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At least 1,333 records · Page 74Linked to original sources

PubMed2006

Comparison of patella lead with blood lead and tibia lead and their associations with neurobehavioral test scores.

OBJECTIVE: Lead exposure in adults is associated with worse cognitive function in cross-sectional and longitudinal studies. Previous studies have mainly examined relations with blood lead or cortical bone lead; few have examined trabecular bone lead. METHODS: We performed a cross-sectional analysis of the relations of patella lead and other lead biomarkers with measures of neurobehavioral and peripheral nervous system function in 652 lead workers. RESULTS: Patella lead was found to be associated with worse performance on seven of 19 tests of manual dexterity, sensory vibration threshold, and depressive symptoms. The associations of patella lead with cognitive function were essentially similar to those with blood lead or tibia lead but of somewhat lower magnitude. CONCLUSIONS: In this study, measurement of patella lead did not aid causal inference regarding cognitive effects when compared with blood lead and tibia lead.

Adult↗

PubMed2004

Initial evaluation of robotic technology for microsurgical vasovasostomy.

PURPOSE: Conventional microscope assisted vasovasostomy (MAVV) is a technically difficult procedure that is most successful in the hands of well-trained microsurgeons. Robotics may help surgeons overcome the microsurgical challenges of tremor, limited dexterity, miniaturized instrumentation and use of fine suture. We determine the feasibility of a robotic assisted vasovasostomy (RAVV) and compare performance measures with those of conventional MAVV. MATERIALS AND METHODS: One surgeon performed 10 vasovasostomies with a modified 1-layer technique and 9-zero suture on fresh human vas specimens using the robot in 5 RAVV cases and standard microsurgical instrumentation in 5 MAVV cases. Pre-specified performance measures and adverse haptic events (broken sutures, bent needles or loose stitches) were recorded. Patency was evaluated by instilling saline through the anastomoses. RESULTS: Mean operating time and number of adverse haptic events were higher for RAVV than for MAVV (84 vs 38 minutes, p = 0.01; 2.4 vs 0.0 events, p = 0.03). The number of needle passes required for the 6 full-thickness stitches was similar in both groups (16.8 vs 15.2 passes, p = 0.55). Although no tremor occurred during RAVV, minimal to moderate amounts occurred during MAVV. Minimal fatigue was noted for both groups. Patency was confirmed in all 10 operations. CONCLUSIONS: Use of RAVV in this human ex vivo vas model was feasible. While RAVV took longer to perform and was associated with adverse haptic events, elimination of tremor and comparable patency rates suggest that it may be a viable surgical alternative for microsurgical vasovasostomy.

Equipment Design↗

PubMed2006

The learning curve in stapes surgery and its implication to training.

OBJECTIVE: To identify the stapedotomy learning curve of two U.K. otolaryngologists. STUDY DESIGN: A retrospective review of the outcome of first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by U.K. otolaryngologists. SETTING: Two tertiary referral centers. PATIENTS: All ears in which primary stapedotomy was performed for otosclerosis. Nonotosclerotic cases and malleus stapedotomy cases were excluded. INTERVENTION: One surgeon used the technique of small fenestra stapedotomy with either a Teflon-wire or titanium piston but without vein graft interposition, whereas the second used the technique of stapedotomy with vein graft interposition and a Teflon piston. MAIN OUTCOME MEASURES: A moving average with a window of 15 dB was used to plot learning curves for the postoperative air-bone gaps. Using a postoperative air-bone gap of 20 dB or better as a definition of 'success,' the success rates with the increase in surgical experience of both surgeons were plotted on graphs, the learning curves. The end point of the learning curve was defined as the point where the curve reached its peak, and the results were sustainable. RESULTS: There was no clear-cut end point in both learning curves, although it appears that there is a landmark point at 60 to 80 cases for both surgeons. Both surgeons also had one "dead ear" in their first 15 cases. The postal survey showed that some trainers only performed small numbers of stapes surgery, whereas some otolaryngologists who performed stapedotomies regularly were not trainers. CONCLUSIONS: The study supports a learning curve in stapes surgery. To maximize the training opportunity of trainee surgeons, it may be advisable for learning centers to form network to provide target training for the trainee who has demonstrated the necessary dexterity and temperament of an otologist.

Adult↗

PubMed2003

Measuring population health: a comparison of three generic health status measures.

OBJECTIVES: The relative performance of three widely used generic health status measures (EQ-5D, a modified HUI3 [mHUI3], and SF-12) was compared within a general population sample. MATERIALS AND METHODS: Data were taken from a cohort of persons identified from the patient list of a large general practice in York, UK. Two-way comparisons were made between EQ-5D and mHUI3 and EQ-5D and SF-12. The measures were assessed in terms of their practical viability, coverage, and discrimination. Practical viability was evaluated in terms of the extent of missing responses and the proportion indicating difficulty with a measure. Coverage examined the range of responses across the items in the measures. Discrimination examined the capacity of the measures to discriminate between persons according to their self-reported morbidity and socioeconomic status. RESULTS: One thousand one hundred twenty-six persons completed a postal questionnaire containing EQ-5D and either mHUI3 (n = 593) or SF-12 (n = 533). Missing responses were low across all three instruments. SF-12 showed a broad distribution of responses across its items however, responses on the mHUI3 hearing, speech and dexterity dimensions and the EQ-5D self-care dimension were highly skewed, with few persons reporting problems. In terms of summary scores, mHUI3 identified more mild health states than EQ-5D. EQ-5D and mHUI3 showed slightly better discrimination than SF-12. CONCLUSIONS: Despite the inherent differences in their descriptive systems and scoring functions, no one instrument performed better or worse than the other with respect to the criteria applied in this study. Some of the issues to be considered when choosing a population health measure are discussed.

Adolescent↗

PubMed2006

Training in laparoscopic urology.

PURPOSE OF REVIEW: Training in laparoscopy has become an important issue in the current surgical scenario. In this overview we aim to update the current knowledge in the field of laparoscopic urological training and to highlight the potential dangers of using simulation for accreditation and selection purposes at this stage. RECENT FINDINGS: Physical simulators are widely available and seem to be equally efficient as virtual reality simulators. Transfer of training has been proven to be beneficial in randomized controlled trials for virtual reality and cholecystectomy. A model for the vesico-urethral suture has been described and integrated in a skills laboratory program. The program has construct validity and can discriminate at least between beginners and advanced laparoscopists. Efforts have still to be made in defining appropriate tools to assess competence and evidence for reliability, and validity must be obtained before including simulators in accreditation programs. SUMMARY: In spite of the abundant literature there is still little evidence about the learning mechanism involved in acquiring laparoscopic skills. Physical and virtual reality simulators have been proven to be efficient in improving dexterity and some evidence exists of a positive transfer from virtual reality to the operating room in cholecystectomy. Very few models, however, have been described for reconstructive urology, and effective transfer to the operating room has not yet been proven, although validation work is in progress in the field of urology.

Clinical Competence↗

PubMedDate not supplied

Evaluation of timed tests in advanced Parkinsonian patients who were candidates for subthalamic stimulation.

UNLABELLED: The evaluation of Parkinson disease relies on the use of clinical scales, mainly the UPDRS. However, especially for those candidates for functional surgery, other objective methods are also considered, including the use of timed tests. METHODS: The authors studied the motor performance of 33 patients with advanced Parkinson disease (PD) who were candidates for subthalamic nucleus (STN) stimulation. Presurgical motor evaluation included UPDRS and the 4 timed tests of the CAPIT protocol, including pronation-supination (PS), finger dexterity (FD), movement between 2 points (MTP), and the walking test (WT). A clinical evaluation was performed during patients' OFF condition and during their best ON state. Fifteen patients were implanted with STN stimulation and were evaluated at 6 months with the same protocol described for the presurgical evaluation. RESULTS: At baseline, all 4 timed tests significantly correlated with total and motor UPDRS scores, in the OFF and ON states, especially MTP. All timed tests, save WT, significantly improved after surgery in the OFF state (especially MTP; P = 0.002). After surgery, all timed tests, save FD, significantly correlated with total and motor UPDRS scores in the OFF state. Timed tests, especially MTP, maintained an excellent correlation with UPDRS in both OFF and ON states before and after surgery.

Aged↗

PubMed1983

Functional status in ulnar deficiency.

Function is the most important consideration in the evaluation of patients with congenital ulnar deficiency. The upper extremity function of 8 patients with ulnar deficiency was evaluated. None of these patients had been treated with surgical procedures directed to the elbow, forearm, or wrist. The functional criteria included: (a) active ranges of elbow, forearm, and wrist motion, (b) power grip, (c) prehension, (d) dexterity, and (e) a patient's activities questionnaire. The averaged total active range of joint motion was 229 degrees or 46% of predicted normal active motion. Power grip averaged 27% of the contralateral extremity, and prehension tests were generally well performed. Timed tests were completed an average of 11.6 s slower than the contralateral control hand. Our patients did not report any deficiencies in bimanual activities. Patients performed most poorly when their congenital anomaly included radiohumeral synostosis or congenital absence, deformity, or contracture of the ipsilateral digits. The radiographic appearances or classification of the ulnar deficiency, in the absence of radiohumeral synostosis, did not correlate well with patient function.

Adolescent↗

PubMed2004

Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases.

Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases. This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000-01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (< or = 0.5 and 0.06-1.0) and certain chronic conditions. Age- and sex-adjusted Odds Ratio (OR) and p values showed an effect among individuals diagnosed with each chronic disease on the overall HUI score. Results of this study showed that arthritis/rheumatism, heart disease, high blood pressure, cataracts, and diabetes had a severe impact on HRQL. Urinary incontinence, Alzheimer/other dementia, effects of stroke, cancers, thyroid condition, and back problems have a moderate impact. Food allergy, allergy other than food, asthma, migraine headaches, and other remaining chronic diseases have a relatively mild effect. It is concluded that major chronic diseases with significant health burden were associated with poor HRQL. The HUI scores facilitate the measurement and interpretation of results of health burden and the HRQL for individuals with chronic diseases and can be useful for development of strategies for the prevention and control of chronic diseases.

Adolescent↗

PubMed2006

Evaluation and measurement of health-related quality of life for individuals with diabetes mellitus by Health Utilities Index Mark 3 (HUI3) system.

The Health Utilities Index Mark 3 (HUI3) is an important indicator when measuring the health-related quality of life (HRQOL) and assessing the burden of disease, especially for chronic conditions such as diabetes mellitus (DM). The objectives of this study were to evaluate the scores of HRQOL for respondents with DM to examine associations between overall HUI3 scores and eight component attributes, and various sociodemographic and lifestyle attributes, and by doing so, provide information to improve the HRQOL of individuals with diabetes. The study was based on the Canadian National Population Survey (NPHS) longitudinal data, from 1994-1995 to 2002-2003. We evaluated overall HUI3 scores and eight attributes (vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain) between respondents with and without diabetes in relation to demographic characteristics (age, sex, lifestyle, and socioeconomic status using ANCOVA[analysis of covariance]). Awareness of diabetes appeared to affect the HRQOL of older age groups more so than younger age groups (p < 0.01). Diabetes also appeared to have a greater impact on males' quality of life compared to females', and among individuals with single marital status and low socioeconomic status (p < 0.01). These findings add to what is known about cognitive representations and the self-regulation of diabetes as well as the relationships between cognitive representations of diabetes, HRQOL, and behavioral factors. In particular, results from this study suggest the need to address ways of reducing the burden of diabetes associated with health behaviours, and increasing the quality of life for the individuals with diabetes in Canada.

Adolescent↗

PubMed2025

Human-specific features of the cerebellum and ZP2-regulated synapse development.

Understanding the unique features of the human brain compared to non-human primates has long intrigued humankind. The cerebellum refines motor coordination and cognitive functions, contributing to the evolutionary development of human adaptability and dexterity. To identify shared and divergent features across primates, we conducted single-nucleus transcriptomic and chromatin accessibility profiling of the adult cerebellar cortex in humans, chimpanzees, macaques, and marmosets. We revealed human-specific transcriptomic and regulatory features, particularly those involved in synaptogenesis. Notably, we identified an enrichment of the sperm receptor zona pellucida glycoprotein 2 (ZP2) and its potential interactors, known for their roles in gamete interaction, in human granule cells. Experimental data show that ZP2 expression in human granule cells is induced by pontine mossy fibers, reducing synaptic proteins at pontocerebellar glomerular synapses, and decreasing cerebellar neuron electrophysiological activity. This unexpected co-option of ZP2 in human-specific synapse regulation provides insights into the evolutionary specialization of the human cerebellum.

Brain evolution↗

PubMed2004

Methods for haptic feedback in teleoperated robot-assisted surgery.

Teleoperated minimally invasive surgical robots can significantly enhance a surgeon's accuracy, dexterity and visualization. However, current commercially available systems do not include significant haptic (force and tactile) feedback to the operator. This paper describes experiments to characterize this problem, as well as several methods to provide haptic feedback in order to improve surgeon's performance. There exist a variety of sensing and control methods that enable haptic feedback, although a number of practical considerations, e.g. cost, complexity and biocompatibility, present significant challenges. The ability of teleoperated robot-assisted surgical systems to measure and display haptic information leads to a number of additional exciting clinical and scientific opportunities, such as active operator assistance through "virtual fixtures" and the automatic acquisition of tissue properties.

Journal Article↗

PubMed1997

Robots in space into the 21st century.

Describes the technological developments which are establishing the foundation for an exciting era of in situ exploration missions to planets, comets and asteroids with advanced robotic systems. Also outlines important concurrent terrestrial applications and spinoffs of the space robotics technology. These include high-precision robotic manipulators for microsurgical operations and dexterous arm control systems.

Electronics↗

PubMed2001

A wavelet-based continuous classification scheme for multifunction myoelectric control.

This work represents an ongoing investigation of dexterous and natural control of powered upper limbs using the myoelectric signal. When approached as a pattern recognition problem, the success of a myoelectric control scheme depends largely on the classification accuracy. A novel approach is described that demonstrates greater accuracy than in previous work. Fundamental to the success of this method is the use of a wavelet-based feature set, reduced in dimension by principal components analysis. Further, it is shown that four channels of myoelectric data greatly improve the classification accuracy, as compared to one or two channels. It is demonstrated that exceptionally accurate performance is possible using the steady-state myoelectric signal. Exploiting these successes, a robust online classifier is constructed, which produces class decisions on a continuous stream of data. Although in its preliminary stages of development, this scheme promises a more natural and efficient means of myoelectric control than one based on discrete, transient bursts of activity.

Algorithms↗

PubMed2000

An active contour model for measuring the area of leg ulcers.

Leg ulcers are chronic skin wounds that affect many people and take a long time to heal. The progress of wound healing and the effect of clinical treatments can be monitored partly by measuring the area of the wound. Measurements taken via manually based methods, such as using a computer pointing device to delineate the wound boundary in a digitized image, suffer from variations due to manual dexterity and differences of opinion between observers. An active contour model is presented that models the contour using piecewise B-spline arcs and uses the minimax principle to adaptively regularize the contour according to the local conditions in the wound image. The model makes use of the existing manual delineation process in order to initialize the solution and is shown to reduce the effect of the inherent variations upon the repeatability and consistency of area measurements in many cases.

Computer Simulation↗

PubMed1999

A biomimetic controller for a multifinger prosthesis.

A novel controller for a multifinger hand prosthesis was developed and tested to measure its accuracy and performance in transducing volitional signals for individual "phantom" fingers. Pneumatic sensors were fabricated from open-cell polymeric foam, and were interposed between the prosthetic socket and superficial extrinsic tendons associated with individual finger flexion. Test subjects were prompted to move individual fingers or combinations thereof to execute either taps or grasps. Sensor outputs were processed by a computer that controlled motions of individual fingers on a mechanical prosthesis. Trials on three upper-limb amputees showed that after brief training sessions, the TAP controller was effective at producing voluntary flexions of individual fingers and grasping motions. Signal energies were between 5 and 25 dB relative to noise from all sources, including adjacent sensors, indicating high degrees of both sensitivity and specificity for tendon-associated transduction. Finger flexions at up to three repetitions per second, and rhythmic tapping of sequential fingers were readily transduced. One amputee subject was able to play a short piano piece with three fingers, at approximately one-quarter normal tempo. TAP sensors responded linearly to graded forces from individual fingers, indicating proportional force control. Our results demonstrate the feasibility of restoring some degree of finger dexterity by noninvasive sensing of extrinsic tendons.

Amputees↗

PubMed2003

A robust, real-time control scheme for multifunction myoelectric control.

This paper represents an ongoing investigation of dexterous and natural control of upper extremity prostheses using the myoelectric signal (MES). The scheme described within uses pattern recognition to process four channels of MES, with the task of discriminating multiple classes of limb movement. The method does not require segmentation of the MES data, allowing a continuous stream of class decisions to be delivered to a prosthetic device. It is shown in this paper that, by exploiting the processing power inherent in current computing systems, substantial gains in classifier accuracy and response time are possible. Other important characteristics for prosthetic control systems are met as well. Due to the fact that the classifier learns the muscle activation patterns for each desired class for each individual, a natural control actuation results. The continuous decision stream allows complex sequences of manipulation involving multiple joints to be performed without interruption. Finally, minimal storage capacity is required, which is an important factor in embedded control systems.

Action Potentials↗

PubMed2005

Continuous myoelectric control for powered prostheses using hidden Markov models.

This paper represents an ongoing investigation of dexterous and natural control of upper extremity prostheses using the myoelectric signal. The scheme described within uses a hidden Markov model (HMM) to process four channels of myoelectric signal, with the task of discriminating six classes of limb movement. The HMM-based approach is shown to be capable of higher classification accuracy than previous methods based upon multilayer perceptrons. The method does not require segmentation of the myoelectric signal data, allowing a continuous stream of class decisions to be delivered to a prosthetic device. Due to the fact that the classifier learns the muscle activation patterns for each desired class for each individual, a natural control actuation results. The continuous decision stream allows complex sequences of manipulation involving multiple joints to be performed without interruption. The computational complexity of the HMM in its operational mode is low, making it suitable for a real-time implementation. The low computational overhead associated with training the HMM also enables the possibility of adaptive classifier training while in use.

Action Potentials↗

PubMedDate not supplied

Development of anthropomorphic multi-D.O.F. master-slave arm for mutual telexistence.

We developed a robotic arm for a master-slave system to support "mutual telexistence," which realizes remote dexterous manipulation tasks and close physical communication with other people using gestures. In this paper, we describe the specifications of the experimental setup of the master-slave arm to demonstrate the feasibility of the mutual telexistence concept. We developed the master arm of a telexistence robot for interpersonal communication. The last degree of the 7-degree-of-freedom slave arm is resolved by placing a small orientation sensor on the operators arm. This master arm is made light and impedance control is applied in order to grant the operator as much freedom of movement as possible. For this development stage, we compared three control methods and confirmed that the impedance control method is the most appropriate to this system.

Arm↗