PubMed HealthSearch

Biomedical subjects

P A Hayes

Publications and source records attributed to P A Hayes.

At least 19 recordsLinked to original sources

Integrating students into interdisciplinary teams: extending the caring circle.

Interdisciplinary teams are considered essential for meeting the health care delivery challenges of the 21st century. Integrating students into these teams is critical to attracting and sustaining a future workforce with the knowledge and skills to maximize health care outcomes. This article describes a caring circle approach to interdisciplinary teams that promotes student learning and benefits the team. The caring circle is based on building relationships through shared knowledge, shared practices, and shared values. Specific strategies to build the caring circle using these building blocks are discussed.

Education, Nursing, Baccalaureate

Formulating a functional model of attention deficit hyperactivity disorder for the practicing speech-language pathologist.

Speech-language pathologists need to embrace new models of service delivery if their work with children having ADHD is to be successful. Old models that are oriented toward deficits have proven to be ineffective, but application of a systems-theory approach from the social sciences to ADHD, together with support from recent educational research, provides a contextually-related model of service delivery. This model is discussed in terms of three major issues--identifying and describing students with ADHD, helping them overcome their problems, and meeting the needs of their teachers and parents--and how it may guide more effective assessment and intervention of ADHD students in educational settings.

Adolescent

Sub-cutaneous fat thickness measured by magnetic resonance imaging, ultrasound, and calipers.

Sub-cutaneous fat thickness was measured at 12 sites on the body surface of 24 males and 26 females using magnetic resonance imaging (MRI), skinfold calipers, and A-mode ultrasound. The mean of the 12 fat thickness measurements and individual site thicknesses were compared between individuals using analysis of variance. In males, the mean thicknesses for ultrasound and calipers were similar (P greater than 0.05) but both were less than the MRI (P less than 0.001). MRI and ultrasound were similar in females but less than calipers (P less than 0.001). A good between-subject correlation was found between all three methods in the males but only the calipers and MRI were well correlated in females. Within-subject correlations are poor for all measures and in both sexes. Factor loadings for a varimax rotation of two principal components indicate that the fat is distributed in 1 of 2 patterns: either principally on the trunk or on the limbs. The principal component analysis and the result of canonical correlations obtained from the factor loadings confirm the findings of the analysis of variance, in that a general level of fatness is measurable by all three methods over a range of subjects. However, the pattern of fat thicknesses measured over a number of specific sites by one method of measurement is unlikely to be duplicated by either of the other two methods on the same individual.

Adipose Tissue

The thermal performance of partial coverage wet suits.

A wet-suit worn external to normal clothing and covering the trunk and arms only has been assessed as a method for providing short-term immersion protection for helicopter passengers in offshore oil field operations. Manikin measurements of effective insulation in water give a mean figure of 0.54 togs for the areas covered by the suit and 0.09 togs for uncovered areas. These figures were used to obtain model predictions of survival time for 'thin' and 'average' men which suggest that the suit can give adequate protection for 1 h at 5 degrees C subject to care in fitting. Direct measurements of heat flux have demonstrated the presence of water flushing beneath the suit and the potentially serious loss of insulation that can result.

Body Temperature Regulation

Oral submucous fibrosis in a 4-year-old girl.

A rare case of oral submucous fibrosis in a 4-year-old Indian girl is presented. The condition is defined, and the clinical and laboratory features are discussed. Different treatment modalities and current theories of etiology are presented. Finally, the importance of regarding this condition as a precancerous lesion is supported.

Child, Preschool

Optimal siting of heat flux transducers for the assessment of body heat loss when immersed in water.

Regional heat flux (intensity of heat flow rate, W m-2) was measured using heat flux transducers affixed to the skin surface at 14 sites on the left arm and 15 sites on both the left leg and the trunk (total of 44 locations) of human subjects during head-out immersion in water at temperatures between 11 and 28 degrees C. The heat flux data and skin temperature data were collected continuously over a 30-min period taking approximately 2.5 min to scan through all transducers in sequence before repeating the process. There were 3 immersions per individual, monitoring the arm or the leg or the trunk. The local measurements of heat flux from each of the body segments were summated and meaned to obtain a value of overall flux for each area of the body for each 2- to 3-min interval. This mean value was taken as the optimal value (Hopt) for any particular body segment. Every permutation of the positions of any 1, 2, 3, 4, or 5 heat flux transducers from the possible 14 or 15 sites was used to obtain a mean value which could be compared to the Hopt over the total duration of each immersion. Comparisons could be made between the best individual sites (Iopt) and Hopt as well as between the overall best site for the group of 10 people (Gopt) and Hopt. All possible permutations could be ranked in ascending order of preference based on a decreasing sum of the squares of the differences between Hopt and either Iopt or Gopt. Confirmation of the validity of this simple ranking system was based on an analysis of the percentage differences between Iopt or Gopt and Hopt. Such an analysis indicated that the better choice of discs when using a small number of transducers was between 3 and 5 sites, affording both reasonable accuracy and practicality. It is recommended that between 3 and 5 discs be used per body segment at specific locations and the calculated heat loss from each segment be weighted according to its area of representation to give a value for the mean rate of total body heat loss. A reasonable level of accuracy was demonstrated using Gopt permutations for measuring both the rate of heat flow as well as the integral of the data to obtain a value of the quantity of heat (Joules) lost from the body.

Adult

U.K. deep diving trials.

Using a breathing medium of 40 kPa oxygen, remainder helium, 18 volunteer subjects participated in a series of 15 exposures to pressures equivalent to depths of 180-540 m s.w. The time of exposure at these pressures was mostly 2 days, except for the 540 m s.w. exposure, when 6 days were spent at full pressure. Compression procedures, based upon placing 'stages' at 60 m s.w. intervals, evolved with experience and proved to be a highly successful way of achieving acceptable pressure-time courses. Decompression combined slow linear release of pressure with overnight halts for sleep. On one occasion a depth of 660 m s.w. was reached by breathing 40 kPa oxygen, 10% nitrogen, remainder helium. Throughout all exposures, teams of investigators followed the changes in cardiovascular, respiratory, haematological, neurophysiological and metabolic status, and mental performance of the volunteers. Some major findings were that the neurophysiological and behavioural changes could be assigned to the motor, or vestibular, or cerebral, or autonomic systems, and were mainly first observed during compression. The subjects suffered, apparently from severe nitrogen narcosis, when breathing 10% (by volume) nitrogen in oxygen-helium at 420 m s.w. Lung ventilation was remarkably adaptable to the oxygen requirements of exercise at all depths, but cardiac output was adversely affected at 540 m s.w., particularly for heavier workloads. Ventilatory responses to carbon dioxide were significantly elevated after diving. Thermal balance was seen to be precarious, but nevertheless it was achieved by the normal subjective assessments of comfort. Water loss was affected by diminished evaporation from the skin. Skin temperature sensitivity was changed and took many days after the dives to return to normal. Energy requirements increased for work purposes, but basal metabolic rate was undisturbed. Body chemistry altered at pressures in excess of 300 m s.w., for example thyroid hormone and nitrogen balances were affected. No decompression sickness was encountered until the pressures were low, but marked haematological changes could occur during decompression. Every change that occurred during these dives reverted to normal, mostly before the end of the decompression. It is concluded that diving with oxygen-helium breathing mixtures to depths as great as 540 m s.w. can be effective and safe. An attempt is made to assess the physiological significance of the principal findings.

Adult

Influence of respiratory heat transfer on thermogenesis and heat storage after cold immersion.

1. Ten male subjects were cooled on three occasions to a rectal temperature of 35 degrees C by immersion to the neck in water at 11.3 degrees C. The subjects were rewarmed for 60 min, once by metabolic heat production alone (shivering), once by inhalation rewarming with spontaneous breathing of saturated air at 47 degrees C (control) and once by inhalation rewarming with ventilation regulated at 40 litres/min by respiring a controlled fraction of CO2 (hyperventilation). 2. Metabolic heat production was substantially reduced by inhalation rewarming (P less than 0.05), from 913 kJ when shivering to 766 kJ (control) and 613 kJ when hyperventilating. The fall in metabolic heat production was greater than the corresponding respiratory heat gain, which increased from a loss of 41 kJ when shivering to gains of 85 kJ (control) and 169 kJ (hyperventilation). 3. As differences in mean skin temperatures were small (less than 1.0 degrees C), it is concluded that the lower metabolic heat production in response to increased respiratory heat input must result from more rapid central temperature gains. This conclusion is supported by the relative values of rectal and tympanic temperatures. It was calculated that the percentage of the total heat supply which was donated to the core increased from 13% during shivering to 16% for the control and 23% in hyperventilation. Results imply that respiratory heat input is more efficient than metabolic heat production in elevating central temperature.

Adult

Respiratory heat transfer in cold water and during rewarming.

Respiratory heat loss was measured during cold water (5-6 degrees C) excursions to depths of 300 m. Losses were computed with and without respiratory gas heating when wearing a diving helmet in current commercial and Service use. A magnitude of heat loss, sufficient to cause undue stress to the respiratory tract, was observed even with gas heating provided, particularly at maximum depth. If the hyperbaric gas is both heated and humidified to a maximum comfort level then respiratory gains in the order of 40 W are possible at 250 m. This technique of utilizing warm wet gas introduced into the respiratory tract was tested as a rewarming technique following immersion in cold water (4-5 degrees C) to the limit of peripheral endurance.

Body Temperature Regulation