Open Access Publications

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Open Access
Comparing Multicarrier Ambiguity Resolution Methods for Geometry-Based GPS and Galileo Relative Positioning and Their Application to Low Earth Orbiting Satellite Attitude Determination
(Hindawi Publishing Corporation, 2009-03-08) O'Keefe, Kyle; Petovello, Mark; Cao, Wei; Lachapelle, Gérard; Guyader, Eric
This paper presents an evaluation of several GNSS multicarrier ambiguity (MCAR) resolution techniques for the purpose of attitude determination of low earth orbiting satellites (LEOs). It is based on the outcomes of the study performed by the University of Calgary and financed by the European 6th Framework Programme for Research and Development as part of the research project PROGENY. The existing MCAR literature is reviewed and eight possible variations of the general MCAR processing scheme are identified based on two possible options for the mathematical model of the float solution, two options for the estimation technique used for the float solution, and finally two possible options for the ambiguity resolution process. The two most promising methods, geometry-based filtered cascading and geometry-based filtered LAMBDA, are analysed in detail for two simulated users modelled after polar orbiting LEOs through an extensive covariance simulation. Both the proposed Galileo constellation and Galileo used in conjunction with the GPS constellation are tested and results are presented in terms of probabilities of correct ambiguity resolution and float and fixed solution baseline accuracies. The LAMBDA algorithm is shown to outperform the cascading method, particularly in the single-frequency dual-GNSS system case. Secondly, more frequencies and multiple GNSS always offer improvement, but the single-frequency dual-system case is found to have similar performance to the dual-frequency single-system case.
Open Access
Assessment of Different Sensor Configurations for Collaborative Driving in Urban Environments
(Hindawi, 2013-01-07) Petovello, Mark G.; Basnayake, Chaminda; O'Keefe, Kyle; Wei, Phil
Vehicle-to-vehicle relative navigation of a network of vehicles travelling in an urban canyon is assessed using least-squares and Kalman filtering covariance simulation techniques. Between-vehicle differential GPS is compared with differential GPS augmented with between-vehicle ultrawideband range and bearing measurements. The three measurement types are combined using both least-squares and Kalman filtering to estimate the horizontal positions of a network of vehicles travelling in the same direction on a road in a simulated urban canyon. The number of vehicles participating in the network is varied between two and nine while the severity of the urban canyon was varied from 15-to 65-degree elevation mask angles. The effect of each vehicle’s azimuth being known a priori, or unknown is assessed. The resulting relative positions in the network of vehicles are then analysed in terms of horizontal accuracy and statistical reliability of the solution. The addition of both range and bearing measurements provides protection levels on the order of 2 m at almost all times where DGPS alone only rarely has observation redundancy and often exhibits estimated accuracies worse than 200 m. Reliability is further improved when the vehicle azimuth is assumed to be known a priori.
Open Access
Integrating Systemic Therapies into the Multimodality Treatment of Resectable Colorectal Liver Metastases
(2018-06-21) Abdel-Rahman, Omar; Cheung, Winson Y.
Colorectal carcinoma (CRC) is one of the most common cancers worldwide. A considerable proportion of CRC patients may present with metastatic disease either at upfront presentation (synchronous with the primary) or following diagnosis and treatment of the primary tumor (metachronous). Management of CRC liver metastases is a challenging endeavor which frequently necessitates proper assessment of patient- and disease-related factors. There is an opportunity within the management of CRC liver metastases to incorporate multiple treatment modalities (including surgery, other locoregional treatments, and systemic therapy). The current review aims to provide an updated overview on the optimal management strategy for CRC patients with liver metastases with a specific focus on the integration of systemic and/or locoregional treatments among patients with resectable or potentially resectable disease.
Open Access
Channeling Vision: CaV1.4—A Critical Link in Retinal Signal Transmission
(2018-05-09) Waldner, D. M.; Bech-Hansen, N. T.; Stell, W. K.
Voltage-gated calcium channels (VGCC) are key to many biological functions. Entry of Ca2+ into cells is essential for initiating or modulating important processes such as secretion, cell motility, and gene transcription. In the retina and other neural tissues, one of the major roles of Ca2+-entry is to stimulate or regulate exocytosis of synaptic vesicles, without which synaptic transmission is impaired. This review will address the special properties of one L-type VGCC, , with particular emphasis on its role in transmission of visual signals from rod and cone photoreceptors (hereafter called “photoreceptors,” to the exclusion of intrinsically photoreceptive retinal ganglion cells) to the second-order retinal neurons, and the pathological effects of mutations in the CACNA1F gene which codes for the pore-forming subunit of
Open Access
Simultaneous Hierarchical Clustering for Cell Formation Problems with Production Information
(2018-05-20) Zhu, Yingyu; Li, Simon
The purpose of this paper is to advance the similarity coefficient method to solve cell formation (CF) problems in two aspects. Firstly, while numerous similarity coefficients have been proposed to incorporate different production factors in literature, a weighted sum formulation is applied to aggregate them into a nonbinary matrix to indicate the dependency strength among machines and parts. This practice allows flexible incorporation of multiple production factors in the resolution of CF problems. Secondly, a two-mode similarity coefficient is applied to simultaneously form machine groups and part families based on the classical framework of hierarchical clustering. This practice not only eliminates the sequential process of grouping machines (or parts) first and then assigning parts (or machines), but also improves the quality of solutions. The proposed clustering method has been tested through twelve literature examples. The results demonstrate that the proposed method can at least yield solutions comparable to the solutions obtained by metaheuristics. It can yield better results in some instances, as well.
Open Access
Bioprocessing of Mesenchymal Stem Cells and Their Derivatives: Toward Cell-Free Therapeutics
(2018-09-12) Phelps, Jolene; Sanati-Nezhad, Amir; Ungrin, Mark; Duncan, Neil A.; Sen, Arindom
Mesenchymal stem cells (MSCs) have attracted tremendous research interest due to their ability to repair tissues and reduce inflammation when implanted into a damaged or diseased site. These therapeutic effects have been largely attributed to the collection of biomolecules they secrete (i.e., their secretome). Recent studies have provided evidence that similar effects may be produced by utilizing only the secretome fraction containing extracellular vesicles (EVs). EVs are cell-derived, membrane-bound vesicles that contain various biomolecules. Due to their small size and relative mobility, they provide a stable mechanism to deliver biomolecules (i.e., biological signals) throughout an organism. The use of the MSC secretome, or its components, has advantages over the implantation of the MSCs themselves: (i) signals can be bioengineered and scaled to specific dosages, and (ii) the nonliving nature of the secretome enables it to be efficiently stored and transported. However, since the composition and therapeutic benefit of the secretome can be influenced by cell source, culture conditions, isolation methods, and storage conditions, there is a need for standardization of bioprocessing parameters. This review focuses on key parameters within the MSC culture environment that affect the nature and functionality of the secretome. This information is pertinent to the development of bioprocesses aimed at scaling up the production of secretome-derived products for their use as therapeutics.
Open Access
Mesenchymal Stromal/Stem Cells in Regenerative Medicine and Tissue Engineering
(2018-08-19) Fitzsimmons, Ross E. B.; Mazurek, Matthew S.; Soos, Agnes; Simmons, Craig A.
As a result of over five decades of investigation, mesenchymal stromal/stem cells (MSCs) have emerged as a versatile and frequently utilized cell source in the fields of regenerative medicine and tissue engineering. In this review, we summarize the history of MSC research from the initial discovery of their multipotency to the more recent recognition of their perivascular identity in vivo and their extraordinary capacity for immunomodulation and angiogenic signaling. As well, we discuss long-standing questions regarding their developmental origins and their capacity for differentiation toward a range of cell lineages. We also highlight important considerations and potential risks involved with their isolation, ex vivo expansion, and clinical use. Overall, this review aims to serve as an overview of the breadth of research that has demonstrated the utility of MSCs in a wide range of clinical contexts and continues to unravel the mechanisms by which these cells exert their therapeutic effects.
Open Access
Innate and Adaptive Cell Populations Driving Inflammation in Dry Eye Disease
(2018-08-12) Reyes, José L.; Vannan, Danielle T.; Eksteen, Bertus; Avelar, Imelda Juárez; Rodríguez, Tonathiu; González, Marisol Ibet; Mendoza, Alicia Vázquez
Dry eye disease (DED) is the most common ocular disease and affects millions of individuals worldwide. DED encompasses a heterogeneous group of diseases that can be generally divided into two forms including aqueous-deficient and evaporative DED. Evidence suggests that these conditions arise from either failure of lacrimal gland secretion or low tear film quality. In its secondary form, DED is often associated with autoimmune diseases such as Sjögren’s syndrome and rheumatoid arthritis. Current treatment strategies for DED are limited to anti-inflammatory medications that target the immune system as the source of deleterious inflammation and tissue injury. However, there is a lack of understanding of the underlying pathogenesis of DED, and subsequently, there are very few effective treatment strategies. The gap in our knowledge of the etiology of primary DED is in part because the majority of research in DED focused on secondary autoimmune causes. This review focuses on what is currently understood about the contribution of innate and adaptive immune cell populations in the pathogenesis of DED and highlights the need to continue investigating the central role of immunity driving DED.
Open Access
Experts’ opinion about the pediatric secondary headaches diagnostic criteria of the ICHD-3 beta
(2017-11-29) Özge, Aynur; Abu-Arafeh, Ishaq; Gelfand, Amy A; Goadsby, Peter J; Cuvellier, Jean C; Valeriani, Massimiliano; Sergeev, Alexey; Barlow, Karen; Uludüz, Derya; Yalın, Osman Ö; Faedda, Noemi; Lipton, Richard B; Rapoport, Alan; Guidetti, Vincenzo
Abstract Background The 2013 International Classification of Headache Disorders-3 was published in a beta version to allow clinicians to confirm the validity of the criteria or suggest improvements based on field studies. The aim of this work was to review the Secondary Headache Disorders and Cranial Neuralgias and Other Headache Disorders sections of ICHD-3 beta data on children and adolescents (age 0–18 years) and to suggest changes, additions, and amendments. Methods Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the available literature on pediatric headache, they made observations and proposed suggestions for the mentioned headache disorders on children and adolescents. Results Some headache disorders in children have specific features, which are different from adults that should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psychosocial basis in children and adolescents making primary headache disorders in children distinct from those in adults. Conclusions Several recommendations are presented in order to make ICHD-3 more appropriate for use in children.
Open Access
Experts’ opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents
(2017-11-23) Özge, Aynur; Faedda, Noemi; Abu-Arafeh, Ishaq; Gelfand, Amy A; Goadsby, Peter J; Cuvellier, Jean C; Valeriani, Massimiliano; Sergeev, Alexey; Barlow, Karen; Uludüz, Derya; Yalın, Osman Ö; Lipton, Richard B; Rapoport, Alan; Guidetti, Vincenzo
Abstract Background The 2013 International Classification of Headache Disorders-3 (ICHD-3) was published in a beta version to allow the clinicians to confirm the validity of the criteria or to suggest improvements based on field studies. The aim of this work was to review the Primary Headache Disorders Section of ICHD-3 beta data on children and adolescents (age 0-18 years), and to suggest changes, additions, and amendments. Methods Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the literature available on pediatric headache, they made observations and proposed suggestions for the primary headache disorders section of ICHD-3 beta data on children and adolescents. Results Some headache disorders in children have specific features which are different from those seen in adults and which should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psycho-social basis in children and adolescents making primary headache disorders in children distinct from those in adults. Conclusions Several recommendations are presented in order to make ICHD-3 more appropriate for use with children.
Open Access
Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements
(2017-04-20) Ma, Irene W Y; Caplin, Joshua D; Azad, Aftab; Wilson, Christina; Fifer, Michael A; Bagchi, Aranya; Liteplo, Andrew S; Noble, Vicki E
Abstract Background Non-invasive measures that can accurately estimate cardiac output may help identify volume-responsive patients. This study seeks to compare two non-invasive measures (corrected carotid flow time and carotid blood flow) and their correlations with invasive reference measurements of cardiac output. Consenting adult patients (n = 51) at Massachusetts General Hospital cardiac catheterization laboratory undergoing right heart catheterization between February and April 2016 were included. Carotid ultrasound images were obtained concurrently with cardiac output measurements, obtained by the thermodilution method in the absence of severe tricuspid regurgitation and by the Fick oxygen method otherwise. Corrected carotid flow time was calculated as systole time/√cycle time. Carotid blood flow was calculated as π × (carotid diameter)2/4 × velocity time integral × heart rate. Measurements were obtained using a single carotid waveform and an average of three carotid waveforms for both measures. Results Single waveform measurements of corrected flow time did not correlate with cardiac output (ρ = 0.25, 95% CI −0.03 to 0.49, p = 0.08), but an average of three waveforms correlated significantly, although weakly (ρ = 0.29, 95% CI 0.02–0.53, p = 0.046). Carotid blood flow measurements correlated moderately with cardiac output regardless of if single waveform or an average of three waveforms were used: ρ = 0.44, 95% CI 0.18–0.63, p = 0.004, and ρ = 0.41, 95% CI 0.16–0.62, p = 0.004, respectively. Conclusions Carotid blood flow may be a better marker of cardiac output and less subject to measurements issues than corrected carotid flow time.
Open Access
Strengthening the research agenda of educational integrity in Canada: a review of the research literature and call to action
(2018-07-25) Eaton, Sarah E; Edino, Rachael I
Abstract We present findings of a literature review on the topic of educational integrity in the Canadian context. Our search revealed 56 sources, published between 1992 and 2017. A historical overview showed a rise in the number of scholarly publications in recent years, but with an overall limited number of research contributions. We identified three major themes in the literature: (a) empirical research; (b) prevention and professional development; and (c) other (scholarly essay). Our analysis showed little evidence of sustained research programs in Canada over time or national funding to support integrity-related inquiry. We also found that graduate students who completed their theses on topics related to educational integrity often have not published further work in the field later in their careers. We provide five concrete recommendations to elevate and accelerate the research agenda on educational integrity in Canada on a national level. We conclude with a call to action for increased research to better understand the particular characteristics of educational integrity in Canada.
Open Access
Physical activity does not alter prolactin levels in post-menopausal women: results from a dose-response randomized controlled trial
(2017-07-13) Brenner, Darren R; Ruan, Yibing; Morielli, Andria R; Courneya, Kerry S; Friedenreich, Christine M
Abstract Background Increased circulating levels of prolactin have been associated with increased risk of both in situ and invasive breast cancer. We investigated whether or not physical activity had a dose–response effect in lowering plasma levels of prolactin in postmenopausal women. Methods Four hundred previously inactive but healthy postmenopausal women aged 50–74 years of age were randomized to 150 or 300 min per week of aerobic physical activity in a year-long intervention. Prolactin was measured from fasting samples with a custom-plex multiplex assay. Results A high compared to moderate volume of physical activity did not reduce plasma prolactin levels in intention-to-treat (Treatment Effect Ratio (TER) 1.00, 95% Confidence Interval (CI) 0.95 – 1.06) or per-protocol analyses (TER 1.02, 95% CI 0.93 – 1.13). Conclusions It is unlikely that changes in prolactin levels mediate the reduced risk of breast cancer development in post-menopausal women associated with increased levels of physical activity. Trial registration clinicaltrials.gov identifier: NCT01435005 .
Open Access
Surgical frailty assessment: a missed opportunity
(2017-07-24) Eamer, Gilgamesh; Gibson, Jennifer A; Gillis, Chelsia; Hsu, Amy T; Krawczyk, Marian; MacDonald, Emily; Whitlock, Reid; Khadaroo, Rachel G
Abstract Background Preoperative frailty predicts adverse postoperative outcomes. Despite the advantages of incorporating frailty assessment into surgical settings, there is limited research on surgical healthcare professionals’ use of frailty assessment for perioperative care. Methods Healthcare professionals caring for patients enrolled at a Canadian teaching hospital were surveyed to assess their perceptions of frailty, as well as attitudes towards and practices for frail patients. The survey contained open-ended and 5-point Likert scale questions. Responses were compared across professions using independent sample t-tests and correlations between survey items were analyzed. Results Nurses and allied health professionals were more likely than surgeons to think frailty should play a role in planning a patient’s care (nurses vs. surgeons p = 0.008, allied health vs. surgeons p = 0.014). Very few respondents (17.5%) reported that they ‘always used’ a frailty assessment tool. Results from qualitative data analysis identified four main barriers to frailty assessment: institutional, healthcare system, professional knowledge, and patient/family barriers. Conclusion Across all disciplines, the lack of knowledge about frailty issues was a prominent barrier to the use of frailty assessments in practice, despite clinicians’ understanding that frailty affects their patients’ outcomes. Confidence in frailty assessment tool use through education and addressing barriers to implementation may increase use and improve patient care. Healthcare professionals agree that frailty assessments should play a role in perioperative care. However, few perform them in practice. Lack of knowledge about frailty is a key barrier in the use of frailty assessments and the majority of respondents agreed that they would benefit from further training.
Open Access
Realizing drug repositioning by adapting a recommendation system to handle the process
(2018-04-12) Ozsoy, Makbule G; Özyer, Tansel; Polat, Faruk; Alhajj, Reda
Abstract Background Drug repositioning is the process of identifying new targets for known drugs. It can be used to overcome problems associated with traditional drug discovery by adapting existing drugs to treat new discovered diseases. Thus, it may reduce associated risk, cost and time required to identify and verify new drugs. Nowadays, drug repositioning has received more attention from industry and academia. To tackle this problem, researchers have applied many different computational methods and have used various features of drugs and diseases. Results In this study, we contribute to the ongoing research efforts by combining multiple features, namely chemical structures, protein interactions and side-effects to predict new indications of target drugs. To achieve our target, we realize drug repositioning as a recommendation process and this leads to a new perspective in tackling the problem. The utilized recommendation method is based on Pareto dominance and collaborative filtering. It can also integrate multiple data-sources and multiple features. For the computation part, we applied several settings and we compared their performance. Evaluation results show that the proposed method can achieve more concentrated predictions with high precision, where nearly half of the predictions are true. Conclusions Compared to other state of the art methods described in the literature, the proposed method is better at making right predictions by having higher precision. The reported results demonstrate the applicability and effectiveness of recommendation methods for drug repositioning.
Open Access
Correction to: Realizing drug repositioning by adapting a recommendation system to handle the process
(2018-07-02) Ozsoy, Makbule G; Özyer, Tansel; Polat, Faruk; Alhajj, Reda
Following publication of the original article [1], the authors reported that there was an error in the spelling of the name of one of the authors.
Open Access
Medication use by middle-aged and older participants of an exercise study: results from the Brain in Motion study
(2017-02-10) Pannu, Tania; Sharkey, Sarah; Burek, Grazyna; Cretu, Daniela; Hill, Michael D; Hogan, David B; Poulin, Marc J
Abstract Background Over the past 50 years, there has been an increase in the utilization of prescribed, over-the-counter (OTC) medications, and natural health products. Although it is known that medication use is common among older persons, accurate data on the patterns of use, including the quantity and type of medications consumed in a generally healthy older population from a Canadian perspective are lacking. In this study, we study the pattern of medication use in a sedentary but otherwise healthy older persons use and determined if there was an association between medication use and aerobic fitness level. Methods All participants enrolled in the Brain in Motion study provided the name, formulation, dosage and frequency of any medications they were consuming at the time of their baseline assessment. Maximal aerobic capacity (VO2max) was determined on each participant. Results Two hundred seventy one participants (mean age 65.9 ± 6.5 years; range 55–92; 54.6% females) were enrolled. Most were taking one or more (1+) prescribed medication (n = 204, 75.3%), 1+ natural health product (n = 221, 81.5%) and/or 1+ over-the-counter (OTC) drug (n = 174, 64.2%). The most commonly used prescribed medications were HMG-CoA reductase inhibitors (statins) (n = 52, 19.2%). The most common natural health product was vitamin D (n = 201, 74.2%). For OTC drugs, non-steroidal anti-inflammatories (n = 82, 30.3%) were the most common. Females were more likely than males to take 1+ OTC medications, as well as supplements. Those over 65 years of age were more likely to consume prescription drugs than their counterparts (p ≤ 0.05). Subjects taking more than two prescribed or OTC medications were less physically fit as determined by their VO2max. The average daily Vitamin D intake was 1896.3 IU per participant. Conclusions Medication use was common in otherwise healthy older individuals. Consumption was higher among females and those older than 65 years. Vitamin D intake was over two-fold higher than the recommended 800 IU/day for older persons, but within the tolerable upper intake of 4,000 IU/day. The appropriateness of the high rate of medication use in this generally healthy population deserves further investigation.
Open Access
Integrative health care – What are the relevant health outcomes from a practice perspective? A survey
(2017-12-22) Kania-Richmond, Ania; Metcalfe, Amy
Abstract Background Integrative health care (IHC) is an innovative approach to health care delivery. There is increasing focus on and demand for the evaluation of IHC practices. To ensure such evaluations capture their full scope, a clear understanding of the types of outcomes relevant to an IHC approach is needed. The objective was to describe the health domains and health outcomes relevant to IHC practices in Canada. Methods An online survey of Canadian IHC clinics. Survey questions were informed by the IN-CAM Health Outcomes Database. Descriptive statistics were used to summarize the data. Chi square tests were used to compare responses between clinic types and patient groups served. Results Surveys were completed by 21 clinics (response rate: 50%). Physical, psychological, social, individualized and holistic were identified as applicable health domains by more than 90% of the clinics. Spiritual domain was the least relevant (70% of clinics). A number of relevant outcomes within each domain were identified. A core set of outcomes were identified and included: fatigue, anxiety, stress, and patient-provider relationship, and quality of life. Clinics with primarily conventional health practitioners were less likely to address overall well-being (p = 0.04), while clinics that provided care to a specialized patient population (i.e. cancer patients) or a mix of general and specialized patients were less likely to address religious practices (p = 0.04) or spiritual experiences (p = 0.007). Conclusions Outcomes across health domains should be considered in the evaluation of IHC models to generate an understanding of the full scope of effectiveness of IHC approaches. The core set of outcomes identified may facilitate this task. Ethics approval (Ethics ID REB14-0495) was received from the Conjoint Health Research Ethics Board at the University of Calgary.
Open Access
World Congress Integrative Medicine & Health 2017: part two
(2017-06-30) Ee, Carolyn; Thuraisingam, Sharmala; Pirotta, Marie; French, Simon; Xue, Charlie; Teede, Helena; Kristoffersen, Agnete E; Sirois, Fuschia; Stub, Trine; Engler, Jennifer; Joos, Stefanie; Güthlin, Corina; Felenda, Jennifer; Beckmann, Christiane; Stintzing, Florian; Evans, Roni; Bronfort, Gert; Keefe, Daniel; Taberko, Anna; Hanson, Linda; Haley, Alex; Ma, Haiwei; Jolton, Joseph; Yarosh, Lana; Keefe, Francis; Nam, Jung; Evans, Roni; Ojala, Liwanag; Kreitzer, Mary J; Hanson, Linda; Fink, Careen; Kraft, Karin; Flower, Andrew; Lewith, George; Harman, Kim; Stuart, Beth; Bishop, Felicity L; Frawley, Jane; Füleki, Lilla; Kiss, Eva; Vancsik, Tamas; Krenacs, Tibor; Funabashi, Martha; Pohlman, Katherine A; Mior, Silvano; Thiel, Haymo; Hill, Michael D; Cassidy, David J; Westaway, Michael; Yager, Jerome; Hurwitz, Eric; Kawchuk, Gregory N; O’Beirne, Maeve; Vohra, Sunita; Gaboury, Isabelle; Morin, Chantal; Gaertner, Katharina; Torchetti, Loredana; Frei-Erb, Martin; Kundi, Michael; Frass, Michael; Gallo, Eugenia; Maggini, Valentina; Comite, Mattia; Sofi, Francesco; Baccetti, Sonia; Vannacci, Alfredo; Di Stefano, Mariella; Monechi, Maria V; Gori, Luigi; Rossi, Elio; Firenzuoli, Fabio; Mediati, Rocco D; Ballerini, Giovanna; Gardiner, Paula; Lestoquoy, Anna S; Negash, Lily; Stillman, Sarah; Shah, Prachi; Liebschutz, Jane; Adelstein, Pamela; Farrell-Riley, Christine; Brackup, Ivy; Penti, Brian; Saper, Robert; Sampedro, Isabel G; Carvajal, Gilda; Gleiss, Andreas; Gross, Marie M; Brendlin, Dorothea; Röttger, Jonas; Stritter, Wiebke; Seifert, Georg; Grzanna, Noelle; Stange, Rainer; Guendling, Peter W; Gu, Wen; Lu, Yan; Wang, Jie; Zhang, Chengcheng; Bai, Hua; He, Yuxi; Zhang, Xiaoxu; Zhang, Zhengju; Wang, Dali; Meng, Fengxian; Hagel, Alexander; Albrecht, Heinz; Vollbracht, Claudia; Dauth, Wolfgang; Hagel, Wolfgang; Vitali, Francesco; Ganzleben, Ingo; Schultis, Hans; Konturek, Peter; Stein, Jürgen; Neurath, Markus; Raithel, Martin; Hagel, Alexander; Vollbracht, Claudia; Raithel, Martin; Konturek, Peter; Krick, Bianka; Haller, Heidemarie; Klose, Petra; Dobos, Gustav; Kümmel, Sherko; Cramer, Holger; Haller, Heidemarie; Saha, Felix J; Kowoll, Anna; Ebner, Barbara; Berger, Bettina; Dobos, Gustav; Choi, Kyung-Eun; He, Lisha; Wang, Han; He, X.; Gu, C.; Zhang, Y.; Zhao, Linhua; Tong, Xiaolin; He, Lisha; Wang, Han; He, Xinhui; Gu, Chengjuan; Zhang, Ying; Zhao, Linhua; Tong, Xiaolin; He, Lisha; Wang, Han; He, Xinhui; Gu, Chengjuan; Zhang, Ying; Zhao, Linhua; Tong, Xiaolin; Ho, Robin S T; Chung, Vincent C H; Wu, Xinyin; Wong, Charlene H L; Wu, Justin C Y; Wong, Samuel Y S; Lau, Alexander Y L; Sit, Regina W S; Wong, Wendy; Holmes, Michelle; Bishop, Felicity; Calman, Lynn; Holmes, Michelle; Bishop, Felicity; Lewith, George; Newell, Dave; Field, Jonathan; Htut, Win L; Han, Dongwoon; Choi, Da I; Choi, Soo J; Kim, Ha Y; Hwang, Jung H; Huang, Ching W; Jang, Bo H; Chen, Fang P; Ko, Seong G; Huang, Wenjing; Jin, De; Lian, Fengmei; Jang, Soobin; Kim, Kyeong H; Lee, Eun K; Sun, Seung H; Go, Ho Y; Ko, Youme; Park, Sunju; Jang, Bo H; Shin, Yong C; Ko, Seong G; Janik, Hubert; Greiffenhagen, Natalie; Bolte, Jürgen; Kraft, Karin; Jaworski, Mariusz; Adamus, Miroslawa; Dobrzynska, Aleksandra; Jeitler, Michael; Jaspers, Jessica; von Scheidt, Christel; Koch, Barbara; Michalsen, Andreas; Steckhan, Nico; Kessler, Christian; Jin, De; Huang, Wen-jing; Pang, Bing; Lian, Feng-Mei; Jong, Miek; Baars, Erik; Glockmann, Anja; Hamre, Harald; Kainuma, Mosaburo; Murakami, Aya; Kubota, Toshio; Kobayashi, Daisuke; Sumoto, Yasuhiro; Furusyo, Norihiro; Ando, Shin-Ichi; Shimazoe, Takao; Kelber, Olaf; Verjee, S.; Gorgus, Eva; Schrenk, Dieter; Kemper, Kathi; Hill, Ellie; Kemper, Kathi; Rao, Nisha; Gascon, Gregg; Mahan, John; Kienle, Gunver; Dietrich, Jörg; Schmoor, Claudia; Huber, Roman; Kim, Weon H; Han, Dongwoon; Ahmed, Mansoor; He, Luzhu; Hwang, Jung H; Kiss, Eva; Vancsik, Tamas; Meggyeshazi, Nora; Kovago, Csaba; Krenacs, Tibor; Klaus, Anne K; Zerm, Roland; Pranga, Danilo; Ostermann, Thomas; Reif, Marcus; von Laue, Hans B; Brinkhaus, Benno; Kröz, Matthias; Klaus, Anne K; Zerm, Roland; Pranga, Danilo; Recchia, Daniela R; Ostermann, Thomas; Reif, Marcus; von Laue, Hans B; Brinkhaus, Benno; Kröz, Matthias; Klein-Laansma, Christien T; Jong, Mats; von Hagens, Cornelia; Jansen, Jean P; van Wietmarschen, Herman; Jong, Miek C; Ko, Youme; Sun, Seung-Ho; Go, Ho-Yeon; Jeon, Chan-Yong; Song, Yun-Kyung; Ko, Seong-Gyu; Koch, Anna K; Rabsilber, Sybille; Lauche, Romy; Kümmel, Sherko; Dobos, Gustav; Langhorst, Jost; Cramer, Holger; Koch, Anna K; Trifunovic-Koenig, Milena; Klose, Petra; Cramer, Holger; Dobos, Gustav; Langhorst, Jost; Koster, Evi; Baars, Erik; Delnoij, Diana; Kroll, Lena; Weiss, Kathrin; Kubo, Ai; Hendlish, Sarah; Altschuler, Andrea; Connolly, Nancy; Avins, Andy; Lauche, Romy; Recchia, Daniela R; Cramer, Holger; Wardle, Jon; Lee, David; Sibbritt, David; Adams, Jon; Ostermann, Thomas; Lauche, Romy; Sibbritt, David; Park, Crystal; Mishra, Gita; Adams, Jon; Cramer, Holger; Lechner, Johann; Lee, Inseon; 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Open Access
Cystic fibrosis physicians’ perspectives on the timing of referral for lung transplant evaluation: a survey of physicians in the United States
(2017-01-19) Ramos, Kathleen J; Somayaji, Ranjani; Lease, Erika D; Goss, Christopher H; Aitken, Moira L
Abstract Background Prior studies reveal that a significant proportion of patients with cystic fibrosis (CF) and advanced lung disease are not referred for lung transplant (LTx) evaluation. We sought to assess expert CF physician perspectives on the timing of LTx referral and investigate their LTx knowledge. Methods We developed an online anonymous survey that was distributed by the Cystic Fibrosis Foundation (CFF) to the medical directors of all CFF-accredited care centers in the United States in 2015. The survey addressed only adult patients (≥18 years old) and was sent to 119 adult CF physicians, 86 CFF-affiliated CF physicians (who see adults and children, but have smaller program sizes than adult or pediatric centers), and 127 pediatric CF physicians (who see some adults, but mostly children). The focus of the questions was on CFF-care center characteristics, physician experience and indications/contraindications to referral for LTx evaluation. Results There were 114/332 (34%) total responses to the survey. The response rates were: 57/119 (48%) adult physicians, 12/86 (14%) affiliate physicians and 43/127 (34%) pediatric physicians; 2 physicians did not include their CFF center type. Despite the poor ability of FEV1 < 30% to predict death within 2 years, 94% of responding CF physicians said they would refer an adult patient for LTx evaluation if the patient’s lung function fell to FEV1 < 30% predicted. Only 54% of respondents report that pulmonary hypertension would trigger referral. Pulmonary hypertension is an internationally recommended indication to list a patient for LTx (not just for referral for evaluation). Very few physicians (N = 17, 15%) employed components of the lung allocation score (LAS) to determine the timing of referral for LTx evaluation. Interestingly, patient preference not to undergo LTx was “often” or “always” the primary patient-related reason to defer referral for LTx evaluation for 41% (47/114) of respondents. Conclusions Some potential barriers to timely LTx referral for patients with CF include physician knowledge regarding non-lung function-based recommendations related to timing of referral and listing for LTx, and patient preference not to undergo LTx. Further exploration of physician-level and CF patient-level barriers to timely LTx referral is warranted.