Unsatisfactory outcomes in myasthenia gravis: influence by care providers

Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. ‘Unchanged', ‘worse', ‘exacerbation' and ‘died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P=0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P=0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcome

Developing Visual Accessibility Options to Empower Grade School Students in Designing Inclusive Mobile Applications

As technology becomes more available to the general public, it is important that it be as accessible as possible. Accessibility for mobile apps is crucial given how pervasive smartphone use has become. For students who use MIT App Inventor -- an online platform that enables users to make their own mobile apps -- part of being an effective app designer is to appreciate the importance and practice of inclusive design. I have empowered young students to make their apps more visually accessible by: (1) offering new options for larger text, higher contrast, and alternate text in App Inventor apps, (2) creating a curriculum for students aged 13-18 about the principles of visually accessible design, and (3) running the workshop three times and collecting student feedback on the curriculum. After the workshop, students reported a more accurate understanding of the nature of low vision as well as increased comfort with making visually accessible apps. Overall, this work has shown that it is both simple and effective to teach the principles of accessible design to students as young as middle-school age. The code changes have been added to MIT App Inventor and the curriculum is available on the App Inventor website.M.Eng

Long-term patterns of gender imbalance in an industry without ability or level of interest differences.

Female representation has been slowly but steadily increasing in many sectors of society. One sector where one would expect to see gender parity is the movie industry, yet the representation of females in most functions within the U.S. movie industry remain surprisingly low. Here, we study the historical patterns of female representation among actors, directors, and producers in an attempt to gain insights into the possible causes of the lack of gender parity in the industry. Our analyses reveals a remarkable temporal coincidence between the collapse in female representation across all functions and the advent of the Studio System, a period when the major Hollywood studios controlled all aspects of the industry. Female representation among actors, directors, producers and writers dropped to extraordinarily low values during the emergence and consolidation of the Studio System that in some cases have not yet recovered to pre-Studio System levels. In order to explore some possible mechanisms behind these patterns, we investigate the association between the gender balance of actors, writers, directors, and producers and a number of economic indicators, movie industry indicators, and movie characteristics. We find robust, strong, and significant associations which are consistent with an important role for the gender of decision makers on the gender balance of other industry functions. While in no way demonstrating causality, our findings add new perspectives to the discussions of the reasons for female under-representation in fields such as computer science and medicine, that have also experienced dramatic changes in female representation

Unsatisfactory outcomes in myasthenia gravis: influence by care providers.

Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. 'Unchanged', 'worse', 'exacerbation' and 'died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P = 0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P = 0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcomes

Marked hemiatrophy in carriers of Duchenne muscular dystrophy

OBJECTIVE: To describe the clinical and molecular genetic findings in 2 carriers of Duchenne muscular dystrophy (DMD) who exhibited marked hemiatrophy. Duchenne muscular dystrophy is an X-linked disorder in which affected male patients harbor mutations in the dystrophin gene. Female patients with heterozygous mutations may be manifesting carriers. DESIGN: Case study. SETTING: Neurology clinic. PATIENTS: Two manifesting carriers of DMD. INTERVENTIONS: Clinical and radiologic examinations along with histologic and molecular investigations. RESULTS: Both patients had marked right-sided hemiatrophy on examination with radiologic evidence of muscle atrophy and fatty replacement on the affected side. In each case, histologic analysis revealed a reduction in dystrophin staining on the right side. Genetic analysis of the dystrophin gene revealed a tandem exonic duplication in patient 1 and a multiexonic deletion in patient 2 with no further point mutations identified on the other chromosome. CONCLUSIONS: Marked hemiatrophy can occur in DMD manifesting carriers. This is likely to result from a combination of skewed X-inactivation and somatic mosaicism