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Machine learning functional impairment classification with electronic health record data.
No full textBackgroundPoor functional status is a key marker of morbidity, yet is not routinely captured in clinical encounters. We developed and evaluated the accuracy of a machine learning algorithm that leveraged electronic health record (EHR) data to provide a scalable process for identification of functional impairment.MethodsWe identified a cohort of patients with an electronically captured screening measure of functional status (Older Americans Resources and Services ADL/IADL) between 2018 and 2020 (N = 6484). Patients were classified using unsupervised learning K means and t-distributed Stochastic Neighbor Embedding into normal function (NF), mild to moderate functional impairment (MFI), and severe functional impairment (SFI) states. Using 11 EHR clinical variable domains (832 variable input features), we trained an Extreme Gradient Boosting supervised machine learning algorithm to distinguish functional status states, and measured prediction accuracies. Data were randomly split into training (80%) and test (20%) sets. The SHapley Additive Explanations (SHAP) feature importance analysis was used to list the EHR features in rank order of their contribution to the outcome.ResultsMedian age was 75.3 years, 62% female, 60% White. Patients were classified as 53% NF (n = 3453), 30% MFI (n = 1947), and 17% SFI (n = 1084). Summary of model performance for identifying functional status state (NF, MFI, SFI) was AUROC (area under the receiving operating characteristic curve) 0.92, 0.89, and 0.87, respectively. Age, falls, hospitalization, home health use, labs (e.g., albumin), comorbidities (e.g., dementia, heart failure, chronic kidney disease, chronic pain), and social determinants of health (e.g., alcohol use) were highly ranked features in predicting functional status states.ConclusionA machine learning algorithm run on EHR clinical data has potential utility for differentiating functional status in the clinical setting. Through further validation and refinement, such algorithms can complement traditional screening methods and result in a population-based strategy for identifying patients with poor functional status who need additional health resources
Impacts of Rainfall Distributions and Land Cover on the Effectiveness of Stormwater Best Management Practices
No full textAs urbanization continues and the effects of climate change intensify, optimizing the effectiveness of stormwater best management practices (BMPs) will be of utmost importance. Previous studies in the Clarksburg, Maryland area have focused on the impacts of different types of BMP infrastructure on stream health, finding conflicting results from sites with similar BMP implementation. The goal of this study was to determine what is causing different benthic outcomes by examining BMP storage capacity and how BMPs respond to varying rainfall events. The results showed that many BMPs are either under or overutilized during both extreme and typical rainfall events, indicating they are not large enough or not placed in a way to maximize their effectiveness. Given this and the lack of strong relationships between land cover types draining into BMPs and benthic outcomes, land cover composition of BMP drainage areas is likely not a great predictor of benthic outcomes by itself, as it fails to account for untreated flow due to limits in capacity
Maternal SARS-CoV-2 infection elicits sexually dimorphic placental immune responses.
No full textThere is a persistent bias toward higher prevalence and increased severity of coronavirus disease 2019 (COVID-19) in males. Underlying mechanisms accounting for this sex difference remain incompletely understood. Interferon responses have been implicated as a modulator of COVID-19 disease in adults and play a key role in the placental antiviral response. Moreover, the interferon response has been shown to alter Fc receptor expression and therefore may affect placental antibody transfer. Here, we examined the intersection of maternal-fetal antibody transfer, viral-induced placental interferon responses, and fetal sex in pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Placental Fc receptor abundance, interferon-stimulated gene (ISG) expression, and SARS-CoV-2 antibody transfer were interrogated in 68 human pregnancies. Sexually dimorphic expression of placental Fc receptors, ISGs and proteins, and interleukin-10 was observed after maternal SARS-CoV-2 infection, with up-regulation of these features in placental tissue of pregnant individuals with male fetuses. Reduced maternal SARS-CoV-2–specific antibody titers and impaired placental antibody transfer were also observed in pregnancies with a male fetus. These results demonstrate fetal sex-specific maternal and placental adaptive and innate immune responses to SARS-CoV-2
Isaiah Berlin's Liberal Humanism
No full textIn this dissertation I trace Isaiah Berlin’s efforts to find a “less internally contradictory” and “less pervertible” concept of liberty. I argue that Berlin’s political philosophy is grounded in a resolve to treat persons as individuals and as capable of choice, a position I call liberal humanism. These two commitments, liberalism and humanism, are ontological: liberalism posits that choice is both desirable and possible for human beings; humanism affirms that the individual person is the fundamental unit of politics, or the entity to which one might ascribe choice, agency, and freedom, and that attempts to divide individuals into sub-personal entities or to aggregate them into super-personal ones are dangerous paths towards dehumanization. Each of the four chapters of this dissertation traces a transformation of the choosing self that leads to equivocation and contradiction, producing situations in which persons are metaphorically “free” while literally unfree. Ultimately, I portray Berlin as a deeply anti-metaphysical thinker, a skeptical anti-idealist who, in the spirit of his hero, the Russian writer Alexander Herzen, sought to avoid the sacrifice of human beings on the altars of abstraction.</p
Patients want to talk about their out-of-pocket costs-Can real-time benefit tools help?
No full textThis editorial comments on the article by Mattingly et al.</jats:p
Performance Evaluation of Heterogeneous GPU Programming Frameworks for Hemodynamic Simulations
No full textMonte Carlo Investigation of Dosimetry Under Partial Transmission Blocks in Total Body Irradiation Treatment
No full textPurpose: Total body irradiation (TBI) is commonly performed using opposing photon beams of maximum field size at extended SSD. Partial transmission blocks (PTB) are utilized to shield critical organs such as the lungs and kidneys. Both phantom measurement and convolution algorithms confirmed that PDD under PTB deviates significantly from those regions without the blocks. The relationship is complex and depends on many factors. In this study, we investigated the dosimetry under the PTB using the Monte Carlo tool.Methods: The photon phase space (PSP) for Truebeam linac from MyVarian was used as input in the EGSnrc package. The PSP was analyzed and separated into primary (originating from the target) and scatter ( extra-focal source originating from flattening filter) components. It was hypothesized that they behave differently in the presence of PTB which is responsible for the uncommon dosimetry. In this study, a virtual filter was developed to simulate the PTB of any transmission factors in EGSnrc. Further, a concept of scatter photon enhancement ratio (SPER=〖scatter〗_PTB/(〖primary〗_PTB+〖scatter〗_PTB )/〖scatter〗_open/(〖primary〗_open+〖scatter〗_open ) ) was proposed to quantify how the scatter photons’ dose contribution changes with SSD, block size, block-to-patient distance, and transmission factor.
Results: Scatter accounts for 12% for 6X, but only 5% for 6XFFF. MC result of the virtual PTB filter agrees well with the measurement for PDD (<1.5%). For a clinical PTB of size 6x12 cm2 at the surface, the SPER at 5cm depth increases from 2.01 to 3.27 when SSD 100 to 400cm; decreases from 3.38 to 1.09 when block-surface-distance 15010cm; and decreases from 8.38 to 2.60 when PTB transmission factor 0 to 30%.
Conclusion: The dosimetry under PTB for TBI can be explained by the different behavior of the primary and scatter photon components. MC allows the separation and independent investigation of each component. For in vivo dose measurement under PTB, the measurement needs to be interpreted carefully using the correct dosimetry.
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Deep-tissue SWIR imaging using rationally designed small red-shifted near-infrared fluorescent protein.
No full textApplying rational design, we developed 17 kDa cyanobacteriochrome-based near-infrared (NIR-I) fluorescent protein, miRFP718nano. miRFP718nano efficiently binds endogenous biliverdin chromophore and brightly fluoresces in mammalian cells and tissues. miRFP718nano has maximal emission at 718 nm and an emission tail in the short-wave infrared (SWIR) region, allowing deep-penetrating off-peak fluorescence imaging in vivo. The miRFP718nano structure reveals the molecular basis of its red shift. We demonstrate superiority of miRFP718nano-enabled SWIR imaging over NIR-I imaging of microbes in the mouse digestive tract, mammalian cells injected into the mouse mammary gland and NF-kB activity in a mouse model of liver inflammation
Team Approach: Safety and Value in the Practice of Complex Adult Spinal Surgery.
No full textSurgical management of complex adult spinal deformities is of high risk, with a substantial risk of operative mortality. Current evidence shows that potential risk and morbidity resulting from surgery for complex spinal deformity may be minimized through risk-factor optimization.
The multidisciplinary team care model includes neurosurgeons, orthopaedic surgeons, physiatrists, anesthesiologists, hospitalists, psychologists, physical therapists, specialized physician assistants, and nurses. The multidisciplinary care model mimics previously described integrated care pathways designed to offer a structured means of providing a comprehensive preoperative medical evaluation and evidence-based multimodal perioperative care. The role of each team member is illustrated in the case of a 66-year-old male patient with previous incomplete spinal cord injury, now presenting with Charcot spinal arthropathy and progressive vertebral-body destruction resulting in lumbar kyphosis