MERMAIDE: Learning to Align Learners using Model-Based Meta-Learning

We study how a principal can efficiently and effectively intervene on the rewards of a previously unseen learning agent in order to induce desirable outcomes. This is relevant to many real-world settings like auctions or taxation, where the principal may not know the learning behavior nor the rewards of real people. Moreover, the principal should be few-shot adaptable and minimize the number of interventions, because interventions are often costly. We introduce MERMAIDE, a model-based meta-learning framework to train a principal that can quickly adapt to out-of-distribution agents with different learning strategies and reward functions. We validate this approach step-by-step. First, in a Stackelberg setting with a best-response agent, we show that meta-learning enables quick convergence to the theoretically known Stackelberg equilibrium at test time, although noisy observations severely increase the sample complexity. We then show that our model-based meta-learning approach is cost-effective in intervening on bandit agents with unseen explore-exploit strategies. Finally, we outperform baselines that use either meta-learning or agent behavior modeling, in both $0$-shot and $K=1$-shot settings with partial agent information

Techniques in Endovascular Aneurysm Repair

Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific areas that are addressed include endograft selection, arterial access, sheath delivery, aortic branch management, graft deployment, intravascular ultrasonography, pressure sensors, management of endoleaks and compressed limbs, and exit strategies

Mid-term results with laser atherectomy in the treatment of infrainguinal occlusive disease

BackgroundLaser atherectomy offers a potential intervention for multivessel infrainguinal disease in patients with poor revascularization options. Despite promising early results reported in the literature, the proper patient population who might benefit from laser atherectomy has yet to be determined.MethodsFrom July 2004 to June 2006, patients undergoing laser atherectomy were retrospectively reviewed and assessed for comorbidities, operative and follow-up variables potentially associated with the end points of nondefinitive therapy, and limb salvage.ResultsDuring the study period, 40 patients (21 women, 19 men) underwent laser atherectomy, and the average follow-up was 461 ± 49 days (range, 17 to 1050 days). Their average age was 68 ± 2 years (range, 43 to 93 years). The indication for laser atherectomy was critical limb ischemia in 26 (65%) and lower limb claudication in 11 (35%). A total of 47 lesions were treated in the following arterial segments: 34 femoropopliteal and 13 infrapopliteal. Femoropopliteal distribution by the Trans-Atlantic Society Classification (TASC) was A in 3, B in 17, C in 10, D in 4, and infrapopliteal lesions distribution was A in 1, B in 3, C in 4, and D in 5. Adjunctive angioplasty was used in 75% of cases. The overall technical success rate (<50% residual stenosis) was 88%. Laser atherectomy–based treatment was the definitive therapy for 23 patients (58%), and the overall 12-month primary patency was 44%. The limb salvage rate at 12 months in 26 patients with critical limb ischemia was 55%. Renal failure was a risk factor for amputation (P < .001) and failed primary patency (P < .05), type 2 diabetes mellitus was a risk factor for amputation (P < .05), and poor tibial runoff was associated with failed primary patency and amputation (P < .05). Outcome was associated with the number of patent infrapopliteal runoff vessels.ConclusionThese data demonstrate that laser atherectomy can be used with high initial technical success rate. Chronic renal failure and diabetes are risk factors for a negative outcome. Poor results in patients with diabetes and renal failure necessitate careful case selection in this subgroup, in which laser atherectomy is less likely to provide a definitive revascularization result or limb salvage