Phase-type survival trees and mixed distribution survival trees for clustering patients' hospital length of stay

Clinical investigators, health professionals and managers are often interested in developing criteria for clustering patients into clinically meaningful groups according to their expected length of stay. In this paper, we propose two novel types of survival trees; phase-type survival trees and mixed distribution survival trees, which extend previous work on exponential survival trees. The trees are used to cluster the patients with respect to length of stay where partitioning is based on covariates such as gender, age at the time of admission and primary diagnosis code. Likelihood ratio tests are used to determine optimal partitions. The approach is illustrated using nationwide data available from the English Hospital Episode Statistics (HES) database on stroke-related patients, aged 65 years and over, who were discharged from English hospitals over a 1-year period.peer-reviewe

A phase type survival tree model for clustering patients’ hospital length of stay

Clinical investigators, health professionals and managers are often interested in developing criteria for clustering patients into clinically meaningful groups according to their expected length of stay. In this paper, we propose phase-type survival trees which extend previous work on exponential survival trees. The trees are used to cluster the patients with respect to length of stay where partitioning is based on covariates such as gender, age at the time of admission and primary diagnosis code. Likelihood ratio tests are used to determine optimal partitions. The approach is illustrated using nationwide data available from the English Hospital Episode Statistics (HES) database on stroke-related patients, aged 65 years and over, who were discharged from English hospitals over a 1-year period.peer-reviewe

A PC based time domain reflectometer for space station cable fault isolation

Significant problems are faced by astronauts on orbit in the Space Station when trying to locate electrical faults in multi-segment avionics and communication cables. These problems necessitate the development of an automated portable device that will detect and locate cable faults using the pulse-echo technique known as Time Domain Reflectometry. A breadboard time domain reflectometer (TDR) circuit board was designed and developed at the NASA-JSC. The TDR board works in conjunction with a GRiD lap-top computer to automate the fault detection and isolation process. A software program was written to automatically display the nature and location of any possible faults. The breadboard system can isolate open circuit and short circuit faults within two feet in a typical space station cable configuration. Follow-on efforts planned for 1994 will produce a compact, portable prototype Space Station TDR capable of automated switching in multi-conductor cables for high fidelity evaluation. This device has many possible commercial applications, including commercial and military aircraft avionics, cable TV, telephone, communication, information and computer network systems. This paper describes the principle of time domain reflectometry and the methodology for on-orbit avionics utility distribution system repair, utilizing the newly developed device called the Space Station Time Domain Reflectometer (SSTDR)

Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk

Background Quitting tobacco or alcohol use has been reported to reduce the head and neck cancer risk in previous studies. However, it is unclear how many years must pass following cessation of these habits before the risk is reduced, and whether the risk ultimately declines to the level of never smokers or never drinkers. Methods We pooled individual-level data from case-control studies in the International Head and Neck Cancer Epidemiology Consortium. Data were available from 13 studies on drinking cessation (9167 cases and 12 593 controls), and from 17 studies on smoking cessation (12 040 cases and 16 884 controls). We estimated the effect of quitting smoking and drinking on the risk of head and neck cancer and its subsites, by calculating odds ratios (ORs) using logistic regression models. Results Quitting tobacco smoking for 1-4 years resulted in a head and neck cancer risk reduction [OR 0.70, confidence interval (CI) 0.61-0.81 compared with current smoking], with the risk reduction due to smoking cessation after ≥20 years (OR 0.23, CI 0.18-0.31), reaching the level of never smokers. For alcohol use, a beneficial effect on the risk of head and neck cancer was only observed after ≥20 years of quitting (OR 0.60, CI 0.40-0.89 compared with current drinking), reaching the level of never drinkers. Conclusions Our results support that cessation of tobacco smoking and cessation of alcohol drinking protect against the development of head and neck cance

A national-scale assessment of climate change impacts on species: assessing the balance of risks and opportunities for multiple taxa

It is important for conservationists to be able to assess the risks that climate change poses to species, in order to inform decision making. Using standardised and repeatable methods, we present a national-scale assessment of the risks of range loss and opportunities for range expansion, that climate change could pose for over 3,000 plants and animals that occur in England. A basic risk assessment that compared projected future changes in potential range with recently observed changes classified 21% of species as being at high risk and 6% at medium risk of range loss under a B1 climate change scenario. A greater number of species were classified as having a medium (16%) or high (38%) opportunity to potentially expand their distribution. A more comprehensive assessment, incorporating additional ecological information, including potentially confounding and exacerbating factors, was applied to 402 species, of which 35 % were at risk of range loss and 42 % may expand their range extent. This study covers a temperate region with a significant proportion of species at their poleward range limit. The balance of risks and opportunities from climate change may be different elsewhere. The outcome of both risk assessments varied between taxonomic groups, with bryophytes and vascular plants containing the greatest proportion of species at risk from climate change. Upland habitats contained more species at risk than other habitats. Whilst the overall pattern was clear, confidence was generally low for individual assessments, with the exception of well-studied taxa such as birds. In response to climate change, nature conservation needs to plan for changing species distributions and increasing uncertainty of the future

Metabolomic Profiling of Bile Acids in Clinical and Experimental Samples of Alzheimer’s Disease

Certain endogenous bile acids have been proposed as potential therapies for ameliorating Alzheimer’s disease (AD) but their role, if any, in the pathophysiology of this disease is not currently known. Given recent evidence of bile acids having protective and anti-inflammatory effects on the brain, it is important to establish how AD affects levels of endogenous bile acids. Using LC-MS/MS, this study profiled 22 bile acids in brain extracts and blood plasma from AD patients (n = 10) and age-matched control subjects (n = 10). In addition, we also profiled brain/plasma samples from APP/PS1 and WT mice (aged 6 and 12 months). In human plasma, we detected significantly lower cholic acid (CA, p = 0.03) in AD patients than age-matched control subjects. In APP/PS1 mouse plasma we detected higher CA (p = 0.05, 6 months) and lower hyodeoxycholic acid (p = 0.04, 12 months) than WT. In human brain with AD pathology (Braak stages V-VI) taurocholic acid (TCA) were significantly lower (p = 0.01) than age-matched control subjects. In APP/PS1 mice we detected higher brain lithocholic acid (p = 0.05) and lower tauromuricholic acid (TMCA; p = 0.05, 6 months). TMCA was also decreased (p = 0.002) in 12-month-old APP/PS1 mice along with 5 other acids: CA (p = 0.02), β-muricholic acid (p = 0.02), Ω-muricholic acid (p = 0.05), TCA (p = 0.04), and tauroursodeoxycholic acid (p = 0.02). The levels of bile acids are clearly disturbed during the development of AD pathology and, since some bile acids are being proposed as potential AD therapeutics, we demonstrate a method that can be used to support work to advance bile acid therapeutics