Comparison of the new-Poisoning Mortality Score and the Modified Early Warning Score for predicting in-hospital mortality in patients with acute poisoning.

INTRODUCTION: The evaluation of acute poisoning is challenging due to varied toxic substances and clinical presentations. The new-Poisoning Mortality Score was recently developed to assess patients with acute poisoning and showed good performance in predicting in-hospital mortality. The objective of this study is to externally validate the performance of the new-Poisoning Mortality Score and to compare it with the Modified Early Warning Score. METHODS: This retrospective analysis used data from the 2019-2020 Injury Surveillance Cohort, established by the Korea Center for Disease Control and Prevention, to perform external validation of the new-Poisoning Mortality Score. The statistical performances of the new-Poisoning Mortality and Modified Early Warning Scores were assessed and compared in terms of discrimination and calibration. Discrimination analysis involved metrics such as sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve. For calibration analysis, the Hosmer-Lemeshow goodness-of-fit test was utilized and calibration curves for each score were generated to elucidate the relationship between observed and predicted mortalities. RESULTS: This study analysed 16,570 patients with acute poisoning. Significant differences were observed between survivors and those who died in-hospital, including age, sex, and vital signs. The new-Poisoning Mortality Score showed better performance over the Modified Early Warning Score in predicting in-hospital mortality, in terms of the area under the receiver operating characteristic curve (0.947 versus 0.800), sensitivity (0.863 versus 0.667), specificity (0.912 versus 0.817), and accuracy (0.911 versus 0.814). When evaluated through calibration curves, the new-Poisoning Mortality Score showed better concordance between predicted and observed mortalities. In subgroup analyses, the score system consistently showed strong performance, excelling particularly in substances with high mortality indices and remaining superior in all substances as a group. CONCLUSIONS: Our study has helped to validate the new-Poisoning Mortality Score as an effective tool for predicting in-hospital mortality in patients with acute poisoning in the emergency department. The score system demonstrated superior performance over the Modified Early Warning Score in various metrics. Our findings suggest that the new-Poisoning Mortality Score can contribute to the enhancement of clinical decision-making and patient management.

Machine Learning-Based Models for Prediction of Critical Illness at Community, Paramedic, and Hospital Stages.

Overcrowding of emergency department (ED) has put a strain on national healthcare systems and adversely affected the clinical outcomes of critically ill patients. Early identification of critically ill patients prior to ED visits can help induce optimal patient flow and allocate medical resources effectively. This study aims to develop ML-based models for predicting critical illness in the community, paramedic, and hospital stages using Korean National Emergency Department Information System (NEDIS) data. Random forest and light gradient boosting machine (LightGBM) were applied to develop predictive models. The predictive model performance based on AUROC in community stage, paramedic stage, and hospital stage was estimated to be 0.870 (95% CI: 0.869-0.871), 0.897 (95% CI: 0.896-0.898), and 0.950 (95% CI: 0.949-0.950) in random forest and 0.877 (95% CI: 0.876-0.878), 0.899 (95% CI: 0.898-0.900), and 0.950 (95% CI: 0.950-0.951) in LightGBM, respectively. The ML models showed high performance in predicting critical illness using variables available at each stage, which can be helpful in guiding patients to appropriate hospitals according to their severity of illness. Furthermore, a simulation model can be developed for proper allocation of limited medical resources.

Analysis of energy intakes, physical activities and metabolic syndrome according to the income level in Korean elderly people: Korean National Health and Nutrition Examination Survey 2016‒2018.

PURPOSE: To determine the correlations of differences in the income level with the presence of metabolic syndrome (MetS), energy intake, and physical activity across Korean elderly populations. METHODS: We obtained data from 2,139 elderly individuals (aged >65 years) based on the Korea National Health and Nutrition Examination Survey (KNHANES) (2016‒2018). We analyzed the levels of physical activity (PA) and energy intake using the survey data. Moreover, we analyzed the differences in energy intake and PA levels according to the income level and MetS. RESULTS: Compared with the non-MetS group, the MetS group displayed significantly higher levels of waist circumference (p=0.000), triglycerides (p=0.000), systolic blood pressure (p=0.000), diastolic blood pressure (p=0.016), and fasting blood glucose (p=0.000) for both high and low income levels. However, the level of high-density lipoprotein cholesterol was significantly lower in the MetS group than that in the non-MetS group (p=0.000). The level of smoking in non-MetS men was significantly higher than that in MetS men across all participants (p=0.047). Except carbohydrate intake, the total energy intake (p=0.022), fat intake (p=0.009), and protein intake (p=0.005) were significantly lower in the MetS group than those in the non-MetS group for high income levels. We obtained similar results for low income levels. The two-way analysis of variance (ANOVA) did not identify an interaction between the income level and the presence of MetS; however, the total energy, i.e., the level of total energy intake, was significantly lower in participants with low income levels than in those with high income levels. For high income levels, transport PA (p=0.002), vigorous recreational PA (p=0.001), moderate recreational PA (p=0.001), and total PA (p=0.000) were significantly lower in the MetS group than those in the non-MetS group. For low income levels, moderate occupational PA (p=0.012), transport PA (p=0.018), and total PA ((p=0.000) were significantly lower in the MetS group than those in the non-MetS group. The total PA, i.e., the level of energy consumption, was significantly lower in the elderly with low income levels than in those with high income levels. CONCLUSION: Regardless of the income level, the elderly with MetS exhibited low levels of energy intake and PA, compared with those without MetS. In addition, regardless of the presence of MetS, the elderly with low income levels exhibited lesser energy intake and PA. These findings implied the need for balanced nutrient intake and increased participation in PA as well as education and program development to prevent MetS in the elderly.

Novel pure α-, ß-, and mixed-phase α/ß-Bi2O3 photocatalysts for enhanced organic dye degradation under both visible light and solar irradiation.

Combining the pure α- and ß-phases of bismuth oxide enhances its photocatalytic activity under both visible and solar irradiation. α-Bi2O3, ß-Bi2O3, and α/ß-Bi2O3 were synthesized by a solvothermal calcination method. The structural, optical, and morphological properties of the as-synthesized catalysts were analyzed using XRD, UV-DRS, XPS, SEM, TEM, and PL. The bandgaps of α/ß-Bi2O3, α-Bi2O3, and ß-Bi2O3 were calculated to be 2.59, 2.73, and 2.34 eV, respectively. The photocatalytic activities of the catalysts under visible and solar irradiation were examined by the degradation of carcinogenic reactive blue 198 and reactive black 5 dyes. The kinetic plots of the degradation reactions followed pseudo-first-order kinetics. α/ß-Bi2O3 exhibited higher photocatalytic activity (∼99%) than α-Bi2O3 and ß-Bi2O3 under visible and solar irradiation. The TOC and COD results confirmed the maximum degradation ability of α/ß-Bi2O3, and the decolorization percentage remained above 90%, even after five cycles under visible irradiation. The photocatalytic dye degradation mechanism employed by α/ß-Bi2O3 was proposed based on active species trapping experiments.

Analysis of Characteristics and Mortality in Cardiac Arrest Patients by Hospital Level: a Nationwide Population-based Study.

BACKGROUND: Survival and post-cardiac arrest care vary considerably by hospital, region, and country. In the current study, we aimed to analyze mortality in patients who underwent cardiac arrest by hospital level, and to reveal differences in patient characteristics and hospital factors, including post-cardiac arrest care, hospital costs, and adherence to changes in resuscitation guidelines. METHODS: We enrolled adult patients (≥ 20 years) who suffered non-traumatic cardiac arrest from 2006 to 2015. Patient demographics, insurance type, admission route, comorbidities, treatments, and hospital costs were extracted from the National Health Insurance Service database. We categorized patients into tertiary hospital, general hospital, and hospital groups according to the level of the hospital where they were treated. We analyzed the patients' characteristics, hospital factors, and mortalities among the three groups. We also analyzed post-cardiac arrest care before and after the 2010 guideline changes. The primary end-point was 30 days and 1 year mortality rates. RESULTS: The tertiary hospital, general hospital, and hospital groups represented 32.6%, 49.6%, and 17.8% of 337,042 patients, respectively. The tertiary and general hospital groups were younger, had a lower proportion of medical aid coverage, and fewer comorbidities, compared to the hospital group. Post-cardiac arrest care, such as percutaneous coronary intervention, targeted temperature management, and extracorporeal membrane oxygenation, were provided more frequently in the tertiary and general hospital groups. After adjusting for age, sex, insurance type, urbanization level, admission route, comorbidities, defibrillation, resuscitation medications, angiography, and guideline changes, the tertiary and general hospital groups showed lower 1-year mortality (tertiary hospital vs. general hospital vs. hospital, adjusted odds ratios, 0.538 vs. 0.604 vs. 1; P < 0.001). After 2010 guideline changes, a marked decline in atropine use and an increase in post-cardiac arrest care were observed in the tertiary and general hospital groups. CONCLUSION: The tertiary and general hospital groups showed lower 30 days and 1 year mortality rates than the hospital group, after adjusting for patient characteristics and hospital factors. Higher-level hospitals provided more post-cardiac arrest care, which led to high hospital costs, and showed good adherence to the guideline change after 2010.

Reducing temperature dependence of the output energy of a quasi-continuous wave diode-pumped Nd:YAG laser.

It is demonstrated by numerical modeling that spectrally dispersed compound pumping diodes and low-loss pumping chamber reduced the temperature dependence of the output energy of quasi-continuous wave diode-pumped Nd:YAG lasers considerably. Several compound diodes with different spectral profiles were tested for pumping. The laser energy was calculated as a function of diode temperature from -30°C to 60°C. When a compound diode with a flat-top spectrum was used for pumping, the mean laser energy was 83% of the maximum energy of a Nd:YAG laser pumped by a diode with a narrow bandwidth. In addition, a compound diode with three emission lines was tested for pumping. When the wavelength gap between the adjacent emission lines of the pumping diode was in the range of 3-10 nm, the mean energy of the Nd:YAG laser became similar to that of a Nd:YAG laser pumped by a diode with a flat-top spectrum.

Phytoremediation of atrazine by poplar trees: toxicity, uptake, and transformation.

Toxicity, uptake, and transformation of atrazine [2-chloro-4-(ethylamino)-6-(isopropylamino)-s-triazine] by three species of poplar tree were assessed. Poplar cuttings were grown in sealed flasks with hydrophonic solutions and exposed to various concentrations of atrazine for a period of two weeks. Toxicity effects were evaluated by monitoring transpiration and measuring poplar cutting mass. Exposure to higher atrazine concentrations resulted in decrease of biomass and transpiration accompanied by leaf chlorosis and abscission. However, poplar cuttings exposed to lower concentrations of atrazine grew well and transpired at a constant rate during experiment periods. Poplar cuttings could take up, hydrolyze, and dealkylate atrazine to less toxic metabolites. Metabolism of atrazine occurred in roots, stems, and leaves and became more complete with increased residence time in tissue. These results suggest that phytoremediation is a viable approach to removing atrazine from contaminated water and should be considered for other contaminants.