Analysis of disease clusters and patient outcomes in people with multiple long term conditions using hypergraphs.

Objectives Having multiple long term health conditions (MLTCs), also known as multimorbidity, is becoming increasingly common as populations age. Understanding how clusters of diseases are likely to lead to other diseases and the effect of multimorbidity on healthcare resource use (HRU) will be of great importance as this trend continues. Approach Graph-based approaches, also called network analysis in the literature, have been used previously to study multimorbidity. The use of hypergraphs, which are generalisations of graphs where edges can connect to any number of nodes, and their application to the problem of understanding multimorbidity will be discussed. Analysis using hypergraphs was carried out using a population-scale cohort of people in the Secure Anonymised Information Linkage (SAIL) Databank to find the diseases and disease sets which are most important based on a measure of prevalence and measures of healthcare resource utilisation in secondary care. Results The most important sets of diseases based on the centrality of a hypergraph weighted by a measure of prevalence featured hypertension, and the most important was hypertension and diabetes. The most important sets of diseases based on the centrality of a hypergraph weighted by a measure of unplanned inpatient HRU were arrhythmia, heart failure and hypertension while for a measure of outpatient HRU the most important set of diseases was diabetes and hypertension. Conclusion Hypergraphs are very flexible and general mathematical objects and there is still a great deal of development that can be done to make them more useful in epidemiological settings and beyond

Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005-2019), by area deprivation profile : linked electronic health records cohort study on 965,905 individuals

Funding: This work was supported by Health Data Research UK (HDRUK) Measuring and Understanding Multimorbidity using Routine Data in the UK (MUrMuRUK, HDR-9006; CFC0110). Health Data Research UK (HDR-9006) is funded by: UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, the National Institute for Health Research (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. This work also was co-funded by the Medical Research Council (MRC) and the National Institute for Health Research (NIHR) through grant number MR/S027750/1. The work was supported by the ADR Wales programme of work, part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1).Background  Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK. Methods  Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups. Findings  In total, 965,905 individuals aged 5-104 were included, from a possible 2·9m individuals following a 5-year clearance period, with an average follow-up of 13·2 years (12·7 million person-years). Some 673,189 (69·7 %) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0·45 years (99%CI:-0·45,-0·44)) and in 70 year old males dying after developing multimorbidity (-1·98 years (99%CI:-2·01,-1·95)). Interpretation  This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks.Publisher PDFPeer reviewe

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Optimization of reactive dye removal by electrochemical oxidation with Ti/nanoZnO (Experimental study)

In the current study, Ti/nanoZnO electrode was prepared by the electrophoretic deposition (EPD) method. The crystal structure, morphology, elemental analysis, and electrochemical properties of the prepared electrode were studied through X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM) with an X-ray spectrometer attached, cyclic voltammetry (CV), linear sweep voltammetry (LSV), electrochemical impedance spectroscopy (EIS), chrono-amperometry (CA), and chrono-potentiometry (CP). Obtained results showed that the prepared Ti/nanoZnO electrode possessed a uniform coating with more porous morphology, reduced charge transfer resistance, and improved electrochemical stability. Electrocatalytic performance was evaluated by studying the electrochemical removal of Reactive orange 7 (RO7) dye as a target pollutant on the Ti/nanoZnO electrode. Independent operating parameters namely pH, current density, electrolyte concentration, and reaction time were selected to model and optimize the removal process by central composite design (CCD). The color removal efficiency of 20.73% was obtained for RO7 after 60 min under optimum conditions. Eventually, from the findings of this study, it can be concluded that modifying the titanium (Ti) substrate using ZnO nanoparticles could significantly improve the electrochemical properties of the bare Ti electrode

Biological effects of low-dose ionizing radiation exposure on interventional cardiologists

Background Interventional cardiologists (ICs) are likely to receive high radiation exposure as a result of procedures they undertake.Aims To assess the effects of low-dose X-ray radiation exposure on chromosomal damage and on selectedindices of cellular and humoral immunity in ICs.Methods The study population consisted of 37 ICs and 37 clinical physicians as the control group with similarage, sex and duration of employment, without any work-related exposure to ionizing radiation. Cytogeneticstudies were performed by chromosome aberration analysis and immunological studies byflow cytometry, enzyme-linked immunosorbent assay and immunodiffusion techniques.Results The frequencies of aberrant cells, chromosome breaks and dicentrics plus centric rings were significantly higher in the exposed group compared to the control group (P , 0.05; P , 0.01; P , 0.001,respectively), without positive correlation between the frequency of dicentric and centric ring aberrationsand the cumulative doses of the ICs (r 5 0.24, not significant). A significant increase was observedin the expression of activation marker CD69 on TCD41 stimulated cells in serum immunoglobulin G and interleukin (IL)-2 (P , 0.05) and a significant decrease in serum IL-10 (P , 0.05) in the ICs compared with that of the control group. There was no statistical difference between the two groups in terms of number of white blood cells and lymphocytes, CD31, CD41 and CD81 T cells, CD191 and CD161 561 cells and concentrations of interferon (IFN)-g, IL-4, IL-6 and IL-8 cytokines.Conclusions While cytogenetic results show higher chromosomal damage, some immune responses are stimulated or modulated immunologically in ICs

Systematic review of the knowledge and attitude about HIV and AIDS among Iranian population

Background: Inadequate knowledge, negative attitudes are major the hindrances to prevent the spread of human immunodeficiency virus (HIV). The objective of this study was to understand the knowledge and attitude about HIV and AIDS in the Iranian population. Methods: We conducted a systematic review, searching online databases through December 2015 focusing on knowledge and attitudes about HIV and AIDS in Iran. Inclusion criteria were the cases which aimed to determine the knowledge and attitudes of people, placed in Iran, and conducted in the last fifteen years. After extraction, documentation, specifications of articles and conference were classified in the Endnote software and duplicated cases were removed using this application and new review of the categories. Results: Twenty four articles met criteria. The knowledge and attitude toward HIV and AIDS were generally found to be different and varied; these differences can be related to the inconsistency of research tools and applied questionnaires, the content of the questions, number of questions, the difference in the ratings and rankings, as well as sample size, methodology and study type. Conclusion: We conclude that our results will guide the development of population-focused HIV/AIDS knowledge and attitude in Iran, which is to be lacking among both the general public and healthcare

Signed Complete Graphs with Maximum Index

Let Γ = (G, σ) be a signed graph, where G is the underlying simple graph and σ E(G) → {−, +} is the sign function on the edges of G. The adjacency matrix of a signed graph has −1 or +1 for adjacent vertices, depending on the sign of the edges. It was conjectured that if is a signed complete graph of order n with k negative edges, k ---lt--- n − 1 and has maximum index, then negative edges form K1,k. In this paper, we prove this conjecture if we confine ourselves to all signed complete graphs of order n whose negative edges form a tree of order k + 1. A [1, 2]-subgraph of G is a graph whose components are paths and cycles. Let Γ be a signed complete graph whose negative edges form a [1, 2]-subgraph. We show that the eigenvalues of Γ satisfy the following inequalities

Interaction effects of nitrogen and phosphorus fertilizer on nitrogen mineralization of wheat residues in a calcareous soil

Because of the high pH of the soil in semiarid regions, phosphorus adsorption is unfavorable. So, considerable amounts of phosphorus fertilizers are used annually, where this fertilizer may affect the plant residues' decomposition. To examine the interaction effects of nitrogen and phosphorus on nitrogen mineralization in calcareous soil, a factorial experiment was performed in a completely randomized design with three replications. The first factor consisted of various C:N ratios (20, 40, and 60 or three levels of nitrogen N-1:0, N-2:11, and N-3:43 kg N ha(-1), respectively) and the second factor consisted of various C:P ratios (87, 174, and 260 or three levels of phosphorus P-1:0, P-2:12, and P-3:45 kg P ha(-1), respectively), under incubation conditions. The results indicated that the cumulative mineral nitrogen content in all treatments, except for N1P2 and N1P3 treatments, started from a positive amount and remained positive until the end of the incubation period. The highest amount of cumulative mineral nitrogen among treatments was related to N3P1 treatment, while the lowest was associated with N2P3 treatment. Mineralization of nitrogen during 60 d of incubation was the dominant phenomenon, except for the N1P2 and N1P3 treatments which remained in the organic phase. The effect of phosphorus on the cumulative mineralization of nitrogen was significant. With increasing the amount of phosphorus, the total inorganic nitrogen diminished. Nitrogen release begins earlier with lower C:N ratios, and therefore the available nitrogen can be released more quickly to the plant. It is generally concluded that, in calcareous soil, the use of nitrogen fertilizer to adjust C:N ratio and to improve the mineralization of wheat residues will be a suitable option.12 month embargo; published online: 13 Sep 2019This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Signed Complete Graphs with Maximum Index

Let Γ = (G, σ) be a signed graph, where G is the underlying simple graph and σ E(G) → {−, +} is the sign function on the edges of G. The adjacency matrix of a signed graph has −1 or +1 for adjacent vertices, depending on the sign of the edges. It was conjectured that if is a signed complete graph of order n with k negative edges, k < n − 1 and has maximum index, then negative edges form K1,k. In this paper, we prove this conjecture if we confine ourselves to all signed complete graphs of order n whose negative edges form a tree of order k + 1. A [1, 2]-subgraph of G is a graph whose components are paths and cycles. Let Γ be a signed complete graph whose negative edges form a [1, 2]-subgraph. We show that the eigenvalues of Γ satisfy the following inequalities: −5 ≤ λn ≤ . . . ≤ λ2 ≤ 3