Variation in Treatment of Patients With Inflammatory Bowel Diseases at Major Referral Centers in the United States

We performed a prospective study of patients with inflammatory bowel diseases to examine variations in treatment among medical centers. In a prospective cohort study of 1659 patients with CD and 946 patients with UC seen at 7 high-volume referral centers, we collected data on demographics, disease characteristic, and medical and surgical treatments. We used logistic regression to determine differences in treatment among centers, controlling for potential confounders. We found significant variations among centers in treatment of CD with immunomodulators (odds ratio [OR], 3.34; 95% confidence interval [CI], 2.09 – 5.32) but not anti-tumor necrosis factor agents (OR, 1.64; 95% CI, 0.97 – 2.77). There was less variation in treatment of UC; we found no difference in use of immunomodulators (OR,1.83 95% CI, 1.00 – 3.36) or anti-TNF therapy (OR, 0.81; 95% CI, 0.40 – 1.65). Development and implementation of evidence-based standards of care for IBD may help reduce variation and improve outcomes

Optimistic Planning for Markov Decision Processes

International audienceThe reinforcement learning community has recently intensified its interest in online planning methods, due to their relative independence on the state space size. However, tight near-optimality guarantees are not yet available for the general case of stochastic Markov decision processes and closed-loop, state-dependent planning policies. We therefore consider an algorithm related to AO* that optimistically explores a tree representation of the space of closed-loop policies, and we analyze the near-optimality of the action it returns after n tree node expansions. While this optimistic planning requires a finite number of actions and possible next states for each transition, its asymptotic performance does not depend directly on these numbers, but only on the subset of nodes that significantly impact near-optimal policies. We characterize this set by introducing a novel measure of problem complexity, called the near-optimality exponent. Specializing the exponent and performance bound for some interesting classes of MDPs illustrates the algorithm works better when there are fewer near-optimal policies and less uniform transition probabilities

Multi-omic approach identifies hypoxic tumor-associated myeloid cells that drive immunobiology of high-risk pediatric ependymoma.

Ependymoma (EPN) is a devastating childhood brain tumor. Single-cell analyses have illustrated the cellular heterogeneity of EPN tumors, identifying multiple neoplastic cell states including a mesenchymal-differentiated subpopulation which characterizes the PFA1 subtype. Here, we characterize the EPN immune environment, in the context of both tumor subtypes and tumor cell subpopulations using single-cell sequencing (scRNAseq, n = 27), deconvolution of bulk tumor gene expression (n = 299), spatial proteomics (n = 54), and single-cell cytokine release assays (n = 12). We identify eight distinct myeloid-derived subpopulations from which a group of cells, termed hypoxia myeloid cells, demonstrate features of myeloid-derived suppressor cells, including IL6/STAT3 pathway activation and wound healing ontologies. In PFA tumors, hypoxia myeloid cells colocalize with mesenchymal-differentiated cells in necrotic and perivascular niches and secrete IL-8, which we hypothesize amplifies the EPN immunosuppressive microenvironment. This myeloid cell-driven immunosuppression will need to be targeted for immunotherapy to be effective in this difficult-to-cure childhood brain tumor. [Abstract copyright: © 2023 The Author(s).

OPTICAL SLIP-RING CONNECTOR

International Telemetering Conference Proceedings / October 25-28, 1999 / Riviera Hotel and Convention Center, Las Vegas, NevadaCurrent ground-based tracking systems at the DoD test and training ranges require transmission of a variety of signals from rotating platform to fixed control and process center. Implementation of commercial off the shelf (COTS) solution for transmitting high-speed, multiple-channel data signals over a rotational platform prompt the development of an advanced electro-optic hybrid rotating-to-fixed information transmission technology. Based on current demand, an Air Force-sponsored Small Business Innovative Research (SBIR) contract has been awarded to Physical Optics Corporation (POC) to modify existing tracking mounts with a unique electro-optic hybrid rotary joint (EOHRJ). The EOHRJ under current development is expected to provide the following features: 1) include a specially designed electrical slip-ring, which is able to accommodate hundreds of transmission channels, including electrical power, control, feedback, and low-speed data signals; 2) include an optical fiber slip-ring which, by incorporating with electrical time division mulitplexing (TDM) and optical wavelength division multiplexing (WDM) technologies, is able to provide multiple channel, high data rate (over gigabits per second), and bi-directional signal transmission; and 3) is designed to be reliable for harsh environmental operation, adaptive to stringent size requirement, and accommodating to existing electrical and mechanical interfaces. Besides the military use, other possible commercial applications include on board monitoring of satellite spinners, surveillance systems, instrumentation and multi spectral vision systems, emergency/medical instruments, remote sensing, and robotics.International Foundation for TelemeteringProceedings from the International Telemetering Conference are made available by the International Foundation for Telemetering and the University of Arizona Libraries. Visit http://www.telemetry.org/index.php/contact-us if you have questions about items in this collection

Electro-Optic Hybrid Rotary Joint (EOHRJ)

International Telemetering Conference Proceedings / October 23-26, 2000 / Town & Country Hotel and Conference Center, San Diego, CaliforniaAn advanced electro-optic hybrid rotary joint (EOHRJ) has been developed in Phase II of an AF SBIR effort with Physical Optics Corporation (POC) to replace cable wrap structure for multi-channel rotation-to-fixed (RTF) signal transmission. The EOHRJ meets AFFTC and other range special needs with a generic, high performance, rotary joint solution. At the moment, we have successfully installed and tested the EOHRJ on our KTM tracker system with the following capabilities: 1) able to accommodate hundreds of transmission channels, including electrical power, control, feedback, and low-speed signals; 2) able to accommodate multiple channel, high data rate (over gigabits per second), and bi-directional signal transmission; 3) able to be reliable for harsh environmental operation, adaptive to stringent sized requirement, and accommodating existing electrical and mechanical interfaces. The completed EOHRJ contains three uniquely integrated functional rings. The first and the outmost one is power ring, which provides RTF transmission channels for over 50 high voltage and high current channels. The second and the middle one is low speed electrical signal ring, which provides RTF transmission for over hundred control, feedback, and low speed data signals. The third and the inmost one is optical fiber slip ring, which, incorporating with current advanced signal multiplexing technologies (either time division or wavelength division multiplexing ) is able to provide multiple channel, high data rate, and bi-directional signal transmission. At the moment, the prototype module of the tree-layer EOHRJ has been successfully assembled in Air Force’s tracker system, and is providing a satisfactory performance. This paper presents our joint work on this project.International Foundation for TelemeteringProceedings from the International Telemetering Conference are made available by the International Foundation for Telemetering and the University of Arizona Libraries. Visit http://www.telemetry.org/index.php/contact-us if you have questions about items in this collection

Variation in Treatment of Patients With Inflammatory Bowel Diseases at Major Referral Centers in the United States

We performed a prospective study of patients with inflammatory bowel diseases to examine variations in treatment among medical centers. In a prospective cohort study of 1659 patients with CD and 946 patients with UC seen at 7 high-volume referral centers, we collected data on demographics, disease characteristic, and medical and surgical treatments. We used logistic regression to determine differences in treatment among centers, controlling for potential confounders. We found significant variations among centers in treatment of CD with immunomodulators (odds ratio [OR], 3.34; 95% confidence interval [CI], 2.09 – 5.32) but not anti-tumor necrosis factor agents (OR, 1.64; 95% CI, 0.97 – 2.77). There was less variation in treatment of UC; we found no difference in use of immunomodulators (OR,1.83 95% CI, 1.00 – 3.36) or anti-TNF therapy (OR, 0.81; 95% CI, 0.40 – 1.65). Development and implementation of evidence-based standards of care for IBD may help reduce variation and improve outcomes

The FreeMABSys project and the BLAD libraries

International audienceNo abstrac