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1.
Nat Commun ; 11(1): 4949, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33009388

RESUMO

Electron microscopy (EM) is widely used for studying cellular structure and network connectivity in the brain. We have built a parallel imaging pipeline using transmission electron microscopes that scales this technology, implements 24/7 continuous autonomous imaging, and enables the acquisition of petascale datasets. The suitability of this architecture for large-scale imaging was demonstrated by acquiring a volume of more than 1 mm3 of mouse neocortex, spanning four different visual areas at synaptic resolution, in less than 6 months. Over 26,500 ultrathin tissue sections from the same block were imaged, yielding a dataset of more than 2 petabytes. The combined burst acquisition rate of the pipeline is 3 Gpixel per sec and the net rate is 600 Mpixel per sec with six microscopes running in parallel. This work demonstrates the feasibility of acquiring EM datasets at the scale of cortical microcircuits in multiple brain regions and species.


Assuntos
Processamento de Imagem Assistida por Computador , Microscopia Eletrônica de Transmissão , Rede Nervosa/ultraestrutura , Neurônios/ultraestrutura , Animais , Automação , Camundongos , Neocórtex/diagnóstico por imagem , Software
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4156-4159, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018913

RESUMO

The aim of this work is to implement and validate an automated method for the localization of body-worn inertial sensors. Often, body-sensor networks with inertial measurement units (IMU) used in rehabilitation and ambient monitoring of patients with movement disorders, require specific markings or labels for the correct body placement. This introduces a burden, which, especially for ambient monitoring, could lead to errors or reduced adherence. We propose a method to automatically identify sensors attached on a predefined set of body placements, namely, wrists, shanks and torso. The method was used in a multi-site clinical trial with Parkinson's disease patients and in 45 sessions it identified sensor placement on torso, wrists and shanks with 100% accuracy, discriminated between left and right shank with 100% accuracy and between left and right wrist with 98% accuracy. This is remarkable, considering the presence of parkinsonian motor symptoms causing abnormal movement patterns, such as dyskinesia.Clinical Relevance- This method can facilitate home monitoring of patients with movement disorders.


Assuntos
Discinesias , Doença de Parkinson , Postura , Dispositivos Eletrônicos Vestíveis , Automação , Humanos , Tronco , Punho
3.
Nat Commun ; 11(1): 4974, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33009381

RESUMO

Generation of bispecific antibodies (bsAbs) requires a combination of compatible binders in formats that support desired functionalities. Here, we report that bsAb-matrices can be generated by Format Chain Exchange (FORCE), enabling screening of combinatorial binder/format spaces. Input molecules for generation of bi/multi-valent bsAbs are monospecific entities similar to knob-into-hole half-antibodies, yet with complementary CH3-interface-modulated and affinity-tagged dummy-chains. These contain mutations that lead to limited interface repulsions without compromising expression or biophysical properties of educts. Mild reduction of combinations of educts triggers spontaneous chain-exchange reactions driven by partially flawed CH3-educt interfaces resolving to perfect complementarity. This generates large bsAb matrices harboring different binders in multiple formats. Benign biophysical properties and good expression yields of educts, combined with simplicity of purification enables process automation. Examples that demonstrate the relevance of screening binder/format combinations are provided as a matrix of bsAbs that simultaneously bind Her1/Her2 and DR5 without encountering binder or format-inflicted interferences.


Assuntos
Anticorpos Biespecíficos/biossíntese , Ensaios de Triagem em Larga Escala , Anticorpos Biespecíficos/isolamento & purificação , Automação , Células HEK293 , Humanos , Mutação/genética , Multimerização Proteica
4.
Stud Health Technol Inform ; 274: 189-205, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32990674

RESUMO

Modern technology development created significant innovations in delivery of healthcare. Artificial intelligence as "a branch of computer science dealing with the simulation of intelligent behaviour in computers" when applied in health care resulted in intelligent support to decision-making, optimised business processes, increased quality, monitoring and delivering of personalised treatment plans and many other applications. Even though the benefits are clear and numerous, there are still open issues in creating automation of healthcare processes, ensuring data protection and integrity, reduction of medical waste etc. However, due to rapid development of AI techniques, more advances and improvements are still expected.


Assuntos
Inteligência Artificial , Assistência à Saúde , Automação
5.
Ann Saudi Med ; 40(5): 373-381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32954791

RESUMO

BACKGROUND: The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has prompted a need for mass testing to identify patients with viral infection. The high demand has created a global bottleneck in testing capacity, which prompted us to modify available resources to extract viral RNA and perform reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) to detect SARS-COV-2. OBJECTIVES: Report on the use of a DNA extraction kit, after modifications, to extract viral RNA that could then be detected using an FDA-approved SARS-COV-2 RT-qPCR assay. MATERIALS AND METHODS: Initially, automated RNA extraction was performed using a modified DNA kit on samples from control subjects, a bacteriophage, and an RNA virus. We then verified the automated extraction using the modified kit to detect in-lab propagated SARSCOV-2 titrations using an FDA approved commercial kit (S, N, and ORF1b genes) and an in-house primer-probe based assay (E, RdRp2 and RdRp4 genes). RESULTS: Automated RNA extraction on serial dilutions SARS-COV-2 achieved successful one-step RT-qPCR detection down to 60 copies using the commercial kit assay and less than 30 copies using the in-house primer-probe assay. Moreover, RT-qPCR detection was successful after automated RNA extraction using this modified protocol on 12 patient samples of SARS-COV-2 collected by nasopharyngeal swabs and stored in viral transport media. CONCLUSIONS: We demonstrated the capacity of a modified DNA extraction kit for automated viral RNA extraction and detection using a platform that is suitable for mass testing. LIMITATIONS: Small patient sample size. CONFLICT OF INTEREST: None.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Nasofaringe/virologia , Pneumonia Viral/diagnóstico , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Animais , Automação , Chlorocebus aethiops , Técnicas de Laboratório Clínico , Vírus da Encefalomiocardite/genética , Humanos , Levivirus/genética , Proteínas do Nucleocapsídeo/genética , Pandemias , RNA Replicase/genética , RNA Viral/análise , Análise de Sequência de RNA , Glicoproteína da Espícula de Coronavírus/genética , Células Vero , Proteínas do Envelope Viral/genética , Proteínas não Estruturais Virais/genética
6.
J Chromatogr A ; 1626: 461349, 2020 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-32797829

RESUMO

In the present work, a very sensitive and fully automated direct immersion PAL SPME Arrow procedure, coupled with GC-MS, has been developed and validated for determination of nine phosphorus flame retardants in different types of water samples (river, drinking and rainwater). PDMS/DVB was selected among three commercially available SPME Arrows (PDMS/DVB, DVB/PDMS/CWR and PDMS/CWR), since it resulted in the best sensitivity. The important experimental parameters were optimized via a central composite design response surface methodology and as result, extraction time of 65 min, extraction temperature of 80 °C and added salt concentration of 19% (w/v), were selected as the optimum values. The optimized method showed linear response over the calibration range (2 - 500 ng L-1), with R2-values higher than 0.9937. The precision (RSD%) measured by replicate analyses (n = 7) was estimated at 2 and 100 ng L-1 and was less than 29% and 21%, respectively. The LOQ of PAL SPME Arrow, calculated as S/N = 10, was between 0.2 and 1.2 ng L-1 (for triphenyl phosphate and tris-(1­chloro­2-propyl) phosphate, respectively) with extraction efficiencies between 5.9 and 31% (for tris-(1,3-dichloro-2-propyl) phosphate and tri-n­butyl phosphate, respectively). To assess the performance of the developed technique for real samples, two river water samples, tap water from two regions and a rainwater sample were analyzed. Most of the target analytes were observed in the river samples with concentrations of 1.0 - 250 ng L-1 and the obtained recoveries at 50 ng L-1 ranged between 60 and 107%. Considering the figures of merit of the optimized method, PAL SPME Arrow-GC-MS showed to be the most sensitive analytical approach for determination of phosphorus flame retardants in water, with satisfying precision and accuracy, compared with conventional SPME-NPD, LLE-GC-MS and SPE-LC-MS/MS.


Assuntos
Retardadores de Chama/análise , Fósforo/análise , Microextração em Fase Sólida/métodos , Poluentes Químicos da Água/análise , Automação , Dimetilpolisiloxanos/química , Cromatografia Gasosa-Espectrometria de Massas , Polivinil/química , Soluções
7.
Int J Nanomedicine ; 15: 4933-4941, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764926

RESUMO

Purpose: The aim of this study was to develop an avidin-modified macromolecular lipid magnetic sphere and its application in differential diagnosis of liver disease and liver cancer. Materials and Methods: Lectin-modified macromolecular lipid magnetic spheres were prepared by thin-film hydration method using lentil lectin derivatives (LCA-HQ) and cholesterol as raw materials. Alpha-fetoprotein variants (AFP-L3) in serum from healthy people, liver disease and liver cancer patients were isolated using the prepared lectin-modified macromolecular lipid magnetic spheres, and alpha-fetoprotein (AFP) and AFP-L3 were detected by fully automatic time-resolved fluorescence immunoassay. Results: The lectin polymer lipid magnetic sphere prepared in this study was superparamagnetic and encapsulated by a lectin derivative. There was no significant difference in the recovery rate of AFP-L3 between avidin magnetic ball-automatic time-resolved fluorescence immunoassay and manual micro-affinity column method (p>0.05). We found that AFP-L3 can be used as a differential indicator between liver cancer and liver disease. The positive rate of AFP and AFP-L3 in liver cancer patients was higher than that in healthy people and liver disease patients (p<0.001). The AUC (95% CI) of AFP and AFP-L3 were 0.743 ± 0.031 and 0.850 ± 0.024, respectively. AFP-L3 AUC value is greater than AFP; therefore, AFP-L3 distinguishes liver cancer more accurately, and the difference is statistically different, p<0.05. Conclusion: We proposed a novel method for integration of the lectin polymer lipid magnetic spheres and time-resolved fluorescence immunoassay that enables simple, accurate and rapid determination of AFP-L3 in clinical samples. To be noted, fully automatic time-resolved fluorescence immunoassay compared with the commonly used techniques in clinical practice, the measurement procedure is simple and is expected to be used for the detection and accurate diagnosis of liver cancer.


Assuntos
Fluorescência , Lipossomos/química , Neoplasias Hepáticas/diagnóstico , Mutação , Polímeros/química , alfa-Fetoproteínas/genética , alfa-Fetoproteínas/metabolismo , Adulto , Área Sob a Curva , Automação , Biomarcadores Tumorais/sangue , Feminino , Humanos , Imunoensaio/métodos , Neoplasias Hepáticas/sangue , Imãs/química , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
8.
Mayo Clin Proc ; 95(9): 1898-1905, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32861334

RESUMO

OBJECTIVE: To model and compare effect of digital contact tracing versus shelter-in-place on severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) spread. METHODS: Using a classical epidemiologic framework and parameters estimated from literature published between February 1, 2020, and May 25, 2020, we modeled two non-pharmacologic interventions - shelter-in-place and digital contact tracing - to curb spread of SARS-CoV-2. For contact tracing, we assumed an advanced automated contact tracing (AACT) application that sends alerts to individuals advising self-isolation based on individual exposure profile. Model parameters included percentage population ordered to shelter-in-place, adoption rate of AACT, and percentage individuals who appropriately follow recommendations. Under influence of these variables, the number of individuals infected, exposed, and isolated were estimated. RESULTS: Without any intervention, a high rate of infection (>10 million) with early peak is predicted. Shelter-in-place results in rapid decline in infection rate at the expense of impacting a large population segment. The AACT model achieves reduction in infected and exposed individuals similar to shelter-in-place without impacting a large number of individuals. For example, a 50% AACT adoption rate mimics a shelter-in-place order for 40% of the population and results in a greater than 90% decrease in peak number of infections. However, as compared to shelter-in-place, with AACT significantly fewer individuals would be isolated. CONCLUSION: Wide adoption of digital contact tracing can mitigate infection spread similar to universal shelter-in-place, but with considerably fewer individuals isolated.


Assuntos
Controle de Doenças Transmissíveis/métodos , Busca de Comunicante/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Software , Automação , Betacoronavirus , Infecções por Coronavirus/transmissão , Humanos , Modelos Teóricos , Pneumonia Viral/transmissão , Isolamento Social
9.
MMWR Morb Mortal Wkly Rep ; 69(31): 1026-1030, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32759918

RESUMO

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is spread from person to person (1-3). Quarantine of exposed persons (contacts) for 14 days following their exposure reduces transmission (4-7). Contact tracing provides an opportunity to identify contacts, inform them of quarantine recommendations, and monitor their symptoms to promptly identify secondary COVID-19 cases (7,8). On March 12, 2020, Maine Center for Disease Control and Prevention (Maine CDC) identified the first case of COVID-19 in the state. Because of resource constraints, including staffing, Maine CDC could not consistently monitor contacts, and automated technological solutions for monitoring contacts were explored. On May 14, 2020, Maine CDC began enrolling contacts of patients with reported COVID-19 into Sara Alert (MITRE Corporation, 2020),* an automated, web-based, symptom monitoring tool. After initial communication with Maine CDC staff members, enrolled contacts automatically received daily symptom questionnaires via their choice of e-mailed weblink, text message, texted weblink, or telephone call until completion of their quarantine. Epidemiologic investigations were conducted for enrollees who reported symptoms or received a positive SARS-CoV-2 test result. During May 14-June 26, Maine CDC enrolled 1,622 contacts of 614 COVID-19 patients; 190 (11.7%) eventually developed COVID-19, highlighting the importance of identifying, quarantining, and monitoring contacts of COVID-19 patients to limit spread. In Maine, symptom monitoring was not feasible without the use of an automated symptom monitoring tool. Using a tool that permitted enrollees to specify a method of symptom monitoring was well received, because the majority of persons monitored (96.4%) agreed to report using this system.


Assuntos
Busca de Comunicante , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Monitoramento Epidemiológico , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Automação , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Maine/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Avaliação de Sintomas/métodos , Adulto Jovem
10.
PLoS One ; 15(8): e0236952, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780751

RESUMO

Rotation schedules for residents must balance individual preferences, compliance with Accreditation Council for Graduate Medical Education guidelines, and institutional staffing requirements. Automation has the potential to improve the consistency and quality of schedules. We designed a novel rotation scheduling tool, the Automated Internal Medicine Scheduler (AIMS), and evaluated schedule quality and resident satisfaction and perceptions of fairness after implementation. We compared schedule uniformity, fulfillment of resident preferences, and conflicting shift assignments for the hand-made 2017-2018 schedule, and the AIMS-generated 2018-2019 schedule. Residents were surveyed in September 2018 to assess perception of schedule quality and fairness. With AIMS, 71/74 (96.0%) interns and 66/82 (80.5%) residents were assigned to their first-choice rotation, a significant increase from the 50/72 (69.4%) interns and 25/82 (30.5%) residents assigned their first-choice in the 2017-2018 academic year. AIMS also yielded significant improvements in the number of night shift/day shift conflicts at the time of rotation switches for interns, with a significant decrease to 0.3 conflicts per intern compared to 0.7 with the prior manual schedule. Twenty-two of 82 residents (27%) completed the survey, and average satisfaction and perception of fairness were 0.7 and 0.9 points higher on a 5-point Likert scale for the AIMS-generated schedule when compared to the non-AIMS schedule. There was no significant difference in the preference for assigned vacation blocks, or in variance for night or ICU rotations. Automated scheduling improved several metrics of schedule quality, as well as resident satisfaction. Future directions include evaluation of the tool in other residency programs and comparison with alternative scheduling algorithms.


Assuntos
Medicina Interna/educação , Internato e Residência , Admissão e Escalonamento de Pessoal , Automação , Connecticut , Feminino , Humanos , Satisfação no Emprego , Masculino , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Jornada de Trabalho em Turnos/normas , Jornada de Trabalho em Turnos/estatística & dados numéricos , Software , Inquéritos e Questionários , Estados Unidos , Tolerância ao Trabalho Programado
11.
PLoS One ; 15(8): e0237386, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790697

RESUMO

The IEEE 802.11ah standard relies on the conventional distributed coordination function (DCF) as a backoff selection method. The DCF is utilized in the contention-based period of the newly introduced medium access control (MAC) mechanism, namely restricted access window (RAW). Despite various advantages of RAW, DCF still utilizes the legacy binary exponential backoff (BEB) algorithm, which suffers from a crucial disadvantage of being prone to high probability of collisions with high number of contending stations. To mitigate this issue, this paper investigates the possibility of replacing the existing exponential sequence (i.e., as in BEB) with a better pseudorandom sequence of integers. In particular, a new backoff algorithm, namely Pseudorandom Sequence Contention Algorithm (PRSCA) is proposed to update the CW size and minimize the collision probability. In addition, the proposed PRSCA incorporates a different approach of CW freezing mechanism and backoff stage reset process. An analytical model is derived for the proposed PRSCA and presented through a discrete 2-D Markov chain model. Performance evaluation demonstrates the efficiency of the proposed PRSCA in reducing collision probability and improving saturation throughput, network throughput, and access delay performance.


Assuntos
Algoritmos , Internet das Coisas , Automação , Cadeias de Markov , Tecnologia sem Fio
12.
PLoS One ; 15(8): e0237473, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813720

RESUMO

Solid phase peptide synthesis (SPPS) has enabled widespread use of synthetic peptides in applications ranging from pharmaceuticals to materials science. The demand for synthetic peptides has driven recent efforts to produce automated SPPS synthesizers which utilize fluid-handling components common to chemistry laboratories to drive costs down to several thousand dollars. Herein, we describe the design and validation of a more 'frugal' SPPS synthesizer that uses inexpensive, consumer-grade fluid-handling components to achieve a prototype price point between US$300 and $600. We demonstrated functionality by preparing and characterizing peptides with a variety of distinct properties including binding functionality, nanoscale self-assembly, and oxidation-induced fluorescence. This system yielded micromoles of peptide at a cost of approximately $1/residue, a cost which may be further reduced by optimization and bulk purchasing.


Assuntos
Peptídeos/síntese química , Técnicas de Síntese em Fase Sólida/métodos , Sequência de Aminoácidos , Automação , Peptídeos Penetradores de Células/síntese química , Peptídeos Penetradores de Células/química , Desenho de Equipamento , Fluorometria , Nanoestruturas/química , Oxirredução , Peptídeos/química , Técnicas de Síntese em Fase Sólida/economia , Técnicas de Síntese em Fase Sólida/instrumentação
13.
J Cardiovasc Magn Reson ; 22(1): 60, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32814579

RESUMO

BACKGROUND: Tissue characterisation with cardiovascular magnetic resonance (CMR) parametric mapping has the potential to detect and quantify both focal and diffuse alterations in myocardial structure not assessable by late gadolinium enhancement. Native T1 mapping in particular has shown promise as a useful biomarker to support diagnostic, therapeutic and prognostic decision-making in ischaemic and non-ischaemic cardiomyopathies. METHODS: Convolutional neural networks (CNNs) with Bayesian inference are a category of artificial neural networks which model the uncertainty of the network output. This study presents an automated framework for tissue characterisation from native shortened modified Look-Locker inversion recovery ShMOLLI T1 mapping at 1.5 T using a Probabilistic Hierarchical Segmentation (PHiSeg) network (PHCUMIS 119-127, 2019). In addition, we use the uncertainty information provided by the PHiSeg network in a novel automated quality control (QC) step to identify uncertain T1 values. The PHiSeg network and QC were validated against manual analysis on a cohort of the UK Biobank containing healthy subjects and chronic cardiomyopathy patients (N=100 for the PHiSeg network and N=700 for the QC). We used the proposed method to obtain reference T1 ranges for the left ventricular (LV) myocardium in healthy subjects as well as common clinical cardiac conditions. RESULTS: T1 values computed from automatic and manual segmentations were highly correlated (r=0.97). Bland-Altman analysis showed good agreement between the automated and manual measurements. The average Dice metric was 0.84 for the LV myocardium. The sensitivity of detection of erroneous outputs was 91%. Finally, T1 values were automatically derived from 11,882 CMR exams from the UK Biobank. For the healthy cohort, the mean (SD) corrected T1 values were 926.61 (45.26), 934.39 (43.25) and 927.56 (50.36) for global, interventricular septum and free-wall respectively. CONCLUSIONS: The proposed pipeline allows for automatic analysis of myocardial native T1 mapping and includes a QC process to detect potentially erroneous results. T1 reference values were presented for healthy subjects and common clinical cardiac conditions from the largest cohort to date using T1-mapping images.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Miocárdio/patologia , Redes Neurais de Computação , Automação , Teorema de Bayes , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Estudos de Casos e Controles , Humanos , Valor Preditivo dos Testes , Controle de Qualidade , Reprodutibilidade dos Testes , Volume Sistólico , Incerteza , Função Ventricular Esquerda
14.
PLoS Biol ; 18(7): e3000794, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32730242

RESUMO

The precision and repeatability of in vivo biological studies is predicated upon methods for isolating a targeted subsystem from external sources of noise and variability. However, in many experimental frameworks, this is made challenging by nonstatic environments during host cell growth, as well as variability introduced by manual sampling and measurement protocols. To address these challenges, we developed Chi.Bio, a parallelised open-source platform that represents a new experimental paradigm in which all measurement and control actions can be applied to a bulk culture in situ. In addition to continuous-culturing capabilities, it incorporates tunable light outputs, spectrometry, and advanced automation features. We demonstrate its application to studies of cell growth and biofilm formation, automated in silico control of optogenetic systems, and readout of multiple orthogonal fluorescent proteins in situ. By integrating precise measurement and actuation hardware into a single low-cost platform, Chi.Bio facilitates novel experimental methods for synthetic, systems, and evolutionary biology and broadens access to cutting-edge research capabilities.


Assuntos
Reatores Biológicos , Técnicas de Cultura/instrumentação , Optogenética/instrumentação , Automação , Biofilmes , Proliferação de Células , Simulação por Computador , Software
16.
Bone Joint J ; 102-B(7_Supple_B): 90-98, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600193

RESUMO

AIMS: The primary aim of this paper was to outline the processes involved in building the Partners Arthroplasty Registry (PAR), established in April 2016 to capture baseline and outcome data for patients undergoing arthroplasty in a regional healthcare system. A secondary aim was to determine the quality of PAR's data. A tertiary aim was to report preliminary findings from the registry and contributions to quality improvement initiatives and research up to March 2019. METHODS: Structured Query Language was used to obtain data relating to patients who underwent total hip or knee arthroplasty (THA and TKA) from the hospital network's electronic medical record (EMR) system to be included in the PAR. Data were stored in a secure database and visualized in dashboards. Quality assurance of PAR data was performed by review of the medical records. Capture rate was determined by comparing two months of PAR data with operating room schedules. Linear and binary logistic regression models were constructed to determine if length of stay (LOS), discharge to a care home, and readmission rates improved between 2016 and 2019. RESULTS: The PAR captured 16,163 THAs and TKAs between April 2016 and March 2019, performed in seven hospitals by 110 surgeons. Manual comparison to operating schedules showed a 100% capture rate. Review of the records was performed for 2,603 random operations; 2,298 (88.3%) had complete and accurate data. The PAR provided the data for three abstracts presented at international conferences and has led to preoperative mental health treatment as a quality improvement initiative in the participating institutions. For primary THA and TKA surgeries, the LOS decreased significantly (p < 0.001) and the rate of home discharge increased significantly (p < 0.001) between 2016 and 2019. Readmission rates did not correlated with the date of surgery (p = 0.953). CONCLUSION: The PAR has high rates of coverage (the number of patients treated within the Partners healthcare network) and data completion and can be used for both research purposes and quality improvement. The same method of creating a registry that was used in the PAR can be applied to hospitals using similar EMR systems. Cite this article: Bone Joint J 2020;102-B(7 Supple B):90-98.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Automação , Melhoria de Qualidade , Sistema de Registros , Idoso , Confiabilidade dos Dados , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Sistemas Multi-Institucionais , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estados Unidos
17.
MMWR Morb Mortal Wkly Rep ; 69(26): 815-819, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32614808

RESUMO

In May 2019, the New York City Department of Health and Mental Hygiene (NYCDOHMH) detected an unusual cluster of five salmonellosis patients via automated spatiotemporal analysis of notifiable diseases using free SaTScan software (1). Within 1 day of cluster detection, graduate student interviewers determined that three of the patients had eaten prepared food from the same grocery store (establishment A) located inside the cluster area. NYCDOHMH initiated an investigation to identify additional cases, establish the cause, and provide control recommendations. Overall, 15 New York City (NYC) residents with laboratory-diagnosed salmonellosis who reported eating food from establishment A were identified. The most commonly consumed food item was chicken, reported by 10 patients. All 11 clinical isolates available were serotyped as Salmonella Blockley, sequenced, and analyzed by core genome multilocus sequence typing; isolates had a median difference of zero alleles. Environmental assessments revealed food not held at the proper temperature, food not cooled properly, and potential cross-contamination during chicken preparation. Elevated fecal coliform counts were found in two of four ready-to-eat food samples collected from establishment A, and Bacillus cereus was detected in three. The outbreak strain of Salmonella was isolated from one patient's leftover chicken. Establishing automated spatiotemporal cluster detection analyses for salmonellosis and other reportable diseases could aid in the detection of geographically focused, community-acquired outbreaks even before laboratory subtyping results become available.


Assuntos
Surtos de Doenças , Vigilância em Saúde Pública/métodos , Intoxicação Alimentar por Salmonella/epidemiologia , Análise Espaço-Temporal , Adulto , Automação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Salmonella/genética , Salmonella/isolamento & purificação , Intoxicação Alimentar por Salmonella/diagnóstico , Sorogrupo
18.
PLoS One ; 15(7): e0229476, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649703

RESUMO

Recent debates on insect decline require sound assessments on the relative drivers that may negatively impact insect populations. Often, baseline data rely on insect monitorings that integrate catches over long time periods. If, however, effects of time-critical environmental factors (e.g., light pollution) are of interest, higher temporal resolution of insect data is required during very specific time intervals (e.g., between dusk and dawn). Conventional time-critical insect trapping is labour-intensive (manual activation/deactivation) and temporally inaccurate as not all traps can be serviced synchronically at different sites. Also, temporal shifts of environmental conditions (e.g., sunset/sunrise) are not accounted for. We present a battery-driven automated insect flight-interception trap which samples insects during seven user-defined time intervals. A commercially available flight-interception trap is fitted to a turntable containing eight positions, seven of them holding cups and one consisting of a pass-through hole. While the cups sample insects during period of interest, the pass-through hole avoids unwanted sampling during time-intervals not of interest. Comparisons between two manual and two automated traps during 71 nights in 2018 showed no difference in caught insects. A study using 20 automated traps during 104 nights in 2019 proved that the automated flight-interception traps are reliable. The automated trap opens new research and application possibilities as arbitrary insect-sampling intervals can be defined. The trap proves efficient, saving manpower and associated costs as activation/deactivation is required only every seven sampling intervals. In addition, the timing of the traps is accurate, as all traps sample at exactly the same intervals and ensure comparability. The automated trap is low maintenance and robust due to straightforward technical design. It can be controlled manually or via smartphone through a Bluetooth connection. Full construction details are given in Appendices.


Assuntos
Voo Animal , Controle de Insetos/métodos , Insetos/fisiologia , Animais , Automação , Desenho de Equipamento
19.
Recenti Prog Med ; 111(7): 404-410, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-32658879

RESUMO

Lockdown and self-isolation are to date the only solution to limit the spread of recent outbreak of coronavirus disease (CoViD-19), highlighting the great advantage of home dialysis in a patient otherwise forced to travel from / to the dialysis center to receive this "life-saving" treatment. Indeed, to prevent spreading of CoViD-19 infection among extremely fragile dialysis patients, as well as among dialysis workers, hemodialysis (HD) centers are adopting specific procedures ("dedicated" dialysis facilities, portable osmosis, etc.) with a great economic and organizational commitment. Peritoneal dialysis (PD) represents a type of home dialysis therapy not yet adequately implemented to date, in spite of safe and simple practice, as well as similar dialytic efficiency vs in-center hemodialysis. Remote patient monitoring (RPM) systems have been developed in automated PD (APD) cyclers in order to improve the acceptance of this dialysis method, to increase the compliance to the prescribed therapy and to control treatment adequacy. In this review we assess the potential advantages of RPM in APD, that are the chance for patients to acquire greater independence and safety in the home treatment, to allow better access to care for residents in remote areas, faster resolution of problems, reduction in hospitalizations and mortality rates, as well as time and cost saving for both the patient and the staff. The use of medical devices (sphygmomanometer, glucometer, balance, etc.), connected by wireless to the clinician's portal, might also allow a wider diffusion of incremental dialysis, an integrated therapy that combines conservative management of ESKD patients with a soft dialysis based on the residual kidney function and symptomatology, with potential prognosis and economic benefits. Although the majority of the studies are small and observational, a wider use of RPM systems is desirable to broaden the spread of home dialysis, as we learnt from Coronavirus pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Hemodiálise no Domicílio , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral , Automação , Infecções por Coronavirus/prevenção & controle , Redução de Custos , Suscetibilidade a Doenças , Acesso aos Serviços de Saúde , Hemodiálise no Domicílio/economia , Hemodiálise no Domicílio/métodos , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Monitorização Fisiológica/instrumentação , Pandemias/prevenção & controle , Cooperação do Paciente , Diálise Peritoneal/instrumentação , Diálise Peritoneal/métodos , Pneumonia Viral/prevenção & controle , Medicina de Precisão , Isolamento Social , Telemedicina
20.
Phys Med Biol ; 65(13): 135011, 2020 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-32657281

RESUMO

Automated multi-organ segmentation on abdominal CT images may replace or complement manual segmentation for clinical applications including image-guided radiation therapy. However, the accuracy of auto-segmentation is challenged by low image contrast, large spatial and inter-patient anatomical variations. In this study, we propose an end-to-end segmentation network, termed self-paced DenseNet, for improved multi-organ segmentation performance, especially for the difficult-to-segment organs. Specifically, a learning-based attention mechanism and dense connection block are seamlessly integrated into the proposed self-paced DenseNet to improve the learning capability and efficiency of the backbone network. To heavily focus on the organs showing low soft-tissue contrast and motion artifacts, a boundary condition is utilized to constrain the network optimization. Additionally, to ease the large learning pace discrepancies of individual organs, a task-wise self-paced-learning strategy is employed to adaptively control the learning paces of individual organs. The proposed self-paced DenseNet was trained and evaluated on a public abdominal CT data set consisting of 90 subjects with manually labeled ground truths of eight organs (including spleen, left kidney, esophagus, gallbladder, stomach, liver, pancreas, and duodenum). For quantitative evaluation, the Dice similarity coefficient (DSC) and average surface distance (ASD) were calculated. An average DSC of 84.46% and ASD of 1.82 mm were achieved on the eight organs, which outperforms the state-of-the-art segmentation methods 2.96% on DSC under the same experimental configuration. Moreover, the proposed segmentation method shows notable improvements on the duodenum and gallbladder, obtaining an average DSC of 69.26% and 80.94% and ASD of 2.14 mm and 2.24 mm, respectively. The results are markedly superior to the average DSC of 63.12% and 76.35% and average ASD of 3.87 mm and 4.33 mm using the vanilla DenseNet, respectively, for the two organs. We demonstrated the effectiveness of the proposed self-paced DenseNet to automatically segment abdominal organs with low boundary conspicuity. The self-paced DenseNet achieved consistently superior segmentation performance on eight abdominal organs with varying segmentation difficulties. The demonstrated computational efficiency (<2 s/CT) makes it well-suited for online applications.


Assuntos
Abdome/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Algoritmos , Artefatos , Automação , Humanos
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