Targeting deprived areas within small areas in Scotland: population study

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Risk of critical illness among patients with solid cancers: a population-based observational study of 118,541 adults

Importance: Critical illness may be a potential determinant of cancer outcomes and geographic variations, but its role has not been described before. Objective: To determine the incidence of admission to intensive care units (ICUs) within 2 years following cancer diagnosis. Design, Setting, and Participants: This was a retrospective observational study using cancer registry data in 4 datasets from 2000 to 2009 with linked ICU admission data from 2000 to 2011, in the West of Scotland region of the United Kingdom (population, 2.4 million; all 16 ICUs within the region). All 118 541 patients (≥16 years) diagnosed as having solid (nonhematological) cancers. Their median age was 69 years, and 52.0% were women. Main Outcomes and Measures: Demographic and clinical variables associated with admission to an ICU and death in an ICU. Results: A total of 118 541 patients met the study criteria. Overall, 6116 patients (5.2% [95% CI, 5.0%-5.3%]) developed a critical illness and were admitted to an ICU within 2 years. Risk of critical illness was highest at ages 60 to 69 years and higher in men. The cumulative incidence of critical illness was greatest for small intestinal (17.2% [95% CI, 13.3%-21.8%]) and colorectal cancers (16.5% [95% CI, 15.9%-17.1%]). The risk following breast cancer was low (0.8% [95% CI, 0.7%-1.0%]). The percentage who died in ICUs was 14.1% (95% CI, 13.3%-15.0%), and during the hospital stay, 24.6% (95% CI, 23.5%-25.7%). Mortality was greatest among emergency medical admissions and lowest among elective surgical patients. The risk of critical illness did not vary by socioeconomic circumstances, but mortality was higher among patients from deprived areas. Conclusions and Relevance: In this study, about 1 in 20 patients experienced a critical illness resulting in ICU admission within 2 years of cancer diagnosis. The associated high mortality rate may make a significant contribution to overall cancer outcomes

Changes in BMI and waist circumference in Scottish adults: use of repeated cross-sectional surveys to explore multiple age groups and birth-cohorts

Objective: To document changes in body mass index (BMI) and waist circumference (WC) over a 10-year period 1998-2008, in representative surveys of adults.<p></p> Subjects: Adults aged 18-72 in the Scottish Health Surveys conducted in 1998, 2003 and 2008 were divided, separately for men and women, into eleven 5-year age bands. ‘Synthetic birth-cohorts’ were created by dividing participants into thirteen 5-years-of-birth bands (n=20,423). Weight, height and waist circumference were objectively measured by trained observers.<p></p> Results: Subjects with data available on BMI/waist circumference were 7743/6894 in 1998, 5838/4437 in 2003 and 4688/925 in 2008 with approximately equal gender distributions. Mean BMI and waist were both greater in successive surveys in both men and women. At most specific ages, people were consistently heavier in 2008 than in 1998 by about 1-1.5 BMI units, and waist circumferences were greater, by about 2-6 cm in men and 5-7 cm in women. Greater increases were seen at younger ages between 1998 and 2003 than between 2003 and 2008, however increases continued at older ages, particularly in waist. All birth-cohorts observed over the 10 years 1998-2008 showed increases in both BMI and waist, most marked in the younger groups. The 10-year increases in waist within birth-cohorts (mean 7.4 cm (8.1%) in men and 8.6 cm (10.9%) in women) were more striking than BMI (mean 1.8 kg/m2 (6.6%) in men and 1.5 kg/m2 (6.4%) in women) were particularly steep in older women.<p></p> Conclusion: People were heavier and fatter in 2003 than those of the same age in 1998, with less marked increases in WC between 2003 and 2008 than 1998 and 2003. There were proportionally greater increases in waist circumference than BMI, especially in older women. This suggests a disproportionate increase in body fat, compared to muscle, particularly among older women.<p></p&gt

Bounding inconsistency using a novel threshold metric for dead reckoning update packet generation

Human-to-human interaction across distributed applications requires that sufficient consistency be maintained among participants in the face of network characteristics such as latency and limited bandwidth. The level of inconsistency arising from the network is proportional to the network delay, and thus a function of bandwidth consumption. Distributed simulation has often used a bandwidth reduction technique known as dead reckoning that combines approximation and estimation in the communication of entity movement to reduce network traffic, and thus improve consistency. However, unless carefully tuned to application and network characteristics, such an approach can introduce more inconsistency than it avoids. The key tuning metric is the distance threshold. This paper questions the suitability of the standard distance threshold as a metric for use in the dead reckoning scheme. Using a model relating entity path curvature and inconsistency, a major performance related limitation of the distance threshold technique is highlighted. We then propose an alternative time—space threshold criterion. The time—space threshold is demonstrated, through simulation, to perform better for low curvature movement. However, it too has a limitation. Based on this, we further propose a novel hybrid scheme. Through simulation and live trials, this scheme is shown to perform well across a range of curvature values, and places bounds on both the spatial and absolute inconsistency arising from dead reckoning

Mean squared error vs. frame potential for unsupervised variable selection

Forward Selection Component Analysis (FSCA) provides a pragmatic solution to the NP-hard unsupervised variable selection problem, but is not guaranteed to be optimal due to the multi-modal nature of the mean squared error (MSE) selection metric used. Frame potential (FP) is a metric that has recently been shown to yield near-optimal greedy sensor selection performance for linear inverse problems. This paper explores if FP offers similar benefits in the unsupervised variable selection context. In addition, the backward elimination counterpart of FSCA is introduced for the first time (BECA) and compared with forward and backward FP based variable selection on a number of simulated and real world datasets. It is concluded that FP does not improve on FSCA and that while BECA yields comparable results to FSCA it is not a competitive alternative due to its much higher computational complexity.</p

Feature Selection for Anomaly Detection Using Optical Emission Spectroscopy

To maintain the pace of development set by Moore's law, production processes in semiconductor manufacturing are becoming more and more complex. The development of efficient and interpretable anomaly detection systems is fundamental to keeping production costs low. As the dimension of process monitoring data can become extremely high anomaly detection systems are impacted by the curse of dimensionality, hence dimensionality reduction plays an important role. Classical dimensionality reduction approaches, such as Principal Component Analysis, generally involve transformations that seek to maximize the explained variance. In datasets with several clusters of correlated variables the contributions of isolated variables to explained variance may be insignificant, with the result that they may not be included in the reduced data representation. It is then not possible to detect an anomaly if it is only reflected in such isolated variables. In this paper we present a new dimensionality reduction technique that takes account of such isolated variables and demonstrate how it can be used to build an interpretable and robust anomaly detection system for Optical Emission Spectroscopy data.</p

Older and wiser? Men’s and women’s accounts of drinking in early mid-life

Most qualitative research on alcohol focuses on younger rather than older adults. To explore older people’s relationship with alcohol, we conducted eight focus groups with 36 men and women aged 35 to 50 years in Scotland, UK. Initially, respondents suggested that older drinkers consume less alcohol, no longer drink to become drunk and are sociable drinkers more interested in the taste than the effects of alcohol. However, as discussions progressed, respondents collectively recounted recent drunken escapades, challenged accounts of moderate drinking, and suggested there was still peer pressure to drink. Some described how their drinking had increased in mid-life but worked hard discursively to emphasise that it was age and stage appropriate (i.e. they still met their responsibilities as workers and parents). Women presented themselves as staying in control of their drinking while men described going out with the intention of getting drunk (although still claiming to meet their responsibilities). While women experienced peer pressure to drink, they seemed to have more options for socialising without alcohol than did men. Choosing not to drink alcohol is a behaviour that still requires explanation in early mid-life. Harm reduction strategies should pay more attention to drinking in this age group

Critical care provision after colorectal cancer surgery

Background: Colorectal cancer (CRC) is the 2nd largest cause of cancer related mortality in the UK with 40 000 new patients being diagnosed each year. Complications of CRC surgery can occur in the perioperative period that leads to the requirement of organ support. The aim of this study was to identify pre-operative risk factors that increased the likelihood of this occurring. Methods: This is a retrospective observational study of all 6441 patients who underwent colorectal cancer surgery within the West of Scotland Region between 2005 and 2011. Logistic regression was employed to determine factors associated with receiving postoperative organ support. Results: A total of 610 (9 %) patients received organ support. Multivariate analysis identified age ≥65, male gender, emergency surgery, social deprivation, heart failure and type II diabetes as being independently associated with organ support postoperatively. After adjusting for demographic and clinical factors, patients with metastatic disease appeared less likely to receive organ support (p = 0.012). Conclusions: Nearly one in ten patients undergoing CRC surgery receive organ support in the post operative period. We identified several risk factors which increase the likelihood of receiving organ support post operatively. This is relevant when consenting patients about the risks of CRC surgery

Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

Objective: To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS). Design: Cross-sectional study. Setting: Regional specialist WMS located in the West of Scotland. Participants: 9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing. Primary and secondary outcome measures: Primary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions. Analysis: Multilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion. Results: Approximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18–24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30–35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas. Conclusions: There was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation

Forward Selection Component Analysis: Algorithms and Applications

Principal Component Analysis (PCA) is a powerful and widely used tool for dimensionality reduction. However, the principal components generated are linear combinations of all the original variables and this often makes interpreting results and root-cause analysis difficult. Forward Selection Component Analysis (FSCA) is a recent technique that overcomes this difficulty by performing variable selection and dimensionality reduction at the same time. This paper provides, for the first time, a detailed presentation of the FSCA algorithm, and introduces a number of new variants of FSCA that incorporate a refinement step to improve performance. We then show different applications of FSCA and compare the performance of the different variants with PCA and Sparse PCA. The results demonstrate the efficacy of FSCA as a low information loss dimensionality reduction and variable selection technique and the improved performance achievable through the inclusion of a refinement step