Prediction of patient-specific post-operative outcomes of TAVI procedure: The impact of the positioning strategy on valve performance

Damaged or disabled tissue is life-threatening due to the lack of proper treatment. Many conventional transplantation methods like autograft, iso-graft and allograft are in existence for ages, but they are not sufficient to treat all types of tissue or organ damages. Stem cells, with their unique capabilities like self-renewal and differentiate into various cell types, can be a potential strategy for tissue regeneration. However, the challenges like reproducibility, uncontrolled propagation and differentiation, isolation of specific kinds of cell and tumorigenic nature made these stem cells away from clinical application. Today, various types of stem cells like embryonic, fetal or gestational tissue, mesenchymal and induced-pluripotent stem cells are under investigation for their clinical application. Tissue engineering helps in configuring the stem cells to develop into a desired viable tissue, to use them clinically as a substitute for the conventional method. The use of stem cell-derived Extracellular Vesicles (EVs) is being studied to replace the stem cells, which decreases the immunological complications associated with the direct administration of stem cells. Tissue engineering also investigates various biomaterials to use clinically, either to replace the bones or as a scaffold to support the growth of stemcells/ tissue. Depending upon the need, there are various biomaterials like bio-ceramics, natural and synthetic biodegradable polymers to support replacement or regeneration of tissue. Like the other fields of science, tissue engineering is also incorporating the nanotechnology to develop nano-scaffolds to provide and support the growth of stem cells with an environment mimicking the Extracellular matrix (ECM) of the desired tissue. Tissue engineering is also used in the modulation of the immune system by using patient-specific Mesenchymal Stem Cells (MSCs) and by modifying the physical features of scaffolds that may provoke the immune system. This review describes the use of various stem cells, biomaterials and the impact of nanotechnology in regenerative medicine.

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Impact of a patient-specific national programme aimed at increasing the use of emollient moisturisers to reduce the risk of skin tears: a longitudinal cohort study

BMJ Open ◽

10.1136/bmjopen-2020-039579 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039579

Author(s):

Anna K Moffat ◽

Kerrie P Westaway ◽

Jemisha Apajee ◽

Oliver Frank ◽

Russell Shute ◽

...

Keyword(s):

Interrupted Time Series ◽

Self Report ◽

Additional Patient ◽

Patient Specific ◽

Department Of Veterans Affairs ◽

National Programme ◽

Sustained Effect ◽

Skin Tears ◽

Comparison Groups ◽

The Impact

ObjectivesTo evaluate the impact of a patient-specific national programme targeting older Australians and health professionals that aimed to increase use of emollient moisturisers to reduce to the risk of skin tears.DesignA prospective cohort intervention.ParticipantsThe intervention targeted 52 778 Australian Government’s Department of Veterans’ Affairs patients aged over 64 years who had risk factors for wound development, and their general practitioners (GPs) (n=14 178).Outcome measuresAn interrupted time series model compared the rate of dispensing of emollients in the targeted cohort before and up to 23 months after the intervention. Commitment questions were included in self-report forms.ResultsIn the first month after the intervention, the rate of claims increased 6.3-fold (95% CI: 5.2 to 7.6, p<0.001) to 10 emollient dispensings per 1000 patients in the first month after the intervention. Overall, the intervention resulted in 10 905 additional patient-months of treatment. The increased rate of dispensing among patients who committed to talking to their GP about using an emollient was six times higher (rate ratio: 6.2, 95% CI: 4.4 to 8.7) than comparison groups.ConclusionsThe intervention had a sustained effect over 23 months. Veterans who responded positively to commitment questions had higher uptake of emollients than those who did not.

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EPID-34. THE DETRIMENTAL EFFECT OF BIOPSY PRECEDING RESECTION IN SURGICALLY ACCESSIBLE GLIOBLASTOMAS: RESULTS FROM THE NATIONAL CANCER DATABASE

Neuro-Oncology ◽

10.1093/neuonc/noaa215.352 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii85-ii86

Author(s):

Ping Zhu ◽

Xianglin Du ◽

Angel Blanco ◽

Leomar Y Ballester ◽

Nitin Tandon ◽

...

Keyword(s):

Logistic Regression ◽

Failure Time ◽

Binary Logistic Regression ◽

Rank Test ◽

Imaging Features ◽

National Cancer Database ◽

Prolonged Length ◽

Logistic Regression Models ◽

Operative Outcomes ◽

The Impact

Abstract OBJECTIVES To investigate the impact of biopsy preceding resection compared to upfront resection in glioblastoma overall survival (OS) and post-operative outcomes using the National Cancer Database (NCDB). METHODS A total of 17,334 GBM patients diagnosed between 2010 and 2014 were derived from the NCDB. Patients were categorized into two groups: “upfront resection” versus “biopsy followed by resection”. Primary outcome was OS. Post-operative outcomes including 30-day readmission/mortality, 90-day mortality, and prolonged length of inpatient hospital stay (LOS) were secondary endpoints. Kaplan-Meier methods and accelerated failure time (AFT) models with gamma distribution were applied for survival analysis. Multivariable binary logistic regression models were performed to compare differences in the post-operative outcomes between these groups. RESULTS Patients undergoing “upfront resection” experienced superior survival compared to those undergoing “biopsy followed by resection” (median OS: 12.4 versus 11.1 months, log-rank test: P=0.001). In multivariable AFT models, significant survival benefits were observed among patients undergoing “upfront resection” (time ratio [TR]: 0.83, 95% CI: 0.75–0.93, P=0.001). Patients undergoing upfront GTR had the longest survival compared to upfront STR, GTR following STR, or GTR and STR following an initial biopsy (14.4 vs. 10.3, 13.5, 13.3, and 9.1, months), respectively (TR: 1.00 [Ref.], 0.75, 0.82, 0.88, and 0.67). Recent years of diagnosis, higher income and treatment at academic facilities were significantly associated with the likelihood of undergoing upfront resection after adjusting the covariates. Multivariable logistic regression revealed that 30-day mortality and 90-day mortality were decreased by 73% and 44% for patients undergoing “upfront resection” over “biopsy followed by resection”, respectively (both p < 0.001). CONCLUSIONS Pre-operative biopsies for surgically accessible tumors with characteristic imaging features of Glioblastoma lead to worse survival despite subsequent resection compared to patients undergoing upfront resection.

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Shooting from the ‘Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting

Vaccines ◽

10.3390/vaccines9050444 ◽

2021 ◽

Vol 9 (5) ◽

pp. 444

Author(s):

Charles Stoecker

Keyword(s):

Positive Impact ◽

National Level ◽

State Level ◽

The United States ◽

Scope Of Practice ◽

Patient Specific ◽

Behavioral Risk ◽

Influenza Immunization ◽

Immunization Rates ◽

The Impact

In the past two decades, most states in the United States have added authorization for pharmacists to administer some vaccinations. Expansions of this authority have also come with prescription requirements or other regulatory burdens. The objective of this study was to evaluate the impact of these expansions on influenza immunization rates in adults age 65 and over. A panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level was used on a combination of a dataset of state-level statute and regulatory changes and influenza immunization data from the Behavioral Risk Factor Surveillance System. Giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of 1.4 percentage points for adults age 65 and over. This effect was diminished by the presence of laws requiring pharmacists to obtain patient-specific prescriptions. There was no evidence that allowing pharmacists to administer vaccinations led patients to have fewer annual check-ups with physicians or not have a usual source of health care. Expanding pharmacists’ scope of practice laws to include administering the influenza vaccine had a positive impact on influenza shot uptake. This may have implications for relaxing restrictions on other forms of care that could be provided by pharmacists.

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Standard versus hypofractionated intensity-modulated radiotherapy for prostate cancer: assessing the impact on dose modulation and normal tissue effects when using patient-specific cancer biology

Physics in Medicine and Biology ◽

10.1088/1361-6560/ab9354 ◽

2020 ◽

Author(s):

Emily Jungmin Her ◽

Martin Andrew Ebert ◽

Angel M Kennedy ◽

Hayley M Reynolds ◽

Yu Sun ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Biology ◽

Normal Tissue ◽

Intensity Modulated Radiotherapy ◽

Patient Specific ◽

Intensity Modulated ◽

Tissue Effects ◽

Specific Cancer ◽

Dose Modulation ◽

The Impact

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Demographics associated with US healthcare disparities are exacerbated by the telemedicine surge during the COVID-19 pandemic

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211025939 ◽

2021 ◽

pp. 1357633X2110259

Author(s):

Kristin N Gmunder ◽

Jose W Ruiz ◽

Dido Franceschi ◽

Maritza M Suarez

Keyword(s):

Income Tax ◽

Healthcare Disparities ◽

Descriptive Statistics ◽

Internal Revenue Service ◽

Patient Specific ◽

Postal Code ◽

The Us ◽

Hispanic Patients ◽

The Impact ◽

Racial Ethnic

Introduction As coronavirus disease 2019 (COVID-19) hit the US, there was widespread and urgent implementation of telemedicine programs nationwide without much focus on the impact on patient populations with known existing healthcare disparities. To better understand which populations cannot access telemedicine during the coronavirus disease 2019 pandemic, this study aims to demographically describe and identify the most important demographic predictors of telemedicine visit completion in an urban health system. Methods Patient de-identified demographics and telemedicine visit data ( N = 362,764) between March 1, 2020 and October 31, 2020 were combined with Internal Revenue Service 2018 individual income tax data by postal code. Descriptive statistics and mixed effects logistic regression were used to determine impactful patient predictors of telemedicine completion, while adjusting for clustering at the clinical site level. Results Many patient-specific demographics were found to be significant. Descriptive statistics showed older patients had lower rates of completion ( p < 0.001). Also, Hispanic patients had statistically significant lower rates ( p < 0.001). Overall, minorities (racial, ethnic, and language) had decreased odds ratios of successful telemedicine completion compared to the reference. Discussion While telemedicine use continues to be critical during the coronavirus disease 2019 pandemic, entire populations struggle with access—possibly widening existing disparities. These results contribute large datasets with significant findings to the limited research on telemedicine access and can help guide us in improving telemedicine disparities across our health systems and on a wider scale.

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Effect of Patient-Specific Preanalytic Variables on CSF Aβ1–42 Concentrations Measured on an Automated Chemiluminescent Platform

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa145 ◽

2020 ◽

Author(s):

Jacqueline A Darrow ◽

Amanda Calabro ◽

Sara Gannon ◽

Amanze Orusakwe ◽

Rianne Esquivel ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Cognitive Impairment ◽

Patient Specific ◽

Csf Biomarkers ◽

Clinical Settings ◽

Blood Contamination ◽

Gradient Effect ◽

Β Amyloid ◽

The Impact ◽

Gradient Effects

Abstract Background Cerebrospinal fluid (CSF) biomarkers are increasingly used to confirm the accuracy of a clinical diagnosis of mild cognitive impairment or dementia due to Alzheimer disease (AD). Recent evidence suggests that fully automated assays reduce the impact of some preanalytical factors on the variability of these measures. This study evaluated the effect of several preanalytical variables common in clinical settings on the variability of CSF β-amyloid 1–42 (Aβ1–42) concentrations. Methods Aβ1–42 concentrations were measured using the LUMIPULSE G1200 from both freshly collected and frozen CSF samples. Preanalytic variables examined were: (1) patient fasting prior to CSF collection, (2) blood contamination of specimens, and (3) aliquoting specimens sequentially over the course of collection (i.e., CSF gradients). Results Patient fasting did not significantly affect CSF Aβ1–42 levels. While assessing gradient effects, Aβ1–42 concentrations remained stable within the first 5 1-mL aliquots. However, there is evidence of a gradient effect toward higher concentrations over successive aliquots. Aβ1–42 levels were stable when fresh CSF samples were spiked with up to 2.5% of blood. However, in frozen CSF samples, even 0.25% blood contamination significantly decreased Aβ1–42 concentrations. Conclusions The preanalytical variables examined here do not have significant effects on Aβ1–42 concentrations if fresh samples are processed within 2 h. However, a gradient effect can be observed on Aβ1–42 concentrations after the first 5 mL of collection and blood contamination has a significant impact on Aβ1–42 concentrations once specimens have been frozen.

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The effects of materialism on consumer evaluation of sustainable synthetic (lab-grown) products

Journal of Consumer Marketing ◽

10.1108/jcm-09-2018-2876 ◽

2020 ◽

Vol 37 (5) ◽

pp. 579-590

Author(s):

Jessica Keech ◽

Maureen Morrin ◽

Jeffrey Steven Podoshen

Keyword(s):

Design Methodology ◽

Socially Responsible ◽

Content Type ◽

Consumer Evaluation ◽

Positioning Strategy ◽

Consumer Markets ◽

The Future ◽

Promotion Strategies ◽

Alternative Sources ◽

The Impact

Purpose The increasing desire of consumers for socially responsible luxury products combined with fluctuating supplies in consumer markets are leading various industries to seek alternative sources to be able to meet the needs of its customers. One possible solution that may meet the demands of the future is lab-grown products. Because these products confer multiple benefits, this study aims to investigate the most effective ways to appeal to consumers by aligning the benefits of the products with their values as marketers seek to find effective promotion for these items. Design/methodology/approach We examine the effectiveness of an ethical positioning strategy for two types of luxury lab-grown (synthetic) products among high versus low materialism consumers in three experiments. Findings Findings suggest that a positioning strategy stressing product ethicality is more effective for low materialism consumers, whereas the strategy is less effective, and may even backfire, for high materialism consumers. The impact on social status consumers perceive from a lab-grown product explains why this effect occurs among low materialism consumers. Therefore, marketers should take caution and use specific appeals for different segments based on values such as consumers’ materialism levels. Originality/value If lab-grown products represent the wave of the future, it is important to understand how consumers will respond to this emerging technology and how promotion strategies may enhance their evaluation.

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3D Kinematics and Decision Trees to Predict the Impact of a Physical Exercise Program on Knee Osteoarthritis Patients

Applied Sciences ◽

10.3390/app11020834 ◽

2021 ◽

Vol 11 (2) ◽

pp. 834

Author(s):

Marwa Mezghani ◽

Nicola Hagemeister ◽

Youssef Ouakrim ◽

Alix Cagnin ◽

Alexandre Fuentes ◽

...

Keyword(s):

Physical Exercise ◽

Knee Osteoarthritis ◽

Decision Trees ◽

Exercise Program ◽

Patient Specific ◽

Pain Level ◽

Knee Kinematic ◽

Kinematic Data ◽

3D Kinematics ◽

The Impact

Measuring knee biomechanics provides valuable clinical information for defining patient-specific treatment options, including patient-oriented physical exercise programs. It can be done by a knee kinesiography test measuring the three-dimensional rotation angles (3D kinematics) during walking, thus providing objective knowledge about knee function in dynamic and weight-bearing conditions. The purpose of this study was to assess whether 3D kinematics can be efficiently used to predict the impact of a physical exercise program on the condition of knee osteoarthritis (OA) patients. The prediction was based on 3D knee kinematic data, namely flexion/extension, adduction/abduction and external/internal rotation angles collected during a treadmill walking session at baseline. These measurements are quantifiable information suitable to develop automatic and objective methods for personalized computer-aided treatment systems. The dataset included 221 patients who followed a personalized therapeutic physical exercise program for 6 months and were then assigned to one of two classes, Improved condition (I) and not-Improved condition (nI). A 10% improvement in pain was needed at the 6-month follow-up compared to baseline to be in the improved group. The developed model was able to predict I and nI with 84.4% accuracy for men and 75.5% for women using a decision tree classifier trained with 3D knee kinematic data taken at baseline and a 10-fold validation procedure. The models showed that men with an impaired control of their varus thrust and a higher pain level at baseline, and women with a greater amplitude of internal tibia rotation were more likely to report improvements in their pain level after 6 months of exercises. Results support the effectiveness of decision trees and the relevance of 3D kinematic data to objectively predict knee OA patients’ response to a treatment consisting of a physical exercise program.

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Baseline local hemodynamics as predictor of lumen remodeling at 1-year follow-up in stented superficial femoral arteries

Scientific Reports ◽

10.1038/s41598-020-80681-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Monika Colombo ◽

Yong He ◽

Anna Corti ◽

Diego Gallo ◽

Stefano Casarin ◽

...

Keyword(s):

Predictive Marker ◽

Patient Specific ◽

Lumen Area ◽

Major Drawback ◽

Area Change ◽

Stent Restenosis ◽

Computed Tomography Images ◽

Relative Residence Time ◽

The Impact

AbstractIn-stent restenosis (ISR) is the major drawback of superficial femoral artery (SFA) stenting. Abnormal hemodynamics after stent implantation seems to promote the development of ISR. Accordingly, this study aims to investigate the impact of local hemodynamics on lumen remodeling in human stented SFA lesions. Ten SFA models were reconstructed at 1-week and 1-year follow-up from computed tomography images. Patient-specific computational fluid dynamics simulations were performed to relate the local hemodynamics at 1-week, expressed in terms of time-averaged wall shear stress (TAWSS), oscillatory shear index and relative residence time, with the lumen remodeling at 1-year, quantified as the change of lumen area between 1-week and 1-year. The TAWSS was negatively associated with the lumen area change (ρ = − 0.75, p = 0.013). The surface area exposed to low TAWSS was positively correlated with the lumen area change (ρ = 0.69, p = 0.026). No significant correlations were present between the other hemodynamic descriptors and lumen area change. The low TAWSS was the best predictive marker of lumen remodeling (positive predictive value of 44.8%). Moreover, stent length and overlapping were predictor of ISR at follow-up. Despite the limited number of analyzed lesions, the overall findings suggest an association between abnormal patterns of WSS after stenting and lumen remodeling.

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