Feeling controlled or being in control? Apps for self-management among older people with neurological disability.

PURPOSE: The aim of this paper was to describe how people living with a neurological disability such as multiple sclerosis, Parkinson's disease and stroke reason regarding using apps to facilitate self-management in everyday life. MATERIAL AND METHODS: A qualitative research approach with a focus group methodology was used. The sample comprised 16 participants, 11 men and 5 women, with an average age of 64 years (ranging from 51-80 years). Six participants were diagnosed with multiple sclerosis, six with Parkinson's disease and four with stroke. Data were analyzed using thematic analysis, which is a method for identifying, analyzing and reporting patterns. RESULTS: The results formed two themes. The first theme "using apps to have control of my health" comprises two subthemes; "monitor and take responsibility for a healthy lifestyle" and "compensate to facilitate everyday life". The second theme "using the app as a tool and means for communication" also comprised two subthemes; "dare to trust the app" and "feeling safe when sharing information with health care professionals". CONCLUSIONS: The use of apps put increased responsibility on the person and had the possibility to make them more involved in their own care. The use of an app can facilitate a healthy lifestyle and help to monitor disease-specific symptoms. In order to be able to use apps for communication with the health care sector legislation and safety issues need to be considered.Implications for rehabilitationApps can be used for self-management if they are safe and can be trusted.People with neurological disabilities want to be involved in their healthcare and needs to be addressed by health care professionals.The use of apps grasp over a wide variety of areas this is something that may be considered in health care and something that can be addressed by interdisciplinary approaches.Ordinary health-oriented apps and disease-specific apps were used differently and for different purposes.

Performance Scaling in Magnetized Liner Inertial Fusion Experiments.

We present experimental results from the first systematic study of performance scaling with drive parameters for a magnetoinertial fusion concept. In magnetized liner inertial fusion experiments, the burn-averaged ion temperature doubles to 3.1 keV and the primary deuterium-deuterium neutron yield increases by more than an order of magnitude to 1.1×10^{13} (2 kJ deuterium-tritium equivalent) through a simultaneous increase in the applied magnetic field (from 10.4 to 15.9 T), laser preheat energy (from 0.46 to 1.2 kJ), and current coupling (from 16 to 20 MA). Individual parametric scans of the initial magnetic field and laser preheat energy show the expected trends, demonstrating the importance of magnetic insulation and the impact of the Nernst effect for this concept. A drive-current scan shows that present experiments operate close to the point where implosion stability is a limiting factor in performance, demonstrating the need to raise fuel pressure as drive current is increased. Simulations that capture these experimental trends indicate that another order of magnitude increase in yield on the Z facility is possible with additional increases of input parameters.

The Use of Apps for Health in Persons with Multiple Sclerosis, Parkinson's Disease and Stroke - Barriers and Facilitators.

INTRODUCTION: The importance of mobile health has increased during recent years but few studies have described the use of apps among persons with neurological disabilities. AIM: The aim of this paper was to describe how persons ageing with a neurological disability experience barriers and facilitators in relation to using apps in everyday life. METHOD: A qualitative approach was used. 16 persons with neurological disorders participated in two group discussions. Data were analyzed by content analysis. RESULTS: The analysis formed four categories; Impairments make apps harder to use, Use of apps is increased by learnability and sharing, Valuating the information in an app, and Apps act supportive and motivating. CONCLUSION: The participants used apps in the same way as persons without disabilities. Impairments and trustworthiness were perceived as barriers, which need to be acknowledged when developing apps for this population. Use of apps was facilitated by the possibility to share data and to connect with others. Apps may have the potential to improve self-management for persons ageing with disabilities but further research is needed.

HIGH-PRESSURE PHYSICS. Direct observation of an abrupt insulator-to-metal transition in dense liquid deuterium.

Eighty years ago, it was proposed that solid hydrogen would become metallic at sufficiently high density. Despite numerous investigations, this transition has not yet been experimentally observed. More recently, there has been much interest in the analog of this predicted metallic transition in the dense liquid, due to its relevance to planetary science. Here, we show direct observation of an abrupt insulator-to-metal transition in dense liquid deuterium. Experimental determination of the location of this transition provides a much-needed benchmark for theory and may constrain the region of hydrogen-helium immiscibility and the boundary-layer pressure in standard models of the internal structure of gas-giant planets.

Non-intercepted dose errors in prescribing anti-neoplastic treatment: a prospective, comparative cohort study.

BACKGROUND: The incidence of non-intercepted prescription errors and the risk factors involved, including the impact of computerised order entry (CPOE) systems on such errors, are unknown. Our objective was to determine the incidence, type, severity, and related risk factors of non-intercepted prescription dose errors. PATIENTS AND METHODS: A prospective, comparative cohort study in two clinical oncology units. One institution used a CPOE system with no connection to the electronic patient record system, while the other used paper-based prescription forms. All standard prescriptions were included and reviewed. Doses were recalculated according to the guidelines of each institution, using the patient data as documented in the patient record, the paper-based prescription form, or the CPOE system. A non-intercepted prescription dose error was defined as ≥10% difference between the administered and the recalculated dose. RESULTS: Data were collected from 1 November 2012 to 15 January 2013. A total of 5767 prescriptions were evaluated, 2677 from the institution using CPOE and 3090 from the institution with paper-based prescription. Crude analysis showed an overall risk of a prescription dose error of 1.73 per 100 prescriptions. CPOE resulted in 1.60 and paper-based prescription forms in 1.84 errors per 100 prescriptions, i.e. odds ratio (OR) = 0.87 [95% confidence interval (CI) 0.59-1.29, P = 0.49]. Fifteen different types of errors and four potential risk factors were identified. None of the dose errors resulted in the death of the patient. CONCLUSIONS: Non-intercepted prescribing dose errors occurred in <2% of the prescriptions. The parallel CPOE system did not significantly reduce the overall risk of dose errors, and although it reduced the risk of calculation errors, it introduced other errors. Strategies to prevent future prescription errors could usefully focus on integrated computerised systems that can aid dose calculations and reduce transcription errors between databases.

Probing the interiors of the ice giants: shock compression of water to 700 GPa and 3.8 g/cm³.

Recently, there has been a tremendous increase in the number of identified extrasolar planetary systems. Our understanding of their formation is tied to exoplanet internal structure models, which rely upon equations of state of light elements and compounds such as water. Here, we present shock compression data for water with unprecedented accuracy that show that water equations of state commonly used in planetary modeling significantly overestimate the compressibility at conditions relevant to planetary interiors. Furthermore, we show that its behavior at these conditions, including reflectivity and isentropic response, is well-described by a recent first-principles based equation of state. These findings advocate that this water model be used as the standard for modeling Neptune, Uranus, and "hot Neptune" exoplanets and should improve our understanding of these types of planets.

Changing the diffusion mechanism of Ge-Si dimers on Si(001) using an electric field.

We change the diffusion mechanism of adsorbed Ge-Si dimers on Si(001) using the electric field of a scanning tunneling microscope tip. By comparing the measured field dependence with first-principles calculations we conclude that, in negative field, i.e., when electrons are attracted towards the vacuum, the dimer diffuses as a unit, rotating as it translates, whereas, in positive field the dimer bond is substantially stretched at the transition state as it slides along the substrate. Furthermore, the active mechanism in positive fields facilitates intermixing of Ge in the Si lattice, whereas intermixing is suppressed in negative fields.

Laminar growth of ultrathin metal films on metal oxides: Co on hydroxylated alpha-Al2O3(0001).

Metals deposited in vacuum on metal oxides such as alumina normally grow as three-dimensional clusters because of weak adatom-substrate interactions. This tendency hinders our ability to form interfaces of ultrathin, laminar metal films on oxides for use in microelectronics and other technologies where nanostructural control is desired. We present experimental and theoretical results showing that room temperature Co deposition on fully hydroxylated clean sapphire (alpha-Al2O3) produces a surface chemical reaction that leads to laminar growth, despite a large mismatch in lattice constants. This process should be applicable to a wide range of metals and metal oxides.

Implant treatment without bone grafting in severely resorbed edentulous maxillae.

PURPOSE: This article describes the surgical technique for implant treatment in severely resorbed edentulous maxillae without any alveolar reconstruction before or combined with implant placement. PATIENTS AND MATERIAL: Fifteen patients with severely resorbed edentulous maxillae were treated with osseointegrated implants and fixed dental prostheses. All patients were initially considered to be treated with bone grafting because of a lack of sufficient bone volume for conventional treatment. Preoperative radiographic examinations showed that the height of the alveolar crest was on average 7.4 mm at the 4-mm-width level (Classes V to VI). RESULTS: By fenestration of the maxillary sinus and uncovering the nasal floor, the maxillary bone could be visualized and used maximally for installation of implants. By angulation of the implants and permitting two to five uncovered fixture threads on the palatal aspect, implants of optimal length could be installed. Eighty-six implants were placed (four to six implants in every patient). One implant was lost during the observation time (range, 36 to 54 months; mean, 45 months). All patients had stable fixed prostheses at the end of the observation time. CONCLUSION: This cost-effective surgical technique may be considered as an alternative to more resource-demanding techniques such as bone grafting in patients with severely resorbed edentulous maxillae. However, further prospective comparative studies are necessary for full evaluation.

Immunological responses to maxillary on-lay allogeneic bone grafts.

4 patients with severely resorbed maxillae underwent rehabilitation with on-lays of allogeneic femoral head bone grafts, titanium implants (Brånemark System) and fixed prostheses. Donors and recipients were matched according to blood groups (ABO/Rh). Potential immunological responses were monitored by determining autoantibodies in peripheral blood, and inflammatory reactions in the recipient site. Biopsies from the bone graft 6 months after grafting showed vital bone. After a mean observation period of 19.5 months, 22 of 23 implants were osseointegrated. None of the investigated autoantibodies were detected in peripheral blood, and there was no local inflammatory response. Allogeneic bone grafts in combination with titanium implants can be used in reconstruction of edentulous severely resorbed maxillae without immunological reactions directed against the graft.

Oral and nutritional status in allogeneic marrow recipients treated with T-cell depletion or cyclosporine combined with methotrexate to prevent graft-versus-host disease.

To investigate how the use of T-cell-depleted marrow or a combination of cyclosporine and methotrexate to prevent graft-versus-host disease affect oral health and the ability to maintain adequate nutrition during the neutropenic phase after allogeneic bone marrow transplantation, 48 allogeneic bone marrow recipients were studied. From a group of adult leukemic marrow recipients of HLA identical sibling marrow, 23 patients were randomly chosen to receive T-cell-depleted marrow and 25 were selected to receive cyclosporine and four doses of methotrexate to prevent graft-versus-host disease. Before the transplantation, all patients were given all necessary dental treatment as well as oral hygiene and nutrition instructions. The oral mucosal and nutritional status in all patients (except one who died) were followed from 5 days before the procedure, during the neutropenic period after transplantation, and until discharge from the hospital. The number of oral lesions was similar in both groups. The subjective experience of orally related problems, such as pain from the oral cavity and number of days with total parenteral nutrition, was less in the T-cell-depleted recipients compared with those who received a graft-versus-host disease prophylaxis with cyclosporine and methotrexate (p less than 0.005). The oral cavity was considered to be the port of entry in four of six patients in the cyclosporine and methotrexate group who developed septicemia, compared with only one of six patients in the T-cell-depleted group with septicemia. The difference in the frequency of septicemia derived from the oral cavity did not, however, reach the significant level.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative immunological analysis of the oral mucosa in chronic graft-versus-host disease and oral lichen planus.

Oral mucosal biopsies of 12 allogeneic marrow transplant recipients with chronic graft-versus-host disease (GVHD) involving the mouth were compared with biopsies taken before transplantation. They were also compared with biopsies from otherwise healthy patients with oral lichen planus, and with those from a control group of normal individuals. Biopsies from chronic GVHD exhibited a low number of infiltrating T lymphocytes (CD3 cells) compared with those from oral lichen planus, which showed intense cell infiltration (p less than 0.005). The ratio of CD4 to CD8 cells in biopsies taken after the manifestation of chronic GVHD exhibited no consistent variation compared with those taken before transplantation or with biopsies of oral lichen planus. The CD4/CD8 ratio in all groups investigated varied between 4:1 and 6:1. The number of natural killer cells (CD57), was increased in biopsy specimens taken before transplantation compared with the other groups. The frequency of homing receptor, Leu-8 bearing T cells was low in the biopsy specimens of all groups, compared with the corresponding frequency in peripheral blood (10-45 and 60-90%, respectively; p less than 0.001). In the biopsies from chronic GVHD and oral lichen planus the number of lymphocytes with transferrin receptors was increased compared with the pretransplant and control groups. Virtually no infiltrating cells were carrying interleukin-2 receptors (CD25) in any of the groups studied. Langerhans cells (CD1) were more frequently found in the specimens from chronic GVHD and oral lichen planus than in the pretransplant specimens and the control group (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Alterations in taste acuity associated with allogeneic bone marrow transplantation.

Taste detection and recognition thresholds were monitored in 10 patients for up to 1 yr after allogeneic bone marrow transplantation (BMT). As well as a control group of 12 healthy volunteers, taste acuity was tested in 10 patients, who had undergone BMT 2-5 yr previously. Immediately after transplantation, there was significant hypogeusia of all four taste modalities compared to registrations one week before the aplastic phase and also compared to the healthy control group. Although some normalization of taste thresholds was registered 3-6 months after transplantation, most subjects still experienced dysgeusia. Of the four taste modalities, the most frequently recorded change was a raised threshold for salt. In about 80% of the patients taste acuity had recovered to the control values one year after transplantation. The group tested 2-5 yr after BMT had normal values for taste acuity.

Variables predicting oral mucosal lesions in allogenic bone marrow recipients.

One hundred and forty-eight (72%) of 205 allogenic bone marrow transplant recipients developed mucosal lesions in the oral cavity during the aplastic period after transplantation. Lesions were most frequent 8 to 9 days after transplantation. Factors that correlated with the development of mucosal lesions after univariate and multivariate analysis were a marrow cell dose of less than 3 x 10(8) cells/kg body weight, (p less than 0.0001), prolonged aplastic period (white blood cell count less than 0.2 x 10(9) cell/l during more than 14 days (p less than 0.005), herpes simplex virus-1 seropositivity of the recipient (p less than 0.01), and conditioning with total body irradiation (p less than 0.02).

Mycetoma: comparison of MR imaging with CT.

Magnetic resonance (MR) images obtained in 18 patients with pathologically confirmed mycetoma in the body (n = 4) or lower extremity (n = 14) were retrospectively reviewed and compared with computed tomographic (CT) scans in 15 patients and surgical findings in 10. T1-weighted images showed an infiltrating mass (same signal intensity as muscle) involving skin, subcutaneous fat, muscles, tendons, and other tissues. On T2-weighted images, the mass and affected structures showed moderately increased signal intensity. Bone marrow involvement was detected in seven patients and was best visualized on T1-weighted images. CT showed moderate enhancement of the infiltrative process in all patients. Bone changes, seen in nine, included coarse trabeculation, periosteal reaction, endosteal proliferation, and patchy destruction. MR imaging and CT were comparable and correlated well with surgery in showing the extent of soft-tissue involvement. Early bone changes (important for therapy planning for pedal mycetoma) were seen only at CT. The study showed that MR imaging is sensitive for assessing the extent of mycetoma in the soft tissues. CT should be the method of choice for staging pedal lesions because it can be used to detect early bone involvement.

Craniofacial growth in bone marrow transplant recipients treated with growth hormone after total body irradiation.

The effect of growth hormone (GH) treatment on craniofacial development was studied in five children exhibiting growth retardation following bone marrow transplantation. Linear and angular measurements were made on lateral radiographic cephalograms taken prior to the start of GH treatment and after an average treatment time of 1.2 yr. The results showed that the mean growth increments of mandibular length in the GH treated children, exceeded the corresponding values of the control group by 150% during the period of investigation. It is suggested that this dimensional increase in the patients was due to GH stimulation on the chondral growth process in the mandibular condyles.

MR imaging of thoracic and abdominal wall infections: comparison with other imaging procedures.

Infections of the chest and abdominal wall are rare but potentially fatal disorders that can occur spontaneously or in association with diabetes mellitus, immunosuppression, or trauma. The condition (either in the form of necrotizing fasciitis and/or pyomyositis) is difficult to diagnose clinically because of poor localizing signs. Prognosis depends on early recognition, extent of disease, and type of causative organism. Pathologically, the infections can manifest as cellulitis, abscess, and/or granulation tissue formation. To determine the value of MR imaging in the assessment of these infections, we compared the findings of MR with those of CT, sonography, scintigraphy, and plain radiography in 13 patients with proved thoracic and/or abdominal wall infection. The imaging findings were correlated with microbiological, pathologic, and/or surgical data. The isolated pathogens were Staphylococcus aureus (n = 6), Klebsiella pneumoniae (n = 1), Mycobacterium tuberculosis (n = 4), and Streptomyces somaliensis (n = 2). In 10 of 13 patients, MR imaging and CT were comparable and proved accurate in detecting the nature and extent of the inflammatory process. In seven of the patients, CT also was useful in guiding percutaneous biopsy and/or partial drainage procedures. Coronal and sagittal MR images were helpful for planning surgery. Rib osteomyelitis was missed with both techniques in one patient; in two other patients who did not have CT, MR imaging missed osteomyelitis of the ribs, the spinous process of a vertebral body, and the iliac bone. Sonography underestimated the extent of the disease in all 13 patients, but detected fluid collections in six. Findings on scintigraphy and plain radiography were the least contributory to the diagnosis and treatment of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiographically detectable degenerative changes of the lumbar spine among concrete reinforcement workers and house painters.

In this study of lumbar degeneration and the role of mechanical loading in its development, lateral lumbar radiographs of 216 concrete reinforcement workers and 201 house painters aged 25-54 years were examined. Disc space narrowing occurred at about 10 years and spondylophytes at about 5 years younger age in the former than in the latter group. Risk ratios (RR) were estimated from the regression coefficients of logistic regression models. RR for the univariate effect of occupation on disc space narrowing was 1.8, and adjustment for age, earlier back accidents, height, body mass index and smoking had only a minor effect on this relationship, adjusted RR 1.8. The crude RR for spondylophytes was 1.5, and the adjusted RR 1.6. Earlier back accidents showed a significant univariate relationship with DSN, but in multivariate analysis this variate did not retain its significance. It was concluded that heavy physical work enhances the degenerative process of the lumbar spine. Materials handling and postural loading are proposed to be occupational factors of importance in the development of both disc space narrowing and spondylophytes.

A longitudinal comparative histometric study of the biocompatibility of three local hemostatic agents.

The biocompatibility was studied of 3 hemostatic agents (Astroplast, Hemastogen and bone wax) implanted into experimental bone cavities together with their clearance from the implantation sites. The 3 agents had an acceptable hemostatic effect during the surgical procedure. However, marked differences regarding tissue reactions in the experimental bone cavities, as well as at the internal bone surfaces, were found between them. Astroplast and Hemastogen appear to provoke more adverse tissue reactions, including foreign body giant cell formation, compared with bone wax. All 3 hemostatic implants showed markedly delayed bone healing. It was concluded that their biocompatibility was not ideal but acceptable in view of the clinical advantages.