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OBJECTIVES As the performance of a conventional track and trigger system in a rapid response system has been unsatisfactory, we developed and implemented an artificial intelligence for predicting in-hospital cardiac arrest, denoted the deep learning-based early warning system. The purpose of this study was to compare the performance of an artificial intelligence-based early warning system with that of conventional methods in a real hospital situation. DESIGN Retrospective cohort study. SETTING This study was conducted at a hospital in which deep learning-based early warning system was implemented. PATIENTS We reviewed the records of adult patients who were admitted to the general ward of our hospital from April 2018 to March 2019. INTERVENTIONS The study population included 8,039 adult patients. A total 83 events of deterioration occurred during the study period. The outcome was events of deterioration, defined as cardiac arrest and unexpected ICU admission. We defined a true alarm as an alarm occurring withiThis study showed the potential and effectiveness of artificial intelligence in an rapid response system, which can be applied together with electronic health records. This will be a useful method to identify patients with deterioration and help with precise decision-making in daily practice.INTRODUCTION EEG monitoring is a critical tool for identifying cerebral ischemia during carotid endarterectomy (CEA). Quantitative EEG can be used to supplement visual EEG review, but which measures best predict post-clamp ischemia is unclear. PURPOSE To determine which quantitative EEG parameters reliably detect intraoperative ischemia during CEA. METHODS The authors identified patients who underwent carotid endarterectomy at Columbia University Medical Center from 2007 to 2014 with intraoperative EEG monitoring. Two masked physicians reviewed these EEGs retrospectively and determined whether there was post-clamp ischemia, categorizing patients into (1) ischemic-change and (2) no-ischemic-change groups. The authors then studied the performance of a battery of quantitative EEG measures (alpha, beta, theta, and delta power bands, alpha-delta ratio, beta-delta ratio, amplitude-integrated EEG, and 90% spectral edge frequency) against physician review as the gold standard. RESULTS Of 118 patients, 15 were included in the ischemic-change group and 103 in the no-ischemic-change group. Ipsilateral post-clamp trough values of all the quantitative EEG measures assessed were significantly decreased for patients in the ischemic-change group. Decreases in alpha, beta, and theta power of 52.1%, 41.6%, and 36.4% or greater, respectively, were most predictive of post-clamp ischemia. CONCLUSIONS Quantitative EEG monitoring during carotid endarterectomy, in addition to visual EEG monitoring, may improve the detection of cerebral ischemia and thus result in fewer perioperative strokes.OBJECTIVES neurologic adverse effects (NAE) induced by biotherapies have been reported in the literature mainly in adult patients with inflammatory bowel disease (IBD), rheumatic diseases or psoriasis. There are scant data in children. Aims of this study are to report and describe non-infective NAE associated with anti-TNFα antibodies in pediatric IBD, and to evaluate their incidence. METHODS we retrospectively collected all reports of NAE in pediatric IBD treated with anti-TNFα antibodies recorded in the French Pharmacovigilance Database. To estimate the national incidence of NAEs, we extrapolated data from the French regional Inception population-based cohort EPIMAD. RESULTS between 2000 and 2018, 231 adverse events in pediatric IBD exposed to anti-TNFα antibodies were reported to this Database. 17 NAE (7.36%) were collected 8 severe NAE (one demyelinating neuropathy, one optic neuritis, one acute transverse myelitis, one polyradiculoneuritis, one sensorineural hearing loss, one seizure, one stroke, and one glioma), 7 moderate NAE (headaches), and 2 neuropsychic events. The median delay between anti-TNFα start and NAE occurrence was 6 months (range 13 days to 26 months). In 10/17 patients, anti-TNFα antibodies were stopped. 9/17 patients had a complete resolution (including 2 severe NAE) and 8/17 a partial resolution (including 6 severe NAE). We estimate the incidence of severe NAE in pediatric IBD treated with anti-TNFα antibodies at 1 case for 10 000 patients-year in France. CONCLUSIONS NAE associated with anti-TNFα antibodies in pediatric IBD are rare. In severe NAE, we recommend to discontinuate anti-TNFα therapy and to consider alternative treatment.OBJECTIVE To quantify the differences in viscosity of over a range of commercial food based formulas and home prepared blenderized feeds used for enteral feeding in the clinical management of gastroesophageal reflux (GER) and GER-related aspiration in children with oropharyngeal dysphagia. METHODS The viscosity of commercial and home blends was measured using 1) digital rotational viscometer and 2) International Dysphagia Diet Standardization Initiative Syringe Flow Test. Additional testing was performed to determine the impact of added cereal, water flushes, and freezing/thawing on formula viscosity. RESULTS There were significant variations in viscosity between commercial blends with values ranging from extremely to mildly thick by Syringe Flow Test. The highest centipoise (cps) value was 13,847 and the lowest 330 and 438 cps. Dilution of 240 mL of commercial blend with 30 ml, 60 ml and 90 ml of water resulted in a decrease in viscosity of 31%, 62% and 85% respectively. Exposure to one freeze/thaw cycle decreased viscosity by as much as 59-80% depending on the blend. Thickening conventional pediatric formulas with rice or oatmeal did not achieve consistency equivalent to most blenderized feeds. CONCLUSIONS Commercial food-based formulas and home prepared blends vary greatly in viscosity, ranging from thin to extremely thick liquids, with the majority achieving viscosity greater than thickened formula. Viscosity is reduced by addition of free water and with freezing and thawing. Trastuzumab Emtansine order These data can inform the clinical choice of feeding regimen depending on the goals of nutritional therapy.
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