DeepCare: A Deep Dynamic Memory Model for Predictive Medicine

Personalized predictive medicine necessitates the modeling of patient illness and care processes, which inherently have long-term temporal dependencies. Healthcare observations, recorded in electronic medical records, are episodic and irregular in time. We introduce DeepCare, an end-to-end deep dynamic neural network that reads medical records, stores previous illness history, infers current illness states and predicts future medical outcomes. At the data level, DeepCare represents care episodes as vectors in space, models patient health state trajectories through explicit memory of historical records. Built on Long Short-Term Memory (LSTM), DeepCare introduces time parameterizations to handle irregular timed events by moderating the forgetting and consolidation of memory cells. DeepCare also incorporates medical interventions that change the course of illness and shape future medical risk. Moving up to the health state level, historical and present health states are then aggregated through multiscale temporal pooling, before passing through a neural network that estimates future outcomes. We demonstrate the efficacy of DeepCare for disease progression modeling, intervention recommendation, and future risk prediction. On two important cohorts with heavy social and economic burden -- diabetes and mental health -- the results show improved modeling and risk prediction accuracy.Comment: Accepted at JBI under the new name: "Predicting healthcare trajectories from medical records: A deep learning approach

Aligning Manifolds of Double Pendulum Dynamics Under the Influence of Noise

This study presents the results of a series of simulation experiments that evaluate and compare four different manifold alignment methods under the influence of noise. The data was created by simulating the dynamics of two slightly different double pendulums in three-dimensional space. The method of semi-supervised feature-level manifold alignment using global distance resulted in the most convincing visualisations. However, the semi-supervised feature-level local alignment methods resulted in smaller alignment errors. These local alignment methods were also more robust to noise and faster than the other methods.Comment: The final version will appear in ICONIP 2018. A DOI identifier to the final version will be added to the preprint, as soon as it is availabl

Hemispheric Asymmetry of Globus Pallidus Explains Reward-related Posterior Alpha Modulation in Humans

While subcortical structures such as the basal ganglia (BG) have been widely explored in relation to motor control, recent evidence suggests that their mechanisms extend to the domain of attentional switching. We here investigated the subcortical involvement in reward related top-down control of visual alpha-band oscillations (8 – 13 Hz), which have been consistently linked to the mechanisms supporting the allocation of visual spatial attention. Given that items associated with contextual saliency (e.g. monetary reward or loss) attract attention, it is not surprising that alpha oscillations are further modulated by the saliency properties of the visual items. The executive network controlling such reward-dependent modulations of oscillatory brain activity has yet to be fully elucidated. Although such network has been explored in terms of cortico-cortical interaction, it likely relies also on the contribution of subcortical regions. To uncover this, we investigated whether derived measures of subcortical structural asymmetries could predict interhemispheric modulation of alpha power during a spatial attention task. We show that volumetric hemispheric lateralization of globus pallidus (GP) and thalamus (Th) explains individual hemispheric biases in the ability to modulate posterior alpha power. Importantly, for the GP, this effect became stronger when the value-saliency parings in the task increased. Our findings suggest that the Th and GP in humans are part of a subcortical executive control network, differently involved in modulating posterior alpha activity. Further investigation aimed at uncovering the interaction between subcortical and neocortical attentional networks would provide useful insight in future studies

Occipital Alpha and Gamma Oscillations Support Complementary Mechanisms for Processing Stimulus Value Associations.

Selective attention is reflected neurally in changes in the power of posterior neural oscillations in the alpha (8–12 Hz) and gamma (40–100 Hz) bands. Although a neural mechanism that allows relevant information to be selectively processed has its advantages, it may lead to lucrative or dangerous information going unnoticed. Neural systems are also in place for processing rewarding and punishing information. Here, we examine the interaction between selective attention (left vs. right) and stimulus's learned value associations (neutral, punished, or rewarded) and how they compete for control of posterior neural oscillations. We found that both attention and stimulus–value associations influenced neural oscillations. Whereas selective attention had comparable effects on alpha and gamma oscillations, value associations had dissociable effects on these neural markers of attention. Salient targets (associated with positive and negative outcomes) hijacked changes in alpha power—increasing hemispheric alpha lateralization when salient targets were attended, decreasing it when they were being ignored. In contrast, hemispheric gamma-band lateralization was specifically abolished by negative distractors. Source analysis indicated occipital generators of both attentional and value effects. Thus, posterior cortical oscillations support both the ability to selectively attend while at the same time retaining the ability to remain sensitive to valuable features in the environment. Moreover, the versatility of our attentional system to respond separately to salient from merely positively valued stimuli appears to be carried out by separate neural processes reflected in different frequency bands

Maxillary Sinus Augmentation With Recombinant Human Bone Morphogenetic Proteinâ 2 and Particulate Allograft Without an Absorbable Sponge: A Case Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141930/1/cap0175.pd

Do MRI findings identify patients with chronic low back pain and Modic changes who respond best to rest or exercise: A subgroup analysis of a randomised controlled trial

Background: No previous clinical trials have investigated MRI findings as effect modifiers for conservative treatment of low back pain. This hypothesis-setting study investigated if MRI findings modified response to rest compared with exercise in patients with chronic low back pain and Modic changes. Methods: This study is a secondary analysis of a randomised controlled trial comparing rest with exercise. Patients were recruited from a specialised outpatient spine clinic and included in a clinical trial if they had chronic low back pain and an MRI showing Modic changes. All patients received conservative treatment while participating in the trial. Five baseline MRI findings were investigated as effect modifiers: Modic changes Type 1 (any size), large Modic changes (any type), large Modic changes Type 1, severe disc degeneration and large disc herniation. The outcome measure was change in low back pain intensity measured on a 0-10 point numerical rating scale at 14-month follow-up (n = 96). An interaction = 1.0 point (0-10 scale) between treatment group and MRI findings in linear regression was considered clinically important. Results: The interactions for Modic Type 1, with large Modic changes or with large Modic changes Type 1 were all potentially important in size (-0.99 (95% CI -3.28 to 1.29), -1.49 (-3.73 to 0.75), -1.49 (-3.57 to 0.58), respectively) but the direction of the effect was the opposite to what we had hypothesized-that people with these findings would benefit more from rest than from exercise. The interactions for severe disc degeneration (0.74 (-1.40 to 2.88)) and large disc herniation (-0.92 (3.15 to 1.31)) were less than the 1.0-point threshold for clinical importance. As expected, because of the lack of statistical power, no interaction term for any of the MRI findings was statistically significant. Conclusions: Three of the five MRI predictors showed potentially important effect modification, although the direction of the effect was surprising and confidence intervals were wide so very cautious interpretation is required. Further studies with adequate power are warranted to study these and additional MRI findings as potential effect modifiers for common interventions

Making space for experiences

Leisure and retail providers need to understand the elements of the visitor experience and the way in which they evaluate their satisfaction. This article suggests a holistic prism model of the interaction between the management and the visitor in a leisure space. This is applied to a netnographic study of visitors to a folk festival to illustrate the interconnectiveness of the different attributes causing dissatisfaction. It found that the physical and operational attributes were evaluated not through a checklist of individual features but as hindrances to the visitor's desire to make best use of the time. Visitors also evaluated the experience in the light of their own values and concerns, passing judgement on the values communicated by the management. At the heart of the experience was the enjoyment of choosing from an abundant offer and discovering something new. The main attraction is often only the pretext for enjoying the company of friends so places to meet before and chill-out afterwards are vital to the experience. The distinctiveness of the setting, the food and drink can become the sensory cues which give the event or location its uniqueness. The challenge to retail and leisure organisations is to design these elements of a memorable experience into their offerings

Seed systems smallholder farmers use

Seed can be an important entry point for promoting productivity, nutrition and resilience among smallholder farmers. While investments have primarily focused on strengthening the formal sector, this article documents the degree to which the informal sector remains the core for seed acquisition, especially in Africa. Conclusions drawn from a uniquely comprehensive data set, 9660 observations across six countries and covering 40 crops, show that farmers access 90.2 % of their seed from informal systems with 50.9 % of that deriving from local markets. Further, 55 % of seed is paid for by cash, indicating that smallholders are already making important investments in this arena. Targeted interventions are proposed for rendering formal and informal seed sector more smallholder-responsive and for scaling up positive impacts