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Esquivel P, McGarvey L, Phelan S, Adams K. Exploring environmental factors affecting assistive technology strategies in mathematics learning for students with physical disabilities. Disabil Rehabil Assist Technol 2024; 19:66-77. [PMID: 35400279 DOI: 10.1080/17483107.2022.2062465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To explore the environmental facilitators and barriers affecting K-12 students with physical disabilities when using two assistive technology (AT) strategies, LEGO Mindstorms robots and a computer, in mathematics lessons. MATERIALS AND METHODS A qualitative multiple case study with three students with physical disabilities was conducted. The participants did five lessons in concepts they were studying in school with each AT strategy in a controlled environment. Observations of the lessons, and parent and teacher interviews after the last session were collected. RESULTS The AT strategies acted as facilitators because they were easy to use, participants could participate actively, and parents and school staff wanted to implement them. However, the strategies presented some barriers since the students required more time to complete the lessons with the robot, and some computer programs were not compatible with the students' skills. Also, barriers such as lack of technical knowledge on the part of parents and teachers, distractions in the environment, and funding issues were reported. CONCLUSION This study may be useful for rehabilitation staff and teachers who are considering implementing AT to support the participation of students with disabilities. Personnel needs to be trained to use the AT strategies, and several modifications may be necessary for the satisfactory use of the devices.IMPLICATIONS FOR REHABILITATIONHands-on manipulation promotes the active learning of early mathematical concepts. Students with disabilities may have the opportunity to participate in active learning through assistive technology (AT).Knowledge about environmental factors that may facilitate or limit the use of AT in the classroom will help teaching staff make decisions when implementing these strategies with students with disabilities.The use of an AT strategy may depend on the objectives the rehabilitation staff and teachers want to achieve during a task. For instance, the robot could be used for tailoring a task according to the student's needs and abilities. On the other hand, computer programs could be considered if time and ease of use are important factors.
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Affiliation(s)
- Paola Esquivel
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Lynn McGarvey
- Faculty of Education, University of Alberta, Edmonton, Canada
| | - Shanon Phelan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Kim Adams
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Adams K. Loose Attitudes: Politics of Self-Knowledge in Our Bodies, Ourselves and The House of God. J Hist Med Allied Sci 2023; 78:381-400. [PMID: 37307426 DOI: 10.1093/jhmas/jrad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Readers of Samuel Shem's medical satire The House of God (1978) have long worried about the bad attitude of his main characters: young male internal medicine trainees. This article examines the interns' atrocious affections, using the feminist classic Our Bodies, Ourselves (1973) as a counterweight to the masculinist perspective of House of God. These radically different critiques of United States medicine derive from a shared sociopolitical context and represent a historically specific response to the personal politics of sexual liberation and self-actualization in the 1970s. I show that Shem and the Boston Women's Health Book Collective share a rhetorical strategy of "loose expertise" grounded in embodied knowledge, which connects both texts to the radical social movements of the late 1960s. Loose expertise enables institutional critique by shifting the domain of knowledge away from traditional structures of authority, but inhibits intersectional critique by essentializing the individual subject position of the author. The article concludes by examining the relationship of both texts to the medical humanities.
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Das A, Adams K, Stoicoiu S, Kunhiabdullah S, Mathew A. Amplification of heart sounds using digital stethoscope in simulation-based neonatal resuscitation. Am J Perinatol 2023. [PMID: 37399848 DOI: 10.1055/a-2121-8500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The accuracy, timeliness, and reliability of the current methods of Heart rate (HR) determination in neonatal resuscitation are debatable, each having its own limitations. We aim to compare three methods of HR assessment: a) Traditional stethoscope, b) Electrocardiogram and traditional stethoscope, and c) digital stethoscope with loudspeaker amplification of heart sounds. STUDY DESIGN This was a simulated crossover experiment using a high-fidelity manikin. Each team with a physician, a nurse and a respiratory therapist performed the resuscitations using the three methods (3 different scenarios) in different order. The person controlling the HR via manikin controller was blinded but the single recorder and the providers were not. RESULTS Eighteen resuscitations were completed (6 teams of 3 methods each). The time to first HR recording (p<0.001), total number of HR recorded (p<0.001) and time to recognize dips in HR was significantly improved in the digital stethoscope group (p=0.009). CONCLUSION Use of digital stethoscope with amplification improved documentation of HR and earlier recognition of HR changes.
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Affiliation(s)
- Anirudha Das
- Neonatology, Cleveland Clinic Children's Hospital, Cleveland, United States
| | - Kim Adams
- Neonatology, Cleveland Clinic Children's Hospital, Cleveland, United States
| | - Shelagh Stoicoiu
- Neonatology, Cleveland Clinic Children's Hospital, Cleveland, United States
| | | | - Ajith Mathew
- Neonatology, Cleveland Clinic Children's Hospital, Cleveland, United States
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D'Costa I, Hunt I, Russell L, Adams K. A racial bias test with tertiary cancer centre employees: why anti-racist measures are required for First Nations Australians cancer care equity. AUST HEALTH REV 2023; 47:5-12. [PMID: 35477644 DOI: 10.1071/ah21113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023]
Abstract
Objective To examine implicit bias in employees at a cancer centre using an Australian race (Aboriginal-white) Implicit Association Test (IAT), in an attempt to understand a potential factor for inequitable outcomes of First Nations Australians cancer patients. Methods All employees at an Australian cancer centre were invited to take part in a web-based, cross-sectional study using an Australian race IAT. The results were analysed using Welch t-tests, linear regression and ANOVA. Results Overall, 538/2871 participants (19%) completed the IAT between January and June 2020. The mean IAT was 0.147 (s.d. 0.43, P < 0.001, 95% CI 0.11-0.18), and 60% had a preference for white over First Nations Australians. There was no significant mean difference in IAT scores between sub-groups of gender, age or clinical/non-clinical employees. 21% of employees (95% CI 17.65-24.53) had moderate to strong preference for white over First Nations Australians, compared to 7.1% with moderate to strong preference for First Nations over white Australians (95% CI 5.01-9.09). Conclusions Inequitable cancer survival for First Nations patients has been well established and cancer is now the leading cause of mortality. This paper documents the presence of racial bias in employees at one cancer centre. We argue that this cannot be understood outside the history of colonialism and its effects on First Nations Australians, healthcare workers and our society. Further research is required to evaluate measures of racism, its effect on health care, and how to eliminate it.
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Affiliation(s)
- I D'Costa
- School of Medicine, Nursing and Health Science, Monash University, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia; and Peter MacCallum Cancer Centre, Melbourne, Vic. 3000, Australia
| | - I Hunt
- University of Tasmania, Launceston, Australia
| | - L Russell
- Monash Indigenous Studies Centre, School of Philosophical, Historical, and International Studies, and Australian Research Council Centre of Excellence in Australian Biodiversity and Heritage, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia
| | - K Adams
- Gukwonderuk Indigenous Health Unit, The Faculty of Medicine, Nursing and Health Sciences School, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia
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Garg PM, Paschal JL, Ansari MAY, Ware J, Adams K, Taylor C, Reddy K, Rosenfeld CR, Mir IN. Correlation of placental pathology with the postoperative outcomes and white matter injury in preterm infants following necrotizing enterocolitis. J Neonatal Perinatal Med 2023; 16:93-103. [PMID: 36744350 DOI: 10.3233/npm-221105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC. METHODS A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions. RESULTS In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05-7.54; p = 0.039). CONCLUSION Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.
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Affiliation(s)
- P M Garg
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.,Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J L Paschal
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - M A Y Ansari
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J Ware
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - K Adams
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - C Taylor
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - K Reddy
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - C R Rosenfeld
- Department of Pediatrics/Neonatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - I N Mir
- Department of Pediatrics/Neonatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Lamidi S, Coe PO, Bordeianou LG, Hart AL, Hind D, Lindsay JO, Lobo AJ, Myrelid P, Raine T, Sebastian S, Fearnhead NS, Lee MJ, Adams K, Almer S, Ananthakrishnan A, Bethune RM, Block M, Brown SR, Cirocco WC, Cooney R, Davies RJ, Atici SD, Dhar A, Din S, Drobne D, Espin‐Basany E, Evans JP, Fleshner PR, Folkesson J, Fraser A, Graf W, Hahnloser D, Hager J, Hancock L, Hanzel J, Hargest R, Hedin CRH, Hill J, Ihle C, Jongen J, Kader R, Karmiris K, Katsanos KH, Keller DS, Kopylov U, Koutrabakis IE, Lamb CA, Landerholm K, Lee GC, Litta F, Limdi JK, Lopes EW, Madoff RD, Martin ST, Martin‐Perez B, Michalopoulos G, Millan M, Münch A, Nakov R, Noor NM, Oresland T, Paquette IM, Pellino G, Perra T, Porcu A, Roslani AC, Samaan MA, Sebepos‐Rogers GM, Segal JP, de Silva SD, Söderholm AM, Spinelli A, Speight RA, Steinhagen RM, Stenström P, Tsimogiannis KE, Varma MG, Verma AM, Verstockt B, Warden C, Yassin NA, Zawadzki A, Carr P, Devlin B, Avery MSP, Gecse KB, Goren I, Hellström PM, Kotze PG, McWhirter D, Naik AS, Sammour T, Selinger CP, Stein SL, Torres J, Wexner SD, Younge LC. Development of a core descriptor set for Crohn's anal fistula. Colorectal Dis 2022; 25:695-706. [PMID: 36461766 DOI: 10.1111/codi.16440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/21/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
AIM Crohn's anal fistula (CAF) is a complex condition, with no agreement on which patient characteristics should be routinely reported in studies. The aim of this study was to develop a core descriptor set of key patient characteristics for reporting in all CAF research. METHOD Candidate descriptors were generated from published literature and stakeholder suggestions. Colorectal surgeons, gastroenterologists and specialist nurses in inflammatory bowel disease took part in three rounds of an international modified Delphi process using nine-point Likert scales to rank the importance of descriptors. Feedback was provided between rounds to allow refinement of the next ratings. Patterns in descriptor voting were assessed using principal component analysis (PCA). Resulting PCA groups were used to organize items in rounds two and three. Consensus descriptors were submitted to a patient panel for feedback. Items meeting predetermined thresholds were included in the final set and ratified at the consensus meeting. RESULTS One hundred and thirty three respondents from 22 countries completed round one, of whom 67.0% completed round three. Ninety seven descriptors were rated across three rounds in 11 PCA-based groups. Forty descriptors were shortlisted. The consensus meeting ratified a core descriptor set of 37 descriptors within six domains: fistula anatomy, current disease activity and phenotype, risk factors, medical interventions for CAF, surgical interventions for CAF, and patient symptoms and impact on quality of life. CONCLUSION The core descriptor set proposed for all future CAF research reflects characteristics important to gastroenterologists and surgeons. This might aid transparent reporting in future studies.
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Affiliation(s)
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- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
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Bossi G, Lopes R, Adams K, Gonzalez V, Wiseman K, Overton D, Carreira R, Curnock A, Mahon T, Weber P. 045 Melanocyte-targeted Bispecific PD-1 Agonists as Localized Immune Suppressants against Vitiligo. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sakamaki I, Tavakoli M, Wiebe S, Adams K. Examination of effectiveness of kinaesthetic haptic feedback for motor imagery-based brain-computer interface training. Brain-Computer Interfaces 2022. [DOI: 10.1080/2326263x.2022.2114225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Isao Sakamaki
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Wiebe
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Kim Adams
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Adams K, Deer P, Jordan T, Klass P. "Now I know how to not repeat history": Teaching and Learning Through a Pandemic with the Medical Humanities. J Med Humanit 2021; 42:571-585. [PMID: 34750698 PMCID: PMC8575676 DOI: 10.1007/s10912-021-09716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
We reflect on our experience co-teaching a medical humanities elective, "Pandemics and Plagues," which was offered to undergraduates during the Spring 2021 semester, and discuss student reactions to studying epidemic disease from multidisciplinary medical humanities perspectives while living through the world Covid-19 pandemic. The course incorporated basic microbiology and epidemiology into discussions of how epidemics from the Black Death to HIV/AIDS have been portrayed in history, literature, art, music, and journalism. Students self-assessed their learning gains and offered their insights using the SALG (Student Assessment of their Learning Gains), describing how the course enhanced their understanding of the current pandemic. In class discussions and written assignments, students paid particular attention to issues of social justice, political context, and connections between past pandemics and Covid-19. Student responses indicate enhanced understanding of the scientific and medical aspects of epidemics and also increased appreciation of the insights to be gained from the medical humanities. We discuss co-teaching the class during a real-time, twenty-four-hour-news-cycle pandemic, and the ways in which that experience underlines the value of a "critical medical humanities" approach for undergraduates.
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Affiliation(s)
- Kim Adams
- College Core Curriculum, New York University, New York, NY, USA
| | - Patrick Deer
- Department of English, New York University, New York, NY, USA
| | - Trace Jordan
- College Core Curriculum, New York University, New York, NY, USA
| | - Perri Klass
- Arthur L. Carter Journalism Institute, New York University, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA.
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Smeltzer M, Liao W, Taylor MB, Fehnel C, Faris N, Lane JG, Williams SC, Akinbobola O, Pacheco A, Epperson A, Luttrell J, McCoy D, Smith E, Adams K, Ray M, Robbins T, Wright J, Osarogiagbon RU. Comparing U.S. Preventive Services Task Force 2013 versus 2021 lung cancer screening eligibility. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13 Background: Early detection of lung cancer provides the best opportunity for long-term survival. In 2021 US Preventive Services Task Force (USPSTF) expanded the 2013 risk-based Low-dose CT (LDCT) screening criteria, in part to reduce unintended race and gender disparities in lung cancer detection. We evaluated the impact of the updated USPSTF criteria in a cohort of patients from an incidental lung nodule program (ILNP). Methods: We implemented an ILNP in a community healthcare system in the mid-south US. Patients with lung lesions on routinely-performed radiologic studies were triaged using evidence-based guidelines. We prospectively tracked patient demographics, clinical characteristics, procedures, complications, and health outcomes. We classified all patients in the ILNP cohort based on USPSTF 2013 and 2021 screening criteria. Statistical analysis used the chi-square test. Results: The ILNP cohort included 14,642 patients from 2015-2021. This cohort was 56% female, 65% White, 29% Black, with a median age of 64 years. Overall 1,581 (10.8%) met 2013 and 2,051 (14.0%) met 2021 USPSTF criteria. 1.9% of subjects eligible by 2013 criteria were diagnosed with lung cancer compared to 2.2% by 2021 criteria. 470 additional patients met screening criteria when we expanded from USPSTF 2013 to 2021. As expected, these patients were younger and less likely to have Medicare insurance. These additional eligible patients were significantly more likely to be female (58% v 49%, p = 0.0011) or Black (28% vs. 18%, p < 0.0001) compared to those eligible by 2013 criteria. 44 of the 470 (9%) were diagnosed with cancer: 36% adenocarcinoma, 18% squamous, and 11% small cell, 11% non-lung primary, 9% non-small cell lung cancer NOS, and 15% other or unknown histology. The median tumor size was 3 cm with an interquartile range from 1.7 to 4.2 cm. The clinical stage distribution was 34% I, 4.5% II, 15.9% III, and 31.8% IV. Conclusions: In this selective community-based cohort, USPSTF 2021 criteria identified a higher percentage of subjects with lung cancer and were more inclusive of women and minorities compared to USPSTF 2013 criteria.
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Affiliation(s)
| | - Wei Liao
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Meghan Brooke Taylor
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Carrie Fehnel
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Nicholas Faris
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | | | - Sara Cat Williams
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Olawale Akinbobola
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Alicia Pacheco
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Amanda Epperson
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Joy Luttrell
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Denise McCoy
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Elizabeth Smith
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Kim Adams
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
| | - Meredith Ray
- University of Memphis, School of Public Health, Memphis, TN
| | - Todd Robbins
- Baptist Cancer Center, Multidisciplinary Thoracic Oncology Department, Memphis, TN
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Mouajou V, Adams K, DeLisle G, Quach C. HAND HYGIENE COMPLIANCE IN THE PREVENTION OF HOSPITAL ACQUIRED INFECTIONS: A SYSTEMATIC REVIEW. J Hosp Infect 2021; 119:33-48. [PMID: 34582962 DOI: 10.1016/j.jhin.2021.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Healthcare worker's (HCW) hands are known to be a primary source of transmission of hospital-acquired infections (HAIs). Thus, practicing hand hygiene (HH) and adhering to HH guidelines are both expected to decrease the risk of transmission but there is no consensus on the optimal hand hygiene compliance (HHC) rate that HCWs should aim for. AIM The objective of this study was to systematically review the published literature to determine an optimal threshold of HCW HHC rate associated with the lowest incidence rate of HAIs. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We searched online databases using a comprehensive search criterion for randomized controlled trials and non-randomized controlled studies, investigating the impact of HCW's HHC rate on HAI rates in patients of all ages, within healthcare facilities in high income countries. FINDINGS Of the 8,093 articles citations and abstracts screened, 35 articles were included in the review. Most studies reported overall HAIs per 1000 patient-days and device-associated HAIs per 1000 device-days. Most studies reported HHC rates between 60%-70%. Lower incidence HAI rates seemed to be achieved with HHC rates of approximately 60%. Studies included were not originally designed to assess the impact of HHC on HAI rates but risk of bias was assessed as per our predetermined exposure and outcome criterion. 11 (31%) of studies were deemed at low risk of bias. CONCLUSIONS Although HHC is part of HCW's code of conduct, very high HHC rates were difficult to reach. In observational studies, HHC and HAI followed a negative relationship up to about 60%. Due to flaws in study design, causality could not be inferred; only general trends could be discussed. Given the limitations, there is a need for high-quality evidence to support the implementation of specified targets of HHC rates.
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Affiliation(s)
- V Mouajou
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada
| | - K Adams
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - G DeLisle
- Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - C Quach
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada; Infection Prevention and Control, CHU Sainte-Justine, Montreal, QC, Canada.
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12
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Almeida Prado PS, Adams K, Fernandes LC, Kranioti E. Frontal sinus as an identity and sex indicator. Morphologie 2021; 105:281-287. [PMID: 33468429 DOI: 10.1016/j.morpho.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/15/2022]
Abstract
The present study explores the variability of frontal sinuses volume in modern Greeks and their potential use in the forensic identification process. METHODS The sample consisted of 102 CT scan images from a modern Greek population. 50 (49%) were male and 52 (51%) were female. Ages ranged from 19 to 101 (mean age 70.6 for males and 69.6 for females). 3D models of the skull were constructed, and volume calculations of the frontal sinus were done with the software Amira 5.4. 10 CT scans were used to extract 2D frontal and lateral images that were used as proxies of antemortem X-rays which were matched to the CT scans using manual craniofacial superimposition. RESULTS The average of frontal sinus volume of male was 9,220 mm3 (±SD) and female was 5,880 mm3 (±SD). Mann-Witney test confirmed that mean values were significantly different (P<0.05) between them. Pearson's correlation coefficient showed no evident correlation between the volumes and ages of the skulls in both groups. Using the lateral and anterior oriented radiographs for matching the sinuses, the method produced 60% sensitivity / 99.32% specificity and 80% sensitivity / 99.97% specificity, respectively. CONCLUSIONS Even though there are statistically significant differences in the shape and volume between sexes, these are not sufficient to be used as an indicator of sex in worldwide populations. The results indicate that using the anterior view of the frontal sinuses is more consistent in human identification, and that the method proves to be reliable, as long as the sinus is adequately observed on the radiograph.
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Affiliation(s)
- P S Almeida Prado
- Laboratoire d'Automatique de Mécanique et d'Informatique industrielles et Humaines (LAMIH), UMR CNRS 8201, Université Polytechnique Hauts-de-France, Valenciennes, France; Department of Bio-morphology, Federal University of Bahia, Salvador, Brazil.
| | - K Adams
- Edinburgh Unit for Forensic Anthropology, School of History, Classics and Archaeology, University of Edinburgh, Edinburgh, UK.
| | | | - E Kranioti
- Forensic Medicine Unit, Department of Forensic Sciences, University of Crete, Crete, Greece.
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Kinney-Lang E, Kelly D, Floreani ED, Jadavji Z, Rowley D, Zewdie ET, Anaraki JR, Bahari H, Beckers K, Castelane K, Crawford L, House S, Rauh CA, Michaud A, Mussi M, Silver J, Tuck C, Adams K, Andersen J, Chau T, Kirton A. Advancing Brain-Computer Interface Applications for Severely Disabled Children Through a Multidisciplinary National Network: Summary of the Inaugural Pediatric BCI Canada Meeting. Front Hum Neurosci 2020; 14:593883. [PMID: 33343318 PMCID: PMC7744376 DOI: 10.3389/fnhum.2020.593883] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/10/2020] [Indexed: 11/15/2022] Open
Abstract
Thousands of youth suffering from acquired brain injury or other early-life neurological disease live, mature, and learn with only limited communication and interaction with their world. Such cognitively capable children are ideal candidates for brain-computer interfaces (BCI). While BCI systems are rapidly evolving, a fundamental gap exists between technological innovators and the patients and families who stand to benefit. Forays into translating BCI systems to children in recent years have revealed that kids can learn to operate simple BCI with proficiency akin to adults. BCI could bring significant boons to the lives of many children with severe physical impairment, supporting their complex physical and social needs. However, children have been neglected in BCI research and a collaborative BCI research community is required to unite and push pediatric BCI development forward. To this end, the pediatric BCI Canada collaborative network (BCI-CAN) was formed, under a unified goal to cooperatively drive forward pediatric BCI innovation and impact. This article reflects on the topics and discussions raised in the foundational BCI-CAN meeting held in Toronto, ON, Canada in November 2019 and suggests the next steps required to see BCI impact the lives of children with severe neurological disease and their families.
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Affiliation(s)
- Eli Kinney-Lang
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Dion Kelly
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Erica D Floreani
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zeanna Jadavji
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Danette Rowley
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ephrem Takele Zewdie
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Javad R Anaraki
- Department of Rehabilitation Science, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,PRISM Laboratory, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Hosein Bahari
- I CAN Centre, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Kim Beckers
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Karen Castelane
- PRISM Laboratory, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Lindsey Crawford
- PRISM Laboratory, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Sarah House
- PRISM Laboratory, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Chelsea A Rauh
- PRISM Laboratory, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Amber Michaud
- I CAN Centre, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Matheus Mussi
- Assistive Technology Laboratory, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jessica Silver
- PRISM Laboratory, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Corinne Tuck
- I CAN Centre, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Kim Adams
- Assistive Technology Laboratory, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - John Andersen
- I CAN Centre, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada.,Assistive Technology Laboratory, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tom Chau
- Department of Rehabilitation Science, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,PRISM Laboratory, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Adam Kirton
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Abulfathi AA, Donald PR, Adams K, Svensson EM, Diacon AH, Reuter H. The pharmacokinetics of para-aminosalicylic acid and its relationship to efficacy and intolerance. Br J Clin Pharmacol 2020; 86:2123-2132. [PMID: 32470182 PMCID: PMC7576629 DOI: 10.1111/bcp.14395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/23/2022] Open
Abstract
Following its introduction as an antituberculosis agent close to 75 years ago, the use of para-aminosalicylic acid (PAS) has been limited by gastrointestinal intolerance and multiple formulations were produced in attempts to reduce its occurrence. More recently, an enteric-coated, granular, slow-release PAS formulation (PASER) was introduced and is now in wide-spread use for the treatment of drug-resistant tuberculosis. The current PASER dosing regimen is based on recommendations derived from older studies using a variety of different PAS formulations and relegate PAS to a role as an exclusively bacteriostatic agent. However, there is ample evidence that if sufficiently high serum concentrations are reached, PAS can be bactericidal and that intolerance following once daily dosing, that aids the achievement of such concentrations, is no worse than that following intermittent daily dosing. In particular, prevention of resistance to companion drugs appears to be dependent on the size of the single dose, and hence the peak concentrations, and not on maintaining serum levels consistently above minimum inhibitory concentration. We present a narrative review of the development of PAS formulations, dosing practices, and published data regarding pharmacokinetics and pharmacodynamics and the relationship of PAS dosage to intolerance and efficacy. Our conclusions suggests that we are at present not using PAS to its maximum ability to contribute to regimen efficacy and protect companion drugs.
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Affiliation(s)
- Ahmed A. Abulfathi
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Peter R. Donald
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Kim Adams
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Elin M. Svensson
- Department of Pharmaceutical BiosciencesUppsala UniversityUppsalaSweden
- Department of Pharmacy, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenthe Netherlands
| | - Andreas H. Diacon
- Task Applied ScienceBellvilleSouth Africa
- Department of Medicine, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Helmuth Reuter
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
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Hussain F, Laharwani H, Sonani H, Adams K. Primary Conjunctival Kaposi Sarcoma; A Rare And Unheard Entity. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Kaposi’s sarcoma (KS) is the most common malignant vascular tumor in human immunodeficiency virus (HIV) patients caused by human herpesvirus 8. It can affect the vascular endothelium of any part of the body however ocular KS as an initial manifestation has been reported only in 3 cases so far. It affects the vascular endothelium of the lacrimal gland, eyelids, orbit, palpebral and bulbar conjunctiva. It presents as a violaceous fleshy nodular mass.
Methods
A 23-year-old male with a past medical history of HIV presented with bilateral eye erythema and significant upper and lower lid edema. The patient was initially admitted for facial swelling which led to a conjunctival biopsy and a diagnosis of KS was made and doxorubicin along with chemotherapy was started. Four months later after the initiation of chemotherapy, the patient experienced worsening of facial swelling, and an area on the left side of his face got very firm. His physical examination was positive for a fever, drooling, facial swelling with trouble swallowing, and change of voice along with shortness of breath.
Results
CT of the orbit revealed symmetric enhancement swelling of the preseptal periorbital soft tissues which was thought to be nonspecific and a differential diagnosis included lymphedema, acute sinusitis, and orbital cellulitis was considered. A chest x-ray revealed bilateral pleural effusions and CT head revealed diffuse scalp and facial cutaneous and subcutaneous edema. Lab findings were significant for a low CD4: CD8 ratio. Cytological examination of the pleural fluid revealed predominantly blood, reactive mesothelial cells, macrophages, neutrophils, and lymphocytes, and appropriately controlled immunostain was positive for ERG and HHV8 with a possibility that Kaposi’s sarcoma cannot be completely excluded. Unfortunately, the patient passed away during the same time of pleural fluid analysis.
Autopsy findings revealed multiple metastatic foci in the mediastinal soft tissue, within the right land left lung, scalp soft tissue, retroperitoneal soft tissue, and hilar lymph node which were positive for CD34, CD31, and HHV8 and consistent with metastatic KS.
Conclusion
Thus, it is important to keep in mind that isolated conjunctival KP with later on systemic metastasis is rare with conjunctiva being an unusual site for the initial presentation, and a possibility of primary conjunctival KS should be considered in HIV positive patients.
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Affiliation(s)
- F Hussain
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
| | - H Laharwani
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
| | - H Sonani
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
| | - K Adams
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi, UNITED STATES
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Sakamaki I, Adams K, Tavakoli M, Wiebe SA. Effect of feedback and target size on eye gaze accuracy in an off-screen task. Disabil Rehabil Assist Technol 2020; 16:769-779. [PMID: 32100583 DOI: 10.1080/17483107.2020.1729874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Eye gaze interfaces have been used by people with severe physical impairment to interact with various assistive technologies. If used to control robots, it would be beneficial if individuals could gaze directly at targets in the physical environment rather than have to switch their gaze between a screen with representations of robot commands and the physical environment to see the response of their selection. By using a homogeneous transformation technique, eye gaze coordinates can be mapped between the reference coordinate frame of eye tracker and the coordinate frame of objects in the physical environment. Feedback about where the eye tracker has determined the eye gaze is fixated is needed so users can select targets more accurately. Screen-based assistive technologies can use visual feedback, but in a physical environment, other forms of feedback need to be examined. MATERIALS AND METHODS In this study, an eye gaze system with different feedback conditions (i.e., visual, auditory, vibrotactile, and no-feedback) was tested when participants received visual feedback on a display (on-screen) and when looking directly at the physical environment (off-screen). Target selection tasks in both screen conditions were performed by ten non-disabled adults, three non-disabled children, and two adults and one child with cerebral palsy. RESULTS Tasks performed with gaze fixation feedback modalities were accomplished faster and with higher success than tasks performed without feedback, and similar results were observed in both screen conditions. No significant difference was observed in performance across the feedback modalities, but participants had personal preferences. CONCLUSION The homogeneous transformation technique enabled the use of a stationary eye tracker to select target objects in the physical environment, and auditory and vibrotactile feedback enabled participants to be more accurate selecting targets than without it.Implications for RehabilitationBeing able to select target objects in the physical environment by eye gaze could make it easier for children with disabilities to control assistive robots, because in this way they do not have to change their focus between a computer screen with commands and the robot.Providing auditory or vibrotactile feedback when using an eye gaze system made it faster and easier to know if a target was being gazed upon.Being able to select targets in the environment using eye gaze could be beneficial for other assistive technology, too, such as destination selection for power wheelchairs.
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Affiliation(s)
- Isao Sakamaki
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kim Adams
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Sandra A Wiebe
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
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17
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Sakamaki I, Adams K, Tavakoli M, Wiebe S. A feasibility study of eye gaze with biofeedback in a human-robot interface. Assist Technol 2020; 34:148-156. [PMID: 31967531 DOI: 10.1080/10400435.2020.1719557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Play is a vital activity in which children learn skills and explore the environment through object manipulation. Assistive robots have been used to provide access to play, and Forbidden Region Virtual Fixture (FRVF) guidance at the user interface could help the users make the robot traverse the play environment more efficiently because it behaves like virtual walls to follow. Eye gaze was used to indicate the user's intended target and generate the location of the virtual walls in a card sorting task. We eliminated the typical computer screen required for visual feedback to confirm gaze location, and examined the use of alternative feedback. In this feasibility study, first a group of adults without physical impairment tested the system with auditory and vibrotactile feedback modalities for the gaze fixation and with the virtual walls on and off for robot movement. Then case studies with children and individuals with physical impairments were performed. Even though gaze fixation feedback and the virtual wall did not improve the performance of adult participants without impairment, the feedback increased the speed and accuracy of the gaze fixation and the virtual walls improved the movement efficiency for the participants with impairment and a 6-year-old child without impairment.
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Affiliation(s)
- Isao Sakamaki
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Kim Adams
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Canada
| | - Sandra Wiebe
- Department of Psychology, University of Alberta, Edmonton, Canada
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18
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Neaves B, Adams K. A100 Clemens von Pirquet Award Recipient LONG-TERM ADHERENCE TO IMPORTED FIRE ANT SUBCUTANEOUS IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Castellanos-Cruz JL, Tavakoli M, Pilarski PM, Adams K. Supporting Play by Applying Haptic Guidance Along a Surface Learnt from Single Motion Trajectories. IEEE Int Conf Rehabil Robot 2019; 2019:175-180. [PMID: 31374626 DOI: 10.1109/icorr.2019.8779391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Haptic-enabled teleoperated robots can help children with physical disabilities to reach toys by applying haptic guidance towards their toys, thus compensating for their limitations in reaching and manipulating objects. In this article we preliminarily tested a learning from demonstration (LfD) approach, where a robotic system learnt the surface that best approximated to all motion trajectories demonstrated by the participants while playing a whack-a-mole game. The end-goal of the system is for therapists or parents to demonstrate to it how to play a game, and then be used by children with physical disabilities. In this study, four adults without disabilities participated, to identify aspects that will be necessary to improve before conducting trials with children. During the demonstration phase, participants played the game in normal teleoperation, assuming the role of the therapist/parent. Then, the surface was modeled using a neural network. Participants played the game without and with the haptic guidance. The movements of the robotic system were mirrored to induce errors in movements, and thus require the guidance. Participants spent more time, moved the robot longer distances, and had jerkier movements when they played the game with the guidance than without it. Possible reasons were discussed, and several solutions were proposed to improve the system. The main contribution of this paper was the learning of a surface instead of learning a single motion trajectory.
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20
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McCann C, Adams K, Schizas A, George M, Barrett NA, Wyncoll DLA, Camporota L. Outcomes of emergency laparotomy in patients on extracorporeal membrane oxygenation for severe respiratory failure: A retrospective, observational cohort study. J Crit Care 2019; 53:253-257. [PMID: 31301640 DOI: 10.1016/j.jcrc.2019.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/21/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE There is a paucity of literature to support undertaking emergency laparotomy when indicated in patients supported on ECMO. Our study aims to identify the prevalence, outcomes and complications of this high risk surgery at a large ECMO centre. MATERIALS AND METHODS A single centre, retrospective, observational cohort study of 355 patients admitted to a university teaching hospital Severe Respiratory Failure service between December 2011 and January 2017. RESULTS The prevalence of emergency laparotomy in patients on ECMO was 3.7%. These patients had significantly higher SOFA and APACHE II scores compared to similar patients not requiring laparotomy. There was no difference in the duration of ECMO or intensive care unit (ICU) stay post decannulation between the two groups. 31% of laparotomy patients survived to hospital discharge. Major haemorrhage was uncommon, however emergency change of ECMO oxygenator was commonly required. CONCLUSION Survival to hospital discharge is possible following emergency laparotomy on ECMO, however the mortality is higher than for those patients not requiring laparotomy, this likely reflects the severity of underlying organ failure rather than the surgery itself. Our service's collocation with a general surgical service has made this development in care possible. ECMO service planning should consider general surgical provision.
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Affiliation(s)
- C McCann
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - K Adams
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - A Schizas
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - M George
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - N A Barrett
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human & Applied Physiological Sciences, King's College London, London, United Kingdom.
| | - D L A Wyncoll
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - L Camporota
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human & Applied Physiological Sciences, King's College London, London, United Kingdom.
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Smeltzer M, Stevens W, Faris NR, Kethireddy J, Meadows MB, Ray M, Epperson A, Adams K, Fulford A, Wagh A, Machin J, Tokin K, Optican R, Wright J, Robbins ET, Osarogiagbon RU. Lung cancer diagnosed by an incidental lung nodule program or lung cancer screening. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8546 Background: Early detection reduces lung cancer (LC) mortality. We prospectively evaluated LC patients diagnosed through Lung Cancer Screening (LCS) or an Incidental Lung Nodule Program (ILNP) (‘early detection’ programs) compared to routinely diagnosed LC patients in a multidisciplinary program (MDP). Methods: We compare demographics, tumor characteristics, and survival between the three groups diagnosed within the same healthcare system from 2015-2018. The ILNP prospectively tracks patients with suspicious lung lesions on routinely-performed studies flagged by radiologists using a standard macro text. LCS used Medicare eligibility criteria. Statistical methods include the chi-square test, Kruskal-Wallis test, and proportional hazards models with hazard ratios (HR) and 95% confidence intervals. Results: ILNP detected 201 lung cancers from 4713 scans (4.3%), LCS yielded 35 lung cancers from 1540 low-dose CT scans (2.3%), while MDC had 926 LC cases not detected by LCS or ILNP. Mean age at diagnosis for ILNP/LCS/MDC was 70/69/67 years (p = 0.0083); African Americans were under-represented in LCS (25%/11%/32%, p = 0.0104). LCS had the highest proportion with commercial insurance (46%/54%/43%, p = 0.3442). Early detection groups were more likely to have adenocarcinoma histology (ILNP/LCS/MDC: 61%/57%/49%, p = 0.0113). Smoking exposure was highest in LCS cohort (mean pack years: 48/64/52, p = 0.0500); 11% of ILNP, 8% MDC patients were never-smokers. Only 36% ILNP and 39% MDC patients were eligible for LCS by NLST criteria and 30%/40% by NELSON criteria. Reasons for ineligibility included smoking status in 73-90% and age in 7-27% of patients. Stage I/II distribution was (66%/58%/21%, p < 0.0001), stage IV 15%/20%/36%; surgical resection rates were (56%/55%/31%, p < 0.0001). Overall survival was longer in early detection groups (LCS HR: 0.31 [0.11,0.82]; ILNP HR: 0.51[0.33,0.81]) compared to MDC (p = 0.0011). Conclusions: The majority of LC patients were ineligible for LCS, but the ILNP identified LC in a high proportion of such patients, with similar stage re-distribution, curative-intent treatment, and survival rates. Structured ILNP complement LCS for early LC detection, such programs need to be built out.
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Affiliation(s)
| | | | | | | | | | - Meredith Ray
- University of Memphis, School of Public Health, Memphis, TN
| | | | | | | | - Ajay Wagh
- Memphis Lung Physician Foundation, Memphis, TN
| | - Jim Machin
- Midsouth Imaging and Therapeutics, Memphis, TN
| | - Keith Tokin
- Midsouth Imaging and Therapeutics, Memphis, TN
| | - Rob Optican
- Midsouth Imaging and Therapeutics, Memphis, TN
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Affiliation(s)
- K Adams
- University of Connecticut, Farmington, CT
| | - R Fortinsky
- Center on Aging, University of Connecticut School of Medicine
| | - D Steffens
- Department of Psychiatry, University of Connecticut Health Center
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Szari S, Adams K, Quinn J, Stokes S, Sacha J, White K. CHARACTERISTICS OF VENOM ALLERGY AT INITIAL EVALUATION. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Neaves B, Adams K, Smith D. SPORADIC CASE OF SPLICE SITE BTK MUTATION WITH DELAYED ONSET OF X-LINKED AGAMMAGLOBULINEMIA (XLA). Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Nath P, Schapira R, Edwards K, Adams K. IMPORTED FIRE ANT HYPERSENSITIVITY AND MASTOCYTOSIS: A CASE SERIES OF SUCCESSFUL IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Barry L, Adams K. THE HEALTHCARE NEEDS OF OLDER WOMEN PRISONERS: A FOCUS GROUP STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Barry
- University of Connecticut Center on Aging
| | - K Adams
- UCONN Health, Department of Psychiatry
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Phelan M, Meldon S, Brenner R, Deadwiler M, Adams K, Simon J, Levinson M, Hustey F, Mace S. 120 Skilled Nursing Facility 3-Day Waiver Pilot: Direct Admission to Skilled Nursing Facilities From the Emergency Department Avoids Hospital Admissions and Decreases Costs. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Adams K, Schulz-Kornas E, Arzi B, Failing K, Vogelsberg J, Staszyk C. Functional anatomy of the equine temporomandibular joint: Histological characteristics of the articular surfaces and underlining tissues. Vet J 2018; 239:35-41. [PMID: 30197107 DOI: 10.1016/j.tvjl.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/29/2018] [Accepted: 08/09/2018] [Indexed: 12/01/2022]
Abstract
It has been assumed that dental conditions cause disorders of the equine temporomandibular joint (TMJ), due to biomechanical overload or aberrant loading. However, the incidence of published TMJ disorders in horses is low and this leads to the question whether the equine TMJ is adapted well to its biomechanical requirements or is able to remodel its articular surfaces in response to modified loading conditions. The aim of this study was to determine the histological characteristics of healthy equine TMJs. The tissue components of the articular surfaces of 10 TMJs obtained from horses without any clinical history of dental or TMJ disorders were analysed. Apart from the mandibular fossa of the temporal bone, the osseous aspects of the TMJ exhibited a uniform zoning pattern. The articular surfaces were composed of three tissue layers: (1) a superficial cell-rich dense connective tissue layer; (2) a middle fibrocartilage layer; and (3) a deep hyaline-like cartilage layer. The articular disc was composed of an inner core of fibrocartilage and hyaline-like cartilage meshwork covered with both cell-rich dense connective tissue and fibrocartilage at its dorsal and ventral aspects. In contrast, the mandibular fossa was only covered by a dense connective tissue, frequently supplemented by a synovial membrane, suggesting low biomechanical stress. Glycosaminoglycans, which are indicative of compressive loads, were predominantly present within the rostral part of the articular tubercle and the retroarticular process, the dorsal part of articular disc and the entire mandibular head, but were absent within the mandibular fossa. The results of this study suggest the presence of different biomechanical demands in the dorsal and ventral compartment of the equine TMJ.
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Affiliation(s)
- K Adams
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - E Schulz-Kornas
- Max Planck Weizmann Centre for Integrative Archaeology and Anthropology, Max Planck Institute for Evolutionary Anthropology, 04103 Leipzig, Germany
| | - B Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis 95616, CA, USA
| | - K Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - J Vogelsberg
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - C Staszyk
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany.
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Catchpole I, Brett S, Sheppard N, Pradas DC, Jing J, Steiner D, Figueroa D, Tsvetkov L, Katlinskaya Y, Kaczynski H, Abbott R, Silk J, Adams K, Gerry A, Quattrini A, Tavano B, Crossland K, Weiderman G, Cornforth T, Britten C. Engineering T-cells for adoptive cell therapy to overcome TGF-β-mediated immunosuppression in the tumour microenvironment. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx711.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Agostini P, Lugg S, Adams K, Smith T, Kalkat M, Rajesh P, Steyn R, Naidu B, Rushton A, Bishay E. MA 08.09 Postoperative Mobilization and Rehabilitation Requirements for Lung Cancer Patients Undergoing Minimally Invasive Surgery. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sakamaki I, Adams K, Medina MFG, Cruz JLC, Jafari N, Tavakoli M, Janz H. Preliminary testing by adults of a haptics-assisted robot platform designed for children with physical impairments to access play. Assist Technol 2017; 30:242-250. [PMID: 28696831 DOI: 10.1080/10400435.2017.1318974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Development of children's cognitive and perceptual skills depends heavily on object exploration and experience in their physical world. For children who have severe physical impairments, one of the biggest concerns is the loss of opportunities for meaningful play with objects, including physical contact and manipulation. Assistive robots can enable children to perform object manipulation through the control of simple interfaces. Touch sensations conveyed through haptic interfaces in the form of force reflection or force assistance can help a child to sense the environment and to control a robot. A robotic system with forbidden region virtual fixtures (VFs) was tested in an object sorting task. Three sorting tasks-by color, by shape, and by both color and shape-were performed by 10 adults without disability and one adult with cerebral palsy. Tasks performed with VFs were accomplished faster than tasks performed without VFs, and deviations of the motion area were smaller with VFs than without VFs. For the participant with physical impairments, two out of three tasks were slower with the VFs. This implies that forbidden region VFs are not always able to improve user task performance. Alignment with an individual's unique motion characteristics can improve VF assistance.
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Affiliation(s)
- Isao Sakamaki
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Alberta , Canada
| | - Kim Adams
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Alberta , Canada.,b Glenrose Rehabilitation Hospital , Edmonton , Alberta , Canada
| | - Maria Fernanda Gomez Medina
- c Facultad de Ciencias de la Salud , Universidad del Rosario , Bogota , Colombia.,d Escuela Colombiana de Ingeniería Julio Garavito , Bogota , Colombia
| | - Javier Leonardo Castellanos Cruz
- c Facultad de Ciencias de la Salud , Universidad del Rosario , Bogota , Colombia.,d Escuela Colombiana de Ingeniería Julio Garavito , Bogota , Colombia
| | - Nooshin Jafari
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Alberta , Canada
| | - Mahdi Tavakoli
- e Department of Electrical and Computer Engineering , University of Alberta , Edmonton , Alberta , Canada
| | - Heidi Janz
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Alberta , Canada
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Jafari N, Adams K, Tavakoli M, Wiebe S, Janz H. Usability testing of a developed assistive robotic system with virtual assistance for individuals with cerebral palsy: a case study. Disabil Rehabil Assist Technol 2017; 13:517-522. [PMID: 28673115 DOI: 10.1080/17483107.2017.1344884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper presents a novel application of an assistive robotic system with virtual assistance to enhance manual performance of individuals with cerebral palsy. Cerebral palsy affects one's voluntary motor movements resulting in limited opportunities to actively engage in physical manipulative activities that require fine motor movements and coordination. Lack of object manipulation and environmental exploration can result in further impairments such as cognitive and social delays. The proposed assistive robotic system has been developed to enhance hand movements of people with disabilities when performing a functional task colouring. This paper presents the usability testing of the effectiveness of the developed system with an individual with cerebral palsy in a set of colouring tasks. Assisted and unassisted approaches were compared and analysed through quantitative and qualitative measures. The robotic-based approach was further compared with the participant's typical alternate access method to perform the same proposed tasks. The robotic system with virtual assistance was clinically validated to be significantly more effective, compared to both unassisted and typical approaches, by increasing the hand controllability, reducing the physical load and increasing the easiness of maintaining movements within the lines. Future studies will inform the use of the system for children with disabilities to provide them with assisted play for functional and playful activities. Implications for rehabilitation Robotic system can enhance manual performance in individuals with disabilities. Participating in a robot-mediated play activity could increase children's motivation and engagement. The developed robotic system can contribute to a basis for clinical and home-based implementation of the technology to promote manual play activities for children with disabilities.
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Affiliation(s)
- Nooshin Jafari
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada
| | - Kim Adams
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada.,b Aleksandar Kostov Assistive Technology Laboratory, Glenrose Rehabilitation Hospital , Edmonton , Canada
| | - Mahdi Tavakoli
- c Department of Electrical and Computer Engineering , University of Alberta , Edmonton , Canada
| | - Sandra Wiebe
- d Department of Psychology , University of Alberta , Edmonton , Canada
| | - Heidi Janz
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada
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Najafi M, Adams K, Tavakoli M. Robotic learning from demonstration of therapist's time-varying assistance to a patient in trajectory-following tasks. IEEE Int Conf Rehabil Robot 2017; 2017:888-894. [PMID: 28813933 DOI: 10.1109/icorr.2017.8009361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The number of people with physical disabilities and impaired motion control is increasing. Consequently, there is a growing demand for intelligent assistive robotic systems to cooperate with people with disability and help them carry out different tasks. To this end, our group has pioneered the use of robot learning from demonstration (RLfD) techniques, which eliminate the need for task-specific robot programming, in robotic rehabilitation and assistive technologies settings. First, in the demonstration phase, the therapist (or in general, a helper) provides an intervention (typically assistance) and cooperatively performs a task with a patient several times. The demonstrated motion is modelled by a statistical RLfD algorithm, which will later be used in the robot controllers to reproduce a similar intervention robotically. In this paper, by proposing a Tangential-Normal Varying-Impedance Controller (TNVIC), the robotic manipulator not only follows the therapist's demonstrated motion, but also mimics his/her interaction impedance during the therapeutic/assistive intervention. The feasibility and efficacy of the proposed framework are evaluated by conducting an experiment involving a healthy adult with cerebral palsy symptoms being induced using transcutaneous electrical nerve stimulation.
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Parés D, Drami I, Adams K, Grossi U, Suliman I, Knowles CH. Use of the Harmonic scalpel for Delorme's procedure. Colorectal Dis 2017; 19:O232-O234. [PMID: 28418599 DOI: 10.1111/codi.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/04/2017] [Indexed: 02/08/2023]
Abstract
AIM There are many surgical techniques that deal with external rectal prolapse but perineal procedures have the advantage of reduced invasiveness. Therefore, despite concerns regarding high recurrence rates, the technique is still used by many surgeons. METHOD This manuscript and video describe our early clinical experience using the Harmonic scalpel in 11 consecutive patients who underwent a Delorme's procedure for external rectal prolapse. RESULTS The median age of patients was 76 (range: 30-94) years. There were no intra-operative complications, and the median operative time was 78 min. Intra-operative blood loss was minimal (mean 45 ml; range 20-70 ml). Median length of stay was 2 (range: 0-8) days. Overall morbidity and recurrence were both 18%, with a median follow-up of 15 (range: 1-23) months. Nine patients were operated on by a senior trainee with consultant supervision. CONCLUSION The advantages of this device are mainly those of ease of mucosal dissection, minimal blood loss and shorter operative time in comparison with published series.
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Affiliation(s)
- D Parés
- National Bowel Research Centre, The Blizzard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - I Drami
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Adams
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - U Grossi
- National Bowel Research Centre, The Blizzard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - I Suliman
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - C H Knowles
- National Bowel Research Centre, The Blizzard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,The Royal London Hospital, Barts Health NHS Trust, London, UK
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Zettler JA, Adams K, Frederick B, Gutting A, Ingebretsen N, Ragsdale A, Schrey A. Genetic structure of Pseudococcus microcirculus (Hemiptera: Pseudococcidae) populations on epiphytic orchids in south Florida. J Genet 2017; 96:33-38. [PMID: 28360387 DOI: 10.1007/s12041-016-0736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In 2012, the orchid mealy bug Pseudococcus microcirculus was first detected in situ in North America's more diverse orchid region, the Big Cypress Basin (Collier Co FL). A follow-up survey showed that the mealy bug is more widespread and found on epiphytic orchids in two locations, in both the Fakahatchee Strand State Preserve (sites B and F) and the Florida Panther National Wildlife Refuge (sites M and C). There, we collected mealy bugs (n = 54) from 35 orchid individuals and screened allelic variation at seven microsatellite loci. We estimated genetic diversity and differentiation among all sites and compared the variation among individuals collected on the same plant. Genetic differentiation between sites M and C (FST = 0.03, P < 0.01) and,Mand B (FST = 0.04, P < 0.01) was detected.We also detected significantly lower mean pairwise relatedness among individuals from site B compared to all the other locations, and this population had the lowest inbreeding coefficient. Genetic diversity and mean pairwise relatedness were highly variable among plants with multiple individuals; however, plants from sites F and M tend to have collections of individuals with higher mean pairwise relatedness compared to sites B and C. Our results indicate that there is genetic diversity and differentiation among mealy bugs in these locations, and that collections of individuals on the same plant are genetically diverse. As such, the mealy bugs throughout these areas are likely to be genetically diverse and exist in multiple distinct populations.
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Affiliation(s)
- J A Zettler
- Department of Biology, Armstrong State University, Savannah, GA 31419, USA.
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Atashzar SF, Jafari N, Shahbazi M, Janz H, Tavakoli M, Patel RV, Adams K. Telerobotics-Assisted Platform for Enhancing Interaction with Physical Environments for People Living with Cerebral Palsy. ACTA ACUST UNITED AC 2017. [DOI: 10.1142/s2424905x17400013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, the design and implementation of a new telerobotics-assisted platform is proposed for individuals who have cerebral palsy (CP). The main objective of the proposed assistive system is to modulate capabilities of individuals through the proposed telerobotic medium and to enhance their control over interaction with objects in a real physical environment. The proposed platform is motivated by evidence showing that lack of interaction with real environments can develop further secondary sensorimotor and cognitive issues for people who grow up with CP. The proposed telerobotic system assists individuals by (a) mapping their limited but convenient motion range to a larger workspace needed for task performance in the real environment, (b) transferring only the voluntary components of the hand motion to the task-side robot to perform tasks and (c) kinaesthetically dissipating the energy of their involuntary motions using a viscous force field implemented in high frequency domain. Consequently, using the proposed system, an individual who has CP will be capable of providing smooth and large-scale motions and presenting enhanced coordination while performing tasks, even if they naturally have involuntary movements, limited range of motion and/or coordination deficits. The proposed architecture is implemented and initially tested for one nondisabled participant. Afterwards, the system is evaluated for one individual who lives with CP. The resulting quality of motion and task performance are analyzed through a designed clinical protocol. The results confirm the functionality of the proposed assistive platform in enhancing the capabilities of individuals who live with CP in interacting with physical environments.
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Affiliation(s)
- Seyed Farokh Atashzar
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Nooshin Jafari
- Faculty of Rehabilitation Medicine, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Mahya Shahbazi
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Heidi Janz
- Faculty of Rehabilitation Medicine, Edmonton, Alberta, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Canada
| | - Rajni V. Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Kim Adams
- Faculty of Rehabilitation Medicine, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
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Najafi M, Sharifi M, Adams K, Tavakoli M. Robotic assistance for children with cerebral palsy based on learning from tele-cooperative demonstration. Int J Intell Robot Appl 2017. [DOI: 10.1007/s41315-016-0006-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Heazlewood I, Walsh J, Climstein M, Adams K, Sevrene T, DeBeliso M. Injury location, type and incidence of male and female athletes competing at the world masters games. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Agostini P, Lugg ST, Adams K, Vartsaba N, Kalkat M, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. S63 Postoperative pulmonary complications and physiotherapy requirements after open thoracotomy versus vats lobectomy: a propensity score-matched analysis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Agostini P, Lugg ST, Adams K, Smith T, Kalkat M, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. S61 Risk factors and short-term outcomes of developing postoperative pulmonary complications after vats lobectomy. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jakes A, Jani P, Menon M, Adams K, Edey M, Fleming S, Bhandari S. Renal Squamous Cell Carcinoma of a Native Kidney After Renal Transplant: A Case Report. Transplant Proc 2016; 48:259-61. [PMID: 26915879 DOI: 10.1016/j.transproceed.2015.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/15/2015] [Accepted: 12/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Renal squamous cell carcinoma is a rare primary tumor of the kidney that rapidly invades local structures and has a poor prognosis. Presentation is usually nonspecific and is associated with renal stone disease and chronic infection. Immunosuppressed renal transplant recipients are more likely to develop a malignancy than the general population. Squamous cell carcinoma of the kidney in the context of a renal transplant and long-term immunosuppression has not previously been described in the literature. CASE REPORT A 46-year-old white man with previous renal stones and recurrent urinary infections underwent a right nephrectomy and subsequent renal transplantation owing to failure of the remaining kidney. Five years posttransplant, an abdominal ultrasound scan was performed owing to recurrent urinary infections and ongoing pyuria. This was reported as normal, but he later developed a discharging sinus in his left flank. A computed tomography (CT) scan revealed a tracking perinephric abscess with an associated cystic lesion of the left kidney. A left nephrectomy was performed and histologic examination suggested an invasive squamous cell carcinoma of the renal pelvis. The patient later required major surgery for chronic infection, and further imaging revealed metastatic disease, resulting in the decision to manage palliatively. CONCLUSION Given the nonspecific nature of the symptoms and the poor prognosis, health care professionals should have a lower threshold for diagnostic imaging in these patients. Abdominal ultrasonography was unhelpful and only a later CT scan revealed the underlying malignancy. This should be expedited if there is a persistent abnormality on urinalysis. Once diagnosed, a change in immunosuppressant regime to include sirolimus should be considered.
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Affiliation(s)
- A Jakes
- Renal Unit, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - P Jani
- Hull-York Medical School, University of Hull, Hull, UK
| | - M Menon
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Adams
- Department of Infection & Tropical Medicine, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Yorkshire, UK
| | - M Edey
- Renal Unit, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Kingston upon Hull, UK
| | - S Fleming
- Cellular and Molecular Pathology, Ninewells Hospital, University of Dundee, Dundee, UK
| | - S Bhandari
- Renal Unit, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Kingston upon Hull, UK.
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Connolly A, Donnellan N, Lutz E, Buys E, Lane F, Gecsi K, Adams K, Kenton K, Amundsen C, Gregory T, Botros S, Blanchard A, Dunivan G, Gosman G. Real-Time Feedback – Trying Something New – What Works? What Gets in the Way? Program Directors’ Perspectives on the myTIPreport Rollout Experience. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stevens B, Bell S, Adams K. Initial evaluation of inlet thermal desorption GC–MS analysis for organic gunshot residue collected from the hands of known shooters. Forensic Chem 2016. [DOI: 10.1016/j.forc.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Adams K, Schulz-Kornas E, Arzi B, Failing K, Vogelsberg J, Staszyk C. Functional anatomy of the equine temporomandibular joint: Collagen fiber texture of the articular surfaces. Vet J 2016; 217:58-64. [PMID: 27810212 DOI: 10.1016/j.tvjl.2016.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
In the last decade, the equine masticatory apparatus has received much attention. Numerous studies have emphasized the importance of the temporomandibular joint (TMJ) in the functional process of mastication. However, ultrastructural and histological data providing a basis for biomechanical and histopathological considerations are not available. The aim of the present study was to analyze the architecture of the collagen fiber apparatus in the articular surfaces of the equine TMJ to reveal typical morphological features indicating biomechanical adaptions. Therefore, the collagen fiber alignment was visualized using the split-line technique in 16 adult warmblood horses without any history of TMJ disorders. Within the central two-thirds of the articular surfaces of the articular tubercle, the articular disc and the mandibular head, split-lines ran in a correspondent rostrocaudal direction. In the lateral and medial aspects of these articular surfaces, the split-line pattern varied, displaying curved arrangements in the articular disc and punctual split-lines in the bony components. Mediolateral orientated split-lines were found in the rostral and caudal border of the articular disc and in the mandibular fossa. The complex movements during the equine chewing cycle are likely assigned to different areas of the TMJ. The split-line pattern of the equine TMJ is indicative of a relative movement of the joint components in a preferential rostrocaudal direction which is consigned to the central aspects of the TMJ. The lateral and medial aspects of the articular surfaces provide split-line patterns that indicate movements particularly around a dorsoventral axis.
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Affiliation(s)
- K Adams
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 98, 35390 Giessen, Germany
| | - E Schulz-Kornas
- Max Planck Weizmann Center for Integrative Archaeology and Anthropology, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
| | - B Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - K Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 95, 35390 Giessen, Germany
| | - J Vogelsberg
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 98, 35390 Giessen, Germany
| | - C Staszyk
- Institute of Veterinary-Anatomy, -Histology and -Embryology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 98, 35390 Giessen, Germany.
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Abstract
AIMS Children with limited gross motor and manual abilities have fewer opportunities to engage in free play. We investigated the effect of a robotic intervention on the playfulness of children with cerebral palsy (CP). METHODS We used a partially nonconcurrent multiple baseline design with four children and their mothers. Children were classified in level IV or V on the Gross Motor Function and Manual Ability Classification Systems. The intervention was the availability of an adapted Lego robot during a 15-min free play session between the child and mother. There were two sessions per week for about 14 weeks. Playfulness was measured using the Test of Playfulness. RESULTS Statistical comparisons using the 2 SD band and X-moving range chart methods revealed that all the children's levels of playfulness increased significantly while they played with the robot. Comparison of baseline and follow-up phase indicated that three children had retention of improved level of playfulness. CONCLUSION Play with adapted Lego robots increased the level of playfulness in all four children during free play with their mothers. The findings have implications for providing children with limitations in motor abilities opportunities for free play with family and friends.
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Affiliation(s)
- Adriana M Ríos-Rincón
- a School of Medicine and Health Sciences, Faculty of Rehabilitation Medicine , Universidad del Rosario, Bogot´ , Colombia.,b University of Alberta , Edmonton , Alberta , Canada
| | - Kim Adams
- b University of Alberta , Edmonton , Alberta , Canada
| | | | - Al Cook
- b University of Alberta , Edmonton , Alberta , Canada
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Batsis M, Dagalakis U, Stratakis CA, Prodanov T, Papadakis GZ, Adams K, Lodish M, Pacak K. Attention Deficit Hyperactivity Disorder in Pediatric Patients with Pheochromocytoma and Paraganglioma. Horm Metab Res 2016; 48:509-13. [PMID: 27171833 PMCID: PMC7441823 DOI: 10.1055/s-0042-106725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of the study is to evaluate if there is an association between attention deficit hyperactivity disorder (ADHD) and the diagnosis of pheochromocytoma/paraganglioma (PHEO/PGL) in pediatric patients. A case series study of 43 patients under the age of 18 with PHEO/PGL tumors who were evaluated at the National Institute of Health between January 2006 and May 2014 is reported. Prior diagnosis of ADHD and treatment course with stimulant medications was recorded. Patient symptoms, catecholamine and metanephrine levels, tumor characteristics, and genetic analyses for syndromes associated with PHEO/PGL were evaluated. A chi-squared test was used to assess the prevalence of ADHD in the PHEO/PGL patients compared to the general population. Nine out of 43 (21%) of patients diagnosed with PHEO/PGL had been diagnosed with ADHD prior to tumor identification. Four of the 9 patients had been treated with amphetamine, dextroamphetamine, and/or methylphenidate, potentially exacerbating an adrenergic crisis. In addition, 4 patients exhibited hypertension at the initial diagnosis of their PHEO/PGL. Three patients had resolution of their ADHD symptoms after successful surgical removal of PHEO/PGL. Our study found a prevalence of ADHD in 21% of our PHEO/PGL patients, significantly higher than 7.2% seen in the general pediatric population. Symptoms of anxiety and difficulty in concentration in these patients may have been related to their underlying PHEO/PGL and were not recognized as part of the constellation of symptoms in a child with PHEO/PGL. In pediatric patients with hypertension and ADHD symptomatology, an evaluation to rule out PHEO/PGL is warranted prior to treatment with stimulant medications.
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Affiliation(s)
- M. Batsis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - U. Dagalakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Albany Medical College, Albany, NY, USA
| | - C. A. Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - T. Prodanov
- Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - G. Z. Papadakis
- Department of Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, USA
| | - K. Adams
- Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - M. Lodish
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - K. Pacak
- Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Encarnação P, Leite T, Nunes C, Nunes da Ponte M, Adams K, Cook A, Caiado A, Pereira J, Piedade G, Ribeiro M. Using assistive robots to promote inclusive education. Disabil Rehabil Assist Technol 2016; 12:352-372. [PMID: 27115833 DOI: 10.3109/17483107.2016.1167970] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This paper describes the development and test of physical and virtual integrated augmentative manipulation and communication assistive technologies (IAMCATs) that enable children with motor and speech impairments to manipulate educational items by controlling a robot with a gripper, while communicating through a speech generating device. METHOD Nine children with disabilities, nine regular and nine special education teachers participated in the study. Teachers adapted academic activities so they could also be performed by the children with disabilities using the IAMCAT. An inductive content analysis of the teachers' interviews before and after the intervention was performed. RESULTS Teachers considered the IAMCAT to be a useful resource that can be integrated into the regular class dynamics respecting their curricular planning. It had a positive impact on children with disabilities and on the educational community. However, teachers pointed out the difficulties in managing the class, even with another adult present, due to the extra time required by children with disabilities to complete the activities. CONCLUSIONS The developed assistive technologies enable children with disabilities to participate in academic activities but full inclusion would require another adult in class and strategies to deal with the additional time required by children to complete the activities. Implications for Rehabilitation Integrated augmentative manipulation and communication assistive technologies are useful resources to promote the participation of children with motor and speech impairments in classroom activities. Virtual tools, running on a computer screen, may be easier to use but further research is needed in order to evaluate its effectiveness when compared to physical tools. Full participation of children with motor and speech impairments in academic activities using these technologies requires another adult in class and adequate strategies to manage the extra time the child with disabilities may require to complete the activities.
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Affiliation(s)
- P Encarnação
- a UCP - Católica Lisbon School of Business & Economics , Lisbon , Portugal
| | - T Leite
- b School of Education , Lisbon Polytechnic Institute , Lisbon , Portugal
| | - C Nunes
- b School of Education , Lisbon Polytechnic Institute , Lisbon , Portugal
| | - M Nunes da Ponte
- c Calouste Gulbenkian Rehabilitation Center for Cerebral Palsy , Lisbon , Portugal
| | - K Adams
- d Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , AB , Canada.,e Glenrose Rehabilitation Hospital , Edmonton , AB , Canada
| | - A Cook
- d Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , AB , Canada
| | - A Caiado
- c Calouste Gulbenkian Rehabilitation Center for Cerebral Palsy , Lisbon , Portugal
| | - J Pereira
- c Calouste Gulbenkian Rehabilitation Center for Cerebral Palsy , Lisbon , Portugal
| | - G Piedade
- a UCP - Católica Lisbon School of Business & Economics , Lisbon , Portugal
| | - M Ribeiro
- a UCP - Católica Lisbon School of Business & Economics , Lisbon , Portugal
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Osinga TE, Xekouki P, Nambuba J, Faucz FR, de la Luz Sierra M, Links TP, Kema IP, Adams K, Stratakis CA, van der Horst-Schrivers ANA, Pacak K. SDH Subunit Mutation Status in Saliva: Genetic Testing in Patients with Pheochromocytoma. Horm Metab Res 2016; 48:247-50. [PMID: 26916530 DOI: 10.1055/s-0035-1569265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Germline mutations occur in up to 30-40% of pheochromocytoma/paraganglioma, with mutations in the succinate dehydrogenase (SDH) subunits B (SDHB) and D (SDHD) being the most common. Blood samples are favored for obtaining high quality DNA, however, leukocytes can also be obtained by collecting saliva. The aim of this study was to determine whether SDHB and SDHD gene mutations in patients with pheochromocytoma/paraganglioma could be determined using a salivary sample. Paired blood and salivary samples were collected from 30 patients: 9 SDHB mutation positive, 13 with a SDHD mutation, and 8 without any SDHx mutations. The Oragene DISCOVER kit was used to collect and extract DNA from saliva. Blood DNA was extracted from EDTA blood samples. The DNA purification and concentration were measured by spectrophotometry. The 8 exons of SDHB and the 4 exons of SDHD were amplified and sequenced by PCR-based bidirectional Sanger sequencing. Total DNA yields from blood DNA were similar to those obtained from saliva DNA [mean (±SD) saliva vs. blood DNA concentration 514.6 (±580.8) ng/µl vs. 360.9 (±262.7) ng/µl; p=0.2)]. The purity of the saliva DNA samples was lower than that of blood [mean OD260/OD280 ratio 1.78 (±0.13) vs. 1.87 (±0.04); p=0.001, respectively], indicating more protein contamination in the saliva-extracted DNA. This study shows that salivary DNA collected from patients with pheochromocytoma/paraganglioma is a good alternative for extraction of genomic DNA for its high DNA concentration and acceptable purity and can be used as an alternative to blood derived DNA in screening for SDHB and SDHD mutations.
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Affiliation(s)
- T E Osinga
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - P Xekouki
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - J Nambuba
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - F R Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - M de la Luz Sierra
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - T P Links
- University of Groningen, Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - I P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K Adams
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - C A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - A N A van der Horst-Schrivers
- University of Groningen, Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - K Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
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Broom J, Broom A, Plage S, Adams K, Post JJ. Barriers to uptake of antimicrobial advice in a UK hospital: a qualitative study. J Hosp Infect 2016; 93:418-22. [PMID: 27130526 DOI: 10.1016/j.jhin.2016.03.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The role of infectious diseases (ID) and clinical microbiology (CM) in hospital settings has expanded in response to increasing antimicrobial resistance, leading to widespread development of hospital antimicrobial stewardship (AMS) programmes, the majority of which include antibiotic approval systems. However, inappropriate antibiotic use in hospitals continues, suggesting potential disjunctions between technical advice and the logics of antibiotic use within hospitals. AIM To examine the experiences of doctors in a UK hospital with respect to AMS guidance of antibiotic prescribing, and experiences of a verbal postprescription antibiotic approval process. METHODS Twenty doctors in a teaching hospital in the UK participated in semi-structured interviews about their experiences of antibiotic use and governance. NVivo10 software was used to conduct a thematic content analysis systematically. FINDINGS This study identified three key themes regarding doctors' relationships with ID/CM clinicians that shaped their antibiotic practices: (1) competing hierarchical influences limiting active consultation with ID/CM; (2) non-ID/CM consultants' sense of ownership over clinical decision-making and concerns about challenges to clinical autonomy; and (3) tensions between evidence-based practice and experiential-style learning. CONCLUSIONS This study illustrates the importance of examining relations between ID/CM and non-ID/CM clinicians in the hospital context, indicating that AMS models that focus exclusively on delivering advice rather than managing interprofessional relationships may be limited in their capacity to optimize antibiotic use. AMS and, specifically, antibiotic approval systems would likely be more effective if they incorporated time and resources for fostering and maintaining professional relationships.
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Affiliation(s)
- J Broom
- Department of Medicine, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia; School of Medicine, The University of Queensland, QLD, Australia.
| | - A Broom
- School of Social Sciences, The University of New South Wales, Sydney, NSW, Australia
| | - S Plage
- School of Social Sciences, The University of New South Wales, Sydney, NSW, Australia
| | - K Adams
- Department of Infectious Diseases, Hull and East Yorkshire NHS Trust, Kingston upon Hull, UK
| | - J J Post
- Department of Infectious Diseases, Prince of Wales Hospital and Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia
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Kvasnovsky CL, Adams K, Sideris M, Laycock J, Haji AK, Haq A, Nunoo-Mensah J, Papagrigoriadis S. Elderly patients have more infectious complications following laparoscopic colorectal cancer surgery. Colorectal Dis 2016; 18:94-100. [PMID: 26331365 DOI: 10.1111/codi.13109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/11/2015] [Indexed: 02/08/2023]
Abstract
AIM Elderly patients may be at higher risk of postoperative complications, particularly infective, than younger patients. METHOD We prospectively followed 163 consecutive patients undergoing elective laparoscopic resection for cancer. We compared patients < 65, 65-80 and > 80 years of age at the time of surgery. RESULTS Seventy (42.9%) patients had no complication; 93 (57.1%) had at least one complication following surgery and in 20 (12.3%) this was major. There was no difference in major complications between the groups (P = 0.47). Patients over 65 years of age were more likely to have a complication of any severity [< 65 years, 39.3%; 65-80 years, 69.3%; and > 80 years, 63.0% (P = 0.002)]. The frequency of gastrointestinal complications (30.1%) was similar in the groups (P = 0.29), as was wound infection (25.2%) (P = 0.65). There was an increase in the frequency of infectious complications, especially chest infection, with age, from 14.8% in patients < 65 years, to 22.7% in patients 65-80 years, to 44.4% in patients > 80 years (P = 0.01). Multivariate analysis showed no increase in overall complications in elderly patients, but Stage II or Stage III cancer (OR = 2.59, P = 0.04) and increasing body mass index (BMI) (OR = 1.07 for each unit increase in BMI, P = 0.04) were related to complications. Age remained the only predictor of an infective complication on multivariate analysis. Patients > 80 years of age had 4.21 times the OR of an infective complication (P = 0.03). CONCLUSION Older patients are more susceptible to infective complications postoperatively, particularly chest complications. Surgeons should alter their practice to reduce morbidity, such as adopting protocols requiring early physiotherapy.
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Affiliation(s)
- C L Kvasnovsky
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - K Adams
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - M Sideris
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - J Laycock
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - A K Haji
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - A Haq
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - J Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - S Papagrigoriadis
- Department of Colorectal Surgery, King's College Hospital, London, UK
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