Age-related macular degeneration (AMD) affects millions of people throughout the world. The intermediate stage may go undetected, as it typically is asymptomatic. However, the preferred practice ...patterns for AMD recommend identifying individuals with this stage of the disease to educate how to monitor for the early detection of the choroidal neovascular stage before substantial vision loss has occurred and to consider dietary supplements that might reduce the risk of the disease progressing from the intermediate to the advanced stage. Identification, though, can be time-intensive and requires expertly trained individuals.
To develop methods for automatically detecting AMD from fundus images using a novel application of deep learning methods to the automated assessment of these images and to leverage artificial intelligence advances.
Deep convolutional neural networks that are explicitly trained for performing automated AMD grading were compared with an alternate deep learning method that used transfer learning and universal features and with a trained clinical grader. Age-related macular degeneration automated detection was applied to a 2-class classification problem in which the task was to distinguish the disease-free/early stages from the referable intermediate/advanced stages. Using several experiments that entailed different data partitioning, the performance of the machine algorithms and human graders in evaluating over 130 000 images that were deidentified with respect to age, sex, and race/ethnicity from 4613 patients against a gold standard included in the National Institutes of Health Age-related Eye Disease Study data set was evaluated.
Accuracy, receiver operating characteristics and area under the curve, and kappa score.
The deep convolutional neural network method yielded accuracy (SD) that ranged between 88.4% (0.5%) and 91.6% (0.1%), the area under the receiver operating characteristic curve was between 0.94 and 0.96, and kappa coefficient (SD) between 0.764 (0.010) and 0.829 (0.003), which indicated a substantial agreement with the gold standard Age-related Eye Disease Study data set.
Applying a deep learning-based automated assessment of AMD from fundus images can produce results that are similar to human performance levels. This study demonstrates that automated algorithms could play a role that is independent of expert human graders in the current management of AMD and could address the costs of screening or monitoring, access to health care, and the assessment of novel treatments that address the development or progression of AMD.
Abstract Background: When left untreated, age-related macular degeneration (AMD) is the leading cause of vision loss in people over fifty in the US. Currently it is estimated that about eight million ...US individuals have the intermediate stage of AMD that is often asymptomatic with regard to visual deficit. These individuals are at high risk for progressing to the advanced stage where the often treatable choroidal neovascular form of AMD can occur. Careful monitoring to detect the onset and prompt treatment of the neovascular form as well as dietary supplementation can reduce the risk of vision loss from AMD, therefore, preferred practice patterns recommend identifying individuals with the intermediate stage in a timely manner. Methods: Past automated retinal image analysis (ARIA) methods applied on fundus imagery have relied on engineered and hand-designed visual features. We instead detail the novel application of a machine learning approach using deep learning for the problem of ARIA and AMD analysis. We use transfer learning and universal features derived from deep convolutional neural networks (DCNN). We address clinically relevant 4-class, 3-class, and 2-class AMD severity classification problems. Results: Using 5664 color fundus images from the NIH AREDS dataset and DCNN universal features, we obtain values for accuracy for the (4-,3-,2-) class classification problem of (79.4%, 81.5%, 93.4%) for machine vs. (75.8%, 85.0%, 95.2%) for physician grading. Discussion: This study demonstrates the efficacy of machine grading based on deep universal features/transfer learning when applied to ARIA and is a promising step in providing a pre-screener to identify individuals with intermediate AMD and also as a tool that can facilitate identifying such individuals for clinical studies aimed at developing improved therapies. It also demonstrates comparable performance between computer and physician grading.
Obstetrical hemorrhage remains a leading cause of maternal mortality worldwide. New concepts involving the pathophysiology of hemorrhage have been described and include early activation of both the ...protein C and fibrinolytic pathways. New strategies in hemorrhage treatment include the use of hemostatic resuscitation, although the optimal ratio to administer the various blood products is still unknown. Massive transfusion protocols involve the early utilization of blood products and limit the traditional approach of early massive crystalloid-based resuscitation. The evidence behind hemostatic resuscitation has changed in the last few years, and debate is ongoing regarding optimal transfusion strategies. The use of tranexamic acid, fibrinogen concentrates, and prothrombin complex concentrates has emerged as new potential alternative treatment strategies with improved safety profiles.
Theoretical models of episodic memory have proposed that retrieval depends on interactions between the hippocampus and neocortex, where hippocampal reinstatement of item-context associations drives ...neocortical reinstatement of item information. Here, we simultaneously recorded intracranial EEG from hippocampus and lateral temporal cortex (LTC) of epilepsy patients who performed a virtual reality spatial navigation task. We extracted stimulus-specific representations of both item and item-context associations from the time-frequency patterns of activity in hippocampus and LTC. Our results revealed a double dissociation of representational reinstatement across time and space: an early reinstatement of item-context associations in hippocampus preceded a later reinstatement of item information in LTC. Importantly, reinstatement levels in hippocampus and LTC were correlated across trials, and the quality of LTC reinstatement was predicted by the magnitude of phase synchronization between hippocampus and LTC. These findings confirm that episodic memory retrieval in humans relies on coordinated representational interactions within a hippocampal-neocortical network.
Amniotic fluid embolism: diagnosis and management Pacheco, Luis D., MD; Saade, George, MD; Hankins, Gary D.V., MD ...
American journal of obstetrics and gynecology,
08/2016, Letnik:
215, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Objective We sought to provide evidence-based guidelines regarding the diagnosis and management of amniotic fluid embolism. Study Design A systematic literature review was performed using MEDLINE, ...PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 through March 2015. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used for defining the strength of recommendations and rating quality of the evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. Results and Recommendations We recommend the following: (1) we recommend consideration of amniotic fluid embolism in the differential diagnosis of sudden cardiorespiratory collapse in the laboring or recently delivered woman (GRADE 1C); (2) we do not recommend the use of any specific diagnostic laboratory test to either confirm or refute the diagnosis of amniotic fluid embolism; at the present time, amniotic fluid embolism remains a clinical diagnosis (GRADE 1C); (3) we recommend the provision of immediate high-quality cardiopulmonary resuscitation with standard basic cardiac life support and advanced cardiac life support protocols in patients who develop cardiac arrest associated with amniotic fluid embolism (GRADE 1C); (4) we recommend that a multidisciplinary team including anesthesia, respiratory therapy, critical care, and maternal-fetal medicine should be involved in the ongoing care of women with AFE (Best Practice); (5) following cardiac arrest with amniotic fluid embolism, we recommend immediate delivery in the presence of a fetus ≥23 weeks of gestation (GRADE 2C); (6) we recommend the provision of adequate oxygenation and ventilation and, when indicated by hemodynamic status, the use of vasopressors and inotropic agents in the initial management of amniotic fluid embolism. Excessive fluid administration should be avoided (GRADE 1C); and (7) because coagulopathy may follow cardiovascular collapse with amniotic fluid embolism, we recommend the early assessment of clotting status and early aggressive management of clinical bleeding with standard massive transfusion protocols (GRADE 1C).
IntroductionAdolescence presents itself as a phase of life marked by rapid changes produced by different social contexts and in many cases, it can be configured in a stressful situation. The ...development of a psychosocial support network is of fundamental importance for adolescents to cope with the pressures of life in challenging situations. Many students, especially living in poor communities, face school problems especially because the curriculum fails to provide relevant knowledge to students in a way it can be meaningful and easier to be taught by teachers and learned by students. When students fail at school usually, they tend to blame themselves and as a result they may develop anxiety, social isolation and even depression.ObjectivesThrough the Bioecological Theory of Human Development, we sought to understand the psychosocial support networks of adolescents, whether or not experiencing school problems, considering this to be a challenging event.MethodsIn this research it was used the Five Fields Map, an instrument that evaluated the psychosocial support network for adolescents. The students with and without school problems filled the map in the beginning of the year and then at the end of the same year while facing a school problem as repeating the whole year because of insufficient grades.ResultsThe number of relationships between students facing and not facing school problems was not different, however, failing students had fewer relationships in the school-church Mesosystem, fewer relationships in the second and third levels in the first and second moments of data collection, and more relationships in level 5 in the second moment.SchoolHomeChurchPublic spacesRel.FactorRel.FactorRel.FactorRel.FactorControlBeginning565,2364,97336,3266,77Control End425,26334,94386,6206,7Total985,23694,97716,45466,74School problem Beginning575,52395,36106,3155,26School Problem End455,4315,67106,3105,6Total1025,47705,51206,3255,53TOTAL2005,31395,23916,37716,06ConclusionsBoth group of students showed great strength of proximity in their psychosocial support networks, indicating that it provided sufficient support so that the outcome of the failure experience was positive.Disclosure of InterestNone Declared
Introduction
Adolescence can be seen as a fundamental stage of life for the construction of the subject, resulting from childhood experiences and decisive for adulthood. It is common stressors to ...appear during adolescence, due to the lack of necessary resources to deal with a stressful problem or event. In this way, the evaluation of a stressful situation by the adolescent is important, because from it he will develop coping strategies that will help him to deal with the problem.
Stressful life experiences, whether important events or even common annoyances, threaten the adolescent’s well-being, in addition to being linked to mental health and behavior problems, both internalizing ones, such as isolation, somatic complaints and anxiety/depression, as well as externalizing factors such as breaking rules and aggressive behavior. Romantic relationships are related to a major source of stress in the lives of these young people when conflicts, jealousy, aggression and infidelity occur, and have a great impact on the mental health of the individuals involved. Breakups, for example, have been linked to the onset of clinical depression in adolescents.
There are three categories of concern for adolescents: (a) related to achievements, such as success in school or opportunity for success in the future; (b) relationships with colleagues or family members; and (c) social problems such as the environment, poverty and unemployment.
Objectives
To identify and describe stressful life events in adolescents from public schools in a poor community in Brazil.
Methods
The study included 64 adolescents, boys (51.56%) and girls (48.43%), aged between 12 and 16 years old (average 13.76%). The Adolescent Perceived Events Scale (APES) was used, which consists of 90 items that correspond to events that may occur in the adolescent’s daily life.
Results
The most significant stressors for the adolescents in this study were those dealing with the death of close people, such as a friend (100%), a family member (96.29%) and a relative (94.73%). Also appearing as major stressors were “plans that did not work” (91.89%), use of alcohol or drugs by family members (87.5%), loss of a job by parents (75%), imprisonment of a family member (75%), fights with boyfriend or girlfriend (86.66%), breakup (75%) and concern about their own appearance (76.52%).
Conclusions
Events referring to interpersonal relationships were considered the greatest stressors, with percentages above 80%. The present study contributed to the understanding of adolescents’ perceptions of their life events. In this way, we can understand the relationship between stressors and the coping strategies. Furthermore, it allows the proposition of preventive intervention strategies in the school context.
Disclosure of Interest
None Declared
IntroductionAutism can be described as a mental disorder that displays social interactions and communication impairments as well as a restricted range of activities or interests. Since autism is ...different for each individual, possible treatments are challenging and should consider individual characteristics at all times. Interactions with peers, family, and teachers are challenging for those with autism as they usually lack behaviors such as eye contact, playing, and talking with other people. It is common to observe sensorial issues as hypersensitivity in these individuals. Patients may have visual, auditive, or even tactile dysfunctions.Dir/Floortime is a comprehensive model that gives theoretical support and methodological approach to lead to development focusing on the development of individual capacities for sensorial organization, motor planning, language, and many abilities that provide a development trail that will help individuals to achieve essential milestones to infants and adolescents. The DIR/Floortime is based on the development as a lifespan event, individual differences, and relationships established with peers and any other people in the child´s context.ObjectivesThe aim of this study was to demonstrate that the DIR/Floortime is a comprehensive method of study and intervention since it matches all necessary characteristics to produce development.MethodsIt was performed a theoretic approach of both DIR/Floortime and Biological Theory of Human Development in search of basis in a contextualist theory to explain a practical method of intervention.ResultsPsychological theories about human development are important tools for understanding the way individuals interact with their context and produce changes in biopsychosocial characteristics. The Bioecological theory of Human Development is a contextualist theory that considers the interactions established between individuals through a model called PPCT, with their characteristics with people, objects, and symbols through interactions known as proximal processes, considered to be meaningful interactions, occurring frequently, through a long time.ConclusionsThe TBDH through the PPCT model can show that the DIR/Floortime presented itself as an efficient method for the treatment of autism since it considers the personal characteristics of the patients, especially their sensory and motor characteristics (Personal Characteristics such as Resource, Demand, and Force). This method has in significant interaction the most efficient way to produce development (equivalent to proximal Proximal Processes), takes into account the contexts where the developing individual attends, especially home, school and therapy, and has time as an essential factor for development to occur.Disclosure of InterestNone Declared
IntroductionChildren with Autism Spectrum Disorder (ASD) have a qualitative deficit in social interaction, engagement, and behavior. The DIR/Floortime model is one of the ways of intervention and is ...based on the child’s Functional Development, Individual differences, and Relationships. It aims to build the foundation for the social, emotional, and intellectual skills of children, instead of having the focus only on isolated behaviors. The model was developed by Stanley Greenspan and Serena Wieder in the United States and is the result of many years of observations and studies on child development since the 1950s. In the 1980s, they unified knowledge from several related studies on child development and mental health and recognized the importance of relationships and affection for learning. One of the considerations of the DIR/Floortime model on children with autism is the individual profile, that is, their individual differences (the I of the DIR). Each child has a unique way of perceiving the world (sight, sounds, touch) and responding to it. They may have difficulties in processing or responding to sensory information. Their individual differences need to be well known so that we can draw up a therapeutic plan to obtain the best developmental evolution.ObjectivesRecognize and analyze the individual differences of each child, so that the appropriate therapeutic plan can be traced for the development of their potential.MethodsParticipated in the study 63 children with ASD, 12 girls (19%) and 51 boys (81%). Global Development Assessment questionnaires were used, based on the FEDC and the FEAS scale of the DIR/Floortime.ResultsAll 63 children presented sensory alterations such as proprioceptive, visual, and vestibular search or hyper-reactivity, directly impacting abilities such as visuospatial processing and motor planning. In addition, 85% of children have low body tone. Regarding the sensory need for visual search, presented by 86% of the children, as well as the vestibular (90%), a recommended therapeutic strategy is mapping the place, with fewer objects. The therapist needs to be in a fixed position and maintain a pleasant, lower tone of voice. The routine framework for motor and action planning, anticipating, and giving the necessary waiting time for the child to get organized. Motor circuits can also help to work with the tone, as well as with praxis.ConclusionsThe DIR/Floortime model aims to make the child develop the ability to interact meaningfully and connect with the outside world. The individual differences of the child need to be known so that this work can take place effectively and so that the therapist can better organize the therapy, providing the best development for the child.Disclosure of InterestNone Declared
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