X-ray absorption spectroscopy and actinide electrochemistry: a setup dedicated to radioactive samples applied to neptunium chemistry.

A spectroelectrochemical setup has been developed to investigate radioactive elements in small volumes (0.7 to 2 ml) under oxidation-reduction (redox) controlled conditions by X-ray absorption spectroscopy (XAS). The cell design is presented together with in situ XAS measurements performed during neptunium redox reactions. Cycling experiments on the NpO22+/NpO2+ redox couple were applied to qualify the cell electrodynamics using XANES measurements and its ability to probe modifications in the neptunyl hydration shell in a 1 mol l-1 HNO3 solution. The XAS results are in agreement with previous structural studies and the NpO22+/NpO2+ standard potential, determined using Nernst methods, is consistent with measurements based on other techniques. Subsequently, the NpO2+, NpO22+ and Np4+ ion structures in solution were stabilized and measured using EXAFS. The resulting fit parameters are again compared with other results from the literature and with theoretical models in order to evaluate how this spectroelectrochemistry experiment succeeds or fails to stabilize the oxidation states of actinides. The experiment succeeded in: (i) implementing a robust and safe XAS device to investigate unstable radioactive species, (ii) evaluate in a reproducible manner the NpO22+/NpO2+ standard potential under dilute conditions and (iii) clarify mechanistic aspects of the actinyl hydration sphere in solution. In contrast, a detailed comparison of EXAFS fit parameters shows that this method is less appropriate than the majority of the previously reported chemical methods for the stabilization of the Np4+ ion.

Using Artificial Intelligence With Natural Language Processing to Combine Electronic Health Record's Structured and Free Text Data to Identify Nonvalvular Atrial Fibrillation to Decrease Strokes and Death: Evaluation and Case-Control Study.

BACKGROUND: Nonvalvular atrial fibrillation (NVAF) affects almost 6 million Americans and is a major contributor to stroke but is significantly undiagnosed and undertreated despite explicit guidelines for oral anticoagulation. OBJECTIVE: The aim of this study is to investigate whether the use of semisupervised natural language processing (NLP) of electronic health record's (EHR) free-text information combined with structured EHR data improves NVAF discovery and treatment and perhaps offers a method to prevent thousands of deaths and save billions of dollars. METHODS: We abstracted 96,681 participants from the University of Buffalo faculty practice's EHR. NLP was used to index the notes and compare the ability to identify NVAF, congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category (CHA2DS2-VASc), and Hypertension, Abnormal liver/renal function, Stroke history, Bleeding history or predisposition, Labile INR, Elderly, Drug/alcohol usage (HAS-BLED) scores using unstructured data (International Classification of Diseases codes) versus structured and unstructured data from clinical notes. In addition, we analyzed data from 63,296,120 participants in the Optum and Truven databases to determine the NVAF frequency, rates of CHA2DS2­VASc ≥2, and no contraindications to oral anticoagulants, rates of stroke and death in the untreated population, and first year's costs after stroke. RESULTS: The structured-plus-unstructured method would have identified 3,976,056 additional true NVAF cases (P<.001) and improved sensitivity for CHA2DS2-VASc and HAS-BLED scores compared with the structured data alone (P=.002 and P<.001, respectively), causing a 32.1% improvement. For the United States, this method would prevent an estimated 176,537 strokes, save 10,575 lives, and save >US $13.5 billion. CONCLUSIONS: Artificial intelligence-informed bio-surveillance combining NLP of free-text information with structured EHR data improves data completeness, prevents thousands of strokes, and saves lives and funds. This method is applicable to many disorders with profound public health consequences.

Electrochemical and Spectroscopic Study of EuIII and EuII Coordination in the 1-Ethyl-3-methylimidazolium Bis(trifluoromethylsulfonyl)imide Ionic Liquid.

Separation processes based on room temperature ionic liquids (RTIL) and electrochemical refining are promising strategies for the recovery of lanthanides from primary ores and electronic waste. However, they require the speciation of dissolved elements to be known with accuracy. In the present study, Eu coordination and EuIII /EuII electrochemical behavior as a function of water content in 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide ([EMIm][NTf2 ]) was investigated using UV-visible spectrophotometry, time-resolved laser fluorescence spectroscopy, electrochemistry, and X-ray absorption spectroscopy. In situ measurements were performed in spectroelectrochemical cells. Under anhydrous conditions, EuIII and EuII were complexed by NTf2 , forming Eu-O and Eu-(N,O) bonds with the anion sulfoxide function and N atoms, respectively. This complexation resulted in a greater stability of EuII , and in quasi-reversible oxidation-reduction with an E0 ' potential of 0.18 V versus the ferrocenium/ferrocene (Fc+ /Fc) couple. Upon increasing water content, progressive incorporation of water in the EuIII coordination sphere occurred. This led to reversible oxidation-reduction reactions, but also to a decrease in stability of the +II oxidation state (E0 '=-0.45 V vs. Fc+ /Fc in RTIL containing 1300 mm water).

Diagnoses per Encounter by Telephone, Televideo, and In-Office Visits.

INTRODUCTION: We sought to determine if there are differences between number of International Classification of Disease-10 (ICD-10) codes per visit before and after COVID-19 when comparing in-office visits and between telemedicine vs in-office visits, toward the goal of determining value of telemedicine visits relative to in-office visits. METHODS: We did a chart review study assessing the number of ICD-10 codes noted by providers at a large academic medical institution in 2019 and 2020. Only in-office visits were reviewed in 2019. The focus of analysis was on individual patient visits per visit type; however, a subset of patients who had visits in both 2019 and 2020 were also analyzed. We compared mean number of diagnoses for encounter types using encounter, billing and coding data. RESULTS: We analyzed 211,829 patient encounters. For 2020, 73% were in office. Mean number of diagnoses per encounter for 2019 was 2.65 (in office only), compared with 3.04 in office, 2.76 telephone, and 2.48 televideo for 2020. DISCUSSION: We found an increase in the number of diagnoses addressed during in-office visits from 2019 to 2020. When looking at diagnoses managed per visit, all 3 types of visits had similar complexity. These results may guide future reimbursement policy for telemedicine visits.

What's Happening in Your Head: Overcoming Our Assumptions to Work Better Together.

Introduction: It is crucial that residents learn in environments that are psychologically safe and free of morale-harming rumors. This workshop introduced the Ladder of Inference as a means for programs to foster psychological safety, mitigate against rumors, and increase trust. Methods: Residents and faculty of two residency programs (cohorts A and B) were introduced to the Ladder of Inference. After an interactive discussion, small groups applied the concept to engaging, highly relevant hypothetical situations. Debriefing and reflection followed the group work. Finally, attendees completed an assessment of the workshop's effectiveness (10 7-point questions) and their satisfaction (one 7-point question). Results: Seventeen residents from cohort A completed the workshop, and 15 completed the assessment (response rate: 88%). Participants found it favorable (M = 65.9 out of 70) and satisfactory (6.3 out of 7). Twenty-eight residents and faculty from cohort B completed the workshop, and 15 completed the assessment (response rate: 54%). Cohort B participants also found the workshop favorable (M = 64.8) and satisfactory (6.8). Both cohorts felt the workshop was effective in helping them understand the concept of the Ladder of Inference (6.5 for both cohorts) and would provide value in their residency program in the future (6.1 for cohort A, 6.7 for cohort B) and at other organizations (6.3 for cohort A, 6.7 for cohort B). Discussion: This workshop is an effective method whereby participants can develop and apply an understanding of the Ladder of Inference. This shared understanding can promote trust and enhance the resilience of a program.

Clinical Tractor: A Framework for Automatic Natural Language Understanding of Clinical Practice Guidelines.

Computational representations of the semantic knowledge embedded within clinical practice guidelines (CPGs) may be a significant aid in creating computer interpretable guidelines (CIGs). Formalizing plain text CPGs into CIGs manually is a laborious and burdensome task, even using CIG tools and languages designed to improve the process. Natural language understanding (NLU) systems perform automated reading comprehension, parsing text and using reasoning to convert syntactic information from unstructured text into semantic information. Influenced by successful systems used in other domains, we present the architecture for a system which uses NLU approaches to create semantic representations of entire CPGs. In the future, these representations may be used to generate CIGs.

Surveying Applicants to Improve the Family Medicine Residency Interview Day.

INTRODUCTION: The diversity of family medicine residency programs across the country makes a generalized assessment of applicant preferences and experiences regarding the interview experience difficult. As such, there have been few publications in recent years relating to interview trail trends and modification of the interview day process to meet the needs of applicants. The purpose of this project was to identify applicant preferences and trends among applicants interviewing at Penn State Health's Milton S. Hershey Medical Center during the 2014-2015 and 2015-2016 application cycles. METHODS: Applicants completed a voluntary, anonymous, 16-question multiple-choice survey during the interview day. Questions explored the preinterview dinner, interview day, and postinterview day communication methods. RESULTS: In total, 67 surveys were collected from 68 eligible candidates (98.5%) in 2014-2015, and 65 surveys from 65 eligible candidates in 2015-2016 (100%) for a total of 132 participants. Applicant preferences focused on use of electronic communication and the importance of interviewing with both the program director and a current resident. Interview day trends experienced by those surveyed emphasized the inclusion of spouses/significant others, program support of hotel costs, frequency of applicant preinterview dinners, and the lack of emphasis on second-look visits. CONCLUSION: This study highlights how the utilization of applicant surveys during the interview day may allow family medicine programs to identify trends occurring on the interview trail, while developing an interview day agenda that meets the desires of the applicants the program attracts.

Comparison of Changes in the Number of Included Patients Between Interventional Trials and Observational Studies Published from 1995 to 2014 in Three Leading Journals.

INTRODUCTION: Since the late 1990s, research and administrative institutions have been developing health data warehouses and increasingly reusing claims data. The impact of these changes is not yet completely quantified. Our objective was to compare the change in the number of patients included per study between observational and interventional studies over a 20-year period starting in 1995. MATERIALS AND METHODS: We extracted all abstracts from studies published in three leading medical journals over the period 1995-2014 (18,107 studies). Then, we divided our study into two steps. First, we constructed an SVM-based predictive model to categorize each abstract into "observational", "interventional" or "other" studies. In a second step, we built an algorithm based on regular expressions to automatically extract the number of included patients. RESULTS: During the investigated period, the median number of enrolled patients per study increased for interventional studies, from 282 in 1995-1999 to 629 in 2010-2014. In the same time, the median number of patients increased more for observational studies, from 368 in 1995-1999 to 2078 in 2010-2014. DISCUSSION: The routine storage of an increasing amount of data (from data warehouses or claims data) has had an impact in recent years on the number of patients included in observational studies. The recent development of "randomized registry trials" combining, on the one hand, an intervention and, on the other hand, the identification of the outcome through data reuse, may also have an impact, over the next decade, on the number of patients included in randomized clinical trials.

Artificial Intelligence: Bayesian versus Heuristic Method for Diagnostic Decision Support.

Evoking strength is one of the important contributions of the field of Biomedical Informatics to the discipline of Artificial Intelligence. The University at Buffalo's Orthopedics Department wanted to create an expert system to assist patients with self-diagnosis of knee problems and to thereby facilitate referral to the right orthopedic subspecialist. They had two independent sports medicine physicians review 469 cases. A board-certified orthopedic sports medicine practitioner, L.B., reviewed any disagreements until a gold standard diagnosis was reached. For each case, the patients entered 126 potential answers to 26 questions into a Web interface. These were modeled by an expert sports medicine physician and the answers were reviewed by L.B. For each finding, the clinician specified the sensitivity (term frequency) and both specificity (Sp) and the heuristic evoking strength (ES). Heuristics are methods of reasoning with only partial evidence. An expert system was constructed that reflected the posttest odds of disease-ranked list for each case. We compare the accuracy of using Sp to that of using ES (original model, p < 0.0008; term importance * disease importance [DItimesTI] model, p < 0.0001: Wilcoxon ranked sum test). For patient referral assignment, Sp in the DItimesTI model was superior to the use of ES. By the fifth diagnosis, the advantage was lost and so there is no difference between the techniques when serving as a reminder system.

HTP-NLP: A New NLP System for High Throughput Phenotyping.

Secondary use of clinical data for research requires a method to quickly process the data so that researchers can quickly extract cohorts. We present two advances in the High Throughput Phenotyping NLP system which support the aim of truly high throughput processing of clinical data, inspired by a characterization of the linguistic properties of such data. Semantic indexing to store and generalize partially-processed results and the use of compositional expressions for ungrammatical text are discussed, along with a set of initial timing results for the system.

Automatically Expanding the Synonym Set of SNOMED CT using Wikipedia.

Clinical terminologies and ontologies are often used in natural language processing/understanding tasks as a method for semantically tagging text. One ontology commonly used for this task is SNOMED CT. Natural language is rich and varied: many different combinations of words may be used to express the same idea. It is therefore essential that ontologies and terminologies have a rich set of synonyms. One source of synonyms is Wikipedia. We examine methods for aligning concepts in SNOMED CT with articles in Wikipedia so that newly-found synonyms may be added to SNOMED CT. Our experiments show promising results and provide guidance to researchers who wish to use Wikipedia for similar tasks.

Utility of the NIH Stroke Scale as a predictor of hospital disposition.

BACKGROUND AND PURPOSE: Early identification of stroke patients in need of rehabilitation or long-term nursing facility (NF) care may promote more efficient use of health care resources and lead to better outcomes. The NIH Stroke Scale (NIHSS) is an attractive candidate predictor of disposition because it is widely used, is easily learned, and can be performed rapidly on admission. METHODS: We present a retrospective study of stroke patients admitted within 24 hours of symptom onset to a university hospital from March through June 2000. Medical records were reviewed for demographic information, stroke type, prestroke living arrangement and independence, initial NIHSS, and medical complications during hospitalization. RESULTS: Among 94 patients evaluated during the study period, 59% were discharged home, 30% to rehabilitation, and 11% to NF. In multivariate analyses, disposition was associated only with initial NIHSS. For each 1-point increase in NIHSS, the likelihood of going home was significantly reduced (odds ratio, 0.79; 95% CI, 0.70 to 0.89, P<0.001). Categorization of NIHSS was also predictive of disposition, with NIHSS < or =5 being most strongly associated with discharge home, NIHSS 6 to 13 with rehabilitation, and NIHSS >13 with NF (P<0.001). Although no other baseline characteristics predicted disposition, major medical complications during hospitalization tended to reduce the odds of going home (odds ratio, 0.30; 95% CI, 0.08 to 1.0, P=0.07). CONCLUSION: The NIHSS predicts postacute care disposition among stroke patients. Predicting disposition on the first day of admission may facilitate the time-consuming and costly process of securing a bed at rehabilitation or NF, and perhaps decrease unnecessary length of stay in acute care settings.

Prediction of hospital disposition after thrombolysis for acute ischemic stroke using the National Institutes of Health Stroke Scale.

BACKGROUND: Early determination of discharge destination after acute stroke may promote earlier rehabilitation and reduce costs by shortening the duration of hospitalization. OBJECTIVE: To determine whether the National Institutes of Health Stroke Scale (NIHSS) score predicts disposition in stroke patients treated with thrombolysis. DESIGN: Cohort study. SETTING: Academic and community hospitals from 3 countries. PATIENTS: Five hundred forty-six patients with acute ischemic stroke treated with recombinant tissue plasminogen activator (rt-PA). INTERVENTIONS: Medical records were reviewed for demographic information, vascular risk factors, location of stroke, initial NIHSS score, acute hospital disposition, and complications of symptomatic or asymptomatic intracerebral hemorrhage (ICH). MAIN OUTCOME MEASURE: Discharge destination to home, acute rehabilitation, or nursing facility. RESULTS: In multinomial regression analysis, increasing NIHSS score was a robust and independent predictor of discharge to rehabilitation or nursing facilities, roughly doubling for each 5-point increment. Patients who developed symptomatic ICH were never discharged to home, but asymptomatic ICH had no significant independent effect on disposition. CONCLUSIONS: Stroke severity as determined by the admission NIHSS score is the major independent predictor of disposition after hospitalization and treatment with rt-PA for acute stroke in a broad-based population. However, symptomatic ICH after rt-PA is a catastrophic event that may preclude discharge to home.

Hemorroidectomía con ligasure®: ¿mejoran el tiempo quirúrgico y la evolución postoperatoría? Comparación de los resultados con la cirugía clásica / Hemorrhoidectomy with ligasure®: do they improve surgical time and postoperative evolution? Comparison of the results with classical surgery

INTRODUCCIÓN: La hemorroidectomía es un procedimiento muy frecuentemente utilizado en la práctica diaria del coloproctólogo. Distintas técnicas fueron propuestas. Las más utilizadas son las abiertas (MilliganMorgan) o las cerradas (Ferguson). Iniciamos en 2010 nuestra experiencia utilizando el Ligasure® con una pinza especialmente diseñada a tal efecto. Los buenos resultados iniciales obtenidos nos motivaron a evaluar objetivamente esta técnica. OBJETIVO: Comparar los resultados de las hemorroidectomías utilizando el Ligasure® y los obtenidos con la clásica cirugía de Milligan-Morgan. DISEÑO: Retrospectivo sobre una base de datos de pacientes prospectiva. PACIENTES Y MÉTODO: Se evaluaron 230 pacientes operados consecutivamente entre enero de 2011 y diciembre de 2014 con el uso del Ligasure®. Estos resultados se compararon con los de otro grupo de 230 pacientes operados previamente con la técnica clásica de hemorroidectomía abierta (grupo control). El seguimiento mínimo fue de 6 meses para todos los pacientes...

BACKGROUND: Hemorrhoidectomy is daily performed in colorectal practice. Open and closed procedures has been described. In 2010 we start to perform hemorrhoidectomy with the use of the Ligasure® with a special device. The results obtained were the base to start a comparison with our standard technique. OBJECTIVE: To compare results between Ligasure® hemorrhoidectomies and classical surgical hemorrhoidectomies (control group). DESIGN: Restrospective comparison with prospective data. PATIENTS AND METHOD: Results of 230 consecutive patients operated on with the Ligasure® were compared with similar series of 230 patients operated with classical open technique. Follow-up was at least 6 months in both groups...

Orgasmic headache with transient basilar artery vasospasm.

A 36-year-old man without significant past medical history presented with recurrent explosive headache at the time of orgasm. Magnetic resonance angiography showed focal mid-basilar artery narrowing. Despite receiving no specific therapy, the patient's headaches and vascular narrowing had resolved completely on follow-up six months later. While a number of pharmacologic agents have been proposed to be of benefit in orgasmic headache, this case suggests that spontaneous resolution may also occur.

Tratamiento laparoscópica de la hernia paraostomal: En búsqueda de una nueva técnica / Laparoscopic repair of parastomal hernia: Searching for a new technique

Introducción: La hernia paraostomal es una complicación frecuente de los pacientes ostomizados. Se presenta en más del 50% de los casos, sin embargo, solo del 10 al 15% son sintomáticas y requieren tratamiento quirúrgico. Objetivo: Describir y analizar una técnica laparoscópica en la que combinamos la reparación anatómica con la colocación de una malla protésica. Material y Método: Se realizó un estudio retrospectivo de una base de datos diseñada en forma prospectiva del servicio de cirugía general del "The Western Pennsylvania Hospital". El período analizado fue de Agosto de 2006 a Octubre de 2007. Se incluyen los procedimientos electivos y aquellos pacientes con hernias paraostomales sintomáticos. Las variables analizadas fueron edad, sexo, estadía hospitalaria, complicaciones intraoperatorias, postoperatorias y recidivas. Resultados: Entre agosto del 2006 y diciembre del 2007 se operaron 6 pacientes con hernias paraostomales sintomáticas. Tres de ellos tenían una amputación abdominoperineal por cáncer de recto; dos proctocolectomías por Enfermedad Inflamatoria Intestinal (Colitis ulcerosa y Crohn), y una colectomía subtotal debido a colitis fulminante secundario a infección por Clostridium Difficile. No se registraron conversiones ni complicaciones intraoperatorias. Un paciente evolucionó con íleo postoperatorio, que revirtió con tratamiento médico. La estadía media hospitalaria fue de 4 días (Rango: 2-7 días). El seguimiento postoperatorio promedio fue de 5,8 meses (rango 1-18 meses). No hubo recidivas. Conclusión: Proponemos una técnica diferente para la reparación de la hernia paraostomal. Además de reducir y disecar el saco herniario, disminuimos el espacio muerto suturando el área que rodea al ostoma a la fascia, con la intención de disminuir la formación de seroma y/o recurrencia.

Background: Parastomal hernia is a common complication of stoma formation that has been reported in more than 50% of patients on long term follows up. Most of them do not require repair; however 10 to 15% will become symptomatic and will need surgical repair. Objective: To describe and analyzed a laparoscopic technique that combines both tissue and mesh repair. Material and Methods: Retrospective review of a prospective collected data from The Western Pennsylvania Hospital. We include all patients who underwent this novel laparoscopic approach of the paraostomal hernia from August 2006 to October 2007 at the Western Pennsylvania Hospital. The surgeries were performed electively and in symptomatic parastomal hernia patients. Data collected included demographies, length of hospital stay, complications and recurrence. Results: We performed 6 laparoscopic parastomal hernia repairs. Three patients had APR due to rectal cancer; two had a proctocolectomy due to Inflammatory Bowel Disease (Ulcerative Colitis and Crohn); and one patient had a subtotal colectomy due to fulminant Clostridium Difficile colitis. There were no conversions to open surgery and no intraoperative complications. One patient developed a postoperative ileus that resolved with a no operative treatment. The mean hospital stay was 4 days (Range: 2 to 7 days). The mean follow up period was 5.8 months (Median 3 month; range: 1-18 month). All patients are asymptomatic and without hernia recurrence. Conclusion: We propose a novel laparoscopic approach to the parastomal hernia. In addition to reducing and dissecting the hernia sac, we reduce the dead space by suturing the area around the stoma to the fascia, thus possibly reducing the incidence of seroma and recurrence.