We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury.
We performed logistic regression (LR), lasso ...regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified.
In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study.
ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations.
Plant roots explore the soil for water and nutrients, thereby determining plant fitness and agricultural yield, as well as determining ground substructure, water levels, and global carbon ...sequestration. The colonization of the soil requires investment of carbon and energy, but how sugar and energy signaling are integrated with root branching is unknown. Here, we show through combined genetic and chemical modulation of signaling pathways that the sugar small-molecule signal, trehalose-6-phosphate (T6P) regulates root branching through master kinases SNF1-related kinase-1 (SnRK1) and Target of Rapamycin (TOR) and with the involvement of the plant hormone auxin. Increase of T6P levels both via genetic targeting in lateral root (LR) founder cells and through light-activated release of the presignaling T6P-precursor reveals that T6P increases root branching through coordinated inhibition of SnRK1 and activation of TOR. Auxin, the master regulator of LR formation, impacts this T6P function by transcriptionally down-regulating the T6P-degrader trehalose phosphate phosphatase B in LR cells. Our results reveal a regulatory energy-balance network for LR formation that links the 'sugar signal' T6P to both SnRK1 and TOR downstream of auxin.
Plant roots explore the soil for water and nutrients, thereby determining plant fitness and agricultural yield, as well as determining ground substructure, water levels, and global carbon ...sequestration. The colonization of the soil requires investment of carbon and energy, but how sugar and energy signaling are integrated with root branching is unknown. Here, we show through combined genetic and chemical modulation of signaling pathways that the sugar small-molecule signal, trehalose-6-phosphate (T6P) regulates root branching through master kinases SNF1-related kinase-1 (SnRK1) and Target of Rapamycin (TOR) and with the involvement of the plant hormone auxin. Increase of T6P levels both via genetic targeting in lateral root (LR) founder cells and through light-activated release of the presignaling T6P-precursor reveals that T6P increases root branching through coordinated inhibition of SnRK1 and activation of TOR. Auxin, the master regulator of LR formation, impacts this T6P function by transcriptionally down-regulating the T6P-degrader trehalose phosphate phosphatase B in LR cells. Our results reveal a regulatory energy-balance network for LR formation that links the 'sugar signal' T6P to both SnRK1 and TOR downstream of auxin.
Co-production and co-creation occur when citizens participate actively in delivering and designing the services they receive. It has come increasingly onto the agenda of policymakers, as interest in ...citizen participation has more generally soared. Expectations are high and it is regarded as a possible solution to the public sector’s decreased legitimacy and dwindling resources, by accessing more of society’s capacities. In addition, it is seen as part of a more general drive to reinvigorate voluntary participation and strengthen social cohesion in an increasingly fragmented and individualized society. Co-Production and Co-Creation: Engaging Citizens in Public Services offers a systematic and comprehensive theoretical and empirical examination of the concepts of co-production and co-creation and their application in practice. It shows the latest state of knowledge on the topic and will be of interest to students at an advanced level, academics and reflective practitioners. It addresses the topics with regard to co-production and co-creation and will be of interest to researchers, academics, policymakers, and students in the fields of public administration, business administration, economics, political science, public management, political science, service management, sociology and voluntary sector studies.
Objective
To compare outcomes between patients with primary external ventricular device (EVD)–driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)–driven ...treatment.
Methods
The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with “center” as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome.
Results
A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval CI OR 0.74 and 95% CI 0.36–1.52, adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio 95% CI 1.70 1.34–2.12, IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs.
Conclusion
We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor–guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group.
Protocol
The core study is registered with
ClinicalTrials.gov
, number NCT02210221, and the Resource Identification Portal (RRID: SCR_015582).
Sarcoidosis is a multisystemic disease usually affecting the lungs and mediastinal lymph nodes. Other organs, such as the liver and the spleen, are less commonly involved. Patients usually present ...with mild nonspecific symptoms. On imaging, hepatosplenomegaly with or without multiple focal lesions within the spleen may be seen in the active disease stage. Rarely, the disease may evolve to cirrhosis and liver failure. We report such a rare case of hepatosplenic sarcoidosis complicated by acute esophageal bleeding due to portal hypertension.
Human trafficking (HT) is a pervasive global issue affecting vulnerable
individuals, violating their fundamental human rights. Investigations reveal
that a significant number of HT cases are ...associated with online advertisements
(ads), particularly in escort markets. Consequently, identifying and connecting
HT vendors has become increasingly challenging for Law Enforcement Agencies
(LEAs). To address this issue, we introduce IDTraffickers, an extensive dataset
consisting of 87,595 text ads and 5,244 vendor labels to enable the
verification and identification of potential HT vendors on online escort
markets. To establish a benchmark for authorship identification, we train a
DeCLUTR-small model, achieving a macro-F1 score of 0.8656 in a closed-set
classification environment. Next, we leverage the style representations
extracted from the trained classifier to conduct authorship verification,
resulting in a mean r-precision score of 0.8852 in an open-set ranking
environment. Finally, to encourage further research and ensure responsible data
sharing, we plan to release IDTraffickers for the authorship attribution task
to researchers under specific conditions, considering the sensitive nature of
the data. We believe that the availability of our dataset and benchmarks will
empower future researchers to utilize our findings, thereby facilitating the
effective linkage of escort ads and the development of more robust approaches
for identifying HT indicators.
The free vascularised corticoperiosteal flap from the medial femoral condyle, as described by Doi and Sakai, can be used for difficult non-unions. This flap is supplied by the Descending Genicular ...Artery (DGA) and the Superomedial Genicular Artery (SMA). In this anatomical study we describe the anatomy of these arteries. The DGA was dominant in 24 of 34 cases (70%). If the DGA was absent or too small, the SMA was sufficiently large for an adequate supply of the graft area. We concluded that of all the dissected specimens the arteries were sufficiently large and long enough to be suited for microsvascular anastomosis.
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