Improving Navy recruiting with data farming

Proceedings of the 2016 Winter Simulation Conference T. M. K. Roeder, P. I. Frazier, R. Szechtman, E. Zhou, T. Huschka, and S. E. Chick, eds.Secretary of the Navy Ray Mabus states that people provide “the Navy and Marine Corps’ greatest edge” (Mabus, 2015). To help recruit and manage this dynamic workforce of more than 300,000 active duty Sailors, the Navy uses mathematical models and simulation to assess the potential impacts and risks of changes to force structure, budgets, policies, and the economy. One important model is the Planned Re-source Optimization (PRO) model. PRO is currently being used to inform recruiting resourcing decisions. The decisions may involve, for example, advertising, enlistment bonuses, number of production recruiters, etc. A limitation of PRO is the lack of an interface to facilitate extensive experimentation. This paper summarizes an effort underway to enhance the analytic utility of the PRO model by embedding it in a data farming environment. This enhanced tool is called the “Planned Resource Optimization Model with Ex-perimental Design” (PROM-WED)

Investigating the role of antibody-dependent cellular cytotoxicity in the prevention of mother-to-child-transmission of HIV-1 through breastfeeding

Immune correlates of protection against Human Immunodeficiency Virus Type 1 (HIV-1) acquisition in humans remain unknown. The role of antibodies in providing protection, either through neutralization to prevent virions from infecting cells or Fragment crystallizable (Fc) effector functions to help clear already infected cells, are poorly understood. Previous work fails to support neutralizing antibodies (nAbs) as an in vivo protective correlate, therefore we sought to investigate whether the Fc effector function, antibody-dependent cellular cytotoxicity (ADCC), was protective. Mother-to-child-transmission (MTCT) cohorts provide a model of passive immunization and viral challenge, because infants acquire antibodies from their mother throughout gestation and breastfeeding and are consistently exposed to HIV. We hypothesized that infants of non-transmitting mothers would be protected due to higher ADCC responses compared to transmitting mother-infant pairs. To address our hypothesis, we developed a cell line susceptible to viruses incorporating HIV envelopes (Envs) isolated from maternal plasma for use in a luciferase-based ADCC assay. Serum samples came from the control arm of the Breastfeeding, Antiretroviral, and Nutrition (BAN) cohort in Malawi where HIV-infected mothers that transmitted (TM) infection to their infants were matched to two non-transmitting (NTM) mothers on parameters known to be important in MTCT, including maternal age, viral load, absolute CD4 count, and time to sample collection. All transmission events occurred during breastfeeding and the samples assessed in this study came from a timepoint prior to documented transmission. HIV-exposed but uninfected (HEU) infants had significantly higher levels of ADCC responses against their corresponding mother’s variants compared to HIV-exposed infected (HEI) infants. Additionally, higher ADCC was associated with reduced morbidity and mortality in infected infants up to 1 year after birth. Although nAbs were previously determined to not play a role in the prevention of MTCT in this cohort, our data suggests that neutralization and ADCC are independent antibody responses that may act in conjunction to prevent transmission. In order to utilize these protective antibodies in a preventative HIV-1 vaccine, the antibodies must recognize a range of Envs to be effective globally. ADCC breadth and potency (ADCCBP) was determined against a panel of heterologous globally diverse variants, unrelated to the infected mother’s Envs. No significant difference in ADCCBP was observed between TM and NTM mother-infant pairs. However, we identified samples with elite ADCCBP, specified as the top 5% of samples tested, and future HIV-1 vaccines may want to elicit the types of antibodies present in these samples. In summary, maternally acquired ADCC correlates with protection against HIV-1 transmission to exposed infants and is associated with lower infant morbidity up to 1 year after birth. Further characterization of antibodies with elite ADCCBP may be helpful in developing an effective vaccine.

Association Between High Perceived Stress Over Time and Incident Hypertension in Black Adults: Findings From the Jackson Heart Study.

Background Chronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community-based cohort of blacks. Methods and Results Analyses included 1829 participants without hypertension at baseline (Exam 1, 2000-2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005-2008) or Exam 3 (2009-2012). Each follow-up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported "a lot" or "extreme" stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow-up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age-, sex-, and time-adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04-1.37) and 1.37 (1.20-1.57), respectively (P trend<0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001). Conclusions In a community-based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk

LSR/angulin-1 is a tricellular tight junction protein involved in blood-brain barrier formation.

The blood-brain barrier (BBB) is a term used to describe the unique properties of central nervous system (CNS) blood vessels. One important BBB property is the formation of a paracellular barrier made by tight junctions (TJs) between CNS endothelial cells (ECs). Here, we show that Lipolysis-stimulated lipoprotein receptor (LSR), a component of paracellular junctions at points in which three cell membranes meet, is greatly enriched in CNS ECs compared with ECs in other nonneural tissues. We demonstrate that LSR is specifically expressed at tricellular junctions and that its expression correlates with the onset of BBB formation during embryogenesis. We further demonstrate that the BBB does not seal during embryogenesis in Lsr knockout mice with a leakage to small molecules. Finally, in mouse models in which BBB was disrupted, including an experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis and a middle cerebral artery occlusion (MCAO) model of stroke, LSR was down-regulated, linking loss of LSR and pathological BBB leakage

Using a resource effect study pre-pilot to inform a large randomized trial: the Decide2Quit.Org Web-assisted tobacco intervention

Resource effect studies can be useful in highlighting areas of improvement in informatics tools. Before a large randomized trial, we tested the functions of the Decide2Quit.org Web-assisted tobacco intervention using smokers (N=204) recruited via Google advertisements. These smokers were given access to Decide2Quit.org for six months and we tracked their usage and assessed their six months cessation using a rigorous follow-up. Multiple, interesting findings were identified: we found the use of tailored emails to dramatically increase participation for a short period. We also found varied effects of the different functions. Functions supporting seeking social support (Your Online Community and Family Tools), Healthcare Provider Tools, and the Library had positive effects on quit outcomes. One surprising finding, which needs further investigation, was that writing to our Tobacco Treatment Specialists was negatively associated with quit outcomes

Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: a national hybrid type 2 implementation study

BACKGROUND: Effective web-assisted tobacco interventions (WATIs) have been underutilized by smokers; moreover, despite practice guideline recommendations, clinical teams do not routinely refer smokers to WATIs. Our goal was to test a clinical practice innovation, an ePortal designed to change practice and patient behavior. Our hypotheses were that the integrated system would result in increased smoker referrals, with an automated follow-up system resulting in more smoker registrations and finally augmentations of the WATI would result in more smokers quitting at 6 months. METHODS: Practice ePortal Implementation Trial: Practices (n = 174) were randomized to an online practice ePortal with an e-referral tool to the WATI (e-referred smokers received automated email reminders from the practice) and with practice feedback reports with patient tracking and practice-to-patient secure messaging versus comparison (a paper referral prescription ). Implementation success was measured by the number of smokers referred and smokers registering. Clinical Effectiveness Trial: To estimate the effectiveness of the WATI components on 6-month smoking cessation, registered smokers were randomized into three groups: a state-of-the-art tailored WATI control [control], the WATI enhanced with proactive, pushed tailored email motivational messaging (messaging), and the WATI with messaging further enhanced with personal secure messaging with a tobacco treatment specialist and an online support group (personalized). RESULTS: Practice ePortal Trial results: A total of 4789 smokers were referred. The mean smokers referred per practice was not statistically different by group (ePortal 24.89 (SD 22.29) versus comparison 30.15 (SD 25.45), p = 0.15). The e-referral portal implementation program resulted in nearly triple the rate of smoker registration (31 % of all smokers referred registered online) versus comparison (11 %, p \u3c 0.001). Clinical Effectiveness Trial results: Active smokers randomized to the personalized group had a 6-month cessation rate of 25.2 %, compared with the messaging group (26.7 %) and the control (17 %). Next, when using an inverse probability weighted selection model to account for attrition, those randomized to the two groups that received motivational messaging (messaging or personalized) were more likely to quit than those in the control (p = 0.04). CONCLUSIONS: Among all smokers referred, the e-referral resulted in nearly threefold greater registrants (31 %) than paper (11 %). The practice ePortal smokers received multiple reminders (increasing registration opportunities), and the practices could track patient progress. The result was more smokers registering and, thus, more cessation opportunities. Combining the proactive referral and the WATI resulted in higher rates of smoking cessation. TRIAL REGISTRATION: Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628

Optical Fiber Distributed Sensing Structural Health Monitoring (SHM) Strain Measurements Taken During Cryotank Y-Joint Test Article Load Cycling at Liquid Helium Temperatures

This paper outlines cryogenic Y-joint testing at Langley Research Center (LaRC) to validate the performance of optical fiber Bragg grating strain sensors for measuring strain at liquid helium temperature (-240 C). This testing also verified survivability of fiber sensors after experiencing 10 thermal cool-down, warm-up cycles and 400 limit load cycles. Graphite composite skins bonded to a honeycomb substrate in a sandwich configuration comprised the Y-joint specimens. To enable SHM of composite cryotanks for consideration to future spacecraft, a light-weight, durable monitoring technology is needed. The fiber optic distributed Bragg grating strain sensing system developed at LaRC is a viable substitute for conventional strain gauges which are not practical for SHM. This distributed sensing technology uses an Optical Frequency Domain Reflectometer (OFDR). This measurement approach has the advantage that it can measure hundreds of Bragg grating sensors per fiber and the sensors are all written at one frequency, greatly simplifying fiber manufacturing. Fiber optic strain measurements compared well to conventional strain gauge measurements obtained during these tests. These results demonstrated a high potential for a successful implementation of a SHM system incorporating LaRC's fiber optic sensing system on the composite cryotank and other future cryogenic applications

Comparison of a Collective Intelligence Tailored Messaging System on Smoking Cessation Between African American and White People Who Smoke: Quasi-Experimental Design

BACKGROUND: The Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT) is a machine learning recommender system with a database of messages to motivate smoking cessation. PERSPeCT uses the collective intelligence of users (ie, preferences and feedback) and demographic and smoking profiles to select motivating messages. PERSPeCT may be more beneficial for tailoring content to minority groups influenced by complex, personally relevant factors. OBJECTIVE: The objective of this study was to describe and evaluate the use of PERSPeCT in African American people who smoke compared with white people who smoke. METHODS: Using a quasi-experimental design, we compared African American people who smoke with a historical cohort of white people who smoke, who both received up to 30 emailed tailored messages over 65 days. People who smoke rated the daily message in terms of perceived influence on quitting smoking for 30 days. Our primary analysis compared daily message ratings between the two groups using a t test. We used a logistic model to compare 30-day cessation between the two groups and adjusted for covariates. RESULTS: The study included 119 people who smoke (African Americans, 55/119; whites, 64/119). At baseline, African American people who smoke were significantly more likely to report allowing smoking in the home (P=.002); all other characteristics were not significantly different between groups. Daily mean ratings were higher for African American than white people who smoke on 26 of the 30 days (P \u3c .001). Odds of quitting as measured by 30-day cessation were significantly higher for African Americans (odds ratio 2.3, 95% CI 1.04-5.53; P=.03) and did not change after adjusting for allowing smoking at home. CONCLUSIONS: Our study highlighted the potential of using a recommender system to personalize for African American people who smoke. TRIAL REGISTRATION: ClinicalTrials.gov NCT02200432; https://clinicaltrials.gov/ct2/show/NCT02200432. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/jmir.6465. Kathleen M Mazor, Thomas K Houston, Rajani S Sadasivam. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 27.04.2020

Osteomyelitis of the ribs in children: a rare and potentially challenging diagnosis

Background Rib osteomyelitis is rare in children and can mimic other pathologies. Imaging has a major role in the diagnosing rib osteomyelitis. Objective To evaluate clinical presentation and imaging findings in children with rib osteomyelitis. Materials and methods We performed a retrospective (2009–2018) study on children with rib osteomyelitis verified by either positive culture or pathology. We excluded children with multifocal osteomyelitis or empyema necessitans. We reviewed medical charts for clinical, laboratory and pathology data, and treatment. All imaging modalities for rib abnormalities were evaluated for presence and location of osteomyelitis and abscess. We calculated descriptive statistics to compare patient demographics, clinical presentation and imaging findings. Results The study group included 10 children (6 boys, 4 girls), with an average age of 7.3 years (range, 3 months to 15.9 years). The most common clinical presentations were fever (n=8) and pain (n=5). Eight children had elevated inflammatory indices (leukocytosis, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]). Localized chest wall swelling was found initially in six children and later in two more children. Rib osteomyelitis was suspected on presentation in only two children. All children had chest radiographs. Rib lytic changes were found on only one chest radiograph, in two of the four ultrasound studies, and in four of eight CTs. Bone marrow signal abnormalities were seen in all eight MRIs. In nine children the osteomyelitis involved the costochondral junction. Six children had an associated abscess. Staphylococcus aureus was cultured in eight children. Osteomyelitis was diagnosed based on pathology in one child with negative cultures. Conclusion While rib osteomyelitis is rare, imaging findings of lytic changes at the costochondral junction combined with a history of fever, elevated inflammatory markers or localized soft-tissue swelling in the chest should raise suspicion for this disease