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  1. Article ; Online: Remote digital health technologies for improving the care of people with respiratory disorders.

    Dunn, Jessilyn / Coravos, Andrea / Fanarjian, Manuel / Ginsburg, Geoffrey S / Steinhubl, Steven R

    The Lancet. Digital health

    2024  Volume 6, Issue 4, Page(s) e291–e298

    Abstract: Respiratory diseases are a leading cause of morbidity and mortality globally. However, existing systems of care, built around scheduled appointments, are not well designed to support the needs of people with chronic and acute respiratory conditions that ... ...

    Abstract Respiratory diseases are a leading cause of morbidity and mortality globally. However, existing systems of care, built around scheduled appointments, are not well designed to support the needs of people with chronic and acute respiratory conditions that can change rapidly and unexpectedly. Home-based and personal digital health technologies (DHTs) allow implementation of new models of care catering to the unique needs of individuals. The high number of respiratory triggers and unique responses to them require a personalised solution for each patient. The real-world, repetitive monitoring capabilities of DHTs enable identification of the normal operating characteristics for each individual and, therefore, recognition of the earliest deviations from that state. However, despite this potential, the number of clinical efficacy studies of DHTs is quite small. Evaluation of clinical effectiveness of DHTs in improving health quality in real-world settings is urgently needed.
    MeSH term(s) Humans ; Digital Health ; Respiratory Tract Diseases/therapy
    Language English
    Publishing date 2024-02-23
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2589-7500
    ISSN (online) 2589-7500
    DOI 10.1016/S2589-7500(23)00248-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Does clinical research account for diversity in deploying digital health technologies?

    Coss, Nathan A / Gaitán, J Max / Adans-Dester, Catherine P / Carruthers, Jessica / Fanarjian, Manuel / Sassano, Caprice / Manuel, Solmaz P / Perakslis, Eric

    NPJ digital medicine

    2023  Volume 6, Issue 1, Page(s) 187

    Abstract: Digital health technologies (DHTs) should expand access to clinical research to represent the social determinants of health (SDoH) across the population. The frequency of reporting participant SDoH data in clinical publications is low and is not known ... ...

    Abstract Digital health technologies (DHTs) should expand access to clinical research to represent the social determinants of health (SDoH) across the population. The frequency of reporting participant SDoH data in clinical publications is low and is not known for studies that utilize DHTs. We evaluated representation of 11 SDoH domains in 126 DHT-enabled clinical research publications and proposed a framework under which these domains could be captured and subsequently reported in future studies. Sex, Race, and Education were most frequently reported (in 94.4%, 27.8%, and 20.6% of publications, respectively). The remaining 8 domains were reported in fewer than 10% of publications. Medical codes were identified that map to each of the proposed SDoH domains and the resulting resource is suggested to highlight that existing infrastructure could be used to capture SDoH data. An opportunity exists to increase reporting on the representation of SDoH among participants to encourage equitable and inclusive research progress through DHT-enabled clinical studies.
    Language English
    Publishing date 2023-10-10
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2398-6352
    ISSN (online) 2398-6352
    DOI 10.1038/s41746-023-00928-2
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  3. Article ; Online: Posterior Reversible Encephalopathic Syndrome in the Setting of Induced Elevated Mean Arterial Pressure in Patients With Spinal Cord Injury.

    Whiting, Alexander C / Fanarjian, Manuel P / Hlubek, Randall J / Godzik, Jakub / Kakarla, U Kumar / Theodore, Nicholas

    Neurosurgery

    2017  Volume 83, Issue 1, Page(s) 16–21

    Abstract: Background and importance: Acute spinal cord injury (SCI) is managed by avoiding hypotension and elevating mean arterial pressure (MAP) to attain optimal perfusion of the spinal cord. Few studies have been published regarding complications related to ... ...

    Abstract Background and importance: Acute spinal cord injury (SCI) is managed by avoiding hypotension and elevating mean arterial pressure (MAP) to attain optimal perfusion of the spinal cord. Few studies have been published regarding complications related to this treatment paradigm.
    Clinical presentation: Three patients with SCI developed posterior reversible encephalopathic syndrome (PRES) during treatment with intravenous fluids and vasopressors administered to maintain elevated MAPs. All of them experienced temporary elevations well above the standard blood pressure goals for acute SCI and deterioration of neurological status.
    Conclusion: PRES is a potential complication of elevated MAPs in patients with SCI, particularly if the blood pressure rises above the goals of standard treatment paradigms. The neurosurgical staff should be suspicious of possible PRES early in the course of acute SCI in patients with unexplained neurological decline. This case series is the first report of PRES in patients with acute SCI.
    MeSH term(s) Aged ; Arterial Pressure/drug effects ; Arterial Pressure/physiology ; Female ; Humans ; Hypertension/complications ; Middle Aged ; Posterior Leukoencephalopathy Syndrome/etiology ; Spinal Cord Injuries/therapy ; Vasoconstrictor Agents/therapeutic use
    Chemical Substances Vasoconstrictor Agents
    Language English
    Publishing date 2017-09-01
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1093/neuros/nyx373
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    Jg. 1995 - 2021: Lesesall (1.OG)
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    Zs.MO 539: Show issues

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  4. Article ; Online: A method for quantifying recurrent patterns of local wavefront direction during atrial fibrillation.

    Hummel, James P / Baher, Alex / Buck, Ben / Fanarjian, Manuel / Webber, Charles L / Akar, Joseph G

    Computers in biology and medicine

    2017  Volume 89, Page(s) 497–504

    Abstract: Introduction: Spiral wave reentry is a potential mechanism of atrial fibrillation (AF), but is difficult to differentiate clinically from multiple wavelet breakup using standard bipolar recordings. We developed a new methodology using bipolar recordings ...

    Abstract Introduction: Spiral wave reentry is a potential mechanism of atrial fibrillation (AF), but is difficult to differentiate clinically from multiple wavelet breakup using standard bipolar recordings. We developed a new methodology using bipolar recordings to estimate the direction of local activation wavefronts during AF by calculating the electrogram conformation (Egm-C). We subsequently used recurrence quantification analysis (RQA) of Egm-C to differentiate regions of spiral wave reentry from wavelet breakup.
    Methods: A 2D computer simulation was created with regions containing a stable spiral wave and also regions of wavebreak. A grid of 40 × 40 unipolar electrodes was superimposed. At each site, the actual wavefront direction (WD) was determined by comparing relative activation timings of the local intracellular recordings, and the estimated wavefront direction (Egm-C) was determined from the morphology of the local bipolar electrogram. RQA of Egm-C was compared to RQA of actual WD in order to differentiate AF mechanisms.
    Results: RQA of actual WD and Egm-C both distinguished regions of spiral wave reentry from wavelet breakup with high correlation between the two methods (recurrence rate, r = 0.96; determinism, r = 0.61; line max, r = 0.95; entropy, r = 0.84; p < 0.001 for all). In areas of stable spiral wave reentry, the recurrence plots of both Egm-C and actual WD demonstrated stable, periodic dynamics, while regions of wavelet breakup demonstrated chaotic behavior largely devoid of repetitive activation patterns.
    Conclusion: Calculation of Egm-C allows RQA to be performed on bipolar electrograms during AF and differentiates regions of spiral wave reentry from multiple wavelet breakup.
    MeSH term(s) Atrial Fibrillation/physiopathology ; Computer Simulation ; Electrocardiography ; Humans ; Models, Cardiovascular
    Language English
    Publishing date 2017-09-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 127557-4
    ISSN 1879-0534 ; 0010-4825
    ISSN (online) 1879-0534
    ISSN 0010-4825
    DOI 10.1016/j.compbiomed.2017.08.027
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    Zs.A 653: Show issues Location:
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  5. Article: A Constant-Volume Ventilator and Gas Recapture System for Hyperpolarized Gas MRI of Mouse and Rat Lungs.

    Nouls, John / Fanarjian, Manuel / Hedlund, Laurence / Driehuys, Bastiaan

    Concepts in magnetic resonance. Part B, Magnetic resonance engineering

    2011  Volume 39B, Issue 2, Page(s) 78–88

    Language English
    Publishing date 2011-03-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 2113479-0
    ISSN 1552-504X ; 1552-5031
    ISSN (online) 1552-504X
    ISSN 1552-5031
    DOI 10.1002/cmr.b.20192
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  6. Article ; Online: Recurrence quantification analysis of complex-fractionated electrograms differentiates active and passive sites during atrial fibrillation.

    Baher, Alex / Buck, Benjamin / Fanarjian, Manuel / Paul Mounsey, J / Gehi, Anil / Chung, Eugene / Akar, Fadi G / Webber, Charles L / Akar, Joseph G / Hummel, James P

    Journal of cardiovascular electrophysiology

    2019  Volume 30, Issue 11, Page(s) 2229–2238

    Abstract: Objectives: To differentiate electrograms representing sites of active atrial fibrillation (AF) drivers from passive ones.: Background: Ablation of complex-fractionated atrial electrograms (CFAEs) is controversial due to difficulty in distinguishing ... ...

    Abstract Objectives: To differentiate electrograms representing sites of active atrial fibrillation (AF) drivers from passive ones.
    Background: Ablation of complex-fractionated atrial electrograms (CFAEs) is controversial due to difficulty in distinguishing CFAEs representing sites of active AF drivers from passive mechanisms. We hypothesized that active CFAE sites exhibit repetitive wavefront directionality, thereby inscribing an electrogram conformation (Egm-C) that is more recurrent compared with passive CFAE sites; and that can be differentiated from passive CFAEs using nonlinear recurrence quantification analysis (RQA).
    Methods: We developed multiple computer models of active CFAE mechanisms (ie, rotors) and passive CFAE mechanisms (ie, wavebreak, slow conduction, and double potentials). CFAE signals were converted into discrete time-series representing Egm-C. The RQA algorithm was used to compare signals derived from active CFAE sites to those from passive CFAEs sites. The RQA algorithm was then applied to human CFAE signals collected during AF ablation (n  =  17 patients).
    Results: RQA was performed in silico on simulated bipolar CFAEs within active (n = 45) and passive (n = 60) areas. Recurrence of Egm-C was significantly higher in active compared with passive CFAE sites (31.8% ± 19.6% vs 0.3% ± 0.5%, respectively, P < .0001) despite no difference in mean cycle length (CL). Similarly, for human AF (n = 39 signals), Egm-C recurrence was higher in active vs passive CFAE areas despite similar CLs (%recurrence 13.6% ± 15.5% vs 0.1% ± 0.3%, P < .002; mean CL 102.5 ± 14.3 vs 106.6 ± 14.4, P = NS).
    Conclusion: Active CFAEs critical to AF maintenance exhibit higher Egm-C recurrence and can be differentiated from passive bystander CFAE sites using RQA.
    MeSH term(s) Action Potentials ; Aged ; Algorithms ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/surgery ; Catheter Ablation ; Computer Simulation ; Electrophysiologic Techniques, Cardiac ; Female ; Heart Atria/physiopathology ; Heart Atria/surgery ; Heart Rate ; Humans ; Male ; Middle Aged ; Models, Cardiovascular ; Predictive Value of Tests ; Signal Processing, Computer-Assisted ; Time Factors
    Language English
    Publishing date 2019-10-02
    Publishing country United States
    Document type Journal Article ; Validation Study ; Video-Audio Media
    ZDB-ID 1025989-2
    ISSN 1540-8167 ; 1045-3873
    ISSN (online) 1540-8167
    ISSN 1045-3873
    DOI 10.1111/jce.14161
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    Zs.A 2863: Show issues Location:
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