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ABSTRACT IMPACT: A machine learning approach using electronic health records can combine descriptive, population-level factors of pressure injury outcomes. OBJECTIVES/GOALS: Pressure injuries cause 60,000 deaths and cost $26 billion annually in the US, but prevention is laborious. We used clinical data to develop a machine learning algorithm for predicting pressure injury risk and prescribe the timing of intervention to help clinicians balance competing priorities. METHODS/STUDY POPULATION: We obtained 94,745 electronic health records with 7,000 predictors to calibrate a predictive algorithm of pressure injury risk. Machine learning was used to mine features predicting changes in pressure injury risk; random forests outperformed neural networks, boosting and bagging in feature selection. These features were fit to multilevel ordered logistic regression to create an algorithm that generated empirical Bayes estimates informing a decision-rule for follow-up based on individual risk trajectories over time. We used cross-validation to verify predictive validity, and constrained optimization to select a best-fit algorithm that reduced the time required to trigger patient follow-up. RESULTS/ANTICIPATED RESULTS: The algorithm significantly improved prediction of pressure injury risk (p<0.001) with an area under the ROC curve of 0.60 compared to the Braden Scale, a traditional clinician instrument of pressure injury risk. At a specificity of 0.50, the model achieved a sensitivity of 0.63 within 2.5 patient-days. Machine learning identified categorical increases in risk when patients were prescribed vasopressors (OR=16.4, p<0.001), beta-blockers (OR=4.8, p<0.001), erythropoietin stimulating agents (OR=3.0, p<0.001), or were ordered a urinalysis screen (OR=9.1, p<0.001), lipid panel (OR=5.7, p<0.001) or pre-albumin panel (OR=2.0, p<0.001). DISCUSSION/SIGNIFICANCE OF FINDINGS: This algorithm could help hospitals conserve resources within a critical period of patient vulnerability for pressure injury not reimbursed by Medicare. Savings generated by this approach could justify investment in machine learning to develop electronic warning systems for many iatrogenic injuries.
Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction.
Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician–patient interaction.
Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback.
All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician–patient interaction.
The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician–patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
Municipal governments are experts in social non-distancing. From swimming pools to libraries, streetcars to public parks, municipalities bring residents together and move them around—services vital to a vibrant community in ordinary times, but potentially disastrous in a pandemic. Municipal decisions to shutter these services and enforce social distancing are thus crucial for a successful COVID-19 response.
Despite aspirations to be a world-class national curriculum, the Australian Curriculum (AC) has been criticised as ‘manifestly deficient’ (Australian Government Department of Education and Training, 2014 p. 5) as an inclusive curriculum, failing to meet the needs of all students with disabilities (SWD) and their teachers. There is a need for research into the daily attempts of educators to navigate the tension between a ‘top-down’ system-wide curriculum and a ‘bottom-up’ regard for individual student needs, with a view to informing both policy and practice. This article is the first of two research papers in which we report the findings from a national online Research in Special Education (RISE) Australian Curriculum Survey of special educators in special schools, classes, and units regarding their experience using the AC to plan for and teach SWD. Survey results indicated (a) inconsistent use of the AC as the primary basis for developing learning objectives and designing learning experiences, (b) infrequent use of the achievement standards to support assessment and reporting, and (c) considerable supplementation of the AC from other resources when educating SWD. Overall, participants expressed a lack of confidence in translating the AC framework into a meaningful curriculum for SWD. Implications for policy, practice, and future research are discussed.
Rapid, non-destructive methods for measuring seed germination and vigour are valuable. Standard germination and seed vigour were determined using 81 soybean seed lots. From these data, seed lots were separated into high and low germinating seed lots as well as high, medium and low vigour seed lots. Near-infrared spectra (950–1650 nm) were collected for training and validation samples for each seed category and used to create partial least squares (PLS) prediction models. For both germination and vigour, qualitative models provided better discrimination of high and low performing seed lots compared with quantitative models. The qualitative germination prediction models correctly identified low and high germination seed lots with an accuracy between 85.7 and 89.7%. For seed vigour, qualitative predictions for the 3-category (low, medium and high vigour) models could not adequately separate high and medium vigour seeds. However, the 2-category (low, medium plus high vigour) prediction models could correctly identify low vigour seed lots between 80 and 100% and the medium plus high vigour seed lots between 96.3 and 96.6%. To our knowledge, the current study is the first to provide near-infrared spectroscopy (NIRS)-based predictive models using agronomically meaningful cut-offs for standard germination and vigour on a commercial scale using over 80 seed lots.
Ceramic fiber–matrix composites (CFMCs) are exciting materials for engineering applications in extreme environments. By integrating ceramic fibers within a ceramic matrix, CFMCs allow an intrinsically brittle material to exhibit sufficient structural toughness for use in gas turbines and nuclear reactors. Chemical stability under high temperature and irradiation coupled with high specific strength make these materials unique and increasingly popular in extreme settings. This paper first offers a review of the importance and growing body of research on fiber–matrix interfaces as they relate to composite toughening mechanisms. Second, micropillar compression is explored experimentally as a high-fidelity method for extracting interface properties compared with traditional fiber push-out testing. Three significant interface properties that govern composite toughening were extracted. For a 50-nm-pyrolytic carbon interface, the following were observed: a fracture energy release rate of ∼2.5 J/m2, an internal friction coefficient of 0.25 ± 0.04, and a debond shear strength of 266 ± 24 MPa. This research supports micromechanical evaluations as a unique bridge between theoretical physics models for microcrack propagation and empirically driven finite element models for bulk CFMCs.
Much of the global agricultural by products go waste, especially in developing nations where much of their revenues depend on the exports of raw agricultural products. Such waste streams, if converted to “value added” products could serve as additional source of revenue while simultaneously having a positive impact on the socio-economic well being of the people. We present a preliminary investigation on utilizing chemical activation technique and ball milling to convert agricultural waste streams such as cocoa pod, coconut husk, palm midrib and calabash commonly found in Ghana into ultra-high surface area activated carbon. Such activated carbons are suitable for myriads of applications in environmental remediation, climate management, energy storage and conversion systems (batteries and supercapacitors), and improving crop productivity. We achieved BET surface area as high as ∼ 3000 m2/g.
Epigenetic modifications to the genome are a key mechanism involved in the biological encoding of experience. Animal studies and a growing body of literature in humans have shown that early adversity is linked to methylation of the gene for the glucocorticoid receptor (GR), which is a key regulator of the hypothalamic–pituitary–adrenal axis as well as a broad range of physiological systems including metabolic and immune function. One hundred eighty-four families participated, including n = 74 with child welfare documentation of moderate-severe maltreatment in the past 6 months. Children ranged in age from 3 to 5 years, and were racially and ethnically diverse. Structured record review and interviews in the home were used to assess a history of maltreatment, other traumas, and contextual life stressors, and a composite variable assessed the number exposures to these adversities. Methylation of regions 1D, 1F, and 1H of the GR gene was measured via sodium bisulfite pyrosequencing. The composite measure of adversity was positively correlated with methylation at exons 1D and 1F in the promoter of the GR gene. Individual stress measures were significantly associated with a several CpG sites in these regions. GR gene methylation may be a mechanism of the biobehavioral effects of adverse exposures in young children.
Despite widespread recognition that the physiological systems underlying stress reactivity are well coordinated at a neurobiological level, surprisingly little empirical attention has been given to delineating precisely how the systems actually interact with one another when confronted with stress. We examined cross-system response proclivities in anticipation of and following standardized laboratory challenges in 664 4- to 14-year-olds from four independent studies. In each study, measures of stress reactivity within both the locus coeruleus-norepinephrine system (i.e., the sympathetic and parasympathetic branches of the autonomic nervous system) and the corticotrophin releasing hormone system (i.e., the hypothalamic–pituitary–adrenal axis) were collected. Latent profile analyses revealed six distinctive patterns that recurred across the samples: moderate reactivity (average cross-system activation; 52%–80% of children across samples), parasympathetic-specific reactivity (2%–36%), anticipatory arousal (4%–9%), multisystem reactivity (7%–14%), hypothalamic–pituitary–adrenal axis specific reactivity (6%–7%), and underarousal (0%–2%). Groups meaningfully differed in socioeconomic status, family adversity, and age. Results highlight the sample-level reliability of children's neuroendocrine responses to stress and suggest important cross-system regularities that are linked to development and prior experiences and may have implications for subsequent physical and mental morbidity.
We present preliminary results on a processing protocol by chemical activation that transforms organic waste product such as coconut husk into high surface area activated carbon. Dried raw materials of the coconut husk were carbonized anaerobically into char. The char was impregnated with KOH of different ratios and were activated at 800°C and 900°C. The transmission electron microscope was used to acquire structural and morphological information of the activated carbon, and the surface area and porosity analysis were performed using Micromeritics ASAP 2020 analyzer. The activated carbons show both micropores and mesopores with specific surface area as high as 2900m2/g.
We have derived and tested a simple analytical model for placing limits on the transit timing variations of circumbinary exoplanets. These are generally of days in magnitude, dwarfing those found in multi-planet systems. The derived method is fast, efficient and is accurate to approximately 1% in predicting limits on the possible times of transits over a 3-year campaign.
Tungsten is one the most important material for both plasma facing and structural applications in current designs for advanced divertors. Recent work has shown that composites can be manufactured from nanostructured tungsten foils which show significantly higher toughness than monolithic tungsten, but there is no data on the radiation resistance of such materials. In this study W-5 wt% Re foil in both an as rolled and annealed condition was implanted with 2MeV W+ ions to two damage levels, 0.07 and 0.4 dpa. The change in hardness was measured using nanoindentation. An increase in hardness was seen in both materials at both damage levels, with more hardening seen for the 0.4 dpa implanted samples. However the increase in hardness due to ion implantation was 2.6 times higher in the annealed material as compared to the as rolled material. This is due to the smaller grain size and higher dislocation density providing more sinks for the irradiation produced defects in the as rolled material as compared to the annealed material. Thus showing that unannealed tungsten foils are superior for use in applications in which they will see significant levels of radiation damage.
The fracture behaviour of individual grain boundaries has been studied in order to understand the mechanisms controlling stress corrosion cracking in nuclear reactors. In particular, the role of oxidation in facilitating crack initiation and propagation has been reviewed. Nickel alloys from pressurized water reactors (PWRs) have been tested in simulated primary water conditions to induce grain boundary oxidation. Microcantilevers containing an oxidized grain boundary plane have been prepared and tested for fracture. The brittle nature of the oxide was demonstrated and the required stress to fracture measured.
Model alloys have been made of pure W and 1% & 5% W-Ta and W-Re. Indentation hardness and modulus data were obtained by nanoindentation to assess the effect of composition on mechanical properties. Results showed that both the Ta and Re compositions hardened with increasing alloy content, greater in the W-5%Ta composition which showed an increase of 1.03GPa (17%), compared to a 0.43GPa (7%) increase in W-5%Re. The samples also showed very small increases in modulus of ∼ 25GPa (6%) in both W-5%Re and W-5%Ta. The samples were implanted with 3000appm concentration of helium. All samples show a substantial increase in hardness of up to 107% in the case of pure W. An appreciable difference in modulus is also seen in all samples. Initial TEM work has shown no visible He bubbles, suggesting that the mechanical properties changes are due to He-vacancy cluster formation below the resolvable limit.