Konzeption und Umsetzung von skalierbaren Algorithmen zur modellbasierten Antennenkalibrierung fur mehrkanalige SAR Sensoren auf verteilten HPC Systemen

Mehr Aufnahmekanäle und genauere Daten machen in der Erdbeobachtung mit dem Radar mit synthetischer Apertur präzisere Modelle und besser skalierende Implementierungen von Kalibrierverfahren notwendig. Ein modellbasiertes Kalibrierverfahren wird auf der Basis einer bestehenden Funktionalität zur Rohdatenanalyse in einer verteilten Spark-Umgebung umgesetzt. Diese Auswertung der Analyseergebnisse bestimmt die dreidimensionale Position des Antennenphasenzentrums unter Berücksichtigung der optimalen Kanalkonsistenz, die Antennenblickrichtungswinkel sowie die Basislinien der einzelnen Antennen untereinander. Zum effizienten Aufstellen und Lösen der Modelle wird die Methode der kleinsten Quadrate angewendet und darauf aufbauend zur Verbesserung des Verhaltens mit realen Messdaten eine L1-Norm Minimierung entwickelt. Die Korrektheit der Implementierung der einzelnen Komponenten sowie der Gesamtimplementierung wird verifiziert. Eine vergleichbare Genauigkeit bei einer um eine Größenordnung geringeren Laufzeit als in der bestehenden Referenzimplementierung wird erzielt

Leveraging driver vehicle and environment interaction: Machine learning using driver monitoring cameras to detect drunk driving

Excessive alcohol consumption causes disability and death. Digital interventions are promising means to promote behavioral change and thus prevent alcohol-related harm, especially in critical moments such as driving. This requires real-time information on a person's blood alcohol concentration (BAC). Here, we develop an in-vehicle machine learning system to predict critical BAC levels. Our system leverages driver monitoring cameras mandated in numerous countries worldwide. We evaluate our system with n=30 participants in an interventional simulator study. Our system reliably detects driving under any alcohol influence (area under the receiver operating characteristic curve [AUROC] 0.88) and driving above the WHO recommended limit of 0.05g/dL BAC (AUROC 0.79). Model inspection reveals reliance on pathophysiological effects associated with alcohol consumption. To our knowledge, we are the first to rigorously evaluate the use of driver monitoring cameras for detecting drunk driving. Our results highlight the potential of driver monitoring cameras and enable next-generation drunk driver interaction preventing alcohol-related harm

Interaction-induced delocalization of two particles in a random potential: Scaling properties

The localization length $\xi_2$ for coherent propagation of two interacting particles in a random potential is studied using a novel and efficient numerical method. We find that the enhancement of $\xi_2$ over the one-particle localization length $\xi_1$ satisfies the scaling relation $\xi_2/\xi_1=f(u/\Delta_\xi)$, where $u$ is the interaction strength and $\Delta_{\xi}$ the level spacing of a wire of length $\xi_1$. The scaling function $f$ is linear over the investigated parameter range. This implies that $\xi_2$ increases faster with $u$ than previously predicted. We also study a novel mapping of the problem to a banded-random-matrix model.Comment: 5 pages and two figures in a uuencoded, compressed tar file; uses revtex and psfig.sty (included); substantial revision of a previous version of the paper including newly discovered scaling behavio

Third Follow-Up of the Study on Occupational Allergy Risks (SOLAR III) in Germany: Design, Methods, and Initial Data Analysis

Introduction: Asthma and allergies are complex diseases affected by genetic and environmental factors, such as occupational and psychosocial factors, as well as interactions between them. Although childhood is a critical phase in the development of asthma and allergies, few cohort studies on occupational outcomes followed up participants from childhood onwards. We present design, methods, and initial data analysis for the third follow-up of SOLAR (Study on Occupational Allergy Risks), a prospective and population-based German asthma and allergy cohort. Methods: The SOLAR cohort was initially recruited in 1995–1996 for Phase II of the German branch of the International Study of Asthma and Allergies in Childhood (ISAAC II) and followed up three times since, in 2002–2003, 2007–2009, and 2017–2018. During the third follow-up (SOLAR III), participants were between 29 and 34 years old. Since SOLAR focuses on occupational exposures, follow-ups were conducted at important points in time of the development of participants' career. To evaluate the potential of selection bias, responders and non-responders were compared based on variables from earlier study phases. In responders, frequency and pattern of missing values were examined and compared within the subsets of paper and online versions of the used questionnaires. Results: In total, 1,359 participants completed the questionnaire of the third follow-up (47.3% of eligible participants). Initially, the cohort started with 6,399 participants from the ISAAC II questionnaire study. A selection process led to a study population that is more female, higher educated, smokes less and has a higher proportion of certain asthma and allergy symptoms (also in their parents) than the initial cohort. Pattern and frequency of missing values were different for paper and online questionnaires. Discussion: The third follow-up of the SOLAR cohort offers the opportunity to analyze the course of asthma and allergies and their associations to environmental, occupational and psychosocial risk factors over more than 20 years from childhood to adulthood. Selection processes within the cohort might lead to bias that needs to be considered in future analyses

Phosphatidylethanol (PEth) for Monitoring Sobriety in Liver Transplant Candidates: Preliminary Results of Differences Between Alcohol-Related and Non-Alcohol-Related Cirrhosis Candidates.

BACKGROUND Monitoring sobriety is mandatory for liver transplant (LT) candidates with alcohol-related cirrhosis in Germany. Prior to listing, abstinence of 6 months is required. However, little is known about biomarker performance in alcohol-related cirrhosis. Routine testing of ethyl glucuronide in urine (uEtG) or hair (hEtG) is prone to manipulation or is unfeasible in anuria. Phosphatidylethanol (PEth) in dried-blood spots is a promising alternative. We compared PEth with routine parameters and self-reports in alcohol-related and non-alcohol-related cirrhosis at our transplant center. MATERIAL AND METHODS All patients received self-report questionnaires (AUDIT & TLFB). Blood, urine and hair samples, as well as PEth dried-blood spots were drawn at baseline. In addition, survival analyses were conducted. RESULTS Out of 66 patients, 53 were listed for LT and 13 were candidates not listed so far. An alcohol-use disorder was found in 25 patients. Positive results for uEtG, hEtG, and PEth were found in 5/65, 9/65, and 34/66 cases, respectively. PEth positivity was found in 52% of patients with alcohol-related cirrhosis, while 53% of patients with other liver diseases were positive. While uEtG, hEtG, and TLFB correlated with higher PEth values, active waiting list status was significantly correlated with negative PEth values. During the mean follow-up of 41.15 months, 23 patients were transplanted (34.9%). None of the biomarkers significantly predicted survival. CONCLUSIONS PEth can importantly assist abstinence monitoring in LT candidates due to its high validity and objectivity. The high percentage of patients with alcohol consumption in the non-alcoholic liver disease cohort underscores the importance of testing all transplant candidates

Individual Patient-Level Meta-Analysis of the Performance of the Decipher Genomic Classifier in High-Risk Men After Prostatectomy to Predict Development of Metastatic Disease.

Purpose To perform the first meta-analysis of the performance of the genomic classifier test, Decipher, in men with prostate cancer postprostatectomy. Methods MEDLINE, EMBASE, and the Decipher genomic resource information database were searched for published reports between 2011 and 2016 of men treated by prostatectomy that assessed the benefit of the Decipher test. Multivariable Cox proportional hazards models fit to individual patient data were performed; meta-analyses were conducted by pooling the study-specific hazard ratios (HRs) using random-effects modeling. Extent of heterogeneity between studies was determined with the I(2) test. Results Five studies (975 total patients, and 855 patients with individual patient-level data) were eligible for analysis, with a median follow-up of 8 years. Of the total cohort, 60.9%, 22.6%, and 16.5% of patients were classified by Decipher as low, intermediate, and high risk, respectively. The 10-year cumulative incidence metastases rates were 5.5%, 15.0%, and 26.7% ( P \u3c .001), respectively, for the three risk classifications. Pooling the study-specific Decipher HRs across the five studies resulted in an HR of 1.52 (95% CI, 1.39 to 1.67; I(2) = 0%) per 0.1 unit. In multivariable analysis of individual patient data, adjusting for clinicopathologic variables, Decipher remained a statistically significant predictor of metastasis (HR, 1.30; 95% CI, 1.14 to 1.47; P \u3c .001) per 0.1 unit. The C-index for 10-year distant metastasis of the clinical model alone was 0.76; this increased to 0.81 with inclusion of Decipher. Conclusion The genomic classifier test, Decipher, can independently improve prognostication of patients postprostatectomy, as well as within nearly all clinicopathologic, demographic, and treatment subgroups. Future study of how to best incorporate genomic testing in clinical decision-making and subsequent treatment recommendations is warranted

Cost Evaluation of a Model for Integrated Care of Seriously Mentally Ill Patients

Background: The model for integrated care (IC) of those seriously mentally ill patients insured with the DAK-Gesundheit health insurance and various Betriebskrankenkassen (members of the VAG Mitte) from the regions Berlin, Brandenburg, Lower Saxony and Bremen allows a complex treatment in the outpatient setting which consists of psychiatrists, general practitioners and clinicians, psychiatric nursing, sociotherapy (only in Berlin), internal medicine quality circles, orientation on treatment guidelines and conceptual consensus with the relevant care clinics. The aim of the evaluation is to illustrate the health economic effects of IC. Methods: In the period from 2006 to 2010 insured members of the DAK-Gesundheit and other involved health insurance companies with a serious mental illness, a significant impairment of social functioning and the need to be treated to avoid or substitute an in-hospital stay were included in the integrated care. The cost perspective was that of the statutory health insurance companies. For the health economic evaluation, the utilisation of continuous IC over 18 months was compared to the last 18 months prior to the inclusion in IC. The clinical findings were gathered quarterly during the IC using CGI (Clinical Global Impressions) and GAF (Global Assessment of Functioning Scale). Results: A total of 1 364 patients receiving IC in 66 doctor's practices were documented (of those, 286 had diagnoses of ICD-10 F2, 724 ICD-10 F32-F39). The median age was 48.8 years, 69% were female. 24% had their own source of income, 40% were on the pension, and the rest of the patients were receiving transfer benefits in some form. In 54% of the cases IC was used to avoid an in-hospital stay, in 46% of the cases to substitute an in-hospital stay. The degree of the CGI was 5.5 on average at the time of inclusion and the GAF score was 36.5 on average. The 226 patients with continuous documentation over 18 months were included in the health economic analysis. The number of days spent in hospital was lower during the IC period as compared to the 18 months prior to IV (11.8 vs. 28.6 days, p<0.001), the inpatient costs were lower (5 929 ± 13 837 Euro vs. 2 458 ± 6 940 Euro, p<0.001), the total was not significantly changed (7 777 ± 14 263 Euro vs. 7 321 ± 7 910 Euro, p=0.65). The substantial reduction of inpatient costs was compensated by the additional costs for medication and the costs of the complex outpatient care. Results were comparable for the 2 subgroups of schizophrenic/schizoaffective (n=66, 40.9 vs. 17.9 days, p=0.03; inpatient cost 9 009 ± 15 677 Euro vs. 3 650 ± 8 486 Euro, p=0.02; total expenditures 11 789 ± 15 975 Euro vs. 9 623 ± 9 262 Euro, p=0.33) and unipolar depressive patients (n=90, 29.8 vs. 9.8 days, p=0.006; inpatient cost 5 664 ± 14 921 Euro vs. 1 967 ± 5 276 Euro, p=0.02; total expenditures 7 146 ± 15 164 Euro vs. 6 234 ± 6 292 Euro, p=0.57). Conclusion: The IC was able to considerably reduce the utilisation of inpatient treatment through offering a complex range of services in the outpatient setting and allowed for a weight-shift in a low-threshold comprehensive care structure without an increase in costs from the statutory health insurance companies' perspective. For a detailed description of clinical effects further studies are required.Hintergrund: Das Modell der Integrierten Versorgung (IV) schwer psychisch Kranker für Versicherte der DAK-Gesundheit und verschiedener Betriebskrankenkassen (Mitglieder der BKK VAG Mitte) der Regionen Berlin, Brandenburg, Niedersachsen und Bremen ermöglicht eine ambulante Komplexbehandlung bestehend aus psychiatrischen Fachärzten, Haus- und Klinikärzten, psychiatrischer Fachpflege, Soziotherapie (nur Berlin), innerärztliche Qualitätszirkelarbeit, Orientierung an Behandlungspfaden und konzeptioneller Abstimmung mit den zuständigen Versorgungskliniken. Ziel der Evaluation war die Darstellung der gesundheitsökonomischen Auswirkungen der IV. Methodik: Im Zeitraum zwischen 2006 und 2010 wurden Versicherte der DAK-Gesundheit und der beteiligten Betriebskrankenkassen mit einer schweren psychischen Erkrankung, einer deutlichen Beeinträchtigung des sozialen Funktionsniveaus und der Erfordernis einer krankenhausvermeidenden oder krankenhausersetzenden Behandlung in die IV eingeschlossen. Die Kostenperspektive war diejenige der Gesetzlichen Krankenversicherung. Für die gesundheitsökonomische Auswertung wurde die Inanspruchnahme über 18 Monate kontinuierliche IV-Behandlung mit den letzten 18 Monaten vor Einschluss in die IV verglichen. Der klinische Befund wurde während der IV quartalsweise mit globaler Schweregrad- (CGI) und Funktionsbeurteilung (GAF) erhoben. Ergebnisse: Insgesamt wurden 1.364 Patienten mit IV-Behandlung in 66 Arztpraxen dokumentiert (davon 286 ICD-10 F2, 724 ICD-10 F32-F39). Das Durchschnittsalter betrug 48,8 Jahre, 69 % waren weiblich. 24 % verfügten über ein eigenes Einkommen, 40 % bezogen Rente, die übrigen Patienten Transferleistungen verschiedener Art. In 54 % der Fälle wurde IV klinikvermeidend, in 46 % klinikersetzend eingesetzt. Der CGI-Schweregrad betrug bei Einschluss durchschnittlich 5,4, der GAF-Score 36,5. In die gesundheitsökonomische Analyse wurden die 226 Patienten mit kontinuierlicher Dokumentation über 18 Monate eingeschlossen. Die Anzahl der Krankenhaustage war in 18 Monaten während IV niedriger als in 18 Monaten vor IV (11,8 vs. 28,6 Tage, p < 0,001), die Ausgaben für stationäre Behandlung signifikant geringer (5.929 ± 13.837 Euro vs. 2.458 ± 6.940 Euro, p < 0,001), die Gesamtausgaben veränderten sich jedoch nicht signifikant (7.777 ± 14.263 Euro vs. 7.321 ± 7.910 Euro, p = 0,65). Die erhebliche Einsparung bei den stationären Ausgaben wurde durch die Mehrausgaben bei Medikamenten und die Ausgaben der ambulanten Komplexleistungen kompensiert. Analoge Ergebnisse erbrachte die Analyse der 2 Subgruppen der Patienten mit Schizophrenie/ schizoaffektiver Störung (n = 66, 40,9 vs. 17,9 Tage, p = 0,03; stationäre Ausgaben 9.009 ± 15.677 Euro vs. 3.650 ± 8.486 Euro, p = 0,02; Gesamtausgaben 11.789 ± 15.975 Euro vs. 9.623 ± 9.262 Euro, p = 0,33) und mit unipolarer Depression (n = 90, 29,8 vs. 9,8 Tage, p = 0,006; stationäre Ausgaben 5.664 ± 14.921 Euro vs. 1.967 ± 5.276 Euro, p = 0,02; Gesamtausgaben 7.146 ± 15.164 Euro vs. 6.234 ± 6.292 Euro, p = 0,57). Schlussfolgerung: Das IV-Modell konnte durch ein komplexes ambulantes Leistungsangebot die stationäre Inanspruchnahme deutlich senken und eine Gewichtsverlagerung in eine niedrigschwellige umfassende Versorgungsstruktur realisieren, ohne dass dies aus GKV-Perspektive mit einer Kostensteigerung verbunden war. Für eine detaillierte Darstellung klinischer Effekte sind weitere Studien erforderlich

Drug-induced anaphylaxis, elicitors, risk factors, and management in Latin America

Nonsteroidal anti-inflammatory drugs were the most frequent triggers of drug-induced anaphylaxis in Latín America, whereas antibiotics elicited faster onset and more scvere reactions. An improvement was observed in epinephrinc use and adherence to guidelines in the emergency department treatment of anaphylaxis in Latín America compared with our last report.Facultad de Ciencias Médica

NASH limits anti-tumour surveillance in immunotherapy-treated HCC.

Hepatocellular carcinoma (HCC) can have viral or non-viral causes1-5. Non-alcoholic steatohepatitis (NASH) is an important driver of HCC. Immunotherapy has been approved for treating HCC, but biomarker-based stratification of patients for optimal response to therapy is an unmet need6,7. Here we report the progressive accumulation of exhausted, unconventionally activated CD8+PD1+ T cells in NASH-affected livers. In preclinical models of NASH-induced HCC, therapeutic immunotherapy targeted at programmed death-1 (PD1) expanded activated CD8+PD1+ T cells within tumours but did not lead to tumour regression, which indicates that tumour immune surveillance was impaired. When given prophylactically, anti-PD1 treatment led to an increase in the incidence of NASH-HCC and in the number and size of tumour nodules, which correlated with increased hepatic CD8+PD1+CXCR6+, TOX+, and TNF+ T cells. The increase in HCC triggered by anti-PD1 treatment was prevented by depletion of CD8+ T cells or TNF neutralization, suggesting that CD8+ T cells help to induce NASH-HCC, rather than invigorating or executing immune surveillance. We found similar phenotypic and functional profiles in hepatic CD8+PD1+ T cells from humans with NAFLD or NASH. A meta-analysis of three randomized phase III clinical trials that tested inhibitors of PDL1 (programmed death-ligand 1) or PD1 in more than 1,600 patients with advanced HCC revealed that immune therapy did not improve survival in patients with non-viral HCC. In two additional cohorts, patients with NASH-driven HCC who received anti-PD1 or anti-PDL1 treatment showed reduced overall survival compared to patients with other aetiologies. Collectively, these data show that non-viral HCC, and particularly NASH-HCC, might be less responsive to immunotherapy, probably owing to NASH-related aberrant T cell activation causing tissue damage that leads to impaired immune surveillance. Our data provide a rationale for stratification of patients with HCC according to underlying aetiology in studies of immunotherapy as a primary or adjuvant treatment