Open Chart Research Articles

Randomized Comparison of Electronic Health Record Alert Types in Eliciting Responses about Prognosis in Gynecologic Oncology Patients.

To compare the ability of different electronic health record alert types to elicit responses from users caring for cancer patients benefiting from goals of care (GOC) conversations. A validated question asking if the user would be surprised by the patient's 6-month mortality was built as an Epic BestPractice Advisory (BPA) alert in three versions-(1) Required on Open chart (pop-up BPA), (2) Required on Close chart (navigator BPA), and (3) Optional Persistent (Storyboard BPA)-randomized using patient medical record number. Meaningful responses were defined as "Yes" or "No," rather than deferral. Data were extracted over 6 months. Alerts appeared for 685 patients during 1,786 outpatient encounters. Measuring encounters where a meaningful response was elicited, rates were highest for Required on Open (94.8% of encounters), compared with Required on Close (90.1%) and Optional Persistent (19.7%) (p < 0.001). Measuring individual alerts to which responses were given, they were most likely meaningful with Optional Persistent (98.3% of responses) and least likely with Required on Open (68.0%) (p < 0.001). Responses of "No," suggesting poor prognosis and prompting GOC, were more likely with Optional Persistent (13.6%) and Required on Open (10.3%) than with Required on Close (7.0%) (p = 0.028). Required alerts had response rates almost five times higher than optional alerts. Timing of alerts affects rates of meaningful responses and possibly the response itself. The alert with the most meaningful responses was also associated with the most interruptions and deferral responses. Considering tradeoffs in these metrics is important in designing clinical decision support to maximize success.

Entanglement Negativity in de Sitter Biverse from Stringy Axionic Bell Pair: An Analysis Using Bunch‐Davies Vacuum

AbstractIn this work, signatures of quantum entanglement by computing entanglement negativity between two causally unrelated regions in 3 + 1 dimensional global de Sitter space are studied. A bipartite quantum field theoretic setup for this purpose, driven by an axionic Bell pair resulting from Type IIB string compactification on a Calabi‐Yau three fold is investigated. A spherical surface that divides the spatial slice of the global de Sitter space into exterior and interior causally unrelated sub regions is taken into account. For the computational purpose, the simplest possible initial choice of quantum vacuum, which is Bunch‐Davies state is used. The quantitative quantum information theoretic measure for entanglement negativity turns out be consistent with the results obtained for entanglement entropy, even it is better than that from quantum information theoretic point of view. The problem in a hyperbolic open chart where one of the causally unrelated observers remains constrained and the scale dependence enters to the corresponding quantum information theoretic entanglement measure for axionic Bell pair is designed. From the analysis it is found that in the large scales, initially maximally entangled Bunch‐Davies state turns out to be strongly entangled or weakly entangled depending on the axionic decay constant and the supersymmetry breaking scale. It is also found that at the small scales the initial entanglement can be perfectly recovered. The possibility of having a biverse picture, which is a mini version of the multiverse in the present theoretical set up is discussed. Last but not the least, the necessary criteria for generating non vanishing quantum entanglement measures within the framework of quantum field theory of global de Sitter space as well as well as in primordial cosmology due to the axion derived from string theory are provided.

A Comparison of Diagnostic Accuracy of Imaging Modalities to Detect Optic Disc Drusen: The Age of Enhanced Depth Imaging Optical Coherence Tomography

To identify the most accurate diagnostic imaging modality to detect optic disc drusen (ODD) between B-scan ultrasonography (US), fundus photography, fundus autofluorescence (FAF), and enhanced depth imaging optical coherence tomography (EDI-OCT). Comparative diagnostic analysis. Two hundred five eyes of 105 patients referred to 2 tertiary care neuro-ophthalmology clinics for suspected ODD were recruited: 108 eyes had ODD and 97 did not have ODD. All eyes received a full in-person ophthalmic exam with 3D view of the optic nerve and all 4 imaging modalities. Images were independently reviewed by 3 masked neuro-ophthalmologists to determine the presence or absence of ODD. Final interpretation was made through consensus. The reference standard was defined as the attending ophthalmologist's clinical judgement based on open chart review, with access to all image modalities and clinical information, including disease course. Main outcome measures were sensitivity, specificity, accuracy, and precision for each imaging modality. Examiner confidence was quantified as the proportion of eyes in which the reviewers were certain of their decision. The EDI-OCT had the highest sensitivity and accuracy (95%, 97%) to detect ODD, compared with FAF (84%, 92%), US (74%, 86%), and fundus photography (38%, 66%), respectively. All image modalities had high specificity (> 97%) and precision (> 93%). The EDI-OCT also had highest examiner confidence (96%) compared with all others (88%). Among all modalities, EDI-OCT was the imaging modality with the highest diagnostic utility for the detection of ODD and should be considered as the preferred initial diagnostic modality.

Learning to discover medicines.

Discovering new medicines is the hallmark of the human endeavor to live a better and longer life. Yet the pace of discovery has slowed down as we need to venture into more wildly unexplored biomedical space to find one that matches today's high standard. Modern AI-enabled by powerful computing, large biomedical databases, and breakthroughs in deep learning offers a new hope to break this loop as AI is rapidly maturing, ready to make a huge impact in the area. In this paper, we review recent advances in AI methodologies that aim to crack this challenge. We organize the vast and rapidly growing literature on AI for drug discovery into three relatively stable sub-areas: (a) representation learning over molecular sequences and geometric graphs; (b) data-driven reasoning where we predict molecular properties and their binding, optimize existing compounds, generate de novo molecules, and plan the synthesis of target molecules; and (c) knowledge-based reasoning where we discuss the construction and reasoning over biomedical knowledge graphs. We will also identify open challenges and chart possible research directions for the years to come.

Supporting Structured Data Capture for Patients With Cancer: An Initiative of the University of Wisconsin Carbone Cancer Center Survivorship Program to Improve Capture of Malignant Diagnosis and Cancer Staging Data.

Structured data elements within electronic health records are health-related information that can be entered, stored, and extracted in an organized manner at later time points. Tracking outcomes for cancer survivors is also enabled by structured data. We sought to increase structured data capture within oncology practices at multiple sites sharing the same electronic health records. Applying engineering approaches and the Plan-Do-Study-Act cycle, we launched dual quality improvement initiatives to ensure that a malignant diagnosis and stage were captured as structured data. Intervention: Close Visit Validation (CVV) requires providers to satisfy certain criteria before closing ambulatory encounters. CVV may be used to track open clinical encounters and chart delinquencies to encourage optimal clinical workflows. We added two cancer-specific required criteria at the time of closing encounters in oncology clinics: (1) the presence of at least one malignant diagnosis on the Problem List and (2) staging all the malignant diagnoses on the Problem List when appropriate. Six months before the CVV implementation, the percentage of encounters with a malignant diagnosis on the Problem List at the time of the encounter was 65%, whereas the percentage of encounters with a staged diagnosis was 32%. Three months after cancer-specific CVV implementation, the percentages were 85% and 75%, respectively. Rates had increased to 90% and 88% more than 2 years after implementation. Oncologist performance improved after the implementation of cancer-specific CVV criteria, with persistently high percentages of relevant malignant diagnoses and cancer stage structured data capture 2 years after the intervention.

Multisystem Spinal Cord Stimulation Trialing: A Single Center, Retrospective, Observational Study

Spinal cord stimulation is a well-established modality for the treatment of chronic intractable pain. The safety and efficacy of various stimulation therapy designs have been demonstrated in multiple randomized controlled studies, oftentimes comparing an investigational device to an existing commercial therapy. In the real-world setting, data are lacking regarding selection of spinal cord stimulation (SCS) therapy, as waveform, pulse trains, and programming are not interchangeable among the devices. The purpose of this study is to help dissect a methodology for a patient centric multisystem trialing. We conducted a single center, retrospective, open label observational chart review. Between June 2017 and June 2019, 83 patients underwent SCS trials. Devices from four commercially available systems were trialed. Patients were given the opportunity to trial up to three systems. If the patient reported 50% or more pain relief/functional improvement with the trial, they were able to choose which system they liked best and proceed with implantation. There were 82% (68/83) of patients who proceeded to permanent implant, with 72 patients electing to trial more than one stimulation paradigm. Of those, 62 trialed 2 SCS systems, whereas 11 trialed 3. During the SCS trials, loss of efficacy due to lead migration was 1.2% (1/83) and no infections occurred. The average pain score measured on the numeric pain rating scale (NRS), improved from 6.8 at baseline to 2.9 after implantation. Multisystem trialing is safe and effective in providing patients increased exposure to multiple commercially available SCS systems.

Generation of genuine tripartite entanglement for continuous variables in de Sitter space

We study the distribution of quantum entanglement for continuous variables among causally disconnected open charts in de Sitter space. It is found that genuine tripartite entanglement is generated among the open chart modes under the influence of curvature of de Sitter space for any nonzero squeezing. Bipartite entanglement is also generated when the curvature is strong enough, even though the observers are separated by the event horizon. This provides a clearcut interpretation of the two-mode squeezing mechanism in the de Sitter space. In addition, the curvature generated genuine tripartite entanglement is found to be less sensitive to the mass parameter than the generated bipartite entanglement. The effects of the curvature of de Sitter space on the generated entanglement become more apparent in the limit of conformal and massless scalar fields.

Quantum entanglement in de Sitter space from stringy axion: An analysis using α vacua

In this work, we study the phenomena of quantum entanglement by computing de Sitter entanglement entropy from von Neumann measure. For this purpose we consider a bipartite quantum field theoretic set up for axion field, previously derived from Type II B string theory compactified to four dimensions. We consider the initial vacuum to be CPT invariant non-adiabatic α vacua state under SO(1,4) isometry, which is characterised by a real one-parameter family. To implement this technique we use a S2 which divide the de Sitter into two exterior and interior sub-regions. First, we derive the wave function of axion in an open chart for α vacua by applying Bogoliubov transformation on the solution for Bunch-Davies vacuum state. Further, we quantify the density matrix by tracing over the contribution from the exterior region. Using this result we derive entanglement entropy, Rényi entropy and explain the long-range quantum effects in primordial cosmological correlations. Our results for α vacua provides the necessary condition for generating non zero entanglement entropy in primordial cosmology.

Quantum entanglement in de Sitter space with a wall and the decoherence of bubble universes

We study the effect of a bubble wall on the entanglement entropy of a free massive scalar field between two causally disconnected open charts in de Sitter space. We assume there is a delta-functional wall between the open charts. This can be thought of as a model of pair creation of bubble universes in de Sitter space. We first derive the Euclidean vacuum mode functions of the scalar field in the presence of the wall in the coordinates that respect the open charts. We then derive the Bogoliubov transformation between the Euclidean vacuum and the open chart vacua that makes the reduced density matrix diagonal. We find that larger walls lead to less entanglement. Our result may be regarded as evidence of decoherence of bubble universes from each other. We also note an interesting relationship between our results and discussions of the black hole firewall problem.

Entangled de Sitter from stringy axionic Bell pair I: an analysis using Bunch\u2013Davies vacuum

In this work, we study the quantum entanglement and compute entanglement entropy in de Sitter space for a bipartite quantum field theory driven by an axion originating from Type IIB string compactification on a Calabi–Yau three fold (mathbf{CY^3}) and in the presence of an mathbf{NS5} brane. For this computation, we consider a spherical surface mathbf{S}^2, which divides the spatial slice of de Sitter (mathbf{dS_4}) into exterior and interior sub-regions. We also consider the initial choice of vacuum to be Bunch–Davies state. First we derive the solution of the wave function of the axion in a hyperbolic open chart by constructing a suitable basis for Bunch–Davies vacuum state using Bogoliubov transformation. We then derive the expression for density matrix by tracing over the exterior region. This allows us to compute the entanglement entropy and Rényi entropy in 3+1 dimension. Furthermore, we quantify the UV-finite contribution of the entanglement entropy which contain the physics of long range quantum correlations of our expanding universe. Finally, our analysis complements the necessary condition for generating non-vanishing entanglement entropy in primordial cosmology due to the axion.

The Fourier Transform on the Group mathrm {GL}_2({mathbb R }) and the Action of the Overalgebra mathfrak {gl}_4

We define a kind of ’operational calculus’ for the Fourier transform on the group mathrm {GL}_2({mathbb R }). Namely, mathrm {GL}_2({mathbb R }) can be regarded as an open dense chart in the Grassmannian of 2-dimensional subspaces in {mathbb R }^4. Therefore the group mathrm {GL}_4({mathbb R }) acts in L^2 on mathrm {GL}_2({mathbb R }). We transfer the corresponding action of the Lie algebra mathfrak {gl}_4 to the Plancherel decomposition of mathrm {GL}_2({mathbb R }), the algebra acts by differential-difference operators with shifts in an imaginary direction. We also write similar formulas for the action of mathfrak {gl}_4oplus mathfrak {gl}_4 in the Plancherel decomposition of mathrm {GL}_2({mathbb C }).

Vacuum state of the Dirac field in de Sitter space and entanglement entropy

We compute the entanglement entropy of a free massive Dirac field between two causally disconnected open charts in de Sitter space. We first derive the Bunch-Davies vacuum mode functions of the Dirac field. We find there exists no supercurvature mode for the Dirac field. We then give the Bogoliubov transformation between the Bunch-Davies vacuum and the open chart vacua that makes the reduced density matrix diagonal. We find that the Dirac field becomes more entangled than a scalar field as m2/H2 becomes small, and the difference is maximal in the massless limit.

Quantum Correlations in de Sitter Space

We study quantum correlation of a massive scalar field in a maximally entangled state in de Sitter space. We prepare two observers, one in a global chart and the other in an open chart of de Sitter space. We find that the state becomes less entangled as the curvature of the open chart gets larger. In particular, for the cases of a massless and a conformally coupled scalar field, the quantum entanglement vanishes in the limit of infinite curvature. However, we find that the quantum discord never disappears, even in the limit that entanglement disappears.

Quantum discord in de Sitter space

We study quantum discord between two free modes of a massive scalar field in a maximally entangled state in de Sitter space. We introduce two observers, one in a global chart and the other in an open chart of de Sitter space, and the observers determine the quantum discord created by each detecting one of the modes. This situation is analogous to the relationship between an observer in a Minkowski chart and another in one of the two Rindler charts in flat space. We find that the state becomes less entangled as the curvature of the open chart gets larger. In particular, for the cases of a massless, and a conformally coupled scalar field, the entanglement vanishes in the limit of infinite curvature. However, we find that the quantum discord never disappears even in the limit that entanglement disappears.

Evaluation of Current Heparin Weight Based Protocol in Obese Patients

Purpose: To evaluate the difference in achieving goal activated partial thromboplastin time (aPTT) within 24 hours utilizing the institutional heparin weight based protocol between obese and non-obese patients. Methods: Retrospective, non-randomized, open label chart review in a community based hospital. Patients age 18 years or older receiving heparin therapy for greater than or equal to 24 hours identified. Patients were excluded if the protocol was utilized for acute coronary syndrome or interrupted within the initial 24 hours of therapy. Patients were also excluded if any deviations from the protocol were identified. The primary endpoint evaluated the difference in achieving goal aPTT within 24 hours between obese and non-obese patients. The secondary endpoint evaluated the difference in achieving goal aPTT within 24-48 hours and safety outcomes such as bleeds. Results: Of the 253 patients identified, 167 patients were included and 86 patients were excluded. Seventy-two (71.3%) of the nonobese and 48 (72.7%) of obese patients achieved goal aPTT within 24 hours (odd ratio [OR]: 0.98, 95 % confidence interval (CI): 0.6 to 1.58). Sixteen (15.8%) of nonobese and 13 (19.7%) of the obese patients achieved goal aPTT within 24 to 48 hours (OR: 0.77, 95 % CI: 0.3 to 1.95). Two (1.9 %) of the nonobese and 3 (4.5 %) of the obese patients had a documented major bleed (OR: 0.42 and 95 % CI: 0.69 to 2.61). Conclusion: Overall, there was no difference in achieving goal aPTT between nonobese and obese patients while utilizing our facility’s weight based heparin dosing. No major bleeding was documented that warranted discontinuation of therapy, and bleeding incidences between both groups were similar.

Entanglement negativity in the multiverse

We explore quantum entanglement between two causally disconnected regions in the multiverse. We first consider a free massive scalar field, and compute the entanglement negativity between two causally separated open charts in de Sitter space. The qualitative feature of it turns out to be in agreement with that of the entanglement entropy. We then introduce two observers who determine the entanglement between two causally disconnected de Sitter spaces. When one of the observers remains constrained to a region of the open chart in a de Sitter space, we find that the scale dependence enters into the entanglement. We show that a state which is initially maximally entangled becomes more entangled or less entangled on large scales depending on the mass of the scalar field and recovers the initial entanglement in the small scale limit. We argue that quantum entanglement may provide some evidence for the existence of the multiverse.

Is there supercurvature mode of massive vector field in openinflation?

We investigate the Euclidean vacuum mode functions of a massive vectorfield in a spatially open chart of de Sitter spacetime. In theone-bubble open inflationary scenario that naturally predicts a negative spatial curvature after a quantum tunneling, it is known that a lightscalar field has the so-called supercurvature mode, i.e. an additionaldiscrete mode which describes fluctuations over scales larger than thespatial curvature scale. If such supercurvature modes exist for a vectorfield with a sufficiently light mass, then they would decay slower and easily survive the inflationary era. However, the existence ofsupercurvature mode strongly depends on details of the system. Toclarify whether a massive vector field has supercurvature modes, weconsider a U(1) gauge field with gauge and conformal invariances spontaneously broken through the Higgs mechanism, and present explicit expressions for the Euclidean vacuum mode functions. We findthat, for any values of the vector field mass, there is nosupercurvature mode. In the massless limit, the absence ofsupercurvature modes in the scalar sector stems from the gaugesymmetry.

Piezoelectric Materials: towards A Powerful Selection Tool from a Specific User Open Chart

The aim of this work is to build software which enables us to set up an active smart materials data base especially the piezoelectric ones. This is done using two approaches: firstly, by mean of literature, allow the different characteristics we select piezoelectric materials. The second approach consists of selecting the appropriate material according to its usage either as a sensor or as an actuator. The purpose is to provide users an easier way to combine use versus characteristics in an automatic manner. Therefore according to a given application we can overcome the selection difficulties by knowing much more about the materials through their integrated functions when actuating as sensors or actuators. This tool remains also based on an open chart that will permit to the user or developer to update it in concordance with future knowledge of material developments. This work presents the developed software (called ExTooPIEZ’s), its main features and first feed backs gained after first usage.

Lookup-Table-Based Deferred-Iteration Aided Low-Complexity Turbo Hybrid ARQ

Since the introduction of turbo-code-aided Hybrid Automatic Repeat reQuest (HARQ) schemes, their complexity reduction has drawn research attention. In our previous work, we proposed an Early Stopping (ES) strategy for a turbo HARQ scheme, which results in beneficial complexity reduction while maintaining a high throughput. However, this scheme was designed to strike a compromise across the full range of channel conditions. As a further advance, in this paper, we propose a new Deferred Iterations (DI) strategy, which is specifically designed to take into account the prevalent channel conditions, as characterized by the Extrinsic Information Transfer (EXIT) chart tunnel opening. More specifically, the DI strategy delays the commencement of the turbo-decoding until an open EXIT chart tunnel appears. Our simulation results demonstrate that the complexity of the proposed DI-aided turbo HARQ schemes is reduced by up to 50%, which is achieved without compromising the packet loss ratio (PLR) or throughput.

Open orbifold Gromov-Witten invariants of $${[\mathbb{C}^3/\mathbb{Z}_n]}$$ : localization and mirror symmetry

We develop a mathematical framework for the computation of open orbifold Gromov-Witten invariants of [C^3/Z_n], and provide extensive checks with predictions from open string mirror symmetry. To this aim we set up a computation of open string invariants in the spirit of Katz-Liu, defining them by localization. The orbifold is viewed as an open chart of a global quotient of the resolved conifold, and the Lagrangian as the fixed locus of an appropriate anti-holomorphic involution. We consider two main applications of the formalism. After warming up with the simpler example of [C^3/Z_3], where we verify physical predictions of Bouchard, Klemm, Marino and Pasquetti, the main object of our study is the richer case of [C^3/Z_4], where two different choices are allowed for the Lagrangian. For one choice, we make numerical checks to confirm the B-model predictions; for the other, we prove a mirror theorem for orbifold disc invariants, match a large number of annulus invariants, and give mirror symmetry predictions for open string invariants of genus \leq 2.