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PubMed1999

Fecal and oral shedding of Helicobacter pylori from healthy infected adults.

CONTEXT: Helicobacter pylori commonly infects humans; however, its mode of transmission remains unknown. OBJECTIVE: To determine how humans-the primary host for H pylori-shed the organism into the environment. DESIGN: Controlled clinical experimental study conducted from February through December 1998. SETTING: Clinical research unit of a hospital in northern California. PATIENTS: Sixteen asymptomatic H pylori-infected and 10 uninfected adults. INTERVENTION: A cathartic (sodium phosphate) and an emetic (ipecac) were given to all infected subjects and an emetic was given to 1 uninfected subject. MAIN OUTCOME MEASURE: Confirmed H pylori isolates cultured from stool, air, or saliva before and after catharsis and emesis and from vomitus during emesis. Isolates were fingerprinted using repetitive extragenic palindromic (REP) polymerase chain reaction and species identity was confirmed by sequencing the 16s ribosomal RNA gene. RESULTS: All vomitus samples from infected subjects grew H pylori, often in high quantities. Air sampled during vomiting grew H pylori from 6 (37.5%) of the 16 subjects. Saliva before and after emesis grew low quantities of H pylori in 3 (18.8%) and 9 (56.3%) subjects, respectively. No normal stools and only 22 (21.8%) of 101 induced stools grew the organism, although 7 (50.0%) of 14 subjects had at least 1 positive culture (2 stool culture samples were contaminated by fungus and were not included). Fingerprints of isolates within subjects were identical to one another but differed among subjects. No samples from uninfected subjects yielded H pylori. CONCLUSIONS: Helicobacter pylori can be cultivated uniformly from vomitus and, occasionally, from saliva and cathartic stools. The organism is potentially transmissible during episodes of gastrointestinal tract illness, particularly with vomiting.

Adult↗

PubMed2005

Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.

CONTEXT: How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate. OBJECTIVE: To study the prevalence and characteristics of defensive medicine among physicians practicing in high-liability specialties during a period of substantial instability in the malpractice environment. DESIGN, SETTING, AND PARTICIPANTS: Mail survey of physicians in 6 specialties at high risk of litigation (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) in Pennsylvania in May 2003. MAIN OUTCOME MEASURES: Number of physicians in each specialty reporting defensive medicine or changes in scope of practice and characteristics of defensive medicine (assurance and avoidance behavior). RESULTS: A total of 824 physicians (65%) completed the survey. Nearly all (93%) reported practicing defensive medicine. "Assurance behavior" such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents' lack of confidence in their liability insurance and perceived burden of insurance premiums. CONCLUSION: Defensive medicine is highly prevalent among physicians in Pennsylvania who pay the most for liability insurance, with potentially serious implications for cost, access, and both technical and interpersonal quality of care.

Defensive Medicine↗

PubMed1994

Galactic cosmic ray transport methods: past, present, and future.

The development of the theory of high charge and energy (HZE) ion transport is reviewed. The basic solution behavior and approximation techniques will be described. An overview of the HZE transport codes currently available at the Langley Research Center will be given. The near term goal of the Langley program is to produce a complete set of one-dimensional transport codes. The ultimate goal is to produce a set of complete three-dimensional codes which have been validated in the laboratory and can be applied in the engineering design environment. Recent progress toward completing these goals is discussed.

Computer Simulation↗

PubMedDate not supplied

Differential effects of ethanol on two synaptic membrane Ca2+ transport systems.

The Na+-Ca2+ exchange activity in synaptic plasma membranes is inhibited by very low concentrations of ethanol (less than 25 mM). The high affinity Mg2+- and ATP-dependent Ca2+ transport in highly purified synaptic membranes is much less sensitive to inhibition by ethanol, with no statistically significant inhibition observed until an ethanol concentration of nearly 800 mM was used. Manipulations of the lipid environment designed to increase membrane fluidity enhanced the activity of the Na+-Ca2+ exchange system but inhibited the ATP-dependent Ca2+ pump. The differential responses of the two synaptic plasma membrane Ca2+ transporting systems to such modifications of membrane structure suggest that these two ion transport processes differ in the extent to which their activity is dependent on the lipid microenvironment in which they reside. Thus, the effects of ethanol on the Na+-Ca2+ antiporter may represent a fairly selective inhibitory process.

Adenosine Triphosphate↗

PubMed1996

Implications of the emerging home systems technologies for rehabilitation.

This paper gives a review of the current and anticipated developments in Integrated Home Systems and raises the implications these have in the field of rehabilitation. Firstly, the systems under consideration are defined and their development world-wide outlined. An overview of the European Home Systems Specification is given. The implications of this technology for rehabilitation are then raised considering: environmental control in the home; how people with degenerative conditions may be more readily able to remain in their homes as condition progresses; and remote health monitoring. The expectation that the initial impact will be in the area of environment control is stated, and a closer look at this field is made comparing current with anticipated systems. An outline is given of the TIDE Project HS-ADEPT (Home Systems--Access for Disabled and Elderly People to this Technology). The key findings of the survey of users made at the outset of the project, relevant to this paper, are given. The ongoing work of the project is described in brief. The continuing developments in Integrated Home Systems and in particular the issue of standards are noted. Concluding comments are offered in the hope of stimulating the necessary interdisciplinary discussion if this technology is to realize its full potential in the field of rehabilitation.

Electronics, Medical↗

PubMed1996

An integrated approach to Smart House technology for people with disabilities.

It is now commonly accepted that 'Smart House' technology can play a significant part in helping both elderly and disabled people enjoy a greater degree of independence in the near future. In order to realize this aspiration, it is necessary to examine a number of factors: the development of the appropriate Home Bus technologies and supported devices; the development of the appropriate user interfaces that will allow people with a range of special needs use the system; the incorporation of the requirements of the 'Smart House' controller with the other technological needs of the user; and the development of mainstream technologies that will affect the cost and availability of devices to the user. This paper will examine the above points and suggest appropriate actions and trends. It will draw upon the work of a four-member consortium currently finalizing a technical development project under the EC TIDE program, the experience of research and commercial organizations engaged in development work in associated areas and the experiences of the Dublin-based, Central Remedial Clinic and in particular, its Client Technical Services Unit. The CTSU have been actively engaged in the development of systems for clients and direct clinical assessments for the last 12 years.

Biomedical Engineering↗

PubMed2004

Freeway safety as a function of traffic flow.

In this paper, we present evidence of strong relationships between traffic flow conditions and the likelihood of traffic accidents (crashes), by type of crash. Traffic flow variables are measured using standard monitoring devices such as single inductive loop detectors. The key traffic flow elements that affect safety are found to be mean volume and median speed, and temporal variations in volume and speed, where variations need to be distinguished by freeway lane. We demonstrate how these relationships can form the basis for a tool that monitors the real-time safety level of traffic flow on an urban freeway. Such a safety performance monitoring tool can also be used in cost-benefit evaluations of projects aimed at mitigating congestion, by comparing the levels of safety of traffic flows patterns before and after project implementation.

Accidents, Traffic↗

PubMed2003

Preferential distal radius fracture in right-handed individuals presenting to an ED.

The purpose of this study was to determine whether there is a lateralizing predisposition toward injury in right hand-dominant (RHD) individuals. The distal radius fracture was used as the injury for evaluation because it is easily defined and can be objectively documented by roentgenography. A prospective case-series design was used to include consecutive RHD patients with a distal radius fracture. There were 86 women with an average age of 63.1 +/- 17.9 years and 41 men with an average age of 44.0 +/- 17.6 years with a significant difference between ages (P <.01). Overall, there were 50 right and 77 left distal radius fractures, which was significantly different than a 50:50 split (P <.025). Stratification and logistic regression analysis revealed that age (dichotomized into age greater than 57 or other) and not gender was a significant factor in the determination of left versus right distal radius fracture. No interaction between age and gender was found. After adjustment for gender, the odds of developing a left compared with right distal radius fracture was 2.3-fold greater for the older compared with the younger age group (95% confidence interval, 1.0-5.2). Preliminary evidence suggests a lateralizing predisposition for left distal radius fractures in older compared with younger individuals who are RHD. If this data holds up, finding the etiology/mechanism of this predisposition might help in designing environments to minimize the impact of this injury pattern in the slightly older individual.

Adult↗

PubMed2006

Alphanumeric paging in an academic hospital setting.

OBJECTIVE: To determine whether implementation of an alphanumeric-paging system would improve physician work environment. DESIGN: Surveys were distributed to all general surgery residents, faculty, and nurses before and after implementation of an alphanumeric-paging system. Housestaff also kept a detailed log of paging activity before and after the intervention. MEASUREMENTS: User satisfaction with the paging system was measured using a Likert format survey. Interruptions to patient care and pages requiring a call back were tracked using paging logs. RESULTS: Physician perceptions of the capability of text paging before the intervention were high and did not differ significantly postintervention. For nursing staff, postintervention perceptions of the text-paging system were significantly more positive than preintervention, especially with regard to perceived improvements in patient care (54.1% versus 81.6%, P < .05). Residents' paging logs reflected significantly decreased interruptions to patient care after the intervention (28.2% versus 46.9%, P < .05), with less pages requiring a call back (100% versus 73.6%, P < .05). CONCLUSIONS: Study participants rated the alphanumeric-paging system highly. Text-paging technology has the potential to reduce interruptions in patient care and improve physician work efficiency and satisfaction.

Chi-Square Distribution↗

PubMedDate not supplied

Preferences and frequencies of visits to public facilities in old age--a pilot study in a Swedish town center.

In societies with an increasing proportion of elderly active people it is valuable to gain knowledge about what elderly people actually do and want to do in relation to activity arenas in the public environment. The main aim of this study was to investigate elderly people's preferences and frequencies of visits to public facilities in a Swedish town center. A further aim was to gather information on elderly people's subjective perception of problematic and favorable environmental conditions in public environments. The study was conducted using a previously developed questionnaire, "My visit preferences to the public environment". The sample comprised 39 persons aged 75-84 years, living in a defined geographic area. The results of this study provide an overview of the public facilities elderly people rate as important to visit. There are public facilities preferred by most elderly people but with varying frequencies of visits. The study also generated information about elderly people's subjective perceptions of problematic and favorable environmental conditions in public environments, demonstrating that more problems were perceived along walking routes in the public outdoor environment than in the public facilities per se. The results are indicative for community planning supporting elderly people's activities in the public environment, but the questionnaire used should be further validated.

Aged↗

PubMed2005

The performance of left-handed participants on a preferential reaching test.

Previous research in our laboratory has examined the distribution of preferred hand (PH) reaches in working space with right-handed participants. In one study, we examined the effects of tool position and task demands on the frequency of PH reaches with right-handers (Mamolo, Roy, Bryden, & Rohr, 2004). We found that PH reaches were at a maximum within ipsilateral space, and predominated within contralateral space. This was mediated by the task demands, as shown by an increased frequency of PH reaches for the more skill demanding tasks. In the current study, we tested left-handed participants on the same procedure. Five different tools were placed in an array in front of the participant, who was required to reach for, and perform one of three tasks with the tool: Lift the tool; lift and Pantomime its use; or lift and Use the tool on its corresponding object. The results showed that PH reaches were at a maximum within ipsilateral space for all three tasks. Significantly fewer PH reaches were made for tools in contralateral space. In particular, almost no PH reaches were made for the Lift task at the most extreme contralateral position. This indicates the willingness of left-handers to use their non-preferred (i.e., right) hand. One possible explanation supported by these results is that left-handers have adapted to an environment designed for right-handers.

Adult↗

PubMed2006

Insights from Australian parents into educational experiences in the early postnatal period.

OBJECTIVE: to investigate the provision of parent education during the early postnatal period in order to gain insight that, through stakeholder collaboration, will contribute to the development of innovative strategies to enhance the provision of postnatal education in a contemporary health-care environment. DESIGN: the study comprises the first stage of an action-research project. The first stage of research sought to explore the experiences of mothers and fathers in the early postnatal period by conducting a questionnaire within 4 weeks of the birth of their baby. The data obtained from the questionnaire is to inform an action-research group for stage two of the project. SETTING: The Children, Youth and Women's Health Service, a large city maternity hospital in South Australia, covering a range of socio-economic strata. PARTICIPANTS: 85 parents completed and returned the questionnaire, comprising 52 mothers and 33 fathers. MEASUREMENT: an anonymous self-report questionnaire was purpose designed to provide each parent with an opportunity to reflect on their own experience, with particular emphasis given to the provision of education and support during the early postnatal period. FINDINGS: a number of themes emerged, including a window of opportunity during the postnatal hospital stay to provide education and support, despite the reduction in the length of stay; the need for a family-centred approach to maternity services; and the significance of self and social network in the early transition to parenthood. CONCLUSIONS: The findings from this stage of the research, combined with a review of the literature, provide insight that will contribute to stage two of the study. At this stage, an action-research group will continue planning to develop specific actions to enhance the provision of education to parents in the early postnatal period. These actions will subsequently be implemented and assessed.

Adaptation, Psychological↗

PubMed2004

Racial and ethnic diversity and organizational behavior: a focused research agenda for health services management.

Initiatives to reduce racial and ethnic disparities are conceptualized as a three-legged stool. Public policy: to ensure a legal and regulatory environment designed to eliminate disparities in access and health status; clinical practice: to ensure patient satisfaction and loyalty and improve treatment outcomes through the cultural competence of clinicians; and organizational behavior: to ensure that leadership, staff, and the culture of the health services organization represents and values the communities they serve. Our review of the health services and general management literature published since 1990 reveals a paucity of research on organizational behavior. Based on our review of health services and general management organizational behavior and racial/ethnic diversity literature, we offer an agenda for future research in this area. Factors that will facilitate or inhibit the pursuit of the proposed research agenda are also identified and discussed. The literature reviewed is mainly from the United States and the proposed research agenda results from that review, which presents a potential limitation to its applicability internationally.

Breast Feeding↗

PubMed2003

Quantitative cell biology with the Virtual Cell.

Cell biological processes are controlled by an interacting set of biochemical and electrophysiological events that are distributed within complex cellular structures. Computational models, comprising quantitative data on the interacting molecular participants in these events, provide a means for applying the scientific method to these complex systems. The Virtual Cell is a computational environment designed for cell biologists, to facilitate the construction of models and the generation of predictive simulations from them. This review summarizes how a Virtual Cell model is assembled and describes the physical principles underlying the calculations that are performed. Applications to problems in nucleocytoplasmic transport and intracellular calcium dynamics will illustrate the power of this paradigm for elucidating cell biology.

Active Transport, Cell Nucleus↗

PubMed2004

Dissecting complex behaviours in the post-genomic era.

Identifying gene functions in behaviours has so far relied mainly on achievements in the field of molecular genetics. Further progress can be made by developing new approaches that allow refinement of behavioural phenotypes. The current availability of several thousand different mutant mice challenges behavioural neuroscientists to extend their views and methodologies, to dissect complex behaviours into behavioural phenotypes, and subsequently to define gene-behavioural phenotype relationships. Here, we plead for multi-day automated behavioural observations in carefully designed environments.

Animals↗

PubMed1999

Radiation: microbial evolution, ecology, and relevance to mars missions.

Ultraviolet (UV) radiation has been an important environmental parameter during the evolution of life on Earth, both in its role as a mutagen and as a selective agent. This was probably especially true during the time from 3.8 to 2.5 billion years ago, when atmospheric ozone levels were less than 1% of present levels. Early Mars may not have had an "ozone shield" either, and it never developed a significant one. Even though Mars is farther away from the Sun than the Earth, a substantial surficial UV flux is present on Mars today. But organisms respond to dose rate, and on Mars, like on Earth, organisms would be exposed to diurnal variations in UV flux. Here we present data on the effect of diurnal patterns of UV flux on microbial ecosystems in nature, with an emphasis on photosynthesis and DNA synthesis effects. These results indicate that diurnal patterns of metabolism occur in nature with a dip in photosynthesis and DNA synthesis in the afternoon, in part regulated by UV flux. Thus, diurnal patterns must be studied in order to understand the effect of UV radiation in nature. The results of this work are significant to the success of human missions to Mars for several reasons. For example, human missions must include photosynthetic organisms for food production and likely oxygen production. An evolutionary approach suggests which organisms might be best suited for high UV fluxes. The diurnal aspect of these studies is critical. Terraforming is a potential goal of Mars exploration, and it will require studies of the effect of Martian UV fluxes, including their diurnal changes, on terrestrial organisms. Such studies may suggest that diurnal changes in UV only require mitigation at some times of day or year.

Atmosphere↗

PubMed2003

Linearization of the activated sludge model ASM1 for fast and reliable predictions.

In this paper a strategy is proposed to reduce the complexity of the activated sludge model no. 1 (ASM1) which describes the biotransformation processes in a common activated sludge process with N-removal. The key feature of the obtained reduced model is that it combines high predictive value (all state variables keep their biological interpretation) with very low computation time. Therefore, this model is a valuable tool in a risk assessment environment (designed for the evaluation of wastewater treatment plants facing stricter effluent norms) as well as in on-line (MPC) control strategies. The complexity reduction procedure consists of four steps. In the first step representative input/output data sets are generated by simulating the full ASM1 model. In the second step the ASM1 model is rewritten in state space format with linear approximations of the nonlinear (kinetic) terms. In the third step the unknown parameters in the linear terms are identified based on the generated input/output data. To reduce the amount of parameter sets that have to be identified (to cover the full operation range of the plant), a Multi-Model interpolation procedure is introduced as a last step.

Biotransformation↗

PubMed1998

Survey of rheumatic heart disease in school children of Kinshasa town.

STUDY OBJECTIVE: To determine the prevalence of rheumatic heart disease and study the association of this disease to factor such as personal host and environment. DESIGN: A cross sectional survey was carried out by a specially trained medical team. SETTING: The study involved high risk school children aged 5-16 years from Binza-Kinshasa urban area and adjoining slums in semi-urban area of Kinshasa town. METHODS: A total of 4848 children randomly selected on the list of semi-urban and urban schools and representing 10% of the schools population were included in the survey with clinical echocardiographic examinations. RESULTS: Of the 4848 children screened, prevalence of rheumatic heart disease was 14.03/1000. The prevalence was significantly greater in slums schools (22.2/1000) than in urban school (4/1000). In slums area, the mitral valve was the valve most commonly affected by rheumatic heart disease. Risk factors such as birth in rainy season (RR=2.2), low birth weight (RR=1.81), low socioeconomic status (RR=2.68), malnutrition 8 persons/household (RR=4.10) and migrant status (RR=4.79) predicted significantly rheumatic heart disease occurrence in children living in the semi-urban area (slums). Only birth in rainy season (RR=3.24) predicted significantly rheumatic heart disease onset in children having residence in the urban area. CONCLUSIONS: Rheumatic heart disease runs a more severe course in Kinshasa, because appropriate medical care, sanitary conditions, primary and secondary prophylaxis are not available. Echocardiograpy is necessary to identify cases of rheumatic heart disease.

Adolescent↗