A Model-Based Solution to the Offline Multi-Agent Reinforcement Learning Coordination Problem

Training multiple agents to coordinate is an important problem with applications in robotics, game theory, economics, and social sciences. However, most existing Multi-Agent Reinforcement Learning (MARL) methods are online and thus impractical for real-world applications in which collecting new interactions is costly or dangerous. While these algorithms should leverage offline data when available, doing so gives rise to the offline coordination problem. Specifically, we identify and formalize the strategy agreement (SA) and the strategy fine-tuning (SFT) challenges, two coordination issues at which current offline MARL algorithms fail. To address this setback, we propose a simple model-based approach that generates synthetic interaction data and enables agents to converge on a strategy while fine-tuning their policies accordingly. Our resulting method, Model-based Offline Multi-Agent Proximal Policy Optimization (MOMA-PPO), outperforms the prevalent learning methods in challenging offline multi-agent MuJoCo tasks even under severe partial observability and with learned world models

A Multidisciplinary Intubation Algorithm for Suspected COVID-19 Patients in the Emergency Department

Introduction: Intubation of patients suspected of having coronavirus disease 2019 (COVID-19) is considered to be a high-risk procedure due to the aerosolization of viral particles. In an effort to minimize the risk of exposure and optimize patient care, we sought to develop, test, provide training, and implement a standardized algorithm for intubating these high-risk patients at our institution.Methods: We developed an initial intubation algorithm, incorporating strategic use of equipment and incorporating emerging best practices. By combining simulation-based training sessions and rapid-cycle improvement methodology with physicians, nurses, and respiratory therapists, and incorporating their feedback into the development, we were able to optimize the process prior to implementation. Training sessions also enabled the participants to practice the algorithm as a team. Upon completion of each training session, participants were invited to complete a brief online survey about their overall experience.Results: An algorithm and training system vetted by simulation and actual practice were developed. A training video and dissemination package were made available for other emergency departments to adopt. Survey results were overall positive, with 97.92% of participants feeling confident in their role in the intubation process, and many participants citing the usefulness of the multidisciplinary approach to the training.Conclusion: A multidisciplinary, team-based approach to the development and training of a standardized intubation algorithm combining simulation and rapid-cycle improvement methodology is a useful, effective process to respond to rapidly evolving clinical information and experiences during a global pandemic

The national comprehensive cancer network distress thermometer as a screening tool for the evaluation of quality of life in uveal melanoma patients

Purpose To assess quality of life (QoL) status via the National Comprehensive Cancer Network (NCCN ) distress thermometer as a psychooncological screening tool in uveal melanoma patients. Methods One hundred and six consecutive patients suffering from uveal melanoma completed the distress thermometer between 04/2018 and 12/2018. Practical, emotional, family concerned, spiritual, physical and overall distress levels, distribution of distress and subgroup analyses defining groups of potential high distress levels in need of intervention were assessed. Descriptive statistics, cross‐tabulations, chi‐square and Fisher's exact test as well as correlation coefficients (Spearman's rho) and receiver operating characteristic (ROC ) were used for analysis. Results Patients with higher T‐category had significantly more emotional problems and spiritual concerns (p = 0.046 and p = 0.023, respectively). Female patients accounted for higher rates of physical issues (p = 0.034). Lower best corrected visual acuity (BCVA ) was correlated with higher distress levels (p = 0.037). Patients resulting in loss of BCVA of ≥3 lines reported higher distress levels (p = 0.029). A distress threshold of 5 on the basis of ROC analysis showed a corresponding sensitivity of 100% and specificity of 76%. Conclusion The NCCN distress thermometer could be integrated well into our clinical routine and proved to be a rapid, yet sensible screening tool for emotional and physical distress in patients with uveal melanoma. Special attention should be paid to patients with higher T‐category and patients resulting in lower levels of BCVA . As in patients with different tumour entities, the established distress threshold of ≥5 proposing intervention proved to be adequate for uveal melanoma patients

Intravitreal ranibizumab versus isovolemic hemodilution in the treatment of macular edema secondary to central retinal vein occlusion: Twelve-month results of a prospective, randomized, multicenter trial

PURPOSE This is a prospective, randomized, multicenter, investigator-initiated trial to evaluate the 12-month effectiveness of isovolemic hemodilution (IH) with prompt versus deferred intravitreal injections (IVI) of ranibizumab 0.5 mg for the treatment of macular edema secondary to early central retinal vein occlusion (CRVO). METHODS Eyes with macular edema due to CRVO having occurred not more than 8 weeks previously received either monthly ranibizumab IVI in combination with IH (group I, n = 28) or IH alone (group II, n = 30). From month 2 to 12, the patients in both groups could be treated with monthly intravitreal ranibizumab. The main outcome variables were gain of visual acuity and the course of central retinal thickness as measured with optical coherence tomography. RESULTS At 12 months, eyes in group I on average gained +28.1 (±19.3) letters compared to +25.2 (±20.9) letters in group II (p = 0.326). This result was achieved with significantly fewer injections in group II. Additionally, 30% of the eyes in group II did not need ranibizumab IVI during the 12 months of the trial. CONCLUSION Ranibizumab IVI in addition to IH proved to be highly effective in increasing visual acuity and reducing macular edema secondary to CRVO. Initial IH in early CRVO may be a first treatment option in patients anxious about IVI

Anyonic physical observables and spin phase transition

The quantization of charged matter system coupled to Chern-Simons gauge fields is analyzed in a covariant gauge fixing, and gauge invariant physical anyon operators satisfying fractional statistics are constructed in a symmetric phase, based on Dirac's recipe performed on QED. This method provides us a definite way of identifying physical spectrums free from gauge ambiguity and constructing physical anyon operators under a covariant gauge fixing. We then analyze the statistical spin phase transition in a symmetry-broken phase and show that the Higgs mechanism transmutes an anyon satisfying fractional statistics into a canonical boson, a spin 0 Higgs boson or a topologically massive photon.Comment: 14 pages, added references, a few improvement

On quantum group symmetry and Bethe ansatz for the asymmetric twin spin chain with integrable boundary

Motivated by a study of the crossing symmetry of the `gemini' representation of the affine Hecke algebra we give a construction for crossing tensor space representations of ordinary Hecke algebras. These representations build solutions to the Yang--Baxter equation satisfying the crossing condition (that is, integrable quantum spin chains). We show that every crossing representation of the Temperley--Lieb algebra appears in this construction, and in particular that this construction builds new representations. We extend these to new representations of the blob algebra, which build new solutions to the Boundary Yang--Baxter equation (i.e. open spin chains with integrable boundary conditions). We prove that the open spin chain Hamiltonian derived from Sklyanin's commuting transfer matrix using such a solution can always be expressed as the representation of an element of the blob algebra, and determine this element. We determine the representation theory (irreducible content) of the new representations and hence show that all such Hamiltonians have the same spectrum up to multiplicity, for any given value of the algebraic boundary parameter. (A corollary is that our models have the same spectrum as the open XXZ chain with nondiagonal boundary -- despite differing from this model in having reference states.) Using this multiplicity data, and other ideas, we investigate the underlying quantum group symmetry of the new Hamiltonians. We derive the form of the spectrum and the Bethe ansatz equations.Comment: 43 pages, multiple figure

Improved Survival Prediction by Combining Radiological Imaging and S-100B Levels Into a Multivariate Model in Metastatic Melanoma Patients Treated With Immune Checkpoint Inhibition

Purpose: We explored imaging and blood bio-markers for survival prediction in a cohort of patients with metastatic melanoma treated with immune checkpoint inhibition. Materials and Methods: 94 consecutive metastatic melanoma patients treated with immune checkpoint inhibition were included into this study. PET/CT imaging was available at baseline (Tp0), 3 months (Tp1) and 6 months (Tp2) after start of immunotherapy. Radiological response at Tp2 was evaluated using iRECIST. Total tumor burden (TB) at each time-point was measured and relative change of TB compared to baseline was calculated. LDH, CRP and S-100B were also analyzed. Cox proportional hazards model and logistic regression were used for survival analysis. Results: iRECIST at Tp2 was significantly associated with overall survival (OS) with C-index=0.68. TB at baseline was not associated with OS, whereas TB at Tp1 and Tp2 provided similar predictive power with C-index of 0.67 and 0.71, respectively. Appearance of new metastatic lesions during follow-up was an independent prognostic factor (C-index=0.73). Elevated LDH and S-100B ratios at Tp2 were significantly associated with worse OS: C-index=0.73 for LDH and 0.73 for S-100B. Correlation of LDH with TB was weak (r=0.34). A multivariate model including TB change, S-100B, and appearance of new lesions showed the best predictive performance with C-index=0.83. Conclusion: Our analysis shows only a weak correlation between LDH and TB. Additionally, baseline TB was not a prognostic factor in our cohort. A multivariate model combining early blood and imaging biomarkers achieved the best predictive power with regard to survival, outperforming iRECIST

Small UAS Detect and Avoid Requirements Necessary for Limited Beyond Visual Line of Sight (BVLOS) Operations

Potential small Unmanned Aircraft Systems (sUAS) beyond visual line of sight (BVLOS) operational scenarios/use cases and Detect And Avoid (DAA) approaches were collected through a number of industry wide data calls. Every 333 Exemption holder was solicited for this same information. Summary information from more than 5,000 exemption holders is documented, and the information received had varied level of detail but has given relevant experiential information to generalize use cases. A plan was developed and testing completed to assess Radio Line Of Sight (RLOS), a potential key limiting factors for safe BVLOS ops. Details of the equipment used, flight test area, test payload, and fixtures for testing at different altitudes is presented and the resulting comparison of a simplified mathematical model, an online modeling tool, and flight data are provided. An Operational Framework that defines the environment, conditions, constraints, and limitations under which the recommended requirements will enable sUAS operations BVLOS is presented. The framework includes strategies that can build upon Federal Aviation Administration (FAA) and industry actions that should result in an increase in BVLOS flights in the near term. Evaluating approaches to sUAS DAA was accomplished through five subtasks: literature review of pilot and ground observer see and avoid performance, survey of DAA criteria and recommended baseline performance, survey of existing/developing DAA technologies and performance, assessment of risks of selected DAA approaches, and flight testing. Pilot and ground observer see and avoid performance were evaluated through a literature review. Development of DAA criteria—the emphasis here being well clear— was accomplished through working with the Science And Research Panel (SARP) and through simulations of manned and unmanned aircraft interactions. Information regarding sUAS DAA approaches was collected through a literature review, requests for information, and direct interactions. These were analyzed through delineation of system type and definition of metrics and metric values. Risks associated with sUAS DAA systems were assessed by focusing on the Safety Risk Management (SRM) pillar of the SMS (Safety Management System) process. This effort (1) identified hazards related to the operation of sUAS in BVLOS, (2) offered a preliminary risk assessment considering existing controls, and (3) recommended additional controls and mitigations to further reduce risk to the lowest practical level. Finally, flight tests were conducted to collect preliminary data regarding well clear and DAA system hazards