Individuals with HIV are at a higher risk of stroke compared to uninfected populations. The role of HIV-related immunosuppression in stroke mechanism is uncertain. Our aim is to test the hypothesis that stroke mechanisms among HIV+ individuals vary according to preceding CD4 counts. We carried out a retrospective chart review of inpatient admissions for ICD-9 defined ischemic events (TIA or stroke) in HIV+ individuals from 2002 to 2016 at a tertiary care center. Stroke mechanisms were ascertained based on radiographic and clinical presentation, and adjudicated by the treating team and confirmed separately by a vascular neurologist. Vascular risk factors, use of antiretroviral drugs (ARVs), nadir CD4 and current CD4 counts (cells/mm) were captured to build logistic regressions and generalized linear models to calculate the odds ratios (OR) and beta estimates with their respective 95% confidence intervals. We found that among 115 cases (median age 52, 64% men), stroke mechanisms were 22% due to large artery atherosclerosis (LAA), 17% small artery disease, 16% infectious, 8% cardioembolic, 21% cryptogenic, and 16% other etiologies. The median nadir CD4-count was 153 (IQR 22-274), and 312 (IQR 88-518) at the time of stroke, and 53% were on ARVs. LAA was more common with longer HIV infection (OR 1.1 per year, 1.0-1.2) and nadir CD4 counts <200 (OR 6.7, 1.4-31.9). Stroke due to LAA was associated with higher CD4 count the year prior to stroke (B = 0.009, P = 0.06 for the interaction) independent of CD4 nadir <200 (B = 1.88, P = 0.035). We concluded that in this sample, LAA was the most frequent stroke mechanism among HIV+ individuals with nadir CD4 < 200 but higher CD4 counts near the time of stroke. Determining the association between pre-stroke immune status and stroke mechanisms may allow a targeted approach to stroke prevention.
Disease-specific care cascades are important public health and organizational tools to characterize gaps in care and target resources, but they are labor-intensive to maintain. Using data available from the electronic medical record, we developed an algorithm with high accuracy for correctly representing an individual’s status in the hepatitis C virus care cascade.
Persons with severe motor impairments depend heavily upon caregivers for the performance of everyday tasks. Ongoing work is exploring the potential of giving motorimpaired users control of semi-autonomous assistive mobile manipulators to enable them to perform some self-care tasks such as scratching or shaving. Because these users are less able to escape a robot malfunction, or operate a traditional runstop, physical human-robot interaction poses safety risks. We review approaches to safety in assistive robotics with a focus on accessible run-stops, and propose wincing as an accessible gesture for activating a run-stop device. We also present the wouse, a novel device for detecting wincing from skin movement near the eye, consisting of optical mouse components mounted near a user's temple via safety goggles. Using this device, we demonstrate a complete system to run-stop a Willow Garage PR2 robot, and perform two preliminary user studies. The first study examines discrimination of wincing from self-produced facial expressions. The results indicate the possibility for discrimination, though variability between users and inconsistent detection of skin movement remain significant challenges. The second experiment examines discrimination of wincing from external mechanical manipulations of the face during self-care tasks. The results indicate that the wouse, using a classifier trained with data from the first experiment, can be used during face-manipulation tasks. The device produced no false positives, but succeeded in correctly identifying wincing events in only two of four subjects.
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