Adaptive Color Gain for Vena Contracta Quantification in Valvular Regurgitation.

Severe valvular regurgitation can lead to pulmonary hypertension, atrial fibrillation and heart failure. Vena contracta width is used to estimate the severity of the regurgitation. Parameters affecting visualization of color Doppler have a significant impact on the measurement. We propose a data-driven method for automated adjustment of color gain based on the peak power of the color Doppler signal in the vicinity of the vena contracta. A linear regression model trained on the peak power was used to predict the orifice diameter. According to our study, the color gain should be set to about 6 dB above where color Doppler data completely disappears from the image. Based on our method, orifices with reference diameters of 4, 6.5 and 8.5 mm were estimated with relative diameter errors within 18%, 12% and 14%, respectively.

When care situations evoke difficult emotions in nursing staff members: an ethnographic study in two Norwegian nursing homes.

BACKGROUND: Caring practice in nursing homes is a complex topic, especially the challenges of meeting the basic needs of residents when their behaviour evokes difficult emotions. Cognitive and physical changes related to aging and disability can contribute to behaviours considered to be unacceptable. For example, resident behaviours such as spitting, making a mess with food or grinding teeth are behaviours that most people do not want to see, hear or experience. The aim of this study was to gain a deeper understanding of how nursing home staff members deal with such behaviours in care situations. METHODS: This article draws on ethnographic data to describe how nursing home staff members manage unpleasant resident behaviours. The study was based on two long-term units in two Norwegian public nursing homes. The Region's Medical Ethics Committee and the Norwegian Social Science Data Services granted approval. In total, 45 participants (37 nursing aides and eight nurses) agreed to participate in this study. Ten of the participants were interviewed at the end of the field study. RESULTS: This study indicates that nursing home staff members experience difficult emotions related to some residents' behaviours. However, they found these feelings difficult to express and rarely verbalized them openly. In addition, they were characterized by a strong obligation to help all residents, despite their own feelings. Therefore, it appears that an inner struggle occurs as a part of everyday practice. CONCLUSIONS: Despite these difficult emotions, nursing staff members believed that they needed to manage their responses and continued to offer good care to all residents. These findings extend our understanding of this unarticulated part of nursing home practice.

Error analysis of subaperture processing in 1-D ultrasound arrays.

To simplify the medical ultrasound system and reduce the cost, several techniques have been proposed to reduce the interconnections between the ultrasound probe and the back-end console. Among them, subaperture processing (SAP) is the most straightforward approach and is widely used in commercial products. This paper reviews the most important error sources of SAP, such as static focusing, delay quantization, linear delay profile, and coarse apodization, and the impacts introduced by these errors are shown. We propose to use main lobe coherence loss as a simple classification of the quality of the beam profile for a given design. This figure-ofmerit (FoM) is evaluated by simulations with a 1-D ultrasound subaperture array setup. The analytical expressions and the coherence loss can work as a quick guideline in subaperture design by equalizing the merit degradations from different error sources, as well as minimizing the average or maximum loss over ranges. For the evaluated 1-D array example, a good balance between errors and cost was achieved using a subaperture size of 5 elements, focus at 40 mm range, and a delay quantization step corresponding to a phase of π/4.

The pendulum time of life: the experience of time, when living with severe incurable disease--a phenomenological and philosophical study.

The aim of this study was to gain a deeper understanding of the experience of time when living with severe incurable disease. A phenomenological and philosophical approach of description and deciphering were used. In our modern health care system there is an on-going focus on utilizing and recording the use of time, but less focus on the patient's experience of time, which highlights the need to explore the patients' experiences, particularly when life is vulnerable and time is limited. The empirical data consisted of 26 open-ended interviews with 23 participants receiving palliative care at home, in hospital or in a nursing home in Norway. The theoretical frameworks used are mainly based upon K. Martinsens philosophy of care, K. E. Løgstrup phenomenological philosophy, in addition to C. Saunders' hospice philosophy, L. Feigenberg's thanatology and U. Qvarnström's research exploring patient's reactions to impending death. Experience of time is described as being a movement that moves the individual towards death in the field of opposites, and deciphered to be a universal, but a typical and unique experience emerging through three integrated levels: Sense of time; where time is described as a movement that is proceeding at varying speeds. Relate to time; where the awareness of limited life changes the understanding of time to be more existential. Being in time; where limited time seems to clarify the basic living conditions and phenomena of life. The existence of life when the prospect of death is present is characterized by emotional swings that move within polarizing dimensions which is reflected in the experience of time illustrated as the moves of the pendulum in a grandfather clock. The diversity of the experience of time is oscillating between going fast or slow, being busy or calm, being unpredictable but predictable, safe or unsafe and between being good or bad, depending on the embodied situation of the individual.

Being in transit and in transition: the experience of time at the place, when living with severe incurable disease--a phenomenological study.

The aim of this study is to describe the experience of time as it presents itself at the place being situated when living with severe incurable disease and receiving palliative care. The empirical data consist of 26 open-ended interviews with 23 patients receiving palliative care at home, at a palliative day care, in a palliative bed unit in hospital or in a nursing home in Norway. A common meaning of a shifting space for living emerged from the analysis and was revealed through three different aspects: (i) Transition from a predictable to an unpredictable time: To live with severe incurable disease marks a transition to a changed life involving an ongoing weakened and altered body with bothersome symptoms making experience of time different and unpredictable. (ii) Transition between a safe and unsafe time: When time is unpredictable, feeling safe is revealed as essential to how time is experienced at the place being situated. (iii) To be in transition from a homely to a homeless existence: In a time of increased bodily weakness, unpredictable ailments and displacements, the sense of belonging to the place is revealed as significant to the experience of time. Not knowing where to be in a time of change is like an existential cry of distress where the foothold in existence is lost. The findings are discussed and interpreted as an embodied experience originating from the passage of time continually affecting life sometimes so fundamentally that it marks a transition to a changed space of life that is reflected in the experience of time.

The double embarrassment: Understanding the actions of nursing staff in an unexpected situation.

A nursing home is a complex multifactorial environment that influences the decisions and actions of nursing staff. Many of the actions performed by nursing staff appear to be straightforward or simple because they are repetitive, encompassing everyday activities such as helping a resident to get up in the morning, shower or get dressed. These daily activities are usually performed smoothly as part of normal care. This article draws on ethnographic data from a study of caring practices in a nursing home with the aim of investigating how a seemingly ordinary, but unexpected, event can develop into a chaotic situation. Staff appeared to have difficulty managing the situation, and they seemed to be disorganized in the application of their skills. First, we describe the situation in detail before investigating and discussing the situation to provide a deeper understanding of the complexity of nursing home practice.

Bodily cleanliness in modern nursing.

Why are bodily washing practices the way they are in nursing? Michel Foucault argues that modern democratic societies discipline human bodies in accordance with political interests. In the extension of that argumentation we will show that bodily cleanliness in modern nursing may have been used as a disciplining tool. The first part of our discussion takes as its point of departure the second half of the 19th/the beginning of the 20th centuries, the period in which modern nursing emerged. At that time scientific theories on hygiene seem to have legitimized the political effort to produce a clean, pleasant-smelling, decent, obedient, and productive population. Doctors, nurses and teachers played important roles in the implementation of hygienic bodily washing practices. The second part of the discussion focuses on the post-war period. At that time humanistic needs theories seem to have legitimized political argumentation for independent patients who washed themselves if possible. Those who could not manage on their own, should, as far as possible, be washed by cheaper staff, so that nurses could concentrate on medical treatment. Finally we argue that present day bodily washing practices in nursing are in accordance with the norms of appearance and smell that arose in the second half of the 19th and the first part of the 20th centuries. We further argue that staff with little or no education perform much of the bodily nursing work. Self-care seems to be of interest only when it reduces public expenses.

Entering a world with no future: a phenomenological study describing the embodied experience of time when living with severe incurable disease.

This article presents findings from a phenomenological study exploring experience of time by patients living close to death. The empirical data consist of 26 open-ended interviews from 23 patients living with severe incurable disease receiving palliative care in Norway. Three aspects of experience of time were revealed as prominent: (i) Entering a world with no future; living close to death alters perception of and relationship to time. (ii) Listening to the rhythm of my body, not looking at the clock; embodied with severe illness, it is the body not the clock that structures and controls the activities of the day. (iii). Receiving time, taking time; being offered - not asked for - help is like receiving time that confirms humanity, in contrast to having to ask for help which is like taking others time and thereby revealing own helplessness. Experience of time close to death is discussed as an embodied experience of inner, contextual, relational dimensions in harmony and disharmony with the rhythm of nature, environment and others. Rhythms in harmony provide relief, while rhythms in disharmony confer weakness and limit time.

New quality regulations versus established nursing home practice: a qualitative study.

BACKGROUND: Western governments have initiated reforms to improve the quality of care for nursing home residents. Most of these reforms encompass the use of regulations and national quality indicators. In the Norwegian context, these regulations comprise two pages of text that are easy to read and understand. They focus particularly on residents' rights to plan their day-to-day life in nursing homes. However, the research literature indicates that the implementation of the new regulations, particularly if they aim to change nursing practice, is extremely challenging. The aim of this study was to further explore and describe nursing practice to gain a deeper understanding of why it is so hard to implement the new regulations. METHODS: For this qualitative study, an ethnographic design was chosen to explore and describe nursing practice. Fieldwork was conducted in two nursing homes. In total, 45 nurses and nursing aides were included in participant observation, and 10 were interviewed at the end of the field study. RESULTS: Findings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines and also that they always seemed to know what to do. Having routines and always knowing what to do mutually strengthen and enhance each other, and together they form a powerful force that makes daily nursing care a taken-for-granted activity. CONCLUSION: New regulations are challenging to implement because nursing practices are so strongly embedded. Improving practice requires systematic and deeply rooted practical change in everyday action and thinking.

Threats and acts of intimate partner violence reported by users at Norwegian women's shelters.

Women (n = 87) at women's shelters in Norway, a country of high welfare and gender equality, reported a multitude of severe threats and actual acts of physical, sexual and psychological violence. An individual threatening to kill his partner represented a significant increased risk for experiencing serious acts of violence, especially when the threats were repeated. A self-administered questionnaire was sent to all the women's shelters. Experiences of violence were measured by The Severity of Violence against Women Scale (SVAWS) and the Psychological Maltreatment of Women Index (PMWI).

How can movement quality be promoted in clinical practice? A phenomenological study of physical therapist experts.

BACKGROUND: In recent years, physical therapists have paid greater attention to body awareness. Clinicians have witnessed the benefits of supporting their patients' learning of movement awareness through the promotion of their movement quality. OBJECTIVE: The aim of this study was to investigate how physical therapist experts promote movement quality in their usual clinical settings. DESIGN: A phenomenological research design that included a sampling strategy was devised. Using specific criteria, 6 lead physical therapists nominated a group of physical therapist experts from the fields of neurology, primary health care, and mental health. Fifteen informants, 5 from each field, agreed to participate. METHODS: In-depth interviews were conducted with a semistructured interview guide. The informants were invited to simply describe what they had experienced to be successful therapeutic processes for promoting movement quality. Each interview was audiotaped and transcribed. The data analysis was based on a multistep model. RESULTS: Three main themes emerged from the data. First, the physical therapists' embodied presence and movement awareness served as a precondition and an orientation for practice. Embodied presence is a bodily felt sense, a form of personal knowing that evokes understanding and fosters meaning. Second, creating a platform for promoting movement quality revealed implementation of psychological attitudes. Third, action strategies for promoting movement quality suggested a movement awareness learning cycle and components for clinical use. CONCLUSIONS: This study demonstrated specific attitudes and skills used by physical therapist experts to promote movement quality in their clinical practice. These results may serve as a therapeutic framework for promoting movement quality in clinical physical therapy, although further research is needed.

Reducing color flow artifacts caused by parallel beamforming.

In color flow imaging for medical diagnosis, the inherent trade-off between frame rate and image quality may often lead to suboptimal images. Parallel receive beamforming is used to help overcome this problem, but this introduces artifacts in the images. In addition to the parallel beamforming artifacts found in B-mode imaging, we have found that a difference in curvature of transmit and receive beams gives a bias in the Doppler velocity estimates. This bias causes a discontinuity in the velocity estimates in color flow images. In this work, we have shown that interpolation of the autocorrelation estimates obtained from overlapping receive beams can reduce these artifacts significantly. Because the autocorrelation function varies quite slowly, the beams can be acquired with a considerable time difference, for instance across interleaving groups or across scan planes in a 3-D scan. We have shown that a high frame rate of color flow images can be maintained with parallel beam acquisition with minimal deterioration of the image quality.

Experience of being the spouse/cohabitant of a person with bipolar affective disorder: a cumulative process over time.

The aim of the study was to identify and describe spouses'/cohabitants' experiences of living with a partner with bipolar affective disorder over time. Qualitative research interviews were conducted with eight spouses/cohabitants. Transcribed interviews were analysed structurally based on Ricoeur's phenomenological hermeneutics as described by Lindseth and Norberg. The participants' shared lives ranged from 6 to 51 years, and the study found three major aspects that characterized their experience along this time-dimension; experience formed part of a cumulative process containing up to 14 experiences. Each experience created a preunderstanding that affected how subsequent experiences were perceived, and mastered. These three major aspects had a reciprocal influence on the following 14 experiences over time: Fear and the incomprehensible. Accusations. Self-doubt and doubt about own powers of judgement. Care and information vs. being overlooked or turned away by health personnel. Stigmatization and loss of social network. Uncertainty, powerlessness and hope. Loneliness. Anger and despair. The persistent threat. Own health problems. Grief over loss. Dawning acceptance. Reconciliation. New hope. A theoretical understanding using gestalt therapy theory suggests that burdensome experience can be seen as an inner imbalance in the spouse/cohabitant when she/he cannot find meaning in their experiences. When only parts of the whole are perceived, an incomplete gestalt is formed in the person's lived-experience that counteracts the equilibrium of the organism. Insight and meaning can protect them against burdensome experiences and nurses can empower them through care, health-promoting education and guidance. Nursing research should develop methods of education and guidance sensitive enough to help each spouse/cohabitant, regardless of where they are in their cumulative process.

An eye for movement quality: a phenomenological study of movement quality reflecting a group of physiotherapists' understanding of the phenomenon.

Movement quality is a phenomenon frequently used by physiotherapists in oral language, written text, and clinical practice, with little clarification. The purpose was to investigate the lived experiences of a group of expert physiotherapists, searching for essential features and characteristics of the phenomenon. A phenomenological study, using in-depth interviews was chosen. Ten copies of Fine Art were used to stimulate the description of the phenomenon. The informants were 15 peer-designated physiotherapists, five from each field of neurology, psychosomatic/psychiatry and primary health care. They were nominated by physical therapist leaders in the region. The interviews were audiotaped and transcribed. Giorgis' recommendation concerning analysis of the interview data was followed. Four main themes were developed, seeing movement quality as biomechanical, physiological, psycho-socio-cultural, and existential, all interacting processes. Each theme includes preconditions to movement quality and movement characteristics. Movement quality in general was seen as a unifying phenomenon, representing a synthesis of the four themes. The outcome of the study is the Movement Quality Model (MQM) illuminating essential features and characteristics of the phenomenon. Further research is needed for clarification and application in clinical practice.

Sense of coherence predicts change in life satisfaction among home-living residents in the community with mental health problems: a 1-year follow-up study.

OBJECTIVES: There is a call for a further investigation of Sense of Coherence (SOC), the central concept in salutogenesis, and its relation to health and life satisfaction. No previous studies have investigated the utility of SOC versus mental symptoms for the prediction of life satisfaction among people with chronic mental health problems (MHP). METHODS: The present study has a prospective design including a baseline assessment and a 1-year follow up. We recruited 107 adults from the community health care system. SOC was measured by the Sense of Coherence questionnaire, mental symptoms by the Symptom Checklist-90 revised and life satisfaction by The Quality of Life Scale (all Norwegian versions). RESULTS: The results show that while SOC predicts change in life satisfaction (standardized beta coefficient for SOC was 0.39, P = 0.014), mental symptoms did not (standardized beta coefficient 0.00, P = 1.0). CONCLUSIONS: These findings emphasize the importance of assessing factors that may explain differences in life satisfaction over and above mental symptoms among people with MHP. The results indicate that improving SOC among people with MHP might provide important opportunities for improving their life satisfaction.

Promoting coping: salutogenesis among people with mental health problems.

This article aims to illustrate how Antonovsky's salutogenic theory and its central concept of sense of coherence can be operationalized into salutogenic therapy principles and an intervention program for promoting a sense of coherence, coping, and mental health among people with mental health problems. The intervention is based on the following five basic components or therapy principles: (1) the health continuum model; (2) the story of the person; (3) health-promoting (salutary) factors; (4) the understanding of tension and strain as potentially health promoting, and (5) active adaptation. The program is a talk therapy group intervention and consists of 16 group meetings and homework. The intervention may serve as a guide to mental health nursing practice when coping is the main target.

Parallel beamforming using synthetic transmit beams.

Parallel beamforming is frequently used to increase the acquisition rate of medical ultrasound imaging. However, such imaging systems will not be spatially shift invariant due to significant variation across adjacent beams. This paper investigates a few methods of parallel beam-forming that aims at eliminating this flaw and restoring the shift invariance property. The beam-to-beam variations occur because the transmit and receive beams are not aligned. The underlying idea of the main method presented here is to generate additional synthetic transmit beams (STB) through interpolation of the received, unfocused signal at each array element prior to beamforming. Now each of the parallel receive beams can be aligned perfectly with a transmit beam--synthetic or real--thus eliminating the distortion caused by misalignment. The proposed method was compared to the other compensation methods through a simulation study based on the ultrasound simulation software Field II. The results have been verified with in vitro experiments. The simulations were done with parameters similar to a standard cardiac examination with two parallel receive beams and a transmit-line spacing corresponding to the Rayleigh criterion, wavelength times f-number (lambda x f#). From the results presented, it is clear that straightforward parallel beamforming reduces the spatial shift invariance property of an ultrasound imaging system. The proposed method of using synthetic transmit beams seems to restore this important property, enabling higher acquisition rates without loss of image quality.

Quality of life among Norwegians with chronic mental health problems living in the community versus the general population.

We used the Quality of Life Scale to assess quality of life among 107 Norwegians with chronic mental health problems (MHP) from the community health care system versus 1893 general population adults. The groups differed in quality of life, including broader life domains. Age and quality of life were more strongly positively correlated in the MHP group than in the general population. Mental symptoms (measured by the Symptom Checklist-90 Revised) and quality of life were strongly negatively correlated in the MHP group. Services for people with chronic MHP should focus on enhancing quality of life and on its role as an outcome variable.

Real-time adaptive clutter rejection filtering in color flow imaging using power method iterations.

We propose a new algorithm for real-time, adaptive-clutter-rejection filtering in ultrasound color flow imaging (CFI) and related techniques. The algorithm is based on regression filtering using eigenvectors of the signal correlation matrix as a basis for representing clutter, a method that previously has been considered too computationally demanding for real-time processing in general CFI applications. The data acquisition and processing scheme introduced allows for a more localized sampling of the clutter statistics and, therefore, an improved clutter attenuation for lower filter orders. By using the iterative power method technique, the dominant eigenvalues and corresponding eigenvectors of the correlation matrix can be estimated efficiently, rendering real-time operation feasible on desktop computers. A new adaptive filter order algorithm is proposed that successfully estimates the proper dimension of the clutter basis, previously one of the major drawbacks of this clutter-rejection technique. The filter algorithm performance and computational demands has been compared to that of conventional clutter filters. Examples have been included which confirms that, by adapting the clutter-rejection filter to estimates of the clutter-signal statistics, improved attenuation of the clutter signal can be achieved in normal as well as more excessive cases of tissue movement and acceleration.