Surveys without Questions: A Reinforcement Learning Approach

The 'old world' instrument, survey, remains a tool of choice for firms to obtain ratings of satisfaction and experience that customers realize while interacting online with firms. While avenues for survey have evolved from emails and links to pop-ups while browsing, the deficiencies persist. These include - reliance on ratings of very few respondents to infer about all customers' online interactions; failing to capture a customer's interactions over time since the rating is a one-time snapshot; and inability to tie back customers' ratings to specific interactions because ratings provided relate to all interactions. To overcome these deficiencies we extract proxy ratings from clickstream data, typically collected for every customer's online interactions, by developing an approach based on Reinforcement Learning (RL). We introduce a new way to interpret values generated by the value function of RL, as proxy ratings. Our approach does not need any survey data for training. Yet, on validation against actual survey data, proxy ratings yield reasonable performance results. Additionally, we offer a new way to draw insights from values of the value function, which allow associating specific interactions to their proxy ratings. We introduce two new metrics to represent ratings - one, customer-level and the other, aggregate-level for click actions across customers. Both are defined around proportion of all pairwise, successive actions that show increase in proxy ratings. This intuitive customer-level metric enables gauging the dynamics of ratings over time and is a better predictor of purchase than customer ratings from survey. The aggregate-level metric allows pinpointing actions that help or hurt experience. In sum, proxy ratings computed unobtrusively from clickstream, for every action, for each customer, and for every session can offer interpretable and more insightful alternative to surveys.Comment: The Thirty-Third AAAI Conference on Artificial Intelligence (AAAI-19

Nose-on-Chip Nanobiosensors for Early Detection of Lung Cancer Breath Biomarkers

Lung cancer remains a global health concern, demanding the development of noninvasive, prompt, selective, and point-of-care diagnostic tools. Correspondingly, breath analysis using nanobiosensors has emerged as a promising noninvasive nose-on-chip technique for the early detection of lung cancer through monitoring diversified biomarkers such as volatile organic compounds/gases in exhaled breath. This comprehensive review summarizes the state-of-the-art breath-based lung cancer diagnosis employing chemiresistive-module nanobiosensors supported by theoretical findings. It unveils the fundamental mechanisms and biological basis of breath biomarker generation associated with lung cancer, technological advancements, and clinical implementation of nanobiosensor-based breath analysis. It explores the merits, challenges, and potential alternate solutions in implementing these nanobiosensors in clinical settings, including standardization, biocompatibility/toxicity analysis, green and sustainable technologies, life-cycle assessment, and scheming regulatory modalities. It highlights nanobiosensors’ role in facilitating precise, real-time, and on-site detection of lung cancer through breath analysis, leading to improved patient outcomes, enhanced clinical management, and remote personalized monitoring. Additionally, integrating these biosensors with artificial intelligence, machine learning, Internet-of-things, bioinformatics, and omics technologies is discussed, providing insights into the prospects of intelligent nose-on-chip lung cancer sniffing nanobiosensors. Overall, this review consolidates knowledge on breathomic biosensor-based lung cancer screening, shedding light on its significance and potential applications in advancing state-of-the-art medical diagnostics to reduce the burden on hospitals and save human lives

A comprehensive review on the removal of noxious pollutants using carrageenan based advanced adsorbents

Rapid industrial development is associated with high discharge of toxic pollutants into the environment. The industries discharge their wastewater containing organic pollutants directly into the water system without treating them that has posed many serious threats to environmental protection. The use of bioadsorbents for the removal of such toxic pollutants from the waste water due to its simple synthesis, easy operation, effectiveness, and economic viability have emerged a new dimension in the wastewater treatment approaches. Various adsorbents have been prepared to examine their adsorption capacity against different adsorbates, but, to attain sustainability, biocompatibility, and biodegradation, bio-adsorbents have been found to won the battle. Seaweed derived polysaccharide; Carrageenan (CR) has been proven to be an excellent adsorbent for the wastewater treatment. It has been successfully modified with various components to form CR based-magnetic composites, hydrogels, nanoparticle modified CR composites and many others to enrich and diversify its properties. In this review, we have explained the adsorption behaviour of various carrageenan based adsorbents for the removal of different dyes. The influence of various parameters such as the effect of initial concentration, adsorbent dosage, contact time, pH, temperature, and ion concentration on dye adsorption is well explained. This paper also summarizes the structure, morphology, swelling ability, and thermal stability of carrageenan. The data also expounds on the adsorption capacity, kinetic model, isotherm model, and nature of the adsorption process. Different types of solvents are used for the regeneration and reusability of carrageenan adsorbents and their regeneration studies and desorption efficiency is well-explained. The adsorption mechanism of dyes onto carrageenan based adsorbents has been well described in this review. This review provides a deep insight about the use of carrageenan based adsorbents for the wastewater treatment

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Wellens\u27 Syndrome: A Rare Presentation After an Endoscopic Retrograde Cholangiopancreatography

Wellens\u27 syndrome is a pattern of ECG changes typically seen in patients with unstable angina that has a high positive predictive value for critical left anterior descending coronary artery stenosis. Recognition of this syndrome can allow for intervention before the patient develops myocardial infarction. We report a case of Wellens\u27 syndrome that was observed after an endoscopic retrograde cholangiopancreatography, which highlights risk factors that needs consideration in evaluating patients with these ECG findings after undergoing procedures even when asymptomatic

Transition from childhood nocturnal enuresis to edult nocturia : a systematic review and meta-analysis

Purpose: Current literature has suggested a relationship between nocturnal enuresis (NE) in childhood and the development of nocturia later in life as both disorders have similar underlying etiologies, comorbidities, and treatments. The objective was to synthesize the available evidence on the association between childhood NE and later presentation of nocturia. Methods: PubMed, CINAHL, Scopus, and Google Scholar were searched for peer-reviewed studies published between January 1980 and April 2021. Case-control and cohort studies that reported on childhood NE and current nocturia were included. The PRISMA protocol was followed (PROSPERO ID: CRD42021256255). A random-effects model was applied to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). Risk of bias was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria and with a funnel plot. Results: Of the 278 articles identified, 8 studies met inclusion criteria. The 6 case-control and 2 prospective cohort studies resulted in a total sample size of 26,070 participants. In a random-effect pooled analysis, childhood NE was significantly associated with the development of nocturia (OR: 1.75, 95% CI: 1.11-2.40). Significant heterogeneity (I-2 = 92.7%, p < 0.01) was identified among the included studies, which was reflected in an asymmetrical funnel plot. NE and nocturia have similar underlying etiologies of hormonal abnormalities, sleep disorders, physiological disorders, and psychological disorders. Conclusion: The history of childhood NE is significantly associated with nocturia later in life. The data in this meta-analysis support this transition and identify potential similarities between the two disorders. The sparse number of articles relevant to this topic is a strong indicator of the need for more work on this transition from childhood to maturity. More studies are warranted to further explore the association between NE and nocturia

Impact of delivery method and fetal size on nocturia: An analysis of the national health and nutrition examination survey

Purpose:: Pregnancy has been associated with long-term lower urinary tract symptoms such as nocturia. The purpose of this study was to explore potential associations between delivery modality and fetal size during pregnancy and the presence of nocturia. Materials and Methods:: Using the National Health and Nutrition Examination Survey (NHANES) database from 2005/06-2017/18, we categorized females by status of prior delivery modalities: nulligravida, vaginal deliveries, and cesarean deliveries. Groups were weighed and case-control matched for age, race, BMI, and number of deliveries. The association of delivery modality and fetal size (≥9 pounds or <5.5 pounds) on odds of nocturia and mean number of nighttime voids was assessed. Results:: Of the 1324 females analyzed (age range 20–49 years), 378 were nulligravida, 473 had vaginal deliveries, and 473 had Cesarean deliveries. Prevalence of nocturia was 18.3% for nulligravida, 24.1% for vaginal deliveries, and 24.1% for Cesarean deliveries subgroups. Both a history of vaginal deliveries (OR = 1.42, p = 0.039) and Cesarean deliveries (OR = 1.42, p = 0.039) showed an association to nocturia, although no differences were seen between the two groups. Number of deliveries or fetal size did not show any associations to nocturia development nor differences in mean number of nighttime voids in comparing the subgroups. Conclusions:: While both delivery modalities were associated with nocturia, the relationship does not differ between vaginal or Cesarean deliveries. No differences in nocturia were seen when the delivery modality groups were further sub-grouped by number of deliveries and fetal size