Introduction: The growing Hispanic community faces disproportionate hardship due to lower financial capital and educational opportunity. The Hispanic health paradox refers to the finding that Hispanics tend to have better cardiovascular outcomes than non-Hispanics, despite facing greater hardships and more cardiovascular risk factors. Behavioral (e.g., sleep) and psychological (e.g., optimism) factors predict recovery after acute coronary syndrome events, but less is known about how these factors differ by ethnicity after cardiac arrest (CA). We tested demographic, psychological, behavioral, and recovery factors that may underlie the Hispanic health paradox among CA survivors. Hypothesis: We hypothesized that Hispanic vs. non-Hispanic cardiac arrest survivors would have lower income and education but would not differ in behavioral, psychological, and recovery factors. Methods: An observational cohort study, Psychological predictors of recovery after an Acute Cardiac Event (PACE) , enrolled 68 neurologically intact CA survivors admitted to NewYork-Presbyterian Hospital. At hospital discharge, self-reported demographic, psychological, behavioral, and recovery variables were assessed. Independent-samples t-tests of Hispanic vs. non-Hispanic CA survivors were conducted comparing income, education, posttraumatic stress symptoms, depression, negative affect, cardiac anxiety, optimism, positive affect, social support, sleep, physical activity, independent activities of daily living, and self-maintenance. Results: As hypothesized, Hispanic vs. non-Hispanic participants had lower income, Mann Whitney U = 99.00, z = -3.46, p < .01, and lower education, Mann Whitney U = 336.00, z = -2.65, p = .01. Unexpectedly, Hispanic patients reported greater cardiac anxiety M = 39.60, SD = 16.70) than non-Hispanic patients ( M = 30.29, SD = 11.67), t (66) = -2.722, p = .008. No other tested factors were significant, all p s ≥ .419. Conclusions: Cardiac anxiety is the only tested variable that differed by ethnicity. While Hispanic ethnicity may be protective for certain aspects of cardiovascular health, the present findings indicate that Hispanic CA survivors experience higher psychological distress, which itself is a known risk factor for poor health behaviors. Future research should assess potential drivers of cardiac anxiety (e.g., mistrust of healthcare system, poor patient-physician communication). Future intervention research should target heart-related fear during CA recovery.

The task of Outside Knowledge Visual Question Answering (OKVQA) requires an automatic system to answer natural language questions about pictures and images using external knowledge. We observe that many visual questions, which contain deictic referential phrases referring to entities in the image, can be rewritten as"non-grounded"questions and can be answered by existing text-based question answering systems. This allows for the reuse of existing text-based Open Domain Question Answering (QA) Systems for visual question answering. In this work, we propose a potentially data-efficient approach that reuses existing systems for (a) image analysis, (b) question rewriting, and (c) text-based question answering to answer such visual questions. Given an image and a question pertaining to that image (a visual question), we first extract the entities present in the image using pre-trained object and scene classifiers. Using these detected entities, the visual questions can be rewritten so as to be answerable by open domain QA systems. We explore two rewriting strategies: (1) an unsupervised method using BERT for masking and rewriting, and (2) a weakly supervised approach that combines adaptive rewriting and reinforcement learning techniques to use the implicit feedback from the QA system. We test our strategies on the publicly available OKVQA dataset and obtain a competitive performance with state-of-the-art models while using only 10% of the training data.

In this paper, we study the"stability"of machine learning (ML) models within the context of larger, complex NLP systems with continuous training data updates. For this study, we propose a methodology for the assessment of model stability (which we refer to as jitter under various experimental conditions. We find that model design choices, including network architecture and input representation, have a critical impact on stability through experiments on four text classification tasks and two sequence labeling tasks. In classification tasks, non-RNN-based models are observed to be more stable than RNN-based ones, while the encoder-decoder model is less stable in sequence labeling tasks. Moreover, input representations based on pre-trained fastText embeddings contribute to more stability than other choices. We also show that two learning strategies -- ensemble models and incremental training -- have a significant influence on stability. We recommend ML model designers account for trade-offs in accuracy and jitter when making modeling choices.

Multi-lingual language models (LM), such as mBERT, XLM-R, mT5, mBART, have been remarkably successful in enabling natural language tasks in low-resource languages through cross-lingual transfer from high-resource ones. In this work, we try to better understand how such models, specifically mT5, transfer *any* linguistic and semantic knowledge across languages, even though no explicit cross-lingual signals are provided during pre-training. Rather, only unannotated texts from each language are presented to the model separately and independently of one another, and the model appears to implicitly learn cross-lingual connections. This raises several questions that motivate our study, such as: Are the cross-lingual connections between every language pair equally strong? What properties of source and target language impact the strength of cross-lingual transfer? Can we quantify the impact of those properties on the cross-lingual transfer? In our investigation, we analyze a pre-trained mT5 to discover the attributes of cross-lingual connections learned by the model. Through a statistical interpretation framework over 90 language pairs across three tasks, we show that transfer performance can be modeled by a few linguistic and data-derived features. These observations enable us to interpret cross-lingual understanding of the mT5 model. Through these observations, one can favorably choose the best source language for a task, and can anticipate its training data demands. A key finding of this work is that similarity of syntax, morphology and phonology are good predictors of cross-lingual transfer, significantly more than just the lexical similarity of languages. For a given language, we are able to predict zero-shot performance, that increases on a logarithmic scale with the number of few-shot target language data points.

Beginning in December 2019, a novel coronavirus, SARS-CoV-2 (COVID-19), began spreading rapidly throughout China and now is a global pandemic, with cases reported in over 192 countries and territories worldwide. Clinically, COVID-19 ranges from a mild, self-limiting respiratory illness to severe progressive pneumonia and multiorgan failure. The first COVID-19 case was reported at the beginning of March in New York City (NYC), and now just 3 weeks later, NYC and its suburbs have over 5% of global cases. Worldwide, there is a rapid increase in the number of cases daily, including the number of patients requiring hospitalization and intensive care support.

May 5, 2019April 9, 2019Free AccessAdmission Hemoglobin Level is Associated with Hematoma Expansion and Poor Outcome after Intracerebral Hemorrhage (S2.001)Jessica Magid-Bernstein, David Albers, Kevin Doyle, Eldad Hod, Andrew Eisenberger, Santosh Murthy, Soojin Park, Sachin Agarwal, E. Sander Connolly, Mitchell Elkind, Jan Claassen, and David RohAuthors Info & AffiliationsApril 9, 2019 issue92 (15_supplement)https://doi.org/10.1212/WNL.92.15_supplement.S2.001 Letters to the Editor

May, Teresa; Riker, Richard; Fraser, Gilles; Duarte, Christine; Agarwal, Sachin; Hirsh, Karen; Soreid, Eldar; Patel, Nainesh; Mooney, Michael; Friberg, Hans; Kent, David; Nielsen, Niklas; Seder, David Author Information

Background: Hemophilia A and Moyamoya have been associated with a rare genetic syndrome known as SHAM syndrome characterized by genetic deletions in Xq28 involving both F8 and BRCC3 genes. With a combined risk of both ischemic and hemorrhagic stroke, optimal treatment for this rare entity has not been adequately described. Case report: A 21-year-old Dominican man with severe hemophilia A (requiring scheduled factor VIII treatments), essential hypertension, skeletal dysplasia, and learning disability presented after losing consciousness. Upon awakening, he complained of severe headaches, had a systolic blood pressure of 270 mmHg and quickly progressed to coma. CT head revealed a right subdural hematoma with 9mm of midline shift. Desmopressin and factor VIII were administered followed by an urgent hemicraniectomy. Follow-up MRI/A brain imaging unexpectedly revealed bilateral intracranial carotid artery stenosis and extensive collateralization. Digital subtraction angiography confirmed the diagnosis of Moyamoya disease. His postoperative course was complicated by status epilepticus in addition to recurrent right frontal 100cc intracerebral hemorrhage requiring clot evacuation and lobectomy. Given his recurrent hemorrhage, a factor VIII infusion was started at 3.5IU/kg/hr for 5 days with transition back to 3 times a day dosing with no further hemorrhage or ischemia on follow-up stability imaging. Genetic testing was sent for SHAM syndrome. His clinical exam improved and he was eventually extubated and discharged to rehab with moderate left sided weakness. Conclusions: Genetic testing confirmed the presence of SHAM syndrome with an 83 kb deletion involving both F8 and BRCC3 genes responsible for severe hemophilia and Moyamoya disease respectively. This case illustrates the first phenotypically and genetically confirmed adult case of SHAM syndrome with intracerebral hemorrhage and highlights the utility/safety of factor VIII infusion in this case. Disclosure: Dr. Roh has nothing to disclose. Dr. Roth has nothing to disclose. Dr. Al-Mufti has nothing to disclose. Dr. Chung has nothing to disclose. Dr. Connolly has nothing to disclose. Dr. Eisenberger has nothing to disclose. Dr. Park has nothing to disclose. Dr. Claassen has received personal compensation for activities with the JSMF Foundation, Actelion, and SAGE Pharmaceutical. Dr. Agarwal has nothing to disclose.

Objective. We sought to determine EEG and multimodality monitoring parameters that best correlate with behavioral assessments of poor grade patients with acute brain injury. Background. Behavioral assessments of consciousness carry tremendous significance in guiding management, but are challenging in acutely brain-injured patients. Design/Methods. EEG, invasive multimodality monitoring brain monitoring, and behavioral assessments were collected during daily interruption of sedation in a consecutive series of 102 poor grade adults with brain hemorrhages. All patients were initially comatose and had invasive brain monitoring placed. Behavioral assessments were categorized into three groups: (1) comatose, (2) eye opening or attending towards a stimulus, and (3) command following. EEG features included power spectral density, permutation entropy, weighted pairwise phase consistency, weighted symbolic mutual information, and phase-amplitude coupling. Comparisons were made using bootstrapping methods and partial least squares regression. Results. We identified 464 artifact free EEG clips following behavioral assessments during daily interruption of sedation: 78 comatose, 246 with eye opening/attending, and 140 following commands. Using a linear model, spectral power in different frequency bands (theta, alpha, and gamma), alpha phase consistency in central and parieto-occipital regions, as well as permutation entropy best predicted the clinical state. Brain physiology measurements of intracranial pressure, cerebral blood flow, brain oxygen tension, and cerebral metabolism assessed using invasive multimodality monitoring only added marginal predictive accuracy to the model. Conclusion. EEG measures may complement the behavioral assessment of unconscious patients with brain hemorrhages shortly after injury.

Background: Platelet-rich plasma (PRP) has shown remarkable beneficial effects without any major adverse reactions in the treatment of androgenic alopecia. The growth factors in activated autologous PRP induce the proliferation of dermal papilla cells. Objectives: The objective was to investigate the clinical efficacy of PRP in treatment of androgenic alopecia. Materials and Methods: Ten patients were given autologous PRP injections on the affected area of alopecia over a period of 3 months at interval of 2-3 weeks and results were assessed. Results: Three months after the treatment, the patients presented clinical improvement in the hair counts, hair thickness, hair root strength, and overall alopecia. Conclusion: PRP appears to be a cheap, effective, and promising therapy for androgenic alopecia with no major adverse effects.

Objectives: Withdrawal of life-sustaining therapy (WLST) is the most common cause of death following cardiac arrest (CA). A well-described “self-fulfilling prophecy” exists, in which a poor exam often prompts WLST. The prognostic value of the neurological exam at various time points, in the absence of WLST, remains unknown. Methods: All patients (N=291) treated at Columbia University with therapeutic hypothermia (TH) following CA between May 2007 and February 2015 were identified. Neurological exams were documented at admission, 72 hours, five days and seven days after arrest. Glasgow coma motor scores (GCS-motor) no better than extensor posturing, bilaterally absent pupillary light response and bilaterally absent corneal reflexes were considered poor exams. Patients were excluded if the cause of death was WLST (n=125) or they died despite full support prior to 7 days (n=70). A cerebral performance score (CPC) at hospital discharge of 3-5 was considered a bad outcome. False positive rates (FPRs) in percentages were calculated. Results: A total of 96 patients were analyzed (average age 59±17 years, 40% female, 91% with pre-hospitalization CPC 1-2, bystander CPR in 69%, initial rhythm of VT/FT in 41%, mean ROSC 19±15 minutes). Sixty-one percent of patients had a poor outcome. GCS-motor was associated with a poor outcome, with FPRs of 36.3% (21-63.6), 29.4% (15.7-47.7), 11.8% (3.8-28.4) and 10.8% (3.5-26.4) at admission, 72 hours, five days and seven days respectively. Bilaterally absent corneal reflexes had FPRs of 29.2% (13.4-51.3), 26.3% (10.1-51.4), 5.3% (0.3-28.1) and 0% (0-18.5). Bilaterally absent pupillary response had the lowest FPRs at 8.3% (2.2-23.6), 0% (0-13.3), 0% (0-14.1), and 0% (0-13.7). Conclusion: A poor neurological exam remains a significant predictor of poor outcome following cardiac arrest. In the setting of TH, the pupillary exam reaches 100% specificity at 72 hours, while the GCS-motor and corneal reflex have unacceptably high rates of good outcomes despite poor exams. They become more specific over time, suggesting that patients may benefit from delaying prognostication until at least five days after arrest.

The paper proposed a methodology to rank the attributes of any product which is beneficial in product design and development. The paper is accomplish with a survey which is conducted to know the required customer choice, attributes preferences in the products. Suggested methodology help the enterprise to know the market demand, according to which product is to be manufactured to satisfy a mass marketing segment. Design and development of the product should mainly focus on those attributes which are as per the ranking of customer’s preferences. Changing requirement of the market, mass customization, timely response and customer satisfaction attributes are the main driving force for modularity concept. Fuzzy logic concept is used to address the uncertainty and imprecise decision in analysis of the attributes of the product. In order to meet the customer’s satisfaction it is presumed that the enterprise should be flexible to meet the rapid changes of the market demand.

Background and Purpose— The ABC/2 score estimates intracerebral hemorrhage (ICH) volume, yet validations have been limited by small samples and inappropriate outcome measures. We determined accuracy of the ABC/2 score calculated at a specialized reading center (RC-ABC) or local site (site-ABC) versus the reference-standard computed tomography–based planimetry (CTP). Methods— In Minimally Invasive Surgery Plus Recombinant Tissue-Type Plasminogen Activator for Intracerebral Hemorrhage Evacuation-II (MISTIE-II), Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR-IVH) and CLEAR-III trials. ICH volume was prospectively calculated by CTP, RC-ABC, and site-ABC. Agreement between CTP and ABC/2 was defined as an absolute difference up to 5 mL and relative difference within 20%. Determinants of ABC/2 accuracy were assessed by logistic regression. Results— In 4369 scans from 507 patients, CTP was more strongly correlated with RC-ABC ( r 2 =0.93) than with site-ABC ( r 2 =0.87). Although RC-ABC overestimated CTP-based volume on average (RC-ABC, 15.2 cm 3 ; CTP, 12.7 cm3), agreement was reasonable when categorized into mild, moderate, and severe ICH (κ=0.75; P <0.001). This was consistent with overestimation of ICH volume in 6 of 8 previous studies. Agreement with CTP was greater for RC-ABC (84% within 5 mL; 48% of scans within 20%) than for site-ABC (81% within 5 mL; 41% within 20%). RC-ABC had moderate accuracy for detecting ≥5 mL change in CTP volume between consecutive scans (sensitivity, 0.76; specificity, 0.86) and was more accurate with smaller ICH, thalamic hemorrhage, and homogeneous clots. Conclusions— ABC/2 scores at local or central sites are sufficiently accurate to categorize ICH volume and assess eligibility for the CLEAR-III and MISTIE III studies and moderately accurate for change in ICH volume. However, accuracy decreases with large, irregular, or lobar clots. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: MISTIE-II NCT00224770; CLEAR-III NCT00784134.

Considering a career in information technology, but don't know where to start? The new Information Technology is no longer only for geeks, math geniuses, or video game-obsessed nerds. The truth is, technology has now taken over everything in our lives and in doing so, it has created new jobs requiring a wide range of skills and abilities. You do not need a computer science degree to get an entry-level job in I.T. that pays well and offers benefits. You do not need any expensive certifications or courses. You need passion, ambition, this book to help you get started, lots of hard work and a bit of luck. This is the first of a series of books that explores the vast number of entry level jobs available within the growing, lucrative I.T. industry. In the first book, \"Is I.T. a Good Fit for You?\", learn the basic skill sets you'll need to break in to the field, as well as what you can expect to encounter in the way of industry culture, terminology, and career paths. Then, turn to subsequent books to learn the specific job requirements for such positions as developer, analyst, tester, and more. Need more information or encouragement before you dive in? Visit our website, (http://www.getITseries.com/), where we post more useful information, training links, articles and tips. Now go GET I.T. and see what a great career you've been missing!

Mobility impairments affect most multiple sclerosis (MS) patients (93%), yet many patients (~40%) “rarely or never” discuss trouble walking with a health care provider (HCP). To facilitate patient-HCP dialogue and early identification of mobility impairments, the Early Mobility Impairment Questionnaire (EMIQ) was developed based on qualitative research with patients diagnosed with MS and in collaboration with key opinion leaders. To minimize the burden associated with administration of the EMIQ, psychometric analyses were applied to the initial draft to produce a parsimonious yet robust instrument. The EMIQ’s psychometric performance was evaluated in a multi-center, prospective, observational study in subjects with an Expanded Disability Status Scale (EDSS) score of 2.0 to 6.0. Iterative exploratory factor analysis (EFA) was used to guide item reduction; subsequently, an item response theory (IRT) graded response model was applied to confirm the robustness of the instrument. Logistic regression analyses (using EDSS scores) were used to confirm discriminatory power. In total, 124 subjects with moderate MS (EDSS mean score = 4.2) were included in the study. Discriminant validity, factor analysis, and IRT modeling identified six items for reduction. The resulting 9-item scale had one strong underlying domain (first eigenvalue explained 60% of variance). The information curve showed sufficient sensitivity (I>3.3 for -2.6≤θ≤2.4) throughout the scale (mild to severe), with the most precise information provided at ½ SD above the mean (I=12 at θ=0.4). Logistic regression showed that the EMIQ was able to discriminate between patients with and without walking impairment (p<0.05). The psychometric analyses resulted in a streamlined scale that is appropriate for the screening of subjects experiencing early mobility impairments due to MS. In addition to a potential role in guiding clinical assessment and intervention, the EMIQ may also prove useful in the longitudinal assessment of mobility, as patients’ conditions decline.

OBJECTIVE: Describe a novel clinical association. BACKGROUND: Hemophagocytic Lymphohystiocytosis (HLH) is a rare, severe immune disorder that is rare in adults. Diagnosis is often challenging because symptoms of HLH can mimic other disorders; it may be diagnosed late during a hospital course, if at all. Symptoms of HLH include fever, pancytopenia, and multi-organ failure. Elevated ferritin levels and bone marrow biopsy demonstrating hemophagocytic cells are diagnostic. HLH may also present with central nervous system (CNS) symptoms that are indistinguishable from encephalitis. DESIGN/METHODS: We identified an index case (case 2 below) and subsequently performed a retrospective chart review of all adult cases meeting our definition of encephalitis admitted to Columbia University with bone marrow biopsy, and identified 1 additional case of HLH-associated encephalitis between 2010- 2013. RESULTS: Case 1: 63 year old man with history significant for rheumatoid arthritis presented with seizures, left-sided hemiplegia, deteriorating mental status and multifocal lesions on MRI. During his hospital course, he developed fever, coagulopathy, liver and respiratory failure. Bone and liver biopsy, elevated ferritin levels, and multi-organ failure confirmed HLH. Dexamethasone and cyclosporine were started and eventually, he was discharged to a long-term acute care facility. Case 2: 27 year old man with no significant past medical history presented with fever, myalgia and arthralgia. He subsequently developed refractory status epilepticus. During his course, he developed pancytopenia, renal, liver and respiratory failure. Evaluation for causes of encephalitis was negative; a bone marrow biopsy revealed HLH. He was started on methotrexate and etoposide, but died from malignant global cerebral edema. CONCLUSIONS: Both patients presented with encephalitis, fever, pancytopenia, and developed multi-organ failure; bone marrow biopsies were consistent with HLH. These cases suggest an association between idiopathic encephalitis and HLH with systemic involvement. HLH is a life-threatening disease, and in patients with a clinical diagnosis of encephalitis and evidence of multi-organ (especially bone marrow) failure, a bone marrow biopsy should be obtained for early diagnosis. Disclosure: Dr. Sheth has nothing to disclose. Dr. Meyers has nothing to disclose. Dr. Jongeling has nothing to disclose. Dr. Mayer has received personal compensation for activities with Actelion, Baxter, Biogen Idec, Codman/Johnson & Johnson Company, CSL Behring, Cornerstone Therapeutics, CR Bard, Novartis, Orsan Technologies, Pfizer Inc, Sage Therapeutics, and Stryker. Dr. Mayer has received research support from Non-Invasive Medical Systems, Inc., and General Electric. Dr. Agarwal has nothing to disclose. Dr. Claassen has nothing to disclose. Dr. Foreman has received research support from Pfizer Inc.