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At least 127 records · Page 7Linked to original sources

PubMed2001

Numerical models for the simulation of flexible artificial heart valves: part I--computational methods.

A numerical model of the coupled motion of a flexing surface in a high Reynolds number flow is presented for the simulation of flexible polyurethane heart valves in the aortic position. This is achieved by matching a Lagrangian dynamic leaflet model with a panel method based flow solver. The two models are coupled via the time-dependent pressure field using the unsteady Bernoulli equation. Incorporation of sub-cycling in the dynamic model equations and fast pre conditioning techniques in the panel method solver yields efficient convergence and near real-time simulations of valve motion. The generality of dynamic model allows different material properties and/or geometries to be studied easily and interactively. This interactivity is realized by embedding the models within a design environment created using the software IRIS Explorer. Two flow domains are developed, an infinite domain and an internal domain using conformal mapping theory. In addition bending stress on the valve is computed using a simple stress model based on spline and circle equation techniques.

Biomechanical Phenomena↗

PubMed2004

Better speech perception in noise with an assistive multimicrophone array for hearing AIDS.

OBJECTIVE: To evaluate the improvement in speech intelligibility in noise obtained with an assistive real-time fixed endfire array of bidirectional microphones in comparison with an omnidirectional hearing aid microphone in a realistic environment. DESIGN: The microphone array was evaluated physically in anechoic and reverberant conditions. Perceptual tests of speech intelligibility in noise were carried out in a reverberant room, with two types of noise and six different noise scenarios with single and multiple noise sources. Ten normal-hearing subjects and 10 hearing aid users participated. The speech reception threshold for sentences was measured in each test setting for the omnidirectional microphone of the hearing aid and for the hearing aid in combination with the array with one and three active microphones. In addition, the extra improvement of five active array microphones, relative to three, was determined in another group of 10 normal-hearing listeners. RESULTS: Improvements in speech intelligibility in noise obtained with the array relative to an omnidirectional microphone depend on noise scenario and subject group. Improvements up to 12 dB for normal-hearing and 9 dB for hearing-impaired listeners were obtained with three active array microphones relative to an omnidirectional microphone for one noise source at 90 degrees . For three uncorrelated noise sources at 90 degrees, 180 degrees, and 270 degrees, improvements of approximately 9 dB and 6 dB were obtained for normal-hearing and hearing-impaired listeners, respectively. Even with a single noise source at 45 degrees, benefits of 4 dB were achieved in both subject groups. Five active microphones in the array can provide an additional improvement at 45 degrees of approximately 1 dB, relative to the three-microphone configuration for normal-hearing listeners. CONCLUSIONS: These improvements in signal-to-noise ratio can be of great benefit for hearing aid users, who have difficulties with speech understanding in noisy environments.

Adolescent↗

PubMed1997

Nutritional status in adults in the pluri-ethnic population of New Caledonia. The CALDIA Study Group.

OBJECTIVE: To describe the nutritional status (body mass index (BMI) and waist-hip ratio (WHR)) of the population of New Caledonia in relation to ethnicity and urban-rural environment. DESIGN: Diabetes screening survey in two rural provinces of New Caledonia and in the suburbs of Noumea. SUBJECTS: 8875 subjects aged 30-59 y, Europeans, Melanesians and Polynesians. MEASUREMENTS: BMI, WHR. RESULTS: Obesity (BMI > or = 27 kg/m2 in men, 25 kg/m2 in women) was highly prevalent in all groups, but varied according to ethnicity: respectively, 43% and 52% in Europeans, 46% and 72% in Melanesians, 72% and 83% in Polynesians. In the urban area, mean WHR values, adjusted for age and BMI, were significantly higher than in rural areas, especially in Melanesians. CONCLUSION: Both ethnicity and urban-rural environment are linked to the amount and distribution of adiposity, which appeared worsened in the urban area in Europeans, and even more in Melanesians.

Adult↗

PubMed2003

Neurocranial suture autotransplantation and periosteal dura stripping to provide a passive growth site in craniosynostosis--a case report.

AIM: The behaviour of a neurocranial suture autograft in a plagiocephalic infant is described. PATIENT AND METHODS: In a 7-month-old girl, born with right-sided unicoronal synostosis, part of the left-sided unicoronal suture was transplanted to the right-sided synostosectomy site. Also, in the pathological area, the periosteal 'layer' of the dura was surgically removed. The suture autotransplantation was integrated into the classical concept of radical remodelling, planned in a computer design environment. Growth of the suture was monitored by CT. RESULTS: Suture patency and osseous growth within the autograft could be demonstrated over a 1-year period. CONCLUSION: Neurocranial suture autotransplantation together with the prohibition of fusion-inducing dural signals seems to be a promising technique in the treatment of certain premature synostoses. This warrants a prospective clinical trial.

Bone Transplantation↗

PubMed2006

Human spatial navigation deficits after traumatic brain injury shown in the arena maze, a virtual Morris water maze.

OBJECTIVE: Survivors of traumatic brain injury (TBI) often have spatial navigation deficits. This study examined such deficits and conducted a detailed analysis of navigational behaviour in a virtual environment. DESIGN: TBI survivors were tested in a computer simulation of the Morris water maze task that required them to find and remember the location of an invisible platform that was always in the same location. A follow-up questionnaire assessed everyday spatial ability. METHOD: Fourteen survivors of moderate-to-severe TBI were compared to 12 non-injured participants. RESULTS: TBI survivors navigated to a visible platform but could not learn the location of the invisible platform. The difference between TBI survivors and uninjured participants was best indicated by two new dependent variables, path efficacy and spatial scores. CONCLUSION: This study confirms the capacity of virtual environments to reveal spatial navigation deficits after TBI and establishes the best way to identify such deficits.

Adult↗

PubMed1998

Current limitations into the application of virtual reality to mental health research.

Virtual Reality (VR) environments have significant potential as a tool in mental health research, but are limited by technical factors and by mental health research factors. Technical difficulties include cost and complexity of virtual environment creation. Mental health research difficulties include current inadequacy of standards to specify needed details for virtual environment design. Technical difficulties are disappearing with technological advances, but the mental health research difficulties will take a concerted effort to overcome. Some of this effort will need to be directed at the formation of collaborative projects and standards for how such collaborations should proceed.

Computer Simulation↗

PubMed1994

[Pregnancy and childbirth in adolescents].

OBJECTIVE: To establish what the most common complications are in the pregnancies of adolescent women in our environment. DESIGN: Retrospective study. SETTING: Pregnant women who had their children in the Ciudad de Jaén Maternity Centre. PATIENTS: Pregnant women who gave birth in our centre in 1991 and 1992. The study group was composed of 104 adolescents (under 19 years old) and the control group by 7,824 non-adolescent pregnant women during this same period. MEASUREMENTS AND MAIN RESULTS: The most common general complication is the threat of premature delivery, which was more common in pregnant women under 19 than in the control group (p < 0.001). There was no higher incidence among the adolescents of any other medical or obstetric pathology, including the frequency of Caesarean deliveries and neonatal morbidity/mortality. CONCLUSIONS: In our environment, the most common complication in adolescent pregnancies is the threat of premature birth. For other pathologies there are no differences from other women.

Adolescent↗

PubMed2001

Designing humanistic critical care environments.

The critical care environment can be designed to become more humanistic. Consideration of the environmental challenges of noise, lights, color, views, temperature, and comfort is essential. This article identifies the issues and concerns in the design of more humanistic healing in critical care units. Strategies to improve the environment include improving the physical and emotional tone of the unit through creative design, family and pet visitation, sleep promotion, and aromatherapy among others. In a life-threatening illness, attention paid to these concerns may significantly improve quality of life for patients and family.

Facility Design and Construction↗

PubMed1995

Compliance with recommendations for universal precautions among prehospital providers.

STUDY OBJECTIVE: To evaluate the compliance of emergency medical responders with local employer and Centers for Disease Control and Prevention recommendations for disposal of sharps and use of personal protective equipment in the prehospital environment. DESIGN: Prospective, single-blinded observational study of 297 ambulance runs conducted for 3 months. SETTING: A metropolitan emergency medical service system. PARTICIPANTS: Sixty-nine emergency medical technicians and paramedics. INTERVENTIONS: None. RESULTS: Observers recorded the handling of sharps and the use of personal protective equipment in four situations: i.v. line placement, endotracheal intubation, large-wound management, and body fluid hazard. Emergency medical workers properly handled sharps in 24 of 65 situations (37%). They were usually compliant with glove use during the observed procedures. However, compliance with the use of other personal protective equipment was poor. CONCLUSION: Sharps were often improperly handled. Most workers complied with recommendations for the use of gloves but often underused goggles, masks, and gowns. Although education and restructuring of the environment and equipment may improve compliance, strong consideration should be given to developing standardized and more practical recommendations for the prehospital environment.

Centers for Disease Control and Prevention, U.S.↗

PubMed2006

The effect of urban quality improvements on economic activity.

This paper is concerned with the link between urban quality improvements and economic activity. A key question is whether improvements in the urban environment which might be achieved, for instance, through pedestrianisation, will affect business location choices--for example, are office or retail businesses particularly keen to locate in more pleasant urban places? The paper outlines the current state of development of the literature with respect to the influence of urban quality on economic activity, and proposes a framework for forecasting economic impacts based on three communities of reference: customers, employees, and the businesses themselves. The results from original modelling of a case study area in Manchester, England are reported and suggest that the positive uplifts that may be expected from environmental improvement programmes may well be on a scale which is significant. The research is obviously important for the urban regeneration and renaissance agendas which posit attractive and well-designed environments as a way to create the right conditions for promoting economic growth.

Community-Institutional Relations↗

PubMed1999

Color discrimination, color naming and color preferences in 80-year olds.

The aim of the present study was to investigate color discrimination, color naming and color preference in a random sample of 80-year-old men and women. Knowledge of color perception in old age can be of value when using color contrast, cues and codes in the environment to promote orientation and function. The color naming test indicated that the colors white, black, yellow, red, blue and green promoted recognition to the highest degree among all subjects. A gender-related difference, in favor of women, occurred in naming five of the mixed colors. Women also used more varied color names than men. Color discrimination was easier in the red and yellow area than in the blue and green area. This result correlates positively with visual function on far sight, and negatively with diagnosis of a cataract. The preference order for seven colors put blue, green and red at the top, and brown at the bottom, hence agreeing with earlier studies, and indicating that the preference order for colors remains relatively stable also in old age. This result should be considered when designing environments for old people.

Aged↗

PubMedDate not supplied

A medical image object-oriented database with image processing and automatic reorganization capabilities.

The paper presents the medical image database developed for use in the methodological research environment and in the laboratory clinical environment, designed to be capable of being interfaced to an image processing system. This database is intended to solve the numerous problems due to the complexity-multidimensionality and multimodality-of medical images. These problems are posed in terms of management, archiving, structuring and accessing of this archive, and specification of the interfaces with users and with image processing system Solving these problems involves making a formal description of the image and the data associated with the image, while taking into account the specifics of medical imaging. The kernel which contains this description allows the physical architecture of the management and archiving system to be decoupled from its logical architecture. This decoupling is essential in order to automate the recording of new data, the automatic reorganization of the system scheme in the event of change in the system environment, and to help in consulting the database.

Algorithms↗

PubMed2001

Incidence of asthma diagnosis and self-reported allergy in relation to the school environment--a four-year follow-up study in schoolchildren.

SETTING: In schools, the indoor air quality is often poor and there is growing concern about its impact on the pupils' health. OBJECTIVE: To study the incidence of asthma diagnosis and self-reported allergy in schoolchildren in relation to the school environment. DESIGN: Data on asthma and allergies were collected through a postal questionnaire answered in 1993 and 1997 by 1347 (78%) pupils (initially aged 7-13 years) in 39 randomly chosen schools. Indoor pollutants were measured in about 100 classrooms in 1993 and 1995. Relationships between indoor pollutants and incidence of asthma diagnosis and self-reported allergy were studied by multiple logistic regression, adjusting for age, sex, atopy and smoking. RESULTS: The incidence of asthma diagnosis was higher in pupils attending schools with more settled dust and more cat allergen (Fel d 1) in this dust. Incidence of self-reported furry pet allergy was higher in schools with more respirable particles. Among children without a history of atopy, a new asthma diagnosis was more common at higher concentrations of formaldehyde and total moulds in the classroom air. CONCLUSION: A school environment with more dust, cat allergen, formaldehyde and moulds may affect the incidence of asthma and sensitivity to furry pets in schoolchildren.

Adolescent↗

PubMed2006

Teaching internal medicine residents in the new era. Inpatient attending with duty-hour regulations.

BACKGROUND: Little is known about the impact of resident duty-hour regulations on the inpatient teaching experience. OBJECTIVE: Provide descriptive information on the effect of resident duty-hour regulations on attendings and the educational environment. DESIGN: Qualitative analysis of attending focus groups and e-mail survey of residents in Internal Medicine. PARTICIPANTS: Inpatient attending physicians at 2 academic centers and residents at the affiliated university-based Internal Medicine residency program in Portland, OR. RESULTS: Seventy-two percent of eligible attendings participated in 2 focus groups. Three themes were generated: increased clinical role, altered time management, and altered teaching. Attending physicians report performing more clinical work, teaching less, using more focused teaching methods, and experiencing an increased perception of intensity. Forty percent of eligible residents completed our e-mail survey. We organized residents data using the same 3 themes as attending physician data. Residents observed attending physicians performing increased clinical work, being more time aware, delivering more focused teaching, and having less time to teach. Participants noted changes in autonomy and professionalism. Strategies to enhance teaching effectiveness in the new environment were described. CONCLUSION: Duty-hour regulations have increased attending clinical responsibility and decreased teaching time in 1 residency program, leading to the perception of a more intense attending experience. Duty-hour regulations encourage educators to determine what is critical to preserve in the educational experiences of learners and challenge us to reexamine autonomy and professionalism in training.

Attitude of Health Personnel↗

PubMed1997

Can students learn clinical method in general practice? A randomised crossover trial based on objective structured clinical examinations.

OBJECTIVE: To determine whether students acquired clinical skills as well in general practice as in hospital and whether there was any difference in the acquisition of specific skills in the two environments. DESIGN: Randomised crossover trial. SUBJECTS AND SETTING: Annual intake of first year clinical students at one medical school. INTERVENTION: A 10 week block of general internal medicine, one half taught in general practice, the other in hospital. Students started at random in one location and crossed over after five weeks. OUTCOME MEASURES: Students' performance in two equivalent nine station objective structured clinical examinations administered at the mid and end points of the block: a direct comparison of the two groups' performance at five weeks; analysis of covariance, using their first examination scores as a covariate, to determine students' relative improvement over the second five weeks of their attachment. RESULTS: 225 students rotated through the block; all took at least one examination and 208 (92%) took both. For the first half of the year there was no significant difference in the students' acquisition of clinical skills in the two environments; later, however, students taught in general practice improved slightly more than those taught in hospital (P = 0.007). CONCLUSIONS: Students can learn clinical skills as well in general practice as in hospital; more work is needed to clarify where specific skills, knowledge, and attitudes are best learnt to allow rational planning of the undergraduate curriculum.

Clinical Competence↗

PubMed2005

Outcome measurement in Australian rehabilitation environments.

OBJECTIVE: To determine the frequency and pattern of methods of outcome assessment used in Australian physical rehabilitation environments. DESIGN: Postal survey. METHODS: A questionnaire on service type, staffing, numbers of adults treated and outcome measures used for 7 conditions related to injury and road trauma as well as stroke and neuromuscular disorders was sent to 973 services providing adult physical rehabilitation treatment. RESULTS: Questionnaires were completed by 440 service providers for a response rate of 45%, similar to that reported in a recent European survey reported in this journal. A small number of measures were reported as in use by most respondents, while a large number of measures were used by a few respondents. Measures of physical changes were used more frequently than those of generic well-being or quality of life. Ease of use and reporting to other professionals were cited as the most important reasons in selection of outcome measures. CONCLUSION: This Australian-wide survey detected considerable heterogeneity in outcome measurement procedures used in rehabilitation environments. While the goal of measurement may vary between providers and differ between conditions, the results highlight opportunities for harmonization, bench-marking and measurement of health-related quality of life.

Adult↗

PubMed1992

Electrocardiographic abnormalities and associated factors in Chinese living in Beijing and in Mauritius. The Mauritius Non-Communicable Disease Study Group.

OBJECTIVE: To compare the prevalence of electrocardiographic abnormalities and to evaluate the association between these abnormalities and the levels of coronary heart disease among Chinese living in different environments. DESIGN: Cross sectional surveys. SETTING: Beijing, China, and the island of Mauritius. SUBJECTS: Random samples of people aged 35-64 years in Beijing (621 men, 642 women) in 1984 and in Mauritius among Chinese (137 men, 130 women) and non-Chinese (1265 men, 1432 women) in 1987. MAIN OUTCOME MEASURES: Prevalence of electrocardiographic abnormalities suggesting coronary heart disease and of associated risk factors. RESULTS: Prevalence of electrocardiographic abnormalities suggesting coronary heart disease was significantly lower in Beijing (4.0%) than in Mauritian Chinese (24.3%) and Mauritian non-Chinese (24.5%). Mean serum concentrations of total and non-high density lipoprotein cholesterol were lower in Beijing Chinese than in Mauritian Chinese, but smoking and hypertension were slightly more prevalent. Overall, men with electrocardiographic abnormalities had higher risk factor levels than those with a normal electrocardiogram regardless of ethnic origin. CONCLUSIONS: The prevalence of coronary heart disease and associated risk factors was different among Chinese living in two different environments: in Beijing in the People's Republic of China and in Mauritius. Chinese, who traditionally have a very low frequency of coronary heart disease, are by no means protected against coronary heart disease and other non-communicable diseases. Therefore, primary prevention of coronary heart disease is a major challenge for preventive medicine in China, as well as in many other developing countries.

Adult↗

PubMedDate not supplied

Out-of-hospital use of a pulse oximeter to determine systolic blood pressures.

STUDY OBJECTIVE: Blood pressure (BP) in the out-of-hospital setting is one of the most important diagnostic tools used by emergency medical services (EMS) providers. Conventional methods of palpation and auscultation can be time consuming, and the measurements often are inaccurate because of the adverse working conditions encountered. Pulse oximetry waveform systolic blood pressure (POWSBP) measurement has been used successfully in emergency departments to monitor BP. The objective of this study was to compare the accuracy of field POWSBP measurements obtained by noninvasive electronic BP measurement (NIBPM), auscultation, and palpation in the out-of-hospital environment. DESIGN: Blood pressure measurements used for this study were obtained by POWSBP, NIBPM (PROPAQ model 102; Protocol Systems, Beaverton, Oregon USA), auscultation, and palpation on patients in moving ambulances. Measurement of POWSBP was accomplished by observing the return of the waveform on the pulse oximeter at the time of cuff deflation. The order in which the readings were obtained as well as the arm chosen for measurement were randomized. SETTING AND PARTICIPANTS: Paramedics and emergency medical technicians in an urban, inner-city emergency medical services (EMS) system. MEASUREMENTS AND MAIN RESULTS: Blood pressure measurements were sampled from 69 patients. Regression analysis identified significant correlation between POWSBP and the four methods utilized, with r = 0.92 for NIPBM, r = 0.95 for auscultation, and r = 0.97 for palpation, all significant at p < 0.0001. CONCLUSIONS: The use of POWSBP measurement is a fast, easy, and accurate technique with which to measure systolic BP in the field. It may have special importance for noisy environments and moving vehicles in which conventional methods of auscultation or palpation may be difficult.

Adolescent↗