Through-time 3D radial GRAPPA for whole heart cardiac imaging

Summary Through-Time 3D Radial GRAPPA can be used to reconstruct 3D CINE images covering the whole heart in a single breathhold. Background Through-Time Non-Cartesian GRAPPA has been previously demonstrated for real-time 2D cardiac imaging (Seiberlich, et al. Magn Reson Med. 2011 Feb;65(2):492-505.). This parallel imaging method works by acquiring several fully-sampled non-Cartesian datasets with a low temporal resolution, and using the coil sensitivity information from these datasets to reconstruct highly undersampled non-Cartesian data acquired in real-time. By modifying this through-time non-Cartesian GRAPPA method to reconstruct highly undersampled 3D data, whole heart 3D CINE images can be generated using data acquired in a single breathhold. Methods A total of 20 fully-sampled 3D stack-of-stars radial datasets were acquired during free-breathing with no EKG gating using a 1.5T Siemens Espree and the following parameters: bSSFP sequence, TE=1.52ms, TR=3.04ms, matrix size = 128x128x20, projections/partition=128, FOV=300x300x90mm3, Flip Angle=45°, 5/8 Partial Fourier, 18 receiver channels. Segmented undersampled data (using only 16 projections/partition, an acceleration factor of R=8) were acquired with EKG gating and the above parameters during a breathhold for 15 heartbeats, resulting in 15 CINE frames. In order to perform the calibration, each of the time frames and partitions were employed as separate sources of calibration information; thus, a total of 300 repetitions could be used to generate the through-time GRAPPA weight sets. After reconstruction, the undersampled data yielded fully-sampled 3D CINE images, each with a temporal footprint of 48ms, an in-plane resolution of 2.3mm2, and a through-plane resolution of 6mm. The total acquisition time was 116s for the calibration and approximately 15 s for the breathhold CINE acquisition. Results Example images from diastole and systole of one healthy volunteer are shown in Figures 1 and 2. It is important to note that these represent just two of the 15 CINE frames acquired in this dataset. Despite the high acceleration factor (R=8 in comparison to the fully-sampled calibration data), the images demonstrate only minor residual aliasing artifacts. Because a 3D dataset is acquired, the images from each partition can be shown in the same cardiac phase, which is challenging when using multiple breathholds to acquire several 2D CINE slices

Drawings as Diagnostic Cues for Metacomprehension Judgment

The accuracy of comprehension monitoring affects the effectiveness of rereading, which in turn affects comprehension. Thus, much research has focused on finding ways to improve monitoring accuracy. The cue-utilization framework of metacognitive monitoring provides a framework for understanding how to improve monitoring accuracy. It suggests that accuracy is driven by cues people use to judge comprehension. When people utilize cues that are highly diagnostic of performance on a test of comprehension, accuracy should improve. Many interventions that have been shown to improve monitoring accuracy have attributed the improved accuracy to increased access to highly diagnostic cues, but have failed to identify highly diagnostic cues. In our recent research, we found that instructing students to generate drawings before judging comprehension improved monitoring accuracy. Using graphic analyses protocol, we identified highly diagnostic cues. In this chapter, we will describe the procedure we used to identify these cues contained in drawings

The Effect Of Medicaid On Medication Use Among Poor Adults: Evidence From Oregon.

Oregon\u27s 2008 Medicaid expansion significantly increased the use of prescription medications in 2009-10

Xpert MTB/RIF - why the lack of morbidity and mortality impact in intervention trials?

Compared with smear microscopy, the Xpert MTB/RIF assay (Xpert), with superior accuracy and capacity to diagnose rifampicin resistance, has advanced TB diagnostic capability. However, recent trials of Xpert impact have not demonstrated reductions in patient morbidity and mortality. We conducted a narrative review of Xpert impact trials to summarize which patient-relevant outcomes Xpert has improved and explore reasons for no observed morbidity or mortality reductions. We searched PubMed, Google Scholar, Cochrane Library and Embase and identified eight trials meeting inclusion criteria: three individually randomized, three cluster-randomized, and two pre-post trials. In six trials Xpert increased diagnostic yield of bacteriologically-confirmed TB from sputa and in four trials Xpert shortened time to TB treatment. However, all-cause mortality was similar between arms in all six trials reporting this outcome, and the only trial to assess Xpert impact on morbidity reported no impact. Trial characteristics that might explain lack of observed impact on morbidity and mortality include: higher rates of empiric TB treatment in microscopy compared with Xpert arms, enrollment of study populations not comprised exclusively of populations most likely to benefit from Xpert, and health system weaknesses. So far as equipoise exists, future trials that address past limitations are needed to inform Xpert use in resource-limited settings

The Effect of Medicaid on Dental Care of Poor Adults: Evidence from the Oregon Health Insurance Experiment.

OBJECTIVE: To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations. DATA SOURCES: Primary and secondary data on health care use and outcomes for participants in Oregon\u27s 2008 Medicaid lottery. STUDY DESIGN: We used the lottery\u27s random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care. DATA COLLECTION: Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229). Emergency department (ED) records were matched to lottery participants in Portland (N = 24,646). PRINCIPAL FINDINGS: Medicaid coverage significantly reduced the share of respondents who reported needing dental care (-9.8 percentage points, p \u3c .001) or having unmet dental care needs (-13.5 percentage points, p \u3c 0.001). Medicaid doubled the share visiting the ED for dental care (+2.6 percentage points, p = .003) and the use of anti-infective medications often prescribed for dental care, but it had no detectable effect on uncovered dental care or out-of-pocket spending. CONCLUSIONS: Expansion of Medicaid covering emergency dental care substantially reduced unmet need for dental care, increasing ED dental visits and medication use, while not changing patient use of uncovered dental services

Utility of broad-spectrum antibiotics for diagnosing pulmonary tuberculosis in adults : a systematic review and meta-analysis

Funding: Helse Nord RHF, Wellcome Trust, and the UK Commonwealth Scholarship Commission.Suboptimal diagnostics for pulmonary tuberculosis drive the use of the so-called trial of antibiotics, a course of broad-spectrum antibiotics without activity against Mycobacterium tuberculosis that is given to patients who are mycobacteriology negative but symptomatic, with the aim of distinguishing pulmonary tuberculosis from bacterial lower respiratory tract infection. The underlying assumption—that patients with lower respiratory tract infection will improve, whereas those with pulmonary tuberculosis will not—has an unclear evidence base for such a widely used intervention (at least 26·5 million courses are prescribed per year). We aimed to collate available evidence on the diagnostic performance of the trial of antibiotics.Publisher PDFPeer reviewe

An Interpersonal Analysis of Pathological Personality Traits in DSM-5

The proposed changes to the personality disorder section of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) places an increased focus on interpersonal impairment as one of the defining features of personality psychopathology. In addition, a proposed trait model has been offered to provide a means of capturing phenotypic variation on the expression of personality disorder. In this study, the authors subject the proposed DSM-5 traits to interpersonal analysis using the Inventory of Interpersonal Problems–Circumplex scales via the structural summary method for circumplex data. DSM-5 traits were consistently associated with generalized interpersonal dysfunction suggesting that they are maladaptive in nature, the majority of traits demonstrated discriminant validity with prototypical and differentiated interpersonal problem profiles, and conformed well to a priori hypothesized associations. These results are discussed in the context of the DSM-5 proposal and contemporary interpersonal theory, with a particular focus on potential areas for expansion of the DSM-5 trait model

The hierarchical structure of DSM-5 pathological personality traits

A multidimensional trait system has been proposed for representing personality disorder (PD) features in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to address problematic classification issues such as comorbidity. In this model, which may also assist in providing scaffolding for the underlying structure of major forms of psychopathology more generally, 25 primary traits are organized by 5 higher order dimensions: Negative Affect, Detachment, Antagonism, Disinhibition, and Psychoticism. We examined (a) the generalizability of the structure proposed for DSM-5 PD traits, and (b) the potential for an integrative hierarchy based upon DSM-5 PD traits to represent the dimensions scaffolding psychopathology more generally. A large sample of student participants (N = 2,461) completed the Personality Inventory for DSM-5, which operationalizes the DSM-5 traits. Exploratory factor analysis replicated the initially reported 5-factor structure, as indicated by high factor congruencies. The 2-, 3-, and 4-factor solutions estimated in the hierarchy of the DSM-5 traits bear close resemblance to existing models of common mental disorders, temperament, and personality pathology. Thus, beyond the description of individual differences in personality disorder, the trait dimensions might provide a framework for the metastructure of psychopathology in the DSM-5 and the integration of a number of ostensibly competing models of personality trait covariation

Periodontal Status and Quality of Life: Impact of Fear of Pain and Dental Fear

Background. Oral health-related quality of life (OHRQoL) is impacted by periodontal disease and orofacial pain. There is a limited research examining the impact of avoidance of care or physiological arousal related to the fear of pain response on periodontal-related OHRQoL. Methods. Data are from the Center for Oral Health Research in Appalachia family-based study focusing on 1,339 adults. Measures included a modified Periodontal Screening and Recording Index across sextants of dentition, dental fear survey, Fear of Pain Questionnaire-9, and Oral Health Impact Profile-14. Structural equation modeling was used to estimate the effects of periodontal disease screening indicators on OHRQoL including the mediating role of dental fear while accounting for fear of pain. Results. A significant total effect was found for the mandibular anterior sextant, components of dental anxiety/fear, and indicators of OHRQoL (pain and discomfort, , ; psychosocial impact, , ). The maxillary anterior region was significantly associated with pain discomfort (, ) and functionality (, ). Conclusions. Findings provide a granular perspective of periodontal disease indicators and OHRQoL. Dental avoidance/anticipatory fear and physiological arousal mediate OHRQoL in individuals who have indicators of periodontal disease in sextants that may be visible and susceptible to higher pain and psychosocial impact

The cost of a primary care-based childhood obesity prevention intervention

Background: United States pediatric guidelines recommend that childhood obesity counseling be conducted in the primary care setting. Primary care-based interventions can be effective in improving health behaviors, but also costly. The purpose of this study was to evaluate the cost of a primary care-based obesity prevention intervention targeting children between the ages of two and six years who are at elevated risk for obesity, measured against usual care. Methods: High Five for Kids was a cluster-randomized controlled clinical trial that aimed to modify children’s nutrition and TV viewing habits through a motivational interviewing intervention. We assessed visit-related costs from a societal perspective, including provider-incurred direct medical costs, provider-incurred equipment costs, parent time costs and parent out-of-pocket costs, in 2011 dollars for the intervention (n = 253) and usual care (n = 192) groups. We conducted a net cost analysis using both societal and health plan costing perspectives and conducted one-way sensitivity and uncertainty analyses on results. Results: The total costs for the intervention group and usual care groups in the first year of the intervention were $65,643 (95$64,522, $66,842]) and$12,192 (95% CI [$11,393,$13,174]). The mean costs for the intervention and usual care groups were $259 (95$255, $264]) and$63 (95% CI [$59,$69]) per child, respectively, for a incremental difference of $196 (95$191, $202]) per child. Children in the intervention group attended a mean of 2.4 of a possible 4 in-person visits and received 0.45 of a possible 2 counseling phone calls. Provider-incurred costs were the primary driver of cost estimates in sensitivity analyses. Conclusions: High Five for Kids was a resource-intensive intervention. Further studies are needed to assess the cost-effectiveness of the intervention relative to other pediatric obesity interventions. Trial registration ClinicalTrials.gov Identifier: NCT00377767