Exploring the potential role of allostatic load biomarkers in risk assessment of patients presenting with depressive symptoms

Background: Depression is a major health problem worldwide and the majority of patients presenting with depressive symptoms are managed in primary care. Current approaches for assessing depressive symptoms in primary care are not accurate in predicting future clinical outcomes, which may potentially lead to over or under treatment. The Allostatic Load (AL) theory suggests that by measuring multi-system biomarker levels as a proxy of measuring multi-system physiological dysregulation, it is possible to identify individuals at risk of having adverse health outcomes at a prodromal stage. Allostatic Index (AI) score, calculated by applying statistical formulations to different multi-system biomarkers, have been associated with depressive symptoms. Aims and Objectives: To test the hypothesis, that a combination of allostatic load (AL) biomarkers will form a predictive algorithm in defining clinically meaningful outcomes in a population of patients presenting with depressive symptoms. The key objectives were: 1. To explore the relationship between various allostatic load biomarkers and prevalence of depressive symptoms in patients, especially in patients diagnosed with three common cardiometabolic diseases (Coronary Heart Disease (CHD), Diabetes and Stroke). 2 To explore whether allostatic load biomarkers predict clinical outcomes in patients with depressive symptoms, especially in patients with three common cardiometabolic diseases (CHD, Diabetes and Stroke). 3 To develop a predictive tool to identify individuals with depressive symptoms at highest risk of adverse clinical outcomes. Methods: Datasets used: ‘DepChron’ was a dataset of 35,537 patients with existing cardiometabolic disease collected as a part of routine clinical practice. ‘Psobid’ was a research data source containing health related information from 666 participants recruited from the general population. The clinical outcomes for 3 both datasets were studied using electronic data linkage to hospital and mortality health records, undertaken by Information Services Division, Scotland. Cross-sectional associations between allostatic load biomarkers calculated at baseline, with clinical severity of depression assessed by a symptom score, were assessed using logistic and linear regression models in both datasets. Cox’s proportional hazards survival analysis models were used to assess the relationship of allostatic load biomarkers at baseline and the risk of adverse physical health outcomes at follow-up, in patients with depressive symptoms. The possibility of interaction between depressive symptoms and allostatic load biomarkers in risk prediction of adverse clinical outcomes was studied using the analysis of variance (ANOVA) test. Finally, the value of constructing a risk scoring scale using patient demographics and allostatic load biomarkers for predicting adverse outcomes in depressed patients was investigated using clinical risk prediction modelling and Area Under Curve (AUC) statistics. Key Results: Literature Review Findings. The literature review showed that twelve blood based peripheral biomarkers were statistically significant in predicting six different clinical outcomes in participants with depressive symptoms. Outcomes related to both mental health (depressive symptoms) and physical health were statistically associated with pre-treatment levels of peripheral biomarkers; however only two studies investigated outcomes related to physical health. Cross-sectional Analysis Findings: In DepChron, dysregulation of individual allostatic biomarkers (mainly cardiometabolic) were found to have a non-linear association with increased probability of co-morbid depressive symptoms (as assessed by Hospital Anxiety and Depression Score HADS-D≥8). A composite AI score constructed using five biomarkers did not lead to any improvement in the observed strength of the association. In Psobid, BMI was found to have a significant cross-sectional association with the probability of depressive symptoms (assessed by General Health Questionnaire GHQ-28≥5). BMI, triglycerides, highly sensitive C - reactive 4 protein (CRP) and High Density Lipoprotein-HDL cholesterol were found to have a significant cross-sectional relationship with the continuous measure of GHQ-28. A composite AI score constructed using 12 biomarkers did not show a significant association with depressive symptoms among Psobid participants. Longitudinal Analysis Findings: In DepChron, three clinical outcomes were studied over four years: all-cause death, all-cause hospital admissions and composite major adverse cardiovascular outcome-MACE (cardiovascular death or admission due to MI/stroke/HF). Presence of depressive symptoms and composite AI score calculated using mainly peripheral cardiometabolic biomarkers was found to have a significant association with all three clinical outcomes over the following four years in DepChron patients. There was no evidence of an interaction between AI score and presence of depressive symptoms in risk prediction of any of the three clinical outcomes. There was a statistically significant interaction noted between SBP and depressive symptoms in risk prediction of major adverse cardiovascular outcome, and also between HbA1c and depressive symptoms in risk prediction of all-cause mortality for patients with diabetes. In Psobid, depressive symptoms (assessed by GHQ-28≥5) did not have a statistically significant association with any of the four outcomes under study at seven years: all cause death, all cause hospital admission, MACE and incidence of new cancer. A composite AI score at baseline had a significant association with the risk of MACE at seven years, after adjusting for confounders. A continuous measure of IL-6 observed at baseline had a significant association with the risk of three clinical outcomes- all-cause mortality, all-cause hospital admissions and major adverse cardiovascular event. Raised total cholesterol at baseline was associated with lower risk of all-cause death at seven years while raised waist hip ratio- WHR at baseline was associated with higher risk of MACE at seven years among Psobid participants. There was no significant interaction between depressive symptoms and peripheral biomarkers (individual or combined) in risk prediction of any of the four clinical outcomes under consideration. Risk Scoring System Development: In the DepChron cohort, a scoring system was constructed based on eight baseline demographic and clinical variables to predict the risk of MACE over four years. The AUC value for the risk scoring system was modest at 56.7% (95% CI 55.6 to 57.5%). In Psobid, it was not possible to perform this analysis due to the low event rate observed for the clinical outcomes. Conclusion: Individual peripheral biomarkers were found to have a cross-sectional association with depressive symptoms both in patients with cardiometabolic disease and middle-aged participants recruited from the general population. AI score calculated with different statistical formulations was of no greater benefit in predicting concurrent depressive symptoms or clinical outcomes at follow-up, over and above its individual constituent biomarkers, in either patient cohort. SBP had a significant interaction with depressive symptoms in predicting cardiovascular events in patients with cardiometabolic disease; HbA1c had a significant interaction with depressive symptoms in predicting all-cause mortality in patients with diabetes. Peripheral biomarkers may have a role in predicting clinical outcomes in patients with depressive symptoms, especially for those with existing cardiometabolic disease, and this merits further investigation.

Dynamically managing sensed context data

This thesis reports on an investigation of the feasibility and usefulness of incorporating dynamic management facilities for managing sensed context data in a distributed contextaware mobile application. The investigation focuses on reducing the work required to integrate new sensed context streams in an existing context aware architecture. Current architectures require integration work for new streams and new contexts that are encountered. This means of operation is acceptable for current fixed architectures. However, as systems become more mobile the number of discoverable streams increases. Without the ability to discover and use these new streams the functionality of any given device will be limited to the streams that it knows how to decode. The integration of new streams requires that the sensed context data be understood by the current application. If the new source provides data of a type that an application currently requires then the new source should be connected to the application without any prior knowledge of the new source. If the type is similar and can be converted then this stream too should be appropriated by the application. Such applications are based on portable devices (phones, PDAs) for semi-autonomous services that use data from sensors connected to the devices, plus data exchanged with other such devices and remote servers. Such applications must handle input from a variety of sensors, refining the data locally and managing its communication from the device in volatile and unpredictable network conditions. The choice to focus on locally connected sensory input allows for the introduction of privacy and access controls. This local control can determine how the information is communicated to others. This investigation focuses on the evaluation of three approaches to sensor data management. The first system is characterised by its static management based on the pre-pended metadata. This was the reference system. Developed for a mobile system, the data was processed based on the attached metadata. The code that performed the processing was static. The second system was developed to move away from the static processing and introduce a greater freedom of handling for the data stream, this resulted in a heavy weight approach. The approach focused on pushing the processing of the data into a number of networked nodes rather than the monolithic design of the previous system. By creating a separate communication channel for the metadata it is possible to be more flexible with the amount and type of data transmitted. The final system pulled the benefits of the other systems together. By providing a small management class that would load a separate handler based on the incoming data, Dynamism was maximised whilst maintaining ease of code understanding. The three systems were then compared to highlight their ability to dynamically manage new sensed context. The evaluation took two approaches, the first is a quantitative analysis of the code to understand the complexity of the relative three systems. This was done by evaluating what changes to the system were involved for the new context. The second approach takes a qualitative view of the work required by the software engineer to reconfigure the systems to provide support for a new data stream. The evaluation highlights the various scenarios in which the three systems are most suited. There is always a trade-o↵ in the development of a system. The three approaches highlight this fact. The creation of a statically bound system can be quick to develop but may need to be completely re-written if the requirements move too far. Alternatively a highly dynamic system may be able to cope with new requirements but the developer time to create such a system may be greater than the creation of several simpler systems.

Data structures for SIMD logic simulation

Due to the growth of design size and complexity, design verification is an important aspect of the Logic Circuit development process. The purpose of verification is to validate that the design meets the system requirements and specification. This is done by either functional or formal verification. The most popular approach to functional verification is the use of simulation based techniques. Using models to replicate the behaviour of an actual system is called simulation. In this thesis, a software/data structure architecture without explicit locks is proposed to accelerate logic gate circuit simulation. We call thus system ZSIM. The ZSIM software architecture simulator targets low cost SIMD multi-core machines. Its performance is evaluated on the Intel Xeon Phi and 2 other machines (Intel Xeon and AMD Opteron). The aim of these experiments is to: • Verify that the data structure used allows SIMD acceleration, particularly on machines with gather instructions ( section 5.3.1). • Verify that, on sufficiently large circuits, substantial gains could be made from multicore parallelism ( section 5.3.2 ). • Show that a simulator using this approach out-performs an existing commercial simulator on a standard workstation ( section 5.3.3 ). • Show that the performance on a cheap Xeon Phi card is competitive with results reported elsewhere on much more expensive super-computers ( section 5.3.5 ). To evaluate the ZSIM, two types of test circuits were used: 1. Circuits from the IWLS benchmark suit [1] which allow direct comparison with other published studies of parallel simulators.2. Circuits generated by a parametrised circuit synthesizer. The synthesizer used an algorithm that has been shown to generate circuits that are statistically representative of real logic circuits. The synthesizer allowed testing of a range of very large circuits, larger than the ones for which it was possible to obtain open source files. The experimental results show that with SIMD acceleration and multicore, ZSIM gained a peak parallelisation factor of 300 on Intel Xeon Phi and 11 on Intel Xeon. With only SIMD enabled, ZSIM achieved a maximum parallelistion gain of 10 on Intel Xeon Phi and 4 on Intel Xeon. Furthermore, it was shown that this software architecture simulator running on a SIMD machine is much faster than, and can handle much bigger circuits than a widely used commercial simulator (Xilinx) running on a workstation. The performance achieved by ZSIM was also compared with similar pre-existing work on logic simulation targeting GPUs and supercomputers. It was shown that ZSIM simulator running on a Xeon Phi machine gives comparable simulation performance to the IBM Blue Gene supercomputer at very much lower cost. The experimental results have shown that the Xeon Phi is competitive with simulation on GPUs and allows the handling of much larger circuits than have been reported for GPU simulation. When targeting Xeon Phi architecture, the automatic cache management of the Xeon Phi, handles and manages the on-chip local store without any explicit mention of the local store being made in the architecture of the simulator itself. However, targeting GPUs, explicit cache management in program increases the complexity of the software architecture. Furthermore, one of the strongest points of the ZSIM simulator is its portability. Note that the same code was tested on both AMD and Xeon Phi machines. The same architecture that efficiently performs on Xeon Phi, was ported into a 64 core NUMA AMD Opteron. To conclude, the two main achievements are restated as following: The primary achievement of this work was proving that the ZSIM architecture was faster than previously published logic simulators on low cost platforms. The secondary achievement was the development of a synthetic testing suite that went beyond the scale range that was previously publicly available, based on prior work that showed the synthesis technique is valid.

Simulation tools for the analysis of single electronic systems

Developments in theory and experiment have raised the prospect of an electronic technology based on the discrete nature of electron tunnelling through a potential barrier. This thesis deals with novel design and analysis tools developed to study such systems. Possible devices include those constructed from ultrasmall normal tunnelling junctions. These exhibit charging effects including the Coulomb blockade and correlated electron tunnelling. They allow transistor-like control of the transfer of single carriers, and present the prospect of digital systems operating at the information theoretic limit. As such, they are often referred to as single electronic devices. Single electronic devices exhibit self quantising logic and good structural tolerance. Their speed, immunity to thermal noise, and operating voltage all scale beneficially with junction capacitance. For ultrasmall junctions the possibility of room temperature operation at sub picosecond timescales seems feasible. However, they are sensitive to external charge; whether from trapping-detrapping events, externally gated potentials, or system cross-talk. Quantum effects such as charge macroscopic quantum tunnelling may degrade performance. Finally, any practical system will be complex and spatially extended (amplifying the above problems), and prone to fabrication imperfection. This summarises why new design and analysis tools are required. Simulation tools are developed, concentrating on the basic building blocks of single electronic systems; the tunnelling junction array and gated turnstile device. Three main points are considered: the best method of estimating capacitance values from physical system geometry; the mathematical model which should represent electron tunnelling based on this data; application of this model to the investigation of single electronic systems. (DXN004909)

Using interaction data for improving the offline and online evaluation of search engines

This thesis investigates how web search evaluation can be improved using historical interaction data. Modern search engines combine offline and online evaluation approaches in a sequence of steps that a tested change needs to pass through to be accepted as an improvement and subsequently deployed. We refer to such a sequence of steps as an evaluation pipeline. In this thesis, we consider the evaluation pipeline to contain three sequential steps: an offline evaluation step, an online evaluation scheduling step, and an online evaluation step. In this thesis we show that historical user interaction data can aid in improving the accuracy or efficiency of each of the steps of the web search evaluation pipeline. As a result of these improvements, the overall efficiency of the entire evaluation pipeline is increased. Firstly, we investigate how user interaction data can be used to build accurate offline evaluation methods for query auto-completion mechanisms. We propose a family of offline evaluation metrics for query auto-completion that represents the effort the user has to spend in order to submit their query. The parameters of our proposed metrics are trained against a set of user interactions recorded in the search engine’s query logs. From our experimental study, we observe that our proposed metrics are significantly more correlated with an online user satisfaction indicator than the metrics proposed in the existing literature. Hence, fewer changes will pass the offline evaluation step to be rejected after the online evaluation step. As a result, this would allow us to achieve a higher efficiency of the entire evaluation pipeline. Secondly, we state the problem of the optimised scheduling of online experiments. We tackle this problem by considering a greedy scheduler that prioritises the evaluation queue according to the predicted likelihood of success of a particular experiment. This predictor is trained on a set of online experiments, and uses a diverse set of features to represent an online experiment. Our study demonstrates that a higher number of successful experiments per unit of time can be achieved by deploying such a scheduler on the second step of the evaluation pipeline. Consequently, we argue that the efficiency of the evaluation pipeline can be increased. Next, to improve the efficiency of the online evaluation step, we propose the Generalised Team Draft interleaving framework. Generalised Team Draft considers both the interleaving policy (how often a particular combination of results is shown) and click scoring (how important each click is) as parameters in a data-driven optimisation of the interleaving sensitivity. Further, Generalised Team Draft is applicable beyond domains with a list-based representation of results, i.e. in domains with a grid-based representation, such as image search. Our study using datasets of interleaving experiments performed both in document and image search domains demonstrates that Generalised Team Draft achieves the highest sensitivity. A higher sensitivity indicates that the interleaving experiments can be deployed for a shorter period of time or use a smaller sample of users. Importantly, Generalised Team Draft optimises the interleaving parameters w.r.t. historical interaction data recorded in the interleaving experiments. Finally, we propose to apply the sequential testing methods to reduce the mean deployment time for the interleaving experiments. We adapt two sequential tests for the interleaving experimentation. We demonstrate that one can achieve a significant decrease in experiment duration by using such sequential testing methods. The highest efficiency is achieved by the sequential tests that adjust their stopping thresholds using historical interaction data recorded in diagnostic experiments. Our further experimental study demonstrates that cumulative gains in the online experimentation efficiency can be achieved by combining the interleaving sensitivity optimisation approaches, including Generalised Team Draft, and the sequential testing approaches. Overall, the central contributions of this thesis are the proposed approaches to improve the accuracy or efficiency of the steps of the evaluation pipeline: the offline evaluation frameworks for the query auto-completion, an approach for the optimised scheduling of online experiments, a general framework for the efficient online interleaving evaluation, and a sequential testing approach for the online search evaluation. The experiments in this thesis are based on massive real-life datasets obtained from Yandex, a leading commercial search engine. These experiments demonstrate the potential of the proposed approaches to improve the efficiency of the evaluation pipeline.