Thrombotic Thrombocytopenic Purpura or Disseminated Intravascular Coagulation? Diagnostic Dilemma in the ICU

IC and TTP are two causes of thrombocytopenia that require timely diagnosis and different treatments. Both conditions can be difficult to recognize as clinical presentations vary and current diagnostic criteria lack specificity. Although clinical presentation and laboratory data often lead to the correct diagnosis, equivocal results can often preclude finding a clear etiology. This is the case of a 77 year old female with PMH of spinal degeneration s/p multiple spinal surgeries, hypertension, and hyperlipidemia, who presented to the surgical ICU s/p T9-ileum posterior fusion transverse osteotomy, L1-L2 transforaminal lumbar interbody fusion, and T11-T12 posterior laminectomy. Our case demonstrates the difficulties in confirming a diagnosis with sensitive but nonspecific criteria. TTP and DIC share similar characteristics, but missing a timely diagnosis of TTP can prove fatal for the patient without treatment

Mirroring to Build Trust in Digital Assistants

We describe experiments towards building a conversational digital assistant that considers the preferred conversational style of the user. In particular, these experiments are designed to measure whether users prefer and trust an assistant whose conversational style matches their own. To this end we conducted a user study where subjects interacted with a digital assistant that responded in a way that either matched their conversational style, or did not. Using self-reported personality attributes and subjects' feedback on the interactions, we built models that can reliably predict a user's preferred conversational style.Comment: Preprin

Preservation Methods Differ in Fecal Microbiome Stability, Affecting Suitability for Field Studies.

Immediate freezing at -20°C or below has been considered the gold standard for microbiome preservation, yet this approach is not feasible for many field studies, ranging from anthropology to wildlife conservation. Here we tested five methods for preserving human and dog fecal specimens for periods of up to 8 weeks, including such types of variation as freeze-thaw cycles and the high temperature fluctuations often encountered under field conditions. We found that three of the methods-95% ethanol, FTA cards, and the OMNIgene Gut kit-can preserve samples sufficiently well at ambient temperatures such that differences at 8 weeks are comparable to differences among technical replicates. However, even the worst methods, including those with no fixative, were able to reveal microbiome differences between species at 8 weeks and between individuals after a week, allowing meta-analyses of samples collected using various methods when the effect of interest is expected to be larger than interindividual variation (although use of a single method within a study is strongly recommended to reduce batch effects). Encouragingly for FTA cards, the differences caused by this method are systematic and can be detrended. As in other studies, we strongly caution against the use of 70% ethanol. The results, spanning 15 individuals and over 1,200 samples, provide our most comprehensive view to date of storage effects on stool and provide a paradigm for the future studies of other sample types that will be required to provide a global view of microbial diversity and its interaction among humans, animals, and the environment. IMPORTANCE Our study, spanning 15 individuals and over 1,200 samples, provides our most comprehensive view to date of storage and stabilization effects on stool. We tested five methods for preserving human and dog fecal specimens for periods of up to 8 weeks, including the types of variation often encountered under field conditions, such as freeze-thaw cycles and high temperature fluctuations. We show that several cost-effective methods provide excellent microbiome stability out to 8 weeks, opening up a range of field studies with humans and wildlife that would otherwise be cost-prohibitive

Dislocation and Relocation: Women in the Federal Prison System and Repurposing FCI Danbury for Men

(Excerpt) This Report tracks the lack of progress in keeping federal prison space in the Northeast available for women and the impact of the absence of bed-spaces for women on the implementation of federal policies committed to reducing over-incarceration. The problems began in the summer of 2013, when the federal Bureau of Prisons (BOP) announced plans to transform its only prison for women in the Northeast—FCI Danbury—into a facility for men. The BOP explained that this self-described “mission change” was a response to the need to provide more low-security beds for male prisoners

Quantum Markov Chain Monte Carlo with Digital Dissipative Dynamics on Quantum Computers

Modeling the dynamics of a quantum system connected to the environment is critical for advancing our understanding of complex quantum processes, as most quantum processes in nature are affected by an environment. Modeling a macroscopic environment on a quantum simulator may be achieved by coupling independent ancilla qubits that facilitate energy exchange in an appropriate manner with the system and mimic an environment. This approach requires a large, and possibly exponential number of ancillary degrees of freedom which is impractical. In contrast, we develop a digital quantum algorithm that simulates interaction with an environment using a small number of ancilla qubits. By combining periodic modulation of the ancilla energies, or spectral combing, with periodic reset operations, we are able to mimic interaction with a large environment and generate thermal states of interacting many-body systems. We evaluate the algorithm by simulating preparation of thermal states of the transverse Ising model. Our algorithm can also be viewed as a quantum Markov chain Monte Carlo (QMCMC) process that allows sampling of the Gibbs distribution of a multivariate model. To demonstrate this we evaluate the accuracy of sampling Gibbs distributions of simple probabilistic graphical models using the algorithm

Large Language Models as Generalizable Policies for Embodied Tasks

We show that large language models (LLMs) can be adapted to be generalizable policies for embodied visual tasks. Our approach, called Large LAnguage model Reinforcement Learning Policy (LLaRP), adapts a pre-trained frozen LLM to take as input text instructions and visual egocentric observations and output actions directly in the environment. Using reinforcement learning, we train LLaRP to see and act solely through environmental interactions. We show that LLaRP is robust to complex paraphrasings of task instructions and can generalize to new tasks that require novel optimal behavior. In particular, on 1,000 unseen tasks it achieves 42% success rate, 1.7x the success rate of other common learned baselines or zero-shot applications of LLMs. Finally, to aid the community in studying language conditioned, massively multi-task, embodied AI problems we release a novel benchmark, Language Rearrangement, consisting of 150,000 training and 1,000 testing tasks for language-conditioned rearrangement. Video examples of LLaRP in unseen Language Rearrangement instructions are at https://llm-rl.github.io

Using the gut microbiota as a novel tool for examining colobine primate GI health

Primates of the Colobinae subfamily are highly folivorous. They possess a sacculated foregut and are believed to rely on a specialized gut microbiota to extract sufficient energy from their hard-to-digest diet. Although many colobines are endangered and would benefit from captive breeding programs, maintaining healthy captive populations of colobines can be difficult since they commonly suffer from morbidity and mortality due to gastrointestinal (GI) distress of unknown cause. While there is speculation that this GI distress may be associated with a dysbiosis of the gut microbiota, no study has directly examined the role of the gut microbiota in colobine GI health. In this study, we used high-throughput sequencing to examine the gut microbiota of three genera of colobines housed at the San Diego Zoo: doucs (Pygathrix) (N=7), colobus monkeys (Colobus) (N=4), and langurs (Trachypithecus) (N=5). Our data indicated that GI-healthy doucs, langurs, and colobus monkeys possess a distinct gut microbiota. In addition, GI-unhealthy doucs exhibited a different gut microbiota compared to GI-healthy individuals, including reduced relative abundances of anti-inflammatory Akkermansia. Finally, by comparing samples from wild and captive Asian colobines, we found that captive colobines generally exhibited higher relative abundances of potential pathogens such as Desulfovibrio and Methanobrevibacter compared to wild colobines, implying an increased risk of gut microbial dysbiosis. Together, these results suggest an association between the gut microbiota and GI illness of unknown cause in doucs. Further studies are necessary to corroborate these findings and determine cause-and-effect relationships. Additionally, we found minimal variation in the diversity and composition of the gut microbiota along the colobine GI tract, suggesting that fecal samples may be sufficient for describing the colobine gut microbiota. If these findings can be validated in wild individuals, it will facilitate the rapid expansion of colobine gut microbiome research

Securing Our Economic Future

The American economy is in the midst of a wrenching crisis, one caused by the COVID-19 pandemic and aggravated further by a series of climate-driven natural disasters. While the economy has made some steps towards recovery, the pandemic has laid bare the reality that too many Americans are unable to meet many of their urgent and basic needs. At the same time, it has become painfully clear that American society is not equipped to deal with the risks emerging from our changing climate. This book is a contribution towards policy options for addressing these challenges. Although it was largely written before the pandemic crises beset our country, the analyses, diagnoses, and prescriptions contained within all shed new light on the underlying fragilities that have since been exposed. The volume is composed of nine commissioned chapters and is divided into three sections, covering the 'Economics of the American Middle Class'; the 'Geographic Disparities in Economic Opportunity'; and the 'Geopolitics of the Climate and Energy Challenge and the US Policy Response.' Part I focuses on the economic wellbeing of the American middle class and the chapters in this section evaluate the prevailing narrative of its decline. The chapters in part II investigate the large variation in income and economic opportunities across places, and include a specific policy proposal for emergency rental assistance. Part III is devoted to the global climate crisis. The chapters in this final section emphasize the mounting social and economic costs of inaction and discuss potential policy approaches for tackling the climate challenge

Somatic Pairing of Chromosome 19 in Renal Oncocytoma Is Associated with Deregulated ELGN2-Mediated Oxygen-Sensing Response

Chromosomal abnormalities, such as structural and numerical abnormalities, are a common occurrence in cancer. The close association of homologous chromosomes during interphase, a phenomenon termed somatic chromosome pairing, has been observed in cancerous cells, but the functional consequences of somatic pairing have not been established. Gene expression profiling studies revealed that somatic pairing of chromosome 19 is a recurrent chromosomal abnormality in renal oncocytoma, a neoplasia of the adult kidney. Somatic pairing was associated with significant disruption of gene expression within the paired regions and resulted in the deregulation of the prolyl-hydroxylase ELGN2, a key protein that regulates the oxygen-dependent degradation of hypoxia-inducible factor (HIF). Overexpression of ELGN2 in renal oncocytoma increased ubiquitin-mediated destruction of HIF and concomitantly suppressed the expression of several HIF-target genes, including the pro-death BNIP3L gene. The transcriptional changes that are associated with somatic pairing of chromosome 19 mimic the transcriptional changes that occur following DNA amplification. Therefore, in addition to numerical and structural chromosomal abnormalities, alterations in chromosomal spatial dynamics should be considered as genomic events that are associated with tumorigenesis. The identification of EGLN2 as a significantly deregulated gene that maps within the paired chromosome region directly implicates defects in the oxygen-sensing network to the biology of renal oncocytoma