The assessment of competence in cognitively impaired elderly persons: a closer look at the vignette method

This article focuses on the assessment of competence of elderly persons both with and without cognitive impairment. In total 113 patients of a geriatric clinic were interviewed. Competence was assessed by using two clinical vignettes, representing respectively a hypothetical treatment situation with mild consequences (endoscopy) and one with severe consequences (operation for colon cancer). Competence was evaluated using the following standards: the ability to evidence a choice, the ability to understand a situation, the ability to reason about a choice, and the ability to appreciate a situation. In the vignette with mild consequences, elderly persons with cognitive impairment performed significantly worse on understanding, reasoning and appreciation than elderly persons without cognitive impairment. In the vignette with severe consequences, elderly persons with cognitive impairment performed significantly worse only on understanding as compared to elderly persons without cognitive impairment. No differences were found for reasoning and appreciation between the cognitively impaired and non-impaired elderly persons. We conclude that competence is less limited by cognitive impairment when assessed in a treatment situation with severe consequences. Therefore, the use of hypothetical vignettes should be carefully reconsidered.     

A preliminary study for identifying olfactory markers of fear in the rat

In stressful situations, many animals release alarm pheromones to warn conspecifics of impending danger. The authors sought to establish experimental conditions for a larger study aimed at identifying alarm pheromones emitted by the rat. They placed rats in a specially designed chamber and exposed them to aversive tactile, visual and acoustic stimuli over the course of a few days. The researchers observed rats' behavior and analyzed air samples taken from their immediate environment under the following conditions: (i) when rats were unstressed; (ii) immediately after rats were exposed to aversive stimuli; and (iii) when rats were left alone in the chamber after being conditioned to fear imminent aversive stimuli. Stressed rats emitted several substances that are known to function as alarm pheromones in insects. When previously unstressed control rats were exposed to these same substances, they had a distinct behavioral fear response.     

Activity monitoring system for elderly in a context of smart home

The Homecare project which is part of a research project funded by the French National Research Agency (ANR), aims to define and experiment a new multi-sensor monitoring system for the elderly with cognitive disabilities in a care unit. The main objective of this project is to follow activities of patients in their living environment. The system consists in a motion sensors network deployed on different areas of the care unit and in an electronic patch worn by the subject to identify him and detect falls. In order to locate tagged subjects inside the care unit we use a network of anchor points. From these positions and movement data, an analysis algorithm detects an abnormal situation and alerts the nursing staff in real time. A web application allows the medical staff to access movements and alarms. The complete monitoring system is functional for several months and monitor continuously two patients 24/24. The first results are encouraging. Seven out of eight falls were detected with one false alarm every week. Finally, activities monitoring allowed medical staff to tailor a treatment for one subject followed. In this paper, we present the system architecture, the technologies used, and some results.     

Pulsed radio frequency energy (PRFE) use in human medical applications

A number of electromagnetic field-based technologies are available for therapeutic medical applications. These therapies can be broken down into different categories based on technical parameters employed and type of clinical application. Pulsed radio frequency energy (PRFE) therapy is a non invasive, electromagnetic field-based therapeutic that is based on delivery of pulsed, shortwave radio frequency energy in the 13-27.12?MHz carrier frequency range, and designed for local application to a target tissue without the intended generation of deep heat. It has been studied for use in a number of clinical applications, including as a palliative treatment for both postoperative and non postoperative pain and edema, as well as in wound healing applications. This review provides an introduction to the therapy, a summary of clinical efficacy studies using the therapy in specific applications, and an overview of treatment-related safety.     

Low cost multi user multi platform accessible HPLC data acquisition system

Summary A low cost multi user multi platform accessible HPLC data acquisition system has been designed for use in a laboratory environment. This system uses available HPLC measurement systems that lack modern network communication tools and a low cost computer with reliable software. HPLC data are portable to any other computer by means of File Transport Protocol (FTP) communication and can then be used for data analysis. Off line analysis of ethanol data showed a substantial improvement over the old system in terms of data accuracy and skewness. Furthermore, off line data analysis could resolve hidden acetaldehyde peaks which revealed to be oscillatory.     

Remote Safety Monitoring for Elderly Persons Based on Omni-Vision Analysis

Remote monitoring service for elderly persons is important as the aged populations in most developed countries continue growing. To monitor the safety and health of the elderly population, we propose a novel omni-directional vision sensor based system, which can detect and track object motion, recognize human posture, and analyze human behavior automatically. In this work, we have made the following contributions: (1) we develop a remote safety monitoring system which can provide real-time and automatic health care for the elderly persons and (2) we design a novel motion history or energy images based algorithm for motion object tracking. Our system can accurately and efficiently collect, analyze, and transfer elderly activity information and provide health care in real-time. Experimental results show that our technique can improve the data analysis efficiency by 58.5% for object tracking. Moreover, for the human posture recognition application, the success rate can reach 98.6% on average.     

Automated tracking of wild hummingbird mass and energetics over multiple time scales using radio frequency identification (RFID) technology

We examined the feasibility of automating the collection of hummingbird mass data facilitated by low‐cost, low‐power radio frequency identification (RFID) technology. In a field study in southern Ontario, wild hummingbirds were captured, subcutaneously implanted with passive integrated transponder (PIT) tags, and released over a three‐year period. Tagged hummingbirds were detected at specially designed feeder stations outfitted with low‐cost, low‐power RFID readers coupled with a perch secured to a digital balance. When tagged birds visited the feeder, transponder detection initiated the recording of the perched hummingbird's mass at regular intervals continuing as long as the bird remained. This permitted a nearly continuous record of mass during each visit. Mass data collected from tagged hummingbirds showed consistent trends at multiple temporal scales: the individual feeder visit, single days, and even whole seasons. These results further confirm that RFID technology is safe for use in the smallest birds. The effective detection range is a function of RFID reader power, antenna, and tag size. Yet, we find that careful arrangement of feeders and detectors allows for reliable detection even when detection range is low. When coupled with additional technologies, such as a precision electronic balance, this approach can yield robust serial measures of physiological parameters such as mass, an indicator of energy balance over time.     

CIRDO: Smart companion for helping elderly to live at home for longer

Cirdo project is intended to establish new healthcare systems to ensure the safety at home of seniors and people with decreasing independence. In particular, extending “e-lio footnote http://www.technosens.fr/” devise, Cirdo aims to develop an audio/video-based system which makes it possible for elderly to live with a sufficient degree of autonomy. To achieve this goal, generic purposes on video analysis and audio processing are discussed and implemented in the same process. Audio and video analysis algorithms are launched simultaneously and thinks to GPU implementation, the tasks are done in real time. To comply with the requirements set out in the Cirdo project namely: respect privacy and preserve personal data, the processing tasks is performed through background tasks, without any human intrusion. In order to have different types of fall for our experiences, multiple scenarios were designed and performed by several persons. Besides the technical aspect, the project also focuses on generic technology validation by potential users and their human environment (family, caregivers/care takers…). Psychological and ergonomic assessment on the use of services developed was conducted. It focused on the usefulness, usability and accessibility and acceptance of the tool. This evaluation was completed by critical investigation of knowledge acquired by professionals (geriatricians, caregivers school and associations).     

Lessons from the Glass Cockpit: Innovation in Alarm Systems to Support Cognitive Work

Nurses working in the hospital setting increasingly have become overburdened by managing alarms that, in many cases, provide low information value regarding patient health. The current trend, aided by disposable, wearable technologies, is to promote patient monitoring that does not require entering a patient''s room. The development of telemetry alarms and middleware escalation devices adds to the continued growth of auditory, visual, and haptic alarms to the hospital environment but can fail to provide a more complete understanding of patient health. As we begin to innovate to both address alarm overload and improve patient management, perhaps using fundamentally different integration architectures, lessons from the aviation flight deck are worth considering. Commercial jet transport systems and their alarms have evolved slowly over many decades and have developed integration methods that account for operational context, provide multiple response protocol levels, and present a more integrated view of the airplane system state. We articulate three alarm system objectives: (1) supporting hazard management, (2) establishing context, and (3) supporting alarm prioritization. More generally, we present the case that alarm design in aviation can spur directions for innovation for telemetry monitoring systems in hospitals.

Healthcare, and the hospital setting in particular, has experienced rapid growth of auditory, visual, and haptic alarms. These alarms can be notoriously unreliable or can focus on narrowly defined changes to the patient''s state.1 Further, this alarm proliferation has led nursing staff to become increasingly overburdened and distressed by managing alarms.2 Current alarm system architectures do not effectively integrate meaningful data that support increased patient status awareness and management.3 In contrast, commercial jet transports, over many decades, have developed integration methods that account for operational context, provide multiple response protocol levels, and present a more integrated view of airplane state to support operational decision making. Similar methods for advanced control rooms in nuclear power generation have been reviewed by Wu and Li.4In healthcare, The Joint Commission (TJC) and hospital quality departments have generated guidance that further elevates the need to address the industry''s “alarm problem.” In 2014, TJC issued an accreditation requirement (National Patient Safety Goal 06.01.01) titled, “Reduce patient harm associated with clinical alarm systems.”5 This requirement continues to be included in the 2020 requirements for accreditation.From the authors'' perspective, this requirement is leading to solutions that will not effectively support performance of essential tasks and is moving away from the types of innovations that are being sought in aviation and other settings. For example, healthcare administrators advocate categorizing alarms into high-priority (“run”), medium-priority (“walk”), and low-priority (“shuffle”) alarms independent of unit context, hospital context, situational context, and historical patient context.6 In addition, each alarm category is assigned a minimum response time. When nurses do not meet response time targets, administrators may add staff (“telemetry monitor watchers”), increase the volume of alarms, escalate alarms to other staff to respond, increase the “startling” nature of alarms to better direct attention, and benchmark average response times by individual nurse identifiers. Although well intentioned, these approaches can sometimes add to the alarm overload problem by creating more alarms and involving more people in alarm response.The authors, who have investigated human performance in several operational settings, believe that a need exists to reflect more broadly on the role of alarms in understanding and managing a system (be it an aircraft or a set of patients in a hospital department). Most alarms in hospitals signal when a variable is outside a prespecified range that is determined from the patient population (e.g., high heart rate), when a change in cardiac rhythm occurs (e.g., ventricular fibrillation [V-fib]), or when a problem occurs with the alarm system (e.g., change battery). These alarms support shifts in attention when the event being alarmed requires an action by a nurse and when the relative priority of the response is clear in relation to competing demands.Certain alarms are useful for other purposes, such as aiding situation awareness about planned, routine tasks (e.g., an expected event of high heart rate has occurred, which indicates that a staff member is helping a patient to the bathroom). Increasingly, secondary alarm notification systems (SANSs), otherwise known as middleware escalation systems, are incorporating communications through alarms, such as patient call systems, staff emergency broadcasts, and demands for “code blue” teams to immediately go to a patient''s bedside.Thus, alarms are used to attract attention (i.e., to orient staff to an important change). However, from a cognitive engineering perspective, we believe alarms can also be used to support awareness, prioritization, and decision making. That is, the current siloed approach to alarm presentation in healthcare, which is driven by technology, impedes the ability to properly understand and appreciate the implications of alarms. Understanding the meaning and implications of alarms can best be achieved when they are integrated via a system interface that places the alarm in the broader context of system state. We hope that sharing our insights can spur both design and alarm management innovations for bedside telemetry monitoring devices and related middleware escalation systems and dashboards.In this article, we provide insights from human factors research, and from the integrated glass cockpit in particular, to prompt innovation with clinical alarm systems. To draw lessons from aviation and other domains, we conducted a series of meetings among three human factors engineers with expertise in alarm design in healthcare, aviation, nuclear power generation, and military command and control domains. In the process, we identified differences in the design, use, and philosophies for managing alarms in different domains; defined alarm systems; clarified common elements in the “alarm problem” across these domains; articulated objectives for an alarm system that supports a human operator in controlling a complex process (i.e., supervisory control); and identified levels of alarm system maturity. Based on these activities, we assert that:

1. Clinical alarm systems fail to reduce unnecessary complexity compared with the integrated glass cockpit.
2. Aviation and clinical alarm systems share core objectives.
3. The challenges with aviation and clinical alarm systems are similar, including where alarm systems fall short of their objectives.
4. We can demarcate levels in the process of alarm system evolution, largely based on alarm reliability, system integration, and how system state is described. The higher levels point the way for innovation in clinical alarm systems.

     

Emergency calls in the Samu system

The French emergency medical system is public and medical. Named Samu, it is almost entirely managed by anesthesiologists specially trained for emergency medical assistance and advanced medical support. The system comprises a reception and dispatching center for emergency calls, directly connected to police and firemen, but assuring patient confidentiality. This fixed center is managing mobile units which are Medical Intensive Care Ambulances (MICA named Smur in France). The Samu's mission consists in performing urgent individual medical assistance and also medical services for treatment of mass casualties. It is also to find adequate hospital units for the patients, to perform medical transport and to be a consultant for general practitioners in emergency.     

An integrated microprocessor-based fermenter control system

An integrated microprocessor-based fermenter controller was developed in 1980 for an operational environment at Cetus Corp. The main goals in the design and construction of the system were (1) to facilitate scale-up; (2) to provide flexibility and high performance for optimizing fermentation processes; and (3) to be cost-effective for 15 in-house systems. It was also developed to work in conjunction with a laboratory minicomputer for on-line optimization experiments. The controller controls temperature, agitation, dissolved oxygen, pH, and foam throughout each fermentation run without manual intervention. The feedback control parameters have been optimized to provide very accurate control over a wide range of setpoint conditions and under rapidly changing metabolic conditions such as induced during an Escherichia coli batch run. The controller has also been configured to monitor, display, and record each of the controlled variables; support the interactive operator console; and communicate with the laboratory computer. In over 4 years of operation, these systems have met the design goals and have proven to be very reliable. The controller is described, its operational performance presented, and a typical fermentation run delineated.     

Bone Fracture Healing using a Capacitatively Coupled Rffield

A new pulsed radio frequency electric field pattern evolved from bone studies was adopted to accelerate fracture healing in rats. The output of a specially designed signal generator was ca-pacitatively coupled to the fracture site using a pair of stainless steel electrodes. In a series of experiments performed on rats, fractures were induced in the femoral shafts and electrical stimulations were applied to one leg. Bone mass formed in the gap was estimated by measurement of the cortical thickness and by ultrasonic attenuation. We found that the stimulated side showed greater bone mass than the contralateral control. We suggest that. this device offers a simple and reliable method of acclerated healing, immediately after fracture.     

Involuntary human hand movements due to FM radio waves in a moving van

Finland TRACT Involuntary movements of hands in a moving van on a public road were studied to clarify the possible role of frequency modulated radio waves on driving. The signals were measured in a direct 2 km test segment of an international road during repeated drives to both directions. Test subjects (n=4) had an ability to sense radio frequency field intensity variations of the environment. They were sitting in a minivan with arm movement detectors in their hands. A potentiometer was used to register the hand movements to a computer which simultaneously collected data on the amplitude of the RF signal of the local FM tower 30 km distance at a frequency of about 100 MHz. Involuntary hand movements of the test subjects correlated with electromagnetic field, i.e. FM radio wave intensity measured. They reacted also on the place of a geomagnetic anomaly crossing the road, which was found on the basis of these recordings and confirmed by the public geological maps of the area.In conclusion, RF irradiation seems to affect the human hand reflexes of sensitive persons in a moving van along a normal public road which may have significance in traffic safety.     

The effect of body size and habitat on the evolution of alarm vocalizations in rodents

When confronted with a predator, many mammalian species emit vocalizations known as alarm calls. Vocal structure variation results from the interactive effects of different selective pressures and constraints affecting their production, transmission, and detection. Body size is an important morphological constraint influencing the lowest frequencies that an organism can produce. The acoustic environment influences signal degradation; low frequencies should be favoured in dense forests compared to more open habitats (i.e. the ‘acoustic adaptation hypothesis’). Such hypotheses have been mainly examined in birds, whereas the proximate and ultimate factors affecting vocalizations in nonprimate mammals have received less attention. In the present study, we investigated the relationships between the frequency of alarm calls, body mass, and habitat in 65 species of rodents. Although we found the expected negative relationship between call frequency and body mass, we found no significant differences in acoustic characteristics between closed and open‐habitat species. The results of the present study show that the acoustic frequencies of alarm calls can provide reliable information about the size of a sender in this taxonomic group, although they generally do not support the acoustic adaptation hypothesis.     

A method for material parameter determination for the human mandible based on simulation and experiment

In cranio-maxillofacial surgery planning and implant design, it is important to know the elastic response of the mandible to load forces as they occur, e.g., in biting. The goal of the present study is to provide a method for a quantitative determination of material parameters for the human jaw bone, whose values can, e.g., be used to devise a prototype plastic model for the mandible. Non-destructive load experiments are performed on a cadaveric mandible using a specially designed test bed. The identical physiological situation is simulated in a computer program. The underlying mathematical model is based on a two component, linear elastic material law. The numerical realization of the model, difficult due to the complex geometry and morphology of the mandible, is via the finite element (FE) method. Combining the validated simulation with the results of the tests, an inverse problem for the determination of Young's modulus and the Poisson ratio of both cortical and cancellous bone can then be solved.     

Major Concerns in Developing Countries: Applications of the Precautionary Principle in Ecuador

Ecuador is a Latin American country with one of the biggest biodiversities. At the same time, social and environmental problems are also big. Poverty, political and social problems as well as questions like old transport systems, imported hazards from industrialized countries and lack of information and weak health care systems are the framework of this situation. The most common problems are the use of heavy metals in many activities without safety and health protection, a low technological oil production during two decades, intensive use of pesticides in agriculture, and some other chemical risks. A limited capacity to develop prevention strategies, reduced technical and scientific skills, and the absence of a reliable information and control system, lead to a weak response mechanism. The Precautionary Principle could help to stimulate prevention, protection and to have a new tool to improve the interest in environment and health problems. Reinforcing the presence of international organizations like WHO and ILO, establishing bridges among scientific organizations from developed and developing countries and introducing the Precautionary Principle in the legislation and daily practices of industry and agriculture could lead to an improvement in our environment and health.     

Validation of an ambient system for the measurement of gait parameters

Fall risk in elderly people is usually assessed using clinical tests. These tests consist in a subjective evaluation of gait performed by healthcare professionals, most of the time shortly after the first fall occurrence. We propose to complement this one-time, subjective evaluation, by a more quantitative analysis of the gait pattern using a Microsoft Kinect. To evaluate the potential of the Kinect sensor for such a quantitative gait analysis, we benchmarked its performance against that of a gold-standard motion capture system, namely the OptiTrack. The “Kinect” analysis relied on a home-made algorithm specifically developed for this sensor, whereas the OptiTrack analysis relied on the “built-in” OptiTrack algorithm. We measured different gait parameters as step length, step duration, cadence, and gait speed in twenty-five subjects, and compared the results respectively provided by the Kinect and OptiTrack systems. These comparisons were performed using Bland-Altman plot (95% bias and limits of agreement), percentage error, Spearman’s correlation coefficient, concordance correlation coefficient and intra-class correlation. The agreement between the measurements made with the two motion capture systems was very high, demonstrating that associated with the right algorithm, the Kinect is a very reliable and valuable tool to analyze gait. Importantly, the measured spatio-temporal parameters varied significantly between age groups, step length and gait speed proving the most effective discriminating parameters. Kinect-monitoring and quantitative gait pattern analysis could therefore be routinely used to complete subjective clinical evaluation in order to improve fall risk assessment during rehabilitation.     

A Method for Material Parameter Determination for the Human Mandible Based on Simulation and Experiment

In cranio-maxillofacial surgery planning and implant design, it is important to know the elastic response of the mandible to load forces as they occur, e.g., in biting. The goal of the present study is to provide a method for a quantitative determination of material parameters for the human jaw bone, whose values can, e.g., be used to devise a prototype plastic model for the mandible. Non-destructive load experiments are performed on a cadaveric mandible using a specially designed test bed. The identical physiological situation is simulated in a computer program. The underlying mathematical model is based on a two component, linear elastic material law. The numerical realization of the model, difficult due to the complex geometry and morphology of the mandible, is via the finite element (FE) method. Combining the validated simulation with the results of the tests, an inverse problem for the determination of Young's modulus and the Poisson ratio of both cortical and cancellous bone can then be solved.     

Assessment of tissue allograft safety monitoring with administrative healthcare databases: a pilot project using Medicare data

Assess whether Medicare data are useful for monitoring tissue allograft safety and utilization. We used health care claims (billing) data from 2007 for 35 million fee-for-service Medicare beneficiaries, a predominantly elderly population. Using search terms for transplant-related procedures, we generated lists of ICD-9-CM and CPT^® codes and assessed the frequency of selected allograft procedures. Step 1 used inpatient data and ICD-9-CM procedure codes. Step 2 added non-institutional provider (e.g., physician) claims, outpatient institutional claims, and CPT codes. We assembled preliminary lists of diagnosis codes for infections after selected allograft procedures. Many ICD-9-CM codes were ambiguous as to whether the procedure involved an allograft. Among 1.3 million persons with a procedure ascertained using the list of ICD-9-CM codes, only 1,886 claims clearly involved an allograft. CPT codes enabled better ascertainment of some allograft procedures (over 17,000 persons had corneal transplants and over 2,700 had allograft skin transplants). For spinal fusion procedures, CPT codes improved specificity for allografts; of nearly 100,000 patients with ICD-9-CM codes for spinal fusions, more than 34,000 had CPT codes indicating allograft use. Monitoring infrequent events (infections) after infrequent exposures (tissue allografts) requires large study populations. A strength of the large Medicare databases is the substantial number of certain allograft procedures. Limitations include lack of clinical detail and donor information. Medicare data can potentially augment passive reporting systems and may be useful for monitoring tissue allograft safety and utilization where codes clearly identify allograft use and coding algorithms can effectively screen for infections.