scholarly journals Numerical Investigation of the Flow Field in Realistic Nasal Septal Perforation Geometry

2014 ◽  
Vol 5 (2) ◽  
pp. ar.2014.5.0090 ◽  
Author(s):  
Mohammad Faramarzi ◽  
Mohammad Hossein Baradaranfar ◽  
Omid Abouali ◽  
Saeid Atighechi ◽  
Goodarz Ahmadi ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Assessment Tool ◽  
Anterior Part ◽  
Three Dimensional ◽  
Preoperative Assessment ◽  
Clinical Decision ◽  
Airflow Rate ◽  
Septal Perforation ◽  
Pressure Drops ◽  
Wide Range

The computational fluid dynamics (CFD) are used to evaluate the physiological function of the nose. We evaluated the aerodynamics of the nasal cavity in a patient with septal perforation (SP), pre- and postvirtual repair. Three-dimensional nasal models were reconstructed, and then a wide range of the pressure drops and flow rates were analyzed. The airflow velocity is higher in the central region and is lower around the boundary of the SP. The air velocity in the SP increases as the pressure drop increases. Furthermore, at the anterior part of the SP, the shear stress is higher in the upper part. In addition, the repair of SP does not affect the total nasal airflow rate and the velocity contour patterns. The potential usage of the CFD technique as a predictive technique to explore the details and a preoperative assessment tool to help in clinical decision making in nasal surgery is emphasized.

Religion and Medicine

2020 ◽  
Author(s):  
Jeff Levin ◽  
Stephen G. Post
Keyword(s):  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Religion And Medicine ◽  
Physical And Mental Health ◽  
Faith Based ◽  
Baylor University ◽  
Wide Range ◽  
History Of ◽  
The Impact

In Religion and Medicine, Dr. Jeff Levin, distinguished Baylor University epidemiologist, outlines the longstanding history of multifaceted interconnections between the institutions of religion and medicine. He traces the history of the encounter between these two institutions from antiquity through to the present day, highlighting a myriad of contemporary alliances between the faith-based and medical sectors. Religion and Medicine tells the story of: religious healers and religiously branded hospitals and healthcare institutions; pastoral professionals involved in medical missions, healthcare chaplaincy, and psychological counseling; congregational health promotion and disease prevention programs and global health initiatives; research studies on the impact of religious and spiritual beliefs and practices on physical and mental health, well-being, and healing; programs and centers for medical research and education within major universities and academic institutions; religiously informed bioethics and clinical decision-making; and faith-based health policy initiatives and advocacy for healthcare reform. Religion and Medicine is the first book to cover the full breadth of this subject. It documents religion-medicine alliances across religious traditions, throughout the world, and over the course of history. It summarizes a wide range of material of relevance to historians, medical professionals, pastors and theologians, bioethicists, scientists, public health educators, and policymakers. The product of decades of rigorous and focused research, Dr. Levin has produced the most comprehensive history of these developments and the finest introduction to this emerging field of scholarship.

scholarly journals Telomere Architecture Correlates with Aggressiveness in Multiple Myeloma

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1969
Author(s):  
Aline Rangel-Pozzo ◽  
Pak Yu ◽  
Sadhana LaL ◽  
Yasmin Asbaghi ◽  
Luiza Sisdelli ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Disease Progression ◽  
Genomic Instability ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Response To Treatment ◽  
Average Intensity ◽  
Patient Response ◽  
Smoldering Multiple Myeloma

The prognosis of multiple myeloma (MM), an incurable B-cell malignancy, has significantly improved through the introduction of novel therapeutic modalities. Myeloma prognosis is essentially determined by cytogenetics, both at diagnosis and at disease progression. However, for a large cohort of patients, cytogenetic analysis is not always available. In addition, myeloma patients with favorable cytogenetics can display an aggressive clinical course. Therefore, it is necessary to develop additional prognostic and predictive markers for this disease to allow for patient risk stratification and personalized clinical decision-making. Genomic instability is a prominent characteristic in MM, and we have previously shown that the three-dimensional (3D) nuclear organization of telomeres is a marker of both genomic instability and genetic heterogeneity in myeloma. In this study, we compared in a longitudinal prospective study blindly the 3D telomeric profiles from bone marrow samples of 214 initially treatment-naïve patients with either monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or MM, with a minimum follow-up of 5 years. Here, we report distinctive 3D telomeric profiles correlating with disease aggressiveness and patient response to treatment in MM patients, and also distinctive 3D telomeric profiles for disease progression in smoldering multiple myeloma patients. In particular, lower average intensity (telomere length, below 13,500 arbitrary units) and increased number of telomere aggregates are associated with shorter survival and could be used as a prognostic factor to identify high-risk SMM and MM patients.

Prognostic Factors for Persistent Symptoms in Adults With Mild Traumatic Brain Injury: an Overview of Systematic Reviews

2021 ◽  
Author(s):  
Julien Déry ◽  
Béatrice Ouellet ◽  
Élaine de Guise ◽  
Ève-Line Bussières ◽  
Marie-Eve Lamontagne
Keyword(s):  
Traumatic Brain Injury ◽  
Prognostic Factors ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Persistent Symptoms ◽  
Wide Range ◽  
Overview Of Systematic Reviews

Abstract Background: Mild traumatic brain injury (mTBI) is an increasing public health problem, because of its persistent symptoms and several functional consequences. Understanding the prognosis of a condition is an important component of clinical decision-making and can help to guide prevention of persistent symptoms following mTBI. Prognosis of mTBI has stimulated several empirical primary research papers and many systematic reviews leading to the identification of a wide range of factors. We aim to synthesize these factors to get a better understanding of their breadth and scope.Methods: We conducted an overview of systematic reviews. We searched in databases systematic reviews synthesizing evidence about prognosis of persistent symptoms after mTBI in the adult population. Two reviewers independently screened all references and selected eligible reviews based on eligibility criteria. They extracted relevant information using an extraction grid. They also rated independently the risk of bias using the ROBIS tool. We synthesized evidence into a comprehensive conceptual map to facilitate the understanding of prognostic factors that have an impact on persistent post-concussion symptoms.Results: From the 3857 references retrieved in database search, we included 25 systematic reviews integrating the results of 312 primary articles published between 1957 and 2019. We examined 35 prognostic factors from the systematics reviews. No single prognostic factor demonstrated convincing and conclusive results. However, age, sex and multiple concussions showed an affirmatory association with persistent post-concussion outcomes in systematic reviews.Conclusion: We highlighted the need of a comprehensive picture of prognostic factors related to persistent post-concussion symptoms. We believe that these prognostic factors would guide clinical decision and research related to prevention and intervention regarding persistent post-concussion symptoms.Systematic review registration: PROSPERO CRD42020176676

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

scholarly journals A Review of Passive Micromixers with a Comparative Analysis

Micromachines ◽  
2020 ◽  
Vol 11 (5) ◽  
pp. 455 ◽  
Author(s):  
Wasim Raza ◽  
Shakhawat Hossain ◽  
Kwang-Yong Kim
Keyword(s):  
Reynolds Number ◽  
Comparative Analysis ◽  
Three Dimensional ◽  
Navier Stokes ◽  
Number Range ◽  
Pressure Drops ◽  
Convection Diffusion ◽  
Wide Range ◽  
Quantitative Analyses ◽  
Mixing Costs

A wide range of existing passive micromixers are reviewed, and quantitative analyses of ten typical passive micromixers were performed to compare their mixing indices, pressure drops, and mixing costs under the same axial length and flow conditions across a wide Reynolds number range of 0.01–120. The tested micromixers were selected from five types of micromixer designs. The analyses of flow and mixing were performed using continuity, Navier-Stokes and convection-diffusion equations. The results of the comparative analysis were presented for three different Reynolds number ranges: low-Re (Re ≤ 1), intermediate-Re (1 < Re ≤ 40), and high-Re (Re > 40) ranges, where the mixing mechanisms are different. The results show a two-dimensional micromixer of Tesla structure is recommended in the intermediate- and high-Re ranges, while two three-dimensional micromixers with two layers are recommended in the low-Re range due to their excellent mixing performance.

scholarly journals Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

2020 ◽  
Vol 9 (7) ◽  
pp. 2237
Author(s):  
Nicola Galea ◽  
Francesco Bandera ◽  
Chiara Lauri ◽  
Camillo Autore ◽  
Andrea Laghi ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Electronic Device ◽  
Multimodality Imaging ◽  
Nuclear Imaging ◽  
Clinical Decision ◽  
Cardiac Device ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Clinical Scenarios ◽  
Wide Range

Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios.

Right ventricle and pulmonary arterial pressure

2016 ◽  
Author(s):  
Annemien E. van den Bosch ◽  
Luigi P. Badano ◽  
Julia Grapsa
Keyword(s):  
Clinical Decision Making ◽  
Complex Geometry ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Prognostic Information ◽  
Recent Developments ◽  
And Function

Right ventricular (RV) performance plays an important role in the morbidity and mortality of patients with left ventricular dysfunction, congenital heart disease, and pulmonary hypertension. Assessment of RV size, function, and haemodynamics has been challenging because of its complex geometry. Conventional two-dimensional echocardiography is the modality of choice for assessment of RV function in clinical practice. Recent developments in echocardiography have provided several new techniques for assessment of RV dimensions and function, include tissue Doppler imaging, speckle-tracking imaging, and volumetric three-dimensional imaging. However, specific training, expensive dedicated equipment, and extensive clinical validation are still required. Doppler methods interrogating tricuspid inflow and pulmonary artery flow velocities, which are influenced by changes in pre- and afterload conditions, may not provide robust prognostic information for clinical decision-making. This chapter addresses the role of the various echocardiographic modalities used to assess the RV and pulmonary circulation. Special emphasis has been placed on technical considerations, limitations, and pitfalls of image acquisition and analysis.

scholarly journals Development of Antibody Immuno-PET/SPECT Radiopharmaceuticals for Imaging of Oncological Disorders—An Update

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1868
Author(s):  
Jonatan Dewulf ◽  
Karuna Adhikari ◽  
Christel Vangestel ◽  
Tim Van Den Wyngaert ◽  
Filipe Elvas
Keyword(s):  
Clinical Decision Making ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Therapy Response ◽  
High Specificity ◽  
Clinical Decision ◽  
Disease Diagnosis ◽  
Emission Computed Tomography ◽  
Wide Range

Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are molecular imaging strategies that typically use radioactively labeled ligands to selectively visualize molecular targets. The nanomolar sensitivity of PET and SPECT combined with the high specificity and affinity of monoclonal antibodies have shown great potential in oncology imaging. Over the past decades a wide range of radio-isotopes have been developed into immuno-SPECT/PET imaging agents, made possible by novel conjugation strategies (e.g., site-specific labeling, click chemistry) and optimization and development of novel radiochemistry procedures. In addition, new strategies such as pretargeting and the use of antibody fragments have entered the field of immuno-PET/SPECT expanding the range of imaging applications. Non-invasive imaging techniques revealing tumor antigen biodistribution, expression and heterogeneity have the potential to contribute to disease diagnosis, therapy selection, patient stratification and therapy response prediction achieving personalized treatments for each patient and therefore assisting in clinical decision making.

scholarly journals Use of Acute Psychiatric Hospitalisation: A Study of the Factors Influencing Decisions to Arrange Acute Admission to Inpatient Mental Health Facilities

2021 ◽  
Vol 12 ◽  
Author(s):  
Rajan Nathan ◽  
Mark Gabbay ◽  
Sean Boyle ◽  
Phil Elliott ◽  
Clarissa Giebel ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Contextual Factors ◽  
Clinical Decision ◽  
Personal Factors ◽  
Liaison Psychiatry ◽  
Acute Admission ◽  
Factors Influencing ◽  
Wide Range

Background: Human decision-making involves a complex interplay of intra- and inter-personal factors. The decisions clinicians make in practise are subject to a wide range of influences. Admission to a psychiatric hospital is a major clinical intervention, but the decision-making processes involved in admissions remain unclear.Aims: To delineate the range of factors influencing clinicians' decisions to arrange acute psychiatric admissions.Methods: We undertook six focus groups with teams centrally involved in decisions to admit patients to hospital (crisis resolution home treatment, liaison psychiatry, approved mental health practitioners and consultant psychiatrists). The data were analysed using qualitative thematic analysis.Results: Our analysis of the data show a complex range of factors influencing decision-making that were categorised as those related to: (i) clinical and risk factors; (ii) fear/threat factors; (iii) interpersonal dynamics; (iv) contextual factors.Conclusions: Decisions to arrange acute admission to hospital are not just based on an appraisal of clinical and risk-related information. Emotional, interpersonal and contextual factors are also critical in decision-making. Delineating the breadth of factors that bear on clinical decision-making can inform approaches to (i) clinical decision-making research, (ii) the training and supervision of clinicians, and (iii) service delivery models.

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