A New Differential Evolution with self-terminating ability using fuzzy control and k-nearest neighbors

A new Differential Evolution (DE) that incorporates fuzzy control and k-nearest neighbors algorithm to determine the terminating condition is proposed. A technique called Iteration Windows is introduced to govern the number of iteration in each searching stage. The size of the iteration windows is controlled by a fuzzy controller, which uses the information provided by the k-nearest neighbors system to analyze the population during the searching process. The controller keeps controlling the iteration windows until the end of the searching process. The wavelet based mutation process is embedded in the DE searching process to enhance the searching performance of DE. The F weight of DE is also controlled by the fuzzy controller to further speed up the searching process. A suite of benchmark test functions is employed to evaluate the performance of the proposed method. It is shown empirically that the proposed method can terminate the searching process with a reasonable number of iteration. © 2010 IEEE

Hypoglycaemia detection using fuzzy inference system with multi-objective double wavelet mutation Differential Evolution

In this paper, a fuzzy inference system (FIS) is developed to recognize hypoglycaemic episodes. Hypoglycaemia (low blood glucose level) is a common and serious side effect of insulin therapy for patients with diabetes. We measure some physiological parameters continuously to provide hypoglycaemia detection for Type 1 diabetes mellitus (TIDM) patients. The FIS captures the relationship between the inputs of heart rate (HR), corrected QT interval of the electrocardiogram (ECG) signal (QTc), change of HR, change of QT c and the output of hypoglycaemic episodes to perform the classification. An algorithm called Differential Evolution with Double Wavelet Mutation (DWM-DE) is introduced to optimize the FIS parameters that govern the membership functions and fuzzy rules. DWM-DE is an improved Differential Evolution algorithm that incorporates two wavelet-based operations to enhance the optimization performance. To prevent the phenomenon of overtraining (over-fitting), a validation approach is proposed. Moreover, in this problem, two targets of sensitivity and specificity should be met in order to achieve good performance. As a result, a multi-objective optimization using DWM-DE is introduced to perform the training of the FIS. Experiments using the data of 15 children with TIDM (569 data points) are studied. The data are randomly organized into a training set with 5 patients (199 data points), a validation set with 5 patients (177 data points) and a testing set with 5 patients (193 data points). The result shows that the proposed FIS tuned by the multi-objective DWM-DE can offer good performance of doing classification. © 2012 Elsevier B.V. All rights reserved

Antithrombotic therapy in patients with liver disease: population-based insights on variations in prescribing trends, adherence, persistence and impact on stroke and bleeding

Background: Patients with liver disease have complex haemostasis and due to such contraindications, landmark randomised controlled trials investigating antithrombotic medicines have often excluded these patients. As a result, there has been limited consensus on the safety, efficacy and monitoring practices of anticoagulant and antiplatelet therapy in patients with liver disease. This study aims to investigate prescribing prevalence, adherence, persistence and impact of adherence on bleeding and stroke risk in people with and without liver disease taking anticoagulants and antiplatelets. / Methods: We employed a population-based cohort consisting of person-level linked records from primary care, secondary care and the death registry. The cohort consisted of 3,929,596 adults aged ≥ 30 years during the study period of 1998 to 2020 and registered with an NHS general practitioner in England. The primary outcome was prescribing prevalence, adherence to and persistence with anticoagulant and antiplatelet therapy comparing patients with and without liver disease. Risk factors for non-adherence and non-persistence were analysed using multivariable logistic regression and Cox regression. Impact of adherence on bleeding and ischaemic stroke was assessed. / Findings: Among patients with any of the six liver diseases (ALD, autoimmune liver disease, cirrhosis, HBV, HCV and NAFLD), we identified 4,237 individuals with incident atrial fibrillation (indication for anticoagulants) and 4,929 individuals with incident myocardial infarction, transient ischaemic attack, unstable angina or peripheral arterial disease (indication for antiplatelets). Among patients without liver disease, 321,510 and 386,643 individuals were identified as having indications for anticoagulant and antiplatelet therapy, respectively. Among drug-naïve individuals, prescribing prevalence was lower in patients with liver disease compared with individuals without liver disease: anticoagulants (20.6% [806/3,921] vs. 33.5% [103,222/307,877]) and antiplatelets (56.2% [2,207/3,927] vs. 71.1% [249,258/350,803]). Primary non-adherence rates (stopping after one prescription) were higher in patients with liver disease, compared with those without liver disease: anticoagulants (7.9% [64/806] vs. 4.7% [4,841/103,222]) and antiplatelets (6.2% [137/2,207] vs. 4.4% [10,993/249,258]). Among individuals who were not primary non-adherent and had at least 12 months of follow-up, patients with liver disease however had a higher one-year adherence rate: anticoagulants (33.1% [208/628] vs. 29.4% [26,615/90,569]) and antiplatelets (40.9% [743/1,818] vs. 34.4% [76,834/223,154]). Likelihood of non-adherence was lower in apixaban and rivaroxaban (relative to warfarin) and lower in clopidogrel (relative to aspirin). Increased comorbidity burden (by CHA2DS2VASc score) was associated with decreased risk of non-adherence and non-persistence with anticoagulants. Overall rates of ‘non-adherent, non-persistent’ were highest in warfarin (compared with apixaban and rivaroxaban) and aspirin (compared with clopidogrel or dipyridamole) in patients with and without liver disease. Among patients without liver disease, not taking antithrombotic medications for >3 months was associated with a higher risk of stroke, however, adherence to these medications was also associated with a small increase in risk of bleeding. Patients with liver disease (when compared with those without liver disease) had higher risks of stroke, especially when they stopped taking antiplatelets for >3 months. Patients with liver disease who were adherent to antiplatelets, however, had a higher risk of bleeding compared with patients without liver disease. / Interpretation: Use of antithrombotic medicines in patients with and without liver disease is suboptimal with heterogeneity across medicines. As patients with liver disease are excluded from major randomised trials for these drugs, our results provide real-world evidence that may inform medicine optimisation strategies. We outline challenges and opportunities for tackling non-adherence, which begins with understanding patients’ views of medicines to help them make informed decisions about appropriate use. / Funding: AGL is supported by funding from the Wellcome Trust (204841/Z/16/Z), National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (BRC714/HI/RW/101440), NIHR Great Ormond Street Hospital Biomedical Research Centre (19RX02), the Health Data Research UK Better Care Catalyst Award (CFC0125) and the Academy of Medical Sciences (SBF006\1084). The funders have no role in the writing of the manuscript or the decision to submit it for publication

Technical note: River modelling to infer flood management framework

River hydraulic models have successfully identified the weaknesses and areas for improvement with respect to flooding in the Sarawak River system, and can also be used to support decisions on flood management measures. Often, the big question is ‘how’. This paper demonstrates a theoretical flood management framework inferred from Sarawak River modelling outputs. The river model simulates the movement of flood waters through river reaches. Information on flood levels and overtopping of embankments is used to guide a flood early warning system. The above-mentioned elements were combined in a logical framework that showed logic sequences and impact indicators for improved flood relief activities in the city of Kuching, Malaysia.Keywords: Flood, framework, InfoWorks RS, logframe, river modellin

Effects of chemical composition on humidity sensitivity of Al/BaTiO3/Si structure

Argon-ion-beam sputtering technique has been applied to deposit barium titanate (BaTiO3) films on silicon wafers at room temperature under vacuum, and then Al/BaTiO3/Si structures were fabricated. Results show that the current and capacitance of these devices are sensitive to the change of relative humidity at room temperature, and saturation absorption (response) time as well as humidity sensitivity of the devices depend on the chemical composition of the BaTiO3 films. For higher annealing temperature and longer annealing time, the oxygen composition increases while fixed charge density decreases. These changes result in lower humidity sensitivity and longer response time.© 1995 American Institute of Physics.published_or_final_versio

Influence of backsurface argon bombardment on SiO2-Si interface characteristics

A low-energy (550 eV) argon-ion beam was used to directly bombard the backsurface of polysilicon-gate metal-oxide-semiconductor (MOS) capacitors after the completion of all conventional processing steps. The interface characteristics of the MOS capacitors were investigated. The results show that, as the bombardment dose increases, the active dopant concentration near the oxide-semiconductor interface gets higher; maximum midgap energy increases; and interface-state density becomes lower. This simple technique is compatible with existing integrated-circuit processing, and can easily improve the interface characteristics, and therefore the electrical characteristics of MOS devices. © 1996 American Institute of Physics.published_or_final_versio

A study of various oxide/silicon interfaces by Ar + backsurface bombardment

A low-energy (550 eV) argon beam is used to bombard the backsurfaces of 6 kinds of metal–oxide–semiconductor capacitors, and the resulting effects on their interface characteristics are then investigated. The gate oxide of these capacitors includes thermal oxide, trichloroethyene (TCE) oxide, NH3-nitrided oxide, reoxidized-nitrided oxide, rapid-thermal-nitrided oxide, and N2O-nitrided oxide. Measurements show that for bombardment times up to 45 min the interface-state density of all the devices, in general, decreases with increasing bombardment time/dose, and the midgap energy at the silicon surface tends to rise. Moreover, the bombardment is more effective in reducing acceptor-type than donor-type interface states. On the other hand, the change of fixed-charge density is more complex. For TCE, N2O-nitrided and reoxidized-nitrided oxides, fixed-charge density decreases initially with increasing bombardment time, but then increases, while the trend is reversed for the other gate oxides. A model with stress compensation and weak bond breaking is suggested to explain the results. ©1999 American Institute of Physics.published_or_final_versio

Primary biliary cirrhosis and scleroderma complicated by Barrett's oesophagus A case report

Oesophageal problems are common in patients with scleroderma. but the association of primary biliary cirrhosis and scleroderma is uncommon. A Barrett's oesophagus identified in a patient with primary biliary cirrhosis and scleroderma is described. The Barrett's oesophagus was probably a complication of scleroderma and resulted from low lower-oesophageal sphincter pressure and severe gastro-oesophageal reflux

Increased burden of cardiovascular disease in people with liver disease: unequal geographical variations, risk factors and excess years of life lost

BACKGROUND: People with liver disease are at increased risk of developing cardiovascular disease (CVD), however, there has yet been an investigation of incidence burden, risk, and premature mortality across a wide range of liver conditions and cardiovascular outcomes. METHODS: We employed population-wide electronic health records (EHRs; from 1998 to 2020) consisting of almost 4 million adults to assess regional variations in disease burden of five liver conditions, alcoholic liver disease (ALD), autoimmune liver disease, chronic hepatitis B infection (HBV), chronic hepatitis C infection (HCV) and NAFLD, in England. We analysed regional differences in incidence rates for 17 manifestations of CVD in people with or without liver disease. The associations between biomarkers and comorbidities and risk of CVD in patients with liver disease were estimated using Cox models. For each liver condition, we estimated excess years of life lost (YLL) attributable to CVD (i.e., difference in YLL between people with or without CVD). RESULTS: The age-standardised incidence rate for any liver disease was 114.5 per 100,000 person years. The highest incidence was observed in NAFLD (85.5), followed by ALD (24.7), HCV (6.0), HBV (4.1) and autoimmune liver disease (3.7). Regionally, the North West and North East regions consistently exhibited high incidence burden. Age-specific incidence rate analyses revealed that the peak incidence for liver disease of non-viral aetiology is reached in individuals aged 50–59 years. Patients with liver disease had a two-fold higher incidence burden of CVD (2634.6 per 100,000 persons) compared to individuals without liver disease (1339.7 per 100,000 persons). When comparing across liver diseases, atrial fibrillation was the most common initial CVD presentation while hypertrophic cardiomyopathy was the least common. We noted strong positive associations between body mass index and current smoking and risk of CVD. Patients who also had diabetes, hypertension, proteinuric kidney disease, chronic kidney disease, diverticular disease and gastro-oesophageal reflex disorders had a higher risk of CVD, as do patients with low albumin, raised C-reactive protein and raised International Normalized Ratio levels. All types of CVD were associated with shorter life expectancies. When evaluating excess YLLs by age of CVD onset and by liver disease type, differences in YLLs, when comparing across CVD types, were more pronounced at younger ages. CONCLUSIONS: We developed a public online app (https://lailab.shinyapps.io/cvd_in_liver_disease/) to showcase results interactively. We provide a blueprint that revealed previously underappreciated clinical factors related to the risk of CVD, which differed in the magnitude of effects across liver diseases. We found significant geographical variations in the burden of liver disease and CVD, highlighting the need to devise local solutions. Targeted policies and regional initiatives addressing underserved communities might help improve equity of access to CVD screening and treatment

Late effects of cancer in children, teenagers and young adults: Population-based study on the burden of 183 conditions, in-patient and critical care admissions and years of life lost

Background: Children, teenagers and young adults who survived cancer are prone to developing late effects. The burden of late effects across a large number of conditions, in-patient hospitalisation and critical care admissions have not been described using a population-based dataset. We aim to systematically quantify the cumulative burden of late effects across all cancer subtypes, treatment modalities and chemotherapy drug classes. // Methods: We employed primary care records linked to hospitals, the death registry and cancer registry from 1998–2020. CTYA survivors were 25 years or younger at the time of cancer diagnosis had survived ≥5 years post-diagnosis. Year-of-birth and sex-matched community controls were used for comparison. We considered nine treatment types, nine chemotherapy classes and 183 physical and mental health late effects. Cumulative burden was estimated using mean cumulative count, which considers recurring events. Multivariable logistic regression was used to investigate the association between treatment exposures and late effects. Excess years of life lost (YLL) attributable to late effects were estimated. // Findings: Among 4,063 patients diagnosed with cancer, 3,466 survived ≥ 5 years (85%); 13,517 matched controls were identified. The cumulative burden of late effects at age 35 was the highest in survivors of leukaemia (23.52 per individual [95% CI:19.85–29.33]) and lowest in survivors of germ cell tumours (CI:6.04 [5.32–6.91]). In controls, the cumulative burden was 3.99 (CI:3.93–4.08) at age 35 years. When survivors reach age 45, the cumulative burden for immunological conditions and infections was the highest (3.27 [CI:3.01–3.58]), followed by cardiovascular conditions (3.08 [CI:1.98–3.29]). Survivors who received chemotherapy and radiotherapy had the highest disease burden compared to those who received surgery only. These patients also had the highest burden of hospitalisation (by age 45: 10.43 [CI:8.27–11.95]). Survivors who received antimetabolite chemotherapy had the highest disease and hospitalisation burden, while the lowest burden is observed in those receiving antitumour antibiotics. Regression analyses revealed that survivors who received only surgery had lower odds of developing cardiovascular (adjusted odds ratio 0.73 [CI:0.56–0.94]), haematological (aOR 0.51 [CI:0.37–0.70]), immunology and infection (aOR 0.84 [CI:0.71–0.99]) and renal (aOR 0.51 [CI:0.39–0.66]) late effects. By contrast, the opposite trend was observed in survivors who received chemo-radiotherapy. High antimetabolite chemotherapy cumulative dose was associated with increased risks of subsequent cancer (aOR 2.32 [CI:1.06–4.84]), metastatic cancer (aOR 4.44 [CI:1.29–11.66]) and renal (aOR 3.48 [CI:1.36–7.86]) conditions. Patients who received radiation dose of ≥50 Gy experienced higher risks of developing metastatic cancer (aOR 5.51 [CI:2.21–11.86]), cancer (aOR 3.77 [CI:2.22–6.34]), haematological (aOR 3.43 [CI:1.54–6.83]) and neurological (aOR 3.24 [CI:1.78–5.66]) conditions. Similar trends were observed in survivors who received more than three teletherapy fields. Cumulative burden analyses on 183 conditions separately revealed varying dominance of different late effects across cancer types, socioeconomic deprivation and treatment modalities. Late effects are associated with excess YLL (i.e., the difference in YLL between survivors with or without late effects), which was the most pronounced among survivors with haematological comorbidities. // Interpretation: To our knowledge, this is the first study to dissect and quantify the importance of late morbidities on subsequent survival using linked electronic health records from multiple settings. The burden of late effects is heterogeneous, as is the risk of premature mortality associated with late effects. We provide an extensive knowledgebase to help inform treatment decisions at the point of diagnosis, future interventional trials and late-effects screening centred on the holistic needs of this vulnerable population