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Abratenko P, An R, Anthony J, Arellano L, Asaadi J, Ashkenazi A, Balasubramanian S, Baller B, Barnes C, Barr G, Basque V, Bathe-Peters L, Benevides Rodrigues O, Berkman S, Bhanderi A, Bhat A, Bishai M, Blake A, Bolton T, Book JY, Camilleri L, Caratelli D, Caro Terrazas I, Castillo Fernandez R, Cavanna F, Cerati G, Chen Y, Cianci D, Conrad JM, Convery M, Cooper-Troendle L, Crespo-Anadón JI, Del Tutto M, Dennis SR, Detje P, Devitt A, Diurba R, Dorrill R, Duffy K, Dytman S, Eberly B, Ereditato A, Evans JJ, Fine R, Fiorentini Aguirre GA, Fitzpatrick RS, Fleming BT, Foppiani N, Franco D, Furmanski AP, Garcia-Gamez D, Gardiner S, Ge G, Gollapinni S, Goodwin O, Gramellini E, Green P, Greenlee H, Gu W, Guenette R, Guzowski P, Hagaman L, Hen O, Hilgenberg C, Horton-Smith GA, Hourlier A, Itay R, James C, Ji X, Jiang L, Jo JH, Johnson RA, Jwa YJ, Kalra D, Kamp N, Kaneshige N, Karagiorgi G, Ketchum W, Kirby M, Kobilarcik T, Kreslo I, LaZur R, Lepetic I, Li K, Li Y, Lin K, Littlejohn BR, Louis WC, Luo X, Manivannan K, Mariani C, Marsden D, Marshall J, Martinez Caicedo DA, Mason K, Mastbaum A, McConkey N, Meddage V, Mettler T, Miller K, Mills J, Mistry K, Mogan A, Mohayai T, Moon J, Mooney M, Moor AF, Moore CD, Mora Lepin L, Mousseau J, Murphy M, Murrells R, Naples D, Navrer-Agasson A, Nebot-Guinot M, Neely RK, Newmark DA, Nowak J, Nunes M, Palamara O, Paolone V, Papadopoulou A, Papavassiliou V, Pate SF, Patel N, Paudel A, Pavlovic Z, Piasetzky E, Ponce-Pinto ID, Prince S, Qian X, Raaf JL, Radeka V, Rafique A, Reggiani-Guzzo M, Ren L, Rice LCJ, Rochester L, Rodriguez Rondon J, Rosenberg M, Ross-Lonergan M, Scanavini G, Schmitz DW, Schukraft A, Seligman W, Shaevitz MH, Sharankova R, Shi J, Sinclair J, Smith A, Snider EL, Soderberg M, Söldner-Rembold S, Spentzouris P, Spitz J, Stancari M, John JS, Strauss T, Sutton K, Sword-Fehlberg S, Szelc AM, Tang W, Terao K, Thorpe C, Totani D, Toups M, Tsai YT, Uchida MA, Usher T, Van De Pontseele W, Viren B, Weber M, Wei H, Williams Z, Wolbers S, Wongjirad T, Wospakrik M, Wresilo K, Wright N, Wu W, Yandel E, Yang T, Yarbrough G, Yates LE, Yu HW, Zeller GP, Zennamo J, Zhang C. Search for Neutrino-Induced Neutral-Current Δ Radiative Decay in MicroBooNE and a First Test of the MiniBooNE Low Energy Excess under a Single-Photon Hypothesis. PHYSICAL REVIEW LETTERS 2022; 128:111801. [PMID: 35363017 DOI: 10.1103/physrevlett.128.111801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
We report results from a search for neutrino-induced neutral current (NC) resonant Δ(1232) baryon production followed by Δ radiative decay, with a ⟨0.8⟩ GeV neutrino beam. Data corresponding to MicroBooNE's first three years of operations (6.80×10^{20} protons on target) are used to select single-photon events with one or zero protons and without charged leptons in the final state (1γ1p and 1γ0p, respectively). The background is constrained via an in situ high-purity measurement of NC π^{0} events, made possible via dedicated 2γ1p and 2γ0p selections. A total of 16 and 153 events are observed for the 1γ1p and 1γ0p selections, respectively, compared to a constrained background prediction of 20.5±3.65(syst) and 145.1±13.8(syst) events. The data lead to a bound on an anomalous enhancement of the normalization of NC Δ radiative decay of less than 2.3 times the predicted nominal rate for this process at the 90% confidence level (C.L.). The measurement disfavors a candidate photon interpretation of the MiniBooNE low-energy excess as a factor of 3.18 times the nominal NC Δ radiative decay rate at the 94.8% C.L., in favor of the nominal prediction, and represents a greater than 50-fold improvement over the world's best limit on single-photon production in NC interactions in the sub-GeV neutrino energy range.
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Zhao A, Larbi M, Miller K, O'Neill S, Jayasekera J. A scoping review of interactive and personalized web-based clinical tools to support treatment decision making in breast cancer. Breast 2022; 61:43-57. [PMID: 34896693 PMCID: PMC8669108 DOI: 10.1016/j.breast.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/20/2021] [Accepted: 12/04/2021] [Indexed: 01/28/2023] Open
Abstract
The increasing attention on personalized breast cancer care has resulted in an explosion of new interactive, tailored, web-based clinical decision tools for guiding treatment decisions in clinical practice. The goal of this study was to review, compare, and discuss the clinical implications of current tools, and highlight future directions for tools aiming to improve personalized breast cancer care. We searched PubMed, Embase, PsychInfo, Cochrane Database of Systematic Reviews, Web of Science, and Scopus to identify web-based decision tools addressing breast cancer treatment decisions. There was a total of 17 articles associated with 21 unique tools supporting decisions related to surgery, radiation therapy, hormonal therapy, bisphosphonates, HER2-targeted therapy, and chemotherapy. The quality of the tools was assessed using the International Patient Decision Aid Standard instrument. Overall, the tools considered clinical (e.g., age) and tumor characteristics (e.g., grade) to provide personalized outcomes (e.g., survival) associated with various treatment options. Fewer tools provided the adverse effects of the selected treatment. Only one tool was field-tested with patients, and none were tested with healthcare providers. Future studies need to assess the feasibility, usability, acceptability, as well as the effects of personalized web-based decision tools on communication and decision making from the patient and clinician perspectives.
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Capan M, Schubel LC, Pradhan I, Catchpole K, Shara N, Arnold R, Schwartz JS, Seagull J, Miller K. Display and perception of risk: Analysis of decision support system display and its impact on perceived clinical risk of sepsis-induced health deterioration. Health Informatics J 2022; 28:14604582211073075. [DOI: 10.1177/14604582211073075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite acknowledging the value of clinical decision support systems (CDSS) in identifying risk for sepsis-induced health deterioration in-hospitalized patients, the relationship between display features, decision maker characteristics, and recognition of risk by the clinical decision maker remains an understudied, yet promising, area. The objective of this study is to explore the relationship between CDSS display design and perceived clinical risk of in-hospital mortality associated with sepsis. The study utilized data collected through in-person experimental sessions with 91 physicians from the general medical and surgical floors who were recruited across 12 teaching hospitals within the United States. Results of descriptive and statistical analyses provided evidence supporting the impact of display configuration and clinical case severity on perceived risk associated with in-hospital mortality. Specifically, findings showed that a high level of information (represented by the Predisposition, Infection, Response and Organ dysfunction (PIRO) score) and Figure display (as opposed to Text or baseline) increased awareness to recognizing the risk for in-hospital mortality of hospitalized sepsis patients. A CDSS display that synthesizes the optimal features associated with information level and design elements has the potential to enhance the quantification and communication of clinical risk in complex health conditions beyond sepsis.
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Byer NW, Fountain ED, Reid BN, Miller K, Kulzer PJ, Peery MZ. Land use and life history constrain adaptive genetic variation and reduce the capacity for climate change adaptation in turtles. BMC Genomics 2021; 22:837. [PMID: 34794393 PMCID: PMC8603537 DOI: 10.1186/s12864-021-08151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid anthropogenic climate change will require species to adapt to shifting environmental conditions, with successful adaptation dependent upon current patterns of genetic variation. While landscape genomic approaches allow for exploration of local adaptation in non-model systems, most landscape genomics studies of adaptive capacity are limited to exploratory identification of potentially important functional genes, often without a priori expectations as to the gene functions that may be most important for climate change responses. In this study, we integrated targeted sequencing of genes of known function and genotyping of single-nucleotide polymorphisms to examine spatial, environmental, and species-specific patterns of potential local adaptation in two co-occuring turtle species: the Blanding's turtle (Emydoidea blandingii) and the snapping turtle (Chelydra serpentina). RESULTS We documented divergent patterns of spatial clustering between neutral and putatively adaptive genetic variation in both species. Environmental associations varied among gene regions and between species, with stronger environmental associations detected for genes involved in stress response and for the more specialized Blanding's turtle. Land cover appeared to be more important than climate in shaping spatial variation in functional genes, indicating that human landscape alterations may affect adaptive capacity important for climate change responses. CONCLUSIONS Our study provides evidence that responses to climate change will be contingent on species-specific adaptive capacity and past history of exposure to human land cover change.
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Steuber T, Maurer T, Miller K. [Metachronous oligometastatic prostate cancer-the more the better or only local treatment?]. Urologe A 2021; 60:1534-1545. [PMID: 34734294 DOI: 10.1007/s00120-021-01701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prostate cancer metastases may occur at diagnosis (de novo) or metachronous after treatment for localized disease. OBJECTIVE To describe location, prognosis, and individual treatment concepts for metachronous oligometastatic prostate cancer. MATERIALS AND METHODS Analysis of current treatment guidelines and literature for hormone sensitive, metachronous metastatic prostate cancer. RESULTS Modern imaging modalities lead to earlier diagnosis of metachronous oligometastatic prostate cancer, which offers the opportunity to develop metastasis-directed treatment concepts. Oligometastatic recurrence may occur in locoregional lymph nodes (N1) or as distant disease (M1). N1 disease is predominantly treated by salvage lymph node dissection or radiation. Distant metastasis may be radiated in order to delay systemic treatment. The combination of androgen deprivation and novel androgen receptor-targeted drugs such as apalutamide or enzalutamide are associated with a significant survival benefit compared to castration alone in bone or visceral oligometastatic metachronous disease. CONCLUSION Metachronous oligometastatic prostate cancer is heterogeneous with slow progression compared to men with high volume metastasis. Individual treatment concepts may decrease risk of progression and, thus, delay time to medical treatment. Multimodal approaches are currently being evaluated in clinical trials.
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Abratenko P, An R, Anthony J, Asaadi J, Ashkenazi A, Balasubramanian S, Baller B, Barnes C, Barr G, Basque V, Bathe-Peters L, Benevides Rodrigues O, Berkman S, Bhanderi A, Bhat A, Bishai M, Blake A, Bolton T, Book JY, Camilleri L, Caratelli D, Caro Terrazas I, Castillo Fernandez R, Cavanna F, Cerati G, Chen Y, Cianci D, Conrad JM, Convery M, Cooper-Troendle L, Crespo-Anadón JI, Del Tutto M, Dennis SR, Devitt D, Diurba R, Dorrill R, Duffy K, Dytman S, Eberly B, Ereditato A, Evans JJ, Fine R, Fiorentini Aguirre GA, Fitzpatrick RS, Fleming BT, Foppiani N, Franco D, Furmanski AP, Garcia-Gamez D, Gardiner S, Ge G, Gollapinni S, Goodwin O, Gramellini E, Green P, Greenlee H, Gu W, Guenette R, Guzowski P, Hagaman L, Hall E, Hen O, Horton-Smith GA, Hourlier A, Itay R, James C, Ji X, Jiang L, Jo JH, Johnson RA, Jwa YJ, Kamp N, Kaneshige N, Karagiorgi G, Ketchum W, Kirby M, Kobilarcik T, Kreslo I, LaZur R, Lepetic I, Li K, Li Y, Lin K, Littlejohn BR, Louis WC, Luo X, Manivannan K, Mariani C, Marsden D, Marshall J, Martinez Caicedo DA, Mason K, Mastbaum A, McConkey N, Meddage V, Mettler T, Miller K, Mills J, Mistry K, Mogan A, Mohayai T, Moon J, Mooney M, Moor AF, Moore CD, Mora Lepin L, Mousseau J, Murphy M, Naples D, Navrer-Agasson A, Neely RK, Nowak J, Nunes M, Palamara O, Paolone V, Papadopoulou A, Papavassiliou V, Pate SF, Paudel A, Pavlovic Z, Piasetzky E, Ponce-Pinto ID, Prince S, Qian X, Raaf JL, Radeka V, Rafique A, Reggiani-Guzzo M, Ren L, Rice LCJ, Rochester L, Rodriguez Rondon J, Rogers HE, Rosenberg M, Ross-Lonergan M, Scanavini G, Schmitz DW, Schukraft A, Seligman W, Shaevitz MH, Sharankova R, Shi J, Siegel H, Sinclair J, Smith A, Snider EL, Soderberg M, Söldner-Rembold S, Spentzouris P, Spitz J, Stancari M, John JS, Strauss T, Sutton K, Sword-Fehlberg S, Szelc AM, Tagg N, Tang W, Terao K, Thorpe C, Totani D, Toups M, Tsai YT, Uchida MA, Usher T, Van De Pontseele W, Viren B, Weber M, Wei H, Williams Z, Wolbers S, Wongjirad T, Wospakrik M, Wresilo K, Wright N, Wu W, Yandel E, Yang T, Yarbrough G, Yates LE, Zeller GP, Zennamo J, Zhang C. Search for a Higgs Portal Scalar Decaying to Electron-Positron Pairs in the MicroBooNE Detector. PHYSICAL REVIEW LETTERS 2021; 127:151803. [PMID: 34678031 DOI: 10.1103/physrevlett.127.151803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/11/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
We present a search for the decays of a neutral scalar boson produced by kaons decaying at rest, in the context of the Higgs portal model, using the MicroBooNE detector. We analyze data triggered in time with the Fermilab NuMI neutrino beam spill, with an exposure of 1.93×10^{20} protons on target. We look for monoenergetic scalars that come from the direction of the NuMI hadron absorber, at a distance of 100 m from the detector, and decay to electron-positron pairs. We observe one candidate event, with a standard model background prediction of 1.9±0.8. We set an upper limit on the scalar-Higgs mixing angle of θ<(3.3-4.6)×10^{-4} at the 95% confidence level for scalar boson masses in the range (100-200) MeV/c^{2}. We exclude, at the 95% confidence level, the remaining model parameters required to explain the central value of a possible excess of K_{L}^{0}→π^{0}νν[over ¯] decays reported by the KOTO collaboration. We also provide a model-independent limit on a new boson X produced in K→πX decays and decaying to e^{+}e^{-}.
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Abratenko P, Alrashed M, An R, Anthony J, Asaadi J, Ashkenazi A, Balasubramanian S, Baller B, Barnes C, Barr G, Basque V, Bathe-Peters L, Benevides Rodrigues O, Berkman S, Bhanderi A, Bhat A, Bishai M, Blake A, Bolton T, Camilleri L, Caratelli D, Caro Terrazas I, Castillo Fernandez R, Cavanna F, Cerati G, Chen Y, Church E, Cianci D, Conrad J, Convery M, Cooper-Troendle L, Crespo-Anadón J, Del Tutto M, Dennis S, Devitt D, Diurba R, Domine L, Dorrill R, Duffy K, Dytman S, Eberly B, Ereditato A, Escudero Sanchez L, Evans J, Fiorentini Aguirre G, Fitzpatrick R, Fleming B, Foppiani N, Franco D, Furmanski A, Garcia-Gamez D, Gardiner S, Ge G, Gollapinni S, Goodwin O, Gramellini E, Green P, Greenlee H, Gu W, Guenette R, Guzowski P, Hagaman L, Hall E, Hamilton P, Hen O, Hill C, Horton-Smith G, Hourlier A, Itay R, James C, Jan de Vries J, Ji X, Jiang L, Jo J, Johnson R, Jwa YJ, Kamp N, Kaneshige N, Karagiorgi G, Ketchum W, Kirby B, Kirby M, Kobilarcik T, Kreslo I, LaZur R, Lepetic I, Li K, Li Y, Littlejohn B, Lorca D, Louis W, Luo X, Marchionni A, Mariani C, Marsden D, Marshall J, Martin-Albo J, Martinez Caicedo D, Mason K, Mastbaum A, McConkey N, Meddage V, Mettler T, Miller K, Mills J, Mistry K, Mogan A, Mohayai T, Moon J, Mooney M, Moor A, Moore C, Mora Lepin L, Mousseau J, Murphy M, Naples D, Navrer-Agasson A, Neely R, Nienaber P, Nowak J, Palamara O, Paolone V, Papadopoulou A, Papavassiliou V, Pate S, Paudel A, Pavlovic Z, Piasetzky E, Ponce-Pinto I, Porzio D, Prince S, Qian X, Raaf J, Radeka V, Rafique A, Reggiani-Guzzo M, Ren L, Rochester L, Rodriguez Rondon J, Rogers H, Rosenberg M, Ross-Lonergan M, Russell B, Scanavini G, Schmitz D, Schukraft A, Seligman W, Shaevitz M, Sharankova R, Sinclair J, Smith A, Snider E, Soderberg M, Söldner-Rembold S, Soleti S, Spentzouris P, Spitz J, Stancari M, John J, Strauss T, Sutton K, Sword-Fehlberg S, Szelc A, Tagg N, Tang W, Terao K, Thorpe C, Toups M, Tsai YT, Uchida M, Usher T, Van De Pontseele W, Viren B, Weber M, Wei H, Williams Z, Wolbers S, Wongjirad T, Wospakrik M, Wu W, Yandel E, Yang T, Yarbrough G, Yates L, Zeller G, Zennamo J, Zhang C. Measurement of the flux-averaged inclusive charged-current electron neutrino and antineutrino cross section on argon using the NuMI beam and the MicroBooNE detector. Int J Clin Exp Med 2021. [DOI: 10.1103/physrevd.104.052002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Dongarwar D, Garcia BY, Miller K, Salihu HM. Assessment of hospitalization rates, factors associated with hospitalization and in-patient mortality in pediatric patients with cystic fibrosis. J Natl Med Assoc 2021; 113:683-692. [PMID: 34479733 DOI: 10.1016/j.jnma.2021.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF), an inherited autosomal recessive disease that results in the accumulation of mucus and damage primarily to the respiratory and digestive tracts is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. In the United States, it has been estimated that CF occurs in 1 out of 3500 infants. The objective of this study was to explore the patient and hospital characteristics associated with CF hospitalizations and inpatient mortality in pediatric CF patients. METHODS Utilizing the National Inpatient Sample database from 2008 to 2017, a retrospective cohort study was conducted to analyze the hospitalization rates, associated factors, and the inpatient mortality of CF patients 0-17 years of age. Hospitalizations with a diagnosis of CF were identified with ICD-9-CM and ICD-10-CM codes. Adjusted survey logistic regression models were utilized to determine factors associated with CF hospitalizations and in-hospital deaths in CF patients. RESULTS There were a total of 98,660 (about 0.2%) CF hospitalizations in patients 17 years of age or younger during the study period. Non-Hispanic (NH) White CF patients had the highest prevalence of CF (26.30 per 10,000 hospitalizations). The prevalence of inpatient deaths were highest among those identified as NH-Others and NH-Blacks (71.35 and 68.83 per 10,000 CF hospitalizations, respectively. When compared with NH-White category, those belonging to NH-Black, Hispanic and Other racial/ethnic sub-group had reduced odds of being hospitalized with CF. DISCUSSION Despite our finding of an increased likelihood of being hospitalized for CF among NH-White and male pediatric patients, no association between race or sex and CF inpatient death was observed when adjusted for covariates. More research is needed to determine the impact of sex and race on CF mortality rates.
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Miller K, Reichert CL, Schmid M. Biogenic Amine Detection Systems for Intelligent Packaging Concepts: Meat and Meat Products. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2021.1961270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Marx Delaney M, Kalita T, Hawrusik B, Neal BJ, Miller K, Ketchum R, Molina RL, Singh S, Kumar V, Semrau K. Modification of oxytocin use through a coaching-based intervention based on the WHO Safe Childbirth Checklist in Uttar Pradesh, India: a secondary analysis of a cluster randomised controlled trial. BJOG 2021; 128:2013-2021. [PMID: 34363293 DOI: 10.1111/1471-0528.16856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To understand the prevalence of intrapartum oxytocin use, assess associated perinatal and maternal outcomes, and evaluate the impact of a WHO Safe Childbirth Checklist intervention on oxytocin use at primary-level facilities in Uttar Pradesh, India. DESIGN Secondary analysis of a cluster-randomised controlled trial. SETTING Thirty Primary and Community public health facilities in Uttar Pradesh, India from 2014 to 2017. POPULATION Women admitted to a study facility for childbirth at baseline, 2, 6 or 12 months after intervention initiation. METHODS The BetterBirth intervention aimed to increase adherence to the WHO Safe Childbirth Checklist. We used Rao-Scott Chi-square tests to compare (1) timing of oxytocin use between study arms and (2) perinatal mortality and resuscitation of infants whose mothers received intrapartum oxytocin versus who did not. MAIN OUTCOME MEASURES Intrapartum and postpartum oxytocin administration, perinatal mortality, use of neonatal bag and mask. RESULTS We observed 5484 deliveries. At baseline, intrapartum oxytocin was administered to 78.2% of women. Two months after intervention initiation, intrapartum oxytocin (I) was administered to 32.1% of women compared with 70.6% in the control (C) (P < 0.01); this difference diminished after the end of the intervention (I = 48.2%, C = 74.7%, P = 0.03). Partograph use remained at <1% at all facilities. Resuscitation was performed on 7.5% of infants whose mother received intrapartum oxytocin versus 2.0% who did not (P < 0.0001). CONCLUSIONS In this setting, intrapartum oxytocin use was high despite limited maternal/fetal monitoring or caesarean capability, and was associated with increased neonatal resuscitation. The BetterBirth intervention was successful at decreasing intrapartum oxytocin use. Ongoing support is needed to sustain these practices. TWEETABLE ABSTRACT Coaching + WHO Safe Childbirth Checklist reduces intrapartum oxytocin use and need for newborn resuscitation.
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Doelman DS, Snik F, Por EH, Bos SP, Otten GPPL, Kenworthy M, Haffert SY, Wilby M, Bohn AJ, Sutlieff BJ, Miller K, Ouellet M, de Boer J, Keller CU, Escuti MJ, Shi S, Warriner NZ, Hornburg K, Birkby JL, Males J, Morzinski KM, Close LM, Codona J, Long J, Schatz L, Lumbres J, Rodack A, Van Gorkom K, Hedglen A, Guyon O, Lozi J, Groff T, Chilcote J, Jovanovic N, Thibault S, de Jonge C, Allain G, Vallée C, Patel D, Côté O, Marois C, Hinz P, Stone J, Skemer A, Briesemeister Z, Boehle A, Glauser AM, Taylor W, Baudoz P, Huby E, Absil O, Carlomagno B, Delacroix C. Vector-apodizing phase plate coronagraph: design, current performance, and future development [Invited]. APPLIED OPTICS 2021; 60:D52-D72. [PMID: 34263828 DOI: 10.1364/ao.422155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
Over the last decade, the vector-apodizing phase plate (vAPP) coronagraph has been developed from concept to on-sky application in many high-contrast imaging systems on 8 m class telescopes. The vAPP is a geometric-phase patterned coronagraph that is inherently broadband, and its manufacturing is enabled only by direct-write technology for liquid-crystal patterns. The vAPP generates two coronagraphic point spread functions (PSFs) that cancel starlight on opposite sides of the PSF and have opposite circular polarization states. The efficiency, that is, the amount of light in these PSFs, depends on the retardance offset from a half-wave of the liquid-crystal retarder. Using different liquid-crystal recipes to tune the retardance, different vAPPs operate with high efficiencies (${\gt}96\%$) in the visible and thermal infrared (0.55 µm to 5 µm). Since 2015, seven vAPPs have been installed in a total of six different instruments, including Magellan/MagAO, Magellan/MagAO-X, Subaru/SCExAO, and LBT/LMIRcam. Using two integral field spectrographs installed on the latter two instruments, these vAPPs can provide low-resolution spectra (${\rm{R}} \sim 30$) between 1 µm and 5 µm. We review the design process, development, commissioning, on-sky performance, and first scientific results of all commissioned vAPPs. We report on the lessons learned and conclude with perspectives for future developments and applications.
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Szot JO, Slavotinek A, Chong K, Brandau O, Nezarati M, Cueto-González AM, Patel MS, Devine WP, Rego S, Acyinena AP, Shannon P, Myles-Reid D, Blaser S, Mieghem TV, Yavuz-Kienle H, Skladny H, Miller K, Riera MDT, Martínez SA, Tizzano EF, Dupuis L, James Stavropoulos D, McNiven V, Mendoza-Londono R, Elliott AM, Phillips RS, Chapman G, Dunwoodie SL. New cases that expand the genotypic and phenotypic spectrum of Congenital NAD Deficiency Disorder. Hum Mutat 2021; 42:862-876. [PMID: 33942433 DOI: 10.1002/humu.24211] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022]
Abstract
Nicotinamide adenine dinucleotide (NAD) is an essential coenzyme involved in over 400 cellular reactions. During embryogenesis, mammals synthesize NAD de novo from dietary l -tryptophan via the kynurenine pathway. Biallelic, inactivating variants in three genes encoding enzymes of this biosynthesis pathway (KYNU, HAAO, and NADSYN1) disrupt NAD synthesis and have been identified in patients with multiple malformations of the heart, kidney, vertebrae, and limbs; these patients have Congenital NAD Deficiency Disorder HAAO and four families with biallelic variants in KYNU. These patients present similarly with multiple malformations of the heart, kidney, vertebrae, and limbs, of variable severity. We show that each variant identified in these patients results in loss-of-function, revealed by a significant reduction in NAD levels via yeast genetic complementation assays. For the first time, missense mutations are identified as a cause of malformation and shown to disrupt enzyme function. These missense and frameshift variants cause moderate to severe NAD deficiency in yeast, analogous to insufficient synthesized NAD in patients. We hereby expand the genotypic and corresponding phenotypic spectrum of Congenital NAD Deficiency Disorder.
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Abratenko P, Alrashed M, An R, Anthony J, Asaadi J, Ashkenazi A, Balasubramanian S, Baller B, Barnes C, Barr G, Basque V, Bathe-Peters L, Benevides Rodrigues O, Berkman S, Bhanderi A, Bhat A, Bishai M, Blake A, Bolton T, Camilleri L, Caratelli D, Caro Terrazas I, Castillo Fernandez R, Cavanna F, Cerati G, Chen Y, Church E, Cianci D, Conrad J, Convery M, Cooper-Troendle L, Crespo-Anadón J, Del Tutto M, Devitt D, Diurba R, Domine L, Dorrill R, Duffy K, Dytman S, Eberly B, Ereditato A, Escudero Sanchez L, Evans J, Fiorentini Aguirre G, Fitzpatrick R, Fleming B, Foppiani N, Franco D, Furmanski A, Garcia-Gamez D, Gardiner S, Ge G, Gollapinni S, Goodwin O, Gramellini E, Green P, Greenlee H, Gu W, Guenette R, Guzowski P, Hall E, Hamilton P, Hen O, Horton-Smith G, Hourlier A, Huang EC, Itay R, James C, Jan de Vries J, Ji X, Jiang L, Jo J, Johnson R, Jwa YJ, Kamp N, Karagiorgi G, Ketchum W, Kirby B, Kirby M, Kobilarcik T, Kreslo I, LaZur R, Lepetic I, Li K, Li Y, Littlejohn B, Lorca D, Louis W, Luo X, Marchionni A, Marcocci S, Mariani C, Marsden D, Marshall J, Martin-Albo J, Martinez Caicedo D, Mason K, Mastbaum A, McConkey N, Meddage V, Mettler T, Miller K, Mills J, Mistry K, Mogan A, Mohayai T, Moon J, Mooney M, Moor A, Moore C, Mousseau J, Murphy M, Naples D, Navrer-Agasson A, Neely R, Nienaber P, Nowak J, Palamara O, Paolone V, Papadopoulou A, Papavassiliou V, Pate S, Paudel A, Pavlovic Z, Piasetzky E, Ponce-Pinto I, Porzio D, Prince S, Qian X, Raaf J, Radeka V, Rafique A, Reggiani-Guzzo M, Ren L, Rochester L, Rodriguez Rondon J, Rogers H, Rosenberg M, Ross-Lonergan M, Russell B, Scanavini G, Schmitz D, Schukraft A, Shaevitz M, Sharankova R, Sinclair J, Smith A, Snider E, Soderberg M, Söldner-Rembold S, Soleti S, Spentzouris P, Spitz J, Stancari M, John J, Strauss T, Sutton K, Sword-Fehlberg S, Szelc A, Tagg N, Tang W, Terao K, Thorpe C, Toups M, Tsai YT, Tufanli S, Uchida M, Usher T, Van De Pontseele W, Viren B, Weber M, Wei H, Williams Z, Wolbers S, Wongjirad T, Wospakrik M, Wu W, Yang T, Yarbrough G, Yates L, Zeller G, Zennamo J, Zhang C. Convolutional neural network for multiple particle identification in the MicroBooNE liquid argon time projection chamber. Int J Clin Exp Med 2021. [DOI: 10.1103/physrevd.103.092003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Miller K, Mayer OH. Pulmonary function testing in patients with neuromuscular disease. Pediatr Pulmonol 2021; 56:693-699. [PMID: 33290643 DOI: 10.1002/ppul.25182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/11/2022]
Abstract
Progressive neuromuscular disease leads to muscle weakness or failure that produces loss of pulmonary function and clinical respiratory morbidity. Tracking pulmonary function in a practical and effective way is very important because it can help identify a stage of disease when a morbidity, such as inadequate airway clearance or respiratory failure, may be present. There are four general categories of pulmonary function outcome measures such as volume, flow, pressure, and gas exchange. These outcome measures have variable precision and accuracy in predicting clinical change, and practicality in performing them relative to age and condition. It is widely recommended to follow multiple measurements longitudinally and create an accurate and timely clinical picture. This manuscript will review the most commonly used and most practical measures for use in clinical practice and how they can help to assess morbidity, disease state, and help optimize patient management.
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Ramdeen S, Ferrell B, Bonk C, Schubel L, Littlejohn R, Capan M, Arnold R, Miller K. The Available Criteria for Different Sepsis Scoring Systems in the Emergency Department-A Retrospective Assessment. Open Access Emerg Med 2021; 13:91-96. [PMID: 33688278 PMCID: PMC7936926 DOI: 10.2147/oaem.s280279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/14/2020] [Indexed: 01/26/2023] Open
Abstract
Objective The goal of the study was to assess the criteria availability of eight sepsis scoring methods within 6 hours of triage in the emergency department (ED). Design Retrospective data analysis study. Setting ED of MedStar Washington Hospital Center (MWHC), a 912-bed urban, tertiary hospital. Patients Adult (age ≥ 18 years) patients presenting to the MWHC ED between June 1, 2017 and May 31, 2018 and admitted with a diagnosis of severe sepsis with or without shock. Main Outcomes Measured Availability of sepsis scoring criteria of eight different sepsis scoring methods at three time points—0 Hours (T0), 3 Hours (T1) and 6 Hours (T2) after arrival to the ED. Results A total of 50 charts were reviewed, which included 23 (46%) males and 27 (54%) females. Forty-eight patients (96%) were Black or African American. Glasgow Coma Scale was available for all 50 patients at T0. Vital signs, except for temperature, were readily available (>90%) at T0. The majority of laboratory values relevant for sepsis scoring criteria were available (>90%) at T1, with exception to bilirubin (66%) and creatinine (80%). NEWS, PRESEP and qSOFA had greater than 90% criteria availability at triage. SOFA and SIRS consistently had the least percent of available criteria at all time points in the ED. Conclusion The availability of patient data at different time points in a patient’s ED visit suggests that different scoring methods could be utilized to assess for sepsis as more patient information becomes available.
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Floyd GC, Dudley JW, Xiao R, Feudtner C, Taquechel K, Miller K, Henrickson SE, Hill DA, Kenyon CC. Prevalence of asthma in hospitalized and non-hospitalized children with COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2077-2079.e2. [PMID: 33676051 PMCID: PMC7927636 DOI: 10.1016/j.jaip.2021.02.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
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Singh A, Mountjoy N, McElroy D, Mittal S, Al Hemyari B, Coffey N, Miller K, Gaines K. Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study. JMIR Cardio 2021; 5:e25074. [PMID: 33385234 PMCID: PMC7834614 DOI: 10.2196/25074] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/23/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results A total of 224 respondents began our survey (11% of our sample of 2019 patients). Our recruitment rate was 86% (n=193) and our completion rate was 62% (n=120). The no-show rate for telehealth visits (345/2019, 17%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63%) cited not being aware of their appointment as a primary factor, and 15 (47%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0% (35/106) of respondents. Conclusions This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits.
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Miller K, Baugh CW, Chai PR, Hasdianda MA, Divatia S, Jambaulikar GD, Boyer EW. Deployment of a wearable biosensor system in the emergency department: a technical feasibility study. PROCEEDINGS OF THE ... ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES. ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES 2021; 2021:3567-3572. [PMID: 33469412 PMCID: PMC7814225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Wearable devices to detect changes in health status are increasingly adopted by consumers, yet hospitals remain slow to assimilate these devices into clinical practice. Despite the clear benefits of capturing clinical information in acutely ill patients, such technology remains difficult to implement in emergency medicine. To improve adoption, barriers must first be removed. In our technical feasibility and acceptability trial, we studied the deployment of a wearable wireless biosensor that collects physiological data. We enrolled 44 adult patients receiving care in an emergency department observation unit. After we consented patients for participation, we applied biosensors to their chest and collected basic demographic and clinical information. We then collected biosensor data on an isolated system and measured patient experience via an exit survey. Throughout this process we documented and studied technical challenges. Overall, the technology was feasible to deploy in the emergency department observation unit and was acceptable to participants. Such technologies have tremendous future operational and clinical implications in settings ranging from emergency to home-care.
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Badker R, Miller K, Pardee C, Ash B, Philippsen T, Ngoon C, Savage P, Madhav N. A new digital surveillance methodology to overcome challenges in reported epidemic data. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Madhav N, Bosa HK, Agyarko RD, Stephenson N, Miller K, Gallivan M, Lam C, Meadows A, Sridharan V, Bah A, Béavogui M. Development of a risk modeling approach to enhance the effectiveness of epidemic preparedness, response, and financing strategies in African countries. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Parker J, Miller K, He Y, Scanlon P, Cai B, Shin HC, Parsons V, Irimata K. Overview and Initial Results of the National Center for Health Statistics' Research and Development Survey. STATISTICAL JOURNAL OF THE IAOS 2020; 36:1199-1211. [PMID: 35923778 PMCID: PMC9345606 DOI: 10.3233/sji-200678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The National Center for Health Statistics is assessing the usefulness of recruited web panels in multiple research areas. One research area examines the use of close-ended probe questions and split-panel experiments for evaluating question-response patterns. Another research area is the development of statistical methodology to leverage the strength of national survey data to evaluate, and possibly improve, health estimates from recruited panels. Recruited web panels, with their lower cost and faster production cycle, in combination with established population health surveys, may be useful for some purposes for statistical agencies. Our initial results indicate that web survey data from a recruited panel can be used for question evaluation studies without affecting other survey content. However, the success of these data to provide estimates that align with those from large national surveys will depend on many factors, including further understanding of design features of the recruited panel (e.g. coverage and mode effects), the statistical methods and covariates used to obtain the original and adjusted weights, and the health outcomes of interest.
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Abratenko P, Alrashed M, An R, Anthony J, Asaadi J, Ashkenazi A, Balasubramanian S, Baller B, Barnes C, Barr G, Basque V, Bathe-Peters L, Benevides Rodrigues O, Berkman S, Bhanderi A, Bhat A, Bishai M, Blake A, Bolton T, Camilleri L, Caratelli D, Caro Terrazas I, Castillo Fernandez R, Cavanna F, Cerati G, Chen Y, Church E, Cianci D, Cohen EO, Conrad JM, Convery M, Cooper-Troendle L, Crespo-Anadón JI, Del Tutto M, Devitt D, Diurba R, Domine L, Dorrill R, Duffy K, Dytman S, Eberly B, Ereditato A, Escudero Sanchez L, Evans JJ, Fiorentini Aguirre GA, Fitzpatrick RS, Fleming BT, Foppiani N, Franco D, Furmanski AP, Garcia-Gamez D, Gardiner S, Gollapinni S, Goodwin O, Gramellini E, Green P, Greenlee H, Gu L, Gu W, Guenette R, Guzowski P, Hall E, Hamilton P, Hen O, Horton-Smith GA, Hourlier A, Huang EC, Itay R, James C, Jan de Vries J, Ji X, Jiang L, Jo JH, Johnson RA, Jwa YJ, Kamp N, Karagiorgi G, Ketchum W, Kirby B, Kirby M, Kobilarcik T, Kreslo I, LaZur R, Lepetic I, Li K, Li Y, Littlejohn BR, Lorca D, Louis WC, Luo X, Marchionni A, Marcocci S, Mariani C, Marsden D, Marshall J, Martin-Albo J, Martinez Caicedo DA, Mason K, Mastbaum A, McConkey N, Meddage V, Mettler T, Miller K, Mills J, Mistry K, Mogan A, Mohayai T, Moon J, Mooney M, Moor AF, Moore CD, Mousseau J, Murphy M, Naples D, Navrer-Agasson A, Neely RK, Nienaber P, Nowak J, Palamara O, Paolone V, Papadopoulou A, Papavassiliou V, Pate SF, Paudel A, Pavlovic Z, Piasetzky E, Ponce-Pinto ID, Porzio D, Prince S, Qian X, Raaf JL, Radeka V, Rafique A, Reggiani-Guzzo M, Ren L, Rochester L, Rodriguez Rondon J, Rogers HE, Rosenberg M, Ross-Lonergan M, Russell B, Scanavini G, Schmitz DW, Schukraft A, Shaevitz MH, Sharankova R, Sinclair J, Smith A, Snider EL, Soderberg M, Söldner-Rembold S, Soleti SR, Spentzouris P, Spitz J, Stancari M, John JS, Strauss T, Sutton K, Sword-Fehlberg S, Szelc AM, Tagg N, Tang W, Terao K, Thornton RT, Thorpe C, Toups M, Tsai YT, Tufanli S, Uchida MA, Usher T, Van De Pontseele W, Van de Water RG, Viren B, Weber M, Wei H, Williams Z, Wolbers S, Wongjirad T, Wospakrik M, Wu W, Yang T, Yarbrough G, Yates LE, Zeller GP, Zennamo J, Zhang C. First Measurement of Differential Charged Current Quasielasticlike ν_{μ}-Argon Scattering Cross Sections with the MicroBooNE Detector. PHYSICAL REVIEW LETTERS 2020; 125:201803. [PMID: 33258649 DOI: 10.1103/physrevlett.125.201803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/11/2020] [Accepted: 10/02/2020] [Indexed: 06/12/2023]
Abstract
We report on the first measurement of flux-integrated single differential cross sections for charged-current (CC) muon neutrino (ν_{μ}) scattering on argon with a muon and a proton in the final state, ^{40}Ar (ν_{μ},μp)X. The measurement was carried out using the Booster Neutrino Beam at Fermi National Accelerator Laboratory and the MicroBooNE liquid argon time projection chamber detector with an exposure of 4.59×10^{19} protons on target. Events are selected to enhance the contribution of CC quasielastic (CCQE) interactions. The data are reported in terms of a total cross section as well as single differential cross sections in final state muon and proton kinematics. We measure the integrated per-nucleus CCQE-like cross section (i.e., for interactions leading to a muon, one proton, and no pions above detection threshold) of (4.93±0.76_{stat}±1.29_{sys})×10^{-38} cm^{2}, in good agreement with theoretical calculations. The single differential cross sections are also in overall good agreement with theoretical predictions, except at very forward muon scattering angles that correspond to low-momentum-transfer events.
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Mayer EL, Abramson V, Jankowitz R, Falkson C, Marcom PK, Traina T, Carey L, Rimawi M, Specht J, Miller K, Stearns V, Tung N, Perou C, Richardson AL, Componeschi K, Trippa L, Tan-Wasielewski Z, Timms K, Krop I, Wolff AC, Winer EP. TBCRC 030: a phase II study of preoperative cisplatin versus paclitaxel in triple-negative breast cancer: evaluating the homologous recombination deficiency (HRD) biomarker. Ann Oncol 2020; 31:1518-1525. [PMID: 32798689 PMCID: PMC8437015 DOI: 10.1016/j.annonc.2020.08.2064] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cisplatin and paclitaxel are active in triple-negative breast cancer (TNBC). Despite different mechanisms of action, effective predictive biomarkers to preferentially inform drug selection have not been identified. The homologous recombination deficiency (HRD) assay (Myriad Genetics, Inc.) detects impaired double-strand DNA break repair and may identify patients with BRCA1/2-proficient tumors that are sensitive to DNA-targeting therapy. The primary objective of TBCRC 030 was to detect an association of HRD with pathologic response [residual cancer burden (RCB)-0/1] to single-agent cisplatin or paclitaxel. PATIENTS AND METHODS This prospective phase II study enrolled patients with germline BRCA1/2 wild-type/unknown stage I-III TNBC in a 12-week randomized study of preoperative cisplatin or paclitaxel. The HRD assay was carried out on baseline tissue; positive HRD was defined as a score ≥33. Crossover to an alternative chemotherapy was offered if there was inadequate response. RESULTS One hundred and thirty-nine patients were evaluable for response, including 88 (63.3%) who had surgery at 12 weeks and 51 (36.7%) who crossed over to an alternative provider-selected preoperative chemotherapy regimen due to inadequate clinical response. HRD results were available for 104 tumors (74.8%) and 74 (71.1%) were HRD positive. The RCB-0/1 rate was 26.4% with cisplatin and 22.3% with paclitaxel. No significant association was observed between HRD score and RCB response to either cisplatin [odds ratio (OR) for RCB-0/1 if HRD positive 2.22 (95% CI: 0.39-23.68)] or paclitaxel [OR for RCB-0/1 if HRD positive 0.90 (95% CI: 0.19-4.95)]. There was no evidence of an interaction between HRD and pathologic response to chemotherapy. CONCLUSIONS In this prospective preoperative trial in TNBC, HRD was not predictive of pathologic response. Tumors were similarly responsive to preoperative paclitaxel or cisplatin chemotherapy.
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Miller K, James N, Oliver M, Ou J, Emerson J, Borgstadt A, DiSilvestro P, Ribeiro J. Immune modeling analysis identifies ICOS and CTLA-4 as predictive biomarkers in serous epithelial ovarian cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kulkarni A, Proussaloglou E, Beffa L, Miller K, Bevis K, Wohlrab K, Lokich E, McCourt C, Glaser G, Brown A, Wethington S, Carlson M, DiSilvestro P, Occhino J, Dunivan G, Tunitsky E, Chen G, Raker C, Luis C, Robison K. Does adjuvant treatment increase risk of midurethral sling complications after concomitant surgery for endometrial cancer and stress urinary incontinence? Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Proussaloglou E, Kulkarni A, Beffa L, Miller K, Wohlrab K, Lokich E, McCourt C, Glaser G, Brown A, Wethington S, Carlson M, DiSilvestro P, Lowder J, Rahn D, Occhino J, Dunivan G, Chen G, Raker C, Robison K. Sexual dysfunction in women with endometrial cancer and stress urinary incontinence. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miller K, Gannon M, Medina J, Clements K, Dodwell D, Horgan K, Cromwell D. Surgery of the primary tumour in women with metastatic breast cancer at diagnosis in England and Wales – how do treatment rates vary at an individual and regional level? Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Trifan G, Goldenberg FD, Caprio FZ, Biller J, Schneck M, Khaja A, Terna T, Brorson J, Lazaridis C, Bulwa Z, Alvarado Dyer R, Saleh Velez FG, Prabhakaran S, Liotta EM, Batra A, Reish NJ, Ruland S, Teitcher M, Taylor W, De la Pena P, Conners JJ, Grewal PK, Pinna P, Dafer RM, Osteraas ND, DaSilva I, Hall JP, John S, Shafi N, Miller K, Moustafa B, Vargas A, Gorelick PB, Testai FD. Characteristics of a Diverse Cohort of Stroke Patients with SARS-CoV-2 and Outcome by Sex. J Stroke Cerebrovasc Dis 2020; 29:105314. [PMID: 32951959 PMCID: PMC7486061 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105314] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 disease is associated with stroke All strokes subtypes are seen in association with COVID-19, with ischemic stroke being most prevalent The most common etiology for ischemic stroke in SARS-CoV2 infection is cryptogenic Sex plays an important role in stroke outcomes in patients with COVID-19 disease Males have higher rates of ICU admission, in-hospital complications and more likely to have worse outcome at hospital discharge compare with females
Background and Purpose Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. Methods This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. Results The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p = 0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p = 0.02) and were less likely to be discharged home (12% vs. 33%; p = 0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR = 1.47, 95% CI = 1.03–2.09). Conclusion In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.
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Profozich A, Sytsma T, Arnold R, Miller K, Capan M. FUTURES: Forecasting the Unexpected Transfer to Upgraded REsources in Sepsis. PROCEEDINGS OF THE INTERNATIONAL SYMPOSIUM OF HUMAN FACTORS AND ERGONOMICS IN HEALTHCARE. INTERNATIONAL SYMPOSIUM OF HUMAN FACTORS AND ERGONOMICS IN HEALTHCARE 2020; 8:187-191. [PMID: 32855979 DOI: 10.1177/2327857919081047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sepsis is one of the most deadly and costly diseases. The Emergency Department (ED) is the initial point of care for most patients who become hospitalized due to sepsis. Quantifying the accuracy of ED clinician forecasting regarding patients' clinical trajectories and outcomes can provide insight into clinical decision making and inform sepsis management.
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Mobley E, Cousineau M, Kim S, Miller K, Tobin J, Freyer D, Milam J. Insurance Instability and Its Impact on Care of Young Adult Survivors of Pediatric Cancer: A Project Forward Study. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fishbein D, Nambiar S, McKenzie K, Mayorga M, Miller K, Tran K, Schubel L, Agor J, Kim T, Capan M. Objective measures of workload in healthcare: a narrative review. Int J Health Care Qual Assur 2020; 33:1-17. [PMID: 31940153 DOI: 10.1108/ijhcqa-12-2018-0288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs unit-level workload) and type of available metrics (e.g. objective vs subjective measures). The purpose of this paper is to provide an overview of objective measures of workload associated with direct care delivery in tertiary healthcare settings, with a focus on measures that can be obtained from electronic records to inform operationalization of workload measurement. DESIGN/METHODOLOGY/APPROACH Relevant papers published between January 2008 and July 2018 were identified through a search in Pubmed and Compendex databases using the Sample, Phenomenon of Interest, Design, Evaluation, Research Type framework. Identified measures were classified into four levels of workload: task, patient, clinician and unit. FINDINGS Of 30 papers reviewed, 9 used task-level metrics, 14 used patient-level metrics, 7 used clinician-level metrics and 20 used unit-level metrics. Key objective measures of workload include: patient turnover (n=9), volume of patients (n=6), acuity (n=6), nurse-to-patient ratios (n=5) and direct care time (n=5). Several methods for operationalization of these metrics into measurement tools were identified. ORIGINALITY/VALUE This review highlights the key objective workload measures available in electronic records that can be utilized to develop an operational approach for quantifying workload. Insights gained from this review can inform the design of processes to track workload and mitigate the effects of increased workload on patient outcomes and clinician performance.
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Fortman E, Hettinger AZ, Howe JL, Fong A, Pruitt Z, Miller K, Ratwani RM. Varying rates of patient identity verification when using computerized provider order entry. J Am Med Inform Assoc 2020; 27:924-928. [PMID: 32377679 DOI: 10.1093/jamia/ocaa047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We sought to determine rates of computerized provider order entry (CPOE) patient identity verification and when and where in the ordering process verification occurred. MATERIALS AND METHODS Fifty-five physicians from 4 healthcare systems completed simulated patient scenarios using their respective CPOE system (Epic or Cerner). Eye movements were recorded and analyzed. RESULTS Across all participants patient id was verified significantly more often than not (62.4% vs 37.6%). Vendor A had significantly higher verification rates than not; vendor B had no difference. Participants using vendor A verified information significantly more often before signing the order than after (88.4% vs 11.6%); there was no difference in vendor B. The banner bar was the most frequent verification location. DISCUSSION Factors such as CPOE design, physician training, and the use of a simulated methodology may be impacting verification rates. CONCLUSIONS Verification rates vary by CPOE product, and this can have patient safety consequences.
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Kennedy JP, Crociata A, Burgess A, Miller K, Escobar-Botero AM, Hasham F. Anesthetic management for cesarean delivery for a parturient with metaphyseal dysplasia and hypophosphatemic rickets. Int J Obstet Anesth 2020; 43:15-16. [PMID: 32464576 DOI: 10.1016/j.ijoa.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/15/2022]
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Youngren WA, Miller K. 1065 A Bout of Sleep Apnea or a Posttrauma Nightmare Occurrence? Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The enigmatic nature of Posttrauma Nightmares (PTNs) has left research without an agreed upon operational definition. This is partially due to PTNs often containing well remembered content that is similar to the triggering trauma, but also manifesting as severe nighttime awakenings without a concise or remembered dream narrative. Given that recent research has linked episodes of Obstructive Sleep Apnea (OSA) to PTNs, this study aimed to examine if OSA could explain why some distressed awakenings occur without memory of nightmare content.
Methods
Participants included 36 trauma survivors who reported experiencing PTNs, recruited from a clinical referral or at a Veterans Affairs Hospital. Presence of OSA was captured from self-reports of previous polysomnography-based sleep study results. PTNs were measured via a self-report measure that assessed past month nightmare frequency and if the content was remembered upon awakening. Analysis included descriptive statistics and chi-square tests.
Results
Out of the group with a reported diagnosis of OSA (N = 8), 75% (n = 6) reported they did not remember the content of their nightmares upon awakening, whereas out of the group without a reported OSA diagnosis (N = 28), only 4% of participants (n = 1) reported not remembering the content of their nightmares. There was a significant difference between OSA diagnosis and remembering nightmare content (X2 = 57.83, p < 0.001).
Conclusion
Individuals with diagnosed OSA commonly experienced nightmares that were often not remembered upon awakening, while the group without OSA most often remembered the content of their nightmares. Due to this relationship, it is possible that some PTNs experienced by the OSA group may instead be misinterpreted respiratory events. Understanding the relationship between OSA and PTNs is crucial for developing the most effective treatment course.
Support
None.
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Beaver JW, Medina-Plaza C, Miller K, Dokoozlian N, Ponangi R, Blair T, Block D, Oberholster A. Effects of the Temperature and Ethanol on the Kinetics of Proanthocyanidin Adsorption in Model Wine Systems. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2020; 68:2891-2899. [PMID: 31180670 DOI: 10.1021/acs.jafc.9b02605] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The kinetics and quantitative and qualitative effects of grape proanthocyanidin (PA) adsorption to grape skin-derived cell wall material (CWM) were investigated in five different temperature-ethanol conditions. Progress curves for each condition were constructed by monitoring the decrease in concentration of PA solutions after exposure to CWM over 720 min. Adsorption isotherms were constructed for each condition, and a Langmuir equation model was applied to each via regression analysis. Compositional changes in the PA solutions after exposure to CWM were determined using phloroglucinolysis and gel permeation chromatography (GPC). A negative correlation between PA adsorption and both the temperature and ethanol concentration was found. Progress curves suggested that both the temperature and ethanol affect the equilibration rate of the adsorption reactions. Additionally, equilibration rates for lower temperature and ethanol concentration conditions were found to be much longer than previously reported, taking up to 720 min. Phloroglucinolysis results showed no discernible correlation between the temperature or ethanol concentration and percent galloylation or percent gallo units of adsorbed compounds. Analyses by phloroglucinolysis and GPC indicate a preferential adsorption of larger molecular weight PAs under all conditions, although no discernible impact on PA composition was detected. Additionally, findings suggest that both the temperature and ethanol concentration impact the percent reduction in molar mass of the PA solution. Data from this study were ultimately utilized to develop a computational model for predicting phenolic extraction during red wine fermentations.
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Abratenko P, Alrashed M, An R, Anthony J, Asaadi J, Ashkenazi A, Balasubramanian S, Baller B, Barnes C, Barr G, Basque V, Berkman S, Bhanderi A, Bhat A, Bishai M, Blake A, Bolton T, Camilleri L, Caratelli D, Caro Terrazas I, Castillo Fernandez R, Cavanna F, Cerati G, Chen Y, Church E, Cianci D, Cohen E, Conrad J, Convery M, Cooper-Troendle L, Crespo-Anadón J, Del Tutto M, Devitt D, Domine L, Duffy K, Dytman S, Eberly B, Ereditato A, Escudero Sanchez L, Evans J, Fitzpatrick R, Fleming B, Foppiani N, Franco D, Furmanski A, Garcia-Gamez D, Gardiner S, Genty V, Goeldi D, Gollapinni S, Goodwin O, Gramellini E, Green P, Greenlee H, Gu L, Gu W, Guenette R, Guzowski P, Hamilton P, Hen O, Hill C, Horton-Smith G, Hourlier A, Huang EC, Itay R, James C, Jan de Vries J, Ji X, Jiang L, Jo J, Johnson R, Joshi J, Jwa YJ, Karagiorgi G, Ketchum W, Kirby B, Kirby M, Kobilarcik T, Kreslo I, LaZur R, Lepetic I, Li Y, Lister A, Littlejohn B, Lockwitz S, Lorca D, Louis W, Luethi M, Lundberg B, Luo X, Marchionni A, Marcocci S, Mariani C, Marshall J, Martin-Albo J, Martinez Caicedo D, Mason K, Mastbaum A, McConkey N, Meddage V, Mettler T, Miller K, Mills J, Mistry K, Mogan A, Mohayai T, Moon J, Mooney M, Moore C, Mousseau J, Murrells R, Naples D, Neely R, Nienaber P, Nowak J, Palamara O, Pandey V, Paolone V, Papadopoulou A, Papavassiliou V, Pate S, Paudel A, Pavlovic Z, Piasetzky E, Porzio D, Prince S, Pulliam G, Qian X, Raaf J, Radeka V, Rafique A, Ren L, Rochester L, Rogers H, Ross-Lonergan M, Rudolf von Rohr C, Russell B, Scanavini G, Schmitz D, Schukraft A, Seligman W, Shaevitz M, Sharankova R, Sinclair J, Smith A, Snider E, Soderberg M, Söldner-Rembold S, Soleti S, Spentzouris P, Spitz J, Stancari M, John JS, Strauss T, Sutton K, Sword-Fehlberg S, Szelc A, Tagg N, Tang W, Terao K, Thornton R, Toups M, Tsai YT, Tufanli S, Uchida M, Usher T, Van De Pontseele W, Van de Water R, Viren B, Weber M, Wei H, Wickremasinghe D, Williams Z, Wolbers S, Wongjirad T, Woodruff K, Wospakrik M, Wu W, Yang T, Yarbrough G, Yates L, Zeller G, Zennamo J, Zhang C. Search for heavy neutral leptons decaying into muon-pion pairs in the MicroBooNE detector. Int J Clin Exp Med 2020. [DOI: 10.1103/physrevd.101.052001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Oczkowski A, Santos E, Gray A, Miller K, Huertas E, Hanson A, Martin R, Watson EB, Wigand C. Tracking the dynamic ecological history of a tropical urban estuary as it responds to human pressures. Ecosystems 2020; 23:231-245. [PMID: 32327932 DOI: 10.1007/s10021-019-00399-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coastal cities in tropical areas are often low-lying and vulnerable to the effects of flooding and storms. San Juan, Puerto Rico is a good example of this. It is built around a lagoon-channel complex called the San Juan Bay Estuary (SJBE). A critical channel in the estuary, the Caño Martín Peña, has filled in and now frequently floods the surrounding communities with sewage-enriched waters, causing a series of human health and ecological problems. Sediment core analyses indicate that portions of the SJBE now function as settling basins. High urban and sewage runoff to the Caño contributes nitrogen (N), but stable isotope and sediment nutrient analyses indicate that this runoff may also enhance conditions for coupled sulfate reduction-nitrogen fixation. The amount of 'new' bioavailable N created from inert atmospheric N2 gas may meet or exceed that from the runoff into the Caño Martín Peña. The ecological consequences of this appear to extend beyond the ponded channel, potentially contributing to the poor water quality of the SJBE, greater than contaminated runoff alone.
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Prints M, Fishbein D, Arnold R, Stander E, Miller K, Kim T, Capan M. Understanding the perception of workload in the emergency department and its impact on medical decision making. Am J Emerg Med 2020; 38:397-399. [PMID: 31378413 DOI: 10.1016/j.ajem.2019.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 11/28/2022] Open
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Lomotan EA, Meadows G, Michaels M, Michel JJ, Miller K. To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support. Appl Clin Inform 2020; 11:112-121. [PMID: 32052388 PMCID: PMC7015815 DOI: 10.1055/s-0040-1701253] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Healthcare systems devote substantial resources to the development of clinical decision support (CDS) largely independently. The process of translating evidence-based practice into useful and effective CDS may be more efficient and less duplicative if healthcare systems shared knowledge about the translation, including workflow considerations, key assumptions made during the translation process, and technical details. OBJECTIVE Describe how a national repository of CDS can serve as a public resource for healthcare systems, academic researchers, and informaticists seeking to share and reuse CDS knowledge resources or "artifacts." METHODS In 2016, the Agency for Healthcare Research and Quality (AHRQ) launched CDS Connect as a public, web-based platform for authoring and sharing CDS knowledge artifacts. Researchers evaluated early use and impact of the platform by collecting user experiences of AHRQ-sponsored and community-led dissemination efforts and through quantitative/qualitative analysis of site metrics. Efforts are ongoing to quantify efficiencies gained by healthcare systems that leverage shared, interoperable CDS artifacts rather than developing similar CDS de novo and in isolation. RESULTS Federal agencies, academic institutions, and others have contributed over 50 entries to CDS Connect for sharing and dissemination. Analysis indicates shareable CDS resources reduce team sizes and the number of tasks and time required to design, develop, and deploy CDS. However, the platform needs further optimization to address sociotechnical challenges. Benefits of sharing include inspiring others to undertake similar CDS projects, identifying external collaborators, and improving CDS artifacts as a result of feedback. Organizations are adapting content available through the platform for continued research, innovation, and local implementations. CONCLUSION CDS Connect has provided a functional platform where CDS developers are actively sharing their work. CDS sharing may lead to improved implementation efficiency through numerous pathways, and further research is ongoing to quantify efficiencies gained.
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Aprile E, Aalbers J, Agostini F, Alfonsi M, Althueser L, Amaro FD, Antochi VC, Angelino E, Arneodo F, Barge D, Baudis L, Bauermeister B, Bellagamba L, Benabderrahmane ML, Berger T, Breur PA, Brown A, Brown E, Bruenner S, Bruno G, Budnik R, Capelli C, Cardoso JMR, Cichon D, Coderre D, Colijn AP, Conrad J, Cussonneau JP, Decowski MP, de Perio P, Depoian A, Di Gangi P, Di Giovanni A, Diglio S, Elykov A, Eurin G, Fei J, Ferella AD, Fieguth A, Fulgione W, Gaemers P, Gallo Rosso A, Galloway M, Gao F, Garbini M, Grandi L, Greene Z, Hasterok C, Hils C, Hogenbirk E, Howlett J, Iacovacci M, Itay R, Joerg F, Kazama S, Kish A, Kobayashi M, Koltman G, Kopec A, Landsman H, Lang RF, Levinson L, Lin Q, Lindemann S, Lindner M, Lombardi F, Lopes JAM, López Fune E, Macolino C, Mahlstedt J, Manfredini A, Marignetti F, Marrodán Undagoitia T, Masbou J, Mastroianni S, Messina M, Micheneau K, Miller K, Molinario A, Morå K, Mosbacher Y, Murra M, Naganoma J, Ni K, Oberlack U, Odgers K, Palacio J, Pelssers B, Peres R, Pienaar J, Pizzella V, Plante G, Podviianiuk R, Qin J, Qiu H, Ramírez García D, Reichard S, Riedel B, Rocchetti A, Rupp N, Dos Santos JMF, Sartorelli G, Šarčević N, Scheibelhut M, Schindler S, Schreiner J, Schulte D, Schumann M, Scotto Lavina L, Selvi M, Shagin P, Shockley E, Silva M, Simgen H, Therreau C, Thers D, Toschi F, Trinchero G, Tunnell C, Upole N, Vargas M, Volta G, Wack O, Wang H, Wei Y, Weinheimer C, Wenz D, Wittweg C, Wulf J, Ye J, Zhang Y, Zhu T, Zopounidis JP. Light Dark Matter Search with Ionization Signals in XENON1T. PHYSICAL REVIEW LETTERS 2019; 123:251801. [PMID: 31922764 DOI: 10.1103/physrevlett.123.251801] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/07/2019] [Indexed: 06/10/2023]
Abstract
We report constraints on light dark matter (DM) models using ionization signals in the XENON1T experiment. We mitigate backgrounds with strong event selections, rather than requiring a scintillation signal, leaving an effective exposure of (22±3) tonne day. Above ∼0.4 keV_{ee}, we observe <1 event/(tonne day keV_{ee}), which is more than 1000 times lower than in similar searches with other detectors. Despite observing a higher rate at lower energies, no DM or CEvNS detection may be claimed because we cannot model all of our backgrounds. We thus exclude new regions in the parameter spaces for DM-nucleus scattering for DM masses m_{χ} within 3-6 GeV/c^{2}, DM-electron scattering for m_{χ}>30 MeV/c^{2}, and absorption of dark photons and axionlike particles for m_{χ} within 0.186-1 keV/c^{2}.
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Ratwani RM, Savage E, Will A, Arnold R, Khairat S, Miller K, Fairbanks RJ, Hodgkins M, Hettinger AZ. A usability and safety analysis of electronic health records: a multi-center study. J Am Med Inform Assoc 2019; 25:1197-1201. [PMID: 29982549 DOI: 10.1093/jamia/ocy088] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/08/2018] [Indexed: 11/15/2022] Open
Abstract
To characterize the variability in usability and safety of EHRs from two vendors across four healthcare systems (2 Epic and 2 Cerner). Twelve to 15 emergency medicine physicians participated from each site and completed six clinical scenarios. Keystroke, mouse click, and video data were collected. From the six scenarios, two diagnostic imaging, laboratory, and medication tasks were analyzed. There was wide variability in task completion time, clicks, and error rates. For certain tasks, there were an average of a nine-fold difference in time and eight-fold difference in clicks. Error rates varied by task (X-ray 16.7% to 25%, MRI: 0 to 10%, Lactate: 0% to 14.3%, Tylenol: 0 to 30%; Taper: 16.7% to 50%). The variability in time, clicks, and error rates highlights the need for improved implementation optimization. EHR implementation, in addition to vendor design and development, is critical to usable and safe products.
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Aprile E, Aalbers J, Agostini F, Alfonsi M, Althueser L, Amaro FD, Antochi VC, Angelino E, Arneodo F, Barge D, Baudis L, Bauermeister B, Bellagamba L, Benabderrahmane ML, Berger T, Breur PA, Brown A, Brown E, Bruenner S, Bruno G, Budnik R, Capelli C, Cardoso JMR, Cichon D, Coderre D, Colijn AP, Conrad J, Cussonneau JP, Decowski MP, de Perio P, Depoian A, Di Gangi P, Di Giovanni A, Diglio S, Elykov A, Eurin G, Fei J, Ferella AD, Fieguth A, Fulgione W, Gaemers P, Gallo Rosso A, Galloway M, Gao F, Garbini M, Grandi L, Greene Z, Hasterok C, Hils C, Hogenbirk E, Howlett J, Iacovacci M, Itay R, Joerg F, Kazama S, Kish A, Kobayashi M, Koltman G, Kopec A, Landsman H, Lang RF, Levinson L, Lin Q, Lindemann S, Lindner M, Lombardi F, Lopes JAM, López Fune E, Macolino C, Mahlstedt J, Manenti M, Manfredini A, Marignetti F, Marrodán Undagoitia T, Masbou J, Mastroianni S, Messina M, Micheneau K, Miller K, Molinario A, Morå K, Mosbacher Y, Murra M, Naganoma J, Ni K, Oberlack U, Odgers K, Palacio J, Pelssers B, Peres R, Pienaar J, Pizzella V, Plante G, Podviianiuk R, Qin J, Qiu H, Ramírez García D, Reichard S, Riedel B, Rocchetti A, Rupp N, Dos Santos JMF, Sartorelli G, Šarčević N, Scheibelhut M, Schindler S, Schreiner J, Schulte D, Schumann M, Scotto Lavina L, Selvi M, Shagin P, Shockley E, Silva M, Simgen H, Therreau C, Thers D, Toschi F, Trinchero G, Tunnell C, Upole N, Vargas M, Volta G, Wack O, Wang H, Wei Y, Weinheimer C, Wenz D, Wittweg C, Wulf J, Ye J, Zhang Y, Zhu T, Zopounidis JP. Search for Light Dark Matter Interactions Enhanced by the Migdal Effect or Bremsstrahlung in XENON1T. PHYSICAL REVIEW LETTERS 2019; 123:241803. [PMID: 31922867 DOI: 10.1103/physrevlett.123.241803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/15/2019] [Indexed: 06/10/2023]
Abstract
Direct dark matter detection experiments based on a liquid xenon target are leading the search for dark matter particles with masses above ∼5 GeV/c^{2}, but have limited sensitivity to lighter masses because of the small momentum transfer in dark matter-nucleus elastic scattering. However, there is an irreducible contribution from inelastic processes accompanying the elastic scattering, which leads to the excitation and ionization of the recoiling atom (the Migdal effect) or the emission of a bremsstrahlung photon. In this Letter, we report on a probe of low-mass dark matter with masses down to about 85 MeV/c^{2} by looking for electronic recoils induced by the Migdal effect and bremsstrahlung using data from the XENON1T experiment. Besides the approach of detecting both scintillation and ionization signals, we exploit an approach that uses ionization signals only, which allows for a lower detection threshold. This analysis significantly enhances the sensitivity of XENON1T to light dark matter previously beyond its reach.
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Miller K, Mosby D, Capan M, Kowalski R, Ratwani R, Noaiseh Y, Kraft R, Schwartz S, Weintraub WS, Arnold R. Interface, information, interaction: a narrative review of design and functional requirements for clinical decision support. J Am Med Inform Assoc 2019; 25:585-592. [PMID: 29126196 DOI: 10.1093/jamia/ocx118] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/25/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Provider acceptance and associated patient outcomes are widely discussed in the evaluation of clinical decision support systems (CDSSs), but critical design criteria for tools have generally been overlooked. The objective of this work is to inform electronic health record alert optimization and clinical practice workflow by identifying, compiling, and reporting design recommendations for CDSS to support the efficient, effective, and timely delivery of high-quality care. Material and Methods A narrative review was conducted from 2000 to 2016 in PubMed and The Journal of Human Factors and Ergonomics Society to identify papers that discussed/recommended design features of CDSSs that are associated with the success of these systems. Results Fourteen papers were included as meeting the criteria and were found to have a total of 42 unique recommendations; 11 were classified as interface features, 10 as information features, and 21 as interaction features. Discussion Features are defined and described, providing actionable guidance that can be applied to CDSS development and policy. To our knowledge, no reviews have been completed that discuss/recommend design features of CDSS at this scale, and thus we found that this was important for the body of literature. The recommendations identified in this narrative review will help to optimize design, organization, management, presentation, and utilization of information through presentation, content, and function. The designation of 3 categories (interface, information, and interaction) should be further evaluated to determine the critical importance of the categories. Future work will determine how to prioritize them with limited resources for designers and developers in order to maximize the clinical utility of CDSS. Conclusion This review will expand the field of knowledge and provide a novel organization structure to identify key recommendations for CDSS.
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Miller K, Joldes GR, Bourantas G, Warfield S, Hyde DE, Kikinis R, Wittek A. Biomechanical modeling and computer simulation of the brain during neurosurgery. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3250. [PMID: 31400252 PMCID: PMC6785376 DOI: 10.1002/cnm.3250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/28/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
Computational biomechanics of the brain for neurosurgery is an emerging area of research recently gaining in importance and practical applications. This review paper presents the contributions of the Intelligent Systems for Medicine Laboratory and its collaborators to this field, discussing the modeling approaches adopted and the methods developed for obtaining the numerical solutions. We adopt a physics-based modeling approach and describe the brain deformation in mechanical terms (such as displacements, strains, and stresses), which can be computed using a biomechanical model, by solving a continuum mechanics problem. We present our modeling approaches related to geometry creation, boundary conditions, loading, and material properties. From the point of view of solution methods, we advocate the use of fully nonlinear modeling approaches, capable of capturing very large deformations and nonlinear material behavior. We discuss finite element and meshless domain discretization, the use of the total Lagrangian formulation of continuum mechanics, and explicit time integration for solving both time-accurate and steady-state problems. We present the methods developed for handling contacts and for warping 3D medical images using the results of our simulations. We present two examples to showcase these methods: brain shift estimation for image registration and brain deformation computation for neuronavigation in epilepsy treatment.
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Schubel LC, Boxley CL, Littlejohn R, Capan M, Arnold R, Miller K. Risky Business: Predicting patient mortality at a glance. ACTA ACUST UNITED AC 2019; 8:261-263. [PMID: 33094111 DOI: 10.1177/2327857919081061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Clinicians are constantly forecasting patient trajectories to make critical point of care decisions intended to influence clinical outcomes. Little is known, however, about how providers interpret mortality risk against validated scoring systems. This research aims to understand how providers forecast mortality specifically for that of patients with sepsis. Defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, sepsis is commonly hard to diagnose, progresses rapidly, and lacks a "gold standard" test. Participants were nurses and doctors from the general medical and surgical floors of six different hospitals. Each was presented with ten different patient cases, categorized into low and high severity sepsis, and were asked about care decisions, along with estimations of mortality risk. The resulting data provides a unique look into the differences of risk forecasting between profession and patient severity.
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Snider J, Molitoris J, Shyu S, Rice S, Kowalski E, DeCesaris C, Remick J, Francis M, Campbell L, Hanna N, Ng V, Miller K, Heath J, Ioffe O, Regine W. Spatially Fractionated GRID Radiotherapy (SFGRT) in Conjunction with Standard Neoadjuvant Radiotherapy for Very High-Risk Soft Tissue and Osteo- Sarcomas: Promising Pathologic Response with Safe Dose-Escalation. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mayer EL, DeMichele A, Rugo HS, Miller K, Waks AG, Come SE, Mulvey T, Jeselsohn R, Overmoyer B, Guo H, Barry WT, Huang Bartlett C, Koehler M, Winer EP, Burstein HJ. A phase II feasibility study of palbociclib in combination with adjuvant endocrine therapy for hormone receptor-positive invasive breast carcinoma. Ann Oncol 2019; 30:1514-1520. [PMID: 31250880 DOI: 10.1093/annonc/mdz198] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The CDK4/6 inhibitor palbociclib prolongs progression-free survival in hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer when combined with endocrine therapy. This phase II trial was designed to determine the feasibility of adjuvant palbociclib and endocrine therapy for early breast cancer. PATIENTS AND METHODS Eligible patients with HR+/HER2- stage II-III breast cancer received 2 years of palbociclib at 125 mg daily, 3 weeks on/1 week off, with endocrine therapy. The primary end point was discontinuation from palbociclib due to toxicity, non-adherence, or events related to tolerability. A discontinuation rate of 48% or higher would indicate the treatment duration of 2 years was not feasible, and was evaluated under a binomial test using a one-sided α = 0.025. RESULTS Overall, 162 patients initiated palbociclib; over half had stage III disease (52%) and most received prior chemotherapy (80%). A total of 102 patients (63%) completed 2 years of palbociclib; 50 patients discontinued early for protocol-related reasons (31%, 95% CI 24% to 39%, P = 0.001), and 10 discontinued due to protocol-unrelated reasons. The cumulative incidence of protocol-related discontinuation was 21% (95% CI 14% to 27%) at 12 months from start of treatment. Rates of palbociclib-related toxicity were congruent with the metastatic experience, and there were no cases of febrile neutropenia. Ninety-one patients (56%) required at least one dose reduction. CONCLUSION Adjuvant palbociclib is feasible in early breast cancer, with a high proportion of patients able to complete 2 years of therapy. The safety profile in the adjuvant setting mirrors that observed in metastatic disease, with approximately half of the patients requiring dose-modification. As extended duration adjuvant palbociclib appears feasible and tolerable for most patients, randomized phase III trials are evaluating clinical benefit in this population. CLINICALTRIALS.GOV REGISTRATION NCT02040857.
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Bonk C, Schubel L, Ferrell B, Ramdeen S, Littlejohn R, Ladkany D, Miller K. Score at the Door: A retrospective data analysis of sepsis scoring criteria in the Emergency Department. PROCEEDINGS OF THE INTERNATIONAL SYMPOSIUM OF HUMAN FACTORS AND ERGONOMICS IN HEALTHCARE. INTERNATIONAL SYMPOSIUM OF HUMAN FACTORS AND ERGONOMICS IN HEALTHCARE 2019; 8:296-298. [PMID: 32855980 PMCID: PMC7449131 DOI: 10.1177/2327857919081071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The goal of this study was to assess the availability of the criteria of eight sepsis scoring methods (SIRS, NEWS, PRESEP, SOFA, qSOFA, SPEED, MEDS, and PIRO) within six hours of triage in the emergency department (ED). Data was analyzed through a retrospective collection of adult (age >18 years) patients presenting to the MedStar Washington Hospital Center (MWHC) emergency department between June 1, 2017 and May 31, 2018 and admitted with a sepsis or sepsis-related diagnosis that progressed to sepsis before discharge. Vital signs are frequently available upon arrival to the ED, while laboratory values tend to be available within three hours and often are not repeated again within the first six hours after arrival. The availability of patient data at different time points in a patient's ED visit suggests that different scoring methods could be utilized to more effectively diagnose and accurately risk-stratify patients within the sepsis spectrum as more information about the patient becomes available.
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Thain E, Shuman C, Miller K, Sappleton K, Myles‐Reid D, Chitayat D, Gibbons C. Prenatal and preconception genetic counseling for consanguinity: Consanguineous couples' expectations, experiences, and perspectives. J Genet Couns 2019; 28:982-992. [DOI: 10.1002/jgc4.1150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 06/18/2019] [Indexed: 01/30/2023]
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Weissberg‐Benchell J, Shapiro JB, Hood K, Laffel LM, Naranjo D, Miller K, Barnard K. Assessing patient-reported outcomes for automated insulin delivery systems: the psychometric properties of the INSPIRE measures. Diabet Med 2019; 36:644-652. [PMID: 30761592 PMCID: PMC6593869 DOI: 10.1111/dme.13930] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 12/17/2022]
Abstract
AIM Participants in clinical trials assessing automated insulin delivery systems report perceived benefits and burdens that reflect their experiences and may predict their likelihood of uptake and continued use of this novel technology. Despite the importance of understanding their perspectives, there are no available validated and reliable measures assessing the psychosocial aspects of automated insulin delivery systems. The present study assesses the initial psychometric properties of the INSPIRE measures, which were developed for youth and adults with Type 1 diabetes, as well as parents and partners. METHODS Data from 292 youth, 159 adults, 150 parents of youth and 149 partners of individuals recruited from the Type 1 Diabetes Exchange Registry were analysed. Participants completed INSPIRE questionnaires and measures of quality of life, fear of hypoglycaemia, diabetes distress, glucose monitoring satisfaction. Exploratory factor analysis assessed factor structures. Associations between INSPIRE scores and other measures, HbA1c , and technology use assessed concurrent and discriminant validity. RESULTS Youth, adult, parent and partner measures assess positive expectancies of automated insulin delivery systems. Measures range from 17 to 22 items and are reliable (α = 0.95-0.97). Youth, adult and parent measures are unidimensional; the partner measure has a two-factor structure (perceptions of impact on partners versus the person with diabetes). Measures showed concurrent and discriminant validity. CONCLUSIONS INSPIRE measures assessing the positive expectancies of automated insulin delivery systems for youth, adults, parents and partners have meaningful factor structures and are internally consistent. The developmentally sensitive INSPIRE measures offer added value as clinical trials test newer systems, systems become commercially available and clinicians initiate using these systems.
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