Fairness and Privacy in Federated Learning and Their Implications in Healthcare

Currently, many contexts exist where distributed learning is difficult or otherwise constrained by security and communication limitations. One common domain where this is a consideration is in Healthcare where data is often governed by data-use-ordinances like HIPAA. On the other hand, larger sample sizes and shared data models are necessary to allow models to better generalize on account of the potential for more variability and balancing underrepresented classes. Federated learning is a type of distributed learning model that allows data to be trained in a decentralized manner. This, in turn, addresses data security, privacy, and vulnerability considerations as data itself is not shared across a given learning network nodes. Three main challenges to federated learning include node data is not independent and identically distributed (iid), clients requiring high levels of communication overhead between peers, and there is the heterogeneity of different clients within a network with respect to dataset bias and size. As the field has grown, the notion of fairness in federated learning has also been introduced through novel implementations. Fairness approaches differ from the standard form of federated learning and also have distinct challenges and considerations for the healthcare domain. This paper endeavors to outline the typical lifecycle of fair federated learning in research as well as provide an updated taxonomy to account for the current state of fairness in implementations. Lastly, this paper provides added insight into the implications and challenges of implementing and supporting fairness in federated learning in the healthcare domain

Developing a Resilient, Robust and Efficient Supply Network in Africa

Purpose — Supply chains need to balance competing objectives; in addition to efficiency, supply chains need to be resilient to adversarial and environmental interference and robust to uncertainties in long-term demand. Significant research has been conducted designing efficient supply chains and recent research has focused on resilient supply chain design. However, the integration of resilient and robust supply chain design is less well studied. The purpose of the paper is to include resilience and robustness into supply chain design. Design/methodology/approach — The paper develops a method to include resilience and robustness into supply chain design. Using the region of West Africa, which is plagued with persisting logistical issues, the authors develop a regional risk assessment framework and then apply categorical risk to the countries of West Africa using publicly available data. A scenario reduction technique is used to focus on the highest risk scenarios for the model to be tractable. Next, the authors develop a mathematical model leveraging this framework to design a resilient supply network that minimizes cost while ensuring the network functions following a disruption. Finally, the authors examine the network\u27s robustness to demand uncertainty via several plausible emergency scenarios. Findings — The authors provide optimal sets of transshipment hubs with varying counts from 5 through 15 hubs. The authors determine there is no feasible solution that uses only five transshipment hubs. The authors\u27 findings reinforce those seven transshipment hubs – the solution currently employed in West Africa – is the cheapest architecture to achieve resilience and robustness. Additionally, for each set of feasibility transshipment hubs, the authors provide connections between hubs and demand spokes. Originality/value — While, at the time of this research, three other manuscripts incorporated both resilience and robustness of the authors\u27 research unique solved the problem as a network flow instead of as a set covering problem. Additionally, the authors establish a novel risk framework to guide the required amount of redundancy, and finally the out research proposes a scenario reduction heuristic to allow tractable exploration of 512 possible demand scenarios

Risk for Postoperative Delirium Related to Comorbidities in Older Adult Cardiac Patients: Systematic Review

Background/objective: Delirium is defined as a sudden onset of confusion due to disruption in normal brain functioning. Although highly prevalent in post-operative patients, most significantly the older adult population, limited research exists explaining why its onset occurs. Due to its broadness, this study serves to determine what specific comorbidities contribute to the development of post-operative delirium in older adults after cardiac surgeries. Methods: Research was conducted through PubMed and EBSCO. The possible Boolean operators used were “cardiac or post cardiac surgery”, “postoperative delirium or confusion or cognitive decline” and “risk factors or comorbidities or chronic illness or healthy”. Studies were narrowed to a specific group of elderly patients and the occurrence of post-operative delirium after cardiac surgery in those with comorbidities. The following scales were used to determine level of delirium after surgery: DSM5, Confusion Assessment Method, MMSE, Richmond Agitation Sedation Scale, and the Delirium Observation Scale. Results: Thirteen articles were selected for the study. The following comorbidities were identified in the studies: Diabetes mellitus, atrial fibrillation, depression, impaired olfaction, pre-existing cerebrovascular disease, pre-existing cardiovascular disease, insomnia, and frailty. Conclusion: Among all of the older adults studied, there was a strong relationship between comorbidities and the development of postoperative delirium. Keywords: postoperative delirium, elderly patients, cardiac surgery, comorbiditie

The complete mitochondrial genome of the plumed worm Diopatra cuprea (Annelida: Onuphidae)

In this study, we describe the complete mitochondrial genome of Diopatra cuprea (Bosc, 1802). The mitogenome was found to contain 14,990 base pairs (67.53% A + T content), with a total of 37 genes (13 protein coding, 22 transfer RNAs, and 2 ribosomal RNAs). This study also examined mitogenome phylogenetics relationships of closely related species and recovered that D. cuprea is closely related to eunicids. This work has added to the genetic resources for furthering evolutionary studies of Annelida

Risk for post-operative delirium related to comorbidities in older adult cardiac patients: An integrative review

Background: Delirium is defined as a sudden onset of confusion due to disruption in normal brain functioning. Although it is highly prevalent in post-operative patients, most significantly the older adult population, limited information exists explaining why its onset occurs. Purpose: This integrative review aimed to synthesise specific comorbidities that can contribute to the development of post-operative delirium in older adult cardiac surgical patients. Methods: PRISMA statement was used to report the identification, selection, appraisal and synthesis of articles and the PRISMA diagram reports the selection process. The Johns Hopkins Evidence-Based Practice Tools were used as guide in literature review, critical analysis, levelling of evidence and quality rating. PubMed, ProQuest, CINAHL plus, EMBASE, MEDLINE, Ovid Nursing Collection and Cochrane databases were searched from 2015 to 2020. Results: The initial search yielded 1529 articles. Following the removal of duplicates and screening, 14 articles were included for this review. The following comorbidities were identified in the studies: Diabetes mellitus, atrial fibrillation, depression, impaired olfaction, pre-existing cerebrovascular disease, pre-existing cardiovascular disease, insomnia and frailty. Conclusion: There was a strong indication of the development of post-operative delirium among older adult cardiac surgical patients with comorbidities. Relevance to clinical practice: Awareness of the impact of comorbidities in developing post-operative delirium may help healthcare providers to plan and implement proper care management among older adult cardiac surgical patients with comorbidities

Prospective Evaluation of Weight-Based Prophylactic Enoxaparin Dosing in Critically Ill Trauma Patients: Adequacy of AntiXa Levels is Improved.

Venous thromboembolism (VTE) is a leading cause of death in multisystem trauma patients; the importance of VTE prevention is well recognized. Presently, standard dose enoxaparin (30 mg BID) is used as chemical prophylaxis, regardless of weight or physiologic status. However, evidence suggests decreased bioavailability of enoxaparin in critically ill patients. Therefore, we hypothesized that a weight-based enoxaparin dosing regimen would provide more adequate prophylaxis (as indicated by antifactor Xa levels) for patients in our trauma intensive care unit (TICU).These data were prospectively collected in TICU patients admitted over a 5-month period given twice daily 0.6 mg/kg enoxaparin (actual body weight). Patients were compared with a historical cohort receiving standard dosing. Anti-Xa levels were collected at 11.5 hours (trough, goal ≥ 0.1 IU/mL) after each evening administration. Patient demographics, admission weight, dose, and daily anti-Xa levels were recorded. Patients with renal insufficiency or brain, spine, or spinal cord injury were excluded. Data were collected from 26 patients in the standard-dose group and 37 in the weight-based group. Sixty-four trough anti-Xa measurements were taken in the standard dose group and 74 collected in the weight-based group. Evaluating only levels measured after the third dose, the change in dosing of enoxaparin from 30 to 0.6 mg/kg resulted in an increased percentage of patients with goal antifactor Xa levels from 8 per cent to 61 per cent (P \u3c 0.0001). Examining all troughs, the change in dose resulted in an increase in patients with a goal anti-Xa level from 19 to 59 per cent (P \u3c 0.0001). Weight-based dosing of enoxaparin in trauma ICU patients yields superior results with respect to adequate anti-Xa levels when compared with standard dosing. These findings suggest that weight-based dosing may provide superior VTE prophylaxis in TICU patients. Evaluation of the effects of this dosing paradigm on actual VTE rate is ongoing at our institution