Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary... more Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary tract symptoms (LUTS). Due to differing perceptions of efficacy and practice patterns, we sought to further evaluate PFBT in our practice. We hypothesized that PFBT results in quiescence of EMG activity during voiding and improves questionnaire scores in patients with LUTS. We retrospectively reviewed all patients undergoing PFBT and refined the analysis to females ≥6 years old with ≥2 sessions with completed voiding questionnaires pre- and post-treatment, active EMG during voiding, with non-neurogenic urinary tract complaints refractory to standard urotherapy. Validated Bladder Bowel Dysfunction (BBD) questionnaires were collected at each visit. Quiescence of EMG activity and changes in BBD score were the primary outcomes. 229 patients underwent ≥1 PFBT session, of which 64 females ≥6 years of age with ≥2 PFBT sessions and completed pre and post PFBT voiding questionnaires were identif...
and Objectives: Urodynamics often guide treatment of neuropathic bladder and are reported as obje... more and Objectives: Urodynamics often guide treatment of neuropathic bladder and are reported as objective data points in multi-institutional trials. Urodynamic interpretation, however, can be variable. In a pilot study, pediatric urologists interpreting videourodynamics (VUDS) showed only moderate agreement despite similar training and practice patterns. We hypothesized the pilot study variability would be replicated in a multi-institutional study. We developed an anonymous electronic survey that contained twenty scenarios, each with a brief patient history, one urodynamic tracing and fluoroscopic image. All VUDS were completed during routine care of patients with neuropathic bladder at a single institution. Pediatric urologists from the CDC Urologic Protocol sites were invited to complete an interpretation instrument for each scenario. Fleiss kappa and 95% confidence limits were reported where Fleiss κ of 1.00 corresponds to perfect agreement. The survey was completed by 14 pediatric ...
Urodynamic studies are crucial to neuropathic bladder management and they often determine surgica... more Urodynamic studies are crucial to neuropathic bladder management and they often determine surgical intervention. However, current evidence indicates that interpretations show poor agreement across physicians. We sought to determine the interrater reliability of urodynamic interpretation in our practice. We hypothesized that there would be strong correlation among pediatric urologists of similar training in a single academic practice. We retrospectively identified patients with neuropathic bladder who underwent urodynamics at our institution between 2014 and 2015. An anonymous electronic survey (phase I) was developed with 20 clinical scenarios, each containing a brief history, a single urodynamic tracing and an accompanying fluoroscopic image. Faculty members assessed each tracing by an online instrument developed using urodynamic reports and published literature. The primary outcome was statistical correlation across raters as measured by the Spearman correlation coefficient. In a ...
We previously reported catheterizable channel associated outcomes and concluded that the incidenc... more We previously reported catheterizable channel associated outcomes and concluded that the incidence of postoperative complications was greatest in the first 2 years after surgery. At that time our followup was short. In this series we sought to determine whether complications continued to accumulate with longer followup in an updated cohort of patients. We comprehensively reviewed the outcomes in 81 consecutive patients who underwent construction of a MACE (Malone antegrade continence enema) and/or a Mitrofanoff channel in association with complex genitourinary reconstruction. Mean followup was 80.1 months. Outcomes of these 119 stomas were classified by Clavien-Dindo grade and time to complication. The 48 unique, channel related events (40.3%) necessitated a total of 70 interventions with a mean 24.2 months to the first event. Difficult catheterization was the most common event, occurring in 20.1% of channels an average of 29.9 months after surgery. Stomal stenosis was also common, ...
We map buried hydrogen-bonding networks within self-assembled monolayers of 3-mercapto-N-nonylpro... more We map buried hydrogen-bonding networks within self-assembled monolayers of 3-mercapto-N-nonylpropionamide on Au{111}. The contributing interactions include the buried S-Au bonds at the substrate surface and the buried plane of linear networks of hydrogen bonds. Both are simultaneously mapped with submolecular resolution, in addition to the exposed interface, to determine the orientations of molecular segments and directional bonding. Two-dimensional mode-decomposition techniques are used to elucidate the directionality of these networks. We find that amide-based hydrogen bonds cross molecular domain boundaries and areas of local disorder.
Sacral neuromodulation has been demonstrated to improve refractory bowel bladder dysfunction in c... more Sacral neuromodulation has been demonstrated to improve refractory bowel bladder dysfunction in children. The purpose of the current study was to determine whether results are durable in children after longer followup, whether children with a lower body mass index are at risk for device failure and whether pretreatment urodynamic evaluation can predict posttreatment outcome. Pediatric patients with refractory bowel bladder dysfunction were enrolled following informed consent and followed prospectively. All patients underwent preoperative videourodynamic evaluation and a 2-stage implantation procedure. Validated questionnaires were used to assess symptom severity and quality of life. Complications were analyzed with regard to treatment required and patient body mass index. During 45 months 30 patients were enrolled. Median age was 8.3 years at enrollment. Median followup was 14.8 months. Patients had significant improvement in quality of life and symptom scores, which persisted at th...
Particle size determination with dynamic light scattering (DLS) is limited by noise. We have used... more Particle size determination with dynamic light scattering (DLS) is limited by noise. We have used a wavelet transform method to reduce noise in the DLS data. A digital storage oscilloscope (DSO) was used to capture the time-history of the scattered light intensity and signal denoising was implemented with a multi-scale packet wavelet transform. The experimental results indicate that, for a threshold of 0, corresponding to no denoising, the DLS signal with noise, does not give good results because the number of samples used to compute the correlation function was only 20k or 10k and the data are noisy. However, denoising with thresholds in the range 0.5-0.8 can give both better particle size values and smaller root mean square error from the same raw light scattering data.
We demonstrate the use of "holey" graphene as a mask against molecular adsorption. Prepared porou... more We demonstrate the use of "holey" graphene as a mask against molecular adsorption. Prepared porous graphene is transferred onto a Au{111} substrate, annealed, and then exposed to dilute solutions of 1-adamantanethiol. In the pores of the graphene lattice, we find islands of organized, self-assembled molecules. The bare Au in the pores can be regenerated by postdeposition annealing, and new molecules can be self-assembled in the exposed Au region. Graphene can serve as a robust, patternable mask against the deposition of self-assembled monolayers.
A substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conduct... more A substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conducted. Pregnant women diagnosed with fetal myelomeningocele were randomly assigned to either prenatal or standard postnatal surgical repair. The substudy included patients randomly assigned after April 18, 2005. The primary outcome was defined in their children as death or the need for clean intermittent catheterization (CIC) by 30 months of age characterized by prespecified criteria. Secondary outcomes included bladder and kidney abnormalities observed by urodynamics and renal/bladder ultrasound at 12 and 30 months, which were analyzed as repeated measures. Of the 115 women enrolled in the substudy, the primary outcome occurred in 52% of children in the prenatal surgery group and 66% in the postnatal surgery group (relative risk [RR]: 0.78; 95% confidence interval [CI]: 0.57-1.07). Actual rates of CIC use were 38% and 51% in the prenatal and postnatal surgery groups, respectively (RR: 0.74...
International braz j urol : official journal of the Brazilian Society of Urology
Literature pertaining to surgical disclosure to the pediatric patient is lacking. We hypothesized... more Literature pertaining to surgical disclosure to the pediatric patient is lacking. We hypothesized parents would find it difficult to disclose urologic surgery to a child. Parents of patients <5 years old undergoing urologic surgery were contacted for telephone survey. Parents were asked about future plans of surgical disclosure, comfort with disclosure, and any support received. 98 parents consented to study participation. 87% of surgeries were on the genitalia with 62% being minor genitalia surgery (i.e. circumcision). 70% of parents would tell their child about minor genital surgery while 84% would tell about major genital surgery (p=0.07). 4 of 20 parents of children undergoing hypospadias repair (major genital surgery) did not plan to tell their child about surgery. All parents of children undergoing non-genital surgery would tell. Of all parents planning to tell their children about surgery, only 14% were nervous. 34% of parents would find guidance in talking to their child ...
Human Factors and Ergonomics Society Annual Meeting Proceedings, 1992
The terms “Virtual Reality”, “Artificial Reality”, and “Cyberspace” have been prevalent in the po... more The terms “Virtual Reality”, “Artificial Reality”, and “Cyberspace” have been prevalent in the popular press recently. There has also been considerable professional interest. (See Table 1 of recent conferences). This field is an outgrowth of three factors: 1) increases in available technologies of display, storage, and CPU along with new interface devices. 2) increases in the awareness of the importance of the “user interface” and 3) an increase in the awareness of the need for better means of collaboration. While “Virtual Reality” is arguably not completely new, it is only in the last few years that these technological and social trends mentioned above have resulted in the growth of “Virtual Reality” as a field. We argue that “Virtual Reality” is an important phenomenon for the human factors community in at least three distinct ways. First, like other new technologies, Virtual Reality requires human factors research to reach its full potential. Second, Virtual Reality offers the hu...
Carboranethiol molecules self-assemble into upright molecular monolayers on Au{111} with aligned ... more Carboranethiol molecules self-assemble into upright molecular monolayers on Au{111} with aligned dipoles in two dimensions. The positions and offsets of each molecule's geometric apex and local dipole moment are measured and correlated with sub-Ångström precision. Juxtaposing simultaneously acquired images, we observe monodirectional offsets between the molecular apexes and dipole extrema. We determine dipole orientations using efficient new image analysis techniques and find aligned dipoles to be highly defect tolerant, crossing molecular domain boundaries and substrate step edges. The alignment observed, consistent with Monte Carlo simulations, forms through favorable intermolecular dipole-dipole interactions.
The present study uses two differential extraction methods (sequential, maceration) to identify b... more The present study uses two differential extraction methods (sequential, maceration) to identify bioactive compounds present in two seaweeds Gracilaria folifera and Sargassum longifolium. Five different solvents namely Petroleum ether, Dichloromethane, Chloroform, ethanol and water were used. The bioactive compounds present in the extracts showed antioxidant and antibacterial activities against Aeromonas salmonicida. Ethanol and aqueous extracts of these seaweeds were found to have better antibacterial activity against bacterial diseases in fish when compared to the other extracts. Toxicological and in vivo pathogenicity studies were performed with the highest concentration of 250 mg/l of extracts. The compounds identified by GC-MS which were found to have antibacterial activity were prepared in the form of a colloidal suspension for oral treatment. The use of algal extracts in aquaculture disease management is a cost effective and eco-friendly approach. These extracts could be used as prophylactics.
To assess the awareness and readiness of both spina bifida patients and parents regarding the tra... more To assess the awareness and readiness of both spina bifida patients and parents regarding the transition process before transitioning, with a secondary aim that included identifying potential factors associated with successful transition. All children aged ≥14 years requiring long-term care were prospectively enrolled. Questions designed by pediatric and adult urologists and an adolescent health specialist addressing the awareness of long-term follow-up and the desire to learn more about transitioning were administered by nursing staff at regularly scheduled clinic appointments. All spina bifida patients evaluated in the past 5 years were identified, and clinical factors associated with transitioning were compared. Statistical analysis using the Fisher exact test and the chi-square test were used to compare patients' and…
Lower urinary tract (LUT) dysfunction in children is a common clinical entity encountered and tre... more Lower urinary tract (LUT) dysfunction in children is a common clinical entity encountered and treated by pediatric urologists. Although the treatments available for this have continued to evolve, not all children are treated or have successful results. Many of these children are lost by the pediatric urologist during their teenage years, and what becomes of them as adults largely remains
The seaweeds are a promising source of natural products .From the preliminary phyto chemical anal... more The seaweeds are a promising source of natural products .From the preliminary phyto chemical analysis we can conclude that the presence of phytochemical in chaetomorpha antennina was more significant when compared to the Caulerapa scalpelliformis. The present study was conducted for the free radical scavenging potentials by using DPPH radical and also for the s antimicrobial properties of chaetomorpha antennina and Caulerapa scalpelliformis in methanolic extract. The tested extract exhibited a dose-dependent free radical scavenging action against DPPH radical and significant antimicrobial potential was observed in Caulerapa scalpelliformis. From the overall results we can conclude that this seaweed could be used against several diseases and in the food processing industry to preserve foods.
Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary... more Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary tract symptoms (LUTS). Due to differing perceptions of efficacy and practice patterns, we sought to further evaluate PFBT in our practice. We hypothesized that PFBT results in quiescence of EMG activity during voiding and improves questionnaire scores in patients with LUTS. We retrospectively reviewed all patients undergoing PFBT and refined the analysis to females ≥6 years old with ≥2 sessions with completed voiding questionnaires pre- and post-treatment, active EMG during voiding, with non-neurogenic urinary tract complaints refractory to standard urotherapy. Validated Bladder Bowel Dysfunction (BBD) questionnaires were collected at each visit. Quiescence of EMG activity and changes in BBD score were the primary outcomes. 229 patients underwent ≥1 PFBT session, of which 64 females ≥6 years of age with ≥2 PFBT sessions and completed pre and post PFBT voiding questionnaires were identif...
and Objectives: Urodynamics often guide treatment of neuropathic bladder and are reported as obje... more and Objectives: Urodynamics often guide treatment of neuropathic bladder and are reported as objective data points in multi-institutional trials. Urodynamic interpretation, however, can be variable. In a pilot study, pediatric urologists interpreting videourodynamics (VUDS) showed only moderate agreement despite similar training and practice patterns. We hypothesized the pilot study variability would be replicated in a multi-institutional study. We developed an anonymous electronic survey that contained twenty scenarios, each with a brief patient history, one urodynamic tracing and fluoroscopic image. All VUDS were completed during routine care of patients with neuropathic bladder at a single institution. Pediatric urologists from the CDC Urologic Protocol sites were invited to complete an interpretation instrument for each scenario. Fleiss kappa and 95% confidence limits were reported where Fleiss κ of 1.00 corresponds to perfect agreement. The survey was completed by 14 pediatric ...
Urodynamic studies are crucial to neuropathic bladder management and they often determine surgica... more Urodynamic studies are crucial to neuropathic bladder management and they often determine surgical intervention. However, current evidence indicates that interpretations show poor agreement across physicians. We sought to determine the interrater reliability of urodynamic interpretation in our practice. We hypothesized that there would be strong correlation among pediatric urologists of similar training in a single academic practice. We retrospectively identified patients with neuropathic bladder who underwent urodynamics at our institution between 2014 and 2015. An anonymous electronic survey (phase I) was developed with 20 clinical scenarios, each containing a brief history, a single urodynamic tracing and an accompanying fluoroscopic image. Faculty members assessed each tracing by an online instrument developed using urodynamic reports and published literature. The primary outcome was statistical correlation across raters as measured by the Spearman correlation coefficient. In a ...
We previously reported catheterizable channel associated outcomes and concluded that the incidenc... more We previously reported catheterizable channel associated outcomes and concluded that the incidence of postoperative complications was greatest in the first 2 years after surgery. At that time our followup was short. In this series we sought to determine whether complications continued to accumulate with longer followup in an updated cohort of patients. We comprehensively reviewed the outcomes in 81 consecutive patients who underwent construction of a MACE (Malone antegrade continence enema) and/or a Mitrofanoff channel in association with complex genitourinary reconstruction. Mean followup was 80.1 months. Outcomes of these 119 stomas were classified by Clavien-Dindo grade and time to complication. The 48 unique, channel related events (40.3%) necessitated a total of 70 interventions with a mean 24.2 months to the first event. Difficult catheterization was the most common event, occurring in 20.1% of channels an average of 29.9 months after surgery. Stomal stenosis was also common, ...
We map buried hydrogen-bonding networks within self-assembled monolayers of 3-mercapto-N-nonylpro... more We map buried hydrogen-bonding networks within self-assembled monolayers of 3-mercapto-N-nonylpropionamide on Au{111}. The contributing interactions include the buried S-Au bonds at the substrate surface and the buried plane of linear networks of hydrogen bonds. Both are simultaneously mapped with submolecular resolution, in addition to the exposed interface, to determine the orientations of molecular segments and directional bonding. Two-dimensional mode-decomposition techniques are used to elucidate the directionality of these networks. We find that amide-based hydrogen bonds cross molecular domain boundaries and areas of local disorder.
Sacral neuromodulation has been demonstrated to improve refractory bowel bladder dysfunction in c... more Sacral neuromodulation has been demonstrated to improve refractory bowel bladder dysfunction in children. The purpose of the current study was to determine whether results are durable in children after longer followup, whether children with a lower body mass index are at risk for device failure and whether pretreatment urodynamic evaluation can predict posttreatment outcome. Pediatric patients with refractory bowel bladder dysfunction were enrolled following informed consent and followed prospectively. All patients underwent preoperative videourodynamic evaluation and a 2-stage implantation procedure. Validated questionnaires were used to assess symptom severity and quality of life. Complications were analyzed with regard to treatment required and patient body mass index. During 45 months 30 patients were enrolled. Median age was 8.3 years at enrollment. Median followup was 14.8 months. Patients had significant improvement in quality of life and symptom scores, which persisted at th...
Particle size determination with dynamic light scattering (DLS) is limited by noise. We have used... more Particle size determination with dynamic light scattering (DLS) is limited by noise. We have used a wavelet transform method to reduce noise in the DLS data. A digital storage oscilloscope (DSO) was used to capture the time-history of the scattered light intensity and signal denoising was implemented with a multi-scale packet wavelet transform. The experimental results indicate that, for a threshold of 0, corresponding to no denoising, the DLS signal with noise, does not give good results because the number of samples used to compute the correlation function was only 20k or 10k and the data are noisy. However, denoising with thresholds in the range 0.5-0.8 can give both better particle size values and smaller root mean square error from the same raw light scattering data.
We demonstrate the use of "holey" graphene as a mask against molecular adsorption. Prepared porou... more We demonstrate the use of "holey" graphene as a mask against molecular adsorption. Prepared porous graphene is transferred onto a Au{111} substrate, annealed, and then exposed to dilute solutions of 1-adamantanethiol. In the pores of the graphene lattice, we find islands of organized, self-assembled molecules. The bare Au in the pores can be regenerated by postdeposition annealing, and new molecules can be self-assembled in the exposed Au region. Graphene can serve as a robust, patternable mask against the deposition of self-assembled monolayers.
A substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conduct... more A substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conducted. Pregnant women diagnosed with fetal myelomeningocele were randomly assigned to either prenatal or standard postnatal surgical repair. The substudy included patients randomly assigned after April 18, 2005. The primary outcome was defined in their children as death or the need for clean intermittent catheterization (CIC) by 30 months of age characterized by prespecified criteria. Secondary outcomes included bladder and kidney abnormalities observed by urodynamics and renal/bladder ultrasound at 12 and 30 months, which were analyzed as repeated measures. Of the 115 women enrolled in the substudy, the primary outcome occurred in 52% of children in the prenatal surgery group and 66% in the postnatal surgery group (relative risk [RR]: 0.78; 95% confidence interval [CI]: 0.57-1.07). Actual rates of CIC use were 38% and 51% in the prenatal and postnatal surgery groups, respectively (RR: 0.74...
International braz j urol : official journal of the Brazilian Society of Urology
Literature pertaining to surgical disclosure to the pediatric patient is lacking. We hypothesized... more Literature pertaining to surgical disclosure to the pediatric patient is lacking. We hypothesized parents would find it difficult to disclose urologic surgery to a child. Parents of patients <5 years old undergoing urologic surgery were contacted for telephone survey. Parents were asked about future plans of surgical disclosure, comfort with disclosure, and any support received. 98 parents consented to study participation. 87% of surgeries were on the genitalia with 62% being minor genitalia surgery (i.e. circumcision). 70% of parents would tell their child about minor genital surgery while 84% would tell about major genital surgery (p=0.07). 4 of 20 parents of children undergoing hypospadias repair (major genital surgery) did not plan to tell their child about surgery. All parents of children undergoing non-genital surgery would tell. Of all parents planning to tell their children about surgery, only 14% were nervous. 34% of parents would find guidance in talking to their child ...
Human Factors and Ergonomics Society Annual Meeting Proceedings, 1992
The terms “Virtual Reality”, “Artificial Reality”, and “Cyberspace” have been prevalent in the po... more The terms “Virtual Reality”, “Artificial Reality”, and “Cyberspace” have been prevalent in the popular press recently. There has also been considerable professional interest. (See Table 1 of recent conferences). This field is an outgrowth of three factors: 1) increases in available technologies of display, storage, and CPU along with new interface devices. 2) increases in the awareness of the importance of the “user interface” and 3) an increase in the awareness of the need for better means of collaboration. While “Virtual Reality” is arguably not completely new, it is only in the last few years that these technological and social trends mentioned above have resulted in the growth of “Virtual Reality” as a field. We argue that “Virtual Reality” is an important phenomenon for the human factors community in at least three distinct ways. First, like other new technologies, Virtual Reality requires human factors research to reach its full potential. Second, Virtual Reality offers the hu...
Carboranethiol molecules self-assemble into upright molecular monolayers on Au{111} with aligned ... more Carboranethiol molecules self-assemble into upright molecular monolayers on Au{111} with aligned dipoles in two dimensions. The positions and offsets of each molecule's geometric apex and local dipole moment are measured and correlated with sub-Ångström precision. Juxtaposing simultaneously acquired images, we observe monodirectional offsets between the molecular apexes and dipole extrema. We determine dipole orientations using efficient new image analysis techniques and find aligned dipoles to be highly defect tolerant, crossing molecular domain boundaries and substrate step edges. The alignment observed, consistent with Monte Carlo simulations, forms through favorable intermolecular dipole-dipole interactions.
The present study uses two differential extraction methods (sequential, maceration) to identify b... more The present study uses two differential extraction methods (sequential, maceration) to identify bioactive compounds present in two seaweeds Gracilaria folifera and Sargassum longifolium. Five different solvents namely Petroleum ether, Dichloromethane, Chloroform, ethanol and water were used. The bioactive compounds present in the extracts showed antioxidant and antibacterial activities against Aeromonas salmonicida. Ethanol and aqueous extracts of these seaweeds were found to have better antibacterial activity against bacterial diseases in fish when compared to the other extracts. Toxicological and in vivo pathogenicity studies were performed with the highest concentration of 250 mg/l of extracts. The compounds identified by GC-MS which were found to have antibacterial activity were prepared in the form of a colloidal suspension for oral treatment. The use of algal extracts in aquaculture disease management is a cost effective and eco-friendly approach. These extracts could be used as prophylactics.
To assess the awareness and readiness of both spina bifida patients and parents regarding the tra... more To assess the awareness and readiness of both spina bifida patients and parents regarding the transition process before transitioning, with a secondary aim that included identifying potential factors associated with successful transition. All children aged ≥14 years requiring long-term care were prospectively enrolled. Questions designed by pediatric and adult urologists and an adolescent health specialist addressing the awareness of long-term follow-up and the desire to learn more about transitioning were administered by nursing staff at regularly scheduled clinic appointments. All spina bifida patients evaluated in the past 5 years were identified, and clinical factors associated with transitioning were compared. Statistical analysis using the Fisher exact test and the chi-square test were used to compare patients' and…
Lower urinary tract (LUT) dysfunction in children is a common clinical entity encountered and tre... more Lower urinary tract (LUT) dysfunction in children is a common clinical entity encountered and treated by pediatric urologists. Although the treatments available for this have continued to evolve, not all children are treated or have successful results. Many of these children are lost by the pediatric urologist during their teenage years, and what becomes of them as adults largely remains
The seaweeds are a promising source of natural products .From the preliminary phyto chemical anal... more The seaweeds are a promising source of natural products .From the preliminary phyto chemical analysis we can conclude that the presence of phytochemical in chaetomorpha antennina was more significant when compared to the Caulerapa scalpelliformis. The present study was conducted for the free radical scavenging potentials by using DPPH radical and also for the s antimicrobial properties of chaetomorpha antennina and Caulerapa scalpelliformis in methanolic extract. The tested extract exhibited a dose-dependent free radical scavenging action against DPPH radical and significant antimicrobial potential was observed in Caulerapa scalpelliformis. From the overall results we can conclude that this seaweed could be used against several diseases and in the food processing industry to preserve foods.
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Papers by John Thomas