Effect of a Computer-Based Decision Support Intervention on Autism Spectrum Disorder Screening in Pediatric Primary Care Clinics: A Cluster Randomized Clinical Trial

Importance: Universal early screening for autism spectrum disorder (ASD) is recommended but not routinely performed. Objective: To determine whether computer-automated screening and clinical decision support can improve ASD screening rates in pediatric primary care practices. Design, Setting, and Participants: This cluster randomized clinical trial, conducted between November 16, 2010, and November 21, 2012, compared ASD screening rates among a random sample of 274 children aged 18 to 24 months in urban pediatric clinics of an inner-city county hospital system with or without an ASD screening module built into an existing decision support software system. Statistical analyses were conducted from February 6, 2017, to June 1, 2018. Interventions: Four clinics were matched in pairs based on patient volume and race/ethnicity, then randomized within pairs. Decision support with the Child Health Improvement Through Computer Automation system (CHICA) was integrated with workflow and with the electronic health record in intervention clinics. Main Outcomes and Measures: The main outcome was screening rates among children aged 18 to 24 months. Because the intervention was discontinued among children aged 18 months at the request of the participating clinics, only results for those aged 24 months were collected and analyzed. Rates of positive screening results, clinicians' response rates to screening results in the computer system, and new cases of ASD identified were also measured. Main results were controlled for race/ethnicity and intracluster correlation. Results: Two clinics were randomized to receive the intervention, and 2 served as controls. Records from 274 children (101 girls, 162 boys, and 11 missing information on sex; age range, 23-30 months) were reviewed (138 in the intervention clinics and 136 in the control clinics). Of 263 children, 242 (92.0%) were enrolled in Medicaid, 138 (52.5%) were African American, and 96 (36.5%) were Hispanic. Screening rates in the intervention clinics increased from 0% (95% CI, 0%-5.5%) at baseline to 68.4% (13 of 19) (95% CI, 43.4%-87.4%) in 6 months and to 100% (18 of 18) (95% CI, 81.5%-100%) in 24 months. Control clinics had no significant increase in screening rates (baseline, 7 of 64 children [10.9%]; 6-24 months after the intervention, 11 of 72 children [15.3%]; P = .46). Screening results were positive for 265 of 980 children (27.0%) screened by CHICA during the study period. Among the 265 patients with positive screening results, physicians indicated any response in CHICA in 151 (57.0%). Two children in the intervention group received a new diagnosis of ASD within the time frame of the study. Conclusions and Relevance: The findings suggest that computer automation, when integrated with clinical workflow and the electronic health record, increases screening of children for ASD, but follow-up by physicians is still flawed. Automation of the subsequent workup is still needed

PredNet and Predictive Coding: A Critical Review

PredNet, a deep predictive coding network developed by Lotter et al., combines a biologically inspired architecture based on the propagation of prediction error with self-supervised representation learning in video. While the architecture has drawn a lot of attention and various extensions of the model exist, there is a lack of a critical analysis. We fill in the gap by evaluating PredNet both as an implementation of the predictive coding theory and as a self-supervised video prediction model using a challenging video action classification dataset. We design an extended model to test if conditioning future frame predictions on the action class of the video improves the model performance. We show that PredNet does not yet completely follow the principles of predictive coding. The proposed top-down conditioning leads to a performance gain on synthetic data, but does not scale up to the more complex real-world action classification dataset. Our analysis is aimed at guiding future research on similar architectures based on the predictive coding theory

A szívinfarktusért felelős ér prognosztikus jelentőségének vizsgálata ST-elevációs szívinfarktusos betegekben | Prognostic significance of the culprit vessel in patients with ST-elevation myocardial infarction treated with primary coronary intervention

Absztrakt Bevezetés: A szívinfarktust okozó ér prognosztikai jelentőségére vonatkozóan kevés irodalmi adat áll rendelkezésre, különösen azokban az esetekben, amikor a betegeknél katéteres revascularisatio történt. Célkitűzés: A szerzők célul tűzték ki annak vizsgálatát, hogy a szívinfarktusért felelős érnek (culprit vessel) van-e prognosztikus jelentősége ST-elevációs myocardialis infarctusos betegekben, akiknél sikeres katéteres érmegnyitás (percutan coronariaintervenció) történt. Módszer: Retrospektív vizsgálatukban 10 763 beteg adatait elemezték. A szívinfarktusért felelős ér alapján négy betegcsoportot alakítottak ki: főtörzs, bal leszálló ág, bal körbefutó ág és jobb koszorúér. Az adatok értékelésekor egyváltozós túlélési görbéket konstruáltak, illetve elvégezték a túlélési idő többváltozós modellezését Cox-regresszióval, az életkor, a nem és a társbetegségek figyelembevételével. Eredmények: Leggyakrabban a bal leszálló ág (44,3%), ezt követte a jobb koszorúér (40,9%), majd a bal körbefutó ág (13,7%), míg a főtörzs 1%-ban volt felelős az infarktus kialakulásáért. Az egyéves túlélés szempontjából a szívinfarktusért felelős ér szignifikáns prognosztikai jelentőséggel bírt (p<0,0001): a jobb koszorúér esetén a hazard ratio 0,69 (95%-os CI: 0,61–0,79, p<0,0001), a főtörzs esetén 1,56 (95%-os CI: 1,04–2,35, p = 0,0321) volt a referenciaérhez (bal leszálló ág) viszonyítva. Következtetés: A vizsgálat eredményei igazolják a szívinfarktusért felelős ér prognosztikai jelentőségét. Orv. Hetil., 2016, 157(32), 1282–1288. | Abstract Introduction: To the best of the authors’ knowledge, very few publications are available which report on the prognostic significance of the culprit vessel in patients with ST elevation myocardial infarction treated with successful primary percutaneous coronary intervention. Aim: The aim of the authors was to obtain data on the significance of the culprit vessel in patients with ST elevation myocardial infarction treated successfully by primary percutaneous coronary intervention. Method: The authors performed a retrospective study in 10,763 patients with ST elevation myocardial infarction who underwent successful primary percutaneous coronary intervention. The culprit vessels were the left main artery, left anterior descendent artery, left circumflex artery, and right coronary artery. The authors constructed univariate survival curves for different culprit vessels and also performed multivariate modelling of time-to-death, controlling for age, sex, and comorbidities. Results: The majority of the culprit lesions were found in the left anterior descendent artery (44.3%), the right coronary artery (40.9%), and the left circumflex artery (13.7%). The culprit vessel was overall a highly significant (p<0.0001) factor of survival, with right coronary artery exhibiting a highly significantly better prognosis (hazard ratio 0.69, 95% CI 0.61–0.79, p<0.0001) and left main artery exhibiting a significantly worse prognosis (hazard ratio 1.56, 95% CI 1.04–2.35, p = 0.0321) than the reference vessel (left anterior descendent artery). Conclusion: These data demonstrate that the culprit vessel has independent prognostic significance. Orv. Hetil., 2016, 157(32), 1282–1288

Time domain classification of grasp and hold tasks

Brain-Computer Interfaces (BCIs) enable its users to interact with their environment only by thought. Earlier studies indicated [1, 2] that BCI might be a suitable method for controlling a neuroprostheses, which could assist people with spinal cord injuries (SCI) in their daily life. One drawback for the end user is that only simple motor imaginations (MI) are available for control e.g. MI of both feet to control ones arm is abstract and in contradiction to an associated natural movement. Therefore we are looking for means to design a more natural control modality. One promising scenario would be to use MI of different grasps to actually control different grasps of the neuroprosthesis. In this study we attempt to classify the execution of different grasp types in low-frequency time-domain EEG signals

Discriminating goal-directed from nongoal-directed movements and its potential impact for BCI control

Differences in the electroencephalographic (EEG) recordings between the execution of goal-directed and nongoal-directed movements have been recently shown in [1]. Such differences can be of interest for brain-computer interfaces (BCIs) control, when combined with information on the kinematic level (e.g. velocity decoding), since this combination mirrors the hierarchic way one plans a movement. In this study, we show that the time-domain differences between these movements are discriminable in a single-trial classification

Comparison of Risk of Recrudescent Fever in Children With Kawasaki Disease Treated With Intravenous Immunoglobulin and Low-Dose vs High-Dose Aspirin

Importance: Timely initiation of intravenous immunoglobulin plus aspirin is necessary for decreasing the risk of recrudescent fever and coronary artery abnormalities in children with Kawasaki disease (KD). The optimal dose of aspirin, however, remains unclear. Objective: To evaluate whether initial treatment with low-dose compared with high-dose aspirin in children with KD is associated with an increase in fever recrudescence. Design, Setting, and Participants: A retrospective cohort study of 260 children with KD at Riley Hospital for Children, Indianapolis, Indiana, between January 1, 2007, and December 31, 2018, was conducted. Children aged 0 to 18 years with a first episode of KD, identified by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes treated within 10 days of symptom onset with high-dose intravenous immunoglobulin plus aspirin were eligible. Patients who received an alternative diagnosis, experienced a second episode of KD, did not receive intravenous immunoglobulin plus aspirin for initial treatment, were not treated within 10 days of symptoms, or had incomplete records were excluded. Exposures: High-dose (≥10 mg/kg/d) or low-dose (<10 mg/kg/d) aspirin therapy. Main Outcomes and Measures: The primary outcome was recrudescent fever necessitating retreatment of KD. The secondary outcomes were coronary artery abnormalities and hospital length of stay. Results: Among the 260 patients included, the median (interquartile range) age was 2.5 (1.6-4.3) years, 103 (39.6%) were girls, 166 (63.8%) were non-Hispanic white, 57 (21.9%) were African American, 22 (8.5%) were Asian, 11 (4.2%) were Hispanic, and 4 (1.5%) were of unknown race/ethnicity. One hundred-forty-two patients (54.6%) were treated with low-dose aspirin. There was no association between recrudescent fever and aspirin dose, with 39 children (27.5%) having recrudescent fever in the low-dose group compared with 26 children (22.0%) in the high-dose group (odds ratio [OR], 1.34; 95% CI, 0.76-2.37; P = .31), with similar results after adjusting for potential confounding variables (OR, 1.63; 95% CI, 0.89-2.97; P = .11). In a subset analysis of 167 children with complete KD, however, there was nearly a 2-fold difference in the odds of recrudescent fever with low-dose aspirin (OR, 1.87; 95% CI, 0.82-4.23; P = .14), although this difference did not reach statistical significance. In addition, no association was identified between treatment group and coronary artery abnormalities (low-dose, 7.4% vs high-dose, 9.4%; OR, 0.86; 95% CI, 0.48-1.55; P = .62) or median (interquartile range) length of stay (3 [3-5] days for both groups; P = .27). Conclusions and Relevance: In this study, low-dose aspirin for the initial treatment of children with KD was not associated with fever recrudescence or coronary artery abnormalities. Given the potential benefits, further study of low-dose aspirin to detect potentially clinically relevant outcome differences is warranted to inform treatment decisions and guideline development

Bleeding Risk, Physical Functioning, and Non-use of Anticoagulation Among Patients with Stroke and Atrial Fibrillation

Background: Atrial fibrillation (AF) is common among people with stroke. Anticoagulation medications can be used to manage the deleterious impact of AF after stroke, however may not be prescribed due to concerns about post-stroke falls and decreased functioning. Thus, the purpose of this study was to identify, among people with stroke and AF, predictors of anticoagulation prescription at hospital discharge. Methods: This is a secondary analysis of a retrospective cohort study of data retrieved via medical records, including: National Institutes of Health Stroke Scale score; Functional Independence Measure (FIM) motor score (motor or physical function); ambulation on 2nd day of hospitalization; Morse Falls Scale (fall risk); and HAS-BLED score (Hypertension; Abnormal renal and liver function; Stroke; Bleeding; Labile INRs; Elderly > 65; and Drugs or alcohol). Data analyses included bivariate comparisons between people with and without anticoagulation at discharge. Logistic-regression modeling was used to assess predictors of discharge anti-coagulation. Results: There were 334 subjects included in the analyses, average age was 75 years old. Anticoagulation was prescribed at discharge for 235 (70%) of patients. In the adjusted regression analyses, only the FIM motor score (adjusted OR = 1.015, 95%CI 1.001-1.028) and the HAS-BLED score (adjusted OR = 0.36, 95%CI 0.22-0.58) were significantly associated with anticoagulation prescription at discharge. Conclusion: It appears that in this sample, post-stroke anti-coagulation decisions appear to be made based on clinical factors associated with bleed risk and motor deficits or physical functioning. However, opportunities may exist for improving clinician documentation of specific reasoning for non-anticoagulation prescription

Movements of the same upper limb can be classified from low-frequency time-domain EEG signals

Brain-computer interfaces (BCIs) can be used to control neuroprostheses of spinal cord injured (SCI) persons. A neuroprosthesis can restore different movement functions (e.g., hand open/close, supination/pronation etc.), and requires a BCI with a sufficiently high number of classes. However, sensorimotor rhythm-based BCIs can often only provide less than 3 classes, and new types of BCIs need to be developed. Since a couple of years, a new EEG feature has evolved: low-frequency time-domain signals. For example movement trajectories [1] and movement directions [2] were decoded using this feature. In the present study, we investigated whether low-frequency time-domain signals can also be used to classify several (executed) hand/arm movements of the same limb. A BCI relying on the imagination of such movements may be used to control a neuroprosthesis more naturally and provide a higher number of classes

A New Advanced Backcross Tomato Population Enables High Resolution Leaf QTL Mapping and Gene Identification.

Quantitative Trait Loci (QTL) mapping is a powerful technique for dissecting the genetic basis of traits and species differences. Established tomato mapping populations between domesticated tomato (Solanum lycopersicum) and its more distant interfertile relatives typically follow a near isogenic line (NIL) design, such as the S. pennellii Introgression Line (IL) population, with a single wild introgression per line in an otherwise domesticated genetic background. Here, we report on a new advanced backcross QTL mapping resource for tomato, derived from a cross between the M82 tomato cultivar and S. pennellii This so-called Backcrossed Inbred Line (BIL) population is comprised of a mix of BC2 and BC3 lines, with domesticated tomato as the recurrent parent. The BIL population is complementary to the existing S. pennellii IL population, with which it shares parents. Using the BILs, we mapped traits for leaf complexity, leaflet shape, and flowering time. We demonstrate the utility of the BILs for fine-mapping QTL, particularly QTL initially mapped in the ILs, by fine-mapping several QTL to single or few candidate genes. Moreover, we confirm the value of a backcrossed population with multiple introgressions per line, such as the BILs, for epistatic QTL mapping. Our work was further enabled by the development of our own statistical inference and visualization tools, namely a heterogeneous hidden Markov model for genotyping the lines, and by using state-of-the-art sparse regression techniques for QTL mapping