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It Is as It Was: MDS-UPDRS Part III Scores Cannot Be Combined with Other Parts to Give a Valid Sum.
No full textBackgroundOriginal clinimetric analyses by the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) developers did not confirm the validity of summing the scores of its parts. Recent studies used the summed score of Part III and other parts as efficacy outcomes.ObjectiveThe aim of this study was to establish whether summing scores of MDS-UPDRS parts can be recommended.MethodsUsing 7466 full MDS-UPDRS scores, we applied two-step factor analysis as in the original article to reassess the validity analysis with the threshold criterion set at comparative fit index ≥0.9.ResultsAll comparative fit indexes of any combination including Part III were lower than 0.90.ConclusionsSumming Part III MDS-UPDRS scores with other parts is not clinimetrically sound. The MDS-UPDRS is a validated four-part scale with corresponding individual part scores and needs to be used within the limits originally presented. © 2022 International Parkinson and Movement Disorder Society
A Multi-Stakeholder Perspective on Factors Affecting Successful Transition to Adulthood for Youth with Severe Emotional Disturbances.
No full textThis study elicited the perspectives of youth, caregivers, service providers and researchers to explore how communities can best support the transition to adulthood for youth ages 16-21 with mental health and functional impairments, who are at risk of disconnecting from health and human services. Framed by Relational Systems Evaluation (RSE) and Positive Youth Development (PYD), our study demonstrates the importance of engagement with youth experts. Group Concept Mapping (GCM), a collaborative multiphase mixed-methods approach, was used as a systematic process for participants to make meaning of qualitative data using multidimensional scaling and hierarchical cluster analysis (Kane and Trochim in Concept mapping for planning and evaluation, Sage Publications Inc., Thousand Oaks, 2007). Across all participant groups, Life Skills were perceived as highly important and highly feasible for a successful transition to adulthood. However, Positive Social Support & Connectedness were viewed as less important and less feasible by all groups. When examined closely, youth perspectives differed from caregiver and provider perspectives in the factors they prioritized and deemed feasible. Our findings have implications for community mental health services and positive youth development program practitioners
Deep learning-based motion compensation for four-dimensional cone-beam computed tomography (4D-CBCT) reconstruction.
No full textBackgroundMotion-compensated (MoCo) reconstruction shows great promise in improving four-dimensional cone-beam computed tomography (4D-CBCT) image quality. MoCo reconstruction for a 4D-CBCT could be more accurate using motion information at the CBCT imaging time than that obtained from previous 4D-CT scans. However, such data-driven approaches are hampered by the quality of initial 4D-CBCT images used for motion modeling.PurposeThis study aims to develop a deep-learning method to generate high-quality motion models for MoCo reconstruction to improve the quality of final 4D-CBCT images.MethodsA 3D artifact-reduction convolutional neural network (CNN) was proposed to improve conventional phase-correlated Feldkamp-Davis-Kress (PCF) reconstructions by reducing undersampling-induced streaking artifacts while maintaining motion information. The CNN-generated artifact-mitigated 4D-CBCT images (CNN enhanced) were then used to build a motion model which was used by MoCo reconstruction (CNN+MoCo). The proposed procedure was evaluated using in-vivo patient datasets, an extended cardiac-torso (XCAT) phantom, and the public SPARE challenge datasets. The quality of reconstructed images for XCAT phantom and SPARE datasets was quantitatively assessed using root-mean-square-error (RMSE) and normalized cross-correlation (NCC).ResultsThe trained CNN effectively reduced the streaking artifacts of PCF CBCT images for all datasets. More detailed structures can be recovered using the proposed CNN+MoCo reconstruction procedure. XCAT phantom experiments showed that the accuracy of estimated motion model using CNN enhanced images was greatly improved over PCF. CNN+MoCo showed lower RMSE and higher NCC compared to PCF, CNN enhanced and conventional MoCo. For the SPARE datasets, the average (± standard deviation) RMSE in mm-1 for body region of PCF, CNN enhanced, conventional MoCo and CNN+MoCo were 0.0040 ± 0.0009, 0.0029 ± 0.0002, 0.0024 ± 0.0003 and 0.0021 ± 0.0003. Corresponding NCC were 0.84 ± 0.05, 0.91 ± 0.05, 0.91 ± 0.05 and 0.93 ± 0.04.ConclusionsCNN-based artifact reduction can substantially reduce the artifacts in the initial 4D-CBCT images. The improved images could be used to enhance the motion modeling and ultimately improve the quality of the final 4D-CBCT images reconstructed using MoCo
Improved prediction of postoperative pediatric cerebellar mutism syndrome using an artificial neural network.
No full textBackgroundPostoperative pediatric cerebellar mutism syndrome (pCMS) is a common but severe complication that may arise following the resection of posterior fossa tumors in children. Two previous studies have aimed to preoperatively predict pCMS, with varying results. In this work, we examine the generalization of these models and determine if pCMS can be predicted more accurately using an artificial neural network (ANN).MethodsAn overview of reviews was performed to identify risk factors for pCMS, and a retrospective dataset was collected as per these defined risk factors from children undergoing resection of primary posterior fossa tumors. The ANN was trained on this dataset and its performance was evaluated in comparison to logistic regression and other predictive indices via analysis of receiver operator characteristic curves. The area under the curve (AUC) and accuracy were calculated and compared using a Wilcoxon signed-rank test, with P ResultsTwo hundred and four children were included, of whom 80 developed pCMS. The performance of the ANN (AUC 0.949; accuracy 90.9%) exceeded that of logistic regression (P P ConclusionUsing an ANN, we show improved prediction of pCMS in comparison to previous models and conventional methods
Cavity-free photon blockade induced by many-body bound states.
No full textThe manipulation of individual, mobile quanta is a key goal of quantum communication; to achieve this, nonlinear phenomena in open systems can play a critical role. We show theoretically that a variety of strong quantum nonlinear phenomena occur in a completely open one-dimensional waveguide coupled to an N-type four-level system. We focus on photon blockade and the creation of single-photon states in the absence of a cavity. Many-body bound states appear due to the strong photon-photon correlation mediated by the four-level system. These bound states cause photon blockade, which can generate a sub-Poissonian single-photon source
"We bleed for our community:" A qualitative exploration of the implementation of a pragmatic weight gain prevention trial from the perspectives of community health center professionals.
No full textBackgroundClinical trial implementation continues to shift toward pragmatic design, with the goal of increasing future adoption in clinical practice. Yet, few pragmatic trials within clinical settings have qualitatively assessed stakeholder input, especially from those most impacted by research implementation and outcomes, i.e., providers and staff. Within this context, we conducted a qualitative study of the implementation of a pragmatic digital health obesity trial with employees at a Federally qualified health center (FQHC) network in central North Carolina.MethodsParticipant recruitment was conducted through purposive sampling of FQHC employees from a variety of backgrounds. Two researchers conducted semi-structured qualitative interviews and collected demographic data. Interviews were digitally recorded, professionally transcribed and double-coded by two independent researchers using NVivo 12. Coding discrepancies were reviewed by a third researcher until intercoder consensus was reached. Responses were compared within and across participants to elucidate emergent themes.ResultsEighteen qualitative interviews were conducted, of whom 39% provided direct medical care to patients and 44% worked at the FQHC for at least seven years. Results illuminated the challenges and successes of a pragmatically designed obesity treatment intervention within the community that serves medically vulnerable patients. Although limited time and staffing shortages may have challenged recruitment processes, respondents described early buy-in from leadership; an alignment of organizational and research goals; and consideration of patient needs as facilitators to implementation. Respondents also described the need for personnel power to sustain novel research interventions and considerations of health center resource constraints.ConclusionsResults from this study contribute to the limited literature on pragmatic trials utilizing qualitative methods, particularly in community-based obesity treatment. To continue to merge the gaps between research implementation and clinical care, qualitative assessments that solicit stakeholder input are needed within pragmatic trial design. For maximum impact, researchers may wish to solicit input from a variety of professionals at trial onset and ensure that shared common goals and open collaboration between all partners is maintained throughout the trial.Trial registrationThis trial was registered with ClinicalTrials.gov (NCT03003403) on December 28, 2016
Marginalized and Monitored: Analyzing Reproductive Health and Digital Surveillance in the United States
No full textThis thesis delves into the complex and intersectional issues surrounding women’s reproductive rights in the United States, with a specific focus on the impact of restrictive abortion legislation after the overturning of Roe v. Wade in the Dobbs v. Jackson Women’s Health Organization Supreme Court decision. The research highlights the disproportionate effects of such restrictions on marginalized communities and exposes the systemic racism and classism embedded in abortion legislation.
Furthermore, this thesis examines the intersection of data privacy and reproductive rights, exploring how recent changes in abortion laws have impacted the privacy of women seeking abortion-related services. The study focuses on the potential impact of post-Roe legislation on data privacy, specifically on the surveillance and targeting of women seeking reproductive health resources. The research was conducted using an online survey that targeted women, aged 18 to 40, in Florida, Texas, and Georgia, examining their attitudes towards data privacy, awareness of existing abortion legislation, and access to various reproductive health services. The survey results indicate a disconnect between participants’ expressed concern about data privacy and their actual behavior, which is particularly alarming given the risks women face with changing restrictive abortion laws. Furthermore, the study highlights the lack of awareness and understanding of abortion laws in their respective states. Ultimately, the research stresses the urgent need to address data privacy concerns and provides recommendations for policymakers and technology companies to safeguard the privacy and autonomy of women seeking abortion-related services. To address these findings, I recommend increased education and awareness campaigns to empower women with knowledge about their legal rights and resources for reproductive healthcare services, ensuring that they can make informed decisions about their bodies and their data
Prevalence and type of cervical deformities among adults with Parkinson's disease: a cross-sectional study.
No full textObjectTo identify the characteristics of cervical deformities in Parkinson's disease (PD) and the role of severity of PD in the development of cervical spine deformities, the authors investigated the prevalence of the cervical deformities, cervical kyphosis (CK), and cervical positive sagittal malalignment (CPSM) in patients with PD. They also analyzed the association of severity of cervical deformities with the stage of PD in the context of global sagittal spinopelvic alignment.MethodsThis study was a prospective assessment of consecutively treated patients (n = 89) with PD. A control group of the age- and sex-matched patients was selected from patients with degenerative cervical spine disease but without PD. Clinical and demographic parameters including age, sex, duration of PD, and Hoehn and Yahr (H&Y) stage were collected. Full-length standing radiographs were used to assess spinopelvic parameters. CK was defined as a C2-7 Cobb angle 4 cm.ResultsA significantly higher prevalence of CPSM (28% vs. 1.1%, p ConclusionsPatients with PD have a significantly higher prevalence of CPSM compared with age- and sex-matched control patients with cervical degenerative disease but without PD. Among patients with PD, CK is not associated with the severity of PD but is associated with overall global sagittal malalignment. In contrast, the presence of CPSM is associated more with the severity of PD than it is with the presence of global sagittal malalignment. Collectively, these data suggest that the neuromuscular pathogenesis of PD may affect the development of CPSM more than of CK