Bulletin of Computer Science and Electrical Engineering (BCSEE)
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945-P: Predictors of Lack of Improvement in Glycemic Control in Persons with Type 2 Diabetes
No full textThe ADA recommends an A1C 8.5% (poor control) were included. Patients with improved glycemic control (current A1C ≤8.5%) were compared with those with lack of improvement (current A1C >8.5%) . On multivariate logistic regression analysis including all variables in the model, independent predictors of lack of improvement were: younger age (OR 0.89 per 1-SD [12 years]; 95 % CI 0.79 - 1.00) , female gender (1.30, 1.- 1.56) , presence of hypertension (1.29, 1.- 1.55) , Black race (1.32, 1.- 1.68, White as reference) , low income area code (1.86,1.28 - 2.68, high as reference) and insurance coverage other than Medicare (1.32, 1.- 1.66) . Presence of current smoking was associated with a paradoxical improvement in A1C (0.69, 0.47 - 0.99) . We conclude that socioeconomic factors like income, insurance coverage and neighborhood are associated with lack of improvement in A1C. Further studies need to identify specific modifiable socioeconomic factors
Analysis of an Antibiotic Stewardship Program for Asymptomatic Bacteriuria in the Veterans Affairs Health Care System
No full textThis quality improvement study explores external and internal facilitation as an implementation strategy for antibiotic stewardship in both acute and long-term care among patients with asymptomatic bacteriuria
Clinical Management of Patients with Schizophrenia Treated with Long-Acting Injectable Antipsychotics and Telepsychiatry Use During COVID-19 Pandemic
No full textThe COVID-19 pandemic substantially impacted care of patients with schizophrenia treated with long-acting injectable antipsychotics (LAIs). This study examined how clinics adapted operations to maintain a standard of care for these patients after pandemic onset.
Online surveys were completed in October-November 2020 by one principal investigator (PI) or PI-appointed designee at 35 clinics participating in OASIS (NCT03919994). Items concerned pandemic impacts on clinic operations, particularly telepsychiatry, and on the care of patients with schizophrenia treated with LAIs.
All 35 clinics reported using telepsychiatry; 20 (57%) implemented telepsychiatry after pandemic onset. Telepsychiatry visits increased from 12%-15% to 45%-69% across outpatient visit types after pandemic onset; frequency of no-show and/or canceled telepsychiatry visits decreased by approximately one-third. Nearly half of clinics increased the frequency of telepsychiatry visits for patients with schizophrenia treated with LAIs. Approximately one-third of participants each reported switching patients treated with LAIs to longer injection interval LAIs or to oral antipsychotics. The most common system/clinic- and patient-related barrier for telepsychiatry visits was lower reimbursement rate and access to technology/reliable internet, respectively. Almost all participants (94%) were satisfied with telepsychiatry for maintaining care of patients with schizophrenia treated with LAIs; most predicted a hybrid of telepsychiatry and office visits post-pandemic.
Changes made by clinics after pandemic onset were viewed by almost all participants as satisfactory for maintaining a standard of care for patients with schizophrenia treated with LAIs. Most participants predicted continuing telepsychiatry to support patient care post-pandemic; equitable access to telepsychiatry will be important in this regard.
Alkermes, Inc
A-214 A Novel Computerized Cognitive Test for the Detection of MCI and its Association with Neurodegeneration in Alzheimer’s Disease Prone Brain Regions
No full textAbstract
Objective: First, to determine whether a digitized cognitive stress test, the Loewenstein-Acevedo Scales for Sematic Interference and Learning, Brief Computerized Version (LASSI-BC) could differentiate between Cognitively Unimpaired (CU) and amnestic Mild Cognitive Impairment (aMCI) groups. Second, to correlate LASSI-BC performance to volumetric reductions in Alzheimer’s disease (AD)-prone regions.
Methods: 111 elders underwent a clinical and neuropsychological evaluation, along with the LASSI-BC. All participants were independent community-dwellers, had knowledgeable informants, and did not meet DSM-V criteria for any active neuropsychiatric disorder, Mood Disorder or Psychotic Disorder. Eighty-seven participants (51 CU; 36 aMCI) underwent MRI imaging. The volumes of 12 AD-prone regions were related to LASSI-BC and other memory indices correcting for False Discovery Rate (FDR).
Results: After adjusting for initial learning ability, the failure to recover from proactive semantic interference (frPSI) of LASSI-BC successfully differentiated between groups. Measures of frPSI were associated with volumetric reductions in AD-prone regions (hippocampus, amygdala, inferior temporal-lobes, precuneus and posterior cingulate) in aMCI cohort. A combination of maximum learning capacity and frPSI on the LASSI-BC yielded an area under ROC curve of 0.876 with greater sensitivity and specificity when compared to other traditional tests (e.g., HVLT).
Conclusions: Performance on the LASSI-BC successfully discriminated between diagnostic groups and is significantly associated with volumetric loss among aMCI individuals. This is significant as diagnostic cognitive tests of preclinical and prodromal AD should also be required to exhibit sensitivity to biomarkers of AD (e.g., amyloid, tau, and neurodegeneration in AD-prone regions), which may address some of the most critical challenges facing clinical trials
Executive Summary of the KDIGO 2022 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease
No full textPhysician Scheduling for Emergency Telemedicine
No full textThe use of technology in the health sector has increased over the years with the aim of providing efficient and quality services to save lives. Physician staffing and scheduling is a major managerial challenge for sustaining effective care in telemedicine especially in the context of emergency medicine. Motivated by an industry project with a telemedicine company that serves to multiple hospitals, this research focuses on the provision of telemedicine for stroke patients. The company operates 24/7 where the physicians perform their work remotely for patients typically located in the emergency wards in hospitals. Since stroke is a state of emergency, the telemedicine system must respond to an arriving case with a physician who is credentialed in the hospital where the patient is treated within a very short time window and as such, queuing the patient is not an option when there is no available on-shift physician. In such cases, the system must invoke the off-shift physicians, which is referred to as a "blast", an option that is required but not preferred by the telemedicine company due to high costs. A novel integer programming model is proposed for physician scheduling, which aims to minimize total costs under a chance constraint that limits the blast probabilities and other tactical constraints that are unique to this setting
Cone Beam CT with Automatic vessel Detection Software versus Conventional 2D Fluoroscopy with Overlay for Prostate Artery Embolization: A Comparison of Prostatic Artery Catheterization Time and Radiation Exposure
No full textAbstract
Purpose
To evaluate the effect of cone-beam computed tomography (CT) with automatic vessel detection software on prostate artery catheterization and fluoroscopy time in prostate artery embolization (PAE).
Methods
Fifty patients undergoing PAE for BPH were enrolled in this prospective study. Twenty-five PAEs were performed using automatic vessel detection software with syngo embolization guidance (study) and were compared with 25 PAEs performed using conventional two-dimensional (2D) fluoroscopy with overlay (control). PAE was performed using 300–500 μm trisacryl gelatin spherical particles. The primary outcome parameters were prostatic artery catheterization time and fluoroscopy time.
Results
Bilateral PAE was achieved in 24/25 cases in both groups. The median right and left prostatic artery catheterization times were similar between the two groups, (
p
= 0.473 and
p
= 0.659, respectively). The median fluoroscopy time (28.0 and 42.0 minutes,
p
= 0.046) and total procedure time (70.0 and 118.0 minutes,
p
< 0.001) were shorter in the study group. The median total dose area product (DAP) was not significantly different. However, the median CBCT DAP (11406 vs. 6248,
p
< 0.001) was higher in the study group, while median fluoroscopy DAP (7371 vs. 8426,
p
< .049) was higher in the control group. Median digital subtraction angiography (DSA), CBCT, and fluoroscopy DAP accounted for 27%, 45%, and 29% of the total DAP in the study group and 32%, 29%, and 39% in the control group (
p
< 0.001), respectively. All complications were Clavien–Dindo Grade 1.
Conclusion
Although CBCT with automatic vessel detection software had no significant effect on time-to-prostatic artery catheterization and total radiation exposure, it reduced the fluoroscopy time and procedure time
Revealing General Patterns of Microbiomes That Transcend Systems: Potential and Challenges of Deep Transfer Learning
No full textA growing body of research has established that the microbiome can mediate the dynamics and functional capacities of diverse biological systems. Yet, we understand little about what governs the response of these microbial commun-ities to host or environmental changes. Most efforts to model microbiomes focus on defining the relationships between the microbiome, host, and environmental fea-tures within a specified study system and therefore fail to capture those that may be evident across multiple systems. In parallel with these developments in microbiome research, computer scientists have developed a variety of machine learning tools that can identify subtle, but informative, patterns from complex data. Here, we rec-ommend using deep transfer learning to resolve microbiome patterns that transcend study systems. By leveraging diverse public data sets in an unsupervised way, such models can learn contextual relationships between features and build on those pat -terns to perform subsequent tasks (e.g., classification) within specific biological contexts
The Effect of Biomarker Use on the Speed and Duration of Clinical Trials for Cancer Drugs
No full textThe purpose of this study was to explore the effects biomarkers have on the duration and speed of clinical trials in oncology.
Clinical trial data was pooled from www.clinicaltrials.gov within the 4 cancer indications of non-small cell lung cancer, breast cancer, melanoma, and colorectal cancer. Heatmaps of clinical timelines were used to display differences in the frequency and timing of clinical trials across trials that used or did not use biomarkers, for all 4 indications.
Screening of 8630 clinical trials across the 4 indications yielded 671 unique drugs corresponding to 1224 eligible trials used in our analysis. The constructed heatmaps visually represented that biomarkers did not have an effect on the time gap between trial phases for non-small cell lung cancer and melanoma but did for colorectal and breast cancer trials, reducing the speed of trial timelines. It was also observed that biomarker trials were more often concurrent over shorter periods of time and began later in the timeline for non-small cell lung and colorectal cancers.
The novel visualization method revealed longer gaps between trial phases, later clinical trial start times, and shorter periods of concurrently run trials for drugs that used biomarkers. The study highlights that biomarker-driven trials might impact drug approval timelines and need to be considered carefully in clinical development plan
Gating Mechanism of HCN Pacemaker Channels
No full textHyperpolarization-activated cyclic nucleotide-gated (HCN) channels are essential for rhythmic activity in the heart and brain, and mutations in HCN channels are linked to heart arrhythmia and epilepsy (18, 19). HCN channels belong to the family of voltage-gated K+ (Kv) channels. However, why HCN channels are activated by hyperpolarization (i.e. when the membrane potential becomes more negative) whereas Kv channels are activated by depolarization (i.e. when the membrane potential becomes more positive) is not clear (9, 20-22). Hyperpolarization-activated HCN channels and depolarization-activated Kv 10.1 (EAG) channels have very similar tetrameric structures with six transmembrane segments (S1-S6) per subunit: S1-S4 form the voltage-sensing domain (VSD) and S5-S6 form the pore domain (PD) (17, 23). In both Kv and HCN channels, S4 is the positively charged voltage sensor (7, 9-11) and the C-terminal part of S6 forms the gate (17, 24-26). Here we find that the most C-terminal region of S4 is required for both S4 movement and the coupling between S4 and the gate in HCN channels. We reverse the voltage dependence of HCN channels by mutating only two residues located at the interface between the C-terminal region of S4 and the PD such that the channels now open upon depolarization instead of hyperpolarization. Because the S4 movement in the mutant depolarization-activated HCN channels is similar to that in hyperpolarization-activated HCN channels, we suggest that these mutations reverse the coupling between S4 and the gate. Our data indicate that what determines whether an HCN channel opens by hyperpolarizations or depolarizations are small differences in free energy between the closed and open states, due to different interactions between S4 and the pore in the different channels. We found that residue E356 in the QWE sequence interacts with N370 in S5, stabilizing the up state of S4. The E356A mutant revealed that a second S4 movement occurs at negative voltages, in the same voltage range as gate opening occurs. Understanding how HCN channels gate will aid in development of better anti-arrhythmic and anti-epileptic drugs targeting HCN channels