Emfit-patjalla mitatun unihäiriön vaikutus suoriutumiseen vireystilakokeessa

Tavoitteet:Tutkia unipolygrafiasta saatujen suureiden ja Emfit-patjalla mitattujen unihäiriöiden vaikutusta päiväaikaiseen suoriutumiseen vireystilakokeessa. Menetelmät: Aineisto koostui 15 koehenkilöstä, joista jokaisella oli jokin unenaikainen hengityshäiriö, ja jotka olivat suorittaneet Cognispeed-vireystilakokeen sekä illalla että aamulla. Yön potilaat nukkuivat Emfit-liikeanturipatjalla, ja heille tehtiin laaja unipolygrafia, joista saadut suureet kirjattiin ylös. Tulokset: Yölliset Emfit-patjalla mitatut periodiset obstruktiohäiriöt (OP1-OP3 –ilmiöt) vaikuttivat aamun reaktioaikaan hidastavasti. Reaktioaikaa hidasti myös S2- unen määrän lisääntyminen, tehokas uni ja uniajan pidentyminen. Reaktioaikoja nopeuttivat S1-unen lisääntyminen ja unenaikaiset aivokuoren lyhyet havahtumisreaktiot. Vireystilakokeen pisteet näyttivät olleen parempia aamulla mikäli unenaikainen apnea ja hypopnea lisääntyi, happisaturaatio laski tai obstruktiohäiriöiden osuus nousi. Pistesuoriutumista huononsi parempi vähimmäishappisaturaatio sekä kokonaisuniajan lisääntyminen. Päätelmä: Unenaikaiset obstruktiohäiriöt tuntuvat aiheuttavan hitaampaa suoriutumista vireystilakokeessa, mutta pinnallisemmin nukutun yön jälkeen päätöksentekoaika näyttää nopeutuvan.Asiasanat: unipolygrafia, uniapnea, vigilance, tarkkaavaisuus, aikuine

Illuminating Collaboration in Emergency Helath Care Situations: Paramedic-Physician Collaboration and 3D Telepresence Technology

Introduction. This paper focuses on paramedics' perspectives regarding paramedic-physician collaboration today, and their perspectives regarding the potential of 3D telepresence technology in the future. Method. Interviews were conducted with forty practicing paramedics. Analysis. The interview data were analysed using open and axial coding. An agreement of 0.82 using Cohen's kappa inter-coder reliability measure was reached. After coding was completed themes and relationships among codes were synthesised using topic memos. Results. Paramedics expressed concern about the lack of respect and trust exhibited towards them by other medical professionals. They discussed how they paint the picture for physicians and the importance of the physician trusting the paramedic. They further reported 3D telepresence technology would make their work visible in ways not previously possible. They also reported the technology would require additional training, changes to existing financial models used in emergency health care, and increased access to physicians. Conclusions. Teaching collaboration skills and strategies to physicians and paramedics could benefit their collaboration today, and increase their readiness to effectively use collaboration technologies in the future

Illuminating collaboration in emergency health care situations:Paramedic-physician collaboration and 3D telepresence technology

Introduction. This paper focuses on paramedics\u27 perspectives regarding paramedic-physician collaboration today, and their perspectives regarding the potential of 3D telepresence technology in the future. Method. Interviews were conducted with forty practicing paramedics. Analysis. The interview data were analysed using open and axial coding. An agreement of 0.82 using Cohen\u27s kappa inter-coder reliability measure was reached. After coding was completed themes and relationships among codes were synthesised using topic memos. Results. Paramedics expressed concern about the lack of respect and trust exhibited towards them by other medical professionals. They discussed how they paint the picture for physicians and the importance of the physician trusting the paramedic. They further reported 3D telepresence technology would make their work visible in ways not previously possible. They also reported the technology would require additional training, changes to existing financial models used in emergency health care, and increased access to physicians. Conclusions. Teaching collaboration skills and strategies to physicians and paramedics could benefit their collaboration today, and increase their readiness to effectively use collaboration technologies in the future

Exploring the potential of video technologies for collaboration in emergency medical care: Part I. Information sharing

We are investigating the potential of 3D telepresence, or televideo, technology to support collaboration among geographically separated medical personnel in trauma emergency care situations. 3D telepresence technology has the potential to provide richer visual information than current 2D video conferencing techniques. This may be of benefit in diagnosing and treating patients in emergency situations where specialized medical expertise is not locally available. The 3D telepresence technology does not yet exist and there is a need to understand its potential before resources are spent on its development and deployment. This poses a complex challenge. How can we evaluate the potential impact of a technology within complex, dynamic work contexts when the technology does not yet exist? To address this challenge we conducted an experiment with a post-test, between-subjects design that takes the medical situation and context into account. In the experiment we simulated an emergency medical situation involving practicing paramedics and physicians, collaborating remotely via two conditions: with today’s 2D videoconferencing and a 3D telepresence proxy. In this paper we examine information sharing between the attending paramedic and collaborating physician. Postquestionnaire data illustrate that the information provided by the physician was perceived to be more useful by the paramedic in the 3D proxy condition than the 2D condition. However, data pertaining to the quality of interaction and trust between the collaborating physician and paramedic show mixed results. Post-interview data help explain these results

3D Medical Collaboration Technology to Enhance Emergency Healthcare

Two-dimensional (2D) videoconferencing has been explored widely in the past 15–20 years to support collaboration in healthcare. Two issues that arise in most evaluations of 2D videoconferencing in telemedicine are the difficulty obtaining optimal camera views and poor depth perception. To address these problems, we are exploring the use of a small array of cameras to reconstruct dynamic three-dimensional (3D) views of a remote environment and of events taking place within. The 3D views could be sent across wired or wireless networks to remote healthcare professionals equipped with fixed displays or with mobile devices such as personal digital assistants (PDAs). The remote professionals’ viewpoints could be specified manually or automatically (continuously) via user head or PDA tracking, giving the remote viewers head-slaved or hand-slaved virtual cameras for monoscopic or stereoscopic viewing of the dynamic reconstructions. We call this idea remote 3D medical collaboration. In this article we motivate and explain the vision for 3D medical collaboration technology; we describe the relevant computer vision, computer graphics, display, and networking research; we present a proof-of-concept prototype system; and we present evaluation results supporting the general hypothesis that 3D remote medical collaboration technology could offer benefits over conventional 2D videoconferencing in emergency healthcare

COL4A2 is associated with lacunar ischemic stroke and deep ICH: Meta-analyses among 21,500 cases and 40,600 controls

Objective: To determine whether common variants in familial cerebral small vessel disease (SVD) genes confer risk of sporadic cerebral SVD. Methods: We meta-analyzed genotype data from individuals of European ancestry to determine associations of common single nucleotide polymorphisms (SNPs) in 6 familial cerebral SVD genes (COL4A1, COL4A2, NOTCH3, HTRA1, TREX1, and CECR1) with intracerebral hemorrhage (ICH) (deep, lobar, all; 1,878 cases, 2,830 controls) and ischemic stroke (IS) (lacunar, cardioembolic, large vessel disease, all; 19,569 cases, 37,853 controls). We applied data quality filters and set statistical significance thresholds accounting for linkage disequilibrium and multiple testing. Results: A locus in COL4A2 was associated (significance threshold p , 3.5 3 1024) with both lacunar IS (lead SNP rs9515201: odds ratio [OR] 1.17, 95%confidence interval [CI] 1.11-1.24, p 56.62 31028) and deep ICH (lead SNP rs4771674: OR 1.28, 95%CI 1.13-1.44, p 55.76 3 1025). A SNP in HTRA1 was associated (significance threshold p , 5.5 3 1024) with lacunar IS (rs79043147: OR 1.23, 95%CI 1.10-1.37, p 5 1.90 3 1024) and less robustly with deep ICH. There was no clear evidence for association of common variants in either COL4A2 or HTRA1 with non-SVD strokes or in any of the other genes with any stroke phenotype

TRIM27 Negatively Regulates NOD2 by Ubiquitination and Proteasomal Degradation

NOD2, the nucleotide-binding domain and leucine-rich repeat containing gene family (NLR) member 2 is involved in mediating antimicrobial responses. Dysfunctional NOD2 activity can lead to severe inflammatory disorders, but the regulation of NOD2 is still poorly understood. Recently, proteins of the tripartite motif (TRIM) protein family have emerged as regulators of innate immune responses by acting as E3 ubiquitin ligases. We identified TRIM27 as a new specific binding partner for NOD2. We show that NOD2 physically interacts with TRIM27 via the nucleotide-binding domain, and that NOD2 activation enhances this interaction. Dependent on functional TRIM27, ectopically expressed NOD2 is ubiquitinated with K48-linked ubiquitin chains followed by proteasomal degradation. Accordingly, TRIM27 affects NOD2-mediated pro-inflammatory responses. NOD2 mutations are linked to susceptibility to Crohns disease. We found that TRIM27 expression is increased in Crohns disease patients, underscoring a physiological role of TRIM27 in regulating NOD2 signaling. In HeLa cells, TRIM27 is partially localized in the nucleus. We revealed that ectopically expressed NOD2 can shuttle to the nucleus in a Walker A dependent manner, suggesting that NOD2 and TRIM27 might functionally cooperate in the nucleus. We conclude that TRIM27 negatively regulates NOD2-mediated signaling by degradation of NOD2 and suggest that TRIM27 could be a new target for therapeutic intervention in NOD2-associated diseases.Funding Agencies|German Research Foundation (DFG)|SFB670-NG01|Swedish Society of Medicine||Regional Research Council of South-East Sweden (FORSS)||Swedish Research Council division of Medicine||Gustav V 90th anniversary foundation||Italian Telethon Foundation||DFG|SE 1122/2-1|</p