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PubMed2004

Laparoscopic surgical management of perforative peritonitis in enteric fever: a preliminary study.

Early surgery in enteric perforation is the only accepted form of treatment in modem day medicine and gives excellent results. Exploratory laparotomy continues to be the mainstay of surgical treatment and several different procedures are recommended in literature. Between January 1998 and November 2001, we have successfully managed 6 consecutive cases of enteric perforation laparoscopically with complete resolution of the disease. There were 4 males and 2 females in our study. The mean time of presentation to us was 38 hours after the perforation (range 22 hours to 63 hours). The mean age was 32 years (range 28 years to 43 years). All patients presented with free air under the diaphragm. A laparoscopic approach was carried out through a 10 mm supraumbilical port and two 5 mm additional ports in the midline infraumbilical area and the left iliac fossa area. Simple one layer closure of the perforation was carried out with 2-0 silk intracorporeally and the peritoneal cavity was washed out and adequately drained. All perforations were localised to the terminal ileum and were single in number. The mean operating time was 54 minutes-(range 42 to 75 minutes). All patients received parenteral ofloxacin and metrogyl. Postoperative recovery was uneventful in all patients and there were no major complications. All patients were discharged from hospital by the 4th postoperative day. Follow up over a period of 12 to 16 months revealed all patients to be in normal health. We strongly recommend a first line laparoscopic approach in all patients with typhoid perforation; as it is a safe and effective method of managing such cases.

Adult↗

PubMed2005

Neoadjuvant therapy: an emerging concept in oncology.

Neoadjuvant therapy, an adjunctive therapy given before the main therapy, has become an integral part of modem multidisciplinary cancer management. Organized by the primary organ involved by cancer, this review summarizes the outcomes of neoadjuvant therapy for common malignant solid tumors, based on large, randomized, controlled trials. In locally advanced rectal, laryngeal, and breast cancer, neoadjuvant therapy enables organ preservation; however, it does not improve overall survival when compared with definitive treatment followed by adjuvant therapy. In locally advanced bladder and cervical cancer, patients who undergo neoadjuvant therapy before radical surgery appear to have better survival than those receiving definitive therapy alone; however, it is unclear if the neoadjuvant approach will be superior to definitive therapy followed by adjuvant therapy. To date, the survival benefits of neoadjuvant therapy for resectable non-small cell lung, esophageal, gastric, and prostate cancer remains under investigation.

Female↗

PubMed2006

Social consequence of disease in the American South, 1900-World War II.

The early 20th century Southerner lived in a disease environment created by a confluence of poverty, climate and the legacy of slavery. A deadly trio of pellagra, hookworm and malaria enervated the poor Southerner--man, woman and child--creating a dull, weakened people ill equipped to prosper in the modem world. The Northern perceptions of the South as a backward and sickly region were only compounded by the realization that her population was malnourished, infected by worms, and continually plagued by agues and fevers. As historian John Duffy concluded, "As a chronically debilitating disease, it [malaria] shared with the other two the responsibility for the term 'lazy Southerner".

History, 20th Century↗

PubMed1995

A video-based system for acquiring biomechanical data synchronized with arbitrary events and activities.

A video-based data acquisition and interactive multimedia data extraction system are described for measuring and synchronizing large quantities of biomechanical analog data with arbitrary events and activities. Analog signals from up to 32 channels are digitized, frequency-shift key (FSK) coded, and recorded directly onto the audio tracks of a video tape in synchronization with the video information. The data acquisition system includes an A/D converter that digitizes up to 16 multiplexed channels of 8-b data at a fixed sample rate between 60 and 960 Hz, and an FSK modem that transfers the data onto one of two VHS high fidelity (20 Hz-20 kHz bandwidth) audio tracks. Twenty megabytes of digitized data and time codes, along with associated video and normal audio are contained on a conventional 120-min video tape. An analyst interactively reviews the video tape off-line using a computer-controlled VCR and identifies specific events that divide arbitrary activities into time segments. The computer automatically extracts the biomechanical data corresponding to each time segment for further processing or analysis. This system is useful for ergonomics, gait analysis, sports medicine, sleep laboratory, biomechanics, or any application where complex visual events are synchronized with low-frequency analog data.

Analog-Digital Conversion↗

PubMed2001

Rapid prototyping of an EEG-based brain-computer interface (BCI).

The electroencephalogram (EEG) is modified by motor imagery and can be used by patients with severe motor impairments (e.g., late stage of amyotrophic lateral sclerosis) to communicate with their environment. Such a direct connection between the brain and the computer is known as an EEG-based brain-computer interface (BCI). This paper describes a new type of BCI system that uses rapid prototyping to enable a fast transition of various types of parameter estimation and classification algorithms to real-time implementation and testing. Rapid prototyping is possible by using Matlab, Simulink, and the Real-Time Workshop. It is shown how to automate real-time experiments and perform the interplay between on-line experiments and offline analysis. The system is able to process multiple EEG channels on-line and operates under Windows 95 in real-time on a standard PC without an additional digital signal processor (DSP) board. The BCI can be controlled over the Internet, LAN or modem. This BCI was tested on 3 subjects whose task it was to imagine either left or right hand movement. A classification accuracy between 70% and 95% could be achieved with two EEG channels after some sessions with feedback using an adaptive autoregressive (AAR) model and linear discriminant analysis (LDA).

Adolescent↗

PubMed1995

A quality study of a computerized medical birth registry.

Processed by a computerized medical birth registry system, the birth records of 20,103 deliveries, from February 1992 to February 1993, were digitized with medium registry. From January 1, to February 28, 1993, the original records (n = 2,840 cases) of all 10 collaborative hospitals were requested for assessment of the data quality. Thirty-six items were scored, data of poor quality was found in 8 items; acceptable quality in 4 items; and good quality in 28 items. The feasibility of data transfer by floppy disc and per modem was evaluated. This registry system had shortened data processing time effectively and improved mutual feedback between data center and delivery units. Errors resulting from technical faults originating in preparation of the data for computerizing at hospital level could be effectively reduced. The validity of diagnosis remained as the major source of errors.

Birth Certificates↗

PubMed1989

Data source automation: new technology for the management of patient-generated test results.

Self-monitoring of blood glucose is widely accepted by patients today, but its usefulness to clinicians has been seriously limited by our inability to interpret the patient-generated data. It is difficult or impossible to make optimal use of hand-kept diaries, no matter how compulsively kept. Patterns elude us, summaries are inaccurate, and large blocks of data are almost entirely ignored. To remedy these problems, data source automation--the automatic recording of data at their site of origin--is being applied to diabetes. Meters will measure blood glucose and memorize the result, date, and time of day. One system even allows the patient to record insulin dosage, exercise, and diet. The advantage of these systems lies in their potential for data management. Recognition of patterns of blood glucose concentration, easy longitudinal comparison of data, and aggregation of large data bases are all facilitated by computerized manipulation of the stored data. In-hospital use of glucose meters can have better documented quality control. It is possible to communicate data to physicians by telephone modem. Effective use of these systems, though, requires convenient software; and their acceptance in actual clinical practice must be demonstrated. But data management capabilities, as they are refined and brought into common use, could significantly improve diabetic management.

Autoanalysis↗

PubMed2002

Risk and protective factors for depressive symptomatology among a community sample of adolescents and young adults.

OBJECTIVES: The study explores the risk and protective factors for current depressive symptomatology in a large community sample of 15-to-24-year-olds. METHODS: The study was designed as a cross-sectional household survey, which used telephone recruitment followed by an anonymous self-report postal questionnaire. The final sample included 3,082 adolescents and young adults from Queensland, Australia. RESULTS: The vast majority of measured risk and protective factors were associated with current depressive symptomatology. Key risk factors included high levels of neuroticism, perceived problems with parents, sexual abuse, relationship break-ups, educational failure and sexual identity conflict. A different profile of protective factors was evident for each of these high-risk groups. Of particular note was the importance of well-developed intrapersonal skills as protective for both males and females. The significance of social connectedness as a protective factor for the males overall and across a range of high-risk groups was a central finding. CONCLUSIONS AND IMPLICATIONS: The implications of these findings in relation to a range of mental health promotion and mental illness prevention and early intervention initiatives are discussed. Supported initiatives include parenting programs that consider the realities of modem families, increasing community awareness of the impact on young people of the breakdown of their intimate relationships, initiatives in educational settings and workplaces to increase tolerance of gay/lesbian and bisexual lifestyles and the enhancement of social connectedness.

Adolescent↗

PubMed1993

Remote control software.

Any of these remote control packages will accomplish the task of controlling another PC from a distant machine. Since all of the programs are easy to use, perform the same functions, and provide excellent security, there is no one clear winner. If your aim is to control Windows programs remotely, then Carbon Copy for Windows is the fastest software. It falls short in running DOS based programs and has greater hardware requirements because it is a Windows application. Norton pcAnywhere is a reliable program that rivals Carbon Copy for Windows' speed, even when controlling a Windows program remotely. Its support for DOS is better. Close-Up is the easiest to install, will run DOS programs without problem, and can run Windows programs as well. Under Windows, DOS programs can be executed in a window or as a full screen application. However, its speed ratings when working in Windows have been among the slowest. Carbon Copy for the Mac brings most of the features of the Windows version of this program to the Macintosh environment. The software allows users to control remote Macintosh computers, and to perform file transfers in the background. It does not permit a PC to control a Mac or a Mac to control a PC. List prices for these programs are $179 to $199 for packages with host and remote software, but street prices range from approximately $100 to $120. A 9600 baud modem with data compression (yielding a net speed of about 14,400 bits/sec) and error correction costs approximately $200 to $300.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Systems↗

PubMed1999

Computers and connectivity in Illinois emergency departments.

UNLABELLED: Although the Internet has been described as "ubiquitous," little is known about the extent to which physicians have access to the Internet while providing clinical care. OBJECTIVE: To assess the extent of Internet connectivity within the clinical area of every ED within the state of Illinois. METHODS: This was a prospective observational study. Each Illinois ED listed in a published directory was called by telephone, and a responsible party was identified to provide information regarding the type and size of the ED, patient demographics, the types of personal computers (PCs) available in the ED (if any), the types of operating systems used, the availability of access to the World Wide Web (Web), and the highest speed at which an Internet connection could be established. Responses regarding the presence and types of PCs and the types of operating systems used were assessed using one-factor chi-square. Univariate and multivariate predictors of the type of PC used, the presence or absence of Web access, and the highest speed of Internet access were evaluated using optimal discriminant analysis and nonlinear classification tree analysis, respectively. RESULTS: One hundred ninety-eight of the 199 EDs in the state of Illinois (99.5%) completed the survey. Of the responding EDs, 50.5% had PCs, but only 17.6% had Web access. When Web access was available, it was most often available through a high-speed Internet connection that was faster than a dial-up modem. Most departments (68.1%) with PCs used the Windows 95 or Windows 98 operating systems. A majority (62.5%) used the Netscape browser exclusively. Larger EDs (more than six ED beds) in rural or suburban areas were more likely to have a PC compared with smaller EDs (six or fewer beds). Large EDs (more than 12 ED beds) in private tertiary care or academic hospitals were most likely to have Web access. CONCLUSIONS: Although half of Illinois EDs have PCs, only one in six has access to the Internet; thus, most emergency physicians do not have ready access to the Web from the site where they deliver clinical care.

Analysis of Variance↗

PubMed2005

Tackling childhood obesity: diet, physical activity or lifestyle change?

UNLABELLED: The present day, almost worldwide, fattening of children is widely attributed to both excessive energy intake and reduced physical activity. However, treatments which only focus on reducing energy intakes and increasing energy expenditures rarely show long-term success. The family attitudes and environments which contribute to energy imbalance and the development of obesity are virtually unchanged by many treatment programmes. We need to learn more about the nurture of those children who retain normal fatness although enveloped by obesity-promoting environments. CONCLUSION: Better understanding of these children's lifestyles could lead to significant community-directed initiatives to promote normal childhood nutrition and growth even within affluent modem society.

Child↗

PubMed1998

Primary health care needs for travel medicine training in Britain.

BACKGROUND: In the UK, travel health advice is mainly provided by practice nurses and general practitioners (GPs). The need for their improved education in travel medicine has been highlighted through previous studies and by an increasing number of requests for training. METHODS: A questionnaire-based survey of 3900 GP practices was conducted to assess training requirements and to establish the demand for an academic course in travel medicine. 1430 (37%) questionnaires were completed. RESULTS: 93% of practices provided a pretravel advice service. 87% of GPs advised an average of 10 travelers per month and only 48% immunized travelers. 98% of nurses advised and immunized an average of 28 travelers a month. 21% of GPs and two-thirds of nurses had attended one or more training sessions in travel medicine. Over 90% of the sample (83% of GPs and 98% of nurses) expressed an interest in attending a formal training program in travel medicine. Eligibility for Post Graduate Education Awards (PGEA) was important for most GPs (88%). Nurses valued approval by the English National Board for Nursing (88%) and a system of Credit Accumulation & Transfer (CATS) (82%). Funding for a course would be met in full by 18% of respondents (mainly GPs) and a further 20% would contribute to fees. Most GPs and nurses have ready access to a range of information sources, e.g., a postgraduate medical centre (85%) and a medical library (91%). Computerized access to information was feasible as 93% had a computer and 54% had a modem attached. CONCLUSIONS: The discipline of travel medicine is becoming increasingly specialized. Future practitioners will need to enhance their skills to meet the demands of today's travelers. Our results show that general practice staff are keen to develop such skills. Specialist training courses need to be expanded to meet this demand.

Communicable Disease Control↗

PubMedDate not supplied

A spreadsheet method of estimating best-fit hydraulic gradients using head data from multiple wells.

Hydraulic gradients from planar water tables, or piezometric surfaces, and horizontal flow regimes can be quickly and conveniently calculated from data sets involving numerous wells. The matrix-solving functions of a modem spreadsheet program (Excel) were used to determine the equation of a water-table plane, Ax + By + Cz - D = 0, and the equation coefficients were then used to determine the magnitude of the hydraulic gradient, according to gradient = square root of A2 + B2/C2, and its direction, according to alpha = arctan B/A, where alpha is the angle measured from the x-axis. A pre-prepared Excel file constructed to handle data from up to 20 wells at once is available for free downloading at www.geo.ku.edu/hydro/KUHydro.html.

Forecasting↗

PubMed1992

An overview of networking for physicians and problems of network consulting in remote areas.

For computer networking the most suitable operating systems are UNIX or MS-DOS. As networking software UUCP and TCP/IP are most common. Hardware requirements are derived from the operating system and from the networking software. Low-cost solutions, for example, uuPC, a public domain version of UUCP, require only an 8088 processor and a 2400-baud modem. TCP/IP fares better with more powerful processors and requires permanent lines between the connecting computers. In developing countries the introduction of computer networks is hampered by several factors: lack of foreign exchange, price of hardware and software, unreliable electricity and telephone lines, lack of hardware and software support, large distances to the nearest center, and incompatibilities between existing systems and the network. Important aspects for clinical networking in developing countries include appointment scheduling in the referral hospitals, access to laboratory and pathology results from the central laboratory, and primary health care information such as epidemiologic data. Advanced systems, for example, for image processing, are not yet feasible in developing countries.

Computer Communication Networks↗

PubMed1992

Improved care of patients with diabetes through telecommunications.

This project tested the importance of enhanced information transfer of home monitoring results to health care providers. The study tested whether computer-assisted communication of medical information between the chronic care patient and the physician can result in health care benefit. The information tools were constructed/adapted as a test of this hypothesis for diabetes mellitus. Patients connected a glucometer to an intelligent modem weekly for six to nine months. Graphical and mathematical tools extracted and emphasized the information content of the home monitoring data arriving at the central site. Data smoothing, trend analysis, and calculation of quality control statistics were incorporated into a graphical time series oriented report that was used by the health care provider during an outpatient visit. The integrated home monitoring system was tested on 20 patients with diabetes in a double cross-over design over a 15-month period. A significant improvement in serum glucose control as measured by glycated hemoglobin was shown in the study group, but not in the control group.

Algorithms↗

PubMedDate not supplied

Geriatric dentistry on the Internet: can we reach our elderly patients using cyberspace?

A growing number of older Americans use a computer at home, and half of seniors who own computers also own modems that can connect them to online services; 25% of seniors with computers communicate with online services. Over 70% of online seniors use their computers every day. The dental office can interactively communicate one-on-one with current and prospective patients using an electronic mail newsletter, a Web page newsletter, an "Ask the Dentist" online service, or by making dental appointments online. Dental practitioners can take advantage of this online revolution and promote oral health for seniors using these technologies.

Aged↗

PubMed2003

Inductively coupled rf coils for examinations of small animals and objects in standard whole-body MR scanners.

Inductively coupled solenoid coils fitting to objects in the size of mice or rats were developed to adapt modem whole-body MR scanners featuring sufficient gradient strength for animal examinations with high spatial resolution. Homogenous receiver characteristics is achievable over almost the whole inner region of the solenoid coils. The SNR can be increased by a factor 2 to 6 with the adapting coils for examinations using the head coil as connected receiver. Standard sequences on clinical 1.5 T scanners can be applied with adapted transmitter voltages. For example, a SNR value of about 30 is achievable in a mouse liver after 10 minutes measuring time using a 2-D spin echo imaging sequence and a size of 0.3 x 0.3 x 0.8 mm3 for the picture elements.

Animals↗

PubMed2003

A state feedback electro-acoustic transducer for active control of acoustic impedance.

In this paper, a new control system in which the acoustic impedance of an electro-acoustic transducer diaphragm can be actively varied by modifying design parameters is presented and its effectiveness is theoretically investigated. The proposed control system is based on a state-space description of the control system derived from an electrical equivalent circuit of an electro-acoustic transducer to which a differentiating circuit is connected, and is designed using modem control theory. The optimal quadratic regulator is used in the control system design, with its quadratic performance index formulated for producing desired acoustic impedance. Computer simulations indicate that the acoustic impedance of the diaphragm can be significantly varied over a wide frequency range that includes the range below the resonance frequency of the electro-acoustic transducer. A computer model of the proposed control system is used to illustrate its application to semi-active noise control in a duct. It is demonstrated that the proposed control system provides substantial reductions in the noise radiating from the outlet of the duct, both in the stiffness control range and in the mass control range.

Journal Article↗