Search PubMed⌕ Search

Biomedical subjects

J R Clarke

Publications and source records attributed to J R Clarke.

At least 55 records · Page 3Linked to original sources
PubMed1996

Casualty modeling for real-time medical training.

We present a model for simulating casualties in virtual environments for real-time medical training. It allows a user to choose diagnostic and therapeutic actions to carry out on a simulated casualty who will manifest appropriate physiological, behavioral, and physical responses. Currently, the user or a "stealth instructor" can specify one or more injuries that the casualty has sustained. The model responds by continuously determining the state of the casualty, responding appropriately to medical assessment and treatment procedures. So far, we have modeled four medical conditions and over 20 procedures. The model has been designed to handle the addition of other injuries and medical procedures.

Computer Simulation↗
PubMed1996

A priori models in the testing of diving life support equipment.

A priori models have been effectively used at the Navy Experimental Diving Unit (NEDU) to aid in the design of tests for diving equipment. These models are computer simulations conducted prior to the initial testing effort, using mechanistic models derived from first principles or based on prior testing. One example of such a model involves the freeze-up susceptibility of SCUBA regulators used in very cold water at depths to 58 msw (190 fsw). The influence of various dive profiles on the risk of regulator freeze-up was estimated for a variety of model parameters. In a second example, a simple model of CO2 canister duration was used to reveal the relative benefits of various competing diver work/rest profiles. The a priori modeling efforts helped NEDU define relatively efficient and unambiguous designs for testing diving equipment.

Carbon Dioxide↗
PubMed1996

The lung in HIV infection: can pulmonary function testing help?

Simple lung function tests have been used to evaluate respiratory symptoms in human immunodeficiency virus (HIV) infected individuals. Abnormalities of simple lung function tests, in particular decreases in the transfer factor of the lung for carbon monoxide (TL,CO) have been described in patients with acquired immune deficiency syndrome (AIDS) who have respiratory disease. Early studies showed marked reductions in TL,CO in patients with pneumocystis pneumonia but other forms of pulmonary infection or neoplasm also resulted in reductions in TL,CO values. Lung function studies in larger numbers of patients have shown reductions in all lung function measurements, particularly in TL,CO. in all categories of HIV disease. The most marked reductions in TL,CO are seen in patients with pneumocystis pneumonia but reductions also occur in pulmonary bacterial infection, tuberculosis and pulmonary Kaposi's sarcoma. TL,CO values improved following recovery from pneumocystis pneumonia but rarely returned to normal. Zidovudine therapy does not contribute to the abnormalities of lung function but smokers generally have worse lung function tests in all categories of HIV disease. The diagnostic usefulness of simple lung function tests is limited. A reduced TL,CO is a highly sensitive index for the presence of pneumonitis (pneumocystis or otherwise) in HIV-infected individuals but lacks the necessary specificity to be a satisfactory diagnostic tool. Simple lung function tests have limitations but have a value as a simple screening test to determine the presence of underlying organic disease in HIV seropositive patients with respiratory symptoms. The presence of a normal TL,CO value makes the presence of pneumonitis unlikely.

AIDS-Related Opportunistic Infections↗
PubMed1996

Decision making with multiple goals: extending the threshold approach.

Given a set of conditions that may be present in a patient, this paper presents a methods for choosing the optimal combination of treatment actions, taking into account interactions among the available therapeutic and diagnostic procedures. The multiple-threshold approach is an extension of the threshold approach for individual conditions, and it offers a precise way of computing the optimal actions. In addition, tests for an example case show a 11-29% increase in the expected utility of treatments using this method.

Algorithms↗
PubMed1995

Bronchial responsiveness in the neonatal period as a risk factor for wheezing in infancy.

Bronchial responsiveness is closely associated with asthma in schoolchildren. We wished to test the hypothesis that bronchial responsiveness in the neonatal period might be a risk factor for lower-respiratory illnesses (LRI), typically cough and wheezing with viral infection, in infants. A cohort of 73 full-term healthy infants of atopic parents were observed during the first year of life. Respiratory illness was recorded and ascertained retrospectively by questionnaires administered to parents at 6-mo intervals, and infants were classified as having: LRI (one or more episode of wheezing in the first year) or no LRI (no wheezing). At approximately 1 mo of age, lung function was measured under sedation, and bronchial responsiveness (BR) to histamine aerosol was determined and expressed as PC30, the provocative concentration of histamine that induced a 30% decrease in maximum flow at FRC (V'maxFRC) by the squeeze technique. For the whole group, no index of lung function predicted subsequent wheezing. Among boys, however, there was a trend toward a lower V'maxFRC in those who subsequently developed LRI than in the group without LRI (median values 62 versus 98 ml/s; 95% CI: -1 to 68; p = 0.06), while among girls the major difference was in PC30, for which those who subsequently had LRI were significantly more responsive as neonates (PC30 was lower) than the group without LRI (1.4 versus 8.3 g/L; 95% CI: 1.0 to 13.1; p < 0.05). These findings suggest that sex differences in airway structure and responsiveness present soon after birth, and representing differences in fetal lung development, are associated with differences in the risk of subsequent LRI with wheezing.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchial Hyperreactivity↗
PubMed1995

Granulated metrial gland cells in the uterine wall and placenta of the pregnant woodmouse, Apodemus sylvaticus.

The differentiation of the decidua and the fetal placenta in the woodmouse, Apodemus sylvaticus, was studied with particular attention to the differentiation and migration of granulated metrial gland cells. Numerous granulated metrial gland cells, characterised by their glycoprotein-containing cytoplasmic granules, were found to differentiate in the decidua basalis and metrial gland of the uterine wall during the first half of pregnancy. Many granulated metrial gland cells appeared to pass into the lumina of blood vessels in the uterine wall and reach the maternal blood spaces of the fetal placenta. In the labyrinthine placenta some granulated metrial gland cells were found associated with degenerate cytotrophoblast lining the maternal blood spaces. This finding supports previous studies of the mouse, Mus musculus, suggesting that the labyrinthine placenta is an important site for the function of the bone marrow-derived granulated metrial gland cell.

Animals↗
PubMed1995

Generating penetration path hypotheses for decision support in multiple trauma.

We present a 3D graphical system that allows users to visualize different penetration path hypotheses for (multiple) gunshot or stab wounds, using a 3D graphical model of a human body with appropriate anatomical structures. The system also identifies the anatomical structures associated with each hypothesis. The various penetration path hypotheses follow from a combinatorial analysis of the set of surface wounds. The affected structures are determined by performing a detailed interpenetration analysis between 3D models of a penetration path and each anatomical structure within the body.

Computer Simulation↗
PubMed1994

Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease.

BACKGROUND: The purpose of this study was to estimate the sensitivity and specificity of diagnostic tests for gallstones and acute cholecystitis. METHODS: All English-language articles published from 1966 through 1992 about tests used in the diagnosis of biliary tract disease were identified through MEDLINE. From 1614 titles, 666 abstracts were examined and 322 articles were read to identify 61 articles with information about sensitivity and specificity. Application of exclusion criteria based on clinical and methodologic criteria left 30 articles for analysis. Cluster-sampling methods were adapted to obtain combined estimates of sensitivities and specificities. Adjustments were made to estimates that were biased because the gold standard was applied preferentially to patients with positive test results. RESULTS: Ultrasound has the best unadjusted sensitivity (0.97; 95% confidence interval, 0.95 to 0.99) and specificity (0.95; 95% confidence interval, 0.88 to 1.00) for evaluating patients with suspected gallstones. Adjusted values are 0.84 (0.76 to 0.92) and 0.99 (0.97 to 1.00), respectively. Adjusted and unadjusted results for oral cholecystogram were lower. Radionuclide scanning has the best sensitivity (0.97; 95% confidence interval, 0.96 to 0.98) and specificity (0.90; 95% confidence interval, 0.86 to 0.95) for evaluating patients with suspected acute cholecystitis; test performance is unaffected by delayed imaging. Unadjusted sensitivity and specificity of ultrasound in evaluating patients with suspected acute cholecystitis are 0.94 (0.92 to 0.96) and 0.78 (0.61 to 0.96); adjusted values are 0.88 (0.74 to 1.00) and 0.80 (0.62 to 0.98). CONCLUSIONS: Ultrasound is superior to oral cholecystogram for diagnosing cholelithiasis, and radionuclide scanning is the test of choice for acute cholecystitis. However, sensitivities and specificities are somewhat lower than commonly reported. We recommend estimates that are midway between the adjusted and unadjusted values.

Acute Disease↗
PubMed1994

Evaluation of a tidal expiratory flow index in healthy and diseased infants.

Patterns of tidal respiratory flow have been shown to relate well to airway function in adults, and one epidemiological study in infants has demonstrated the value of the ratio of time to reach peak tidal expiratory flow to the total expiratory time (tpef/te) in predicting subsequent wheezing. The aim of this study was to evaluate tpef/te as a measure of lung function, by sequential observations over the first year, on a group of 22 healthy infants and on 32 infants with a history of mild recurrent lower respiratory illness (LRI), and by single observations on 20 infants with asthma and 20 with severe chronic lung disease of prematurity. We compared tpef/te measured in quiet, supine sleep (under sedation) through a face mask and pneumotachograph, with a measure of airway function, maximal flow at functional residual capacity (VmaxFRC), obtained from partial forced expiratory flow volume loops using the "squeeze" technique. In healty infants tpet/te was significantly longer at 1 month than at 6 months (median values, 0.38 (95% CI, 0.36-0.43) and 0.28 (95% CI, 0.26-0.33), respectively). Between 6 and 12 months tpef/te did not alter significantly and it was independent of VmaxFRC. Both tpef and te as well as their ratio varied with frequency of breathing over the first year of life, but not within each individual age band, due to the narrow spread of frequencies at each age. In assessing airway obstruction, tpef/te was less sensitive than VmaxFRC. There was no difference between healthy infants, those with LRI, and infants with asthma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

HIV-1 proviral DNA copy number in peripheral blood leucocytes and bronchoalveolar lavage cells of AIDS patients.

In this study we have determined by polymerase chain reaction (PCR) the quantity of HIV-1 proviral DNA in cells obtained by bronchoalveolar lavage (BAL) from the lung of HIV-1+ individuals. This has been compared quantitatively with the proviral DNA in peripheral blood leucocytes (PBL) obtained simultaneously from the same patients. The mean HIV DNA copy number per 10(6) cells was 391 for PBL, with a range of 1-9000, and 2971 for BAL cells, with a range of < 1-70,000. The quantity of HIV DNA detected in BAL cells was higher than that detected in the corresponding PBL samples in 44 out of 78 (56%) individuals, whilst more HIV DNA was detected in the PBL compared with BAL cells in 14 out of 78 (18%) patients. In both BAL and PBL higher levels of HIV DNA were detected in the adherent (monocyte/macrophage) enriched cell populations compared with other non-adherent cells (leucocytes). A direct relationship between HIV DNA copy number and ability to recover infectious HIV progeny in vitro by co-cultivation with cord blood leucocytes was found for both PBL and BAL cells. Individuals known to be receiving azidothymidine treatment had a lower mean HIV DNA load in all cell fractions compared with those patients on no antiretroviral therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Characterization and measurement of elastance with application to underwater breathing apparatus.

The elastic loads inherent in underwater breathing apparatus (UBA) can affect diver performance. This work quantitatively examines elastance, its measurement by static tests, and its relationship to UBA. A rigid, fixed-volume container and a vertical water column with straight and parallel sides produce elastic loads that have application to closed-circuit UBA. We derived equations to describe the pressure-volume relationships of these elements from first principles and tested the equations experimentally for system pressure produced by a swept volume in a breathing machine. Our work demonstrates that simplified equations to describe elastance may not be sufficiently accurate for all situations. In addition, static measurements of elastance of a UBA or other element will not be reproducible unless all the volumes within the testing apparatus are accounted for; we provide experimental and mathematical techniques for doing so.

Diving↗
PubMed1993

Comparative study of the isolation of human immunodeficiency virus from the lung and peripheral blood of AIDS patients.

HIV-1 proviral DNA was detected by the polymerase chain reaction (PCR) in leucocytes from the peripheral blood (PBL) and bronchoalveolar lavage (BAL) of 100% and 72%, respectively, of HIV-1 seropositive patients. Infective virus isolated by cocultivation was recovered from the PBL and BAL of 50% and 59% of individuals, respectively. Isolation of HIV-1 was more readily made from the lung of individuals undergoing Pneumocystis carinii pneumonia (PCP) than from patients with non-PCP lung infections. The concomitant infection of lung cells with cytomegalovirus did not affect the isolation rate of HIV-1 from the lung. HIV-1 was isolated from BAL of 23 out of 36 (64%) individuals receiving no antiviral chemotherapy and from 13 out of 24 (54%) patients who were receiving AZT.

AIDS-Related Opportunistic Infections↗