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Ainara Garde, Parastoo Dekhordi, J Mark Ansermino, Guy A Dumont, Ainara Garde, Parastoo Dekhordi, J Mark Ansermino, Guy A Dumont, J Mark Ansermino, Parastoo Dekhordi, Guy A Dumont, Ainara Garde
Sleep apnea, characterized by frequent pauses in breathing during sleep, poses a serious threat to the healthy growth and development of children. Polysomnography (PSG), the gold standard for sleep apnea diagnosis, is resource intensive and confined to sleep laboratories, thus reducing its accessibility. Pulse oximetry alone, providing blood oxygen saturation (SpO2) and blood volume changes in tissue (PPG), has the potential to identify children with sleep apnea. Thus, we aim to develop a tool for at-home sleep apnea screening that provides a detailed and automated 30 sec epoch-by-epoch sleep apnea analysis...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Matthias Görges, Guohai Zhou, Rollin Brant, J Mark Ansermino
Estimation of the dose-response curve for new anesthetic protocols typically focuses on identifying minimum effective doses. The application of a sequential experimental method is appropriate, as it minimizes sample size requirements by updating dose assignments based on information accrued from successive subjects. One approach is the up-and-down method for estimating the median effective dose in a patient population (ED50 ). Designs better suited for achieving greater than 50% effectiveness, include the biased coin approach, and continual reassessment method...
February 17, 2017: Paediatric Anaesthesia
Philippe Bousquet, Hélène Ansermino, Pierre Canal, Matthieu Renaud, Christèle Artz
Using implant to replace a tooth is a well known treatment. However, the practitioner must keep in mind that osteointegrated implants behave like ankylosed teeth, and their evolution does not follow the alveolar processes of the adjacent teeth during growth. This growth decreases after 20 years, but remains present. This can lead to infraposition functionally and aesthetically failure for the implant therapy. Risk factors, like patient's age, sex and shape of the face must be evaluated. Most palatal implant positioning and use of screwed prosthetic tooth can permit the infraposition treatment during years of aging...
September 2016: L' Orthodontie Française
Helen M Ryan, Sumedha Sharma, Laura A Magee, J Mark Ansermino, Karen MacDonell, Beth A Payne, Keith R Walley, Peter von Dadelszen
OBJECTIVE: To assess the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) mortality prediction model in pregnant and recently pregnant women receiving critical care in low-, middle-, and high-income countries during the study period (1985-2015), using a structured literature review. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science, and Evidence-Based Medicine Reviews, searched for articles published between 1985 and 2015. STUDY SELECTION: Twenty-five studies (24 publications), of which two were prospective, were included in the analyses...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Matthew O Wiens, Elias Kumbakumba, Charles P Larson, Peter P Moschovis, Celestine Barigye, Jerome Kabakyenga, Andrew Ndamira, Lacey English, Niranjan Kissoon, Guohai Zhou, J Mark Ansermino
BACKGROUND: Recurrent illness following hospital discharge is a major contributor to childhood mortality in resource-poor countries. Yet post-discharge care is largely ignored by health care workers and policy makers due to a lack of resources to identify children with recurrent illness and a lack of cohesive systems to provide care. The purpose of this proof-of-concept study was to evaluate the effectiveness of a bundle of interventions at discharge to improve health outcomes during the vulnerable post-discharge period...
September 28, 2016: Global Health, Science and Practice
Matthias Görges, Nicholas C West, Edda Karlsdóttir, J Mark Ansermino, Myles Cassidy, Gillian R Lauder
BACKGROUND: Commonly used general anesthetics are considered to be neurotoxic to the developing rodent brain, leading to poor long-term outcome. However, it is unclear whether these rodent studies can be extrapolated to the human neonate. Given that anesthesia for urgent neonatal surgery cannot be avoided, it is vitally important to assess other factors that may impact neurological outcome following anesthesia and surgery. OBJECTIVE: The purpose of this study is to identify thresholds for detecting vital sign deviations, which may have the potential for affecting neurological outcome following anesthesia and surgery in neonates...
November 2016: Paediatric Anaesthesia
Ainara Garde, Guohai Zhou, Shahreen Raihana, Dustin Dunsmuir, Walter Karlen, Parastoo Dekhordi, Tanvir Huda, Shams El Arifeen, Charles Larson, Niranjan Kissoon, Guy A Dumont, J Mark Ansermino
OBJECTIVE: Hypoxaemia is a strong predictor of mortality in children. Early detection of deteriorating condition is vital to timely intervention. We hypothesise that measures of pulse oximetry dynamics may identify children requiring hospitalisation. Our aim was to develop a predictive tool using only objective data derived from pulse oximetry and observed respiratory rate to identify children at increased risk of hospital admission. SETTING: Tertiary-level hospital emergency department in Bangladesh...
2016: BMJ Open
Christian Leth Petersen, Matthias Görges, Roslyn Massey, Guy Albert Dumont, J Mark Ansermino
BACKGROUND: Recent research and advances in the automation of anesthesia are driving the need to better understand electroencephalogram (EEG)-based anesthesia end points and to test the performance of anesthesia monitors. This effort is currently limited by the need to collect raw EEG data directly from patients. METHODS: A procedural method to synthesize EEG signals was implemented in a mobile software application. The application is capable of sending the simulated signal to an anesthesia depth of hypnosis monitor...
July 26, 2016: Anesthesia and Analgesia
Matthew O Wiens, Niranjan Kissoon, Elias Kumbakumba, Joel Singer, Peter P Moschovis, J Mark Ansermino, Andrew Ndamira, Julius Kiwanuka, Charles P Larson
BACKGROUND: Post-discharge mortality is a frequent but poorly recognized contributor to child mortality in resource limited countries. The identification of children at high risk for post-discharge mortality is a critically important first step in addressing this problem. OBJECTIVES: The objective of this project was to determine the variables most likely to be associated with post-discharge mortality which are to be included in a prediction modelling study. METHODS: A two-round modified Delphi process was completed for the review of a priori selected variables and selection of new variables...
March 2016: African Health Sciences
Matthew O Wiens, Charles P Larson, Elias Kumbakumba, Niranjan Kissoon, J Mark Ansermino, Joel Singer, Hubert Wong, Andrew Ndamira, Jerome Kabakyenga, Peter Moschovis, Julius Kiwanuka
OBJECTIVES: Acute infectious diseases are the most common cause of under-5 mortality. However, the hospital burden of nonneonatal pediatric sepsis has not previously been described in the resource poor setting. The objective of this study was to determine the prevalence of sepsis among children 6 months to 5 years old admitted with proven or suspected infection and to evaluate the presence of sepsis as a predictive tool for mortality during admission. DESIGN: In this prospective cohort study, we used the pediatric International Consensus Conference definition of sepsis to determine the prevalence of sepsis among children admitted to the pediatric ward with a proven or suspected infection...
May 2016: Pediatric Critical Care Medicine
Nasim Lowlaavar, Charles P Larson, Elias Kumbakumba, Guohai Zhou, J Mark Ansermino, Joel Singer, Niranjan Kissoon, Hubert Wong, Andrew Ndamira, Jerome Kabakyenga, Julius Kiwanuka, Matthew O Wiens
BACKGROUND: Pediatric hospital mortality from infectious diseases in resource constrained countries remains unacceptably high. Improved methods of risk-stratification can assist in referral decision making and resource allocation. The purpose of this study was to create prediction models for in-hospital mortality among children admitted with suspected infectious diseases. METHODS: This two-site prospective observational study enrolled children between 6 months and 5 years admitted with a proven or suspected infection...
2016: PloS One
Ainara Garde, Aryannah Umedaly, Sayed Mazdak Abulnaga, Anne Junker, Jean Pierre Chanoine, Mika Johnson, John Mark Ansermino, Guy Albert Dumont
Physical inactivity is increasing among children globally and has been directly linked to the growing problems of overweight and obesity. We aim to assess the impact of a new mobile exergame, MobileKids Monster Manor (MKMM), in a school-based setting. MKMM, developed with input from youth to enhance physical activity, is wirelessly connected to an accelerometer-based activity monitor. Forty-two healthy students (11.3 ± 1.2 years old and 0.28 ± 1.29 body-mass index [BMI] z-score) participated in a randomized 4-week crossover study to evaluate the game intervention...
March 2016: Cyberpsychology, Behavior and Social Networking
Lauren Lacey English, Dustin Dunsmuir, Elias Kumbakumba, John Mark Ansermino, Charles P Larson, Richard Lester, Celestine Barigye, Andrew Ndamira, Jerome Kabakyenga, Matthew O Wiens
BACKGROUND: Postdischarge death in children is increasingly being recognized as a major contributor to overall child mortality. The PAediatric Risk Assessment (PARA) app is an mHealth tool developed to aid health care workers in resource-limited settings such as Sub-Saharan Africa to identify pediatric patients at high risk of both in-hospital and postdischarge mortality. The intended users of the PARA app are health care workers (ie, nurses, doctors, and clinical officers) with varying levels of education and technological exposure, making testing of this clinical tool critical to successful implementation...
2016: JMIR MHealth and UHealth
Chang-Sei Kim, J Mark Ansermino, Jin-Oh Hahn
The goal of this study is to derive a minimally complex but credible model of respiratory CO2 gas exchange that may be used in systematic design and pilot testing of closed-loop end-tidal CO2 controllers in mechanical ventilation. We first derived a candidate model that captures the essential mechanisms involved in the respiratory CO2 gas exchange process. Then, we simplified the candidate model to derive two lower-order candidate models. We compared these candidate models for predictive capability and reliability using experimental data collected from 25 pediatric subjects undergoing dynamically varying mechanical ventilation during surgical procedures...
2016: Frontiers in Bioengineering and Biotechnology
Matthias Görges, Nicholas C West, Nancy A Christopher, Jennifer L Koch, Sonia M Brodie, Nasim Lowlaavar, Gillian R Lauder, J Mark Ansermino
BACKGROUND: Respiratory depression in children receiving postoperative opioid infusions is a significant risk because of the interindividual variability in analgesic requirement. Detection of respiratory depression (or apnea) in these children may be improved with the introduction of automated acoustic respiratory rate (RR) monitoring. However, early detection of adverse events must be balanced with the risk of alarm fatigue. Our objective was to evaluate the use of acoustic RR monitoring in children receiving opioid infusions on a postsurgical ward and identify the causes of false alarm and optimal alarm thresholds...
April 2016: Anesthesia and Analgesia
Ainara Garde, Parastoo Dehkordi, David Wensley, J Mark Ansermino, Guy A Dumont
Obstructive sleep apnea (OSA) disrupts normal ventilation during sleep and can lead to serious health problems in children if left untreated. Polysomnography, the gold standard for OSA diagnosis, is resource intensive and requires a specialized laboratory. Thus, we proposed to use the Phone Oximeter™, a portable device integrating pulse oximetry with a smartphone, to detect OSA events. As a proportion of OSA events occur without oxygen desaturation (defined as SpO2 decreases ≥ 3%), we suggest combining SpO2 and pulse rate variability (PRV) analysis to identify all OSA events and provide a more detailed sleep analysis...
2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Parastoo Dehkordi, Ainara Garde, Behnam Molavi, Christian L Petersen, J Mark Ansermino, Guy A Dumont
The photoplethysmogram (PPG) obtained from pulse oximetry shows the local changes of blood volume in tissues. Respiration induces variation in the PPG baseline due to the variation in venous blood return during each breathing cycle. We have proposed an algorithm based on the synchrosqueezing transform (SST) to estimate instantaneous respiratory rate (IRR) from the PPG. The SST is a combination of wavelet analysis and a reallocation method which aims to sharpen the time-frequency representation of the signal and can provide an accurate estimation of instantaneous frequency...
2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Mahdi Yousefi, Klaske van Heusden, Guy A Dumont, J Mark Ansermino
In safety-critical control systems, such as closed-loop control of anesthesia, it is of utmost importance to guarantee the ability of a control approach to maintain states of the systems within a safe region. In this paper, we address the problem by applying a safety-preserving control technique to anesthesia control. The approach relies on a conservative approximation of the viability set. The set specifies initial states for which there exists an input that keeps the trajectory emanating from those states within the safe region...
August 2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Parastoo Dehkordi, Ainara Garde, Walter Karlen, Christian L Petersen, David Wensley, Guy A Dumont, J Mark Ansermino
Individuals with sleep disordered breathing (SDB) can experience changes in automatic cardiac regulation as a result of frequent sleep fragmentation and disturbance in normal respiration and oxygenation that accompany most apnea/hypopnea events. In adults, these changes are reflected in enhanced sympathetic and reduced parasympathetic activity. In this study, we examined the autonomic cardiac regulation in children with and without SDB, through spectral and detrended fluctuation analysis (DFA) of pulse rate variability (PRV)...
February 2016: Physiological Measurement
M O Wiens, E Kumbakumba, C P Larson, J M Ansermino, J Singer, N Kissoon, H Wong, A Ndamira, J Kabakyenga, J Kiwanuka, G Zhou
OBJECTIVES: To derive a model of paediatric postdischarge mortality following acute infectious illness. DESIGN: Prospective cohort study. SETTING: 2 hospitals in South-western Uganda. PARTICIPANTS: 1307 children of 6 months to 5 years of age were admitted with a proven or suspected infection. 1242 children were discharged alive and followed up 6 months following discharge. The 6-month follow-up rate was 98.3%. INTERVENTIONS: None...
2015: BMJ Open
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