1
|
Gramp PE, Dooley J, O'Brien B, Jones A, Tan L, Robson J, Robertson T, Simos P, Fuller R, Gramp DV, Meumann EM. Fatal granulomatous amebic encephalitis initially presenting with a cutaneous lesion. Australas J Dermatol 2023; 64:e256-e261. [PMID: 37154242 DOI: 10.1111/ajd.14068] [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: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
We present a case of a 66-year-old man with a cutaneous Balamuthia mandrillaris lesion that progressed to fatal granulomatous amoebic encephalitis. We provide a summary of Australian cases and describe the clinical features and approach to diagnosing this rare but devastating condition, including the importance of PCR for diagnosis.
Collapse
Affiliation(s)
- Prudence E Gramp
- Dermatology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - John Dooley
- NH Diagnostics, Gold Coast, Queensland, Australia
| | - Blake O'Brien
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| | - Andrew Jones
- Infectious Disease Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Leong Tan
- Neurosurgery Department, Pindara Hospital, Queensland, Gold Coast, Australia
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| | - Thomas Robertson
- Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| | - Peter Simos
- Infectious Disease Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Robert Fuller
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Dallas V Gramp
- Dermatology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ella M Meumann
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| |
Collapse
|
2
|
McDonald C, Claussen H, Farrell R, Dooley J. FPGA implementation of a sub-400ns 6G free-space optical wireless communications transmitter. Opt Express 2023; 31:25933-25942. [PMID: 37710466 DOI: 10.1364/oe.486057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/05/2023] [Indexed: 09/16/2023]
Abstract
Future wireless networks are planned to service many applications with an Ultra Low-Latency (ULL) requirement. Numerous 6G systems have been proposed including more traditional electro-magnetic (EM) antenna transmissions and optical wireless communications (OWC). For extremely wide-band operation, the traditional approaches require digital pre-distortion and other processing techniques which, in turn, require more computational resources and processing times thus increasing latency. Alternatively, OWC has the potential for extremely wide bandwidths in 6G without the need for as much digital signal processing. In order to realise ULL performance, a minimum number of digital signal processing (DSP) blocks is required, as well as an optimal design of each of these. In this letter, we propose a DSP solution for ULL and peak to average power ratio (PAPR) reduction for OWC systems. Unitary checkerboard precoding - orthogonal frequency division multiplexing (UCP-OFDM) is chosen as the modulation scheme and has been implemented within a single digital block avoiding the use of standard OFDM which would otherwise require multiple digital blocks. Experimentally validated results successfully demonstrate a 2.21184 GSps wireless link at distances of up to 2m in noisy daylight settings. Bit error rates (BER) of 0 at root mean square (RMS) error vector magnitude (EVM) of 4.09% are achieved. A complete digital line-up of an OWC transmitter chain for this work contains only three core blocks and ULL of less than 400 ns.
Collapse
|
3
|
Pillai M, Shumway JW, Adapa K, Dooley J, McGurk R, Mazur LM, Das SK, Chera BS. Augmenting Quality Assurance Measures in Treatment Review with Machine Learning in Radiation Oncology. Adv Radiat Oncol 2023; 8:101234. [DOI: 10.1016/j.adro.2023.101234] [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] [Received: 08/02/2022] [Accepted: 03/26/2023] [Indexed: 04/08/2023] Open
|
4
|
Pillai M, Adapa K, Dooley J, Das S, Mazur L. Improving Interpretability of Machine Learning in Head and Neck Radiation Therapy Pretreatment Physics Plan Reviews. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.944] [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: 11/16/2022]
|
5
|
Hammers J, Lindsay D, Narayanasamy G, Sud S, Tan X, Dooley J, Marks LB, Chen RC, Das SK, Mavroidis P. Evaluation of the clinical impact of the differences between planned and delivered dose in prostate cancer radiotherapy based on CT-on-rails IGRT and patient-reported outcome scores. J Appl Clin Med Phys 2022; 24:e13780. [PMID: 36087039 PMCID: PMC9859987 DOI: 10.1002/acm2.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To estimate the clinical impact of differences between delivered and planned dose using dose metrics and normal tissue complication probability (NTCP) modeling. METHODS Forty-six consecutive patients with prostate adenocarcinoma between 2010 and 2015 treated with intensity-modulated radiation therapy (IMRT) and who had undergone computed tomography on rails imaging were included. Delivered doses to bladder and rectum were estimated using a contour-based deformable image registration method. The bladder and rectum NTCP were calculated using dose-response parameters applied to planned and delivered dose distributions. Seven urinary and gastrointestinal symptoms were prospectively collected using the validated prostate cancer symptom indices patient reported outcome (PRO) at pre-treatment, weekly treatment, and post-treatment follow-up visits. Correlations between planned and delivered doses against PRO were evaluated in this study. RESULTS Planned mean doses to bladder and rectum were 44.9 ± 13.6 Gy and 42.8 ± 7.3 Gy, while delivered doses were 46.1 ± 13.4 Gy and 41.3 ± 8.7 Gy, respectively. D10cc for rectum was 64.1 ± 7.6 Gy for planned and 60.1 ± 9.3 Gy for delivered doses. NTCP values of treatment plan were 22.3% ± 8.4% and 12.6% ± 5.9%, while those for delivered doses were 23.2% ± 8.4% and 9.9% ± 8.3% for bladder and rectum, respectively. Seven of 25 patients with follow-up data showed urinary complications (28%) and three had rectal complications (12%). Correlations of NTCP values of planned and delivered doses with PRO follow-up data were random for bladder and moderate for rectum (0.68 and 0.67, respectively). CONCLUSION Sensitivity of bladder to clinical variations of dose accumulation indicates that an automated solution based on a DIR that considers inter-fractional organ deformation could recommend intervention. This is intended to achieve additional rectum sparing in cases that indicate higher than expected dose accumulation early during patient treatment in order to prevent acute severity of bowel symptoms.
Collapse
Affiliation(s)
- Jacob Hammers
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Daniel Lindsay
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Ganesh Narayanasamy
- Department of Radiation OncologyUniversity of Arkansas for Medical SciencesArkansasUSA
| | - Shivani Sud
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Xianming Tan
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina HospitalsChapel HillNorth CarolinaUSA
| | - John Dooley
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Lawrence B. Marks
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Ronald C. Chen
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Shiva K. Das
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Panayiotis Mavroidis
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| |
Collapse
|
6
|
Loughman M, Barton S, Farrell R, Dooley J. Early Stopping Criterion for Recursive Least Squares Training of Behavioural Models. Wirel Pers Commun 2022; 126:1633-1648. [PMID: 36160318 PMCID: PMC9489559 DOI: 10.1007/s11277-022-09813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 06/16/2023]
Abstract
The necessity of the rapid evolution of wireless communications, with continuously increasing demands for higher data rates and capacity Zheng (Big datadriven optimization for mobile networks toward 5g 30:44-51, 2016), is constantly augmenting the complexity of radio frequency (RF) transceiver architecture. A significant component in the configuration of such complex radio transceivers is the power amplifier(PA). Multiple distributed PAs are now common in proposed RF architectures. PAs exhibit non linear behaviour, causing signal distortion in transmission. Behavioural models offer a concise representation of a PAs characteristic performance which is extremely useful in simulating performance of multiple nonlinear power amplifiers. A considerable drawback with using the Recursive Least Squares (RLS) technique is that the instability of the coefficients during the training of the model. This manuscript provides a computationally efficient technique to detect the onset of instability during adaptive RLS training and subsequently to inform the decision to cease training of dynamic memory polynomial based behavioural models, to avoid the onset of instability. The proposed technique does not require modification of the RLS algorithm, merely an observation of the pre-exsisting autocorrelation function based update. This technique is experimentally validated using four different signal modulation schemes, LTE OFDM, 5G-NR, DVBS2X and WCDMA.
Collapse
Affiliation(s)
- Méabh Loughman
- Department of Electronic Engineering, Maynooth University, Co. Kildare, Ireland
| | - Sinéad Barton
- Department of Electronic Engineering, Maynooth University, Co. Kildare, Ireland
| | - Ronan Farrell
- Department of Electronic Engineering, Maynooth University, Co. Kildare, Ireland
| | - John Dooley
- Department of Electronic Engineering, Maynooth University, Co. Kildare, Ireland
| |
Collapse
|
7
|
Pillai M, Adapa K, Shumway JW, Dooley J, Das SK, Chera BS, Mazur L. Feature Engineering for Interpretable Machine Learning for Quality Assurance in Radiation Oncology. Stud Health Technol Inform 2022; 290:460-464. [PMID: 35673057 DOI: 10.3233/shti220118] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chart checking is a time intensive process with high cognitive workload for physicists. Previous studies have partially automated and standardized chart checking, but limited studies implement data-driven approaches to reduce cognitive workload for quality assurance processes. This study aims to evaluate feature selection methods to improve the interpretability and transparency of machine learning models in predicting the degree of difficulty for a pretreatment physics chart check. We compare chi-square, mutual information, feature importance thresholding, and greedy feature selection for four different classifiers. Random forest has the highest performance with SMOTE oversampling using mutual information for feature selection (accuracy 84.0%, AUC 87.0%, precision 80.0%, recall 80.0%). This study demonstrates that feature selection methods can improve model interpretability and transparency.
Collapse
Affiliation(s)
- Malvika Pillai
- Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina
| | - Karthik Adapa
- Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina.,Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - John W Shumway
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - John Dooley
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Shiva K Das
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Lukasz Mazur
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
8
|
Evans M, Hall S, Dooley J. Evoking the Mythic: Hearing the Sound of Sukhāvatī. EAI Endorsed Transactions on Creative Technologies 2021. [DOI: 10.4108/eai.31-3-2021.169171] [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: 11/05/2022] Open
|
9
|
Shumway J, Pillai M, Dooley J, Das S, Chera B. Machine Learning to Improve the Prioritization and Effectiveness of Pre-Treatment Physics Chart Checks. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2177] [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: 10/23/2022]
|
10
|
Mosaly PR, Adams R, Tracton G, Dooley J, Adapa K, Nuamah JK, Marks LB, Mazur LM. Impact of Workspace Design on Radiation Therapist Technicians' Physical Stressors, Mental Workload, Situation Awareness, and Performance. Pract Radiat Oncol 2020; 11:e3-e10. [PMID: 32707097 DOI: 10.1016/j.prro.2020.07.002] [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: 03/14/2020] [Revised: 06/03/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Our purpose was to assess the effect of workspace configuration on radiation therapists' (RTs) physical stressors, mental workload (WL), situational awareness (SA), and performance during routine treatment delivery tasks in a simulated environment. METHODS AND MATERIALS Fourteen RTs were randomized to 2 workspace configurations while performing 4 simulated scenarios: current (not ergonomically optimized; n = 7) and enhanced (ergonomically optimized, n = 7). Physical stressors were objectively assessed using a rapid upper limb assessment tool. Mental WL was measured at the end of each simulated scenario subjectively using the NASA Task-Load Index and objectively throughout the scenario using eye-tracking metrics (pupil diameter and blink rate). SA was measured at the end of each simulated scenario subjectively using the situation awareness and review technique. Performance was measured objectively via assessment of time-out compliance, error detection, and procedural compliance. Analysis of variance was used to test the effect of workspace configuration on physical stressors, mental WL, SA, and performance. RESULTS The enhanced configuration significantly reduced physical stressors (rapid upper limb assessment; P < .01) and resulted in a higher rate of time-out compliance (P = .01) compared with current workspace configuration. No significant effect on other metrics was measured. CONCLUSIONS Our results suggest that an ergonomically designed workspace may minimize physical stressors and improve the performance of RTs.
Collapse
Affiliation(s)
- Prithima R Mosaly
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Information and Library Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Robert Adams
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gregg Tracton
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John Dooley
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karthik Adapa
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Information and Library Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph K Nuamah
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lukasz M Mazur
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Information and Library Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
11
|
Pillai M, Adapa K, Das SK, Mazur L, Dooley J, Marks LB, Thompson RF, Chera BS. Using Artificial Intelligence to Improve the Quality and Safety of Radiation Therapy. J Am Coll Radiol 2019; 16:1267-1272. [DOI: 10.1016/j.jacr.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023]
|
12
|
Dooley J, Armstrong RA, Jepson M, Squire Y, Hinchliffe RJ, Mouton R. Qualitative study of clinician and patient perspectives on the mode of anaesthesia for emergency surgery. Br J Surg 2019; 107:e142-e150. [PMID: 31368512 PMCID: PMC6973173 DOI: 10.1002/bjs.11243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 12/23/2022]
Abstract
Background Although delivering a chosen mode of anaesthesia for certain emergency surgery procedures is potentially beneficial to patients, it is a complex intervention to evaluate. This qualitative study explored clinician and patient perspectives about mode of anaesthesia for emergency surgery. Methods Snowball sampling was used to recruit participants from eight National Health Service Trusts that cover the following three emergency surgery settings: ruptured abdominal aortic aneurysms, hip fractures and inguinal hernias. A qualitative researcher conducted interviews with clinicians and patients. Thematic analysis was applied to the interview transcripts. Results Interviews were conducted with 21 anaesthetists, 21 surgeons, 14 operating theatre staff and 23 patients. There were two main themes. The first, impact of mode of anaesthesia in emergency surgery, had four subthemes assessing clinician and patient ideas about: context and the ‘best’ mode of anaesthesia; balance in choosing it over others; change and developments in anaesthesia; and the importance of mode of anaesthesia in emergency surgery. The second, tensions in decision‐making about mode of anaesthesia, comprised four subthemes: clinical autonomy and guidelines in anaesthesia; conforming to norms in mode of anaesthesia; the relationship between expertise, preference and patient involvement; and team dynamics in emergency surgery. The results highlight several interlinking factors affecting decision‐making, including expertise, preference, habit, practicalities, norms and policies. Conclusion There is variation in practice in choosing the mode of anaesthesia for surgery, alongside debate as to whether anaesthetic autonomy is necessary or results in a lack of willingness to change.
Collapse
Affiliation(s)
- J Dooley
- Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | - R A Armstrong
- Anaesthetic Department, Southmead Hospital, Bristol, UK
| | - M Jepson
- Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Y Squire
- Anaesthetic Department, Southmead Hospital, Bristol, UK
| | - R J Hinchliffe
- Bristol Surgical Trials Centre, Bristol Medical School, Bristol, UK
| | - R Mouton
- Anaesthetic Department, Southmead Hospital, Bristol, UK
| |
Collapse
|
13
|
Abstract
Objective: Emerging evidence suggests that moral processes are disrupted by traumatic brain injury (TBI). The objective of this study was to explore moral reasoning (MR) and decision-making in adolescents with TBI, and to examine potential associations with global manifestations of social competence.Design: This retrospective, cross-sectional research design compared MR and decision-making in adolescents with mild TBI (n = 20), moderate-severe TBI (n = 23) and typically developing controls (n = 93).Methods: Participants completed a visual task of socio-moral reasoning (SoMoral) and the Index of Empathy for Children and Adolescents. Their parents completed questionnaires documenting their child's behavior (Child Behavior Checklist) and adaptive functioning (Adaptive Behavior Assessment System-Second Edition).Main results: Adolescents with both mild and moderate-severe TBI displayed more immature MR than typically developing peers. Participants with TBI also provided fewer socially adapted decisions. Closer inspection revealed that this difference was apparent only in the mild TBI group. No significant group differences were observed for empathy, behavior or adaptive skills.Conclusions: Sustaining TBI appears to affect adolescents' ability to provide mature moral justifications when faced with moral dilemmas representative of everyday social conflicts. These difficulties do not appear to be associated with behavior problems, reduced empathy, or adaptive functioning.
Collapse
Affiliation(s)
- M H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada.,Sainte-Justine Hospital Research Center, Montreal, Canada
| | - E Vera-Estay
- Department of Psychology, University of Montreal, Montreal, Canada.,Sainte-Justine Hospital Research Center, Montreal, Canada
| | - F Morasse
- Department of Psychology, University of Montreal, Montreal, Canada.,Sainte-Justine Hospital Research Center, Montreal, Canada
| | - V Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
| | - J Dooley
- Cuyahoga County Court Psychiatric Clinic, Cleveland, Ohio, USA
| |
Collapse
|
14
|
Mavroidis P, Pearlstein KA, Dooley J, Sun J, Saripalli S, Das SK, Wang AZ, Chen RC. Fitting NTCP models to bladder doses and acute urinary symptoms during post-prostatectomy radiotherapy. Radiat Oncol 2018; 13:17. [PMID: 29394931 PMCID: PMC5797360 DOI: 10.1186/s13014-018-0961-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/18/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To estimate the radiobiological parameters of three popular normal tissue complication probability (NTCP) models, which describe the dose-response relations of bladder regarding different acute urinary symptoms during post-prostatectomy radiotherapy (RT). To evaluate the goodness-of-fit and the correlation of those models with those symptoms. METHODS Ninety-three consecutive patients treated from 2010 to 2015 with post-prostatectomy image-guided intensity modulated radiotherapy (IMRT) were included in this study. Patient-reported urinary symptoms were collected pre-RT and weekly during treatment using the validated Prostate Cancer Symptom Indices (PCSI). The assessed symptoms were flow, dysuria, urgency, incontinence, frequency and nocturia using a Likert scale of 1 to 4 or 5. For this analysis, an increase by ≥2 levels in a symptom at any time during treatment compared to baseline was considered clinically significant. The dose volume histograms of the bladder were calculated. The Lyman-Kutcher-Burman (LKB), Relative Seriality (RS) and Logit NTCP models were used to fit the clinical data. The fitting of the different models was assessed through the area under the receiver operating characteristic curve (AUC), Akaike information criterion (AIC) and Odds Ratio methods. RESULTS For the symptoms of urinary urgency, leakage, frequency and nocturia, the derived LKB model parameters were: 1) D50 = 64.2Gy, m = 0.50, n = 1.0; 2) D50 = 95.0Gy, m = 0.45, n = 0.50; 3) D50 = 83.1Gy, m = 0.56, n = 1.00; and 4) D50 = 85.4Gy, m = 0.60, n = 1.00, respectively. The AUC values for those symptoms were 0.66, 0.58, 0.64 and 0.64, respectively. The differences in AIC between the different models were less than 2 and ranged within 0.1 and 1.3. CONCLUSIONS Different dose metrics were correlated with the symptoms of urgency, incontinence, frequency and nocturia. The symptoms of urinary flow and dysuria were poorly associated with dose. The values of the parameters of three NTCP models were determined for bladder regarding four acute urinary symptoms. All the models could fit the clinical data equally well. The NTCP predictions of urgency showed the best correlation with the patient reported outcomes.
Collapse
Affiliation(s)
- Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7512 USA
| | - Kevin A. Pearlstein
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7512 USA
| | - John Dooley
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7512 USA
| | - Jasmine Sun
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7512 USA
| | - Srinivas Saripalli
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7512 USA
| | - Shiva K. Das
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7512 USA
| | - Andrew Z. Wang
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7512 USA
| | - Ronald C. Chen
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7512 USA
| |
Collapse
|
15
|
Kortekaas Krohn I, Bobic S, Dooley J, Lan F, Zhang N, Bachert C, Steelant B, Bullens DM, Liston A, Ceuppens JL, Seys SF, Hellings PW. Programmed cell death-1 expression correlates with disease severity and IL-5 in chronic rhinosinusitis with nasal polyps. Allergy 2017; 72:985-993. [PMID: 28122135 DOI: 10.1111/all.13136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Programmed cell death-1 (PD-1) is a negative regulator of T-cell responses. Expression of PD-1 and its ligands PD-L1 and PD-L2 in chronic rhinosinusitis with nasal polyps (CRSwNP) is poorly studied. METHODS Expression of PD-1, PD-L1, PD-L2, TGF-β, IL-5, and IL-10 mRNA was measured by real-time quantitative PCR on tissue homogenates of patients with CRSwNP (n = 21) and healthy controls (n = 21) and on primary epithelial cells. Disease severity was scored using the Lund-Mackay scores of maxillofacial computed tomography (CT) scans. Expression of PD-1 and PD-L1/L2 was evaluated at the cellular and tissue levels (n = 6) by flow cytometry and immunohistochemistry. RESULTS Programmed cell death-1 mRNA expression was increased in tissue homogenates from patients with CRSwNP compared with controls, irrespective of the atopy status. Importantly, expression of PD-1 correlated with the total CT scan scores (r = 0.5, P = 0.02). Additionally, a significant association was found between PD-1 mRNA and expression of IL-5 mRNA in control nasal tissue (r = 0.95, P < 0.0001) and in CRSwNP (r = 0.63, P = 0.002). PD-1 was expressed on different subsets of T cells and CD11b- dendritic cells. Both PD-1 and its ligands were expressed on primary epithelial cells from control nasal tissue and nasal polyp tissue. CONCLUSIONS Higher PD-1 expression was found in CRSwNP than in nasal tissue from controls. This was associated with disease severity and tissue IL-5 expression but unrelated to the patients' atopy status.
Collapse
Affiliation(s)
- I. Kortekaas Krohn
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - S. Bobic
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - J. Dooley
- Translational Immunology Laboratory; VIB; University of Leuven; Leuven Belgium
| | - F. Lan
- Upper Airway Research Laboratory; Department of Otorhinolaryngology; University Hospital Ghent; Ghent Belgium
| | - N. Zhang
- Upper Airway Research Laboratory; Department of Otorhinolaryngology; University Hospital Ghent; Ghent Belgium
| | - C. Bachert
- Upper Airway Research Laboratory; Department of Otorhinolaryngology; University Hospital Ghent; Ghent Belgium
| | - B. Steelant
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - D. M. Bullens
- Pediatric Immunology; Department of Microbiology and Immunology; University of Leuven; Leuven Belgium
- Clinical Department of Pediatrics; University Hospitals Leuven; Leuven Belgium
| | - A. Liston
- Translational Immunology Laboratory; VIB; University of Leuven; Leuven Belgium
| | - J. L. Ceuppens
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - S. F. Seys
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - P. W. Hellings
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
- Clinical Division of Otorhinolaryngology; University Hospitals Leuven; Leuven Belgium
- Clinical Division of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
| |
Collapse
|
16
|
Roth T, Dooley J, Zhu T, Woods R, Mavroidis P, Lian J. SU-F-T-592: A Delivery QA-Free Approach for Adaptive Therapy of Prostate Cancer with Static Intensity Modulated Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956777] [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: 11/07/2022] Open
|
17
|
Tang X, Cullip T, Dooley J, Zagar T, Jones E, Chang S, Zhu X, Lian J, Marks L. Dosimetric effect due to the motion during deep inspiration breath hold for left-sided breast cancer radiotherapy. J Appl Clin Med Phys 2015. [PMID: 26219001 PMCID: PMC5690002 DOI: 10.1120/jacmp.v16i4.5358] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Deep inspiration breath‐hold (DIBH) radiotherapy for left‐sided breast cancer can reduce cardiac exposure and internal motion. We modified our in‐house treatment planning system (TPS) to retrospectively analyze breath‐hold motion log files to calculate the dosimetric effect of the motion during breath hold. Thirty left‐sided supine DIBH breast patients treated using AlignRT were studied. Breath‐hold motion was recorded — three translational and three rotational displacements of the treatment surface — the Real Time Deltas (RTD). The corresponding delivered dose was estimated using the beam‐on portions of the RTDs. Each motion was used to calculate dose, and the final estimated dose was the equally weighted average of the multiple resultant doses. Ten of thirty patients had internal mammary nodes (IMN) purposefully included in the tangential fields, and we evaluated the percentage of IMN covered by 40 Gy. The planned and delivered heart mean dose, lungs V20 (volume of the lungs receiving >20 Gy), percentage of IMN covered by 40 Gy, and IMN mean dose were compared. The averaged mean and standard deviation of the beam‐on portions of the absolute RTDs were 0.81±1.29 mm, 0.68±0.85 mm, 0.76±0.85 mm, 0.96°±0.49°,0.93°±0.43°, and 1.03°±0.50°, for vertical, longitudinal, lateral, yaw, roll, and pitch, respectively. The averaged planned and delivered mean heart dose were 99 and 101 cGy. Lungs V20 were 6.59% and 6.74%. IMN 40 Gy coverage was 83% and 77%, and mean IMN dose was 4642 and 4518 cGy. The averaged mean motion during DIBH was smaller than 1 mm and 1°, which reflects the relative reproducibility of the patient breath hold. On average, the mean heart dose and lungs V20 were reasonably close to what have been planned. IMN 40 Gy coverage might be modestly reduced for certain cases. PACS number: 87.55.km, 87.55.N
Collapse
|
18
|
Rivera J, Dooley J, Belley M, Stanton I, Langloss B, Therien M, Yoshizumi T, Chang S. WE-AB-BRB-12: Nanoscintillator Fiber-Optic Detector System for Microbeam Radiation Therapy Dosimetry. Med Phys 2015. [DOI: 10.1118/1.4925853] [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: 11/07/2022] Open
|
19
|
Lee PC, Dietsche L, Dooley J, Parashar S. Improving Film Die Flow Uniformity Using Optimization Methods Coupled with Finite Element Computational Fluid Dynamics (CFD) Analysis. INT POLYM PROC 2015. [DOI: 10.3139/217.2887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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]
Abstract
Abstract
The aim of this study was to evaluate various optimization strategies to be used with computational fluid dynamics (CFD), in order to optimize the geometry for a polymer die to meet the dual objectives of uniform flow at the exit with minimal pressure drop. 3D finite element simulations using the numerically optimized geometry predict a more uniform flow than simulations using the baseline geometry. However, some of the initial optimized results yielded die geometries that would be impractical to fabricate. Additional constraints were placed on the allowable geometric parameters and solution space to push the optimization towards more feasible optimal solutions. Thus we have shown how CFD-based optimization methods, coupled with knowledge of die design technology and fabrication techniques can lead to the design of better performing polymer dies.
Collapse
Affiliation(s)
- P. C. Lee
- School of Engineering , University of Vermont, Burlington, VT , USA
| | - L. Dietsche
- The Dow Chemical Company , Midland, MI , USA
| | - J. Dooley
- The Dow Chemical Company , Midland, MI , USA
| | | |
Collapse
|
20
|
Zhu X, Chang S, Cullip T, Yuan L, Lian J, Zhang X, Tang X, Tracton G, Dooley J. SU-E-T-521: Feasibility Study of a Rotational Step-And-Shoot IMRT Treatment Planning Approach. Med Phys 2014. [DOI: 10.1118/1.4888854] [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: 11/07/2022] Open
|
21
|
Tang X, Cullip T, Dooley J, Potter L, Chera B, Lian J, Chang S, Zhu X. SU-E-J-236: Feasibility of Using Infrared Imaging to Verify the Accuracy of the Radiotherapy Delivery. Med Phys 2014. [DOI: 10.1118/1.4888289] [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: 11/07/2022] Open
|
22
|
Zhu X, Cullip T, Tracton G, Tang X, Lian J, Dooley J, Chang SX. Direct aperture optimization using an inverse form of back‐projection. J Appl Clin Med Phys 2014; 15:4545. [PMID: 24710439 PMCID: PMC5875482 DOI: 10.1120/jacmp.v15i2.4545] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/30/2013] [Accepted: 10/24/2013] [Indexed: 11/23/2022] Open
Affiliation(s)
- Xiaofeng Zhu
- Department of Radiation OncologyUniversity of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Timothy Cullip
- Department of Radiation OncologyUniversity of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Gregg Tracton
- Department of Radiation OncologyUniversity of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Xiaoli Tang
- Department of Radiation OncologyUniversity of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Jun Lian
- Department of Radiation OncologyUniversity of North Carolina at Chapel Hill Chapel Hill NC USA
| | - John Dooley
- Department of Radiation OncologyUniversity of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Sha X Chang
- Department of Radiation OncologyUniversity of North Carolina at Chapel Hill Chapel Hill NC USA
| |
Collapse
|
23
|
Tang X, Cullip T, Dooley J, Zhu X, Lian J, Lawrence M, Zagar T, Jones E, Marks L, Chang S. SU-E-J-222: An Analysis of the Deep Inspiration Breath Hold (DIBH) Treatment Delivery Uncertainties. Med Phys 2013. [DOI: 10.1118/1.4814434] [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: 11/07/2022] Open
|
24
|
Price MJ, Fontenot JD, Lian J, Nichols G, Burkhardt K, Erwin R, VanderWalde N, Dooley J, Tracton G, Chang S. SU-E-T-485: Comparison of the Oncogenic Potential for Radiation-Associated, Second Malignant Neoplasms for Several Prostate Radiotherapy Modalities as a Function of Relative OAR & PTV Volumes. Med Phys 2013. [DOI: 10.1118/1.4814918] [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: 11/07/2022] Open
|
25
|
Zhu X, Cullip T, Tracton G, Dooley J, Chang S. SU-E-T-654: Direct Aperture Optimization Using An Inverse Form of Back Projection. Med Phys 2013. [DOI: 10.1118/1.4815081] [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: 11/07/2022] Open
|
26
|
Ducas R, Philipp R, Wassef A, Jassal D, Khadem A, Hussain F, Ducas J, Dooley J, Schmidt C, Weldon E, Grierson R, Tam J. 388 How good are paramedic responders in the diagnosis of STEMI? Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.327] [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: 10/16/2022] Open
|
27
|
Murphy MJ, Adler JR, Bodduluri M, Dooley J, Forster K, Hai J, Le Q, Luxton G, Martin D, Poen J. Image-Guided Radiosurgery for the Spine and Pancreas. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080009148895] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
28
|
Dooley J, Kelly L, St Pierre-Hansen N, Antone I, Guilfoyle J, O'Driscoll T. Rural and remote obstetric care close to home: program description, evaluation and discussion of Sioux Lookout Meno Ya Win Health Centre obstetrics. Can J Rural Med 2009; 14:75-79. [PMID: 19379632] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PROBLEM BEING ADDRESSED Aboriginal and non-Aboriginal women in rural and remote settings struggle to access obstetric care close to home. Objective of the program: To deliver a full range of modern and safe obstetric care to 28 remote Aboriginal communities served by rural-based health care. PROGRAM DESCRIPTION Rural family physicians provide intrapartum, cesarean delivery and anesthesia services to 350 rural, primarily Aboriginal women in a collegial, supportive environment. CONCLUSION Rural and remote obstetric services need support before they fail. Patient volume, remote location and organizational culture are key elements. Evidence teaches us that outcomes are best when women deliver closer to home.
Collapse
Affiliation(s)
- J Dooley
- Northern Ontario School of Medicine, Sioux Lookout, Ont, Canada.
| | | | | | | | | | | |
Collapse
|
29
|
Balakrishnan B, Dooley J, Kopia G, Edelman ER. Thrombus causes fluctuations in arterial drug delivery from intravascular stents. J Control Release 2008; 131:173-80. [PMID: 18713645 DOI: 10.1016/j.jconrel.2008.07.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 06/28/2008] [Accepted: 07/12/2008] [Indexed: 11/19/2022]
Abstract
Arterial drug concentrations determine local toxicity. As such the emergent safety concerns surrounding drug-eluting stents mandate an investigation of the factors contributing to fluctuations in arterial drug uptake. Drug-eluting stents were implanted into porcine coronary arteries, arterial drug uptake was followed and modeled using 2-dimensional computational drug transport. Arterial drug uptake in vivo occurred faster than predicted by free drug diffusion, thus an alternate, mechanism for rapid transport has been proposed involving carrier-mediated transport. Though there was minimal variation in vivo in release kinetics from stent to stent, arterial drug deposition varied by up to 114% two weeks after stent implantation. The extent of adherent mural thrombus also fluctuated by 113% within 3 days after implantation. The computational drug transport model predicted that focal and diffuse thrombi elevate arterial drug deposition in proportion to the thrombus size by reducing drug washout subsequently increasing local drug availability. Fluctuations in arterial drug uptake are commonly reported. We now explain that variable peristrut thrombus can explain such observations even in the face of a narrow range of drug release from the stent. The mural thrombus effects on arterial drug deposition may be circumvented by forcing slow, rate limiting arterial transport that cannot be further hindered by mural thrombus.
Collapse
Affiliation(s)
- Brinda Balakrishnan
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | | | | | | |
Collapse
|
30
|
Muniruzzaman M, Dooley J, Kilby W, Lee M, Maurer C, Sims C. WE-E-AUD B-02: Validation Tests for CyberKnife® Monte Carlo Dose Calculations Using Heterogeneous Phantoms. Med Phys 2008. [DOI: 10.1118/1.2962776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
31
|
Walczak K, Gupta M, Koppi K, Dooley J, Spalding M. Elongational viscosity of LDPEs and polystyrenes using entrance loss data. POLYM ENG SCI 2008. [DOI: 10.1002/pen.20818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
32
|
Abstract
A survey of 224 individuals using SureStart services (for young families) within an inner-London area was complemented by qualitative data from five focus groups of parents and general practitioners in the same area. Descriptive and multivariate statistics were used to identify and describe discrete geographical districts with differing patterns of health information seeking. A geographically defined group of 'information hungry'/'online' health seekers was identified. This group contrasted with those acquiring information through 'assimilation' ('offline' information seekers). Qualitative data revealed the processes underpinning these characteristics and professional attitudes towards the Internet as a source of health information.
Collapse
Affiliation(s)
- M Malone
- Florence Nightingale School of Nursing and Midwifery, King's College London, UK.
| | | | | | | |
Collapse
|
33
|
Wu X, Dooley J, Yang J, Persaud V, Bossart E, Shao H, Both J, de la Zerda A, Schwade J, Markoe A. TU-C-T-617-04: Beam Configuration of Photon-Based Stereotactic Radiosurgery. Med Phys 2005. [DOI: 10.1118/1.1999706] [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: 11/07/2022] Open
|
34
|
Locke CFS, Dooley J, Gerber J. Rates of clinically apparent heparin-induced thrombocytopenia for unfractionated heparin vs. low molecular weight heparin in non-surgical patients are low and similar. Thromb J 2005; 3:4. [PMID: 15807892 PMCID: PMC1087886 DOI: 10.1186/1477-9560-3-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 04/04/2005] [Indexed: 01/27/2023] Open
Abstract
With the growing use of low-molecular-weight heparins (LMWH) for the treatment and prevention of venous thromboembolism (VTE), it is important to provide an evidence-based comparison with unfractionated heparin (UFH) concerning rates of heparin-induced thrombocytopenia (HIT). Such comparisons are essential in clinical decision-making and cost-modeling. In this paper we review data regarding non-surgical (medical) patients. We conclude that the lack of uniform evaluation and standardized testing for HIT in the current literature precludes making a reliable estimate of the relative risk of HIT in UFH vs. LMWH in either the treatment or prevention of VTE in non-surgical patients. However, current data suggest that the risk of thrombocytopenia and HIT is low and similar for non-surgical patients who receive either LMWH or UFH.
Collapse
Affiliation(s)
- Charles FS Locke
- Johns Hopkins Community Physicians Department of Internal Medicine 2360 W. Joppa Rd., Suite 306 Lutherville, MD 21093 USA
| | - John Dooley
- Johns Hopkins Community Physicians Department of Internal Medicine 2360 W. Joppa Rd., Suite 306 Lutherville, MD 21093 USA
| | - Jonathan Gerber
- Johns Hopkins Community Physicians Department of Internal Medicine 2360 W. Joppa Rd., Suite 306 Lutherville, MD 21093 USA
| |
Collapse
|
35
|
Carter AJ, Wei W, Gibson L, Collingwood R, Tio F, Dooley J, Kopia GA. Segmental vessel wall shear stress and neointimal formation after sirolimus-eluting stent implantation: physiological insights in a porcine coronary model. Cardiovascular Revascularization Medicine 2005; 6:58-64. [PMID: 16263360 DOI: 10.1016/j.carrev.2005.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Accepted: 05/16/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low vessel-wall shear stress promotes atherosclerosis and restenosis. We conducted serial analysis of vessel-wall shear stress following placement of metal and sirolimus (SRL) stents to determine the relationship between shear stress and neointima. METHODS Serial quantitative coronary angiography, intracoronary ultrasound (IVUS), and Doppler flow analysis were performed at baseline, immediately poststent, and at 30 and 90 days on 16 stents (metal, n = 8; SRL, n = 8) implanted in the coronary arteries of eight miniswine. Segmental vessel-wall shear stress (dyn/cm2) was calculated at 10 sections within the stent and normalized to the average proximal and distal reference vessel shear stress using IVUS and hyperemic average peak flow velocity. At 90 days, histological analysis was completed to determine vessel-wall morphometry on corresponding sections from each stent. RESULTS Stent placement resulted in a similar degree of in-stent stenosis (-5% to 25%) and immediate post-in-stent shear stress. At 30 days, the IVUS neointimal cross-sectional area and percentage of area stenosis were significantly less in SRL (1.2+/-0.8 mm2; 12.7+/-8.5%) versus metal stents (2.3+/-0.4 mm2; 28.2+/-3.4%, P < .003). In-stent normalized shear stress was less for SRL (0.93+/-0.07) versus metal (1.07+/-0.08, P = .002) stents. At 90 days, the mean neointimal area was similar for the SRL (2.50+/-0.47 mm2) and metal stents (2.72+/-1.15 mm2). Linear regression documented a negative correlation between poststent shear stress and neointima for metal stents (r = .61, P < .0001). In the SRL stents, however, the post-in-stent shear stress had a positive correlation with neointima (r = .40, P = .0002). CONCLUSIONS The placement of oversized stents causes alteration of segmental vessel-wall shear stress, which appears to be an important physiological stimulus for neointimal formation, and may influence the pharmacodynamics of SRL-eluting stent in the porcine coronary model.
Collapse
Affiliation(s)
- Andrew J Carter
- Medical Device Research Laboratory, Borgess Medical Center, Kalamazoo, MI 49024, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Shiu KY, Radu M, McFarlane L, Dooley J, Thomas D. An audit of anticipated discharge planning for acute medical and orthopaedic admissions. International Journal of Therapy and Rehabilitation 2004. [DOI: 10.12968/ijtr.2004.11.11.17199] [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: 11/11/2022]
Abstract
The authors of this article audited an anticipated discharge survey on acute medical and orthopaedic admissions to a UK hospital over a 2-month period. An anticipated discharge form was filled in on admission by an experienced clinician and a discharge date set based on the patient's clinical condition, age and social circumstances. In total, 31 patients (51%) went home on the day planned or within one day of this date. The reasons for delays in discharge included failure of doctors to review patients, slow response to treatment and waiting for social services. Slow mobilization in eight patients accounted for the longest length of stays. The authors found that discharge plans may break down at weekends and are exploring innovative ways of solving this problem.
Collapse
Affiliation(s)
| | - Margaret Radu
- Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN, UK
| | | | - John Dooley
- Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN, UK
| | - David Thomas
- Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN, UK
| |
Collapse
|
37
|
Carter AJ, Aggarwal M, Kopia GA, Tio F, Tsao PS, Kolata R, Yeung AC, Llanos G, Dooley J, Falotico R. Long-term effects of polymer-based, slow-release, sirolimus-eluting stents in a porcine coronary model. Cardiovasc Res 2004; 63:617-24. [PMID: 15306217 DOI: 10.1016/j.cardiores.2004.04.029] [Citation(s) in RCA: 222] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2004] [Revised: 03/31/2004] [Accepted: 04/26/2004] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stent-based delivery of sirolimus (SRL) has shown reduction in neointimal hyperplasia and restenosis. The purpose of this study was to evaluate the chronic vascular response and the expression of cell cycle regulators after SRL-eluting stent implantation in a porcine coronary model. METHODS Forty-nine pigs underwent placement of 109 oversized stents (control, n=54, SRL (140 microg/cm(2)), n=55) in the coronary arteries with histologic analysis and Western blot (PCNA, p27(kip1), CD45, MCP-1, IL-2, IL-6, TNF-beta) at 3, 30, 90 or 180 days. RESULTS At 3 days, the mean thrombus area was similar for control (0.38+/-0.19 mm(2)) and SRL (0.29+/-0.09 mm(2)) stents. After 30 days, the mean neointimal area was significantly less for the SRL (1.40+/-0.35 mm(2)) versus the control stents (2.94+/-1.28 mm(2), p<0.001). At 90 and 180 days, the mean neointimal area was similar for the SRL (3.03+/-0.92 and 3.34+/-0.99 mm(2)) as compared with control stents (3.45+/-1.09 and 3.65+/-1.23 mm(2)). Western blot analysis demonstrated an increased expression of p27(kip1) in the vessel wall at 90 days for the SRL versus control stents (p=0.05) but with increased levels of PCNA in the SRL as compared with control stents (p=0.003). CONCLUSION SRL-eluting stents favorably modulate neointimal formation for 30 days in the porcine coronary model. Long-term inhibition of neointimal hyperplasia is not sustained presumably due to delayed cellular proliferation despite increased levels of the cyclin-dependent kinase p27(kip1) in the vessel wall.
Collapse
Affiliation(s)
- Andrew J Carter
- Providence Heart and Vascular Institute, Providence St. Vincent Medical Center, 9205 SW Barnes Road, Portland, OR 97225-5218, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Ikeno F, Bailey L, Willard C, Kopia GA, Tio F, Dooley J. 1139-49 Sirolimus-eluting stents: Pharmacokinetics in blood, vessel, and myocardium in a porcine coronary model. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90346-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Abstract
This article presents a response from a group of lecturers at Florence Nightingale School of Nursing and Midwifery, King's College London and one service user to the perception of a crisis of confidence within health visiting. Changes in registration procedures and shifts in policy have led health visiting to question its place within primary care and the model of preparation for health visiting practice. The group argues that this debate is based on a misunderstanding of the changing health care environment and that health visiting can find a place within the primary care team. Key to this is the continued adherence to a basic nursing training. The authors suggest an incremental model of health visitor training to provide the fullest scope to implement the new health agenda.
Collapse
Affiliation(s)
- M Malone
- Florence Nightingale School of Nursing and Midwifery, King's College London, London.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Millar C, Moore J, Lowery C, McCorry K, Dooley J. Successful PCR amplification of genomic DNA from Cryptosporidium parvum oocysts extracted from a human faecal sample: a rapid and simple method suited for outbreak analysis. Int J Hyg Environ Health 2001; 204:191-4. [PMID: 11759164 DOI: 10.1078/1438-4639-00090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A method to extract genomic DNA from oocysts of Cryptosporidium parvum in human faecal material was developed and consisted of a simple alkali wash, freeze/boil technique. This method was simple, quick, sensitive, inexpensive and resulted in the production of genomic DNA which was free of PCR inhibitors and as such was a suitable template for the detection of C. parvum by various PCR amplification targets.
Collapse
Affiliation(s)
- C Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast BT9 7AD, Northern Ireland, United Kingdom
| | | | | | | | | |
Collapse
|
41
|
Abstract
PURPOSE In children with childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE), to determine the impact of failure of initial antiepileptic drug (AED) for lack of efficacy in eventual seizure control and long-term remission of epilepsy. METHODS Centralized EEG records for the province of Nova Scotia allowed identification of all children seen with CAE or JAE between 1977 and 1985. Information regarding success or failure of initial AED in fully controlling seizures and long-term seizure control and remission of epilepsy was collected by patient questionnaire and chart review. RESULTS Eighty-six of 92 eligible patients were followed up (75 CAE, 11 JAE). Initial AED treatment was successful in 52 (60%) of 86. Success tended to be greater for valproate (VPA) than for other AEDs (p = 0.07), and lower if generalized tonic-clonic or myoclonic seizures coexisted (p < 0.004 and p < 0.03). Terminal remission was more likely if the initial AED was successful than if it had failed (69% vs. 41%; p < 0.02). Compared with those in whom the initial AED was successful, subjects whose initial AED had failed were more likely to progress to juvenile myoclonic epilepsy (JME) at last follow-up (32% vs. 10%; p < 0.02) and to develop intractable epilepsy (17% vs. 2%; p < 0.04). CONCLUSIONS Initial AED was successful in 60% of children with AE. If the first AED failed, the outcome was less favorable, with a lower rate of terminal remission and a higher rate of progression to JME and intractable epilepsy.
Collapse
Affiliation(s)
- E Wirrell
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
| | | | | | | |
Collapse
|
42
|
Murphy MJ, Adler JR, Bodduluri M, Dooley J, Forster K, Hai J, Le Q, Luxton G, Martin D, Poen J. Image-guided radiosurgery for the spine and pancreas. Comput Aided Surg 2001; 5:278-88. [PMID: 11029160 DOI: 10.1002/1097-0150(2000)5:4<278::aid-igs6>3.0.co;2-k] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A robotic image-guided radiosurgical system has been modified to treat extra-cranial sites using implanted fiducials and skeletal landmarks to locate the treatment targets. The system has been used to treat an artero-venous malformation in the cervical spine, a recurrent schwannoma of the thoracic spine, a metastatic adenocarcinoma of the lumbar spine, and three pancreatic cancers. During each treatment, the image guidance system monitored the position of the target site and relayed the target coordinates to the beam-pointing system at discrete intervals. The pointing system then dynamically aligned the therapy beam with the lesion, automatically compensating for shifts in target position. Breathing-related motion of the pancreas lesions was managed by coordinating beam gating with breath-holding by the patient. The system maintained alignment with the spine lesions to within +/- 0.2 mm on average, and to within +/- 1 mm for the pancreatic tumors. This experience has demonstrated the feasibility of using image-guided robotic radiosurgery outside the cranium.
Collapse
Affiliation(s)
- M J Murphy
- Department of Radiation Oncology, Stanford University School of Medicine, CA 94305, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Shubrook JH, Dooley J. Effects of a structured curriculum in osteopathic manipulative treatment (OMT) on osteopathic structural examinations and use of OMT for hospitalized patients. J Am Osteopath Assoc 2000; 100:554-8. [PMID: 11057072] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Osteopathic manipulative treatment (OMT) is a defining feature of osteopathic medicine; however, use of OMT by osteopathic physicians is declining. Recent studies reveal that many osteopathic physicians are abandoning use of OMT as early as medical school. Current national efforts are aimed at reversing this trend by standardizing osteopathic medical records and clinical training in OMT. The authors found that a structured clinical curriculum in OMT taught to house staff significantly increased the percentage of patients who received osteopathic structural examinations and the percentage of patients who received OMT as part of their hospital care.
Collapse
Affiliation(s)
- J H Shubrook
- Firelands Community Hospital, Ohio University College of Osteopathic Medicine, Athens 45701, USA
| | | |
Collapse
|
44
|
Cao Y, Abbas J, Wu X, Dooley J, van Amburg AL. Anti-Yo positive paraneoplastic cerebellar degeneration associated with ovarian carcinoma: case report and review of the literature. Gynecol Oncol 1999; 75:178-83. [PMID: 10502450 DOI: 10.1006/gyno.1999.5553] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Paraneoplastic cerebellar degeneration (PCD) is a rare nonmetastatic neurological complication in cancer patients. Anti-Yo is one of the anti-onconeural antibodies found in PCD patients. It is believed that anti-Yo occurs almost always in women and is most likely associated with gynecologic or breast cancers, although exceptions exist. Here we report a PCD patient with ovarian cancer having high-titer anti-Yo. The acute onset of her PCD symptoms mimicked that of a stroke. Her ovarian cancer tissue contained abundant plasma cells and lymphocytes. After a thorough review of the literature, we propose a schematic hypothesis for the autoimmune pathogenesis of PCD. Despite anecdotal case reports of neurological improvement with different combinations of treatment, including IVIg, there is still no definitely effective treatment for PCD. Further research on the pathogenesis of PCD may lead to more effective therapies.
Collapse
Affiliation(s)
- Y Cao
- Department of Internal Medicine, St. Luke's Hospital, Chesterfield, Missouri, 63017, USA
| | | | | | | | | |
Collapse
|
45
|
Doctor N, Dick R, Rai R, Dafnios N, Salamat A, Whiteway H, Dooley J, Davidson BR. Results of percutaneous plastic stents for malignant distal biliary obstruction following failed endoscopic stent insertion and comparison with current literature on expandable metallic stents. Eur J Gastroenterol Hepatol 1999; 11:775-80. [PMID: 10445799 DOI: 10.1097/00042737-199907000-00016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Endoscopic stenting is an effective method of relieving biliary obstruction in patients with unresectable malignancy. If this fails, optimal management is controversial. Percutaneous insertion of plastic or mesh metal stents has been advocated. AIM To review the outcome of percutaneous plastic stents and compare this with contemporary data from the literature on mesh metal stenting. PATIENTS AND METHODS Over a period of six years, 400 patients had attempted endoscopic stenting for distal malignant biliary obstruction which failed in 54 (13.5%). These 54 patients were treated with percutaneously placed plastic stents. RESULTS Percutaneous stenting was technically successful in 48 patients (89%). Early complications occurred in 13 patients (24%), the commonest being acute cholangitis in seven (12%). There was no procedure-related mortality but a 30-day mortality of 11 % (n = 6). Ten patients (18%) required re-admission after 30 days for stent block (mean period 4 months). Forty-seven patients (87%) were followed up until death. The median survival for the patients undergoing palliative stenting was 3 months (5 days to 17 months). CONCLUSIONS These results suggest that percutaneous plastic stents can be used safely and effectively in patients who have failed endoscopic stenting.
Collapse
Affiliation(s)
- N Doctor
- Department of Surgery, Royal Free Hospital and Medical School, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Morrison N, Dooley J. The Sioux Lookout Diabetes Program: diabetes prevention and management in northwestern Ontario. Int J Circumpolar Health 1999; 57 Suppl 1:364-9. [PMID: 10093307] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Clinically, non-insulin-dependent diabetes mellitus (NIDDM) in the First Nations population of the Sioux Lookout Zone (SLZ), Northwestern Ontario, represents a very different entity than that found in the general Canadian population. Here, its prevalence reaches upwards of 17% (over the age of 10) and children as young as five years of age have been diagnosed. Diabetic ketoacidosis is frequently found, and clients with blood glucose levels of 50 mmol/L or more have remained asymptomatic. Prevention and management of NIDDM in the SLZ must reflect this reality, as well as those of geographic remoteness; community-specific needs; and cultural, in addition to personal, relevance. Over the past five years, the Sioux Lookout Diabetes Program has been developing innovative services and resources to address these needs. Traveling foot-care and diabetes education programs, Community Health Representative training programs, a youth camp, school programs, grocery store labeling programs, and culturally relevant education manuals are a few such initiatives. Visions for the future include the development of a network of community-based diabetes workers to address more completely prevention and management needs on an ongoing basis and the development of stress management workshops for First Nations clients. With our current programming, these new initiatives, and an aggressive early screening program, we hope to stem the imminent onslaught of amputations, heart attacks, renal failure, and blindness.
Collapse
Affiliation(s)
- N Morrison
- University of Toronto Sioux Lookout Diabetes Program, Sioux Lookout, Ontario, Canada
| | | |
Collapse
|
47
|
Mohamed N, Dooley J. Gestational diabetes and subsequent development of NIDDM in aboriginal women of northwestern Ontario. Int J Circumpolar Health 1999; 57 Suppl 1:355-8. [PMID: 10093305] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES To determine (1) the risk of development of non-insulin-dependent diabetes mellitus (NIDDM) in women with a previous history of gestational diabetes mellitus (GDM), (2) the average duration between diagnoses of GDM and NIDDM, (3) various modes of presentation, and (4) adequacy of follow-up post diagnosis of GDM. METHODS A retrospective chart review of women diagnosed with GDM in the Sioux Lookout Zone between 1985-1995. There were 4,211 pregnancies and 332 women with a diagnosis of GDM. Sixty-one charts were randomly selected. Both GDM and NIDDM were defined according to World Health Organization standards. RESULTS Seventy percent of the women with GDM went on to develop NIDDM. The average duration between diagnosis of GDM and diagnosis of NIDDM was three years. Greater than 70% of the women developed NIDDM within four years post diagnosis of GDM. The majority presented with asymptomatic hyperglycemia (88%); 3% presented with acidosis; 6% presented with symptoms of polydipsia and polyuria; and 3% presented with abnormal weight gain. Specific physician-requested follow-up after six weeks postpartum occurred in only 38% of the cases. However six-week follow-up occurred in 41%, a yearly follow-up occurred in 61% of the women, and 81% of the women had some sort of follow-up post diagnosis of GDM. CONCLUSIONS The risk of developing NIDDM after GDM is very high in Aboriginal women of the Sioux Lookout Zone. There is an urgent need for a structured follow-up program for this group of high-risk women. Furthermore, the offspring of these pregnancies should be a focus for follow-up and preventive programs.
Collapse
Affiliation(s)
- N Mohamed
- Sioux Lookout Zone Hospital, University of Toronto Program, Ontario, Canada
| | | |
Collapse
|
48
|
Abstract
Becaplermin (recombinant human platelet-derived growth factor-BB [BB homodimer, rhPDGF-BB]) has demonstrated a favorable safety profile in a series of nonclinical studies designed to assess its systemic toxicity, sensitization, local irritation, and genotoxic potential. No significant local or systemic toxicity directly attributable to becaplermin was observed following single and multiple intravenous or subcutaneous administration at doses up to 3 mg/kg in monkeys. Administration of single large intravenous doses (up to 100 mg/kg) and repeated dosing at 1 or 3 mg/kg in mice resulted in rapidly reversible vasodilation and central nervous system depression. In a bone-toxicity study, becaplermin produced histomorphologic changes suggestive of accelerated bone remodeling, which were judged to be potentially reversible. Similar findings have not been observed in humans. Although becaplermin was not considered a dermal or ocular irritant, some skin-sensitizing effects were observed in animals; this finding was not unexpected for a recombinant human-derived protein. Becaplermin was not genotoxic in a variety of in vitro assays and in one in vivo assay.
Collapse
Affiliation(s)
- E V Knight
- The R.W. Johnson Pharmaceutical Research Institute, Raritan, New Jersey 08869, USA
| | | | | | | | | |
Collapse
|
49
|
Fidler HM, Butler P, Burroughs AK, McIntyre N, Bunn C, McMorrow M, Walmsley R, Dooley J. Co-screening for primary biliary cirrhosis and coeliac disease. Primary biliary cirrhosis and coeliac disease: a study of relative prevalences. Gut 1998; 43:300. [PMID: 10189863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
|
50
|
Affiliation(s)
- J Dooley
- Department of Pediatrics (Neurology), Dalhousie University and IWK-Grace Health Centre, Halifax, Nova Scotia
| | | | | |
Collapse
|