Machine learning models in electronic health records can outperform conventional survival models for predicting patient mortality in coronary artery disease

Prognostic modelling is important in clinical practice and epidemiology for patient management and research. Electronic health records (EHR) provide large quantities of data for such models, but conventional epidemiological approaches require significant researcher time to implement. Expert selection of variables, fine-tuning of variable transformations and interactions, and imputing missing values are time-consuming and could bias subsequent analysis, particularly given that missingness in EHR is both high, and may carry meaning. Using a cohort of 80,000 patients from the CALIBER programme, we compared traditional modelling and machine-learning approaches in EHR. First, we used Cox models and random survival forests with and without imputation on 27 expert-selected, preprocessed variables to predict all-cause mortality. We then used Cox models, random forests and elastic net regression on an extended dataset with 586 variables to build prognostic models and identify novel prognostic factors without prior expert input. We observed that data-driven models used on an extended dataset can outperform conventional models for prognosis, without data preprocessing or imputing missing values. An elastic net Cox regression based with 586 unimputed variables with continuous values discretised achieved a C-index of 0.801 (bootstrapped 95% CI 0.799 to 0.802), compared to 0.793 (0.791 to 0.794) for a traditional Cox model comprising 27 expert-selected variables with imputation for missing values. We also found that data-driven models allow identification of novel prognostic variables; that the absence of values for particular variables carries meaning, and can have significant implications for prognosis; and that variables often have a nonlinear association with mortality, which discretised Cox models and random forests can elucidate. This demonstrates that machine-learning approaches applied to raw EHR data can be used to build models for use in research and clinical practice, and identify novel predictive variables and their effects to inform future research

Lowly Polarized Light from a Highly Magnetized Jet of GRB 190114C

We report multicolor optical imaging and polarimetry observations of the afterglow of the first TeV-detected gamma-ray burst (GRB), GRB 190114C, using the RINGO3 and MASTER II polarimeters. Observations begin 31 s after the onset of the GRB and continue until ~7000 s postburst. The light curves reveal a chromatic break at ~400–500 s, with initial temporal decay α = 1.669 ± 0.013 flattening to α ~ 1 postbreak, which we model as a combination of reverse and forward shock components with magnetization parameter R B ~ 70. The observed polarization degree decreases from 7.7% ± 1.1% to 2%–4% 52–109 s postburst and remains steady at this level for the subsequent ~2000 s at a constant position angle. Broadband spectral energy distribution modeling of the afterglow confirms that GRB 190114C is highly obscured (A v,HG = 1.49 ± 0.12 mag; ${N}_{{\rm{H}},\mathrm{HG}}=(9.0\pm 0.03)\,\times {10}^{22}\,$ cm−2). We interpret the measured afterglow polarization as intrinsically low and dominated by dust —in contrast to the P > 10% measured previously for other GRB reverse shocks—with a small contribution from polarized prompt photons in the first minute. We test whether first- and higher-order inverse Compton scattering in a magnetized reverse shock can explain the low optical polarization and subteraelectronvolt emission but conclude that neither is explained in the reverse shock inverse Compton model. Instead, the unexpectedly low intrinsic polarization degree in GRB 190114C can be explained if large-scale jet magnetic fields are distorted on timescales prior to reverse shock emission

Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours

Although compulsive sexual behaviour (CSB) has been conceptualized as a "behavioural" addiction and common or overlapping neural circuits may govern the processing of natural and drug rewards, little is known regarding the responses to sexually explicit materials in individuals with and without CSB. Here, the processing of cues of varying sexual content was assessed in individuals with and without CSB, focusing on neural regions identified in prior studies of drug-cue reactivity. 19 CSB subjects and 19 healthy volunteers were assessed using functional MRI comparing sexually explicit videos with non-sexual exciting videos. Ratings of sexual desire and liking were obtained. Relative to healthy volunteers, CSB subjects had greater desire but similar liking scores in response to the sexually explicit videos. Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala. Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire (but not liking) to a greater degree in CSB relative to non-CSB subjects. The dissociation between desire or wanting and liking is consistent with theories of incentive motivation underlying CSB as in drug addictions. Neural differences in the processing of sexual-cue reactivity were identified in CSB subjects in regions previously implicated in drug-cue reactivity studies. The greater engagement of corticostriatal limbic circuitry in CSB following exposure to sexual cues suggests neural mechanisms underlying CSB and potential biological targets for interventions

A survey of oral health in a Sudanese population

10.1186/1472-6831-12-5BMC Oral Health121

The positive and negative impact of an intergenerational digital technology education programme on younger people’s perceptions of older adults

In order to meet the technological needs of older adults, and ensure digital inclusion, it is important for digital technology designers to accurately assess and understand older adults’ needs and requirements, free from the influence of societal assumptions of their capabilities. This study evaluated the impact of an intergenerational digital technology education programme on younger adults’ stereotypes of older people. Using an experimental design, results show that compared to a control group, students taking part in the programme subsequently rated older adults as more friendly but less competent. Practical implications for developing intergenerational education programmes are discussed

A family of oxide ion conductors based on the ferroelectric perovskite Na0.5Bi0.5TiO3

Oxide ion conductors find important technical applications in electrochemical devices such as solid-oxide fuel cells (SOFCs), oxygen separation membranes and sensors1, 2, 3, 4, 5, 6, 7, 8, 9. Na0.5Bi0.5TiO3 (NBT) is a well-known lead-free piezoelectric material; however, it is often reported to possess high leakage conductivity that is problematic for its piezo- and ferroelectric applications10, 11, 12, 13, 14, 15. Here we report this high leakage to be oxide ion conduction due to Bi-deficiency and oxygen vacancies induced during materials processing. Mg-doping on the Ti-site increases the ionic conductivity to ~0.01 S cm−1 at 600 °C, improves the electrolyte stability in reducing atmospheres and lowers the sintering temperature. This study not only demonstrates how to adjust the nominal NBT composition for dielectric-based applications, but also, more importantly, gives NBT-based materials an unexpected role as a completely new family of oxide ion conductors with potential applications in intermediate-temperature SOFCs and opens up a new direction to design oxide ion conductors in perovskite oxides

Розрахунок та проектування окремого фундаменту будівлі на природній ґрунтовій основі. Методичні рекомендації до виконання практичних завдань та курсового проекту з дисципліни «Механіка ґрунтів, основи і фундаменти» сту- дентами напрямів підготовки 6.060101 Будівництво та 6.050301 Гірництво

Подано методичні рекомендації до виконання практичних завдань та кур- сового проекту з дисципліни «Механіка ґрунтів, основи і фундаменти» для сту- дентів напрямів підготовки 6.060101 Будівництво та 6.050301 Гірництво. Розглянуто порядок проектування фундаменту будівлі мілкого закладан- ня на природній ґрунтовій основі. Методичні рекомендації передбачають виконання курсового проекту «Розрахунок та проектування окремого фундаменту будівлі на природній ґрун- товій основі» як із викладачем, так і під час самостійної роботи. Можна використовувати також у підготовці курсового та дипломного про- ектування

The impact of oral conditions on children in England, Wales and Northern Ireland 2013

Background: The 2013 Children's Dental Health survey is the fifth in a series of national surveys. / Aim: To summarise key findings on oral health perceptions, oral symptoms, and the impacts of oral conditions on the daily life of children and their families. / Methodology: A representative sample of children (aged 5, 8 12 and 15 years) and their parents in England, Wales and Northern Ireland completed relevant questionnaires. / Results: Oral symptoms, even more profound ones such as toothache, were prevalent among all age groups. Overall, 58% of 12- and 45% of 15-year-olds reported at least one oral impact in the past three months. The most prevalent oral impact was feeling embarrassed to smile or laugh, followed by difficulty eating. These symptoms and oral impacts were disproportionately high among children eligible for free school meals. Furthermore, one fifth to one third of parents reported that their children's oral conditions had some impact on their family life. / Conclusion: Oral symptoms were common and oral conditions had a negative impact on the quality of life of large proportions of children. There were clear and marked socioeconomic inequalities, with considerably worse oral health perceptions and higher levels of oral impacts among the more deprived children

Anti-ischemic therapy and stress testing: pathophysiologic, diagnostic and prognostic implications

Anti-ischemic therapy, in particular beta-blockers, is the most commonly employed drug for the control of myocardial ischemia in patients with stable coronary artery disease. Its widespread use also in patients with suspected coronary artery disease has important practical, clinical diagnostic and prognostic implications because diagnostic tests are heavily influenced by its effects. In the present review, the pathophysiological mechanisms of ischemia protection by antianginal therapy are described. Not all stressors are created equal in front of the different classes of antianginal drugs and on their turn the different classes of drugs exert different levels of protection on inducible ischemia. Several clinical implications can be drawn: From the diagnostic viewpoint antianginal therapy decreases test sensitivity, offsetting the real ischemic burden for a too high percentage of false negative tests. From the prognostic viewpoint test positivity in medical therapy identifies a group of subjects at higher risk of experiencing cardiac death and positivity on medical therapy can be considered a parameter of ischemia severity. Nonetheless in patients with known coronary artery disease the ability of antianginal therapy to modify the ischemic threshold at stress testing represent a powerful means to assess therapy efficacy. From a practical viewpoint, the use of antianginal therapy at time of testing has advantages and disadvantages which are largely dependent on the purpose a test is performed: if the purpose of testing is to diagnose ischemia, it should be performed in the absence of antianginal medications. If the purpose of testing is to assess the protective effects of antianginal therapy, the test should be performed on medications