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PubMed2004

Auxiliary technologies related to transport and communication for obstetric emergencies.

OBJECTIVES: To review the evidence on appropriate transport and communications technologies for obstetrical referrals in developing countries. METHODS: Review of articles published in peer-reviewed journals and gray literature, supplemented by email and telephone consultations with key informants and field programmers. RESULTS: A wide range of transportation options have been attempted. Initial approaches--such as those relying on ambulances owned and operated by health systems--have evolved into recommendations that emphasize community-based solutions. There are fewer options within the realm of communications technologies, and the recommendations are more consistent. Public health researchers are only beginning to evaluate the cost and effectiveness of different options. CONCLUSIONS: One of the greatest barriers to effective use of transport and communications for obstetric emergencies is the short time interval necessary for action, which limits options for obstetric referrals more than for other medical referrals. Although evidence is still scarce, experience suggests that motorized transport is likely to be the most acceptable and effective transportation option. More sophisticated communications technologies such as cell phones are both practical and effective, and are increasingly becoming the technologies of choice for low-resource settings.

Communication↗
PubMed2006

Dual intracordal unilateral vocal fold cysts: a perplexing diagnostic and therapeutic challenge.

SUMMARY: A 52-year-old professional voice user, a director of international sales and marketing and sports coach, described a 40-year history of severe hoarseness, with recent progressive dysphonia. He could not be heard on a cell phone and was unable to raise the volume or intensity of his voice. Strobovideolaryngoscopy revealed a perplexing set of dual intracordal lesions in the left vocal fold and a posterior glottal gap. The amplitude and magnitude of the left vocal fold mucosal waves were barely perceptible and were severely decreased in the right. There was marked phase asymmetry and aperiodicity bilaterally. A computed tomography scan of the neck with contrast and multiplanar reformatted reconstructions and a magnetic resonance imaging (MRI) of the neck with and without contrast revealed the nodular appearing masses of the left vocal fold without any definite evidence of paraglottic or supraglottic extension and no cervical lymphadenopathy. He had a hyperfunctional larynx with laryngopharyngeal reflux and chronic reflux laryngitis. Voice restoration required antireflux therapy, voice therapy, and phonomicrosurgical excision of the lesions. One benign epidermoid malformation cyst was lined by squamous epithelium. The second was a retention cyst lined with cuboidal epithelium. Finally, after 40 years, he has a normal voice.

Cysts↗
PubMed2006

Effects of 1.8 GHz radiofrequency field on DNA damage and expression of heat shock protein 70 in human lens epithelial cells.

To investigate the DNA damage, expression of heat shock protein 70 (Hsp70) and cell proliferation of human lens epithelial cells (hLEC) after exposure to the 1.8 GHz radiofrequency field (RF) of a global system for mobile communications (GSM). An Xc-1800 RF exposure system was used to employ a GSM signal at 1.8 GHz (217 Hz amplitude-modulated) with the output power in the specific absorption rate (SAR) of 1, 2 and 3 W/kg. After 2 h exposure to RF, the DNA damage of hLEC was accessed by comet assay at five different incubation times: 0, 30, 60, 120 and 240 min, respectively. Western blot and RT-PCR were used to determine the expression of Hsp70 in hLECs after RF exposure. The proliferation rate of cells was evaluated by bromodeoxyuridine incorporation on days 0, 1 and 4 after exposure. The results show that the difference of DNA-breaks between the exposed and sham-exposed (control) groups induced by 1 and 2 W/kg irradiation were not significant at any incubation time point (P > 0.05). The DNA damage caused by 3 W/kg irradiation was significantly increased at the times of 0 and 30 min after exposure (P < 0.05), a phenomenon that could not be seen at the time points of 60, 120 or 240 min (P > 0.05). Detectable mRNA as well as protein expression of Hsp70 was found in all groups. Exposure at SARs of 2 and 3 W/kg for 2 h exhibited significantly increased Hsp70 protein expression (P < 0.05), while no change in Hsp70 mRNA expression could be found in any of the groups (P > 0.05). No difference of the cell proliferation rate between the sham-exposed and exposed cells was found at any exposure dose tested (P > 0.05). The results indicate that exposure to non-thermal dosages of RF for wireless communications can induce no or repairable DNA damage and the increased Hsp70 protein expression in hLECs occurred without change in the cell proliferation rate. The non-thermal stress response of Hsp70 protein increase to RF exposure might be involved in protecting hLEC from DNA damage and maintaining the cellular capacity for proliferation.

Bromodeoxyuridine↗
PubMed2006

Simplified dispatch-assisted CPR instructions outperform standard protocol.

OBJECTIVE: Dispatch-assisted chest compressions only CPR (CC-CPR) has gained widespread acceptance, and recent research suggests that increasing the proportion of compression time during CPR may increase survival from out-of-hospital cardiac arrest. We created a simplified CC-CPR protocol to reduce time to start chest compressions and to increase the proportion of time spent delivering chest compressions. This simplified protocol was compared to a published protocol, Medical Priority Dispatch System (MPDS) Version 11.2, recommended by the National Academies of Emergency Dispatch. METHODS: Subjects were randomized to the MPDS v11.2 protocol or a simplified protocol. Data was recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions for both protocols. Outcomes included chest compression rate, depth, hand position, full release, overall proportion of compressions without error, time to start of CPR and total hands-off chest time. Proportions were analyzed by Wilcoxon's Rank Sum tests and time variables with Welch ANOVA and Wilcoxon's Rank Sum test. All tests used a two-sided alpha-level of 0.05. RESULTS: One hundred and seventeen subjects were randomized prospectively, 58 to the standard protocol and 59 to the simplified protocol. The average age of subjects in both groups was 25 years old. For both groups, the compression rate was equivalent (104 simplified versus 94 MPDS, p = 0.13), as was the proportion with total release (1.0 simplified versus 1.0 MPDS, p = 0.09). The proportion to the correct depth was greater in the simplified protocol (0.31 versus 0.03, p < 0.01), as was the proportion of compressions done without error (0.05 versus 0.0, p = 0.16). Time to start of chest compressions and total hands-off chest time were better in the simplified protocol (start time 60.9s versus 78.6s, p < 0.0001; hands-off chest time 69 s versus 95 s, p < 0.0001). The proportion with correct hand position, however, was worse in the simplified protocol (0.35 versus 0.84, p < 0.01). CONCLUSIONS: The simplified protocol was as good as, or better than the MPDS v11.2 protocol in every aspect studied except hand position, and the simplified protocol resulted in significant time savings. The protocol may need modification to ensure correct hand position. Time savings and improved quality of CPR achieved by the new set of instructions could be important in strengthening critical links in the cardiac chain of survival.

Adult↗
PubMed2001

The implantable cardioverter defibrillator.

Implantable cardioverter defibrillators (ICDs) have evolved from the treatment of last resort to the gold standard therapy for patients at high risk for ventricular tachyarrhythmias. High-risk patients include those who have survived life-threatening arrhythmias, and individuals with cardiac diseases who are at risk for such arrhythmias, but are symptomless. Use of an ICD will affect the patient's quality of life. Some drugs can substantially affect defibrillator function and efficacy, and possible drug-device interactions should be considered. Patients with ICDs may encounter cell phones, antitheft detectors, and many other sources of potential electromagnetic Interference. In addition to treating ventricular tachyarrhythmias, new defibrillators provide full featured dual chamber pacing, and could treat atrial arrhythmias, and congestive heart failure by means of biventricular pacing.

Arrhythmias, Cardiac↗
PubMed2004

[Non-justified visits to emergency units. Proposal of differentiated care].

OBJECTIVE: The number of visits to emergency units in public hospital settings in France increases every year. The adequation between admission to an SAU--Service d'accueil d'urgence (emergency unit) and the clinical status of the patient must be checked to improve handling upstream of the SAU. METHOD: A prospective study was conducted in the SAU of the University Hospital in Nantes to assess the proportion of patients who would benefit from direct hospitalisation, scheduled in a department of specialised or polyvalent medicine. RESULTS: This proportion was of 10%. Seventy-three percent of the patients were aged over 60. They were referred in 77% of cases by their treating physician and in 10.4% of cases by the physician on duty. Thirty-three percent of cases were non-specified organ diseases, 20% were dermatological affections, 12% broncho-pulmonary infections and in the same proportion rheumatological pathologies; other affections were rare. COMMENTS: The results of this study must be confirmed in a pilot study in which the general practitioner would refer any patient, that he would have sent to an SAU, directly to a medical department without passing through the SAU. To do so, using a cell phone, the practitioner would contact the hospital physician who would find a hospital bed. The impact of this new modality of hospitalisation on the SAU could be assessed in terms of the number of admissions avoided to the SAU.

Aged↗
PubMed2002

Driver workload response to in-vehicle device operations.

A central concern of Intelligent Transportation Systems (ITS) is the effect of in-vehicle devices (e.g., cell phones, navigation systems, radios, etc.) on driver performance and safety. As diverse and innovative technologies are designed and implemented for in-vehicle use, questions regarding the presence and use of these devices assume progressively greater importance. Further concerns for advanced driver training require us to develop and validate reliable and effective procedures for assessing such effects. This work examines a number of candidate procedures, in particular the evaluation of change in cognitive workload as a strategy by which such goals might be achieved.

Attention↗
PubMed2006

Can EMF exposure during development leave an imprint later in life?

People in industrialized nations live in an environment of ubiquitous electromagnetic field (EMF) exposure, both natural and anthropogenic. The intensity, variety, and geographic distribution of anthropogenic EMF exposures have grown dramatically since the mid 20th century, with many uses serving, and in close proximity to, human populations, such as electric power distribution, radio and television transmission, and more recently, personal cell phone communication units and transmitting towers. Thus, it is reasonable to ask if this EMF exposure could cause alterations in the physiology of developing organisms, since they are generally assumed to be the most sensitive to chemical stressors. In this report, we review work published beginning in the late 1980s. Initial reports indicated that exposure of chicken eggs during embryonic development to power-line electric fields of 50 and 60 Hz, at 10 V/m in air (which is frequently in locations inhabited by humans), could cause the brain tissues of the hatched chickens to respond differently in a particular test. More recently, an anecdotal report of human sensitivity to EMF has appeared that shows a health-related influence of prior exposure history to particular power-line frequencies in chemically sensitized individuals. These reports open the question of whether the ambient electromagnetic environment can leave an imprint on developing organisms and if such imprint changes have the potential for health consequences.

Animals↗
PubMed2006

Address-based versus random-digit-dial surveys: comparison of key health and risk indicators.

Use of random-digit dialing (RDD) for conducting health surveys is increasingly problematic because of declining participation rates and eroding frame coverage. Alternative survey modes and sampling frames may improve response rates and increase the validity of survey estimates. In a 2005 pilot study conducted in six states as part of the Behavioral Risk Factor Surveillance System, the authors administered a mail survey to selected household members sampled from addresses in a US Postal Service database. The authors compared estimates based on data from the completed mail surveys (n = 3,010) with those from the Behavioral Risk Factor Surveillance System telephone surveys (n = 18,780). The mail survey data appeared reasonably complete, and estimates based on data from the two survey modes were largely equivalent. Differences found, such as differences in the estimated prevalences of binge drinking (mail = 20.3%, telephone = 13.1%) or behaviors linked to human immunodeficiency virus transmission (mail = 7.1%, telephone = 4.2%), were consistent with previous research showing that, for questions about sensitive behaviors, self-administered surveys generally produce higher estimates than interviewer-administered surveys. The mail survey also provided access to cell-phone-only households and households without telephones, which cannot be reached by means of standard RDD surveys.

Adolescent↗
PubMed2006

An internet-based method of selecting control populations for epidemiologic studies.

Identifying control subjects for epidemiologic studies continues to increase in difficulty because of changes in telephone technology such as answering services and machines, caller identification, and cell phones. An Internet-based method for obtaining study subjects that may increase response rates has been developed and is described. This method uses information from two websites that, when combined, provide accurate and complete lists of names, addresses, and listed phone numbers. This method was developed by use of randomly selected streets in a suburb of Salt Lake City, Utah, in June 2005.

Case-Control Studies↗
PubMed2002

Epidemiology of primary brain tumors: current concepts and review of the literature.

The purpose of this review is to provide a sufficiently detailed perspective on epidemiologic studies of primary brain tumors to encourage multidisciplinary etiologic and prognostic studies among surgeons, neuro-oncologists, epidemiologists, and molecular scientists. Molecular tumor markers that predict survival and treatment response are being identified with hope of even greater gains in this area from emerging array technologies. Regarding risk factors, studies of inherited susceptibility and constitutive polymorphisms in genes pertinent to carcinogenesis (for example, DNA repair and detoxification genes and mutagen sensitivity) have revealed provocative findings. Inverse associations of the history of allergies with glioma risk observed in 3 large studies and reports of inverse associations of glioma with common infections suggest a possible role of immune factors in glioma genesis or progression. Studies continue to suggest that brain tumors might result from workplace, dietary, and other personal and residential exposures, but studies of cell phone use and power frequency electromagnetic fields have found little to support a causal connection with brain tumors; caveats remain. The only proven causes of brain tumors (that is, rare hereditary syndromes, therapeutic radiation, and immune suppression giving rise to brain lymphomas) account for a small proportion of cases. Progress in understanding primary brain tumors might result from studies of well-defined histologic and molecular tumor types incorporating assessment of potentially relevant information on subject susceptibility and environmental and noninherited endogenous factors (viruses, radiation, and carcinogenic or protective chemical exposures through diet, workplace, oxidative metabolism, or other sources). Such studies will require the cooperation of researchers from many disciplines.

Age Distribution↗
PubMedDate not supplied

Anti-tobacco messages from different sources make a difference with secondary school students.

Mass media campaigns are often effective in reducing tobacco use, but research has typically focused on these campaigns without considering other sources of anti-tobacco information. The present study examined whether the number of sources of anti-tobacco information (family, sports, and other community events, advertisements, and the Internet), made a difference in use and attitudes of high school students. A representative sample of 1,151 students in grades 6 to 12 in one southeastern state were interviewed at school on cell phones provided by researchers. They reported on average 2.49 of the 4 sources of anti-tobacco information. Students who heard anti-tobacco messages from a variety of sources of information were less likely to use tobacco than students who heard anti-tobacco messages from few sources. Never-users, nonsmokers, and relatively younger youth reported more sources than ever-users, smokers, and relatively older youth. Surprisingly, those who reported more sources labeled smokers as attractive more than those who reported fewer sources. Although having a variety of sources of anti-tobacco messages is associated with less tobacco use, an implication of present results is that anti-tobacco information needs to convey the point that using tobacco is ugly.

Adolescent↗
PubMed2004

Teleradiology in orthopaedics.

Teleradiology is a means of electronically transmitting radiographic image files from one location to another. Technologic advances in digital imaging, telecommunications, digital storage, and viewing technologies have made teleradiology readily available and reasonably affordable. The five components of a teleradiology system include: a sending station, a transmission network, a storage device, a viewing station and, a software package. The advantage of teleradiology is the mobility of digital images. In contrast to plain radiographs that only can be seen in one location at a time, multiple persons who are at different locations can view digital images simultaneously. When applied to orthopaedic trauma applications, when the consulting orthopaedist is at a remote location from the patient, teleradiology has been shown to improve diagnostic accuracy, disposition planning of patients from emergency departments or outlying hospitals, and planning of surgical procedures. These systems also improve the comfort level of consulting orthopaedic surgeons and potentially limit the risk of litigation for incorrect diagnosis. The quality, convenience, and effectiveness of teleradiology systems should improve as the technologies continue to mature. Having radiographic images available on handheld devices, such as cell phones, is likely to be a reality in the near future.

Computer Systems↗
PubMed2003

Scaling laws for the movement of people between locations in a large city.

Large scale simulations of the movements of people in a "virtual" city and their analyses are used to generate insights into understanding the dynamic processes that depend on the interactions between people. Models, based on these interactions, can be used in optimizing traffic flow, slowing the spread of infectious diseases, or predicting the change in cell phone usage in a disaster. We analyzed cumulative and aggregated data generated from the simulated movements of 1.6 x 10(6) individuals in a computer (pseudo-agent-based) model during a typical day in Portland, Oregon. This city is mapped into a graph with 181,206 nodes representing physical locations such as buildings. Connecting edges model individual's flow between nodes. Edge weights are constructed from the daily traffic of individuals moving between locations. The number of edges leaving a node (out-degree), the edge weights (out-traffic), and the edge weights per location (total out-traffic) are fitted well by power-law distributions. The power-law distributions also fit subgraphs based on work, school, and social/recreational activities. The resulting weighted graph is a "small world" and has scaling laws consistent with an underlying hierarchical structure. We also explore the time evolution of the largest connected component and the distribution of the component sizes. We observe a strong linear correlation between the out-degree and total out-traffic distributions and significant levels of clustering. We discuss how these network features can be used to characterize social networks and their relationship to dynamic processes.

Community Networks↗
PubMed1999

Evaluation in humans of the effects of radiocellular telephones on the circadian patterns of melatonin secretion, a chronobiological rhythm marker.

A decrease in melatonin secretion has been observed in small mammals under exposure to extremely low frequency electromagnetic fields. As there is some concern about possible health effects of the increasing use of radiocellular telephones emitting radiofrequency electromagnetic fields, we examined whether such fields would alter melatonin levels in the human. Volunteers were two groups totalling 38 men, 20-32 yr old. Exposures were to commercially available cellular telephones of the GSM 900 type (Global System for Mobile communication at 900 MHz) or DCS 1800 type (Digital Communication System at 1800 MHz), for 2 hr/day, 5 days/wk, for 4 wk, at their maximum power. Attention of the volunteers was sustained by TV projection of movies. Blood samples were collected hourly during the night and every 3 hr in the daytime. Four sampling sessions were performed at 15-day intervals: before the beginning of the exposure period, at the middle and the end of the exposure period, and 15 days later to evaluate the persistence or late appearance of potential effects. Evaluated parameters were the maximum serum concentration, the time of this maximum, and the area under the curve of the hormone profile. Melatonin circadian profile was not disrupted in 37 young male volunteers submitted to a typical pattern of exposure to the electromagnetic fields generated by two common types of cell phones.

Adult↗
PubMed2005

Materials science. Electronics without lead.

In conventional consumer electronics such as cell phones, lead-containing interconnects provide the conductive path between different circuit elements. Environmental concerns have led to a search for lead-free alternatives. In their Perspective, Li et al. review these efforts, which have focused on lead-free alloys and electrically conductive adhesives. Both of these approaches are showing promise, but no one lead-free interconnect material can serve as a substitute for the conventional tin-lead solder in all devices.

Journal Article↗
PubMed2006

Sex work in Tallinn, Estonia: the sociospatial penetration of sex work into society.

BACKGROUND: It is important to describe and understand the underlying patterns and dynamics that govern sex work in societies undergoing rapid political and social changes, its heterogeneity across populations, and its evolution through time in order to inform future research, sound policy formation, and programme delivery. OBJECTIVES: To describe the socioeconomic and cultural determinants, organisational structure, distinct categories, and spatial patterning of sex work in Tallinn, Estonia, and identify recent temporal changes in sex work patterns. METHODS: In-depth interviews with key informants; naturalistic observations of sex work and drug use venues, geo-mapping of sex work sites, review of media, public policy, and commissioned reports, and analyses of existing data. RESULTS: Sex work takes place in a hierarchy of locations in Tallinn ranging from elite brothels and "love flats" to truck stops. These sites vary in terms of their public health importance and social organisation. There are full time, part time, and intermittent male and female sex workers. Among others, the taxi driver, madam and the bartender are central roles in the organisation of sex work in Tallinn. Cell phone and internet technology enable sex work to be highly dispersed and spatially mobile. CONCLUSION: Future research and programmatic service delivery or outreach efforts should respond to the changing profile of sex work in Tallinn and its implications for STD/HIV epidemiology.

Adolescent↗
PubMedDate not supplied

A novel standard-compliant audience response system for medical education.

Audience response systems (ARSs) have been suggested as a means to improve the effectiveness of didactic lectures, but their widespread use has been limited because of cost and complexity. The authors developed a simple, cost-effective ARS that relies completely on standard networking technology, is embedded easily into a PowerPoint presentation, and operates without the need for extensive server setup and configuration. A PowerPoint Add-in that capitalizes on WiFi (wireless fidelity) technology was created that allows lecturers to easily add interactive question and response slides to an existing PowerPoint presentation. In the system, audience members can submit responses by using any wireless network-enabled device (eg, laptop computer, cell phone). The system was designed to be easy to use, to be standard compliant, and to eliminate the high operating costs associated with current interactive ARSs.

Communication↗