Somatic PDGFRB activating variants in fusiform cerebral aneurysms

The role of somatic genetic variants in the pathogenesis of intracranial-aneurysm formation is unknown. We identified a 23-year-old man with progressive, right-sided intracranial aneurysms, ipsilateral to an impressive cutaneous phenotype. The index individual underwent a series of genetic evaluations for known connective-tissue disorders, but the evaluations were unrevealing. Paired-sample exome sequencing between blood and fibroblasts derived from the diseased areas detected a single novel variant predicted to cause a p.Tyr562Cys (g.149505130T>C [GRCh37/hg19]; c.1685A>G) change within the platelet-derived growth factor receptor β gene (PDGFRB), a juxtamembrane-coding region. Variant-allele fractions ranged from 18.75% to 53.33% within histologically abnormal tissue, suggesting post-zygotic or somatic mosaicism. In an independent cohort of aneurysm specimens, we detected somatic-activating PDGFRB variants in the juxtamembrane domain or the kinase activation loop in 4/6 fusiform aneurysms (and 0/38 saccular aneurysms; Fisher's exact test, p < 0.001). PDGFRB-variant, but not wild-type, patient cells were found to have overactive auto-phosphorylation with downstream activation of ERK, SRC, and AKT. The expression of discovered variants demonstrated non-ligand-dependent auto-phosphorylation, responsive to the kinase inhibitor sunitinib. Somatic gain-of-function variants in PDGFRB are a novel mechanism in the pathophysiology of fusiform cerebral aneurysms and suggest a potential role for targeted therapy with kinase inhibitors

Graphical models for interactive POMDPs: representations and solutions

We develop new graphical representations for the problem of sequential decision making in partially observable multiagent environments, as formalized by interactive partially observable Markov decision processes (I-POMDPs). The graphical models called interactive inf uence diagrams (I-IDs) and their dynamic counterparts, interactive dynamic inf uence diagrams (I-DIDs), seek to explicitly model the structure that is often present in real-world problems by decomposing the situation into chance and decision variables, and the dependencies between the variables. I-DIDs generalize DIDs, which may be viewed as graphical representations of POMDPs, to multiagent settings in the same way that IPOMDPs generalize POMDPs. I-DIDs may be used to compute the policy of an agent given its belief as the agent acts and observes in a setting that is populated by other interacting agents. Using several examples, we show how I-IDs and I-DIDs may be applied and demonstrate their usefulness. We also show how the models may be solved using the standard algorithms that are applicable to DIDs. Solving I-DIDs exactly involves knowing the solutions of possible models of the other agents. The space of models grows exponentially with the number of time steps. We present a method of solving I-DIDs approximately by limiting the number of other agents’ candidate models at each time step to a constant. We do this by clustering models that are likely to be behaviorally equivalent and selecting a representative set from the clusters. We discuss the error bound of the approximation technique and demonstrate its empirical performance

Reliability of the Marlowe-Crowne social desirability scale in Ethiopia, Kenya, Mozambique, and Uganda

<p>Abstract</p> <p>Background</p> <p>Studies of HIV often use self-reported surveys to measure sexual knowledge, attitudes, and practices. However, the self-reported data are vulnerable to social desirability (SD), a propensity of individuals to report favorable responses. The Marlowe-Crowne Social Desirability Scale (MC-SDS) was developed as a measure of the effect of social desirability, but it has not been adapted for or used in Africa. This study aimed to apply the MC-SDS nested in an HIV behavioral intervention program and to measure its reliability in four African countries.</p> <p>Methods</p> <p>The MC-SDS was adapted based on consultations with local stakeholders and pilot tested in Ethiopia, Kenya, Mozambique, and Uganda. Trained interviewers administered the modified 28-item MC-SDS survey to 455 men and women (ages 15-24 years). The scores for the social desirability scales were calculated for all participants. An analysis of the internal consistency of responses was conducted using the Cronbach's α coefficient. Acceptable internal consistency was defined as an α coefficient of ≥ 0.70.</p> <p>Results</p> <p>Mean social desirability scores ranged from a low of 15.7 in Kenya to a high of 20.6 in Mozambique. The mean score was 17.5 for Uganda and 20.6 for Mozambique. The Cronbach's α coefficients were 0.63 in Kenya, 0.66 in Mozambique, 0.70 in Uganda, and 0.80 in Ethiopia.</p> <p>Conclusions</p> <p>The MC-SDS can be effectively adapted and implemented in sub-Saharan Africa. The reliability of responses in these settings suggest that the MC-SDS could be a useful tool for capturing potential SD in surveys of HIV related risk behaviors.</p

Optimal control as a graphical model inference problem

We reformulate a class of non-linear stochastic optimal control problems introduced by Todorov (2007) as a Kullback-Leibler (KL) minimization problem. As a result, the optimal control computation reduces to an inference computation and approximate inference methods can be applied to efficiently compute approximate optimal controls. We show how this KL control theory contains the path integral control method as a special case. We provide an example of a block stacking task and a multi-agent cooperative game where we demonstrate how approximate inference can be successfully applied to instances that are too complex for exact computation. We discuss the relation of the KL control approach to other inference approaches to control.Comment: 26 pages, 12 Figures; Machine Learning Journal (2012

Can bounded and self-interested agents be teammates? Application to planning in ad hoc teams

Planning for ad hoc teamwork is challenging because it involves agents collaborating without any prior coordination or communication. The focus is on principled methods for a single agent to cooperate with others. This motivates investigating the ad hoc teamwork problem in the context of self-interested decision-making frameworks. Agents engaged in individual decision making in multiagent settings face the task of having to reason about other agents’ actions, which may in turn involve reasoning about others. An established approximation that operationalizes this approach is to bound the infinite nesting from below by introducing level 0 models. For the purposes of this study, individual, self-interested decision making in multiagent settings is modeled using interactive dynamic influence diagrams (I-DID). These are graphical models with the benefit that they naturally offer a factored representation of the problem, allowing agents to ascribe dynamic models to others and reason about them. We demonstrate that an implication of bounded, finitely-nested reasoning by a self-interested agent is that we may not obtain optimal team solutions in cooperative settings, if it is part of a team. We address this limitation by including models at level 0 whose solutions involve reinforcement learning. We show how the learning is integrated into planning in the context of I-DIDs. This facilitates optimal teammate behavior, and we demonstrate its applicability to ad hoc teamwork on several problem domains and configurations

Challenges in assessing and managing multi-hazard risks: A European stakeholders perspective

The latest evidence suggests that multi-hazards and their interrelationships (e.g., triggering, compound, and consecutive hazards) are becoming more frequent across Europe, underlying a need for resilience building by moving from single-hazard-focused to multi-hazard risk assessment and management. Although significant advancements were made in our understanding of these events, mainstream practice is still focused on risks due to single hazards (e.g., flooding, earthquakes, droughts), with a limited understanding of the stakeholder needs on the ground. To overcome this limitation, this paper sets out to understand the challenges for moving towards multi-hazard risk management through the perspective of European stakeholders. Based on five workshops across different European pilots (Danube Region, Veneto Region, Scandinavia, North Sea, and Canary Islands) and an expert workshop, we identify five prime challenges: i) governance, ii) knowledge of multi-hazards and multi-risks, iii) existing approaches to disaster risk management, iv) translation of science to policy and practice, and v) lack of data. These challenges are inherently linked and cannot be tackled in isolation with path dependency posing a significant hurdle in transitioning from single- to multi-hazard risk management. Going forward, we identify promising approaches for overcoming some of the challenges, including emerging approaches for multi-hazard characterisation, a common understanding of terminology, and a comprehensive framework for guiding multi-hazard risk assessment and management. We argue for a need to think beyond natural hazards and include other threats in creating a comprehensive overview of multi-hazard risks, as well as promoting thinking of multi-hazard risk reduction in the context of larger development goals

Meta-ethnography of experiences of early discharge, with a focus on paediatric febrile neutropenia

PURPOSE (STATING THE MAIN PURPOSES AND RESEARCH QUESTION): Many children have no significant sequelae of febrile neutropenia. A systematic review of clinical studies demonstrated patients at low risk of septic complications can be safely treated as outpatients using oral antibiotics with low rates of treatment failure. Introducing earlier discharge may improve quality of life, reduce hospital acquired infection and reduce healthcare service pressures. However, the review raised concerns that this might not be acceptable to patients, families and healthcare professionals. METHODS: This qualitative synthesis explored experiences of early discharge in paediatric febrile neutropenia, including reports from studies of adult febrile neutropenia and from other paediatric conditions. Systematic literature searching preceded meta-ethnographic analysis, including reading the studies and determining relationships between studies, translation of studies and synthesis of these translations. RESULTS: Nine papers were included. The overarching experience of early discharge is that decision-making is complex and difficult and influenced by fear, timing and resources. From this background, we identified two distinct themes. First, participants struggled with practical consequences of treatment regimens, namely childcare, finances and follow-up. A second theme identified social and emotional issues, including isolation, relational and environmental challenges. Linking these, participants considered continuity of care and the need for information important. CONCLUSIONS: Trust and confidence appeared interdependent with resources available to families-both are required to manage early discharge. Socially informed resilience is relevant to facilitating successful discharge strategies. Interventions which foster resilience may mediate the ability and inclination of families to accept early discharge. Services have an important role in recognising and enhancing resilience

Invited perspectives: A research agenda towards disaster risk management pathways in multi-(hazard-)risk assessment

Whilst the last decades have seen a clear shift in emphasis from managing natural hazards to managing risk, the majority of natural-hazard risk research still focuses on single hazards. Internationally, there are calls for more attention for multi-hazards and multi-risks. Within the European Union (EU), the concepts of multi-hazard and multi-risk assessment and management have taken centre stage in recent years. In this perspective paper, we outline several key developments in multi-(hazard-)risk research in the last decade, with a particular focus on the EU. We present challenges for multi-(hazard-)risk management as outlined in several research projects and papers. We then present a research agenda for addressing these challenges. We argue for an approach that addresses multi-(hazard-)risk management through the lens of sustainability challenges that cut across sectors, regions, and hazards. In this approach, the starting point is a specific sustainability challenge, rather than an individual hazard or sector, and trade-offs and synergies are examined across sectors, regions, and hazards. We argue for in-depth case studies in which various approaches for multi-(hazard-)risk management are co-developed and tested in practice. Finally, we present a new pan-European research project in which our proposed research agenda will be implemented, with the goal of enabling stakeholders to develop forward-looking disaster risk management pathways that assess trade-offs and synergies of various strategies across sectors, hazards, and spatial scales