477 results on '"A. E. Mandel"'
Search Results
2. Airflow recovery from thoracic and abdominal movements using synchrosqueezing transform and locally stationary Gaussian process regression.
- Author
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Whitney K. Huang, Yu-Min Chung 0002, Yu-Bo Wang 0004, Jeff E. Mandel, and Hau-Tieng Wu
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- 2022
- Full Text
- View/download PDF
3. Optimizing Travel Time to Outpatient Interventional Radiology Procedures in a Multi-Site Hospital System Using a Google Maps Application.
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Jacob E. Mandel, Louis Morel-Ovalle, Franz E. Boas, Etay Ziv, Hooman Yarmohammadi, Amy Deipolyi, Heeralall R. Mohabir, and Joseph P. Erinjeri
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- 2018
- Full Text
- View/download PDF
4. ON THE LIFE AND SCIENTIFIC ACTIVITY OF PROFESSOR A.Ya.ORLOV (125th anniversary of birthday)
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M. Yu. Volyanska, V. G. Karetnikov, and O. E. Mandel
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Astronomy ,QB1-991 - Published
- 2017
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5. Photorefractive Changes in the Refractive Index in a LiNbO$${}_{3}$$:Cu Crystal with a Surface Doping
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A. D. Bezpaly, V. I. Bykov, and A. E. Mandel
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Electrical and Electronic Engineering ,Condensed Matter Physics ,Instrumentation - Published
- 2022
6. PHOTOREFRACTIVE CHANGES OF THE REFRACTIVE INDEX IN A LiNbO3:Cu CRYSTAL WITH SURFACE DOPING
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A. D. Bezpaly, V. I. Bykov, and A. E. Mandel
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Control and Systems Engineering ,Software - Published
- 2022
7. V.P.TSESSEVICH - A SCIENTIFIC SUPERVISOR OF THE ODESSA OBSERVATORY EXPEDITION ON THE DETERMINATION OF LATITUDE AND LONGITUDE FOR BTA POSITION SITE
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M. Yu. Volyanskaya, E. Mandel, and Yu. D. Russo
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Astronomy ,QB1-991 - Abstract
In the paper one from little known pages of Prof. V.P.Tsessevich' life and scientific activity as an organizer and scientifics supervisor of expedition on the determination of coordinates of site, where BTA would be placed, is described. V.P.Tsessevich have formed a staff of expedition, scientific problems and have taken direct part of the first and final stages of the expedition. As a result of expedition coordinates which corresponded to requirements of astroplace of the second class (expeditionary) have been obtained and axes of BTA have been traced on the locality.
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- 2017
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8. Probability Ramp Control reduces the number of sessions required to find an acceptable dose of succinylcholine during Electroconvulsive Therapy - an in silico analysis
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Jeff E Mandel
- Abstract
IntroductionElectroconvulsive Therapy may be utilized in as many as 76,000 cases annually in the US, with the majority of cases employing succinylcholine. The reported dose spans the range of 0.29 - 2.1 mg/kg, and while motor seizures only last 36 ± 6 seconds, the duration of paralysis extends to 310 ± 38 seconds. While a model of succinylcholine pharmacokinetics/pharmacodynamics exists, this has not been employed to facilitate dose selection in clinical practice. Probability ramp control was investigated for this purpose.MethodsTwo approaches to dose finding were implemented. The first was an optimized Up-Down Method (UDM) that utilized an initial bolus, an adjustment dose, and a decrement to decrease the adjustment when crossing the target of 95% twitch depression. The second utilized probability ramp control (PRC) comprised of an infusion sequence that stopped when 95% twitch depression was obtained, a model that mapped the times for onset and offset of blockade to a subsequent bolus, and an adjustment dose to refine this dose when needed. Two populations of 10000 randomly parameterized models were developed from published data to train and evaluate the performance. Performance was assessed with a fuzzy classifier that segmented outcomes into three sets – LOW, HIGH, and SUCCESS. A loss function was developed that determined the number of sessions required to bring all models to SUCCESS. The probability distributions were compared using the Kolmogorov-Smirnov 2 sample test, with PResultsOptimal values for the UDM parameters BOLUS, ADJUSTMENT, and DECREMENT were 0.7834 mg/kg, 0.3334 mg/kg, and 0.4056. Optimal values for the PRC SEQUENCE were 0.2663 mg/kg/min for 3 minutes followed by 0.7028 mg/kg/min. A fourth order polynomial MODEL produced estimates of the bolus that brought 99% of models to SUCCESS on the second session, while UDM required 6 sessions to achieve 99% SUCCESS. The probability distributions were distinct with P
- Published
- 2022
9. Quality improvement as a primary approach to change in healthcare: a precarious, self-limiting choice?
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Keith E Mandel and Steven H Cady
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Health Policy ,Humans ,Health Facilities ,Quality Improvement ,Delivery of Health Care - Published
- 2021
10. VLADIMIR PLATONOVICH TSESSEVICH - ASTRONOMER-ROMANTIC
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M. Yu. Volyanska, V. G. Karetnikov, and O. E. Mandel
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Astronomy ,QB1-991 - Published
- 2007
- Full Text
- View/download PDF
11. Airflow recovery from thoracic and abdominal movements using synchrosqueezing transform and locally stationary Gaussian process regression
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Jeff E. Mandel, Yu-Min Chung, Hau-Tieng Wu, Yu-Bo Wang, and Whitney K. Huang
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Signal Processing (eess.SP) ,FOS: Computer and information sciences ,Statistics and Probability ,Computer Science - Machine Learning ,Computer science ,Applied Mathematics ,Airflow ,Machine Learning (stat.ML) ,Gold standard (test) ,Signal ,Machine Learning (cs.LG) ,law.invention ,Computational Mathematics ,Computational Theory and Mathematics ,Statistics - Machine Learning ,Control theory ,Kriging ,law ,Ventilation (architecture) ,FOS: Electrical engineering, electronic engineering, information engineering ,Electrical Engineering and Systems Science - Signal Processing ,Abdominal movements ,Spirometer - Abstract
A wealth of information about respiratory system is encoded in the airflow signal. While direct measurement of airflow via spirometer with an occlusive seal is the gold standard, this may not be practical for ambulatory monitoring of patients. Advances in sensor technology have made measurement of motion of the thorax and abdomen feasible with small inexpensive devices, but estimating airflow from these time series is challenging due to the presence of complicated nonstationary oscillatory signals. To properly extract the relevant oscillatory features from thoracic and abdominal movement, a nonlinear-type time-frequency analysis tool, the synchrosqueezing transform, is employed; these features are then used to estimate the airflow by a locally stationary Gaussian process regression. It is shown that, using a dataset that contains respiratory signals under normal sleep conditions, accurate airflow out-of-sample predictions, and hence the precise estimation of an important physiological quantity, inspiration respiration ratio, can be achieved by fitting the proposed model both in the intra- and inter-subject setups. The method is also applied to a more challenging case, where subjects under general anesthesia underwent transitions from pressure support to unassisted ventilation to further demonstrate the utility of the proposed method.
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- 2022
12. Comment on: 'Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65'
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Jeff E. Mandel
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Anesthesiology and Pain Medicine - Published
- 2022
13. The Integrated IR Residency Curriculum: Current State of Affairs
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Chris Molloy, Jacob E Mandel, David P. Duncan, Geogy Vatakencherry, Muhammad Noor, N. Gutta, Jacob W. Fleming, and Mina S. Makary
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Medical education ,business.industry ,Residency curriculum ,Internship and Residency ,State of affairs ,Radiology, Interventional ,Radiography, Interventional ,Education, Medical, Graduate ,Radiologists ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Clinical Competence ,Curriculum ,Current (fluid) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
14. Optically Induced Channel Waveguide Structures with Spatial Modulation of Parameters in the Surface Layer of Lithium Niobate
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Vladymir M. Shandarov, A. E. Mandel, A. D. Bezpaly, K. M. Mambetova, and V. I. Bykov
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010302 applied physics ,Materials science ,Channel (digital image) ,010308 nuclear & particles physics ,business.industry ,Lithium niobate ,Physics::Optics ,General Physics and Astronomy ,Photorefractive effect ,Radiation ,Laser ,01 natural sciences ,Waveguide (optics) ,law.invention ,chemistry.chemical_compound ,chemistry ,law ,0103 physical sciences ,Optoelectronics ,Surface layer ,business ,Refractive index - Abstract
Results of experimental studies of channel optical waveguide structures with spatially-modulated parameters obtained by point-by-point inducing of refractive index perturbations upon exposure to laser radiation of visible range in Y-cut LiNbO3 samples with photorefractive surface layer are presented.
- Published
- 2019
15. Retrieval of Inferior Vena Cava Filters Temporarily Placed in a Suprarenal Position: A Review of 13 Patients
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Mario A. Cedillo, Aaron M. Fischman, Vivian Bishay, Robert A. Lookstein, Edward Kim, Pratik A. Shukla, S.F. Nowakowski, Mona Ranade, Jason A. Fisher, Rahul S. Patel, and Jacob E Mandel
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Adult ,Male ,medicine.medical_specialty ,Vena Cava Filters ,Computed Tomography Angiography ,Vena Cava, Inferior ,030204 cardiovascular system & hematology ,Inferior vena cava ,030218 nuclear medicine & medical imaging ,Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Humans ,Medicine ,Device Removal ,Retrospective Studies ,Thesaurus (information retrieval) ,business.industry ,Endovascular Procedures ,Phlebography ,General Medicine ,Middle Aged ,Position (obstetrics) ,Treatment Outcome ,medicine.vein ,Female ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose: To evaluate the safety and efficacy of retrieval of inferior vena cava filters (IVCF) temporarily placed in a suprarenal position. Methods: Retrieval of IVCF placed in a suprarenal position was performed in 13 patients (5 men and 8 women; mean age: 45.1 ± 13.8 years) between July 2006 and May 2018 using either a loop snare technique or endobronchial forceps. Electronic medical records were reviewed for patient demographics and procedural information. Results: Inferior vena cava filters retrieved included Option Elite (n = 9, 69%) and Günther Tulip (n = 4, 31%). Caval thrombosis was not detected in any patients on pre- or postretrieval cavogram. Eleven suprarenal IVCF (84%) were retrieved during the first retrieval attempt after a median indwelling time of 1.8 months (range, 0.03-12.10 months). Retrieval was initially unsuccessful in 2 (16%) patients with Option Elite filters, but both were successfully removed on second attempt using endobronchial forceps. Thirteen suprarenal IVCF (100%) were ultimately retrieved. Conclusion: Endovascular retrieval of IVCF temporarily placed in a suprarenal position is safe and efficacious.
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- 2019
16. Electrically controllable diffraction of light on periodic domain structures in ferroelectric crystals
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Stanislav M. Shandarov, A. E. Mandel, A. R. Akhmatkhanov, V. Ya. Shur, M. V. Borodin, and E. N. Savchenkov
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010302 applied physics ,Diffraction ,Light diffraction ,Materials science ,Period (periodic table) ,business.industry ,02 engineering and technology ,021001 nanoscience & nanotechnology ,Condensed Matter Physics ,01 natural sciences ,Ferroelectric crystal ,Symmetry (physics) ,Electronic, Optical and Magnetic Materials ,Electric field ,0103 physical sciences ,Domain (ring theory) ,Cathode ray ,Optoelectronics ,0210 nano-technology ,business - Abstract
The Bragg light diffraction on periodic domain structures (PDS) with spatial period of 8.79 μm in MgO:LiNbO3 crystals with 3m symmetry in external electric field has been analyzed. Time dep...
- Published
- 2019
17. Capacity of the Quantum Key Distribution System with Single-Qubit Encoding via Satellite-Mediated Quantum Free-Space Link
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A. E. Mandel, A. S. Zadorin, Radioelectronics (Tusur), S. I. Razgulyaev, R. S. Kruglov, and V. A. Krakowski
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Physics ,biology ,Qubit ,Encoding (memory) ,Satellite (biology) ,General Medicine ,Free space ,Link (geometry) ,Quantum key distribution ,Topology ,biology.organism_classification ,Quantum - Published
- 2019
18. Refractive index changes induced in the surface layer of a lithium niobate crystal during the channel waveguide formation for optoelectronic devices
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Radioelectronics (Tusur), V. I. Bykov, A. D. Bezpaly, A. E. Mandel, and V. A. Krakovskiy
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Materials science ,Lithium niobate crystal ,business.industry ,Optoelectronics ,General Medicine ,Surface layer ,business ,Waveguide (optics) ,Refractive index ,Communication channel - Published
- 2019
19. Idiopathic Inflammatory Myopathies: A Review of the Classification and Impact of Pathogenesis
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Dana E. Mandel, Charles J. Malemud, and Ali D. Askari
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idiopathic ,inflammation ,muscle diseases ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune muscle diseases with significant morbidity and mortality. This review details and updates the pathogenesis and emerging importance of myositis-specific antibodies in the development of IIMs. An increase in the understanding of how these myositis-specific antibodies play a role in IIMs has led to the further categorization of IIMs from the traditional polymyositis versus dermatomyositis, to additional subcategories of IIMs such as necrotizing autoimmune myositis (NAM). The diagnosis of IIMs, including manual muscle testing, laboratory studies, and non-invasive imaging have become important in classifying IIM subtypes and for identifying disease severity. Treatment has evolved from an era where glucocorticoid therapy was the only option to a time now that includes traditional steroid-sparing agents along with immunoglobulin therapy and biologics, such as rituximab.
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- 2017
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20. Percutaneous Cryoablation Provides Disease Control for Extra-Abdominal Desmoid-Type Fibromatosis Comparable with Surgical Resection
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Karissa Whiting, Joseph P. Erinjeri, Samuel Singer, Etay Ziv, Mrinal M. Gounder, Li-Xuan Qin, Mary Louise Keohan, Hooman Yarmohammadi, Sandra P. D'Angelo, Aimee M. Crago, Jacob E Mandel, and DaeHee Kim
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Adult ,medicine.medical_specialty ,Percutaneous cryoablation ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Cryoablation ,Fibroma ,Desmoid type fibromatosis ,Disease control ,Cryosurgery ,Article ,Surgery ,Exact test ,Fibromatosis, Aggressive ,Oncology ,Surgical oncology ,Risk Factors ,Propensity score matching ,medicine ,Catheter Ablation ,Humans ,business - Abstract
PURPOSE. The aim of this study was to determine outcomes and prognostic factors for patients with primary and locally recurrent extraabdominal desmoid tumors who underwent percutaneous cryoablation, and to compare with patients treated with surgery. METHODS. Group characteristics were compared using Fisher’s exact test, and propensity score matching was performed using the nearest-neighbor approach. Kaplan–Meier and log-rank analyses were used to evaluate the variation in first local recurrence and disease control, while multivariate Cox regression was used to identify factors associated with first local recurrence. All statistical tests were two-sided and a p-value of 0.05 was considered statistically significant. RESULTS. Twenty-two cryoablation patients were matched with 33 surgical patients (n = 55). Median follow-up after cryoablation was 16.3 months versus 14.9 months after surgery. Two-year local recurrence-free survival (LRFS) was 59% after cryoablation and 71% after surgery, and median LRFS was 26.6 months after cryoablation but was not reached after surgery. Two-year disease control for all patients was 85%, however median disease control was not reached in either the cryoablation or surgery groups. There was no significant difference in LRFS or disease control between matched cryoablation and surgical patients. No local recurrences occurred after the first cryoablation in patients with zero or one of the following risk factors: tumor size > 5 cm, age ≤ 25 years, or locally recurrent disease. All patients with two or more of these risk factors recurred locally after the first cryoablation. CONCLUSION. Percutaneous cryoablation of primary and locally recurrent extra-abdominal desmoid tumors provides freedom from first local recurrence and long-term disease control comparable with surgery.
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- 2020
21. Underexpansion of Wallstents® in the Treatment of Nonthrombotic Iliac Vein Lesions
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Anil Hingorani, Natalie Marks, Enrico Ascher, Yuriy Ostrozhynskyy, and Jacob E. Mandel
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medicine.medical_specialty ,Chronic venous insufficiency ,business.industry ,medicine.medical_treatment ,Stent ,Retrospective cohort study ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Balloon ,Surgery ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,medicine.anatomical_structure ,Angioplasty ,medicine ,Etiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Vein - Abstract
Background Iliac vein stenting is increasingly being used in the treatment of chronic venous insufficiency caused by nonthrombotic iliac vein lesions (NIVL). We have noticed that many stents do not deploy to the expected stent area (ESA) as designated by the manufactured stent diameter (MSD). The purpose of this study was to identify factors predictive of Wallstent® underexpansion in the iliocaval venous system. Methods Retrospective analysis of all patients with NIVL who were treated with iliac vein stenting using Wallstents® was performed. None of the patients in this study underwent pre- or post-stenting balloon angioplasty. Multiway analysis of variance and multiple linear regression analysis were performed to examine the effects of gender, age, stent laterality, location of stenosis, and CEAP (clinical, etiology, anatomy, and pathophysiology) score at presentation on the proportion of observed stent area (OSA) to ESA. Results Two-hundred three patients (64 male and 139 female; mean age: 68 ± 13.9 years) underwent 242 treatments between December 2012 and January 2016. Disease severity based on CEAP score were: C1 (0), C2 (0), C3 (n = 59, 24%), C4 (n = 148, 61%), C5 (n = 4, 2%), and C6 (n = 31, 13%). On average, stents deployed to 69.58% of the ESA (range, 23.87–123.35%). Multiple linear regression analysis showed a significant negative correlation between increasing MSD and ESA achieved. Regression coefficients for differences in percent difference between ESA and OSA based on MSD were as follows: 16 mm (−15.0, P = 0.1519), 18 mm (−21.0, P = 0.0077), 20 mm (−23.2, P = 0.0059), and 20–22 mm (−35.3, P Conclusions Larger MSD is associated with greater magnitude of stent underexpansion. These findings may have implications for future venous stent designing.
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- 2018
22. Optimizing Travel Time to Outpatient Interventional Radiology Procedures in a Multi-Site Hospital System Using a Google Maps Application
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H. Mohabir, Hooman Yarmohammadi, Louis Morel-Ovalle, Jacob E. Mandel, Joseph P. Erinjeri, Amy R. Deipolyi, Etay Ziv, and Franz E. Boas
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Computer science ,Site selection ,Radiology, Interventional ,Article ,Time ,03 medical and health sciences ,0302 clinical medicine ,Outpatients ,medicine ,Humans ,Web application ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Travel ,Radiological and Ultrasound Technology ,Application programming interface ,medicine.diagnostic_test ,business.industry ,Multi site ,Interventional radiology ,medicine.disease ,Mobile Applications ,Computer Science Applications ,Travel time ,Hospital system ,030220 oncology & carcinogenesis ,Rush hour ,Medical emergency ,business ,Software ,Maps as Topic - Abstract
The purpose of this study is to determine whether a custom Google Maps application can optimize site selection when scheduling outpatient interventional radiology (IR) procedures within a multi-site hospital system. The Google Maps for Business Application Programming Interface (API) was used to develop an internal web application that uses real-time traffic data to determine estimated travel time (ETT; minutes) and estimated travel distance (ETD; miles) from a patient’s home to each a nearby IR facility in our hospital system. Hypothetical patient home addresses based on the 33 cities comprising our institution’s catchment area were used to determine the optimal IR site for hypothetical patients traveling from each city based on real-time traffic conditions. For 10/33 (30%) cities, there was discordance between the optimal IR site based on ETT and the optimal IR site based on ETD at non-rush hour time or rush hour time. By choosing to travel to an IR site based on ETT rather than ETD, patients from discordant cities were predicted to save an average of 7.29 min during non-rush hour (p = 0.03), and 28.80 min during rush hour (p
- Published
- 2018
23. Drug-induced sleep endoscopy
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Joshua H. Atkins and Jeff E. Mandel
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Drug ,medicine.medical_specialty ,media_common.quotation_subject ,MEDLINE ,Electroencephalography ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Anesthesia ,030223 otorhinolaryngology ,Intensive care medicine ,Propofol ,media_common ,Sleep Apnea, Obstructive ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Sleep apnea ,Endoscopy ,medicine.disease ,Obstructive sleep apnea ,Anesthesiology and Pain Medicine ,Sleep endoscopy ,Sleep ,business ,Surgical interventions ,030217 neurology & neurosurgery - Abstract
Provide a practical update on drug-induced sleep endoscopy (DISE) for anesthesia providers, which can also serve as a reference for those preparing to establish a DISE program.New developments in surgical approaches to OSA and the growing global incidence of the condition have stimulated increased interest and demand for drug-induced sleep endoscopy. New techniques include transoral robotic surgery and hypoglossal nerve stimulation. Recent DISE literature has sought to address numerous debates including relevance of DISE findings to those during physiologic sleep and the most appropriate depth and type of sedation for DISE. Propofol and dexmedetomidine have supplanted midazolam as the drugs of choice for DISE. Techniques based on pharmacokinetic models of propofol are superior to empiric dosing with regard to risk of respiratory compromise and the reliability of dexmedetomidine to achieve adequate conditions for a complete DISE exam is questionable.The role of DISE in surgical evaluation and planning for treatment of OSA continues to develop. Numerous questions as to the optimal anesthetic approach remain unanswered. Multicenter studies that employ a standardized approach using EEG assessment, pharmacokinetic-pharmacodynamic modelling, and objectively defined clinical endpoints will be helpful. There may be benefit to undertaking DISE studies in non-OSA patients.
- Published
- 2018
24. Sudden Tracheal Collapse during EGD and Subsequent Anesthetic Management with Dexmedetomidine-Ketamine in a Patient with Achalasia and Tracheomalacia
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Joshua H. Atkins, Jeff E. Mandel, and David C. Metz
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Anesthesiology ,RD78.3-87.3 - Abstract
We present a patient who experienced airway obstruction during an elective esophagogastroduodenoscopy (EGD) under anesthesia secondary to previously undiagnosed tracheomalacia. Physiology of airway obstruction with forced breathing maneuvers is discussed along with the potential advantages of dexmedetomidine-ketamine sedation for management of patients with achalasia undergoing outpatient endoscopic procedures.
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- 2011
- Full Text
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25. Linear diffraction of light waves in periodically poled lithium niobate crystal
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M. V. Borodin, Stanislav M. Shandarov, V. Ya. Shur, A. R. Akhmatkhanov, S. V. Smirnov, A. V. Andrianova, G. I. Bolshanin, A. Yu. Kim, and A. E. Mandel
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010302 applied physics ,Diffraction ,Materials science ,business.industry ,Numerical analysis ,Isotropy ,Boundary problem ,Lithium niobate ,Physics::Optics ,02 engineering and technology ,021001 nanoscience & nanotechnology ,Condensed Matter Physics ,01 natural sciences ,Crystallographic defect ,Electronic, Optical and Magnetic Materials ,chemistry.chemical_compound ,Optics ,chemistry ,Duty cycle ,0103 physical sciences ,0210 nano-technology ,business ,Beam (structure) - Abstract
Results of theoretical analysis of dielectric permittivity perturbations in lithium niobate crystal with periodically poled domain structure are presented. The deviation of periodical domain structure duty cycle from 0.5 and the electric bias field created by point defects are taken into consideration. The isotropic diffraction with many maxima is considered as a boundary problem for symmetric propagation of probing beam. The agreement between numerical analysis and experimental study of the isotropic diffraction patterns performed for laser beam polarized along domain walls and propagating along polar axis through the periodically poled domain structure confirmed the proposed theoretical model.
- Published
- 2017
26. Channel waveguide structures optically induced in a lithium niobate crystal with a photorefractive surface layer
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Radioeleсtronics, A. D. Bezpaly, A. E. Mandel, and Vladymir M. Shandarov
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Materials science ,Lithium niobate crystal ,business.industry ,Waveguide (acoustics) ,Optoelectronics ,General Medicine ,Surface layer ,Photorefractive effect ,business ,Communication channel - Published
- 2018
27. Patient Satisfaction and Benefits of Music Therapy Services to Manage Stress and Pain in the Hospital Emergency Department
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Susan E. Mandel, Michelle Secic, and Beth A Davis
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Complementary and Manual Therapy ,Adult ,Male ,medicine.medical_specialty ,Music therapy ,Pain ,Personal Satisfaction ,behavioral disciplines and activities ,Patient satisfaction ,Pain control ,Surveys and Questionnaires ,Stress (linguistics) ,medicine ,Humans ,Pain Management ,Active listening ,In patient ,Music Therapy ,General Medicine ,Emergency department ,humanities ,Patient Satisfaction ,Family medicine ,Female ,Singing ,Psychology ,Emergency Service, Hospital ,Music ,Stress, Psychological - Abstract
The goal of the study was to gather data about patient satisfaction with and benefit from music therapy (MT) services to inform development of a model of MT service in emergency departments (EDs). The objectives were to compare patient satisfaction scores on pain control, ED recommendation, and staff care of ED patients who received MT with patients who did not receive MT services; to examine the benefit of MT services to manage ED patients' stress and pain; and to gather information about staff members' perceptions about MT services for ED patients. Over 1,500 patients engaged in MT with a board-certified music therapist during the 3-year term of the study. Treatment included music-assisted relaxation, therapeutic listening/musical requests, musical diversion, song writing, and therapeutic singing. Using items from the Press Ganey ED Survey to measure patient satisfaction of 90 MT patients who received and responded to the survey with a matched control group, no statistically significant differences in patient satisfaction were found. Significant improvements were seen in both stress and pain for MT patients, and the benefit of MT in procedural support was explored. A staff questionnaire revealed that 92% of respondents would be likely to recommend MT sessions for future patients, and 80% indicated that the music therapist's practice improved their caregiving experience. All MT patients indicated that they would request future MT in the ED. The study provides important information for the development of MT programming in hospital EDs.
- Published
- 2019
28. Investigation of the interaction of a pair of bright optical spatial pyroelectric solitons during their in-phase propagation in an undoped lithium niobate crystal at a wavelength of 532 nm
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D. K. Romanenko, A. S. Perin, A. E. Mandel, A. V. Sokolnikov, D. V. Okunev, and M. N. Gapparova
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History ,Wavelength ,Materials science ,Lithium niobate crystal ,business.industry ,Phase (waves) ,Physics::Optics ,Optoelectronics ,business ,Computer Science Applications ,Education ,Pyroelectricity - Abstract
The formation of two-dimensional bright spatial solitons by in-phase laser beams with a wavelength of 532 nm propagating in the bulk of photorefractive lithium niobate crystal under the reversal of the sign of the nonlinear optical response of the material with the contribution of the pyroelectric effect has been experimentally demonstrated. It is shown that varying the distance between the beams at the input face of the crystal leads to the interaction of pyroelectric solitons, which allows the formation of non-rectilinear propagation paths of light beams.
- Published
- 2020
29. Collinear and isotropic diffraction of laser beam and incoherent light on periodically poled domain structures in lithium niobate
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S. V. Smirnov, V. Ya. Shur, M. V. Borodin, A. E. Mandel, Stanislav M. Shandarov, T. M. Akylbaev, and A. R. Akhmatkhanov
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Diffraction ,Materials science ,business.industry ,Isotropy ,Poling ,Lithium niobate ,Physics::Optics ,02 engineering and technology ,021001 nanoscience & nanotechnology ,Condensed Matter Physics ,01 natural sciences ,Electronic, Optical and Magnetic Materials ,010309 optics ,Crystal ,chemistry.chemical_compound ,Optics ,Lithium niobate crystal ,chemistry ,0103 physical sciences ,Domain (ring theory) ,0210 nano-technology ,business ,Laser beams - Abstract
Possible variants of light diffraction from periodically poled domain structures in lithium niobate crystal are analyzed theoretically. It is shown that along with isotropic diffraction, elastic strains created by domain walls make it possible to observe the collinear interaction of ordinary and extraordinary waves propagating along X axis of the crystal. Diffraction of incoherent light in the collinear geometry on the PPLN with spatial period of 6.89 μm, developed on the basis of a Z-cut MgO:LiNbO3 crystal using electric-field poling, is investigated experimentally.
- Published
- 2016
30. Hilbert-Huang Transform Yields Improved Minute Volume Estimates from Respiratory Inductance Plethysmography During Transitions to Paradoxical Breathing
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Joshua H. Atkins and Jeff E. Mandel
- Subjects
Methyl Ethers ,medicine.medical_specialty ,Time Factors ,Pressure support ventilation ,law.invention ,Sevoflurane ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,030202 anesthesiology ,law ,Monitoring, Intraoperative ,Internal medicine ,Tidal Volume ,medicine ,Humans ,Respiratory inductance plethysmography ,Prospective Studies ,Time domain ,Lung ,Tidal volume ,business.industry ,Respiration ,Signal Processing, Computer-Assisted ,Respiration, Artificial ,Plethysmography ,Anesthesiology and Pain Medicine ,Nonlinear Dynamics ,Spirometry ,Anesthesia ,Frequency domain ,Anesthetics, Inhalation ,Linear Models ,Breathing ,Cardiology ,Anesthesia, Inhalation ,business ,030217 neurology & neurosurgery ,Respiratory minute volume ,Spirometer - Abstract
BACKGROUND Anesthesia and sedation are associated with paradoxical breathing. Respiratory inductance plethysmography (RIP) permits measurement of respiratory motion in clinical settings not conducive to spirometry, but correlation of RIP volume changes and spirometer flow in the time domain is degraded by the development of paradoxical breathing. The Hilbert-Huang transform (HHT) is a nonlinear signal analysis method that permits the instantaneous magnitude and phase of nonstationary signals to be estimated in the frequency domain. We hypothesized that these frequency domain estimates would provide higher correlation between RIP and spirometer signals than time domain signals during the transition between normal and paradoxical breathing. METHODS From 51 patients undergoing sevoflurane anesthesia for minor procedures, a 5-minute epoch containing transitions between pressure support ventilation and spontaneous ventilation was selected for analysis. Pearson correlation for models based on HHT magnitude and phase was compared with models based on time domain signals. Bland-Altman analysis was performed to assess deviation from linearity in the models. RESULTS For the 51 patients analyzed, the modulation of tidal volume over the epoch ranged from 30% to 215% of epoch mean. The coefficient of determination for time domain analysis was 0.62 ± 0.2 compared with 0.93 ± 0.07 for the HHT model incorporating phase. This improvement of 0.31 (99% confidence interval, 0.24-0.37) was significant (P < 0.0001). No trend was observed in prediction residuals. CONCLUSIONS Under conditions of changing ventilation, HHT-derived magnitude and phase measures provide higher correlation with spirometry than those obtained with traditional time domain methods.
- Published
- 2016
31. Recent advances in control of sedation
- Author
-
Jeff E. Mandel
- Subjects
medicine.medical_specialty ,business.industry ,Sedation ,Control (management) ,Gastroenterology ,Human control ,Patient response ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Medicine ,030211 gastroenterology & hepatology ,Radiology, Nuclear Medicine and imaging ,Dosing ,medicine.symptom ,business ,Cost of care ,Propofol ,Intensive care medicine ,medicine.drug - Abstract
Procedural sedation is commonly employed in endoscopic procedures, and increasingly uses propofol. The use of propofol is commonly restricted to anesthesia providers, and this may increase the cost of care. Administration of propofol requires a special set of skills to deal with the variability of patient response and the consequences of improper dosing. This has stoked interest in the use of automated systems to reduce manpower costs associated with propofol. This article examines why propofol poses challenges for human control, and how various automated systems have been used to address these challenges. We examine target-controlled infusions, patient-controlled sedation, the SEDASYS System, and optimized ramp induction. The article emphasizes on how the various approaches deal with the range of variability in propofol response. No single system is capable of dealing with all patients without some human supervision and intervention.
- Published
- 2016
32. Results from 404 drug-induced sleep endoscopies with probability ramp control: lessons for pharmacokinetic design of DISE protocols
- Author
-
Jeff E. Mandel and Joshua H. Atkins
- Subjects
Drug ,Pharmacokinetics ,business.industry ,Anesthesia ,media_common.quotation_subject ,Medicine ,Sleep (system call) ,business ,media_common - Published
- 2020
33. Recent advances in respiratory monitory in nonoperating room anesthesia
- Author
-
Jeff E. Mandel
- Subjects
medicine.medical_specialty ,Capnography ,medicine.diagnostic_test ,business.industry ,Endoscopic sedation ,Apnea ,Sedation ,030208 emergency & critical care medicine ,Endoscopy ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Respiratory Rate ,030202 anesthesiology ,Medicine ,Humans ,Anesthesia ,medicine.symptom ,business ,Intensive care medicine ,Photoplethysmography ,Monitoring, Physiologic - Abstract
PURPOSE OF REVIEW Sedation for nonoperating room procedures is experiencing a considerable increase in demand. Respiratory compromise is one of the most common adverse events seen in sedation. Capnography is a modality that has been widely adopted in this area, but may not be well suited to the special demands of nonoperating room sedation. This review is an assessment of new technologies that may improve outcomes beyond those achievable with capnography. RECENT FINDINGS New devices for detecting the onset of apnea and for assessing respiratory depression have emerged which have advantages over conventional capnography for detecting apnea without excessive false positive and false negative rates. In addition, monitors that assess respiratory drive have become available, and these may prove useful in regulating depth of sedation. SUMMARY No single monitor is ideal for all settings. During brief endoscopic sedation, detection of apnea is paramount, while during longer procedures, avoiding excessive respiratory depression is more critical. The clinician must choose the appropriate monitor based on an understanding of the challenges of the particular environment.
- Published
- 2018
34. Underexpansion of Wallstents
- Author
-
Jacob E, Mandel, Yuriy, Ostrozhynskyy, Anil, Hingorani, Natalie, Marks, and Enrico, Ascher
- Subjects
Aged, 80 and over ,Male ,Constriction, Pathologic ,Iliac Vein ,Middle Aged ,Prosthesis Design ,Prosthesis Failure ,Treatment Outcome ,Venous Insufficiency ,Risk Factors ,Chronic Disease ,Humans ,Female ,Stents ,Angioplasty, Balloon ,Aged ,Retrospective Studies - Abstract
Iliac vein stenting is increasingly being used in the treatment of chronic venous insufficiency caused by nonthrombotic iliac vein lesions (NIVL). We have noticed that many stents do not deploy to the expected stent area (ESA) as designated by the manufactured stent diameter (MSD). The purpose of this study was to identify factors predictive of Wallstent® underexpansion in the iliocaval venous system.Retrospective analysis of all patients with NIVL who were treated with iliac vein stenting using Wallstents® was performed. None of the patients in this study underwent pre-or post-stenting balloon angioplasty. Multiway analysis of variance and multiple linear regression analysis were performed to examine the effects of gender, age, stent laterality, location of stenosis, and CEAP (clinical, etiology, anatomy, and pathophysiology) score at presentation on the proportion of observed stent area (OSA) to ESA.Two-hundred three patients (64 male and 139 female; mean age: 68 ± 13.9 years) underwent 242 treatments between December 2012 and January 2016. Disease severity based on CEAP score were: C1 (0), C2 (0), C3 (n = 59, 24%), C4 (n = 148, 61%), C5 (n = 4, 2%), and C6 (n = 31, 13%). On average, stents deployed to 69.58% of the ESA (range, 23.87–123.35%). Multiple linear regression analysis showed a significant negative correlation between increasing MSD and ESA achieved. Regression coefficients for differences in percent difference between ESA and OSA based on MSD were as follows: 16 mm (−15.0, P = 0.1519), 18 mm (−21.0, P = 0.0077), 20 mm (−23.2, P = 0.0059), and 20–22 mm (−35.3, P0.0001). No significant difference in stent underexpansion was detected based on gender, age, stent laterality, location of stenosis, or CEAP score.Larger MSD is associated with greater magnitude of stent underexpansion. These findings may have implications for future venous stent designing.
- Published
- 2017
35. A new endovascular technique for the treatment of dialysis-associated steal syndrome
- Author
-
Natalie Marks, Anil Hingorani, Jacob E. Mandel, and Enrico Ascher
- Subjects
medicine.medical_specialty ,Brachial Artery ,medicine.medical_treatment ,030232 urology & nephrology ,Arteriovenous fistula ,030204 cardiovascular system & hematology ,Anastomosis ,Veins ,Upper Extremity ,03 medical and health sciences ,0302 clinical medicine ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,medicine.artery ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Brachial artery ,Dialysis ,Gangrene ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Stent ,General Medicine ,medicine.disease ,Surgery ,body regions ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,Arteriovenous Fistula ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Dialysis access-associated steal syndrome is a major complication of arteriovenous fistula creation whereby the low-resistance venous conduit shunts arterial inflow through the anastomosis, resulting in clinically significant distal artery insufficiency. Herein, we describe a case of severe steal phenomenon with gangrene of a digit following placement of an arteriovenous fistula that was treated with a novel, entirely endovascular technique. To our knowledge, this was the first totally endovascular approach to dialysis access-associated steal syndrome. Methods Catheterization of the right subclavian, axillary, and brachial arteries was performed. A short 5-Fr sheath was exchanged for a long destination 6-Fr sheath and placed in the proximal brachial artery. An arteriogram showed no stenosis of the arterial system, but did show substantial steal phenomenon with inflow to the arteriovenous fistula, instead of the forearm. We placed a stent graft in the brachial artery across the anastomosis such that the graft covered 3/4 of the length of the opening of the anastomosis. Results Immediately after placement of the stent graft the clinical picture improved dramatically. Patient was followed for 15 months after this procedure until her demise for unrelated causes without ever experiencing dialysis access-associated steal syndrome and with a patent and functional arteriovenous fistula. Conclusion We present a patient with severe dialysis access-associated steal syndrome complicated by third fingertip gangrene, which was successfully treated using a completely endovascular technique. This novel endovascular approach enabled a high-risk patient to avoid open surgery, preserve her limb, and maintain the function of her arteriovenous fistula.
- Published
- 2017
36. Anesthesia in the Electrophysiology Laboratory
- Author
-
Jeff E. Mandel, William G. Stevenson, and David S. Frankel
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Sedation ,Hemodynamics ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,030202 anesthesiology ,Medicine ,Humans ,Anesthesia ,Intensive care medicine ,Phrenic nerve ,business.industry ,General Medicine ,Electrophysiology ,Anesthesiology and Pain Medicine ,Control of respiration ,Anesthetic ,medicine.symptom ,business ,medicine.drug - Abstract
The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. We review a range of electrophysiology procedures and discuss anesthetic approaches that balance patient safety and favorable outcomes.
- Published
- 2017
37. Performance of Masimo Rainbow Acoustic Monitoring for Tracking Changing Respiratory Rates Under Laryngeal Mask Airway General Anesthesia for Surgical Procedures in the Operating Room
- Author
-
Jeff E. Mandel and Joshua H. Atkins
- Subjects
Spirometry ,Operating Rooms ,Time Factors ,Respiratory rate ,Early detection ,Anesthesia, General ,Laryngeal Masks ,Respiratory Rate ,Laryngeal mask airway ,Predictive Value of Tests ,Monitoring, Intraoperative ,Humans ,Medicine ,Prospective Studies ,Respiratory system ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Acoustics ,Surgical procedures ,Anesthesiology and Pain Medicine ,Anesthesia ,Urologic Surgical Procedures ,Observational study ,business - Abstract
Accurate monitoring of respiratory rate may be useful for the early detection of patient deterioration. Monitoring of respiratory rate in the operating room under general anesthesia by spirometry is technically straightforward and demonstrates high fidelity. Accurate measurement of the respiratory rate of an unattended patient outside the operating room is fraught with challenges. Monitors such as capnometry and thoracic impedance pneumography have significant drawbacks. Respiratory acoustic monitoring (RRa™) is a new technology for respiratory rate monitoring, which has been demonstrated to provide accurate respiratory rates in patients recovering from anesthesia, but the performance of this RRa-enabled monitor under conditions of major respiratory rate variation has not been evaluated.We enrolled 53 patients undergoing urologic procedures in the operating room under general anesthesia with a laryngeal mask airway, spontaneous ventilation, and no muscle relaxation in an observational study. Respiratory signals (RRa and in-circuit pneumotachograph) were stored for later analysis. Artifacts were excluded based on visual inspection of the raw respiratory waveforms. Instantaneous respiratory rates were obtained from the pneumotachograph signal using the Hilbert-Huang Transform. Instantaneous rate estimates (IREs) were compared with RRa by 3 methods. First, the mean delay between IREs and RRa was determined. Second, precision was obtained by Bland-Altman analysis for repeated measures. Third, for all disparities in rates exceeding 4 breaths per minute (bpm), the probability of persistent error was determined as a function of time, with 95% confidence intervals estimated by bootstrap analysis.Data were collected from 53 patients. Three patients were excluded due to missing data. There were no adverse events related to RRa monitoring. RRa demonstrated a median delay of 45 seconds (interquartile range 20 seconds) to detect a 1- bpm change in IREs. Bland-Altman revealed 95% limits of agreement of -2.1 to 2.2 bpm across the range of 7 to 48 bpm. Disparities in respiratory rate4 bpm between the 2 methods did not persist beyond 160 seconds, and 90% of these differences resolved within 33 seconds (95% confidence interval 23-48 seconds).The data demonstrate that, under conditions of general anesthesia with a laryngeal mask airway and spontaneous ventilation, the RRa rapidly detects changes in respiratory rate, demonstrates minimal bias, and when errors in rate occur, these do not persist. The utility of this monitoring technology in detecting rate changes in unattended patients will require further study.
- Published
- 2014
38. Understanding Infusion Pumps
- Author
-
Jeff E. Mandel
- Subjects
business.industry ,Syringes ,Control engineering ,Equipment Design ,Risk Assessment ,Equipment failure ,Anesthesiology and Pain Medicine ,Anesthetic induction ,Risk Factors ,Anesthetic ,Anesthesia, Intravenous ,Medicine ,Humans ,Equipment Failure ,Patient Safety ,business ,Infusions, Intravenous ,Syringe ,Anesthetics, Intravenous ,Infusion Pumps ,medicine.drug ,Gravitation - Abstract
Infusion systems are complicated electromechanical systems that are used to deliver anesthetic drugs with moderate precision. Four types of systems are described-gravity feed, in-line piston, peristaltic, and syringe. These systems are subject to a number of failure modes-occlusion, disconnection, siphoning, infiltration, and air bubbles. The relative advantages of the various systems and some of the monitoring capabilities are discussed. A brief example of the use of an infusion system during anesthetic induction is presented. With understanding of the functioning of these systems, users may develop greater comfort.
- Published
- 2017
39. Idiopathic Inflammatory Myopathies: A Review of the Classification and Impact of Pathogenesis
- Author
-
Charles J. Malemud, Dana E. Mandel, and Ali D. Askari
- Subjects
0301 basic medicine ,Review ,Polymyositis ,Catalysis ,Dermatomyositis ,Autoimmune myositis ,Autoimmune Diseases ,lcsh:Chemistry ,Inorganic Chemistry ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Disease severity ,medicine ,Animals ,Humans ,Physical and Theoretical Chemistry ,lcsh:QH301-705.5 ,Molecular Biology ,Spectroscopy ,Autoantibodies ,030203 arthritis & rheumatology ,Myositis ,business.industry ,Organic Chemistry ,General Medicine ,medicine.disease ,Computer Science Applications ,030104 developmental biology ,Idiopathic inflammatory myopathies ,lcsh:Biology (General) ,lcsh:QD1-999 ,Glucocorticoid therapy ,inflammation ,muscle diseases ,Immunology ,idiopathic ,Rituximab ,business ,medicine.drug - Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune muscle diseases with significant morbidity and mortality. This review details and updates the pathogenesis and emerging importance of myositis-specific antibodies in the development of IIMs. An increase in the understanding of how these myositis-specific antibodies play a role in IIMs has led to the further categorization of IIMs from the traditional polymyositis versus dermatomyositis, to additional subcategories of IIMs such as necrotizing autoimmune myositis (NAM). The diagnosis of IIMs, including manual muscle testing, laboratory studies, and non-invasive imaging have become important in classifying IIM subtypes and for identifying disease severity. Treatment has evolved from an era where glucocorticoid therapy was the only option to a time now that includes traditional steroid-sparing agents along with immunoglobulin therapy and biologics, such as rituximab.
- Published
- 2017
40. Joint Hypermobility Syndrome and Postural Orthostatic Tachycardia Syndrome (HyPOTS)
- Author
-
Dana E. Mandel, Charles J. Malemud, Ali D Askari, and Artan Kaso
- Subjects
Joint hypermobility ,medicine.medical_specialty ,Physical medicine and rehabilitation ,business.industry ,Postural Orthostatic Tachycardia Syndrome ,medicine ,General Medicine ,medicine.disease ,business - Published
- 2017
41. Provocation of Atrial Fibrillation Triggers During Ablation: Does the Use of General Anesthesia Affect Inducibility?
- Author
-
Francis E. Marchlinski, Jeff E. Mandel, Mathew D. Hutchinson, Stavros E. Mountantonakis, M.S.C.E. Nabil Elkassabany M.D., and Lavanya Kondapalli
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Sedation ,Provocation test ,Case-control study ,Atrial fibrillation ,Catheter ablation ,medicine.disease ,Ablation ,Autonomic nervous system ,Physiology (medical) ,Internal medicine ,Anesthesia ,Cohort ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
AF Triggers During General Anesthesia Introduction The autonomic nervous system exerts important effects upon atrial fibrillation (AF) initiation. The strategy of anesthesia used during AF ablation may impact the provocation of AF triggers. We hypothesized that the use of general anesthesia (GA) would reduce the incidence of provokable AF triggers in patients undergoing AF ablation compared to patients studied while receiving only conscious sedation (CS). Methods and Results We performed a prospective, case control study comparing the incidence of provokable AF triggers in a consecutive series of patients undergoing AF ablation under GA using a standard trigger induction protocol. We compared the frequency and distribution of AF triggers to a second cohort of historical controls (matched for age, gender, left atrial dimension, and AF phenotype) who underwent ablation while receiving CS. We calculated that 44 total subjects (22 patients in each group) were required to detect a 50% reduction in the incidence of AF triggers in the GA cohort. There was no difference between the 2 groups in the rate of AF trigger inducibility (77% vs. 68%, P = 0.26) or the number of triggers provoked per patient (1.2 ± 0.8 vs. 1.3 ± 0.8, P = 0.38). Patients ablated under GA required higher doses of phenylephrine during the trigger induction protocol (408.3 mg [52–600] vs. 158.3 mg [0–75]; P = 0.003), and tended to require higher doses of isoproterenol to initiate triggers (92.8 mg [20–111] vs. 63.6 mg [6–103]; P = 0.25). Conclusion AF trigger induction during GA is both safe and efficacious.
- Published
- 2014
42. Time-Delay When Updating Infusion Rates in the Graseby 3400 Pump Results in Reduced Drug Delivery
- Author
-
Jeff E. Mandel and Elie H. Sarraf
- Subjects
Syringe driver ,Time Factors ,business.industry ,Equipment Design ,Drug Delivery Systems ,Anesthesiology and Pain Medicine ,Pharmaceutical Preparations ,Pharmacokinetics ,Anesthesia ,Drug delivery ,Medicine ,Infusions, Intravenous ,business ,Infusion Pumps ,Syringe - Abstract
Infusion pumps are commonly used for infusion of drugs for physiologic control, and infusion rate has been demonstrated to affect the parameters of pharmacokinetic models. In attempting to develop a model that explained this behavior, we examined the behavior of the Graseby 3400 syringe pump under a range of flow conditions and with variations in syringe characteristics. Two issues were identified: start-up loss (the difference between actual and ideal delivery on initial infusion) and update loss (the difference between actual and ideal delivery when transmitting a command to change infusion rate). Under worst-case conditions, this may result in a 20-second period of zero delivery during start-up, and when updating infusion rates once per second, zero output. These effects are influenced by syringe characteristics and vary sufficiently as to make it impossible to isolate this effect from the pharmacokinetic process being controlled. The implications of this for previous published results and clinical application of target-controlled infusions are discussed.
- Published
- 2014
43. Harmony of the Heart: Music Therapy
- Author
-
Suzanne B. Hanser and Susan E. Mandel
- Subjects
Harmony (color) ,Psychotherapist ,Blood pressure ,Music therapy ,Randomized controlled trial ,law ,medicine ,Anxiety ,Small sample ,medicine.symptom ,Psychology ,law.invention - Abstract
This article presents a research agenda that began with the development of a clinical music therapy protocol, including music-assisted relaxation and imagery (MARI), for individuals with heart conditions who are referred for cardiac rehabilitation. Health-related outcomes of this program were investigated in a randomized controlled trial, finding significant changes in blood pressure over time, and short-term changes in stress and anxiety. A mixed methods study then examined process and outcomes more thoroughly in a small sample of patients. In a more recent trial, this approach was applied to individuals who have diabetes. Coming full circle, the research investigations informed an adaptation of the original music therapy protocol for clinical use in cardiac rehabilitation. Underlying mechanisms in the autonomic nervous system and future research directions are also discussed.
- Published
- 2014
44. Nintendo® Wii Fit based sleepiness tester detects impairment of postural steadiness due to 24h of wakefulness
- Author
-
Jeff E. Mandel, Aino Tietäväinen, Edward Hæggström, Fred Gates, and Antti Meriläinen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Injury control ,Accident prevention ,Biomedical Engineering ,Biophysics ,Poison control ,Models, Biological ,050105 experimental psychology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,Humans ,0501 psychology and cognitive sciences ,Wakefulness ,Postural Balance ,business.industry ,05 social sciences ,Balance board ,Circadian Rhythm ,Body sway ,Alertness ,Video Games ,Physical therapy ,Female ,Sleep ,business ,030217 neurology & neurosurgery - Abstract
A field-usable sleepiness tester could reduce sleepiness related accidents. 15 subjects' postural steadiness was measured with a Nintendo(®) Wii Fit balance board every hour for 24 h. Body sway was quantified with complexity index, CI, and the correlation between CI and alertness predicted by a three-process model of sleepiness was calculated. The CI group average was 8.9 ± 1.3 for alert and 7.9 ± 1.4 for sleep deprived subjects (p < 0.001, ρ = 0.94). The Wii Fit board detects the impairment of postural steadiness. This may allow large scale sleepiness testing outside the laboratory setting.
- Published
- 2013
45. Diagnostic Reference Ranges for Pediatric Abdominal CT
- Author
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Jeffrey S. Prince, Alexander J. Towbin, Michael J. Callahan, Laura Coombs, Kassa Darge, David B. Larson, Keith E Mandel, Daniel J. Podberesky, Sjirk J. Westra, Marilyn J. Goske, Donald P. Frush, and Keith J. Strauss
- Subjects
Male ,Radiography, Abdominal ,medicine.medical_specialty ,Quality management ,Adolescent ,Image quality ,Radiography ,Abdominal ct ,Contrast Media ,Radiation Dosage ,Reference Values ,X ray computed ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Registries ,Child ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,Radiation dose ,Infant, Newborn ,Infant ,Retrospective cohort study ,Multicenter study ,Child, Preschool ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
To develop diagnostic reference ranges (DRRs) and a method for an individual practice to calculate site-specific reference doses for computed tomographic (CT) scans of the abdomen or abdomen and pelvis in children on the basis of body width (BW).This HIPAA-compliant multicenter retrospective study was approved by institutional review boards of participating institutions; informed consent was waived. In 939 pediatric patients, CT doses were reviewed in 499 (53%) male and 440 (47%) female patients (mean age, 10 years). Doses were from 954 scans obtained from September 1 to December 1, 2009, through Quality Improvement Registry for CT Scans in Children within the National Radiology Data Registry, American College of Radiology. Size-specific dose estimate (SSDE), a dose estimate based on BW, CT dose index, dose-length product, and effective dose were analyzed. BW measurement was obtained with electronic calipers from the axial image at the splenic vein level after completion of the CT scan. An adult-sized patient was defined as a patient with BW of 34 cm. An appropriate dose range for each DRR was developed by reviewing image quality on a subset of CT scans through comparison with a five-point visual reference scale with increments of added simulated quantum mottle and by determining DRR to establish lower and upper bounds for each range.For 954 scans, DRRs (SSDEs) were 5.8-12.0, 7.3-12.2, 7.6-13.4, 9.8-16.4, and 13.1-19.0 mGy for BWs less than 15, 15-19, 20-24, 25-29, and 30 cm or greater, respectively. The fractions of adult doses, adult SSDEs, used within the consortium for patients with BWs of 10, 14, 18, 22, 26, and 30 cm were 0.4, 0.5, 0.6, 0.7, 0.8, and 0.9, respectively.The concept of DRRs addresses the balance between the patient's risk (radiation dose) and benefit (diagnostic image quality). Calculation of reference doses as a function of BW for an individual practice provides a tool to help develop site-specific CT protocols that help manage pediatric patient radiation doses.
- Published
- 2013
46. Exemplar Pediatric Collaborative Improvement Networks: Achieving Results
- Author
-
Paul J. Sharek, Amy L. Billett, Carole Lannon, Stephen E. Muething, Richard B. Colletti, Marlene R. Miller, and Keith E. Mandel
- Subjects
medicine.medical_specialty ,Certification ,Quality management ,Adolescent ,Population ,Child Welfare ,Quality care ,Community Networks ,Pediatrics ,Translational Research, Biomedical ,Patient safety ,Cost Savings ,Pregnancy ,Surgical site ,Hospital discharge ,Humans ,Medicine ,Cooperative Behavior ,Child ,Intensive care medicine ,education ,Societies, Medical ,Quality Indicators, Health Care ,Asthma ,education.field_of_study ,business.industry ,Crohn disease ,Infant, Newborn ,Infant ,Hospitals, Pediatric ,medicine.disease ,Quality Improvement ,United States ,Outcome and Process Assessment, Health Care ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Interdisciplinary Communication ,Guideline Adherence ,Health Services Research ,business - Abstract
A number of pediatric collaborative improvement networks have demonstrated improved care and outcomes for children. Regionally, Cincinnati Children’s Hospital Medical Center Physician Hospital Organization has sustained key asthma processes, substantially increased the percentage of their asthma population receiving “perfect care,” and implemented an innovative pay-for-performance program with a large commercial payor based on asthma performance measures. The California Perinatal Quality Care Collaborative uses its outcomes database to improve care for infants in California NICUs. It has achieved reductions in central line–associated blood stream infections (CLABSI), increased breast-milk feeding rates at hospital discharge, and is now working to improve delivery room management. Solutions for Patient Safety (SPS) has achieved significant improvements in adverse drug events and surgical site infections across all 8 Ohio children’s hospitals, with 7700 fewer children harmed and >$11.8 million in avoided costs. SPS is now expanding nationally, aiming to eliminate all events of serious harm at children’s hospitals. National collaborative networks include ImproveCareNow, which aims to improve care and outcomes for children with inflammatory bowel disease. Reliable adherence to Model Care Guidelines has produced improved remission rates without using new medications and a significant increase in the proportion of Crohn disease patients not taking prednisone. Data-driven collaboratives of the Children’s Hospital Association Quality Transformation Network initially focused on CLABSI in PICUs. By September 2011, they had prevented an estimated 2964 CLABSI, saving 355 lives and $103 722 423. Subsequent improvement efforts include CLABSI reductions in additional settings and populations.
- Published
- 2013
47. Abdominal relaxation during emergence from general anesthesia with propofol and remifentanil
- Author
-
Jeff E. Mandel and Joshua H. Atkins
- Subjects
Thorax ,medicine.medical_specialty ,Apnea ,Muscle Relaxation ,Laryngoscopy ,Remifentanil ,Pilot Projects ,High-Frequency Jet Ventilation ,Piperidines ,Bronchoscopy ,medicine ,Humans ,Respiratory inductance plethysmography ,Propofol ,Abdominal Muscles ,Monitoring, Physiologic ,Postoperative Care ,medicine.diagnostic_test ,business.industry ,Anesthetics, Combined ,Surgery ,Plethysmography ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Exhalation ,Anesthesia ,Anesthesia Recovery Period ,Anesthesia, Intravenous ,Respiratory Mechanics ,Breathing ,Abdomen ,medicine.symptom ,business ,Anesthetics, Intravenous ,medicine.drug - Abstract
Study Objective To characterize respiratory dynamics during emergence from propofol-remifentanil anesthesia using noninvasive respiratory inductance plethysmography (RIP). Design Observational pilot study. Setting Operating room in a university-affiliated teaching hospital. Patients 50 ASA physical status 1, 2, and 3 patients scheduled for microdirect laryngoscopy or bronchoscopy using total intravenous anesthesia (TIVA) with high-frequency jet ventilation. Interventions Patients were fitted with plethysmography bands around the chest and abdomen prior to induction. Following completion of surgery in patients undergoing brief airway procedures using propofol-remifentanil general anesthesia, the anesthetic infusions were stopped and ventilation suspended until resumption of spontaneous ventilation or desaturation below 90%. During this period of apnea, abdominal and thoracic girth was assessed with noninvasive RIP. Measurements Cross-sectional area of the thorax and abdomen during emergence were measured. Main Results Useful data were obtained from 41 patients, with stable apnea lasting 404 ± 193.1 seconds; of these, 34 exhibited a slow and significant decrease in abdominal girth over a period of 267.8 ± 128.5 seconds. Resumption of spontaneous ventilation generally coincided with the end of this abdominal relaxation. Conclusion Slow expiration is the initial step in the resumption of spontaneous ventilation during apnea induced with TIVA using propofol-remifentanil.
- Published
- 2013
48. Spectral dependences of the optical absorption in bismuth germanium oxide crystals annealed in vacuum
- Author
-
É. V. Pozdeeva, Yu. F. Kargin, Stanislav M. Shandarov, A. E. Mandel, M. G. Kisteneva, A. N. Grebenchukov, and A. S. Akrestina
- Subjects
Materials science ,Annealing (metallurgy) ,Analytical chemistry ,General Physics and Astronomy ,chemistry.chemical_element ,Oxygen ,Bismuth ,Crystal ,Condensed Matter::Materials Science ,chemistry ,Impurity absorption ,Air atmosphere ,Wide band ,Germanium oxide - Abstract
Results of experimental investigations into the spectral dependences of the light absorption coefficient of an undoped Bi12GeO20 crystal annealed in vacuum at a temperature of 650°С and subsequently annealed in the air atmosphere at temperatures in the range Т АА = 315–590°С are presented for the spectral range 400–1100 nm at room temperature. It is established that the optical absorption of the crystal after temperature annealing in vacuum increases in the entire examined spectral range. Subsequent annealing in air leads to gradual restoration of the initial impurity absorption spectrum in the range from 530 to 1100 nm. The wide band that can be caused by oxygen vacancies is observed in the spectrum of absorption changes induced by annealing in vacuum.
- Published
- 2012
49. The use of high-frequency jet ventilation for out of operating room anesthesia
- Author
-
Jesse Raiten, Jeff E. Mandel, and Nabil M. Elkassabany
- Subjects
Mechanical ventilation ,Operating Rooms ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Cardiac arrhythmia ,Arrhythmias, Cardiac ,Catheter ablation ,Interventional radiology ,Carbon Dioxide ,Ambulatory Surgical Procedure ,High-Frequency Jet Ventilation ,Jet ventilation ,Anesthesiology and Pain Medicine ,High frequency jet ventilation ,Ambulatory Surgical Procedures ,Lithotripsy ,Anesthesia ,Catheter Ablation ,medicine ,Humans ,In patient ,business - Abstract
High-frequency jet ventilation is a novel technique for providing mechanical ventilation in the out of operating room (OOR) setting. Case reports and a small series of patients have shown it to be useful in patients undergoing cardiac arrhythmia ablations, interventional radiology procedures, and extracorporeal shock wave lithotripsy. Recently, interest in the technique has grown tremendously as the ability to provide superior surgical conditions may lead to improved efficiency and less side-effects in a variety of procedures.Atrial fibrillation ablation procedures, liver tumor ablations, and extracorporeal shock wave lithotripsy are all the procedures that benefit from minimal movement of the heart, liver, and kidney, respectively, during the procedure. Although randomized controlled trials are lacking, increasing data suggest that by maintaining the thoracic and abdominal structures relatively immobile throughout the respiratory cycle, the efficiency and safety of these procedures may be improved.Technological advances are allowing an increasing number of surgical procedures to be performed in the OOR setting. Such procedures often depend on the precise application of ablation catheters or shock waves. High-frequency jet ventilation facilitates the improved accuracy of catheter and shock wave placement, as well as efficiency of a variety of procedures. Improved efficiency, with fewer side-effects, has tremendous implications for the growth of such procedures in the OOR setting.
- Published
- 2012
50. Anesthetic Management of Patients Undergoing Pulmonary Vein Isolation for Treatment of Atrial Fibrillation Using High-Frequency Jet Ventilation
- Author
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Sanjay Dixit, Jesse Raiten, Jeff E. Mandel, Francis E. Marchlinski, Nabil M. Elkassabany, Erica S. Zado, Fermin C. Garcia, William Gao, Rebecca M. Speck, Cory M. Tschabrunn, and Khan Chaichana
- Subjects
Male ,medicine.medical_specialty ,Partial Pressure ,medicine.medical_treatment ,Catheter ablation ,Anesthesia, General ,Body Mass Index ,Pulmonary vein ,law.invention ,High-Frequency Jet Ventilation ,Intraoperative Period ,law ,Atrial Fibrillation ,medicine ,Humans ,Aged ,Retrospective Studies ,Ejection fraction ,business.industry ,Retrospective cohort study ,Atrial fibrillation ,Perioperative ,Carbon Dioxide ,Middle Aged ,medicine.disease ,Ablation ,Surgery ,Oxygen ,Anesthesiology and Pain Medicine ,Pulmonary Veins ,Anesthesia ,Ventilation (architecture) ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives The aim of this study was to describe anesthetic management and perioperative complications in patients undergoing pulmonary vein isolation for the treatment of atrial fibrillation under general anesthesia using high-frequency jet ventilation. The authors also identified variables associated with longer ablation times in this patient cohort. Design A retrospective observational study. Setting The electrophysiology laboratory in a major university hospital. Participants One hundred eighty-eight consecutive patients undergoing pulmonary vein isolation under general anesthesia with high-frequency jet ventilation. Interventions High-frequency jet ventilation was used as the primary mode of ventilation under general anesthesia. Measurements and Main Results High-frequency jet ventilation was performed successfully throughout the ablation procedure in 175 cases of the study cohort. The remaining 13 patients had to be converted to conventional positive-pressure ventilation because of high PaCO 2 or low PaO 2 on arterial blood gas measurements. Variables associated with a shorter ablation time included a higher ejection fraction ( p = 0.04) and case volume performed by each electrophysiologist in the study group ( p = 0.001). Conclusions High-frequency jet ventilation is generally a safe technique that can be used in catheter ablation treatment under general anesthesia.
- Published
- 2012
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