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Journal of Developmental and Behavioral... 2017Bryan is a 10-year-old boy who is brought to his pediatrician by his parents with concerns about oppositional behaviors. Bryan's parents report that he has always been...
Bryan is a 10-year-old boy who is brought to his pediatrician by his parents with concerns about oppositional behaviors. Bryan's parents report that he has always been hyperactive and oppositional since a very young age. He has been previously diagnosed with attention-deficit hyperactivity disorder and has been treated with appropriate stimulant medications for several years; however, despite this, his parents feel increasingly unable to manage his difficult behaviors. He refuses to do chores or follow through with household routines. He refuses to go to bed at night. His family feels unable to take him to public places because he "climbs all over everything." At school, he acts up in class, is often disruptive, and requires close supervision by teachers. He was recently kicked off of the school bus. He has very few friends, and his parents state that other children do not enjoy to be around him.Bryan's parents also report that he is "obsessed" with electronics. He spends most his free time watching TV and movies and playing computer games. He has a television in his bedroom because otherwise he "monopolizes" the family television. The family also owns several portable electronic devices that he frequently uses. Bryan insists on watching TV during meals and even that the TV stays on in an adjacent room while showering. He gets up early each morning and turns on the television. He refuses to leave the house unless he can take a portable screen device with him. His parents admit to difficulty placing limits on this behavior because they feel it is the only way to keep his other behaviors under control. His mother explains "it is our only pacifier" and that attempts to place restrictions are met with explosive tantrums and have thus been short lived. These efforts have also been impeded due to the habits of his parents and older sibling, who also enjoy spending a significant amount of time watching television.
Topics: Attention Deficit and Disruptive Behavior Disorders; Behavior, Addictive; Child; Humans; Male; Television; Video Games
PubMed: 28141727
DOI: 10.1097/DBP.0000000000000404 -
International Journal of Health... Nov 2008An increasing number of studies suggest that characteristics of context, or the attributes of the places within which we live, work and socialize, are associated with... (Comparative Study)
Comparative Study
BACKGROUND
An increasing number of studies suggest that characteristics of context, or the attributes of the places within which we live, work and socialize, are associated with variations in health-related behaviours and outcomes. The challenge for health research is to ensure that these places are accurately represented spatially, and to identify those aspects of context that are related to variations in health and amenable to modification. This study focuses on the design of a wearable global positioning system (GPS) data logger for the purpose of objectively measuring the temporal and spatial features of human activities. Person-specific GPS data provides a useful source of information to operationalize the concept of place.
RESULTS
We designed and tested a lightweight, wearable GPS receiver, capable of logging location information for up to 70 hours continuously before recharging. The device is accurate to within 7 m in typical urban environments and performs well across a range of static and dynamic conditions.
DISCUSSION
Rather than rely on static areal units as proxies for places, wearable GPS devices can be used to derive a more complete picture of the different places that influence an individual's wellbeing. The measures are objective and are less subject to biases associated with recall of location or misclassification of contextual attributes. This is important for two reasons. First, it brings a dynamic perspective to place and health research. The influence of place on health is dynamic in that certain places are more or less relevant to wellbeing as determined by the length of time in any location and by the frequency of activity in the location. Second, GPS data can be used to assess whether the characteristics of places at specific times are useful to explaining variations in health and wellbeing.
Topics: Biomedical Research; Equipment Design; Geographic Information Systems; Health Behavior; Humans
PubMed: 19032783
DOI: 10.1186/1476-072X-7-59 -
The Journal of Vascular Access Sep 2022Ultrasound-guided peripheral intravenous (USPIV) catheters are being placed in emergency department (ED) patients with increasing frequency. USPIV catheters have been...
OBJECTIVE
Ultrasound-guided peripheral intravenous (USPIV) catheters are being placed in emergency department (ED) patients with increasing frequency. USPIV catheters have been shown to improve the success rates of cannulation. It is unknown what the long-term effect of USPIV placement will be on fistula creation in chronic kidney disease (CKD) patients considering these ultrasound-guided peripheral lines often target the same deeper vessels used for fistulas. This study aimed to survey whether emergency medicine programs place restrictions on USPIV placement in patients with CKD stages 3-5.
METHODS
This was a survey study encompassing all 110 emergency ultrasound fellowship directors in the United States at the time the survey was conducted. Data was collected on an anonymous and voluntary basis. The primary outcome was the number of programs with restrictions on USPIV placement in patients with CKD stage 3 or greater.
RESULTS
Of the 56 programs that responded, 21% reported having policies limiting which patients were appropriate for USPIV. Despite this, only one program reported placing restrictions on USPIV in CKD stage 3 or greater ( < 0.0001).
CONCLUSIONS
Emergency departments do not have or follow restrictions placed on USPIV placement in patients with CKD stage 3 or greater. The use of these veins in the ED may result in thrombosis as well as inflammation and permanent scarring which could negatively impact the ability to utilize those vessels for fistula creation. Future studies are needed to further characterize the impact of USPIV on fistula creation.
Topics: Administration, Intravenous; Catheterization, Peripheral; Emergency Service, Hospital; Humans; Renal Insufficiency, Chronic; Ultrasonography, Interventional
PubMed: 33926286
DOI: 10.1177/11297298211012212 -
Environmental Entomology Jun 2011Formica neorufibarbis Emery is a dominant alpine ant in North America. Above timberline, colonies nest under rocks, placing brood against the rock surface to warm during...
Formica neorufibarbis Emery is a dominant alpine ant in North America. Above timberline, colonies nest under rocks, placing brood against the rock surface to warm during the day. We tested the hypothesis that nest rock preference represents a mechanism of behavioral thermoregulation and used a demographic model to explore its impact on the species' altitudinal range. Under sunny conditions rocks provide warm microclimates. Across a 400-m altitudinal gradient from below timberline to high alpine tundra, nest rocks warmed on average 5°C above ambient at mid-day, but cooled to near ambient before dawn. Soil was warmer at mid-day under rocks occupied by ants than under randomly chosen unoccupied rocks in the same area. Occupied nest rocks were painted white or black to manipulate temperature and test its impact on colony occupancy. In addition, black-painted and white-painted rocks of similar size were placed in the field to test for a temperature effect on nest site colonization. Likelihood of nest persistence and colonization decreased under cooler, white-painted rocks and depended strongly on rock warming capacity. Experimental results showed that nest site colonization and occupancy are favored in microsites maintaining mid-day temperature ≥22°C. Across the altitudinal gradient, 66-90% of nest microsites occupied by F. neorufibarbis met this temperature threshold. Conversely, none of the exposed microsites and only 15% of those microsites under randomly selected rocks warmed to 22°C at the high altitude site (3,900 m). Results support the conclusion that nest site preference contributes to the broad altitudinal distribution of F. neorufibarbis.
Topics: Altitude; Animals; Ants; Body Temperature Regulation; Colorado; Nesting Behavior; Population Dynamics; Temperature
PubMed: 22251630
DOI: 10.1603/EN10304 -
Journal of Dentistry Nov 2005It is aim of this paper to investigate the outcome of direct-placement restorations provided within the General Dental Services in England and Wales, in relation to the...
AIM
It is aim of this paper to investigate the outcome of direct-placement restorations provided within the General Dental Services in England and Wales, in relation to the factors related to time and place of restoration placement.
METHODS
A modified version of Kaplan-Meier statistical methodology was used to plot survival curves for restorations placed at different times and places, within the population of patients for whom data were available.
RESULTS
The results indicated that overall, restoration survival time to re-intervention has declined over the last decade, but that most of the decline can be accounted for by the change in the relative numbers of amalgam and other direct restorations. Restoration survival to re-intervention is independent of whether the water is fluoridated in the area of the dentist's surgery address. Variation with region is not great, but restorations placed in Wales survived to re-intervention significantly longer than those in England (P<0.0001).
CONCLUSIONS
Overall, there was some evidence of a reduction in survival times with time. Restorations placed in Wales survived longer to re-intervention than restorations placed in England. Restoration survival was not dependent on whether the dentist who placed the restoration practised in an area in which the water was fluoridated. Performance of amalgam restorations was not found to have altered significantly with time, but performance of composite and glass ionomer deteriorated with time.
Topics: Acrylic Resins; Dental Amalgam; Dental Restoration, Permanent; England; Fluoridation; Humans; Silicon Dioxide; Survival Analysis; Time Factors; Wales
PubMed: 16221518
DOI: 10.1016/j.jdent.2005.03.010 -
Obesity Surgery Nov 2009Isolated sleeve gastrectomy is being used with increasing frequency for the treatment of morbid obesity. This study was done to determine the potential benefit of... (Comparative Study)
Comparative Study
BACKGROUND
Isolated sleeve gastrectomy is being used with increasing frequency for the treatment of morbid obesity. This study was done to determine the potential benefit of placing a band of processed human dermis around the upper portion of a sleeve gastrectomy to prevent late dilatation and weight gain.
METHODS
Twenty-seven patients underwent a sleeve gastrectomy followed by placement of a band of biological tissue (AlloDerm) placed 6 cm from the gastroesophageal junction. The results were compared to 54 patients with a Roux-en-Y gastric bypass (GBP), matched for sex, age, and initial body mass index.
RESULTS
All 27 patients had improvement or resolution of their diabetes, hypertension, hyperlipidemia, and sleep apnea after banded sleeve gastrectomy (BSG) similar to the control GBP group. There were no deaths, but one patient had a pulmonary embolus and another had a presumed leak. Symptoms of gastroesophageal reflux disease generally improved. Overall, results were almost identical to patients with GBP.
CONCLUSIONS
BSG provides results comparable to GBP in the short-term follow-up, but avoids potential long-term complications including internal hernias, postoperative bowel obstructions, anastomotic complications of the jejunojejunostomy, hypoglycemia, bacterial overgrowth, and a spectrum of malabsorptive problems. While this study documents the feasibility and possible benefits of this modification, prospective controlled studies with long-term follow-up are needed to establish its place in procedures for surgical weight loss.
Topics: Adolescent; Adult; Body Mass Index; Female; Gastrectomy; Gastric Bypass; Humans; Male; Middle Aged; Obesity, Morbid; Patient Satisfaction; Postoperative Complications; Treatment Outcome; Weight Loss; Young Adult
PubMed: 19727978
DOI: 10.1007/s11695-009-9964-x -
Revue de L'infirmiere Oct 2018Foot wounds are frequent and not usually serious. The first caregiver to provide treatment must decide on the most appropriate action to take, sometimes in inadequate...
Foot wounds are frequent and not usually serious. The first caregiver to provide treatment must decide on the most appropriate action to take, sometimes in inadequate places. We present an analysis of the management of these traumas to highlight the key stages of the evaluation and initial treatment of the wound while placing the patient on a coherent and efficient clinical pathway.
Topics: Analgesics; Bandages; Burns; Foot Injuries; Humans; Therapeutic Irrigation
PubMed: 30415688
DOI: 10.1016/j.revinf.2018.08.011 -
Journal of Echocardiography Sep 2021The use of enhancing agents in echocardiography has been shown to facilitate improved study quality. Despite the known benefits, its use remains limited by institutional...
BACKGROUND
The use of enhancing agents in echocardiography has been shown to facilitate improved study quality. Despite the known benefits, its use remains limited by institutional policies.
METHODS
We aimed to retrospectively evaluate if allowing sonographers to place a peripheral intravenous catheter and administer enhancing agent led to a decrease in time to complete outpatient transthoracic echocardiograms in comparison to using nursing personnel. Three separate protocols were employed. The 'nurse driven protocol' utilized nurses to place a peripheral intravenous catheter and inject enhancing agent. In a 'mixed protocol,' a nurse placed a peripheral intravenous catheter and the sonographer gave the enhancing agent. The 'sonographer driven protocol' involved the sonographer placing the peripheral intravenous catheter and delivering enhancing agent.
RESULTS
A total of 232 echocardiograms were included for analysis. Patient characteristics across the three protocols were not statistically significant. The 'mixed protocol' had an average study time that was significantly less than the 'nurse driven protocol' (49.4 min ± 11.4 vs 54.6 min ± 12.9; p = 0.024). The 'sonographer driven protocol' also showed a significant reduction in study time (50.3 min ± 12.6) when compared to the 'nurse driven protocol' (p = 0.017). The additional task for the sonographer to place the peripheral intravenous catheter did not significantly increase the time to complete the study.
CONCLUSION
Allowing sonographers to administer enhancing agent reduced individual echocardiogram study times by approximately 5 min, supporting that a 'sonographer driven protocol' is more efficient with potential downstream economic benefits.
Topics: Echocardiography; Humans; Retrospective Studies
PubMed: 33797745
DOI: 10.1007/s12574-021-00523-y -
The International Journal of Medical... Jun 2012In contemporary surgical clinical practice, spinal instability is often treated with mechanical stabilization techniques in order to protect the spinal cord and nerve...
BACKGROUND
In contemporary surgical clinical practice, spinal instability is often treated with mechanical stabilization techniques in order to protect the spinal cord and nerve roots. These techniques involve placing screws in defined regions of the vertebrae, typically the pedicle, where the strongest bone is found. The challenge for the surgeon is the accurate placement of screws for good mechanical purchase and to avoid damage to surrounding vital anatomical structures. This is especially critical in the cervical region, where the target bone mass is smaller and the spinal cord, nerve roots and vertebral arteries are all at risk. A robotic system enabling the surgeon to precisely place implants into the vertebrae should enhance safety and may potentially improve surgical results.
METHODS
We describe such a system, which consists of a compact robot positioned using a passive structure, an optical tracking system, a surgical input device and planning and navigational software. The implant trajectory in each vertebra is planned preoperatively, using fine-cut computerized tomography (CT) scans. During surgery, registration matching between the CT scan and the patient's anatomy is achieved using point to point registration, refined with a surface merge technique. Approximate robot positioning is done passively by the surgeon. Final precise instrument positioning is performed by the robot according to the planned trajectory through the target vertebra. Implants (screws) are then placed through the robot-guided working channel.
RESULTS
Six cadaver experiments, consisting of placing transarticular (i.e. crossing the joints between the vertebrae) screws in the upper two vertebrae of the human cervical spine, were performed. Implant placement accuracy was comparable with that achieved using freehand image-guided techniques by an experienced surgeon.
CONCLUSIONS
These results confirm the utility and applicability of the system. It is currently in redesign to improve accuracy and to render it compatible with on-line planning.
Topics: Bone Screws; Cadaver; Cervical Vertebrae; Equipment Design; Ergonomics; Feasibility Studies; Humans; Neurons; Orthopedic Procedures; Reproducibility of Results; Robotics; Software; Spine; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 22190547
DOI: 10.1002/rcs.446 -
Journal of Emergency Nursing Jan 2021The emergency department is a care environment in which indwelling urinary catheters are placed frequently; however, the significance of the role of the emergency...
The emergency department is a care environment in which indwelling urinary catheters are placed frequently; however, the significance of the role of the emergency department in catheter-associated urinary tract infection prevention has been overlooked. The use of an external female urinary catheter is an alternative to placing an indwelling urinary catheter for female patients in the emergency department who are incontinent of urine or are immobile. The purpose was to describe the implementation of an initiative to decrease the number of indwelling urinary catheters and increase the use of external urinary female catheters in non-critically ill women who visited the emergency department at a 451-bed Magnet-designated community hospital in the Southeast. For this clinical implementation project, the Plan, Do, Check, Act framework was used to develop the initiative, and outcome data were collected retrospectively and included an indirect calculation of the number of indwelling urinary catheters placed in the emergency department. A total of 187 external catheters were used in place of indwelling catheters in female patients over a 3-month period. No skin irritation or breakdown was observed. This project demonstrated the initial staff acceptability and feasibility of external female urinary catheter use in the ED setting.
Topics: Allied Health Personnel; Catheter-Related Infections; Cross Infection; Emergency Nursing; Emergency Service, Hospital; Equipment Design; Female; Humans; Urinary Catheterization; Urinary Catheters
PubMed: 33187721
DOI: 10.1016/j.jen.2020.09.008