Telemedicine infectious diseases consultations and clinical outcomes: A systematic review

Background: Telemedicine use is increasing in many specialties, but its impact on clinical outcomes in infectious diseases has not been systematically reviewed. We reviewed the current evidence for clinical effectiveness of telemedicine infectious diseases consultations, including outcomes of mortality, hospital readmission, antimicrobial use, cost, length of stay, adherence, and patient satisfaction. Methods: We queried Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov 1997- through August 5, 2019, for studies looking at clinical outcomes of infectious diseases in the setting of telemedicine use. We did not restrict by language or year of publication. Clinical outcomes searched included 30-day all-cause mortality, 30-day readmissions, patient compliance/adherence, patient satisfaction, cost or cost-effectiveness, length of hospital stay, antimicrobial use, and antimicrobial stewardship. Bias was assessed using standard methodologies. PROSPERO CRD42018105225. Results: From a search pool of 1154 studies, only 18 involved telemedicine infectious diseases consultation and our selected clinical outcomes. The outcomes tracked were heterogeneous, precluding meta-analysis, and the majority of studies were of poor quality. Overall, clinical outcomes with telemedicine infectious diseases consultation seem comparable to in-person infectious diseases consultation. Conclusions: Although in widespread use, the clinical effectiveness of telemedicine infectious diseases consultations has yet to be sufficiently studied. Further studies, or publication of previously collected and available data, are warranted to verify the cost-effectiveness of this widespread practice. Systematic review registration: PROSPERO CRD42018105225

STARRY: Analytic Occultation Light Curves

We derive analytic, closed form, numerically stable solutions for the total flux received from a spherical planet, moon or star during an occultation if the specific intensity map of the body is expressed as a sum of spherical harmonics. Our expressions are valid to arbitrary degree and may be computed recursively for speed. The formalism we develop here applies to the computation of stellar transit light curves, planetary secondary eclipse light curves, and planet-planet/planet-moon occultation light curves, as well as thermal (rotational) phase curves. In this paper we also introduce STARRY, an open-source package written in C++ and wrapped in Python that computes these light curves. The algorithm in STARRY is six orders of magnitude faster than direct numerical integration and several orders of magnitude more precise. STARRY also computes analytic derivatives of the light curves with respect to all input parameters for use in gradient-based optimization and inference, such as Hamiltonian Monte Carlo (HMC), allowing users to quickly and efficiently fit observed light curves to infer properties of a celestial body's surface map.Comment: 55 pages, 20 figures. Accepted to the Astronomical Journal. Check out the code at https://github.com/rodluger/starr

Achieving Generalizable Robustness of Deep Neural Networks by Stability Training

We study the recently introduced stability training as a general-purpose method to increase the robustness of deep neural networks against input perturbations. In particular, we explore its use as an alternative to data augmentation and validate its performance against a number of distortion types and transformations including adversarial examples. In our image classification experiments using ImageNet data stability training performs on a par or even outperforms data augmentation for specific transformations, while consistently offering improved robustness against a broader range of distortion strengths and types unseen during training, a considerably smaller hyperparameter dependence and less potentially negative side effects compared to data augmentation.Comment: 18 pages, 25 figures; Camera-ready versio

Changes in the multidisciplinary management of rectal cancer from 2009 to 2015 and associated improvements in short‐term outcomes

Aim: Significant recent changes in management of locally advanced rectal cancer include preoperative staging, use of extended neoadjuvant therapies, and minimally invasive surgery (MIS). This study was aimed at characterizing those changes and associated short‐term outcomes. Method: We retrospectively analysed treatment and outcome data from patients with T3/4 or N+ locally advanced rectal cancer ≤15 cm from the anal verge who were evaluated at a comprehensive cancer center in 2009–2015. Results: In total, 798 patients were identified and grouped into five cohorts based on treatment year: 2009‐2010, 2011, 2012, 2013, and 2014‐2015. Temporal changes included increased reliance on MRI staging, from 57% in 2009‐2010 to 98% in 2014‐2015 (p < 0.001); increased use of total neoadjuvant therapy, from 17% to 76% (p < 0.001); and increased use of MIS, from 33% to 70% (p < 0.001). Concurrently, median hospital stay decreased (from 7 to 5 days; p < 0.001), as did the rates of grade III‐V complications (from 13% to 7%; p < 0.05), surgical site infections (from 24% to 8%; p < 0.001), anastomotic leak (from 11% to 3%; p < 0.05), and positive circumferential resection margin (from 9% to 4%; p < 0.05). TNM downstaging increased from 62% to 74% (p = 0.002). Conclusion: Shifts toward MRI‐based staging, total neoadjuvant therapy, and MIS occurred between 2009 and 2015. Over the same period, treatment responses improved, and lengths of stay and the incidence of complications decreased