Computational models for improved diagnosis and prognosis of stroke using robot-based biomarkers

Stroke is a leading cause of death and permanent disability worldwide, affecting millions of individuals. Traditional clinical scores for assessment of stroke-related impairments are inherently subjective and limited by inter-rater and intra-rater reliability, as well as floor and ceiling effects. In contrast, robotic technologies provide objective, highly repeatable tools for quantification of neurological impairments following stroke. KINARM is an exoskeleton robotic device that provides objective, reliable tools for assessment of sensorimotor, proprioceptive and cognitive brain function by means of a battery of behavioral tasks. As such, KINARM is particularly useful for assessment of neurological impairments following stroke. This thesis introduces a computational framework for assessment of neurological impairments using the data provided by KINARM. This is done by achieving two main objectives. First, to investigate how robotic measurements can be used to estimate current and future abilities to perform daily activities for subjects with stroke. We are able to predict clinical scores related to activities of daily living at present and future time points using a set of robotic biomarkers. The findings of this analysis provide a proof of principle that robotic evaluation can be an effective tool for clinical decision support and target-based rehabilitation therapy. The second main objective of this thesis is to address the emerging problem of long assessment time, which can potentially lead to fatigue when assessing subjects with stroke. To address this issue, we examine two time reduction strategies. The first strategy focuses on task selection, whereby KINARM tasks are arranged in a hierarchical structure so that an earlier task in the assessment procedure can be used to decide whether or not subsequent tasks should be performed. The second strategy focuses on time reduction on the longest two individual KINARM tasks. Both reduction strategies are shown to provide significant time savings, ranging from 30% to 90% using task selection and 50% using individual task reductions, thereby establishing a framework for reduction of assessment time on a broader set of KINARM tasks. All in all, findings of this thesis establish an improved platform for diagnosis and prognosis of stroke using robot-based biomarkers.

Transportation system management: promise, performance and prognosis. Summary final report.

Transportation Department, Research and Special Programs Administration, Washington, D.C.

The individual delinquent : a text-book of diagnosis and prognosis for all concerned in understanding offenders /

Bibliography: p.791-808.

The physician's vade-mecum : containing the symptoms, causes, diagnosis, prognosis and treatment of diseases, accompanied by a select collection of formulae and a glossary of terms /

Mode of access: Internet.

Observationum et curationum medicinalium, sive, Medicinae theoricae & practicae, libri XXVIII [i.e. XXXII] ... : in quibus eorundem caussae, signa, prognosis & curationes graphice depinguntur

Contiene solamente 2ª parte del Vol.1.: Obseruationum et curationum medicinalium . Liber decimussextus... De pectoris pulmonisque vitiis ac morbis.

MFPG : detection, diagnosis, and prognosis : proceedings of the 26th meeting of the Mechanical Failures Prevention Group, held at the IIT Research Institute, Chicago, Illinois, May 17-19, 1977 /

"Sponsored by the Institute for Materials Research of the National Bureau of Standards ... [et al.]"

Observationum et curationum medicinalium sive medicinae theoricae [et] practicae : libri XXVIII ... in quibus eorundem caussae, signa, prognosis [atque] curationes graphice depinguntur /

Contiene con numeración propia y sin portada.: Obseruationum et curationum medicinalium ... De morbis oculurum et palpebrarum. - Obseruationum et curationum medicinalium ... De pectoris pulmonisque vitiis ac morbis.

Current cancer research on breast cancer : diagnosis, prognosis, and treatment.

Prepared for the ICRDB Program by the Current Cancer Research Project Analysis Center.

Economics of Douglas-fir tussock moth control : an analysis using the combined stand prognosis/Douglas-fir tussock moth outbreak model and the FORPLAN linear programming model on the Clearwater and Malheur National Forests /

"March 1984."

On spermatorrhoea: its causes, symptomatology, pathology, prognosis, diagnosis, and treatment.

Later eds. have title: Spermatorrhoea.

Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy

OBJECTIVES This study was designed to predict the response and prognosis after cardiac resynchronization therapy (CRT) in patients with end-stage heart failure (HF). BACKGROUND Cardiac resynchronization therapy improves HF symptoms, exercise capacity, and left ventricular (LV) function. Because not all patients respond, preimplantation identification of responders is needed. In the present study, response to CRT was predicted by the presence of LV dyssynchrony assessed by tissue Doppler imaging. Moreover, the prognostic value of LV dyssynchrony in patients undergoing CRT was assessed. METHODS Eighty-five patients with end-stage HF, QRS duration >120 ins, and left bundle-branch block were evaluated by tissue Doppler imaging before CRT. At baseline and six months follow-up, New York Heart Association functional class, quality of life and 6-min walking distance, LV volumes, and LV ejection fraction were determined. Events (death, hospitalization for decompensated HF) were obtained during one-year follow-up. RESULTS Responders (74%) and nonresponders (26%) had comparable baseline characteristics, except for a larger dyssynchrony in responders (87 +/- 49 ms vs. 35 +/- 20 ms, p < 0.01). Receiver-operator characteristic curve analysis demonstrated that an optimal cutoff value of 65 ms for LV dyssynchrony yielded a sensitivity and specificity of 80% to predict clinical improvement and of 92% to predict LV reverse remodeling. Patients with dyssynchrony :65 ms had an excellent prognosis (6% event rate) after CRT as compared with a 50% event rate in patients with dyssynchrony <65 ins (p < 0.001). CONCLUSIONS Patients with LV dyssynchrony greater than or equal to65 ms respond to CRT and have an excellent prognosis after CRT. (C) 2004 by the American College of Cardiology Foundation.

Synovial sarcoma - Towards a simplified approach to prognosis

Background: Synovial sarcoma is a high grade sarcoma that usually occurs in adults. Numerous studies have attempted to identify prognostic factors that might allow more effective treatment for particular subgroups of patients. Methods: We studied 25 histologically confirmed cases of synovial sarcoma in an attempt to identify particular patient, tumour or treatment characteristics that might have a prognostic significance using Cox proportional hazards regression modelling to identify differences in survival rates. All patients received their definitive surgical treatment from a single orthopaedic surgeon reducing the likelihood of bias related to variations in surgical technique. Results: Statistically significant higher survival rates were seen in female patients (P = 0.040) and in patients aged

Novel markers for poor prognosis in head and neck cancer

Head and neck cancer (HNSCC) is one of the most distressing human cancers, causing pain and affecting the basic survival functions of breathing and swallowing. Mortality rates have not changed despite recent advances in radiotherapy and surgical treatment. We have compared the expression of over 13,000 unique genes in 7 cases of matched HNSCC and normal oral mucosa. Of the 1,260 genes that showed statistically significant differences in expression between normal and tumor tissue at the mRNA level, the three top ranking of the top 5% were selected for further analysis by immunohistochemistry on paraffin sections,. along with the tumor suppressor genes p16 and p53, in a total of 62 patients including 55 for whom >4-year clinical data was available. Using univariate and multivariate survival analysis, we identified SPARC/osteonectin as a powerful independent prognostic marker for short disease-free interval (DFI) (p < 0.002) and poor overall survival (OS) (p = 0.018) of HNSCC patients. In combination with other ECM proteins found in our analysis, PAI-1 and uPA, the association with DFI and OS became even more significant (p < 0.001). Our study represents the first instance of SPARC as an independent prognostic marker in HNSCC.