19 research outputs found
Can doctors identify older patients at risk of medication harm following hospital discharge?: A multicentre prospective study in the UK
No full textAims: Medication-related harm (MRH) is common in older adults following hospital discharge. In resource-limited health systems, interventions to reduce this risk can be targeted at high-risk patients. This study aims to determine whether (1) doctors can predict which older patients will experience MRH requiring healthcare following hospital discharge, (2) clinical experience and confidence in prediction influence the accuracy of the prediction. Methods: This was a multicentre observational prospective study involving five teaching hospitals in England between September 2013 and November 2015. Doctors discharging patients (aged ≥65 years) from medical wards predicted the likelihood of their patient experiencing MRH requiring healthcare (hospital readmission or community healthcare) in the initial 8-week period post-discharge. Patients were followed up by senior pharmacists to determine MRH occurrence. Results: Data of 1066 patients (83%) with completed predictions and follow-up, out of 1280 recruited patients, were analysed. Patients had a median age of 82 years (65-103 years), and 58% were female. Most predictions (85%) were made by junior doctors with less than 5 years' clinical experience. There was no relationship between doctors' predictions and patient MRH (OR 1.10, 95% CI 0.82-1.46, P = 0.53), irrespective of years of clinical experience. Doctors' predictions were more likely to be accurate when they reported higher confidence in their prediction, especially in predicting MRH-associated hospital readmissions (OR 1.58, 95% CI 1.42-1.76, P < 0.001). Conclusions: Clinical judgement of doctors is not a reliable tool to predict MRH in older adults post-discharge.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Applied Ergonomics and Desig
Computational Imaging Using Deterministic Optical Fields and Non-linear Reconstruction
No full textComputational imaging techniques are indirect ones consisting of two steps: optical recording and computational reconstruction. In this study, deterministic optical fields such as Bessel, Airy, Gaussian and Laguerre-Gaussian were studied in this indirect imaging framework
Poly(1-Napthylamine) Nanoparticles as Potential Scaffold for Supercapacitor and Photocatalytic Applications
No full textHerein, we explore the supercapacitor and photocatalytic applications of poly(1-naphthylamine) (PNA) nanoparticles. The PNA nanoparticles were synthesized by using polymerization of 1-naphthylamine and characterized with several techniques in order to understand the morphological, structural, optical and compositional properties. The structural and morphological properties confirmed the formation of crystalline nanoparticles of PNA. The Fourier-transform infrared (FTIR) spectrum revealed the successful polymerization of 1-naphthylamine monomer to PNA. The absorption peaks that appeared at 236 and 309 nm in the UV–Vis spectrum for PNA nanoparticles represented the π–π* transition. The supercapacitor properties of the prepared PNA nanoparticles were evaluated with cyclic voltammetry (CV) and galvanostatic charge–discharge (GCD) methods at different scan rates and current densities, respectively. The effective series resistance was calculated using electrochemical impedance spectroscopy (EIS), resulting in a minimum resistance value of 1.5 Ω. The highest specific capacitance value of PNA was found to be 255 Fg−1. This electrode also exhibited excellent stability with >93% capacitance retention for 1000 cycles, as measured at 1A g−1. Further, the prepared PNA nanoparticles were used as an effective photocatalyst for the photocatalytic degradation of methylene blue (MB) dye, which exhibited ~61% degradation under UV light irradiation. The observed results revealed that PNA nanoparticles are not only a potential electrode material for supercapacitor applications but also an efficient photocatalyst for the photocatalytic degradation of hazardous and toxic organic dyes
Phosphorylated fetuin-A-containing calciprotein particles are associated with aortic stiffness and a procalcific milieu in patients with pre-dialysis CKD
No full textBackground. Vascular calcification is highly prevalent in chronic kidney disease (CKD) patients. This calcification leads to arterial stiffening. Fetuin-A is an endogenous inhibitor of vascular calcification and has been associated with arterial stiffness and mortality in dialysis patients. We tested the relationship between fetuin-A and change in arterial stiffness in CKD stages 3 and 4.Methods. We measured fetuin-A concentrations in 92 patients with CKD stages 3 and 4 and studied the association with clinical, biochemical and vascular parameters including arterial stiffness measured by carotid-femoral pulse wave velocity (PWV) at 0 and 12 months.Results. Fetuin-A was significantly lower in the non-diabetic group (n = 73) compared to the diabetic group (n = 19, P = 0.018). There was a significant interaction between diabetic status and fetuin-A concentration. Univariate analysis of the non-diabetic group showed association between change in aortic stiffness over 1 year with fetuin-A (r =-0.481, P < 0.0001) and systolic blood pressure (r = 0.389, P = 0.001) and baseline PWV (r = 0.240, P = 0.041). In multivariate analysis, fetuin-A, systolic blood pressure and baseline PWV independently predicted change in carotid-femoral PWV at 1 year (ß =-0.355, P = < 0.001; ß = 0.426, P < 0.001; and ß =-0.383, P < 0.001, respectively; model R2 = 0.455).Conclusions. In patients with non-diabetic CKD stages 3 and 4, fetuin-A is an independent risk factor for progressive arterial stiffness. © 2010 The Author
Medication-related harm in older adults following hospital discharge: Development and validation of a prediction tool
No full textObjectives To develop and validate a tool to predict the risk of an older adult experiencing medication-related harm (MRH) requiring healthcare use following hospital discharge. Design, setting, participants Multicentre, prospective cohort study recruiting older adults (≥65 years) discharged from five UK teaching hospitals between 2013 and 2015. Primary outcome measure Participants were followed up for 8 weeks in the community by senior pharmacists to identify MRH (adverse drug reactions, harm from non-adherence, harm from medication error). Three data sources provided MRH and healthcare use information: Hospital readmissions, primary care use, participant telephone interview. Candidate variables for prognostic modelling were selected using two systematic reviews, the views of patients with MRH and an expert panel of clinicians. Multivariable logistic regression with backward elimination, based on the Akaike Information Criterion, was used to develop the PRIME tool. The tool was internally validated. Results 1116 out of 1280 recruited participants completed follow-up (87%). Uncertain MRH cases (â 'possible' and 'aprobable') were excluded, leaving a tool derivation cohort of 818. 119 (15%) participants experienced 'definite' MRH requiring healthcare use and 699 participants did not. Modelling resulted in a prediction tool with eight variables measured at hospital discharge: Age, gender, antiplatelet drug, sodium level, antidiabetic drug, past adverse drug reaction, number of medicines, living alone. The tool's discrimination C-statistic was 0.69 (0.66 after validation) and showed good calibration. Decision curve analysis demonstrated the potential value of the tool to guide clinical decision making compared with alternative approaches. Conclusions The PRIME tool could be used to identify older patients at high risk of MRH requiring healthcare use following hospital discharge. Prior to clinical use we recommend the tool's evaluation in other settings.Applied Ergonomics and Desig
Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study)
No full textBackground: Medication related harm (MRH) is a common cause of morbidity and hospital admission in the elderly, and has significant cost implications for both primary and secondary healthcare resources. The development of risk prediction models has become an increasingly common phenomenon in medicine and can be useful to guide objective clinical decision making, resource allocation and intervention. There are no risk prediction models that are widely used in clinical practice to identify elderly patients at high risk of MRH following hospitaldischarge. The aim of this study is to develop a risk prediction model (RPM) to identify elderly patients at high risk of MRH upon discharge from hospital, and to compare this with routine clinical judgment.Methods/Design: This is a multi-centre, prospective observational study following a cohort of patients for 8 weeks after hospital discharge. Data collection including patient characteristics, medication use, social factors and frailty will take place prior to patient discharge and then the patient will be followed up in the community over the next 8 weeks to determine if they have experienced MRH. Research pharmacists will determine whether patients haveexperienced MRH by prospectively reviewing records for unplanned emergency department attendance, hospital readmission and GP consultation related to MRH. Research pharmacists will also telephone patients directly todetermine self-reported MRH, which patients may not have sought further medical attention for. The data collected will inform the development of a RPM which will be externally validated in a follow-up study. Discussion: There are no RPMs that are used in clinical practice to help stratify elderly patients at high risk of MRH in the community following hospital discharge, despite this being a significant public health problem. This study plans to develop a clinically useful RPM that is better than routine clinical judgment. As this is a multi-centre studyinvolving clinical settings that serve elderly people of heterogeneous sociodemographic background, it is anticipated that this RPM will be generalizable
Telling your story: autobiographical metadata and the semantic web
No full textGiven the current explosion of user-generated content driven by the ever-decreasing price of sensing and storage hardware the dream of capturing and archiving the entirety of a human life is slowly being realised. The Semantic Web, a discipline of Computer Science, aims to support the sharing and interoperation of knowledge using the Web’s infrastructure. This thesis aims to roadmap a framework utilising the principles and technologies underpinning the Semantic Web, enabling the vision of global knowledge sharing, in an open and policy aware manner, with the end aim of supporting a network for the exploitation of personal information. This sharing is facilitated through the adoption of a lingua franca, shared conceptualisations for domain knowledge, and some core design principles. The main focus of Semantic Web research has been the development of a web-scale knowledge-base whereby information is stored and exposed in a machine-readable format with the ultimate aim of aggregating information from disparate sources, allowing for statements to be contextualised with respect to others culminating in a web-scale knowledge resource accessible through standard protocols.The current popularity of social computing – Web 2.0 – where users post personal information to online communities is eluding to the fact that information, linked and shared within a social-context presents added value to the end-user. Given the sensitive nature of personal information, one may not wish to expose all of the information about them self to the World Wide Web, but may wish to benefit by linking to knowledge residing on this shared resource. This ability to store personal information privately, in ones own personal web-space and not on a third party server, whilst at the same time connecting to the publicly available information is presented as key challenge facing the Computer Science community today. Specific information pertaining to one aspect of a user’s activities, such as their picture taking habits or their geographic log, may not present a detailed account of a user’s actions, but as more information is pushed into the public domain and aggregation technologies mature individuals and their day-to-day activities will be easier to track. As more and more of our personal lives are pushed into the public domain, the notion of an online-persona is becoming more and more applicable to the average person.This thesis presents an infrastructure for the capturing and archival of autobiographical metadata, whereby information from multiple sensors is aggregated and stored in a personal Lifelog. The surrender of digital identity has become commonplace, for purposes ranging from commerce, marketing, social networking, government, receipt of services, travel or security, Lifelogging has the potential to reaffirm the individual’s control of his or her own digital identity. The Lifelog is a constructed identity that outweighs the others simply by weight of evidence, complexity and comprehensiveness. This thesis presents an infrastructure for the capture and exploitation of personal metadata to drive research into context aware systems. The aim is to expose ongoing research in the areas of capture of personal experiences, context aware systems, multimedia annotation systems, narrative generation, all set in the context of enabling and supporting the Semantic Web Vision. The thesis details the work underway towards the goal of creating a multi-domain contextual log, and is followed by a discussion of how such a log can be used to drive the development of detailed Lifelog and an investigation into the amount of personal information being pushed into the public domain.<br/
Open Problems in Technical AI Governance
No full textAI progress is creating a growing range of risks and opportunities, but it is
often unclear how they should be navigated. In many cases, the barriers and
uncertainties faced are at least partly technical. Technical AI governance,
referring to technical analysis and tools for supporting the effective
governance of AI, seeks to address such challenges. It can help to (a) identify
areas where intervention is needed, (b) identify and assess the efficacy of
potential governance actions, and (c) enhance governance options by designing
mechanisms for enforcement, incentivization, or compliance. In this paper, we
explain what technical AI governance is, why it is important, and present a
taxonomy and incomplete catalog of its open problems. This paper is intended as
a resource for technical researchers or research funders looking to contribute
to AI governance.Comment: Ben Bucknall and Anka Reuel contributed equally and share the first
author positio
A pleiotropic variant in <I>DNAJB4</I> is associated with multiple myeloma risk
No full textPleiotropy, which consists of a single gene or allelic variant affecting multiple unrelated traits, is common across cancers, with evidence for genome-wide significant loci shared across cancer and noncancer traits. This feature is particularly relevant in multiple myeloma (MM) because several susceptibility loci that have been identified to date are pleiotropic. Therefore, the aim of this study was to identify novel pleiotropic variants involved in MM risk using 28 684 independent single nucleotide polymorphisms (SNPs) from GWAS Catalog that reached a significant association (P < 5 × 10−8) with their respective trait. The selected SNPs were analyzed in 2434 MM cases and 3446 controls from the International Lymphoma Epidemiology Consortium (InterLymph). The 10 SNPs showing the strongest associations with MM risk in InterLymph were selected for replication in an independent set of 1955 MM cases and 1549 controls from the International Multiple Myeloma rESEarch (IMMEnSE) consortium and 418 MM cases and 147 282 controls from the FinnGen project. The combined analysis of the three studies identified an association between DNAJB4-rs34517439-A and an increased risk of developing MM (OR = 1.22, 95%CI 1.13-1.32, P = 4.81 × 10−7). rs34517439-A is associated with a modified expression of the FUBP1 gene, which encodes a multifunctional DNA and RNA-binding protein that it was observed to influence the regulation of various genes involved in cell cycle regulation, among which various oncogenes and oncosuppressors. In conclusion, with a pleiotropic scan approach we identified DNAJB4-rs34517439 as a potentially novel MM risk locus.</p
