Healthcare-associated infections is the most common healthcare related injury and affect almost every tenth patient. With the purpose of reducing these infections Infektionsverktyget, The Anti-Infection Tool, was developed for registration and feedback of infection data. The tool is now used in all Swedish county councils resulting in a wealth of data. The purpose of this thesis was thus to investigate how data mining can be applied to describe patterns in this data and predict patient outcomes regarding healthcare-associated infections that need to be treated with antibiotics. Data mining was performed with Microsoft SQL Server 2008 in which models based on six different data mining algorithms with different parameter settings were developed. They used the attributes gender, age and previous diagnoses and medical actions as inputs and antibiotic treated healthcare-associated infection outcome as output. The predictive performance of the models was evaluated using 5-fold cross validation and macro averaged measures of recall, precision and F-measure. Patterns generated by selected models were extracted. Models based on the Naive Bayes algorithm showed the highest predictive capabilities with respect to recall and models based on the Decision Trees algorithm with low pruning had the highest precision. Although, none were considered to perform sufficiently well and several areas of improvement were identified. The most important factor in the inadequate performance is believed to be the relatively rare occurrences of infections in the dataset. Extracted patterns based on the Association Rules algorithm were considered the easiest to interpret. Patterns included clinically valid and invalid as well as trivial relationships. Future studies should be focused on further model improvements and gathering of more patient data. The idea is that data mining in Infektionsverktyget in the future could be used both to provide ideas for further medical research and to identify risk patients and prevent healthcare-associated infections in daily clinical work. / Vårdrelaterade infektioner är den vanligaste vårdskadan och drabbar nästan var tionde patient. Med syfte att minska antalet vårdrelaterade infektioner utvecklades Infektionsverktyget för registrering och återkoppling av infektionsdata. Verktyget används nu i alla Sveriges landsting vilket resulterar i stora mängder data. Syftet med detta examensarbete var därför att undersöka hur data mining kan användas för att beskriva mönster i denna data och för att förutsäga om patienter kommer att drabbas av en vårdrelaterad infektion som behöver antibiotikabehandlas. Data mining genomfördes med Microsoft SQL Server 2008 där modeller baserade på sex olika data mining-algoritmer med olika parameterinställningar utvecklades. De hade inputattributen kön, ålder och tidigare diagnoser och medicinska åtgärder, och outputattributet utfall av antibiotikabehandlad vårdrelaterad infektion. Förutsägelseförmågan hos modellerna utvärderades med 5-delad korsvalidering och makrogenomsnitt av måtten recall, precision och F-measure. Fyra modeller användes även för att ta fram mönster ur datamängden. Modeller baserade på Naive Bayes-algoritmen hade den bästa förutsägelseförmågan med avseende på recall och modeller baserade på Decision Trees-algoritmen med en låg beskärningsnivå uppnådde bäst precision. Trots detta ansågs ingen av modellerna prestera tillräckligt bra och flera möjliga förbättringsområden hittades. Den viktigaste anledningen till den otillräckliga förutsägelseförmågan tros vara att infektioner är relativt ovanliga i datamängden. Mönster som tagits fram med Association Rules-algoritmen ansågs vara lättast att tolka. Mönstren innehöll både kliniskt relevanta och irrelevanta såväl som triviala samband. Framtida studier bör fokuseras på att förbättra modellerna ytterligare och att samla in mer patientdata. Idén är att data mining i Infektionsverktyget i framtiden skulle kunna användas för att ge uppslag till medicinsk forskning och för att identifiera riskpatienter och därmed förebygga vårdrelaterade infektioner i den dagliga kliniska verksamheten.

Povrch buněk je bohatě pokryt oligosacharidy, které jsou v plazmalemě ukotvené pomocí proteinů a lipidů. Oligosacharidy zprostředkují vzájemnou vazbu mezi buňkami nebo vazbu buněk k složkám extracelulární matrix. Galektiny jsou živočišné lektinů které mají afinitu k oligosacharidům obsahujícím β-galaktózu. Jsou to multifaktoriální proteiny, které se účastňují řady reakcí v organizmu, jako jsou mezibuněčné interakce, interakce buněk s mezibuněčnou hmotou, proliferace i apoptóza a sestřih pre-mRNA. Proteiny po translaci procházejí různými strukturálnimy úpravami, které mají vliv na jejich funkci. Galektin-3 je možný prognostický ukazatel u nádorů vycházejících z vrstevnatých dlaždicových epitelů je fosforylován na N-konci. Prokázali jsme, že tato posttranslační modifikace nemá vliv na jeho vazebnou reaktivitu. Jiný endogenní lektin, galektin-1 je charakteristickou molekulou nádorového stromatu a granulační tkáně hojícího se poranění. Zjistili jsme, že galektin-1 indukuje na TGF-β nezávislý in vitro přechod normálních fibroblastů na myofibroblasty včetně produkce sítě extracelulární matrix bohaté fibronektinem a galektinem-1. Tento poznatek je využitelný v terapii hojení ran a v tkáňovém inženýrství. Dnes je jasné, že nádorové stroma ovlivňuje i biologické vlastnosti nádoru (lokální agresivita,...

BACKGROUND. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a risk factor for coronary artery disease (CAD) in nontransplant patients. We evaluated the association between Lp-PLA2, cardiac allograft vasculopathy (CAV) assessed by 3D intravascular ultrasound, and incidence of cardiac adverse events in heart transplant recipients. MATERIALS AND METHODS. Fasting blood samples were obtained and stored from a cross-section of 112 cardiac transplant recipients attending the Mayo cardiac transplant clinic in 2000 to 2001, mean of 4.7 years after transplant. Lp-PLA2 was measured in plasma aliquots using an enzyme-linked immunoassay. Fifty-six of these patients subsequently underwent two 3D intravascular ultrasound studies in 2004 to 2006 12 months apart. Cardiovascular (CV) events included percutaneous coronary intervention, coronary artery bypass grafting (CABG), reduction in left ventricular ejection fraction (LVEF) ≤45% secondary to CAV and CV death. RESULTS. High Lp-PLA2 level was associated with increase in plaque volume (r=0.43, P=0.0026) and percent plaque volume (r=0.45, P=0.0004). The association remained significant after adjusting for clinical and lipid variables. During follow-up of 5.1±1.6 years, 24 CV adverse events occurred in 15 of 112 (13%) heart transplant patients. Lp-PLA2 level>236 ng/mL (higher tertile) identified a subgroup of patients having a 2.4-fold increase of relative risk for combined endpoint of CV events (percutaneous coronary intervention, CABG, LVEF<45%, and CV death; 95% CI 1.16-5.19, P=0.012) compared with patients with Lp-PLA2≤236 ng/mL. CONCLUSIONS. Lp-PLA2 is independently associated with progression of CAV and predicts a higher incidence of CV events and CV death in transplant patients. This finding supports the concept that systemic inflammation is an important mediator of CAV. Lp-PLA2 may be a useful marker for risk of CAV and a therapeutic target in posttransplant patients.

Title: Comparing hydration practices of long-distance runners during intended training, an intended event, and an actual event during COVID-19. Context: Prior studies on long-distance runners have yet to compare hydration practices intended in training to an actual event. Optimal hydration strategies and knowledge of EAH was assessed. Objective: The purpose of this research was to assess and compare the self-reported hydration practices of long-distance runners during an intended training run, an intended event, and during an event. Design: Cross-sectional online survey design Setting: 2020 Hyannis, Massachusetts Marathon; Connecticut trail races; online. Participants: There were 46 participants in the Hyannis, 26 participants in the Connecticut trail races, and 203 participants in the long-distance running studies. Main outcome Measure(s): Survey questions addressed hydration practices, including hydration strategies, and volumes consumed before and during a run. Additional data included demographics, training experience, sources of hydration information, and knowledge of EAH. Results: When comparing volumes consumed, higher correlations were found when comparing intended events in all three studies. In other words, runners intended to drink the same in an intended training run and an intended event. More variation was found when comparing intended volumes to actual volumes. All studies showed strong agreement in the selected hydration strategies between the scenarios and most were statistically significant. The “drinking to thirst hydration strategy”, was selected on average 17% of the time for Hyannis marathoners, 30% of the time for Connecticut trail runners, and 23% of the time for long-distance runners. This hydration strategy is recommended to decrease the risk of EAH in lieu of a personalized hydration plan. EAH awareness among runners was reported between 50-59% of the time in all studies. However, there was inconsistency in recognizing contributing and preventive EAH factors. Conclusion: There were differences in hydration practices when comparing an intended training run, an intended event, and an event. This indicates a need for ongoing education on hydration practices and EAH. If runners mimic appropriate hydration practices during training when running in an event, the risk of EAH may be decreased. The limitation of this research is the self-reported nature of historical data.

No description available.

Pathogen-associated molecular pattern (PAMP) recognition occurs by plasma membrane located receptors that induce among other processes nuclear gene expression. The plant FLS2-BAK1 receptor complex binds the bacterial PAMP, flg22 and induces a series of defense responses. The resulting signal transduction events occur through the activation of two MAPK signaling cascades, which trigger a rapid and strong activation of MPK3, MPK4 and MPK6. Cellular responses to pathogens are regulated by the activated MAPKs, which lead to the eventual phosphorylation of cytoplasmic and nuclear substrates. These MAPK substrates in turn respond to phosphorylation by reprogramming the expression of defense genes. A large scale phosphoproteomics screen of nuclear proteins in wild type and mpk mutant plants in response to flg22 revealed several novel putative targets of MAP kinases. This thesis is aimed at identifying the role of two of these chromatin associated proteins in plant immunity and their signaling mechanisms. The chromatin associated proteins we chose to study here are LITTLE NUCLEI/CROWDED NUCLEI (LINC/CRWN), LINC1 and the AT-HOOK MOTIF CONTANING NUCLEAR LOCALIZED 13 (AHL13) proteins. We demonstrate that these two chromatin associated proteins play a positive regulatory role in jasmonic acid signaling and immunity. Knock out mutants for both genes exhibit impairment in early and late innate immune reposes to both PAMP and hemibiotrophic pathogen strains. We also demonstrate that these mutants are compromised in regulating the expression of genes involved in jasmonic acid (JA) signaling and responses and genes involved in the biosynthesis both the indole and aliphatic glucosinolate (GS) pathways. Moreover, Pst DC3000 hrcC triggers JA and JAIle accumulation in these mutants, whereas salicylic acid (SA) levels are unchanged. We were also able to identify and validate two novel MAPK targeted phosphosites in AHL13 that affect the protein stability of AHL13 and we establish its role as a MPK6 substrate that affects jasmonic acid biosynthesis and PTI responses. Together this work identifies two novel signaling components involved in the regulation of jasmonic acid homeostasis and immunity.

This study examined the changes in symptoms of anxiety, depression, and social ill dysfunction associated with a history of child trauma after adding animal-assisted therapy (AAT) to conventional psychotherapy for adolescents living in a residential treatment facility in northern California. Using a quasiexperimental design, participants were followed over a period of nine weeks, with both groups completing the State-Trait Anxiety Inventory, the Beck Depression Inventory , an abbreviated version of the Beck Depression Inventory, and the Youth Self-Report, and residential staff completing the Youth Outcome Questionnaire at three time points. In addition, the treatment group completed state anxiety and depression assessments before and after receiving the adjunctive AAT at each of these assessment points. Analyses suggest that the treatment group mean depression score was lower than the control group's score, but only at week 5. The significance of group differences in mean anxiety at posttest assessments could not be determined due to pretreatment group differences. Within-subjects analyses suggest that the treatment group experienced significant reductions in mean state anxiety scores after receiving the AAT at each of the three assessment points over the nine weeks. These reductions in anxiety were not, however , maintained between assessments. No significant changes in self- or other-reported social behaviors were found. Implications of these findings are discussed as well as suggestions for future research.

I studied the characteristics of fence mortality in pronghorn (Antilocapra americana), mule deer (Odocoileus hemionus), and elk (Cervus elaphus) along roads in Colorado and Utah from June 2004 to June 2005. I defined a direct-fence mortality as a carcass caught directly in a fence and an indirect-fence mortality as a carcass on the ground within 10 m of a fence. I estimated an average annual direct mortality occurrence of 0.25 mortalities/km (0.078 mule deer mortalities/km, 0.113 pronghorn mortalities/km, and 0.061 elk mortalities/km). The highest fence-mortality rates for ungulates occurred during August, which coincided with weaning of fawns on my study area. Mule deer and pronghorn both jumped fences in >81% of observed crossings and did not differ in their crossing methods (P = 0.37). Getting caught between the top 2 wires was the leading cause of death for fence mortalities. Mule deer suffered higher fence-mortality rates than elk or pronghorn because they crossed fences more frequently and fed in the right-of-way of the road more often (P < 0.001). Juveniles were 8 times more likely to die in fences than adults. Woven-wire fence types were more lethal to ungulates (especially juveniles) than other fence types (P < 0.001). Woven wire with a single strand of barbed wire above it was significantly more lethal to ungulates than woven wire with 2 strands of barbed wire above it, or 4-strand barbed-wire fence (P < 0.001). There was a direct relationship between the frequency of fence-mortalities and ungulate abundance (P < 0.001 ). Traffic volumes had an inverse relationship with fence mortality frequencies (P < 0.001) and ungulate densities along the right-of-way (P < 0.001). Indirect mortality (i.e., carcasses within 10 m of fences) composed 66% of fence-related mortality, whereas direct-fence mortality (i.e., carcasses in fences) composed a mere 33%. Additionally, indirect-fence mortality was found to be greater along woven-wire fences, when compared to barbed-wire fence types (P = 0.003).

Indiana University-Purdue University Indianapolis (IUPUI) / Up to 75% of the more than 3.5 million breast cancer survivors (BCS) living in the United States report cognitive dysfunction. However, little is known about cognitive dysfunction among older BCS, who may be at greater risk. Therefore, the purpose of this dissertation was to characterize cognitive dysfunction in older BCS. Specific aims included: (1) synthesize the literature regarding cognitive dysfunction in older BCS; and (2) examine the relationships between a) objective cognitive function (immediate memory, delayed memory, attention, executive function-working memory, verbal fluency) and subjective cognitive function (attention); b) demographic factors, medical factors, treatment factors, and cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive function; and c) comorbidity and cognitive function and physical functioning, and quality of life (QoL) in older BCS. In an integrative review, to address aim 1, 12 studies were identified. Up to 41% of older BCS showed objective cognitive dysfunction on neuropsychological assessment, up to 64% reported subjective cognitive dysfunction concerns pre-treatment, and 50% incurred cognitive decline from pre- to post-treatment. Cognitive dysfunction was associated with older age, multiple comorbidities, chemotherapy, sleep disturbance, neuropsychological symptom cluster, frailty, and poorer QoL. To address aim 2, data were leveraged from a large, nationwide, QoL in younger versus older BCS study (PI: Champion), which included 335 older BCS who were ≥60 years of age, had breast cancer (stage I-IIIa), received chemotherapy, and were 3-8 years post-diagnosis without recurrence. Findings included up to 19% of older BCS had mild-moderate objective cognitive dysfunction on at least one neuropsychological assessment, with 26% reporting poor-moderate subjective attention function. BCS, who were older, had less education and more depressive symptoms had greater cognitive dysfunction. Objective attention and executive function-working memory significantly and positively correlated with subjective attention. In turn, subjective cognitive dysfunction and increased number of comorbidities were related to poorer physical functioning. Subjective cognitive dysfunction was also related to poorer QoL. The findings from this study highlights the prevalence and complexity of cognitive dysfunction in older BCS. Further research is needed to better understand the intersection of aging, cancer, comorbidities and cognitive dysfunction and the negative implications in older BCS.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18546号 / 医博第3939号 / 新制||医||1006(附属図書館) / 31446 / 京都大学大学院医学研究科医学専攻 / (主査)教授 武田 俊一, 教授 松田 文彦, 教授 小松 賢志 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM