Association Between Transthoracic Echocardiography Appropriateness and Echocardiographic Findings.

Background: The association between appropriate use criteria and echocardiographic findings in patients with chronic cardiovascular diseases is unknown.

Methods: As a substudy of the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly) trial, 9,230 transthoracic echocardiographic (TTE) examinations from six Ontario academic hospitals were linked to a registry of echocardiographic findings. The TTE studies were rated appropriate), rarely appropriate, or may be appropriate according to the 2011 appropriate use criteria.

Improving the Appropriate Use of Transthoracic Echocardiography: The Echo WISELY Trial.

Background: Appropriate use criteria (AUC) have defined transthoracic echocardiogram (TTE) indications for which there is a clear lack of benefit as rarely appropriate (rA).

Objectives: This study sought to investigate the impact of an AUC-based educational intervention on outpatient TTE ordering by cardiologists and primary care providers.

Methods: The authors conducted a prospective, investigator-blinded, multicenter, randomized controlled trial of an AUC-based educational intervention aimed at reducing rA outpatient TTEs.

Direct interactions with both p27 and Cdk2 regulate Spy1-mediated proliferation in vivo and in vitro.

Families of cyclin-like proteins have emerged that bind and activate cyclin dependent kinases (Cdk)s, directing the phosphorylation of noncanonical Cdk substrates. One of these proteins, Spy1, has demonstrated the unique ability to directly bind and activate both Cdk1 and Cdk2, as well as binding and promoting the degradation of at least one Cdk inhibitor, p27(Kip1). Spy1 accelerates somatic cell growth and proliferation and is implicated in a number of human cancers including the breast, brain and liver.

A smartphone version of the Faces Pain Scale-Revised and the Color Analog Scale for postoperative pain assessment in children.

Background: Effective pain assessment is essential during postoperative recovery. Extensive validation data are published supporting the Faces Pain Scale-Revised (FPS-R) and the Color Analog Scale (CAS) in children. Panda is a smartphone-based application containing electronic versions of these scales.

Design and methods of the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen SignificantlY) study: An investigator-blinded randomized controlled trial of education and feedback intervention to reduce inappropriate echocardiograms.

Background: Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings.

Estimation of respiratory rate from photoplethysmographic imaging videos compared to pulse oximetry.

We present a study evaluating two respiratory rate estimation algorithms using videos obtained from placing a finger on the camera lens of a mobile phone. The two algorithms, based on Smart Fusion and empirical mode decomposition (EMD), consist of previously developed signal processing methods to detect features and extract respiratory induced variations in photoplethysmographic signals to estimate respiratory rate. With custom-built software on an Android phone, photoplethysmographic imaging videos were recorded from 19 healthy adults while breathing spontaneously at respiratory rates between 6 to 32 breaths/min.

Respiratory rate assessment from photoplethysmographic imaging.

We present a study investigating the suitability of a respiratory rate estimation algorithm applied to photoplethysmographic imaging on a mobile phone. The algorithm consists of a cascade of previously developed signal processing methods to detect features and extract respiratory induced variations in photoplethysmogram signals to estimate respiratory rate. With custom-built software on an Android phone (Camera Oximeter), contact photoplethysmographic imaging videos were recorded using the integrated camera from 19 healthy adults breathing spontaneously at respiratory rates between 6 and 40 breaths/min.

The safety of modern anesthesia for children with long QT syndrome.

Background: Patients with long QT syndrome (LQTS) may experience a clinical spectrum of symptoms, ranging from asymptomatic, through presyncope, syncope, and aborted cardiac arrest, to sudden cardiac death. Arrhythmias in LQTS are often precipitated by autonomic changes. This patient population is believed to be at high risk for perioperative arrhythmia, specifically torsades de pointes (TdP), although this perception is largely based on limited literature that predates current anesthetic drugs and standards of perioperative monitoring.

Identifying a rapid bolus dose of dexmedetomidine (ED50) with acceptable hemodynamic outcomes in children.

Background: Dexmedetomidine is a highly sensitive, specific α2 adrenoceptor agonist with anxiolytic, sedative, and analgesic effects. Administration is recommended as a loading dose infused over 10 min. Clinical experience and a previous study suggested a shorter time frame might be used without causing adverse hemodynamic effects.

Real-time cardiorespiratory coherence is blind to changes in respiration during general anesthesia.

Purpose: A novel real-time cardiorespiratory coherence (CRC) algorithm has been developed to monitor nociception during general anesthesia. CRC uses custom designed filters to track and analyze the respiratory sinus arrhythmia (RSA) as it moves in time and frequency. CRC is a form of sensor fusion between heart rate and respiration, estimating the strength of linear coupling between the two signals.

Monitoring nociception during general anesthesia with cardiorespiratory coherence.

A novel wavelet transform cardiorespiratory coherence (WTCRC) algorithm has been developed to measure the autonomic state. WTCRC may be used as a nociception index, ranging from 0 (no nociception, strong coherence) to 100 (strong nociception, low coherence). The aim of this study is to estimate the sensitivity of the algorithm to nociception (dental dam insertions) and antinociception (bolus doses of anesthetic drugs).

Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia.

Background: Emergence delirium (ED) refers to a variety of behavioral disturbances commonly seen in children following emergence from anesthesia. Vapor-based anesthesia with sevoflurane, the most common pediatric anesthetic technique, is associated with the highest incidence of ED. Propofol has been shown to reduce ED, but these studies have been methodologically limited.

Real-time cardiorespiratory coherence detects antinociception during general anesthesia.

Heart rate variability (HRV) may provide anesthesiologists with a noninvasive tool for monitoring nociception during general anesthesia. A novel real-time cardiorespiratory coherence (CRC) algorithm has been developed to analyze the strength of linear coupling between heart rate (HR) and respiration. CRC values range from 0 (low coherence, strong nociception) to 1 (high coherence, no nociception).

Wavelet transform cardiorespiratory coherence detects patient movement during general anesthesia.

Heart rate variability (HRV) may provide anesthesiologists with a noninvasive tool for monitoring nociception during general anesthesia. A novel wavelet transform cardiorespiratory coherence (WTCRC) algorithm has been developed to calculate estimates of the linear coupling between heart rate and respiration. WTCRC values range from 1 (high coherence, no nociception) to 0 (low coherence, strong nociception).

An allometric model to estimate fluid requirements in children following burn injury.

Objectives: To evaluate the ability of an allometric 3/4 Power Model combined with the Galveston Formula (Galveston-3/4 PM Formula) to predict fluid resuscitation requirements in children suffering burn injuries in comparison with the frequently used Parkland Formula and Galveston Formula using the Du Bois formula for surface area estimation (Galveston-DB Formula).

Aim: To demonstrate that the Galveston-3/4 PM Formula is clinically equivalent to the Galveston-DB Formula for the estimation of fluid requirements in pediatric burn injury cases.

Background: Fluid resuscitation requirements differ in children suffering burn injuries when compared to adults.

The Spy1/RINGO family represents a novel mechanism regulating mammary growth and tumorigenesis.

Spy1A is a unique cell cycle activator known to mediate cell cycle progression and override the DNA damage response. This study focused on determining the role of this protein on postnatal mammary gland morphogenesis and neoplasia. Herein, we show that Spy1A levels are tightly regulated during mammary gland development and that ectopic expression stimulates precocious development and results in disrupted morphology of the gland.