Extracting Patient-Centered Outcomes from Clinical Notes in Electronic Health Records: Assessment of Urinary Incontinence After Radical Prostatectomy

Objective: To assess documentation of urinary incontinence (UI) in prostatectomy patients using unstructured clinical notes from Electronic Health Records (EHRs). Methods: We developed a weakly-supervised natural language processing tool to extract assessments, as recorded in unstructured text notes, of UI before and after radical prostatectomy in a single academic practice across multiple clinicians. Validation was carried out using a subset of patients who completed EPIC-26 surveys before and after surgery. The prevalence of UI as assessed by EHR and EPIC-26 was compared using repeated-measures ANOVA. The agreement of reported UI between EHR and EPIC-26 was evaluated using Cohen\u2019s Kappa coefficient. Results: A total of 4870 patients and 716 surveys were included. Preoperative prevalence of UI was 12.7 percent. Postoperative prevalence was 71.8 percent at 3 months, 50.2 percent at 6 months and 34.4 and 41.8 at 12 and 24 months, respectively. Similar rates were recorded by physicians in the EHR, particularly for early follow-up. For all time points, the agreement between EPIC-26 and the EHR was moderate (all p < 0.001) and ranged from 86.7 percent agreement at baseline (Kappa = 0.48) to 76.4 percent agreement at 24 months postoperative (Kappa = 0.047). Conclusions: We have developed a tool to assess documentation of UI after prostatectomy using EHR clinical notes. Our results suggest such a tool can facilitate unbiased measurement of important PCOs using real-word data, which are routinely recorded in EHR unstructured clinician notes. Integrating PCO information into clinical decision support can help guide shared treatment decisions and promote patient-valued care

A LAK of Direction Misalignment Between the Goals of Learning Analytics and its Research Scholarship

Learning analytics defines itself with a focus on data from learners and learning environments, with corresponding goals of understanding and optimizing student learning. In this regard, learning analytics research, ideally, should be characterized by studies that make use of data from learners engaged in education systems, should measure student learning, and should make efforts to intervene and improve these learning environments

Self-interest And Public Interest: The Motivations Of Political Actors

Self-Interest and Public Interest in Western Politics showed that the public, politicians, and bureaucrats are often public spirited. But this does not invalidate public-choice theory. Public-choice theory is an ideal type, not a claim that self-interest explains all political behavior. Instead, public-choice theory is useful in creating rules and institutions that guard against the worst case, which would be universal self-interestedness in politics. In contrast, the public-interest hypothesis is neither a comprehensive explanation of political behavior nor a sound basis for institutional design

Fabrication of biomolecule–copolymer hybrid nanovesicles as energy conversion systems

This work demonstrates the integration of the energy-transducing proteins bacteriorhodopsin (BR) from Halobacterium halobium and cytochrome c oxidase (COX) from Rhodobacter sphaeroides into block copolymeric vesicles towards the demonstration of coupled protein functionality. An ABA triblock copolymer-based biomimetic membrane possessing UV-curable acrylate endgroups was synthesized to serve as a robust matrix for protein reconstitution. BR-functionalized polymers were shown to generate light-driven transmembrane pH gradients while pH gradient-induced electron release was observed from COX-functionalized polymers. Cooperative behaviour observed from composite membrane functionalized by both proteins revealed the generation of microamp-range currents with no applied voltage. As such, it has been shown that the fruition of technologies based upon bio-functionalizing abiotic materials may contribute to the realization of high power density devices inspired by nature

Large scale outflows from z ~ 0.7 starburst galaxies identified via ultra-strong MgII quasar absorption lines

(Abridged) Star formation-driven outflows are a critical phenomenon in theoretical treatments of galaxy evolution, despite the limited ability of observations to trace them across cosmological timescales. If the strongest MgII absorption-line systems detected in the spectra of background quasars arise in such outflows, "ultra-strong" MgII (USMgII) absorbers would identify significant numbers of galactic winds over a huge baseline in cosmic time, in a manner independent of the luminous properties of the galaxy. To this end, we present the first detailed imaging and spectroscopic study of the fields of two USMgII absorber systems culled from a statistical absorber catalog, with the goal of understanding the physical processes leading to the large velocity spreads that define such systems. Each field contains two bright emission-line galaxies at similar redshift (dv < 300 km/s) to that of the absorption. Lower-limits on their instantaneous star formation rates (SFR) from the observed OII and Hb line fluxes, and stellar masses from spectral template fitting indicate specific SFRs among the highest for their masses at z~0.7. Additionally, their 4000A break and Balmer absorption strengths imply they have undergone recent (~0.01 - 1 Gyr) starbursts. The concomitant presence of two rare phenomena - starbursts and USMgII absorbers - strongly implies a causal connection. We consider these data and USMgII absorbers in general in the context of various popular models, and conclude that galactic outflows are generally necessary to account for the velocity extent of the absorption. We favour starburst driven outflows over tidally-stripped gas from a major interaction which triggered the starburst as the energy source for the majority of systems. Finally, we discuss the implications of these results and speculate on the overall contribution of such systems to the global SFR density at z~0.7.Comment: 15 pages, 6 figure, accepted for publication by MNRA

Spitzer Space Telescope observations of the Carina Nebula: The steady march of feedback-driven star formation

We report the first results of imaging the Carina Nebula with Spitzer/IRAC, providing a catalog of point sources and YSOs based on SED fits. We discuss several aspects of the extended emission, including dust pillars that result when a clumpy molecular cloud is shredded by massive star feedback. There are few "extended green objects" (EGOs) normally taken as signposts of outflow activity, and none of the HH jets detected optically are seen as EGOs. A population of "extended red objects" tends to be found around OB stars, some with clear bow-shocks. These are dusty shocks where stellar winds collide with flows off nearby clouds. Finally, the relative distributions of O stars and subclusters of YSOs as compared to dust pillars shows that while some YSOs are located within pillars, many more stars and YSOs reside just outside pillar heads. We suggest that pillars are transient phenomena, part of a continuous outwardly propagating wave of star formation driven by massive star feedback. As pillars are destroyed, they leave newly formed stars in their wake, which are then subsumed into the young OB association. Altogether, the current generation of YSOs shows no strong deviation from a normal IMF. The number of YSOs suggests a roughly constant star-formation rate over the past 3Myr, implying that star formation in pillars constitutes an important mechanism to construct unbound OB associations. Accelerated pillars may give birth to O-type stars that, after several Myr, could appear to have formed in isolation.Comment: 25 pages, 15 figures, MNRAS accepte

Extensive degeneracy, Coulomb phase and magnetic monopoles in an artificial realization of the square ice model

Artificial spin ice systems have been introduced as a possible mean to investigate frustration effects in a well-controlled manner by fabricating lithographically-patterned two-dimensional arrangements of interacting magnetic nanostructures. This approach offers the opportunity to visualize unconventional states of matter, directly in real space, and triggered a wealth of studies at the frontier between nanomagnetism, statistical thermodynamics and condensed matter physics. Despite the strong efforts made these last ten years to provide an artificial realization of the celebrated square ice model, no simple geometry based on arrays of nanomagnets succeeded to capture the macroscopically degenerate ground state manifold of the corresponding model. Instead, in all works reported so far, square lattices of nanomagnets are characterized by a magnetically ordered ground state consisting of local flux-closure configurations with alternating chirality. Here, we show experimentally and theoretically, that all the characteristics of the square ice model can be observed if the artificial square lattice is properly designed. The spin configurations we image after demagnetizing our arrays reveal unambiguous signatures of an algebraic spin liquid state characterized by the presence of pinch points in the associated magnetic structure factor. Local excitations, i.e. classical analogues of magnetic monopoles, are found to be free to evolve in a massively degenerated, divergence-free vacuum. We thus provide the first lab-on-chip platform allowing the investigation of collective phenomena, including Coulomb phases and ice-like physics.Comment: 26 pages, 10 figure

Improving the efficacy of cellular therapy by magnetic cell targeting

Poster presented at Biomedical Technology Showcase 2006, Philadelphia, PA. Retrieved 18 Aug 2006 from http://www.biomed.drexel.edu/new04/Content/Biomed_Tech_Showcase/Poster_Presentations/Barbee.pdf.The hot topic of stem cell research has raised hopes for new treatments for a breadth of ailments. As the expectations continue to mount, most related engineering research has been focused around new tools for isolation and propagation of cell lines, with inadequate attention to effective delivery strategies. Invasive or systemic injections come with increased risk and poor efficiency, often wasting a vast majority of the total cellular dosage. We present a method for magnetic targeting of cells in the body with the use of a two-source method of magnetic drug delivery proposed previously in the literature

An Analytic Model for the Evolution of the Stellar, Gas, and Metal Content of Galaxies

We present an analytic formalism that describes the evolution of the stellar, gas, and metal content of galaxies. It is based on the idea, inspired by hydrodynamic simulations, that galaxies live in a slowly-evolving equilibrium between inflow, outflow, and star formation. We argue that this formalism broadly captures the behavior of galaxy properties evolving in simulations. The resulting equilibrium equations for the star formation rate, gas fraction, and metallicity depend on three key free parameters that represent ejective feedback, preventive feedback, and re-accretion of ejected material. We schematically describe how these parameters are constrained by models and observations. Galaxies perturbed off the equilibrium relations owing to inflow stochasticity tend to be driven back towards equilibrium, such that deviations in star formation rate at a given mass are correlated with gas fraction and anti-correlated with metallicity. After an early gas accumulation epoch, quiescently star-forming galaxies are expected to be in equilibrium over most of cosmic time. The equilibrium model provides a simple intuitive framework for understanding the cosmic evolution of galaxy properties, and centrally features the cycle of baryons between galaxies and surrounding gas as the driver of galaxy growth.Comment: 11 pages, MNRAS, accepte

Radiation management and credentialing of fluoroscopy users

During the last 15 years, developments in X-ray technologies have substantially improved the ability of practitioners to treat patients using fluoroscopically guided interventional techniques. Many of these procedures require a greater use of fluoroscopy and more recording of images. This increases the potential for radiation-induced dermatitis and epilation, as well as severe radiation-induced burns to patients. Many fluoroscope operators are untrained in radiation management and do not realize that these procedures increase the risk of radiation injury and radiation-induced cancer in personnel as well as patients. The hands of long-time fluoroscope operators in some cases exhibit radiation damage—especially when sound radiation protection practices have not been followed. In response, the Center for Devices and Radiological Health of the United States Food and Drug Administration has issued an Advisory calling for proper training of operators. Hospitals and administrators need to support and enforce the need for this training by requiring documentation of credentials in radiation management as a prerequisite for obtaining fluoroscopy privileges. A concerted effort on the part of professional medical organizations and regulatory agencies will be required to train fluoroscopy users to prevent physicians from unwittingly imparting serious radiation injuries to their patients