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1.
Cogn Res Princ Implic ; 8(1): 69, 2023 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-37980697

RESUMEN

In a dynamic decision-making task simulating basic ship movements, participants attempted, through a series of actions, to elicit and identify which one of six other ships was exhibiting either of two hostile behaviors. A high-performing, although imperfect, automated attention aid was introduced. It visually highlighted the ship categorized by an algorithm as the most likely to be hostile. Half of participants also received automation transparency in the form of a statement about why the hostile ship was highlighted. Results indicated that while the aid's advice was often complied with and hence led to higher accuracy with a shorter response time, detection was still suboptimal. Additionally, transparency had limited impacts on all aspects of performance. Implications for detection of hostile intentions and the challenges of supporting dynamic decision making are discussed.


Asunto(s)
Algoritmos , Intención , Humanos , Automatización , Hostilidad , Hidrolasas
2.
Hum Factors ; 65(4): 592-617, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-34233530

RESUMEN

OBJECTIVE: Three experiments sought to understand performance limitations in controlling a ship attempting to meet another moving ship that approached from various trajectories. The influence of uncertainty, resulting from occasional unpredictable delays in one's own movement, was examined. BACKGROUND: Cognitive elements of rendezvous have been little studied. Related work such as the planning fallacy and bias toward underestimating time-to-contact imply a tendency toward late arrival at a rendezvous. METHODS: In a simplified simulation, participants controlled the speed and/or heading of their own ship once per scenario to try to rendezvous with another ship. Forty-five scenarios of approximately 30 s were conducted with different starting geometries and, in two of three experiments, with different frequencies and lengths of the unexpected delays. RESULTS: Perfect rendezvous were hard to obtain, with a general tendency to arrive late and pass behind the target vessel, although this was dependent on the angle of approach and relative speed. When occasional delays were introduced, less frequent but longer delays disrupted performance more than shorter but more frequent delays. Where delays were possible, but no delay occurred, there was no longer evidence of a general tendency to more frequently pass behind the target ship. Additionally, people did not wait to see if the unpredictable delays would occur before executing a course of action. Different control strategies were deployed and dual axis control was preferred. CONCLUSIONS: The tendency to arrive late and the influence of the possibility of uncertain delays are discussed in relationship to control strategies.


Asunto(s)
Incertidumbre , Humanos , Simulación por Computador
3.
Hum Factors ; 65(2): 227-236, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33957812

RESUMEN

OBJECTIVE: The ability of people to infer intentions from movement of other vessels was investigated. Across three levels of variability in movements in the path of computer-controlled ships, participants attempted to determine which entity was hostile. BACKGROUND: Detection of hostile intentions through spatial movements of vessels is important in an array of real-world scenarios. This experiment sought to determine baseline abilities of humans to do so. METHODS: Participants selected a discrete movement direction of their ship. Six other ships' locations then updated. A single entity displayed one of two hostile behaviors: shadowing, which involved mirroring the participant's vessel's movements; and hunting, which involved closing in on the participant's vessel. Trials allowed up to 35 moves before identifying the hostile ship and its behavior. Uncertainty was introduced through adding variability to ships' movements such that their path was 0%, 25%, or 50% random. RESULTS: Even with no variability in the ships' movements, accurate detection was low, identifying the hostile entity about 60% of the time. Variability in the paths decreased detection. Detection of hunting was strongly degraded by distance between ownship and the hostile ship, but shadowing was not. Strategies employing different directions of movement across the trial, but also featuring some runs of consecutive movements, facilitated detection. CONCLUSIONS: Early identification of threats based on movement characteristics alone is likely to be difficult, but particularly so when adversaries employ some level of uncertainty to mask their intentions. These findings highlight the need to develop decision aids to support human performance.


Asunto(s)
Intención , Movimiento , Humanos , Navíos
4.
Cogn Res Princ Implic ; 7(1): 41, 2022 05 12.
Artículo en Inglés | MEDLINE | ID: mdl-35556185

RESUMEN

Previous research suggests people struggle to detect a series of movements that might imply hostile intentions of a vessel, yet this ability is crucial in many real world Naval scenarios. To investigate possible mechanisms for improving performance, participants engaged in a simple, simulated ship movement task. One of two hostile behaviors were present in one of the vessels: Shadowing-mirroring the participant's vessel's movements; and Hunting-closing in on the participant's vessel. In the first experiment, history trails, showing the previous nine positions of each ship connected by a line, were introduced as a potential diagnostic aid. In a second experiment, the number of computer-controlled ships on the screen also varied. Smaller set size improved detection performance. History trails also consistently improved detection performance for both behaviors, although still falling well short of optimal, even with the smaller set size. These findings suggest that working memory plays a critical role in performance on this dynamic decision making task, and the constraints of working memory capacity can be decreased through a simple visual aid and an overall reduction in the number of objects being tracked. The implications for the detection of hostile intentions are discussed.


Asunto(s)
Intención , Memoria a Corto Plazo , Hostilidad , Humanos , Movimiento
5.
Pulmonology ; 27(2): 134-143, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32739326

RESUMEN

BACKGROUND: Study reproducibility is valuable for validating or refuting results. Provision of reproducibility indicators, such as materials, protocols, and raw data in a study improve its potential for reproduction. Efforts to reproduce noteworthy studies in the biomedical sciences have resulted in an overwhelming majority of them being found to be unreplicable, causing concern for the integrity of research in other fields, including medical specialties. Here, we analyzed the reproducibility of studies in the field of pulmonology. METHODS: 500 pulmonology articles were randomly selected from an initial PubMed search for data extraction. Two authors scoured these articles for reproducibility indicators including materials, protocols, raw data, analysis scripts, inclusion in systematic reviews, and citations by replication studies as well as other factors of research transparency including open accessibility, funding source and competing interest disclosures, and study preregistration. FINDINGS: Few publications included statements regarding materials (10%), protocols (1%), data (15%), and analysis script (0%) availability. Less than 10% indicated preregistration. More than half of the publications analyzed failed to provide a funding statement. Conversely, 63% of the publications were open access and 73% included a conflict of interest statement. INTERPRETATION: Overall, our study indicates pulmonology research is currently lacking in efforts to increase replicability. Future studies should focus on providing sufficient information regarding materials, protocols, raw data, and analysis scripts, among other indicators, for the sake of clinical decisions that depend on replicable or refutable results from the primary literature.


Asunto(s)
Investigación Biomédica/ética , Neumología/normas , Reproducibilidad de los Resultados , Investigación Biomédica/economía , Investigación Biomédica/estadística & datos numéricos , Estudios Transversales , Manejo de Datos , Medicina Basada en la Evidencia , Humanos , Metaanálisis como Asunto , Publicaciones/economía , Publicaciones/estadística & datos numéricos , Neumología/estadística & datos numéricos , Revisiones Sistemáticas como Asunto
6.
J Elder Abuse Negl ; 32(4): 334-356, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32886027

RESUMEN

Elder financial exploitation (EFE), the misuse of a vulnerable adult's property or resources for personal gain, is a form of elder abuse. This study addresses whether dual-eligible EFE victims were experiencing pent-up demand for health services alleviated through investigation by Adult Protective Services (APS). A quasi-experimental design addressed health service utilization and costs for 131 dual-eligible Maine APS clients over age 60 with substantiated allegations of EFE relative to comparable non-APS controls. APS case files spanning 2007-2012 were linked to 2006-2014 Medicare and Medicaid claims data. Service utilization and costs were analyzed 1 year prior, during, and 2 years after the initial APS investigation. Difference in differences logistic regression and generalized linear models addressed the likelihood of incurring costs and expenditure levels relative to matched controls, respectively. Victims of EFE had higher overall odds of using inpatient and long-term services and supports (LTSS) and higher odds of using LTSS post-investigation than controls. Higher overall levels of outpatient and prescriptions expenditures and higher inpatient expenditures during the APS event year contributed toward APS clients incurring $1,142 higher PMPM total costs than controls. Victims of EFE were experiencing significant pent-up demand for health services post-APS involvement.


Asunto(s)
Abuso de Ancianos , Necesidades y Demandas de Servicios de Salud , Medicaid/economía , Medicare/economía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Maine , Masculino , Estados Unidos
7.
Complement Ther Med ; 52: 102469, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32951719

RESUMEN

OBJECTIVES: To undertake a systematic review of the safety and effectiveness of mind body approaches for women with hypertensive disorders in pregnancy (HDP). DESIGN: A search was undertaken of databases from inception to 2019 for randomised and quasi randomised controlled trials. MAIN OUTCOME MEASURES: The primary outcome was a reduction in systolic and / or diastolic blood pressure for women with hypertension and or preeclampsia in pregnancy. RESULTS: 121 studies were identified and eight studies were included in this review. These included mind body interventions examining yoga, guided imagery, relaxation, music, and acupuncture for HDP. Two studies of relaxation found a reduction in systolic (MD -11.3, 95%CI -13.23 to -9.39) and diastolic blood pressure (MD -6.59, 95%CI -9.43 to -3.75) and reduced stress (MD -11.4, 95%CI -16.5 to -6.3). In one study of yoga, the risk of developing HDP was reduced (RR 0.28, 95% CI 0.09 to 0.91, 59 women) and a second study found a reduction in stress at the end of the intervention of yoga. One trial of guided imagery found a reduction in mean arterial blood pressure compared to the control (4.35, 95% -8.04 to -0.66, p=0.02). Overall there was no effect on the development of preeclampsia, use of anti-hypertensive medication and any neonatal outcomes from the interventions evaluated. Few trials reported on safety outcomes, one trial of acupuncture reported one case of placental abruption and three cases of acupuncture related side effects. CONCLUSION: Few high quality trials have examined the effectiveness and safety of mind body interventions to manage HDP. Relaxation, yoga, guided imagery and music may have some potential benefit. Safety issues are completely unclear and thus the risk-benefit ratio of all interventions could not be determined. Further research is recommended.


Asunto(s)
Hipertensión Inducida en el Embarazo/terapia , Terapias Mente-Cuerpo/métodos , Preeclampsia/terapia , Complicaciones del Embarazo/terapia , Presión Sanguínea/fisiología , Femenino , Humanos , Seguridad del Paciente , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Rev Sci Instrum ; 91(4): 043902, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32357733

RESUMEN

We report details of an experimental platform implemented at the National Ignition Facility to obtain in situ powder diffraction data from solids dynamically compressed to extreme pressures. Thin samples are sandwiched between tamper layers and ramp compressed using a gradual increase in the drive-laser irradiance. Pressure history in the sample is determined using high-precision velocimetry measurements. Up to two independently timed pulses of x rays are produced at or near the time of peak pressure by laser illumination of thin metal foils. The quasi-monochromatic x-ray pulses have a mean wavelength selectable between 0.6 Å and 1.9 Å depending on the foil material. The diffracted signal is recorded on image plates with a typical 2θ x-ray scattering angle uncertainty of about 0.2° and resolution of about 1°. Analytic expressions are reported for systematic corrections to 2θ due to finite pinhole size and sample offset. A new variant of a nonlinear background subtraction algorithm is described, which has been used to observe diffraction lines at signal-to-background ratios as low as a few percent. Variations in system response over the detector area are compensated in order to obtain accurate line intensities; this system response calculation includes a new analytic approximation for image-plate sensitivity as a function of photon energy and incident angle. This experimental platform has been used up to 2 TPa (20 Mbar) to determine the crystal structure, measure the density, and evaluate the strain-induced texturing of a variety of compressed samples spanning periods 2-7 on the periodic table.

9.
Hum Factors ; 62(8): 1304-1321, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-31532229

RESUMEN

OBJECTIVE: Experimentally investigate maneuver decision preferences in navigating ships to avoid a collision. How is safety (collision avoidance) balanced against efficiency (deviation from path and delay) and rules of the road under conditions of both trajectory certainty and uncertainty. BACKGROUND: Human decision error is a prominent factor in nautical collisions, but the multiple factors of geometry of collisions and role of uncertainty have been little studied in empirical human factors literature. APPROACH: Eighty-seven Mechanical Turk participants performed in a lower fidelity ship control simulation, depicting ownship and a cargo ship hazard on collision or near-collision trajectories of various conflict geometries, while controlling heading and speed with the sluggish relative dynamics. Experiment 1 involved the hazard on a straight trajectory. In Experiment 2, the hazard could turn on unpredictable trials. Participants were rewarded for efficiency and penalized for collisions or close passes. RESULTS: Participants made few collisions, but did so more often when on a collision path. They sometimes violated the instructed rules of the road by maneuvering in front of the hazard ship's path. They preferred speed control to heading control. Performance degraded in conditions of uncertainty. CONCLUSION: Data reveal an understanding of maneuver decisions and conditions that affect the balance between safety and efficiency. APPLICATION: The simulation and data highlight the degrading role of uncertainty and provide a foundation upon which more complex questions can be asked, asked of more trained navigators, and decision support tools examined.


Asunto(s)
Cognición , Navíos , Simulación por Computador , Humanos , Incertidumbre
10.
Epidemiol Infect ; 147: e310, 2019 11 28.
Artículo en Inglés | MEDLINE | ID: mdl-31775940

RESUMEN

This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2-5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6-5.7, P < 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation; HR 0.64 95% CI 0.47-0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.


Asunto(s)
Hospitalización , Subtipo H1N1 del Virus de la Influenza A , Subtipo H3N2 del Virus de la Influenza A , Gripe Humana/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Subtipo H1N1 del Virus de la Influenza A/patogenicidad , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Subtipo H3N2 del Virus de la Influenza A/patogenicidad , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Gripe Humana/terapia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Australia Occidental/epidemiología , Adulto Joven
11.
Rev Sci Instrum ; 90(3): 035110, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30927771

RESUMEN

The MAPS direct geometry time-of-flight chopper spectrometer at the ISIS pulsed neutron and muon source has been in operation since 1999, and its novel use of a large array of position-sensitive neutron detectors paved the way for a later generations of chopper spectrometers around the world. Almost two decades of experience of user operations on MAPS, together with lessons learned from the operation of new generation instruments, led to a decision to perform three parallel upgrades to the instrument. These were to replace the primary beamline collimation with supermirror neutron guides, to install a disk chopper, and to modify the geometry of the poisoning in the water moderator viewed by MAPS. Together, these upgrades were expected to increase the neutron flux substantially, to allow more flexible use of repetition rate multiplication and to reduce some sources of background. Here, we report the details of these upgrades and compare the performance of the instrument before and after their installation as well as to Monte Carlo simulations. These illustrate that the instrument is performing in line with, and in some respects in excess of, expectations. It is anticipated that the improvement in performance will have a significant impact on the capabilities of the instrument. A few examples of scientific commissioning are presented to illustrate some of the possibilities.

12.
Hum Factors ; 61(2): 255-272, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30235007

RESUMEN

OBJECTIVE: The aim of this study was to explore the impact of prior information on spatial prediction and understanding of variability. BACKGROUND: In uncertain spatial prediction tasks, such as hurricane forecasting or planning search-and-rescue operations, decision makers must consider the most likely case and the distribution of possible outcomes. Base performance on these tasks is varied (and in the case of understanding the distribution, often poor). Humans must update mental models and predictions with new information, sometimes under cognitive workload. METHOD: In a spatial-trajectory prediction task, participants were anchored on accurate or inaccurate information, or not anchored, regarding the future behavior of an object (both average behavior and the variability). Subsequently, they predicted an object's future location and estimated its likelihood at multiple locations. In a second experiment, participants repeated the process under varying levels of external cognitive workload. RESULTS: Anchoring influenced understanding of most likely predicted location, with fairly rapid adjustment following inaccurate anchors. Increasing workload resulted in decreased overall performance and an impact on the adjustment component of the task. Overconfidence was present in all conditions. CONCLUSION: Prior information exerted short-term influence on spatial predictions. Cognitive load impaired users' ability to effectively adjust to new information. Accurate graphical anchors did not improve user understanding of variability. APPLICATION: Prior briefings or forecasts about spatiotemporal trajectories affect decisions even in the face of initial contradictory information. To best support spatial prediction tasks, efforts also need to be made to separate extraneous load-causing tasks from the process of integrating new information. Implications are discussed.


Asunto(s)
Anticipación Psicológica/fisiología , Percepción Espacial/fisiología , Pensamiento/fisiología , Incertidumbre , Adulto , Humanos , Adulto Joven
13.
Hum Factors ; 60(3): 324-339, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29498888

RESUMEN

OBJECTIVE: The goal of this study was to explore the ways in which visualizations influence the prediction of uncertain spatial trajectories (e.g., the unknown path of a downed aircraft or future path of a hurricane) and participant overconfidence in such prediction. BACKGROUND: Previous research indicated that spatial predictions of uncertain trajectories are challenging and are often associated with overconfidence. Introducing a visualization aid during training may improve the understanding of uncertainty and reduce overconfidence. METHOD: Two experiments asked participants to predict the location of various trajectories at a future time. Mean and variance estimates were compared for participants who were provided with a visualization and those who were not. RESULTS: In Experiment 1, participants exhibited less error in mean estimations when a linear visualization was present but performed worse than controls once the visualization was removed. Similar results were shown in Experiment 2, with a nonlinear visualization. However, in both experiments, participants who were provided with a visualization did not retain any advantage in their variance estimations once the visualization was removed. CONCLUSIONS: Visualizations may support spatial predictions under uncertainty, but they are associated with benefits and costs for the underlying knowledge being developed. APPLICATION: Visualizations have the potential to influence how people make spatial predictions in the presence of uncertainty. Properly designed and implemented visualizations may help mitigate the cognitive biases related to such predictions.


Asunto(s)
Visualización de Datos , Toma de Decisiones/fisiología , Metacognición/fisiología , Percepción Espacial/fisiología , Transferencia de Experiencia en Psicología/fisiología , Incertidumbre , Percepción Visual/fisiología , Adulto , Humanos , Adulto Joven
14.
Sci Rep ; 7(1): 10545, 2017 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-28874820

RESUMEN

Micron-scale droplets isolated by an immiscible liquid can provide miniaturised reaction vessels which can be manipulated in microfluidic networks, and has seen a rapid growth in development. In many experiments, the precise volume of these microdroplets is a critical parameter which can be influenced by many external factors. In this work, we demonstrate the combination of imaging-based feedback and pressure driven pumping to accurately control the size of microdroplets produced in a microfluidic device. The use of fast-response, pressure-driving pumps allows the microfluidic flow to be quickly and accurately changed, while directly measuring the droplet size allows the user to define the more meaningful parameters of droplet size and generation frequency rather than flow rates or pressures. The feedback loop enables the drift correction of pressure based pumps, and leads to a large increase in the mono-dispersity of the droplets produced over long periods. We also show how this can be extended to control multiple liquid flows, allowing the frequency of droplet formation or the average concentration of living cells per droplet to be controlled and kept constant.

15.
Eye (Lond) ; 31(2): 209-217, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28085141

RESUMEN

Retinal ganglion cell (RGC) loss is the hallmark of optic neuropathies, including glaucoma, where damage to RGC axons occurs at the level of the optic nerve head. In experimental glaucoma, damage is assessed at the axon level (in the retinal nerve fibre layer and optic nerve head) or at the soma level (in the retina). In clinical glaucoma where measurements are generally limited to non-invasive techniques, structural measurements of the retinal nerve fibre layer and optic nerve head, or functional measurements with perimetry provide surrogate estimates of RGC integrity. These surrogate measurements, while clinically useful, are several levels removed from estimating actual RGC loss. Advances in imaging, labelling techniques, and transgenic medicine are making enormous strides in experimental glaucoma, providing knowledge on the pathophysiology of glaucoma, its progression and testing new therapeutic avenues. Advances are also being made in functional imaging of RGCs. Future efforts will now be directed towards translating these advances to clinical care.


Asunto(s)
Disco Óptico/diagnóstico por imagen , Enfermedades del Nervio Óptico/diagnóstico , Células Ganglionares de la Retina/patología , Animales , Axones/metabolismo , Axones/patología , Modelos Animales de Enfermedad , Humanos , Fibras Nerviosas/metabolismo , Fibras Nerviosas/patología , Coloración y Etiquetado/métodos , Tomografía de Coherencia Óptica , Pruebas del Campo Visual
16.
Midwifery ; 40: 124-31, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27428108

RESUMEN

OBJECTIVE: to gain insight into the experiences of women, partners and midwives who participated in the Complementary Therapies for Labour and Birth Study, an evidence based complementary medicine (CM) antenatal education course. DESIGN: qualitative in-depth interviews and a focus group as part of the Complementary Therapies for Labour and Birth Study. SETTING AND PARTICIPANTS: thirteen low risk primiparous women and seven partners who had participated in the study group of a randomised controlled trial of the complementary therapies for labour and birth study, and 12 midwives caring for these women. The trial was conducted at two public hospitals, and through the Western Sydney University in Sydney, Australia. INTERVENTIONS: the Complementary Therapies for Labour and Birth (CTLB) protocol, based on the She Births® course and the Acupressure for labour and birth protocol, incorporated six evidence-based complementary medicine (CM) techniques; acupressure, relaxation, visualisation, breathing, massage, yoga techniques and incorporated facilitated partner support. Randomisation to the trial occurred at 24-36 weeks' gestation, and participants attended a two-day antenatal education programme, plus standard care, or standard care alone. FINDINGS: the overarching theme identified in the qualitative data was making sense of labour and birth. Women used information about normal birth physiology from the course to make sense of labour, and to utilise the CM techniques to support normal birth and reduce interventions in labour. Women's, partners' and midwives' experience of the course and its use during birth gave rise to supporting themes such as: working for normal; having a toolkit; and finding what works. KEY CONCLUSIONS: the Complementary Therapies for Labour and Birth Study provided women and their partners with knowledge to understand the physiology of normal labour and birth and enabled them to use evidence-based CM tools to support birth and reduce interventions. IMPLICATIONS FOR PRACTICE: the Complementary Therapies for Labour and Birth Study introduces concepts of what constitutes normal birth and provides skills to support women, partners and midwives. It appears to be an effective form of antenatal education that supports normal birth, and maternity services need to consider how they can reform current antenatal education in line with this evidence.


Asunto(s)
Terapias Complementarias/normas , Enfermeras Obstetrices/educación , Satisfacción del Paciente , Educación Prenatal/métodos , Adulto , Australia , Femenino , Grupos Focales , Humanos , Trabajo de Parto/fisiología , Embarazo , Mujeres Embarazadas/psicología
17.
BMJ Open ; 6(7): e010691, 2016 07 12.
Artículo en Inglés | MEDLINE | ID: mdl-27406639

RESUMEN

OBJECTIVE: To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use. DESIGN: Open-label, assessor blind, randomised controlled trial. SETTING: 2 public hospitals in Sydney, Australia. POPULATION: 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics. METHODS AND INTERVENTION: The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24-36 weeks' gestation, and participants attended a 2-day antenatal education programme plus standard care, or standard care alone. MAIN OUTCOME MEASURES: Rate of analgesic epidural use. Secondary: onset of labour, augmentation, mode of birth, newborn outcomes. RESULTS: There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p<0.0001); caesarean section (RR=0.52 (95% CI 0.31 to 0.87), p=0.017); length of second stage (mean difference=-0.32 (95% CI -0.64 to 0.002), p=0.05); any perineal trauma (0.88 (95% CI 0.78 to 0.98), p=0.02) and resuscitation of the newborn (RR=0.47 (95% CI 0.25 to 0.87), p≤0.015). There were no statistically significant differences found in spontaneous onset of labour, pethidine use, rate of postpartum haemorrhage, major perineal trauma (third and fourth degree tears/episiotomy), or admission to special care nursery/neonatal intensive care unit (p=0.25). CONCLUSIONS: The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence. TRIAL REGISTRATION NUMBER: ACTRN12611001126909.


Asunto(s)
Terapias Complementarias , Medicina Integrativa , Dolor de Parto , Trabajo de Parto , Manejo del Dolor , Adulto , Analgesia Epidural , Australia , Cesárea , Femenino , Humanos , Educación del Paciente como Asunto , Embarazo , Atención Prenatal
18.
Clin Pharmacol Ther ; 100(4): 380-8, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27311679

RESUMEN

We compared whole exome sequencing (WES, n = 176 patients) and whole genome sequencing (WGS, n = 68) and clinical genotyping (DMET array-based approach) for interrogating 13 genes with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. We focused on 127 CPIC important variants: 103 single nucleotide variations (SNV), 21 insertion/deletions (Indel), HLA-B alleles, and two CYP2D6 structural variations. WES and WGS provided interrogation of nonoverlapping sets of 115 SNV/Indels with call rate >98%. Among 68 loci interrogated by both WES and DMET, 64 loci (94.1%, confidence interval [CI]: 85.6-98.4%) showed no discrepant genotyping calls. Among 66 loci interrogated by both WGS and DMET, 63 loci (95.5%, CI: 87.2-99.0%) showed no discrepant genotyping calls. In conclusion, even without optimization to interrogate pharmacogenetic variants, WES and WGS displayed potential to provide reliable interrogation of most pharmacogenes and further validation of genome sequencing in a clinical lab setting is warranted.


Asunto(s)
Exoma/genética , Genoma Humano/genética , Técnicas de Genotipaje , Secuenciación de Nucleótidos de Alto Rendimiento , Farmacogenética/métodos , Humanos
19.
Am J Physiol Heart Circ Physiol ; 311(1): H157-67, 2016 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-27199133

RESUMEN

The decompensatory phase of hemorrhage (shock) is caused by a poorly defined phenomenon termed vascular hyporeactivity (VHR). VHR may reflect an acute in vivo imbalance in levels of contractile and relaxant stimuli favoring net vascular smooth muscle (VSM) relaxation. Alternatively, VHR may be caused by intrinsic VSM desensitization of contraction resulting from prior exposure to high levels of stimuli that temporarily adjusts cell signaling systems. Net relaxation, but not desensitization, would be expected to resolve rapidly in an artery segment removed from the in vivo shock environment and examined in vitro in a fresh solution. Our aim was to 1) induce shock in rabbits and apply an in vitro mechanical analysis on muscular arteries isolated pre- and postshock to determine whether VHR involves intrinsic VSM desensitization, and 2) identify whether net VSM relaxation induced by nitric oxide and cyclic nucleotide-dependent protein kinase activation in vitro can be sustained for some time after relaxant stimulus washout. The potencies of phenylephrine- and histamine-induced contractions in in vitro epigastric artery removed from rabbits posthemorrhage were decreased by ∼0.3 log units compared with the control contralateral epigastric artery removed prehemorrhage. Moreover, a decrease in KCl-induced tonic, relative to phasic, tension of in vitro mesenteric artery correlated with the degree of shock severity as assessed by rates of lactate and K(+) accumulation. VSM desensitization was also caused by tyramine in vivo and PE in vitro, but not by relaxant agents in vitro. Together, these results support the hypothesis that VHR during hemorrhagic decompensation involves contractile stimulus-induced long-lasting, intrinsic VSM desensitization.


Asunto(s)
Músculo Liso Vascular/fisiopatología , Choque Hemorrágico/fisiopatología , Vasoconstricción , Vasodilatación , Animales , Proteínas Quinasas Dependientes de AMP Cíclico/metabolismo , Proteínas Quinasas Dependientes de GMP Cíclico/metabolismo , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Arterias Epigástricas/efectos de los fármacos , Arterias Epigástricas/metabolismo , Arterias Epigástricas/fisiopatología , Técnicas In Vitro , Ácido Láctico/metabolismo , Masculino , Arterias Mesentéricas/efectos de los fármacos , Arterias Mesentéricas/metabolismo , Arterias Mesentéricas/fisiopatología , Músculo Liso Vascular/efectos de los fármacos , Músculo Liso Vascular/metabolismo , Óxido Nítrico/metabolismo , Conejos , Choque Hemorrágico/metabolismo , Transducción de Señal , Factores de Tiempo , Vasoconstricción/efectos de los fármacos , Vasoconstrictores/farmacología , Vasodilatación/efectos de los fármacos , Vasodilatadores/farmacología
20.
Sci Total Environ ; 568: 1146-1156, 2016 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-27067833

RESUMEN

The State of California conducted an extensive and systematic survey of mercury (Hg) in fish from the California coast in 2009 and 2010. The California survey sampled 3483 fish representing 46 species at 68 locations, and demonstrated that methylHg in fish presents a widespread exposure risk to fish consumers. Most of the locations sampled (37 of 68) had a species with an average concentration above 0.3µg/gwet weight (ww), and 10 locations an average above 1.0µg/gww. The recent and robust dataset from California provided a basis for a broader examination of spatial and temporal patterns in fish Hg in coastal waters of Western North America. There is a striking lack of data in publicly accessible databases on Hg and other contaminants in coastal fish. An assessment of the raw data from these databases suggested the presence of relatively high concentrations along the California coast and in Puget Sound, and relatively low concentrations along the coasts of Alaska and Oregon, and the outer coast of Washington. The dataset suggests that Hg concentrations of public health concern can be observed at any location on the coast of Western North America where long-lived predator species are sampled. Output from a linear mixed-effects model resembled the spatial pattern observed for the raw data and suggested, based on the limited dataset, a lack of trend in fish Hg over the nearly 30-year period covered by the dataset. Expanded and continued monitoring, accompanied by rigorous data management procedures, would be of great value in characterizing methylHg exposure, and tracking changes in contamination of coastal fish in response to possible increases in atmospheric Hg emissions in Asia, climate change, and terrestrial Hg control efforts in coastal watersheds.


Asunto(s)
Peces/metabolismo , Mercurio/metabolismo , Contaminantes Químicos del Agua/metabolismo , Animales , California , Monitoreo del Ambiente , Estados del Pacífico
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