Maximum Entropy Exploration in Contextual Bandits with Neural Networks and Energy Based Models.

Contextual bandits can solve a huge range of real-world problems. However, current popular algorithms to solve them either rely on linear models or unreliable uncertainty estimation in non-linear models, which are required to deal with the exploration-exploitation trade-off. Inspired by theories of human cognition, we introduce novel techniques that use maximum entropy exploration, relying on neural networks to find optimal policies in settings with both continuous and discrete action spaces. We present two classes of models, one with neural networks as reward estimators, and the other with energy based models, which model the probability of obtaining an optimal reward given an action. We evaluate the performance of these models in static and dynamic contextual bandit simulation environments. We show that both techniques outperform standard baseline algorithms, such as NN HMC, NN Discrete, Upper Confidence Bound, and Thompson Sampling, where energy based models have the best overall performance. This provides practitioners with new techniques that perform well in static and dynamic settings, and are particularly well suited to non-linear scenarios with continuous action spaces.

Altmetric and bibliometric analysis of obstetrics and gynecology research: influence of public engagement on citation potential.

BACKGROUND: Whether research engagement on social media and other public platforms results in increased citations in obstetrics and gynecology remains uncertain. The Altmetric Attention Score is a metric of research influence based on mentions on social media and public platforms, such as newsfeeds and Wikipedia. The correlation between Altmetric Attention Scores, absolute citation rates, and the Relative Citation Ratio (a novel metric of research engagement also based on citation rates) in obstetrics and gynecology research is uncertain. OBJECTIVE: To evaluate the correlation between Altmetric Attention Score, absolute citation rate, and Relative Citation Ratio for articles published in obstetrics and gynecology journals from 2004 to 2019. Our second objective was to identify, characterize, and compare the 100 articles with highest Altmetric Attention Scores, the 100 most-cited articles, and the 100 articles with highest Relative Citation Ratios. STUDY DESIGN: We performed a cross-sectional altmetric and bibliometric study of all obstetrics and gynecology articles indexed in the National Institutes of Health Open Citation Collection from 2004 to 2019. Articles were included if they were published in obstetrics and gynecology journals according to InCites Journal Citation Reports indexing. Citation data, including citation numbers and Relative Citation Ratios, were downloaded on March 20, 2021 and merged with altmetric data from the Altmetric Explorer on the basis of each article's unique PubMed identification number. We assessed correlation between Altmetric Attention Scores and number of citations and Altmetric Attention Scores and Relative Citation Ratios by calculating the Pearson correlation coefficient. The 100 articles with highest Altmetric Attention Scores, the 100 most-cited articles, and the 100 articles with highest Relative Citation Ratios were characterized and compared using means (standard deviations) and mean differences (95% confidence intervals). RESULTS: There were 156,592 articles published in 82 obstetrics and gynecology journals and indexed in the National Institutes of Health Open Citation Collection between 2004 and 2019. The correlation coefficient was 0.18 (95% confidence interval, 0.17-0.19) for Altmetric Attention Scores vs number of citations and 0.10 (95% confidence interval, 0.09-0.11) for Altmetric Attention Scores vs Relative Citation Ratios. There was no overlap among the 100 articles on the highest Altmetric Attention Score list and the 100 most-cited list, and there was minimal overlap among the 100 articles on the highest Altmetric Attention Score list and the 100 highest Relative Citation Ratio list (98 unique articles on each list). Articles with highest Altmetric Attention Scores generated substantially more engagement on social media and other public platforms than most-cited articles (mean Altmetric Attention Score, 763.1 [standard deviation, 520.8] vs 49.9 [standard deviation, 81.6]; mean difference, -713.2 [95% confidence interval, -819.9 to -606.6]) and highest Relative Citation Ratio articles (mean, 116.2 [standard deviation, 415.9]; mean difference, -661.5 [95% confidence interval, -746.2 to -576.9]). In contrast, the articles with highest Altmetric Attention Scores generated far fewer citations than most-cited articles (mean, 39.7 [standard deviation, 47.6] vs 541.8 [standard deviation, 312.8]; mean difference, 502.0 [95% confidence interval, 439.0-565.0]) and highest Relative Citation Ratio articles (mean, 458.9 [standard deviation, 363.5]; mean difference, 427.7 [95% confidence interval, 353.8-501.6]). Nearly half of articles with highest Altmetric Attention Scores were basic/translational studies, often about menopause and environmental factors impacting fertility, whereas most-cited articles and articles with highest Relative Citation Ratios were more likely to be reviews and consensus statements, respectively, often about placentation and polycystic ovary syndrome, respectively. Articles with highest Altmetric Attention Scores were more likely to be published as open-access. CONCLUSION: There seems to be weak short-term correlation between Altmetric Attention Scores and citation rates. Further study is warranted to ascertain whether there may be long-term correlation between alternative metrics and citation rates in obstetrics and gynecology.

Stress-induced diabetic ketoacidosis in concurrent ectopic pregnancy: A case report.

Ectopic pregnancy occurs in 1-2% of all pregnancies. The majority occur in the fallopian tube, requiring intervention in the form of methotrexate or surgery. Ruptured ectopic pregnancies can lead to hemodynamic instability, requiring immediate surgical intervention. In the case reported here, the patient presented in diabetic ketoacidosis with a pregnancy of unknown location. Upon further evaluation she was found to have a ruptured ectopic pregnancy and was taken to the operating room for surgical management. We discuss the rarity of these concurrent disorders, the pathophysiology behind stress-induced diabetic ketoacidosis, the effects of elevated glucose in peri-operative management, and the importance of multi-disciplinary approaches to urgent clinical decision-making.

Resident Burnout Trends During COVID-19: A Retrospective Observational Study.

OBJECTIVE: This study was designed to assess the effects of the coronavirus disease pandemic on job satisfaction (JS) and burnout among surgical sub-specialty residents. DESIGN: This is a retrospective, observational, survey-based study. We administered a web-based questionnaire to surgical sub-specialty residents, and results were compared to a prior study in 2016. The questionnaire included elements on demographics, JS, burnout, and self-care habits. Basic statistical analyses were used to compare data from 2020 and 2016. SETTING: This study takes place at Robert Wood Johnson University Hospital, a single mid-sized New Jersey-based academic institution. PARTICIPANTS: This survey was sent to all obstetrics and gynecology and general surgery residents from every postgraduate year based out of our institution. The survey was sent to a total of 50 residents across the 2 programs. Forty total residents responded to the survey, with a response rate of 80%. RESULTS: JS was significantly higher in 2020 than 2016 (p < 0.001). There were no differences between postgraduate years for 2020 or 2016 in emotional exhaustion (p = 0.29, p = 0.75), personal accomplishment (p = 0.88, p = 0.26), or depersonalization (p = 0.14, p = 0.59) burnout scores. A total of 0% of residents in 2020 worked fewer than 61 hours per week. Residents in 2020 exercised more (40.0% vs 21.6%), had similar alcohol usage (60%), and had similar diets to residents in 2016. Residents in 2020 were less likely to regret their specialty (7.5% vs 21.6%), consider changing residencies (30.0% vs 37.8%), or consider a career change (15.0% vs 45.9%). CONCLUSIONS: JS scores were significantly higher during the coronavirus disease pandemic. The cancellation of elective surgeries led to a lighter workload for surgical residents. Residents were uncertain of their role during the pandemic, however, new stressors encouraged residents to seek alternative methods for personal wellness.

Decompression of hematocolpos caused by acquired obstruction in patient with prior radiation therapy for vaginal cancer.

Background: This report is intended to present a unique patient with acquired vaginal obstruction due to prior radiation therapy and subsequent development of hematocolpos. We present a method of surgical decompression for the hematocolpos as well as this patient's follow-up and prevention of re-epithelialization. Case: One patient was recruited and consented for this case study. Pre-operative evaluation, including examination and imaging, intra-operative findings, and post-operative evaluation were reported in this study. After surgical evaluation and drainage of hematocolpos via incision and drainage, a foley balloon was placed to prevent re-epithelialization. Intra-operative fluid cultures yielded no growth. At her follow-up appointment, the foley balloon was removed and the vaginal canal was intact without agglutination or re-accumulation of hematocolpos. Conclusions: This is a unique case of acquired obstruction from radiation therapy causing significant symptomatic hematocolpos. We offer a minimally invasive approach for decompression, evaluation of malignancy, and prevention of re-obstruction. Her post-operative appointment showed resolution of symptoms and patent vaginal canal. Long-term outcomes are still required, including monitoring for malignant recurrence, re-obstruction and stenosis, and sexual health. If re-epithelialization occurs, more definitive therapy will be required, including excision of the vaginal septum or hysterectomy.