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PubMed1998

"Virtual" clinical trials: case control experiments utilizing a health services research workstation.

We created an interface to a growing repository of clinical and administrative information to facilitate the design and execution of case-control experiments. The system enables knowledgeable users to generate and test hypotheses regarding associations among diseases and outcomes. The intuitive interface allows the user to specify criteria for selecting cases and defining putative risks. The repository contains comprehensive administrative and selected clinical information on all ambulatory and emergency department visits as well as hospital admissions since 1994. We tested the workstation's ability to determine relationships between outpatient diagnoses including hypertension, osteoarthritis and hypercholesterolemia with the occurrence of admissions for stroke and myocardial infarction and achieved results consistent with published studies. Successful implementation of this Health Services Research Workstation will allow "virtual" clinical trials to validate the results of formal clinical trials on a local population and may provide meaningful analyses of data when formal clinical trials are not feasible.

Case-Control Studies↗

PubMed1998

Delivering labeled teaching images over the Web.

The Web provides educators with the best opportunity to date for distributing teaching images across the educational enterprise and within the clinical environment. Experience in the pre-Web era showed that labels and information linked to parts of the image are crucial to student learning. Standard Web technology does not enable the delivery of labeled images. We have developed an environment called OverLayer that succeeds in the authoring and delivering of such images in a variety of formats. OverLayer has a number of functional specifications, based on the literature and on our experience, among them, the following: Users should be able to find components by name or by image; to receive feedback about their choice to test themselves. The image should be of arbitrary size; should be reusable; should be linked to further information; should be stand-alone files. The labels should not obscure the image; should be linked to further information. Images should be stand-alone files that can be transferred among faculty members. Implemented in Java, OverLayer (http:/(/)omie.med.jhmi.edu/overlayer) has at its heart a set of object classes that have been reused in a number of applets for different teaching purposes and a file format for creating OverLayer images. We have created a 350-image histology library and a 500-image pathology library, and are working on a 400-image GI endoscopy library. We hope that the OverLayer suite of classes and implementations will help to further the gains made by previous image-based hyperlinked technologies.

Anatomy↗

PubMed1985

Effects of smokeless tobacco on the periodontal, mucosal and caries status of adolescent males.

The use of smokeless tobacco (ST) products, such as snuff and chewing tobacco, was investigated in a school population of 565 males with a mean age of 13.8 years. All students completed a tobacco usage questionnaire and were given intraoral examinations by a team of dentists to determine the possible relationship of ST usage to the presence of gingivitis, gingival recession, mucosal pathology and caries. The overall prevalence of ST usage was 13.3%, which was much higher than the 1.4% prevalence of cigarette smoking. Pairwise chi square analysis revealed that there was no relationship between ST usage and the prevalence of gingivitis, but that the prevalence of gingival recession was significantly elevated in ST users, P less than 0.001. The odds of having gingival recession were 9 times greater in the students using smokeless tobacco as compared to healthy, non-user cohorts. ST usage did not affect the prevalence of gingival recession in students without gingivitis. The frequency of occurrence of soft tissue pathology was significantly elevated, about 6-fold in students who used smokeless tobacco, as compared to non-users, P less than 0.01. This was principally due to the increased prevalence of white mucosal lesions in smokeless tobacco users. However, there was no attributable risk for mucosal pathology in ST users who were free of gingivitis. Similarly, the use of smokeless tobacco was associated with a 1.6-fold elevation in mean DMF in students with gingivitis, P less than 0.001, but this increase in caries experience was not seen in ST users who were free of gingivitis. In summary, in students with clean mouths that were free of gingivitis, the use of smokeless tobacco was not associated with a change in the prevalence of gingival recession, mucosal pathology, or in the mean DMF score. In contrast, smokeless tobacco usage was a significant risk factor in individuals with co-existing gingivitis, associated with a marked increase in the prevalence of gingival recession, mucosal pathology and caries experience.

Adolescent↗

PubMed1986

Computer-aided measuring of motor functions using pursuit tracking.

The necessity of evaluating motor functions objectively and quantitatively is discussed. Tracking tasks and their appropriateness in assessing motor performance is reviewed. Motor performance can be effectively assessed by means of tracking tasks. A simple tracking device is presented which allows the measurement of motor performance in different conditions. It is pointed out that computers are well suited for driving the stimulus in tracking tasks as well as recording the performance in experiments based on tracking tasks. Differences between open and closed loop conditions, compensatory tracking, pursuit tracking, preview tracking and cognitive tracking are discussed. A flexible computer-controlled device is presented with which diverse experiments based on tracking tasks can be performed and their results recorded. A complete description of the user-oriented, interactive programs with which the experiments can be controlled and the relevant performance data can be recorded is given. An example of their application on measuring the effects of levodopa therapy on the motor symptoms of Parkinson's disease is presented.

Computers↗

PubMed2004

An interpretative phenomenological analysis of the embodiment of artificial limbs.

PURPOSE: To gain an understanding of the embodied perceptual experience of successful prosthesis. METHOD: The data for this study were transcripts derived from in-depth semi-structured e-mail (n=21) and face-to-face (n=14) interviews, and the documentary analysis of an e-mail discussion group for prosthesis users. This qualitative data was subject to an Interpretative Phenomenological Analysis. RESULTS: Analysis of the research data identified six themes in the perceptually embodied experiences of prosthesis users: Adjusting to a prosthetic; The Balance of the Body; Awareness of the Prosthesis; The Knowing Body; The Phantom Becomes the Prosthesis: Extending the Body; and The Prosthesis as Tool or Corporeal Structure. CONCLUSION: The often-cited reasons for the rejection of prostheses are frequently part of the initial experiences of 'successful' prosthesis users also. This suggests the need to sufficiently motivate potential prosthesis users in the period between an experience of prosthesis use as unnatural and wieldy to one of pre-reflective, natural use. In addition, two broad forms of prosthesis experience were identified: one in which the prosthesis was experienced as a corporeal structure; and one in which it was viewed as a tool. While future work may be able to explore the psychosocial correlates of these experiences, it is nonetheless the case that persons with these differing experiences were able to enjoy the benefits imbued by prosthesis use.

Adaptation, Psychological↗

PubMedDate not supplied

Utilization of a paediatric link collection by health professionals and laypersons.

The Internet is an evolving resource for health-care information. However little information exists on providers' and other web patrons' usage of the 'medical' Internet. This study aims to characterize the users of a large paediatric link collection, describe their objectives and track their use of the information provided by the site. We utilized a paediatric link collection called the Pediatric Points of Interest (POI) and a combination of a questionnaire, unique user identifier and link-tracking system to collect data about POI patrons' demographics and Internet resource utilization. During a five week period, 5216 individuals visited the POI and requested 36,187 links. The majority of users had less than one year of Internet experience and were first-time visitors to the POI. More than 83% of users were from North America. Medical professionals were more likely to return to the POI during the study period and reported visiting the POI mainly for 'medical education', 'research', 'resource identification', and 'disease specific information'; they proceeded primarily to the resource categories 'Medical Institutions and Agencies' (32%) and 'Professional Education and Resources' (28%). Laypersons expressed the greatest interest in 'disease specific information' and 'patient education' and most frequently visited the category. 'Patient Education' (42%). On average, users were able to identify resources related to their stated goals within one level of searching. Health care providers and other web patrons are actively utilizing Internet sites to seek medical information and are able to identify resources with a minimum of searching.

Adolescent↗

PubMed1984

The Life Sciences Programme of the European Space Agency, and opportunities for radiation biology experiments.

With the advent of Europe's commitment to contribute the European Space Agency (ESA) to the NASA Space Transportation System (STS) by means of the Spacelab programme, a new area for research opportunities on Life Sciences has been created for the European scientific community. Although considered as a young and new discipline, the goals of Life Sciences research in space had soon been defined by the ESA advising Life Sciences Working Group in the beginning of 1977. The programme proposals of the various subdisciplines concentrated on the advantageous use of the microgravity environment, to study in more depth the gravity relevance of biological systems. It included, however, also the use of other factors during space flight which cannot be reproduced or adequately simulated on the ground: cosmic radiation in its total spectrum, particularly HZE particles, solar and UV radiation, vacuum, and the combination of radiation and weightlessness, etc. On this basis, call for proposals in the various subdisciplines resulted in experiments also in the field of radiation biology which were flown on the Spacelab 1 mission and which were selected for later missions. In particular, ESA is providing the science community with mission opportunities on Spacelab, either European or International, with platforms to be launched by STS, and with so called multi-user facilities (e.g. Biorack). Typically, the experiments will be the responsibility of the scientists, the integration and mission phase the responsibility of ESA. Both mission definition and experiment selection rests with the ultimate decision of the responsible ESA Programme Board. A further description of missions envisioned, the Spacelab facility, platforms, multi-user facilities and areas of research applicable to radiobiology will be given. ESA's continuing interaction with the scientific community through the Life Sciences Working Group, and the advice on future programmes will be stressed as a vital factor contributing to a European Life Sciences Programme in Space.

Adaptation, Physiological↗

PubMed2006

Health care consumers' experiences of information communication technology--a summary of literature.

BACKGROUND: There is an increasing interest in reaching consumers directly through the Internet and different telecommunication systems. The most important contacts in health care will always be the face-to-face meetings, but the tools of health informatics can be seen as a means to an end, which is to provide the best possible health care. A variety of applications have been described in different references. To our knowledge there has been no review of a research-based state of the art in the field of consumers' experiences in using different applications in health informatics. According to the benefits in using information communication technology (ICT) as being cost-effective and timesaving it is of great importance to focus on and examine consumers' experiences. It is important that it is user friendly and regarded as valuable and useful. AIM: The aim of this study was to describe consumers' subjective experiences of using electronic resources with reference to health and illness. DESIGN AND/OR METHOD: A systematic literature search was performed in databases CINAHL, Medline and Cochrane, as well as a manual search. Retrieved references (n=14) were appraised according to their scientific structure and quality. A broad search was performed in order to find as many different applications as possible. Our primary intention was to identify existing references describing consumers' experiences with ICT. RESULTS: In spite of this broad search few references were found. Twelve references remained and three themes were identified: support and help, education and information, and telecommunication instead of on-site visiting. Consumers felt more confident and empowered, their knowledge increased and their health status improved due to the ICT resources. Lack of face-to-face meetings or privacy did not appear to be a problem. CONCLUSION: ICT can improve the nurse-patient relationship and augment well-being for consumers. More research is needed to measure consumers' experiences and factors that influence it.

Biotechnology↗

PubMed2005

Development of the seating and mobility script concordance test for spinal cord injury: obtaining content validity evidence.

The appropriateness of a consumer's seating and mobility system varies considerably depending on the competence, proficiency, and experience of the professionals assisting the user. At present, there is a scarcity of skilled and knowledgeable therapists to evaluate and recommend seating and mobility devices. There is also a lack of measurement tests available to evaluate the impact of educational experiences or clinical practice on the ability to make specialized clinical decisions about seating and mobility needs. The Seating and Mobility Script Concordance Test (SMSCT) is a new assessment tool, grounded in the hypothetico-deductive and schema theories of clinical reasoning. The test is designed to assess therapists by examining the organization of their knowledge, associations between items of their knowledge, and the adequacy of their clinical decisions as compared to expert consensus. This article describes the interview, test development, and content/item review processes used for the collection of content validity evidence. The iterative process employed and the appraisal of the content validity evidence that resulted in the final version of the SMSCT are presented. The SMSCT appears to be a promising assessment tool representing content within the domain of seating and mobility for individuals with spinal cord injuries. The process utilized to develop the SMSCT in spinal cord injury can be replicated for other diagnoses and domains.

Adult↗

PubMed1993

Graphical interface for medical image processing.

We have developed a graphical interface which allows users of varying levels of computer experience and proficiency to manipulate medical image-processing data with "point-and-click" ease. The power which had formerly been associated with protocols and shell scripts has been combined with the flexibility and "user-friendliness" of buttons and dialog boxes.

Computer Graphics↗

PubMed1987

A packetised remote visual access data system for space station interactive payload operations.

Potential users of the pressurised Columbus elements, (the Attached Pressurised Module and the Man-Tended Free Flyer), were consulted in order to establish the requirements necessary to achieve effective and efficient remote interactive payload operations. These are briefly described and clearly indicate that the key to such operations is a versatile remote visual access (video) system which is well-tuned to the requirements of the users in both the on-board and ground segments. A packetised remote visual access data system is proposed which accommodates these requirements and offers a very flexible operational environment. It incorporates a scheme for optimising users' remote visual access to their experiments. Methods of implementing the necessary multiplexing and compression aspects of the system are discussed. A scheme for centralized on-board monitoring, which is complicated by the wide range of video sources required by the users, is outlined and aspects of the ground segment, in particular the problem is link delays, are considered.

Computer Communication Networks↗

PubMed2005

A mechanical instrument for 3D ultrasound probe calibration.

We present a novel technique for 3D ultrasound probe calibration. The principle of operation is that the beam is aligned with a set of coplanar wires strung across a rigid frame. The probe and frame are mounted on a precision-manufactured mechanical instrument which allows adjustment and measurement of their relative pose. Semi-automatic image processing facilitates alignment of the beam and wires to within a tolerance of around 0.2 mm, despite the considerable beam thickness. The calibration process requires just a single view and relatively little user expertise. In a series of experiments with different ultrasound probes, we demonstrate the technique's high accuracy and precision. The latter is partly due to the elimination of the position sensor, a significant source of measurement noise, from the end-user calibration process.

Calibration↗

PubMed2001

In vivo microdialysis for nonapeptides in rat brain--a practical guide.

Microdialysis provides a direct approach to monitor changes in interneuronal communication by monitoring the fluctuation of local, extracellular concentrations of potential neurotransmitters/neuromodulators. The present article is based on more than 10 years experience in performing microdialysis experiments in freely moving animals with inexpensive self-made microdialysis probes and accessories for monitoring of intracerebral neuropeptide release. On the basis of this experience, we provide a guide for the construction of different types of microdialysis probes and their application. Furthermore, we give information about organizing and performing a microdialysis experiment that can easily be adapted to fit individual applications needs. Finally, on the basis of theoretical background information advantages as well as limitations of the microdialysis technique are discussed with the intent to provide help to potential users for designing an appropriate microdialysis experiment.

Animals↗

PubMed1997

Dermal exposure of amateur or non-occupational users to wood-preservative fluids applied by brushing outdoors.

The results of an experiment to determine the likely dermal exposure of amateur or occasional users to wood-preservative fluids, applied by brushing onto a wooden fence outdoors are presented. Exposure was measured using FIVES, a fluorescence monitoring technique developed at the Health and Safety Laboratory. Dermal exposure could be examined and measured in a detail that would have been impossible using any other technique. A number of factors were found to affect dermal exposure, including some that were unexpected. Trousers, a long-sleeved shirt and permeable gloves offered 20 times the protection of shorts and a T-shirt. Differences between individual subjects' behaviour gave rise to variations of a factor of 10. There was far more contamination at lower ambient temperatures, possibly because of more vigorous brushing. Spirit-based fluid caused more exposure than water-based fluid, probably because the spirit flicked easily from the brush as a spray whereas the water remained in soapy globules. Only 1.6 times more fluid was applied in 1 h than in 0.5 h, but it caused 3.7 times as much contamination.

Environmental Exposure↗

PubMed2003

The prevalence and correlates of gamma-hydroxybutyrate (GHB) overdose among Australian users.

AIM: The aim of this study was to examine the correlates, context and risk perceptions regarding gamma-hydroxybutyrate (GHB) overdose among a sample of recreational GHB users in Australia. DESIGN: A cross-sectional survey of 76 GHB users who were administered a structured interview on GHB use. They were asked a series of questions regarding whether they had ever experienced a GHB overdose, the context of their most recent GHB overdose, and about their perceptions of the risks of GHB overdose. FINDINGS: This sample of GHB users had not had a long or extensive experience with GHB use; despite this, half (53%) had experienced a GHB overdose. This sample of GHB users appeared to be well-educated, employed and a history of either drug treatment or incarceration was uncommon. There were no differences between those who had or had not overdosed in terms of socio-demographic characteristics, extent of other drug use or typical patterns of other drug use when using GHB. However, those who had overdosed on GHB had used it more times during their life-time, and had been using it for a longer period of time. CONCLUSIONS: GHB-related overdoses were common among a sample of GHB users who had only recently begun using the drug. The only apparent distinguishing factor between those who had and had not overdosed on GHB was the amount of experience with GHB use.

Adult↗

PubMed1991

Clinical experience with a modern low-dose oral contraceptive in almost 100,000 users.

Efficacy, cycle control, tolerance, and adverse events were studied in a clinical Phase IV study using a new progestogen, gestodene, in an amount of 75 micrograms combined with 30 micrograms ethinylestradiol. The study was performed as a multicenter trial in 96,000 patients over a period of 6 cycles. Half of the patients taking the new preparation were first-time OC users, the other half switched from another OC. With regard to contraceptive efficacy, the life-table analysis showed a value of 0.032% for method failure and 0.114% for patient failure. The correspondent Pearl-Index is 0.062 and 0.22. The new drug was found acceptable by more than 90% of the women involved in the trial. Dysmenorrhea present in the "switchers" mostly disappeared on the new OC, while body weight and blood pressure remained virtually unchanged. Thus, it can be concluded that blood pressure and body weight behaviour is similar to that seen with other low-dose OCs. The new combined pill offers excellent cycle stability and has a very favourable effect on dysmenorrhea. The number of clinically diagnosed thrombotic events documented in this study was 0.65 per 1000 woman-years (TWY) and does not exceed the range of events seen in groups of women using non-hormonal methods of contraception (Oxford-FPA study 0.4/TWY and RCGP study 0.8/TWY).

Adult↗

PubMed2005

End-to-end signal processing from the embedded body sensor to the medical end user through QoS-less public communication channels: the U-R-SAFE experience.

The URSafe project (IST-2001-33352) aims at creating a telemedicine care environment for the elderly and convalescent. The idea is to provide a portable device which monitors autonomously different biomedical signals and is able to send an alarm to a medical center if an abnormality is detected. In the initial version of URSafe, three sensors where included in the platform: electrocardiogram (ECG), oxygen rate (SpO2) and Fall Detector. This paper presents the signal processing algorithms involved in the project. These are at two levels: ECG analysis and signal transmission.

Accidental Falls↗

PubMed2001

About the impossibility of a single (ex-)user and survivor of psychiatry position.

OBJECTIVE: To present the European Network of (ex-)users and survivors of psychiatry and discuss issues of concern among (ex-)users and survivors. METHOD: Material from papers and documents published by and discussed among (ex-)users and survivors of psychiatry is used to outline topics of interest. RESULTS: The European Network of (ex-)Users and Survivors of Psychiatry (ENUSP) was founded in 1991 as an association of national/regional organizations of (ex-)users and survivors of psychiatry. The network organizes biennial conferences, all delegates are (ex-)users and survivors of psychiatry. ENUSP aims include the fight against discrimination of people with experience of the psychiatric system, support for (ex-)user/ survivor organizations, influence on policy-making, legislation and human rights debates, demedicalizing psychiatry, and opposition to unidimensional approaches to mental and emotional distress. CONCLUSION: (Ex-)users and survivors should be involved in monitoring psychiatric services, education and examination of mental health professionals. User/survivor-controlled services constitute an important innovative service.

Europe↗