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1.
J Gen Intern Med ; 36(4): 1061-1066, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33469745

RESUMO

Despite increasing interest in how artificial intelligence (AI) can augment and improve healthcare delivery, the development of new AI models continues to outpace adoption in existing healthcare processes. Integration is difficult because current approaches separate the development of AI models from the complex healthcare environments in which they are intended to function, resulting in models developed without a clear and compelling use case and not tested or scalable in a clinical setting. We propose that current approaches and traditional research methods do not support successful AI implementation in healthcare and outline a repeatable mixed-methods approach, along with several examples, that facilitates uptake of AI technologies into human-driven healthcare processes. Unlike traditional research, these methods do not seek to control for variation, but rather understand it to learn how a technology will function in practice coupled with user-centered design techniques. This approach, leveraging design thinking and quality improvement methods, aims to increase the adoption of AI in healthcare and prompt further study to understand which methods are most successful for AI implementations.

2.
Iperception ; 11(3): 2041669520929047, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32547725

RESUMO

A test cross that flickers between light yellow and dark blue at 5 to 8Hz looks apparently yellow on a dark gray surround and apparently blue on a light gray surround (flicker augmented contrast). The achromatic surround cannot be inducing the perceived colors. Instead, the visual system selects the more salient apparent color with the higher Michelson contrast. The same is true for dichoptic vision. When one eye views a steady, light yellow cross and the other eye views a congruent steady dark blue cross, the binocular combination of colors looks apparently yellow on a dark gray surround and apparently blue on a light gray surround. Thus, when competing stimuli are distributed over time (flicker) or space (dichoptic vision), the visual system overweights the stimulus with the higher contrast. To see objects clearly, we accept the best view of any object and downplay inferior alternatives.

3.
Psychiatr Serv ; 71(3): 228-235, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31847738

RESUMO

OBJECTIVE: Early intervention programs are designed to address the needs of youths experiencing first-episode psychosis (FEP). Washington State developed New Journeys, a network of coordinated specialty care programs for FEP. In this study, the authors have outlined components of the New Journeys model and preliminary findings since its initial implementation. METHODS: Youths and young adults diagnosed as having psychosis (N=112) completed measures at and after intake on a range of mental health assessments and functional outcomes for the first 12 months of treatment. Administrative data including state-funded emergency department and psychiatric hospitalizations were assessed 24 months before and after intake. Generalized estimating equations were used to assess change over time on multiple measures of mental health status. RESULTS: Compared with their condition at intake, clients had significant decreases in symptoms of anxiety (ß=-2.48, p<0.001), psychotic experiences (ß=-3.37, p<0.05), and clinician-rated psychotic symptoms (ß=-1.47, p<0.05) during treatment. Additionally, quality of life (ß=-5.95, p<0.001) and school attendance (odds ratio=1.42, p<0.05) significantly improved during treatment. Administrative data indicated that postintake, clients were less likely to visit the emergency department for psychiatric reasons (ß=0.22, p<0.05), utilize community psychiatric inpatient services (ß=0.31, p<0.001), and utilize public assistance (ß=0.71, p<0.05) compared with 24 months before intake. CONCLUSIONS: New Journeys clients experienced improved clinical and functional outcomes during their first year of treatment, and rates of state-funded service utilization decreased during their treatment.

4.
J Biomech Eng ; 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31253990

RESUMO

Millions of people have reduced hand function; this loss of function can be due to injury, disease, or aging. Loss of hand function is identified as reduced motion abilities in the fingers or a decrease in the ability of the fingers to generate force. Unfortunately, there are limited data available regarding each finger's ability to produce force and how those force characteristics vary with changes in finger posture. To relate motion and force abilities of the fingers, first an approach to measure and map them together is needed. The goal of this work was to develop and demonstrate a method to quantify the force abilities of the fingers and map these forces to the kinematic space associated with each finger. Using motion capture and multi-axis load cells finger forces were quantified at different positions over their ranges of motion. These two sets of data were then converted to the same coordinate space and mapped together. Further, the data were normalized for the index finger and mapped as a population space model. The ability to quantify motion and force data for each finger and map them together will provide an improved understanding the effects of treatments and rehabilitation, identifying functional loss due to injury or disease, and device design.

5.
Hum Mol Genet ; 25(24): 5395-5406, 2016 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-27798107

RESUMO

Duchenne muscular dystrophy (DMD) is a genetic disorder that causes progressive muscle weakness, ultimately leading to early mortality in affected teenagers and young adults. Previous work from our lab has shown that a small transmembrane protein called sarcospan (SSPN) can enhance the recruitment of adhesion complex proteins to the cell surface. When human SSPN is expressed at three-fold levels in mdx mice, this increase in adhesion complex abundance improves muscle membrane stability, preventing many of the histopathological changes associated with DMD. However, expressing higher levels of human SSPN (ten-fold transgenic expression) causes a severe degenerative muscle phenotype in wild-type mice. Since SSPN-mediated stabilization of the sarcolemma represents a promising therapeutic strategy in DMD, it is important to determine whether SSPN can be introduced at high levels without toxicity. Here, we show that mouse SSPN (mSSPN) can be overexpressed at 30-fold levels in wild-type mice with no deleterious effects. In mdx mice, mSSPN overexpression improves dystrophic pathology and sarcolemmal stability. We show that these mice exhibit increased resistance to eccentric contraction-induced damage and reduced fatigue following exercise. mSSPN overexpression improved pulmonary function and reduced dystrophic histopathology in the diaphragm. Together, these results demonstrate that SSPN overexpression is well tolerated in mdx mice and improves sarcolemma defects that underlie skeletal muscle and pulmonary dysfunction in DMD.


Assuntos
Proteínas de Transporte/genética , Proteínas de Membrana/genética , Distrofia Muscular de Duchenne/genética , Proteínas de Neoplasias/genética , Sarcolema/genética , Animais , Proteínas de Transporte/biossíntese , Modelos Animais de Doenças , Regulação da Expressão Gênica/genética , Humanos , Pneumopatias/genética , Pneumopatias/patologia , Proteínas de Membrana/biossíntese , Camundongos , Camundongos Endogâmicos mdx , Camundongos Transgênicos , Contração Muscular/genética , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Distrofia Muscular de Duchenne/metabolismo , Distrofia Muscular de Duchenne/patologia , Proteínas de Neoplasias/biossíntese , Sarcolema/patologia
6.
Ecol Appl ; 25(4): 943-55, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26465035

RESUMO

Lake water quality is affected by local and regional drivers, including lake physical characteristics, hydrology, landscape position, land cover, land use, geology, and climate. Here, we demonstrate the utility of hypothesis testing within the landscape limnology framework using a random forest algorithm on a national-scale, spatially explicit data set, the United States Environmental Protection Agency's 2007 National Lakes Assessment. For 1026 lakes, we tested the relative importance of water quality drivers across spatial scales, the importance of hydrologic connectivity in mediating water quality drivers, and how the importance of both spatial scale and connectivity differ across response variables for five important in-lake water quality metrics (total phosphorus, total nitrogen, dissolved organic carbon, turbidity, and conductivity). By modeling the effect of water quality predictors at different spatial scales, we found that lake-specific characteristics (e.g., depth, sediment area-to-volume ratio) were important for explaining water quality (54-60% variance explained), and that regionalization schemes were much less effective than lake specific metrics (28-39% variance explained). Basin-scale land use and land cover explained between 45-62% of variance, and forest cover and agricultural land uses were among the most important basin-scale predictors. Water quality drivers did not operate independently; in some cases, hydrologic connectivity (the presence of upstream surface water features) mediated the effect of regional-scale drivers. For example, for water quality in lakes with upstream lakes, regional classification schemes were much less effective predictors than lake-specific variables, in contrast to lakes with no upstream lakes or with no surface inflows. At the scale of the continental United States, conductivity was explained by drivers operating at larger spatial scales than for other water quality responses. The current regulatory practice of using regionalization schemes to guide water quality criteria could be improved by consideration of lake-specific characteristics, which were the most important predictors of water quality at the scale of the continental United States. The spatial extent and high quality of contextual data available for this analysis makes this work an unprecedented application of landscape limnology theory to water quality data. Further, the demonstrated importance of lake morphology over other controls on water quality is relevant to both aquatic scientists and managers.


Assuntos
Lagos/química , Poluentes Químicos da Água/química , Qualidade da Água , Estados Unidos
8.
Arthritis Rheum ; 62(9): 2757-66, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20496415

RESUMO

OBJECTIVE: Myofiber necrosis without prominent inflammation is a nonspecific finding in patients with dystrophies and toxic or immune-mediated myopathies. However, the etiology of a necrotizing myopathy is often obscure, and the question of which patients would benefit from immunosuppression remains unanswered. The aim of this study was to identify novel autoantibodies in patients with necrotizing myopathy. METHODS: Muscle biopsy specimens and serum samples were available for 225 patients with myopathy. Antibody specificities were determined by performing immunoprecipitations from (35)S-methionine-labeled HeLa cell lysates. Selected biopsy specimens were stained for membrane attack complex, class I major histocompatibility complex (MHC), and endothelial cell marker CD31. RESULTS: Muscle biopsy specimens from 38 of 225 patients showed predominantly myofiber necrosis. Twelve of these patients had a known autoantibody association with or other etiology for their myopathy. Sixteen of the remaining 26 sera immunoprecipitated 200-kd and 100-kd proteins; this specificity was observed in only 1 of 187 patients without necrotizing myopathy. Patients with the anti-200/100 autoantibody specificity had proximal weakness (100%), high creatine kinase levels (mean maximum 10,333 IU/liter), and an irritable myopathy on electromyography (88%). Sixty-three percent of these patients had been exposed to statins prior to the onset of weakness. All patients responded to immunosuppressive therapy, and many experienced a relapse of weakness when the medication was tapered. Immunohistochemical studies showed membrane attack complex on small blood vessels in 6 of 8 patients and on the surface of non-necrotic myofibers in 4 of 8 patients. Five of 8 patients had abnormal capillary morphology, and 4 of 8 patients expressed class I MHC on the surface of non-necrotic myofibers. CONCLUSION: An anti-200/100-kd specificity defines a subgroup of patients with necrotizing myopathy who previously were considered to be autoantibody negative. We propose that these patients have an immune-mediated myopathy that is frequently associated with prior statin use and should be treated with immunosuppressive therapy.


Assuntos
Autoanticorpos/sangue , Proteínas Musculares/imunologia , Músculo Esquelético/patologia , Miosite/imunologia , Miosite/patologia , Idoso , Biomarcadores/metabolismo , Complexo de Ataque à Membrana do Sistema Complemento/metabolismo , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Células HeLa , Antígenos de Histocompatibilidade Classe I/metabolismo , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Técnicas Imunoenzimáticas , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fibras Musculares Esqueléticas/efeitos dos fármacos , Fibras Musculares Esqueléticas/metabolismo , Fibras Musculares Esqueléticas/patologia , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/metabolismo , Miosite/tratamento farmacológico , Necrose , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo
9.
Arthritis Care Res (Hoboken) ; 62(9): 1328-34, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20506493

RESUMO

OBJECTIVE: The myopathy associated with anti-signal recognition particle (anti-SRP) is a severe necrotizing immune-mediated disease characterized by rapidly progressive proximal muscle weakness, markedly elevated serum creatine kinase (CK) levels, and poor responsiveness to traditional immunosuppressive therapies. Reports on the efficacy of B cell depletion therapy for anti-SRP-associated myopathy are mixed. We describe 8 patients with anti-SRP-associated myopathy and their response to treatment with the anti-CD20 monoclonal antibody rituximab. METHODS: We identified 8 patients with myopathy who tested positive for anti-SRP antibodies by immunoprecipitation and were treated with rituximab as part of clinical care. We reviewed their medical records to assess clinical, serologic, and histologic characteristics and response to therapy. In 5 patients, serum was collected before and after rituximab therapy. Autoantibodies were detected by immunoprecipitation and quantitated by densitometry, and the percent decreases in anti-SRP autoantibody levels were calculated. RESULTS: Six of 8 patients who had been refractory to standard immunosuppressive therapy demonstrated improved manual muscle strength and/or decline in CK levels as early as 2 months after rituximab treatment. Three patients sustained the response for 12-18 months after initial dosing. All of the patients were continued on adjunctive corticosteroids, but doses were substantially reduced after rituximab. Quantitative levels of serum anti-SRP antibodies also decreased after rituximab treatment. CONCLUSION: B cell depletion therapy with rituximab is effective for patients with myopathy associated with anti-SRP. The substantial decrease in anti-SRP antibody levels after rituximab treatment also suggests that B cells and anti-SRP antibodies may play a role in the pathogenesis of this myopathy.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Fatores Imunológicos/uso terapêutico , Debilidade Muscular/imunologia , Miosite/imunologia , Partícula de Reconhecimento de Sinal/imunologia , Adulto , Idoso , Anticorpos Monoclonais Murinos , Autoanticorpos/sangue , Autoanticorpos/imunologia , Linfócitos B/efeitos dos fármacos , Linfócitos B/imunologia , Creatina Quinase/sangue , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/sangue , Debilidade Muscular/tratamento farmacológico , Debilidade Muscular/etiologia , Miosite/sangue , Miosite/complicações , Miosite/tratamento farmacológico , Estudos Retrospectivos , Rituximab , Resultado do Tratamento , Adulto Jovem
10.
Chest ; 135(6): 1550-1556, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19225060

RESUMO

BACKGROUND: The antisynthetase syndrome consists of interstitial lung disease (ILD), arthritis, myositis, fever, mechanic's hands, and Raynaud phenomenon in the presence of an antisynthetase autoantibody, most commonly anti-Jo-1. It is believed that all the antisynthetases are associated with a similar clinical profile, but definitive data in this diverse group are lacking. The purpose of this study was to examine the clinical profile of anti-PL-12, an antisynthetase autoantibody directed against alanyl-transfer RNA synthetase. METHODS: Thirty-one subjects with anti-PL-12 autoantibody were identified from the databases at the Medical University of South Carolina, the University of Pittsburgh Medical Center, Johns Hopkins Medical Center, and Brigham and Women's Hospital. The medical charts were reviewed and the following data were recorded: demographic information; pulmonary and rheumatologic symptoms; connective tissue disease (CTD) diagnoses; serologic autoantibody findings; CT scan results; BAL findings; pulmonary function test results; lung histopathology; and treatment interventions. RESULTS: The median age at symptom onset was 51 years; 81% were women and 52% were African American. Ninety percent of anti-PL-12-positive patients had ILD, 65% of whom presented initially to a pulmonologist. Ninety percent of anti-PL-12-positive patients had an underlying CTD. Polymyositis and dermatomyositis were the most common underlying diagnoses. Raynaud phenomenon occurred in 65% of patients, fever in 45% of patients, and mechanic's hands in 16% of patients. Test results for the presence of antinuclear antibody were positive in 48% of cases. CONCLUSIONS: Anti-PL-12 is strongly associated with the presence of ILD, but less so with myositis and arthritis. Idiopathic ILD diagnosed as idiopathic pulmonary fibrosis may, in fact, be associated with anti-PL-12 and be a "forme fruste" of an underlying autoimmune disorder.


Assuntos
Aminoacil-tRNA Sintetases/imunologia , Autoanticorpos/imunologia , Doenças Autoimunes/diagnóstico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artrite/complicações , Artrite/imunologia , Doenças Autoimunes/epidemiologia , Estudos de Coortes , Feminino , Febre/complicações , Febre/imunologia , Mãos/fisiopatologia , Humanos , Incidência , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/imunologia , Masculino , Pessoa de Meia-Idade , Polimiosite/complicações , Polimiosite/imunologia , Prognóstico , Doença de Raynaud/complicações , Doença de Raynaud/imunologia , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais , Síndrome , Adulto Jovem
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