Machine Learning-Based Routine Laboratory Tests Predict One-Year Cognitive and Functional Decline in a Population Aged 75+ Years

BACKGROUND

Cognitive and functional decline are common problems in older adults, especially in those 75+ years old. Currently, there is no specific plasma biomarker able to predict this decline in healthy old-age people. Machine learning (ML) is a subarea of artificial intelligence (AI), which can be used to predict outcomes Aim: This study aimed to evaluate routine laboratory variables able to predict cognitive and functional impairment, using ML algorithms, in a cohort aged 75+ years, in a one-year follow-up study.

METHOD

One hundred and thirty-two older adults aged 75+ years were selected through a community-health public program or from long-term-care institutions. Their functional and cognitive performances were evaluated at baseline and one year later using a functional activities questionnaire, Mini-Mental State Examination, and the Brief Cognitive Screening Battery. Routine laboratory tests were performed at baseline. ML algorithms-random forest, support vector machine (SVM), and XGBoost-were applied in order to describe the best model able to predict cognitive and functional decline using routine tests as features.

RESULTS

The random forest model showed better accuracy than other algorithms and included triglycerides, glucose, hematocrit, red cell distribution width (RDW), albumin, hemoglobin, globulin, high-density lipoprotein cholesterol (HDL-c), thyroid-stimulating hormone (TSH), creatinine, lymphocyte, erythrocyte, platelet/leucocyte (PLR), and neutrophil/leucocyte (NLR) ratios, and alanine transaminase (ALT), leukocyte, low-density lipoprotein cholesterol (LDL-c), cortisol, gamma-glutamyl transferase (GGT), and eosinophil as features to predict cognitive decline (accuracy = 0.79). For functional decline, the most important features were platelet, PLR and NLR, hemoglobin, globulin, cortisol, RDW, glucose, basophil, B12 vitamin, creatinine, GGT, ALT, aspartate transferase (AST), eosinophil, hematocrit, erythrocyte, triglycerides, HDL-c, and monocyte (accuracy = 0.92).

CONCLUSIONS

Routine laboratory variables could be applied to predict cognitive and functional decline in oldest-old populations using ML algorithms.

Efficacy of cognitive behavioral therapy in reducing psychiatric symptoms in patients with implantable cardioverter defibrillator: an integrative review

This article is a systematic review of the available literature on the benefits that cognitive behavioral therapy (CBT) offers patients with implanted cardioverter defibrillators (ICDs) and confirms its effectiveness. After receiving the device, some patients fear that it will malfunction, or they remain in a constant state of tension due to sudden electrical discharges and develop symptoms of anxiety and depression. A search with the key words "anxiety", "depression", "implantable cardioverter", "cognitive behavioral therapy" and "psychotherapy" was carried out. The search was conducted in early January 2013. Sources for the search were ISI Web of Knowledge, PubMed, and PsycINFO. A total of 224 articles were retrieved: 155 from PubMed, 69 from ISI Web of Knowledge. Of these, 16 were written in a foreign language and 47 were duplicates, leaving 161 references for analysis of the abstracts. A total of 19 articles were eliminated after analysis of the abstracts, 13 were eliminated after full-text reading, and 11 articles were selected for the review. The collection of articles for literature review covered studies conducted over a period of 13 years (1998-2011), and, according to methodological design, there were 1 cross-sectional study, 1 prospective observational study, 2 clinical trials, 4 case-control studies, and 3 case studies. The criterion used for selection of the 11 articles was the effectiveness of the intervention of CBT to decrease anxiety and depression in patients with ICD, expressed as a ratio. The research indicated that CBT has been effective in the treatment of ICD patients with depressive and anxiety symptoms. Research also showed that young women represented a risk group, for which further study is needed. Because the number of references on this theme was small, further studies should be carried out.

The criminal purchase of firearm ammunition

OBJECTIVE

Laws that prohibit certain individuals from owning firearms also pertain to ammunition. Whereas retail sales of firearms to criminals are regularly disrupted by instant background checks, sales of ammunition are essentially unchecked and the rate at which criminals acquire ammunition is unknown. This research describes the ammunition market and estimates the rate at which criminals are acquiring ammunition.

DESIGN

Criminal background checks conducted on individuals purchasing ammunition in the City of Los Angeles in April and May 2004.

SETTING

Los Angeles, CA, USA.

SUBJECTS

Ammunition purchasers.

MAIN OUTCOME MEASURES

Criminal activity that prohibits one from owning, purchasing, or possessing ammunition.

RESULTS

2.6% (95% CI 1.9% to 3.2%) of ammunition purchasers had a prior felony conviction or another condition that prohibited them from possessing ammunition. During the study period prohibited possessors purchased 10,050 rounds of ammunition in Los Angeles.

CONCLUSIONS

These estimates suggest that monitoring ammunition transactions may help reduce the supply of ammunition to criminals and the frequency of injuries from felonious gun assaults. Such a record can also provide information for generating leads on illegal firearm possession.

Effect of angiotensin-(1-7) on jejunal absorption of water in rats

The effect of angiotensin-(1-7) on jejunal water absorption in rats was investigated. The jejunal sac of anesthetized rats was filled with two ml of tyrode solution containing 3.7 MBq of tritiated water. A femoral vein was cannulated for administration of peptides and drugs. Infusion of Ang-(1-7) at the dose of 0.7 ng/kg.min produced a significant increase in jejunal water absorption compared to control (32% increase). The Ang-(1-7) antagonist A-779 abolished the effect of Ang-(1-7) on water absorption. A reduction of the Ang-(1-7) effect was also produced by treatment with the AT(1) receptor antagonist, losartan or the AT(2) receptor antagonist, PD123.177. The increase in jejunal water absorption produced by Ang-(1-7) was blocked by the nitric oxide synthase inhibitor, L-NAME and by indomethacin. These data suggest that the effect of Ang-(1-7) on the jejunal loop is mediated by activation of a multiple angiotensin receptors and/or by an atypical angiotensin receptor. Furthermore, the effect of Ang-(1-7) on jejunal water absorption is mediated by nitric oxide and by a cyclooxygenase-dependent mechanism.

Influence of obstructive jaundice on jejunal absorption of glucose, electrolytes, and vitamin A in rats

Jejunal absorption of glucose, electrolytes, and vitamin A was investigated in rats. A Tyrode solution containing glucose, sodium, and potassium in concentrations two and four times higher than usual was infused through the jejunal loops of jaundiced and control rats during 40 min. The glucose values in the influx and effluent were not different during the experiment time. However, the concentrations of sodium and potassium of the effluent decreased with concentrations twice normal. The osmotic pressure of the effluent was directly related to the electrolytic concentration. When the perfusate fluid was four times higher, the differences between sham and jaundiced groups remained unchanged. The osmotic pressure means of the jaundiced group decreased during the experimental time. The absorption of vitamin A increased during the 40-min experiment time in the control rats. On the other hand, vitamin A concentration in the perfused lumen of the jaundiced group did not change over the time. These data indicate that obstructive jaundice has little influence on glucose and electrolytes absorption, while vitamin A is impaired by this condition.

Screening of yeasts from Brazilian Amazon rain forest for extracellular proteinases production

Eighty seven yeast strains representing 34 species isolated from Parahancornia amapa fruit and associated Drosophila flies collected in the Brazilian Amazon rain forest, were screened for proteinase production. Proteolytic activity was tested through casein hydrolysis in solid medium supplemented with 0.5% casein and glucose. Among 23 strains, 18 from genus Candida and 5 from Pichia were caseinolytic and produced proteinases in yeast carbon base liquid medium supplemented with casein 0.01%. The proteolytic activity was tested on pH ranging from 2.0 to 9.0 in correspondence to the pH of the cultures media in which the yeasts were grown. Six highly proteolytic strains: Candida parapsilosis AP153A, C. krusei AP176, C. sorbosa DR215, C. sorbosa AP259, C. valida AP209A and C. sorboxylosa AP287 were selected and the pH optima of production and the proteolytic activity were determined. In general the secretion of proteinase was maximum throughout the exponential and the stationary phases. Greater production occurred in acidic culture and high activity was observed at pH 3.0, 4.0 and 5.0.

[Cerebral malaria and AIDS: case report]

Although it has not been definitely proven that the severity of malaria is associated to human immunodeficiency virus (HIV) we know that infection through Plasmodium falciparum can favor a rapid evolution of the HIV infection. Besides, association of malaria with HIV/AIDS from a clinical point of view can be clinically severe in the face of the occurrence of other microorganisms or neoplasias, which worsens the evolution and prognosis of the affected patients. The concurrence of HIV with Plasmodium in malaria endemic zones is a possibility which should always be taken into consideration, since transmission is related to risk factors caused by people's behavior which are not always promptly revealed and/or identified. The authors report one case of brain malaria infection by Plasmodium vivax and Plasmodium falciparum in a patient with AIDS. They describe the clinical evolution and therapy.

Evaluation of a program to overcome vitamin A and iron deficiencies in areas of poverty in Minas Gerais, Brazil

Randon samples of children from both sexes from Belo Horizonte, the capital City, and from Turmalina, Jequitinhonha Valley, Minas Gerais, Brazil, were submitted to nutritional evaluation before and after the intervention "Program to Overcome Vitamin A and Iron Deficiencies in Areas of Poverty in Minas Gerais, Brazil". After the first examination, all the children received, with an interval of 180 days, a single oral dose of vitamin A, oral iron sulfate during 50 days, and 200 mg of Mebendazol/day for three days. Thirty days after ending administration of the third dose of medicine, the children were subjected to a new evaluation. In Belo Horizonte, the first evaluation revealed a high prevalence of deficient and low values of vitamin A in preschool children (21.5%) and school children (21.7%). A small prevalence of low hematocrit values was also observed in both groups. Deficient and low values of hemoglobin were found as well in 21.5% of preschool children and in 17.5% of school children. The second evaluation, practiced 30 days after the third dose of medicine, showed a small incidence of low vitamin A values (4.3% in preschool children and 2.9% in school children) and low hemoglobin values (6.5% in preschool children and 2.9% in school children). No deficient values of hemoglobin and vitamin A were observed. Concerning the hematocrit value, only one school child presented a low value at the second evaluation. On the other hand, in Jequitinhonha Valley, five cases of Bitot spot with conjunctival xerosis, two cases of corneal xerosis, and one case of keratomalacia were detected at the first examination. Thirty days after ending the third dose of medicine, only one corneal scar was observed. Only a small number of children with deficient and low levels of vitamin A and hemoglobin was found in the final evaluation (less than 8%), while this number was high at the first evaluation (above 38 and 12%, respectively). These results show the efficiency of the intervention Program in relation to hypovitaminosis A and iron anemia prevention. The Program is now being implemented by the Brazilian Ministry of Health.