ANZ JOURNAL OF SURGERY, Issue 6 2007
Peng Yao
Background: In liver surgery, the increase in advancement of laparoscopic equipment has allowed the feasibility and safety of complex laparoscopic liver resection. However, blood loss and the potential risk of gas embolism seem to be the main obstacles. In this study, we successfully used the InLine radiofrquency ablation (RFA) device to carry out laparoscopic hand-assisted liver resection in pigs. Methods: Under general anaesthesia with tracheal intubation, pigs underwent InLine RFA-assisted laparoscopic liver resection. After installation of Hand Port and trocars, the InLine RFA device was introduced through Hand Port system and inserted into the premarked resection line. Then the generator was turned on and the power was applied according to the power setting. The resection was finally carried out using diathermy or stapler. For the control group, resection was simply carried out by diathermy or stapler. Results: Eight Landrace pigs underwent 23 liver resections. Blood loss was reduced significantly in the InLine group (P < 0.001) when compared with control group in both surgical methods (diathermy and stapler). Conclusion: In this study, we successfully carried out InLine RFA-assisted laparoscopic liver resection in both stapled and diathermy group. We showed that there was a highly significant difference between InLine and other liver resection techniques laparoscopically. [source]

CURRENT TECHNIQUES AND DEVICES FOR SAFE AND CONVENIENT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AND KOREAN EXPERIENCE OF ESD

DIGESTIVE ENDOSCOPY, Issue 3 2008
Sang-Yong Seol
Conventional endoscopic mucosal resection (EMR) technique has limitations in its capacity of achieving en bloc resection and, for lesions greater than 20 mm, removal in a piecemeal resection is often required. This leads to uncertainty as to whether or not the lesion has been completely removed and to an increase in local recurrence. To overcome this limitation, a new technique using specifically designed cutting devices, termed endoscopic submucosal dissection (ESD) has been developed. The present article discuss the current indication, new diagnostic, cutting and hemostatic devices and long-term outcomes of EMR and ESD in early gastric cancer in Korea. [source]

REDUCING INCIDENTAL MORTALITY OF FRANCISCANA DOLPHIN PONTOPORIA BLAINVILLEI WITH ACOUSTIC WARNING DEVICES ATTACHED TO FISHING NETS

MARINE MAMMAL SCIENCE, Issue 4 2002
P. Bordino
Abstract We conducted a double blind experiment in an artisanal gillnet fishery in Argentina to determine the effectiveness of acoustic deterrents (pingers) at reducing bycatch of the Franciscana dolphin (Pontoporia blainvillei). The fishery was conducted by small inflatable and fiberglass vessels operating between 0.5 and 7 krn from the coast. Each vessel carried an independent observer who was rotated from vessel to vessel throughout the course of the experiment. Information on the number of dolphins captured, geographic position, depth, configuration of fishing gear, soak time, biomass of fish caught, and sea lion predation in a string/net producing any damage was recorded. Equivalent numbers of active and silent pingers were used during the experiment. A total of 45 dolphins were caught in the silent nets, and seven were caught in the active pinger nets, demonstrating a highly significant reduction in bycatch for this species. However, sea-lions (Otaria flavescens) damaged the fish in active pinger nets significantly more than silent nets, and the damage increased over the course of the experiment. Although pingers show promise as a management tool for this species, pinniped depredation suggests that higher pinger frequencies will be needed to avoid a "dinner bell" effect. [source]

RECOGNIZED RIGHTS AS DEVICES OF PUBLIC REASON*

PHILOSOPHICAL PERSPECTIVES, Issue 1 2009
G. F. Gaus
First page of article [source]

Extended Mechanical Circulatory Support With a Continuous-Flow Rotary Left Ventricular Assist Device

CONGESTIVE HEART FAILURE, Issue 2 2010
Scott Harris DO
Background LVAD therapy is an established treatment modality for patients with advanced heart failure. Pulsatile LVADs have limitations in design precluding their use for extended support. Continuous-flow rotary LVADs represent an innovative design with potential for small size and greater reliability by simplification of the pumping mechanism. Methods In a prospective multicenter study, 281 patients urgently listed (United Network for Organ Sharing status 1A or 1B) for heart transplant underwent implant of a continuous-flow LVAD. Survival and transplant rates were assessed at 18 months. Patients were assessed for adverse events throughout the study and for quality of life, functional status, and organ function for 6 months. Results Of 281 patients, 222 (79%) underwent transplant or LVAD removal for cardiac recovery or had ongoing LVAD support at 18-month follow-up. Actuarial survival on support was 72% (95% confidence interval, 65%,79%) at 18 months. At 6 months, there were significant improvements in functional status and 6-minute walk test results (from 0% to 83% of patients in New York Heart Association functional class I or II and from 13% to 89% of patients completing a 6-minute walk test) and in quality of life (mean values improved 41% with Minnesota Living With Heart Failure and 75% with Kansas City Cardiomyopathy questionnaires). Major adverse events included bleeding, stroke, right heart failure, and percutaneous lead infection. Pump thrombosis occurred in 4 patients. Conclusions A continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplant, with improved functional status and quality of life. [source]

Effect of Energetic-Ion-Driven MHD Instabilities on Energetic-Ion-Transport in Compact Helical System and Large Helical Device

CONTRIBUTIONS TO PLASMA PHYSICS, Issue 6-7 2010
M. Isobe
Abstract This paper describes 1) representative results on excitation of energetic-particle mode (EPM) and toroidicity-induced Alfvén eigenmode (TAE) and consequent beam-ion losses in CHS, and 2) recent results on beam-ion transport and/or losses while EPMs are destabilized in LHD. Bursting EPMs and TAEs are often excited by co-injected beam ions in the high-beam ion pressure environment and give a significant effect on co-going beam ions in both experiments. It seems that in CHS, resonant beam ions are lost within a relatively short-time scale once they are anomalously transported due to energetic-ion driven MHD modes, whereas unlike CHS, redistribution of beam ions due to energetic-ion driven MHD modes is seen in LHD, suggesting that not all anomalously transported beam ions escape from the plasma (© 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Disparate Scale Nonlinear Interactions in Edge Turbulence

CONTRIBUTIONS TO PLASMA PHYSICS, Issue 1-3 2008
M. Yagi
Abstract In this topical review, we explain the recent achievement in the study of nonlinear interactions, putting an emphasis on the relevance to edge turbulence. First, we start from the survey of the essence in the nonlinear theory of drift wave -zonal flows systems, and visit the experimental observations of the nonlinear interactions of tokamak edge turbulence. Secondly, the universality of intermittent convective transport in the SOL of different magnetic devices are shown. Then, we discuss evolution of collisional drift wave instability in the linear plasma configuration, which is bounded by end plates having analogy to SOL plasmas. By introducing the Numerical Linear Device, the intermittent evolution of large-amplitude instabilities, generation mechanism of the poloidal flow and other nonlinear process are examined. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Application of a New Intense Pulsed Light Device in the Treatment of Photoaging Skin in Asian Patients

DERMATOLOGIC SURGERY, Issue 11 2008
YUAN-HONG LI MD
BACKGROUND Intense pulsed light (IPL) technology has long been used in the treatment of photoaging skin. OBJECTIVE To evaluate the efficacy and safety of a new IPL device in the treatment of photoaging skin in Asian patients. METHODS One hundred fifty-two Chinese women with photoaging skin were enrolled in this open-labeled study. Subjects received four IPL treatments at 3- to 4-week intervals. Changes of photoaging were evaluated using a global evaluation, an overall self-assessment, a Mexameter, and a Corneometer. RESULTS One hundred thirty-nine of 152 patients (91.44%) experienced a score decrease of 3 or 2 grades, according to the dermatologist. One hundred thirty-six of 152 patients (89.47%) rated their overall improvement as excellent or good. The mean skin melanin index (MI) and erythema index values deceased with each session. MI on forehead and EI on cheilion decreased most significantly. Adverse effects were limited to mild pain and transient erythema. CONCLUSION IPL treatment is a safe and effective method for photoaging skin in Asian patients. Adverse effects were minimal and acceptable. [source]

Near Painless, Nonablative, Immediate Skin Contraction Induced by Low-Fluence Irradiation with New Infrared Device: A Report of 25 Patients

DERMATOLOGIC SURGERY, Issue 5 2006
JAVIER RUIZ-ESPARZA MD
BACKGROUND Nonablative radiofrequency (NARF) has been the only method for producing noninvasive skin tightening. Nevertheless, significant pain during the procedure is an important downside of this technology. A new nonablative medical device, Titan (Cutera, Inc., Brisbane, CA, USA), capable of fluences much lower than those possible with NARF, was tested as a less painful alternative. OBJECTIVES To produce skin contraction leading to lifting of eyebrows and/or improvement of lower face and neck skin laxity using fluences below pain levels. PATIENTS AND METHODS Twenty-five patients were treated. Standardized photographs were obtained preoperatively, after a few days, a few weeks, and up to 12 months after the procedure. RESULTS Immediate changes were obtained in 22 of 25 patients. Examination of photographs revealed that the initial improvement was maintained throughout the follow-up period. CONCLUSION Immediate true skin contraction persisting through the immediate, intermediate, and long-term follow-up was found in the vast majority of patients in this group. Edema as an artifact simulating immediate improvement was excluded by serial photographs taken during the follow-up period. Skin contraction occurred at low fluences, below the threshold of pain. This, to the best of our knowledge, has not been previously described in the medical literature. [source]

Concurrent Use of a Handheld Forced Cold Air Device Minimizes Patient Discomfort during Fractional Photothermolysis

DERMATOLOGIC SURGERY, Issue 2005
Galen H. Fisher MD
Objective:. To assess the analgesic effect of a handheld forced cold air device during fractional photothermolysis. Methods. Twenty patients who were being treated with full-face fractional photothermolysis were asked to rate their pain level with and without the handheld air-cooling device. Pain was rated on a scale of 1 to 10, with 10 being the worst. Results. Nineteen of 20 patients noted decreased pain with the addition of handheld cooling. The mean level of pain without air-cooling was 6.95 6 2.0. The mean level of discomfort with air cooling was 4.0 6 1.8. The mean decrease in pain with the addition of air-cooling was 2.9 6 1.8. Conclusion:. The addition of a handheld forced cold air device to cool the skin before and after fractional photothermolysis treatment is an effective adjunctive analgesic modality. [source]

3D In-Vivo Optical Skin Imaging for Topographical Quantitative Assessment of Non-Ablative Laser Technology

DERMATOLOGIC SURGERY, Issue 3 2002
Paul M. Friedman MD
background. A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, a new noninvasive objective assessment is required to accurately assess the outcomes of these procedures. objective. The purpose of this study was to measure and objectively quantify facial skin using a novel, noninvasive, In-vivo method for assessing three-dimensional topography. This device was used to quantify the efficacy of five treatment sessions with the 1064 nm QS Nd:YAG laser for rhytides and acne scarring, for up to six months following laser treatment. methods. Two subjects undergoing facial rejuvenation procedures were analyzed before and after therapy using a 30-mm, three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin using a Digital Micromirror Device (DMDÔ Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at three and six-month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to In-vivo acquisition. results. Skin roughness decreased by 11% from baseline after three treatment sessions in the wrinkles subject, while a 26% improvement of skin roughness was recorded by 3D In-vivo assessment six months following the fifth treatment session. The subject with acne scarring demonstrated a 33% decrease in roughness analysis after three treatment sessions by 3D In-vivo assessment. A 61% improvement in surface topography was recorded 3-months following the fifth treatment session, which was maintained at the 6-month follow-up. conclusion. Three-dimensional In-vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines following multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. This imaging technique provided objective verification and technical understanding of nonablative laser technology. Wrinkle depth and skin roughness decreased at the three and six-month follow-up evaluations by 3D In-vivo assessment, indicating ongoing dermal collagen remodeling after the laser treatment protocol. Future applications may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists. [source]

Suction Device for Epidermal Grafting in Vitiligo: Employing a Syringe and a Manometer to Provide an Adequate Negative Pressure

DERMATOLOGIC SURGERY, Issue 7 2000
Han-uk Kim MD
Background. Suction devices for epidermal grafting need a suction pump to provide a negative pressure. The authors have developed a suction device in which a syringe and a manometer are employed to provide a negative pressure. Objective. The purpose of this study was to evaluate the efficacy of our suction device in vitiligo patients. Methods. The suction device was used to obtain epidermal blisters from the donor site. A CO2 laser was employed to remove the depigmented epidermis. The blister roofs of the donor site were harvested and were placed onto the recipient area. Ten patients with stable vitiligo were treated by epidermal grafting. Results. Epidermal blisters were produced by suction in all patients. Also, all 10 patients regained repigmentation. Conclusion. Our suction blister device is simple and inexpensive to make, and it may become an alternative to the other suction devices. [source]

The Liposuction Apparatus "Suspension Device": Hi-Plane Liposculpture

DERMATOLOGIC SURGERY, Issue 6 2000
Paul Weber MD
Background The improvement of liposuction equipment and techniques has resulted in a cumbersome operating room array of aspirator hoses, irrigation/infiltration tubing, and the insulated command and control wiring of current ultrasonic or power liposuction devices. This situation is further complicated by the presence of a second surgeon, the concomitant use of additional traditional or ultrasonic cannulas, and the suction hose of a second aspirator. Objective To solve the problems of sterility and operating room organization, the authors describe a simple, releasable suspension design. Method This apparatus can be temporarily or permanently installed in minutes and is easily maintained to control numerous sterile hoses and wires required for certain liposuction procedures. Results This suspension method appeared to enhance the efficiency and ease of use by single and dual surgeons during cases utilizing ultrasonic and nonultrasonic cannulas. The time savings and ease of use was most noticeable in cases of dual surgeons using both ultrasonic and nonultrasonic systems simultaneously. In addition, surgical personnel were freed for other tasks. Single-surgeon, traditional liposuction was less notably facilitated in terms of speed and fewer personnel. However, wiring and tubing control is facilitated in any case. Conclusion A simple liposuction suspension system facilitates the liposuction procedure to varying degrees depending upon the number of surgeons and devices in simultaneous use. [source]

Embolization of Atrial Septal Occluder Device into the Pulmonary Artery: A Rare Complication and Usefulness of Live/Real Time Three-Dimensional Transthoracic Echocardiography

ECHOCARDIOGRAPHY, Issue 6 2009
Harvinder S. Dod M.D.
Percutaneous closure of atrial septal defects (ASD) in adults has emerged as an alternative to surgery. We report a rare complication of an atrial septal occluder device embolization into the pulmonary artery which was detected by fluoroscopy and echocardiography. The potential usefulness of live/real time three-dimensional transthoracic echocardiography in the management of patients undergoing percutaneous ASD occlusion is described. (ECHOCARDIOGRAPHY, Volume 26, July 2009) [source]

Triage Patients with Suspected Pulmonary Embolism in the Emergency Department Using a Portable Ultrasound Device

ECHOCARDIOGRAPHY, Issue 5 2008
Nicolas Mansencal M.D.
The diagnosis of pulmonary embolism (PE) is difficult, despite validated diagnostic models. We sought to determine the value of a portable ultrasound device for triage of patients with suspected PE referred to the emergency department, using simplified echo criteria. We prospectively studied 103 consecutive patients with suspected PE, referred to our emergency department. After D-dimer screening, 76 patients were prospectively enrolled in this ultrasound study and underwent helical chest tomography, transthoracic echocardiography, and venous ultrasonography. Among patients with PE (n = 31), a right ventricular dilation was detected in 17 patients (55%), a direct visualization of clot in the lower limbs was present in 18 patients (58%), and 8 patients (26%) had both right ventricular dilation and deep venous thrombosis. The sensitivity and specificity of a combined ultrasound strategy using echocardiography and venous ultrasonography were respectively 87% (95% confidence interval 74% to 96%), and 69% (95% confidence interval 53% to 82%). The sensitivity of this combined strategy was significantly improved as compared to venous ultrasonography alone (P = 0.01) or echocardiography alone (P = 0.005). In patients with dyspnea or with high clinical probability of PE, this combined strategy was particularly relevant with high sensitivities (respectively 94% and 100%). Echocardiography combined with venous ultrasonography using a portable ultrasound device is a reliable method for screening patients with suspected PE referred to an emergency department, especially in patients with dyspnea or with high clinical probability. [source]

Evaluation of Peripheral Vascular Endothelial Function with a Portable Ultrasound Device

ECHOCARDIOGRAPHY, Issue 8 2006
Alawi A. Alsheikh-Ali M.D.
Endothelial function can be assessed noninvasively by imaging the brachial artery with ultrasound before and during reactive hyperemia. However, the standard ultrasound equipment typically used for this purpose is limited by size and expense of the machinery. In this study, we compared the ability of a portable ultrasound device to standard ultrasound equipment to visualize the brachial artery for purposes of assessing peripheral vascular endothelial function. The portable device provided comparable imaging of the brachial artery at rest and during hyperemia to that of standard ultrasound technology. These findings support the feasibility of noninvasive evaluation of peripheral endothelial function in the ambulatory setting. [source]

Spontaneous Echocardiographic Contrast in the Ascending Aorta Mimicking the Appearance of Aortic Dissection in a Patient with a Left Ventricular Assist Device

ECHOCARDIOGRAPHY, Issue 2 2004
Dermot G. Nicolson M.B.B.Ch.
We describe a patient with a previously implanted Jarvik 2000 left ventricular assist device (LVAD), who presented with bacteraemia and with features suspected for aortic dissection at the CT scan. However, transesophageal echocardiography showed competition in the ascending aorta between the retrograde pump flow and the anterograde transaortic output, which mimicked true aortic dissection and could be resolved by lowering the pump speed. As patients with LVAD are increasing in number, clinicians should be aware of this possible effect. (ECHOCARDIOGRAPHY, Volume 21, February 2004) [source]

A Hand-Carried Personal Ultrasound Device for Rapid Evaluation of Left Ventricular Function: Use After Limited Echo Training

ECHOCARDIOGRAPHY, Issue 4 2003
Kristina Lemola
A hand-carried personal ultrasound device (HCPUD) may be used for rapid cardiac screening by physicians with limited echo training. Our objective was to determine the accuracy of rapid HCPUD evaluation of left ventricular (LV) size and function when used by a Cardiology Fellow. Forty-five patients underwent an HCPUD exam using a 2.4-kg device with a 2- to 4-MHz curved transducer and color power Doppler (SonoSite). The results were compared with sonographer-performed and echocardiographer-interpreted exams using conventional equipment. The HCPUD exam lasted 6 ± 2 minutes. There was 100% agreement between HCPUD and conventional echo on qualitative assessment of LV systolic function. Comparing the HCPUD and conventional linear measurements of left ventricular end-diastolic dimension (LVEDD) and of interventricular septal (IVS) thickness: LVEDD is HCPUD = 0.94 conventional ,0.2,r = 0.82, P < 0.0001; IVS is HCPUD= 0.59conventional+0.6, r = 0.69, P < 0.0001. Thus, an HCPUD can effectively be used after limited training to rapidly screen for qualitative abnormalities of LV systolic function. Quantitative measurements of smaller structures with the HCPUD are more challenging. (ECHOCARDIOGRAPHY, Volume 20, May 2003) [source]

Study on Glucose Biofuel Cells Using an Electrochemical Noise Device

ELECTROANALYSIS, Issue 14 2008
Yueming Tan
Abstract An electrochemical noise (ECN) device was utilized for the first time to study and characterize a glucose/O2 membraneless biofuel cell (BFC) and a monopolar glucose BFC. In the glucose/O2 membraneless BFC, ferrocene (Fc) and glucose oxidase (GOD) were immobilized on a multiwalled carbon nanotubes (MWCNTs)/Au electrode with a gelatin film at the anode; and laccase (Lac) and an electron mediator, 2,2,-azinobis (3-ethylbenzothiazoline-6-sulfonate) diammonium salt (ABTS), were immobilized on a MWCNTs/Au electrode with polypyrrole at the cathode. This BFC was performed in a stirred acetate buffer solution (pH,5.0) containing 40,mmol/L glucose in air, with a maximum power density of 8,,W/cm2, an open-circuit cell voltage of 0.29,V, and a short-circuit current density of 85,,A/cm2, respectively. The cell current at the load of 100,k, retained 78.9% of the initial value after continuous discharging for 15,h in a stirred acetate buffer solution (pH,5.0) containing 40,mmol/L glucose in air. The performance decrease of the BFC resulted mainly from the leakage of the ABTS mediator immobilized at the cathode, as revealed by the two-channel quartz crystal microbalance technique. In addition, a monopolar glucose BFC was performed with the same anode as that in the glucose/O2 membraneless BFC in a stirred phosphate buffer solution (pH,7.0) containing 40,mmol/L glucose, and a carbon cathode in Nafion-membrane-isolated acidic KMnO4, with a maximum power density of 115,,W/cm2, an open-circuit cell voltage of 1.24,V, and a short-circuit current density of 202,,A/cm2, respectively, which are superior to those of the glucose/O2 membraneless BFC. A modification of the anode with MWCNTs for the monopolar glucose BFC increased the maximum power density by a factor of 1.8. The ECN device is highly recommended as a convenient, real-time and sensitive technique for BFC studies. [source]

Spectroelectrochemical Sensing Based on Multimode Selectivity Simultaneously Achievable in a Single Device.

ELECTROANALYSIS, Issue 5 2007

Abstract Quaternized poly(4-vinylpyridine) (QPVP) has been incorporated as an anion exchanger into sol-gel derived silica films for use in a spectroelectrochemical sensor. The preparation, characteristics and performance of these films are described. The films, which are spin-coated onto the surface of a planar optically transparent electrode, are optically transparent and uniform. Scanning electron microscopy and spectroscopic ellipsometry have been used to examine film structure, thickness and optical properties. These films have been shown both spectroscopically and electrochemically to preconcentrate ferrocyanide, a model analyte for the sensor. The films can be regenerated for multiple measurements by exposure to 1,M KNO3. The effects of polymer molecular weight and storage conditions on film performance are described. The overall response of this film is comparable to the poly(dimethyldiallylammonium chloride)-silica films previously used for this sensor. [source]

Pseudomonas fluorescens' view of the periodic table

ENVIRONMENTAL MICROBIOLOGY, Issue 1 2008
Matthew L. Workentine
Summary Growth in a biofilm modulates microbial metal susceptibility, sometimes increasing the ability of microorganisms to withstand toxic metal species by several orders of magnitude. In this study, a high-throughput metal toxicity screen was initiated with the aim of correlating biological toxicity data in planktonic and biofilm cells to the physiochemical properties of metal ions. To this end, Pseudomonas fluorescens ATCC 13525 was grown in the Calgary Biofilm Device (CBD) and biofilms and planktonic cells of this microorganism were exposed to gradient arrays of different metal ions. These arrays included 44 different metals with representative compounds that spanned every group of the periodic table (except for the halogens and noble gases). The minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and minimum biofilm eradication concentration (MBEC) values were obtained after exposing the biofilms to metal ions for 4 h. Using these values, metal ion toxicity was correlated to the following ion-specific physicochemical parameters: standard reduction-oxidation potential, electronegativity, the solubility product of the corresponding metal,sulfide complex, the Pearson softness index, electron density and the covalent index. When the ions were grouped according to outer shell electron structure, we found that heavy metal ions gave the strongest correlations to these parameters and were more toxic on average than the other classes of the ions. Correlations were different for biofilms than for planktonic cells, indicating that chemical mechanisms of metal ion toxicity differ between the two modes of growth. We suggest that biofilms can specifically counter the toxic effects of certain physicochemical parameters, which may contribute to the increased ability of biofilms to withstand metal toxicity. [source]

Emergency Medicine Resident Patient Care Documentation Using a Hand-held Computerized Device

ACADEMIC EMERGENCY MEDICINE, Issue 12 2001
Steven B. Bird MD
Abstract Objective: To determine whether emergency medicine (EM) resident documentation of procedures, patient encounters, and patient follow-ups improved after implementation of a personal digital assistant (PDA) hand-held recording system. Methods: All first-year EM residents were provided a PalmV (Palm, Inc., Santa Clara, CA) PDA. A customized patient procedure and encounter program was constructed using Pendragon Forms (Pendragon Software Corporation, Libertyville, IL) and loaded into each PDA. Residents were instructed to enter information on patients who had any of 21 procedures performed or were considered to be clinically unstable. These data were downloaded to the residency coordinator's desktop computer. The mean number of procedures, encounters, and follow-ups performed per resident were then compared with those of a group of 36 historical controls from the three previous first-year resident classes who recorded the same information using a handwritten card system. Data from the historical controls were combined and the means of each group were compared by Student's t-test. Results: Mean documentation of three procedures was significantly increased in the PDA group versus the index card system: conscious sedation 5.8 vs. 0.03 (p < 0.000005), thoracentesis 2.2 vs. 0.0 (p = 0.002), ultrasound 6.3 vs. 0.0 (p = 0.002). The mean numbers of pericardiocenteses and unstable pediatric surgical patient evaluations were significantly decreased in the hand-held group [from 1.2 to 0.4 (p = 0.03) and from 9.1 to 2.2 (p = 0.02), respectively]. Patient follow-up documentations were not statistically different between the two groups. Conclusions: Use of a hand-held PDA was associated with an increase in first-year EM resident documentation in three of 20 procedures and a decrease in one procedure and the number of unstable surgical pediatric patient resuscitations. The overall time savings in constructing a resident procedure database, as well as the other uses of the PDAs, may make transition to a hand-held computer-based procedure log an attractive option for EM residencies. [source]

Assessment of Family Functioning in Caucasian and Hispanic Americans: Reliability, Validity, and Factor Structure of the Family Assessment Device

FAMILY PROCESS, Issue 4 2007
GREGORY A. AARONS PH.D.
The purpose of this study was to examine the factor structure, reliability, and validity of the Family Assessment Device (FAD) among a national sample of Caucasian and Hispanic American families receiving public sector mental health services. A confirmatory factor analysis conducted to test model fit yielded equivocal findings. With few exceptions, indices of model fit, reliability, and validity were poorer for Hispanic Americans compared with Caucasian Americans. Contrary to our expectation, an exploratory factor analysis did not result in a better fitting model of family functioning. Without stronger evidence supporting a reformulation of the FAD, we recommend against such a course of action. Findings highlight the need for additional research on the role of culture in measurement of family functioning. [source]

Coherent Accounts of Coping with a Chronic Illness: Convergences and Divergences in Family Measurement Using a Narrative Analysis

FAMILY PROCESS, Issue 4 2003
BARBARA H. FIESE Ph.D.
Researchers and clinicians have shown increasing interest in family narratives as an avenue for accessing the family meaning-making process. In this study, we examine the convergences and divergences between narrative assessment, family self-report, and verbal accounts of family climate. Sixty-two families with a child with pediatric asthma were interviewed about the impact that asthma had on family life. These interviews were coded for narrative coherence, relationship expectations, and engagement with the interviewer. Primary caregivers were also interviewed using the Five Minute Speech sample (FMSS) and completed self-report assessments of family functioning (Family Assessment Device [FAD] Impact on the Family Scale [IOF]). Contrary to prediction. Narrative coherence was higher in those cases where Emotional Over-involvement (EOI) was present on the FMSS. Narrative coherence and engagement with the interviewer were positively related to self-report of family problem solving, communication, and affective responsiveness as measured on the FAD. Divergences and convergences between different types of family measurement are discussed in light of meaning-making processes associated with coping with a chronic illness. [source]

Fabrication of Microbeads with a Controllable Hollow Interior and Porous Wall Using a Capillary Fluidic Device

ADVANCED FUNCTIONAL MATERIALS, Issue 18 2009
Sung-Wook Choi
Abstract Poly(D,L -lactide-co-glycolide) (PLGA) microbeads with a hollow interior and porous wall are prepared using a simple fluidic device fabricated with PVC tubes, glass capillaries, and a needle. Using the fluidic device with three flow channels, uniform water-in-oil-in-water (W-O-W) emulsions with a single inner water droplet can be achieved with controllable dimensions by varying the flow rate of each phase. The resultant W-O-W emulsions evolve into PLGA microbeads with a hollow interior and porous wall after the organic solvent in the middle oil phase evaporates. Two approaches are employed for developing a porous structure in the wall: emulsion templating and fast solvent evaporation. For emulsion templating, a homogenized, water-in-oil (W/O) emulsion is introduced as the middle phase instead of the pure oil phase. Low-molecular-weight fluorescein isothiocyanate (FITC) and high-molecular-weight fluorescein isothiocyanate,dextran conjugate (FITC,DEX) is added to the inner water phase to elucidate both the pore size and their interconnectivity in the wall of the microbeads. From optical fluorescence microscopy and scanning electron microscopy images, it is confirmed that the emulsion-templated microbeads (W-W/O-W) have larger and better interconnected pores than the W-O-W microbeads. These microstructured microbeads can potentially be employed for cell encapsulation and tissue engineering, as well as protection of active agents. [source]

Generation of Monodisperse Inorganic,Organic Janus Microspheres in a Microfluidic Device

ADVANCED FUNCTIONAL MATERIALS, Issue 10 2009
Naveen Prasad
Abstract This study presents a simple synthetic approach for the in situ preparation of monodisperse hybrid Janus microspheres (HJM) having organic and inorganic parts in a PDMS-based microfluidic device. Based on the mechanism of shear-force-driven break-off, merged droplets of two photocurable oligomer solutions having distinctive properties are generated into an immiscible continuous phase. Functionalized perfluoropolyether (PFPE) as the organic phase and hydrolytic allylhydridopolycarbosilane (AHPCS) as the inorganic phase are used for the generation in aqueous medium of HJM with well-defined morphology and high monodispersity (average diameter of 162,µm and a 3.5% coefficient of variation). The size and shape of the HJM is controlled by varying the flow rate of the disperse and continuous phases. The HJM have two distinctive regions: a hydrophobic hemisphere (PFPE) having a smooth surface and a relatively hydrophilic region (AHPCS) with a rough, porous surface. In addition, pyrolysis and subsequent oxidation of these HJM convert them into SiC-based ceramic hemispheres through the removal of the organic portion and etching off the silica shell. The selective incorporation of magnetic nanoparticles into the inorganic part shows the feasibility of the forced assembly of HJM in an applied magnetic field. [source]

An In Situ Device to Measure Oxygen in the Vadose Zone and in Ground Water: Laboratory Testing and Field Evaluation

GROUND WATER MONITORING & REMEDIATION, Issue 2 2008
Bradley M Patterson
Oxygen probes developed to measure in situ oxygen concentrations in gaseous and aqueous environments were evaluated in laboratory tests and during long-term field evaluation trials at contaminated sites. The oxygen probes were shown to have a linear calibration and to be accurate compared to conventional dissolved oxygen electrodes and gas chromatography, both of which require labor-intensive sample collection and processing. The probes, once calibrated, required no maintenance or recalibration for up to a period of 7 years in low-oxygen environments, demonstrating long-term stability. Times to achieve 90% of the stabilized concentration (t90) after a step change in aqueous oxygen concentration were 100,120 min in laboratory experiments and up to 180 min in field experiments, which is adequate for monitoring subsurface changes. Field application data demonstrated that the oxygen probes could monitor oxygen concentrations in hydrocarbon-contaminated ground water to a depth of 20 m below the water table or in pyritic vadose zones over extended periods. During bioremediation field trials, oxygen monitoring enabled estimation of oxygen utilization rates by microorganisms and hydrocarbon biodegradation rates. Also, probes were able to monitor the development of ground water desaturation during air sparging trials, enabling the automated assessment of the distribution of injected air. [source]