by
Ryan P. Barbaro;
Matthew L Paden;
Yigit S. Guner;
Lakshmi Raman;
Lindsay M. Ryerson;
Peta Alexander;
Viviane G. Nasr;
Melania M. Bembea;
Peter T. Rycus;
Ravi R. Thiagarajan
The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric extracorporeal life support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers. By 2015, that number grew to 2,992 cases in 227 centers, reflecting a 24% increase in patients and 55% growth in centers. ECLS delivered to neonates (0-28 days) for respiratory support was the largest subcategory of ECLS among children <18-years old. Overall, 48% of ECLS was delivered for respiratory support and 52% was for cardiac support or extracorporeal life support to support cardiopulmonary resuscitation (ECPR). During the study period, over half of children were supported on ECLS with centrifugal pumps (51%) and polymethylpentene oxygenators (52%). Adverse events including neurologic events were common during ECLS, a fact that underscores the opportunity and need to promote quality improvement work.
Substantial evidence indicates that youth physical fitness levels are an important marker of lifestyle and cardio-metabolic health profiles and predict future risk of chronic diseases. The reliability physical fitness tests have not been explored in Latino-American youth population. This study's aim was to examine the reliability of health-related physical fitness tests that were used in the Colombian health promotion "Fuprecol study". Participants were 229 Colombian youth (boys n = 124 and girls n = 105) aged 9 to 17.9 years old. Five components of health-related physical fitness were measured: 1) morphological component: height, weight, body mass index (BMI), waist circumference, triceps skinfold, subscapular skinfold, and body fat (%) via impedance; 2) musculoskeletal component: handgrip and standing long jump test; 3) motor component: speed/agility test (4x10 m shuttle run); 4) flexibility component (hamstring and lumbar extensibility, sit-and-reach test); 5) cardiorespiratory component: 20-meter shuttle-run test (SRT) to estimate maximal oxygen consumption. The tests were performed two times, 1 week apart on the same day of the week, except for the SRT which was performed only once. Intra-observer technical errors of measurement (TEMs) and inter-rater (reliability) were assessed in the morphological component. Reliability for the Musculoskeletal, motor and cardiorespiratory fitness components was examined using Bland-Altman tests. For the morphological component, TEMs were small and reliability was greater than 95% of all cases. For the musculoskeletal, motor, flexibility and cardiorespiratory components, we found adequate reliability patterns in terms of systematic errors (bias) and random error (95% limits of agreement). When the fitness assessments were performed twice, the systematic error was nearly 0 for all tests, except for the sit and reach (mean difference: -1.03% [95% CI = -4.35% to -2.28%]. The results from this study indicate that the "Fuprecol study" health-related physical fitness battery, administered by physical education teachers, was reliable for measuring health-related components of fitness in children and adolescents aged 9-17.9 years old in a school setting in Colombia.
The gold-standard measure of tic severity in tic disorders (TD), the Yale Global Tic Severity Scale (YGTSS), is a semistructured clinician-administered interview that can be time consuming and requires highly trained interviewers. Moreover, the YGTSS does not provide information regarding frequency and intensity of specific tics because all motor and all vocal tics are rated as a group. The aim of the present study is to describe and test the Adult Tic Questionnaire (ATQ), a measure for the assessment of tic severity in adults, and to report its preliminary psychometric properties. The ATQ is a brief self-report questionnaire that provides information regarding frequency, intensity, and severity of 27 specific tics. In addition, the ATQ produces total frequency, intensity, and severity scores for vocal and motor tics, as well as a global total tic severity score. Results showed that the ATQ demonstrated very good internal consistency and temporal stability. The total, vocal, and motor tic severity scales of the ATQ showed strong correlation with corresponding subscales of the YGTSS, indicating strong convergent validity. Weak correlations with measures of severity of obsessive-compulsive disorder and attention deficit/hyperactivity disorder, indicated strong discriminant validity. The ATQ, a promising measure for the assessment of tic severity in adults with TD, may be a valuable supplement to the current recommended assessment battery for TD. Furthermore, the ATQ enables clinicians and researchers to track changes in the frequency and intensity of specific tics, which is important given their complex and dynamic nature.
We discuss in this paper the validation of an open source framework for the solution of problems arising in hemodynamics. The proposed framework is assessed through experimental data for fluid flow in an idealized medical device with rigid boundaries and a numerical benchmark for flow in compliant vessels. The core of the framework is an open source parallel finite element library that features several algorithms to solve both fluid and fluid-structure interaction problems. The numerical results for the flow in the idealized medical device (consisting of a conical convergent, a narrow throat, and a sudden expansion) are in good quantitative agreement with the measured axial components of the velocity and pressures for three different flow rates corresponding to laminar, transitional, and turbulent regimes. We emphasize the crucial role played by the accuracy in performing numerical integration, mesh, and time step to match the measurements. The numerical fluid-structure interaction benchmark deals with the propagation of a pressure wave in a fluid-filled elastic tube. The computed pressure wave speed and frequency of oscillations, and the axial velocity of the fluid on the tube axis are close to the values predicted by the analytical solution associated with the benchmark. A detailed account of the methods used for both benchmarks is provided.
by
Julie A. Womack;
Terrence E. Murphy;
Harini Bathulapalli;
Kathleen M. Akgun;
Cynthia Gibert;
Ken M. Kunisaki;
David Rimland;
Maria Rodriguez-Barradas;
H. Klar Yaggi;
Amy C. Justice;
Nancy S. Redeker
by
Qiang Wen;
Benjamin Goldenson;
Serena J. Silver;
Monica Schenone;
Vladimir Dancik;
Zan Huang;
Ling-Zhi Wang;
Timothy Lewis;
W. Frank An;
Xiaoyu Li;
Mark-Anthony Bray;
Clarisse Thiollier;
Lauren Diebold;
Laure Gilles;
Martha S. Vokes;
Christopher B. Moore;
Meghan Bliss-Moreau;
Lynn VerPlank;
Nicola J. Tolliday;
William G Woods
The mechanism by which cells decide to skip mitosis to become polyploid is largely undefined. Here we used a high-content image-based screen to identify small-molecule probes that induce polyploidization of megakaryocytic leukemia cells and serve as perturbagens to help understand this process. Our study implicates five networks of kinases that regulate the switch to polyploidy. Moreover, we find that dimethylfasudil (diMF, H-1152P) selectively increased polyploidization, mature cell-surface marker expression, and apoptosis of malignant megakaryocytes. An integrated target identification approach employing proteomic and shRNA screening revealed that a major target of diMF is Aurora kinase A (AURKA). We further find that MLN8237 (Alisertib), a selective inhibitor of AURKA, induced polyploidization and expression of mature megakaryocyte markers in acute megakaryocytic leukemia (AMKL) blasts and displayed potent anti-AMKL activity in vivo. Our findings provide a rationale to support clinical trials of MLN8237 and other inducers of polyploidization and differentiation in AMKL.
by
Robert Ward;
Shiva Ponamgi;
Christopher DeSimone;
Stephen English;
David O Hodge;
Joshua P Slusser;
Jonathan Graff-Radford;
Alejandro A Rabinstein;
Sameul J Asirvatham;
David Holmes
Objective: To determine the utility of the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol concomitantly) and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age, Diabetes, previous Stroke/transient ischemic attack–VAScular disease) scores among patients on anticoagulation (AC) therapy for atrial fibrillation (AF) who have evidence of cerebral amyloid angiopathy (CAA). Patients and Methods: Patients older than 55 years with a diagnosis of AF who had a nontraumatic intracerebral hemorrhage (ICH) while on AC therapy between 1995 and 2016 were identified using the Rochester Epidemiology Project Database. Medical records were reviewed, including imaging of the brain, to identify baseline characteristics, AC use, and outcomes. Results: A total of 65 patients were identified (mean age, 81.3 years); 35 (53.8%) had evidence of possible/probable CAA. Mean HAS-BLED score in the CAA group was significantly lower (2.1) than that of the non-CAA group (2.9; P<.001). Mortality after ICH, adjusted for HAS-BLED scores, was not significantly different among patients with and without CAA. Sixteen patients restarted on AC therapy after ICH; CHA2DS2-VASc scores were no different between this group and those who were not restarted. Among patients with CAA, the overall rate of ICH recurrence was 8.6% over 93.5 person-years of follow-up. Among patients with CAA, the rate of ICH recurrence was 3.2 per 100 patient-years, higher than their HAS-BLED scores would predict (1.9 bleeds/100 patient-years). Conclusion: HAS-BLED scores were lower in patients who had evidence of CAA compared with those without, suggesting underestimation of ICH risk in patients with CAA. CHA2DS2-VASc scores did not affect resumption of AC therapy. ICH recurrence was higher in patients with CAA than their HAS-BLED scores predicted. Current risk assessment scoring systems do not accurately account for CAA in patients with AF on AC.
by
Liyong Lin;
Sheng Huang;
Minglei Kang;
Petri Hiltunen;
Reynald Vanderstraeten;
Jari Lindberg;
Sami Siljamaki;
Todd Wareing;
Ian Davis;
Allen Barnett;
John McGhee;
Charles B. Simone;
Timothy D. Solberg;
James E. McDonough;
Christopher Ainsley
AcurosPT is a Monte Carlo algorithm in the Eclipse 13.7 treatment planning system, which is designed to provide rapid and accurate dose calculations for proton therapy. Computational run-time in minimized by simplifying or eliminating less significant physics processes. In this article, the accuracy of AcurosPT was benchmarked against both measurement and an independent MC calculation, TOPAS. Such a method can be applied to any new MC calculation for the detection of potential inaccuracies. To validate multiple Coulomb scattering (MCS) which affects primary beam broadening, single spot profiles in a Solidwater® phantom were compared for beams of five selected proton energies between AcurosPT, measurement and TOPAS. The spot Gaussian sigma in AcurosPT was found to increase faster with depth than both measurement and TOPAS, suggesting that the MCS algorithm in AcurosPT overestimates the scattering effect. To validate AcurosPT modeling of the halo component beyond primary beam broadening, field size factors (FSF) were compared for multi-spot profiles measured in a water phantom. The FSF for small field sizes were found to disagree with measurement, with the disagreement increasing with depth. Conversely, TOPAS simulations of the same FSF consistently agreed with measurement to within 1.5%. The disagreement in absolute dose between AcurosPT and measurement was smaller than 2% at the mid-range depth of multi-energy beams. While AcurosPT calculates acceptable dose distributions for typical clinical beams, users are cautioned of potentially larger errors at distal depths due to overestimated MCS and halo implementation.
by
Stacy Cooper Bailey;
Guisselle A. Wismer;
Ruth M Parker;
Surrey M. Walton;
Alastair J.J. Wood;
Amisha Wallia;
Samantha A. Brokenshire;
Alexandra C. Infanzon;
Laura M. Curtis;
Mary J. Kwasny;
Michael S. Wolf
Background Patients with chronic conditions are often responsible for self-managing complex, multi-drug regimens with minimal professional clinical support. While numerous interventions to promote and support medication adherence have been tested, most have had limited success or have been too resource-intensive for real-world implementation. Objective To compare the effectiveness of multiple low-cost, technology-enabled strategies, alone and in combination, for promoting medication regimen adherence among older adults. Methods Older, English or Spanish-speaking patients on complex drug regimens (N = 1505) will be recruited from a community health system in Chicago, IL. Enrolled patients will be randomized to one of four study arms, receiving either: 1) enhanced usual care alone; 2) daily medication reminders via SMS text messages; 3) medication monitoring via a patient portal-based assessment; or 4) both SMS text message reminders and portal-based medication monitoring. The primary outcome of the study is medication adherence, which will be assessed via multiple measures at baseline, 2 months, and 6 months. The effect of intervention strategies on clinical markers (hemoglobin A1c, blood pressure, cholesterol level), as well as intervention fidelity and the barriers and costs of implementation will also be evaluated. Conclusions This randomized controlled trial will evaluate the impact of various low-cost intervention strategies on adherence to complex medication regimens and will explore barriers to implementation. If the studied intervention strategies are shown to be effective, then these approaches could be effectively deployed across a diverse range of clinical settings and patient populations. Clinical Trial Registration: This trial is registered on clinicaltrials.govNCT02820753.
Study Objectives: We examined associations between self-reports about typical sleep patterns and sleep data derived from a wearable device worn on a nightly basis for a prolonged period (mean = 214 nights). We hypothesized that sleep characteristics would correlate better across different methods of assessment (self-report versus wearable) than they would correlate within the same method, a classic psychometric approach (multitrait, multimethod matrix). Methods: A cross-national sample of 6,230 adult wearable users completed a brief sleep questionnaire collecting data on sleep duration and number of awakenings (NAW) and provided informed consent to link their responses to data from their wearable watches. The data collection for the wearable occurred over 12 months and the sleep questionnaire was completed subsequent to that. Results: Results indicated a large (r =. 615) correlation between sleep duration as assessed with the wearable and by self-report. A medium-to-large correlation (r =. 406) was also seen for NAW. The multitrait, multimethod matrix suggested minimal method variance, i.e. similar "traits"(sleep duration and NAW) correlated across methods but within a given method, and such "traits"were generally unrelated. Conclusions: The results suggest that the longer period of data collection with the wearable generates more stable estimates of sleep than have been reported in most studies of actigraphy. Alternatively, the data might imply that individuals modify their self-reports about sleep via daily feedback to align their perceptions to the output of the wearable.