Utilizing the Boston Syncope Observation Management Pathway to Reduce Hospital Admission and Decrease Adverse Outcomes

Introduction: In an age of increasing scrutiny of each hospital admission, emergency department (ED) observation has been identified as a low-cost alternative. Prior studies have shown admission rates for syncope in the United States to be as high as 70%. However, the safety and utility of substituting ED observation unit (EDOU) syncope management has not been well studied. The objective of this study was to evaluate the safety of EDOU for the management of patients presenting to the ED with syncope and its efficacy in reducing hospital admissions. Methods: This was a prospective before-and-after cohort study of consecutive patients presenting with syncope who were seen in an urban ED and were either admitted to the hospital, discharged, or placed in the EDOU. We first performed an observation study of syncope management and then implemented an ED observation-based management pathway. We identified critical interventions and 30-day outcomes. We compared proportions of admissions and adverse events rates with a chisquared or Fisher’s exact test. Results: In the “before” phase, 570 patients were enrolled, with 334 (59%) admitted and 27 (5%) placed in the EDOU; 3% of patients discharged from the ED had critical interventions within 30 days and 10% returned. After the management pathway was introduced, 489 patients were enrolled; 34% (p\u3c0.001) of pathway patients were admitted while 20% were placed in the EDOU; 3% (p=0.99) of discharged patients had critical interventions at 30 days and 3% returned (p=0.001). Conclusion: A focused syncope management pathway effectively reduces hospital admissions and adverse events following discharge and returns to the ED. [West J Emerg Med. 2019;20(2)250–255.

Distributed Information Bottleneck for a Primitive Gaussian Diamond MIMO Channel

This paper considers the distributed information bottleneck (D-IB) problem for a primitive Gaussian diamond channel with two relays and MIMO Rayleigh fading. The channel state is an independent and identically distributed (i.i.d.) process known at the relays but unknown to the destination. The relays are oblivious, i.e., they are unaware of the codebook and treat the transmitted signal as a random process with known statistics. The bottleneck constraints prevent the relays to communicate the channel state information (CSI) perfectly to the destination. To evaluate the bottleneck rate, we provide an upper bound by assuming that the destination node knows the CSI and the relays can cooperate with each other, and also two achievable schemes with simple symbol-by-symbol relay processing and compression. Numerical results show that the lower bounds obtained by the proposed achievable schemes can come close to the upper bound on a wide range of relevant system parameters

Probabilistic Reconstruction in Compressed Sensing: Algorithms, Phase Diagrams, and Threshold Achieving Matrices

Compressed sensing is a signal processing method that acquires data directly in a compressed form. This allows one to make less measurements than what was considered necessary to record a signal, enabling faster or more precise measurement protocols in a wide range of applications. Using an interdisciplinary approach, we have recently proposed in [arXiv:1109.4424] a strategy that allows compressed sensing to be performed at acquisition rates approaching to the theoretical optimal limits. In this paper, we give a more thorough presentation of our approach, and introduce many new results. We present the probabilistic approach to reconstruction and discuss its optimality and robustness. We detail the derivation of the message passing algorithm for reconstruction and expectation max- imization learning of signal-model parameters. We further develop the asymptotic analysis of the corresponding phase diagrams with and without measurement noise, for different distribution of signals, and discuss the best possible reconstruction performances regardless of the algorithm. We also present new efficient seeding matrices, test them on synthetic data and analyze their performance asymptotically.Comment: 42 pages, 37 figures, 3 appendixe

Hadamard upper bound on optimum joint decoding capacity of Wyner Gaussian cellular MAC

This article presents an original analytical expression for an upper bound on the optimum joint decoding capacity of Wyner circular Gaussian cellular multiple access channel (C-GCMAC) for uniformly distributed mobile terminals (MTs). This upper bound is referred to as Hadamard upper bound (HUB) and is a novel application of the Hadamard inequality established by exploiting the Hadamard operation between the channel fading matrix G and the channel path gain matrix Ω. This article demonstrates that the actual capacity converges to the theoretical upper bound under the constraints like low signal-to-noise ratios and limiting channel path gain among the MTs and the respective base station of interest. In order to determine the usefulness of the HUB, the behavior of the theoretical upper bound is critically observed specially when the inter-cell and the intra-cell time sharing schemes are employed. In this context, we derive an analytical form of HUB by employing an approximation approach based on the estimation of probability density function of trace of Hadamard product of two matrices, i.e., G and Ω. A closed form of expression has been derived to capture the effect of the MT distribution on the optimum joint decoding capacity of C-GCMAC. This article demonstrates that the analytical HUB based on the proposed approximation approach converges to the theoretical upper bound results in the medium to high signal to noise ratio regime and shows a reasonably tighter bound on optimum joint decoding capacity of Wyner GCMAC

Digestibility of resistant starch containing preparations using two in vitro models

BACKGROUND: Resistant starch (RS) is known for potential health benefits in the human colon. To investigate these positive effects it is important to be able to predict the amount, and the structure of starch reaching the large intestine. AIM OF THE STUDY: The aim of this study was to compare two different in vitro models simulating the digestibility of two RS containing preparations. METHODS: The substrates, high amylose maize (HAM) containing RS type 2, and retrograded long chain tapioca maltodextrins (RTmd) containing RS type 3 were in vitro digested using a batch and a dynamic model, respectively. Both preparations were characterized before and after digestion by using X-Ray and DSC, and by measuring their total starch, RS and protein contents. RESULTS: Using both digestion models, 60-61 g/100 g of RTmd turned out to be indigestible, which is very well in accordance with 59 g/100 g found in vivo after feeding RTmd to ileostomy patients. In contrast, dynamic and batch in vitro digestion experiments using HAM as a substrate led to 58 g/100 g and 66 g/100 g RS recovery. The degradability of HAM is more affected by differences in experimental parameters compared to RTmd. The main variations between the two in vitro digestion methods are the enzyme preparations used, incubation times and mechanical stress exerted on the substrate. However, for both preparations dynamically digested fractions led to lower amounts of analytically RS and a lower crystallinity. CONCLUSIONS: The two in vitro digestion methods used attacked the starch molecules differently, which influenced starch digestibility of HAM but not of RTmd

Secured Communication over Frequency-Selective Fading Channels: a practical Vandermonde precoding

In this paper, we study the frequency-selective broadcast channel with confidential messages (BCC) in which the transmitter sends a confidential message to receiver 1 and a common message to receivers 1 and 2. In the case of a block transmission of N symbols followed by a guard interval of L symbols, the frequency-selective channel can be modeled as a N * (N+L) Toeplitz matrix. For this special type of multiple-input multiple-output (MIMO) channels, we propose a practical Vandermonde precoding that consists of projecting the confidential messages in the null space of the channel seen by receiver 2 while superposing the common message. For this scheme, we provide the achievable rate region, i.e. the rate-tuple of the common and confidential messages, and characterize the optimal covariance inputs for some special cases of interest. It is proved that the proposed scheme achieves the optimal degree of freedom (d.o.f) region. More specifically, it enables to send l <= L confidential messages and N-l common messages simultaneously over a block of N+L symbols. Interestingly, the proposed scheme can be applied to secured multiuser scenarios such as the K+1-user frequency-selective BCC with K confidential messages and the two-user frequency-selective BCC with two confidential messages. For each scenario, we provide the achievable secrecy degree of freedom (s.d.o.f.) region of the corresponding frequency-selective BCC and prove the optimality of the Vandermonde precoding. One of the appealing features of the proposed scheme is that it does not require any specific secrecy encoding technique but can be applied on top of any existing powerful encoding schemes.Comment: To appear in EURASIP journal on Wireless Communications and Networking, special issue on Wireless Physical Security, 200