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George E, Vassar R, Mogga A, Li Y, Norton ME, Gano D, Glenn OA. Spectrum of Fetal Intraparenchymal Hemorrhage in COL4A1/A2-Related Disorders. Pediatr Neurol 2023; 147:63-67. [PMID: 37562171 DOI: 10.1016/j.pediatrneurol.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND COL4A1/A2 variants affecting the alpha 1 and 2 chains of type IV collagen are increasingly recognized as a cause of fetal and neonatal intracranial hemorrhage, porencephaly, and schizencephaly. Fetal magnetic resonance imaging (MRI) findings in COL4A1/A2-related disorders are not well characterized. METHODS This is a retrospective case series of fetal MRI findings in eight patients with intraparenchymal hemorrhage (IPH) and COL4A1/A2 variants, five of whom have postnatal imaging and clinical follow-up. RESULTS IPH was multifocal and bilateral in four of eight patients. IPH involved the frontal lobes in all cases and basal ganglia in six of eight. The median maximum diameter of IPH was 16 mm (range 6 to 65 mm). All patients had ventriculomegaly, and four of eight had intraventricular hemorrhage. Prenatal IPH size correlated clinically with motor outcomes, and none had clinically symptomatic recurrent hemorrhage. CONCLUSION COL4A1/A2 variants can present with a spectrum of IPH prenatally, including small and/or unifocal IPH, as well as multifocal and bilateral IPH, involving the frontal lobes and basal ganglia. Given the wide spectrum of IPH severity seen on fetal brain MRI, genetic testing for COL4A1/A2 variants should be considered in all cases of fetal IPH.
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Affiliation(s)
- Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
| | - Rachel Vassar
- Department of Neurology, University of California San Francisco, San Francisco, California
| | | | - Yi Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Mary E Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Dawn Gano
- Departments of Neurology & Pediatrics, University of California San Francisco, San Francisco, California
| | - Orit A Glenn
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
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Fong N, Langnas E, Law T, Reddy M, Lipnick M, Pirracchio R. Availability of information needed to evaluate algorithmic fairness - A systematic review of publicly accessible critical care databases. Anaesth Crit Care Pain Med 2023; 42:101248. [PMID: 37211215 DOI: 10.1016/j.accpm.2023.101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Machine learning (ML) may improve clinical decision-making in critical care settings, but intrinsic biases in datasets can introduce bias into predictive models. This study aims to determine if publicly available critical care datasets provide relevant information to identify historically marginalized populations. METHOD We conducted a review to identify the manuscripts that report the training/validation of ML algorithms using publicly accessible critical care electronic medical record (EMR) datasets. The datasets were reviewed to determine if the following 12 variables were available: age, sex, gender identity, race and/or ethnicity, self-identification as an indigenous person, payor, primary language, religion, place of residence, education, occupation, and income. RESULTS 7 publicly available databases were identified. Medical Information Mart for Intensive Care (MIMIC) reports information on 7 of the 12 variables of interest, Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) on 7, COVID-19 Mexican Open Repository on 4, and eICU on 4. Other datasets report information on 2 or fewer variables. All 7 databases included information about sex and age. Four databases (57%) included information about whether a patient identified as native or indigenous. Only 3 (43%) included data about race and/or ethnicity. Two databases (29%) included information about residence, and one (14%) included information about payor, language, and religion. One database (14%) included information about education and patient occupation. No databases included information on gender identity and income. CONCLUSION This review demonstrates that critical care publicly available data used to train AI algorithms do not include enough information to properly look for intrinsic bias and fairness issues towards historically marginalized populations.
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Affiliation(s)
- Nicholas Fong
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States; School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Erica Langnas
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States; Philip R. Lee Institute for Health Policy Studies at UCSF, San Francisco, CA, United States; Center for Health Equity in Surgery and Anesthesia University of California San Francisco, San Francisco, CA, United States
| | - Tyler Law
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States; Center for Health Equity in Surgery and Anesthesia University of California San Francisco, San Francisco, CA, United States
| | - Mallika Reddy
- Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Michael Lipnick
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States; Center for Health Equity in Surgery and Anesthesia University of California San Francisco, San Francisco, CA, United States
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States; Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States.
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Inkster B, Kadaba M, Subramanian V. Understanding the impact of an AI-enabled conversational agent mobile app on users' mental health and wellbeing with a self-reported maternal event: a mixed method real-world data mHealth study. Front Glob Womens Health 2023; 4:1084302. [PMID: 37332481 PMCID: PMC10272556 DOI: 10.3389/fgwh.2023.1084302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Maternal mental health care is variable and with limited accessibility. Artificial intelligence (AI) conversational agents (CAs) could potentially play an important role in supporting maternal mental health and wellbeing. Our study examined data from real-world users who self-reported a maternal event while engaging with a digital mental health and wellbeing AI-enabled CA app (Wysa) for emotional support. The study evaluated app effectiveness by comparing changes in self-reported depressive symptoms between a higher engaged group of users and a lower engaged group of users and derived qualitative insights into the behaviors exhibited among higher engaged maternal event users based on their conversations with the AI CA. Methods Real-world anonymised data from users who reported going through a maternal event during their conversation with the app was analyzed. For the first objective, users who completed two PHQ-9 self-reported assessments (n = 51) were grouped as either higher engaged users (n = 28) or lower engaged users (n = 23) based on their number of active session-days with the CA between two screenings. A non-parametric Mann-Whitney test (M-W) and non-parametric Common Language effect size was used to evaluate group differences in self-reported depressive symptoms. For the second objective, a Braun and Clarke thematic analysis was used to identify engagement behavior with the CA for the top quartile of higher engaged users (n = 10 of 51). Feedback on the app and demographic information was also explored. Results Results revealed a significant reduction in self-reported depressive symptoms among the higher engaged user group compared to lower engaged user group (M-W p = .004) with a high effect size (CL = 0.736). Furthermore, the top themes that emerged from the qualitative analysis revealed users expressed concerns, hopes, need for support, reframing their thoughts and expressing their victories and gratitude. Conclusion These findings provide preliminary evidence of the effectiveness and engagement and comfort of using this AI-based emotionally intelligent mobile app to support mental health and wellbeing across a range of maternal events and experiences.
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Affiliation(s)
- Becky Inkster
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Wysa Inc., Boston, MA, United States
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Khanna RR, Murray SG, Wen T, Salmeen K, Illangasekare T, Benfield N, Adler-Milstein J, Savage L. Protecting reproductive health information in the post-Roe era: interoperability strategies for healthcare institutions. J Am Med Inform Assoc 2022; 30:161-166. [PMID: 36287823 PMCID: PMC9748529 DOI: 10.1093/jamia/ocac194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/12/2022] [Accepted: 10/07/2022] [Indexed: 12/15/2022] Open
Abstract
On June 24, 2022, the US Supreme Court ended constitutional protections for abortion, resulting in wide variability in access from severe restrictions in many states and fewer restrictions in others. Healthcare institutions capture information about patients' pregnancy and abortion care and, due to interoperability, may share it in ways that expose their providers and patients to social stigma and potential legal jeopardy in states with severe restrictions. In this article, we describe sources of risk to patients and providers that arise from interoperability and specify actions that institutions can take to reduce that risk. Institutions have significant power to define their practices for how and where care is documented, how patients are identified, where data are sent or hosted, and how patients are counseled, and thus should protect patients' privacy and ability to receive medical care that is safe and legal where it is performed.
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Affiliation(s)
- Raman R Khanna
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Sara G Murray
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Kirsten Salmeen
- Maternal Fetal Medicine, Kaiser Permanente, San Francisco, California, USA
| | - Tushani Illangasekare
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Nerys Benfield
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Julia Adler-Milstein
- Department of Medicine, UCSF, San Francisco, California, USA
- Center for Clinical Informatics and Improvement Research, UCSF, San Francisco, California, USA
| | - Lucia Savage
- Omada Health, Inc., San Francisco, California, USA
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Friedman AB, Bauer L, Gonzales R, McCoy MS. Prevalence of Third-Party Tracking on Abortion Clinic Web Pages. JAMA Intern Med 2022; 182:1221-1222. [PMID: 36074500 PMCID: PMC9459905 DOI: 10.1001/jamainternmed.2022.4208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
This cross-sectional study assesses how often third-party domains use tracking data from visitors to abortion clinic web pages.
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Affiliation(s)
- Ari B. Friedman
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lujo Bauer
- Carnegie Mellon CyLab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Rachel Gonzales
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Matthew S. McCoy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
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