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1.
Percept Mot Skills ; 130(4): 1400-1414, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37119199

RESUMO

The human vestibulo-ocular reflex (VOR) leads to maintenance of the acuity of an image on the retina and contributes to the perception of orientation during high acceleration head movements. Our objective was to determine whether vision affects the horizontal VOR by assessing and comparing the performance at the boundaries of contribution of: (a) unrestricted visual information and (b) no visual information. Understanding how the VOR performs under both lighted and unlighted conditions is of paramount importance to avoiding falls, perhaps particularly among the elderly. We tested 23 participants (M age = 35.3 years, standard error of mean (SEM) = 2.0 years). The participants were tested with the video Head Impulse Test (vHIT), EyeSeeCam from Interacoustics™, which assesses whether VOR is of the expected angular velocity compared to head movement angular velocity. The vHIT tests were performed under two conditions: (a) in a well-lit room and (b) in complete darkness. The VOR was analyzed by evaluating the gain (quotient between eye and head angular velocity) at 40, 60 and 80 ms time stamps after the start of head movement. Additionally, we calculated the approximate linear gain between 0-100 ms through regression. The gain decreased significantly faster across time stamps in complete darkness (p < .001), by 10% in darkness compared with a 2% decrease in light. In complete darkness, the VOR gain gradually declined, reaching a marked reduction at 80 ms by 10% (p < .001), at which the head velocities were 150°/second or faster. The approximate linear gain value was not significantly different in complete darkness and in light. These findings suggest that information from the visual system can modulate the high velocity VOR. Subsequently, fast head turns might cause postural imbalance and momentary disorientation in poor light in people with reduced sensory discrimination or motor control, like the elderly.


Assuntos
Reflexo Vestíbulo-Ocular , Visão Ocular , Humanos , Idoso , Adulto , Escuridão , Movimentos da Cabeça , Aceleração
2.
IEEE Trans Neural Netw Learn Syst ; 34(8): 4841-4855, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34767516

RESUMO

This article addresses the distributed cooperative control design for a class of sampled-data teleoperation systems with multiple slave mobile manipulators grasping an object in the presence of communication bandwidth limitation and time delays. Discrete-time information transmission with time-varying delays is assumed, and the Round-Robin (RR) scheduling protocol is used to regulate the data transmission from the multiple slaves to the master. The control task is to guarantee the task-space position synchronization between the master and the grasped object with the mobile bases in a fixed formation. A fully distributed control strategy including neural-network-based task-space synchronization controllers and neural-network-based null-space formation controllers is proposed, where the radial basis function (RBF) neural networks with adaptive estimation of approximation errors are used to compensate the dynamical uncertainties. The stability and the synchronization/formation features of the single-master-multiple-slaves (SMMS) teleoperation system are analyzed, and the relationship among the control parameters, the upper bound of the time delays, and the maximum allowable sampling interval is established. Experiments are implemented to validate the effectiveness of the proposed control algorithm.

3.
Sci Rep ; 11(1): 23550, 2021 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-34876604

RESUMO

Parkinson's disease (PD) is characterized by rigidity, akinesia, postural instability and tremor. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor but the effects on postural instability are inconsistent. Another component of postural control is the postural strategy, traditionally referred to as the ankle or hip strategy, which is determined by the coupling between the joint motions of the body. We aimed to determine whether DBS STN and vision (eyes open vs. eyes closed) affect the postural strategy in PD in quiet stance or during balance perturbations. Linear motion was recorded from the knee, hip, shoulder and head in 10 patients with idiopathic PD with DBS STN (after withdrawal of other anti-PD medication), 25 younger adult controls and 17 older adult controls. Correlation analyses were performed on anterior-posterior linear motion data to determine the coupling between the four positions measured. All participants were asked to stand for a 30 s period of quiet stance and a 200 s period of calf vibration. The 200 s vibration period was subdivided into four 50 s periods to study adaptation between the first vibration period (30-80 s) and the last vibration period (180-230 s). Movement was recorded in patients with PD with DBS ON and DBS OFF, and all participants were investigated with eyes closed and eyes open. DBS settings were randomized and double-blindly programmed. Patients with PD had greater coupling of the body compared to old and young controls during balance perturbations (p ≤ 0.046). Controls adopted a strategy with greater flexibility, particularly using the knee as a point of pivot, whereas patients with PD adopted an ankle strategy, i.e., they used the ankle as the point of pivot. There was higher flexibility in patients with PD with DBS ON and eyes open compared to DBS OFF and eyes closed (p ≤ 0.011). During balance perturbations, controls quickly adopted a new strategy that they retained throughout the test, but patients with PD were slower to adapt. Patients with PD further increased the coupling between segmental movement during balance perturbations with DBS ON but retained a high level of coupling with DBS OFF throughout balance perturbations. The ankle strategy during balance perturbations in patients with PD was most evident with DBS OFF and eyes closed. The increased coupling with balance perturbations implies a mechanism to reduce complexity at a cost of exerting more energy. Strategic alterations of posture were altered by DBS in patients with PD and were delayed. Our findings therefore show that DBS does not fully compensate for disease-related effects on posture.


Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Equilíbrio Postural/fisiologia , Adaptação Fisiológica , Adulto , Idoso , Articulação do Tornozelo/fisiopatologia , Estudos de Casos e Controles , Sinais (Psicologia) , Método Duplo-Cego , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Postura/fisiologia , Vibração/efeitos adversos , Visão Ocular/fisiologia , Adulto Jovem
4.
PLoS One ; 16(12): e0259862, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34905546

RESUMO

Parkinson's disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.


Assuntos
Adaptação Fisiológica , Estimulação Encefálica Profunda/métodos , Cifose/terapia , Doença de Parkinson/terapia , Equilíbrio Postural/fisiologia , Idoso , Articulação do Tornozelo/fisiologia , Estudos de Casos e Controles , Feminino , Globo Pálido/fisiopatologia , Cabeça/fisiologia , Articulação do Quadril/fisiologia , Humanos , Articulação do Joelho/fisiologia , Cifose/etiologia , Cifose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Postura/fisiologia , Articulação do Ombro/fisiologia , Núcleo Subtalâmico/fisiopatologia
5.
Gait Posture ; 86: 217-225, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33765547

RESUMO

BACKGROUND: The characteristics of Parkinson's disease (PD) include postural instability and resting tremor. However, reductions of tremor amplitude do not always improve postural stability. RESEARCH QUESTION: What is the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on spectral analysis of body movement in patients with PD when tested without anti-PD medication? The effect of visual cues was also studied. METHODS: Ten patients with PD (mean age 64.3 years, range 59-69 years) and 17 control participants (mean age 71.2 years, range 65-79 years) were recruited. Spectral power following a period of quiet stance (35 s) was analysed in three different spectral power bands (0-4 Hz, 4-7 Hz and 7-25 Hz). Motion markers were secured to the head, shoulder, hip, and knee, which recorded movements in two directions, the anteroposterior and lateral. RESULTS: DBS STN significantly changed the spectral distribution pattern across the body in the anteroposterior (p = 0.029) and lateral directions (p ≤ 0.003). DBS predominantly reduced spectral power at the head (p ≤ 0.037) and shoulder (p ≤ 0.031) in the lateral direction. The spectral power of the lower and upper body in patients with PD, with DBS ON, were more similar to the control group, than to DBS OFF. Visual cues mainly reduced spectral power in the anteroposterior direction at the shoulder (p ≤ 0.041) in controls and in patients with PD with DBS ON. SIGNIFICANCE: There is an altered postural strategy in patients with PD with DBS ON as shown by an altered spectral power distribution pattern across body segments and a reduction of spectral power in the lateral direction at the head and shoulder. A reduction of spectral power in controls and in patients with PD with DBS ON suggests that visual cues are able to reduce spectral power to some extent, but not with DBS OFF where postural sway and power are larger.


Assuntos
Estimulação Encefálica Profunda , Movimento/fisiologia , Doença de Parkinson/terapia , Idoso , Sinais (Psicologia) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Equilíbrio Postural/fisiologia , Núcleo Subtalâmico/fisiologia
6.
Comput Biol Med ; 122: 103828, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32658731

RESUMO

The standard approach to the evaluation of tremor in medical practice is subjective scoring. The objective of this study was to show that signal processing of physiological data, that are known to be altered by tremor in Parkinson's disease (PD), can quantify the postural dynamics and the effects of DBS. We measured postural control and its capacity to adapt to balance perturbations with a force platform and perturbed balance by altering visual feedback and using pseudo-random binary sequence perturbations (PRBS) of different durations. Our signal processing involved converting the postural control data into spectral power with Fast-Fourier Transformation across a wide bandwidth and then subdividing this into three bands (0-4 Hz, 4-7 Hz and 7-25 Hz). We quantified the amount of power in each bandwidth. From 25 eligible participants, 10 PD participants (9 males, mean age 63.8 years) fulfilled the inclusion criteria; idiopathic PD responsive to l-Dopa; >1 year use of bilateral STN stimulation. Seventeen controls (9 males, mean age 71.2 years) were studied for comparison. Participants with PD were assessed after overnight withdrawal of anti-PD medications. Postural control was measured with a force platform during quiet stance (35 s) and during PRBS calf muscle vibration that perturbed stance (200 s). Tests were performed with eyes open and eyes closed and with DBS ON and DBS OFF. The balance perturbation period was divided into five sequential 35-s periods to assess the subject's ability to address postural imbalance using adaptation. The signal processing analyses revealed that DBS did not significantly change the dynamics of postural control in the 0-4 Hz spectral power but the device reduced the use of spectral power >4 Hz; a finding that was present in both anteroposterior and lateral directions, during vibration, and more so in eyes open tests. Visual feedback, which usually improves postural stability, was less effective in participants with PD with DBS OFF across all postural sway frequencies during quiet stance and during balance perturbations. The expected adaptation of postural control was found in healthy participants between the first and last balance perturbation period. However, adaptation was almost abolished across all spectral frequencies in both the anteroposterior and lateral directions, with both eyes open and eyes closed and DBS ON and OFF in participants with PD. To conclude, this study revealed that DBS altered the spectral frequency dynamics of postural control in participants through a reduction of the power used >4 Hz. Moreover, DBS tended to increase the stabilizing effect of vision across all spectral bands. However, the signal processing analyses also revealed that DBS was not able to restore adaptive motor control abilities in PD.


Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson , Idoso , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/terapia , Equilíbrio Postural , Tremor
7.
J Neuroeng Rehabil ; 17(1): 56, 2020 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-32334622

RESUMO

BACKGROUND: Tremor is a cardinal symptom of Parkinson's disease (PD) that may cause severe disability. As such, objective methods to determine the exact characteristics of the tremor may improve the evaluation of therapy. This methodology study aims to validate the utility of two objective technical methods of recording Parkinsonian tremor and evaluate their ability to determine the effects of Deep Brain Stimulation (DBS) of the subthalamic nucleus and of vision. METHODS: We studied 10 patients with idiopathic PD, who were responsive to L-Dopa and had more than 1 year use of bilateral subthalamic nucleus stimulation. The patients did not have to display visible tremor to be included in the study. Tremor was recorded with two objective methods, a force platform and a 3 dimensional (3D) motion capture system that tracked movements in four key proximal sections of the body (knee, hip, shoulder and head). They were assessed after an overnight withdrawal of anti-PD medications with DBS ON and OFF and with eyes open and closed during unperturbed and perturbed stance with randomized calf vibration, using a randomized test order design. RESULTS: Tremor was detected with the Unified Parkinson's Disease Rating Scale (UPDRS) in 6 of 10 patients but only distally (hands and feet) with DBS OFF. With the force platform and the 3D motion capture system, tremor was detected in 6 of 10 and 7 of 10 patients respectively, mostly in DBS OFF but also with DBS ON in some patients. The 3D motion capture system revealed that more than one body section was usually affected by tremor and that the tremor amplitude was non-uniform, but the frequency almost identical, across sites. DBS reduced tremor amplitude non-uniformly across the body. Visual input mostly reduced tremor amplitude with DBS ON. CONCLUSIONS: Technical recording methods offer objective and sensitive detection of tremor that provide detailed characteristics such as peak amplitude, frequency and distribution pattern, and thus, provide information that can guide the optimization of treatments. Both methods detected the effects of DBS and visual input but the 3D motion system was more versatile in that it could detail the presence and properties of tremor at individual body sections.


Assuntos
Imageamento Tridimensional/métodos , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Tremor/diagnóstico , Idoso , Estimulação Encefálica Profunda/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Núcleo Subtalâmico/fisiologia , Tremor/etiologia
8.
J Clin Monit Comput ; 32(3): 429-437, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28602010

RESUMO

The purpose of this concept study was to investigate the possibility of automatic mean arterial pressure (MAP) regulation in a porcine heart-beating brain death (BD) model. Hemodynamic stability of BD donors is necessary for maintaining acceptable quality of donated organs for transplantation. Manual stabilization is challenging, due to the lack of vasomotor function in BD donors. Closed-loop stabilization therefore has the potential of increasing availability of acceptable donor organs, and serves to indicate feasibility within less demanding patient groups. A dynamic model of nitroglycerine pharmacology, suitable for controller synthesis, was identified from an experiment involving an anesthetized pig, using a gradient-based output error method. The model was used to synthesize a robust PID controller for hypertension prevention, evaluated in a second experiment, on a second, brain dead, pig. Hypotension was simultaneously prevented using closed-loop controlled infusion of noradrenaline, by means of a previously published controller. A linear model of low order, with variable (uncertain) gain, was sufficient to describe the dynamics to be controlled. The robustly tuned PID controller utilized in the second experiment kept the MAP within a user-defined range. The system was able to prevent hypertension, exceeding a reference of 100 mmHg by more than 10%, during 98% of a 12 h experiment. This early work demonstrates feasibility of the investigated modelling and control synthesis approach, for the purpose of maintaining normotension in a porcine BD model. There remains a need to characterize individual variability, in order to ensure robust performance over the expected population.


Assuntos
Anestesia com Circuito Fechado/métodos , Pressão Arterial , Morte Encefálica , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Animais , Gasometria , Hemodinâmica , Humanos , Hipertensão , Hipotensão , Modelos Animais , Contração Miocárdica , Suínos
9.
Proc Natl Acad Sci U S A ; 111(14): 5409-14, 2014 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-24706865

RESUMO

One hallmark of multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE) is infiltration of leukocytes into the CNS, where chemokines and their receptors play a major mediatory role. CX3CR1 is a chemokine receptor involved in leukocyte adhesion and migration and hence a mediator of immune defense reactions. The role of CX3CR1 in MS and EAE pathogenesis however remains to be fully assessed. Here, we demonstrate CX3CR1 mRNA expression on inflammatory cells within active plaque areas in MS brain autopsies. To test whether blocking CNS infiltration of peripheral leukocytes expressing CX3CR1 would be a suitable treatment strategy for MS, we developed a selective, high-affinity inhibitor of CX3CR1 (AZD8797). The compound is active outside the CNS and AZD8797 treatment in Dark Agouti rats with myelin oligodendrocyte glycoprotein-induced EAE resulted in reduced paralysis, CNS pathology, and incidence of relapses. The compound is effective when starting treatment before onset, as well as after the acute phase. This treatment strategy is mechanistically similar to, but more restricted than, current very late antigen-4-directed approaches that have significant side effects. We suggest that blocking CX3CR1 on leukocytes outside the CNS could be an alternative approach to treat MS.


Assuntos
Encéfalo/metabolismo , Modelos Animais de Doenças , Esclerose Múltipla/patologia , Receptores de Quimiocinas/antagonistas & inibidores , Animais , Receptor 1 de Quimiocina CX3C , Doença Crônica , Ratos , Receptores de Quimiocinas/metabolismo , Recidiva
10.
J Med Chem ; 56(8): 3177-90, 2013 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-23516963

RESUMO

We have developed two parallel series, A and B, of CX3CR1 antagonists for the treatment of multiple sclerosis. By modifying the substituents on the 7-amino-5-thio-thiazolo[4,5-d]pyrimidine core structure, we were able to achieve compounds with high selectivity for CX3CR1 over the closely related CXCR2 receptor. The structure-activity relationships showed that a leucinol moiety attached to the core-structure in the 7-position together with α-methyl branched benzyl derivatives in the 5-position displayed promising affinity, and selectivity as well as physicochemical properties, as exemplified by compounds 18a and 24h. We show the preparation of the first potent and selective orally available CX3CR1 antagonists.


Assuntos
Esclerose Múltipla/tratamento farmacológico , Pirimidinas/farmacologia , Receptores de Quimiocinas/antagonistas & inibidores , Tiazóis/farmacologia , Amino Álcoois/síntese química , Amino Álcoois/farmacocinética , Amino Álcoois/farmacologia , Animais , Receptor 1 de Quimiocina CX3C , Células CACO-2 , Humanos , Pirimidinas/síntese química , Pirimidinas/química , Pirimidinas/farmacocinética , Ratos , Relação Estrutura-Atividade , Tiazóis/síntese química , Tiazóis/química , Tiazóis/farmacocinética
12.
J Physiol Paris ; 103(3-5): 159-77, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19671443

RESUMO

This paper presents a theoretical model of stability and coordination of posture and locomotion, together with algorithms for continuous-time quadratic optimization of motion control. Explicit solutions to the Hamilton-Jacobi equation for optimal control of rigid-body motion are obtained by solving an algebraic matrix equation. The stability is investigated with Lyapunov function theory and it is shown that global asymptotic stability holds. It is also shown how optimal control and adaptive control may act in concert in the case of unknown or uncertain system parameters. The solution describes motion strategies of minimum effort and variance. The proposed optimal control is formulated to be suitable as a posture and movement model for experimental validation and verification. The combination of adaptive and optimal control makes this algorithm a candidate for coordination and control of functional neuromuscular stimulation as well as of prostheses. Validation examples with experimental data are provided.


Assuntos
Modelos Biológicos , Movimento/fisiologia , Equilíbrio Postural/fisiologia , Postura/fisiologia , Desempenho Psicomotor/fisiologia , Adaptação Fisiológica/fisiologia , Algoritmos , Simulação por Computador , Retroalimentação Fisiológica , Humanos , Dinâmica não Linear , Processamento de Sinais Assistido por Computador , Fatores de Tempo
13.
Artigo em Inglês | MEDLINE | ID: mdl-18002378

RESUMO

A new algorithm, based on embedding phase space, to detect the P-wave characteristic points of an ECG signal is reported in this paper. The multi-lead ECG is transformed into points of an embedding phase space where similar ECG morphologies are converted into phase space points that are close using some distance measure. The algorithm is robust with respect to the type of selected characteristic points (onset, peak and end), morphology changes, baseline oscillations and high frequency noise. The performance of the algorithm has been successfully validated using both simulated and real ECG signals.


Assuntos
Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Processamento de Sinais Assistido por Computador , Algoritmos , Artefatos , Automação , Calibragem , Simulação por Computador , Processamento Eletrônico de Dados , Sistema de Condução Cardíaco , Humanos , Modelos Estatísticos , Redes Neurais de Computação , Reprodutibilidade dos Testes , Técnica de Subtração , Fatores de Tempo
14.
J Vestib Res ; 17(1): 47-62, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18219104

RESUMO

Control of orthograde posture and use of adaptive adjustments constitutes essential topics of human movement control, both in maintenance of static posture and in ensuring body stability during locomotion. The objective was to investigate, in twelve normal subjects, how head, shoulder, hip and knee movements and torques induced towards the support surface were affected by vibratory proprioceptive and galvanic vestibular stimulation, and to investigate whether movement pattern, body posture and movement coordination were changed over time. Our findings suggest that the adaptive process to enhance stability involves both alteration of the multi-segmented movement pattern and alteration of body posture. The magnitude of the vibratory stimulation intensity had a prominent influence on the evoked multi-segmented movement pattern. The trial conditions also influenced whether the posture were altered and if these posture adjustments were done directly at stimulation onset or gradually over a longer period. Moreover, the correlation values showed that the subjects, primarily during trials with vibratory stimulation alone, significantly increased the body movement coordination at stimulation onset and maintained this movement pattern throughout the stimulation period. Furthermore, when exposed to balance perturbations the test subjects synchronized significantly the head and torso movements in anteroposterior direction during all trial conditions.


Assuntos
Movimento/fisiologia , Postura/fisiologia , Propriocepção/fisiologia , Desempenho Psicomotor/fisiologia , Vestíbulo do Labirinto/fisiologia , Vibração , Adaptação Fisiológica , Adulto , Estimulação Elétrica , Feminino , Humanos , Masculino , Orientação/fisiologia , Valores de Referência , Estatísticas não Paramétricas
15.
Eur J Clin Pharmacol ; 62(1): 57-63, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16372173

RESUMO

BACKGROUND AND OBJECTIVES: Drug and Therapeutics Committees (DTCs), which are essential for ensuring the rational use of drugs (RUD) in hospitals, have recently been established in Laos. Sub-optimal performance had been reported. The aims of this study were to determine those factors in the working environment that relate to DTC performance in Lao hospitals and evaluate whether DTC performance could be improved through an educational intervention utilizing auditing and feedback targeted towards DTC members. METHODS: This was a quasi-experimental (before and after) study. Two central and seven provincial hospitals and the DTC members from these hospitals participated in the study. Performance of the DTCs was assessed by means of specifically developed indicators on structure and process combined with indicators for RUD and adherence to Standard Treatment Guidelines (STG). Data were collected for a 3-month period at baseline and for three consecutive periods thereafter. The results of the first three data collections were shared and discussed with the DTC members during feedback sessions. The DTC members were also interviewed in order to identify factors they thought may have an impact on DTC performance. RESULTS: Following the intervention, there was a significant improvement in the overall score for DTC performance (p<0.001) and, in particular, in general activity and feedback and drug information to staff. The STG scores also improved (p<0.01). Interviews indicated that one negative factor was the experience of the DTC members being overloaded with other work, resulting in DTC meetings being held irregularly and drawing poor attendance. CONCLUSION: Continuous self-monitoring of performance by means of indicators, followed by feedback discussions, is suggested the means of improving the work of the DTC.


Assuntos
Fidelidade a Diretrizes/normas , Administração Hospitalar/normas , Comitê de Farmácia e Terapêutica/organização & administração , Doenças Transmissíveis/tratamento farmacológico , Revisão de Uso de Medicamentos , Pesquisa sobre Serviços de Saúde , Humanos , Laos , Indicadores de Qualidade em Assistência à Saúde/normas
16.
Int J Med Robot ; 2(1): 21-7, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17520610

RESUMO

BACKGROUND: During 20 years of development of catheter-based technologies in the management of cardiac arrhythmias, electrophysiological mapping/ablation systems have evolved from single-plane fluoroscopic mapping to three-dimensional (3-D) non-fluoroscopic computer-based mapping systems. METHODS: Based on magnetic technology, the electro-anatomic CARTO mapping system can accurately correlate local electrograms with recording sites, by which the system can reconstruct 3-D maps with colour-coded electrophysiological information superimposed on the anatomy. Whereas the CARTO system is primarily designed for studying cardiac activation and not repolarisation, the system has been widely used in the diagnosis and ablation of cardiac arrhythmias and in the research of basic arrhythmic mechanisms. RESULTS: In order to study cardiac repolarisation in vivo, an innovative method, the monophasic action potential (MAP) mapping technique, which integrates MAP recording with electroanatomical mapping, has recently been developed in our centre. Using the MAP technique, global sequence and dispersion of atrial/ventricular repolarisation have been evaluated in vivo in both experimental and clinical settings. CONCLUSION: The innovative MAP technique provides unique research opportunities for in vivo studies of basic electrophysiological mechanisms.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Cateterismo Cardíaco , Técnicas Eletrofisiológicas Cardíacas , Potenciais de Ação , Cateterismo Cardíaco/instrumentação , Ablação por Cateter , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Humanos , Processamento de Imagem Assistida por Computador , Magnetismo
17.
Europace ; 7 Suppl 2: 39-48, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16102502

RESUMO

AIMS: When analyzing P-wave morphology, the vectorcardiogram (VCG) has been shown useful to identify indicators of propensity to atrial fibrillation (AF). Since VCG is rarely used in the clinical routine, we wanted to investigate if these indicators could be accurately determined in VCG derived from standard 12-lead ECG (dVCG). METHODS: ECG and VCG recordings from 21 healthy subjects and 20 patients with a history of AF were studied. dVCG was calculated from ECG using the inverse Dower transform. Following signal averaging of P-waves, comparisons were made between VCG and dVCG, where three parameters characterizing signal shape and 15 parameters describing the P-wave morphology were used to assess the compatibility of the two recording techniques. The latter parameters were also used to compare the healthy and the AF groups. RESULTS: After transformation, P-wave shape was convincingly preserved. P-wave morphology parameters were consistent within the respective groups when comparing VCG and dVCG, with better preservation observed in the healthy group. CONCLUSION: VCG derived from routine 12-lead ECG may be a useful alternate method for studying orthogonal P-wave morphology.


Assuntos
Fibrilação Atrial/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Vetorcardiografia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Matemática , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador
18.
J Med Chem ; 47(16): 3927-30, 2004 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-15267230

RESUMO

The understanding of the physiological role of the G-protein coupled serotonin 5-HT(7) receptor is largely rudimentary. Therefore, selective and potent pharmacological tools will add to the understanding of serotonergic effects mediated through this receptor. In this report, we describe two compound classes, chromans and tetralins, encompassing compounds with nanomolar affinity for the 5-HT(7) receptor and with good selectivity. Within theses classes, we have discovered both agonists and antagonists that can be used for further understanding of the pharmacology of the 5-HT(7) receptor.


Assuntos
Cromanos/síntese química , Receptores de Serotonina/efeitos dos fármacos , Antagonistas da Serotonina/síntese química , Agonistas do Receptor de Serotonina/síntese química , Tetra-Hidronaftalenos/síntese química , Animais , Células CHO , Cromanos/química , Cromanos/farmacologia , Cricetinae , AMP Cíclico/biossíntese , Ligantes , Receptores de Serotonina/metabolismo , Antagonistas da Serotonina/química , Antagonistas da Serotonina/farmacologia , Agonistas do Receptor de Serotonina/química , Agonistas do Receptor de Serotonina/farmacologia , Estereoisomerismo , Relação Estrutura-Atividade , Tetra-Hidronaftalenos/química , Tetra-Hidronaftalenos/farmacologia
19.
Anal Bioanal Chem ; 378(7): 1847-53, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-14762647

RESUMO

Solid phase micro-extraction (SPME) was used to collect air samples of semi-volatile organophosphate triesters, a group of compounds that are commonly used as flame retardants/plasticisers and have therefore become ubiquitous indoor air pollutants. SPME is a simple sampling technique with several major advantages, including time-efficiency and low solvent consumption. Analyte losses also tend to be relatively low. In quantitative SPME, measurements are normally taken after the analyte has reached partitioning equilibrium between the fibre and the sample matrix. However, equilibrium sampling of semi-volatile compounds in air with SPME often takes several hours. Clearly, time-weighted average (TWA) sampling using SPME under non-equilibrium conditions could be considerably faster. So, in this study, the possibility of sampling organophosphate triesters under non-equilibrium conditions was tested. The most important variables proved to be the fibre coating and the air velocity during sampling. The highest uptake rate was obtained with polydimethylsiloxane (PDMS, 100 microm). The rate for this fibre was 150-fold higher than obtained with PDMS/DVB and Carbowax/DVB, both 65 microm. Contrary to theoretical expectations, the uptake rate appeared to be constant for all tested air velocities over the fibre surface >7 cm/s. These findings suggest that the uptake rate for non-equilibrium SPME sampling is independent of the sampling flow above this flow rate, which would considerably enhance the robustness and flexibility of the method. Applying this method for TWA sampling, with sampling periods of 1 h, detection limits lower than 2 ng/m(3) for individual organophosphate esters were obtained.

20.
IEEE Trans Biomed Eng ; 50(12): 1310-9, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14656060

RESUMO

The objective for this study was to investigate whether the adaptation of postural control was similar during galvanic vestibular stimulation and during vibratory proprioceptive stimulation of the calf muscles. Healthy subjects were tested during erect stance with eyes open or closed. An analysis method designed to consider the adaptive adjustments was used to evaluate the motion dynamics and the evoked changes of posture and stimulation response. Galvanic vestibular stimulation induced primarily lateral body movements and vibratory proprioceptive stimulation induced anteroposterior movements. The lateral body sway generated by the galvanic stimulation was proportionally smaller and contained more high-frequency movements (> 0.1 Hz) than the anteroposterior body sway induced by the vibratory stimulation. The adaptive adjustments of the body sway to the stimulation had similar time course and magnitude during galvanic and vibratory stimulation. The perturbations induced by stimulation were gradually reduced within the same time range (15-20 s) and both kinds of stimulation induced a body leaning whose direction was dependent on stimulus. The similarities in the adjustment patterns suggest that postural control operates in the same way independent of the receptor systems affected by the disturbance and irrespective of whether the motion responses were induced in a lateral or anteroposterior direction.


Assuntos
Estimulação Elétrica , Modelos Biológicos , Movimento/fisiologia , Equilíbrio Postural/fisiologia , Postura/fisiologia , Propriocepção/fisiologia , Nervo Vestibular/fisiologia , Adaptação Fisiológica/fisiologia , Adulto , Simulação por Computador , Retroalimentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Física/métodos , Vibração , Percepção Visual/fisiologia
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