OBJECTIVE: To evaluate whether less pulsatile levodopa therapy (LPT) can reduce the development of levodopa-induced dyskinesia (LID). METHODS: This is a retrospective cohort study of patients with Parkinson’s disease at the movement disorders clinic of Medstar Washington Hospital Center. The study was not blinded or randomized. Patients were seen between August 2002 and August 2018. During these years, we treated patients with less pulsatile (6 doses daily) levodopa treatment to reduce LID. Occurrence of LID was recorded. RESULTS: Ninety-five patients with Parkinson’s disease taking levodopa were divided into two groups: 1) patients who were initially managed on LPT or who switched from traditional therapy (TT) (n = 61) (mean disease duration: 7.7 ± 4.8 years, mean levodopa duration: 5.6 ± 4.5 years and mean observation time: 4.3 ± 3.4 years), and 2) patients on TT throughout the observation period or until they developed dyskinesia (n = 34) (mean disease duration: 8.3 ± 3.8 years, mean levodopa duration: 6.2 ± 4.2 years and mean observation time: 4.1 ± 3.4 years). Three of the 61 LPT patients developed dyskinesia during the observation period. One of the patients developed dyskinesia after being switched to pulsatile doses by another doctor. In the other two, dyskinesia was minimal. In contrast to this 4.9% cumulative incidence, dyskinesia occurred in 50% (17/34) of TT patients, an incidence similar to that in published data (p < 0.001). CONCLUSION: Less pulsatile levodopa with 6 daily doses was associated with a low incidence of LID. Further study of this method of treatment is warranted.
Cohort Studies ; Dyskinesias ; Humans ; Incidence ; Levodopa ; Methods ; Movement Disorders ; Parkinson Disease ; Retrospective Studies ; Washington

Segmentation of fundamental heart sounds–S1 and S2 is important for automated monitoring of cardiac activity including diagnosis of the heart diseases. This pa-per proposes a novel hybrid method for S1 and S2 heart sound segmentation using group sparsity denoising and variation mode decomposition (VMD) technique. In the proposed method, the measured phonocardiogram (PCG) signals are denoised using group sparsity algorithm by exploiting the group sparse (GS) property of PCG signals. The denoised GS-PCG signals are then decomposed into subsequent modes with specific spectral characteristics using VMD algorithm. The appropriate mode for further processing is selected based on mode central frequencies and mode energy. It is then followed by the extraction of Hilbert envelope (HEnv) and a thresholding on the selected mode to segment S1 and S2 heart sounds. The performance advantage of the proposed method is verified using PCG signals from benchmark databases namely eGeneralMedical, Littmann, Washington, and Michigan. The proposed hybrid algorithm has achieved a sensitivity of 100%, positive predictivity of 98%, accuracy of 98% and detection error rate of 1.5%. The promising results obtained suggest that proposed approach can be considered for automated heart sound segmentation.
Benchmarking ; Diagnosis ; Heart Diseases ; Heart Sounds ; Heart ; Methods ; Michigan ; Washington

OBJECTIVE: To compare the effects of low intensity ultrasound (LIUS), traditional exercise therapy (TET), low level laser therapy (LLLT) and TET on temporomandibular joint (TMJ) pain and trismus following recovery from head and neck cancer (HNC). METHODS: Sixty participants following, who had experienced HNC, were randomly allocated to three groups of 20 people each. Each group received different therapy. Group A received LIUS and TET; group B received LLLT and TET; while group C received TET. All 60 participants were evaluated under the visual analog scale (VAS), the University of Washington Quality of Life questionnaire (UW-QOL) and the Vernier caliper scale (VCS) at the beginning of the therapies and after 4 weeks. RESULTS: ANOVA test revealed significant improvements across all three groups with outcomes of p < 0.05. The results of the UW-QOL questionnaire showed a significant difference between groups A, B and C in favor of group A (p < 0.05). The VAS results showed a more improvement in group A as compared to group B (p < 0.05), while there was no statistical difference between groups B and C (p>0.05). The VCS results showed more improvement for the individuals in group B as compared to those in group C (p < 0.05), while there was minimal difference between groups A and B (p>0.05). CONCLUSION: The LIUS and TET are more effective than LLLT and/or TET in reducing TMJ pain and trismus following HNC.
Exercise Therapy ; Exercise* ; Head and Neck Neoplasms* ; Head* ; Low-Level Light Therapy ; Quality of Life ; Temporomandibular Joint* ; Trismus* ; Ultrasonics ; Ultrasonography* ; Visual Analog Scale ; Washington

OBJECTIVE: The use of robotic radical hysterectomy has greatly increased in the treatment of early stage cervical cancer. We sought to compare surgical and oncologic outcomes of women undergoing robotic radical hysterectomy compared to open radical hysterectomy. METHODS: The clinic-pathologic, treatment, and recurrence data were abstracted through an Institutional Review Board-approved protocol at 2 separate large tertiary care centers in Seattle, Swedish Medical Center and the University of Washington. Data were collected from 2001–2012. Comparisons between the robotic and open cohorts were made for complications, recurrence, progression-free survival (PFS), and overall survival (OS). RESULTS: In the study period, 109 robotic radical hysterectomies were performed. These were compared to 202 open radical hysterectomies. The groups were comparable in terms of age and body mass index (BMI). Length of stay (LOS) was considerably shorter in the robotic group (42.7 vs. 112.6 hours, p<0.001) as was estimated blood loss (EBL; 105.9 vs. 482.6 mL, p<0.001). There were more complications in the open radical hysterectomy group, 23.4% vs. 9.2% in the robotic group (p=0.002). The recurrence rate was comparable between the groups (10.1% vs. 10.4%, p=0.730). In multivariate adjusted analysis, robotic surgery was not a statistically significant predictor of PFS (p=0.230) or OS (0.85). CONCLUSION: Our study, one of the largest multi-institution cohorts of patients undergoing robotic radical hysterectomy, suggest robotic radical hysterectomy leads to comparable oncologic outcomes in the treatment of early stage cervical cancer with improved short-term surgical outcomes such as decreased LOS and EBL.
Body Mass Index ; Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Female ; Humans ; Hysterectomy* ; Length of Stay ; Recurrence ; Tertiary Care Centers ; Uterine Cervical Neoplasms* ; Washington

Job hazard analyses were conducted to assess exposure to musculoskeletal disorder (MSD) risk factors in seven workers of three dry-cleaning establishments. In accordance with the Washington State Ergonomics Rule, the analyses were performed in two separate steps: (1) observation and checklist approaches were made to identify a “caution zone job” in the seven workers' pressing operations across the three shops; and (2) detailed posture and motion analyses were undertaken to determine a “MSD hazard” in one worker's operation using a video technique. One “caution zone job” was identified and it was the pressing operation job in which five physical risk factors were found in the pressing operations. The detailed analyses confirmed that one “MSD hazard”, i.e., awkward posture in shoulders, was prevalent in the pressing operations of the three dry-cleaning facilities. It would be desirable to reduce MSD risk factors including awkward shoulder posture in the dry-cleaning industry.
Checklist ; Human Engineering ; Posture ; Risk Factors* ; Shoulder ; Washington

As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment.
Africa ; Chemoprevention ; Diagnosis ; Hospitals, Teaching* ; Humans ; Length of Stay ; Malaria* ; Mortality ; Plasmodium falciparum ; Plasmodium vivax ; Retrospective Studies ; United States ; Washington*

INTRODUCTION: Quality of life (QoL) studies provide information about the impact of disease, the treatment of symptoms, and outcomes following treatment. The present study aims to evaluate the postoperative QoL of patients treated for oral cancer in a Nigerian government tertiary hospital. MATERIALS AND METHODS: A prospective study on consenting patients with oral cancer was undertaken at Aminu Kano Teaching Hospital, Kano, Nigeria. The subjects completed the University of Washington QoL (UW-QoL) questionnaire one day prior to surgery and postoperatively after 7 days, 1 month, 3 months, and 6 months. RESULTS: Sixty-eight patients with oral cancer were recruited. Of these, 38 were males, and 30 were females (male : female, 1.3 : 1). Twenty-four patients (12 males and 12 females) underwent surgery and completed postoperative QoL assessment using the UW-QoL questionnaire. Preoperative QoL mean score was 2.21, while postoperative mean scores after 1 week, 1 month, 3 months, and 6 months were 3.67, 3.46, 2.82, and 2.61, respectively. CONCLUSION: An improvement in QoL following surgical treatment for patients with oral cancer was observed. 'Appearance,' 'recreation,' and 'chewing' were identified as the most important determinants of postoperative QoL in patients with oral cancer in our study.
Female ; Hospitals, Teaching ; Humans ; Male ; Mouth Neoplasms* ; Nigeria ; Prospective Studies ; Quality of Life* ; Surveys and Questionnaires ; Tertiary Care Centers ; Washington

OBJECTIVES: Existing methods for practically evaluating musculoskeletal exposures such as posture and repetition in workplace settings have limitations. We aimed to automate the estimation of parameters in the revised United States National Institute for Occupational Safety and Health (NIOSH) lifting equation, a standard manual observational tool used to evaluate back injury risk related to lifting in workplace settings, using depth camera (Microsoft Kinect) and skeleton algorithm technology. METHODS: A large dataset (approximately 22,000 frames, derived from six subjects) of simultaneous lifting and other motions recorded in a laboratory setting using the Kinect (Microsoft Corporation, Redmond, Washington, United States) and a standard optical motion capture system (Qualysis, Qualysis Motion Capture Systems, Qualysis AB, Sweden) was assembled. Error-correction regression models were developed to improve the accuracy of NIOSH lifting equation parameters estimated from the Kinect skeleton. Kinect-Qualysis errors were modelled using gradient boosted regression trees with a Huber loss function. Models were trained on data from all but one subject and tested on the excluded subject. Finally, models were tested on three lifting trials performed by subjects not involved in the generation of the model-building dataset. RESULTS: Error-correction appears to produce estimates for NIOSH lifting equation parameters that are more accurate than those derived from the Microsoft Kinect algorithm alone. Our error-correction models substantially decreased the variance of parameter errors. In general, the Kinect underestimated parameters, and modelling reduced this bias, particularly for more biased estimates. Use of the raw Kinect skeleton model tended to result in falsely high safe recommended weight limits of loads, whereas error-corrected models gave more conservative, protective estimates. CONCLUSIONS: Our results suggest that it may be possible to produce reasonable estimates of posture and temporal elements of tasks such as task frequency in an automated fashion, although these findings should be confirmed in a larger study. Further work is needed to incorporate force assessments and address workplace feasibility challenges. We anticipate that this approach could ultimately be used to perform large-scale musculoskeletal exposure assessment not only for research but also to provide real-time feedback to workers and employers during work method improvement activities and employee training.
Automation* ; Back Injuries ; Back Pain ; Bias (Epidemiology) ; Dataset ; Human Engineering ; Lifting* ; National Institute for Occupational Safety and Health (U.S.) ; Posture ; Skeleton ; Trees ; United States ; Washington

As the International Human Epigenome Consortium (IHEC) launched officially at the 2010 Washington meeting, a giant step toward the conquest of unexplored regions of the human genome has begun. IHEC aims at the production of 1,000 reference epigenomes to the international scientific community for next 7-10 years. Seven member institutions, including South Korea, Korea National Institute of Health (KNIH), will produce 25-200 reference epigenomes individually, and the produced data will be publically available by using a data center. Epigenome data will cover from whole genome bisulfite sequencing, histone modification, and chromatin access information to miRNA-seq. The final goal of IHEC is the production of reference maps of human epigenomes for key cellular status relevant to health and disease.
Chromatin ; Genome ; Genome, Human ; Histones ; Humans ; Korea ; MicroRNAs ; Republic of Korea ; Sulfites ; Washington

OBJECTIVES: Geographic Information Systems (GIS) is a powerful tool for assessing exposure in epidemiologic studies. We used GIS to determine the geographic extent of contamination by perfluorooctanoic acid, C8 (PFOA) that was released into the environment from the DuPont Washington Works Facility located in Parkersburg, West Virginia. METHODS: Paper maps of pipe distribution networks were provided by six local public water districts participating in the community cross-sectional survey, the C8 Health Project. Residential histories were also collected in the survey and geocoded. We integrated the pipe networks and geocoded addresses to determine which addresses were serviced by one of the participating water districts. The GIS-based water district assignment was then compared to the participants' self-reported source of public drinking water. RESULTS: There were a total of 151,871 addresses provided by the 48,800 participants of the C8 Health Project that consented to geocoding. We were able to successfully geocode 139,067 (91.6%) addresses, and of these, 118,209 (85.0%) self-reported water sources were confirmed using the GIS-based method of water district assignment. Furthermore, the GIS-based method corrected 20,858 (15.0%) self-reported public drinking water sources. Over half (54%) the participants in the lowest GIS-based exposure group self-reported being in a higher exposed water district. CONCLUSIONS: Not only were we able to correct erroneous self-reported water sources, we were also able to assign water districts to participants with unknown sources. Without the GIS-based method, the reliance on only self-reported data would have resulted in exposure misclassification.
Cross-Sectional Studies ; Drinking Water* ; Drinking* ; Epidemiologic Studies ; Geographic Information Systems* ; Geographic Mapping ; Methods ; Washington ; Water ; West Virginia