RECAP-KG: Mining Knowledge Graphs from Raw GP Notes for Remote COVID-19 Assessment in Primary Care

Clinical decision-making is a fundamental stage in delivering appropriate care to patients. In recent years several decision-making systems designed to aid the clinician in this process have been developed. However, technical solutions currently in use are based on simple regression models and are only able to take into account simple pre-defined multiple-choice features, such as patient age, pre-existing conditions, smoker status, etc. One particular source of patient data, that available decision-making systems are incapable of processing is the collection of patient consultation GP notes. These contain crucial signs and symptoms - the information used by clinicians in order to make a final decision and direct the patient to the appropriate care. Extracting information from GP notes is a technically challenging problem, as they tend to include abbreviations, typos, and incomplete sentences. This paper addresses this open challenge. We present a framework that performs knowledge graph construction from raw GP medical notes written during or after patient consultations. By relying on support phrases mined from the SNOMED ontology, as well as predefined supported facts from values used in the RECAP (REmote COVID-19 Assessment in Primary Care) patient risk prediction tool, our graph generative framework is able to extract structured knowledge graphs from the highly unstructured and inconsistent format that consultation notes are written in. Our knowledge graphs include information about existing patient symptoms, their duration, and their severity. We apply our framework to consultation notes of COVID-19 patients in the UK COVID-19 Clinical Assesment Servcie (CCAS) patient dataset. We provide a quantitative evaluation of the performance of our framework, demonstrating that our approach has better accuracy than traditional NLP methods when answering questions about patients

Modeling Riparian Restoration Impacts on the Hydrologic Cycle at the Babacomari Ranch, SE Arizona, USA

This paper describes coupling field experiments with surface and groundwater modeling to investigate rangelands of SE Arizona, USA using erosion-control structures to augment shallow and deep aquifer recharge. We collected field data to describe the physical and hydrological properties before and after gabions (caged riprap) were installed in an ephemeral channel. The modular finite-difference flow model is applied to simulate the amount of increase needed to raise groundwater levels. We used the average increase in infiltration measured in the field and projected on site, assuming all infiltration becomes recharge, to estimate how many gabions would be needed to increase recharge in the larger watershed. A watershed model was then applied and calibrated with discharge and 3D terrain measurements, to simulate flow volumes. Findings were coupled to extrapolate simulations and quantify long-term impacts of riparian restoration. Projected scenarios demonstrate how erosion-control structures could impact all components of the annual water budget. Results support the potential of watershed-wide gabion installation to increase total aquifer recharge, with models portraying increased subsurface connectivity and accentuated lateral flow contributions.Walton Family Foundation; Land Change Science (LCS) Program, under the Land Resources Mission Area of the US Geological Survey (USGS); NSF [DBI-0735191, DBI-1265383]Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Expanding the diversity of mycobacteriophages: insights into genome architecture and evolution.

Mycobacteriophages are viruses that infect mycobacterial hosts such as Mycobacterium smegmatis and Mycobacterium tuberculosis. All mycobacteriophages characterized to date are dsDNA tailed phages, and have either siphoviral or myoviral morphotypes. However, their genetic diversity is considerable, and although sixty-two genomes have been sequenced and comparatively analyzed, these likely represent only a small portion of the diversity of the mycobacteriophage population at large. Here we report the isolation, sequencing and comparative genomic analysis of 18 new mycobacteriophages isolated from geographically distinct locations within the United States. Although no clear correlation between location and genome type can be discerned, these genomes expand our knowledge of mycobacteriophage diversity and enhance our understanding of the roles of mobile elements in viral evolution. Expansion of the number of mycobacteriophages grouped within Cluster A provides insights into the basis of immune specificity in these temperate phages, and we also describe a novel example of apparent immunity theft. The isolation and genomic analysis of bacteriophages by freshman college students provides an example of an authentic research experience for novice scientists

Honor Among Thieves: A Zooarchaeological Study of Neanderthal Ecology

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38561/1/19_ftp.pd

The role of hydrogen and fuel cells in the global energy system

Hydrogen technologies have experienced cycles of excessive expectations followed by disillusion. Nonetheless, a growing body of evidence suggests these technologies form an attractive option for the deep decarb onisation of global energy systems, and that recent improvements in their cost and performance point towards economic viability as well. This paper is a comprehensive review of the potential role that hydrogen could play in the provision of electricity, h eat, industry, transport and energy storage in a low - carbon energy system, and an assessment of the status of hydrogen in being able to fulfil that potential. The picture that emerges is one of qualified promise: hydrogen is well established in certain nic hes such as forklift trucks, while mainstream applications are now forthcoming. Hydrogen vehicles are available commercially in several countries, and 225,000 fuel cell home heating systems have been sold. This represents a step change from the situation of only five years ago. This review shows that challenges around cost and performance remain, and considerable improvements are still required for hydrogen to become truly competitive. But such competitiveness in the medium - term future no longer seems an unrealistic prospect, which fully justifies the growing interest and policy support for these technologies around the world

Evaluating the Sensitivity of Cross Section Positioning when Computing Peak Flow Discharge using the Slope-Area Computation in a Mountain Stream

The slope-area method is a commonly used and widely accepted technique for estimating peak flood flows in rivers where direct discharge measurements could not be obtained during the flood. The method makes multiple assumptions to simplify calculations which include assuming uniform flow conditions between surveyed cross sections, and that losses of energy in the reach occur only due to bank friction. Even though flows in nature do not always exhibit these simplified conditions, this method has been proven to provide adequate results when compared to direct measurements and thus, has become the go-to approach. To conduct a slope-area computation, the hydrologist needs to make multiple assumptions in the field based on experience, judgment, and published resources as guides. One of these assumptions is determining where to locate cross sections for the slope-area computation such that they sufficiently represent the cross-sectional area and slope of the channel. Traditional methods suggest to place the cross sections at breaks in the water surface slope. This research focuses on the variability of results of computed discharge values when cross sections are located at many different locations in the reach. What has been found is that many combinations of cross sections in the reach, including sections not located at the breaks in water surface slope, produce similar results when compared to the traditional methods. In fact, 121 of these combinations of cross sections produce peak discharge calculations within plus or minus five percent of the traditional methodology. What also was found was that variability in channel geometry goes unnoticed when using the traditional locating method, and losses due to expansion and contraction of flow area at locations which would not have been traditionally surveyed are occurring at multiple cross sections in the reach. The results suggest that reaches be evaluated for changes in geometry and not overlooked, so that the changes in shape, and subsequent losses in energy, be considered in the computation