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PubMed2004

Clinically significant virtual environments for the treatment of panic disorder and agoraphobia.

The aim of this work is the description of virtual environments designed to apply exposure therapy in the treatment of panic disorder and agoraphobia. The program allows the simultaneous exposure to two different kinds of stimuli usually avoided by panic disorder and agoraphobia sufferers (external and interoceptive). The characteristics of the virtual environments are described, as well as the target behaviors that can be simulated with these virtual environments.

Agoraphobia↗

PubMed1980

Design considerations for mental health facilities.

The design environment of mental health facilities can facilitate the human interactions essential to treatment and can help in meeting clients' basic needs for safety and security, for self-esteem, and for the development of interpersonal and social skills. To determine the factors in the design of interior spaces that optimize clients' response to therapy, the author made a study of six Indiana community mental health centers. Drawing on that study and other sources, she presents design recommendations for mental health facilities for such areas as reception and admission areas, corridors and stairwells, therapists' offices, inpatient rooms, and dayrooms. Other discussions cover the relation of color, visual patterning, and light, and the selection of materials and finishes.

Architectural Accessibility↗

PubMed2002

Variability in conversion of beta-carotene to vitamin A in men as measured by using a double-tracer study design.

BACKGROUND: The vitamin A activity of beta-carotene is variable and surprisingly low in women. The reasons for this are not well understood. The vitamin A activity of beta-carotene in men is still uncertain. Contributions of dietary factors compared with individual traits are largely unknown. OBJECTIVE: Our objective was to measure the intrinsic variability in the vitamin A activity of beta-carotene among healthy, well-fed men living in a controlled environment. DESIGN: We used a double-tracer test-retest design. We dosed 11 healthy men orally with 30 micromol hexadeuterated (D6) retinyl acetate (all-trans-19,19,19,20,20,20-[2H6]retinyl acetate) and then with 37 micromol D6 beta-carotene (19,19,19,19',19',19'-[2H6]beta-carotene) 1 wk later. Doses were taken with breakfasts containing 16 g fat. We measured D6 retinol, D6 beta-carotene, and trideuterated (D3) retinol (derived from D6 beta-carotene) concentrations in plasma. Areas under the plasma concentration x time since dosing curves (AUCs) were determined for D6 retinol, D6 beta-carotene, and D3 retinol. RESULTS: All men had detectable D6 retinol concentrations in plasma. The mean (+/-SE) absorption of D6 beta-carotene in all subjects was 2.235 +/- 0.925%, and the mean conversion ratio was 0.0296 +/- 0.0108 mol retinol to 1 mol beta-carotene. Only 6 of 11 men had sufficient plasma concentrations of D6 beta-carotene and D3 retinol that we could measure. The mean absorption of D6 beta-carotene in these 6 subjects was 4.097 +/- 1.208%, and the mean conversion ratio was 0.0540 +/- 0.0128 mol retinol to 1 mol beta-carotene. CONCLUSION: The vitamin A activity of beta-carotene, even when measured under controlled conditions, can be surprisingly low and variable.

Absorption↗

PubMed1998

A transitional living environment for persons with brain injuries: staff and client perceptions.

Given increasing interest in social ecology and the impact of environmental factors upon rehabilitation outcomes, the purpose of this study was to begin to document the characteristics of a particular environment designed to meet the needs of persons with traumatic brain injuries. Staff and clients at the Transitional Living Centre of Kingston, Ontario (TLC), a community based post-acute rehabilitation programme providing both residential and day programmes for adults who have acquired brain injuries participated in this study by completing the Community-Oriented Programme Environment Scale (COPES). While COPES subscale scores for clients and staff were within the average range, the results of a multivariate analysis of variance indicated that client and staff perceptions of the TLC environment differed significantly on two subscales within the Personal Development Dimension (i.e., Personal Problem Orientation, Anger and Aggression) and on one subscale under the System Maintenance Dimension (i.e., Staff Control). The results of this study suggest that future research should consider the impact of staff and client perceptions on the effectiveness of the therapeutic environment of brain injury programmes.

Activities of Daily Living↗

PubMedDate not supplied

How tutors assist adults with learning disabilities to use virtual environments.

PURPOSE: To describe strategies used by tutors teaching adults with learning disabilities to use desktop virtual environments and to investigate their effectiveness by examining changes over time in tutor and learner behaviour. METHOD: Twenty adults with learning disabilities spent 12 sessions with one of four non-disabled tutors learning to use desktop virtual environments designed to teach independent living skills. Sessions were recorded on videotape, categories of behaviour were described and tapes analysed for frequency of tutor behaviours and goals achieved by learners. RESULTS: Tutor strategies were described in terms of whether they aimed to help the learner master the interaction devices or to navigate and achieve goals in the virtual environments and how directive they were. There were some differences between tutors but this did not relate to whether tutors were experienced users themselves of the environments or were initially unfamiliar with them. Goal achievement was maintained at a constant level while help with the interaction devices and specific information about the environment decreased over repeated sessions. Rates of non-specific information did not change. CONCLUSIONS: Pretraining with the interaction devices would free both tutor and learner to concentrate on achieving goals in the environments. Much of the specific help given by the tutor could be incorporated into the software.

Adult↗

PubMed1994

Laminar air flow versus reverse isolation: nurses' assessments of moods, behaviors, and activity levels in patients receiving bone marrow transplants.

PURPOSE/OBJECTIVES: To compare nursing assessments of moods, behaviors, and activity levels of patients receiving bone marrow transplants (BMTs) according to type of isolation environment. DESIGN: Retrospective, descriptive. SETTING: University BMT unit. SAMPLE: Records of 22 patients receiving BMT treated over a two-year period-12 were treated in laminar air flow (LAF) rooms and 10 in reverse isolation. METHODS: Using a retrospective chart review, daily nursing assessments of patients' moods, behaviors, and activity levels were collected and compared based on type of isolation. MAIN RESEARCH VARIABLES: Type of isolation and patient's behavior, mood, and activity level. FINDINGS: Patients assigned to LAF had significantly higher anxiety levels at admission than those assigned to reverse isolation. CONCLUSIONS: Admission to LAF isolation appeared to be more anxiety-provoking than admission to reverse isolation; however, this finding needs to be replicated in a study with a prospective design using standardized psychosocial assessment. Findings are consistent with the evidence that patients view isolation as a temporary inconvenience rather than a major stressor. IMPLICATIONS FOR NURSING PRACTICE: Future research is needed. Preparing patients for isolation can include tours, educational materials, and explanations of procedures and events. Physical contact, even through gloves, can impart warmth and caring in the isolation environment.

Activities of Daily Living↗

PubMed2003

[Effectiveness of comprehensive geriatric assessment in primary care].

OBJECTIVE: To review and update evidence on the effectiveness of the comprehensive geriatric assessment (CGA) of the elderly in the community environment. DESIGN: Systematic review. DATA SOURCES: MEDLINE (January 1997 to November 2001) and The Cochrane Library, completed with a manual search. SELECTION OF STUDIES: Randomised clinical trials (RCT) to study the effects of a CGA in people over 64 and not in an institution. Trials that assessed mortality, institutionalisation and functional status were included. Those conducted after hospital discharge or not in a community environment were excluded. 133 summaries were reviewed and 16 articles analysed. DATA EXTRACTION: Methodological quality assessed with adapted Jadad scale. A data archive was worked out to collect information on characteristics of the population and the intervention and on the main findings. RESULTS: The quality of the trials was adequate, though they had important methodological differences. Eleven trials found no favourable effects in the result variables studied. Five of the twelve trials which assessed functional status and one of the twelve that evaluated admissions to institutions found some favourable effect. None of the nine studies with mortality data found favourable results. CONCLUSIONS: Evidence for the effectiveness of the CGA for the elderly not in institutions continues to be inconsistent and insufficient. Nevertheless, given the complexity of this intervention, it seems prudent to continue to conduct CGAs of the elderly in the PC environment until such time as further studies clarify the role of these programmes.

Aged↗

PubMed2005

Patient-centred improvements in health-care built environments: perspectives and design indicators.

OBJECTIVE: To explore patients' perceptions of health-care built environments, to assess how they perceived health-care built facilities and designs. To develop a set of patient-centred indicators by which to appraise future health-care designs. DESIGN: Qualitative and quantitative methodologies, including futures group conferencing, autophotographic study, novice-expert exchanges and a questionnaire survey of a representative sample of past patients. SETTING AND PARTICIPANTS: The research was carried out at Salford Royal Hospitals NHS Trust (SRHT), Greater Manchester, UK, selected for the study because of planned comprehensive redevelopment based on the new NHS vision for hospital care and service delivery for the 21st century. Participants included 35 patients who took part in an autophotographic study, eight focus groups engaged in futures conferencing, a sample of past inpatients from the previous 12 months that returned 785 completed postal questionnaires. RESULTS: The futures group provided suggestions for radical improvements which were categorized into transport issues; accessibility and mobility; ground and landscape designs; social and public spaces; homeliness and assurance; cultural diversity; safety and security; personal space and access to outside. Patients' autophotographic study centred on: the quality of the ward design, human interactions, the state and quality of personal space, and facilities for recreation and leisure. The novices' suggestions were organized into categories of elemental factors representing patient-friendly designs. Experts from the architectural and surveying professions and staff at SRHT in turn considered these categories and respective subsets of factors. They agreed with the novices in terms of the headings but differed in prioritizing the elemental factors. The questionnaire survey of past patients provided opinions about ward designs that varied according to where they stayed, single room, bay ward or long open ward. The main concerns were limitation of private space around the bed area, supportive of privacy and dignity, ward noise and other disturbances. CONCLUSIONS: Patients perceived sustainable health-care environments to be supportive of their health and recovery. The design indicators developed from their perspectives and from their considerations for improvements to the health-care built environment were based on their visions of the role of the health-care facilities. These were homely environments that supported normal lifestyle and family functioning and designs that were supportive of accessibility and travel movements through transitional spaces.

Focus Groups↗

PubMed2005

Effects of the home environment on school-aged children's sleep.

STUDY OBJECTIVE: Examine the relationship between the sleep behavior of elementary school-aged children and characteristics of the home environment. DESIGN: Cross-sectional analysis of children participating in a cohort study. SETTING: Cleveland Children's Sleep and Health Study, an ethnically mixed, urban, community-based cohort. PARTICIPANTS: Four hundred forty-nine children (50% girls, 46% African-American) aged 8 to 11 years. MEASUREMENTS AND RESULTS: Sleep and health data were obtained from a child-completed 7-day sleep journal and caregiver-completed health and sleep questionnaire. Home-environment predictors were Middle-Childhood Home Observation for Measurement of the Environment (MC-HOME) total score and Encouragement of Maturity and Physical Environment subscale scores. Sleep outcomes were mean nightly sleep duration, night-to-night variation in sleep duration, and bedtime of 11 PM or later. Adjusted analyses showed that higher Encouragement of Maturity subscale scores were associated with longer sleep duration (P < .05) and decreased odds of a bedtime at 11 PM or later (odds ratio = .74, 95% confidence interval, .58-.95). In girls, higher Encouragement of Maturity scores were also associated with decreased nightly variation in mean sleep duration (P < .001). Increases in total MC-HOME score were associated with increased mean sleep duration among African-American children only (P < .05). CONCLUSION: Collectively, results indicate that a parenting style encouraging social maturity in children is linked to healthier sleep patterns.

Child↗

PubMed2004

Representing older and disabled people in virtual user trials: data collection methods.

A database was developed to support the creation of a computer-based tool which will support design teams in evaluating the usability of a design during early prototyping and indicate which individuals are effectively excluded or designed out. Methods are described for the collection of multivariate data on 100 real individuals covering a range of physical characteristics and capabilities. These data were tested to ensure a breadth of representation of individuals (particularly older and disabled people) in terms of anthropometry, joint constraints, postural capabilities and task behaviours. The concept of the design tool itself is explored by conducting virtual user trials in the computer-aided design environment. The novel approach of the research encourages empathy with individual users and allows generic abilities, such as bending, reaching and lifting to be assessed.

Adolescent↗

PubMed2002

Scale-up of polymerization processes.

Scale-up and/or scale-down procedures are crucial during the development of chemical processes. These procedures should be integrated to form a multidisciplinary approach encompassing several branches of science and engineering. The challenge is to find a balance between chemistry, design, environment, hygiene and safety (EHS) compliance and economic factors. The iterative process of scale-up procedures also requires concept discrimination at early stages of process development. Scale-up studies should predict the reactor behavior and the quality and properties of a product from laboratory and pilot plant to full scale; however, not every pilot scale presents a valid industrial scaled-down size. A rational mathematical model describing the process reasonably well for large scale is important for designing industrial processing units, but this is only feasible if a phenomenological understanding is achieved, and if the necessary constants and parameters are estimated accurately. An accomplished process development procedure must lead to products presenting the same properties at both small and large scale.

Animals↗

PubMed2003

NOSTOS: a paper-based ubiquitous computing healthcare environment to support data capture and collaboration.

In this paper, we present a new approach to clinical workplace computerization that departs from the window-based user interface paradigm. NOSTOS is an experimental computer-augmented work environment designed to support data capture and teamwork in an emergency room. NOSTOS combines multiple technologies, such as digital pens, walk-up displays, headsets, a smart desk, and sensors to enhance an existing paper-based practice with computer power. The physical interfaces allow clinicians to retain mobile paper-based collaborative routines and still benefit from computer technology. The requirements for the system were elicited from situated workplace studies. We discuss the advantages and disadvantages of augmenting a paper-based clinical work environment.

Computer Peripherals↗

PubMed1982

[The sensory-integrative process and its influence on child development (author's transl)].

A child develops and learns skills by interacting with his environment. Play provides him with the sensory stimulation his brain needs in order to be able to allow him to respond in a meaningful way to these stimuli. Until the age of seven the brain is thus prepared for the challenges of the classroom. The neurologic problem in the child with a sensory integrative dysfunction prevents him from processing the sensations of his own play, so he cannot develop the adaptive responses that organize the brain and his actions. This child needs a specially designed environment in order to experience joy and satisfaction during his play, that allow him to learn higher skills and organize the brain functions. The purpose of this article is to clarify what sensory integration is and how it influences the child's development.

Attention Deficit Disorder with Hyperactivity↗

PubMed2000

Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis.

AIMS: To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN: Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS: Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS: Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS: Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.

Child↗

PubMed2005

Health@Home: the work of health information management in the household (HIMH): implications for consumer health informatics (CHI) innovations.

OBJECTIVE: Contemporary health care places enormous health information management demands on laypeople. Insights into their skills and habits complements current developments in consumer health innovations, including personal health records. Using a five-element human factors model of work, health information management in the household (HIMH) is characterized by the tasks completed by individuals within household organizations, using certain tools and technologies in a given physical environment. DESIGN: We conducted a descriptive-exploratory study of the work of HIMH, involving 49 community-dwelling volunteers from a rural Midwestern community. MEASUREMENTS: During in-person interviews, we collected data using semistructured questionnaires and photographs of artifacts used for HIMH. RESULTS: The work of HIMH is largely the responsibility of a single individual, primarily engaged in the tasks of acquiring, managing, and organizing a diverse set of health information. Paper-based tools are most common, and residents develop strategies for storing information in the household environment aligned with anticipated use. Affiliative relationships, e.g., parent-child or spousal, within the household serve as the organization that gives rise to health information management practices. Synthesis of these findings led to identification of several storage strategies employed in HIMH. These strategies are labeled "just-in-time," "just-because," "just-in-case," and "just-at-hand," reflecting location of the artifacts of health information and anticipated urgency in the need to retrieve it. CONCLUSION: Laypeople develop and employ robust, complex strategies for managing health information in the home. Capitalizing on these strategies will complement and extend current consumer health innovations to provide functional support to people who face increasing demands to manage personal health information.

Adolescent↗

PubMed2006

A pilot study in the application of texture relief for digitally designed facial prostheses.

This pilot research aims to identify and assess suitable technologies that may be used to capture, create, and produce fine textures and wrinkles that may be incorporated into computer aided prosthesis design and production techniques. A range of suitable technologies is identified and two methods that may be used in different prosthetic rehabilitation situations are assessed: the creation of three-dimensional relief in a computer aided design environment and the capture of facial anatomy and texture using fringe-projection surface scanning. Patterns were produced using the suitable rapid prototyping processes identified, and these were assessed by a qualified and experienced prosthetist. The suitability of the technologies is commented upon, limitations discussed, and future directions identified.

Computer Simulation↗

PubMed1986

Initial environment influences amphetamine-induced stereotypy: subsequently environment change has little effect.

Saline-treated and amphetamine-treated (7 mg/kg, ip, immediate) male rats from a Sprague-Dawley substrain were observed in two test environments designed to elicit different investigative responses in normal rats. Snout contact with the substrate was generated by placing the rat in a small enclosed cage. Absence of snout contact was induced by placement of the rat on a square elevated platform. Detailed ethological records were kept of locomotion, rearing, sitting, grooming, gnawing, and sleeping throughout the 90-min session. Amphetamine-treated rats incorporated environmentally contingent bodily postures into their forms of stereotyped behavior. The postures were characteristic of those evinced initially by the saline-treated rats in the same test environment. The control rats showed appropriate changes in their investigative behavior when the apparatus was changed at 10 and at 30 min postinjection. The amphetamine-treated rats, however, were completely unresponsive to such changes at 30 min and only partially so at 10 min postinjection. It was concluded that there is a temporal gradient of decreasing readiness to modify repetitive behavior after a single, large dose of amphetamine.

Amphetamine↗

PubMed1998

[Characteristics of the leadership of health center coordinators in the autonomous community of Murcia].

OBJECTIVE: To describe the style and effectiveness (adaptability) of the leadership of coordinators of an autonomous community according to the model of leadership on the ground, analysing its relationship with the work environment. DESIGN: Observational crossover study. SETTING: All the functioning teams in this community. PARTICIPANTS: Medical and nursing coordinators. MEASUREMENTS AND MAIN RESULTS: Hersey and Blanchard's questionnaire on leadership on the ground was employed. This identifies 1) the predominant style (scoring for style 0-12). On the approach of the coordinator to personal relationships and/or task development, it identifies 4 points: direction, persuasion, participation, delegation. 2) Adaptability of the manager (ranging from +24 to -24), based on that the best choice between different options depends on the maturity of the group. To contrast work environment and leadership, a validated questionnaire, adapted to our milieu, was used. Overall reply rate (51 coordinators) was 89.4%. Analysis of styles was: persuasive 5.05 points (SD = 1.25), participatory 4.74 (SD 1.76), directive 1.2 (SD 1.11) and delegating 0.34 (SD 0.68). Adaptability scored 8.38 points (SD = 4.67), and was greater for the nursing coordinators (p < 0.002) without differences for type, place or teaching qualifications. The work environment, both overall and by dimensions, correlated with adaptability, although no relationship was found with leaders' styles. CONCLUSIONS: Leadership adaptability was quite high and greater in nursing. The most prevalent styles were the persuasive and the participatory, more efficacious in teams of average maturity. Theoretical effectiveness was positively related to a better work environment.

Cross-Over Studies↗