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At least 235 records · Page 13Linked to original sources

PubMed2000

A critical analysis of the content of the tools that measure breast-feeding interaction.

OBJECTIVE: To undertake a critical analysis of the content of six tools, which have been designed to evaluate the breast-feeding interaction. DESIGN: The tools are viewed as discourses and are examined in terms of the insight they give into the assumptions about and attitudes towards breast-feeding inherent in the authors who have produced them. FINDINGS: The findings indicate that there is little agreement between the existing breast-feeding assessment tools as to how to measure a successful breast feed and that the tools appear to place insufficient reliance upon the research evidence related to lactation. KEY CONCLUSIONS: The lack of commonality between evaluation tools appears to reflect a prevailing inconsistency in the advice given by health workers to breast-feeding mothers. Reports of their unreliability may be indicative of the problems inherent when attempting to impose a biomedical model upon an intrinsically natural interaction. IMPLICATIONS FOR PRACTICE: It is suggested that, if evaluations of the breast-feeding interaction are to be useful, a tool which places greater emphasis on the research evidence is called for. Otherwise, given the limitations of such tools, their use may actively hinder the establishment of successful breast feeding.

Breast Feeding↗

PubMed2004

Predicting thermal displacements in modular tool systems.

In the last decade, there has been an increasing interest in compensating thermally induced errors to improve the manufacturing accuracy of modular tool systems. These modular tool systems are interfaces between spindle and workpiece and consist of several complicatedly formed parts. Their thermal behavior is dominated by nonlinearities, delay and hysteresis effects even in tools with simpler geometry and it is difficult to describe it theoretically. Due to the dominant nonlinear nature of this behavior the so far used linear regression between the temperatures and the displacements is insufficient. Therefore, in this study we test the hypothesis whether we can reliably predict such thermal displacements via nonlinear temperature-displacement regression functions. These functions are estimated first from learning measurements using the alternating conditional expectation (ACE) algorithm and then tested on independent data sets. First, we analyze data that were generated by a finite element spindle model. We find that our approach is a powerful tool to describe the relation between temperatures and displacements for simulated data. Next, we analyze the temperature-displacement relationship in a silent real experimental setup, where the tool system is thermally forced. Again, the ACE algorithm is powerful to estimate the deformation with high precision. The corresponding errors obtained by using the nonlinear regression approach are 10-fold lower in comparison to multiple linear regression analysis. Finally, we investigate the thermal behavior of a modular tool system in a working milling machine and again get promising results. The thermally induced errors can be estimated with 1-2 microm accuracy using this nonlinear regression analysis. Therefore, this approach seems to be very useful for the development of new modular tool systems.

Computer Simulation↗

PubMed2002

Active tool use with the contralesional hand can reduce cross-modal extinction of touch on that hand.

After a unilateral brain lesion, patients may show cross-modal, visual-tactile extinction. Such patients may fail to report tactile stimuli on the contralesional hand when presented together with competing visual stimuli near the ipsilesional hand. In this work we tested the hypothesis that this cross-modal extinction may be reduced when a patient has used a tool with the contralesional hand to reach for objects in the ipsilesional visual field. Consistent with previous work, we hypothesize that active use of a tool may extend cross-modal interactions between visual stimuli at the tip of the tool and tactile stimuli on the hand wielding the tool. In the new situation of a tool connecting the contralesional hand with ipsilesional visual space, competition between stimuli on these opposite sides may be reduced, so that extinction decreases. We studied patient BV, who showed reliable cross-modal, visual-tactile extinction after right-hemisphere stroke. In two separate sessions we showed that prolonged tool use (10-20 min) with the contralesional hand in ipsilesional space reduced cross-modal extinction for up to 60-90 min post-training. We propose that an actively used tool may be effective in linking cross-modal stimuli presented along its extension. This can then overcome competition between stimuli presented on opposite sides of the body midline, thus modulating extinction.

Aged↗

PubMed1989

Muscle response to pneumatic hand tool torque reaction forces.

Surface electromyography was used for studying the effects of torque reaction force acting against the hand, on forearm muscle activity and grip force for five subjects operating right angle, air shut-off nutrunners. Four tools having increasing spindle torque were operated using short and long torque reaction times. Nutrunner spindle torque ranged between 30 Nm and 100 Nm. Short torque reaction time was considered 0.5 s while long torque reaction time was 2 s. Peak horizontal force was the greatest component of the reaction force acting against the hand and accounted for more than 97% of the peak resultant hand force. Peak hand force increased from 89 N for the smallest tool to 202 N for the largest tool. Forearm muscle rms EMG, scaled for grip force, indicated average flexor activity during the Torque-reaction phase was more than four times greater than the Pre-start and Post Shut-off phases, and two times greater than the Run-down phase. Flexor EMG activity during the Torque-reaction phase increased for increasing tool peak spindle torque. Average flexor rms EMG activity, scaled for grip force, during the Torque-reaction phase increased from 372 N for the 30 Nm nutrunner to 449 N for the 100 Nm nutrunner. Flexor rms EMG activity averaged during the Torque-reaction phase and scaled for grip force was 390 N for long torque reaction times and increased to 440 N for short torque reaction times. Flexor rms EMG integrated over the torque reaction phase was 839 Ns for long torque reaction times and decreased to 312 Ns for short torque reaction times. The average latency between tool spindle torque onset and peak initial flexor rms EMG for long torque reaction times was 294 ms which decreased to 161 ms for short torque reaction times. The average latency between peak tool spindle torque, just prior to tool shut-off, and peak final rms EMG for long torque reaction times was 97 ms for flexors and 188 ms for extensors, which decreased for short torque reaction times to 47 ms for flexors and 116 ms for extensors. The results suggest that right angle nutrunner torque reaction forces can affect extrinsic hand muscles in the forearm, and hence grip exertions, by way of a reflex response.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1999

Effect of carpal tunnel syndrome on grip force coordination on hand tools.

This study investigated coordination of the grip force on and force applied with a hand tool using a precision pinch grip. A simulated hand tool was developed to measure grip force exerted on the tool as a function of the force transmitted from the tool to an external object in a dynamic force matching paradigm. Grip force coordination measures reflected subjects' abilities to modulate grip force in parallel with the tool application force and their abilities to minimize excessive grip force. These measures were calculated for seven subjects with a diagnosis of carpal tunnel syndrome (CTS) and seven age- and gender-matched controls. The absolute magnitude of excessive grip force (safety margin) was unreliable because of the high intrasubject variability in coefficient of friction measurements. Linear regression equations predicting coefficient of friction from pinch force magnitude had low r2 coefficients of determination and were generally not statistically significant (p > 0.05). Relative comparisons of grip force control showed that individuals with CTS exhibited a statistically significant (p < 0.05) increase in ratio of grip force to application force (54% higher than controls) and a significant (p < 0.05) decrease in modulation of pinch force with application force (12% lower than controls). These results suggest that individuals with CTS lose some ability to coordinate efficiently grip force on hand tools and exert higher grip forces on tools, at equivalent application forces, than controls. This is believed to be a result of tactile sensibility deficits associated with CTS. As a result, workers with CTS may be at increased risk of accelerating the progression of their musculoskeletal disorder.

Adult↗

PubMed2006

Identification of aphasia post stroke: a review of screening assessment tools.

INTRODUCTION: Aphasia is one of the most common consequences of stroke. Early identification, diagnosis and treatment of language deficits are important steps in maximizing rehabilitation gains. A routine screening test is an invaluable tool in the identification and appropriate referral of patients with potential communication problems. The present study presents an evaluation of the measurement properties of screening tools for aphasia found within the stroke research literature. METHODS: Screening tools were identified following searches of the published research literature in stroke. Instruments were reviewed on the basis of reliability, validity, classification sensitivity and practical utility. RESULTS: Six aphasia screening tools were identified. For most tools, information pertaining to measurement properties and clinical utility was limited. CONCLUSIONS: The Frenchay Aphasia Screening Test (FAST) appears to be the most widely used and thoroughly evaluated tool found within the stroke research literature. Further evaluation of the measurement properties and clinical utility of screening tools is recommended.

Aphasia↗

PubMedDate not supplied

The credibility of the Breast Cancer Risk Assessment (BCRA) tool for Asians.

This paper presents an overview of the Breast Cancer Risk Assessment (BCRA) Tool, assessing the credibility of the BCRA tool in estimating the risk of developing breast cancer for Asians and the carrying out of tests to identify the changes in the risks that follow with changes in one or more risk factors of the tool. It is essential to increase the awareness of women of their risk of developing breast cancer, as it is not surprising that some women may not even be conscious of the individual factors that might contribute to the increase of their risk of developing breast cancer. On the other hand, relatively accurate means of determining increases in relative risks of developing breast cancer due to changes in some of the risk factors are also important. This is done so that unnecessary worry due to an overestimation of an individual's risk of developing breast cancer can be avoided. Due to the origin of the BCRA tool which is used in this study, it is important to verify the validity of the tool on Asians and to identify, as far as possible, the effect that each risk factor has on individuals. The effect that a specific risk factor has on a white woman may not be exactly the same for that of an Asian woman. As the above-mentioned tool has been arrived at using the statistics and databases of white women, in this work, tests have been carried out to determine the suitability of the tool on Asian women. On top of that, various tests are also carried out to determine the effects of the change of certain risk factors on a woman's risk of developing breast cancer. These factors include age, number of breast biopsies and number of first-degree relatives with breast cancer. Five-year risks and lifetime risks are also looked into separately with the change of each of these factors.

Adult↗

PubMed2000

Antiretroviral medication adherence and persistence with respect to adherence tool usage.

Adherence to complex drug regimens over an extended period is a key factor in reaping the health benefits of highly active antiretroviral therapy (HAART). Forgetting a dose is the most commonly stated reason for suboptimal adherence, indicating a potential benefit of reminder devices. We examined antiretroviral drug adherence and duration of therapy with respect to adherence tool usage. Adherence was monitored for 12 months in a cohort of patients, using pharmacy refill data. Seventy-eight subjects were administered a questionnaire with regard to tool use at least once at 6 and/or 12 months; patients who replied to the questionnaire were eligible for this study. Persistence of remaining on therapy was obtained from the subjects, charts. The tools included individualized schedules, dosettes and electronic reminder devices, which were offered free of charge to all patients. Of the 64 subjects who entered this study, 60.9% (n = 39) used at least one adherence tool. The median adherence in those using tools was 95%; three quarters showed greater than 91% adherence. Adherence rates with respect to individual tools did not differ significantly for schedules and dosettes, with medians of 95% (n = 31) and 94% (n = 13), respectively. Median adherence with electronic reminders was 76% (n = 5). Seventy-four percent of patients remained on therapy after 12 months of study. Taking into consideration previous antiretroviral treatment, actual persistence at 12 months was 87%. Employing and individualizing strategies, including adherence tools, to enhance patient adherence to complex regimens in addition to counseling and follow-up, has resulted in good adherence rates and persistence.

Adult↗

PubMed2004

Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review.

OBJECTIVE: To identify all published papers on risk factors and risk assessment tools for falls in hospital inpatients. To identify clinical risk assessment tools or individual clinical risk factors predictive of falls, with the ultimate aim of informing the design of effective fall prevention strategies. DESIGN: Systematic literature review (Cochrane methodology). Independent assessment of quality against agreed criteria. Calculation of odds ratios and 95% confidence intervals for risk factors and of sensitivity, specificity, negative and positive predictive value for risk assessment tools (with odds ratios and confidence intervals), where published data sufficient. RESULTS: 28 papers on risk factors were identified, with 15 excluded from further analysis. Despite the identification of 47 papers purporting to describe falls risk assessment tools, only six papers were identified where risk assessment tools had been subjected to prospective validation, and only two where validation had been performed in two or more patient cohorts. CONCLUSIONS: A small number of significant falls risk factors emerged consistently, despite the heterogeneity of settings namely gait instability, agitated confusion, urinary incontinence/frequency, falls history and prescription of 'culprit' drugs (especially sedative/hypnotics). Simple risk assessment tools constructed of similar variables have been shown to predict falls with sensitivity and specificity in excess of 70%, although validation in a variety of settings and in routine clinical use is lacking. Effective falls interventions in this population may require the use of better-validated risk assessment tools, or alternatively, attention to common reversible falls risk factors in all patients.

Accidental Falls↗

PubMed2025

AQuA Tools: clear and reliable BEDPE operations for 3D genomics.

MOTIVATION: The genome interacts with itself within the volume of the cell nucleus to process information. These interactions mediate signal integration, gene regulation, and cell identity. The identification of new therapeutic targets from non-coding disease-associated variants relies critically on correctly assigning variants to genes through 3D interactions. Experimental techniques in 3D genomics, such as HiC and HiChIP, allow the mapping of interactions through sequencing. Bioinformatics for 3D genomics contends primarily with contact matrices that contain interaction frequencies for all possible element pairs, and BEDPE files that store element pairs that interact. Whereas the tools available for processing linear genomic data are mature, operating on contact matrices and BEDPE files remains cumbersome, opaque, and error-prone, as researchers have had to shoehorn tools originally designed for linear data. A genome arithmetic designed from the ground up for 3D genomics does not yet exist. RESULTS: We present AQuA Tools, a suite of shell- and R-based command-line tools that provide a set of core operations on contact matrices and BEDPE files motivated by key questions in population genetics, cancer research, and precision medicine. We have designed our core operations to be clear, reliable, intuitive and versatile. Core operations can be chained together along with standard UNIX commands. Our goal is to make AQuA Tools easy for the novice to learn and the go-to choice for power users. We hope our tools will motivate more researchers to use 3D genomic data in their projects. AVAILABILITY AND IMPLEMENTATION: We provide and maintain AQuA Tools at https://github.com/axiotl/aqua-tools.

Genomics↗

PubMed2026

Comprehensive evaluation of ACMG/AMP-based variant classification tools.

MOTIVATION: The American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines represent the gold standard for clinical variant interpretation. Despite the widespread adoption of ACMG/AMP guidelines, a comprehensive comparison of the software tools designed to implement them has been lacking. This represents a significant gap, as clinicians require evidence-based guidance on which tools to use in their practice. RESULTS: We benchmarked four ACMG/AMP-based tools (Franklin, InterVar, TAPES, Genebe) selected from 22 tools, and compared their performance with LIRICAL, a top-performing phenotype-driven tool, using 151 expert-curated datasets from Mendelian disorders. Selection criteria included free availability, VCF compatibility, operational reliability, and not being disease-specific. Our evaluation framework assessed top-N accuracy (N = 1, 5, 10, 20, 50), retention rates, precision, recall, F1 scores, and area under the curve (AUC). Statistical validation employed bootstrap confidence intervals (n = 1000) and Friedman tests. LIRICAL (68.21%) and Franklin (61.59%) demonstrated superior top-10 variant prioritization accuracy in Mendelian disorders, significantly outperforming other tools (P = .0000). Results demonstrate that tools with advanced phenotypic integration significantly outperform those relying primarily on genomic features. AVAILABILITY AND IMPLEMENTATION: All data and source code required to reproduce the findings of this study are openly available in the Code Ocean repository at https://doi.org/10.24433/CO.6562438.v1.

Software↗

PubMed2005

The effectiveness of quality improvement tools: joint working in integrated community teams.

OBJECTIVE: To explore the effectiveness of integrated care pathways in facilitating integration in community-based teams. DESIGN: Case comparison of models of integrated care pathways in two different settings: community mental health teams in one Scottish region and care of the elderly rapid response teams in three Scottish regions. In both settings, an integrated care pathway was used as a tool for integration, but in different ways. Comparison is made by first identifying key factors structuring team-work in both settings, then analysing how the constellation of these factors results in different dynamics of team-work in each setting. The pathway tool used in each setting is then outlined and an analysis presented of how the tool interacts with the organizational dynamics in and around the teams to produce observed outcomes in each setting. RESULTS: In both settings impact of tool was shaped by the same organizational dynamics which produced the nature of team-work. In neither setting was the tool optimally effective in improving integration. In community mental health teams a prescriptive, management-driven integrated care pathway was introduced. This presumed a degree of task sharing in teams which was absent. It was resisted by the teams. In rapid response teams a flexible, team-driven pathway tool was being introduced to help teams conceptualize and communicate about the service. This approach fitted with autonomy and task sharing in rapid response teams and uptake was good. However, management did not engage. CONCLUSION: The effectiveness of the tool in both settings requires attention to organizational context.

Aged↗

PubMed2006

New Onto-Tools: Promoter-Express, nsSNPCounter and Onto-Translate.

The Onto-Tools suite is composed of an annotation database and eight complementary, web-accessible data mining tools: Onto-Express, Onto-Compare, Onto-Design, Onto-Translate, Onto-Miner, Pathway-Express, Promoter-Express and nsSNPCounter. Promoter-Express is a new tool added to the Onto-Tools ensemble that facilitates the identification of transcription factor binding sites active in specific conditions. nsSNPCounter is another new tool that allows computation and analysis of synonymous and non-synonymous codon substitutions for studying evolutionary rates of protein coding genes. Onto-Translate has also been enhanced to expand its scope and accuracy by fully utilizing the capabilities of the Onto-Tools database. Currently, Onto-Translate allows arbitrary mappings between 28 types of IDs for 53 organisms. Onto-Tools are freely available at http://vortex.cs.wayne.edu/Projects.html.

Binding Sites↗

PubMed2000

Dynamic size-change of hand peripersonal space following tool use.

Humans and monkeys share similar sensory integrated processing of tactile and peri-hand visual inputs for coding peripersonal space surrounding the hand. In monkeys, tool use is known to induce a transient elongation of hand-centred peripersonal space along the tool axis. Here we report evidence that, also in humans, the use of a tool can increase the spatial extent of the representation of peri-hand visual space to incorporate the tool. We investigated this phenomenon in patients with tactile extinction, by using a cross-modal paradigm well suited to reveal visual-tactile integration near patients' hand. In the present study cross-modal extinction was assessed far from patients' ipsilesional hand, at the distal edge of a hand-held rake. We found that cross-modal extinction was more severe after patients used the rake to retrieve distant objects with respect to a condition in which the rake was not used. This evidence of an expansion of peri-hand space lasted only a few minutes after tool use. By contrast, peri-hand space expansion was not observed when motor actions towards distant objects did not involve the tool. These findings show that visual peri-hand space has important dynamic properties in humans; it can be expanded and contracted depending upon tool use.

Aged↗

PubMed2005

Determining older people's needs for care by Registered Nurses: the Nursing Needs Assessment Tool.

AIMS: This paper reports a study to determine an appropriate framework for assessing older people's needs for nursing within the policy of 'free nursing', and to attempt to identify valid, reliable and usable assessment tool for determining this eligibility. BACKGROUND: In 2001, the United Kingdom government introduced 'free nursing care' legislation, eligibility for which was subject to a nursing needs assessment. This paper outlines the search for and subsequent development of an appropriate tool for assessing older people's eligibility for free nursing care in Northern Ireland. METHODS: Following a systematic search of the literature, existing tools used in ascertaining older people's nursing needs were identified. Each tool was systematically assessed in accordance with criteria of validity, reliability, usability, comprehensiveness of assessment and ability to quantify nursing care needs. From the findings, an assessment instrument, Nursing Needs Assessment Tool was subsequently developed and tested. Paired assessments of older people were undertaken independently by assessor dyads and evaluated statistically. Assessors' opinions on the usability of the instrument were sought through a focus group. RESULTS: One hundred and ten paired assessments were returned (63%). Overall there was 65% agreement between assessors. Kappa scores indicated good levels of inter-rater reliability. Correlation co-efficient measures reinforced these results. Findings from the focus group confirmed the validity, usability and comprehensiveness of the tool. CONCLUSIONS: The Nursing Needs Assessment Tool is a reliable, valid and usable instrument. This has major implications for the standardization of assessment for older people.

Aged↗

PubMed2006

Clinical pathway audit tools: a systematic review.

AIM: To determine whether clinical/care pathway audit tools can identify the characteristics of well-organized care processes. BACKGROUND: Although pathways are used worldwide, confusion exists about the concept and impact. Evaluation Search of OVID-Medline, Cinahl, British Nursing Index; manual search of the Journal of Integrated Care Pathways; contact with Smartgroup on Clinical Pathways and board members of the European Pathway Association and Google search. KEY ISSUES: We selected seven of 15 clinical pathway audit tools for this review. Through content analysis, we identified 17 characteristics and grouped them using the realistic evaluation paradigm. The Integrated Care Pathway Appraisal Tool is the most appropriate audit tool to assess clinical pathway documents. CONCLUSIONS: It is astonishing that so little research on clinical pathway audit tools has been underwent, given the prevalent use of clinical pathways. Because the concept of clinical pathways remains unclear, a variety of audit tools are needed to help clarify the concept. Further research on the construct and criterion validity of pathway audit tools is necessary to fully understand why and under which circumstances pathways lead to improved care.

Critical Pathways↗

PubMed2004

Validation of a brief nurse-administered migraine assessment tool.

OBJECTIVE: To validate a brief tool for screening migraine. BACKGROUND: Migraine is a common, but underdiagnosed condition. Effective utilization of nonphysician personnel to reliably screen patients for migraine may improve identification of migraineurs for clinical treatment and research. METHODS: An 8-question Migraine Assessment Tool (based on International Headache Society criteria) was designed for administration by a nurse with no specialized headache training as a pre-assessment for the diagnosis of migraine for use in either a research or clinical environment. A community sample of 80 adults (71 women, 9 men; mean age, 33.7 years; 80% white, 14% African American, 2.5% Asian American) with self-reported headache was recruited through advertisements. A headache specialist independently diagnosed subjects using clinical assessment, and a nurse who works in a balance disorder clinic used the Migraine Assessment Tool. Agreement between physician and nurse-administered Migraine Assessment Tool diagnoses was determined. Each subject returned in 2 to 4 weeks for a second assessment, administered by the same nurse. Agreement between the 2 diagnoses from the Migraine Assessment Tool was calculated. RESULTS: Comparison between diagnosis by the physician versus the Migraine Assessment Tool revealed a positive predictive value of 0.85; negative predictive value, 0.84; sensitivity, 0.89; specificity, 0.79; and observed agreement, 0.85. Cohen's kappa reliability measure was 0.69, indicating good test reliability. Interestingly, in 8 of the 12 cases of disagreement, the examiner diagnosing nonmigraine diagnosed analgesic overuse headache. Comparing diagnoses assigned by the 2 separate administrations of the Migraine Assessment Tool revealed a Cohen's kappa of 0.69. Notably, 9 of the 12 cases of nonagreement on the 2 assessments were due to subjects endorsing analgesic overuse in only 1 of the 2 testing sessions. CONCLUSIONS: This study showed good reliability and stability of a new, brief, nurse-administered migraine questionnaire. In addition, the study also showed that consistency in self-reporting analgesic overuse within individuals with headache is poor. This suggests the need for repeat questioning about analgesic overuse on subsequent appointments to ensure absence of analgesic overuse headache.

Adult↗

PubMed2003

An evaluation of molecular diagnostic tools for the detection and differentiation of human-pathogenic Cryptosporidium spp.

The performance of 10 commonly used genotyping tools in the detection and differentiation of 7 human-pathogenic Cryptosporidium spp. (C. hominis, C. parvum, C. meleagridis, C. felis, C. canis, C. muris and Cryptosporidium pig genotype 1) was evaluated. All 3 SU rRNA gene-based tools could amplify the DNA of 7 Cryptosporidium spp. efficiently. However, the tools based on the antigens TRAP-C1, TRAP-C2 and COWP genes, the housekeeping genes HSP70 and DHFR, or a genomic sequence, failed to detect the DNA of C. felis, C. canis, Cryptosporidium pig genotype I, and C. muris. With the exception of 1 tool based on the TRAP-C2 gene, the PCR-RFLP or the PCR sequencing tools evaluated in this study could differentiate C. hominis, C. parvum and C. meleagridis from each other, and 2 SSU rRNA gene-based tools could differentiate all 7 Cryptosporidium spp. Thus, a thorough understanding of the strength and weakness of each technique is needed when using molecular diagnostic tool in epidemiological investigations of human cryptosporidiosis.

Animals↗