Contribution of clinical course to outcome after traumatic brain injury: mining patient trajectories from European intensive care unit data

Existing methods to characterise the evolving condition of traumatic brain injury (TBI) patients in the intensive care unit (ICU) do not capture the context necessary for individualising treatment. We aimed to develop a modelling strategy which integrates all data stored in medical records to produce an interpretable disease course for each TBI patient's ICU stay. From a prospective, European cohort (n=1,550, 65 centres, 19 countries) of TBI patients, we extracted all 1,166 variables collected before or during ICU stay as well as 6-month functional outcome on the Glasgow Outcome Scale-Extended (GOSE). We trained recurrent neural network models to map a token-embedded time series representation of all variables (including missing data) to an ordinal GOSE prognosis every 2 hours. With repeated cross-validation, we evaluated calibration and the explanation of ordinal variance in GOSE with Somers' Dxy. Furthermore, we applied TimeSHAP to calculate the contribution of variables and prior timepoints towards transitions in patient trajectories. Our modelling strategy achieved calibration at 8 hours, and the full range of variables explained up to 52% (95% CI: 50-54%) of the variance in ordinal functional outcome. Up to 91% (90-91%) of this explanation was derived from pre-ICU and admission information. Information collected in the ICU increased explanation (by up to 5% [4-6%]), though not enough to counter poorer performance in longer-stay (>5.75 days) patients. Static variables with the highest contributions were physician prognoses and certain demographic and CT features. Among dynamic variables, markers of intracranial hypertension and neurological function contributed the most. Whilst static information currently accounts for the majority of functional outcome explanation, our data-driven analysis highlights investigative avenues to improve dynamic characterisation of longer-stay patients

Effect of heating rate during baking on the properties of carbon anodes used in aluminum industry

Carbon anodes are called the heart of aluminum electrolysis cells and contribute to about 15% of total production cost of aluminum. In case of poor quality, this contribution can reach 25%. The final quality of the carbon anodes and their behavior in the electrolysis cells depend on the conditions during the baking process. In any case, a low-quality green anode cannot be improved during baking. However, the quality of green anodes can deteriorate if the parameters of the baking process are not properly adjusted. The objective of this work is to study the effect of introducing a plateau during baking on the properties of carbon anodes. The samples were characterized before and after baking by measuring their density and electrical resistivity which are important in defining the final quality of the anode samples. The experimental data were also analysed using the artificial neural network model (ANN). The article will present the results of this study

Institutions for Asian Connectivity

To make Asia more economically sustainable and resilient against external shocks, regional economies need to be rebalanced toward regional demand- and trade-driven growth through increased regional connectivity. The effectiveness of connectivity depends on the quality of hard and soft infrastructure. Of particular importance in terms of soft infrastructure which makes hard infrastructure work are the facilitating institutions that support connectivity through appropriate policies, reforms, systems, and procedures and through promoting effective coordination and cooperation. Asia has many overlapping subregional institutions involved in national and regional energy, transport, and telecommunications infrastructure connectivity. However, these institutions are characterized as being less effective, informal, and lacking a clear and binding system of rules and policies. This paper draws linkages between connectivity, growth and development, governance, and institutions. It details the benefits the region could achieve by addressing needed connectivity enhancements and the connectivity and financing challenges it faces. In addition, it presents various institutional options for regional infrastructure financing. To build seamless Asian connectivity, Asia needs an effective, formal, and rules-based institutional framework. The paper presents a new institutional framework together with the organizational structures of two new regional institutional mechanisms, namely the Pan-Asian Infrastructure Forum and the Asian Infrastructure Fund

An approach to verification and validation of MHD codes for fusion applications

We propose a new activity on verification and validation (V&V) of MHD codes presently employed by the fusion community as a predictive capability tool for liquid metal cooling applications, such as liquid metal blankets. The important steps in the development of MHD codes starting from the 1970s are outlined first and then basic MHD codes, which are currently in use by designers of liquid breeder blankets, are reviewed. A benchmark database of five problems has been proposed to cover a wide range of MHD flows from laminar fully developed to turbulent flows, which are of interest for fusion applications: (A) 2D fully developed laminar steady MHD flow, (B) 3D laminar, steady developing MHD flow in a non-uniform magnetic field, (C) quasi-two-dimensional MHD turbulent flow, (D) 3D turbulent MHD flow, and (E) MHD flow with heat transfer (buoyant convection). Finally, we introduce important details of the proposed activities, such as basic V&V rules and schedule. The main goal of the present paper is to help in establishing an efficient V&V framework and to initiate benchmarking among interested parties. The comparison results computed by the codes against analytical solutions and trusted experimental and numerical data as well as code-to-code comparisons will be presented and analyzed in companion paper/paper

Traceability of raw materials in silos in an anode plant

Carbon anodes, regularly consumed in primary aluminum production, are made of calcined petroleum coke, coal tar pitch, and recycled materials. The properties of calcined coke depend on the source of crude oil and the calcination conditions. Similarly, pitch properties depend on the coal tar source and the manufacturing process. Different calcined coke and pitch mixtures are commonly used in anode manufacturing to meet various regulations and/or due to economics and availability. This makes it hard to maintain the anode quality. Calcined coke and pitch are placed in silos and used when required for production. It is hard for the industries to track the source of raw materials used in their daily recipes. This article presents an approach to trace back the details of the use of particulate raw materials with a custom-made software, which takes into account the type (mass flow or funnel flow) of silos. Such tracking can help identify the causes of problems and maintain/improve anode quality

TILTomorrow today: dynamic factors predicting changes in intracranial pressure treatment intensity after traumatic brain injury

Practices for controlling intracranial pressure (ICP) in traumatic brain injury (TBI) patients admitted to the intensive care unit (ICU) vary considerably between centres. To help understand the rational basis for such variance in care, this study aims to identify the patient-level predictors of changes in ICP management. We extracted all heterogeneous data (2008 pre-ICU and ICU variables) collected from a prospective cohort (n = 844, 51 ICUs) of ICP-monitored TBI patients in the Collaborative European NeuroTrauma Effectiveness Research in TBI study. We developed the TILTomorrow modelling strategy, which leverages recurrent neural networks to map a token-embedded time series representation of all variables (including missing values) to an ordinal, dynamic prediction of the following day’s five-category therapy intensity level (TIL(Basic)) score. With 20 repeats of fivefold cross-validation, we trained TILTomorrow on different variable sets and applied the TimeSHAP (temporal extension of SHapley Additive exPlanations) algorithm to estimate variable contributions towards predictions of next-day changes in TIL(Basic). Based on Somers’ Dxy, the full range of variables explained 68% (95% CI 65–72%) of the ordinal variation in next-day changes in TIL(Basic) on day one and up to 51% (95% CI 45–56%) thereafter, when changes in TIL(Basic) became less frequent. Up to 81% (95% CI 78–85%) of this explanation could be derived from non-treatment variables (i.e., markers of pathophysiology and injury severity), but the prior trajectory of ICU management significantly improved prediction of future de-escalations in ICP-targeted treatment. Whilst there was no significant difference in the predictive discriminability (i.e., area under receiver operating characteristic curve) between next-day escalations (0.80 [95% CI 0.77–0.84]) and de-escalations (0.79 [95% CI 0.76–0.82]) in TIL(Basic) after day two, we found specific predictor effects to be more robust with de-escalations. The most important predictors of day-to-day changes in ICP management included preceding treatments, age, space-occupying lesions, ICP, metabolic derangements, and neurological function. Serial protein biomarkers were also important and may serve a useful role in the clinical armamentarium for assessing therapeutic needs. Approximately half of the ordinal variation in day-to-day changes in TIL(Basic) after day two remained unexplained, underscoring the significant contribution of unmeasured factors or clinicians’ personal preferences in ICP treatment. At the same time, specific dynamic markers of pathophysiology associated strongly with changes in treatment intensity and, upon mechanistic investigation, may improve the timing and personalised targeting of future care

sbhattacharyay/TILTomorrow: TILTomorrow code repository

<p>This repository contains the code underlying the article entitled <strong>TILTomorrow today: dynamic factors predicting changes in intracranial pressure treatment intensity after traumatic brain injury</strong> from the Collaborative European NeuroTrauma Effectiveness Research in TBI (<a href="https://www.center-tbi.eu/" rel="nofollow">CENTER-TBI</a>) consortium. The code in this repository is commented throughout to provide a description of each step alongside the code which achieves it.</p&gt

A simple model for dynamic phase transitions in cell spreading

There are some interesting experimental results on cell spreading at macroscopic scales (cell size) where people have observed various dynamic phases in terms of rate of spreading of area of adherence to the substrate. In the present paper, we develop a very simple phenomenological model to capture those apparent dynamic phases of a spreading cell without going into the microscopic details of actin polymerization which is the main driving force for such processes. Our conclusion is that the dynamic phases of cell spreading depend on some gross parameters of the cell rather than on complex signalling pathways

In silico Analysis of Phytochemicals from Neem Leaves against Sterol 14-alpha Demethylase of Microsporum sp Causing Skin Disease

This analysis aims at evaluating the effects of Neem leaves extract on Skin disease. Skin disease is caused by Microsporum sp. The phytochemicals of Neem leaves were interacted with sterol 14-alpha demethylase enzyme involved in sterol biosynthesis metabolic pathway of Microsporum sp. Sterol 14-alpha demethylase was taken as receptor and phytochemicals present in Neem leaves were considered as ligands. All the interactions were done in Biovia discovery Studio 2020 and the process is known as molecular Docking. Molecular Docking provides us an opportunity to identify the potential phytochemical or component which can act as powerful tool against the pathogen. Out of all the phytochemicals, Glutamic acid and Oleic Acid of Neem leaves inhibits or blocks the mechanism or action of sterol 14-alpha demethylase enzyme of Microsporum sp. There is high possibility that these phytochemicals can potentially inhibit others enzymes involved in various metabolic pathways of Microsporum sp.</jats:p

Detection of pesticide by polymeric enzyme electrodes

Screen-printed electrodes (SPEs) containing immobilized acetylcholine esterase (AChE) enzyme were used for the electrochemical determination of organophosphorous (OP) and carbamate pesticides. The extent of AChE deactivation by the pesticide was determined in the presence of acetylcholine (AChCl) substrate. The unique nature of this approach lies in the enzyme immobilization procedure in which AChE was attached to the SPE by in situ bulk polymerization of acrylamide to ensure efficient adherence within the membrane with minimal losses in enzyme activity. Responses were observed for the pesticides Monocrotophos, Malathion, Metasystox and Lannate over the concentration range 0-10 ppb (mu g L-1). (C) 2007 Elsevier Inc. All rights reserved.</p