Real-time classification of causes death using Artificial Intelligence – sensitivity analysis

Background

Last year Europe registered >365 000 excess deaths, most from preventable causes. In order to timely track deaths, the Portuguese Directorate-General of Health developed a deep neural network that codifies ICD-10 causes of death (AUTOCOD) by analyzing free text in a death certificate (DC). While the performance of AUTOCOD has been demonstrated, it was not clear if it was sustained during excess mortality periods, when text quality could be lower due to the increased pressure on health services.

Methods

We performed a sensitivity analysis comparing the ICD-10 classifications of 330 098 Portuguese DC by AUTOCOD and by human-coders, from 2016 to 2019. Excess mortality was defined using the EuroMOMO methodology and a sub-analysis in periods of extreme excess (+4 and +6 SD). We compared the periods without excess mortality with the periods of excess and extreme mortality by chapter. The same analysis was performed for ICD-10 blocks, for the three most common chapters (neoplasms; diseases circulatory and respiratory system). The confusion matrixes allowed us to calculate AUTOCOD's performance metrics, like sensitivity.

Results

AUTOCOD showed high sensitivity (≥0.75) in 10 chapters, with values above 0.90 for the three most common ones. The weighted-average of sensitivity showed no difference between periods without excess mortality and periods of excess mortality, a difference of 0.01 for periods of extreme mortality (+4 SD) and a difference of 0.04 for periods of extreme mortality (+6 SD). For the block classification, performance was similar.

Conclusions

Even in periods of excess and extreme mortality, AUTOCOD accurately predicts the classification of the cause of death. Meaning that it is not affected by a potential loss in text-quality due to pressure in health services. This allows for the use of AUTOCOD for real time mortality surveillance and it highlights the importance of Artificial Intelligence as an advisory tool for Public Health policies in emergencies.

Key messages

• Artificial Intelligence algorithms like AUTOCOD can predict the ICD-10 cause of death with very high sensitivity, during periods with and without excess mortality.

• Artificial Intelligence algorithms like AUTOCOD can be used for real-time cause specific mortality surveillance, providing valuable information for policy making during periods of excess mortality.

Electrical conductance: a controversial parameter in the evaluation of emollients in atopic dermatitis

BACKGROUND/AIMS

Essential fatty acids are important in maintaining skin function and their deficiency is associated with scali-ness and increased transepidermal water loss (TEWL). This can be one of the pathogenic processes implicated in atopic dermatitis (AD). Several studies have assessed the value of essential fatty acid-enriched diets in AD but the benefits of topical γ-lino-lenic acid (GLA) therapy have been less well evaluated. The aims of this study were: a) to compare the effects of GLA-con-taining emollients and classical emollients, regarding clinical benefits, cutaneous hydration (by a conductance method) and TEWL; b) to assess the clinical relevance of these two biomet-rical methods (conductance and TEWL).

METHODS

Twenty-three AD children were randomised into four groups, to compare three emollients containing GLA in different concentrations and one classical emollient. They were evaluated in eight visits for 12 weeks, using a clinical score and measurements of TEWL with the Tewameter™ and of cutaneous hydration with the Nova™.

RESULTS

Kruskal-Wallis statistical analysis showed significant differences in cutaneous hydration (P<0.05) between each of the three treatment groups and the control group. TEWL and clinical scores did not show statistically significant differences. During the study no children from the GLA groups developed eczematous lesions versus two children from the non-GLA group.

CONCLUSIONS

Discrepancies between conductance and TEWL measurements may represent false positive results of the former method due to electrical phenomena related to polarity of the GLA molecule or of other elements in the formulations. However, some differences in clinical evolution between the GLA and non-GLA groups require further studies to assess the possible additional benefits of topical emollients containing GLA.

Effects of Pamidronate on Dental Enamel Formation Assessed by Light Microscopy, Energy-Dispersive X-Ray Analysis, Scanning Electron Microscopy, and Microhardness Testing

The aim of the present work was to investigate birefringence and morphology of the secretory-stage enamel organic extracellular matrix (EOECM), and structural and mechanical properties of mature enamel of upper incisors from adult rats that had been treated with pamidronate disodium (0.5 mg/kg/week for 56 days), using transmitted polarizing and bright-field light microscopies (TPLM and BFLM), energy-dispersive X-ray (EDX) analysis, scanning electron microscopy (SEM) and microhardness testing. BFLM showed no morphological changes of the EOECM in pamidronate and control groups, but TPLM revealed a statistically significant reduction in optical retardation values of birefringence brightness of pamidronate-treated rats when compared with control animals (p0.05). The present study indicates that pamidronate can affect birefringence of the secretory-stage EOECM, which does not seem to be associated with significant changes in morphological and/or mechanical properties of mature enamel.

On the nature of consonant/vowel differences in letter position coding: Evidence from developing and adult readers

In skilled adult readers, transposed-letter effects (jugde-JUDGE) are greater for consonant than for vowel transpositions. These differences are often attributed to phonological rather than orthographic processing. To examine this issue, we employed a scenario in which phonological involvement varies as a function of reading experience: A masked priming lexical decision task with 50-ms primes in adult and developing readers. Indeed, masked phonological priming at this prime duration has been consistently reported in adults, but not in developing readers (Davis, Castles, & Iakovidis, 1998). Thus, if consonant/vowel asymmetries in letter position coding with adults are due to phonological influences, transposed-letter priming should occur for both consonant and vowel transpositions in developing readers. Results with adults (Experiment 1) replicated the usual consonant/vowel asymmetry in transposed-letter priming. In contrast, no signs of an asymmetry were found with developing readers (Experiments 2-3). However, Experiments 1-3 did not directly test the existence of phonological involvement. To study this question, Experiment 4 manipulated the phonological prime-target relationship in developing readers. As expected, we found no signs of masked phonological priming. Thus, the present data favour an interpretation of the consonant/vowel dissociation in letter position coding as due to phonological rather than orthographic processing.

Clinico-biochemical characteristics of 229 Portuguese infertile women with polycystic ovary syndrome: clinical relevance and relationship with fertility treatment results

PURPOSE

Polycystic ovary syndrome (PCOS) affects 6-20% of reproductive-age women. The authors aimed to evaluate the characteristics of PCOS women and its relationship with fertility treatment outcomes.

MATERIALS AND METHODS

The authors reviewed records of PCOS women assisted at Hospital Santa Maria. Fertility treatment results were assessed as pregnancy rate, number of cycles, and miscarriage rate.

RESULTS

They identified 229 PCOS women, 179 (78.2%) had waist circumference > 80 cm, 72 (31.4%) had type 2 diabetes mellitus (T2DM) familial history and glucose abnormalities, hypertriglyceridemia and low cholesterol-HDL were detected in 23(10.1%), 15 (6.6%) and 103 (45.0%), respectively. Pregnancy was achieved in 164 women. The mean number of cycles to achieve pregnancy was 2.7 (±2.2). Statistical analysis identified factors associated with longer/higher number of treatments: primary infertility, T2DM familial history, hypertriglyceridemia, and low cholesterol-HDL. Waist circumference > 80 cm, older age, and increased LH level were associated with miscarriage.

CONCLUSIONS

Primary infertility, T2DM familial history, hypertriglyceridemia, low cholesterol-HDL, older age, waist circumference > 80 cm, and high LH may confer poorer fertility treatment results.

Facilitative effect of cognate words vanishes when reducing the orthographic overlap: The role of stimuli list composition

Recent research has shown that cognate word processing is modulated by variables such as degree of orthographic and phonological overlap of cognate words and task requirements in such a way that the typical preferential processing observed in the literature for cognate words relative to non-cognate words can be annulled or even reversed (Comesaña et al., 2012; Dijkstra, Miwa, Brummelhuis, Sappelli, & Baayen, 2010). These findings beg the question about the precise representation and processing of identical cognates (e.g., plata-plata, silver in Spanish and Catalan, respectively) and non-identical cognates (e.g., braç-brazo [arm]). The aim of the present study was to further explore this issue by manipulating for the 1st time cross-linguistic similarities of identical and non-identical cognate words as well as stimuli list composition. Proficient balanced Catalan-Spanish bilinguals performed a lexical decision task in Spanish. In Experiment 1 identical and non-identical cognates along with non-cognates made up the experimental list, whereas in Experiment 2 identical cognates were excluded from the list. Results showed modulations in cognate processing as a function of their degree of orthographic and phonological overlap. These results confirm prior findings regarding the processing of cognates when cross-linguistic similarities are taken into account. Most important, the direction of the cognate effect was affected by the stimuli list composition (i.e., the preferential processing for cognate words was restricted to the list containing identical cognates). Results have important implications for the Bilingual Interactive Activation Plus model (BIA+; Dijkstra & van Heuven, 2002), especially regarding identical and non-identical cognate word representation.

On the role of the upper part of words in lexical access: evidence with masked priming

More than 100 years ago, Huey (1908/1968) indicated that the upper part of words was more relevant for perception than the lower part. Here we examined whether mutilated words, in their upper/lower portions (e.g., ), can automatically access their word units in the mental lexicon. To that end, we conducted four masked repetition priming experiments with the lexical decision task. Results showed that mutilated primes produced a sizeable masked repetition priming effect. Furthermore, the magnitude of the masked repetition priming effect was greater when the upper part of the primes was preserved than when the lower portion was preserved-this was the case not only when the mutilated words were presented in lower case but also when the mutilated words were presented in upper case. Taken together, these findings suggest that the front-end of computational models of visual-word recognition should be modified to provide a more realistic account at the level of letter features.

Characterizing partial AZFc deletions of the Y chromosome with amplicon-specific sequence markers

BACKGROUND

The AZFc region of the human Y chromosome is a highly recombinogenic locus containing multi-copy male fertility genes located in repeated DNA blocks (amplicons). These AZFc gene families exhibit slight sequence variations between copies which are considered to have functional relevance. Yet, partial AZFc deletions yield phenotypes ranging from normospermia to azoospermia, thwarting definite conclusions on their real impact on fertility.

RESULTS

The amplicon content of partial AZFc deletion products was characterized with novel amplicon-specific sequence markers. Data indicate that partial AZFc deletions are a male infertility risk [odds ratio: 5.6 (95% CI: 1.6-30.1)] and although high diversity of partial deletion products and sequence conversion profiles were recorded, the AZFc marker profiles detected in fertile men were also observed in infertile men. Additionally, the assessment of rearrangement recurrence by Y-lineage analysis indicated that while partial AZFc deletions occurred in highly diverse samples, haplotype diversity was minimal in fertile men sharing identical marker profiles.

CONCLUSION

Although partial AZFc deletion products are highly heterogeneous in terms of amplicon content, this plasticity is not sufficient to account for the observed phenotypical variance. The lack of causative association between the deletion of specific gene copies and infertility suggests that AZFc gene content might be part of a multifactorial network, with Y-lineage evolution emerging as a possible phenotype modulator.

Laugier-Hunziker syndrome: case report and treatment with the Q-switched Nd-Yag laser

We report the case of a 46-year-old Caucasian female presenting with mucocutaneous pigmentation on the lips, oral mucosa, hands, feet and nails, as well as on a psoriatic plaque. She was successfully treated with Q-switched Nd-Yag laser, with double frequency, for both the mucosal and cutaneous lesions.