A multi-objective optimization of stent geometries.

Stents are scaffolding cardiovascular implants used to restore blood flow in narrowed arteries. However, the presence of the stent alters local blood flow and shear stresses on the surrounding arterial wall, which can cause adverse tissue responses and increase the risk of adverse outcomes. There is a need for optimization of stent designs for hemodynamic performance. We used multi-objective optimization to identify ideal combinations of design variables by assessing potential trade-offs based on common hemodynamic indices associated with clinical risk and mechanical performance of the stents. We studied seven design variables including strut cross-section, strut dimension, strut angle, cell alignment, cell height, connector type and connector arrangement. Optimization objectives were the percentage of vessel area exposed to adversely low time averaged WSS (TAWSS) and adversely high Wall Shear Stress (WSS) assessed using computational fluid dynamics modeling, as well as radial stiffness of the stent using FEA simulation. Two multi-objective optimization algorithms were used and compared to iteratively predict ideal designs. Out of 50 designs, three best designs with respect to each of the three objectives, and two designs in regard to overall performance were identified.

Relationship of the Patient-Specific Functional Scale to commonly used clinical measures in hand osteoarthritis.

STUDY DESIGN: Prospective cohort correlation study. INTRODUCTION: There is no known published research on correlations between the Patient-Specific Functional Scale (PSFS), hand grip strength, and the Disability of the Arm, Shoulder and Hand (DASH) in a population with hand osteoarthritis (OA). PURPOSE: The purpose of this study is to establish reliability of the PSFS and to evaluate the relationship between the PSFS, hand grip strength, and the DASH for a population with hand OA. METHODS: Thirty-five participants in 4 hand clinics completed the PSFS, hand grip strength testing, and the DASH at the onset of therapy and at discharge. Eighteen participants enrolled at the primary investigator's site completed a baseline PSFS one week before the pretreatment collection with data used to establish relative and absolute reliability. Data were analyzed separately at pretreatment and posttreatment with Spearman's rho correlation (P < .05). Intraclass correlation (2, 1), standard error of the measurement, and minimum detectable change (MDC90 and MDC95) were calculated from the repeated baseline and pretreatment PSFS. RESULTS: Intraclass correlation for PSFS was (r = 0.80) with the standard error of the measurement = 0.56, MDC90 = 1.30, and MDC95 = 1.56. Small correlation between the PSFS and DASH scores was found pretreatment (ρ = -0.10) and change scores (ρ = 0.13). CONCLUSION: Excellent reliability with small measurement error has established clinical utility of the PSFS for the population with hand OA. These outcome measures were shown to measure different constructs and therefore should not be used interchangeably. LEVEL OF EVIDENCE: 3.

Implementing an early intervention program for residential students who present with suicide risk: a case study.

OBJECTIVE: This case study examined the effects of an early intervention program designed to respond to residential college students demonstrating risk for suicide. PARTICIPANTS: Participants were 108 undergraduates at a large northeastern public university referred to an early intervention program subsequent to presenting with risk factors for suicide between Fall 2004 and Spring 2011. METHODS: Data were collected from archival records to examine quality of early intervention services, student retention, and grade point average (GPA) during the semesters prior to, during, and subsequent to the referral incident. RESULTS: Program implementation was timely and responsive to student needs; students successfully completing the early intervention program remained in school and demonstrated small but significant rebounds in GPA the semester subsequent to the incident. CONCLUSIONS: There are benefits associated with the implementation of early intervention programs designed to respond to students manifesting risk for suicide, such as connecting the student to vital services and support networks.

Implementing an audience-specific small-group gatekeeper training program to respond to suicide risk among college students: a case study.

OBJECTIVE: This case study evaluated the effectiveness of an audience-specific, single-session, small-group interactive gatekeeper training program conducted at a large northeastern public university. PARTICIPANTS: Participants were 335 faculty, staff, and students completing gatekeeper training programs tailored to their group needs. METHODS: Baseline assessments of knowledge about suicide, risk factors, resources for assistance, and comfort in intervening with a student in distress were administered to participants prior to the small-group training sessions; posttest assessments of knowledge and comfort in intervening with students in distress were administered upon completion of training and at 3-month follow-up. RESULTS: There was a statistically significant increase in knowledge and comfort upon completion of training for both faculty/staff and student groups, although degradation of training effects at 3-month follow-up was evident. CONCLUSIONS: There are benefits associated with the implementation of audience-specific gatekeeper training programs. Booster training sessions to address skill degradation over time are recommended.