Optical Imaging Technology: A Useful Tool to Identify Remission in Cushing Disease After Surgery.

We recently reported the use of optical imaging technology to quantify facial plethora in endogenous Cushing syndrome (CS). In the present study, we studied a larger cohort of patients with Cushing disease (CD) and examined water content fraction as well as blood volume fraction as bio-optic markers for determining the efficacy of this methodology as a predictor of lasting remission after surgery for CS. We imaged 49 patients before and after transsphenoidal surgery (TSS) for Cushing disease (CD); 22 patients were also seen at 3-6 months, and 13 patients 12 months post-operatively. On all patients, we used multi-spectral imaging (MSI) to evaluate hemodynamic distributions as well as water content at a specific area of the face. We found a decrease in blood volume fraction after vs. before surgical treatment in the tested facial area in 37 of the 40 patients, as determined with biochemical markers (p<0.001). All patients that were followed up for up to 12 months showed the same decrease from preoperative values and they remained in remission from CD. We conclude that MSI can be used for the evaluation of remission from CD, at least in the immediate post-operative period and up to one year after surgery. The use of this technology can supplement biochemical and other testing for the evaluation of the various treatment modalities available for patients with CD.

MITIGATING COGNITIVE BIASES IN RISK IDENTIFICATION: Practitioner Checklist for the AEROSPACE SECTOR.

This research contributes an operational checklist for mitigating cognitive biases in the aerospace sector risk management process. The Risk Identification and Evaluation Bias Reduction Checklist includes steps for grounding the risk identification and evaluation activities in past project experiences through historical data, and emphasizes the importance of incorporating multiple methods and perspectives to guard against optimism and a singular project instantiation-focused view. The authors developed a survey to elicit subject matter expert judgment on the value of the checklist to support its use in government and industry as a risk management tool. The survey also provided insights on bias mitigation strategies and lessons learned. This checklist addresses the deficiency in the literature in providing operational steps for the practitioner to recognize and implement strategies for bias reduction in risk management in the aerospace sector.

Facial Plethora: Modern Technology for Quantifying an Ancient Clinical Sign and Its Use in Cushing Syndrome.

CONTEXT: Facial plethora is a clinical sign described since ancient times for a variety of diseases. In the 19th century, it was linked to increased blood volume or flow, but this has never been proven. Facial plethora is also one of the earliest described clinical features of Cushing's syndrome (CS). OBJECTIVE: This study aimed to quantify facial plethora changes in CS as an early assessment of cure after surgery using noninvasive near-infrared multispectral imaging (MSI). DESIGN: The longitudinal cohort study was initiated in August 2012 and completed in August 2014. SETTING: Clinical research hospital, National Institutes of Health. PATIENTS: Thirty-four of the 38 patients who received surgical treatment for CS under protocol 97CH0076 during this period were included. INTERVENTION(S): MSI was performed on the right cheek of patients before surgery and 4.9 ± 3.1 days afterward. MAIN OUTCOME MEASURE(S): Average blood volume fraction as measured by MSI and serum cortisol. RESULTS: All but four of the 28 patients (86%) who were assessed as cured by postoperative plasma cortisol measurements of < 3 µg/dL showed a decrease in blood volume fraction (17.7 ± 0.03 vs 15.8 ± 0.03%; P = .0019), whereas an increase was seen in patients with persistent CS (18.5 ± 0.03 vs 21.4 ± 0.04%; P = .0017). Change in blood volume fraction before and after surgery was correlated with postoperative cortisol (rs = 0.58; P = .0003). CONCLUSIONS: Clinical data obtained from 34 patients indicate that a decrease in facial plethora after surgery, as evidenced by a decrease in blood volume fraction, is correlated with CS outcome. This novel technology for the first time identified a physiological mechanism associated with an ancient clinical sign. Furthermore, as a proof of principle, MSI is a promising early marker of cure in patients with CS that complements biochemical and clinical data.

Efficient Allocation of Resources for Defense of Spatially Distributed Networks Using Agent-Based Simulation.

This article presents ongoing research that focuses on efficient allocation of defense resources to minimize the damage inflicted on a spatially distributed physical network such as a pipeline, water system, or power distribution system from an attack by an active adversary, recognizing the fundamental difference between preparing for natural disasters such as hurricanes, earthquakes, or even accidental systems failures and the problem of allocating resources to defend against an opponent who is aware of, and anticipating, the defender's efforts to mitigate the threat. Our approach is to utilize a combination of integer programming and agent-based modeling to allocate the defensive resources. We conceptualize the problem as a Stackelberg "leader follower" game where the defender first places his assets to defend key areas of the network, and the attacker then seeks to inflict the maximum damage possible within the constraints of resources and network structure. The criticality of arcs in the network is estimated by a deterministic network interdiction formulation, which then informs an evolutionary agent-based simulation. The evolutionary agent-based simulation is used to determine the allocation of resources for attackers and defenders that results in evolutionary stable strategies, where actions by either side alone cannot increase its share of victories. We demonstrate these techniques on an example network, comparing the evolutionary agent-based results to a more traditional, probabilistic risk analysis (PRA) approach. Our results show that the agent-based approach results in a greater percentage of defender victories than does the PRA-based approach.

Temporary disaster debris management site identification using binomial cluster analysis and GIS.

An essential component of disaster planning and preparation is the identification and selection of temporary disaster debris management sites (DMS). However, since DMS identification is a complex process involving numerous variable constraints, many regional, county and municipal jurisdictions initiate this process during the post-disaster response and recovery phases, typically a period of severely stressed resources. Hence, a pre-disaster approach in identifying the most likely sites based on the number of locational constraints would significantly contribute to disaster debris management planning. As disasters vary in their nature, location and extent, an effective approach must facilitate scalability, flexibility and adaptability to variable local requirements, while also being generalisable to other regions and geographical extents. This study demonstrates the use of binomial cluster analysis in potential DMS identification in a case study conducted in Hamilton County, Indiana.

The next challenge to interoperability? A first look at robotic system wireless interoperability in emergency response.

System interoperability enables public safety agencies to communicate and share information. Past failures have demonstrated that systems of different agencies are not inherently interoperable. Therefore, as efforts continue toward the resolutions of these problems, it is incumbent on technology developers to assess the interoperability of new systems. Robotic systems can offer new capabilities to public safety personnel; however, these systems also include new communication technology to share and distribute information. Research has been initiated to examine the interoperability of public safety robotic systems. Definitions for robotic communication interoperability types are introduced.

Uncertainty and sensitivity analyses of a dynamic economic evaluation model for vaccination programs.

UNLABELLED: With public health policy increasingly relying on mathematical models to provide insights about the impacts of potential policy options, the demand for uncertainty and sensitivity analyses that explore the implications of different assumptions in a model continues to expand. Although analysts continue to develop methods to meet the demand, most modelers rely on a single method in the context of their assessments and presentations of results, and few analysts provide results that facilitate comparisons between uncertainty and sensitivity analysis methods. METHODS: vary in their degree of analytical difficulty and in the nature of the information that they provide, and analysts should communicate results with a note that not all methods yield the same insights. The authors explore several sensitivity analysis methods to test whether the choice of method affects the insights and importance rankings of inputs from the analysis. They use a dynamic cost-effectiveness model of a hypothetical infectious disease as the basis to perform 1-way and multi-way sensitivity analyses, design of experiments, and Morris' method. They also compute partial derivatives as well as a number of probabilistic sensitivity measures, including correlations, regression coefficients, and the correlation ratio, to demonstrate the existing methods and to compare them. The authors find that the magnitudes and rankings of sensitivity measures depend on the selected method(s) and make recommendations regarding the choice of method depending on the complexity of the model, number of uncertain inputs, and desired types of insights from the sensitivity analysis.