Early hospital readmissions post‐kidney transplantation are associated with inferior clinical outcomes

Unplanned hospital readmissions are common early post‐kidney transplantation. We investigated the relationship between early hospital readmissions and clinical outcomes in a single‐center retrospective study that included all adult kidney transplant patients between 2004 and 2008 with follow‐up to December 2012. The early hospital readmissions within the first 30 d were numbered and the diagnosis ascertained. Patients were grouped as none, once, and twice or more readmissions. Predictors of early readmissions were assessed, and clinical outcomes and patient and death‐censored kidney survival were compared. Among 1064 patients, 203 (19.1%) patients had once and 83 (7.8%) patients had twice or more readmissions within 30 d. Surgical complications, infections, and acute kidney injuries/acute rejection were three most common diagnoses. The length of initial hospital stay and African American race were among the variables associated significantly with readmissions. Patients with early readmissions had lower baseline renal function (p < 0.01) and more early acute rejection (p < 0.01). During follow‐up, only frequent readmissions, twice or more, within 30 d were associated with increased risk of death ( AHR 1.75, p   =   0.01) and death‐censored kidney failure ( AHR 2.20, p < 0.01). Frequent early hospital readmissions post‐transplantation identify patients at risk for poor long‐term outcomes, and more studies are needed to understand the mechanisms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106830/1/ctr12347.pd

Linear Estimation of Location and Scale Parameters Using Partial Maxima

Consider an i.i.d. sample X^*_1,X^*_2,...,X^*_n from a location-scale family, and assume that the only available observations consist of the partial maxima (or minima)sequence, X^*_{1:1},X^*_{2:2},...,X^*_{n:n}, where X^*_{j:j}=max{X^*_1,...,X^*_j}. This kind of truncation appears in several circumstances, including best performances in athletics events. In the case of partial maxima, the form of the BLUEs (best linear unbiased estimators) is quite similar to the form of the well-known Lloyd's (1952, Least-squares estimation of location and scale parameters using order statistics, Biometrika, vol. 39, pp. 88-95) BLUEs, based on (the sufficient sample of) order statistics, but, in contrast to the classical case, their consistency is no longer obvious. The present paper is mainly concerned with the scale parameter, showing that the variance of the partial maxima BLUE is at most of order O(1/log n), for a wide class of distributions.Comment: This article is devoted to the memory of my six-years-old, little daughter, Dionyssia, who leaved us on August 25, 2010, at Cephalonia isl. (26 pages, to appear in Metrika

Assessment of mesial temporal sclerosis through MRI processing

[EN] Mesial temporal sclerosis (MTS) is the principal cause of complex epilepsy, is manifested principally by gliosis and hippocampal volume loss. This project aims to develop an algorithm that allows automatic measurement of hippocampal volume and signal intensity in magnetic resonance imaging. The algorithm developed uses preprocessing of the images to reduce the artifacts and for the extraction of the features were used techniques of machine learning (support vector machine) and texture analysis. Results can help to optimize time in the assessment of the mesial temporal sclerosis and can contribute to the best training to the youngers neuroradiologists.Castillo-Malla, DP.; Samaniego, R.; Jimenez-Gaona, Y.; Sánchez, A.; Carrión, J.; Rodríguez-Álvarez, MJ. (2020). Assessment of mesial temporal sclerosis through MRI processing. Proceedings of SPIE (Online). 1-7. https://doi.org/10.1117/12.2569043S1

Effects of uncertainty in soil properties on simulated hydrological states and fluxes at different spatio-temporal scales

Soil properties show high heterogeneity at different spatial scales and their correct characterization remains a crucial challenge over large areas. The aim of the study is to quantify the impact of different types of uncertainties that arise from the unresolved soil spatial variability on simulated hydrological states and fluxes. Three perturbation methods are presented for the characterization of uncertainties in soil properties. The methods are applied on the soil map of the upper Neckar catchment (Germany), as an example. The uncertainties are propagated through the distributed mesoscale hydrological model (mHM) to assess the impact on the simulated states and fluxes. The model outputs are analysed by aggregating the results at different spatial and temporal scales. These results show that the impact of the different uncertainties introduced in the original soil map is equivalent when the simulated model outputs are analysed at the model grid resolution (i.e. 500 m). However, several differences are identified by aggregating states and fluxes at different spatial scales (by subcatchments of different sizes or coarsening the grid resolution). Streamflow is only sensitive to the perturbation of long spatial structures while distributed states and fluxes (e.g. soil moisture and groundwater recharge) are only sensitive to the local noise introduced to the original soil properties. A clear identification of the temporal and spatial scale for which finer-resolution soil information is (or is not) relevant is unlikely to be universal. However, the comparison of the impacts on the different hydrological components can be used to prioritize the model improvements in specific applications, either by collecting new measurements or by calibration and data assimilation approaches. In conclusion, the study underlines the importance of a correct characterization of uncertainty in soil properties. With that, soil maps with additional information regarding the unresolved soil spatial variability would provide strong support to hydrological modelling applications

Tuning and hybrid parallelization of a genetic-based multi-point statistics simulation code

One of the main difficulties using multi-point statistical (MPS) simulation based on annealing techniques or genetic algorithms concerns the excessive amount of time and memory that must be spent in order to achieve convergence. In this work we propose code optimizations and parallelization schemes over a genetic-based MPS code with the aim of speeding up the execution time. The code optimizations involve the reduction of cache misses in the array accesses, avoid branching instructions and increase the locality of the accessed data. The hybrid parallelization scheme involves a fine-grain parallelization of loops using a shared-memory programming model (OpenMP) and a coarse-grain distribution of load among several computational nodes using a distributed-memory programming model (MPI). Convergence, execution time and speed-up results are presented using 2D training images of sizes 100 × 100 × 1 and 1000 × 1000 × 1 on a distributed-shared memory supercomputing facility.Peer ReviewedPostprint (author's final draft

Transitional palliative care interventions for older adults with advanced non-malignant diseases and frailty: a systematic review

Purpose: To identify transitional palliative care (TPC) interventions for older adults with non-malignant chronic diseases and complex conditions. Design/methodology/approach: A systematic review of the literature was conducted. CINAHL, Cochrane Library, Embase and Pubmed databases were searched for studies reporting TPC interventions for older adults, published between 2002 and 2019. The Crowe Critical Appraisal Tool was used for quality appraisal. Findings: A total of six studies were included. Outcomes related to TPC interventions were grouped into three categories: healthcare system-related outcomes (rehospitalisation, length of stay [LOS] and emergency department [ED] visits), patient-related outcomes and family/carer important outcomes. Overall, TPC interventions were associated with lower readmission rates and LOS, improved quality of life and better decision-making concerning hospice care among families. Outcomes for ED visits were unclear. Research limitations/implications: Positive outcomes related to healthcare services (including readmissions and LOS), patients (quality of life) and families (decision-making) were reported. However, the number of studies supporting the evidence were limited. Originality/value: Studies examining the effectiveness of existing care models to support transitions for those in need of palliative care are limited. This systematic literature review identified and appraised interventions aimed at improving transitions to palliative care in older adults with advanced non-malignant diseases or frailty

Pre‐Eruptive Outgassing and Pressurization, and Post‐Fragmentation Bubble Nucleation, Recorded by Vesicles in Breadcrust Bombs From Vulcanian Activity at Guagua Pichincha Volcano, Ecuador

Breadcrust bombs formed during Vulcanian eruptions are assumed to originate from the shallow plug or dome. Their rim to core texture reflects the competition between cooling and degassing timescales, which results in a dense crust with isolated vesicles contrasting with a highly vesicular vesicle network in the interior. Due to relatively fast quenching, the crust can shed light on pre- and syn-eruptive conditions prior to or during fragmentation, whereas the interior allows us to explore post-fragmentation vesiculation. Investigation of pre- to post-fragmentation processes in breadcrust bombs from the 1999 Vulcanian activity at Guagua Pichincha, Ecuador, via 2D and 3D textural analysis reveals a complex vesiculation history, with multiple, spatially localized nucleation and growth events. Large vesicles (Type 1), present in low number density in the crust, are interpreted as pre-eruptive bubbles formed by outgassing and collapse of a permeable bubble network during ascent or stalling in the plug. Haloes of small, syn-fragmentation vesicles (Type 2), distributed about large vesicles, are formed by pressurization and enrichment of volatiles in these haloes. The nature of the pressurization process in the plug is discussed in light of seismicity and ground deformation signals, and previous textural and chemical studies. A third population (Type 3) of post-fragmentation small vesicles appears in the interior of the bomb, and growth and coalescence of Type 2 and 3 vesicles causes the transition from isolated to interconnected bubble network in the interior. We model the evolution of viscosity, bubble growth rate, diffusion timescales, bubble radius and porosity during fragmentation and cooling. These models reveal that thermal quenching dominates in the crust whereas the interior undergoes a viscosity quench caused by degassing, and that the transition from crust to interior corresponds to the onset of percolation and development of permeability in the bubble network

Vitamin food fortification today

Historically, food fortification has served as a tool to address population-wide nutrient deficiencies such as rickets by vitamin D fortified milk. This article discusses the different policy strategies to be used today. Mandatory or voluntary fortification and fortified foods, which the consumer needs, also have to comply with nutritional, regulatory, food safety and technical issues. The ‘worldwide map of vitamin fortification’ is analysed, including differences between develop and developing countries. The vitamins, folate and vitamin D, are taken as practical examples in the review of the beneficial effect of different strategies on public health. The importance of the risk–benefit aspect, as well as how to identify the risk groups, and the food vehicles for fortification is discussed

Eruption type probability and eruption source parameters at Cotopaxi and Guagua Pichincha volcanoes (Ecuador) with uncertainty quantification

Future occurrence of explosive eruptive activity at Cotopaxi and Guagua Pichincha volcanoes, Ecuador, is assessed probabilistically, utilizing expert elicitation. Eight eruption types were considered for each volcano. Type event probabilities were evaluated for the next eruption at each volcano and for at least one of each type within the next 100&nbsp;years. For each type, we elicited relevant eruption source parameters (duration, average plume height, and total tephra mass). We investigated the robustness of these elicited evaluations by deriving probability uncertainties using three expert scoring methods. For Cotopaxi, we considered both rhyolitic and andesitic magmas. Elicitation findings indicate that the most probable next eruption type is an andesitic hydrovolcanic/ash-emission (~ 26–44% median probability), which has also the highest median probability of recurring over the next 100&nbsp;years. However, for the next eruption at Cotopaxi, the average joint probabilities for sub-Plinian or Plinian type eruption is of order 30–40%—a significant chance of a violent explosive event. It is inferred that any Cotopaxi rhyolitic eruption could involve a longer duration and greater erupted mass than an andesitic event, likely producing a prolonged emergency. For Guagua Pichincha, future eruption types are expected to be andesitic/dacitic, and a vulcanian event is judged most probable for the next eruption (median probability ~40–55%); this type is expected to be most frequent over the next 100&nbsp;years, too. However, there is a substantial probability (possibly &gt;40% in average) that the next eruption could be sub-Plinian or Plinian, with all that implies for hazard levels