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1.
BJOG ; 127(1): 18-26, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31538709

RESUMO

BACKGROUND: Anterior compartment prolapse is the most common pelvic organ prolapse (POP) with a range of surgical treatment options available. OBJECTIVES: To compare the clinical effectiveness and cost-effectiveness of surgical treatments for the repair of anterior POP. METHODS: We conducted a systematic review of randomised controlled trials comparing surgical treatments for women with POP. Network meta-analysis was possible for anterior POP, same-site recurrence outcome. A Markov model was used to compare the cost-utility of surgical treatments for the primary repair of anterior POP from a UK National Health Service perspective. MAIN RESULTS: We identified 27 eligible trials for the network meta-analysis involving eight surgical treatments tested on 3194 women. Synthetic mesh was the most effective in preventing recurrence at the same site. There was no evidence to suggest a difference between synthetic non-absorbable mesh, synthetic partially absorbable mesh, and biological mesh. The cost-utility analysis, which incorporated effectiveness, complications and cost data, found non-mesh repair to have the highest probability of being cost-effective. The conclusions were robust to model inputs including effectiveness, costs and utility values. CONCLUSIONS: Anterior colporrhaphy augmented with mesh appeared to be cost-ineffective in women requiring primary repair of anterior POP. There is a need for further research on long-term effectiveness and the safety of mesh products to establish their relative cost-effectiveness with a greater certainty. TWEETABLE ABSTRACT: New study finds mesh cost-ineffective in women with anterior pelvic organ prolapse.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/economia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/economia , Análise Custo-Benefício , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Meta-Análise em Rede , Prolapso de Órgão Pélvico/economia , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevenção Secundária/economia , Resultado do Tratamento
2.
BJOG ; 127(1): 28-35, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31541614

RESUMO

BACKGROUND: Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There is limited knowledge or guidance on the effective management for mesh-related complications. OBJECTIVE: To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline 'Urinary incontinence (update) and pelvic organ prolapse in women: management'. SEARCH STRATEGY: Search strategies were developed for each indication for referral. SELECTION CRITERIA: Relevant interventions included complete or partial mesh removal, mesh division, and non-surgical treatments such as vaginal estrogen. DATA COLLECTION AND ANALYSIS: Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted. MAIN RESULTS: Twenty-four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely. CONCLUSIONS: The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh-related complications. Robust data are needed so that mesh complications can be managed effectively in the future. TWEETABLE ABSTRACT: Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adolescente , Adulto , Idoso , Perda Sanguínea Cirúrgica , Dispareunia/etiologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Recidiva , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Adulto Jovem
3.
Cogn Behav Ther ; 48(5): 353-368, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30221589

RESUMO

This study provides a preliminary exploration of factors which differentially predict treatment response to telephone-delivered cognitive behavioural therapy (TCBT) compared to face-to-face CBT (CBT) in a randomised non-inferiority controlled trial of 72 children (aged 11-18 years) with obsessive-compulsive disorder (OCD). Potential moderator variables, their interaction with treatment group (CBT, TCBT) and baseline levels of OCD severity were entered into separate regression models where the primary outcome measure was the post-intervention Children's Yale-Brown Obsessive-Compulsive Scale total score (CYBOCS). Separate regressions were also used to test associations between predictors and outcome controlling for pretreatment CYBOCS. Only pretreatment level of parent-rated child peer problems moderated the effects of the two interventions on CYBOCS severity at post-treatment. After controlling for baseline CYBOCS, only family accommodation rated by mothers predicted poorer outcomes in both groups. While CBT and TCBT may be equally effective for adolescents with OCD, the current results tentatively suggest that higher baseline level of peer problems strengthened the response to therapy for youth receiving TCBT and the predictor analyses reinforce the importance of directly addressing family accommodation during CBT for paediatric OCD regardless of delivery mode. Limitations of the current findings and directions for future work are discussed.

4.
J Laryngol Otol ; 132(11): 984-989, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30353795

RESUMO

OBJECTIVE: To assess, using standardised tools, the quality and readability of online tinnitus information that patients are likely to access. METHODS: A standardised review was conducted of websites relating to tinnitus and its management. Each website was scored using the DISCERN instrument and the Flesch Reading Ease scale. RESULTS: Twenty-seven unique websites were evaluated. The mean DISCERN score of the websites was 34.5 out of 80 (standard deviation = 11.2). This would be considered 'fair' in quality. Variability in DISCERN score between websites was high (range, 15-57: 'poor' to 'very good'). Website readability was poor, with a mean Flesch Reading Ease score of 52.6 (standard deviation = 7.7); this would be considered 'difficult' to read. CONCLUSION: In general, the quality of tinnitus websites is fair and the readability is poor, with substantial variability in quality between websites. The Action on Hearing Loss and the British Tinnitus Association websites were identified as providing the highest quality information.


Assuntos
Informação de Saúde ao Consumidor/normas , Zumbido , Compreensão , Humanos , Internet , Ferramenta de Busca
5.
J Dairy Sci ; 101(6): 5474-5485, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29525299

RESUMO

The global dairy industry needs to reappraise the systems of milk production that are operated at farm level with specific focus on enhancing technical efficiency and competitiveness of the sector. The objective of this study was to quantify the factors associated with costs of production, profitability, and pasture use, and the effects of pasture use on financial performance of dairy farms using an internationally recognized representative database over an 8-yr period (2008 to 2015) on pasture-based systems. To examine the associated effects of several farm system and management variables on specific performance measures, a series of multiple regression models were developed. Factors evaluated included pasture use [kg of dry matter/ha and stocking rate (livestock units/ha)], grazing season length, breeding season length, milk recording, herd size, dairy farm size (ha), farmer age, discussion group membership, proportion of purchased feed, protein %, fat %, kg of milk fat and protein per cow, kg of milk fat and protein per hectare, and capital investment in machinery, livestock, and buildings. Multiple regression analysis demonstrated costs of production per hectare differed by year, geographical location, soil type, level of pasture use, proportion of purchased feed, protein %, kg of fat and protein per cow, dairy farm size, breeding season length, and capital investment in machinery, livestock, and buildings per cow. The results of the analysis revealed that farm net profit per hectare was associated with pasture use per hectare, year, location, soil type, grazing season length, proportion of purchased feed, protein %, kg of fat and protein per cow, dairy farm size, and capital investment in machinery and buildings per cow. Pasture use per hectare was associated with year, location, soil type, stocking rate, dairy farm size, fat %, protein %, kg of fat and protein per cow, farmer age, capital investment in machinery and buildings per cow, breeding season length, and discussion group membership. On average, over the 8-yr period, each additional tonne of pasture dry matter used increased gross profit by €278 and net profit by €173 on dairy farms. Conversely, a 10% increase in the proportion of purchased feed in the diet resulted in a reduction in net profit per hectare by €97 and net profit by €207 per tonne of fat and protein. Results from this study, albeit in a quota limited environment, have demonstrated that the profitability of pasture-based dairy systems is significantly associated with the proportion of pasture used at the farm level, being cognizant of the levels of purchased feed.


Assuntos
Ração Animal , Bovinos , Indústria de Laticínios , Leite/economia , Leite/metabolismo , Animais , Indústria de Laticínios/economia , Indústria de Laticínios/instrumentação , Indústria de Laticínios/métodos , Dieta , Fazendas , Feminino , Poaceae
7.
Ecol Appl ; 25(5): 1187-96, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26485948

RESUMO

A rare opportunity to test hypotheses about potential fishery benefits of large-scale closures was initiated in July 2004 when an additional 28.4% of the 348 000 km2 Great Barrier Reef (GBR) region of Queensland, Australia was closed to all fishing. Advice to the Australian and Queensland governments that supported this initiative predicted these additional closures would generate minimal (10%) initial reductions in both catch and landed value within the GBR area, with recovery of catches becoming apparent after three years. To test these predictions, commercial fisheries data from the GBR area and from the two adjacent (non-GBR) areas of Queensland were compared for the periods immediately before and after the closures were implemented. The observed means for total annual catch and value within the GBR declined from preclosure (2000-2003) levels of 12780 Mg and Australian $160 million, to initial post-closure (2005-2008) levels of 8143 Mg and $102 million; decreases of 35% and 36% respectively. Because the reference areas in the non-GBR had minimal changes in catch and value, the beyond-BACI (before, after, control, impact) analyses estimated initial net reductions within the GBR of 35% for both total catch and value. There was no evidence of recovery in total catch levels or any comparative improvement in catch rates within the GBR nine years after implementation. These results are not consistent with the advice to governments that the closures would have minimal initial impacts and rapidly generate benefits to fisheries in the GBR through increased juvenile recruitment and adult spillovers. Instead, the absence of evidence of recovery in catches to date currently supports an alternative hypothesis that where there is already effective fisheries management, the closing of areas to all fishing will generate reductions in overall catches similar to the percentage of the fished area that is closed.


Assuntos
Recifes de Corais , Pesqueiros , Peixes/fisiologia , Animais , Austrália , Monitoramento Ambiental , Densidade Demográfica
8.
Bone Joint Res ; 4(4): 65-9, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25868938

RESUMO

OBJECTIVES: The evidence base to inform the management of Achilles tendon rupture is sparse. The objectives of this research were to establish what current practice is in the United Kingdom and explore clinicians' views on proposed further research in this area. This study was registered with the ISRCTN (ISRCTN68273773) as part of a larger programme of research. METHODS: We report an online survey of current practice in the United Kingdom, approved by the British Orthopaedic Foot and Ankle Society and completed by 181 of its members. A total of ten of these respondents were invited for a subsequent one-to-one interview to explore clinician views on proposed further research in this area. RESULTS: The survey showed wide variations in practice, with patients being managed in plaster cast alone (13%), plaster cast followed by orthoses management (68%), and orthoses alone (19%). Within these categories, further variation existed regarding the individual rehabilitation facets, such as the length of time worn, the foot position within them and weight-bearing status. The subsequent interviews reflected this clinical uncertainty and the pressing need for definitive research. CONCLUSIONS: The gap in evidence in this area has resulted in practice in the United Kingdom becoming varied and based on individual opinion. Future high-quality randomised trials on this subject are supported by the clinical community. Cite this article: Bone Joint Res 2015;4:65-9.

9.
Nat Commun ; 6: 6029, 2015 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-25585382

RESUMO

Hominin reliance on Oldowan stone tools-which appear from 2.5 mya and are believed to have been socially transmitted-has been hypothesized to have led to the evolution of teaching and language. Here we present an experiment investigating the efficacy of transmission of Oldowan tool-making skills along chains of adult human participants (N=184) using five different transmission mechanisms. Across six measures, transmission improves with teaching, and particularly with language, but not with imitation or emulation. Our results support the hypothesis that hominin reliance on stone tool-making generated selection for teaching and language, and imply that (i) low-fidelity social transmission, such as imitation/emulation, may have contributed to the ~700,000 year stasis of the Oldowan technocomplex, and (ii) teaching or proto-language may have been pre-requisites for the appearance of Acheulean technology. This work supports a gradual evolution of language, with simple symbolic communication preceding behavioural modernity by hundreds of thousands of years.


Assuntos
Paleontologia/métodos , Ensino , Comportamento de Utilização de Ferramentas , Adulto , Animais , Evolução Biológica , Comunicação , Hominidae , Humanos , Linguagem , Comportamento Social , Aprendizagem Verbal
10.
Pediatr Pulmonol ; 50(5): 479-86, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25603969

RESUMO

BACKGROUND: Rates of extubation failure of extremely preterm infants remain high. Analysis of breathing patterns variability during spontaneous breathing under endotracheal tube continuous positive airway pressure (ETT-CPAP) is a potential tool to predict extubation readiness. OBJECTIVE: To investigate if automated analysis of respiratory signals would reveal differences in respiratory behavior between infants that were successfully extubated or not. METHODS: Respiratory Inductive Plethysmography (RIP) signals were recorded during ETT-CPAP just prior to extubation. Signals were digitized, and analyzed using an Automated Unsupervised Respiratory Event Analysis (AUREA). Extubation failure was defined as reintubation within 72 hr. Statistical differences between infants who were successfully extubated or failed were calculated. RESULTS: A total of 56 infants were enrolled and one was excluded due to instability during the ETT-CPAP; 11 out of 55 infants studied failed extubation (20%). No differences in demographics were observed between the success and failure groups. Significant differences on the variability of some respiratory parameters or 'metrics' estimated by AUREA were observed between the 2 groups. Indeed, a simple classification using the variability of two metrics of respiratory behavior predicted extubation failure with high accuracy. CONCLUSION: Automated analysis of respiratory behavior during a short ETT-CPAP period may help in the prediction of extubation readiness in extremely preterm infants.


Assuntos
Algoritmos , Processamento Eletrônico de Dados/métodos , Lactente Extremamente Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Desmame do Respirador/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Feminino , Humanos , Recém-Nascido , Intubação Intratraqueal , Masculino , Pletismografia/métodos
11.
Conf Proc IEEE Eng Med Biol Soc ; 2013: 2295-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24110183

RESUMO

Oximeters are commonly used in abbreviated cardiorespiratory studies (ACS) to monitor blood oxygen saturation and heart rate using the photoplethysmography (PPG) signal. These data are prone to movement artifacts, especially in infants who move or need to be handled often. Therefore segments of PPG data contaminated by movement artifact must be detected as a first stage of analysis. In ACS this identification is generally done manually, by having an expert visually assess the quality of the signal. This is subjective and very time consuming, especially for long data records. For this reason we present a novel detector of PPG movement artifacts that uses moving average filters to remove trends, reduce the effect of white noise, and notch filter pulse-related information. The normalized root mean square of the filtered signal is then used as a detection statistic. We demonstrate its detection properties using a data set from infants recovering from anesthesia, and show that it performs better than other automated methods based on entropy or higher-order statistics. Furthermore, the new method is more robust than the other methods in the presence of large noise.


Assuntos
Artefatos , Movimento/fisiologia , Fotopletismografia/métodos , Processamento de Sinais Assistido por Computador , Algoritmos , Feminino , Humanos , Lactente , Masculino , Curva ROC , Razão Sinal-Ruído
12.
Bone Joint Res ; 2(10): 227-32, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24135556

RESUMO

OBJECTIVES: To conduct a pilot randomised controlled trial to evaluate the feasibility of conducting a larger trial to evaluate the difference in Victorian Institute of Sports Assessment-Achilles (VISA-A) scores at six months between patients with Achilles tendinopathy treated with a platelet-rich plasma (PRP) injection compared with an eccentric loading programme. METHODS: Two groups of patients with mid-substance Achilles tendinopathy were randomised to receive a PRP injection or an eccentric loading programme. A total of 20 patients were randomised, with a mean age of 49 years (35 to 66). All outcome measures were recorded at baseline, six weeks, three months and six months. RESULTS: The mean VISA-A score for the injection group at the primary endpoint of six months was 76.0 (95% confidence interval (CI) 58.3 to 93.7) and for the exercise group was 57.4 (95% CI 38.1 to 76.7). There was no statistically significant difference between these scores (p = 0.171), which was expected from such a pilot study. CONCLUSIONS: This pilot study has been key to providing data to inform a larger study and shows that the methodology is feasible. Cite this article: Bone Joint Res 2013;2:227-32.

13.
Med Teach ; 35(7): e1319-26, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23444887

RESUMO

BACKGROUND/AIMS: The purpose of this study was to explore the attitudes and experiences of leaders responsible for making rapid changes to a medical school curriculum in response to an adverse accreditation report. The new curriculum was based on the principles of problem-based learning ('Discovery Learning'), with changes to the way that students were assessed. METHODS: We conducted semi-structured interviews with leaders responsible for education at the school two and a half years after the adoption of the new curriculum. We coded the resulting transcripts to identify major and minor themes expressed by participants. RESULTS: Thirty-five senior leaders, administrators and course directors were invited for the interview; 14 (40%) were interviewed. Five main themes were noted in the data: (1) organization and control of the curriculum; (2) changes in the practices of teaching and learning; (3) effects on faculty members; (4) sources of resistance and (5) attitudes to curriculum change in general. CONCLUSION: This study demonstrates that major curriculum change can be achieved successfully in a short period of time. This study also illustrates some of the problems associated with making rapid changes to the medical school curriculum, and highlights the importance of attitudes to change amongst the leadership of a medical school.


Assuntos
Acreditação , Currículo/tendências , Educação de Graduação em Medicina/tendências , Aprendizagem Baseada em Problemas , Atitude do Pessoal de Saúde , Humanos , Entrevistas como Assunto , Liderança
14.
Ir J Med Sci ; 182(3): 409-14, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23354493

RESUMO

AIM: The accuracy and inter-observer reliability (IOR) of acetate templating on hard copy X-rays in 33 primary total hip arthroplasties as measured by consultant and trainee surgeons was analyzed to find out how accurate are junior surgeons undertaking specialty training. METHODS: The study was questionnaire-based using a prospective cohort over a 4 weeks period. The Surgeon measurements of acetabular cup, femoral stem and femoral offset sizes were noted following acetate measurements and then compared with the final implant chosen during surgery. RESULTS: Prediction of sizing to within one size of the final match size was 75% accurate for cup and 91% accurate for femoral stem. Prediction of exact femoral offset sizes was 91% accurate. Templating showed strong IOR between senior consultant surgeon and junior trainee registrar within one size for cup (83%) and stem (100%) and for exact hip offset prediction (92%). CONCLUSION: We conclude that acetate templating on hard copy X-rays is beneficial to surgeons to gauge acetabular cup and femoral stem size to within one size range. This further helps in predicting nearly exact femoral offset size.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Ajuste de Prótese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/educação , Artroplastia de Quadril/métodos , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cuidados Pré-Operatórios , Estudos Prospectivos , Desenho de Prótese , Radiografia , Reprodutibilidade dos Testes , Cirurgia Assistida por Computador
15.
J Obstet Gynaecol ; 33(1): 60-3, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23259881

RESUMO

The ageing population of the UK means that demand for urogynaecology services is expected to increase substantially, particularly in patients aged over 65 years. To assess service provision and predict future needs, we reviewed the demographic profile and service requirements of elderly patients referred to our urogynaecology service. We performed a retrospective review of case notes of 125 patients over 65 years of age who attended our urogynaecology clinic within a 6 month period, including comorbidity scoring using a validated instrument. A substantial proportion (56%) of patients did not require hospital-based management, and none of the patients had an adult comorbidity evaluation (ACE-27) score >2. Hence, we recommend assessing patients using the ACE-27 score and not on chronological age alone. A restructuring of urogynaecology services towards better access to community-based clinics is required to reflect the treatment needs of the patient population. This would be in line with national continence care guidance.


Assuntos
Idoso de 80 Anos ou mais/estatística & dados numéricos , Idoso/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Atenção Primária à Saúde , Urologia/estatística & dados numéricos , Feminino , Humanos
16.
BJOG ; 120(2): 200-204, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23190206

RESUMO

OBJECTIVE: To report the numbers of patients having childbirth after pelvic floor surgery in England. DESIGN: Retrospective analysis of Hospital Episode Statistics data. SETTING: Hospital Episode Statistics database. POPULATION: Women, aged 20-44 years, undergoing childbirth after pelvic floor surgery between the years 2002 and 2008. METHODS: Analysis of the Hospital Episode Statistics database using Office of Population, Censuses and Surveys: Classification of Interventions and Procedures, 4th Revision (OPCS-4) code at the four-character level for pelvic floor surgery and delivery, in women aged 20-44 years, between the years 2002 and 2008. MAIN OUTCOME MEASURES: Numbers of women having delivery episodes after previous pelvic floor surgery, and numbers having further pelvic floor surgery after delivery. RESULTS: Six hundred and three women had a delivery episode after previous pelvic floor surgery in the time period 2002-2008. In this group of 603 women, 42 had a further pelvic floor surgery episode following delivery in the same time period. The incidence of repeat surgery episode following delivery was higher in the group delivered vaginally than in those delivered by caesarean (13.6 versus 4.4%; odds ratio, 3.38; 95% confidence interval, 1.87-6.10). CONCLUSIONS: There were 603 women having childbirth after pelvic floor surgery in the time period 2002-2008. The incidence of further pelvic floor surgery after childbirth was lower after caesarean delivery than after vaginal delivery, and this may indicate a protective effect of abdominal delivery.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Distúrbios do Assoalho Pélvico/cirurgia , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Parto Obstétrico/métodos , Inglaterra , Feminino , Humanos , Parto , Distúrbios do Assoalho Pélvico/complicações , Gravidez , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Slings Suburetrais , Incontinência Urinária/etiologia , Procedimentos Cirúrgicos Urológicos/instrumentação
17.
J Bone Joint Surg Br ; 94(1): 28-31, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22219243

RESUMO

Rupture of the tendo Achillis is a common injury with a rising incidence. Traditionally the key question following this injury has been whether or not to operate. However a contemporary Cochrane review highlighted that the method of rehabilitation may also have an important contribution to the outcome. Since this review, various early weight-bearing rehabilitation protocols have been described. Currently evidence points to the use of early functional rehabilitation, regardless of operative or non-operative management. However, there is no consensus on which exact functional rehabilitation protocol should be used. Future research should be directed towards improving our understanding of how the different rehabilitative components interact in the tendo Achillis as it heals.


Assuntos
Tendão do Calcâneo/lesões , Traumatismos dos Tendões/reabilitação , Doença Aguda , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ruptura/reabilitação , Resultado do Tratamento
18.
Br Dent J ; 212(2): 55, 2012 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-22281614
19.
Conf Proc IEEE Eng Med Biol Soc ; 2012: 6333-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23367377

RESUMO

The typical approach for analysis of respiratory records consists of detection of respiratory pauses and elimination of segments corrupted by movement artifacts. This is motivated by established rules used for manual scoring of respiratory events, which focus on pause segmentation and do not define criteria to identify breathing segments. With this strategy, breathing segments can only be inferred indirectly from the absence of abnormalities, yielding an unclear and ambiguous definition. In this work we present novel detectors for synchronous and asynchronous breathing, and compare them with AUREA, a novel system for Automated Unsupervised Respiratory Event Analysis, which performs indirect classification of breathing. Results from analysis of real infant respiratory data show an improvement in the identification of synchronous and asynchronous breathing of 9% and 27% respectively, demonstrating that direct detection of breathing enhances the classification performance.


Assuntos
Respiração , Feminino , Humanos , Recém-Nascido , Masculino
20.
Conf Proc IEEE Eng Med Biol Soc ; 2012: 3316-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23366635

RESUMO

This paper presents an algorithm for the identification of Hammerstein cascades with hard nonlinearities. The nonlinearity of the cascade is described using a B-spline basis with fixed knot locations; the linear dynamics are described using a state-space model. The algorithm automatically estimates both the order of the linear system and the number and locations of the knots used to characterize the nonlinearity. Therefore, it significantly reduces the a priori knowledge about the underlying system required for identification. A simulation study on a model of reflex stiffness shows that the new method estimates the nonlinearity accurately in the presence of output noise.


Assuntos
Algoritmos , Fenômenos Biomecânicos
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