged, but the recent literature was reviewed and is included where appropriate.
We present an early version of a Susceptible–Exposed–Infected–Recovered–Deceased (SEIRD) mathematical model based on partial differential equations coupled with a heterogeneous diffusion model. The ...model describes the spatio-temporal spread of the COVID-19 pandemic, and aims to capture dynamics also based on human habits and geographical features. To test the model, we compare the outputs generated by a finite-element solver with measured data over the Italian region of Lombardy, which has been heavily impacted by this crisis between February and April 2020. Our results show a strong qualitative agreement between the simulated forecast of the spatio-temporal COVID-19 spread in Lombardy and epidemiological data collected at the municipality level. Additional simulations exploring alternative scenarios for the relaxation of lockdown restrictions suggest that reopening strategies should account for local population densities and the specific dynamics of the contagion. Thus, we argue that data-driven simulations of our model could ultimately inform health authorities to design effective pandemic-arresting measures and anticipate the geographical allocation of crucial medical resources.
Acute myeloid leukemia (AML) is the most aggressive type of blood cancer, and there is a continued need for new treatments that are well tolerated and improve long-term survival rates in patients. ...Induction of differentiation has emerged as a promising alternative to conventional cytotoxic chemotherapy, but known agents lack efficacy in genetically distinct patient populations. Previously, we established a phenotypic screen to identify small molecules that could stimulate differentiation in a range of AML cell lines. Utilising this strategy, a 1,5-dihydrobenzo
1,4oxazepin-2(3
)-one hit compound was identified. Herein, we report the hit validation in vitro, structure-activity relationship (SAR) studies and the pharmacokinetic profiles for selected compounds.
Background: Body mass index (BMI) is the most widely used measure to diagnose obesity. However, the accuracy of BMI in detecting excess body adiposity in the adult general population is largely ...unknown. Methods: A cross-sectional design of 13 601 subjects (age 20-79.9 years; 49% men) from the Third National Health and Nutrition Examination Survey. Bioelectrical impedance analysis was used to estimate body fat percent (BF% ). We assessed the diagnostic performance of BMI using the World Health Organization reference standard for obesity of BF% >25% in men and>35% in women. We tested the correlation between BMI and both BF% and lean mass by sex and age groups adjusted for race. Results: BMI-defined obesity (30 kg m- 2) was present in 19.1% of men and 24.7% of women, while BF% -defined obesity was present in 43.9% of men and 52.3% of women. A BMI30 had a high specificity (men=95% , 95% confidence interval (CI), 94-96 and women=99% , 95% CI, 98-100), but a poor sensitivity (men=36% , 95% CI, 35-37 and women=49% , 95% CI, 48-50) to detect BF% -defined obesity. The diagnostic performance of BMI diminished as age increased. In men, BMI had a better correlation with lean mass than with BF% , while in women BMI correlated better with BF% than with lean mass. However, in the intermediate range of BMI (25-29.9 kg m- 2), BMI failed to discriminate between BF% and lean mass in both sexes. Conclusions: The accuracy of BMI in diagnosing obesity is limited, particularly for individuals in the intermediate BMI ranges, in men and in the elderly. A BMI cutoff of30 kg m- 2 has good specificity but misses more than half of people with excess fat. These results may help to explain the unexpected better survival in overweight/mild obese patients.
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