Three-dimensional Ultrasound Measurements of Carotid Atherosclerosis in Vulnerable Patient Populations

Atherosclerosis is a progressive disease that leads to plaque development and is associated with cardiovascular events such as myocardial infarction and stroke. Several biomarkers have been established as surrogates of plaque development yet none can provide direct, noninvasive, rapid measurements of atherosclerotic disease. Three-dimensional Ultrasound (3DUS) image acquisition is safe, inexpensive and fast, however 3DUS image measurements are limited due to time consuming manual image analyses. In addition, the true clinical meaning of 3DUS carotid imaging measurements has not yet been established. A semi-automated approach for the estimation of 3DUS Total Plaque Volume (TPV) was developed with similar variability and high agreement with manual measurements. 3DUS measurements such as Vessel Wall Volume (VWV) and TPV were shown to have similar associations of plaque and Intima-media Thickness (IMT) with age in males however this relationship did not exist in females. 3DUS measurements of carotid atherosclerosis can provide a more sensitive estimation of disease burden in vulnerable patient populations than traditional measures

Impaired memory retrieval correlates with individual differences in cortisol response but not autonomic response

Stress can enhance or impair memory performance. Both cortisol release and sympathetic nervous system responses have been implicated in these differential effects. Here we investigated how memory retrieval might be affected by stress-induced cortisol release, independently of sympathetic nervous system stress responses. Thirty-two healthy participants (16 women) learned emotionally arousing and neutral words. One hour later, half of the participants underwent a stressor (cold pressor test) and the other half, a control warm water exposure, both followed by a delayed free recall task. The stressed participants were split into those who did (responders, N = 8) and those who did not (nonresponders, N = 6) show a cortisol response. Both responders and nonresponders showed comparable sympathetic nervous system activity (skin conductance level) during the cold pressor. The cortisol responders recalled significantly fewer words compared to nonresponders, and compared to control participants; this effect was most pronounced for moderately arousing words (compared to highly arousing and neutral words). These results suggest that individual differences in cortisol reactivity affect memory retrieval performance, and help to explain the differential effects of stress on memory

A High-p/Low-p Procedure to Improve Recall Memory in Elderly Patients with Mild to Moderate Cognitive Impairment

The objective of this study was to demonstrate the effectiveness of implementing two types of high-probability of naming/low-probability of naming procedures to improve object recall memory in elderly individuals with cognitive impairment. The procedures involved the use of directives for recall compliance with a demonstrated high rate of compliance followed by embedded directives with a demonstrated low rate of recall. Two elderly subjects in states of cognitive decline were used in this demonstration. Results indicated positive outcomes with both procedures. Recall-based interventions were more effective than recognition-based procedures

Implications of Skinner\u27s Verbal Behavior for Studying Dementia

Persons with dementia experience continual declines in a number of abilities. Language abilities are particularly hard hit and become increasingly impaired as the underlying disease progresses. These language impairments make verbal communication very challenging for family and professional caregivers. As a result, caregivers may inadvertently punish verbal behavior, thereby exacerbating the deterioration of verbal repertoires. Although the topography of language impairments associated with dementia have been well described, less empirical work has been conducted concerning how to minimize these impairments and their deleterious effects. In 1957 B.F. Skinner outlined his conceptualization of language and cognition in his book Verbal Behavior. This paper will explore the implications of Skinner’s Verbal Behavior for studying communication impairments associated with dementia

Dietary treatment of Crohn’s disease: perceptions of families with children treated by exclusive enteral nutrition, a questionnaire survey

Background: Diet is strongly associated with the aetiology of Crohn’s Disease (CD) and exclusive enteral nutrition (EEN) is the primary induction treatment in paediatric CD. This study explored opinions around the use of EEN and alternative novel, solid food-based diets (SFDs) expressed by paediatric patients with CD, previously treated with EEN and their parents. Methods: This anonymous questionnaire surveyed families of CD patients treated with EEN over 1 year. Two questionnaire forms were completed; one asking the patients’ opinions and another referring to their main carer. This questionnaire explored participants’ demographic characteristics; acceptability of a repeat EEN course to treat a future flare (EEN repeat); their opinion on how difficult EEN would be compared to an example SFD; and their intention to participate in a future clinical trial assessing the therapeutic efficacy of an SFD in CD. Results: Forty-one families of CD patients were approached with 29 sending replies (71%). Most of our participants were positive on completing another EEN course, however the majority would choose an SFD alternative (Patients: 66, Parents:72%). Both patients and their parents rated EEN to be more difficult to adhere to compared to an example SFD (p < 0.05), and their ratings were strongly correlated (EEN:r = 0.83, SFD:r = 0.75, p < 0.001). The majority of our respondents would agree to participate in a clinical trial assessing an SFD’s effectiveness (Patients:79, Parents:72%) for the management of active CD. Conclusions: While patients with CD and their families would accept an EEN repeat, the majority would prefer an SFD alternative. CD families surveyed are supportive of the development of solid food-based dietary treatments

Electronic Health Record-Based Surveillance for Community Transmitted COVID-19 in the Emergency Department

Introduction: SARS-CoV-2, a novel coronavirus, manifests as a respiratory syndrome (COVID-19) and is the cause of an ongoing pandemic. The response to COVID-19 in the United States has been hampered by an overall lack of diagnostic testing capacity. To address uncertainty about ongoing levels of SARS-CoV-2 community transmission early in the pandemic, we aimed to develop a surveillance tool using readily available emergency department (ED) operations data extracted from the electronic health record (EHR). This involved optimizing the identification of acute respiratory infection (ARI)-related encounters and then comparing metrics for these encounters before and after the confirmation of SARS-CoV-2 community transmission.Methods: We performed an observational study using operational EHR data from two Midwest EDs with a combined annual census of over 80,000. Data were collected three weeks before and after the first confirmed case of local SARS-CoV-2 community transmission. To optimize capture of ARI cases, we compared various metrics including chief complaint, discharge diagnoses, and ARI-related orders. Operational metrics for ARI cases, including volume, pathogen identification, and illness severity, were compared between the pre- and post-community transmission timeframes using chi-square tests of independence.Results: Compared to our combined definition of ARI, chief complaint, discharge diagnoses, and isolation orders individually identified less than half of the cases. Respiratory pathogen testing was the top performing individual ARI definition but still only identified 72.2% of cases. From the pre to post periods, we observed significant increases in ED volumes due to ARI and ARI cases without identified pathogen.Conclusion: Certain methods for identifying ARI cases in the ED may be inadequate and multiple criteria should be used to optimize capture. In the absence of widely available SARS-CoV-2 testing, operational metrics for ARI-related encounters, especially the proportion of cases involving negative pathogen testing, are useful indicators for active surveillance of potential COVID-19 related ED visits

A Fault Tolerant Core for Parallel Execution of Ultra Reduced Instruction Set (URISC) and MIPS Instructions

Modern safety critical systems require the ability to detect and handle situations where an error has occurred. Efficient coding and protection schemes are widely used to protect the communication links and memories of such systems. The remaining system components, and focus of this work, are primarily computation units where most protection schemes involve a high cost by fully duplicating the computation unit. Previous work presented the Ultra Reduced Instruction Set Co-processor (URISC) core that provides a low area overhead approach to detect and recover from errors in any core computation unit (touring complete). It executes URISC or MIPS instructions in order and no more than one instruction per cycle. This thesis analyses the overhead introduced in the previous core design to identify opportunities to accelerate the computation. We design and build an out of order core supporting both MIPS and URISC instructions. This new core effectively exploits the parallelism available in MIPS-URISC programs and significantly reduces the overhead introduced when checking or substituting URISC instructions for faulted MIPS instructions