Publications by authors named "Jaffe M"

437 Publications

Scaling up effective treatment of hypertension-A pathfinder for universal health coverage.

J Clin Hypertens (Greenwich) 2019 10 23;21(10):1442-1449. Epub 2019 Sep 23.

Resolve to Save Lives, an initiative of Vital Strategies, New York, New York.

High blood pressure is the world's leading cause of death, but despite treatment for hypertension being safe, effective, and low cost, most people with hypertension worldwide do not have it controlled. This article summarizes lessons learned in the first 2 years of the Resolve to Save Lives (RTSL) hypertension management program, operated in coordination with the World Health Organization (WHO) and other partners. Better diagnosis, treatment, and continuity of care are all needed to improve control rates, and five necessary components have been recommended by RTSL, WHO and other partners as being essential for a successful hypertension control program. Several hurdles to hypertension control have been identified, with most related to limitations in the health care system rather than to patient behavior. Treatment according to standardized protocols should be started as soon as hypertension is diagnosed, and medical practices and health systems must closely monitor patient progress and system performance. Improvement in hypertension management and control, along with elimination of artificial trans fat and reduction of dietary sodium consumption, will improve many aspects of primary care, contribute to goals for universal health coverage, and could save 100 million lives worldwide over the next 30 years.
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http://dx.doi.org/10.1111/jch.13655DOI Listing
October 2019

Catalyzing decisions: How a coin flip strengthens affective reactions.

PLoS One 2019 14;14(8):e0220736. Epub 2019 Aug 14.

Center for Social Psychology, University of Basel, Basel, Switzerland.

When individuals are undecided between options, they may flip a coin or use other aids that produce random outcomes to support decision-making. Such aids lead to clear suggestions, which, interestingly, individuals do not necessarily follow. Instead when looking at the outcome, individuals sometimes appear to like or dislike the suggestion, and then decide according to this feeling. In this manuscript we argue that such a decision aid can function as a catalyst. As it points to one option over the other, individuals focus on obtaining this option and engage in a more vivid representation of the same. By imagining obtaining the option, feelings related to the option become stronger, which then drive feelings of satisfaction or dissatisfaction with the outcome of the decision aid. We provide support for this phenomenon throughout two studies. Study 1 indicates that using a catalyst leads to stronger feelings. Study 2 replicates this finding using a different catalyst, and rules out alternative explanations. Here, participants report that after having used a catalyst, they experienced a stronger feeling of suddenly knowing what they want compared to the control group that did not use a catalyst. Implications of these results for research and practice are discussed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220736PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693849PMC
March 2020

Optimizing observer performance of clinic blood pressure measurement: a position statement from the Lancet Commission on Hypertension Group.

J Hypertens 2019 09;37(9):1737-1745

Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.

: High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer performance in clinic BP measurement, with special attention given to low-to-middle-income settings, where resource limitations, heavy workloads, time constraints, and lack of electrical power make measurement more challenging. Many measurement errors can be minimized by appropriate patient preparation and standardized techniques. Validated semi-automated/automated upper arm cuff devices should be used instead of auscultation to simplify measurement and prevent observer error. Task sharing, creating a dedicated measurement workstation, and using semi-automated or solar-charged devices may help. Ensuring observer training, and periodic re-training, is critical. Low-cost, easily accessible certification programs should be considered to facilitate best BP measurement practice.
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http://dx.doi.org/10.1097/HJH.0000000000002112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686964PMC
September 2019

Efficacy and safety of dual combination therapy of blood pressure-lowering drugs as initial treatment for hypertension: a systematic review and meta-analysis of randomized controlled trials.

J Hypertens 2019 09;37(9):1768-1774

The George Institute for Global Health, University of New South Wales, Sydney, New South Wales.

Objective: To assess the efficacy and tolerability of dual combination of blood pressure (BP)-lowering drugs as initial treatment for hypertension.

Methods: MEDLINE, Embase, CENTRAL were searched until August 2017 for randomized, double-blind trials of dual combination therapy vs. monotherapy in adults with hypertension who were either treatment naïve or untreated for at least 4 weeks. Regimens were classified with reference to usual daily 'standard-dose'; for example, <1 + <1 for a combination of two drugs both at less than one standard-dose. Random-effects models were used for meta-analysis.

Results: Thirty-three trials (13 095 participants) with mean baseline mean BP 155/100 mmHg were included. Compared with standard-dose monotherapy, dual combinations of <1 + <1, 1 + <1 and 1 + 1 (i.e. low-to-standard dose), showed a dose-response relationship in reducing SBP [mean differences (95% confidence interval) of 2.8 (1.6-4.0), 4.6 (3.4-5.7) and 7.5 (5.4-9.5) mmHg, respectively], and in improving BP control [risk ratio (RR) (95% confidence interval) 1.11 (0.92-1.34), 1.25 (1.16-1.35) and 1.42 (1.27-1.58), respectively]. Withdrawals due to adverse events were uncommon with low-to-standard dose dual combinations, with no significant difference compared with standard-dose monotherapy [2.9 vs. 2.2%; RR 1.28 (0.85 to 1.92)]. There were fewer data for higher dose dual combinations, which did not appear to produce substantial additional efficacy and could potentially be less tolerable.

Conclusion: Compared with standard-dose monotherapy, initiating treatment with low-to-standard dose dual combination therapy is more efficacious without increasing withdrawals due to adverse events.

Prospero Registration: CRD42016032822.
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http://dx.doi.org/10.1097/HJH.0000000000002096DOI Listing
September 2019

Improved discovery of genetic interactions using CRISPRiSeq across multiple environments.

Genome Res 2019 04 19;29(4):668-681. Epub 2019 Feb 19.

Department of Genetics, Stanford University School of Medicine, Stanford, California 94305, USA.

Large-scale genetic interaction (GI) screens in yeast have been invaluable for our understanding of molecular systems biology and for characterizing novel gene function. Owing in part to the high costs and long experiment times required, a preponderance of GI data has been generated in a single environmental condition. However, an unknown fraction of GIs may be specific to other conditions. Here, we developed a pooled-growth CRISPRi-based sequencing assay for GIs, CRISPRiSeq, which increases throughput such that GIs can be easily assayed across multiple growth conditions. We assayed the fitness of approximately 17,000 strains encompassing approximately 7700 pairwise interactions in five conditions and found that the additional conditions increased the number of GIs detected nearly threefold over the number detected in rich media alone. In addition, we found that condition-specific GIs are prevalent and improved the power to functionally classify genes. Finally, we found new links during respiratory growth between members of the Ras nutrient-sensing pathway and both the COG complex and a gene of unknown function. Our results highlight the potential of conditional GI screens to improve our understanding of cellular genetic networks.
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http://dx.doi.org/10.1101/gr.246603.118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442382PMC
April 2019

Fixed-dose combination pharmacologic therapy to improve hypertension control worldwide: Clinical perspective and policy implications.

J Clin Hypertens (Greenwich) 2019 01 27;21(1):4-15. Epub 2018 Nov 27.

Department of Non-Communicable Diseases and Mental Health, The Pan-American Health Organization, Washington, District of Columbia.

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http://dx.doi.org/10.1111/jch.13426DOI Listing
January 2019

Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial.

Diabet Med 2019 01 7;36(1):52-61. Epub 2018 Nov 7.

Kaiser Permanente Division of Research, Oakland, CA.

Aims: To evaluate the effectiveness of automated symptom and side effect monitoring on quality of life among individuals with symptomatic diabetic peripheral neuropathy.

Methods: We conducted a pragmatic, cluster randomized controlled trial (July 2014 to July 2016) within a large healthcare system. We randomized 1834 primary care physicians and prospectively recruited from their lists 1270 individuals with neuropathy who were newly prescribed medications for their symptoms. Intervention participants received automated telephone-based symptom and side effect monitoring with physician feedback over 6 months. The control group received usual care plus three non-interactive diabetes educational calls. Our primary outcomes were quality of life (EQ-5D) and select symptoms (e.g. pain) measured 4-8 weeks after starting medication and again 8 months after baseline. Process outcomes included receiving a clinically effective dose and communication between individuals with neuropathy and their primary care provider over 12 months. Interviewers collecting outcome data were blinded to intervention assignment.

Results: Some 1252 participants completed the baseline measures [mean age (sd): 67 (11.7), 53% female, 57% white, 8% Asian, 13% black, 20% Hispanic]. In total, 1179 participants (93%) completed follow-up (619 control, 560 intervention). Quality of life scores (intervention: 0.658 ± 0.094; control: 0.653 ± 0.092) and symptom severity were similar at baseline. The intervention had no effect on primary [EQ-5D: -0.002 (95% CI -0.01, 0.01), P = 0.623; pain: 0.295 (-0.75, 1.34), P = 0.579; sleep disruption: 0.342 (-0.18, 0.86), P = 0.196; lower extremity functioning: -0.079 (-1.27, 1.11), P = 0.896; depression: -0.462 (-1.24, 0.32); P = 0.247] or process outcomes.

Conclusions: Automated telephone monitoring and feedback alone were not effective at improving quality of life or symptoms for people with symptomatic diabetic peripheral neuropathy.

Trial Registration: ClinicalTrials.gov (NCT02056431).
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http://dx.doi.org/10.1111/dme.13840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236318PMC
January 2019

Fixed-dose combinations for hypertension.

Lancet 2018 09;392(10150):819-820

Resolve To Save Lives, New York, NY, USA.

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http://dx.doi.org/10.1016/S0140-6736(18)31814-2DOI Listing
September 2018

Efficient Adiabatic Spin-Dependent Kicks in an Atom Interferometer.

Phys Rev Lett 2018 Jul;121(4):040402

Department of Physics and Astronomy, University of California, Los Angeles, California 90095, USA.

We present an atom interferometry technique in which the beam splitter is split into two separate operations. A microwave pulse first creates a spin-state superposition, before optical adiabatic passage spatially separates the arms of that superposition. Despite using a thermal atom sample in a small (600  μm) interferometry beam, this procedure delivers an efficiency of 99% per ℏk of momentum separation. Utilizing this efficiency, we first demonstrate interferometry with up to 16ℏk momentum splitting and free-fall limited interrogation times. We then realize a single-source gradiometer, in which two interferometers measuring a relative phase originate from the same atomic wave function. Finally, we demonstrate a resonant interferometer with over 100 adiabatic passages, and thus over 400ℏk total momentum transferred.
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http://dx.doi.org/10.1103/PhysRevLett.121.040402DOI Listing
July 2018

Monitoring and evaluation framework for hypertension programs. A collaboration between the Pan American Health Organization and World Hypertension League.

J Clin Hypertens (Greenwich) 2018 06 22;20(6):984-990. Epub 2018 May 22.

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

The Pan American Health Organization (PAHO)-World Hypertension League (WHL) Hypertension Monitoring and Evaluation Framework is summarized. Standardized indicators are provided for monitoring and evaluating national or subnational hypertension control programs. Five core indicators from the World Health Organization hearts initiative and a single PAHO-WHL core indicator are recommended to be used in all hypertension control programs. In addition, hypertension control programs are encouraged to select from 14 optional qualitative and 33 quantitative indicators to facilitate progress towards enhanced hypertension control. The intention is for hypertension programs to select quantitative indicators based on the current surveillance mechanisms that are available and what is feasible and to use the framework process indicators as a guide to program management. Programs may wish to increase or refine the number of indicators they use over time. With adaption the indicators can also be implemented at a community or clinic level. The standardized indicators are being pilot tested in Cuba, Colombia, Chile, and Barbados.
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http://dx.doi.org/10.1111/jch.13307DOI Listing
June 2018

Comparative Trends in Heart Disease, Stroke, and All-Cause Mortality in the United States and a Large Integrated Healthcare Delivery System.

Am J Med 2018 07 2;131(7):829-836.e1. Epub 2018 Apr 2.

Division of Research, Kaiser Permanente Northern California, Oakland; Department of Cardiology, Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California, San Francisco, San Francisco.

Objectives: Heart disease and stroke remain among the leading causes of death nationally. We examined whether differences in recent trends in heart disease, stroke, and total mortality exist in the United States and Kaiser Permanente Northern California (KPNC), a large integrated healthcare delivery system.

Methods: The main outcome measures were comparisons of US and KPNC total, age-specific, and sex-specific changes from 2000 to 2015 in mortality rates from heart disease, coronary heart disease, stroke, and all causes. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data system was used to determine US mortality rates. Mortality rates for KPNC were determined from health system, Social Security vital status, and state death certificate databases.

Results: Declines in age-adjusted mortality rates were noted in KPNC and the United States for heart disease (36.3% in KPNC vs 34.6% in the United States), coronary heart disease (51.0% vs 47.9%), stroke (45.5% vs 38.2%), and all-cause mortality (16.8% vs 15.6%). However, steeper declines were noted in KPNC than the United States among those aged 45 to 65 years for heart disease (48.3% KPNC vs 23.6% United States), coronary heart disease (55.6% vs 35.9%), stroke (55.8% vs 26.0%), and all-cause mortality (31.5% vs 9.1%). Sex-specific changes were generally similar.

Conclusions: Despite significant declines in heart disease and stroke mortality, there remains an improvement gap nationally among those aged less than 65 years when compared with a large integrated healthcare delivery system. Interventions to improve cardiovascular mortality in the vulnerable middle-aged population may play a key role in closing this gap.
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http://dx.doi.org/10.1016/j.amjmed.2018.02.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005733PMC
July 2018

Improved Cardiovascular Risk Factors Control Associated with a Large-Scale Population Management Program Among Diabetes Patients.

Am J Med 2018 06 22;131(6):661-668. Epub 2018 Mar 22.

Division of Endocrinology, Kaiser Permanente Northern California, South San Francisco.

Background: Optimal cardiovascular risk factors control among individuals with diabetes remains a challenge. We evaluated changes in glucose, lipid, and blood pressure control among diabetes patients after implementation of a large-scale population management program, known as Preventing Heart Attacks and Strokes Everyday, at Kaiser Permanente Northern California (KPNC), during 2004-2013.

Methods: We used National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set cut points to identify prevalence of poor glycemic (hemoglobin A1c > 9%) control, good lipid control (low-density lipoprotein cholesterol < 100 mg/dL), and good blood pressure control (blood pressure < 140/90 mm Hg) in each year (N range = 98,345 to 122,177 over the entire period). We assessed trends in risk factor control based on Joinpoint regression and average annual percentage change (AAPC) compared with published National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set commercial rates.

Results: We found that the prevalence of poor glycemic control (hemoglobin A1c > 9%) declined in both KPNC and nationally, but was statistically significant only in KPNC (AAPC = -4.8; P < .05). The prevalence of good lipid control (low-density lipoprotein cholesterol < 100 mg/dL) increased significantly in KPNC (47% to 71%; AAPC = +4.3; P < .05), but there was no significant improvement nationally (40% to 44%; AAPC = +1.4; P = .2). The prevalence of blood pressure control (<140/90 mm Hg) was higher in KPNC (77% to 82%; AAPC = +1.1; P < .05) versus nationally (57% to 62%; AAPC = +1.9; P < .05) during the reported years 2007-2013.

Conclusions: Relative to national benchmarks, a substantially greater improvement in risk factor control among adults with diabetes was observed after implementation of a comprehensive population management program.
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http://dx.doi.org/10.1016/j.amjmed.2018.01.024DOI Listing
June 2018

Journal of Clinical Monitoring and Computing 2017 end of year summary: respiration.

J Clin Monit Comput 2018 Apr 26;32(2):197-205. Epub 2018 Feb 26.

Cardiorespiratory Consulting, LLC, Cheshire, CT, USA.

This paper reviews 32 papers or commentaries published in Journal of Clinical Monitoring and Computing in 2016, within the field of respiration. Papers were published covering airway management, ventilation and respiratory rate monitoring, lung mechanics and gas exchange monitoring, in vitro monitoring of lung mechanics, CO monitoring, and respiratory and metabolic monitoring techniques.
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http://dx.doi.org/10.1007/s10877-018-0121-8DOI Listing
April 2018

Patient-reported adherence to statin therapy, barriers to adherence, and perceptions of cardiovascular risk.

PLoS One 2018 8;13(2):e0191817. Epub 2018 Feb 8.

Resolve to Save Lives, New York, New York, United States of America.

Background: Patient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy. We examined these factors and their associations with adherence.

Methods: We conducted telephone interviews among a stratified random sample of adults receiving statins within an integrated delivery system (N = 730, 81% response rate) in 2010. We sampled equal numbers of individuals in three clinical risk categories: those with 1) coronary artery disease; 2) diabetes or other ASCVD diagnosis; and 3) no diabetes or ASCVD diagnoses. We assessed 15 potential concerns about and barriers to taking statins, and perceived risk of having a heart attack in the next 10 years (0-10 scale). We calculated the proportion of days covered (PDC) by statins in the last 12 months using dispensing data and used multivariate logistic regression to examine the characteristics associated with non-adherence (PDC<80%). Analyses were weighted for sampling proportions.

Results: Sixty-one percent of patients with PDC<50% reported not filling a new prescription, splitting or skipping statins, or stopping refilling statins in the last 12 months vs. 15% of those with PDC≥80% (p<0.05). The most commonly reported concerns about statins were preferring to lower cholesterol with lifestyle changes (66%), disliking medications in general (59%), and liver or kidney problems (31%); having trouble remembering to take statins (9%) was the most common reason for taking less than prescribed. In multivariate analyses, clinical risk categories were not significantly associated with odds of non-adherence; however, those with higher perceived risk of heart attack were less likely to be non-adherent.

Conclusions: Patient-reported medication-taking behaviors were correlated with statin PDC and those with lower perceived cardiovascular risk were less likely to be adherent. These findings highlight the importance of eliciting from and educating patients on their adherence behaviors and ASCVD risks.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191817PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805247PMC
March 2018

Saving 100 million lives by improving global treatment of hypertension and reducing cardiovascular disease risk factors.

J Clin Hypertens (Greenwich) 2018 02 25;20(2):208-211. Epub 2018 Jan 25.

Resolve to Save Lives, New York, NY, USA.

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http://dx.doi.org/10.1111/jch.13195DOI Listing
February 2018

Pathology in Practice.

J Am Vet Med Assoc 2018 Feb;252(3):297-299

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http://dx.doi.org/10.2460/javma.252.3.297DOI Listing
February 2018

Respiratory Gas Analysis-Technical Aspects.

Authors:
Michael B Jaffe

Anesth Analg 2018 03;126(3):839-845

From Cardiorespiratory Consulting, LLC, Cheshire, Connecticut.

A technology-focused review of respiratory gas analysis, with an emphasis on carbon dioxide analysis, is presented. The measurement technologies deployed commercially are highlighted, and the basic principles and technical concerns of infrared spectroscopy and mainstream versus sidestream gas sampling are discussed. The specifications of particular interest to the clinician, accuracy and response time, and the related standard, with typical values for a capnometer, are presented. Representative time and volumetric capnograms are shown with the clinically relevant parameters described. Aspects of the terminology in present-day use and the need for clarity in defining what is a breath and an end-tidal value are reviewed. The applications of capnography of particular interest to the anesthesiologist are noted, and key references are provided. Ongoing developments with respect to respiratory gas analysis, and those that will impact it, are noted.
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http://dx.doi.org/10.1213/ANE.0000000000002384DOI Listing
March 2018

Pregnancy and Subsequent Glucose Intolerance in Women of Childbearing Age: Heeding the Early Warning Signs for Primary Prevention of Cardiovascular Disease in Women.

JAMA Intern Med 2017 12;177(12):1742-1744

Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, California.

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http://dx.doi.org/10.1001/jamainternmed.2017.4768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957275PMC
December 2017

Three-dimensional piezoelectric fibrous scaffolds selectively promote mesenchymal stem cell differentiation.

Biomaterials 2017 Dec 19;149:51-62. Epub 2017 Sep 19.

Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102-1982, USA. Electronic address:

The discovery of electric fields in biological tissues has led to efforts in developing technologies utilizing electrical stimulation for therapeutic applications. Native tissues, such as cartilage and bone, exhibit piezoelectric behavior, wherein electrical activity can be generated due to mechanical deformation. Yet, the use of piezoelectric materials have largely been unexplored as a potential strategy in tissue engineering, wherein a piezoelectric biomaterial acts as a scaffold to promote cell behavior and the formation of large tissues. Here we show, for the first time, that piezoelectric materials can be fabricated into flexible, three-dimensional fibrous scaffolds and can be used to stimulate human mesenchymal stem cell differentiation and corresponding extracellular matrix/tissue formation in physiological loading conditions. Piezoelectric scaffolds that exhibit low voltage output, or streaming potential, promoted chondrogenic differentiation and piezoelectric scaffolds with a high voltage output promoted osteogenic differentiation. Electromechanical stimulus promoted greater differentiation than mechanical loading alone. Results demonstrate the additive effect of electromechanical stimulus on stem cell differentiation, which is an important design consideration for tissue engineering scaffolds. Piezoelectric, smart materials are attractive as scaffolds for regenerative medicine strategies due to their inherent electrical properties without the need for external power sources for electrical stimulation.
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http://dx.doi.org/10.1016/j.biomaterials.2017.09.024DOI Listing
December 2017

Spatiotemporal modeling of laser tissue soldering using photothermal nanocomposites.

Lasers Surg Med 2018 02 9;50(2):143-152. Epub 2017 Oct 9.

Department of Chemical and Biological Engineering, Montana State University, Bozeman, Montana.

Objective: Laser tissue soldering using photothermal solders is a technology that facilitates rapid sealing using heat-induced changes in the tissue and the solder material. The solder material is made of gold nanorods embedded in a protein matrix patch that can be placed over the tissue rupture site and heated with a laser. Although laser tissue soldering is an attractive approach for surgical repair, potential photothermal damage can limit the success of this approach. Development of predictive mathematical models of photothermal effects including cell death, can lead to more efficient approaches in laser-based tissue repair.

Methods: We describe an experimental and modeling investigation into photothermal solder patches for sealing porcine and mouse cadaver intestine sections using near-infrared laser irradiation. Spatiotemporal changes in temperature were determined at the surface as well as various depths below the patch. A mathematical model, based on the finite element method, predicts the spatiotemporal temperature distribution in the patch and surrounding tissue, as well as concomitant cell death in the tissue is described.

Results: For both the porcine and mouse intestine systems, the model predicts temperatures that are quantitatively similar to the experimental measurements with the model predictions of temperature increase often being within a just a few degrees of experimental measurements.

Conclusion: This mathematical model can be employed to identify optimal conditions for minimizing healthy cell death while still achieving a strong seal of the ruptured tissue using laser soldering. Lasers Surg. Med. 50:143-152, 2018. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/lsm.22746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820132PMC
February 2018

Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects.

Injury 2017 Oct 12;48(10):2276-2284. Epub 2017 Jul 12.

International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA.

Introduction: This study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10cm in length.

Methods: In a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates.

Results: The mean size of the bone defect was 7cm in Group A, and 5.8cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P=0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P=0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P=0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P=0.28).

Conclusions: While both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures.

Level Of Evidence: Level III; Retrospective comparative study.
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http://dx.doi.org/10.1016/j.injury.2017.07.018DOI Listing
October 2017

Heterogeneity in national U.S. mortality trends within heart disease subgroups, 2000-2015.

BMC Cardiovasc Disord 2017 07 18;17(1):192. Epub 2017 Jul 18.

Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.

Background: The long-term downward national U.S. trend in heart disease-related mortality slowed substantially during 2011-2014 before turning upward in 2015. Examining mortality trends in the major subgroups of heart disease may provide insight into potentially more targeted and effective prevention and treatment approaches to promote favorable trajectories. We examined national trends between 2000 and 2015 in mortality attributed to major heart disease subgroups including ischemic heart disease, heart failure, and all other types of heart disease.

Methods: Using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) data system, we determined national trends in age-standardized mortality rates attributed to ischemic heart disease, heart failure, and other heart diseases from January 1, 2000, to December 31, 2011, and from January 1, 2011, to December 31, 2015. Annual rate of changes in mortality attributed to ischemic heart disease, heart failure, and other heart diseases for 2000-2011 and 2011-2015 were compared.

Results: Death attributed to ischemic heart disease declined from 2000 to 2015, but the rate of decline slowed from 4.96% (95% confidence interval 4.77%-5.15%) for 2000-2011 to 2.66% (2.00%-3.31%) for 2011-2015. In contrast, death attributed to heart failure and all other causes of heart disease declined from 2000 to 2011 at annual rates of 1.94% (1.77%-2.11%) and 0.64% (0.44%-0.82%) respectively, but increased from 2011 to 2015 at annual rates of 3.73% (3.21% 4.26%) and 1.89% (1.33-2.46%). Differences in 2000-2011 and 2011-2015 decline rates were statistically significant for all 3 endpoints overall, by sex, and all race/ethnicity groups except Asian/Pacific Islanders (heart failure only significant) and American Indian/Alaskan Natives.

Conclusions: While the long-term decline in death attributed to heart disease slowed between 2011 and 2014 nationally before turning upward in 2015, heterogeneity existed in the trajectories attributed to heart disease subgroups, with ischemic heart disease mortality continuing to decline while death attributed to heart failure and other heart diseases switched from a downward to upward trend. While systematic efforts to prevent and treat ischemic heart disease continue to be effective, urgent attention is needed to address the challenge of heart failure.
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http://dx.doi.org/10.1186/s12872-017-0630-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516392PMC
July 2017

Journal of Clinical Monitoring and Computing 2016 end of year summary: respiration.

J Clin Monit Comput 2017 Apr 2;31(2):247-252. Epub 2017 Mar 2.

Cardiorespiratory Consulting, LLC, Cheshire, CT, USA.

This paper reviews 16 papers or commentaries published in Journal of Clinical Monitoring and Computing in 2016, within the field of respiration. Papers were published covering peri- and post-operative monitoring of respiratory rate, perioperative monitoring of CO, modeling of oxygen gas exchange, and techniques for respiratory monitoring.
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http://dx.doi.org/10.1007/s10877-017-0008-0DOI Listing
April 2017

Implementing standardized performance indicators to improve hypertension control at both the population and healthcare organization levels.

J Clin Hypertens (Greenwich) 2017 May 13;19(5):456-461. Epub 2017 Feb 13.

Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.

The ability to reliably evaluate the impact of interventions and changes in hypertension prevalence and control is critical if the burden of hypertension-related disease is to be reduced. Previously, a World Hypertension League Expert Committee made recommendations to standardize the reporting of population blood pressure surveys. We have added to those recommendations and also provide modified recommendations from a Pan American Health Organization expert meeting for "performance indicators" to be used to evaluate clinical practices. Core indicators for population surveys are recommended to include: (1) mean systolic blood pressure and (2) mean diastolic blood pressure, and the prevalences of: (3) hypertension, (4) awareness of hypertension, (5) drug-treated hypertension, and (6) drug-treated and controlled hypertension. Core indicators for clinical registries are recommended to include: (1) the prevalence of diagnosed hypertension and (2) the ratio of diagnosed hypertension to that expected by population surveys, and the prevalences of: (3) controlled hypertension, (4) lack of blood pressure measurement within a year in people diagnosed with hypertension, and (5) missed visits by people with hypertension. Definitions and additional indicators are provided. Widespread adoption of standardized population and clinical hypertension performance indicators could represent a major step forward in the effort to control hypertension.
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http://dx.doi.org/10.1111/jch.12980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476944PMC
May 2017

iSeq: A New Double-Barcode Method for Detecting Dynamic Genetic Interactions in Yeast.

G3 (Bethesda) 2017 01 5;7(1):143-153. Epub 2017 Jan 5.

The Laufer Center for Physical and Quantitative Biology, Stony Brook University, New York 11794

Systematic screens for genetic interactions are a cornerstone of both network and systems biology. However, most screens have been limited to characterizing interaction networks in a single environment. Moving beyond this static view of the cell requires a major technological advance to increase the throughput and ease of replication in these assays. Here, we introduce iSeq-a platform to build large double barcode libraries and rapidly assay genetic interactions across environments. We use iSeq in yeast to measure fitness in three conditions of nearly 400 clonal strains, representing 45 possible single or double gene deletions, including multiple replicate strains per genotype. We show that iSeq fitness and interaction scores are highly reproducible for the same clonal strain across replicate cultures. However, consistent with previous work, we find that replicates with the same putative genotype have highly variable genetic interaction scores. By whole-genome sequencing 102 of our strains, we find that segregating variation and de novo mutations, including aneuploidy, occur frequently during strain construction, and can have large effects on genetic interaction scores. Additionally, we uncover several new environment-dependent genetic interactions, suggesting that barcode-based genetic interaction assays have the potential to significantly expand our knowledge of genetic interaction networks.
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http://dx.doi.org/10.1534/g3.116.034207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5217104PMC
January 2017

The Importance of State and Context in Safe Interoperable Medical Systems.

IEEE J Transl Eng Health Med 2016 8;4:2800110. Epub 2016 Aug 8.

MDPnP Program Department of Anesthesia Massachusetts General Hospital Boston MA 02114 USA.

This paper describes why "device state" and "patient context" information are necessary components of device models for safe interoperability. This paper includes a discussion of the importance of describing the roles of devices with respect to interactions (including human user workflows involving devices, and device to device communication) within a system, particularly those intended for use at the point-of-care, and how this role information is communicated. In addition, it describes the importance of clinical scenarios in creating device models for interoperable devices.
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http://dx.doi.org/10.1109/JTEHM.2016.2596283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052027PMC
August 2016

The Need to Apply Medical Device Informatics in Developing Standards for Safe Interoperable Medical Systems.

Anesth Analg 2017 01;124(1):127-135

From the *Office of Science and Engineering Laboratories, FDA/CDRH, Silver Spring, Maryland; †MDPnP Program, Massachusetts General Hospital, Boston, Massachusetts; ‡ISO, Geneva, Switzerland, and AAMI, Arlington, Virginia; §Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; and ‖Partners HealthCare System, Boston, Massachusetts.

Medical device and health information technology systems are increasingly interdependent with users demanding increased interoperability. Related safety standards must be developed taking into account these systems' perspective. In this article, we describe the current development of medical device standards and the need for these standards to address medical device informatics. Medical device information should be gathered from a broad range of clinical scenarios to lay the foundation for safe medical device interoperability. Five clinical examples show how medical device informatics principles, if applied in the development of medical device standards, could help facilitate the development of safe interoperable medical device systems. These examples illustrate the clinical implications of the failure to capture important signals and device attributes. We provide recommendations relating to the coordination between historically separate standards development groups, some of which focus on safety and effectiveness and others focus on health informatics. We identify the need for a shared understanding among stakeholders and describe organizational structures to promote cooperation such that device-to-device interactions and related safety information are considered during standards development.
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http://dx.doi.org/10.1213/ANE.0000000000001386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010005PMC
January 2017
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