A review of the readmissions of patients with tetraplegia to the Regional Spinal Injuries Centre, Southport, United Kingdom, between January 1994 and December 1995

Patients with chronic tetraplegia are prone to develop unique clinical problems which require readmission to specialised centres where the health professionals are trained specifically to diagnose, and treat the diseases afflicting this group of patients. An appraisal of the readmission pattern of tetraplegic patients will provide the necessary data for planning allocation of beds for treatment of chronic tetraplegic patients. Hospital records of patients with tetraplegia readmitted to the Regional Spinal Injuries Centre, Southport, UK between 1 January 1994 and 31 December 1995 were analyzed to find out the number of tetraplegic patients who required readmission, reasons for readmission, duration of hospital stay, and mortality among patients readmitted. During the 2-year period, 155 tetraplegic patients were readmitted and 44 of them (28.4%) required more than one readmission (total readmission episodes: 221); these patients occupied 4.5 beds which is equivalent to 11.5% of the total bed capacity of the spinal unit. Among the reasons for the readmissions, evaluation and care of urinary tract disorders topped the list with 96 readmission episodes (43.43%) involving 70 patients; the median hospital stay was 3 days, and 18 patients (26%) required more than one readmission during this period. One hospital bed was occupied by the tetraplegic patients requiring treatment/evaluation of urinary tract disorders. Assessment and treatment of cardio-respiratory diseases was the second most common reason for readmission with 51 readmission episodes pertaining to 27 patients having a median hospital stay of 6 days; 13 patients (48%) were readmitted more than once within this 2-year period. Treatment of cardio-respiratory diseases in chronic tetraplegic patients required 1.2 hospital beds yearly. Only five tetraplegic patients were readmitted for treatment of pressure sore(s); however they had a prolonged hospital stay (median duration: 101 days). Social reasons accounted for 13 readmission episodes concerning nine patients who stayed in the hospital for varying periods (median: 6.5 days; mean: 35 days). Four tetraplegic patients readmitted with acute chest infection expired. An 81 year-old tetraplegic died of myocardial infarction. Urinary sepsis, renal insufficiency, respiratory failure and intra-cerebral haemorrhage accounted for the demise of a 41 year-old tetraplegic patient following surgical removal of a large, impacted stone at the pelviureteric junction. A tetraplegic patient who was admitted with haematuria subsequently underwent cystectomy for squamous cell carcinoma of the urinary bladder; he developed secondaries and expired 5 months later. As more patients with high cervical spinal cord injury survive the initial period of trauma, and as the life expectancy of tetraplegic patients increases, it is likely that greater numbers of tetraplegic patients will be requiring readmission to spinal injuries centre. Although it may be possible to prevent some of the complications of spinal cord injury and hence the need for a readmission, progress in medicine and rehabilitation technology will create additional demands for readmissions of chronic tetraplegic patients in order to implement the newer therapeutic strategies. Thus a change in the pattern of readmission of chronic tetraplegic patients is likely to be the future trend and this should be taken into account while making plans for providing the optimum care to chronic tetraplegic patients.     

The role of integer matrices in multidimensional multirate systems

Various theoretical issues in multidimensional (m-D) multirate signal processing are formulated and solved. In the problems considered, the decimation matrix and the expansion matrix are nondiagonal, so that extensions of 1-D results are nontrivial. The m -D polyphase implementation technique for rational sampling rate alterations, the perfect reconstruction properties for the m-D delay-chain systems, and the periodicity matrices of decimated m-D signals (both deterministic and statistical) are treated. The discussions are based on several key properties of integer matrices, including greatest common divisors and least common multiples. These properties are reviewed     

Sampling methods for potential epidemic vectors of eastern equine encephalomyelitis virus in Massachusetts

The neurotoxic effect of monosodium L-glutamate (MSG) on the morphologies in the darkly stained sexually dimorphic nucleus of the preoptic area (SDN-POA) and the lighter-staining surrounding area (non-SDN-POA) within the medial preoptic nucleus (MPN) was evaluated. Male and female Long-Evans rats were used. MSG (4 mg/g of body weight) was administered subcutaneously to pups on days 1 and 3 postnatally. Normal saline was used as the vehicle. At the age of 6 months, the rats were sacrificed and the brain tissues were fixed for histological examination. The morphological changes, i.e., total volume, density, total neuron number, neuronal nuclear volume (NNV) and ratio of pyknosis, of the SDN-POA and non-SDN-POA within the MPN, were estimated using the AMS VIDS III semiautomatic image-analytic system. The results indicate that neonatal MSG treatment caused significant neuronal loss and decreases in total volume of the SDN-POA and non-SDN-POA of male and female rats. However, only the SDN-POA of MSG-treated male rats showed a significant increase of pyknosis and decrease of neuronal density. A significant enlargement of NNV in the SDN-POA and non-SDN-POA was observed in the MSG-treated male rats. These results indicate that the MPN shows sex-specific and area-specific changes after neonatal neurotoxicity due to MSG.     

Enhancing the quality of life through wearable technology

An overview of the key challenges facing the practice of medicine today is presented along with the need for technological solutions that can "prevent" problems. Then, the development of the Wearable Motherboard/spl trade/ (Smart Shirt) as a platform for sensors and monitoring devices that can unobtrusively monitor the health and well being of individuals (directly and/or remotely) is described. This is followed by a discussion of the applications and impact of this technology in the continuum of life-from preventing SIDS to facilitating independent living for senior citizens. Finally, the future advancements in the area of wearable, yet comfortable, systems that can continue the transformation of healthcare - all aimed at enhancing the quality of life for humans - are presented.     

HYDROSOL DEPOSITION IN GRANULAR BEDS—AN EXPERIMENTAL STUDY

Experiments were conducted to study the deposition of particles from suspensions flowing through packed beds. The experimental data obtained include both the initial and transient state particle collection. The initial collection efficiencies were compared with predictions based on existing theories. Agreement between experiments and predictions was generally good except for the case when significant repulsive force barrier exists between filter grains and particles. The transient state data obtained under the presence of unfavorable surface interactions show a steady decline in collection efficiency with time, which cannot be reconciled with any existing theories.     

Recurrent bilateral renal calculi in a tetraplegic patient

An 18-year-old male developed C-5 complete tetraplegia following a motor-cycle accident in May 1975. The neuropathic bladder was managed by an indwelling urethral catheter. He developed recurrent episodes of urinary infection with Proteus species. In September 1975, an X-ray of the abdomen revealed small calculi in both the kidneys. In July 1976, he underwent transurethral resection of the bladder neck and division of the external urethral sphincter; subsequently, he was put on a penile sheath drainage. He continued to suffer from repeated episodes of urinary tract infection with Proteus, Providencia, and Pseudomonas species, and he was treated with antibiotics. In 1980, intravenous urography (IVU) showed two large stones in the left kidney with marked caliectasis. The IVU performed in 1984 showed an increase in the size of the calculi in the left kidney which was grossly hydronephrotic. There were clusters of small calculi in the right kidney. The left renal calculi were treated by percutaneous lithotripsy in two sessions. In 1988, an X-ray of the abdomen revealed staghorn calculus in the right kidney and recurrence of stones in the left kidney. The staghorn calculus in the right kidney was treated by percutaneous nephrostolithotomy in two sessions. In 1991, he was admitted with acute urinary infection. IVU showed a stone in the pelviureteric junction with no excretion of contrast in the left kidney. Percutaneous nephrostomy drainage was established followed by left percutaneous nephrostolithotomy. In 1992, he was found to retain large amount of urine in the bladder; subsequently, his mother was taught to perform regular intermittent catheterisations. In 1995, he was admitted with acute urine infection. Abdominal X-ray revealed recurrence of large stones in both kidneys. With multiple sessions of Extracorporeal Shockwave Lithotripsy (ESWL), about 80% clearance was achieved on the left side. Right staghorn renal stone awaits treatment. This case shows that recurrent urinary infection in spinal cord injury patients is a predisposing factor for renal lithiasis. These patients require annual urological evaluation. Urinary tract calculi, if detected, should be dealt with promptly to prevent renal damage due to urinary obstruction and urosepsis. Renal calculi can be treated effectively and safely by ESWL in spinal cord injury patients, thus avoiding the need for an invasive procedure. It is essential to achieve low-pressure, adequate emptying of the urinary bladder in patients with spinal cord injury in order to prevent recurrent urinary infection and its sequelae. Social issues involved in the care of a tetraplegic patient play a vital role in the implementation of ideal medical treatment and need to be addressed promptly to avoid any compromise in the quality of medical care.     

Electronic textiles: A platform for pervasive computing

The invention of the Jacquard weaving machine led to the concept of a stored "program" and "mechanized" binary information processing. This development served as the inspiration for C. Babbage's analytical engine-the precursor to the modern-day computer. Today, more than 200 years later, the link between textiles and computing is more realistic than ever. In this paper, we look at the synergistic relationship between textiles and computing and identify the need for their "integration" using tools provided by an emerging new field of research that combines the strengths and capabilities of electronics and textiles into one: electronic textiles, or e-textiles. E-textiles, also called smart fabrics, have not only "wearable" capabilities like any other garment, but also have local monitoring and computation, as well as wireless communication capabilities. Sensors and simple computational elements are embedded in e-textiles, as well as built into yarns, with the goal of gathering sensitive information, monitoring vital statistics, and sending them remotely (possibly over a wireless channel) for further processing. The paper provides an overview of existing efforts and associated challenges in this area, while describing possible venues and opportunities for future research.     

Linear phase cosine modulated maximally decimated filter banks withperfect reconstruction

We propose a novel way to design maximally decimated FIR cosine modulated filter banks, in which each analysis and synthesis filter has a linear phase. The system can be designed to have either the approximate reconstruction property (pseudo-QMF system) or perfect reconstruction property (PR system). In the PR case, the system is a paraunitary filter bank. As in earlier work on cosine modulated systems, all the analysis filters come from an FIR prototype filter. However, unlike in any of the previous designs, all but two of the analysis filters have a total bandwidth of 2π/M rather than π/M (where 2M is the number of channels in our notation). A simple interpretation is possible in terms of the complex (hypothetical) analytic signal corresponding to each bandpass subband. The coding gain of the new system is comparable with that of a traditional M-channel system (rather than a 2M-channel system). This is primarily because there are typically two bandpass filters with the same passband support. Correspondingly, the cost of the system (in terms of complexity of implementation) is also comparable with that of an M-channel system. We also demonstrate that very good attenuation characteristics can be obtained with the new system     

The digital all-pass filter: a versatile signal processing buildingblock

The properties of digital all-pass filters are reviewed and a broad overview of the diversity of applications in digital filtering is provided. Starting with the definition and basic properties of a scalar all-pass function, a variety of structures satisfying the all-pass property are assembled, with emphasis placed on the concept of structural losslessness. Applications are then outlined in notch filtering, complementary filtering and filter banks, multirate filtering, spectrum and group-delay equalization, and Hilbert transformations. In all cases, the structural losslessness property induces very robust performance in the face of multiplier coefficient quantization. Finally, the state-space manifestations of the all-pass property are explored, and it is shown that many all-pass filter structures are devoid of limit cycle behavior and feature very low roundoff noise gain