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Kale MS, Diefenbach M, Masse S, Kee D, Schnur J. Patient impressions of the impact of comorbidities on lung cancer screening benefits and harms: A qualitative analysis. Patient Educ Couns 2023; 108:107590. [PMID: 36528981 PMCID: PMC9877186 DOI: 10.1016/j.pec.2022.107590] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To learn about the beliefs and preferences of lung cancer screening (LCS) among patients undergoing LCS decision making. Specifically, we investigated how their comorbidity influences their interest in screening. The goal was to inform shared-decision making discussions around the role of comorbidities and LCS. METHODS We recruited English-speaking LCS-eligible individuals with comorbidities from general medicine outpatient clinics at an academic medical center in New York City. The interviewers followed a semi-structured interview guide and all interviews were professionally transcribed. Study investigators independently conducted thematic analysis of de-identified transcripts; after coding, investigators discussed and agreed upon identified themes (Jacobs et al., 1999 [3]). This study was IRB-approved. RESULTS We achieved thematic saturation after 15 interviews. We identified the following themes: 1) Comorbidities were perceived as unrelated to LCS decision-making, 2) Lung cancer knowledge is valuable and worth any risks, 3) No matter what the guidelines or my providers say, the LCS decision is up to me. CONCLUSION/PRACTICE IMPLICATIONS Implications of these findings are that conversations where providers recommend against LCS may likely require time, patient education, and appreciation of the patient perspective.
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Affiliation(s)
- Minal S Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, USA.
| | - Michael Diefenbach
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, USA
| | - Sybil Masse
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Dustin Kee
- Icahn School of Medicine at Mount Sinai, NY, USA
| | - Julie Schnur
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, NY, USA
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Gorbenko K, Baim-Lance A, Franzosa E, Wurtz H, Schiller G, Masse S, Ornstein KA, Federman A, Levine DM, DeCherrie LV, Leff B, Siu A. A national qualitative study of Hospital-at-Home implementation under the CMS Acute Hospital Care at Home waiver. J Am Geriatr Soc 2023; 71:245-258. [PMID: 36197021 DOI: 10.1111/jgs.18071] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services (CMS) announced the Acute Hospital Care at Home (AHCaH) waiver program in November 2020 to help expand hospital capacity to cope with the COVID-19 pandemic. The AHCaH waived the 24/7 on-site nursing requirement and enabled hospitals to obtain full hospital-level diagnosis-related group (DRG) reimbursement for providing Hospital-at-Home (HaH) care. This study sought to describe AHCaH implementation processes and strategies at the national level and identify challenges and facilitators to launching or adapting a HaH to meet waiver requirements. METHODS We conducted semi-structured interviews to explore barriers and facilitators of HaH implementation. The analysis was informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework. Interviews were audio recorded for transcription and thematic coding. PRINCIPAL FINDINGS We interviewed a sample of clinical leaders (N = 18; clinical/medical directors, operational and program managers) from 14 new and pre-existing U.S. HaH programs diverse by size, urbanicity, and geography. Participants were enthusiastic about the AHCaH waiver. Participants described barriers and facilitators at planning and implementation stages within three overarching themes influencing waiver program implementation: 1) institutional value and assets; 2) program components, such as electronic health records, vendors, pharmacy, and patient monitoring; and 3) patient enrollment, including eligibility and geographic limits. CONCLUSIONS Implementation of AHCaH waiver is a complex process that requires building components in compliance with the requirements to extend the hospital into the home, in coordination with internal and external partners. The study identified barriers that potential adopters and proponents should consider alongside the strategies that some organizations have found useful. Clarity regarding the waiver's future may expedite HaH model dissemination and ensure longevity of this valuable model of care delivery.
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Affiliation(s)
- Ksenia Gorbenko
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Institute for Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA
| | - Abigail Baim-Lance
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Veteran Affairs, James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center, Bronx, New York, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Veteran Affairs, James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center, Bronx, New York, USA
| | - Heather Wurtz
- Human Rights Institute, University of Connecticut, Storrs, Connecticut, USA
| | - Gabrielle Schiller
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sybil Masse
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex Federman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David M Levine
- Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Ariadne Labs, Boston, Massachusetts, USA
| | - Linda V DeCherrie
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Albert Siu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Veteran Affairs, James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center, Bronx, New York, USA
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3
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Gorbenko K, Franzosa E, Baim-Lance A, Schiller G, Wurtz H, Masse S, Levine D, Siu A. CONTENDING WITH UNCERTAINTY: IMPLEMENTING THE CMS ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAM IN THE UNITED STATES. Innov Aging 2022. [PMCID: PMC9770143 DOI: 10.1093/geroni/igac059.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
As Congress considers renewing the Acute Hospital Care At Home (AHCaH) waiver, which provides a full hospital payment for Hospital at Home (HaH) care, evaluating uncertainty around the future of HaH payment is critical. Our qualitative study explored HaH leaders’ experiences with implementing HaH (N=18, clinical/medical directors, operational and program managers) from 14 new and pre-existing programs across the U.S. We conducted semi-structured interviews with HaH programs diverse by size, urbanicity, and geography. We analyzed transcripts using a thematic approach. Participants across settings and regions wanted greater clarity about the waiver’s future. Lack of clarity affected staffing (nurses reluctant to take temporary jobs) and investment in establishing programs (building EMR components, changing workflows, creating inpatient processes in an outpatient setting). Programs adapted to uncertainty in multiple ways: 1) operating parallel waiver and non-waiver programs; 2) seeking to determine/ calculate the HaH value for their institution; 3) determining which patients would benefit most from HaH; and 4) seeking additional health system financing options beyond the CMS reimbursement (new programs) or relying on existing contracts with payers (existing programs). Implementing HaH is a complex and resource intensive process. Greater clarity from CMS regarding the waiver’s future state will encourage programs to invest the resources that they need to establish their programs long-term. Waiver extension/ permanence would also enable programs to develop and test measures of value, making rigorous evaluations possible to optimize different HaH components.
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Affiliation(s)
- Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Abigail Baim-Lance
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Heather Wurtz
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Sybil Masse
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - David Levine
- Mass General Brigham, Boston, Massachusetts, United States
| | - Albert Siu
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Franzosa E, Gorbenko K, Baim-Lance A, Schiller G, Wurtz H, Masse S, Ornstein K, Leff B. PROVIDING INPATIENT CARE BEYOND HOSPITAL WALLS: GEOGRAPHIC FACTORS IN ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAMS. Innov Aging 2022. [PMCID: PMC9765209 DOI: 10.1093/geroni/igac059.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The Centers for Medicare and Medicaid Services’ (CMS) Acute Hospital Care at Home waiver offers hospital-level reimbursement to provide acute hospital-level care in patients’ homes for the first time. While this initiative may make acute care at home more financially viable for health systems, it also requires aligning Hospital at Home (HaH) operations with inpatient, rather than outpatient, regulatory requirements. We aimed to understand how participating HaH programs adapted to these requirements. We conducted semi-structured interviews with multiple leaders from 14 HaH waiver programs (n=18 clinical/medical, operational and program directors) varying in size, urbanicity, structure, and region, examining data through thematic analysis. Both urban and rural participants described geographic effects of waiver requirements. For instance, to ensure response to patient emergencies within 30 minutes, programs contracted with paramedic services to expand service areas, added program locations or moved primary locations to other system hubs. Programs maximized staff capacity across service areas by “leasing” staff from other home-based programs, focusing on urban hubs with more staff, balancing in-person visits with remote monitoring, and providing “hybrid” in-person/video appointments. However, travel time, length of acute care visits, staffing shortages, the need for new skills (e.g., acute care nurses, dietitians) and limited state scope of practice regulations, particularly for paramedics, limited the area and populations served. Adapting to waiver requirements required significant efforts to address staffing, logistical and regulatory challenges. Future waiver improvements should explicitly consider the unique resources needed to expand hospital-level care in geographically diverse ambulatory environments.
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Affiliation(s)
- Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Abigail Baim-Lance
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | | | - Heather Wurtz
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Sybil Masse
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | | | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Gorbenko K, Franzosa E, Masse S, Brody A, Ripp J, Ornstein K, Federman A. The Psychological Impact of COVID-19 on Home Based Primary Care Providers in New York: A Qualitative Study. Innov Aging 2021. [PMCID: PMC8679756 DOI: 10.1093/geroni/igab046.1477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.
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Affiliation(s)
- Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Sybil Masse
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Abraham Brody
- NYU Hartford Institute for Geriatric Nursing, New York, New York, United States
| | - Jonathan Ripp
- Mount Sinai Health System, New York, New York, United States
| | - Katherine Ornstein
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Alex Federman
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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6
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Gorbenko K, Franzosa E, Masse S, Brody AA, Sheehan O, Kinosian B, Ritchie CS, Leff B, Ripp J, Ornstein KA, Federman AD. "I felt useless": a qualitative examination of COVID-19's impact on home-based primary care providers in New York. Home Health Care Serv Q 2021; 40:1-15. [PMID: 34301160 PMCID: PMC8783921 DOI: 10.1080/01621424.2021.1935383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in New York City including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call schedules, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.
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Affiliation(s)
- Ksenia Gorbenko
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute of Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Sybil Masse
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abraham A Brody
- Hartford Institute of Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Orla Sheehan
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bruce Kinosian
- Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Geriatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatrics, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Katherine A. Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex D. Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gueneau R, Behillil S, Enouf V, Masse S, Vilcu A, Madec Y, Van der Werf S. Déterminants de la charge virale nasopharyngée chez les patients infectés par un virus grippal, consultant en soins primaire : 2010–2018. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Hotradat M, Balasundaram K, Masse S, Nair K, Nanthakumar K, Umapathy K. Empirical mode decomposition based ECG features in classifying and tracking ventricular arrhythmias. Comput Biol Med 2019; 112:103379. [PMID: 31419628 DOI: 10.1016/j.compbiomed.2019.103379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/10/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
Ventricular arrhythmias (VA) are life-threatening pathophysiological conditions that seriously impact the normal functioning of the heart. Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the two well known types of VA. VF is the lethal of the VAs and could be characterized by its organizational progression over time. The success of cardiac resuscitation strongly depends on the type of VA, its evolution over time and response to therapy. Due to the time critical nature of VF, computationally efficient quantification of VAs and swift feedback are essential. This work attempted to arrive at computationally efficient and data-driven techniques based on Empirical Mode Decomposition for classifying and tracking VAs over time. The approaches are divided into two aims: (1) 'in-hospital' scenarios for characterizing the dynamics of VA episodes to assist clinicians in planning long-term therapy options, and (2) 'out-of-hospital' scenarios for providing near real-time feedback to detect/track the progression of VAs over time to assist medical personnel select/modify therapy options. Using an ECG database of 61 60-s VA segments obtained for classifying VT vs. VF and sub-classifying VF into organized VF (OVF) and disorganized VF (DVF), maximum classification accuracies of 96.7% (AUC = 0.993) and 87.2% (AUC = 0.968) were obtained for classifying VT vs. VF and OVF vs. DVF during 'in-hospital' analysis. Additionally, two near real-time approaches were presented for 'out-of-hospital' analysis where average accuracies of 71% and 73% were achieved for VT/VF and OVF/DVF classification, as well as demonstrating strong potential for monitoring VA progressions over time.
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Affiliation(s)
- M Hotradat
- Department of ECBE, Ryerson University, 350 Victoria St., Toronto, M5B2K3, Canada
| | - K Balasundaram
- Department of ECBE, Ryerson University, 350 Victoria St., Toronto, M5B2K3, Canada
| | - S Masse
- THFCFML, Toronto General Hospital, 200 Elizabeth St., Toronto, M5G2C4, Canada
| | - K Nair
- THFCFML, Toronto General Hospital, 200 Elizabeth St., Toronto, M5G2C4, Canada
| | - K Nanthakumar
- THFCFML, Toronto General Hospital, 200 Elizabeth St., Toronto, M5G2C4, Canada
| | - K Umapathy
- Department of ECBE, Ryerson University, 350 Victoria St., Toronto, M5B2K3, Canada.
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Cicculli V, Capai L, Quilichini Y, Masse S, Fernández-Alvarez A, Minodier L, Bompard P, Charrel R, Falchi A. Molecular investigation of tick-borne pathogens in ixodid ticks infesting domestic animals (cattle and sheep) and small rodents (black rats) of Corsica, France. Ticks Tick Borne Dis 2019; 10:606-613. [PMID: 30777731 DOI: 10.1016/j.ttbdis.2019.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/09/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
Although livestock farming (sheep, goats, pigs, and cattle) is an important economic activity in Corsica, a French Mediterranean island, knowledge about the tick fauna and microorganisms carried by them remains scarce. This study aimed to investigate the presence and perform molecular characterization of Anaplasmataceae, Rickettsia spp., and Borrelia burgdorferi sensu lato (sl) in tick species collected in Corsica. Ticks from cattle (Bos taurus), sheep (Ovis aries), and rodents (Rattus rattus) were collected from May to September 2016. DNA was purified from ticks, submitted to quantitative real-time polymerase chain reaction (qPCR) and sequenced for phylogenetic analysis. In total, 660 ticks were collected from 111 animals during the study. The most abundant collected tick species from cattle was Rhipicephalus bursa (n = 495; 84.5%), followed by Hyalomma marginatum (n = 91; 15.5%). Rhipicephalus bursa and Ixodes ricinus were the only tick species collected from sheep and rodents, respectively. Overall, Rickettsia was the most common pathogen group (n = 48; 24%) detected in ticks. Sequence analysis of partial gltA and ompA genes revealed the presence of Ri. aeschlimannii and Candidatus Ri. barbariae. Anaplasmataceae DNA was detected in eight (6%) of the 127 cattle pools and in one (2%) of the 61 R. bursa specimens collected from sheep. Sequence analysis of the rpoB gene revealed the presence of one Anaplasma species, A. marginale. Borrelia burgdorferi sl DNA was detected in one pool of H. marginatum collected from cattle and in two (15%) of the 13 I. ricinus pools collected from nine black rats. To our knowledge, this is the first report of the occurrence and molecular characterization of Candidatus Ri. barbariae, an emerging member of the Rickettsia group causing spotted fever, in Corsica. The detection of B. burgdorferi sl DNA, which was previously believed to be rare in Corsica, confirms the presence of this agent on the island.
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Affiliation(s)
- V Cicculli
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
| | - L Capai
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
| | - Y Quilichini
- CNRS - Università di Corsica, UMR 6134 - SPE, Corte, France.
| | - S Masse
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
| | | | - L Minodier
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
| | - P Bompard
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 56, Boulevard Vincent Auriol, 81393-75646, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP UMRS 1136), Paris, France.
| | - R Charrel
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille Univ - IRD 190 - Inserm 1207 - EHESP - IHU Méditerranée Infection), Marseille, France
| | - A Falchi
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
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Souty C, Masse S, Valette M, Behillil S, Bonmarin I, Pino C, Turbelin C, Capai L, Vilcu AM, Lina B, van der Werf S, Blanchon T, Falchi A, Hanslik T. Baseline characteristics and clinical symptoms related to respiratory viruses identified among patients presenting with influenza-like illness in primary care. Clin Microbiol Infect 2019; 25:1147-1153. [PMID: 30703528 PMCID: PMC7172742 DOI: 10.1016/j.cmi.2019.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/07/2019] [Accepted: 01/20/2019] [Indexed: 11/28/2022]
Abstract
Objectives We aimed to identify patients' clinical characteristics associated with respiratory viruses identified among patients presenting with influenza-like illness (ILI). Methods A sample of patients of all ages presenting with ILI was included by physicians of the French Sentinelles network during two seasons (2015/16 and 2016/17). Nasopharyngeal samples were tested for the presence of influenza virus (IV), respiratory syncytial virus (RSV), human rhinovirus (HRV) and human metapneumovirus (HMPV). Patients' characteristics associated with each of the four virus classes were studied using multivariate logistic regressions. Results A total of 5859 individuals were included in the study: 48.0% tested positive for IV, 7.9% for HRV, 7.5% for RSV and 4.1% for HMPV. Cough was associated with IV (OR 2.14, 95% CI 1.81–2.52) RSV (OR 2.52, 95% CI 1.75–3.74) and HMPV detection (OR 2.15, 95% CI 1.40–3.45). Rhinorrhoea was associated mainly with HRV detection (OR 1.75, 95% CI 1.34–2.32). Headache was associated with IV detection (OR 1.75, 95% CI 1.34–2.32), whereas absence of headache was associated with RSV and HMPV detection. Dyspnoea was associated with RSV detection (OR 2.33, 95% CI 1.73–3.12) and absence of dyspnoea with IV detection. Conjunctivitis was associated with IV detection (OR 1.27, 95% CI 1.08–1.50). Some associations were observed only in children: dyspnoea and cough with RSV detection (age <5 years), conjunctivitis with IV detection (age <15 years). Period of onset of symptoms differed among aetiological diagnoses. Seasonal influenza vaccination decreased the risk of IV detection (OR, 0.67, 95% CI 0.51–0.86). Conclusions This study allowed the identification of symptoms associated with several viral aetiologies in patients with ILI. A proper knowledge and understanding of these clinical signs may improve the medical management of patients.
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Affiliation(s)
- C Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France.
| | - S Masse
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France; EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - M Valette
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Centre National de Référence des virus respiratoires (dont la grippe), Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, France
| | - S Behillil
- Institut Pasteur, Unité de Génétique Moléculaire des Virus à ARN, Paris, France; Institut Pasteur, Centre Coordonnateur du Centre National de Référence des virus des infections respiratoires (dont la grippe), Paris, France; UMR CNRS 3569, 75015, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Unité de Génétique Moléculaire des Virus à ARN, Paris, France
| | - I Bonmarin
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - C Pino
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - C Turbelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - L Capai
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France; EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - A M Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - B Lina
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Centre National de Référence des virus respiratoires (dont la grippe), Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, France
| | - S van der Werf
- Institut Pasteur, Unité de Génétique Moléculaire des Virus à ARN, Paris, France; Institut Pasteur, Centre Coordonnateur du Centre National de Référence des virus des infections respiratoires (dont la grippe), Paris, France; UMR CNRS 3569, 75015, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Unité de Génétique Moléculaire des Virus à ARN, Paris, France
| | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - A Falchi
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - T Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France; Université de Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine, Versailles, France; Assistance Publique - Hôpitaux de Paris APHP, Hôpital Ambroise Paré, Service de Médecine Interne, Boulogne Billancourt, France
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11
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Si D, Azam M, Lai P, Masse S, Nanthakumar K. DOES SGLT2 INHIBITION ALTER CARDIAC ELECTROPHYSIOLOGY IN RABBIT MODEL? Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.176] [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: 11/17/2022] Open
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12
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Azam M, Si D, Kusha M, Kichigina G, Lai P, Masse S, Bokhari M, Nanthakumar K. EFFECTS OF PKA AND CAMKII INHIBITION ON VENTRICULAR RE-FIBRILLATION FOLLOWING MYOCARDIAL ISCHEMIA. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.395] [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: 10/28/2022] Open
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13
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Nayyar S, Beheshti M, Liang T, Masse S, Bhaskaran A, Downar E, Vigmond E, Nanthakumar K. PREDICTING VENTRICULAR TACHYCARDIA CHANNELS IN HUMANS FROM ENTROPY ANALYSIS OF SINUS RHYTHM ELECTROGRAMS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.396] [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: 10/28/2022] Open
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14
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Bhaskaran A, Magtibay K, Masse S, Porta-Sanchez A, LaFlamme M, Deno D, Nanthakumar K. DRAG AND MAP STRATEGY FOR DYNAMIC DETECTION OF DISEASED MYOCARDIUM: INNOVATIVE OMNIPOLAR APPLICATION WITH ADVISOR HD GRID. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Bokhari M, Nanthakumar K, Spears D, Lai P, Masse S, Si D, Billia F, Parker J, Al-Hesayen A, Azam M, Porta-Sanchez A, Riazi S. SAFETY OF CHRONIC CARDIAC RYANODINE RECEPTOR MODULATION: A 10-YEAR EXPERIENCE. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.115] [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] Open
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16
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Porta Sanchez A, Magtibay K, Masse S, Nayyar S, Bhaskaran A, Deno DC, Nanthakumar K. 1019Equi-Spaced Electrode Array for Orientation Independent Bipolar Substrate Mapping. Europace 2018. [DOI: 10.1093/europace/euy015.568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Porta Sanchez
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - K Magtibay
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - S Masse
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - S Nayyar
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - A Bhaskaran
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
| | - D C Deno
- St Jude Medical, Minneapolis, United States of America
| | - K Nanthakumar
- University Health Network, The Hull Family Cardiac Fibrillation Management Laboratory, Toronto, Canada
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Bekkali CE, Bouyarmane H, Karbane ME, Masse S, Saoiabi A, Coradin T, Laghzizil A. Zinc oxide-hydroxyapatite nanocomposite photocatalysts for the degradation of ciprofloxacin and ofloxacin antibiotics. Colloids Surf A Physicochem Eng Asp 2018. [DOI: 10.1016/j.colsurfa.2017.12.051] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Porta Sanchez A, Haldar S, Magtibay K, Masse S, Kusha M, Azam MA, Asta J, Lai PFH, Deno DC, Nanthakumar K. 1155Assessment of transmurality during lesion formation with electrograms. Europace 2017. [DOI: 10.1093/ehjci/eux152.003] [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: 11/12/2022] Open
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19
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Porta Sanchez A, Haldar S, Magtibay K, Masse S, Kusha M, Azam MA, Asta J, Lai PFH, Deno DC, Nanthakumar K. P382Bipolar electrograms directed across wavefronts provide greater physiological accuracy. Europace 2017. [DOI: 10.1093/ehjci/eux141.107] [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: 11/14/2022] Open
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20
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Masse S, Zanni H, Lecourtier J, Roussel JC, Rivereau A. High temperature hydration of tricalcium silicate, the major component of Portland cement: a silicon-29 NMR contribution. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/jcp/1995921861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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21
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Masse S, Minodier L, Heuze G, Blanchon T, Capai L, Falchi A. Influenza-like illness outbreaks in nursing homes in Corsica, France, 2014-2015: epidemiological and molecular characterization. Springerplus 2016; 5:1338. [PMID: 27563533 PMCID: PMC4981007 DOI: 10.1186/s40064-016-2957-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/29/2016] [Indexed: 11/25/2022]
Abstract
Background To study the molecular epidemiology of the influenza outbreaks in nursing homes (NHs) to determine whether multiple influenza strains were involved. Methods From September to December 2014, NHs in Corsica were invited to participate in an ongoing daily epidemiological and microbiological surveillance for influenza-like illness (ILI) among residents and health care workers (HCWs). Results The study involved 12 NHs. Respiratory illness meeting the ILI case definition was observed among 44 residents from whom 22 specimens were collected. Of the 22 residents with a nasopharyngeal sample, 13 (59 %) were positive for at least one of the 11 pathogens analysed. Among these 13 patients, 11 (92 %) presented a confirmed influenza (A/H3N2) and two had another respiratory virus: one human metapneumovirus and one human coronavirus. Of patients with a confirmed influenza A(H3N2), 10 (91 %) were vaccinated against influenza during the 2014–2015 season. Two influenza outbreaks were reported in two NHs, caused by influenza A(H3N2) strains belonging to cluster 3C.3 and 3C.2a. Although antivirals were available, prophylaxis was not used. Conclusions Phylogenetic analysis seems to suggest no multiple introduction into the two NHs reporting the two influenza A(H3N2) outbreaks. A number of factors could have contributed to transmitting influenza in NHs including, the absence of administration of antiviral treatment for prophylaxis of all residents/staff regardless of immunization status because of the poor vaccine match during each outbreak, the intensive contacts with incompletely protected residents and HCWs, and the low adherence of NHs to notification of ILI outbreaks to the health authorities. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-2957-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Masse
- EA 7310, Laboratory of Virology, University of Corsica-Inserm, Corte, France
| | - L Minodier
- EA 7310, Laboratory of Virology, University of Corsica-Inserm, Corte, France
| | - G Heuze
- CIRE-SUD Paca Corse, InVS, Saint-Maurice Cedex, Paris, France
| | - T Blanchon
- UPMC Univ Paris 06, UMR_S 1136, Sorbonne Universités, Paris, France ; INSERM, UMR_S 1136, Paris, France
| | - L Capai
- EA 7310, Laboratory of Virology, University of Corsica-Inserm, Corte, France ; UPMC Univ Paris 06, UMR_S 1136, Sorbonne Universités, Paris, France ; INSERM, UMR_S 1136, Paris, France
| | - A Falchi
- EA 7310, Laboratory of Virology, University of Corsica-Inserm, Corte, France
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22
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Beheshti M, Foomany FH, Magtibay K, Masse S, Lai P, Asta J, Jaffray DA, Nanthakumar K, Krishnan S, Umapathy K. Modeling Current Density Maps Using Aliev-Panfilov Electrophysiological Heart Model. Cardiovasc Eng Technol 2016; 7:238-53. [PMID: 27357301 DOI: 10.1007/s13239-016-0271-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
Abstract
Most existing studies of cardiac arrhythmia rely on surface measurements through optical or electrical mapping techniques. Current density imaging (CDI) is a method which enables us to study current pathways inside the tissue. However, this method entails implementation complexities for beating ex vivo hearts. Hence, this work presents an approach to simulate and study the current distributions in different cardiac electrophysiological states. The results are corroborated by experimental data, and they indicate that different states were distinguishable. The CDI simulations can be used for studying cardiac arrhythmias under simulation conditions which are otherwise impossible or difficult to be implemented experimentally.
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Affiliation(s)
- M Beheshti
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada.
| | - F H Foomany
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
| | - K Magtibay
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
| | - S Masse
- The Hull Family Cardiac Fibrillation Management Lab, Toronto General Hospital, Toronto, ON, Canada
| | - P Lai
- The Hull Family Cardiac Fibrillation Management Lab, Toronto General Hospital, Toronto, ON, Canada
| | - J Asta
- The Hull Family Cardiac Fibrillation Management Lab, Toronto General Hospital, Toronto, ON, Canada
| | - D A Jaffray
- Princess Margarett Hospital, Toronto, ON, Canada
| | - K Nanthakumar
- The Hull Family Cardiac Fibrillation Management Lab, Toronto General Hospital, Toronto, ON, Canada
| | - S Krishnan
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
| | - K Umapathy
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
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23
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Azam M, Zamiri N, Masse S, Kusha M, Lai P, Asta J, Nair G, Nanthakumar K. LATE SODIUM CURRENT INHIBITOR RANOLAZINE REDUCED SUSCEPTIBILITY TO RE-FIBRILLATIONS FOLLOWING LONG DURATION VF. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.404] [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: 10/22/2022] Open
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24
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Porta-Sanchez A, Alqubbany A, Das M, Downar E, Masse S, Harris L, Cameron D, Nair K, Chauhan V, Spears D, Ha A, Gollob M, Jackson N, Nanthakumar K. USING TIMING RELATIONSHIPS OF SINGLE DIASTOLIC ELECTROGRAMS DURING RAPID ACTIVATION MAPPING TO DETERMINE CRITICAL SITE DURING VENTRICULAR TACHYCARDIA ABLATION. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.600] [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: 11/24/2022] Open
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25
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Magtibay K, Beheshti M, Foomany FH, Balasundaram K, Masse S, Lai P, Asta J, Zamiri N, Jaffray DA, Nanthakumar K, Krishnan S, Umapathy K. Fusion of structural and functional cardiac magnetic resonance imaging data for studying ventricular fibrillation. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:5579-82. [PMID: 25571259 DOI: 10.1109/embc.2014.6944891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Magnetic Resonance Imaging (MRI) techniques such as Current Density Imaging (CDI) and Diffusion Tensor Imaging (DTI) provide a complementing set of imaging data that can describe both the functional and structural states of biological tissues. This paper presents a Joint Independent Component Analysis (jICA) based fusion approach which can be utilized to fuse CDI and DTI data to quantify the differences between two cardiac states: Ventricular Fibrillation (VF) and Asystolic/Normal (AS/NM). Such an approach could lead to a better insight on the mechanism of VF. Fusing CDI and DTI data from 8 data sets from 6 beating porcine hearts, in effect, detects the differences between two cardiac states, qualitatively and quantitatively. This initial study demonstrates the applicability of MRI-based imaging techniques and jICA-based fusion approach in studying cardiac arrhythmias.
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26
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Rasooli M, Foomany F, Balasundaram K, Masse S, Zamiri N, Ramadeen A, Hu X, Dorian P, Nanthakumar K, Krishnan S, Beheshti S, Umapathy K. Analysis of electrocardiogram pre-shock waveforms during ventricular fibrillation. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Bouyarmane H, El Hanbali I, El Karbane M, Rami A, Saoiabi A, Saoiabi S, Masse S, Coradin T, Laghzizil A. Parameters influencing ciprofloxacin, ofloxacin, amoxicillin and sulfamethoxazole retention by natural and converted calcium phosphates. J Hazard Mater 2015; 291:38-44. [PMID: 25749000 DOI: 10.1016/j.jhazmat.2015.02.049] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 06/04/2023]
Abstract
The retention of four antibiotics, ciprofloxacin, ofloxacin, amoxicillin and sulfamethoxazole by a natural phosphate rock (francolite) was studied and compared with a converted hydroxyapatite powder. The maximum sorption capacities were found to correlate with the molecular weight of the molecules. The mechanisms of sorption depended mostly on the charge of the antibiotic whereas the kinetics of the process was sensitive to their hydrophobic/hydrophilic character. The two materials showed slightly distinct affinities for the various antibiotics but exhibited similar maximum sorption capacities despite different specific surface areas. This was mainly attributed to the more pronounced hydrophobic character of the francolite phase constituting the natural phosphate. These data enlighten that the retention properties of these mineral phases depend on a complex interplay between the inter-molecular and molecule-solid interactions. These findings are relevant to understand better the contribution of calcium phosphates in the fate and retention of antibiotics in soils.
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Affiliation(s)
- H Bouyarmane
- Laboratoire de Chimie Physique Générale, Université Mohammed V-Agdal, Faculté des Sciences, BP. 1014 Rabat, Morocco
| | - I El Hanbali
- Laboratoire de Chimie Physique Générale, Université Mohammed V-Agdal, Faculté des Sciences, BP. 1014 Rabat, Morocco; Sorbonne Universités, UPMC Univ Paris 06, UMR 7574, Laboratoire de Chimie de la Matière Condensée de Paris, F-75005 Paris, France; CNRS, UMR 7574, Laboratoire de Chimie de la Matière Condensée de Paris, F-75005 Paris, France
| | - M El Karbane
- Laboratoire National de Contrôle des Médicaments, Rabat, Morocco
| | - A Rami
- Laboratoire National de Contrôle des Médicaments, Rabat, Morocco
| | - A Saoiabi
- Laboratoire de Chimie Physique Générale, Université Mohammed V-Agdal, Faculté des Sciences, BP. 1014 Rabat, Morocco
| | - S Saoiabi
- Laboratoire de Chimie Physique Générale, Université Mohammed V-Agdal, Faculté des Sciences, BP. 1014 Rabat, Morocco
| | - S Masse
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7574, Laboratoire de Chimie de la Matière Condensée de Paris, F-75005 Paris, France; CNRS, UMR 7574, Laboratoire de Chimie de la Matière Condensée de Paris, F-75005 Paris, France
| | - T Coradin
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7574, Laboratoire de Chimie de la Matière Condensée de Paris, F-75005 Paris, France; CNRS, UMR 7574, Laboratoire de Chimie de la Matière Condensée de Paris, F-75005 Paris, France.
| | - A Laghzizil
- Laboratoire de Chimie Physique Générale, Université Mohammed V-Agdal, Faculté des Sciences, BP. 1014 Rabat, Morocco.
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Foomany FH, Beheshti M, Magtibay K, Masse S, Lai P, Asta J, Zamiri N, Jaffray DA, Krishnan S, Nanthakumar K, Umapathy K. A novel approach to quantification of real and artifactual components of current density imaging for phantom and live heart. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:1075-8. [PMID: 25570148 DOI: 10.1109/embc.2014.6943780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Spatial distribution of injected current in a subject could be calculated and visualized through current density imaging (CDI). Calculated CDI paths however have a limited degree of accuracy due to both avoidable methodological errors and inevitable limitations dictated by MR imaging constraints. The source and impact of these limitations are scrutinized in this paper. Quantification of such limitations is an essential step prior to passing any judgment about the results especially in biomedical applications. An innovative technique along with metrics for evaluation of range of errors using baseline and phase cycle MR images is proposed in this work. The presented approach is helpful in pinpointing the local artifacts (areas for which CDI results are suspect), evaluation of global noises and artifacts and assessment of the effect of approximation algorithms on real and artifactual components. We will demonstrate how this error/reliability evaluation is applicable to interpretation of CDI results and in this framework, report the CDI results for an artificial phantom and a live pig heart in Langendorff setup. It is contended here that using this method, the inevitable trade-off between details and approximations of CDI components could be monitored which provides a great opportunity for robust interpretation of results. The proposed approach could be extended, adapted and used for statistical analysis of similar methods which aim at mapping current and impedance based on magnetic flux images obtained through MRI.
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Abdulmajeed R, Ramadeen A, Masse S, Foomany FH, Balasundaram K, Hu X, Nanthakumar K, Dorian P, Umapathy K. The effects of long chain polyunsaturated fatty acids on local activation properties in dogs vulnerable to atrial fibrillation. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:1067-70. [PMID: 25570146 DOI: 10.1109/embc.2014.6943778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Marine derived long chain polyunsaturated fatty acids (PUFAs) were found to have benefits in reducing inducibility and maintenance of atrial fibrillation (AF) in a dog model. This study was conducted to evaluate the effect of PUFAs on local atrial electrical conduction properties acquired via a multi-electrode plaque sutured to the posterior wall of the left atrium of the heart in these dogs. Eleven dogs underwent simultaneous atrioventricular pacing (SAVP) for 2 weeks, and were organized into 2 groups: 5 dogs received no PUFAs (SAVP-PLACEBO), 6 dogs received Eicosapentaenoic or Docosahexaenoic acid derived from fish oils (SAVP-PUFA), where PUFAs were given for 21 days, starting 1 week prior to pacing and during the 2 week pacing period. Three features were extracted, which were the average conduction velocity, average intra atrial conduction time, and total activation time. The PUFA group had a faster average conduction velocity (0.82±0.19 m/s) than the PLACEBO group (0.47±0.21 m/s, P=0.02). Using the average conduction velocity feature, classification was performed with a linear classifier and leave-one-out method. In the SAVP-PLACEBO group, 60% of the dogs were correctly classified, and 66% of the dogs were correctly classified in SAVP-PUFA group, leading to an overall classification accuracy of 63.5%.
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Gizurarson S, Spears D, Sivagangabalan G, Farid T, Ha ACT, Masse S, Kusha M, Chauhan VS, Nair K, Harris L, Downar E, Nanthakumar K. Bipolar ablation for deep intra-myocardial circuits: human ex vivo development and in vivo experience. Europace 2014; 16:1684-8. [DOI: 10.1093/europace/euu001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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31
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Roshan J, Gizurarson S, Kusha M, Dimagiba L, Khan K, Masse S, Harris L, Downar E, Nanthakumar K. Is There an Ideal Strategy to Maximize Endo- and Epicardial Late Potentials Mapping in Patients Undergoing Ablation for Ischemic Ventricular Tachycardia? Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.395] [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: 10/26/2022] Open
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32
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Rasooli M, Foomany FH, Balasundaram K, Masse S, Zamiri N, Ramadeen A, Hu X, Dorian P, Nanthakumar K, Beheshti S, Umapathy K. Blind source separation in characterizing ECG pre-shock waveforms during Ventricular Fibrillation. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:5833-5836. [PMID: 24111065 DOI: 10.1109/embc.2013.6610878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ventricular Fibrillation (VF) is a cardiac arrhythmia for which the only available treatment option is defibrillation by electrical shock. Existing literature indicates that VF could be the manifestation of different sources controlling the heart with different degrees of organization. In this work we test the hypothesis that the pre-shock waveforms of successful and unsuccessful shock outcomes could be related to the number of independent sources present in these waveforms. The proposed method uses Blind Source Separation (BSS) to extract independent components in frequency direction from a pig database consisting of 20 pre-shock waveforms. The slope of the energy capture curve was used as an indicator to demonstrate the number of independent sources required to model the pre-shock waveforms. The results were also quantified by performing a linear discriminant analysis based classification achieving an overall classification accuracy of 75%. The results indicate that successful cases can be modeled with less number of independent sources compared to unsuccessful cases.
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33
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Foomany FH, Beheshti M, Magtibay K, Masse S, Foltz W, Sevaptsidis E, Lai P, Jaffray DA, Krishnan S, Nanthakumar K, Umapathy K. Analysis of reliability metrics and quality enhancement measures in current density imaging. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:4394-4397. [PMID: 24110707 DOI: 10.1109/embc.2013.6610520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Low frequency current density imaging (LFCDI) is a magnetic resonance imaging (MRI) technique which enables calculation of current pathways within the medium of study. The induced current produces a magnetic flux which presents itself in phase images obtained through MRI scanning. A class of LFCDI challenges arises from the subject rotation requirement, which calls for reliability analysis metrics and specific image registration techniques. In this study these challenges are formulated and in light of proposed discussions, the reliability analysis of calculation of current pathways in a designed phantom and a pig heart is presented. The current passed is measured with less than 5% error for phantom, using CDI method. It is shown that Gauss's law for magnetism can be treated as reliability metric in matching the images in two orientations. For the phantom and pig heart the usefulness of image registration for mitigation of rotation errors is demonstrated. The reliability metric provides a good representation of the degree of correspondence between images in two orientations for phantom and pig heart. In our CDI experiments this metric produced values of 95% and 26%, for phantom, and 88% and 75% for pig heart, for mismatch rotations of 0 and 20 degrees respectively.
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Balasundaram K, Masse S, Nair K, Umapathy K. Automated signal pattern detection in ECG during human ventricular arrhythmias. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:1029-1032. [PMID: 24109866 DOI: 10.1109/embc.2013.6609679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ventricular arrhythmias seriously affects cardiac function. Of these arrhythmias, Ventricular fibrillation is considered as a lethal cardiac condition. Recent studies have reported that ventricular arrhythmias are not completely random and may exhibit regional spatio-temporal organizations. These organizations could be indicative of reoccurring signal patterns and might be embedded within the surface electrocardiograms (ECGs) during ventricular arrhythmias. In this work, we aim to identify such reoccurring ECG signal patterns during ventricular arrhythmias. The detection of such signal patterns and their distribution could be of help in sub-classifying the affected population for better targeted diagnosis and treatment. Our analysis on 14 ECG segments (on average 3.24 minutes per segment) obtained from the MIT-BIH ventricular arrhythmia database identified three reoccurring signal patterns. A wavelet based technique was developed for automating the pattern identification process using ECGs. The proposed method achieved automated detection accuracies of 73.3%, 75.0% and 86.6% for the proposed signal patterns.
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Masse S, Downar E, Sevaptsidis E, Asta J, Harris L, Cameron D, Nair K, Chauhan V, Spears D, Ha A, Nanthakumar K. 734 Exit Site of Ischemic Ventricular Tachycardia: Lessons From Simultaneous Multi-Electrode Mapping Era Applied to Sequential Mapping Era. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Zamiri N, Ramadeen A, Hu X, Farid T, Masse S, Dorian P, Nanthakumar K. 621 Developing an In-Vivo Model of Ventricular Re-Fibrillation. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Spears D, Sivagangabalan G, Barry A, Farid T, Sevaptsidis E, Masse S, Kusha M, Ha A, Nair K, Downar E, Chauhan V, Harris L, Khan F, Das M, Roshan J, Scott L, Nanthakumar K. 736 Bipolar Catheter Ablation for Ventricular Tachycardia in Humans: Ex-Vivo Development and In-Vivo Experience. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nair K, Farid T, Masse S, Umapathy K, Watkins S, Poku K, Asta J, Kusha M, Sevaptsidis E, Jacob J, Floras JS, Nanthakumar K. Studying semblances of a true killer: experimental model of human ventricular fibrillation. Am J Physiol Heart Circ Physiol 2012; 302:H1533-7. [PMID: 22268105 DOI: 10.1152/ajpheart.00471.2011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It is unknown whether ventricular fibrillation (VF) studied in experimental models represents in vivo human VF. First, we examined closed chest in vivo VF induced at defibrillation threshold testing (DFT) in four patients with ischemic cardiomyopathy pretransplantation. We examined VF in these same four hearts in an ex vivo human Langendorff posttransplantation. VF from DFT was compared with VF from the electrodes from a similar region in the right ventricular endocardium in the Langendorff using two parameters: the scale distribution width (extracted from continuous wavelet transform) and VF mean cycle length (CL). In a second substudy group where multielectrode phase mapping could be performed, we examined early VF intraoperatively (in vivo open chest condition) in three patients with left ventricular cardiomyopathy. We investigated early VF in the hearts of three patients in an ex vivo Langendorff and compared findings with intraoperative VF using two metrics: dominant frequency (DF) assessed by the Welch periodogram and the number of phase singularities (lasting >480 ms). Wavelet analysis (P = 0.9) and VF CL were similar between the Langendorff and the DFT groups (225 ± 13, 218 ± 24 ms; P = 0.9), indicating that wave characteristics and activation rate of VF was comparable between the two models. Intraoperative DF was slower but comparable with the Langendorff DF over the endocardium (4.6 ± 0.1, 5.0 ± 0.4 Hz; P = 0.9) and the epicardium (4.5 ± 0.2, 5.2 ± 0.4 Hz; P = 0.9). Endocardial phase singularity number (9.6 ± 5, 12.1 ± 1; P = 0.6) was lesser in number but comparable between in vivo and ex vivo VF. VF dynamics in the limited experimental human studies approximates human in vivo VF.
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Affiliation(s)
- K Nair
- Division of Cardiology, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada
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Afatmirni E, Nanthakumar K, Masse S, Nair K, Farid T, Krishnan S, Dorian P, Umapathy K. Predicting refibrillation from pre-shock waveforms in optimizing cardiac resuscitation. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:251-4. [PMID: 22254297 DOI: 10.1109/iembs.2011.6090048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ventricular fibrillation (VF) is a lethal cardiac arrhythmia that if untreated within minutes of its occurrence will lead to sudden cardiac death. Defibrillation using electric shocks is the only choice of treatment to restore the heart to normal rhythm especially in out-of-the-hospital VF incidents. Refibrillation (i.e., recurrence of VF) is a common and significant problem in cardiac resuscitation as it negatively impacts the survival rates. In such refibrillation cases administration of anti-arrhythmic drugs could improve the shock outcomes or prevent refibrillation. In cases of prolonged VF, cardio pulmonary resuscitation (CPR) prior to the shocks have been shown to improve the survival rates. The proposed work using wavelet analysis of the pre-shock VF electrograms attempts to predict the shock outcomes as successful, refibrillation, and unsuccessful categories. This feedback in real-time would be of immense assistance to the Emergency Medical Services (EMS) personnel in choosing the right combination of therapies (i.e., shock, CPR, pharmacology interventions) in improving the shock outcomes. Using a real-word database of 34 pre-shock VF electrograms obtained from Toronto area EMS personnel, the proposed method achieved classification accuracies of 76.5% and 75% for a two level binary classification of the three groups.
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Jeyaratnam J, Umapathy K, Masse S, Nair K, Farid T, Krishnan S, Nanthakumar K. Relating spatial heterogeneities to rotor formation in studying human ventricular fibrillation. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:231-4. [PMID: 22254292 DOI: 10.1109/iembs.2011.6090043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ventricular fibrillation (VF) occurs due to disorganized electrical activity in the ventricles. This leads to rapid uncoordinated contractions of the ventricles and sudden cardiac death if not treated within minutes of its occurrence. The mechanism of VF initiation and maintenance is still elusive, however the mother rotor and multiple wavelet theories attempt to explain the mechanism behind this lethal arrhythmia. In mother rotor theory, VF is believed to be maintained by high frequency periodic sources called rotors that could be tracked using the phase progression along and through the myocardium using spatio-temporal electrical mapping of the heart. There are exiting works including our previous works that have related the formation of these rotors to anatomical and physiological heterogeneities observed in the myocardium. In this study we performed an correlation exercise of the locations of rotors with scar boundary maps and dominant frequency maps and elucidated this relation using human VF data acquired from isolated human hearts. The results suggest that in 14 rotors over 6 human hearts that we studied, all rotors co-localized to boundary zones of scar and low-high dominant frequency locations. The mean variance of the dominant frequency over the spatial location of the rotor was found to be 0.55 with average minimum of 4.15 Hz to a maximum of 5.71 Hz. This results in human VF data strongly suggest that boundary zones of healthy-non-healthy tissues and low-high frequency boundaries form a favorite substrate for rotor formation.
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Kusha M, Masse S, Farid T, Urch B, Sivagangabalan G, Silverman F, Gold D, Lukic K, Speck M, Nanthakumar K. 265 Does exposure to air pollution cause T wave alternans in subjects with no pre-existing cardiovascular disease? Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.197] [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: 11/24/2022] Open
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Farid T, Nair K, Masse S, Quadros K, Poku K, Umapathy K, Kusha M, Sevaptsidis E, Asta J, Nanthakumar K. 264 Is ventricular fibrillation different in ischemic compared to non-ischemic dilated cardiomyopathic human hearts? Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Foomany FH, Umapathy K, Sugavaneswaran L, Krishnan S, Masse S, Farid T, Nair K, Dorian P, Nanthakumar K. Wavelet-based markers of ventricular fibrillation in optimizing human cardiac resuscitation. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2010:2001-4. [PMID: 21097215 DOI: 10.1109/iembs.2010.5627841] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
During cardiac resuscitation from ventricular fibrillation (VF) it would be helpful if we could monitor and predict the optimal state of the heart to be shocked into a perfusing rhythm. Real-time feedback of this state to the emergency medical staff (EMS) could improve the survival rate after resuscitation. In this paper, using real world out-of-the-hospital human VF data obtained during resuscitation by EMS personnel, we present the results of applying wavelet markers in predicting the shock outcomes. We also performed comparative analysis of 5 existing techniques (spectral and correlation based approaches) against the proposed wavelet markers. A database of 29 human VF tracings was extracted from the defibrillator recordings collected by the EMS personnel and was used to validate the waveform markers. The results obtained by the comparison of the wavelet based features with other spectral, and correlation-based features indicates that the proposed wavelet features perform well with an overall accuracy of 79.3% in predicting the shock outcomes and hence demonstrate potential to provide near real-time feedback to EMS personnel in optimizing resuscitation outcomes.
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Balasundaram K, Masse S, Nair K, Farid T, Nanthakumar K, Umapathy K. Wavelet-based features for characterizing ventricular arrhythmias in optimizing treatment options. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2011:969-972. [PMID: 22254473 DOI: 10.1109/iembs.2011.6090219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ventricular arrhythmias arise from abnormal electrical activity of the lower chambers (ventricles) of the heart. Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the two major subclasses of ventricular arrhythmias. While VT has treatment options that can be performed in catheterization labs, VF is a lethal cardiac arrhythmia, often when detected the patient receives an implantable defibrillator which restores the normal heart rhythm by the application of electric shocks whenever VF is detected. The classification of these two subclasses are important in making a decision on the therapy performed. As in the case of all real world process the boundary between VT and VF is ill defined which might lead to many of the patients experiencing arrhythmias in the overlap zone (that might be predominately VT) to receive shocks by the an implantable defibrillator. There may also be a small population of patients who could be treated with anti-arrhythmic drugs or catheterization procedure if they can be diagnosed to suffer from predominately VT after objectively analyzing their intracardiac electrogram data obtained from implantable defibrillator. The proposed work attempts to arrive at a quantifiable way to scale the ventricular arrhythmias into VT, VF, and the overlap zone arrhythmias as VT-VF candidates using features extracted from the wavelet analysis of surface electrograms. This might eventually lead to an objective way of analyzing arrhythmias in the overlap zone and computing their degree of affinity towards VT or VF. A database of 24 human ventricular arrhythmia tracings obtained from the MIT-BIH arrhythmia database was analyzed and wavelet-based features that demonstrated discrimination between the VT, VF, and VT-VF groups were extracted. An overall accuracy of 75% in classifying the ventricular arrhythmias into 3 groups was achieved.
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Umapathy K, Krishnan S, Masse S, Hu X, Dorian P, Nanthakumar K. Optimizing cardiac resuscitation outcomes using wavelet analysis. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2009:6761-6764. [PMID: 19963687 DOI: 10.1109/iembs.2009.5332509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ventricular fibrillation (VF) is the most lethal of cardiac arrhythmias that leads to sudden cardiac death if untreated within minutes of its occurrence. Defibrillation using electric shock resets the heart to return to spontaneous circulation (ROSC) state, however the success of which depends on various factors such as the viability of myocardium and the time lag between the onset of VF to defibrillation. Recent studies have reported that performing cardio pulmonary resuscitation (CPR) procedure prior to applying shock increases the survival rate especially when VF is untreated for more than 5 minutes. Considering the limited time within which the VF has to be treated for better survival rates, the choice of the right therapy (shock parameters, shock first or CPR first, drug administration) is vital. In aiding this choice, it would be of immense help for emergency medical staff (EMS) if an objective feedback could be provided at near real-time rate on the VF characteristics and its relation to the shock outcomes. Existing works in the literature have demonstrated correlation between the characteristics of the VF waveform and the outcome (ROSC) of the defibrillation. The proposed work improves on this by attempting to arrive at a near real-time monitoring tool in aiding the EMS staff. Using data collected from 16 pigs during VF, the proposed wavelet methodology achieved an overall accuracy of 94% in successfully predicting the shock outcomes.
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Westergaard P, Umapathy K, Masse S, Sevapstisidis E, Asta J, Farid T, Nair K, Krishnan S, Nanthakumar K. Non-linear image registration for correction of motion artifacts during optical imaging of human hearts. ACTA ACUST UNITED AC 2008. [DOI: 10.1109/ccece.2008.4564839] [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: 11/08/2022]
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Ficko C, Rapp C, Barruet R, Masse S, Claude V, Imbert P, Debord T. Une cause inhabituelle de méningite du sujet jeune: la maladie de Kikuchi. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.162] [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: 11/27/2022]
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Saito J, Downar E, Doig JC, Masse S, Sevaptsidis E, Shi MH, Chen TC, Kimber S, Harris L, Mickleborough LL. Characteristics of local electrograms with diastolic potentials: identification of different components of return pathways in ventricular tachycardia. J Interv Card Electrophysiol 1998; 2:235-45. [PMID: 9870017 DOI: 10.1023/a:1009776618809] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Diastolic potentials are often sought as a possible site for catheter ablation in post-infarct ventricular tachycardia. However, delivery of energy at such sites is often unsuccessful. The purpose of this study was to determine the characteristics of local electrograms with diastolic potentials and to identify activation pattern which might indicate the critical portion of the return path of the ventricular tachycardia reentry circuit. METHODS In 17 patients with post-myocardial infarction ventricular tachycardia, 30 ventricular tachycardias were mapped with an 112 bipolar endocardial balloon at the time of surgery. Diastolic mapping of the return tract in ventricular tachycardia was performed. Four activation patterns were observed (15 figure 8 patterns, 2 circular patterns, 2 biregional patterns and 11 monoregional patterns). Of 3,360 local electrograms, 207 (6.2%) demonstrated a diastolic potential in ventricular tachycardia. They were classified into following four categories, based on the appearance and timing of the systolic component. Type A-1 electrogram: systolic activation was of low amplitude (< 2 mV) and was prolonged (> or = 100 msec), but preceded the onset of the surface QRS in ventricular tachycardia. Type A-2 electrogram: systolic activation was of low amplitude, was prolonged, but followed the onset of the surface QRS. Type B electrogram: systolic electrogram was fractionated, but relatively normal amplitude (2.0-3.6 mV). Type C electrogram: systolic electrogram was almost normal. RESULTS Of all electrograms with diastolic potentials, three type A-1 electrograms (1.4%) were located at the exit of the return pathway, 11 type A-1 electrograms (5.3%) were located at the pre-exit site. No type A-1 was found at an entrance/bystander area. 21 type A-2 electrograms (10.1%) were at the pre-exit and 83 type A-2 electrograms (40.2%) were located at the entrance/bystander area, but such electrograms were never found at the exit site. 71 type B electrograms (34.3%) and 18 type C electrograms (8.7%) were located at the entrance/bystander area. To distinguish the type A-2 electrograms at the pre-exit site from those at the entrance/bystander area, the diastolic potential to QRS interval was measured. This interval at the pre-exit was significantly shorter than that at the entrance/bystander area (-47.2 +/- 10.7 vs -96.3 +/- 31.3 msec, p = 0.0001). CONCLUSION Type A-1 electrograms indicated the exit or pre-exit site of return pathway. Type A-2 electrograms with diastolic potential to QRS interval < -50 msec indicated the pre-exit site. However, the other types of local electrograms with diastolic potential did not indicate the critical portion of the ventricular tachycardia circuit. These observations may be helpful during catheter mapping and ablation of patients with post-infarct ventricular tachycardia. CONDENSED ABSTRACT Diastolic potentials are often sought to direct catheter ablation in post-infarct ventricular tachycardia. We investigated the characteristics of local electrograms showing diastolic activity in an attempt to determine whether critical portions of the ventricular tachycardia circuit could be identified by a typical "signature." In 17 patients with a remote myocardial infarction, 30 ventricular tachycardias were mapped with 112 bipolar endocardial balloon at the time of surgery. Diastolic potentials in association with low amplitude (< 2 mV) and prolonged (> or = 100 msec) systolic electrograms preceding the onset of QRS were found at the exit site and pre-exit site of return pathway. A similar systolic electrogram occurring after QRS onset with a diastolic potential to QRS interval of < -50 msec was found at the pre-exit site. However, other local electrograms with diastolic activity were at sites remote from the exit or pre-exit of the return pathway. These observations may be helpful during catheter mapping and ablation in patients with ventricular tachycardia.
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Affiliation(s)
- J Saito
- Division of Cardiology and Cardiovascular Surgery, Toronto Hospital, University of Toronto, Ontario, Canada
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Abstract
A screen was designed to identify Saccharomyces cerevisiae mutants that were defective in meiosis yet proficient for meiotic ectopic recombination in the return-to-growth protocol. Seven mutants alleles were isolated; two are important for chromosome synapsis (RED1, MEK1) and five function independently of recombination (SPO14, GSG1, SPOT8/MUM2, 3, 4). Similar to the spoT8-1 mutant, mum2 deletion strains do not undergo premeiotic DNA synthesis, arrest prior to the first meiotic division and fail to sporulate. Surprisingly, although DNA replication does not occur, mum2 mutants are induced for high levels of ectopic recombination. gsg1 diploids are reduced in their ability to complete premeiotic DNA synthesis and the meiotic divisions, and a small percentage of cells produce spores. mum3 mutants sporulate poorly and the spores produced are inviable. Finally, mum4-1 mutants produce inviable spores. The meiotic/sporulation defects of gsg1, mum2, and mum3 are not relieved by spo11 or spo13 mutations, indicating that the mutant defects are not dependent on the initiation of recombination or completion of both meiotic divisions. In contrast, the spore inviability of the mum4-1 mutant is rescued by the spo13 mutation. The mum4-1 spo13 mutant undergoes a single, predominantly equational division, suggesting that MUM4 functions at or prior to the first meiotic division. Although recombination is variably affected in the gsg1 and mum mutants, we hypothesize that these mutants define genes important for aspects of meiosis not directly related to recombination.
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Affiliation(s)
- J Engebrecht
- Department of Pharmacological Sciences, State University of New York, Stony Brook 11794-8651, USA.
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Dufresne A, Bégin R, Churg A, Masse S. Mineral fibre content of lungs in mesothelioma cases seeking compensation in quebec. Lung Cancer 1996. [DOI: 10.1016/0169-5002(96)81622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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