Concurrent Validity of a Low-Cost Manometer for Objective Assessments of Respiratory Muscle Strength.

OBJECTIVE(S): This study examined the agreement in maximal expiratory (MEP) and inspiratory (MIP) pressure readings between two digital manometers: (1) the MicroRPM - the gold-standard manometer for respiratory muscle strength testing; and (2) the LDM - a low-cost, commercially available, alternative manometer. METHODS: Positive (MEP) and negative (MIP) pressures were simultaneously applied to the MicroRPM and LDM using a 3-liter syringe within a controlled laboratory setting. Pressure readings were compared, and agreement was analyzed using Lin's concordance correlation (ρc ). Agreement was interpreted as 'poor' if <0.90, 'moderate' if 0.90 - <0.95, 'substantial' if 0.95 - <0.99, and 'excellent' if ≥0.99. Twenty percent of the pressure trials were repeated by a second researcher to examine test-retest reliability. RESULTS: A total of 150 trials were completed, ranging from -167 to +208 cmH2 O. There was a median absolute difference of 0.3 cmH2 O in pressure readings between the MicroRPM and the LDM. Lin's concordance correlation revealed 'excellent' agreement between the LDM and MicroRPM devices, with test-retest reliability assessment revealing 'substantial-to-excellent' agreement between the LDM and MicroRPM devices, with a concordance correlation coefficient of ρc = 0.999 (95% CI: 0.999-0.999). CONCLUSIONS: There was a median difference of 1.0% in MEP and MIP pressure readings consistently observed between the LDM and MicroRPM. Despite these relatively small differences, excellent agreement between the two manometers was present. These data suggest the LDM may be a valid, lower cost alternative to the MicroRPM for objectively assessing respiratory strength in clinical practice; however, additional research is needed in healthy adults and in patient populations. LEVEL OF EVIDENCE: NA Laryngoscope, 134:1831-1836, 2024.

Handheld Cough Testing: A Novel Tool for Cough Assessment and Dysphagia Screening.

Aspiration pneumonia is a leading cause of death in Parkinson's disease (PD), occurring as a result of impaired cough and swallowing function. However, portable diagnostic tools for cough assessment and dysphagia screening are limited. Therefore, the aims of this study were to determine if: (1) 'Handheld Cough Testing' (HCT), a novel tool developed for cough assessments, could detect differences in cough airflow and sensation during reflex and voluntary cough tasks; and (2) HCT could screen for dysphagia in PD with high sensitivity. Twenty-two people with PD underwent HCT and swallowing assessments. Cough airflow ('PEFR') and sensation ('UTC') was recorded during reflex and voluntary cough tasks. Flexible endoscopy was used to identify people with and without dysphagia. Within-subject statistical analyses were used to detect differences in PEFR and UTC across cough tasks and between-subject statistical analyses were used to detect differences in cough function between people with and without dysphagia. Results revealed significant differences in PEFR (p < 0.0005) and UTC (p < 0.0005) across cough tasks using HCT. Additionally, reflex cough PEFR was significantly different between people with and without dysphagia (p < 0.05). A cut-off of 42.5 L/min exhibited an excellent ability to predict dysphagia in people with PD (90.9% sensitivity; 80.0% specificity). This study revealed that HCT was a valid tool for cough assessment and dysphagia screening. It identified differences in cough airflow and sensation during reflex and voluntary cough tasks and screened for people with dysphagia in PD with high sensitivity.

Propofol-based versus dexmedetomidine-based sedation in cardiac surgery patients.

OBJECTIVES: To evaluate the effects of propofol-based and dexmedetomidine-based sedation regimens on achieving early extubation, length of stay (LOS), intensive care length of stay (ICU-LOS), total hospital costs, and mortality rates in cardiac surgery patients. DESIGN: Twenty-three-month retrospective analysis. SETTING: Single center, 907 bed community teaching hospital. PARTICIPANTS: Five hundred eighty-two patients ≥ 18 years of age who received propofol-based or dexmedetomidine-based sedation after cardiac valve or coronary artery bypass grafting (CABG) surgery and who did not undergo prolonged surgery (≤ 8 hours). INTERVENTION: Retrospective review of medical records. MEASUREMENTS AND MAIN RESULTS: Baseline characteristics (eg, age, sex, comorbidities) and outcomes (eg, achievement of early extubation, LOS, ICU-LOS, total hospital costs, pharmacy costs) were collected. Early extubation was achieved more frequently in the dexmedetomidine group when compared with the propofol group (68.7% v 58.1%, p = 0.008). The mean postoperative time to extubation and hospital LOS were shorter in the dexmedetomidine group when compared with the propofol group (8.8 v 12.8 hours, p = 0.026) and (181.9 v 221.3 hours, p = 0.001), respectively. There was a reduced ICU-LOS in the dexmedetomidine group compared with the propofol group that did not reach statistical significance (43.9 v 52.5 hours, p = 0.067). Average total hospital charges for the dexmedetomidine group were approximately $4000.00 less than the propofol group. CONCLUSIONS: Dexmedetomidine-based sedation resulted in achievement of early extubation more frequently than propofol-based sedation. Mean postoperative time to extubation and average hospital LOS were shorter with dexmedetomidine-based sedation and met a statistical level of significance. There was no difference in ICU-LOS or in-hospital mortality between the two groups. Total hospital charges were similar, although slightly higher in the propofol group.

A robust model for read count data in exome sequencing experiments and implications for copy number variant calling.

MOTIVATION: Exome sequencing has proven to be an effective tool to discover the genetic basis of Mendelian disorders. It is well established that copy number variants (CNVs) contribute to the etiology of these disorders. However, calling CNVs from exome sequence data is challenging. A typical read depth strategy consists of using another sample (or a combination of samples) as a reference to control for the variability at the capture and sequencing steps. However, technical variability between samples complicates the analysis and can create spurious CNV calls. RESULTS: Here, we introduce ExomeDepth, a new CNV calling algorithm designed to control for this technical variability. ExomeDepth uses a robust model for the read count data and uses this model to build an optimized reference set in order to maximize the power to detect CNVs. As a result, ExomeDepth is effective across a wider range of exome datasets than the previously existing tools, even for small (e.g. one to two exons) and heterozygous deletions. We used this new approach to analyse exome data from 24 patients with primary immunodeficiencies. Depending on data quality and the exact target region, we find between 170 and 250 exonic CNV calls per sample. Our analysis identified two novel causative deletions in the genes GATA2 and DOCK8. AVAILABILITY: The code used in this analysis has been implemented into an R package called ExomeDepth and is available at the Comprehensive R Archive Network (CRAN).