560 research outputs found

    Complementary frailty and mortality prediction models on older patients as a tool for assessing palliative care needs

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    [EN] Palliative care (PC) has demonstrated benefits for life-limiting illnesses. Bad survival prognosis and patients' decline are working criteria to guide PC decision-making for older patients. Still, there is not a clear consensus on when to initiate early PC. This work aims to propose machine learning approaches to predict frailty and mortality in older patients in supporting PC decision-making. Predictive models based on Gradient Boosting Machines (GBM) and Deep Neural Networks (DNN) were implemented for binary 1-year mortality classification, survival estimation and 1-year frailty classification. Besides, we tested the similarity between mortality and frailty distributions. The 1-year mortality classifier achieved an Area Under the Curve Receiver Operating Characteristic (AUC ROC) of 0.87 [0.86, 0.87], whereas the mortality regression model achieved an mean absolute error (MAE) of 333.13 [323.10, 342.49] days. Moreover, the 1-year frailty classifier obtained an AUC ROC of 0.89 [0.88, 0.90]. Mortality and frailty criteria were weakly correlated and had different distributions, which can be interpreted as these assessment measurements are complementary for PC decision-making. This study provides new models that can be part of decision-making systems for PC services in older patients after their external validation.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the InAdvance project (H2020-SC1-BHC-2018-2020 No. 825750).Blanes-Selva, V.; Doñate-Martínez, A.; Linklater, G.; Garcia-Gomez, JM. (2022). Complementary frailty and mortality prediction models on older patients as a tool for assessing palliative care needs. Health Informatics Journal. 28(2):1-18. https://doi.org/10.1177/1460458222109259211828

    Trends in the epidemiology of larynx and lung cancer in south-east England, 1985–2004

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    We analysed data on 8987 larynx and 174060 lung cancer patients diagnosed between 1985 and 2004, of which 17.3% of larynx and 35.5% of lung cancers were in females. The age-standardised rates for each cancer declined in both sexes, but since the 1990s, the rates in females over 70 years of age have been diverging

    Responsive and Minimalist App Based on Explainable AI to Assess Palliative Care Needs during Bedside Consultations on Older Patients

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    [EN] Palliative care is an alternative to standard care for gravely ill patients that has demonstrated many clinical benefits in cost-effective interventions. It is expected to grow in demand soon, so it is necessary to detect those patients who may benefit from these programs using a personalised objective criterion at the correct time. Our goal was to develop a responsive and minimalist web application embedding a 1-year mortality explainable predictive model to assess palliative care at bedside consultation. A 1-year mortality predictive model has been trained. We ranked the input variables and evaluated models with an increasing number of variables. We selected the model with the seven most relevant variables. Finally, we created a responsive, minimalist and explainable app to support bedside decision making for older palliative care. The selected variables are age, medication, Charlson, Barthel, urea, RDW-SD and metastatic tumour. The predictive model achieved an AUC ROC of 0.83 [CI: 0.82, 0.84]. A Shapley value graph was used for explainability. The app allows identifying patients in need of palliative care using the bad prognosis criterion, which can be a useful, easy and quick tool to support healthcare professionals in obtaining a fast recommendation in order to allocate health resources efficiently.This work was supported by the InAdvance project (H2020-SC1-BHC-2018-2020 grant agreement number 825750.) and the CANCERLEss project (H2020-SC1-2020-Single-Stage-RTD grant agreement number 965351), both funded by the European Union's Horizon 2020 research and innovation programme.Blanes-Selva, V.; Doñate-Martínez, A.; Linklater, G.; Garcés-Ferrer, J.; Garcia-Gomez, JM. (2021). Responsive and Minimalist App Based on Explainable AI to Assess Palliative Care Needs during Bedside Consultations on Older Patients. Sustainability. 13(17):1-11. https://doi.org/10.3390/su13179844111131

    Inequalities in the incidence of cervical cancer in South East England 2001–2005: an investigation of population risk factors

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    BACKGROUND: The incidence of cervical cancer varies dramatically, both globally and within individual countries. The age-standardised incidence of cervical cancer was compared across primary care trusts (PCTs) in South East England, taking into account the prevalence of known behavioural risk factors, screening coverage and the deprivation of the area. METHODS: Data on 2,231 cases diagnosed between 2001 and 2005 were extracted from the Thames Cancer Registry, and data on risk factors and screening coverage were collated from publicly available sources. Age-standardised incidence rates were calculated for each PCT using cases of squamous cell carcinoma in the screening age group (25-64 years). RESULTS: The age-standardised incidence rate for cervical cancer in South East England was 6.7 per 100,000 population (European standard) but varied 3.1 fold between individual PCTs. Correlations between the age-standardised incidence rate and smoking prevalence, teenage conception rates, and deprivation were highly significant at the PCT level (p < 0.001). However, screening coverage was not associated with the incidence of cervical cancer at the PCT level. Poisson regression indicated that these variables were all highly correlated and could not determine the level of independent contribution at a population level. CONCLUSION: There is excess disease burden within South East England. Significant public health gains can be made by reducing exposure to known risk factors at a population level

    Mapping the shoreface of coastal sediment compartments to improve shoreline change forecasts in New South Wales, Australia

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    The potential response of shoreface depositional environments to sea level rise over the present century and beyond remains poorly understood. The shoreface is shaped by wave action across a sedimentary seabed and may aggrade or deflate depending on the balance between time-averaged wave energy and the availability and character of sediment, within the context of the inherited geological control. For embayed and accommodation-dominated coastal settings, where shoreline change is particularly sensitive to cross-shore sediment transport, whether the shoreface is a source or sink for coastal sediment during rising sea level may be a crucial determinant of future shoreline change. While simple equilibrium-based models (e.g. the Bruun Rule) are widely used in coastal risk planning practice to predict shoreline change due to sea level rise, the relevance of fundamental model assumptions to the shoreface depositional setting is often overlooked due to limited knowledge about the geomorphology of the nearshore seabed. We present high-resolution mapping of the shoreface-inner shelf in southeastern Australia from airborne lidar and vessel-based multibeam echosounder surveys, which reveals a more complex seabed than was previously known. The mapping data are used to interpret the extent, depositional character and morphodynamic state of the shoreface, by comparing the observed geomorphology to theoretical predictions from wave-driven sediment transport theory. The benefits of high-resolution seabed mapping for improving shoreline change predictions in practice are explored by comparing idealised shoreline change modelling based on our understanding of shoreface geomorphology and morphodynamics before and after the mapping exercise

    Rethinking globalised resistance : feminist activism and critical theorising in international relations

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    This article argues that a feminist approach to the 'politics of resistance' offers a number of important empirical insights which, in turn, open up lines of theoretical inquiry which critical theorists in IR would do well to explore. Concretely, we draw on our ongoing research into feminist 'anti-globalisation' activism to rethink the nature of the subject of the politics of resistance, the conditions under which resistance emerges and how resistance is enacted and expressed. We begin by discussing the relationship of feminism to critical IR theory as a way of situating and explaining the focus and approach of our research project. We then summarise our key empirical arguments regarding the emergence, structure, beliefs, identities and practices of feminist 'anti-globalisation' activism before exploring the implications of these for a renewed critical theoretical agenda in IR

    Foraging site recursion by forest elephants Elephas maximus borneensis

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    Recursion by herbivores is the repeated use of the same site or plants. Recursion by wild animals is rarely investigated but may be ubiquitous. Optimal foraging theory predicts site recursion as a function of the quality of the site, extent of its last use, and time since its last use because these influence site resource status and recovery. We used GPS collars, behaviour and site sampling to investigate recursion to foraging sites for two elephant Elephas maximus borneensis herds in the Lower Kinabatangan Wildlife Sanctuary, Borneo, over a 12 month period. Recursion occurred to 48 out of 87 foraging sites and was most common within 48 hours or between 151–250 days, indicating two different types of recursion. Recursion was more likely to occur if the site had previously been occupied for longer. Moreover, the time spent at a site at recursion was the same as the time spent at the site on the first occasion. The number of days that had passed between the first visit and recursion was also positively correlated with how much time was spent at the site at recursion. Habitat type also influenced the intensity of site-use, with more time spent at recursion within riverine/open grass areas along forest margins compared to other habitat types. Recursion is a common behaviour used by the elephants and its pattern suggests it may be a foraging strategy for revisiting areas of greater value. The qualities of recursion sites might usefully be incorporated into landscape management strategies for elephant conservation in the are

    The ethical challenge of Touraine's 'living together'

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    In Can We Live Together? Alain Touraine combines a consummate analysis of crucial social tensions in contemporary societies with a strong normative appeal for a new emancipatory 'Subject' capable of overcoming the twin threats of atomisation or authoritarianism. He calls for a move from 'politics to ethics' and then from ethics back to politics to enable the new Subject to make a reality out of the goals of democracy and solidarity. However, he has little to say about the nature of such an ethics. This article argues that this lacuna could usefully be filled by adopting a form of radical humanism found in the work of Erich Fromm. It defies convention in the social sciences by operating from an explicit view of the 'is' and the 'ought' of common human nature, specifying reason, love and productive work as the qualities to be realised if we are to move closer to human solidarity. Although there remain significant philosophical and political differences between the two positions, particularly on the role to be played by 'the nation', their juxtaposition opens new lines of inquiry in the field of cosmopolitan ethics

    Global citizenship as the completion of cosmopolitanism

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    A conception of global citizenship should not be viewed as separate from, or synonymous with, the cosmopolitan moral orientation, but as a primary component of it. Global citizenship is fundamentally concerned with individual moral requirements in the global frame. Such requirements, framed here as belonging to the category of individual cosmopolitanism, offer guidelines on right action in the context of global human community. They are complementary to the principles of moral cosmopolitanism – those to be used in assessing the justice of global institutions and practices – that have been emphasised by cosmopolitan political theorists. Considering principles of individual and moral cosmopolitanism together can help to provide greater clarity concerning individual duties in the absence of fully global institutions, as well as clarity on individual obligations of justice in relation to emerging and still-developing trans-state institutions
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