Competing risk models in early warning systems for in-hospital deterioration: the role of missing data imputation

Early Warning Systems (EWS) are useful and very important tools for evaluating the health deteriorating of hospitalised patients, using vital signs (such as heart rate, temperature, etc.) as the main input, based on electronic health records (EHR) which most of the time result in sparse data sets with high rates of missing data. In this work, we aim to study the effect of different imputation techniques on time-to-event (survival) models. For each case we have patient's sex and age, as well as longitudinal data along the hospitalisation for 7 vital signs (temperature, systolic and diastolic pressure, heart and respiratory rates, oxygen saturation and neurological state). We summarise these longitudinal data with the following central tendency, order and dispersion statistics: maximum, minimum, first observation, last observation, mean, standard deviation, average variance percentage and average derivative, transforming the original variables into a cross-sectional higher dimensional space, that still having missing data problems. Each hospitalisation has two possible final states: clinical deterioration or favourable discharge. Here, we model the time-to-event with competitive risk models taking into account the covariates. In the Galdakao-Usansolo University Hospital (Basque Country, Spain), a total of 19.602 hospitalisations (lengths of stay at least 24 hours) were collected during the year 2019, of which 852 (4.35\%) resulted in deterioration. These data correspond to 55.8\% of males and 44.2\% of females. We are using a set of imputation methods, such as central tendency statistics (mean and mode), Multiple Imputation by Chained Equations (MICE), Non-Linear Principal Components Analysis (NLPCA) and Random Forest. We evaluate the performances of the imputation methods described before, via root mean square error and conclude the pros and cons of using each one in medical practice. Then, we use Fine and Gray's competitive risk models and the cause-specific Cox proportional hazard regression to model the time-to-event as a function of imputed summarised data. Finally, we evaluate these models employing the traditional and time-dependent area under the ROC curve, for horizon times of 24, 48, 72, 96 and 120 hospitalisation hours

Competing risk modelling for in-hospital length of stay

In this study, we propose a framework for analysing in-hospital patient data from electronic health records. We transform longitudinal sparse vital signs measurements into cross-sectional data via descriptive statistics, imputing missing values, and evaluating variables strongly associated with time to mutually exclusive events (favourable medical discharge or deterioration). We employ competing risk and random survival forest techniques to predict patients’ length of stay and evaluate models’ performance via Brier score

Effectiveness of a stress management pilot program aimed at reducing the incidence of sports injuries in young football (soccer) players

Objectives Several attempts to reduce the incidence of sport injuries using psychosocial interventions produced fruitful, although inconclusive results. This paper presents the effectiveness and implementation issues of a pilot 3-month stress-management and muscle relaxation program aimed at reducing sport injury incidence. Design Pre-post treatment-non treatment group comparison. Program administration The program was administered by a trained psychologist on a once-a-week, 1-h session basis. Participants Seventy-four male soccer players from four National Youth league teams voluntarily participated. Teams were randomly assigned to either treatment/non-treatment group. Measures Injury protocol, Self-monitoring cards, Athletes' satisfaction and commitment survey, Coaches' interview. Results Group main effect and Time-Group interaction effect were both statistically significant, F(1,60) = 8.30, p = 0.005, η2p = 0.121, with the average number of injuries larger in the post-treatment phase of non-treatment group (p = 0.005, η2p = 0.077). There was a significant decrease in the average number of injuries for the intervention group before and after implementing the program (p < 0.001, η2p = 0.309). Conclusions A controlled implementation of a psychosocial program was effective in reducing youth soccer sport injuries, with a high level of satisfaction and commitment from the athletes, as well as high acceptance from the coachesThis research was supported by the Spanish MINECO (grant PSI2011-27000) and by the Murcia (Spain) Regional Football Association's Proyecto Fútbol, (grant FFRM-UMU-04 0092 321B 6450214704

Determination of the psychological and sportive variables related to sports injuries: a bayesian analysis

This study analyzes the relationship between psychological and physical variables and sports injuries. A total of 297 athletes from 26 different sports participated in the study. Variables related to biomedical, psychological and sports injuries were collected. The analysis of data was performed through Bayesian networks. Our results suggest that a high probability of self-efficacy produce statistical dependence to high likelihood of sports injuries. This variable receives previous influences of biomedical variables (BMI) and psychological variables (stress). There are also consequential variables to the injury: coping strategies, and locus of controlEste estudio analiza la relación entre variables psicológicas y las lesiones deportivas. Participaron en el estudio un total de 297 deportistas, de 26 distintos deportes. Se recogieron variables biomédicas, deportivas, psicológicas y referentes a la lesión deportiva. El análisis de los datos se llevó a cabo por medio de redes Bayesianas. Nuestros resultados parecen indicar que una elevada probabilidad de autoeficacia produce dependencia estadística de más probabilidad de lesión deportiva. Esta variable recibe influencias antecedentes tanto de variables biomédicas (IMC) como de variables psicológicas (estrés). También existen variables consecuentes a la lesión: uso de estrategias de afrontamiento, y locus de controlEste estudo analisa a relação entre as variáveis psicológicas e as lesões esportivas. Participaram no estudo um total de 297 atletas de 26 deportos distintos. Foram recolhidas variáveis biomédicas, desportivas, psicológicos e referentes à lesão desportiva. A análise de dados foi realizada através de redes de Bayesianas. Os nossos resultados sugerem que uma alta probabilidade de auto-eficácia produz dependência de maior probabilidade de lesão desportiva. Esta variável recebe as influências antecedentes tanto de variáveis biomédicas (IMC) como de variáveis psicológicas (stress). Existem também variáveis consequentes à lesão: uso de estratégias de confronto e locus de controloEsta investigación ha podido ser realizada gracias a la ayuda del Ministerio de Ciencia e Innovación (actualmente Ministerio de Economía y Competitividad), referencia PSI2011-27000

Competencia y confianza profesional en atención temprana en el uso de prácticas recomendadas y su relación con la involucración parental

Parent involvement in early childhood intervention (ECI) is considered an important component of recommended ECI practices. However, how parents are involved in their child’s early intervention differs considerably between ECI practitioners. Current research indicates that practitioners’ competence and confidence appraisals influence the use of ECI practices. The purposes of this study were to (1) adapt and validate the Early Childhood Intervention Practitioner Competence and Confidence Scale for use in Spain, (2) examine the psychometric properties of the scale, (3) compare practitioners’ beliefs about their competence and confidence in using recommended ECI practices, and (4) evaluate the relationship between belief appraisals and practitioners’ judgmentsof parent involvement in ECI. The sample included 130 Spanish ECI practitioners. The results indicated that the scale is a valid and reliable instrument for measuring practitioners’ competence and confidence in using six ECI recommended practices in Spain. Practitioners’ appraisals of competence and confidence, however, differed across the recommended practices. Significant positive correlations were found between the practitioners’ appraisals of competence and confidence and their judgments of parent in-volvement. These results show that a strong sense of competence and confidence in using different kinds of ECI-recommended practices is related to increased parent involvement in active child participation in learning and development in everyday activities.Research and practical implications are discussed.La involucración parental es un componente importante de las prácticas recomendadas en atención temprana (AT). Sin embargo, la forma en que los padres son involucrados en la intervención temprana de sus hijos difiere considerablemente entre los profesionales. En este sentido, la investigación actual muestra que el juicio de los profesionales en relación a su competencia y confianza influye el uso de prácticas de AT. Los objetivos de este estudio fueron (1) adaptar y validar la Early Childhood Intervention Practitioner Competence and Confidence Scale para su uso en España, (2) examinar las propiedades psicométricas de esta escala, (3) comparar las creencias de los profesionales en relación a su competencia y confianza en el uso de prácticas recomendadas, y (4) analizar la relación entre estas creencias y el juicio de los profesionales sobre la involucración parental en AT. A este fin, se contó con una muestra española de 130 profesionales de AT. Los resultados indicaron que la escala es un instrumento válido y fiable para medir la competencia y confianza profesional en el uso de seis prácticas recomendadas de AT en el contexto español. El juicio de los profesionales respecto a su competencia y confianza difirió entre las diversas prácticas recomendadas. Se encontraron correlaciones positivas y significativas entre las valoraciones de competencia y confianza de los profesionales y sus juicios sobre la involucración parental. Estos resultados muestran que una elevada competencia y confianza en el uso de diferentes tipos de prácticas recomendadas en AT está relacionada con una mayor involucración parental en la participación activa del niño en su aprendizaje y desarrollo en actividades cotidianas. Se discuten las implicaciones prácticas y de investigación

Assessment of soil redistribution rates in a Mediterranean olive orchard in South Spain using two approaches: 239+240Pu and soil erosion modelling

Soil redistribution by water and tillage soil erosion has a profound effect on the spatial variability of soil security indicators. In this study, we assess the potential of estimating long-term soil redistribution rates across a Mediterranean olive orchard catchment using two methods: 239+240Pu and the WaTEM/SEDEM model. Additionally, we identify potential sources of uncertainty explain result discrepancies, and offer guidance for reducing uncertainty. Soil sampling points were taken both in the inter-row areas and below the tree canopies and 239+240Pu inventories were converted into soil redistribution rates using MODERN. Sediment yield data measured in the catchment outlet is used to calibrate WaTEM/SEDEM. The results show a poor agreement between both methods. In this sense, these results indicate that both methods are considerably affected by several sources of uncertainty, both inherent to the methods themselves and related to the specific conditions of the study area. The latter are mainly related to anthropogenic changes in the soil surface related to soil tillage and rill filling practices and an important past land leveling effect. Despite the discrepancies, both methods convey a similar overarching message: soil security and olive production can be highly threatened in the Mediterranean in the next decades. This study demonstrates the potential advantages of combining FRN-based estimates and model simulations and highlights the importance of selecting an appropriate study area in this type of studies and the need to recognize associated uncertainties when estimating soil redistribution rates, whether employing FRN-based or modelling methods

Psychological profiling of triathlon and road cycling athletes

Psychological characteristics of athletes play a key role in sport performance and may moderate and mediate the influence of technical, tactical, and physical abilities athletes show. Different authors have emphasized the special attention such psychological characteristics should receive considering the extent they can influence athletes' behavior either in training or in competition. This paper is aimed at describing the psychological profiles of two cycling sports: triathlon and road cycling. One hundred and twenty-nine male and female professional and amateur cycling athletes (35.74 years old average age ±12.79; 14.94 average number of years practicing cycling ±11.20) were assessed on different psychological characteristics. For that purpose, the Psychological Characteristics related to the Sport Performance (CPRD) Questionnaire and the Psychological Skills Inventory for Sports (PSIS) was used. Results showed significant differences among triathlon and road cyclists (Stress control = t116=-3.711, p = 0.000, d = 0.48 ; Influence of Performance Evaluation = t115=-3-115, p = 0.002, d = 0.49; Motivation = t124=-5.520, p = 0.000, d = 0.82; Mental Skills = t119=-4.985, p = 0.000, d = 1.02). There were no significant differences between men and women though there were differences among pros and amateur athletes. Triathlon professional, compared to amateurs, showed higher scores in all the psychological dimensions assessed (Stress control = t85= 3.005, p = 0.003, d = 1.07; Influence of Performance Evaluation = t83= 2.858, p = 0.005, 0.77; Motivation = t91= 2.721, p = 0.008, d = 0.26; Mental Skills = t87= 2.556, p = 0.012, d = 0.77). The results of this descriptive study contribute to establishing a model of optimal psychological profiling applied to the different cycling groups that can be used by sport psychologist, trainers, and coaches in order to promote peak performance of these athletes.This research was supported by ELIT-in “Integration of elite athletes into the labour market through the valorization of their transversal competences” (590520-EPP-1-2017-1-ES-SPO-SCP

Preparation of a pure inoculum of acetic acid bacteria for the selective conversion of glucose in strawberry purée into gluconic acid

Strawberry surpluses, which may account for about 20% of the whole production, could bean example of what is happening with other fruits. This surplus is largely transformed intostrawberry purée which, although is especially suitable for various bioconversions, is mainlyused as an additional ingredient to produce other foods. With a view to using strawberrypurée to obtain a new, naturally sweet beverage containing no glucose, the conversion of glu-cose into gluconic acid, while maintaining the original fructose of the purée, was assessed.Additionally it is important to preserve the sensory and nutritional properties of the fruitso pasteurized rather than sterilized purée must be used.The use of Gluconobacter japonicus strain (CECT 8443) was studied by batch experi-ments. Different preparation stages were evaluated for ascertaining whether the inoculumrequired pre-cultivation in strawberry purée and whether using pasteurized rather thansterilized substrate would influence prevalence of the inoculated strain over unwantedmicroorganisms—yeasts, mainly.The strain converted glucose into gluconic acid preserving the original fructose contentof the substrate. The optimum inoculum preparation conditions involved microbial growthin Glucose Yeast Extract Peptone synthetic medium for 24 h first and in sterilized strawberrypurée for 24 h additional then

Internal electric fields and color shift in Cr3+-based gemstones

Seeking to better understand the origin of the different colors of emerald and ruby, both ab initio periodic and cluster calculations have been carried out. The calculations reproduce the interatomic distances measured for pure Be3Si6Al2O18 and Al2O3 as well as the Cr3+?O2? distances in emerald and ruby. The mean Cr3+?O2? distance for Be3Si6Al2O18:Cr3+ and Al2O3:Cr3+ is found to be practically equal to 1.97 Å, in agreement with recent experimental values. The present calculations confirm that the variations of optical properties due to Cr3+ impurities along the series of ionic oxides can be understood merely through the CrO69? unit but subject to the electric field due to the rest of the lattice ions. As a salient feature it is proved that changes in electronic density and covalency due to the internal field are not the cause of the color shift. Therefore, the red color of ruby is not due to the polarization of the electronic cloud around chromium as a result of the C3 local symmetry. The present study also demonstrates that the variation of the ligand field splitting parameter, 10Dq, induced by the internal electric field comes mainly from the contributions of first shells of ions around the CrO69? unit. As a consequence, 10Dq in emerald is not influenced by the internal field, as the contribution from Be2+ first neighbors is practically compensated by that of Si4+ second neighbors. In contrast, in ruby the t2g levels are shifted by the internal field 0.24 eV more than the eg ones, so explaining the color shift in this gemstone in comparison with emerald. This result is shown to arise partially from the asymmetric form of the internal electrostatic potential along the C3 axis in Al2O3.Support from the Spanish Ministerio de Ciencia y Tecnología under Project No. FIS2009-07083 is acknowledge