Παρασκευή 16 Σεπτεμβρίου 2016

Latent Patient Cluster Discovery for Robust Future Forecasting and New-Patient Generalization

by Ting Qian, Aaron J. Masino

Commonly referred to as predictive modeling, the use of machine learning and statistical methods to improve healthcare outcomes has recently gained traction in biomedical informatics research. Given the vast opportunities enabled by large Electronic Health Records (EHR) data and powerful resources for conducting predictive modeling, we argue that it is yet crucial to first carefully examine the prediction task and then choose predictive methods accordingly. Specifically, we argue that there are at least three distinct prediction tasks that are often conflated in biomedical research: 1) data imputation, where a model fills in the missing values in a dataset, 2) future forecasting, where a model projects the development of a medical condition for a known patient based on existing observations, and 3) new-patient generalization, where a model transfers the knowledge learned from previously observed patients to newly encountered ones. Importantly, the latter two tasks—future forecasting and new-patient generalizations—tend to be more difficult than data imputation as they require predictions to be made on potentially out-of-sample data (i.e., data following a different predictable pattern from what has been learned by the model). Using hearing loss progression as an example, we investigate three regression models and show that the modeling of latent clusters is a robust method for addressing the more challenging prediction scenarios. Overall, our findings suggest that there exist significant differences between various kinds of prediction tasks and that it is important to evaluate the merits of a predictive model relative to the specific purpose of a prediction task.

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Apple’s New iPhone 7: What’s the Effect on HA Service and Delivery?

On September 7, Apple introduced the iPhone 7 smartphone, which was largely regarded by tech reporters as a “ho-hum” event, except for the excitement surrounding what was missing: the 3.5-mm phone jack. Although they announced that the “lightning” cable could now carry audio-by-wire, they also announced the AirPod wireless headphones, along with the Bragi Dash, Samsung Gear IconX, and several other devices that have become to be called “hearables” for their ability to stream audio and monitor biometric information.



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Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age.

Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age.

Int J Audiol. 2016 Sep 14;:1-12

Authors: Cupples L, Ching TY, Button L, Leigh G, Marnane V, Whitfield J, Gunnourie M, Martin L

Abstract
OBJECTIVE: This study examined language and speech outcomes in young children with hearing loss and additional disabilities.
DESIGN: Receptive and expressive language skills and speech output accuracy were evaluated using direct assessment and caregiver report. Results were analysed first for the entire participant cohort, and then to compare results for children with hearing aids (HAs) versus cochlear implants (CIs).
STUDY SAMPLE: A population-based cohort of 146 five-year-old children with hearing loss and additional disabilities took part.
RESULTS: Across all participants, multiple regressions showed that better language outcomes were associated with milder hearing loss, use of oral communication, higher levels of cognitive ability and maternal education, and earlier device fitting. Speech output accuracy was associated with use of oral communication only. Average outcomes were similar for children with HAs versus CIs, but their associations with demographic variables differed. For HA users, results resembled those for the whole cohort. For CI users, only use of oral communication and higher cognitive ability levels were significantly associated with better language outcomes.
CONCLUSIONS: The results underscore the importance of early device fitting for children with additional disabilities. Strong conclusions cannot be drawn for CI users given the small number of participants with complete data.

PMID: 27630013 [PubMed - as supplied by publisher]



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Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies.

Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies.

Int J Audiol. 2016 Sep 14;:1-9

Authors: Pohl F, Paasche G, Lenarz T, Schuon R

Abstract
OBJECTIVE: To investigate and establish the use of tympanometry in conscious sheep to provide a means of objective assessment of tympanic membrane integrity, middle ear ventilation and functioning of the Eustachian tube (ET).
DESIGN: After conditioning the sheep for four weeks, tympanometric measurements at 226 Hz were carried out weekly for 13 weeks. Before measurements, the external ear canal had been cleaned. Resultant curves were classified according to human reference values.
STUDY SAMPLE: Tests were performed on 12 female blackface sheep.
RESULTS: After cleaning of the external ear canal under otoscopic control, tympanic membranes were intact with no evidence of acute or chronic middle ear inflammation, middle ear effusion or retraction. Cleaning ensured valid, objective and reproducible measurements. As the majority of normal tympanograms were notched without the appearance of any malformation, an additional tympanogram type (AN) was introduced. The notched appearance can most likely be explained by the anatomy of the middle ear of the sheep and the test frequency that was used.
CONCLUSION: The current study demonstrated how tympanometry can be used to evaluate treatment modalities for middle ear and ET function in conscious sheep. This provided a large animal model for further human research in otology.

PMID: 27627838 [PubMed - as supplied by publisher]



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Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age.

Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age.

Int J Audiol. 2016 Sep 14;:1-12

Authors: Cupples L, Ching TY, Button L, Leigh G, Marnane V, Whitfield J, Gunnourie M, Martin L

Abstract
OBJECTIVE: This study examined language and speech outcomes in young children with hearing loss and additional disabilities.
DESIGN: Receptive and expressive language skills and speech output accuracy were evaluated using direct assessment and caregiver report. Results were analysed first for the entire participant cohort, and then to compare results for children with hearing aids (HAs) versus cochlear implants (CIs).
STUDY SAMPLE: A population-based cohort of 146 five-year-old children with hearing loss and additional disabilities took part.
RESULTS: Across all participants, multiple regressions showed that better language outcomes were associated with milder hearing loss, use of oral communication, higher levels of cognitive ability and maternal education, and earlier device fitting. Speech output accuracy was associated with use of oral communication only. Average outcomes were similar for children with HAs versus CIs, but their associations with demographic variables differed. For HA users, results resembled those for the whole cohort. For CI users, only use of oral communication and higher cognitive ability levels were significantly associated with better language outcomes.
CONCLUSIONS: The results underscore the importance of early device fitting for children with additional disabilities. Strong conclusions cannot be drawn for CI users given the small number of participants with complete data.

PMID: 27630013 [PubMed - as supplied by publisher]



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Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies.

Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies.

Int J Audiol. 2016 Sep 14;:1-9

Authors: Pohl F, Paasche G, Lenarz T, Schuon R

Abstract
OBJECTIVE: To investigate and establish the use of tympanometry in conscious sheep to provide a means of objective assessment of tympanic membrane integrity, middle ear ventilation and functioning of the Eustachian tube (ET).
DESIGN: After conditioning the sheep for four weeks, tympanometric measurements at 226 Hz were carried out weekly for 13 weeks. Before measurements, the external ear canal had been cleaned. Resultant curves were classified according to human reference values.
STUDY SAMPLE: Tests were performed on 12 female blackface sheep.
RESULTS: After cleaning of the external ear canal under otoscopic control, tympanic membranes were intact with no evidence of acute or chronic middle ear inflammation, middle ear effusion or retraction. Cleaning ensured valid, objective and reproducible measurements. As the majority of normal tympanograms were notched without the appearance of any malformation, an additional tympanogram type (AN) was introduced. The notched appearance can most likely be explained by the anatomy of the middle ear of the sheep and the test frequency that was used.
CONCLUSION: The current study demonstrated how tympanometry can be used to evaluate treatment modalities for middle ear and ET function in conscious sheep. This provided a large animal model for further human research in otology.

PMID: 27627838 [PubMed - as supplied by publisher]



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Mutations of SGO2 and CLDN14 collectively cause coincidental Perrault syndrome.

Mutations of SGO2 and CLDN14 collectively cause coincidental Perrault syndrome.

Clin Genet. 2016 Sep 15;

Authors: Faridi R, Rehman AU, Morell RJ, Friedman PL, Demain L, Zahra S, Khan AA, Tohlob D, Assir MZ, Beaman G, Khan SN, Newman WG, Riazuddin S, Friedman TB

Abstract
Perrault syndrome (PS) is a genetically heterogeneous disorder characterized by primary ovarian insufficiency (POI) in females and sensorineural hearing loss in males and females. In many PS subjects, causative variants have not been found in the five reported PS genes. The objective of this study was to identify the genetic cause of PS in an extended consanguineous family with six deaf individuals. Whole exome sequencing (WES) was completed on four affected members of a large family, and variants and co-segregation was confirmed by Sanger sequencing. All hearing impaired individuals, including the proband, are homozygous for a pathogenic variant of CLDN14, but this only explains the deafness. The PS proband is also homozygous for a frameshift variant (c.1453_1454delGA, p.Glu485Lysfs*5) in exon 7 of SGO2 encoding shugoshin 2, which is the likely cause of her concurrent ovarian insufficiency. In mouse, Sgol2a encoding shugoshin-like 2a is necessary during meiosis in both sexes to maintain the integrity of the cohesin complex that tethers sister chromatids. Human SGO2 has not previously been implicated in any disorder, but in this case of POI and perhaps others, it is a candidate for unexplained infertility.

PMID: 27629923 [PubMed - as supplied by publisher]



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Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age.

Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age.

Int J Audiol. 2016 Sep 14;:1-12

Authors: Cupples L, Ching TY, Button L, Leigh G, Marnane V, Whitfield J, Gunnourie M, Martin L

Abstract
OBJECTIVE: This study examined language and speech outcomes in young children with hearing loss and additional disabilities.
DESIGN: Receptive and expressive language skills and speech output accuracy were evaluated using direct assessment and caregiver report. Results were analysed first for the entire participant cohort, and then to compare results for children with hearing aids (HAs) versus cochlear implants (CIs).
STUDY SAMPLE: A population-based cohort of 146 five-year-old children with hearing loss and additional disabilities took part.
RESULTS: Across all participants, multiple regressions showed that better language outcomes were associated with milder hearing loss, use of oral communication, higher levels of cognitive ability and maternal education, and earlier device fitting. Speech output accuracy was associated with use of oral communication only. Average outcomes were similar for children with HAs versus CIs, but their associations with demographic variables differed. For HA users, results resembled those for the whole cohort. For CI users, only use of oral communication and higher cognitive ability levels were significantly associated with better language outcomes.
CONCLUSIONS: The results underscore the importance of early device fitting for children with additional disabilities. Strong conclusions cannot be drawn for CI users given the small number of participants with complete data.

PMID: 27630013 [PubMed - as supplied by publisher]



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Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies.

Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies.

Int J Audiol. 2016 Sep 14;:1-9

Authors: Pohl F, Paasche G, Lenarz T, Schuon R

Abstract
OBJECTIVE: To investigate and establish the use of tympanometry in conscious sheep to provide a means of objective assessment of tympanic membrane integrity, middle ear ventilation and functioning of the Eustachian tube (ET).
DESIGN: After conditioning the sheep for four weeks, tympanometric measurements at 226 Hz were carried out weekly for 13 weeks. Before measurements, the external ear canal had been cleaned. Resultant curves were classified according to human reference values.
STUDY SAMPLE: Tests were performed on 12 female blackface sheep.
RESULTS: After cleaning of the external ear canal under otoscopic control, tympanic membranes were intact with no evidence of acute or chronic middle ear inflammation, middle ear effusion or retraction. Cleaning ensured valid, objective and reproducible measurements. As the majority of normal tympanograms were notched without the appearance of any malformation, an additional tympanogram type (AN) was introduced. The notched appearance can most likely be explained by the anatomy of the middle ear of the sheep and the test frequency that was used.
CONCLUSION: The current study demonstrated how tympanometry can be used to evaluate treatment modalities for middle ear and ET function in conscious sheep. This provided a large animal model for further human research in otology.

PMID: 27627838 [PubMed - as supplied by publisher]



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Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age.

Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age.

Int J Audiol. 2016 Sep 14;:1-12

Authors: Cupples L, Ching TY, Button L, Leigh G, Marnane V, Whitfield J, Gunnourie M, Martin L

Abstract
OBJECTIVE: This study examined language and speech outcomes in young children with hearing loss and additional disabilities.
DESIGN: Receptive and expressive language skills and speech output accuracy were evaluated using direct assessment and caregiver report. Results were analysed first for the entire participant cohort, and then to compare results for children with hearing aids (HAs) versus cochlear implants (CIs).
STUDY SAMPLE: A population-based cohort of 146 five-year-old children with hearing loss and additional disabilities took part.
RESULTS: Across all participants, multiple regressions showed that better language outcomes were associated with milder hearing loss, use of oral communication, higher levels of cognitive ability and maternal education, and earlier device fitting. Speech output accuracy was associated with use of oral communication only. Average outcomes were similar for children with HAs versus CIs, but their associations with demographic variables differed. For HA users, results resembled those for the whole cohort. For CI users, only use of oral communication and higher cognitive ability levels were significantly associated with better language outcomes.
CONCLUSIONS: The results underscore the importance of early device fitting for children with additional disabilities. Strong conclusions cannot be drawn for CI users given the small number of participants with complete data.

PMID: 27630013 [PubMed - as supplied by publisher]



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Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies.

Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies.

Int J Audiol. 2016 Sep 14;:1-9

Authors: Pohl F, Paasche G, Lenarz T, Schuon R

Abstract
OBJECTIVE: To investigate and establish the use of tympanometry in conscious sheep to provide a means of objective assessment of tympanic membrane integrity, middle ear ventilation and functioning of the Eustachian tube (ET).
DESIGN: After conditioning the sheep for four weeks, tympanometric measurements at 226 Hz were carried out weekly for 13 weeks. Before measurements, the external ear canal had been cleaned. Resultant curves were classified according to human reference values.
STUDY SAMPLE: Tests were performed on 12 female blackface sheep.
RESULTS: After cleaning of the external ear canal under otoscopic control, tympanic membranes were intact with no evidence of acute or chronic middle ear inflammation, middle ear effusion or retraction. Cleaning ensured valid, objective and reproducible measurements. As the majority of normal tympanograms were notched without the appearance of any malformation, an additional tympanogram type (AN) was introduced. The notched appearance can most likely be explained by the anatomy of the middle ear of the sheep and the test frequency that was used.
CONCLUSION: The current study demonstrated how tympanometry can be used to evaluate treatment modalities for middle ear and ET function in conscious sheep. This provided a large animal model for further human research in otology.

PMID: 27627838 [PubMed - as supplied by publisher]



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Efficacy of CDP and ENG in Detecting Balance Impairment Associated With Cerebral White Matter Changes.

Efficacy of CDP and ENG in Detecting Balance Impairment Associated With Cerebral White Matter Changes.

Otol Neurotol. 2016 Sep 14;

Authors: Urban MJ, Sataloff RT

Abstract
OBJECTIVE: To examine the relationship between white matter changes (WMCs) and abnormal balance test results on computerized dynamic posturography (CDP) and electronystagmography (ENG). Also, to compare the utility of CDP with ENG for this purpose.
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary care referral center.
PATIENTS: A retrospective review of 137 subjects was conducted. The CDP and ENG results were compared between patients with (80) and without (57) WMCs as detected byT2/fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI).
MAIN OUTCOME MEASURES: CDP analysis consisted of both sensory organization test (SOT) and motor control test (MCT) results, and ENG analysis included positional, oculomotor, and bithermal caloric testing. Multivariate logistic regression was performed to control for age and hearing loss discrepancies between the two groups.
RESULTS: Ninety three percent of patients with WMCs had an abnormal CDP result, as compared with 44% of patients lacking WMCs (p < 0.001). Eighty six percent of patients with WMCs had an abnormal ENG, as did 81% of patients without WMCs (p = 0.435). Multivariate regression analysis maintained that an abnormal CDP result was significantly associated with WMCs when controlling for age and hearing loss (p < 0.001).
CONCLUSION: These findings suggest that patients with cerebral small-vessel ischemic changes are significantly more likely to have an abnormal balance result as detected by CDP, than by ENG. Hence, CDP may be a better study to identify and document patients who have balance dysfunction associated with this central finding. Such identification will permit additional evaluation and treatment based on objective confirmation of balance dysfunction, in this group of balance-impaired subjects who may have normal ENG's.

PMID: 27631826 [PubMed - as supplied by publisher]



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Efficacy of CDP and ENG in Detecting Balance Impairment Associated With Cerebral White Matter Changes.

Efficacy of CDP and ENG in Detecting Balance Impairment Associated With Cerebral White Matter Changes.

Otol Neurotol. 2016 Sep 14;

Authors: Urban MJ, Sataloff RT

Abstract
OBJECTIVE: To examine the relationship between white matter changes (WMCs) and abnormal balance test results on computerized dynamic posturography (CDP) and electronystagmography (ENG). Also, to compare the utility of CDP with ENG for this purpose.
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary care referral center.
PATIENTS: A retrospective review of 137 subjects was conducted. The CDP and ENG results were compared between patients with (80) and without (57) WMCs as detected byT2/fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI).
MAIN OUTCOME MEASURES: CDP analysis consisted of both sensory organization test (SOT) and motor control test (MCT) results, and ENG analysis included positional, oculomotor, and bithermal caloric testing. Multivariate logistic regression was performed to control for age and hearing loss discrepancies between the two groups.
RESULTS: Ninety three percent of patients with WMCs had an abnormal CDP result, as compared with 44% of patients lacking WMCs (p < 0.001). Eighty six percent of patients with WMCs had an abnormal ENG, as did 81% of patients without WMCs (p = 0.435). Multivariate regression analysis maintained that an abnormal CDP result was significantly associated with WMCs when controlling for age and hearing loss (p < 0.001).
CONCLUSION: These findings suggest that patients with cerebral small-vessel ischemic changes are significantly more likely to have an abnormal balance result as detected by CDP, than by ENG. Hence, CDP may be a better study to identify and document patients who have balance dysfunction associated with this central finding. Such identification will permit additional evaluation and treatment based on objective confirmation of balance dysfunction, in this group of balance-impaired subjects who may have normal ENG's.

PMID: 27631826 [PubMed - as supplied by publisher]



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