Social networks : the future for health care delivery

With the rapid growth of online social networking for health, health care systems are experiencing an inescapable increase in complexity. This is not necessarily a drawback; self-organising, adaptive networks could become central to future health care delivery. This paper considers whether social networks composed of patients and their social circles can compete with, or complement, professional networks in assembling health-related information of value for improving health and health care. Using the framework of analysis of a two-sided network – patients and providers – with multiple platforms for interaction, we argue that the structure and dynamics of such a network has implications for future health care. Patients are using social networking to access and contribute health information. Among those living with chronic illness and disability and engaging with social networks, there is considerable expertise in assessing, combining and exploiting information. Social networking is providing a new landscape for patients to assemble health information, relatively free from the constraints of traditional health care. However, health information from social networks currently complements traditional sources rather than substituting for them. Networking among health care provider organisations is enabling greater exploitation of health information for health care planning. The platforms of interaction are also changing. Patient-doctor encounters are now more permeable to influence from social networks and professional networks. Diffuse and temporary platforms of interaction enable discourse between patients and professionals, and include platforms controlled by patients. We argue that social networking has the potential to change patterns of health inequalities and access to health care, alter the stability of health care provision and lead to a reformulation of the role of health professionals. Further research is needed to understand how network structure combined with its dynamics will affect the flow of information and potentially the allocation of health care resources

Environmental Correlates of Nesting Success in Red-Shouldered Hawks

We evaluated the influence of weather on reproduction of the Red-shouldered Hawk (Buteo lineatus) in an agricultural landscape in south-central Florida where we found relatively high densities of successfully nesting hawks. We used a generalized linear modeling approach within an information-theoretic framework to examine the influence of total rainfall, rainfall frequency, and temperature on the timing of nesting, nesting success, and productivity of hawks during 1995-2000. The best models indicated an influence of rainfall frequency and laying period on hawk reproduction. During years with less frequent rainfall in the summer and fall months prior to the beginning of the breeding season, fewer pairs attempted to nest, and hawks nested later and had smaller clutch sizes and lower productivity. Hawks that nested later in the breeding season had lower hatching success and lower overall nest success. Although Red-shouldered Hawks are generally reported to inhabit forested landscapes throughout their range, a common feature seems to be a dependence on wetlands and riparian habitat for foraging. We propose that the proportion of wetlands throughout the landscape is a unique aspect of south-central Florida that may allow for persistence of unusually high numbers of hawks

Environmental Correlates of Breeding in the Crested Caracara (Caracara cheriway)

We evaluated the influence of weather on reproduction of the Crested Caracara (Caracara cheriway) in an agricultural landscape in south-central Florida. We used a mixed logistic-regression modeling approach within an information-theoretic framework to examine the influence of total rainfall, rainfall frequency, and temperature on the number of breeding pairs, timing of breeding, nest success, and productivity of Crested Caracaras during 1994–2000. The best models indicated an influence of rainfall frequency and laying period on reproduction. More individuals nested and more pairs nested earlier during years with more frequent rainfall in late summer and early fall. Pairs that nested later in each breeding season had smaller clutches, lower nest success and productivity, and higher probability of nest failure. More frequent rainfall during early spring months that are usually characterized by water deficit (March–May), more frequent rainfall during the fall drawdown period (September–November), and a shorter winter dry period showed some association with higher probability of brood reduction and lower nest success. The proportion of nests that failed was higher in wet years, when total rainfall during the breeding season (September–April) was \u3e10% above the 20-year average. Rainfall may influence reproduction in Crested Caracaras indirectly through food resources. As total rainfall increased during February–April, when most pairs are feeding nestlings or dependent fledglings, the proportion of drawdown-dependent species (those that become available as rainfall decreases and wetlands become isolated and shallow) in the diet of Crested Caracaras declined, which may indicate reduced availability of foraging habitat for this primarily terrestrial raptor

Categorification of persistent homology

We redevelop persistent homology (topological persistence) from a categorical point of view. The main objects of study are diagrams, indexed by the poset of real numbers, in some target category. The set of such diagrams has an interleaving distance, which we show generalizes the previously-studied bottleneck distance. To illustrate the utility of this approach, we greatly generalize previous stability results for persistence, extended persistence, and kernel, image and cokernel persistence. We give a natural construction of a category of interleavings of these diagrams, and show that if the target category is abelian, so is this category of interleavings.Comment: 27 pages, v3: minor changes, to appear in Discrete & Computational Geometr

Solving Directed Laplacian Systems in Nearly-Linear Time through Sparse LU Factorizations

We show how to solve directed Laplacian systems in nearly-linear time. Given a linear system in an $n \times n$ Eulerian directed Laplacian with $m$ nonzero entries, we show how to compute an $\epsilon$-approximate solution in time $O(m \log^{O(1)} (n) \log (1/\epsilon))$. Through reductions from [Cohen et al. FOCS'16] , this gives the first nearly-linear time algorithms for computing $\epsilon$-approximate solutions to row or column diagonally dominant linear systems (including arbitrary directed Laplacians) and computing $\epsilon$-approximations to various properties of random walks on directed graphs, including stationary distributions, personalized PageRank vectors, hitting times, and escape probabilities. These bounds improve upon the recent almost-linear algorithms of [Cohen et al. STOC'17], which gave an algorithm to solve Eulerian Laplacian systems in time $O((m+n2^{O(\sqrt{\log n \log \log n})})\log^{O(1)}(n \epsilon^{-1}))$. To achieve our results, we provide a structural result that we believe is of independent interest. We show that Laplacians of all strongly connected directed graphs have sparse approximate LU-factorizations. That is, for every such directed Laplacian ${\mathbf{L}}$, there is a lower triangular matrix $\boldsymbol{\mathit{{\mathfrak{L}}}}$ and an upper triangular matrix $\boldsymbol{\mathit{{\mathfrak{U}}}}$, each with at most $\tilde{O}(n)$ nonzero entries, such that their product $\boldsymbol{\mathit{{\mathfrak{L}}}} \boldsymbol{\mathit{{\mathfrak{U}}}}$ spectrally approximates ${\mathbf{L}}$ in an appropriate norm. This claim can be viewed as an analogue of recent work on sparse Cholesky factorizations of Laplacians of undirected graphs. We show how to construct such factorizations in nearly-linear time and prove that, once constructed, they yield nearly-linear time algorithms for solving directed Laplacian systems.Comment: Appeared in FOCS 201

Phase II prospective randomized trial of weight loss prior to radical prostatectomy.

BACKGROUND:Obesity is associated with poorly differentiated and advanced prostate cancer and increased mortality. In preclinical models, caloric restriction delays prostate cancer progression and prolongs survival. We sought to determine if weight loss (WL) in men with prostate cancer prior to radical prostatectomy affects tumor apoptosis and proliferation, and if WL effects other metabolic biomarkers. METHODS:In this Phase II prospective trial, overweight and obese men scheduled for radical prostatectomy were randomized to a 5-8 week WL program consisting of standard structured energy-restricted meal plans (1200-1500 Kcal/day) and physical activity or to a control group. The primary endpoint was apoptotic index in the radical prostatectomy malignant epithelium. Secondary endpoints were proliferation (Ki67) in the radical prostatectomy tissue, body weight, body mass index (BMI), waist to hip ratio, body composition, and serum PSA, insulin, triglyceride, cholesterol, testosterone, estradiol, leptin, adiponectin, interleukin 6, interleukin 8, insulin-like growth factor 1, and IGF binding protein 1. RESULTS:In total 23 patients were randomized to the WL intervention and 21 patients to the control group. Subjects in the intervention group had significantly more weight loss (WL:-3.7 ± 0.5 kg; Control:-1.6 ± 0.5 kg; p = 0.007) than the control group and total fat mass was significantly reduced (WL:-2.1 ± 0.4; Control: 0.1 ± 0.3; p = 0.015). There was no significant difference in apoptotic or proliferation index between the groups. Among the other biomarkers, triglyceride, and insulin levels were significantly decreased in the WL compared with the control group. CONCLUSIONS:In summary, this short-term WL program prior to radical prostatectomy resulted in significantly more WL in the intervention vs. the control group and was accompanied by significant reductions in body fat mass, circulating triglycerides, and insulin. However, no significant changes were observed in malignant epithelium apoptosis or proliferation. Future studies should consider a longer term or more intensive weight loss intervention

Modeling and Testing a Family of Surgical Robots: An Experience Report

Safety-critical applications often use dependability cases to validate that specified properties are invariant, or to demonstrate a counter example showing how that property might be violated. However, most dependability cases are written with a single product in mind. At the same time, software product lines (families of related software products) have been studied with the goal of modeling variability and commonality, and building family based techniques for both analysis and testing. However, there has been little work on building an end to end dependability case for a software product line (where a property is modeled, a counter example is found and then validated as a true positive via testing), and none that we know of in an emerging safety-critical domain, that of robotic surgery. In this paper, we study a family of surgical robots, that combine hardware and software, and are highly configurable, representing over 1300 unique robots. At the same time, they are considered safety-critical and should have associated dependability cases. We perform a case study to understand how we can bring together lightweight formal analysis, feature modeling, and testing to provide an end to end pipeline to find potential violations of important safety properties. In the process, we learned that there are some interesting and open challenges for the research community, which if solved will lead towards more dependable safety-critical cyber-physical systems

Metabolic Feedback Inhibition Influences Metabolite Secretion by the Human Gut Symbiont Bacteroides thetaiotaomicron

Microbial metabolism and trophic interactions between microbes give rise to complex multispecies communities in microbe-host systems. Bacteroides thetaiotaomicron (B. theta) is a human gut symbiont thought to play an important role in maintaining host health. Untargeted nuclear magnetic resonance metabolomics revealed B. theta secretes specific organic acids and amino acids in defined minimal medium. Physiological concentrations of acetate and formate found in the human intestinal tract were shown to cause dose-dependent changes in secretion of metabolites known to play roles in host nutrition and pathogenesis. While secretion fluxes varied, biomass yield was unchanged, suggesting feedback inhibition does not affect metabolic bioenergetics but instead redirects carbon and energy to CO2 and H2. Flux balance analysis modeling showed increased flux through CO2-producing reactions under glucose-limiting growth conditions. The metabolic dynamics observed for B. theta, a keystone symbiont organism, underscores the need for metabolic modeling to complement genomic predictions of microbial metabolism to infer mechanisms of microbemicrobe and microbe-host interactions

What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial.

ObjectiveTo test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust.MethodsThis was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site.ResultsThe decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint ] = 0.14) or physician trust more in parents with low health literacy (Pint  = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, -8.14, 95% CI: -12.33 to -3.95; Pint  = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint  = 0.04).ConclusionsUse of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents