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EHRs contain a rich source of real-world data that can support evidence generation to better understand mental disorders and improve treatment outcomes. However, EHR datasets are complex and include unstructured free text data that are time consuming to manually review and analyse. We present NeuroBlu, a secure, cloud-based analytic tool that includes bespoke NLP software to enable users to analyse large volumes of EHR data to generate real-world evidence in mental healthcare.
(i) To assemble a large mental health EHR dataset in a secure, cloud-based environment.
(ii) To apply NLP software to extract data on clinical features as part of the Mental State Examination (MSE).
(iii) To analyse the distribution of NLP-derived MSE features by psychiatric diagnosis.
EHR data from 25 U.S. mental healthcare providers were de-identified and transformed into a common data model. NLP models were developed to extract 241 MSE features using a deep learning, long short-term memory (LSTM) approach. The NeuroBlu tool (https://www.neuroblu.ai/) was used to analyse the associations of MSE features in 543,849 patients.
The figure below illustrates the percentage of patients in each diagnostic category with at least one recorded MSE feature.
Delusions and hallucinations were more likely to be recorded in people with schizophrenia and schizoaffective disorder, and cognitive features were more likely to be recorded in people with dementia. However, mood symptoms were frequently recorded across all diagnoses illustrating their importance as a transdiagnostic clinical feature. NLP-derived clinical information could enhance the potential of EHR data to generate real-world evidence in mental healthcare.
To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza.
US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011–2012 through 2018–2019 seasons.
Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza.
Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons.
Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.
Arrhinia is defined as the partial or complete absence of the nasal structures. It is a defect of embryonal origin and can be seen in association with other craniofacial anomalies, central nervous system anomalies, absence of paranasal sinuses, and other palatal and ocular abnormalities. Very few patients with arrhinia have been reported so far in the history of modern medicine.
This study reports an adult patient with congenital partial arrhinia and reviews the literature along with the embryological basis of such a rare disease.
Arrhinia is a medical condition with scarce documentation in the literature. This article presents the clinical as well as radiological features of this rare entity.
To determine the radiological prevalence of frontal cells according to the International Frontal Sinus Anatomy Classification in patients undergoing computed tomography of the paranasal sinuses for clinical symptoms of chronic rhinosinusitis, and to examine the association between cell classification and frontal sinusitis development.
A total of 180 (left and right) sides of 90 patients were analysed. The prevalence of each International Frontal Sinus Anatomy Classification cell was assessed. Logistic regression analysis was used to compare the distribution of various cells in patients with and without frontal sinusitis.
The agger nasi cell was the most commonly occurring cell, seen in 95.5 per cent of patients. The prevalence rates for supra agger cells, supra agger frontal cells, supra bullar frontal cells, supra bullar cells, supra-orbital ethmoid cells and frontal septal cells were 33.3 per cent, 22.2 per cent, 21.1 per cent, 36.1 per cent, 39.4 per cent and 21.1 per cent, respectively. There was no significant difference in the occurrence of any of the cell types in patients with frontal sinusitis compared to those without (p > 0.05).
The presence of any of the International Frontal Sinus Anatomy Classification cells was not significantly associated with frontal sinusitis.
Abnormalities in the semantic and syntactic organization of speech have been reported in individuals at clinical high-risk (CHR) for psychosis. The current study seeks to examine whether such abnormalities are associated with changes in brain structure and functional connectivity in CHR individuals.
Automated natural language processing analysis was applied to speech samples obtained from 46 CHR and 22 healthy individuals. Brain structural and resting-state functional imaging data were also acquired from all participants. Sparse canonical correlation analysis (sCCA) was used to ascertain patterns of covariation between linguistic features, clinical symptoms, and measures of brain morphometry and functional connectivity related to the language network.
In CHR individuals, we found a significant mode of covariation between linguistic and clinical features (r = 0.73; p = 0.003), with negative symptoms and bizarre thinking covarying mostly with measures of syntactic complexity. In the entire sample, separate sCCAs identified a single mode of covariation linking linguistic features with brain morphometry (r = 0.65; p = 0.05) and resting-state network connectivity (r = 0.63; p = 0.01). In both models, semantic and syntactic features covaried with brain structural and functional connectivity measures of the language network. However, the contribution of diagnosis to both models was negligible.
Syntactic complexity appeared sensitive to prodromal symptoms in CHR individuals while the patterns of brain-language covariation seemed preserved. Further studies in larger samples are required to establish the reproducibility of these findings.
Bats are known to be reservoirs of several medically important viruses including lyssaviruses. However, no systematic surveillance for bat rabies has been carried out in India, a canine rabies endemic country with a high burden of human rabies. Surveillance for rabies virus (RABV) infection in bats was therefore carried out in Nagaland, a north-eastern state in India at sites with intense human–bat interfaces during traditional bat harvests. Brain tissues and sera from bats were tested for evidence of infection due to RABV. Brain tissues were subjected to the fluorescent antibody test for detection of viral antigen and real-time reverse transcriptase PCR for presence of viral RNA. Bat sera were tested for the presence of rabies neutralizing antibodies by the rapid fluorescent focus inhibition test. None of the bat brains tested (n = 164) were positive for viral antigen or viral RNA. However, rabies neutralizing antibodies were detected in 4/78 (5·1%) bat sera tested, suggesting prior exposure to RABV or related lyssaviruses. The serological evidence of lyssaviral infection in Indian bats may have important implications in disease transmission and rabies control measures, and warrant extensive bat surveillance to better define the prevalence of lyssaviral infection in bats.
Medulloblastoma (MB) is the most common malignant pediatric brain tumour, and is categorized into four molecular subgroups, with Group 3 MB having the worst prognosis due to the highest rate of metastatic dissemination and relapse. In this work, we describe the epigenetic regulator Bmi1 as a novel therapeutic target for treatment of recurrent Group 3 MB. Through comparative profiling of primary and recurrent MB, we show that Bmi1 defines a treatment-refractory cell population that is uniquely targetable by a novel class of small molecule inhibitors. We have optimized an in vivo mouse-adapted therapy model that has the advantage of generating recurrent, human, treatment-refractory MBs. Our preliminary studies showed that although chemoradiotherapy administered to mice engrafted with human MB showed reduction in tumour size, Bmi1 expression was enriched in the post-treatment residual tumour. Furthermore, we found that knockdown of Bmi1 in human recurrent MB cells decreases proliferation and self-renewing capacities of MB cells in vitro as well as both tumour size and extent of spinal leptomeningeal metastases in vivo. Oral administration of a potent Bmi1 inhibitor, PTC 028, resulted in a marked reduction in tumour burden and an increased survival in treatment cohort. Bmi1 inhibitors showed high specificity for MB cells and spared normal human neural stem cells, when treated with doses relevant for MB cells. As Group 3 medulloblastoma is often metastatic and uniformly fatal at recurrence, with no current or planned trials of targeted therapy, an efficacious agent such as Bmi1 inhibitor could be rapidly transitioned to clinical trials.
As indicated by the sporadic Japanese encephalitis (JE) cases reported from the districts of Uttar Pradesh (UP), India, the disease is endemic in the state despite the fact that a JE vaccination programme has been ongoing in the state since 2006. Hence, the present study was undertaken to study the annual trend of JE in UP during January 2011 to December 2013. CSF and/or serum samples collected from acute encephalitis syndrome (AES) cases were referred to the virology laboratory at King George's Medical University, Lucknow and were tested for anti-JEV IgM antibodies by JEV MAC-ELISA kit. The study reveals that 26·9%, 9·9% and 14·8% of AES cases were positive for anti-JEV IgM in the years 2011, 2012 and 2013, respectively. Of the total JE confirmed cases, 30% were adults. Males were more commonly affected than females. A distinct peak of JE was seen in the monsoon and post-monsoon season, although sporadic cases were also reported in other months. JE vaccination by district in UP is discussed. This study reports that the proportion of JE positives in AES cases is decreasing in UP although the number of AES cases has not decreased. The study also discusses the probable causes of this decrease, including JE vaccination and natural periodicity due to herd immunity.
The present cross-sectional study was conducted to determine the vitamin D status of pregnant Indian women and their breast-fed infants. Subjects were recruited from the Department of Obstetrics, Armed Forces Clinic and Army Hospital (Research and Referral), Delhi. A total of 541 apparently healthy women with uncomplicated, single, intra-uterine gestation reporting in any trimester were consecutively recruited. Of these 541 women, 299 (first trimester, ninety-seven; second trimester, 125; third trimester, seventy-seven) were recruited in summer (April–October) and 242 (first trimester, fifty-nine, second trimester, ninety-three; third trimester, ninety) were recruited in winter (November–March) to study seasonal variations in vitamin D status. Clinical, dietary, biochemical and hormonal evaluations for the Ca–vitamin D–parathormone axis were performed. A subset of 342 mother–infant pairs was re-evaluated 6 weeks postpartum. Mean serum 25-hydroxyvitamin D (25(OH)D) of pregnant women was 23·2 (sd 12·2) nmol/l. Hypovitaminosis D (25(OH)D < 50 nmol/l) was observed in 96·3 % of the subjects. Serum 25(OH)D levels were significantly lower in winter in the second and third trimesters, while serum intact parathormone (iPTH) and alkaline phosphatase levels were significantly higher in winter in all three trimesters. A significant negative correlation was found between serum 25(OH)D and iPTH in mothers (r − 0·367, P = 0·0001) and infants (r − 0·56, P = 0·0001). A strong positive correlation was observed between 25(OH)D levels of mother–infant pairs (r 0·779, P = 0·0001). A high prevalence of hypovitaminosis D was observed in pregnancy, lactation and infancy with no significant inter-trimester differences in serum 25(OH)D levels.
Remotely sensed estimates of biochemical parameters of agricultural crops are central to the precision management of agricultural crops (precision farming). Past research using in situ and airborne spectral reflectance measurements of various vegetation species has proved the usefulness of hyperspectral data for the estimation of various biochemical parameters of vegetation. In order to exploit the vast spectral and radiometric resources offered by space-borne hyperspectral remote sensing for the improved estimation of plant biochemical parameters, the relationships observed between spectral reflectance and various biochemical parameters at in situ and airborne levels needed to be evaluated in order to establish the existence of a reliable and stable relationship between spectral reflectance and plant biochemical parameters at the pixel scale. The potential of the EO-1 Hyperion hyperspectral sensor was investigated for the estimation of total chlorophyll and nitrogen concentrations of cotton crops in India by developing regression models between hyperspectral reflectance and laboratory measurements of leaf total chlorophyll and nitrogen concentrations. A comprehensive and rigorous analysis was carried out to identify the spectral bands and spectral indices for accurate retrieval of leaf total chlorophyll and nitrogen concentrations of cotton crop. The performance of these critical spectral reflectance indices was validated using independent samples. A new vegetation index, named the plant biochemical index (PBI), is proposed for improved estimation of the plant biochemicals from space-borne hyperspectral data; it is simply the ratio of reflectance at 810 and 560 nm. Further, the applicability of PBI to a different crop and at a different geographical location was also assessed. The present results suggest the use of space-borne hyperspectral data for accurate retrieval of leaf total chlorophyll and nitrogen concentrations and the proposed PBI has the potential to retrieve leaf total chlorophyll and nitrogen concentrations of various crops and at different geographical locations.
We present the first results from our next-generation microlensing survey, the SuperMACHO project. We are using the CTIO 4m Blanco telescope and the MOSAIC imager to carry out a search for microlensing toward the Large Magellanic Cloud (LMC). We plan to ascertain the nature of the population responsible for the excess microlensing rate seen by the MACHO project. Our observing strategy is optimized to measure the differential microlensing rate across the face of the LMC. We find this derivative to be relatively insensitive to the details of the LMC's internal structure but a strong discriminant between Galactic halo and LMC self lensing. In December 2003 we completed our third year of survey operations. 2003 also marked the first year of real-time microlensing alerts and photometric and spectroscopic followup. We have extracted several dozen microlensing candidates, and we present some preliminary light curves and related information. Similar to the MACHO project, we find SNe behind the LMC to be a significant contaminant - this background has not been completely removed from our current single-color candidate sample. Our follow-up strategy is optimized to discriminate between SNe and true microlensing.To search for other articles by the author(s) go to: http://adsabs.harvard.edu/abstract_service.html
Serum leucine aminopeptidase (LAP) activity was assayed in patients with head and neck cancer. The levels were found to be significantly higher than the controls. However, the rise in serum LAP was nearly the same in all the patients studied, irrespective of the character or histopathology of the lesion but varied with respect to the site involved, i.e. from about 40 per cent in cancer of the hypopharynx to more than 100 per cent in cancer of the nasopharynx. Serum LAP activity was found to increase with the extent of the lymph node spread. After treatment the levels were found to be reduced.
Plasma-assisted chemical vapor deposition (PACVD) is used extensively to coat planar (2-dimensional) substrates. In principle, the technique can be used to deposit coatings on 3-dinensional objects. However, extending PACVD to coat 3-dimensional objects uniformly requires careful control of the plasma, substrate temperature, and reactant concentrations over a large volume. A novel low-temperature radio frequency PACVD reactor design was developed to deposit coatings uniformly and reproducibly on 3-dimensional metallic substrates. The design features a temperature-controlled reaction chamber fitted with one or more rf-driven electrodes to generate uniform, large-volume plasma. The reactor was used to develop a series of silicon carbide coatings, which were deposited at or below 500°C. The coatings contain SiC and varying amounts of free silicon and/or amorphous carbon (diamond-like carbon), depending on reagent gas composition and reactor operating parameters. The coatings significantly reduced wear on stainless steel samples in ball-on-disk and abrasive wear tests and provided oxidation protection to molybdenum and titanium alloy.
An increasing problem faced by the aerospace industry is the erosive wear of engine components. Various PVD protection coatings have been used previously to combat this wear problem, but with limited success. This paper presents results obtained with a low-temperature CVD, erosion resistant, multilayer tungsten carbide coating system. The coating can be deposited at temperatures below 500°C on ferrous alloys used in the aerospace industry. The low temperature of deposition eliminates the problem of degradation of mechanical properties that occurs with normal high-temperature chemical vapor deposition processes. High-cycle fatigue strength and other mechanical property data are presented for coated stainless steel, as well as results on erosion and impact resistance at 90° impingement.
More than 200 wild type isolates of chickpea (C. arietinum) rhizobia were screened for their drug resistance. Only 15 were found to be resistant to one or more antibiotics at a concentration of 5 μg/ml (units/ml). When tested for multiple drug resistance, some were found to be resistant to more than one antibiotic. In competition studies, rhizobia resistant to streptomycin were found to be more competitive than antibioticsensitive strains, while those resistant to penicillin could not compete even with antibiotic-sensitive strains.
Counter current Immunoelectrophoresis was used to detect porcine cysticcrcosis and water soluble extracts of scolex and of scolex with cyst wall were used as antigens. Serum samples from 40 pigs infected with Cysticercus cellulosae, five infected with C. tenuicollis and five with hydatid cysts, and 15 healthy pigs were tested. A sharp and thick concave precipitin band was observed at the point of interaction of antigen and antibody within 90min in 39 sera from infected pigs (97–5%). The precipitin reaction was better in barbitone buffer of pH 8–6 with the well distance at 6 mm. No false or cross reaction were found and the test was rapid and sensitive.