Discrete Optimization for Interpretable Study Populations and Randomization Inference in an Observational Study of Severe Sepsis Mortality

Motivated by an observational study of the effect of hospital ward versus intensive care unit admission on severe sepsis mortality, we develop methods to address two common problems in observational studies: (1) when there is a lack of covariate overlap between the treated and control groups, how to define an interpretable study population wherein inference can be conducted without extrapolating with respect to important variables; and (2) how to use randomization inference to form confidence intervals for the average treatment effect with binary outcomes. Our solution to problem (1) incorporates existing suggestions in the literature while yielding a study population that is easily understood in terms of the covariates themselves, and can be solved using an efficient branch-and-bound algorithm. We address problem (2) by solving a linear integer program to utilize the worst case variance of the average treatment effect among values for unobserved potential outcomes that are compatible with the null hypothesis. Our analysis finds no evidence for a difference between the sixty day mortality rates if all individuals were admitted to the ICU and if all patients were admitted to the hospital ward among less severely ill patients and among patients with cryptic septic shock. We implement our methodology in R, providing scripts in the supplementary material

The success-index: an alternative approach to the h-index for evaluating an individual's research output

Among the most recent bibliometric indicators for normalizing the differences among fields of science in terms of citation behaviour, Kosmulski (J Informetr 5(3):481-485, 2011) proposed the NSP (number of successful paper) index. According to the authors, NSP deserves much attention for its great simplicity and immediate meaning— equivalent to those of the h-index—while it has the disadvantage of being prone to manipulation and not very efficient in terms of statistical significance. In the first part of the paper, we introduce the success-index, aimed at reducing the NSP-index's limitations, although requiring more computing effort. Next, we present a detailed analysis of the success-index from the point of view of its operational properties and a comparison with the h-index's ones. Particularly interesting is the examination of the success-index scale of measurement, which is much richer than the h-index's. This makes success-index much more versatile for different types of analysis—e.g., (cross-field) comparisons of the scientific output of (1) individual researchers, (2) researchers with different seniority, (3) research institutions of different size, (4) scientific journals, etc

Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis.

OBJECTIVES: A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure temporal trends in sepsis survivorship and hospital-based acute care use in sepsis survivors. In addition, because readmissions after pneumonia are subject to penalty under the national readmission reduction program, we examined whether readmission rates declined after sepsis hospitalizations related to pneumonia. DESIGN AND SETTING: Retrospective, observational cohort study conducted within an academic healthcare system from 2010 to 2015. PATIENTS: We used three validated, claims-based approaches to identify 17,256 sepsis or severe sepsis hospitalizations to examine trends in hospital-based acute care after sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of medical and surgical discharges at-risk for hospital readmission after sepsis increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined modestly, from 26.4% in 2010 to 23.1% in 2015, driven largely by a decline in readmission rates among survivors of nonsevere sepsis, and nonpneumonia sepsis specifically, as the readmission rate of severe sepsis survivors was stable. The modest decline in 30-day readmission rates was offset by an increase in emergency department treat-and-release visits, from 2.8% in 2010 to a peak of 5.4% in 2014. CONCLUSIONS: Owing to increasing incidence and declining mortality, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. The 30-day hospital readmission rates for sepsis declined modestly but were offset by a rise in emergency department treat-and-release visits

The Role of Whey Acidic Protein Four-Disulfide-Core Proteins in Respiratory Health and Disease

Abstract Members of the whey acidic protein (WAP) or WAP four-disulfide-core (WFDC) family of proteins are a relatively under-explored family of low molecular weight proteins. The two most prominent WFDC proteins, secretory leukocyte protease inhibitor (SLPI) and elafin (or the precursor, trappin-2), have been shown to possess multiple functions including anti-protease, anti-bacterial, anti-viral and anti-inflammatory properties. It is therefore of no surprise that both SLPI and elafin/trappin-2 have been developed as potential therapeutics. Given the abundance of SLPI and elafin/trappin-2 in the human lung, most work in the area of WFDC research has focused on the role of WFDC proteins in protecting the lung from proteolytic attack. In this review, we will outline the current evidence regarding the expanding role of WFDC protein function with a focus on WFDC activity in lung disease as well as emerging data regarding the function of some of the more recently described WFDC proteins.</jats:p

Technologies for restricting mould growth on baled silage

End of project reportSilage is made on approximately 86% of Irish farms, and 85% of these make some baled silage. Baled silage is particularly important as the primary silage making, storage and feeding system on many beef and smaller sized farms, but is also employed as a secondary system (often associated with facilitating grazing management during mid-summer) on many dairy and larger sized farms (O’Kiely et al., 2002). Previous surveys on farms indicated that the extent of visible fungal growth on baled silage was sometimes quite large, and could be a cause for concern. Whereas some improvements could come from applying existing knowledge and technologies, the circumstances surrounding the making and storage of baled silage suggested that environmental conditions within the bale differed from those in conventional silos, and that further knowledge was required in order to arrive at a secure set of recommendations for baled silage systems. This report deals with the final in a series (O’Kiely et al., 1999; O’Kiely et al., 2002) of three consecutive research projects investigating numerous aspect of the science and technology of baled silage. The success of each depended on extensive, integrated collaboration between the Teagasc research centres at Grange and Oak Park, and with University College Dublin. As the series progressed the multidisciplinary team needed to underpin the programme expanded, and this greatly improved the amount and detail of the research undertaken. The major objective of the project recorded in this report was to develop technologies to improve the “hygienic value” of baled silage

Elastic energy of polyhedral bilayer vesicles

In recent experiments [M. Dubois, B. Dem\'e, T. Gulik-Krzywicki, J.-C. Dedieu, C. Vautrin, S. D\'esert, E. Perez, and T. Zemb, Nature (London) Vol. 411, 672 (2001)] the spontaneous formation of hollow bilayer vesicles with polyhedral symmetry has been observed. On the basis of the experimental phenomenology it was suggested [M. Dubois, V. Lizunov, A. Meister, T. Gulik-Krzywicki, J. M. Verbavatz, E. Perez, J. Zimmerberg, and T. Zemb, Proc. Natl. Acad. Sci. U.S.A. Vol. 101, 15082 (2004)] that the mechanism for the formation of bilayer polyhedra is minimization of elastic bending energy. Motivated by these experiments, we study the elastic bending energy of polyhedral bilayer vesicles. In agreement with experiments, and provided that excess amphiphiles exhibiting spontaneous curvature are present in sufficient quantity, we find that polyhedral bilayer vesicles can indeed be energetically favorable compared to spherical bilayer vesicles. Consistent with experimental observations we also find that the bending energy associated with the vertices of bilayer polyhedra can be locally reduced through the formation of pores. However, the stabilization of polyhedral bilayer vesicles over spherical bilayer vesicles relies crucially on molecular segregation of excess amphiphiles along the ridges rather than the vertices of bilayer polyhedra. Furthermore, our analysis implies that, contrary to what has been suggested on the basis of experiments, the icosahedron does not minimize elastic bending energy among arbitrary polyhedral shapes and sizes. Instead, we find that, for large polyhedron sizes, the snub dodecahedron and the snub cube both have lower total bending energies than the icosahedron

An accretion model for the growth of the central black hole associated with ionization instability in quasars

A possible accretion model associated with the ionization instability of quasar disks is proposed to address the growth of the central black hole harbored in the host galaxy.The mass ratio between black hole and its host galactic bulge is a nature consequence of our model.Comment: submitted to ApJ, 15 page

Heat to Electricity Conversion by a Graphene Stripe with Heavy Chiral Fermions

A conversion of thermal energy into electricity is considered in the electrically polarized graphene stripes with zigzag edges where the heavy chiral fermion (HCF) states are formed. The stripes are characterized by a high electric conductance Ge and by a significant Seebeck coefficient S. The electric current in the stripes is induced due to a non-equilibrium thermal injection of "hot" electrons. This thermoelectric generation process might be utilized for building of thermoelectric generators with an exceptionally high figure of merit Z{\delta}T \simeq 100 >> 1 and with an appreciable electric power densities \sim 1 MW/cm2.Comment: 8 pages, 3 figure

Peroxisomes in intestinal and gallbladder epithelial cells of the stickleback, Gasterosteus aculeatus L. (Teleostei)

The occurrence of microbodies in the epithelial cells of the intestine and gallbladder of the stickleback, Gasterosteus aculeatus L., is described. In the intestine the organelles are predominantly located in the apical and perinuclear zone of the cells and may contain small crystalline cores. In gallbladder epithelial cells the microbodies are distributed randomly. The latter organdies are characterized by the presence of large crystalloids. Cytochemical and biochemical experiments show that catalase and D-amino acid oxidase are main matrix components of the microbodies in both the intestinal and gallbladder epithelia. These organelles therefore are considered peroxisomes. In addition, in intestinal mucosa but not in gallbladder epithelium a low activity of palmitoyl CoA oxidase was detected biochemically. Urate oxidase and L-α hydroxy acid oxidase activities could not be demonstrated.

The Star Formation Rate Function of the Local Universe

We have derived the bivariate luminosity function for the far ultraviolet (1530Angstroms) and far infrared (60 microns). We used matched GALEX and IRAS data, and redshifts from NED and PSC-z. We have derived a total star formation luminosity function phi(L_{tot}), with L_{tot} = L_{FUV}+L_{FIR}. Using these, we determined the cosmic ``star formation rate'' function and density for the local universe. The total SFR function is fit very well by a log-normal distribution over five decades of luminosity. We find that the bivariate luminosity function phi(L_{FUV},L_{FIR}) shows a bimodal behavior, with L_{FIR} tracking L_{FUV} for L_{TOT}< 10^10 L_sun, and L_{FUV} saturating at 10^10 L_sun, while L_{TOT} L_{FIR} for higher luminosities. We also calculate the SFR density and compare it to other measurements.Comment: This paper will be published as part of the Galaxy Evolution Explorer (GALEX) Astrophysical Journal Letters Special Issue. Links to the full set of papers will be available at http:/www.galex.caltech.edu/PUBLICATIONS/ after November 22, 200