Ultrasound guided placement of the distal catheter in paediatric ventriculoatrial shunts—an appraisal of efficacy and complications

Ventriculoatrial (VA) shunts are commonly used as a second-line treatment of hydrocephalus when the peritoneum is an unsuitable site for the distal catheter. Many centres now utilise ultrasound and interventional radiology techniques to aid placement of the distal catheter. The purpose of this study was to conduct a contemporary audit of VA shunting in children using interventional radiology techniques for placement of the distal catheter

Evaluation of a two-way, HIPAA-compliant text-messaging platform in a health system specialty pharmacy

PDJ Clark, PharmD, PGY1 Pharmacy Practice ResidentAdam Saulles, PharmD, CSP, BCACP; Tara Berkson, PharmD, BCACP Providence Health and Services, Portland, Oregon Evaluation of a two-way, HIPAA-compliant text-messaging platform in a health system specialty pharmacy Specialty medications, including those used to treat Multiple Sclerosis (MS), represent a growing proportion of prescription drug expenditures in the United States. MS is a chronic, progressive condition that requires maintenance therapy with disease-modifying medications. Many patients with MS rely on specialty pharmacies to obtain, dispense, and perform the necessary monitoring for these complex medication regimens. A study performed in 2017 by Munsell et al, demonstrated that only ~50% of patients with MS are adherent to prescribed regimens when initiating disease-modifying therapy. Routine pharmacy outreach could potentially help improve medication adherence in a population at high risk of disease progression secondary to non-adherence. Prior to July 2019, this health system specialty pharmacy only contacted MS patients via phone call to perform refill coordination and pharmacist follow-up. This strategy has been effective, but is not without flaws. Oftentimes, patients prefer not to receive phone calls or are unavailable during pharmacy business hours. This can lead to repeat outreach phone calls from caregivers and gaps in therapy. In July 2019, a HIPAA-compliant messaging platform was implemented. With this program, patients can respond to refill inquiries at their convenience and provide typed responses to medication-related safety, adherence, and efficacy follow-up questions sent by specialty pharmacists. This project seeks to identify whether implementation of the aforementioned messaging platform has had a quantifiable benefit on patient outreach and workflow outcomes within a health system specialty pharmacy setting. This single center, retrospective cohort analysis evaluated adult patients with a diagnosis of MS and at least 2 dispenses of disease-modifying medications. Data was collected via the electronic health record and the implemented text messaging application. The primary outcome is time between pharmacy technician outreach and medication refill. Secondary outcomes include medication adherence reported as medication possession ratio (MPR), the proportion of patients enrolled in the specialty pharmacy’s patient management program, patient satisfaction, and pharmacy phone call volume. Between group differences were described using simple descriptive statistics and T-tests, where applicable. A total of 335 patient had fills prior to and post-implementation of the text messaging platform, and 313 had multiple fills in each category, allowing for calculation of MPR. Response time (HH:MM ± 95% Confidence interval) was significantly decreased with utilization of text-message refill reminders (32:03 ± 7:09 vs 68:34 ± 11:37; phttps://digitalcommons.psjhealth.org/pharmacy_PGY1/1002/thumbnail.jp

A catchment-scale irrigation systems model for sugarcane Part 1: Model development

In South Africa, the demand for water exceeds available supplies in many catchments. In order to justify existing water requirements and to budget and plan in the context of growing uncertainty regarding water availability, a model to assist in the assessment and management of catchment water supply and demand interactions, and the associated impacts on theprofitability of irrigated sugarcane, has been developed. The model, ACRUCane, operates as a submodel within the ACRU agrohydrological model and simulates the water budget of a field of irrigated sugarcane. The water budget is based on the integration of several widely accepted algorithms and concepts, accounts for different irrigation system types performing at different levels of uniformity and different water management strategies. Furthermore, it can simulate a wide variety ofwater availability scenarios and constraints through its link with ACRU simulated hydrology. The crop yield algorithms used in the model were verified using data from three different irrigation trials with widely varying irrigation treatments, where the model was shown to adequately distinguish the impacts of different watering strategies on crop yields. A description of the model algorithms and results from verification studies are presented in this paper. Application of the model is presentedin a companion paper

Multiplex cytokine analysis of dermal interstitial blister fluid defines local disease mechanisms in systemic sclerosis.

Clinical diversity in systemic sclerosis (SSc) reflects multifaceted pathogenesis and the effect of key growth factors or cytokines operating within a disease-specific microenvironment. Dermal interstitial fluid sampling offers the potential to examine local mechanisms and identify proteins expressed within lesional tissue. We used multiplex cytokine analysis to profile the inflammatory and immune activity in the lesions of SSc patients

A Retrospective Cohort Study to Assess Patient and Physician Reported Outcome Measures After Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke.

INTRODUCTION: Decompressive hemicraniectomy for malignant middle cerebral artery (MCA) infarction is known to reduce mortality. However, there are on-going concerns in terms of the quality of life in survivors. We aimed to examine the correlation between patient and physician reported outcome measures in decompressive hemicraniectomy. PATIENTS AND METHODS: We analyzed outcomes in 21 patients who underwent decompressive hemicraniectomy for malignant MCA infarction between September 2003 and August 2013 within a regional health system. Patient and physician reported outcome measures were collected at follow-up. These were Stroke Impact Scale (SIS) Version 3, modified Rankin Scale (mRS), National Hospital Seizure Severity Scale, Headache Impact Test and Patient Health Questionnaire for depression. RESULTS: There was a good correlation between physician and patient reported outcome measures. The Spearman's rank correlation coefficient between mRS and structured SIS Version 3 was -0.887 (p < 0.001); with unstructured SIS results, the correlation coefficient was -0.663 (p = 0.001). There was no statistically significant correlation between life worth and modified Rankin Scale: r = -0.3383 (p = 0.087). DISCUSSION: Our findings of a statistically significant correlation between mRS and SIS have not previously been reported in patients with this condition. These findings provide further information to inform patient and next of kin discussions regarding outcomes from decompressive hemicraniectomy in malignant MCA infarction

Capturing egocentric biases in reference reuse during collaborative dialogue

Words that are produced aloud—and especially self-produced ones—are remembered better than words that are not, a phenomenon labeled the production effect in the field of memory research. Two experiments were conducted to determine whether this effect can be generalized to dialogue, and how it might affect dialogue management. Triads (Exp. 1) or dyads (Exp. 2) of participants interacted to perform a collaborative task. Analyzing reference reuse during the interaction revealed that the participants were more likely to reuse the references that they had presented themselves, on the one hand, and those that had been accepted through verbatim repetition, on the other. Analyzing reference recall suggested that the greater accessibility of self-presented references was only transient. Moreover, among partner-presented references, those discussed while the participant had actively taken part in the conversation were more likely to be recalled than those discussed while the participant had been inactive. These results contribute to a better understanding of how individual memory processes might contribute to collaborative dialogue

Endoscopic navigation in the absence of CT imaging

Clinical examinations that involve endoscopic exploration of the nasal cavity and sinuses often do not have a reference image to provide structural context to the clinician. In this paper, we present a system for navigation during clinical endoscopic exploration in the absence of computed tomography (CT) scans by making use of shape statistics from past CT scans. Using a deformable registration algorithm along with dense reconstructions from video, we show that we are able to achieve submillimeter registrations in in-vivo clinical data and are able to assign confidence to these registrations using confidence criteria established using simulated data.Comment: 8 pages, 3 figures, MICCAI 201

Synoptic-scale and mesoscale controls for tornadogenesis on cold fronts: Shear-zone vortex-genesis in a developing frontal wave

High-resolution model simulations and radar observations are used to investigate the onset of vortex-genesis in a tornadic narrow cold-frontal rain band (NCFR). The timing and location of vortex-genesis was strongly constrained by a developing frontal wave, which tracked northeast across the United Kingdom and Ireland on 17 October 2011. In the simulations, vortices occurred preferentially during the early stages of wave development and just down-front of the wave centre, where large increases in vertical vorticity occurred in concert with decreases in the cross-frontal confluence. Vortex-genesis ceased as the frontal wave matured, due to the onset of frontal fracture. Two distinct scales of vortex-genesis are documented: primary vortex-genesis on the meso-γ-scale, and secondary vortex-genesis on the miso-scale. We show that horizontal shearing instability is the most likely vortex-genesis mechanism, consistent with previous theoretical work on the stability of vertical vortex strips in the presence of horizontal stretching deformation. Secondary vortices occurred along the braid regions between primary vortices where the shear zone became particularly narrow and intense. In the model, these vortices developed extremely rapidly (from small perturbations to maximum vertical vorticity in 5–15 min) and the strongest exhibited near-surface vertical vorticity maxima approaching 10−1 s−1. Vortices of both scales were associated with characteristic local perturbations in the NCFR and we show, by comparison with radar reflectivity data, that primary and secondary vortices were likely present in the real NCFR. Tornado reports were associated with small NCFR perturbations like those associated with the secondary vortices in the model simulations. Analysis of the sub-structure of individual simulated vortices suggests that tornado-genesis is most likely within a region of intense near-surface vertical vorticity stretching at the north or northwest flank of the secondary vortices