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1.
PLoS One ; 17(6): e0270371, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35737667

RESUMO

BACKGROUND: The aim of this study was to characterize three regions of interest (ROI) around the knee with a portable 3D scanner (Artec 3D scanner EVA). Soft tissue topography assessment with an optimized, precise, and reproducible method may assist surgeons when managing soft tissue swelling in the post traumatic setting. METHODS: 12 healthy volunteers (24 legs, 7 women, 5 man) were included in this study. The patient cohort showed a mean age of 27.1 years (SD±3), a mean weight of 70 kg (SD±13) and a mean height of 171 cm (SD±8.8). All scans were recorded by the same examiner in the same room and with the same scanner (Artec, 3 D scanner EVA). Three volume regions of interest (ROI) were defined: the distal femur (circumference measured between the of superior extent of the patella to 10 cm proximal), the knee joint (measured from the top of the patella to the tibial tuberosity) and the proximal tibia (tibial tuberosity to 10 cm distal). RESULTS: The mean volume of the right leg was 3.901 l (I. distal femur: 1.63 l, knee joint: 1.33 l, proximal tibia: 1.10 l) and mean volume of the left leg was 3.910 l (I. distal femur: 1.66 l, knee joint: 1.34 l, proximal tibia: 1.12 l). The volume difference between the right and left leg was 0.094 l (SD ± 0.083 l) The Wilcoxon-Mann-Whitney test showed no significant differences of the volumes between the right and left leg. CONCLUSIONS: This study demonstrates that portable 3D scanning could be an accurate and reliable tool for orthopedics and trauma surgeons. Based on the ROIs of this pilot study, further studies are needed to test the significance for clinical applications for patients with an injured knee.


Assuntos
Ortopedia , Adulto , Feminino , Fêmur/cirurgia , Humanos , Joelho , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Projetos Piloto , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
2.
J Hand Microsurg ; 14(1): 79-84, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35256831

RESUMO

Introduction The range of motion of the carpometacarpal (CMC) joints is difficult to assess in clinical practice. Materials and Methods The purpose of this study was to measure a precise range of motion measurement of the metacarpal arc during maximum palmar flexion of the fifth CMC joint in healthy persons with three different methods: optical, electrogoniometrical, and sonographical. Results The metacarpal arc motion measured with the optical technique was 24.9 degrees (standard deviation [SD]: 6.2 degrees), with the electrogoniometric technique was 24.3 degrees (SD: 3.6 degrees) and with sonography was 25.1 degrees (SD: 3.5 degrees), with no differences between left and right hand for all methods. Conclusion This study shows that different techniques can be used for the measurement of the metacarpal arc motion. With these techniques, it is possible to assess the metacarpal arc in patients with fractures to the CMC joints to evaluate posttraumatic function und rehabilitation progress. This study shows level of evidence as III.

4.
Nat Biomed Eng ; 5(6): 613-623, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33707779

RESUMO

The de novo design of antimicrobial therapeutics involves the exploration of a vast chemical repertoire to find compounds with broad-spectrum potency and low toxicity. Here, we report an efficient computational method for the generation of antimicrobials with desired attributes. The method leverages guidance from classifiers trained on an informative latent space of molecules modelled using a deep generative autoencoder, and screens the generated molecules using deep-learning classifiers as well as physicochemical features derived from high-throughput molecular dynamics simulations. Within 48 days, we identified, synthesized and experimentally tested 20 candidate antimicrobial peptides, of which two displayed high potency against diverse Gram-positive and Gram-negative pathogens (including multidrug-resistant Klebsiella pneumoniae) and a low propensity to induce drug resistance in Escherichia coli. Both peptides have low toxicity, as validated in vitro and in mice. We also show using live-cell confocal imaging that the bactericidal mode of action of the peptides involves the formation of membrane pores. The combination of deep learning and molecular dynamics may accelerate the discovery of potent and selective broad-spectrum antimicrobials.


Assuntos
Antibacterianos/farmacologia , Peptídeos Catiônicos Antimicrobianos/farmacologia , Aprendizado Profundo , Desenho de Fármacos , Descoberta de Drogas/métodos , Farmacorresistência Bacteriana/efeitos dos fármacos , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/crescimento & desenvolvimento , Acinetobacter baumannii/ultraestrutura , Sequência de Aminoácidos , Animais , Antibacterianos/síntese química , Peptídeos Catiônicos Antimicrobianos/síntese química , Escherichia coli/efeitos dos fármacos , Escherichia coli/crescimento & desenvolvimento , Escherichia coli/ultraestrutura , Feminino , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/crescimento & desenvolvimento , Klebsiella pneumoniae/ultraestrutura , Camundongos , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Simulação de Dinâmica Molecular , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/crescimento & desenvolvimento , Pseudomonas aeruginosa/ultraestrutura , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus aureus/ultraestrutura , Relação Estrutura-Atividade
5.
Acad Pediatr ; 20(8): 1101-1108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32540424

RESUMO

OBJECTIVE: Shared decision-making (SDM) may improve outcomes for children with medical complexity (CMC). CMC have lower rates of SDM than other children, but little is known about how to improve SDM for CMC. The objective of this study is to describe parent perspectives of SDM for CMC and identify opportunities to improve elements of SDM specific to this vulnerable population. METHODS: Interviews with parents of CMC explored SDM preferences and experiences. Eligible parents were ≥18 years old, English- or Spanish-speaking, with a CMC <12 years old. Interviews were recorded, transcribed, and analyzed by independent coders for shared themes using modified grounded theory. Codes were developed using an iterative process, beginning with open-coding of a subset of transcripts followed by discussion with all team members, and distillation into preliminary codes. Subsequent coding reviews were conducted until no new themes emerged and existing themes were fully explored. RESULTS: We conducted interviews with 32 parents (27 in English, mean parent age 34 years, standard deviation = 7; mean child age 4 years, standard deviation = 4; 50% with household income <$50,000, 47% with low health literacy) in inpatient and outpatient settings. Three categories of themes emerged: participant, knowledge, and context. Key opportunities to improve SDM included: providing a shared decision timeline, purposefully integrating patient preferences and values, and addressing uncertainty in decisions. CONCLUSION: Our results provide insight into parent experiences with SDM for CMC. We identified unique opportunities to improve SDM for CMC that will inform future research and interventions to improve SDM for CMC.


Assuntos
Tomada de Decisão Compartilhada , Pais , Adolescente , Adulto , Criança , Pré-Escolar , Tomada de Decisões , Humanos , Participação do Paciente
6.
J Hand Surg Am ; 45(7): 619-625, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32291096

RESUMO

PURPOSE: To assess radiocarpal articular cartilage after distal radius fracture, with and without intra-articular extension, compared with healthy controls using multiparametric, nonenhanced magnetic resonance imaging (MRI). METHODS: In this prospective study, multiparametric MRI of the radiocarpal articular cartilage was performed in 26 participants (16 males and 10 females; mean age, 39.5 ± 14.7 years; range, 20-70 years) using 3T MRI. The cohort consisted of 14 patients with a distal radius fracture and 12 healthy volunteers. The radiocarpal articular cartilage was assessed using morphological (Double Echo Steady-State [DESS] and True Fast Imaging With Steady-State Precession [TrueFISP]) and biochemical (T2∗) MRI sequences without an intravenous contrast agent. The modified Outerbridge classification system for morphological analyses and region-of-interest biochemical analysis were applied to assess the degree of articular cartilage damage in each patient. RESULTS: Morphological articular cartilage assessment showed no difference between the DESS sequence and the reference standard, TrueFISP. In the morphological (DESS and TrueFISP) and biochemical (T2∗) assessments, patients with intra-articular fractures did not show articular cartilage damage different from those with extra-articular fractures. Greater articular cartilage degradation was observed after distal radius fracture compared with controls. CONCLUSIONS: Posttraumatic radiocarpal articular cartilage damage did not differ between fractures with intra-articular and extra-articular extension, but patients with fractures had notably higher articular cartilage degradation compared with healthy controls. Magnetic resonance imaging using advanced multiparametric sequences may facilitate accurate, noninvasive assessment of articular cartilage changes after distal radius fracture without the need for a contrast agent. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.


Assuntos
Cartilagem Articular , Fraturas do Rádio , Adulto , Cartilagem Articular/diagnóstico por imagem , Meios de Contraste , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fraturas do Rádio/diagnóstico por imagem , Adulto Jovem
7.
PLoS One ; 15(2): e0228870, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084161

RESUMO

Understanding and predicting how individuals perform in high-pressure situations is of importance in designing and managing workplaces. We investigate performance under pressure in professional darts as a near-ideal setting with no direct interaction between players and a high number of observations per subject. Analyzing almost one year of tournament data covering 32,274 dart throws, we find no evidence in favor of either choking or excelling under pressure.


Assuntos
Desempenho Atlético/psicologia , Desempenho Atlético/fisiologia , Desempenho Atlético/estatística & dados numéricos , Humanos , Modelos Psicológicos , Modelos Estatísticos , Destreza Motora/fisiologia , Esportes/psicologia , Esportes/estatística & dados numéricos , Estresse Psicológico
8.
Foot Ankle Surg ; 26(8): 924-929, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31980383

RESUMO

BACKGROUND: Driving a motor vehicle needs a specific joint mobility and yet only limited knowledge exists regarding the necessary ankle range of motion. The goal of this study is to characterize the sequence and range of ankle motion. METHODS: The arc of plantarflexion/dorsiflexion and supination/pronation was recorded in the right and left ankle using electrogoniometers while thirty laps were driven by fifteen healthy participants around a course in a manual transmission car with a left sided steering wheel. The driver was required to perform the following maneuvers during each lap: (I) Vehicle acceleration and gear change, (II) Sudden evasion, (III) Routine turning, (IV) Rapid turning, (V) Vehicle acceleration followed by emergency braking. RESULTS: Driving required the right ankle to plantarflex 13±9 and dorsiflex 22±7 while supinating 15±7 degrees and pronating minimally. The left ankle plantarflexed 19±10and dorsiflexed 17±10 while supinating 15±7 degrees and pronating minimally. The right ankle dorsiflexed significantly more (p=0.00), and yet the left ankle had a significantly higher maximum plantarflexion and range of plantarflexion/dorsiflexion (p=0.00). Emergency braking resulted in a significantly higher maximum plantarflexion as well as plantarflexion/dorsiflexion range when compared to other maneuvers. CONCLUSION: This study describes the range of ankle motion identified to drive a car with a manual transmission and a left-sided steering wheel. The right and left ankle exhibit different arcs of motion during driving. This knowledge may assist when evaluating a patient's driving capability. Further studies are needed to investigate whether movement restrictions impair driving. LEVEL OF EVIDENCE: Basic science study.


Assuntos
Articulação do Tornozelo/fisiologia , Condução de Veículo , Pronação/fisiologia , Amplitude de Movimento Articular/fisiologia , Supinação/fisiologia , Adulto , Artrometria Articular , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Músculo Esquelético , Valores de Referência
9.
IEEE Trans Vis Comput Graph ; 26(1): 884-894, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425116

RESUMO

Automation of tasks can have critical consequences when humans lose agency over decision processes. Deep learning models are particularly susceptible since current black-box approaches lack explainable reasoning. We argue that both the visual interface and model structure of deep learning systems need to take into account interaction design. We propose a framework of collaborative semantic inference (CSI) for the co-design of interactions and models to enable visual collaboration between humans and algorithms. The approach exposes the intermediate reasoning process of models which allows semantic interactions with the visual metaphors of a problem, which means that a user can both understand and control parts of the model reasoning process. We demonstrate the feasibility of CSI with a co-designed case study of a document summarization system.


Assuntos
Gráficos por Computador , Aprendizado Profundo , Semântica , Simulação por Computador , Humanos , Interface Usuário-Computador , Redação
10.
J Shoulder Elbow Surg ; 28(6): 1139-1145, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30770312

RESUMO

BACKGROUND: Immobilization of the upper extremity after an acute injury or postoperatively affects an individual's ability to safely operate a motor vehicle. The elbow is particularly sensitive to immobilization, with subsequent stiffness leading to functional limitations. Most activities of daily living are successfully achieved within a "functional arc" of elbow motion between 30° and 130° of flexion. No objective guidelines exist regarding the range of motion needed to safely operate a vehicle. In this study, we measured the range of motion of right and left elbows while driving a manual-transmission car. MATERIALS AND METHODS: Using electro-goniometers, we measured the flexion and extension, as well as pronation and supination, of the right and left elbows in 20 healthy, right hand-dominant subjects while driving a car. These measurements were recorded on (1) city streets, (2) country roads, and (3) highways. RESULTS: For city streets, the range of motion in terms of flexion and pronation/supination was 15°-105° and 0°-45°/0°-35°, respectively, for the right elbow and 20°-95° and 0°-45°/0°-40°, respectively, for the left. For country roads, it was 10°-100° and 0°-40°/0°-35°, respectively, for the right elbow and 20°-95° and 0°-30°/0°-30°, respectively, for the left. For highways, it was 5°-100° and 0°-40°/0°-35°, respectively, for the right elbow and 20°-90° and 0°-30°/0°-25°, respectively, for the left. Mean pronation was significantly higher for the right elbow (P < .01). CONCLUSION: This study describes the range of elbow motion identified to drive a car with a manual transmission and a left-sided steering wheel. Mean pronation of the right elbow is significantly higher than that of the left. Further studies are needed to investigate the relevance of movement restrictions as they relate to handedness, steering-wheel side, and driving impairment.


Assuntos
Condução de Veículo , Articulação do Cotovelo/fisiologia , Amplitude de Movimento Articular , Atividades Cotidianas , Adulto , Feminino , Lateralidade Funcional , Voluntários Saudáveis , Humanos , Masculino , Pronação , Supinação , Adulto Jovem
11.
Eur Radiol ; 29(5): 2581-2588, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30542752

RESUMO

OBJECTIVES: To identify differences of radiocarpal cartilage alterations in osteoarthritis and arthritis using multiparametrical magnetic resonance imaging (MRI) comprising morphological and biochemical sequences without gadolinium-based contrast agent administration. METHODS: In this prospective study, multiparametrical MRI of the radiocarpal cartilage was performed in 47 participants (mean age, 46.6 ± 17.6 years; min., 20 years; max., 79 years) on a 3 Tesla MRI. The cohort consisted of 11 patients suffering from arthritis, 10 patients with osteoarthritis, 14 patients after distal radius fracture, and 12 healthy volunteers. The radiocarpal cartilage was assessed using morphological (DESS, TrueFISP) and biochemical (T2*) MRI sequences without the application of intravenous contrast agent. The modified Outerbridge classification system for morphological and region-of-interest analyses for biochemical analysis was applied to assess the degree of cartilage damage in each patient before data were statistically tested for significant difference between the groups using a post hoc Tukey test. RESULTS: In morphological imaging, cartilage damage was significantly more frequent in arthritis and osteoarthritis than in healthy volunteers (DESS: p = 0.01, p = 0.0004; TrueFISP: p = 0.02, p = 0.0001). In T2* imaging, patients with osteoarthritis showed higher cartilage damage compared to patients with arthritis (p = 0.01). CONCLUSION: With multiparametrical MRI, it is possible to identify differences of radiocarpal cartilage alterations of patients with arthritis and osteoarthritis using the combination of morphological and biochemical MR imaging of the radiocarpal cartilage without the application of contrast agent. Multiparametrical MRI without the usage of contrast agent may be a potential tool helping to distinguish both entities. KEY POINTS: • Multiparametrical MRI with morphological and biochemical sequences allows the differentiation of patients with arthritis and osteoarthritis. • High-resolution MRI of radiocarpal cartilage is possible without administration of contrast agent.


Assuntos
Artrite/diagnóstico , Cartilagem Articular/patologia , Gadolínio DTPA/administração & dosagem , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Estudos Prospectivos , Adulto Jovem
12.
Knee ; 26(1): 33-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30502934

RESUMO

BACKGROUND: One of the most important activities of daily living is operating a motor vehicle. With increasing age the prevalence of musculoskeletal disorders such as knee osteoarthritis may interfere with an individual's ability to do so safely. Physicians are tasked with determining a patient's ability to drive and yet the necessary joint range of motion required for driving a car has not been characterized. METHODS: The range of motion of the right and left knees was recorded using electrogoniometers in 20 healthy subjects while driving a car on three route types (a) city streets, b) country roads and c) highways). Special emphasis was placed on the left knee associated with changing a gear. RESULTS: The range of motion while driving is 40-80° for the right and 20-85° flexion for the left knee. A significant difference was noted for each side (p < 0.01) with a higher flexion occurring in the left knee (p < 0.01). The average position of the knee while changing a gear (beginning, maximum, ending) was: right: 55°±10°, 62°±10°, 53°±10°; left: 67°±7°, 39°±8°, 66°±8° (mean flexion±standard deviation). CONCLUSION: This study characterized the knee range of motion that occurs while driving a car. Our data suggests that common driving activities such as accelerating a vehicle or braking can be achieved with the right knee through a limited range of motion. The greater range of motion and the higher flexion of the left knee are mainly attributed to the gear changing. The present data may benefit physicians in their evaluation of driving capability.


Assuntos
Atividades Cotidianas , Condução de Veículo , Articulação do Joelho/fisiologia , Amplitude de Movimento Articular/fisiologia , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Relações Médico-Paciente , Adulto Jovem
13.
Hand (N Y) ; 14(2): 259-263, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29072491

RESUMO

BACKGROUND: The metacarpophalangeal joints exhibit range of motion that is influenced by wrist position. Synergistic motion occurs between the wrist and the metacarpophalangeal joints with different static wrist positions affecting joints' motion capability. The aim of this study was to determine how different wrist positions influence the active range of motion of the index through small finger metacarpophalangeal joints. METHODS: The active range of motion of the index through small finger metacarpophalangeal joints of 31 healthy subjects was measured in flexion/extension and radial/ulnar deviation in 5 different flexion/extension wrist positions, using biaxial electrogoniometers. RESULTS: There was a difference in range of motion of all fingers depending on the wrist position. The minimum metacarpophalangeal joint range of motion was found in 80° wrist extension, the maximum in neutral wrist position. For the index finger, flexion/extension was 84.7° (±8.6°) to 25.9° (±10.2°) and radial/ulnar deviation was 32.1° (±11.3°) to 22.6° (±12.8°). For the middle finger, flexion/extension was 84.8° (±8.5°) to 25.9° (±10.1°) and radial/ulnar deviation 28.8° (±11.1°) to 22.1° (±8.9). The fourth finger showed a range of motion for flexion/extension of 87.2° (±11.5°) to 22.8° (±11.6°) and radial/ulnar deviation of 8.1° (±5.8°) to 32.3° (±12.4°). The highest range of motion was measured at the fifth finger with flexion/extension of 84.0° (±8.6°) to 32.1°(±16.8°) and radial/ulnar deviation of 15.1° (±12.9°) up to 54.6° (±18.7°). CONCLUSIONS: The range of motion of the index through small finger metacarpophalangeal joints was significantly influenced by wrist position. The highest metacarpophalangeal joint range of motion of all fingers was conducted in neutral wrist positions. Apart from ergonomic implications, we conclude that metacarpophalangeal joint motion should be assessed under standardized wrist positions.


Assuntos
Articulação Metacarpofalângica/fisiologia , Amplitude de Movimento Articular/fisiologia , Articulação do Punho/fisiologia , Adolescente , Adulto , Idoso , Artrometria Articular , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Hand (N Y) ; 14(3): 402-407, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29216764

RESUMO

BACKGROUND: Medial collateral ligament (MCL) reconstruction of the elbow mandates precise characterization of where the centerline of elbow rotation projects onto the medial epicondyle (ME). A muscle-splitting approach allows the flexor-pronator muscles to remain attached to the ME and facilitates visualization of the MCL remnant, the sublime tubercle, and the ulnohumeral joint line. Knowledge of where the centerline of rotation intersects the ME relative to the ulnohumeral joint line may assist the surgeon during placement of the proximal drill hole. METHODS: Models were created from the computed tomography scans of 29 normal elbows. The centerline of rotation, center of the trochlea, sublime tubercle, and ulnohumeral joint line were identified. Measurements were taken from the ulnohumeral joint line to the center of the trochlea and to the centerline of rotation in the sagittal view and along the course of the MCL. RESULTS: The centerline of rotation intersected the ME in a consistent location. With the elbow flexed 90°, the trochlea center and the centerline of rotation are essentially in line with each other. There are significant differences between the distances from the ulnohumeral joint line to the center of the trochlea and to the centerline of rotation in both the sagittal view and along the course of the MCL. CONCLUSIONS: The centerline of rotation is located 14.31 mm (1.70) from the ulnohumeral joint line in the sagittal view and 16.54 mm (2.09) from the ulnohumeral joint line along the course of the MCL.


Assuntos
Ligamentos Colaterais/transplante , Articulação do Cotovelo/cirurgia , Músculo Esquelético/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Ligamentos Colaterais/fisiopatologia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Antebraço/diagnóstico por imagem , Antebraço/fisiopatologia , Antebraço/cirurgia , Humanos , Úmero/anatomia & histologia , Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Músculo Esquelético/anatomia & histologia , Amplitude de Movimento Articular , Rotação , Tomografia Computadorizada por Raios X/métodos , Ulna/anatomia & histologia , Ulna/diagnóstico por imagem , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-30334796

RESUMO

Neural sequence-to-sequence models have proven to be accurate and robust for many sequence prediction tasks, and have become the standard approach for automatic translation of text. The models work with a five-stage blackbox pipeline that begins with encoding a source sequence to a vector space and then decoding out to a new target sequence. This process is now standard, but like many deep learning methods remains quite difficult to understand or debug. In this work, we present a visual analysis tool that allows interaction and "what if"-style exploration of trained sequence-to-sequence models through each stage of the translation process. The aim is to identify which patterns have been learned, to detect model errors, and to probe the model with counterfactual scenario. We demonstrate the utility of our tool through several real-world sequence-to-sequence use cases on large-scale models.

16.
Int J Med Inform ; 112: 68-73, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29500024

RESUMO

Advancement of Artificial Intelligence (AI) capabilities in medicine can help address many pressing problems in healthcare. However, AI research endeavors in healthcare may not be clinically relevant, may have unrealistic expectations, or may not be explicit enough about their limitations. A diverse and well-functioning multidisciplinary team (MDT) can help identify appropriate and achievable AI research agendas in healthcare, and advance medical AI technologies by developing AI algorithms as well as addressing the shortage of appropriately labeled datasets for machine learning. In this paper, our team of engineers, clinicians and machine learning experts share their experience and lessons learned from their two-year-long collaboration on a natural language processing (NLP) research project. We highlight specific challenges encountered in cross-disciplinary teamwork, dataset creation for NLP research, and expectation setting for current medical AI technologies.


Assuntos
Algoritmos , Inteligência Artificial , Tomada de Decisão Clínica , Aprendizado de Máquina , Processamento de Linguagem Natural , Humanos
17.
PLoS One ; 13(2): e0192360, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29447188

RESUMO

In secondary analysis of electronic health records, a crucial task consists in correctly identifying the patient cohort under investigation. In many cases, the most valuable and relevant information for an accurate classification of medical conditions exist only in clinical narratives. Therefore, it is necessary to use natural language processing (NLP) techniques to extract and evaluate these narratives. The most commonly used approach to this problem relies on extracting a number of clinician-defined medical concepts from text and using machine learning techniques to identify whether a particular patient has a certain condition. However, recent advances in deep learning and NLP enable models to learn a rich representation of (medical) language. Convolutional neural networks (CNN) for text classification can augment the existing techniques by leveraging the representation of language to learn which phrases in a text are relevant for a given medical condition. In this work, we compare concept extraction based methods with CNNs and other commonly used models in NLP in ten phenotyping tasks using 1,610 discharge summaries from the MIMIC-III database. We show that CNNs outperform concept extraction based methods in almost all of the tasks, with an improvement in F1-score of up to 26 and up to 7 percentage points in area under the ROC curve (AUC). We additionally assess the interpretability of both approaches by presenting and evaluating methods that calculate and extract the most salient phrases for a prediction. The results indicate that CNNs are a valid alternative to existing approaches in patient phenotyping and cohort identification, and should be further investigated. Moreover, the deep learning approach presented in this paper can be used to assist clinicians during chart review or support the extraction of billing codes from text by identifying and highlighting relevant phrases for various medical conditions.


Assuntos
Idioma , Aprendizagem , Fenótipo , Humanos
18.
IEEE Trans Vis Comput Graph ; 24(1): 667-676, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28866526

RESUMO

Recurrent neural networks, and in particular long short-term memory (LSTM) networks, are a remarkably effective tool for sequence modeling that learn a dense black-box hidden representation of their sequential input. Researchers interested in better understanding these models have studied the changes in hidden state representations over time and noticed some interpretable patterns but also significant noise. In this work, we present LSTMVis, a visual analysis tool for recurrent neural networks with a focus on understanding these hidden state dynamics. The tool allows users to select a hypothesis input range to focus on local state changes, to match these states changes to similar patterns in a large data set, and to align these results with structural annotations from their domain. We show several use cases of the tool for analyzing specific hidden state properties on dataset containing nesting, phrase structure, and chord progressions, and demonstrate how the tool can be used to isolate patterns for further statistical analysis. We characterize the domain, the different stakeholders, and their goals and tasks. Long-term usage data after putting the tool online revealed great interest in the machine learning community.


Assuntos
Gráficos por Computador , Redes Neurais de Computação , Reconhecimento Automatizado de Padrão/métodos , Interface Usuário-Computador , Aprendizado de Máquina
19.
Hand (N Y) ; 13(4): 376-383, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29078727

RESUMO

BACKGROUND: The goal of proximal phalangeal fracture management is to allow for fracture healing to occur in acceptable alignment while maintaining gliding motion of the extensor and flexor tendons. METHODS: We reviewed the most current literature on various treatment methods of proximal phalanx fractures, focusing on the indications and outcomes of nonoperative as well as operative interventions. RESULTS: Stable fractures can be successfully treated nonoperatively, whereas unstable injuries benefit from surgery. Regardless of the surgical intervention employed, the overriding goal is to restore anatomy and impart enough stability to allow for early motion. The surgical dissection contributes to soft tissue scarring and should be minimized. CONCLUSIONS: Clinical success is achieved when acceptable fracture alignment and stability occur in the setting of unobstructed tendon gliding and early active range of motion.


Assuntos
Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fraturas Ósseas/terapia , Algoritmos , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Contenções
20.
Handchir Mikrochir Plast Chir ; 49(5): 309-314, 2017 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-28847017

RESUMO

Fracture dislocations of the STT joint are extremely rare. We present the case of a 50-year-old worker, who sustained a crush injury of his left hand with a dorsal fracture dislocation of the trapezoid bone and the associated second metacarpal bone at the STT, and a concomitant compartment syndrome of the hand. The fracture was reduced immediately and compartment release was performed, followed by percutaneous stabilisation using three K-wires. Material removal after six weeks was followed by intensive physical therapy. At the final follow-up examination after three months, we observed a good recovery of hand function compared to the unaffected right side with 75 % grip strength, 90 % ROM in extension/flexion and full thumb opposition (Kapandji score 9/10). Immediate surgical treatment of this rare injury can lead to a good functional result of the hand.


Assuntos
Lesões por Esmagamento/cirurgia , Fratura-Luxação/cirurgia , Traumatismos da Mão/cirurgia , Traumatismos Ocupacionais/cirurgia , Trapezoide/lesões , Fios Ortopédicos , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/cirurgia , Lesões por Esmagamento/diagnóstico por imagem , Seguimentos , Fratura-Luxação/diagnóstico por imagem , Fixação Interna de Fraturas , Traumatismos da Mão/diagnóstico por imagem , Força da Mão/fisiologia , Humanos , Imageamento Tridimensional , Masculino , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/lesões , Ossos Metacarpais/cirurgia , Pessoa de Meia-Idade , Traumatismos Ocupacionais/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Tomografia Computadorizada por Raios X , Trapezoide/diagnóstico por imagem , Trapezoide/cirurgia
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