On the usage of health records for the design of virtual patients: a systematic review

BACKGROUND: The process of creating and designing Virtual Patients for teaching students of medicine is an expensive and time-consuming task. In order to explore potential methods of mitigating these costs, our group began exploring the possibility of creating Virtual Patients based on electronic health records. This review assesses the usage of electronic health records in the creation of interactive Virtual Patients for teaching clinical decision-making. METHODS: The PubMed database was accessed programmatically to find papers relating to Virtual Patients. The returned citations were classified and the relevant full text articles were reviewed to find Virtual Patient systems that used electronic health records to create learning modalities. RESULTS: A total of n = 362 citations were found on PubMed and subsequently classified, of which n = 28 full-text articles were reviewed. Few articles used unformatted electronic health records other than patient CT or MRI scans. The use of patient data, extracted from electronic health records or otherwise, is widespread. The use of unformatted electronic health records in their raw form is less frequent. Patient data use is broad and spans several areas, such as teaching, training, 3D visualisation, and assessment. CONCLUSIONS: Virtual Patients that are based on real patient data are widespread, yet the use of unformatted electronic health records, abundant in hospital information systems, is reported less often. The majority of teaching systems use reformatted patient data gathered from electronic health records, and do not use these electronic health records directly. Furthermore, many systems were found that used patient data in the form of CT or MRI scans. Much potential research exists regarding the use of unformatted electronic health records for the creation of Virtual Patients

Casebook: a virtual patient iPad application for teaching decision-making through the use of electronic health records

BACKGROUND: Virtual Patients are a well-known and widely used form of interactive software used to simulate aspects of patient care that students are increasingly less likely to encounter during their studies. However, to take full advantage of the benefits of using Virtual Patients, students should have access to multitudes of cases. In order to promote the creation of collections of cases, a tablet application was developed which makes use of electronic health records as material for Virtual Patient cases. Because electronic health records are abundantly available on hospital information systems, this results in much material for the basis of case creation. RESULTS: An iPad-based Virtual Patient interactive software system was developed entitled Casebook. The application has been designed to read specially formatted patient cases that have been created using electronic health records, in the form of X-ray images, electrocardiograms, lab reports, and physician notes, and present these to the medical student. These health records are organised into a timeline, and the student navigates the case while answering questions regarding the patient along the way. Each health record can also be annotated with meta-information by the case designer, such as insight into the thought processes and the decision-making rationale of the physician who originally worked with the patient. Students learn decision-making skills by observing and interacting with real patient cases in this simulated environment. This paper discusses our approach in detail. CONCLUSIONS: Our group is of the opinion that Virtual Patient cases, targeted at undergraduate students, should concern patients who exhibit prototypical symptoms of the kind students may encounter when beginning their first medical jobs. Learning theory research has shown that students learn decision-making skills best when they have access to multitudes of patient cases and it is this plurality that allows students to develop their illness scripts effectively. Casebook emphasises the use of pre-existing electronic health record data as the basis for case creation, thus, it is hoped, making it easier to produce cases in larger numbers. By creating a Virtual Patient system where cases are built from abundantly available electronic health records, collections of cases can be accumulated by institutions

The Ahlfors Lemma and Picard\u27s Theorems

The article introduces Ahlfors\u27 generalization of Schwarz\u27 lemma. With this powerful geometric tool of complex functions in one variable, we are able to prove some theorems concerning the size of images under holomorphic mappings, including celebrated Picard\u27s theorems. The article concludes with a brief insight into the theory of Kobayashi hyperbolic complex manifolds. Although this survey paper does not contain any new results, it may be useful for the beginner in complex analysis to better understands the concept of hyperbolicity in complex geometry

Master of Science

thesisTerm co-occurrence data has been extensively used in many applications ranging from information retrieval to word sense disambiguation. There are two major limitations of co-occurrence data. The first limitation is known as the data sparseness problem or the zero frequency problem: For a majority of pairs, the probability that they co-occur in even a large corpus is very small. The second limitation is that in co-occurrence data, each term is considered as a meaningless symbol, or in other words, terms do not have types, or any semantic relationships with other terms. In this paper, we introduce a novel approach to address these two limitations. We create concept aware co-occurrence data wherein each term is not a symbol, but an entry in a large-scale, data-driven semantic network. We show that with concepts or types, we are able to address the data sparseness problem through generalization. Furthermore, using concept co-occurrence, we show that our approach can benefit a large range of applications, including short text understanding

New effective results in the theory of the Riemann zeta-function

Results in the present thesis are divided into four groups and are mainly effective estimates for the Riemann zeta function $\zeta(s)$ and associated functions under the assumption of the (Generalized) Riemann Hypothesis. The first group of results consists of explicit and RH estimates for the moduli of $S(t)$, i.e., the argument of \zeta(1/2+\ie t), its antiderivative $S_1(t)$ and \zeta(1/2+\ie t). We follow techniques outlined by Selberg (1944), Fujii (2004, 2006) and Soundararajan (2009). The second group of results consists of explicit and RH estimates for $\log{\frac{1}{|\zeta(s)|}}$ and $\log{|\zeta(s)|}$ to the right of the critical line by following techniques developed by Titchmarsh (1927) while using also results from the first group. Moreover, we use these bounds to obtain effective and conditional estimates for the summatory function $M(x)$ of the M\"{o}bius function and for the number of $k$-free numbers. These estimates are of Titchmarsh's (1927) and Montgomery--Vaughan's (1981) strength, respectively. The third group of results consists of GRH estimates for $\left|\log{\mathcal{L}(s)}\right|$ and $\left|\left(\mathcal{L}'/\mathcal{L}\right)(s)\right|$ in the neighbourhood of the 1-line for functions in the Selberg class with a polynomial Euler product. The shape of these bounds are that of Littlewood (1912). We provide effective estimates for $\zeta(s)$, Dirichlet $L$-functions with primitive characters and Dedekind zeta-functions, together with an improvement over a particular estimate for $M(x)$ from the second group of results. The fourth group of results consists of effective and GRH estimates for $\left|\left(L'/L\right)(\sigma,\chi)\right|$ for Dirichlet $L$-functions with primitive characters $\chi$ modulo $q$, where $1/2+1/\log{\log{q}}\leq\sigma\leq 1-1/\log{\log{q}}$ and $\sigma=1$, by combining methods from Selberg (1944) and from the theory of bandlimited functions applied to the Guinand--Weil exact formula. We also provide effective and GRH estimate for \left|\left(\zeta'/\zeta\right)(1+\ie t)\right|

Indications of Linkage and Association of Gilles de la Tourette Syndrome in Two Independent Family Samples: 17q25 Is a Putative Susceptibility Region

Gilles de la Tourette syndrome (GTS) is characterized by multiple motor and phonic tics and high comorbidity rates with other neurobehavioral disorders. It is hypothesized that frontal-subcortical pathways and a complex genetic background are involved in the etiopathogenesis of the disorder. The genetic basis of GTS remains elusive. However, several genomic regions have been implicated. Among them, 17q25 appears to be of special interest, as suggested by various independent investigators. In the present study, we explored the possibility that 17q25 contributes to the genetic component of GTS. The initial scan of chromosome 17 performed on two large pedigrees provided a nonparametric LOD score of 2.41 near D17S928. Fine mapping with 17 additional microsatellite markers increased the peak to 2.61 (P=.002). The original families, as well as two additional pedigrees, were genotyped for 25 single-nucleotide polymorphisms (SNPs), with a focus on three genes in the indicated region that could play a role in the development of GTS, on the basis of their function and expression profile. Multiple three-marker haplotypes spanning all three genes studied provided highly significant association results (P<.001). An independent sample of 96 small families with one or two children affected with GTS was also studied. Of the 25 SNPs, 3 were associated with GTS at a statistically significant level. The transmission/disequilibrium test for a three-site haplotype moving window again provided multiple positive results. The background linkage disequilibrium (LD) of the region was studied in eight populations of European origin. A complicated pattern was revealed, with the pairwise tests producing unexpectedly high LD values at the telomeric TBCD gene. In conclusion, our findings warrant the further investigation of 17q25 as a candidate susceptibility region for GTS

Is it Living? Insights from Modeling Event-Oriented, Self-Motivated, Acting,Learning and Conversing Game Agents

A cognitive architecture is presented, which combines insights from artificial intelligence with cognitive psychology,biology, and linguistics. Using a Super Mario clone, we equipped the simulated agents with (i) motivational behavioral systems,(ii) reasoning and planning capabilities, (iii) event-based schema learning and sensorimotor exploration, and (iv) speech com-prehension and generation mechanisms. The motivational system activates goal events to maintain internal homeostasis. Toinvoke selected events, hierarchical action planning and control unfolds both on an event-schematic and a sensorimotor level.Schema learning is based on the detection of event changes, which are not predicted by the basic sensorimotor forward model.Language is comprehended and generated using context-free grammars linked to the schema-based knowledge structure. Thework offers an approach to develop and thus to ground conceptual, semantic world knowledge in sensorimotor interactions andto couple this knowledge with a language to generate and comprehend language about the agent’s virtual world meaningfully

Reconstruction of the mouse extrahepatic biliary tree using primary human extrahepatic cholangiocyte organoids

Treatment of common bile duct disorders such as biliary atresia or ischaemic strictures is limited to liver transplantation or hepatojejunostomy due to the lack of suitable tissue for surgical reconstruction. Here, we report a novel method for the isolation and propagation of human cholangiocytes from the extrahepatic biliary tree and we explore the potential of bioengineered biliary tissue consisting of these extrahepatic cholangiocyte organoids (ECOs) and biodegradable scaffolds for transplantation and biliary reconstruction in vivo. ECOs closely correlate with primary cholangiocytes in terms of transcriptomic profile and functional properties (ALP, GGT). Following transplantation in immunocompromised mice ECOs self-organize into tubular structures expressing biliary markers (CK7). When seeded on biodegradable scaffolds, ECOs form tissue-like structures retaining biliary marker expression (CK7) and function (ALP, GGT). This bioengineered tissue can reconstruct the wall of the biliary tree (gallbladder) and rescue and extrahepatic biliary injury mouse model following transplantation. Furthermore, it can be fashioned into bioengineered ducts and replace the native common bile duct of immunocompromised mice, with no evidence of cholestasis or lumen occlusion up to one month after reconstruction. In conclusion, ECOs can successfully reconstruct the biliary tree following transplantation, providing proof-of-principle for organ regeneration using human primary cells expanded in vitro

Anxiety and Depression in Adults with Autism Spectrum Disorder: A Systematic Review and Meta-analysis

Adults with autism spectrum disorder (ASD) are thought to be at disproportionate risk of developing mental health comorbidities, with anxiety and depression being considered most prominent amongst these. Yet, no systematic review has been carried out to date to examine rates of both anxiety and depression focusing specifically on adults with ASD. This systematic review and meta-analysis examined the rates of anxiety and depression in adults with ASD and the impact of factors such as assessment methods and presence of comorbid intellectual disability (ID) diagnosis on estimated prevalence rates. Electronic database searches for studies published between January 2000 and September 2017 identified a total of 35 studies, including 30 studies measuring anxiety (n = 26 070; mean age = 30.9, s.d. = 6.2 years) and 29 studies measuring depression (n = 26 117; mean age = 31.1, s.d. = 6.8 years). The pooled estimation of current and lifetime prevalence for adults with ASD were 27% and 42% for any anxiety disorder, and 23% and 37% for depressive disorder. Further analyses revealed that the use of questionnaire measures and the presence of ID may significantly influence estimates of prevalence. The current literature suffers from a high degree of heterogeneity in study method and an overreliance on clinical samples. These results highlight the importance of community-based studies and the identification and inclusion of well-characterized samples to reduce heterogeneity and bias in estimates of prevalence for comorbidity in adults with ASD and other populations with complex psychiatric presentations