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Results for “virtual intervention”

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At least 667 records · Page 37Linked to original sources

PubMed1998

Serial magnetic resonance imaging findings for a spontaneously resolving spinal subdural hematoma: case report.

OBJECTIVE AND IMPORTANCE: Spinal subdural hematoma (SSDH) is a rare entity, and cases are usually managed as surgical emergencies. We describe a patient with a SSDH who demonstrated incomplete clinical resolution with nonsurgical management, despite continued anticoagulation treatment. We provide the most complete demonstration of the magnetic resonance imaging (MRI) characteristics of a large SSDH from its initiation to its radiological resolution. CLINICAL PRESENTATION: A 61-year-old woman developed a large SSDH as a complication of a lumbar puncture. Her only neurological deficit was urinary retention. INTERVENTION: Because of the extensiveness of the hematoma and the relative neurological preservation of the patient, she was treated conservatively. Serial MRI scans were obtained at 4, 7, 13, and 25 days. The evolution of deoxyhemoglobin in the hematoma to methemoglobin was observed. By 25 days, MRI scans showed virtual resolution. CONCLUSION: SSDHs undergo MRI signal changes that are similar to those of brain hematomas. In certain cases, even large SSDHs demonstrate swift and dramatic spontaneous resolution, despite continued anticoagulation treatment. This report suggests that there is a role for conservative management for selected cases of SSDHs.

Female↗

PubMed1994

Reemergence and extinction of self-injurious escape behavior during stimulus (instructional) fading.

Based on results of a functional analysis indicating that the self-injurious behavior (SIB) of 3 individuals was maintained by negative reinforcement (escape from instructional situations), the effects of stimulus (instructional) fading were evaluated in a multiple baseline design across subjects. The rate of instructions was reduced to zero at the beginning of treatment and was gradually increased (faded in) across sessions as long as SIB remained low. However, if SIB remained high for 10 consecutive sessions, extinction was implemented until SIB decreased, at which point extinction was withdrawn and fading was resumed. Treatment was completed when the rate of instructions was the same as in baseline (two per minute), and SIB remained below 0.5 responses per minute for two consecutive sessions. Results showed that instructional fading (without extinction) virtually eliminated SIB initially, but these effects were not maintained. All 3 subjects required multiple exposures to extinction and over 150 treatment sessions in order to meet the end-of-treatment criteria. Advantages and limitations of fading procedures without an extinction component, as well as extensions of both interventions to other clinical problems, are discussed.

Adult↗

PubMedDate not supplied

Health care policies for children in out-of-home care.

Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care.

Child↗

PubMed1985

The clinicopathological spectrum of non-tuberculous mycobacterial osteoarticular infections.

We studied the clinicopathological features of eight patients in whom a non-tuberculous mycobacterium was unexpectedly isolated from osteoarticular material obtained at operation. Three distinct types of infection with non-tuberculous mycobacteria were found: tenosynovitis, synovitis, and osteomyelitis. Tissue specimens from these sites showed a spectrum of pathological findings, including (1) virtually no inflammation, (2) mild to severe non-specific chronic inflammation, (3) granulomas without necrosis, and (4) caseating epithelioid granulomas that were indistinguishable from those of tuberculosis. In six patients the infection responded well to adequate surgical excision alone. In the remaining two the infection responded to surgical intervention and antituberculous therapy.

Adolescent↗

PubMed1993

Cerebral oxygen metabolism in newborns.

OBJECTIVE: A better understanding of the developmental changes in brain energy metabolism that occur in human neonates is critically important for designing rational treatment strategies that ensure an adequate supply of nutrients to the brain and minimize deleterious side effects of therapeutic interventions in sick newborns. METHODS: Cerebral metabolic rate for oxygen (CMRO2) was measured with positron emission tomography in 11 sick newborns of different gestational ages. RESULTS: In five preterm infants, mean hemispheric CMRO2 was 0.06 to 0.54 mL 100 g-1 min-1. Two of these preterm infants with virtually absent CMRO2 (0.06 mL 100 g-1 min-1) had minimal or no evidence of parenchymal brain injury detected in the newborn period. In six term infants, mean hemispheric CMRO2 was 0.0 to 1.3 mL 100 g-1 min-1. Two with no neurological disease had mean hemispheric CMRO2 of 0.4 and 0.7 mL 100 g-1 min-1 and were normal at 6 and 7 months, respectively. CONCLUSIONS: CMRO2 in four newborns who had minimal or no detectable brain injury was considerably below the threshold for brain viability in adults of 1.3 mL 100 g-1 min-1. This indicates that energy requirements in fetal and newborn brain are minimal or can be met by nonoxidative metabolism.

Brain↗

PubMed1996

Melanoma: epidemiology, pathogenesis, and new modes of treatment.

The treatment of patients with advanced stage (stage III and IV) melanoma remains discouraging. Except for the study using tamoxifen, combination chemotherapy (cisplatin, DTIC, BCNU), plus biological therapy (IFN-alpha and/or IL-2), which achieved a 57% response rate, virtually any combination of agents or modalities yielded response rates of only 20% to 30%, and none are effective in central nervous system metastases. Durable clinical cures in patients with advanced-stage disease are extremely rare and can probably be attributed more to host defense mechanisms than iatrogenic intervention. The future in treatment then can only look promising to immunologists, molecular biologists, and clinicians striving to elucidate the biological mechanisms isolated patients have for destroying melanoma cells and incorporating those mechanisms into therapeutics for the remainder of melanoma victims.

Humans↗

PubMed2005

Feasibility report for retreatment of locally recurrent head-and-neck cancers by combined brachy-chemotherapy using frameless image-guided 3D interstitial brachytherapy.

PURPOSE: Brachytherapy re-irradiation may offer an alternative re-treatment of recurrent head-and-neck cancer even after previous full dose radiation therapy. The purposes of this study were to determine the feasibility and accuracy of frameless image-guided interstitial needle implantation. METHODS AND MATERIALS: Between January 2000 and March 2003, 14 patients with biopsy-proven locally recurrent head-and-neck-cancer were retreated after previous full dose irradiation with combined external beam-brachytherapy with concomitant chemotherapy. Brachytherapy needle implantation was virtually planned taking into account the surrounding risk structures. Needles were implanted using an adapted frameless navigation system. Chemoradiotherapy was followed by 2-4 courses of chemotherapy every fourth week starting 4 weeks after the end of brachytherapy. RESULTS: The 1- and 2-year local control rates were 78% and 57%, respectively. Local control was obtained in 8/14 patients. The actuarial 1- and 2-year survival rates were 83% and 64%, respectively. The median survival was 28 months after a median follow-up of 21 months (range, 8-53). Six weeks after brachytherapy, 1 patient developed localized soft tissue necrosis which did not require surgical intervention. No additional grade III or IV late toxicity was seen after re-irradiation. Mean deviation of image-guided needle implantation was 3.4 mm for each needle (SD, 1.9 mm; range, 0.5-14 mm). The mean deviation of all needles of an implant was 4.3 mm (range, 2.3-8.6 mm). CONCLUSIONS: These data demonstrate that pulsed-dose-rate brachytherapy in combination with sequential chemotherapy is effective and safe in re-irradiation of locally recurrent oropharyngeal carcinomas and can be offered to patients with curative intent. Image guidance allows virtual planning and navigated implantation of brachytherapy needles with regard to optimized needle distribution and risk structures.

Adult↗

PubMed1993

A controlled study of the effects of an early intervention on acute musculoskeletal pain problems.

Current conceptions of chronic pain clearly suggest that proper care at the acute stage should prevent the development of chronic problems. Patients (198) seeking help for acute musculoskeletal pain (MSP), e.g., back and neck pain participated in two studies of the effects of an Early Active intervention which underscored 'well' behavior and function compared to a Treatment as usual control group. The quantity of the Early Active treatment was a median of 1 doctor's appointment and 3 meetings with a physical therapist. Study I concerned patients with a prior history of sick-listing for MSP, while study II involved patients with no prior history of MSP. Treatment satisfaction, pain experience, activities and sickness absenteeism were assessed before, after and at a 12-month follow-up. In study I (patients with a history of MSP), the results showed significant improvements for both groups, but virtually no differences between the groups. Similarly, in study II (no history of MSP) both groups demonstrated significant improvements, e.g., for pain intensity and activity levels. However, the Early Active treatment resulted in significantly less sick-listing relative to the control group. Moreover, the risk of developing chronic (> 200 sick days) pain was 8 times lower for the Early Activation group. This investigation shows that relatively simple changes in treatment result in reduced sickness absenteeism for 'first-time' sufferers only. Consequently, the content and timing of treatment for pain appear to be crucial. Properly administered early intervention may therefore decrease sick leave and prevent chronic problems, thus saving considerable resources.

Absenteeism↗

PubMed2001

Attempts to identify a control system for chemical reactivity in the living state using virtual energy.

This thesis explores the activation of chemicals in metabolic systems from the viewpoint that this activation is under the control of elements of the space-sea in which the chemicals are immersed. Themselves inert, the chemicals are theorised to exploit a force or action issuing from space (fluctuation) and characterized by the homogeneity (termed symmetry) of this medium. The fluctuation is heterogenized upon collision with matter from the intervention of well recognized fields of gravity and electromagnetism at the instant of its issue to form the near field of radiation. Fractions of original space waves and of their intrinsic spin are produced resulting in the activation of the orbitals (valency) in the chemical itself. The thesis continues: the disturbed fluctuation must return to space, obliging in turn, a prior return to the homogeneous state requiring special restorative wave rearrangements known as resonance. The success of the restorative resonance is signalled by a singularity of the fluctuation now propelled to infinity (space), and the contingent chemical reactions thereby terminated. Compromise to this return can occur from many causes and, in its presence, activation of the orbitals continues. They now effectively constitute autonomous reactions alienated from the system as a whole. The thesis is supported from evidence from diverse fields such as space theory, history of quantum field theory in attempts to derive its meaning, dielectrics and the near field of electromagnetic radiation, electron-space interactions at the Fermi surface during phase transitions and evolution of equilibrium conditions in resonance phenomena. The utility of the hypothesis rests on recognition of the resonance condition at various points in the system sufficiently macroscopic as to be available clinically as an abrupt interface between physiology and pathology.

Energy Metabolism↗

PubMed2026

Game changer? Cognitive-motor effects of VR exergaming compared to video-based training.

BACKGROUND/OBJECTIVE: Virtual reality (VR) exergaming enhances several cognitive domains through multisensory engagement. Acute cognitive benefits of VR are established, but evidence for direct comparisons with non-immersive controls is limited. This study aimed to determine whether VR exercise provides additional cognitive and cognitive-motor benefits beyond a matched non-immersive active stick-fight video (SFV) intervention, and whether effects persist after training. METHODS: In this randomized quasi-experimental study, N = 55 healthy adults (VR: n = 30; SFV: n = 25; 25.5 ± 7.1 years; 41.8% female) completed an 8-week program (2 × 30 min/week), of VR or SFV matched in movement patterns, frequency, intensity and duration. Measurements included reaction time (RT), Stroop Test (versions 1-3), Letter Cancellation Test (LCT), Trail Making Test (TMT), Trail Walking Test (TWT) and Fitts task (difficulty level 1-4). Data were analyzed using mixed-design ANOVAs. RESULTS: Improvements were observed in Stroop reading (F(1,53) = 14.84, p < .001, η2 = 0.219), Stroop inhibition (F(1,53) = 10.99, p = .002, η2 = 0.172), and LCT (F(1,53) = 4.57, p = .037, η2 = 0.079). A time × group interaction was found for TMT (F(1,53) = 6.55, p = .031, η2 = 0.110), indicating greater changes following VR training. Both groups improved cognitive-motor performance (TWT: F(1,25) = 55.32, p < .001, η2 = 0.689; Fitts3: F(1,53) = 44.97, p < .001, η2 = 0.459), with greater gains for VR in Fitts3 (p = .006). CONCLUSION(S): Eight weeks of VR and SFV enhanced cognitive and cognitive-motor performance. VR provided domain-specific advantages in executive function, but these effects were not uniformly persistent. SFV sustained more improvements in real-world-relevant cognitive-motor tasks.

Humans↗

PubMed1998

Evaluation of the research norms of scientists and administrators responsible for academic research integrity.

CONTEXT: The professional integrity of scientists is important to society as a whole and particularly to disciplines such as medicine that depend heavily on scientific advances for their progress. OBJECTIVE: To characterize the professional norms of active scientists and compare them with those of individuals with institutional responsibility for the conduct of research. DESIGN: A mailed survey consisting of 12 scenarios in 4 domains of research ethics. Respondents were asked whether an act was unethical and, if so, the degree to which they considered it unethical and to select responses and punishments for the act. PARTICIPANTS: A total of 924 National Science Foundation research grantees in 1993 or 1994 in molecular or cellular biology and 140 representatives from the researchers' institutions to the US Department of Health and Human Services Office of Research Integrity. MAIN OUTCOME MEASURES: Percentage of respondents considering an act unethical and the mean malfeasance rating on a scale of 1 to 10. RESULTS: A total of 606 research grantees and 91 institutional representatives responded to the survey (response rate of 69% of those who could be contacted). Respondents reported a hierarchy of unethical research behaviors. The mean malfeasance rating was unrelated to the characteristics of the investigator performing the hypothetical act or to its consequences. Fabrication, falsification, and plagiarism received malfeasance ratings higher than 8.6, and virtually all thought they were unethical. Deliberately misleading statements about a paper or failure to give proper attribution received ratings between 7 and 8. Sloppiness, oversights, conflicts of interest, and failure to share were less serious still, receiving malfeasance ratings between 5 and 6. Institutional representatives proposed more and different interventions and punishments than the scientists. CONCLUSIONS: Surveyed scientists and institutional representatives had strong and similar norms of professional behavior, but differed in their approaches to an unethical act.

Biomedical Research↗

PubMed2007

Creating a robust public health infrastructure for physical activity promotion.

The essential role of physical activity both as an independent protective factor against numerous common chronic diseases and as a means to maintain a healthy weight is gaining increasing scientific recognition. Although the science of physical activity promotion is advancing rapidly, the practice of promoting physical activity at a population level is in its infancy. The virtual absence of a public health practice infrastructure for the promotion of physical activity at the local level presents a critical challenge to control policy for chronic disease, and particularly obesity. To translate the increasing evidence of the value of physical activity into practice will require systemic, multilevel, and multisectoral intervention approaches that build individual capability and organizational capacity for behavior change, create new social norms, and promote policy and environmental changes that support higher levels of energy expenditure across the population. This paper highlights societal changes contributing to inactivity; describes the evolution and current status of population-based public health physical activity promotion efforts in research and practice settings; suggests strategies for engaging decision makers, stakeholders, and the general public in building the necessary infrastructure to effectively promote physical activity; and identifies specific recommendations to spur the creation of a robust public health infrastructure for physical activity.

Exercise↗

PubMed2000

Indigence, marginalization and HIV infection among Brazilian cocaine users.

In recent years the HIV/AIDS epidemic in Brazil has increasingly affected younger and more impoverished segments of the population. The rate of infection among drug users has also risen dramatically over the past decade. Despite these alarming trends, epidemiologic studies of indigent drug users in Brazil are virtually nonexistent. In order to fill this void, a research demonstration program was initiated in Rio de Janeiro which targeted drug users from the poorest strata of society, assessed their HIV risk behaviors and serostatus, and provided HIV prevention counseling, hygiene materials, and follow-up. Because participation in the intervention program appeared to impact on drug use and sexual risk behaviors, the implementation of successful prevention programs with this population appears feasible. In that HIV prevalence among this sample of poor injectors was markedly lower than that reported in previous studies of higher socioeconomic status injectors, the timely and widespread implementation of risk reduction strategies assumes great importance for the prevention of HIV infection in the most marginalized segments of Brazilian society.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Prehospital endotracheal intubation for severe head injury in children: a reappraisal.

Controversy exists regarding the efficacy of prehospital assisted ventilation by endotracheal intubation (ETI) versus bag-valve-mask (BVM) in serious pediatric head injury. The National Pediatric Trauma Registry (NPTR-3) data set was analyzed to examine this question. NPTR-3 (n = 31,464) was queried regarding the demographics, injury mechanism, injury severity, prehospital interventions, transport mode, mortality rate, injury complications, procedure and equipment failure or complications, and functional outcome of seriously head-injured patients (n = 578) with comparable injury mechanisms and injury severity who received endotracheal intubation (ETI) (n = 479; 83%) versus those who received BVM (n = 99; 17%). Mortality rate was virtually identical between the 2 groups (ETI = 48%, BVM = 48%), although children receiving ETI were significantly older (P < .01), more often transported by helicopter (P < .01), and more often received intravenous fluid in the field (P < .05). However, injury complications affecting nearly every body system or organ (except kidney, gut, and skin) occurred less often in children receiving ETI (ETI = 58%, BVM = 71%, P < .05). Procedure and equipment failure or complications, and functional outcome, were similar between the 2 groups. Prehospital endotracheal intubation appears to offer no demonstrable survival or functional advantage when compared with prehospital bag-valve-mask for prehospital assisted ventilation in serious pediatric head injury. Injury complications appear to occur somewhat less often among patients intubated in the field.

Adolescent↗

PubMed1991

Tobacco and the European common agricultural policy.

The common agricultural policy of the European Community subsidizes tobacco production to the tune of 1,300 million ecu a year (US$ 1,500 million, UK pounds 900 million). This amounts to 2,500 ecu ($3,100, pounds 1,700) per minute, and is more in one year than the total amount spent on tobacco subsidies by the US in the last 50 years. The purpose of this policy was to maintain farmers' incomes and adapt community production to demand. Demand for the dark tobaccos which dominate EC production has fallen, while demand for light flue cured tobacco like Virginia has risen. A complex system of production subsidies and quotas was intended to discourage production of the dark tobaccos, for which there is virtually no market, and lead to more Virginia production. The policy has failed. Expenditure has spiralled out of control, production of unmarketable tobacco varieties has risen enormously, and the EC is the world's largest importer of raw tobacco. As a result tobacco is being bought by the community for intervention storage and surpluses of the dark high tar varieties are being 'exported' to eastern Europe and north Africa at giveaway prices. There has been no effective monitoring or control of this policy. This paper explains how this has happened and argues that, in view of the health risks attached to tobacco, these subsidies should be abolished.

Agriculture↗

PubMed2001

[Advances in the diagnosis of tumours by imaging methods (possibilities of three-dimensional imaging and application to volumetric resections of brain tumours with evaluation in virtual reality and subsequent stereotactically navigated demarcation].

Oncological problems are so varied that it is very difficult to record all advances in different diagnostic branches in a comprehensive manner. In the first part the authors focus attention on an example of the possible use of imaging examination methods in conjunction with different types of three-dimensional imaging used in their hospital. The second part is devoted to volumetric resections of brain tumours with navigated demarcation. In 17 patients the authors used the PC working station equipped with navigation software STEREOPLAN PLUS for planning volumetric resection of different brain tumours in virtual reality. The demarcation proper of the brain tumour size during surgery was implemented by means of a stereotactic apparatus ZAMORANO-DUJOVNY and a pointer in the field of the microscope. The accuracy of navigation of the whole system for demarcation of the tumourous affection was +/- 1 mm. The intervention was supplemented by functional examination by means of surface electrodes during partial awakening of the patient for mapping the functional areas of the cerebral cortex. The result was resection of relatively precise volumes of tumourous tissue with the possibility of maximum preservation in particular of motor but also other functions of the CNS.

Adult↗

PubMed2006

Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy.

BACKGROUND: The GI Mentor is a virtual reality simulator that uses force feedback technology to create a realistic training experience. OBJECTIVE: To define the benefit of training on the GI Mentor on competency acquisition in colonoscopy. DESIGN: Randomized, controlled, blinded, multicenter trial. SETTING: Academic medical centers with accredited gastroenterology training programs. PATIENTS: First-year GI fellows. INTERVENTIONS: Subjects were randomized to receive 10 hours of unsupervised training on the GI Mentor or no simulator experience during the first 8 weeks of fellowship. After this period, both groups began performing real colonoscopies. The first 200 colonoscopies performed by each fellow were graded by proctors to measure technical and cognitive success, and patient comfort level during the procedure. MAIN OUTCOME MEASUREMENTS: A mixed-effects model comparison between the 2 groups of objective and subjective competency scores and patient discomfort in the performance of real colonoscopies over time. RESULTS: Forty-five fellows were randomized from 16 hospitals over 2 years. Fellows in the simulator group had significantly higher objective competency rates during the first 100 cases. A mixed-effects model demonstrated a higher objective competence overall in the simulator group (P < .0001), with the difference between groups being significantly greater during the first 80 cases performed. The median number of cases needed to reach 90% competency was 160 in both groups. The patient comfort level was similar. CONCLUSIONS: Fellows who underwent GI Mentor training performed significantly better during the early phase of real colonoscopy training.

Clinical Competence↗

PubMed1992

Immunological manipulation of adiposity.

Although hormonal regulators of adiposity are available they as yet have not been licensed for use. Withdrawal periods and delivery systems are still potential problems in maximizing their effectiveness. Immunization techniques, on the other hand, suffer none of the problems of withdrawal periods or requirement for frequent injection/implantation. As such they are clearly perceived as safe, economic and should have a positive animal welfare image. They are, however, not without their problems. Active immunization in particular involves an autoimmune response and this is typically difficult to evoke and virtually impossible to regulate. In addition, the fact that antibodies may have immunoneutralizing and immunoenhancing properties may explain the apparently contradictory results obtained in various studies as, for example, in the case of immunization against somatostatin. As our knowledge of immune responsiveness and its control increases, however, the possibilities for immune intervention should increase considerably. We may then be faced with ethical rather than practical limitations as to how far we should manipulate growth and body composition.

Adipose Tissue↗