39 research outputs found
Left ventricular systolic deformation in subclinical metabolic cardiomyopathies
Get PDFCardiovascular disease is a significant contributor to morbidity and mortality in patients with inherited metabolic disorders or chronic kidney disease. Conventional echocardiography typically identifies cardiac involvement at a more established stage of the disease. Strain echocardiography, which assesses the deformation of the myocardium, has the potential for early detection of subclinical myocardial dysfunction. This thesis consists of 3 studies of left ventricular myocardial deformation in patients with diseases causing metabolic myocardial alterations, associated with development of cardiomyopathy. In study 1, Doppler strain echocardiography was performed in 40 patients with Stage II and III chronic kidney disease. In study 2, speckle strain echocardiography was performed in 68 patients who underwent renal transplantation in childhood, and in study 3, speckle strain echocardiography was performed in 38 patients with Fabry disease. In all studies, the ability of strain echocardiography to detect subclinical cardiac dysfunction not detected by conventional echocardiography was studied. As demonstrated by the results of this thesis, echocardiography, using Doppler or speckle strain, detected impaired left ventricular long axis function in the studied patient groups. In particular, left ventricular longitudinal strain was reduced, while ejection fraction, measured by conventional echocardiography, was generally preserved in patients with early-stage chronic kidney disease and in patients with mild Fabry disease compared to healthy subjects. Furthermore, having metabolic disease was associated with lower left ventricular systolic strain independent of left ventricular mass. In patients who underwent childhood renal transplantation, hypertension was common and a main covariate of left ventricular diastolic dysfunction. In contrast, left ventricular systolic deformation was comparable between patients and healthy subjects. In conclusion, Doppler or speckle strain echocardiography, may detect impaired myocardial function in patients with diseases causing metabolic myocardial alterations, in spite of normal findings on conventional echocardiography and without clinical evidence of heart disease
Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department
No full textObjective. Triage is a tool developed to identify patients who need immediate care and those who can safely wait. The aim of this study was to assess the validity and interrater reliability of a modified version of the pediatric South African triage scale (pSATS) in a single-center tertiary pediatric emergency department in Norway. Methods. This prospective, observational study included all patients with medical conditions, referred to the pediatric emergency department of a tertiary hospital in Norway from September 1, 2015, to November 17, 2015. Their assigned triage priority was compared with rate of hospitalization and resource utilization. Validity parameters were sensitivity, specificity, positive and negative predictive value, and percentage of over- and undertriage. Interrater agreement and accuracy of the triage ratings were calculated from triage performed by nurses on written case scenarios. Results. During the study period, 1171 patients arrived at the hospital for emergency assessment. A total of 790 patients (67 %) were triaged and included in the study. The percentage of hospital admission increased with increasing level of urgency, from 30 % of the patients triaged to priority green to 81 % of those triaged to priority red. The sensitivity was 74 %, the specificity was 48 %, the positive predictive value was 52 %, and the negative predictive value was 70 % for predicting hospitalization. The level of over- and undertriage was 52 % and 26 %, respectively. Resource utilization correlated with higher triage priority. The interrater agreement had an intraclass correlation coefficient of 0.99 by Cronbach’s alpha, and the accuracy was 92 %. Conclusions. The modified pSATS had a moderate sensitivity and specificity but showed good correlation with resource utilization. The nurses demonstrated excellent interrater agreement and accuracy when triaging written case scenarios
Atomistic-informed kinetic phase-field modeling of non-equilibrium crystal growth during rapid solidification
Get PDFA novel method based on molecular dynamics (MD) is developed to make the kinetic phase-field (PF) model quantitative in predicting non-equilibrium crystal growth during rapid solidification. MD-calculated variations of the diffuse solid-liquid (SL) interface width versus interface velocity are used to parameterize the kinetic PF model. Two approaches are adopted to study temperature independent and temperature dependent interfacial properties on the accuracy of predictions. MD simulations of slow and rapid solidification regimes for an fcc metal (Ni) show that the SL interface width decreases by increasing the solidification velocity. Fitting the dynamic response of the interface width to the traveling wave solution of hyperbolic PF equation determines the target SL interfacial properties, namely propagation velocity and diffusion coefficient. Independently, the MD calculations of nonlinearity in velocity versus undercooling is used to validate the atomistic-informed kinetic PF model. Both parabolic and kinetic PF models parameterized by temperature-independent material properties can accurately simulate the linear portion of near-equilibrium crystal growth during solidification. However, they both fail to predict the crystal growth kinetics during rapid solidification. The kinetic PF model parameterized with the temperature-dependent SL interfacial properties can accurately predict both the equilibrium and non-equilibrium crystal growth during slow and rapid solidification. MD simulation results on Ni along with some analytical analysis on the variation of interface width versus interface velocity show that for fcc metals, in general, {110} interface has a smaller propagation velocity in comparison to {100} interface, resulting in a larger non-linear behavior at smaller undercooling. © 2023 The Author(s)2031800; National Science Foundation, NSF: TG-DMR140008; Russian Science Foundation, RSF: 21-19-00279This study was supported by the National Science Foundation , NSF-CMMI 2031800 , and by Russian Science Foundation under 21-19-00279 . S. Kavousi and M. Asle Zaeem are grateful for the supercomputing time allocation provided by the NSF 's ACCESS (Advanced Cyberinfrastructure Coordination Ecosystem: Services & Support), Award No. TG-DMR140008
Validation of childhood lupus specific targets: Ensuring accurate assessment of disease control in younger, lighter paediatric patients
Get PDF\ua9 2025 The Author(s).Objectives: To validate novel childhood-onset systemic lupus erythematosus (cSLE) treat-To-Target targets including childhood lupus low disease activity state (cLLDAS), cSLE clinical remission on steroids (cCR) and cSLE clinical remission off steroids (cCR-0), as compared with adult-onset SLE (aSLE) targets. Methods: Attainment of the aforementioned cSLE-specific and aSLE-specific targets (LLDAS, DORIS 2021 Remission) was assessed at each visit in UK JSLE Cohort Study patients. Univariable and multivariable Prentice-Williams-Peterson (PWP) gap-Time models investigated the impact of target attainment on new damage and severe flare. Results: The cohort included 430 cSLE patients. Attainability was comparable between corresponding cSLE and aSLE targets. Achieving cLLDAS (hazard ratio [HR] 0.18 [95% CI: 0.14, 0.23]), cCR (HR 0.18 [0.13, 0.23]) and cCR-0 (HR 0.17 [0.13, 0.23]) reduced the risk of severe flare (all P < 0.001). Risk of new damage was reduced in those reaching cLLDAS (HR 0.22 [0.11, 0.44]), cCR (HR 0.25 [0.13, 0.49]) and cCR-0 (HR 0.30 [0.15, 0.60]) (all P < 0.001). Inappropriate attainment of LLDAS and DORIS remission occurred at 35 and 52 visits, respectively, in younger (median age 7.3 and 8.8 years, respectively) and lighter (median weight 26.8 and 37.1 kg, respectively) patients whilst on prednisolone doses that precluded cSLE target attainment (median 0.17 [IQR 0.16-0.24] and 0.13 [IQR 0.11-0.16] mg/kg/day, respectively). Conclusions: This study validates novel paediatric-specific targets, demonstrating that achieving cLLDAS, cCR and cCR-0 reduces risks of new damage and severe flare, which is comparable to aSLE targets. Using cSLE-specific targets prevents misclassification of disease activity in paediatric patients, enabling more accurate disease control assessments in younger, lighter patients
Advising Patients with Cardiac Disease and after Cardiac Interventions about Sports Activities
No full textAssessment of Physical Activity in Children and Adolescents with Congenital Heart Defects
No full textDisorder of the cardiovascular system is the most common cause of death worldwide and sufficient physical activity plays an import role in preventing these deaths. Children and adolescents with congenital heart defect are at risk of living a sedentary life as a result of overprotection and uncertainty regarding physical activity recommendations. Assessment of physical activity level should therefore be part of regular follow-up in this population. A whole range of subjective and objective measure instruments of physical activity are available. However, not all are suitable in children and adolescents. Questionnaires have the advantage of being inexpensive and simple, but reduced recall capability of children and adolescents and low-to-moderate correlation with objective measures of physical activity are of concern. At present a single unobtrusive motion sensor allowing valid and long-term monitoring of physical activity may be the best choice
Hvem? Hvor mange?
Get PDFIn a world marked by surging international conflicts, labour market globalisation, ever-widening economic inequities, steady improvement in the flow of information, and increasing possibilities for mobility over greater distances, the number of migrants on a worldwide basis is hardly likely to decrease in coming years. Immigration regulations are devised within a confluence of national interests, international laws, and attention to migrants’ individual rights. The tension between these disparate considerations begs the question: How can we best safeguard both universal rights issues and European economic integration, as well as the Norwegian state’s obligation, vis-à-vis the distribution of benefits, to its own citizens. We are moving into extremely complex ethical and legal territory, where there are no easy answers. In this book, the author puts Norway’s immigration policy under a moral-philosophical loupe for a thorough analysis of various answers to key questions in the Norwegian immigration debate.
This book is aimed at anyone interested in immigration policy issues, but especially persons working professionally in the field, such as political philosophers, politicians, lawyers, case managers and political scientists
Advanced Processing for Synthetic Aperture Sonar
No full textSynthetic aperture sonar (SAS) is a technique for acoustic imaging and mapping of the seafloor. SAS systems are typically operated from autonomous underwater vehicles in a side-looking configuration. They can provide images with resolution down to a few centimeters out to a range of several hundred meters. The high resolution is obtained through the SAS processing, where measurements recorded at different positions are combined coherently by accounting for the vehicle navigation.
In this work I investigate the information collected by SAS systems that is not expressed directly in the SAS intensity images. This includes information that can be used to refine the navigation solution for the AUV, and information on physical properties that can support the detection and classification of objects of interest. I establish the spatial coherence of speckle for SAS systems, and use this to obtain successful repeat-pass SAS micro-navigation updates with ten times the track separation reported in earlier studies. I establish the support and quality of frequency- and aspect-dependent information for SAS systems, and improve interferometric depth estimates by incorporating the frequency-dependent data quality. I extract information on aspect-dependent scattering from objects on the seafloor, and develop a calibration target for extraction of the frequency dependency
On Motivating Operations at the Point of Online Purchase Setting
No full textConsumer behavior analysis can be applied over a wide range of economic topics in which the main focus is the contingencies that influence the behavior of the economic agent. This paper provides an overview on the work that has been done on the impact from motivating operations at the point of online purchase situation. Motivating operations, a behavior analytic formulation of motivation is defined as any environmental event that (a) establishes (or abolishes) the reinforcing or punishing effect of another event and (b) evokes (or abates) behavior related to that event. Our conclusion is that the concept of motivating operations has two advantages. First, it provides understanding about the impact from observable environmental stimuli to consumers' purchases in an online situation. Second, the concept is designed specifically to facilitate intervention as it is formulated in terms of behavior-environmental relations that can be manipulated directly. Accordingly, findings derived using the concept of motivating operations can be more immediately applied to the design of the company's Web site. [ABSTRACT FROM AUTHOR
