Predicting symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage with an artificial neural network in a pediatric population

PURPOSE: Artificial neural networks (ANN) are increasingly applied to complex medical problem solving algorithms because their outcome prediction performance is superior to existing multiple regression models. ANN can successfully identify symptomatic cerebral vasospasm (SCV) in adults presenting after aneurysmal subarachnoid hemorrhage (aSAH). Although SCV is unusual in children with aSAH, the clinical consequences are severe. Consequently, reliable tools to predict patients at greatest risk for SCV may have significant value. We applied ANN modeling to a consecutive cohort of pediatric aSAH cases to assess its ability to predict SCV. METHODS: A retrospective chart review was conducted to identify patients \u3c 21 years of age who presented with spontaneously ruptured, non-traumatic, non-mycotic, non-flow-related intracranial arterial aneurysms to our institution between January 2002 and January 2015. Demographics, clinical, radiographic, and outcome data were analyzed using an adapted ANN model using learned value nodes from the adult aneurysmal SAH dataset previously reported. The strength of the ANN prediction was measured between - 1 and 1 with - 1 representing no likelihood of SCV and 1 representing high likelihood of SCV. RESULTS: Sixteen patients met study inclusion criteria. The median age for aSAH patients was 15 years. Ten underwent surgical clipping and 6 underwent endovascular coiling for definitive treatment. One patient experienced SCV and 15 did not. The ANN applied here was able to accurately predict all 16 outcomes. The mean strength of prediction for those who did not exhibit SCV was - 0.86. The strength for the one patient who did exhibit SCV was 0.93. CONCLUSIONS: Adult-derived aneurysmal SAH value nodes can be applied to a simple AAN model to accurately predict SCV in children presenting with aSAH. Further work is needed to determine if ANN models can prospectively predict SCV in the pediatric aSAH population in toto; adapted to include mycotic, traumatic, and flow-related origins as well

Serving two masters: Methodism and the negotiation of masculinity in the antebellum South

This dissertation examines the development of a distinct southern Methodist masculinity from the 1830s to the 1860s. More than a church history, this study explores the relationship between non-religious and religious society, the tensions inherent in to relationship, and the ethical questions that emerged from that tension. As Methodism evolved in the South, it took on regional social practices and affectations while also maintaining a denominational identity that opposed southern culture. Southern Methodists served two masters—the church and society—and both demanded obedience to divergent visions of masculinity and manhood. Although they rejected many manly pursuits, ministers adopted a proslavery ideology and patriarchal practices and reflected southern attitudes in their church doctrine and structure. My study argues that the ethical shift that occurred in the southern Methodist Church in the 1840s resulted from the dual demands of southern and denominational culture, which led them to construct their own vision of masculine identity. This study uses the Methodist Church as an example of the friction caused and questions raised by the intersection of gender, religion, and ethics in a constricted, patriarchal society. (Published By University of Alabama Libraries