Publications by authors named "Diego D"

11 Publications

  • Page 1 of 1

Tracking the Development of Cerebrovascular Risk Factors Following Pregnancy With Preeclampsia.

J Stroke Cerebrovasc Dis 2020 Jun 24;29(6):104720. Epub 2020 Mar 24.

University of Maryland Medical System, Miami, Florida.

Objective: To evaluate the development and management of cerebrovascular risk factors following a pregnancy with preeclampsia.

Methods: This is a retrospective chart review including women diagnosed with preeclampsia between 2012 and 2013 with later encounters within 2014-2016. For each subject that met inclusion criteria, the development of cerebrovascular risk factors was determined using ICD codes within the 2014-2016 electronic medical record (EMR). For subjects who developed risk factors, current treatment was determined from the EMR. Demographic data was also documented. Differences in the development and treatment of risk factors were compared among racial groups and age. Descriptive statistics were calculated using SAS statistical software.

Results: Compared to prepregnancy health status, the incidence of hypertension increased by 1.7 times (P < .05), hyperlipidemia increased by 4.5 (P < .05), migraines increased by 2.2 (P < .05), and diabetes mellitus increased by 2 (P < .05) after a pregnancy with preeclampsia. Black non-Hispanics had highest rates of hypertension, obesity, and migraines (20.5%, 9.1%, and 6.8%, respectively.) Of hypertensives, 73.6% (42/57) were prescribed medication. Of diabetics, 88.9% (16/18) were prescribed medication. No patients with hyperlipidemia were prescribed a statin. Black non-Hispanics had higher rates of risk factor management (74.3% of hypertensives and 100% of diabetics treated) than white Hispanics (55% and 77.8%, respectively).

Conclusions: This study shows a significant increased risk of the development of cerebrovascular risk factors such as hypertension, hyperlipidemia, migraines, and diabetes following a diagnosis of preeclampsia. Opportunities exist for the early treatment of these risk factors, which could reduce the long-term rate of stroke in these women.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104720DOI Listing
June 2020

Transfer entropy computation using the Perron-Frobenius operator.

Phys Rev E 2019 Apr;99(4-1):042212

Department of Earth Science, University of Bergen, PO Box 7803, NO-5020 Bergen, Norway.

We propose a method for computing the transfer entropy between time series using Ulam's approximation of the Perron-Frobenius (transfer) operator associated with the map generating the dynamics. Our method differs from standard transfer entropy estimators in that the invariant measure is estimated not directly from the data points, but from the invariant distribution of the transfer operator approximated from the data points. For sparse time series and low embedding dimension, the transfer operator is approximated using a triangulation of the attractor, whereas for data-rich time series or higher embedding dimension, we use a faster grid approach. We compare the performance of our methods with existing estimators such as the k nearest neighbors method and kernel density estimation method, using coupled instances of well known chaotic systems: coupled logistic maps and a coupled Rössler-Lorenz system. We find that our estimators are robust against moderate levels of noise. For sparse time series with less than 100 observations and low embedding dimension, our triangulation estimator shows improved ability to detect coupling directionality, relative to standard transfer entropy estimators.
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http://dx.doi.org/10.1103/PhysRevE.99.042212DOI Listing
April 2019

Developing a web-based LGBT cultural competency training for oncologists: The COLORS training.

Patient Educ Couns 2019 05 7;102(5):984-989. Epub 2019 Jan 7.

H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.

Objective: Despite substantial LGBT cancer health disparities, there are no LGBT cultural competency trainings tailored for oncologists. Here we describe the systematic development of a web-based, oncology-focused LGBT cultural competency training.

Methods: A literature review regarding LGBT cancer outcomes and competency training was conducted to identify potential training content. An expert panel meeting, including LGBT cancer survivors, cultural competency experts, oncologists, a web designer, and an instructional designer, was held to solidify the training content focus. Following the panel, the training was developed in collaboration with an instructional designer, a web designer, and LGBT community members.

Results: The training modules include: 1) LGBT Basics; 2) Inclusive Environments; 3) Initiating Oncology Care with LGBT Patients; and 4) Issues in Cancer Survivorship among LGBT Patients. Module content is interactive, and models effective communication.

Conclusion: The process of collaboration with a diverse group of stakeholders and three cancer centers in Florida has resulted in a practical and efficient web-based resource for LGBT cultural competency training for oncologists.

Practice Implications: Feedback from stakeholders indicates that training in this area is needed and will be well-received by oncologists. We are currently conducting an evaluation of this training among oncologists and LGBT community members.
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http://dx.doi.org/10.1016/j.pec.2019.01.006DOI Listing
May 2019

Forcing of late Pleistocene ice volume by spatially variable summer energy.

Sci Rep 2018 08 1;8(1):11520. Epub 2018 Aug 1.

Department of Earth Science, University of Bergen, P.O. Box 7803, N-5020, Bergen, Norway.

Changes in Earth's orbit set the pace of glacial cycles, but the role of spatial variability in the insolation forcing of global ice volume remains unknown. Here, we leverage the intrinsic dynamical information in empirical records to show that ice volume responded to summer energy at high northern latitudes, as predicted by Milankovitch theory. However, the external forcing of ice volume encompasses insolation signals with a wide range of orbital frequency content, and cannot be fully accounted for by a unique time series. Southern mid-latitude insolation forcing coincides with the position of the subtropical front and the westerlies, which have been implicated in Quaternary climate changes. Dominant forcing modes at northern mid-latitudes are anti-phased with the canonical Milankovitch forcing, consistent with ice volume sensitivity to latitudinal insolation gradients.
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http://dx.doi.org/10.1038/s41598-018-29916-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070525PMC
August 2018

Common species link global ecosystems to climate change: dynamical evidence in the planktonic fossil record.

Proc Biol Sci 2017 Jul;284(1858)

Centre for Ecological and Evolutionary Synthesis, Department of Biosciences, University of Oslo, PO Box 1066, Blindern, 0316 Oslo, Norway.

Common species shape the world around us, and changes in their commonness signify large-scale shifts in ecosystem structure and function. However, our understanding of long-term ecosystem response to environmental forcing in the deep past is centred on species richness, neglecting the disproportional impact of common species. Here, we use common and widespread species of planktonic foraminifera in deep-sea sediments to track changes in observed global occupancy (proportion of sampled sites at which a species is present and observed) through the turbulent climatic history of the last 65 Myr. Our approach is sensitive to relative changes in global abundance of the species set and robust to factors that bias richness estimators. Using three independent methods for detecting causality, we show that the observed global occupancy of planktonic foraminifera has been dynamically coupled to past oceanographic changes captured in deep-ocean temperature reconstructions. The causal inference does not imply a direct mechanism, but is consistent with an indirect, time-delayed causal linkage. Given the strong quantitative evidence that a dynamical coupling exists, we hypothesize that mixotrophy (symbiont hosting) may be an ecological factor linking the global abundance of planktonic foraminifera to long-term climate changes via the relative extent of oligotrophic oceans.
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http://dx.doi.org/10.1098/rspb.2017.0722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524498PMC
July 2017

The cost of severe haemophilia in Europe: the CHESS study.

Orphanet J Rare Dis 2017 05 31;12(1):106. Epub 2017 May 31.

FedHemo, Madrid, Spain.

Background: Severe haemophilia is associated with major psychological and economic burden for patients, caregivers, and the wider health care system. This burden has been quantified and documented for a number of European countries in recent years. However, few studies have taken a standardised methodology across multiple countries simultaneously, and sought to amalgamate all three levels of burden for severe disease. The overall aim of the 'Cost of Haemophilia in Europe: a Socioeconomic Survey' (CHESS) study was to capture the annualised economic and psychosocial burden of severe haemophilia in five European countries. A cross-section of haemophilia specialists (surveyed between January and April 2015) provided demographic and clinical information and 12-month ambulatory and secondary care activity for patients via an online survey. In turn, patients provided corresponding direct and indirect non-medical cost information, including work loss and out-of-pocket expenses, as well as information on quality of life and adherence. The direct and indirect costs for the patient sample were calculated and extrapolated to population level.

Results: Clinical reports for a total of 1,285 patients were received. Five hundred and fifty-two patients (43% of the sample) provided information on indirect costs and health-related quality of life via the PSC. The total annual cost of severe haemophilia across the five countries for 2014 was estimated at EUR 1.4 billion, or just under EUR 200,000 per patient. The highest per-patient costs were in Germany (mean EUR 319,024) and the lowest were in the United Kingdom (mean EUR 129,365), with a study average of EUR 199,541. As expected, consumption of clotting factor replacement therapy represented the vast majority of costs (up to 99%). Indirect costs are driven by patient and caregiver work loss.

Conclusions: The results of the CHESS study reflect previous research findings suggesting that costs of factor replacement therapy account for the vast majority of the cost burden in severe haemophilia. However, the importance of the indirect impact of haemophilia on the patient and family should not be overlooked. The CHESS study highlights the benefits of observational study methodologies in capturing a 'snapshot' of information for patients with rare diseases.
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http://dx.doi.org/10.1186/s13023-017-0660-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452407PMC
May 2017

Axillary migration of Nexplanon®: Case report.

Contraception 2017 Feb 16;95(2):218-220. Epub 2016 Nov 16.

Obstetrics and Gynecology Department, University of Miami, Miller School of Medicine. Electronic address:

A 19-year-old patient presented to the clinic, and we inserted a single rod subdermal etonogestrel implant (Nexplanon ®), which subsequently migrated to the ipsilateral axilla. Distant Nexplanon® migration is a rare serious complication that should be considered when a device is nonpalpable. Management options are discussed.
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http://dx.doi.org/10.1016/j.contraception.2016.11.002DOI Listing
February 2017

Modeling the downward transport of (210)Pb in Peatlands: Initial Penetration-Constant Rate of Supply (IP-CRS) model.

Sci Total Environ 2016 Jan 11;541:1222-1231. Epub 2015 Nov 11.

Department of Ecology and Environmental Science, Umeå University, SE-90187, Umeå, Sweden.

The vertical distribution of (210)Pb is commonly used to date peat deposits accumulated over the last 100-150 years. However, several studies have questioned this method because of an apparent post-depositional mobility of (210)Pb within some peat profiles. In this study, we introduce the Initial Penetration–Constant Rate of Supply (IP-CRS) model for calculating ages derived from 210Pb profiles that are altered by an initial migration of the radionuclide. This new, two-phased, model describes the distribution of atmospheric-derived (210)Pb ((210)Pbxs) in peat taking into account both incorporation of (210)Pb into the accumulating peat matrix as well as an initial flushing of (210)Pb through the uppermost peat layers. The validity of the IP-CRS model is tested in four anomalous (210)Pb peat records that showed some deviations from the typical exponential decay profile not explained by variations in peat accumulation rates. Unlike the most commonly used (210)Pb-dating model (Constant Rate of Supply (CRS)), the IP-CRS model estimates peat accumulation rates consistent with typical growth rates for peatlands from the same areas. Confidence in the IP-CRS chronology is also provided by the good agreement with independent chronological markers (i.e. (241)Am and (137)Cs). Our results showed that the IP-CRS can provide chronologies from peat records where (210)Pb mobility is evident, being a valuable tool for studies reconstructing past environmental changes using peat archives during the Anthropocene.
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http://dx.doi.org/10.1016/j.scitotenv.2015.09.131DOI Listing
January 2016

Modeling the connection between primary and metastatic tumors.

J Math Biol 2013 Sep 25;67(3):657-92. Epub 2012 Jul 25.

Departamento de Matemáticas, E.T.S.I. Industriales and Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Universidad de Castilla-La Mancha, 13071, Ciudad Real, Spain.

We put forward a model for cancer metastasis as a migration phenomenon between tumor cell populations coexisting and evolving in two different habitats. One of them is a primary tumor and the other one is a secondary or metastatic tumor. The evolution of the different cell phenotype populations in each habitat is described by means of a simple quasispecies model allowing for a cascade of mutations between the different phenotypes in each habitat. The cell migration event is supposed to be unidirectional and take place continuously in time. The possible clinical outcomes of the model depending on the parameter space are analyzed and the effect of the resection of the primary tumor is studied.
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http://dx.doi.org/10.1007/s00285-012-0565-2DOI Listing
September 2013

Bright solitary waves in malignant gliomas.

Phys Rev E Stat Nonlin Soft Matter Phys 2011 Aug 19;84(2 Pt 1):021921. Epub 2011 Aug 19.

Departamento de Matemáticas, E. T. S. I. Industriales and Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Universidad de Castilla-La Mancha, E-13071 Ciudad Real, Spain.

We put forward a nonlinear wave model describing the fundamental dynamical features of an aggressive type of brain tumors. Our model accounts for the invasion of normal tissue by a proliferating and propagating rim of active glioma cancer cells in the tumor boundary and the subsequent formation of a necrotic core. By resorting to numerical simulations, phase space analysis, and exact solutions we prove that bright solitary tumor waves develop in such systems. Possible implications of our model as a tool to extract relevant patient specific tumor parameters in combination with standard preoperative clinical imaging are also discussed.
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http://dx.doi.org/10.1103/PhysRevE.84.021921DOI Listing
August 2011