Feature Selection Based on Modified Bio-inspired Atomic Orbital Search Using Arithmetic Optimization and Opposite-Based Learning

Feature selection (FS) has the largest influence on the performance of machine learning methods. FS can remove the irrelevant and redundancy features from the data while preserving the same quality of increasing it. However, the traditional FS methods are time-consuming and can be stuck in local optima. So, the metaheuristic (MH) techniques are used to avoid these limitations since they have several operators that explore and exploit the search domain better than traditional methods. Besides these behaviors of MH, we present an improved atomic orbital search (IAOS) algorithm using a global search strategy that uses the operators of arithmetic optimization algorithm (AOA), which has proven a good exploration ability to provide a promising candidate solution. The opposite-based learning (OBL) is applied to enhance the initial population, which leads to enhancing the convergence rate towards the optimal solution. In addition, a dynamic photon rate is used to enhance the balance between exploration and exploitation. Finally, the sequential backward selection (SBS) is used as a local search strategy to improve the best solution, and this leads to obtaining a set of relevant features that increase the classification accuracy. To evaluate the performance of the presented IAOS-SBS as an FS method, a set of twenty UCI datasets is used; also, it is compared with other well-known FS methods. The results show the superiority of IAOS-SBS among the performance measures. Finally, it is concluded that IAOS-SBS can select fewer features with achieving high classification accuracy for most of the datasets utilized in the study. This indicates the use of OBL and SBS leads to enhancing the original AOS.

     

Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis

OBJECTIVES

We set out to review the efficacy of Community Health Worker (CHW) interventions to improve glycemia in people with diabetes.

METHODS

Data sources included the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, Google Scholar, and reference lists of previous publications. We reviewed randomized controlled trials (RCTs) that assessed the efficacy of CHW interventions, as compared to usual care, to lower hemoglobin A1c (A1c). Two investigators independently reviewed the RCTs and assessed their quality. Only RCTs with a follow-up of at least 12 months were meta-analyzed. A random effects model was used to estimate, from unadjusted within-group mean reductions, the standardized mean difference (SMD) in A1c achieved by the CHW intervention, beyond usual care.

RESULTS

Thirteen RCTs were included in the narrative review, and nine of them, which had at least 12 months of follow-up, were included in the meta-analysis. Publication bias could not be ruled-out due to the small number of trials. Outcome heterogeneity was moderate (I²= 37 %). The SMD in A1c (95 % confidence interval) was 0.21 (0.11-0.32). Meta-regression showed an association between higher baseline A1c and a larger effect size.

CONCLUSIONS

CHW interventions showed a modest reduction in A1c compared to usual care. A1c reduction was larger in studies with higher mean baseline A1c. Caution is warranted, given the small number of studies.     

Cost-effectiveness analysis of medical intervention in patients with early detected of Diabetic Nephropathy in a tertiary care hospital in Bangladesh

The economic burden resulting from Diabetic Nephropathy (DN) consumes a major portion of resources allocated for health-care services. Cost-effectiveness of various interventions on DN and its complications have relatively been well explored in developed countries, but these are almost absent in developing countries. The present study was undertaken to assess the cost-effectiveness of medical intervention in patients with DN. Two hundred patients with DN, with at least 1 yr of follow-up, were purposively selected from BIRDEM (tertiary diabetes care hospital) of Bangladesh. Of them 100 were late in detection (Serum Creatinine ≥4.0 mmom/l, Late detected DN or Late detected diabetic nephropathy) and 100 were detected early (Serum Creatinine <4.0 mmom/l, early detected DN or early detected diabetic nephropathy). The degree and extent of complications like cardiopathy, peripheral neuropathy, retinopathy and vasculopathy, treatment outcome, clinical effectiveness of interventions and direct, indirect and incremental cost of complications were calculated. Comparison was made between the groups. Cost included drugs, hospitalizations, diagnostics and visits. A total of 200 patients were considered for an average of 365 days, amounting to 651 person years of observation in total. The mean ± SD fasting serum glucose of the groups was 9.36 ± 0.40 mmol/l and 4.78 ± 0.38 mmol/l, total cholesterol was 206.50 ± 42.60 and 104.20 ± 35.50 mg/dl, HbA1c was 9.80 ± 0.50% and 5.70 ± 0.38%, TG was 163.76 ± 99.46 and 155.67 ± 94.84 mg/dl and serum creatinine was 0.89 ± 0.03 and 4.90 ± 1.17 mmol/l in Late detected diabetic nephropathy and early detected diabetic nephropathy respectively. About 19% patients in Late detected diabetic nephropathy and 36% in early detected diabetic nephropathy were free of diabetic complications other than DN. In Late detected diabetic nephropathy, 32% had one complication, 29% had two and 20% had more than two complications. On the other hand, in early detected diabetic nephropathy the corresponding values were 48%, 10% and 6% respectively. The most frequent complication was cardiopathy, which affected 33% patients in Late detected diabetic nephropathy and 27% in early detected diabetic nephropathy, followed by peripheral neuropathy 21% and 18%, retinopathy 17% and 13%, and vasculopathy 10% and 6% respectively. The average annual cost of care was US$ 27,954 (direct US$ 16,983 and indirect US$ 10,971), with an average US$ 140 per patient. Among the average annual cost Late detected diabetic nephropathy consumed US$ 19,837 (US$ 198 per patient) and early detected diabetic nephropathy US$ 8117 (US$ 81 per patient). 48% (US$ 13,473) of costs were attributable to drugs for both groups of which US$ 10,817 (80%) was for Late detected diabetic nephropathy and US$ 2656 (20%) for early detected diabetic nephropathy, 31% (US$ 8739) to hospitalizations of which US$ 5211 (60%) for Late detected diabetic nephropathy and 3528 (40%) for early detected diabetic nephropathy. In case of diagnostics and visits the corresponding values were US$ 2136 (60%) and 1419 (40%) and US$ 1673 (76%) and 514 (24%) for Late detected diabetic nephropathy and early detected diabetic nephropathy respectively. The annual medical costs increased with the number of complications from US$ 1320–2296 and to 3989 in Late detected diabetic nephropathy with one, two and more than two complications (other than DN) which is increasing at a rapid rate and US$ 917–1556 and to 2372 in early detected diabetic nephropathy respectively, increasing at a diminishing marginal rate. The regression equation showed that medical cost is significantly related to complications tested in both univariate (P < 0.0001) and multiple linear regression analyses (R² = 0.52; F = 82.3, P < 0.0001). Proper management with regular screening substantially reduces the expenditure related to care of patients with Diabetic Nephropathy and related complications even in a developing country. Strategies aimed at preventing Diabetic Nephropathy and early detection of the onset of nephropathy complication will reduce medical costs in a substantial way.     

Association between antibiotic use and changes in susceptibility patterns of Pseudomonas aeruginosa in an intensive care burn unit: a 5-year study, 2000-2004

This study aimed to evaluate the relationship between antimicrobial resistance in Pseudomonas aeruginosa and annual antibiotic use in a burn unit.From 1 January 2000 to 31 December 2004, 203 non-repetitive strains of Ps. aeruginosa were recovered from various clinical specimens. Antimicrobial susceptibility testing was performed using the disc diffusion method, and susceptibility data were interpreted according to break points recommended by the French Society of Microbiology. The antibiotic consumption for imipenem, ceftazidime, cefotaxime, piperacillin-tazobactam, ofloxacin, ciprofloxacin, gentamicin and amikacin was calculated with antimicrobial density. The relationship between antibiotic use and the resistance of Ps. aeruginosa was analysed.The consumption of ceftazidime and amikacin showed no association with resistance. A statistically significant relationship was observed between increasing use of ciprofloxacin and the incidence of resistant Ps. aeruginosa to this antibiotic (rs = 0.89, p = 0.05), and a significant correlation between ciprofloxacin consumption and resistance to imipenem was noted (rs = 0.89, p = 0.043). Restricted use of ciprofloxacin during 2003 and 2004 was followed by a significant decrease of resistance in Ps. aeruginosa. Our report illustrates the major role of ciprofloxacin in the emergence of resistant Ps. aeruginosa.     

Factors predictive of elevated serum CA125 levels in patients with epithelial ovarian cancer

Our objective was to identify factors that correlate with high CA125 (cancer antigen 125) concentrations in Tunisian women with epithelial ovarian cancer and to introduce recommendations for reporting and interpreting individual CA125 assay results. We analyzed repeated serum CA125 levels, by the immunoenzymatic assay using an AxSym CA125 kit, in 90 patients who were treated for ovarian cancer from 1994 to 2006 in CHU Farhat Hached Sousse Tunisia. Using a logistic model, we found that carcinosis is significantly predictive of high levels of serum CA125 (p = 0.005). A woman's age (> or = 45 years, p = 0.016) and menopausal status (postmenopausal patient, p = 0.034) are also predictive of increased CA125 concentration. Patients with serous histological subtype have higher CA125 values (p = 0.001). Presence of ascites is associated with high serum CA125 values and thus could be considered as a predictor of high serum CA125 concentration (p = 0.023). The International Federation of Gynecology and Obstetrics stage and primary tumor size are not significant predictors of CA125 concentrations (p > 0.05). We conclude that clinically significant parameters should lead to the best interpretation of rising CA125 levels and consequently to more appropriate management of epithelial ovarian cancer patients.     

Insertional oncogenesis in 4 patients after retrovirus-mediated gene therapy of SCID-X1

Previously, several individuals with X-linked SCID (SCID-X1) were treated by gene therapy to restore the missing IL-2 receptor gamma (IL2RG) gene to CD34+ BM precursor cells using gammaretroviral vectors. While 9 of 10 patients were successfully treated, 4 of the 9 developed T cell leukemia 31-68 months after gene therapy. In 2 of these cases, blast cells contained activating vector insertions near the LIM domain-only 2 (LMO2) proto-oncogene. Here, we report data on the 2 most recent adverse events, which occurred in patients 7 and 10. In patient 10, blast cells contained an integrated vector near LMO2 and a second integrated vector near the proto-oncogene BMI1. In patient 7, blast cells contained an integrated vector near a third proto-oncogene,CCND2. Additional genetic abnormalities in the patients' blast cells included chromosomal translocations, gain-of-function mutations activating NOTCH1, and copy number changes, including deletion of tumor suppressor gene CDKN2A, 6q interstitial losses, and SIL-TAL1 rearrangement. These findings functionally specify a genetic network that controls growth in T cell progenitors. Chemotherapy led to sustained remission in 3 of the 4 cases of T cell leukemia, but failed in the fourth. Successful chemotherapy was associated with restoration of polyclonal transduced T cell populations. As a result, the treated patients continued to benefit from therapeutic gene transfer.     

Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review

Maternal and Child Health Journal - Total adverse childhood experiences (ACEs) are gaining prominence as a risk factor for preterm birth (PTB). The emerging literature examining this relationship...     

Insertion Sites in Engrafted Cells Cluster Within a Limited Repertoire of Genomic Areas After Gammaretroviral Vector Gene Therapy

Vector-associated side effects in clinical gene therapy have provided insights into the molecular mechanisms of hematopoietic regulation in vivo. Surprisingly, many retrovirus insertion sites (RIS) present in engrafted cells have been found to cluster nonrandomly in close association with specific genes. Our data demonstrate that these genes directly influence the in vivo fate of hematopoietic cell clones. Analysis of insertions thus far has been limited to individual clinical studies. Here, we studied >7,000 insertions retrieved from various studies. More than 40% of all insertions found in engrafted gene-modified cells were clustered in the same genomic areas covering only 0.36% of the genome. Gene classification analyses displayed significant overrepresentation of genes associated with hematopoietic functions and relevance for cell growth and survival in vivo. The similarity of insertion distributions indicates that vector insertions in repopulating cells cluster in predictable patterns. Thus, insertion analyses of preclinical in vitro and murine in vivo studies as well as vector insertion repertoires in clinical trials yielded concerted results and mark a small number of interesting genomic loci and genes that warrants further investigation of the biological consequences of vector insertions.