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Pediatric Emergency Care Jul 2024This cross-sectional study aimed to assess the process of clinical practice guideline (CPG) development in pediatric emergency medicine departments (PEDs) across the...
OBJECTIVE
This cross-sectional study aimed to assess the process of clinical practice guideline (CPG) development in pediatric emergency medicine departments (PEDs) across the United States, with a focus on identifying areas for improvement to enhance the quality of CPGs.
METHODS
An electronic survey was distributed to PEDs with pediatric emergency medicine fellowship programs. Respondents were asked about their CPG development processes (ie, guideline committee composition, consideration of conflicts of interest, grading recommendations, guideline training opportunities) based on the Appraisal of Guidelines, Research, and Evaluation (AGREE II) tool as well as implementation and monitoring. Univariate analysis was used to assess associations between the number of AGREE II elements adhered to and annual patient volume.
RESULTS
Of the 84 PEDs surveyed, 44 (52.4%) responded, representing institutions from 28 states. Most PEDs (97.7%, n = 43) reported developing their own guidelines, citing the need to improve care quality and standardize patient care as primary reasons. Although most guideline committees included multidisciplinary team members (74.4%, n = 32), routine patient involvement in committees was rare (11.6%, n = 5), and barriers such as time and resource constraints hindered their inclusion. Formal training for committee members in guideline development was uncommon (18.6%, n = 8). There was an association between higher annual patient volume and the number of AGREE II elements adhered to (P = 0.03). Few PEDs considered potential conflicts of interest among committee members (13.6%, n = 6). Over half of surveyed PEDs (54.5%, n = 24) lacked a systematic approach to grading recommendations. Educational materials and workshops were the most common guideline implementation strategies.
CONCLUSIONS
Our findings highlight need for improvement in the CPG development process in PEDs. Including patients in committees, providing formal training for committee members, and adopting a rigorous approach to grading recommendations are crucial steps toward enhancing guideline quality. Emphasizing these improvements has the potential to improve the quality of CPGs for pediatric emergency care.
PubMed: 38950408
DOI: 10.1097/PEC.0000000000003230 -
Proceedings of the National Academy of... Jul 2024Functional changes in the pediatric brain following neural injuries attest to remarkable feats of plasticity. Investigations of the neurobiological mechanisms that...
Functional changes in the pediatric brain following neural injuries attest to remarkable feats of plasticity. Investigations of the neurobiological mechanisms that underlie this plasticity have largely focused on activation in the penumbra of the lesion or in contralesional, homotopic regions. Here, we adopt a whole-brain approach to evaluate the plasticity of the cortex in patients with large unilateral cortical resections due to drug-resistant childhood epilepsy. We compared the functional connectivity (FC) in patients' preserved hemisphere with the corresponding hemisphere of matched controls as they viewed and listened to a movie excerpt in a functional magnetic resonance imaging (fMRI) scanner. The preserved hemisphere was segmented into 180 and 200 parcels using two different anatomical atlases. We calculated all pairwise multivariate statistical dependencies between parcels, or parcel edges, and between 22 and 7 larger-scale functional networks, or network edges, aggregated from the smaller parcel edges. Both the left and right hemisphere-preserved patient groups had widespread reductions in FC relative to matched controls, particularly for within-network edges. A case series analysis further uncovered subclusters of patients with distinctive edgewise changes relative to controls, illustrating individual postoperative connectivity profiles. The large-scale differences in networks of the preserved hemisphere potentially reflect plasticity in the service of maintained and/or retained cognitive function.
Topics: Humans; Child; Magnetic Resonance Imaging; Female; Male; Adolescent; Neuroimaging; Epilepsy; Cerebral Cortex; Neuronal Plasticity; Drug Resistant Epilepsy; Brain Mapping; Functional Laterality
PubMed: 38950362
DOI: 10.1073/pnas.2317458121 -
Health Affairs (Project Hope) Jul 2024Percutaneous coronary intervention (PCI) is a procedure that opens blocked arteries and restores blood flow to the heart. Timely access to hospitals offering PCI...
Percutaneous coronary intervention (PCI) is a procedure that opens blocked arteries and restores blood flow to the heart. Timely access to hospitals offering PCI services can be a matter of life or death for patients experiencing a heart attack; however, hospitals' adoption of PCI services may vary between communities, posing potential barriers to critical care. Our cohort study of US general acute hospitals during the period 2000-20 examined PCI service adoption across communities stratified by race, ethnicity, income, and rurality and further classified as segregated or integrated. Of 5,260 hospitals, 1,621 offered PCI services in 2020 or before, 630 added PCI services between 2001 and 2010, and 225 added PCI services between 2011 and 2020. Hospitals serving Black, racially segregated communities were 48 percent less likely to adopt PCI services compared with hospitals serving non-Black, racially segregated communities, and hospitals serving Hispanic, ethnically segregated communities were 41 percent less likely to do so than those serving non-Hispanic, ethnically segregated communities. Hospitals in high-income, economically integrated communities were 1.8 times more likely to adopt PCI services than those in high-income, economically segregated communities, and rural hospitals were less likely to do so than urban hospitals. Understanding where services are expanding in relation to community need may aid in successful policy interventions.
Topics: Percutaneous Coronary Intervention; Humans; United States; Healthcare Disparities; Hospitals; Health Services Accessibility; Female; Male; Cohort Studies
PubMed: 38950302
DOI: 10.1377/hlthaff.2023.01649 -
Optics Letters Jul 2024Underwater communication and positioning are essential for autonomous underwater vehicle (AUV) docking and formation. The traditional methods for communication and...
Underwater communication and positioning are essential for autonomous underwater vehicle (AUV) docking and formation. The traditional methods for communication and positioning are mainly independent from each other, increasing the redundancy and integration difficulty for AUVs. In this Letter, we demonstrate a real-time underwater wireless optical communication and positioning (UWOCP) integrated system. The LED array is adopted as a light source, and the pulse-position modulation (PPM) is used for a maximum transmission and sensing distance. By employing the silicon photomultiplier (SiPM) array, which consists of five SiPMs with different angles, the high sensitivity and ability to distinguish angles are obtained. Through calculating the relationship between the received pulse signal intensity of the five SiPMs, the pitch angle and yaw angle can be obtained. The experimental results in the pool show that the Ethernet bandwidth of 2.2 Mbps with an average angular error of 3.08° for one-dimensional positioning can be realized at a 50 m distance. To the best of our knowledge, this is the longest distance at which a real-time UWOCP system has been demonstrated. The proposed UWOCP system has the advantages of high sensitivity, computing efficiency, and compact structure, presenting great potential for underwater applications.
PubMed: 38950258
DOI: 10.1364/OL.522308 -
Optics Letters Jul 2024In this paper, we proposed a 2 × 2 multiple-input multiple-output (MIMO) dual spiral octagonal prism liquid dielectric resonator antenna (DRA) with snake-shaped...
In this paper, we proposed a 2 × 2 multiple-input multiple-output (MIMO) dual spiral octagonal prism liquid dielectric resonator antenna (DRA) with snake-shaped defective ground structure (DGS) for space multiplexing of orbital angular momentum (OAM). The DRA element adopts an inner and outer nested dual spiral structure filled with 0.035 g/ml of brine outside and a cylinder filled with distilled water inside. The proposed MIMO antenna can generate resonance at 1.78-3.02 GHz and 4.01-7.73 GHz (S≤-10 dB). The isolation among ports is below -20 dB at 2.6 GHz and below -40 dB at 5.1 GHz, which can effectively isolate the l = ±1 and l = ±3 modes' OAM waves through the snake-shaped DGS. The proposed MIMO antenna improves spectral efficiency by OAM spatial multiplexing with l = ±1 and l = ±3 modes' OAM, which improves the data transmission efficiency. The proposed MIMO antenna provides a novel, to the best of our knowledge, solution for wireless communications to improve spectral efficiency.
PubMed: 38950250
DOI: 10.1364/OL.525505 -
Optics Letters Jul 2024We report highly sensitive detection of carbon monoxide (CO) and nitrous oxide (NO) using doubly resonant photoacoustic spectroscopy paired with a quantum cascade laser...
We report highly sensitive detection of carbon monoxide (CO) and nitrous oxide (NO) using doubly resonant photoacoustic spectroscopy paired with a quantum cascade laser (QCL) at 4.57 μm. The butterfly-packaged QCL is used to exploit the CO absorption line at 2190.02 cm and the NO absorption line at 2191.42 cm by scanning the injection current. Leveraging the simultaneous acoustic and optical resonances and adopting a lower photoacoustic detection frequency, we achieve a minimum detection limit of 0.85 part-per-trillion (ppt) for CO over the 500 s averaging time, and 0.7 ppt for NO over the 200 s averaging time. Our approach demonstrates record sensitivity for CO and NO detection compared to state-of-the-art optical gas sensors.
PubMed: 38950231
DOI: 10.1364/OL.530578 -
Optics Letters Jul 2024Real-time tracking and 3D trajectory computation of fast-moving objects is a promising technology, especially in the field of autonomous driving. However, existing...
Real-time tracking and 3D trajectory computation of fast-moving objects is a promising technology, especially in the field of autonomous driving. However, existing image-based tracking methods face significant challenges when it comes to real-time tracking, primarily due to the limitation of storage space and computational resources. Here, we propose a novel approach that enables real-time 3D tracking of a fast-moving object without any prior motion information and at a very low computational cost. To enable 3D coordinate synthesis with a space-efficient optical setup, geometric moment patterns are projected on two non-orthogonal planes with a spatial resolution of 125 μm. Our experiment demonstrates an impressive tracking speed of 6667 frames per second (FPS) with a 20 kHz digital micromirror device (DMD), which is more than 200 times faster than the widely adopted video-based tracking methods. To the best of our knowledge, this is the highest tracking speed record in the field of single-pixel 3D trajectory tracking. This method promotes the development of real-time tracking techniques with single-pixel imaging (SPI).
PubMed: 38950226
DOI: 10.1364/OL.521176 -
Biomacromolecules Jul 2024Different from conventional synthetic polymers, polypeptides exhibit a distinguishing characteristic of adopting specific secondary structures, including random coils,...
Different from conventional synthetic polymers, polypeptides exhibit a distinguishing characteristic of adopting specific secondary structures, including random coils, α-helixes, and β-sheets. The conformation determines the rigidity and solubility of polypeptide chains, which further direct the self-assembly and morphology of the nanostructures. We studied the effect of distinct secondary structures on the self-assembly behavior of polytyrosine (PTyr)-derived amphiphilic copolymers. Two block copolymers of enantiopure poly(ethylene glycol)--poly(l-tyrosine) (PEG--P(l-Tyr)) and racemic poly(ethylene glycol)--poly(dl-tyrosine) (PEG--P(dl-Tyr)) were synthesized through the ring-opening polymerization of l-tyrosine -thiocarboxyanhydride (l-Tyr-NTA) and dl-tyrosine -thiocarboxyanhydride (dl-Tyr-NTA), respectively, by using poly(ethylene glycol) amine as the initiator. PEG--P(l-Tyr) adopts a β-sheet conformation and self-assembles into rectangular nanosheets in aqueous solutions, while PEG--P(dl-Tyr) is primarily in a random coil conformation with a tiny content of β-sheet structures, which self-assembles into sheaf-like nanofibrils. A pH increase results in the ionization of phenolic hydroxyl groups, which decreases the β-sheet content and increases the random coil content of the PTyr segments. Accordingly, PEG--P(l-Tyr) and PEG--P(dl-Tyr) self-assemble to form slender nanobelts and twisted nanoribbons, respectively, in alkaline aqueous solutions. The secondary structure-driven self-assembly of PTyr-derived copolymers is promising to construct filamentous nanostructures, which have potential for applications in controlled drug release.
PubMed: 38950188
DOI: 10.1021/acs.biomac.4c00437 -
Journal of Managed Care & Specialty... Jul 2024Oncology clinical trial enrollment is strongly recommended for patients with cancer who are not eligible for established and approved therapies. Many trials are specific...
Real-world clinical and economic outcomes for patients with advanced non-small cell lung cancer enrolled in a clinical trial following comprehensive genomic profiling via liquid biopsy.
BACKGROUND
Oncology clinical trial enrollment is strongly recommended for patients with cancer who are not eligible for established and approved therapies. Many trials are specific to biomarker-targeted therapies, which are typically managed as specialty pharmacy services. Comprehensive genomic profiling (CGP) of advanced cancers has been shown to detect biomarkers, guide targeted treatment, improve outcomes, and result in the clinical trial enrollment of patients, which is modeled to offset pharmacy costs experienced by US payers, yet payer policy coverage remains inconsistent. A common concern limiting coverage of CGP by payers is the potential of identifying biomarkers beyond guideline-recommended treatments, which creates a perception that insurance companies are being positioned to "pay for research." However, these biomarkers can increase clinical trial eligibility, and specialty pharmacy management may have an interest in maximizing the clinical trial enrollment of members.
OBJECTIVE
To investigate if clinical trial enrollment following liquid biopsy CGP for non-small cell lung cancer (NSCLC) is clinically and/or economically impactful from a payer claims perspective.
METHODS
Clinical and economic outcomes were studied using a real-world clinical genomic database (including payer claims data) from patients with NSCLC who enrolled in clinical trials immediately following liquid biopsy CGP (using Guardant360) and matched NSCLC patient controls also tested with liquid biopsy CGP.
RESULTS
Real-world overall survival was significantly (log-rank < 0.0001) better for patients enrolled in clinical trials with similar costs of care, albeit with more outpatient encounters among those enrolled compared with matched controls.
CONCLUSIONS
The results, together with previous analyses, suggest that, in addition to the clinical benefits associated with targeted therapies directed by CGP and other testing approaches, payers and specialty pharmacy managers may consider clinical trial direction and enrollment as a clinical and economic benefit of liquid biopsy CGP and adopt this into coverage decision frameworks and formularies.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Liquid Biopsy; Female; Male; Middle Aged; Aged; Clinical Trials as Topic; Biomarkers, Tumor; Genomics; United States
PubMed: 38950156
DOI: 10.18553/jmcp.2024.30.7.660 -
Circulation Jul 2024Despite data suggesting that apolipoprotein B (apoB) measurement outperforms low-density lipoprotein cholesterol level measurement in predicting atherosclerotic... (Review)
Review
Despite data suggesting that apolipoprotein B (apoB) measurement outperforms low-density lipoprotein cholesterol level measurement in predicting atherosclerotic cardiovascular disease risk, apoB measurement has not become widely adopted into routine clinical practice. One barrier for use of apoB measurement is lack of consistent guidance for clinicians on how to interpret and apply apoB results in clinical context. Whereas guidelines have often provided clear low-density lipoprotein cholesterol targets or triggers to initiate treatment change, consistent targets for apoB are lacking. In this review, we synthesize existing data regarding the epidemiology of apoB by comparing guideline recommendations regarding use of apoB measurement, describing population percentiles of apoB relative to low-density lipoprotein cholesterol levels, summarizing studies of discordance between low-density lipoprotein cholesterol and apoB levels, and evaluating apoB levels in clinical trials of lipid-lowering therapy to guide potential treatment targets. We propose evidence-guided apoB thresholds for use in cholesterol management and clinical care.
Topics: Humans; Apolipoproteins B; Cholesterol, LDL; Practice Guidelines as Topic; Cardiovascular Diseases; Biomarkers; Atherosclerosis; Apolipoprotein B-100
PubMed: 38950110
DOI: 10.1161/CIRCULATIONAHA.124.068885