[First results of a German second opinion program show high patient satisfaction and large discrepancies between initial therapy recommendations and second opinion].

Science.gov (United States)

Weyerstraß, Jan; Prediger, Barbara; Neugebauer, Edmund; Pieper, Dawid

2018-02-23

Although legally anchored, there are no empirical results from German second opinion programs. In this study, various aspects within a population of a second opinion program are examined. In this study patients were analyzed who sought a second opinion in the period from August 2011 to December 2016. Differences in patient characteristics, differentiated by agreement of first and second opinion, were analyzed using multivariate logistic regression. Patients' satisfaction and quality of life were examined one, three and six months after obtaining the second opinion. In total, 1,414 patients sought a second opinion. Most frequent medical indications were the knee (38.7 %), the back (26.8 %), the hip (11.7 %), and the shoulder (10.2 %). Except for the indication (p=0.035), no patient characteristic had influence on the conformation of the second opinion. Approximately two out of three initial recommendations were not confirmed by the specialists. 89 % of the patients were satisfied or very satisfied with the second opinion and the service offered. The second opinion offers patients the opportunity to seek an additional independent medical opinion and thus provide support for decision making. Further research is needed to examine the reasons for the high discrepancies between the first and second opinions. Copyright © 2018. Published by Elsevier GmbH.

Getting a Second Opinion Before Surgery

Science.gov (United States)

... for a second opinion before surgery. When your doctor says you have a health problem that needs surgery, you have the right to: • Know and understand your treatment choices • Have another doctor look at those choices with you (second opinion) • ...

The Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal.

Science.gov (United States)

Gentry Iii, James L; Phelan, Dermot; Desai, Milind Y; Griffin, Brian P

Stress echocardiography is a widely available, safe, low-cost, versatile imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with native and prosthetic left-sided valvular heart disease. It provides a quantitative assessment to help guide clinical decision-making when discordance exists between symptoms and severity of valve disease. Exercise (treadmill or bicycle) remains the preferred stress modality, but pharmacological augmentation with dobutamine can be used if needed. Low-dose dobutamine stress echocardiography is specifically valuable in patients with low-flow, low-gradient aortic stenosis when attempting to differentiate true severe aortic stenosis from pseudo-severe aortic stenosis. Stress echocardiography not only identifies high-risk features that indicate need for earlier surgery, it also provides useful information for the peri- and postoperative period, including long-term outcome, risk stratification to guide monitoring frequency, and offers guidance for eligibility in competitive sports participation. As research continues to expand the utility of stress echocardiography in the management of patients with valvular heart disease, future research should focus on the recognition of newer parameters identifying high-risk features including subsequent validation in a large population. © 2017 S. Karger AG, Basel.

Assessment of Myocardial Ischemia in Obese Individuals Undergoing Physical Stress Echocardiography (PSE

Directory of Open Access Journals (Sweden)

Mara Graziele Maciel Silveira

2015-05-01

Full Text Available Background: Physical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ≥ 30 kg/m2 the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group. Objective: To assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences. Methods: 4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3% and non-obese (n = 3,105; 76.6%. Results: There was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67 and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001, diabetis mellitus (15.2% vs. 10.9%; p < 0.0001, dyslipidemia (59.5% vs 51.9%; p < 0.0001, family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023 and physical inactivity (71.4% vs. 52.9%, p < 0.0001. The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001, left atrium (3.97 vs. 3.72 cm; p < 0.0001 and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001. Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41. In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension. Conclusion: Obesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese.

Stress echocardiography in valvular heart disease: a current appraisal.

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Naji, Peyman; Patel, Krishna; Griffin, Brian P; Desai, Milind Y

2015-03-01

Stress echocardiography is increasingly used in the management of patients with valvular heart disease and can aid in evaluation, risk stratification and clinical decision making in these patients. Evaluation of symptoms, exercise capacity and changes in blood pressure can be done during the exercise portion of the test, whereas echocardiographic portion can reveal changes in severity of disease, pulmonary artery pressure and left ventricular function in response to exercise. These parameters, which are not available at rest, can have diagnostic and prognostic importance. In this article, we will review the indications and diagnostic implications, prognostic implications, and clinical impact of stress echocardiography in decision making and management of patients with valvular heart disease.

Results of a Prospective Echocardiography Trial in International Space Station Crew

Science.gov (United States)

Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David; Garcia, Kathleen M.; Melton, Shannon; Feiverson, Alan; Dulchavsky, Scott A.

2009-01-01

In the framework of an operationally oriented investigation, we conducted a prospective trial of a standard clinical echocardiography protocol in a cohort of long-duration crewmembers. The resulting primary and processed data appear to have no precedents. Our tele-echocardiography paradigm, including just-in-time e-training methods, was also assessed. A critical review of the imaging technique, equipment and setting limitations, and quality assurance is provided, as well as the analysis of "space normal" data.

Four-dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis.

Science.gov (United States)

Deng, Yan; Peng, Long; Liu, Yuan-Yuan; Yin, Li-Xue; Li, Chun-Mei; Wang, Yi; Rao, Li

2017-09-01

The aim of this prospective study was to assess the diagnosis value of four-dimensional echocardiography area strain (AS) combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis. Based on treadmill exercise load status, two-dimensional conventional echocardiography and four-dimensional echocardiography area strain were performed on patients suspected coronary artery disease before coronary angiogram. Thirty patients (case group) with mild left anterior descending coronary artery stenosis (stenosis Four-dimensional echocardiography area strain combined with exercise stress echocardiography could sensitively find left ventricular regional systolic function abnormality in patients with mild single vessel coronary artery stenosis, and locate stenosis coronary artery accordingly. © 2017, Wiley Periodicals, Inc.

Integrated quadruple stress echocardiography.

Science.gov (United States)

Picano, Eugenio; Morrone, Doralisa; Scali, Maria C; Huqi, Alda; Coviello, Katia; Ciampi, Quirino

2018-04-11

Stress Echocardiography (SE) is an established diagnostic technique. For 40 years, the cornerstone of the technique has been the detection of regional wall motion abnormalities (RWMA), due to the underlying physiologically-relevant epicardial coronary artery stenosis. In the last decade, three new parameters (more objective than RWMA) have shown the potential to integrate and comple- ment RWMA: 1- B-lines, also known as ultrasound lung comets, as a marker of extra-vascular lung water, measured using lung ultrasound with the 4-site simplified scan symmetrically of the antero- lateral thorax on the third intercostal space, from mid-axillary to anterior axillary and mid- clavicular line; 2-left ventricular contractile reserve (LVCR), assessed as the peak stress/rest ratio of left ventricular force, also known as elastance (systolic arterial pressure by cuff sphygmomanome- ter/end-systolic volume from 2D echocardiography); 3- coronary flow velocity reserve (CFVR) on left anterior descending coronary artery, calculated as peak stress/rest ratio of diastolic peak flow velocity assessed using pulsed-wave Doppler. The 4 parameters (RWMA, B-lines, LVCR and CFVR) now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-SE. IQ-SE optimizes the versatility of SE to include in a one-stop shop the core "ABCD" (Asynergy+B-lines+Contractile reserve+Doppler flowmetry) protocol. It allows a synoptic assess- ment of parameters mirroring the epicardial artery stenosis (RWMA), interstitial lung water (B- lines), myocardial function (LVCR) and small coronary vessels (CFVR). Each variable has a clear clinical correlate, different and complementary to all others: RWMA identify an ischemic vs non- ischemic heart; B-lines a wet vs dry lung; LVCR a strong vs weak heart; CFVR a warm vs cold heart. IQ-SE is highly feasible, with minimal increase in the imaging and analysis time, and obvi- ous diagnostic and prognostic impact also beyond coronary artery

Comparison of exercise stress testing with dobutamine stress echocardiography and exercise technetium-99m isonitrile single photon emission computerized tomography for diagnosis of coronary artery disease

International Nuclear Information System (INIS)

Oguzhan, A.; Kisacik, H.L.; Ozdemir, K.

1997-01-01

To compare the value of exercise electrocardiography with dobutamine stress echocardiography and exercise technetium-99m isonitrile single-photon emission computed tomography for coronary artery disease, 70 patients with either suspected or proven coronary artery disease underwent dobutamine stress echocardiography, exercise technetium-99m isonitrile single-photon emission computed tomography (mibi-SPECT) and treadmill exercise electrocardiography (ECG). Dobutamine echocardiography and exercise mibi-SPECT revealed a higher overall sensitivity than exercise testing (90 vs 57%, p 0.05; 90 and 62% p<0.05, respectively) but the difference between dobutamine stress echocardiography and exercise mibi-SPECT was not statistically significant. Diagnostic accuracy of dobutamine stress echocardiography and exercise mibi-SPECT was higher than that of exercise testing (90 vs 59%, p<0.001; 89 vs 59%, p<0.001, respectively). Dobutamine stress echocardiography and exercise mibi-SPECT have superiority over exercise testing in the diagnosis of coronary artery disease and dobutamine stress echocardiography is an alternative for exercise mibi-SPECT. (author)

Diagnostic value of exercise stress testing, dipyridamole stress-echocardiography and perfusion stress-scintigraphy for identification of coronary artery disease in women

International Nuclear Information System (INIS)

Debnath, S.; Tyrnovska-Kydreva, R.; Khalacheva, S.; Radoslavova, R.; Stoyanova, N.; Draganov, T.; Elenkova, A.; Garcheva, M.; Shejretova, E.

1995-01-01

To compare the value of exercise stress testing (EST), dipyridamole stress echocardiography and 99m Tc-methoxy-isobutyl-isonitrile (MIBI)-planer scintigraphy, 75 female patients with angina pectoris who underwent coronary angiography were studied. Significant (≥50% stenosis) coronary artery disease (CAD) was present in 38 of the patients. EST was performed in all of the patients but dipyridamole echocardiography and MIBI-planer scintigraphy - in 36 of them (22 with and 14 without CAD). Compared with dipyridamole echocardiography, EST and MIBI-planer scintigraphy had a significantly higher sensitivity (74% vs 45%, p<0.01 and 82% vs 45%, p<0.01, respectively). There was no significant difference in sensitivity between EST and MIBI-planer scintigraphy. Dipyridamole echocardiography and MIBI-planer scintigraphy showed a higher specificity than EST (93% vs 54%, p<0.01 and 93% vs 54%, p<0.01, respectively). Diagnostic accuracy of MIBI-planer scintigraphy was higher than that of dipyridamole echocardiography and EST (86% vs 64%, p<0.05 and 86 vs 64%, p<0.01, respectively). Thus, MIBI-planer scintigraphy appears to be superior to EST and dipyridamole echocardiography for the evaluation of CAD in symptomatic women. 20 refs., 2 tabs. (author)

Predictive role of stress echocardiography before carotid endarterectomy in patients with coronary artery disease.

Science.gov (United States)

Galyfos, George; Tsioufis, Constantinos; Theodorou, Dimitris; Katsaragakis, Stilianos; Zografos, Georgios; Filis, Konstantinos

2015-07-01

Our aim was to examine the predictive value of preoperative stress echocardiography regarding early myocardial ischemia and late cardiac events after carotid endarterectomy (CEA). Patients with coronary artery disease undergoing CEA were prospectively included in this study. All patients (n = 162) were classified into low, medium, and high cardiac risk group, according to preoperative stress echocardiography. Classification was based on the criteria of the American Society of Echocardiography. For all patients, cTnI was measured before surgery and on postoperative days 1, 3, and 7. Postoperative cTnI values ranging from 0.05 to 0.5 ng/mL were classified as myocardial ischemia; values >0.5 ng/mL were classified as myocardial infarction. Cardiac damage was defined as either myocardial ischemia or infarction. No deaths, strokes, or symptomatic coronary events were observed during the early postoperative period. There were 112 low cardiac risk patients, 42 medium-risk patients, and 8 high-risk patients, according to stress echocardiography findings. Overall, there were 22 patients (14%) that increased their cTnI values postoperatively (12 of low cardiac risk and 10 of medium cardiac risk), and all of them were asymptomatic. None of the high-risk patients showed any troponin increase. Late cardiac events were associated with cTnI increase, although no high-risk patients showed any late event. Preoperative stress echocardiography does not seem to independently recognize patients in high risk for asymptomatic cardiac damage after CEA. Postoperative troponin elevation seems to be more predictive for late adverse cardiac events than preoperative stress echocardiography. © 2014, Wiley Periodicals, Inc.

Comparison of Hyperemic Impedance Echocardiography with Dobutamine Stress Echocardiography to Detect Inducible Myocardial Ischemia: A Pilot Study.

Science.gov (United States)

Patel, Jijibhoy J; Gupta, Ankur; Nanda, Navin C

2016-03-01

Stress echocardiography using exercise or pharmacological stressors is either contraindicated or associated with significant side effects in some patients. This pilot study was designed to evaluate a new technique, hyperemic impedance echocardiography (HIE). It is based on reactive coronary hyperemia when transient limb ischemia is induced by tourniquet inflation. We hypothesized that this physiologic coronary hyperemia can identify inducible myocardial ischemia by assessment of regional wall motion abnormalities on echocardiography when compared with dobutamine stress echocardiography (DSE). Twenty consecutive outpatients with suspected stable coronary artery disease (CAD) who underwent clinically indicated DSE were recruited for performance of HIE after informed consent was obtained. Standard graded dobutamine infusion protocol from 5 to 40 μg/kg per min was used for DSE. HIE was performed by inflating tourniquets at a pressure of 10 mmHg below the systolic blood pressure for 1 minute in three of four extremities at a time for total of four cycles. Echocardiography was performed immediately after the last rotating tourniquet deflation. DSE and HIE were classified as abnormal for development of new or worsening wall motion abnormality in at least one myocardial segment. Test characteristics were also determined for a subset of these patients (n = 12) who underwent clinically indicated coronary angiography. Hyperemic impedance echocardiography showed 86% sensitivity, 67% specificity, 86% positive predictive value, and 67% negative predictive value with a test accuracy of 80% to detect inducible myocardial wall motion abnormalities when compared with DSE. HIE also showed 83% sensitivity, 75% negative predictive value with a test accuracy of 66.7% for detection of significant (≥50% diameter stenosis) CAD on coronary angiography. In this pilot study, HIE was a feasible, safe, and promising method for detection of inducible myocardial ischemia by assessment of

Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia

Directory of Open Access Journals (Sweden)

Ana Carla Pereira de Araujo

2014-11-01

Full Text Available Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1 or positive (G2 for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%. During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016. The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022 and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively. Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.

Comparision the value of detecting myocardial viability between low dose dobutamine stress MRI and echocardiography

International Nuclear Information System (INIS)

He Yi; Zhang Zhaoqi; Yu Wei; Miao Cuilian; Zhao Yike; Yan Zixu

2006-01-01

Objective: To Compare the diagnostic value between low dose dobutamine stress transthrotic echocardiography and low dose dobutamine stress MRI in detecting myocardial viability of chronic myocardial infarction. Methods: Rest and low dose dobutamine (5, 10 μg·kg -1 ·min -1 ) stress transthrotic echocardiography and cine-MRI were performed in 30 patients with chronic myocardial infarction. 24 patients underwent successful revascularization and 10 of them underwent another rest cine-MRI study to assess segmental myocardial functional recovery. Left ventricular were divided into 16 segments, the criteria of viability in different techniques is: MRI: dobutamine induced systolic wall thickening was ≥2 mm in akinetic or diskinetic segments at rest; Echocardiography: wall motion score reduced at least 1 after dobutamine stress in akinetic or' diskinetic segments at rest. Results: One hundren and eight segments showed wall motion abnormalities of 30 patients, 65 and 56 segments shows positive reaction, 43 and 52 segments shows negativereaction in MRI and echocardiography after dobutamine stress respectively. Kappa value of the two techniques is 0.75, concordance in both techniques is 88%. Twenty-four segments showed functional recovery, 14 segments remained dysfunction 3-6 months after revascularization, the sensitivity, specificity and accuracy of detecting myocardial viability in chronic myocardial infarction in MRI and echocardiography is 95.8% vs 79.2% (P>0.05), 85.7% vs 85.7% (P>0.05), 92.1% vs 81.6% (P>0.05) respectively. The sensitivity and accuracy of MRI is a little higher. Conclusion: The ability of detecting myocardial viability by both low dose dobutamine stress transthrotic echocardiography and low dose dobutamine stress MRI is similer, the sensitivity and accuracy of MRI is a little higher. (authors)

Myocardial Contrast Agents – Safety Considerations and Clinical Efficacy in Stress Echocardiography

Directory of Open Access Journals (Sweden)

Maier Anca

2016-11-01

Full Text Available Transthoracic echocardiographic examination is known to be a safe, non-invasive and reproducible method, used in every day clinical practice to obtain important information about cardiac structure and function. Unfortunately, a significant proportion of studies have highlighted the considerable technically difficultly in producing diagnostic images due to a poor acoustic window and more than 33% of patients undergoing stress echocardiography have suboptimal echocardiographic images. All these limitations have led to the use of contrast agents to improve the quality of standard ultrasound examination to provide a better delineation of left ventricle endocardial borders or to obtain information that cannot be achieved by using standard echocardiography, such as assessing myocardial microcirculation and therefore perfusion. This paper sought to review the clinical efficacy and safety of ultrasound contrast agents focusing on stress echocardiography.

Motives for seeking a second opinion in orthopaedic surgery.

NARCIS (Netherlands)

Dalen, I. van; Groothoff, J.; Stewart, R.; Spreeuwenberg, P.; Groenewegen, P.; Horn, J. van

2001-01-01

The number of second opinions in orthopaedic surgery is increading rapidly, yet the grounds on which patients and their doctors decide to seek a second opinion have been little studied. The goal of the study was to identify patient and consultant factors that appeared to contribute to a second

Breast Imaging Second Opinions Impact Surgical Management.

Science.gov (United States)

Spivey, Tara Lynn; Carlson, Kjirsten Ayn; Janssen, Imke; Witt, Thomas R; Jokich, Peter; Madrigrano, Andrea

2015-07-01

Breast surgeons often see women for second opinions for abnormalities found on breast imaging. For second opinions, these images are submitted for review and interpretation by dedicated breast imagers. This study evaluated the conformity of results among interpretation of imaging submitted from outside hospitals both from tertiary care centers, as well as community programs, in an attempt to evaluate the utility of this practice for the sake of clinical management and resource utilization. A retrospective chart review was conducted on all breast patients that submitted outside imaging films for the years 2011 to 2013 at Rush University Medical Center (RUMC). The radiologic diagnosis and each patient's proposed management plan was collected and evaluated for concordance between the outside institutions and RUMC. A total of 380 patients who presented for second opinions with an interpretation of outside exams were evaluated. In 47.4 % [95 % confidence interval (CI) 42.4-52.4] of cases there was distinct variance in radiologic impression. For 53.5 % (95 % CI 48.4-58.5) of patients, there was a change in recommended management plan, which included recommendations for either additional imaging or need for additional biopsy. In total, this changed the overall surgical management in 27.1 % (95 % CI 22.8-31.9) of cases. In six patients, the reinterpretation of outside imaging detected new malignancies not previously identified. Overall, 83.7 % (95 % CI 79.7-87.1) of patients who submitted imaging from outside institutions chose to complete the remainder of their treatment at RUMC. The practice of second opinion review changed overall definitive management at our specialty center in more than one in four cases. In addition, the review identified six previously unrecognized malignancies. Given this data, the practice of second opinions and interpretation of outside exams should continue despite the additional resources required.

Magnetic resonance pharmacological stress for detecting coronary disease. Comparison with echocardiography

International Nuclear Information System (INIS)

Baer, F.M.; Crnac, J.; Jochims, M.; Schneider, C.; Erdmann, E.; Schmidt, M.; Theissen, P.; Schicha, H.

2000-01-01

Stress testing is the cornerstone in the diagnosis of patients with suspected coronary artery disease (CAD). Although exercise ECG remains the primary approach for the detection of ischemia in patients with chest pain syndromes, its sensitivity and specificity is limited and exercise ECG does not provide detailed information about the localisation and extent of CAD. Stress echocardiography has been used for the detection of ischemia for more than a decade and has become an increasingly popular noninvasive method for the detection of CAD. In experienced hands wall motion analysis based on stress echocardiography has proved to be as sensitive and specific for the detection of myocardial ischemia as scintigraphic techniques. Recent technical improvements, namely the availability of ultrafast imaging sequences with a significant reduction of imaging time have initiated several studies which examined the combination of pharmacological stress and magnetic resonance imaging (MRI) for the detection of suspected CAD. The most well developed stress-MRI technique is wall motion imaging during dobutamine stress. This technique is analogous to stress echocardiography, but MRI has the inherent advantages of better resolution, higher reproducibility and true long and short axis imaging with contiguous parallel slices. However, the clinical impact of MRI for the diagnosis of CAD is still low. Further technical developments including real time imaging and a reliable automated quantitative analysis of left ventricular function are required before stress-MRI becomes a serious challenge to stressechocardiography in the clinical arena. Currently, only a few MRI facilities and physicians are dedicated to pharmacological stress testing with MRI and the future clinical impact of this promising technique will depend on its potential to provide information beyond myocardial function including perfusion, metabolism and coronary anatomy in form of a ''one-stop''-shop for the cardiac patient

Feasibility, safety and tolerability of accelerated dobutamine stress echocardiography

Directory of Open Access Journals (Sweden)

Pavaci Herribert

2007-11-01

Full Text Available Abstract A continuous infusion of a single high dose of dobutamine has been, recently, suggested as a simple and effective protocol of stress echocardiography. The present study assesses the feasibility, safety, and tolerability of an accelerated dobutamine stress protocol performed in patients with suspected or known coronary artery disease. Two hundred sixty five consecutive patients underwent accelerated dobutamine stress echocardiography: the dobutamine was administered at a constant dose of 50 μg/kg/min for up to 10 minutes. The mean weight-adjusted cumulative dose of dobutamine used was 330 ± 105.24 μg/kg. Total duration of dobutamine infusion was 6.6 ± 2.1 min. Heart rate rose from 69.9 ± 12.1 to 123.1 ± 22.1 beats/min at peak with a concomitant change in systolic blood pressure (127.6 ± 18.1 vs. 167.6 ± 45.0 mmHg. Dobutamine administration produced a rapid increase in heart rate (9.4 ± 5.9 beats/min2. The side effects were similar to those described with the standard protocol; the most common were frequent premature ventricular complexes (21.5%, frequent premature atrial complexes (1.5% and non sustained ventricular tachycardia (1.5%; among non cardiac symptoms the most frequent were nausea (3.4%, headache (1.1% and symptomatic hypotension (1.1%. No major side effects were observed during the test. Our data demonstrate that a continous infusion of a single high dose of dobutamine is a safe and well tolerated method of performing stress echocardiography in patients with suspected or known coronary artery disease. This new protocol requires the administration of lower cumulative dobutamine dose than standard protocol and results in a significant reduction in test time.

Characteristics associated with requests by pathologists for second opinions on breast biopsies.

Science.gov (United States)

Geller, Berta M; Nelson, Heidi D; Weaver, Donald L; Frederick, Paul D; Allison, Kimberly H; Onega, Tracy; Carney, Patricia A; Tosteson, Anna N A; Elmore, Joann G

2017-11-01

Second opinions in pathology improve patient safety by reducing diagnostic errors, leading to more appropriate clinical treatment decisions. Little objective data are available regarding the factors triggering a request for second opinion despite second opinion consultations being part of the diagnostic system of pathology. Therefore we sought to assess breast biopsy cases and interpreting pathologists characteristics associated with second opinion requests. Collected pathologist surveys and their interpretations of 60 test set cases were used to explore the relationships between case characteristics, pathologist characteristics and case perceptions, and requests for second opinions. Data were evaluated by logistic regression and generalised estimating equations. 115 pathologists provided 6900 assessments; pathologists requested second opinions on 70% (4827/6900) of their assessments 36% (1731/4827) of these would not have been required by policy. All associations between case characteristics and requesting second opinions were statistically significant, including diagnostic category, breast density, biopsy type, and number of diagnoses noted per case. Exclusive of institutional policies, pathologists wanted second opinions most frequently for atypia (66%) and least frequently for invasive cancer (20%). Second opinion rates were higher when the pathologist had lower assessment confidence, in cases with higher perceived difficulty, and cases with borderline diagnoses. Pathologists request second opinions for challenging cases, particularly those with atypia, high breast density, core needle biopsies, or many co-existing diagnoses. Further studies should evaluate whether the case characteristics identified in this study could be used as clinical criteria to prompt system-level strategies for mandating second opinions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Magnetic resonance pharmacological stress for detecting coronary disease. Comparison with echocardiography

Energy Technology Data Exchange (ETDEWEB)

Baer, F.M.; Crnac, J.; Jochims, M.; Schneider, C.; Erdmann, E. [Clinic III of Internal Medicine, Univ. of Cologne (Germany); Schmidt, M.; Theissen, P.; Schicha, H. [Clinic und Ambulant Clinic of Nuclear Medicine, Univ. of Cologne (Germany)

2000-06-01

Stress testing is the cornerstone in the diagnosis of patients with suspected coronary artery disease (CAD). Although exercise ECG remains the primary approach for the detection of ischemia in patients with chest pain syndromes, its sensitivity and specificity is limited and exercise ECG does not provide detailed information about the localisation and extent of CAD. Stress echocardiography has been used for the detection of ischemia for more than a decade and has become an increasingly popular noninvasive method for the detection of CAD. In experienced hands wall motion analysis based on stress echocardiography has proved to be as sensitive and specific for the detection of myocardial ischemia as scintigraphic techniques. Recent technical improvements, namely the availability of ultrafast imaging sequences with a significant reduction of imaging time have initiated several studies which examined the combination of pharmacological stress and magnetic resonance imaging (MRI) for the detection of suspected CAD. The most well developed stress-MRI technique is wall motion imaging during dobutamine stress. This technique is analogous to stress echocardiography, but MRI has the inherent advantages of better resolution, higher reproducibility and true long and short axis imaging with contiguous parallel slices. However, the clinical impact of MRI for the diagnosis of CAD is still low. Further technical developments including real time imaging and a reliable automated quantitative analysis of left ventricular function are required before stress-MRI becomes a serious challenge to stressechocardiography in the clinical arena. Currently, only a few MRI facilities and physicians are dedicated to pharmacological stress testing with MRI and the future clinical impact of this promising technique will depend on its potential to provide information beyond myocardial function including perfusion, metabolism and coronary anatomy in form of a ''one-stop''-shop for

Second opinion oral pathology referrals in New Zealand.

Science.gov (United States)

Seo, B; Hussaini, H M; Rich, A M

2017-04-01

Referral for a second opinion is an important aspect of pathology practice, which reduces the rate of diagnostic error and ensures consistency with diagnoses. The Oral Pathology Centre (OPC) is the only specialist oral diagnostic centre in New Zealand. OPC provides diagnostic services to dentists and dental specialists throughout New Zealand and acts as a referral centre for second opinions for oral pathology specimens that have been sent to anatomical pathologists. The aim of this study was to review second opinion referral cases sent to the OPC over a 15-year period and to assess the levels of concordance between the original and final diagnoses. The findings indicated that the majority of referred cases were odontogenic lesions, followed by connective tissue, epithelial and salivary lesions. The most prevalent diagnoses were ameloblastoma and keratocystic odontogenic tumour, followed by oral squamous cell carcinoma. Discordant diagnoses were recorded in 24% of cases. Diagnostic discrepancies were higher in odontogenic and salivary gland lesions, resulting in the change of diagnoses. Second opinion of oral pathology cases should be encouraged in view of the relative rarity of these lesions in general pathology laboratories and the rates of diagnostic discrepancy, particularly for odontogenic and salivary gland lesions. Copyright © 2017 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.

Can Stress Echocardiography Compete with Perfusion Scintigraphy in the Detection of Coronary Artery Disease and Cardiac Risk Assessment?

NARCIS (Netherlands)

M.L. Geleijnse (Marcel); A. Elhendy (Abdou)

2000-01-01

textabstractAims: The aim of this review was to define the place of stress echocardiography in the context of perfusion scintigraphy for the detection of coronary artery disease (CAD) and the assessment of cardiac risk. Stress echocardiography has the benefits of widespread availability, relatively

The role of specialist neuroradiology second opinion reporting: is there added value?

International Nuclear Information System (INIS)

Briggs, G.M.; Flynn, P.A.; Worthington, M.; Rennie, I.; McKinstry, C.S.

2008-01-01

Aim: To assess the impact on patient management of formal neuroradiology 'second reading' of computed tomography (CT) and magnetic resonance imaging (MRI) images initially interpreted by general radiologists. Materials and methods: Second opinion reports during the calendar year 2004 were compared with the original report and assessed for major or minor discrepancies. A major discrepancy was separated from a minor discrepancy whereby a change in opinion significantly affected patient management. Results: There were 506 second opinions during 2004 given by three consultant neuroradiologists. Incomplete data were found in 141. Forty-one percent were CT images and the remainder MRI. The majority of second opinions were requested by neurologists. Most of the remaining referrals were from neurosurgeons or the primary radiologist. There was a 13% major and a 21% minor discrepancy rate. The remaining 66% were in complete agreement. There was a mixture of overcalls, misinterpretation, and undercalls. There were similar rates of minor and major discrepancies in both CT and MRI. Conclusion: There is a significant major discrepancy rate between specialist neuroradiology second opinion and general radiologists. The benefit of a formal specialist second opinion service is clearly demonstrated; however, it is time-consuming

Determinants of Pediatric Echocardiography Laboratory Productivity: Analysis from the Second Survey of the American Society of Echocardiography Committee on Echocardiography Laboratory Productivity.

Science.gov (United States)

Srivastava, Shubhika; Allada, Vivekanand; Younoszai, Adel; Lopez, Leo; Soriano, Brian D; Fleishman, Craig E; Van Hoever, Andrea M; Lai, Wyman W

2016-10-01

The American Society of Echocardiography Committee on Pediatric Echocardiography Laboratory Productivity aimed to study factors that could influence the clinical productivity of physicians and sonographers and assess longitudinal trends for the same. The first survey results indicated that productivity correlated with the total volume of echocardiograms. Survey questions were designed to assess productivity for (1) physician full-time equivalent (FTE) allocated to echocardiography reading (echocardiograms per physician FTE per day), (2) sonographer FTE (echocardiograms per sonographer FTE per year), and (3) machine utilization (echocardiograms per machine per year). Questions were also posed to assess work flow and workforce. For fiscal year 2013 or academic year 2012-2013, the mean number of total echocardiograms-including outreach, transthoracic, fetal, and transesophageal echocardiograms-per physician FTE per day was 14.3 ± 5.9, the mean number of echocardiograms per sonographer FTE per year was 1,056 ± 441, and the mean number of echocardiograms per machine per year was 778 ± 303. Both physician and sonographer productivity was higher at high-volume surgical centers and with echocardiography slots scheduled concordantly with clinic visits. Having an advanced imaging fellow and outpatient sedation correlated negatively with clinical laboratory productivity. Machine utilization was greater in laboratories with higher sonographer and physician productivity and lower for machines obtained before 2009. Measures of pediatric echocardiography laboratory staff productivity and machine utilization were shown to correlate positively with surgical volume, total echocardiography volumes, and concordant echocardiography scheduling; the same measures correlated negatively with having an advanced imaging fellow and outpatient sedation. There has been no significant change in staff productivity noted over two Committee on Pediatric Echocardiography Laboratory

Regulation, control, tele-management; Regulation, commande, telegestion

Energy Technology Data Exchange (ETDEWEB)

NONE

2001-07-01

In 1998, the French public authorities have started an ambitious energy mastery policy under the auspices of the Agency of environment and energy mastery (Ademe). One aspect of this policy concerns the R and D, industrial development and applications of automation and computerized control to the energy systems of buildings. This RCT 2000 seminar takes stock of the recent advances in this domain 7 years after the previous RCT issue. The first day of the seminar was devoted to new developments in regulation and control (ergonomics aspects, lighting systems, air conditioning in accommodations, solar systems etc..). Stress was put on the revolution expected with the introduction of domestic computer applications and Internet. This first day ended with a precise status of the standardization and future regulatory aspects. The second day was dealing with tele-management and technical management systems for buildings with an analysis of the impact of Internet and of the sensors and actuators capacity in information processing. The consequences and new requirements of the thermal regulation 2000 and the factors of success of a new start-up of the tele-management market in local authorities and social accommodations were analyzed too. (J.S.)

Sensibility and specificity of the stress echocardiography with Dobutamine for the detection of coronary disease

International Nuclear Information System (INIS)

Senior, Juan Manuel; Escobar, Carlos Ignacio; Jaramillo, Mario and others

2001-01-01

Dobutamine stress echocardiography has become a useful method for detecting coronary artery disease in the high prevalence population. The reported sensitivity varies between 76-90% and the specificity between 60-95%. 60-95% there have been few reports regarding sensitivity and specificity among our population. The aim of this study was to evaluate the sensitivity of dopamine stress echocardiography in a population with a high probability of coronary disease. This was a randomized retrospective-prospective study. Between February 1 of 1998 and February 1 of 1999. 409 patients underwent dopamine stress echocardiography and were analyzed according to established protocol. The Dobutamine stress echocardiography as well as the angiography was checked in a blind form by one of the participating researchers trained in those procedures. The diagnostic concordance was found to be greater than 90%. Significant coronary disease was considered to be present in those cases in which there was severe stenosis greater than 50% in a major epicardial artery or greater than 40 % in the left main artery. Coronary arteriography was performed within three months of Dobutamine stress echocardiography imaging. A sixteen-segment model was used as the index for the evaluation of systolic wall thickening and the results were classified as follows: normal (l), ischemia (ll), fixed abnormality (lll) and mixed (lV). 409 patients with an average age of 62.8 +/- 12) were included in the study at random. Six patients with mediocre technical examinations were excluded. 47 % were male. 29% had a history of myocardial infarction, 35 % had a history of arterial hypertension and 10% had diabetes mellitus. The average ejection fraction was 54 +/- 13%. The examination was prescribed in order to detect the presence of ischemia in 95.8% of the cases and as part of preoperative evaluation in 4.2 %. There were adverse effects in 40% of the cases; 15% of these were systemic and 25 % cardiac. The test was

Tele-AAC Resolution

Directory of Open Access Journals (Sweden)

Kate Anderson

2012-12-01

Full Text Available Approximately 1.3% of all people, or about 4 million Americans, cannot rely on their natural speech to meet their daily communication needs. Telepractice offers a potentially cost-effective service delivery mechanism to provide clinical AAC services at a distance to the benefit of underserved populations in the United States and worldwide.  Tele-AAC is a unique cross-disciplinary clinical service delivery model that requires expertise in both telepractice and augmentative and alternative communication (AAC systems.  The Tele-AAC Working Group of the 2012 ISAAC Research Symposium therefore drafted a resolution underscoring the importance of identifying and characterizing the unique opportunities and constraints of Tele-AAC in all aspects of service delivery. These include, but are not limited to: needs assessments; implementation planning; device/system procurement, set-up and training; quality assurance, client progress monitoring, and follow-up service delivery. Tele-AAC, like other telepractice applications, requires adherence to the ASHA Code of Ethics and other policy documents, and state, federal, and international laws, as well as a competent technological infrastructure. The Working Group recommends that institutions of higher education and professional organizations provide training in Tele-AAC service provision. In addition, research and development are needed to create validity measures across Tele-AAC practices (i.e., assessment, implementation, and consultation; determine the communication competence levels achieved  by Tele-AAC users; discern stakeholders’  perceptions of Tele-AAC services (e.g., acceptability and viability; maximize Tele-AAC’s capacity to engage multiple team members in AAC assessment and ongoing service; identify the limitations and barriers of Tele-AAC provision; and develop potential solutions. 

A low cost tele-imaging platform for developing countries

Directory of Open Access Journals (Sweden)

Kokou eADAMBOUNOU

2014-09-01

Full Text Available Purpose: To design a low cost tele-imaging method allowing real time tele-ultrasound expertise, delayed tele-ultrasound diagnosis and tele-radiology between remote peripherals hospitals and clinics (patient centres and university hospital centres (expert centre.Materials and Methods: A system of communication via internet (IP camera and remote access software enabling transfer of ultrasound videos and images between two centres, allows a real time tele-radiology expertise in the presence of a junior sonographer or radiologist at the patient centre. In the absence of a sonographer or radiologist at the patient centre, a 3D reconstruction program allows a delayed tele-ultrasound diagnosis with images acquired by a lay operator (e.g. midwife, nurse, technician. The system was tested both with high and low bandwidth. The system can further accommodate non-ultrasound tele-radiology (conventional radiography, mammography and computer tomography for example. The system was tested on 50 patients between CHR Tsevie in Togo (40km from Lomé-Togo and 4500km from Tours-France and CHU Campus at Lomé and CHU Trousseau in Tours.Results: A real time tele-expertise was successfully performed with a delay of approximately 1.5 seconds with an internet bandwidth of around 1Mbps (IP Camera and 512kbps (remote access software. A delayed tele-ultrasound diagnosis was also performed with satisfactory results. The transmission of radiological images from the patient centre to the expert centre was of adequate quality. Delayed tele-ultrasound and tele-radiology was possible even in the presence of a low bandwidth internet connection. Conclusion: This tele-imaging method, requiring nothing by readily available and inexpensive technology and equipment, offers a major opportunity for telemedicine in developing countries.

Prognostic value of stress echocardiography in women with high (⩾80%) probability of coronary artery disease

OpenAIRE

Davar, J; Roberts, E; Coghlan, J; Evans, T; Lipkin, D

2001-01-01

OBJECTIVE—To assess the prognostic significance of stress echocardiography in women with a high probability of coronary artery disease (CAD).
SETTING—Secondary and tertiary cardiology unit at a university teaching hospital.
PARTICIPANTS—A total of 135 women (mean (SD) age 63 (9) years) with pre-test probability of CAD ⩾80% were selected from a database of patients investigated by treadmill or dobutamine stress echocardiography between 1995 and 1998.
MAIN OUTCOME MEASURES—Patients were followe...

A Second Opinion is Worth the Cost - 12479

Energy Technology Data Exchange (ETDEWEB)

Madsen, Drew [Project Time and Cost Inc. (United States)

2012-07-01

This paper, 'A Second Opinion is Worth the Cost', shows how a second opinion for a Department of Energy (DOE) Project helped prepare and pass a DOE Order 413.3A 'Program and Project Management for the acquisition of Capital Assets' Office of Engineering and Construction Management (OECM) required External Independent Review (EIR) in support of the approved baseline for Critical Decision (CD) 2. The DOE project personnel were informed that the project's Total Project Cost (TPC) was going to increase from $815 million to $1.1 billion due to unforeseen problems and unexplained reasons. The DOE Project Team determined that a second opinion was needed to review and validate the TPC. Project Time and Cost, Inc. (PT and C) was requested to evaluate the cost estimate, schedule, basis of estimate (BOE), and risk management plan of the Project and to give an independent assessment of the TPC that was presented to DOE. This paper will demonstrate how breaking down a project to the work breakdown structure (WBS) level allows a project to be analyzed for potential cost increases and/or decreases, thus providing a more accurate TPC. The review Team's cost analyses of Projects identified eight primary drivers resulting in cost increases. They included: - Overstatement of the effort required to develop drawings and specifications. - Cost allocation to 'Miscellaneous' without sufficient detail or documentation. - Cost for duplicated efforts. - Vendor estimates or quotations without sufficient detail. - The practice of using the highest price quoted then adding an additional 10% mark-up. - Application of Nuclear Quality Assurance (NQA) highest level quality requirements when not required. - Allocation of operational costs to the Project Costs instead of to the Operating Expenses (OPEX). OPEX costs come from a different funding source. - DOE had not approved the activities. By using a Team approach with professionals from cost, civil

Brazilian doctors' perspective on the second opinion strategy before a C-section.

Science.gov (United States)

Osis, Maria José Duarte; Cecatti, José Guilherme; de Pádua, Karla Simônia; Faúndes, Anibal

2006-04-01

To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.

The development and feasibility of an online aphasia group intervention and networking program - TeleGAIN.

Science.gov (United States)

Pitt, Rachelle; Theodoros, Deborah; Hill, Anne J; Russell, Trevor

2017-09-04

Aphasia group therapy offers many benefits, however people with aphasia report difficulty accessing groups and speech-language pathologists are faced with many challenges in providing aphasia group therapy. Telerehabilitation may offer an alternative service delivery option. An online aphasia group therapy program - Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN) - has been developed according to the guidelines of the Medical Research Council (MRC) framework for complex interventions. The purpose of this paper is to describe the development of TeleGAIN and the results of a pilot trial to determine feasibility and acceptability. The development of TeleGAIN was informed through literature reviews in relevant topic areas, consideration of expert opinion and application of the social cognitive theory. TeleGAIN was then modelled through a feasibility pilot trial with four people with aphasia. TeleGAIN appeared to be feasible and acceptable to participants and able to be implemented as planned. Participant satisfaction with treatment was high and results suggested some potential for improvements in language functioning and communication-related quality of life. TeleGAIN appeared to be feasible and acceptable, however the study highlighted issues related to technology, clinical implementation and participant-specific factors that should be addressed prior to a larger trial.

Evaluation of viability of infarcted myocardium by low dose dobutamine stress echocardiography. Comparison with exercise stress 201Tl myocardial scintigraphy

International Nuclear Information System (INIS)

Nagahara, Toshihiro; Sakamoto, Kazunori; Sofue, Akira; Horiuchi, Toshimitsu; Yamazaki, Shigeki; Kuwako, Kenji

1999-01-01

Exercise stress 201 Tl myocardial single-photon emission computed tomography (SPECT) is recognized to be a excellent method for identifying viability after myocardial infarction, but it is expensive and needs a longer time for data acquisition than echocardiography. We therefore performed this study to evaluate the effectiveness of low dose (5-10 μg/kg/min) dobutamine stress echocardiography (DSE) in 30 patients (61±8 years old: 24 men and 6 women) within 4 weeks after myocardial infarction in identifying viable myocardium, compared to results obtained by SPECT. Defining an akinetic or dyskinetic segment obtained by rest echocardiography as a definite infarct area, altogether 96 segments out of 716 segments were shown to be infarct areas. Of these, 75 (78%) segments were identified as viable by DSE, and 77 (80%) by SPECT. Only 2 segments were shown to be discrepant on DSE and SPECT. Subsequently, the sensitivity, specificity and accuracy rates for DSE were 96%, 100% and 96%, respectively. In conclusion, DSE is as effective and useful as SPECT in the evaluation of viability after myocardial infarction. (author)

Concierge and Second-Opinion Radiology: Review of Current Practices.

Science.gov (United States)

Shaikh, Shehbaz; Bafana, Rounak; Halabi, Safwan S

2016-01-01

Radiology's core assets include the production, interpretation, and distribution of quality imaging studies. Second-opinion services and concierge practices in radiology aim to augment traditional services by providing patient-centered and physician-centered care, respectively. Patient centeredness enhances patients' understanding and comfort with their radiology tests and procedures and allows them to make better decisions about their health care. As the fee-for-service paradigm shifts to value-based care models, radiology practices have begun to diversify imaging service delivery and communication to coincide with the American College of Radiology Imaging 3.0 campaign. Physician-centered consultation allows for communication of evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. There are disparate practice models and payment schema for the various second-opinion and concierge practices. This review article explores the current state and payment models of second-opinion and concierge practices in radiology. This review also includes a discussion on the benefits, roadblocks, and ethical issues that surround these novel types of practices. Copyright © 2015 Mosby, Inc. All rights reserved.

Second-opinion interpretations of gynecologic oncologic MRI examinations by sub-specialized radiologists influence patient care

International Nuclear Information System (INIS)

Lakhman, Yulia; Vargas, Hebert Alberto; Sosa, Ramon E.; Hricak, Hedvig; Sala, Evis; D'Anastasi, Melvin; Micco, Maura; Scelzo, Chiara; Nougaret, Stephanie; Chi, Dennis S.; Abu-Rustum, Nadeem R.

2016-01-01

To determine if second-opinion review of gynaecologic oncologic (GynOnc) magnetic resonance imaging (MRI) by sub-specialized radiologists impacts patient care. 469 second-opinion MRI interpretations rendered by GynOnc radiologists were retrospectively compared to the initial outside reports. Two gynaecologic surgeons, blinded to the reports' origins, reviewed all cases with discrepancies between initial and second-opinion MRI reports and recorded whether these discrepancies would have led to a change in patient management defined as a change in treatment approach, counselling, or referral. Histopathology or minimum 6-month imaging follow-up were used to establish the diagnosis. Second-opinion review of GynOnc MRIs would theoretically have affected management in 94/469 (20 %) and 101/469 (21.5 %) patients for surgeons 1 and 2, respectively. Specifically, second-opinion review would have theoretically altered treatment approach in 71/469 (15.1 %) and 60/469 (12.8 %) patients for surgeons 1 and 2, respectively. According to surgeons 1 and 2, these treatment changes would have prevented unnecessary surgery in 35 (7.5 %) and 31 (6.6 %) patients, respectively, and changed surgical procedure type/extent in 19 (4.1 %) and 12 (2.5 %) patients, respectively. Second-opinion interpretations were correct in 103 (83 %) of 124 cases with clinically relevant discrepancies between initial and second-opinion reports. Expert second-opinion review of GynOnc MRI influences patient care. (orig.)

Complications during pharmacological stress echocardiography: a video-case series

Directory of Open Access Journals (Sweden)

Bigi Riccardo

2005-09-01

Full Text Available Abstract Background Stress echocardiography is a cost-effective tool for the modern noninvasive diagnosis of coronary artery disease. Several physical and pharmacological stresses are used in combination with echocardiographic imaging, usually exercise, dobutamine and dipyridamole. The safety of a stress is (or should be a major determinant in the choice of testing. Although large scale single center experiences and multicenter trial information are available for both dobutamine and dipyridamole stress echo testing, complications or side effects still can occur even in the most experienced laboratories with the most skilled operators. Case presentation We decided to present a case collection of severe complications during pharmacological stress echo testing, including a ventricular tachycardia, cardiogenic shock, transient ischemic attack, torsade de pointe, fatal ventricular fibrillation, and free wall rupture. Conclusion We believe that, in this field, every past complication described is a future complication avoided; what happens in your lab is more true of what you read in journals; and Good Clinical Practice is not "not having complications", but to describe the complications you had.

Tele-education in South Africa.

Science.gov (United States)

Mars, Maurice

2014-01-01

Telemedicine includes the use of information and communication technology for education in the health sector, tele-education. Sub-Saharan Africa has an extreme shortage of health professionals and as a result, doctors to teach doctors and students. Tele-education has the potential to provide access to education both formal and continuing medical education. While the uptake of telemedicine in Africa is low, there are a number of successful and sustained tele-education programs. The aims of this study were (i) to review the literature on tele-education in South Africa, (ii) describe tele-education activities at the University of KwaZulu-Natal (UKZ-N) in South Africa, and (iii) review the development of these programs with respect to current thinking on eHealth project implementation. A literature review of tele-education in South Africa was undertaken. The development of the tele-education services at UKZ-N from 2001 to present is described. The approaches taken are compared with current teaching on eHealth implementation and a retrospective design-reality gap analysis is made. Tele-education has been in use in South Africa since the 1970s. Several forms of tele-education are in place at the medical schools and in some Provincial Departments of Health (DOH). Despite initial attempts by the National DOH, there are no national initiatives in tele-education. At UKZ-N, a tele-education service has been running since 2001 and appears to be sustainable and reaching maturity, with over 1,400 h of videoconferenced education offered per year. The service has expanded to offer videoconferenced education into Africa using different ways of delivering tele-education. Tele-education has been used in different forms for many years in the health sector in South Africa. There is little hard evidence of its educational merit or economic worth. What it apparent is that it improves access to education and training in resource constrained settings. The development of local and

Application of Handheld Tele-ECG for Health Care Delivery in Rural India

Directory of Open Access Journals (Sweden)

Meenu Singh

2014-01-01

Full Text Available Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG developed by Bhabha Atomic Research Center (BARC to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058 residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER, Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3% was the commonest abnormality followed closely by old myocardial infarction (5.3%. Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas.

Relevance of tissue Doppler in the quantification of stress echocardiography for the detection of myocardial ischemia in clinical practice

Directory of Open Access Journals (Sweden)

Sicari Rosa

2005-01-01

Full Text Available Abstract In the present article we review the main published data on the application of Tissue Doppler Imaging (TDI to stress echocardiography for the detection of myocardial ischemia. TDI has been applied to stress echocardiography in order to overcome the limitations of visual analysis for myocardial ischemia. The introduction of a new technology for clinical routine use should pass through the different phases of scientific assessment from feasibility studies to large multicenter studies, from efficacy to effectiveness studies. Nonetheless the pro-technology bias plays a major role in medicine and expensive and sophisticated techniques are accepted before their real usefulness and incremental value to the available ones is assessed. Apparently, TDI is not exempted by this approach : its applications are not substantiated by strong and sound results. Nonetheless, conventional stress echocardiography for myocardial ischemia detection is heavily criticized on the basis of its subjectivity. Stress echocardiography has a long lasting history and the evidence collected over 20 years positioned it as an established tool for the detection and prognostication of coronary artery disease. The quantitative assessment of myocardial ischemia remains a scientific challenge and a clinical goal but time has not come for these newer ultrasonographic techniques which should be restricted to research laboratories.

Orthopedic surgeons’ and neurologists’ attitudes towards second opinions in the Israeli healthcare system: a qualitative study

Directory of Open Access Journals (Sweden)

Greenfield Geva

2012-07-01

Full Text Available Abstract Background Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians’ attitudes toward second opinion motivated this study to explore those attitudes within the Israeli healthcare system. Methods We interviewed 35 orthopedic surgeons and neurologists in Israel and qualitatively analyzed the data using the Grounded Theory approach. Results As a common tool, second opinion reflects the broader context of the Israeli healthcare system, specifically tensions associated with health inequalities. We identified four issues: (1 inequalities between central and peripheral regions of Israel; (2 inequalities between private and public settings; (3 implementation gap between the right to a second opinion and whether it is covered by the National Health Insurance Law; and (4 tension between the authorities of physicians and religious leaders. The physicians mentioned that better mechanisms should be implemented for guiding patients to an appropriate consultant for a second opinion and for making an informed choice between the two opinions. Conclusions While all the physicians agreed on the importance of the second opinion as a tool, they raised concerns about the way it is provided and utilized. To be optimally implemented, second opinion should be institutionalized and regulated. The National Health Insurance Law should strive to provide the mechanisms to access second opinion as stipulated in the Patient’s Rights Law. Further studies are needed to assess the patients' perspectives.

Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography. Experience in 1118 patients.

Science.gov (United States)

Mertes, H; Sawada, S G; Ryan, T; Segar, D S; Kovacs, R; Foltz, J; Feigenbaum, H

1993-07-01

The use of dobutamine stress echocardiography for the evaluation of coronary artery disease is rapidly expanding. New applications of the technique are being investigated in a wide variety of patients including those with advanced coronary artery disease. Despite its widespread use, the safety of dobutamine stress echocardiography has not been sufficiently documented. A consecutive series of 1118 patients undergoing dobutamine stress echocardiography for evaluation of known or suspected coronary artery disease form the basis of this report. Dobutamine stress testing was performed for evaluation of chest pain, risk assessment before noncardiac surgery, after recent myocardial infarction, or as a part of ongoing research protocols. Over the study period, the maximal dose of dobutamine used was increased from 30 to 50 micrograms/kg per minute, and atropine was used in 420 (37%) patients. There were no occurrences of death, myocardial infarction, or episodes of sustained ventricular tachycardia as a result of dobutamine stress testing. The major reasons for test termination were achievement of target heart rate in 583 patients (52.1%), maximum dose in 255 (22.8%), and angina pectoris in 142 (13%). The test was terminated in 36 (3%) patients because of noncardiac side effects including nausea, anxiety, headache, tremor, and urgency. Angina pectoris occurred in 216 (19.3%) patients. Sublingual nitroglycerin, a short-acting beta-blocker, or both types of medication were administered in 80 of these patients for relief of angina pectoris. None required intravenous nitroglycerin. A total of 736 (65%) patients had stable sinus rhythm throughout the test. The most common arrhythmias were frequent premature ventricular complexes (six or more per minute) in 172 patients (15%), and frequent premature atrial complexes in 86 (8%). There were 40 patients with nonsustained ventricular tachycardia. None had symptoms associated with the tachycardia, and only one received specific

Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations.

NARCIS (Netherlands)

Mellink, W.A.M.; Dulmen, A.M. van; Wiggers, TH.; Spreeuwenberg, P.M.M.; Eggermont, A.M.M.; Bensing, J.M.

2003-01-01

Purpose: To explore the sociodemographic and clinical characteristics of cancer patients seeking a second-opinion consultation and to analyze their second opinion-related motives, needs, and expectations. Patients and methods: In 212 consecutive patients seeking a second opinion at the Surgical

Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography

International Nuclear Information System (INIS)

Schmidt, M.; Theissen, P.; Voth, E.; Schicha, H.; Jochims, M.; Baer, F.M.; Crnac, J.; Schneider, C.A.; Erdmann, E.

2001-01-01

Aim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutamine-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echo-cardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-segment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modell. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis ≥50%). Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. For dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer. (orig.) [de

Extreme Tele-Echocardiography: Methodology for Remote Guidance of In-Flight Echocardiography Aboard the International Space Station

Science.gov (United States)

Martin, David S.; Borowski, Allan; Bungo, Michael W.; Gladding, Patrick; Greenberg, Neil; Hamilton, Doug; Levine, Benjamin D.; Lee, Stuart M.; Norwood, Kelly; Platts, Steven H.;

Echocardiography and cardiac MRI in mutation-negative hypertrophic cardiomyopathy in an older patient: a case defining the need for ICD.

Science.gov (United States)

Rodriguez, Fatima; Degnan, Kathleen O; Seidman, Christine E; Mangion, Judy R

2014-08-01

We report the case of a 67-year-old man with hypertrophic cardiomyopathy who presented for a second opinion about implantable cardio-defibrillator (ICD) placement after a witnessed syncopal episode. Despite his older age, being mutation-negative, and having a maximal septal thickness of 2.2 cm on echocardiography, he demonstrated rapid progression of myocardial fibrosis on cardiac MRI, correlating to ventricular tachyarrhythmias and syncope. We review the role of echocardiography and cardiac MRI in optimizing medical care for such patients who may not otherwise meet criteria for an ICD placement or further interventions. © 2014, Wiley Periodicals, Inc.

Outcomes in Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction Undergoing Rest and Treadmill Stress Echocardiography.

Science.gov (United States)

Huded, Chetan P; Masri, Ahmad; Kusunose, Kenya; Goodman, Andrew L; Grimm, Richard A; Gillinov, A Marc; Johnston, Douglas R; Rodriguez, L Leonardo; Popovic, Zoran B; Svensson, Lars G; Griffin, Brian P; Desai, Milind Y

2018-04-12

In asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction, we sought to assess the incremental prognostic value of resting valvuloarterial impedence (Zva) and left ventricular global longitudinal strain (LV-GLS) to treadmill stress echocardiography. We studied 504 such patients (66±12 years, 78% men, 32% with coronary artery disease who underwent treadmill stress echocardiography between 2001 and 2012. Clinical and exercise variables (% of age-sex predicted metabolic equivalents [%AGP-METs]) were recorded. Resting Zva ([systolic arterial pressure+mean aortic valve gradient]/[LV-stroke volume index]) and LV-GLS (measured offline using Velocity Vector Imaging, Siemens) were obtained from the baseline resting echocardiogram. Death was the primary outcome. There were no major adverse cardiac events during treadmill stress echocardiography. Indexed aortic valve area, Zva, and LV-GLS were 0.46±0.1 cm 2 /m 2 , 4.5±0.9 mm Hg/mL per m 2 and -16±4%, respectively; only 50% achieved >100% AGP-METs. Sixty-four percent underwent aortic valve replacement. Death occurred in 164 (33%) patients over 8.9±3.6 years (2 within 30 days of aortic valve replacement). On multivariable Cox survival analysis, higher Society of Thoracic Surgeons score (hazard ratio or HR 1.06), lower % AGP-METS (HR 1.16), higher Zva (HR 1.25) and lower LV-GLS (HR 1.12) were associated with higher longer-term mortality, while aortic valve replacement (HR 0.45) was associated with improved survival (all P statistic from 0.65 to 0.69 and 0.75, respectively, both P stress echocardiography, LV-GLS and ZVa offer incremental prognostic value. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T

NARCIS (Netherlands)

Bholasingh, Radha; Cornel, Jan Hein; Kamp, Otto; van Straalen, Jan P.; Sanders, Gerard T.; Tijssen, Jan G. P.; Umans, Victor A. W. M.; Visser, Cees A.; de Winter, Robbert J.

2003-01-01

OBJECTIVES We prospectively studied the prognostic value of predischarge dobutamine stress echocardiography (I)SE) in low-risk chest pain patients with a normal or nondiagnostic electrocardiogram (ECG) and a negative serial troponin T. BACKGROUND Noninvasive stress testing is recommended before

German second-opinion network for testicular cancer: sealing the leaky pipe between evidence and clinical practice.

Science.gov (United States)

Zengerling, Friedemann; Hartmann, Michael; Heidenreich, Axel; Krege, Susanne; Albers, Peter; Karl, Alexander; Weissbach, Lothar; Wagner, Walter; Bedke, Jens; Retz, Margitta; Schmelz, Hans U; Kliesch, Sabine; Kuczyk, Markus; Winter, Eva; Pottek, Tobias; Dieckmann, Klaus-Peter; Schrader, Andres Jan; Schrader, Mark

2014-06-01

In 2006, the German Testicular Cancer Study Group initiated an extensive evidence-based national second-opinion network to improve the care of testicular cancer patients. The primary aims were to reflect the current state of testicular cancer treatment in Germany and to analyze the project's effect on the quality of care delivered to testicular cancer patients. A freely available internet-based platform was developed for the exchange of data between the urologists seeking advice and the 31 second-opinion givers. After providing all data relevant to the primary treatment decision, urologists received a second opinion on their therapy plan within testicular cancer patient in Germany were submitted to second-opinion centers. Second-opinion centers can help to improve the implementation of evidence into clinical practice.

Your cancer diagnosis - Do you need a second opinion?

Science.gov (United States)

... doctor can make recommendations for how your treatment will progress. ... second opinion include: Ask another doctor that you trust to give ... The new doctor will meet with you and perform a physical exam. ...

[German national second-opinion network for testicular cancer and penile carcinoma : Two sources for evidence-based information].

Science.gov (United States)

Schrader, M; Zengerling, F; Hakenberg, O W; Protzel, C

2016-09-01

The second-opinion network for testicular cancer is an internet-based platform addressing physicians treating testicular cancer patients. They are offered a second-opinion before determining further therapy after orchiectomy and completion of staging. The high rate of discrepancies between the first and second opinion in more than 30 % supports the assumption of a deficit in the implementation of treatment guidelines. In 2015, approximately 22 % of the newly diagnosed cases with testicular cancer in Germany were covered by this system. According to the present interim analysis, the second-opinion platform helps to avoid overtreatment of testicular cancer patients. The high acceptance of the project and the encouraging results of this interim analysis gave rise to considerations to apply the second-opinion model to penile carcinoma. Data from the UK and the Netherlands show that the second-opinion network for penile cancer could help to improve treatment standards and results in Germany. Current data and the intended further development of the system are discussed.

An exploration of the dynamics and influences upon second medical opinion consultations in cancer care.

Science.gov (United States)

Philip, Jennifer; Gold, Michelle; Schwarz, Max; Komesaroff, Paul

2011-03-01

The aim of this study was to explore the dynamics within second medical opinion consultations in patients with cancer. Semi-structured interviews were held with four oncologists and were subjected to a thematic analysis to define the broad issues. These formed the basis of a survey distributed to Australian medical oncologists. Overall 65 surveys were returned representing an overall response rate of 30% (10% and 63% electronic and hardcopy response rates, respectively). The dynamics in giving second medical opinions are influenced by the collegiate relationships of the doctors. Nearly two-thirds of oncologists believed that the first doctors' treatment and recommendations influenced the outcome of the second opinion, more than one-third believed the outcome was influenced by the relationship between the two doctors, and 41% believed the public nature of a second opinion was influential. In each case, these figures were more than double their assessments of patients' beliefs of these influences. Care was taken not to criticise the primary doctor. Second medical opinions provide an opportunity for oncologists to review medical care and engage in enhanced communication with patients who have additional needs. These consultations do not, however, occur in a vacuum but are influenced by the need to attend to relationships between the patient and their primary doctor and between the doctors themselves. The second medical opinion is embedded within a network of relationships and within the illness journey. © 2010 Blackwell Publishing Asia Pty Ltd.

A Low-Cost Tele-Presence Wheelchair System

OpenAIRE

Shen, Jiajun; Xu, Bin; Pei, Mingtao; Jia, Yunde

2016-01-01

This paper presents the architecture and implementation of a tele-presence wheelchair system based on tele-presence robot, intelligent wheelchair, and touch screen technologies. The tele-presence wheelchair system consists of a commercial electric wheelchair, an add-on tele-presence interaction module, and a touchable live video image based user interface (called TIUI). The tele-presence interaction module is used to provide video-chatting for an elderly or disabled person with the family mem...

Dobutamine stress thallium-201 single-photon emission tomography versus echocardiography for evaluation of the extent and location of coronary artery disease late after myocardial infarction

International Nuclear Information System (INIS)

Elhendy, A.; Bax, J.J.; Domburg, R.T. van; Cornel, J.H.; Roelandt, J.R.T.C.; Valkema, R.; Reijs, A.E.M.; Krenning, E.P.

1999-01-01

Dobutamine stress echocardiography and thallium-201 myocardial perfusion scintigraphy are clinically useful methods for the evaluation of coronary artery disease (CAD). However, the relative merits of these imaging modalities in the evaluation of the extent of CAD after myocardial infarction have not been well studied. The aim of this study was to compare the accuracy of dobutamine stress echocardiography and simultaneous 201 Tl single-photon emission tomography (SPET) imaging for the diagnosis and localization of CAD late after acute myocardial infarction. Dobutamine (up to 40 μg kg -1 min -1 )-atropine (up to 1 mg) stress echocardiography in conjunction with stress-reinjection 201 Tl SPET was performed for the evaluation of myocardial ischaemia in 90 patients with previous myocardial infarction who underwent coronary angiography. Significant CAD was predicted on bases of myocardial ischemia (new or worsening wall motion abnormalities on echocardiography and reversible perfusion defects on 201 Tl SPET). Significant CAD (≥ 50% luminal diameter stenosis) was detected in 73 (81%) patients. The sensitivity, specificity and accuracy of echocardiography in detecting remote ischaemia for the diagnosis of remote CAD (present in 53 patients) were, respectively, 79% (CI 70%-88%), 85% (CI 77%-93%) and 81% (CI 73%-90%), while the corresponding figures for 201 Tl SPET were 75% (CI 66%-85%), 78% (CI 69%-87%) and 76% (CI 67%-86%) respectively (P = NS vs echocardiography). The sensitivity, specificity and accuracy of echocardiography in detecting peri-infarction ischaemia for the diagnosis of infarct-related artery stenosis (present in 70 patients) were, rspectively, 77% (CI 68%-86%), 85% (CI 78%-92%) and 79% (CI 70%-87%) while the corresponding figures for 201 Tl SPET were 73% (CI 64%-82%), 85% (CI 78%-92%) and 76% (CI 67%-84%) respectively (P = NS vs echocardiography). The agreement between the two methods for the diagnosis of peri-infarction and remote ischaemia was 70

Patient satisfaction in neurological second opinions and tertiary referrals

NARCIS (Netherlands)

Wijers, D.; Wieske, L.; Vergouwen, M. D. I.; Richard, E.; Stam, J.; Smets, E. M. A.

2010-01-01

Although the number of neurological second opinions (SOs) and tertiary referrals (TRs) is increasing, only little is known about expectations and patient satisfaction in this group of patients. Therefore, the purpose of this study was to explore expectations of patients who get a neurological SO or

Echocardiography in the Era of Multimodality Cardiovascular Imaging

Science.gov (United States)

Shah, Benoy Nalin

2013-01-01

Echocardiography remains the most frequently performed cardiac imaging investigation and is an invaluable tool for detailed and accurate evaluation of cardiac structure and function. Echocardiography, nuclear cardiology, cardiac magnetic resonance imaging, and cardiovascular-computed tomography comprise the subspeciality of cardiovascular imaging, and these techniques are often used together for a multimodality, comprehensive assessment of a number of cardiac diseases. This paper provides the general cardiologist and physician with an overview of state-of-the-art modern echocardiography, summarising established indications as well as highlighting advances in stress echocardiography, three-dimensional echocardiography, deformation imaging, and contrast echocardiography. Strengths and limitations of echocardiography are discussed as well as the growing role of real-time three-dimensional echocardiography in the guidance of structural heart interventions in the cardiac catheter laboratory. PMID:23878804

WhatsApp is an effective tool for obtaining second opinion in oral pathology practice.

Science.gov (United States)

Sarode, Sachin C; Sarode, Gargi S; Anand, Rahul; Patil, Shankargouda; Unadkat, Hemant

2017-08-01

The aim of this study was to find out the efficacy of WhatsApp application for obtaining second opinion on histopathological diagnosis in oral pathology practice. A total of 247 cases comprising of 34 different oral pathologies were photomicrographed using smartphone cameras through compound microscopes and sent for second opinion diagnosis (SOD) to 20 different oral pathologists using WhatsApp. Of 4795 (97.06%) total second opinion received, correct SOD were received for 4710 (98.22%) cases. Hundred percent times correct SOD was received for lesions including adenomatoid odontogenic tumor, keratinizing cystic odontogenic tumor, odontome, and dentigerous cyst. Lesions such as myoepithelial carcinoma, osteosarcoma, fibrosarcoma, and intravascular papillary endothelial hyperplasia received less percentage of correct SOD (85.71-75.75%). Correct SOD was obtained for variants of ameloblastoma (99.01%), grading of epithelial dysplasia (87.54%), and squamous cell carcinoma (95.26%). A positive correlation was observed between correct SOD and age (P = 0.0143) and experience (P = 0.0189) of the pathologist. The time taken for giving second opinion by the pathologists ranged from 81.98 ± 32.89 to 90.72 ± 38.88 min. Smartphone camera is a handy and efficient tool in capturing photomicrographs from the compound microscope. Transfer of such photomicrograph via WhatsApp is an effective and convenient approach in procuring second opinion on histopathological diagnosis of oral pathologies. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pressure-volume Relationship in the Stress-echocardiography Laboratory: Does (Left Ventricular End-diastolic) Size Matter?

Science.gov (United States)

Bombardini, Tonino; Mulieri, Louis A; Salvadori, Stefano; Costantino, Marco Fabio; Scali, Maria Chiara; Marzilli, Mario; Picano, Eugenio

2017-02-01

The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. Whether and to what extent it depends on end-diastolic volume remains unclear. The aim of this study was to assess the dependence of the delta rest-stress end-systolic pressure-volume relation on end-diastolic volume in patients with negative stress echo and all ranges of resting left ventricular function. We analyzed interpretable data obtained in 891 patients (593 men, age 63 ± 12 years) with ejection fraction 47% ± 12%: 338 were normal or near-normal or hypertensive; 229 patients had coronary artery disease; and 324 patients had ischemic or nonischemic dilated cardiomyopathy. They were studied with exercise (n = 172), dipyridamole (n = 482) or dobutamine (n = 237) stress echocardiography. The end-systolic pressure-volume relation was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson rule 2-dimensional echocardiography. Absolute values of delta rest-stress end-systolic pressure-volume relation were higher for exercise and dobutamine than for dipyridamole. In the overall population, an inverse relationship between end-systolic pressure-volume relation and end-diastolic volume was present at rest (r 2 = 0.69, P stress (r 2 = 0.56, P stress end-systolic pressure-volume relation was considered (r 2 = 0.13). Left ventricular end-diastolic volume does not affect the rest-stress changes in end-systolic pressure-volume relation in either normal or abnormal left ventricles during physical or pharmacological stress. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Beperkte opbrengst van een diagnostische second opinion op een neurologieafdeling

NARCIS (Netherlands)

Wieske, Luuk; Vergouwen, Mervyn D. I.; Wijers, Dorien; Stam, Jan; Smets, Ellen M. A.; Richard, Edo

2011-01-01

To describe the short and long term results of neurological second opinions with regard to medical aspects and patient satisfaction. Prospective observational cohort study Data regarding medical relevance and patient satisfaction were collected for all patients referred to the neurological

Tele-transmission of EEG recordings.

Science.gov (United States)

Lemesle, M; Kubis, N; Sauleau, P; N'Guyen The Tich, S; Touzery-de Villepin, A

2015-03-01

EEG recordings can be sent for remote interpretation. This article aims to define the tele-EEG procedures and technical guidelines. Tele-EEG is a complete medical act that needs to be carried out with the same quality requirements as a local one in terms of indications, formulation of the medical request and medical interpretation. It adheres to the same quality requirements for its human resources and materials. It must be part of a medical organization (technical and medical network) and follow all rules and guidelines of good medical practices. The financial model of this organization must include costs related to performing the EEG recording, operating and maintenance of the tele-EEG network and medical fees of the physician interpreting the EEG recording. Implementing this organization must be detailed in a convention between all parties involved: physicians, management of the healthcare structure, and the company providing the tele-EEG service. This convention will set rules for network operation and finance, and also the continuous training of all staff members. The tele-EEG system must respect all rules for safety and confidentiality, and ensure the traceability and storing of all requests and reports. Under these conditions, tele-EEG can optimize the use of human resources and competencies in its zone of utilization and enhance the organization of care management. Copyright © 2015. Published by Elsevier SAS.

A Second Opinion: A Case Narrative on Clinical Ethics Mediation.

Science.gov (United States)

Weinstein, Michael S

2015-01-01

Contrasting traditional and common forms if ethics consultation with bioethics mediation. I describe the case of a "second opinion" consultation in the care of a patient with advanced cancer for whom treatment was futile. While the initial ethics consultation, performed by a colleague, let to a recommendation that some may deem ethical, the process failed to involve key stakeholders and failed to explore the underlying values and reasons for the opinions voiced by various stakeholders. The process of mediation ultimately led to creative solutions in which all stakeholders could reach consensus on a plan of care.

Recent advances in echocardiography for nuclear medicine physician

International Nuclear Information System (INIS)

Hong, Geu Ru; Shin, Dong Gu

2005-01-01

Echocardiography is one of the most frequently used techniques for diagnosing cardiovascular diseases. Over the last twenty years, technological advances have enabled the application of high-quality imaging. Important recent developments have occurred in echocardiography that are already being used clinically. Equipment and hardware is now available to produce real time three-dimensional and contrast enhanced imaging. Tissue Doppler and stress echocardiography have provided potential benefit to analyze hemodynamic information of heart. This review discusses each of these new developments and their potential impact on the practice of echocardiography and cardiology in general

Tele consultation and tele follow up of thyroid cancer patients: A pilot study

International Nuclear Information System (INIS)

Pradhan, P.K.; Das, B.K.; Mohanty, B.N.; Mishra, S.K.

2005-01-01

Full text: Radioiodine therapy is an essential component of thyroid cancer management and these patients require life long follow up at timed interval. Though radioiodine therapy is a well established adjuvant treatment for well differentiated thyroid cancer, still the acceptance by the surgical colleagues and patients is not uniform. In addition, this facility is not available in the eastern part of the country. Therefore, such patients are required to travel more than 1500 K.M. to avail this treatment and subsequent follow up at our Institution. The existing telemedicine facility between SGPGIMS, Lucknow and SCB Medical College, Cuttack provided the opportunity to utilise the system for tele-consultation and tele follow up of thyroid cancer patients. The rationale of this ongoing study is to evaluate the suitability of telemedicine for tele consultation prior to radioiodine therapy and tele follow up following radioiodine therapy of patients with well differentiated thyroid cancer. Thirty patients (10 new cases and 20 follow up cases) were included in this study. New cases were studied on the basis of case history inputs by the operating surgeon and direct patient consultation to find out their suitability for high dose radioiodine therapy. At the same time pre-therapy instructions as well as details of admission were finalised. Follow up of patients (20 in number) were discussed and examined on live along with operating surgeon with respect to compliance of thyroxine suppression therapy, local recurrence and need for further high dose radioiodine therapy. Each time, at least one surgeon and nuclear physician were involved during live evaluation of patients which was done with VSAT, broad band of 256 Kbps band width provided by ISRO, Bangalore, India and case history, radiological and nuclear medicine images were already transmitted prior to live evaluation. All ten new cases were found to be suitable for high dose radioiodine therapy. The appointment dates for

Long-term satisfaction after neurological second opinions and tertiary referrals

NARCIS (Netherlands)

Wieske, L.; Richard, E.; Wijers, D.; Stam, J.; Smets, E. M. A.; Vergouwen, M. D. I.

2011-01-01

The number of second opinions (SO) and tertiary referrals (TR) in neurology is increasing. Previously, we showed that a day-care admission for neurological SO's and TR's often results in a new diagnosis and/or treatment advice and increases patient satisfaction. However, long-term satisfaction for

A Second Opinion: A Case Narrative on Clinical Ethics Mediation.

Science.gov (United States)

Weinstein, Michael S

2015-01-01

Contrasting traditional and common forms of ethics consultation with bioethics mediation, I describe the case of a "second opinion" consultation in the care of a patient with advanced cancer for whom treatment was futile. While the initial ethics consultation, performed by a colleague, led to a recommendation that some may deem ethical, the process failed to involve key stakeholders and failed to explore the underlying values and reasons for the opinions voiced by various stakeholders. The process of mediation ultimately led to creative solutions in which all stakeholders could reach consensus on a plan of care. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Women’s opinions about stress during a visit to the gynaecologist’s office

Directory of Open Access Journals (Sweden)

Piotr Niziurski

2016-07-01

Full Text Available Introduction: According to the guidelines of Royal College of Obstetricians and Gynaecologists gynaecological treatment (including the treatment with a speculum and bimanual treatment and test nipple is one of the most intimate medical procedures that in many women can cause a feeling of shame and embarrassment. At the same time, in some patients, the study calls so considerable discomfort, anger and embarrassment and even if they don’t tell, they may experience prolonged stress resulting from the unpleasant and traumatic experience. Aim of the research: To investigate the opinions of women about the stress associated with their visit to the gynaecologist’s. Material and methods: The study included 331 anonymous, non-pregnant, randomly selected women. The respondents were divided into three age groups: the first group were women aged 29 years and below, the second group aged 30–39, and the third group aged 40 years and above. The study was conducted in the author’s private gynaecological office and in the Faculty of Health Sciences at the University of Jan Kochanowski in Kielce. The measurement tool was a survey of his own authorship. Results and conclusions: The greatest stress associated with gynaecological examination accompanied the woman aged 29 years and below, and the smallest at the age of 40 years and over (respectively, 46% and 35%. For most women, the gender of the gynaecologist does not matter when choosing a doctor. The opinion of the studied woman states that the most embarrassing moment of a visits at the gynaecologist is sitting down on the specialist chair and the gynaecological treatment, whereas the highest stress is evoked by the palpation through the anus and vagina. The frequency of reporting for a gynaecological examination decreases with the women’s age. Most women during the gynaecological treatment visit feel safe when alone with the doctor. Women expect the gynaecologist to be nice, talkative, and calm. When

Formal reporting of second-opinion CT interpretation: experience and reimbursement in the emergency department setting.

Science.gov (United States)

Jeffers, Adam B; Saghir, Amina; Camacho, Marc

2012-06-01

The purpose of this study is to describe a system for formally reporting second-opinion interpretations of CT imaging exams accompanying patients transferred emergently to a tertiary care center. Second-opinion interpretations of cross-sectional imaging exams rendered in the emergency department setting over 6 months spanning 22 September 2009 to 22 March 2010 were reviewed and tallied by two radiologists and a research assistant, with a focus on professional fee reimbursement rates. A more in depth review was performed of those exams for which a clinical referral request form was available, detailing such information as the clinical history, content and source of available initial interpretation, and congruity of the initial interpretation with clinical data. Discrepancies between outside and second-opinion interpretations were also assessed. This quality assurance exercise was reviewed by our institutional review board, which waived formal informed consent. Formal second-opinion interpretation was rendered for 370 exams on 198 patients (mean age, 53.5 years; 45.1% female), received from 50 referring facilities. Head CT was the most common imaging exam referred for second opinion. Forty-one of 370 exams (11%) were submitted for self-pay, and 43 (12%) were written off as free care. The remaining 286 exams (77%) were submitted for reimbursement of the professional fee only. Ultimately, of the 286 exams submitted, 260 (91%) were reimbursed for professional fees, 199 (70%) on the initial submission. Of 29 health plans contracted with our facility, 22 ultimately approved all claims made. Three plans denied all claims submitted. The largest payer was Medicare, which reimbursed 88 of 90 submitted claims. Clinical intake forms were available for 184 exams on 107 patients (mean age, 52.7 years, 43.0% female). Trauma was the most common indication, or history, provided (55% of 184 exams, 40% of 107 patients). An outside report of some form was available for 112 of the 184

Usefulness and limitations of transthoracic echocardiography in heart transplantation recipients

Directory of Open Access Journals (Sweden)

Galderisi Maurizio

2008-01-01

Full Text Available Abstract Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It is a versatile tool which provides comprehensive information about cardiac structure and function. Echocardiographic examinations can be easily performed at the bedside and serially repeated without any patient's discomfort. This review highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart transplant recipients. The main experiences performed by either standard Doppler echocardiography and new high-tech ultrasound technologies are summarised, pointing out advantages and limitations of the described techniques in diagnosing acute allograft rejection and cardiac graft vasculopathy. Despite the sustained efforts of echocardiographic technique in predicting the biopsy state, endocardial myocardial biopsies are still regarded as the gold standard for detection of acute allograft rejection. Conversely, stress echocardiography is able to identify accurately cardiac graft vasculopathy and has a recognised prognostic in this clinical setting. A normal stress-echo justifies postponement of invasive studies. Another use of transthoracic echocardiography is the monitorisation and the visualisation of the catheter during the performance of endomyocardial biopsy. Bedside stress echocardiography is even useful to select appropriately heart donors with brain death. The ultrasound monitoring is simple and effective for monitoring a safe performance of biopsy procedures.

A software communication tool for the tele-ICU.

Science.gov (United States)

Pimintel, Denise M; Wei, Shang Heng; Odor, Alberto

2013-01-01

The Tele Intensive Care Unit (tele-ICU) supports a high volume, high acuity population of patients. There is a high-volume of incoming and outgoing calls, especially during the evening and night hours, through the tele-ICU hubs. The tele-ICU clinicians must be able to communicate effectively to team members in order to support the care of complex and critically ill patients while supporting and maintaining a standard to improve time to intervention. This study describes a software communication tool that will improve the time to intervention, over the paper-driven communication format presently used in the tele-ICU. The software provides a multi-relational database of message instances to mine information for evaluation and quality improvement for all entities that touch the tele-ICU. The software design incorporates years of critical care and software design experience combined with new skills acquired in an applied Health Informatics program. This software tool will function in the tele-ICU environment and perform as a front-end application that gathers, routes, and displays internal communication messages for intervention by priority and provider.

Tele-periodontics - Oral health care at a grass root level.

Science.gov (United States)

Avula, Haritha

2015-01-01

A new concept of tele-periodontics, which merges the innovative technology of telecommunications and the field of periodontics, is proposed. This new field of tele-periodontics will have an infinite potential where access to a specialist will be provided at a grass root level, enhancing effective delivery of therapy and information to the rural and under privileged areas. It would allow the specialist and the patient to interact either by video conferencing (real time) or through supportive information (store and forward) over geographic distances. Different probabilities of tele-periodontics such as tele consultation, tele training, tele education and tele support are also discussed in this paper.

Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment.

Science.gov (United States)

Takaki, Jiro; Hibino, Yuri

2014-09-02

The purpose of this study is to investigate how family-related opinions and stressful situations are related to psychological distress in women undergoing infertility treatment. The subjects in this cross-sectional study were recruited from female patients undergoing infertility treatment (n = 2540) at 70 infertility treatment institutions in Japan. Because of non-participation or missing data, the number of subjects included in the analysis was 635 (response rate, 25.0%). The family-related opinions and stressful situations were evaluated using the original questions. Psychological distress was assessed using a self-report measure, the Kessler Six-question Psychological Distress Scale (K6). The K6 scores of the following participants were significantly (p women should devote themselves to their household duties" those who had considered stopping treatment, those without the opinion that "married life without children is favorable" and those who had experienced stressful situations such as inadequate explanation by doctors, frustration of multiple failed attempts, differences of opinion with the partner, and lack of knowledge regarding when to stop treatment. Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment are outlined. The results of this study may contribute to the prevention of and care for psychological distress in female patients undergoing infertility treatment.

The Value of Contrast Echocardiography

Directory of Open Access Journals (Sweden)

Shannon C. Treiber

2016-01-01

Full Text Available Purpose: There is much evidence-based research proving the effectiveness of contrast echocardiography, but there are still questions and concerns about its specific uses. This study tested the effectiveness of contrast echocardiography in defining the left ventricular endocardial border. Methods: From 30 patients, a total of 60 echocardiograms –– 30 with and 30 without use of contrast –– were retrospectively reviewed by four blinded cardiologists with advanced training in echocardiography. No single cardiologist reviewed contrast and noncontrast images of the same patient. Each set of 30 echocardiograms was then studied for wall-motion scoring. Visualization of left ventricular wall segments and a global visualization confidence level of interpretation were recorded. Results: Of all wall segments (N = 510, 91% were visualized in echocardiograms with use of contrast, whereas 75% of the walls were visualized in echocardiograms without contrast (P < 0.001. Of 30 examinations, 17 contrast echocardiograms were read with high confidence compared to 6 without contrast use (P = 0.004. The number of walls visualized with contrast was increased in 18 patients (60%, whereas noncontrast echocardiograms yielded more visualized walls in 6 patients (20%, P = 0.002. Conclusions: This study demonstrates that contrast is valuable to echocardiographic imaging. Its use should be supported throughout echocardiography clinics and encouraged in certain patients for whom resting and stress echocardiography results without contrast often prove uninterpretable.

Family-Related Opinions and Stressful Situations Associated with Psychological Distress in Women Undergoing Infertility Treatment

Directory of Open Access Journals (Sweden)

Jiro Takaki

2014-09-01

Full Text Available The purpose of this study is to investigate how family-related opinions and stressful situations are related to psychological distress in women undergoing infertility treatment. The subjects in this cross-sectional study were recruited from female patients undergoing infertility treatment (n = 2540 at 70 infertility treatment institutions in Japan. Because of non-participation or missing data, the number of subjects included in the analysis was 635 (response rate, 25.0%. The family-related opinions and stressful situations were evaluated using the original questions. Psychological distress was assessed using a self-report measure, the Kessler Six-question Psychological Distress Scale (K6. The K6 scores of the following participants were significantly (p < 0.05 and independently high: those with more frequent miscarriage/stillbirth/abortions, those with repeated miscarriages as the cause of infertility, those with infertility of unknown causes, those living with no child, those having a low joint income with their partner, those with the opinion that “women should devote themselves to their household duties” those who had considered stopping treatment, those without the opinion that “married life without children is favorable” and those who had experienced stressful situations such as inadequate explanation by doctors, frustration of multiple failed attempts, differences of opinion with the partner, and lack of knowledge regarding when to stop treatment. Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment are outlined. The results of this study may contribute to the prevention of and care for psychological distress in female patients undergoing infertility treatment.

Prognostic Value of Exercise-Stress Echocardiography in Asymptomatic Patients With Aortic Valve Stenosis.

Science.gov (United States)

Goublaire, Coppelia; Melissopoulou, Maria; Lobo, David; Kubota, Naozumi; Verdonk, Constance; Cimadevilla, Claire; Codogno, Isabelle; Brochet, Eric; Vahanian, Alec; Messika-Zeitoun, David

2017-07-19

This study sought to evaluate the prognostic value of mean pressure gradient (MPG) increase and peak systolic pulmonary artery pressure (SPAP) measured during exercise stress echocardiography in asymptomatic patients with aortic stenosis (AS). Exercise testing is recommended in asymptomatic AS patients, but the additional value of exercise-stress echocardiography, especially the prognostic value of MPG increase and peak SPAP, is still debated. We enrolled all consecutive patients with pure, isolated, asymptomatic AS and preserved ejection fraction ≥50% and normal SPAP (20 mm Hg and/or SPAP at peak exercise >60 mm Hg). These 112 patients were managed conservatively. During a mean follow-up of 14 ± 8 months, an AS-related event occurred in 30 patients, and 25 patients underwent surgery. Neither MPG increase >20 mm Hg nor peak SPAP >60 mm Hg was predictive of occurrence of AS-related events or aortic valve replacement (all p > 0.20). In contrast, baseline AS severity was an important prognostic factor (all p < 0.01). In this observational study including 148 patients with asymptomatic AS, we confirmed and extended the importance of exercise testing for unveiling functional limitation. More importantly, neither the increase in MPG nor in SPAP at peak exercise was predictive of outcome. Our results do not support the use of these parameters in risk-stratification and clinical management of asymptomatic AS patients. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Public perception on nuclear energy and radioactive waste - The second opinion poll

International Nuclear Information System (INIS)

Diaconu, Stela; Covreag Ilinca

2009-01-01

In 2008 ANDRAD started the second national opinion poll which had the purpose to identify the support of Romanian citizen for energy production by nuclear power stations, which is perceived as a less expensive energy, that could reduces the oil dependence of our country. The questionnaire consisted in 22 questions aiming to assess: the level of information about radioactive waste, the actual knowledge about radioactive waste management, the support and the opinion on nuclear energy, the public attitude regarding radioactive waste disposal, the trust in information sources and the public involvement in the decision-making process. (authors)

Attitudes of COPD patients towards tele-rehabilitation

DEFF Research Database (Denmark)

Dinesen, Birthe; Huniche, Lotte; Toft, Egon

2013-01-01

about their tele-rehabilitation: indifference, learning as part of situations in everyday life, feeling of security and motivation for performing physical training. The patients express the view that they circulate between these attitudes depending on their physical and emotional state as they perform......The aim of this paper is to describe patients’ attitudes towards tele-rehabilitation in the Danish TELEKAT (for Telehomecare, Chronic Patients and the Integrated Healthcare System) project, in order to better understand patients’ behavior when performing tele-rehabilitation activities in home...

Tele-centres as a way of achieving universal access

DEFF Research Database (Denmark)

Falch, Morten; Anyimadu, Amos

2003-01-01

The success of tele-centres in Ghana is discussed. The tele-centres offer a low cost opportunity to empower local communities in developed and developing countries to meet the challenges of the information society. The tele-centres can also contribute more directly to the supply of non-commercial...

TeleAbilitation

DEFF Research Database (Denmark)

Brooks, Anthony Lewis

2013-01-01

This chapter presents the TeleAbilitation concept and describes the potential of contemporary video game gesture controllers in rehabilitation and therapy via their online connectivity. It reflects on the author’s previous work focusing on ability rather than on impairment. A novel sensor-based p...

Tele-surgery: a new virtual tool for medical education.

Science.gov (United States)

Russomano, Thais; Cardoso, Ricardo B; Fernandes, Jefferson; Cardoso, Paulizan G; Alves, Jarcedy M; Pianta, Christina D; Souza, Hamilton P; Lopes, Maria Helena I

2009-01-01

The rapid evolution of telecommunication technology has enabled advances to be made in low cost video-conferencing through the improvement of high speed computer communication networks and the enhancement of Internet security protocols. As a result of this progress, eHealth education programs are becoming a reality in universities, providing the opportunity for students to have greater interaction at live surgery classes by means of virtual participation. Undergraduate students can be introduced to new concepts of medical care, remote second opinion and to telecommunication systems, whilst virtually experiencing surgical procedures and lectures. The better access this provides to the operating theater environment, the patient and the surgeon can improve the learning process for students. An analogical system was used for this experimental pilot project due to the benefits of it being low cost with a comparatively easy setup. The tele-surgery lectures were also transmitted to other universities by means of a Pentium 4 computer using open source software and connected to a portable image acquisition device located in the São Lucas University Hospital. Telemedicine technology has proven to be an important instrument for the improvement of medical education and health care. This study allowed health professionals, professors and students to have greater interaction during surgical procedures, thus enabling a greater opportunity for knowledge exchange.

Long-term prognostic value of transesophageal atrial pacing stress echocardiography.

Science.gov (United States)

Płońska, Edyta; Kasprzak, Jarosław D; Kornacewicz-Jach, Zdzisława

2005-07-01

The aim of our study was to evaluate the long-term prognostic value of transesophageal atrial pacing stress echocardiography (TAPSE) for the prediction of cardiovascular events (myocardial infarction) and mortality at 10-year follow-up. TAPSE was applied as a diagnostic modality in 93 consecutive patients (mean age 45 +/- 8 years) who were diagnosed for the cause of chest pain. Long-term follow-up data were obtained from 87 (94%) patients with a mean duration of follow-up of 92 +/- 4 months. Stress echocardiography was performed using TAPSE with a mean pacing rate of 142 +/- 18/min. Predefined cardiac events occurred during the follow-up period in 45 (52%) patients, including 24 (28%) with hard end points: 10 (12%) with nonfatal myocardial infarction and 17 who died (events overlap). Positive result of TAPSE was found in 47 (54%) patients and among those with positive TAPSE result, 16 died (94% of total mortality) and 21 had a hard event (death or infarction-88% of total prevalence). Survival free from hard events was noted in 37 (92%) patients with negative TAPSE and only in 26 (55%) of those with positive TAPSE ( P = .001). Independent predictive factors for mortality were TAPSE positivity (relative risk with 95% confidence interval [RR/CI] = 39.6 [36.3-42.9], P = .0006) and diabetes (RR/CI = 10.2 [8.6-11.8], P = .0026). Independent predictive factors for myocardial infarction were diabetes (RR/CI = 8.1 [6.3-9.9], P = .0186) and significant coronary stenosis in angiography (RR/CI = 9.0 [6.8-11.2], P = .0479). Independent predictive factors for death or nonfatal myocardial infarction were TAPSE positivity (RR/CI = 12.3 [11.1-13.3], P = .0001) and diabetes (RR/CI = 7.0 [5.8-8.2], P = .0018). Positive TAPSE result carries long-term prognostic information regarding mortality and risk of myocardial infarction that can be used to identify patients requiring more aggressive treatment. Negative TAPSE allows highly accurate definition of low-risk population with

A Tele-Behavioral Health Intervention to Reduce Depression, Anxiety, and Stress and Improve Diabetes Self-Management.

Science.gov (United States)

Mochari-Greenberger, Heidi; Vue, Lee; Luka, Andi; Peters, Aimee; Pande, Reena L

2016-08-01

Depression is prevalent among individuals with diabetes and associated with suboptimal self-management. Little is known about the feasibility and potential impact of tele-behavioral therapy to improve depressive symptoms and self-management among diabetes patients. This was a retrospective observational study of consecutive graduates enrolled in a national 8-week diabetes behavioral telehealth program between August 1, 2014, and January 31, 2015 (N = 466; mean age 56.8 ± 5.0 years; 56% female). Participant characteristics (demographics, comorbidities) were obtained by standardized questionnaire. Depression, anxiety, and stress symptoms (DASS; validated Depression Anxiety and Stress Scale 21 survey), and glucose self-testing frequency and values (point-of-care monitor) were measured at program start and completion. Changes in DASS severity and glucose self-testing frequency were assessed by chi-square tests. Changes in DASS and blood glucose levels were evaluated by paired t-tests. At baseline, approximately one in three participants had elevated depression (32%), anxiety (33%), or stress (31%) scores. Significant reductions in average DASS, depression (-8.8), anxiety (-6.9), and stress (-9.9), scores were observed at graduation among those with elevated baseline scores (p depression, anxiety, or stress categories. Improved glucose self-testing frequency (69% vs. 60% tested ≥once per week; p = 0.0005) and significant reductions in mean morning glucose levels (-12.3 mg/dL; p = 0.0002) were observed from baseline to graduation. Participants with normal versus non-normal depression scores were more likely to have lower (depression, anxiety, stress, and glucose levels, as well as increased frequency of glucose self-testing, among participants in a diabetes behavioral telehealth program.

Demonstration of improved seismic source inversion method of tele-seismic body wave

Science.gov (United States)

Yagi, Y.; Okuwaki, R.

2017-12-01

Seismic rupture inversion of tele-seismic body wave has been widely applied to studies of large earthquakes. In general, tele-seismic body wave contains information of overall rupture process of large earthquake, while the tele-seismic body wave is inappropriate for analyzing a detailed rupture process of M6 7 class earthquake. Recently, the quality and quantity of tele-seismic data and the inversion method has been greatly improved. Improved data and method enable us to study a detailed rupture process of M6 7 class earthquake even if we use only tele-seismic body wave. In this study, we demonstrate the ability of the improved data and method through analyses of the 2016 Rieti, Italy earthquake (Mw 6.2) and the 2016 Kumamoto, Japan earthquake (Mw 7.0) that have been well investigated by using the InSAR data set and the field observations. We assumed the rupture occurring on a single fault plane model inferred from the moment tensor solutions and the aftershock distribution. We constructed spatiotemporal discretized slip-rate functions with patches arranged as closely as possible. We performed inversions using several fault models and found that the spatiotemporal location of large slip-rate area was robust. In the 2016 Kumamoto, Japan earthquake, the slip-rate distribution shows that the rupture propagated to southwest during the first 5 s. At 5 s after the origin time, the main rupture started to propagate toward northeast. First episode and second episode correspond to rupture propagation along the Hinagu fault and the Futagawa fault, respectively. In the 2016 Rieti, Italy earthquake, the slip-rate distribution shows that the rupture propagated to up-dip direction during the first 2 s, and then rupture propagated toward northwest. From both analyses, we propose that the spatiotemporal slip-rate distribution estimated by improved inversion method of tele-seismic body wave has enough information to study a detailed rupture process of M6 7 class earthquake.

Comparison of dobutamine stress echocardiography and technetium-99m sestamibi single-photon emission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy

International Nuclear Information System (INIS)

Elhendy, A.; Geleijnse, M.L.; Van Domburg, R.T.; Bax, J.J.; Nierop, P.R.; Beerens, S.A.M.; Mohsen Ibrahim, M.; Roelandt, J.R.T.C.; Valkema, R.; Krenning, E.P.

1998-01-01

The aim of this study was to compare the accuracy of these two imaging modalities in conjunction with dobutamine stress test for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Dobutamine stress echocardiography in conjunction with sestamibi (MIBI) SPET was performed in 84 patients with the diagnosis of systemic hypertension who had been referred for evaluation of myocardial ischaemia. Significant coronary artery disease (≥50% luminal diameter stenosis) was detected in 66 patients (79%). The sensitivity, specificity and accuracy of the ischaemic pattern at echocardiography for the diagnosis of coronary artery disease were 73% (CI 63%-82%), 83% (CI 75%-91%) and 75% (CI 66%-84%), those for MIBI were 67% (CI 57%-77%), 83% (CI 75%-91%) and 70% (CI 60%-80%) respectively (P = NS vs echocardiography). Significant stenosis was detected in 123 (49%) of the 252 analysed coronary arteries. The sensitivity, specificity and accuracy of echocardiography for the regional diagnosis of coronary artery disease were 63% (CI 56%-69%), 90% (CI 86%-94%) and 77% (CI 72%-82%). Those for MIBI were 58% (CI 51%-64%), 91% (CI 87%-94%) and 75% (CI 69%-80) respectively (P = NS vs echocardiography). Left ventricular hypertrophy was detected in 59 patients (70%) by echocardiography and did not influence the overall or regional specificity of echocardiography or MIBI SPET.(orig./MG) (orig.)

Echocardiography in the flight program

Science.gov (United States)

Charles, John B.; Bungo, Michael W.; Mulvagh, Sharon L.

1991-01-01

Observations on American and Soviet astronauts have documented the association of changes in cardiovascular function during orthostasis with space flight. A basic understanding of the cardiovascular changes occurring in astronauts requires the determination of cardiac output and total peripheral vascular resistance as a minimum. In 1982, we selected ultrasound echocardiography as our means of acquiring this information. Ultrasound offers a quick, non-invasive and accurate means of determining stroke volume which, when combined with the blood pressure and heart rate measurements of the stand test, allows calculation of changes in peripheral vascular resistance, the body's major response to orthostatic stress. The history of echocardiography in the Space Shuttle Program is discussed and the results are briefly presented.

Emotional attachment and emotional availability tele-intervention for adoptive families.

Science.gov (United States)

Baker, Megan; Biringen, Zeynep; Meyer-Parsons, Beatrice; Schneider, Abby

2015-01-01

This study evaluated the new online Emotional Attachment and Emotional Availability (EA2) Intervention for use with adoptive families in enhancing parent-child EA, parental perceptions of EA, child attachment behaviors, parent-child emotional attachment, and reducing parent-reported child behavioral problems and parenting-related stress. Participants in this study were adoptive parents and their adopted children ages 1.5 to 5 years old (N = 15 dyads). Participants were placed in an immediate intervention group (IG) or a delayed intervention group (DG) that would receive the 6-week EA2 Tele-Intervention after the IG. Results revealed significant differences in the IG in child behavioral problems, parent-child EA, parental perceptions of EA, and parent-child emotional attachment, improvements not seen in the DG. Analysis of effects of the DG after receiving the EA2 Tele-Intervention revealed significant differences over time also in most of these qualities. © 2015 Michigan Association for Infant Mental Health.

Exercise-Stress Echocardiography Reveals Systolic Anterior Motion of the Mitral Valve as a Cause of Syncopes in a Cardiac Amyloidosis Patient

DEFF Research Database (Denmark)

Clemmensen, Tor Skibsted; Mølgaard, Henning; Andersen, Niels Frost

2016-01-01

increased left ventricular outflow track (LVOT) velocity. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity, and severe systolic anterior motion of the mitral valve. The patients' symptoms were...

Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel.

Science.gov (United States)

Shmueli, Liora; Davidovitch, Nadav; Pliskin, Joseph S; Balicer, Ran D; Hekselman, Igal; Greenfield, Geva

2017-12-08

Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO. A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, for the same medical concern. We describe the characteristics of respondents who obtained SOs, their reasons for doing so and their perceived outcomes: (1) Satisfaction with the SO; (2) Experiencing health improvement after receiving a SO; (3) A difference in the diagnosis or treatment suggested in the first opinions and the second opinions; (4) Preference of the SO over the first one. Most of the respondents who sought a SO (n = 344) were above 60 years old, secular, living with a partner, perceived their income to be above average and their health status to be not so good. For the patients who utilized SOs, orthopedic surgeons were sought out more than any other medical professional.Reasons for seeking a SO included doubts about diagnosis or treatment (38%), search for a sub-specialty expert (19%) and dissatisfaction with communication (19%). SO seekers most frequently chose a specific specialist based on a recommendation from a friend or a relative (33%). About half of the SO seekers also searched for information on the internet. Most of the respondents who sought a SO mentioned that they were satisfied with it (84%), felt health improvement (77%), mentioned that there was a difference between the diagnosis or treatment between the first opinion and the SO (56%) and preferred the SO over the first one (91%). Clinical uncertainty or dissatisfaction with patient-physician communication

Bauru School of Dentistry Tele-Health League: an educational strategy applied to research, teaching and extension among applications in tele-health.

Science.gov (United States)

Silva, Andressa Sharllene Carneiro da; Rizzante, Fabio Antonio Piola; Picolini, Mirela Machado; Campos, Karis de; Corrêa, Camila de Castro; Franco, Elen Caroline; Pardo-Fanton, Cássia de Souza; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

2011-01-01

Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP) has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL), in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%), and by the performance of tests and paperwork about the theoretical content provided. In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%), an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. The results showed that the TLFOB-USP members, adjoining to the professor's participants, develop projects

Bauru School of Dentistry Tele-Health League: an educational strategy applied to research, teaching and extension among applications in tele-health

Directory of Open Access Journals (Sweden)

Andressa Sharllene Carneiro da Silva

2011-12-01

Full Text Available Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL, in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. Objective: The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. Material and Methods: The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%, and by the performance of tests and paperwork about the theoretical content provided. Results: In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%, an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. Conclusions: The results showed that the TLFOB

Second medical opinions: the views of oncology patients and their physicians.

Science.gov (United States)

Philip, Jennifer; Gold, Michelle; Schwarz, Max; Komesaroff, Paul

2010-09-01

Second medical opinions (SMOs) are common in oncology practice, but the nature of these consultations has received relatively little attention. This study examines the views of patients with advanced cancer and their physicians of SMOs. Parallel, concurrent surveys were developed for patients and physicians. The first was distributed to outpatients with advanced cancer-attending specialist clinics in an Australian quaternary hospital. The second survey, developed on the basis of results of exploratory interviews with medical oncologists, was distributed to medical oncologists in Australia. Seventeen of fifty two (33%) patients had sought a SMO, most commonly prompted by concerns around communication with their first doctor, the extreme and desperate nature of their medical condition and the need for reassurance. Most (94%) patients found the SMO helpful, with satisfaction related to improved communication and reassurance. Patients were concerned that seeking a second medical opinion may affect their relationship with their primary doctor. Most physicians (82%) reported seeing between one and five SMO per month, with patients being motivated by the need for additional information and reassurance. Physicians regarded SMO patients as having greater information needs (84%), greater psychosocial needs (58%) and requiring more of the physician's time and energy (77%) than other patients. SMOs are common in cancer care with most patients motivated by the need for improved communication, additional information and reassurance. Physicians identify patients who seek SMOs as having additional psychosocial needs compared with other oncology patients.

Contrast echocardiography: history, micro bubble characteristics and instrumental techniques

International Nuclear Information System (INIS)

Cubides, Carlos; Restrepo, Gustavo; Aristizabal, Dagnovar; Munera, Ana

2006-01-01

This article describes the history of contrast echocardiography, the physical characteristics of the contrast agent's micro bubbles, the main instrumental tools (mechanical index, focus and focusing, frame rate), and the echocardiography techniques (second harmonic imaging, fusion harmonic, power pulse inversion imaging, triggered imaging, intermittent harmonic power Doppler, color power angio and acoustic densitometry), actually available for clinical use

Empowering Patients with COPD Using Tele-Homecare Technology

DEFF Research Database (Denmark)

Huniche, Lotte

2010-01-01

Abstract. This paper describes how a tele-rehabilitation program using home tele-monitoring empowers patients with COPD. The paper is based on findings from an ongoing research and innovation project, called “Telehomecare, chronic patients and the integrated healthcare system” (the TELEKAT project......) that employs triple interventions related to patients, professionals, and the organisation of care. The ways COPD patients utilize home tele-monitoring in the TELEKAT project points to the relevance of empowerment, as rooted in ideologies of social action, and focusing on the improvement of both personal...

Patients' reflections on communication in the second-opinion hematology-oncology consultation.

Science.gov (United States)

Goldman, Roberta E; Sullivan, Amy; Back, Anthony L; Alexander, Stewart C; Matsuyama, Robin K; Lee, Stephanie J

2009-07-01

The nature of communication between patients and their second-opinion hematology consultants may be very different in these one-time consultations than for those that are within long-term relationships. This study explored patients' perceptions of their second-opinion hematology-oncology consultation to investigate physician-patient communication in malignant disease at a critical juncture in cancer patients' care and decision-making. In-depth telephone interviews with a subset of 20 patients from a larger study, following their subspecialty hematology consultations. Most patients wanted to contribute to the consultation agenda, but were unable to do so. Patients sought expert and honest advice delivered with empathy, though most did not expect the consultant to directly address their emotions. They wanted the physician to apply his/her knowledge to the specifics of their individual cases, and were disappointed and distrustful when physicians cited only general prognostic statistics. In contrast, physicians' consideration of the unique elements of patients' cases, and demonstrations of empathy and respect made patients' feel positively about the encounter, regardless of the prognosis. Patients provided concrete recommendations for physician and patient behaviors to enhance the consultation. Consideration of these recommendations may result in more effective communication and increased patient satisfaction with medical visits.

Maestro: a tele-robotic system for decommissioning of nuclear plants

International Nuclear Information System (INIS)

Desbats, P.; Idasiak, J.M.

2008-01-01

Compared to electric manipulators, hydraulic manipulators can handle higher payloads with respect to their size and mass. However, due to their limited positioning resolution and dexterity, they are usually disqualified for precise tele-manipulation and high quality tele-operation. More over, experience feedback has shown that on-the-shelf hydraulic manipulators are not reliable when performing high demanding tasks in tele-operation for dismantling applications. In order to solve this problem, CEA (Commissariat l'Energie Atomique), in collaboration with Cybernetix company, has developed a computer-aided, high-precision remote handling system with force-feedback featuring the advanced hydraulic tele-robotic arm Maestro. (authors)

What Is Echocardiography?

Science.gov (United States)

... Intramural Research Home / Echocardiography Echocardiography Also known as Echo , Surface echo , Ultrasound of ... other tests, echo doesn't involve radiation. Transthoracic Echocardiography Transthoracic (tranz-thor-AS-ik) echo is the ...

Tele-education.

Science.gov (United States)

Curran, Vernon R

2006-01-01

Tele-education has been used for many years to deliver continuing education programmes to rural health-care professionals. The main modes are audio, video and computer. Audio technologies involve the transmission of the spoken word (voice) between learners and instructors, either synchronously or asynchronously. Examples of the former include audioconferencing and short-wave radio; examples of the latter include audiotape or audiocassette. Video for distance learning, like audio, can be used in either synchronous or asynchronous fashion. Videoconferencing, or interactive television, are considered synchronous because there is the opportunity for live visual and verbal interaction between instructors and learners. Asynchronous instructional video tools include slow-scan video, interactive videodiscs and videotapes. Computer-assisted learning or instruction can be defined as any learning that is mediated by a computer and which requires no direct interaction between the user and a human instructor in order to run. It is becoming increasingly common. Examples include: the Internet and World Wide Web, email, synchronous and asynchronous computer-mediated communication applications and interactive multimedia applications on CD-ROM. Tele-education technologies have an important role to play in addressing the professional isolation which is experienced by rural and remote health-care professionals.

The value of β-blockers administration during recovery phase of dobutamine stress echocardiography: a review.

Science.gov (United States)

Nguyen, James; Juneman, Elizabeth; Movahed, Mohammad Reza

2013-07-01

Dobutamine stress echocardiography (DSE) is a successful technique for detection of ischemia in patients with suspected coronary artery disease (CAD). There are some data that administration of β-blocker after peak infusion of dobutamine can improve sensitivity. The goal of this manuscript is to review the current literature in regard to the mechanism and accuracy of post-dobutamine β-blocker administration for ischemia detection. In this review, we present 2 case reports followed by detailed review of the literature. © 2013. This article is a U.S. Government work and is in the public domain in the USA.

Evaluation of a tele-education programme in Brazil.

Science.gov (United States)

Joshi, Ashish; Novaes, Magdala A; Iyengar, Sriram; Machiavelli, Josiane L; Zhang, Jiajie; Vogler, Robert; Hsu, Chiehwen E

2011-01-01

We evaluated a tele-education programme for primary care staff in Pernambuco State, Brazil. During 2008 and 2009, tele-education sessions occurred four times each week for one hour per day. The topics included public health, child and adolescent health, mental health and nursing. After each session, participants completed an evaluation questionnaire. A total of 73 municipalities and 141 health centres participated in the programme. There were 254 tele-education sessions scheduled during the 20-month study period; of these, 224 sessions were successfully performed and 30 were cancelled. We collected 3504 responses from the satisfaction survey. There was high acceptance of the programme: 97% rated it as excellent or good.

Perceived Stress among French Dental Students and Their Opinion about Education Curriculum and Pedagogy.

Science.gov (United States)

Inquimbert, Camille; Tramini, Paul; Alsina, Ivan; Valcarcel, Jean; Giraudeau, Nicolas

2017-10-01

The purpose of this study was to identify the major sources of perceived stress and their relation to a student satisfaction questionnaire about the curriculum and the pedagogy among French dental students. All dental students ( n = 178) from years 4 to 6 at the University of Montpellier (France) participated in this exploratory survey. In spring 2016, a 3-part questionnaire was distributed during clinical sessions: the first part asked about sociodemographic and living conditions, the second part aimed to assess the students' perceived stress (Dental Environmental Stress questionnaire), and the third part was a satisfaction questionnaire exploring the clinical organization and the teaching methodologies (Student Course Experience Questionnaire). A Spearman's correlation test and a principal component analysis were used to assess the relation between the variables of the questionnaire. The response rate was 99.4%. The most stressful items were "the number of tasks to be performed during clinical practice," "the waiting time before opinion from teachers," and "the administrative part and computer problems." Fifty-four percent of the students claimed to be satisfied with their studies, showing a score of seven or higher. There was a negative correlation between the level of student satisfaction and the level of perceived stress. Although most of the students were globally satisfied with their curriculum, this study highlighted dysfunctions in the clinical education with a level of stress correlated with the student's dissatisfaction. Most of all, students found that examinations were too stressful and that the clinical requested task quotas were overestimated.

Perceived Stress among French Dental Students and Their Opinion about Education Curriculum and Pedagogy

Science.gov (United States)

Inquimbert, Camille; Tramini, Paul; Alsina, Ivan; Valcarcel, Jean; Giraudeau, Nicolas

2017-01-01

Objectives: The purpose of this study was to identify the major sources of perceived stress and their relation to a student satisfaction questionnaire about the curriculum and the pedagogy among French dental students. Materials and Methods: All dental students (n = 178) from years 4 to 6 at the University of Montpellier (France) participated in this exploratory survey. In spring 2016, a 3-part questionnaire was distributed during clinical sessions: the first part asked about sociodemographic and living conditions, the second part aimed to assess the students' perceived stress (Dental Environmental Stress questionnaire), and the third part was a satisfaction questionnaire exploring the clinical organization and the teaching methodologies (Student Course Experience Questionnaire). A Spearman's correlation test and a principal component analysis were used to assess the relation between the variables of the questionnaire. Results: The response rate was 99.4%. The most stressful items were “the number of tasks to be performed during clinical practice,” “the waiting time before opinion from teachers,” and “the administrative part and computer problems.” Fifty-four percent of the students claimed to be satisfied with their studies, showing a score of seven or higher. There was a negative correlation between the level of student satisfaction and the level of perceived stress. Conclusion: Although most of the students were globally satisfied with their curriculum, this study highlighted dysfunctions in the clinical education with a level of stress correlated with the student's dissatisfaction. Most of all, students found that examinations were too stressful and that the clinical requested task quotas were overestimated. PMID:29184835

Assessment of left ventricular function using dobutamine stress echocardiography and myocardial scintigraphy in valvular heart disease

International Nuclear Information System (INIS)

Ozaki, Nobuchika; Sugimoto, Takaki; Okada, Masayoshi

1999-01-01

To assess the left ventricular (LV) function in valvular heart disease, we employed the preoperative dobutamine stress echocardiography and the myocardial scintigraphy. During the past 13 years, 37 of 324 the patients showed LV dysfunction with the % fractional shortening (%FS) of 25% or less in the preoperative echocardiogram. These patients were retrospectively divided into two groups; Group A (n=21): %FS has improved late after operation; Group B (n=16): %FS has deteriorated or LV failure occurred. The mean follow-up period was 84±54 months after valve surgery. No significant differences were observed in the preoperative characteristics and operative variables between these two groups. The dobutamine stress test had been performed in 8 patients in Group A and 9 patients in Group B preoperatively, and the maximum increase ratio of %FS (Δ%FS) was used for assessment. Seven patients in Group A had showed Δ%FS of more than 9%, while all patients in Group B had showed Δ%FS of less than 9%. Myocardial scintigraphy was performed in 11 patients of them, and another 22 patients with %FS of above 25% acted as the control group. The Defect Score, which was defined as the sum of defect scales in 25 LV segments, showed a significant difference between 11 patients with LV dysfunction and control group. The distribution of the Defect Score in each myocardial segment, showed significantly higher in the posterior and inferior LV segments. In addition, the perfusion defect on myocardial imaging was initiated in the junction between the septal and LV free wall, and extended from the posterior to the lateral wall along with deterioration of LV function. In conclusion, preoperative dobutamine stress echocardiography proved to be very useful for prediction of the postoperative LV function, and myocardial scintigraphy might be indicative of LV function even in valvular heart disease. (author)

Assessment of left ventricular function using dobutamine stress echocardiography and myocardial scintigraphy in valvular heart disease

Energy Technology Data Exchange (ETDEWEB)

Ozaki, Nobuchika; Sugimoto, Takaki; Okada, Masayoshi [Kobe Univ. (Japan). School of Medicine

1999-02-01

To assess the left ventricular (LV) function in valvular heart disease, we employed the preoperative dobutamine stress echocardiography and the myocardial scintigraphy. During the past 13 years, 37 of 324 the patients showed LV dysfunction with the % fractional shortening (%FS) of 25% or less in the preoperative echocardiogram. These patients were retrospectively divided into two groups; Group A (n=21): %FS has improved late after operation; Group B (n=16): %FS has deteriorated or LV failure occurred. The mean follow-up period was 84{+-}54 months after valve surgery. No significant differences were observed in the preoperative characteristics and operative variables between these two groups. The dobutamine stress test had been performed in 8 patients in Group A and 9 patients in Group B preoperatively, and the maximum increase ratio of %FS ({delta}%FS) was used for assessment. Seven patients in Group A had showed {delta}%FS of more than 9%, while all patients in Group B had showed {delta}%FS of less than 9%. Myocardial scintigraphy was performed in 11 patients of them, and another 22 patients with %FS of above 25% acted as the control group. The Defect Score, which was defined as the sum of defect scales in 25 LV segments, showed a significant difference between 11 patients with LV dysfunction and control group. The distribution of the Defect Score in each myocardial segment, showed significantly higher in the posterior and inferior LV segments. In addition, the perfusion defect on myocardial imaging was initiated in the junction between the septal and LV free wall, and extended from the posterior to the lateral wall along with deterioration of LV function. In conclusion, preoperative dobutamine stress echocardiography proved to be very useful for prediction of the postoperative LV function, and myocardial scintigraphy might be indicative of LV function even in valvular heart disease. (author)

MODELS OF MAJOR ADVERSE CARDIAC EVENT RISK USING RESULTS OF EXERCISE STRESS ECHOCARDIOGRAPHY WITH NONINVASIVE CORONARY ARTERY FLOW ASSESSMENT IN PATIENTS WITH ISCHEMIC HEART DISEASE

Directory of Open Access Journals (Sweden)

A. V. Zagatina

2017-01-01

Full Text Available Ultrasound non-invasive coronary artery imaging contributes to the diagnosis of ischemic heart disease (IHD in clinical practice. However, data of the prognostic value obtained from a complex analysis of contractility disorders and coronary blood flow parameters during exercise tests in the world literature are still not available. Aim. To develop risk models for adverse outcomes in patients with probable or definite IHD based on the results of a stress test with a noninvasive coronary blood flow study. Material and methods. Medical data of 689 patients with probable or definite IHD who underwent stress echocardiography with satisfactory visualization of the anterior interventricular artery (AIVA were included in the analysis. All patients had stress echocardiography on a horizontal bicycle ergometer. Registration of coronary blood flow in the middle third of the AIVA was performed at rest and at the peak of the load with calculation of the coronary reserve value. Further patient follow-up lasted 3 years. Models of further negative outcomes were developed on the basis of the stress echocardiography results and of coronary blood flow parameters. Results. Three models that take into account the factors associated with further mortality, mortality/myocardial infarction and sum of negative outcomes were developed in the study. These models divide a cohort of patients with probable or definite IHD into groups of low, medium and very high risks. Factors associated with the risk of death include: age >56 years, load power <100 W, breach of contractility in the blood supply zone of the circumflex artery initially and during exercise, the difference in blood flow velocities in the AIVA<10 cm/s, coronary reserve of AIVA<2. The risk model of death, taking into account these factors, suggests dividing patients into low-risk group if there are ≤2 factors (mortality 0.6% for 3 years, medium risk – from 2 to 4 factors (mortality 1.8%, high risk – ≥5

Fetal echocardiography

Science.gov (United States)

... page: //medlineplus.gov/ency/article/007340.htm Fetal echocardiography To use the sharing features on this page, please enable JavaScript. Fetal echocardiography is a test that uses sound waves ( ultrasound ) ...

Prenatal diagnosis of congenital heart disease using four-dimensional spatio-temporal image correlation (STIC) telemedicine via an Internet link: a pilot study.

Science.gov (United States)

Viñals, F; Mandujano, L; Vargas, G; Giuliano, A

2005-01-01

To assess whether the spatio-temporal image correlation (STIC) acquisition technique can be taught to a general obstetrician by e-mail; whether STIC volume datasets can be transmitted over the Internet; and whether STIC volume datasets analyzed offline at a remote setting can be used to confirm or exclude major cardiac defects (TELE-STIC). This was a prospective study involving 50 pregnant women with gestational ages ranging between 20 and 36 weeks. These patients were selected by two general obstetricians (operators) working in geographically remote areas of Chile. Although both obstetricians were users of equipment capable of four-dimensional (4D) ultrasound with STIC, they lacked skill in the performance of fetal cardiac examination. A dedicated web disk was created to upload the acquired volume datasets using an Internet broadband connection. Offline analysis was performed by a single investigator experienced in fetal echocardiography (the administrator). A telemedicine link via the Internet was possible in all cases. Seventy-seven volume datasets were sent to the web server. A complete cardiac examination according to set criteria was achieved by the administrator in 86% of the cases scanned by one operator and 95% of the cases scanned by the other operator. Three patients had cardiac defects confirmed postnatally, two fetuses had extracardiac anomalies and one fetus had a suspected cardiac defect unconfirmed by second-opinion TELE-STIC. There were two isolated major congenital heart defects. Both patients were given advice by e-mail and teleconference using a web camera about the likely outcome and benefits of scheduling in utero transport to a tertiary care center. STIC volumes can be obtained by operators inexperienced in fetal echocardiography, transmitted via the Internet, and their analysis enables recognition of most of the structures and views necessary to assess fetal cardiac anatomy. The preliminary use of TELE-STIC allowed us to demonstrate that

Robotics and tele-operation technology for applications in nuclear fields

International Nuclear Information System (INIS)

Kosuge, Kazuhiro; Hirata, Yasuhisa; Takeo, Koji

2002-01-01

In this article, we introduce available robotics and tele-operation technology for applications in Nuclear Fields. First, robotics technology for manipulation of a large object is introduced which has been experimentally applied to ITER Maintenance Robot. Then, transportation technology of a large object by multiple mobile robots is reviewed. At last, recent tele-operation technologies and a prototype tele-operation system, referred to as VISIT (Visual Interface System for Interactive Task-execution), is introduced. Several experimental results are also introduced. (author)

Simulation-based training in echocardiography.

Science.gov (United States)

Biswas, Monodeep; Patel, Rajendrakumar; German, Charles; Kharod, Anant; Mohamed, Ahmed; Dod, Harvinder S; Kapoor, Poonam Malhotra; Nanda, Navin C

2016-10-01

The knowledge gained from echocardiography is paramount for the clinician in diagnosing, interpreting, and treating various forms of disease. While cardiologists traditionally have undergone training in this imaging modality during their fellowship, many other specialties are beginning to show interest as well, including intensive care, anesthesia, and primary care trainees, in both transesophageal and transthoracic echocardiography. Advances in technology have led to the development of simulation programs accessible to trainees to help gain proficiency in the nuances of obtaining quality images, in a low stress, pressure free environment, often with a functioning ultrasound probe and mannequin that can mimic many of the pathologies seen in living patients. Although there are various training simulation programs each with their own benefits and drawbacks, it is clear that these programs are a powerful tool in educating the trainee and likely will lead to improved patient outcomes. © 2016, Wiley Periodicals, Inc.

Virtual rapid response: the next evolution of tele-ICU.

Science.gov (United States)

Hawkins, Carrie L

2012-01-01

The first of its kind in the Veterans Affairs (VA) system, the Denver VA Medical Center's tele-intensive care unit (ICU) program is unique because it is entirely nurse driven. A nontraditional tele-ICU model, the program was tailored to meet the needs of rural veterans by using critical care nursing expertise in Denver, Colorado. An experienced CCRN-certified nurse manages the system 24 hours a day, 7 days a week, from Eastern Colorado Health Care System. The virtual ICU provides rapid response interventions through virtual technology. This tele-ICU technology allows for a "virtual handshake" by nursing staff at the start of the shift and a report on potential patient issues. Clinical relationships have been strengthened between all 5 VA facilities in the Rocky Mountain Region, increasing the likelihood of early consultation at the onset of clinical decline of a patient. In addition, the tele-ICU nurse is available for immediate nursing consultation and support, coordinates point-to-point virtual consultation between physicians at the rural sites and specialists in Denver, and assists in expediting critical care transfers. The primary objectives for the tele-ICU program include improving quality and access of care to critical care services in rural sites, reducing community fee basis costs and frequency of transfers, and increasing collaboration and collegiality among nursing and medical staff in all Region 19's medical centers.

On-Orbit Prospective Echocardiography on International Space Station Crew

Science.gov (United States)

Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David S.; Garcia, Kathleen M.; Melton, Shannon L.; Feiveson, Alan; Dulchavsky, Scott A.

2010-01-01

Introduction A prospective trial of echocardiography was conducted on of six crewmembers onboard the International Space Station. The main objective was to determine the efficacy of remotely guided tele-echocardiography, including just-in-time e-training methods and determine what "space normal" echocardiographic data is. Methods Each crewmember operator (n=6) had 2-hour preflight training. Baseline echocardiographic data were collected 55 to 167days preflight. Similar equipment was used in each 60-minute in-flight session (mean microgravity exposure - 114 days (34 -- 190)). On Orbit ultrasound operators used an e-learning system within 24h of these sessions. Expert assistance was provided using ultrasound video downlink and two-way voice. Testing was repeated 5 to 16 days after landing. Separate ANOVA was used on each echocardiographic variable (n=33). Within each ANOVA, three tests were made: a) effect of mission phase (preflight, in-flight, post flight); b) effect of echo technician (two technicians independently analyzed the data); c) interaction between mission phase and technician. Results Nine rejections of the null hypothesis (mission phase or technician or both had no effect) were discovered and considered for follow up. Of these, six rejections were for significant technician effects, not as a result of space flight. Three rejections of the null hypothesis (Aortic Valve time velocity integral, Mitral E wave Velocity and heart rate) were attributable to space flight, however determined not to be clinically significant. No rejections were due to the interaction between technician and space flight. Conclusion No consistent clinically significant effects of long-duration space flight were seen in echocardiographic variables of the given group of subjects.

Quantitation of stress echocardiography by tissue Doppler and strain rate imaging: a dream come true?

Science.gov (United States)

Galderisi, Maurizio; Mele, Donato; Marino, Paolo Nicola

2005-01-01

Tissue Doppler (TD) is an ultrasound tool providing a quantitative agreement of left ventricular regional myocardial function in different modalities. Spectral pulsed wave (PW) TD, performed online during the examination, measures instantaneous myocardial velocities. By means of color TD, velocity images are digitally stored for subsequent off-line analysis and mean myocardial velocities are measured. An implementation of color TD includes strain rate imaging (SRI), based on post-processing conversion of regional velocities in local myocardial deformation rate (strain rate) and percent deformation (strain). These three modalities have been applied to stress echocardiography for quantitative evaluation of regional left ventricular function and detection of ischemia and viability. They present advantages and limitations. PWTD does not permit the simultaneous assessment of multiple walls and therefore is not compatible with clinical stress echocardiography while it could be used in a laboratory setting. Color TD provides a spatial map of velocity throughout the myocardium but its results are strongly affected by the frame rate. Both color TD and PWTD are also influenced by overall cardiac motion and tethering from adjacent segments and require reference velocity values for interpretation of regional left ventricular function. High frame rate (i.e. > 150 ms) post-processing-derived SRI can potentially overcome these limitations, since measurements of myocardial deformation have not any significant apex-to-base gradient. Preliminary studies have shown encouraging results about the ability of SRI to detect ischemia and viability, in terms of both strain rate changes and/or evidence of post-systolic thickening. SRI is, however, Doppler-dependent and time-consuming. Further technical refinements are needed to improve its application and introduce new ultrasound modalities to overcome the limitations of the Doppler-derived deformation analysis.

Measuring tele-ICU impact: does it optimize quality outcomes for the critically ill patient?

Science.gov (United States)

Goran, Susan F

2012-04-01

To determine the relationship between tele-ICU (intensive care unit) implementations and improvement in quality measures and patient outcomes. Tele-ICUs were designed to leverage scarce critical-care experts and promised to improve patient quality. Abstracts and peer-reviewed articles were reviewed to identify the associations between tele-ICU programmes and clinical outcomes, cost savings, and customer satisfaction. Few peer-reviewed studies are available and many variables in each study limit the ability to associate study conclusions to the overall tele-ICU programme. Further research is required to explore the impact of the tele-ICU on patient/family satisfaction. Research findings are highly dependent upon the level of ICU acceptance. The tele-ICU, in collaboration with the ICU team, can be a valuable tool for the enhancement of quality goals although the ability to demonstrate cost savings is extremely complex. Studies clearly indicate that tele-ICU nursing vigilance can enhance patient safety by preventing potential patient harm. Nursing managers and leaders play a vital part in optimizing the quality role of the tele-ICU through supportive modelling and the maximization of ICU integration. © 2012 Blackwell Publishing Ltd.

Arizona TeleMedicine Project.

Science.gov (United States)

Arizona Univ., Tucson. Coll. of Medicine.

Designed to provide health services for American Indians living on rurally isolated reservations, the Arizona TeleMedicine Project proposes to link Phoenix and Tucson medical centers, via a statewide telecommunications system, with the Hopi, San Carlos Apache, Papago, Navajo, and White Mountain Apache reservations. Advisory boards are being…

Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography

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Ugo Fabrizio

2010-05-01

Full Text Available Abstract Background We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE. Wall motion (WM assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD, particularly in patients with isolated intermediate (50%-70% coronary stenosis. Methods We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography. Results and discussion When CAD was defined as the presence of a ≥50% stenosis, the addition of MPI increased sensitivity (+30% and decreased specificity (-14%, with a final increase in total diagnostic accuracy (+16%, p Conclusions The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition (≥50% or > 70% stenosis, but it is mainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis. The total diagnostic accuracy increased only when defining CAD as ≥50% stenosis, since in patients with severe stenosis (> 70% the decrease in specificity is not counterbalanced by the minor sensitivity increase.

Avaliação de um sistema de segunda opinião em radiologia Evaluation of a second opinion system in radiology

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Ricardo Alfredo Quintano Neira

2010-06-01

Full Text Available OBJETIVO: A segunda opinião médica pode auxiliar no processo de investigação do problema de saúde de um paciente e na definição da conduta terapêutica. Este trabalho tem por objetivo demonstrar um processo de segunda opinião médica por meio de um sistema web multiespecialidades adaptado para a radiologia. MATERIAIS E MÉTODOS: O sistema foi utilizado por 49 médicos residentes da Universidade Federal de São Paulo, os quais responderam a 52 solicitações de segunda opinião. Como instrumentos de avaliação foram utilizados questionários. RESULTADOS: Foram avaliadas 1.704 respostas de segunda opinião. Deste total, 514 (29,1% foram definidas como satisfatórias. Em 64,4% as respostas dos questionários indicaram que a qualidade das imagens não comprometeu o diagnóstico. O tempo médio para emitir a segunda opinião remota foi de 6 minutos e 26 segundos. CONCLUSÃO: O processo de segunda opinião médica realizado por intermédio de um sistema web multiespecialidades ajustado para a radiologia pode ser uma excelente ferramenta para o manejo das condutas médicas.OBJECTIVE: A second medical opinion can aid in the investigation of a health problem as well as in the definition of the therapeutic approach. The present study is aimed at demonstrating a process of second medical opinion by means of a web-based multispecialty system adapted for radiology. MATERIALS AND METHODS: The system was utilized by 49 residents at Universidade Federal de São Paulo, Brazil, who gave their medical opinion on 52 second opinion requests. Questionnaires were utilized as an evaluation tool. RESULTS: A total of 1704 medical second opinions were evaluated and 514 (29.1% of them were defined as satisfactory. In 64.4% of cases, the answers of the questionnaires indicated that the images quality did not affect the diagnosis. On average, 6 minutes and 26 seconds was the time required to issue a remote second medical opinion. CONCLUSION: A process of second

[Medical tele-imaging: a good chance for the future].

Science.gov (United States)

Bonnin, A

1999-01-01

Tele-imaging is an important part of telemedicine: it includes the transmission of medical digital images and plays a role in all fields of telemedicine, such as expertise, consultation, teaching and research. Tele-imaging has been made possible through the digitalization of medical imaging. There are two possibilities: either digitalization of conventional radiological film or direct acquisition of digital images. The transmission of medical imaging requires a high data rate so as to obtain a good quality transmission of the initial images in a reasonable delay. In order to deal with the great amount of information to be stocked and transmitted, a compression of the data, without loss of information, is usually necessary. Interactivity is very important in all these types of transmissions. These tele-transmission techniques are already used world wide, especially in Japan and in the United States, to help in therapeutic or diagnostic decisions. In France, we have been performing real time interactive tele-imaging sessions between radiology and endocrinology departments of Hotel Dieu in Montréal and Hôpital Cochin in Paris. This experimental device includes a visual-conference link between the medical teams and a real time link between two CT scanners. The CT scanner slices appear simultaneously both CT scanner screens; it is even possible to guide a CT scanner examination using remote control from the other hospital. We have successfully repeated the experiment between Cochin and a private hospital in Paris. In the case of the "Prison de la Santé", we have been using telemedicine in order to reduce problematic transfers of prison inmates. Moreover, access to doctors in the prison is sometimes difficult. The system ensures the daily transmission of X-rays, which are immediately read by radiologists at Cochin. In the past, 50 to 70 X-rays had to be read during one weekly visit. Medical tele-imaging raises certain legal, ethical and economic issues, such as

A secure and synthesis tele-ophthalmology system.

Science.gov (United States)

Wei, Zhuo; Wu, Yongdong; Deng, Robert H; Yu, Shengsheng; Yao, Haixia; Zhao, Zhigang; Ngoh, Lek Heng; Han, Lim Tock; Poh, Eugenie W T

2008-10-01

This paper describes a secure and synthesis ophthalmology telemedicine system, referred to as TeleOph. Under a Secure Socket Layer (SSL) channel, patient prerecorded data can be safely transferred via the Internet. With encrypted videoconference and white-board, the system not only supports hospital-to-clinic consultation, but also supplies hospital-tohospital joint discussion. Based on Directshow technology (Microsoft Corporation, Redmond, WA), video cameras connected to the computer by firewire can be captured and controlled to sample video data. By using TWAIN technology, the system automatically identifies networked still cameras (on fundus and slitlamp devices) and retrieves images. All the images are stored in a selected format (such as JPEG, DICOM, BMP). Besides offline-transferring prerecorded data, the system also supplies online sampling of patient data (real-time capturing from remote places). The system was deployed at Tan Tock Seng Hospital, Singapore and Ang Mo Kio, Singapore, where 100 patients were enrolled in the system for examination. TeleOph can be successfully used for patient consultation, and hospital joint discussion. Meanwhile, TeleOph can supply both offline and online sampling of patient data.

Dobutamine stress echocardiography related sustained ventricular tachycardia in a patient with ischaemic cardiomyopathy

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Amrit S Lota

2014-01-01

Full Text Available A 66 year-old Asian man; with a complex history of ischaemic heart disease presented with cardiac and troponin negative chest pain. His ECG showed sinus bradycardia with old left bundle branch block. The transthoracic echocardiography showed severely impaired left ventricular systolic function (EF 30-35%. The patient had had coronary artery bypass grafting at age of 42 years and remained asymptomatic until age of 56 years when he presented with incessant ventricular tachycardia requiring amiodarone, lidocaine and electrical cardioversion. Coronary angiography at that time showed occluded vein grafts to the circumflex and diagonal arteries. The right coronary artery (RCA was small and received collaterals from the left system. A myocardial perfusion scan showed extensive inferolateral infarction but no evidence for reversible ischaemia. An implantable cardiac defibrillator (ICD was thus inserted. Over the following years, the patient underwent multiple PCI procedures with rotational atherectomy to the native LAD and associated vein graft, but subsequently developed in-stent restenosis. He also had PCI to the native RCA. He declined a minimally invasive grafting of the left internal mammary artery (LIMA to the LAD and re-implantation of a new ICD after ex-plantation of the original one due to sepsis. His coronary artery disease remained stable following a recent admission with Troponin positive event which was confirmed by a repeat angiogram, therefore, had up-titrated anti-anginal medications. A low dose beta-blockade was discontinued due to documented sinus pauses up to 3 seconds. Following the recent admission, a joint cardiology-cardiothoracic meeting discussion recommended a stress echocardiogram with highdose dobutamine to guide towards considering re-do bypass grafting.

Three-dimensional echocardiography

International Nuclear Information System (INIS)

Buck, Thomas

2011-01-01

Presents tips and tricks for beginners and experts Provides educational material for 3D training courses Features comprehensively illustrated cases Includes an accompanying DVD with video clips of all sample cases Three-dimensional echocardiography is the most recent fundamental advancement in echocardiography. Since real-time 3D echocardiography became commercially available in 2002, it has rapidly been accepted in echo labs worldwide. This book covers all clinically relevant aspects of this fascinating new technology, including a comprehensive explanation of its basic principles, practical aspects of clinical application, and detailed descriptions of specific uses in the broad spectrum of clinically important heart disease. The book was written by a group of well-recognized international experts in the field, who have not only been involved in the scientific and clinical evolution of 3D echocardiography since its inception but are also intensively involved in expert training courses. As a result, the clear focus of this book is on the practical application of 3D echocardiography in daily clinical routine with tips and tricks for both beginners and experts, accompanied by more than 150 case examples comprehensively illustrated in more than 800 images and more than 500 videos provided on a DVD. In addition to an in-depth review of the most recent literature on real-time 3D echocardiography, this book represents an invaluable reference work for beginners and expert users of 3D echocardiography. - Tips and tricks for beginners and experts - Educational material for 3D training courses - Comprehensively illustrated cases - DVD with video clips of all sample cases.

O papel do escravo em Aristóteles e Hegel

OpenAIRE

Nicuia, Eurico Jorge

2009-01-01

A presente dissertação tem por objetivo analisar o papel do escravo em Aristóteles e em Hegel, tendo presente os contextos histórico-filosóficos da escravidão no primeiro capítulo; bem como a abordagem filosófica da escravidão em Aristóteles e em Hegel no segundo capítulo; finalmente, debruçar-se-á sobre o papel do escravo nos dois filósofos, no terceiro capítulo onde destacamos os seguintes: i) doméstico, o único papel descrito por Aristóteles porque o escravo não participava de outras ativi...

Communication Framework for Tele-rehabilitation Systems with QoS Guarantee

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Dandanov Nikolay

2017-01-01

Full Text Available Nowadays, there is great interest in developing telemedicine technologies. These technologies will provide health care from distance swiftly and lightly, as well as reduce the expenses for activities, such as rehabilitation. Telemedicine applications are possible due to the advances in information technologies and the ever-expanding communication network infrastructure. The network characteristics bandwidth, packet loss, latency, jitter and policies are crucial for the performance of tele-rehabilitation systems. Because in tele-rehabilitation human lives are at stake, guaranteeing the Quality of Service (QoS is important. In this paper, an approach for assuring the QoS for information transmission in tele-rehabilitation systems is proposed.

Disseminating Health Disparities Education Through Tele-Learning

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LaSonya Knowles

2008-08-01

Full Text Available Twenty years of research demonstrate that there are wide disparities in health throughout America. Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist when specific population subgroups are compared. Health Disparities in America: Working Toward Social Justice is a course instructed every fall by Dr. Lovell Jones, director of The Center for Research on Minority Health (CRMH at UT M.D. Anderson Cancer Center. The CRMH has created a course that examines the social and societal factors that are fundamental in creating disparities in health. Students from 10 different academic programs and institutions participate in this course. The course is unique in the aspect that various, diverse speakers whom are experts in their field of study instruct each class. This health disparities course is conducted at one of three different academic institutions in the Houston area and broadcast via satellite to various academic institutions by means of teleeducation. Tele-education is defined as a mode of instruction utilizing different forms of media such as video, audio technology tools and computers. Video and audio technologies involve the transmission of interface between learners and instructors, either interactive or non-interactive. Tele-education technologies have an important role to play in addressing the dissemination of health disparities education. The purpose of this program is to determine the feasibility of tele-education as a mode of instruction to introduce the multi-disciplinary components of health disparities. Our findings suggest that tele-education is a useful tool in imparting health disparities education.

Tele-education as method of medical education.

Science.gov (United States)

Masic, Izet; Pandza, Haris; Kulasin, Igor; Masic, Zlatan; Valjevac, Salih

2009-01-01

Development of computer networks and introduction and application of new technologies in all aspects of human activity needs to be followed by universities in their transformation on how to approach scientific, research, and education teaching curricula. Development and increased use of distance learning (DL) over the past decade have clearly shown the potential and efficiency of information technology applied in education. Use of information technology in medical education is where medical informatics takes its place as important scientific discipline which ensures benefit from IT in teaching and learning process involved. Definition of telemedicine as "use of technologies based on health care delivered on distance" covers areas such as electronic health, tele-health (eHealth), telematics, but also tele-education. Web based medical education today is offered in different forms--from online lectures, online exams, web based continuous education programs, use of electronic libraries, online medical and scientific databases etc. Department of Medical Informatics of Medical Faculty of University of Sarajevo has taken many steps to introduce distance learning in medical curricula--from organising professional--scientific events (congresses, workshop etc), organizing first tele-exam at the faculty and among first at the university, to offering online lectures and online education material at the Department's website (www.unsa-medinfo.org). Distance learning in medical education, as well as telemedicine, significantly influence health care in general and are shaping the future model of medical practice. Basic computer and networks skills must be a part of all future medical curricula. The impact of technical equipment on patient-doctor relationship must be taken into account, and doctors have to be trained and prepared for diagnosing or consulting patients by use of IT. Telemedicine requires special approach in certain medical fields--tele-consultation, tele

Second opinion and discrepancy in the diagnosis of soft tissue lesions at surgical pathology

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Sharif Muhammad

2010-07-01

Full Text Available Objective: To determine the frequency and magnitude of discrepancies in the surgical pathological diagnosis of soft tissue lesions on review and second opinion in a histopathology center. Study Design: Cross-sectional, observational. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from April 2006 to May 2007. Materials and Methods: All the cases of soft tissue as well as bone lesions, irrespective of age and gender, which were referred for second opinion or review after being reported elsewhere, were included in the study. A panel of antibodies of soft tissue, epithelial and lymphoid markers was applied according to the requirements of each case. The cases were categorized as category A where there was concurrence between initial diagnosis and diagnosis at review. Category B included cases where there was disagreement in the specific diagnostic entity as per WHO classifications without therapeutic implications. Category C was cases where the category of benign or malignant diagnosis remained the same but there was disagreement in the specific diagnosis with definite therapeutic implications. Category D had diagnosis of benign changed to malignant while category E had cases where diagnosis of malignancy was changed to a benign lesion. Results: During the study period, 34 cases of soft tissue lesions were received for review and second opinion. The mean age of the patients was 39 ΁ 22 years and immunohistochemistry was performed in 21 (62% of 34 cases. Concurrence between the review and initial diagnosis was seen in 18 (53% cases (category A. Discrepancy in the diagnosis at review and initial consultation was seen in 16 (47% cases. There were four (11.8% cases that were placed in category B as the diagnosis of benign and malignant remained the same but the specific diagnostic entity was changed. Category C included eight (23.5% cases where the review diagnosis changed the therapeutic

Data retention in Europe - the Tele2 case and beyond

DEFF Research Database (Denmark)

Jakobsen, Søren Sandfeld; Udsen, Henrik; Pedersen, Anja Møller

2018-01-01

Analyses the Court of Justice of the European Union's judgment in the "Tele2 case" and evaluates the impact of the judgment on national data retention regimes.......Analyses the Court of Justice of the European Union's judgment in the "Tele2 case" and evaluates the impact of the judgment on national data retention regimes....

Nuclear tele medicine

International Nuclear Information System (INIS)

Vargas, L.; Hernandez, F.; Fernandez, R.

2005-01-01

The great majority of the digital images of nuclear medicine are susceptible of being sent through internet. This has allowed that the work in diagnosis cabinets by image it can benefit of this modern technology. We have presented in previous congresses works related with tele medicine, however, due to the speed in the evolution of the computer programs and the internet, becomes necessary to make a current position in this modality of work. (Author)

Baseline mitral regurgitation predicts outcome in patients referred for dobutamine stress echocardiography.

Science.gov (United States)

O'Driscoll, Jamie M; Gargallo-Fernandez, Paula; Araco, Marco; Perez-Lopez, Manuel; Sharma, Rajan

2017-11-01

A number of parameters recorded during dobutamine stress echocardiography (DSE) are associated with worse outcome. However, the relative importance of baseline mitral regurgitation (MR) is unknown. The aim of this study was to assess the prevalence and associated implications of functional MR with long-term mortality in a large cohort of patients referred for DSE. 6745 patients (mean age 64.9 ± 12.2 years) were studied. Demographic, baseline and peak DSE data were collected. All-cause mortality was retrospectively analyzed. DSE was successfully completed in all patients with no adverse outcomes. MR was present in 1019 (15.1%) patients. During a mean follow up of 5.1 ± 1.8 years, 1642 (24.3%) patients died and MR was significantly associated with increased all-cause mortality (p statistic models significantly improved discrimination. MR is associated with all-cause mortality and adds incremental prognostic information among patients referred for DSE. The presence of MR should be taken into account when evaluating the prognostic significance of DSE results.

Tele-asistencia y tele-alarma para adultos mayores: experiencias preliminares en Mexico

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Liliana Giraldo-Rodriguez

2013-08-01

Full Text Available OBJETIVO Analizar el efecto de un programa piloto de tele-asistencia y tele-alarma en la autopercepción del estado de salud de los adultos mayores y conocer la satisfacción y aceptación del programa. METODOS Estudio transversal que incluyó entrevistas a 378 adultos mayores, 294 cuidadores/familiares y 53 profesionales de la salud, realizado en la Ciudad de México en 2010. Variables sociodemográficas, de autopercepción del estado de salud, satisfacción y aceptación del programa se obtuvieron por medio de cuestionario estandarizado. Se realizó análisis descriptivo y se utilizaron pruebas no paramétricas. RESULTADOS Se observaron efectos significativos en la autopercepción del estado de salud, 6,17 (DE 17,9 p < 0,05 puntos por encima de la media. El programa tuvo una buena aceptación por parte de los adultos mayores, de sus cuidadores familiares y de los profesionales de la salud. CONCLUSIONES El programa contribuye a mantener o mejorar la calidad de vida, permite la atención preventiva y es un medio ideal para dar apoyo psicosocial a los adultos mayores.

Hemodynamic stress echocardiography in patients supported with a continuous-flow left ventricular assist device

DEFF Research Database (Denmark)

Andersen, Mads Jønsson; Gustafsson, Finn; Madsen, Per Lav

2010-01-01

exercise. Exercise induced an increase in cardiac output, systolic pulmonary artery pressure, and diastolic pulmonary artery pressure. Although no changes in left ventricular dimensions or fractional shortening were seen on echocardiography, systolic mitral annular motion (S') increased significantly (in...... parallel with cardiac output) and diastolic E/e' ratio decreased (correlating inversely with diastolic pulmonary artery pressure). These findings emphasize the potential role of exercise echocardiography in studying exercise hemodynamics in LVAD patients....

Design of a Matrix Transducer for Three-Dimensional Second Harmonic Transesophageal Echocardiography

Science.gov (United States)

Blaak, Sandra; van Neer, Paul L. M. J.; Prins, Christian; Bosch, Johan G.; Lancée, Charles T.; van der Steen, Antonius F. W.; de Jong, Nico

Three-dimensional (3D) echocardiography visualizes the 3D anatomy and function of the heart. For 3D imaging an ultrasound matrix of several thousands of elements is required. To connect the matrix to an external imaging system, smart signal processing with integrated circuitry in the tip of the TEE probe is required for channel reduction. To separate the low voltage integrated receive circuitry from the high voltages required for transmission, our design features a separate transmit and receive subarray. In this study we focus on the transmit subarray. A 3D model of an individual element was developed using the finite element method (FEM). The model was validated by laser interferometer and acoustic measurements. Measurement and simulations matched well. The maximum transmit transfer was 3 nm/V at 2.4 MHz for both the FEM simulation of an element in air and the laser interferometer measurement. The FEM simulation of an element in water resulted in a maximum transfer of 43 kPa/V at 2.3 MHz and the acoustic measurement in 55 kPa/V at 2.5 MHz. The maximum pressure is ~1 MPa/120Vpp, which is sufficient pressure for second harmonic imaging. The proposed design of the transmit subarray is suitable for its role in a 3D 2H TEE probe.

Construction Tele-Robotics System with AR Presentation

International Nuclear Information System (INIS)

Ootsubo, K; Kawamura, T; Yamada, H

2013-01-01

Tele-Robotics system using bilateral control is an effective tool for task in disaster scenes, and also in extreme environments. The conventional systems are equipped with a few color video cameras captures view of the task field, and their video images are sent to the operator via some network. Usually, the images are captured only from some fixed angles. So the operator cannot obtain intuitively 3D-sense of the task field. In our previous study, we proposed a construction tele-robotics system based on VR presentation. The operator intuits the geometrical states of the robot presented by CG, but the information of the surrounding environment is not included like a video image. So we thought that the task efficiency could be improved by appending the CG image to the video image. In this study, we developed a new presentation system based on augmented reality (AR). In this system, the CG image, which represents 3D geometric information for the task, is overlaid on the video image. In this study, we confirmed the effectiveness of the system experimentally. Additionally, we verified its usefulness to reduction of the communication delay associated with a tele-robotics system.

Application of an internet web-site of medical images in tele-radiology

International Nuclear Information System (INIS)

Wang Weizhong; Wang Hua; Xie Jingxia; Wang Songzhang; Li Xiangdong; Qian Min; Cao Huixia

2000-01-01

Objective: To build and Internet web-site of medical images for tele-education and tele-consultation. Methods: Collecting medical images of cases that fulfilled diagnostic standards for teaching and were pathologically proved. The images were digitized using digital camera and scanner. Frontpage 98, Homesite 2.5 and text editors were used for programming. Results: The web site encompasses many useful cases and was update every week. With smart and friendly interface, easy used navigation, the site runs reliably in TCP/IP environment. The site's URL is http://imager.163.net. At present, the site has received about 100 visits per week. Conclusion: The well-designed and programmed internet web site of medical images would be easily acceptable and is going to play an important role in tele-education and tele-consultation

Advanced echocardiography and clinical surrogates to risk stratify and manage patients with structural heart disease

NARCIS (Netherlands)

Debonnaire, Philippe Jean Marc Rita

2016-01-01

Part I focuses on the potential role of 3-dimensional echocardiography. At first a clinical risk score model for prediction of outcome in patients undergoing TAVI is presented (Chapter 2). Second the role of 3D-echocardiography is explored in depth in patients with mitral valve disease. Different

Immersive Virtual Reality with Applications to Tele-Operation and Training

Science.gov (United States)

2016-03-07

reviewed journals : Number of Papers published in non peer-reviewed journals : Final Report: Immersive Virtual Reality with Applications to Tele-Operation... Immersive Virtual Reality with Applications to Tele-Operation and Training The proposed project aims to develop a fundamental framework for...establishing an immersive virtual reality environment for robust and scalable human robotics interaction in a cooperative intelligent architecture at the

Effect of Nurse-Led Telephone Follow ups (Tele-Nursing) on Depression, Anxiety and Stress in Hemodialysis Patients.

Science.gov (United States)

Kargar Jahromi, Marzieh; Javadpour, Shohreh; Taheri, Leila; Poorgholami, Farzad

2015-07-26

Depressive and anxious patients on hemodialysis have a higher risk of death and hospitalizations. The aim of this study was to evaluate the effect of nurse-led telephone follow ups (tele-nursing) on depression, anxiety and stress in hemodialysis patients. The subjects of the study who were selected based on double blind randomized clinical trial consisted of 60 patients with advanced chronic renal disease treated with hemodialysis. The patients were placed in two groups of 30 individuals. Before the intervention, a questionnaire was completed by patients.  There was no telephone follow up in the control group and the patients received only routine care in the hospital. The participants allocated to the intervention group received telephone follow-up 30 days after dialysis shift, in addition to conventional treatment. Every session lasted 30 minutes, as possible. Then the DASS scale was filled out by the patients after completion of study by two groups. Significant differences were observed between the two groups in the posttest regarding the dimensions scores of DASS scale. The result of this trial is expected to provide new knowledge to support the effective follow-up for hemodialysis patient in order to improve their emotional and health status.

Comparison of Quantitative Wall Motion Analysis and Strain For Detection Of Coronary Stenosis With Three-Dimensional Dobutamine Stress Echocardiography

Science.gov (United States)

Parker, Katherine M.; Clark, Alexander P.; Goodman, Norman C.; Glover, David K.; Holmes, Jeffrey W.

2015-01-01

Background Quantitative analysis of wall motion from three-dimensional (3D) dobutamine stress echocardiography (DSE) could provide additional diagnostic information not available from qualitative analysis. In this study we compare the effectiveness of 3D fractional shortening (3DFS), a measure of wall motion computed from 3D echocardiography (3DE), to strain and strain rate measured with sonomicrometry for detecting critical stenoses during DSE. Methods Eleven open-chest dogs underwent DSE both with and without a critical stenosis. 3DFS was measured from 3DE images acquired at peak stress. 3DFS was normalized by subtracting average 3DFS during control peak stress (Δ3DFS). Strains in the perfusion defect (PD) were measured from sonomicrometry, and PD size and location were measured with microspheres. Results A Δ3DFS abnormality indicated the presence of a critical stenosis with high sensitivity and specificity (88% and 100%, respectively), and Δ3DFS abnormality size correlated with PD size (R2=0.54). The sensitivity and specificity for Δ3DFS was similar to that for area strain (88%, 100%) and circumferential strain and strain rate (88%, 92% and 88%, 86%, respectively), while longitudinal strain and strain rate were less specific. Δ3DFS correlated significantly with both coronary flow reserve (R2=0.71) and PD size (R2=0.97), while area strain correlated with PD size only (R2=0.67), and other measures were not significantly correlated with flow reserve or PD size. Conclusion Quantitative wall motion analysis using Δ3DFS is effective for detecting critical stenoses during DSE, performing similarly to 3D strain, and provides potentially useful information on the size and location of a perfusion defect. PMID:24815588

Working Alliance, Interpersonal Problems, and Depressive Symptoms in Tele-Interpersonal Psychotherapy for HIV-infected Rural Persons: Evidence for Indirect Effects.

Science.gov (United States)

Anderson, Timothy; McClintock, Andrew S; McCarrick, Shannon S; Heckman, Timothy G; Heckman, Bernadette D; Markowitz, John C; Sutton, Mark

2018-03-01

Interpersonal psychotherapy (IPT) has demonstrated efficacy for the treatment of depression, yet little is known about its therapeutic mechanisms. As a specific treatment, IPT has been shown to directly reduce depressive symptoms, although it is unclear whether these reductions occur via interpersonal changes. Within IPT, the potential role of the working alliance, a common factor, as a predictor of depression and interpersonal changes is also unclear. Participants were 147 depressed persons living with HIV in rural communities of 28 U.S. states enrolled in a randomized clinical trial. Seventy-five patients received up to 9 sessions of telephone-administered IPT (tele-IPT) plus standard care and 72 patients received standard care only. Two models were tested; one included treatment condition (tele-IPT vs. control) and another included the working alliance as independent variables. The first model found an indirect effect whereby tele-IPT reduced depression via decreased social avoidance. There was a direct effect between tele-IPT and reduced depression. In the second model, the working alliance influenced depressive symptom relief via reductions in social avoidance. Both goal and task working alliance subscales were indirectly associated with reductions in depressive symptoms, also through reductions in social avoidance. There were no direct effects involving the working alliance. Tele-IPT's influence on depressive symptom reduction was primarily through a direct effect, whereas the influence of working alliance depression was almost entirely via an indirect effect through interpersonal problems. Study findings have implications for IPT when intervening with depressed rural people living with HIV/AIDS over the telephone. © 2017 Wiley Periodicals, Inc.

Beating the blues after Cancer: randomised controlled trial of a tele-based psychological intervention for high distress patients and carers

Directory of Open Access Journals (Sweden)

Hutchison Sandy

2009-06-01

Full Text Available Abstract Background The diagnosis and treatment of cancer is a major life stress such that approximately 35% of patients experience persistent clinically significant distress and carers often experience even higher distress than patients. This paper presents the design of a two arm randomised controlled trial with patients and carers who have elevated psychological distress comparing minimal contact self management vs. an individualised tele-based cognitive behavioural intervention. Methods/design 140 patients and 140 carers per condition (560 participants in total will been recruited after being identified as high distress through caller screening at two community-based cancer helplines and randomised to 1 a single 30-minute telephone support and education session with a nurse counsellor with self management materials 2 a tele-based psychologist delivered five session individualised cognitive behavioural intervention. Session components will include stress reduction, problem-solving, cognitive challenging and enhancing relationship support and will be delivered weekly. Participants will be assessed at baseline and 3, 6 and 12 months after recruitment. Outcome measures include: anxiety and depression, cancer specific distress, unmet psychological supportive care needs, positive adjustment, overall Quality of life. Discussion The study will provide recommendations about the efficacy and potential economic value of minimal contact self management vs. tele-based psychologist delivered cognitive behavioural intervention to facilitate better psychosocial adjustment and mental health for people with cancer and their carers. Trial Registration ACTRN12609000301268.

Preventative tele-health supported services for early stage chronic obstructive pulmonary disease: a protocol for a pragmatic randomized controlled trial pilot

Directory of Open Access Journals (Sweden)

Mountain Gail A

2011-01-01

Full Text Available Abstract Background Chronic Obstructive Pulmonary Disease (COPD is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care. Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life. Methods/Design We describe a pilot study for a two arm, one site randomized controlled trial (RCT to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a Tele-health supported Community COPD Service; or (b Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service. Discussion The tele-health service under study is a

Effectiveness of Myocardial Contrast Echocardiography Quantitative Analysis during Adenosine Stress versus Visual Analysis before Percutaneous Therapy in Acute Coronary Pain: A Coronary Artery TIMI Grading Comparing Study

Science.gov (United States)

Yang, Lixia; Mu, Yuming; Quaglia, Luiz Augusto; Tang, Qi; Guan, Lina; Wang, Chunmei; Shih, Ming Chi

2012-01-01

The study aim was to compare two different stress echocardiography interpretation techniques based on the correlation with thrombosis in myocardial infarction (TIMI ) flow grading from acute coronary syndrome (ACS) patients. Forty-one patients with suspected ACS were studied before diagnostic coronary angiography with myocardial contrast echocardiography (MCE) at rest and at stress. The correlation of visual interpretation of MCE and TIMI flow grade was significant. The quantitative analysis (myocardial perfusion parameters: A, β, and A × β) and TIMI flow grade were significant. MCE visual interpretation and TIMI flow grade had a high degree of agreement, on diagnosing myocardial perfusion abnormality. If one considers TIMI flow grade <3 as abnormal, MCE visual interpretation at rest had 73.1% accuracy with 58.2% sensitivity and 84.2% specificity and at stress had 80.4% accuracy with 76.6% sensitivity and 83.3% specificity. The MCE quantitative analysis has better accuracy with 100% of agreement with different level of TIMI flow grading. MCE quantitative analysis at stress has showed a direct correlation with TIMI flow grade, more significant than the visual interpretation technique. Further studies could measure the clinical relevance of this more objective approach to managing acute coronary syndrome patient before percutaneous coronary intervention (PCI). PMID:22778555

Tele-Intervention: The Wave of the Future Fits Families' Lives Today

Science.gov (United States)

Behl, Diane D.; Houston, K. Todd; Guthrie, W. Spencer; Guthrie, Nancy K.

2010-01-01

This article provides information on providing early intervention services virtually using distance communication technologies. It describes "tele-intervention," a new method of providing services to children and their families, and how it is used in a family with a deaf child. Tele-intervention has proven to be a viable service delivery model for…

2010 Canadian Cardiovascular Society/Canadian Society of Echocardiography Guidelines for Training and Maintenance of Competency in Adult Echocardiography.

Science.gov (United States)

Burwash, Ian G; Basmadjian, Arsene; Bewick, David; Choy, Jonathan B; Cujec, Bibiana; Jassal, Davinder S; MacKenzie, Scott; Nair, Parvathy; Rudski, Lawrence G; Yu, Eric; Tam, James W

2011-01-01

Guidelines for the provision of echocardiography in Canada were jointly developed and published by the Canadian Cardiovascular Society and the Canadian Society of Echocardiography in 2005. Since their publication, recognition of the importance of echocardiography to patient care has increased, along with the use of focused, point-of-care echocardiography by physicians of diverse clinical backgrounds and variable training. New guidelines for physician training and maintenance of competence in adult echocardiography were required to ensure that physicians providing either focused, point-of-care echocardiography or comprehensive echocardiography are appropriately trained and proficient in their use of echocardiography. In addition, revision of the guidelines was required to address technological advances and the desire to standardize echocardiography training across the country to facilitate the national recognition of a physician's expertise in echocardiography. This paper summarizes the new Guidelines for Physician Training and Maintenance of Competency in Adult Echocardiography, which are considerably more comprehensive than earlier guidelines and address many important issues not previously covered. These guidelines provide a blueprint for physician training despite different clinical backgrounds and help standardize physician training and training programs across the country. Adherence to the guidelines will ensure that physicians providing echocardiography have acquired sufficient expertise required for their specific practice. The document will also provide a framework for other national societies to standardize their training programs in echocardiography and will provide a benchmark by which competency in adult echocardiography may be measured. Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Tele-Pediatric Intensive Care for Critically Ill Children in Syria.

Science.gov (United States)

Ghbeis, Muhammad Bakr; Steffen, Katherine M; Braunlin, Elizabeth A; Beilman, Gregory J; Dahman, Jay; Ostwani, Waseem; Steiner, Marie E

2017-12-12

Armed conflicts can result in humanitarian crises and have major impacts on civilians, of whom children represent a significant proportion. Usual pediatric medical care is often disrupted and trauma resulting from war-related injuries is often devastating. High pediatric mortality rates are thus experienced in these ravaged medical environments. Using simple communication technology to provide real-time management recommendations from highly trained pediatric personnel can provide substantive clinical support and have a significant impact on pediatric morbidity and mortality. We implemented a "Tele-Pediatric Intensive Care" program (Tele-PICU) to provide real-time management consultation for critically ill and injured pediatric patients in Syria with intensive care needs. Over the course of 7 months, 19 cases were evaluated, ranging in age from 1 day to 11 years. Consultation questions addressed a wide range of critical care needs. Five patients are known to have survived, three were transferred, five died, and six outcomes were unknown. Based on this limited undertaking with its positive impact on survival, further development of Tele-PICU-based efforts with attention to implementation and barriers identified through this program is desirable. Even limited Tele-PICU can provide timely and potentially lifesaving assistance to pediatric care providers. Future efforts are encouraged.

The practice of echocardiography

International Nuclear Information System (INIS)

Kraus, R.

1985-01-01

This volume is an anthology by noted authorities on all clinically useful aspects of echocardiography. Its articles cover such subjects as: historical perspectives, physics, instrumentation and techniques, M mode and 2D echocardiography

Three-dimensional echocardiography of normal and pathologic mitral valve: a comparison with two-dimensional transesophageal echocardiography

NARCIS (Netherlands)

Salustri, A.; Becker, A. E.; van Herwerden, L.; Vletter, W. B.; ten Cate, F. J.; Roelandt, J. R.

1996-01-01

This study was done to ascertain whether three-dimensional echocardiography can facilitate the diagnosis of mitral valve abnormalities. The value of the additional information provided by three-dimensional echocardiography compared with two-dimensional multiplane transesophageal echocardiography for

The history of echocardiography.

Science.gov (United States)

Edler, Inge; Lindström, Kjell

2004-12-01

Following a brief review of the development of medical ultrasonics from the mid-1930s to the mid-1950s, the collaboration between Edler and Hertz that began in Lund in 1953 is described. Using an industrial ultrasonic flaw detector, they obtained time-varying echoes transcutaneously from within the heart. The first clinical applications of M-mode echocardiography were concerned with the assessment of the mitral valve from the shapes of the corresponding waveforms. Subsequently, the various M-mode recordings were related to their anatomical origins. The method then became established as a diagnostic tool and was taken up by investigators outside Lund, initially in China, Germany, Japan and the USA and, subsequently, world-wide. The diffusion of echocardiography into clinical practice depended on the timely commercial availability of suitable equipment. The discovery of contrast echocardiography in the late 1960s further validated the technique and extended the range of applications. Two-dimensional echocardiography was first demonstrated in the late 1950s, with real-time mechanical systems and, in the early 1960s, with intracardiac probes. Transesophageal echocardiography followed, in the late 1960s. Stop-action two-dimensional echocardiography enjoyed a brief vogue in the early 1970s. It was, however, the demonstration by Bom in Rotterdam of real-time two-dimensional echocardiography using a linear transducer array that revolutionized and popularized the subject. Then, the phased array sector scanner, which had been demonstrated in the late 1960s by Somer in Utrecht, was applied to cardiac studies from the mid-1970s onwards. Satomura had demonstrated the use of the ultrasonic Doppler effect to detect tissue motion in Osaka in the mid-1950s and the technique was soon afterwards applied in the heart, often in combination with M-mode recording. The development of the pulsed Doppler method in the late 1960s opened up new opportunities for clinical innovation. The

Tele-operated service robots : ROSE

NARCIS (Netherlands)

Osch, van M.P.W.J.; Bera, D.; Hee, van K.M.; Koks, Y.; Zeegers, H.

2014-01-01

Service robots are robots that are intended to perform tasks normally done by humans in an environment in which humans work as well. However, they are neither required to accomplish these tasks in the same way as humans nor need to look like a human being. A tele-operated robot is controlled from a

Evaluation of 17-mm St. Jude Medical Regent prosthetic aortic heart valves by rest and dobutamine stress echocardiography

Directory of Open Access Journals (Sweden)

Minardi Giovanni

2006-09-01

Full Text Available Abstract Background The prosthesis used for aortic valve replacement in patients with small aortic root can be too small in relation to body size, thus showing high transvalvular gradients at rest and/or under stress conditions. This study was carried out to evaluate rest and Dobutamine stress echocardiography (DSE hemodynamic response of 17-mm St. Jude Medical Regent (SJMR-17 mm in relatively aged patients at mean 24 months follow-up. Methods and results The study population consisted of 19 patients (2 men, 17 women, mean age 69.2 ± 7.3 years. All patients underwent rest Doppler echocardiography before and after surgery and basal and DSE at follow up (infused at rate of 5 micrg/Kg/min and increased by 5 microg/Kg/min at 5 min intervals up to 40 microg/Kg/min. The following parameters were evaluated at rest and/or under DSE: heart rate (HR, ejection fraction (EF, cardiac output (CO, peak and mean velocity and pressure gradients (MxV, MnV, MxPG, MnPG, effective orifice area (EOA, indexed EOA (EOAi, left ventricular mass (LVM, indexed LVM (LVMi, Velocity Time Integral at left ventricular outflow tract (VTI LVOT and transvalvular (Aortic VTI, Doppler velocity index (DVI. At rest MxPG and MnPG were 29.2 ± 7.1 and 16.6 ± 5.8mmHg, respectively; EOA and EOAi resulted 1.14 ± 0.3 cm2 and 0.76 ± 0.2 cm2/m2; DVI was normal (0.50 ± 0.1. At follow-up LVM and LVMi decreased significantly from pre-operative value of 258 ± 43g and 157.4 ± 27.7g/m2 to 191 ± 23.8g and 114.5 ± 10.6g/m2, respectively. DSE increased significantly HR, CO, EF, MxGP (up to 83.4 ± 2 1.9mmHg, MnPG (up to 43.2 ± 12.7mmHg. EOA, EOAi, DVI increased insignificantly (from baseline up to 1.2 ± 0.4 cm2, 0.75 ± 0.3cm2/m2 and 0.48 ± 0.1 respectively. Two patients developed significant intraventricular gradients. Conclusion These data show that SJMR 17-mm prostheses can be safely implanted in aortic position in relatively aged patients, offering a satisfactory hemodynamic

Prediction of functional recovery in patients with myocardial infarction after revascularization. Comparison of low-dose dobutamine stress echocardiography with fluorine-18 fluorodeoxyglucose positron emission tomography

International Nuclear Information System (INIS)

Tani, Tomoko; Teragaki, Masakazu; Watanabe, Hiroyuki; Muro, Takashi; Yamagishi, Hiroyuki; Akioka, Kaname; Takeuchi, Kazuhide; Yoshikawa, Junichi

2001-01-01

The present study investigated the agreement between low-dose dobutamine stress echocardiography (LDDSE) and fluorine-18 fluorodeoxyglusose positron emission tomography (FDG-PET) and compared each technique's ability to detect myocardial viability and predict functional recovery in 30 patients. All patients underwent revascularization, followed by echocardiography 5±3 months. Of the 390 segments analyzed by echocardiography before revascularization, 110 (28%) had abnormal wall motion. LDDSE showed viability in 66 sites of the 110 dyssynergic segments and 58 of these viable segments recovered their wall motion. With FDG-PET, 78 of the 110 dyssynergic segments were diagnosed as viable and 62 of these showed improvement of the wall motion. The sensitivities for LDDSE and FDG-PET to assess functional recovery were 84% and 90%, respectively; specificities were 80% and 64%, respectively. Positive predictive values for LDDSE and FDG-PET were 88% and 79%; negative predictive values were 75% and 78%, respectively. Both methods had good sensitivity for detecting improvement in regional function after revascularization, but LDDSE had a higher specificity for detecting viability and a better positive predictive value for left ventricular functional recovery. (author)

A pilot trial of tele-ophthalmology for diagnosis of chronic blurred vision.

Science.gov (United States)

Tan, Johnson Choon Hwai; Poh, Eugenie Wei Ting; Srinivasan, Sanjay; Lim, Tock Han

2013-02-01

We evaluated the accuracy of tele-ophthalmology in diagnosing the major causes of chronic blurring of vision. Thirty consecutive patients attending a primary eye-care facility in Singapore (the Ang Mo Kio Polyclinic, AMKP) with the symptom of chronic blurred vision were recruited. An ophthalmic technician was trained to perform Snellen acuity; auto-refraction; intraocular pressure measurement; red-colour perimetry; video recordings of extraocular movement, cover tests and pupillary reactions; and anterior segment and fundus photography. Digital information was transmitted to a tertiary hospital in Singapore (the Tan Tock Seng Hospital) via a tele-ophthalmology system for teleconsultation with an ophthalmologist. The diagnoses were compared with face-to-face consultation by another ophthalmologist at the AMKP. A user experience questionnaire was administered at the end of the consultation. Using face-to-face consultation as the gold standard, tele-ophthalmology achieved 100% sensitivity and specificity in diagnosing media opacity (n = 29), maculopathy (n = 23) and keratopathy (n = 30) of any type; and 100% sensitivity and 92% specificity in diagnosing optic neuropathy of any type (n = 24). The majority of the patients (97%) were satisfied with the tele-ophthalmology workflow and consultation. The tele-ophthalmology system was able to detect causes of chronic blurred vision accurately. It has the potential to deliver high-accuracy diagnostic eye support to remote areas if suitably trained ophthalmic technicians are available.

Persepsi Masyarakat terhadap Hidroponik di Kelurahan Teling Bawah, Kota Manado

OpenAIRE

Sengkey, Mercy Y; Wangke, Welson M; Manginsela, Elsje P

2017-01-01

This study aimed to analyze and determine the public perception of hydroponic in the distict Teling Bawah Manado City. This aims was conducted over five months from November 2016 to the month of Maret 2017 from preparation to the arrangement of research reports. The location of research is in districts Teling Bawah Manado City. This research uses primary data and secondary data. Primary data was obtained from 30 respondents using questionnaires, while secondary data obtained from the office d...

Clinical utility and prognostic value of appropriateness criteria in stress echocardiography for the evaluation of valvular heart disease.

Science.gov (United States)

Bhattacharyya, Sanjeev; Kamperidis, Vasilis; Shah, Benoy Nalin; Roussin, Isabelle; Chahal, Navtej; Li, Wei; Khattar, Rajdeep; Senior, Roxy

2013-09-01

We examined the prognostic value of stress echocardiography appropriateness criteria for evaluation of valvular heart disease in 100 consecutive patients. Of the studies, 49%, 36%, and 15% were classified as appropriate, uncertain, and inappropriate, respectively. Over a median of 12.6 months, 24 events (12 deaths and 12 heart failure admissions) occurred. The 12-month event-free survival was significantly reduced in patients with appropriate or uncertain studies compared with patients with inappropriate studies (p = 0.04 and p = 0.005, respectively). There was no survival difference between patients with an appropriate or uncertain indication (p = 0.1). The only independent predictors of events were a positive stress echocardiogram (hazard ratio: 15.5, p valvular heart disease provide the ability to differentiate between patients at high- (appropriate group) and low- (inappropriate group) risk of cardiac events. Reclassification of the uncertain group may improve the differential value of these criteria. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

American Society of Echocardiography

Science.gov (United States)

American Society of Echocardiography Join Ase Renew Member Portal Log In Membership Member Portal Log In Join ASE Renew Benefits Rates FASE – Fellow of the American Society of Echocardiography Member Referral Program FAQs Initiatives Advocacy Awards, Grants, ...

Echocardiography Practice: Insights into Appropriate Clinical Use, Technical Competence and Quality Improvement Program

Science.gov (United States)

Kossaify, Antoine; Grollier, Gilles

2014-01-01

Echocardiography accounts for nearly half of all cardiac imaging techniques. It is a widely available and adaptable tool, as well as being a cost-effective and mainly a non-invasive test. In addition, echocardiography provides extensive clinical data, which is related to the presence or advent of different modalities (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, contrast echo, etc.), different approaches (transesophageal, intravascular, etc.), and different applications (ie, heart failure/resynchronization studies, ischemia/stress echo, etc.). In view of this, it is essential to conform to criteria of appropriate use and to keep standards of competence. In this study, we sought to review and discuss clinical practice of echocardiography in light of the criteria of appropriate clinical use, also we present an insight into echocardiographic technical competence and quality improvement project. PMID:24516342

Doppler echocardiography in pediatric cardiology

International Nuclear Information System (INIS)

Allen, H.D.; Marx, G.R.

1986-01-01

Congenital heart disease encompasses abnormalities in cardiac development which generally have in common either valve stenoses or connections between chambers or great vessels. Usually, abnormalities of intracardiac anatomy, and often, abnormalities of great vessel anatomy, can be unraveled by two-dimensional echocardiography. However, echocardiography offers little information regarding flow characteristics in the various congenital lesions. Addition of the Doppler principle, particularly when combined with the two-dimensional examination, can characterize the source of a flow disturbance, quantify gradients across a site of obstruction, and quantify flow volume across sites where flow is nonturbulent. These features make Doppler echocardiography unique for noninvasive accurate evaluation of children and adults with various forms of congenital heart disease. In this report, the authors discuss some of the present uses of Doppler echocardiography in congenital heart disease. Application of this technique requires greater understanding of certain physics principles than does routine echocardiography

WTP (willingness to pay) for tele-health consultation service in Hokkaido, Japan.

Science.gov (United States)

Ogasawara, Katsuhiko; Abe, Tamotsu

2013-01-01

We developed a tele-health consultation system that combines a sphygmomanometer with a tele-conference system. These were placed in pharmacies and the University. We selected five pharmacies to set up a consultation room; one in a local area, two in a suburban area, and the remaining two in an urban area. Nurses with more than 5 years of clinical experience were assigned as consultants. These consultants offer health consultation but do not practice medicine. Some researchers have indicated the economic viability of at-home health management systems, but nothing has been researched on the economic viability of tele-health consultation. The objective of present study was estimated Willingness to Payment (WTP) of Tele-health consultation service. The WTP was estimated by Double-Bounded Dichotomous-Choice model. We performed logistic-regression analysis to confirm factors to affect WTP. The number of the respondent was 480. Mean WTP was calculated 495 yen and the median was 367 yen. There was significant difference for factor of "annual income", "have a willingness to use this system", and "have a child/children".

Echocardiography-guided or "sided" pericardiocentesis.

Science.gov (United States)

Degirmencioglu, Aleks; Karakus, Gultekin; Güvenc, Tolga Sinan; Pinhan, Osman; Sipahi, Ilke; Akyol, Ahmet

2013-10-01

Echocardiography-guided pericardiocentesis is the first choice method for relieving cardiac tamponade, but the exact role of the echocardiography at the moment of the puncture is still controversial. In this report, detailed echocardiographic evaluation was performed in 21 consecutive patients with cardiac tamponade just before the pericardiocentesis. Appropriate needle position was determined according to the probe position using imaginary x, y, and z axes. Pericardiocentesis was performed successfully using this technique without simultaneous echocardiography and no complications were observed. We concluded that bedside echocardiography with detailed evaluation of the puncture site and angle is enough for pericardiocentesis instead of real time guiding. © 2013, Wiley Periodicals, Inc.

Co-operation and Haptic Assistance for Tele-manipulated Control over Two Asymmetric Slaves

NARCIS (Netherlands)

van Oosterhout, J.

2018-01-01

The success of future fusion power plants as a sustainable energy source greatly depends on their uptime. This uptime relies on the plant's maintenance, which must be performed via tele-manipulation. Tele-manipulated maintenance is challenging, as exemplified by strictly selected and highly trained

Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits.

Science.gov (United States)

Goedken, Cassie Cunningham; Moeckli, Jane; Cram, Peter M; Reisinger, Heather Schacht

2017-06-01

This study evaluates rural hospital staff perceptions of a telemedicine ICU (Tele-ICU) before and after implementation. We conducted a longitudinal qualitative study utilising semistructured group or individual interviews with staff from three rural ICU facilities in the upper Midwest of the United States that received Tele-ICU support. Interviews occurred pre-implementation and at two time points post-implementation. Interviews were conducted with: ICU administrators (n=6), physicians (n=3), nurses (n=9), respiratory therapists (n=5) and other (n=1) from July 2011 to May 2013. Transcripts were analysed for thematic content. Overall, rural ICU staff viewed Tele-ICU as a welcome benefit for their facility. Major themes included: (1) beneficial where recruitment and retention of staff can be challenging; (2) extra support for day shifts and evening, night and weekend shifts; (3) reduction in the number of transfers larger tertiary hospitals in the community; (4) improvement in standardisation of care; and (5) organisational culture of rural ICUs may lead to under-utilisation. ICU staff at rural facilities view Tele-ICU as a positive, useful tool to provide extra support and assistance. However, more research is needed regarding organisational culture to maximise the potential benefits of Tele-ICU in rural hospitals. Published by Elsevier Ltd.

Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

Science.gov (United States)

Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

2014-02-01

Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

Detection of hibernating myocardium in patients with myocardial infarction by low-dose dobutamine echocardiography. Comparison with thallium-201 scintigraphy with reinjection

International Nuclear Information System (INIS)

Takagi, Tsutomu; Yoshikawa, Junichi; Yoshida, Kiyoshi; Akasaka, Takashi; Honda, Yasuhiro; Yonezawa, Yoshihiro; Shakudo, Masahiro

1995-01-01

The identification of hibernating myocardium is important for selecting patients who will benefit from coronary revascularization. The relationship between echocardiographic and radioisotopic markers of hibernating myocardium and postrevascularization recovery of myocardial function was investigated in 21 patients who underwent successful revascularization. Each patient underwent low-dose dobutamine stress echocardiography and thallium-201 ( 201 Tl) scintigraphy with reinjection before revascularization. The presence of contractile reserve in dobutamine stress echocardiography and Tl uptake in 201 Tl scintigraphy with reinjection were defined as markers of hibernating myocardium. Follow-up echocardiograms were evaluated for improved regional wall motion in all patients at a mean of 8.6 months after revascularization. Sensitivity, specificity, and positive and negative predictive values of low-dose dobutamine stress echocardiography for indicating recovery of function after revascularization were 75.0%, 77.8%, 81.8%, and 70.0%, respectively. Sensitivity, specificity, and positive and negative predictive values of 201 Tl scintigraphy with reinjection for indicating recovery of function after revascularization were 91.7%, 55.6%, 73.3%, and 83.3%, respectively. There were no statistical differences between low-dose dobutamine echocardiography and 201 Tl scintigraphy in predicting postrevascularization recovery of function in patients with hibernating myocardium. (author)

Clinical applications of contrast echocardiography

International Nuclear Information System (INIS)

Jorge, Leon Galindo

2005-01-01

The echocardiography is the technique more used for the diagnosis and pursuit of the cardiovascular illnesses; therefore, their diagnostic precision has acquired a vital importance in the handling of the patients with cardiovascular pathologies. However, with relative frequency, the diagnostic capacity of the echocardiography exam is diminished by limitations of the acoustic window, mainly in-patient with obesity, lung illnesses and alterations of the thoracic wall. This can be obviated with the use of the intra-esophagus echocardiography, although this it is a procedure semi-invasive and not very practical of carrying out in all the patients with problems of acoustic window. In this article the clinical applications are revised more common of the contrast echocardiography

Tele2 kutsus kliendid teatrisse ja kontsertidele

Index Scriptorium Estoniae

2007-01-01

Suvel kutsus Tele 2 kliendid Victor Hugo loo "Jumalaema kiriku kellamees" muusikalisele vaatemängule Tartus (lavastajad Urmas Lennuk ja Andres Dvinjaninov), Muhu Tulevikumuusika festivalile "Juu Jääb" ja Tallinna Linnateatri suvelavastusele "Ronk" (lavastaja Elmo Nüganen)

How to develop a tele-ICU model?

Science.gov (United States)

Rogove, Herb

2012-01-01

The concept of the tele-ICU (intensive care unit) is about 30 years old and more hospitals are utilizing it to cover multiple hospitals in their system or for hospitals that lack on-site critical care coverage such as in the rural setting. Doing a needs analysis, picking the appropriate committee to oversee development of the correct model, choosing quality metrics to measure, and designing an implementation plan that has a timeline is how the process should begin. Research including visitation to established programs and connecting with professional societies are helpful. Developing both a business and financial plan will optimize the value of a tele-ICU program. The innovative ICU nursing director will help to integrate a telemedicine program seamlessly with the on-site program to insure a successful program that benefits patients, their families, the ICU staff, and the hospital.

Fetal echocardiography

International Nuclear Information System (INIS)

Chaubal, Nitin G.; Chaubal, Jyoti

2009-01-01

USG performed with a high-end machine, using a good cine-loop facility is extremely helpful in the diagnosis of fetal cardiac anomalies. In fetal echocardiography, the four-chamber view and the outflow-tract view are used to diagnose cardiac anomalies. The most important objective during a targeted anomaly scan is to identify those cases that need a dedicated fetal echocardiogram. Associated truncal and chromosomal anomalies need to be identified. This review shows how fetal echocardiography, apart from identifying structural defects in the fetal heart, can be used to look at rhythm abnormalities and other functional aspects of the fetal heart

The development of graphic simulation technology for tele-operated robot

International Nuclear Information System (INIS)

Kim, Chang Hoi; Kim, Seung Ho; Kim, Ki Ho; Jung, Seung Ho; Hwang, Suk Yeoung; Kim, Byung Soo; Seo, Yong Chil; Lee, Young Kwang

1998-02-01

In hostile environments like a nuclear power plant, human access is limited to the strict minimum due to the high-level of radiation. The design of tele-robotic system requires careful preparation because of the nature of its safety. Also, the human operator should have a capability of supervising the robot system and responding promptly to the unexpected events. In this study, the graphic simulation technology has been developed to construct tele-robotic system which can effectively perform the specified tasks in nuclear facilities. The developed graphic simulator utilizes the Indigo 2 workstation of Silicon Graphics as a main computer and its software is written in the OpenGL graphic library in X windows environments. The developed simulator, interfaced with the control system of the real robot through the ethernet, acts as a supervisory controller. Since clear and concise visual information on real robot posture and task environments can be processed in real time, the efficiency of tele-operation can be remarkably enhanced with this simulator. This simulator using advanced 3 dimensional graphics has many advantages of modeling complicated shapes of robot and constructing the virtual work environments similar to the real ones. With the use of this developed simulator, the operator can evaluate the performance of the tele-robot before it is put into real operation. This system can prevents the possible disaster of the robot resulting from the collision with its work environments. (author). 9 refs., 23 tabs., 13 figs

[Psychiatric expert opinions on asylum seekers in Germany].

Science.gov (United States)

Sieberer, Marcel; Ziegenbein, Marc; Eckhardt, Gudrun; Machleidt, Wielant; Calliess, Iris T

2011-01-01

To investigate the frequency of traumatisation, suicidality and given diagnoses in expert opinions on asylum seekers and to describe the sociodemographic characteristics of this population. The psychiatric expert opinions on asylum seekers, furnished in an 8-year-period at Hannover Medical School, were analysed retrospectively for qualitative and quantitative characteristics. 62 psychiatric expert opinions on asylum seekers were included in this study. The asylum seekers originated from 18 different countries, mainly from Turkey and former Yugoslavia. Most expert opinions were given in secondary asylum procedures, i. e. after the initial asylum request had been rejected. The asylum seekers reported on traumatisation in 82.3 %. The most frequently reported forms of traumatisation were rape in female, and torture in male persons. According to ICD-10 or DSM-IV-R criteria posttraumatic stress disorder (PTSD) was the most frequent diagnosis (74.1 %) in this study. The second most common diagnoses were depressive disorders (ICD-10: F32.x in 33.9 % and ICD-10: F33.x in 25.9 %). Suicidal tendency was found in 56.5 % of the asylum seekers. Cultural differences, language barriers, a heavy burden by psychological symptoms, and clinical severity are difficulties in the process of psychiatric assessment of refugees in legal asylum procedures. © Georg Thieme Verlag KG Stuttgart · New York.

Effect of gender on the prognostic value of dobutamine stress myocardial contrast echocardiography

Directory of Open Access Journals (Sweden)

Constantina Aggeli

2017-11-01

Full Text Available Background: Dobutamine stress contrast echo (DSCE has a well-established prognostic value in the context of coronary artery disease (CAD. However, data regarding its prognostic capability separately in men and women are scarce. The aim of the current study was to assess gender-related differences in the prognostic performance of DSCE. Methods: DSCE was performed in 2645 consecutive patients, who were classified into two groups depending on gender. Follow-up lasted 57.1±10.1 months. End points included all-cause mortality, cardiac death, late revascularization, and hospitalizations. Survival analysis was performed comparing men and women. Results: Of the 2645 patients (59.3±8.7 years, 69.1% were men. DSCE was positive in 23.4% of male patients, while in females, the respective percentage was 14.3%. There was statistically significant difference between the two groups with regard to end point occurrence (11.6% vs. 6.1%, p<0.05. Multivariate analysis revealed that the DSCE response was the strongest predictor of adverse outcomes (Exp(B=51.9, p<0.05 in both groups. The predictive model including DSCE results along with clinical data performed well without significant differences between males and females (C-index 0.93 vs. 0.87 respectively, p=NS. Conclusion: DSCE has a strong prognostic value for patients with known or suspected CAD, regardless of patient gender. This makes DSCE an attractive screening option for women in whom CAD assessment can be challenging. Keywords: stress echocardiography, women, gender, prognosis, coronary artery disease

A pilot study for the integration of cytometry reports in digital cytology telemedicine applications.

Science.gov (United States)

Giansanti, Daniele; Cerroni, Fabio; Amodeo, Rachele; Filoni, Marco; Giovagnoli, Maria Rosaria

2010-01-01

Up to date, tele-pathology in the three different forms of application, "dynamic", "static" and "virtual microscopy" has been mainly based on tele-hystology remote consulting. Today the diffusion of specialized WAN connections is guiding the research of new applications of tele-pathology. A specific analysis has been conducted, focused on digital cytology, in the biomedical laboratory of Sant'Andrea Hospital to investigate the technologies potentially useful to integrate in the LAN/WAN for telemedicine applications. Among the possible tools useful to be integrated in the LAN/WAN for telemedicine applications, the cytometry equipment available in the technical unity of cytometry has been considered important. The study finally provides a proposal for a tele-consulting architecture for the integration of cytometry reports both in the hospital LAN and the WAN for possible cooperative diagnosis and second opinion support.

A pilot study for the integration of cytometry reports in digital cytology telemedicine applications

Directory of Open Access Journals (Sweden)

Daniele Giansanti

2010-06-01

Full Text Available Up to date, tele-pathology in the three different forms of application, "dynamic", "static" and "virtual microscopy" has been mainly based on tele-hystology remote consulting. Today the diffusion of specialized WAN connections is guiding the research of new applications of tele-pathology. A specific analysis has been conducted, focused on digital cytology, in the biomedical laboratory of Sant'Andrea Hospital to investigate the technologies potentially useful to integrate in the LAN/WAN for telemedicine applications. Among the possible tools useful to be integrated in the LAN/WAN for telemedicine applications, the cytometry equipment available in the technical unity of cytometry has been considered important. The study finally provides a proposal for a tele-consulting architecture for the integration of cytometry reports both in the hospital LAN and the WAN for possible cooperative diagnosis and second opinion support.

Force-feedback tele operation of industrial robots a cost effective solution for decontamination of nuclear plants

International Nuclear Information System (INIS)

Desbats, P.; Andriot, C.; Gicquel, P.; Viallesoubranne, J.P.; Souche, C.

1998-01-01

Decontamination and maintenance in hot cells are some new emerging applications of industrial robots in the nuclear fuel cycle plants. Industrial robots are low cost, accurate and reliable manipulator arms which are used in manufacturing industries usually. Thanks to the recent evolution of robotics technologies, some industrial robots may be adapted to nuclear environment. These robots are transportable, sealed and can be decontaminated, and they may be 'hardened' up to a level of irradiation dose sufficient for operation in low and medium irradiating/contaminating environments. Although industrial robots are usually programmed to perform specific and repetitive tasks, they may be remotely tele-operated by human operators as well. This allows industrial robots to perform usual tele-manipulation tasks encountered in the nuclear plants and more. The paper presents the computer based tele-operation control system TAO2000 TM , developed by the Tele-operation and Robotics Service of CEA, which has been applied to the RX90 TM industrial robot from ST-UBLI company. This robot has been selected in order to perform various maintenance and decontamination tasks in COGEMA plants. TAO2000 provides the overall tele-robotic and robotic functions necessary to perform any remote tele-operation application in hostile environment: force-feedback master-slave control; computer- assisted tele-operation of mechanical processes; trajectory programming as well as various robotics functions; graphical modelling of working environment and simulation; automatic path planning with obstacle avoidance; man-machine interface for tasks programming and mission execution. Experimental results reported in the paper demonstrate the feasibility of force-feedback master-slave control of standard industrial robots. Finally, the design of new, cost effective. tele-operation systems based on industrial robots may be intended for nuclear plants maintenance. (author)

Nuclear cardiology between echocardiography and coronary angiography in the management of CAD

International Nuclear Information System (INIS)

Anger, K.

1996-01-01

In managing coronary artery disease there are clearly posed questions: In diagnosis to assess presence, extent and severity of CAD, in therapy to assess prognosis and benefit of PTCA and ACVB. Coronary angiography remains the gold standard for assessing coronary stenosis, function imaging - stress echocardiography - and myocardial perfusion imaging (MIP) are assessing ischemia, i.e. extent and severity of CAD meaning prognosis and benefit of invasive therapy. The costs of echo /MPI/ catherization are 1 : 2: 6. When the essential conditions in non invasive investigations are observed - exact indication, maximal quality, evaluation of efficacy D, M and O - equal acceptance of all methods by cardiologists is attainable and there will be a great potential of cost saving in invasive diagnostics and therapy. The part of MPI is assessed in evaluating myocardium viability and benefit of invasive therapy, in the diagnosis of ischemia and evaluation of outcome MPI eventually will be replaced by stress echocardiography in future. (orig.) [de

An open real-time tele-stethoscopy system

Directory of Open Access Journals (Sweden)

Foche-Perez Ignacio

2012-08-01

Full Text Available Abstract Background Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient’s body. Methods A real-time wireless stethoscopy system was designed. The initial requirements were: 1 The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2 It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3 Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, pleural friction rub sounds. Results The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to

An open real-time tele-stethoscopy system.

Science.gov (United States)

Foche-Perez, Ignacio; Ramirez-Payba, Rodolfo; Hirigoyen-Emparanza, German; Balducci-Gonzalez, Fernando; Simo-Reigadas, Francisco-Javier; Seoane-Pascual, Joaquin; Corral-Peñafiel, Jaime; Martinez-Fernandez, Andres

2012-08-23

Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient's body. A real-time wireless stethoscopy system was designed. The initial requirements were: 1) The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2) It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3) Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias) and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, pleural friction rub) sounds. The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to minimize manufacturing costs and look for alliances to

Experiences with tele-health follow-up in patients with rheumatoid arthritis: a qualitative interview study

DEFF Research Database (Denmark)

Raunsbæk Knudsen, Line; Thurah, Annette De; Lomborg, Kirsten

2017-01-01

the patients' different needs, wishes and abilities to take part in tele-health follow-up. Our findings reveal a need for more insight into how tele-health follow-up could be integrated in routine clinical practice, paying special attention to how reluctant patients may be supported.......: Adopting a strategy of interpretive description, we conducted individual, semi-structured interviews with 15 RA patients participating in a tele-health follow-up. Participants were selected purposively and consecutive from both genders and with various ages, disease durations and disease severity....... The analysis was inductive with a constant comparative approach. First, we identified the main themes conveying the participants' experiences. Then, we constructed patient typologies to explain different perspectives on the tele-health follow-up. RESULTS: Five themes covered the participants' experiences: 'A...

Bravocom süüdistab Tele2 ja EMT-d alatus konkurentsivõitluses / Kristiina Viiron

Index Scriptorium Estoniae

Viiron, Kristiina, 1971-

2007-01-01

Kallines Tele2 ja EMT võrgust Bravocomi mobiilinumbritele helistamise minutihind. Bravocomi juhatuse esimees Peep Põldsamm peab nii kalli hinna - 4.50 minut - kehtestamist konkurentsivõitluseks. Tabelid: Hinnavõrdlus. Lisa: Tele2 ja EMT kommentaarid

Guideline from Japanese Society of Echocardiography: 2018 focused update incorporated into Guidance for the Management and Maintenance of Echocardiography Equipment.

Science.gov (United States)

Daimon, Masao; Akaishi, Makoto; Asanuma, Toshihiko; Hashimoto, Shuji; Izumi, Chisato; Iwanaga, Shiro; Kawai, Hiroya; Toide, Hiroyuki; Hayashida, Akihiro; Yamada, Hirotsugu; Murata, Mitsushige; Hirano, Yutaka; Suzuki, Kengo; Nakatani, Satoshi

2018-03-01

Echocardiography plays a pivotal role as an imaging modality in the modern cardiology practice. Information derived from echocardiography is definitely helpful for a patient care. The Japanese Society of Echocardiography has promoted echocardiography for a routine clinical and research use. One of the missions of the Society is to provide information that is useful for high-quality examinations. To ensure it, we believe equipment in good conditions and a comfortable environment are important for both a patient and an examiner. Thus, the Committee for Guideline Writing, the Japanese Society of Echocardiography published brief guidance for the routine use of echocardiography equipment in 2015. Recently, the importance of international standardization has been emphasized in the medical laboratories. Accordingly, the committee has revised and updated our guidance for the routine use of echocardiography equipment.

Integrity mechanism for eHealth tele-monitoring system in smart home environment.

Science.gov (United States)

Mantas, Georgios; Lymberopoulos, Dimitrios; Komninos, Nikos

2009-01-01

During the past few years, a lot of effort has been invested in research and development of eHealth tele-monitoring systems that will provide many benefits for healthcare delivery from the healthcare provider to the patient's home. However, there is a plethora of security requirements in eHealth tele-monitoring systems. Data integrity of the transferred medical data is one of the most important security requirements that should be satisfied in these systems, since medical information is extremely sensitive information, and even sometimes life threatening information. In this paper, we present a data integrity mechanism for eHealth tele-monitoring system that operates in a smart home environment. Agent technology is applied to achieve data integrity with the use of cryptographic smart cards. Furthermore, the overall security infrastructure and its various components are described.

Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy

Energy Technology Data Exchange (ETDEWEB)

Hansen, Nienke L. [University Hospital RWTH Aachen, Department of Diagnostic and Interventional Radiology, Aachen (Germany); Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Koo, Brendan C.; Gallagher, Ferdia A. [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); Warren, Anne Y. [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital, Department of Pathology, Cambridge (United Kingdom); Doble, Andrew; Gnanapragasam, Vincent; Bratt, Ola; Kastner, Christof [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital, Department of Urology, Cambridge (United Kingdom); Barrett, Tristan [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); University of Cambridge School of Clinical Medicine, Department of Radiology, Box 218, Cambridge (United Kingdom)

2017-06-15

To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy. Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher's exact test. Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00. Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions. (orig.)

Arizona TeleMedicine Network: System Procurement Specifications.

Science.gov (United States)

Atlantic Research Corp., Alexandria, VA.

Providing general specifications and system descriptions for segments within the Arizona TeleMedicine Project (a telecommunication system designed to deliver health services to rurally isolated American Indians in Arizona), this document, when used with the appropriate route segment document, will completely describe the project's required…

75 FR 69470 - Tele Atlas North America, Inc., Currently Doing Business as Tom Tom Including Off-Site Workers...

Science.gov (United States)

2010-11-12

...,839B; TA-W-70,839C] Tele Atlas North America, Inc., Currently Doing Business as Tom Tom Including Off... Business as Tom Tom, Concord, MA; Tele Atlas North America, Inc. Currently Doing Business as Tom Tom, Detroit, MI; Tele Atlas North America, Inc. Currently Doing Business as Tom Tom, Redwood, CA; Amended...

Transesophageal echocardiography in NeoChord procedure

Directory of Open Access Journals (Sweden)

Pittarello Demetrio

2015-01-01

Full Text Available Background: Transapical off-pump mitral valve intervention with neochord implantation for degenerative mitral valve disease have been recently introduced in the surgical practice. The procedure is performed under 2D-3D transesophageal echocardiography guidance. Methods: The use of 3D real-time transesophageal echocardiography provides more accurate information than 2D echocardiography only in all the steps of the procedure. In particular 3D echocardiography is mandatory for preoperative assessment of the morphology of the valve, for correct positioning of the neochord on the diseased segment , for the final tensioning of the chordae and for the final evaluation of the surgical result. Result and Conclusion: This article is to outline the technical aspects of the transesophageal echocardiography guidance of the NeoChord procedure showing that the procedure can be performed only with a close and continuous interaction between the anesthesiologist and the cardiac surgeon.

Arizona TeleMedicine Network: Engineering Master Plan.

Science.gov (United States)

Atlantic Research Corp., Alexandria, VA.

As the planning document for establishing a statewide health communications system initially servicing the Papago, San Carlos and White Mountain Apache, Navajo, and Hopi reservations, this document prescribes the communications services to be provided by the Arizona TeleMedicine Network. Specifications include: (1) communications services for each…

TAO2000 V2 computer-assisted force feedback tele-manipulators used as maintenance and production tools at the AREVA NC-La Hague fuel recycling plant

International Nuclear Information System (INIS)

Geffard, Franck; Garrec, Philippe; Piolain, Gerard; Brudieu, Marie-Anne; Thro, Jean-Francois; Coudray, Alain; Lelann, Eric

2012-01-01

During a 15-year joint research program, French Atomic Energy Agency Interactive Robotics Laboratory (CEA LIST) and AREVA have developed several remote operation devices, also called tele-robots. Some of them are now commonly used for maintenance operations at the AREVA NC (Nuclear Cycle) La Hague reprocessing plant. Since the first maintenance operation in 2005, several other successful interventions have been realized using the industrial MA23/RX170 tele-manipulation system. Moreover, since 2010, the through-the-wall tele-robot named MT200 TAO based on the slave arm of the MSM MT200 (La Calhene TM ), has been evaluated in an active production cell at the AREVA NC La Hague fuel recycling plant. Although these evaluations are ongoing, the positive results obtained have led to an update and industrialization program. All these developments are based on the same generic control platform, called TAO2000 V2. TAO2000 V2 is the second release of the CEA LIST core software platform dedicated to computer aided force-feedback tele-operation (TAO is the French acronym for computer aided tele-operation). This paper presents all these developments resulting from the joint research program CEA LIST/AREVA. The TAO2000 V2 controller is first detailed, and then two maintenance operations using the industrial robot RX170 are presented: the removal of the nuclear fuel dissolver wheel rollers and the cleanup of the dissolver wheel inter-bucket spaces. Finally, the new MT200 TAO system and its evaluations at the AREVA NC La Hague facilities are discussed. (authors)

Nuclear tele medicine; Telemedicina nuclear

Energy Technology Data Exchange (ETDEWEB)

Vargas, L.; Hernandez, F.; Fernandez, R. [Departamento de Medicina Nuclear, Imagenologia Diagnostica, Xalapa, Veracruz (Mexico)

2005-07-01

The great majority of the digital images of nuclear medicine are susceptible of being sent through internet. This has allowed that the work in diagnosis cabinets by image it can benefit of this modern technology. We have presented in previous congresses works related with tele medicine, however, due to the speed in the evolution of the computer programs and the internet, becomes necessary to make a current position in this modality of work. (Author)

Australian national networked tele-test facility for integrated systems

Science.gov (United States)

Eshraghian, Kamran; Lachowicz, Stefan W.; Eshraghian, Sholeh

2001-11-01

The Australian Commonwealth government recently announced a grant of 4.75 million as part of a 13.5 million program to establish a world class networked IC tele-test facility in Australia. The facility will be based on a state-of-the-art semiconductor tester located at Edith Cowan University in Perth that will operate as a virtual centre spanning Australia. Satellite nodes will be located at the University of Western Australia, Griffith University, Macquarie University, Victoria University and the University of Adelaide. The facility will provide vital equipment to take Australia to the frontier of critically important and expanding fields in microelectronics research and development. The tele-test network will provide state of the art environment for the electronics and microelectronics research and the industry community around Australia to test and prototype Very Large Scale Integrated (VLSI) circuits and other System On a Chip (SOC) devices, prior to moving to the manufacturing stage. Such testing is absolutely essential to ensure that the device performs to specification. This paper presents the current context in which the testing facility is being established, the methodologies behind the integration of design and test strategies and the target shape of the tele-testing Facility.

Head-to-head comparison of dipyridamole, dobutamine and pacing stress echocardiography for the detection of myocardial ischemia in an animal model of coronary artery stenosis

Directory of Open Access Journals (Sweden)

A. Schmidt

2001-07-01

Full Text Available To compare the sensitivity of dipyridamole, dobutamine and pacing stress echocardiography for the detection of myocardial ischemia we produced a physiologically significant stenosis in the left circumflex artery of 14 open-chest dogs (range: 50 to 89% reduction in luminal diameter. In each study, dobutamine (5 to 40 µg kg-1 min-1 in 3-min stages and pacing (20 bpm increments, each 2 min, up to 260 bpm were performed randomly, and then followed by dipyridamole (up to 0.84 mg/kg over 10 min. The positivity of stress echocardiography tests was quantitatively determined by a significant (P<0.05 reduction of or failure to increase absolute and percent systolic wall thickening in the stenotic artery supplied wall, as compared to the opposite wall (areas related to the left anterior descending artery. Systolic and diastolic frozen images were analyzed off-line by two blinded observers in the control and stress conditions. The results showed that 1 the sensitivity of dobutamine, dipyridamole and pacing stress tests was 57, 57 and 36%, respectively; 2 in animals with positive tests, the mean percent change of wall thickening in left ventricular ischemic segments was larger in the pacing (-19 ± 11% and dipyridamole (-18 ± 16% tests as compared to dobutamine (-9 ± 6% (P = 0.05, but a similar mean reduction of wall thickening was observed when this variable was normalized to a control left ventricular segment (area related to the left anterior descending artery (pacing: -16 ± 7%; dipyridamole: -25 ± 16%; dobutamine: -26 ± 10%; not significant, and 3 a significant correlation was observed between magnitude of coronary stenosis and left ventricular segmental dysfunction induced by ischemia in dogs submitted to positive stress tests. We conclude that the dobutamine and dipyridamole stress tests showed identical sensitivities for the detection of myocardial ischemia in this one-vessel disease animal model with a wide range of left circumflex artery

Value of dobutamine stress tissue Doppler in evaluation of LV ...

African Journals Online (AJOL)

Shaimaa Ahmed Mostafa

2014-12-12

Dec 12, 2014 ... Prediction of functional recovery, based on the detection of contractile reserve with dobutamine stress echocardiography. (DSE), includes myocardial perfusion imaging, metabolic imaging with conventional scintigraphy and positron emission tomography (PET).12. Dobutamine stress echocardiography is ...

Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery.

Science.gov (United States)

Balicki, Marcin; Xia, Tian; Jung, Min Yang; Deguet, Anton; Vagvolgyi, Balazs; Kazanzides, Peter; Taylor, Russell

2011-06-01

This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information.

TeleMed: Wide-area, secure, collaborative object computing with Java and CORBA for healthcare

Energy Technology Data Exchange (ETDEWEB)

Forslund, D.W.; George, J.E.; Gavrilov, E.M.

1998-12-31

Distributed computing is becoming commonplace in a variety of industries with healthcare being a particularly important one for society. The authors describe the development and deployment of TeleMed in a few healthcare domains. TeleMed is a 100% Java distributed application build on CORBA and OMG standards enabling the collaboration on the treatment of chronically ill patients in a secure manner over the Internet. These standards enable other systems to work interoperably with TeleMed and provide transparent access to high performance distributed computing to the healthcare domain. The goal of wide scale integration of electronic medical records is a grand-challenge scale problem of global proportions with far-reaching social benefits.

TeleFood: a worldwide appeal.

Science.gov (United States)

1997-12-01

In 1997, the UN Food and Agriculture Organization (FAO) broadcast its first global television program on the theme of "Food for All" to an audience of approximately 450 million viewers. The objective of "TeleFood" was to raise awareness of the scale of the problem and to encourage solidarity in the fight against hunger. TeleFood raised funds to support the FAO's Special Programme for Food Security (SPFS) and similar grassroots projects that target rural people in developing countries. The SPFS project, now operational in 19 countries and being formulated in 32 more, emphasizes national ownership, farmer participation, environmental awareness, and recognition of the role of women in food production and marketing. The 3-year SPFS pilot phase involves 1) small-scale water harvesting, irrigation, and drainage; 2) sustainable intensification of crop production; 3) diversification of production; and 4) removal of policies that impede food security. Results to date include 1) greatly increased maize and potato yields in Bolivia and more modest increases in Nepal; 2) doubled yields of maize and rice in Tanzania; and 3) expansion of the area under low-cost irrigation in Zambia. South-South cooperation is allowing some developing countries to benefit from experience gained in other developing countries. The pilot activities are being funded with an increasing number of "soft" loans from governments and financial institutions.

Tele-Interpersonal Psychotherapy Acutely Reduces Depressive Symptoms in Depressed HIV-Infected Rural Persons: A Randomized Clinical Trial.

Science.gov (United States)

Heckman, Timothy G; Heckman, Bernadette D; Anderson, Timothy; Lovejoy, Travis I; Markowitz, John C; Shen, Ye; Sutton, Mark

2017-01-01

Human immunodeficiency virus (HIV)-positive rural individuals carry a 1.3-times greater risk of a depressive diagnosis than their urban counterparts. This randomized clinical trial tested whether telephone-administered interpersonal psychotherapy (tele-IPT) acutely relieved depressive symptoms in 132 HIV-infected rural persons from 28 states diagnosed with Diagnostic and Statistical Manual of Mental Disorders-IV major depressive disorder (MDD), partially remitted MDD, or dysthymic disorder. Patients were randomized to either 9 sessions of one-on-one tele-IPT (n = 70) or standard care (SC; n = 62). A series of intent-to-treat (ITT), therapy completer, and sensitivity analyses assessed changes in depressive symptoms, interpersonal problems, and social support from pre- to postintervention. Across all analyses, tele-IPT patients reported significantly lower depressive symptoms and interpersonal problems than SC controls; 22% of tele-IPT patients were categorized as a priori "responders" who reported 50% or higher reductions in depressive symptoms compared to only 4% of SC controls in ITT analyses. Brief tele-IPT acutely decreased depressive symptoms and interpersonal problems in depressed rural people living with HIV.

A user interface for mobile robotized tele-echography

Energy Technology Data Exchange (ETDEWEB)

Triantafyllidis, G.A. [Informatics and Telematics Institute ITI-CERTH, Thessaloniki (Greece)]. E-mail: gatrian@iti.gr; Thomos, N. [Informatics and Telematics Institute ITI-CERTH, Thessaloniki (Greece); Canero, C. [Computer Vision Center, UAB, Barcelona (Spain); Vieyres, P. [Laboratoire Vision and Robotique Universite d' Orleans, Bourges (France); Strintzis, M.G. [Informatics and Telematics Institute ITI-CERTH, Thessaloniki (Greece)

2006-12-20

Ultrasound imaging allows the evaluation of the degree of emergency of a patient. However, in many situations no experienced sonographer is available to perform such echography. To cope with this issue, the OTELO project 'mObile Tele-Echography using an ultra-Light rObot' (OTELO) aims to develop a fully integrated end-to-end mobile tele-echography system using an ultralight, remotely controlled six degree-of-freedom (DOF) robot. In this context, this paper deals with the user interface environment of the OTELO system, composed by the following parts: an ultrasound video transmission system providing real-time images of the scanned area at each moment, an audio/video conference to communicate with the paramedical assistant and the patient, and finally a virtual reality environment, providing visual and haptic feedback to the expert, while capturing the expert's hand movements with a one-DOF hand free input device.

A user interface for mobile robotized tele-echography

International Nuclear Information System (INIS)

Triantafyllidis, G.A.; Thomos, N.; Canero, C.; Vieyres, P.; Strintzis, M.G.

2006-01-01

Ultrasound imaging allows the evaluation of the degree of emergency of a patient. However, in many situations no experienced sonographer is available to perform such echography. To cope with this issue, the OTELO project 'mObile Tele-Echography using an ultra-Light rObot' (OTELO) aims to develop a fully integrated end-to-end mobile tele-echography system using an ultralight, remotely controlled six degree-of-freedom (DOF) robot. In this context, this paper deals with the user interface environment of the OTELO system, composed by the following parts: an ultrasound video transmission system providing real-time images of the scanned area at each moment, an audio/video conference to communicate with the paramedical assistant and the patient, and finally a virtual reality environment, providing visual and haptic feedback to the expert, while capturing the expert's hand movements with a one-DOF hand free input device

Agreement of left ventricular ejection fraction and volumes between adenosine stress TL-201 gated SPECT and echocardiography

Energy Technology Data Exchange (ETDEWEB)

Pai, M. S. [College of Medicine, Univ. of Ewha, Seoul (Korea, Republic of); Moon, D. H.; Kim, H. M.; Yang, Y. J.; Kang, D. H. [Asan Medical Center, Seoul (Korea, Republic of)

2003-07-01

Electrocardiogram-gated TI-201 SPECT measurements of left ventricular ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) have shown high correlation with conventional methods. However, how much these parameters measured by TI-201 gated SPECT differ from those by echocardiography has not been assessed. Adenosine stress (Ad-G) and redistribution TI-201 gated SPECT (Re-G) and resting echocardiography were conducted in 337 patients (184 male, 153 female). EDV, ESV and LVEF measured by QGS software were compared with the results by echocardiography. Patients with arrhythmia (atrial fibrillation or frequent premature contractions) or evidence of fixed or reversible perfusion defects on TI-201 SPECT were excluded. EF, EDV and ESV measured by Ad-G (63.3{+-}9.8,73.8{+-}30.2,29.1{+-}20.1) and Re-G (65.2{+-}11.6,69.1{+-}30.1,26.5{+-}20.3) correlated well with those by Echo (61.4{+-}7.9,78.3{+-}2.7, 30.7{+-} 17.5 ; r of Ad-G=0.547, 0.850, 0.827, p<0.001 ; r of Re-G=0.585, 0.838, 0.819, p<0.001). However the difference (mean, SD, SEE of Echo - gated SPECT) was statistically significant (EF: Ad-G=1.71, 8.92, 0.48, Re-G=3.59, 10.39, 0.56, p<0.001 ; EDV: Ad-G=4.75, 16.21, 0.88, Re-G=9.53, 16.77, 0.91, p<0.001 ; ESV: Ad-G=1.75, 11.35, 0.61, p<0.05, Re-G=4.29, 11.7, 0.63, p<0.001). Bland-Altman plots showed that the difference of EDV and ESV did not vary in any systematic way over the range of measurement, whereas the difference of EF increased with increasing average EF by Echo and gated-SPECT. The difference of EF, EDV, and ESV between Ad-G and Echo was significantly smaller than those between Re-G and Echo (p<0.001). Gated TI-201 SPECT underestimates EDV and ESV over a wide range of volume. As a result, EF by gated TI-201 SPECT is overestimated especially in patients with small LV volume. Ad-G is preferable to Re-G in assessing left ventricular ejection fraction and volume in place of Echo because of smaller bias.

Student tutors for hands-on training in focused emergency echocardiography – a randomized controlled trial

Directory of Open Access Journals (Sweden)

Kühl Matthias

2012-10-01

Full Text Available Abstract Background Focused emergency echocardiography performed by non-cardiologists has been shown to be feasible and effective in emergency situations. During resuscitation a short focused emergency echocardiography has been shown to narrow down potential differential diagnoses and to improve patient survival. Quite a large proportion of physicians are eligible to learn focused emergency echocardiography. Training in focused emergency echocardiography usually comprises a lecture, hands-on trainings in very small groups, and a practice phase. There is a shortage of experienced echocardiographers who can supervise the second step, the hands-on training. We thus investigated whether student tutors can perform the hands-on training for focused emergency echocardiography. Methods A total of 30 volunteer 4th and 5th year students were randomly assigned to a twelve-hour basic echocardiography course comprising a lecture followed by a hands-on training in small groups taught either by an expert cardiographer (EC or by a student tutor (ST. Using a pre-post-design, the students were evaluated by an OSCE. The students had to generate two still frames with the apical five-chamber view and the parasternal long axis in five minutes and to correctly mark twelve anatomical cardiac structures. Two blinded expert cardiographers rated the students’ performance using a standardized checklist. Students could achieve a maximum of 25 points. Results Both groups showed significant improvement after the training (p Conclusions Hands-on training by student tutors led to a significant gain in echocardiography skills, although inferior to teaching by an expert cardiographer.

Advanced Tele-operation

International Nuclear Information System (INIS)

Decreton, M.

1998-01-01

Maintenance, repair, and dismantling operations in nuclear facilities have to be performed remotely when high radiation doses exclude hands-on operation, but also to minimize contamination risks and occupational doses to the operators. Computer-aided and sensor-based tele-operation enhances safety, reliability, and performance by helping the operator in difficult tasks with poor remote environmental perception. The objectives of work in this domain are to increase the scientific knowledge of the studied phenomena, to improve the interpretation of data, to improve the piloting og experimental devices during irradiation, to reveal and to understand possible unexpected phenomena occurring during irradiation. This scientific report describes the achievements for 1997 in the area of radiation tolerance for of remote-sensing, optical fibres and optical fibre sensors

Fetal Echocardiography/Your Unborn Baby's Heart

Science.gov (United States)

... Artery Disease Venous Thromboembolism Aortic Aneurysm More Fetal Echocardiography / Your Unborn Baby's Heart Updated:Oct 6,2016 ... Your Risk • Symptoms & Diagnosis Introduction Common Tests Fetal Echocardiography/Your Unborn Baby's Heart - Fetal Echocardiogram Test - Detection ...

Meta-Analysis of Stress Myocardial Perfusion Imaging

Science.gov (United States)

2017-06-06

Coronary Disease; Echocardiography; Fractional Flow Reserve, Myocardial; Hemodynamics; Humans; Magnetic Resonance Imaging; Myocardial Perfusion Imaging; Perfusion; Predictive Value of Tests; Single Photon Emission Computed Tomography; Positron Emission Tomography; Multidetector Computed Tomography; Echocardiography, Stress; Coronary Angiography

TelePresence in Rural Medical Education: A Mixed Methods Evaluation

Directory of Open Access Journals (Sweden)

Katherine Gray

2014-01-01

Full Text Available In response to rural health workforce shortages, universities and training providers offer rural and remote clinical placements. This has led to development of educational methods to counter the barriers of distance. In this emerging field, recent improvements in technology have provided solutions including the use of sophisticated videoconferencing systems such as the Cisco TelePresence model CTS-500. This paper evaluates the use of TelePresence in diverse medical education activities using a mixed methods design—questionnaires n=60, individual interviews n=33, and observed practice of activities n=22. TelePresence was found to be beneficial to learning and teaching and superior to other systems participants had used. In particular, the audiovisual quality, resulting intimacy, convenience, and ease of use facilitated teaching and learning, while the fixed camera and poorly arranged physical environment were found to be limitations. The system is best suited for small group activities. Clinical skills-based activities are viable. It is recommended that technical support be available during setup and use and a picture-in-picture mode be included and improved integration of office suite software to provide a joint workspace for display of presentations, images, editing or annotation of documents, and file sharing.

The TeleTOP initiative: new learning, new technology

NARCIS (Netherlands)

Collis, Betty

2002-01-01

In response to the challenge to make learning more flexible while at the same time maintaining the positive qualities of classroom and campus-based settings, the TeleTOP Initiative at the University of Twente has grown from a faculty initiative to an internationally recognised Web-based learning

Home-based tele-assisted robotic rehabilitation of joint impairments in children with cerebral palsy.

Science.gov (United States)

Chen, Kai; Ren, Yupeng; Gaebler-Spira, Deborah; Zhang, Li-Qun

2014-01-01

A portable rehabilitation robot incorporating intelligent stretching, robot-guided voluntary movement training with motivating games and tele-rehabilitation was developed to provide convenient and cost-effective rehabilitation to children with cerebral palsy (CP) and extend rehabilitation care beyond hospital. Clinicians interact with the patients remotely for periodic evaluations and updated guidance. The tele-assisted stretching and active movement training was done over 6-week 18 sessions on the impaired ankle of 23 children with CP in their home setting. Treatment effectiveness was evaluated using biomechanical measures and clinical outcome measures. After the tele-assisted home robotic rehabilitation intervention, there were significant increases in the ankle passive and active range of motion, muscle strength, a decrease in spasticity, and increases in balance and selective control assessment of lower-extremity.

The safety and clinical usefulness of dobutamine stress echocardiography among octogenarians.

Science.gov (United States)

O'Driscoll, Jamie M; Marciniak, Anna; Ray, Kausik K; Schmid, Katharina; Smith, Robert; Sharma, Rajan

2014-07-01

Increasing numbers of octogenarians are being referred for investigation of chest pain. While dobutamine stress echocardiography (DSE) has been shown to be useful in younger patients, its role among octogenarians remains unclear. This investigation aimed to investigate the safety and prognostic benefits of DSE on cardiac events and total mortality in octogenarians. 550 consecutive patients aged ≥80 years underwent DSE for suspected cardiac chest pain. All subjects were followed-up prospectively until March 2011, and the study end-points were a major cardiac event and total mortality. One hundred and eighty-three (33%) patients had a positive DSE result, 271 (49%) had a normal study, and 164 (30%) had fixed-wall motion abnormalities. During a mean follow-up of 2.14±1.13 years, there were 217 (39%) cardiac events and 63 (11%) deaths, of which 46 (73%) were cardiac. The absolute risk of cardiac events increased with burden of ischaemia on DSE, from 13%/year (none), to 26%/year (1-3 ischaemic (LV) segments), and 38%/year (>3 ischaemic LV segments), p3 ischaemic LV segments were 1.34 (95% CI 1.13 to 1.29) and 1.86 (95% CI 1.16 to 2.98), respectively. Addition of echocardiographic parameters to basic models improved the C statistic from 0.77 to 0.89 (p<0.001). Among octogenarians referred with suspected cardiac chest pain, DSE is safe and, importantly, identifies a subset at high risk of cardiac events. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Non-consensus Opinion Models on Complex Networks

Science.gov (United States)

Li, Qian; Braunstein, Lidia A.; Wang, Huijuan; Shao, Jia; Stanley, H. Eugene; Havlin, Shlomo

2013-04-01

Social dynamic opinion models have been widely studied to understand how interactions among individuals cause opinions to evolve. Most opinion models that utilize spin interaction models usually produce a consensus steady state in which only one opinion exists. Because in reality different opinions usually coexist, we focus on non-consensus opinion models in which above a certain threshold two opinions coexist in a stable relationship. We revisit and extend the non-consensus opinion (NCO) model introduced by Shao et al. (Phys. Rev. Lett. 103:01870, 2009). The NCO model in random networks displays a second order phase transition that belongs to regular mean field percolation and is characterized by the appearance (above a certain threshold) of a large spanning cluster of the minority opinion. We generalize the NCO model by adding a weight factor W to each individual's original opinion when determining their future opinion (NCO W model). We find that as W increases the minority opinion holders tend to form stable clusters with a smaller initial minority fraction than in the NCO model. We also revisit another non-consensus opinion model based on the NCO model, the inflexible contrarian opinion (ICO) model (Li et al. in Phys. Rev. E 84:066101, 2011), which introduces inflexible contrarians to model the competition between two opinions in a steady state. Inflexible contrarians are individuals that never change their original opinion but may influence the opinions of others. To place the inflexible contrarians in the ICO model we use two different strategies, random placement and one in which high-degree nodes are targeted. The inflexible contrarians effectively decrease the size of the largest rival-opinion cluster in both strategies, but the effect is more pronounced under the targeted method. All of the above models have previously been explored in terms of a single network, but human communities are usually interconnected, not isolated. Because opinions propagate not

The Evolutionary Development of Echocardiography

Science.gov (United States)

Maleki, Majid; Esmaeilzadeh, Maryam

2012-01-01

Echocardiography is a non-invasive diagnostic technique which provides information on cardiac morphology, function, and hemodynamics. It is the most frequently used cardiovascular diagnostic test only after electrocardiography. In less than five decades, the evolution in this technique has made it the basic part of cardiovascular medicine. Herein, the evolution of various forms of echocardiography is briefly described. PMID:23390327

Virtual TeleRehab: a case study.

Science.gov (United States)

Pareto, Lena; Johansson, Britt; Zeller, Sally; Sunnerhagen, Katharina S; Rydmark, Martin; Broeren, Jurgen

2011-01-01

We examined the efficacy of a remotely based occupational therapy intervention. A 40-year-old woman who suffered a stroke participated in a telerehabilitation program. The intervention method is based on virtual reality gaming to enhance the training experience and to facilitate the relearning processes. The results indicate that Virtual TeleRehab is an effective method for motivational, economical, and practical reasons by combining game-based rehabilitation in the home with weekly distance meetings.

Second-Line Hormonal Therapy for Men With Chemotherapy-Naïve, Castration-Resistant Prostate Cancer: American Society of Clinical Oncology Provisional Clinical Opinion.

Science.gov (United States)

Virgo, Katherine S; Basch, Ethan; Loblaw, D Andrew; Oliver, Thomas K; Rumble, R Bryan; Carducci, Michael A; Nordquist, Luke; Taplin, Mary-Ellen; Winquist, Eric; Singer, Eric A

2017-06-10

Purpose ASCO provisional clinical opinions (PCOs) offer direction to the ASCO membership after publication or presentation of potential practice-changing data. This PCO addresses second-line hormonal therapy for chemotherapy-naïve men with castration-resistant prostate cancer (CRPC) who range from being asymptomatic with only biochemical evidence of CRPC to having documented metastases but minimal symptoms. Clinical Context The treatment goal for CRPC is palliation. Despite resistance to initial androgen deprivation therapy, most men respond to second-line hormonal therapies. However, guidelines have neither addressed second-line hormonal therapy for nonmetastatic CRPC nor provided specific guidance with regard to the chemotherapy-naïve population. Recent Data Six phase III randomized controlled trials and expert consensus opinion inform this PCO. Provisional Clinical Opinion For men with CRPC, a castrate state should be maintained indefinitely. Second-line hormonal therapy (eg, antiandrogens, CYP17 inhibitors) may be considered in patients with nonmetastatic CRPC at high risk for metastatic disease (rapid prostate-specific antigen doubling time or velocity) but otherwise is not suggested. In patients with radiographic evidence of metastases and minimal symptoms, enzalutamide or abiraterone plus prednisone should be offered after discussion with patients about potential harms, benefits, costs, and patient preferences. Radium-223 and sipuleucel-T also are options. No evidence provides guidance about the optimal order of hormonal therapies for CRPC beyond second-line treatment. Prostate-specific antigen testing every 4 to 6 months is reasonable for men without metastases. Routine radiographic restaging generally is not suggested but can be considered for patients at risk for metastases or who exhibit symptoms or other evidence of progression. Additional information is available at www.asco.org/genitourinary-cancer-guidelines and www.asco.org/guidelineswiki .

Quantification of informed opinion

International Nuclear Information System (INIS)

Rasmuson, D.M.

1985-01-01

The objective of this session, Quantification of Informed Opinion, is to provide the statistician with a better understanding of this important area. The NRC uses informed opinion, sometimes called engineering judgment or subjective judgment, in many areas. Sometimes informed opinion is the only source of information that exists, especially in phenomenological areas, such as steam explosions, where experiments are costly and phenomena are very difficult to measure. There are many degrees of informed opinion. These vary from the weatherman who makes predictions concerning relatively high probability events with a large data base to the phenomenological expert who must use his intuition tempered with basic knowledge and little or no measured data to predict the behavior of events with a low probability of occurrence. The first paper in this session provides the reader with an overview of the subject area. The second paper provides some aspects that must be considered in the collection of informed opinion to improve the quality of the information. The final paper contains an example of the use of informed opinion in the area of seismic hazard characterization. These papers should be useful to researchers and statisticians who need to collect and use informed opinion in their work

Transesophageal echocardiography. 3. rev. and enl. ed.

International Nuclear Information System (INIS)

Lambertz, Heinz; Lethen, Harald

2013-01-01

The book on transesophageal echocardiography covers the following issues: Development of transesophageal echocardiography, technical advances; indications and contraindication for transesophageal echocardiography; systematic of the medical examination process; cardiac valves and valve prostheses; mitral and aortic valvuloplasty, TAVI and interventional treatment of mitral regurgitation; infectious endocarditis; one-way and effluence disturbances of the left and right ventricle; diseases of the thoracic aorta; undefined right ventricle enlargement; lung embolism, acute infarct complications; TEE during anesthesia and perioperative intensive medicine, cardiac sources of embolism; cardiac tumors, mediastinal lymph nodes; pericardiac diseases; congenital heart diseases in childhood and adulthood; catheter interventions and heart valve reconstruction; surgically corrected congenital cardiac defects; intracavitary versus transesophageal echocardiography; three-dimensional TEE; coronary diagnostics; ischemia and vitality diagnostics.

Dosimetric evaluation in panoramic and tele-radiography procedures

International Nuclear Information System (INIS)

Oliveira, Georgge Gomes

2004-01-01

The present work had as an objective to evaluate the skin surface entrance dose in panoramic and tele radiography procedures in three clinics in Recife - Pernambuco - Brazil, and to contribute with data for the determination of reference levels for super cited extra oral procedures, for this purpose, operational conditions in 3 clinics were evaluated in Recife, aiming to evaluate the existence and integrity of the radioprotection equipment, manner and conditions of image processing; and radiographic equipment parameters such as the dimension of the irradiation filed, the total filtration, the exposure time and the potential applied to the X ray tube. For an estimation of the skin entrance dose of the patient, the phantom Randon Alderson and thermoluminescence dosemeters were used. From these values and the conversion factors determined by the Monte Carlo technique, with the phantom MAX it was possible to estimate the dose absorbed in the organ due to the tele radiography procedures. Regarding panoramic radiography the study showed that the more elevated doses occurred in the parotid gland region which is near rotational venters. In the case of tele radiography the highest dose value occurred in the regions corresponding to the temporal lobe of the brain, followed by linfonodes, ears and parotid glands. The doses absorbed in the eyes and the thyroid gland were, 0.037 mGy and 0.002 mGy in Clinic A and 0.062 mGy and 0.003 mGy in Clinic C, respectively. Regarding equipment test, inadequacy was found in the beam collimation in Clinic A and in the reproducibility of the X ray exposure in Clinic C. The total filtration in both clinics was inadequate.(author)

Carcinoid syndrome diagnosed by echocardiography.

Science.gov (United States)

Garg, Scot; Bourantas, Christos V; Nair, Rajesh K; Alamgir, Farqad

2011-02-17

Right heart failure is a common presentation to both general physicians and cardiologists. Echocardiography is a useful investigation, and usually imaging of the liver is confined to helping estimate the right atrial pressure. We report a case of right heart failure where incidental imaging of the liver architecture during transoesophageal echocardiography helped in establishing the final diagnosis. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

THE EFFECT OF TELE-MONITORING ON EXERCISE TRAINING ADHERENCE, FUNCTIONAL CAPACITY, QUALITY OF LIFE AND GLYCEMIC CONTROL IN PATIENTS WITH TYPE II DIABETES

Directory of Open Access Journals (Sweden)

Tracy Marios

2012-03-01

Full Text Available We used tele-monitoring to attempt to improve exercise adherence (number of hours of exercise completed, peak VO2, HbA1c% and quality of life in an unsupervised, home based exercise program in people with type II diabetes, a cost analysis was also conducted. Thirty-nine patients with type II diabetes were randomized to tele-monitoring (TELE or control (CON groups. All patients were asked to complete 6 months exercise training and complete an exercise activity diary. The TELE group was instructed to record their exercise heart rates using a monitor and received weekly telephone calls from an exercise physiologist. Six TELE patients and seven CON patients did not complete the 6 month testing. TELE patients completed a mean weekly volume of 138 minutes, moderate intensity exercise, while CON patients completed 58 minutes weekly (p < 0.02. Neither group achieved the American Heart Association statement guideline for weekly exercise volume of 150 minutes. TELE patients improved peak VO2 (5.5 %, but neither group improved HbA1c% or quality of life. The CON group showed a 4.9% reduction in peak VO2. While tele-monitored patients completed more hours of exercise and demonstrated improved peak VO2 compared to controls, the exercise volume completed was insufficient to improve glycemic control. There is the potential via tele-monitoring to enable people with diabetes to meet exercise training guidelines.

Assisted supervision of a computer aided tele-operation system

Energy Technology Data Exchange (ETDEWEB)

Le Bars, H; Gravez, P; Fournier, R

1994-12-31

This paper talks about Computer Aided Tele-operation (CAT) in dismantling and maintenance of nuclear plants. The current research orientations at CEA, basic concepts of the supervision assistance system and the realisation of a prototype are presented. (TEC). 3 refs., 4 figs.

Assisted supervision of a computer aided tele-operation system

International Nuclear Information System (INIS)

Le Bars, H.; Gravez, P.; Fournier, R.

1994-01-01

This paper talks about Computer Aided Tele-operation (CAT) in dismantling and maintenance of nuclear plants. The current research orientations at CEA, basic concepts of the supervision assistance system and the realisation of a prototype are presented. (TEC). 3 refs., 4 figs

Recent advances in echocardiography for valvular heart disease.

Science.gov (United States)

Hahn, Rebecca

2015-01-01

Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population.

A tele-operated mobile ultrasound scanner using a light-weight robot.

Science.gov (United States)

Delgorge, Cécile; Courrèges, Fabien; Al Bassit, Lama; Novales, Cyril; Rosenberger, Christophe; Smith-Guerin, Natalie; Brù, Concepció; Gilabert, Rosa; Vannoni, Maurizio; Poisson, Gérard; Vieyres, Pierre

2005-03-01

This paper presents a new tele-operated robotic chain for real-time ultrasound image acquisition and medical diagnosis. This system has been developed in the frame of the Mobile Tele-Echography Using an Ultralight Robot European Project. A light-weight six degrees-of-freedom serial robot, with a remote center of motion, has been specially designed for this application. It holds and moves a real probe on a distant patient according to the expert gesture and permits an image acquisition using a standard ultrasound device. The combination of mechanical structure choice for the robot and dedicated control law, particularly nearby the singular configuration allows a good path following and a robotized gesture accuracy. The choice of compression techniques for image transmission enables a compromise between flow and quality. These combined approaches, for robotics and image processing, enable the medical specialist to better control the remote ultrasound probe holder system and to receive stable and good quality ultrasound images to make a diagnosis via any type of communication link from terrestrial to satellite. Clinical tests have been performed since April 2003. They used both satellite or Integrated Services Digital Network lines with a theoretical bandwidth of 384 Kb/s. They showed the tele-echography system helped to identify 66% of lesions and 83% of symptomatic pathologies.

3D Stereo Visualization for Mobile Robot Tele-Guide

DEFF Research Database (Denmark)

Livatino, Salvatore

2006-01-01

The use of 3D stereoscopic visualization may provide a user with higher comprehension of remote environments in tele-operation when compared to 2D viewing. In particular, a higher perception of environment depth characteristics, spatial localization, remote ambient layout, as well as faster system...

Tele-auscultation support system with mixed reality navigation.

Science.gov (United States)

Hori, Kenta; Uchida, Yusuke; Kan, Tsukasa; Minami, Maya; Naito, Chisako; Kuroda, Tomohiro; Takahashi, Hideya; Ando, Masahiko; Kawamura, Takashi; Kume, Naoto; Okamoto, Kazuya; Takemura, Tadamasa; Yoshihara, Hiroyuki

2013-01-01

The aim of this research is to develop an information support system for tele-auscultation. In auscultation, a doctor requires to understand condition of applying a stethoscope, in addition to auscultatory sounds. The proposed system includes intuitive navigation system of stethoscope operation, in addition to conventional audio streaming system of auscultatory sounds and conventional video conferencing system for telecommunication. Mixed reality technology is applied for intuitive navigation of the stethoscope. Information, such as position, contact condition and breath, is overlaid on a view of the patient's chest. The contact condition of the stethoscope is measured by e-textile contact sensors. The breath is measured by a band type breath sensor. In a simulated tele-auscultation experiment, the stethoscope with the contact sensors and the breath sensor were evaluated. The results show that the presentation of the contact condition was not understandable enough for navigating the stethoscope handling. The time series of the breath phases was usable for the remote doctor to understand the breath condition of the patient.

Fetal Echocardiography and Indications

Directory of Open Access Journals (Sweden)

Melih Atahan Güven

2008-09-01

Full Text Available Congenital heart diseases are encountered in 0.8% of live births and are among the most frequently diagnosed malformations. At least half of these anomalies end up with death or require surgical interventions and are responsible for 30% of the perinatal mortality. Fetal echocardiography is the sum of knowledge, skill and orientation rather than knowing the embryologic details of the fetal heart. The purpose of fetal echocardiography is to document the presence of normal fetal cardiac anatomy and rhythm in high risk group and to define the anomaly and arrhythmia if present. A certain sequence should be followed during the evaluation of fetal heart. Sequential segmental analysis (SSA and basic definition terminology made it possible to determine a lot of complex cardiac anomalies during prenatal period. By the end of 1970’s, Shinebourne started using sequential segmental analysis for fetal cardiac evaluation and today, prenatal diagnosis of congenital heart disease is possible without any confusion. In this manner, whole fetal heart can be evaluated as the relation of three segments (atria, ventricles and the great arteries with each other, irrelevant of complexity of a possible cardiac anomaly. Presence of increased nuchal thickness during early gestation and abnormal four-chamber-view during ultrasonography by the obstetrician presents a clear indication for fetal echocardiography,however, one should keep in mind that 80-90% of the babies born with a congenital heart disease do not have a familial or maternal risk factor. In addition, it should be remembered that expectant mothers with diabetes mellitus pose an indication for fetal echocardiography.

Endocarditis : Effects of routine echocardiography during Gram-positive bacteraemia

NARCIS (Netherlands)

Vos, F J; Bleeker-Rovers, C P; Sturm, P D; Krabbe, P F M; van Dijk, A P J; Oyen, W J G; Kullberg, B J

2011-01-01

BACKGROUND: Despite firm recommendations to perform echocardiography in high-risk patients with Gram-positive bacteraemia, routine echocardiography is not embedded in daily practice in many settings. The aim of this study was to evaluate whether a regime including routine echocardiography results in

POT: Planning, Organisation and Tele-Information

DEFF Research Database (Denmark)

Vidal, Rene Victor Valqui

1996-01-01

The main purpose of this paper is to introduce the framwork of a research project carried out at the Technical University of Denmark dealing with 'holistic' and interdisciplinary (systems oriented)methods for strategic planning and organisational re-design in connection with the introduction...... of tele-information technologies and hte new demands of hte so-called information society, the POT proejct. Three specirfic projects are shortly introduced: planning in networked firms, strategic approaches to climate change and strategies for the schools of the future....

Guidelines for transoesophageal echocardiographic probe cleaning and disinfection from the British Society of Echocardiography.

Science.gov (United States)

Kanagala, P; Bradley, C; Hoffman, P; Steeds, R P

2011-10-01

The clinical utility of transoesophageal echocardiography (TOE) is well established. Being a semi-invasive procedure, however, the potential for transmission of infection between sequential patients exists. This has implications for the protection of both patients and medical staff. Guidelines for disinfection during gastrointestinal endoscopy (GIE) have been in place for many years.(1,2) Unfortunately, similar guidance is lacking with respect to TOE. Although traversing the same body cavities and sharing many similarities with upper GIE, there are fundamental structural and procedural differences with TOE which merit special consideration in establishing a decontamination protocol. This document provides recommendations for TOE probe decontamination based on the available evidence, expert opinion, and modification of the current British Society of Gastroenterology guidelines.

Passive hybrid force-position control for tele-operation based on real-time simulation of a virtual mechanism

International Nuclear Information System (INIS)

Joly, L.; Andriot, C.

1995-01-01

Hybrid force-position control aims at controlling position and force in separate directions. It is particularly useful to perform certain robotic tasks. In tele-operation context, passivity is important because it ensures stability when the system interacts with any passive environment. In this paper, we propose an original approach to hybrid force-position control of a force reflecting tele-robot system. It is based on real-time simulation of a virtual mechanism corresponding to the task. the resulting control law is passive. Experiments on a 6 degrees of freedom tele-operation system consisting in following a bent pipe under several control modes validate the approach. (authors). 12 refs., 6 figs

O PERCURSO EPISTÊMICO DO SÁBIO NA METAFÍSICA DE ARISTÓTELES

Directory of Open Access Journals (Sweden)

Carlos Wagner Benevides Gomes

2015-06-01

Full Text Available Aristóteles (383-322 a.C foi considerado, dentre os primeiros pensadores (os Pré-Socráticos, o responsável pela pesquisa sistemática da filosofia. Aristóteles, em Metafísica, explicita com a chamada “filosofia primeira” o problema de um conceito de Sabedoria e da “ciência investigada”, que é a do ser enquanto ser. Diferente da tradição platônica, Aristóteles propôs uma filosofia voltada para o mundo exterior, pois enquanto o conhecimento para Platão tinha relação com uma “reminiscência das formas” (Teoria das Ideias ou das Formas, para Aristóteles o conhecimento se diz de muitas maneiras, porque relaciona-se aos diversos modos de captarmos os objetos pelas senso-percepções. Este artigo tem como objetivo explicitar, a partir da Metafísica, nos Livros I (capítulos 1, 2 e 3, II (capítulo 1 e III (capítulo 1, o processo epistemológico do Sábio (Sophos, perpassando pelos elementos que conduzem à Sabedoria (Sophia como ciência teórica. Por conseguinte, analisa-se alguns conceitos pertinentes às seguintes problemáticas do conhecimento humano: a senso-percepção, a imagem, a memória e a experiência. Além de, a questão do Sábio, as Causas, a investigação da verdade e as ciências especulativas e práticas. Portanto, conclui-se que Aristóteles mostrou o percurso das senso-percepções à formulação do “Universal” que conduz o filósofo à Sabedoria, ou seja, aos princípios primeiros que consistem no conhecimento das causas de todas as coisas, à medida que o Sábio enfrenta algumas dificuldades (Aporia.

TELE-X and its role in a future operational Nordic satellite system

Science.gov (United States)

Anderson, Lars

In the middle of 1987 it is planned to launch TELE-X, the first Nordic telecommunications satellite. The Swedish-Norwegian company NOTELSAT (Nordic Telecommunications Satellite Corporation) will be responsible for the operation of the TELE-X system. Via the experimental TELE-X satellite the Nordic countries will get access to direct broadcasting of two TV-programs and at least four digital sound programs in stereo by use of two transponders in the 12.2 to 12.5 GHz band. The programs are planned to be composed of nationally produced programs in Norway. Sweden and Finland. By means of distributing these programs via satellite they will reach up to 4 times as many viewers and listernes as presently in the terrestrial national systems. The basic motivations for exchanging programs are to strengthen the cultural ties between the Nordic countries and to give the individuals more freedom in the choice of programs. Another goal is to give the public a better sound and picture quality than can be achieved today. These quality improvements shall be met by using small receiver parabolas of less than 1 m in diameter. Contributing to the improved quality is the choice of the C-MAC (Multiplexed Analoque Components) modulation system. TELE-X is a multipurpose satellite which besides the two TV-transponders will have two transponders for data/video communication in the frequency band 12.5 to 12.75 GHz. The choice of system for data and video is based on the philosophy of thin-route traffic between small and low cost earth stations (1.8 to 2.5 m) placed directly at the subscribers premises. The system includes an advanced Data/Video Control Station which automatically connects the traffic stations with standarized transmission speeds up to 2 Mbps. The system which is based on the SCPC/DAMA method can be expanded up to 5000 traffic stations. Numerous data/video applications will be investigated in the initial experimental phase of the project which also will be used for market

Estabelecimento de serviço de tele-eletrocardiografia digital no sul do Brasil = Establishment of a Digital Tele-Electrocardiographic System in southern Brazil

Directory of Open Access Journals (Sweden)

Sparenberg, Adolfo Luiz Falcão

2005-01-01

Conclusão: Em decorrência dos resultados descritos e de seu baixo custo, o Sistema de Tele-ECG Digital foi considerado como de grande utilidade para as Instituições de Saúde, beneficiando pequenas cidades, comunidades remotas e áreas rurais do Brasil

Application of Echocardiography on Transgenic Mice with Cardiomyopathies

Directory of Open Access Journals (Sweden)

G. Chen

2012-01-01

Full Text Available Cardiomyopathies are common cardiac disorders that primarily affect cardiac muscle resulting in cardiac dysfunction and heart failure. Transgenic mouse disease models have been developed to investigate the cellular mechanisms underlying heart failure and sudden cardiac death observed in cardiomyopathy cases and to explore the therapeutic outcomes in experimental animals in vivo. Echocardiography is an essential diagnostic tool for accurate and noninvasive assessment of cardiac structure and function in experimental animals. Our laboratory has been among the first to apply high-frequency research echocardiography on transgenic mice with cardiomyopathies. In this work, we have summarized our and other studies on assessment of systolic and diastolic dysfunction using conventional echocardiography, pulsed Doppler, and tissue Doppler imaging in transgenic mice with various cardiomyopathies. Estimation of embryonic mouse hearts has been performed as well using this high-resolution echocardiography. Some technical considerations in mouse echocardiography have also been discussed.

Tele-treatment of patients with amyotrophic lateral sclerosis (ALS)

NARCIS (Netherlands)

Oude Nijeweme-d'Hollosy, Wendy; Janssen, Emile P.F.; Huis in 't Veld, M.H.A.; Spoelstra, Jos; Vollenbroek-Hutten, Miriam Marie Rosé; Hermens, Hermanus J.

2006-01-01

Management of patients with amyotrophic lateral sclerosis (ALS) mainly consists of (psycho) social support and advice on activities of daily living. We evaluated the effects of tele-treatment in addition to the conventional method of care in four patients with ALS. A Web application was built with

The development of advanced robotic technology. A study on the tele-existence and intelligent control of a robot system for nuclear power plants

Energy Technology Data Exchange (ETDEWEB)

Chung, Myung Jin; Byun, Jueng Nam; Kim, Jong Hwan; Lee, Ju Jang; Bang, Seok Won; Chu, Gil Hwan; Park, Jong Cheol; Choi, Jong Seok; Yang, Jung Min; Hong, Sun Ki [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

1995-07-01

To increase the efficiency of human intelligence it is required to develop an intelligent monitoring and system. In this research, we develop intelligent control methods related with tele-operation, tele-existence, real-time control technique, and intelligent control technique. Those are key techniques in tele-operation, especially for the repair and maintenance of nuclear power plants. The objective of this project is to develop of the tele-existence and intelligent control system for a robot used in the nuclear power plants. (author). 20 refs.

What every radiologist should know about paediatric echocardiography

International Nuclear Information System (INIS)

Sorantin, Erich; Heinzl, Bernd

2014-01-01

Congenital heart defects (CHD) occur in less than one percent of all newborns. Echocardiography represents the imaging modality of choice for morphological and functional assessment. In childhood the different CHD types can be diagnosed trustfully and can be performed bedside. In the follow-up of CHD cross sectional imaging plays an important role and therefore it is essential for the radiologist to know the features, challenges and limitations of echocardiography. Within this review article a systematic approach for morphological and functional assessment of the heart will is given along with representative example images. In addition, typical echocardiographic findings in common CHD is presented. In older children, adolescents and grown-ups with CHD (GUCH) echocardiography suffers from limitations – partially due to skeletal deformations and lung emphysema. In particular right ventricular function assessment is not always possible by echocardiography. Therefore strengths and limitations of echocardiography will be discussed the role of cardiac magnetic resonance imaging (cMRI) and cardiac computed tomography (cCT) emphasized

What every radiologist should know about paediatric echocardiography

Energy Technology Data Exchange (ETDEWEB)

Sorantin, Erich, E-mail: erich.sorantin@medunigraz.at [Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz (Austria); Heinzl, Bernd [Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz (Austria)

2014-09-15

Congenital heart defects (CHD) occur in less than one percent of all newborns. Echocardiography represents the imaging modality of choice for morphological and functional assessment. In childhood the different CHD types can be diagnosed trustfully and can be performed bedside. In the follow-up of CHD cross sectional imaging plays an important role and therefore it is essential for the radiologist to know the features, challenges and limitations of echocardiography. Within this review article a systematic approach for morphological and functional assessment of the heart will is given along with representative example images. In addition, typical echocardiographic findings in common CHD is presented. In older children, adolescents and grown-ups with CHD (GUCH) echocardiography suffers from limitations – partially due to skeletal deformations and lung emphysema. In particular right ventricular function assessment is not always possible by echocardiography. Therefore strengths and limitations of echocardiography will be discussed the role of cardiac magnetic resonance imaging (cMRI) and cardiac computed tomography (cCT) emphasized.

Assistant Personal Robot (APR: Conception and Application of a Tele-Operated Assisted Living Robot

Directory of Open Access Journals (Sweden)

Eduard Clotet

2016-04-01

Full Text Available This paper presents the technical description, mechanical design, electronic components, software implementation and possible applications of a tele-operated mobile robot designed as an assisted living tool. This robotic concept has been named Assistant Personal Robot (or APR for short and has been designed as a remotely telecontrolled robotic platform built to provide social and assistive services to elderly people and those with impaired mobility. The APR features a fast high-mobility motion system adapted for tele-operation in plain indoor areas, which incorporates a high-priority collision avoidance procedure. This paper presents the mechanical architecture, electrical fundaments and software implementation required in order to develop the main functionalities of an assistive robot. The APR uses a tablet in order to implement the basic peer-to-peer videoconference and tele-operation control combined with a tactile graphic user interface. The paper also presents the development of some applications proposed in the framework of an assisted living robot.

Pretest Score for Predicting Microbubble Contrast Agent Use in Stress Echocardiography: A Method to Increase Efficiency in the Echo Laboratory

Directory of Open Access Journals (Sweden)

Mathieu Bernier

2009-01-01

contrast. Logistic regression models were used to evaluate the association between individual characteristics and contrast use. An 11-point score was derived from the significant characteristics. Results. Variables associated with microbubble use were age, sex, smoking, presence of multiple risk factors, bodymass index (BMI, referral for dobutamine stress echocardiography, history of coronary artery disease, and abnormal baseline electrocardiogram. All variables except BMI were given a score of 1 if present and 0 if absent; BMI was given a score of 0 to 4 according to its value. An increased score was directly proportional to increased likelihood of contrast use. The score cutoff value to optimize sensitivity and specificity was 5. Conclusions. A pretest score can be computed from information available before imaging. It may facilitate contrast agent use through early identification of patients who are likely to benefit from improved endocardial border definition.

Stress Echocardiography and Major Cardiac Events in Patients with Normal Exercise Test

Science.gov (United States)

Calasans, Flávia Ricci; Santos, Bruno Fernandes de Oliveira; Silveira, Débora Consuelo Rocha; de Araújo, Ana Carla Pereira; Melo, Luiza Dantas; Barreto-Filho, José Augusto; Sousa, Antônio Carlos Sobral; Oliveira, Joselina Luzia Menezes

2013-01-01

Background Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events. Objective To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET. Methods 397 patients with intermediate CAD pretest probability, estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI). Results G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23). Conclusion Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET. PMID:23765384

Echocardiography and cardiac resynchronisation therapy, friends or foes?

Science.gov (United States)

van Everdingen, W M; Schipper, J C; van 't Sant, J; Ramdat Misier, K; Meine, M; Cramer, M J

2016-01-01

Echocardiography is used in cardiac resynchronisation therapy (CRT) to assess cardiac function, and in particular left ventricular (LV) volumetric status, and prediction of response. Despite its widespread applicability, LV volumes determined by echocardiography have inherent measurement errors, interobserver and intraobserver variability, and discrepancies with the gold standard magnetic resonance imaging. Echocardiographic predictors of CRT response are based on mechanical dyssynchrony. However, parameters are mainly tested in single-centre studies or lack feasibility. Speckle tracking echocardiography can guide LV lead placement, improving volumetric response and clinical outcome by guiding lead positioning towards the latest contracting segment. Results on optimisation of CRT device settings using echocardiographic indices have so far been rather disappointing, as results suffer from noise. Defining response by echocardiography seems valid, although re-assessment after 6 months is advisable, as patients can show both continuous improvement as well as deterioration after the initial response. Three-dimensional echocardiography is interesting for future implications, as it can determine volume, dyssynchrony and viability in a single recording, although image quality needs to be adequate. Deformation patterns from the septum and the derived parameters are promising, although validation in a multicentre trial is required. We conclude that echocardiography has a pivotal role in CRT, although clinicians should know its shortcomings.

Diagnostic value of echocardiography in infective endocarditis

International Nuclear Information System (INIS)

Luo Yinli; Ni Xianda; Hu Yuanping; Liu Jingyun; Yang Weiyu

2010-01-01

Objective: To investigate the feature and value of echocardiography for diagnosing infective endocarditis. Methods: The shape, size, echogenicity, distribution of vegetations and valvular injury of the heart were observed in 30 patients with infective endocarditis. Results: The vegetations were located in the aortic valves (10 cases), bicuspid valves (5), tricuspid valve (1), pulmonary valve (2), main pulmonary artery with patent ductus arteriosus (2), and right ventricle with ventricular septal defect (2). The size of vegetation ranged from 2 to 27 mm and the echogenicity of vegetations was low to high. The location, size, shape and amount of vegetations observed on echocardiography correlated well with the operative findings. Echocardiography also demonstrated underlying heart disease and abnormal hemodynamics induced by infective endocarditis. Conclusion: Echocardiography can determine the location, size, shape, amount of vegetation and concomitant cardiac disease in patients with infective endocarditis. It play an important role in treatment and prognosis. (authors)

Design of a Tele-Control Electrical Vehicle System Using a Fuzzy Logic Control

Directory of Open Access Journals (Sweden)

M. Boukhnifer

2012-11-01

Full Text Available This paper presents a fuzzy logic design of a tele-control electrical vehicle system. We showed that the application of fuzzy logic control allows the stability of tele-vehicle system in spite of communication delays between the operator and the vehicle. A robust bilateral controller design using fuzzy logic frameworks was proposed. This approach allows a convenient means to trade off robustness and stability for a pre-specified time-delay margin. Both the performance and robustness of the proposed method were demonstrated by simulation results for a constant time delay between the operator and the electrical vehicle system.

Echocardiography as an indication of continuous-time cardiac quiescence

Science.gov (United States)

Wick, C. A.; Auffermann, W. F.; Shah, A. J.; Inan, O. T.; Bhatti, P. T.; Tridandapani, S.

2016-07-01

Cardiac computed tomography (CT) angiography using prospective gating requires that data be acquired during intervals of minimal cardiac motion to obtain diagnostic images of the coronary vessels free of motion artifacts. This work is intended to assess B-mode echocardiography as a continuous-time indication of these quiescent periods to determine if echocardiography can be used as a cost-efficient, non-ionizing modality to develop new prospective gating techniques for cardiac CT. These new prospective gating approaches will not be based on echocardiography itself but on CT-compatible modalities derived from the mechanics of the heart (e.g. seismocardiography and impedance cardiography), unlike the current standard electrocardiogram. To this end, echocardiography and retrospectively-gated CT data were obtained from ten patients with varied cardiac conditions. CT reconstructions were made throughout the cardiac cycle. Motion of the interventricular septum (IVS) was calculated from both echocardiography and CT reconstructions using correlation-based, deviation techniques. The IVS was chosen because it (1) is visible in echocardiography images, whereas the coronary vessels generally are not, and (2) has been shown to be a suitable indicator of cardiac quiescence. Quiescent phases were calculated as the minima of IVS motion and CT volumes were reconstructed for these phases. The diagnostic quality of the CT reconstructions from phases calculated from echocardiography and CT data was graded on a four-point Likert scale by a board-certified radiologist fellowship-trained in cardiothoracic radiology. Using a Wilcoxon signed-rank test, no significant difference in the diagnostic quality of the coronary vessels was found between CT volumes reconstructed from echocardiography- and CT-selected phases. Additionally, there was a correlation of 0.956 between the echocardiography- and CT-selected phases. This initial work suggests that B-mode echocardiography can be used as a

An open real-time tele-stethoscopy system

OpenAIRE

Foche-Perez, Ignacio; Ramirez-Payba, Rodolfo; Hirigoyen-Emparanza, German; Balducci-Gonzalez, Fernando; Simo-Reigadas, Francisco-Javier; Seoane-Pascual, Joaquin; Corral-Peñafiel, Jaime; Martinez-Fernandez, Andres

2012-01-01

Abstract Background Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respir...

MODERN POSSIBILITIES OF SPECKLE TRACKING ECHOCARDIOGRAPHY IN CLINICAL PRACTICE

Directory of Open Access Journals (Sweden)

V. S. Nikiforov

2017-01-01

Full Text Available Speckle-tracking echocardiography is promising modern technique for evaluation of structural and functional changes in the myocardium. It evaluates the indicator of global longitudinal myocardial deformation, which is more sensitive than ejection fraction to early changes of left ventricular contractility. The diagnostic capabilities of speckle tracking echocardiography are reflected in clinical recommendations and consensus statements of European Society of Cardiology (ESC, European Association of Cardiovascular Imaging (EACVI and American Society of Echocardiography (ASE. The aim of this paper is describe basic principles of speckle tracking echocardiography and clinical applications of this new technology. Attention is paid to the use of speckle tracking echocardiography in such heart pathologies as heart failure, coronary heart disease and myocardial infarction, left ventricular hypertrophy in arterial hypertension, hypertrophic cardiomyopathy and amyloidosis of the heart, valvular heart disease, constrictive pericarditis and cancer therapy-induced cardiotoxicity.

The use of echocardiography in acute cardiovascular care

DEFF Research Database (Denmark)

Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

2014-01-01

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use...... of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...

The use of echocardiography in acute cardiovascular care

DEFF Research Database (Denmark)

Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

2015-01-01

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/ critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use...... of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...

The use of echocardiography in acute cardiovascular care

DEFF Research Database (Denmark)

Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

2015-01-01

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use...... of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...

Analysis of human-in-the-loop tele-operated maintenance inspection tasks using VR

International Nuclear Information System (INIS)

Boessenkool, H.; Abbink, D.A.; Heemskerk, C.J.M.; Steinbuch, M.; Baar, M.R. de; Wildenbeest, J.G.W.; Ronden, D.; Koning, J.F.

2013-01-01

Highlights: ► Execution of tele-operated inspection tasks for ITER maintenance was analyzed. ► Human factors experiments using Virtual Reality showed to be a valuable approach. ► A large variation in time performance and number of collisions was found. ► Results indicate significant room for improvement for teleoperated free space tasks. ► A promising solution is haptic shared control: assist operator with guiding forces. -- Abstract: One of the challenges in future fusion plants such as ITER is the remote maintenance of the plant. Foreseen human-in-the-loop tele-operation is characterized by limited visual and haptic feedback from the environment, which results in degraded task performance and increased operator workload. For improved tele-operated task performance it is required to get insight in the expected tasks and problems during maintenance at ITER. By means of an exploratory human factor experiment, this paper analyses problems and bottlenecks during the execution of foreseen tele-operated maintenance at ITER, identifying most promising areas of improvement. The focus of this paper is on free space (sub)tasks where contact with the environment needs to be avoided. A group of 5 subjects was asked to carry-out an ITER related free space task (visual inspection), using a six degree of freedom master device connected to a simulated hot cell environment. The results show large variation in time performance between subjects and an increasing number of collisions for more difficult tasks, indicating room for improvement for free space (sub)tasks. The results will be used in future research on the haptic guidance strategies in the ITER Remote Handling framework

Analysis of human-in-the-loop tele-operated maintenance inspection tasks using VR

Energy Technology Data Exchange (ETDEWEB)

Boessenkool, H., E-mail: h.boessenkool@differ.nl [FOM Institute DIFFER (Dutch Institute for Fundamental Energy Research), Association EURATOM-FOM, Partner in the Trilateral Euregio Cluster, PO Box 1207, 3430 BE Nieuwegein (Netherlands); Eindhoven University of Technology, Department of Mechanical Engineering, Dynamics and Control Group, PO Box 513, 5600 MB Eindhoven (Netherlands); Abbink, D.A. [Delft University of Technology, Faculty of 3mE, BioMechanical Engineering Department, Mekelweg 2, 2628 CD Delft (Netherlands); Heemskerk, C.J.M. [Heemskerk Innovative Technology B.V., Jonckerweg 12, 2201 DZ Noordwijk (Netherlands); Steinbuch, M. [Eindhoven University of Technology, Department of Mechanical Engineering, Dynamics and Control Group, PO Box 513, 5600 MB Eindhoven (Netherlands); Baar, M.R. de [FOM Institute DIFFER (Dutch Institute for Fundamental Energy Research), Association EURATOM-FOM, Partner in the Trilateral Euregio Cluster, PO Box 1207, 3430 BE Nieuwegein (Netherlands); Eindhoven University of Technology, Department of Mechanical Engineering, Dynamics and Control Group, PO Box 513, 5600 MB Eindhoven (Netherlands); Wildenbeest, J.G.W. [Delft University of Technology, Faculty of 3mE, BioMechanical Engineering Department, Mekelweg 2, 2628 CD Delft (Netherlands); Heemskerk Innovative Technology B.V., Jonckerweg 12, 2201 DZ Noordwijk (Netherlands); Ronden, D. [FOM Institute DIFFER (Dutch Institute for Fundamental Energy Research), Association EURATOM-FOM, Partner in the Trilateral Euregio Cluster, PO Box 1207, 3430 BE Nieuwegein (Netherlands); Koning, J.F. [Heemskerk Innovative Technology B.V., Jonckerweg 12, 2201 DZ Noordwijk (Netherlands)

2013-10-15

Highlights: ► Execution of tele-operated inspection tasks for ITER maintenance was analyzed. ► Human factors experiments using Virtual Reality showed to be a valuable approach. ► A large variation in time performance and number of collisions was found. ► Results indicate significant room for improvement for teleoperated free space tasks. ► A promising solution is haptic shared control: assist operator with guiding forces. -- Abstract: One of the challenges in future fusion plants such as ITER is the remote maintenance of the plant. Foreseen human-in-the-loop tele-operation is characterized by limited visual and haptic feedback from the environment, which results in degraded task performance and increased operator workload. For improved tele-operated task performance it is required to get insight in the expected tasks and problems during maintenance at ITER. By means of an exploratory human factor experiment, this paper analyses problems and bottlenecks during the execution of foreseen tele-operated maintenance at ITER, identifying most promising areas of improvement. The focus of this paper is on free space (sub)tasks where contact with the environment needs to be avoided. A group of 5 subjects was asked to carry-out an ITER related free space task (visual inspection), using a six degree of freedom master device connected to a simulated hot cell environment. The results show large variation in time performance between subjects and an increasing number of collisions for more difficult tasks, indicating room for improvement for free space (sub)tasks. The results will be used in future research on the haptic guidance strategies in the ITER Remote Handling framework.

New tools for C.A.D. of input devices for tele-operation with force feedback

International Nuclear Information System (INIS)

Gosselin, F.

2000-01-01

The performances of a tele-operation system are related to the master arm's ability to emulate the behavior of the remote environment. Ideally, it allows the operator to control the slave arm in a natural way as if that were an extension of its own body. The criteria to be checked for that are known but contradictory. It is thus necessary to make trade-offs on which there is not consensus. Existing input devices are therefore very varied thus more or less adapted to the tasks considered, which is in general checked a posteriori. In this document, we propose an original approach allowing to dimension the master arm a priori according to the use which one wishes to make. For that, we developed two tools: - the first one makes it possible to establish his specifications by taking account of the transmission of information between the operator and the slave arm. By exploiting their respective limitations, one is assured that the master arm will not limit the performances of the system, - the second one allows to design it (kinematics, size, motorization... ) according to the preceding specifications. For that, we use well-known theoretical tools which however are approached here as design tools. This leads to the definition of new concepts which do not appear in the literature. This approach is used to establish the specifications of a master arm for nuclear and offshore tele-operation then to design two input devices answering these specifications. The first has 3 degrees of freedom with force feedback. Its performances are higher than those of the best existing input devices. The second is a mock-up of a 6 degrees of freedom master arm. It uses a new parallel structure that is redundant in actuation and whose performances are remarkable. (author) [fr

Can regional strain and strain rate measurement be performed during both dobutamine and exercise echocardiography, and do regional deformation responses differ with different forms of stress testing?

Science.gov (United States)

Davidavicius, Giedrius; Kowalski, Miroslaw; Williams, R Ian; D'hooge, Jan; Di Salvo, Giovanni; Pierre-Justin, Gilbert; Claus, Piet; Rademakers, Frank; Herregods, Marie-Christine; Fraser, Alan G; Pierard, Luc A; Bijnens, Bart; Sutherland, George R

2003-04-01

Regional strain (epsilon) and strain rate (SR) measurement could be the optimal approach to quantifying stress echocardiography images. However, signal noise could preclude their use. Study aims Our aim was to compare the feasibility of regional peak systolic (p) velocity (Vel), pSR/epsilon measurement, and their normal responses during upright (group 1, n = 10) and supine (group 2, n = 10) bicycle exercise and (group 3, n = 10) dobutamine stress. For each type of stress study, pVel/pSR/epsilon data were acquired at baseline, low (100-120 bpm), and peak (140-160 bpm) heart rate (HR); and during recovery. During dobutamine pVel/pSR/epsilon were interpretable in >95% of segments at every stress stage, whereas in groups 1 and 2 pSR/epsilon responses were noninterpretable in >36% of segments (P pVel and SR values increased linearly and reached maximal value at peak HR (P pVel increased linearly, whereas pepsilon response was biphasic as a result of the reduced filling at higher HRs.

Development of a program for tele-rehabilitation of COPD patients across sectors: co-innovation in a network

Directory of Open Access Journals (Sweden)

Birthe Dinesen

2011-03-01

Full Text Available Introduction: The aim of the Telekat project is to prevent re-admissions of patients with chronic obstructive pulmonary disease (COPD by developing a preventive programof tele-rehabilitation across sectors for COPD patients. The development of the program is based on a co-innovation process between COPD patients, relatives, healthcare professionals and representatives from private firms and universities. This paper discusses theobstacles that arise in the co-innovation process of developing an integrated technique for tele-rehabilitation of COPD patients.Theory: Network and innovation theory.Methods: The casestudy was applied. A triangulation of data collection techniques was used: documents, observations (123 hours, qualitative interviews (n=32 and action research.Findings: Obstacles were identified in the network context; these obstacles included the mindset of the healthcare professionals, inter-professionals relations, views of technology as a tool and competing visions for the goals of tele-rehabilitation.Conclusion: We have identified obstacles that emerge in the co-innovation process when developing a programme for tele-rehabilitation of COPD patients in an inter-organizational context. Action research has been carried out and can have helped to facilitate the co-innovation process.

MRI and echocardiography in the diagnosis of cardiac amyloidosis

International Nuclear Information System (INIS)

Wang Jing; Kong Xiangquan; Zhou Guofeng; Xu Haibo; Chang Dandan; Feng Yiming; Liu Dingxi; Zhang Li; Xie Mingxing

2010-01-01

Objective: To assess the values of MRI and echocardiography for the diagnosis of cardiac amyloidosis (CA). Methods: Eleven cases with CA proved pathologically performed MRI and echocardiography, the findings were analyzed retrospectively. Results: The characteristic features of cardiac amyloidosis on MRI and echocardiography were: diffuse slight myocardial thickening of the left ventricular wall and interventricular septum (11 cases), slight myocardial thickening of the interatrial septum (5 cases), increased left ventricular mass (7 cases), enlarged left atrium (7 cases), impaired ventricular systolic and diastolic function (10 cases), pleural and pericardial effusions (11 and 9 cases). Echocardiography showed that myocardium was hyperechoic and presented as ground glass with some spotty hyperechoes in 6 cases. MRI revealed a distinct diffuse delayed enhancement of subendocardial and entire myocardium in 8 cases. Conclusion: Doppler echocardiography is the first-choice imaging technique and cardiac magnetic resonance imaging can provide more information for the diagnosis of CA. (authors)

The Arab Spring is a Latin American Winter: TeleSUR’s “Ideological Approach” and the Breakaway from the Al-Jazeera Network

Directory of Open Access Journals (Sweden)

Massimo Di Ricco

2012-05-01

Full Text Available The Arab Spring represents a breaking point in the cooperation between the pan-Latin American satellite television TeleSUR and Al-Jazeera. Even if in February TeleSUR firmly condemned the closure by Egyptian authorities of the Al-Jazeera Cairo offices, NATO military intervention in Libya and the beginning of protests in Syria provoked an important change in TeleSUR coverage of the Arab Spring. This shift coincided with a departure from the Al-Jazeera network, sanctioning the possible end of a collaboration that always had strong political connotations. TeleSUR joined the cause of the protesters in the coverage of the Egyptian and Tunisian uprisings, meanwhile it took what we can refer to as an “ideological approach” in the coverage of the uprisings after the international intervention in Libya, implicitly embracing the official media version of the Arab regimes. This stance sparked controversy especially within grassroots Latin American movements, igniting a strong debate mainly visible on the web. At an international level, the undeclared departure from the Al-Jazeera network reflects the future split between leftist Latin American governments, who embrace and fund the multi-state TV network TeleSUR, and the forces that will come out from the Arab Spring. Finally, the Arab Spring represented a missing opportunity for TeleSUR to play an important role in global media, and not only for a national or regional audience. Indeed, TeleSUR gave more importance to the political interests of the channel's founders, than in pursuing a balanced information out of ideological interests or geopolitical strategies..

Leveraging Scarce Resources With Bone Health TeleECHO to Improve the Care of Osteoporosis.

Science.gov (United States)

Lewiecki, E Michael; Rochelle, Rachelle; Bouchonville, Matthew F; Chafey, David H; Olenginski, Thomas P; Arora, Sanjeev

2017-12-01

Osteoporosis is a common condition with serious consequences because of fractures. Despite availability of treatments to reduce fracture risk, there is a large osteoporosis treatment gap that has reached crisis proportions. There are too few specialists to provide services for patients who need them. Bone Health Extension for Community Health Care Outcomes (TeleECHO) is a strategy using real-time ongoing videoconferencing technology to mentor health care professionals in rural and underserved communities to achieve an advanced level of knowledge for the care of patients with skeletal diseases. Over the first 21 months of weekly Bone Health TeleECHO programs, there were 263 registered health care professionals in the United States and several other countries, with 221 attending at least 1 online clinic and typically 35 to 40 attendees at each session at the end of the reported period. Assessment of self-confidence in 20 domains of osteoporosis care showed substantial improvement with the ECHO intervention ( P = 0.005). Bone Health TeleECHO can contribute to mitigating the crisis in osteoporosis care by leveraging scarce resources, providing motivated practitioners with skills to provide better skeletal health care, closer to home, with greater convenience, and lower cost than referral to a specialty center. Bone Health TeleECHO can be replicated in any location worldwide to reach anyone with Internet access, allowing access in local time zones and languages. The ECHO model of learning can be applied to other aspects of bone care, including the education of fracture liaison service coordinators, residents and fellows, and physicians with an interest in rare bone diseases.

The use of echocardiography in Wolff-Parkinson-White syndrome.

Science.gov (United States)

Cai, Qiangjun; Shuraih, Mossaab; Nagueh, Sherif F

2012-04-01

Endocardial mapping and radiofrequency catheter ablation are well established modalities for the diagnosis and treatment of patients with Wolff-Parkinson-White (WPW) syndrome associated with tachyarrhythmias. However, the electrophysiologic techniques are invasive, require radiation exposure, and lack spatial resolution of cardiac structures. A variety of echocardiographic techniques have been investigated as a non-invasive alternative for accessory pathway localization. Conventional M-mode echocardiography can detect the fine premature wall motion abnormalities associated with WPW syndrome. However, it is unable to identify the exact site of accessory pathway with sufficient accuracy. 2D, 2D-guided M-mode, and 2D phase analysis techniques are limited by image quality and endocardial border definition. Various modalities of tissue Doppler echocardiography significantly increase the accuracy of left-sided accessory pathway localization to 80-90% even in patients with poor acoustic window. However, right-sided pathways remain a diagnostic challenge. Strain echocardiography by speckle tracking has recently been evaluated and appears promising. Different cardiac abnormalities have been detected by echocardiography in WPW patients. Patients with WPW syndrome and tachyarrhythmias have impaired systolic and diastolic function which improves after radiofrequency ablation. Echocardiography is useful in identifying patient with accessory pathway-associated left ventricular dyssynchrony and dysfunction who may benefit from ablation therapy. Transesophageal and intracardiac echocardiography have been used to guide ablation procedure. Ablation-related complications detected by routine echocardiography are infrequent, rarely clinically relevant, and of limited value.

Quantification in echocardiography

NARCIS (Netherlands)

Korsten, H.H.M.; Mischi, M.; Grouls, R.J.E.; Jansen, A.H.M.; Dantzig, van J.M.; Peels, C.H.

2006-01-01

Until recently, more than 2200 Swan Ganz catheters were used annually in the operating rooms (OR) and intensive care unit (ICU) of the Catharina Hospital in Eindhoven, The Netherlands. After cardiologists who were specialists in echocardiography (ECHO) trained anesthesiologists in ECHO, the need for

Systematic review of cardiac output measurements by echocardiography vs. thermodilution

DEFF Research Database (Denmark)

Wetterslev, Mik; Møller-Sørensen, Hasse; Johansen, Rasmus Rothmann

2016-01-01

PURPOSE: Echocardiography is frequently used in the hemodynamic evaluation of critically ill patients, but inaccurate measurements may lead to wrong clinical decisions. The aim of our systematic review was to investigate the interchangeability of echocardiography with thermodilution technique...... of the studies assessed left-sided heart structures and the majority had small bias, wide limits of agreement, and high percentage error between echocardiography and thermodilution. In only two of the 24 studies the precision of each technique (echocardiography and thermodilution) was assessed before comparing...... them. In the single study evaluating trending ability using valid methodology, agreement was observed between echocardiography and thermodilution in detecting the directional changes in cardiac output, but the magnitude of changes varied considerably. CONCLUSIONS: The majority of studies comparing...

Imposing motion constraints to a force reflecting tele-robot through real-time simulation of a virtual mechanism

Energy Technology Data Exchange (ETDEWEB)

Joly, L.; Andriot, C.

1995-12-31

In a tele-operation system, assistance can be given to the operator by constraining the tele-robot position to remain within a restricted subspace of its workspace. A new approach to motion constraint is presented in this paper. The control law is established simulating a virtual ideal mechanism acting as a jig, and connected to the master and slave arms via springs and dampers. Using this approach, it is possible to impose any (sufficiently smooth) motion constraint to the system, including non linear constraints (complex surfaces) involving coupling between translations and rotations and physical equivalence ensures that the controller is passive. Experimental results obtained with a 6-DOF tele-operation system are given. Other applications of the virtual mechanism concept include hybrid position-force control and haptic interfaces. (authors). 11 refs., 7 figs.

Imposing motion constraints to a force reflecting tele-robot through real-time simulation of a virtual mechanism

International Nuclear Information System (INIS)

Joly, L.; Andriot, C.

1995-01-01

In a tele-operation system, assistance can be given to the operator by constraining the tele-robot position to remain within a restricted subspace of its workspace. A new approach to motion constraint is presented in this paper. The control law is established simulating a virtual ideal mechanism acting as a jig, and connected to the master and slave arms via springs and dampers. Using this approach, it is possible to impose any (sufficiently smooth) motion constraint to the system, including non linear constraints (complex surfaces) involving coupling between translations and rotations and physical equivalence ensures that the controller is passive. Experimental results obtained with a 6-DOF tele-operation system are given. Other applications of the virtual mechanism concept include hybrid position-force control and haptic interfaces. (authors). 11 refs., 7 figs

Tele-care robot for assisting independent senior citizens who live at home.

Science.gov (United States)

Katz, Reuven

2015-01-01

In the last twenty years most developed countries face dramatic demographic changes, and predominantly the rapid aging of their population. As the share of elderly people is climbing while the number of care providers is declining, the aging problem is becoming an increasingly important social and economic challenge. The supply of care at home, utilizing affordable tele-care systems and smart home technologies, is one of the promising strategies to cope with challenges posed by these demographic changes. The goal of this paper is to present a tele-care robot (TCR) aimed to assist Senior citizens who live independently at their home, that need assistance in daily life activities. The idea of the proposed system is that a caregiver, operating from a central location, will be able to service between 10 to 20 patients living at their home, by using the tele-care robot. The robot will possess motion control capabilities to move inside the house of each patient and alert in case that emergency events occur. The robot will allow the care provider to communicate remotely with the patient using audio and video equipment installed on the robot. By using the robot, the caregiver will be able to examine several times during the day the well-being of the patient, his medication consumption, and his overall functionality.

Teaching focused echocardiography for rheumatic heart disease screening

Directory of Open Access Journals (Sweden)

Daniel Engelman

2015-01-01

Full Text Available Screening for rheumatic heart disease (RHD requires workers skilled in echocardiography, which typically involves prolonged, specialized training. Task shifting echocardiographic screening to nonexpert health workers may be a solution in settings with limited human resources. An 8-week training program was designed to train health workers without any prior experience in focused echocardiography for RHD screening. Seven health workers participated. At the completion of training, the health workers performed unsupervised echocardiography on 16 volunteer children with known RHD status. A pediatric cardiologist assessed image quality. Participants provided qualitative feedback. The quality of echocardiograms were high at completion of training (55 of 56 were adequate for diagnosis and all cases of RHD were identified. Feedback was strongly positive. Training health workers to perform focused echocardiography for RHD screening is feasible. After systematic testing for accuracy, this training program could be adapted in other settings seeking to expand echocardiographic capabilities.

Teaching focused echocardiography for rheumatic heart disease screening

International Nuclear Information System (INIS)

Engelman, Daniel; Kado, Joseph H; Reményi, Bo; Colquhoun, Samantha M; Watson, Caroline; Rayasidamu, Sera C; Steer, Andrew C

2005-01-01

Screening for rheumatic heart disease (RHD) requires workers skilled in echocardiography, which typically involves prolonged, specialized training. Task shifting echocardiographic screening to nonexpert health workers may be a solution in settings with limited human resources. An 8-week training program was designed to train health workers without any prior experience in focused echocardiography for RHD screening. Seven health workers participated. At the completion of training, the health workers performed unsupervised echocardiography on 16 volunteer children with known RHD status. A pediatric cardiologist assessed image quality. Participants provided qualitative feedback. The quality of echocardiograms were high at completion of training (55 of 56 were adequate for diagnosis) and all cases of RHD were identified. Feedback was strongly positive. Training health workers to perform focused echocardiography for RHD screening is feasible. After systematic testing for accuracy, this training program could be adapted in other settings seeking to expand echocardiographic capabilities

Tele-education vs classroom training of neonatal resuscitation: a randomized trial.

Science.gov (United States)

Jain, A; Agarwal, R; Chawla, D; Paul, V; Deorari, A

2010-12-01

To compare gain in knowledge and skills of neonatal resuscitation using tele-education instruction vs conventional classroom teaching. This randomized controlled trial was conducted in the tele-education facility of a tertiary care center. In-service staff nurses were randomized to receive training by tele-education instruction (TI, n=26) or classroom teaching (CT, n=22) method from two neonatology instructors using a standardized teaching module on neonatal resuscitation. Gain in knowledge and skill scores of neonatal resuscitation were measured using objective assessment methods. Age, educational qualification and professional experience of the participants in two groups were comparable. Pre-training mean knowledge scores were higher in TI group (8.3±1.7 vs 6.6±1.4, P=0.004). However, skill scores were comparable in the two groups (11.7±3 vs 10.3±2.9, P=0.13). Training resulted in a significant and comparable gain in knowledge scores (4.2±2.2 vs 5.3±1.7; P=0.06) and skills scores (4.5±3.3 vs 5.0±3.1, P=0.62) in both the groups. The post-training knowledge scores (TI: 12.5±1.7 vs CT: 12.0±1.7, P=0.37) and the post-training skill scores (TI: 16.0±0.5 vs CT: 15.6±2.5, P=0.55) were comparable in the two groups. However, the post-training scores, adjusted for baseline knowledge scores, were statistically higher in the in-person group compared with the telemedicine group (knowledge: 12.46±0.03 vs 12.16±0.01, P=0.00; skills: 15.6±2.5 vs 16.0±2.8, P=0.00). The quantum of lower scores in the telemedicine group was only 2% for knowledge and 6% for skills. This difference was felt to be of only marginal importance. Satisfaction scores among trainees and instructors were comparable in the two groups. Tele-education offers a feasible and effective alternative to conventional training in neonatal resuscitation among health-care providers.

A Browser-Server-Based Tele-audiology System That Supports Multiple Hearing Test Modalities.

Science.gov (United States)

Yao, Jianchu Jason; Yao, Daoyuan; Givens, Gregg

2015-09-01

Millions of global citizens suffering from hearing disorders have limited or no access to much needed hearing healthcare. Although tele-audiology presents a solution to alleviate this problem, existing remote hearing diagnosis systems support only pure-tone tests, leaving speech and other test procedures unsolved, due to the lack of software and hardware to enable communication required between audiologists and their remote patients. This article presents a comprehensive remote hearing test system that integrates the two most needed hearing test procedures: a pure-tone audiogram and a speech test. This enhanced system is composed of a Web application server, an embedded smart Internet-Bluetooth(®) (Bluetooth SIG, Kirkland, WA) gateway (or console device), and a Bluetooth-enabled audiometer. Several graphical user interfaces and a relational database are hosted on the application server. The console device has been designed to support the tests and auxiliary communication between the local site and the remote site. The study was conducted at an audiology laboratory. Pure-tone audiogram and speech test results from volunteers tested with this tele-audiology system are comparable with results from the traditional face-to-face approach. This browser-server-based comprehensive tele-audiology offers a flexible platform to expand hearing services to traditionally underserved groups.

Tele-Lab IT-Security: an Architecture for an online virtual IT Security Lab

Directory of Open Access Journals (Sweden)

Christoph Meinel

2008-05-01

Full Text Available Recently, Awareness Creation in terms of IT security has become a big thing – not only for enterprises. Campaigns for pupils try to highlight the importance of IT security even in the user’s early years. Common practices in security education – as seen in computer science courses at universities – mainly consist of literature and lecturing. In the best case, the teaching facility offers practical courses in a dedicated isolated computer lab. Additionally, there are some more or less interactive e-learning applications around. Most existing offers can do nothing more than impart theoretical knowledge or basic information. They all lack of possibilities to provide practical experience with security software or even hacker tools in a realistic environment. The only exceptions are the expensive and hard-to-maintain dedicated computer security labs. Those can only be provided by very few organizations. Tele-Lab IT-Security was designed to offer hands-on experience exercises in IT security without the need of additional hardware or maintenance expenses. The existing implementation of Tele-Lab even provides access to the learning environment over the Internet – and thus can be used anytime and anywhere. The present paper describes the extended architecture on which the current version of the Tele-Lab server is built.

Clinical Efficacy of Transthoracic Echocardiography for Screening Abdominal Aortic Aneurysm in Turkish Patients.

Science.gov (United States)

Kilic, Salih; Saracoglu, Erhan; Cekici, Yusuf

2018-03-01

The objective of this study was to investigate the prevalence of abdominal aortic aneurysm (AAA) in Turkish patients aged ≥ 65 years, and to demonstrate the applicability of echocardiography to AAA screening. Transthoracic echocardiography (TTE) was performed in all consecutive patients aged ≥ 65 years who were referred to cardiology clinics or were referred from other outpatient clinics. The abdominal aorta (AA) of each patient was scanned using the same probe, and the time spent was recorded. Demographic and clinic characteristics of the patients were recorded at the end of the echocardiography. Among 1948 patients (mean age 70.9 ± 6 years; 49.8% male), the AA was visualized in 96.3%. AAA was identified in 3.7% (69/1878) of the patients, of whom AAA was previously known in 20.3% (n = 14). The prevalence of unknown AAA was 2.93%. The average time needed to scan and measure the AA was 1 minute and 3 seconds (±23 seconds). Aortic root diameters were significantly higher in the patients with AAA than in those without AAA (34.7 ± 4.2 vs. 29.8 ± 4.7; p < 0.001). Age (per 1 year increase) [odds ratio (OR), 1.245; p < 0.001], male gender (OR, 5.382; p < 0.001), smoking (OR, 2.118; p = 0.037), and aortic root diameter (per 1 mm increase) (OR, 1.299; p < 0.001) were independent predictors of AAA. This study is important in that it showed a high prevalence of AAA in Turkish patients aged ≥ 65 years, and demonstrated that AAA can be visualized in the majority of patients in as little as 1 minute during TTE.

Detection of congenital heart disease by fetal echocardiography

International Nuclear Information System (INIS)

Fayyaz, A.; Majeed, S.M.I.

2013-01-01

Objective: The objective of the study was to determine the sensitivity, specificity, accuracy and predictive value of fetal echocardiography in our set up using postnatal echocardiography as gold standard. Study Design: Validation study. Place and Duration of study: This is an ongoing study in the Radiology department of CMH Rawalpindi and Armed Forces Institute of Cardiology (AFIC) Rawalpindi and the data collected from January 2007 to Jan 2012 is presented. Patients and Methods: Two hundred eighty seven patients reported for fetal echocardiography. Two hundred twenty nine patients were subsequently included in the study. These included patients of all ages who reported to the Radiology department of CMH Rawalpindi for fetal echocardiography. Fetal echo was done on Toshiba Aplio with 3.5 MHz probe having Doppler facility. Post natal evaluation was done by a pediatric cardiologist. Results: There were 207 (90.4%) true negative cases, 15 (6.6%) true positive, 2 (0.9%) false positive and 6 (2.2%) false negative cases. The sensitivity, specificity, positive and negative predictive values were 75%, 99%, 88%, 97% respectively. Conclusion: Fetal echocardiography has high specificity, negative predictive values and accuracy and cases diagnosed as normal can reassure the parents about the normal cardiac status of the fetus. (author)

[Second victim : Critical incident stress management in clinical medicine].

Science.gov (United States)

Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A

2013-09-01

Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

The Relationship Between Second Language Anxiety and International Nursing Students Stress

Science.gov (United States)

Khawaja, Nigar G.; Chan, Sabrina; Stein, Georgia

2017-01-01

We examined the relationship between second language anxiety and international nursing student stress after taking into account the demographic, cognitive, and acculturative factors. International nursing students (N = 152) completed an online questionnaire battery. Hierarchical regression analysis revealed that spoken second language anxiety and…

The role of echocardiography in diagnosis and follow up of patients with takotsubo cardiomyopathy or acute ballooning syndrome.

Science.gov (United States)

Naser, Nabil; Buksa, Marko; Kusljugic, Zumreta; Terzic, Ibrahim; Sokolovic, Sekib; Hodzic, Enisa

2011-01-01

The transient left ventricular apical ballooning syndrome, also known as takotsubo cardiomyopathy was first described in Japan approximately 20 years ago (Satoh and coworkers, 1991). It was later described elsewhere as well and is being increasingly recognized. Takotsubo Cardiomyopathy characterized by transient apical and midventricular LV dysfunction in the absence of significant coronary artery disease that is triggered by emotional or physical stress. Its name refers to a contraption used for catching octopuses and suggests the aspect assumed by the ventricle during the systole due to the typical regional wall motion abnormalities that occur after onset. Takotsubo cardiomiopathy occurring mainly in post-menopausal women, echocardiography in the Takotsubo cardiomyopathy reveals during its acute phase a ballooning resembling the octopus trap configuration--the apex and lateral ventricular segments are hypokinetic while the base is hyperkinetic--along with reduced ejection fraction. Ventricular function will usually recover within a few days/weeks. The objective of this study is to determine the role of echocardiography in detecting and establishing the diagnosis of Takotsubo cardiomiopathy in patients with suspect acute coronary syndrome and during the follow up period. The study covered 12 adult patients the majority are women (92%) who were subjected to echocardiography evaluation as part of the clinical cardiological examination due to suspect acute coronary syndrome or Takotsubo Stress Cardiomyopathy. The patients were examined on an ultrasound machine Philips iE 33 x Matrix, ATL HDI and GE Vived 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated clinical characteristics, LV systolic function, biomarkers, and prognosis in all patients. Among all the patients referred for Echocardiographic evaluation for left ventricle motion abnormalities with suspect acute coronary syndrome, the echo exam revealed 12 patients with acute

Improvement of stress-rupture life of GTD-111 by second solution heat treatment

International Nuclear Information System (INIS)

Yang, Caixiong; Xu, Yulai; Zhang, Zixing; Nie, Heng; Xiao, Xueshan; Jia, Guoqing; Shen, Zhi

2013-01-01

Highlights: ► The second solution heat treatment promoted the solution of γ–γ′ eutectic into γ matrix. ► The volume fraction of γ′ increases significantly after adding the second solution heat treatment. ► The improved stress-rupture life is primarily due to the increased volume fraction of γ′ phase. -- Abstract: An added second solution heat treatment was conducted to investigate its effects on the microstructures and stress-rupture properties of GTD-111. The microstructures were analyzed by scanning electron microscope after each step of heat treatments. The stress-rupture life of GTD-111 dramatically increases from about 180 to 288 h at 871 °C/310 MPa after adding a second solution heat treatment. The added second solution heat treatment promoted the solution of γ–γ′ eutectic into γ matrix, and facilitated the nucleation and precipitate of the secondary γ′ particles. The distribution of γ′ phase becomes much denser, the width of γ matrix channel is also reduced, and the volume fraction of γ′ phase significantly increases from about 29.3% to 44.2%. The improved stress-rupture life is primarily due to the increased volume fraction of γ′ phase. The carbides mainly consist of MC and a small amount of M 23 C 6 , which may prevent the dislocation moving and/or grain boundary sliding, and further improve the stress-rupture properties of GTD-111.

Effects of home-based tele-exercise on sarcopenia among community-dwelling elderly adults: Body composition and functional fitness.

Science.gov (United States)

Hong, Jeeyoung; Kim, Jeongeun; Kim, Suk Wha; Kong, Hyoun-Joong

2017-01-01

This study aims to develop a form of tele-exercise that would enable real-time interactions between exercise instructors and community-dwelling elderly people and to investigate its effects on improvement of sarcopenia-related factors of body composition and functional fitness among the elderly. Randomized, controlled trial, with a 12-week intervention period. Community-dwelling senior citizens in Gangseo-gu, Seoul, South Korea. The participants were 23 elderly individuals (tele-exercise group: 11, control group: 12), aged 69 to 93years. The tele-exercise program was developed utilizing a 15-in. all-in-one PC and video conferencing software (Skype™), with broadband Internet connectivity. The tele-exercise group performed supervised resistance exercise at home for 20-40min a day three times per week for 12weeks. The remote instructor provided one-on-one instruction to each participant during the intervention. The control group maintained their lifestyles without any special intervention. The sarcopenia-related factors of body composition and functional fitness were examined prior to, as well as following, a 12-week intervention period. The data were analyzed with a two-way repeated measures ANOVA. There were significant improvements in lower limb muscle mass (p=0.017), appendicular lean soft tissue (p=0.032), total muscle mass (p=0.033), and chair sit-and-reach length (p=0.019) for the tele-exercise group compared to the control group. No group×time interaction effects were detected for the 2-min step, chair stand, and time effects (psarcopenia-related factors such as total-body skeletal muscle mass, appendicular lean soft tissue, lower limb muscle mass, and the chair sit-and-reach scores among community-dwelling elderly adults. These results imply that tele-exercise can be a new and effective intervention method for increasing skeletal muscle mass and the physical functioning of the lower limbs from the perspective of sarcopenia improvement among the elderly

Radiological Protection and Quality Assurance in Health Sciences: Tele-Education for continued Postgraduate Training

International Nuclear Information System (INIS)

Alcaraz, M.; Chico, P.; Armero, D.; Saura Iniesta, A. M.; Vicente, V.

2003-01-01

The establishment of an inter departmental project, financed by the Spanish Ministry of Education, has made possible the development to specific didactic materials on Radiological Protection and Quality Assurance in Medical Radiodiagnostic Practices. These have been published as a manual and practical notebook. This material constitutes the grounding work for the first continuous tele-education training course via Internet that Spanish professionals exposed to ionising radiation are following. Interactive multimedia training and tele-education may become one of the alternatives that allow health science professionals to receive continuous training, provided that adequate content and aims had been established during undergraduate training. (Author) 18 refs

Tele Hyper Virtuality

Science.gov (United States)

Terashima, Nobuyoshi

1994-01-01

In the future, remote images sent over communication lines will be reproduced in virtual reality (VR). This form of virtual telecommunications, which will allow observers to engage in an activity as though it were real, is the focus of considerable attention. Taken a step further, real and unreal objects will be placed in a single space to create an extremely realistic environment. Here, imaginary and other life forms as well as people and animals in remote locations will gather via telecommunication lines that create a common environment where life forms can work and interact together. Words, gestures, diagrams and other forms of communication will be used freely in performing work. Actual construction of a system based on this new concept will not only provide people with experiences that would have been impossible in the past, but will also inspire new applications in which people will function in environments where it would have been difficult if not impossible for them to function until now. This paper describes Tele Hyper Virtuality concept, its definition, applications, the key technologies to accomplish it and future prospects.

A study on maternal-fetal attachment in pregnant women undergoing fetal echocardiography

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Concetta Polizzi

2017-03-01

Full Text Available Purpose: To investigate the possible effects of the fetal echocardiography experience on the prenatal attachment process. The predictive effect of specific women’s psychological variables will be explored as well.Design and methods: This between groups study involved 85 women with pregnancy at risk who underwent the fetal echocardiography, and 83 women who were about to undergo the morphological scan. The tools employed were: the Prenatal Attachment Inventory (P.A.I. to explore the maternal-fetal attachment; the Maternity Social Support Scale to investigate the woman perception of being socially supported during pregnancy; both the Big Five Questionnaire and the FACES III to explore the personality traits of pregnant women and their perception of their couple relationship functioning.Findings: The outcomes of ANOVA do not show statistically significant differences between the two groups of the mothers-to-be with regard to the scores of the P.A.I. (F = .017; p = .897; η2 = .000, while the regression analysis of the possible effect of the maternal psychological variables on the mother-fetus relationship shows a statistically significant result only with regard to the “social support” variable (r2 = .061; df = 80; p = .025.Conclusions: It would seem that the process of the prenatal attachment develops independently whether the woman has to undergo a first level screening or a second level examination such as the fetal echocardiography.

Mobile application development for Tele-ECG

International Nuclear Information System (INIS)

Srivastava, Shikha; Bharade, Sandeep; Sinha, Vineet; Sarade, Bhagyashree; Jindal, G.D.; Ananthakrishnan, T.S.; Pithawa, C.K.

2010-01-01

Mobile computing has caught the attention of research community for quite some time. The constant improvement of hardware and software related to mobile computing (e.g. better computing power, larger wireless network bandwidth) clearly enhance capabilities of mobile devices. The acceptance of mobile technology by the population at large would suggest that this could be the basis of a system for the communication of medical data from patients to remote physician and vice versa. This paper presents a mobile solution, which makes use of a Tele-ECG unit with a mobile phone to collect, store and forward ECG data to a cardiologist for diagnosis and recommendation. (author)

"3D fusion" echocardiography improves 3D left ventricular assessment: comparison with 2D contrast echocardiography.

Science.gov (United States)

Augustine, Daniel; Yaqub, Mohammad; Szmigielski, Cezary; Lima, Eduardo; Petersen, Steffen E; Becher, Harald; Noble, J Alison; Leeson, Paul

2015-02-01

Three-dimensional fusion echocardiography (3DFE) is a novel postprocessing approach that utilizes imaging data acquired from multiple 3D acquisitions. We assessed image quality, endocardial border definition, and cardiac wall motion in patients using 3DFE compared to standard 3D images (3D) and results obtained with contrast echocardiography (2DC). Twenty-four patients (mean age 66.9 ± 13 years, 17 males, 7 females) undergoing 2DC had three, noncontrast, 3D apical volumes acquired at rest. Images were fused using an automated image fusion approach. Quality of the 3DFE was compared to both 3D and 2DC based on contrast-to-noise ratio (CNR) and endocardial border definition. We then compared clinical wall-motion score index (WMSI) calculated from 3DFE and 3D to those obtained from 2DC images. Fused 3D volumes had significantly improved CNR (8.92 ± 1.35 vs. 6.59 ± 1.19, P echocardiography (1.06 ± 0.09 vs. 1.07 ± 0.15, P = 0.69), whereas unfused images produced significantly more variable results (1.19 ± 0.30). This was confirmed by a better intraclass correlation coefficient (ICC 0.72; 95% CI 0.32-0.88) relative to comparisons with unfused images (ICC 0.56; 95% CI 0.02-0.81). 3DFE significantly improves left ventricular image quality compared to unfused 3D in a patient population and allows noncontrast assessment of wall motion that approaches that achieved with 2D contrast echocardiography. © 2014, Wiley Periodicals, Inc.

A novel approach to haptic tele-operation of aerial robot vehicles

NARCIS (Netherlands)

Stramigioli, Stefano; Mahony, Robert; Corke, Peter

2010-01-01

We present a novel, simple and effective approach for tele-operation of aerial robotic vehicles with haptic feedback. Such feedback provides the remote pilot with an intuitive feel of the robot's state and perceived local environment that will ensure simple and safe operation in cluttered 3D

Head-to-head comparison of peak supine bicycle exercise echocardiography and treadmill exercise echocardiography at peak and at post-exercise for the detection of coronary artery disease.

Science.gov (United States)

Peteiro, Jesús; Bouzas-Mosquera, Alberto; Estevez, Rodrigo; Pazos, Pablo; Piñeiro, Miriam; Castro-Beiras, Alfonso

2012-03-01

Supine bicycle exercise (SBE) echocardiography and treadmill exercise (TME) echocardiography have been used for evaluation of coronary artery disease (CAD). Although peak imaging acquisition has been considered unfeasible with TME, higher sensitivity for the detection of CAD has been recently found with this method compared with post-TME echocardiography. However, peak TME echocardiography has not been previously compared with the more standardized peak SBE echocardiography. The aim of this study was to compare peak TME echocardiography, peak SBE echocardiography, and post-TME echocardiography for the detection of CAD. A series of 116 patients (mean age, 61 ± 10 years) referred for evaluation of CAD underwent SBE (starting at 25 W, with 25-W increments every 2-3 min) and TME with peak and postexercise imaging acquisition, in a random sequence. Digitized images at baseline, at peak TME, after TME, and at peak SBE were interpreted in a random and blinded fashion. All patients underwent coronary angiography. Maximal heart rate was higher during TME, whereas systolic blood pressure was higher during SBE, resulting in similar rate-pressure products. On quantitative angiography, 75 patients had coronary stenosis (≥50%). In these patients, wall motion score indexes at maximal exercise were higher at peak TME (median, 1.45; interquartile range [IQR], 1.13-1.75) than at peak SBE (median, 1.25; IQR, 1.0-1.56) or after TME (median, 1.13; IQR, 1.0-1.38) (P = .002 between peak TME and peak SBE imaging, P peak TME (median, 5; IQR, 2-12) compared with peak SBE (median, 3; IQR, 0-8) or after TME (median, 2; IQR, 0-4) (P peak TME and peak SBE imaging, P peak TME, peak SBE, and post-TME echocardiography for CAD was 84%, 75%, and 60% (P = .001 between post-TME and peak TME echocardiography, P = .055 between post-TME and peak SBE echocardiography), with specificity of 63%, 80%, and 78%, respectively (P = NS) and accuracy of 77%, 77%, and 66%, respectively (P = NS). Peak TME

Technetium-99m sestamibi myocardial tomography based on dipyridamole echocardiography testing in hypertensive patients with chest pain

Energy Technology Data Exchange (ETDEWEB)

Schillaci, O. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy); Moroni, C. [Department of Internal Medicine, University ``La Sapienza``, Rome (Italy); Scopinaro, F. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy); Tavolaro, R. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy); Danieli, R. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy); Bossini, A. [Department of Internal Medicine, University ``La Sapienza``, Rome (Italy); Cassone, R. [Department of Internal Medicine, University ``La Sapienza``, Rome (Italy); Colella, A.C. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy)

1997-07-01

The aim of this study was to evaluate the diagnostic capability of technetium-99m sestamibi tomography based on dipyridamole echocardiography testing in hypertensives with chest pain, and to compare the scintigraphic results with those of coronary angiography, exercise electrocardiography and dipyridamole echocardiography. Forty subjects with mild to moderate hypertension, chest pain and no previous myocardial infarction were submitted to {sup 99m}Tc-sestamibi tomography (at rest and after high-dose dipyridamole echocardiography) and to exercise electrocardiography testing. At coronary angiography 22 patients (group A) had significant epicardial coronary artery disease ({>=}70% stenosis of at least one major vessel) and 18 normal main coronary vessels (group B). Dipyridamole {sup 99m}Tc-sestamibi imaging was positive in 21/22 patients of group A and in 5/18 of group B. Dipyridamole echocardiography was positive in 18/22 patients of group A and in 5/18 of group B. Exercise electrocardiography was positive in 15/22 patients of group A and in 11/18 of group B. Four out of five subjects in group B with positive results in all the tests showed a slow run-off of angiographic contrast medium, probably due to small-vessel disease. Significant epicardial coronary artery disease in hypertensives with chest pain is unlikely when dipyridamole {sup 99m}Tc-sestamibi tomography is negative. When scintigraphy is positive, either epicardial coronary artery disease or a small-vessel disease condition is possible. The association of scintigraphy with dipyridamole echocardiography testing allows the assessment of contractile function and myocardial perfusion by a single pharmacological stress. (orig./AJ). With 3 figs., 2 tabs.

3D Harmonic Echocardiography:

NARCIS (Netherlands)

M.M. Voormolen (Marco)

2007-01-01

textabstractThree dimensional (3D) echocardiography has recently developed from an experimental technique in the ’90 towards an imaging modality for the daily clinical practice. This dissertation describes the considerations, implementation, validation and clinical application of a unique

A Bio-Inspired Model-Based Approach for Context-Aware Post-WIMP Tele-Rehabilitation

Directory of Open Access Journals (Sweden)

Víctor López-Jaquero

2016-10-01

Full Text Available Tele-rehabilitation is one of the main domains where Information and Communication Technologies (ICT have been proven useful to move healthcare from care centers to patients’ home. Moreover, patients, especially those carrying out a physical therapy, cannot use a traditional Window, Icon, Menu, Pointer (WIMP system, but they need to interact in a natural way, that is, there is a need to move from WIMP systems to Post-WIMP ones. Moreover, tele-rehabilitation systems should be developed following the context-aware approach, so that they are able to adapt to the patients’ context to provide them with usable and effective therapies. In this work a model-based approach is presented to assist stakeholders in the development of context-aware Post-WIMP tele-rehabilitation systems. It entails three different models: (i a task model for designing the rehabilitation tasks; (ii a context model to facilitate the adaptation of these tasks to the context; and (iii a bio-inspired presentation model to specify thoroughly how such tasks should be performed by the patients. Our proposal overcomes one of the limitations of the model-based approach for the development of context-aware systems supporting the specification of non-functional requirements. Finally, a case study is used to illustrate how this proposal can be put into practice to design a real world rehabilitation task.

Echocardiography in Infective Endocarditis: State of the Art.

Science.gov (United States)

Afonso, Luis; Kottam, Anupama; Reddy, Vivek; Penumetcha, Anirudh

2017-10-25

In this review, we examine the central role of echocardiography in the diagnosis, prognosis, and management of infective endocarditis (IE). 2D transthoracic echocardiography (TTE) and transesophageal echocardiography TEE have complementary roles and are unequivocally the mainstay of diagnostic imaging in IE. The advent of 3D and multiplanar imaging have greatly enhanced the ability of the imager to evaluate cardiac structure and function. Technologic advances in 3D imaging allow for the reconstruction of realistic anatomic images that in turn have positively impacted IE-related surgical planning and intervention. CT and metabolic imaging appear to be emerging as promising ancillary diagnostic tools that could be deployed in select scenarios to circumvent some of the limitations of echocardiography. Our review summarizes the indispensable and central role of various echocardiographic modalities in the management of infective endocarditis. The complementary role of 2D TTE and TEE are discussed and areas where 3D TEE offers incremental value highlighted. An algorithm summarizing a contemporary approach to the workup of endocarditis is provided and major societal guidelines for timing of surgery are reviewed.

Ocio estético valioso en la Poética de Aristóteles

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Mª Luisa Amigo Fernández De Arroyabe

2015-01-01

Full Text Available Este artículo se centra en el ocio estético valioso en Aristóteles, partiendo del análisis de la Poética y, específicamente, de la comprensión de la experiencia estética como actividad mental. Se destaca su dimensión ética, realzando su valor en el desarrollo del ser humano, así como el de la propia obra de arte, en la medida en que el poeta ha sabido construirla, encarnando en la trama los hechos y universalizándolos, al modo que le es propio. Aristóteles se refiere a la tragedia, pero por extensión esta valoración proporciona una pauta de lectura de la experiencia de ocio estético. El marco autónomo para el ámbito estético, que inaugura Aristóteles, y su valoración vinculada a la dimensión ética, a la comprensión intelectual y al placer estético proporcionan la base para sostener que el ocio estético se confirma como un horizonte enmarcado en la senda de lo valioso y adecuado para realizar la vida que le es propia al ser humano.

Histamine and tele-methylhistamine quantification in cerebrospinal fluid from narcoleptic subjects by liquid chromatography tandem mass spectrometry with precolumn derivatization.

Science.gov (United States)

Croyal, Mikaël; Dauvilliers, Yves; Labeeuw, Olivier; Capet, Marc; Schwartz, Jean-Charles; Robert, Philippe

2011-02-01

An ultra-performance liquid chromatography tandem mass spectrometry (UPLC™-MS/MS) assay was developed for the simultaneous analysis of histamine, its major metabolite tele-methylhistamine, and an internal standard (N-tele-(R)-α-dimethylhistamine) from human cerebrospinal fluid (CSF) samples. The method involves derivatization of primary amines with 4-bromobenzenesulfonyl chloride and subsequent analysis by reversed phase liquid chromatography with mass spectrometry detection and positive electrospray ionization. The separation of derivatized biogenic amines was achieved within 3.5 min on an Acquity® BEH C(18) column by elution with a linear gradient of acetonitrile/water/formic acid (0.1%). The assay was linear in the concentration range of 50-5000 pM for each amine (5.5-555 pg/ml for histamine and 6.25-625 pg/ml for tele-methylhistamine). For repeatability and precision determination, coefficients of variation (CVs) were less than 11.0% over the tested concentration ranges, within acceptance criteria. Thus, the developed method provides the rapid, easy, highly sensitive, and selective requirement to quantify these amines in human CSF. No significant difference was found in the mean ± standard error levels of these amines between a group of narcoleptic patients (histamine=392 ± 64 pM, tele-methylhistamine=2431 ± 461 pM, n=7) and of neurological control subjects (histamine=402 ± 72 pM, tele-methylhistamine=2209 ± 463 pM, n=32). Copyright © 2010 Elsevier Inc. All rights reserved.

Contradictions and Consensus--Clusters of Opinions on E-Books

Science.gov (United States)

Shrimplin, Aaron K.; Revelle, Andy; Hurst, Susan; Messner, Kevin

2011-01-01

Q methodology was used to determine attitudes and opinions about e-books among a group of faculty, graduate students, and undergraduates at Miami University of Ohio. Oral interviews formed the basis for a collection of opinion statements concerning e-books versus print. These statements were then ranked by a second group of research participants.…

Development Of A Mobile Robot As A Test Bed For Tele-Presentation

Directory of Open Access Journals (Sweden)

Diogenes Armando D. Pascua

2016-01-01

Full Text Available In this paper a human-sized tracked wheel robot with a large payload capacity for tele-presentation is presented. The robot is equipped with different sensors for obstacle avoidance and localization. A high definition web camera installed atop a pan and tilt assembly was in place as a remote environment feedback for users. An LCD monitor provides the visual display of the operator in the remote environment using the standard Skype teleconferencing software. Remote control was done via the internet through the free Teamviewer VNC remote desktop software. Moreover, this paper presents the design details, fabrication and evaluation of individual components. Core mobile robot movement and navigational controls were developed and tested. The effectiveness of the mobile robot as a test bed for tele-presentation were evaluated and analyzed by way of its real time response and time delay effects of the network.

Development of a Mobile Robot as a Test Bed for Tele-Presentation

Directory of Open Access Journals (Sweden)

Diogenes Armando D. Pascua

2016-05-01

Full Text Available In this paper a human-sized tracked wheel robot with a large payload capacity for tele-presentation is presented. The robot is equipped with different sensors for obstacle avoidance and localization. A high definition web camera installed atop a pan and tilt assembly was in place as a remote environment feedback for users. An LCD monitor provides the visual display of the operator in the remote environment using the standard Skype teleconferencing software. Remote control was done via the internet through the free Teamviewer VNC remote desktop software. Moreover, this paper presents the design details, fabrication and evaluation of individual components. Core mobile robot movement and navigational controls were developed and tested. The effectiveness of the mobile robot as a test bed for tele-presentation were evaluated and analyzed by way of its real time response and time delay effects of the network

An intelligent tele-healthcare environment offering person-centric and wellness-maintenance services.

Science.gov (United States)

Abidi, S S

2001-06-01

Worldwide healthcare delivery trends are undergoing a subtle paradigm shift--patient centered services as opposed to provider centered services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE--Tele-Healthcare Information and Diagnostic Environment. TIDE manifests an 'intelligent' healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services--i.e., both wellness maintenance and illness management services--ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role--spanning from wellness to illness issues--the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro-active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies--Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics--to implement a sophisticated healthcare delivery infostructure.

The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal

Science.gov (United States)

Gaspar, Heloisa Amaral; Morhy, Samira Saady

2015-01-01

Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged. PMID:26605333

Echocardiography in Ebstein's anomaly

NARCIS (Netherlands)

W.J. Gussenhoven (Wilhelmina Johanna)

1984-01-01

textabstractIn this thesis the value of echocardiography is evaluated for the diagnosis of Ebstein's anomaly of the tricuspid valve. This congenital heart defect, first described in 1866 by Wilhelm Ebstein, is characterized by an apical displacement of the septal and inferior tricuspid valve

More than 30 years of opinion of French people on nuclear risks - Special release of the 2012 IRSN opinion survey

International Nuclear Information System (INIS)

El Jammal, Marie-Helene; Rollinger, Francois; Mur, Emmanuelle; Schuler, Matthieu; Tchernia, Jean-Francois

2013-01-01

Illustrated by many graphs and tables, this report comments and discusses the evolution of opinion surveys performed in France on the perception of nuclear risks through thirty annual IRSN opinion surveys. It appears that the opinion on nuclear is rather steady, and that French people have a rather rational perception of risk hierarchy. The first part outlines that unemployment is the main concern for French people, and that environmental concerns depend on current events. The second part analyses the perception of the nuclear risk with respect to other societal concerns and to other risks, and discusses the evolution of opinion from a quantitative to a qualitative sensitivity. The third part addresses the representations people have of nuclear activities and how they challenge the reality: perception of nuclear plants and of radioactive wastes, fear of a serious accident. The last part deals with issues related to responsibilities, abilities and governance: how actors of nuclear risk management are perceived, and expectations in terms of transparency and opinion plurality

Color M-mode and pulsed wave tissue Doppler echocardiography

DEFF Research Database (Denmark)

Møller, J E; Søndergaard, E; Poulsen, S H

2001-01-01

To assess the association between color M-mode flow propagation velocity and the early diastolic mitral annular velocity (E(m)) obtained with tissue Doppler echocardiography and to assess the prognostic implications of the indexes, echocardiography was performed on days 1 and 5, and 1 and 3 month...

Role of echocardiography in the evaluation of syncope: a prospective study

Science.gov (United States)

Sarasin, F P; Junod, A-F; Carballo, D; Slama, S; Unger, P-F; Louis-Simonet, M

2002-01-01

Objective: To study the role of echocardiography in the stepwise evaluation of syncope. Design: A prospective observational study with an 18 month follow up. Setting: University teaching hospital providing primary and tertiary care. Subjects: 650 consecutive patients with syncope and clinical suspicion of an obstructive valvar lesion, or with syncope not explained by history, physical examination, or a 12 lead ECG, who underwent bidimensional Doppler transthoracic echocardiography. Main outcome measures: The causes of syncope were assigned using published diagnostic criteria. Echocardiography was considered diagnostic when confirming a suspected diagnosis, or when revealing occult cardiac disease explaining the syncope. Results: A systolic murmur was identified in 61 of the 650 patients (9%). Severe aortic stenosis was suspected in 20 of these and was confirmed by echocardiography in eight. Follow up excluded further cases of aortic stenosis. In patients with unexplained syncope (n = 155), routine echocardiography showed no abnormalities that established the cause of the syncope. Echocardiography was normal or non-relevant in all patients with a negative cardiac history and a normal ECG (n = 67). In patients with a positive cardiac history or an abnormal ECG (n = 88), echocardiography showed systolic dysfunction (left ventricular ejection fraction ≤ 40%) in 24 (27%) and minor non-relevant findings in the remaining 64. Arrhythmias were diagnosed in 12 of the 24 patients with systolic dysfunction (50%), and in 12 of the 64 remaining patients (19%) (p < 0.01). Conclusions: Echocardiography was most useful for assessing the severity of the underlying cardiac disease and for risk stratification in patients with unexplained syncope but with a positive cardiac history or an abnormal ECG. PMID:12231593

Imaging the heart: cardiac scintigraphy and echocardiography in US hospitals (1983)

International Nuclear Information System (INIS)

McPhee, S.J.; Garnick, D.W.

1986-01-01

The rapid growth of cardiac catheterization has raised questions about the availability of less costly, noninvasive tests such as cardiac scintigraphy and echocardiography. To assess their availability and rates of use, we surveyed 3778 non-federal short-term US hospitals in June, 1983. Overall, 2605 hospitals (69%) offered 201 Tl myocardial perfusion scans, 2580 (68%) 99mTc equilibrium gated blood pool scans, and 2483 (67%) cardiac shunt scans; 1679 hospitals (44%) offered M-mode and/or 2-dimensional echocardiography, and 768 (20%) pulsed Doppler echocardiography. Volumes of procedures varied enormously among hospitals capable of performing them. High volumes of both scintigraphy and echocardiography were performed in a small number of hospitals. Larger, voluntary, and teaching hospitals performed higher volumes of both procedures. Despite widespread availability of these noninvasive technologies, high volumes of both cardiac scintigraphy and echocardiography procedures are concentrated in a small number of US hospitals

A case of complete double aortic arch visualized by transthoracic echocardiography.

Science.gov (United States)

Saito, Naka; Kato, Shingo; Saito, Noritaka; Nakachi, Tatsuya; Fukui, Kazuki; Iwasawa, Tae; Kosuge, Masami; Kimura, Kazuo

2017-08-01

A case of double aortic arch that was well visualized using transthoracic echocardiography is reported. A 38-year-old man underwent transthoracic echocardiography for the evaluation of dyspnea. A suprasternal view of transthoracic echocardiography showed the ascending aorta bifurcate to left and right aortic arches, with blood flow from the ascending aorta to bilateral aortic arches. The diagnosis of right side-dominant double aortic arch was made, and the patient's symptom was conceivably related to compression of the trachea due to a vascular ring. This report indicates the potential usefulness of transthoracic echocardiography for noninvasive detection of double aortic arch in adults. © 2017, Wiley Periodicals, Inc.

Aristóteles: justicia y eudaimonia. Una investigación sobre la ética neoaristotélica

OpenAIRE

Clusa Capell, Josep

2015-01-01

El objetivo de la tesis es hacer una contribución al debate entre la ética neoaristotélica contemporánea y sus rivales —las éticas deontológica y consecuencialista— por medio de un análisis de los conceptos de justicia y eudaimonia en Aristóteles. Los filósofos morales neoaristotélicos (autores como Elizabeth Anscombe, Philippa Foot, o Julia Annas) asumen, como Aristóteles, una conexión esencial entre ambos conceptos: la justicia constituye un ingrediente indispensable de la eudaimonia. En ca...

Targeted neonatal echocardiography services: need for standardized training and quality assurance.

Science.gov (United States)

Finan, Emer; Sehgal, Arvind; Khuffash, Afif El; McNamara, Patrick J

2014-10-01

Targeted neonatal echocardiography refers to a focused assessment of myocardial performance and hemodynamics directed by a specific clinical question. It has become the standard of care in many parts of the world, but practice is variable, and there has been a lack of standardized training and evaluation to date. Targeted neonatal echocardiography was first introduced to Canada in 2006. The purpose of this study was to examine the characteristics of targeted neonatal echocardiography practice and training methods in Canadian neonatal intensive care units (NICUs). A total of 142 Canadian neonatologists were invited to participate in an online survey, which was conducted in September 2010. The survey consisted of questions related to the availability of targeted neonatal echocardiography, clinical indications, benefits and risks, and training methods. The overall survey response rate was 65%. Forty-eight respondents (34%) indicated that targeted neonatal echocardiography was available in their units, and the program was introduced within the preceding 1 to 5 years. In centers where it was unavailable, lack of on-site echocardiography expertise was cited as the major barrier to implementation. The most common indications for targeted neonatal echocardiography included evaluation of a hemodynamically significant ductus arteriosus, systemic or pulmonary blood flow, and response to cardiovascular treatments. Only 27% of respondents, working in centers where targeted neonatal echocardiography existed, actually performed the studies themselves; most individuals completed 11 to 20 studies per month. Almost half of the respondents said that training was available in their institutions, but methods of training and evaluation were inconsistent. Eighty-seven percent of respondents reported no formalized process for assessment of ongoing competency after the initial training period. Targeted neonatal echocardiography is becoming more widely available and is gaining acceptance in

Second trimester cardiac diagnosis : screening standards and outcomes

NARCIS (Netherlands)

Clur, Sally-Ann B.; Bilardo, Caterina M.

2014-01-01

Second trimester screening for congenital heart defects occurs during the routine 18-20 weeks' anomaly scan in many countries. Most congenital heart defects can be prenatally detected by experts in foetal echocardiography working in tertiary centres with high-risk pregnancies. Many studies, however,

Second trimester cardiac diagnosis: screening standards and outcomes

NARCIS (Netherlands)

Clur, Sally-Ann B.; Bilardo, Caterina M.

2014-01-01

Second trimester screening for congenital heart defects occurs during the routine 18-20 weeks' anomaly scan in many countries. Most congenital heart defects can be prenatally detected by experts in foetal echocardiography working in tertiary centres with high-risk pregnancies. Many studies, however,

Real-Time Tele-Mentored Low Cost "Point-of-Care US" in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists.

Directory of Open Access Journals (Sweden)

Floriana Zennaro

Full Text Available The use of point-of-care ultrasonography (POC US in paediatrics is increasing. This study investigated the diagnostic accuracy of POC US in children accessing the emergency department (ED when performed by paediatricians under the remote guidance of radiologists (TELE POC.Children aged 0 to 18 years accessing the ED of a third level research hospital with eight possible clinical scenarios and without emergency/severity signs at the triage underwent three subsequent US tests: by a paediatrician guided remotely by a radiologist (TELE POC; by the same radiologist (UNBLIND RAD; by an independent blinded radiologist (BLIND RAD. Tele-radiology was implemented using low cost "commercial off-the-shelf" (COTS equipment and open-source software. Data were prospectively collected on predefined templates.Fifty-two children were enrolled, for a total of 170 ultrasound findings. Sensitivity, specificity, positive and negative predictive values of TELE POC were: 93.8, 99.7, 96.8, 99.4 when compared to UNBLIND RAD and 88.2, 99.7, 96.8, 98.7 when compared to BLIND RAD. The inter-observers agreement between the paediatricians and either the unblind or blind radiologist was excellent (k = 0.93. The mean duration of TELE POC was 6.3 minutes (95% CI 4.1 to 8.5. Technical difficulties occurred in two (3.8% cases. Quality of the transmission was rated as fair, good, very good and excellent in 7.7%, 15.4%, 42.3% and 34.6% of cases respectively, while in no case was it rated as poor.POC US performed by paediatricians in ED guided via tele-radiology by an expert radiologist (TELE POC produced reliable and timely diagnoses. Findings of this study, especially for the rarer conditions under evaluation, need further confirmation. Future research should investigate the overall benefits and the cost savings of using tele-ultrasound to perform US "at children's bedsides", under remote guidance of expert radiologists.

Low Complexity Connectivity Driven Dynamic Geometry Compression for 3D Tele-Immersion

NARCIS (Netherlands)

R.N. Mekuria (Rufael); D.C.A. Bulterman (Dick); P.S. Cesar Garcia (Pablo Santiago)

2014-01-01

htmlabstractGeometry based 3D Tele-Immersion is a novel emerging media application that involves on the fly reconstructed 3D mesh geometry. To enable real-time communication of such live reconstructed mesh geometry over a bandwidth limited link, fast dynamic geometry compression is needed. However,

TeleSUR: la creación televisiva de “lo latinoamericano”

Directory of Open Access Journals (Sweden)

Günther Maihold

2014-06-01

Full Text Available Nueva Televisión del Sur C. A. (Tele-SUR es el nombre de la empresa interestatal que ha iniciado sus transmisiones en el año 2005, en el marco de las nuevas iniciativas integracionistas del presidente venezolano Hugo Chávez, enfocada fundamentalmente al área noticiera para el continente americano. Concebida por su director general, el periodista uruguayo Aram Aharonian, como “alternativa a la hegemonía comunicacional, al pensamiento y la imagen únicas”, TeleSUR es parte de un proceso político más amplio, recubierto de barniz bolivariano, para reencontrar, a través de los medios electrónicos, la unidad e identidad latinoamericana frente a las grandes cadenas y corporaciones informativas internacionales, entre las cuales cuentan CNN en español, Fox News, ESPN y la BBC, con sus programas en castellano, y las grandes empresas nacionales como Televisa de México, Globo en Brasil y tanto el grupo Cisneros en Venezuela como Clarín en Argentina.

Communication Framework for Tele-rehabilitation Systems with QoS Guarantee

OpenAIRE

Dandanov Nikolay; Semov Plamen; Ivanov Antoni; Christoff Nicole; Poulkov Vladimir

2017-01-01

Nowadays, there is great interest in developing telemedicine technologies. These technologies will provide health care from distance swiftly and lightly, as well as reduce the expenses for activities, such as rehabilitation. Telemedicine applications are possible due to the advances in information technologies and the ever-expanding communication network infrastructure. The network characteristics bandwidth, packet loss, latency, jitter and policies are crucial for the performance of tele-reh...

Echocardiography in the adult's congenital cardiopaties

International Nuclear Information System (INIS)

Escobar Q, Carlos I; Jaramillo U, Mario; Tenorio, Luis F; Molina V, Claudia; Saldarriaga A, Marcela; Arango, Angela M

2003-01-01

The number of adults with congenital heart disease is steadily increasing in the course of time. We ignore the prevalence and the most frequent diagnoses in our environment. A descriptive prospective study is presented. Between November 1 1999 and July 31 2001, 8871 Tran-thoracic and Tran-esophageal echocardiographies were performed in the Clinica Cardiovascular Santa Maria's echocardiography service. We found 143 congenital cardiopathies (1.6%) in 74 men and 69 women with a mean age of 37.7 +/- 18.4 years. the most frequent diagnoses were bicuspid aortic valve, atrial septal defect, ventricular septal defect, patent ductus arteriosus and Ebstein's anomaly. these findings agree with world wide data

Comparative study between MRI and echocardiography in noncompaction of ventricular myocardium

International Nuclear Information System (INIS)

Sun Ziyan; Xia Liming; Wang Chengyuan; Rao Jingjing; Shenyu Weihui

2007-01-01

Objective: To investigate the MRI and echocardiography manifestations of noncompaction of ventricular myocardium(NVM) and assess the role of MR1 in the diagnosis of NVM by comparing it with echocardiography. Methods: Fourteen cases of NVM diagnosed by echocardiography were examined with MRI, including scanning of black-blood sequences, double inversion recovery fast spin echo (DIBFSE) and triple inversion recovery fast spin echo (TIRFSE), and white blood sequence: fast imaging employ steady state acquisition (FIESTA). Scanning plane includes short axis view, four-chamber view and long axis view. Results: Both MRI and echocardiography displayed involvement of left ventricles in thirteen cases and involvement of double ventricles in one case. Apexes of heart and the intermedius are commonly affected. MRI showed 54 segments and echocardiography showed 53 segments affected, and there is no significant difference between the capability of MRI and echocardiography (P=1,000). The affected myocardium consisted of two layers: subendocardial noncompacted myocardium and epicardial compacted myocardium, and the ratio measurement of N/C by MRI was 3.37±0.89 and it was 3.19±0.82 by echocardiography. Noncompacted myocardium was characterized by prominent and excessive myocardial trabeculations and deep intratrabecular recesses, in which the blood flow was communicated with the ventricle. One case was complicated with ventricular aneurysm, and coronary arteriography was performed with unremarkable findings. One case underwent heart transplantation because of progressive heart failure, Gross findings demonstrated prominent muscular' trabeculations with deep intratrabecular recesses, which coincided well with MRI findings. Conclusion: The MRI manifestation of NVM is characteristic, and MRI with multiple series and planes is helpful in the diagnose of NVM. Compared with echocardiography, MRI could display the pathological cardiac muscle more clearly, because of its high soft

Opinion Spreading with Mobility on Scale-Free Networks

International Nuclear Information System (INIS)

Qiang, Guo; Xing-Wen, Chen; Jian-Guo, Liu; Bing-Hong, Wang; Tao, Zhou; Yu-Hua, Yao

2008-01-01

A continuum opinion dynamic model is presented based on two rules. The first one considers the mobilities of the individuals, the second one supposes that the individuals update their opinions independently. The results of the model indicate that the bounded confidence in c , separating consensus and incoherent states, of a scale-free network is much smaller than the one of a lattice. If the system can reach the consensus state, the sum of all individuals' opinion change O c (t) quickly decreases in an exponential form, while if it reaches the incoherent state finally O c (t) decreases slowly and has the punctuated equilibrium characteristic

Dobutamine Stress Echocardiography Safety in Chagas Disease Patients.

Science.gov (United States)

Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Furtado, Rogerio Gomes; Turco, Fabio de Paula; Melato, Luciano Henrique; Hotta, Viviane Tiemi; Nunes, Colandy Godoy de Oliveira; Rassi, Luiz; Rassi, Salvador

2017-02-01

A few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD). As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE) has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease. To assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam. Retrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed. Their mean age was 64±10 years and most patients were females (65.4%). No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%. DSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found. Até poucas décadas atrás, os pacientes chagásicos eram predominantemente trabalhadores rurais, com baixo perfil de risco para doença obstrutiva coronária. Com a crescente urbanização, passaram a ter os mesmos fatores de risco para doença aterosclerótica que indivíduos não infectados. O ecocardiograma sob estresse com dobutamina (EED) é uma importante ferramenta no diagnóstico de coronariopatia. É referido, porém, como um método potencialmente arritmogênico, mas

Speckle tracking echocardiography in acute lupus myocarditis: comparison to conventional echocardiography

Directory of Open Access Journals (Sweden)

Riëtte Du Toit

2017-07-01

Full Text Available Aims: Lupus myocarditis occurs in 5–10% of patients with systemic lupus erythematosus (SLE. No single feature is diagnostic of lupus myocarditis. Speckle tracking echocardiography (STE can detect subclinical left ventricular dysfunction in SLE patients, with limited research on its utility in clinical lupus myocarditis. We report on STE in comparison to conventional echocardiography in patients with clinical lupus myocarditis. Methods and results: A retrospective study was done at a tertiary referral hospital in South Africa. SLE patients with lupus myocarditis were included and compared to healthy controls. Echocardiographic images were reanalyzed, including global longitudinal strain through STE. A poor echocardiographic outcome was defined as final left ventricular ejection fraction (LVEF <40%. 28 SLE patients fulfilled the criteria. Global longitudinal strain correlated with global (LVEF: r = −0.808; P = 0.001 and regional (wall motion score: r = 0.715; P < 0.001 function. In patients presenting with a LVEF ≥50%, global longitudinal strain (P = 0.023, wall motion score (P = 0.005 and diastolic function (P = 0.004 were significantly impaired vs controls. Following treatment, LVEF (35–47% (P = 0.023 and wall motion score (1.88–1.5 (P = 0.017 improved but not global longitudinal strain. Initial LVEF (34%; P = 0.046 and global longitudinal strain (−9.5%; P = 0.095 were lower in patients with a final LVEF <40%. Conclusions: This is the first known report on STE in a series of patients with clinical lupus myocarditis. Global longitudinal strain correlated with regional and global left ventricular function. Global longitudinal strain, wall motion score and diastolic parameters may be more sensitive markers of lupus myocarditis in patients presenting with a preserved LVEF ≥50%. A poor initial LVEF and global longitudinal strain were associated with a persistent LVEF <40%. Echocardiography is a non-invasive tool with diagnostic and

PVMapper: Report on the Second Public Opinion Survey

Energy Technology Data Exchange (ETDEWEB)

Carlisle, Juliet [Idaho National Lab. (INL), Idaho Falls, ID (United States); Joe, Jeffrey [Idaho National Lab. (INL), Idaho Falls, ID (United States); Kane, Stephanie [Idaho National Lab. (INL), Idaho Falls, ID (United States); Koehler, Dave [Idaho National Lab. (INL), Idaho Falls, ID (United States); Solan, David [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2013-06-24

This report has been developed as an integral part of the PVMapper project, funded by the U.S. Department of Energy’s Office of Energy Efficiency and Renewable Energy’s SunShot program. The objective of the SunShot program is to reduce the total costs of solar energy systems. The scope of PVMapper is to develop a geographic information system (GIS) based project planning tool to identify optimal utility-scale solar facility sites. The specific objectives of the project are to 1) develop the software on an open-source platform; 2) integrate the appropriate data sets and GIS layers; 3) include a measure of social risk and public acceptance; 4) enable customization of variable weights; 5) provide a free and accessible platform for software download; and 6) provide a sustainability plan to ensure future relevance of the software. When completed, PVMapper is intended to be used by solar developers, Authorities Having Jurisdiction (AHJs), and other interested parties. This project supports SunShot’s objective by reducing the non-hardware balance of system costs (“soft costs”) for utility-scale solar project development. In order to accomplish the third project objective – including a measure of social risk and public acceptance within PVMapper – the project team has developed a time-series public opinion survey, administered yearly over the course of the three-year project. This report highlights the results and preliminary analyses from the second survey in this series. While the results of this survey are valuable to both PVMapper and future utility-scale solar development, the time-series design is extremely important. The completion of the series enables the extension of the dataset to much richer information. For example, the research team altered this iteration to sharpen the focus on specific topics (those posing potentially higher risks) and target specific locations in the oversample (such as communities near existing facilities). Using similar

Analysis of chronic aortic regurgitation by 2D and 3D echocardiography and cardiac MRI

DEFF Research Database (Denmark)

Stoebe, Stephan; Metze, Michael; Jurisch, Daniel

2018-01-01

) were assessed retrospectively by 2D, 3D echocardiography and cMRI in 55 chronic AR patients. Semi-quantitative parameters were assessed by 2D echocardiography. RESULTS: 22 (40%) patients had mild, 25 (46%) moderate and 8 (14%) severe AR. The quantitative volumetric approach was feasible using 2D, 3D...... echocardiography and cMRI, whereas the feasibility of semi-quantitative parameters varied considerably. LV volume (LVEDV, LVESV, SVtot) analyses showed good correlations between the different imaging modalities, although significantly increased LV volumes were assessed by cMRI. RVol was significantly different...... between 2D/3D echocardiography and 2D echocardiography/cMRI but was not significantly different between 3D echocardiography/cMRI. RF was not statistically different between 2D echocardiography/cMRI and 3D echocardiography/cMRI showing poor correlations (r

Stress cine MRI for detection of coronary artery disease

International Nuclear Information System (INIS)

Sommer, T.; Hofer, U.; Schild, H.

2002-01-01

Stress testing is the cornerstone in the diagnosis of patients with suspected coronary artery disease (CAD). Stress echocardiography has become a well-established modality for the detection of ischemia-induced wall motion abnormalities. However, display and reliable interpretation of stress echocardiography studies are user-dependent, the test reproducibility is low, and 10 to 15% of patients yield suboptimal or non-diagnostic images. Due to its high spatial and contrast resolution, MRI is known to permit an accurate determination of left ventricular function and wall thickness at rest. Early stress MRI studies provided promising results with respect to the detection of CAD. However, the clinical impact was limited due to long imaging time and problematic patient monitoring in the MRI environment. Recent technical improvements - namely ultrafast MR image acquisition - led to a significant reduction of imaging time and improved patient safety. Stress can be induced by physical exercise or pharmacologically by administration of a beta 1 -agonist (dobutamine) or vasodilatator (dipyridamole and adenosine). The best developed and most promising stress MRI technique is a high-dose dobutamine/atropine stress protocol (10, 20, 30, 40 μg/kg/min; optionally 0.25-mg fractions of atropine up to maximal dose 1 mg). Severe complications (myocardial infarction, ventricular fibrillation and sustained tachycardia, cardiogenic shock) may be expected in 0.25% of patients. Currently, data of three high-dose dobutamine stress MRI studies are available, revealing a good sensitivity (83 - 87%) and specificity (83 - 86%) in the assessment of CAD. The direct comparison between echocardiography and MRI for the detection of stress-induced wall motion abnormalities yielded better results for dobutamine-MRI in terms of sensitivity (86.2% vs. 74.3%; p [de

Long-term hand tele-rehabilitation on the PlayStation 3: benefits and challenges.

Science.gov (United States)

Burdea, Grigore C; Jain, Abhishek; Rabin, Bryan; Pellosie, Richard; Golomb, Meredith

2011-01-01

Rehabilitation interventions for the hand have shown benefits for children with Hemiplegia due to cerebral palsy or traumatic brain injury. Longer interventions are facilitated if training is provided in the patient's home, due to easier access to care and reduced impact on school or work activities. Providing remote rehabilitation over lengthy periods of time has however its own challenges. This paper presents two pediatric patients with hemiplegia, who practiced virtual hand rehabilitation games using a modified PlayStation 3 and 5DT sensing gloves. Despite severe initial hand spasticity, and occasional technology shortcomings, the subjects practiced for about 14 months, and 6 months, respectively. Game performance data for the second patient is presented. Follow-up evaluations 14 months from the removal of the PlayStation 3 from the home of the child with cerebral palsy showed that the patient had good retention in terms of grasp strength, hand function and bone health. Challenges of long-term home tele-rehabilitation are also discussed.

Adaptive Tele-Therapies Based on Serious Games for Health for People with Time-Management and Organisational Problems: Preliminary Results

OpenAIRE

Frutos-Pascual, Maite; García Zapirain, Begoña; Méndez Zorrilla, Amaia

2014-01-01

Attention Deficit with Hyperactivity Disorder (ADHD) is one of the most prevalent disorders within the child population today. Inattention problems can lead to greater difficulties in completing assignments, as well as problems with time management and prioritisation of tasks. This article presents an intelligent tele-therapy tool based on Serious Games for Health, aimed at the improvement of time management skills and the prioritisation of tasks. This tele-system is based on the use of decis...

Simulation for transthoracic echocardiography of aortic valve

Science.gov (United States)

Nanda, Navin C.; Kapur, K. K.; Kapoor, Poonam Malhotra

2016-01-01

Simulation allows interactive transthoracic echocardiography (TTE) learning using a virtual three-dimensional model of the heart and may aid in the acquisition of the cognitive and technical skills needed to perform TTE. The ability to link probe manipulation, cardiac anatomy, and echocardiographic images using a simulator has been shown to be an effective model for training anesthesiology residents in transesophageal echocardiography. A proposed alternative to real-time reality patient-based learning is simulation-based training that allows anesthesiologists to learn complex concepts and procedures, especially for specific structures such as aortic valve. PMID:27397455

Customer needs, expectations, and satisfaction with clinical neurophysiology services in Ireland: a case for tele-neurophysiology development.

Science.gov (United States)

Fitzsimons, M; Ronan, L; Murphy, K; Browne, G; Connolly, S; McMenamin, J; Delanty, N

2004-01-01

Although equitable access to services should be based on need, geographical location of patients and their clinicians can give rise to inequalities in healthcare delivery. Development of tele-medicine services can improve equity of access. The specialty of Clinical Neurophysiology (CN), currently under-developed in Ireland provides an example of such potential. This study aimed to determine the needs, expectations, and satisfaction of CN customers, namely patients and referring clinicians. The goal was to examine geographical impediments to access that might be addressed by the introduction of tele-neurophysiology. Two customer surveys were conducted: CN referring clinicians and CN patients. Thirty-one North Western Health Board (NWHB) consultant clinicians responded to a postal survey. Distance and delays caused by long waiting lists were felt to deter or make CN referral irrelevant. Ninety-seven percent believed the lack of a local service negatively impacts on patient management and 93% would welcome the introduction of a tele-neurophysiology service. The geographical location of patient's residence and/or the location of the referring clinician's practice influenced waiting lists for CN. Fifty-eight (105/182) percent of patients living in a region with a CN service compared to 39% (50/128) of those living in a region with no service received an appointment within one month. In addition to the current insufficient CN service capacity in Ireland, these surveys highlighted geographical inequities. Tele-neurophysiology has the potential to speed-up diagnosis, result in more patients being appropriately investigated and be fairer to patients.

Analysis of chronic aortic regurgitation by 2D and 3D echocardiography and cardiac MRI

Science.gov (United States)

Stoebe, Stephan; Metze, Michael; Jurisch, Daniel; Tayal, Bhupendar; Solty, Kilian; Laufs, Ulrich; Pfeiffer, Dietrich; Hagendorff, Andreas

2018-01-01

Purpose The study compares the feasibility of the quantitative volumetric and semi-quantitative approach for quantification of chronic aortic regurgitation (AR) using different imaging modalities. Methods Left ventricular (LV) volumes, regurgitant volumes (RVol) and regurgitant fractions (RF) were assessed retrospectively by 2D, 3D echocardiography and cMRI in 55 chronic AR patients. Semi-quantitative parameters were assessed by 2D echocardiography. Results 22 (40%) patients had mild, 25 (46%) moderate and 8 (14%) severe AR. The quantitative volumetric approach was feasible using 2D, 3D echocardiography and cMRI, whereas the feasibility of semi-quantitative parameters varied considerably. LV volume (LVEDV, LVESV, SVtot) analyses showed good correlations between the different imaging modalities, although significantly increased LV volumes were assessed by cMRI. RVol was significantly different between 2D/3D echocardiography and 2D echocardiography/cMRI but was not significantly different between 3D echocardiography/cMRI. RF was not statistically different between 2D echocardiography/cMRI and 3D echocardiography/cMRI showing poor correlations (r echocardiography and 2D echocardiography/cMRI and good agreement was observed between 3D echocardiography/cMRI. Conclusion Semi-quantitative parameters are difficult to determine by 2D echocardiography in clinical routine. The quantitative volumetric RF assessment seems to be feasible and can be discussed as an alternative approach in chronic AR. However, RVol and RF did not correlate well between the different imaging modalities. The best agreement for grading of AR severity by RF was observed between 3D echocardiography and cMRI. LV volumes can be verified by different approaches and different imaging modalities. PMID:29519957

Secure environment for real-time tele-collaboration on virtual simulation of radiation treatment planning.

Science.gov (United States)

Ntasis, Efthymios; Maniatis, Theofanis A; Nikita, Konstantina S

2003-01-01

A secure framework is described for real-time tele-collaboration on Virtual Simulation procedure of Radiation Treatment Planning. An integrated approach is followed clustering the security issues faced by the system into organizational issues, security issues over the LAN and security issues over the LAN-to-LAN connection. The design and the implementation of the security services are performed according to the identified security requirements, along with the need for real time communication between the collaborating health care professionals. A detailed description of the implementation is given, presenting a solution, which can directly be tailored to other tele-collaboration services in the field of health care. The pilot study of the proposed security components proves the feasibility of the secure environment, and the consistency with the high performance demands of the application.

Digital echocardiography and telemedicine applications in pediatric cardiology.

Science.gov (United States)

Sable, Craig

2002-01-01

Digital echocardiography offers several advantages over videotape, including easy review, comparison, storage, postprocessing, and sharing of studies, quantitative analysis, and superior resolution. Newer echocardiography systems can write digital data to computer hardware, whereas older systems require digitization of analog data. Clinical and digital data compression is required to reduce study size. Clinical compression has been validated in several adult studies and one pediatric study. JPEG and MPEG digital compression ratios of 26:1 and 200:1, respectively, approximate S-videotape quality. JPEG is the DICOM 3.0 standard and is ideal for short loops, serial comparisons, and quantitative analysis. MPEG (the motion picture standard) lends itself to digitization of video streams and may be more attractive to pediatric cardiologists. Options for data storage and transfer range from limited local review to multiple offline review stations linked by a wide-area network. Telemedicine expands the capabilities of digital echocardiography in a "store and forward" or "real-time" format. Real-time neonatal telecardiology is accurate, impacts patient care, is cost-effective, and does not increase utilization. Cost, increased reliance on sonographers' skills, lack of accepted standards, and legal, licensure, and billing issues are obstacles to widespread acceptance of digital echocardiography and telemedicine.

Evaluation of prosthetic heart valves by transesophageal echocardiography: problems, pitfalls, and timing of echocardiography

NARCIS (Netherlands)

van den Brink, Renee B. A.

2006-01-01

Transesophageal echocardiography (TEE) is especially suitable for examination of prosthetic valves because of the proximity of the esophagus to the heart and absence of interference with lungs and ribs. This article reviews normal and abnormal morphologic characteristics of prosthetic valves such as

Recommendations for fetal echocardiography in twin pregnancy in 2016

Directory of Open Access Journals (Sweden)

Leszczyńska Katarzyna

2016-01-01

Full Text Available Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton pregnancies but also in multiple pregnancies. Proper interpretation of prenatal echocardiography is critical to clinical decision making, family counseling and perinatal management for obstetricians, maternal fetal medicine specialists, neonatologists and pediatric cardiologists. Fetal echocardiography is one of the most challenging and time-consuming prenatal examinations to perform, especially in multiple gestations. Performing just the basic fetal exam in twin gestations may take an hour or more. Thus, it is not practical to perform this exam in all cases of multiple gestations. Therefore our review and recommendations are related to fetal echocardiography in twin gestation.

Cardiodiagnostic imaging. MRT, CT, echocardiography and other methods

International Nuclear Information System (INIS)

Erbel, R.; Kreitner, K.F.; Barkhausen, J.; Thelen, M.

2007-01-01

The book presents a differentiated approach to cardiac imaging. The focus is n cardio-MR/-CT and echocardiography. These are highly complex methods involving new equipment, new protocols and indications. The techniques are new and difficult to learn for everybody concerned. MR, CT and echocardiography must always be viewed in the context of other diagnostic methods. The interdisciplinary approach of the book addresses both radiologists and cardiologists and relies on the vast experience of the authors. The book offers more than 500 large high-quality reference images reflecting the latest state of the art. It has amethodological section in which the current methods are described (X-ray, echocardiography, nuclear medicine, angiography, CT, MRT etc.) along with their advantages and shortcomings, and a clinical section in which the main indications are described in the common standardized way (anatomy, clinical picture, interpretation, differential diagnosis). (orig.)

Continuous Opinion Dynamics Under Bounded Confidence:. a Survey

Science.gov (United States)

Lorenz, Jan

Models of continuous opinion dynamics under bounded confidence have been presented independently by Krause and Hegselmann and by Deffuant et al. in 2000. They have raised a fair amount of attention in the communities of social simulation, sociophysics and complexity science. The researchers working on it come from disciplines such as physics, mathematics, computer science, social psychology and philosophy. In these models agents hold continuous opinions which they can gradually adjust if they hear the opinions of others. The idea of bounded confidence is that agents only interact if they are close in opinion to each other. Usually, the models are analyzed with agent-based simulations in a Monte Carlo style, but they can also be reformulated on the agent's density in the opinion space in a master equation style. The contribution of this survey is fourfold. First, it will present the agent-based and density-based modeling frameworks including the cases of multidimensional opinions and heterogeneous bounds of confidence. Second, it will give the bifurcation diagrams of cluster configuration in the homogeneous model with uniformly distributed initial opinions. Third, it will review the several extensions and the evolving phenomena which have been studied so far, and fourth it will state some open questions.

Three-dimensional echocardiography in valve disease

Directory of Open Access Journals (Sweden)

Cesare Fiorentini

2009-08-01

Full Text Available This review covers the role of three-dimensional (3D echocardiography in the diagnosis of heart valve disease. Several factors have contributed to the evolution of this technique, which is currently a simple and routine method: rapid evolution in probe and computer technologies, demonstration that 3D data sets allowed more complete and accurate evaluation of cardiac structures, emerging clinical experience indicating the strong potential particularly in valve diseases, volume and function of the two ventricle measurements and several other fields. This report will review current and future applications of 3D echocardiography in mitral, aortic and tricuspid valve diseases underlying both qualitative (morphologic and quantitative advantages of this technique. (Heart International 2007; 3: 35-41

Comparative cost-benefit analysis of tele-homecare for community-dwelling elderly in Japan: Non-Government versus Government Supported Funding Models.

Science.gov (United States)

Akiyama, Miki; Abraham, Chon

2017-08-01

Tele-homecare is gaining prominence as a viable care alternative, as evidenced by the increase in financial support from international governments to fund initiatives in their respective countries. The primary reason for the funding is to support efforts to reduce lags and increase capacity in access to care as well as to promote preventive measures that can avert costly emergent issues from arising. These efforts are especially important to super-aged and aging societies such as in Japan, many European countries, and the United States (US). However, to date and to our knowledge, a direct comparison of non-government vs. government-supported funding models for tele-homecare is particularly lacking in Japan. The aim of this study is to compare these operational models (i.e., non-government vs. government-supported funding) from a cost-benefit perspective. This simulation study applies to a Japanese hypothetical cohort with implications for other super-aged and aging societies abroad. We performed a cost-benefit analysis (CBA) on two operational models for enabling tele-homecare for elderly community-dwelling cohorts based on a decision tree model, which we created with parameters from published literature. The two models examined are (a) Model 1-non-government-supported funding that includes monthly fixed charges paid by users for a portion of the operating costs, and (b) Model 2-government-supported funding that includes startup and installation costs only (i.e., no operating costs) and no monthly user charges. We performed base case cost-benefit analysis and probabilistic cost-benefit analysis with a Monte Carlo simulation. We calculated net benefit and benefit-to-cost ratios (BCRs) from the societal perspective with a five-year time horizon applying a 3% discount rate for both cost and benefit values. The cost of tele-homecare included (a) the startup system expense, averaged over a five-year depreciation period, and (b) operation expenses (i.e., labor and non

PERCEPÇÃO E CONHECIMENTO SEGUNDO ARISTÓTELES, PLATÃO E PROTÁGORAS: UMA BREVE COMPARAÇÃO

Directory of Open Access Journals (Sweden)

Juliana Aggio

2009-02-01

Full Text Available O texto examina a relação entre conhecimento e sensação, sensação e pensamento, ser eperceber segundo Protágoras, Platão e Aristóteles, com o objetivo de mostrar o que é a percepçãosegundo o paradigma sofístico e o platônico e, por fim, qual é o lugar da tese aristotélica sobre apercepção diante desses dois paradigmas. Como resultado da investigação, temos que, paraAristóteles, diferentemente de Protágoras, a sensação não é responsável por todos os julgamentos,nem por discriminar todos objetos cognoscíveis; também para Aristóteles e diferentemente de Platão,o extremo oposto não é verdadeiro, a saber, que a sensação não discrimina seus próprios objetos.Conhecimento e sensação, portanto, não devem ser idênticos ou distintos de modo absoluto, nem oser é absolutamente ser percebido, nem o ser percebido é absolutamente indeterminado, mas, paraAristóteles, o ser é, em parte, percebido e determinado pela faculdade perceptiva e, em parte,conhecido pelo intelecto. O texto, deste modo, pretende elucidar como o ser é conhecido pelapercepção segundo Aristóteles, tratando assim de um ponto extremamente controverso, a saber:como a sensação discrimina seus próprios objetos sem a intervenção do pensamento, se taldiscriminação resume-se apenas em processos fisiológicos ou é também uma atividade da alma e, seé também uma atividade da alma, em que sentido a alteração física ocorrida no corpo,conjuntamente com uma certa atividade da alma, constituem a percepção.

Real-time 3-dimensional fetal echocardiography with an instantaneous volume-rendered display: early description and pictorial essay.

Science.gov (United States)

Sklansky, Mark S; DeVore, Greggory R; Wong, Pierre C

2004-02-01

Random fetal motion, rapid fetal heart rates, and cumbersome processing algorithms have limited reconstructive approaches to 3-dimensional fetal cardiac imaging. Given the recent development of real-time, instantaneous volume-rendered sonographic displays of volume data, we sought to apply this technology to fetal cardiac imaging. We obtained 1 to 6 volume data sets on each of 30 fetal hearts referred for formal fetal echocardiography. Each volume data set was acquired over 2 to 8 seconds and stored on the system's hard drive. Rendered images were subsequently processed to optimize translucency, smoothing, and orientation and cropped to reveal "surgeon's eye views" of clinically relevant anatomic structures. Qualitative comparison was made with conventional fetal echocardiography for each subject. Volume-rendered displays identified all major abnormalities but failed to identify small ventricular septal defects in 2 patients. Important planes and views not visualized during the actual scans were generated with minimal processing of rendered image displays. Volume-rendered displays tended to have slightly inferior image quality compared with conventional 2-dimensional images. Real-time 3-dimensional echocardiography with instantaneous volume-rendered displays of the fetal heart represents a new approach to fetal cardiac imaging with tremendous clinical potential.

Second language social networks and communication-related acculturative stress: The role of interconnectedness

OpenAIRE

Marina M Doucerain; Raheleh eShiri Varnaamkhaasti; Norman eSegalowitz; Norman eSegalowitz; Andrew G Ryder; Andrew G Ryder

2015-01-01

Although a substantial amount of cross-cultural psychology research has investigated acculturative stress in general, little attention has been devoted specifically to communication-related acculturative stress. In line with the view that cross-cultural adaptation and second language (L2) learning are social and interpersonal phenomena, the present study examines the hypothesis that migrants' L2 social network size and interconnectedness predict communication-related acculturative stress. The...

PERANCANGAN SISTEM TELE-NAVIGATION PADA PESAWAT TANPA AWAK (MICRO UAV

Directory of Open Access Journals (Sweden)

Agus Basukesti

2016-04-01

Full Text Available Sistem navigasi pada pengoperasian pesawat tanpa awak (Micro UAV saat ini terdapat 2 cara yaitu dengan cara pandangan manual (line of sight dan sistem autopilot. Sistem navigasi line of sight memiliki kelemahan jangkauan pesawat tanpa awak hanya pada radius 200 meter karena keterbatasan penglihatan dari pengendali. Metode autopilot adalah metode kendali pesawat dengan algoritma lock position and homing. Sistem autopilot bekerja dengan cara mencari koordinat posisi yang dituju kemudian kembali ke lokasi awal. Keunggulan teknologi ini adalah pesawat dapat menjangkau jarak yang cukup jauh. Akan tetapi metode ini memiliki kelemahan yaitu pesawat harus terbang tinggi dan pesawat belum bisa menghindari halangan seperti gedung pencakar langit maupun pepohonan tinggi. Dalam penelitian ini dirancang sebuah sistem tele-navigasi yang merupakan modifikasi sistem navigasi line of sight dan autopilot sehingga dapat menutupi kelemahan dari masing masing metode navigasi yang ada saat ini. metode penelitian yang digunakan dalam penelitian ini adalah metode eksperimen yaitu dengan membuat pilot plan sistem Tele-navigasi yang selanjutnya akan diuji dengan pesawat tanpa awak (micro UAV jenis flying wing. Metode dokumentasi dan metode studi pustaka juga digunakan untuk melengkapi data teknis alat yang digunakan sehingga dapat dilakukan analisis mendalam terhadap performa alat yang dirancang. Kata kunci: line of sight, lock position and homing, autopilot, micro UAV.

Recommendations for terminology and display for doppler echocardiography

International Nuclear Information System (INIS)

Anon.

1986-01-01

Doppler echocardiography has recently emerged as a major noninvasive technique with many applications in cardiology. To a large extent, this has been based upon a combination of clinical and engineering advances which now make possible the use of quantitative Doppler echocardiography in combination with two-dimensional imaging for measurement of volume flows, transvalve gradients, and other physiologic flow parameters which reflect cardiac function. It was the purpose of this Committee to provide a glossary of terms which could be used in standard fashion for papers and discussions related to Doppler echocardiography. As part of its task, the Committee also undertook an attempt to recommend a standard for display of Doppler information which would be useful, both for manufacturers and for clinicians. The document, therefore, includes: Section I, the Committee's recommendations for Doppler display. Section II, the glossary of Doppler terms, related to engineering and to clinical applications

A Robust Automated Cataract Detection Algorithm Using Diagnostic Opinion Based Parameter Thresholding for Telemedicine Application

Directory of Open Access Journals (Sweden)

Shashwat Pathak

2016-09-01

Full Text Available This paper proposes and evaluates an algorithm to automatically detect the cataracts from color images in adult human subjects. Currently, methods available for cataract detection are based on the use of either fundus camera or Digital Single-Lens Reflex (DSLR camera; both are very expensive. The main motive behind this work is to develop an inexpensive, robust and convenient algorithm which in conjugation with suitable devices will be able to diagnose the presence of cataract from the true color images of an eye. An algorithm is proposed for cataract screening based on texture features: uniformity, intensity and standard deviation. These features are first computed and mapped with diagnostic opinion by the eye expert to define the basic threshold of screening system and later tested on real subjects in an eye clinic. Finally, a tele-ophthamology model using our proposed system has been suggested, which confirms the telemedicine application of the proposed system.

OpinionFlow: Visual Analysis of Opinion Diffusion on Social Media.

Science.gov (United States)

Wu, Yingcai; Liu, Shixia; Yan, Kai; Liu, Mengchen; Wu, Fangzhao

2014-12-01

It is important for many different applications such as government and business intelligence to analyze and explore the diffusion of public opinions on social media. However, the rapid propagation and great diversity of public opinions on social media pose great challenges to effective analysis of opinion diffusion. In this paper, we introduce a visual analysis system called OpinionFlow to empower analysts to detect opinion propagation patterns and glean insights. Inspired by the information diffusion model and the theory of selective exposure, we develop an opinion diffusion model to approximate opinion propagation among Twitter users. Accordingly, we design an opinion flow visualization that combines a Sankey graph with a tailored density map in one view to visually convey diffusion of opinions among many users. A stacked tree is used to allow analysts to select topics of interest at different levels. The stacked tree is synchronized with the opinion flow visualization to help users examine and compare diffusion patterns across topics. Experiments and case studies on Twitter data demonstrate the effectiveness and usability of OpinionFlow.

Exercise echocardiography in asymptomatic survivors of childhood cancer treated with anthracyclines

DEFF Research Database (Denmark)

Sieswerda, Elske; Kremer, Leontien C M; Vidmar, Suzanna

2010-01-01

BACKGROUND: Exercise echocardiography reveals abnormalities in asymptomatic childhood cancer survivors who previously have been treated with anthracyclines. We determined the added value of monitoring childhood cancer survivors with exercise echocardiography compared to monitoring with resting ec...

Stress fracture of the second metacarpal bone in a badminton player.

Science.gov (United States)

Fukuda, Koji; Fujioka, Hiroyuki; Fujita, Ikuo; Uemoto, Harunobu; Hiranaka, Takafumi; Tsuji, Mitsuo; Kurosaka, Masahiro

2008-07-18

We present a rare case of stress fracture of the second metacarpal bone. A 14-year-old girl felt pain on the dorsal aspect of the right wrist without any history of major trauma, when she played a smash during a game of badminton. On the radiographs, periosteal reaction was detected on the ulnar aspect of the base of the second metacarpal bone. She was treated conservatively and she returned to the original activity level.

Targeted neonatal echocardiography services: need for standardized training and quality assurance.

LENUS (Irish Health Repository)

Finan, Emer

2014-10-01

Targeted neonatal echocardiography refers to a focused assessment of myocardial performance and hemodynamics directed by a specific clinical question. It has become the standard of care in many parts of the world, but practice is variable, and there has been a lack of standardized training and evaluation to date. Targeted neonatal echocardiography was first introduced to Canada in 2006. The purpose of this study was to examine the characteristics of targeted neonatal echocardiography practice and training methods in Canadian neonatal intensive care units (NICUs).

The diagnostic ability of echocardiography for infective endocarditis and its associated complications.

Science.gov (United States)

Vilacosta, Isidre; Olmos, Carmen; de Agustín, Alberto; López, Javier; Islas, Fabián; Sarriá, Cristina; Ferrera, Carlos; Ortiz-Bautista, Carlos; Sánchez-Enrique, Cristina; Vivas, David; San Román, Alberto

2015-11-01

Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations.

Exploring the opinion of hemodialysis patients about their dialysis unit

OpenAIRE

Ahmed Farouk Donia; Mohamed Ahmed Elhadedy; Hanzada Mohamed El-Maghrabi; Mohamed Hamed Abbas; Mohamed Ashraf Foda

2015-01-01

Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients′ opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients′ opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of pa...

Tele-evidence: A videoconferencing tool as a viable alternative to physical appearance of doctors for the judicial summons.

Science.gov (United States)

Bari, S; Arora, P; Gupta, A K; Singh, M; Aggarwal, A K

2018-06-26

The role of physicians often extends beyond provision of direct patient care and includes appearance in courts as professional or expert witnesses to give their testimony in various legal cases. This often consumes precious time and resources of the doctors and the hospitals. This study was taken up to evaluate the present system of the physical appearance of the doctors to various courts and compare it with the videoconferencing mode of giving testimony (tele-evidence). Available records of summons and vehicles used were analyzed to calculate the cost involved and man-hours consumed in honoring the court summons. Telemedicine facility, available in our institute, was used for conducting tele-evidence with selected courts of the two states as a pilot, which was later expanded. A survey was also done to assess the experience of the physicians with physical appearance and videoconferencing using structured questionnaire after approval from the Institute's Ethics Committee. Likert scale of 0-10 points was used to measure satisfaction. There was 43% drop in the monthly mileage of vehicles, 49% reduction in the fuel cost per month, and 28% savings in terms of time consumed for court duties. Satisfaction score for parameters of time consumed, physical strain, mental strain, communication with Honorable Judges, and overall experience was 87% through tele-evidence as compared to 31% with physical appearance. Tele-evidence is an acceptable and implementable mode of testifying and has led to tremendous resource savings in our tertiary care setting. The model needs to be replicated for deliverance of justice and is in consonance with Government's push toward Digital India.

Improving fatigue in multiple sclerosis by smartphone-supported energy management: The MS TeleCoach feasibility study.

Science.gov (United States)

D'hooghe, Marie; Van Gassen, Geert; Kos, Daphne; Bouquiaux, Olivier; Cambron, Melissa; Decoo, Danny; Lysandropoulos, Andreas; Van Wijmeersch, Bart; Willekens, Barbara; Penner, Iris-Katharina; Nagels, Guy

2018-03-27

Fatigue is a frequently occurring, often disabling symptom in MS with no single effective treatment. In current fatigue management interventions, personalized, real-time follow-up is often lacking. The objective of the study is to assess the feasibility of the MS TeleCoach, a novel intervention offering telemonitoring of fatigue and telecoaching of physical activity and energy management in persons with MS (pwMS) over a 12-week period. The goal of the MS TeleCoach, conceived as a combination of monitoring, self-management and motivational messages, is to enhance levels of physical activity thereby improving fatigue in pwMS in an accessible and interactive way, reinforcing self-management of patients. We conducted a prospective, open-label feasibility study of the MS TeleCoach in pwMS with Expanded Disability Status Scale ≤ 4 and moderate to severe fatigue as measured by the Fatigue Scale for Motor and Cognitive Functions (FSMC). Following a 2-week run-in period to assess the baseline activity level per patient, the target number of activity counts was gradually increased over the 12-week period through telecoaching. The primary efficacy outcome was change in FSMC total score from baseline to study end. A subset of patients was asked to fill in D-QUEST 2.0, a usability questionnaire, to evaluate the satisfaction with the MS TeleCoach device and the experienced service. Seventy-five patients were recruited from 16 centres in Belgium, of which 57 patients (76%) completed the study. FSMC total score (p = 0.009) and motor and cognitive subscores (p = 0.007 and p = 0.02 respectively) decreased from baseline to week 12, indicating an improvement in fatigue. One third of participants with severe fatigue changed to a lower FSMC category for both FSMC total score and subscores. The post-study evaluation of patient satisfaction showed that the intervention was well accepted and that patients were very satisfied with the quality of the professional services

Simplified single plane echocardiography is comparable to conventional biplane two-dimensional echocardiography in the evaluation of left atrial volume: a study validated by three-dimensional echocardiography in 143 individuals.

Science.gov (United States)

Vieira-Filho, Normando G; Mancuso, Frederico J N; Oliveira, Wercules A A; Gil, Manuel A; Fischer, Cláudio H; Moises, Valdir A; Campos, Orlando

2014-03-01

The left atrial volume index (LAVI) is a biomarker of diastolic dysfunction and a predictor of cardiovascular events. Three-dimensional echocardiography (3DE) is highly accurate for LAVI measurements but is not widely available. Furthermore, biplane two-dimensional echocardiography (B2DE) may occasionally not be feasible due to a suboptimal two-chamber apical view. Simplified single plane two-dimensional echocardiography (S2DE) could overcome these limitations. We aimed to compare the reliability of S2DE with other validated echocardiographic methods in the measurement of the LAVI. We examined 143 individuals (54 ± 13 years old; 112 with heart disease and 31 healthy volunteers; all with sinus rhythm, with a wide range of LAVI). The results for all the individuals were compared with B2DE-derived LAVIs and validated using 3DE. The LAVIs, as determined using S2DE (32.7 ± 13.1 mL/m(2)), B2DE (31.9 ± 12.7 mL/m(2)), and 3DE (33.1 ± 13.4 mL/m(2)), were not significantly different from each other (P = 0.85). The S2DE-derived LAVIs correlated significantly with those obtained using both B2DE (r = 0.98; P < 0.001) and 3DE (r = 0.93; P < 0.001). The mean difference between the S2DE and B2DE measurements was <1.0 mL/m(2). Using the American Society of Echocardiography criteria for grading LAVI enlargement (normal, mild, moderate, severe), we observed an excellent agreement between the S2DE- and B2DE-derived classifications (κ = 0.89; P < 0.001). S2DE is a simple, rapid, and reliable method for LAVI measurement that may expand the use of this important biomarker in routine echocardiographic practice. © 2013, Wiley Periodicals, Inc.

MASCOT 6: a modern computer-assisted haptic tele-manipulator

International Nuclear Information System (INIS)

Skilton, R.; Owen, T.

2015-01-01

MASCOT is a two-armed master-slave tele-manipulator device with 7 degrees of freedom per arm. The master and slave movements are linked by force-reflecting servomechanisms, giving the operator a tactile sensation of doing the work. The slave is typically attached to a boom which transports it to the work area. The master is normally located in the control room from where the operator-controlled input actions provide the motion that the Mascot slave will replicate. MASCOT version 4.5 is currently in use at the Joint European Torus (JET) experimental nuclear fusion facility. Its role is to maintain the inside of the reactor vessel without the need for manned entry. The MASCOT-6 project, funded by EFDA, was initiated to address reliability and availability issues arising as a result of obsolete technologies. In particular, the Mascot actuators based around obsolete 2-phase AC induction motors are to be replaced with actuators based on commercial off-the-shelf (COTS) Permanent Magnet Synchronous Motors (PMSMs). As a consequence of its highly integrated, monolithic design, the entire Mascot 4.5 control system, including servo-amplifiers, controllers, control software and HMI (Human Machine Interface)needs to be redesigned. The MASCOT-6 control system is designed to maximise reliability, availability, maintainability, and inspectability (RAMI) of the system, as well as providing significant future-proofing. EtherCAT has been selected as a scalable, modular and extremely fast field-bus to provide communication between the control system and easily replaceable COTS servo drives. MASCOT-6 includes a high-level control system designed with modern software engineering practises in mind, and provides a modular, generic framework which can be extended to cater for any tele-operation or robotic system. Advanced Computer-Aided-Tele-operation features such as dynamic force compensation and load cancellation are presented. Communication between the MASCOT-6 control system and its

Somatic diseases in child survivors of the Holocaust with posttraumatic stress disorder: a comparative study.

Science.gov (United States)

Sperling, Wolfgang; Kreil, Sebastian; Biermann, Teresa

2012-05-01

The incidence of mental and somatic sequelae has been shown to be very high in people who survived the Holocaust. In the current study, 80 Holocaust survivors with posttraumatic stress disorder were examined based on evaluation of their complete record (medical reports, clinical history, medical statements, and handwritten declarations of patients under oath). These survivors were compared with subjects with posttraumatic stress disorder caused by traumata other than the Holocaust. The data were analyzed for the presence of cardiovascular, gastrointestinal, and orthopedic diseases that developed in the time between the earliest medical report (expert opinion) and the latest expert opinion. Analysis revealed an increase in myocardial infarction, chronic degenerative diseases, and cancerous changes in the second expert opinion. No differences between the groups were seen with regard to sex, age at traumatization, or age at examination. Several implications of the data are discussed, including the implication that the survivors examined in this study may comprise a highly resilient group, inasmuch as they had reached an advanced age.

Treating tension-type headache -- an expert opinion

DEFF Research Database (Denmark)

Bendtsen, Lars; Jensen, Rigmor

2011-01-01

treatment of chronic TTH. Mirtazapine and venlafaxine are second-choice drugs. EXPERT OPINION: There is an urgent need for more research in nonpharmacological as well as pharmacological treatment possibilities of TTH. Future studies should examine the relative efficacy of the various treatment modalities...

A guideline update for the practice of echocardiography in the cardiac screening of sports participants: a joint policy statement from the British Society of Echocardiography and Cardiac Risk in the Young

Directory of Open Access Journals (Sweden)

David Oxborough PhD

2018-03-01

Full Text Available Sudden cardiac death (SCD in an athlete is a rare but tragic event. In view of this, pre-participation cardiac screening is mandatory across many sporting disciplines to identify those athletes at risk. Echocardiography is a primary investigation utilized in the pre-participation setting and in 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint policy document providing guidance on the role of echocardiography in this setting. Recent developments in our understanding of the athlete’s heart and the application of echocardiography have prompted this 2018 update.

Evaluation of echocardiography in the management of elderly patients with heart failure.

Science.gov (United States)

Hendry, A; Hacking, L; Langhorne, P; Vallance, R; MacDonald, J

1999-09-01

To determine the validity of a clinical diagnosis of systolic dysfunction in elderly patients with heart failure and assess the contribution of echocardiography to their management. 61 elderly patients with a diagnosis of heart failure in a geriatric assessment unit setting. Prospective study determining sensitivity, specificity and predictive values of a clinical and radiological diagnosis compared with echocardiographic standard. Proposed management was compared before and after echocardiography. Clinical assessment was highly sensitive (93%) but lacked specificity (32%). Combining radiological and clinical diagnoses increased specificity to 58%. Echocardiography revised the lead cardiac diagnosis for 28% of patients and influenced patient management plans for 41%. For elderly patients with heart failure, echocardiography improves diagnostic accuracy and identifies those patients with potential to benefit from angiotensin-converting enzyme inhibitors.

Echocardiography in patients with complications related to pacemakers and cardiac defibrillators.

Science.gov (United States)

Almomani, Ahmed; Siddiqui, Khadija; Ahmad, Masood

2014-03-01

The evolving indications and uses for implantable cardiac devices have led to a significant increase in the number of implanted devices each year. Implantation of endocardial leads for permanent pacemakers and cardiac defibrillators can cause many delayed complications. Complications may be mechanical and related to the interaction of the device leads with the valves and endomyocardium, e.g., perforation, infection, and thrombosis, or due to the electrical pacing of the myocardium and conduction abnormalities, e.g., left ventricular dyssynchrony. Tricuspid regurgitation, another delayed complication in these patients, may be secondary to both mechanical and pacing effects of the device leads. Echocardiography plays an important role in the diagnosis of these device-related complications. Both two-dimensional transthoracic echocardiography and transesophageal echocardiography provide useful diagnostic information. Real time three-dimensional echocardiography is a novel technique that can further enhance the detection of lead-related complications. © 2013, Wiley Periodicals, Inc.

Intraoperative echocardiography of a dislodged Björk-Shiley mitral valve disc.

Science.gov (United States)

Tanaka, M; Abe, T; Takeuchi, E; Watanabe, T; Tamaki, S

1991-02-01

The successful management of a patient who suffered an outlet strut fracture of a Björk-Shiley 60-degree convexo-concave mitral valve prosthesis is reported. Emergency operation was life-saving. Preoperative echocardiography assisted in making a prompt diagnosis, and intraoperative echocardiography allowed the detection and removal of the dislodged disc from the left ventricle at the time of the operation. The role of intraoperative echocardiography in the diagnosis of prosthetic strut fracture is emphasized.

Visualization of traumatic tricuspid insufficiency by three-dimensional echocardiography.

Science.gov (United States)

Nishimura, Kazuhisa; Okayama, Hideki; Inoue, Katsuji; Saito, Makoto; Nagai, Takayuki; Suzuki, Jun; Ogimoto, Akiyoshi; Ohtsuka, Tomoaki; Higaki, Jitsuo

2010-01-01

A 19-year-old male was admitted to the emergency room of our hospital after a motor vehicle accident. During his first physical examination, a holosystolic murmur was heard at the fourth left parasternal border. Transthoracic echocardiography showed severe tricuspid insufficiency, but the cause of tricuspid insufficiency was unclear. Therefore, three-dimensional echocardiography was performed and demonstrated flail anterior, posterior and septal leaflets of the tricuspid valve. The diagnosis was tricuspid insufficiency due to papillary muscle rupture secondary to chest blunt trauma. Surgical repair of the tricuspid valve was performed in this patient. After surgery, the signs and symptoms of right ventricular heart failure were relieved. In this case, three-dimensional echocardiography was very useful for the evaluation of spatial destruction of the tricuspid valve and papillary muscle. 2009 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Usefulness of exercise echocardiography in ischemic heart disease. Comparison with exercise cardiac scintigraphy

International Nuclear Information System (INIS)

Tashiro, Hideki; Koyanagi, Samon; Narabayashi, Hideki; Inou, Tetsuji; Takeshita, Akira

1999-01-01

Exercise echocardiography and exercise thallium-201 ( 201 Tl) single photon emission computed tomography (SPECT) were performed in 152 patients with suspected coronary artery disease, including 61 patients with old myocardial infarction. All patients underwent coronary arteriography, and coronary artery disease was defined as ≥75% diameter stenosis. Digital two-dimensional echocardiography was performed before and after the treadmill exercise test, and wall motion abnormality was evaluated using quad-screen. Sensitivity and specificity for the diagnosis of coronary artery disease were similar for the 2 exercise tests (77% and 80% for echocardiography and 75%, and 83% for SPECT, respectively). Diagnoses for one-vessel disease, 2-vessel disease and 3-vessel disease were similar for echocardiography (79%, 72% and 77%, respectively) and SPECT (74%, 75% and 77%, respectively). Sensitivity for the diagnosis of ischemia at the area remote from infarct area was low for both exercise echocardiography and exercise SPECT (45% and 48%, respectively). Exercise echocardiography has comparable diagnostic value to SPECT for the detection of coronary artery disease. However, both exercise tests have limitations for the diagnosis of ischemia at the area remote from infarct area. (author)

Three-dimensional transesophageal echocardiography of the atrial septal defects

Directory of Open Access Journals (Sweden)

Romero-Cárdenas Ángel

2008-07-01

Full Text Available Abstract Transesophageal echocardiography has advantages over transthoracic technique in defining morphology of atrial structures. Even though real time three-dimensional echocardiographic imaging is a reality, the off-line reconstruction technique usually allows to obtain higher spatial resolution images. The purpose of this study was to explore the accuracy of off-line three-dimensional transesophageal echocardiography in a spectrum of atrial septal defects by comparing them with representative anatomic specimens.

Factors associated with diagnostic discrepancy for left ventricular hypertrophy between electrocardiography and echocardiography

DEFF Research Database (Denmark)

Sandager Petersen, Søren; Reinholdt Pedersen, Line; Pareek, Manan

2017-01-01

(absolute value/cut-off value for LVH) were used as outcome variables in order to identify explanatory variables associated with diagnostic discrepancies between ECG and echocardiography. RESULTS: Of the 1382 subjects included, 77% did not display any signs of LVH, 6% had LVH defined by ECG only, 13% had...... LVH defined by echocardiography only, and 5% had LVH on both ECG and echocardiography. Older subjects and those with higher blood pressure and RWT were more likely to have a relatively greater LVMI on echocardiography than that predicted on ECG (odds ratio: 1.65 per 10 years (95% confidence interval...... and odds ratio: 1.41 (95% CI: 1.06-1.87), p = .02), but FPG did not independently influence discrepancy between ECG and echocardiography. CONCLUSION: Age, blood pressure, female sex, greater RWT and use of antihypertensive medication were associated with a greater risk of non-consistency between LVH...

Second language social networks and communication-related acculturative stress: The role of interconnectedness

Directory of Open Access Journals (Sweden)

Marina M Doucerain

2015-08-01

Full Text Available Although a substantial amount of cross-cultural psychology research has investigated acculturative stress in general, little attention has been devoted specifically to communication-related acculturative stress. In line with the view that cross-cultural adaptation and second language (L2 learning are social and interpersonal phenomena, the present study examines the hypothesis that migrants' L2 social network size and interconnectedness predict communication-related acculturative stress. The main idea underlying this hypothesis is that L2 social networks play an important role in fostering social and cultural aspects of communicative competence. Specifically, higher interconnectedness may reflect greater access to unmodified natural cultural representations and L2 communication practices, thus fostering communicative competence through observational learning. As such, structural aspects of migrants' L2 social networks may be protective against acculturative stress arising from chronic communication difficulties. Results from a study of first generation migrant students (N=100 support this idea by showing that both inclusiveness and density of the participants' L2 network account for unique variance in communication-related acculturative stress but not in general acculturative stress. These results support the idea that research on cross-cultural adaptation would benefit from disentangling the various facets of acculturative stress and that the structure of migrants' L2 network matters for language related outcomes. Finally, this study contributes to an emerging body of work that attempts to integrate cultural/cross-cultural research on acculturation and research on intercultural communication and second language learning.

Prognostic value of exercise echocardiography: validation of a new risk index combining echocardiographic, treadmill, and exercise electrocardiographic parameters.

Science.gov (United States)

Mazur, Wojciech; Rivera, Jose M; Khoury, Alexander F; Basu, Abhijeet G; Perez-Verdia, Alejandro; Marks, Gary F; Chang, Su Min; Olmos, Leopoldo; Quiñones, Miguel A; Zoghbi, William A

2003-04-01

Exercise (Ex) echocardiography has been shown to have significant prognostic power, independent of other known predictors of risk from an Ex stress test. The purpose of this study was to evaluate a risk index, incorporating echocardiographic and conventional Ex variables, for a more comprehensive risk stratification and identification of a very low-risk group. Two consecutive, mutually exclusive populations referred for treadmill Ex echocardiography with the Bruce protocol were investigated: hypothesis-generating (388 patients; 268 males; age 55 +/- 13 years) and hypothesis-testing (105 patients; 61 males age: 54 +/- 14 years).Cardiac events included cardiac death, myocardial infarction, late revascularization (>90 days), hospital admission for unstable angina, and admission for heart failure. Mean follow-up in the hypothesis-generating population was 3.1 years. There were 38 cardiac events. Independent predictors of events by multivariate analysis were: Ex wall motion score index (odds ratio [OR] = 2.77/Unit; P or = 1 mm (OR = 2.84; P =.002); and treadmill time (OR = 0.87/min; P =.037). A risk index was generated on the basis of the multivariate Cox regression model as: risk index = 1.02 (Ex wall motion score index) + 1.04 (S-T change) - 0.14 (treadmill time). The validity of this index was tested in the hypothesis-testing population. Event rates at 3 years were lowest (0%) in the lower quartile of risk index (-1.22 to -0.47), highest (29.6%) in the upper quartile (+0.66 to +2.02), and intermediate (19.2% to 15.3%) in the intermediate quartiles. The OR of the risk index for predicting cardiac events was 2.94/Unit ([95% confidence interval: 1.4 to 6.2]; P =.0043). Echocardiographic and Ex parameters are independent powerful predictors of cardiac events after treadmill stress testing. A risk index can be derived with these parameters for a more comprehensive risk stratification with Ex echocardiography.

Usefulness of pulse-wave doppler tissue sampling and dobutamine stress echocardiography for identification of false positive inferior wall defects in SPECT

International Nuclear Information System (INIS)

Altinmakas, S.; Dagdeviren, B.; Turkmen, M.; Gursurer, M.; Say, B.; Tezel, T.; Ersek, B.

2000-01-01

False positive inferior wall perfusion defects restrict the accuracy of SPECT in diagnosis of coronary artery disease (CAD). Pulse-Wave Tissue Doppler (PWTD) has been recently proposed to assess regional wall motion velocities. The objectives of this study were to evaluate the presence of CAD by using PWTD during dobutamine stress echocardiography (DSE) in patients with an inferior perfusion defect detected by SPECT and compare PWTD parameters of normal cases with patients who had inferior perfusion defect and CAD. Sixty-five patients (mean age 58±8 years, 30 men) with a normal LV systolic function at rest according to echocardiographic evaluation with an inferior ischemia determined by SPECT and a control group (CG) of 34 normal cases (mean age 56±7 years, 16 men) were included in this study. All patients underwent a standard DSE (up to 40 μg/kg/min with additional atropine during sub-maximum heart rate responses). Pulse-wave Doppler tissue sampling of inferior wall was performed in the apical 2-chamber view at rest and stress. The coronary angiography was performed within 24 hours. The results were evaluated for the prediction of significant right coronary artery (RCA) and/or left circumflex coronary artery (CX) with narrowing (≥50% diameter stenosis, assessed by quantitative coronary angiography). It was observed that the peak stress mean E/A ratio was lower in patients with CAD when compared to patients without CAD (0.78±0.2 versus 1.29±0.11 p<0.0001). Also the peak stress E/A ratio of normal cases was significantly higher than patients who had CAD (1.19±0.3 versus 0.78±0.2 p<0.0001). When the cut off point for the E/A ratio was determined as 1, the sensitivity and specificity of dobutamine stress PWTD E/A were 89% and 86%, respectively. The peak stress E/A ratio was higher than 1 in all patients with a false positive perfusion defect. Systolic S velocity increase during DSE was significantly lower in patients with CAD (54%±17 versus 99%±24 p=0

Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction

DEFF Research Database (Denmark)

Haugaa, Kristina H; Grenne, Bjørnar L; Eek, Christian H

2013-01-01

The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI).......The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI)....

Effect of a tele-training programme on radiographers in the interpretation of CT colonography

DEFF Research Database (Denmark)

Lauridsen, Carsten; Lefere, Philippe; Gerke, Oke

2012-01-01

OBJECTIVE: To assess the performance of radiographers in CT colonography (CTC) after a tele-training programme, supervised by 2 experienced radiologists. MATERIALS AND METHODS: Five radiographers underwent training in CTC using a tele-training programme mainly based on the interpretation of 75...... training cases performed in the novice department. To evaluate the educational performance, each radiographer was tested on 20 test cases with 27 lesions >6mm (12: 6-9mm; 15: >10mm). Sensitivity, specificity and PPV for polyps ≥6mm and ≥10mm were calculated with point estimates and 95% confidence interval...... (95% CI). The results were compared by comparing 95% CI with a 5% significance level. RESULTS: In the training cases overall per-polyp sensitivity was 57% (95% CI 46.1-67.9) and 69.1% (95% CI 50.6-87.5) for lesions ≥6mm and ≥10mm, respectively. Overall per patient sensitivity, specificity and PPV were...

Exercise echocardiography for structural heart disease.

Science.gov (United States)

Izumo, Masaki; Akashi, Yoshihiro J

2016-03-01

Since the introduction of transcatheter structural heart intervention, the term "structural heart disease" has been widely used in the field of cardiology. Structural heart disease refers to congenital heart disease, valvular heart disease, and cardiomyopathy. In structural heart disease, valvular heart disease is frequently identified in the elderly. Of note, the number of patients who suffer from aortic stenosis (AS) and mitral regurgitation (MR) is increasing in developed countries because of the aging of the populations. Transcatheter aortic valve replacement and percutaneous mitral valve repair has been widely used for AS and MR, individually. Echocardiography is the gold standard modality for initial diagnosis and subsequent evaluation of AS and MR, although the difficulties in assessing patients with these diseases still remain. Here, we review the clinical usefulness and prognostic impact of exercise echocardiography on structural heart disease, particularly on AS and MR.

Rapid Deployment of International Tele-Intensive Care Unit Services in War-Torn Syria.

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Moughrabieh, Anas; Weinert, Craig

2016-02-01

The conflict in Syria has created the largest humanitarian emergency of the twenty-first century. The 4-year Syrian conflict has destroyed hospitals and severely reduced the capacity of intensive care units (ICUs) and on-site intensivists. The crisis has triggered attempts from abroad to support the medical care of severely injured and acutely ill civilians inside Syria, including application of telemedicine. Within the United States, tele-ICU programs have been operating for more than a decade, albeit with high start-up costs and generally long development times. With the benefit of lessons drawn from those domestic models, the Syria Tele-ICU program was launched in December 2012 to manage the care of ICU patients in parts of Syria by using inexpensive, off-the-shelf video cameras, free social media applications, and a volunteer network of Arabic-speaking intensivists in North America and Europe. Within 1 year, 90 patients per month in three ICUs were receiving tele-ICU services. At the end of 2015, a network of approximately 20 participating intensivists was providing clinical decision support 24 hours per day to five civilian ICUs in Syria. The volunteer clinicians manage patients at a distance of more than 6,000 miles, separated by seven or eight time zones between North America and Syria. The program is implementing a cloud-based electronic medical record for physician documentation and a medication administration record for nurses. There are virtual chat rooms for patient rounds, radiology review, and trainee teaching. The early success of the program shows how a small number of committed physicians can use inexpensive equipment spawned by the Internet revolution to support from afar civilian health care delivery in a high-conflict country.

Multidetector CT evaluation of total anomalous pulmonary venous connections: comparison with echocardiography

International Nuclear Information System (INIS)

Oh, Ki Ho; Choo, Ki Seok; Lim, Soo Jin; Lee, Hyoung Doo; Park, Ji Ae; Jo, Min Jung; Sung, Si Chan; Chang, Yun Hee; Jeong, Dong Wook; Kim, Siho

2009-01-01

Although echocardiography is the first-line imaging modality in the diagnosis of total anomalous pulmonary venous connection (TAPVC), multidetector CT (MDCT) could have advantages in the diagnosis of TAPVC in certain cases. To compare MDCT with echocardiography in the evaluation of TAPVC. Enrolled in the study were 23 patients with surgically proven TAPVC. The echocardiography and MDCT findings were independently interpreted by a paediatric cardiologist and cardiac radiologist in terms of: (1) the drainage site of the common pulmonary vein, (2) stenosis of the vertical vein, and (3) the course of the atypical vessel into the systemic vein in the case of vertical vein stenosis. The findings from both modalities were correlated with the results obtained at surgery (n=22) or autopsy (n=1). In all patients, MDCT correctly depicted the drainage site of the common pulmonary vein, stenosis of the vertical vein and the course of the atypical vessel into the systemic vein (sensitivity 100%, specificity 100%). The specificity of echocardiography was 100% for the three defined findings. The sensitivity of echocardiography, however, was 87%, 71% and 0%, respectively. MDCT can facilitate the diagnosis of TAPVC in certain cases. (orig.)

[Teleconsulting in echocardiography using a standard cable on HDSL].

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Mantero, Antonio; Catena, Emanuele; Tarelli, Giuseppe; Torta, Daniela; Barbier, Paolo; Pedroncelli, Elena; Begnis, Roberto; Tappia, Danilo; Lombardi, Federico; Vitali, Ettore

2007-03-01

Teleconsultation in echocardiography is complex owing to the heavy images and video files to be exchanged; moreover standards for data acquisition still need to be defined. The aim of this experience was to verify the feasibility to connect two laboratories for teleconsulting using a standard HDSL telephone cable. Hardware included one echocardiograph, one PC, video aquisition board and network board, USB webcam, Network router and an HDSL line for data communication. Software includes MS Windows XP and Netmeeting. The live interactivity between the labs was granted by a video streaming in MPEG4 format, directly delivered by the PC communication software. Standard DICOM was used for formal aspects. The platform has been verified during a demo at "National Congress of Cardiovascular Echography" in 2005. The experiment survey collected at the Teleconference gave a consistently good result. Twenty-one subjects filled in the questionnaire: 12 of them (57%) reported a difference between the video streaming and DICOM; whereas 7 of them (33%) did not point out it. Overall findings have been positive, even though 15 members (71%) reported feasibility with some difficulties; 18 members (86%) reported the possibility of really using this technology in the future. The total cost was 145000 euro. In our opinion, overall cost is more than acceptable especially considering how often to send data is more convenient than moving sick people or consultants.

Fukushima effects in Germany? Changes in media coverage and public opinion on nuclear power.

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Arlt, Dorothee; Wolling, Jens

2016-10-01

Based on a literature review on factors that explain media effects and previous findings on media coverage and public opinion on nuclear power, this article examines the effects of Fukushima on media coverage and public opinion in Germany in two studies. The first study uses content analysis data to analyse changes in media coverage, and the second one is based on panel survey data to examine attitude changes on an individual level. The results of both studies show changes in media coverage and public opinion on nuclear power. Furthermore, the second study reveals that individual attitude changes cannot necessarily be explained by the same factors as the distribution of attitudes. © The Author(s) 2015.

Video equipment of tele dosimetry and audio

International Nuclear Information System (INIS)

Ojeda R, M.A.; Padilla C, I.

2007-01-01

To develop a work in an area with high radiation, it requires of a detailed knowledge of the surroundings work, a communication and effective vision, a near dosimetric control. In a work where the spaces variables and reduced accesses exist, noise that hinders the communication, defendant operative condition, radiation field and taking of decision, it is necessary to have tools that allow a total control of the environment to make opportune and effective decisions, there where the task is developed. Under this elementary concept, it was developed in the Laguna Verde Central a project that it allowed a mechanism, interactive of control in spaces complex; to see, to hear, to speak, to measure. This concept takes to the creation of an equipped system with closed circuit of television, wireless communication systems, tele dosimetry wireless systems, VHS and DVD recording equipment, uninterrupted energy units. The system requires of an electric power socket, and the installation of two cables by CCTV camera. The system is mobilized by a person. He puts on in operation in 5 minutes using a verification list. The concept was developed in the project denominated VETA-1, (Video Equipment of Tele dosimetry and Audio). It is objective of this work to present before the society the development of the VETA-1 tool that conclude in their first prototype in May of the present year. The VETA-1 project arises by a necessity of optimizing dose, it is an ALARA tool, with a countless applications, like it was proven in the 12 recharge stop of the Unit 1. The VETA-1 project integrate a recording system, with the primary end of analyzing in the place where the task is developed the details for an effective and opportune decision, but the resulting information is of utility for the personnel's training and the planning of future works. The VETA-1 system is an ALARA tool of quick response control. (Author)

P-02: Echocardiography Has Low Clinical Efficacy of Libyan Screening Protocol in Athletes

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Salaheddin Sharif

2017-03-01

Full Text Available INTRODUCTIONPre-participation screening has been largely accepted as a means to identify those athletes at risk of cardiovascular diseases which are responsible for sudden cardiac death. The objectives of athlete screening are to reduce injuries and prevent sudden. However, there is no single commonly adopted protocol to screen athletes. Although the European Society of Cardiology and the American Heart Association recommend the routine screening of athletes to prevent sudden death, there is significant disagreement regarding use 12 lead ECG. FIFA has recommend the inclusion of an Echocardiography (ECHO in screening protocol.PURPOSEExplore the debate regarding differences between European and the USA pre-participation screening protocol for sudden death while also considering pre-competition medical assessment protocol used by the Libyan Football Federation. To provide evidence based recommendations on the best protocol to be used for pre-participation screening, and thus to standardize the screening method.MATERIALS and METHOD1236 male athletic received a medical history, general physical examination, cardiovascular and musculoskeletal examination, 12 lead ECG, blood laboratory test, and echocardiography.FINDINGS1235 athletics were found to be eligible to participate in sport and were given a full medical clearance. One athletic was diagnosed with second degree heart block by ECG while his medical history, physical examination, echocardiograph, and blood test were normal.DISCUSSIONEchocardiography alone do did not identify pathological condition and using echocardiography is still controversial and clinically not effective in young athletesCONCLUSIONThe Screening protocol should include a combination of medical history, physical examination and ECG due to the high sensitivity found, and thus it was able to identify all athletes at risk for the disease.

The importance of echocardiography in transcatheter aortic valve implantation.

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Bilen, Emine; Sari, Cenk; Durmaz, Tahir; Keleş, Telat; Bayram, Nihal A; Akçay, Murat; Ayhan, Hüseyin M; Bozkurt, Engin

2014-01-01

Valvular heart diseases cause serious health problems in Turkey as well as in Western countries. According to a study conducted in Turkey, aortic stenosis (AS) is second after mitral valve disease among all valvular heart diseases. AS is frequently observed in elderly patients who have several cardiovascular risk factors and comorbidities. In symptomatic severe AS, surgical aortic valve replacement (AVR) is a definitive treatment. However, in elderly patients with left ventricular dysfunction and comorbidities, the risk of operative morbidity and mortality increases and outweighs the gain obtained from AVR surgery. As a result, almost one-third of the patients with serious AS are considered ineligible for surgery. Transcatheter aortic valve implantation (TAVI) is an effective treatment in patients with symptomatic severe AS who have high risk for conventional surgery. Since being performed for the first time in 2002, with a procedure success rate reported as 95% and a mortality rate of 5%, TAVI has become a promising method. Assessment of vascular anatomy, aortic annular diameter, and left ventricular function may be useful for the appropriate selection of patients and may reduce the risk of complications. Cardiac imaging methods including 2D and 3D echocardiography and multidetector computed tomography are critical during the evaluation of suitable patients for TAVI as well as during and after the procedure. In this review, we describe the role of echocardiography methods in clinical practice for TAVI procedure in its entirety, i.e. from patient selection to guidance during the procedure, and subsequent monitoring. © 2013, Wiley Periodicals, Inc.

[Real time 3D echocardiography

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Bauer, F.; Shiota, T.; Thomas, J. D.

2001-01-01

Three-dimensional representation of the heart is an old concern. Usually, 3D reconstruction of the cardiac mass is made by successive acquisition of 2D sections, the spatial localisation and orientation of which require complex guiding systems. More recently, the concept of volumetric acquisition has been introduced. A matricial emitter-receiver probe complex with parallel data processing provides instantaneous of a pyramidal 64 degrees x 64 degrees volume. The image is restituted in real time and is composed of 3 planes (planes B and C) which can be displaced in all spatial directions at any time during acquisition. The flexibility of this system of acquisition allows volume and mass measurement with greater accuracy and reproducibility, limiting inter-observer variability. Free navigation of the planes of investigation allows reconstruction for qualitative and quantitative analysis of valvular heart disease and other pathologies. Although real time 3D echocardiography is ready for clinical usage, some improvements are still necessary to improve its conviviality. Then real time 3D echocardiography could be the essential tool for understanding, diagnosis and management of patients.

Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease: protocol for a systematic review.

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Telford, Lisa H; Abdullahi, Leila H; Ochodo, Eleanor A; Zühlke, Liesl J; Engel, Mark E

2018-02-10

Rheumatic heart disease (RHD) is a preventable and treatable chronic condition which persists in many developing countries largely affecting impoverished populations. Handheld echocardiography presents an opportunity to address the need for more cost-effective methods of diagnosing RHD in developing countries, where the disease continues to carry high rates of morbidity and mortality. Preliminary studies have demonstrated moderate sensitivity as well as high specificity and diagnostic odds for detecting RHD in asymptomatic patients. We describe a protocol for a systematic review on the diagnostic performance of handheld echocardiography compared to standard echocardiography using the 2012 World Heart Federation criteria for diagnosing subclinical RHD. Electronic databases including PubMed, Scopus, Web of Science and EBSCOhost as well as reference lists and citations of relevant articles will be searched from 2012 to date using a predefined strategy incorporating a combination of Medical Subject Heading terms and keywords. The methodological validity and quality of studies deemed eligible for inclusion will be assessed against review specific Quality Assessment of Diagnostic Accuracy Studies 2 criteria and information on metrics of diagnostic accuracy and demographics extracted. Forest plots of sensitivity and specificity as well as scatter plots in receiver operating characteristic (ROC) space will be used to investigate heterogeneity. If possible, a meta-analysis will be conducted to produce summary results of sensitivity and specificity using the Hierarchical Summary ROC method. In addition, a sensitivity analysis will be conducted to investigate the effect of studies with a high risk of bias. Ethics approval is not required for this systematic review of previously published literature. The planned review will provide a summary of the diagnostic accuracy of handheld echocardiography. Results may feed into evidence-based guidelines and should the findings of this

Echocardiography as an approach for canine cardiac disease diagnosis

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P. Singh

2014-11-01

Full Text Available Aim: The aim of the study was to establish the methods for diagnosis various canine cardiac ailments using echocardiography. Materials and Methods: M-mode, two-dimensional echocardiography and Doppler studies were performed on 10 cases. Dogs showing signs of cardiac ailment either clinically, radiographic or via electrocardiographic examination were selected for study. Right parasternal short axis view was used for echocardiographic measurements. Right parasternal long axis and left parasternal apical views were used for Doppler studies. Doppler studies were performed at the level of aortic valve and atrioventricular valves for semi quantitative diagnosis of regurgitation. Results: Dogs were found affected with dilated cardiomyopathy (DCM (n=5, pericardial effusion (PE (n=1, combined PE and DCM (n=2 and remaining two showed abnormality on radiographic or electrographically evaluation but were found out to be normal echocardiographically (n=2. Conclusion: Echocardiography is an effective tool for diagnosis of various heart ailments.

Development of a prototype of the tele-localisation system in radiotherapy using personal digital assistant via wireless communication.

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Wu, Vincent Wing-Cheung; Tang, Fuk-hay; Cheung, Wai-kwan; Chan, Kit-chi

2013-02-01

In localisation of radiotherapy treatment field, the oncologist is present at the simulator to approve treatment details produced by the therapist. Problems may arise if the oncologist is not available and the patient requires urgent treatment. The development of a tele-localisation system is a potential solution, where the oncologist uses a personal digital assistant (PDA) to localise the treatment field on the image sent from the simulator through wireless communication and returns the information to the therapist after his or her approval. Our team developed the first tele-localisation prototype, which consisted of a server workstation (simulator) for the administration of digital imaging and communication in medicine localisation images including viewing and communication with the PDA via a Wi-Fi network; a PDA (oncologist's site) installed with the custom-built programme that synchronises with the server workstation and performs treatment field editing. Trial tests on accuracy and speed of the prototype system were conducted on 30 subjects with the treatment regions covering the neck, skull, chest and pelvis. The average time required in performing the localisation using the PDA was less than 1.5 min, with the blocked field longer than the open field. The transmission speed of the four treatment regions was similar. The average physical distortion of the images was within 4.4% and the accuracy of field size indication was within 5.3%. Compared with the manual method, the tele-localisation system presented with an average deviation of 5.5%. The prototype system fulfilled the planned objectives of tele-localisation procedure with reasonable speed and accuracy. © 2012 The Authors. Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists.

Dynamic release and clearance of circulating microparticles during cardiac stress.

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Augustine, Daniel; Ayers, Lisa V; Lima, Eduardo; Newton, Laura; Lewandowski, Adam J; Davis, Esther F; Ferry, Berne; Leeson, Paul

2014-01-03

Microparticles are cell-derived membrane vesicles, relevant to a range of biological responses and known to be elevated in cardiovascular disease. To investigate microparticle release during cardiac stress and how this response differs in those with vascular disease. We measured a comprehensive panel of circulating cell-derived microparticles by a standardized flow cytometric protocol in 119 patients referred for stress echocardiography. Procoagulant, platelet, erythrocyte, and endothelial but not leukocyte, granulocyte, or monocyte-derived microparticles were elevated immediately after a standardized dobutamine stress echocardiogram and decreased after 1 hour. Twenty-five patients developed stress-induced wall motion abnormalities suggestive of myocardial ischemia. They had similar baseline microparticle levels to those who did not develop ischemia, but, interestingly, their microparticle levels did not change during stress. Furthermore, no stress-induced increase was observed in those without inducible ischemia but with a history of vascular disease. Fourteen patients subsequently underwent coronary angiography. A microparticle rise during stress echocardiography had occurred only in those with normal coronary arteries. Procoagulant, platelet, erythrocyte, and endothelial microparticles are released during cardiac stress and then clear from the circulation during the next hour. This stress-induced rise seems to be a normal physiological response that is diminished in those with vascular disease.

National French survey on tele-transmission of EEG recordings: More than a simple technological challenge.

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Sauleau, Paul; Despatin, Jane; Cheng, Xufei; Lemesle, Martine; Touzery-de Villepin, Anne; N'Guyen The Tich, Sylvie; Kubis, Nathalie

2016-04-01

Assessment of current practice and the need for tele-transmission and remote interpretation of EEG in France. Transmission of EEG to a distant center could be a promising solution to the problem of decreasing availability of neurophysiologists for EEG interpretation, in order to provide equity within health care services in France. This practice should logically follow the legal framework of telemedicine and the recommendations that were recently edited by the Société de neurophysiologie clinique de langue française (SNCLF) and the Ligue française contre l'épilepsie (LCFE). A national survey was designed and performed under the auspices of the SNCLF. This survey reveals that there is an important gap between the official recommendations and the "reality on the ground". These local organizations were mainly established through the impulse of individual initiatives, rarely driven by health regulatory authorities and sometimes far from legal frameworks. For the majority, they result from a need to improve medical care, especially in pediatrics and neonatology, and to ensure continuity of care. When present, tele-transmission of EEG is often only partially satisfactory, since many technical procedures have to be improved. Conversely, the lack of tele-transmission of EEG would penalize medical care for some patients. The survey shows both the wealth of local initiatives and the fragility of most existing networks, emphasizing the need for better cooperation between regulatory authorities and health care professionals to establish or improve the transmission of EEG in France. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

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Esmaeilzadeh, Maryam; Parsaee, Mozhgan; Maleki, Majid

2013-01-01

Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea. This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction. PMID:23646042

Cardiac MR imaging: Comparison with echocardiography and dynamic CT

International Nuclear Information System (INIS)

Colletti, P.M.; Norris, S.; Raval, J.; Boswell, W.; Lee, K.; Ralls, P.; Haywood, J.; Halls, J.

1986-01-01

The authors compared gated cardiac MR imaging with two-dimensional and Doppler echocardiography and dynamic CT. Gated cardiac MR imaging (VISTA unit, 0.5 T) was performed in 55 patients with a variety of conditions. Accuracy of diagnosis was compared. CT showed arterial, valvular, and pericardial calcifications not seen on MR imaging. Many lesions were seen as well on CT as on MR imaging. Two-dimensional echocardiography was superior in demonstrating wall motion and valvular disease. MR imaging was superior in demonstrating myocardial structures

Effectiveness of simulator-based echocardiography training of noncardiologists in congenital heart diseases.

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Wagner, Robert; Razek, Vit; Gräfe, Florentine; Berlage, Thomas; Janoušek, Jan; Daehnert, Ingo; Weidenbach, Michael

2013-07-01

Congenital heart diseases (CHD) are responsible for substantial morbidity and mortality in neonates. The preliminary diagnosis often is made by noncardiologists. For this reason, there is a huge demand of training in echocardiography of CHD. This is difficult to achieve due to limited resources of specialized centers. The goal of this study was to investigate the training effect of the echocardiography simulator EchoCom on trainee's ability to diagnose CHD. We enrolled 10 residents for simulator-based training in echocardiography of CHD. All participants were instructed on the simulator's basic handling and had one hour to scan the first 9 datasets information (ventricular septal defect, atrial septal defect, atrioventricular septal defect, Tetralogy of Fallot, transposition of great arteries, congenital corrected transposition of great arteries, common arterial trunk, hypoplastic left heart syndrome, normal anatomy) and establish a diagnosis. No help was given except for support regarding simulator related issues. Afterward, 2 rounds of structured simulator based echocardiography training focused on echocardiographic anatomy, spatial orientation, standard views, and echocardiographic anatomy of different CHD followed. All participants completed a standardized questionnaire containing 10 multiple-choice (MC) questions focusing on basic theoretical knowledge in echocardiographic anatomy and common CHD. Almost all of the residents invited from the affiliated children's hospital had little (20%) or no experience (80%) in echocardiography of CHD. Their Pretest and Posttest scores showed significant improvement for both, MC test and performance test, respectively. Our study showed that simulator-based training in echocardiography in CHD could be very effective and may assist with training outside the scope of CHD. © 2013, Wiley Periodicals, Inc.

Satellites, Plasmas and Law: The Role of TeleCourt in Changing Conceptions of Justice and Authority in Ethiopia

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Zenebe Beyene

2015-05-01

Full Text Available An ambitious experiment in the ICT and justice sector is underway in Ethiopia. As part of an effort to improve service delivery and the responsiveness of the state, the Ethiopian government has created 'TeleCourt,' a system that allows trials to take place between remote areas and regional or federal courts through videoconferencing and a satellite Internet connection. This article is the first to analyze how TeleCourt operates, with a particular focus on the perspectives of end-users, those who have had first-hand experience of how 'justice at a distance' actually works. The findings suggest general satisfaction with the savings - both in terms of financial burden and time costs that are often incurred when travelling to trials - which TeleCourt allows. As the system improves ways to provide justice to the grassroots, in line with the government's commitment towards peasants, this must also be considered in the context of the Ethiopian government's growing efforts to use law to curb political dissent. This is indicative of a broader tendency of selectively adopting and reshaping ICTs and extending them to the poorest people in Ethiopia in order to support the functioning of the state, while other uses of ICTs that are seen as potentially destabilizing are discouraged or forbidden.

Evaluation of Computer-Based Training for Health Workers in Echocardiography for RHD.

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Engelman, Daniel; Okello, Emmy; Beaton, Andrea; Selnow, Gary; Remenyi, Bo; Watson, Caroline; Longenecker, Chris T; Sable, Craig; Steer, Andrew C

2017-03-01

The implementation of screening for rheumatic heart disease at a population-scale would require a considerable increase in human resources. Training nonexpert staff in echocardiography requires appropriate methods and materials. This pre/post study aims to measure the change in the knowledge and confidence of a group of health workers after a computer-assisted training intervention in basic echocardiography for rheumatic heart disease. A syllabus of self-guided, computer-based modules to train nonexpert health workers in basic echocardiography for rheumatic heart disease was developed. Thirty-eight health workers from Uganda participated in the training. Using a pre/post design, identical test instruments were administered before and after the training intervention, assessing the knowledge (using multiple-choice questions) and confidence (using Likert scale questions) in clinical science and echocardiography. The mean total score on knowledge tests rose from 44.8% to 85.4% (mean difference: 40.6%, 95% confidence interval [CI]: 35.4% to 45.8%), with strong evidence for an increase in scores across all knowledge theme areas (p science (difference: 7.1, 95% CI: 6.2 to 8.0; p computer-assisted learning may reduce the human resource requirements for training staff in echocardiography. Copyright © 2016 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

Effect of streptozotocin-induced diabetes on myocardial blood flow reserve assessed by myocardial contrast echocardiography in rats

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Weytjens Caroline

2008-09-01

Full Text Available Abstract The role of structural and functional abnormalities of small vessels in diabetes cardiomyopathy remains unclear. Myocardial contrast echocardiography allows the quantification of myocardial blood flow at rest and during dipyridamole infusion. The aim of the study was to determine the myocardial blood flow reserve in normal rats compared with Streptozotocin-induced diabetic rats using contrast echocardiography. Methods We prospectively studied 40 Wistar rats. Diabetes was induced by intravenous streptozotocin in 20 rats. All rats underwent baseline and stress (dipyridamole: 20 mg/kg high power intermittent imaging in short axis view under anaesthesia baseline and after six months. Myocardial blood flow was determined and compared at rest and after dipyridamole in both populations. The myocardial blood flow reserve was calculated and compared in the 2 groups. Parameters of left ventricular function were determined from the M-mode tracings and histological examination was performed in all rats at the end of the study. Results At six months, myocardial blood flow reserve was significantly lower in diabetic rats compared to controls (3.09 ± 0.98 vs. 1.28 ± 0.67 ml min-1 g-1; p Conclusion In this animal study, diabetes induced a functional alteration of the coronary microcirculation, as demonstrated by contrast echocardiography, a decrease in capillary density and of the cardiac systolic function. These findings may offer new insights into the underlying mechanisms of diabetes cardiomyopathy.

Quality of Life and Stressful Life Events in First and Second Generation Immigrant Adolescents

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Ida Lemos

2013-09-01

Full Text Available The aim of this study was to examine differences in quality of life and stressful life events, in first and second generation immigrant adolescents living in Algarve. A total of 172 immigrant adolescents participated in the study, completing the kidscreen-52, the stressful and negative life events inventory and a socio-demographic questionnaire. Results suggest that younger immigrant adolescents report more physical well-being and a higher mood level. Concerning gender differences, girls scored higher than boys in physical well-being, mood and self-perception, but no differences were found on the other kidscreen subscales. First generation immigrants scored significantly higher than second generation ones on the general quality of life index, psychological well-being, autonomy, financial resources and school environment. However, the second-generation immigrants did not seem to be more exposed to stressful life events than the first-generation group. When selecting relevant variables for well-being promotion and for intervention, we must consider that immigrants are more exposed to economic vulnerability, may experience difficulties in adapting to a different school context, and are at higher risk of social exclusion.

Second language social networks and communication-related acculturative stress: the role of interconnectedness

OpenAIRE

Doucerain, Marina M.; Varnaamkhaasti, Raheleh S.; Segalowitz, Norman; Ryder, Andrew G.

2015-01-01

Although a substantial amount of cross-cultural psychology research has investigated acculturative stress in general, little attention has been devoted specifically to communication-related acculturative stress (CRAS). In line with the view that cross-cultural adaptation and second language (L2) learning are social and interpersonal phenomena, the present study examines the hypothesis that migrants’ L2 social network size and interconnectedness predict CRAS. The main idea underlying this hypo...

Role of echocardiography for catheter-based management of valvular heart disease.

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Shiota, Takahiro

2017-01-01

Catheter-based treatment of valvular heart disease, such as transvalvular aortic valve replacement (TAVR) or mitral clip procedure, has been increasingly accepted as a treatment choice for the past several years. Such new treatment options have been changing the management of patients with valvular heart disease drastically while socio-economic factors regarding their application need to be taken into consideration. The use of echocardiography, including transesophageal echocardiography (TEE), for such catheter-based treatments is essential for the success of the procedures. Severe hypotension after TAVR is a life-threatening emergency. Rapid assessment and diagnosis in the catheterization or hybrid laboratory is essential for safety and a positive outcome. Possible diagnoses in this critical situation would include severe left ventricular dysfunction due to coronary obstruction, cardiac tamponade, aortic rupture, acute severe aortic and/or mitral valve regurgitation, and hypovolemia due to bleeding. Although new types of TAVR valves reduce para-valvular aortic regurgitation (AR) significantly, it is still important to judge the severity of para-valvular AR correctly in the laboratory. As for mitral clip procedure, TEE is vital for guiding and monitoring the entire process. Accurate identification of the location and the geometry of the regurgitant orifice is necessary for proper placement of the clip. Real-time 3D TEE provides helpful en face view of the mitral valve and clip together to this end. Residual mitral regurgitation (MR) after the first clip is not uncommon. Quick and precise imaging of the residual MR (location and severity) with TEE is extremely important for the interventionist to place the second clip and possibly third clip properly. After the completion of the clip procedure, mitral valve stenosis and also iatrogenic atrial septal defect need to be checked by TEE. Echocardiography, especially TEE, is also vital for the success of other newer trans

Comparison of dipyridamole-echocardiography with dipyridamole-thallium scintigraphy for the diagnosis of myocardial ischemia

International Nuclear Information System (INIS)

Perin, E.C.; Moore, W.; Blume, M.; Hernandez, G.; Dhekne, R.; DeCastro, C.M.

1991-01-01

After an intravenous infusion of dipyridamole (0.56 mg/kg), the authors performed both echocardiography and thallium scintigraphy in 63 patients who were referred for known or suspected coronary artery disease. Of those patients, 25 returned for coronary arteriography within 1 month after the tests, thus forming the study group for this report. Sensitivity for detection of coronary artery disease, when analyzed region-by-region, was 80% for thallium scintigraphy and 57% for echocardiography, whereas specificity was 85% and 98%, respectively. When evaluating individual patients for the presence or absence of ischemia, they found a sensitivity of 95% for scintigraphy and 58% for echocardiography; corresponding specificities were 50% and 100%. By using arteriography as the gold standard for comparison, it appears that thallium scintigraphy has a significantly higher sensitivity but lower specificity for the detection of coronary artery disease than does echocardiography. Echocardiography may, however, be a useful adjunct to thallium scintigraphy in the evaluation of patients with coronary artery disease

Lahendite Tele2 Sverige ja Digital Rights Ireland mõju sideandmete mugavkasutusele Eestis / Piret Schasmin, Carri Ginter

Index Scriptorium Estoniae

Schasmin, Piret, 1987-

2017-01-01

Euroopa Kohtu Tele2 Sverige ja Digital Rights Ireland kohtulahendi mõjust Eesti õiguse seaduslikkusele, Eesti kohtutele ja uurimisasutustele. Puudustest Eesti kehtivas õiguses, elektroonilise side andmete säilitamisest, kasutamisest ja hävitamisest

The Global Education Network for Retinopathy of Prematurity (Gen-Rop): Development, Implementation, and Evaluation of A Novel Tele-Education System (An American Ophthalmological Society Thesis)

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Chan, R.V. Paul; Patel, Samir N.; Ryan, Michael C.; Jonas, Karyn E.; Ostmo, Susan; Port, Alexander D.; Sun, Grace I.; Lauer, Andreas K.; Chiang, Michael F.

2015-01-01

Purpose: To describe the design, implementation, and evaluation of a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmology residents. Methods: A secure Web-based tele-education system was developed utilizing a repository of over 2,500 unique image sets of ROP. For each image set used in the system, a reference standard ROP diagnosis was established. Performance by ophthalmology residents (postgraduate years 2 to 4) from the United States and Canada in taking the ROP tele-education program was prospectively evaluated. Residents were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters. Accuracy and reliability of ROP diagnosis (eg, plus disease, zone, stage, category) were determined using sensitivity, specificity, and the kappa statistic calculations of the results from the pretest and posttest. Results: Fifty-five ophthalmology residents were provided access to the ROP tele-education program. Thirty-one ophthalmology residents completed the program. When all training levels were analyzed together, a statistically significant increase was observed in sensitivity for the diagnosis of plus disease, zone, stage, category, and aggressive posterior ROP (P<.05). Statistically significant changes in specificity for identification of stage 2 or worse (P=.027) and pre-plus (P=.028) were observed. Conclusions: A tele-education system for ROP education is effective in improving diagnostic accuracy of ROP by ophthalmology residents. This system may have utility in the setting of both healthcare and medical education reform by creating a validated method to certify telemedicine providers and educate the next generation of ophthalmologists. PMID:26538772

Application of Contrast Echocardiography in Invasive Cardiology

Directory of Open Access Journals (Sweden)

Mustafa Bulut

2010-12-01

Full Text Available Contrast echocardiography by rendering better imaging of the borders of cardiac chambers is a useful tool for evaluating cardiac function, mass, myocardial vascularization, microvascular structure (small vessel vasculature and viability. Contrast was first started to be used for patients with suboptimal image quality. It can be used in detecting defects in myocardial blood supply in patients with chest pain and determining the success of interventionalprocedures. It can also be of help in demonstrating myocardial viability after reperfusion treatment in patients who had myocardial infarction. It is expected to be used more widely in invasive cardiology for decision making, guiding and determining the success of the procedures. Advances in imaging techniques , development of contrast materials for evaluation of left system, contrast echocardiography may become a routine clinical practice.

A enfermeira no cuidado aos pacientes submetidos ao eco-stress farmacológico: implicações para a prática clínica El rol de la enfermera en la atención de pacientes sometidos al ecoestrés farmacológico: implicaciones en la práctica clínica Nursing care for patients undergoing pharmacological stress echocardiography: implications for clinical practice

Directory of Open Access Journals (Sweden)

Marta Georgina Oliveira de Goes

2012-06-01

cuidados al paciente sometido al mismo.The study aim was both to identify signs and symptoms previous to and during the pharmacological stress echocardiography test and to describe the nurse's role and nursing care principles for this exam. This is a descriptive study, carried out in cardiac care unit in a University Hospital in Porto Alegre, RS. Two hundred forty-six records of patients submitted to stress echocardiography were retrospectively reviewed, according to four different pharmacological schedules. The statistical comparison showed that signs and symptoms were related to the type of drug used during the exam, namely: typical angina, precordial ache, tiredness, headache and premature complexes. These results enabled a better understanding of pharmacological stress echocardiography and the instrumentalization of nurses in order to plan individualized and qualified nursing care assistance. Aside from helping develop nursing practices for the pharmacological stress echocardiography test, this knowledge could also be used by nurses who carry out their activities in institutions that use this diagnostic method.

Betabloqueador tópico pode determinar resultados inconclusivos no ecocardiograma sob estresse com dobutamina em pacientes com glaucoma Topical betablocker use can result in inconclusive dobutamine stress echocardiography in patients with glaucoma

Directory of Open Access Journals (Sweden)

Adriana Cordovil

2007-07-01

Full Text Available O ecocardiograma sob estresse com dobutamina é um método bem estabelecido para avaliar doença arterial coronária, cuja sensibilidade tem sido potencializada pela adição de atropina no final do protocolo. Indivíduos com glaucoma, doença com alta prevalência em pacientes cardiopatas com mais de 40 anos, não podem se beneficiar do uso de atropina por ser contra-indicada neste grupo. Além disso, estes indivíduos são tratados freqüentemente com betabloqueadores tópicos (colírios, que podem exercer efeitos sistêmicos diminuindo a freqüência cardíaca, pressão arterial e capacidade pulmonar. O objetivo do nosso trabalho foi verificar se a ocorrência de um possível efeito sistêmico causado por estes colírios, causando baixa resposta cronotrópica, poderia determinar resultados inconclusivos no ecocardiograma sob estresse pela dobutamina nestes pacientes com glaucoma.Dobutamine stress echocardiography is a well-established method to assess coronary artery disease, of which sensitivity has been enhanced by adding atropine at the end of the protocol. Individuals with glaucoma, a disease with a high prevalence in patients with cardiac diseases older than 40 years, cannot benefit from the use of atropine as it is contraindicated for this group of patients. Additionally, these individuals are often treated with topical betablockers (eye drops, which can have systemic effects by decreasing cardiac frequency, blood pressure and pulmonary capacity. The aim of our study was to verify whether a possible systemic effect caused by the use of these eye drops, yielding a low chronotropic response, could result in inconclusive dobutamine stress echocardiography in patients with glaucoma.

Evaluation of Left Atrial Volumes Using Multidetector Computed Tomography: Comparison with Echocardiography

International Nuclear Information System (INIS)

Gweon, Hye Mi; Kim, Sang Jin; Kim, Tae Hoon; Lee, Sang Min; Hong, Yoo Jin; Rim, Se Joong

2010-01-01

To prospectively assess the relationship between the two different measurement methods for the evaluation of left atrial (LA) volume using cardiac multidetector computed tomography (MDCT) and to compare the results between cardiac MDCT and echocardiography. Thirty-five patients (20 men, 15 women; mean age, 60 years) underwent cardiac MDCT angiography for coronary artery disease. The LA volumes were measured using two different methods: the two dimensional (2D) length-based (LB) method measured along the three-orthogonal planes of the LA and the 3D volumetric threshold-based (VTB) method measured according to the threshold 3D segmentation of the LA. The results obtained by cardiac MDCT were compared with those obtained by echocardiography. The LA end-systolic and end-diastolic volumes (LAESV and LAEDV) measured by the 2D-LB method correlated well with those measured by the 3DVTB method using cardiac MDCT (r = 0.763, r = 0.786, p = 0.001). However, there was a significant difference in the LAESVs between the two measurement methods using cardiac MDCT (p < 0.05). The LAESV measured by cardiac MDCT correlated well with measurements by echocardiography (r = 0.864, p = 0.001), however with a significant difference (p < 0.01) in their volumes. The cardiac MDCT overestimated the LAESV by 22% compared to measurements by echocardiography. A significant correlation was found between the two different measurement methods for evaluating LA volumes by cardiac MDCT. Further, cardiac MDCT correlates well with echocardiography in evaluating the LA volume. However, there are significant differences in the LAESV between the two measurement methods using cardiac MDCT and between cardiac MDCT and echocardiography

Image-guided neurosurgery. Global concept of a surgical tele-assistance using obstacle detection robotics

International Nuclear Information System (INIS)

Desgeorges, M.; Bellegou, N.; Faillot, Th.; Cordoliani, Y.S.; Dutertre, G.; Blondet, E.; Soultrait, F. de; Boissy, J.M.

2000-01-01

Surgical tele-assistance significantly increases accuracy of surgical gestures, especially in the case of brain tumor neurosurgery. The robotic device is tele-operated through a microscope and the surgeon's gestures are guided by real-time overlaying of the X-ray imagery in the microscope. During the device's progression inside the brain, the focus is ensured by the microscope auto-focus feature. The surgeon can thus constantly check his position on the field workstation. Obstacles to avoid or dangerous areas can be previewed in the operation field. This system is routinely used for 5 years in the neurosurgery division of the Val de Grace hospital. More than 400 brain surgery operations have been done using it. An adaptation is used for rachis surgery. Other military hospitals begin to be equipped with similar systems. It will be possible to link them for data transfer. When it will be operational, such a network it will show what could be, in the future, a medical/surgical remote-assistance system designed to take care of wounded/critical conditions people, including assistance to surgical gestures. (authors)

Adaptive tele-application for remote neurology diagnosis.

Science.gov (United States)

Garcia, E; Guyennet, H; Lapayre, J-C; Moulin, T

2005-12-01

This paper presents the Collaborative Tele-Neurology (TeNeCi) project which allows practitioners to use telecommunication technologies to provide medical information and services for neurological diseases. Specificities of remote neurology are described and the Cooperative Application Framework (CAliF) multimedia platform on which TeNeCi relies is presented. The technical requirements of such a project in terms of communication and consistency management, audio and video transmissions, and network support, as well as implementation of TeNeCi was evaluated. The software used in this application is composed of several services, such as a Digital Imaging and Communications in Medicine (DICOM) explorer, a DICOM viewer, and a security service. Tests performed on this first TeNeCi release showed good results, and allowed us to explore a larger collaborative experimentation between hospitals in France and Switzerland.

Second language social networks and communication-related acculturative stress: the role of interconnectedness.

Science.gov (United States)

Doucerain, Marina M; Varnaamkhaasti, Raheleh S; Segalowitz, Norman; Ryder, Andrew G

2015-01-01

Although a substantial amount of cross-cultural psychology research has investigated acculturative stress in general, little attention has been devoted specifically to communication-related acculturative stress (CRAS). In line with the view that cross-cultural adaptation and second language (L2) learning are social and interpersonal phenomena, the present study examines the hypothesis that migrants' L2 social network size and interconnectedness predict CRAS. The main idea underlying this hypothesis is that L2 social networks play an important role in fostering social and cultural aspects of communicative competence. Specifically, higher interconnectedness may reflect greater access to unmodified natural cultural representations and L2 communication practices, thus fostering communicative competence through observational learning. As such, structural aspects of migrants' L2 social networks may be protective against acculturative stress arising from chronic communication difficulties. Results from a study of first generation migrant students (N = 100) support this idea by showing that both inclusiveness and density of the participants' L2 network account for unique variance in CRAS but not in general acculturative stress. These results support the idea that research on cross-cultural adaptation would benefit from disentangling the various facets of acculturative stress and that the structure of migrants' L2 network matters for language related outcomes. Finally, this study contributes to an emerging body of work that attempts to integrate cultural/cross-cultural research on acculturation and research on intercultural communication and second language learning.

Estimation of left ventricular blood flow parameters: clinical application of patient-specific CFD simulations from 4D echocardiography

Science.gov (United States)

Larsson, David; Spühler, Jeannette H.; Günyeli, Elif; Weinkauf, Tino; Hoffman, Johan; Colarieti-Tosti, Massimiliano; Winter, Reidar; Larsson, Matilda

2017-03-01

Echocardiography is the most commonly used image modality in cardiology, assessing several aspects of cardiac viability. The importance of cardiac hemodynamics and 4D blood flow motion has recently been highlighted, however such assessment is still difficult using routine echo-imaging. Instead, combining imaging with computational fluid dynamics (CFD)-simulations has proven valuable, but only a few models have been applied clinically. In the following, patient-specific CFD-simulations from transthoracic dobutamin stress echocardiography have been used to analyze the left ventricular 4D blood flow in three subjects: two with normal and one with reduced left ventricular function. At each stress level, 4D-images were acquired using a GE Vivid E9 (4VD, 1.7MHz/3.3MHz) and velocity fields simulated using a presented pathway involving endocardial segmentation, valve position identification, and solution of the incompressible Navier-Stokes equation. Flow components defined as direct flow, delayed ejection flow, retained inflow, and residual volume were calculated by particle tracing using 4th-order Runge-Kutta integration. Additionally, systolic and diastolic average velocity fields were generated. Results indicated no major changes in average velocity fields for any of the subjects. For the two subjects with normal left ventricular function, increased direct flow, decreased delayed ejection flow, constant retained inflow, and a considerable drop in residual volume was seen at increasing stress. Contrary, for the subject with reduced left ventricular function, the delayed ejection flow increased whilst the retained inflow decreased at increasing stress levels. This feasibility study represents one of the first clinical applications of an echo-based patient-specific CFD-model at elevated stress levels, and highlights the potential of using echo-based models to capture highly transient flow events, as well as the ability of using simulation tools to study clinically complex

Incremental value of contrast echocardiography in the evaluation of a cardiac thrombus.

Science.gov (United States)

Po, Jose Ricardo F; Tong, Matthew S; Grove, Erica L; Biederman, Robert W W

2017-02-01

A 52-year-old man presented with altered mental status and report of prior complaint of chest pain. On electrocardiography, anterolateral ST-segment elevations with Q-waves in the septal leads were seen. Initial echocardiography images demonstrated a thickened anteroseptum. Further imaging showed the presence of a well-attached laminated apical thrombus. Contrast echocardiography images showed that the thrombus had minimal attachment to the endocardial surface. CT head subsequently showed the presence of acute stroke. The case demonstrates the additional value of contrast echocardiography in the evaluation of cardiac masses despite the certainty in the diagnosis of a thrombus. © 2017, Wiley Periodicals, Inc.

Audit of cardiac pathology detection using a criteria-based perioperative echocardiography service.

Science.gov (United States)

Faris, J G; Hartley, K; Fuller, C M; Langston, R B; Royse, C F; Veltman, M G

2012-07-01

Transthoracic echocardiography is often used to screen patients prior to non-cardiac surgery to detect conditions associated with perioperative haemodynamic compromise and to stratify risk. However, anaesthetists' use of echocardiography is quite variable. A consortium led by the American College of Cardiology Foundation has developed appropriate use criteria for echocardiography. At Joondalup Hospital in Western Australia, we have used these criteria to order echocardiographic studies in patients attending our anaesthetic pre-admission clinic. We undertook this audit to determine the incidence of significant echocardiographic findings using this approach. In a 22-month period, 606 transthoracic echocardiographic studies were performed. This represented 8.7% of clinic attendees and 1.7% of all surgical patients. In about two-thirds of the patients, the indication for echocardiography was identified on the basis of a telephone screening questionnaire. The most common indications were poor exercise tolerance (27.4%), ischaemic heart disease (20.9%) and cardiac murmurs (16.3%). Over 26% of patients studied had significant cardiac pathology (i.e. moderate or severe echocardiographic findings), most importantly moderate or severe aortic stenosis (8.6%), poor left ventricular function (7.1%), a regional wall motion abnormality (4.3%) or moderate or severe mitral regurgitation (4.1%). Using appropriate use criteria to guide ordering transthoracic echocardiography studies led to a high detection rate of clinically important cardiac pathology in our perioperative service.

Course on Radiological Protection and Quality Assurance in Radiology. Tele-education course: A Possible Solution to continued Postgraduate training

International Nuclear Information System (INIS)

Alcaraz, M.; Chico, P.; Saura Iniesta, A.; Armero, D.; Vicente, V.

2004-01-01

The creation of an interdepartmental project subsidised by the Spanish Ministry of Education has made it possible to create a series of specific didactic materials on Radiological Protection and Quality Assurance in Medical Radiodiagnostic Practices, leading to the publication of a specific manual and practical notebook. As a result, this material now constitutes the working basis for those professionals exposed to ionising radiation who are following the first continuous tele-education training course in Spanish via the Internet on this subject. Interactive multimedia training and tele-education may become one of the alternatives that allow health science professionals to receive continuous training, if adequate content and aims have been established during undergraduate training. (Author) 18 refs

Dynamic 3D echocardiography in virtual reality.

NARCIS (Netherlands)

A.E. van den Bosch (Annemien); A.H.J. Koning (Anton); F.J. Meijboom (Folkert); J.S. Vletter-McGhie (Jackie); M.L. Simoons (Maarten); P.J. van der Spek (Peter); A.J.J.C. Bogers (Ad)

2005-01-01

textabstractBACKGROUND: This pilot study was performed to evaluate whether virtual reality is applicable for three-dimensional echocardiography and if three-dimensional echocardiographic 'holograms' have the potential to become a clinically useful tool. METHODS: Three-dimensional echocardiographic

Intra-cardiac echocardiography in alcohol septal ablation

DEFF Research Database (Denmark)

Cooper, Robert M; Shahzad, Adeel; Newton, James

2015-01-01

Alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy reduces left ventricular outflow tract gradients. A third of patients do not respond; inaccurate localisation of the iatrogenic infarct can be responsible. Transthoracic echocardiography (TTE) using myocardial contrast can...

Externally Acquired Radiological Data for the Clinical Routine - A Review of the Reimbursement Situation in Germany.

Science.gov (United States)

Schreyer, Andreas G; Steinhäuser, René T; Rosenberg, Britta

2018-02-07

 Interdisciplinary radiological conferences and boards can improve therapeutic pathways. Because of the reinterpretation and presentation of external image data, which already was read, an additional workload is created which is currently not considered by health care providers. In this review we discuss the ongoing basics and possibilities in health economy for a radiological second opinion for the outpatient and inpatient sector in Germany.  Based on up-to-date literature and jurisdiction, we discuss the most important questions for the reimbursement for second opinions and conference presentations of external image data in an FAQ format. Additionally, we focus on the recently introduced E-Health law accordingly.  Radiological services considering second opinion or board presentation of externally acquired image data are currently not adequately covered by health care providers. In particular, there is no reimbursement possibility for the inpatient sector. Only patients with private insurance or privately paid second opinions can be charged when these patients visit the radiologist directly.  Currently there is no adequate reimbursement possibility for a radiological second opinion or image demonstrations in clinical conferences. It will be essential to integrate adequate reimbursement by health care providers in the near future because of the importance of radiology as an essential diagnostic and therapeutic medical partner.   · Currently there is no reimbursement for image interpretation and presentation in boards.. · Second opinions can only be reimbursed for patients with private insurance or privately recompensed.. · The E-Health law allows reimbursement for tele-counsel in very complex situations.. · It will be crucial to integrate radiological second opinion in future reimbursement policies by health care providers.. · Schreyer AG, Steinhäuser RT, Rosenberg B. Externally Acquired Radiological Data for the Clinical Routine - A Review of

Nuclear power and public opinion

International Nuclear Information System (INIS)

Kazanikov, I.A.; Klykov, S.A.

2000-01-01

The public opinion on Nuclear Power is not favorable. A purposeful work with public perception is necessary. One way to create a positive image of the nuclear industry is to improve public radiological education. This challenge can be resolved in the close cooperation with state school and preschool education. The formation about nuclear power should be simple and symbolical. Our society can be divided into 4 parts which can be called as target groups: First group - People from the nuclear industry with special education working at nuclear facilities or related to the industry. Second group - People working in the fields connected with nuclear power. Third group - People not related to nuclear power or even with negative impression to the industry. This group is the largest and the work required is the most difficult. Fourth group - The number of this group's members is the least, but it has strong influence on public opinion. 'Greens' and a broad spectrum of ecological organizations can be included in this group. (Authors)

Task analysis of human-in-the-loop tele-operated maintenance: What can be learned from JET?

International Nuclear Information System (INIS)

Boessenkool, H.; Thomas, J.; Heemskerk, C.J.M.; Baar, M.R. de; Steinbuch, M.; Abbink, D.A.

2014-01-01

Highlights: •Maintenance task execution at JET was analyzed to guide improvements for ITER. •A large variation in task duration was found for various operator experience levels. •Results indicate significant room for improvement for tele-operated performance. •Improvent of visual feedback and artificial guiding forces was considered promising. -- Abstract: Remote maintenance will determine the available uptime of future fusion plants such as ITER. Experience at predecessor JET showed that a human-in-the-loop tele-operated approach is crucial, although this approach entails drawbacks such as the unavoidable extensive operator training and relatively long execution times. These drawbacks are common knowledge, but little quantitative research is available to guide improvements (such as improved training methods, or active operator support systems). The aim of this paper is to identify the key areas for further improvement of tele-operated maintenance. This is achieved by a detailed task analysis based on recent maintenance at JET, using task logbooks and video data as well as interviews with experienced master–slave operators. The resulting task analysis shows the (sub)tasks that were most time-consuming and shows a large variance in time performance within operators, but also substantial differences between qualified operators with different levels of experience. The operator interviews indicate that intuitive (virtual) visual feedback and artificial (guiding) forces are promising directions for improvement. The results found in this study will be used for future research and development activities focusing on haptic guiding strategies, with the aim to further design and optimize RH maintenance systems for ITER and beyond

ARISTÓTELES Y LA ECONOMÍA ENTRE LOS LÍMITES DE LA RAZÓN PRÁCTICA

Directory of Open Access Journals (Sweden)

MATTHIAS VOLLET

2007-01-01

Full Text Available Resumen: Comparada con la economía de hoy, la de la Grecia antigua -por lo menos en una de sus concepciones- era una economía limitada. Exteriormente, porque en Hesíodo sirve para el sustento de la casa, y en Aristóteles para el sustento de la ciudad; interiormente y de manera sistemática, en el primer caso, por su origen divino y su sentido dentro de la relación hombre-dioses, y en el segundo caso, por su subordinación a la teleología ética y política de la vida humana, tal y como la concibe Aristóteles. La autarquía, como límite de la economía, es doble. Por una parte, autarquía económica en sentido estricto, ya que la economía sólo ha de llegar hasta el punto de poder asegurar la supervivencia de la comunidad que es su sujeto. Pero, por otra, la autarquía, para Aristóteles, tiene sobre todo un sentido antropológico: el hombre más autárquico es el que practica aquello que, para su praxis, no necesita de otra cosa: esta praxis más alta es la de la razón, desarrollada en la Polis, que es su meta. Esta autarquía del ser razonable da sentido y también límite al buen actuar económico, que es una mera herramienta.

Echocardiography for patent ductus arteriosus including closure in adults.

Science.gov (United States)

Chugh, Reema; Salem, Morris M

2015-01-01

Patent ductus arteriosus (PDA) represents at least 5-10% of all congenital heart defects (CHDs) making it a very important commonly diagnosed lesion. Although spontaneous closure of the PDA occurs within 24 to 48 hours after birth in the majority, those children who do not have natural or surgical closure may have a persistent PDA into adulthood. The diagnosis is most often confirmed by echocardiography that also guides catheter-based interventions and surgeries. Echocardiography continues to be the most important tool in long-term follow-up of residua and sequelae. © 2014, Wiley Periodicals, Inc.

Opinion formation driven by PageRank node influence on directed networks

Science.gov (United States)

Eom, Young-Ho; Shepelyansky, Dima L.

2015-10-01

We study a two states opinion formation model driven by PageRank node influence and report an extensive numerical study on how PageRank affects collective opinion formations in large-scale empirical directed networks. In our model the opinion of a node can be updated by the sum of its neighbor nodes' opinions weighted by the node influence of the neighbor nodes at each step. We consider PageRank probability and its sublinear power as node influence measures and investigate evolution of opinion under various conditions. First, we observe that all networks reach steady state opinion after a certain relaxation time. This time scale is decreasing with the heterogeneity of node influence in the networks. Second, we find that our model shows consensus and non-consensus behavior in steady state depending on types of networks: Web graph, citation network of physics articles, and LiveJournal social network show non-consensus behavior while Wikipedia article network shows consensus behavior. Third, we find that a more heterogeneous influence distribution leads to a more uniform opinion state in the cases of Web graph, Wikipedia, and Livejournal. However, the opposite behavior is observed in the citation network. Finally we identify that a small number of influential nodes can impose their own opinion on significant fraction of other nodes in all considered networks. Our study shows that the effects of heterogeneity of node influence on opinion formation can be significant and suggests further investigations on the interplay between node influence and collective opinion in networks.

High prevalence of rheumatic heart disease detected by echocardiography in school children.

Science.gov (United States)

Bhaya, Maneesha; Panwar, Sadik; Beniwal, Rajesh; Panwar, Raja Babu

2010-04-01

It is fairly easy to detect advanced valve lesions of established rheumatic heart disease by echocardiography in the clinically identified cases of rheumatic heart disease. However, to diagnose a subclinical case of rheumatic heart disease, no uniform set of echocardiographic criteria exist. Moderate thickening of valve leaflets is considered an indicator of established rheumatic heart disease. World Health Organization criteria for diagnosing probable rheumatic heart disease are more sensitive and are based on the detection of significant regurgitation of mitral and/or aortic valves by color Doppler. We attempted diagnosing RHD in school children in Bikaner city by cardiac ultrasound. The stratified cluster sampling technique was employed to identify 31 random clusters in the coeducational schools of Bikaner city. We selected 1059 school children aged 6-15 years from these schools. An experienced operator did careful cardiac auscultation and echocardiographic study. A second expert confirmed the echocardiographic findings. The prevalence of lesions suggestive of rheumatic heart disease by echocardiography was 51 per 1,000 (denominator = 1059; 95% CI: 38-64 per 1,000). We were able to clinically diagnose RHD in one child. None of these children or their parents having echocardiographic evidence of RHD could provide a positive history of acute rheumatic fever. By echocardiographic screening, we found a high prevalence of rheumatic heart disease in the surveyed population. Clinical auscultation had much lower diagnostic efficacy.

Assessment of left ventricular wall motion and function by cross-sectional echocardiography

International Nuclear Information System (INIS)

Ono, Akifumi; Hirata, Shunkichi; Ishikawa, Kyozo

1982-01-01

The clinical efficacy of cross-sectional echocardiography (CSE) was evaluated with M-mode echocardiography and radionuclide cardioangiography (RCG) in 50 cases including 30 patients with myocardial infarction. Segmental wall motion by CSE was highly correlated with segmental wall motion and left ventricular ejection fraction by RCG (r = 0.89 in the former, r = -0.84 in the latter). On the other hand, the left ventricular ejection fraction by M-mode echocardiography revealed a fairly well correlation with that by RCG ( r = 0.68). These results suggest that, as compared with RCG, CSE is quite useful in an evaluation of left ventricular function and in a detection of segmental wall motion abnormalities. (author)

Tele-Operated Echography and Remote Guidance for Performing Tele-Echography on Geographically Isolated Patients

Directory of Open Access Journals (Sweden)

Philippe Arbeille

2016-06-01

Full Text Available Objective: To evaluate the performance of three tele-echography systems for routine use in isolated medical centers. Methods: Three systems were used for deep (abdomen, pelvis, fetal and superficial (muscle, thyroid, carotid artery examinations: (a a robotic arm (RA holding an echographic probe; (b an echograph with a motorized probe (MP; and (c remote guidance (RG where the patient site operator performed the examination assisted by an expert via videoconference. All systems were tested in the same medical center located 60 km away from the university hospital. Results: A total of 340 remote echography examinations were performed (41% RA and MP, 59% RG. MP and RA allowed full control of the probe orientation by the expert, and provided diagnoses in 97% of cases. The use of RG was sufficient for superficial vessel examinations and provided diagnoses in 98% of cases but was not suited for deep or superficial organs. Assessment of superficial organs was best accomplished using the MP. Discussion: Both teleoperated systems provided control of the probe orientation by the expert necessary for obtaining appropriate views of deep organs but the MP was much more ergonomic and easier to use than the RA. RG was appropriate for superficial vessels while the MP was better for superficial volumic organs.

Female False Positive Exercise Stress ECG Testing - Fact Verses Fiction.

Science.gov (United States)

Fitzgerald, Benjamin T; Scalia, William M; Scalia, Gregory M

2018-03-07

Exercise stress testing is a well validated cardiovascular investigation. Accuracy for treadmill stress electrocardiograph (ECG) testing has been documented at 60%. False positive stress ECGs (exercise ECG changes with non-obstructive disease on anatomical testing) are common, especially in women, limiting the effectiveness of the test. This study investigates the incidence and predictors of false positive stress ECG findings, referenced against stress echocardiography (SE) as a standard. Stress echocardiography was performed using the Bruce treadmill protocol. False positive stress ECG tests were defined as greater than 1mm of ST depression on ECG during exertion, without pain, with a normal SE. Potential causes for false positive tests were recorded before the test. Three thousand consecutive negative stress echocardiograms (1036 females, 34.5%) were analysed (age 59+/-14 years. False positive (F+) stress ECGs were documented in 565/3000 tests (18.8%). F+ stress ECGs were equally prevalent in females (194/1036, 18.7%) and males (371/1964, 18.9%, p=0.85 for the difference). Potential causes (hypertension, left ventricular hypertrophy, known coronary disease, arrhythmia, diabetes mellitus, valvular heart disease) were recorded in 36/194 (18.6%) of the female F+ ECG tests and 249/371 (68.2%) of the male F+ ECG tests (preinforce the value of stress imaging, particularly in women. Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

A web application to support telemedicine services in Brazil.

Science.gov (United States)

Barbosa, Ana Karina P; de A Novaes, Magdala; de Vasconcelos, Alexandre M L

2003-01-01

This paper describes a system that has been developed to support Telemedicine activities in Brazil, a country that has serious problems in the delivery of health services. The system is a part of the broader Tele-health Project that has been developed to make health services more accessible to the low-income population in the northeast region. The HealthNet system is based upon a pilot area that uses fetal and pediatric cardiology. This article describes both the system's conceptual model, including the tele-diagnosis and second medical opinion services, as well as its architecture and development stages. The system model describes both collaborating tools used asynchronously, such as discussion forums, and synchronous tools, such as videoconference services. Web and free-of-charge tools are utilized for implementation, such as Java and MySQL database. Furthermore, an interface with Electronic Patient Record (EPR) systems using Extended Markup Language (XML) technology is also proposed. Finally, considerations concerning the development and implementation process are presented.

The Interplay between Fasting Glucose, Echocardiography, and Biomarkers

DEFF Research Database (Denmark)

Pareek, Manan

preventive setting, remains incomplete. Phenotypical heterogeneity may be even greater among subjects with hyperglycemic conditions, i.e., prediabetes and diabetes, which is worrisome, given the dramatic global rise in mean fasting glucose levels, and the strong association with adverse cardiovascular...... subclinical changes to manifest disease include echocardiography and circulating biomarkers. Objectives 1) To examine whether greater fasting plasma glucose (FPG) levels were associated with left ventricular mass (LVM), geometric pattern, diastolic function, and concentrations of N-terminal prohormone...... from the three categories defined by baseline FPG, i.e., normal fasting glucose, impaired fasting glucose, and diabetes, including use of anti-diabetic medication. Blood samples for cardiovascular biomarker assessments were drawn at the time of echocardiography and kept frozen until analysis. Outcome...

Usefulness of three-dimensional echocardiography in the assessment of valvular involvement in Loeffler endocarditis.

Science.gov (United States)

Hernandez, Carlos M; Arisha, Mohammed J; Ahmad, Amier; Oates, Ethan; Nanda, Navin C; Nanda, Anil; Wasan, Anita; Caleti, Beda E; Bernal, Cinthia L P; Gallardo, Sergio M

2017-07-01

Loeffler endocarditis is a complication of hypereosinophilic syndrome resulting from eosinophilic infiltration of heart tissue. We report a case of Loeffler endocarditis in which three-dimensional transthoracic and transesophageal echocardiography provided additional information to what was found by two-dimensional transthoracic echocardiography alone. Our case illustrates the usefulness of combined two- and three-dimensional echocardiography in the assessment of Loeffler endocarditis. In addition, a summary of the features of hypereosinophilic syndrome and Loeffler endocarditis is provided in tabular form. © 2017, Wiley Periodicals, Inc.

Portopulmonary hypertension: Improved detection using CT and echocardiography in combination

Energy Technology Data Exchange (ETDEWEB)

Devaraj, Anand [Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, London (United Kingdom); Loveridge, Robert; Bernal, William; Willars, Christopher; Wendon, Julia A.; Auzinger, Georg [King' s College Hospital NHS Foundation Trust, The Institute of Liver Studies, King' s Health Partners, King' s College London, London (United Kingdom); Bosanac, Diana; Stefanidis, Konstantinos; Desai, Sujal R. [King' s College Hospital NHS Foundation Trust, Department of Radiology, King' s Health Partners, King' s College London, London (United Kingdom)

2014-10-15

To establish the relationship between CT signs of pulmonary hypertension and mean pulmonary artery pressure (mPAP) in patients with liver disease, and to determine the additive value of CT in the detection of portopulmonary hypertension in combination with transthoracic echocardiography. Forty-nine patients referred for liver transplantation were retrospectively reviewed. Measured CT signs included the main pulmonary artery/ascending aorta diameter ratio (PA/AA{sub meas}) and the mean left and right main PA diameter (RLPA{sub meas}). Enlargement of the pulmonary artery compared to the ascending aorta was also assessed visually (PA/AA{sub vis}). CT measurements were correlated with right-sided heart catheter-derived mPAP. The ability of PA/AA{sub vis} combined with echocardiogram-derived right ventricular systolic pressure (RVSP) to detect portopulmonary hypertension was tested with ROC analysis. There were moderate correlations between mPAP and both PA/AA{sub meas} and RLPA{sub meas} (r{sub s} = 0.41 and r{sub s} = 0.42, respectively; p < 0.005). Compared to transthoracic echocardiography alone (AUC = 0.59, p = 0.23), a diagnostic algorithm incorporating PA/AA{sub vis} and transthoracic echocardiography-derived RVSP improved the detection of portopulmonary hypertension (AUC = 0.8, p < 0.0001). CT contributes to the non-invasive detection of portopulmonary hypertension when used in a diagnostic algorithm with transthoracic echocardiography. CT may have a role in the pre-liver transplantation triage of patients with portopulmonary hypertension for right-sided heart catheterisation. (orig.)

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism.

Science.gov (United States)

Saric, Muhamed; Armour, Alicia C; Arnaout, M Samir; Chaudhry, Farooq A; Grimm, Richard A; Kronzon, Itzhak; Landeck, Bruce F; Maganti, Kameswari; Michelena, Hector I; Tolstrup, Kirsten

2016-01-01

Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Directly Estimating Earthquake Rupture Area using Second Moments to Reduce the Uncertainty in Stress Drop

Science.gov (United States)

McGuire, Jeffrey J.; Kaneko, Yoshihiro

2018-06-01

The key kinematic earthquake source parameters: rupture velocity, duration and area, shed light on earthquake dynamics, provide direct constraints on stress-drop, and have implications for seismic hazard. However, for moderate and small earthquakes, these parameters are usually poorly constrained due to limitations of the standard analysis methods. Numerical experiments by Kaneko and Shearer [2014,2015] demonstrated that standard spectral fitting techniques can lead to roughly 1 order of magnitude variation in stress-drop estimates that do not reflect the actual rupture properties even for simple crack models. We utilize these models to explore an alternative approach where we estimate the rupture area directly. For the suite of models, the area averaged static stress drop is nearly constant for models with the same underlying friction law, yet corner frequency based stress-drop estimates vary by a factor of 5-10 even for noise free data. Alternatively, we simulated inversions for the rupture area as parameterized by the second moments of the slip distribution. A natural estimate for the rupture area derived from the second moments is A=πLcWc, where Lc and Wc are the characteristic rupture length and width. This definition yields estimates of stress drop that vary by only 10% between the models but are slightly larger than the true area-averaged values. We simulate inversions for the second moments for the various models and find that the area can be estimated well when there are at least 15 available measurements of apparent duration at a variety of take-off angles. The improvement compared to azimuthally-averaged corner-frequency based approaches results from the second moments accounting for directivity and removing the assumption of a circular rupture area, both of which bias the standard approach. We also develop a new method that determines the minimum and maximum values of rupture area that are consistent with a particular dataset at the 95% confidence

Acute right ventricular dysfunction: real-time management with echocardiography.

Science.gov (United States)

Krishnan, Sundar; Schmidt, Gregory A

2015-03-01

In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.

Leader's opinion priority bounded confidence model for network opinion evolution

Science.gov (United States)

Zhu, Meixia; Xie, Guangqiang

2017-08-01

Aiming at the weight of trust someone given to participate in the interaction in Hegselmann-Krause's type consensus model is the same and virtual social networks among individuals with different level of education, personal influence, etc. For differences between agents, a novelty bounded confidence model was proposed with leader's opinion considered priority. Interaction neighbors can be divided into two kinds. The first kind is made up of "opinion leaders" group, another kind is made up of ordinary people. For different groups to give different weights of trust. We also analyzed the related characteristics of the new model under the symmetrical bounded confidence parameters and combined with the classical HK model were analyzed. Simulation experiment results show that no matter the network size and initial view is subject to uniform distribution or discrete distribution. We can control the "opinion-leader" good change the number of views and values, and even improve the convergence speed. Experiment also found that the choice of "opinion leaders" is not the more the better, the model well explain how the "opinion leader" in the process of the evolution of the public opinion play the role of the leader.

Telemedicine and advances in urban and rural healthcare delivery in Africa.

Science.gov (United States)

Mars, Maurice

2013-01-01

Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine. © 2013.

Unique identification code for medical fundus images using blood vessel pattern for tele-ophthalmology applications.

Science.gov (United States)

Singh, Anushikha; Dutta, Malay Kishore; Sharma, Dilip Kumar

2016-10-01

Identification of fundus images during transmission and storage in database for tele-ophthalmology applications is an important issue in modern era. The proposed work presents a novel accurate method for generation of unique identification code for identification of fundus images for tele-ophthalmology applications and storage in databases. Unlike existing methods of steganography and watermarking, this method does not tamper the medical image as nothing is embedded in this approach and there is no loss of medical information. Strategic combination of unique blood vessel pattern and patient ID is considered for generation of unique identification code for the digital fundus images. Segmented blood vessel pattern near the optic disc is strategically combined with patient ID for generation of a unique identification code for the image. The proposed method of medical image identification is tested on the publically available DRIVE and MESSIDOR database of fundus image and results are encouraging. Experimental results indicate the uniqueness of identification code and lossless recovery of patient identity from unique identification code for integrity verification of fundus images. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Archeological Echocardiography: Digitization and Speckle Tracking Analysis of Archival Echocardiograms in the HyperGEN Study.

Science.gov (United States)

Aguilar, Frank G; Selvaraj, Senthil; Martinez, Eva E; Katz, Daniel H; Beussink, Lauren; Kim, Kwang-Youn A; Ping, Jie; Rasmussen-Torvik, Laura; Goyal, Amita; Sha, Jin; Irvin, Marguerite R; Arnett, Donna K; Shah, Sanjiv J

2016-03-01

Several large epidemiologic studies and clinical trials have included echocardiography, but images were stored in analog format and these studies predated tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). We hypothesized that digitization of analog echocardiograms, with subsequent quantification of cardiac mechanics using STE, is feasible, reproducible, accurate, and produces clinically valid results. In the NHLBI HyperGEN study (N = 2234), archived analog echocardiograms were digitized and subsequently analyzed using STE to obtain tissue velocities/strain. Echocardiograms were assigned quality scores and inter-/intra-observer agreement was calculated. Accuracy was evaluated in: (1) a separate second study (N = 50) comparing prospective digital strain versus post hoc analog-to-digital strain, and (2) in a third study (N = 95) comparing prospectively obtained TDI e' velocities with post hoc STE e' velocities. Finally, we replicated previously known associations between tissue velocities/strain, conventional echocardiographic measurements, and clinical data. Of the 2234 HyperGEN echocardiograms, 2150 (96.2%) underwent successful digitization and STE analysis. Inter/intra-observer agreement was high for all STE parameters, especially longitudinal strain (LS). In accuracy studies, LS performed best when comparing post hoc STE to prospective digital STE for strain analysis. STE-derived e' velocities correlated with, but systematically underestimated, TDI e' velocity. Several known associations between clinical variables and cardiac mechanics were replicated in HyperGEN. We also found a novel independent inverse association between fasting glucose and LS (adjusted β = -2.4 [95% CI -3.6, -1.2]% per 1-SD increase in fasting glucose; P echocardiography, the digitization and speckle tracking analysis of archival echocardiograms, is feasible and generates indices of cardiac mechanics similar to contemporary studies. © 2015, Wiley Periodicals, Inc.

Differing professional opinions: 1987 special review panel

International Nuclear Information System (INIS)

1988-01-01

In November 1987, the five-member Differing Professional Opinions Special Review Panel established by the Executive Director for Operations of the US Nuclear Regulatory Commission to review agency policies and procedures for handling differing professional opinions (DPOs) presented its findings and recommendations in NUREG-1290. The issuance of that report completed the first task of the panel's charter. In accordance with Manual chapter 4125, Section L, and the charter of the Special Review Panel, the panel's second task was to ''...review...the DPOs submitted subsequent to the previous Panel's review, in order to identify any employee whose DPO made a significant contribution to the Agency or to the public safety but who has not yet been recognized for such contribution.'' This Addendum provides the findings of that review

An investigation into the causes of unexpected intra-operative transoesophageal echocardiography findings.

Science.gov (United States)

Skinner, H J; Mahmoud, A; Uddin, A; Mathew, T

2012-04-01

There is uncertainty regarding echocardiography before cardiac surgery, especially with regard to timing and disease progression as well as potential errors. We investigated the causes of unexpected intra-operative transoesophageal echocardiography findings by performing a 33-month audit. We found that there were 50/797 (6%) unexpected findings that led to an alteration in surgical strategy in 34 (4%) patients. Of the unexpected findings, 25 (50%) were unrelated to pre-operative pathology. After reviewing pre-operative studies and reports, unexpected findings were found to be due to: reporting errors in 20 patients (44%); limitations in transthoracic compared to transoesophageal echocardiography in 14 patients (30%); disease progression in 10 patients (22%); and inter-observer variability in two patients (4%). We identified six reports out of 797 (0.8%) that contained potentially serious errors. Surgical management changed in 18/20 (90%) patients in whom the unexpected change was due to reporting error, compared to 16/30 (53%) patients whose pre-operative echocardiogram was correctly reported (p = 0.006). Our study suggests that pre-operative echocardiography reporting errors are common and important. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

Implementing a Continuous Quality Improvement Program in a High-Volume Clinical Echocardiography Laboratory: Improving Care for Patients With Aortic Stenosis.

Science.gov (United States)

Samad, Zainab; Minter, Stephanie; Armour, Alicia; Tinnemore, Amanda; Sivak, Joseph A; Sedberry, Brenda; Strub, Karen; Horan, Seanna M; Harrison, J Kevin; Kisslo, Joseph; Douglas, Pamela S; Velazquez, Eric J

2016-03-01

The management of aortic stenosis rests on accurate echocardiographic diagnosis. Hence, it was chosen as a test case to examine the utility of continuous quality improvement (CQI) approaches to increase echocardiographic data accuracy and reliability. A novel, multistep CQI program was designed and prospectively used to investigate whether it could minimize the difference in aortic valve mean gradients reported by echocardiography when compared with cardiac catheterization. The Duke Echo Laboratory compiled a multidisciplinary CQI team including 4 senior sonographers and MD faculty to develop a mapped CQI process that incorporated Intersocietal Accreditation Commission standards. Quarterly, the CQI team reviewed all moderate- or greater-severity aortic stenosis echocardiography studies with concomitant catheterization data, and deidentified individual and group results were shared at meetings attended by cardiologists and sonographers. After review of 2011 data, the CQI team proposed specific amendments implemented over 2012: the use of nontraditional imaging and Doppler windows as well as evaluation of aortic gradients by a second sonographer. The primary outcome measure was agreement between catheterization- and echocardiography-derived mean gradients calculated by using the coverage probability index with a prespecified acceptable echocardiography-catheterization difference of <10 mm Hg in mean gradient. Between January 2011 and January 2014, 2093 echocardiograms reported moderate or greater aortic stenosis. Among cases with available catheterization data pre- and post-CQI, the coverage probability index increased from 54% to 70% (P=0.03; 98 cases, year 2011; 70 cases, year 2013). The proportion of patients referred for invasive valve hemodynamics decreased from 47% pre-CQI to 19% post-CQI (P<0.001). A laboratory practice pattern that was amenable to reform was identified, and a multistep modification was designed and implemented that produced clinically

Role of four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation in detecting fetal pulmonary veins.

Science.gov (United States)

Sun, Xue; Zhang, Ying; Fan, Miao; Wang, Yu; Wang, Meilian; Siddiqui, Faiza Amber; Sun, Wei; Sun, Feifei; Zhang, Dongyu; Lei, Wenjia; Hu, Guyue

2017-06-01

Prenatal diagnosis of fetal total anomalous pulmonary vein connection (TAPVC) remains challenging for most screening sonographers. The purpose of this study was to evaluate the use of four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation (4D-HDFI) in identifying pulmonary veins in normal and TAPVC fetuses. We retrospectively reviewed and performed 4D-HDFI in 204 normal and 12 fetuses with confirmed diagnosis of TAPVC. Cardiac volumes were available for postanalysis to obtain 4D-rendered images of the pulmonary veins. For the normal fetuses, two other traditional modalities including color Doppler and HDFI were used to detect the number of pulmonary veins and comparisons were made between each of these traditional methods and 4D-HDFI. For conventional echocardiography, HDFI modality was superior to color Doppler in detecting more pulmonary veins in normal fetuses throughout the gestational period. 4D-HDFI was the best method during the second trimester of pregnancy in identifying normal fetal pulmonary veins. 4D-HDFI images vividly depicted the figure, course, and drainage of pulmonary veins in both normal and TAPVC fetuses. HDFI and the advanced 4D-HDFI technique could facilitate identification of the anatomical features of pulmonary veins in both normal and TAPVC fetuses; 4D-HDFI therefore provides additional and more precise information than conventional echocardiography techniques. © 2017, Wiley Periodicals, Inc.

Distinctive roles of lead users and opinion leaders in the social networks of schoolchildren

DEFF Research Database (Denmark)

Kratzer, Jan; Lettl, Christopher

2009-01-01

Prior research has shown that both lead users and opinion leaders may propel the diffusion of innovation. This raises the question of whether lead users and opinion leaders are positioned similarly in social networks, which we addressed using a sample of 23 school classes consisting of 537 children....... Research among children is very scarce in this particular domain. Our statistical analyses based on hierarchical linear modeling reveal two general results: First, lead users among children appear to possess a variety of links between clusters. Second, opinion leaders are locally positioned within clusters...

Remote tele-mentored ultrasound for non-physician learners using FaceTime: A feasibility study in a low-income country.

Science.gov (United States)

Robertson, Thomas E; Levine, Andrea R; Verceles, Avelino C; Buchner, Jessica A; Lantry, James H; Papali, Alfred; Zubrow, Marc T; Colas, L Nathalie; Augustin, Marc E; McCurdy, Michael T

2017-08-01

Ultrasound (US) is a burgeoning diagnostic tool and is often the only available imaging modality in low- and middle-income countries (LMICs). However, bedside providers often lack training to acquire or interpret US images. We conducted a study to determine if a remote tele-intensivist could mentor geographically removed LMIC providers to obtain quality and clinically useful US images. Nine Haitian non-physician health care workers received a 20-minute training on basic US techniques. A volunteer was connected to an intensivist located in the USA via FaceTime. The intensivist remotely instructed the non-physicians to ultrasound five anatomic sites. The tele-intensivist evaluated the image quality and clinical utility of performing tele-ultrasound in a LMIC. The intensivist agreed (defined as "agree" or "strongly agree" on a five-point Likert scale) that 90% (57/63) of the FaceTime images were high quality. The intensivist felt comfortable making clinical decisions using FaceTime images 89% (56/63) of the time. Non-physicians can feasibly obtain high-quality and clinically relevant US images using video chat software in LMICs. Commercially available software can connect providers in institutions in LMICs to geographically removed intensivists at a relatively low cost and without the need for extensive training of local providers. Copyright © 2017 Elsevier Inc. All rights reserved.

Validating the TeleStroke Mimic Score: A Prediction Rule for Identifying Stroke Mimics Evaluated Over Telestroke Networks.

Science.gov (United States)

Ali, Syed F; Hubert, Gordian J; Switzer, Jeffrey A; Majersik, Jennifer J; Backhaus, Roland; Shepard, L Wylie; Vedala, Kishore; Schwamm, Lee H

2018-03-01

Up to 30% of acute stroke evaluations are deemed stroke mimics, and these are common in telestroke as well. We recently published a risk prediction score for use during telestroke encounters to differentiate stroke mimics from ischemic cerebrovascular disease derived and validated in the Partners TeleStroke Network. Using data from 3 distinct US and European telestroke networks, we sought to externally validate the TeleStroke Mimic (TM) score in a broader population. We evaluated the TM score in 1930 telestroke consults from the University of Utah, Georgia Regents University, and the German TeleMedical Project for Integrative Stroke Care Network. We report the area under the curve in receiver-operating characteristic curve analysis with 95% confidence interval for our previously derived TM score in which lower TM scores correspond with a higher likelihood of being a stroke mimic. Based on final diagnosis at the end of the telestroke consultation, there were 630 of 1930 (32.6%) stroke mimics in the external validation cohort. All 6 variables included in the score were significantly different between patients with ischemic cerebrovascular disease versus stroke mimics. The TM score performed well (area under curve, 0.72; 95% confidence interval, 0.70-0.73; P mimic during telestroke consultation in these diverse cohorts was similar to its performance in our original cohort. Predictive decision-support tools like the TM score may help highlight key clinical differences between mimics and patients with stroke during complex, time-critical telestroke evaluations. © 2018 American Heart Association, Inc.

The importance of echocardiography in diagnostics of idiopathic pulmonary arterial hypertension: A case report

Directory of Open Access Journals (Sweden)

Stojković Gabrijela

2011-01-01

Full Text Available Introduction. Idiopathic pulmonary arterial hypertension (IPAH is rare and difficult progressive disease with prevalence of approximately 15 cases per million residents, with predominant female cases. Case Outline. A 47-year-old female presented with symptoms and signs of the right heart chambers failure. Over prior seven years the patient had the feeling of suffocation and fatigue when walking, and received treatment for bronchial asthma. Physical examination revealed a marked loud second heart sound over the pulmonary artery. Electrocardiogram: right ventricular hypertrophy. Spirometric (pulmonary capacity test, cardiac perfusion scan and spiral CT scanning excluded secondary pulmonary arterial hypertension. Blood testing for connective tissue diseases and HIV were within normal reference limits. Transthoracic colour Doppler echocardiography demonstrated a mild tricuspid regurgitation with high values of estimated maximal and middle systolic pressure of the right ventricle (135/110 mm Hg, and excluded previous heart disease. Cardiac catheterization confirmed IPAH diagnosis, with systolic right ventricular pressure of 101/47/66 mm Hg and pulmonary capillary pressure of 30/13/10 mm Hg. Basic therapy with sildenafil, nevertheless, considerable limitations of strain tolerance was still present. Conclusion. IPAH is a severe heart disease with non-specific signs and symptoms. Screening for IPAH is transthoracic colour Doppler echocardiography shows high correlation with cardiac catheterization.

Intracardiac echocardiography: use during transcatheter device closure of a patent ductus arteriosus in a dog.

Science.gov (United States)

Chetboul, V; Damoiseaux, C; Behr, L; Morlet, A; Moise, N S; Gouni, V; Lavennes, M; Pouchelon, J-L; Laborde, F; Borenstein, N

2017-06-01

Intracardiac echocardiography (ICE) is used in humans for percutaneous interventional procedures, such as transcatheter device closures. Intracardiac echocardiography provides high-resolution imaging of cardiac structures with two-dimensional, M-mode, Doppler, and also three-dimensional modalities. The present report describes application of ICE during transcatheter occlusion of patent ductus arteriosus using a canine ductal occluder in a dog for which transesophageal echocardiography could not provide an optimal acoustic window. Copyright © 2017 Elsevier B.V. All rights reserved.

The Global Education Network for Retinopathy of Prematurity (Gen-Rop): Development, Implementation, and Evaluation of A Novel Tele-Education System (An American Ophthalmological Society Thesis).

Science.gov (United States)

Chan, R V Paul; Patel, Samir N; Ryan, Michael C; Jonas, Karyn E; Ostmo, Susan; Port, Alexander D; Sun, Grace I; Lauer, Andreas K; Chiang, Michael F

2015-01-01

To describe the design, implementation, and evaluation of a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmology residents. A secure Web-based tele-education system was developed utilizing a repository of over 2,500 unique image sets of ROP. For each image set used in the system, a reference standard ROP diagnosis was established. Performance by ophthalmology residents (postgraduate years 2 to 4) from the United States and Canada in taking the ROP tele-education program was prospectively evaluated. Residents were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters. Accuracy and reliability of ROP diagnosis (eg, plus disease, zone, stage, category) were determined using sensitivity, specificity, and the kappa statistic calculations of the results from the pretest and posttest. Fifty-five ophthalmology residents were provided access to the ROP tele-education program. Thirty-one ophthalmology residents completed the program. When all training levels were analyzed together, a statistically significant increase was observed in sensitivity for the diagnosis of plus disease, zone, stage, category, and aggressive posterior ROP (Peducation system for ROP education is effective in improving diagnostic accuracy of ROP by ophthalmology residents. This system may have utility in the setting of both healthcare and medical education reform by creating a validated method to certify telemedicine providers and educate the next generation of ophthalmologists.

Master-slave tele-tongs

International Nuclear Information System (INIS)

1992-05-01

In a 'hot laboratory', manipulation is concerned with mechanical devices, controlled by a human operator and used to move or manipulate radioactive objects without direct contact. Master-slave Manipulators and Tele-tongs are devices permitting a worker on one side of the shield of a 'hotcell' or a 'gloves-box', to carry out safe laboratory operations, with radioactive materials on the other side. This instrument is used mainly for remote-manipulation purposes, that is, to handle elements, substances or equipment across a protective wall. A typical example of its use is the fractioning of radioisotopes (for medical and agricultural purposes), or the handling of toxic substances, the fractioning and/or mixing of noxious components constituting a health hazard for operators, etc. Mechanic-type manipulator and tongs usually operated in pairs, endowed with a high level of sensitivity which enables the operator, duly protected, to perform what would otherwise be hazardous and delicate tasks. INVAP manipulators are suitable for all king of installations with 'hot-cells' or 'gloves-box'. INVAP manipulators were developed to meet the problem of introducing it through the shielding wall of the 'hotcells' or 'gloves-box', without violating shielding integrity. To prevent any possibility of contamination, the telemanipulator has been lined with an airtight sheath or booting, also especially developed by INVAP for this instrument. Moreover, it has developed a special set of tools for booting- changing under perfectly safe conditions

Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy

DEFF Research Database (Denmark)

Gerdts, Eva; Okin, Peter M; Boman, Kurt

2012-01-01

The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain.......The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain....

A literature review of tele-dermatology programs in the South African public health sector: Kwazulu-Natal perspective

CSIR Research Space (South Africa)

Walters, Laticha EM

2015-11-01

Full Text Available South Africa’s HIV/AIDS prevalence rate is 17,9%, the highest being in KwaZulu-Natal. Dermatological diseases are linked to HIV/AIDS. Tele-dermatology was not part of the 1998 National Telemedicine Project. Only phase I (of three) was implemented...

Stress Induced Cardiomyopathy Triggered by Acute Myocardial Infarction: A Case Series Challenging the Mayo Clinic Definition.

Science.gov (United States)

Christodoulidis, Georgios; Kundoor, Vishwa; Kaluski, Edo

2017-08-28

BACKGROUND Various physical and emotional factors have been previously described as triggers for stress induced cardiomyopathy. However, acute myocardial infarction as a trigger has never been reported. CASE REPORT We describe four patients who presented with an acute myocardial infarction, in whom the initial echocardiography revealed wall motion abnormalities extending beyond the coronary distribution of the infarct artery. Of the four patients identified, the mean age was 59 years; three patients were women and two patients had underlying psychiatric history. Electrocardiogram revealed ST elevation in the anterior leads in three patients; QTc was prolonged in all cases. All patients had ≤ moderately elevated troponin. Single culprit lesion was found uniformly in the proximal or mid left anterior descending artery. Initial echocardiography revealed severely reduced ejection fraction with relative sparing of the basal segments, whereas early repeat echocardiography revealed significant improvement in the left ventricular function in all patients. CONCLUSIONS This is the first case series demonstrating that acute myocardial infarction can trigger stress induced cardiomyopathy. Extensive reversible wall motion abnormalities, beyond the ones expected from angiography, accompanied by modest elevation in troponin and marked QTc prolongation, suggest superimposed stress induced cardiomyopathy.

Avoiding transthoracic echocardiography and transesophageal echocardiography for patients with variable body mass indexes in infective endocarditis

Directory of Open Access Journals (Sweden)

Robert Sogomonian

2016-04-01

Full Text Available Background: Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE or transesophageal echocardiography (TEE in patients with a body mass index (BMI greater than or equal to 25 kg/m2 and less than 25 kg/m2. Methods: A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study. Results: Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65% were discovered to have native valve vegetations on TEE and 58 (35% with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m2 and the subsequent group with a BMI <25 kg/m2. Patients with a BMI ≥25 kg/m2 who underwent a TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI < 25 kg/m2 had a TTE sensitivity and specificity of 78 and 95%, respectively. Conclusions: Patients with a BMI <25 kg/m2 and a negative TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m2 may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE.

Pericardial Effusion and Pericardiocentesis: Role of Echocardiography

Science.gov (United States)

2012-01-01

Pericardial effusion can develop from any pericardial disease, including pericarditis and several systemic disorders, such as malignancies, pulmonary tuberculosis, chronic renal failure, thyroid diseases, and autoimmune diseases. The causes of large pericardial effusion requiring invasive pericardiocentesis may vary according to the time, country, and hospital. Transthoracic echocardiography is the most important tool for diagnosis, grading, the pericardiocentesis procedure, and follow up of pericardial effusion. Cardiac tamponade is a kind of cardiogenic shock and medical emergency. Clinicians should understand the tamponade physiology, especially because it can develop without large pericardial effusion. In addition, clinicians should correlate the echocardiographic findings of tamponade, such as right ventricular collapse, right atrial collapse, and respiratory variation of mitral and tricuspid flow, with clinical signs of clinical tamponade, such as hypotension or pulsus paradoxus. Percutaneous pericardiocentesis has been the most useful procedure in many cases of large pericardial effusion, cardiac tamponade, or pericardial effusion of unknown etiology. The procedure should be performed with the guidance of echocardiography. PMID:23236323

French opinion on Nuclear Energy

International Nuclear Information System (INIS)

Bucaille, A.

2003-01-01

Contrary to what many think or say, most French people do not have a clear-cut opinion about nuclear power. And until public opinion can be accurately assessed, we should be worried of speaking on its behalf. More than half the population of France believes that nuclear power is the cheapest option, but 40% of them have no idea what the situation really is. The French are keenly aware of the what is at stake at the international level, and the fact that energy is becoming a worldwide issue. What they are most concerned about is nuclear waste and the possibility of a catastrophe of the Chernobyl type occurring. Disquiet about the first is now dissipating, after having increased. But attitudes about the second are ambivalent. A quarter of the French are very ignorant about radioactivity. 20% of the population complain that not enough information is forthcoming, particularly as concerns advances in technology. As can be anticipated, awareness of the question of climate change is growing year by year, with increased reporting of storms, floods and heat waves

Intraoperative transesophageal echocardiography in congenital heart diseases surgery

International Nuclear Information System (INIS)

Ozores Suarez, Francisco Javier; Perez de Ordaz, Luis Bravo

2010-01-01

The intraoperative transesophageal echocardiography is very used in pediatric cardiovascular surgery. The aim of present paper was to determine its impact on the surgery immediate results after a previous experience of authors with this type of procedure

Transesophageal echocardiography. 3. rev. and enl. ed.; Transoesophageale Echokardiografie. Lehrbuch und Altlas zur Untersuchungstechnik und Befundinterpretation

Energy Technology Data Exchange (ETDEWEB)

Lambertz, Heinz [ECHOECUCT-Akademie, Wiesbaden (Germany); Lethen, Harald (eds.) [Internistische Intensivmedizin, Wiesbaden (Germany). Innere Medizin/Kardiologie

2013-02-01

The book on transesophageal echocardiography covers the following issues: Development of transesophageal echocardiography, technical advances; indications and contraindication for transesophageal echocardiography; systematic of the medical examination process; cardiac valves and valve prostheses; mitral and aortic valvuloplasty, TAVI and interventional treatment of mitral regurgitation; infectious endocarditis; one-way and effluence disturbances of the left and right ventricle; diseases of the thoracic aorta; undefined right ventricle enlargement; lung embolism, acute infarct complications; TEE during anesthesia and perioperative intensive medicine, cardiac sources of embolism; cardiac tumors, mediastinal lymph nodes; pericardiac diseases; congenital heart diseases in childhood and adulthood; catheter interventions and heart valve reconstruction; surgically corrected congenital cardiac defects; intracavitary versus transesophageal echocardiography; three-dimensional TEE; coronary diagnostics; ischemia and vitality diagnostics.

Evaluation of regional wall motion abnormalities of the heart. Comparison with Doppler tissue echocardiography, MR-tagging and levocardiography

International Nuclear Information System (INIS)

Kivelitz, D.E.; Enzweiler, C.N.H.; Hamm, B.; Borges, A.C.; Walde, T.; Rutsch, W.; Baumann, G.

2004-01-01

Purpose: To compare the visual analysis of magnetic resonance imaging (MRI) with the tagging technique and Doppler tissue echocardiography with invasive ventriculography in detecting and quantifying regional left ventricular wall motion abnormalities. Materials and Methods: Sixteen patients with coronary artery disease and a history of prior myocardial infarction underwent invasive ventriculography. Doppler tissue echocardiography and MR-tagging within one week. Regional wall motion abnormalities (WMA) were detected in all patients. WMA were graded as normal=1; hypokinetic=2; akinetic=3; or dyskinetic=4. For agreement between MRI, echocardiography, and ventriculography the kappa coefficient (κ) according to Cohen was calculated. Results: The kappa coefficient (κ) was 0.962 for agreement between MRI and echocardiography and 0.602 for agreement between MRI and ventriculography as well as between echocardiography and ventriculography. Conclusion: Reliable analysis of regional left ventricular wall motion abnormalities is feasible using visual analysis of MR-tagging. MRI and Doppler tissue echocardiography detect more WMA than invasive ventriculography and grade them as more severe. (orig.)

Borges, Averroes y Aristóteles: Literatura y filosofía

OpenAIRE

Kamel, Fawzia

2006-01-01

El trabajo es un acercamiento a "La busca de Averroes" de J. L. Borges donde el autor reitera su fe en una biblioteca universal de múltiples culturas (La biblioteca de Babel) pero, a la vez, reconoce la dificultad de la tarea. Las dificultades con que se enfrenta Averroes en explicar el texto de Aristóteles sin ver ni saber qué es teatro, se ven desdobladas en la dificultad de Borges pintando a Averroes, en la España del siglo XII, a través de unas pocas notas biográficas. El cuento es la his...

Diagnostic value of dobutamine echocardiography in myocardial viability of about 85 cases

International Nuclear Information System (INIS)

El Hammami, El Mondher

2009-01-01

Stress echocardiography in low-dose dobutamine is part of the proposed techniques for the identification of viable myocardium. Unlike isotopic techniques that analyze the viability in terms of perfusion and membrane integrity, the echo dobutamine studying the functional aspect of sustain ability is - to - say the existence of a reservation contraction in segments asynergic. To establish the diagnostic value of echo dobutamine in search of sustain ability we conducted a prospective study to nearly 85 patients all presented with a recent myocardial infarction whose average age is 55 years and the sex ratio is 0.95. The examination was performed for all our patients on average twelfth day of myocardial infarction, improved segmental kinetics at least one grade in at least two adjacent segments relative to the ground state is considered as ultrasound test of the viability.

Outpatient echocardiography in the evaluation of innocent murmurs in children: utilisation benchmarking.

Science.gov (United States)

Frias, Patricio A; Oster, Matthew; Daley, Patricia A; Boris, Jeffrey R

2016-03-01

We sought to benchmark the utilisation of echocardiography in the outpatient evaluation of heart murmurs by evaluating two large paediatric cardiology centres. Although criteria exist for appropriate use of echocardiography, there are no benchmarking data demonstrating its utilisation. We performed a retrospective cohort study of outpatients aged between 0 and 18 years at the Sibley Heart Center Cardiology and the Children's Hospital of Philadelphia Division of Cardiology, given a sole diagnosis of "innocent murmur" from 1 July, 2007 to 31 October, 2010. Using internal claims data, we compared the utilisation of echocardiography according to centre, patient age, and physician years of service. Of 23,114 eligible patients (Sibley Heart Center Cardiology: 12,815, Children's Hospital of Philadelphia Division of Cardiology: 10,299), 43.1% (Sibley Heart Center Cardiology: 45.2%, Children's Hospital of Philadelphia Division of Cardiology: 40.4%; p1-5 years had the lowest utilisation (32.7%). In two large paediatric cardiology practices, the overall utilisation of echocardiography by physicians with a sole diagnosis of innocent murmur was similar. There was significant and similar variability in utilisation by provider at both centres. Although these data serve as initial benchmarking, the variability in utilisation highlights the importance of appropriate use criteria.

Transthoracic Doppler echocardiography – noninvasive diagnostic window for coronary flow reserve assessment

Directory of Open Access Journals (Sweden)

Dimitrow Paweł

2003-04-01

Full Text Available Abstract This review focuses on transthoracic Doppler echocardiography as noninvasive method used to assess coronary flow reserve (CFR in a wide spectrum of clinical settings. Transthoracic Doppler echocardiography is rapidly gaining appreciation as popular tool to measure CFR both in stenosed and normal epicardial coronary arteries (predominantly in left anterior descending coronary artery. Post-stenotic CFR measurement is helpful in: functional assessment of moderate stenosis, detection of significant or critical stenosis, monitoring of restenosis after revascularization. In the absence of stenosis in the epicardial coronary artery, decreased CFR enable to detect impaired microvascular vasodilatation in: reperfused myocardial infarct, arterial hypertension with or without left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, syndrome X, hypertrophic cardiomyopathy. In these diseases, noninvasive transthoracic Doppler echocardiography allows for serial CFR evaluations to explore the effect of various pharmacological therapies.

A tele-home care system exploiting the DVB-T technology and MHP.

Science.gov (United States)

Angius, G; Pani, D; Raffo, L; Randaccio, P; Seruis, S

2008-01-01

The aim of this research work is the development of a low-cost system for telemedicine based on the DVB-T technology. The diffusion of DVB-T standard and the low cost of DVB-T set-top boxes bring the vision of a capillary distribution of tele-home care monitoring systems with easy-to-use patient's interface. Exploiting the potentiality of the DVB-T set-top box, we transformed it into an "on-demand tele-home care interface". The Xlet we developed is able to govern the functionality of an external microcontroller-based unit for the acquisition of the bio-signals of interest. The uplink connection is used to send the exam results to a remote care center. The Xlet providing the patient interface on the set-top box is uploaded by a DVB-T broadcaster without any intervention in the patient's home. A prototypal low-cost base station for the acquisition of the patient's signals (1-lead ECG) has been developed. It is able to be connected to the set-top box via an infrared link. A smart-card-based system is in charge for the customization of the Xlet for every patient. The proposed system, based on a currently widespread infrastructure, is able to allow the patients monitoring from home without any installation procedure. Even untrained (or elderly) people can easily use such system due to their practice with the basic DVB-T home-entertainment equipments.

Training of beauty salon professionals in disease prevention using interactive tele-education.

Science.gov (United States)

Vieira Júnior, Elso Elias; Wen, Chao Lung

2015-01-01

Infectious diseases can be acquired in places where invasive procedures are often performed without the proper care of hand washing and material sterilization. There are approximately 500,000 beauty and esthetics centers in Brazil, which are visited by thousands of people every day. Many diseases, including sexually transmitted infections, are still highly prevalent in Brazil, such as warts caused by human papillomavirus, hepatitis B and C, and human immunodeficiency virus infection, and can be transmitted in beauty salons. We have developed a tele-education course divided into four main themes: sexually transmitted infections, indoor health in beauty salon workplaces, hand washing, and material sterilization. The course was made available through a Web site, which included a face-to-face meeting, Web synchronous meetings (chats and Web conferences), and asynchronous resources (reading material, discussion lists, situations simulator, educational videos, and three-dimensional virtual human video animation on sexually transmitted infections and hand washing), mediated by professors and coordinators. Fifty-two beauty professionals and 33 other professionals were enrolled from different regions. Of the 61 who completed the course and received a certificate at the course's end, 100% considered good to excellent the course's applicability to everyday life and would recommend it to a fellow professional. The results demonstrate the feasibility of an interactive, tele-education model using low-cost tools as an educational resource to teach beauty professionals. In the future, this may become a branch of nationwide telehealth action.

Network Support for Social 3-D Immersive Tele-Presence with Highly Realistic Natural and Synthetic Avatar Users

NARCIS (Netherlands)

R.N. Mekuria (Rufael); A. Frisiello (Antonella); M Pasin (Marco); P.S. Cesar Garcia (Pablo Santiago)

2015-01-01

htmlabstractThe next generation in 3D tele-presence is based on modular systems that combine live captured object based 3D video and synthetically authored 3D graphics content. This paper presents the design, implementation and evaluation of a network solution for multi-party real-time communication

Dosimetric evaluation in panoramic and tele-radiography procedures; Avaliacao dosimetrica em procedimentos de radiografia panoramica e teleradiografias

Energy Technology Data Exchange (ETDEWEB)

Oliveira, Georgge Gomes

2004-07-01

The present work had as an objective to evaluate the skin surface entrance dose in panoramic and tele radiography procedures in three clinics in Recife - Pernambuco - Brazil, and to contribute with data for the determination of reference levels for super cited extra oral procedures, for this purpose, operational conditions in 3 clinics were evaluated in Recife, aiming to evaluate the existence and integrity of the radioprotection equipment, manner and conditions of image processing; and radiographic equipment parameters such as the dimension of the irradiation filed, the total filtration, the exposure time and the potential applied to the X ray tube. For an estimation of the skin entrance dose of the patient, the phantom Randon Alderson and thermoluminescence dosemeters were used. From these values and the conversion factors determined by the Monte Carlo technique, with the phantom MAX it was possible to estimate the dose absorbed in the organ due to the tele radiography procedures. Regarding panoramic radiography the study showed that the more elevated doses occurred in the parotid gland region which is near rotational venters. In the case of tele radiography the highest dose value occurred in the regions corresponding to the temporal lobe of the brain, followed by linfonodes, ears and parotid glands. The doses absorbed in the eyes and the thyroid gland were, 0.037 mGy and 0.002 mGy in Clinic A and 0.062 mGy and 0.003 mGy in Clinic C, respectively. Regarding equipment test, inadequacy was found in the beam collimation in Clinic A and in the reproducibility of the X ray exposure in Clinic C. The total filtration in both clinics was inadequate.(author)

Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery

DEFF Research Database (Denmark)

Olsen, Niels Thue; Søgaard, Peter; Larsson, Henrik B W

2011-01-01

Objectives The aim of this study was to test myocardial deformation imaging using speckle-tracking echocardiography for predicting outcomes in chronic aortic regurgitation. Background In chronic aortic regurgitation, left ventricular (LV) dysfunction must be detected early to allow timely surgery....... Speckle-tracking echocardiography has been proposed for this purpose, but the clinical value of this method in aortic regurgitation has not been established. Methods A longitudinal study was performed in 64 patients with moderate to severe aortic regurgitation. Thirty-five patients were managed...... conservatively with frequent clinical visits and sequential echocardiography and followed for an average of 19 ± 8 months, while 29 patients underwent surgery for the valve lesion and were followed for 6 months post-operatively. Baseline LV function by speckle-tracking and conventional echocardiography...

Significance of blood pool scintigraphy and echocardiography in the investigation of left heart ventricle

International Nuclear Information System (INIS)

Otto, L.; Krosse, B.; Neumann, G.; Rother, T.; Loebe, M.; Otto, J.; Koegler, A.; Wuensche, A.; Schneider, G.

1990-01-01

Left ventricular ejection (LVEF) was assessed by both radionuclide ventriculography and echocardiography. The correlation coefficient of 0.74 revealed a just good agreement. It was better in the range of normal than of pathological values. The analysis of regional wall motion performed by echocardiography was not as reliable as by radionuclide ventriculography. The main advantage of echocardiography is its good spatial resolution. Its domain is the diagnosis of pathomorphological changes including valvular disorders. Advantages of radionuclide ventriculography are good temporal resolution, registration of the third dimension practicability during exercise and as bedside method (nuclear stethoscope). Functional disturbances of both ventricles are its field of application. (author)

Os princí­pios de verdade no Livro IV da Metafí­sica de Aristóteles

Directory of Open Access Journals (Sweden)

Nazareno Eduardo de Almeida

2010-09-01

Full Text Available Este artigo mostra que o princípio primário da ciência do ente enquanto ente, apresentado e defendido por Aristóteles no Livro IV da Metafísica, é constituído pela bi-implicaçáo necessária (modal entre os princípios de náo-contradiçáo e do terceiro excluído, e náo somente, como na interpretaçáo tradicional, pelo primeiro destes princípios. Tal é mostrado através de uma interpretaçáo de uma parte do capítulo 3 e, em especial, de três partes do capítulo 4 deste escrito, onde Aristóteles desenvolve o que chamou "demonstraçáo refutativa", que consiste na demonstraçáo indireta do princípio primário por meio da refutaçáo da tese que nega (de modo forte este mesmo princípio. A interpretaçáo apresentada no artigo mostra que neste procedimento lógico Aristóteles está defendendo tanto o princípio de náo-contradiçáo quanto o princípio do terceiro excluído, assumindo ambos como formulações equivalentes do princípio primário da ciência do ser enquanto ser.

Opinion and Persuasion

OpenAIRE

Ioan Constantin Dima; Daniela Gîfu

2014-01-01

The research proves that persuasion has two types of objectives. Its main objective is the change of opinion. Its fundamental and foundational objectives are the change in attitude, generic conduct and situational behaviour. The main objective controls the fundamental objectives. The change in attitudes and conduct/behaviour is presided by changes in opinion. Persuasion is thus shown to be primarily and ultimately a matter of opinion. As such, its mechanism to manage and generate ...

Defining user requirements for tele-nuclear medicine applications: from technical feasibility to clinical results

International Nuclear Information System (INIS)

Todd-Pokropek, A.; Chanachai, R.

2002-01-01

Purpose: Defining the user requirements for tele-nuclear medicine systems, in particular in developing countries, is an important prerequisite to establishing a service. However, the availability of low cost PC based servers and, now, access to local ISPs, has made the technical provision of such networks relatively simple and low cost, although transfer of data to and form legacy systems still present many difficulties. Method and Materials: The key driving force in developing countries is the imbalance between skills in the relatively few centres of excellence and the increasing number of installations overall. Requirements include both very rapid remote reporting and/or overnight tele-consultation. Original raw NM data must be available not just 'images'. Using current network standards (VPN) data transfer rate requirements are low. Provision of image fusion between NM, CT and MRI is also highly desirable. Results: Experience has been obtained e.g. in Thailand and Morocco, where a network of servers and remote users, with cardiac application of particular importance, has demonstrated benefit, and increasing volumes of usage. Conclusions: However, the requirements need to be clearly defined, and a staff training program is essential, as is a full evaluation. The transfer of skills is important in raising the overall quality of health care

TIA Caused by Contrast Echocardiography in Patient with Platypnea-Orthodeoxia.

Science.gov (United States)

Loncar, Goran; Payot, Laurent; Dubois, Mathieu

2015-10-01

Platypnea-orthodeoxia syndrome (POS) is a rare clinical disorder characterized by dyspnea caused by the upright position and relieved at recumbent position. Few cases of POS and stroke were reported in literature, and the association between stroke and POS with evidence of patent foramen ovale (PFO) is rare. Stroke may occur in patients with cardiac shunt who undergo contrast echocardiography. We present a patient with POS who experienced transitory ischemic attack (TIA) most likely caused by injection of agitated saline microbubbles during screen for PFO. No case report of TIA/stroke during contrast echocardiography in patients with POS has previously been published. © 2015, Wiley Periodicals, Inc.

Prenatal Diagnosis of Fetal Interrupted Aortic Arch Type A by Two-Dimensional Echocardiography and Four-Dimensional Echocardiography with B-Flow Imaging and Spatiotemporal Image Correlation.

Science.gov (United States)

Zhang, Dongyu; Zhang, Ying; Ren, Weidong; Sun, Feifei; Guo, Yajun; Sun, Wei; Wang, Yu; Huang, Liping; Cai, Ailu

2016-01-01

Fetal interrupted aortic arch (IAA) is a rare cardiac anomaly and its prenatal diagnosis is challenging. The purpose of our report is to evaluate the use of two-dimensional echocardiography (2DE) and 4D echocardiography with B-flow imaging and spatiotemporal image correlation (4D BF-STIC) in detecting IAA type A (IAA-A). Twenty-three cases of confirmed IAA-A identified by fetal echocardiography were involved in the study. The fetal echocardiography image data were reviewed to analyze the ratio of right ventricle to left ventricle (RV/LV) diameter, the ratio of main pulmonary artery to ascending aorta (MPA/AAO) diameter, and the correlation of RV/LV diameter ratio and size of ventricular septal defect (VSD). 4D BF-STIC was performed in 21 fetuses using the sagittal view (4D BF-STIC-sagittal) and the four-chamber view (4D BF-STIC-4CV) as initial planes of view. An additional 183 normal fetuses were also included in our study. RV/LV and MPA/AAO ratios were calculated and compared with that of IAA-A fetuses. Fetal 2DE, 4D BF-STIC-sagittal, and 4D BF-STIC-4CV were used to visualize the aortic arch and its associated neck vessels. Six subgroups were evaluated according to gestational age. Fetal 2DE, 4D BF-STIC-sagittal, and 4D BF-STIC-4CV made the correct prenatal diagnosis of IAA-A in 19/23 (82.6%), 14/21 (66.7%), and 19/21 (90.5%) of patients, respectively. A significantly enlarged MPA combined with symmetric ventricles was found in the IAA-A fetuses, while the size of the VSD was negatively correlated with RV/LV ratio. 4D BF-STIC-sagittal and 4D BF-STIC-4CV were better than traditional 2D ultrasound in detecting the aortic arch and neck vessels between 17 and 28 gestational weeks and 29 to 40 gestational weeks in normal fetuses. It is demonstrated that IAA-A could be diagnosed by traditional fetal echocardiography, while 4D technique could better display the anatomic structure and the spatial relationships of the great arteries. Use of volume reconstruction may

Myocardial perfusion SPECT for assessment of left ventricular function and volume- comparison with echocardiography

International Nuclear Information System (INIS)

Cheng Xu; Huang Gang

2004-01-01

Objective: The purpose of this study was to evaluate left ventricular volume and function by gated SPECT and comparison of the results with echocardiography. Methods: 65 Consecutive patients (49 male, 16 female; mean age 61+11 years) who underwent both gated 99m Tc-MIBI myocardial perfusion SPECT and echocardiography within a 15 days period were included in the study. Exclusion criteria were any change in clinical status between acquisition of the gated SPECT and echocardiography studies, acute myocardial infarction occurring less than 7 days before study, and surgical procedures occurring within 30 days of the study. The clinical diagnosis of each patient was not considered, as this was not relevant to the purpose of the study. The diagnoses were as follows: coronary artery disease (n=46), hypertensive heart disease (n=8), old myocardial infarction (n=5), myocarditis (n=2), and routine medical examination(n=4). A dose of 740 MBq of 99 Tc m -sestamibi was administered in resting condition. Gated SPECT images were obtained with ADAC Vertex MCD-AC SPECT system. The raw projection images were reconstructed with filtered back-projection (ramp filter), without attenuation correction. The data, including left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV) were obtained using AUTOQUANT software (ADAC corporation). The echocardiography study used its standard techniques. Two nuclear medicine physicians processed the raw images respectively to evaluate internal reproducibility of gated SPECT. In order to compare the results of gated SPECT with echocardiography on different left ventricular volumes, all patients were divided into two groups (EDV 90 ml, n=34) based by EDV measurements in echocardiography. Results: The correlation coefficient of LVEF, EDV, ESV between SPECT and echocardiography were 0.77, 0.86 and 0.90 respectively. P 0.07). The reproducibility of gated SPECT was excellent. There were no significant differences in

Saline Contrast Echocardiography in the Era of Multimodality Imaging--Importance of "Bubbling It Right".

Science.gov (United States)

Gupta, Saurabh K; Shetkar, Sudhir S; Ramakrishnan, Sivasubramanian; Kothari, Shyam S

2015-11-01

Saline contrast echocardiography is an established imaging modality. Logical interpretation of a carefully performed study is vital to realize its diagnostic potential. In this review, we discuss utility of saline contrast echocardiography in evaluation of various pathologies within and outside the heart other than a patent foramen ovale. © 2015, Wiley Periodicals, Inc.

Opinion dynamics in activity-driven networks

Science.gov (United States)

Li, Dandan; Han, Dun; Ma, Jing; Sun, Mei; Tian, Lixin; Khouw, Timothy; Stanley, H. Eugene

2017-10-01

Social interaction between individuals constantly affects the development of their personal opinions. Previous models such as the Deffuant model and the Hegselmann-Krause (HK) model have assumed that individuals only update their opinions after interacting with neighbors whose opinions are similar to their own. However, people are capable of communicating widely with all of their neighbors to gather their ideas and opinions, even if they encounter a number of opposing attitudes. We propose a model in which agents listen to the opinions of all their neighbors. Continuous opinion dynamics are investigated in activity-driven networks with a tolerance threshold. We study how the initial opinion distribution, tolerance threshold, opinion-updating speed, and activity rate affect the evolution of opinion. We find that when the initial fraction of positive opinion is small, all opinions become negative by the end of the simulation. As the initial fraction of positive opinions rises above a certain value —about 0.45— the final fraction of positive opinions sharply increases and eventually equals 1. Increased tolerance threshold δ is found to lead to a more varied final opinion distribution. We also find that if the negative opinion has an initial advantage, the final fraction of negative opinion increases and reaches its peak as the updating speed λ approaches 0.5. Finally we show that the lower the activity rate of individuals, the greater the fluctuation range of their opinions.