Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 954
Filtrar
1.
PLoS One ; 19(2): e0295263, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38354116

RESUMO

Most semantic segmentation works have obtained accurate segmentation results through exploring the contextual dependencies. However, there are several major limitations that need further investigation. For example, most approaches rarely distinguish different types of contextual dependencies, which may pollute the scene understanding. Moreover, local convolutions are commonly used in deep learning models to learn attention and capture local patterns in the data. These convolutions operate on a small neighborhood of the input, focusing on nearby information and disregarding global structural patterns. To address these concerns, we propose a Global Domain Adaptation Attention with Data-Dependent Regulator (GDAAR) method to explore the contextual dependencies. Specifically, to effectively capture both the global distribution information and local appearance details, we suggest using a stacked relation approach. This involves incorporating the feature node itself and its pairwise affinities with all other feature nodes within the network, arranged in raster scan order. By doing so, we can learn a global domain adaptation attention mechanism. Meanwhile, to improve the features similarity belonging to the same segment region while keeping the discriminative power of features belonging to different segments, we design a data-dependent regulator to adjust the global domain adaptation attention on the feature map during inference. Extensive ablation studies demonstrate that our GDAAR better captures the global distribution information for the contextual dependencies and achieves the state-of-the-art performance on several popular benchmarks.


Assuntos
Benchmarking , Equipamentos Médicos Duráveis , Semântica , Processamento de Imagem Assistida por Computador
2.
Nurs Open ; 11(1): e2078, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38268245

RESUMO

AIM: This study aims to understand the perceptions regarding physical restraints of the elder-care professional's stakeholders. DESIGN: A qualitative methodology was employed. METHODS: Semi-structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. RESULTS: Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework.


Assuntos
Cuidados de Enfermagem , Restrição Física , Humanos , Pesquisa Qualitativa , Equipamentos Médicos Duráveis , Casas de Saúde
3.
Artigo em Inglês | MEDLINE | ID: mdl-38248539

RESUMO

OBJECTIVE: to map the existing knowledge on nursing ethical decision making in the physical restraint of hospitalised adults. (1) Background: physical restraint is a technique that conditions the free movement of the body, with risks and benefits. The prevalence of physical restraint in healthcare suffers a wide variation, considering the environment or pathology, and it raises ethical issues that hinders decision making. This article intends to analyse and discuss this problem, starting from a literature review that will provoke a grounded discussion on the ethical and legal aspects. Inclusion criteria are: studies on physical restraint (C) and ethical nursing decision making (C) in hospitalized adults (P); (2) methods: a three-step search strategy was used according to the JBI. The databases consulted were CINAHL Plus with Full Text (EBSCOhost), MEDLINE Full Text (EBSCOhost), Nursing and Allied Health Collection: Comprehensive and Cochrane Database of Systematic Reviews (by Cochrane Library, RCAAP and Google Scholar. All articles were analysed by two independent reviewers; (3) results: according to the inclusion criteria, 18 articles were included. The categories that influence ethical decision in nursing are: consequence of the decision, the context, the nature of the decision in terms of its complexity, the principles of the ethical decision in nursing, ethical issues and universal values; (4) conclusions: the findings of this review provide evidence that there is extensive knowledge regarding nursing ethical decision making in adult physical restriction, also, it is considered an ethical issue with many associated assumptions. In this article we aim to confront all these issues from a legal perspective.


Assuntos
Equipamentos Médicos Duráveis , Restrição Física , Adulto , Humanos , Bases de Dados Factuais , Tomada de Decisões , Revisões Sistemáticas como Assunto
4.
PLoS One ; 19(1): e0291714, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38261569

RESUMO

Synchronization of the chaotic systems has attracted much attention in recent years due to its vital applications in secured communication systems. In this paper, an implementation and comparative analysis of two different control approaches for synchronization between two identical four-dimensional hyperchaotic systems is presented. The two control approaches are the Adaptive nonlinear controller and the linear optimal quadratic regulator LQR. To demonstrate the effectiveness of each controller, the numerical simulation is presented using Matlab/Simulink and the control law is derived. The performance of the proposed controllers is compared based on four factors; response time, squared error integration, energy applied from the controller, and cost function. To measure the robustness of the control approaches, the performance factors are compared when there is a change in system parameters and a variation in the initial conditions. Then the proposed synchronization methods are implemented on the FPGA platform to demonstrate the utilized resources on Field Programmable Gate Array (FPGA) hardware platform and the operation speed. Finally, to generalize the results of the comparison, the study is implemented for the synchronization of another secured communication system consisting of two identical three-dimensional chaotic. The experimental results show that the LQR method is more effective than the Adaptive controller based on the performance factors we propose. Moreover, the LQR is much simpler to implement on hardware and requires fewer resources on the FPGA.


Assuntos
Comunicação , Equipamentos Médicos Duráveis , Simulação por Computador , Tempo de Reação
5.
PeerJ ; 12: e16786, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38250716

RESUMO

The Chinese mitten crab (Eriocheir sinensis) is an important commercial species in China. E. sinensis is typically farmed in rice-crab symbiosis, as an important ecological farming model. However, E. sinensis is often exposed to a high ammonia environment due to the application of nitrogen fertilizers essential for rice growth. We investigated the molecular mechanisms in the gills of E. sinensis exposed to high ammonia at transcriptional and histological levels. We randomly assigned E. sinensis to two groups (control group, CG; ammonia stress group, AG), and gill samples were excised from the CG and AG groups for histopathological and transcriptome analyses. The histopathological evaluation revealed that ammonia stress damaged the gills of E. sinensis. The transcriptome analysis showed that some essential genes, including Xanthine dehydrogenase (XDH), Ubiquitin C-terminal hydrolase-L3 (UCHL3), O-linked N-acetylglucosamine transferase (OGT), Cathepsin B (CTSB), and Ubiquitin-conjugating enzyme E2 W (UBE2W) changed significantly during ammonia exposure. These genes are related to ammonia detoxification, the immune response, and apoptosis. This study demonstrated the molecular response mechanism of E. sinensis gills to ammonia stress at the transcriptional and histological levels. This study provides insight for further study on the molecular mechanism of ammonia stress in crustaceans and supplies technical support for rice crab symbiosis.


Assuntos
Amônia , Infestações por Piolhos , Animais , Amônia/toxicidade , Brânquias , Equipamentos Médicos Duráveis , Perfilação da Expressão Gênica
6.
Am J Otolaryngol ; 45(2): 104179, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38118384

RESUMO

PURPOSE: Tracheostomy care is supply- and resource-intensive, and airway-related adverse events in community settings have high rates of readmission and mortality. Devices are often implicated in harm, but little is known about insurance coverage, gaps, and barriers to obtaining tracheostomy-related medically necessary durable medical equipment. We aimed to identify barriers patients may encounter in procuring tracheostomy-related durable medical equipment through insurance plan coverage. MATERIALS AND METHODS: Tracheostomy-related durable medical equipment provisions were evaluated across insurers, extracting data via structured telephone interviews and web-based searches. Each insurance company was contacted four times and queried iteratively regarding the range of coverage and co-pay policies. Outcome measures include call duration, consistency of explanation of benefits, and the number of transfers and disconnects. We also identified six qualitative themes from patient interviews. RESULTS: Tracheostomy-related durable medical equipment coverage was offered in some form by 98.1 % (53/54) of plans across 11 insurers studied. Co-pays or deductibles were required in 42.6 % (23/54). There was significant variability in out-of-pocket expenditures. Fixed co-pays ranged from $0-30, and floating co-pays ranged from 0 to 40 %. During phone interviews, mean call duration was 19 ± 10 min, with an average of 2 ± 1 transfers between agents. Repeated calls revealed high information variability (mean score 2.4 ± 1.5). Insurance sites proved challenging to navigate, scoring poorly on usability, literacy, and information quality. CONCLUSIONS: Several factors may limit access to potentially life-saving durable medical equipment for patients with tracheostomy. Barriers include out-of-pocket expenditures, lack of transparency on coverage, and low-quality information. Further research is necessary to evaluate patient outcomes.


Assuntos
Equipamentos Médicos Duráveis , Traqueostomia , Humanos , Cobertura do Seguro
7.
Adv Life Course Res ; 57: 100560, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-38054865

RESUMO

Migrants are faced with the task of creating a sense of home in a new context. As migrants grow older in their host countries, they are also making important decisions on where to live out the rest of their lives, making salient the places they attach themselves to. Place attachment, and its subcomponents of place identity and place dependence, are concepts that have been explored in the ageing and migration literature, demonstrating that positive, emotional attachments to places are positively correlated with better health outcomes. Although it has been established that individuals' attachments to places are dynamic, multidimensional and change over the life course, there is a paucity of research exploring the place attachments of migrants as they age using a life course approach. This study adopted a life course approach to investigate how the components of place attachment shifted over time for migrant people in Aotearoa New Zealand as they aged, and to better understand the mechanisms and barriers to establishing a sense of home in a foreign land. We examined the narratives of ten older migrants (65 years or older) who migrated to Aotearoa before the age of 50. Key findings illustrated that all participants had strong place identities (i.e., explicit self-identification and sense of belonging) to their countries of origin before migrating to Aotearoa, all participants developed strong place dependence (i.e., fulfilment of functional needs) to Aotearoa over their life course, but not everyone was able to develop place identity to Aotearoa. Mechanisms such as language, cultural attitudes, and values can both facilitate and prevent attachments to either home or host country. These results uncover how Aotearoa's ageing migrants negotiate their attachments to places over the life course.


Assuntos
Aranhas , Migrantes , Humanos , Animais , Idoso , Acontecimentos que Mudam a Vida , Envelhecimento , Equipamentos Médicos Duráveis , Emoções
8.
JAMA Netw Open ; 6(10): e2339449, 2023 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-37874565

RESUMO

Importance: Although durable medical equipment and supplies (DMES) are commonly used to optimize the health and function in pediatric patients, little is known about the prevalence of use and spending on DMES. Objective: To categorize the Healthcare Common Procedure Coding System (HCPCS) for distinguishing DMES types, and to measure the prevalence and related spending of DMES in pediatric patients using Medicaid. Design, Setting, and Participants: This study is a cross-sectional analysis of the 2018 Merative Medicaid Database and included 4 569 473 pediatric patients aged 0 to 21 years enrolled in Medicaid in 12 US states from January 1 to December 31, 2018. Data were analyzed from February 2019 to April 2023. Exposure: DMES exposure was identified with the Centers for Medicare & Medicaid Services HCPCS codes. Three pediatricians categorized HCPCS DMES codes submitted by vendors for reimbursement of dispensed DMES into DMES types and end-organ systems; 15 expert reviewers refined the categorization (2576 DMES codes, 164 DMES types, 14 organ systems). Main Outcomes and Measures: The main outcome was DMES prevalence & Medicaid spending. The χ2 test was used to compare DMES prevalence and Wilcoxon rank sum tests were used to compare per-member-per-year (PMPY) spending by complex chronic conditions (CCC). Results: Of the 4 569 473 patients in the study cohort, 49.3% were female and 56.1% were aged 5 to 15 years. Patients used 133 of 164 (81.1%) DMES types. The DMES prevalence was 17.1% (95% CI, 17.0%-17.2%) ranging from 10.1% (95% CI, 10.0%-10.2%) in patients with no chronic condition to 60.9% (95% CI, 60.8%-61.0%) for patients with 2 or more CCCs. The PMPY DMES spending was $593, ranging from $349 for no chronic condition to $4253 for 2 or more CCCs. Lens (7.9%), vision frames (6.2%), and orthotics for orthopedic injury (0.8%) were the most common DME in patients with no chronic condition. Enteral tube / feeding supplies (19.8%), diapers (19.2%), lower extremity orthotics (12.3%), wheelchair (9.6%), oxygen (9.0%), and urinary catheter equipment (4.2%) were among the most common DMES in children with 2 or more CCCs. Conclusions and Relevance: In this cross-sectional study, HCPCS distinguished a variety of DME types and use across pediatric populations. Further investigation should assess the utility of the HCPCS DMES categorization with efforts to optimize the quality and safety of DMES use.


Assuntos
Equipamentos Médicos Duráveis , Medicare , Criança , Humanos , Idoso , Feminino , Estados Unidos , Masculino , Estudos Transversais , Medicaid , Doença Crônica
10.
PLoS One ; 18(10): e0292437, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37796772

RESUMO

In order to enhance the mitigation of crack occurrence and propagation within basement concrete structures, this research endeavors to propose an optimization methodology grounded in the Mask Region-based Convolutional Neural Network (Mask-RCNN) and an analysis of temperature effects. Initially, the Mask-RCNN algorithm is employed to perform image segmentation of the basement concrete structure, facilitating the precise identification of crack locations and shapes within the structure. Subsequently, the finite element analysis method is harnessed to simulate the structural stress and deformation in response to temperature variations. An optimization algorithm is introduced to adjust geometric parameters and material properties using insights from the temperature effect analysis. This algorithm aims to minimize stress concentration and deformation within the structure, thus diminishing the incidence and proliferation of cracks. In order to assess the efficacy of the optimization approach, an authentic basement concrete structure is selected for scrutiny, and the structure is monitored in real-time through the installation of strain gauges and monitoring equipment. These instruments track structural stress and deformation under diverse temperature conditions, and the evolution of cracks is meticulously documented. The outcomes demonstrate that by adjusting the structural geometric parameters and material properties, the crack density experiences a notable reduction of 60.22%. Moreover, the average crack length and width witness reductions of 40.24% and 35.43%, respectively, thereby corroborating the efficacy of the optimization method. Furthermore, an assessment of stress concentration and deformation within the structure is conducted. Through the optimization process, the maximum stress concentration in the structure diminishes by 25.22%, while the maximum deformation is curtailed by 30.32%. These results signify a substantial enhancement in structural stability. It is evident that the optimization algorithm exhibits robustness and stability in the context of crack control, consistently delivering favorable outcomes across diverse parameter configurations.


Assuntos
Algoritmos , Redes Neurais de Computação , Temperatura , Equipamentos Médicos Duráveis , Análise de Elementos Finitos
11.
PLoS One ; 18(9): e0288010, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37676886

RESUMO

Refined handling improves laboratory mouse welfare and research outcomes when compared to traditional tail handling, yet implementation does not seem to be widespread. Refined handling includes picking up a mouse using a tunnel or cupped hands. The aim of this study was to determine the current prevalence of and beliefs towards refined handling using the theory of planned behavior. It was predicted that refined handling prevalence is low compared to traditional handling methods, and its implementation is determined by individual and institutional beliefs. Research personnel were recruited via online convenience sampling through email listservs and social media. A total of 261 participants in diverse roles (e.g. veterinarians, managers, caretakers, researchers, etc.) responded primarily from the USA (79%) and academic institutions (61%) Participants were surveyed about their current use, knowledge, and beliefs about refined handling. Quantitative data were analyzed via descriptive statistics and generalised regression. Qualitative data were analyzed by theme. Research personnel reported low levels of refined handling implementation, with only 10% of participants using it exclusively and a median estimate of only 10% of institutional mice being handled with refined methods. Individually, participants had positive attitudes, neutral norms, and positive control beliefs about refined handling. Participants' intention to provide refined handling in the future was strongly associated with their attitudes, norms, and control beliefs (p<0.01). Participants believed barriers included jumpy mice, perceived incompatibility with restraint, lack of time, and other personnel. However, participants also believed refined handling was advantageous to mouse welfare, handling ease, personnel, and research. Although results from this survey indicate that current refined handling prevalence is low in this sample, personnel believe it has important benefits, and future use is associated with their beliefs about the practice. People who believed refined handling was good, felt pressure to use it, and were confident in their use reported higher implementation. Increased refined handling could be encouraged through education on misconceptions, highlighting advantages, and addressing important barriers.


Assuntos
Benchmarking , Equipamentos Médicos Duráveis , Animais , Camundongos , Prevalência , Projetos de Pesquisa , Confiabilidade dos Dados
12.
Unfallchirurgie (Heidelb) ; 126(8): 615-622, 2023 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-37273117

RESUMO

BACKGROUND: Due to a constantly increasing life expectancy and the need to stay mobile at a high age, the proportion of over 65-year-olds in traffic accidents is increasing from year to year. METHOD: In order to identify potentials for increasing the safety of seniors in road traffic, accident data were analyzed with respect to the categories of road users and accident types of this age group. Based on the accident data analysis, active and passive safety systems are described that could increase the road safety particular for senior citizens. RESULTS: It was found that older road users are frequently involved in accidents as car occupants, cyclists and pedestrians. In addition, car drivers and cyclists aged 65 years and older are frequently involved in driving, turning and crossing accidents. Lane departure warning and emergency braking assistants have a high potential for accident avoidance as they can defuse critical situations at the last moment. Restraint systems (airbags, seat belts) adapted to physical characteristics could minimize the severity of injuries to older car occupants.


Assuntos
Acidentes de Trânsito , Cintos de Segurança , Acidentes de Trânsito/prevenção & controle , Equipamentos Médicos Duráveis , Restrição Física , Humanos , Idoso
13.
Bull World Health Organ ; 101(6): 412-417, 2023 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-37265675

RESUMO

Modern health-care facilities rely on medical devices and equipment. However, keeping up with the development of new technology is unfeasible for many health facilities, especially in low-resource settings. Thus, the demand for refurbished medical devices is increasing worldwide, especially in low- and middle-income countries. Refurbished medical devices are restored devices that are rebuilt to meet safety and performance requirements comparable to their condition when new, without changing the intended use of the original device. While new medical devices are controlled by well-established and stringent safety and quality regulations, a great variation in the regulations of refurbished medical devices exists across countries. Here we discuss the different regulations and practices specific to refurbished medical devices in countries of major markets. We also explore the opportunities and challenges for expanding the refurbished medical device market. Finally, we suggest that regulatory guidelines pertaining to the import, sale, labelling and use of a refurbished medical product are needed, and authorities should implement these guidelines to ensure a high quality and safety standard of refurbished devices.


Les établissements de soins de santé modernes dépendent d'équipements et dispositifs médicaux. Pour nombre de ces établissements, il est toutefois impossible de suivre l'évolution des nouvelles technologies, surtout dans les lieux manquant de ressources. La demande en dispositifs médicaux remis à neuf est donc en hausse partout dans le monde, en particulier dans les pays à revenu faible et intermédiaire. Il s'agit de dispositifs restaurés, remaniés pour répondre aux mêmes exigences de sécurité et de performances que lorsqu'ils sont neufs, sans que l'usage prévu du dispositif d'origine ne soit modifié. Alors que les dispositifs médicaux neufs sont soumis à des normes de qualité et de sécurité strictes et bien établies, leurs équivalents restaurés font l'objet de règles nettement plus variables d'un pays à l'autre. Dans le présent document, nous évoquons les différentes réglementations et pratiques spécifiques aux dispositifs médicaux remis à neuf dans les pays qui abritent les principaux marchés. Nous nous intéressons en outre aux opportunités et aux défis liés à un développement du marché des dispositifs médicaux remis à neuf. Enfin, nous suggérons l'adoption de lignes directrices réglementaires concernant l'importation, la vente, l'étiquetage et l'utilisation de tels dispositifs; ces lignes directrices sont à faire appliquer par les autorités afin de garantir les normes les plus élevées en matière de qualité et de sécurité.


Los centros sanitarios modernos dependen de dispositivos y equipos médicos. Sin embargo, mantenerse al día en el desarrollo de las nuevas tecnologías no es viable para muchos centros sanitarios, sobre todo en los de escasos recursos. Por este motivo, la demanda de dispositivos médicos renovados está aumentando en todo el mundo, especialmente en los países de ingresos bajos y medios. Los dispositivos médicos renovados son dispositivos restaurados que se reconstruyen para que cumplan unos requisitos de seguridad y rendimiento comparables a los que tenían cuando eran nuevos, sin cambiar el uso previsto del dispositivo original. Mientras que los dispositivos médicos nuevos están sujetos a reglamentos estrictos y bien establecidos en materia de seguridad y calidad, los reglamentos de los dispositivos médicos renovados varían mucho de un país a otro. En este artículo, se analizan los diferentes reglamentos y prácticas específicos de los dispositivos médicos renovados en los países de los principales mercados. También se exploran las oportunidades y los desafíos que plantea la expansión del mercado de dispositivos médicos renovados. Por último, se propone que se establezcan directrices reglamentarias relativas a la importación, venta, etiquetado y uso de los dispositivos médicos renovados y que las autoridades las apliquen para asegurar su calidad y seguridad.


Assuntos
Equipamentos Médicos Duráveis , Reutilização de Equipamento , Regulamentação Governamental , Equipamentos Médicos Duráveis/normas , Reutilização de Equipamento/legislação & jurisprudência , Reutilização de Equipamento/normas
14.
PLoS One ; 18(5): e0285267, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37159447

RESUMO

Terror Management Theory (TMT) postulates that humans, in response to awareness of their death, developed complex defenses to remove the salience and discomfort stemming from those thoughts. In a standard paradigm to test this theory, an individual is presented with a death-related prime (Mortality Salience; MS), such as writing the details of their own death, or something neutral, such as watching television. After a distractor task (for delay), participants complete the dependent variable, such as rating how much they like or agree with a pro- or anti-national essay and its author. Individuals in the MS condition typically exhibit greater worldview defense than control conditions by rating the pro-national essay more positively and the anti-national essay more negatively. We completed five separate studies across five unique samples with the goal of replicating and extending this well-established pattern to provide further understanding of the phenomena that underlie the effects of MS. However, despite using standard procedures, we were unable to replicate basic patterns of the dependent variable in the MS conditions. We also pooled all responses into two meta-analyses, one examining all dependent variables and one focusing on the anti-national essay; yet the effect sizes in these analyses did not significantly differ from zero. We discuss the methodological and theoretical implications of these (unintended) failures to replicate. It is not clear if these null findings were due to methodological limitations, restraints of online/crowd-sourced recruitment, or ever-evolving sociocultural factors.


Assuntos
Replicação do DNA , Equipamentos Médicos Duráveis , Humanos , Pâncreas , Recreação , Redação
15.
Epidemiology ; 34(5): 700-711, 2023 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-37255240

RESUMO

BACKGROUND: People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires. METHODS: We obtained 2016-2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM) 2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM 2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models. RESULTS: Among 236,732 DME users, 10 µg/m 3 increases in wildfire PM 2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03-1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency. CONCLUSIONS: Our results support the hypothesis that wildfire smoke or proximity interrupts DME users' routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group.


Assuntos
Poluentes Atmosféricos , Incêndios Florestais , Humanos , Poluentes Atmosféricos/análise , Equipamentos Médicos Duráveis , Hospitalização , Exposição Ambiental/efeitos adversos , Material Particulado/análise , Fumaça/efeitos adversos , California/epidemiologia
17.
JAMA Pediatr ; 177(6): 561-562, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-37093608

RESUMO

This Viewpoint reviews activities to increase pediatric medical device development, assesses ongoing challenges, and recommends strategies to strengthen pediatric programs.


Assuntos
Equipamentos Médicos Duráveis , Criança , Humanos
18.
Disabil Rehabil Assist Technol ; 18(8): 1393-1403, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-34958616

RESUMO

PURPOSE: This study was designed to investigate the effect of wheel and tire selections on the propulsion characteristics of a high-strength lightweight manual wheelchair using robotic wheelchair propulsion. MATERIALS AND METHODS: Four configurations were compared with differing combinations of drive wheel tires and casters, with the baseline reflecting the manufacturer configuration of a solid mag drive wheel and 8"×1" caster. The robotic wheelchair tester propelled the chair using pre-generated straight and curvilinear manoeuvres using repeatable and reliable cyclic torque profiles. Additionally, energy loss of the components was measured using coast-down deceleration tests to approximate the system-level rolling resistance of each configuration. RESULTS: Results indicate a significant decrease in propulsion cost, increased distance travelled and increased manoeuvrability across all configurations, with upgraded casters and tires. CONCLUSIONS: These results indicated that with better casters and drive wheel tires, the performance of high strength lightweight wheelchairs can be improved and better meet the mobility needs of users.Implications for rehabilitationWheel and tire selection can have a demonstrable impact on the propulsion efficiency of manual wheelchairsCoast-down test protocols can be used as a simple and cost-effective means of assessing representative energy losses across various surfacesWheelchair configurations can be optimized with proper knowledge of the main energetic loss contributions and the environments and contexts of use.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Cadeiras de Rodas , Humanos , Desenho de Equipamento , Equipamentos Médicos Duráveis , Fadiga , Fenômenos Biomecânicos
19.
Disabil Rehabil Assist Technol ; 18(1): 1-7, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-33705256

RESUMO

PURPOSE: This research paper examines how contouring of a wheelchair seating base can help prevent pressure sores by distributing pressure over the buttocks. Contouring wheelchair cushioning is already done to some extent and has proved to be beneficial for pressure distribution. We researched the effect of contouring the seating base, and whether contouring the seating base affects effectiveness in pressure distribution and perceived discomfort. MATERIALS & METHODS: 13 healthy participants performed a within-subject experiment with three differently contoured seating bases. Perceived comfort and seating pressure were measured for each condition. RESULTS: Results indicate that a more contoured base is positive for both comfort and increased pressure distribution. CONCLUSIONS: Contoured seating bases can provide increased comfort and improved pressure distribution over flat seating bases. Future research should examine the effect of contouring on stability, as well as compare the effects of contoured seating bases and contoured cushions.Implications for rehabilitationWe evaluated the comfort and pressure characteristics of three differently contoured hard seating bases for a wheelchair. The outcomes of the research shows that providing increased contour to seatings could be beneficial to reduce pressure peaks in the buttocks.Contour in the seating is conventionally created by shaping the cushions, this research shows the possibility of using a hard base underneath a cushion to create the desired contour.


Assuntos
Lesão por Pressão , Cadeiras de Rodas , Humanos , Lesão por Pressão/prevenção & controle , Nádegas , Equipamentos Médicos Duráveis , Desenho de Equipamento
20.
Disabil Rehabil Assist Technol ; 18(5): 693-703, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-33904351

RESUMO

PURPOSE: The study had three main objectives. (1) To investigate the perceived impact of power-assist devices (PADs) on manual wheelchair (MWC) user mobility. (2) To compare perceptions about different types of PADs. (3) To identify preferred features and design characteristics of PADs. METHODS: Semi-structured interviews were conducted with community-dwelling MWC users aged 31 years and older, with at least 2.5 years of experience using an MWC independently (n = 16). Data were thematically analysed using an inductive approach. RESULTS: Two main themes related to participants' perceptions about the effects of PAD use were identified: (1) "Expanding my world", which illustrated the perceived benefits of using PADs (e.g., gaining a sense of autonomy and access to new environments, maintaining physical health) and (2) "Falling short", which described challenges with PADs (e.g., safety, reliability and portability issues). Participants also identified strengths and limitations of different types of PADs that were mainly related to specific user-device and device-environment interactions as well as various functional characteristics. Moreover, participants outlined their priorities for future PAD design, including improving controllability, customizability and affordability of these devices. CONCLUSIONS: Participants' perceptions about PADs varied across different types of devices and in different contexts. However, PADs were generally perceived as enhancing the capabilities of MWCs. Our findings provide insight into the factors that can be considered when selecting a PAD and can inform the development of future PADs that are better equipped to overcome challenges that MWC users frequently encounter.Implications for RehabilitationPower-assist devices (PADs) for manual wheelchairs (MWCs) have the potential to improve the mobility, community participation and well-being of users.Some of the existing PADs have safety and reliability issues that affect their performance and limit their use by MWC users.The three types of PADs (front-mounted attachments, rear-mounted attachments, powered wheels) offer different types of assistance that can benefit users with various capabilities.


Assuntos
Pessoas com Deficiência , Cadeiras de Rodas , Humanos , Reprodutibilidade dos Testes , Vida Independente , Equipamentos Médicos Duráveis
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...