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Flurpiridaz F-18 PET Myocardial Perfusion Imaging in Patients With Suspected Coronary Artery Disease. J Am Coll Cardiol 2023; 82:1598-1610. [PMID: 37821170 DOI: 10.1016/j.jacc.2023.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Flurpiridaz F-18 (flurpiridaz) is a novel positron emission tomography (PET) myocardial perfusion imaging tracer. OBJECTIVES The purpose of this study was to further assess the diagnostic efficacy and safety of flurpiridaz for the detection and evaluation of coronary artery disease (CAD) defined as ≥50% stenosis by quantitative invasive coronary angiography (ICA). METHODS In this second phase 3 prospective multicenter clinical study, 730 patients with suspected CAD from 48 clinical sites in the United States, Canada, and Europe were enrolled. Patients underwent 1-day rest/stress flurpiridaz PET and 1- or 2-day rest-stress Tc-99m-labeled single photon emission computed tomography (SPECT) before ICA. PET and SPECT images were read by 3 experts blinded to clinical and ICA data. RESULTS A total of 578 patients (age 63.7 ± 9.5 years) were evaluable; 32.5% were women, 52.3% had body mass index ≥30 kg/m2, and 33.6% had diabetes. Flurpiridaz PET met the efficacy endpoints of the study; its sensitivity and specificity were significantly higher than the prespecified threshold value by 2 of the 3 readers. The sensitivity of flurpiridaz PET was higher than SPECT (80.3% vs 68.7%; P = 0.0003) and its specificity was noninferior to SPECT (63.8% vs 61.7%; P = 0.0004). PET area under the receiver-operating characteristic curves were higher than SPECT in the overall population (0.80 vs 0.68; P < 0.001), women, and obese patients (P < 0.001 for both). Flurpiridaz PET was superior to SPECT (P < 0.001) for perfusion defect size/severity evaluation, image quality, diagnostic certainty, and radiation exposure. Flurpiridaz PET was safe and well tolerated. CONCLUSIONS This second flurpiridaz PET myocardial perfusion imaging trial shows that flurpiridaz has utility as a new tracer for CAD detection, specifically in women and obese patients. (An International Study to Evaluate Diagnostic Efficacy of Flurpiridaz [18F] Injection PET MPI in the Detection of Coronary Artery Disease [CAD]; NCT03354273).
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Initial Clinical Experience Using Daily Artificial Intelligence-Assisted Adaptive Radiotherapy on Cone-Beam CT for Cancer of the Head and Neck. Int J Radiat Oncol Biol Phys 2023; 117:e622. [PMID: 37785863 DOI: 10.1016/j.ijrobp.2023.06.2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adaptive radiation therapy (ART) has emerged as a promising method to modify treatment plans in response to structural and spatial changes that occur during a treatment course. In particular, patients with locally advanced Head and Neck (HN) Cancers often experience changes in target volumes and organs-at risk requiring replanning throughout treatment. The implementation of daily ART using daily cone-beam Cone-Beam CT (CBCT) imaging is a solution that may improve the therapeutic ratio by accounting for intra-fractional changes throughout the patient's treatment course. MATERIALS/METHODS We evaluated the initial clinical experience of daily ART for patients with locally advanced HN cancer using a commercially available, online adaptive platform with AI-assisted workflows on daily CBCT. For treatment, AI-based auto-contour and structure deformation of OARs and Targets were reviewed and edited by the treating physician. Two plans were generated including, a CT sim-based plan with deformed structures (scheduled) and a re-optimized plan (adaptive) of which both plans evaluated and the best one approved and delivered. Clinical outcomes and dosimetric parameters were reviewed. RESULTS A total of 23 patients with locally advanced HN cancers (7 Nasopharynx, 6 Oropharynx, 2 oral cavity, 8 larynx) were treated with daily ART from December 2020 until November 2022. 655 adaptive and scheduled radiotherapy plans were generated of which 95.7% of the adaptive plans were chosen. Adaptive plans demonstrated superior V95 PTV70, PTV60, PTV56 mean coverage by 1.02%, 8.14%, and 7.2%, respectively. At a median follow up of 10.1 months, the local control was 91.3%. The 1-year actuarial PFS was 86.9% and 1 year actuarial OS was 82.6%. Two patients required prophylactic g-tube. 30% and 21% of patients had acute grade 3 dysphagia and odynophagia, respectively; 13% with chronic grade 2 xerostomia. There were no grade 4 or grade 5 toxicities. CONCLUSION These findings provide evidence for the feasibility and potential clinical benefit of incorporating daily adaptive AI radiotherapy on CBCT in the treatment of locally advanced HN cancer. Further prospective studies are needed to confirm these findings and determine the optimal clinical applications of this approach.
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Searching for clinical trials in oncology: finding a path through the maze. Ann Oncol 2023; 34:732-733. [PMID: 37385470 DOI: 10.1016/j.annonc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
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Initial Experience Using Daily Artificial Intelligence-Assisted Adaptive Radiotherapy on Cone-Beam CT for Bladder Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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P2.08-09 Adaptation of Empathic Communication Skills Training for Oncology Care Providers to Reduce Lung Cancer Stigma. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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P2.08-07 The Campaign to End Lung Cancer Stigma: The ACS National Lung Cancer Roundtable Efforts to Confront and Extinguish Lung Cancer Stigma. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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MA14.04 Sexual Health Assessment in Women with Lung Cancer (SHAWL) Study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts' ambulance diversion ban. BMC Health Serv Res 2022; 22:987. [PMID: 35918721 PMCID: PMC9347077 DOI: 10.1186/s12913-022-08358-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background The impact of ambulance diversion on potentially diverted patients, particularly racial/ethnic minority patients, is largely unknown. Treating Massachusetts’ 2009 ambulance diversion ban as a natural experiment, we examined if the ban was associated with increased concordance in Emergency Medical Services (EMS) patients of different race/ethnicity being transported to the same emergency department (ED). Methods We obtained Medicare Fee for Service claims records (2007–2012) for enrollees aged 66 and older. We stratified the country into patient zip codes and identified zip codes with sizable (non-Hispanic) White, (non-Hispanic) Black and Hispanic enrollees. For a stratified random sample of enrollees from all diverse zip codes in Massachusetts and 18 selected comparison states, we identified EMS transports to an ED. In each zip code, we identified the most frequent ED destination of White EMS-transported patients (“reference ED”). Our main outcome was a dichotomous indicator of patient EMS transport to the reference ED, and secondary outcome was transport to an ED serving lower-income patients (“safety-net ED”). Using a difference-in-differences regression specification, we contrasted the pre- to post-ban changes in each outcome in Massachusetts with the corresponding change in the comparison states. Results Our study cohort of 744,791 enrollees from 3331 zip codes experienced 361,006 EMS transports. At baseline, the proportion transported to the reference ED was higher among White patients in Massachusetts and comparison states (67.2 and 60.9%) than among Black (43.6 and 46.2%) and Hispanic (62.5 and 52.7%) patients. Massachusetts ambulance diversion ban was associated with a decreased proportion transported to the reference ED among White (− 2.7 percentage point; 95% CI, − 4.5 to − 1.0) and Black (− 4.1 percentage point; 95% CI, − 6.2 to − 1.9) patients and no change among Hispanic patients. The ban was associated with an increase in likelihood of transport to a safety-net ED among Hispanic patients (3.0 percentage points, 95% CI, 0.3 to 5.7) and a decreased likelihood among White patients (1.2 percentage points, 95% CI, − 2.3 to − 0.2). Conclusion Massachusetts ambulance diversion ban was associated with a reduction in the proportion of White and Black EMS patients being transported to the most frequent ED destination for White patients, highlighting the role of non-proximity factors in EMS transport destination. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08358-8.
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ESMO expert consensus statements on the management of EGFR mutant non-small-cell lung cancer. Ann Oncol 2022; 33:466-487. [PMID: 35176458 DOI: 10.1016/j.annonc.2022.02.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/14/2022] [Accepted: 02/06/2022] [Indexed: 12/14/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) held a virtual consensus-building process on epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer in 2021. The consensus included a multidisciplinary panel of 34 leading experts in the management of lung cancer. The aim of the consensus was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where the available evidence is either limited or conflicting. The main topics identified for discussion were: (i) tissue and biomarkers analyses; (ii) early and locally advanced disease; (iii) metastatic disease and (iv) clinical trial design, patient's perspective and miscellaneous. The expert panel was divided into four working groups to address questions relating to one of the four topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the recommendations developed, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation.
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Population Mobility and Socioeconomic Indicators in California, USA and Ontario, Canada during the COVID-19 Pandemic. Int J Infect Dis 2022. [PMCID: PMC8884814 DOI: 10.1016/j.ijid.2021.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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A Multi-Center, Open-Label, Randomized, Two-Arm Study, to Evaluate the Efficacy of Osimertinib with Early Intervention SRS Treatment Compared to the Continuation of Osimertinib Alone, in Patients with EGFR-Mutated NSCLC and Asymptomatic Brain Metastases. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.10.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Potential bypassing of nearest emergency department by EMS transports. Health Serv Res 2021; 57:300-310. [PMID: 34723392 DOI: 10.1111/1475-6773.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Guidelines recommend emergency medical services (EMS) patients to be transported to the nearest appropriate emergency department (ED). Our objective was to estimate the prevalence of EMS transport to an ED other than the nearest ED ("potential bypassing"). DATA SOURCES Illinois Prehospital Patient Care Report Data of EMS transports (July 2019 to December 2019). DATA COLLECTION/EXTRACTION METHODS We identified all EMS ground transports with an advanced life-support (ALS) paramedic to an ED for patients aged 21 years and older. Using street address of incident location, we performed geocoding and driving route analyses and obtained estimated driving distance and time to the destination ED and alternative EDs. MAIN OUTCOME AND MEASURES Our main outcomes were dichotomous indicators of potential bypassing of the nearest ED based on distance and time. As secondary outcomes we examined potential bypassing indicators based on excess driving distance and time. STUDY DESIGN We used Poisson regression models to obtain adjusted relative rates of potential bypassing indicators by acuity level, primary impression, patient demographics and geographic characteristics. PRINCIPAL FINDINGS Our study cohort of 361,051 EMS transports consisted of 5.8% critical, 37.2% emergent and 57.0% low acuity cases transported to 222 EDs. The observed rate of potential bypassing was approximately 34% of cases for each acuity level. Treating the cardiovascular primary impression code group as the reference case, we found small to no differences in potential bypassing rates across other primary impression code groups of all acuity levels, with the exception of critical acuity trauma cases for which potential bypassing rate was 64% higher (incidence rate ratio = 1.64, 95% confidence interval, 1.54-1.74). Compared to zip codes with one ED within a 5-mile vicinity, potential bypassing was higher in areas with no ED or multiple EDs within a 5-mile vicinity. CONCLUSION Approximately one-third of EMS transports potentially bypassed the nearest ED. EMS transport destination may be motivated by factors other than proximity.
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OA10.02 Psychosocial Distress in Patients with Driver-Mutant Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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MA07.01 How Lung Cancer Patients Perceive their Treating Doctors and Engage in medical decision-making: Lessons from Project PRIORITY. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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P30.05 Perception of Palliative Care and Prognostic Awareness of Lung Cancer Treatment in an Oncogene-Driven Lung Cancer Community. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Census tract-level association between racial composition and life expectancy among 492 large cities in the United States. Ann Epidemiol 2019. [DOI: 10.1016/j.annepidem.2019.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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OA03.06 Impact of an EGFR-Lung Cancer Diagnosis on Quality of Life of Patients: Learnings from Project Priority. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
IMPORTANCE Evidence from national studies indicates systematic differences in hospitals in which racial/ethnic minorities receive care, with most care obtained in a small proportion of hospitals. Little is known about the source of these differences. OBJECTIVES To examine the patterns of emergency department (ED) destination of emergency medical services (EMS) transport according to patient race/ethnicity, and to compare the patterns between those transported by EMS and those who did not use EMS. DESIGN, SETTING, AND PARTICIPANTS This cohort study of US EMS and EDs used Medicare claims data from January 1, 2006, to December 31, 2012. Enrollees aged 66 years or older with continuous fee-for-service Medicare coverage (N = 864 750) were selected for the sample. Zip codes with a sizable count (>10) of Hispanic, non-Hispanic black, and non-Hispanic white enrollees were used for comparison of EMS use across racial/ethnic subgroups. Data on all ED visits, with and without EMS use, were obtained. Data analysis was performed from December 18, 2018, to July 7, 2019. MAIN OUTCOMES AND MEASURES The main outcome measure was whether an EMS transport destination was the most frequent ED destination among white patients (reference ED). The secondary outcomes were (1) whether the ED destination was a safety-net hospital and (2) the distance of EMS transport from the ED destination. RESULTS The study cohort comprised 864 750 Medicare enrollees from 4175 selected zip codes who had 458 701 ED visits using EMS transport. Of these EMS-transported enrollees, 26.1% (127 555) were younger than 75 years, and most were women (302 430 [66.8%]). Overall, the proportion of white patients transported to the reference ED was 61.3% (95% CI, 61.0% to 61.7%); this rate was lower among black enrollees (difference of -5.3%; 95% CI, -6.0% to -4.6%) and Hispanic enrollees (difference of -2.5%; 95% CI, -3.2% to -1.7%). A similar pattern was found among patients with high-risk acute conditions; the proportion transported to the reference ED was 61.5% (95% CI, 60.7% to 62.2%) among white enrollees, whereas this proportion was lower among black enrollees (difference of -6.7%; 95% CI, -8.3% to -5.0%) and Hispanic enrollees (difference of -2.6%; 95% CI, -4.5% to -0.7%). In major US cities, a larger black-white discordance in ED destination was observed (-9.3%; 95% CI, -10.9% to -7.7%). Black and Hispanic patients were more likely to be transported to a safety-net ED compared with their white counterparts; the proportion transported to a safety-net ED among white enrollees (18.5%; 95% CI, 18.1% to 18.7%) was lower compared with that among black enrollees (difference of 2.7%; 95% CI, 2.2% to 3.2%) and Hispanic enrollees (difference of 1.9%; 95% CI, 1.3% to 2.4%). Concordance rates of non-EMS-transported ED visits were statistically significantly lower than for EMS-transported ED visits; the concordance rate among white enrollees of 52.9% (95% CI, 52.1% to 53.6%) was higher compared with that among black enrollees (difference of -4.8%; 95% CI, -6.4% to -3.3%) and Hispanic enrollees (difference of -3.0%; 95% CI, -4.7% to -1.3%). CONCLUSIONS AND RELEVANCE This study found race/ethnicity variation in ED destination for patients using EMS transport, with black and Hispanic patients more likely to be transported to a safety-net hospital ED compared with white patients living in the same zip code.
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C-51 Long Term Neuropsychological Follow-Up of Radiation Induced Cognitive Decline (RICD) in Cerebellar Medulloblastoma. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
We expanded upon an early case study suggesting long-term, sequential neurocognitive evaluation and academic interventions following pediatric cerebellar medulloblastoma. This five-year-old patient (now forty) has indeed undergone lifespan assessment and clearly benefitted from appropriate interventions to date.
Method
This left-handed, white, male is status post (s/p) gross total resection and whole brain radiation. In adulthood, he developed radiation necrosis with hemorrhage and refractory seizures (s/p right temporal lobectomy). More recently, radiation induced bilateral parietal meningiomas were identified (s/p gamma knife).
Results
We analyzed cognitive, medical/oncological, imaging and interventional data at developmentally meaningful time points and found consistent declines in intellectual skills and cognitive function spanning attention/concentration, processing speed, visual perceptual/organization and visually based learning/memory; however, we noted stabilization and even improvement in important areas. Areas of age-appropriate functioning were noted in expressive vocabulary, verbal abstract reasoning, delayed verbal memory, and problem-solving, among others.
Conclusions
Although some studies have addressed long-term outcomes in pediatric medulloblastoma, we provide a unique perspective to the literature by documenting serial neurocognitive findings in addition to interventions across the lifespan. Our findings suggest that appropriate academic interventions/neurocognitive rehabilitation strategies are in fact meaningful at the individual level and propose that a focus on strengths can improve outcomes. We propose that this previously recommended model of assessment/intervention truly become the available standard of care in all pediatric oncologic populations.
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Normas de Atención para la salud de personas trans y con variabilidad de género. INT J TRANSGENDERISM 2018. [DOI: 10.1080/15532739.2018.1503902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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P1.02-04 The EGFR Resisters Lung Cancer Group: A Patient-Driven Initiative to Understand and Improve Treatments for EGFR+ Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Geographic Variation in Use of Ambulance Transport to the Emergency Department. Ann Emerg Med 2017; 70:533-543.e7. [PMID: 28559039 DOI: 10.1016/j.annemergmed.2017.03.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/23/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Evidence on variability in emergency medical services use is limited. We obtain national evidence on geographic variation in the use of ambulance transport to the emergency department (ED) among Medicare enrollees and assess the role of health status, socioeconomic status, and provider availability. METHODS We used 2010 Medicare claims data for a random sample of 999,999 enrollees aged 66 years and older, and identified ambulance transport and ED use. The main outcome measures were number of ambulance transports to the ED per 100 person-years (ambulance transport rate) and proportion (percentage) of ED visits by ambulance transport by hospital referral regions. RESULTS The national ambulance transport rate was 22.2 and the overall proportion of ED visits by ambulance was 36.7%. Relative to hospital referral regions in the lowest rate quartile, those in the highest quartile had a 75% higher ambulance transport rate (incidence rate ratio [IRR] 1.75; 95% confidence interval [CI] 1.69 to 1.81) and a 15.5% higher proportion of ED visits by ambulance (IRR 1.155; 95% CI 1.146 to 1.164). Adjusting for health status, socioeconomic status, and provider availability reduced quartile 1 versus quartile 4 difference in ambulance transport rate by 43% (IRR 1.43; 95% CI 1.38 to 1.48) and proportion of ED visits by ambulance by 7% (IRR 1.145; 95% CI 1.135 to 1.155). Among the 3 covariate domains, health status was associated with the largest variability in ambulance transport rate (30.1%), followed by socioeconomic status (12.8%) and provider availability (2.9%). CONCLUSION Geographic variability in ambulance use is large and associated with variation in patient health status and socioeconomic status.
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Image Segmentation and Machine Learning for Detection of Abdominal Free Fluid in Focused Assessment With Sonography for Trauma Examinations: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2501-2509. [PMID: 27738293 PMCID: PMC7929643 DOI: 10.7863/ultra.15.11017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/04/2016] [Indexed: 06/06/2023]
Abstract
The objective of this pilot study was to test the feasibility of automating the detection of abdominal free fluid in focused assessment with sonography for trauma (FAST) examinations. Perihepatic views from 10 FAST examinations with positive results and 10 FAST examinations with negative results were used. The sensitivity and specificity compared to manual classification by trained physicians was evaluated. The sensitivity and specificity (95% confidence interval) were 100% (69.2%-100%) and 90.0% (55.5%-99.8%), respectively. These findings suggest that computerized detection of free fluid on abdominal ultrasound images may be sensitive and specific enough to aid clinicians in their interpretation of a FAST examination.
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Methodology of AA CRASH: a prospective observational study evaluating the incidence and pathogenesis of adverse post-traumatic sequelae in African-Americans experiencing motor vehicle collision. BMJ Open 2016; 6:e012222. [PMID: 27601501 PMCID: PMC5020668 DOI: 10.1136/bmjopen-2016-012222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A motor vehicle collision (MVC) is one of the most common life-threatening events experienced by individuals living in the USA. While most individuals recover following MVC, a significant proportion of individuals develop adverse post-traumatic sequelae such as post-traumatic stress disorder or persistent musculoskeletal pain. Adverse post-traumatic sequelae are common, morbid and costly public health problems in the USA and other industrialised countries. The pathogenesis of these disorders following MVC remains poorly understood. In the USA, available data suggest that African-Americans experience an increased burden of adverse post-traumatic sequelae after MVC compared to European Americans, but to date no studies examining the pathogenesis of these disorders among African-Americans experiencing MVC have been performed. METHODS AND ANALYSIS The African-American CRASH (AA CRASH) study is an NIH-funded, multicentre, prospective study that enrols African-Americans (n=900) who present to the emergency department (ED) within 24 hours of MVC. Participants are enrolled at 13 ED sites in the USA. Individuals who are admitted to the hospital or who report a fracture or tissue injury are excluded. Participants complete a detailed ED interview that includes an assessment of crash history, current post-traumatic symptoms and health status prior to the MVC. Blood samples are also collected in the ED using PAXgene DNA and PAXgene RNA tubes. Serial mixed-mode assessments 6 weeks, 6 months and 1 year after MVC include an assessment of adverse sequelae, general health status and health service utilisation. The results from this study will provide insights into the incidence and pathogenesis of persistent pain and other post-traumatic sequelae in African-Americans experiencing MVC. ETHICS AND DISSEMINATION AA CRASH has ethics approval in the USA, and the results will be published in a peer-reviewed journal.
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(100) African Americans experience a greater burden of acute pain after motor vehicle collision than European Americans. THE JOURNAL OF PAIN 2016. [DOI: 10.1016/j.jpain.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Incentives to participate in clinical trials: practical and ethical considerations. Am J Emerg Med 2015; 33:1197-200. [PMID: 26095131 PMCID: PMC4562811 DOI: 10.1016/j.ajem.2015.05.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical trials often offer incentives to encourage individuals to enroll and to enhance follow-up. The scope and nature of incentives used in emergency department (ED)-based trials are unknown. OBJECTIVES The objective of this study is to characterize the quantity and quality of incentives and other forms of compensation used in clinical trials of human subjects recruited in US EDs. A secondary goal is to provide an historical and ethical analysis of the use of incentives in clinical trials. METHODS We reviewed English-language randomized clinical trials conducted in US EDs from 2009 to 2013. Full text of the studies was reviewed to identify whether incentives were used, their value, and timing. Funding source was noted as well. Data are presented with descriptive statistics. RESULTS Of 1151 articles identified, 76 (6.6%) fit criteria for review. Of these, 7 (9.2%) provided incentive payments. A recently published eighth trial was included as well. The total cash value of incentives offered ranged from $10 to $195. Four studies offered payment at enrollment only. Incentives included cash, debit cards, and gift cards. CONCLUSION The use of financial incentives in ED-based trials is uncommon. Studies that use incentives are generally extramurally funded, usually by a federal agency, and include waves of follow-up that continue after discharge from the ED. Payment size is modest. Incentives may improve recruitment and retention in ED-based trials, but authoritative data are lacking. Investigators need to take care to avoid incentives that may be coercive or unduly influence research participants.
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Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes. Am J Psychiatry 2015; 172:344-52. [PMID: 25827032 PMCID: PMC4537796 DOI: 10.1176/appi.ajp.2014.14030357] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few studies targeting obesity in serious mental illness have reported clinically significant risk reduction, and none have been replicated in community settings or demonstrated sustained outcomes after intervention withdrawal. The authors sought to replicate positive health outcomes demonstrated in a previous randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population. METHOD Persons with serious mental illness and a body mass index (BMI) >25 receiving services in three community mental health organizations were recruited and randomly assigned either to the 12-month In SHAPE program, which included membership in a public fitness club and weekly meetings with a health promotion coach, or to fitness club membership alone. The primary outcome measures were weight and cardiorespiratory fitness (as measured with the 6-minute walk test), assessed at baseline and at 3, 6, 9, 12, and 18 months. RESULTS Participants (N=210) were ethnically diverse (46% were nonwhite), with a mean baseline BMI of 36.8 (SD=8.2). At 12 months, the In SHAPE group (N=104) had greater reduction in weight and improved fitness compared with the fitness club membership only group (N=106). Primary outcomes were maintained at 18 months. Approximately half of the In SHAPE group (51% at 12 months and 46% at 18 months) achieved clinically significant cardiovascular risk reduction (a weight loss ≥5% or an increase of >50 meters on the 6-minute walk test). CONCLUSIONS This is the first replication study confirming the effectiveness of a health coaching intervention in achieving and sustaining clinically significant reductions in cardiovascular risk for overweight and obese persons with serious mental illness.
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Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness. Am J Geriatr Psychiatry 2014; 22:1251-61. [PMID: 23954039 PMCID: PMC3836872 DOI: 10.1016/j.jagp.2013.04.013] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 03/28/2013] [Accepted: 04/24/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This report describes 1-, 2-, and 3-year outcomes of a combined psychosocial skills training and preventive healthcare intervention (Helping Older People Experience Success [HOPES]) for older persons with serious mental illness. METHODS A randomized controlled trial compared HOPES with treatment as usual (TAU) for 183 older adults (age ≥ 50 years [mean age: 60.2]) with serious mental illness (28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression) from two community mental health centers in Boston, Massachusetts, and one in Nashua, New Hampshire. HOPES comprised 12 months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive healthcare visits, followed by a 1-year maintenance phase of monthly sessions. Blinded evaluations of functioning, symptoms, and service use were conducted at baseline and at a 1-year (end of the intensive phase), 2-year (end of the maintenance phase), and 3-year (12 months after the intervention) follow-up. RESULTS HOPES compared with TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive healthcare (more frequent eye exams, visual acuity, hearing tests, mammograms, and Pap smears), and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at the 3-year follow-up. CONCLUSION Skills training and nurse facilitated preventive healthcare for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive healthcare screening, and advance care planning.
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272 Efficacy of Topical Perfluoro t-butylcyclohexane, Oxygen-Saturated Gel in a Model of Delayed Wound Healing: Partial Thickness Burn Wound With Pseudomonas Infection in Swine. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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C-60 * Prospective Neurocognitive Longitudinal Study of Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bayesian Hierarchical Grouping: perceptual grouping as mixture estimation. J Vis 2014. [DOI: 10.1167/14.10.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Local and global cues to depth in line drawings. J Vis 2014. [DOI: 10.1167/14.10.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Combination of contour convexity and accretion/deletion in the perception of relative depth. J Vis 2014. [DOI: 10.1167/14.10.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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In reply. Ann Emerg Med 2014; 64:98-9. [DOI: 10.1016/j.annemergmed.2014.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
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Totally Implantable IV Treprostinil Therapy in Pulmonary Arterial Hypertension: Assessment of the Implantation Procedure. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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"No diversion": a qualitative study of emergency medicine leaders in Boston, MA, and the effects of a statewide diversion ban policy. Ann Emerg Med 2013; 63:589-597.e7. [PMID: 24120631 DOI: 10.1016/j.annemergmed.2013.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/08/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE We examine the attitudes of emergency department (ED) key informants about the perceived effects of a statewide ban on ambulance diversion on patients, providers, and working relationships in a large urban emergency medical system. METHODS We performed a qualitative study to examine the effects of a diversion ban on Boston area hospitals. Key informants at each site completed semistructured interviews that explored relevant domains pre- and postban. Interviews were deidentified, transcribed, coded, and analyzed with grounded theory for emerging themes. We identified important themes focused on patient safety, quality of care, and relationships before and after implementation of the diversion ban. RESULTS Nine of 9 eligible sites participated. Eighteen interviews were completed: 7 MD ED directors, 2 MD designees, and 9 registered nurse leaders. Although most participants had negative opinions about diversion, some had considered diversion a useful procedure. Key themes associated with diversion were adverse effects on patient care quality, patient satisfaction, and a source of conflict among ED staff and with emergency medical services (EMS). All key informants described some positive effect of the ban, including those who reported that the ban had no direct effect on their individual hospital. Although the period preceding the ban was reported to be a source of apprehension about its effects, most key informants believed the ban had improved quality of care and relationships between hospital staff and EMS. CONCLUSION Key informants considered the diversion ban to have had a favorable effect on emergency medical care in Boston. These results may inform the discussion in other states considering a diversion ban.
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Volatile, Isotope, and Organic Analysis of Martian Fines with the Mars Curiosity Rover. Science 2013; 341:1238937. [DOI: 10.1126/science.1238937] [Citation(s) in RCA: 327] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Detecting shapes in noise: the role of contour-based and region-based representations. J Vis 2013. [DOI: 10.1167/13.9.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Geometric figure-ground cues override standard depth from accretion-deletion. J Vis 2013. [DOI: 10.1167/13.9.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Probabilistic Interpretation of Depth in Line Drawings due to T-junctions. J Vis 2013. [DOI: 10.1167/13.9.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Anomalous 3D structure-from-motion arises from accretion-deletion and figure-ground cues. J Vis 2013. [DOI: 10.1167/13.9.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abundance and Isotopic Composition of Gases in the Martian Atmosphere from the Curiosity Rover. Science 2013; 341:263-6. [PMID: 23869014 DOI: 10.1126/science.1237966] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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A randomized controlled trial of family intervention for co-occurring substance use and severe psychiatric disorders. Schizophr Bull 2013; 39:658-72. [PMID: 22282453 PMCID: PMC3627753 DOI: 10.1093/schbul/sbr203] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2011] [Indexed: 11/13/2022]
Abstract
Substance use disorders have a profound impact on the course of severe mental illnesses and on the family, but little research has evaluated the impact of family intervention for this population. To address this question, a randomized controlled trial was conducted comparing a brief (2-3 mo) Family Education (ED) program with a longer-term (9-18 mo) program that combined education with teaching communication and problem-solving skills, Family Intervention for Dual Disorders (FIDD). A total of 108 clients (77% schizophrenia-spectrum) and a key relative were randomized to either ED or FIDD and assessed at baseline and every 6 months for 3 years. Rates of retention of families in both programs were moderate. Intent-to-treat analyses indicated that clients in both programs improved in psychiatric, substance abuse, and functional outcomes, as did key relatives in knowledge of co-occurring disorders, burden, and mental health functioning. Clients in FIDD had significantly less severe overall psychiatric symptoms and psychotic symptoms and tended to improve more in functioning. Relatives in FIDD improved more in mental health functioning and knowledge of co-occurring disorders. There were no consistent differences between the programs in substance abuse severity or family burden. The findings support the utility of family intervention for co-occurring disorders, and the added benefits of communication and problem-solving training, but also suggest the need to modify these programs to retain more families in treatment in order to provide them with the information and skills they need to overcome the effects of these disorders.
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Abstract
This purpose of this mixed methods study was to understand access to primary care among older adults who present to an inner city emergency department (ED) for nonurgent care. Questionnaires ( N = 62) included demographic, illness characteristics, and health care utilization. Qualitative interviews ( N = 20) were conducted. Data was analyzed using descriptive statistics, and qualitative methodology. More than half of the participants were female (60%), African American (57%) and pain was the presenting symptoms among 48% of the participants. Nearly all participants reported barriers to primary care; difficulty with phone systems and staff, and lack of available appointments resulting in an ED visit. Older adults face barriers accessing primary care and as a result, can turn to the ED for their primary care needs. Interventions to improve access for vulnerable older adults might have benefits not only for patient outcomes but also for health policy issues related to cost effective care and overcrowded EDs.
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In situ cleaning of instruments for the sensitive detection of organics on Mars. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2012; 83:105109. [PMID: 23126806 DOI: 10.1063/1.4757861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A method is presented for in situ cleaning of spacecraft instruments that analyze planetary soil and rock. We have found that vibrating hardware, used to facilitate powder transport, was also effective at removing contamination. Surfaces can be cleaned below monolayer levels using vibrating surfaces in the presence of mineral powder. Both organic and particulate contamination is efficiently removed. Fine grained regolith from the planetary surface or an organic free reference material may serve as the powder used for cleaning. We present both analytical and experimental results for the contamination transfer fraction and the conditions required to clean the hardware prior to sensitive chemical analysis.
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In situ cleaning of instruments for the sensitive detection of organics on Mars. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2012. [PMID: 23126806 DOI: 10.1063/1061.4757861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A method is presented for in situ cleaning of spacecraft instruments that analyze planetary soil and rock. We have found that vibrating hardware, used to facilitate powder transport, was also effective at removing contamination. Surfaces can be cleaned below monolayer levels using vibrating surfaces in the presence of mineral powder. Both organic and particulate contamination is efficiently removed. Fine grained regolith from the planetary surface or an organic free reference material may serve as the powder used for cleaning. We present both analytical and experimental results for the contamination transfer fraction and the conditions required to clean the hardware prior to sensitive chemical analysis.
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