A North American, single-center experience implanting fenestrated atrial devices and atrial flow regulators into a heterogeneous group of pediatric pulmonary hypertension patients

IntroductionThe clinical deterioration commonly experienced by pediatric patients with pulmonary arterial hypertension (PAH) has motivated a shift in the treatment of pulmonary hypertension (PH) through innovations in surgical salvage interventions. The Occlutech fenestrated atrial septal defect (FASD) Occluder and the atrial flow regulator (AFR), which provides a protective, atrial-level shunt during hypertensive crises, have found an important role in treating pediatric patients with PAH. Other groups of pediatric patients with PH may also benefit from a similar protective physiology. The primary aim of this work is to present a single center's experience with AFR and FASD devices for managing a heterogeneous group of pediatric PH patients. A secondary goal is to identify hemodynamic changes and complications following device implantation.Materials and MethodsWe performed a retrospective review of all pediatric PH patients who, after being found suitable, either successfully or unsuccessfully received an FASD or AFR device between January 2015 and December 2021 at the Stollery Children's Hospital in Edmonton, Canada.ResultsFourteen patients (eight female) with a median age of 4.6 (range 0.3–17.9) years and a median body mass index of 15.1 (Q1 = 13.8, Q3 = 16.8) kg/m2 underwent device implantation: five received FASDs, eight received AFRs, and one was ultimately unable to receive an implant due to thrombosed iliac vessels and required surgical intervention. Of the fourteen patients, seven were in group 1 (PAH), one was in group 3 (lung disease), and six were in group 5 (primarily pulmonary hypertension vascular disease) under the World Symposium PH classification. All patients were on mono-, dual-, or triple-drug PH therapy. Device stabilization was not possible for two patients, who then required a repeat catheterization. Of the group 1 patients, three AFR and three FASD implants were successful, while one FASD implant was unsuccessful due to thrombosed vessels. At a six-month clinical assessment, all group 1 patients had patent devices and improved WHO FCs.ConclusionThis work presents a single center's experience with AFR and FASD implants in a heterogeneous group of fourteen pediatric patients with severe PH. This treatment strategy is novel in the pediatric population and so this work provides momentum for future studies of interventional cardiac catheterization procedures for pediatric patients with PH. Further collaborations are required to develop criteria to identify ideal pediatric candidates and optimally time interventions in order to maximize the benefits of this treatment

Point Clouds and Heatmaps: A Practical Approach to Multidimensional Persistent Homology for Robust Shape Recognition

Persistent homology is a technique in algebraic and computational topology useful in recovering the underlying topology of a given dataset, and has a wide range of applications in computer vision, statistics, genomics, and beyond. This technique suffers, however, through its inability to simultaneously consider multiple parameters describing a dataset—a mathematically difficult and unsolved problem. In particular, this prevents persistent homology from distinguishing between distinct yet topologically-equivalent shapes, such as circles and ellipses, that could otherwise be differentiated by examining both scale and curvature. In this presentation, we put forth a novel extension of persistent homology to two parameters, which we call Heatmap Pseudo-Bifiltration. Furthermore, we develop a robust statistical test to detect differences between point-cloud datasets on the basis of scale, curvature, and topological structure. The effect of sampling variability and noise on the results of this technique will be examined, particularly in the context of point-cloud curvature estimation in arbitrary dimensions.Non UBCUnreviewedAuthor affiliation: University of AlbertaOthe

Introducing the Copyright Anxiety Scale

Navigating copyright issues can be frustrating to the point of causing anxiety, potentially discouraging or inhibiting legitimate uses of copyright-protected materials. A lack of data about the extent and impact of these phenomena, known as copyright anxiety and copyright chill, respectively, motivated the authors to create the Copyright Anxiety Scale (CAS). This article provides an overview of the CAS’s development and validity testing. Results of an initial survey deployment drawing from a broad cross-section of respondents living in Canada and the United States (n = 521) establishes that the phenomenon of copyright anxiety is prevalent and likely associated with copyright chill

Call of the wild: Creating a formal wilderness medicine elective for Canadian pre-clerkship medical students

Implication StatementWilderness medicine education is interesting to medical students, yet not widely implemented in Canadian medical curricula. We describe a curriculum for a pre-clerkship wilderness medicine elective at a Canadian medical school. Our study reports increased student awareness of career opportunities in wilderness medicine after elective completion, and interest in hands-on learning for wilderness medicine topics. Medical schools may benefit from incorporating feedback from our elective towards a successful wilderness medicine curriculum in their own programs.Énoncé des implications de la rechercheLa médecine en milieu sauvage est un domaine que les étudiants trouvent intéressant, mais dont l’enseignement est peu répandu dans les programmes d’études médicales au Canada. Nous décrivons le contenu d’un stage au choix de médecine en milieu sauvage offert au pré-externat dans une faculté de médecine canadienne. Notre étude montre qu’à la suite du stage, les étudiants sont mieux informés des possibilités de carrière en médecine en milieu sauvage et qu’ils manifestent un intérêt pour l’apprentissage pratique dans ce domaine médical. Les commentaires recueillis sur notre stage peuvent être utiles à d’autres facultés souhaitant introduire une formation en médecine en milieu sauvage dans leur programme

Reproducing kernel-based functional linear expectile regression

Expectile regression is a useful alternative to conditional mean and quantile regression for characterizing a conditional response distribution, especially when the distribution is asymmetric or when its tails are of interest. In this article, we propose a class of scalar-on-function linear expectile regression models where the functional slope parameter is assumed to reside in a reproducing kernel Hilbert space (RKHS). Our perspective addresses numerous drawbacks to existing estimators based on functional principal components analysis (FPCA), which make implicit assumptions about RKHS eigenstructure.We show that our proposed estimator can achieve an optimal rate of convergence by establishing asymptotic minimax lower and upper bounds on prediction error. Under this framework, we propose a flexible implementation based on the alternating direction method of multipliers algorithm. Simulation studies and an analysis of real-world neuroimaging data validate our methodology and theoretical findings and, furthermore, suggest its superiority over FPCA-based approaches in numerous settings

Associations between Longitudinal Gestational Weight Gain and Scalar Infant Birth Weight: A Bayesian Joint Modeling Approach

Despite the importance of maternal gestational weight gain, it is not yet conclusively understood how weight gain during different stages of pregnancy influences health outcomes for either mother or child. We partially attribute this to differences in and the validity of statistical methods for the analysis of longitudinal and scalar outcome data. In this paper, we propose a Bayesian joint regression model that estimates and uses trajectory parameters as predictors of a scalar response. Our model remedies notable issues with traditional linear regression approaches found in the clinical literature. In particular, our methodology accommodates nonprospective designs by correcting for bias in self-reported prestudy measures; truly accommodates sparse longitudinal observations and short-term variation without data aggregation or precomputation; and is more robust to the choice of model changepoints. We demonstrate these advantages through a real-world application to the Alberta Pregnancy Outcomes and Nutrition (APrON) dataset and a comparison to a linear regression approach from the clinical literature. Our methods extend naturally to other maternal and infant outcomes as well as to areas of research that employ similarly structured data

13Th International Conference On Conservative Management Of Spinal Deformities And First Joint Meeting Of The International Research Society On Spinal Deformities And The Society On Scoliosis Orthopaedic And Rehabilitation Treatment – Sosort-Irssd 2016 Meeting

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