Pre Vertical Jump Performance to Regulate the Training Volume

The purpose of this study was to assess the effect of training load regulation, using the CMJ at the beginning of the session, on the total plyometric training load and the vertical jump performance. 44 males were divided into 4 groups: No Regulation Group (nRG), Regulation Group (RG), Yoked Group (YG) and Control Group (CG). The nRG received 6 weeks of plyometric training, with no adjustment in training load. The RG underwent the same training; however, the training load was adjusted according to the CMJ performance at the beginning of each session. The adjustment made in RG was replicated for the volunteers from the corresponding quartile in the YG, with no consideration given to the YG participant's condition at the beginning of its session. At the end of the training, the CMJ and SJ performance of all of the participants was reassessed. The total training load was significantly lower (p=0.036; ES=0.82) in the RG and the YG (1905 +/- 37 jumps) compared to the nRG (1926 +/- 0 jumps). The enhancement in vertical jump performance was significant for the groups that underwent the training (p<0.001). Vertical jump performance, performed at the beginning of the session, as a tool to regulate the training load resulted in a decrease of the total training load, without decreasing the long-term effects on vertical jump performance.

Therapeutisches Drug Monitoring in der ambulanten Psychopharmakotherapie

Während Therapeutisches Drug Monitoring (TDM) im klinischen Alltag der stationären Behandlung in der Psychiatrie bereits fest etabliert ist, kommt es in der ambulanten Betreuung von psychisch Kranken bislang noch selten zum Einsatz. Ziel dieser Arbeit war es zu klären, wie TDM im ambulanten Bereich eingesetzt wird, wann seine Anwendung sinnvoll ist und ob es Hinweise gibt, dass TDM zu einer besseren Psychopharmakotherapie beitragen kann. rnEine Grundvoraussetzung für den Einsatz von TDM ist die Messbarkeit des Arzneistoffes. Am Beispiel des Antipsychotikums Flupentixol wurde eine Quantifizierungsmethode entwickelt, validiert und in die Laborroutine integriert. Die neue Methode erfüllte alle nach Richtlinien vorgegebenen Anforderungen für quantitative Laboruntersuchungen. Die Anwendbarkeit in der Laborroutine wurde anhand von Untersuchungen an Patienten gezeigt. rnEine weitere Voraussetzung für eine TDM-geleitete Dosisanpassung ist die Kenntnis des therapeutischen Referenzbereiches. In dieser Arbeit wurde exemplarisch ein Referenzbereich für das Antipsychotikum Quetiapin ermittelt. Die Untersuchung verglich darüber hinaus die neu eingeführten Arzneiformulierung Quetiapin retard mit schnell freisetzendem Quetiapin. Es zeigte sich, dass die therapiebegleitenden Blutspiegelkontrollen beider Formulierungen mit der Einstellung des Blutspiegels auf den therapeutischen Bereich von 100 - 500 ng/ml die Wahrscheinlichkeit des Therapieansprechens erhöhen. Bei den verschiedenen Formulierungen musste unbedingt auf den Zeitpunkt der Blutentnahmen nach Einnahme geachtet werden.rnEs wurde eine multizentrische Querschnittsuntersuchung zur Analyse von TDM unter naturalistischen Bedingungen an ambulanten Patienten durchgeführt, und zwar in Ambulanzen, in denen TDM als fester Bestandteil der Therapieüberwachung genutzt wurde und in Ambulanzen, in denen TDM sporadisch engesetzt, bzw. neu eingeführt wurde. Nach dieser Erhebung schien die Anwendung von TDM zu einer besseren Versorgung der Patienten beizutragen. Es wurde festgestellt, dass in den Ambulanzen mit bewusster Anwendung von TDM mehr Patienten mit Blutspiegeln im therapeutischen Bereich vorkamen als in den Ambulanzen mit nur sporadisch durchgeführten Blutspiegelmessungen. Bei Letzteren betrug die mittlere Anzahl an Medikamenten pro Patient 2,8 gegenüber 2,2 in den anderen Ambulanzen, was mit höheren Nebenwirkungsraten einherging. Die Schlussfolgerung, dass das Einstellen der Blutspiegel auf den therapeutischen Bereich auch tatsächlich zu besseren Therapieeffekten führte, konnte mit der Studie nicht valide überprüft werden, da die Psychopathologie nicht adäquat abgebildet werden konnte. Eine weitere Erkenntnis war, dass das reine Messen des Blutspiegels nicht zu einer Verbesserung der Therapie führte. Eine Verbesserung der Anwendung von TDM durch die Behandler wurde nach einer Schulung festgestellt, die das Ziel hatte, die Interpretation der Blutspiegelbefunde im Kontext mit patienten- und substanzspezifischen Informationen zu verbessern. Basierend auf dieser Erfahrung wurden Arzneistoffdatenblätter für die häufigsten angewandten Antipsychotika und Antidepressiva entwickelt, um damit die ambulanten Ärzte für eine eigenständige Befundinterpretation zu unterstützen. rnEin weiterer Schwerpunkt der Untersuchungen an ambulanten Patienten war die Aufdeckung von Non-Compliance durch TDM. Ein neu entwickeltes Verfahren, durch Berechnung der Streuung der mittleren Blutspiegel, erwies sich als geeignetes Instrument zur Compliance-Kontrolle in der Clozapin-Langzeittherapie. Es war etablierten anderen Verfahren überlegen. Demnach hatten Patienten ein erhöhtes Rückfallrisiko, wenn der Variationskoeffizient von nur drei nacheinander gemessenen Blutspiegeln größer als 20 % war. Da für die Beurteilung des Variationskoeffizienten das Messen von nur drei aufeinander folgenden Blutspiegeln notwendig war, kann diese Methode leicht in den ambulanten Alltag integriert werden. Der behandelnde Arzt hat so die Möglichkeit, einen rückfallgefährdeten Patienten noch vor seiner psychopathologischen Verschlechterung zu erkennen und ihn beispielsweise durch engmaschigeres Supervidieren vor einem Rückfall zu bewahren.rnAlles in allem konnte durch die eigenen Untersuchungen an psychiatrischen Patienten, die unter naturalistischen Bedingungen behandelt wurden, gezeigt werden, wie die Voraussetzungen für die Anwendung von TDM geschaffen werden, nämlich durch die Etablierung und Validierung einer Messmethode und durch die Evaluierung eines therapeutischen Referenzbereiches und wie TDM bei adäquatem Einsatz, nach Verbesserung der Compliance und des Kenntnisstandes der behandelnden Ärzte im praktischen und theoretischen Umgang mit TDM, die Versorgung ambulanter psychiatrischer Patienten unterstützen kann.

Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation

Cardiac patients after an acute event and/or with chronic heart disease deserve special attention to restore their quality of life and to maintain or improve functional capacity. They require counselling to avoid recurrence through a combination of adherence to a medication plan and adoption of a healthy lifestyle. These secondary prevention targets are included in the overall goal of cardiac rehabilitation (CR). Cardiac rehabilitation can be viewed as the clinical application of preventive care by means of a professional multi-disciplinary integrated approach for comprehensive risk reduction and global long-term care of cardiac patients. The CR approach is delivered in tandem with a flexible follow-up strategy and easy access to a specialized team. To promote implementation of cardiac prevention and rehabilitation, the CR Section of the EACPR (European Association of Cardiovascular Prevention and Rehabilitation) has recently completed a Position Paper, entitled 'Secondary prevention through cardiac rehabilitation: A condition-oriented approach'. Components of multidisciplinary CR for seven clinical presentations have been addressed. Components include patient assessment, physical activity counselling, exercise training, diet/nutritional counselling, weight control management, lipid management, blood pressure monitoring, smoking cessation, and psychosocial management. Cardiac rehabilitation services are by definition multi-factorial and comprehensive, with physical activity counselling and exercise training as central components in all rehabilitation and preventive interventions. Many of the risk factor improvements occurring in CR can be mediated through exercise training programmes. This call-for-action paper presents the key components of a CR programme: physical activity counselling and exercise training. It summarizes current evidence-based best practice for the wide range of patient presentations of interest to the general cardiology community.

A Time-Motion Study of Registered Nurses’ Workflow in Intensive Care Unit Remote Monitoring

Utilizing advanced information technology, Intensive Care Unit (ICU) remote monitoring allows highly trained specialists to oversee a large number of patients at multiple sites on a continuous basis. In the current research, we conducted a time-motion study of registered nurses’ work in an ICU remote monitoring facility. Data were collected on seven nurses through 40 hours of observation. The results showed that nurses’ essential tasks were centered on three themes: monitoring patients, maintaining patients’ health records, and managing technology use. In monitoring patients, nurses spent 52% of the time assimilating information embedded in a clinical information system and 15% on monitoring live vitals. System-generated alerts frequently interrupted nurses in their task performance and redirected them to manage suddenly appearing events. These findings provide insight into nurses’ workflow in a new, technology-driven critical care setting and have important implications for system design, work engineering, and personnel selection and training.

Effect of endurance, speed and strength training on skin temperature measured by infrared thermography = Efecto del entrenamiento de resistencia, velocidad y fuerza en la temperatura de la piel a través de la termografía infrarroja

La termografía infrarroja (TI) es una técnica no invasiva y de bajo coste que permite, con el simple acto de tomar una fotografía, el registro sin contacto de la energía que irradia el cuerpo humano (Akimov & Son’kin, 2011, Merla et al., 2005, Ng et al., 2009, Costello et al., 2012, Hildebrandt et al., 2010). Esta técnica comenzó a utilizarse en el ámbito médico en los años 60, pero debido a los malos resultados como herramienta diagnóstica y la falta de protocolos estandarizados (Head & Elliot, 2002), ésta se dejó de utilizar en detrimento de otras técnicas más precisas a nivel diagnóstico. No obstante, las mejoras tecnológicas de la TI en los últimos años han hecho posible un resurgimiento de la misma (Jiang et al., 2005, Vainer et al., 2005, Cheng et al., 2009, Spalding et al., 2011, Skala et al., 2012), abriendo el camino a nuevas aplicaciones no sólo centradas en el uso diagnóstico. Entre las nuevas aplicaciones, destacamos las que se desarrollan en el ámbito de la actividad física y el deporte, donde recientemente se ha demostrado que los nuevos avances con imágenes de alta resolución pueden proporcionar información muy interesante sobre el complejo sistema de termorregulación humana (Hildebrandt et al., 2010). Entre las nuevas aplicaciones destacan: la cuantificación de la asimilación de la carga de trabajo físico (Čoh & Širok, 2007), la valoración de la condición física (Chudecka et al., 2010, 2012, Akimov et al., 2009, 2011, Merla et al., 2010), la prevención y seguimiento de lesiones (Hildebrandt et al., 2010, 2012, Badža et al., 2012, Gómez Carmona, 2012) e incluso la detección de agujetas (Al-Nakhli et al., 2012). Bajo estas circunstancias, se acusa cada vez más la necesidad de ampliar el conocimiento sobre los factores que influyen en la aplicación de la TI en los seres humanos, así como la descripción de la respuesta de la temperatura de la piel (TP) en condiciones normales, y bajo la influencia de los diferentes tipos de ejercicio. Por consiguiente, este estudio presenta en una primera parte una revisión bibliográfica sobre los factores que afectan al uso de la TI en los seres humanos y una propuesta de clasificación de los mismos. Hemos analizado la fiabilidad del software Termotracker, así como su reproducibilidad de la temperatura de la piel en sujetos jóvenes, sanos y con normopeso. Finalmente, se analizó la respuesta térmica de la piel antes de un entrenamiento de resistencia, velocidad y fuerza, inmediatamente después y durante un período de recuperación de 8 horas. En cuanto a la revisión bibliográfica, hemos propuesto una clasificación para organizar los factores en tres grupos principales: los factores ambientales, individuales y técnicos. El análisis y descripción de estas influencias deben representar la base de nuevas investigaciones con el fin de utilizar la TI en las mejores condiciones. En cuanto a la reproducibilidad, los resultados mostraron valores excelentes para imágenes consecutivas, aunque la reproducibilidad de la TP disminuyó ligeramente con imágenes separadas por 24 horas, sobre todo en las zonas con valores más fríos (es decir, zonas distales y articulaciones). Las asimetrías térmicas (que normalmente se utilizan para seguir la evolución de zonas sobrecargadas o lesionadas) también mostraron excelentes resultados pero, en este caso, con mejores valores para las articulaciones y el zonas centrales (es decir, rodillas, tobillos, dorsales y pectorales) que las Zonas de Interés (ZDI) con valores medios más calientes (como los muslos e isquiotibiales). Los resultados de fiabilidad del software Termotracker fueron excelentes en todas las condiciones y parámetros. En el caso del estudio sobre los efectos de los entrenamientos de la velocidad resistencia y fuerza en la TP, los resultados muestran respuestas específicas según el tipo de entrenamiento, zona de interés, el momento de la evaluación y la función de las zonas analizadas. Los resultados mostraron que la mayoría de las ZDI musculares se mantuvieron significativamente más calientes 8 horas después del entrenamiento, lo que indica que el efecto del ejercicio sobre la TP perdura por lo menos 8 horas en la mayoría de zonas analizadas. La TI podría ser útil para cuantificar la asimilación y recuperación física después de una carga física de trabajo. Estos resultados podrían ser muy útiles para entender mejor el complejo sistema de termorregulación humano, y por lo tanto, para utilizar la TI de una manera más objetiva, precisa y profesional con visos a mejorar las nuevas aplicaciones termográficas en el sector de la actividad física y el deporte Infrared Thermography (IRT) is a safe, non-invasive and low-cost technique that allows the rapid and non-contact recording of the irradiated energy released from the body (Akimov & Son’kin, 2011; Merla et al., 2005; Ng et al., 2009; Costello et al., 2012; Hildebrandt et al., 2010). It has been used since the early 1960’s, but due to poor results as diagnostic tool and a lack of methodological standards and quality assurance (Head et al., 2002), it was rejected from the medical field. Nevertheless, the technological improvements of IRT in the last years have made possible a resurgence of this technique (Jiang et al., 2005; Vainer et al., 2005; Cheng et al., 2009; Spalding et al., 2011; Skala et al., 2012), paving the way to new applications not only focused on the diagnose usages. Among the new applications, we highlighted those in physical activity and sport fields, where it has been recently proven that a high resolution thermal images can provide us with interesting information about the complex thermoregulation system of the body (Hildebrandt et al., 2010), information than can be used as: training workload quantification (Čoh & Širok, 2007), fitness and performance conditions (Chudecka et al., 2010, 2012; Akimov et al., 2009, 2011; Merla et al., 2010; Arfaoui et al., 2012), prevention and monitoring of injuries (Hildebrandt et al., 2010, 2012; Badža et al., 2012, Gómez Carmona, 2012) and even detection of Delayed Onset Muscle Soreness – DOMS- (Al-Nakhli et al., 2012). Under this context, there is a relevant necessity to broaden the knowledge about factors influencing the application of IRT on humans, and to better explore and describe the thermal response of Skin Temperature (Tsk) in normal conditions, and under the influence of different types of exercise. Consequently, this study presents a literature review about factors affecting the application of IRT on human beings and a classification proposal about them. We analysed the reliability of the software Termotracker®, and also its reproducibility of Tsk on young, healthy and normal weight subjects. Finally, we examined the Tsk thermal response before an endurance, speed and strength training, immediately after and during an 8-hour recovery period. Concerning the literature review, we proposed a classification to organise the factors into three main groups: environmental, individual and technical factors. Thus, better exploring and describing these influence factors should represent the basis of further investigations in order to use IRT in the best and optimal conditions to improve its accuracy and results. Regarding the reproducibility results, the outcomes showed excellent values for consecutive images, but the reproducibility of Tsk slightly decreased with time, above all in the colder Regions of Interest (ROI) (i.e. distal and joint areas). The side-to-side differences (ΔT) (normally used to follow the evolution of some injured or overloaded ROI) also showed highly accurate results, but in this case with better values for joints and central ROI (i.e. Knee, Ankles, Dorsal and Pectoral) than the hottest muscle ROI (as Thigh or Hamstrings). The reliability results of the IRT software Termotracker® were excellent in all conditions and parameters. In the part of the study about the effects on Tsk of aerobic, speed and strength training, the results of Tsk demonstrated specific responses depending on the type of training, ROI, moment of the assessment and the function of the considered ROI. The results showed that most of muscular ROI maintained warmer significant Tsk 8 hours after the training, indicating that the effect of exercise on Tsk last at least 8 hours in most of ROI, as well as IRT could help to quantify the recovery status of the athlete as workload assimilation indicator. Those results could be very useful to better understand the complex skin thermoregulation behaviour, and therefore, to use IRT in a more objective, accurate and professional way to improve the new IRT applications for the physical activity and sport sector.

Development of a human movement monitoring system based on wearable devices

It is essential to remotely and continuously monitor the movements of individuals in many social areas, for example, taking care of aging people, physical therapy, athletic training etc. Many methods have been used, such as video record, motion analysis or sensor-based methods. Due to the limitations in remote communication, power consumption, portability and so on, most of them are not able to fulfill the requirements. The development of wearable technology and cloud computing provides a new efficient way to achieve this goal. This paper presents an intelligent human movement monitoring system based on a smartwatch, an Android smartphone and a distributed data management engine. This system includes advantages of wide adaptability, remote and long-term monitoring capacity, high portability and flexibility. The structure of the system and its principle are introduced. Four experiments are designed to prove the feasibility of the system. The results of the experiments demonstrate the system is able to detect different actions of individuals with adequate accuracy.

Non-invasive user monitoring in daily tasks for cognitive rehabilitation

El uso de técnicas para la monitorización del movimiento humano generalmente permite a los investigadores analizar la cinemática y especialmente las capacidades motoras en aquellas actividades de la vida cotidiana que persiguen un objetivo concreto como pueden ser la preparación de bebidas y comida, e incluso en tareas de aseo. Adicionalmente, la evaluación del movimiento y el comportamiento humanos en el campo de la rehabilitación cognitiva es esencial para profundizar en las dificultades que algunas personas encuentran en la ejecución de actividades diarias después de accidentes cerebro-vasculares. Estas dificultades están principalmente asociadas a la realización de pasos secuenciales y al reconocimiento del uso de herramientas y objetos. La interpretación de los datos sobre la actitud de este tipo de pacientes para reconocer y determinar el nivel de éxito en la ejecución de las acciones, y para ampliar el conocimiento en las enfermedades cerebrales, sus consecuencias y severidad, depende totalmente de los dispositivos usados para la captura de esos datos y de la calidad de los mismos. Más aún, existe una necesidad real de mejorar las técnicas actuales de rehabilitación cognitiva contribuyendo al diseño de sistemas automáticos para crear una especie de terapeuta virtual que asegure una vida más independiente de estos pacientes y reduzca la carga de trabajo de los terapeutas. Con este objetivo, el uso de sensores y dispositivos para obtener datos en tiempo real de la ejecución y estado de la tarea de rehabilitación es esencial para también contribuir al diseño y entrenamiento de futuros algoritmos que pudieran reconocer errores automáticamente para informar al paciente acerca de ellos mediante distintos tipos de pistas como pueden ser imágenes, mensajes auditivos o incluso videos. La tecnología y soluciones existentes en este campo no ofrecen una manera totalmente robusta y efectiva para obtener datos en tiempo real, por un lado, porque pueden influir en el movimiento del propio paciente en caso de las plataformas basadas en el uso de marcadores que necesitan sensores pegados en la piel; y por otro lado, debido a la complejidad o alto coste de implantación lo que hace difícil pensar en la idea de instalar un sistema en el hospital o incluso en la casa del paciente. Esta tesis presenta la investigación realizada en el campo de la monitorización del movimiento de pacientes para proporcionar un paso adelante en términos de detección, seguimiento y reconocimiento del comportamiento de manos, gestos y cara mediante una manera no invasiva la cual puede mejorar la técnicas actuales de rehabilitación cognitiva para la adquisición en tiempo real de datos sobre el comportamiento del paciente y la ejecución de la tarea. Para entender la importancia del marco de esta tesis, inicialmente se presenta un resumen de las principales enfermedades cognitivas y se introducen las consecuencias que tienen en la ejecución de tareas de la vida diaria. Más aún, se investiga sobre las metodologías actuales de rehabilitación cognitiva. Teniendo en cuenta que las manos son la principal parte del cuerpo para la ejecución de tareas manuales de la vida cotidiana, también se resumen las tecnologías existentes para la captura de movimiento de manos. Una de las principales contribuciones de esta tesis está relacionada con el diseño y evaluación de una solución no invasiva para detectar y seguir las manos durante la ejecución de tareas manuales de la vida cotidiana que a su vez involucran la manipulación de objetos. Esta solución la cual no necesita marcadores adicionales y está basada en una cámara de profundidad de bajo coste, es robusta, precisa y fácil de instalar. Otra contribución presentada se centra en el reconocimiento de gestos para detectar el agarre de objetos basado en un sensor infrarrojo de última generación, y también complementado con una cámara de profundidad. Esta nueva técnica, y también no invasiva, sincroniza ambos sensores para seguir objetos específicos además de reconocer eventos concretos relacionados con tareas de aseo. Más aún, se realiza una evaluación preliminar del reconocimiento de expresiones faciales para analizar si es adecuado para el reconocimiento del estado de ánimo durante la tarea. Por su parte, todos los componentes y algoritmos desarrollados son integrados en un prototipo simple para ser usado como plataforma de monitorización. Se realiza una evaluación técnica del funcionamiento de cada dispositivo para analizar si es adecuada para adquirir datos en tiempo real durante la ejecución de tareas cotidianas reales. Finalmente, se estudia la interacción con pacientes reales para obtener información del nivel de usabilidad del prototipo. Dicha información es esencial y útil para considerar una rehabilitación cognitiva basada en la idea de instalación del sistema en la propia casa del paciente al igual que en el hospital correspondiente. ABSTRACT The use of human motion monitoring techniques usually let researchers to analyse kinematics, especially in motor strategies for goal-oriented activities of daily living, such as the preparation of drinks and food, and even grooming tasks. Additionally, the evaluation of human movements and behaviour in the field of cognitive rehabilitation is essential to deep into the difficulties some people find in common activities after stroke. This difficulties are mainly associated with sequence actions and the recognition of tools usage. The interpretation of attitude data of this kind of patients in order to recognize and determine the level of success of the execution of actions, and to broaden the knowledge in brain diseases, consequences and severity, depends totally on the devices used for the capture of that data and the quality of it. Moreover, there is a real need of improving the current cognitive rehabilitation techniques by contributing to the design of automatic systems to create a kind of virtual therapist for the improvement of the independent life of these stroke patients and to reduce the workload of the occupational therapists currently in charge of them. For this purpose, the use of sensors and devices to obtain real time data of the execution and state of the rehabilitation task is essential to also contribute to the design and training of future smart algorithms which may recognise errors to automatically provide multimodal feedback through different types of cues such as still images, auditory messages or even videos. The technology and solutions currently adopted in the field don't offer a totally robust and effective way for obtaining real time data, on the one hand, because they may influence the patient's movement in case of marker-based platforms which need sensors attached to the skin; and on the other hand, because of the complexity or high cost of implementation, which make difficult the idea of installing a system at the hospital or even patient's home. This thesis presents the research done in the field of user monitoring to provide a step forward in terms of detection, tracking and recognition of hand movements, gestures and face via a non-invasive way which could improve current techniques for cognitive rehabilitation for real time data acquisition of patient's behaviour and execution of the task. In order to understand the importance of the scope of the thesis, initially, a summary of the main cognitive diseases that require for rehabilitation and an introduction of the consequences on the execution of daily tasks are presented. Moreover, research is done about the actual methodology to provide cognitive rehabilitation. Considering that the main body members involved in the completion of a handmade daily task are the hands, the current technologies for human hands movements capture are also highlighted. One of the main contributions of this thesis is related to the design and evaluation of a non-invasive approach to detect and track user's hands during the execution of handmade activities of daily living which involve the manipulation of objects. This approach does not need the inclusion of any additional markers. In addition, it is only based on a low-cost depth camera, it is robust, accurate and easy to install. Another contribution presented is focused on the hand gesture recognition for detecting object grasping based on a brand new infrared sensor, and also complemented with a depth camera. This new, and also non-invasive, solution which synchronizes both sensors to track specific tools as well as recognize specific events related to grooming is evaluated. Moreover, a preliminary assessment of the recognition of facial expressions is carried out to analyse if it is adequate for recognizing mood during the execution of task. Meanwhile, all the corresponding hardware and software developed are integrated in a simple prototype with the purpose of being used as a platform for monitoring the execution of the rehabilitation task. Technical evaluation of the performance of each device is carried out in order to analyze its suitability to acquire real time data during the execution of real daily tasks. Finally, a kind of healthcare evaluation is also presented to obtain feedback about the usability of the system proposed paying special attention to the interaction with real users and stroke patients. This feedback is quite useful to consider the idea of a home-based cognitive rehabilitation as well as a possible hospital installation of the prototype.

FY 81-SYEP monitoring guide.

Mode of access: Internet.

"Streamlined auditing and monitoring of community based services: first steps toward a more efficient system for providers, state government, and the community" : report to the Illinois General Assembly as required by PA 96-1141 /

The Steering Committee recognizes that the Departments may need to implement reviews necessary to address specific Federal requirements and that while consolidated reporting should be used when possible, the review and reporting processes should facilitate the ability to garner Federal funding. However, the analysis thus far confirms the need for change and a significant potential to reduce redundant monitoring and reporting. At the end of this Executive Summary, there is a summary presentation, including a timeline and progress indicators, that gives more details on these recommendations.

Accuracy of SRM and power tap power monitoring systems for bicycling

Purpose: Although manufacturers of bicycle power monitoring devices SRM and Power Tap (PT) claim accuracy to within 2.5%, there are limited scientific data available in support. The purpose of this investigation was to assess the accuracy of SRM and PT under different conditions. Methods: First, 19 SRM were calibrated, raced for 11 months, and retested using a dynamic CALRIG (50-1000 W at 100 rpm). Second, using the same procedure, five PT were repeat tested on alternate days. Third, the most accurate SRM and PT were tested for the influence of cadence (60, 80, 100, 120 rpm), temperature (8 and 21degreesC) and time (1 h at similar to300 W) on accuracy. Finally, the same SRM and PT were downloaded and compared after random cadence and gear surges using the CALRIG and on a training ride. Results: The mean error scores for SRM and PT factory calibration over a range of 50-1000 W were 2.3 +/- 4.9% and -2.5 +/- 0.5%, respectively. A second set of trials provided stable results for 15 calibrated SRM after 11 months (-0.8 +/- 1.7%), and follow-up testing of all PT units confirmed these findings (-2.7 +/- 0.1%). Accuracy for SRM and PT was not largely influenced by time and cadence; however. power output readings were noticeably influenced by temperature (5.2% for SRM and 8.4% for PT). During field trials, SRM average and max power were 4.8% and 7.3% lower, respectively, compared with PT. Conclusions: When operated according to manufacturers instructions, both SRM and PT offer the coach, athlete, and sport scientist the ability to accurately monitor power output in the lab and the field. Calibration procedures matching performance tests (duration, power, cadence, and temperature) are, however, advised as the error associated with each unit may vary.

The effects of ambient music on simulated anaesthesia monitoring

We examined the effect of no music, classical music or rock music on simulated patient monitoring. Twenty-four non-anaesthetist participants with high or low levels of musical training were trained to monitor visual and auditory displays of patients' vital signs. In nine anaesthesia test scenarios, participants were asked every 50-70 s whether one of five vital signs was abnormal and the trend of its direction. Abnormality judgements were unaffected by music or musical training. Trend judgements were more accurate when music was playing (p = 0.0004). Musical participants reported trends more accurately (p = 0.004), and non-musical participants tended to benefit more from music than did the musical participants (p = 0.063). Music may provide a pitch and rhythm standard from which participants can judge changes in vital signs from auditory displays. Nonetheless, both groups reported that it was easier to monitor the patient with no music (p = 0.0001), and easier to rely upon the auditory displays with no music (p = 0.014).

Routine physiotherapy does not induce cardiorespiratory training effect post-stroke

Background and Purpose. Cardiorespiratory fitness is increasingly being recognized as an impairment requiring physiotherapy intervention after stroke. The present study seeks to investigate if routine physiotherapy treatment is capable of inducing a cardiorespiratory training effect and if stroke patients attending physiotherapy who are unable to walk experience less cardiorespiratory stress during physiotherapy when compared to those who are able to walk. Method. A descriptive, observational study, with heart rate monitoring and video-recording of physiotherapy rehabilitation, was conducted. Thirty consecutive stroke patients from a geriatric and rehabilitation unit of a tertiary metropolitan hospital, admitted for rehabilitation, and requiring physiotherapy were included in the study. The main measures of the study were duration (time) and intensity (percentage of heart rate reserve) of standing and walking activities during physiotherapy rehabilitation for non-walking and walking stroke patients. Results. Stroke patients spent an average of 21 minutes participating in standing and walking activities that were capable of inducing a cardiorespiratory training effect. Stroke patients who were able to walk spent longer in these activities during physiotherapy rehabilitation than non-walking stroke patients (p < 0.05). An average intensity of 24% heart rate reserve (HRR) during standing and walking activities was insufficient to result in a cardiorespiratory training effect, with a maximum of 35% achieved for the stroke patients able to walk and 30% for those unable to walk. Conclusions. Routine physiotherapy rehabilitation had insufficient duration and intensity to result in a cardiorespiratory training effect in our group of stroke patients. Copyright © 2006 John Wiley & Sons, Ltd.

Earcon for intermittent information in monitoring environments

In this paper we discuss the first of a series of experiments evaluating earcons for critical care environments. We examine peoples’ ability to monitor earcons conveying systolic and diastolic blood pressure while conducting a distractor task. The results showed that when a beacon is present prior to the earcon, participants’ judgment of pitch and duration information improved. The results of the study also indicated presence of historical information in the earcon may interfere with participants’ judgments. However, since participants felt more confident in their recall of previous values when the historical information was present, the results may reflect insufficient training.

Embedded progressive-three-layered fiber long-period gratings for respiratory monitoring

A long-period grating (LPG) was written into a progressive three-layered single-mode fiber that was embedded into a flexible platform as a curvature sensor. The spectral location and profile of the LPGs were unaltered after implantation in the platform. The curvature sensitivity was 3.747 nm m with a resolution of ± 1.1 × 10-2 m-1. The bend sensor is intended to be part of a respiratory monitoring system and was tested on a resuscitation training manikin. © 2003 society of Photo-Optical Instrumentation Engineers.

Practices and views on fetal heart monitoring:A structured observation and interview study

Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. © RCOG 2006.