Studying mutation rate evolution in primates—a need for systematic comparison of computational pipelines

The lack of consensus methods to estimate germline mutation rates from pedigrees has led to substantial differences in computational pipelines in the published literature. Here, we answer Susanne Pfeifer's opinion piece discussing the pipeline choices of our recent article estimating the germline mutation rate of rhesus macaques (Macaca mulatta). We acknowledge the differences between the method that we applied and the one preferred by Pfeifer. Yet, we advocate for full transparency and justification of choices as long as rigorous comparison of pipelines remains absent because it is the only way to conclude on best practices for the field.

Perceptions of precision health approaches in hypertension management; a quality improvement study (Preprint)

BACKGROUND Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50% of the United States (US) adult population; however, only 30% of these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take into consideration individual patient needs such as remote BP monitoring may improve hypertension management. OBJECTIVE The Stanford Precision Health pilot, Humanwide, aimed to leverage high-tech and high-touch medicine to tailor individualized care for conditions such as hypertension. We examined multi-stakeholder perceptions of hypertension management in Humanwide to evaluate the program’s acceptability, appropriateness, feasibility, and sustainability. METHODS We conducted semi-structured interviews with 16 patients and 15 providers to assess their experiences with hypertension management in Humanwide. We transcribed and analyzed interviews using a hybrid approach of inductive and deductive analysis to identify common themes around hypertension management and consensus methods to ensure reliability and validity. RESULTS Ten patients and six providers mentioned hypertension in the context of Humanwide. These participants reported remote BP monitoring improving motivation, BP control, and clinic efficiency. Providers discussed feasibility challenges including time needed to analyze BP data and give individualized feedback, integration of BP data, technological difficulties with the BP cuff, and decreased use of remote BP monitoring over time. CONCLUSIONS Remote BP monitoring for hypertension management in Humanwide was acceptable to patients and providers, and appropriate for care. Important challenges need to be addressed to improve the feasibility and sustainability of this approach by leveraging team-based care, engaging patients to sustain remote BP monitoring, standardizing EMR integration of BP measurements, and finding more user-friendly BP cuffs. CLINICALTRIAL n/a

Adaptive fully-distributed sign-consensus control approach for nonlinear multi-agent systems over a signed graph

In this paper, the notion of sign-consensus for the Lipschitz nonlinear multi-agents over a signed graph is introduced and controller design conditions are provided for realizing consensus among signs of states of agents. The previous works on sign-consensus are limited to the linear systems only. The attainment of sign-consensus for the nonlinear multi-agent systems is a non-trivial control problem, for which Lipschitz nonlinear dynamics are reformulated using the linear parameter varying (LPV) transformation. To guarantee the sign-consensus in a network of multiple agents, fully-distributed adaptive protocol is applied using reformulated Lipschitz nonlinear dynamics, and two design conditions are provided based on the Lipschitz constant oriented and LPV-based approaches. The first approach is comparatively less computationally complex while LPV approach holds significance for developing less conservative sign-consensus control scheme. To the best of our knowledge, distributed sign consensus methods for Lipschitz systems, based on LPV formulation, have been analyzed for the first time. The proposed approach is adaptive and can be regarded as fully-distributed, as it does not require the central knowledge of graph properties. Further, results are extended for nonlinear systems undergoing disturbances and ultimate boundedness of sign-consensus error is guaranteed. Numerical simulations on groups of Chua’s circuits and mechanical oscillators are presented to validate the results.

A Time-Series-Based New Behavior Trace Model for Crowd Workers That Ensures Quality Annotation

Crowdsourcing is a new mode of value creation in which organizations leverage numerous Internet users to accomplish tasks. However, because these workers have different backgrounds and intentions, crowdsourcing suffers from quality concerns. In the literature, tracing the behavior of workers is preferred over other methodologies such as consensus methods and gold standard approaches. This paper proposes two novel models based on workers’ behavior for task classification. These models newly benefit from time-series features and characteristics. The first model uses multiple time-series features with a machine learning classifier. The second model converts time series into images using the recurrent characteristic and applies a convolutional neural network classifier. The proposed models surpass the current state of-the-art baselines in terms of performance. In terms of accuracy, our feature-based model achieved 83.8%, whereas our convolutional neural network model achieved 76.6%.

Reference Case Methods for Expert Elicitation in Health Care Decision Making

Background The evidence used to inform health care decision making (HCDM) is typically uncertain. In these situations, the experience of experts is essential to help decision makers reach a decision. Structured expert elicitation (referred to as elicitation) is a quantitative process to capture experts’ beliefs. There is heterogeneity in the existing elicitation methodology used in HCDM, and it is not clear if existing guidelines are appropriate for use in this context. In this article, we seek to establish reference case methods for elicitation to inform HCDM. Methods We collated the methods available for elicitation using reviews and critique. In addition, we conducted controlled experiments to test the accuracy of alternative methods. We determined the suitability of the methods choices for use in HCDM according to a predefined set of principles for elicitation in HCDM, which we have also generated. We determined reference case methods for elicitation in HCDM for health technology assessment (HTA). Results In almost all methods choices available for elicitation, we found a lack of empirical evidence supporting recommendations. Despite this, it is possible to define reference case methods for HTA. The reference methods include a focus on gathering experts with substantive knowledge of the quantities being elicited as opposed to those trained in probability and statistics, eliciting quantities that the expert might observe directly, and individual elicitation of beliefs, rather than solely consensus methods. It is likely that there are additional considerations for decision makers in health care outside of HTA. Conclusions The reference case developed here allows the use of different methods, depending on the decision-making setting. Further applied examples of elicitation methods would be useful. Experimental evidence comparing methods should be generated.

Research and Applied Perspective to Blockchain Technology: A Comprehensive Survey

Blockchain being a leading technology in the 21st century is revolutionizing each sector of life. Services are being provided and upgraded using its salient features and fruitful characteristics. Businesses are being enhanced by using this technology. Countries are shifting towards digital currencies i.e., an initial application of blockchain application. It omits the need of central authority by its distributed ledger functionality. This distributed ledger is achieved by using a consensus mechanism in blockchain. A consensus algorithm plays a core role in the implementation of blockchain. Any application implementing blockchain uses consensus algorithms to achieve its desired task. In this paper, we focus on provisioning of a comparative analysis of blockchain’s consensus algorithms with respect to the type of application. Furthermore, we discuss the development platforms as well as technologies of blockchain. The aim of the paper is to provide knowledge from basic to extensive from blockchain architecture to consensus methods, from applications to development platform, from challenges and issues to blockchain research gaps in various areas.

Combined Naïve Bayesian, Chemical Fingerprints and Molecular Docking Classifiers to Model and Predict Androgen Receptor Binding Data for Environmentally- and Health-Sensitive Substances

Many chemicals that enter the environment, food chain, and the human body can disrupt androgen-dependent pathways and mimic hormones and therefore, may be responsible for multiple diseases from reproductive to tumor. Thus, modeling and predicting androgen receptor activity is an important area of research. The aim of the current study was to find a method or combination of methods to predict compounds that can bind to and/or disrupt the androgen receptor, and thereby guide decision making and further analysis. A stepwise procedure proceeded from analysis of protein structures from human, chimp, and rat, followed by docking and subsequent ligand, and statistics based techniques that improved classification gradually. The best methods used multivariate logistic regression of combinations of chimpanzee protein structural docking scores, extended connectivity fingerprints, and naïve Bayesians of known binders and non-binders. Combination or consensus methods included data from a variety of procedures to improve the final model accuracy.

International Practice Recommendations for the Recognition and Management of Hearing and Vision Impairment in People with Dementia

<b><i>Introduction:</i></b> Hearing, vision, and cognitive impairment commonly co-occur in older people. However, the rate of recognition and appropriate management of combined hearing and vision impairment in people with dementia impairment is low. The aim of this work was to codevelop internationally relevant, multidisciplinary practice recommendations for professionals involved in the diagnosis, care, and management of older people with these concurrent conditions. <b><i>Methods:</i></b> We applied consensus methods with professional and lay expert stakeholders, using an adapted version of the <i>World Health Organization Handbook for Guideline Development</i>. The development involved 4 phases and included: (1) collating existing evidence, (2) filling the gaps in evidence, (3) prioritising evidence, and (4) refining the final list of recommendations. Each phase encompassed various methodologies including a review of existing guidelines within the 3 clinical domains, systematic reviews, qualitative studies, a clinical professional consortium, surveys, and consensus meetings with interdisciplinary domain experts. <b><i>Results:</i></b> The task force evaluated an initial list of 26 recommendations, ranking them in the order of priority. A consensus was reached on 15 recommendations, jwhich are classified into 6 domains of “awareness and knowledge,” “recognition and detection,” “evaluation,” “management,” “support,” and “services and policies.” Pragmatic options for implementation for each domain were then developed. <b><i>Conclusion:</i></b> This is the first set of international, interdisciplinary practice recommendations that will guide the development of multidisciplinary services and policy to improve the lives of people with dementia and hearing and vision impairment.

A Delphi study to identify prehospital and emergency department trauma care modifiers for older adults

Background: Older patients (age ≥ 65 yr) with trauma have increased morbidity and mortality compared to younger patients; this is partly explained by undertriage of older patients with trauma, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. The objective of this study was to identify modifiers to the prehospital and emergency department phases of major trauma care for older adults based on expert consensus. Methods: We conducted a modified Delphi study between May and September 2019 to identify major trauma care modifiers for older adults based on national expert consensus. The panel consisted of 24 trauma care professionals from across Canada from the prehospital and emergency department phases of care. The survey consisted of 16 trauma care modifiers. Three online survey rounds were distributed. Consensus was defined a priori as a disagreement index score less than 1. Results: There was a 100% response rate for all survey rounds. Three new trauma care modifiers were suggested by panellists. The panel achieved consensus agreement for 17 of the 19 trauma care modifiers. The prehospital modifier with the strongest agreement to transfer to a trauma centre was a respiratory rate less than 10 or greater than 20 breaths/min or need for ventilatory support. The emergency department modifier with the strongest level of agreement was obtaining 12-lead electrocardiography following the primary and secondary survey. Conclusion: Using a modified Delphi process, an expert panel agreed on 17 trauma care modifiers for older adults in the prehospital and emergency department settings. These modifiers may improve the delivery of trauma care for older adults and should be considered when developing local and national trauma guidelines.

Toward Consensus in Assessing Upper Limb Muscle Strength and Pinch and Grip Strength in People With Tetraplegia Having Upper Limb Reconstructions

Objectives: To reach agreement on standardized protocols for assessing upper limb strength and grip and pinch force for upper limb reconstructive surgery for tetraplegia. Methods: Selected members of an expert panel composed of international therapists formed at the 2018 International Congress for Upper Limb Surgery for Tetraplegia conducted a literature review of current practice that identified gaps and inconsistencies in measurement protocols and presented to workshop attendees. To resolve discrepancies, a set of questions was presented to workshop attendees who voted electronically. Consensus was set at 75% agreement. Results: For manual muscle testing, consensus was reached for using the Medical Research Council scale, without plus or minus, and the use of resistance through range when testing grade 4 and grade 5 strength. Pectoralis major and serratus anterior should be routinely tested, however there was no consensus on other shoulder muscles. Grip and pinch strength should be tested according to the American Society of Hand Therapists positioning. For grip strength, either the Jamar or Biometrics dynamometer expressed in kilograms should be used. For grip and pinch strength, three measurements should be performed at each testing. No consensus was reached on a device for pinch strength. Conclusion: This work is an important step to enable comparable data in the future. Further consensus methods will work toward developing more comprehensive guidelines in this population. Building international consensus for pre- and postoperative measures of function supports objective evaluation of novel therapies and interpretation of multicenter studies.