supine position

Objective: To examine whether grip strengths were different when measured in supine and sitting positions. Design: Comparison, convenience sample Setting: Community. Participants: Seventy-four healthy adult participants with no history of psychiatric or neurological dysfunction, or upper extremity orthopedic dysfunction after the age of 18. Interventions: Participants performed grips with each hand while sitting and standing. Shoulder was adducted and extended, with the elbow flexed, and wrist and forearm in neutral. Main Outcome Measure: The mean of the three trials with each hand in each posture. Results: Men were stronger (49kg) than women (29kg; p < ,001). Right hands were stronger (41kg) than left (39kg; p < .OOl). However, grip strengths while sitting were equivalent to those tested while supine (p > S9). Conclusions: Using identical upper extremity positions, grip

Background and purpose: Investigation of the use of TomoTherapy and TomoDirect versus conventional radiotherapy for the treatment of post-operative breast carcinoma. This study concentrates on the evaluation of the planning protocol for the TomoTherapy and TomoDirect TPS, dose verification and the implementation of in vivo dosimetry. Materials and methods: Eight patients with different breast cancer indications (left/right tumor, axillary nodes involvement (N+)/no nodes (N0), tumorectomy/mastectomy) were enrolled. TomoTherapy, Tomo-Direct and conventional plans were generated for prone and supine positions leading to six or seven plans per patient. Dose prescription was 42 Gy in 15 fractions over 3 weeks. Dose verification of a TomoTherapy plan is performed using TLDs and EDR2 film inside a home-made wax breast phantom fixed on a randoalderson phantom. In vivo dosimetry was performed with TLDs. Results: It is possible to create clinically acceptable plans with TomoTherapy and TomoDirect. TLD calibration protocol with a water equivalent phantom is accurate. TLD verification with the phantom shows measured over calculated ratios within 2.2% (PTV). An overresponse of the TLDs was observed in the low dose regions (<0.1 Gy). The film measurements show good agreement for high and low dose regions inside the phantom. A sharp gradient can be created to the thoracic wall. In vivo dosimetry with TLDs was clinically feasible. Conclusions: The TomoTherapy and TomoDirect modalities can deliver dose distributions which the radiotherapist judges to be equal to or better than conventional treatment of breast carcinoma according to the organ to be protected.

Patient positioning in theatre pertains to how a patient is transferred and positioned for a specific procedure. Patient safety is a central focus of care within the NHS and every healthcare practitioner must ensure that patients are protected from harm where possible. ...

Patient positioning in theatre pertains to how a patient is transferred and positioned for a specific procedure. Patient safety is a central focus of care within the NHS and every healthcare practitioner must ensure that patients are protected from harm where possible. ...

Background: Differences in the incidence of SIDS between dWesternT and dEasternT countries has been attributed to cultural practices, which may affect the infants care and thermal environment. Aim: The purpose of this work was to estimate for selected dcommonlyT used bedding, sleep positions and practices in Japan, Korea and New Zealand, the intrinsic ddryT thermal resistance of bedding. Insulation levels are also discussed in the context of published information about the thermal environment in which the bedding is likely to be used. Method: Selected Japanese, Korean and New Zealand bedding was loosely tucked over an infant manikin in the lateral, prone and supine sleep positions. Thickness in use was measured, and intrinsic ddryT thermal resistance estimated using the Wilson Laing model which accommodates the effect on insulation of the three-dimensional arrangement of bedding combinations during use. Results and discussion: Thickness of under-and upper-bedding varied among countries with thickness and estimated ddryT thermal resistance of the upperbedding affected by the type/combination of bedding and the infants sleep position. Insulation levels are discussed in relation to environmental conditions within and among countries and between seasons. Further information on thermal environments, bedding combinations used and care practices within both Asian and Western countries is needed. Conclusions: dEasternT infants appear likely to be generally covered in bedding combinations of greater insulation than those used to cover dWesternT infants in comparable seasons. Differences existed between insulation of the Japanese and

Introduction: In this study we aimed to determine whether high-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches. We also attempted to identify the best approach for visualizing these structures. Methods: Normal anatomy of the pudendal nerve was evaluated in 3 cadavers and 20 healthy volunteers proximally at the level of the ischial spine and distally with low-frequency (2-5-MHZ) and high-frequency (12-7-MHZ and 17-5-MHZ) transducers. Two musculoskeletal radiologists performed the examinations and evaluations. Volunteers were placed in 3 different positions, which allowed different approaches (posterior, medial, and anterior transperineal). A 0-3 scale was used to assess nerve visibility. Results: Visualization of the pudendal nerve at the ischial spine was best when using a medial approach (P < 0.004); the terminal branches were seen best with the anterior approach (P < 0.002). Conclusion: High-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches.

Neurogenic orthostatic hypotension (nOH) is common in patients with neurodegenerative disorders such as Parkinson&#39;s disease, multiple system atrophy, pure autonomic failure, dementia with Lewy bodies, and peripheral neuropathies including amyloid or diabetic neuropathy. Due to the frequency of nOH in the aging population, clinicians need to be well informed about its diagnosis and management. To date, studies of nOH have used different outcome measures and various methods of diagnosis, thereby preventing the generation of evidence-based guidelines to direct clinicians towards &#39;best practices&#39; when treating patients with nOH and associated supine hypertension. To address these issues, the American Autonomic Society and the National Parkinson Foundation initiated a project to develop a statement of recommendations beginning with a consensus panel meeting in Boston on November 7, 2015, with continued communications and contributions to the recommendations through October of...

BACKGROUND Cheyne-Stokes Respiration (CSR) is a common finding in Chronic Heart Failure and Stroke patients. The body position effect during sleep on obstructive breathing abnormalities is well known. However, the effect of body position during sleep on breathing abnormalities of central type like CSR has not been well documented. MATERIAL/METHODS Six sleep studies (two complete Polysomnographic (PSG) evaluations and four Pulse Oximetry recordings (PO)), were carried out in a 57-year-old female patient with a recent Cerebro Vascular Accident (CVA who had both Obstructive Sleep Apnea (OSA) and CSR. RESULTS The first PSG was carried out two months post-stroke and revealed a severe, continuous CSR pattern during Non Rapid Eye Movements (NREM) sleep (mainly with central apneas), and Obstructive Sleep Apnea (OSA) during Rapid Eye Movements (REM) sleep, independent of body position: Supine Respiratory Disturbance Index (SRDI) = 85.2 and Lateral RDI (LRDI) = 95.4. A second PSG was performe...

PURPOSE To compare results of studies on supine and prone percutaneous nephrolithotomy (PCNL) techniques to find the best position for treating kidney stones. MATERIALS AND METHODS A systematic literature review was done in April 2016 using PubMed, Scopus, and Web of Science databases to identify the relevant studies. Article selection was based on the preferred reporting elements of systematic reviews and meta-analysis criteria. A subgroup analysis was done comparing standard prone and supine PCNLs separately. RESULTS Twenty studies were selected for the analysis including 7733 PCNL cases: 2110 cases were (27.3%) in supine and 5623 cases were (72.7%) in prone position. Supine and prone PCNL had a similar stone-free rate (OR: 0.95; 95% CI: 070-1.27; P = 0.73), operation time (difference in means = -0.01, 95% CI: -0.07 to 0.03; P = .53), hospital stay (differencein means = 0.01, 95% CI: -0.07 to 0.03; P = .52), complication rate (OR: 0.88; 95% CI: 0.76-1.02; P = .09) and urinary leak...

Introduction Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device's utility, precision and impact on pulmonary mechanics. Secondly-to measure the gas distribution in supine and lateral decubitus position. Materials and methods 69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance. Results Our results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the nondependent lung. The control system positively affected non-dependent and dependent lung PLOS ONE |

The purpose of this study was to determine the effectiveness of a new liberatory maneuver in the management of the geotropic variant of horizontal canal paroxysmal positional vertigo (HC-PPV). Study Design: Case review. Setting: Outpatient clinic. Patients: The diagnosis of HC-PPV was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal geotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were 11 men and 21 women ranging in age from 30 to 85 years (average 55.43 years), and the average duration of symptoms was 7.68 days. Interventions: All patients were treated with a liberatory maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the en-dolymph of the posterior arm of the semicircular horizontal canal. The maneuver favors their outmigration into the utricle. Patients were reexamined immediately after the treatment and again 2 days later. Main Outcome Measure: The treatment outcome was considered as responsive when, after one or more liberatory maneuvers, the clinical signs of PPV disappeared at the end of physical therapy. Results: The liberatory maneuver resulted in a complete remission of the positioning vertigo and nystagmus in all patients after the first session. Conclusions: This approach represents a simple and effective approach to the management of the geotropic form of HC-PPV.

Vasomotor sympathetic activity plays an important role in arterial pressure maintenance via the baroreflex during acute orthostasis in humans. If orthostasis is prolonged, blood pressure may be supported additionally by humoral factors with a possible reduction in sympathetic baroreflex sensitivity. We tested the hypothesis that baroreflex control of muscle sympathetic nerve activity (MSNA) decreases during prolonged upright posture. MSNA and haemodynamics were measured supine and during 45 min 60 deg upright tilt in 13 healthy individuals. Sympathetic baroreflex sensitivity was quantified using the slope of the linear correlation between MSNA and diastolic pressure during spontaneous breathing. It was further assessed as the relationship between MSNA and stroke volume, with stroke volume derived from cardiac output (C 2 H 2 rebreathing) and heart rate. Total peripheral resistance was calculated from mean arterial pressure and cardiac output. We found that MSNA increased from supine to upright (17 ± 8 (S.D.) versus 38 ± 12 bursts min −1 ; P < 0.01), and continued to increase to a smaller degree during sustained tilt (39 ± 11, 41 ± 12, 43 ± 13 and 46 ± 15 bursts min −1 after 10, 20, 30 and 45 min of tilt; between treatments P < 0.01). Sympathetic baroreflex sensitivity increased from supine to upright (−292 ± 180 versus −718 ± 362 units beat −1 mmHg −1 ; P < 0.01), but remained unchanged as tilting continued (−611 ± 342 and −521 ± 221 units beat −1 mmHg −1 after 20 and 45 min of tilt; P = 0.49). For each subject, changes in MSNA were associated with changes in stroke volume (r = 0.88 ± 0.13, P < 0.05), while total peripheral resistance was related to MSNA during 45 min upright tilt (r = 0.82 ± 0.15, P < 0.05). These results suggest that the vasoconstriction initiated by sympathetic adrenergic nerves is maintained by ongoing sympathetic activation during sustained (i.e. 45 min) orthostasis without obvious changes in vasomotor sympathetic neural control.

This paper summarises a 1-day scientific consensus forum that reviewed the evidence underpinning the Australian SIDS and Kids Safe Sleeping Health Promotion Programme. The focus was on each of the potentially modifiable risk factors for sudden unexpected deaths in infancy, including sudden infant death syndrome (SIDS) and fatal sleeping accidents. In particular infant sleeping position, covering of the face, exposure to cigarette smoke, room sharing, unsafe sleeping environments, bed sharing, immunisation, breastfeeding, pacifier use and Indigenous issues were discussed in depth. The participants recommended that future 'Reducing the Risk' campaign messages should focus on back to sleep, face uncovered, avoidance of cigarette smoke before and after birth, safe sleeping environment, room sharing and sleeping baby in own cot.

The "Dependent Viscera" Sign in CT Diagnosis of Blunt Traumatic Diaphragmatic Rupture OBJECTIVE. The objective of our study was to describe the "dependent viscera" sign and determine its usefulness at CT in the diagnosis of diaphragmatic rupture after blunt abdominal trauma. MATERIALS AND METHODS. The study sample consisted of 28 consecutive patients (19 men, nine women) between 17 and 74 years old (mean age, 31 years) who had undergone abdominal CT and subsequent emergency laparotomy after a blunt trauma. Ten patients had a diaphragmatic rupture (six, right-sided; four, left-sided) at laparotomy. An experienced radiologist unaware of the surgical findings retrospectively reviewed the CT scans, and then a second radiologist reviewed the scans to provide interobserver agreement. Note was made of discontinuity of the diaphragm, intrathoracic herniation of abdominal contents, and waistlike constriction of bowel (the collar sign). Also noted was whether the upper one third of the liver abutted the posterior right ribs or whether the bowel or stomach lay in contact with the posterior left ribs. Either of these findings was termed the "dependent viscera" sign. The radiologists' detection rate of diaphragmatic rupture on the CT scans via observance of the dependent viscera sign was determined. Interobserver agreement was assessed using Cohen's kappa statistic. RESULTS. The dependent viscera sign was observed on the CT scans of 100% of the patients with a left-sided diaphragmatic rupture and of 83% of the patients with right-sided diaphragmatic rupture. Both observers missed one case of right-sided diaphragmatic rupture. The radiologists' overall rate of detecting diaphragmatic rupture was 90% using the dependent viscera sign. We found excellent interobserver agreement (κ = 1) for detection of the dependent viscera sign and for the diagnosis of diaphragmatic tear on CT scans. CONCLUSION. The dependent viscera sign increases the detection at CT of acute diaphragmatic rupture after blunt trauma.

The aim of this study was to determine the relationship between falls and beat-to-beat blood pressure (BP) variability.Continuous noninvasive BP measurement is as accurate as invasive techniques. We evaluated beat-to-beat supine and standing BP variability (BPV) using time and frequency domain analysis from noninvasive continuous BP recordings.A total of 1218 older adults were selected. Continuous BP recordings obtained were analyzed to determine standard deviation (SD) and root mean square of real variability (RMSRV) for time domain BPV and fast-Fourier transform low frequency (LF), high frequency (HF), total power spectral density (PSD), and LF:HF ratio for frequency domain BPV.Comparisons were performed between 256 (21%) individuals with at least 1 fall in the past 12 months and nonfallers. Fallers were significantly older (P = .007), more likely to be female (P = .006), and required a longer time to complete the Timed-Up and Go test (TUG) and frailty walk test (P ≤ .001). Standi...

Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls. Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac load...

To evaluate the effect of supine position when compared with periodic change of position during phototherapy in late preterm and term neonates (35 to 42 weeks) with hyperbilirubinemia on the duration of phototherapy. STUDY DESIGN: We randomly allocated enrolled neonates with hyperbilirubinemia to either no change in position (supine group (SG); n ¼ 54) or two-hourly change of position from supine to prone and vice versa (turning group (TG); n ¼ 46). All the infants received single surface phototherapy by two dedicated compact fluorescent light units. Total serum bilirubin (TSB) was measured at the start of phototherapy and then every 12 ± 2 h until the end of phototherapy. Phototherapy was stopped when two values were below the cutoff for age and gestational age as per the American Academy of Pediatrics Subcommittee on Hyperbilirubinemia guidelines nomogram for the management of hyperbilirubinemia in infants 435 weeks of gestation. The primary outcome was duration of phototherapy and secondary outcome was rate of fall of bilirubin within the first 24 ± 2 h after the initiation of phototherapy. RESULT: Baseline characteristics including birth weight (g, 2752±478 vs 2748±416 P ¼ 0.96), gestation (week, 37.1±1.2 vs 37.4 ± 1.3, P ¼ 0.26) were similar in the two groups. There was no difference in the duration of phototherapy between the SG (mean ± s.d., hour, 25.5 ± 8) and TG (mean ± s.d., hour, 24.8 ± 5), mean difference (95% confidence interval), hour, 0.7 (À 2.03, 3.44, P ¼ 0.6). Rate of fall of bilirubin was also similar in both supine and turning groups with mean difference of À 0.020 (95% confidence interval: À 0.061, 0.021, P ¼ 0.34). CONCLUSION: Nursing babies in supine position when compared with periodic position change during phototherapy does not decrease the duration of phototherapy.

ObjectiveAccidental decannulation is the most common and serious complication associated with tracheostomy in obese patients. We lack a simple way to choose appropriate-size tracheostomy tubes in this patient subset. Our purpose was to 1) establish the range of trachea-to-skin soft tissue thickness (TTSSTT) in obese patients and 2) determine which easily obtained anthropometric measurements are most predictive of TTSSTT.

To determine the most effective position jaundiced neonates should assume during phototherapy from appraised randomised controlled trials. Many local hospitals still alternate positions of jaundiced neonates receiving phototherapy despite the safe infant sleeping protocol of placing them supine. A systematic review was conducted. Databases that included Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Embase and The Cochrane Library were used. Randomized controlled trials published in English language that evaluate the best position for healthy jaundiced neonates aged day 1 to 14 under phototherapy were searched. In addition, any positioning done every 2-3 hours during phototherapy with the outcome measures being bilirubin reduction and duration of phototherapy were also searched and included (n = 5). Physiotherapy Evidence Database scale was adopted for quality assessment. All processes were conducted by both reviewers independently. Discrepancies were resol...

The aim of this study is to determine what mothers know about infant sleep practices and the environment. DESIGN AND METHODS. Data were collected with a semistructured questionnaire. The research was conducted with 231 mothers who delivered an infant and who agreed to participate between September and December 2005. RESULTS. It was determined that 70.6% (n = 163) of mothers would use a pillow with their sleeping infants, and 44.2% (n = 102) would cover their infants' faces. When infants were alone in a room, 96.5% of mothers would leave them in the supine position. PRACTICE IMPLICATIONS. Public health interventions should alert women to the increased risk of sudden infant death syndrome associated with identifiable risk factors, and specific intervention campaigns for safe sleeping can be developed for Turkish families.

1. J Vasc Interv Radiol. 2007 Jul;18(7):833-4. Brachial plexus injury related to patient positioning. Pillai AK, Ferral H, Desai S, Paruchuri S, Asselmeier S, Perez-Gautrin R. Department of Interventional Radiology, Rush University Medical Center, Chicago, IL 60612, USA. ...

Cardiovascular variability reflects autonomic regulation of blood pressure (BP) and heart rate (HR). However, systolic BP (SBP) variability also may be induced by fluctuations in stroke volume through left ventricular end-diastolic pressure (LVEDP) variability via dynamic ventricular-arterial coupling during respiration. We hypothesized that dynamic ventricular-arterial coupling is modulated by changes in left ventricular compliance associated with altered preload and that a cascade control mechanism of ventricular-arterial coupling with arterial-cardiac baroreflex function contributes to the genesis of cardiovascular variability at the respiratory frequency. Seven healthy young subjects underwent 6-min recordings of beat-by-beat LVEDP, SBP, and HR in the supine position with controlled respiration at 0.2 Hz during hyper- and hypovolemia. Spectral and transfer function analysis of these variables was conducted between 0.18 and 0.22 Hz. Dynamic ventricular-arterial coupling gain (Gai...

Context:Hamstring muscle length is commonly measured because of its perceived relationship to injury of both the hamstrings themselves and the pelvis and lumbar spine. The popliteal (knee-extension) angle measured from the starting position hip and knee at 90° is a commonly used indirect measure of hamstring muscle length. When this measure has been undertaken in the literature previously, little attention was paid to the position of the pelvis, which may significantly influence measurements taken.Design:Repeated-measures.Setting:University human performance laboratory.Participants:60 healthy physically active males (mean age 20.1 ± 1.8 y, range 18–24 y).Intervention:The 2 extremes of pelvic position (anterior and posterior).Main Outcome Measure:Popliteal angle (with maximal knee extension) was measured in 2 positions, 1 of full anterior and 1 of full posterior pelvic tilt.Results:The mean difference in popliteal angle between anterior to posterior pelvic positions was 13.4° ± 9° (r...

AIM: To investigate the agreement between esophageal manometry and pH step-up method in two different patient positions. METHODS: Eighteen subjects were included in the study. First, the distance from the nose to the proximal border of the lower esophageal sphincter (LES) was measured manometrically. Then a different investigator, who was blinded to the results of the first study, measured the same distance using the pH step-up method, with the patient in both upright and supine positions. An assessment of agreement between the two techniques was performed. RESULTS: In the supine position, the measurement of only one subject was outside the range accepted for correct positioning (≤ 3 cm distal or proximal to the LES). In the upright position, errors in measurement were recognized in five subjects. Bland-Altman plots revealed good agreement between measurements obtained manometrically and by the pH-step up method with the patient in the supine position. CONCLUSION: In the case of nonavailability of manometric detection device, the pH step-up method can facilitate the positioning of the 24 h pH monitoring catheter with the patient in the supine position. This should increase the use of pH-metry in clinical practice for subjects with suspected gastroesophageal reflux disease if our results are supported by further studies.

The haemodynamic changes of the prone position were investigated in 40 ASA I–II patients undergoing lumbar spine surgery. Patients were randomly assigned, following propofol intravenous induction, to receive maintenance of anaesthesia using either isoflurane 1–1.2 % in air or target controlled propofol 3 lg.ml)1 infusion. Measurements of non-invasive blood pressure, heart rate and cardiac output were made in the supine position. The patient was then turned prone onto a Montreal pattern mattress and measurements repeated. Cardiac output measurements were made using a non-invasive cardiac output monitor. We found a significant reduction in cardiac index in both groups and a significantly greater change with propofol compared to isoflurane on turning supine to prone (CI change 0.4 vs 0.7 l.min)1.m)2 p = 0.001 and SVRI change 89 vs 177 dyne.s)1.cm)5, p = 0.041). We conclude that turning healthy patients prone produces a clinically significant reduction in cardiac output, the change bein...

Purpose: To evaluate clinical targeting precision and assess patient movement data during fiducial-free, singlefraction spinal radiosurgery with the Cyberknife (CK). Methods and Materials: Image-guided spine tracking accuracy was tested using two phantoms. Movement patterns (three translations, roll, pitch and yaw) were obtained from log files of 260 patient treatments (47 cervical, 89 thoracic, 90 lumbar, and 34 pelvic/sacral). For two treatments (average and maximum motion scenario), we added offsets to all beams according to recorded patient movements and recalculated the delivered dose distribution to simulate the dosimetric impact of intrafraction motion. Results: Phantom spine position was registered with an accuracy of <0.2 mm for translational and <0.3 for rotational directions. Residual patient motion yielded mean targeting errors per beam of 0.28 ± 0.13 mm (X), 0.25 ± 0.15 mm (Y), 0.19 ± 0.11 mm (Z) and 0.40 ± 0.20 (roll), 0.20 ± 0.08 (pitch), and 0.19 ± 0.08 (yaw). Spine region had little influence on overall targeting error, which was <1 mm for more than 95% of treatments (median, 0.48 mm). In the maximum motion case, target coverage decreased by 1.7% (from 92.1% to 90.4%) for the 20-Gy prescription isodose. Spinal cord volume receiving more than 8 Gy increased slightly, from 2.41 to 2.46 cm 3. Conclusions: Submillimeter targeting precision was obtained for fiducial-free spinal radiosurgery despite patient motion. Patient motion has little effect on the delivered dose distribution when image-guided correction of beam aiming is employed.

Prematurely born infants are at increased risk of sudden infant death syndrome (SIDS) if slept prone. Prematurely born infants would have an impaired response to an added dead space and lower respiratory muscle strength in the prone compared to the supine position. Prospective study. PATIENT-SUBJECT SELECTION: Twenty-five infants, median gestational age of 30 (range 26-32) weeks. The infants were studied supine and prone at a median of 36 weeks postmenstrual age. Breath by breath minute volume was measured at baseline and after a dead space was incorporated into the breathing circuit; the time constant of the response was calculated. The maximum inspiratory occlusion pressure generated (MIOP) and the pressure generated over the first 100 msec (P(0.1)) during airway occlusion were assessed. The median time constant was longer (26 (range 8-106) sec vs. 22 (range 6-92) sec (P = 0.045)) and the median MIOP (P = 0.001) and P(0.1) (P = 0.003) were lower in the prone compared to the supine position. Prematurely born infants have a dampened response to tube breathing and reduced respiratory muscle strength in the prone compared to the supine position, which may contribute to their increased vulnerability to SIDS in the prone position.

Introduction: Transcutaneous oximetry measurement (TCOM) is a non-invasive method of determining oxygen tension at the skin level using heated electrodes. Aim: To compare TCOM values generated by different machines and to establish lower limb TCOM values in a cohort of healthy individuals younger than 40 years of age. Method: Sixteen healthy, non-smoking volunteers aged 18 to 39 years were recruited. TCOM was obtained at six locations on the lower leg and foot using three different Radiometer machines. Measurements were taken with subjects lying supine, breathing air. Results: Except for one sensor site, there were no statistical differences in measurements obtained by the different TCOM machines. There was no statistical difference in measurements comparing left and right legs. Room air TCOM values for the different lower leg sites were (mean (SD) in mmHg): lateral leg 61.5 (9.2); lateral ankle 61.1 (9.7); medial ankle 59.1 (10.8); foot, first and second toe 63.4 (10.6); foot, fifth toe 59.9 (13.2) and plantar foot 74.1 (8.8). The overall mean TCOM value for the lower limb was 61 (10.8; 95% confidence intervals 60.05-62.0) mmHg. Conclusion: Lower-leg TCOM measurements using different Radiometer TCOM machines were comparable. Hypoxia has been defined as lower-leg TCOM values of less than 40 mmHg in non-diabetic patients and this is supported by our measurements. The majority (96.9%) of the lower leg TCOM values in healthy young adults are above the hypoxic threshold.

Prone, supine, and side position exercises are employed to enhance core stability. Overall core muscle activity would be greater in prone position exercises compared with supine and side position exercises. Controlled laboratory study. Eighteen men and women between 23 and 45 years of age served as subjects. Surface electrodes were positioned over the upper and lower rectus abdominis, external and internal obliques, rectus femoris, latissimus dorsi, and lumbar paraspinals. Electromyography data were collected during 5 repetitions of 10 exercises, then normalized by maximum voluntary isometric contractions (MVIC). Differences in muscle activity were assessed using 1-way repeated-measures analysis of variance, while t tests with a Bonferroni correction were employed to assess pairwise comparisons. Upper and lower rectus abdominis activity was generally significantly greater in the crunch, bent-knee sit-up, and prone position exercises compared with side position exercises. External ob...

The prevalence of balance symptoms (vertigo, dizziness, and dysequilibrium) was investigated in an epidemiological study of elderly people, the longitudinal and cross-sectional gerontological and geriatric population study from Göteborg, Sweden (H70). Three different age cohorts were studied, one at age 70, one at age 75 and one at ages 79, 82, 85, 88 and 90 years. Altogether 2011 participants answered the questionnaire at 3197 occasions. The overall prevalence of balance problems at age 70 was 36% (women) and 29% (men). Balance symptoms were more common among women than men, and increased with increasing age. At ages 88–90 years the corresponding values were 51–45%.. The most common symptom was poor balance/general unsteadiness (11–41%). Rotatory symptoms occurred in 2–17%. Other types of symptoms were less common. Precipitating factors were rising from supine to sitting position in 17–40%. Balance symptoms in a side position were uncommon, but occurred more often when tilting the ...

The location and morphology of abdominal organs due to postural changes have implications in the prediction of trauma via computational models. The purpose of this study is to use data from a multimodality image set to devise a method for examining changes in organ location, morphology, and rib coverage from the supine to seated postures. Medical images of a male volunteer (78.6±0.77 kg, 175 cm) in three modalities (Computed Tomography, Magnetic Resonance Imaging (MRI), and Upright MRI) were used. Through image segmentation and registration, an analysis between organs in each posture was conducted. For the organs analyzed (liver, spleen, and kidneys), location was found to vary between postures. Increases in rib coverage from the supine to seated posture were observed for the liver, with a 9.6% increase in a lateral projection and a 4.6% increase in a frontal projection. Rib coverage area was found to increase 11.7% for the spleen. Morphological changes in the organs were also obser...

Neurodynamic assessment and management are advocated for femoral nerve pathology. Contrary to neurodynamic techniques for other nerves, there is limited research that quantifies femoral nerve biomechanics. To quantify longitudinal and transverse excursion of the femoral nerve during knee and neck movements. Single-group, experimental study, with within-participant comparisons. High-resolution ultrasound recordings of the femoral nerve were made in the proximal thigh/groin region in 30 asymptomatic participants. Scans were made during knee flexion in supine and a semi-seated position, and during neck flexion in side-lying slump (Slump ). Healthy participants were assessed to reveal normal nerve biomechanics, not influenced by pathology. Data were analysed with one-sample and paired t-tests. Reliability was assessed with intraclass correlation coefficients (ICC). Longitudinal and transverse excursion measurements were reliable (ICC≥0.87). With knee flexion, longitudinal femoral nerve ...

Articles Clinical Investigation nature publishing group Background: Preterm infants are at increased risk of sudden infant death syndrome (SIDS). Use of a dummy/ pacifier is thought to be protective against SIDS; accordingly, we assessed the effects of dummy/pacifier use on blood pressure, cerebral oxygenation, and heart rate control over the first 6 mo of life after term corrected age (CA) when SIDS risk is greatest. Methods: Thirty-five preterm infants were studied longitudinally at 2-4 wk, 2-3 mo, and 5-6 mo CA. Cardiac control was assessed from spectral indices of heart rate variability (HRV) in the low frequency (LF) and the high frequency (HF) range, and the ratio of HF/LF indicating sympathovagal balance was calculated. results: Overall, at 2-3 mo, mean arterial pressure was significantly higher in the supine position in dummy/pacifier users in both quiet sleep (70 ± 2 vs. 60 ± 2 mm Hg; P < 0.05) and active sleep (74 ± 3 vs. 69 ± 2 mm Hg; P < 0.05). Dummy/pacifier users had higher LF HRV and LF/HF ratio and lower HF HRV. conclusion: Dummy/pacifier use increased blood pressure during sleep, at the age of greatest SIDS risk. Overall, LF HRV was elevated and HF HRV reduced in dummy/pacifier users, suggesting that dummy use alters cardiac control in preterm infants.

BACKGROUND: Although the incidence of iatrogenic ureteral strictures is low, the treatment remains challenging. OBJECTIVE: To report our technique of robot-assisted uretero-ureterostomy (RAUU) for adults with iatrogenic lumbar and iliac stricture. DESIGN, ...

We investigated the role of body position on performance in four distinct types of mental imagery processing. Previous studies used the upright body position as standard procedure and therefore do not address the issue of whether mental imagery tasks are processed in accordance with ego-centered or gravitational coordinates. In the present study, the subjects were brought into one of three different body positions: upright, horizontal, or supine. In each of these body positions, we measured performance in four imagery tasks, which assessed (1) the ability to generate vivid, high-resolution mental images; (2) the ability to compose mental images from separate parts; (3) the ability to inspect patterns in mental images; and, (4) the ability to mentally rotate patterns in images. Not all processes were affected in the same way when subjects performed them in different body positions. Performance in the image composition and detection tasks depended on body position, whereas there was n...

A dramatic decrease of sudden infant death syndrome (SIDS) has been noted following the issuance of recommendations to adopt the supine sleeping position for infants. It has been suggested that the increased risk could be related to heat stress associated with body position. In the present study, the dry heat losses of small-for-gestational-age newborns nude or clothed were assessed and compared to see whether there is a difference in the ability to lose heat between the prone and supine positions. An anthropomorphic thermal mannequin was exposed to six environmental temperatures, ranging between 25 and 37°C, in a single-walled, air-heated incubator. The magnitudes of heat losses did not significantly differ between the two body positions for the nude (supine 103.46 Ϯ 29.67 vs. prone 85.78 Ϯ 34.91 W/m 2) and clothed mannequin (supine 59.35 Ϯ 21.51 vs. prone 63.17 Ϯ 23.06 W/m 2). With regard to dry heat exchanges recorded under steady-state conditions, the results show that there is no association between body position and body overheating.

The hypothesis that hypertonic saline infusion induces a greater natriuresis than infusion of the same amount of sodium as isotonic saline was tested in 8 supine subjects on fixed sodium intake of 150 mmol NaCl day ±1. Sodium loads equivalent to the amount of sodium contained in 10% of measured extracellular volume were administered intravenously over 90 min either as isotonic saline or as hypertonic saline (850 mmol L ±1). A third series without saline infusion served as time control. Experiments lasted 8 h. Water balance and sodium loads were maintained by replacing the excreted amounts every hour. Plasma sodium concentrations only increased following hypertonic saline infusion (by 2.7 0.3 mmol L ±1). Oncotic pressure decreased signi®cantly more with isotonic saline (4.1 0.3 mmHg) than with hypertonic saline (3.2 0.2 mmHg), indicating that isotonic saline induced a stronger volumetric stimulus. Renal sodium excretion increased more than a factor of four with isotonic and hypertonic saline but also increased during time control (factor of three). Cumulated sodium excretions following isotonic (131 13 mmol) and hypertonic saline (123 10 mmol) were statistically identical exceeding that of time control (81 9 mmol). Plasma angiotensin II decreased in all series but plasma ANP concentrations and urinary excretion rates of endothelin-1 remained unchanged. In conclusion, hypertonic saline did not produce excess natriuresis. However, as the two loading procedures induced similar natriureses during different volumetric stimuli, part of the natriuresis elicited by hypertonic saline could be mediated by stimulation of osmoreceptors involved in renal sodium excretion. The supine position does not provide stable time control conditions with regard to renal excretory function.

We investigated the integrated cardiovascular responses of 15 human subjects to the acute gravitational changes (micro- and hypergravity portions) of parabolic flight. Measurements were made with subjects quietly seated and while subjects performed controlled Valsalva maneuvers. During quiet, seated, parabolic flight, mean arterial pressure increased during the transition into microgravity but decreased as microgravity was sustained. The decrease in mean arterial pressure was accompanied by immediate reflexive increases in heart rate but by absent (or later-than-expected) reflexive increases in total vascular resistance. Mean arterial pressure responses in Valsalva phases IIl, III, and IV were accentuated in hypergravity relative to microgravity (P &lt; 0.01, P &lt; 0.01, and P &lt; 0. 05, respectively), but accentuations differed qualitatively and quantitatively from those induced by a supine-to-seated postural change in 1 G. This study is the first systematic evaluation of tempora...

BACKGROUND Respiratory sinus arrhythmia (RSA) has been proposed as a physiological marker of emotion-regulation capacity, and shown to be cross-sectionally associated with depression. Little is known about the role of RSA as a predictor of (subclinical) depressive symptoms over time and as a modifier of the depressogenic effect of stressful life events (SLEs). METHODS In a longitudinal population-based study with data collected in 1653 adolescents twice (at age 11 and 13.5 years, respectively), RSA was assessed in supine position at the first assessment wave. Depressive symptoms were assessed at both waves and SLEs experienced between the two waves at the last wave. RESULTS Low levels of RSA were not associated with concurrent or future depressive symptoms, and did not enhance the depressogenic effects of SLEs. CONCLUSIONS In a normal population of young adolescents, a low level of RSA does not identify adolescents at risk for depressive symptoms when confronted with SLEs. In post hoc analyses, among those reporting high exposure to stressful life events, higher RSA tended to predict less self-reported anxiety and more self-reported somatic symptoms as compared to those with lower RSA.

Purpose: To compare results of studies on supine and prone percutaneous nephrolithotomy (PCNL) techniques to find the best position for treating kidney stones. Materials and methods: A systematic literature review was done in April 2016 using PubMed, Scopus, and Web of Science databases to identify the relevant studies. Article selection was based on the preferred reporting elements of systematic reviews and meta-analysis criteria. A subgroup analysis was done comparing standard prone and supine PCNLs separately. Results: Twenty studies were selected for the analysis including 7733 PCNL cases: 2110 cases were (27.3%) in supine and 5623 cases were (72.7%) in prone position. Supine and prone PCNL had a similar stone-free rate (OR: 0.95; 95% CI: 070-1.27; P = 0.73), operation time (difference in means = -0.01, 95% CI: -0.07 to 0.03; P = .53), hospital stay (differencein means = 0.01, 95% CI: -0.07 to 0.03; P = .52), complication rate (OR: 0.88; 95% CI: 0.76-1.02; P = .09) and urinary leakage (OR: 1.14; 95% CI: 0.50-2.59; P = .75). However, patients received less blood transfusion (OR: 0.72; 95% CI: 0.55-0.94; P = .01) and had less fever rates (OR: 0.65; 95% CI: 0.52-0.80; P &lt; 0.001) in supine PCNL. Conclusion: Supine PCNL has similar stone-free rate, operation time, and hospital stay relative to prone PCNL. However, the supine position has the advantage of less fever and need for blood transfusion. Although both prone and supine PCNLs are suggested for treatment, supine PCNL may have advantages especially in patients with comorbidity.&nbsp.

We report a 54-year old man diagnosed as idiopathic hyperaldosteronism (IHA) at least 12 years after the onset. At the age of 42, he showed hypertension (162/100mmHg), hypokalemia, metabolic alkalosis, low plasma renin activity (PRA) and normal plasma aldosterone concentration (PAC) in a supine posture. Both PRA and PAC were elevated after a 2-hour ambulation following furosemide (60mg) injection. Since the accumulation of radioactivity following 131I-aldosterol injection with combined administration of dexamethasone was equally detected in both adrenal areas, he was diagnosed as low-renin essential hypertension (LREH). Blood pressure (BP) decreased to the normal range after treatment with nifedipine (40mg/day). At the age of 47, however, BP was hypertensive (164/106mmHg) serum potassium (K) level was normal. Although PAC was normal in a supine posture, it increased after a 2-hour ambulation following furosemide (60mg) injection. PRA after the stimulation was still suppressed despit...

Acquisition in the prone position has been demonstrated to improve the specificity of visually analyzed myocardial perfusion SPECT (MPS) for detecting coronary artery disease (CAD). However, the diagnostic value of prone imaging alone or combined acquisition has not been previously described using quantitative analysis. Methods: A total of 649 patients referred for MPS comprised the study population. Separate supine and prone normal limits were derived from 40 males and 40 females with a low likelihood (LLk) of CAD using a 3 average-deviation cutoff for all pixels on the polar map. These limits were applied to the test population of 369 consecutive patients (65% males; age, 65 6 13 y; 49% exercise stress) without known CAD who had diagnostic coronary angiography within 3 mo of MPS. Total perfusion deficit (TPD), defined as a product of defect extent and severity scores, was obtained for supine (S-TPD), prone (P-TPD), and combined supine-prone datasets (C-TPD). The angiographic group was randomly divided into 2 groups for deriving and validating optimal diagnostic cutoffs. Normalcy rates were validated in 2 additional groups of consecutive LLk patients: unselected patients (n 5 100) and patients with body mass index .30 (n 5 100). Results: C-TPD had a larger area under the receiver-operating-characteristic (ROC) curve than S-TPD or P-TPD for identification of stenosis $70% (0.86, 0.88, and 0.90 for S-TPD, P-TPD, and C-TPD, respectively; P , 0.05). In the validation group, sensitivity for P-TPD was lower than for S-or C-TPD (P , 0.05). C-TPD yielded higher specificity than S-TPD and a trend toward higher specificity than P-TPD (65%, 83%, and 86% for S-, P-, and C-TPD, respectively, P , 0.001; vs. S-TPD and P 5 0.06 vs. P-TPD). Normalcy rates for C-TPD were higher than for S-TPD in obese LLk patients (78% vs. 95%, P , 0.001). Conclusion: Combined supine-prone quantification significantly improves the area under the ROC curve and specificity of MPS in the identification of obstructive CAD compared with quantification of supine MPS alone.

This paper summarises a 1-day scientific consensus forum that reviewed the evidence underpinning the Australian SIDS and Kids Safe Sleeping Health Promotion Programme. The focus was on each of the potentially modifiable risk factors for sudden unexpected deaths in infancy, including sudden infant death syndrome (SIDS) and fatal sleeping accidents. In particular infant sleeping position, covering of the face, exposure to cigarette smoke, room sharing, unsafe sleeping environments, bed sharing, immunisation, breastfeeding, pacifier use and Indigenous issues were discussed in depth. The participants recommended that future 'Reducing the Risk' campaign messages should focus on back to sleep, face uncovered, avoidance of cigarette smoke before and after birth, safe sleeping environment, room sharing and sleeping baby in own cot.

Prone position is effective in mechanically ventilated patients to improve oxygenation. It is unknown if prone position affects gastric emptying and the ability of continued enteral feeding. To determine tolerance of enteral feeding by measuring gastric residual volumes in enterally fed patients during supine and prone positions. Consecutive mechanically ventilated intensive care patients who were turned to prone position were included. All patients were studied for 6 hours in supine position, immediately followed by 6 hours in prone position, or vice versa. The rate of feeding was unchanged during the study period. Gastric residual volume was measured by suctioning the naso-gastric tube after 3 and 6 hours in the same position. Wilcoxon test and regression analysis were used for analysis. The median volume of administered enteral feeds was 95 ml after 6 hours in supine position and 110 ml after 6 hours in prone position (P = 0.85). In 10 patients, a greater gastric residual volume ...

Objectives: To compare operative time, safety, and effectiveness of percutaneous nephrolithotomy in the supine versus prone position in a prospective randomized trial. Material and methods: From October 2005 to June 2007, 75 patients (33 men, 42 women; mean age, 39.3 yr) were prospectively enrolled and randomly divided into group A (39 patients, supine position) and group B (36 patients, prone position). Inclusion criteria were diagnosis of single or multiple renal stones (pelvic-caliceal) treatable with a single percutaneous access, stone diameter >2.5 cm, body mass index (BMI) <30 kg/m 2 , and no contraindications to perform the operation in the prone position. Exclusion criteria were stones in more than one calyx, complete staghorn stones, and coexisting renal anomalies. Results: The two groups were comparable in age, BMI, male-to-female ratio, and stone size. No significant difference was ascertained between the two groups in terms of stone-free rate (group A, 88.7% vs. group B, 91.6%, p = 0.12), mean blood loss (group A, D hemoglobin À2.3 g/dl vs. group B, À2.2 g/dl, p = 0.23), and mean hospital stay (group A, 4.3 d vs. group B, 4.1 d, p = 0.18). The only significant difference reported was mean operative time (group A, 43 min vs. group B, 68 min, p < 0.001). No blood transfusions were needed and no organ injuries were reported. Conclusions: In this carefully selected patient population with uncomplicated renal stones, the supine position was similar to the prone position for percutaneous stone removal.