Machine Learning Algorithm Predicts Mortality Risk in Intensive Care Unit for Patients with Traumatic Brain Injury.

BACKGROUND: Numerous mortality prediction tools are currently available to assist patients with moderate to severe traumatic brain injury (TBI). However, an algorithm that utilizes various machine learning methods and employs diverse combinations of features to identify the most suitable predicting outcomes of brain injury patients in the intensive care unit (ICU) has not yet been well-established. METHOD: Between January 2016 and December 2021, we retrospectively collected data from the electronic medical records of Chi Mei Medical Center, comprising 2260 TBI patients admitted to the ICU. A total of 42 features were incorporated into the analysis using four different machine learning models, which were then segmented into various feature combinations. The predictive performance was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and validated using the Delong test. RESULT: The AUC for each model under different feature combinations ranged from 0.877 (logistic regression with 14 features) to 0.921 (random forest with 22 features). The Delong test indicated that the predictive performance of the machine learning models is better than that of traditional tools such as APACHE II and SOFA scores. CONCLUSION: Our machine learning training demonstrated that the predictive accuracy of the LightGBM is better than that of APACHE II and SOFA scores. These features are readily available on the first day of patient admission to the ICU. By integrating this model into the clinical platform, we can offer clinicians an immediate prognosis for the patient, thereby establishing a bridge for educating and communicating with family members.

Validation of Agitated Patient Remote Monitoring Alarm System in the Intensive Care Unit.

The purpose of this research is to innovate and develop a vision-based remote monitoring alarm system for agitated patients to provide intensive care unit (ICU) nurses with action warnings for agitated patients during their busy work. After the system is completed, preliminary laboratory verification is carried out, and the results are 94.87% in sensitivity, 97.44% in specificity, and 96.15% in accuracy, which enhances the confidence of the follow-up system in clinical testing.

Diversity of nasal microbiota and its interaction with surface microbiota among residents in healthcare institutes.

Nasal microbial communities may have crucial implications for human health, including for residents of healthcare institutes (HCIs). Factors that determine the diversity of nasal microbiota in HCIs remain unclear. Herein, we used 16S rRNA amplicon sequencing to investigate the relationship between nasal and surface microbiota in three HCIs. Participants were classified into a hospitalised or nonhospitalised group based on their most recent date of hospitalisation. A total of 88 nasal samples and 83 surface samples were analysed. Dysgonomonas and Corynebacterium were the most abundant taxa in the surface and nasal samples, respectively. Significant differences were discovered in microbiota diversity among HCIs when comparing the surface and nasal samples. Fifteen taxa were identified as present in all the surface and nasal samples. SourceTracker analysis revealed that the ventilation conditions of environment might be associated with the proportion of shared microbial communities between nasal and surface. Additionally, as compared with the nonhospitalised group, the hospitalised group had a higher proportion of surface microbiota in their nasal samples, which might lead to a higher risk of human-related microorganisms or pathogens colonising the nasal cavity. The data suggest that nasal bacterial diversity could be influenced by both health status and living environment. Our results therefore highlight the importance of the indoor environment for HCI residents.

Profiling the fecal carriage of ß-lactamase genes in long-term care facility residents: A longitudinal study.

BACKGROUND: The fecal carriage of ß-lactamase (BL)-producing bacteria may play a major role in the spread of these organisms in long-term care facilities (LTCFs). The aims of this study were (1) to describe the gene profiles of fecal BL in 3 LCTFs in Taiwan and (2) to analyze the fecal carriage burden of BL genes between the residents (patient group) and staff (staff group) of LTCFs. METHODS: Thirty fecal samples were collected during June 2013 and July 2015: 20 were obtained from 10 residents both during hospitalization (T1) and 1 month after discharge (T2), and 10 were obtained from 10 staff members. RESULTS: In total, 80%, 70%, and 50% of the samples in the patient group at T1, staff group at T2, and patient group at T2, respectively, contained >2 BL genes. In the patient group, the predominant genes belonged to extended-spectrum BL genes (90%-100%) and AmpC BL genes (90%-100%). Furthermore, carbapenemase genes were approximately 20% during T1 and T2. The relative levels of SHV-type BLs were significantly higher (P < .05) in the patient group at T2 compared with the staff group. CONCLUSIONS: In this study, we found a high carriage of fecal BLs among LTCF residents and staff. The monitoring of fecal BL carriage in LTCFs is needed for infection control measures and antibiotic choice for health care-associated infections.

Human infection with avian influenza A H6N1 virus: an epidemiological analysis.

BACKGROUND: Avian influenza A H6N1 virus is one of the most common viruses isolated from wild and domestic avian species, but human infection with this virus has not been previously reported. We report the clinical presentation, contact, and environmental investigations of a patient infected with this virus, and assess the origin and genetic characteristics of the isolated virus. METHODS: A 20-year-old woman with an influenza-like illness presented to a hospital with shortness of breath in May, 2013. An unsubtyped influenza A virus was isolated from her throat-swab specimen and was transferred to the Taiwan Centres for Disease Control (CDC) for identification. The medical records were reviewed to assess the clinical presentation. We did a contact and environmental investigation and collected clinical specimens from the case and symptomatic contacts to test for influenza virus. The genomic sequences of the isolated virus were determined and characterised. FINDINGS: The unsubtyped influenza A virus was identified as the H6N1 subtype, based on sequences of the genes encoding haemagglutinin and neuraminidase. The source of infection was not established. Sequence analyses showed that this human isolate was highly homologous to chicken H6N1 viruses in Taiwan and had been generated through interclade reassortment. Notably, the virus had a G228S substitution in the haemagglutinin protein that might increase its affinity for the human α2-6 linked sialic acid receptor. INTERPRETATION: This is the first report of human infection with a wild avian influenza A H6N1 virus. A unique clade of H6N1 viruses with a G228S substitution of haemagglutinin have circulated persistently in poultry in Taiwan. These viruses continue to evolve and accumulate changes, increasing the potential risk of human-to-human transmission. Our report highlights the continuous need for preparedness for a pandemic of unpredictable and complex avian influenza. FUNDING: Taiwan Centres for Disease Control.

The relationship between energy status and AMP-activated protein kinase in human H460 lung cancer cells.

In cultured cells, glucose and serum provide constant sources of energy and growth factors, both of which are important for cell survival and proliferation. AMP-activated protein kinase (AMPK) plays a key role in sensing intracellular ATP levels and acts as a critical regulator of energy homeostasis. To investigate the relationship between energy status and AMPK activity in lung cancer, H460 cells were starved in either glucose-free or serum-free medium and then re-stimulated with glucose and serum, respectively. The levels of ATP and lactate and the activities of AMPK and lactate dehydrogenase (LDH) were analyzed at different time intervals. During glucose treatment, the activity of AMPK was induced by glucose and showed biphasic reaction kinetics. The ATP level was gradually increased up to 2-fold compared with that in serum treatment after 24 h and lactate level was decreased to approximately 60%. The LDH activity slightly increased and reached a peak after 6 h. During serum treatment, the activity of AMPK was suppressed and the ATP level showed a dramatic 30% increase after 1 h. In contrast, the lactate level was gradually increased and then reverted to the background level after 24 h. The activity of LDH was slightly decreased after 12 h and eventually returned to the background level. This study showed the alteration of energy status in lung cancer cells in response to altered levels of glucose and serum. We suggest that the activation of AMPK and inhibition of glycolysis might be exploited as therapeutic tactics in cancer treatment.

Overcoming patient-related barriers to cancer pain management for home care patients. A pilot study.

The purpose of this pilot study was to explore the effectiveness of a pain education program to overcome patient-related barriers in managing cancer pain for Taiwanese home care patients with cancer. The pain education program was developed based on previous studies of Taiwanese patient-related barriers to cancer pain management. The Barriers Questionnaire-Taiwan form, the Brief Pain Inventory, the Medication Adherence Questionnaire, and a demographic questionnaire were used for data collection. The sample consisted of 18 patients in the experimental group and 19 patients in the control group. Descriptive statistics, tests, and paired tests were used to analyze the data. Results of this study revealed that patients who received the pain educational program had significantly greater reduction in Barriers Questionnaire-Taiwan form scores and more improvement in medication adherence compared with patients who did not participate in the program. When compared to pretest scores, patients scores after receiving the pain education intervention showed significant improvement on the Barriers Questionnaire-Taiwan form, medication adherence, pain intensity, and pain interference. The results of this study support the effectiveness of the pain education program on overcoming the barriers to cancer pain management for Taiwanese home care patients with cancer.