Preserving the knowledge of long clinical texts using aggregated ensembles of large language models

Clinical texts, such as admission notes, discharge summaries, and progress notes, contain rich and valuable information that can be used for various clinical outcome prediction tasks. However, applying large language models, such as BERT-based models, to clinical texts poses two major challenges: the limitation of input length and the diversity of data sources. This paper proposes a novel method to preserve the knowledge of long clinical texts using aggregated ensembles of large language models. Unlike previous studies which use model ensembling or text aggregation methods separately, we combine ensemble learning with text aggregation and train multiple large language models on two clinical outcome tasks: mortality prediction and length of stay prediction. We show that our method can achieve better results than baselines, ensembling, and aggregation individually, and can improve the performance of large language models while handling long inputs and diverse datasets. We conduct extensive experiments on the admission notes from the MIMIC-III clinical database by combining multiple unstructured and high-dimensional datasets, demonstrating our method's effectiveness and superiority over existing approaches. We also provide a comprehensive analysis and discussion of our results, highlighting our method's applications and limitations for future research in the domain of clinical healthcare. The results and analysis of this study is supportive of our method assisting in clinical healthcare systems by enabling clinical decision-making with robust performance overcoming the challenges of long text inputs and varied datasets.Comment: 17 pages, 4 figures, 4 tables, 9 equations and 1 algorith

Competition Kinetics: An Experimental Approach

In this chapter, free radical kinetics with the help of competition kinetics and some experimental results calculated by competition kinetics to find out the rate constant of reactive species (●OH, eaq−, ●H) with target compound, which is used by radiation chemists is briefly discussed. The competition kinetics method is well validated by taking ciprofloxacin, norfloxacin and bezafibrate as example compounds. The bimolecular rate constants of hydroxyl radical, hydrate electron and hydrogen atom has been calculated for example solute species (ciprofloxacin, norfloxacin and bezafibrate)

Characterisation of drug-resistant Mycobacterium tuberculosis mutations and transmission in Pakistan

Tuberculosis, caused by Mycobacterium tuberculosis, is a high-burden disease in Pakistan, with multi-drug (MDR) and extensive-drug (XDR) resistance, complicating infection control. Whole genome sequencing (WGS) of M. tuberculosis is being used to infer lineages (strain-types), drug resistance mutations, and transmission patterns-all informing infection control and clinical decision making. Here we analyse WGS data on 535 M. tuberculosis isolates sourced across Pakistan between years 2003 and 2020, to understand the circulating strain-types and mutations related to 12 anti-TB drugs, as well as identify transmission clusters. Most isolates belonged to lineage 3 (n = 397; 74.2%) strain-types, and were MDR (n = 328; 61.3%) and (pre-)XDR (n = 113; 21.1%). By inferring close genomic relatedness between isolates (\u3c 10-SNPs difference), there was evidence of M. tuberculosis transmission, with 55 clusters formed consisting of a total of 169 isolates. Three clusters consist of M. tuberculosis that are similar to isolates found outside of Pakistan. A genome-wide association analysis comparing \u27transmitted\u27 and \u27non-transmitted\u27 isolate groups, revealed the nusG gene as most significantly associated with a potential transmissible phenotype (P = 5.8 × 10-10). Overall, our study provides important insights into M. tuberculosis genetic diversity and transmission in Pakistan, including providing information on circulating drug resistance mutations for monitoring activities and clinical decision making

Analytical Model for Underwater Wireless Sensor Network Energy Consumption Reduction

In an Underwater Wireless Sensor Network (UWSN), extreme energy loss is carried out by the early expiration of sensor nodes and causes a reduction in efficiency in the submerged acoustic sensor system. Systems based on clustering strategies, instead of each node sending information by itself, utilize cluster heads to collect information inside the clusters for forwarding collective information to sink. This can effectively minimize the total energy loss during transmission. The environment of UWSN is 3D architecture-based and follows a complex hierarchical clustering strategy involving its most effecting unique parameters such as propagation delay and limited transmission bandwidth. Round base clustering strategy works in rounds, where each round comprises three fundamental stages: cluster head selection, grouping or node association, and data aggregation followed by forwarding data to the sink. In UWSN, the energy consumed during the formation of clusters has been considered casually or completely evaded in the previous works. In this paper, the cluster head setup period has been considered the main contributor to extra energy utilizer. A numerical channel model is proposed to compute extra energy. It is performed by using a UWSN broad model. The results have shown that extra maximum energy consumption is approximately 12.9 percent of the system total energy consumed in information transmissions

Outcome of perforator propeller flap for the coverage of soft tissue defects over middle and distal part of leg

Background: Plastic surgery is a constant battle between blood supply and beauty. The end result of a reconstructive procedure is primarily attributable to the stability of the vascular component, which is fundamental in that it ensures survival and proper functioning of tissues that have been transferred to the recipient site. The aim of the study was to evaluate the clinical outcome of perforator propeller flap for coverage of soft tissue defects in middle and distal legs. Methods: This was a prospective observational study and was conducted in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from September 2018 to February 2020. The study population includes the total of 30 patients having soft tissue defects of the middle and distal thirds of leg necessary for flap coverage in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh. Results: In total 30 patients maximum 11 (36.7%) were in 31-40 years age group. Majority 27 (90%) were male and 3 (10%) were female in our study. Out of 22 flaps in distal leg necrosis occurred in 4 (18.19%) and among 8 flaps in middle leg necrosis occurred in 1 (12.5%). Conclusions: This study observed that that perforator propeller flaps are ideal in reconstructing soft tissue defects of the middle and distal third of the leg, being safe, easy to perform, providing similar tissue in texture and thickness of damaged tissues, with low donor site morbidity

Impact of a multifaceted intervention on physicians' knowledge, attitudes and practices in relation to pharmaceutical incentivisation: protocol for a randomised control trial.

INTRODUCTION: In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands. METHODS AND ANALYSIS: This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and will be randomly assigned to intervention and control groups. The intervention group GPs will be exposed to emotive and educational seminars on medical ethics, whereas control group GPs will be given seminars on general medical topics. The primary outcome measure will be GPs' prescribing practices, whereas the secondary outcome measures will be their knowledge and attitudes regarding COI that arises from pharmaceutical incentivisation. In addition to a novel standardised pharmaceutical representatives (SPSR) method, in which field researchers will simulate pharmaceutical marketing with GPs, presurvey and postsurvey, and qualitative interviewing will be performed to collect data on GPs' knowledge, attitudes and practices in relation to COI linked with pharmaceutical incentives. Univariate and multivariate statistical analyses will be performed to measure a change in GPs' knowledge, attitudes and practices, while qualitative analysis will add to our understanding of the quantitative SPSR data. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Pakistan National Bioethics Committee (# 4-87/NBC-582/21/1364), the Aga Khan University (# 2020-4759-1129) and the London School of Hygiene and Tropical Medicine (# 26506). We will release results within 6-9 months of the study's completion. TRIAL REGISTRATION NUMBER: ISRCTN12294839

Adaptive energy efficient circular spinning protocol for dynamic cluster based UWSNs

Under Water Sensor Network (UWSN) is a novel paradigm for exploring marine environments such as offshore and mineral exploration, underwater surveillance, and sea habitat monitoring. However, a good quality underwater communication is difficult to achieve due to different constraints such as limited bandwidth, acoustic propagation issues, delays, battery replacement hitches, etc. In recent works, efficient energy-based designing and overall performance evaluation of the UWSN has become a major consideration. Cluster-based sensor networks have proven to be a successful way to increase the network's load congruency and scalability while lowering the system's total energy consumption. Usually, clustering algorithms work in three phases; cluster setup, data collection, and transmission to sink. In these types of dynamic cluster-based networks, energy consumed in cluster setup has been considered insignificant. Since these network energy consumptions are not part of data communication, we consider it extra energy consumption. In this paper, a new Energy Efficient Circular Spinning (EECS) dynamic clustering algorithm has been proposed to provide an improved cluster setup system and to minimize energy usage in re-clustering or cluster setup. Our proposed EECS mechanism suggests that system performance can improve by reducing the Cluster Head (CH) selection phase or cluster setup phase and can ultimately minimize the energy consumption of networks. It is demonstrated that by reducing the transmission of superfluous control messages during the cluster arrangement stage, approximately 21.5% to28.4% of the total network energy expended can be saved. This paper also compares the extra energy consumption, total network energy consumption, and life of the network in our proposed EECS mechanism to two different mechanisms, (1) Adaptive LEACH for UW, (2) UMOD-LEACH. The optimum value of cluster head has been calculated from energy consumption of different protocols and results show that our proposed EECS can prolong network lifetime by 21.5% and 28.4%from the above-mentioned algorithms consequently. In future, we will extend outwork for multi-hop dynamic cluster base mechanism for UW

Toxicities, kinetics and degradation pathways investigation of ciprofloxacin degradation using iron-mediated H\u3csub\u3e2\u3c/sub\u3eO\u3csub\u3e2\u3c/sub\u3e based advanced oxidation processes

© 2018 Institution of Chemical Engineers Ciprofloxacin (CIP) is a widespread emerging water pollutant and thus its removal from aquatic environment is vital. The use of Fe3+/H2O2 and Fe2+/H2O2 resulted in 38 and 64% removal of CIP (8.0 ppm), respectively, within 80 min reaction time (pH 5.8, [H2O2]0 = 80 ppm, and [iron]0 = 20 ppm). Low pH, high temperature, high dose of H2O2 and Fe2+, and low CIP concentration facilitated removal of CIP. The radical scavenger studies proved in situ generated [rad]OH to be involved primarily in the removal of CIP. The effect of temperature was used to estimate enthalpy and activation energies of the removal of CIP. At 800 min reaction time, the Fe2+/H2O2 resulted in 54% mineralization of CIP using 16.0 ppm [CIP]0, 320.0 ppm [H2O2]0, and 40.0 ppm [Fe2+]0. The potential degradation pathways of CIP established from the degradation of CIP by [rad]OH and products evolved was found to be initiated at C6 through the loss of fluoride ion. The acute and chronic toxicities of CIP and its degradation products were estimated with the final product found to be non-toxic. The results suggest that Fe2+/H2O2-mediated AOPs have high potential for degradation as well as toxicity elimination of CIP and its degradation products

Synergistic effects of H\u3csub\u3e2\u3c/sub\u3eO\u3csub\u3e2\u3c/sub\u3e and S\u3csub\u3e2\u3c/sub\u3eO\u3csub\u3e8\u3c/sub\u3e\u3csup\u3e2−\u3c/sup\u3e in the gamma radiation induced degradation of congo-red dye: Kinetics and toxicities evaluation

© 2019 Elsevier B.V. Gamma radiation has received increasing attention due to their high potential in degradation of recalcitrant pollutants. Thus in the present study, gamma radiation was used for degradation of congo-red (CR) dye, a highly toxic and carcinogenic pollutant, in the presence of H2O2 and S2O82−. The CR was significantly degraded by gamma radiation (i.e., 53%), however, presence of H2O2 and S2O82− promoted degradation of CR to 98 and 87%, respectively, at 1184 Gy absorbed dose. The radical scavengers and electron spin resonance studies revealed that gamma radiation decompose H2O2 and S2O82− into [rad]OH and SO4[rad]− and both [rad]OH and SO4[rad]− caused degradation of CR. The CR showed high reactivity, i.e., 3.25 × 109 and 8.50 × 108 M−1 s−1 with [rad]OH and SO4[rad]−, respectively, and removal of CR was inhibited in the presence of [rad]OH and SO4[rad]− scavengers. The removal of CR was promoted with elevating initial concentrations of H2O2 and S2O82− and decreasing initial concentrations of CR. pH of aqueous solution also significantly influenced removal of the dye. The proposed degradation pathways of CR were established from the [rad]OH mediated degradation of CR and nature of identified degradation products. The greater mineralization of CR, formation of small molecular mass degradation product, and decline in concentration of acetate after extended treatment suggest the gamma-ray mediated peroxide based process to be a promising alternative for potential degradation of CR

Characterisation of drug-resistant Mycobacterium tuberculosis mutations and transmission in Pakistan

Tuberculosis, caused by Mycobacterium tuberculosis, is a high-burden disease in Pakistan, with multi-drug (MDR) and extensive-drug (XDR) resistance, complicating infection control. Whole genome sequencing (WGS) of M. tuberculosis is being used to infer lineages (strain-types), drug resistance mutations, and transmission patterns—all informing infection control and clinical decision making. Here we analyse WGS data on 535 M. tuberculosis isolates sourced across Pakistan between years 2003 and 2020, to understand the circulating strain-types and mutations related to 12 anti-TB drugs, as well as identify transmission clusters. Most isolates belonged to lineage 3 (n = 397; 74.2%) strain-types, and were MDR (n = 328; 61.3%) and (pre-)XDR (n = 113; 21.1%). By inferring close genomic relatedness between isolates (< 10-SNPs difference), there was evidence of M. tuberculosis transmission, with 55 clusters formed consisting of a total of 169 isolates. Three clusters consist of M. tuberculosis that are similar to isolates found outside of Pakistan. A genome-wide association analysis comparing ‘transmitted’ and ‘non-transmitted’ isolate groups, revealed the nusG gene as most significantly associated with a potential transmissible phenotype (P = 5.8 × 10–10). Overall, our study provides important insights into M. tuberculosis genetic diversity and transmission in Pakistan, including providing information on circulating drug resistance mutations for monitoring activities and clinical decision making