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A27 DEVELOPMENT OF A LUNG VOLUME RECRUITMENT ADHERENCE MEASUREMENT DEVICE FOR TETRAPLEGIC PATIENTS O.D. Khan, B , MD; D. McKim, MD, FRCPC, FCCP, ABSM. Division of Pulmonary Rehabilitation Services, Department of Medicine, University of Ottawa, The Rehabilitation Centre, Ottawa, Ontario, Canada Objectives: To develop an accurate, dependable and practical method of measuring adherence to lung volume recruitment LVR ; in tetraplegic patients. Methods: A resuscitation bag equipped with an extension tube, mouth piece and one-way valve is routinely used for breath-stacking LVR ; and maintenance of pulmonary health in spinal cord injured patients at The Rehabilitation Centre TRC ; . This standard equipment was fitted with a minimumthreshold pressure triggered digital counting device and a mouth piece pressure activation switch. Activation of the device required simultaneous depression of the switch embedded within the mouth piece and sufficient air pressure sensed by the counting device. Patients were instructed on how to use the apparatus appropriately and were aware of its intention to measure adherence to LVR but were blinded to the precise method of its recording. This setup was created to make it extremely difficult for patients to deceive the measurement device. Validation of the LVR counting device was performed in mid-to-lower level C4-C8 ; tetraplegic patients at TRC. Counts of LVR in the form of stacked breaths were recorded by the device over a one week period and compared for accuracy to those recorded by an experienced health care provider observing patient use of LVR gold standard ; . Results: Preliminary results have shown this LVR counting device to be greater than 98% accurate in measurement of patient use of LVR. Minimal undercounting occurred rarely. The addition of the recording equipment adds very little weight and does not interfere with patient use. Data on additional patients is currently being collected for analysis. The device is capable of continuously collecting data for up to one year. Longer-term use in the home-based setting is currently being evaluated. Conclusions: This device appears accurate in measurement of patient adherence to LVR. Obtaining data on patient adherence to LVR will provide a better understanding of factors that influence its usage among spinal cord injured individuals as a method of maintaining pulmonary health. Additional data collection is ongoing in the acute rehabilitation setting. Further studies will involve longer-term data collection and determination of patient adherence in an outpatient setting.
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The reason for such a low number could be that NCC is indolent in many patients. Tapeworms usually survive for 3-7 years and some may live as long as 25 years 1 ; . Lack of clinical manifestations in NCC, and the fact that many patients could remain asymptomatic for a long term, even with severe infections 20 ; , makes the detection of NCC a challenge. This can create added confusion when clinical criteria for example: seizure should be the presenting complaint ; alone is used for entry in to a prospective epidemiological study. Alternatively, we believe that NCC is indeed uncommon in this part of the country. Kerala State in this respect is acknowledged for its high literacy rate 90% ; , low infant mortality rate IMR ; , improved health status and efficiency of health delivery system as compared to other states in India 16 ; . This has been made possible by the dual efforts of government and people participation in implementing public policies. We firmly believe that provision of sanitary water supplies, absence of pig dwelling, improved personal hygiene, washing and cooking of vegetables and meat under hygienic conditions have all contributed to this low occurrence of NCC in Kerala. Nevertheless, we suggest that a case-control population study is urgently needed to address these issues in a more comprehensive manner.
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Family research and child-care, health impacts and outcomes; parenting; attachment patterns; family structure; impact of poverty; abuse specific childhood and youth-related conditions: causal factors, prevention, early identification, treatment and long term management including school-related issues application of clinical interventions in the child and adolescent populations impacts of health status in early life on adult health outcomes development: molecular, genetic, cellular, tissue, organ, systems, and whole organism approaches development and implementation of health technologies and tools e.g. imaging, diagnostics, medical devices ; ethics issues related to research, care strategies, and access to care e.g. embryo research, informed consent for minors, economic impacts of pre-term birth ; Abstract submitted by: John Challis, Scientific Director Loretta Wong, Institute Liaison CIHR Institute of Human Development, Child and Youth Health 3. Institute of Nutrition, Metabolism and Diabetes The CIHR Institute of Nutrition, Metabolism and Diabetes will support research to enhance health in relation to diet, digestion, excretion, and metabolism; and to address causes, prevention, screening, diagnosis, treatment, support systems, and palliation for a wide range conditions and problems associated with hormone, digestive system, kidney, and liver function. Research areas include but are not limited to: health promotion policies and strategies individual, community, and population based understanding motivations for healthy living practices e.g. eating habits ; health determinantsto elucidate the multi-dimensional factors that affect the health of populations and lead to a differential prevalence of health concerns identification of health advantage and health risk factors related to the interaction of environments cultural, social, psychological, behavioural, physical, genetic ; disease and disability prevention strategies at the individual and population levels nutrition, food and health: population and life-cycle nutrient use and requirements; pathogenesis of nutrient imbalance; non-oral feeding strategies; food production techniques and food handling clinical research and health outcomes research into diagnostic technologies and methods; therapies e.g. drug therapies, surgical or behavioural interventions treatment, care, and rehabilitation strategies long and short-term ; conditions related to hormone, digestive, kidney, liver or basic metabolic function e.g. diabetes, stomach ulcers, Crohn's disease, kidney failure, hepatitis, obesity ; design and implementation of health services deliveryfrom prevention, to screening, to diagnosis, to intervention or treatment, to rehabilitation, to palliation.
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Sreekumar, Anuroop, see Cheok, Adrian David, Apr.June, pp. 6269. Storz, Oliver, Adrian Friday, Nigel Davies, Joe Finney, Corina Sas, and Jennifer Sheridan, "Public Ubiquitous Computing Systems: Lessons from the eCampus Display Deployments, " JulySept., pp. 4047. Strangio, Maurizio Adriano, see Me, Gianluigi. Strassberger, Markus, see Kosch, Timo. Sun Jie, see Pan, Gang. Surana, Sonesh, see Brewer, Eric. Synnes, Kre, see Drugge, Mikael. Tanenbaum, Andrew S., see Rieback, Melanie R. Thamsirianunt, Manop, see Opasjumruskit, Karn. Thanachayanont, Apinunt, see Opasjumruskit, Karn. Thang, Le Nam, see Cheok, Adrian David. Thanthipwan, Thaweesak, see Opasjumruskit, Karn. Thiesse, Frdric, Markus Dierkes, and, because coumadin.
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Historically, community mental health services Observations and Opportunities have been funded through a combination of state grants to local providers and Medicaid funding for Indiana has experienced significant growth in the Medicaid Rehabilitation Option for persons those persons eligible for Medicaid. In the 1990s, with serious mental illness. states across the country experienced significant Indiana's experience is not significantly increases in Medicaid financed mental health different than the national experience. services. Nationally, Medicaid expenditures for Indiana operates a largely public sector mental mental health services increased 69 percent from health system. A further review of Medicaid fiscal year 1997 to fiscal year 2001, 167 and Medicaidand non-Medicaid mental health and substance abuse service provision could funded services are a growing percentage of total provide insight into opportunities for expenditures on mental health services. This trend public private partnerships in operating the has resulted primarily from aggressive federal fund mental health system. maximization strategies on the part of states. Notwithstanding this financing shift, Medicaid remains but one of many funding streams in the public mental health system. Delivery of mental health services generally occurs in institutions and in outpatient community settings, with an increasing reliance on the Medicaid rehabilitation services option for community funding. The Indiana Division of Mental Health and Addiction is responsible for oversight and delivery of mental health services. Mental health services in Indiana are delivered in six state psychiatric hospitals and in the community through a network of public community mental health centers that provide or coordinate care. Inpatient and community services are available to all persons with severe and persistent mental illness, regardless of Medicaid eligibility. The administration of the delivery of behavioral health services, including mental health and substance abuse services, varies by state. Some states have chosen to blend Medicaid and nonMedicaid mental health and substance abuse funds and services into a single system of care. Some of these states use an outside contractor to manage the delivery of services within the entire Medicaid public mental health system under one of the following two models: a carved-out model168 for behavioral health services managed through an at-risk contract with a behavioral health organization, or, for example, hcl.
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Henics, T., Nagy, E., Oh, H. J., Csermely, P., von Gabain, A. and Subjeck, J. R. 1999 ; . Mammalian Hsp70 and Hsp110 proteins bind to RNA motifs involved in mRNA stability. J Biol Chem. 274, 17318-17324. Huttinger, R., Staffler, G., Majdic, O. and Stockinger, H. 1999 ; . Analysis of the early biogenesis of CD1b: involvement of the chaperones calnexin and calreticulin, the proteasome and beta 2 ; -microglobulin. Int Immunol. 11, 1615-1623. Kanda, K., Kempkes, B., Bornkamm, G. W., von Gabain, A. and Decker, T. 1999 ; . The Epstein-Barr virus nuclear antigen 2 EBNA2 ; , a protein required for B lymphocyte immortalization, induces the synthesis of type I interferon in Burkitt's lymphoma cell lines. Biol Chem. 380, 213-221. Kircheis, R., Schuller, S., Brunner, S., Ogris, M., Heider, K.H., Zauner, W. and Wagner E. 1999 ; . Polycation-based DNA complexes for tumor-targeted gene delivery in vivo. J Gene Med. 1, 111-120. Koch, C., Staffler, G., Huttinger, R., Hilgert, I., Prager, E., Cerny, J., Steinlein, P., Majdic, O., Horejsi, V. and Stockinger, H. 1999 ; . T-cell activation-associated epitopes of CD147 in regulation of the T-cell response, and their definition by antibody affinity and antigen density. Int Immunol 11, 777-786.
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