OBJECTIVES:To compare the incidence of delirium and early (at 1 week) postoperative cognitive dysfunction (POCD) between propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia with sevoflurane in adult patients undergoing elective coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). DESIGN:This was a prospective randomized single-blinded study. SETTING:The study was conducted at a single institution, the Sree Chitra Tirunal Institute for Medical Sciences and Technology, a tertiary care institution and university-level teaching hospital. PARTICIPANTS:Seventy-two patients undergoing elective CABG under CPB participated in this study. INTERVENTIONS:This study was conducted on 72 adult patients (>18 years) undergoing elective CABG under CPB who were randomized to receive propofol or sevoflurane. Anesthetic depth was monitored to maintain the bispectral index between 40 and 60. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Early POCD was diagnosed when there was a reduction of >2 points in the Montreal Cognitive Assessment score compared to baseline. Cerebral oximetry changes using near-infrared spectroscopy (NIRS), atheroma grades, and intraoperative variables were compared between the 2 groups. MEASUREMENTS & MAIN RESULTS:Seventy-two patients were randomized to receive propofol (n = 36) or sevoflurane (n = 36). The mean patient age was 59.4 ± 8.6 years. The baseline and intraoperative variables, including atheroma grades, NIRS values, hemoglobin, glycemic control, and oxygenation, were comparable in the 2 groups. Fifteen patients (21.7%) patients developed delirium, and 31 patients (44.9%) had early POCD. The incidence of delirium was higher with sevoflurane (n = 12; 34.2%) compared to propofol (n = 3; 8.8%) (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.13-2.62; p = 0.027)*. POCD was higher with sevoflurane (n = 20; 57.1%) compared to propofol (n = 11; 32.3%) (OR, 1.63; 95% CI, 1.01-2.62; p = 0.038)*. In patients aged >65 years, delirium was higher with sevoflurane (7/11; 63.6%) compared to propofol (1/7; 14.2%) (p = 0.03)*. CONCLUSIONS:Propofol-based TIVA was associated with a lower incidence of delirium and POCD compared to sevoflurane in this cohort of patients undergoing CABG under CPB. Large-scale, multicenter randomized trials with longer follow-up are needed to substantiate the clinical relevance of this observation.

ObjectiveDelirium and postoperative cognitive dysfunction (POCD) are major causes of morbidity after coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB). Anesthetic agents such as propofol and sevoflurane potentially have a role in pathogenesis of cognitive dysfunction. There is scarce literature comparing these two agents in CABG with CPB despite the relatively high incidence of cognitive dysfunction in this patient population. The authors compared the incidence of delirium and early POCD (at one week) between propofol-based TIVA and volatile anesthesia with sevoflurane in adult patients undergoing elective CABG with CPB.DesignA prospective randomized single blinded study.SettingThis study was conducted at a single institution (Sree Chitra Tirunal Institute for Medical Sciences and Technology, a Tertiary care Institute and a university level teaching hospital)ParticipantsSeventy two patients undergoing elective CABG under CPB participated in this study.InterventionsThis study was conducted on 72 adult patients (> 18 years) undergoing elective CABG under CPB who were randomised to receive propofol or sevoflurane. Anesthetic depth was monitored to maintain bispectral index between 40-60. Delirium was assessed using the Confusion-Assessment Method for the intensive care unit (CAM-ICU). Early POCD was diagnosed when there was a reduction of > 2 points in the Montreal Cognitive Assessment (MoCA) score compared to baseline. Cerebral oximetry changes using near infrared spectroscopy (NIRS), atheroma grades and intraoperative variables were compared between the two groups.Measurements & Main ResultsSeventy-two patients were randomised to receive propofol (36) or sevoflurane (36). The mean age was 59.4 years (SD 8.6 years). The baseline and intraoperative variables including atheroma grades, NIRS values, hemoglobin, glycemic control, oxygenation were comparable between the two groups. Fifteen (21.7%) patients developed delirium and 31 (44.9%) had early POCD. The incidence of delirium was higher with sevoflurane (12, 34.2%) compared to propofol (3, 8.8%), OR 1.72 (95% CI: 1.13-2.62), p 0.027*. POCD was higher with sevoflurane (20, 57.1%) compared to propofol (11,32.3%), OR 1.63 (95% CI: 1.01-2.62), p value 0.038*. In patients age > 65 years, delirium was higher with sevoflurane (7/11,63.6%) compared to propofol (1/7, 14.2%), p 0.03*.ConclusionsPropofol based TIVA was associated with a lower incidence of delirium and POCD compared to sevoflurane in this cohort of patients undergoing CABG under CPB. Large scale, multi-centre, randomized trials with longer follow-up duration are needed to substantiate the clinical relevance of this observation.

A 45-year-old man underwent mitral valve replacement with a #31 tilting disk mechanical prosthesis for severe mitral valve regurgitation secondary to infective endocarditis. After separation from cardiopulmonary bypass, transesophageal echocardiography demonstrated a normally functioning prosthesis without a paravalvular leak. The patient was taken to the intensive care unit after an uneventful surgery. A postoperative chest radiograph was taken in the intensive care unit with the head of the patient's bed elevated, during which we noticed several episodes of intermittent electromechanical dissociation (Fig 1). The electrocardiogram showed sinus rhythm, but the arterial and pulse oximetry waveforms indicated missed beats. A repeat transesophageal echocardiography showed an intermittent aberrant intravalvular jet. A suture tip was projecting into the prosthetic mitral valve minor orifice, preventing its closure. No left ventricular ejection occurred when the valve disk was stuck in the open position (Video 1). During the chest radiograph, hypovolemia in a sitting position was most likely responsible for the observed electromechanical dissociation. The decision was made to intervene only if the event recurred. Once the volume status was corrected, the electromechanical dissociation disappeared, probably resulting from the adequate separation of the suture tip from the tilting disc's motion path. No further episodes occurred during the remainder of the patient's postoperative course. Subsequent follow-up echocardiography also showed the normal function of the mechanical prosthesis. Electromechanical dissociation after mitral valve surgery has been reported as resulting from acute thrombus formation or valve impingement by the chordae tendineae, but our patient had a highly unusual presentation.1Kaur V Robertson MN Zamvar V. Mechanical prosthetic valve dysfunction causing pulsus alternans leading to intermittent electromechanical dissociation: A case report and literature review.J Card Surg. 2007; 22: 528-532Crossref PubMed Scopus (1) Google Scholar,2Abid I Vivek VP Koniparambil PU et al.Acute dysfunction of tilting disc valve after mitral valve replacement.Indian Heart J. 2018; 2: 218-220Google ScholarVideo 1Midesophageal left ventricular outflow tract long-axis view with color-flow Doppler for comparison. Between 0.2-to-0.3 seconds, the mitral valve remains stuck, probably secondary to a physical obstruction to the movement of the disc near the minor orifice by the suture (red circle).View Large Image Figure ViewerDownload Hi-res image Download (PPT) None. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4OWE3MzI1OTkxMGYzZjMzNDRjNTc2Y2Y0YzkwMjRiYyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNzAxMDA1NjA1fQ.NINgHg2V3mXlrB62Yz4nEt9LZZ8W5PNco2HX0unpV1MjOJEs0p7QQGlOo1BzjtyJdOlE-KO9mxHZqSu3ay6nlOYm3TfhR9pwvsGN_g3JyE5quw9iWGCVVFIRRqJEt40z3VGWZYgHWoDLfOnGLO1OEXZSdJzMkx_7Xy51f4h3DzNRm20xOw34H9K1-Rk4rRQdNeKByJtVRUvGeHzEtx1mOryQeYXD9ehKJEiTzHvc0sgosqtlZYC3GpdHuCQsZedlUoIaikzVlhpLaw8F686CJS3Ll41lKA8E0S6uE33q4CCMif-gQ1dgNZ64UG__4Zvpszy5pk6LCf1SjPUZmU-7qg Download .mp4 (4.31 MB) Help with .mp4 files

Two main hypotheses regarding the directional flow of visual information processing in the brain have been proposed: feed-forward (bottom-up) and re-entrant (top-down). Early theories espoused feed-forward principles in which processing was said to advance from simple to increasingly complex attributes terminating at a higher area where conscious perceptions occur. That view is disconfirmed by advances in neuroanatomy and neurophysiology, which implicate re-entrant two-way signaling as the predominant form of communication between brain regions. With some notable exceptions, the notion of re-entrant processing has had a relatively modest effect on computational models of perception and cognition, which continue to be predominantly based on feed-forward or within-level re-entrant principles. In the present work we describe five sets of empirical findings that defy interpretation in terms of feed-forward or within-level re-entrant principles. We conclude by urging the adoption of psychophysical, biological, and computational models based on cross-level iterative re-entrant principles.

Background:In a neonatal intensive care unit, streaming healthcare data comes from many sources, but humans are unable to understand relationships between data variables. Data mining and analysis are just beginning to get utilized in critical care. We present a case study using electronic medical record data in the neonatal intensive care unit and explore possible avenues of advancement using temporal data analytics.Case Presentation:Electronic medical record data were collected for physiological monitor data. Heart rate, respiratory rate, oxygen saturation and temperature data were retrospectively analyzed by temporal data mining. Three premature babies were selected and data de-identified. The first case of a urinary tract infection showed nursing ability to synthesize data streams coming from a patient. For the second case of necrotizing enterocolitis, Temporal-Data-Mining analysis of combinations of clinical events based on deviations from the mean showed specific heuristic biomarkers related to events before discovery of necrotizing enterocolitis. Specific sequences 6-event and 5-event in length were identified with nursing unease at clinical deterioration, which were 100- and 87-times unlikely to occur randomly with 99.5% confidence. No such sequences were found in the rest of the 37 days for the second case and entire 133 days of stay in the third case of an uneventful premature baby.Conclusion:Temporal data mining is a possible clinical tool in providing useful information in the neonatal intensive care unit for diagnosis of adverse clinical occurrences such as necrotizing enterocolitis. There is the possibility of changing the clinical paradigm of episodic watchfulness to constant vigilance using real-time data gathering.

Congenital long QT syndrome (LQTS) is a rare cardiac condition characterized by abnormality of either sodium or potassium ion channels resulting in prolongation of QT interval and thereby predisposing to life-threatening arrhythmia. Once the syndrome is diagnosed, measures should be taken to avoid sudden cardiac death. We present a rare case of LQTS associated with patent ductus arteriosus in a child, and a unique approach was used in managing both conditions.

PULMONARY ATRESIA with intact ventricular septum (PA-IVS) is a complex cyanotic congenital heart condition accounting for 3% of all congenital heart disease. 1 Anderson RH Anderson C Zuberbuhler JR Further morphologic studies on hearts with pulmonary atresia and intact ventricular septum. Cardiol Young. 1991; 1: 105-113 Crossref Scopus (34) Google Scholar This malformation is characterized by lack of egress from the right ventricle (RV) into the pulmonary trunk, along with varying degrees of tricuspid valve and RV hypoplasia. Coronary circulation abnormalities, such as ventriculo-coronary connections, coronary stenosis, or atresia, also can be associated with this complex cardiac anomaly. 2 Zuberbuhler JR Anderson RH. Morphological variations in pulmonary atresia with intact ventricular septum. Br Heart J. 1979; 41: 281-288 Crossref PubMed Scopus (98) Google Scholar ,3 Giglia TM Mandell VS Connor AR et al. Diagnosis and management of right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum. Circulation. 1992; 86: 1516-1528 Crossref PubMed Scopus (139) Google Scholar This case report describes intraoperative implications of ventriculo-coronary connection detected by transesophageal echocardiography (TEE) in a child with PA-IVS with functionally univentricular physiology undergoing stage- 2 palliation.

We present a method for fast inference in Capsule Networks (CapsNets) by taking advantage of a key insight regarding the routing coefficients that link capsules between adjacent network layers. Since the routing coefficients are responsible for assigning object parts to wholes, and an object whole generally contains similar intra-class and dissimilar inter-class parts, the routing coefficients tend to form a unique signature for each object class. For fast inference, a network is first trained in the usual manner using examples from the training dataset. Afterward, the routing coefficients associated with the training examples are accumulated offline and used to create a set of "master" routing coefficients. During inference, these master routing coefficients are used in place of the dynamically calculated routing coefficients. Our method effectively replaces the for-loop iterations in the dynamic routing procedure with a single matrix multiply operation, providing a significant boost in inference speed. Compared with the dynamic routing procedure, fast inference decreases the test accuracy for the MNIST, Background MNIST, Fashion MNIST, and Rotated MNIST datasets by less than 0.5% and by approximately 5% for CIFAR10.

Capsule Networks (CapsNet) use the Softmax function to convert the logits of the routing coefficients into a set of normalized values that signify the assignment probabilities between capsules in adjacent layers. We show that the use of Softmax prevents capsule layers from forming optimal couplings between lower and higher-level capsules. Softmax constrains the dynamic range of the routing coefficients and leads to probabilities that remain mostly uniform after several routing iterations. Instead, we propose the use of Max-Min normalization. Max-Min performs a scale-invariant normalization of the logits that allows each lower-level capsule to take on an independent value, constrained only by the bounds of normalization. Max-Min provides consistent improvement in test accuracy across five datasets and allows more routing iterations without a decrease in network performance. A single CapsNet trained using Max-Min achieves an improved test error of 0.20% on the MNIST dataset. With a simple 3-model majority vote, we achieve a test error of 0.17% on MNIST.

BackgroundAcute prosthetic valve dysfunction is a serious complication following valve replacement surgeries. Extrinsic prosthetic valve obstructions usually limit valve function, thus affecting cardiac output.Materials and methodsWe report a case of double valve replacements with mono leaflet tilting disc valves and tricuspid repair. Patient had normal prosthetic valve function in immediate post-operative period. She developed episodes of pulseless electrical activity with low cardiac output on the first post-operative day. Patient was re-explored with suspicion of valve dysfunction and pericardial effusion. Transesophageal echocardiogram showed intermittent extrinsic obstruction of mitral prosthesis.ResultsWe observe that acute prosthetic dysfunction can present with unexplained pulse less electrical activity and can be confirmed with transesophageal echocardiography.ConclusionElectro mechanical dissociation and low cardiac output following prosthetic valve replacement may be due to acute prosthetic dysfunction. A high index of suspicion and early intervention can be vital in such patients.

ObjectiveTo evaluate the feasibility of intraoperative real time three‐dimensional echocardiography (RT3DE) for identification and quantification of transient and persistent regional wall motion abnormalities (RWMAs) in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG).DesignA prospective observational studySettingSingle‐center study in an academic tertiary care hospitalParticipantsA series of 42 patients undergoing elective CABG over a 2‐year period were included.InterventionAfter induction of anesthesia, a comprehensive transesophageal echocardiography (TEE) examination was performed to evaluate regional wall motion using two‐dimensional wall motion score index (WMSI) and RT3D echocardiographic parameters at three specific time points during the operative phase.Measurements and main resultsThe 3D assessment of LV function was based on the quantification of change in LV chamber volume over time from each segment excursion. Patients were divided into two groups and subgroups based on TEE findings. There was significant mechanical dyssynchrony in patients with RWMAs (WMSI > 1; systolic dyssynchrony index [SDI] = 7.0 ± 3.66) as compared to the patients having normal wall motion (WMSI = 1; SDI = 2.0 ± 0.95; P = .001). Patients with contractile dysfunction were found to have low values of segmental excursion and high values of negative excursion on parametric imaging. Persistent RWMAs due to hibernating myocardium showed significant resolution of mechanical dyssynchrony after revascularization. Parametric imaging could detect transient RWMAs due to stunning and graft dysfunction. Early activating segments (EAS) on “timing bull's‐eye” may represent hypercontractile segments and may influence inotrope administration.ConclusionThe RT3DE is a valuable modality for precise quantification of regional wall motion during revascularization procedure.

Iatrogenic injury to the aortic valve is a rare but frequently reported complication during mitral valve surgeries. Intraoperative 2-dimensional transesophageal echocardiography (2D TEE) has a major impact in diagnosing these injuries, so that timely intervention is possible. However, 2D TEE has lot of limitations during the perioperative period, which can be overcome by the three dimensional echocardiography (3D-TEE). We report a case where 3D TEE has undoubtedly delineated the cause for distortion of aortic sinus after mitral valve replacement and helped in the successful outcome.

Stochastic Modeling and Analytics in Healthcare Delivery Systems, pp. 281-305 (2017) No Access11: Growth Curves of American Children Differ Significantly from CDC Reference StandardsXiang Zhong, Jingshan Li, Goutham Rao, and K. P. UnnikrishnanXiang ZhongDepartment of Industrial and Systems Engineering, University of Florida, Gainesville, FL 32611, USA, Jingshan LiDepartment of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA, Goutham RaoCenter for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL 60201, USA, and K. P. UnnikrishnanGlobal Data Insight and Analytics (GDIA), Ford Motor Company, Dearborn, MI, 48126, USAhttps://doi.org/10.1142/9789813220850_0011Cited by:0 PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail Abstract: Background: Anthropometric measurements such as weight, height (stature), and body mass index (BMI) provide reliable indicators of children's growth. The national standards in USA for these measurements are the 2000 Centers for Disease Control and Prevention (CDC) growth charts, which were generated using data from 1963 to 1994. In this paper, methodologies identical to that of the CDC were used to generate growth charts from more recent datasets. These charts, derived from both publically available and hospital system datasets, provide a glimpse of the current growth of American children. Methods: The datasets were from the National Health and Nutrition Examination Survey (NHANES) for years 1999 to 2010 and from NorthShore University HealthSystem's Enterprise Data Warehouse (NS-EDW) for years 2006 to 2012. The weight-for-age, stature-for-age, and BMI-for-age percentile curves and the associated L, M, and S parameters for both boys and girls aged 2–20 years were generated. A free-standing software program to achieve this was also created. Results: The weight and BMI percentile curves generated from NS-EDW and NHANES data differ substantially from the CDC percentile curves, while those for stature do not. The weight and BMI of children at each of the percentiles are significantly higher at all ages compared with the CDC reference standard curves. Conclusion: A software program that generates growth curves of any population of children using the CDC method was developed and successfully applied to two recent datasets. Meaningful comparisons between the growth curves generated from these datasets, and the CDC's reference curves were provided. These charts provided a visual representation of how dramatically the weight and BMI growth curves of today's children differ from the CDC's reference standard curves. FiguresReferencesRelatedDetails Stochastic Modeling and Analytics in Healthcare Delivery SystemsMetrics History PDF download

SUPERIOR SINUS VENOSUS atrial septal defect (SV-ASD) is an interatrial defect with partial anomalous pulmonary venous connection (PAPVC) draining into the right atrium (RA). The principle for SV-ASD surgical repair involves redirecting the pulmonary venous blood back to the left atrium and closure of the atrial septal defect without causing systemic venous and pulmonary venous obstruction. Closing the ASD with a single intracardiac patch that includes PAPVC can result in superior vena cava (SVC) or pulmonary vein obstruction. 1 Stewart R.D. Bailliard F. Kelle A.M. et al. Evolving surgical strategy for sinus venosus atrial septal defect: Effect on sinus node function and late venous obstruction. Ann Thorac Surg. 2007; 84: 1651-1655 Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar , 2 Okonta K.E. Tamatey M. Is double or single-patch for sinus venosus atrial septal defect repair the better option in prevention of postoperative venous obstruction?. Interact Cardiovasc Thorac Surg. 2012; 15: 900-903 Crossref PubMed Scopus (6) Google Scholar This has led to the evolution of other surgical options, such as double-patch repair and caval division repair (Warden’s procedure). In double-patch repair, an atriocavoplasty is done in addition to the intracardiac patch to augment the SVC, thus avoiding SVC stenosis. However, the atriocavoplasty across the SVC-RA junction may result in sinoatrial node dysfunction by disrupting the sinoatrial node or the sinoatrial node artery. To avoid the risk of sinoatrial node injury, caval division repair (Warden’s procedure) has evolved. The Warden procedure routes the proximal portion of the SVC (draining the anomalous pulmonary veins) through the atrial septal defect to the left atrium. The distal portion of the SVC is connected to the right atrial appendage to reestablish SVC blood flow to the right atrium.

Repeating patterns of precisely timed activity across a group of neurons called frequent episodes are indicative of networks in the underlying neural tissue. This letter develops statistical methods to determine functional connectivity among neurons based on nonoverlapping occurrences of episodes. We study the distribution of episode counts and develop a two-phase strategy for identifying functional connections. For the first phase, we develop statistical procedures that are used to screen all two-node episodes and identify possible functional connections edges. For the second phase, we develop additional statistical procedures to prune the two-node episodes and remove false edges that can be attributed to chains or fan-out structures. The restriction to nonoverlapping occurrences makes the counting of all two-node episodes in phase 1 computationally efficient. The second pruning phase is critical since phase 1 can yield a large number of false connections. The scalability of the two-phase approach is examined through simulation. The method is then used to reconstruct the graph structure of observed neuronal networks, first from simulated data and then from recordings of cultured cortical neurons.

Inferring the functional connectivity in a neural tissue by analyzing simultaneously recorded spike trains is an interesting, but challenging problem. Current techniques, based on cross-correlograms, principal component analysis, etc. are computationally intensive for discovering patterns of connectivity involving large number of neurons. We present temporal data mining techniques that overcome many of these difficulties. Multi-neuronal spike train data Multi-neuron spike train data is obtained from experiments using Micro-electrode arrays (MEAs) and imaging techniques with indicator dyes for ions like Ca2+. Cross-correlogram and PSTH reveal pair-wise interactions between spike trains of neurons. Such methods become computationally infeasible when extended to more than 3 or 4 neurons. Discovery vs. Search: Looking for (?→?→ . . .→?) The challenge is to discover all frequent/significant patterns in the data without exhaustive enumeration of all possibilities. No. of neurons No. of possible in a pattern (N) patterns 2 3,600 5 777,600,000 7 2,799,360,000,000 10 604,661,760,000,000,000 Table 1: Combinatorially possible patterns of size N neurons in a 60neuron system We present techniques that overcome this difficulty using principles of data mining and make discovery of higher order interactions feasible. Frequent Episode Discovery Framework In this framework, data is viewed as a sequence of time-ordered events. Episodes are time-constrained partially ordered sets of event types (AxxxBxxC). Figure 1: Spike train as event sequence for frequent episode discovery Serial Episode: ordered set of events (A→ C → B). Parallel Episode: events occur in any order (B C D). Figure 2: Occurrences of serial and parallel episodes Solving combinatorial explosion!!! In this approach the curse of dimensionality is overcome using a three fold approach. • Level-wise discovery: For large patterns, the number of candidates grows too fast. But we only want patterns which occur sufficiently often. Given size N frequent patterns, generate size N+1 candidate patterns that could be frequent. ( a ) Level-wise discovery ( b ) Efficient candidate generation Figure 3: Apriori-like mining of patterns • Frequency measure: Counting all possible occurrences is inefficient. We use non-overlapped count [1] as frequency and hence have efficient algorithms for frequent episode discovery. Figure 4: Efficient counting algorithm The runtimes for this class of automaton based algorithms scale linearly with data length i.e. O(N) where N is the number of spikes in the spike trains. • Temporal constraints: Still, we may come up with too many patterns because the discovery is totally unsupervised. We use temporal constraints as a handle to make the discovery efficient as well as to focus search on relevant patterns. See Figure 5. The serial episode mining can automatically select the appropriate inter-event intervals for consecutive events. Figure 5: Inter-event and expiry time constraints for serial and parallel episodes respectively Details of efficient algorithms for mining episodes with temporal constraints are given in [2]. Network structure through episodes

Anthropometric measurements such as weight, stature (height), and body mass index (BMI) provide reliable indicators of children's growth. The 2000 CDC growth charts are the national standards in the United States for these important measures. But these growth charts were generated using data from 1963-1994. To understand the growth patterns of US children since 1994, we generate weight-for-age, stature-for-age and BMI-for-age percentile curves for both boys and girls aged 2-20 through the methods used to generate the 2000 CDC growth charts. Our datasets are from the National Health and Nutrition Examination Survey (NHANES) for years 1999-2010 and and from NorthShore University HealthSystem's Enterprise Data Warehouse (NS-EDW) for years 2006-2012. The weight and BMI percentile curves generated from NS-EDW and NHANES data differ substantially from the CDC percentile curves, while those for stature do not differ substantially. We conclude that the population weight and BMI values of US children in recent years have increased significantly since 2000 and the 2000 CDC growth charts may no longer be applicable to the current population of US children. Our charts poignantly reveals the increasing obesity of American children.

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. The progression and severity of MS varies by individual, but it is generally a disabling disease. Although medications have been developed to slow the disease progression and help manage symptoms, MS research has yet to result in a cure. Early diagnosis and treatment of the disease have been shown to be effective at slowing the development of disabilities. However, early MS diagnosis is difficult because symptoms are intermittent and shared with other diseases. Thus most previous works have focused on uncovering the risk factors associated with MS and predicting the progression of disease after a diagnosis rather than disease prediction. This paper investigates the use of data available in electronic medical records (EMRs) to create a risk prediction model; thereby helping clinicians perform the difficult task of diagnosing an MS patient. Our results demonstrate that even given a limited time window of patient data, one can achieve reasonable classification with an area under the receiver operating characteristic curve of 0.724. By restricting our features to common EMR components, the developed models also generalize to other healthcare systems.