ORCID Profile
0000-0003-1253-8628
Current Organisations
Thomas Jefferson University Hospital
,
Médecins Sans Frontières/Doctors Without Borders (MSF)
,
Point-of-care Ultrasound in Resource-limited Environments (PURE)
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Publisher: Springer Science and Business Media LLC
Date: 18-02-2021
DOI: 10.1186/S12245-021-00338-9
Abstract: The COVID-19 pandemic has disrupted traditional global point-of-care ultrasound (POCUS) education and training, as a result of travel restrictions. It has also provided an opportunity for innovation using a virtual platform. Tele-ultrasound and video-conferencing are alternative and supportive tools to augment global POCUS education and training. There is a need to support learners and experts to ensure that maximum benefit is gained from the use of these innovative modalities.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
DOI: 10.1097/ACM.0000000000001959
Abstract: During the Ebola Virus Disease (EVD) epidemic in West Africa (2014–2016), many faculty, staff, and trainees from U.S. academic medical centers (i.e., teaching hospitals and their affiliated medical schools AMCs) wished to contribute to the response to the outbreak, but many barriers prevented their participation. Here, the authors describe a successful long-term academic collaboration in Liberia that facilitated participation in the EVD response. This Perspective outlines the role the authors played in the response (providing equipment and training, supporting the return of medical education), the barriers they faced (logistical and financial), and elements that contributed to their success (partnering and coordinating their response with both U.S. and African institutions). There is a paucity of literature discussing the role of AMCs in disaster response, so the authors discuss the lessons learned and offer suggestions about the responsibilities that AMCs have and the roles they can play in responding to disaster situations.
Publisher: Springer Science and Business Media LLC
Date: 08-04-2021
DOI: 10.1186/S13089-021-00220-Y
Abstract: A point-of-care ultrasound education program in obstetrics was developed to train antenatal healthcare practitioners in rural Zanzibar. The study group consisted of 13 practitioners with different training backgrounds: physicians, clinical officers, and nurse/midwives. Trainees received an intensive 2-week antenatal ultrasound course consisting of lectures and hands-on practice followed by 6 months of direct supervision of hands-on scanning and bedside education in their clinical practice environments. Trainees were given a pre-course written exam, a final exam at course completion, and practical exams at 19 and 27 weeks. Trainees were expected to complete written documentation and record ultrasound images of at least 75 proctored ultrasounds. The objective of this study was prospectively to analyze the success of a longitudinal point-of-care ultrasound training program for antepartum obstetrical care providers in Zanzibar. During the 6-month course, trainees completed 1338 ultrasound exams (average 99 exams per trainee with a range of 42–128 and median of 109). Written exam scores improved from a mean of 33.7% (95% CI 28.6–38.8%) at pre-course assessment to 77.5% (95% CI 71–84%) at course completion ( P 0.0001). Practical exam mean scores improved from 71.2% at course midpoint (95% CI 62.3–80.1%) to 84.7% at course completion (95% Cl 78.5–90.8%) ( P 0.0005). Eight of the 13 trainees completed all training requirements including 75 proctored ultrasound exams. Trainees improved significantly on all measures after the training program. 62% of the participants completed all requirements. This relatively low completion rate reflects the challenges of establishing ultrasound capacity in this type of setting. Further study is needed to determine trainees’ long-term retention of ultrasound skills and the impact of the program on clinical practice and health outcomes.
Publisher: Western Journal of Emergency Medicine
Date: 10-07-2020
Publisher: Public Library of Science (PLoS)
Date: 12-12-2018
Publisher: Cureus, Inc.
Date: 17-08-2019
DOI: 10.7759/CUREUS.5413
Publisher: Wiley
Date: 21-11-2020
DOI: 10.1002/AET2.10551
Publisher: Springer Science and Business Media LLC
Date: 24-01-2018
Publisher: American Diabetes Association
Date: 21-07-2017
DOI: 10.2337/DB17-0517
Abstract: Granzyme A is a protease implicated in the degradation of intracellular DNA. Nucleotide complexes are known triggers of systemic autoimmunity, but a role in organ-specific autoimmune disease has not been demonstrated. To investigate whether such a mechanism could be an endogenous trigger for autoimmunity, we examined the impact of granzyme A deficiency in the NOD mouse model of autoimmune diabetes. Granzyme A deficiency resulted in an increased incidence in diabetes associated with accumulation of ssDNA in immune cells and induction of an interferon response in pancreatic islets. Central tolerance to proinsulin in transgenic NOD mice was broken on a granzyme A–deficient background. We have identified a novel endogenous trigger for autoimmune diabetes and an in vivo role for granzyme A in maintaining immune tolerance.
Publisher: Wiley
Date: 24-07-2018
DOI: 10.1002/JUM.14697
Abstract: Ultrasound (US) is increasingly used in settings where commercial US gel is unavailable. This study evaluated noncommercial gel recipes compared to commercial gel. A search for US gel formulations revealed 6 recipes. Half-strength commercial gel and a modified glucomannan recipe were also tested. Nine gels, including commercial gel, were tested in Liberia and the United States. In each session, 2 physician sonologists evaluated 9 gels on 2 models, obtaining videos from the hepatorenal space with a curvilinear transducer, the cardiac parasternal long view with a phased array transducer, and the left basilic vein with a linear transducer. The sonologists and models, who were blinded to gel identity, made independent quantitative and qualitative gel evaluations comparing the test gel to commercial gel. Two physician sonologists who were blinded to the gel identities and a US operator reviewed the images and rated their quality. An analysis of variance in repeated measures was performed to test for differences in the overall score, real-time quality, and other characteristics. Post hoc pairwise comparisons to commercial gel were performed with a Tukey-Kramer adjustment. Inter- and intra-rater reliability was calculated for the image review. Commercial gel earned a perfect score. Compared to commercial gel, xanthine gum gel scored highest, followed by half-strength commercial gel. Hot concentrated glucomannan and cold glucomannan gel were found to be significantly worse than commercial gel. No significant difference was found between images based on the gel used on the image review. No significant difference in image quality was found between commercial and noncommercial gels on US image review.
Publisher: Wiley
Date: 06-09-2019
DOI: 10.1002/JUM.15126
Abstract: The aim of this study was to evaluate the accuracy and timeliness of resident‐performed point‐of‐care lung ultrasound (LUS) examinations for the follow‐up of pneumothorax (PTX) after tube thoracostomy. After brief training, Rwandan surgical residents blinded to chest radiography (CXR) performed and interpreted LUS examinations for PTX in participants undergoing CXR for PTX follow‐up. Treating clinicians interpreted CXR for the presence of PTX for therapeutic decisions. Lung ultrasound was later reviewed by ultrasound experts, and CXR was reviewed by a radiologist. We defined expert LUS interpretation as the reference standard. The sensitivity and specificity of resident‐performed LUS examinations for diagnosing PTX were calculated. We assessed agreement between trained resident versus expert LUS and clinician versus radiology CXR using the Cohen κ coefficient. We compared the time to results between LUS and CXR. Over an 8‐month period, 51 participants were enrolled. Compared to expert LUS interpretation, the sensitivity and specificity (95% confidence intervals) of resident LUS were 100% (85%–100%) and 96% (82%–100%), respectively, whereas the sensitivity and specificity of clinician‐interpreted CXR were 48% (27%–69%) and 100% (88%–100%). The agreement between resident and expert LUS was excellent (κ = 0.96), whereas the agreement between clinician and radiologist CXR was only moderate (κ = 0.60). The time to results was significantly longer for CXR than LUS (mean, 1335 versus 396 minutes P = .0001). A resident‐performed LUS examination was a quicker imaging modality with superior sensitivity compared to clinician‐interpreted CXR for PTX follow‐up after tube thoracostomy in this Rwandan study. Lung ultrasound can be a valuable imaging tool for PTX follow‐up, especially in resource‐limited settings.
Publisher: Oxford University Press (OUP)
Date: 31-03-2017
DOI: 10.1093/CID/CIX290
Publisher: Cold Spring Harbor Laboratory
Date: 10-12-2019
DOI: 10.1101/869149
Abstract: Cytotoxic T-lymphocytes (CTLs) and natural killer cells (NKs) kill compromised cells to defend against tumor and viral infections. Both effector cell types use multiple strategies to induce target cell death including Fas/CD95 activation and the release of perforin and a group of lymphocyte granule serine proteases called granzymes. Granzymes have relatively broad and overlapping substrate specificities and may hydrolyze a wide range of peptidic epitopes it is therefore challenging to identify their natural and synthetic substrates and to distinguish their localization and functions. Here, we present a specific and potent substrate, an inhibitor, and an activity-based probe of Granzyme A (GrA) that can be used to follow functional GrA in cells.
Publisher: Wiley
Date: 19-10-2016
DOI: 10.1111/TMI.12780
Abstract: We delivered a point-of-care ultrasound training programme in a resource-limited setting in Rwanda, and sought to determine participants' knowledge and skill retention. We also measured trainees' assessment of the usefulness of ultrasound in clinical practice. This was a prospective cohort study of 17 Rwandan physicians participating in a point-of-care ultrasound training programme. The follow-up period was 1 year. Participants completed a 10-day ultrasound course, with follow-up training delivered over the subsequent 12 months. Trainee knowledge acquisition and skill retention were assessed via observed structured clinical examinations (OSCEs) administered at six points during the study, and an image-based assessment completed at three points. Trainees reported minimal structured ultrasound education and little confidence using point-of-care ultrasound before the training. Mean scores on the image-based assessment increased from 36.9% (95% CI 32-41.8%) before the initial 10-day training to 74.3% afterwards (95% CI 69.4-79.2 P < 0.001). The mean score on the initial OSCE after the introductory course was 81.7% (95% CI 78-85.4%). The mean OSCE performance at each subsequent evaluation was at least 75%, and the mean OSCE score at the 58-week follow up was 84.9% (95% CI 80.9-88.9%). Physicians providing acute care in a resource-limited setting demonstrated sustained improvement in their ultrasound knowledge and skill 1 year after completing a clinical ultrasound training programme. They also reported improvements in their ability to provide patient care and in job satisfaction.
Publisher: Walter de Gruyter GmbH
Date: 15-05-2019
Abstract: In human α1-antitrypsin deficiency, homozygous carriers of the Z (E324K) mutation in the gene SERPINA1 have insufficient circulating α1-antitrypsin and are predisposed to emphysema. Misfolding and accumulation of the mutant protein in hepatocytes also causes endoplasmic reticulum stress and underpins long-term liver damage. Here, we describe transgenic zebrafish ( Danio rerio ) expressing the wildtype or the Z mutant form of human α1-antitrypsin in hepatocytes. As observed in afflicted humans, and in rodent models, about 80% less α1-antitrypsin is evident in the circulation of zebrafish expressing the Z mutant. Although these zebrafish also show signs of liver stress, they do not accumulate α1-antitrypsin in hepatocytes. This new zebrafish model will provide useful insights into understanding and treatment of α1-antitrypsin deficiency.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2019
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/ACEM.14004
Publisher: Springer Science and Business Media LLC
Date: 05-03-2019
Publisher: American Society of Tropical Medicine and Hygiene
Date: 03-02-2021
Abstract: Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with “poor outcome,” defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15–28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0 95% CI: 1.7–14.6 P = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome.
Publisher: Massachusetts Medical Society
Date: 29-01-2015
Publisher: Springer Science and Business Media LLC
Date: 20-02-2018
DOI: 10.1007/S00134-018-5098-8
Abstract: In Table 1 of this article, the numerical data were correct but the graphic part was imprecise.
Publisher: Elsevier BV
Date: 11-2020
Publisher: BMJ
Date: 05-02-2021
DOI: 10.1136/BMJMILITARY-2020-001696
Abstract: Civilian–military relations play an important yet under-researched role in low-income and middle-income country epidemic response. One crucial component of civilian–military relations is defining the role of the military. This paper evaluates the role of Nigerian military during the 2014–2016 West African Ebola epidemic. Focus groups and key informant interviews were conducted throughout three states in North East region of Nigeria: Borno, Yobe and Adamawa. Participants were identified through mapping of stakeholder involvement in Nigerian epidemic response. English-translated transcripts of each key informant interview and focus group discussion were then coded and key themes were elucidated and analysed. Major themes elucidated include developing inclusive coordination plans between civilian and military entities, facilitating human rights reporting mechanisms and distributing military resources more equitably across geographical catchment areas. The Nigerian Military served numerous functions: 37% (22/59) of respondents indicated ‘security eace’ as the military’s primary function, while 42% (25/59) cited health services. Variations across geographic settings were also noted: 35% (7/20) of participants in Borno stated the military primarily provided transportation, while 73% (11/15) in Adamawa and 29% (7/24) in Yobe listed health services. Robust civilian–military relations require an appropriately defined role of the military and clear civilian–military communication. Important considerations to contextualise civilian–military relations include military cultural–linguistic understanding, human rights promotion, and community-based needs assessments such foci can facilitate the military’s understanding of community norms and civilian cooperation with military aims. In turn, more robust civilian–military relations can promote overall epidemic response and reduce the global burden of disease.
Publisher: JMIR Publications Inc.
Date: 18-05-2020
Abstract: elehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19–related concerns. his study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic. creening algorithms for patients with SARS-CoV-2–related complaints were created, and 150 new clinicians were trained within 72 hours to address increased patient demand. Simultaneously, Jefferson Health created mobile testing sites throughout eastern Pennsylvania and the southern New Jersey region. Visit volume, the number of SARS-CoV-2 tests ordered, and the number of positive tests were evaluated, and the volume was compared with preceding time periods. rom March 8, 2020, to April 11, 2020, 4663 patients were screened using telehealth, representing a surge in visit volume. There were 1521 patients sent to mobile testing sites, and they received a telephone call from a centralized call center for results. Of the patients who were tested, nearly 20% (n=301) had a positive result. ur model demonstrates how using telehealth for a referral to central testing sites can increase access to community-based care, decrease clinician exposure, and minimize the demand for personal protective equipment. The scaling of this innovation may allow health care systems to focus on preparing for and delivering hospital-based care needs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2020
Publisher: Cureus, Inc.
Date: 02-04-2017
DOI: 10.7759/CUREUS.1129
Publisher: Springer Science and Business Media LLC
Date: 07-2009
DOI: 10.1017/S1481803500011398
Abstract: Insertion of central venous catheters (CVCs) is an essential competency for emergency physicians. Ultrasound-guided (USG) insertion of CVCs has been shown to be safer than the traditional landmark technique. There is no clear consensus on effective methods for training physicians in USG insertion of CVCs. We developed and evaluated a novel educational training program in the USG technique for insertion of CVCs. Sixteen emergency medicine residents volunteered for a pre- and postprogram evaluation study, which was approved by our research ethics board. After their previous experience was determined, each participant was videotaped inserting a USG CVC in the right internal jugular vein on models. Participants then reviewed a Web-based instructional module and had a practical session. Participants were again videotaped inserting a USG CVC. The primary outcome was the change in score before and after the training program, using an expert-validated performance evaluation tool used to review the videotaped performances in a blinded fashion. Participants also completed a questionnaire to measure their satisfaction with the training program and any change in their perceived competence. Participants ranged from residency year 1 to 5. Thirteen of 16 (81%) had never attempted USG insertion of a CVC. Participants reported that the models were realistic. Performance scores (12/19 to 13.2/19) and global ratings assessments (3.5/7 to 5.5/7) improved significantly ( p & 0.01 the effect size, Cohen d = 1.12 before and 1.28 after) after the instruction. There was good interrater reliability between evaluators of the videotaped performances regarding performance scores (r = 0.68) and global rating scores ( r = 0.75). All participants felt their confidence and technical skills were improved ( p & 0.01) and all felt satisfied with the training program. This brief innovative multimethod training program was effective in enhancing emergency medicine resident competence in USG insertion of CVCs.
Publisher: Springer Science and Business Media LLC
Date: 31-08-2019
DOI: 10.1007/S11886-019-1200-2
Abstract: Acute heart failure (AHF) is a common emergency presentation in Sub-Saharan Africa (SSA). In the current review, we present the most recent data on the epidemiology of AHF in SSA and discuss recommended approaches to management in resource-limited settings, with a particular focus on primary and secondary facilities (e.g., health centers and district hospitals), where these patients often present. AHF in SSA is most often due to hypertension, cardiomyopathies, and rheumatic heart disease. The etiology of AHF may be different in rural as compared with urban settings. Diagnostic tools for AHF are often lacking in SSA, especially at the first-level facilities. Point-of-care ultrasound (POCUS) and biomarker tests, such as brain natriuretic peptide (BNP), offer promise in helping to mitigate diagnostic challenges. POCUS can also help distinguish among types of heart failure and prompt the correct treatment strategy. Many of the drugs and equipment commonly used to treat AHF in resource-rich settings are lacking in SSA. However, some adaptations of commonly available materials may provide temporary alternatives. The epidemiology of AHF in SSA differs from that of high-income settings. Management of AHF at the first-level facility in SSA is an important and understudied problem. Simplified diagnostic and treatment algorithms rooted in knowledge of the local epidemiology should be developed and tested as part of broader efforts to combat cardiovascular disease in SSA.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.ANNEMERGMED.2014.04.013
Abstract: The value of point-of-care ultrasound education in resource-limited settings is increasingly recognized, though little guidance exists on how to best construct a sustainable training program. Herein we offer a practical overview of core factors to consider when developing and implementing a point-of-care ultrasound education program in a resource-limited setting. Considerations include analysis of needs assessment findings, development of locally relevant curriculum, access to ultrasound machines and related technological and financial resources, quality assurance and follow-up plans, strategic partnerships, and outcomes measures. Well-planned education programs in these settings increase the potential for long-term influence on clinician skills and patient care.
Publisher: JMIR Publications Inc.
Date: 16-10-2020
DOI: 10.2196/20419
Abstract: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19–related concerns. This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic. Screening algorithms for patients with SARS-CoV-2–related complaints were created, and 150 new clinicians were trained within 72 hours to address increased patient demand. Simultaneously, Jefferson Health created mobile testing sites throughout eastern Pennsylvania and the southern New Jersey region. Visit volume, the number of SARS-CoV-2 tests ordered, and the number of positive tests were evaluated, and the volume was compared with preceding time periods. From March 8, 2020, to April 11, 2020, 4663 patients were screened using telehealth, representing a surge in visit volume. There were 1521 patients sent to mobile testing sites, and they received a telephone call from a centralized call center for results. Of the patients who were tested, nearly 20% (n=301) had a positive result. Our model demonstrates how using telehealth for a referral to central testing sites can increase access to community-based care, decrease clinician exposure, and minimize the demand for personal protective equipment. The scaling of this innovation may allow health care systems to focus on preparing for and delivering hospital-based care needs.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.AJEM.2019.07.022
Abstract: The purpose of this pilot study was to investigate whether use of a guidewire improves successful placement of ultrasound-guided peripheral IVs (PIV) in difficult intravenous access patients in the emergency department (ED). This was an unblinded, prospective, randomized trial performed by emergency medicine (EM) clinicians at a single academic ED. Eligible participants were randomized to ultrasound-guided PIV placement with or without the use of a guidewire. PIV access was obtained using the Accucath™ 20 gauge × 5.7 cm catheters by way of deployment or non-deployment of the guidewire. Primary outcome measure was first-pass success rate and secondary outcomes included number of attempts, complication rates, and clinician reported ease of insertion. Seventy patients were enrolled and 69 were included in the final analysis. Thirty-four participants were randomized to use of guidewire and 35 to no guidewire. First-pass success rates were similar with and without guidewire use, 47.1% vs. 45.7%, (p = 0.9). There were no differences found in median number of attempts between the two techniques, 2 (IQR 1-2) vs 2 (IQR 1-2), (p = 0.60). The complication rates were similar, 15% vs. 29% (p = 0.25). Clinicians reported no difference in ease of insertion between methods on a 5-point Likert Scale, mean 2.6 vs 2.7 (p = 0.76). In this pilot study comparing ultrasound-guided PIV placement in ED patients using an integrated guidewire versus no guidewire, there was no significant difference in first-pass success, number of attempts, or complication rates. This study provides preliminary data for further investigations.
Publisher: Public Library of Science (PLoS)
Date: 11-06-2021
DOI: 10.1371/JOURNAL.PONE.0252591
Abstract: During the early months of the COVID-19 pandemic, mortality associated with the disease declined in the United States. The standard of care for pharmacological interventions evolved during this period as new and repurposed treatments were used alone and in combination. Though these medications have been studied in idually, data are limited regarding the relative impact of different medication combinations. The objectives of this study were to evaluate the association of COVID-19-related mortality and observed medication combinations and to determine whether changes in medication-related practice patterns and measured patient characteristics, alone, explain the decline in mortality seen early in the COVID-19 pandemic. A retrospective cohort study was conducted at a multi-hospital healthcare system exploring the association of mortality and combinations of remdesivir, corticosteroids, anticoagulants, tocilizumab, and hydroxychloroquine. Multivariable logistic regression was used to identify predictors of mortality for both the overall population and the population stratified by intensive care and non-intensive care unit admissions. A separate model was created to control for the change in unmeasured variables over time. For all patients, four treatment combinations were associated with lower mortality: Anticoagulation Only (OR 0.24, p 0.0001), Anticoagulation and Remdesivir (OR 0.25, p = 0.0031), Anticoagulation and Corticosteroids (OR 0.53, p = 0.0263), and Anticoagulation, Corticosteroids and Remdesivir (OR 0.42, p = 0.026). For non-intensive care unit patients, the same combinations were significantly associated with lower mortality. For patients admitted to the intensive care unit, Anticoagulation Only was the sole treatment category associated with decreased mortality. When adjusted for demographics, clinical characteristics, and all treatment combinations there was an absolute decrease in the mortality rate by 2.5% between early and late periods of the study. However, when including an additional control for changes in unmeasured variables overtime, the absolute mortality rate decreased by 5.4%. This study found that anticoagulation was the most significant treatment for the reduction of COVID-related mortality. Anticoagulation Only was the sole treatment category associated with a significant decrease in mortality for both intensive care and non-intensive care patients. Treatment combinations that additionally included corticosteroids and/or remdesivir were also associated with decreased mortality, though only in the non-intensive care stratum. Further, we found that factors other than measured changes in demographics, clinical characteristics or pharmacological interventions accounted for an additional decrease in the COVID-19-related mortality rate over time.
Publisher: BMJ
Date: 11-03-2016
Publisher: Elsevier BV
Date: 12-2016
Publisher: Wiley
Date: 04-03-2017
Abstract: Few studies of point-of-care ultrasound training and use in low resource settings have reported the impact of examinations on clinical management or the longer-term quality of trainee-performed studies. We characterized the long-term effect of a point-of-care ultrasound program on clinical decision making, and evaluated the quality of clinician-performed ultrasound studies. We conducted point-of-care ultrasound training for physicians from Rwandan hospitals. Physicians then used point-of-care ultrasound and recorded their findings, interpretation, and effects on patient management. Data were collected for 6 months. Trainee studies were reviewed for image quality and accuracy. Fifteen participants documented 1158 ultrasounds 590 studies (50.9%) had matched images and interpretations for review. Abdominal ultrasound for free fluid was the most frequently performed application. The mean image quality score was 2.36 (95% confidence interval, 2.28-2.44). Overall sensitivity and specificity for trainee-performed examinations was 94 and 98%. Point-of-care ultrasound use most commonly changed medications administered (42.4%) and disposition (30%). A point-of-care ultrasound training intervention in a low-resource setting resulted in high numbers of diagnostic-quality studies over long-term follow-up. Ultrasound use routinely changed clinical decision making.
Publisher: Massachusetts Medical Society
Date: 04-07-2019
DOI: 10.1056/NEJMP1902830
Publisher: Elsevier BV
Date: 11-2013
Publisher: Cold Spring Harbor Laboratory
Date: 17-03-2019
DOI: 10.1101/580712
Abstract: Macrophage Expressed Gene-1 (MPEG-1 also termed Perforin-2) is an endosomal / phagolysosomal perforin-like protein that is conserved across the metazoan kingdom and that functions within the phagolysosome to damage engulfed microbes. Like the Membrane Attack Complex and perforin, MPEG-1 has been postulated to form pores in target membranes, however, its mode of action remains to be established. We used single particle cryo-Electron Microscopy to determine the 2.4 Å structure of a hexadecameric assembly of MPEG-1 that displays the expected features of a soluble pre-pore complex. We further discovered that the MPEG-1 pre-pore-like assemblies can be induced to perforate membranes through mild acidification, such as would occur within maturing phagolysosomes. We next solved the 3.6 Å cryo-EM structure of MPEG-1 in complex with liposomes. Remarkably these data revealed that a C-terminal Multi-vesicular body of 12 kDa (MVB12)-associated β -prism (MABP) domain interacts with target membranes in a mode that positions the pore forming machinery of MPEG-1 to point away from the bound membrane. This unexpected mechanism of membrane interaction raises the intriguing possibility that MPEG-1 may be able to remain bound to the phagolysosome membrane while simultaneously forming pores in engulfed bacterial targets.
Location: United States of America
Location: United States of America
Location: Canada
Location: United States of America
Location: United States of America
No related grants have been discovered for Patricia Henwood.