Chapter 13. Biomechanics and orthopaedic disorders elicited using a trap door which was released ... more Chapter 13. Biomechanics and orthopaedic disorders elicited using a trap door which was released on the treadmill at a preprogrammed delay. Results: Whole body reactions were observed after the inversion. First, a lateral shift of the knee occured, thereby decreasing the ankle inversion angle. Secondly, responses were observed comparable to balance correcting responses after a perturbation in the roll plane during standing. The EMG responses in the peroneal muscle were detected during weight acceptance of the ipsilateral leg. Conclusion: It is concluded that reactions following an ankle inversion during gait are well-suited to avoide excessive stretch of the lateral ligaments and muscles of the lower leg and maintaining balance.
A method of measuring human postural movement is described, using measurement of the total length... more A method of measuring human postural movement is described, using measurement of the total length of the locus of postural sway in 60-second epochs with the eyes open and with the eyes closed and expressed as average speed in centimetres per minute. The ratio of the overall mean speed values derived with the eyes open to that with the eyes closed provides an indication of the subject’s dependence upon vision. Two sample case studies indicate clinical applications of the method.
Learning to control a prosthetic knee is a difficult task for the above-knee amputee. A biofeedba... more Learning to control a prosthetic knee is a difficult task for the above-knee amputee. A biofeedback training system was designed to help with this problem. The system was found to be useful with several aspects of knee control. Fifteen patients completed a biofeedback training program. Two of these patients did not benefit to the same degree as the other thirteen.
Polysomnography is a comprehensive modality for diagnosing sleep apnea (SA), but it is expensive ... more Polysomnography is a comprehensive modality for diagnosing sleep apnea (SA), but it is expensive and not widely available. Several technologies have been developed for portable diagnosis of SA in the home, most of which lack the ability to detect sleep status. Wrist actigraphy (accelerometry) has been adopted to cover this limitation. However, head actigraphy has not been systematically evaluated for this purpose. Therefore, the aim of this study was to evaluate the ability of head actigraphy to detect sleep/wake status. We obtained full overnight 3-axis head accelerometry data from 75 sleep apnea patient recordings. These were split into training and validation groups (2:1). Data were preprocessed and 5 features were extracted. Different feature combinations were fed into 3 different classifiers, namely support vector machine, logistic regression, and random forests, each of which was trained and validated on a different subgroup. The random forest algorithm yielded the highest performance, with an area under the receiver operating characteristic (ROC) curve of 0.81 for detection of sleep status. This shows that this technique has a very good performance in detecting sleep status in SA patients despite the specificities in this population, such as respiration related movements.
ABSTRACT An electronic system to increase compliance with hand hygiene rules and clinical tests w... more ABSTRACT An electronic system to increase compliance with hand hygiene rules and clinical tests which demonstrated the function and acceptability of the system are described.
Prosthetics and Orthotics International, Apr 1, 1985
Shape sensing is useful in the computer aided prosthetic fitting process for two purposes. 1. To ... more Shape sensing is useful in the computer aided prosthetic fitting process for two purposes. 1. To input characteristic prosthetic shapes that have been developed over the years through the experience of prosthetists. 2. To provide an accurate and rapid measurement of the anatomical shape of the stump. This paper describes two instruments which have been built to meet these objectives.
An experimental study was performed investigating the influence of handrail height on the ability... more An experimental study was performed investigating the influence of handrail height on the ability of stainvay users to generate stabilizing forces and moments, with the aim of improving stainvay safety by developing better handrail design standards. The experiments involved measurement of the maximum forces and moments that subjects were able to exert on a handrail while they stood stationary in an upright position. Two age groups were tested: young (20 to 45 years) and elderly (59 years and over), with a total of 35 subjects. All subjects showed a strong linear dependence on handrail height in generating stabilizing forces and moments. Ability to generate fonvardlbackward forces and fonvardlbackward moments increased linearly with il1creasing handrail height. Ability to generate upward force decreased linearly with increasing handrail height. Based on the results, an optimal design range for hm1drail height \Vas estimated.
Objective We examine the relationships between contemporary progress in on‐road vehicle automatio... more Objective We examine the relationships between contemporary progress in on‐road vehicle automation and its coherence with an envisioned “autopia” (automobile utopia) whereby the vehicle operation task is removed from all direct human control. Background The progressive automation of on‐road vehicles toward a completely driverless state is determined by the integration of technological advances into the private automobile market; improvements in transportation infrastructure and systems efficiencies; and the vision of future driving as a crash‐free enterprise. While there are many challenges to address with respect to automated vehicles concerning the remaining driver role, a considerable amount of technology is already present in vehicles and is advancing rapidly. Methods A multidisciplinary team of experts met to discuss the most critical challenges in the changing role of the driver, and associated safety issues, during the transitional phase of vehicle automation where human drivers continue to have an important but truncated role in monitoring and supervising vehicle operations. Results The group endorsed that vehicle automation is an important application of information technology, not only because of its impact on transportation efficiency, but also because road transport is a life critical system in which failures result in deaths and injuries. Five critical challenges were identified: driver independence and mobility, driver acceptance and trust, failure management, third-party testing, and political support. Conclusion Vehicle automation is not technical innovation alone, but is a social as much as a technological revolution consisting of both attendant costs and concomitant benefits.
A new and measurable parameter in the study of static equilibrium is described. Using a minicompu... more A new and measurable parameter in the study of static equilibrium is described. Using a minicomputer, the locus of postural sway was measured during 1 minute periods in 144 volunteer subjects, including 105 control subjects and 39 persons with above-knee amputations. It was hypothesized that the above-knee amputee group had lost a relatively predictable degree of proprioception and kinesthetic sense. Vestibular mechanisms were normal and, therefore, constant in both groups. Using a simple arithmetic formula, the effect of such loss of proprioception was estimated by comparing the amputee group with the nonamputee group, while the contribution of visual input was estimated by comparing both groups with their eyes open and closed. Using this parameter, no clear age dependency was demonstrated. The mean locus of sway for the amputee group was the same as the nonamputee group with the eyes open. However, a comparison of the eyes open/eyes closed ratio in both groups demonstrated a significantly greater increase for the amputee group than for control subjects (p less than 0.001). In the future, mean locus of sway might provide a useful clinical method of measurement and the eyes open/eyes closed ratio might provide a simple and useful method to communicate the dependency upon vision in individual patients.
Always cite the published version, so the author(s) will receive recognition through services tha... more Always cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the TSpace version (original manuscript or accepted manuscript) because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page. Age-related differences in dynamic balance control during stair descent and effect of varying step geometry Novak AC a , Komisar V a,b , Maki BE a,b,c,d , Fernie GR a,b,c,d
Background: Despite several measures to monitor and improve hand hygiene (HH) in health care sett... more Background: Despite several measures to monitor and improve hand hygiene (HH) in health care settings, health care-acquired infections (HAIs) remain prevalent. The measures used to calculate HH performance are not able to fully benefit from the high-resolution data collected using electronic monitoring systems. Objective: This study proposes a novel parameter for quantifying the HAI exposure risk of individual patients by considering temporal and spatial features of health care workers' HH adherence. Methods: Patient exposure risk is calculated as a function of the number of consecutive missed HH opportunities, the number of unique rooms visited by the health care professional, and the time duration that the health care professional spends inside and outside the patient's room without performing HH. The patient exposure risk is compared to the entrance compliance rate (ECR) defined as the ratio of the number of HH actions performed at a room entrance to the total number of entrances into the room. The compliance rate is conventionally used to measure HH performance. The ECR and the patient exposure risk are analyzed using the data collected from an inpatient nursing unit for 12 weeks. Results: The analysis of data collected from 59 nurses and more than 25,600 records at a musculoskeletal rehabilitation unit at the Toronto Rehabilitation Institute, KITE, showed that there is no strong linear relation between the ECR and patient exposure risk (r=0.7, P<.001). Since the ECR is calculated based on the number of missed HH actions upon room entrance, this parameter is already included in the patient exposure risk. Therefore, there might be scenarios that these 2 parameters are correlated; however, in several cases, the ECR contrasted with the reported patient exposure risk. Generally, the patients in rooms with a significantly high ECR can be potentially exposed to a considerable risk of infection. By contrast, small ECRs do not necessarily result in a high patient exposure risk. The results clearly explained the important role of the factors incorporated in patient exposure risk for quantifying the risk of infection for the patients. Conclusions: Patient exposure risk might provide a more reliable estimation of the risk of developing HAIs compared to ECR by considering both the temporal and spatial aspects of HH records.
Occupational medicine and health affairs, Sep 23, 2015
Ben Leaker is in the 3rd year of his UnderGraduate degree in Engineering Science at University of... more Ben Leaker is in the 3rd year of his UnderGraduate degree in Engineering Science at University of Toronto. He is currently in the middle of a 12-month work term with Toronto Rehabilitation Institute as part of the professional employment year program at University of Toronto.
Proceedings of the Human Factors Society annual meeting, Oct 1, 1983
Although changes in handrail design parameters might affect the energy requirements and speed of ... more Although changes in handrail design parameters might affect the energy requirements and speed of stairway gait, there is little doubt that the primary consideration in handrail design lies in the prevention of falling accidents. The overall objective of this work is to evaluate the effects of changes in handrail design on stairway safety. Due to time constraints, the present study was limited to an investigation of handrail height, although there is no reason why the present experimental paradigm could not be used to study other handrail parameters.
Infection Control and Hospital Epidemiology, Sep 1, 2014
research briefs 1189 table 1 (Continued) Patient Surgery Surgery duration No. of times intravenou... more research briefs 1189 table 1 (Continued) Patient Surgery Surgery duration No. of times intravenous medications administered Catheter manifold lumen flush Catheter stopcock culture Thioglycolate broth culture results Gram stain Identification by Vitek 2 Semiquantitative colony counts on agar plates Identification by MALDI-TOF 20 Aortic valve replacement 4h22min 32 NG 20a 20b 20c NG NG NG 21 CABG 6h26min 23 NG 21a 21b 21c NG NG NG 22 Aortic valve replacement 6h47min 35 NG 22a 22b 22c NG NG NG 23 CABG 4h40min 28 S. epidermidis 23a 23b 23c NG NG NG 24 Aortic valve replacement 5h6min 18 NG 24a 24b 24c NG NG NG note. AHS, a-hemolytic Streptococcus; CABG, coronary artery bypass graft; G, growth; GNR, gram-negative rod; GPR, gram-positive rod; MALDI-TOF, matrix-assisted laser desorption/ionization time-of-flight analysis; NG, no growth; STCN, coagulase-negative staphylococci. ers have utilized comprehensive programs to successfully mitigate the risk of catheter-associated bloodstream infections in the operating room. 8 We hope that our findings will stimulate interest in strategies aimed at minimizing stopcock contamination in the operating room setting. acknowledgments Potential conflicts of interest. L.A.M. reports having served as a consultant for, being a paid lecturer for, or receiving research funding from CareFusion, Bard, ICU Medical, 3M, Marvao, Fresenius, Astellas, and Theravance. All other authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.
Prosthetics and Orthotics International, Dec 1, 1990
Forty-eight below-knee amputees compared sockets designed using CANFIT computer aided design (CAD... more Forty-eight below-knee amputees compared sockets designed using CANFIT computer aided design (CAD) software with sockets designed using conventional methads. Each subject was fitted by one prosthetist who used conventional techniques and one who used the CANFlT system to design the socket. Prosthetists alternated design methods for each new subject. The prosthetist using the conventional techniques was allowed up to 2 design attempts and the prosthetist using the CANFIT system was allowed up to 5 design attempts. After 2 design attempts with each method 21% of the subjects preferred the CANFIT design socket. Following up to 5 attempts 54% preferred the CANF'IT designed socket. A jury of experts made an assessment of the CANFIT system and of CAD in prosthetics. The jury did not think that the version of the system tested was cost effective but that at the rate that it was improving it would become such within 3 to 5 years. The jury noted that, as well as monetary benefits, CAD presents the possibility of benefits in other areas such as research and teaching. A number of specific suggestions regarding the use and development of CAD in prosthetics were also made.
The similarities between unvoiced speech sounds and turbulent breath sounds were used to detect c... more The similarities between unvoiced speech sounds and turbulent breath sounds were used to detect change in sound characteristics caused by narrowing of the upper airway (UA), similar to that occurring in obstructive sleep apnea (OSA). In 18 awake subjects, UA resistance (R AU), an index of UA narrowing, was measured simultaneously with breath sounds recording. Linear Prediction Coding was applied on turbulent inspiratory sounds drawn from low and high R AU conditions and K-means was used to cluster the resulting coefficients. The resulting 2 clusters were tested for agreement with the underlying R AU status. Distinct clusters were formed when R UA increased relatively high but not in cases with lower rise in R UA (P<0.01 for all indicators.) This is the first work to show the utility of LPC in breath sounds analysis confirmed by an objective indicator or UA narrowing.
American Journal of Infection Control, Apr 1, 2019
Background: Improving hand hygiene compliance among healthcare professionals is the most effectiv... more Background: Improving hand hygiene compliance among healthcare professionals is the most effective way to reduce healthcare−acquired infections. Electronic systems developed to increase hand hygiene performance show promise but might not maintain staff participation over time. In this study, we investigated an intermittent deployment strategy to overcome potentially declining participation levels. Methods: An electronic monitoring system was deployed 3 times at 6-month intervals on a musculoskeletal rehabilitation nursing unit in Toronto. Each deployment lasted 4 consecutive weeks. Each wall-mounted soap and hand rub dispenser was outfitted with an activation counter to assess the impact of system deployments on overall handwashing activity. Results: System deployments took place in October 2016, April 2017, and October 2017. A total of 76,130 opportunities were recorded, with an aggregate hand hygiene performance of 67.43%. A total of 515,156 dispenser activations were recorded. There was a significant increase in aggregate dispenser use with every deployment and a decrease over several weeks following each withdrawal. Participation was high at the beginning of each deployment and declined during each deployment but was restored to a high level with the start of the next deployment. Conclusions: Intermittent deployment of an electronic monitoring intervention counteracts potential declines in participation rates sometimes seen with continuous system use. However, adoption of this strategy requires the acceptance of lower periods of performance between each deployment.
Chapter 13. Biomechanics and orthopaedic disorders elicited using a trap door which was released ... more Chapter 13. Biomechanics and orthopaedic disorders elicited using a trap door which was released on the treadmill at a preprogrammed delay. Results: Whole body reactions were observed after the inversion. First, a lateral shift of the knee occured, thereby decreasing the ankle inversion angle. Secondly, responses were observed comparable to balance correcting responses after a perturbation in the roll plane during standing. The EMG responses in the peroneal muscle were detected during weight acceptance of the ipsilateral leg. Conclusion: It is concluded that reactions following an ankle inversion during gait are well-suited to avoide excessive stretch of the lateral ligaments and muscles of the lower leg and maintaining balance.
A method of measuring human postural movement is described, using measurement of the total length... more A method of measuring human postural movement is described, using measurement of the total length of the locus of postural sway in 60-second epochs with the eyes open and with the eyes closed and expressed as average speed in centimetres per minute. The ratio of the overall mean speed values derived with the eyes open to that with the eyes closed provides an indication of the subject’s dependence upon vision. Two sample case studies indicate clinical applications of the method.
Learning to control a prosthetic knee is a difficult task for the above-knee amputee. A biofeedba... more Learning to control a prosthetic knee is a difficult task for the above-knee amputee. A biofeedback training system was designed to help with this problem. The system was found to be useful with several aspects of knee control. Fifteen patients completed a biofeedback training program. Two of these patients did not benefit to the same degree as the other thirteen.
Polysomnography is a comprehensive modality for diagnosing sleep apnea (SA), but it is expensive ... more Polysomnography is a comprehensive modality for diagnosing sleep apnea (SA), but it is expensive and not widely available. Several technologies have been developed for portable diagnosis of SA in the home, most of which lack the ability to detect sleep status. Wrist actigraphy (accelerometry) has been adopted to cover this limitation. However, head actigraphy has not been systematically evaluated for this purpose. Therefore, the aim of this study was to evaluate the ability of head actigraphy to detect sleep/wake status. We obtained full overnight 3-axis head accelerometry data from 75 sleep apnea patient recordings. These were split into training and validation groups (2:1). Data were preprocessed and 5 features were extracted. Different feature combinations were fed into 3 different classifiers, namely support vector machine, logistic regression, and random forests, each of which was trained and validated on a different subgroup. The random forest algorithm yielded the highest performance, with an area under the receiver operating characteristic (ROC) curve of 0.81 for detection of sleep status. This shows that this technique has a very good performance in detecting sleep status in SA patients despite the specificities in this population, such as respiration related movements.
ABSTRACT An electronic system to increase compliance with hand hygiene rules and clinical tests w... more ABSTRACT An electronic system to increase compliance with hand hygiene rules and clinical tests which demonstrated the function and acceptability of the system are described.
Prosthetics and Orthotics International, Apr 1, 1985
Shape sensing is useful in the computer aided prosthetic fitting process for two purposes. 1. To ... more Shape sensing is useful in the computer aided prosthetic fitting process for two purposes. 1. To input characteristic prosthetic shapes that have been developed over the years through the experience of prosthetists. 2. To provide an accurate and rapid measurement of the anatomical shape of the stump. This paper describes two instruments which have been built to meet these objectives.
An experimental study was performed investigating the influence of handrail height on the ability... more An experimental study was performed investigating the influence of handrail height on the ability of stainvay users to generate stabilizing forces and moments, with the aim of improving stainvay safety by developing better handrail design standards. The experiments involved measurement of the maximum forces and moments that subjects were able to exert on a handrail while they stood stationary in an upright position. Two age groups were tested: young (20 to 45 years) and elderly (59 years and over), with a total of 35 subjects. All subjects showed a strong linear dependence on handrail height in generating stabilizing forces and moments. Ability to generate fonvardlbackward forces and fonvardlbackward moments increased linearly with il1creasing handrail height. Ability to generate upward force decreased linearly with increasing handrail height. Based on the results, an optimal design range for hm1drail height \Vas estimated.
Objective We examine the relationships between contemporary progress in on‐road vehicle automatio... more Objective We examine the relationships between contemporary progress in on‐road vehicle automation and its coherence with an envisioned “autopia” (automobile utopia) whereby the vehicle operation task is removed from all direct human control. Background The progressive automation of on‐road vehicles toward a completely driverless state is determined by the integration of technological advances into the private automobile market; improvements in transportation infrastructure and systems efficiencies; and the vision of future driving as a crash‐free enterprise. While there are many challenges to address with respect to automated vehicles concerning the remaining driver role, a considerable amount of technology is already present in vehicles and is advancing rapidly. Methods A multidisciplinary team of experts met to discuss the most critical challenges in the changing role of the driver, and associated safety issues, during the transitional phase of vehicle automation where human drivers continue to have an important but truncated role in monitoring and supervising vehicle operations. Results The group endorsed that vehicle automation is an important application of information technology, not only because of its impact on transportation efficiency, but also because road transport is a life critical system in which failures result in deaths and injuries. Five critical challenges were identified: driver independence and mobility, driver acceptance and trust, failure management, third-party testing, and political support. Conclusion Vehicle automation is not technical innovation alone, but is a social as much as a technological revolution consisting of both attendant costs and concomitant benefits.
A new and measurable parameter in the study of static equilibrium is described. Using a minicompu... more A new and measurable parameter in the study of static equilibrium is described. Using a minicomputer, the locus of postural sway was measured during 1 minute periods in 144 volunteer subjects, including 105 control subjects and 39 persons with above-knee amputations. It was hypothesized that the above-knee amputee group had lost a relatively predictable degree of proprioception and kinesthetic sense. Vestibular mechanisms were normal and, therefore, constant in both groups. Using a simple arithmetic formula, the effect of such loss of proprioception was estimated by comparing the amputee group with the nonamputee group, while the contribution of visual input was estimated by comparing both groups with their eyes open and closed. Using this parameter, no clear age dependency was demonstrated. The mean locus of sway for the amputee group was the same as the nonamputee group with the eyes open. However, a comparison of the eyes open/eyes closed ratio in both groups demonstrated a significantly greater increase for the amputee group than for control subjects (p less than 0.001). In the future, mean locus of sway might provide a useful clinical method of measurement and the eyes open/eyes closed ratio might provide a simple and useful method to communicate the dependency upon vision in individual patients.
Always cite the published version, so the author(s) will receive recognition through services tha... more Always cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the TSpace version (original manuscript or accepted manuscript) because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page. Age-related differences in dynamic balance control during stair descent and effect of varying step geometry Novak AC a , Komisar V a,b , Maki BE a,b,c,d , Fernie GR a,b,c,d
Background: Despite several measures to monitor and improve hand hygiene (HH) in health care sett... more Background: Despite several measures to monitor and improve hand hygiene (HH) in health care settings, health care-acquired infections (HAIs) remain prevalent. The measures used to calculate HH performance are not able to fully benefit from the high-resolution data collected using electronic monitoring systems. Objective: This study proposes a novel parameter for quantifying the HAI exposure risk of individual patients by considering temporal and spatial features of health care workers' HH adherence. Methods: Patient exposure risk is calculated as a function of the number of consecutive missed HH opportunities, the number of unique rooms visited by the health care professional, and the time duration that the health care professional spends inside and outside the patient's room without performing HH. The patient exposure risk is compared to the entrance compliance rate (ECR) defined as the ratio of the number of HH actions performed at a room entrance to the total number of entrances into the room. The compliance rate is conventionally used to measure HH performance. The ECR and the patient exposure risk are analyzed using the data collected from an inpatient nursing unit for 12 weeks. Results: The analysis of data collected from 59 nurses and more than 25,600 records at a musculoskeletal rehabilitation unit at the Toronto Rehabilitation Institute, KITE, showed that there is no strong linear relation between the ECR and patient exposure risk (r=0.7, P<.001). Since the ECR is calculated based on the number of missed HH actions upon room entrance, this parameter is already included in the patient exposure risk. Therefore, there might be scenarios that these 2 parameters are correlated; however, in several cases, the ECR contrasted with the reported patient exposure risk. Generally, the patients in rooms with a significantly high ECR can be potentially exposed to a considerable risk of infection. By contrast, small ECRs do not necessarily result in a high patient exposure risk. The results clearly explained the important role of the factors incorporated in patient exposure risk for quantifying the risk of infection for the patients. Conclusions: Patient exposure risk might provide a more reliable estimation of the risk of developing HAIs compared to ECR by considering both the temporal and spatial aspects of HH records.
Occupational medicine and health affairs, Sep 23, 2015
Ben Leaker is in the 3rd year of his UnderGraduate degree in Engineering Science at University of... more Ben Leaker is in the 3rd year of his UnderGraduate degree in Engineering Science at University of Toronto. He is currently in the middle of a 12-month work term with Toronto Rehabilitation Institute as part of the professional employment year program at University of Toronto.
Proceedings of the Human Factors Society annual meeting, Oct 1, 1983
Although changes in handrail design parameters might affect the energy requirements and speed of ... more Although changes in handrail design parameters might affect the energy requirements and speed of stairway gait, there is little doubt that the primary consideration in handrail design lies in the prevention of falling accidents. The overall objective of this work is to evaluate the effects of changes in handrail design on stairway safety. Due to time constraints, the present study was limited to an investigation of handrail height, although there is no reason why the present experimental paradigm could not be used to study other handrail parameters.
Infection Control and Hospital Epidemiology, Sep 1, 2014
research briefs 1189 table 1 (Continued) Patient Surgery Surgery duration No. of times intravenou... more research briefs 1189 table 1 (Continued) Patient Surgery Surgery duration No. of times intravenous medications administered Catheter manifold lumen flush Catheter stopcock culture Thioglycolate broth culture results Gram stain Identification by Vitek 2 Semiquantitative colony counts on agar plates Identification by MALDI-TOF 20 Aortic valve replacement 4h22min 32 NG 20a 20b 20c NG NG NG 21 CABG 6h26min 23 NG 21a 21b 21c NG NG NG 22 Aortic valve replacement 6h47min 35 NG 22a 22b 22c NG NG NG 23 CABG 4h40min 28 S. epidermidis 23a 23b 23c NG NG NG 24 Aortic valve replacement 5h6min 18 NG 24a 24b 24c NG NG NG note. AHS, a-hemolytic Streptococcus; CABG, coronary artery bypass graft; G, growth; GNR, gram-negative rod; GPR, gram-positive rod; MALDI-TOF, matrix-assisted laser desorption/ionization time-of-flight analysis; NG, no growth; STCN, coagulase-negative staphylococci. ers have utilized comprehensive programs to successfully mitigate the risk of catheter-associated bloodstream infections in the operating room. 8 We hope that our findings will stimulate interest in strategies aimed at minimizing stopcock contamination in the operating room setting. acknowledgments Potential conflicts of interest. L.A.M. reports having served as a consultant for, being a paid lecturer for, or receiving research funding from CareFusion, Bard, ICU Medical, 3M, Marvao, Fresenius, Astellas, and Theravance. All other authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.
Prosthetics and Orthotics International, Dec 1, 1990
Forty-eight below-knee amputees compared sockets designed using CANFIT computer aided design (CAD... more Forty-eight below-knee amputees compared sockets designed using CANFIT computer aided design (CAD) software with sockets designed using conventional methads. Each subject was fitted by one prosthetist who used conventional techniques and one who used the CANFlT system to design the socket. Prosthetists alternated design methods for each new subject. The prosthetist using the conventional techniques was allowed up to 2 design attempts and the prosthetist using the CANFIT system was allowed up to 5 design attempts. After 2 design attempts with each method 21% of the subjects preferred the CANFIT design socket. Following up to 5 attempts 54% preferred the CANF'IT designed socket. A jury of experts made an assessment of the CANFIT system and of CAD in prosthetics. The jury did not think that the version of the system tested was cost effective but that at the rate that it was improving it would become such within 3 to 5 years. The jury noted that, as well as monetary benefits, CAD presents the possibility of benefits in other areas such as research and teaching. A number of specific suggestions regarding the use and development of CAD in prosthetics were also made.
The similarities between unvoiced speech sounds and turbulent breath sounds were used to detect c... more The similarities between unvoiced speech sounds and turbulent breath sounds were used to detect change in sound characteristics caused by narrowing of the upper airway (UA), similar to that occurring in obstructive sleep apnea (OSA). In 18 awake subjects, UA resistance (R AU), an index of UA narrowing, was measured simultaneously with breath sounds recording. Linear Prediction Coding was applied on turbulent inspiratory sounds drawn from low and high R AU conditions and K-means was used to cluster the resulting coefficients. The resulting 2 clusters were tested for agreement with the underlying R AU status. Distinct clusters were formed when R UA increased relatively high but not in cases with lower rise in R UA (P<0.01 for all indicators.) This is the first work to show the utility of LPC in breath sounds analysis confirmed by an objective indicator or UA narrowing.
American Journal of Infection Control, Apr 1, 2019
Background: Improving hand hygiene compliance among healthcare professionals is the most effectiv... more Background: Improving hand hygiene compliance among healthcare professionals is the most effective way to reduce healthcare−acquired infections. Electronic systems developed to increase hand hygiene performance show promise but might not maintain staff participation over time. In this study, we investigated an intermittent deployment strategy to overcome potentially declining participation levels. Methods: An electronic monitoring system was deployed 3 times at 6-month intervals on a musculoskeletal rehabilitation nursing unit in Toronto. Each deployment lasted 4 consecutive weeks. Each wall-mounted soap and hand rub dispenser was outfitted with an activation counter to assess the impact of system deployments on overall handwashing activity. Results: System deployments took place in October 2016, April 2017, and October 2017. A total of 76,130 opportunities were recorded, with an aggregate hand hygiene performance of 67.43%. A total of 515,156 dispenser activations were recorded. There was a significant increase in aggregate dispenser use with every deployment and a decrease over several weeks following each withdrawal. Participation was high at the beginning of each deployment and declined during each deployment but was restored to a high level with the start of the next deployment. Conclusions: Intermittent deployment of an electronic monitoring intervention counteracts potential declines in participation rates sometimes seen with continuous system use. However, adoption of this strategy requires the acceptance of lower periods of performance between each deployment.
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