Finite-Time Lyapunov Exponents of Deep Neural Networks.

We compute how small input perturbations affect the output of deep neural networks, exploring an analogy between deep feed-forward networks and dynamical systems, where the growth or decay of local perturbations is characterized by finite-time Lyapunov exponents. We show that the maximal exponent forms geometrical structures in input space, akin to coherent structures in dynamical systems. Ridges of large positive exponents divide input space into different regions that the network associates with different classes. These ridges visualize the geometry that deep networks construct in input space, shedding light on the fundamental mechanisms underlying their learning capabilities.

Reducing Nonemergent Visits to the Emergency Department in a Veterans Affairs Multistate System.

STUDY OBJECTIVE: The purpose of this quality improvement study was to reduce nonemergent visits to the emergency department attendance within a multistate Veterans Health Affairs network. METHODS: Telephone triage protocols were developed and implemented for registered nurse staff to triage selected calls to a same-day telephonic or video virtual visit with a provider (physician or nurse practitioner). Calls, registered nurse triage dispositions, and provider visit dispositions were tracked for 3 months. RESULTS: There were 1606 calls referred by registered nurses for provider visits. Of these, 192 were initially triaged as emergency department dispositions. Of these, 57.3% of calls that would have been referred to the emergency department were resolved via the virtual visit. Thirty-eight percent fewer calls were referred to the emergency department following licensed independent provider visit compared to the registered nurse triage. CONCLUSION: Telephone triage services augmented by virtual provider visits may reduce emergency department disposition rates, resulting in fewer nonemergent patient presentations to the emergency department and reducing unnecessary emergency department overcrowding. Reducing nonemergent attendance to emergency departments can improve outcomes for patients with emergent dispositions.

Socioeconomic status and risk of intensive care unit admission with sepsis.

BACKGROUND: A recent study showed higher risk of bacteremia among individuals with low socioeconomic status (SES). We hypothesized that patients with a low SES have a higher risk of intensive care unit (ICU) admission with sepsis compared to patients with higher SES. METHODS: This was a case-control study on patients with sepsis admitted to the ICU at Aarhus University Hospital, Denmark (2008-2010). Three hundred eighty-three sepsis patients were matched on sex, age, and zip code with controls retrieved from the background population. SES was defined as highest accomplished educational level, yearly income, cohabitation status, and occupation. The odds ratio (OR) of being admitted with sepsis to the ICU was calculated using conditional logistic regression, adjusting for the Charlson Comorbidity Index and the remaining socioeconomic variables. RESULTS: The adjusted odds of being admitted to the ICU with sepsis were significantly higher among individuals living alone (OR 1.72, 95% confidence interval (CI) 1.33-2.24, P < 0.001) compared to individuals living with a cohabitant. Individuals outside the labor force had an adjusted OR of 3.50 (CI 2.36-5.18, P < 0.001) compared to individuals in the labor force. Individuals with a medium level of education had an increased risk of admission to the ICU with sepsis compared to a high level of education (adjusted OR 1.43, CI 1.02-2.00, P = 0.04). There was no significant association between income and risk of ICU admission with sepsis after adjustment. CONCLUSION: Individuals living alone, being outside the labor force, or having a medium level of education had significantly higher risk of ICU admission with sepsis.

Plasma levels of mannan-binding lectin (MBL)-associated serine proteases (MASPs) and MBL-associated protein in cardio- and cerebrovascular diseases.

Growing evidence suggests a prominent role of the complement system in the pathogenesis of cardio- and cerebrovascular diseases (CVD). Mannan-binding lectin-associated serine proteases (MASPs) MASP-1 and MASP-2 of the complement lectin pathway contribute to clot formation and may represent an important link between inflammation and thrombosis. MBL-associated protein MAp44 has shown cardioprotective effects in murine models. However, MAp44 has never been measured in patients with CVD and data on MASP levels in CVD are scarce. Our aim was to investigate for the first time plasma levels of MAp44 and MASP-1, -2, -3 concomitantly in patients with CVD. We performed a pilot study in 50 healthy volunteers, in stable coronary artery disease (CAD) patients with one-vessel (n = 51) or three-vessel disease (n = 53) and age-matched controls with normal coronary arteries (n = 53), 49 patients after myocardial infarction (MI) and 66 patients with acute ischaemic stroke. We measured MAp44 and MASP-1 levels by in-house time-resolved immunofluorometric assays. MASP-2 and MASP-3 levels were measured using commercial enzyme-linked immunosorbent assay kits. MASP-1 levels were highest in subacute MI patients and lowest in acute stroke patients. MASP-2 levels were lower in MI and stroke patients compared with controls and CAD patients. MASP-3 and MAp44 levels did not differ between groups. MASP or MAp44 levels were not associated with severity of disease. MASP and MAp44 levels were associated with cardiovascular risk factors including dyslipidaemia, obesity and hypertension. Our results suggest that MASP levels may be altered in vascular diseases. Larger studies are needed to confirm our results and elucidate the underlying mechanisms.

Does psi exist? Comments on Milton and Wiseman's (1999) meta-analysis of ganzfeld research.

J. Milton and R. Wiseman (1999) attempted to replicate D. Bem and C. Honorton's (1994) meta-analysis, which yielded evidence that the ganzfeld is a suitable method for demonstrating anomalous communication. Using a database of 30 ganzfeld and autoganzfeld studies, Milton and Wiseman's meta-analysis yielded an effect size (ES) of only 0.013 (Stouffer Z = 0.70, p = .24, one-tailed). Thus they failed to replicate Bem and Honorton's finding (ES = 0.162, Stouffer Z = 2.52, p = 5.90 x 10(-3), one-tailed). The authors conducted stepwise performance comparisons between all available databases of ganzfeld research, which were argued not to be lacking in quality. Larger aggregates of such studies were formed, including a database comprising 79 ganzfeld-autoganzfeld studies (ES = 0.138, Stouffer Z = 5.66, p = 7.78 x 10(-9)). Thus Bem and Honorton's positive conclusion was confirmed. More accurate population parameters for the ganzfeld and autoganzfeld domains were calculated. Significant bidirectional psi effects were also found in all databases. The ganzfeld appears to be a replicable technique for producing psi effects in the laboratory.

[Chronic abdominal pain and eosinophilia in a young African patient]. / Chronische Abdominalschmerzen und Eosinophilie bei einer jungen Afrikanerin.

A 20-year-old African female was hospitalized several times for diffuse chronic abdominal pain. The following exclusions were made: Acute adnexitis (by laparoscopy), acute appendicitis (by appendectomy), gastric ulcerations (by esophagogastroduodenoscopy) as well as Crohn's disease and ulcerative colitis. However, once taking a closer microscopical look at the mucosa, that otherwise appeared colonoscopically to be normal, multiple eggs of schistosomiasis mansoni (S. mansoni) were found in the colon as well as the rectum. Thus, the diagnosis of an intestinal bilharziosis was finely established. In retrospect even the sample taken for the appendix could have indicated this diagnosis already earlier on. Both the antibodies (ELISA/IFAT) and the specific immunoglobulins (IgE) for S. mansoni proved significantly positive. Therapy of choice was a single oral dosage of praziquantel. Migration and tourism have considerably increased the range of tropical and infectious diseases that need to be included into differential diagnosis. This case report focuses on intestinal bilharziosis as a potential underlying cause of chronic abdominal pain in immigrants of endemically affected areas. Direct diagnosis is the most important diagnostic method. The adult worms are usually inaccessible, so the method of choice to assess both diagnosis and the degree of activity of a chronic infection is evidence of living eggs in the stool. Alternatively, in case of lack of direct evidence diagnosis can be established by endoscopy and rectal biopsy.

The revised transliminality scale: reliability and validity data from a Rasch top-down purification procedure.

The concept of transliminality ("a hypothesized tendency for psychological material to cross thresholds into or out of consciousness") was anticipated by William James (1902/1982), but it was only recently given an empirical definition by Thalbourne in terms of a 29-item Transliminality Scale. This article presents the 17-item Revised Transliminality Scale (or RTS) that corrects age and gender biases, is unidimensional by a Rasch criterion, and has a reliability of.82. The scale defines a probabilistic hierarchy of items that address magical ideation, mystical experience, absorption, hyperaesthesia, manic experience, dream interpretation, and fantasy proneness. These findings validate the suggestions by James and Thalbourne that some mental phenomena share a common underlying dimension with selected sensory experiences (such being overwhelmed by smells, bright lights, sights, and sounds). Low scores on transliminality remain correlated with "tough mindedness" in on Cattell 16PF test, as well as "self-control" and "rule consciousness," whereas high scores are associated with "abstractedness" and an "openness to change" on that test. An independent validation study confirmed the predictions implied by our definition of transliminality. Implications for test construction are discussed.