Freezing of gait (FOG) is a debilitating problem that markedly impairs the mobility and independence of 38-65% of people with Parkinson’s disease. During a FOG episode, patients report that their ...feet are suddenly and inexplicably “glued” to the floor. The lack of a widely applicable, objective FOG detection method obstructs research and treatment. To address this problem, we organized a 3-month machine-learning contest, inviting experts from around the world to develop wearable sensor-based FOG detection algorithms. 1,379 teams from 83 countries submitted 24,862 solutions. The winning solutions demonstrated high accuracy, high specificity, and good precision in FOG detection, with strong correlations to gold-standard references. When applied to continuous 24/7 data, the solutions revealed previously unobserved patterns in daily living FOG occurrences. This successful endeavor underscores the potential of machine learning contests to rapidly engage AI experts in addressing critical medical challenges and provides a promising means for objective FOG quantification.The absence of an objective way of assessing freezing of gait in Parkinson’s Disease hinders research and care. A machine-learning contest using wearable sensor data delivered detection algorithms with high precision and identified time-of-day effects.
Background: Although enamel matrix derivative (EMD) has demonstrated the ability to promote angiogenesis and osteogenesis both in vitro and in vivo, the specific elements within the EMD compound ...responsible for these effects remain unknown.
Methods: Nine different protein pools from a commercially produced EMD were collected based on molecular weight. Six of these pools, along with the complete EMD unfractionated compound and positive and negative controls, were tested for their ability to induce bone formation in a calvarial induction assay. Immunocytochemistry of phosphorylated SMAD1/5/8 (phospho‐SMAD), osterix, and vascular endothelial growth factor A (VEGF‐A) was carried out at selected time points. Finally, proteomic analysis was completed to determine the specific protein‐peptide content of the various osteoinductive pools.
Results: One of the lower‐molecular‐weight pools tested, pool 7, showed bone induction responses significantly greater than those of the other pools and the complete EMD compound and was concentration dependent. Dynamic bone formation rate analysis demonstrated that pool 7 was optimally active at the 5‐ to 10‐μg concentration. It was demonstrated that EMD and pool 7 induced phospho‐SMAD, osterix, and VEGF‐A, which is indicative of increased bone morphogenetic protein (BMP) signaling. Proteomic composition analysis demonstrated that pool 7 had the highest concentration of the biologically active amelogenin–leucine‐rich amelogenin peptide and ameloblastin 17‐kDa peptides.
Conclusions: These studies demonstrate that the low‐molecular‐weight protein pools (7 to 17 kDa) within EMD have greater osteoinductive potential than the commercially available complete EMD compound and that the mechanism of action, in part, is through increased BMP signaling and increased osterix and VEGF‐A. With this information, selected components of EMD can now be formulated for optimal osteo‐ and angio‐genesis.
Different genotypes of Loblolly pine (Pinus taeda) are planted across the United States for the purpose of timber production. Genotypes from the eastern portion of the range are faster growing, but ...less drought resistant, and are often planted across the south for the growth benefits that they provide. Genotypes from the western portion of the range are more drought resistant but slower growing. As the climate continues to change drought will become more common, especially in the western portion of the range where they occur more frequently. A common practice to mitigate drought stress is thinning, or the removal of trees from the site. This thesis looks at the difference in three of these genotypes, two of eastern origin (756-OP, 93-V) and one of western origin (LA-OP), on the basis of sap flux, sap flow, height growth, and diameter growth in their response to drought and thinning. It was found that the western genotype was more able to acquire water and transport it to the canopy than the eastern genotypes when under drought stress.
•Only stand density kept below 297 TPH from age 7 reduced MOE, MOR, and specific gravity.•As planting density declined the age of transition corewood to outerwood decreased.•Specific gravity was ...similar among planting densities at a well-drained site.•Outerwood transition occurred earlier for a relocated Coastal Plain genotype.•A relocated Coastal Plain genotype had higher latewood proportion.
Changes in ownership and forest product use patterns have incentivized growing loblolly pine (Pinus taeda L.) for chip-and-saw and sawtimber in shorter rotations in the southeastern United States. These management objectives can be accomplished by relatively low stand densities and moving fast-growing genotypes from the Atlantic Coastal Plain to other regions of the loblolly pine range, but wood quality concerns accompany these silvicultural options. In three trials in the Western Gulf region of the mid-South United States, effects of stand density management options on key wood properties (specific gravity, corewood (juvenile wood) diameter, corewood proportion, latewood proportion, corewood:outerwood (juvenile wood:mature wood) transition age as determined using specific gravity) were tested. At one site, clearwood modulus of elasticity (MOE) and modulus of rupture (MOR) were measured. Genotypes of Atlantic Coastal Plain and Western Gulf origin were also tested at two sites. In a trial in which stand density was managed at diverse levels through sequential thinning, beginning at precommercial size, only a regime that was commercially thinned to half its density two times from 297 TPH at age 7 to 62 TPH by age 41 had significant reductions in MOE, MOR, and specific gravity. Corewood diameter increased with decreasing planting density at two sites at the northwestern edge of the loblolly pine range, but corewood proportion declined with decreasing planting density due to greater diameter growth and earlier transition from corewood to outerwood. Specific gravity differences among planting densities was site-specific, with no differences at the more well-drained site. Latewood proportion, which was greater at higher planting densities, was more strongly correlated with specific gravity differences among planting densities. A planting density between 1075 and 1680 TPH would likely be optimum for these site conditions for balancing tree volume growth with minimizing reductions in specific gravity associated with reduced latewood proportion and larger corewood size. The Atlantic Coastal Plain genotype retained its tendencies to transition to outerwood earlier and have greater latewood proportions relative to a local genotype when planted at these Western Gulf sites, and its specific gravity was similar to that of the local genotype. Together these trials suggest that forest managers have flexibility in managing loblolly pine stand density without altering wood properties. Furthermore, these results provide some evidence that moving genotypes may not carry a risk of reduced wood specific gravity.
A prospective cost analysis of pancreatoduodenectomy Holbrook, Ryan F.; Margrave, Kent; William Traverse, L.
The American journal of surgery,
05/1996, Letnik:
171, Številka:
5
Journal Article, Conference Proceeding
Recenzirano
In our cost-conscious health care system hospitals are finding that costs are as important as charges or reimbursements, especially as hospitals compete for managed care contracts. We have ...prospectively gathered cost data for more than 60 common operations performed at our institution over the last 3 years.
Over a 25-month period, from January 1993 to February 1995, 30 pancreaticoduodenectomy procedures were performed for which cost data were available. Cases were divided according to diagnosis (neoplastic or benign) and were evaluated for complications which prolonged length of stay (LOS). Costs were analyzed by an item-by-item prospective micro-cost analysis technique. Items were grouped into two areas: operating room (OR) costs and hospital (ward) costs. OR costs included disposable equipment, nondisposable equipment, OR room, OR staff, postanesthesia care, and anesthesia costs. Ward costs included hospital room, pharmacy, and radiology costs.
OR costs for the 30 PD patients were similar and represented approximately 21 % of total hospital costs. Of the 30 patients, complications resulting in a prolonged LOS occurred in 10 (33%): intra abdominal abscess in 3 (2 with pancreatic leaks), superficial marginal ulceration in 2, delayed return of gastrointestinal function in 2 (1 with pulmonary edema) and 1 each of bile leak, urosepsis, and chylous ascites. No cost differences were observed when comparing neoplasm versus chronic pancreatitis for all parameters. When comparing patients who had complications versus those who did not, however, there was a statistically significant cost difference for both hospital ward or total costs. Regardless of whether a PD was performed for neoplastic or benign disease, postoperative complications increased hospital ward costs by 76% due to increased LOS.
This cost analysis study is an example of the methodology that would allow surgeons to investigate any common surgical procedure by first identifying areas of increased costs. This quantitative knowledge focuses the clinician on areas to improve quality which will then lower costs.
Resection of malignant primary liver tumors Holbrook, Ryan F.; Koo, Kenny; Ryan, John A.
The American journal of surgery,
05/1996, Letnik:
171, Številka:
5
Journal Article, Conference Proceeding
Recenzirano
Malignant primary liver tumors are an uncommon and challenging surgical problem. In spite of multimodality therapies, surgical resection remains the mainstay of treatment and the most likely chance ...for cure. We reviewed the 13-year resection experience of a single surgeon at our institution to evaluate the results.
A retrospective review from July 1982 to June 1995 was performed for patients presenting with a diagnosis of primary liver cancer. Those undergoing resection of their primary liver tumors form the basis of this report.
One hundred eighty-four patients with a diagnosis of primary liver cancer were seen at our institution. Of these, 43 patients underwent 46 resections of their cancers by a single surgeon. There were 22 females (51%) and 21 males (49%). The average age was 61 years with a median age of 63 years (range, 19–85 years). Tumors resected included 27 hepatomas, 16 cholangiocellular carcinomas, 1 carcinoid tumor, 1 low grade mucinous cystadenocarcinoma, and 1 cystadenocarcinoma. Resections were as follows: 9 right trisegmentectomies, 8 right lobectomies, 1 left trisegmentectomy, 4 left lobectomies, 7 left lateral segmentectomies, and 17 partial lobectomies. Major complications occurred in 11 patients (26%). There were 3 deaths, for a 30-day perioperative death rate of 7%. Of the 43 patients, 13 had follow-up of less than 12 months and 30 had follow-up for more than 1 year. The mean survival of the 30 patients who had their tumors resected and were followed up for more than 1 year was 27.2 months and the median survival was 21 months. The median survival of patients not undergoing resection was less than 6 months. The 1-, 2-, 3-, and 5-year survival rates were 57%, 52%, 40%, and 33%, respectively.
Primary liver cancer can be treated by resection with acceptable results. This remains the standard treatment of any liver cancer. Surival rates of patients after resection are much better than survival rates of patients who do not undergo surgery.
We prospectively performed nuclear biliary patency imaging (HIDA scanning) in 62 patients who had undergone endoscopic retrograde sphincterotomy for management of pancreaticobiliary disease with ...their gallbladders in situ. Elective cholecystectomy was not recommended because of advanced age, comorbidity, or absence of gallstones. All patients had patent cystic ducts at endoscopic retrograde cholangiopancreatography balloon cholangiography. Eighteen (29.1%) of 62 patients had nonvisualizing HIDA scans, and in 44 (70.9%) of 62 visualization was normal or delayed. Six cholecystectomies were required for colic (n = 1), acute cholecystitis (n = 4), and acute cholecystocholedochal fistula with cholangitis (n = 1). Among the patients with cholelithiasis and nonvisualization (n = 13), five (38.5%) required surgery, whereas only one (4.8%) of 21 patients with cholelithiasis and visualization required surgery. Nonvisualizing HIDA scans are frequent (30%) after endoscopic retrograde sphincterotomy and have no clinical relevance in patients without cholelithiasis but predict the need for cholecystectomy within 16 months in 38.5% of patients with cholelithiasis.
From July 1988 to January 1989, we compared the course of 48 patients undergoing elective cholecystectomy with that of 18 undergoing extracorporeal shock wave lithotripsy for symptomatic ...cholelithiasis with respect to treatment, hospitalization, recovery, and cost. For elective cholecystectomy, average length of surgery was 76 minutes (range, 31 to 186 minutes); average length of stay was 4 days; total cost was $6240; morbidity was 10%; and return to work averaged 5 weeks. Average extracorporeal shock wave lithotripsy treatment length was 136 minutes (80 to 158 minutes); average length of stay was 2 days; total cost was $5921; and hematuria and petechiae were seen in 33% and 28%, respectively. Re-treatment cost was $4880. All of these patients were active in 24 hours; return to work averaged 3 days. As results of the Food and Drug Administration study are still pending, recurrence and re-treatment rates are unknown. We conclude that extracorporeal shock wave lithotripsy is less costly, initially, with further reductions probable when performed on an outpatient basis. Though re-treatment may be required, return to normal activity is dramatically shortened.
After the success of shock-wave therapy for fragmentation of renal stones, machines for shock-wave therapy of gallbladder stones were quick to follow. In Munich, gallstones were successfully treated ...in 174 of 175 patients who were also taking ursodiol to help solubilize the calculous rubble left after treatment. In Boston, of the initial 87 patients accepted, 58 were treated for a single stone (mean diameter 15.7 mm), 16 were treated for 2 stones, and 13 for 3 stones. Although reporting of exact results is not possible before the Food and Drug Administration issues a clearance, it is fair to say that both patients and physicians are generally pleased with the results.
