Construction data mining methods in the prediction of death in hemodialysis patients using support vector machine, neural network, logistic regression and decision tree

Objectives: Chronic kidney disease (CKD) is one of the main causes of morbidity and mortality worldwide. Detecting survival modifiable factors could help in prioritizing the clinical care and offers a treatment decision-making for hemodialysis patients. The aim of this study was to develop the best predictive model to explain the predictors of death in Hemodialysis patients by using data mining techniques. Methods: In this study, we used a dataset included records of 857 dialysis patients. Thirty-one potential risk factors, that might be associated with death in dialysis patients, were selected. The performances of four classifiers of support vector machine, neural network, logistic regression and decision tree were compared in terms of sensitivity, specificity, total accuracy, positive likelihood ratio and negative likelihood ratio. Results: The average total accuracy of all methods was over 61%; the greatest total accuracy belonged to logistic regression (0.71). Also, logistic regression produced the greatest specificity (0.72), sensitivity (0.69), positive likelihood ratio (2.48) and the lowest negative likelihood ratio (0.43). Conclusions: Logistic regression had the best performance in comparison to other methods for predicting death among hemodialysis patients. According to this model female gender, increasing age, addiction, low Iron level, C-reactive protein positive and low urea reduction ratio were the main predictors of death in hemodialysis patients

Gene expression level of toll-like receptor 4 and insulin receptor substrate 1 in type II diabetic Malay patients and their first-degree relatives

Background: Type II diabetes mellitus (T2DM) is a polygenic disorder that can be prevented or delayed in case of the adoption of proper interventions. The identification of susceptible genes and novel biomarkers of T2DM could be of great help in the early detection of high-risk individuals. First-degree relatives of T2DM patients have a high risk of this disease, even when they have no major abnormalities in glucose metabolism. The present study was conducted to examine the status of the expression of two genes, namely toll-like receptor 4 (TLR4) and insulin receptor substrate (IRS1), involved in glucose metabolism in peripheral blood, in individuals genetically predisposed to T2DM development. Methods: Blood samples were collected from 54 participants in three research groups, including Malay subjects with T2DM, first-degree relatives of T2DM patients, and healthy controls. The measurement of gene expression was accomplished using a quantitative real-time polymerase chain reaction. Result: The results were indicative of the significant upregulation and downregulation of TLR4 in patients with T2DM and their first-degree relatives, respectively (P<0.05). With regard to IRS1, the data revealed a decreased expression in T2DM patients as compared to that in the healthy controls (p<0.05). Conclusion: The results indicated that TLR4 and IRS1 might be involved in the pathogenesis of T2DM. Moreover,the altered expression of TLR4 in the first-degree relatives of diabetic patients is an important marker showing a genetic predisposition to T2DM. Therefore, the two investigated genes could be used as a diagnostic tool for the prediction of T2DM in this population

40-Years of Lake Urmia Restoration Research: Synthesis and Next Steps

Lake Urmia’s desiccation and recent nascent recovery have garnered international and Iranian attention. Lake restoration at this scale requires integration across many sciences, technology, engineering, management, and governance topics. Here, we synthesized 544 peer-reviewed articles on Lake Urmia indexed in the Scopus database, answered nine restoration questions of scientific and popular interest, and recommended next steps for consequential lake restoration. We find: (1) research on diverse topics is fragmented and needs more integration. (2) Ecological and limnological studies have mostly focused on salinity, Artemia, and Flamingos. (3) Dust from the dry lakebed and nearby regions has negatively impacted human health. (4) Most research seeks to restore the lake to a single, uniform level of 1274.1 m thought to recover Artemia. (5) The lake’s north and south arms have different chemical and physical properties but researchers disagree on how newly breaching the causeway that separates the arms will impact salinities, evaporation, and ecosystems. (6) Expanding irrigated agriculture, dam construction, and mismanagement had a larger impact on lake decline than temperature increases and precipitation decreases. (7) The Iranian government’s 5-year recovery effort helped raise lake level about 1 m and immobilize lakebed dust. (8) Only one study publicly shared data, and only three studies described engagement with stakeholders or managers. (9) Numerous suggestions to improve economic conditions, work with farmers, or change farmer-government processes require varying effort and most still require implementation. We see next steps for lake recovery to monitor ungauged or poorly characterized water flows throughout the basin; develop alternative livelihoods beyond agriculture; describe the entire food web that supports migratory birds; manage for diverse ecosystem objectives and their associated lake levels; adapt basin water management to available water and lake evaporation; build capacity to share data, models, and code; train researchers in data-sharing tools and best practices; and better connect research topics, researchers, stakeholders, and managers. All of our findings and next steps encourage Lake Urmia managers to extend restoration efforts beyond five years and cultivate more public support

How Can Researchers and Managers Better Collaborate on Lake Urmia Restoration?

The large decline in Lake Urmia\u27s level since 1995 has prompted a correspondingly large increase in research to help inform lake restoration. Here we synthesize results from 451 English-language articles (Figure 1) to answer four lake restoration questions of interest to the public and lake managers. We ask: 1) What lake restoration levels were considered besides the ecological level of 1274.1 m? 2) How has the causeway affected lake conditions? 3) Do we know enough about lake limnology and ecology to facilitate recovery? And 4) what to learn from Great Salt Lake management? We seek to share these findings with Lake Urmia managers, solicit feedback, and identify next steps for restoration and collaborative work

Analysis of selected glutathione S-transferase gene polymorphisms in Malaysian type 2 diabetes mellitus patients with and without cardiovascular disease

Type 2 diabetes mellitus (T2DM) is believed to be associated with excessive production of reactive oxygen species. Glutathione S-transferase (GST) polymorphisms result in decreased or absent enzyme activity and altered oxidative stress, and have been associated with cardiovascular disease (CVD). The present study assessed the effect of GST polymorphisms on the risk of developing T2DM in individuals of Malaysian Malay ethnicity. A total of 287 subjects, consisting of 87 T2DM and 64 CVD/T2DM patients, as well as 136 healthy gender- and age-matched controls were genotyped for selected polymorphisms to evaluate associations with T2DM susceptibility. Genomic DNA was extracted using commercially available kits, and GSTM1, GSTT1, and α-globin sequences were amplified by multiplex polymerase chain reaction. Biochemical parameters were measured with a Hitachi autoanalyzer. The Fisher exact test, the chi-square statistic, and means ± standard deviations were calculated using the SPSS software. Overall, we observed no significant differences regarding genotype and allele frequencies between each group (P = 0.224 and 0.199, respectively). However, in the combined analysis of genotypes and blood measurements, fasting plasma glucose, HbA1c, and triglyceride levels, followed by age, body mass index, waist-hip ratio, systolic blood pressure, and history of T2DM significantly differed according to GST polymorphism (P ˂ 0.05). Genetically induced absence of the GSTT1 enzyme is an independent and powerful predictor of premature vascular morbidity and death in individuals with T2DM, and might be triggered by cigarette smoking’s oxidative effects. These polymorphisms could be screened in other ethnicities within Malaysia to determine further possible risk factors

Cytotoxicity and Proapoptotic Effects of Allium atroviolaceum

Breast cancer is the second leading cause of cancer death among women and despite significant advances in therapy, it remains a critical health problem worldwide. Allium atroviolaceum is an herbaceous plant, with limited information about the therapeutic capability. We aimed to study the anticancer effect of flower extract and the mechanisms of action in MCF-7 and MDA-MB-231. The extract inhibits the proliferation of the cells in a time- and dose-dependent manner. The underlying mechanism involved the stimulation of S and G2/M phase arrest in MCF-7 and S phase arrest in MDA-MB-231 associated with decreased level of Cdk1, in a p53-independent pathway. Furthermore, the extract induces apoptosis in both cell lines, as indicated by the percentage of sub-G0 population, the morphological changes observed by phase contrast and fluorescent microscopy, and increase in Annexin-V-positive cells. The apoptosis induction was related to downregulation of Bcl-2 and also likely to be caspase-dependent. Moreover, the combination of the extract and tamoxifen exhibits synergistic effect, suggesting that it can complement current chemotherapy. LC-MS analysis displayed 17 major compounds in the extract which might be responsible for the observed effects. Overall, this study demonstrates the potential applications of Allium atroviolaceum extract as an anticancer drug for breast cancer treatment

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens