Utilizing timestamps of longitudinal electronic health record data to classify clinical deterioration events

ObjectiveTo propose an algorithm that utilizes only timestamps of longitudinal electronic health record data to classify clinical deterioration events.Materials and methodsThis retrospective study explores the efficacy of machine learning algorithms in classifying clinical deterioration events among patients in intensive care units using sequences of timestamps of vital sign measurements, flowsheets comments, order entries, and nursing notes. We design a data pipeline to partition events into discrete, regular time bins that we refer to as timesteps. Logistic regressions, random forest classifiers, and recurrent neural networks are trained on datasets of different length of timesteps, respectively, against a composite outcome of death, cardiac arrest, and Rapid Response Team calls. Then these models are validated on a holdout dataset.ResultsA total of 6720 intensive care unit encounters meet the criteria and the final dataset includes 830 578 timestamps. The gated recurrent unit model utilizes timestamps of vital signs, order entries, flowsheet comments, and nursing notes to achieve the best performance on the time-to-outcome dataset, with an area under the precision-recall curve of 0.101 (0.06, 0.137), a sensitivity of 0.443, and a positive predictive value of 0. 092 at the threshold of 0.6.Discussion and ConclusionThis study demonstrates that our recurrent neural network models using only timestamps of longitudinal electronic health record data that reflect healthcare processes achieve well-performing discriminative power.     

In vivo biodegradability and biocompatibility evaluation of novel alanine ester based polyphosphazenes in a rat model

Amino acid ester substituted polyphosphazenes are attractive candidates for various biomedical applications because of their biocompatibility, controllable hydrolytic degradation rates, and nontoxic degradation products. In this study, the biocompatibility of three L-alanine ethyl ester functionalized polyphosphazenes was evaluated in a subcutaneous rat model. The polymers used in the study were poly[bis(ethylalanato)phosphazene] (PNEA), poly[(50% ethylalanato) (50% methylphenoxy) phosphazene] (PNEA(50)mPh(50)), and poly[(50% ethylalanato)(50% phenyl phenoxy) phosphazene] (PNEA(50)PhPh(50)). Polymer disks of diameter 7.5 mm were prepared by a solvent evaporation technique and were implanted subcutaneously in rats. After 2, 4, and 12 weeks, the polymer along with the surrounding tissues were excised, prepared, and viewed by light microscopy to evaluate the tissue responses of the implanted polymers. The tissue responses were classified as minimal, mild, or moderate, based on a biocompatibility scheme developed in our laboratory. Minimal inflammation was characterized by the presence of few neutrophils, erythrocytes, and lymphocytes; mild response was characterized by the predominant presence of macrophages, fibroblasts, or giant cells; and moderate inflammation was characterized by the abundance of macrophages, giant cells, and by the presence of tissue exudates. The in vivo degradation profiles of the polymers at various time points were evaluated by gel permeation chromatography (GPC). PNEA and PNEA(50)mPh(50) matrices elicited varying levels of tissue responses during the 12-week implantation period. At 2 weeks both polymers evoked a moderate response, and by 12 weeks the response was found to be mild. However, PNEA(50)PhPh(50) elicited a mild response at the end of 2 weeks and demonstrated a further decreased inflammatory response after 12 weeks. The in vivo degradation of the polymers was followed by determining the molecular weights of the explanted polymer disks. PNEA and PNEA(50)mPh(50) disks showed significant decrease in molecular weight after 2 weeks of implantation. The molecular weights of PNEA and PNEA(50)mPh(50) residues could not be determined by GPC after 12 weeks of implantation because of almost complete degradation. On the other hand the in vivo degradation of PNEA(50)PhPh(50) was found to be slow, with a 63% loss in molecular weight in 12 weeks. Furthermore, this polymer maintained its shape and structure during the entire study. Thus, these polymers demonstrated excellent tissue compatibility and in vivo biodegradability and can be potential candidates for various biomedical applications.     

Nanofibers and nanoparticles for orthopaedic surgery applications

The ability of nanostructures to elicit altered cell behaviors, including cell adhesion, proliferation, orientation, motility, integrin expression, cytoskeletal organization, and modulation of intracellular signaling, has raised heightened interest in these materials for various biomedical applications, including orthopaedic repair and regeneration. Studies have demonstrated that nanofibrous structures can favorably modulate osteoblast, osteoclast, and fibroblast activities toward implant and/or scaffold materials. Nanomaterials based on silver nanoparticles have received significant attention. Apart from their unique wound-healing ability, silver nanoparticles also exhibit high antibacterial properties, making them potential candidates for use in the development of infection-resistant biomaterials.     

Pharmacological profile of antipsychotics at monoamine receptors: atypicality beyond 5-HT2A receptor blockade

Antipsychotic drugs (APD) are widely prescribed for the treatment of schizophrenia. The APD are differentiated into typical and atypical based on the lower incidence of extra-pyramidal side-effects associated with the newer atypical APD. It was suggested that atypicality may arise from an interaction with the 5-hydroxytryptamine (5-HT)(2) receptor and specifically on the 5-HT(2):dopamine D(2) affinity ratio. It is now realised that multiple subtypes of these receptors exist and that in addition, atypical APD interact with many monoamine receptors. The aim of the present study was to characterise the interaction of APD with a variety of monoamine receptors in terms of both affinity and efficacy. The data produced has highlighted that the atypical profile of APD such as olanzapine and clozapine may reflect antagonism of the 5-HT(2A) and 5-HT(2C) receptors, whilst that of, ziprasidone and quetiapine may reflect partial agonist activity at the 5-HT(1A) receptor, and that of aripiprazole may reflect partial agonist activity at the 5-HT(1A) receptor as well as is its claimed partial agonist activity at the dopamine D(2) receptor.     

Onset of myasthenia gravis in a patient affected by rheumatoid arthritis never treated with disease-modifying anti-rheumatic drugs.

We describe a patient affected by rheumatoid arthritis (RA) that developed myasthenia gravis (MG) after 20 years of illness. The peculiarity of this case concerns both the rare association between these diseases and the fact that the patients had never assumed disease modifying antirheumatic drugs. These treatments have been associated in some clinical reports with the onset of MG during the clinical course of RA. To our knowledge this is the first case described in medical literature up to now.     

Left-hemisphere processing of emotional connotation during word generation

Areas of the brain's left hemisphere involved in retrieving words with emotional connotations were studied with fMRI. Participants silently generated words from different semantic categories which evoked either words with emotional connotations or emotionally neutral words. Participants repeated emotionally neutral words as a control task. Compared with generation of emotionally neutral words, generation of words with emotional connotations engaged cortices near the left frontal and temporal poles which are connected to the limbic system. Thus, emotional connotations of words are processed in or near cortices with access to emotional experience.