SAFS: A Deep Feature Selection Approach for Precision Medicine

In this paper, we propose a new deep feature selection method based on deep architecture. Our method uses stacked auto-encoders for feature representation in higher-level abstraction. We developed and applied a novel feature learning approach to a specific precision medicine problem, which focuses on assessing and prioritizing risk factors for hypertension (HTN) in a vulnerable demographic subgroup (African-American). Our approach is to use deep learning to identify significant risk factors affecting left ventricular mass indexed to body surface area (LVMI) as an indicator of heart damage risk. The results show that our feature learning and representation approach leads to better results in comparison with others

SUBIC: A Supervised Bi-Clustering Approach for Precision Medicine

Traditional medicine typically applies one-size-fits-all treatment for the entire patient population whereas precision medicine develops tailored treatment schemes for different patient subgroups. The fact that some factors may be more significant for a specific patient subgroup motivates clinicians and medical researchers to develop new approaches to subgroup detection and analysis, which is an effective strategy to personalize treatment. In this study, we propose a novel patient subgroup detection method, called Supervised Biclustring (SUBIC) using convex optimization and apply our approach to detect patient subgroups and prioritize risk factors for hypertension (HTN) in a vulnerable demographic subgroup (African-American). Our approach not only finds patient subgroups with guidance of a clinically relevant target variable but also identifies and prioritizes risk factors by pursuing sparsity of the input variables and encouraging similarity among the input variables and between the input and target variable

A cost-benefit analysis of a pellet boiler with electrostatic precipitator versus conventional biomass technology: A case study of an institutional boiler in Syracuse, New York

BACKGROUND: Biomass facilities have received increasing attention as a strategy to increase the use of renewable fuels and decrease greenhouse gas emissions from the electric generation and heating sectors, but these facilities can potentially increase local air pollution and associated health effects. Comparing the economic costs and public health benefits of alternative biomass fuel, heating technology, and pollution control technology options provides decision-makers with the necessary information to make optimal choices in a given location. METHODS: For a case study of a combined heat and power biomass facility in Syracuse, New York, we used stack testing to estimate emissions of fine particulate matter (PM2.5) for both the deployed technology (staged combustion pellet boiler with an electrostatic precipitator) and a conventional alternative (wood chip stoker boiler with a multicyclone). We used the atmospheric dispersion model AERMOD to calculate the contribution of either fuel-technology configuration to ambient primary PM2.5 in a 10 km x 10 km region surrounding the facility, and we quantified the incremental contribution to population mortality and morbidity. We assigned economic values to health outcomes and compared the health benefits of the lower-emitting technology with the incremental costs. RESULTS: In total, the incremental annualized cost of the lower-emitting pellet boiler was $190,000 greater, driven by a greater cost of the pellet fuel and pollution control technology, offset in part by reduced fuel storage costs. PM2.5 emissions were a factor of 23 lower with the pellet boiler with electrostatic precipitator, with corresponding differences in contributions to ambient primary PM2.5 concentrations. The monetary value of the public health benefits of selecting the pellet-fired boiler technology with electrostatic precipitator was$1.7 million annually, greatly exceeding the differential costs even when accounting for uncertainties. Our analyses also showed complex spatial patterns of health benefits given non-uniform age distributions and air pollution levels. CONCLUSIONS: The incremental investment in a lower-emitting staged combustion pellet boiler with an electrostatic precipitator was well justified by the population health improvements over the conventional wood chip technology with a multicyclone, even given the focus on only primary PM2.5 within a small spatial domain. Our analytical framework could be generalized to other settings to inform optimal strategies for proposed new facilities or populations.This research was supported by the New York State Energy Research and Development Authority (NYSERDA), via an award to the Northeast States for Coordinated Air Use Management (Agreement #92229). The SCICHEM work of KMZ was supported by the Electric Power Research Institute (EPRI)

Evaluating the Diversity of Emergency Medicine Foundation (EMF) Grant Recipients in the Last Decade

On behalf of the ACEP Research CommitteeIntroduction: To study diversity of researchers and barriers to success among Emergency Medicine Foundation (EMF) grant recipients in the last 10 years.Methods: EMF grant awardees were approached to complete a brief survey, which included demographics, queries related to contributions to the literature, success in obtaining grants, and any perceived barriers they encountered.Results: Of the 342 researchers contacted by email, a total of 147 completed the survey for a response rate of 43%. The respondents were predominately mid to late career white-male-heterosexual-Christian with an average age of 44 years (range 25-69 years of age). With regards to training and education, the majority of respondents (50%) were either Associate or Professor clinical rank (8% instructor/resident/fellow and 31% Assistant). Sixty-two percent of the respondents reported perceived barriers to career advancement since completion of residency. The largest perceived barrier to success was medical specialty (26%), followed by gender (21%) and age (16%).Conclusion: Our survey of EMF grant recipients in the last 10 years shows a considerable lack of diversity. The most commonly perceived barriers to career advancement by this cohort were medical specialty, gender, and age. An opportunity exists for further definition of barriers and development of mechanisms to overcome them, with a goal of increased success for those that are underrepresented. 

Micropower Impulse Radar: A Novel Technology for Rapid, Real-Time Detection of Pneumothorax

Pneumothorax detection in emergency situations must be rapid and at the point of care. Current standards for detection of a pneumothorax are supine chest X-rays, ultrasound, and CT scans. Unfortunately these tools and the personnel necessary for their facile utilization may not be readily available in acute circumstances, particularly those which occur in the pre-hospital setting. The decision to treat therefore, is often made without adequate information. In this report, we describe a novel hand-held device that utilizes Micropower Impulse Radar to reliably detect the presence of a pneumothorax. The technology employs ultra wide band pulses over a frequency range of 500 MHz to 6 GHz and a proprietary algorithm analyzes return echoes to determine if a pneumothorax is present with no user interpretation required. The device has been evaluated in both trauma and surgical environments with sensitivity of 93% and specificity of 85%. It is has the CE Mark and is available for sale in Europe. Post market studies are planned starting in May of 2011. Clinical studies to support the FDA submission will be completed in the first quarter of 2012

The Relationship Between Aldosterone and Left Ventricular Hypertrophy in Hypertensive Patients

Background - Aldosterone is a pertinent hormone in naturally elevating blood pressure within the body by increasing fluid retention in the body via electrolyte reabsorption in the kidneys. Consequently, aldosterone can have an indirect effect on the incidence of LVH considering the hormone can reinforce high blood pressure. However, recent studies have suggested that aldosterone and the renin-angiotensin-aldosterone-system (RAAS) may have a direct role in leading to an increase in left ventricular mass. Patients with hyperaldosteronism, otherwise elevated circulating aldosterone, have shown high frequencies of LVH regardless of the presence of hypertension. Furthermore, cardiomyocytes have been seen to contain mineralocorticoid receptors that bind to aldosterone and can be affected by different RAAS inactivating medications. Overall, current research suggests there may be a regression between LVH and aldosterone. Methods and Results – A retrospective model comparing plasma aldosterone levels and left ventricular hypertrophy measurements in a hypertensive cohort of African Americans from the AdDReaCH trial. Follow-up over the course of a year allowed for multivariate analysis to determine whether elevated levels of plasma aldosterone induced changes in left ventricular mass and diastolic function independent of blood pressure and other variables. Left ventricular hypertrophy was assessed through various left ventricular measurements from contrast-aided MRI examinations. Though average LVMI was greater in patients with greater aldosterone-renin ratios, multivariate analysis suggested that plasma aldosterone-renin ratio does not have a significant, independent relationship to the incidence and severity of LVH. Results call for further research on the topic, as the current study confounds results from prior studies

Magnetization plateaux in an extended Shastry-Sutherland model

We study an extended two-dimensional Shastry-Sutherland model in a magnetic field where besides the usual Heisenberg exchanges of the Shastry-Sutherland model two additional SU(2) invariant couplings are included. Perturbative continous unitary transformations are used to determine the leading order effects of the additional couplings on the pure hopping and on the long-range interactions between the triplons which are the most relevant terms for small magnetization. We then compare the energy of various magnetization plateaux in the classical limit and we discuss the implications for the two-dimensional quantum magnet SrCu$_2$(BO$_3$)$_2$.Comment: 8 pages, Proceedings of the HFM2008 Conferenc

Reductions in ambulatory blood pressure in young normotensive men and women after isometric resistance training and its relationship with cardiovascular reactivity

Background: There has been very little published work exploring the comparative effects of isometric resistance training (IRT) on blood pressure (BP) in men and women. Most of the previously published work has involved men and used resting BP as the primary outcome variable. Early evidence suggests that IRT is particularly effective in older women and has a positive influence on ambulatory BP, a better predictor of disease risk. Objectives: With the WHO now placing global emphasis on the primary prevention of hypertension, the goals of this proof-of-concept study were to (i) examine whether sex differences exist in the ambulatory BP-lowering effects of IRT in young, normotensive men and women and (ii) determine whether these reductions can be predicted by simple laboratory stress tasks (a 2-min sustained isometric contraction and a math task involving subtracting a two-digit number from a series of numbers). Results: There were no differences in the IRT-induced reductions in 24-h (men: Δ4 mmHg, women: Δ4 mmHg), daytime (men: Δ3 mmHg, women: Δ4 mmHg), or night-time (men: Δ4 mmHg, women: Δ3 mmHg) ambulatory BP in men (n=13) and women (n=11) (P0.05). Conclusion: Our data suggest that lower ambulatory BP can be achieved, to a similar magnitude in young healthy women as well as men, with IRT; however, the BP-lowering effectiveness cannot be predicted by systolic BP reactivity. Taken together, this work heralds a potentially novel approach to the primary prevention of hypertension in both men and women and warrants further investigation in a larger clinical outcome trial

The role of the emergency department in the management of acute heart failure: an international perspective on education and research

Emergency departments are a major entry point for the initial management of acute heart failure (AHF) patients throughout the world. The initial diagnosis, management and disposition - the decision to admit or discharge - of AHF patients in the emergency department has significant downstream implications. Misdiagnosis, under or overtreatment, or inappropriate admission may place patients at increased risk for adverse events, and add costs to the healthcare system. Despite the critical importance of initial management, data are sparse regarding the impact of early AHF treatment delivered in the emergency department compared to inpatient or chronic heart failure management. Unfortunately, outcomes remain poor, with nearly a third of patients dying or re-hospitalised within 3 months post-discharge. In the absence of robust research evidence, consensus is an important source of guidance for AHF care. Thus, we convened an international group of practising emergency physicians, cardiologists and advanced practice nurses with the following goals to improve outcomes for AHF patients who present to the emergency department or other acute care setting through: (a) a better understanding of the pathophysiology, presentation and management of the initial phase of AHF care; (b) improving initial management by addressing knowledge gaps between best practices and current practice through education and research; and (c) to establish a framework for future emergency department-based international education and research

N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study

Background Contemporary reconsideration of diagnostic N-terminal pro–B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed. Objectives This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting. Methods Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (−) likelihood ratios (LRs) for acute HF. Results Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR− was 0.09 (95% CI: 0.05 to 0.13). Conclusions In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF