Predictability Bounds of Electronic Health Records

The ability to intervene in disease progression given a person’s disease history has the potential to solve one of society’s most pressing issues: advancing health care delivery and reducing its cost. Controlling disease progression is inherently associated with the ability to predict possible future diseases given a patient’s medical history. We invoke an information-theoretic methodology to quantify the level of predictability inherent in disease histories of a large electronic health records dataset with over half a million patients. In our analysis, we progress from zeroth order through temporal informed statistics, both from an individual patient’s standpoint and also considering the collective effects. Our findings confirm our intuition that knowledge of common disease progressions results in higher predictability bounds than treating disease histories independently. We complement this result by showing the point at which the temporal dependence structure vanishes with increasing orders of the time-correlated statistic. Surprisingly, we also show that shuffling individual disease histories only marginally degrades the predictability bounds. This apparent contradiction with respect to the importance of time-ordered information is indicative of the complexities involved in capturing the health-care process and the difficulties associated with utilising this information in universal prediction algorithms.General Electric CompanyAT&T FoundationNational Science Foundation (U.S.)American Society for Engineering Education. National Defense Science and Engineering Graduate FellowshipAudi Volkswage

Early Elevation of Matrix Metalloproteinase-8 and -9 in Pediatric ARDS Is Associated with an Increased Risk of Prolonged Mechanical Ventilation

BACKGROUND: Matrix metalloproteinases (MMP) -8 and -9 may play key roles in the modulation of neutrophilic lung inflammation seen in pediatric Acute Respiratory Distress Syndrome (ARDS). We aimed to perform a comprehensive analysis of MMP-8 and MMP-9 activity in tracheal aspirates of pediatric ARDS patients compared with non-ARDS controls, testing whether increased MMP-8 and -9 activities were associated with clinical outcomes. METHODS: Tracheal aspirates were collected from 33 pediatric ARDS patients and 21 non-ARDS controls at 48 hours of intubation, and serially for those who remained intubated greater than five days. MMPs, tissue inhibitor of metalloproteinases (TIMPs), human neutrophil elastase (HNE) and myeloperoxidase (MPO) activity were measured by ELISA, and correlated with clinical indicators of disease severity such as PRISM (Pediatric Risk of Mortality) scores, oxygen index (OI), multi-organ system failure (MOSF) and clinical outcome measures including length of intubation, ventilator-free days (VFDs) and mortality in the Pediatric Intensive Care Unit (PICU). RESULTS: Active MMP-9 was elevated early in pediatric ARDS subjects compared to non-ARDS controls. Higher MMP-8 and active MMP-9 levels at 48 hours correlated with a longer course of mechanical ventilation (r = 0.41, p = 0.018 and r = 0.75, p<0.001; respectively) and fewer number of VFDs (r = -0.43, p = 0.013 and r = -0.76, p<0.001; respectively), independent of age, gender and severity of illness. Patients with the highest number of ventilator days had the highest levels of active MMP-9. MMP-9 and to a lesser extent MMP-8 activities in tracheal aspirates from ARDS subjects were sensitive to blockade by small molecule inhibitors. CONCLUSIONS: Higher MMP-8 and active MMP-9 levels at 48 hours of disease onset are associated with a longer duration of mechanical ventilation and fewer ventilator-free days among pediatric patients with ARDS. Together, these results identify early biomarkers predictive of disease course and potential therapeutic targets for this life threatening disease

Impact of the first COVID lockdown on accident- and injury-related pediatric intensive care admissions in Germany - a multicenter study

Children’s and adolescents’ lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017–2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85–1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93–1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57–1.02 and 0.26 (0.05–0.75)), whereas household and leisure accidents increased (1.33 (1.06–1.66) and 1.34 (1.06–1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38–1.16) and 2.09 (1.19–3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42–1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51–3.02)), but decreased in adolescent girls (0.56 (0.32–0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

Digital Rights Enforcement for Pervasive Computing Applications

Increasingly, application software is expanding from the desktop into mobile application environments, such as handset devices and embedded systems which are more limited in resources and volatile in their network connectivity. An integrated architecture that can protect intellectual property for both types of environments should offer the promise of reduced software maintenance costs. Software licensing is an existing mechanism by which specific license agreements are enforced between a software provider and the users of the software. Usually, the license terms are activated by a unique activation code delivered to the user. Digital Rights Management (DRM) is a more recent development that covers the description, identification, trading, protection, monitoring, and tracking of all forms of rights usage over both tangible and intangible assets. This includes the management of Rights Holder relationships with the help of special purpose rights expression languages (REL). Both, software licensing and DRM approaches have failed to address the new challenges posed by protecting intellectual property for mobile application software. This thesis, therefore, proposes a solution to merge the best of both approaches for the special case of application software rights enforcement. It is targeted to mobile computing platforms to meet the challenges in that area. Existing distributed software licensing systems were originally designed for fixed network applications and typically assume the immediate availability of a network connection to verify and validate rights with a rights server. Yet, this approach is not feasible for mobile environments, because of occasional connected network characteristics. Moreover, software licensing systems do not implement an existing standard for the description of license terms which cause interoperability issues with asset management software. The focus of the DRM community to date has been on rights management for media content, which has left many issues unresolved for the specific case of rights management for application software.The difficulties of developing an all-encompassing DRM solution for the media industry has left standards based work on the enforcement of rights for application software under-specified. This is mainly because the media industry requires a broad consensus of hardware and software manufacturers to implement an agreed standard, whereas application software does not require runtime support of the underlying hardware or any third party applications. The existing rights expression languages supported by DRM systems lack the support for the explicit specification of application-level features. Existing usage-based restrictions on digital work usually include display, print, play, and execute permissions. Also, the assumption of immediate or constant network connectivity to a rights management server cannot be made for the validation and enforcement of rights on a pervasive computing platform, because factors such as network unavailability have to be anticipated. Therefore, the introduction of more flexible rights models for occasionally connected mobile environments is required. This is achieved through the specification and implementation of novel rights models, such as audit-based and feature-based models. The introduction of these flexible rights models poses new challenges to designing an enforcement architecture for pervasive environments. The enforcement architecture has to deal with resource constraints on mobile devices, such as limited memory and processor power, while at the same time provide an extensible set of APIs so that it can be adapted for different computing platforms. This thesis proposes a solution to enforce and deliver application software rights implemented in a generic enforcement framework, based on an extended version of the Open Digital Rights Language (ODRL), called PARMA REL, that accounts for the characteristics of applications in pervasive environments. In particular, the architecture supports the enforcement of audit-based and feature-based rights models. While the architecture in this thesis has specific support for mobile environments, it has also been designed to operate in a fixed network environment. A further contribution of this thesis is to present a pervasive application rights enforcement framework which does not make any assumptions on the target platform by basing the design on the dependency inversion and Hollywood principles. The architecture is designed in a way that decouples functional and rights enforcement logic. It supports the association of rights with application-level features by leveraging aspect-oriented software engineering techniques to weave the enforcement as an orthogonal service into any existing J2ME, J2SE, or J2EE application. This makes it possible to restrict access to certain modules at runtime. Developer support is provided by tools to generate aspects based on the rights description and the target platform. Furthermore, a MDA-oriented development process is introduced to cover the generation and weaving of rights into the application in a non-intrusive manner. Consequently, the rights models designed for pervasive computing environments combined with the flexible enforcement architecture enable the enforcement of rights of applications in new, sophisticated and standard-compliant ways. The enforcement architecture is evaluated with respect to the ability to adapt to different platforms, to operate in resource-constrained environments, and to guard against potential attacks. Also the execution and runtime overhead of the enforcement logic is evaluated and the architecture is compared with existing enforcement architectures. The enforcement architecture is implemented for two platforms, J2ME and J2SE

Workshop on Pervasive Urban Applications

On 12 June 2011, the first International Workshop on Pervasive Urban Applications (PURBA) was held in conjunction with the International Conference on Pervasive Computing (Pervasive 2011) in San Francisco. The workshop aimed to bring together researchers and practitioners to discuss and explore the research challenges and opportunities in applying the pervasive computing paradigm to urban spaces