Community resources for clients with mobility problems

Clients are leaving the hospital "quicker and sicker," and they frequently have acute care needs that must be met by resources outside the hospital setting. Community resources are diverse, vary widely from place to place, and have no central administration. Thus, using them can be challenging for both the nurse, client, and family. Reimbursement mechanisms underlie a person's ability to use resources and receive health care. By presenting two actual case scenarios where clients have mobility problems commonly seen by orthopaedic nurses, the authors discuss the community resources available, avenues of access to them, and their reimbursement mechanisms.     

User sensitive research in e-learning: exploring the role of individual user characteristics

The increasing need for active and accessible learning in the inclusive knowledge society drives the demand for e-learning that engages users much more effectively than ever before. In this context, it is crucial to conduct research that embraces innovation in user sensitive design, or else influential individual user differences may be overlooked. The objective of this paper is to explore the creation of successful e-learning systems that are able to increase users’ learning performance and enhance their personal learning experiences. The paper reports two converging and complimentary approaches, namely case studies and experimentation. First, case studies are used to explore the extent to which effective e-learning systems comply with eight specific factors. Of the eight, accessibility, individual differences and student modeling turn out to be the weakest points in current practice. Second, an empirical study investigates the influences of user individual user differences on users’ learning outcomes in an e-learning environment. The experiment found that individual differences in motivation to learn and expectations about e-learning significantly impacted users’ learning achievements. Third, based on these studies, improvements in research methodology are identified towards greater consideration of user sensitive research issues, thus enabling us to outline improved experimental procedures. Further experiment results should provide us with better insights into the arguments needed to carefully assess benefits of developing and involving a user model in an e-learning application. Consequently, evaluation and justification could now encompass both system performance as well as user performance.     

Label-free Growth Receptor-2 Detection and Dissociation Constant Assessment in Diluted Human Serum Using a Longitudinal Extension Mode of a Piezoelectric Microcantilever Sensor

We have investigated real-time, label-free, in-situ detection of human epidermal growth factor receptor 2 (Her2) in diluted serum using the first longitudinal extension mode of a lead zirconate-lead titanate (PZT)/glass piezoelectric microcantilever sensor (PEMS) with H3 single-chain variable fragment (scFv) immobilized on the 3-mercaptopropyltrimethoxysilane (MPS) insulation layer of the PEMS surface. We showed that with the longitudinal extension mode, the PZT/glass PEMS consisting of a 1 mm long and 127 μm thick PZT layer bonded with a 75 μm thick glass layer with a 1.8 mm long glass tip could detect Her2 at a concentration of 6-60 ng/ml (or 0.06-0.6 nM) in diluted human serum, about 100 times lower than the concentration limit obtained using the lower-frequency flexural mode of a similar PZT/glass PEMS. We further showed that with the longitudinal mode, the PZT/glass PEMS determined the equilibrium H3-Her2 dissociation constant K(d) to be 3.3±0.3 × 10(-8) M consistent with the value, 3.2±0.28 ×10(-8) M deduced by the surface plasmon resonance method (BIAcore).     

Simulated environments with animated agents: effects on visual attention,emotion, performance,and perception

This research assessed how emotive animated agents in a simulation‐based training affect the performance outcomes and perceptions of the individuals interacting in real time with the training application. A total of 56 participants consented to complete the study. The material for this investigation included a nursing simulation in which participants interacted with three animated agents. The results of this investigation indicated that both experienced and novice participants focused more visual attention time on the body of the animated agent than the other defined areas of interest in the simulated environment. The results also indicated that novice participants conveyed more neutral facial expressions during the interaction with the animated agents than experience participants. The results of the simulation performance scores indicated that novice participants achieved higher simulation performance scores on the simulation task than experienced participants. Lastly, the results of the agent persona instrument showed that experienced and novice participants perceived the animated agents as facilitators of learning, credible, human‐like and engaging.     

State-Space Synthesis of Virtual Auditory Space

Binaural displays for immersive listening must model realistic acoustic environments, multiple sound sources, and accommodate source and head motion. Many displays accomplish this by convolving collections of spatially distributed point sources with head-related transfer functions (HRTFs). The computational load of such a system scales linearly with the number of HRTFs modeled by the display. Realistic scenes often require a large number of HRTFs, and this framework is computationally burdensome. We propose a method that significantly eases this load by formulating the HRTF filter array as a state-space system. Three state-space architectures are explored. The performance of the most general architecture is found to suffer due to the interaural time delay (ITD). This problem may be circumvented with two alternative architectures, although the ideal choice depends on the specific display application. For each architecture, two order-reduction techniques are explored. Both techniques are based on the Hankel operator; one is ad hoc and simple to implement whereas the other is optimal in the Hankel norm. The two methods yield similar auditory performance, although the optimal method may be desirable for HRTF approximation.     

Convergent Smoothing and Segmentation of Noisy Range Data in Multiscale Space

With few exceptions, most of the existing noise reduction and data segmentation algorithms are only suited to image data. Therefore, an adaptive smoothing algorithm, with model-based masks, within a scale space framework is proposed for range data in this paper. This algorithm smoothes range data that conform to predefined, geometric models, while leaving other data points unaffected. The convergence of the algorithm in yielding dominant features is shown based on its compliance with the anisotropic diffusion concept. The weights of the smoothing masks are adaptively calculated according to the Mahalanobis distances between range data and model-based predictions. These behave as the diffusion coefficient in the anisotropic diffusion equation, thus satisfying the requirements of the causality criterion that no new features are introduced from fine to coarse scales. The computational complexity of this algorithm is examined and compared to that of the well-known RANSAC feature extraction algorithm. Unlike RANSAC, it has the advantage that the computational complexity is less affected by increasing the order of the model, and is independent of the number of model outliers. The proposed algorithm can be used to smooth range data in multiscale space by increasing the number of smoothing iterations. Robust, robot-occlusion-invariant features are then easily extracted from the smoothed data by least squares fitting algorithms.     

Pancreatic xanthomatous neuropathy associated with hyperlipidemia: a cause of abdominal pain mimicking chronic pancreatitis

"Hyperlipidemic crisis" is a term used to describe episodic abdominal pain in patients with hyperlipidemia. The morphologic correlates of this phenomenon have not been investigated and the etiology of the disorder is uncertain. We report a unique histologic finding in the pancreas of a 34-year-old woman with a 17-year history of episodic abdominal pain, sometimes accompanied by hyperamylasemia. At the age of 18 years, grossly elevated cholesterol and triglyceride levels were documented and type V hyperlipidemia was diagnosed. At the age of 34 years, subtotal pancreatectomy was performed for intractable abdominal pain. Histologic examination identified an increased number of enlarged pancreatic nerves that were infiltrated by foamy macrophages and encircled by fibrous tissue; endoneurial infiltration with macrophages occasionally split nerves into individual fascicles. Otherwise, the pancreas had only minimal fibrosis, nesidioblastosis, mucinous metaplasia of some pancreatic ducts, and scattered small collections of chronic inflammatory cells, subtle features suggesting very mild chronic pancreatitis. We propose that this novel xanthomatous neuropathy mimicked pancreatitis and was one of the underlying pathophysiologic mechanisms of abdominal pain in this patient. Further studies are necessary to document the prevalence of this new entity in patients with hyperlipidemia and to correlate its occurrence with "hyperlipidemic crisis" in those individuals.