Background: Family structure is known to influence children's behavioral, educational, and cognitive outcomes, and recent studies suggest that family structure affects children's access to health care as well.However, no study has addressed whether family structure is associated with the care children receive for particular conditions or with their physical health outcomes.Objective: To assess the effects of family structure on the treatment and outcomes of children with asthma.Methods: Our data sources were the 1996-2003 Medical Expenditure Panel Survey (MEPS) and the 2003 National Survey of Children's Health (NSCH).The study samples consisted of children 2-17 years of age with asthma who lived in single-mother or two-parent families.We assessed the effect of number of parents and number of other children in the household on office visits for asthma and use of asthma medications using negative binomial regression, and we assessed the effect of family structure on the severity of asthma symptoms using binary and ordinal logistic regression.Our regression models adjusted for sociodemographic characteristics, parental experience in child-rearing and in caring for an asthmatic child and, when appropriate, measures of children's health status.Results: Asthmatic children in single-mother families had fewer office visits for asthma and filled fewer prescriptions for controller medications than children with two parents.In addition, children living in families with three or more other children had fewer office visits and filled fewer prescriptions for reliever and controller medications than children living with no other children.Children from single-mother families had more health difficulties from asthma than children with two parents, and children living with two or more other children were more likely to have an asthma attack in the past 12 months than children living with no other children.Conclusions: For children with asthma, living with a single mother and the presence of additional children in the household are associated with less treatment for asthma and worse asthma outcomes.
Chest X-ray is one of the most commonly performed radiologic procedures for respiratory diseases. Digital tomosynthesis (DTS) provides volumetric anatomic information at lower cost and dose compared to computed tomography (CT). However, current DTS system provides insufficient patient positioning feedback and requires a large number of reconstructed slices in order to ensure imaging the entirety of targeted anatomy. We propose an anatomy registration prototype using measurements from RGB-D cameras to 1) assist acquisition workflow, 2) provide individual-specific anatomical information to improve tomosynthesis reconstruction. Our experiments show that anatomy registration can provide real-time feedback of patient 2D position and body thickness. Our reconstruction simulations show that the anatomy and body information can speed up DTS reconstruction, reduce the number of redundant tomosynthesis slices, and help reduce image interpretation time.
We study Milky Way kinematics using a sample of 18.8 million main-sequence stars with r<20 and proper-motion measurements derived from SDSS and POSS astrometry, including ~170,000 stars with radial-velocity measurements from the SDSS spectroscopic survey. Distances to stars are determined using a photometric parallax relation, covering a distance range from ~100 pc to 10 kpc over a quarter of the sky at high Galactic latitudes (|b|>20 degrees). We find that in the region defined by 1 kpc
Rationale: Tunneled, indwelling pleural catheters (IPCs) have been demonstrated to be an effective method of managing malignant pleural effusions. However, they allow pleurodesis and can therefore be removed in only a subset of patients. A novel, silver nitrate-coated IPC was developed with the intention of creating a rapid, effective chemical pleurodesis to allow more frequent and earlier catheter removal. This study represents the pivotal clinical trial evaluating that catheter versus the standard IPC. Objectives: To compare the efficacy of a novel silver nitrate-eluting indwelling pleural catheter (SNCIPC) with that of a standard, uncoated catheter. Methods: The SWIFT [A Pivotal Multi-Center, Randomized, Controlled, Single-Blinded Study Comparing the Silver Nitrate-Coated Indwelling Pleural Catheter (SNCIPC) to the Uncoated PleurX® Pleural Catheter for the Management of Symptomatic, Recurrent, Malignant Pleural Effusions] trial was a multicenter, parallel-group, randomized, controlled, patient-blind trial. Central randomization occurred according to a computer-generated schedule, stratified by site. Recruitment was from 17 secondary or tertiary care hospitals in the United States and 3 in the United Kingdom and included adult patients with malignant pleural effusion needing drainage, without evidence of lung entrapment or significant loculation. The intervention group underwent insertion of an SNCIPC with maximal fluid drainage, followed by a tapering drainage schedule. The control group received a standard, uncoated catheter. Follow-up was conducted until 90 days. The primary outcome measure was pleurodesis efficacy, measured by fluid drainage, at 30 days. Results: A total of 119 patients were randomized. Five withdrew before receiving treatment, leaving 114 (77 SNCIPC, 37 standard IPC) for analysis. The mean age was 66 years (standard deviation, 11). More patients in the SNCIPC group were inpatients (39% vs. 14%; P = 0.009). For the primary outcome, pleurodesis rates were 12 (32%) of 37 in the control group and 17 (22%) of 77 in the SNCIPC group (rate difference, -0.10; 95% confidence interval, -0.30 to 0.09). Median time to pleurodesis was 11 days (interquartile range, 9 to 23) in the control group and 4 days (interquartile range, 2 to 15) in the SNCIPC group. No significant difference in treatment-related adverse event rates was noted between groups. Conclusions: The SNCIPC did not improve pleurodesis efficacy compared with a standard IPC. This study does not support the wider use of the SNCIPC device. Clinical trial registered with www.clinicaltrials.gov (NCT02649894).
Pulmonary nodules remain a diagnostic challenge for physicians. Minimally invasive biopsy methods include bronchoscopy and CT guided transthoracic needle aspiration (TTNA). A novel electromagnetic guidance transthoracic needle aspiration (ETTNA) procedure which can be combined with navigational bronchoscopy (NB) and endobronchial ultrasound (EBUS) in a single setting has become available.A prospective pilot study examining the safety, feasibility and diagnostic yield of ETTNA in a single procedural setting. All patients enrolled underwent EBUS for lung cancer staging followed by NB and ETTNA. Feasibility of performing ETTNA and a safety assessment by recording procedural related complications including pneumothorax or bleeding was performed. Diagnostic yield of ETTNA defined by a definitive pathologic tissue diagnosis was recorded. An additional diagnostic yield analysis was performed using a cohort analysis of combined interventions (EBUS + NB + ETTNA). All non-diagnostic biopsies were either followed with radiographic imaging or a surgical biopsy was performed.Twenty-four subjects were enrolled. ETTNA was feasible in 96% of cases. No bleeding events occurred. There were five pneumothoraces (21%) of which only two (8%) subjects required drainage. The diagnostic yield for ETTNA alone was 83% and increased to 87% (P=0.0016) when ETTNA was combined with NB. When ETTNA and NB were performed with EBUS for complete staging, the diagnostic yield increased further to 92% (P=0.0001).This is the first human pilot study demonstrating an acceptable safety and feasibility profile with a novel ETTNA system. Further studies are needed to investigate the increased diagnostic yield from this pilot study.
Responding to an article on pacemaker complications published in the December issue of the British Journal of Cardiac Nursing, Cardiologist, Alex Chen, sent in a Letter to the Editor with his thoughts…
The use of mapping to guide peripheral lung navigation (PLN) represents an advance in the management of peripheral pulmonary lesions (PPL). Software has been developed to virtually reconstruct computed tomography images into 3-dimensional airway maps and generate navigation pathways to target PPL. Despite this there remain significant gaps in understanding the factors associated with navigation success and failure including the cartographic performance characteristics of these software algorithms. This study was designed to determine whether differences exist when comparing PLN mapping platforms.An observational direct comparison was performed to evaluate navigation planning software packages for the lung. The primary endpoint was distance from the terminal end of the virtual navigation pathway to the target PPL. Secondary endpoints included distal virtual and segmental airway generations built to the target and/or in each lung.Twenty-five patient chest computed tomography scans with 41 PPL were evaluated. Virtual airway and navigation pathway maps were generated for each scan/nodule across all platforms. Virtual navigation pathway comparison revealed differences in the distance from the terminal end of the navigation pathway to the target PPL (robotic bronchoscopy 9.4 mm vs. tip-tracked electromagnetic navigation 14.2 mm vs. catheter based electromagnetic navigation 17.2 mm, P=0.0005) and in the generation of complete distal airway maps.Comparing PLN planning software revealed significant differences in the generation of virtual airway and navigation maps. These differences may play an unrecognized role in the accurate PLN and biopsy of PPL. Further prospective trials are needed to quantify the effect of the differences reported.
