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PubMed2005

Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder.

INTRODUCTION: Numerous studies have documented an increased frequency of vehicular crashes, traffic citations, driving performance deficits, and driving-related cognitive impairments in teens and adults with attention deficit hyperactivity disorder. METHOD: The present study evaluated the effects of two single, acute doses of methylphenidate (10 and 20 mg) and a placebo on the driving performance of 53 adults with ADHD (mean age=37 years, range=18-65) using a virtual reality driving simulator, examiner and self-ratings of simulator performance, and a continuous performance test (CPT) to evaluate attention and inhibition. A double-blind, drug-placebo, within-subjects crossover design was used in which all participants were tested at baseline and then experienced all three drug conditions. RESULTS: A significant beneficial effect for the high dose of medication was observed on impulsiveness on CPT, variability of steering in the standard driving course, and driving speed during the obstacle course. A beneficial effect of the low dose of medication also was evident on turn signal use during the standard driving course. An apparent practice effect was noted on some of the simulator measures between the baseline and subsequent testing sessions that may have interacted with and thereby obscured drug effects on those measures. CONCLUSIONS: The results, when placed in the context of prior studies of stimulants on driving performance, continue to recommend their clinical use as one means of reducing the driving risks in ADHD teens and adults. IMPACT ON INDUSTRY: Given the significantly higher risk of adverse driving outcomes associated with ADHD, industry needs to better screen for ADHD among employees who drive as part of employment so as to improve safety and reduce costs. Use of stimulants to treat the adult ADHD driver may reduce safety risks.

Adolescent↗
PubMed1994

An NMR study of pyridine associated with DMPC liposomes and magnetically ordered DMPC-surfactant mixed micelles.

With molecular dynamics simulations of phospholipid membranes becoming a reality, there is a growing need for experiments that provide the molecular details necessary to test these computational results. Pyridine is used here to explore the interaction of planar aromatic groups with the water-lipid interface of membranes. It is shown by magic angle spinning 13C nuclear magnetic resonance (NMR) to bind between the glycerol and choline groups of dimyristoylphosphatidylcholine (DMPC) liposomes. The axial pattern for the 31P NMR spectrum of DMPC liposomes is preserved even with more than half of the interfacial sites occupied, indicating that pyridine does not disrupt the lamellar phase of this lipid. 2H NMR experiments of liposomes in deuterium oxide demonstrate that pyridine might promote greater penetration of water into restricted regions in the interface. Magnetically oriented DMPC/surfactant micelles were investigated as a means for improving resolution and sensitivity in NMR studies of species bound to bilayers. The quadrupolar splittings in the 2H NMR spectra of d5-pyridine in DMPC liposomes and magnetically oriented DMPC/Trixon X-100 micelles indicate a common bound state for the two bilayer systems. The well resolved quadrupolar splittings of d5-pyridine in oriented micelles were used to establish the tilt of the pyridine ring relative to the bilayer plane.

Calorimetry, Differential Scanning↗
PubMed2006

Effects of two doses of alcohol on simulator driving performance in adults with attention-deficit/hyperactivity disorder.

Prior studies have documented greater impairments in driving performance and greater alcohol consumption among adults with attention-deficit/hyperactivity disorder (ADHD). This study examined whether alcohol consumption produces a differentially greater impairment in driving among adults with ADHD in comparison to a community control group. The present study compared 50 adults with ADHD (mean age 33 years) and 40 control adults (mean age 29 years) on the effects of 2 single, acute doses of alcohol (0.04 and 0.08 blood alcohol concentration) and a placebo on their driving performance. The authors used a virtual reality driving simulator, examiner and self-ratings of simulator performance, and a continuous performance test (CPT) to evaluate attention and inhibition. Approximately half of the adults in each group were randomized to either the low or high dose alcohol treatment arms. Alcohol consumption produced a greater impact on the CPT inattention measures of the ADHD than the control group. Similar results were obtained for the behavioral observations taken during the operation of the driving simulator. Driving simulator scores, however, showed mainly a deleterious effect of alcohol on all participants but no differentially greater effect on the ADHD group. The present results demonstrated that alcohol may have a greater detrimental effect on some aspects of driving performance in ADHD than control adults.

Adult↗
PubMed2006

The Rutgers Arm, a rehabilitation system in virtual reality: a pilot study.

Stroke is one of the leading causes of death and disability worldwide. Its prevalence calls for innovative rehabilitation methods. The Rutgers Arm is a novel upper extremity rehabilitation system consisting of a low-friction table, three-dimensional (3D) tracker, custom forearm support, PC workstation, library of Java 3D virtual reality (VR) exercises, clinical database module, and a tele-rehabilitation extension. The system was tested on a chronic stroke subject, under local and tele-rehabilitation conditions, over 5 weeks of training. Results show improvements in arm motor control and shoulder range of motion, corresponding to improved Fugl-Meyer test scores. Exercise duration, level of difficulty, and patient motivation were maintained under tele-rehabilitaion. A 1-week retention trial showed that gains were maintained.

Computer Simulation↗
PubMed1992

Long-term care personnel assess their attitudes and knowledge of the older adult.

The purpose of this study was to compare long-term care employees' attitude and knowledge about myths of ageing and normal age changes, before and after exposure to formal educational sessions. The researchers investigated if there was a difference in knowledge level and change in attitudes of long-term care employees after educational sessions. The subjects for this study were defined as persons who had any contact with the residents at St Charles Care Center. The final data set used in the analysis contained 84 observations. Each participant attended three 1-hour classes which consisted of simulation of handicaps, normal age-related changes, and myths and realities of ageing. Overall, there was a significant increase in knowledge from the pre-test to the post-test. The study also tested for a negative (anti-aged) bias attitude and a positive (falsely pro-aged) bias attitude among the individuals. At the end of the study there was still a slight negative biased attitude towards ageing. The data suggest that continuing education is an effective means of influencing the knowledge and attitudes of personnel in long-term care facilities. Recommendation for future research should be that this study be replicated in another long-term care facility with the addition of a job satisfaction tool.

Aged↗
PubMed2001

A plea to bridge the gap between antifungals and the management of onychomycosis.

Onychomycosis represents a stubborn problem for the clinician facing up to the realities of antifungal treatments. There are obvious discrepancies between data given by in vitro antifungal testings, pharmacodynamics and pharmacokinetics, and those gathered from clinical experience. This critical review is an attempt at bridging the gap between in vitro and in vivo information about oral antifungals that aim to treat onychomycoses. Common sense shows that the in vitro concept of fungicidy cannot be simply extrapolated into clinical practice. Indeed, chlamidoconidia and arthroconidia present in vivo are much more resistant to antifungals than hyphae. Corneofungimetry may be a realistic bioassay in predicting antifungal activity in human infections. Boosting hyphae growth from conidia while taking antifungals is a new and appealing treatment modality that deserves controlled study.

Antifungal Agents↗
PubMed2004

Simulator sickness when performing gaze shifts within a wide field of view optic flow environment: preliminary evidence for using virtual reality in vestibular rehabilitation.

BACKGROUND: Wide field of view virtual environments offer some unique features that may be beneficial for use in vestibular rehabilitation. For one, optic flow information extracted from the periphery may be critical for recalibrating the sensory processes used by people with vestibular disorders. However, wide FOV devices also have been found to result in greater simulator sickness. Before a wide FOV device can be used in a clinical setting, its safety must be demonstrated. METHODS: Symptoms of simulator sickness were recorded by 9 healthy adult subjects after they performed gaze shifting tasks to locate targets superimposed on an optic flow background. Subjects performed 8 trials of gaze shifting on each of the six separate visits. RESULTS: The incidence of symptoms of simulator sickness while subjects performed gaze shifts in an optic flow environment was lower than the average reported incidence for flight simulators. The incidence was greater during the first visit compared with subsequent visits. Furthermore, the incidence showed an increasing trend over the 8 trials. CONCLUSION: The performance of head unrestrained gaze shifts in a wide FOV optic flow environment is tolerated well by healthy subjects. This finding provides rationale for testing these environments in people with vestibular disorders, and supports the concept of using wide FOV virtual reality for vestibular rehabilitation.

Journal Article↗
PubMed1994

Overview: diagnostic tests for viral infections transmitted by blood.

The risk of transmitting viral infections by transfusion today is quite remote. The many, sensitive, diagnostic tests in place, when applied to the blood of volunteer, unpaid (unremunerated), unpressured donors who are also carefully evaluated at the time of donation, make blood and blood component transfusions very safe. A number of sensitive laboratory tests are performed on each unit of donated blood and plasma to reduce the risk of transmission of hepatitis viruses and retroviruses from asymptomatic donors to transfusion recipients. With the tests, we hope to catch otherwise undetectable individuals who may be carrying these viruses yet appear healthy and deny risk factors for their carriage. However, the laboratory tests in use in blood banks were designed to aid in the diagnosis of patients with viral diseases. Therefore, a reactive test, even if reproducible, on a sample from a healthy blood donor is more apt to be falsely than truly positive. An ideal microbiologic test is one which is one hundred percent sensitive, i.e., it will identify every person with an infectious disease (including asymptomatic carriers). In addition, a perfect test would have one hundred percent specificity, i.e., it would not be reactive in anyone without the infectious agent. The decision point or "cutoff" for an ideal test would be above the (negative) results for all normal and uninfected samples, but below that for all (positive) infectious ones. In reality, there is an overlap between some of the results on normals and those on diseased individuals, including persons who are carrying an infectious agent. When we try to obtain maximal sensitivity, e.g., to detect all asymptomatic carriers of a virus, the assay cutoff is set very low for tests applied to blood donors; but this approach will compromise the specificity of a test. The net effect is that many normal people donating blood are said to have "abnormal" test results which, among other things, necessitates the loss of their blood and plasma. In addition, we must follow up the reactive results by enzyme linked immunoassays (EIA or ELISA) or radioimmunoassays (RIA) used to screen or preliminarily test blood from donors with supplemental or confirmatory tests to verify whether the initial test is a true positive or a false positive one. Trying to explain the significance of a false positive test for AIDS or hepatitis to a healthy donor often causes fear, concern and/or anger. Thus, the use of very sensitive tests on blood donors will increase the safety of transfusion for recipients but result in loss of some donors and discard of many blood components unnecessarily. Despite the problems in applying sensitive tests to asymptomatic individuals who are not patients, the assays in place in blood banks have, nonetheless, resulted in remarkably small risks of virus transmission by transfusions. Currently, the risk of HCV infection following a transfusion is about 1 in 3,300 per unit transfused. This is an enormous improvement compared to the risks of what was called non-A, non-B hepatitis in the 1970s and 1980s before the use of the test for antibodies to HCV. For HTLV-1 (and, potentially, HTLV-II) the risk of transfusion transmission is about 1 in 50,000 per unit of screened blood. Using blood which is anti-HIV-1/2 non-reactive, the risk is about 1 in 225,000 units of transmitting HIV. The risk of transfusion associated AIDS is thus quite remote in 1993. For hepatitis B virus, only about 1 in 200,000 units of blood transmit this virus now. In sum, only about 3 units of blood per 10,000 of those collected from acceptable, volunteer donors are currently likely to transmit a serious or fatal transfusion-transmitted viral infection. In contrast, in America, about 6 out of every 1,000 patients hospitalized will die from an accidental or preventable cause other than the underlying disease for which he/she was hospitalized. (ABSTRACT TRUNCATED)

Acquired Immunodeficiency Syndrome↗
PubMed1975

The fluorescent treponemal antibody-absorption (FTA-ABS) test for syphilis.

The FTA test was developed at a time when immunofluorescence procedures were not well-defined. Through technique control and research, a modification of the FTA test, the FTA-ABS, has attained a position as one of the leading treponemal tests to confirm the reagin tests for syphilis. In this review of the FTA-ABS test, attention has been focused on reagent development, with the anticipation that reagent standardization may soon become a reality. The T. pallidum antigen obtained by extracting infected rabbit testicular tissue has evolved from a preparation in which the treponemes remained in the initial extracting fluid to a reagent that can be free of rabbit tissue and globulin. These washed antigen preparations improve visibility of the treponemes on the microscope slide, reduce background fluorescence, and reduce or prevent from occurring nonspecific reactions that are a result of tissue and globulin components. Both washed and nonwashed antigens are available commercially, and, to date, little differentiation has appeared on the product label. The predominant immunoglobulin that reacts with T. pallidum in the indirect fluorescent antibody tests appears to be IgG. This is the major immunoglobulin detected in the FTA-ABS test. IgM, although increased in early syphilis, is also increased in other clinical conditions. Several reports suggest that adult IgM detection in the present FTA-ABS test would be nonspecific. Until specific IgM antibody in adult syphilis can be detected without a risk to test specificity, the conjugate for the FTA-ABS test should continue to be an anti-IgG reagent. Class-specific, anti-IgG reagents are more expensive than other reagents; however, their use may eliminate the problem of nonspecificity resulting from IgM detection. Additionally, micromethods can be used to reduce cost, and this possibility should be investigated. The sorbent that contains an antigen to the Reiter treponeme may or may not specifically absorb the reactivity that occurs in normal sera; certainly, there are questionable aspects about this reagent. Group antibodies not related to Reiter treponemes may be responsible for some nonspecific reactivity; additionally, antiglobulin factors have been reported to participate in the reaction. Antigens free of rabbit serum factors and class-specific, antiimmunoglobulin reagents are available, and may lead to a better understanding of nonspecific reactions. These reagents should allow resolution of the possible multiplicity of reactivity. In this interim period, the sorbent, with its possible nonspecific nature, appears to maintain a biological balance between natural or group and immune antibodies when used to detect IgG antibody.

Absorption↗
PubMed2005

Diagnosis and rehabilitation of hemispatial neglect patients with virtual reality technology.

Victims of a stroke or an accident with damage on the parietal lobe can suffer from hemispatial neglect. This disorder is characterized by misperception of the space contralateral to the damaged area. Paper and pencil tests, such as line bisection tests, are used to diagnose hemispatial neglect. Unfortunately, they fail to quantify the degree of the neglect. Moreover, the neglect has different manifestations in each sensorial space and frame of references. In order to diagnose disorders of spatial recognition and analyze the neglected area in visual and somatic spaces, we developed a 3D-haptic virtual reality system coupled with an eye-tracking device. The haptic interface was used to interact with virtual objects. The virtual world can use the eye-gaze information to let patients overcome the neglect. We tested the system at a rehabilitation center and observed different approaches between normal subjects and hemiplegics patients. The first group was getting close to the target and then slowed down to grab it, whereas the later group proceeded by trial and error. The feature of trajectories of the hand in the 3D space could be used to determine the degree of the motion handicap. However, more specific virtual worlds are needed for efficiently extracting the feature of the patients.

Adult↗
PubMed2003

Depth cue reliance in surgeons and medical students.

BACKGROUND: Depth perception is reduced in endoscopic surgery, although little is known about the effect this has on surgical performance. METHODS: To assess the role of depth cues, 45 subjects completed tests of depth cue reliance. Surgical skill was assessed using the Minimally Invasive Surgical Trainer-Virtual Reality, a previously validated laparoscopic simulator. RESULTS: We could demonstrate no difference in cue reliance for three depth cues--namely stereo, texture, and outline--between surgeons and medical students. Greater dominance on stereo for medical students was a positive finding and a negative finding for the surgeons when correlated with surgical performance. CONCLUSIONS: We suggest that surgeons learn to adapt to the nonstereo environment in MIS, and this is the first study to show evidence of this phenomenon. This difference in stereo reliance is a reflection of the experience that surgeons have with laparoscopy compared with medical students, who have none.

Adult↗
PubMed2003

Electrodermal responsivity distinguishes ERP activity and symptom profile in schizophrenia.

BACKGROUND: Traditional averaging of late component Event Related Potentials (ERPs) might obscure important psychophysiological subprocesses underlying schizophrenia disturbances in cognitive functioning. One such subprocess could be the active orientation of attention to significant or novel stimuli. In this study, we used skin conductance responses (SCRs) to index orienting responses (ORs). ERP activity was examined in relation to concomitant ORs in a schizophrenia and nonpsychiatric control group. Schizophrenia responses were considered with respect to the Reality Distortion, Disorganisation and Psychomotor Poverty syndromes. METHOD: Forty schizophrenia and 40 age and sex matched control subjects were tested. The three schizophrenia syndromes were derived from a principal component analysis of Positive and Negative Syndrome Scale (PANSS) ratings. Auditory ERPs (N100, N200, P200, P300) were elicited using a conventional auditory oddball paradigm, and electrodermal SCR data were acquired simultaneously. RESULTS: ERP data were sub-averaged according to the presence/absence of an OR. For both 'with-' and 'without-OR' ERPs, schizophrenia subjects as a group showed reduced N100 (associated with vigilance level) and N200 (associated with response selection) amplitude, and for with-OR responses, they showed an additional reduction in P300 (context processing). Concerning schizophrenia syndromes, Reality Distortion was related primarily to frontal disturbances (earlier N100/N200 latency and decreased P200/P300 amplitude), and Psychomotor Poverty to a generally delayed P300 latency. Similarly delayed P300 in Disorganisation was explained by medication effects. There were no associations with syndromes for without-OR ERPs. CONCLUSION: These results suggest that schizophrenia syndromes are dissociated with regard to both the direction and nature of speed of information processing disturbances, in relation to task-relevant information that produces active orientation.

Adolescent↗
PubMed2001

Advances in management of neurosurgical trauma in different continents.

Neurotrauma is a major public health problem. The incidence varies from 67 to 317 per 100,000 and mortality rates are in the range of near 1% for minor injury, 18% for mild injury, and 48% for severe head injury. It is the main cause of death and disability in people under 40 years old. Several problems appear when outcome measurements, rehabilitation programs and treatment options are considered. In order to solve these problems a worldwide campaign is outlined. It focuses on epidemiology, prevention, education, treatment, rehabilitation, social re-insertion, and outcome measurements. The goals of such a program are to take into account realities in both developed and developing countries, to develop worldwide acceptable programs and guidelines, and to test those guidelines and programs and diminish mortality and morbidity, improving quality of life. We describe the concept of Centers of Excellence and an educational program, Advanced Brain Life Support. Such a program is a moral obligation because mortality and morbidity tend to decrease in Centers of Excellence.

Brain Injuries↗
PubMed2005

Mechanisms of virtual reality exposure therapy: the role of the behavioral activation and behavioral inhibition systems.

J. A. Gray's (1975) theory distinguishes between two motivational systems, which he refers to as the behavioral activation system (BAS) and the behavioral inhibition system (BIS). D. C. Fowles (1980) has shown that heart rate responses reflect activity of the BAS, and electrodermal responses reflect activity of the BIS. Both BAS and BIS are reliably activated during in-vivo exposure to fearful situations (F. H. Wilhelm & W. T. Roth, 1998). However, due to the constraints imposed by virtual reality (VR), we hypothesized that VR exposure to fearful situations would activate the BIS alone. To test this hypothesis, a VR free-standing elevator simulation was presented to participants selected for high and low fear of heights. As predicted, the high-anxious group strongly responded electrodermally (effect size d = 1.53), but showed only minimal HR elevations during exposure (d = 0.12), and little other cardiovascular or respiratory changes. The low-anxious control group showed little electrodermal and HR reactivity (d = 0.28 and 0.12). A comparison with data from a previous study demonstrated that this pattern was in stark contrast to the large electrodermal and cardiovascular response observed during situational in-vivo exposure outside the laboratory. We conclude that the BIS, but not BAS, is selectively activated during VR exposure, causing discordance between self-report and commonly used physiological measures of anxiety. Results are discussed within the framework of E. B. Foa & M. J. Kozak's (1986) emotional processing theory of fear modification, suggesting different mechanisms underlying VR and in-vivo exposure treatments.

Adolescent↗
PubMed2000

Evaluation of two new ecological interface approaches for the anesthesia workplace.

OBJECTIVE: Currently, vital parameters are commonly displayed as trends along a timeline. However, clinical decisions are more often based upon concepts, such as the depth of anesthesia, that are derived by combining parameter relationships and additional context information. The current displays do not visualize such concepts and therefore do not optimally support the decision process. A new display should present an ecological interface (EI). The principle of EI design is to visualize all of the information necessary for decision making in one single display. METHODS: In the first approach, we developed an EI that visualizes 35 relevant parameters for anesthesia monitoring. All of the parameters are generated by an anesthesia software simulator. Sixteen anesthetists had to administer two simulated general anesthetics: in one setting working only with the simulator's monitors ("Sim Only"), and in another setting working with the simulator's monitors in combination with the EI ("Combi1"). During each experiment, one unexpected critical incident (either blood loss or a cuff leakage) had to be identified. The control and monitoring behavior was analyzed by recording the subjects' eye movements and think-aloud protocol. With the help of the eye-tracking results, we re-designed the EI. The new EI was then tested with no eye tracking ("Combi2") on eight anesthetists under analogous conditions as in "Combi1." RESULTS: Cuff leakage was identified significantly quicker in "Combi1" (7 of 8 cases; time (T): 65 s +/- 73 s) than in "SimOnly" (6 of 8 cases; T: 222 s +/- 187 s). Blood loss was identified in 5 of 8 cases (T: 215 s +/- 76 s) in "Combi1" as quickly as in "SimOnly" (all cases; T: 217 s +/- 72 s). In "Combi1," the EI was used as the main source of information (in 43 +/- 19% of time) and was frequently favored when identifying an evolving critical incident. In "Combi2," cuff leakage was identified in 7 of 8 cases (T: 70 s +/- 111 s) as quickly as in "Combi1." Blood loss was identified significantly quicker in all cases (T: 147 s +/- 62 s) in "Combi2" than in "Combi1" and in "SimOnly." CONCLUSION: The results have shown that appropriately designed EIs may improve the anesthetist's decision making and focus attention on specific problems. Now, the findings have to be tested in future studies by widening the scope using other simulated scenarios and being closer to reality under real conditions in the OR. Eye tracking proved to be a useful method to analyze the anesthetists' decision making and appropriately re-design interfaces.

Anesthesia, General↗
PubMed1993

The role of the female doctorally prepared nurse in caring for infertile women.

Today, in medical and nursing literature, infertility is described as a couple problem, with interventions aimed at treating the couple. While not dismissing the fact that the conception does involve both genders, the reality of infertility treatment is that the woman, not the couple, undergoes the majority of infertility testing and treatment. The numerous physical demands made of women during infertility investigation and therapy are associated with significant emotional and informational needs. As such, all infertility practices should offer supportive counseling to their clients. Incorporation of such services into general infertility treatment will ensure that the greatest number of female infertility clients receive the information and emotional support they need. The health care professional best qualified to provide these services is the female doctorally prepared nurse. By virtue of both her gender and training, she is more likely to be capable of intervening therapeutically, woman to woman, in a sensitive and empathic manner. Furthermore, she can anticipate extending her role to include the following services: (a) provision of basic gynecological care, (b) follow-up of patients on hormone therapy, (c) coordination of patient care, (d) provision of supportive counseling, and (e) participation in research. To secure a position, the female doctorally prepared nurse needs to recognize the importance of promoting herself in the infertility marketplace. Ultimately, both the establishment and survival of her role will depend on her professional uniqueness.

Education, Nursing, Graduate↗