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9 Predictive Ability of the Performance Assessment of Self-Care Skills (PASS) in a Sample of Predominantly Low-Income, Community Dwelling, African American Older Adults
- Ashlyn Runk, Meryl A Butters, Andrea Rosso, Tamara Dubowitz, Wendy Troxel, Juleen Rodakowski, Tiffany L. Gary-Webb, Ann Haas, Bonnie Ghosh-Dastidar, Andrea M Weinstein
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 221-222
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Objective:
Mild decline in independent functioning is a core diagnostic criterion for Mild Cognitive Impairment. Performance-based assessments have been considered the gold standard to identify subtle deficits in functioning. Existing assessments were largely designed using demographically homogenous samples (white, highly educated, middle class) and often assume tasks are performed similarly across populations. The current study aimed to validate the utility of the Performance Assessment of Self-Care Skills (PASS) in determining cognitive status in a sample of predominantly African American, low-income older adults.
Participants and Methods:Cognition and functional capacity were measured in n=245 older participants (aged 50+ years) who were recruited from a larger community study located in Pittsburgh, PA. Cognitive status was defined by a mean split on the Modified Mini Mental Status Examination (3MS) score (84/100). Participants above the cutoff were classified as unlikely cognitive impairment (UCI) and those below classified as potential cognitive impairment (PCI). Functional capacity was assessed using the number of cues provided on three PASS subtasks: shopping, medication management, and critical information retrieval (higher score = worse functioning). Self-reported cognitive and functional decline was assessed via the Everyday Cognition (ECog) questionnaire (higher score = greater decline). Generalized linear models compared performance scores between groups adjusting for literacy (WRAT3), age, and education. Receiver operating characteristic curve (ROC) analyses were run for select functional performance scores to assess their predictive ability in discriminating between PCI and UCI.
Results:Compared to the UCI group (N = 179), the PCI group (N = 66) was older (68 vs. 65 years, p = 0.05), less educated (11 years vs. 12 years, p < 0.01), had lower WRAT3 z-scores (0.19 vs. -0.55, p < .01), and required more cues on the shopping (4.33 vs. 8.54, p < 0.01) and medication management PASS subtasks (2.74 vs. 6.56, p < .01). Both groups reported elevated levels of subjective cognitive complaints on the ECog (1.46 vs. 1.56, p = .09) and performed similarly on the critical information retrieval PASS subtask (0.25 vs 0.54, p = .06). When discerning between UCI and PCI groups, the PASS Shopping subtask had an optimal cut-off score of 4, sensitivity of 0.86, specificity of 0.47, positive predictive value (PPV) of 0.37, and area under the curve (AUC) of 0.71. PASS Medication Management had an optimal cut-off score of 3, sensitivity of 0.77, specificity of 0.56, PPV of 0.39, and AUC of 0.74.
Conclusions:Subjective functional decline and performance on the critical information retrieval subtask were not associated with cognitive groups. PASS shopping and medication management had moderately high AUCs, suggesting they can reliably distinguish between groups. However, both tasks also exhibited low PPVs, low levels of specificity, and high levels of sensitivity, making them strong “rule-out” tests but poor “rule-in” tests in this sample. Because accurate assessment of functioning is useful for MCI and critical to dementia diagnosis, it is imperative we understand how these tasks function across different populations. Future work should 1) validate measures of functional ability across different populations and 2) develop population-appropriate assessments for use in clinical and research settings.
Extra-cardiac and complex Fontan baffle fenestration using radio frequency current via surgical electrocautery
- Asra Khan, Athar M. Qureshi, Manish Bansal, Gary Stapleton, Melissa K. Webb, Wilson Lam, Lindsay Eilers, Harinder R. Singh, Srinath T. Gowda
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- Journal:
- Cardiology in the Young / Volume 33 / Issue 12 / December 2023
- Published online by Cambridge University Press:
- 24 April 2023, pp. 2621-2627
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Background:
Fontan baffle punctures and creation of Fontan fenestration for cardiac catheterisation procedures remain challenging especially due to the heavy calcification of prosthetic material and complex anatomy.
Objectives:We sought to evaluate our experience using radiofrequency current via surgical electrocautery needle for Fontan baffle puncture to facilitate diagnostic, electrophysiology, and interventional procedures.
Methods:A retrospective chart review of all Fontan patients (pts) who underwent Fontan baffle puncture using radiofrequency energy via surgical electrocautery from three centres were performed from January 2011 to July 2021.
Results:A total of 19 pts underwent 22 successful Fontan baffle puncture. The median age and weight were 17 (3–36 years) and 55 (14–88) kg, respectively. The procedural indications for Fontan fenestration creation included: diagnostic study (n = 1), atrial septostomy and stenting (n = 1), electrophysiology study and ablation procedures (n = 8), Fontan baffle stenting for Fontan failure including protein-losing enteropathy (n = 7), and occlusion of veno-venous collaterals (n = 2) for cyanosis. The type of Fontan baffles included: extra-cardiac conduits (n = 12), lateral tunnel (n = 5), classic atrio-pulmonary connection (n = 1), and intra-cardiac baffle (n = 1). A Fontan baffle puncture was initially attempted using traditional method in 6 pts and Baylis radiofrequency trans-septal system in 2 pts unsuccessfully. In all pts, Fontan baffle puncture using radiofrequency energy via electrocautery needle was successful. The radiofrequency energy utilised was (10–50 W) and required 1–5 attempts for 2–5 seconds. There were no vascular or neurological complications.
Conclusions:Radiofrequency current delivery using surgical electrocautery facilitates Fontan baffle puncture in patients with complex and calcified Fontan baffles for diagnostic, interventional, and electrophysiology procedures.
A history of high-power laser research and development in the United Kingdom
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- Colin N. Danson, Malcolm White, John R. M. Barr, Thomas Bett, Peter Blyth, David Bowley, Ceri Brenner, Robert J. Collins, Neal Croxford, A. E. Bucker Dangor, Laurence Devereux, Peter E. Dyer, Anthony Dymoke-Bradshaw, Christopher B. Edwards, Paul Ewart, Allister I. Ferguson, John M. Girkin, Denis R. Hall, David C. Hanna, Wayne Harris, David I. Hillier, Christopher J. Hooker, Simon M. Hooker, Nicholas Hopps, Janet Hull, David Hunt, Dino A. Jaroszynski, Mark Kempenaars, Helmut Kessler, Sir Peter L. Knight, Steve Knight, Adrian Knowles, Ciaran L. S. Lewis, Ken S. Lipton, Abby Littlechild, John Littlechild, Peter Maggs, Graeme P. A. Malcolm, OBE, Stuart P. D. Mangles, William Martin, Paul McKenna, Richard O. Moore, Clive Morrison, Zulfikar Najmudin, David Neely, Geoff H. C. New, Michael J. Norman, Ted Paine, Anthony W. Parker, Rory R. Penman, Geoff J. Pert, Chris Pietraszewski, Andrew Randewich, Nadeem H. Rizvi, Nigel Seddon, MBE, Zheng-Ming Sheng, David Slater, Roland A. Smith, Christopher Spindloe, Roy Taylor, Gary Thomas, John W. G. Tisch, Justin S. Wark, Colin Webb, S. Mark Wiggins, Dave Willford, Trevor Winstone
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- Journal:
- High Power Laser Science and Engineering / Volume 9 / 2021
- Published online by Cambridge University Press:
- 27 April 2021, e18
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The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Re-Acceleration of Energetic Particles in Large-Scale Heliospheric Magnetic Cavities
- Olga V. Khabarova, Olga E. Malandraki, Gary P. Zank, Gang Li, Jakobus A. le Roux, Gary M. Webb
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- Journal:
- Proceedings of the International Astronomical Union / Volume 13 / Issue S335 / July 2017
- Published online by Cambridge University Press:
- 24 July 2018, pp. 75-81
- Print publication:
- July 2017
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Case studies show that some energetic particle flux enhancements up to MeV/nuc. observed at 1 AU cannot be treated as a consequence of particle acceleration at shocks or during flares. Atypical energetic particle events (AEPEs) are often detected during crossings of magnetic cavities formed by strong current sheets of various origins in the solar wind. Such cavities confine small-scale magnetic islands (SMIs) produced by magnetic reconnection. SMIs, in turn, trap and re-accelerate energetic particles according to predictions based on the theory of Zank et al. describing stochastic particle energization in the supersonic solar wind via numerous dynamically interacting SMIs. AEPEs possess energies that overlap SEP events and can be an important component in understanding space weather.
Contributors
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- By Chittima Aryuthaka, William J. Baker, Chris Banks, David R. Bellwood, David Bickford, Rafe M. Brown, Mark de Bruyn, Patrick Campbell, Charles H. Cannon, Gary R. Carvalho, Craig M. Costion, Thomas L. P. Couvreur, Ben J. Evans, Nicholas J. Evans, Matthias Glaubrecht, David J. Gower, Robert Hall, Fabian Herder, Aljosja Hooijer, Agata Hoscilo, Chawaporn Jittanoon, Kenneth G. Johnson, Michael A. Kendall, Peter B. Mather, Yaowaluk Monthum, Robert J. Morley, Alexandra N. Muellner, Vincent Nijman, Les R. Noble, Kevin M. O’Neill, Susan Page, Gordon L. J. Paterson, Sinlan Poo, Mary Rose C. Posa, Richard Ree, Willem Renema, James E. Richardson, Jack Rieley, Kristina von Rintelen, Thomas von Rintelen, Brian R. Rosen, Lukas Rüber, Christoph D. Schubart, Chris R. Shepherd, Bryan L. Stuart, Matthew Todd, Campbell O. Webb, Suzanne T. Williams, John van Wyhe
- Edited by David Gower, Natural History Museum, London, Kenneth Johnson, Natural History Museum, London, James Richardson, Royal Botanic Garden Edinburgh, Brian Rosen, Natural History Museum, London, Lukas Rüber, Suzanne Williams, Natural History Museum, London
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- Book:
- Biotic Evolution and Environmental Change in Southeast Asia
- Published online:
- 05 August 2012
- Print publication:
- 19 July 2012, pp vii-x
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Neuropathic pain syndrome as an occult manifestation of injury of the spinal cord after surgical repair of aortic coarctation
- Luc M Beauchesne, Angela Mailis, Gary D Webb
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- Cardiology in the Young / Volume 10 / Issue 4 / July 2000
- Published online by Cambridge University Press:
- 19 August 2008, pp. 413-415
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Injury to the spinal cord injury with paraplegia, is a rare complication of surgical repair of aortic coarctation recognized immediately post-operatively. We present the case of a 41-year-old male undergoing surgery for restenosis at the site of a repair. Intra-operatively, he suffered inadvertent injury to an intercostal arterial branch during isolation of the aorta below the graft. Over the following months, he developed unusual symptoms involving the legs and genitourinary tract which, only after extensive investigations, were attributed to ischemic damage to the spinal cord related to the surgery. We suspect that similar syndromes reflecting injury to the spinal cord injury may be unrecognized following surgical repair of coarctation.
Caring for adults with congenital cardiac disease: successes and challenges for 2007 and beyond
- Joseph A. Dearani, Heidi M. Connolly, Richard Martinez, Hector Fontanet, Gary D. Webb
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- Journal:
- Cardiology in the Young / Volume 17 / Issue S4 / September 2007
- Published online by Cambridge University Press:
- 26 November 2007, pp. 87-96
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Patients with congenital cardiac disease require lifelong medical care. Current challenges that face practitioners who care for adults with congenital heart disease include identifying the best location for procedures, which could be a children’s hospital, an adult hospital, or a tertiary care facility; providing appropriate antenatal management of pregnant women with congenitally malformed hearts, and continuing this care in the peripartum period; and securing the infrastructure and expertise of the non-cardiac subspecialties, such as nephrology, hepatology, pulmonary medicine, and haematology. The objectives of this review are to outline the common problems that confront this population of patients and the medical community, to identify challenges encountered in establishing a programme for care of adults with congenitally malformed hearts, and to review the spectrum of disease and operations that have been identified in a high volume tertiary care centre for adult patients with congenital cardiac disease. Three chosen examples of the fundamental problems facing the practitioner and patient in the United States of America in 2007 are the neglected patient with congenital cardiac disease, weak infrastructure for adults with congenital cardiac disease, and family planning and management of pregnancy for patients with congenital cardiac disease.
Patients with adult congenital cardiac disease often do not receive appropriate surveillance. Three fundamental reasons for this problem are, first, that most adults with congenitally malformed hearts have been lost to follow-up by specialists, and are either receiving community care or no care at all. Second, patients and their families have not been educated about their malformed hearts, what to expect, and how to protect their interests most effectively. Third, adult physicians have not been educated about the complexity of the adult with a congenitally malformed heart. This combination can be fatal for adults with complications related to their congenitally malformed heart, or its prior treatment. Two solutions would improve surveillance and care for the next generation of patients coming out of the care of paediatric cardiologists. The first would be to educate patients and their families during childhood and adolescence. They would learn the names of the diagnoses and treatments, the problems they need to anticipate and avoid, the importance of expert surveillance, career and family planning information, and appropriate self-management. The second solution would be to encourage an orderly transfer of patients from paediatric to adult practice, usually at about 18 years of age, and at the time of graduation from high school.
Clinics for adults with congenital cardiac disease depend upon multidisciplinary collaboration with specialties in areas such as congenital cardiac imaging, diagnostic and interventional catheterization, congenital cardiac surgery and anaesthesia, heart failure, transplantation, electrophysiology, reproductive and high risk pregnancy services, genetics, pulmonary hypertension, hepatology, nephrology, haematology, and others. None of these services are easily available “off the rack”, although with time, experience, and determination, these services can develop very well. Facilities with experienced personnel to provide competent care for adults with congenital cardiac disease are becoming increasingly available. Parents and patients should learn that these facilities exist, and be directed to one by their paediatric caregivers when the time comes for transition to adult care.
With the steady increase in the number of adults with congenital heart disease, an ever increasing number of women with such disease are becoming pregnant. Services are not widely available to assess competently and plan a pregnancy for those with more complex disease. It is essential to have a close interplay between the obstetrician, the adult congenital cardiologist, the fetal medicine perinatologist, and neonatologist.
In both a community based programme and a tertiary care centre, the nuances and complexities of congenital cardiac anatomy, coupled with the high probability of previous operation during childhood, makes the trained congenital cardiothoracic surgeon best suited to deal with the surgical needs of this growing population. It is clear that the majority of adults with congenital heart disease are not “cured”, but require lifelong comprehensive care from specialists who have expertise in this complex arena. There is a growing cadre of healthcare professionals dedicated to improving the care of these patients. More information has become available about their care, and will be improved upon in the next decade. With the support of the general paediatric and paediatric cardiologic communities, and of the Adult Congenital Heart Association, and with the persistence of the providers of care for adults with congenital cardiac disease currently staffing clinics, the care of these patients should become more secure in the next decade as we mature our capabilities.