Discrete Optimization for Interpretable Study Populations and Randomization Inference in an Observational Study of Severe Sepsis Mortality

Motivated by an observational study of the effect of hospital ward versus intensive care unit admission on severe sepsis mortality, we develop methods to address two common problems in observational studies: (1) when there is a lack of covariate overlap between the treated and control groups, how to define an interpretable study population wherein inference can be conducted without extrapolating with respect to important variables; and (2) how to use randomization inference to form confidence intervals for the average treatment effect with binary outcomes. Our solution to problem (1) incorporates existing suggestions in the literature while yielding a study population that is easily understood in terms of the covariates themselves, and can be solved using an efficient branch-and-bound algorithm. We address problem (2) by solving a linear integer program to utilize the worst case variance of the average treatment effect among values for unobserved potential outcomes that are compatible with the null hypothesis. Our analysis finds no evidence for a difference between the sixty day mortality rates if all individuals were admitted to the ICU and if all patients were admitted to the hospital ward among less severely ill patients and among patients with cryptic septic shock. We implement our methodology in R, providing scripts in the supplementary material

"It\u27s not about the grades!". On shadow education in Denmark and how parents wish to help their children get ahead

This article is about shadow education in Denmark. Based on qualitative interview data with families that purchase private supplementary tutoring, we analyse how this tutoring is related to child-rearing strategies in the families. With theoretical inspiration from Annette Lareau, we analyse the parents’ involvement in their children’s education as aspects of concerted cultivation. With the concept parentocracy, we shed light on the role parents’ wealth and wishes play in their children’s educational life. Finally, we look to contemporary educational youth research and the concept performance culture, to address implications such as stress, pressure, competitiveness, and a strong focus on grades among students in Danish upper secondary education. (DIPF/Orig.

Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis.

OBJECTIVES: A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure temporal trends in sepsis survivorship and hospital-based acute care use in sepsis survivors. In addition, because readmissions after pneumonia are subject to penalty under the national readmission reduction program, we examined whether readmission rates declined after sepsis hospitalizations related to pneumonia. DESIGN AND SETTING: Retrospective, observational cohort study conducted within an academic healthcare system from 2010 to 2015. PATIENTS: We used three validated, claims-based approaches to identify 17,256 sepsis or severe sepsis hospitalizations to examine trends in hospital-based acute care after sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of medical and surgical discharges at-risk for hospital readmission after sepsis increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined modestly, from 26.4% in 2010 to 23.1% in 2015, driven largely by a decline in readmission rates among survivors of nonsevere sepsis, and nonpneumonia sepsis specifically, as the readmission rate of severe sepsis survivors was stable. The modest decline in 30-day readmission rates was offset by an increase in emergency department treat-and-release visits, from 2.8% in 2010 to a peak of 5.4% in 2014. CONCLUSIONS: Owing to increasing incidence and declining mortality, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. The 30-day hospital readmission rates for sepsis declined modestly but were offset by a rise in emergency department treat-and-release visits

Conducting Research with young people and developing the MTW Approach - a methodology that grasps young people’s perspectives

Peer reviewedPublisher PD

Targeting integrins in malignant glioma

The integrin family of cell adhesion receptors is emerging as a promising target of anticancer therapy. AlphaVbeta3 and alphaVbeta5 integrins are overexpressed on both glioma cells and tumor vasculature. Cilengitide, the most advanced specific integrin inhibitor in oncology, has shown antitumor activity against glioma in early clinical trials. Durable remissions have been observed in phase I and phase II trials for recurrent glioblastoma (GBM) with both lower and higher doses of cilengitide. Pilot trials in newly diagnosed glioblastoma in conjunction with standard chemoradiotherapy have been encouraging. Preclinical data suggest synergy with concomitant chemo- and radiation therapy. A pivotal phase III study (CENTRIC) in newly diagnosed GBM patients is currently recruiting. This paper summarizes the current understanding of the role of integrins and their inhibition in gliomagenesis. The background and design of ongoing trials are outline

Implementing an Insect Brain Computational Circuit Using III–V Nanowire Components in a Single Shared Waveguide Optical Network

Recent developments in photonics include efficient nanoscale optoelectronic components and novel methods for sub-wavelength light manipulation. Here, we explore the potential offered by such devices as a substrate for neuromorphic computing. We propose an artificial neural network in which the weighted connectivity between nodes is achieved by emitting and receiving overlapping light signals inside a shared quasi 2D waveguide. This decreases the circuit footprint by at least an order of magnitude compared to existing optical solutions. The reception, evaluation and emission of the optical signals are performed by a neuron-like node constructed from known, highly efficient III-V nanowire optoelectronics. This minimizes power consumption of the network. To demonstrate the concept, we build a computational model based on an anatomically correct, functioning model of the central-complex navigation circuit of the insect brain. We simulate in detail the optical and electronic parts required to reproduce the connectivity of the central part of this network, using experimentally derived parameters. The results are used as input in the full model and we demonstrate that the functionality is preserved. Our approach points to a general method for drastically reducing the footprint and improving power efficiency of optoelectronic neural networks, leveraging the superior speed and energy efficiency of light as a carrier of information.Comment: 28 pages, 6 figures; supplementary information 15 pages, 8 figure