No abstract

Evoking strength is one of the important contributions of the field of Biomedical Informatics to the discipline of Artificial Intelligence. The University at Buffalo's Orthopedics Department wanted to create an expert system to assist patients with self-diagnosis of knee problems and to thereby facilitate referral to the right orthopedic subspecialist. They had two independent sports medicine physicians review 469 cases. A board-certified orthopedic sports medicine practitioner, L.B., reviewed any disagreements until a gold standard diagnosis was reached. For each case, the patients entered 126 potential answers to 26 questions into a Web interface. These were modeled by an expert sports medicine physician and the answers were reviewed by L.B. For each finding, the clinician specified the sensitivity (term frequency) and both specificity (Sp) and the heuristic evoking strength (ES). Heuristics are methods of reasoning with only partial evidence. An expert system was constructed that reflected the posttest odds of disease-ranked list for each case. We compare the accuracy of using Sp to that of using ES (original model, < 0.0008; term importance * disease importance [DItimesTI] model, < 0.0001: Wilcoxon ranked sum test). For patient referral assignment, Sp in the DItimesTI model was superior to the use of ES. By the fifth diagnosis, the advantage was lost and so there is no difference between the techniques when serving as a reminder system.

Background Nonvalvular atrial fibrillation (NVAF) affects almost 6 million Americans and is a major contributor to stroke but is significantly undiagnosed and undertreated despite explicit guidelines for oral anticoagulation. Objective The aim of this study is to investigate whether the use of semisupervised natural language processing (NLP) of electronic health record’s (EHR) free-text information combined with structured EHR data improves NVAF discovery and treatment and perhaps offers a method to prevent thousands of deaths and save billions of dollars. Methods We abstracted 96,681 participants from the University of Buffalo faculty practice’s EHR. NLP was used to index the notes and compare the ability to identify NVAF, congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category (CHA2DS2-VASc), and Hypertension, Abnormal liver/renal function, Stroke history, Bleeding history or predisposition, Labile INR, Elderly, Drug/alcohol usage (HAS-BLED) scores using unstructured data (International Classification of Diseases codes) versus structured and unstructured data from clinical notes. In addition, we analyzed data from 63,296,120 participants in the Optum and Truven databases to determine the NVAF frequency, rates of CHA2DS2‑VASc ≥2, and no contraindications to oral anticoagulants, rates of stroke and death in the untreated population, and first year’s costs after stroke. Results The structured-plus-unstructured method would have identified 3,976,056 additional true NVAF cases (P<.001) and improved sensitivity for CHA2DS2-VASc and HAS-BLED scores compared with the structured data alone (P=.002 and P<.001, respectively), causing a 32.1% improvement. For the United States, this method would prevent an estimated 176,537 strokes, save 10,575 lives, and save >US $13.5 billion. Conclusions Artificial intelligence–informed bio-surveillance combining NLP of free-text information with structured EHR data improves data completeness, prevents thousands of strokes, and saves lives and funds. This method is applicable to many disorders with profound public health consequences.

Separation processes based on room temperature ionic liquids (RTIL) and electrochemical refining are promising strategies for the recoveryo fl anthanides from primary ores and electronic waste. However,t hey require the speciation of dissolved elements to be knownw ith accuracy. In the present study,E uc oordination and Eu III /Eu II electrochemical behavior as af unction of water contenti n1-ethyl-3methylimidazolium bis(trifluoromethylsulfonyl)imide ([EMIm] [NTf 2 ]) was investigatedu sing UV-visible spectrophotometry, time-resolvedl aser fluorescence spectroscopy,e lectrochemistry,a nd X-ray absorption spectroscopy. In situ measurements were performed in spectroelectrochemicalc ells. Undera nhydrous conditions, Eu III and Eu II were complexed by NTf 2 ,f orming EuÀOa nd EuÀ(N,O) bonds with the anion sulfoxide functiona nd Na toms, respectively.T his complexation resulted in agreater stabilityofEu II ,and in quasi-reversible oxidation-reduction with an E 0 'p otential of 0.18 V versust he ferrocenium/ferrocene (Fc + /Fc) couple. Upon increasingw ater content,p rogressivei ncorporation of water in the Eu III coordination sphereo ccurred. This led to reversible oxidation-reduction reactions, but also to ad ecreasei n stabilityo ft he + II oxidation state (E 0 ' = À0.45 Vv s. Fc + /Fc in RTIL containing 1300 mm water).

Based on our preceding studies on the aerodynamics of a falcoperegrinus in diving flight along a vertical dam it is known that even when the body shape of the bird is rather streamlined in V-shape some feathers tips may elevate in certain regions of the body. These regions were identified in wind tunnel tests for typical diving flight conditions as regions of locally separated flow. A life-size model in V-shape of a falcoperegrinus with artificial feathers fixed along the body was studied in a wind tunnel to focus on the fluid-structure interaction of feathers located in this sector. The distal ends of the feathers show flow-induced vibrations at typical flight conditions which grow linear in amplitude with increasing angle of incidence until incipient separation. In light of the proven existence of vibration-sensitive mechanoreceptors in the follicles of secondary feathers in birds it is hypothesized that this linear amplitude response offers the bird to sense the angle of incidence during the diving flight using the vibration magnitude as sensory stimulus. Thus the bird in streamlined shape has still a good measure to control its attitude to be in the narrow window of safe angle of incidence. This might have implications also for other birds or technical applications of airfoil sensors regarding incipient separation detection.