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PubMed2004

The quantal theory of how the immune system discriminates between "self and non-self"

In the past 50 years, immunologists have accumulated an amazing amount of information as to how the immune system functions. However, one of the most fundamental aspects of immunity, how the immune system discriminates between self vs. non-self, still remains an enigma. Any attempt to explain this most intriguing and fundamental characteristic must account for this decision at the level of the whole immune system, but as well, at the level of the individual cells making up the immune system. Moreover, it must provide for a molecular explanation as to how and why the cells behave as they do. The "Quantal Theory", proposed herein, is based upon the "Clonal Selection Theory", first proposed by Sir McFarland Burnet in 1955, in which he explained the remarkable specificity as well as diversity of recognition of everything foreign in the environment. The "Quantal Theory" is built upon Burnet's premise that after antigen selection of cell clones, a proliferative expansion of the selected cells ensues. Furthermore, it is derived from experiments which indicate that the proliferation of antigen-selected cell clones is determined by a quantal, "all-or-none", decision promulgated by a critical number of cellular receptors triggered by the T Cell Growth Factor (TCGF), interleukin 2 (IL2). An extraordinary number of experiments reported especially in the past 20 years, and detailed herein, indicate that the T cell Antigen Receptor (TCR) behaves similarly, and also that there are several critical numbers of triggered TCRs that determine different fates of the T cells. Moreover, the fates of the cells appear ultimately to be determined by the TCR triggering of the IL2 and IL2 receptor (IL2R) genes, which are also expressed in a very quantal fashion. The "Quantal Theory" states that the fundamental decisions of the T cell immune system are dependent upon the cells receiving a critical number of triggered TCRs and IL2Rs and that the cells respond in an all-or-none fashion. The "Quantal Theory" accounts fully for the development of T cells in the thymus, and such fundamental cellular fates as both "positive" and "negative" selection, as well as the decision to differentiate into a "Regulatory T cell" (T-Reg). In the periphery, the "Quantal Theory" accounts for the decision to proliferate or not in response to the presence of an antigen, either non-self or self, or to differentiate into a T-Reg. Since the immune system discriminates between self and non-self antigens by the accumulated number of triggered TCRs and IL2Rs, therapeutic manipulation of the determinants of these quantal decisions should permit new approaches to either enhance or dampen antigen-specific immune responses.

Journal Article↗

PubMedDate not supplied

[Sick building syndrome--a result of modern lifestyle].

Sick building syndrome (SBS) is a term used to describe situation in building when more than 30% of occupants suffer from various symptoms which tend to increase by severity during the time people spend in "sick" building and disappear when they leave the building. Typical cases of SBS report vague symptoms, which cannot be objectively measured, and sufferers usually show no clinical signs of illness. Symptom heterogeneity suggests that they do not represent a single disorder. The objective of our study was to establish if SBS is present in our town because new buildings have been built lately producing the artificial environment--exclusively artificial lightning and mechanical ventilation. A total of 812 subjects were included in our study. The investigation of SBS was performed by standardized questionnaires to determine the prevalence of symptoms and complaints. Questionnaires were used to collect data on perception of environment conditions and health during the period they work in this building. The subjects were divided in three groups according to sex, level of education and ownership. Our data suggested that the incidence of symptoms was higher in employers than in owners of the offices. Moreover, the prevalence of SBS was very high-up to 74.76%. It is obvious that certain physical, psychological and organizational factors are involved in the incidence of symptoms, but our investigation suggests that physical factor has a dominant role in development of symptoms, particularly low humidity and low air flow. In addition, our judgment is that SBS exists in our city, probably in the whole country and, therefore, it must be investigated properly.

Adult↗

PubMed2002

Knowledge management: evaluating the organizational requirements and culture for an emerging technology.

The purpose of this paper is to explore the application of knowledge management concepts to an information systems (IS) knowledge base, as opposed to a clinical one. The field of Medical Informatics is committed to helping others manage medical information and knowledge through the application of information technology. At Partners HealthCare, a wide variety of clinical information management systems have been built and implemented in complex environments, creating an extensive applied informatics knowledge base. How should healthcare IS departments manage this intellectual capital? That's the question that Partners HealthCare is asking its senior and middle IS managers. This paper reports on an internal survey addressing Knowledge Management (KM) requirements, the potential application of this technology in our organization, and discusses where we are today and where to go from here.

Data Collection↗

PubMed2005

[The therapeutic promises of a building. Vijverdal Community Mental Hospital 1969-2004].

In 1972 the psychiatric hospital 'Vijverdal' opened its doors in Maastricht. The building of this Community Mental Hospital was reported to be 'revolutionary'. Inspired by American architectural concepts about the construction of hospitals, Vijverdal arose as a huge complex with a nine storey radial block of flats: a unique building in Dutch psychiatry. The first reactions were very positive. The imposing flat expressed psychiatric optimism and therapeutic promises. However, confronted by the dynamic developments in psychiatry at the end of the seventies, the hospital more and more appeared to be a therapeutic monstrum: the flat became a symbol of alienation and medical detachment. Adapting it to the new ideas about differentiation and de-concentration appeared difficult, however. Only in 2000 Vijverdal started a fundamental renovation. The flat will be torn down in 2006. This changing evaluation of Vijverdal makes us wonder about the biography of this psychiatric hospital. Which intentions and which psychiatric concepts inspired Vijverdal to be built? How functioned the building environment of Vijverdal in practice? Could the hospital be accommodated to the new notions and wishes about psychiatric care? Moreover, in what way did the architecture determine the history of Vijverdal? And eventually, how are new conceptions about psychiatric care translated in the present renovation and reconstruction of Vijverdal? Do therapeutic promises play a role again? The adventures of Vijverdal tell us about the risks of visionary architecture, but also that a building matters: the psychiatric patients appreciate the new houses and the privacy of a room for their own.

History, 20th Century↗

PubMedDate not supplied

Making the transition to critical pathways--a community behavioral health center's approach.

BACKGROUND: Shawnee Hills, Inc., formally began the transition to critical pathways in January 1996. The goal was to design and implement a service delivery model with clearly defined clinical paths and appropriate and functional technical support systems. No specific goal date for full implementation was designated; however, the intent was to move into the new system in a manner that allowed both consumer and employee participation in the planning process and to accommodate the organization's transition from a fee-for-service to a capitated model of contracting for services. The target date for completion of phase one, research and initial planning, was March 1, 1996. Although there were a number of benefits anticipated in adopting the critical paths method (CPM), the primary rationale was threefold: (1) standardizing the quality of care and treatment, (2) cost containment, and (3) better positioning of the organization for success within a capitated funding environment. A review of the publications indicated that the CPM had proved to be effective in other healthcare fields. In addition, the goals and approaches inherent within the CPM were consistent with the organization's total quality management (TQM) philosophy and operational practices. METHOD: By using the approach common to the organization since the adoption of the principles and practices of TQM in early 1992, a team was appointed with the mission of reengineering the clinical services delivery model. Unlike previous instances, however, this team was comprised largely of senior leadership, and two staff members were assigned on a full-time basis. A more detailed review of publications was conducted and, where possible, identification of critical pathways developed within the mental health field in other states were secured. Focus groups were used to address "best" or "preferred" practices for specific populations and age groups. Team members provided an orientation to the process, along with the opportunity to critique proposed pathways and models for service delivery as they were drafted to all employees through participation in ongoing staff development efforts. The center leadership was kept informed and was provided additional opportunities for input through regular presentations to the Quality Council that meets on a weekly basis. RESULTS: The first phase of the transition, research and initial planning, was completed on March 1, 1996. To date, the team has adopted or developed initial drafts of proposed clinical pathways for frequently occurring diagnoses within adult and child mental health, adult and child substance abuse, and specific to early childhood for the mental retarded or developmentally delayed. A model for clinical pathways was developed incorporating the JCAHO requirements to address assessment, care, and education at the major junctures of service delivery. In addition, the team formulated recommendations specific to priority areas for each major pathway and the approach to be taken in the transition from a fee-for-service to a capitated environment. A service delivery model built around acute care and continuing care was outlined, but remains a work-in-progress at this time. Finalizing the model and the completion of the clinical pathways for specific diagnostic groupings are two priorities for the second phase, product development-continued planning and transition, now underway. CONCLUSIONS: Although the effort is very much outcomes-oriented, data are not available at this early stage in the process. (ABSTRACT TRUNCATED)

Adult↗

PubMedDate not supplied

[Consensus, hedonism: the characteristics of new family and their consequences for the development of children].

Over the last three decades, the marital family model described by Durkheim at the end of the nineteenth century has undergone numerous changes, e.g. questioning about the principle of authority, women emancipation, occurrence of the "new fathers", the growing influence of the media on the daily life of families, the less frequent and most precious child (due to the reduced number of children per family),... Through clinical, psychoanalytical and developmental models we, here, analyze these changes together with their impact on child. Historical and sociological approaches also allowed us to examine some of the effects induced by consensus and hedonism, the new familial parameters, on the child's life and development. The modern family being classically founded upon duty (central value) and the principle of authority to settle relationships between individuals, its main features are opposed to those of the contemporary family. The latter, which started to emerge over the sixties, is characterized by both the prevalence of parent-child relationships symmetrization and the emergence of the search for immediate pleasure. The change from parental authority to consensus as a principle ruling the relationships within families leads to many consequences later noticed through changes in the construction of the child's psyche along his development and in the relationships dynamics. Authority imposes on child to submit to the parents-mediatized requirements of the society and implies a change in impulses through the setting of Superego agencies and Ego Ideal, which (both ?) represent taboos and social ideals in the psyche. When consensus is at the center of the family, and according to concrete meetings with the other offered by the thousand and one situations met in the daily life, the aims and satisfaction modalities of the child's impulses will evolve into a relation often based on either strength or seduction. As a result, the settlement of classical instances will be affected. It will result in. Considering hedonism as the central value in child education leads one to support the pleasure principle and contributes to making more difficult the switching to the reality principle. The couple " I want, I don't want" is at the origin of most behaviors, and then further leads to the development of the assertive agency, "I do what I want, and thus I am". The libidinal excitation is, therefore, little restricted and reinforced by the media-based environment. The child's Superego is built on the concrete practices of his parents, but not on their Superego, whereas the Ideal of Ego is poorly socialized and driven towards the ideal Ego, early narcissist formation with the signs of child megalomania. Due to these early years of life throughout which the pleasure principle has been favored by their environment, the children are not prepared for life with its restrictions and unavoidable frustrations possibly experienced as persecutions. In the same way, when they have to meet the requirements of life in community, eg the discipline imposed within a college, these rules are more and more often felt by a pupil as unfair, arbitrary persecutions sometimes related to his own personality, "the teacher doesn't like me" of course, it is all the more legitimate to rebel against them as the charter of the pupils' rights, posted up in the school, has been read through very quickly by the teenagers. This mechanism takes one back to the archaically perception of environment by the very young child and to the projection developed by S. Freud in his description of the building "Ego-pure pleasure", (moi-plaisir purifie) (The Ego and the id, 1920). The opposed mechanism is expressed through an experience of shame felt by the subject when he is unable to satisfy, not the requests of his own impulses, but the social group's requirements. From the libidinal point of view, advertisements stimulate one's desires, incite one to consume and are at the origin of consumer needs. As a consequence, there is a resonance between the individual pleasure principle and the promotion of hedonism suggested by the society. The modern children have their mastery of impulse motions hampered by this phenomenon. The temporality of , new children " in new families sounds centered on the present, which is made of moments of eternity, always restarted (cyclic time of the first ages of life) ; it overrides historical time with a start, an end and references to intergeneration difference and filiations. This prevalence of present offers few support to neurotic defenses, with predictable problems in social interactions due to an inability to manage the tensions issued from the time discrepancies between one and his alter ego. Tran cultural studies have shown that to any social and cultural organization corresponds one or several basic personalities; among them, modem society has exuded the standard neurotic personality characterized by an ample mental space, a strict modulation of behaviors governed by the representations play and spreading out in Le théâtre du Je (The I theatre, Mac Dougall, 1982), a conflict between desire and internalized taboo, and the problematic of transgression and guilt. The modern family produces different personality structures. This led us to assume new basic personalities as follows, and to envision some psychopathological consequences: The passive dependent personality with an extreme narcissist fragility and at high risks of depressive disorders; The perverse-anarchistic personality characterized by subjects unable to feel guilty, taking at the best advantage of others to achieve his own ends thanks to his grasping of social situations and to his own seduction, lacking of true empathy; The slightly-psychopathic personality: these subjects can integrate well, but for a short time, in a social structure. They need to frequently find a new job, move in another place or country. Their relationships with others are always disrupted and changing for they can be involved in only short commitments. They are very susceptible to immediate gratifications.

Adult↗

PubMed1997

Paleobiology of the Mesoproterozoic-Neoproterozoic transition: the Sukhaya Tunguska Formation, Turukhansk Uplift, Siberia.

Silicified carbonates of the latest Mesoproterozoic Sukhaya Tunguska Formation, northwestern Siberia, contain abundant and diverse permineralized microfossils. Peritidal environments are dominated by microbial mats built by filamentous cyanobacteria comparable to modern species of Lyngbya and Phormidium. In subtidal to lower intertidal settings, mat-dwelling microbenthos and possible coastal microplankton are abundant. In contrast, densely woven mat populations with few associated taxa characterize more restricted parts of tidal flats; the preservation of vertically oriented sheath bundles and primary fenestrae indicates that in these mats carbonate cementation was commonly penecontemporaneous with mat growth. Eoentophysalis mats are limited to restricted environments where microlaminated carbonate precipitates formed on or just beneath the sediment surface. Most microbenthic populations are cyanobacterial, although eukaryotic microfossils may occur among the simple spheroidal cells interpreted as coastal plankton. Protists are more securely represented by large (up to 320 micrometers in diameter) but poorly preserved acritarchs in basinal facies. The Sukhaya Tunguska assemblage contains 27 species in 18 genera. By virtue of their stratigraphic longevity and their close and predictable association with specific paleoenvironmental conditions, including substrates, Proterozoic cyanobacteria support a model of bacterial evolution in which populations adapt rapidly to novel environments and, thereafter, resist competitive replacement. The resulting evolutionary pattern is one of accumulation and stasis rather than the turnover and replacement characteristic of Phanerozoic plants and animals.

Biological Evolution↗

PubMed1991

Transformation into a healing healthcare environment: recovering the possibilities of psychiatric/mental health nursing.

The author describes the transformation of an inpatient psychiatric unit into a healing healthcare environment through the application of principles built upon the ARTWorks Paradigm (Acceptance, Responsibility, and Trust). Parallels are drawn among the transformation seen in clients, the growth evidenced in nurses working on the unit, and the changes reflected within the nursing profession as a whole. Paradigm themes and specific program components are shared to demonstrate applicability in a variety of settings.

Health Facility Environment↗

PubMed2002

Are evidenced-based practice and best practice the same?

In summarizing this discussion of the meaning of EvBP and best practice and their relationship to each other, there is merit in beginning with a delineation of six characteristics of quality care. These six characteristics synthesized by Brown (2001, p. 1) consist of care that is (a) patient centered, (b) scientifically based, (c) population outcomes based, (d) refined through quality improvement and benchmarking, (e) individualized to each patient, and (f) compatible with system policies and resources. These characteristics set the stage and reinforce critical aspects of the definition of both concepts: EvBP and best practice. For evidence to be meaningfully and successfully translated into practice by individuals, and groups of practitioners, the concept of best practice adds an organizational and ongoing quality monitoring to promote continual improvement. Best practice is not a specific practice per se but rather a level of agreement about research-based knowledge and an integrative process of embedding this knowledge into the organization and delivery of health care. The question "Are EvBP and best practice the same?" has guided this discussion, which has focused on how these concepts are related to each other but not the same. Best practice requires a level of agreement about evidence to be integrated into practice. The challenge now is to answer this question: "How can practice be built based on evidence and an environment supportive of this kind of practice?" The struggle needing to be faced is how to devise strategies to operationalize best practice. A beginning identification of the multiple questions and issues in doing so are outlined by Harrison, Logan, Lynn, and Graham (1998), and Newman and Papadopoulos (2000). Plus, Mulhall (1998) poses the challenging question of how is nursing best placed to maximize the benefits that some kind of evidenced-based care can bring? Research is needed into the situations under which evidence can be adopted into practice--and into the consequences of doing so. Best practice, built on a foundation of EvBP, can bridge the practice-research gap and provide a basis for researchers and clinicians to work together to translate research into meaningful practice. Understanding the concept of EvBP and joining together to devise best practice for health care organizations can promote achieving the goal of desired patient outcomes.

Benchmarking↗

PubMed2002

Psychosocial aspects of Costa Rican adolescents' eating and physical activity patterns.

PURPOSE: To determine the importance of some psychosocial aspects on the eating and physical activity patterns of Costa Rican adolescents. METHODS: A total of 1200 adolescents were included in the study. Data were collected using a self-administered instrument containing the following elements: questions to elicit demographic information and five sections with several items (stated as positive or negative behaviors) to study the influence of peers, parents, social environment, body image, and self-efficacy on five target behaviors, intake of foods rich in saturated fats, calcium, and iron, along with consumption of fruits and vegetables and physical activity practices. Data were analyzed using a factor analysis with main component extraction and varimax rotation, along with multiple regression analyses. RESULTS: Social environment and peer influence were the major factors that predict behaviors associated with the intake of foods rich in saturated fat. Meanwhile, parental and social environment influences were the main factors in explaining the fruit and vegetable intake-related behaviors. Self-efficacy was a significant predictor of behaviors associated with physical activity. Body image influence was an important variable associated with all the behaviors analyzed. Multiple regression analyses suggest that the fathers' educational level, the adolescents' age, being female, and living in a rural area may have positive influence on the behaviors studied; however, the overall R(2) for all regression models was quite small (<.03). CONCLUSIONS: Most of the variability in adolescents' food intake and physical activity-related behaviors remained unexplained by the demographic variables included in the study. Nevertheless, the results suggest that promotion of health programs built on the influence of social environment, peers and family members, and self-efficacy may have a positive impact on the adolescents' food and physical activity patterns. However, the clear definition of which psychosocial aspect(s) strongly influence the behavior to be modified, is essential for designing an intervention that is properly directed at the correct target.

Adolescent↗

PubMed2005

eLearning techniques supporting problem based learning in clinical simulation.

UNLABELLED: This paper details the results of the first phase of a project using eLearning to support students' learning within a simulated environment. The locus was a purpose built clinical simulation laboratory (CSL) where the School's philosophy of problem based learning (PBL) was challenged through lecturers using traditional teaching methods. THE SOLUTION: a student-centred, problem based approach to the acquisition of clinical skills that used high quality learning objects embedded within web pages, substituting for lecturers providing instruction and demonstration. This encouraged student nurses to explore, analyse and make decisions within the safety of a clinical simulation. Learning was facilitated through network communications and reflection on video performances of self and others. Evaluations were positive, students demonstrating increased satisfaction with PBL, improved performance in exams, and increased self-efficacy in the performance of nursing activities. These results indicate that eLearning techniques can help students acquire clinical skills in the safety of a simulated environment within the context of a problem based learning curriculum.

Clinical Competence↗

PubMed1979

Comparison of AMP deaminase from skeletal muscle of acidotic and normal rats.

The deamination of AMP by AMP aminohydrolase (EC 3.5.4.6.) serves as the major source of ammonia production in skeletal muscle. It has been suggested that the ammonia may serve either in a buffering capacity to combat acidosis due to the accumulation of lactic acid produced during prolonged muscular activity, or as a substrate for glutamine formation which can ultimately be utilized by the kidney in adapting to metabolic acidosis. In view of this proposal, the properties of the enzyme obtained from skeletal muscle of acidotic rats have been compared with the enzyme from normal muscle. The specific activity of AMP deaminase in crude homogenates of acidotic muscle was not significantly different from normal levels. The enzyme from acidotic muscle was purified to homogeneity and was found to be identical to the enzyme obtained from normal muscle by the criteria of electrophoretic mobility, pH optimum, molecular weight, sedimentation coefficient, subunit composition, amino acid composition, monovalent cation requirement, substrate saturation, and inhibition by ATP, Pi and creatine-P. Thus, if the enzyme functions to prevent acidosis, the ability to respond to changes in the intracellular environment which accompany acidosis must be built into the structure of the enzyme normally found in skeletal muscle. Three lines of evidence strongly support this viewpoint: (a) the rate of deamination is approximately 2-fold higher at pH 6.5 than at pH 7.0, (b) the activity increases linearly with a decrease in the adenylate energy charge, and (c) within the normal physiological range of the adenylate energy charge, the enzyme is operating at only 10--20% of its maximum capacity.

AMP Deaminase↗

PubMed1998

Data base management in interventional electrophysiology--the relational advantage.

UNLABELLED: A relational database was designed to facilitate patient management and storage of complex electrophysiologic data of patients undergoing radiofrequency catheter ablation. The database has to deal with multiple data entries per patient record like radiofrequency current applications and catheters. BACKGROUND: Due to the complexity of catheter mapping and ablation therapy, the investigators have to handle various data types. Contradictory to a flat-file database, a relational structured database is not limited to a "single record structure". IMPLEMENTATION: The designed database is built on the relational database programming environment 4th Dimension (ACI). It is implemented on an Apple Macintosh computer system. The relational structure consists of 13 data files and enables an unlimited data entry of multiple items per data field: In 1288 patients 10308 radiofrequency current applications were applied for ablation therapy and 4798 diagnostic or therapeutic catheters were used.

Arrhythmias, Cardiac↗

PubMed2001

Principles of computer-assisted arthroscopy of the temporomandibular joint with optoelectronic tracking technology.

PURPOSE: This preliminary clinical study evaluated the applicability, accuracy, and benefits of computer-assisted arthroscopy of the temporomandibular joint (TMJ) with optoelectronic tracking technology. MATERIALS AND METHODS: A hybrid of reality and virtual reality is built as a composite-reality environment by extracting 3-dimensional anatomical structures through use of computed tomography, magnetic resonance imaging, radiography, and other types of imaging procedures commonly used in clinical praxis. These various independent sources of imaging data of a particular patient can be combined with and complemented by complex graphic simulations. Intraoperatively they are merged with online position data of surgical instruments inside the patient's TMJ. This hybrid model of detailed anatomical structures, guidelines, and real-time instrument positions allows the surgeon to accurately plan the arthroscopic intervention as well as to navigate effectively intraoperatively. RESULTS: In the first 10 cases of computer-assisted TMJ arthroscopy, composite reality environment technology permitted the online visualization of TMJ structures, puncture sites, instrument positions, and virtual pathways in relation to anatomical landmarks with high spatial accuracy (minimum, 0.0 mm; maximum, 2.5 mm; mean, 1.4 mm; SD, 0.6 mm) and high temporal resolution (100 ms). Past, present, and possible future instrument positions can be displayed. The application of computer-assisted arthroscopy caused little immobility for either surgeon or patient. CONCLUSION: Even experienced surgeons profit from improved precision in the handling of the arthroscope; thus this technology was found to be particularly useful in degenerative temporomandibular disorders and for triangulation procedures.

Arthroscopes↗

PubMed1989

A new scale for the assessment of functional status in Alzheimer's disease and related disorders.

Assessment of the functional competencies of patients with dementia is typically conducted in an indirect manner. Psychological tests of cognition or descriptions by relatives or other caregivers are often used to make judgments as to the patient's ability to adapt to the demands of the environment. However, these methods have built-in biases. The need for direct assessment of functional status was addressed by developing a standardized operational procedure to examine areas of functional competence which may become impaired in Alzheimer's disease and other related memory disorders. The resulting instrument has high interrater and test-retest reliabilities. Convergent validity is evidenced by significant correlations between the scale and established measures of functional status. Patients with Alzheimer's disease exhibited deficits in functional capacities relative to age-equivalent normal controls and to elderly patients with a primary major depression.

Activities of Daily Living↗

PubMed2004

SeqVISTA: a new module of integrated computational tools for studying transcriptional regulation.

Transcriptional regulation is one of the most basic regulatory mechanisms in the cell. The accumulation of multiple metazoan genome sequences and the advent of high-throughput experimental techniques have motivated the development of a large number of bioinformatics methods for the detection of regulatory motifs. The regulatory process is extremely complex and individual computational algorithms typically have very limited success in genome-scale studies. Here, we argue the importance of integrating multiple computational algorithms and present an infrastructure that integrates eight web services covering key areas of transcriptional regulation. We have adopted the client-side integration technology and built a consistent input and output environment with a versatile visualization tool named SeqVISTA. The infrastructure will allow for easy integration of gene regulation analysis software that is scattered over the Internet. It will also enable bench biologists to perform an arsenal of analysis using cutting-edge methods in a familiar environment and bioinformatics researchers to focus on developing new algorithms without the need to invest substantial effort on complex pre- or post-processors. SeqVISTA is freely available to academic users and can be launched online at http://zlab.bu.edu/SeqVISTA/web.jnlp, provided that Java Web Start has been installed. In addition, a stand-alone version of the program can be downloaded and run locally. It can be obtained at http://zlab.bu.edu/SeqVISTA.

Algorithms↗

PubMed2005

Consumer perspectives in adolescent ward design.

AIMS: The aim of the study was to gain an understanding of the environment and facilities that adolescents require in a purpose-built adolescent ward. BACKGROUND: People who are hospitalized have limited control over their care and environment. The experience of hospitalization is also considered a highly stressful event. It is essential that patients have an opportunity to participate in the planning and design of ward environments in order to reduce their stress and better accommodate their treatment needs. METHODS: An interpretative qualitative design was used. Seven chronically ill adolescents were asked to design their own ward in order to obtain consumer input about what the perceived necessary facilities for adolescent wards. FINDINGS: The adolescents provided clear information about the facilities that should be incorporated into an adolescent ward to maintain their privacy and independence. Further research needs to be conducted seeking consumer input, especially if it can enhance the stay of adolescent patients while they are hospitalized. RELEVANCE TO CLINICAL PRACTICE: Adolescent voice is more often than not represented by nurses, or other healthcare professionals in the patients' best interest. This practice acts on the assumption that the adult knows best and/or that adolescents are unable to articulate their own needs. Adolescent consumers contribute worthwhile recommendations to how a ward is run providing insight about their needs in the ward environment.

Adolescent↗

PubMed1987

Development of tests to evaluate candidate elastomers for artificial heart diaphragms.

Blood pump diaphragms are required to be biocompatible and must be capable of long-term flexing without failure. There are currently only a few elastomers that are competing for acceptance in this application. Introduction of other candidate elastomers (including modifications to currently used materials) for these applications is hindered by a lack of accepted short-term in vitro testing methodology to evaluate alternate materials. Accelerated fatigue testing methodology has been developed that will predict long-term in vivo performance of candidate materials for artificial heart diaphragms. A 100-position fatigue testing machine was designed and built for operation in a controlled environment. This machine, along with a previously constructed 30-position fatigue tester, has allowed the generation of fatigue data on 13 elastomeric materials under a wide variety of conditions. The results of the relatively short-term fatigue tests have been shown to correlate well with longer-term fatigue tests.

Biocompatible Materials↗