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Biomedical subjects

R Conway

Publications and source records attributed to R Conway.

At least 19 recordsLinked to original sources
PubMed2006

The application of a use case/task based approach in the development of software for a portable neuromuscular stimulator device.

This paper describes the use of a use case/task based method in the development of a portable neuromuscular stimulator device. The developed unit allows a variety of stimulus delivery algorithms to be incorporated dependent on the patient's requirements. The developed system consists of a stimulator unit, stimulator firmware, external sensors, a programmer unit, two stimulation channels and electrodes. A clinician specifies a suitable algorithm for a particular patient and then selects the relevant stimulus parameters for that algorithm using the programmer unit. The stimulator unit's architecture supports the addition of future algorithms. The device was developed in accordance with the European Medical Devices Directive 93/42/EEC resulting in the need for a well-defined development lifecycle during the design and development of the neuromuscular stimulator. This development lifecycle must place emphasis on the need to identify potential hazards. Therefore, the adoption of a use case/task driven approach as one of the strategies in eliciting the requirements, both functional and non-functional and specification stages of the development lifecycle resulted in a more rigid hazard/risk analysis leading ultimately to a more robust final system. A comprehensive review of the literature has revealed that use cases have been in use in other contexts but not so in a biomedical context. Therefore, this is a novel strategy to the development of a device in this field. A brief background on the historical development of drop foot stimulators shall be presented thereby displaying the benefits of the programmability feature of our stimulator.

Ambulatory Care↗
PubMed2005

A system for the delivery of programmable, adaptive stimulation intensity envelopes for drop foot correction applications.

We describe the design of an intelligent drop foot stimulator unit for use in conjunction with a commercial neuromuscular electrical nerve stimulation (NMES) unit, the NT2000. The developed micro-controller unit interfaces to a personal computer (PC) and a graphical user interface (GUI) allows the clinician to graphically specify the shape of the stimulation intensity envelope required for a subject undergoing drop foot correction. The developed unit is based on the ADuC812S micro-controller evaluation board from Analog Devices and uses two force sensitive resistor (FSR) based foot-switches to control application of stimulus. The unit has the ability to display to the clinician how the stimulus intensity envelope is being delivered during walking using a data capture capability. The developed system has a built-in algorithm to dynamically adjust the delivery of stimulus to reflect changes both within the gait cycle and from cycle to cycle. Thus, adaptive control of stimulus intensity is achieved.

Computer Graphics↗
PubMed2005

Paraneoplastic limbic encephalitis.

Paraneoplastic limbic encephalitis (PLE) is a rare neurological consequence of a variety of cancers, most commonly originating from lung, breast and testis. The aetiology is believed to be immune-mediated, caused by tumour-induced autoimmunity launching an attack against one's own central nervous system. The patient may present with amnesia, depression, anxiety, seizures and/or personality changes. The onset of these symptoms may precede the diagnosis of malignancy by a period of up to 2 years. The malignancy may be occult and unless the syndrome is recognised, it may fail to be detected. The diagnosis of PLE is suggested by the clinical picture, MRI evidence of mesial temporal lobe abnormality and CSF abnormalities such as the presence of oligoclonal bands. It may be further supported by the presence of paraneoplastic antibodies in the serum. Immunosuppression has been tried in some cases but memory impairment is often irreversible. There are several case reports in the literature of paraneoplastic limbic encephalitis but few emphasise the resulting impact that this may have on the patient's quality of life and their carers. The accompanying amnesia is often far more distressing to the carers, who are aware of the limitations of treatment of the underlying malignancy. Hospices offer the appropriate palliative environment for such patients as well as physical and psychological respite to the carers.

Fatal Outcome↗
PubMed2003

INTERMAP: the dietary data--process and quality control.

The aim of this report is to describe INTERMAP standardized procedures for assessing dietary intake of 4680 individuals from 17 population samples in China, Japan, UK and USA: Based on a common Protocol and Manuals of Operations, standardized collection by centrally trained certified staff of four 24 h dietary recalls, two timed 24-h urines, two 7-day histories of daily alcohol intake per participant; tape recording of all dietary interviews, and use of multiple methods for ongoing quality control of dietary data collection and processing (local, national, and international); one central laboratory for urine analyses; review, update, expansion of available databases for four countries to produce comparable data on 76 nutrients for all reported foods; use of these databases at international coordinating centres to compute nutrient composition. Chinese participants reported 2257 foods; Japanese, 2931; and UK, 3963. In US, use was made of 17,000 food items in the online automated Nutrition Data System. Average time/recall ranged from 22 min for China to 31 min for UK. Among indicators of dietary data quality, coding error rates (from recoding 10% random samples of recalls) were 2.3% for China, 1.4% for Japan, and UK; an analogous US procedure (re-entry of recalls into computer from tape recordings) also yielded low discrepancy rates. Average scores on assessment of taped dietary interviews were high, 40.4 (Japan) to 45.3 (China) (highest possible score: 48); correlations between urinary and dietary nutrient values--similar for men and women--were, for all 4680 participants, 0.51 for total protein, range across countries 0.40-0.52; 0.55 for potassium, range 0.30-0.58; 0.42 for sodium, range 0.33-0.46. The updated dietary databases are valuable international resources. Dietary quality control procedures yielded data generally indicative of high quality performance in the four countries. These procedures were time consuming. Ongoing recoding of random samples of recalls is deemed essential. Use of tape recorded dietary interviews contributed to quality control, despite feasibility problems, deemed remediable by protocol modification. For quality assessment, use of correlation data on dietary and urinary nutrient values yielded meaningful findings, including evidence of special difficulties in assessing sodium intake by dietary methods.

Adult↗
PubMed1999

Dietary restraint and weight gain during pregnancy.

OBJECTIVES: To explore dietary intake and weight gain during pregnancy in relation to dietary restraint. DESIGN: Longitudinal prospective study. Attitudes to weight gain during pregnancy were assessed using self-administered questionnaires and dietary intake by 7-d weighed diet records in early and late pregnancy. SETTING: South West London 1995-1996. SUBJECTS: 74 Caucasian pregnant women expecting their first or second baby were recruited through a London hospital and data from 62 women were analysed. RESULTS: Restrained eaters were significantly less likely to experience weight gains within the recommended range for their pre-pregnancy body mass index (BMI) (P=0.026). They gained either more or less weight than recommended. CONCLUSIONS: Dietary restraint appears to have undesirable influences on eating and weight gain during pregnancy which require further attention.

Adult↗
PubMed1999

Substance-use assessment for hospital inpatients.

Many patients are not assessed for substance use and few are assessed comprehensively. Nurses are more likely than doctors to take a comprehensive substance-use history. A substance-use history assessment tool can be used hospital-wide.

Attitude of Health Personnel↗
PubMed1998

Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial.

OBJECTIVE: To compare the effectiveness of biofeedback/relaxation, exercise, and a combined program for the treatment of fibromyalgia. METHODS: Subjects (n = 119) were randomly assigned to one of 4 groups: 1) biofeedback/relaxation training, 2) exercise training, 3) a combination treatment, or 4) an educational/attention control program. RESULTS: All 3 treatment groups produced improvements in self-efficacy for function relative to the control condition. In addition, all treatment groups were significantly different from the control group on tender point index scores, reflecting a modest deterioration by the attention control group rather than improvements by the treatment groups. The exercise and combination groups also resulted in modest improvements on a physical activity measure. The combination group best maintained benefits across the 2-year period. CONCLUSION: This study demonstrates that these 3 treatment interventions result in improved self-efficacy for physical function which was best maintained by the combination group.

Activities of Daily Living↗
PubMed1997

PROFILE: Multiattribute Utility Analysis as a Framework for Public Participation in Siting a Hazardous Waste Management Facility

/ In an attempt to facilitate the resolution of contentious environmental problems, public and private organizations are experimenting with collaborative approaches wherein stakeholders participate in the decision-making process. A dilemma for the design of collaborative approaches is the technical complexity of many environmental problems. How can members of the public play a meaningful role in decisions that involve complicated scientific arguments?This paper describes a public participation exercise in which stakeholders used an approach based on multiattribute utility analysis to select a site for a hazardous waste management facility. The key to success was the ability to separate and address two types of judgments inherent in environmental decisions-technical judgments regarding the likely consequences of alternative choices and value judgments regarding the importance or seriousness of those consequences. The approach enabled technical specialists to communicate the essential technical considerations and allowed stakeholders to establish the value judgments for the decision. Although rarely used in public participation, the multiattribute utility approach appears to provide a useful framework for the collaborative resolution of complex environmental decision problems.KEY WORDS: Multiattribute utility analysis; Public involvement; Collaboration; Dispute resolution; Environmental management

Journal Article↗
PubMed1996

Self-efficacy predicting outcome among fibromyalgia subjects.

OBJECTIVES: This study examined whether pretreatment self-efficacy and pre- to post-treatment changes in self-efficacy predict post-treatment tender point index, disease severity, pain, and physical activity. METHODS: One hundred nine subjects with fibromyalgia were assessed before and after a 6-week training intervention. Measures included tender point index, physician ratings of disease severity, the visual analog scale for pain, the Physical Activities subscale of the Arthritis Impact Measurement Scales, and the Arthritis Self-Efficacy Scale. RESULTS: Pretreatment self-efficacy significantly predicted post-treatment physical activity, with higher self-efficacy associated with better physical activity outcome. Changes in self-efficacy significantly predicted post-treatment tender point index, disease severity, and pain; improvements in self-efficacy were associated with better outcomes on each measure. CONCLUSIONS: Higher levels of self-efficacy are associated with better outcome, and may mediate the effectiveness of rehabilitation-based treatment programs for fibromyalgia.

Activities of Daily Living↗
PubMed1996

The mysteries of the Milton Tank!

In today's health care environment, one is often confronted with arguments for and against the casualisation of nursing staff in our hospitals. The question is, can one nurse really so easily replace another? What do we really know about the experienced nurse changing jobs? The author uses her personal experience-her transition from adult to paediatric nursing-to describe the difficulties associated with nursing in vastly different areas. Supported by nurse theorist Patricia Benner's ideas on skill and competence levels (1984), the author recounts the crisis in confidence she experienced when confronted with the paediatric "culture". Also discussed are the ways in which paediatric nursing knowledge develops (in this country it develops very much on the job) and the implications this has for staffing.

Adult↗
PubMed1993

Protein and lipoprotein uptake by developing oocytes of the hawkmoth Manduca sexta. An ultrastructural and immunocytochemical study.

The ultrastructure of developing Manduca sexta oocytes is described with respect to the endocytic pathway for protein incorporation. Three major (lipo) protein components of mature M. sexta eggs, lipophorin, vitellogenin and microvitellogenin, were localized along this pathway by immuno-fluorescence and immuno-gold labeling techniques. Labeling of the antigens was observed in the extracellular spaces of the follicle. In those cases where fixation and en bloc staining procedures did not destroy antigenicity, antigens were detected in coated pits and coated vesicles near the plasma membrane of the oocyte. All three antigens were demonstrated to be present in endosomes in the cortex of the oocyte. Both the morphology and the labeling pattern of the endosomes indicate that this organelle is a compartment of uncoupling of receptor and ligand. Tubular elements at the surface of the endosome, interpreted to be involved in the recycling of receptors and membrane to the oocyte surface, were not labeled. Strong labeling of lipophorin, vitellogenin and microvitellogenin was observed in the developing yolk bodies, the main protein storage compartment of the oocyte. The uptake and storage of hemolymph proteins and lipoproteins by M. sexta oocytes is discussed in comparison with other insect and vertebrate endocytic systems.

Animals↗
PubMed1992

Reliability of the tear break-up time technique of assessing tear stability and the locations of the tear break-up in Hong Kong Chinese.

The measurement of tear break-up time (TBUT) in assessing stability of the tear film is somewhat controversial, even though the technique is widely used. We examined reliability of the technique within and among examiners and conclude that measurements of TBUT can be made reliably; full-beam observation of the cornea is preferable to scanning the cornea with a narrow slit in making the measurements. There may be differences in TBUT measurements made in the same subjects among examiners, but these differences are smaller with more experienced practitioners. In the Hong Kong Chinese (HK-Chinese), tear break-up appears to be more likely to first occur in the inferior periphery of the cornea. In this population mean TBUT is about 7.20 s; assuming a Gaussian distribution of TBUT values, 2.1 s should be adopted as the lower limit for normal TBUT in HK-Chinese.

Adolescent↗
PubMed1991

The comparative evaluation of three-dimensional magnetic resonance for carotid artery disease.

Conventional angiography is the current standard for the evaluation of carotid artery disease. The excellent resolution of this invasive study is offset by the potential for contrast-related, embolic, and puncture site complications. Three-dimensional magnetic resonance angiography may offer a noninvasive diagnostic alternative. We examined this possibility by performing both conventional angiography and three-dimensional magnetic resonance angiography in 13 patients. Cervical duplex scans were also obtained in these patients. Contiguous transverse cervical magnetic resonance images were acquired in a 1.5 tesla magnet, by use of a posterior neck coil and a gradient echo pulse sequence. These "raw" data were transferred to a real-time workstation where three-dimensional cervical arterial images were reformatted, magnified, and examined from multiple angles. Total study time from patient positioning to image generation was approximately 30 minutes. In all patients, on three-dimensional magnetic resonance angiography the common, external, and internal carotid arteries and distal vertebral arteries were easily discernable and correctly identified as patent, stenotic, or occluded. Three-dimensional magnetic resonance angiography was not accurate in detecting carotid ulcers. The degree of internal carotid artery stenosis measured from the three-dimensional magnetic resonance angiography studies correlated well with the internal carotid artery stenosis measured with conventional angiography (r = 0.866, r2 = 75.1%, p = less than or equal to 0.0001). This recent technologic advance represents significant progress toward achieving the goal of completely noninvasive vascular assessment in this patient population.

Aged↗
PubMed1989

Myopia in optometry students: family history, age of onset and personality.

The relationship between refractive error and family history, age of onset and personality was investigated in 189 optometry students. Subjects completed a questionnaire requesting details of their refractive history, type of correction and their family history. Subjects also completed an Eysenck Personality Inventory (EPI). Subjects were categorized as hyperopes, emmetropes or myopes on the basis of their questionnaire responses. No significant relationship was found between refractive group and the prevalence of myopia in parents. Myopic subjects, however, showed a significantly higher prevalence of myopic siblings. Furthermore, late-onset myopes showed a higher prevalence of myopic siblings than early-onset myopes. No significant personality differences were found between the refractive groups.

Adolescent↗
PubMed1986

Insulin-induced factitious hypoglycemic coma.

Hypoglycemia due to the ingestion of oral hypoglycemic agents or injection of insulin is a common way for chronic factitious disorder to present to physicians. Despite this fact, factitious hypoglycemic coma is rare. Because hypoglycemia is potentially fatal, with numerous sequelae, physicians need to be aware of its occurrence and method of detection. A case of chronic factitious disorder presenting as hypoglycemic coma is presented and its implications discussed.

Adult↗