scholarly journals Fractal circuit sensors enable rapid quantification of biomarkers for donor lung assessment for transplantation

2015 ◽  
Vol 1 (7) ◽  
pp. e1500417 ◽  
Author(s):  
Andrew T. Sage ◽  
Justin D. Besant ◽  
Laili Mahmoudian ◽  
Mahla Poudineh ◽  
Xiaohui Bai ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Three Dimensional ◽  
Extended Period ◽  
Clinical Decision ◽  
Gene Profiling ◽  
Assessment Process ◽  
Human Donor ◽  
Sensitive Organ ◽  
Donor Lung ◽  
Lung Biopsies

Biomarker profiling is being rapidly incorporated in many areas of modern medical practice to improve the precision of clinical decision-making. This potential improvement, however, has not been transferred to the practice of organ assessment and transplantation because previously developed gene-profiling techniques require an extended period of time to perform, making them unsuitable in the time-sensitive organ assessment process. We sought to develop a novel class of chip-based sensors that would enable rapid analysis of tissue levels of preimplantation mRNA markers that correlate with the development of primary graft dysfunction (PGD) in recipients after transplant. Using fractal circuit sensors (FraCS), three-dimensional metal structures with large surface areas, we were able to rapidly (<20 min) and reproducibly quantify small differences in the expression of interleukin-6 (IL-6), IL-10, and ATP11B mRNA in donor lung biopsies. A proof-of-concept study using 52 human donor lungs was performed to develop a model that was used to predict, with excellent sensitivity (74%) and specificity (91%), the incidence of PGD for a donor lung. Thus, the FraCS-based approach delivers a key predictive value test that could be applied to enhance transplant patient outcomes. This work provides an important step toward bringing rapid diagnostic mRNA profiling to clinical application in lung transplantation.

Supporting the Development of Clinical Reasoning of Preprofessional Novices in Dysphagia Management

2019 ◽  
Vol 40 (03) ◽  
pp. 151-161 ◽  
Author(s):  
Sebastian Doeltgen ◽  
Stacie Attrill ◽  
Joanne Murray
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Management Practice ◽  
Clinical Decision ◽  
Assessment Process ◽  
Evidence Based ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Implicit Processing ◽  
Reasoning Skills

AbstractProficient clinical reasoning is a critical skill in high-quality, evidence-based management of swallowing impairment (dysphagia). Clinical reasoning in this area of practice is a cognitively complex process, as it requires synthesis of multiple sources of information that are generated during a thorough, evidence-based assessment process and which are moderated by the patient's individual situations, including their social and demographic circumstances, comorbidities, or other health concerns. A growing body of health and medical literature demonstrates that clinical reasoning skills develop with increasing exposure to clinical cases and that the approaches to clinical reasoning differ between novices and experts. It appears that it is not the amount of knowledge held, but the way it is used, that distinguishes a novice from an experienced clinician. In this article, we review the roles of explicit and implicit processing as well as illness scripts in clinical decision making across the continuum of medical expertise and discuss how they relate to the clinical management of swallowing impairment. We also reflect on how this literature may inform educational curricula that support SLP students in developing preclinical reasoning skills that facilitate their transition to early clinical practice. Specifically, we discuss the role of case-based curricula to assist students to develop a meta-cognitive awareness of the different approaches to clinical reasoning, their own capabilities and preferences, and how and when to apply these in dysphagia management practice.

scholarly journals Telomere Architecture Correlates with Aggressiveness in Multiple Myeloma

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1969
Author(s):  
Aline Rangel-Pozzo ◽  
Pak Yu ◽  
Sadhana LaL ◽  
Yasmin Asbaghi ◽  
Luiza Sisdelli ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Disease Progression ◽  
Genomic Instability ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Response To Treatment ◽  
Average Intensity ◽  
Patient Response ◽  
Smoldering Multiple Myeloma

The prognosis of multiple myeloma (MM), an incurable B-cell malignancy, has significantly improved through the introduction of novel therapeutic modalities. Myeloma prognosis is essentially determined by cytogenetics, both at diagnosis and at disease progression. However, for a large cohort of patients, cytogenetic analysis is not always available. In addition, myeloma patients with favorable cytogenetics can display an aggressive clinical course. Therefore, it is necessary to develop additional prognostic and predictive markers for this disease to allow for patient risk stratification and personalized clinical decision-making. Genomic instability is a prominent characteristic in MM, and we have previously shown that the three-dimensional (3D) nuclear organization of telomeres is a marker of both genomic instability and genetic heterogeneity in myeloma. In this study, we compared in a longitudinal prospective study blindly the 3D telomeric profiles from bone marrow samples of 214 initially treatment-naïve patients with either monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or MM, with a minimum follow-up of 5 years. Here, we report distinctive 3D telomeric profiles correlating with disease aggressiveness and patient response to treatment in MM patients, and also distinctive 3D telomeric profiles for disease progression in smoldering multiple myeloma patients. In particular, lower average intensity (telomere length, below 13,500 arbitrary units) and increased number of telomere aggregates are associated with shorter survival and could be used as a prognostic factor to identify high-risk SMM and MM patients.

Right ventricle and pulmonary arterial pressure

2016 ◽  
Author(s):  
Annemien E. van den Bosch ◽  
Luigi P. Badano ◽  
Julia Grapsa
Keyword(s):  
Clinical Decision Making ◽  
Complex Geometry ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Prognostic Information ◽  
Recent Developments ◽  
And Function

Right ventricular (RV) performance plays an important role in the morbidity and mortality of patients with left ventricular dysfunction, congenital heart disease, and pulmonary hypertension. Assessment of RV size, function, and haemodynamics has been challenging because of its complex geometry. Conventional two-dimensional echocardiography is the modality of choice for assessment of RV function in clinical practice. Recent developments in echocardiography have provided several new techniques for assessment of RV dimensions and function, include tissue Doppler imaging, speckle-tracking imaging, and volumetric three-dimensional imaging. However, specific training, expensive dedicated equipment, and extensive clinical validation are still required. Doppler methods interrogating tricuspid inflow and pulmonary artery flow velocities, which are influenced by changes in pre- and afterload conditions, may not provide robust prognostic information for clinical decision-making. This chapter addresses the role of the various echocardiographic modalities used to assess the RV and pulmonary circulation. Special emphasis has been placed on technical considerations, limitations, and pitfalls of image acquisition and analysis.

scholarly journals SGPNet: A Three-Dimensional Multitask Residual Framework for Segmentation and IDH Genotype Prediction of Gliomas

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Yao Wang ◽  
Yan Wang ◽  
Chunjie Guo ◽  
Shuangquan Zhang ◽  
Lili Yang
Keyword(s):  
Brain Tumor ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Error Rates ◽  
The Cancer Genome Atlas ◽  
Classification Error ◽  
Tumor Segmentation ◽  
Brain Tumor Segmentation ◽  
The Status

Glioma is the main type of malignant brain tumor in adults, and the status of isocitrate dehydrogenase (IDH) mutation highly affects the diagnosis, treatment, and prognosis of gliomas. Radiographic medical imaging provides a noninvasive platform for sampling both inter and intralesion heterogeneity of gliomas, and previous research has shown that the IDH genotype can be predicted from the fusion of multimodality radiology images. The features of medical images and IDH genotype are vital for medical treatment; however, it still lacks a multitask framework for the segmentation of the lesion areas of gliomas and the prediction of IDH genotype. In this paper, we propose a novel three-dimensional (3D) multitask deep learning model for segmentation and genotype prediction (SGPNet). The residual units are also introduced into the SGPNet that allows the output blocks to extract hierarchical features for different tasks and facilitate the information propagation. Our model reduces 26.6% classification error rates comparing with previous models on the datasets of Multimodal Brain Tumor Segmentation Challenge (BRATS) 2020 and The Cancer Genome Atlas (TCGA) gliomas’ databases. Furthermore, we first practically investigate the influence of lesion areas on the performance of IDH genotype prediction by setting different groups of learning targets. The experimental results indicate that the information of lesion areas is more important for the IDH genotype prediction. Our framework is effective and generalizable, which can serve as a highly automated tool to be applied in clinical decision making.

scholarly journals Investigating the Benefits of Using 3D Camera Technology to Improve Wound Measurements in a Tissue Viability Service: Outcomes of a Pilot Implementation Study

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
King BM ◽  
◽  
Doyle K ◽  
Kelley J ◽  
Taylor C ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Outcome Measurement ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Case Depth ◽  
Continuous Assessment ◽  
Tissue Viability ◽  
Important Indicator ◽  
Manual Measurement ◽  
Depth Measurement

Sub-optimal experience and outcomes for people with stalled wounds is common. Clinicians have limited methods for reliably and accurately measure wounds. Depth measurement is an important indicator of healing, and digital methods of imaging the wound may offer increased accuracy and enable clinical decision-making. This study aimed to implement a Panasonic FZ-M1 toughpad with WoundCareLite software version 1.5.0.0, to enable three-dimensional measurements in Tissue Viability (TV) service. Length, width, and depth measurement were compared with usual manual measurement using a paper ruler alongside a 2D photographic image. Statistical analysis included the comparison of wound dimension measures and a presentation of visual healing trajectories over 4 weeks using run-charts. 30 patients were recruited over five weeks (13 female and 17 male), representing 4% of the usual caseload. Manual measurement and 3D software automatic method demonstrated that the width and depth 3D auto measures were more accurate than manual measures but depth measures were often wrong thus making volumetric measures inaccurate. Consistent wound size measurement was feasible, and healing trajectories provide a useful means of continuous assessment. Technology guided measurement has potential benefits over manual measurement as a means of more accurately monitoring healing. In this case, depth measurement could not be accurately assessed in practice and further software innovation is indicated to enable outcome measurement in tissue viability services.

scholarly journals Effectiveness of Global Optimisation and Direct Kinematics in Predicting Surgical Outcome in Children with Cerebral Palsy

Life ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 1306
Author(s):  
Claude Fiifi Hayford ◽  
Emma Pratt ◽  
John P. Cashman ◽  
Owain G. Evans ◽  
Claudia Mazzà
Keyword(s):  
Cerebral Palsy ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Contact Forces ◽  
Gait Quality ◽  
Children With Cerebral Palsy ◽  
Profile Score ◽  
Joint Contact ◽  
Direct Kinematics

Multibody optimisation approaches have not seen much use in routine clinical applications despite evidence of improvements in modelling through a reduction in soft tissue artifacts compared to the standard gait analysis technique of direct kinematics. To inform clinical use, this study investigated the consistency with which both approaches predicted post-surgical outcomes, using changes in Gait Profile Score (GPS) when compared to a clinical assessment of outcome that did not include the 3D gait data. Retrospective three-dimensional motion capture data were utilised from 34 typically developing children and 26 children with cerebral palsy who underwent femoral derotation osteotomies as part of Single Event Multi-Level Surgeries. Results indicated that while, as expected, the GPS estimated from the two methods were numerically different, they were strongly correlated (Spearman’s ρ = 0.93), and no significant differences were observed between their estimations of change in GPS after surgery. The two scores equivalently classified a worsening or improvement in the gait quality in 93% of the cases. When compared with the clinical classification of responders versus non-responders to the intervention, an equivalent performance was found for the two approaches, with 27/41 and 28/41 cases in agreement with the clinical judgement for multibody optimisation and direct kinematics, respectively. With this equivalent performance to the direct kinematics approach and the benefit of being less sensitive to skin artefact and allowing additional analysis such as estimation of musculotendon lengths and joint contact forces, multibody optimisation has the potential to improve the clinical decision-making process in children with cerebral palsy.

Three-dimensional surface imaging for clinical decision making in pectus excavatum

2021 ◽  
Author(s):  
Jean H.T. Daemen ◽  
Nadine A. Coorens ◽  
Karel W.E. Hulsewé ◽  
Thomas J.J. Maal ◽  
Jos G. Maessen ◽  
...  
Keyword(s):  
Decision Making ◽  
Pectus Excavatum ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Surface Imaging ◽  
Dimensional Surface

scholarly journals Numerical Investigation of the Flow Field in Realistic Nasal Septal Perforation Geometry

2014 ◽  
Vol 5 (2) ◽  
pp. ar.2014.5.0090 ◽  
Author(s):  
Mohammad Faramarzi ◽  
Mohammad Hossein Baradaranfar ◽  
Omid Abouali ◽  
Saeid Atighechi ◽  
Goodarz Ahmadi ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Assessment Tool ◽  
Anterior Part ◽  
Three Dimensional ◽  
Preoperative Assessment ◽  
Clinical Decision ◽  
Airflow Rate ◽  
Septal Perforation ◽  
Pressure Drops ◽  
Wide Range

The computational fluid dynamics (CFD) are used to evaluate the physiological function of the nose. We evaluated the aerodynamics of the nasal cavity in a patient with septal perforation (SP), pre- and postvirtual repair. Three-dimensional nasal models were reconstructed, and then a wide range of the pressure drops and flow rates were analyzed. The airflow velocity is higher in the central region and is lower around the boundary of the SP. The air velocity in the SP increases as the pressure drop increases. Furthermore, at the anterior part of the SP, the shear stress is higher in the upper part. In addition, the repair of SP does not affect the total nasal airflow rate and the velocity contour patterns. The potential usage of the CFD technique as a predictive technique to explore the details and a preoperative assessment tool to help in clinical decision making in nasal surgery is emphasized.

scholarly journals Emergency department-based 3D echocardiogram use: a case series

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Sajith Matthews ◽  
Phillip D. Levy
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Case Series ◽  
Clinical Decision ◽  
Volumetric Imaging ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography ◽  
And Function

Abstract Background Three-dimensional echocardiography (3DE) with real-time volumetric imaging can be a vital modality in clinical practice. Despite its potential, it remains underutilized in the acute care setting. Case presentation We present two cases describing the use of 3DE in the emergency department (ED) for acute heart failure (AHF) and discuss the potential benefits of routine use in acute care settings. Conclusions Three-dimensional echocardiography offers unique information as it relates to cardiac structure and function, and can be valuable for diagnosis and clinical decision-making in the ED.

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