Capturing user requirements in medical device development: the role of ergonomics

Czerniak, L. / SS. Cyril & Methodius Grad. Clas

Clinicopathological characteristics of histiocytic sarcoma affecting the central nervous system in dogs.

BackgroundHistiocytic sarcoma affecting the central nervous system (CNS HS) in dogs may present as primary or disseminated disease, often characterized by inflammation. Prognosis is poor, and imaging differentiation from other CNS tumors can be problematic.ObjectiveTo characterize the clinicopathological inflammatory features, breed predisposition, and survival in dogs with CNS HS.AnimalsOne hundred two dogs with HS, 62 dogs with meningioma.MethodsRetrospective case series. Records were reviewed for results of cerebrospinal fluid (CSF) analysis, CBC, treatment, and outcome data.ResultsPredisposition for CNS HS was seen in Bernese Mountain Dogs, Golden Retrievers, Rottweilers, Corgis, and Shetland Sheepdogs (P ≤ .001). Corgis and Shetland Sheepdogs had predominantly primary tumors; Rottweilers had exclusively disseminated tumors. Marked CSF inflammation was characteristic of primary rather than disseminated HS, and neoplastic cells were detected in CSF of 52% of affected dogs. Increased neutrophil to lymphocyte ratios were seen in all groups relative to controls (P <.008) but not among tumor subtypes. Definitive versus palliative treatment resulted in improved survival times (P < .001), but overall prognosis was poor.Conclusions and clinical importanceClinicopathological differences between primary and disseminated HS suggest that tumor biological behavior and origin may be different. Corgis and Shetland Sheepdogs are predisposed to primary CNS HS, characterized by inflammatory CSF. High total nucleated cell count and the presence of neoplastic cells support the use of CSF analysis as a valuable diagnostic test. Prognosis for CNS HS is poor, but further evaluation of inflammatory mechanisms may provide novel therapeutic opportunities

Dive Behavior of Eastern Chukchi Beluga Whales (Delphinapterus leucas), 1998–2008

We provide an exploratory description of the dive behavior of 23 beluga whales of the eastern Chukchi Sea stock, tagged with satellite-linked time and depth recorders at Point Lay, Alaska, between 1998 and 2007. Because of differences in how transmitters were parameterized, we analyzed data from tags deployed from 1998 to 2002 (n = 20 tags) and data from tags deployed in 2007 (n = 3 tags) separately. Using cluster analysis, we found three basic dive types in the 1998–2002 dataset. “Shallow” diving behavior was characterized by dives mostly 50 m in depth. “Intermediate” diving behavior was characterized by having one mode near the surface and a second mode near 250 m. “Deep” diving behavior was characterized by having one mode near the surface and a second mode more than 400 m from the surface. The average number of dives per hour ranged from 5.1 (SD = 2.1) to 9.8 (SD = 2.9) across dive types, with the fewest dives per hour in the deep diving category. In general, duration of dives ranged from 1 to 18 minutes; however, dives up to 21 minutes occurred in the deepest diving category. We found little evidence that dive behavior of the belugas in our sample varied by sex or age. In general, belugas dove more deeply in the eastern Beaufort Sea than in the western Beaufort or Chukchi Seas. The depths to which belugas most commonly dive in Barrow Canyon and along the Beaufort shelf break (200–300 m) correspond to the boundary where colder Pacific water overlies warmer Atlantic water, which is probably where Arctic cod (Boreogadus saida) are most dense. Diving depths within the Arctic Basin suggest that belugas are foraging mostly within the warm layer of Atlantic Water (~200–1000 m).Nous dressons une description exploratoire du comportement de plongée de 23 bélugas du cheptel de l’est de la mer des Tchouktches dotés de marqueurs d’enregistreurs satellitaires de profondeur temporelle à Point Lay, en Alaska, entre 1998 et 2007. En raison des différences de paramétrage des transmetteurs, nous avons analysé séparément les données de marqueurs déployés de 1998 à 2002 (n = 20 marqueurs) et les données de marqueurs déployés en 2007 (n = 3 marqueurs). Grâce à une analyse par grappes, nous avons trouvé trois types de plongée fondamentaux dans l’ensemble des données de 1998 à 2002. Le comportement de plongée « en eau peu profonde » était principalement caractérisé par des plongées de 50 m de profondeur. Le comportement de plongée « intermédiaire » était caractérisé par un mode de plongée près de la surface et un autre mode à près de 250 m. Le comportement de plongée « en profondeur » était caractérisé par un mode de plongée près de la surface et un deuxième mode à plus de 400 m de la surface. Le nombre moyen de plongées à l’heure variait de 5,1 (écart-type = 2,1) à 9,8 (écart-type = 2,9) pour ce qui est de tous les types de plongée, la catégorie des plongées en profondeur ayant enregistré le moins grand nombre de plongées. En général, la durée des plongées durait de 1 à 18 minutes, mais cela dit, certaines des plongées en profondeur ont duré jusqu’à 21 minutes. Nous avons trouvé peu d’indices portant à croire que le comportement de plongée des bélugas de notre échantillon variait en fonction du sexe ou de l’âge. De manière générale, les bélugas plongeaient plus en profondeur dans l’est de la mer de Beaufort que dans l’ouest de la mer de Beaufort ou dans la mer des Tchouktches. Les profondeurs auxquelles les bélugas plongent le plus souvent dans le canyon Barrow et le long du rebord continental de Beaufort (de 200 à 300 m) correspondent à la limite où l’eau plus froide du Pacifique se superpose à l’eau plus chaude de l’Atlantique, là où la morue polaire (Boreogadus saida) est plus dense. Dans le bassin arctique, la profondeur des plongées suggère que les bélugas s’alimentent surtout dans la couche tempérée d’eau de l’Atlantique (~200 à 1 000 m)

The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project

Background: Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture. Methods: During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital’s repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT. Result: Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction. Conclusions: Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learnin

HIV-1 Selection by Epidermal Dendritic Cells during Transmission across Human Skin

Macrophage tropic HIV-1 is predominant during the initial viremia after person to person transmission of HIV-1 (Zhu, T., H. Mo, N. Wang, D.S. Nam, Y. Cao, R.A. Koup, and D.D. Ho. 1993. Science. 261:1179–1181.), and this selection may occur during virus entry and carriage to the lymphoid tissue. Human skin explants were used to model HIV-1 selection that may occur at the skin or mucosal surface. Macrophage tropic, but not T cell line tropic strains of HIV-1 applied to the abraded epidermis were recovered from the cells emigrating from the skin explants. Dermis and epidermis were separated by dispase digestion after virus exposure to determine the site of viral selection within the skin. Uptake and transmission to T cells of all HIV-1 isolates was found with the dermal emigrant cells, but only macrophage tropic virus was transferred by emigrants from the epidermis exposed to HIV-1, indicating selection only within the epidermis. CD3+, CD4+ T cells were found in both the dermal and epidermal emigrant cells. After cell sorting to exclude contaminating T cells, macrophage tropic HIV-1 was found in both the dermal emigrant dendritic cells and in dendritic cells sorted from the epidermal emigrants. These observations suggest that selective infection of the immature epidermal dendritic cells represents the cellular mechanism that limits the initial viremia to HIV-1 that can use the CCR5 coreceptor

Characterization of Histone Modifications in Late-Stage Rotator Cuff Tendinopathy

The development and progression of rotator cuff tendinopathy (RCT) is multifactorial and likely to manifest through a combination of extrinsic, intrinsic, and environmental factors, including genetics and epigenetics. However, the role of epigenetics in RCT, including the role of histone modification, is not well established. Using chromatin immunoprecipitation sequencing, differences in the trimethylation status of H3K4 and H3K27 histones in late-stage RCT compared to control were investigated in this study. For H3K4, 24 genomic loci were found to be significantly more trimethylated in RCT compared to control (p < 0.05), implicating genes such as DKK2, JAG2, and SMOC2 in RCT. For H3K27, 31 loci were shown to be more trimethylated (p < 0.05) in RCT compared to control, inferring a role for EPHA3, ROCK1, and DEFβ115. Furthermore, 14 loci were significantly less trimethylated (p < 0.05) in control compared to RCT, implicating EFNA5, GDF6, and GDF7. Finally, the TGFβ signaling, axon guidance, and regulation of focal adhesion assembly pathways were found to be enriched in RCT. These findings suggest that the development and progression of RCT is, at least in part, under epigenetic control, highlighting the influence of histone modifications in this disorder and paving the way to further understand the role of epigenome in RCT

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals

Objective To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. Data Sources/Study Setting Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. Study Design A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. Data Collection Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. Principal Findings The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. Conclusions Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls

An automated quasi-continuous capillary refill timing device

Capillary refill time (CRT) is a simple means of cardiovascular assessment which is widely used in clinical care. Currently, CRT is measured through manual assessment of the time taken for skin tone to return to normal colour following blanching of the skin surface. There is evidence to suggest that manually assessed CRT is subject to bias from ambient light conditions, a lack of standardisation of both blanching time and manually applied pressure, subjectiveness of return to normal colour, and variability in the manual assessment of time. We present a novel automated system for CRT measurement, incorporating three components: a non-invasive adhesive sensor incorporating a pneumatic actuator, a diffuse multi-wavelength reflectance measurement device, and a temperature sensor; a battery operated datalogger unit containing a self contained pneumatic supply; and PC based data analysis software for the extraction of refill time, patient skin surface temperature, and sensor signal quality. Through standardisation of the test, it is hoped that some of the shortcomings of manual CRT can be overcome. In addition, an automated system will facilitate easier integration of CRT into electronic record keeping and clinical monitoring or scoring systems, as well as reducing demands on clinicians. Summary analysis of volunteer (n = 30) automated CRT datasets are presented, from 15 healthy adults and 15 healthy children (aged from 5 to 15 years), as their arms were cooled from ambient temperature to 5°C. A more detailed analysis of two typical datasets is also presented, demonstrating that the response of automated CRT to cooling matches that of previously published studies