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"Weeks, Sarah"
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Soof
All her life Aurora has heard stories about how wonderful and lucky Heidi is, and soon this paragon (now grown up and expecting a baby) will be visiting; but before she arrives part of their house is damaged in a fire, and worse, Aurora's beloved dog disappears--and while her parents have always believed in \"soof\" (Heidi's mom's word for love), Aurora, who has never really fit in with children her own age, will just have to find her own soof.
Book
Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy
Background
The presence and extent of late gadolinium enhancement (LGE) has been associated with adverse events in patients with hypertrophic cardiomyopathy (HCM). Signal intensity (SI) threshold techniques are routinely employed for quantification; Full-Width at Half-Maximum (FWHM) techniques are suggested to provide greater reproducibility than Signal Threshold versus Reference Mean (STRM) techniques, however the accuracy of these approaches versus the manual assignment of optimal SI thresholds has not been studied. In this study, we compared all known semi-automated LGE quantification techniques for accuracy and reproducibility among patients with HCM.
Methods
Seventy-six HCM patients (51 male, age 54 ±13 years) were studied. Total LGE volume was quantified using 7 semi-automated techniques and compared to expert manual adjustment of the SI threshold to achieve optimal segmentation. Techniques tested included STRM based thresholds of >2, 3, 4, 5 and 6 SD above mean SI of reference myocardium, the FWHM technique, and the Otsu-auto-threshold (OAT) technique. The SI threshold chosen by each technique was recorded for all slices. Bland-Altman analysis and intra-class correlation coefficients (ICC) were reported for each semi-automated technique versus expert, manually adjusted LGE segmentation. Intra- and inter-observer reproducibility assessments were also performed.
Results
Fifty-two of 76 (68%) patients showed LGE on a total of 202 slices. For accuracy, the STRM >3SD technique showed the greatest agreement with manual segmentation (ICC =0.97, mean difference and 95% limits of agreement =1.6 ± 10.7 g) while STRM >6SD, >5SD, 4SD and FWHM techniques systematically underestimated total LGE volume. Slice based analysis of selected SI thresholds similarly showed the STRM >3SD threshold to most closely approximate manually adjusted SI thresholds (ICC =0.88). For reproducibility, the intra- and inter-observer reproducibility of the >3SD threshold demonstrated an acceptable mean difference and 95% limits of agreement of -0.5 ± 6.8 g and -0.9 ± 5.6 g, respectively.
Conclusions
FWHM segmentation provides superior reproducibility, however systematically underestimates total LGE volume compared to manual segmentation in patients with HCM. The STRM >3SD technique provides the greatest accuracy while retaining acceptable reproducibility and may therefore be a preferred approach for LGE quantification in this population.
Journal Article
Children's book of philosophy : an introduction to the world's great thinkers and their big ideas
Explores philosophy and notable philosophers, discussing \"thought experiments,\" and how to explain a complex idea through a story.
Book
The Alberta Heart Failure Etiology and Analysis Research Team (HEART) study
Background
Nationally, symptomatic heart failure affects 1.5-2% of Canadians, incurs $3 billion in hospital costs annually and the global burden is expected to double in the next 1–2 decades. The current one-year mortality rate after diagnosis of heart failure remains high at >25%. Consequently, new therapeutic strategies need to be developed for this debilitating condition.
Methods/Design
The objective of the Alberta HEART program (
http://albertaheartresearch.ca
) is to develop novel diagnostic, therapeutic and prognostic approaches to patients with heart failure with preserved ejection fraction. We hypothesize that novel imaging techniques and biomarkers will aid in describing heart failure with preserved ejection fraction. Furthermore, the development of new diagnostic criteria will allow us to: 1) better define risk factors associated with heart failure with preserved ejection fraction; 2) elucidate clinical, cellular and molecular mechanisms involved with the development and progression of heart failure with preserved ejection fraction; 3) design and test new therapeutic strategies for patients with heart failure with preserved ejection fraction. Additionally, Alberta HEART provides training and education for enhancing translational medicine, knowledge translation and clinical practice in heart failure. This is a prospective observational cohort study of patients with, or at risk for, heart failure. Patients will have sequential testing including quality of life and clinical outcomes over 12 months. After that time, study participants will be passively followed via linkage to external administrative databases. Clinical outcomes of interest include death, hospitalization, emergency department visits, physician resource use and/or heart transplant. Patients will be followed for a total of 5 years.
Discussion
Alberta HEART has the primary objective to define new diagnostic criteria for patients with heart failure with preserved ejection fraction. New criteria will allow for targeted therapies, diagnostic tests and further understanding of the patients, both at-risk for and with heart failure.
Trial registration
ClinicalTrials.gov
NCT02052804
.
Journal Article
Lizzy McTizzy and the busy dizzy day
\"Lizzy McTizzy can't find her shoe! She's late for the party, but what can she do? Lizzy will stop at nothing to find her missing shoe! Whether she's swinging from the chandelier or looking under the cat, Lizzy is determined to find it in time for the party. After all, she needs two matching shoes . . . or does she? Join Lizzy as she learns that being yourself is the best accessory of all!\"--Jacket flap.
Book
940 A retrospective service evaluation of margins used to create planning target volume (PTV) in definitive external beam image guided radiotherapy (IGRT) for cervical cancer at the royal devon university healthcare
Introduction/BackgroundOur aim was to analyse the PTV used for cervical external beam radiotherapy and to determine whether smaller margins could be used without affecting clinical target volume (CTV) coverage to reduce toxicity.The significant organ motion during pelvic radiotherapy is well recognised and locally the INTERLACE protocol for IGRT using intensity modulated radiotherapy (IMRT) has been adopted with 2cm or 3cm PTV set-up margin with a ‘plan of the day’ model.MethodologyAll patients receiving radical definitive radiotherapy for cervical cancer at the Royal Devon and Exeter Hospital between 1/3/2021 and 31/12/2021 were included (n=13). They received 45 gray (6/13) or 55 gray (7/13) in 25 fractions. The radiographer-led choice between 2cm or 3cm margins with daily on-set cone beam computed tomography (CBCT) was reviewed. Based on CBCT, a margin calculation was performed to determine what margin was required to cover the disease.ResultsResults showed 23.1% (3/13) of patients were adequately treated with 2cm margin throughout, described as non-movers. These 3 patients could have been adequately treated with a 1.5cm margin; a 1cm margin would cover 77.3% of fractions. The remaining 10 patients required the 3cm margin for 15.9% of fractions (mean 3.9/25, range 2–8). For these patients a 1cm margin would cover 31.8% of fractions and 1.5cm 66.6%.ConclusionIn conclusion a smaller set-up margin can be utilised, particularly in ‘non-movers’, without compromising disease coverage. Reducing the PTV allows decreased dose to organs at risk, reducing likelihood of toxicity but further analysis of dosimetry and radiographer plan selection is requiredDisclosuresNil
Journal Article
Save me a seat
Ravi has just moved to the United States from India and has always been at the top of his class; Joe has lived in the same town his whole life and has learning problems--but when their lives intersect in the first week of fifth grade they are brought together by a common enemy (the biggest bully in their class) and the need to take control of their lives.
Book
Catfish Kate and the sweet swamp band
While Catfish Kate and her friends are making sweet swamp music, Skink and his Skunktail boys are trying to read and they demand that the girls be quiet, but Kate finds a clever compromise.
Book
Statin induced regression of cardiomyopathy trial: A randomized, placebo-controlled double-blind trial
Hypertrophic cardiomyopathy (HCM), characterized by a thickened, fibrotic myocardium, remains the most common cause of sudden cardiac death in young adults. Based on animal and clinical data, we hypothesized that atorvastatin would induce left ventricular (LV) mass regression.
Statin Induced Regression of Cardiomyopathy Trial (SIRCAT) was a randomized, placebo-controlled study. The primary endpoint was change in LV mass measured by cardiac magnetic resonance imaging 12 months after treatment with once-daily atorvastatin 80 mg or placebo. A key secondary endpoint was diastolic dysfunction measured echocardiographically by transmitral flow velocities. SIRCAT is registered with www.clinicaltrials.gov (NCT00317967).
Of 222 screened patients, 22 were randomized evenly to atorvastatin and placebo. The mean age was 47 ± 10 years, and 15 (68%) were male. All subjects completed the protocol. At baseline, LV masses were 197 ± 76 g and 205 ± 82 g in the placebo and atorvastatin groups, respectively. After 12 months treatment, the LV masses in the placebo and atorvastatin groups were 196 ± 80 versus 206 ± 92 g (
= 0.80), respectively. Echocardiographic indices were not different in the two groups at baseline. After 12 months, diastolic dysfunction as assessed using transmitral flow velocities E/E', A/A', and peak systolic mitral velocity showed no benefit from atorvastatin.
In patients with HCM, atorvastatin did not cause LV mass regression or improvements in LV diastolic function.
Journal Article