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PubMed1993

[Epidemiology of HIV infection].

HIV-infected people are infectious during the 10-20 years' incubation time as well as while suffering from AIDS. The disaster of this lentivirus epidemic is that there is a long time interval between source (virus inoculation) and result (manifestation of AIDS). The registered AIDS cases represent only the tip of a mountain. By now, more than half of a million AIDS cases are reported to the WHO, but the real number is assumed to be double. In Europe about 80,000 AIDS patients are registered. In most of the industrialized countries where now a certain stagnation among the typical risk groups of homosexuals and drug addicts is visible, now one can see a slow, steady increase among the heterosexual population. In Europe at this time 18% of the newly diagnosed AIDS cases are women. The number of HIV-infected persons reflects the number of AIDS patients to be expected for the next years. In Germany 1 per thousand of the population are infected (55,000-90,000 persons), in Switzerland 2-4 per thousand (20,000-30,000 persons). Worldwide 12-13 millions of people are estimated to be HIV-infected, and projections for the year 2000 expect 38-110 millions. More than 50% of AIDS patients have ocular manifestations.

AIDS-Related Opportunistic Infections↗

PubMed1999

Heart Center nursing research: a team effort. Heart Center Nursing Research Work Group Members.

Our Heart Center staff identified a need to become more involved in nursing research and evidence based practice. A lack of awareness of the research process and current Heart Center nursing research studies resulted in low patient enrollment. To overcome these challenges a Heart Center Nursing Research Work Group (HCNRWG) was created with support of management. Staff nurses from each unit within the Heart Center participated, and sessions were facilitated by an Assistant Nurse Manager and Clinical Nurse Specialist. Advanced Practice Nurses functioned as consultants. The goal was to support nurses in developing a greater understanding of research and promote nursing research and visibility. Results included the development of research notebooks, inclusive of medical, nursing, and collaborative research projects, "Ask Me About Nursing Research" buttons, and mechanisms for study enrollment for each unit. Writing workshops were held to assist nurses with the preparation of abstracts, manuscripts, and research. A "hot line" was established to answer questions and informational packets and newsletters were distributed to staff and leadership quarterly. An increased awareness of research among the health care team has ensued. Meeting attendance has tripled, more nursing abstracts have been submitted to national conferences and there are ongoing research studies on all heart center units with increased patient enrollment.

Diffusion of Innovation↗

PubMedDate not supplied

Pain management: improving documentation of assessment and intensity.

As a result of standards published by the Joint Commission on Accreditation of Healthcare Organizations, there is new emphasis in the area of pain management. This pilot study was conducted to assess the visibility of pain management through documentation; the effect of implementing new tools (forms) was measured to determine whether they improve documentation of pain management assessment and intensity. A retrospective chart review was conducted to determine presence of this documentation. This study found that it is possible to improve the quality of information related to pain assessment through the development of explicit documentation tools.

Adolescent↗

PubMed2001

The twilight envelope: a user-centered approach to describing roadway illumination at night.

Visual recognition functions, such as acuity and contrast sensitivity, deteriorate rapidly over the declining luminances found during civil twilight. Thus civil twilight, a critical part of the transition between daylight and darkness, represents lighting conditions that may be useful to describe artificial illumination. Automotive headlamps project a three-dimensional beam that ranges from illumination levels comparable to daylight at the vehicle to the dark limit of civil twilight (3.3 1x) at some distance ahead. This twilight envelope is characterized as a distance beyond which foveal visual functions are severely impaired, and thus it provides a general, functional description of the useful extent of the headlamp beam. This user-centered approach to describing illumination is useful for characterizing visibility when driving at night or in other artificially lit environments. This paper discusses the twilight envelope approach and its application to intervehicle variations in headlamp systems. Actual or potential applications of this research include user-centered description of artificial illumination and driver/pedestrian safety education.

Accidents, Traffic↗

PubMed2006

A VR planning system for craniosynostosis surgery.

The goal of our project is to build a system which could utilize the Virtual Reality (VR) techniques for the pre-operative planning of craniosynostosis. The system includes different modules. We use the tetrahedral volume meshes for the basic structure for the models which surgery is planning on. This paper will describe the procedures of above stages, from the processing of 2D image slices, 3D modeling, smoothing, simplification, and visibility ordering, to volume meshes generation. We have demonstrated the initial results on a variety of stereo devices. The testing results show the processing time is acceptable and the rendering effect is pretty well.

Computer Simulation↗

PubMed1990

Critical evaluation of the radial head-capitellum view in acute elbow with an effusion.

The radial head-capitellum (RHC) view was performed in 125 patients following acute elbow trauma in which an elbow fat-pad effusion was visible on the standard antero-posterior and lateral projections. Seventy-four fractures were identified of which 63 (85%) involved the radial head. In only one case (1%) did the RHC view reveal a radial head fracture not seen on the standard two views. In eight cases (11%) the RHC view did not confirm a radial head fracture seen on the standard radiographs. Magnification blurring and the vertical orientation of the radial head fractures missed on the RHC view are responsible for this confusing situation. Routine use of the RHC view even in acute elbow trauma significant enough to produce an effusion is generally unhelpful and potentially misleading.

Acute Disease↗

PubMed2006

[Success and complication rate of CT-guided marking of pulmonary nodules with coil wires for video-assisted thoracoscopic surgery (VATS)].

PURPOSE: To assess the success and complication rate of the CT-guided marking of pulmonary nodules for video-assisted thoracoscopic surgery (VATS). MATERIALS AND METHODS: Pulmonary nodules (mean diameter 9 +/- 5 mm, mean pleural distance 7 +/- 5 mm) were marked with a coil wire in 30 patients (20 males, mean age 57.6 +/- 15.5 years, 22 patients with a history of malignancy). The intended coil-nodule distance was < or = 10 mm. RESULTS: 81 % of nodules were not visible by thoracoscopy. The technical success rate of CT-guided marking was 86.7 %. The projected nodule-coil distance was achieved in 90 % of cases. The procedure had to be changed from thoracoscopy to thoracotomy in 4 patients due to coil wire marking problems: 2 x coil displacement, 1 x coil-nodule distance > 10 mm, unfavorable direction of wire. Histology was determined in all patients (70 % malignant, 30 % benign). Complications requiring therapy were not observed. CONCLUSIONS: The CT-guided marking of pulmonary nodules is a precondition for VATS if the nodule does not involve the visceral pleura in the majority of cases. The success rate is high with a low complication rate.

Adult↗

PubMed2003

Human immunodeficiency virus type 1 pharmacogenomics in clinical practice: relevance of HIV-1 drug resistance testing (Part 2).

Throughout most of the past century, physicians could offer patients no treatments for infections caused by viruses. The experience with treatment of infection by human immunodeficiency virus (HIV) has changed the way healthcare workers deal with viral infections and has triggered a growing rate of discovery and use of antiviral agents, the first fruits of the expanding genomics revolution. HIV treatment also provides an informative paradigm for pharmacogenomics because control of infection and its consequences is limited by the development of viral drug resistance and by host factors. This report summarizes studies published to date on the significance of testing of HIV-1 resistance to antiretroviral drugs. The only Food and Drug Administration-approved kit is commercially available through Visible Genetics, Inc., for HIV drug resistance testing by genotypic sequencing. Genotyping sequencing alone is most likely an adequate test to assist in the therapeutic decision-making process in cases of previous regimen failure, treatment-naïve patients in areas of high prevalence of transmitted resistant virus, and pregnant women. However, in exceptional cases of highly complex mutation patterns and extensive cross-resistance, it may be useful to obtain a phenotype test, because that result may more easily identify drugs to which the virus is least resistant. There are no published clinical trial results on the usefulness of the so-called virtual phenotype over genotypic sequencing alone. The paradigm of viral pharmacogenomics in the form of HIV genotypic sequencing has been not only useful to the treatment of other viral diseases but also important to the real-life implementation of the growing discipline of genomics or molecular medicine. The application of this paradigm to the thousands of potential therapeutic targets that have become available through the various human genome projects will certainly gradually change the landscape of diagnosis and management of many diseases, including cancer.

Antiviral Agents↗

PubMed1998

Segmental pulmonary arteries: two-dimensional and three-dimensional time-of-flight magnetic resonance angiography.

The authors compared two-dimensional (2D) and three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography in ten healthy volunteers to establish which of two techniques is more effective in representing the pulmonary segmental arteries. No respiratory trigger or electrocardiogram gating was used. Presaturation pulses were used to eliminate venous flow. Images acquired in the sagittal planes were processed using maximum intensity projection. A total of 200 segmental arteries were evaluated with each technique by three observers (M.S., C.S., A.R.) in terms of vessel visibility. There was no significant difference among the observers' interpretations (p > 0.05). On average, 2D fast, low-angle shot breath-hold TOF sequences showed 136.1 of 200 (68%) segmental arteries, 74.1 of 100 in the right lung and 62 of 100 in the left lung. Three-dimensional fast imaging with steady state precession showed 171.6 of 200 (85.8%) segmental arteries, 94 of 100 in the left lung and 77.6 of 100 in the left lung. Three-dimensional imaging appeared to be better than 2D MRA for demonstration of segmental pulmonary arteries.

Adult↗

PubMed1987

Optimal preprocessing Butterworth-Wiener filter for Tl-201 myocardial SPECT.

The optimal frequency characteristic of Butterworth-Wiener filters (BWF) for improving the image quality of 201Tl myocardial SPECT was determined by a phantom experiment. Thirty two projection images of the phantom containing 11.1 MBq of 201Tl with 4 different cold lesions were collected during a 180 degree arc of a gamma camera. A set of the projection images were processed with each of 27 different BWFs, and SPECT images were reconstructed by Shepp-Logan filtered backprojection. The SPECT images were evaluated for their diagnostic ability to visibly detect the cold lesions by four nuclear medicine physicians. The lesion contrasts were used as an adjunctive tool to determine the optimum filter. The optimal combination of the parameters determining BWF characteristics (for the data of about 100 count/pixel at the myocardium) is: 1) cutoff of 0.25/pixel, 2) FWHM of 3 pixels, 3) noise/signal ratio of 0.02. FWHM and noise/signal ratio affected lesion contrast much less than cutoff frequency. Clinical myocardial SPECT images processed with the optimal BWF showed less noise and sharper delineation of the myocardium.

Filtration↗

PubMed2001

Allergic respiratory disease and fungal remediation in a building in a subtropical climate.

An outbreak of allergic respiratory disease occurred in a new building that was characterized from initial occupancy by the presence of extensive visible mold (especially Aspergillus versicolor) on interior surfaces. Epidemiological study of the occupants of both the affected building and a comparison neighboring structure indicated high rates of respiratory and other symptoms among persons working in the affected building. Subsequent clinical evaluations of some persons occupying the building for up to five years identified several cases of building-related allergic respiratory disease, including asthma and hypersensitivity pneumonitis. Based on these findings, the building was evacuated before remediation began. The mycological goal of the three-year building restoration project was to reduce concentration of non-phylloplane fungi such as A. versicolor to the lowest feasible level. All visibly colonized materials in the building were discarded and all fine dust on interior surfaces was removed by vacuuming and/or damp wiping. A medical surveillance program utilizing serial self-reported questionnaires and readily available clinical evaluations was designed to monitor the health of building occupants after re-entry. Symptom rates just prior to building reentry were substantially lower than those found before evacuation and have remained unchanged after re-occupancy was completed. No new or recrudescent cases of illness are known to have occurred after building re-entry.

Aspergillus↗

PubMed1992

MR imaging of lung parenchyma: a solution to susceptibility.

The authors have developed a pulse sequence for imaging lung parenchyma with projection reconstruction magnetic resonance (MR) imaging that reduces the effects of motion and susceptibility. In this study, the projection reconstruction technique was further modified by optimizing MR signal frequencies for reconstructing the images. This was done by means of one of two methods. With the first method, a susceptibility map was derived from the raw image data and this map was used to indicate the optimal frequencies for reconstructing the images. The second method of susceptibility correction was a postprocessing technique in which the optimal reconstruction frequencies were selected with use of specific focusing criteria to generate the least blurred image. The effect of using susceptibility map correction on a phantom was demonstrated, and both of these methods were used to improve the visibility of pulmonary structures on images of subjects with normal and abnormal lungs.

Humans↗

PubMed1996

CT imaging of radiopaque shunt catheter after endolymphatic duct surgery.

Until now, shunt catheters used in endolymphatic sac (ELS) and duct surgery have not been visible at computed tomography (CT) imaging. This report summarizes findings at postoperative CT in 50 patients who underwent endolymphatic system decompressive surgery with a new opaque shunt catheter placed at or into the endolymphatic duct (ELD). The catheter was visible in all 50 cases, and the best projection for visualization was the semicoronal view. The postoperative visualization of the opaque shunt catheter allows determination of the exact placement of the catheter (a) in the bony vestibular aqueduct (within the membranous ELD); (b) at the external aperture of the bony vestibular aqueduct (within or at the membranous ELD at its junction with the ELS); or (c) outside the bony vestibular aqueduct system or aperture but presumably within the membranous ELS. These objective findings may be used as a marker to help predict outcomes from this type of nondestructive inner ear surgery, as well as to determine exactly where the surgeon placed the shunt-tube catheter tip.

Endolymphatic Duct↗

PubMed1980

Flow cytometry in bladder cancer detection and evaluation using acridine orange metachromatic nucleic acid staining of irrigation cytology specimens.

A new technique for simultaneous multiparameter deoxyribonucleic acid, ribonucleic acid and nuclear size measurements by flow cytometry was applied to the examination of bladder irrigation cytology specimens from 107 urologic patients. The cell samples from patients with bladder carcinoma could be distinguished from normal by 2 features: 1) an increase in the proportion of bladder epithelial cells with more than diploid deoxyribonucleic acid and 2) aneuploid cell peaks. These criteria identified 12 of 13 cases of invasive carcinoma, 24 of 28 cases of carcinoma in situ and 11 of 13 cases of papillary carcinoma. An increased proportion of cells with more than diploid deoxyribonucleic acid or aneuploidy was found in 9 of 14 patients with papilloma and 6 of 19 patients with a history of bladder tumors but no evident disease at present--these were believed owing to increased epithelial proliferative rates or nuclear chromatin abnormalities not visible by light microscopy. None of the 20 patients who had never had bladder tumors was abnormal. While the results in this small clinical trial have been most encouraging an additional descriptor of nuclear chromatin structure is believed necessary to discriminate benign, reactive proliferative epithelium from neoplasm when the latter is near diploid or shedding few cells. Studies to develop such a parameter presently are under way.

Acridine Orange↗

PubMedDate not supplied

Total hip prosthesis metal-artifact suppression using iterative deblurring reconstruction.

PURPOSE: CT of total joint prostheses is limited by metal artifact produced mainly by missing projection data. Iterative deblurring reconstruction is less sensitive to missing projection data than filtered backprojection. A software CT simulator was used to compare total hip prosthesis images reconstructed using standard filtered backprojection, filtered backprojection after linear interpolation of missing data, and iterative deblurring. METHOD: Unilateral and bilateral total hip replacements with metal-backed or all-polyethylene acetabular prostheses were simulated using bone, metal, and polyethylene annuli and circles of metal and water (soft tissue). Material attenuation properties were taken from the literature. The simulation assumed that no X-rays penetrated the metal. Simulated projection data were reconstructed using filtered backprojection, filtered backprojection after linear interpolation of missing data, and iterative deblurring. Visual observations and objective region-of-interest analyses were made. RESULTS: Even with no X-rays penetrating the metal, iterative deblurring produced almost no visible artifact within the bone or soft tissues. Bone edge detection and sizing were more easily and accurately done from the iterative deblurring images. All reconstruction techniques underestimated bone and water CT attenuation values. Metal artifact was worse for the bilateral or metal-backed prostheses. CONCLUSION: Iterative deblurring generated nearly metal-artifact-free images in this simulation. Filtered backprojection, even after linear interpolation, produced typical clinical metal-artifact images.

Artifacts↗

PubMed1996

Social support as road map and vehicle: an analysis of data from focus group interviews with a group of African American women.

As part of a larger study of the impact of a social support intervention on pregnancy outcome for lower-income African American women, 6 African American women (a medical social worker, a physician's assistant, 2 community outreach workers, a lactation consultant, and a health project representative) participated in focus group discussions concerning the unique social support needs of lower-income African American women during pregnancy. Transcripts of focus group interviews were analyzed using qualitative content analysis. Emergent themes included strengths of African American communities, deficiencies in social support for many lower-income African American women, the meaning of pregnancy for African American women, the ability of many pregnant women to "make it" without visible means of support, young women's locations "inside" and "outside" of "mainstream" life, and the importance of social support as a mechanism for guiding and transporting "lost souls" back into the mainstream.

Black or African American↗

PubMed2002

[Dacryocystography and dacryoscintigraphy in diagnosis of naso-lacrimal duct obstruction].

PURPOSE: To find the right diagnostic test through checking the drainage of lacrimal ducts. MATERIAL AND METHODS: Dacryocystography of lacrimal ducts was performed in 25 patients by using 0.5-1 ml of Lipidiol and conducting X rays in different head positions--3-4 photograph in A-P projection (exposition's parameters 85-90 kV and 12-15 mAs, distance lamp-table: 100-130 cm, Philips Diagnose 93). For stereo estimation--2 oblique photographs of head, deviated at 45 towards central body line. Patient is brought on vertical position and after 5 minutes radiography in A--P projection can show remaining contrast in lacrimal duct. Dacroscintigraphy was done in 200 patients by dropping in conjunctival sac 1 drop of sterile 99mTc, in dose 3.7-7.4 MBq (100-200 uCi). The patients head is immobilized on the support, close to detection head of gamma camera (ediso Nucline TH) with LEHR. Distribution of this drug was visible on the monitor and saved in the computer's memory. Data was registered during 10 minutes, summed up into end picture and then evaluated by sight. RESULTS: Many authors consider dacryoscintigraphy and dacryocystography as methods of choice in establishing correct diagnosis. High sensitiveness and mutual completion of both methods lets us quickly explain the reasons of epiphora and settle further management.

Aged↗

PubMed1998

The U.S. federal framework for research on endocrine disruptors and an analysis of research programs supported during fiscal year 1996.

The potential health and ecological effects of endocrine disrupting chemicals has become a high visibility environmental issue. The 1990s have witnessed a growing concern, both on the part of the scientific community and the public, that environmental chemicals may be causing widespread effects in humans and in a variety of fish and wildlife species. This growing concern led the Committee on the Environment and Natural Resources (CENR) of the National Science and Technology Council to identify the endocrine disruptor issue as a major research initiative in early 1995 and subsequently establish an ad hoc Working Group on Endocrine Disruptors. The objectives of the working group are to 1) develop a planning framework for federal research related to human and ecological health effects of endocrine disrupting chemicals; 2) conduct an inventory of ongoing federal research programs; and 3) identify research gaps and develop a coordinated interagency plan to address priority research needs. This communication summarizes the activities of the federal government in defining a common framework for planning an endocrine disruptor research program and in assessing the status of the current effort. After developing the research framework and compiling an inventory of active research projects supported by the federal government in fiscal year 1996, the CENR working group evaluated the current federal effort by comparing the ongoing activities with the research needs identified in the framework. The analysis showed that the federal government supports considerable research on human health effects, ecological effects, and exposure assessment, with a predominance of activity occurring under human health effects. The analysis also indicates that studies on reproductive development and carcinogenesis are more prevalent than studies on neurotoxicity and immunotoxicity, that mammals (mostly laboratory animals) are the main species under study, and that chlorinated dibenzodioxins and polychlorinated biphenyls are the most commonly studied chemical classes. Comparison of the inventory with the research needs should allow identification of underrepresented research areas in need of attention.

Endocrine Glands↗