Introduction of a new removable adjustable intraoral maxillary distraction system for correction of maxillary hypoplasia.

PubMed

Figueroa, Alvaro A; Polley, John W; Figueroa, Alexander L

2009-09-01

Distraction osteogenesis has become a treatment alternative to treat severe craniofacial skeletal dysplasias. A rigid external distraction device has been successfully used to advance the maxilla as well as the maxillary, orbital, and forehead complex (monobloc) in children as young as 2 years, adolescents, and adults. For this severe group of patients, the technique has been found to be simpler and safer than traditional surgical methods. Maxillary and midfacial advancement through distraction has been found to be extremely stable in the patients in whom the technique was used.The authors introduce an intraoral distractor for those patients requiring a moderate maxillary advancement. The advantages of the device include ease of insertion, vector adjustability, reactivation capabilities, and no need for second procedure for its removal.The above approaches have provided predictable and stable results. A detailed description of the device, necessary orthodontic and surgical procedures, case reports, and cephalometric outcomes are presented. The techniques can be applied alone or as an adjunct to traditional orthognathic and craniofacial surgical procedures.

Maxillary-driven simultaneous maxillo-mandibular distraction for hemifacial microsomia.

PubMed

Nakajima, Hideo; Sakamoto, Yoshiaki; Tamada, Ikkei; Ogata, Hisao; Kishi, Kazuo; Sakamoto, Teruo

2011-12-01

We treat hemifacial microsomia with a combination of surgery and orthodontic treatment during the growth period, resulting in early improvement in facial asymmetry and the induction of normal growth. We previously used gradual distraction of the mandibular ramus for Pruzansky's type II classification (Pruzansky, 1969). In type II cases, the maxilla should also be treated actively as, using this technique, improvement of the occlusal plane is difficult to achieve, resulting in a cross bite and difficulties in post-operative orthodontic treatment-especially in older patients. Morphologically, the mandibular angle region of the operative side is flat, and the angle of the mouth remains elevated. We performed mandibular-driven simultaneous maxillo-mandibular distraction while the occlusion was maintained using intermaxillary anchorage. However, mandibular-driven distraction tended to elongate the face because the mandible only elongated downwards and the mandibular ramus did not reach the glenoid. Furthermore, external distraction devices produce significant distress for patients until removal of the device and cause scars on the face. We developed a new internal distraction device with a variable angle and performed maxillary-driven simultaneous maxillo-mandibular distraction using this device. The result was morphologically satisfactory and solved the above problems. Because the patient was in the growth period, careful follow-up and induction to normal growth were important while the inferior growth of the affected side was monitored. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Simultaneous maxillary distraction osteogenesis using a twin-track distraction device combined with alveolar bone grafting in cleft patients: preliminary report of a technique.

PubMed

Suzuki, Eduardo Yugo; Watanabe, Masayo; Buranastidporn, Boonsiva; Baba, Yoshiyuki; Ohyama, Kimie; Ishii, Masatoshi

2006-01-01

The simultaneous use of cleft reduction and maxillary advancement by distraction osteogenesis has not been applied routinely because of the difficulty in three-dimensional control and stabilization of the transported segments. This report describes a new approach of simultaneous bilateral alveolar cleft reduction and maxillary advancement by distraction osteogenesis combined with autogenous bone grafting. A custom-made Twin-Track device was used to allow bilateral alveolar cleft closure combined with simultaneous maxillary advancement, using distraction osteogenesis and a rigid external distraction system in a bilateral cleft lip and palate patient. After a maxillary Le Fort I osteotomy, autogenous iliac bone graft was placed in the cleft spaces before suturing. A latency period of six days was observed before activation. The rate of activation was one mm/d for the maxillary advancement and 0.5 mm/d for the segmental transport. Accordingly, the concave facial appearance was improved with acceptable occlusion, and complete bilateral cleft closure was attained. No adjustments were necessary to the vector of the transported segments during the activation and no complications were observed. The proposed Twin-Track device, based on the concept of track-guided bone transport, permitted three-dimensional control over the distraction processes allowing simultaneous cleft closure, maxillary distraction, and autogenous bone grafting. The combined simultaneous approach is extremely advantageous in correcting severe deformities, reducing the number of surgical interventions and, consequently, the total treatment time.

Evaluation of bone healing in femurs lengthened via the gradual distraction method.

PubMed

Jochymek, Jiri; Gal, Petr

2007-06-01

Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s. In the years 1990 through 2006 a total of 57 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations. In 11 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 46 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 9 cases after the removal of the distraction apparatus. The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach.

[Analysis of the results of bone healing in femurs lengthened by the gradual distraction method in children and adolescents].

PubMed

Jochymek, J; Skvaril, J; Ondrus, S

2009-10-01

Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s. In the years 1990 through 2007 a total of 67 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations. In 13 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 54 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 12 cases after the removal of the distraction apparatus. Our results fully correspond with the data and experience of others cited authors. In addition our study showed deceleration in bone healing in girls over 12 years and in boys over 14 years of age and serious problem in healing when is lack of periostal callus five weeks after surgery. The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach. Key words: leg lengthening, gradual distraction, external fixation, leg discrepancy, complication.

Maxillary distraction osteogenesis in cleft lip and palate cases with midface hypoplasia using rigid external distractor: an alternative technique.

PubMed

Dua, Gaurav; Navin Kumar, Andrews; Roy, Indranil Deb; Roy, Supriyo Kumar

2014-05-01

Patients with operated cleft lip and palate present with a problem of midface hypoplasia, and such patients have been traditionally treated with orthognathic surgery. Such a procedure has its own limitations of relapse and hence a newer modality of distraction osteogenesis with histiogenesis can be chosen to overcome such limitations for midfacial advancement. The purpose of this study is to evaluate an alternative technique and its postoperative stability in maxillary distraction osteogenesis in patients of cleft lip and cleft palate using a rigid external device (RED). Nine patients with midface bone stock deficiency were selected for maxillary advancement. At the first surgery under general anesthesia, after Le Fort I osteotomy, RED system was used with the alternative technique. After distraction, evaluation was done for ease of the procedure, stability, and complications. Lateral cephalograms were evaluated at 3 stages: T1, pre-distraction; T2, post-distraction; and T3, 1 year post-distraction. A mean 13.4-mm midface advancement was shown with bone formation at the pterygomaxillary region without losing the vector and having a standby mode in case the wire broke during distraction The results were stable even at 1 year of follow-up. Maxillary position improved in relation to the cranial base. This study showed that the RED was versatile in midface advancement.

Distraction osteogenesis of costochondral bone grafts in the mandible.

PubMed

Stelnicki, Eric J; Hollier, Larry; Lee, Catherine; Lin, Wen-Yuan; Grayson, Barry; McCarthy, Joseph G

2002-03-01

Costochondral grafting for reconstruction of the Pruzansky type III mandible has given variable results. Lengthening of the rib graft by means of distraction had been advocated when subsequent growth of the grafted mandible is inadequate. This retrospective study reviews a series of patients with mandibular costochondral grafts who underwent subsequent distraction osteogenesis of the graft. A retrospective review identified two patient groups: group 1 consisted of individuals (n = 9) who underwent costochondral rib grafting of the mandible followed by distraction osteogenesis several months later at a rate of 1 mm/day. Group 2 consisted of patients with Pruzansky type II mandibles who had distraction osteogenesis without prior rib grafting (n = 9). The biomechanical parameters, orthodontic treatment regimens, and complications were examined versus patient age and quality of the rib graft. Distraction osteogenesis was successfully performed in six of the rib graft patients (group 1) and in all of the group 2 individuals. On the basis of the Haminishi scale, the computed tomographic scan appearance of the regenerate was classified as "standard or external" in six of the group 1 patients and as either "agenetic" or "pillar" (fibrous union) in the remaining three patients. In group 1, the average device was expanded 23 mm (range, 20 to 30 mm). Group 2 mandibular distraction results were all classified as either standard or external, and there was an average device expansion of 22.4 mm (range, 16 to 30 mm). The length of consolidation averaged 12.6 weeks in group 1, compared with 8.5 weeks in the traditional mandibular distraction patients (group 2). The mean shift of the dental midline to the contralateral side was 2.5 mm in group 1 versus 4.0 mm in group 2. Complex multiplanar and transport distractions were successfully performed on grafts of adequate bony volume. All four patients in group 1 with tracheostomies were successfully decannulated after consolidation. Rib graft distraction complications included pin tract infections in two patients, hardware failure with premature pin pullout in one patient, and evidence of fibrous nonunions in three young patients with single, diminutive rib grafts. In group 2, there were no distraction failures. Distraction osteogenesis can be successfully performed on costochondral rib grafts of the mandible; however, the complication rate is higher than in non-rib-graft patients. Performing the technique on older, more cooperative individuals seems to reduce this risk. In addition, placement of a double rib graft or an iliac bone graft of sufficient volume to create a neomandible with greater bone stock is an absolute requirement to decrease the risk of fibrous nonunion and provide a bone base of sufficient size for retention of the distraction device and manipulation of the regenerate.

Nonunion of the external maxillary distraction in cleft lip and palate: analysis of possible reasons.

PubMed

He, Dongmei; Genecov, David G; Barcelo, Raul

2010-10-01

Distraction osteogenesis (DO) is an effective way to treat severe maxillary deficiency in patients with cleft lip and palate. It has been reported to have long-term stability and low relapse rate compared with conventional maxillary osteotomy in large maxillary movement. However, complications such as nonunion are seldom reported. While developing our external distraction techniques, we had 4 nonunion cleft lip and palate (CLP) patients. The aim of this study is to analyze the possible reasons for these conditions by comparing them to patients successfully treated at 1 craniofacial institute. Fifty-six patients with CLP deformities treated with external maxillary distraction from 2000 to 2006 in 1 craniofacial center were reviewed. Among them, 17 had full records and follow-up time of more than 1 year. They had rigid external halo distraction with dental splint after a high Le Fort I osteotomy. Distraction was started at 5 days with a rate of 1 mm per day until the maxilla acquired the planned correction. Consolidation time ranged from 4 weeks to 3 months. Patients' general information, DO protocol, and cephalometric radiograph measurements before DO, immediately after DO, and follow-ups were evaluated. Thirteen of 17 patients successfully completed DO, whereas 4 others developed dental occlusion relapse 2 to 3 months after device removal. Later jaw surgery showed nonunion at the distraction sites. These were our first patients treated with external distraction. Their consolidation time was from 4 to 6 weeks with a mean of 5.2 weeks. After increasing the consolidation time up to 12 weeks, all of the other 13 patients had successful results without nonunion. Their mean consolidation time was 9.8 weeks. The nonunion group had significantly shorter consolidation time, older age, and larger distraction osteogenesis (DO) advancement than the successful group statistically. There was also a greater percentage of bilateral CLP patients in the nonunion group than in the successful treatment group. Among the 4 nonunion patients, 2 had failed alveolar bone graft before DO, and 3 did not have face mask retention therapy after device removal. The horizontal relapse rate in the 13 successful patients was 1 to 3 mm (mean, 11.9%) after 1 to 3 years of follow-up. All of these patients had good occlusion in the short-term follow-up (1 yr). Five developed end-to-end or Class III malocclusion in the long-term follow-up (1-3 yrs) because of maxillary relapse and continued mandibular growth that required jaw surgery later. A short consolidation time can cause nonunion, and should be lengthened to 12 weeks or more for a stable maxilla. Older age, bilateral CLP, large DO advancement (>15 mm), and compromised bone healing are the risk factors for nonunion. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Distracted by Your Mind? Individual Differences in Distractibility Predict Mind Wandering

ERIC Educational Resources Information Center

Forster, Sophie; Lavie, Nilli

2014-01-01

Attention may be distracted from its intended focus both by stimuli in the external environment and by internally generated task-unrelated thoughts during mind wandering. However, previous attention research has focused almost exclusively on distraction by external stimuli, and the extent to which mind wandering relates to external distraction is…

Long-term follow-up after maxillary distraction osteogenesis in growing children with cleft lip and palate.

PubMed

Huang, Chiung-Shing; Harikrishnan, Pandurangan; Liao, Yu-Fang; Ko, Ellen W C; Liou, Eric J W; Chen, Philip K T

2007-05-01

To evaluate the changes in maxillary position after maxillary distraction osteogenesis in six growing children with cleft lip and palate. Retrospective, longitudinal study on maxillary changes at A point, anterior nasal spine, posterior nasal spine, central incisor, and first molar. The University Hospital Craniofacial Center. Cephalometric radiographs were used to measure the maxillary position immediately after distraction, at 6 months, and more than 1 year after distraction. After maxillary distraction with a rigid external distraction device, the maxilla (A point) on average moved forward 9.7 mm and downward 3.5 mm immediately after distraction, moved backward 0.9 mm and upward 2.0 mm after 6 months postoperatively, and then moved further backward 2.3 mm and downward 6.8 mm after more than 1 year from the predistraction position. In most cases, maxilla moved forward at distraction and started to move backward until 1 year after distraction, but remained forward, as compared with predistraction position. Maxilla also moved downward during distraction and upward in 6 months, but started descending in 1 year. There also was no further forward growth of the maxilla after distraction in growing children with clefts.

Anterior maxillary segmental distraction for correction of maxillary hypoplasia and dental crowding in cleft palate patients: a preliminary report.

PubMed

Wang, X-X; Wang, X; Li, Z-L; Yi, B; Liang, C; Jia, Y-L; Zou, B-S

2009-12-01

To evaluate the feasibility of anterior maxillary segmental distraction (AMSD) to correct maxillary hypoplasia and severe dental crowding in cleft lip and palate (CLP) patients, 7 patients (average age 16.4 years) with maxillary hypoplasia, shortened maxillary dental arch length and severe anterior dental crowding secondary to CLP were selected for this study. After anterior maxillary segmental osteotomy, 3 patients were treated using bilateral internal distraction devices, and 4 patients were treated using rigid external distraction devices. Photographs and radiographs were taken to review the improvement in facial profile and occlusion after distraction. An average 10.25 mm anterior maxillary advancement was obtained in all patients after 10-23 days of distraction and 9-16 weeks of consolidation. The sella-nasion-point A (SNA) angle increased from 69.5 degrees to 79.6 degrees. Midface convexity was greatly improved and velopharyngeal competence was preserved. The maxillary dental arch length was greatly increased by 10.1 mm (P<0.01). Dental crowding and malocclusion were corrected by orthodontic treatment. These results show that AMSD can effectively correct the hypoplastic maxilla and severe dental crowding associated with CLP by increasing the midface convexity and dental arch length while preserving velopharyngeal function, and dental crowding can be corrected without requiring tooth extraction.

Three-dimensional computed tomographic evaluation of Le Fort III distraction osteogenesis with an external device in syndromic craniosynostosis.

PubMed

Wery, M F; Nada, R M; van der Meulen, J J; Wolvius, E B; Ongkosuwito, E M

2015-03-01

There is little anteroposterior growth of the midface in patients with syndromic craniosynostosis who are followed up over time without intervention. A Le Fort III with distraction osteogenesis can be done to correct this. This is a controlled way in which to achieve appreciable stable advancement of the midface without the need for bone grafting, but the vector of the movement is not always predictable. The purpose of this study was to evaluate the 3-dimensional effect of Le Fort III distraction osteogenesis with an external frame. Ten patients (aged 7-19 years) who had the procedure were included in the study. The le Fort III procedure and the placement of the external frame were followed by an activation period and then a 3-month retention period. Computed tomographic (CT) images taken before and after operation were converted and loaded into 3-dimensional image rendering software and compared with the aid of a paired sample t test and a colour-coded qualitative analysis. Comparison of the CT data before and after distraction indicated that the amount of midface advancement was significant. Le Fort III distraction osteogenesis is an effective way to advance the midface. However, the movement during osteogenesis is not always exactly in the intended direction, and a secondary operation is often necessary. Three-dimensional evaluation over a longer period of time is necessary. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Rigid external maxillary distraction and rhinoplasty for pyknodysostosis.

PubMed

Varol, Altan; Sabuncuoglu, Fidan Alakus; Sencimen, Metin; Akcam, Timur; Olmez, Hüseyin; Basa, Selçuk

2011-05-01

This article reports the treatment of an 33-year-old female patient with pyknodysostosis by rigid external distraction II midface distraction system. The patient with pyknodysostosis described in this report had severe midfacial hypoplasia. Correction of this by use of routine orthognathic surgery would require osteosynthesis and bone grafting. Risk of infection and/or nonunion after such a surgical procedure was considered too great, and therefore the possibility of treatment by distraction osteogenesis of the maxilla was evaluated. The rigid external distraction II midface distraction system was used to relocate the hypoplastic maxilla at anterior-inferior projection. Distraction osteogenesis should be considered as the primary reconstructive method for maxillofacial deformities in patients with sclerosing bone dysplasias, since this is the second reported case treated successfully with rigid external distraction.

Skeletal and dental stability after maxillary distraction with a rigid external device in adult cleft lip and palate patients.

PubMed

Aksu, Muge; Saglam-Aydinatay, Banu; Akcan, Cenk Ahmet; El, Hakan; Taner, Tulin; Kocadereli, Ilken; Tuncbilek, Gokhan; Mavili, Mehmet Emin

2010-02-01

To evaluate skeletal and dental stability in adult cleft lip and palate patients treated with a rigid external distraction system at the end of distraction and during the postdistraction period. Lateral cephalograms of 7 patients were obtained before distraction, at the end of distraction, and during the postdistraction period. The mean age before distraction was 21.56 +/- 4.73 years. The mean follow-up was 37.3 +/- 12.4 months. The assessment of findings showed that skeletal maxillary sagittal movement was achieved in a superoanterior direction. The maxillary depth angle and effective maxillary length increased significantly (2 degrees and 9 mm, respectively) after distraction, whereas the palatal plane angle increased by 8 degrees , resulting in an anterior movement of the maxilla with a counterclockwise rotation. The lower facial height showed no significant changes after distraction. The sagittal movement of the upper incisors and the angulation of the upper first molars increased significantly (4.5 mm and 5.5 degrees , respectively). During the postdistraction period, the maxilla showed a slight relapse (22%). The effective maxillary length decreased by 2 mm. The palatal plane angle almost returned to its original position, showing 7 degrees of clockwise rotation. The lower facial height remained stable. The upper incisors moved anteriorly and the upper first molars showed a significant mesioangular change during follow-up. After distraction, significant maxillary advancement was achieved with a counterclockwise rotation. The upper incisors moved labially, and the upper first molars angulated mesially. After 3 years, a 22% relapse rate was seen in the maxilla. The counterclockwise rotation of the maxilla was returned to its original position. The upper incisors moved more anteriorly. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Anterior maxillary segmental distraction in the treatment of severe maxillary hypoplasia secondary to cleft lip and palate.

PubMed

Li, Hongliang; Dai, Jiewen; Si, Jiawen; Zhang, Jianfei; Wang, Minjiao; Shen, Steve Guofang; Yu, Hongbo

2015-01-01

Anterior maxillary segmental distraction (AMSD) is an effective surgical procedure in the treatment of maxillary hypoplasia secondary to cleft lip and palate. Its unique advantage of preserving velopharyngeal function makes this procedure widely applied. In this study, the application of AMSD was described and its long-term stability was explored. Eight patients with severe maxillary hypoplasia secondary to CLP were included in this study. They were treated with AMSD using rigid external distraction (RED) device. Cephalometric analysis was performed twice at three time points for evaluation: before surgery (T1), after distraction (T2), and 2 years after treatment (T3). One-way analysis of variance was used to assess the differences statistically. All the distractions completed smoothly, and maxilla was distracted efficiently. The value of SNA, NA-FH, Ptm-A, U1-PP, overjet and PP (ANS-PNS) increased significantly after the AMSD procedure (P < 0.05), with the mean overjet increased by 14.28 mm. However, comparison of cephalometric analysis between T2 and T3 showed no significant difference (P > 0.05). Changes of palatopharyngeal depth and soft palatal length were insignificant. AMSD with RED device provided an effective way to correct maxillary hypoplasia secondary to CLP, extended the palatal and arch length, avoided damage on velopharyngeal closure function and reduced the relapse rate. It is a promising and valuable technique in this potentially complicated procedure.

Joint distraction for thumb carpometacarpal osteoarthritis: a feasibility study with 1-year follow-up.

PubMed

Spaans, Anne J; Minnen, L Paul van; Braakenburg, Assa; Mink van der Molen, Aebele B

2017-08-01

The purpose of this pilot study was to evaluate the feasibility of joint distraction of the first carpometacarpal (CMC1) joint in patients with CMC1 osteoarthritis (OA). An external joint distractor was placed over the CMC1 joint by K-wire fixation in the trapezium and the metacarpal. The joint was distracted 3 mm during surgery. The device was then kept in place for 8 weeks. Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcome Questionnaire (MHQ), Visual Analogue Scale (VAS), and grip strength were recorded preoperatively and at set postoperative intervals. Five female patients with an average age of 53 years (range = 41-61) were included. One year postoperatively, average DASH, MHQ, and VAS scores improved compared to preoperative values; DASH 53 to 27, MHQ 48 to 76, and VAS pain 48 to 14. There were no technical problems associated with the device. One patient had a local pin site infection treated successfully with oral antibiotics. This study concludes that joint distraction of the osteoarthritic CMC1 joint is technically feasible. In this small, prospective pilot study the majority of the results were favourable during short-term follow-up.

Anterior maxillary segmental distraction in the treatment of severe maxillary hypoplasia secondary to cleft lip and palate

PubMed Central

Li, Hongliang; Dai, Jiewen; Si, Jiawen; Zhang, Jianfei; Wang, Minjiao; Shen, Steve Guofang; Yu, Hongbo

2015-01-01

Anterior maxillary segmental distraction (AMSD) is an effective surgical procedure in the treatment of maxillary hypoplasia secondary to cleft lip and palate. Its unique advantage of preserving velopharyngeal function makes this procedure widely applied. In this study, the application of AMSD was described and its long-term stability was explored. Eight patients with severe maxillary hypoplasia secondary to CLP were included in this study. They were treated with AMSD using rigid external distraction (RED) device. Cephalometric analysis was performed twice at three time points for evaluation: before surgery (T1), after distraction (T2), and 2 years after treatment (T3). One-way analysis of variance was used to assess the differences statistically. All the distractions completed smoothly, and maxilla was distracted efficiently. The value of SNA, NA-FH, Ptm-A, U1-PP, overjet and PP (ANS-PNS) increased significantly after the AMSD procedure (P < 0.05), with the mean overjet increased by 14.28 mm. However, comparison of cephalometric analysis between T2 and T3 showed no significant difference (P > 0.05). Changes of palatopharyngeal depth and soft palatal length were insignificant. AMSD with RED device provided an effective way to correct maxillary hypoplasia secondary to CLP, extended the palatal and arch length, avoided damage on velopharyngeal closure function and reduced the relapse rate. It is a promising and valuable technique in this potentially complicated procedure. PMID:26629107

Segmental transport after unreamed intramedullary nailing. Preliminary report of a "Monorail" system.

PubMed

Raschke, M J; Mann, J W; Oedekoven, G; Claudi, B F

1992-09-01

The Ilizarov method of segmental bone transport has been shown to be an alternative to more conventional treatments of posttraumatic bony defects. After extensive clinical experience with the unreamed tibial nail in open fractures up to Grade IIIb, a new monorail fixation system for callus distraction and segmental bone transport was devised. This Monorail system is composed of an unreamed intramedullary (IM) nail and a unilateral AO distraction device. The new fixation method and the preliminary clinical experience are reported here. Four patients who previously sustained Grades II-IIIb open tibial fractures had an average bony defect of 9 cm. Two patients had previous bony infections. All patients had had serial debridements and myocutaneous flaps were required in three patients. An unreamed IM nail was inserted, and the transport device was applied. After an osteotomy, segmental transport was carried out until docking was achieved. The external fixator was removed after interlocking of the transported segment. The mean duration of external fixation was 17.9 days/cm and the mean period until roentgenographic consolidation of the distraction and nonunion site was 41.2 days/cm. There were two pin-tract infections but no IM infections. One nail broke after osseous consolidation of the regenerate at the distal interlocking site and required exchange. The goal of transport was achieved in all cases without angular or rotational deformity or length discrepancy. There were no neurovascular injuries.

Maxillary Distraction Osteogenesis Using a Rigid External Distractor: Which Clinical Factors Are Related With Relapse?

PubMed

Kim, Jeenam; Uhm, Ki-Il; Shin, Donghyeok; Lee, Jina; Choi, Hyungon

2015-06-01

Maxillary distraction osteogenesis is a reliable treatment for cleft lip and palate with midfacial retrusion. The purpose of this study was to evaluate the results of long-term follow-up in patients with cleft lip and palate after maxillary distraction osteogenesis and to find clinical factors related to relapse. From February 2002 to June 2008, 21 patients with severe class III malocclusion were treated at our hospital. We performed distraction osteotomy with a rigid external distractor device. The distraction length was more than 15 mm in all patients. Preoperative and postoperative lateral cephalometric radiographs were used for analysis. The sella-nasion-subnasale, sella-nasion-supramentale, and point-A-point-B-nasion (sella-nasion-subnasale-sella-nasion-supramentale) angles were recorded. The timelines for follow-up were preoperatively, after distraction, after consolidation, at 3 years, and once fully grown (5- to 8-year follow-ups). A comparative analysis of clinical factors was performed for the relapsing and nonrelapsing groups. Of the 21 patients, 14 had relapsed. The mean age in the relapsing group was 9.1 years (7 boys and 7 girls) with 9 patients with unilateral cleft palate and 5 c bilateral cleft palate. The mean age in the nonrelapsing group was 11.7 years (4 boys and 3 girls) with 5 patients with unilateral cleft palate and 2 patients with bilateral cleft palate. Despite greater anterior overcorrection, relapse occurred owing to scar tissue retraction and mandibular compensatory hypertrophy. The results suggest that the younger the patient, the more likely relapse will occur.

Changes in nasorespiratory function in association with maxillary distraction osteogenesis in subjects with cleft lip and palate.

PubMed

Saito, Kiyo; Ono, Takashi; Mochida, Masumi; Ohyama, Kimie

2006-01-01

The current study aimed to determine how nasorespiratory function changes in association with maxillary distraction osteogenesis (DO). Furthermore, with regard to impaired nasorespiratory function, the possibility of a relationship between the cleft side and laterality and any effect of maxillary distraction osteogenesis was investigated. In this descriptive, prospective clinical report, subjective and objective data regarding nasorespiratory function before and after maxillary distraction osteogenesis were compared. Data from 13 subjects with cleft lip and palate were used. Subjects had a severe maxillary deficiency and underwent distraction osteogenesis using a rigid external device system. The subjective measure was the score on a questionnaire regarding nasorespiratory function using a visual analog scale. The objective measure was nasal resistance. The visual analog scale score for two items significantly decreased just after distraction osteogenesis. Nasal resistance also significantly decreased 1 year after distraction osteogenesis. Moreover, nasal resistance on the cleft side was significantly greater than that on the noncleft side just before and 1 year after distraction osteogenesis. There was a significant positive correlation between changes in the visual analog scale score and nasal resistance. These results suggest that nasorespiratory function changes in association with maxillary distraction osteogenesis in subjects with cleft lip and palate. Moreover, it appears that nasal obstruction on the cleft side does not change in subjects with unilateral cleft lip and palate.

Le Fort III Distraction With Internal vs External Distractors: A Cephalometric Analysis.

PubMed

Robertson, Kevin J; Mendez, Bernardino M; Bruce, William J; McDonnell, Brendan D; Chiodo, Michael V; Patel, Parit A

2018-05-01

This study compares the change in midface position following Le Fort III advancement using either rigid external distraction (group 1) or internal distraction (group 2). We hypothesized that, with reference to right-facing cephalometry, internal distraction would result in increased clockwise rotation and inferior displacement of the midface. Le Fort III osteotomies and standardized distraction protocols were performed on 10 cadaveric specimens per group. Right-facing lateral cephalograms were traced and compared across time points to determine change in position at points orbitale, anterior nasal spine (ANS), A-point, and angle ANB. Institutional. Twenty cadaveric head specimens. Standard subcranial Le Fort III osteotomies were performed from a coronal approach and adequately mobilized. The specified distraction mechanism was applied and advanced by 15 mm. Changes of position were calculated at various skeletal landmarks: orbitale, ANS, A-point, and ANB. Group 1 demonstrated relatively uniform x-axis advancement with minimal inferior repositioning at the A-point, ANS, and orbitale. Group 2 demonstrated marked variation in x-axis advancement among the 3 points, along with a significant inferior repositioning and clockwise rotation of the midface ( P < .0001). External distraction resulted in more uniform advancement of the midface, whereas internal distraction resulted in greater clockwise rotation and inferior displacement. External distraction appears to provide increased vector control of the midface, which is important in creating a customized distraction plan based on the patient's individual occlusal and skeletal needs.

A simplified modification of a reconstruction plate into a mandibular transport distraction device: A technical note.

PubMed

Mohanty, Sujata; Dabas, Jitender; Gupta, Rekha

2015-01-01

Transport distraction is nowadays gaining enormous popularity and is becoming a promising option for reconstruction of mandibular defects. However, the vast number of distraction device designs create huge confusion in the clinician's mind to choose the right one. Considering these complex and costly designs, the authors decided to find a simplified way of combining a modified conventional reconstruction plate and monofocal distraction device that can act as a transport distraction device for bridging of bony defects. A case performed by this technique and device has been presented along with the description of device design.

A simple mechanism for measuring and adjusting distraction forces during maxillary advancement.

PubMed

Suzuki, Eduardo Yugo; Suzuki, Boonsiva

2009-10-01

Direct measurement of distraction forces on the craniofacial skeleton has never been reported. The present report describes the development of a method of assessing and adjusting traction forces applied through maxillary distraction osteogenesis. A simple mechanism to measure and adjust tension force during maxillary distraction osteogenesis was developed and connected bilaterally to the traction screws of a rigid external distraction device. Measurements were carried out before and after activation using a Shimpo (Nidec-Shimpo America Corporation, Itasca, IL) force gauge in 4 patients (2 with unilateral cleft lip and/or palate, 1 with bilateral cleft lip and palate, and 1 with noncleft) during the distraction process. Activation was performed twice a day at a rate of 1 mm/day. The average maximum force applied throughout the distraction period was 42.5 N (range 16.4 to 65.3 N), with increments, after activation, averaging 10.5 N (range 7.9 to 15.7 N). In patients with unilateral cleft lip and/or palate, distraction forces on the larger segment were 65.1% higher than on the lesser segment. A differential pattern of forces was also observed in the patients with asymmetric noncleft. However, the differential forces between lateral segments were not observed in the patient with bilateral cleft lip and palate. During the activation period, distraction forces progressively increased, whereas the amount of maxillary movement decreased. Pain and discomfort were reported with high forces. Through this mechanism, direct measurement and adjustment of distraction forces during maxillary advancement was possible. The unbalanced pattern of forces observed in patients with cleft suggests the necessity of individual adjustments for controlling pain and clinical symptoms. Accordingly, assessment of distraction forces during maxillary distraction osteogenesis is extremely helpful in understanding the biomechanics of the distraction process.

Complications of the Intramedullary Skeletal Kinetic Distractor (ISKD) in distraction osteogenesis.

PubMed

Lee, Dong Hoon; Ryu, Keun Jung; Song, Hae Ryong; Han, Soo-Hong

2014-12-01

The Intramedullary Skeletal Kinetic Distractor (ISKD) (Orthofix Inc, Lewisville, TX, USA) is an intramedullary device designed for more comfortable limb lengthening than that with external fixators; lengthening is achieved with this nail using rotational oscillation between two telescoping sections. However, the degree to which this device achieves this goal and its complication rate have not been fully documented. We determined (1) the frequency with which distraction was not achieved at the desired rate, (2) whether pain differed between patients with normally and abnormally distracting nails, (3) risk factors for abnormal nails, and (4) other complications. We analyzed 35 lengthening segments (26 femurs, nine tibias) in 19 patients. Mean length achieved was 47 mm. Femoral nails were categorized into four groups according to distraction rate: normal, runaway (unintentionally faster rate [> 1.5 mm/day]), difficult-to-distract (slower rate [< 0.8 mm/day] requiring manual manipulation but not requiring general anesthesia), and nondistracting (slower rate [< 0.8 mm/day] requiring manual manipulation under general anesthesia or reosteotomy). Possible risk factors, including age, BMI, preoperative thigh circumferences, degree of intramedullary overreaming, and length of the thicker portion of the nail within the distal fragment, were compared among groups. VAS pain scores were compared among groups under three conditions: rest, physiotherapy, and distraction motion. Complications were also analyzed. Minimum followup was 15 months (mean, 26 months; range, 15-38 months) after first-stage surgery. Abnormal distraction rate was observed in 21 of 35 segments (60%; 17 femurs, four tibias). VAS pain scores showed no differences among groups during rest or physiotherapy but were higher (p = 0.02) in the problematic nails (7-8 points) versus normal nails (3 points) during distraction. Only mean length of the thicker portion of the nail within the distal fragment differed between normally and abnormally distracting nails (95 mm versus 100 mm; p = 0.03), although this was unlikely to be clinically important. Complications occurred in 10 patients (53%), including five with decreased ankle ROM during distraction, four with delayed bone healing, and one with mechanical device failure during distraction. Rate control was difficult to achieve with the ISKD nail for femoral and tibial lengthenings, complications were relatively common, and among patients in whom rate control was not achieved, pain levels were high. Based on our findings, we believe that surgeons should avoid use of this nail. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Anterior maxillary distraction using a tooth-borne device for hypoplastic cleft maxillas-a pilot study.

PubMed

Richardson, Sunil; Agni, Nisheet A; Selvaraj, Dhivakar

2011-12-01

The management of maxillary retrusion in a patient with cleft lip and palate is performed using Le Fort I advancement or distraction osteogenesis using an external or an internal device. Distraction mostly involves movement of the entire maxilla at the Le Fort I level and is characterized by a higher relapse rate and a hampering of speech. Hence, distraction of the anterior maxilla was performed using a tooth-borne palatal distractor similar to the one proposed by Gunaseelan et al (J Oral Maxillofac Surg 65:1044, 2007). However, the technique was modified by placing the distractor preoperatively before performing the osteotomy cut. The main advantage of this modification is that more control over the vector can be achieved and chances of cement failure caused by contamination and an inability to achieve isolation is drastically decreased. This study investigated the efficacy and stability of anterior maxillary distraction in the management of cleft maxillary retrognathia and any resulting complications. Fourteen patients older than 12 years with cleft maxillary retrognathia were included in the study irrespective of gender, type of cleft lip and palate, and the amount of advancement needed. The patients were evaluated using Orthopantomogram and lateral cephalograms preoperatively and at 3 months postoperatively (ie, before appliance removal) and at 6 months postoperatively. The distractor was fabricated extraorally on a cast and cemented into the patient's mouth the day before surgery. The initial deficiency, amount of advancement achieved, and relapses at 6 months, if any, were studied. The data were tabulated and analyzed. Only 1 of the 14 patients showed a relapse, of 2 mm, because this patient was lost to follow-up and thus delayed tooth replacement. Anterior maxillary distraction with a tooth-borne device is a feasible modality for the management of cleft maxillary retrognathia, with stable results. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Joint distraction and movement for repair of articular cartilage in a rabbit model with subsequent weight-bearing.

PubMed

Nishino, T; Chang, F; Ishii, T; Yanai, T; Mishima, H; Ochiai, N

2010-07-01

We have previously shown that joint distraction and movement with a hinged external fixation device for 12 weeks was useful for repairing a large articular cartilage defect in a rabbit model. We have now investigated the results after six months and one year. The device was applied to 16 rabbits who underwent resection of the articular cartilage and subchondral bone from the entire tibial plateau. In group A (nine rabbits) the device was applied for six months. In group B (seven rabbits) it was in place for six months, after which it was removed and the animals were allowed to move freely for an additional six months. The cartilage remained sound in all rabbits. The areas of type II collagen-positive staining and repaired soft tissue were larger in group B than in group A. These findings provide evidence of long-term persistence of repaired cartilage with this technique and that weight-bearing has a positive effect on the quality of the cartilage.

Stem cells rejuvenate radiation-impaired vasculogenesis in murine distraction osteogenesis.

PubMed

Deshpande, Sagar S; Gallagher, Kathleen K; Donneys, Alexis; Nelson, Noah S; Guys, Nicholas P; Felice, Peter A; Page, Erin E; Sun, Hongli; Krebsbach, Paul H; Buchman, Steven R

2015-03-01

Radiotherapy is known to be detrimental to bone and soft-tissue repair. Bone marrow stromal cells have been shown to enhance bone regeneration during distraction osteogenesis following radiation therapy. The authors posit that transplanted bone marrow stromal cells will significantly augment the mandibular vascularity devastated by radiation therapy. Nineteen male Lewis rats were split randomly into three groups: distraction osteogenesis only (n = 5), radiation therapy plus distraction osteogenesis (n = 7), and radiation therapy plus distraction osteogenesis with intraoperative placement of 2 million bone marrow stromal cells (n = 7). A mandibular osteotomy was performed, and an external fixator device was installed. From postoperative days 4 through 12, rats underwent a gradual 5.1-mm distraction followed by a 28-day consolidation period. On postoperative day 40, Microfil was perfused into the vasculature and imaging commenced. Vascular radiomorphometric values were calculated for regions of interest. An analysis of variance with post hoc Tukey or Games-Howell tests was used, dependent on data homogeneity. Stereologic analysis indicated significant remediation in vasculature in the bone marrow stromal cell group compared with the radiation therapy/distraction osteogenesis group. Each of five metrics idicated significant improvements from radiation therapy/distraction osteogenesis to the bone marrow stromal cell group, with no difference between the bone marrow stromal cell group and the distraction osteogenesis group. Bone marrow stromal cells used together with distraction osteogenesis can rejuvenate radiation-impaired vasculogenesis in the mandible, reversing radiation therapy-induced isotropy and creating a robust vascular network. Bone marrow stromal cells may offer clinicians an alternative reconstructive modality that could improve the lifestyle of patients with hypovascular bone.

Management of post midface distraction occlusal discrepancy using temporary anchorage devices in a cleft patient

PubMed Central

Koteswara Prasad, N. K.; Hussain, Syed Altaf; Chitharanjan, Arun B.; Murthy, Jyotsna

2015-01-01

Open bite deformity following a successful midface advancement by distraction osteogenesis is a common complication. Temporary anchorage devices can be deployed during the distraction and post-distraction settling phases for restoring the occlusion even in severe cases. The following report describes the management of severe anterior open bite following maxillary distraction. PMID:25991895

Transantral distraction devices in correction of severe maxillary deformity in cleft patients.

PubMed

Shokirov, Shokhruh; Wangerin, Konrad

2011-01-01

Maxillary advancement by Le Fort I osteotomy in cleft patients has an average relapse of about 40-60 percent. With extraoral distraction devices it is possible to obtain an almost unlimited advancement of the upper jaw. Due to the social problems the retention period is normally reduced to some monthes. A relapse of 10-25 % can be seen in these cases. Le Fort I internal distraction osteogenesis offers an alternative to one-step orthognathic advancement, with advantages of gradual lengthening through scar and earlier treatment in growing patients. The objective of this study was to present our experience in the treatment of maxillary deficiency in cleft patients using transantral internal distraction devices. The distraction procedure was successfully accomplished in seventeen patients. For all the seventeen patients maxillary distraction device designed by Konrad Wangerin was used. The distraction distances were 8 to 24 mm. Preoperative, postoperative, and follow-up (12 and 24 months) lateral cephalogram measurements were compared including angular and linear changes. A good new bone was found that was formed in distraction pitch between lines of osteotomy. After distraction of median facial zone, occlusion and profile of soft tissues were considerably improved. All patients after postoperative time required final orthodontic treatment and their final occlusal relationships were satisfactory. The transantral distraction device is a new option for the treatment of severe maxillary hypoplasia in cleft patients.

Dynamic Distraction External Fixation for Contracture of the Metacarpophalangeal Joint.

PubMed

Seigerman, Daniel A; Tan, Virak

2015-12-01

Metacarpophalangeal (MP) joint contractures are common after traumatic injury, and can be difficult to manage. After surgical capsulectomy, it remains challenging to maintain motion that was obtained at the time of surgery. Our group uses a novel, prefabricated digital external fixator to provide both distraction, and motion therapy across the MP joint after surgical treatment of MP contracture. The purpose of this technique is to demonstrate the effectiveness of an adjunctive dynamic distraction external fixator for the maintenance of joint motion after surgical treatment of MP contractures of the border digits.

The potential effect of technology and distractions on undergraduate students' concentration.

PubMed

Attia, Najya A; Baig, Lubna; Marzouk, Yousef I; Khan, Anwar

2017-01-01

In the present era, it is difficult to keep the concentration of college students at its maximum potential during the class time, as there are many distractions that negatively impact students' concentration and prevent optimal learning. Technologies such as laptops and cell phones have invaded the classroom, raising considerable concerns about their effects on college students' attention in the classroom. Despite these concerns, no research has been done in Saudi Arabia on the effects of technology and other types of classroom distractions on students' concentration. In the current study, we have attempted to identify students' perceptions of major distractions in the classroom based on seventeen internally (self-produced) and twenty-four externally produced classroom situations. The students participating in this study rated the degree to which each distraction interferes with their concentration on the class materials and their ability to learn. Data were collected through surveys of 265 students (66 and 199 students from medical and basic classes, respectively), including 97 females and 168 males 17-23 years of age from the academic years 2010 to 2014. A validated self-administered questionnaire was handed to the students in the classroom. The students were asked to report and rate the classroom distraction produced by 24 external internal distracters (Table-II), on a 5-point scale. The results revealed that ringing cell phones in the class were the most commonly reported electronic external distractor for 68% of students, and 21% of them reported being extremely distracted by this noise. Having an instructor who is difficult to understand was the most commonly reported external behavioral distractor for 75% of students, and 48% of them rated this as extremely distracting. Students talking in class were the most self-produced distractor for 72% of students; negatively impacting their concentration and ability to learn, and 42% of them rated it as an extreme distractor. Wearing clothing with unusual words, drinking and eating in the classroom were minimally distracting colleagues. Overall, distractions (internal and external) were more significant for fifth-year students than the other years at a p-value < 0.001. Students believed that laptop and cell phone use in the classroom can effect their concentration and ability to learn. The students also felt that inappropriate behavior is a major distraction for students as well, and thus necessitates monitoring and improvement.

The potential effect of technology and distractions on undergraduate students’ concentration

PubMed Central

Attia, Najya A.; Baig, Lubna; Marzouk, Yousef I.; Khan, Anwar

2017-01-01

Background and Objectives: In the present era, it is difficult to keep the concentration of college students at its maximum potential during the class time, as there are many distractions that negatively impact students’ concentration and prevent optimal learning. Technologies such as laptops and cell phones have invaded the classroom, raising considerable concerns about their effects on college students’ attention in the classroom. Despite these concerns, no research has been done in Saudi Arabia on the effects of technology and other types of classroom distractions on students’ concentration. In the current study, we have attempted to identify students’ perceptions of major distractions in the classroom based on seventeen internally (self-produced) and twenty-four externally produced classroom situations. Methods: The students participating in this study rated the degree to which each distraction interferes with their concentration on the class materials and their ability to learn. Data were collected through surveys of 265 students (66 and 199 students from medical and basic classes, respectively), including 97 females and 168 males 17–23 years of age from the academic years 2010 to 2014. A validated self-administered questionnaire was handed to the students in the classroom. The students were asked to report and rate the classroom distraction produced by 24 external internal distracters (Table-II), on a 5-point scale. Results: The results revealed that ringing cell phones in the class were the most commonly reported electronic external distractor for 68% of students, and 21% of them reported being extremely distracted by this noise. Having an instructor who is difficult to understand was the most commonly reported external behavioral distractor for 75% of students, and 48% of them rated this as extremely distracting. Students talking in class were the most self-produced distractor for 72% of students; negatively impacting their concentration and ability to learn, and 42% of them rated it as an extreme distractor. Wearing clothing with unusual words, drinking and eating in the classroom were minimally distracting colleagues. Overall, distractions (internal and external) were more significant for fifth-year students than the other years at a p-value < 0.001. Conclusion: Students believed that laptop and cell phone use in the classroom can effect their concentration and ability to learn. The students also felt that inappropriate behavior is a major distraction for students as well, and thus necessitates monitoring and improvement. PMID:29067054

Similarities and differences between mind-wandering and external distraction: a latent variable analysis of lapses of attention and their relation to cognitive abilities.

PubMed

Unsworth, Nash; McMillan, Brittany D

2014-07-01

The current study examined the extent to which task-unrelated thoughts represent both vulnerability to mind-wandering and susceptibility to external distraction from an individual difference perspective. Participants performed multiple measures of attention control, working memory capacity, and fluid intelligence. Task-unrelated thoughts were assessed using thought probes during the attention control tasks. Using latent variable techniques, the results suggested that mind-wandering and external distraction reflect distinct, yet correlated constructs, both of which are related to working memory capacity and fluid intelligence. Furthermore, the results suggest that the common variance shared by mind-wandering, external distraction, and attention control is what primarily accounts for their relation with working memory capacity and fluid intelligence. These results support the notion that lapses of attention are strongly related to cognitive abilities. Copyright © 2014 Elsevier B.V. All rights reserved.

Treatment of displaced intra-articular calcaneal fractures with triangular tube-to-bar external fixation: long-term clinical follow-up and radiographic analysis.

PubMed

Roukis, Thomas S; Wünschel, Markus; Lutz, Hans-Peter; Kirschner, Peter; Zgonis, Thomas

2008-04-01

Sixty-six feet (62 patients) with displaced intra-articular calcaneal fractures underwent manual reduction and distraction with the use of a triangular tube-to-bar external fixation device and were retrospectively reviewed at a minimum of 1-year post-operative. Final radiographic follow-up revealed complete consolidation in all fractures, maintenance of reduction, and limited degenerative osteoarthrosis about the subtalar joint. Our results indicate that with proper application and attention to detail, restoration of calcaneal morphology using triangular tube-to-bar external fixation should be considered a viable alternative in the treatment of displaced intra-articular fractures of the calcaneus.

Le Fort I distraction using internal devices for maxillary hypoplasia in patients with cleft lip, palate, and alveolus: complications and their prevention and management.

PubMed

Mitsukawa, Nobuyuki; Satoh, Kaneshige; Morishita, Tadashi

2010-09-01

In recent years, advancement has been made in distraction osteogenesis in the facial area. It has been applied actively to treat maxillary hypoplasia in patients with cleft lip, palate, and alveolus. Le Fort I distraction using internal devices does not lead to disability in daily living, including during the retention period, and has low surgical invasiveness, facile management, and superior aesthetics. Thus, there have been occasional reports on this procedure in recent years. Because an internal device is unidirectional, the greatest disadvantage is the inability to adjust the direction of distraction after its placement. However, past reports have emphasized its advantages, and its complications have rarely been discussed. We performed Le Fort I distraction using internal devices on 15 young patients. Our results showed notable complications in a few cases. When serial cephalometric analysis was performed after maxillary distraction, it demonstrated that the maxilla assumes various three-dimensional distraction morphologies. In particular, cases with insufficient bone grafting of alveolar clefts developed collapse mainly in the alveolar cleft region during postoperative distraction. Mobility and deviation of the maxillary bone fragment occurred. We implemented preventative measures against complications such as using modifications to place the devices parallel on the left and right sides and using a bite splint for distraction. These measures produced improved outcomes, and we describe here the details.

A novel anchorage technique for transnasal traction in rigid external maxillary distraction.

PubMed

Varol, A; Basa, S

2013-12-01

We describe an effective technique for anchorage of transnasal traction in the management of maxillary rotation during external distraction. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Relationships between mind-wandering and attentional control abilities in young adults and adolescents.

PubMed

Stawarczyk, David; Majerus, Steve; Catale, Corinne; D'Argembeau, Arnaud

2014-05-01

Recent findings suggest that mind-wandering-the occurrence of thoughts that are both stimulus-independent and task-unrelated-corresponds to temporary failures in attentional control processes involved in maintaining constant task-focused attention. Studies supporting this proposal are, however, limited by a possible confound between mind-wandering episodes and other kinds of conscious experiences, such as external distractions (i.e., interoceptive sensations and exteroceptive perceptions). In the present study, we addressed this issue by examining, in adolescents and young adults, the relations between tasks measuring attentional control abilities and a measure of mind-wandering that is distinct from external distractions. We observed (1) that adolescents experienced more frequent external distractions, but not more mind-wandering, than young adults during the Sustained Attention to Response Task (SART) and (2) that, in young adults, the influence of external distractions on SART performance was fully accounted for by attentional control abilities, whereas mind-wandering was associated with decreases in SART performance above and beyond what was explained by attentional control abilities. These results show that mind-wandering cannot be entirely reduced to failures in the ability to maintain one's attention focused on task, and suggest that external distractions rather than mind-wandering are due to attentional control failures. Copyright © 2014 Elsevier B.V. All rights reserved.

Exploring Factors That Influence Technology-Based Distractions in Bring Your Own Device Classrooms

ERIC Educational Resources Information Center

Kay, Robin; Benzimra, Daniel; Li, Jia

2017-01-01

Previous research on distractions and the use of mobile devices (personal digital assistants, tablet personal computers, or laptops) have been conducted almost exclusively in higher education. The purpose of the current study was to examine the frequency and influence of distracting behaviors in Bring Your Own Device secondary school classrooms.…

A Novel Spinal Implant for Fusionless Scoliosis Correction: A Biomechanical Analysis of the Motion Preserving Properties of a Posterior Periapical Concave Distraction Device.

PubMed

Holewijn, Roderick M; de Kleuver, Marinus; van der Veen, Albert J; Emanuel, Kaj S; Bisschop, Arno; Stadhouder, Agnita; van Royen, Barend J; Kingma, Idsart

2017-08-01

Biomechanical study. Recently, a posterior concave periapical distraction device for fusionless scoliosis correction was introduced. The goal of this study was to quantify the effect of the periapical distraction device on spinal range of motion (ROM) in comparison with traditional rigid pedicle screw-rod instrumentation. Using a spinal motion simulator, 6 human spines were loaded with 4 N m and 6 porcine spines with 2 N m to induce flexion-extension (FE), lateral bending (LB), and axial rotation (AR). ROM was measured in 3 conditions: untreated, periapical distraction device, and rigid pedicle screw-rod instrumentation. The periapical distraction device caused a significant ( P < .05) decrease in ROM of FE (human, -40.0% and porcine, -55.9%) and LB (human, -18.2% and porcine, -17.9%) as compared to the untreated spine, while ROM of AR remained unaffected. In comparison, rigid instrumentation caused a significantly ( P < .05) larger decrease in ROM of FE (human, -80.9% and porcine, -94.0%), LB (human, -75.0% and porcine, -92.2%), and AR (human, -71.3% and porcine, -86.9%). Although no destructive forces were applied, no device failures were observed. Spinal ROM was significantly less constrained by the periapical distraction device compared to rigid pedicle screw-rod instrumentation. Therefore, provided that scoliosis correction is achieved, a more physiological spinal motion is expected after scoliosis correction with the posterior concave periapical distraction device.

Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates: distraction osteogenesis performed separately for each bone segment.

PubMed

Mitsukawa, Nobuyuki; Saiga, Atsuomi; Morishita, Tadashi; Satoh, Kaneshige

2014-07-01

Patients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results. The subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia. All patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory. This method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Disposed to distraction: Genetic variation in the cholinergic system influences distractibility but not time-on-task effects

PubMed Central

Berry, Anne S.; Demeter, Elise; Sabhapathy, Surya; English, Brett A.; Blakely, Randy D.; Sarter, Martin; Lustig, Cindy

2015-01-01

Both the passage of time and external distraction make it difficult to keep attention on the task at hand. We tested the hypothesis that time-on-task and external distraction pose independent challenges to attention, and that the brain’s cholinergic system selectively modulates our ability to resist distraction. Participants with a polymorphism limiting cholinergic capacity (Ile89Val variant (rs1013940) of the choline transporter gene SLC5A7) and matched controls completed self-report measures of attention and a laboratory task that measured decrements in sustained attention with and without distraction. We found evidence that distraction and time-on-task effects are independent and that the cholinergic system is strongly linked to greater vulnerability to distraction. Ile89Val participants reported more distraction during everyday life than controls, and their task performance was more severely impacted by the presence of an ecologically valid video distractor (similar to a television playing in the background). These results are the first to demonstrate a specific impairment in cognitive control associated with the Ile89Val polymorphism, and add to behavioral and cognitive neuroscience studies indicating the cholinergic system’s critical role in overcoming distraction. PMID:24666128

Teens' distracted driving behavior: Prevalence and predictors.

PubMed

Gershon, Pnina; Zhu, Chunming; Klauer, Sheila G; Dingus, Tom; Simons-Morton, Bruce

2017-12-01

Teen drivers' over-involvement in crashes has been attributed to a variety of factors, including distracted driving. With the rapid development of in-vehicle systems and portable electronic devices, the burden associated with distracted driving is expected to increase. The current study identifies predictors of secondary task engagement among teenage drivers and provides basis for interventions to reduce distracted driving behavior. We described the prevalence of secondary tasks by type and driving conditions and evaluated the associations between the prevalence of secondary task engagement, driving conditions, and selected psychosocial factors. The private vehicles of 83 newly-licensed teenage drivers were equipped with Data Acquisition Systems (DAS), which documented driving performance measures, including secondary task engagement and driving environment characteristics. Surveys administered at licensure provided psychosocial measures. Overall, teens engaged in a potentially distracting secondary task in 58% of sampled road clips. The most prevalent types of secondary tasks were interaction with a passenger, talking/singing (no passenger), external distraction, and texting/dialing the cell phone. Secondary task engagement was more prevalent among those with primary vehicle access and when driving alone. Social norms, friends' risky driving behaviors, and parental limitations were significantly associated with secondary task prevalence. In contrast, environmental attributes, including lighting and road surface conditions, were not associated with teens' engagement in secondary tasks. Our findings indicated that teens engaged in secondary tasks frequently and poorly regulate their driving behavior relative to environmental conditions. Practical applications: Peer and parent influences on secondary task engagement provide valuable objectives for countermeasures to reduce distracted driving among teenage drivers. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Five years experience with a new intraoral maxillary distraction device (RID).

PubMed

Picard, Arnaud; Diner, Patrick A; Galliani, Eva; Tomat, Catherine; Vazquez, Ma rie Paule; Carls, Friedrich P

2011-10-01

Maxillary distraction osteogenesis is well established for the treatment of severe retromaxilla. We report our experience since 2004 of the treatment of 19 patients using a new intraoral maxillary distraction device. Maxillary advancement was successful in all patients with mean advancement of 9.6mm (range 4-17) measured at a point in lateral cephalograms. The new device limited surgical exposure and the amount of materials implanted, and improved control in every phase of the distraction. It was psychologically accepted by patients and was more comfortable than existing devices. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Distraction and mind-wandering under load.

PubMed

Forster, Sophie

2013-01-01

Attention research over the last several decades has provided rich insights into the determinants of distraction, including distractor characteristics, task features, and individual differences. Load Theory represented a particularly important breakthrough, highlighting the critical role of the level and nature of task-load in determining both the efficiency of distractor rejection and the stage of processing at which this occurs. However, until recently studies of distraction were restricted to those measuring rather specific forms of distraction by external stimuli which I argue that, although intended to be irrelevant, were in fact task-relevant. In daily life, attention may be distracted by a wide range of stimuli, which may often be entirely unrelated to any task being performed, and may include not only external stimuli but also internally generated stimuli such as task-unrelated thoughts. This review outlines recent research examining these more general, entirely task-irrelevant, forms of distraction within the framework of Load Theory. I discuss the relation between different forms of distraction, and the universality of load effects across different distractor types and individuals.

A Novel Spinal Implant for Fusionless Scoliosis Correction: A Biomechanical Analysis of the Motion Preserving Properties of a Posterior Periapical Concave Distraction Device

PubMed Central

Holewijn, Roderick M.; de Kleuver, Marinus; van der Veen, Albert J.; Emanuel, Kaj S.; Bisschop, Arno; Stadhouder, Agnita; van Royen, Barend J.

2017-01-01

Study Design: Biomechanical study. Objective: Recently, a posterior concave periapical distraction device for fusionless scoliosis correction was introduced. The goal of this study was to quantify the effect of the periapical distraction device on spinal range of motion (ROM) in comparison with traditional rigid pedicle screw-rod instrumentation. Methods: Using a spinal motion simulator, 6 human spines were loaded with 4 N m and 6 porcine spines with 2 N m to induce flexion-extension (FE), lateral bending (LB), and axial rotation (AR). ROM was measured in 3 conditions: untreated, periapical distraction device, and rigid pedicle screw-rod instrumentation. Results: The periapical distraction device caused a significant (P < .05) decrease in ROM of FE (human, −40.0% and porcine, −55.9%) and LB (human, −18.2% and porcine, −17.9%) as compared to the untreated spine, while ROM of AR remained unaffected. In comparison, rigid instrumentation caused a significantly (P < .05) larger decrease in ROM of FE (human, −80.9% and porcine, −94.0%), LB (human, −75.0% and porcine, −92.2%), and AR (human, −71.3% and porcine, −86.9%). Conclusions: Although no destructive forces were applied, no device failures were observed. Spinal ROM was significantly less constrained by the periapical distraction device compared to rigid pedicle screw-rod instrumentation. Therefore, provided that scoliosis correction is achieved, a more physiological spinal motion is expected after scoliosis correction with the posterior concave periapical distraction device. PMID:28811983

Internal maxillary distraction with a new bimalar device.

PubMed

Kahn, David M; Broujerdi, Joseph; Schendel, Stephen A

2008-04-01

Distraction osteogenesis of the Le Fort I segment is advocated for patients who require significant advancement of the maxilla or who have a soft tissue envelope compromised by scar tissue. We present a technique for maxillary distraction using an interconnecting intraoral device anchored to the malar prominences above the osteotomy and either the maxilla and/or the dentition below the level of the osteotomy. Ten patients with nonsyndromic cleft lip and palate, mean age of 18, underwent Le Fort I maxillary distraction osteogenesis for management of maxillary hypoplasia. A Le Fort I osteotomy is performed and a Spectrum Intraoral Midface Multi-Vector Distractor (OsteoMed, Addison, TX) is placed leaving a 1 mm to 2 mm distraction gap. After a 2 to 4 day latency period, distraction begins at a rate of 1 mm a day. Once the desired occlusion is achieved the device is left in place for a minimum of 2 months for consolidation. Preoperative Sella-Nasion-A point measurements from lateral cephalograms averaged 74 degrees (range, 70-76 degrees). Postoperative Sella-Nasion-A point averaged 81 degrees (range, 75-89 degrees). Preoperative overjet averaged -7.4 mm (range, -3 to -13 mm). Postoperative overjet averaged 2.6 mm (range, 1-3 mm). Average distraction was 9 mm (range, 6-16 mm). The average vertical movement was 7.2 mm in an inferior direction (range, 0-15 mm). The results remained stable at a follow-up of 30 months. We report on distraction of the Le Fort I segment using an internal device. The device design allows the forces of distraction to be shared across a larger surface area delivering a uniform and reliable vector of distraction with increased stability.

Brain Activity and Network Interactions in the Impact of Internal Emotional Distraction.

PubMed

Iordan, A D; Dolcos, S; Dolcos, F

2018-06-14

Emotional distraction may come from the external world and from our mind, as internal distraction. Although external emotional distraction has been extensively investigated, less is known about the mechanisms associated with the impact of internal emotional distraction on cognitive performance, and those involved in coping with such distraction. These issues were investigated using a working memory task with emotional distraction, where recollected unpleasant autobiographical memories served as internal emotional distraction. Emotion regulation was manipulated by instructing participants to focus their attention either on or away from the emotional aspects of their memories. Behaviorally, focusing away from emotion was associated with better working memory performance than focusing on the recollected emotions. Functional MRI data showed reduced response in brain regions associated with the salience network, coupled with greater recruitment of executive prefrontal and memory-related temporoparietal regions, and with increased frontoparietal connectivity, when subjects focused on nonemotional contextual details of their memories. Finally, temporal dissociations were also identified between regions involved in self-referential (showing faster responses) versus context-related processing (showing delayed responses). These findings demonstrate that focused attention is an effective regulation strategy in coping with internal distraction, and are relevant for understanding clinical conditions where coping with distressing memories is dysfunctional.

A new palatal distractor device for bodily movement of maxillary bones by rigid self-locking miniplates and screws system.

PubMed

Cortese, Antonio; Savastano, Mauro; Cantone, Antonio; Claudio, Pier Paolo

2013-07-01

A new palatal distractor device for bodily movement of the maxillary bones after complete segmented Le Fort I osteotomy for 1-stage transversal distraction and tridimensional repositioning on 1 patient is presented. The new distractor has an intrinsic tridimensional rigidity also in the fixation system by self-locking miniplates and screws for better control of the 2 maxillary fragments during distraction. Le Fort I distraction and repositioning procedure in association with a bilateral sagittal split osteotomy were performed on 1 patient with complete solution of the cross-bite and class III malocclusion. Results of dental and cephalometric analysis performed before surgery (T1), after surgery and distraction time (T2), and 18 months after surgery and orthodontic appliance removal (T3) are reported. No complications were encountered using the new distractor device. Advantages of this device and technique are presented including improved rigidity of both distraction (jackscrew) and fixation (4 self-locking miniplates and screws) systems resulting in complete control of the position of the 2 maxillary fragments during distraction and surgery. In addition, this new device allows resuming palatal distraction in the event of cross-bite relapse without causing dental-related problems or the risks of screw slackening.

A new distraction arthroplasty device using magnetic force; a cadaveric study.

PubMed

Kamei, Goki; Ochi, Mitsuo; Okuhara, Atsushi; Fujimiya, Mineko; Deie, Masataka; Adachi, Nobuo; Nakamae, Atsuo; Nakasa, Tomoyuki; Ohkawa, Shingo; Takazawa, Kobun; Eguchi, Akio; Katou, Tomohiro; Takada, Tsuyoshi; Usman, Muhammad Andry

2013-04-01

It is difficult for an articular cartilage injury to repair spontaneously. There are many procedures for treating cartilage injury, however there is no standard procedure for middle-aged patients who have diffuse knee osteoarthritis, especially of the lateral compartment. Therefore, Ochi developed a new distraction device that uses magnetic power to enlarge a joint space and promote cartilage regeneration with microfracture. The purpose of this study is to evaluate this new distraction arthroplasty system by using the cadaveric knee. This study used ten knees from six cadavers that were embalmed by Thiel's methods. The medial and lateral joint space was measured by AP radiographic view before and after distraction, and after weight-bearing to evaluate the joint distraction. The contact pressure of the medial and lateral compartments at the knee extension position by using a prescale film system was measured before and after weight-bearing with a 15 or 30-kg weight-bearing load to evaluate the effectiveness of this device. The lateral joint space significantly increased from the pre-distraction to the post-distraction; however, it did not change significantly between post-distraction and post-weight-bearing. With a 15 or 30-kg weight-bearing load, the contact pressure of the lateral compartment significantly decreased from the pre-distraction to the post-distraction. The most important advantage of this device is that it maintains a continuous distraction tension and enables almost the full range of motion of the knee. We believe that joint distraction by using magnetic force can be a promising option for cartilage injury in middle-aged patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

Type IIIb Endoleak and Relining: A Mathematical Model of Distraction Forces.

PubMed

Swaelens, Charles; Poole, Robert J; Torella, Francesco; McWilliams, Richard G; England, Andrew; Fisher, Robert K

2016-04-01

To examine the changes in distraction force following relining of a conventional abdominal aortic stent-graft with a type IIIb endoleak using the Nellix endovascular sealing device compared to a unilateral stent-graft. Relining is often used to repair type IIIb endoleaks, but the consequences to graft stability are unknown. A mathematical model was constructed based on pressure and volume flow through the stent-grafts, incorporating recognized distraction force equations. Steady flow was presumed at peak systolic pressures to calculate the maximum distraction force, with gravity ignored. Distraction forces for 28- to 36-mm-diameter stent-graft bodies with 16-mm limbs were calculated and compared to forces following relining with single and double Nellix devices or the Renu unilateral device. Distraction forces for the 28-, 32-, and 36-mm stent-grafts prior to relining were 5.99, 10.21, and 14.99 N, respectively. Similar forces were reported after relining with bilateral Nellix devices (5.86, 10.08, and 14.86 N, respectively). However, use of a unilateral Nellix increased the distraction forces to 9.92, 14.14, and 18.92 N, respectively. These were comparable to the increase observed after relining with a Renu unilateral stent-graft (9.87, 14.09, and 18.86 N, respectively). The proportional increase in distraction force for a unilateral relining ranged from 26% to 66%, with the greatest increase noted in the smaller diameter main bodies. Relining a stent-graft with a type IIIb endoleak using bilateral Nellix devices does not increase the distraction force. However, a unilateral Nellix device or the Renu system could theoretically increase the distraction force by up to 66%, potentially risking migration and type Ia endoleak. In clinical practice, these results suggest that a relining with bilateral Nellix may have benefits over the Renu unilateral stent-graft. © The Author(s) 2016.

The prevalence of distraction among passenger vehicle drivers: a roadside observational approach.

PubMed

Huisingh, Carrie; Griffin, Russell; McGwin, Gerald

2015-01-01

Distracted driving contributes to a large proportion of motor vehicle crashes, yet little is known about the prevalence of distracted driving and the specific types of distracting behaviors. The objective of this study was to estimate the prevalence of driver distraction using a roadside observational study design. A cross-sectional survey involving direct roadside observation was conducted at 11 selected intersections. Trained investigators observed a sample of passenger vehicles and recorded distraction-related behaviors, driver characteristics, and contextual factors such as vehicle speed and traffic flow. Of the 3,265 drivers observed, the prevalence of distracted driving was 32.7%. Among those involved in a distracting activity, the most frequently observed distractions included interacting with another passenger (53.2%, where passengers were present), talking on the phone (31.4%), external-vehicle distractions (20.4%), and texting/dialing a phone (16.6%). The prevalence of talking on the phone was higher among females than males (38.6% vs. 24.3%), whereas external vehicle distractions were higher among males than females (25.8% vs. 24.3%). Drivers <30 years were observed being engaged in any distracting activity, interacting with other passengers, and texting/dialing more frequently than drivers aged 30-50 and >50 years. Drivers were engaged in distracting behaviors more frequently when the car was stopped. When using similar methodology, roadside observational studies generate comparable prevalence estimates of driver distraction as naturalistic driving studies. Driver distraction is a common problem among passenger vehicle drivers. Despite the increased awareness on the dangers of texting and cell phone use while driving, these specific activities were 2 of the most frequently observed distractions. There is a continued need for road safety education about the dangers of distracted driving, especially for younger drivers.

Distraction rate and latency: factors in the outcome of paediatric maxillary distraction.

PubMed

Higuera, Stephen; Cole, Patrick; Stephenson, J B; Hollier, Larry

2009-12-01

Over 50 years ago, current tenets of distraction osteogenesis were developed through work on the lower extremity; however, the application of these tenets in the paediatric craniofacial skeleton remains questionable. Prompted by recent concern that traditional aspects of distraction may be either outdated or wholly inapplicable to the paediatric maxilla, we retrospectively evaluated maxillary distraction protocol using a 24-h latency period in conjunction with a distraction rate of 2mm/day. Following maxillary advancement via a distraction protocol consisting of a 24-h latency period and a distraction rate of 2mm/day, seven consecutive paediatric cases were evaluated. Standard profile photos and cephalometric films taken preoperatively, at device removal and at 1-year follow-up were compared. With the sella as the point of registration, pre- and post-distraction films were superimposed on the sella-nasion plane. Sella-nasion-subspinale, the angle of convexity, the distance from incisal edges to the y-axis, and angulation of the upper incisor to the sella-nasion plane were analysed to evaluate hard-tissue changes. Patient age ranged from 3 to 14 years (mean=7.43 years). Maxillary distraction length averaged 11 mm (range=10-12 mm). Interval from device application to removal averaged 98 days (range=75-180 days). The interval of the active distraction ranged from 11 to 65 days (mean=24 days). From distraction completion to device removal averaged 85 days (range=60-150). Follow-up intervals ranged from 52 to 24 months (mean=34 months). All patients demonstrated substantial clinical advancement of the maxilla with correction of midfacial deficiencies. A single patient developed mild cellulitis at one skin-device interface; no other complications were noted. Cephalometric and clinical evaluations at 1 year post-distraction demonstrated stable results, and parental satisfaction was qualitatively high. The surgical dogma of lower-extremity distraction osteogenesis is not absolute and may not be optimal for use in the paediatric maxilla. Our results demonstrate effective maxillary correction following application of a 24-h latency period coupled with rapid distraction at 2mm/day. Our success with a short latency period and more rapid device expanse may be a product of the significant vascularity and improved healing potential of the paediatric maxilla.

Long-term skeletal stability after maxillary advancement with distraction osteogenesis in nongrowing patients.

PubMed

Kanno, Takahiro; Mitsugi, Masaharu; Hosoe, Michi; Sukegawa, Shintaro; Yamauchi, Kensuke; Furuki, Yoshihiko

2008-09-01

We assessed the long-term skeletal stability of the repositioned maxilla, midface in patients who underwent maxillary advancement using distraction osteogenesis (DO). The study included 19 nongrowing patients with maxillary hypoplasia with a Class III relationship, a normally developed mandible, and follow-up after DO exceeding 2 years. Eleven men and 8 women participated, with a mean age at treatment of 20.7 years (range 15.4-33.4 years). Twelve patients had midfacial hypoplasia associated with a cleft lip and palate (CLP), and 7 patients had developed noncleft-related hypoplasia. The surgical treatment included our modified Le Fort I osteotomy in combination with intraoral (5 cases) or extraoral (14 cases) distraction devices. Distraction was started after a latency period of 5 to 7 days and continued until the proper convexity was obtained. After active distraction, a 3- to 4-week period of retention was allowed, followed by rigid internal fixation (IF) with or without distractor removal. Lateral cephalometric films before midfacial distraction (T0), after IF with or without distractor removal (T1), 6 months after T1 (T2), and 2 or more years (mean 2.8 years) after T1 (T3) were analyzed. The maxillary A-point in the Frankfort horizontal reference plane was used to assess the skeletal changes in the maxillary position (x, y) at each time point (T1-T3). In addition, we analyzed the differences in the devices and techniques. Midfacial DO was successful in all cases, resulting in a mean change obtained at point A of 10.3 mm (8.4 mm horizontally, 4.7 mm inferiorly). Point A underwent a moderate amount of skeletal relapse at T2 [0.4 mm (5%) horizontally and 0.6 mm (13%) superiorly], with a mean of 8% (0.6 mm) horizontally and 19% (1.0 mm) superiorly over the mean 2.8-year (2.0-4.8 years) follow-up. After long-term follow-up, the maxillary advancement with DO was stable in both CLP and non-CLP patients with maxillary hypoplasia. In addition, our original technique using a rigid external device provided the most reliable results in terms of skeletal stability. This retrospective study showed that DO of the maxilla gives a very stable midface, offering a promising treatment alternative for patients with maxillary hypoplasia.

Management of Late Onset Perthes: Evaluation of Distraction by External Fixator—5-Year Follow-Up

PubMed Central

Srivastava, Rajeshwar N.; Shukla, Prashant; Pushkar, Amit; Ali, Sabir

2014-01-01

Background. Hip distraction in Perthes' disease unloads the joint, which negates the harmful effect of the stresses on the articular surfaces, which may promote the sound healing of the area of necrosis. We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes' disease. Methods and Materials. Twelve children with age more than 8 years with Perthes' disease of less than one year were treated with hip distraction by a hinged monolateral external fixator. Observation and Results. Mean duration of distraction was 13.9 days. These children were evaluated by clinicoradiological parameters for a mean period of 32.4 months. There was a significant improvement in the range of movements and mean epiphyseal index, but the change in the percentage of uncovered head femur was insignificant. There was significant improvement in Harris Hip score. Conclusions. Hip distraction by hinged monolateral external fixator seems to be a valid treatment option in cases with Perthes' disease in the selected group of patients, where poor results are expected from conventional treatment. PMID:25580302

Transpalatal distraction for the management of maxillary constriction in pediatric patients.

PubMed

Adolphs, Nicolai; Ernst, Nicole; Hoffmeister, Bodo; Raguse, Jan-Dirk

2015-01-01

The management of severe maxillary constriction can be challenging. For that purpose surgically assisted maxillary expansion by transpalatal distraction (TPD) can typically be recommended after skeletal maturity. However in selected cases bone borne transpalatal distraction devices can contribute to improve maxillary constriction considerably earlier already during mixed dentition. To assess the possibility of bone borne transpalatal distraction in pediatric patients. Clinical paper. Since 2010 TPD has been applied to six pediatric patients during mixed dentition when severe maxillary constriction was present and conventional orthodontic widening has already failed. Individually selected devices (Surgitec, Belgium) were inserted in general anaesthesia and distraction was performed according to well known parameters. Maxillary constriction could be improved in all six patients without any drawbacks by bone borne devices during mixed dentition. Skeletal conditions were obviously improved for subsequent orthodontic or orthognathic therapy without functional impairment. Follow-up is up to 36 months after device removal. Transpalatal Distraction is recommendable in selected pediatric patients if massive growth disturbance is present or has to be expected. TPD allows for individually adapted maxillary expansion by selection and positioning of appropriate devices in combination with intraoperative testing of maxillary movements and controlled bone removal.

Temporary Segmental Distraction in a Dog with Degenerative Lumbosacral Stenosis.

PubMed

Willems, Nicole; Kersten, Roel F M R; van Gaalen, Steven M; Öner, F Cumhur; Strijkers, Gustav J; Veraa, Stefanie; Beukers, Martijn; Tryfonidou, Marianna A; Meij, Björn P

2018-06-02

 Degenerative lumbosacral stenosis (DLSS) is characterized by intervertebral disc degeneration and causes lower back pain in dogs. Temporary distraction in rabbit models with induced intervertebral disc degeneration showed signs of intervertebral disc repair. In the present study, we assessed safety and efficacy of temporary segmental distraction in a dog with clinical signs of DLSS.  Distraction of the lumbosacral junction by pedicle screw-rod fixation was applied in a 5-year-old Greyhound with DLSS and evaluated by radiography, magnetic resonance imaging, and force plate analysis before and after distraction.  Safe distraction of the lumbosacral junction was demonstrated, with improvement of clinical signs after removal of the distraction device. Signal intensity of the intervertebral disc showed no changes over time. T2 value was highest directly after removal of the distraction device but decreased by 10% of the preoperative value at 9 months of follow-up. Disc height decreased (8%) immediately after removal of the distraction device, but recovered to the initial value. A decrease in the pelvic/thoracic propulsive force during pedicle screw-rod fixation and distraction was demonstrated, which slowly increased by 4% compared with the initial value.  Temporary pedicle screw-rod fixation in combination with distraction in a dog with DLSS was safe, improved clinical signs and retained disc height at 9 months of follow-up. Schattauer GmbH Stuttgart.

[Maxillary distraction complications in cleft patients].

PubMed

Jeblaoui, Y; Morand, B; Brix, M; Lebeau, J; Bettega, G

2008-09-01

Cleft lip and palate (CLP) patients often present with a class III malocclusion in connection with a three dimensional maxillary hypoplasia. Twenty-five to 60% of these patients require a maxillary advancement. Two solutions are possible: orthognathic surgery and maxillary distraction. The purpose of this study was to evaluate the complications of the maxillary distraction in CLP patients. Data was collected from the records of patients treated at our Surgery Unit between 2000 and 2007. Among the eight patients (four male and four female), five presented a bilateral CLP, two a unilateral CLP and one a unilateral cleft lip associated to a soft palate cleft. The average age at surgery was 17 years old. All had a Le Fort I osteotomy with a pterygomaxillary disjunction. The first two patients had external distractors and the six following internal ones. After a seven-day latency, activation was led to the rate of 1mm per day twice. The period of consolidation was four months on average. The maxillary advancement varied between 7 and 19 mm with an average of 12.6mm. The average follow-up was four years. We encountered difficulties and/or complications in seven patients: one intraoperatively haemorrhage, one avulsion of a tooth fixed at the pterygoid process during the osteotomy, three device failures, two cases of significant pains during activation, one dissociation of the dental anchorage of an external system, two labial ulcerations and one maxillary sinusitis by migration of the 18. Difficulties of maxillary distraction in CLP patients are very frequent. The majority is related to the distractors and did not interfere with the final result. But this frequency must be taken into account in the indication and in the choice of the material. Two types of complications can occur during distraction: those related to the osteotomy and those related to the material. The complications related to the osteotomy are in connection with the cicatricial ground of the CLP. They are not specific of the distraction. We especially managed complications related to the material. The social benefit of the internal distractors is undeniable, but the design of certain models must be reexamined to improve their tolerance.

75 FR 45696 - Pipeline Safety: Personal Electronic Device Related Distractions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... of PEDs. Such distractions may also hinder their prompt recognition and reaction to abnormal... distractions caused by the use of PEDs. Such distractions may also hinder their prompt recognition and reaction...

An Efficient and Reproducible Protocol for Distraction Osteogenesis in a Rat Model Leading to a Functional Regenerated Femur.

PubMed

Pithioux, Martine; Roseren, Flavy; Jalain, Christian; Launay, Franck; Charpiot, Philippe; Chabrand, Patrick; Roffino, Sandrine; Lamy, Edouard

2017-10-23

This protocol describes the use of a newly developed external fixator for distraction osteogenesis in a rat femoral model. Distraction osteogenesis (DO) is a surgical technique leading to bone regeneration after an osteotomy. The osteotomized extremities are moved away from each other by gradual distraction to reach the desired elongation. This procedure is widely used in humans for lower and upper limb lengthening, treatment after a bone nonunion, or the regeneration of a bone defect following surgery for bone tumor excision, as well as in maxillofacial reconstruction. Only a few studies clearly demonstrate the efficiency of their protocol in obtaining a functional regenerated bone, i.e., bone that will support physiological weight-bearing without fracture after removal of the external fixator. Moreover, protocols for DO vary and reproducibility is limited by lack of information, making comparison between studies difficult. The aim of this study was to develop a reproducible protocol comprising an appropriate external fixator design for rat limb lengthening, with a detailed surgical technique that permits physiological weight-bearing by the animal after removal of the external fixator.

Distraction and Mind-Wandering Under Load

PubMed Central

Forster, Sophie

2013-01-01

Attention research over the last several decades has provided rich insights into the determinants of distraction, including distractor characteristics, task features, and individual differences. Load Theory represented a particularly important breakthrough, highlighting the critical role of the level and nature of task-load in determining both the efficiency of distractor rejection and the stage of processing at which this occurs. However, until recently studies of distraction were restricted to those measuring rather specific forms of distraction by external stimuli which I argue that, although intended to be irrelevant, were in fact task-relevant. In daily life, attention may be distracted by a wide range of stimuli, which may often be entirely unrelated to any task being performed, and may include not only external stimuli but also internally generated stimuli such as task-unrelated thoughts. This review outlines recent research examining these more general, entirely task-irrelevant, forms of distraction within the framework of Load Theory. I discuss the relation between different forms of distraction, and the universality of load effects across different distractor types and individuals. PMID:23734138

Distraction and Pedestrian Safety: How Talking on the Phone, Texting, and Listening to Music Impact Crossing the Street

PubMed Central

Schwebel, David C.; Stavrinos, Despina; Byington, Katherine W.; Davis, Tiffany; O’Neal, Elizabeth E.; de Jong, Desiree

2011-01-01

As use of handheld multimedia devices has exploded globally, safety experts have begun to consider the impact of distraction while talking, text-messaging, or listening to music on traffic safety. This study was designed to test how talking on the phone, texting, and listening to music may influence pedestrian safety. 138 college students crossed an interactive, semi-immersive virtual pedestrian street. They were randomly assigned to one of four groups: crossing while talking on the phone, crossing while texting, crossing while listening to a personal music device, or crossing while undistracted. Participants distracted by music or texting were more likely to be hit by a vehicle in the virtual pedestrian environment than were undistracted participants. Participants in all three distracted groups were more likely to look away from the street environment (and look toward other places, such as their telephone or music device) than were undistracted participants. Findings were maintained after controlling for demographics, walking frequency, and media use frequency. Distraction from multimedia devices has a small but meaningful impact on college students’ pedestrian safety. Future research should consider the cognitive demands of pedestrian safety, and how those processes may be impacted by distraction. Policymakers might consider ways to protect distracted pedestrians from harm and to reduce the number of individuals crossing streets while distracted. PMID:22269509

Distraction and pedestrian safety: how talking on the phone, texting, and listening to music impact crossing the street.

PubMed

Schwebel, David C; Stavrinos, Despina; Byington, Katherine W; Davis, Tiffany; O'Neal, Elizabeth E; de Jong, Desiree

2012-03-01

As use of handheld multimedia devices has exploded globally, safety experts have begun to consider the impact of distraction while talking, text-messaging, or listening to music on traffic safety. This study was designed to test how talking on the phone, texting, and listening to music may influence pedestrian safety. 138 college students crossed an interactive, semi-immersive virtual pedestrian street. They were randomly assigned to one of four groups: crossing while talking on the phone, crossing while texting, crossing while listening to a personal music device, or crossing while undistracted. Participants distracted by music or texting were more likely to be hit by a vehicle in the virtual pedestrian environment than were undistracted participants. Participants in all three distracted groups were more likely to look away from the street environment (and look toward other places, such as their telephone or music device) than were undistracted participants. Findings were maintained after controlling for demographics, walking frequency, and media use frequency. Distraction from multimedia devices has a small but meaningful impact on college students' pedestrian safety. Future research should consider the cognitive demands of pedestrian safety, and how those processes may be impacted by distraction. Policymakers might consider ways to protect distracted pedestrians from harm and to reduce the number of individuals crossing streets while distracted. Copyright © 2011 Elsevier Ltd. All rights reserved.

Management of Cleft Maxillary Hypoplasia with Anterior Maxillary Distraction: Our Experience.

PubMed

Chacko, Tojan; Vinod, Sankar; Mani, Varghese; George, Arun; Sivaprasad, K K

2014-12-01

Maxillary hypoplasia is a common developmental problem in cleft lip and palate deformities. Since 1970s these deformities have traditionally been corrected by means of orthognathic surgery. Management of skeletal deformities in the maxillofacial region has been an important challenge for maxillofacial surgeons and orthodontists. Distraction osteogenesis is a surgical technique that uses body's own repairing mechanisms for optimal reconstruction of the tissues. We present four cases of anterior maxillary distraction osteogenesis with tooth borne distraction device-Hyrax, which were analyzed retrospectively for the efficacy of the tooth borne device-Hyrax and skeletal stability of distracted anterior maxillary segment.

Skeletal and soft tissue changes and stability in cleft lip and palate patients after distraction osteogenesis using a new intraoral maxillary device.

PubMed

Ansari, Edward; Tomat, Catherine; Kadlub, Natacha; Diner, Patrick A; Bellocq, Thomas; Vazquez, Marie-Paule; Picard, Arnaud

2015-04-01

The authors have recently reported on the use of an internal maxillary distraction device. In this study, we report on the hard and soft tissue movements achieved with this intraoral distraction device, and the stability changes after distraction osteogenesis for maxillary hypoplasia in patients with cleft lip and palate. Ten male patients with severe hypoplasia of the maxilla, with complete uni- or bilateral cleft lip and palate were included. The mean age of the patients at the time of operation was 11.91 years (±3.41). To evaluate the distraction process and stability, superimpositions on the preoperative lateral cephalograms were performed. The mean follow-up (FU) was 15.42 months (±3.94). Cephalometric measurements at all of the maxillary hard and soft tissue points improved significantly. Maxillary point A was advanced by 8.25 mm (±3.17; P < 0.001). After distraction soft tissue point A' had advanced 7.10 mm (±2.69; P < 0.001). The soft tissue to hard tissue ratio at point A was 0.86:1 after distraction. Maxillary horizontal relapse at point A was 14.1% at FU. Vertical relapse was not significant. This rigid intraoral distraction device can be successfully used in the correction of severe maxillary hypoplasia. The marked aesthetic improvement and low psychological encumbrance make this device viable for the treatment of cleft-related hypoplasia of the maxilla. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

77 FR 11199 - Visual-Manual NHTSA Driver Distraction Guidelines for In-Vehicle Electronic Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-24

...The National Highway Traffic Safety Administration (NHTSA) is concerned about the effects of distraction due to drivers' use of electronic devices on motor vehicle safety. Consequently, NHTSA is issuing nonbinding, voluntary NHTSA Driver Distraction Guidelines (NHTSA Guidelines) to promote safety by discouraging the introduction of excessively distracting devices in vehicles. This notice details the contents of the first phase of the NHTSA Driver Distraction Guidelines. These NHTSA Guidelines cover original equipment in-vehicle device secondary tasks (communications, entertainment, information gathering, and navigation tasks not required to drive are considered secondary tasks) performed by the driver through visual-manual means (meaning the driver looking at a device, manipulating a device-related control with the driver's hand, and watching for visual feedback). The proposed NHTSA Guidelines list certain secondary, non-driving related tasks that, based on NHTSA's research, are believed by the agency to interfere inherently with a driver's ability to safely control the vehicle. The Guidelines recommend that those in-vehicle devices be designed so that they cannot be used by the driver to perform such tasks while the driver is driving. For all other secondary, non-driving-related visual-manual tasks, the NHTSA Guidelines specify a test method for measuring the impact of task performance on driving safety while driving and time-based acceptance criteria for assessing whether a task interferes too much with driver attention to be suitable to perform while driving. If a task does not meet the acceptance criteria, the NHTSA Guidelines recommend that in- vehicle devices be designed so that the task cannot be performed by the driver while driving. In addition to identifying inherently distracting tasks and providing a means for measuring and evaluating the level of distraction associated with other non-driving-related tasks, the NHTSA Guidelines contain several design recommendations for in-vehicle devices in order to minimize their potential for distraction. NHTSA seeks comments on these NHTSA Guidelines and any suggestions for how to improve them so as to better enhance motor vehicle safety.

Atlantoaxial Joint Distraction with a New Expandable Device for the Treatment of Basilar Invagination with Preservation of the C2 Nerve Root: A Cadaveric Anatomical Study.

PubMed

Polli, Filippo Maria; Trungu, Sokol; Miscusi, Massimo; Forcato, Stefano; Visocchi, Massimiliano; Raco, Antonino

2017-01-01

Atlantoaxial joint distraction has been advocated for the decompression of the brain stem in patients affected by basilar invagination, avoiding direct transoral decompression. This technique requires C2 ganglion resection and it is often impossible to perform due to the peculiar bony anatomy. We describe a cadaveric anatomical study supporting the feasibility of C1-C2 distraction performed with an expandable device, allowing easier insertion of the tool and preservation of the C2 nerve root. In five adult cadaveric specimens, posterior atlantoaxial surgical exposure was performed and an expandable system was inserted within the C1-C2 joint. The expansion of the device, leading to active distraction of the joint space, together with all the surgical steps of the technique was recorded with anatomical pictures and the final results were checked with a computed tomography (CT) scan. Insertion of the device was easily performed in all cases without anatomical conflict with the C2 ganglion; CT scans confirmed the distraction of the C1-C2 joint. This cadaveric anatomical study confirms the feasibility of the introduction of an expandable and flexible device within the C1-C2 joint, allowing it's distraction and preservation of the C2 ganglion.

Perioperative incidents associated with internal maxillary distraction osteogenesis: a retrospective study of 20 patients.

PubMed

Kristian, Andersen; Erik, Nørholt Sven; Annelise, Küseler; John, Jensen; Klit, Pedersen Thomas

2012-12-01

This retrospective study aimed to assess the frequency and distribution of incidents encountered during the perioperative period of maxillary distraction with internal devices. The perioperative period was defined as the period between device placement and removal. Records of 20 patients treated during 2004-2011 with internal maxillary distraction osteogenesis were examined. Incidents were registered in terms of severity and need of intervention. Eighty percent of the patients experienced minor incidents, of which the most frequent were pain during activation and infections; 80% of these experienced ≥1 hard and soft tissue-related incidents, and 20% ≥1 device-related incidents. All incidents were solved with minimal or no intervention. Maxillary distraction using internal devices is a safe treatment with only minor incidents in the perioperative period. Preoperative planning and good cooperation are essential for preventing postoperative incidents. Prophylactic antibiotic treatment during the distraction period may be indicated. Copyright © 2012 Elsevier Inc. All rights reserved.

Novel Three-Dimensional Understanding of Maxillary Cleft Distraction.

PubMed

Vaughan, Stephen Michael; Kau, Chung How; Waite, Peter Daniel

2016-09-01

To set forth a universal standard methodology for quantifying volumetric and linear changes in the craniofacial complex, utilizing three-dimensional data captured from a cleft-lip palate patient who underwent rigid external device (RED) distraction. Cone beam computed tomography images of a 14-year-old patient were captured using a Kodak 9500 (Atlanta, GA) Cone Beam system device and a stereophotogrammetric system (3dMDface(TM) Atlanta, GA). The subject was a nonsyndromic unilateral cleft-lip palate patient who received RED distraction as part of maxillary advancement in conjunction with orthodontic treatment. Preop (T1) and postop (T2) images were superimposed using Invivo 5.2.3 (San Jose, CA) software. Volumetric rendering of the airway, bone, and soft tissues, as well as linear measurements were analyzed. Each measurement was captured 10 times to ensure reliability and reproducibility of methodology. Data from T1 to T2 revealed mean differences as follows: airway total volume +5250 mm, minimum cross-sectional area +67.84 mm; bone +1719 mm, soft tissue +44,432 mm. Mean of linear measurements: Pronasale 1.98 mm, Subnasale 3.35 mm, Labial superius 10.79 mm, Labial inferius 4.13 mm, Right alare 5.71 mm, Right cheilion 7.83 mm, Left alare 4.97 mm, Left cheilion 5.50 mm, Pogonion 3.01 mm, B-point 2.49 mm, U1-U1 9.77 mm, and L1-L1 0.00 mm. P values are <0.001 for each analysis. This paper represents a novel and innovative way to look at prepost RED distractions in a three-dimensional format. A universal standard analysis of the craniofacial complex can be implemented using the techniques and method outlined in this study.

Development of a pneumatic tensioning device for gap measurement during total knee arthroplasty.

PubMed

Kwak, Dai-Soon; Kong, Chae-Gwan; Han, Seung-Ho; Kim, Dong-Hyun; In, Yong

2012-09-01

Despite the importance of soft tissue balancing during total knee arthroplasty (TKA), all estimating techniques are dependent on a surgeon's manual distraction force or subjective feeling based on experience. We developed a new device for dynamic gap balancing, which can offer constant load to the gap between the femur and tibia, using pneumatic pressure during range of motion. To determine the amount of distraction force for the new device, 3 experienced surgeons' manual distraction force was measured using a conventional spreader. A new device called the consistent load pneumatic tensor was developed on the basis of the biomechanical tests. Reliability testing for the new device was performed using 5 cadaveric knees by the same surgeons. Intraclass correlation coefficients (ICCs) were calculated. The distraction force applied to the new pneumatic tensioning device was determined to be 150 N. The interobserver reliability was very good for the newly tested spreader device with ICCs between 0.828 and 0.881. The new pneumatic tensioning device can enable us to properly evaluate the soft tissue balance throughout the range of motion during TKA with acceptable reproducibility.

Measurement of Distraction Force in Cleft Lip and Palate Patients During Le Fort I Maxillary Advancement With Rigid External Distraction.

PubMed

Sawada, Hiromi; Ogawa, Takuya; Kataoka, Keiichi; Baba, Yoshiyuki; Moriyama, Keiji

2017-03-01

Maxillary distraction osteogenesis (DO) is a mainstream surgical technique for patients who have severe maxillary hypoplasia associated with craniofacial syndromes and cleft-related deformities. However, limited information about the biomechanical aspects of maxillary DO is available limiting broad utilization and improvements to the procedure. The objective of this study was to analyze force levels during the active distraction process and to investigate the relationship between distraction force and maxillary movement during Le Fort I maxillary DO using a rigid external distraction (RED) system. Microtension gauges were integrated into the distraction wires on each side of the RED system. Six patients with cleft lip and palate aged 12.8 to 23.5 years underwent strain gauge measurements during maxillary advancement with DO using an RED system. Lateral cephalograms were taken to measure maxillary horizontal, vertical, and linear movements after DO. The average linear maxillary movement was 11.2 mm (range 8.5-15.9 mm). The applied forces ranged from 13.4 to 26.8 N. The distance of maxillary movement was proportional to the distraction force. The measurement of distraction forces during DO provides important information with which to establish appropriate protocols. Patients requiring more advancement may require more distraction force. However, other factors such as scarring, patient anatomy, surgical freedom of the osteotomized maxilla, and the like, may affect the required force during DO with the RED system.

Students distracted by electronic devices perform at the same level as those who are focused on the lecture.

PubMed

Nalliah, Romesh P; Allareddy, Veerasathpurush

2014-01-01

Background. Little is known about the characteristics of internet distractions that students may engage in during lecture. The objective of this pilot study is to identify some of the internet-based distractions students engage in during in-person lectures. The findings will help identify what activities most commonly cause students to be distracted from the lecture and if these activities impact student learning. Methods. This study is a quasi-experimental pilot study of 26 students from a single institution. In the current study, one class of third-year students were surveyed after a lecture on special needs dentistry. The survey identified self-reported utilization patterns of "smart" devices during the lecture. Additionally, twelve quiz-type questions were given to assess the students' recall of important points in the lecture material that had just been covered. Results. The sample was comprised of 26 students. Of these, 17 were distracted in some form (either checking email, sending email, checking Facebook, or sending texts). The overall mean score on the test was 9.85 (9.53 for distracted students and 10.44 for non-distracted students). There were no significant differences in test scores between distracted and non-distracted students (p = 0.652). Gender and types of distractions were not significantly associated with test scores (p > 0.05). All students believed that they understood all the important points from the lecture. Conclusions. Every class member felt that they acquired the important learning points during the lecture. Those who were distracted by electronic devices during the lecture performed similarly to those who were not. However, results should be interpreted with caution as this study was a small quasi-experimental design and further research should examine the influence of different types of distraction on different types of learning.

Displaceability of SLAP lesion on shoulder MR arthrography with external rotation position.

PubMed

Jung, Jin Young; Ha, Doo Hoe; Lee, Sang Min; Blacksin, Marcia F; Kim, Kyung Ah; Kim, Jae Wha

2011-08-01

To investigate the usefulness of the external rotation (ER) position on magnetic resonance (MR) arthrography for the diagnosis of superior labral anterior to posterior (SLAP) lesion. Approval of institutional review board was obtained, and informed consent was waived. The MR arthrograms of 210 shoulders that were arthroscopically confirmed as SLAP lesion in 163 shoulders and intact superior labrum in 47 shoulders were retrospectively reviewed in each neutral and ER position for the diagnosis of SLAP lesion, the extent of distraction of the torn labrum, and the external rotation angle. The sensitivity, specificity, and diagnostic accuracy of MR arthrograms for determining SLAP lesion were assessed in each position. For the arthroscopically confirmed group, the diagnosis of SLAP lesion and the extent of distraction about the tear were compared between neutral and ER positions by Fisher's exact test and the paired t-test. The correlation between the external rotation angle and the diagnosis of SLAP lesion, and between the external rotation angle and the differences in the extent of distraction were evaluated in the ER position using the ANOVA test. Sensitivity and diagnostic accuracy of MR arthrography for SLAP lesion increased from 64.4% and 71.0% in the neutral position to 78.5% and 81.9% in the ER position, respectively, without change of specificity, which was 93.6% in both positions. The diagnosis of SLAP lesion was changed from negative to SLAP lesion in 16.0% of the arthroscopically confirmed group. Mean difference in the extent of distraction about the tear was 0.69 mm (range -1.40 ∼ 6.67 mm), which was statistically significant. There was no relationship between the external rotation angle and the diagnosis of SLAP lesion, and between the external rotation angle and the differences in the extent of distraction. Shoulder MR arthrography with additional ER positioning helps in the diagnosis of SLAP lesion and provides information about the displaceability of the torn labrum.

78 FR 24817 - Visual-Manual NHTSA Driver Distraction Guidelines for In-Vehicle Electronic Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-26

...The National Highway Traffic Safety Administration (NHTSA) is concerned about the effects of distraction on motor vehicle safety due to drivers' use of electronic devices. Consequently, NHTSA is issuing nonbinding, voluntary Driver Distraction Guidelines (NHTSA Guidelines) to promote safety by discouraging the introduction of excessively distracting devices in vehicles. This notice announces the issuance of the final version of the first phase of the NHTSA Guidelines. This first phase applies to original equipment (OE) in-vehicle electronic devices used by the driver to perform secondary tasks (communications, entertainment, information gathering, navigation tasks, etc. are considered secondary tasks) through visual-manual means (i.e., the driver looks at a device, manipulates a device-related control with his or her hand, and/or watches for visual feedback). The NHTSA Guidelines list certain secondary tasks believed by the agency to interfere inherently with a driver's ability to safely control the vehicle. The NHTSA Guidelines recommend that in-vehicle devices be designed so that they cannot be used by the driver to perform these inherently distracting secondary tasks while driving. For all other visual-manual secondary tasks, the NHTSA Guidelines specify a test method for measuring eye glance behavior during those tasks. Eye glance metrics are compared to acceptance criteria to evaluate whether a task interferes too much with driver attention, rendering it unsuitable for a driver to perform while driving. If a task does not meet the acceptance criteria, the NHTSA Guidelines recommend that the task be made inaccessible for performance by the driver while driving. In addition, the NHTSA Guidelines contain several recommendations to limit and reduce the potential for distraction associated with the use of OE in-vehicle electronic devices.

Maxillary segmental distraction in children with unilateral clefts of lip, palate, and alveolus.

PubMed

Zemann, Wolfgang; Pichelmayer, Margit

2011-06-01

Alveolar clefts are commonly closed by a bone grafting procedure. In cases of wide clefts the deficiency of soft tissue in the cleft area may lead to wound dehiscence and loss of the bony graft. Segmental maxillary bony transfer has been mentioned to be useful in such cases. Standard distraction devices allow unidirectional movement of the transported segment. Ideally the distraction should strictly follow the dental arch. The aim of this study was to analyze distraction devices that were adapted to the individual clinical situation of the patients. The goal was to achieve a distraction strictly parallel to the dental arch. Six children with unilateral clefts of lip, palate, and alveolus between 12 and 13 years of age were included in the study. The width of the cleft was between 7 and 19 mm. Dental cast models were used to manufacture individual distraction devices that should allow a segmental bony transport strictly parallel to the dental arch. Segmental osteotomy was performed under general anesthesia. Distraction was started 5 days after surgery. All distracters were tooth fixed but supported by palatal inserted orthodontic miniscrews. In all patients, a closure of the alveolar cleft was achieved. Two patients required additional bone grafting after the distraction procedure. The distraction was strictly parallel to the dental arch in all cases. In 1 case a slight cranial displacement of the transported maxillary segment could be noticed, leading to minor modifications of the following distractors. Distraction osteogenesis is a proper method to close wide alveolar clefts. Linear segmental transport is required in the posterior part of the dental arch, whereas in the frontal part the bony transport should run strictly parallel to the dental arch. An exact guided segmental transport may reduce the postoperative orthodontic complexity. Copyright © 2011 Mosby, Inc. All rights reserved.

Perpendicular serial maxillary distraction osteogenesis in cleft lip and palate patients

PubMed Central

Ylikontiola, Leena P.; Sándor, George K.; Harila, Virpi

2015-01-01

Background: Cleft lip and palate patients often have a retruded maxilla with a severely narrowed deficient maxillary arch. This report aims to describe the management of severe maxillary retrusion and constriction in cleft lip and palate patients using distraction osteogenesis applied in serial sequence in two directions perpendicular to each other. Materials and Methods: Two adult male cleft lip and palate patients were treated with maxillary distraction osteogenesis in two stages. In the first stage, surgically assisted rapid palatal expansion with a tooth-borne device was performed to significantly expand the maxillary arch in the transverse dimension. After the teeth were orthodontically aligned, the horizontal distraction of the maxilla was made by two internal maxillary distraction devices. Results: In the first patient, the maxilla was initially widened by 11 mm and then distracted forward by 20 mm. Despite the breakage of the shaft of one of the two distractors at the end of distraction, a satisfactory occlusion was found at the time of distractor device removal. The maxillary position has remained stable through 8 years of follow-up. In the second patient, the palate was widened by 14 mm and the maxilla was distracted forward by 22 mm. The maxillary position has remained stable through 3 years of follow-up. Conclusion: Sequential serial distraction of maxilla in two planes perpendicular to each other is a safe and stable approach for the treatment of cleft lip and palate patients with severe transverse and anteroposterior discrepancies. PMID:26981462

Perpendicular serial maxillary distraction osteogenesis in cleft lip and palate patients.

PubMed

Ylikontiola, Leena P; Sándor, George K; Harila, Virpi

2015-01-01

Cleft lip and palate patients often have a retruded maxilla with a severely narrowed deficient maxillary arch. This report aims to describe the management of severe maxillary retrusion and constriction in cleft lip and palate patients using distraction osteogenesis applied in serial sequence in two directions perpendicular to each other. Two adult male cleft lip and palate patients were treated with maxillary distraction osteogenesis in two stages. In the first stage, surgically assisted rapid palatal expansion with a tooth-borne device was performed to significantly expand the maxillary arch in the transverse dimension. After the teeth were orthodontically aligned, the horizontal distraction of the maxilla was made by two internal maxillary distraction devices. In the first patient, the maxilla was initially widened by 11 mm and then distracted forward by 20 mm. Despite the breakage of the shaft of one of the two distractors at the end of distraction, a satisfactory occlusion was found at the time of distractor device removal. The maxillary position has remained stable through 8 years of follow-up. In the second patient, the palate was widened by 14 mm and the maxilla was distracted forward by 22 mm. The maxillary position has remained stable through 3 years of follow-up. Sequential serial distraction of maxilla in two planes perpendicular to each other is a safe and stable approach for the treatment of cleft lip and palate patients with severe transverse and anteroposterior discrepancies.

[Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: a case report].

PubMed

Golubović, Ivan; Vukašinović, Zoran; Stojiljković, Predrag; Golubović, Zoran; Stojiljković, Danilo; Radovanović, Zoran; Ilić, Nenad; Najman, Stevo; Višnjić, Aleksandar; Arsić, Stojanka

2012-01-01

The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Contamination and devitalization of the soft-tissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury.

Design and characterization of a new bioreactor for continuous ultra-slow uniaxial distraction of a three-dimensional scaffold-free stem cell culture.

PubMed

Weiss, S; Henle, P; Roth, W; Bock, R; Boeuf, S; Richter, W

2011-01-01

A computer controlled dynamic bioreactor for continuous ultra-slow uniaxial distraction of a scaffold-free three-dimensional (3D) mesenchymal stem cell pellet culture was designed to investigate the influence of stepless tensile strain on behavior of distinct primary cells like osteoblasts, chondroblasts, or stem cells without the influence of an artificial culture matrix. The main advantages of this device include the following capabilities: (1) Application of uniaxial ultra-slow stepless distraction within a range of 0.5-250 μm/h and real-time control of the distraction distance with high accuracy (mean error -3.4%); (2) tension strain can be applied on a 3D cell culture within a standard CO(2) -incubator without use of an artificial culture matrix; (3) possibility of histological investigation without loss of distraction; (4) feasibility of molecular analysis on RNA and protein level. This is the first report on a distraction device capable of applying continuous tensile strain to a scaffold-free 3D cell culture within physiological ranges of motion comparable to distraction ostegenesis in vivo. We expect the newly designed microdistraction device to increase our understanding on the regulatory mechanisms of mechanical strains on the metabolism of stem cells. Copyright © 2010 American Institute of Chemical Engineers (AIChE).

Subtalar distraction osteogenesis for posttraumatic arthritis following intra-articular calcaneal fractures.

PubMed

Fan, Wei-Li; Sun, Hong-Zhen; Wu, Si-Yu; Wang, Ai-Min

2013-03-01

The most common treatment for old calcaneal fractures accompanied by subtalar joint injury is the use of subtalar in situ arthrodesis and subtalar distraction bone-block arthrodesis or osteotomy. This article describes the introduction of a novel surgical treatment, gradual subtalar distraction with external fixation and restoration of the calcaneal height, and presents an assessment of its efficacy. The protruding lateral calcaneus and the articular surfaces and subchondral bone of the posterior facet of the subtalar joint were surgically removed. An external fixator, attached with 2 pins in the subcutaneous tibia and 2 pins in the posterolateral calcaneus, was used to fix the subtalar joint for 7 to 10 days followed by gradual subtalar distraction at 1 mm/d. The lengthening procedure was stopped when the calcaneal height was restored according to radiography. The external fixator was removed after bone fusion. Seven cases of old calcaneal fractures accompanied by severe subtalar joint injury (8 feet) were treated using this method. Average follow-up was 14.3 months (range, 7-36 months). In all 7 cases (1 case of both feet), the postoperative wound healed primarily. The calcaneal heights of all 8 feet were partially restored. Subtalar joint bone fusion was completed within 4 to 6 months after the operation. The average preoperative American Orthopedic Foot & Ankle Society (AOFAS) hindfoot score was 25.3, and the average postoperative AOFAS score was 76.3. Subtalar distraction osteogenesis with external fixation was a novel and effective method for the treatment of old calcaneal fractures accompanied by severe subtalar joint injury in this small group of patients. Level IV, retrospective case series.

Ankle Distraction Arthroplasty: Indications, Technique, and Outcomes.

PubMed

Bernstein, Mitchell; Reidler, Jay; Fragomen, Austin; Rozbruch, S Robert

2017-02-01

Ankle distraction is an alternative to ankle arthrodesis or total ankle arthroplasty in younger patients with arthritis. Ankle distraction involves the use of external fixation to mechanically unload the ankle joint, which allows for stable, congruent range of motion in the setting of decreased mechanical loading, potentially promoting cartilage repair. Adjunct surgical procedures are frequently done to address lower-extremity malalignment, ankle equinus contractures, and impinging tibiotalar osteophytes. Patients can bear full weight during the treatment course. The distraction frame frequently uses a hinge, and patients are encouraged to do daily range-of-motion exercises. Although the initial goal of the procedure is to delay arthrodesis, many patients achieve lasting clinical benefits, obviating the need for total ankle arthroplasty or fusion. Complications associated with external fixation are common, and patients should be counseled that clinical improvements occur slowly and often are not achieved until at least 1 year after frame removal.

Transsutural distraction osteogenesis applied to maxillary complex with new internalized distraction device: analysis of the feasibility and long-term osteogenesis outcome.

PubMed

Tong, Haizhou; Gao, Feng; Yin, Jiapeng; Zhang, Xiangyu; Zhang, Chen; Yin, Ningbei; Zhao, Zhenmin

2015-03-01

The purposes of this study were to evaluate the effects of transsutural distraction osteogenesis applied to the maxillary complex with a new internalized distraction device and to analyze the long-term osteogenesis outcome. Three-month-old beagle dogs were treated with a self-designed internalized distractor. The feasibility was evaluated, and the effects of the maxillary growth were measured using radiography and computed tomography (CT). The regenerated bone was examined with micro-CT, biomechanical testing, and histology 1 year after the distraction. The experimental group showed significantly larger forward displacement of maxillary during the distraction. One year after the distraction, the micro-CT showed more incompact structure and bone volume/total volume was significantly less in the experimental group. Biomechanical testing also showed a significantly lower yield but with no difference in stiffness. Histologic staining found osteoclasts deposited in the region of the suture and osteoblasts on the bone surface. The immunohistochemical staining of osteoprotegrin and receptor activator of nuclear factor-κ B ligand showed evidence of expression in suture area components and osteocytes with no difference between the groups. Transsutural distraction osteogenesis using an internalized distractor with skull anchorage demonstrated feasibility. It is expected that this device may provide new thoughts in developing an appropriate appliance for clinical use in young patients with midfacial hypoplasia. Moreover, the long-term osteogenesis analysis findings suggest that the metabolism of sutural area still remained active, which enhanced our understanding of bone remodeling in the sutural area to manage maxillary relapse after transsutural distraction osteogenesis.

Technology-related distracted walking behaviours in Manhattan's most dangerous intersections.

PubMed

Basch, Corey H; Ethan, Danna; Rajan, Sonali; Basch, Charles E

2014-10-01

Use of mobile devices has been cited as a distraction while driving, and more recently, among pedestrians crossing urban streets. In 2010, over half of New York City traffic fatalities were pedestrians. The aim of this study was to estimate the prevalence of distracted walking due to pedestrians' use of headphones, mobile phones, or both. Data were gathered by direct observations at the 10 intersections in Manhattan with the highest frequency of pedestrian-motor vehicle collisions. More than 1 in 4 of the >3500 pedestrians observed were distracted by mobile electronic devices while crossing during the 'walk' (28.8%) and 'don't walk' (26.3%) signals. Poisson regression analyses established there was a significant difference in individuals talking on a mobile device during the 'walk' signal versus the 'don't walk' signal; however, no other significant differences in other distracted walking behaviours were observed. This study contributes to the emerging literature on distracted walking behaviour by pedestrians in busy urban areas and can help to inform pedestrian-focused safety efforts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Family-centred care during midface advancement with a rigid external device: what do families need?

PubMed

Bredero-Boelhouwer, H; Joosten, K F M; van Veen-van der Hoek, M; Mathijssen, I M J

2013-08-01

Midface advancement with distraction osteogenesis using the rigid external device (RED) is an effective but invasive treatment to correct the hypoplastic midface. This study draws up an inventory of the stressors, needs and coping strategies of families during this treatment, to determine the best conditions for family-centred care. Data were collected by reviewing the patients' files and administering semi-structured interviews. The data were analysed using the software program Atlas.ti and were re-analysed by an independent researcher. Parents and patients were interviewed separately. Fourteen families participated. Four patients had an absolute indication for surgery. All families were eager to have the patient's facial appearance improved. Nevertheless, despite psychological counselling, they experienced stress when confronted with the changed facial appearance. Another stressor was weight loss. Six patients were in a state of acute malnutrition and needed supplementary feeding. We conclude that the best conditions for family-centred care should be aligned to the different phases of treatment. Leading up to surgery it is important to screen families' expectations regarding aesthetic, functional and social outcomes and to assess their capacity to cope with the long treatment and effects of changed facial appearance. Peer contact and psychosocial training to increase self-esteem are tools to enhance co-operation and satisfaction. During the distraction and stabilisation phase, we advise the monitoring of nutritional intake and weight. During all phases of treatment easy accessibility to the team is recommended. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Effect of maxillary distraction osteogenesis on velopharyngeal function: a pilot study.

PubMed

Harada, Kiyoshi; Ishii, Yoshimasa; Ishii, Masatoshi; Imaizumi, Humiko; Mibu, Michiko; Omura, Ken

2002-05-01

The purpose of this study was to examine preoperative and postoperative changes of velopharyngeal function in cleft patients who underwent maxillary distraction osteogenesis using the Rigid External Distraction System. Six cleft patients followed for a minimum of 12 months after maxillary distraction were examined. Plain and contrast lateral-cephalograms were obtained preoperatively and postoperatively, and speech evaluation was performed by the same authorized speech therapist at the same time points. The mean distraction amount at the anterior nasal spine was 11.7 mm (range, 7.4 mm - 15.0 mm). Both the nasopharyngeal depth and velar length increased after maxillary distraction, but the need ratio (nasopharyngeal depth/velar length) also increased after distraction. Although scores for velopharyngeal closure dropped a few points after maxillary distraction, the rating for hypernasality remained unchanged in all patients but the patient whose distraction amount was 15.0 mm. These results suggest that maxillary distraction of less than 15 mm may not markedly affect velopharyngeal function in cleft patients.

U.S. State and Federal Laws Targeting Distracted Driving

PubMed Central

Catherine Chase, J.D.

2014-01-01

Distracted driving has burgeoned with the proliferation of cell phones, global positioning systems and other in-vehicle and personal electronic devices. Annually more than 3,300 people are killed and an additional 400,000 are injured in the United States in distracted driving crashes. The United States (U.S.) federal and state governments have responded to this public health problem with policies and laws; however, a more comprehensive and more effective approach is still needed. Some restrictions on the use of electronic devices while driving by federal employees and some voluntary guidelines and recommendations have been issued. Public opinion polls show support for addressing the issue of distracted driving with state laws. The majority of states have laws banning text messaging while driving and prohibiting the use of an electronic device by teenage or novice drivers. Some states prohibit all drivers from using a hand-held cellphone. Currently no state has a total ban on the use of personal electronic devices while driving. Successful past traffic safety campaigns changing driver behavior have demonstrated the necessity to adopt a “three Es” approach of Enactment of a law, Education of the public about the law, and rigorous Enforcement of the law. Experience reveals that this approach, along with future federal regulation of in-vehicle electronic devices and the employment of technology to limit the use of electronic devices while driving, is needed to alter personal behavior in order to reduce distractions and keep drivers focused on the driving task. PMID:24776229

U.s. State and federal laws targeting distracted driving.

PubMed

Catherine Chase, J D

2014-01-01

Distracted driving has burgeoned with the proliferation of cell phones, global positioning systems and other in-vehicle and personal electronic devices. Annually more than 3,300 people are killed and an additional 400,000 are injured in the United States in distracted driving crashes. The United States (U.S.) federal and state governments have responded to this public health problem with policies and laws; however, a more comprehensive and more effective approach is still needed. Some restrictions on the use of electronic devices while driving by federal employees and some voluntary guidelines and recommendations have been issued. Public opinion polls show support for addressing the issue of distracted driving with state laws. The majority of states have laws banning text messaging while driving and prohibiting the use of an electronic device by teenage or novice drivers. Some states prohibit all drivers from using a hand-held cellphone. Currently no state has a total ban on the use of personal electronic devices while driving. Successful past traffic safety campaigns changing driver behavior have demonstrated the necessity to adopt a "three Es" approach of Enactment of a law, Education of the public about the law, and rigorous Enforcement of the law. Experience reveals that this approach, along with future federal regulation of in-vehicle electronic devices and the employment of technology to limit the use of electronic devices while driving, is needed to alter personal behavior in order to reduce distractions and keep drivers focused on the driving task.

75 FR 59118 - Limiting the Use of Wireless Communication Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-27

... Texting Prohibition D. Investigations and Studies on Driver Distraction E. Existing Texting Prohibitions...). As a result of the Summit, and based on data from studies on distracted driving, FMCSA is considering... electronic devices in the cab, presumably prohibiting texting. D. Investigations and Studies on Driver...

[An adjustable distractor for transverse maxillary distraction osteogenesis].

PubMed

Leyder, P; Wycisk, G; Quilichini, J

2013-06-01

The posterior skeletal widening in conventional distractions (Surgical Assisted Rapid Maxillary Expansion) is often modest, in contrast with a predominant anterior expansion. Until recently, it was not possible to consider transverse palatal distraction osteogenesis and Le Fort I impaction or advancement in the same procedure, as the osteosynthesis plates impeded maxillary anterior opening. We developed new sliding osteosynthesis plates allowing to perform an advancement or impaction Le Fort I osteotomy associated with a low-resistance bipartite palatal distraction osteogenesis. We had for aim to describe the device and to determine its clinical applications. This new palatal distractor is made up of two independent stainless steel jacks allowing for an adjustable distraction in the anterior or posterior area as needed. Bone-borne and tooth-borne versions are available. This new distractor can be adjusted sagittally. The distraction can be angular or parallel, and the distraction mode can be modified during post-operative distraction. This device should be adapted to all clinical presentations. It can be used in combination with sliding osteosynthesis to perform a Le Fort 1 osteotomy and at the same time a complete correction of vertical, horizontal, and sagittal deficiencies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Initial Experience With a New Intraoral Midface Distraction Device.

PubMed

Burstein, Fernando; Soldanska, Magdalena; Granger, Michael; Berhane, ChiChi; Schoemann, Mark

2015-06-01

Maxillary hypoplasia that necessitates surgical advancement affects approximately 25% of patients born with cleft lip and palate. Syndromic conditions such as Crouzon may also be accompanied by significant maxillary hypoplasia. Severe maxillary hypoplasia can result in airway obstruction, malocclusion, proptosis, and facial disfigurement. For optimal stability, severe hypoplasia is best addressed with maxillary distraction osteogenesis. Twenty-two patients (15 boys, 7 girls, ages 6-16 years, mean age 10 years) with severe midface hypoplasia underwent midface distraction with new internal maxillary distraction (IMD) device at our institution. Total distraction distances ranged from 15 to 30 mm. There were no major complications, and all of them had improvement in functional and aesthetic parameters. There were 2 minor complications and 2 patients failed to distract the full distance because of converging vectors. Early maxillary distraction in patients with severe midface hypoplasia is a useful technique to provide interval correction of severe maxillary hypoplasia before skeletal maturity and definitive orthognathic surgery is contemplated, and it is a good tool to improve occlusion, aesthetics, and self-perception in younger patients.

Initial Experience With a New Intraoral Midface Distraction Device

PubMed Central

Burstein, Fernando; Soldanska, Magdalena; Granger, Michael; Berhane, ChiChi; Schoemann, Mark

2015-01-01

Abstract Maxillary hypoplasia that necessitates surgical advancement affects approximately 25% of patients born with cleft lip and palate. Syndromic conditions such as Crouzon may also be accompanied by significant maxillary hypoplasia. Severe maxillary hypoplasia can result in airway obstruction, malocclusion, proptosis, and facial disfigurement. For optimal stability, severe hypoplasia is best addressed with maxillary distraction osteogenesis. Twenty-two patients (15 boys, 7 girls, ages 6–16 years, mean age 10 years) with severe midface hypoplasia underwent midface distraction with new internal maxillary distraction (IMD) device at our institution. Total distraction distances ranged from 15 to 30 mm. There were no major complications, and all of them had improvement in functional and aesthetic parameters. There were 2 minor complications and 2 patients failed to distract the full distance because of converging vectors. Early maxillary distraction in patients with severe midface hypoplasia is a useful technique to provide interval correction of severe maxillary hypoplasia before skeletal maturity and definitive orthognathic surgery is contemplated, and it is a good tool to improve occlusion, aesthetics, and self-perception in younger patients. PMID:26080162

Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss.

PubMed

Kabata, Tamon; Tsuchiya, Hiroyuki; Sakurakichi, Keisuke; Yamashiro, Teruhisa; Watanabe, Koji; Tomita, Kasuro

2005-06-01

Nonunions of a juxta-articular lesion with bone loss, which represent a challenging therapeutic problem, were treated using external fixation and distraction osteogenesis. Seven juxta-articular nonunions (five septic and two aseptic) were treated. The location of the nonunion was the distal femur in four patients, the proximal tibia in one patient, and the distal tibia in two patients. All of them were located within 5 cm from the affected joints. Preoperative limb shortening was present in six cases, averaging 2.9 cm (range, 1-7 cm). The reconstructive procedure consisted of refreshment of the nonunion site, deformity correction, stabilization by external fixation, and lengthening to eliminate leg length discrepancy or to fill the defect. Shortening-distraction was applied to six patients and bone transport to one patient for reconstruction. Intramedullary nailing to reduce the duration of external fixation was simultaneously performed in two cases. All the patients had at least 1 year of follow-up evaluation. Osseous union without angular deformity or leg length discrepancy greater than 1 cm was achieved in all patients. The mean amount of lengthening was 5.8 cm (range, 2.2-10.0 cm). The mean external fixation period was 219 days (range, 98-317 days), and the mean external fixation index was 34.4 days/cm (range, 24.5-47.6 days/cm). All patients reported excellent pain reduction. There were no recurrences of infection in five patients with prior history of osteomyelitis. The functional results were categorized as excellent in two, good in three, and fair in two. Despite the length of postoperative external fixation, distraction osteogenesis can be a valuable alternative for the treatment of juxta-articular nonunions.

Deadly distractions.

PubMed

Zuzek, Crystal

2013-04-01

In 2011, the National Transportation Safety Board urged all states to ban the use of portable electronic devices while driving, including hand-held and hands-free devices. Texting while driving concerns several Texas legislators, who have filed bills, backed by the Texas Medical Association, to ban the practice. TMA physicians recognize that the use of hand-held and hands-free devices and other factors associated with distracted driving affect their patients' safety.

Minimum distraction gap: how much ankle joint space is enough in ankle distraction arthroplasty?

PubMed

Fragomen, Austin T; McCoy, Thomas H; Meyers, Kathleen N; Rozbruch, S Robert

2014-02-01

The success of ankle distraction arthroplasty relies on the separation of the tibiotalar articular surfaces. The purpose of this study was to find the minimum distraction gap needed to ensure that the tibiotalar joint surfaces would not contact each other with full weight-bearing while under distraction. Circular external fixators were mounted to nine cadaver ankle specimens. Each specimen was then placed into a custom-designed load chamber. Loads of 0, 350, and 700N were applied to the specimen. Radiographic joint space was measured and joint contact pressure was monitored under each load. The external fixator was then sequentially distracted, and the radiographic joint space was measured under the three different loads. The experiment was stopped when there was no joint contact under 700N of load. The radiographic joint space was measured and the initial (undistracted) radiographic joint space was subtracted from it yielding the distraction gap. The minimum distraction gap (mDG) that would provide total unloading was calculated. The average mDG was 2.4 mm (range, 1.6 to 4.0 mm) at 700N of load, 4.4 mm (range, 3.7 to 5.8 mm) at 350N of load, and 4.9 mm (range, 3.7 to 7.0 mm) at 0N of load. These results suggest that if the radiographic joint space of on a standing X-ray of an ankle undergoing distraction arthroplasty shows a minimum of 5.8 mm of DG, then there will be no contact between joint surfaces during full weight-bearing. Therefore, 5 mm of radiographic joint space, as recommended historically, may not be adequate to prevent contact of the articular surfaces during weight-bearing.

Profile Changes and Stability following Distraction Osteogenesis with Rigid External Distraction in Adult Cleft Lip and Palate Deformities

PubMed Central

Painatt, Jaeson M.; Veeraraghavan, Ravi; Puthalath, Ushass; Peter, Sherry; Rao, Latha P.; Kuriakose, Maria

2017-01-01

Objectives: The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result. Materials and Methods: Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin. Statistical Analysis Used: Wilcoxon Signed-Ranks test was used, and the probability value (P value) of 0.05 was considered as statistically significant level. Results: Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm (P < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° (P < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm (P < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm (P < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable. Conclusion: The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This stressed on the need for overcorrection of about 35%–40% for adult CLP patients. PMID:28839409

Mechanisms of Working Memory Disruption by External Interference

PubMed Central

Rubens, Michael T.; Gazzaley, Adam

2010-01-01

The negative impact of external interference on working memory (WM) performance is well documented; yet, the mechanisms underlying this disruption are not sufficiently understood. In this study, electroencephalogram and functional magnetic resonance imaging (fMRI) data were recorded in separate experiments that each introduced different types of visual interference during a period of WM maintenance: distraction (irrelevant stimuli) and interruption (stimuli that required attention). The data converged to reveal that regardless of the type of interference, the magnitude of processing interfering stimuli in the visual cortex (as rapidly as 100 ms) predicted subsequent WM recognition accuracy for stored items. fMRI connectivity analyses suggested that in the presence of distraction, encoded items were maintained throughout the delay period via connectivity between the middle frontal gyrus and visual association cortex, whereas memoranda were not maintained when subjects were interrupted but rather reactivated in the postinterruption period. These results elucidate the mechanisms of external interference on WM performance and highlight similarities and differences of distraction and multitasking. PMID:19648173

Corrected Cephalometric Analysis to Determine the Distance and Vector of Distraction Osteogenesis for Syndromic Craniosynostosis

PubMed Central

Fukawa, Toshihiko; Hirakawa, Takashi; Satake, Toshihiko; Maegawa, Jiro

2017-01-01

Background: The purpose of this study was to confirm the utility of a corrected cephalometric analysis to facilitate the planning of distraction osteogenesis with Le Fort III osteotomy for syndromic craniosynostosis. Methods: This prospective study involved 4 male and 2 female patients (mean patient age, 8 years 9 months; age range, 4 years 6 months to 13 years 2 months) with Crouzon syndrome who were treated with Le Fort III maxillary distraction using our previously described system of analysis of a corrected cephalogram and who underwent clinical follow-up. Lateral cephalograms were obtained immediately after device removal. Results: Distraction of orbitale moved the vector downward to the adult profile, but there was slightly less elongation than the adult profile for the distraction distance. The desired and real mean angles after distraction of point A were 29.2 ± 7.9° and 6.1 ± 8.5°, respectively, and the desired and the real mean distances after distraction of point A were 30.6 ± 12.7 mm and 29.4 ± 4.1 mm, respectively. Conclusions: Using the corrected cephalometric analysis, the distance and vector of distraction osteogenesis with Le Fort III osteotomy could be determined in patients with syndromic craniosynostosis. The distraction system brought the patients' facial bones to the planned position using controlling devices. PMID:29062650

The use of internal maxillary distraction for maxillary hypoplasia: a preliminary report.

PubMed

Van Sickels, Joseph E; Madsen, Mathew J; Cunningham, Larry L; Bird, Douglas

2006-12-01

Distraction osteogenesis is a useful alternative to advance the maxilla in complicated cases of maxillary hypoplasia. The purpose of this article is to review the workup, experience, and preliminary results with the use of internal distraction osteogenesis for maxillary hypoplasia at one teaching institution. Over a 5-year period, more than 300 patients with craniofacial and dentofacial defects have undergone oral and maxillofacial surgery at our center to correct their skeletal discrepancies. Of these, 10 have had maxillary distraction osteogenesis done with internal distractors. Follow-up of 6 months or more was available for 8 patients. Stereolithographic models were used to bend distractors prior to surgery in 6 patients. Latency prior to the start of distraction was 3 to 7 days and varied with the age of the patient. Distraction occurred at approximately 1 mm per day with an average distraction length of 8.5 mm (range, 6-10 mm). Excellent occlusal results were obtained in 5 patients. Major complications including nonunion and failure to achieve acceptable occlusal results were observed in 3 patients. Minor complications including pain and loosening of the distracter devices were observed in 2 patients, but did not appear to affect the esthetic and functional results. Distraction osteogenesis is a useful alternative to traditional orthognathic surgery to treat maxillary hypoplasia. Internal distractions are attractive to patients, but are more difficult to place and can cause discomfort to patients when trying to achieve an ideal primary vector of distraction. Stereolithographic models can help with placement of the device. Changes in design of distractors may help with patient discomfort.

Direct hip joint distraction during acetabular fracture surgery using the AO universal manipulator.

PubMed

Calafi, L Afshin; Routt, M L Chip

2010-02-01

Certain acetabular fractures may necessitate distraction of the hip joint for removal of intra-articular debris and assessment of reduction. Distraction can be accomplished by manual traction, using a traction table or an AO universal manipulator (UM). The UM is a relatively simple and an inexpensive device that can provide focal distraction in a controlled manner without the risks associated with the use of a traction table. We describe a technique using the UM for hip joint distraction during acetabular fracture surgery through a Kocher-Langenbeck surgical exposure.

Evidence of cartilage repair by joint distraction in a canine model of osteoarthritis.

PubMed

Wiegant, Karen; Intema, Femke; van Roermund, Peter M; Barten-van Rijbroek, Angelique D; Doornebal, Arie; Hazewinkel, Herman A W; Lafeber, Floris P J G; Mastbergen, Simon C

2015-02-01

Knee osteoarthritis (OA) is a degenerative joint disorder characterized by cartilage, bone, and synovial tissue changes that lead to pain and functional impairment. Joint distraction is a treatment that provides long-term improvement in pain and function accompanied by cartilage repair, as evaluated indirectly by imaging studies and measurement of biochemical markers. The purpose of this study was to evaluate cartilage tissue repair directly by histologic and biochemical assessments after joint distraction treatment. In 27 dogs, OA was induced in the right knee joint (groove model; surgical damage to the femoral cartilage). After 10 weeks of OA development, the animals were randomized to 1 of 3 groups. Two groups were fitted with an external fixator, which they wore for a subsequent 10 weeks (one group with and one without joint distraction), and the third group had no external fixation (OA control group). Pain/function was studied by force plate analysis. Cartilage integrity and chondrocyte activity of the surgically untouched tibial plateaus were analyzed 25 weeks after removal of the fixator. Changes in force plate analysis values between the different treatment groups were not conclusive. Features of OA were present in the OA control group, in contrast to the generally less severe damage after joint distraction. Those treated with joint distraction had lower macroscopic and histologic damage scores, higher proteoglycan content, better retention of newly formed proteoglycans, and less collagen damage. In the fixator group without distraction, similarly diminished joint damage was found, although it was less pronounced. Joint distraction as a treatment of experimentally induced OA results in cartilage repair activity, which corroborates the structural observations of cartilage repair indicated by surrogate markers in humans. Copyright © 2015 by the American College of Rheumatology.

One-step transversal palatal distraction and maxillary repositioning: technical considerations, advantages, and long-term stability.

PubMed

Cortese, Antonio; Savastano, Mauro; Savastano, Germano; Claudio, Pier Paolo

2011-09-01

Transversal maxillary hypoplasia in adolescence is a frequently seen pathology, which can be treated with a combination of surgery and orthodontic treatment to widen the maxilla in skeletally matured patients.We evaluated the advantages of a new surgical technique: Le Fort I distraction osteogenesis using a bone-borne device. Because relapse is one of the main problems in surgical maxillary expansion, long-term stability of this new technique was evaluated. Data from 4 adult patients with maxillary restriction, class III malocclusion, or maxillary malposition were collected preoperatively, 4 months after distraction, and 5 years after distraction. Measurements were recorded on dental models to detect palatal expansion at dental level; cephalograms by lateral and posteroanterior plane were analyzed to detect maxillary movements. Maxillary measurements were substantially stable 5 years after distractions. Only minor dental movements occurred at the dental analysis after 5 years related to a lack of orthodontic contention without any compromise of the dental result (no crossbite relapse and class I stability). Le Fort I with down-fracture for expansion and repositioning by bone-borne distractor device can [corrected] be used to simultaneously widen, advance, and vertically reposition the maxilla without causing healing problems, particularly using a rigid distraction device. Long-term stability can be achieved; however, further studies with a larger number of patients will be necessary for better evaluation.

[Results of femoral lengthening over an intramedullary nail and external fixator].

PubMed

Jasiewicz, Barbara; Kacki, Wojciech; Tesiorowski, Maciej; Potaczek, Tomasz

2008-01-01

Current techniques of operative limb lengthening usually are based on distraction osteogenesis. One of the techniques is limb lengthening over an intramedullary nail. The goal of this study is to evaluate the results of femoral lengthening over an intramedullary nail. Between 1999 and 200619 femoral "over nail" lengthenings were performed. There were 7 males and 12 females. Mean patients' age at surgery was 15.8 years, and mean initial femoral shortening was 5.1 cm. Operative technique consisted of one-stage implantation of intramedullary nail and external fixator. Ilizarov apparatus was used in 9 patients, monolateral fixator in 10 cases--ORTHOFIX in 9 patients, Wagner fixator--in 1 patient. Intramedullary nail was locked proximally with screws or Schanz pins from external fixator. After distraction phase, external fixator was removed and distal locking screws were applied. Evaluation criteria: obtained lengthening, time of external fixator, treatment time, healing index, external fixation index, range of motion in hip and knee joints and complications according to Paley. The mean lengthening was 4.6 cm, and mean distraction time was 66.6 days. Mean time of external fixation was 115.5 days, and external fixation index was 26.2 days for centimeter. Healing index was 36.9 days for centimeter. In cases with monolateral fixator, healing index did not differ with the whole group. During treatment 18 complications occurred, for a rate of 0.9 complication per segment. Lengthening over an intramedullary nail reduces the time of external fixator. Over nail femoral lengthening can prevent axis deviation following regenerate bending. Complication rate is similar to lengthenings with the classic Ilizarov technique. There are no differences in the treatment time in relation to the type of external fixator.

Effectiveness of non-pharmacological measures for reducing pain and fear in children during venipuncture in the emergency department: a vibrating cold devices versus distraction.

PubMed

García-Aracil, Noelia; Ramos-Pichardo, Juan Diego; Castejón-de la Encina, María Elena; José-Alcaide, Lourdes; Juliá-Sanchís, Rocío; Sanjuan-Quiles, Ángela

2018-06-01

To assess the effectiveness of a physical method of managing pain and fear in children and anxiety in the accompanying adult during venous puncture in the emergency department. Quasi-experimental study of 3 groups: one group used a combination of directed distraction by means of a vibration device with ice pack, a second group received only distraction, and no strategy was used in the third. Pain and adult anxiety were similar in the 2 groups in which a pain management strategy was applied. Pain and adult anxiety were greater when no strategy was adopted. We detected no differences in the level of the children's fear. Directed distraction can be useful for managing pain in children and it reduces the anxiety experienced by accompanying adults. The use of a vibration device with ice does not add benefits. Fear is not reduced by any of these measures.

Unfavourable results with distraction in craniofacial skeleton

PubMed Central

Agarwal, Rajiv

2013-01-01

Distraction osteogenesis has revolutionised the management of craniofacial abnormalities. The technique however requires precise planning, patient selection, execution and follow-up to achieve consistent and positive results and to avoid unfavourable results. The unfavourable results with craniofacial distraction stem from many factors ranging from improper patient selection, planning and use of inappropriate distraction device and vector. The present study analyses the current standards and techniques of distraction and details in depth the various errors and complications that may occur due to this technique. The commonly observed complications of distraction have been detailed along with measures and suggestions to avoid them in clinical practice. PMID:24501455

Tooth-borne distraction osteogenesis versus conventional Le Fort I in maxillary advancement of cleft lip and palate patients.

PubMed

Jamilian, Abdolreza; Showkatbakhsh, Rahman; Behnaz, Mohammad; Ghassemi, Alireza; Kamalee, Zinat; Perillo, Letizia

2018-01-31

Distraction osteogenesis (DO) is rapidly becoming a mainstream surgical technique for correction of maxillary deficiency. The aim of this study was to compare the effectiveness of a newly designed tooth-borne osteogenic distraction device with conventional LeFort 1 osteotomy in maxillary advancement of cleft lip and palate patients. The DO group consisted of 10 subjects (7 males, 3 females) with a mean age of 21.2 (SD 4.2) years. In these patients, the newly designed distraction device which exerted force anteroposteriorly was cemented after mobilization of the maxilla. After a latency period of 7 days, the distractor was activated twice daily by a total amount of 0.5 mm per day. The activation was continued for 3 weeks. After an 8-week consolidation period, the distraction appliance was removed. Cephalograms of DO patients were obtained at the start of distraction and at the end of consolidation. The LeFort 1 group consisted of 11 subjects (6 males, 5 females) with a mean age of 22.3 (SD 3.7) years. Pre and post-surgery lateral cephalograms were obtained. T-Test and paired T-test were used to evaluate the data. At the end of treatment, the SNA angle of LeFort 1 patients increased by 5.5° (SD 2.3) (P<0.001) and the SNA angle of DO patients increased by 3.4° (SD 2) (P<0.001). Current evidence suggests that both conventional LeFort 1 and tooth-borne osteogenic distraction device can effectively advance the maxilla forward in patients with cleft lip.

The effect of cleft maxillary distraction osteogenesis on the levator veli palatini and velopharyngeal function.

PubMed

Chen, Philip Kuo-Ting; Por, Yong-Chen; Liou, Eric Jein-Wein; Chang, Frank Chun-Shin

2015-05-01

Le Fort I maxillary distraction with the rigid external distraction (RED) device is performed to correct severe midface retrusion in cleft patients, but it may adversely affect velopharyngeal function. This study aims to investigate the angular changes in the levator veli palatini (LVP) and its influence on velopharyngeal function after maxillary distraction using 3-dimensional computed tomography (3D CT) scan volume rendered images. This was a retrospective study of 12 patients. Group 1 had no velopharyngeal function deterioration and group 2 had velopharyngeal function deterioration. Preoperative and 1 year postoperative CT scans were analyzed with Mimics v10 software. Segmentation of the LVP and the nasopharyngeal airway was performed and volumetric images were obtained. Six measurements were made: (1) the angle between the levator plane and the Frankfort horizontal, (2) the angle between the levator plane and the soft palate plane, (3) the angle between the 2 LVP muscles, (4) the pharyngeal depth, and (5, 6) the movement of the inferior pharyngeal point with respect to the horizontal and vertical planes. The independent samples t test, Mann-Whitney test, and paired t tests were used for statistical analyses (P < 0.05). Group 2 had statistically significant reduction in the angle between the levator plane and Frankfort horizontal as well as the soft palate plane. Group 1 had a statistically significant increase in the pharyngeal depth and movement of the inferior pharyngeal point with respect to the horizontal plane. A decrease in the angle between the levator plane and the Frankfort horizontal or the soft palate plane was associated with velopharyngeal function deterioration.

Digital Distraction: Shedding Light on the 21st-Century College Classroom

ERIC Educational Resources Information Center

Aaron, Lynn S.; Lipton, Talia

2018-01-01

It is not uncommon to walk into a college classroom and find all heads bowed down to a flashing screen and the room . . . silent. While digital devices can certainly support learning, what about when they are a distraction? This study explored this 21st-century phenomenon from two perspectives: Does the use of a device for nonacademic purposes…

The effect of soft tissue distraction on deformity recurrence after centralization for radial longitudinal deficiency.

PubMed

Manske, M Claire; Wall, Lindley B; Steffen, Jennifer A; Goldfarb, Charles A

2014-05-01

To assess recurrence and complications in children with radial longitudinal deficiency treated with or without external fixator soft tissue distraction prior to centralization. Thirteen upper extremities treated with centralization alone were compared with 13 treated with ring fixator distraction followed by centralization. Resting wrist position between the 2 groups was compared before surgery, approximately 2 years after surgery (midterm), and at final follow-up, which was at a mean of 10 years for the centralization-alone group and 6 years for the distraction group. Radiographs were reviewed for hand-forearm angle, hand-forearm position, volar carpal subluxation, ulnar length, and physeal integrity. The clinical resting wrist position was improved significantly after surgery and at final follow-up in both groups, but recurrence was worse at final follow-up in the distraction group patients. Radiographically, in the centralization alone group, the hand-forearm angle improved from 53° before surgery to 13° at midterm but worsened to 27° at final follow-up. In the distraction group, the hand-forearm angle improved from 53° before surgery to 21° at midterm but worsened to 36° at final follow-up. The hand-forearm position improved between preoperative and final assessment in both groups, but at final follow-up, the centralization-alone group had a significantly better position. Volar subluxation was 4 mm improved in the centralization alone group and 2 mm worse in the distraction group at final follow-up. Centralization, with or without distraction with an external fixator, resulted in improved alignment of the wrist. Distraction facilitated centralization, but it did not prevent deformity recurrence and was associated with a worse final radial deviation and volar subluxation position compared with wrists treated with centralization alone. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Special Considerations in Distracted Driving with Teens

PubMed Central

Durbin, Dennis R; McGehee, Daniel V; Fisher, Donald; McCartt, Anne

2014-01-01

Novice teen drivers have long been known to have an increased risk of crashing, as well as increased tendencies toward unsafe and risky driving behaviors. Teens are unique as drivers for several reasons, many of which have implications specifically in the area of distracted driving. This paper reviews several of these features, including the widespread prevalence of mobile device use by teens, their lack of driving experience, the influence of peer passengers as a source of distraction, the role of parents in influencing teens’ attitudes and behaviors relevant to distracted driving and the impact of laws designed to prevent mobile device use by teen drivers. Recommendations for future research include understanding how engagement in a variety of secondary tasks by teen drivers affects their driving performance or crash risk; understanding the respective roles of parents, peers and technology in influencing teen driver behavior; and evaluating the impact of public policy on mitigating teen crash risk related to driver distraction. PMID:24776228

Maxillary distraction osteogenesis using Le Fort I osteotomy without intraoperative down-fracture.

PubMed

Yamauchi, K; Mitsugi, M; Takahashi, T

2006-06-01

The aim of this study is to present a technique for maxillary distraction osteogenesis using Le Fort I osteotomy without down-fracture. Six cleft-related patients suffering from severe midfacial deficiency were treated with maxillary distraction osteogenesis. The RED II system was chosen as the extraoral device and the Leipzig retention plate system to anchor the maxillary segment. Maxillary distraction osteogenesis was successful in all cases. Cephalometric and clinical evaluation after an average follow-up period of 1 year showed stable results with respect to skeletal and dental relationships. The SNA angle increased from 72.3 degrees to 81.4 degrees and the ANB angle increased by 11.0 degrees immediately after removing the distraction device. After 1 year, the sagittal bone gain remained and the SNA angle had decreased by 0.8 degrees . This technique seems to minimize the risk of the surgical procedure and shorten the operation time. It may become an alternative method for the treatment of patients with severe midfacial hypoplasia.

Repair of large full-thickness articular cartilage defects in the rabbit: the effects of joint distraction and autologous bone-marrow-derived mesenchymal cell transplantation.

PubMed

Yanai, T; Ishii, T; Chang, F; Ochiai, N

2005-05-01

We produced large full-thickness articular cartilage defects in 33 rabbits in order to evaluate the effect of joint distraction and autologous culture-expanded bone-marrow-derived mesenchymal cell transplantation (ACBMT) at 12 weeks. After fixing the knee on a hinged external fixator, we resected the entire surface of the tibial plateau. We studied three groups: 1) with and without joint distraction; 2) with joint distraction and collagen gel, and 3) with joint distraction and ACBMT and collagen gel. The histological scores were significantly higher in the groups with ACBMT collagen gel (p < 0.05). The area of regenerated soft tissue was smaller in the group allowed to bear weight (p < 0.05). These findings suggest that the repair of large defects of cartilage can be enhanced by joint distraction, collagen gel and ACBMT.

Comprehensive Review of Adipose Stem Cells and Their Implication in Distraction Osteogenesis and Bone Regeneration

PubMed Central

Morcos, Mina W.; Al-Jallad, Hadil; Hamdy, Reggie

2015-01-01

Bone is one of the most dynamic tissues in the human body that can heal following injury without leaving a scar. However, in instances of extensive bone loss, this intrinsic capacity of bone to heal may not be sufficient and external intervention becomes necessary. Several techniques are available to address this problem, including autogenous bone grafts and allografts. However, all these techniques have their own limitations. An alternative method is the technique of distraction osteogenesis, where gradual and controlled distraction of two bony segments after osteotomy leads to induction of new bone formation. Although distraction osteogenesis usually gives satisfactory results, its major limitation is the prolonged duration of time required before the external fixator is removed, which may lead to numerous complications. Numerous methods to accelerate bone formation in the context of distraction osteogenesis have been reported. A viable alternative to autogenous bone grafts for a source of osteogenic cells is mesenchymal stem cells from bone marrow. However, there are certain problems with bone marrow aspirate. Hence, scientists have investigated other sources for mesenchymal stem cells, specifically adipose tissue, which has been shown to be an excellent source of mesenchymal stem cells. In this paper, the potential use of adipose stem cells to stimulate bone formation is discussed. PMID:26448947

Non-erotic cognitive distractions during sexual activity in sexual minority and heterosexual young adults.

PubMed

Lacefield, Katharine; Negy, Charles

2012-04-01

The present study examined 100 lesbian and gay college students and 100 heterosexual students to determine whether group differences exist in frequency of a range of non-erotic cognitive distractions during sexual activity. Non-erotic cognitive distraction is a descriptive term for both self-evaluative cognitions related to physical performance and body image concerns, as well as additional cognitive distractions (e.g., contracting an STI or emotional concerns) during sexual activity. Participants were matched on gender (96 males and 104 females), age, and ethnicity, and completed questionnaires assessing frequency of non-erotic cognitive distractions during sexual activity, as well as measures of additional variables (trait and body image anxiety, attitudes toward sexual minorities, self-esteem, and religiosity). Results indicated that sexual minorities experienced significantly more cognitive distractions related to body image, physical performance, and STIs during sexual activity than heterosexuals. Regarding gender, men reported more distractions related to STIs than women. Interaction effects were observed between sexual orientation and gender for body image-, disease-, and external/emotional-based distractions. Implications of these findings are discussed.

Limb Lengthening and Then Insertion of an Intramedullary Nail: A Case-matched Comparison

PubMed Central

Kleinman, Dawn; Fragomen, Austin T.; Ilizarov, Svetlana

2008-01-01

Distraction osteogenesis is an effective method for lengthening, deformity correction, and treatment of nonunions and bone defects. The classic method uses an external fixator for both distraction and consolidation leading to lengthy times in frames and there is a risk of refracture after frame removal. We suggest a new technique: lengthening and then nailing (LATN) technique in which the frame is used for gradual distraction and then a reamed intramedullary nail inserted to support the bone during the consolidation phase, allowing early removal of the external fixator. We performed a retrospective case-matched comparison of patients lengthened with LATN (39 limbs in 27 patients) technique versus the classic (34 limbs in 27 patients). The LATN group wore the external fixator for less time than the classic group (12 versus 29 weeks). The LATN group had a lower external fixation index (0.5 versus 1.9) and a lower bone healing index (0.8 versus 1.9) than the classic group. LATN confers advantages over the classic method including shorter times needed in external fixation, quicker bone healing, and protection against refracture. There are also advantages over the lengthening over a nail and internal lengthening nail techniques. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18800209

Maxillary Distraction Osteogenesis in Unilateral Cleft Lip and Palate Patients with Rigid External Distraction System.

PubMed

Alkhouri, Shadi; Waite, Peter D; Davis, Matthew B; Lamani, Ejvis; Kau, Chung How

2017-01-01

Distraction osteogenesis (DO) is a treatment option for patients with maxillary hypoplasia secondary to cleft lip and palate (CLP). The aim of this study is to present a technique for maxillary DO using Le Fort I osteotomy with rigid external distraction (RED) system. The patient presented in this paper was an Asian female with CLP aged 13 years and 6 months. She presented with severe midfacial deficiency with a Class III dental malocclusion with a negative overjet and concave facial profile. Cone-beam computed tomography images were recorded preoperatively and the operation performed involved a high Le Fort I osteotomy. The appliance fabricated was banded to upper first molars used for anchorage of the RED system. Distraction of the maxilla was initiated after 7-day latency period. Postoperative cephalometric analysis showed maxillary advancement anteriorly and superiorly, the total distraction treatment period was 10 days. The maxillary advancement was 10.5 mm and the SNA angle increased from 67.5° to 77.9°. Furthermore, the ANB angle changed from -9.8° to 1.6° and the occlusion changed from Class III to Class I. The profile of the face changed from concave to convex and a much better esthetic result was achieved. The study suggests RED system to be a reliable alternative procedure for the treatment of midfacial hypoplasia with or without cleft. Furthermore, it minimizes the risk of the surgical procedure and shortens the operating time.

New fixation method for maxillary distraction osteogenesis using locking attachments.

PubMed

Suzuki, Eduardo Yugo; Buranastidporn, Boonsiva; Ishii, Masatoshi

2006-10-01

The external traction hooks of the intraoral splint used in the rigid external distraction (RED) system for maxillary distraction osteogenesis interfere with the surgical procedures. The purpose of this study is to introduce an innovative splint fixation method for maxillary distraction osteogenesis with Locking Attachments and evaluate their advantages, such as reduction of operating time compared with the traditional intraoral splint method. Retrospective comparison of operative times of maxillary Le Fort I osteotomy procedures was carried out with the traditional protocol using the intraoral splint cemented to the maxillary dentition (n = 14), and a removable intraoral splint that is inserted postsurgically (n = 14). Operative procedure times were compared and analyzed statistically using the data extracted from the surgical records. There were no complications inserting the removable splint postsurgically, including pain, discomfort, or time-consuming procedure. Stable and secure splint fixation was obtained before the distraction procedure and the desired treatment goals were obtained in all patients. The total operative procedure times were significantly reduced in the Locking Attachments group by 24% to 41% (approximately 65 minutes) compared with earlier operations involving the conventional splints (P < .05). Maxillary distraction osteogenesis with the Locking Attachments is a highly effective fixation approach to manage severe hypoplastic maxilla, eliminating lip constraints resulting from scarring and allowing for easier, more deliberate and careful dissection. The use of the Locking Attachments is reliable in craniofacial surgery and has proved to be advantageous in the reduction of the operating time and surgical risks.

One-stage tooth-borne distraction versus two stage bone-borne distraction in surgically assisted maxillary expansion (SARME).

PubMed

Seeberger, Robin; Abe-Nickler, Dorothee; Hoffmann, Jürgen; Kunzmann, Kevin; Zingler, Sebastian

2015-12-01

To evaluate and compare the effects of tooth-borne and bone-borne distraction devices in surgically assisted maxillary expansion (SARME) on dental and skeletal structures. A sample of 33 skeletally mature patients with transverse maxillary deficiencies was examined with cone beam computed tomography (CBCT) before and 3 months after surgery. Fourteen patients were treated with tooth-borne devices and 19 patients with bone-borne devices. Dental crown expansion in the first premolars did not differ significantly between the two groups, and median expansion was 5.55 mm (interquartile range [IQR] 5.23) in the tooth-borne device group and 4.6 mm (IQR 3.4) in the bone-borne device group. In the first molars, crown expansion and lateral tipping were significantly greater in the tooth-borne device group (P ≤ .02). The median skeletal nasal isthmus increase was significantly more in the bone-borne device group at 3.0 mm than in the tooth-borne device group at 0.98 mm (P ≤ .02). Both tooth-borne and bone-borne devices are effective treatment modalities to correct maxillary transverse deficiencies. Bone-borne devices produced greater widening of the skeletal nasal floor and fewer dental side effects in the first molars. Copyright © 2015 Elsevier Inc. All rights reserved.

Biomechanical Effects of Capsular Shift in the Treatment of Hip Microinstability: Creation and Testing of a Novel Hip Instability Model.

PubMed

Jackson, Timothy J; Peterson, Alexander B; Akeda, Masaki; Estess, Allyson; McGarry, Michelle H; Adamson, Gregory J; Lee, Thay Q

2016-03-01

A capsular shift procedure has been described for the treatment of hip instability; however, the biomechanical effects of such a shift are unknown. To create a cadaveric model of hip capsule laxity and evaluate the biomechanical effects of a capsular shift used to treat hip instability on this model. Controlled laboratory study. Eight cadaveric hips with an average age of 58.5 years were tested with a custom hip testing system in 6 conditions: intact, vented, instability, capsulotomy, side-to-side repair, and capsular shift. To create the hip model, the capsule was stretched in extension under 35 N·m of torque for 1 hour in neutral rotation. Measurements included internal and external rotation with 1.5 N·m of torque at 5 positions: 5° of extension and 0°, 15°, 30°, and 45° of flexion for each of the above conditions. The degree of maximum extension with 5 N·m of torque and the amount of femoral distraction with 40 N and 80 N of force were measured. Statistical analysis was performed by use of repeated-measures analysis of variance with Tukey post hoc analysis. The instability state significantly increased internal rotation at all flexion angles and increased distraction compared with the intact state. The capsulotomy condition resulted in significantly increased external rotation and internal rotation at all positions, increased distraction, and maximum extension compared with the intact state. The side-to-side repair condition restored internal rotation back to the instability state but not to the intact state at 5° of extension and 0° of flexion. The capsular shift state significantly decreased internal rotation compared with the instability state at 5° of extension and 0° and 15° of flexion. The capsular shift and side-to-side repair conditions had similar effects on external rotation at all flexion-extension positions. The capsular shift state decreased distraction and maximum extension compared with the instability state, but the side-to-side repair state did not. The hip capsular instability model was shown to have significantly greater total range of motion, external rotation, and extension compared with the intact condition. The greatest effects of capsular shift are seen with internal rotation, maximum extension, and distraction, with minimal effect on external rotation compared with the side-to side repair state. The biomechanical effects of the capsular shift procedure indicate that it can be used to treat hip capsular laxity by decreasing extension and distraction with minimal effect on external rotation. © 2015 The Author(s).

Joint distraction attenuates osteoarthritis by reducing secondary inflammation, cartilage degeneration and subchondral bone aberrant change.

PubMed

Chen, Y; Sun, Y; Pan, X; Ho, K; Li, G

2015-10-01

Osteoarthritis (OA) is a progressive joint disorder. To date, there is not effective medical therapy. Joint distraction has given us hope for slowing down the OA progression. In this study, we investigated the benefits of joint distraction in OA rat model and the probable underlying mechanisms. OA was induced in the right knee joint of rats through anterior cruciate ligament transaction (ACLT) plus medial meniscus resection. The animals were randomized into three groups: two groups were treated with an external fixator for a subsequent 3 weeks, one with and one without joint distraction; and one group without external fixator as OA control. Serum interleukin-1β level was evaluated by ELISA; cartilage quality was assessed by histology examinations (gross appearance, Safranin-O/Fast green stain) and immunohistochemistry examinations (MMP13, Col X); subchondral bone aberrant changes was analyzed by micro-CT and immunohistochemistry (Nestin, Osterix) examinations. Characters of OA were present in the OA group, contrary to in general less severe damage after distraction treatment: firstly, IL-1β level was significantly decreased; secondly, cartilage degeneration was attenuated with lower histologic damage scores and the lower percentage of MMP13 or Col X positive chondrocytes; finally, subchondral bone abnormal change was attenuated, with reduced bone mineral density (BMD) and bone volume/total tissue volume (BV/TV) and the number of Nestin or Osterix positive cells in the subchondral bone. In the present study, we demonstrated that joint distraction reduced the level of secondary inflammation, cartilage degeneration and subchondral bone aberrant change, joint distraction may be a strategy for slowing OA progression. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Harnessing the wandering mind: the role of perceptual load.

PubMed

Forster, Sophie; Lavie, Nilli

2009-06-01

Perceptual load is a key determinant of distraction by task-irrelevant stimuli (e.g., Lavie, N. (2005). Distracted and confused?: Selective attention under load. Trends in Cognitive Sciences, 9, 75-82). Here we establish the role of perceptual load in determining an internal form of distraction by task-unrelated thoughts (TUTs or "mind-wandering"). Four experiments demonstrated reduced frequency of TUTs with high compared to low perceptual load in a visual-search task. Alternative accounts in terms of increased demands on responses, verbal working memory or motivation were ruled out and clear effects of load were found for unintentional TUTs. Individual differences in load effects on internal (TUTs) and external (response-competition) distractors were correlated. These results suggest that exhausting attentional capacity in task-relevant processing under high perceptual load can reduce processing of task-irrelevant information from external and internal sources alike.

Unplanned gait termination in individuals with multiple sclerosis.

PubMed

Roeing, Kathleen L; Moon, Yaejin; Sosnoff, Jacob J

2017-03-01

Despite the pervasive nature of gait impairment in multiple sclerosis (MS), there is limited information concerning the control of gait termination in individuals with MS. The purpose of this investigation was to examine unplanned gait termination with and without cognitive distractors in individuals with MS compared to healthy controls. Thirty-one individuals with MS and 14 healthy controls completed a series of unplanned gait termination tasks over a pressure sensitive walkway under distracting and non-distracting conditions. Individuals with MS were further broken down into groups based on assistive device use: (no assistive device (MS noAD ) n=18; and assistive device (MS AD ) n=13). Individuals with MS who walked with an assistive device (MS AD : 67.8±15.1cm/s) walked slower than individuals without an assistive device (MS noAD : 110.4±32.3cm/s, p<0.01) and controls (120.0±30.0cm/s; p<0.01). There was a significant reduction in velocity in the cognitively distracting condition (93.4±32.1cm/s) compared to the normal condition [108.8±36.2cm/s; F(1,43)=3.4, p=0.04]. All participants took longer to stop during the distracting condition (1.7±0.6s) than the non-distracting condition (1.4±0.4s; U=673.0 p<0.01). After controlling for gait velocity, post-hoc analysis revealed the MS AD group took significantly longer to stop compared to the control group (p=0.05). Further research investigating the control of unplanned gait termination in MS is warranted. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison between innominate osteotomy and arthrodistraction as a primary treatment for Legg-Calvé-Perthes disease: a prospective controlled trial.

PubMed

Volpon, José Batista

2012-09-01

Legg-Calvé-Perthes (LCP) disease is currently managed by mechanical containment of the femoral head in the hip socket. As evidence suggests that hip distraction may offer a new treatment strategy, we used arthrodistraction as a primary treatment for active forms of LCP disease and prospectively compared the results with the Salter innominate osteotomy. A total of 54 children, six years or older of both genders with severe forms of LCP disease in the stages of necrosis or revascularisation, were enrolled. Patients were submitted to either Salter innominate osteotomy (n = 28) or hip arthrodistraction (n = 26). Final radiographs were used to evaluate the Mose index, Wiberg angle, extrusion index and the Stulberg et al. classification. There were no significant differences in gender, age, lateral pillar classification and average follow-up time between the two groups. The osteotomy group progressed without major complications, but children in the joint distraction group experienced episodes of pin tract pain and infection, leading to the early removal of the external device in one case. Two patients developed joint stiffness, treated by physiotherapy or manipulation, and one child developed subluxation of the femoral head. The average time in distraction was 4.44 months (2.53-7.23 months). In the final evaluation the osteotomy group showed better containment of the femoral head. The Mose index and the Stulberg et al. classification were statistically similar between the two groups. Despite similar final radiological results, arthrodistraction was associated with a higher morbidity. Consequently, we do not recommend hip distraction as a primary treatment for the early stages of LCP disease.

What's the law got to do with it? Legislation regarding in-vehicle technology use and its impact on driver distraction.

PubMed

Parnell, Katie J; Stanton, Neville A; Plant, Katherine L

2017-03-01

Legislation in the road transport domain aims to control safety on the roads. Despite this, a critical issue affecting road safety is that of driver distraction. Although poorly defined, distraction is a significant road safety issue which, in part, is caused by the prevalence of technology within vehicles. Legislation surrounding the use of in-vehicle technologies are explored in this paper from a socio-technical system perspective. This reveals the wider context of the road transport system operating under the current laws using an Accimap analysis. A distinction in the law between the use of hand-held mobile phones, a device that is typically banned for use by drivers worldwide, and the use of other technological devices that are covered by more general laws against 'careless' and/or 'dangerous' driving was found. Historically, individual drivers' have been blamed for distraction, whereas the systems approach shows how current legislation may have created the conditions necessary for driver distraction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Maxillary Distraction Osteogenesis in Unilateral Cleft Lip and Palate Patients with Rigid External Distraction System

PubMed Central

Alkhouri, Shadi; Waite, Peter D.; Davis, Matthew B.; Lamani, Ejvis; Kau, Chung How

2017-01-01

Aim: Distraction osteogenesis (DO) is a treatment option for patients with maxillary hypoplasia secondary to cleft lip and palate (CLP). Purpose: The aim of this study is to present a technique for maxillary DO using Le Fort I osteotomy with rigid external distraction (RED) system. Subjects and Methods: The patient presented in this paper was an Asian female with CLP aged 13 years and 6 months. She presented with severe midfacial deficiency with a Class III dental malocclusion with a negative overjet and concave facial profile. Cone-beam computed tomography images were recorded preoperatively and the operation performed involved a high Le Fort I osteotomy. The appliance fabricated was banded to upper first molars used for anchorage of the RED system. Distraction of the maxilla was initiated after 7-day latency period. Results: Postoperative cephalometric analysis showed maxillary advancement anteriorly and superiorly, the total distraction treatment period was 10 days. The maxillary advancement was 10.5 mm and the SNA angle increased from 67.5° to 77.9°. Furthermore, the ANB angle changed from −9.8° to 1.6° and the occlusion changed from Class III to Class I. The profile of the face changed from concave to convex and a much better esthetic result was achieved. Conclusion: The study suggests RED system to be a reliable alternative procedure for the treatment of midfacial hypoplasia with or without cleft. Furthermore, it minimizes the risk of the surgical procedure and shortens the operating time. PMID:28713737

Carpal tunnel volume changes of the wrist under distraction.

PubMed

Cho, M S; Means, K R; Shrout, J A; Segalman, K A

2008-10-01

This study attempts to determine changes in carpal canal volume with distraction across the wrist. Uniform longitudinal distraction was maintained with two external fixators on the radial and ulnar aspects of the forearm axis of five cadaver specimens. After CT scanning, volume determinations were made at 5 mm increments beginning at the lunocapitate joint to a point 1.5 cm distal to the middle finger carpometacarpal joint. There was a statistically significant decrease of the mean total carpal canal volume from 0 to 4.54 kg of distraction, with no statistically significant decrease from 0 to 2.27 kg or 2.27 to 4.54 kg. The largest decrease occurred at 15 and 20 mm distal to the proximal edge of the transverse carpal ligament corresponding to the level of the hamate hook. Reduction in mean carpal canal volume was 10.2% and 7.5% at these distances, respectively, from 0 to 4.54 kg of distraction. Progressive distraction across the wrist causes a decrease in total carpal canal volume.

Internal Distraction Osteogenesis With Piezosurgery Oblique Osteotomy of Supraorbital Margin of Frontal Bone for the Treatment of Unilateral Coronal Synostosis.

PubMed

Shen, Weimin; Cui, Jie; Chen, Jianbing; Ji, Yi; Kong, Liangliang

2017-05-01

To assess the utility of internal distraction osteogenesis with Piezosurgery oblique osteotomy of supraorbital margin of frontal bone for the treatment of unilateral coronal synostosis and to study the outcome and complications of this procedure. Oblique osteotomy allows for entry into the cranial cavity, and along with parallel cut to the roof of the orbit, avoids the need to cut into the orbit which forms the frontal flap. Oblique osteotomy was performed along the supraorbital rim to do a frontal suture of the glabella (ages of patients were less than 1 year) or on the opposite side of the supraorbital rim (ages of patients were older than 1 year) after performing a suturectomy of the effected coronal suture. Two internal distraction devices were subsequently placed across the osteotomized, fused coronal suture. Finally, the cranium pieces were divided in the middle and placed in the middle of the frontal bone using biological glue. Five days after the operation, a 0.6-mm distraction was done twice daily. The distraction was removed 6 months after reaching 2 to 3 cm. Internal distraction osteogenesis with supraorbital oblique osteotomy was performed in 9 patients suffering from unilateral coronal synostosis. Eight patients had no postoperative infections around the shaft puncture wounds. One patient had infection in the rods around the distraction during the period of fixed, but was cured with antibiotic treatment. During a mean follow-up period of 12 months (5-26 months), all patients were satisfied with the cosmetic and functional results. No complications, including fixed screw displacement, penetration of the cranium and dura mater or retraction of distraction devices, occurred. The devices were exposed in 1 patient, resulting in a postoperative scar. Despite these complications, the cranium was successfully expanded in all patients. Use of this procedure avoids the need for frontal osteotomy to move the orbit forward. Adding 2 cranium strips can be used to reconstruct the frontal nodule to make up for inadequacy of the frontal nodules highlighting to distract operation. Retracting a separated cranium is not easy after it has been fixed for 6 months. Thus, the management of unilateral coronal synostosis using internal distraction osteogenesis with supraorbital oblique osteotomy is safe and effective.

Distraction for proximal interphalangeal joint contractures: long-term results.

PubMed

Houshian, Shirzad; Jing, Shan Shan; Kazemian, Gholam Hussein; Emami-Moghaddam-Tehrani, Mohammad

2013-10-01

To report the medium- to long-term outcomes of joint distraction using a unilateral external fixator in the treatment of chronic post-traumatic proximal interphalangaeal (PIP) joint contractures. Between September 2001 and October 2011, 94 consecutive patients (98 PIP joints) with a mean age of 43 years (range, 17-69 y) were treated with external fixation for chronic flexion deformity of the PIP joint from trauma. The average time from injury to surgery was 48 months (range, 6-84 mo), and the duration of joint distraction was 10 days (range, 7-22 d). Patients were followed for a mean period of 54 months (range, 12-72 mo). The average gain in joint flexion was 25° and in joint extension was 40°. The mean improvement in the active range of movement was 67° (range. 30°-90°). There was no loss of motion on the latest follow-up. Patients younger than 40 years fared slightly better than those older than 40 years. Two patients developed swelling, pain, and erythema during treatment, which resolved upon temporarily stopping the distraction process. There were 12 cases of superficial pin-site infections, which were managed conservatively without serious complications or adverse outcome. External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results. Careful patient selection and monitoring are required. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

A Cognitive Paradigm to Investigate Interference in Working Memory by Distractions and Interruptions

PubMed Central

Janowich, Jacki; Mishra, Jyoti; Gazzaley, Adam

2015-01-01

Goal-directed behavior is often impaired by interference from the external environment, either in the form of distraction by irrelevant information that one attempts to ignore, or by interrupting information that demands attention as part of another (secondary) task goal. Both forms of external interference have been shown to detrimentally impact the ability to maintain information in working memory (WM). Emerging evidence suggests that these different types of external interference exert different effects on behavior and may be mediated by distinct neural mechanisms. Better characterizing the distinct neuro-behavioral impact of irrelevant distractions versus attended interruptions is essential for advancing an understanding of top-down attention, resolution of external interference, and how these abilities become degraded in healthy aging and in neuropsychiatric conditions. This manuscript describes a novel cognitive paradigm developed the Gazzaley lab that has now been modified into several distinct versions used to elucidate behavioral and neural correlates of interference, by to-be-ignored distractors versus to-be-attended interruptors. Details are provided on variants of this paradigm for investigating interference in visual and auditory modalities, at multiple levels of stimulus complexity, and with experimental timing optimized for electroencephalography (EEG) or functional magnetic resonance imaging (fMRI) studies. In addition, data from younger and older adult participants obtained using this paradigm is reviewed and discussed in the context of its relationship with the broader literatures on external interference and age-related neuro-behavioral changes in resolving interference in working memory. PMID:26273742

Evaluation of cranial bone transport distraction with and without adipose grafting.

PubMed

Koch, Felix P; Yuhasz, Mikell M; Travieso, Rob; Wong, Kenneth; Clune, James; Zhuang, Zhen W; Van Houten, Joshua; Steinbacher, Derek M

2014-05-01

Transport distraction osteogenesis (DO) can be used to autologously reconstitute calvarial defects. The purpose of this study is to histomorphologically interrogate osteogenic formation during cranial transport distraction using a novel device. We also evaluate the effect of fat grafting on the regenerate and soft-tissue stability during distraction. This study was approved by Yale IACUC. Ten male New Zealand white rabbits (3 mo; 3.5 kg) were used (8 treatment, 2 control). A 16 × 16 mm defect was created abutted by a 10 × 16 mm transport disc. The device was fixated anterioposteriorly. Four animals were fat-grafted using 2 mL of subdermal intrascapular fat deposited along the distraction site. Latency (1 d), active distraction (12-14 d) (1.5 mm/d), and consolidation (4 wk) followed. Calcein and xylene orange fluorochromes were injected subcutaneously during and post-distraction to mark sites of bone formation. Following sacrifice, osteogenesis was assessed using microCT, histology, and fluorescence. Treatment animals demonstrated regenerate bone between distracted segments on microCT. MicroCT analysis of non-fat-grafted and fat-grafted animals revealed a mean density of 2271.95 mgHA/ccm and 2254.27 mgHA/ccm (P = 0.967), respectively, and defect bone versus total volume (BV/TV) of 0.0999 and 0.0766 (P = 0.5979), respectively. Controls had minimal reossification. Histologically, mean densities measured 43.63% and 8.19%, respectively. Fluorescence revealed ossification from the callus as well as from dura and periosteum in the cranial defect. Transport distraction is effective to reconstruct critically sized rabbit calvarial defects. Regenerate bone arises predominantly from the callus with contribution from surrounding dura and periosteum. Adipose grafting is well tolerated but does not enhance osseous regeneration.

Maxillary movement in distraction osteogenesis using internal devices in cleft palate patients.

PubMed

Tomita, Daisuke; Omura, Susumu; Ozaki, Shusaku; Shimazaki, Kazuo; Fukuyama, Eiji; Tohnai, Iwai; Torikai, Katsuyuki

2011-03-01

The purpose of this cephalometric study was to compare the actual movement with the planned movement of the maxilla by using internal maxillary distraction in cleft lip and palate patients. Twelve patients, including eight with unilateral and four with bilateral cleft lip and palate, underwent maxillary advancement with internal maxillary distractors. Lateral cephalometric radiographs obtained preoperatively, predistraction, and postdistraction were used for analysis. The movement of the maxilla, angular change of the internal devices and rotation of the mandible were measured at each stage, and the planned vector of advancement predicted from the placement vector of the distractors was compared with the actual vector. Internal maxillary distractors were rotated in a clockwise direction during the distraction period. The angular change of the distractors was 7.7°. The amount of actual advancement at anterior nasal spine with distraction was 6.3 mm, which represented about 70% of the distance of activation of distraction. The actual advanced vector at anterior nasal spine was 9.7° smaller than the planned vector. The mandible underwent a clockwise rotation of 3.5°. In the internal distraction technique, the maxilla was advanced inferiorly to the planned vector and with a slight clockwise rotation. These results are useful for surgical planning when using internal distractors.

Assessment of truck driver distraction problem and research needs

DOT National Transportation Integrated Search

2005-05-01

The issue of driver distraction associated with the use of in-vehicle devices in heavy vehicles was explored through interviews with truck drivers and safety regulators. In order to characterize some of the interface designs and better understand the...

Impact of intraoperative distractions on patient safety: a prospective descriptive study using validated instruments.

PubMed

Sevdalis, Nick; Undre, Shabnam; McDermott, James; Giddie, Jasdeep; Diner, Lila; Smith, Gillian

2014-04-01

There is emerging evidence indicating that distractions in the operating room (OR) are prevalent. Studies have shown a negative impact of distractions, but they have been conducted mostly with residents in simulated environments. We tested the hypothesis that intraoperative distractions are associated with deterioration in patient safety checks in the OR. We assessed 24 elective urologic procedures. Blinded trained assessors (two surgeons, one psychologist) used validated instruments to prospectively assess in vivo frequency and severity of distractions (related to communication, phones/pagers, equipment/provisions, OR environment, other hospital departments, or a member of the OR team) and completion of safety-related tasks (related to the patient, equipment, and communication). Descriptive and correlational analyses were conducted. Mean case duration was 70 min (mean intraoperative time 31 min). A mean of 4.0 communication distractions (range 0-9) and 2.48 other distractions (range 0-5) were recorded per case (distraction rate of one per 10 min). Distractions from external visitors (addressed to the entire team or the surgeon) and distractions due to lack of coordination between hospital departments were most disruptive. Regarding safety checks, patient tasks were completed most often (85-100 %) followed by equipment tasks (75-100 %) and communication tasks (55-90 %). Correlational analyses showed that more frequent/severe communication distractions were linked to lower completion of patient checks intraoperatively (median rho -0.56, p < 0.05). Distractions are prevalent in ORs and in this study were linked to deterioration in intraoperative patient safety checks. Surgeons should be mindful of their tolerance to distractions. Surgical leadership can help control distractions and reduce their potential impact on patient safety and performance.

Biomechanical influence of pin placement and elbow angle on joint distraction and hinge alignment for an arthrodiatasis elbow-pin-fixator construct.

PubMed

Lee, Wei-Shiun; Linz, Shang-Chih; Shih, Kao-Shang; Chao, Ching-Kong; Chen, Yeung-Jen; Fan, Chang-Yuan

2012-10-01

Stiffness and contracture of the periarticular tissues are common complications of a post-traumatic elbow. Arthrodiatasis is a surgical technique that uses an external fixator for initial immobilization and subsequent distraction. The two prerequisites for an ideal arthrodiatasis are concentric distraction (avoiding bony contact) and hinge alignment (reducing internal stress). This study used the finite element (FE) method to clarify the relationship between these two prerequisites and the initial conditions (pin placement, elbow angle, and distraction mode). A total of 12 variations of the initial conditions were symmetrically arranged to evaluate their biomechanical influence on concentric distraction and hinge alignment. The humeroulnar surface was hypothesized to be ideally distracted orthogonal to the line joining the tips of the olecranon and the coronoid. The eccentric separation of the humeroulnar surfaces is a response to the non-orthogonality of the distracting force and joining line. Pin placement significantly affects the effective moment arm of the fixing pins to distract the bridged elbow. Both elbow angle and distraction mode directly alter the direction of the distracting force at the elbow center. In general, the hinges misalignment occurs in a direction opposite to the distraction-activated site. After joint distraction, the elastic deflection of the fixing pins inevitably makes both elbow and fixator hinges to misalign. This indicates that both joint distraction and hinge alignment are the interactive mechanisms. The humeroulnar separation is more concentric in the situation of the 120 degrees humeral distraction by using stiffer pins with convergent placement. Even so, the eccentric displacement of the elbow hinge is a crucial consideration in the initial placement of the guiding pin to compensate for hinge misalignment.

Knee arthrodesis after infected tumor mega prosthesis of the knee using an intramedullary nail for callus distraction.

PubMed

Kühne, C A; Taeger, G; Nast-Kolb, D; Ruchholtz, S

2003-03-01

Infected tumor endoprosthesis of the knee in young patients can prove to be challenging. Common procedures are débridement and prosthesis reimplantation, amputation, revision arthroplasty, and arthrodesis. We report the case of a 44-year-old man treated by arthrodesis followed by callus distraction after removal of an infected tumor mega prosthesis (Kotz type). Callus distraction was performed over a distance of 11 cm in 4 months using a femorotibial intramedullary nail with an external traction rope-winch system. The clinical, radiological, technical, and therapeutic features are discussed.

Treatment of maxillary cleft palate: Distraction osteogenesis vs. orthognathic surgery

PubMed Central

Rachmiel, Adi; Even-Almos, Michal; Aizenbud, Dror

2012-01-01

Purpose: The purpose of this paper is to compare the treatment of hypoplastic, retruded maxillary cleft palate using distraction osteogenesis vs. orthognathic surgery in terms of stability and relapse, growth after distraction and soft tissue profile changes. Materials and Methods: The cleft patients showed anteroposterior maxillary hypoplasia with class III malocclusion and negative overjet resulting in a concave profile according to preoperative cephalometric measurements, dental relationship, and soft tissue analysis. The patients were divided in two groups of treatment : S0 eventeen were treated by orthognathic Le Fort I osteotomy fixed with four mini plates and 2 mm screws, and 19 were treated by maxillary distraction osteogenesis with rigid extraoral devices (RED) connected after a Le Fort I osteotomy. The rate of distraction was 1 mm per day to achieve Class I occlusion with slight overcorrection and to create facial profile convexity. Following a 10 week latency period the distraction devices were removed. Results: In the RED group the maxilla was advanced an average of 15.80 mm. The occlusion changed from class III to class I. The profile of the face changed from concave to convex. At a 1-year follow up the results were stable. The mean orthognathic movement was 8.4 mm. Conclusion: In mild maxillary deficiency a one stage orthognathic surgery is preferable. However, in patients requiring moderate to large advancements with significant structural deficiencies of the maxilla or in growing patients the distraction technique is preferred. PMID:23483803

Maxillary advancement using distraction osteogenesis with intraoral device.

PubMed

Takigawa, Yoko; Uematsu, Setsuko; Takada, Kenji

2010-11-01

This article describes the surgical orthodontic treatment of maxillary hypoplasia in a patient with cleft lip and palate using maxillary distraction osteogenesis with internal maxillary distractors. Maxillary advancement was performed to correct the retrusive maxillary facial profile and Class III malocclusion. Rotational movement of the distraction segment was made to correct the upper dental midline. Although maxillary advancement was insufficient because of unexpected breakage of the intraoral distractor after completion of the distraction, skeletal traction with a face mask compensated for the shortage. Successful esthetic improvement and posttreatment occlusal stability were achieved with no discernible relapse after 2 years of retention.

Bone-borne palatal distraction to correct the constricted cleft maxilla.

PubMed

Vyas, Raj M; Jarrahy, Reza; Sisodia, Manisha; Jourabchi, Natanel; Wasson, Kristy L; Bradley, James P

2009-05-01

Transverse maxillary hypoplasia, with or without cleft deformity, is typically treated with orthodontic expansion. However, the management of those patients who present later in life with severe uncorrected deformities or who have failed prior orthodontic care remains controversial. Tooth-borne palatal expanders have limitations in this subset of patients with scarred, constricted cleft palate. In this study, we assess the efficacy and safety of using a bone-borne palatal distraction device as an alternative treatment for this difficult subset of patients. Older children with a constricted maxilla who previously had unilateral or bilateral cleft lip and palate repairs and failed orthodontic expansion were included in the study (n = 15). Patients underwent Le Fort I corticotomy with placement of the bone-borne distraction device, expansion at a rate of 0.5 mm/d, and subsequent alveolar bone grafting. Preoperative and follow-up maxillary impressions were compared with assessed improvements in intermolar distance, intercanine distance, alveolar cleft width, and total palatal area. In addition, a small group of noncleft patients with constricted maxillas was treated with bone-borne palatal distraction without a corticotomy (n = 4). The mean amount of distraction in all patients was 14.1 mm, with a follow-up period of 19 months (range, 8-30 months). The average increase in intermolar distance was 8.4 mm, intercanine distance increased by an average of 9.5 mm, and palate surface areas were increased by a mean of 28.9 mm2. Relapse was between 4% and 7%, and all patients underwent subsequent alveolar bone grafting. In addition, the noncleft patients successfully underwent bone-borne palatal distraction without a corticotomy, with a 4% to 5% relapse. Rapid palatal expansion using a bone-borne distraction device in cleft patients with transverse maxillary hypoplasia who have failed nonsurgical orthodontic expansion provides adequate expansion necessary for alveolar bone grafting and stable results.

Evaluating handoffs in the context of a communication framework.

PubMed

Hasan, Hani; Ali, Fadwa; Barker, Paul; Treat, Robert; Peschman, Jacob; Mohorek, Matthew; Redlich, Philip; Webb, Travis

2017-03-01

The implementation of mandated restrictions in resident duty hours has led to increased handoffs for patient care and thus more opportunities for errors during transitions of care. Much of the current handoff literature is empiric, with experts recommending the study of handoffs within an established framework. A prospective, single-institution study was conducted evaluating the process of handoffs for the care of surgical patients in the context of a published communication framework. Evaluation tools for the source, receiver, and observer were developed to identify factors impacting the handoff process, and inter-rater correlations were assessed. Data analysis was generated with Pearson/Spearman correlations and multivariate linear regressions. Rater consistency was assessed with intraclass correlations. A total of 126 handoffs were observed. Evaluations were completed by 1 observer (N = 126), 2 observers (N = 23), 2 receivers (N = 39), 1 receiver (N = 82), and 1 source (N = 78). An average (±standard deviation) service handoff included 9.2 (±4.6) patients, lasted 9.1 (±5.4) minutes, and had 4.7 (±3.4) distractions recorded by the observer. The source and receiver(s) recognized distractions in >67% of handoffs, with the most common internal and external distractions being fatigue (60% of handoffs) and extraneous staff entering/exiting the room (31%), respectively. Teams with more patients spent less time per individual patient handoff (r = -0.298; P = .001). Statistically significant intraclass correlations (P ≤ .05) were moderate between observers (r ≥ 0.4) but not receivers (r < 0.4). Intraclass correlation values between different types of raters were inconsistent (P > .05). The quality of the handoff process was affected negatively by presence of active electronic devices (β = -0.565; P = .005), number of teaching discussions (β = -0.417; P = .048), and a sense of hierarchy between source and receiver (β = -0.309; P = .002). Studying the handoff process within an established framework highlights factors that impair communication. Internal and external distractions are common during handoffs and along with the working relationship between the source and receiver impact the quality of the handoff process. This information allows further study and targeted interventions of the handoff process to improve overall effectiveness and patient safety of the handoff. Copyright © 2016 Elsevier Inc. All rights reserved.

Development and calibration of a load sensing cervical distractor capable of withstanding autoclave sterilization.

PubMed

Demetropoulos, C K; Truumees, E; Herkowitz, H N; Yang, K H

2005-05-01

In surgery of the cervical spine, a Caspar pin distractor is often used to apply a tensile load to the spine in order to open up the disc space. This is often done in order to place a graft or other interbody fusion device in the spine. Ideally a tight interference fit is achieved. If the spine is over distracted, allowing for a large graft, there is an increased risk of subsidence into the endplate. If there is too little distraction, there is an increased risk of graft dislodgement or pseudoarthrosis. Generally, graft height is selected from preoperative measurements and observed distraction without knowing the intraoperative compressive load. This device was designed to give the surgeon an assessment of this applied load. Instrumentation of the device involved the application of strain gauges and the selection of materials that would survive standard autoclave sterilization. The device was calibrated, sterilized and once again calibrated to demonstrate its suitability for surgical use. Results demonstrate excellent linearity in the calibration, and no difference was detected in the pre- and post-sterilization calibrations.

A minipig model of maxillary distraction osteogenesis.

PubMed

Papadaki, Maria E; Troulis, Maria J; Glowacki, Julie; Kaban, Leonard B

2010-11-01

To establish a porcine model for maxillary distraction osteogenesis and to document the sequence of bone formation in the zone of advancement. Female Yucatan minipigs (n = 9) in the mixed dentition stage underwent modified Le Fort I osteotomy through a vestibular incision under general anesthesia. A unidirectional, semiburied Le Fort I distraction device was fixed across the osteotomy. The distraction protocol was 0-day latency, 1-mm/d rate for 12 days, and 24 days of fixation. Maxillary specimens (n = 9) were harvested and divided in half at the end of distraction (n = 6 sides), midfixation (n = 6), and the end of fixation (n = 6). Clinical stability, volume, and radiographic density across the zone of advancement were graded on semiquantitative scales. Specimens were stained with hematoxylin and eosin and examined with light microscopy. Animals tolerated the operation, the distraction and fixation periods. There were no infections and no devices failed. At the end of the distraction period, bone trabeculae were present at the periphery and fibrous tissues, and vessels, preosteoblasts, and osteoblasts were present in the center of the zone of advancement. Islands of chondrocyte-like cells appeared in 1 specimen each at midfixation and the end of fixation. At the end of fixation, clinical stability and radiographic density were graded 3/3 and bone formation was complete across the advancement zone in all specimens. A model for Le Fort I distraction osteogenesis was established. Intramembranous bone formation was the predominant mechanism of healing in the zone of advancement. Latency was not necessary for bone formation in this minipig model. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

[Distraction Osteogenesis is an Effective Method to Lengthen Digits in Congenital Malformations].

PubMed

Mann, M; Hülsemann, W; Winkler, F; Habenicht, R

2016-02-01

The aim of this study was to investigate the feasible amount of lengthening by distraction osteogenesis in congenital hand deficiencies. A total of 60 patients (1.6-17.8 years) underwent lengthening of 71 bones between 1994 and 2014. Bone lengthening was performed on 46 metacarpals and 25 phalanges. Mostly the first (n=30) and the fifth (n=21) rays were lengthened. Bone lengthening was performed to treat primarily symbrachydactyly (b=32) and amniotic band syndrome (n=10). To analyze the amount of lengthening preoperative radiographs and radiographs taken while removing the external fixator were compared. The charts were reviewed regarding age at surgery, duration of lengthening, duration of bony consolidation, complication, etc. The average of metacarpal distraction was 18.4 mm=73% lengthening with respect to the preoperative length; the average of phalange distraction was 14.0 mm=77% of the preoperative length. In both, metacarpals and phalanges, a lengthening of > 100% of the preoperative bone length was possible. In target length was reached in 89% of the procedures. The average time for consolidation was 6.1 (1-20) days/mm lengthening. The external fixator was in use on average for 140 (50-346) days. After removing of the external fixator an axial K-wire was used to stabilize the callus in 9 procedure, and an iliac bone craft plus axial K-wire in 11 procedures. The rate of complications was 30% (early consolidation, deviation, joint dislocation, pin infection, tendon dislocation). All complications could be treated without with acceptable results. Metacarpal and phalangeal distraction lengthening is an effective but demanding technique for ray reconstruction in congenital malformations of the hand. It is possible to lengthen a bone by more than 100%. Complications are common, but in most cases easy to handle. © Georg Thieme Verlag KG Stuttgart · New York.

Proximal femoral resection and articulated hip distraction with an external fixator for the treatment of painful spastic hip dislocations in pediatric patients with spastic quadriplegia.

PubMed

Lampropulos, Mario; Puigdevall, Miguel H; Zapozko, Daniel; Malvárez, Héctor R

2008-01-01

We describe the results obtained with an alternative method of treatment for spastic painful hip dislocations in nonambulatory patients, which consists of a proximal femoral resection with capsular interposition arthroplasty, and the addition of a hinged external fixator for postoperative articulated hip distraction to allow for an immediate upright position and the ability to sit in a wheelchair. We performed this technique in three patients (four hips) with a mean age at the time of surgery of 15 years. Postoperatively, clinical improvement was observed in all four hips, with respect to pain relief, sitting tolerance, perineal care and functional range of motion.

Lengthening by distraction osteogenesis in congenital shortening of metacarpals.

PubMed

Bulut, Mehmet; Uçar, Bekir Yavuz; Azboy, Ibrahim; Belhan, Oktay; Yilmaz, Erhan; Karakurt, Lokman

2013-01-01

The aim of this study was to present the results of seven cases of metacarpal lengthening by distraction osteogenesis and to discuss the ideal daily rate of distraction. Metacarpal lengthening was performed by distraction osteogenesis in the seven metacarpals of four patients (3 females, 1 male; mean age: 14.9 years). A unilateral external fixator was used for lengthening. Lengthening was initiated with a distraction rate of 2x0.5 mm/day in the patient with bilateral involvement of the middle and ring metacarpals. On the tenth day of lengthening, distraction was discontinued due to pain and contracture. Then, distraction was continued with a rate of 2x0.25 mm/day. In all other cases, the distraction rate was 0.5 mm/day. Pre- and postoperative range of motion was measured with a goniometer. Patient satisfaction was evaluated with visual analog scale. The mean pre- and postoperative metacarpal lengths were 34.6 mm (range: 33 to 37) and 49.7 mm (range: 47 to 52), respectively. The mean lengthening achieved was 15.1 mm (range: 14 to 17), while the mean distraction rate was 0.55 mm/day (range: 0.48 to 0.63). No functional loss was observed in the fingers at the final check-up. The patients were happy with the functional and cosmetic results. Distraction osteogenesis is a safe method providing acceptable cosmetic and functional results in patients with congenital metacarpal shortness. The length of metacarpals and muscles that will be affected from lengthening should be considered when determining the daily rate of distraction.

Texting at the light and other forms of device distraction behind the wheel.

PubMed

Bernstein, James J; Bernstein, Joseph

2015-09-26

Cell phones are a well-known source of distraction for drivers, and owing to the proliferation of text messaging services, web browsers and interactive apps, modern devices provide ever-increasing temptation for drivers to take their eyes off the road. Although it is probably obvious that drivers' manual engagement of a device while their vehicles are in motion is potentially dangerous, it may not be clear that such engagement when the vehicle is at rest (an activity broadly labeled "texting at the light") can also impose risks. For one thing, a distracted driver at rest may fail to respond quickly to sudden changes in road conditions, such as an ambulance passing through. In addition, texting at the light may decrease so-called "situational awareness" and lead to driving errors even after the device is put down. To our knowledge, the direct comparison of the rate of device usage by drivers at rest with the rate of device usage by drivers in motion has not been reported. We collected information on 2000 passenger vehicles by roadside observation. For the first group of 1000 passenger vehicles stopped at a traffic light, device usage ("texting", "talking", "none"), gender of the driver, vehicle type, seatbelt usage and presence of front seat passengers were recorded. For a second set of 1000 vehicles in motion, device usage alone was noted. Statistical significance for differences in rates was assessed with the chi-square test. We found that 3 % of drivers in motion were texting and 5 % were talking. Among the stopped drivers, 14.5 % were texting and 6.3 % were talking. In the stopped-vehicle set, gender and vehicle type were not associated with significant differences in device usage, but having a front seat passenger and using seatbelts were. Device usage is markedly higher among drivers temporarily at rest compared with those in motion, and the presence of a front seat passenger, who may help alleviate boredom or reprimand bad behavior, is associated with lower device usage rates among vehicles stopped at a light. These observations may help identify suitable steps to decrease distracted driving and thereby minimize traffic trauma.

Understanding commercial truck drivers' decision-makin process concerning distracted driving.

PubMed

Swedler, David I; Pollack, Keshia M; Gielen, Andrea C

2015-05-01

A concurrent mixed methods design was used to explore personal and workplace factors, informed by the Theory of Planned Behavior, that affect truck drivers' decision-making about distracted driving on the job. Qualitative data were collected via semi-structured interviews with experts in truck safety and distracted driving, and quantitative data were collected via online survey of truck drivers in the United States. Findings from the interviews illustrated how drivers perceived distractions and the importance of supervisors enforcing organizational distracted driving policies. Survey results found that behavioral intentions were most important in regards to texting and crash and near-crash outcomes, while perceived norms from management best described the correlation between dispatch device use and negative crash-related outcomes. By using a mixed methods design, rather than two separate studies, these findings revealed nuanced differences into the influence of supervisors on distracted driving. Copyright © 2015 Elsevier Ltd. All rights reserved.

Bone-lengthening for symbrachydactyly of the hand with the technique of callus distraction.

PubMed

Miyawaki, Takeshi; Masuzawa, Genzo; Hirakawa, Masahiko; Kurihara, Kunihiro

2002-06-01

Bone-lengthening in the hand and foot is a relatively new application for distraction osteogenesis. We present the operative treatment and postoperative outcome for four patients with M ller type-D symbrachydactyly of the hand who underwent metacarpal lengthening with use of a distraction device to establish pinch function. Four patients who underwent distraction osteogenesis for the treatment of congenital symbrachydactyly of the hand were evaluated over a thirteen-year period. The nondominant right hand was treated in two patients, and the nondominant left hand was treated in the other two. The patients included three boys and one girl; all patients had the operation between the ages of five and eleven years. Distraction osteogenesis was performed on the fifth metacarpal in one patient and on the fourth and fifth metacarpals in the remaining three, in whom both bones were lengthened simultaneously with use of a single device. Postoperative bone elongation was analyzed with radiographs made at the time of removal of the distractor. The sensory function of the treated fingers and any growth disturbance of the distracted bones were evaluated. The mean duration of distraction was 37.3 days (range, thirty-two to forty-nine days), and the distractor was removed at a mean of eighty-four days after surgery. The bones were lengthened by a mean of 22.3 mm (81.6% of their original length) at a rate of 0.6 mm/day. Pinch function was improved in all patients. On the basis of our limited experience, we found that distraction osteogenesis of the metacarpals was an effective technique for the establishment of pinch function. We also found that an intramedullary Kirschner wire could maintain the alignment of the osteotomized bone. Although distraction requires a longer treatment period, it is apparently more effective than bone-grafting in terms of achieving adequate bone length. Simultaneous lengthening of two metacarpals also was found to be an effective technique.

Anterior Segmental Distraction Osteogenesis in the Hypoplastic Cleft Maxilla

PubMed Central

Rao (Janardhan), Sruthi; Kotrashetti, S. M.; Lingaraj, J. B.; Pinto, P. X.; Keluskar, K. M.; Jain, Siddharth; Sone, Piyush; Rao, Santhosh

2013-01-01

Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech. PMID:23984033

A low-cost method of craniofacial distraction osteogenesis.

PubMed

Greyvensteyn, Gerhardus A; Madaree, Anil

2016-03-01

Distraction osteogenesis is an effective treatment modality for the correction of craniofacial deformities. The cost of these devices is significant and may preclude routine use of these distractors in developing countries. Hence, distraction osteogenesis was performed using medical equipment that was readily available in any hospital at minimal cost. From 2008 to 2013, a retrospective study was performed on infants and neonates who underwent primary distraction for craniofacial abnormalities. Midface or mandibular distraction was performed because of respiratory impairment and/or globe exposure. The apparatus used included Steinmann pins, stainless steel wires, attachment bolts, orthopaedic pulleys, string and intravenous bags for weights. For midface distraction, a transzygomatic pin was inserted, and a transmandibular pin or a cerclage wire was inserted into the mandible through the symphysis or body of the mandible and connected to the pulley system. Distraction osteogenesis was performed on five patients - three mandibular distractions (Pierre Robin sequence) and two transfacial distractions (Apert syndrome/Pfeiffer syndrome type III). The mean age, duration of distraction and duration of consolidation at the time of distraction was 60.5 days, 18.6 days and 16.4 days, respectively. The mean length of distraction achieved was 12 mm. Common complications observed were pin loosening, pressure necrosis of the skin and uneven pull. A major disadvantage was the longer hospital stay required. The African method of distraction is effective, easy and cost effective and could be used in third-world hospitals where surgical expertise or expensive distraction sets are not freely available. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Recovering Faces from Memory: The Distracting Influence of External Facial Features

ERIC Educational Resources Information Center

Frowd, Charlie D.; Skelton, Faye; Atherton, Chris; Pitchford, Melanie; Hepton, Gemma; Holden, Laura; McIntyre, Alex H.; Hancock, Peter J. B.

2012-01-01

Recognition memory for unfamiliar faces is facilitated when contextual cues (e.g., head pose, background environment, hair and clothing) are consistent between study and test. By contrast, inconsistencies in external features, especially hair, promote errors in unfamiliar face-matching tasks. For the construction of facial composites, as carried…

A novel osteogenic distraction device for the transversal correction of temporozygomatic hypoplasia.

PubMed

Pagnoni, Mario; Fadda, Maria Teresa; Cascone, Piero; Iannetti, Giorgio

2014-07-01

Hemifacial microsomia (HFM) is a congenital disorder characterized by craniofacial malformation of one or both sides of the lower face. Since these anomalies are associated with soft-tissue deficiencies, corrective surgery is often difficult. Bone grafts have typically been used for augmentation, but distraction osteogenesis now offers an alternative for many craniofacial deficiencies, but there are few if any appropriate distraction devices and surgical procedures for the augmentation of craniofacial transversal dimensions. The aim of this study was to evaluate a technique for guided augmentation of craniofacial transversal dimensions through distraction osteogenesis. We tested the efficacy of a prototype distractor, developed in collaboration with Medartis, using cadavers and demonstrated its application for the correction of the transverse dimension of the temporozygomatic region in a patient with Goldenhar syndrome. CT scans showed a 4-mm transverse augmentation of the bony surface after 9 days and a 10-mm increase after 30 days. Upon removal of the distractor (60 days after the first surgery) CT indicated good bony fusion and a stable result in the transverse plane. Six months after removal of the distractor, 3D computed tomography confirmed the success of the transverse augmentation, as it appeared to be stable and reliable. Distraction osteogenesis, using our device, can be used to correct the transverse dimension of the temporozygomatic region in HFM patients. It should also be considered for the correction of residual postsurgical skeletal deficiency due to surgical relapse or deficient growth, and unsatisfactory skeletal contour. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Distraction-free ankle arthroscopy for anterolateral impingement.

PubMed

Rouvillain, Jean Louis; Daoud, Wael; Donica, Adrian; Garron, Emmanuel; Uzel, André Pierre

2014-08-01

The origin of chronic pain after external ankle sprain is better known with arthroscopy's contribution. Chronic hypertrophic synovitis of the anterolateral ankle region is seemingly the cause, resulting in "anterolateral ankle impingement." But is partial synovectomy with fibrosis resection under arthroscopy always possible without any distraction? Are results affected? This retrospective study concerned only patients with soft tissue ankle impingement. All cases with bone and joint diseases were excluded. The final sample of 24 patients had a mean age of 35 years (21-54 years) and presented anterolateral mechanical pain associated with oedema following external ankle sprain. Medical and rehabilitative treatment was undertaken for more than 6 months before arthroscopy. Average time between trauma and arthroscopy was 21 months (5-60 months). Clinical examination revealed no ankle instability or laxity. Debridement with joint lavage was systematically performed under arthroscopy without any distraction. Average patient follow-up was 22 months (12-92 months). All patients had a good Kitaoka score, with 22 patients registering excellent results. There were no septic complications or algodystrophy. Two transient hypoesthesias were observed in the dorsal surface and lateral border of the foot with full postoperative recovery at 6 months. Distraction was never used and simple dorsiflexion was sufficient to perform arthroscopic debridement. In this study, anterolateral ankle impingement diagnosis was primarily clinical. Arthroscopic treatment yielded significant benefits on pain, oedema and resumption of sport activities. Arthroscopic treatment of anterolateral ankle impingements is thus possible with simple dorsiflexion and no distraction, resulting in a possible decrease in complication rates. Level of evidence Retrospective cohort study, Level IV.

Body Image in Dyadic and Solitary Sexual Desire: The Role of Encoding Style and Distracting Thoughts.

PubMed

Dosch, Alessandra; Ghisletta, Paolo; Van der Linden, Martial

2016-01-01

This study explored the link between body image and desire to engage in sexual activity (dyadic and solitary desire) in adult women living in a long-term couple relationship. Moreover, it considered two psychological factors that may underlie such a link: the occurrence of body-related distracting thoughts during sexual activity and encoding style (i.e., the tendency to rely on preexisting internal schemata versus external information at encoding). A total of 53 women (29 to 47 years old) in heterosexual relationships completed questionnaires assessing sexual desire (dyadic, solitary), body image, body-related distracting thoughts during sexual activity, and encoding style. Results showed that poor body image was associated with low dyadic and solitary sexual desire. Body-related distracting thoughts during sexual activity mediated the link between body image and solitary (but not dyadic) sexual desire. Finally, the mediation of body-related distracting thoughts between body image and solitary sexual desire was moderated by encoding style. A negative body image promoted the occurrence of body-related distracting thoughts during sexual activity, especially in internal encoders. Our study highlights the importance of body image, distracting thoughts, and encoding style in women's solitary sexuality and suggests possible factors that may reduce the impact of those body-related factors in dyadic sexual desire.

Does linear separability really matter? Complex visual search is explained by simple search

PubMed Central

Vighneshvel, T.; Arun, S. P.

2013-01-01

Visual search in real life involves complex displays with a target among multiple types of distracters, but in the laboratory, it is often tested using simple displays with identical distracters. Can complex search be understood in terms of simple searches? This link may not be straightforward if complex search has emergent properties. One such property is linear separability, whereby search is hard when a target cannot be separated from its distracters using a single linear boundary. However, evidence in favor of linear separability is based on testing stimulus configurations in an external parametric space that need not be related to their true perceptual representation. We therefore set out to assess whether linear separability influences complex search at all. Our null hypothesis was that complex search performance depends only on classical factors such as target-distracter similarity and distracter homogeneity, which we measured using simple searches. Across three experiments involving a variety of artificial and natural objects, differences between linearly separable and nonseparable searches were explained using target-distracter similarity and distracter heterogeneity. Further, simple searches accurately predicted complex search regardless of linear separability (r = 0.91). Our results show that complex search is explained by simple search, refuting the widely held belief that linear separability influences visual search. PMID:24029822

Promoted new bone formation in maxillary distraction osteogenesis using a tissue-engineered osteogenic material.

PubMed

Kinoshita, Kazuhiko; Hibi, Hideharu; Yamada, Yoichi; Ueda, Minoru

2008-01-01

Bilateral maxillary distraction was performed at a higher rate in rabbits to determine whether locally applied tissue-engineered osteogenic material (TEOM) enhances bone regeneration. The material was an injectable gel composed of autologous mesenchymal stem cells, which were cultured then induced to be osteogenic in character, and platelet-rich plasma (PRP). After a 5-day latency period, distraction devices were activated at a rate of 2.0 mm once daily for 4 days. Twelve rabbits were divided into 2 groups. At the end of distraction, the experimental group of rabbits received an injection of TEOM into the distracted tissue on one side, whereas, saline solution was injected into the distracted tissue on the contralateral side as the internal control. An additional control group received an injection of PRP or saline solution into the distracted tissue in the same way as the experimental group. The distraction regenerates were assessed by radiological and histomorphometric analyses. The radiodensity of the distraction gap injected with TEOM was significantly higher than that injected with PRP or saline solution at 2, 3, and 4 weeks postdistraction. The histomorphometric analysis also showed that both new bone zone and bony content in the distraction gap injected with TEOM were significantly increased when compared with PRP or saline solution. Our results demonstrated that the distraction gap injected with TEOM showed significant new bone formation. Therefore, injections of TEOM may be able to compensate for insufficient distraction gaps.

Mindless Feeding: Is Maternal Distraction During Bottle-Feeding Associated with Overfeeding?

PubMed Central

Golen, Rebecca B.; Ventura, Alison K.

2015-01-01

Mindless eating, or eating while distracted by surrounding stimuli, leads to overeating. The present study explored whether “mindless feeding,” or maternal distraction during bottle-feeding, is associated with greater infant formula/milk intakes and lower maternal sensitivity to infant cues. Mothers and their ≤24-week-old bottle-feeding infants (N=28) visited our laboratory for a video-recorded feeding observation. Infant intake was assessed by weighing bottles before and after the feedings. Maternal sensitivity to infant cues was objectively assessed by behavioral coding of video-records using the Nursing Child Assessment Feeding Scale. Maternal distraction was defined as looking away from the infant >75% of the feeding; using a mobile device; conversing with another adult; or sleeping. Twenty-nine percent (n=8) of mothers were distracted. While differences in intakes for infants of distracted vs. not distracted mothers did not reach significance (p=0.24), the association between distraction and infant intake was modified by two dimensions of temperament: orienting/regulation capacity (p=0.03) and surgency/extraversion (p=0.04). For infants with low orienting/regulation capacity, infants of distracted mothers consumed more (177.1 ± 33.8 ml) than those of not distracted mothers (92.4 ± 13.8 ml). Similar findings were noted for infants with low surgency/extraversion (distracted: 140.6 ± 22.5 ml; not distracted: 78.4 ± 14.3 ml). No association between distraction and intake was seen for infants with high orienting/regulation capacity or surgency/extraversion. A significantly greater proportion of distracted mothers showed low sensitivity to infant cues compared to not distracted mothers (p=0.04). In sum, mindless feeding may interact with infant characteristics to influence feeding outcomes; further experimental and longitudinal studies are needed. PMID:25953601

Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome.

PubMed

Bansal, V; Singh, S; Garg, N; Dubey, P

2014-02-01

This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via 'lazy-S' incision. A gap arthroplasty was performed, followed by a 'reverse L' osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13-27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

A new therapeutic strategy for lengthening severe short nose.

PubMed

Rikimaru, Hideaki; Kiyokawa, Kensuke; Watanabe, Koichi; Koga, Noriyuki; Nishi, Yukiko

2010-03-01

Correction of severe short nose is a distressing problem for plastic surgeons. It is difficult to simultaneously lengthen the 3 components of the nose, which are the outer skin envelope, the framework, and the mucosal lining. We developed a new method to lengthen the nose more than 10 mm definitively and safely, which was performed using the technique of distraction osteogenesis. The procedure involves a 2-stage operation. At the first stage, boat-shaped iliac bone is grafted on the dorsum. More than 6 months later, the second-stage operation is performed. The grafted bone is cut horizontally in the center, and the distraction device is applied to it. Distraction osteogenesis is started after a latency period of 14 days and performed at a rate of 0.6 mm once daily. The distraction device is replaced by a special attachment (Ribbond; Ribbond Inc) during the 3-month consolidation period. Our method was applied for 2 patients with congenitally and posttraumatic severe short nose, respectively. The total amount of distraction osteogenesis was 12.6 and 13.8 mm, respectively. The profiles of both of the patients improved, and they were satisfied with the results. The method we developed is an entirely new approach to the correction of severe short nose. Furthermore, it was determined that nonvascularized grafted iliac bone could be lengthened by distraction osteogenesis. Our new method was a very effective and definitive technique and could become a mainstream procedure for the correction of severe short nose.

Orthodontic Considerations for Maxillary Distraction Osteogenesis in Growing Patients with Cleft Lip and Palate Using Internal Distractors

PubMed Central

Silveira, Adriana da; Moura, Pollyana Marques de; Harshbarger, Raymond J.

2014-01-01

The orthodontist plays a key role in the selection of the optimal treatment for patients followed by a craniofacial team. For patients with cleft lip and palate, the need for multidisciplinary treatment planning and sequentially staged treatment is essential for successful patient outcomes. The technique of Le Fort I distraction osteogenesis of the maxilla using an internal device is potentially a predictable, stable, and convenient option for the correction of severe maxillary hypoplasia. It is an alternative option for treatment of maxillary hypoplasia in growing patients. In this article, the authors describe the orthodontist's approach to the management of cleft patients with severe maxillary deficiency with the use of an internal distraction device. The information is presented with a focus on the clinical aspects of treatment, using case illustrations and appropriate literature. PMID:25383056

Orthodontic considerations for maxillary distraction osteogenesis in growing patients with cleft lip and palate using internal distractors.

PubMed

Silveira, Adriana da; Moura, Pollyana Marques de; Harshbarger, Raymond J

2014-11-01

The orthodontist plays a key role in the selection of the optimal treatment for patients followed by a craniofacial team. For patients with cleft lip and palate, the need for multidisciplinary treatment planning and sequentially staged treatment is essential for successful patient outcomes. The technique of Le Fort I distraction osteogenesis of the maxilla using an internal device is potentially a predictable, stable, and convenient option for the correction of severe maxillary hypoplasia. It is an alternative option for treatment of maxillary hypoplasia in growing patients. In this article, the authors describe the orthodontist's approach to the management of cleft patients with severe maxillary deficiency with the use of an internal distraction device. The information is presented with a focus on the clinical aspects of treatment, using case illustrations and appropriate literature.

The Endo-Distractor for preimplant mandibular regeneration.

PubMed

Krenkel, C; Grunert, I

2009-02-01

A simple practical device for a new technique of vertical distraction osteogenesis was developed. The Endo-Distractor Krenkel was originally intended for the anterior regeneration of highly atrophic mandibles. The Endo-Distractor features several novelties. Placement is made intraosseously in the basal cortical bone. The distraction screw length may be adapted to the depth of chin soft tissues. The quality of anchorage in the basal cortical bone guarantees the stability of the distraction vector. The endobuccal emergence is that of an artificial crown, and does not cause any patient discomfort. The device can easily be removed without secondary surgery. All kinds of implants may be placed after the retention time. This study's objective was to evaluate the use of the Endo-Distractor Krenkel in edentulous patients with highly atrophic mandibles. This new device was used on 18 patients, between January 2000 and September 2004, who were then followed-up for at least 36 months. Mandibular atrophy was measured with a lateral cephalogram, then classified according to Atwood's modified classification. The studied criteria included the amplitude of distraction, its duration, the distractor's lingual tilt, the number and outcome of implants, and complications. The sex ratio was 17 female for one male patient. The mean patient age was 56 years (43 to 66 years). The mean distraction amplitude was 11.3mm (8 to 14 mm). The mean retention time was 186.8 days (37 to 309 days). The distractor's mean lingual tilt was 4.3 degrees (0 to 23 degrees ). Two mandibular fractures occurred 6 weeks after placing the Endo-Distractor. The first one was treated medically, and the second one required removing the Endo-Distractor and osteosynthesis. An average of four interforaminal implants were placed for a total of 24 Brånemark and 51 Straumann implants. Four implants were lost in a patient due to infection. All other implants were osseointegrated. No bone loss was detected at follow-up after functional loading. These results show that alveolar distraction is possible on severely atrophic mandibles. The quality of bone and gum reconstruction is satisfactory both for functional and esthetic results. Surgical difficulty and rate of complications were lower than with conventional distraction techniques.

Le Fort I Maxillary Advancement Using Distraction Osteogenesis

PubMed Central

Combs, Patrick D.; Harshbarger, Raymond J.

2014-01-01

Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hypoplasia in cleft, syndromic, and noncleft patients. In this article, the authors provide a review of current data and recommendations concerning Le Fort I advancement with distraction osteogenesis. In addition, they outline their technique for treating severe maxillary hypoplasia with distraction osteogenesis using internal devices. PMID:25383054

Distracted Biking: An Observational Study.

PubMed

Wolfe, Elizabeth Suzanne; Arabian, Sandra Strack; Breeze, Janis L; Salzler, Matthew J

2016-01-01

Commuting via bicycle is a very popular mode of transportation in the Northeastern United States. Boston, MA, has seen a rapid increase in bicycle ridership over the past decade, which has raised concerns and awareness about bicycle safety. An emerging topic in this field is distracted bicycle riding. This study was conducted to provide descriptive data on the prevalence and type of distracted bicycling in Boston at different times of day. This was a cross-sectional study in which observers tallied bicyclists at 4 high traffic intersections in Boston during various peak commuting hours for 2 types of distractions: auditory (earbuds/phones in or on ears), and visual/tactile (electronic device or other object in hand). Nineteen hundred seventy-four bicyclists were observed and 615 (31.2%), 95% CI [29, 33%], were distracted. Of those observed, auditory distractions were the most common (N = 349; 17.7%), 95% CI [16, 19], p = .0003, followed by visual/tactile distractions (N = 266; 13.5%), 95% CI [12, 15]. The highest proportion (40.7%), 95% CI [35, 46], of distracted bicyclists was observed during the midday commute (between 13:30 and 15:00). Distracted bicycling is a prevalent safety concern in the city of Boston, as almost a third of all bicyclists exhibited distracted behavior. Education and public awareness campaigns should be designed to decrease distracted bicycling behaviors and promote bicycle safety in Boston. An awareness of the prevalence of distracted biking can be utilized to promote bicycle safety campaigns dedicated to decreasing distracted bicycling and to provide a baseline against which improvements can be measured.

Distracted Biking: An Observational Study

PubMed Central

Wolfe, Elizabeth Suzanne; Arabian, Sandra Strack; Breeze, Janis L; Salzler, Matthew J.

2016-01-01

Commuting via bicycle is a very popular mode of transportation in the Northeastern United States (US). Boston, MA has seen a rapid increase in bicycle ridership over the past decade which has raised concerns and awareness about bicycle safety. An emerging topic in this field is distracted bicycle riding. This study was conducted to provide descriptive data on the prevalence and type of distracted bicycling in Boston at different times of day. This was a cross-sectional study in which observers tallied bicyclists at four high traffic intersections in Boston during various peak commuting hours for two types of distractions: auditory (ear buds/phones in or on ears), and visual/tactile (electronic device or other object in hand). Nineteen hundred seventy-four bicyclists were observed and 615 (31.2%, 95% CI: 29%-33%) were distracted. Of those observed, auditory distractions were the most common (N= 349 [17.7%, 95% CI: 16%-19%], p=0.0003) followed by visual/tactile distractions (N= 266 [13.5%, 95% CI: 12%-15%]). The highest proportion (40.7%, 95% CI: 35%-46%) of distracted bicyclists was observed during the midday commute (between 13:30-15:00). Distracted bicycling is a prevalent safety concern in the city of Boston, as almost one-third of all bicyclists exhibited distracted behavior. Education and public awareness campaigns should be designed to decrease distracted bicycling behaviors and promote bicycle safety in Boston. An awareness of the prevalence of distracted biking can be utilized to promote bicycle safety campaigns dedicated to decreasing distracted bicycling and to provide a baseline against which improvements can be measured. PMID:26953533

Angioplasty balloon catheters used for distraction of the ankle joint.

PubMed

Sartoretti, C; Sartoretti-Schefer, S; Duff, C; Buchmann, P

1996-02-01

Arthroscopy of the ankle joint is now routinely performed in diagnostic and therapeutic interventions but is still a demanding and difficult operative procedure in this very small and tight joint. Arthroscopy can be facilitated by a sufficient distraction that gives a better overview of the joint space. However, it is still a matter of debate how to obtain the adequate distraction. Distention by manual strength as well as by the help of a technical device have been proposed. We report our experience with distraction of the ankle joint by the help of one or two intraarticularily located and secondarily insufflated angioplasty balloon catheters that are routinely used in interventional radiology. These special catheters allow a careful and controlled distention of the joint with a fixed space of distraction and, according to our limited experience, without any morbidity.

Creating the environment for driver distraction: A thematic framework of sociotechnical factors.

PubMed

Parnell, Katie J; Stanton, Neville A; Plant, Katherine L

2018-04-01

As modern society becomes more reliant on technology, its use within the vehicle is becoming a concern for road safety due to both portable and built-in devices offering sources of distraction. While the effects of distracting technologies are well documented, little is known about the causal factors that lead to the drivers' engagement with technological devices. The relevance of the sociotechnical system within which the behaviour occurs requires further research. This paper presents two experiments, the first aims to assess the drivers self-reported decision to engage with technological tasks while driving and their reasoning for doing so with respect to the wider sociotechnical system. This utilised a semi-structured interview method, conducted with 30 drivers to initiate a discussion on their likelihood of engaging with 22 different tasks across 7 different road types. Inductive thematic analysis provided a hierarchical thematic framework that detailed the self-reported causal factors that influence the drivers' use of technology whilst driving. The second experiment assessed the relevance of the hierarchical framework to a model of distraction that was established from within the literature on the drivers use of distracting technologies while driving. The findings provide validation for some relationships studied in the literature, as well as providing insights into relationships that require further study. The role of the sociotechnical system in the engagement of distractions while driving is highlighted, with the causal factors reported by drivers suggesting the importance of considering the wider system within which the behaviour is occurring and how it may be creating the conditions for distraction to occur. This supports previous claims made within the literature based model. Recommendations are proposed that encourage a movement away from individual focused countermeasures towards systemic actors. Copyright © 2017 Elsevier Ltd. All rights reserved.

Distraction to treat knee osteoarthritis.

PubMed

Flouzat-Lachaniette, Charles-Henri; Roubineau, François; Heyberger, Clémence; Bouthors, Charlie

2017-03-01

The objective of this article is to review data on joint distraction used to treat knee osteoarthritis. Joint distraction is a surgical procedure in which the two bony ends of the joint are gradually pulled apart then kept separated for 2 months in an external fixation frame. Weight bearing is continued to ensure variations in hydrostatic pressure within the joint. In published studies, joint distraction provided substantial clinical and structural improvements in patients with knee osteoarthritis, delaying joint replacement surgery for at least 2 years. Animal studies showed that joint distraction was associated with decrease in the secondary inflammatory response, cartilage breakdown, and subchondral bone remodeling. In vitro, the intermittent application of hydrostatic pressure stimulated the production of extracellular matrix, particularly in joints with osteoarthritis. Nevertheless, several considerations invite caution when considering the more widespread use of joint distraction. Published studies have short follow-ups and small sample sizes. In addition, the high frequency of pin tract infection is of concern, since most patients eventually require knee replacement surgery. These two considerations indicate a need for longer-term prospective studies of patient cohorts. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Backward distraction osteogenesis in a patient with severe mandibular micrognathia.

PubMed

Mitsukawa, Nobuyuki; Morishita, Tadashi; Saiga, Atsuomi; Akita, Shinsuke; Kubota, Yoshitaka; Satoh, Kaneshige

2013-09-01

Maxillary skeletal prognathism can involve severe mandibular micrognathia with marked mandibular retrognathism or hypoplasia. For patients with such a condition, a conventional treatment is mandibular advancement by sagittal split ramus osteotomy (SSRO). This procedure has problems such as insufficient advancement, instability of jaw position, and postoperative relapse. Thus, in recent years, mandibular distraction osteogenesis has been used in some patients. Mandibular distraction has many advantages, but an ideal occlusion is difficult to achieve using this procedure. That is, 3-dimensional control cannot be attained using an internal device that is unidirectional. This report describes a case of severe mandibular micrognathia in a 14-year-old girl treated using backward distraction osteogenesis. This procedure was first reported by Ishii et al (Jpn J Jaw Deform 2004; 14:49) and involves a combination of SSRO and ramus distraction osteogenesis. In the present study, intermaxillary fixation in centric occlusion was performed after osteotomy, and proximal bone segments were distracted in a posterosuperior direction. This procedure is a superior surgical technique that avoids the drawbacks of SSRO and conventional mandibular distraction. However, it applies a large load to the temporomandibular joints and requires thorough management. Thus, careful evaluation needs to be made of the indication for backward distraction osteogenesis.

Transpalatal distraction--state of the art for the individual management of transverse maxillary deficiency--a review of 50 consecutive cases.

PubMed

Adolphs, Nicolai; Ernst, Nicole; Menneking, Horst; Hoffmeister, Bodo

2014-12-01

Transpalatal distraction has been established as a technique for surgical assisted rapid palatal/maxillary expansion (SARPE/SARME) in order to correct transverse maxillary deficiency. From 2007 until 2013 bone borne transpalatal distraction devices have been inserted in 50 patients affected by transverse maxillary deficiency and transpalatal distraction has been performed by the same surgical team. Patient records were retrospectively evaluated after ending of the active distraction phase with respect to indication, achieved expansion, additional procedures and side effects. In all cases the existing transverse maxillary deficiency was corrected by means of transpalatal distraction according to the individual needs. No complications were observed that interfered with that therapeutic aim. Evaluation of the records showed a wide variance of parameters which impedes evidence based statements. According to that series transpalatal distraction is a safe, powerful and reliable procedure and can be recommended as a state of the art procedure for the individually adapted correction of transverse maxillary deficiency if well known parameters of distraction are respected. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Arthroscopic ankle arthrodesis with intra-articular distraction.

PubMed

Kim, Hyong Nyun; Jeon, June Young; Noh, Kyu Cheol; Kim, Hong Kyun; Dong, Quanyu; Park, Yong Wook

2014-01-01

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Distracted Driving, A Major Preventable Cause of Motor Vehicle Collisions: “Just Hang Up and Drive”

PubMed Central

Kahn, Christopher A.; Cisneros, Victor; Lotfipour, Shahram; Imani, Ghasem; Chakravarthy, Bharath

2015-01-01

For years, public health experts have been concerned about the effect of cell phone use on motor vehicle collisions, part of a phenomenon known as “distracted driving.” The Morbidity and Mortality Weekly Report (MMWR) article “Mobile Device Use While Driving - United States and Seven European Countries 2011” highlights the international nature of these concerns. Recent (2011) estimates from the National Highway Traffic Safety Administration are that 10% of fatal crashes and 17% of injury crashes were reported as distraction-affected. Of 3,331 people killed in 2011 on roadways in the U.S. as a result of driver distraction, 385 died in a crash where at least one driver was using a cell phone. For drivers 15–19 years old involved in a fatal crash, 21% of the distracted drivers were distracted by the use of cell phones. Efforts to reduce cell phone use while driving could reduce the prevalence of automobile crashes related to distracted driving. The MMWR report shows that there is much ground to cover with distracted driving. Emergency physicians frequently see the devastating effects of distracted driving on a daily basis and should take a more active role on sharing the information with patients, administrators, legislators, friends and family. PMID:26759649

Distracted Driving, A Major Preventable Cause of Motor Vehicle Collisions: "Just Hang Up and Drive".

PubMed

Kahn, Christopher A; Cisneros, Victor; Lotfipour, Shahram; Imani, Ghasem; Chakravarthy, Bharath

2015-12-01

For years, public health experts have been concerned about the effect of cell phone use on motor vehicle collisions, part of a phenomenon known as "distracted driving." The Morbidity and Mortality Weekly Report (MMWR) article "Mobile Device Use While Driving - United States and Seven European Countries 2011" highlights the international nature of these concerns. Recent (2011) estimates from the National Highway Traffic Safety Administration are that 10% of fatal crashes and 17% of injury crashes were reported as distraction-affected. Of 3,331 people killed in 2011 on roadways in the U.S. as a result of driver distraction, 385 died in a crash where at least one driver was using a cell phone. For drivers 15-19 years old involved in a fatal crash, 21% of the distracted drivers were distracted by the use of cell phones. Efforts to reduce cell phone use while driving could reduce the prevalence of automobile crashes related to distracted driving. The MMWR report shows that there is much ground to cover with distracted driving. Emergency physicians frequently see the devastating effects of distracted driving on a daily basis and should take a more active role on sharing the information with patients, administrators, legislators, friends and family.

Changes after surgically-assisted maxillary expansion (SARME) to the dentoalveolar, palatal and nasal structures by using tooth-borne distraction devices.

PubMed

Seeberger, Robin; Kater, Wolfgang; Schulte-Geers, Michael; Davids, Rolf; Freier, Kolja; Thiele, Oliver

2011-07-01

Different devices are available to aid surgically-assisted maxillary expansion. In this study we have evaluated the changes to the anchoring teeth, the hard palate, and the lower nasal passage made by tooth-borne distraction devices. Thirty-one patients (mean (SD) age 28 (2) years) with deficiencies in the transverse width of the maxilla were examined by computed tomography and cone beam scans before and after operation. The data were analysed with the help of Wilcoxon's signed rank test and Spearman's r correlation. The mean (SD) distraction width was 6.5 (2.3) mm. All anchorage teeth were tilted (p<0.01). The axes changed by a mean (SD) of 4.8 (0.9)° in the first premolar and 3.1 (0.8)° in the first molar. The nasal isthmus increased by a mean (SD) of 2.5 (0.3) mm. The hard palate adjacent to the anchoring teeth increased anteriorly by a mean (SD) of 2.8 (0.4) mm and posteriorly by 2.7 (0.4) mm. The hard palate was lowered by 1.2 (0.8) mm. There was a significant correlation in the distraction width, with changes in the intercoronal and interapical distances of the anchoring premolars (p<0.05) and with the interapical distance of the anchoring molars (p<0.01). There was also a correlation between the distraction width and the overall gain in width of the lower nasal passage (p<0.05). The results suggested that surgically-assisted maxillary expansion with tooth-borne devices has significant effects on the anchoring teeth, the nasal floor, and the hard palate. Both tilting of the teeth and an evenly distributed movement of the segments were seen. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Joint Distraction Treatments of Intra-Articular Fracture-Induced Posttraumatic Osteoarthritis in a Large Animal Model

DTIC Science & Technology

2017-10-01

that was developed this Year for use in the upcoming Aim 2 studies. 15. SUBJECT TERMS External Fixator, Fracture Fixation Delay, Yucatan Minipig 16... Yucatan minipig model of PTOA after IAF that was developed during our previous work (W81XWH-10-1-0864) to investigate the use of joint distraction to...proactive treatment for PTOA. 2. KEYWORDS Post-traumatic Osteoarthritis Intra-articular Fracture Yucatan Miniature Pig Impact Ankle Cartilage

Pharyngeal airway changes associated with maxillary distraction osteogenesis in adult cleft lip and palate patients.

PubMed

Aksu, Muge; Taner, Tülin; Sahin-Veske, Pınar; Kocadereli, Ilken; Konas, Ersoy; Mavili, Mehmet Emin

2012-02-01

To investigate 1) the changes in pharyngeal airway sizes associated with maxillary distraction osteogenesis and 2) the correlations between maxillary skeletal variables and the pharyngeal airway in adult patients with cleft lip and palate. The study was carried out in 14 adult subjects with cleft lip and palate. Predistraction records were taken at a mean age of 22.7 ± 4.6 years. All patients had placement of a rigid external distraction device (RED I; KLS Martin, Tuttlingen, Germany) after Le Fort I osteotomy. Lateral cephalograms were assessed before surgery and at short-term follow-up (8.0 ± 6.4 months). The cephalometric skeletal and pharyngeal airway variables were statistically evaluated by use of the Wilcoxon signed-rank test. Spearman ρ correlation was performed to check the correlations between maxillary skeletal and pharyngeal variables. The maxillary movement was 8.7 mm (P < .01). The maxillary depth angle (+7.9°) and effective maxillary length (9.4 mm) increased significantly (P < .01) after distraction, whereas the palatal plane angle remained unchanged. Anterior nasal spine (8.2 mm) and Posterior nasal spine (6.9 mm) moved anteriorly. The overjet increased (9.5 mm) significantly (P < .01). Posterior, superoposterior, and middle airway spaces increased significantly, with mean differences of 7.5 mm, 5.1 mm, and 3.3 mm, respectively. The soft palate moved anteriorly, with the greatest movement at its superior point. Significant positive correlations were observed for the posterior and superoposterior airway spaces and maxillary movement. PNS changes showed the highest correlation with posterior airway changes. The significant anterior movement of the maxilla resulted in significant increases in posterior, superoposterior, and middle airway spaces. The posterior airway space showed the highest significant positive correlation with the movement of PNS. The posterior and superoposterior airway spaces also showed significant positive correlations with the maxillary skeletal variables. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Multi-modal distraction. Using technology to combat pain in young children with burn injuries.

PubMed

Miller, Kate; Rodger, Sylvia; Bucolo, Sam; Greer, Ristan; Kimble, Roy M

2010-08-01

The use of non-pharmacological pain management remains adhoc within acute paediatric burns pain management protocols despite ongoing acknowledgement of its role. Advancements in adult based pain services including the integration of virtual reality has been adapted to meet the needs of children in pain, as exemplified by the development of multi-modal distraction (MMD). This easy to use, hand held interactive device uses customized programs designed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes. (1) To investigate if either MMD procedural preparation (MMD-PP) or distraction (MMD-D) has a greater impact on child pain reduction compared to standard distraction (SD) or hand held video game distraction (VG), (2) to understand the impact of MMD-PP and MMD-D on clinic efficiency by measuring length of treatment across groups, and lastly, (3) to assess the efficacy of distraction techniques over three dressing change procedures. A prospective randomised control trial was completed in a paediatric tertiary hospital Burns Outpatient Clinic. Eighty participants were recruited and studied over their first three dressing changes. Pain was assessed using validated child report, caregiver report, nursing observation and physiological measures. MMD-D and MMD-PP were both shown to significantly relieve reported pain (p

Comparative study of different osteotomy modalities in maxillary distraction osteogenesis for cleft lip and palate.

PubMed

Yu, Hongbo; Wang, Xudong; Fang, Bing; Shen, Steve Guofang

2012-11-01

Conventional maxillary distraction osteogenesis and anterior maxillary segmental distraction were applied in the treatment of severe maxillary hypoplasia secondary to cleft clip and palate. The aim of the present study was to compare the difference between these 2 osteotomy modalities used for rigid external distraction. Ten patients with severe maxillary hypoplasia secondary to CLP were enrolled in our study. They were randomly divided into 2 groups. Conventional maxillary distraction osteogenesis was performed in 5 patients and anterior maxillary segmental distraction in 5 patients. The preoperative and postoperative lateral cephalograms were compared, and cephalometric analysis was performed. The independent sample t test was used to evaluate the differences between the 2 groups. All patients healed uneventfully, and the maxillae moved forward satisfactorily. The sella-nasion-point A angles, nasion-point A-Frankfort horizontal plane angles, overjets, and 0-meridian to subnasale distances had increased significantly after distraction osteogenesis. Significant differences were found in the changes in palatal length between the 2 groups (P < .05). A mean increase of 7.50 mm in palatal length was found in the anterior maxillary segmental distraction group. No significant difference in the changes in palatopharyngeal depth or soft palatal length was found. With the ability of increasing the palatal and arch length, avoiding changes in palatopharyngeal depth, and preserving palatopharyngeal closure function, anterior maxillary segmental distraction has great value in the treatment of maxillary hypoplasia secondary to CLP. It is a promising and valuable technique in this potentially complicated procedure. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Does wearable device bring distraction closer to drivers? Comparing smartphones and Google Glass.

PubMed

He, Jibo; McCarley, Jason S; Crager, Kirsten; Jadliwala, Murtuza; Hua, Lesheng; Huang, Sheng

2018-07-01

Head-up and wearable displays, such as Google Glass™, are sometimes marketed as safe in-vehicle alternatives to phone-based displays, as they allow drivers to receive messages without eye-off-the-road glances. However, head-up displays can still compromise driver performance (e.g., He et al., 2015b), as the distracting effect of interacting with any device will depend on the user's multitasking strategies. The present experiment examined drivers' interaction with a head-down smartphone display and a wearable head-up display. Participants performed a simulated driving task while receiving and responding to text messages via smartphone or the head-mounted display (HMD) on the Google Glass™. Incoming messages were signaled by an auditory alert, and responses were made vocally. When using Google Glass, participants' responses were quicker than that of smartphone, and the time to engage in a task did not vary according to lane-keeping difficulty. Results suggest that a willingness to engage more readily in distracting tasks may offset the potential safety benefits of wearable devices. Copyright © 2018 Elsevier Ltd. All rights reserved.

The correction of maxillary defciency with internal distraction devices: a multidisciplinary approach.

PubMed

Oz, A Alper; Ozer, Mete; Eroglu, Lütfi; Ozdemir, Oguz Suleyman

2013-09-01

The purpose of this case report is to present the orthodontic, surgical and restorative treatments in the case of an operated cleft lip and palate and severe maxillary defciency in a 14-year-old female patient. Only orthodontic treatment could be ineffcient for cleft lip and palate patients characterized with maxillary hypoplasia. Orthodontic and surgical treatment shows suffcient results, especially with severe skeletal defciency. A cleft lip and palate patient required complex multidisciplinary treatment to preserve health and restore esthetics. Dental leveling and alignment of the maxillary and mandibular teeth were provided before the surgery. Maxillary advancement and clockwise rotation of the maxillary-mandibular complex was applied by a Le Fort 1 osteotomy with two internal distraction devices. After the active treatment including orthodontic treatment and orthognathic surgery, upper full mouth ceramic restoration was applied. This report shows the efficiency of internal distraction devices in cleft lip palate patients and exemplifes the multidisciplinary care required for such diffcult cases. Clinical signifcance: Stable improved occlusion and skeletal relations were observed after a follow-up examination period of 12 months.

Alveolar distraction osteogenesis: revive and restore the native bone.

PubMed

Sant, Sumedha; Jagtap, Amit

2009-12-01

In prosthodontics, knife-edge bony alveolar ridges can cause a problem in their rehabilitation. The distraction osteogenesis process raises the medullary component of the alveolus, allowing the labial plate of the existing natural bone to be displaced. This process involves mobilization, transport, and fixation of a healthy segment of bone adjacent to the deficient site. It entails use of the gradual controlled displacement of surgically created fractures, which results in simultaneous expansion of soft tissue and bone volume. A mechanical device, the alveolar distraction device, is used for this purpose. This modality of treatment can be used in implant dentistry cases for rehabilitation of resorbed ridges. The objective of this overview is to explain this procedure wherein the alveolar housing, including the osseous and soft-tissue components, is enlarged in a single, simultaneous process, which makes creation of an appropriate alveolar morphology possible.

A 3 year update on the influence of noise on performance and behavior.

PubMed

Clark, Charlotte; Sörqvist, Patrik

2012-01-01

The effect of noise exposure on human performance and behavior continues to be a focus for research activities. This paper reviews developments in the field over the past 3 years, highlighting current areas of research, recent findings, and ongoing research in two main research areas: Field studies of noise effects on children's cognition and experimental studies of auditory distraction. Overall, the evidence for the effects of external environmental noise on children's cognition has strengthened in recent years, with the use of larger community samples and better noise characterization. Studies have begun to establish exposure-effect thresholds for noise effects on cognition. However, the evidence remains predominantly cross-sectional and future research needs to examine whether sound insulation might lessen the effects of external noise on children's learning. Research has also begun to explore the link between internal classroom acoustics and children's learning, aiming to further inform the design of the internal acoustic environment. Experimental studies of the effects of noise on cognitive performance are also reviewed, including functional differences in varieties of auditory distraction, semantic auditory distraction, individual differences in susceptibility to auditory distraction, and the role of cognitive control on the effects of noise on understanding and memory of target speech materials. In general, the results indicate that there are at least two functionally different types of auditory distraction: One due to the interruption of processes (as a result of attention being captured by the sound), another due to interference between processes. The magnitude of the former type is related to individual differences in cognitive control capacities (e.g., working memory capacity); the magnitude of the latter is not. Few studies address noise effects on behavioral outcomes, emphasizing the need for researchers to explore noise effects on behavior in more detail.

Forearm lengthening by distraction osteogenesis: A report on 5 limbs in 3 cases.

PubMed

Tonogai, Ichiro; Takahashi, Mitsuhiko; Tsutsui, Takahiko; Goto, Tomohiro; Hamada, Daisuke; Suzue, Naoto; Matsuura, Tetsuya; Yasui, Natsuo; Sairyo, Koichi

2015-01-01

Radioulnar length discrepancy causes pain and decreases function of the wrist, forearm, and elbow. Limb lengthening, which has been used in the treatment of various deformities of the forearm, is necessary to restore balance between the ulna and radius. We treated 5 limbs in 3 patients (2 boys, 1 girl; mean age 9.3 years old) with radioulnar length discrepancy by distraction osteogenesis of either the ulna or radius using external fixators. We dissected the interosseous membrane between the ulna and radius in 3 limbs in 2 cases and did not do so in 2 limbs of 1 case. These cases include 2 cases with hereditary multiple exostoses, and 1 case with multiple epiphyseal dysplasia. The results were investigated and evaluated in this study, using appropriate clinical and radiographic parameters, noting the state of the interosseous membrane, which has an important role in forearm stability. The mean fixation period was 113 days. The mean distraction distance was 22.8 mm. The mean follow-up period was 637.7 days. The mean ulnar shortening and radial articular angle respectively improved from 7.4 mm and 30.2° preoperatively to -0.1 mm and 34.8° postoperatively. Balance between the ulna and radius was restored, and the results showed significant improvements in range of motion of the joints. However, 2 unintended radial head subluxations occurred in 2 limbs without dissection of the interosseous membrane. In addition, a keloid remained in 1 limb due to pin site infection. Forearm lengthening by distraction osteogenesis was useful in our cases. It is important to recognize the function of the interosseous membrane when lengthening is performed by osteotomy of the proximal ulna by gradual distraction with an external fixator.

Long-Term Results of Mandibular Distraction Osteogenesis with a Resorbable Device in Infants with Robin Sequence: Effects on Developing Molars and Mandibular Growth.

PubMed

Paes, Emma C; Bittermann, Gerhard K P; Bittermann, Dirk; Muradin, Marvick M; van Hogezand, Rose; Etty, Erika; Mink van der Molen, Aebele B; Kon, Moshe; Breugem, Corstiaan C

2016-02-01

Mandibular distraction osteogenesis with a unidirectional resorbable device is an effective treatment option for severe upper airway obstruction in infants with Robin sequence. Long-term effects, especially with regard to tooth development and mandibular outgrowth, are not known. Robin sequence infants with a follow-up of greater than or equal to 5 years were included. Baseline characteristics were extracted from medical records. Panoramic and lateral cephalometric radiographs were analyzed and patients were recalled for physical examination. Ten infants underwent mandibular distraction osteogenesis at a mean age of 3.7 months (median, 19 months; range, 11 days to 27 months). Mean length of follow-up was 6.8 years (range, 5.0 to 7.9 years). Ten Robin sequence infants without mandibular distraction osteogenesis (mean length of follow-up, 7.4 years; range, 6.7 to 8.9 years) were the controls. Shape anomalies, positional changes, and root malformations of molars were seen significantly more often than in the control group (p = 0.007, p = 0.009, and p = 0.043, respectively). Mandibular length was shorter (p = 0.030), but mandibular ramus height was comparable (p = 0.838) with that of the non-mandibular distraction osteogenesis group. Compared with healthy controls, all Robin sequence infants had a significantly shorter mandible. Mandibular distraction osteogenesis with a resorbable system reveals overall good short- and long-term results, but the effects on developing molars and mandibular outgrowth likely necessitate secondary procedures. This factor should be considered when deciding on treatment options and counseling of parents. Therapeutic, III.

Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction.

PubMed

Katz-Sidlow, Rachel J; Ludwig, Allison; Miller, Scott; Sidlow, Robert

2012-10-01

While there are numerous benefits of smartphone use for physicians, little is known about the negative effects of using these devices in the context of patient care. To assess resident and faculty smartphone use during inpatient attending rounds and its potential as a source of distraction during transfer of clinical information. Cross-sectional survey. University-affiliated public teaching hospital. All housestaff and inpatient faculty in the departments of Medicine and Pediatrics. Participants were asked about smartphone ownership, usage patterns during attending rounds, and whether team members had ever missed important data during rounds due to distraction from smartphones. Attendings were asked whether policies should be established for smartphone use during rounds. The overall response rate was 73%. Device ownership was prevalent (89% residents, 98% faculty), as was use of smartphones during inpatient rounds (57% residents, 28% attendings). According to self-reports, smartphones were used during rounds for patient care (85% residents, 48% faculty), reading/responding to personal texts/e-mails (37% residents, 12% faculty), and other non-patient care uses (15% residents, 0% faculty). Nineteen percent of residents and 12% of attendings believed they had missed important information because of distraction from smartphones. Residents and faculty agreed that smartphones "can be a serious distraction during attending rounds," and nearly 80% of faculty believed that smartphone policies should be established. Smartphone use during attending rounds is prevalent and can distract users during important information transfer. Attendings strongly favored the institution of formal policies governing appropriate smartphone use during inpatient rounds. Copyright © 2012 Society of Hospital Medicine.

Nonoperative Management of Craniocervical Ligamentous Distraction Injury: Literature Review.

PubMed

Kaplan, Nathan B; Molinari, Christine; Molinari, Robert W

2015-12-01

Study Design Literature review and case report. Objective Review the existing literature and report the successful nonoperative management of a two-level craniocervical ligamentous distraction injury. Methods A PubMed and Medline review revealed only three limited reports involving the nonoperative management of patients with craniocervical distraction injury. This article reviews the existing literature and reports the case of a 27-year-old man who was involved in a motorcycle accident and sustained multiple systemic injuries and ligamentous distraction injuries to both occipitocervical joints and both C1-C2 joints. The patient's traumatic brain injury and bilateral pulmonary contusions precluded safe operative management of the two-level craniocervical distraction injury. Therefore, the patient was placed in a halo immobilization device. Results The literature remains unclear as to the specific indications for nonoperative management of ligamentous craniocervical injuries. Nonoperative management was associated with poor outcomes in the majority of reported patients. We report a patient who was managed for 6 months in a halo device. Posttreatment computed tomography and flexion-extension radiographs demonstrated stable occipitocervical and C1-C2 joints bilaterally. The patient reported minimal neck pain and had excellent functional outcome with a Neck Disability Index score of 2 points at 41 months postoperatively. He returned to preinjury level of employment without restriction. Conclusions Further study is needed to determine which craniocervical injuries may be managed successfully with nonoperative measures.

Nonoperative Management of Craniocervical Ligamentous Distraction Injury: Literature Review

PubMed Central

Kaplan, Nathan B.; Molinari, Christine; Molinari, Robert W.

2015-01-01

Study Design Literature review and case report. Objective Review the existing literature and report the successful nonoperative management of a two-level craniocervical ligamentous distraction injury. Methods A PubMed and Medline review revealed only three limited reports involving the nonoperative management of patients with craniocervical distraction injury. This article reviews the existing literature and reports the case of a 27-year-old man who was involved in a motorcycle accident and sustained multiple systemic injuries and ligamentous distraction injuries to both occipitocervical joints and both C1–C2 joints. The patient's traumatic brain injury and bilateral pulmonary contusions precluded safe operative management of the two-level craniocervical distraction injury. Therefore, the patient was placed in a halo immobilization device. Results The literature remains unclear as to the specific indications for nonoperative management of ligamentous craniocervical injuries. Nonoperative management was associated with poor outcomes in the majority of reported patients. We report a patient who was managed for 6 months in a halo device. Posttreatment computed tomography and flexion–extension radiographs demonstrated stable occipitocervical and C1–C2 joints bilaterally. The patient reported minimal neck pain and had excellent functional outcome with a Neck Disability Index score of 2 points at 41 months postoperatively. He returned to preinjury level of employment without restriction. Conclusions Further study is needed to determine which craniocervical injuries may be managed successfully with nonoperative measures. PMID:26682101

Safety of railroad employees' use of personal electronic devices

DOT National Transportation Integrated Search

2014-06-01

This report describes two studies sponsored by the Federal Railroad Administration that examined distraction from personal electronic device (PED) usage among safety-critical railroad employees. Study I considered railroad rules, railroad efficiency ...

Mandibular distraction osteogenesis with newly designed electromechanical distractor.

PubMed

Aykan, Andac; Ugurlutan, Rifat; Zor, Fatih; Ozturk, Serdar

2014-07-01

The purposes of this study were to design a fully automatic electromechanical distractor for continuous mandibular distraction osteogenesis and to investigate the efficacy of this newly developed distractor on sheep mandible model. Five sheep underwent unilateral mandibular osteotomy, and the mechanical component of electromechanical distractor was fixed on both sides of the osteotomy site using pins. After a 5-day latency period, the electromechanical distractor was activated at a rate of 0.30 mm per 8 hours using an electronic control unit. The bone was lengthened for 20 days without any intervention to the electromechanical distractor. The animals were killed on the sixth week of the consolidation period, and 5 distracted mandibles were examined through macroscopic observation and computed tomography. Distracted bone length was measured through computed tomography on sagittal slices. The device was tolerated by the distraction process without complications in all animals. New callus formation was observed on the distraction gap. Radiologic evaluation showed new callus formation in the distraction gap. New callus length was found to be, in average, 18.28 mm. In this preliminary study, a newly designed electromechanical distractor was successfully used for mandible distraction, which mainly provided a continuous lengthening during activation period spontaneously without any intervention. We think that the clinical application of this electromechanic distractor may provide patient comfort during distraction. Moreover, electromechanical distractor has the potential for high-resolution movement capacity when compared with annual distraction. The promising results from this prototype are encouraging to further investigations for human applications.

Devices, Distractions and Digital Literacy: "Bring Your Own Device" to Polytech

ERIC Educational Resources Information Center

Drew, Leoni; Forbes, Dianne

2017-01-01

The purpose of this study is to investigate the ways polytechnic students use personal mobile devices to support their learning. This study used purposive sampling and mixed methods to generate data about student ownership and use of mobile digital devices within a single institution. Findings reveal patterns of device ownership, insights into how…

Recovering faces from memory: the distracting influence of external facial features.

PubMed

Frowd, Charlie D; Skelton, Faye; Atherton, Chris; Pitchford, Melanie; Hepton, Gemma; Holden, Laura; McIntyre, Alex H; Hancock, Peter J B

2012-06-01

Recognition memory for unfamiliar faces is facilitated when contextual cues (e.g., head pose, background environment, hair and clothing) are consistent between study and test. By contrast, inconsistencies in external features, especially hair, promote errors in unfamiliar face-matching tasks. For the construction of facial composites, as carried out by witnesses and victims of crime, the role of external features (hair, ears, and neck) is less clear, although research does suggest their involvement. Here, over three experiments, we investigate the impact of external features for recovering facial memories using a modern, recognition-based composite system, EvoFIT. Participant-constructors inspected an unfamiliar target face and, one day later, repeatedly selected items from arrays of whole faces, with "breeding," to "evolve" a composite with EvoFIT; further participants (evaluators) named the resulting composites. In Experiment 1, the important internal-features (eyes, brows, nose, and mouth) were constructed more identifiably when the visual presence of external features was decreased by Gaussian blur during construction: higher blur yielded more identifiable internal-features. In Experiment 2, increasing the visible extent of external features (to match the target's) in the presented face-arrays also improved internal-features quality, although less so than when external features were masked throughout construction. Experiment 3 demonstrated that masking external-features promoted substantially more identifiable images than using the previous method of blurring external-features. Overall, the research indicates that external features are a distractive rather than a beneficial cue for face construction; the results also provide a much better method to construct composites, one that should dramatically increase identification of offenders.

Distracted pedestrian sustains orbital fracture while on cell phone.

PubMed

Edell, Aimée R; Jung, Jesse J; Solomon, Joel M; Palu, Richard N

2013-01-01

Use of cell phones in the general population has become increasingly commonplace. The distracting effects of cell phones among automobile drivers are well established, and legislation prohibits the use of handheld cell phones while driving in several states. Recent research has focused on the similar distracting effects of cell phones in the pedestrian population. In this report, an older gentleman suffered extensive facial trauma requiring surgery as a direct effect of cell phone use at the time the trauma occurred. This case highlights the role that portable electronic devices can play as a cause of ocular trauma.

Mid-maxillary distraction osteogenesis of cleft patients using a special custom-made tooth-borne device.

PubMed

Dias, D K; De Silva, H L; Senadeera, W M

2011-09-01

A relatively new approach to maxillary advancement by maxillary distraction using a combined surgical and modified orthodontic technique is described. This protocol and the technique have been used for the past 3 years (2006 to 2009) on more than 60 patients, aged between 14-29 years. Distraction of between 7 and 18 mm has been achieved, creating class 1 or mild class 2 arch relationships in cleft lip and cleft palate patients who had class 3 arch relationship compounded by significant maxillary retrusion. The technique is simple, inexpensive and less time consuming.

Correlation of Shoulder and Elbow Kinetics With Ball Velocity in Collegiate Baseball Pitchers.

PubMed

Post, Eric G; Laudner, Kevin G; McLoda, Todd A; Wong, Regan; Meister, Keith

2015-06-01

Throwing a baseball is a dynamic and violent act that places large magnitudes of stress on the shoulder and elbow. Specific injuries at the elbow and glenohumeral joints have been linked to several kinetic variables throughout the throwing motion. However, very little research has directly examined the relationship between these kinetic variables and ball velocity. To examine the correlation of peak ball velocity with elbow-valgus torque, shoulder external-rotation torque, and shoulder-distraction force in a group of collegiate baseball pitchers. Cross-sectional study. Motion-analysis laboratory. Sixty-seven asymptomatic National Collegiate Athletic Association Division I baseball pitchers (age = 19.5 ± 1.2 years, height = 186.2 ± 5.7 cm, mass = 86.7 ± 7.0 kg; 48 right handed, 19 left handed). We measured peak ball velocity using a radar gun and shoulder and elbow kinetics of the throwing arm using 8 electronically synchronized, high-speed digital cameras. We placed 26 reflective markers on anatomical landmarks of each participant to track 3-dimensional coordinate data. The average data from the 3 highest-velocity fastballs thrown for strikes were used for data analysis. We calculated a Pearson correlation coefficient to determine the associations between ball velocity and peak elbow-valgus torque, shoulder-distraction force, and shoulder external-rotation torque (P < .05). A weak positive correlation was found between ball velocity and shoulder-distraction force (r = 0.257; 95% confidence interval [CI] = 0.02, 0.47; r(2) = 0.066; P = .018). However, no significant correlations were noted between ball velocity and elbow-valgus torque (r = 0.199; 95% CI = -0.043, 0.419; r(2) = 0.040; P = .053) or shoulder external-rotation torque (r = 0.097; 95% CI = -0.147, 0.329; r(2) = 0.009; P = .217). Although a weak positive correlation was present between ball velocity and shoulder-distraction force, no significant association was seen between ball velocity and elbow-valgus torque or shoulder external-rotation torque. Therefore, other factors, such as improper pitching mechanics, may contribute more to increases in joint kinetics than peak ball velocity.

Correlation of Shoulder and Elbow Kinetics With Ball Velocity in Collegiate Baseball Pitchers

PubMed Central

Post, Eric G.; Laudner, Kevin G.; McLoda, Todd A.; Wong, Regan; Meister, Keith

2015-01-01

Context Throwing a baseball is a dynamic and violent act that places large magnitudes of stress on the shoulder and elbow. Specific injuries at the elbow and glenohumeral joints have been linked to several kinetic variables throughout the throwing motion. However, very little research has directly examined the relationship between these kinetic variables and ball velocity. Objective To examine the correlation of peak ball velocity with elbow-valgus torque, shoulder external-rotation torque, and shoulder-distraction force in a group of collegiate baseball pitchers. Design Cross-sectional study. Setting Motion-analysis laboratory. Patients or Other Participants Sixty-seven asymptomatic National Collegiate Athletic Association Division I baseball pitchers (age = 19.5 ± 1.2 years, height = 186.2 ± 5.7 cm, mass = 86.7 ± 7.0 kg; 48 right handed, 19 left handed). Main Outcome Measure(s) We measured peak ball velocity using a radar gun and shoulder and elbow kinetics of the throwing arm using 8 electronically synchronized, high-speed digital cameras. We placed 26 reflective markers on anatomical landmarks of each participant to track 3-dimensional coordinate data. The average data from the 3 highest-velocity fastballs thrown for strikes were used for data analysis. We calculated a Pearson correlation coefficient to determine the associations between ball velocity and peak elbow-valgus torque, shoulder-distraction force, and shoulder external-rotation torque (P < .05). Results A weak positive correlation was found between ball velocity and shoulder-distraction force (r = 0.257; 95% confidence interval [CI] = 0.02, 0.47; r2 = 0.066; P = .018). However, no significant correlations were noted between ball velocity and elbow-valgus torque (r = 0.199; 95% CI = −0.043, 0.419; r2 = 0.040; P = .053) or shoulder external-rotation torque (r = 0.097; 95% CI = −0.147, 0.329; r2 = 0.009; P = .217). Conclusions Although a weak positive correlation was present between ball velocity and shoulder-distraction force, no significant association was seen between ball velocity and elbow-valgus torque or shoulder external-rotation torque. Therefore, other factors, such as improper pitching mechanics, may contribute more to increases in joint kinetics than peak ball velocity. PMID:25756790

The Impact of Operating Room Distractions on Stress, Workload, and Teamwork.

PubMed

Wheelock, Ana; Suliman, Amna; Wharton, Rupert; Babu, E D; Hull, Louise; Vincent, Charles; Sevdalis, Nick; Arora, Sonal

2015-06-01

To investigate whether distractions in the operating room (OR) are associated with higher mental workload and stress, and poorer teamwork among OR personnel. Engaging in multiple tasks can affect performance. There is little research on the effect of distractions on surgical team members' behavior and cognitive processes. Ninety general surgery cases were observed in real time. Cases were assessed by a surgeon and a behavioral scientist using 4 validated tools: OR Distractions Assessment Form, the Observational Teamwork Assessment for Surgery tool, NASA-Task Load Index, and short form of the State Trait Anxiety Inventory. Analysis of variance was performed to evaluate significant differences between teamwork, workload, and stress level among team members. Correlations (Pearson r) were computed to evaluate associations between variables. The most prevalent distractions were those initiated by external staff, followed by case-irrelevant conversations. Case-irrelevant conversations were associated with poorer team performance. Irrelevant conversations initiated by surgeons were associated with lower teamwork in surgeons (across team skills: r = -0.44 to -0.58, P < 0.05 to 0.01) and anesthesiologists (r = -0.38 and r = -0.40, for coordination and leadership; P < 0.05). Equipment-related distractions correlated with higher stress (r = 0.48, P < 0.05) and lower teamwork (across team skills: r = -0.42 to -0.50, P < 0.05) in nurses. Acoustic distractions correlated with higher stress in surgeons (r = 0.32, P < 0.05) and higher workload in anesthesiologists (r = 0.30, P < 0.05). Although some distractions may be inevitable in the OR, they can also be detrimental to the team. A deeper understanding of the effect of distractions on teams and their outcomes can lead to targeted quality improvement.

Parathyroid hormone therapy mollifies radiation-induced biomechanical degradation in murine distraction osteogenesis.

PubMed

Deshpande, Sagar S; Gallagher, Katherine K; Donneys, Alexis; Tchanque-Fossuo, Catherine N; Sarhaddi, Deniz; Nelson, Noah S; Chepeha, Douglas B; Buchman, Steven R

2013-07-01

Descriptions of mandibular distraction osteogenesis for tissue replacement after oncologic resection or for defects caused by osteoradionecrosis have been limited. Previous work demonstrated radiation decreases union formation, cellularity and mineral density in mandibular distraction osteogenesis. The authors posit that intermittent systemic administration of parathyroid hormone will serve as a stimulant to cellular function, reversing radiation-induced damage and enhancing bone regeneration. Twenty male Lewis rats were randomly assigned to three groups: group 1 (radiation and distraction osteogenesis, n = 7) and group 2 (radiation, distraction osteogenesis, and parathyroid hormone, n = 5) received a human-equivalent dose of 35 Gy of radiation (human bioequivalent, 70 Gy) fractionated over 5 days. All groups, including group 3 (distraction osteogenesis, n = 8), underwent a left unilateral mandibular osteotomy with bilateral external fixator placement. Distraction osteogenesis was performed at a rate of 0.3 mm every 12 hours to reach a gap of 5.1 mm. Group 2 was injected with parathyroid hormone (60 µg/kg) subcutaneously daily for 3 weeks after the start of distraction osteogenesis. On postoperative day 40, all left hemimandibles were harvested. Biomechanical response parameters were generated. Statistical significance was considered at p ≤ 0.05. Parathyroid hormone-treated mandibles had significantly higher failure load and higher yield than did untreated mandibles. However, these values were still significantly lower than those of nonirradiated mandibles. The authors have successfully demonstrated the therapeutic efficacy of parathyroid hormone to stimulate and enhance bone regeneration in their irradiated murine mandibular model of distraction osteogenesis. Anabolic regimens of parathyroid hormone, a U.S. Food and Drug Administration-approved drug on formulary, significantly improve outcomes in a model of postoncologic craniofacial reconstruction.

Parathyroid Hormone Therapy Mollifies Radiation-Induced Biomechanical Degradation in Murine Distraction Osteogenesis

PubMed Central

Deshpande, Sagar S.; Gallagher, Katherine K.; Donneys, Alexis; Tchanque-Fossuo, Catherine N.; Sarhaddi, Deniz; Nelson, Noah S.; Chepeha, Douglas B.; Buchman, Steven R.

2015-01-01

Objective Descriptions of mandibular distraction osteogenesis for tissue replacement after oncologic resection or for defects caused by osteoradionecrosis have been limited. Previous work demonstrated radiation decreases union formation, cellularity and mineral density in mandibular distraction osteogenesis. The authors posit that intermittent systemic administration of parathyroid hormone will serve as a stimulant to cellular function, reversing radiation-induced damage and enhancing bone regeneration. Methods Twenty male Lewis rats were randomly assigned to three groups: group 1 (radiation and distraction osteogenesis, n = 7) and group 2 (radiation, distraction osteogenesis, and parathyroid hormone, n = 5) received a human-equivalent dose of 35 Gy of radiation (human bioequivalent, 70 Gy) fractionated over 5 days. All groups, including group 3 (distraction osteogenesis, n = 8), underwent a left unilateral mandibular osteotomy with bilateral external fixator placement. Distraction osteogenesis was performed at a rate of 0.3 mm every 12 hours to reach a gap of 5.1 mm. Group 2 was injected with parathyroid hormone (60 μg/kg) subcutaneously daily for 3 weeks after the start of distraction osteogenesis. On postoperative day 40, all left hemimandibles were harvested. Biomechanical response parameters were generated. Statistical significance was considered at p ≤ 0.05. Results Parathyroid hormone–treated mandibles had significantly higher failure load and higher yield than did untreated mandibles. However, these values were still significantly lower than those of nonirradiated mandibles. Conclusions The authors have successfully demonstrated the therapeutic efficacy of parathyroid hormone to stimulate and enhance bone regeneration in their irradiated murine mandibular model of distraction osteogenesis. Anabolic regimens of parathyroid hormone, a U.S. Food and Drug Administration–approved drug on formulary, significantly improve outcomes in a model of postoncologic craniofacial reconstruction. PMID:23806959

Segmental maxillary distraction with a novel device for closure of a wide alveolar cleft

PubMed Central

Bousdras, Vasilios A.; Liyanage, Chandra; Mars, Michael; Ayliffe, Peter R

2014-01-01

Treatment of a wide alveolar cleft with initial application of segmental distraction osteogenesis is reported, in order to minimise cleft size prior to secondary alveolar bone grafting. The lesser maxillary segment was mobilised with osteotomy at Le Fort I level and, a novel distractor, facilitated horizontal movement of the dental/alveolar segment along the curvature of the maxillary dental arch. Following a latency period of 4 days distraction was applied for 7 days at a rate of 0.5 mm twice daily. Radiographic, ultrasonographic and clinical assessment revealed new bone and soft tissue formation 8 weeks after completion of the distraction phase. Overall the maxillary segment did move minimising the width of the cleft, which allowed successful closure with a secondary alveolar bone graft. PMID:24987601

Segmental maxillary distraction with a novel device for closure of a wide alveolar cleft.

PubMed

Bousdras, Vasilios A; Liyanage, Chandra; Mars, Michael; Ayliffe, Peter R

2014-01-01

Treatment of a wide alveolar cleft with initial application of segmental distraction osteogenesis is reported, in order to minimise cleft size prior to secondary alveolar bone grafting. The lesser maxillary segment was mobilised with osteotomy at Le Fort I level and, a novel distractor, facilitated horizontal movement of the dental/alveolar segment along the curvature of the maxillary dental arch. Following a latency period of 4 days distraction was applied for 7 days at a rate of 0.5 mm twice daily. Radiographic, ultrasonographic and clinical assessment revealed new bone and soft tissue formation 8 weeks after completion of the distraction phase. Overall the maxillary segment did move minimising the width of the cleft, which allowed successful closure with a secondary alveolar bone graft.

Personal Communication Device Use by Nurses Providing In-Patient Care: Survey of Prevalence, Patterns, and Distraction Potential.

PubMed

McBride, Deborah L; LeVasseur, Sandra A

2017-04-13

Coincident with the proliferation of employer-provided mobile communication devices, personal communication devices, including basic and enhanced mobile phones (smartphones) and tablet computers that are owned by the user, have become ubiquitous among registered nurses working in hospitals. While there are numerous benefits of personal communication device use by nurses at work, little is known about the impact of these devices on in-patient care. Our aim was to examine how hospital-registered nurses use their personal communication devices while doing both work-related and non‒work-related activities and to assess the impact of these devices on in-patient care. A previously validated survey was emailed to 14,797 members of two national nursing organizations. Participants were asked about personal communication device use and their opinions about the impact of these devices on their own and their colleagues' work. Of the 1268 respondents (8.57% response rate), only 5.65% (70/1237) never used their personal communication device at work (excluding lunch and breaks). Respondents self-reported using their personal communication devices at work for work-related activities including checking or sending text messages or emails to health care team members (29.02%, 363/1251), as a calculator (25.34%, 316/1247), and to access work-related medical information (20.13%, 251/1247). Fewer nurses reported using their devices for non‒work-related activities including checking or sending text messages or emails to friends and family (18.75%, 235/1253), shopping (5.14%, 64/1244), or playing games (2.73%, 34/1249). A minority of respondents believe that their personal device use at work had a positive effect on their work including reducing stress (29.88%, 369/1235), benefiting patient care (28.74%, 357/1242), improving coordination of patient care among the health care team (25.34%, 315/1243), or increasing unit teamwork (17.70%, 220/1243). A majority (69.06%, 848/1228) of respondents believe that on average personal communication devices have a more negative than positive impact on patient care and 39.07% (481/1231) reported that personal communication devices were always or often a distraction while working. Respondents acknowledged their own device use negatively affected their work performance (7.56%, 94/1243), or caused them to miss important clinical information (3.83%, 47/1225) or make a medical error (0.90%, 11/1218). Respondents reported witnessing another nurse's use of devices negatively affect their work performance (69.41%, 860/1239), or cause them to miss important clinical information (30.61%, 378/1235) or make a medical error (12.51%, 155/1239). Younger respondents reported greater device use while at work than older respondents and generally had more positive opinions about the impact of personal communication devices on their work. The majority of registered nurses believe that the use of personal communication devices on hospital units raises significant safety issues. The high rate of respondents who saw colleagues distracted by their devices compared to the rate who acknowledged their own distraction may be an indication that nurses are unaware of their own attention deficits while using their devices. There were clear generational differences in personal communication device use at work and opinions about the impact of these devices on patient care. Professional codes of conduct for personal communication device use by hospital nurses need to be developed that maximize the benefits of personal communication device use, while reducing the potential for distraction and adverse outcomes. ©Deborah L McBride, Sandra A LeVasseur. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 13.04.2017.

[Multimodal distraction to relieve pain in children undergoing acute medical procedures].

PubMed

Miller, Kate; Rodger, Sylvia; Bucolo, Sam; Wang, Xue-Qing; Kimble, Roy M

2009-10-01

Non-pharmacological approaches to pain management have been used by therapists for decades to reduce the anxiety and pain experienced by children during burn care procedures. With a greater understanding of pain and the principles behind what causes a child to be distracted, combined with access to state of the art technology, we have developed an easy to use, hand held multimodal distraction device (MMD). MMD is an interactive device that prepares the child for a procedure and uses developmentally appropriate distraction stories and games during the procedures to alleviate anxiety and pain. This paper summarizes the results of three randomized control trials. The trials aimed to understand the effectiveness of MMD as a distraction and preparation tool in reducing anxiety and pain in children undergoing burns and non-burns medical procedures compared to pure pharmacological approaches Standard Distraction (SD) and off the shelf video games (VG). Three separate prospective randomized control trials involving 182 children having 354 dressing changes were conducted in the burns and orthopedic departments at Royal Children's Hospital, Brisbane, Australia, to address the above aims. Pain and anxiety scores were completed for the child, caregiver and nursing staff according to the Modified Faces, Legs, Activity, Cry and Consolability Scale, Faces Pain Scale-Revised, Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale. Procedural length was recorded. MMD as a preparation and distraction tool were shown to have a significant impact on child, parent and nursing staff reported anxiety and pain during procedures compared to standard care and video games (P < 0.01). The MMD had a positive effect on clinical time and was shown to sustain its impact on pain and time with further dressing changes. MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures as compared with SD and VG. MMD is continuing to be trialed and is continuing to show positive clinical outcomes.

Six weeks of continuous joint distraction appears sufficient for clinical benefit and cartilaginous tissue repair in the treatment of knee osteoarthritis.

PubMed

van der Woude, J A D; van Heerwaarden, R J; Spruijt, S; Eckstein, F; Maschek, S; van Roermund, P M; Custers, R J H; van Spil, W E; Mastbergen, S C; Lafeber, F P J G

2016-10-01

Knee joint distraction (KJD) is a surgical joint-preserving treatment in which the knee joint is temporarily distracted by an external frame. It is associated with joint tissue repair and clinical improvement. Initially, patients were submitted to an eight-week distraction period, and currently patients are submitted to a six-week distraction period. This study evaluates whether a shorter distraction period influences the outcome. Both groups consisted of 20 patients. Clinical outcome was assessed by WOMAC questionnaires and VAS-pain. Cartilaginous tissue repair was assessed by radiographic joint space width (JSW) and MRI-observed cartilage thickness. Baseline data between both groups were comparable. Both groups showed an increase in total WOMAC score; 24±4 in the six-week group and 32±5 in the eight-week group (both p<0.001). Mean JSW increased 0.9±0.3mm in the six-week group and 1.1±0.3mm in the eight-week group (p=0.729 between groups). The increase in mean cartilage thickness on MRI was 0.6±0.2mm in the eight-week group and 0.4±0.1mm in the six-week group (p=0.277). A shorter distraction period does not influence short-term clinical and structural outcomes statistically significantly, although effect sizes tend to be smaller in six week KJD as compared to eight week KJD. Copyright © 2016 Elsevier B.V. All rights reserved.

Muscle response to leg lengthening during distraction osteogenesis.

PubMed

Thorey, Fritz; Bruenger, Jens; Windhagen, Henning; Witte, Frank

2009-04-01

Continuous lengthening of intact muscles during distraction osteogenesis leads to an increase of sarcomeres and enhances the regeneration of tendons and blood vessels. A high distraction rate leads to an excessive leg and muscle lengthening and might cause damages of muscle fibers with fibrosis, necrosis, and muscle weakness. Complications like muscle contractures or atrophy after postoperative immobilization emphazize the importance of muscles and their function in the clinical outcome. In an animal model of distraction osteogenesis, 18 sheep were operated with an external fixator followed by 4 days latency, 21 days distraction (1.25 mm per day) and 51 days consolidation. The anatomical location (gastrocnemius, peroneus tertius, and first flexor digitorum longus muscle), dimension and occurrence of muscular defects were characterized histologically. The callus formation and leg axis was monitored by weekly X-rays. Additionally, serum creatine kinase was analyzed during a distraction and consolidation period. Significant signs of muscle lesions in all three observed muscles can be found postoperatively, whereas normal callus formation and regular leg axis was observed radiologically. The peroneus tertius and first flexor digitorum longus muscles were found to have significantly more signs of fibrosis, inflammatory, and necrosis. Creatine kinase showed two peaks: 4 and 39 days postoperative as an indication of muscle damage and regeneration. The study implicates that muscle damages should be considered when a long-distance distraction osteogenesis is planned. The surgeon should consider these muscle responses and individually discuss a two-stage treatment or additional muscle tendon releases to minimize the risk of muscle damages.

Five Tips for Managing Mobile Devices

ERIC Educational Resources Information Center

Tucker, Catlin

2015-01-01

The author, an outspoken advocate for using technology in the classroom, knows how important it is to establish expectations for responsible use of mobile devices. She's found that five strategies help ensure that mobile devices enhance, rather than distract from, learning. Teachers need to establish new norms that clarify responsible use,…

Ambulatory cell phone injuries in the United States: an emerging national concern.

PubMed

Smith, Daniel C; Schreiber, Kristin M; Saltos, Andreas; Lichenstein, Sarah B; Lichenstein, Richard

2013-12-01

Over the past 15 years, the use of cell phones has increased 8-fold in the United States. Cell phone use has been shown to increase crash risks for drivers, but no systematic analyses have described injuries related to ambulatory cell phone use. The purpose of this study is to describe and quantitate injuries and deaths among persons using cell phones while walking. We searched the National Electronic Injury Surveillance System (NEISS) for emergency department (ED) reports of injuries related to phone use. The cases that returned were screened initially using words that would eliminate cases unlikely to be related to cell phone use and walking, possibly linked to distraction. The resulting cases were randomized and evaluated for consistency with predetermined case definitions by two authors blinded to the dates of the incidents. Cases that were disagreed upon were evaluated in a second screening by both authors for final case determination. National ED visit rates were estimated based on NEISS sampling methods. Annual variations were analyzed using linear regression with a restricted maximum likelihood approach. Our screening process identified 5,754 possible cases that occurred between 2000 and 2011, and 310 were agreed on as cases of cell-phone-induced distraction. The majority of the patients were female (68%) and 40 years of age or younger (54%). The primary mechanism of injury was a fall (72%), and most patients were treated and released from the ED (85%). No patients died from their injuries while they were in the ED. Linear modeling by year revealed a statistically significant increase in distraction injury rates over the years of study (p<0.001 for trend). The number of ED visits by ambulatory persons injured while being distracted by cell phone use has been increasing. More research is needed to determine the risks associated with walking and talking on a cell phone and to develop strategies for intervention. Cell phone use continues to increase both at home and outdoor environments. The use of smart phones, with their more enticing features, increases the likelihood of distraction-induced injuries even more. Manufacturers should consider the addition of tools or applications on smart phones to remind users to remain alert to outside auditory stimuli that herald external hazards and to encourage them to not use these devices while engaged in other activities. © 2013.

Bring Your Own Device or Bring Your Own Distraction

ERIC Educational Resources Information Center

Laxman, Kumar; Holt, Craig

2017-01-01

The purpose of this exploratory case study was to investigate the utilisation of Bring Your Own Device (BYOD) technologies in the classroom to determine if students and teachers perceive that the use of a digital device increased a learner's access to learning opportunities within the classroom, and, if the use of digital devices increased their…

The epidemic of distraction.

PubMed

Weksler, Marc E; Weksler, Babette B

2012-01-01

Multitasking is a rapidly growing phenomenon affecting all segments of the population but is rarely as successful as its proponents believe. The use of mobile electronic devices contributes importantly to multitasking and cognitive overload. Although personal electronic devices provide many benefits, their adverse effects are frequently overlooked. Personal observation and a review of the scientific literature supports the view that overuse or misuse of personal electronic devices promotes cognitive overload, impairs multitasking and lowers performance at all ages but particularly in the elderly. This phenomenon appears to be rapidly increasing and threatens to become a tsunami as spreading electronic waves cause an 'epidemic of distraction'. Mobile electronic devices often bring benefits to their users in terms of rapid access to information. However, there is a dark side to the increasing addiction to these devices that challenges the health and well-being of the entire population, targeting, in particular, the aged and infirm. New approaches to information gathering can foster creativity if cognitive overload is avoided. Copyright © 2012 S. Karger AG, Basel.

Strategies for reducing driver distraction from in-vehicle telematics devices : a discussion document

DOT National Transportation Integrated Search

2003-04-01

"In-Vehicle Telematics" refers to devices incorporating wireless communications technologies in order to provide information services, vehicle automation and other functions. While cellular phones are currently the most common type of telematics devi...

Maxillary distraction osteogenesis in cleft lip and palate patients with skeletal anchorage.

PubMed

Minami, Katsuhiro; Mori, Yoshihide; Tae-Geon, Kwon; Shimizu, Hidetaka; Ohtani, Miyuki; Yura, Yoshiaki

2007-03-01

Maxillary distraction osteogenesis with the rigid external distraction (RED) system has been used to treat cleft lip and palate (CLP) patients with severe maxillary hypoplasia. We introduce maxillary distraction osteogenesis for CLP patients with skeletal anchorage adapted on a stereolithographic model. Six maxillary deficiency CLP patients treated according to our CLP treatment protocol had undergone maxillary distraction osteogenesis. In all patients, computed tomography (CT) images were recorded preoperatively, and the data were transferred to a workstation. Three-dimensional skeletal structures were reconstructed with CT data sets, and a stereolithographic model was produced. On the stereolithographic model, miniplates were adapted to the surface of maxilla beside aperture piriforms. The operation performed involved a high Le Fort I osteotomy with pterygomaxillary disjunction. Miniplates were fixed to the maxillary segment with three or four screws and used for anchorage of the RED system. Retraction of the maxillary segment was initiated after 1 week. The accuracy of the stereolithographic models was enough to adapt the miniplates so that there was no need to readjust the plates during surgery. Postoperative cephalometric analysis showed that the direction of the retraction was almost parallel to the palatal plane, and dental compensation did not occur. We performed maxillary distraction osteogenesis with skeletal anchorage adapted on the stereolithographic models. Excellent esthetic outcome and skeletal advancement were achieved without dentoalveolar compensations.

76 FR 23923 - Hazardous Materials: Restricting the Use of Cellular Phones by Drivers of Commercial Motor...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

... associated with the use of cellular (mobile) phones and electronic devices while operating a commercial motor... mobile communication device that falls under or uses any commercial mobile radio service, as defined in... restricting the use of mobile telephones and other distracting electronic devices by railroad operating...

Radiographic Outcomes of Dorsal Distraction Distal Radius Plating for Fractures With Dorsal Marginal Impaction.

PubMed

Huish, Eric G; Coury, John G; Ibrahim, Mohamed A; Trzeciak, Marc A

2017-04-01

The purpose of this study is to compare radiographic outcomes of patients treated with dorsal spanning plates with previously reported normal values of radiographic distal radius anatomy and compare the results with prior publications for both external fixation and internal fixation with volar locked plates. Patients with complex distal radius fractures including dorsal marginal impaction pattern necessitating dorsal distraction plating at the discretion of the senior authors (M.A.T. and M.A.I.) from May 30, 2013, to December 29, 2015, were identified and included in the study. Retrospective chart and radiograph review was performed on 19 patients, 11 male and 8 female, with mean age of 47.83 years (22-82). No patients were excluded from the study. All fractures united prior to plate removal. The average time the plate was in place was 80.5 days (49-129). Follow-up radiographs showed average radial inclination of 20.5° (13.2°-25.5°), radial height of 10.7 mm (7.5-14 mm), ulnar variance of -0.3 mm (-2.1 to 3.1 mm), and volar tilt of 7.9° (-3° to 15°). One patient had intra-articular step-off greater than 2 mm. Dorsal distraction plating of complex distal radius fractures yields good radiographic results with minimal complications. In cases of complex distal radius fractures including dorsal marginal impaction where volar plating is not considered adequate, a dorsal distraction plate should be considered as an alternative to external fixation due to reduced risk for infection and better control of volar tilt.

Driver Distraction Using Visual-Based Sensors and Algorithms.

PubMed

Fernández, Alberto; Usamentiaga, Rubén; Carús, Juan Luis; Casado, Rubén

2016-10-28

Driver distraction, defined as the diversion of attention away from activities critical for safe driving toward a competing activity, is increasingly recognized as a significant source of injuries and fatalities on the roadway. Additionally, the trend towards increasing the use of in-vehicle information systems is critical because they induce visual, biomechanical and cognitive distraction and may affect driving performance in qualitatively different ways. Non-intrusive methods are strongly preferred for monitoring distraction, and vision-based systems have appeared to be attractive for both drivers and researchers. Biomechanical, visual and cognitive distractions are the most commonly detected types in video-based algorithms. Many distraction detection systems only use a single visual cue and therefore, they may be easily disturbed when occlusion or illumination changes appear. Moreover, the combination of these visual cues is a key and challenging aspect in the development of robust distraction detection systems. These visual cues can be extracted mainly by using face monitoring systems but they should be completed with more visual cues (e.g., hands or body information) or even, distraction detection from specific actions (e.g., phone usage). Additionally, these algorithms should be included in an embedded device or system inside a car. This is not a trivial task and several requirements must be taken into account: reliability, real-time performance, low cost, small size, low power consumption, flexibility and short time-to-market. The key points for the development and implementation of sensors to carry out the detection of distraction will also be reviewed. This paper shows a review of the role of computer vision technology applied to the development of monitoring systems to detect distraction. Some key points considered as both future work and challenges ahead yet to be solved will also be addressed.

Anterior ankle arthroscopy, distraction or dorsiflexion?

PubMed

de Leeuw, Peter A J; Golanó, Pau; Clavero, Joan A; van Dijk, C Niek

2010-05-01

Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, whereas in ankle distraction the anterior neurovascular bundle is pulled tight towards the joint, thereby decreasing the safe anterior working area. Six fresh frozen ankle specimens, amputated above the knee, were scanned with computed tomography. Prior to scanning the anterior tibial artery was injected with contrast fluid and subsequently each ankle was scanned both in ankle dorsiflexion and in distraction. A special device was developed to reproducibly obtain ankle dorsiflexion and distraction in the computed tomography scanner. The distance between the anterior border of the inferior tibial articular facet and the posterior border of the anterior tibial artery was measured. The median distance from the anterior border of the inferior tibial articular facet to the posterior border of the anterior tibial artery in ankle dorsiflexion and distraction was 0.9 cm (range 0.7-1.5) and 0.7 cm (range 0.5-0.8), respectively. The distance in ankle dorsiflexion significantly exceeded the distance in ankle distraction (P = 0.03). The current study shows a significantly increased distance between the anterior distal tibia and the overlying anterior neurovascular bundle with the ankle in a slightly dorsiflexed position as compared to the distracted ankle position. We thereby conclude that the distracted ankle position puts the neurovascular structures more at risk for iatrogenic damage when performing anterior ankle arthroscopy.

Anterior ankle arthroscopy, distraction or dorsiflexion?

PubMed Central

Golanó, Pau; Clavero, Joan A.; van Dijk, C. Niek

2010-01-01

Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, whereas in ankle distraction the anterior neurovascular bundle is pulled tight towards the joint, thereby decreasing the safe anterior working area. Six fresh frozen ankle specimens, amputated above the knee, were scanned with computed tomography. Prior to scanning the anterior tibial artery was injected with contrast fluid and subsequently each ankle was scanned both in ankle dorsiflexion and in distraction. A special device was developed to reproducibly obtain ankle dorsiflexion and distraction in the computed tomography scanner. The distance between the anterior border of the inferior tibial articular facet and the posterior border of the anterior tibial artery was measured. The median distance from the anterior border of the inferior tibial articular facet to the posterior border of the anterior tibial artery in ankle dorsiflexion and distraction was 0.9 cm (range 0.7–1.5) and 0.7 cm (range 0.5–0.8), respectively. The distance in ankle dorsiflexion significantly exceeded the distance in ankle distraction (P = 0.03). The current study shows a significantly increased distance between the anterior distal tibia and the overlying anterior neurovascular bundle with the ankle in a slightly dorsiflexed position as compared to the distracted ankle position. We thereby conclude that the distracted ankle position puts the neurovascular structures more at risk for iatrogenic damage when performing anterior ankle arthroscopy. PMID:20217392

Driver Distraction Using Visual-Based Sensors and Algorithms

PubMed Central

Fernández, Alberto; Usamentiaga, Rubén; Carús, Juan Luis; Casado, Rubén

2016-01-01

Driver distraction, defined as the diversion of attention away from activities critical for safe driving toward a competing activity, is increasingly recognized as a significant source of injuries and fatalities on the roadway. Additionally, the trend towards increasing the use of in-vehicle information systems is critical because they induce visual, biomechanical and cognitive distraction and may affect driving performance in qualitatively different ways. Non-intrusive methods are strongly preferred for monitoring distraction, and vision-based systems have appeared to be attractive for both drivers and researchers. Biomechanical, visual and cognitive distractions are the most commonly detected types in video-based algorithms. Many distraction detection systems only use a single visual cue and therefore, they may be easily disturbed when occlusion or illumination changes appear. Moreover, the combination of these visual cues is a key and challenging aspect in the development of robust distraction detection systems. These visual cues can be extracted mainly by using face monitoring systems but they should be completed with more visual cues (e.g., hands or body information) or even, distraction detection from specific actions (e.g., phone usage). Additionally, these algorithms should be included in an embedded device or system inside a car. This is not a trivial task and several requirements must be taken into account: reliability, real-time performance, low cost, small size, low power consumption, flexibility and short time-to-market. The key points for the development and implementation of sensors to carry out the detection of distraction will also be reviewed. This paper shows a review of the role of computer vision technology applied to the development of monitoring systems to detect distraction. Some key points considered as both future work and challenges ahead yet to be solved will also be addressed. PMID:27801822

[Effects of hyperbaric oxygen treatment on healing of maxillary distraction osteogenesis in beagle dogs].

PubMed

Kudoh, Atsuo

2008-03-01

Distraction osteogenesis has been widely used even in the craniofacial region. A long fixation time during the consolidation period, however, is a major clinical disadvantage. Hyperbaric oxygen (HBO) has been used to improve healing in ischemic wounds. We have recently started applying hyperbaric oxygen to cleft palate patients after maxillary distraction, but there is little basic evidence. We hypothesized that hyperbaric oxygen would enhance the healing of distraction osteogenesis in the cleft palate model in dogs. A bony segment including a canine was transported proximally into an artificial bone defect in the left palate. Three dogs were treated with hyperbaric oxygen for 20 days just after the distraction and three other dogs underwent only the distraction process (control group). Blood flow of the canine pulp in the bone segment was monitored using a laser Doppler flowmeter throughout the experiment. All the dogs were sacrificed on day 100, and radiological analysis using peripheral quantitative CT and histomorphometric evaluations were performed. Blood flow in the HBO-treated group recovered to the original level about 30 days faster than in the control group (p<0.05). Cortical bone mineral density was significantly higher at the distraction site in the HBO-treated group than in the control group (p<0.05). The histomorphometric analysis revealed that the newly formed bone area was also larger in the HBO-treated group than in the control group (p<0.05). These results suggest that hyperbaric oxygen treatment could be useful for early removal of the distraction device in distraction osteogenesis.

Five-year follow-up of maxillary distraction osteogenesis on the dentofacial structures of children with cleft lip and palate.

PubMed

Gürsoy, Seda; Hukki, Jyri; Hurmerinta, Kirsti

2010-04-01

To determine the long-term outcomes of maxillary distraction osteogenesis (DO) on skeletal and dental structures of growing children with cleft lip and palate. Severe maxillary deficiencies were treated with a rigid external distractor device followed by a consolidation period. Preoperative and postoperative orthodontic treatment lasted a mean of 14 months and 16 months, respectively. The landmarks on standard lateral cephalometric x-rays were digitized and angular and linear measurements were compared by Student's t test to assess the changes before distraction, after distraction, after consolidation, at 1-year follow-up, and at 2-year follow-up. Long-term follow-up (5 years) was interpreted according to mean values because of the small sample size. During DO, the maxilla was horizontally advanced and moved downward as indicated by the significant changes at the SNA and ANB angles (13 degrees) and at maxillary points A, ANS, and PNS. The increase at the divergence between the maxilla and mandible (ANS-PNS/Me-Go) was found to be significant. The mandible (B, Pg, Me) also moved downward (2-4 mm) and backward (Gn) significantly because of mandibular autorotation. The overjet increased (mean increase, 13.7 mm) and the overbite decreased significantly. The advancement of the upper incisors (13.3 mm) and upper molars (12.3 mm) was slightly more than the skeletal points. In a long-term follow-up (5 years), the ANB angle and horizontal overjet continued to decrease but both values remained positive, indicating a Class I relationship. This cephalometric study of young adolescents with cleft lips and palates found great improvement in dentofacial structure after maxillary DO and stability in maxillary skeletal advancement. During a 5-year follow-up, the achieved dentoskeletal treatment outcome was partly diminished. The extreme need for maxillary advancement or facial correction because of psychosocial stress and providing an easier approach for finalizing osteotomy are the major 2 indications for DO treatment. 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Regenerate Healing Outcomes in Unilateral Mandibular Distraction Osteogenesis Using Quantitative Histomorphometry

PubMed Central

Schwarz, Daniel A.; Arman, Krikor G.; Kakwan, Mehreen S.; Jamali, Ameen M.; Elmeligy, Ayman A.; Buchman, Steven R.

2015-01-01

Background The authors’ goal was to ascertain regenerate bone-healing metrics using quantitative histomorphometry at a single consolidation period. Methods Rats underwent either mandibular distraction osteogenesis (n=7) or partially reduced fractures (n=7); their contralateral mandibles were used as controls (n=11). External fixators were secured and unilateral osteotomies performed, followed by either mandibular distraction osteogenesis (4 days’ latency, then 0.3 mm every 12 hours for 8 days; 5.1 mm) or partially reduced fractures (fixed immediately postoperatively; 2.1 mm); both groups underwent 4 weeks of consolidation. After tissue processing, bone volume/tissue volume ratio, osteoid volume/tissue volume ratio, and osteocyte count per high-power field were analyzed by means of quantitative histomorphometry. Results Contralateral mandibles had statistically greater bone volume/tissue volume ratio and osteocyte count per high-power field compared with both mandibular distraction osteogenesis and partially reduced fractures by almost 50 percent, whereas osteoid volume/tissue volume ratio was statistically greater in both mandibular distraction osteogenesis specimens and partially reduced fractures compared with contralateral mandibles. No statistical difference in bone volume/tissue volume ratio, osteoid volume/tissue volume ratio, or osteocyte count per high-power field was found between mandibular distraction osteogenesis specimens and partially reduced fractures. Conclusions The authors’ findings demonstrate significantly decreased bone quantity and maturity in mandibular distraction osteogenesis specimens and partially reduced fractures compared with contralateral mandibles using the clinically analogous protocols. If these results are extrapolated clinically, treatment strategies may require modification to ensure reliable, predictable, and improved outcomes. PMID:20463629

Maxillary distraction osteogenesis in the adolescent cleft patient: three-dimensional computed tomography analysis of linear and volumetric changes over five years.

PubMed

Chen, Philip Kuo-Ting; Por, Yong-Chen; Liou, Eric Jein-Wein; Chang, Frank Chun-Shin

2011-07-01

To assess the results of maxillary distraction osteogenesis with the Rigid External Distraction System using three-dimensional computed tomography scan volume-rendered images with respect to stability and facial growth at three time frames: preoperative (T0), 1-year postoperative (T1), and 5-years postoperative (T2). Retrospective analysis. Tertiary. A total of 12 patients with severe cleft maxillary hypoplasia were treated between June 30, 1997, and July 15, 1998. The mean age at surgery was 11 years 1 month. Le Fort I maxillary distraction osteogenesis. Distraction was started 2 to 5 days postsurgery at a rate of 1 mm per day. The consolidation period was 3 months. No face mask was used. A paired t test was used for statistical analysis. Overjet, ANB, and SNA and maxillary, pterygoid, and mandibular volumes. From T0 to T1, there were statistically significant increments of overjet, ANB, and SNA and maxillary, pterygoid, and mandibular volumes. The T1 to T2 period demonstrated a reduction of overjet (30.07%) and ANB (54.42%). The maxilla showed a stable SNA and a small but statistically significant advancement of the ANS point. There was a significant increase in the mandibular volume. However, there was no significant change in the maxillary and pterygoid volumes. Maxillary distraction osteogenesis demonstrated linear and volumetric maxillary growth during the distraction phase without clinically significant continued growth thereafter. Overcorrection is required to take into account recurrence of midface retrusion over the long term.

Two-stage distraction lengthening of the forearm.

PubMed

Taghinia, Amir H; Al-Sheikh, Ayman A; Panossian, Andre E; Upton, Joseph

2013-01-01

Single-stage lengthening of the forearm using callus distraction is well described; however, forearm lengthening using a 2-stage technique of distraction followed by bone grafting has received less attention. A 2-staged technique can be a better alternative in cases where the surgeon desires extensive lengthening. A retrospective review was undertaken of eleven 2-stage forearm lengthening procedures performed by 1 surgeon over a 15-year period. Indications were radial longitudinal deficiency (8 patients), neonatal ischemic contractures (2 patients), and septic growth arrest (1 patient). Average follow-up was 2.8 years. Distraction was performed on patients an average of 82 mm over an average duration of 24 weeks. Average time to union from the time of distractor removal and grafting was 87 days. Average healing index was 32.1 d/cm. Distraction problems were common and related to the length of time that the distractor was in place; they included pain, pin-related infections, and multiple mechanical device difficulties. Three patients had nonunion, and another had delayed union; however, additional procedures resulted in ultimate bony union in all patients. Demineralized bone matrix and autologous corticocancellous bone grafts yielded predictable healing and good functional results in short-distance distractions. For longer distractions, free vascularized fibula transfer produced the best outcomes. Intercalary cortical allografts did not heal well. Patients with neonatal Volkmann contractures had the most difficulty with distraction and healing, ultimately obtaining little to no lengthening and poor functional outcomes.

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia

PubMed Central

Mitsugi, Masaharu; Alcalde, Rafael E.; Yano, Tomoyuki; Uemura, Noriko; Okazaki, Mutsumi

2015-01-01

Backgrounds: The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. Methods: After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. Results: As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Conclusion Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained. PMID:26301156

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia.

PubMed

Ito, Osamu; Mitsugi, Masaharu; Alcalde, Rafael E; Yano, Tomoyuki; Uemura, Noriko; Okazaki, Mutsumi

2015-07-01

The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained.

Factors associated with civilian drivers involved in crashes with emergency vehicles.

PubMed

Drucker, Christopher; Gerberich, Susan G; Manser, Michael P; Alexander, Bruce H; Church, Timothy R; Ryan, Andrew D; Becic, Ensar

2013-06-01

Motor vehicle crashes involving civilian and emergency vehicles (EVs) have been a known problem that contributes to fatal and nonfatal injuries; however, characteristics associated with civilian drivers have not been examined adequately. This study used data from The National Highway Traffic Safety Administration's Fatality Analysis Reporting System and the National Automotive Sampling System General Estimates System to identify driver, roadway, environmental, and crash factors, and consequences for civilian drivers involved in fatal and nonfatal crashes with in-use and in-transport EVs. In general, drivers involved in emergency-civilian crashes (ECCs) were more often driving: straight through intersections (vs. same direction) of four-points or more (vs. not at intersection); where traffic signals were present (vs. no traffic control device); and at night (vs. midday). For nonfatal ECCs, drivers were more often driving: distracted (vs. not distracted); with vision obstructed by external objects (vs. no obstruction); on dark but lighted roads (vs. daylight); and in opposite directions (vs. same directions) of the EVs. Consequences included increased risk of injury (vs. no injury) and receiving traffic violations (vs. no violation). Fatal ECCs were associated with driving on urban roads (vs. rural), although these types of crashes were less likely to occur on dark roads (vs. daylight). The findings of this study suggest drivers may have difficulties in visually detecting EVs in different environments. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effect of gradual weight-bearing on regenerated articular cartilage after joint distraction and motion in a rabbit model.

PubMed

Nishino, Tomofumi; Ishii, Tomoo; Chang, Fei; Yanai, Takaji; Watanabe, Arata; Ogawa, Takeshi; Mishima, Hajime; Nakai, Kenjiro; Ochiai, Naoyuki

2010-05-01

The purpose of this study was to clarify the effect of gradual weight bearing (GWB) on regenerating cartilage. We developed a novel external fixation device (EFD) with a controllable weight-bearing system and continuous passive motion (CPM). A full-thickness defect was created by resection of the entire articular surface of the tibial plateau after the EFD was fixed in the rabbit's left knee. In the GWB group (n=6), GWB was started 6 weeks after surgery. In the CPM group (n=6), CPM with EFD was applied in the same manner without GWB. The control group (n=5) received only joint distraction. All rabbits were sacrificed 9 weeks after surgery. The central one-third of the regenerated tissue was assessed and scored blindly using a grading scale modified from the International Cartilage Repair Society visual histological assessment scale. The areas stained by Safranin-O and type II collagen antibody were measured, and the percentage of each area was calculated. There was no significant difference in the histological assessment scale among the groups. The percentage of the type II collagen-positive area was significantly larger in the GWB group than in the CPM group. The present study suggests that optimal mechanical stress, such as GWB, may affect regeneration of cartilage, in vivo. Copyright (c) 2009 Orthopaedic Research Society.

Hinged external fixation of the elbow.

PubMed

Chen, Neal C; Julka, Abhishek

2010-08-01

Hinged external fixation of the elbow provides the advantages of static fixation with the benefits of continued motion through the joint. Indications for the use of this method of fixation include traumatic instability, distraction interposition arthroplasty, instability after contracture release, and instability after excision of heterotopic ossification. Orthopedic surgeons should be familiar with hinged fixators and their application when faced with an unstable ulnohumeral joint. 2010 Elsevier Inc. All rights reserved.

The natural limb is best: joint preservation and reconstruction by distraction osteogenesis for high-grade juxta-articular osteosarcomas.

PubMed

Tsuchiya, Hiroyuki; Abdel-Wanis, Mohamed E; Kitano, Shinji; Sakurakichi, Keisuke; Yamashiro, Teruhisa; Tomita, Katsuro

2002-01-01

This paper introduces an innovative technique of highly conservative limb-saving surgery for juxta-articular osteosarcoma. This technique consists of marginal tumour excision, joint preservation and reconstruction by distraction osteogenesis. Ten patients, with a mean age of 19.5 years and high-grade osteosarcoma, underwent this procedure. The distal femur and proximal tibia were affected in five patients each. After effective pre-operative chemotherapy, the tumour was excised with preservation of the epiphysis, the articular surface and the maximun amount of healthy soft tissue. This was followed by application of an external fixator. Bone transport was performed for seven patients and shortening-distraction for three. The limb function was rated excellent in seven patients, good in one and fair in two. At the final follow-up, three patients were dead after a mean of 25.3 months while seven patients remained free of disease with a mean follow-up of 55.4 months. Joint preservation and biological reconstruction through distraction osteogenesis can produce excellent and long-lasting functional results.

Using Virtual Reality to Distract Overweight Children from Bodily Sensations During Exercise.

PubMed

Baños, Rosa M; Escobar, Patricia; Cebolla, Ausias; Guixeres, Jaime; Alvarez Pitti, Julio; Lisón, Juan Francisco; Botella, Cristina

2016-02-01

This study analyzes the potential of virtual reality (VR) to enhance attentional distraction in overweight children as they experience bodily sensations during exercise. It has been suggested that one reason why obese children stop exercising is the perception of bodily sensations. In a counterbalanced design, a total of 109 children (33 overweight, 10-15 years old) were asked to walk twice for 6 minutes on a treadmill under one of two conditions: (a) traditional condition (TC)-focusing their attention on their physical feelings and sensations or (b) distraction condition (DC)-focusing their attention on a virtual environment. Attentional focus during exercise, bad-good feeling states (pre- and postexperimental), perceived exertion (3 minutes and post), heart rate, and enjoyment were assessed. Results indicated that overweight children focused on internal information under the TC, but they significantly shifted their attention to regard the external environment in the DC. This attentional distraction effect of VR was more intense in overweight than in normal-weight children. No differences between groups were found when examining changes in feeling states and perceived exertion. VR increased enjoyment during exercise, and children preferred exercise using virtual environments. VR is useful to promote distraction and may help overweight and obese children to enjoy exercise.

Using Personal Portable Devices as Learning Tools in the English Class

ERIC Educational Resources Information Center

Herrera Díaz, Luz Edith; Cruz Ramos, María de los Milagros; Sandoval Sánchez, Mario Alberto

2014-01-01

A group of university students used a variety of personal portable devices (cellphones, tablets, laptops, and netbooks) which distracted them in English class. This qualitative action research aimed to implement activities entailing the use of such devices and to learn their impact on students' learning and the use of English in class. Thus, a…

Proactive, Preventive or Indifference? Reaction Modes of Faculty towards Use of Personal Mobile Devices in Courses

ERIC Educational Resources Information Center

Forkosh-Baruch, Alona; Meishar-Tal, Hagit

2016-01-01

Students enter classes with mobile devices and use them for learning; however, these are also distracting devices. Some teacher educators display positive attitudes; others display negative attitudes, depending on their perception of the advantages and disadvantages of mobile technology for learning. This paper represents findings of a study that…

Distraction lengthening of the proximal phalanx in distal thumb amputations.

PubMed

Cansü, Eren; Ünal, Mehmet Bekir; Parmaksızoğlu, Fatih; Gürcan, Serkan

2015-01-01

Thumb amputation is a major cause of hand dysfunction, and the treatment for distal thumb amputations remains controversial. Although finger reconstruction methods using distraction lengthening are known to restore finger length and function, we found no reports in the literature regarding phalangeal lengthening in thumb amputations. We aimed to evaluate proximal phalangeal lengthening in thumb amputations at or near the interphalangeal (IP) joint. We retrospectively evaluated patients who had undergone distraction lengthening of the proximal phalanx of the thumb. All patients underwent osteotomy, either during the initial procedure or as a second-stage procedure. Distraction began 10 days after osteotomy with the use of an external fixator that remained in place until ossification of the gap occurred without bone grafting. Patients were evaluated using the QuickDASH score. Fourteen patients with a mean age of 27 years and a mean follow-up period of 7 years were enrolled. The mean phalangeal lengthening achieved was 20 mm. Ossification occurred at all distraction sites, and the fixators were maintained for a mean of 85 days. The mean healing index was 42.5 days/cm. All 14 patients achieved the desired amount of phalangeal lengthening without major complications such as nonunion, premature union, or gross infection. For reconstruction in cases of distal thumb amputations, distraction lengthening of the proximal phalanx can be used to improve absolute length, web space, and grip distance. The technique is safe and effective, improves functionality/cosmesis, and offers a low complication risk.

Conformational Changes in the Carpus During Finger Traps Distraction

PubMed Central

Leventhal, Evan L.; Moore, Douglas C.; Akelman, Edward; Wolfe, Scott W.; Crisco, Joseph J.

2010-01-01

Introduction Wrist distraction is a common treatment maneuver used clinically for the reduction of distal radial fractures and mid-carpal dislocations. Wrist distraction is also required during wrist arthroscopy to access the radiocarpal joint and has been used as a test for scapholunate ligament injury. However, the effect of a distraction load on the normal wrist has not been well studied. The purpose of this study was to measure the 3-D conformational changes of the carpal bones in the normal wrist as a result of a static distractive load. Methods The dominant wrists of 14 healthy volunteers were scanned using computed tomography at rest and during application of 98N of distraction. Load was applied using finger traps and volunteers were encouraged to relax their forearm muscles and to allow distraction of the wrist. The motions of the bones in the wrist were tracked between the unloaded and loaded trial using markerless bone registration. The average displacement vector of each bone was calculated relative to the radius as well as the interbone distances for 20 bone-bone interactions. Joint separation was estimated at the radiocarpal, midcarpal and carpal-metacarpal joints in the direction of loading using the radius, lunate, capitate and 3rd metacarpal. Results With loading, the distance between the radius and 3rd metacarpal increased an average of 3.3±3.1mm in the direction of loading. This separation was primarily located in the axial direction at the radiocarpal (1.0±1.0mm) and midcarpal (2.0±1.7mm) joints. There were minimal changes in the transverse direction within the distal row, although the proximal row narrowed by 0.98±0.7mm. Distraction between the radius and scaphoid (2.5±2.2mm) was 2.4 times greater than between the radius and lunate (1.0±1.0mm). Conclusions Carpal distraction has a significant effect on the conformation of the carpus, especially at the radiocarpal and midcarpal joints. In the normal wrist, external traction causes twice as much distraction at the lunocapitate joint than at the radiolunate joint. PMID:20141894

Conformational changes in the carpus during finger trap distraction.

PubMed

Leventhal, Evan L; Moore, Douglas C; Akelman, Edward; Wolfe, Scott W; Crisco, Joseph J

2010-02-01

Wrist distraction is a common treatment maneuver used clinically for the reduction of distal radial fractures and midcarpal dislocations. Wrist distraction is also required during wrist arthroscopy to access the radiocarpal joint and has been used as a test for scapholunate ligament injury. However, the effect of a distraction load on the normal wrist has not been well studied. The purpose of this study was to measure the three-dimensional conformational changes of the carpal bones in the normal wrist as a result of a static distractive load. Using computed tomography, the dominant wrists of 14 healthy volunteers were scanned at rest and during application of 98 N of distraction. Load was applied using finger traps, and volunteers were encouraged to relax their forearm muscles and to allow distraction of the wrist. The motions of the bones in the wrist were tracked between the unloaded and loaded trial using markerless bone registration. The average displacement vector of each bone relative to the radius was calculated, as were the interbone distances for 20 bone-bone interactions. Joint separation was estimated at the radiocarpal, midcarpal, and carpometacarpal joints in the direction of loading using the radius, lunate, capitate, and third metacarpal. With loading, the distance between the radius and third metacarpal increased an average of 3.3 mm +/- 3.1 in the direction of loading. This separation was primarily in the axial direction at the radiocarpal (1.0 mm +/- 1.0) and midcarpal (2.0 mm +/- 1.7) joints. There were minimal changes in the transverse direction within the distal row, although the proximal row narrowed by 0.98 mm +/- 0.7. Distraction between the radius and scaphoid (2.5 mm +/- 2.2) was 2.4 times greater than that between the radius and lunate (1.0 mm +/- 1.0). Carpal distraction has a significant (p < .01) effect on the conformation of the carpus, especially at the radiocarpal and midcarpal joints. In the normal wrist, external traction causes twice as much distraction at the lunocapitate joint than at the radiolunate joint. Copyright 2010. Published by Elsevier Inc.

Fatalities of pedestrians, bicycle riders, and motorists due to distracted driving motor vehicle crashes in the U.S., 2005-2010.

PubMed

Stimpson, Jim P; Wilson, Fernando A; Muelleman, Robert L

2013-01-01

Distracted driving is an increasingly deadly threat to road safety. This study documents trends in and characteristics of pedestrian, bicycle rider, and other victim deaths caused by distracted drivers on U.S. public roads. We obtained data from the Fatality Analysis Reporting System database from 2005 to 2010 on every crash that resulted in at least one fatality within 30 days occurring on public roads in the U.S. Following the definition used by the National Highway Traffic Safety Administration, we identified distracted driving based on whether police investigators determined that a driver had been using a technological device, including a cell phone, onboard navigation system, computer, fax machine, two-way radio, or head-up display, or had been engaged in inattentive or careless activities. The rate of fatalities per 10 billion vehicle miles traveled increased from 116.1 in 2005 to 168.6 in 2010 for pedestrians and from 18.7 in 2005 to 24.6 in 2010 for bicyclists. Pedestrian victims of distracted driving crashes were disproportionately male, 25-64 years of age, and non-Hispanic white. They were also more likely to die at nighttime, be struck by a distracted driver outside of a marked crosswalk, and be in a metro location. Bicycling victims of distracted crashes were disproportionately male, non-Hispanic white, and struck by a distracted driver outside of a crosswalk. Compared with pedestrians, bicyclists were less likely to be hit in early morning. Distracted drivers are the cause of an increasing share of fatalities found among pedestrians and bicycle riders. Policies are needed to protect pedestrians and bicycle riders as they cross intersections or travel on roadways.

Biomechanical comparison of two intraoperative mobilization techniques for maxillary distraction osteogenesis: Down-fracture versus non-down-fracture.

PubMed

Yang, Lili; Suzuki, Eduardo Yugo; Suzuki, Boonsiva

2014-01-01

The purpose of this study was to compare the distraction forces and the biomechanical effects between two different intraoperative surgical procedures (down-fracture [DF] and non-DF [NDF]) for maxillary distraction osteogenesis. Eight patients were assigned into two groups according to the surgical procedure: DF, n = 6 versus NDF, n = 2. Lateral cephalograms taken preoperatively (T1), immediately after removal of the distraction device (T2), and after at least a 6 months follow-up period (T3) were analyzed. Assessment of distraction forces was performed during the distraction period. The Mann-Whitney U-test was used to compare the difference in the amount of advancement, the maximum distraction force and the amount of relapse. Although a significantly greater amount of maxillary movement was observed in the DF group (median 9.5 mm; minimum-maximum 7.9-14.1 mm) than in the NDF group (median 5.9 mm; minimum-maximum 4.4-7.6 mm), significantly lower maximum distraction forces were observed in the DF (median 16.4 N; minimum-maximum 15.1-24.6 N) than in the NDF (median 32.9 N; minimum-maximum 27.6-38.2 N) group. A significantly greater amount of dental anchorage loss was observed in the NDF group. Moreover, the amount of relapse observed in the NDF group was approximately 3.5 times greater than in the DF group. In this study, it seemed that, the use of the NDF procedure resulted in lower levels of maxillary mobility at the time of the maxillary distraction, consequently requiring greater amounts of force to advance the maxillary bone. Moreover, it also resulted in a reduced amount of maxillary movement, a greater amount of dental anchorage loss and poor treatment stability.

The effects of iPod and text-messaging use on driver distraction: a bio-behavioral analysis.

PubMed

Mouloua, M; Ahern, A; Quevedo, A; Jaramillo, D; Rinalducci, E; Smither, J; Alberti, P; Brill, C

2012-01-01

This study was designed to empirically examine the effects of iPod device and text-messaging activities on driver distraction. Sixty participants were asked to perform a driving simulation task while searching for songs using an iPod device or text messaging. Driving errors as measured by lane deviations were recorded and analyzed as a function of the distracters. Physiological measures (EEG) were also recorded during the driving phases in order to measure participant levels of cortical arousal. It was hypothesized that iPod use and text messaging would result in a profound effect on driving ability. The results showed a significant effect of iPod use and text-messaging on driving performance. Increased numbers of driving errors were recorded during the iPod and text-messaging phases than the pre- and post-allocation phases. Higher levels of Theta activity were also observed during the iPod and Text-messaging phase than the pre- and post-allocation phases. Implications for in-vehicle systems design, training, and safety are also discussed.

Long-term results of maxillary distraction osteogenesis in nongrowing cleft: 5-years experience using internal device.

PubMed

Hirjak, D; Reyneke, J P; Janec, J; Beno, M; Kupcova, I

2016-01-01

Patients with cleft lip and palate (CLP) related deformities frequently have maxillary hypoplasia in all dimensions. These patients usually present with class III malocclusions, retruded midfaces and narrow hard palates. The skeletal problems can be treated by means of Le Fort I maxillary procedures. Surgical and orthodontic correction of severe maxillary hypoplasia, as often seen in CLP patients, has however proved to be challenging. The magnitude of the advancement is often hampered and the post operative stability significantly affected by palatal soft tissue scarring. The slow distraction of bone and the histogenic abilities of distraction osteogenesis (DO) have made it an atractive alternative treatment option for the management of maxillary hypoplasia in these patients. This paper presents the treatment results of 15 nongrowing CLP patients with severe maxillary hypoplasia treated by means of intra oral distraction. The mean anterior distraction of the maxillas was 12.7 mm (9-15.0 mm). The long-term cephalometric and clinical evaluation after a minimum of 60 months (mean follow-up 71 months) proved to be stable. The treatment results revealed, that distraction osteogenesis in nongrowing CLP patients with severe maxillary hypoplasia proved to be a predictable and stable option (Tab. 2, Fig. 3, Ref. 26).

Impaired joint motion and contractures in callus distraction and segment transport: a retrospective data analysis.

PubMed

Zak, Lukas; Wozasek, Gerald E

2013-11-01

The temporary loss of motion of adjacent joints is a common complication after distraction osteogenesis of the lower limb. The aim of this study was to investigate the incidence of tendon contracture and impaired joint motion of the knee and/or ankle joint during and after callus distraction with a ring fixator. Twenty patients (2 female, 18 male, average age: 36 years) were surgically treated for callus distraction and segment transport with an external ring fixator after traumatic bone loss in 21 lower limbs. The impaired joint motion of the adjacent joints during and after treatment was evaluated. During treatment, we observed the free range of motion (ROM) of the ankle joint in 4 cases (19 %), restricted motion in 11 cases (52 %), and complete loss of motion in 6 cases (33 %). After treatment,free ROM was observed in 12 cases (57 %), impaired motion in 3 cases (14 %), and fixed joint position in 6 cases (29 %, 2 arthrodesis). This represents an improvement of motion in eight cases (38 %) and an impairment in two cases (10 %). In 11 cases, the ROM remained unchanged. During treatment, six restrictions in extension (24 %) and five (33 %) restrictions in flexion occurred in the knee joint, ultimately resulting in one loss of extension and three losses of flexion after frame removal. The impairment of joint motion during bone lengthening with an external ring fixator in the lower extremity occurs in most cases at the ankle joint. Various treatment options are available to address tendon shortening, but accompanying physiotherapy may prevent or moderate its onset.

Automated Continuous Distraction Osteogenesis May Allow Faster Distraction Rates: A Preliminary Study

PubMed Central

Peacock, Zachary S.; Tricomi, Brad; Murphy, Brian; Magill, John; Kaban, Leonard B.; Troulis, Maria

2013-01-01

Purpose To determine if automated continuous distraction osteogenesis at rates > 1mm/day would result in clinical and radiographic bone formation in a minipig model. Materials and Methods An automated, continuous, curvilinear distraction device was placed across a mandibular osteotomy in 10 minipigs. After 12 mm of distraction and 24 days fixation, animals were sacrificed and bone healing evaluated. The continuous distraction rates were 1.5 (n=5) and 3 mm/day (n=5). A semiquantitative scale was used to assess ex-vivo clinical appearance of the distraction gap (3= osteotomy not visible; 2= <50%; 1= >50%; 0= 100% visible); stability (3 = no mobility; 2 and 1 = mobility in 2 or 1 plane respectively; 0= mobility in 3 planes); radiographic density (4 = 100% gap opaque, 3= >75%, 2 = 50% – 75%, 1= <50%, or 0 = radiolucent). Groups of 4 minipigs distracted discontinuously at 1, 2, and 4 mm/day served as controls. Results The continuous DO 1.5 mm/day group had significantly higher scores for appearance and radiographic density compared to the discontinuous 4 mm/day group. The continuous DO 3mm/day group had significantly higher scores for appearance and radiographic density compared to the discontinuous 4 mm/day group, and higher stability compared to the discontinuous 2 and 4 mm/day groups. Conclusions Results of this preliminary study indicate that continuous DO at rates of 1.5 and 3.0 mm/day produces better bone formation when compared to discontinuous DO at rates faster than 1mm/day. PMID:23499159

Curbing Digital Distractions in the Classroom

ERIC Educational Resources Information Center

Seemiller, Corey

2017-01-01

Whether banking, communicating, watching television, or shopping, people can now do nearly anything on their personal digital devices. This digital access even extends to the college classroom where students use their personal devices for a multitude of non-class related purposes. Findings from a survey of 193 college undergraduates found that…

Mind wandering and the attention network system.

PubMed

Gonçalves, Óscar F; Rêgo, Gabriel; Oliveira-Silva, Patrícia; Leite, Jorge; Carvalho, Sandra; Fregni, Felipe; Amaro, Edson; Boggio, Paulo S

2017-01-01

Attention and mind wandering are often seen as anticorrelated. However, both attention and mind wandering are multi-component processes, and their relationship may be more complex than previously thought. In this study, we tested the interference of different types of thoughts as measured by a Thought Identification Task - TIT (on task thoughts, task related interference thoughts, external distractions, stimulus independent and task unrelated thoughts) on different components of the attention network system - ANT (alerting, orienting, executive). Results show that, during the ANT, individuals were predominantly involved in task related interference thoughts which, along with external distractors, significantly impaired their performance accuracy. However, mind wandering (i.e., stimulus independent and task unrelated thoughts) did not significantly interfere with accuracy in the ANT. No significant relationship was found between type of thoughts and alerting, orienting, or executive effects in the ANT. While task related interference thoughts and external distractions seemed to impair performance on the attention task, mind wandering was still compatible with satisfactory performance in the ANT. The present results confirmed the importance of differentiating type of "out of task" thoughts in studying the relationship between though distractors and attention. Copyright © 2016 Elsevier B.V. All rights reserved.

Feature-based attention and conflict monitoring in criminal offenders: interactive relations of psychopathy with anxiety and externalizing.

PubMed

Zeier, Joshua D; Newman, Joseph P

2013-08-01

As predicted by the response modulation model, psychopathic offenders are insensitive to potentially important inhibitory information when it is peripheral to their primary focus of attention. To date, the clearest tests of this hypothesis have manipulated spatial attention to cue the location of goal-relevant versus inhibitory information. However, the theory predicts a more general abnormality in selective attention. In the current study, male prisoners performed a conflict-monitoring task, which included a feature-based manipulation (i.e., color) that biased selective attention toward goal-relevant stimuli and away from inhibitory distracters on some trials but not others. Paralleling results for spatial cuing, feature-based cuing resulted in less distracter interference, particularly for participants with primary psychopathy (i.e., low anxiety). This study also investigated the moderating effect of externalizing on psychopathy. Participants high in psychopathy but low in externalizing performed similarly to primary psychopathic individuals. These results demonstrate that the abnormal selective attention associated with primary psychopathy is not limited to spatial attention but, instead, applies to diverse methods for establishing attentional focus. Furthermore, they demonstrate a novel method of investigating psychopathic subtypes using continuous analyses. PsycINFO Database Record (c) 2013 APA, all rights reserved.

The impact of billboards on driver visual behavior: a systematic literature review.

PubMed

Decker, John S; Stannard, Sarah J; McManus, Benjamin; Wittig, Shannon M O; Sisiopiku, Virginia P; Stavrinos, Despina

2015-01-01

External distraction appears to affect at least 6-9% of distraction-affected motor vehicle collisions. Billboards may be good models for studying external distraction in general, and it is also desirable to understand billboard-related distraction per se. However, there has not yet been a clear consensus on the scope of billboard-related distraction or its dynamics with respect to characteristics of drivers, billboards, traffic, and the roadway. To narrow these knowledge gaps, a systematic literature review was conducted on billboard-related changes in driver visual behavior. A systematic literature search yielded 443 results, of which 8 studies met all inclusion criteria. Five studies meeting all inclusion criteria were later identified and added. RESULTS were analyzed in terms of 4 categories of visual behavior: (1) gaze variability (GV), glance pattern activity (GPA), and percentage of time spent glancing at the forward roadway; (2) glances at unexpected drive-relevant stimuli; (3) glances at expected drive-relevant stimuli; and (4) glances at billboards. There was considerable evidence that about 10-20% of all glances at billboards were ≥0.75 s, that active billboards drew more glances and more long glances (≥0.75 s, ≥2.0 s) than passive billboards but did not attract a longer average glance, and that there was large variability among individual billboards within categories (e.g., active vs. passive). The extent to which billboards attracted glances ≥ 2.0 s was uncertain. There was tentative evidence that billboards did not affect GPA, glances at expected drive-relevant stimuli, or the proportion of time drivers spent glancing at the forward roadway and that they did affect vertical GV and glances at unexpected drive-relevant stimuli. Generally, billboard-related distraction appeared to be minor and regulated by drivers as the demands of the driving task changed. However, this review's findings suggest that this may not be true in all cases. Future research should emphasize the tails of the distribution in addition to average cases, in terms of both the analysis of visual behavior and the complexity of driving tasks. Further research is also needed to understand the effects of billboard design, driver characteristics, and road and traffic context.

The Effect of Virtual Reality Distraction on Pain Relief During Dressing Changes in Children with Chronic Wounds on Lower Limbs.

PubMed

Hua, Yun; Qiu, Rong; Yao, Wen-Yan; Zhang, Qin; Chen, Xiao-Li

2015-10-01

It has been demonstrated that patients with chronic wounds experience the most pain during dressing changes. Currently, researchers focus mostly on analgesics and appropriate dressing materials to relieve pain during dressing changes of chronic wounds. However, the effect of nonpharmacologic interventions, such as virtual reality distraction, on pain management during dressing changes of pediatric chronic wounds remains poorly understood. To investigate the effect of virtual reality distraction on alleviating pain during dressing changes in children with chronic wounds on their lower limbs. A prospective randomized study. A pediatric center in a tertiary hospital. Sixty-five children, aged from 4 to 16 years, with chronic wounds on their lower limbs. Pain and anxiety scores during dressing changes were recorded by using the Wong-Baker Faces picture scale, visual analogue scale, and pain behavior scale, as well as physiological measurements including pulse rate and oxygen saturation. Time length of dressing change was recorded. Virtual reality distraction significantly relieved pain and anxiety scores during dressing changes and reduced the time length for dressing changes as compared to standard distraction methods. The use of virtual reality as a distraction tool in a pediatric ward offered superior pain reduction to children as compared to standard distractions. This device can potentially improve clinical efficiency by reducing length time for dressing changes. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The influence of anticipatory processing on attentional biases in social anxiety.

PubMed

Mills, Adam C; Grant, DeMond M; Judah, Matt R; White, Evan J

2014-09-01

Research on cognitive theories of social anxiety disorder (SAD) has identified individual processes that influence this condition (e.g., cognitive biases, repetitive negative thinking), but few studies have attempted to examine the interaction between these processes. For example, attentional biases and anticipatory processing are theoretically related and have been found to influence symptoms of SAD, but they rarely have been studied together (i.e., Clark & Wells, 1995). Therefore, the goal of the current study was to examine the effect of anticipatory processing on attentional bias for internal (i.e., heart rate feedback) and external (i.e., emotional faces) threat information. A sample of 59 participants high (HSA) and low (LSA) in social anxiety symptoms engaged in a modified dot-probe task prior to (Time 1) and after (Time 2) an anticipatory processing or distraction task. HSAs who anticipated experienced an increase in attentional bias for internal information from Time 1 to Time 2, whereas HSAs in the distraction condition and LSAs in either condition experienced no changes. No changes in biases were found for HSAs for external biases, but LSAs who engaged in the distraction task became less avoidant of emotional faces from Time 1 to Time 2. This suggests that anticipatory processing results in an activation of attentional biases for physiological information as suggested by Clark and Wells. Copyright © 2014. Published by Elsevier Ltd.

Teacher perceptions of usefulness of mobile learning devices in rural secondary science classrooms

NASA Astrophysics Data System (ADS)

Tighe, Lisa

The internet and easy accessibility to a wide range of digital content has created the necessity for teachers to embrace and integrate digitial media in their curriculums. Although there is a call for digital media integration in curriculum by current learning standards, rural schools continue to have access to fewer resources due to limited budgets, potentially preventing teachers from having access to the most current technology and science instructional materials. This dissertation identifies the perceptions rural secondary science teachers have on the usefulness of mobile learning devices in the science classroom. The successes and challenges in using mobile learning devices in the secondary classroom were also explored. Throughout this research, teachers generally supported the integration of mobile devices in the classroom, while harboring some concerns relating to student distractability and the time required for integrating mobile devices in exisiting curriculum. Quantitative and qualitative data collected through surveys, interviews, and classroom observations revealed that teachers perceive that mobile devices bring benefits such as ease of communication and easy access to digitial information. However, there are perceived challenges with the ability to effectively communicate complex scientific information via mobile devices, distractibility of students, and the time required to develop effective curriculum to integrate digital media into the secondary science classroom.

Smart instrumentation for determination of ligament stiffness and ligament balance in total knee arthroplasty.

PubMed

Hasenkamp, W; Villard, J; Delaloye, J R; Arami, A; Bertsch, A; Jolles, B M; Aminian, K; Renaud, P

2014-06-01

Ligament balance is an important and subjective task performed during total knee arthroplasty (TKA) procedure. For this reason, it is desirable to develop instruments to quantitatively assess the soft-tissue balance since excessive imbalance can accelerate prosthesis wear and lead to early surgical revision. The instrumented distractor proposed in this study can assist surgeons on performing ligament balance by measuring the distraction gap and applied load. Also the device allows the determination of the ligament stiffness which can contribute a better understanding of the intrinsic mechanical behavior of the knee joint. Instrumentation of the device involved the use of hall-sensors for measuring the distractor displacement and strain gauges to transduce the force. The sensors were calibrated and tested to demonstrate their suitability for surgical use. Results show the distraction gap can be measured reliably with 0.1mm accuracy and the distractive loads could be assessed with an accuracy in the range of 4N. These characteristics are consistent with those have been proposed, in this work, for a device that could assist on performing ligament balance while permitting surgeons evaluation based on his experience. Preliminary results from in vitro tests were in accordance with expected stiffness values for medial collateral ligament (MCL) and lateral collateral ligament (LCL). Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

Digital Lengthening to Treat Finger Deficiency: An Experience of 201 Digits in 104 Patients

PubMed Central

2017-01-01

Objectives. We evaluated the results of digital lengthening by distraction and second-stage bone graft. Methods. We treated finger deficiency of 201 digits in 104 patients (68 males, 36 females) by digital distraction and second-stage bone graft. The distraction was performed with a rate of 1 mm/day (for the first ten days) and 0.5 mm/day followed by using a self-designed bilateral tubal-helical external fixator. The mean follow-up period was 42 months (range 6 to 60 months). Results. The mean lengthening was 29.2 mm (range 25 to 40 mm) and 18.7 mm (range 12 to 32 mm) for metacarpal bones and phalanges, respectively. The mean elongation rate was 174.4% (range 145% to 202%) and 184.8% (range 115% to 283%) for metacarpal bones and phalanges, respectively. The static two-point discriminations and SpO2 showed no significant differences before and after distraction. Four complications were observed (two skin ruptures and two phalangeal splitting). No pin tract infection or tendon rupture showed. Digital lengthening improved functions of the hand. Conclusion. Digital distraction and second-stage bone graft is an effective method to compensate disabilities caused by lack of finger length. It could be an alternative plan for patients with thumb deficiency instead of toe-to-thumb transplant and patients with finger deficiency instead of ray resection. PMID:28286765

Digital Lengthening to Treat Finger Deficiency: An Experience of 201 Digits in 104 Patients.

PubMed

Ding, Zhenyu; Zhu, Xiaozhong; Fu, Kai; Zheng, Xianyou

2017-01-01

Objectives. We evaluated the results of digital lengthening by distraction and second-stage bone graft. Methods. We treated finger deficiency of 201 digits in 104 patients (68 males, 36 females) by digital distraction and second-stage bone graft. The distraction was performed with a rate of 1 mm/day (for the first ten days) and 0.5 mm/day followed by using a self-designed bilateral tubal-helical external fixator. The mean follow-up period was 42 months (range 6 to 60 months). Results. The mean lengthening was 29.2 mm (range 25 to 40 mm) and 18.7 mm (range 12 to 32 mm) for metacarpal bones and phalanges, respectively. The mean elongation rate was 174.4% (range 145% to 202%) and 184.8% (range 115% to 283%) for metacarpal bones and phalanges, respectively. The static two-point discriminations and SpO 2 showed no significant differences before and after distraction. Four complications were observed (two skin ruptures and two phalangeal splitting). No pin tract infection or tendon rupture showed. Digital lengthening improved functions of the hand. Conclusion. Digital distraction and second-stage bone graft is an effective method to compensate disabilities caused by lack of finger length. It could be an alternative plan for patients with thumb deficiency instead of toe-to-thumb transplant and patients with finger deficiency instead of ray resection.

Percutaneous distraction lengthening in brachymetacarpia.

PubMed

Volpi, Alexander D; Fragomen, Austin T

2011-08-08

Brachymetacarpia is a condition manifesting a shortened metacarpal that is caused by early closure of the epiphyseal plate and believed to arise idiopathically. The correction for brachymetacarpia is usually for cosmetic reasons as brachymetacarpia does not impair function. The literature indicates several different approaches to lengthening digits, including single-stage lengthening and rapid distraction lengthening with a bone graft. However, gradual distraction is the preferred method due to excellent cosmetic outcomes and few postoperative complications. This article reports a case of brachymetacarpia treated with distraction lengthening using a minimally invasive, percutaneous approach. A 16-year-old girl presented with a shortened left ring finger and underwent surgery to correct the deformity. The left ring finger measured 12 mm shorter than her right ring finger; however, there was normal mobility at the joints. In the operating room, an external fixator was attached using 4 self-drilling, self-tapping pins through several 3-mm skin incisions. The total fixation time was 14 weeks; however, the achieved length of 12 mm was achieved 6 weeks postoperatively. The healing index of the fixation period was 81 days/cm. The postoperative course and fixation period were uneventful, with no complications except for 2 pin infections that were treated with oral antibiotics. The method of gradual distraction lengthening in this case successfully achieved the desired length and yielded an excellent cosmetic result. Copyright 2011, SLACK Incorporated.

Determination of ankle external fixation stiffness by expedited interactive finite element analysis.

PubMed

Nielsen, Jonathan K; Saltzman, Charles L; Brown, Thomas D

2005-11-01

Interactive finite element analysis holds the potential to quickly and accurately determine the mechanical stiffness of alternative external fixator frame configurations. Using as an example Ilizarov distraction of the ankle, a finite element model and graphical user interface were developed that provided rapid, construct-specific information on fixation rigidity. After input of specific construct variables, the finite element software determined the resulting tibial displacement for a given configuration in typically 15s. The formulation was employed to investigate constructs used to treat end-stage arthritis, both in a parametric series and for five specific clinical distraction cases. Parametric testing of 15 individual variables revealed that tibial half-pins were much more effective than transfixion wires in limiting axial tibial displacement. Factors most strongly contributing to stiffening the construct included placing the tibia closer to the fixator rings, and mounting the pins to the rings at the nearest circumferential location to the bone. Benchtop mechanical validation results differed inappreciably from the finite element computations.

Conventional bone-anchored palatal distractor using an orthodontic palatal expander for the transverse maxillary distraction osteogenesis: technical note.

PubMed

Iida, Seiji; Haraguchi, Seiji; Aikawa, Tomonao; Yashiro, Kohtaro; Okura, Masaya; Kogo, Mikihiko

2008-02-01

Surgical-assisted rapid palatal expansion includes various treatment procedures for solving transverse maxillary deficiencies, especially in cases with a matured palatal suture. Recent introduction of the concept of distraction osteogenesis has contributed to generalize this useful treatment and to develop some bone-borne devices that will not cause the problems found in cases treated by tooth-supported palatal expander. This report shows a conventional bone-borne distractor using commercially available orthodontic palatal expansion screws. The distractor consists of 2 parts: one is a commercially available orthodontic palatal expansion screw (Hyrax type, Fan style) and another is a screw-ring, which is one of the attached parts of the mandibular distraction system. The bone screws are inserted transmucosally to the palatal bone via the screw-rings. The palatal distractor can be applied to varied palatal shapes and can expand the palate without any trouble. This conventional palatal distractor may contribute to generalize the transpalatal maxillary distraction osteogenesis for cases with maxillary teeth problems.

Midfacial Changes Through Anterior Maxillary Distraction Osteogenesis in Patients With Cleft Lip and Palate.

PubMed

Kanzaki, Hiroyuki; Imai, Yoshimichi; Nakajo, Tetsu; Daimaruya, Takayoshi; Sato, Akimitsu; Tachi, Masahiro; Nunomura, Youhei; Itagaki, Yusuke; Nishimura, Kazuaki; Kochi, Shoko; Igarashi, Kaoru

2017-06-01

Maxillary hypoplasia is a major issue in cleft lip and palate patients, and predictable surgical maxillary advancement is required. In the present study, the changes and stability of the maxilla and soft tissue profile achieved after the application of anterior maxillary distraction osteogenesis (AMDO) using intraoral expander in unilateral cleft lip and palate and isolated cleft palate patients were investigated by comparing to the Le Fort I osteotomy (LFI) and maxillary distraction osteogenesis (DO) with rigid external distraction (RED) system.Ten patients who underwent orthognathic treatment with AMDO were examined (AMDO group). Changes in the positions of soft and hard tissue landmarks were calculated from the lateral cephalograms taken before the distraction, at the end of the distraction, and 1 year after the surgery. They were compared with the changes in 7 other unilateral cleft lip and palate patients who underwent LFI (LFI group) and 6 others who underwent DO with RED (RED group).The mean maxillary advancement of the AMDO group was similar to that of the RED group, judged by the change of point A. During DO, the AMDO group showed less clockwise rotation of mandible compared to the RED group. The soft tissue advancement of the upper lip and nose in the AMDO group was similar to that in the RED group, which was significantly larger than that in the LFI group.Our results indicate that AMDO can be surgical option to cleft lip and palate patients with less invasive but excellent improvement in both midfacial skeletal and soft tissue similar to DO-RED.

Treatment of unstable intraarticular fracture of distal radius: POP casting with external fixation.

PubMed

ur Rahman, Obaid; Khan, Mohammad Qadeem; Rasheed, Haroon; Ahmad, Saleem

2012-04-01

To compare radiological and functional outcome of external fixation and distraction with conservative Plaster of Paris (POP) cast for unstable intra-articular fractures of the distal radius. The study was conducted on 60 patients with unstable intra-articular fracture of distal radius who reported to emergency or outpatient Orthopaedic Surgery department of Benazir Bhutto Hospital, Rawalpindi, between March and August 2007. They were divided into two equal groups: Group A and Group B, treated by Plaster of Paris cast, and external fixation with distraction respectively. The functional outcome in terms of freedom from pain, range of movement, grip power and deformity, and the radiological outcome of radial length, incongruity and radio-ulnar joint position were analysed at three months follow-up using a 3-point scoring scale. In Group A, 1 (3%) patient showed excellent result, 8 (27%) patients good results, 19 (63%) patients fair results and 2 (7%) patients poor result. In Group B, 14 (47%) patients showed excellent results, 11 (37%) patients good results, 4 (13%) patients fair results and 1 (3%) patient poor result. The outcome score of the Group B patients was significantly better compared to the Group A patients (p value < 0.05). External fixation has definite advantages over conventional Plaster of Paris cast in the treatment of unstable intra-articular fractures of distal radius.

Google glass: a driver distraction cause or cure?

PubMed

Sawyer, Ben D; Finomore, Victor S; Calvo, Andres A; Hancock, P A

2014-11-01

We assess the driving distraction potential of texting with Google Glass (Glass), a mobile wearable platform capable of receiving and sending short-message-service and other messaging formats. A known roadway danger, texting while driving has been targeted by legislation and widely banned. Supporters of Glass claim the head-mounted wearable computer is designed to deliver information without concurrent distraction. Existing literature supports the supposition that design decisions incorporated in Glass might facilitate messaging for drivers. We asked drivers in a simulator to drive and use either Glass or a smartphone-based messaging interface, then interrupted them with an emergency brake event. Both the response event and subsequent recovery were analyzed. Glass-delivered messages served to moderate but did not eliminate distracting cognitive demands. A potential passive cost to drivers merely wearing Glass was also observed. Messaging using either device impaired driving as compared to driving without multitasking. Glass in not a panacea as some supporters claim, but it does point the way to design interventions that effect reduced load in multitasking. Discussions of these identified benefits are framed within the potential of new in-vehicle systems that bring both novel forms of distraction and tools for mitigation into the driver's seat.

The usage of the three-dimension distractor in the NAVID system for plagiocephaly-three case reports.

PubMed

Osawa, Hirokatsu; Kato, Mihoko; Nagakura, Masamune; Morishita, Tsuyoshi; Kondo, Goro; Kurimoto, Michihiro

2015-12-01

Distraction osteogenesis is a standard method for craniosynostosis. However, the technique using conventional devices still has some disadvantages, especially for anterior or posterior plagiocephaly with complex deformities. In the Nakajima's angle-variable internal distraction (NAVID) system originally for maxillary surgeries, the cranial three-dimension (D) distractor with three dimensionally movable joint at the anterior arm has been developed recently in order to prevent the interference in the distraction process and excessive force. In this paper, we first reported two cases of anterior plagiocephaly, and one case of posterior plagiocephaly received distraction osteogenesis using new 3-D distractor in the NAVID system. In two cases of anterior plagiocephaly, the reshaping of supra-orbital bar in reference of simulating by the 3-D skull model was performed. In all cases, we fixed two paralleled 2-D distractors and a 3-D distractor in the upper frontal or parietal region. Within the limitations of this study, we believe that the NAVID system is suitable for infant plagiocephaly due to the simple and small joint arm. Furthermore, the usage of the 3-D distractor would reduce the interference with 2-D distractors and easily lead to attainment of targeted distracting distance.

Mobile Devices in the Classroom

ERIC Educational Resources Information Center

Schachter, Ron

2009-01-01

As cell phones--with ever-expanding possibilities of texting, Web browsing, and game playing--have multiplied in recent years among teenagers and even preteens, so have the concerns of teachers and administrators about the distractions these devices can cause. A survey of students and parents earlier this year by the group Common Sense Media found…

Enhancing Secondary Science Content Accessibility with Video Games

ERIC Educational Resources Information Center

Marino, Matthew T.; Becht, Kathleen M.; Vasquez, Eleazar, III; Gallup, Jennifer L.; Basham, James D.; Gallegos, Benjamin

2014-01-01

Mobile devices, including iPads, tablets, and so on, are common in high schools across the country. Unfortunately, many secondary teachers see these devices as distractions rather than tools for scaffolding instruction. This article highlights current research related to the use of video games as a means to increase the cognitive and social…

Mobile Devices: Driving Us to Distraction?

ERIC Educational Resources Information Center

Goodwin, Bryan

2015-01-01

In this article, Bryan Goodwin delves into the reason behind addictive use of smartphones, tablets, netbooks, and e-readers, and considers whether introducing them into classrooms will help or hinder learning.

76 FR 67020 - Railroad Safety Advisory Committee; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... Device Distraction, Critical Incident, Track Safety Standards, Dark Territory, Passenger Safety, and... railroad safety matters. The RSAC is composed of 54 voting representatives from 31 member organizations...

Transverse maxillary distraction with a bone-anchored appliance: dento-periodontal effects and clinical and radiological results.

PubMed

Ramieri, G A; Spada, M C; Austa, M; Bianchi, S D; Berrone, S

2005-06-01

In 29 adult patients presenting with maxillary deficiency, a bone-anchored palatal distractor (Surgi-Tec NV, Brugge, Belgium) was applied after osteotomy of the anterolateral walls of the maxillary sinuses, midpalatal suture, and, eventually, separation of the pterygomaxillary sutures. Expansion proceeded at a rate of 0.33-0.66 mm per day and the device was retained for 4-6 months for consolidation. Active orthodontic therapy was started after 8-10 weeks. The increment of arch width and the perimeter were evaluated using dental casts. Tooth thermal sensitivity and the periodontal side effects of treatment were monitored clinically after distraction, at device removal, and after 1 year. Bone healing was also investigated during the procedure using conventional radiological techniques. This experience confirms that transverse maxillary distraction is an effective technique in adult patients, leading to the formation of new bone. There were no noticeable intraoperative complications, but postsurgical periodontal side effects were documented. The procedure offers advantages over traditional teeth-borne appliances in terms of rapidity of treatment and the absence of mechanical forces acting on the teeth. Further evaluation is required to assess the long-term stability and periodontal consequences of this technique.

Biomechanical comparison of two intraoperative mobilization techniques for maxillary distraction osteogenesis: Down-fracture versus non-down-fracture

PubMed Central

Yang, Lili; Suzuki, Eduardo Yugo; Suzuki, Boonsiva

2014-01-01

Purposes: The purpose of this study was to compare the distraction forces and the biomechanical effects between two different intraoperative surgical procedures (down-fracture [DF] and non-DF [NDF]) for maxillary distraction osteogenesis. Materials and Methods: Eight patients were assigned into two groups according to the surgical procedure: DF, n = 6 versus NDF, n = 2. Lateral cephalograms taken preoperatively (T1), immediately after removal of the distraction device (T2), and after at least a 6 months follow-up period (T3) were analyzed. Assessment of distraction forces was performed during the distraction period. The Mann–Whitney U-test was used to compare the difference in the amount of advancement, the maximum distraction force and the amount of relapse. Results: Although a significantly greater amount of maxillary movement was observed in the DF group (median 9.5 mm; minimum-maximum 7.9-14.1 mm) than in the NDF group (median 5.9 mm; minimum-maximum 4.4-7.6 mm), significantly lower maximum distraction forces were observed in the DF (median 16.4 N; minimum-maximum 15.1-24.6 N) than in the NDF (median 32.9 N; minimum-maximum 27.6-38.2 N) group. A significantly greater amount of dental anchorage loss was observed in the NDF group. Moreover, the amount of relapse observed in the NDF group was approximately 3.5 times greater than in the DF group. Conclusions: In this study, it seemed that, the use of the NDF procedure resulted in lower levels of maxillary mobility at the time of the maxillary distraction, consequently requiring greater amounts of force to advance the maxillary bone. Moreover, it also resulted in a reduced amount of maxillary movement, a greater amount of dental anchorage loss and poor treatment stability. PMID:25593865

A Prospective Randomized Controlled Trial of Nonpharmacological Pain Management During Intravenous Cannulation in a Pediatric Emergency Department.

PubMed

Miller, Kate; Tan, Xianghong; Hobson, Andrew Dillon; Khan, Asaduzzaman; Ziviani, Jenny; OʼBrien, Eavan; Barua, Kim; McBride, Craig A; Kimble, Roy M

2016-07-01

Intravenous (IV) cannulation is commonly performed in pediatric emergency departments (EDs). The busy ED environment is often not conducive to conventional nonpharmacological pain management. This study assessed the use of Ditto (Diversionary Therapy Technologies, Brisbane, Australia), a handheld electronic device which provides procedural preparation and distraction, as a means of managing pain and distress during IV cannulation performed in the pediatric ED. A randomized controlled trial with 98 participants, aged 3 to 12 years, was conducted in a pediatric ED. Participants were recruited and randomized into 5 intervention groups as follows: (1) Standard Distraction, (2) PlayStation Portable Distraction, (3) Ditto Distraction, (4) Ditto Procedural Preparation, and (5) Ditto Preparation and Distraction. Children's pain and distress levels were assessed via self-reports and observational reports by caregivers and nursing staff across the following 3 time points: (1) before, (2) during, and (3) after IV cannulation. Caregivers and nursing staff reported significantly reduced pain and distress levels in children accessing the combined preparation and distraction Ditto protocol, as compared to standard distraction (P ≤ 0.01). This intervention also saw the greatest reduction in pain and distress as reported by the child. Caregiver reports indicate that using the combined Ditto protocol was most effective in reducing children's pain experiences while undergoing IV cannulation in the ED. The use of Ditto offers a promising opportunity to negotiate barriers to the provision of nonpharmacological approaches encountered in the busy ED environment, and provide nonpharmacological pain-management interventions in pediatric EDs.

Interactive lectures: Clickers or personal devices?

PubMed

Morrell, Lesley J; Joyce, Domino A

2015-01-01

Audience response systems ('clickers') are frequently used to promote participation in large lecture classes, and evidence suggests that they convey a number of benefits to students, including improved academic performance and student satisfaction. The limitations of these systems (such as limited access and cost) can be overcome using students' personal electronic devices, such as mobile phones, tablets and laptops together with text message, web- or app-based polling systems. Using questionnaires, we compare student perceptions of clicker and smartphone based polling systems. We find that students prefer interactive lectures generally, but those that used their own device preferred those lectures over lectures using clickers. However, device users were more likely to report using their devices for other purposes (checking email, social media etc.) when they were available to answer polling questions. These students did not feel that this distracted them from the lecture, instead, concerns over the use of smartphones centred around increased battery usage and inclusivity for students without access to suitable technology. Our results suggest that students generally preferred to use their own devices over clickers, and that this may be a sensible way to overcome some of the limitations associated with clickers, although issues surrounding levels of distraction and the implications for retention and recall of information need further investigation.

Interactive lectures: Clickers or personal devices?

PubMed Central

Morrell, Lesley J.; Joyce, Domino A.

2015-01-01

Audience response systems (‘clickers’) are frequently used to promote participation in large lecture classes, and evidence suggests that they convey a number of benefits to students, including improved academic performance and student satisfaction. The limitations of these systems (such as limited access and cost) can be overcome using students’ personal electronic devices, such as mobile phones, tablets and laptops together with text message, web- or app-based polling systems. Using questionnaires, we compare student perceptions of clicker and smartphone based polling systems. We find that students prefer interactive lectures generally, but those that used their own device preferred those lectures over lectures using clickers. However, device users were more likely to report using their devices for other purposes (checking email, social media etc.) when they were available to answer polling questions. These students did not feel that this distracted them from the lecture, instead, concerns over the use of smartphones centred around increased battery usage and inclusivity for students without access to suitable technology. Our results suggest that students generally preferred to use their own devices over clickers, and that this may be a sensible way to overcome some of the limitations associated with clickers, although issues surrounding levels of distraction and the implications for retention and recall of information need further investigation. PMID:26594327

Digital Devices, Distraction, and Student Performance: Does In-Class Cell Phone Use Reduce Learning?

ERIC Educational Resources Information Center

Duncan, Douglas K.; Hoekstra, Angel R.; Wilcox, Bethany R.

2012-01-01

The recent increase in use of digital devices such as laptop computers, iPads, and web-enabled cell phones has generated concern about how technologies affect student performance. Combining observation, survey, and interview data, this research assesses the effects of technology use on student attitudes and learning. Data were gathered in eight…

Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study

PubMed Central

Intema, Femke; Van Roermund, Peter M; Marijnissen, Anne C A; Cotofana, Sebastian; Eckstein, Felix; Castelein, Rene M; Bijlsma, Johannes W J; Mastbergen, Simon C; Lafeber, Floris P J G

2011-01-01

Background Modification of joint tissue damage is challenging in late-stage osteoarthritis (OA). Few options are available for treating end-stage knee OA other than joint replacement. Objectives To examine whether joint distraction can effectively modify knee joint tissue damage and has the potential to delay prosthesis surgery. Methods 20 patients (<60 years) with tibiofemoral OA were treated surgically using joint distraction. Distraction (∼5 mm) was applied for 2 months using an external fixation frame. Tissue structure modification at 1 year of follow-up was evaluated radiographically (joint space width (JSW)), by MRI (segmentation of cartilage morphology) and by biochemical markers of collagen type II turnover, with operators blinded to time points. Clinical improvement was evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) pain score. Results Radiography demonstrated an increase in mean and minimum JSW (2.7 to 3.6 mm and 1.0 to 1.9 mm; p<0.05 and <0.01). MRI revealed an increase in cartilage thickness (2.4 to 3.0 mm; p<0.001) and a decrease of denuded bone areas (22% to 5%; p<0.001). Collagen type II levels showed a trend towards increased synthesis (+103%; p<0.06) and decreased breakdown (−11%; p<0.08). The WOMAC index increased from 45 to 77 points, and VAS pain decreased from 73 to 31 mm (both p<0.001). Conclusions Joint distraction can induce tissue structure modification in knee OA and could result in clinical benefit. No current treatment is able to induce such changes. Larger, longer and randomised studies on joint distraction are warranted. PMID:21565898

Non-lethal laser dazzling as a personnel countermeasure

NASA Astrophysics Data System (ADS)

Shannon, David C.

2013-10-01

Optical distraction is likely one of the original and simpler optical countermeasure concepts with a technology history dating back to the 1800's. The objective is to distract or suppress either equipment or personnel with optical radiation from a safe distance. This paper is intended to review and expand on the concepts presented at the 2012 SPIE Security and Defense meeting; "Non-Lethal Optical Interruption (Dazzling): Technology, Devices, and Scenarios". The information that follows will focus primarily on the technology and techniques associated with the safe laser dazzling of personnel. Key product design guidelines will be highlighted and reviewed. Recent advances in laser technology and their associated impact on hand-held devices will also be discussed. Finally, the author will offer his opinion on the growth rate of military and non-military markets for laser dazzlers.

Impact of social and technological distraction on pedestrian crossing behaviour: an observational study

PubMed Central

Thompson, Leah L; Rivara, Frederick P; Ayyagari, Rajiv C; Ebel, Beth E

2013-01-01

Objectives The objective of the present work was to study the impact of technological and social distraction on cautionary behaviours and crossing times in pedestrians. Methods Pedestrians were observed at 20 high-risk intersections during 1 of 3 randomly assigned time windows in 2012. Observers recorded demographic and behavioural information, including use of a mobile device (talking on the phone, text messaging, or listening to music). We examined the association between distraction and crossing behaviours, adjusting for age and gender. All multivariate analyses were conducted with random effect logistic regression (binary outcomes) and random effect linear regression (continuous outcomes), accounting for clustering by site. Results Observers recorded crossing behaviours for 1102 pedestrians. Nearly one-third (29.8%) of all pedestrians performed a distracting activity while crossing. Distractions included listening to music (11.2%), text messaging (7.3%) and using a handheld phone (6.2%). Text messaging, mobile phone use and talking with a companion increased crossing time. Texting pedestrians took 1.87 additional seconds (18.0%) to cross the average intersection (3.4 lanes), compared to undistracted pedestrians. Texting pedestrians were 3.9 times more likely than undistracted pedestrians to display at least 1 unsafe crossing behaviour (disobeying the lights, crossing mid-intersection, or failing to look both ways). Pedestrians listening to music walked more than half a second (0.54) faster across the average intersection than undistracted pedestrians. Conclusions Distracting activity is common among pedestrians, even while crossing intersections. Technological and social distractions increase crossing times, with text messaging associated with the highest risk. Our findings suggest the need for intervention studies to reduce risk of pedestrian injury. PMID:23243104

Soft-tissue volumetric changes following monobloc distraction procedure: analysis using digital three-dimensional photogrammetry system (3dMD).

PubMed

Chan, Fuan Chiang; Kawamoto, Henry K; Federico, Christina; Bradley, James P

2013-03-01

We have previously reported that monobloc advancement by distraction osteogenesis resulted in decreased morbidity and greater advancement with less relapse compared with acute monobloc advancement with bone grafting. In this study, we examine the three-dimensional (3D) volumetric soft-tissue changes in monobloc distraction.Patients with syndromic craniosynostosis who underwent monobloc distraction from 2002 to 2010 at University of California-Los Angeles Craniofacial Center were studied (n = 12). We recorded diagnosis, indications for the surgery, and volumetric changes for skeletal and soft-tissue midface structures (preoperative/postoperative [6 weeks]/follow-up [>1 year]). Computed tomography scans and a digital 3D photogrammetry system were used for image analysis.Patients ranged from 6 to 14 years of age (mean, 10.1 years) at the time of the operation (follow-up 2-11 years); mean distraction advancement was 19.4 mm (range, 14-25 mm). There was a mean increase in the 3D volumetric soft-tissue changes: 99.5 ± 4.0 cm(3) (P < 0.05) at 6 weeks and 94.9 ± 3.6 cm(3) (P < 0.05) at 1-year follow-up. When comparing soft-tissue changes at 6 weeks postoperative to 1-year follow-up, there were minimal relapse changes. The overall mean 3D skeletal change was 108.9 ± 4.2 cm. For every 1 cm of skeletal gain, there was 0.78 cm(3) of soft-tissue gain.Monobloc advancement by distraction osteogenesis using internal devices resulted in increased volumetric soft-tissue changes, which remained stable at 1 year. The positive linear correlation between soft-tissue increments and bony advancement can be incorporated during the planning of osteotomies to achieve optimum surgical outcomes with monobloc distraction.

Multi-modal vehicle display design and analysis

DOT National Transportation Integrated Search

2004-10-01

It is now evident from anecdotal evidence and preliminary research that distractions can : hinder the task of operating a vehicle, and consequently reduce driver safety. However with : increasing wireless connectivity and the mobility of office devic...

When Rewards Go Wrong: A Tale of Five Motivational Misdirects

ERIC Educational Resources Information Center

Steel, Piers; MacDonnell, Rhiannon

2012-01-01

At the heart of most performance management systems is a reward program. However, even when we are doing everything else right, rewards can go wrong. Here, we explore five ways that external incentives can damage performance, from destroying altruistic behavior to distracting people from the task. Fortunately, most of these downfalls are…

A New Device for Alveolar Bone Transportation

PubMed Central

Vega, Omar; Pérez, Daniel; Páramo, Viviana; Falcón, Jocelyn

2011-01-01

We present a retrospective review of a new technique for the transportation of alveolar bone using a Hyrax device modified by the principal author (O.A.V.). There were seven patients (five males and two females), including five patients with cleft palate and lip diagnosis, one patient with a high-speed gunshot wound, and one patient with facial trauma sequel due to mandibular fracture. They were all treated with an alveolar bone transportation technique (ABT) through the use of the modified Hyrax device (VEGAX). Before surgery, distraction osteogenesis of the bifocal type was performed on four patients, and the trifocal type was performed on the other three patients. However, in one case, direct dental anchorage was not used, only orthodontic appliances. In all the cases, new bone formation and gingival tissue around the defect were obtained, posterior to the alveolar distraction process; no complications were observed in any patient. In one case, two teeth involved in the disk of the ABT were extracted, due to a previous condition of periodontal disease. The alveolar bone transport with the VEGAX device is an accessible technique for almost every patient with alveolar defects due to diverse causes. In all the presented cases, predictability and success were demonstrated. PMID:22655120

The effects of text messaging on young drivers.

PubMed

Hosking, Simon G; Young, Kristie L; Regan, Michael A

2009-08-01

This study investigated the effects of using a cell phone to retrieve and send text messages on the driving performance of young novice drivers. Young drivers are particularly susceptible to driver distraction and have an increased risk of distraction-related crashes. Distractions from in-vehicle devices, particularly, those that require manual input, are known to cause decrements in driving performance. Twenty young novice drivers used a cell phone to retrieve and send text messages while driving a simulator. The amount of time that drivers spent not looking at the road when text messaging was up to approximately 400% greater than that recorded in baseline (notext-messaging) conditions. Furthermore, drivers' variability in lane position increased up to approximately 50%, and missed lane changes increased 140%. There was also an increase of up to approximately 150% in drivers' variability in following distances to lead vehicles. Previous research has shown that the risk of crashing while dialing a handheld device, such as when text messaging and driving, is more than double that of conversing on a cell phone. The present study has identified the detrimental effects of text messaging on driving performance that may underlie such increased crash risk. More effective road safety measures are needed to prevent and mitigate the adverse effects on driving performance of using cell phones to retrieve and send text messages.

The impact of zoledronic acid on regenerate and native bone after consolidation and removal of the external fixator: an animal model study.

PubMed

Saghieh, Said; Khoury, Nabil J; Tawil, Ayman; Masrouha, Karim Z; Musallam, Khaled M; Khalaf, Kinda; Dosh, Laura; Jaouhari, Rosemarie Reich; Birjawi, Ghina; El-Hajj-Fuleihan, Ghada

2010-02-01

We investigated the role of zoledronic acid on the regenerate and native bone after consolidation and removal of the external fixator in a rabbit model of distraction osteogenesis using 28 New Zealand white rabbits. The rabbits were randomly distributed into two groups. The first group received three doses of zoledronic acid (ZA) 0.1 mg/kg subcutaneously at weekly intervals while the second group received injections of sterile saline. Distraction started on day 7 at a rate of 0.8 mm/day for 12 days. At week 3 the average lengthening, regenerate density, and regenerate continuity were comparable between the two groups. At week 11 the regenerate in the treated group had a significant increase in Bone Mineral Density (BMD) and Bone Mineral Content (BMC) compared to the placebo group. On axial compression, the regenerate showed an increase in the peak load and a higher modulus of elasticity in the treated group. At 6 months, radiographs demonstrated signs of osteopenia of the proximal metaphysis in the control group, and failure of new bone formation around the pin sites in the treated group. BMC and BMD value differences between the two groups were not statistically significant. Histologically, there was persistence of more bone trabeculae in the medullary canal of the regenerate with the persistence of the pin-holes in the treated group. Mechanically, the regenerates in the treated group remain stronger in resisting the axial compression. The proximal fragment in the treated group exhibited a statistically significant decrease in the peak load, toughness and efail %. In conclusion, bisphosphonate-treated rabbits have a stronger regenerate during distraction, and directly after removal of the fixator. They do not develop disuse osteopenia in their lengthened tibia. This treatment may shorten the time in the external fixator and prevent fragility fractures in the treated extremity. However, its long-term safety has not yet been established. (c) 2009 Elsevier Inc. All rights reserved.

Use of a Multivector Mandibular Distractor for Treatment of Pediatric Proximal Interphalangeal Joint Pilon Fractures: A Case-Based Review.

PubMed

Pedreira, Rachel; Cho, Brian H; Geer, Angela; DeJesus, Ramon A

2018-04-01

The difficulties in surgical treatment of pilon fractures of the finger include fragment reconstitution and posthealing stiffness. In adults, external fixation with traction and early active range of motion (AROM)/passive range of motion (PROM) during healing is considered necessary for avoiding joint stiffness and attaining realignment. The authors present a unique approach to pediatric pilon fractures that uses open reduction and multivector external fixation with delayed AROM/PROM. Initial immobilization and significant traction allowed for joint realignment and prevented noncompliance with staged distraction. The authors believe this immobilization leads to a superior outcome because, unlike adults, children tend to avoid stiffness and a larger distraction force allowed for sufficient joint realignment to regain range of motion (ROM). A right-handed 13-year-old boy sustained a right ring finger fracture and presented 12 days later. Radiographs revealed a comminuted Salter-Harris 4 fracture of the middle phalanx. The patient underwent open reduction and placement of multivector external fixation using a pediatric mandibular distractor/fixator. Significant traction was applied to distract the finger to length. Hardware was removed 6 weeks postoperatively and AROM was initiated after splinting. The patient started PROM 8 weeks postoperatively. Strengthening was initiated 2 weeks later. ROM improved and rehabilitation was continued. The patient exhibited nearly equal grip strength 12 weeks postoperatively. At 14 months follow-up, radiographs showed complete healing and joint realignment. There was no deformity or pain and finger length was restored. Management of pediatric pilon fractures is rarely described and presents unique considerations. Early-stage traction and immobilization using a multivector mandibular fixator/distractor is suitable in a child because noncompliance is avoided and there is a decreased risk for stiffness. Combining early immobilization with subsequent-staged AROM, PROM, and strengthening resulted in no loss of ROM and maintained articular symmetry.

Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review.

PubMed

Rivera, Jessica C; Beachler, Jason A

2018-01-23

Post-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50 years of age. Research databases were searched and abstracts screened for relevance on our topic of interest. Abstracts meeting screening criteria with high interobserver reliability underwent full-manuscript review and coding for pertinent citation, study level, treatment, and outcome variables. Outcome variables for patient-reported pain scales, validated outcome measurement tools, radiographic progression, reoperation/re-treatment rates, and complication rates were recorded. Out of 105 unique citations, 10 publications were included. The distraction arthroplasty studies had 36 out of 181 patients requiring reoperation for complications (19.9%), while other joint-preserving procedures studies had 40 out of 177 patients requiring reoperations for complications (22.6%). Clinical outcome scores at mean follow-up time ranging from 2 to 10 years between studies were similar. Reported results for a variety of cartilage preservation procedures, including distraction arthroplasty, are satisfactory and reoperation rates for complication are similar. Limitations in available data and underlying study quality affect synthesis of the results therein. While distraction arthroplasty is an option for cartilage preservation in patients with PTA of the ankle, the technique is highly specialized which may affect the external validity. III.

Joint distraction results in clinical and structural improvement of haemophilic ankle arthropathy: a series of three cases.

PubMed

Van Meegeren, M E R; Van Veghel, K; De Kleijn, P; Van Roermund, P M; Biesma, D H; Lafeber, F P J G; Roosendaal, G

2012-09-01

The incidence of haemophilic arthropathy in multiple joints decreased due to treatment with clotting factor. Nowadays patients are enabled to live a rather normal life, resulting in more (sports) trauma-induced arthropathy in isolated joints like the ankle. As surgical treatment options, fusion of the tibiotalar joint and total ankle replacement are available. Both standard treatments have complications and therefore an alternative treatment is desired. In this study, treatment of haemophilic ankle arthropathy with joint distraction was explored. Three patients with haemophilic ankle arthropathy were treated with joint distraction using an Ilizarov external fixator. Clinical outcomes like function, participation and pain were evaluated in retrospect with three different questionnaires: haemophilia activities list, impact on participation and autonomy and the Van Valburg questionnaire. Structural changes were assessed blinded on X-ray by the Pettersson score and ankle images digital analysis (AIDA) and by an MRI score. All three patients were very satisfied with the clinical outcome of the procedure. They reported a clear improvement for self-perceived functional health, participation in society and autonomy and pain. Partial ankle joint mobility was preserved in the three patients. The Pettersson score remained the same in one patient and slightly improved in the two other patients, while joint space width measured by AIDA and the MRI score demonstrated improvement for all three patients after ankle distraction. This study suggests that joint distraction is a promising treatment for individual cases of haemophilic ankle arthropathy, without additional risk of bleedings during treatment. © 2012 Blackwell Publishing Ltd.

Transverse maxillary distraction in patients with periodontal pathology or insufficient tooth anchorage using custom-made devices.

PubMed

Fernández-Sanromán, Jacinto; Donascimento, Montserrat González; López, Alberto Costas; Ferro, Martín Fernández; Berrondo, Ibon Almandoz

2010-07-01

We present our experience using modified Hyrax devices for treating transverse deficiencies of the maxilla in adult patients with periodontal pathology or insufficient tooth anchorage. The surgical technique, clinical indications, and results are discussed. Eight adult patients (6 females, 2 males) requiring maxillary expansion were studied prospectively between July 2002 and July 2007. All the patients had periodontal pathology or insufficient tooth anchorage preventing the use of conventional Hyrax devices. Patients underwent surgically assisted rapid maxillary expansion with the use of custom-made modified Hyrax devices (bone-borne or tooth-bone-borne devices). Patients received preoperatively (T1), at the end of distraction (T2), at removal of the expansion device (T3), and 12 months after surgery (T4) lateral and posterior anterior cephalograms and study models to measure the width of the anterior and posterior dental arches with a digital sliding calliper. Mean age was 28.5 years (range, 18-45 years). A significant widening of the anterior (6.3 +/- 1.6 mm) and posterior (7.1 +/- 1.2 mm) dental arches was demonstrated. No significant differences were found when comparing T3 with T4 measures. No significant complications were found. The results indicated that maxillary expansion with custom-made devices in adults was an easy, affordable, predictable and stable technique without significant complications in patients who suffer periodontal pathology or patients without enough dental support. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Proof of Concept Study for the Design, Manufacturing, and Testing of a Patient-Specific Shape Memory Device for Treatment of Unicoronal Craniosynostosis.

PubMed

Borghi, Alessandro; Rodgers, Will; Schievano, Silvia; Ponniah, Allan; Jeelani, Owase; Dunaway, David

2018-01-01

Treatment of unicoronal craniosynostosis is a surgically challenging problem, due to the involvement of coronal suture and cranial base, with complex asymmetries of the calvarium and orbit. Several techniques for correction have been described, including surgical bony remodeling, early strip craniotomy with orthotic helmet remodeling and distraction. Current distraction devices provide unidirectional forces and have had very limited success. Nitinol is a shape memory alloy that can be programmed to the shape of a patient-specific anatomy by means of thermal treatment.In this work, a methodology to produce a nitinol patient-specific distractor is presented: computer tomography images of a 16-month-old patient with unicoronal craniosynostosis were processed to create a 3-dimensional model of his skull and define the ideal shape postsurgery. A mesh was produced from a nitinol sheet, formed to the ideal skull shape and heat treated to be malleable at room temperature. The mesh was afterward deformed to be attached to a rapid prototyped plastic skull, replica of the patient initial anatomy. The mesh/skull construct was placed in hot water to activate the mesh shape memory property: the deformed plastic skull was computed tomography scanned for comparison of its shape with the initial anatomy and with the desired shape, showing that the nitinol mesh had been able to distract the plastic skull to a shape close to the desired one.The shape-memory properties of nitinol allow for the design and production of patient-specific devices able to deliver complex, preprogrammable shape changes.

Speaking and cognitive distractions during EEG-based brain control of a virtual neuroprosthesis-arm.

PubMed

Foldes, Stephen T; Taylor, Dawn M

2013-12-21

Brain-computer interface (BCI) systems have been developed to provide paralyzed individuals the ability to command the movements of an assistive device using only their brain activity. BCI systems are typically tested in a controlled laboratory environment were the user is focused solely on the brain-control task. However, for practical use in everyday life people must be able to use their brain-controlled device while mentally engaged with the cognitive responsibilities of daily activities and while compensating for any inherent dynamics of the device itself. BCIs that use electroencephalography (EEG) for movement control are often assumed to require significant mental effort, thus preventing users from thinking about anything else while using their BCI. This study tested the impact of cognitive load as well as speaking on the ability to use an EEG-based BCI. Six participants controlled the two-dimensional (2D) movements of a simulated neuroprosthesis-arm under three different levels of cognitive distraction. The two higher cognitive load conditions also required simultaneously speaking during BCI use. On average, movement performance declined during higher levels of cognitive distraction, but only by a limited amount. Movement completion time increased by 7.2%, the percentage of targets successfully acquired declined by 11%, and path efficiency declined by 8.6%. Only the decline in percentage of targets acquired and path efficiency were statistically significant (p < 0.05). People who have relatively good movement control of an EEG-based BCI may be able to speak and perform other cognitively engaging activities with only a minor drop in BCI-control performance.

Attitudes and behaviors related to distracted driving in college students: a need for interventions in adolescence.

PubMed

Basch, Corey H; MacLean, Sarah A; Garcia, Philip

2017-08-05

Objective One of the biggest contributors to distracted driving among young people in the United States is technology. The objective of this study was to describe distracted driving behaviors among college students, with a specific focus on attitudes towards and use of social media. Methods With written permission, a survey was adapted from the Distracted Driving Public Opinion Poll distributed by the National Safety Council. The survey comprised 43 questions assessing attitudes and behaviors. A total of 411 students enrolled in a personal health course were invited to complete the survey. In total 324 surveys were completed, resulting in a response rate of 79%. Results Among students with a driver's license, 95.2% reported engaging in distracted driving behaviors. The use of social media while driving was common, with 30.7% reporting that they glance at, read, or post to social media while driving, most commonly on Snapchat or Instagram. It was common for students to make or answer phone calls (72.0%), review or send text messages (54.6%), or glance at or read automatic notifications (43.3%). Almost all students (91.5%) reported that they believed a hands-free solution is safer than holding the phone while driving, but only 67.9% reported that they usually used a hands-free device. Students in a health major and students who drive in urban areas were more likely to engage in distracted driving behaviors. Conclusions These findings suggest a need for interventions, particularly those which target adolescents in an attempt to deter these behaviors as they transition into adulthood.

Modified animal model and computer-assisted approach for dentoalveolar distraction osteogenesis to reconstruct unilateral maxillectomy defect.

PubMed

Feng, Zhihong; Zhao, Jinlong; Zhou, Libin; Dong, Yan; Zhao, Yimin

2009-10-01

The purpose of this report is to show the establishment of an animal model with a unilateral maxilla defect, application of virtual reality and rapid prototyping in the surgical planning for dentoalveolar distraction osteogenesis (DO). Two adult dogs were used to develop an animal model with a unilateral maxillary defect. The 3-dimensional model of the canine craniofacial skeleton was reconstructed with computed tomography data using the software Mimics, version 12.0 (Materialise Group, Leuven, Belgium). A virtual individual distractor was designed and transferred onto the model with the defect, and the osteotomies and distraction processes were simulated. A precise casting technique and numeric control technology were applied to produce the titanium distraction device, which was installed on the physical model with the defect, which was generated using Selective Laser Sintering technology, and the in vitro simulation of osteotomies and DO was done. The 2 dogs survived the operation and were lively. The osteotomies and distraction process were simulated successfully whether on the virtual or the physical model. The bone transport could be distracted to the desired position both in the virtual environment and on the physical model. The novel method to develop an animal model with a unilateral maxillary defect was feasible, and the animal model was suitable to develop the reconstruction method for unilateral maxillary defect cases with dentoalveolar DO. Computer-assisted surgical planning and simulation improved the reliability of the maxillofacial surgery, especially for the complex cases. The novel idea to reconstruct the unilateral maxillary defect with dentoalveolar DO was proved through the model experiment.

Combined maxillary and mandibular distraction osteogenesis in patients with hemifacial microsomia.

PubMed

Sant'Anna, Eduardo Franzotti; Lau, Geórgia W T; Marquezan, Mariana; de Souza Araújo, Mônica Tirre; Polley, John W; Figueroa, Alvaro A

2015-05-01

Hemifacial microsomia is a deformity of variable expressivity with unilateral hypoplasia of the mandible and the ear. In this study, we evaluated skeletal soft tissue changes after bimaxillary unilateral vertical distraction. Eight patients (4 preadolescents 4 adolescents) each with a grade II mandibular deformity underwent a LeFort I osteotomy and an ipsilateral horizontal mandibular ramus osteotomy. A semiburied distraction device was placed over the ramus, and intermaxillary fixation was applied. Anteroposterior cephalometric and frontal photographic analyses were conducted before and after distraction. Statistics were used to analyze the preoperative and postoperative changes. Cephalometrically, the nasal floor and the occlusal and gonial plane angles decreased. The ratios of affected-unaffected ramus and gonial angle heights improved by 15% and 20%, respectively. The position of menton moved toward the midline. The photographic analysis showed a decrease of the nasal and commissure plane angles, and the chin moved to the unaffected side. The parallelism between the horizontal skeletal and soft tissue planes improved, with an increase in the affected side ramus height and correction of the chin point toward the midline. Simultaneous maxillary and mandibular distraction improved facial balance and symmetry. Patients in the permanent dentition with fixed orthodontic appliances and well-aligned dental arches responded well to this intervention. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

An Exploration and Evaluation of the Attitudes and Perceptions of Students toward Use of Mobile Technology in Higher Education in the Kingdom of Jordan

ERIC Educational Resources Information Center

Allathkani, Mahmoud A.

2013-01-01

Despite the growth and use of mobile internet devices in many parts of the world, including the US, UK, and other countries, Jordanian universities have remained resistant regarding adoption of such technology. Many reasons exist behind this specific resistance in implementing mobile learning technology: cost of the devices, distractibility caused…

Assessing the Educational Value of One-to-One Devices: Have We Been Asking the Right Questions?

ERIC Educational Resources Information Center

Blikstad-Balas, Marte; Davies, Chris

2017-01-01

The provision for every pupil in schools of one-to-one digital devices such as tablets and laptops is claimed to offer a range of benefits, both practical and educational. Opinions are still divided as to whether the benefits for teaching and learning in fact outweigh the cost, disruption to established teaching practice, and distraction for…

Identification of common features of vehicle motion under drowsy/distracted driving: A case study in Wuhan, China.

PubMed

Chen, Zhijun; Wu, Chaozhong; Zhong, Ming; Lyu, Nengchao; Huang, Zhen

2015-08-01

Drowsy/distracted driving has become one of the leading causes of traffic crash. Only certain particular drowsy/distracted driving behaviors have been studied by previous studies, which are mainly based on dedicated sensor devices such as bio and visual sensors. The objective of this study is to extract the common features for identifying drowsy/distracted driving through a set of common vehicle motion parameters. An intelligent vehicle was used to collect vehicle motion parameters. Fifty licensed drivers (37 males and 13 females, M=32.5 years, SD=6.2) were recruited to carry out road experiments in Wuhan, China and collecting vehicle motion data under four driving scenarios including talking, watching roadside, drinking and under the influence of drowsiness. For the first scenario, the drivers were exposed to a set of questions and asked to repeat a few sentences that had been proved valid in inducing driving distraction. Watching roadside, drinking and driving under drowsiness were assessed by an observer and self-reporting from the drivers. The common features of vehicle motions under four types of drowsy/distracted driving were analyzed using descriptive statistics and then Wilcoxon rank sum test. The results indicated that there was a significant difference of lateral acceleration rates and yaw rate acceleration between "normal driving" and drowsy/distracted driving. Study results also shown that, under drowsy/distracted driving, the lateral acceleration rates and yaw rate acceleration were significantly larger from the normal driving. The lateral acceleration rates were shown to suddenly increase or decrease by more than 2.0m/s(3) and the yaw rate acceleration by more than 2.5°/s(2). The standard deviation of acceleration rate (SDA) and standard deviation of yaw rate acceleration (SDY) were identified to as the common features of vehicle motion for distinguishing the drowsy/distracted driving from the normal driving. In order to identify a time window for effectively extracting the two common features, a double-window method was used and the optimized "Parent Window" and "Child Window" were found to be 55s and 6s, respectively. The study results can be used to develop a driving assistant system, which can warn drivers when any one of the four types of drowsy/distracted driving is detected. Copyright © 2015. Published by Elsevier Ltd.

Assessment that Matters: Integrating the "Chore" of Department-Based Assessment with Real Improvements in Political Science Education

ERIC Educational Resources Information Center

Deardorff, Michelle D.; Folger, Paul J.

2005-01-01

Assessment requirements often raise great concerns among departments and faculty: fear of loss of autonomy, distraction from primary departmental goals, and the creation of alien and artificial external standards. This article demonstrates how one political science department directly responded to their own unique circumstances in assessing their…

Distinct mechanisms for the impact of distraction and interruption on working memory in aging

PubMed Central

Clapp, Wesley C; Gazzaley, Adam

2010-01-01

Interference is known to negatively impact the ability to maintain information in working memory (WM), an effect that is exacerbated with aging. Here, we explore how distinct sources of interference, i.e., distraction (stimuli to-be-ignored) and interruption (stimuli requiring attention), differentially influence WM in younger and older adults. EEG was recorded while participants engaged in three versions of a delayed-recognition task: no interference, a distracting stimulus, and an interrupting stimulus presented during WM maintenance. Behaviorally, both types of interference negatively impacted WM accuracy in older adults significantly more than younger adults (with a larger deficit for interruptions). N170 latency measures revealed that the degree of processing both distractors and interruptors predicted WM accuracy in both populations. However, while WM impairments could be explained by excessive attention to distractors by older adults (a suppression deficit), impairment induced by interruption were not clearly mediated by age-related increases in attention to interruptors. These results suggest that distinct underlying mechanisms mediate the impact of different types of external interference on WM in normal aging. PMID:20144492

Electronic distractions of the respiratory therapist and their impact on patient safety.

PubMed

Papadakos, Peter J

2014-08-01

Over the last decade, data from the lay press, government agencies, and the business world have identified ever-growing problems with electronic distraction and changes in human relationships in this electronically interconnected planet. As health professionals, we are well aware of the epidemic growth of injuries and deaths related to texting and driving. It should not surprise us that this distracted behavior has affected all levels of health-care providers and has impacted patient care. This advent of “distracted doctoring” was first coined by the Pulitzer Prize-winning correspondent Matt Richtel in a landmark article in the New York Times, “As doctors use more devices, potential for distraction grows.” This article was a flashpoint for professional organizations to reflect on this change in behavior and how it will impact patient safety and how we relate to patients. The explosion in technology (both personnel and hospital-based), coupled with a rapid social shift, creates an environment that constantly tempts health-care workers to surf the internet, check social media outlets, or respond to e-mails. Studies and commentaries in the medical literature only support how this is a growing problem in patient safety and may both increase medical errors and affects costs and the way we relate to patients and fellow staff. The Emergency Care Research Institute (ECRI) released its annual list of technology hazards for 2013, and three ring true for United States caregivers: distractions from smartphones and mobile devices, alarm hazards, and patient/data mismatches in electronic medical records and other health IT systems, all being in the top 10. How do we begin to address these new technological threats to our patients? First and foremost, we accept that this problem exists. We begin by educating our students and staff that this electronic explosion affects our behavior through addiction and the environment within our hospital through the use of electronic medical records, alarms, and alerts that may impact vigilance and affect our focus. These educational and policy changes should, at their core, address human-to-technology interfacing and teach electronic etiquette. How we approach patients should always have at its core the ancient adage “know thyself”; in other words, always practice self-examination in our daily interactions with technology.

The biology of distraction osteogenesis for correction of mandibular and craniomaxillofacial defects: A review

PubMed Central

Natu, Subodh Shankar; Ali, Iqbal; Alam, Sarwar; Giri, Kolli Yada; Agarwal, Anshita; Kulkarni, Vrishali Ajit

2014-01-01

Limb lengthening by distraction osteogenesis was first described in 1905. The technique did not gain wide acceptance until Gavril Ilizarov identified the physiologic and mechanical factors governing successful regeneration of bone formation. Distraction osteogenesis is a new variation of more traditional orthognathic surgical procedure for the correction of dentofacial deformities. It is most commonly used for the correction of more severe deformities and syndromes of both the maxilla and the mandible and can also be used in children at ages previously untreatable. The basic technique includes surgical fracture of deformed bone, insertion of device, 5-7 days rest, and gradual separation of bony segments by subsequent activation at the rate of 1 mm per day, followed by an 8-12 weeks consolidation phase. This allows surgeons, the lengthening and reshaping of deformed bone. The aim of this paper is to review the principle, technical considerations, applications and limitations of distraction osteogenesis. The application of osteodistraction offers novel solutions for surgical-orthodontic management of developmental anomalies of the craniofacial skeleton as bone may be molded into different shapes along with the soft tissue component gradually thereby resulting in less relapse. PMID:24688555

Treatment of brachymetatarsia by callus distraction (callotasis).

PubMed

Kawashima, T; Yamada, A; Ueda, K; Harii, K

1994-02-01

Callus distraction (callotasis) has already become a popular procedure in the lengthening of limbs. With the development of a small device, it can also be applied to the hand or foot, thus providing benefits in the treatment of brachymetatarsia. Four toes of 3 patients with brachymetatarsia of the fourth toe were treated by this method, and excellent elongation of from 17.50 to 32.55 mm (average, 23.71 mm) was acquired. The treatment period ranged from 78 to 141 days (average, 112.5 days). More time was required in the earlier cases, but the most recent took only 11 weeks. The optimal distraction rate is considered to be 0.35 mm per half-day. Reshortening after treatment ranged from 3.6 to 5.5 mm (average, 4.7 mm), or from 15% to 26% (average, 20.5%) of the distracted length. About 90% of the resorption was observed within 1 month, except in a case that involved a postoperative fracture, and no resorption was seen after 2 surgical months. Regarding complications, subluxation of joints was seen in 2 patients and a postoperative fracture in 1 patient. Subluxation was caused by tendons resisting elongation. The procedure is described, representative cases are illustrated, and problems encountered are discussed.

The distracted mind on the wheel: Overall propensity to mind wandering is associated with road crash responsibility

PubMed Central

Née, Mélanie; Lagarde, Emmanuel; Schooler, Jonathan; Contrand, Benjamin; Orriols, Ludivine; Galera, Cédric

2017-01-01

The role of distractions on attentional lapses that place road users in higher risk of crash remains poorly understood. We aimed to assess the respective impact of (i) mind wandering trait (propensity to mind wander in the everyday life as measured with a set of 4 questions on the proportion of time spent mind wandering in 4 different situations) and (ii) mind wandering state (disturbing thoughts just before the crash) on road crash risk using a comparison between responsible and non-responsible drivers. 954 drivers injured in a road crash were interviewed at the adult emergency department of the Bordeaux university hospital in France (2013–2015). Responsibility for the crash, mind wandering (trait/state), external distraction, alcohol use, psychotropic drug use, and sleep deprivation were evaluated. Based on questionnaire reports, 39% of respondents were classified with a mind wandering trait and 13% reported a disturbing thought just before the crash. While strongly correlated, mind wandering state and trait were independently associated with responsibility for a traffic crash (State: OR = 2.51, 95% CI: 1.64–3.83 and Trait: OR = 1.62, 95% CI: 1.22–2.16 respectively). Self-report of distracting thoughts therefore did not capture the entire risk associated with the propensity of the mind to wander, either because of under-reported thoughts and/or other deleterious mechanisms to be further explored. PMID:28771623

The distracted mind on the wheel: Overall propensity to mind wandering is associated with road crash responsibility.

PubMed

Gil-Jardiné, Cédric; Née, Mélanie; Lagarde, Emmanuel; Schooler, Jonathan; Contrand, Benjamin; Orriols, Ludivine; Galera, Cédric

2017-01-01

The role of distractions on attentional lapses that place road users in higher risk of crash remains poorly understood. We aimed to assess the respective impact of (i) mind wandering trait (propensity to mind wander in the everyday life as measured with a set of 4 questions on the proportion of time spent mind wandering in 4 different situations) and (ii) mind wandering state (disturbing thoughts just before the crash) on road crash risk using a comparison between responsible and non-responsible drivers. 954 drivers injured in a road crash were interviewed at the adult emergency department of the Bordeaux university hospital in France (2013-2015). Responsibility for the crash, mind wandering (trait/state), external distraction, alcohol use, psychotropic drug use, and sleep deprivation were evaluated. Based on questionnaire reports, 39% of respondents were classified with a mind wandering trait and 13% reported a disturbing thought just before the crash. While strongly correlated, mind wandering state and trait were independently associated with responsibility for a traffic crash (State: OR = 2.51, 95% CI: 1.64-3.83 and Trait: OR = 1.62, 95% CI: 1.22-2.16 respectively). Self-report of distracting thoughts therefore did not capture the entire risk associated with the propensity of the mind to wander, either because of under-reported thoughts and/or other deleterious mechanisms to be further explored.

77 FR 15452 - Visual-Manual NHTSA Driver Distraction Guidelines for In-Vehicle Electronic Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-15

... proposed NHTSA Guidelines are meant to promote safety by discouraging the introduction of excessively... your statement or other material (e.g., film clips and slides) so that it can be placed into the docket...

14 CFR 142.15 - Facilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... adequate periods of time and at a location approved by the Administrator, adequate flight training equipment and courseware, including at least one flight simulator or advanced flight training device. [Doc... significant distractions caused by flight operations and maintenance operations at the airport. (b) An...

14 CFR 142.15 - Facilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... adequate periods of time and at a location approved by the Administrator, adequate flight training equipment and courseware, including at least one flight simulator or advanced flight training device. [Doc... significant distractions caused by flight operations and maintenance operations at the airport. (b) An...

14 CFR 142.15 - Facilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... adequate periods of time and at a location approved by the Administrator, adequate flight training equipment and courseware, including at least one flight simulator or advanced flight training device. [Doc... significant distractions caused by flight operations and maintenance operations at the airport. (b) An...

14 CFR 142.15 - Facilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... adequate periods of time and at a location approved by the Administrator, adequate flight training equipment and courseware, including at least one flight simulator or advanced flight training device. [Doc... significant distractions caused by flight operations and maintenance operations at the airport. (b) An...

Radio tuning effects on visual and driving performance measures : simulator and test track studies.

DOT National Transportation Integrated Search

2013-05-01

Existing driver distraction guidelines for visual-manual device interface operation specify traditional : manual radio tuning as a reference task. This project evaluated the radio tuning reference task through two activities. : The first activity con...

77 FR 24764 - Visual-Manual NHTSA Driver Distraction Guidelines for In-Vehicle Electronic Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-25

... provided a 60-day comment period. We received a petition from the Alliance of Automobile Manufacturers...). We provided a 60-day comment period. In a petition dated March 9, 2012,\\1\\ the Alliance of Automobile...

Osteodistraction With Dental Implant-Borne Devices for Bone Regeneration in Atrophied Premaxilla.

PubMed

Carlino, Francesco; Villani, Gian Piero; Berti, Andrea; Pantaleo, Giuseppe; Cortese, Antonio; Claudio, Pier Paolo

2016-11-01

Aim of this work is to present the evolution of an innovative technique for tooth/implant supported bone distraction, leading to proper oral rehabilitation in patients with atrophic alveolar bone, even when a complete premaxilla expansion is needed, or in patients in whom implants were already present, but inserted in wrong position.Distraction osteogenesis was selected because of its moderate invasiveness, the few surgical steps needed, and the proper cost/benefits balance. This procedure is particularly suited for young patients with remarkable aesthetic demands related to active social and working life, as for elderly patients expecting lower surgical stress and risks.

The effects of age on crash risk associated with driver distraction.

PubMed

Guo, Feng; Klauer, Sheila G; Fang, Youjia; Hankey, Jonathan M; Antin, Jonathan F; Perez, Miguel A; Lee, Suzanne E; Dingus, Thomas A

2017-02-01

Driver distraction is a major contributing factor to crashes, which are the leading cause of death for the US population under 35 years of age. The prevalence of secondary-task engagement and its impacts on distraction and crashes may vary substantially by driver age. Driving performance and behaviour data were collected continuously using multiple cameras and sensors in situ for 3542 participant drivers recruited for up to 3 years for the Second Strategic Highway Research Program Naturalistic Driving Study. Secondary-task engagement at the onset of crashes and during normal driving segments was identified from videos. A case-cohort approach was used to estimate the crash odds ratios associated with, and the prevalence of, secondary tasks for four age groups: 16-20, 21-29, 30-64 and 65-98 years of age. Only severe crashes (property damage and higher severity) were included in the analysis. Secondary-task-induced distraction posed a consistently higher threat for drivers younger than 30 and above 65 when compared with middle-aged drivers, although senior drivers engaged in secondary tasks much less frequently than their younger counterparts. Secondary tasks with high visual-manual demand (e.g. visual-manual tasks performed on cell phones) affected drivers of all ages. Certain secondary tasks, such as operation of in-vehicle devices and talking/singing, increased the risk for only certain age groups. Teenaged, young adult drivers and senior drivers are more adversely impacted by secondary-task engagement than middle-aged drivers. Visual-manual distractions impact drivers of all ages, whereas cognitive distraction may have a larger impact on young drivers. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Gestural Communication With Accelerometer-Based Input Devices and Tactile Displays

DTIC Science & Technology

2008-12-01

and natural terrain obstructions, or concealment often impede visual communication attempts. To overcome some of these issues, “daisy-chaining” or...the intended recipients. Moreover, visual communication demands a focus on the visual modality possibly distracting a receiving soldier’s visual

Prediction of cartilaginous tissue repair after knee joint distraction.

PubMed

van der Woude, J A D; Welsing, P M; van Roermund, P M; Custers, R J H; Kuchuk, N O; Lafeber, F P J G G

2016-10-01

For young patients (<65years), knee joint distraction (KJD) may be a joint-saving treatment option for end-stage knee osteoarthritis. Distracting the femur from the tibia by five millimeters for six to eight weeks using an external fixation frame results in cartilaginous tissue repair, in addition to clinical benefits. This study is a first attempt to predict the degree of cartilaginous tissue repair after KJD. Fifty-seven consecutive patients received KJD. At baseline and at one year of follow-up, mean and minimum joint space width (JSW) of the most-affected compartment was determined on standardized radiographs. To evaluate the predictive ability of baseline characteristics for JSW at one year of follow-up, multivariable linear regression analysis was performed. Mean JSW±SD of the most affected compartment increased by 0.95±1.23mm to 3.08±1.43mm at one year (P<0.001). The minimum JSW increased by 0.94±1.03mm to 1.63±1.21mm at one year of follow-up (P<0.001). For a larger mean JSW one year after KJD, only Kellgren & Lawrence grade (KLG) at baseline was predictive (Regression coefficient (β)=0.47, 95% CI=0.18 to 0.77, P=0.002). For a larger minimum JSW, KLG (β=0.46, 95% CI=0.19 to 0.73, P=0.001) and male gender (β=0.52, 95% CI=0.06 to 0.99, P=0.028) were statistically predictive. Eight weeks of distraction time neared significance (β=0.44, 95% CI=-0.05 to 0.93, P=0.080). In our cohort of patients treated with KJD, males with higher KLG had the best chance of cartilaginous tissue repair by distraction. Copyright © 2016 Elsevier B.V. All rights reserved.

Hard and Soft Tissue Changes Following Maxillary Distraction Osteogenesis and Mandibular Setback with Bilateral Sagittal Split Osteotomy.

PubMed

Bawane, Shilpa S; Andrade, Neelam N

2016-12-01

(1) To highlight the role of intraoral submerged device in distraction osteogenesis (DO) of patients requiring two jaw surgeries for the correction of severe developmental maxillary hypoplasia (MH) and mandibular prognathism (MP) (2) To analyse the hard and soft tissue changes following maxillary DO and mandibular setback with bilateral sagittal split osteotomy (BSSO) in patients with severe MH and MP requiring two jaw surgeries. During the period Jan 2004 to Dec 2006, five patients with severe developmental MH along with MP were treated. In 1st stage maxillary distraction was done. Distraction started on 6th postoperative day, 1 mm distraction was carried out for 10-15 days on either side. Serial radiographs were taken immediate postoperative period for baseline comparison, post-distraction and at the end of distraction. After a period of 3-4 months of distraction 2nd stage was done. In 2nd stage, mandibular setback was done with BSSO and distractors were removed under general anesthesia. Radiographs were taken immediately and at 4 months post-operatively. Cephalometric tracings were carried out preoperatively, post DO and finally after mandibular setback with BSSO. The mean horizontal movement of maxilla was 11.4 mm at ANS and 9.6 mm at A point. Upper incisor edge was advanced by 8.8 mms. SNA increased by 8.4° and SNB decreased by 4.6°. Nasal projection advanced by 4°. Nasolabial angle normalized in all patients, mean change achieved was 10.8°. Upper lip moved forward by 5.4 mm. Lower lip moved backward by 5.4 mm. Mandible positioned backward by 4 mm at B point. No vertical change occurred in the position of A, ANS and upper incisor edges. Mean increase in skeletal angle of convexity was 26.4°. Concave profile was significantly changed to convex in all patients. Maxillary DO and mandibular setback with BSSO was associated with improved facial balance and esthetics.

External fixation techniques for distal radius fractures.

PubMed

Capo, John T; Swan, Kenneth G; Tan, Virak

2006-04-01

Fractures of the distal radius are common injuries. Low-energy or high-energy mechanisms may be involved. Unstable distal radius fractures present a challenge to the treating orthopaedic surgeon. External fixation is a valuable instrument for fracture reduction and stabilization. Limited open incisions, early range of motion, and treatment of complex wounds are a few of the benefits of external fixation. Fixators may be spanning or nonbridging and may be used alone or in combination with other stabilization methods to obtain and maintain distal radius fracture reduction. Augmentation with percutaneous wires allows for optimal fracture stabilization with physiologic alignment of the wrist. Moderate distraction at the carpus does not induce postoperative stiffness. The distal radioulnar joint must be assessed and may need to be stabilized. Complications of external fixation are usually minor, but must be anticipated and treated early. Level V (expert opinion).

Effect of osteogenic periosteal distraction by a modified Hyrax device with and without platelet-rich fibrin on bone formation in a rabbit model: a pilot study.

PubMed

Pripatnanont, P; Balabid, F; Pongpanich, S; Vongvatcharanon, S

2015-05-01

This study evaluated the effect of a modified Hyrax device and platelet-rich fibrin (PRF) on osteogenic periosteal distraction (OPD). Twelve adult male New Zealand white rabbits were separated into two main groups (six in each) according to the duration of the consolidation period (4 or 8 weeks). In each main group, the animals underwent OPD of the left and right sides of the mandible and were divided into four subgroups (three animals per group): device vs. device+PRF, and PRF vs. sham. Radiographic, histological, histomorphometric, and micro-computed tomography (micro-CT) analyses were performed. New bone formation was observed on the lateral and vertical sides of the mandible of all groups. Micro-CT and histomorphometry showed that the device+PRF group presented the highest percentages of bone volume and bone area at 4 weeks (56.67 ± 12.67%, 41.37 ± 7.57%) and at 8 weeks (49.67 ± 8.33%, 55.46 ± 10.67%; significantly higher than the other groups, P<0.001), followed by the device group at 4 weeks (33.00 ± 1.73%, 33.21 ± 11.00%) and at 8 weeks (30.00 ± 3.00%, 23.25 ± 5.46%). In conclusion, the modified Hyrax device was used successfully for OPD in a rabbit model to gain vertical ridge augmentation, and greater bone maturation was achieved with the addition of PRF. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Virtual reality intervention for older women with breast cancer.

PubMed

Schneider, Susan M; Ellis, Mathew; Coombs, William T; Shonkwiler, Erin L; Folsom, Linda C

2003-06-01

This study examined the effects of a virtual reality distraction intervention on chemotherapy-related symptom distress levels in 16 women aged 50 and older. A cross-over design was used to answer the following research questions: (1) Is virtual reality an effective distraction intervention for reducing chemotherapy-related symptom distress levels in older women with breast cancer? (2) Does virtual reality have a lasting effect? Chemotherapy treatments are intensive and difficult to endure. One way to cope with chemotherapy-related symptom distress is through the use of distraction. For this study, a head-mounted display (Sony PC Glasstron PLM - S700) was used to display encompassing images and block competing stimuli during chemotherapy infusions. The Symptom Distress Scale (SDS), Revised Piper Fatigue Scale (PFS), and the State Anxiety Inventory (SAI) were used to measure symptom distress. For two matched chemotherapy treatments, one pre-test and two post-test measures were employed. Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and received no distraction intervention (control condition) during an alternate chemotherapy treatment. Analysis using paired t-tests demonstrated a significant decrease in the SAI (p = 0.10) scores immediately following chemotherapy treatments when participants used VR. No significant changes were found in SDS or PFS values. There was a consistent trend toward improved symptoms on all measures 48 h following completion of chemotherapy. Evaluation of the intervention indicated that women thought the head mounted device was easy to use, they experienced no cybersickness, and 100% would use VR again.

Tooth-borne distraction of the lower anterior subapical segment for correction of class II malocclusion, subsequent to genioplasty.

PubMed

Matsushita, Kazuhiro; Inoue, Nobuo; Yamaguchi, Hiro-o; Ooi, Kazuhiro; Totsuka, Yasunori

2011-09-01

Alveolar distraction is mainly used to increase height and width of the alveolar crest. This technique, however, is not typically used for lengthening the perimeter of the dental arch or improving teeth axes. We applied alveolar distraction in a tooth-borne manner in the second stage of our original method and obtained favorable results. We therefore present an outline of this method. Genioplasty was first performed to create an infrastructure for sequential advancement of the subapical alveolar segment. After bone union, anterior subapical alveolar osteotomy was performed. The stump of the osteotomized dentate segment was moved forward without changing the incisal edge position, and a box-type bioabsorbable plate with four holes was fixed only onto the dentate segment using two screws. After a latency period, two distraction devices were placed bilaterally to the brackets and activated at 1.0 mm/day. After reaching the desired position, the distractor was immobilized, and then replaced by resin temporary teeth to retain the created space. After the consolidation period, orthodontic treatment was restarted and teeth moved into the newly created space. Bimaxillary surgery was performed after completing pre-surgical orthodontic treatment. Finally, both desirable occlusion and functional masticatory function were obtained. This tooth-borne distraction system is one applicable method for patients with skeletal class II and crowding of lower anterior teeth, achieving good results particularly in combination with our original method.

Brain activity during driving with distraction: an immersive fMRI study

PubMed Central

Schweizer, Tom A.; Kan, Karen; Hung, Yuwen; Tam, Fred; Naglie, Gary; Graham, Simon J.

2013-01-01

Introduction: Non-invasive measurements of brain activity have an important role to play in understanding driving ability. The current study aimed to identify the neural underpinnings of human driving behavior by visualizing the areas of the brain involved in driving under different levels of demand, such as driving while distracted or making left turns at busy intersections. Materials and Methods: To capture brain activity during driving, we placed a driving simulator with a fully functional steering wheel and pedals in a 3.0 Tesla functional magnetic resonance imaging (fMRI) system. To identify the brain areas involved while performing different real-world driving maneuvers, participants completed tasks ranging from simple (right turns) to more complex (left turns at busy intersections). To assess the effects of driving while distracted, participants were asked to perform an auditory task while driving analogous to speaking on a hands-free device and driving. Results: A widely distributed brain network was identified, especially when making left turns at busy intersections compared to more simple driving tasks. During distracted driving, brain activation shifted dramatically from the posterior, visual and spatial areas to the prefrontal cortex. Conclusions: Our findings suggest that the distracted brain sacrificed areas in the posterior brain important for visual attention and alertness to recruit enough brain resources to perform a secondary, cognitive task. The present findings offer important new insights into the scientific understanding of the neuro-cognitive mechanisms of driving behavior and lay down an important foundation for future clinical research. PMID:23450757

Computer-aided surgical planner for a new bone deformity correction device using axis-angle representation.

PubMed

Wu, Ying Ying; Plakseychuk, Anton; Shimada, Kenji

2014-11-01

Current external fixators for distraction osteogenesis (DO) are unable to correct all types of deformities in the lower limb and are difficult to use because of the lack of a pre-surgical planning system. We propose a DO system that consists of a surgical planner and a new, easy-to-setup unilateral fixator that not only corrects all lower limb deformity, but also generates the contralateral/predefined bone shape. Conventionally, bulky constructs with six or more joints (six degrees of freedom, 6DOF) are needed to correct a 3D deformity. By applying the axis-angle representation, we can achieve that with a compact construct with only two joints (2DOF). The proposed system makes use of computer-aided design software and computational methods to plan and simulate the planned procedure. Results of our stress analysis suggest that the stiffness of our proposed fixator is comparable to that of the Orthofix unilateral external fixator. We tested the surgical system on a model of an adult deformed tibia and the resulting bone trajectory deviates from the target bone trajectory by 1.8mm, which is below our defined threshold error of 2mm. We also extracted the transformation matrix that defines the deformity from the bone model and simulated the planned procedure. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

PubMed Central

Kim, Hayoung; Kim, Kap Jung; Ahn, Jae Hoon; Choy, Won Sik; Kim, Yong In; Koo, Jea Yun

2008-01-01

The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5–5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45–51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications. PMID:18415098

Latent profiles of DSM-5 PTSD symptoms and the "Big Five" personality traits.

PubMed

Contractor, Ateka A; Armour, Cherie; Shea, M Tracie; Mota, Natalie; Pietrzak, Robert H

2016-01-01

Typologies of DSM-5 PTSD symptoms and personality traits were evaluated in regard to coping styles and treatment preferences using data from 1266 trauma-exposed military veterans of which the majority were male (n=1097; weighted 89.6%). Latent profile analyses indicated a best-fitting 5-class solution; PTSD asymptomatic and emotionally stable (C1); predominant re-experiencing and avoidance symptoms and less emotionally stable (C2); subsyndromal PTSD (C3); predominant negative alterations in mood/cognitions and combined internalizing-externalizing traits (C4); and high PTSD severity and combined internalizing-externalizing traits (C5). Compared to C5, C1 members were less likely to use self-distraction, denial, and substance use and more likely to use active coping; C2 and C4 members were less likely to use denial and more likely to use behavioral disengagement; C3 members were less likely to use denial and instrumental coping and more likely to use active coping; most classes were less likely to seek mental health treatment. Compared to C1, C2 members were more likely to use self-distraction, substance use, behavioral disengagement and less likely to use active coping; C3 members were more likely to use self-distraction, and substance use, and less likely to use positive reframing, and acceptance; and C4 members were more likely to use denial, substance use, emotional support, and behavioral disengagement, and less likely to use active coping, positive reframing, and acceptance; all classes were more likely to seek mental health treatment. Emotional stability was most distinguishing of the typologies. Other implications are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Commercial Truck Driver Health and Safety: Exploring Distracted Driving Performance and Self-Reported Driving Skill.

PubMed

Stavrinos, Despina; Heaton, Karen; Welburn, Sharon C; McManus, Benjamin; Griffin, Russell; Fine, Philip R

2016-08-01

Reducing distracters detrimental to commercial truck driving is a critical component of improving the safety performance of commercial drivers, and makes the highways safer for all drivers. This study used a driving simulator to examine effects of cell phone, texting, and email distractions as well as self-reported driver optimism bias on the driving performance of commercial truck drivers. Results revealed that more visually demanding tasks were related to poorer driving performance. However, the cell phone task resulted in less off-the-road eye glances. Drivers reporting being "very skilled" displayed poorer driving performance than those reporting being "skilled." Onboard communication devices provide a practical, yet visually and manually demanding, solution for connecting drivers and dispatchers. Trucking company policies should minimize interaction between dispatchers and drivers when the truck is in motion. Training facilities should integrate driving simulators into the instruction of commercial drivers, targeting over-confident drivers. © 2016 The Author(s).

Fill 'Er Up

ERIC Educational Resources Information Center

Ramaswami, Rama

2008-01-01

Administrators are often confounded by this question: "How can educators incorporate the use of cell phones and other handheld devices as instructional tools rather than instructional distractions?" In North Carolina, school systems are aiming to show how it can be done. The North Carolina Department of Public Instruction (NCDPI), which…

The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities.

PubMed

Tekin, Ali Çağrı; Çabuk, Haluk; Dedeoğlu, Süleyman Semih; Saygılı, Mehmet Selçuk; Adaş, Müjdat; Esenyel, Cem Zeki; Büyükkurt, Cem Dinçay; Tonbul, Murat

2016-03-22

To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame) in patients with lower extremity shortness and deformity. The study comprised 17 patients (14 male, 3 female) who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure's level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. The mean age of the patients was 24.58 years (range, 5-51 years). The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6-31 months) from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1-6 cm). The mean duration of fixator application was 202.7 days (range, 104-300 days). The mean External Fixator Index was 98 days/cm (range, 42-265 days/cm). The mean Distraction Index was 10.49 days/cm (range, 10-14 days/cm). The computer-assisted external fixator system (spider frame) achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity.

[Smartphone use in nursing population: a narrative review].

PubMed

Pucciarelli, Gianluca; Simeone, Silvio; Madonna, Giuseppe; Virgolesi, Michele

2017-01-01

In healthcare, smartphone is becoming an important tool among nursing population. With the smartphones, it was possible to implement new care models. However, if used incorrectly, it could be the cause of nurses' distraction and nosocomial infection. To analyze the various apps used by the nursing population and describe the smartphones' positive and negative aspects on health care by review the literature. PubMed, CINAHL, SCOPUS e Web of Knowledge, Google Schoolar, databases were used to perform this study. The following keywords were used: ((nurse* NOT (student* OR physician*)) AND (smartphone* OR phone* OR mobile* OR cellphone) AND (app OR use* OR benefit OR distraction OR stress OR abuse OR work-related). A total of 34 articles were included in the review. Medical calculation, heart measurement and chronic patient-nurse communication apps were described. While smartphones may cause distraction, nosocomial infection or interference with other medical devices, on the other hand they could improve the well-being, job satisfaction, productivity and decrease stress in nurse population. There are potential benefits of the smartphone use, but the smartphone misuse could have negative consequences on the quality care and patient' safety due to nurses' distraction and interruptions. For this reason, nurses should be careful when they use their smartphone for no work-related activities.

Alternative Distraction Osteogenesis Technique After Implant Placement for Alveolar Ridge Augmentation of the Maxilla.

PubMed

Nogueira, Renato Luiz Maia; Osterne, Rafael Lima Verde; Abreu, Ricardo Teixeira; Araújo, Phelype Maia

2017-07-01

An alternative technique to reconstruct atrophic alveolar vertical bone after implant placement is presented. The technique consists of distraction osteogenesis or direct surgical repositioning of an implant-and-bone block segment after segmental osteotomies that can be used in esthetic or unesthetic cases. Initially, casts indicating the implant position are obtained and the future ideal prosthetic position is determined to guide the model surgery. After the model surgery, a new provisional prosthesis is fabricated, and an occlusal splint, which is used as a surgical guide and a device for distraction osteogenesis, is custom fabricated. Then, the surgery is performed. For mobilization of the implant-and-bone block segment, 2 vertical osteotomies are performed and then joined by a horizontal osteotomy. The implant-and-bone block segment is moved to the planned position. If a small movement is planned, then the implant-and-bone segment is stabilized; for larger movements, the implant-and-bone segment can be gradually moved to the final position by distraction osteogenesis. This technique has good predictability of the final position of the implant-and-bone segment and relatively fast esthetic rehabilitation. It can be considered for dental implants in regions of vertical bone atrophy. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Limb lengthening in Turner syndrome.

PubMed Central

Noonan, K. J.; Leyes, M.; Forriol, F.

1997-01-01

We report the results and complications of eight consecutive patients who underwent bilateral tibial lengthenings for dwarfism associated with Turner syndrome. Lengthening was performed via distraction osteogenesis with monolateral external fixation. Tibias were lengthened an average distance of 9.2 centimeters or 33 percent of the original tibial length. The average total treatment time was 268 days. The overall complication rate was 169 percent for each tibia lengthened and each segment required an average of 1.7 additional procedures. Seven cases (44 percent) required Achilles tendon lengthening and nine cases (56 percent) developed angulation before or after fixator removal; six of these segments required corrective osteotomy for axial malalignment. Two cases (12.5 percent) developed distraction site nonunion and required plating and bone grafting. From this series we conclude that tibial lengthening via distraction osteogenesis can be used to treat disproportionate short stature in patients with Turner syndrome. However, the benefit of a cosmetic increase in height may not compensate for the high complication rate. Efforts to determine the psychosocial and functional benefits of limb lengthening in patients with short stature is necessary to determine the true cost-benefit ratio of this procedure. Images Figure 1a Figure 1b Figure 1c PMID:9234980

Rethinking 'rational imitation' in 14-month-old infants: a perceptual distraction approach.

PubMed

Beisert, Miriam; Zmyj, Norbert; Liepelt, Roman; Jung, Franziska; Prinz, Wolfgang; Daum, Moritz M

2012-01-01

In their widely noticed study, Gergely, Bekkering, and Király (2002) showed that 14-month-old infants imitated an unusual action only if the model freely chose to perform this action and not if the choice of the action could be ascribed to external constraints. They attributed this kind of selective imitation to the infants' capacity of understanding the principle of rational action. In the current paper, we present evidence that a simpler approach of perceptual distraction may be more appropriate to explain their results. When we manipulated the saliency of context stimuli in the two original conditions, the results were exactly opposite to what rational imitation predicts. Based on these findings, we reject the claim that the notion of rational action plays a key role in selective imitation in 14-month-olds.

Maxillary Hypoplasia With Congenital Oligodontia Treated by Maxillary Distraction Osteogenesis.

PubMed

Mishima, Sayaka; Yamaguchi, Takako; Watanabe, Takuma; Komatani, Toru; Nakao, Kazumasa; Takahashi, Katsu; Bessho, Kazuhisa

2018-02-27

It is known that congenitally missing teeth can often cause differences in craniofacial morphology; however, there are few reported cases of orthognathic surgical treatment for these patients. Herein, the authors report a rare case of maxillary hypoplasia with congenital oligodontia treated by maxillary distraction osteogenesis with internal device. A 17-year-old male presenting with multiple tooth agenesis and maxillary recession was referred to our hospital for orthognathic surgical treatment. Preoperative simulation surgery was performed using Full-Color 3-dimensional salt model. After surgery, improvement in maxillary recession and occlusal stability was observed. This report demonstrates the advantages of the method used herein, which includes reduction in operating time with increase in the safety of the procedure.

NPSNET: Aural cues for virtual world immersion

NASA Astrophysics Data System (ADS)

Dahl, Leif A.

1992-09-01

NPSNET is a low-cost visual and aural simulation system designed and implemented at the Naval Postgraduate School. NPSNET is an example of a virtual world simulation environment that incorporates real-time aural cues through software-hardware interaction. In the current implementation of NPSNET, a graphics workstation functions in the sound server role which involves sending and receiving networked sound message packets across a Local Area Network, composed of multiple graphics workstations. The network messages contain sound file identification information that is transmitted from the sound server across an RS-422 protocol communication line to a serial to Musical Instrument Digital Interface (MIDI) converter. The MIDI converter, in turn relays the sound byte to a sampler, an electronic recording and playback device. The sampler correlates the hexadecimal input to a specific note or stored sound and sends it as an audio signal to speakers via an amplifier. The realism of a simulation is improved by involving multiple participant senses and removing external distractions. This thesis describes the incorporation of sound as aural cues, and the enhancement they provide in the virtual simulation environment of NPSNET.

An on-road assessment of cognitive distraction: impacts on drivers' visual behavior and braking performance.

PubMed

Harbluk, Joanne L; Noy, Y Ian; Trbovich, Patricia L; Eizenman, Moshe

2007-03-01

In this on-road experiment, drivers performed demanding cognitive tasks while driving in city traffic. All task interactions were carried out in hands-free mode so that the 21 drivers were not required to take their visual attention away from the road or to manually interact with a device inside the vehicle. Visual behavior and vehicle control were assessed while they drove an 8 km city route under three conditions: no additional task, easy cognitive task and difficult cognitive task. Changes in visual behavior were most apparent when performance between the No Task and Difficult Task conditions were compared. When looking outside of the vehicle, drivers spent more time looking centrally ahead and spent less time looking to the areas in the periphery. Drivers also reduced their visual monitoring of the instruments and mirrors, with some drivers abandoning these tasks entirely. When approaching and driving through intersections, drivers made fewer inspection glances to traffic lights compared to the No Task condition and their scanning of intersection areas to the right was also reduced. Vehicle control was also affected; during the most difficult cognitive tasks there were more occurrences of hard braking. Although hands-free designs for telematics devices are intended to reduce or eliminate the distraction arising from manual operation of these units, the potential for cognitive distraction associated with their use must also be considered and appropriately assessed. These changes are captured in measures of drivers' visual behavior.

Virtual Reality Intervention for Older Women with Breast Cancer

PubMed Central

SCHNEIDER, SUSAN M.; ELLIS, MATHEW; COOMBS, WILLIAM T.; SHONKWILER, ERIN L.; FOLSOM, LINDA C.

2013-01-01

This study examined the effects of a virtual reality distraction intervention on chemotherapy-related symptom distress levels in 16 women aged 50 and older. A cross-over design was used to answer the following research questions: (1) Is virtual reality an effective distraction intervention for reducing chemotherapy-related symptom distress levels in older women with breast cancer? (2) Does virtual reality have a lasting effect? Chemotherapy treatments are intensive and difficult to endure. One way to cope with chemotherapy-related symptom distress is through the use of distraction. For this study, a head-mounted display (Sony PC Glasstron PLM—S700) was used to display encompassing images and block competing stimuli during chemotherapy infusions. The Symptom Distress Scale (SDS), Revised Piper Fatigue Scale (PFS), and the State Anxiety Inventory (SAI) were used to measure symptom distress. For two matched chemotherapy treatments, one pre-test and two post-test measures were employed. Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and received no distraction intervention (control condition) during an alternate chemotherapy treatment. Analysis using paired t-tests demonstrated a significant decrease in the SAI (p = 0.10) scores immediately following chemotherapy treatments when participants used VR. No significant changes were found in SDS or PFS values. There was a consistent trend toward improved symptoms on all measures 48 h following completion of chemotherapy. Evaluation of the intervention indicated that women thought the head mounted device was easy to use, they experienced no cybersickness, and 100% would use VR again. PMID:12855087

75 FR 45697 - Safety Advisory Notice: Personal Electronic Device Related Distractions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... the Federal safety authority for the transportation of hazardous materials by air, rail, highway, and... transportation of hazardous materials. In light of PHMSA's vital safety mission, we issue this advisory bulletin... hazardous materials transportation. Issued in Washington, DC, on July 27, 2010. Magdy El-Sibaie, Associate...

Student Distraction in a 1:1 Learning Environment

ERIC Educational Resources Information Center

Tagsold, Jennifer Tingen

2012-01-01

K-12 education research has become increasingly concerned with technology's impact on students' attention in the classroom, particularly with regard to laptop computers and other mobile devices (Gay & Hembrooke, 2004; Jackson, 2008; Mann, 2008; Kraushaar & Novak, 2010). While this classroom technology has created many positive…

21 CFR 870.4885 - External vein stripper.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External vein stripper. 870.4885 Section 870.4885...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Surgical Devices § 870.4885 External vein stripper. (a) Identification. An external vein stripper is an extravascular device used to remove a section of...

21 CFR 870.4885 - External vein stripper.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External vein stripper. 870.4885 Section 870.4885...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Surgical Devices § 870.4885 External vein stripper. (a) Identification. An external vein stripper is an extravascular device used to remove a section of...

21 CFR 870.4885 - External vein stripper.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External vein stripper. 870.4885 Section 870.4885...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Surgical Devices § 870.4885 External vein stripper. (a) Identification. An external vein stripper is an extravascular device used to remove a section of...

21 CFR 870.4885 - External vein stripper.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External vein stripper. 870.4885 Section 870.4885...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Surgical Devices § 870.4885 External vein stripper. (a) Identification. An external vein stripper is an extravascular device used to remove a section of...

21 CFR 870.4885 - External vein stripper.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External vein stripper. 870.4885 Section 870.4885...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Surgical Devices § 870.4885 External vein stripper. (a) Identification. An external vein stripper is an extravascular device used to remove a section of...

Prejudices and perceptions: patient acceptance of mobile technology use in health care.

PubMed

Alexander, S M; Nerminathan, A; Harrison, A; Phelps, M; Scott, K M

2015-11-01

mHealth is transforming health care, yet few studies have evaluated patient and carer perceptions of the use of smartphones at the patient bedside. In this study, 70 patients and carers answered a short survey on health professionals' use of mobile devices. Half the participants were tolerant of doctors using such devices if it was work-related; others believed it was a distraction and not beneficial to patient care. Changes in practice and patient education may be needed to enable effective use of mobile devices in health. © 2015 Royal Australasian College of Physicians.

An Evaluative Report on the Current Status of Parapsychology

DTIC Science & Technology

1986-05-01

mentation" (Stanford, 1979). The ganzfeld procedure eliminates patterned stimulation in the visual h and auditory modes. Visual isolation is provided by...distracting external stimulation . The most popular of such techniques is the ganzfeld, a procedure in which the subject looks through halves of ping...powerful statistical analyses. Ongoing analog or digital feedback can be provided to subjects in innumerable ways in either the visual or auditory mode

Practical Aspects of Posttrauma Reconstruction With an Intramedullary Lengthening Nail

PubMed Central

2017-01-01

Summary: Limb equalization using the Ilizarov method has evolved and adapted the use of internal lengthening devices. One of the newest devices, termed “PRECICE,” is a magnetically controlled telescoping nail. Complications such as pin site infection and skin irritation are eliminated. Despite trauma surgeons’ familiarity with intramedullary nailing, the Ilizarov method requires sound knowledge of deformity analysis and awareness of specific complications associated with distraction osteogenesis. This manuscript discusses some of the practical preoperative and intraoperative components of limb lengthening. PMID:28486286

Pedestrian Inattention Blindness While Playing Pokémon Go as an Emerging Health-Risk Behavior: A Case Report

PubMed Central

Bergamini, Mauro; Previato, Sara; Stefanati, Armando; Gaudio, Rosa Maria

2017-01-01

Background Cases of trauma resulting from the use of mobile phones while driving motor vehicles have become quite common in recent years. Road injuries incurred by people playing video games on mobile phones (or other media devices) while walking have also become a cause for concern. Pokémon Go has been the world's most popular game since it was launched in July 2016, with more than 15 million players trying to catch all Pokémon available in the game; however, the case detailed here is the first reported accident in the medical literature caused by a pedestrian distracted by the game while crossing a street. Objective We aim to provide additional information on the innovative nature of distractions that generate risks in road-users, and to explore the underreporting of pedestrian-motor vehicle collisions due to mobile device usage. Methods We included in this case report a 25-year-old male who suddenly crossed a road while playing Pokémon Go and was hit by a van, reporting several injuries and being assisted by the Emergency Medical Service of our hospital (Padova, Italy). The patient’s history, the circumstances in which the collision happened, imaging data, and clinical course information were recorded per our hospital’s privacy policy. Results The patient hit by the van was playing Pokémon Go on his mobile phone while crossing a street, despite red traffic lights, which he did not notice due to of the distraction induced by the game. Conclusions Mobile videogames that imply movement (ie, walking, running, cycling) to play are an effective way to improve physical activity practice, especially in adolescents and young adults. Nevertheless, cases like the one presented here point out that these games could pose a significant risk to users who play while walking, cycling, or driving in unsafe areas such as city streets, because players become distracted and may ignore surrounding hazards. Comprehensive, multilevel interventions are needed to reduce accidents caused by distraction, and to stress findings on the positive and negative effects of video games, which are becoming a source of public health concern. Health care providers should be aware of their chief role in these possible prevention strategies, based on their direct interactions with road incident victims. PMID:28365563

Virtual Reality: A Distraction Intervention for Chemotherapy

PubMed Central

Schneider, Susan M.; Hood, Linda E.

2007-01-01

Purpose/Objectives To explore virtual reality (VR) as a distraction intervention to relieve symptom distress in adults receiving chemotherapy treatments for breast, colon, and lung cancer. Design Crossover design in which participants served as their own control. Setting Outpatient clinic at a comprehensive cancer center in the southeastern United States. Sample 123 adults receiving initial chemotherapy treatments. Methods Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and then received no intervention (control) during an alternate matched chemotherapy treatment. The Adapted Symptom Distress Scale–2, Revised Piper Fatigue Scale, and State Anxiety Inventory were used to measure symptom distress. The Presence Questionnaire and an open-ended questionnaire were used to evaluate the subjects’ VR experience. The influence of type of cancer, age, and gender on symptom outcomes was explored. Mixed models were used to test for differences in levels of symptom distress. Main Research Variables Virtual reality and symptom distress. Findings Patients had an altered perception of time (p < 0.001) when using VR, which validates the distracting capacity of the intervention. Evaluation of the intervention indicated that patients believed the head-mounted device was easy to use, they experienced no cybersickness, and 82% would use VR again. However, analysis demonstrated no significant differences in symptom distress immediately or two days following chemotherapy treatments. Conclusions Patients stated that using VR made the treatment seem shorter and that chemotherapy treatments with VR were better than treatments without the distraction intervention. However, positive experiences did not result in a decrease in symptom distress. The findings support the idea that using VR can help to make chemotherapy treatments more tolerable, but clinicians should not assume that use of VR will improve chemotherapy-related symptoms. Implications for Nursing Patients found using VR during chemotherapy treatments to be enjoyable. VR is a feasible and cost-effective distraction intervention to implement in the clinical setting. PMID:17562631

Effects of mobile Internet use on college student pedestrian injury risk.

PubMed

Byington, Katherine W; Schwebel, David C

2013-03-01

College-age individuals have the highest incidence of pedestrian injuries of any age cohort. One factor that might contribute to elevated pedestrian injuries among this age group is injuries incurred while crossing streets distracted by mobile devices. Examine whether young adult pedestrian safety is compromised while crossing a virtual pedestrian street while distracted using the Internet on a mobile "smartphone." A within-subjects design was implemented with 92 young adults. Participants crossed a virtual pedestrian street 20 times, half the time while undistracted and half while completing an email-driven "scavenger hunt" to answer mundane questions using mobile Internet on their cell phones. Six measures of pedestrian behavior were assessed during crossings. Participants also reported typical patterns of street crossing and mobile Internet use. Participants reported using mobile Internet with great frequency in daily life, including while walking across streets. In the virtual street environment, pedestrian behavior was greatly altered and generally more risky when participants were distracted by Internet use. While distracted, participants waited longer to cross the street (F=42.37), missed more safe opportunities to cross (F=42.63), took longer to initiate crossing when a safe gap was available (F=53.03), looked left and right less often (F=124.68), spent more time looking away from the road (F=1959.78), and were more likely to be hit or almost hit by an oncoming vehicle (F=29.54; all ps<0.01). Results were retained after controlling for randomized order; participant gender, age, and ethnicity; and both pedestrian habits and mobile Internet experience. Pedestrian behavior was influenced, and generally considerably riskier, when participants were simultaneously using mobile Internet and crossing the street than when crossing the street with no distraction. This finding reinforces the need for increased awareness concerning the risks of distracted pedestrian behavior. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effects of Mobile Internet Use On College Student Pedestrian Injury Risk

PubMed Central

Byington, Katherine W.; Schwebel, David C.

2012-01-01

Background College-age individuals have the highest incidence of pedestrian injuries of any age cohort. One factor that might contribute to elevated pedestrian injuries among this age group is injuries incurred while crossing streets distracted by mobile devices. Objectives Examine whether young adult pedestrian safety is compromised while crossing a virtual pedestrian street while distracted using the internet on a mobile “smartphone.” Method A within-subjects design was implemented with 92 young adults. Participants crossed a virtual pedestrian street 20 times, half the time while undistracted and half while completing an email-driven “scavenger hunt” to answer mundane questions using mobile internet on their cell phones. Six measures of pedestrian behavior were assessed during crossings. Participants also reported typical patterns of street crossing and mobile internet use. Results Participants reported using mobile internet with great frequency in daily life, including while walking across streets. In the virtual street environment, pedestrian behavior was greatly altered and generally more risky when participants were distracted by internet use. While distracted, participants waited longer to cross the street (F = 42.37), missed more safe opportunities to cross (F = 42.63), took longer to initiate crossing when a safe gap was available (F = 53.03), looked left and right less often (F = 124.68), spent more time looking away from the road (F = 1959.78), and were more likely to be hit or almost hit by an oncoming vehicle (F = 29.54; all ps< 0.01). Results were retained after controlling for randomized order; participant gender, age, and ethnicity; and both pedestrian habits and mobile internet experience. Conclusion Pedestrian behavior was influenced, and generally considerably riskier, when participants were simultaneously using mobile internet and crossing the street than when crossing the street with no distraction. This finding reinforces the need for increased awareness concerning the risks of distracted pedestrian behavior. PMID:23201755

Extensive limb lengthening in Ollier's disease: 25-year follow-up.

PubMed

Märtson, Aare; Haviko, Tiit; Kirjanen, Kaur

2005-01-01

A case of extensive lower limb lengthening (32 cm) in a 14-year-old male patient with Ollier's disease is reported. A varus deformity of the femur and a valgus deformity of the tibia were evident. The femur was successfully lengthened 22 cm by metaphyseal distraction, and the tibia was lengthened 10 cm by two-stage distraction-compression method with a cylindrical bone allograft. Ilizarov's distraction device was used. Radiologically, a good bone regenerate was formed. Host bone has incorporated (like sarcophagi) the allograft of tibia. No evidence of vascular or neural disturbances was found. The lengthening indices were counted for femur 22.5 days per centimeter and for tibia 21 days per centimeter, altogether 15.5 days per centimeter. Bone lengthening was performed through the Ollier's disease foci. Fine needle biopsy investigation showed that most embryonic cartilage cells had been replaced with bone tissue. After five years and a 25-year follow-up the patient was satisfied with the result. The function of the knee joint was limited, but the limb was fully weight-bearing. Signs of knee osteoarthritis were found.

77 FR 12907 - Visual-Manual NHTSA Driver Distraction Guidelines for In-Vehicle Electronic Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-02

... impact of task performance while driving on driving safety and time-based acceptance criteria for... feedback). The proposed NHTSA Guidelines list certain secondary, non-driving related tasks that, based on... cannot be used by the driver to perform such tasks while the driver is driving. For all other secondary...

78 FR 49323 - Proposed Agency Information Collection Activities; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-13

... Information Collection Request (ICR) abstracted below will be forwarded to the Office of Management and Budget... for clearance by OMB as required by the PRA. Title: Electronic Device Distraction: Test of Peer to... consoles, personal computers, etc.) is known to be a factor in some accidents and suspected of being the...

The Rules of Engagement

ERIC Educational Resources Information Center

Raths, David

2013-01-01

There is a civil war simmering in classrooms nationwide. Arrayed on one side are students who would sooner cut off an arm than sacrifice their mobile devices. On the other stand faculty members who expect to be the focal point of their classes and will not abide distractions. Caught in the crossfire are instructional technology professionals.…

An EUD Approach to the Design of Educational Games

ERIC Educational Resources Information Center

Ardito, Carmelo; Lanzilotti, Rosa

2011-01-01

Distance education has experienced profound changes due to the introduction of new technologies, especially mobile devices of different types. It is necessary to define new learning techniques which are able to capture students' attention and to engage them in their learning activities, reducing problems like distraction generated by the use of…

Applications of self-control procedures by children: a review.

PubMed Central

O'Leary, S G; Dubey, D R

1979-01-01

Self-control procedures as used by children to affect their own behavior were reviewed. Particular emphasis was placed on self-instruction, self-determined criteria, self-assessment, and self-reinforcement. Self-punishment, comprehensive programs, and innovative self-control procedures (distraction and restatement of contingencies) were also evaluated. Basic effectiveness, comparisons with similar externally imposed interventions, maintenance, and the augmental value of the procedures were assessed. Important problems for future research were identified. PMID:389917

Biomechanical effect of interspinous process distraction height after lumbar fixation surgery: An in vitro model.

PubMed

Fu, Lin; Ma, Jianxiong; Lu, Bin; Jia, Haobo; Zhao, Jie; Kuang, Mingjie; Feng, Rui; Xu, Liyan; Bai, Haohao; Sun, Lei; Wang, Ying; Ma, Xinlong

2017-07-01

Pedicle screw fixation may induce abnormal activity at adjacent segment and accelerate the degeneration of lumbar vertebrae. Dynamic stabilizers could provide an intermediate solution between conservative treatment and fusion surgery. Lumbar vertebral segment cephalad to instrumented fixation was the most common localization of adjacent segment degeneration. The aim of this study is to explore the use of interspinous process devices in the lumbar vertebral segment cephalad to fixation segment in changing the mechanical distribution and limiting abnormal activity of the spine. Eight specimens were tested in the following groups: intact group, instability group (bilateral facetectomy at L3-L4), fixation group (bilateral facetectomy and pedicle screw fixation at L3-L4), and hybrid fixation group (fixation at L3-L4 and simulating interspinous device implantation of 6, 8, 10, 12, 14, 16, and 18 mm at L2-L3). Range of motion, motion of vertebral body, and strain distribution change were recorded. The range of motion in extension with 16- and 18-mm hybrid constructs was significantly lower than intact, instability, and fixation groups. In flexion and lateral bending, the strain values of L4 inferior articular process with 18-mm hybrid construct have a significant difference compared with other groups. In axial rotation, under the condition of a contralateral state, the strain values of L2 superior articular process with 18-mm hybrid construct have a significant difference compared with intact and fixation groups. The strain value of the L4 inferior articular process had negative correlation with height distraction in three dimensions, except extension. A negative correlation between the strain value of the L2 superior articular process and distraction height was found in contralateral bending and contralateral axial rotation. Interspinous process devices above the fixation segment can change the mechanical distribution of the spine and limit activity in some of the segments of the spine, which may delay the degeneration of the adjacent segment.

Ubiquitous Games for Learning (UbiqGames): Weatherlings, a Worked Example

ERIC Educational Resources Information Center

Klopfer, E.; Sheldon, J.; Perry, J.; Chen, V. H. -H.

2012-01-01

This paper provides a rationale for a class of mobile, casual, and educational games, which we call UbiqGames. The study is motivated by the desire to understand how students use educational games in light of additional distractions on their devices, and how game design can make those games appealing, educationally useful, and practical. In…

Teaching Evolution through the Hardy-Weinberg Principle: A Real-Time, Active-Learning Exercise Using Classroom Response Devices

ERIC Educational Resources Information Center

Brewer, Michael S.; Gardner, Grant E.

2013-01-01

Teaching population genetics provides a bridge between genetics and evolution by using examples of the mechanisms that underlie changes in allele frequencies over time. Existing methods of teaching these concepts often rely on computer simulations or hand calculations, which distract students from the material and are problematic for those with…

Why Aren't They Paying Attention to Me? Strategies for Preventing Distraction in a 1:1 Learning Environment

ERIC Educational Resources Information Center

Tagsold, Jennifer T.

2013-01-01

K-12 education research has become increasingly concerned with technology's impact on students' attention in the classroom, particularly with regard to laptop computers and other mobile devices (Gay & Hembrooke, 2004; Jackson, 2008; Mann, 2008; Kraushaar & Novak, 2010). While this classroom technology has created many positive implications…

Strategic offloading of delayed intentions into the external environment.

PubMed

Gilbert, Sam J

2015-01-01

In everyday life, we often use external artefacts such as diaries to help us remember intended behaviours. In addition, we commonly manipulate our environment, for example by placing reminders in noticeable places. Yet strategic offloading of intentions to the external environment is not typically permitted in laboratory tasks examining memory for delayed intentions. What factors influence our use of such strategies, and what behavioural consequences do they have? This article describes four online experiments (N = 1196) examining a novel web-based task in which participants hold intentions for brief periods, with the option to strategically externalize these intentions by creating a reminder. This task significantly predicted participants' fulfilment of a naturalistic intention embedded within their everyday activities up to one week later (with greater predictive ability than more traditional prospective memory tasks, albeit with weak effect size). Setting external reminders improved performance, and it was more prevalent in older adults. Furthermore, participants set reminders adaptively, based on (a) memory load, and (b) the likelihood of distraction. These results suggest the importance of metacognitive processes in triggering intention offloading, which can increase the probability that intentions are eventually fulfilled.

Perceived Discrimination, Coping Strategies, and Mexican Origin Adolescents' Internalizing and Externalizing Behaviors: Examining the Moderating Role of Gender and Cultural Orientation.

PubMed

Brittian, Aerika S; Toomey, Russell B; Gonzales, Nancy A; Dumka, Larry E

2013-01-01

The literature identifying effective coping strategies related to perceived discrimination has yielded mixed findings, suggesting that recommendations for effective coping may vary by individual and group differences. The current study examined the influence of perceived discrimination and coping strategies on Mexican origin adolescents' later internalizing symptoms and externalizing behaviors, and assessed the moderating roles of gender and cultural orientation. Participants included 189 adolescents (46% male, 54% female) interviewed at 7 th and 8 th grade. Results suggested that the associations between perceived discrimination and internalizing symptoms were buffered by distraction coping among youth that were low on Anglo orientation but not among youth high on Anglo orientation. In addition, the associations between perceived discrimination and externalizing behaviors were buffered by social support seeking, but only among youth that were low on Mexican orientation. Directions for future research and application of the current research are discussed.

Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence?

PubMed

Krage, Ralf; Zwaan, Laura; Tjon Soei Len, Lian; Kolenbrander, Mark W; van Groeningen, Dick; Loer, Stephan A; Wagner, Cordula; Schober, Patrick

2017-11-01

Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary resuscitation (CPR) is increasingly emphasised. Nonetheless, the relationship between non-technical skills and technical performance is poorly understood. We hypothesise that non-technical skills become increasingly important under stressful conditions when individuals are distracted from their tasks, and investigated the relationship between non-technical and technical skills under control conditions and when external stressors are present. In this simulator-based randomised cross-over study, 30 anaesthesiologists and anaesthesia residents from the VU University Medical Center, Amsterdam, the Netherlands, participated in two different CPR scenarios in random order. In one scenario, external stressors (radio noise and a distractive scripted family member) were added, while the other scenario without stressors served as control condition. Non-technical performance of the team leader and technical performance of the team were measured using the 'Anaesthetists' Non-technical Skill' score and a recently developed technical skills score. Analysis of variance and Pearson correlation coefficients were used for statistical analyses. Non-technical performance declined when external stressors were present (adjusted mean difference 3.9 points, 95% CI 2.4 to 5.5 points). A significant correlation between non-technical and technical performance scores was observed when external stressors were present (r=0.67, 95% CI 0.40 to 0.83, p<0.001), while no evidence for such a relationship was observed under control conditions (r=0.15, 95% CI -0.22 to 0.49, p=0.42). This was equally true for all individual domains of the non-technical performance score (task management, team working, situation awareness, decision-making). During CPR with external stressors, the team's technical performance is related to the non-technical skills of the team leader. This may have important implications for training of CPR teams. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence?

PubMed Central

Krage, Ralf; Zwaan, Laura; Tjon Soei Len, Lian; Kolenbrander, Mark W; van Groeningen, Dick; Loer, Stephan A; Wagner, Cordula; Schober, Patrick

2017-01-01

Background Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary resuscitation (CPR) is increasingly emphasised. Nonetheless, the relationship between non-technical skills and technical performance is poorly understood. We hypothesise that non-technical skills become increasingly important under stressful conditions when individuals are distracted from their tasks, and investigated the relationship between non-technical and technical skills under control conditions and when external stressors are present. Methods In this simulator-based randomised cross-over study, 30 anaesthesiologists and anaesthesia residents from the VU University Medical Center, Amsterdam, the Netherlands, participated in two different CPR scenarios in random order. In one scenario, external stressors (radio noise and a distractive scripted family member) were added, while the other scenario without stressors served as control condition. Non-technical performance of the team leader and technical performance of the team were measured using the ‘Anaesthetists’ Non-technical Skill’ score and a recently developed technical skills score. Analysis of variance and Pearson correlation coefficients were used for statistical analyses. Results Non-technical performance declined when external stressors were present (adjusted mean difference 3.9 points, 95% CI 2.4 to 5.5 points). A significant correlation between non-technical and technical performance scores was observed when external stressors were present (r=0.67, 95% CI 0.40 to 0.83, p<0.001), while no evidence for such a relationship was observed under control conditions (r=0.15, 95% CI −0.22 to 0.49, p=0.42). This was equally true for all individual domains of the non-technical performance score (task management, team working, situation awareness, decision-making). Conclusions During CPR with external stressors, the team’s technical performance is related to the non-technical skills of the team leader. This may have important implications for training of CPR teams. PMID:28844039

Resource-sharing between internal maintenance and external selection modulates attentional capture by working memory content.

PubMed

Kiyonaga, Anastasia; Egner, Tobias

2014-01-01

It is unclear why and under what circumstances working memory (WM) and attention interact. Here, we apply the logic of the time-based resource-sharing (TBRS) model of WM (e.g., Barrouillet et al., 2004) to explore the mixed findings of a separate, but related, literature that studies the guidance of visual attention by WM contents. Specifically, we hypothesize that the linkage between WM representations and visual attention is governed by a time-shared cognitive resource that alternately refreshes internal (WM) and selects external (visual attention) information. If this were the case, WM content should guide visual attention (involuntarily), but only when there is time for it to be refreshed in an internal focus of attention. To provide an initial test for this hypothesis, we examined whether the amount of unoccupied time during a WM delay could impact the magnitude of attentional capture by WM contents. Participants were presented with a series of visual search trials while they maintained a WM cue for a delayed-recognition test. WM cues could coincide with the search target, a distracter, or neither. We varied both the number of searches to be performed, and the amount of available time to perform them. Slowing of visual search by a WM matching distracter-and facilitation by a matching target-were curtailed when the delay was filled with fast-paced (refreshing-preventing) search trials, as was subsequent memory probe accuracy. WM content may, therefore, only capture visual attention when it can be refreshed, suggesting that internal (WM) and external attention demands reciprocally impact one another because they share a limited resource. The TBRS rationale can thus be applied in a novel context to explain why WM contents capture attention, and under what conditions that effect should be observed.

Techniques for small-bone lengthening in congenital anomalies of the hand and foot.

PubMed

Minguella, J; Cabrera, M; Escolá, J

2001-10-01

The purpose of this study is to analyse three different lengthening techniques used in 31 small bones for congenital malformations of the hand and foot: 15 metacarpals, 12 metatarsals, 1 foot stump and 3 spaces between a previously transplanted phalanx end of the carpus or the metacarpal. Progressive lengthening with an external fixator device was performed in 23 cases: the callus distraction (callotasis) technique was used in 15 cases, whereas in the other 8 cases the speed of lengthening was faster and the defect bridged with a bone graft as a second stage. In another eight cases, a one-stage lengthening was performed. In the callotasis group, the total length gained ranged from 9 mm to 30 mm and the percentage of lengthening obtained (compared with the initial bone length) averaged 53.4%; in the fast lengthening group, the length gained ranged from 8 mm to 15 mm, and the average percentage of lengthening was 53.1%; and in the one-stage group, the length gained ranged from 7 mm to 15 mm, and the average percentage of lengthening was 43%. The overall complication rate was 22.5%.

Pedestrian Inattention Blindness While Playing Pokémon Go as an Emerging Health-Risk Behavior: A Case Report.

PubMed

Barbieri, Stefania; Vettore, Gianna; Pietrantonio, Vincenzo; Snenghi, Rossella; Tredese, Alberto; Bergamini, Mauro; Previato, Sara; Stefanati, Armando; Gaudio, Rosa Maria; Feltracco, Paolo

2017-04-01

Cases of trauma resulting from the use of mobile phones while driving motor vehicles have become quite common in recent years. Road injuries incurred by people playing video games on mobile phones (or other media devices) while walking have also become a cause for concern. Pokémon Go has been the world's most popular game since it was launched in July 2016, with more than 15 million players trying to catch all Pokémon available in the game; however, the case detailed here is the first reported accident in the medical literature caused by a pedestrian distracted by the game while crossing a street. We aim to provide additional information on the innovative nature of distractions that generate risks in road-users, and to explore the underreporting of pedestrian-motor vehicle collisions due to mobile device usage. We included in this case report a 25-year-old male who suddenly crossed a road while playing Pokémon Go and was hit by a van, reporting several injuries and being assisted by the Emergency Medical Service of our hospital (Padova, Italy). The patient's history, the circumstances in which the collision happened, imaging data, and clinical course information were recorded per our hospital's privacy policy. The patient hit by the van was playing Pokémon Go on his mobile phone while crossing a street, despite red traffic lights, which he did not notice due to of the distraction induced by the game. Mobile videogames that imply movement (ie, walking, running, cycling) to play are an effective way to improve physical activity practice, especially in adolescents and young adults. Nevertheless, cases like the one presented here point out that these games could pose a significant risk to users who play while walking, cycling, or driving in unsafe areas such as city streets, because players become distracted and may ignore surrounding hazards. Comprehensive, multilevel interventions are needed to reduce accidents caused by distraction, and to stress findings on the positive and negative effects of video games, which are becoming a source of public health concern. Health care providers should be aware of their chief role in these possible prevention strategies, based on their direct interactions with road incident victims. ©Stefania Barbieri, Gianna Vettore, Vincenzo Pietrantonio, Rossella Snenghi, Alberto Tredese, Mauro Bergamini, Sara Previato, Armando Stefanati, Rosa Maria Gaudio, Paolo Feltracco. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.04.2017.

Implantation reduces the negative effects of bio-logging devices on birds.

PubMed

White, Craig R; Cassey, Phillip; Schimpf, Natalie G; Halsey, Lewis G; Green, Jonathan A; Portugal, Steven J

2013-02-15

Animal-borne logging or telemetry devices are widely used for measurements of physiological and movement data from free-living animals. For such measurements to be relevant, however, it is essential that the devices themselves do not affect the data of interest. A recent meta-analysis reported an overall negative effect of these devices on the birds that bear them, i.e. on nesting productivity, clutch size, nest initiation date, offspring quality, body condition, flying ability, foraging behaviours, energy expenditure and survival rate. Method of attachment (harness, collar, glue, anchor, implant, breast-mounted or tailmount) had no influence on the strength of these effects but anchored and implanted transmitters had the highest reported rates of device-induced mortality. Furthermore, external devices, but not internal devices, caused an increase in 'device-induced behaviour' (comfort behaviours such as preening, fluffing and stretching, and unrest activities including unquantifiable 'active' behaviours). These findings suggest that, with the exception of device-induced behaviour, external attachment is preferable to implantation. In the present study we undertake a meta-analysis of 183 estimates of device impact from 39 studies of 36 species of bird designed to explicitly compare the effects of externally attached and surgically implanted devices on a range of traits, including condition, energy expenditure and reproduction. In contrast to a previous study, we demonstrate that externally attached devices have a consistent detrimental effect (i.e. negative influences on body condition, reproduction, metabolism and survival), whereas implanted devices have no consistent effect. We also show that the magnitude of the negative effect of externally attached devices decreases with time. We therefore conclude that device implantation is preferable to external attachment, providing that the risk of mortality associated with the anaesthesia and surgery required for implantation can be mitigated. We recommend that studies employing external devices use devices that can be borne for long periods, and, wherever possible, deploy devices in advance of the time period of interest.

Wearable technology as a booster of clinical care

NASA Astrophysics Data System (ADS)

Jonas, Stephan; Hannig, Andreas; Spreckelsen, Cord; Deserno, Thomas M.

2014-03-01

Wearable technology defines a new class of smart devices that are accessories or clothing equipped with computational power and sensors, like Google Glass. In this work, we propose a novel concept for supporting everyday clinical pathways with wearable technology. In contrast to most prior work, we are not focusing on the omnipresent screen to display patient information or images, but are trying to maintain existing workflows. To achieve this, our system supports clinical staff as a documenting observer, only intervening adequately if problems are detected. Using the example of medication preparation and administration, a task known to be prone to errors, we demonstrate the full potential of the new devices. Patient and medication identifier are captured with the built-in camera, and the information is send to a transaction server. The server communicates with the hospital information system to obtain patient records and medication information. The system then analyses the new medication for possible side-effects and interactions with already administered drugs. The result is sent to the device while encapsulating all sensitive information respecting data security and privacy. The user only sees a traffic light style encoded feedback to avoid distraction. The server can reduce documentation efforts and reports in real-time on possible problems during medication preparation or administration. In conclusion, we designed a secure system around three basic principles with many applications in everyday clinical work: (i) interaction and distraction is kept as low as possible; (ii) no patient data is displayed; and (iii) device is pure observer, not part of the workflow. By reducing errors and documentation burden, our approach has the capability to boost clinical care.

Eating behaviour associated with differences in conflict adaptation for food pictures.

PubMed

Husted, Margaret; Banks, Adrian P; Seiss, Ellen

2016-10-01

The goal conflict model of eating (Stroebe, Mensink, Aarts, Schut, & Kruglanski, 2008) proposes differences in eating behaviour result from peoples' experience of holding conflicting goals of eating enjoyment and weight maintenance. However, little is understood about the relationship between eating behaviour and the cognitive processes involved in conflict. This study aims to investigate associations between eating behaviour traits and cognitive conflict processes, specifically the application of cognitive control when processing distracting food pictures. A flanker task using food and non-food pictures was used to examine individual differences in conflict adaptation. Participants responded to target pictures whilst ignoring distracting flanking pictures. Individual differences in eating behaviour traits, attention towards target pictures, and ability to apply cognitive control through adaptation to conflicting picture trials were analysed. Increased levels of external and emotional eating were related to slower responses to food pictures indicating food target avoidance. All participants showed greater distraction by food compared to non-food pictures. Of particular significance, increased levels of emotional eating were associated with greater conflict adaptation for conflicting food pictures only. Emotional eaters demonstrate greater application of cognitive control for conflicting food pictures as part of a food avoidance strategy. This could represent an attempt to inhibit their eating enjoyment goal in order for their weight maintenance goal to dominate. Copyright © 2016 Elsevier Ltd. All rights reserved.

E-textbooks: A Personalized Learning Experience or a Digital Distraction?

ERIC Educational Resources Information Center

Dobler, Elizabeth

2015-01-01

This article explores the digital reading preferences and strategies used by preservice teachers when reading an e-textbook in a literacy methods course. The use of e-textbooks is becoming more prevalent due to an increase in access to mobile devices, acceptance of e-books in general, and the high cost of print textbooks. To ensure comprehension,…

A Pilot and Feasibility Study of Virtual Reality as a Distraction for Children with Cancer

ERIC Educational Resources Information Center

Gershon, Jonathan; Zimand, Elana; Pickering, Melissa; Rothbaum, Barbara Olasov; Hodges, Larry

2004-01-01

Objective: To pilot and test the feasibility of a novel technology to reduce anxiety and pain associated with an invasive medical procedure in children with cancer. Method: Children with cancer (ages 7-19) whose treatment protocols required access of their subcutaneous venous port device (port access) were randomly assigned to a virtual reality…

A Workmanship of Risk: The Crafting of Thought in an Age of Speed and Distraction

ERIC Educational Resources Information Center

Jackson, Maggie

2017-01-01

"How much can one fathom in a heartbeat or know deeply at a glance? In a culture smitten with technology, what does good thinking look like?" This question sets the stage as Maggie Jackson explores society's relationship with devices and society's use of technology. She examines ways in which multitasking has jeopardized our ability to…

Computed tomographic analysis of temporal maxillary stability and pterygomaxillary generate formation following pediatric Le Fort III distraction advancement.

PubMed

Hopper, Richard A; Sandercoe, Gavin; Woo, Albert; Watts, Robyn; Kelley, Patrick; Ettinger, Russell E; Saltzman, Babette

2010-11-01

Le Fort III distraction requires generation of bone in the pterygomaxillary region. The authors performed retrospective digital analysis on temporal fine-cut computed tomographic images to quantify both radiographic evidence of pterygomaxillary region bone formation and relative maxillary stability. Fifteen patients with syndromic midface hypoplasia were included in the study. The average age of the patients was 8.7 years; 11 had either Crouzon or Apert syndrome. The average displacement of the maxilla during distraction was 16.2 mm (range, 7 to 31 mm). Digital analysis was performed on fine-cut computed tomographic scans before surgery, at device removal, and at annual follow-up. Seven patients also had mid-consolidation computed tomographic scans. Relative maxillary stability and density of radiographic bone in the pterygomaxillary region were calculated between each scan. There was no evidence of clinically significant maxillary relapse, rotation, or growth between the end of consolidation and 1-year follow-up, other than a relatively small 2-mm subnasal maxillary vertical growth. There was an average radiographic ossification of 0.5 mm/mm advancement at the time of device removal, with a 25th percentile value of 0.3 mm/mm. The time during consolidation that each patient reached the 25th percentile of pterygomaxillary region bone density observed in this series of clinically stable advancements ranged from 1.3 to 9.8 weeks (average, 3.7 weeks). There was high variability in the amount of bone formed in the pterygomaxillary region associated with clinical stability of the advanced Le Fort III segment. These data suggest that a subsection of patients generate the minimal amount of pterygomaxillary region bone formation associated with advancement stability as early as 4 weeks into consolidation.

Driver crash risk factors and prevalence evaluation using naturalistic driving data.

PubMed

Dingus, Thomas A; Guo, Feng; Lee, Suzie; Antin, Jonathan F; Perez, Miguel; Buchanan-King, Mindy; Hankey, Jonathan

2016-03-08

The accurate evaluation of crash causal factors can provide fundamental information for effective transportation policy, vehicle design, and driver education. Naturalistic driving (ND) data collected with multiple onboard video cameras and sensors provide a unique opportunity to evaluate risk factors during the seconds leading up to a crash. This paper uses a National Academy of Sciences-sponsored ND dataset comprising 905 injurious and property damage crash events, the magnitude of which allows the first direct analysis (to our knowledge) of causal factors using crashes only. The results show that crash causation has shifted dramatically in recent years, with driver-related factors (i.e., error, impairment, fatigue, and distraction) present in almost 90% of crashes. The results also definitively show that distraction is detrimental to driver safety, with handheld electronic devices having high use rates and risk.

Driver crash risk factors and prevalence evaluation using naturalistic driving data

PubMed Central

Dingus, Thomas A.; Guo, Feng; Lee, Suzie; Antin, Jonathan F.; Perez, Miguel; Buchanan-King, Mindy; Hankey, Jonathan

2016-01-01

The accurate evaluation of crash causal factors can provide fundamental information for effective transportation policy, vehicle design, and driver education. Naturalistic driving (ND) data collected with multiple onboard video cameras and sensors provide a unique opportunity to evaluate risk factors during the seconds leading up to a crash. This paper uses a National Academy of Sciences-sponsored ND dataset comprising 905 injurious and property damage crash events, the magnitude of which allows the first direct analysis (to our knowledge) of causal factors using crashes only. The results show that crash causation has shifted dramatically in recent years, with driver-related factors (i.e., error, impairment, fatigue, and distraction) present in almost 90% of crashes. The results also definitively show that distraction is detrimental to driver safety, with handheld electronic devices having high use rates and risk. PMID:26903657

Treatment of Combined Spinal Deformity in Patient with Ollier Disease and Abnormal Vertebrae

PubMed Central

Ryabykh, S. О.; Gubin, A. V.; Prudnikova, О. G.; Kobyzev, А. Е.

2012-01-01

We report staged treatment of severe combined spinal deformity in an 11-year-old patient with Ollier disease and abnormal cervical vertebra. Combined scoliosis with systemic pathology and abnormal vertebrae is a rare condition and features atypical deformity location and rapid progression rate and frequently involves the rib cage and pelvis, disturbing the function of chest organs and skeleton. Progressive deformity resulted in cachexia and acute respiratory failure. A halo-pelvic distraction device assembled of Ilizarov components was employed for a staged surgical treatment performed for lifesaving indications. After vital functions stabilized, the scoliosis curve of the cervical spine was corrected and fixed with a hybrid system of transpedicular supporting points, connecting rods, and connectors that provided staged distraction during growth. The treatment showed good functional and cosmetic result. PMID:24436859

Soft-tissue tension total knee arthroplasty.

PubMed

Asano, Hiroshi; Hoshino, Akiho; Wilton, Tim J

2004-08-01

It is far from clear how best to define the proper strength of soft-tissue tensioning in total knee arthroplasty (TKA). We attached a torque driver to the Monogram balancer/tensor device and measured soft-tissue tension in full extension and 90 degrees flexion during TKA. In our surgical procedure, when we felt proper soft-tissue tension was being applied, the mean distraction force was noted to be 126N in extension and 121N in flexion. There was no significant correlation between soft-tissue tension and the postoperative flexion angle finally achieved. To the best of our knowledge, this is the first study to assess the actual distraction forces in relation to soft-tissue tension in TKA. Further study may reveal the most appropriate forces to achieve proper soft-tissue tension in the wide variety of circumstances presenting at knee arthroplasty.

Assessment of distraction from erotic stimuli by nonerotic interference.

PubMed

Anderson, Alex B; Hamilton, Lisa Dawn

2015-01-01

Distraction from erotic cues during sexual encounters is a major contributor to sexual difficulties in men and women. Being able to assess distraction in studies of sexual arousal will help clarify underlying contributions to sexual problems. The current study aimed to identify the most accurate assessment of distraction from erotic cues in healthy men (n = 29) and women (n = 38). Participants were assigned to a no distraction, low distraction, or high distraction condition. Distraction was induced using an auditory distraction task presented during the viewing of an erotic video. Attention to erotic cues was assessed using three methods: a written quiz, a visual quiz, and a self-reported distraction measure. Genital and psychological sexual responses were also measured. Self-reported distraction and written quiz scores most accurately represented the level of distraction present, while self-reported distraction also corresponded with a decrease in genital arousal. Findings support the usefulness of self-report measures in conjunction with a brief quiz on the erotic material as the most accurate and sensitive ways to simply measure experimentally-induced distraction. Insight into distraction assessment techniques will enable evaluation of naturally occurring distraction in patients suffering from sexual problems.

The Effects of Interactive and Passive Distraction on Cold Pressor Pain in Preschool-aged Children

PubMed Central

Dahlquist, Lynnda M.; Wohlheiter, Karen

2011-01-01

Objective Using a mixed model design, this study examined the effects of interactive versus passive distraction on healthy preschool-aged children’s cold pressor pain tolerance. Methods Sixty-one children aged 3–5 years were randomly assigned to one of the following: interactive distraction, passive distraction, or no distraction control. Participants underwent a baseline cold pressor trial followed by interactive distraction trial, passive distraction trial, or second baseline trial. One or two additional trials followed. Children originally assigned to distraction received the alternate distraction intervention. Controls participated in both interactive and passive distraction trials in counterbalanced order. Results Participants showed significantly higher pain tolerance during both interactive and passive distraction relative to baseline. The two distraction conditions did not differ. Conclusions Interactive and passive video game distraction appear to be effective for preschool-aged children during laboratory pain exposure. Future studies should examine whether more extensive training would enhance effects of interactive video game distraction. PMID:21278378

The MAGEC system for spinal lengthening in children with scoliosis: A NICE Medical Technology Guidance.

PubMed

Jenks, Michelle; Craig, Joyce; Higgins, Joanne; Willits, Iain; Barata, Teresa; Wood, Hannah; Kimpton, Christine; Sims, Andrew

2014-12-01

Scoliosis-structural lateral curvature of the spine-affects around four children per 1,000. The MAGEC system comprises a magnetically distractible spinal rod implant and an external remote controller, which lengthens the rod; this system avoids repeated surgical lengthening. Rod implants brace the spine internally and are lengthened as the child grows, preventing worsening of scoliosis and delaying the need for spinal fusion. The Medical Technologies Advisory Committee at the National Institute for Health and Care Excellence (NICE) selected the MAGEC system for evaluation in a NICE medical technologies guidance. Six studies were identified by the sponsor (Ellipse Technologies Inc.) as being relevant to the decision problem. Meta-analysis was used to compare the clinical evidence results with those of one conventional growth rod study, and equal efficacy of the two devices was concluded. The key weakness was selection of a single comparator study. The External Assessment Centre (EAC) identified 16 conventional growth rod studies and undertook meta-analyses of relevant outcomes. Its critique highlighted limitations around study heterogeneity and variations in baseline characteristics and follow-up duration, precluding the ability to draw firm conclusions. The sponsor constructed a de novo costing model showing that MAGEC rods generated cost savings of £9,946 per patient after 6 years, compared with conventional rods. The EAC critiqued and updated the model structure and inputs, calculating robust cost savings of £12,077 per patient with MAGEC rods compared with conventional rods over 6 years. The year of valuation was 2012. NICE issued a positive recommendation as supported by the evidence (Medical Technologies Guidance 18).

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 878.3750 - External prosthesis adhesive.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External prosthesis adhesive. 878.3750 Section 878.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3750 External prosthesis...

21 CFR 878.3750 - External prosthesis adhesive.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External prosthesis adhesive. 878.3750 Section 878.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3750 External prosthesis...

21 CFR 878.3750 - External prosthesis adhesive.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External prosthesis adhesive. 878.3750 Section 878.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3750 External prosthesis...

21 CFR 878.3750 - External prosthesis adhesive.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External prosthesis adhesive. 878.3750 Section 878.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3750 External prosthesis...

21 CFR 878.3750 - External prosthesis adhesive.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External prosthesis adhesive. 878.3750 Section 878.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3750 External prosthesis...

Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome

PubMed Central

Tsui, Wai Kin; Yang, Yanqi; Cheung, Lim Kwong; Leung, Yiu Yan

2016-01-01

Abstract Background: To conduct a systematic review to answer the clinical question “What are the effectiveness of mandibular distraction osteogenesis (MDO) and its complications to treat patients with obstructive sleep apnea syndrome (OSAS)?”. Methods: A systematic search including a computer search with specific keywords, reference list search, and manual search were done. Relevant articles on MDO were assessed and selected in 3 rounds for final review based on 5 predefined inclusion criteria and followed by a round of critical appraisal. Different types of distraction and their treatment outcomes of OSAS were recorded with standardized form and analyzed. Results: Twelve articles were included in the final review. A total of 256 patients aged 7 days to 60 years were treated with either external or internal MDO, with a mean follow-up period of 6 to 37 months. The average distraction distance of 12 to 29 mm was achieved with various distraction protocols. The success rate for adult patients was 100%, and cure rates were ranged from 82% to 100%. The definition of success or cure for OSAS in children or infants was not defined. Therefore, there were no clearly reported success or cure rates for children/infants in the included studies. However, all studies reported that these patients showed significant improvement in OSAS, with many of them who avoided tracheostomy or had the tracheostomy decannulated. The complication rates were ranged from 0% to 21.4%, with most being from local wound infections or neurosensory disturbances. Conclusion: This systematic review showed that MDO was effective in resolving OSAS in adults with retrognathic mandible. MDO also showed promising results in infants or children with OSAS. From the results of this systematic review, we recommend to define the criteria of success or cure for OSAS surgery in children and infants. We also recommend setting up randomized controlled trials to compare MDO with traditional maxillomandibular advancement surgery for OSAS patients and to provide a better evidence on the success and complication rates of the techniques. PMID:27603361

A Comprehensive Study of Internal Distraction Plating, an Alternative Method for Distal Radius Fractures.

PubMed

Jain, Mohit J; Mavani, Kinjal J

2016-12-01

The management of highly comminuted distal radius fractures still remains a major treatment challenge. Articular comminution and compromised bone quality are the culprits. One novel approach is the technique of Internal Distraction Plating which involves "bridging" the fracture with the use of a standard 3.5mm plate applied dorsally in distraction from the radius, proximal to the fracture, to the long finger metacarpal distally, bypassing the comminuted segment. The plate is removed once fracture union has been achieved. The present study was conducted with the aim to evaluate the role of internal dorsal distraction plating as an alternative method in the treatment of fracture distal radius in terms of special indications, technique and outcome. This study was a prospective longitudinal study on 20 patients (mean age 62 years) treated with internal distraction plating for comminuted distal radius fractures with specific indications. Regular follow-ups with standard radiographs and analysis were done upto 24 months. Functional outcome were assessed by DASH Score and the Gartland and Werley demerit score. At final follow-up, all fractures had united and X-rays showed mean palmar tilt of 7°, positive ulnar variance of 0.5mm, radial inclination of 18° and average loss of 2mm of radial height. Mean range of motion values for wrist flexion 46°, extension 50°, pronation 79° and supination 77° At final follow-up, the mean DASH score was 32. 85% patient had excellent to good result as per Gartland and Werley demerit score. This construct has yield satisfactory clinical and radiographic results with these very challenging injuries. The purpose of this study was to report the radiographic and the functional outcomes of treatment with this technique. External fixator and volar plating in communited distal end radius fractures are not always satisfactory in old age with osteoporotic bone because of complications associated with them. The current technique represents an alternative that provides union of the comminuted distal radius fracture with anatomical alignment, optimal range of motion and with minimal clinical disability.

The role of motivation in distracting attention away from pain: an experimental study.

PubMed

Verhoeven, Katrien; Crombez, Geert; Eccleston, Christopher; Van Ryckeghem, Dimitri M L; Morley, Stephen; Van Damme, Stefaan

2010-05-01

Research on the effectiveness of distraction as a method of pain control is inconclusive. One mechanism pertains to the motivational relevance of distraction tasks. In this study the motivation to engage in a distraction task during pain was experimentally manipulated. Undergraduate students (N=73) participated in a cold pressor test (CPT) and were randomly assigned to three groups: a distraction-only group performed a tone-detection task during the CPT, a motivated-distraction group performed the same task and received a monetary reward for good task performance, and a control group did not perform the tone-detection task. Results indicated that engagement in the distraction task was better in the motivated-distraction group in comparison with the distraction-only group. Participants in both distraction groups experienced less pain compared to the control group. There were no overall differences in pain intensity between the two distraction groups. The effect of distraction was influenced by the level of catastrophic thinking about pain. For low catastrophizers, both distraction groups reported less pain as compared to the non-distracted control group. This was not the case for high catastrophizers. For high catastrophizers it mattered whether the distraction task was motivationally relevant: high catastrophizers reported less intense pain in the motivated-distraction group, as compared to the non-distracted control group. We conclude that increasing the motivational relevance of the distraction task may increase the effects of distraction, especially for those who catastrophize about pain. Copyright 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

21 CFR 874.5800 - External nasal splint.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External nasal splint. 874.5800 Section 874.5800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Therapeutic Devices § 874.5800 External nasal splint. (a...

21 CFR 874.5800 - External nasal splint.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External nasal splint. 874.5800 Section 874.5800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Therapeutic Devices § 874.5800 External nasal splint. (a...

21 CFR 874.5800 - External nasal splint.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External nasal splint. 874.5800 Section 874.5800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Therapeutic Devices § 874.5800 External nasal splint. (a...

21 CFR 874.5800 - External nasal splint.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External nasal splint. 874.5800 Section 874.5800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Therapeutic Devices § 874.5800 External nasal splint. (a...

21 CFR 874.5800 - External nasal splint.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External nasal splint. 874.5800 Section 874.5800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Therapeutic Devices § 874.5800 External nasal splint. (a...

Distracted driving behaviors of adults while children are in the car.

PubMed

Roney, Linda; Violano, Pina; Klaus, Greg; Lofthouse, Rebecca; Dziura, James

2013-10-01

Cell phone use while driving is common and can result in driver distraction. However, data on the frequency of this behavior with other occupants in the vehicle are lacking. This study investigates whether adult drivers engage in cell phone use with passengers in the car and determines whether the frequency of these behaviors was modified if the passenger was a child. Subjects (N = 539) who have driven children during the previous 30 days were recruited to complete a survey regarding their cell phone usage while driving. The inclusion criteria of participants were as follows: 18 years or older with a valid driver's license, owns/uses a cell phone, drives with children, and reads English. Results were reported on a 4-point Likert scale (always, often, rarely, and never). Eighty percent of respondents reported cell phone use in some way while driving with children. As compared with similar behaviors when driving alone or with adult passengers, the odds of reporting "always" compared with "often, rarely, or never" of holding a cell phone in hand was 0.66 when driving with children. No significant differences were noted for the following variables: use of a blue tooth device or use of a cell phone to speak or text when parked. Cell phone use while driving is common. Distracted driving behaviors, although less frequent, persist when children are passengers in the vehicle. Further research into the effect of cell phone-related distracted driving behaviors of adults with child passengers is needed to address this public health concern.

Audiovisual distraction as a useful adjunct to epidural anesthesia and sedation for prolonged lower limb microvascular orthoplastic surgery.

PubMed

Athanassoglou, Vassilis; Wallis, Anna; Galitzine, Svetlana

2015-11-01

Lower limb orthopedic operations are frequently performed under regional anesthesia, which allows avoidance of potential side effects and complications of general anesthesia and sedation. Often though, patients feel anxious about being awake during operations. To decrease intraoperative anxiety, we use multimedia equipment consisting of a tablet device, noise-canceling headphones, and a makeshift frame, where patients can listen to music, watch movies, or occupy themselves in numerous ways. These techniques have been extensively studies in minimally invasive, short, or minor procedures but not in prolonged orthoplastic operations. We report 2 cases where audiovisual distraction was successfully applied to 9.5-hour procedures, proved to be a very useful adjunct to epidural anesthesia + sedation, and made an important contribution to positive patients' outcomes and overall patients' experience with regional anesthesia for complex limb reconstructive surgery. In the era when not only patients' safety and clinical outcomes but also patients' positive experiences are of paramount importance, audiovisual distraction may provide a simple tool to help improve experience of appropriately informed patients undergoing suitable procedures under regional anesthesia. The anesthetic technique received a very positive appraisal by both patients and encouraged us to study further the impact of modern audiovisual technology on anxiolysis for major surgery under regional anesthesia. The duration of surgery per se is not a contraindication to the use of audiovisual distraction. The absolute proviso of successful application of this technique to major surgery is effective regional anesthesia and good teamwork between the clinicians and the patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Cartilage regeneration for treatment of osteoarthritis: a paradigm for nonsurgical intervention

PubMed Central

Sabaawy, Hatem E.

2015-01-01

Osteoarthritis (OA) is associated with articular cartilage abnormalities and affects people of older age: preventative or therapeutic treatment measures for OA and related articular cartilage disorders remain challenging. In this perspective review, we have integrated multiple biological, morphological, developmental, stem cell and homeostasis concepts of articular cartilage to develop a paradigm for cartilage regeneration. OA is conceptually defined as an injury of cartilage that initiates chondrocyte activation, expression of proteases and growth factor release from the matrix. This regenerative process results in the local activation of inflammatory response genes in cartilage without migration of inflammatory cells or angiogenesis. The end results are catabolic and anabolic responses, and it is the balance between these two outcomes that controls remodelling of the matrix and regeneration. A tantalizing clinical clue for cartilage regrowth in OA joints has been observed in surgically created joint distraction. We hypothesize that cartilage growth in these distracted joints may have a biological connection with the size of organs and regeneration. Therefore we propose a novel, practical and nonsurgical intervention to validate the role of distraction in cartilage regeneration in OA. The approach permits normal wake-up activity while during sleep; the index knee is subjected to distraction with a pull traction device. Comparison of follow-up magnetic resonance imaging (MRI) at 3 and 6 months of therapy to those taken before therapy will provide much-needed objective evidence for the use of this mode of therapy for OA. We suggest that the paradigm presented here merits investigation for treatment of OA in knee joints. PMID:26029269

An anterior cervical retractor utilizing a novel principle.

PubMed

Seex, Kevin A

2010-05-01

The alarmingly high soft-tissue complication rates after anterior cervical surgery suggests that the design of current retractors is inadequate. A review of retractor design and consideration of new designs is worthwhile. The author reviewed the literature and the 7 described devices (Cloward, Caspar, Thompson-Farley, Tresserras, Ozer, Takayasu, and Oh devices). With the exception of Cloward/Caspar and Thomson-Farley systems, the author's search of the literature failed to disclose any independent review or investigations of the other retractors, suggesting that the use of these devices is limited. The Cloward/Caspar-style retractors depend for stability on small teeth at the ends of the blades that impale and stretch the longus colli muscle. For stability this self-retaining design requires equal tissue counterpressure. These devices are thus ill suited for a wound with substantially greater pressure from the medial structures and are prone to migration. The Thomson-Farley type of systems use arms with mechanical joints fixed to a table-mounted frame. The releasable joints allow adjustability and independent relaxation. Their limitations include bulk causing obstruction to the surgeons and radiographs, increased setup time, and ease with which excessive force can be applied. The author describes a new anterior cervical retractor that is based on a novel principle. The principle is that bone fixation can be used to provide the retractor blade an axis of rotation inside the wound. This gives improved retractor blade stability with the mechanical advantage of a lever. The stable rotation produced allows adjustable retraction and tissue relaxation without compromise in stability. To the author's knowledge, there are no previously described retractors with this ability. The system consists of a small 2-piece sliding frame fixed to the spine with the distraction screws. Bone fixation is preferable to sharp teeth and longus colli dissection because it works better and heals without scarring. Surgery is carried out through the frame, which slides during distraction. Independent retractor blades are attached to the sides of the frame, which provides a stable craniocaudal axis inside the wound. The blades rotate to provide retraction or relaxation as required. Intermittent relaxation of tissues under retractors has been shown to be beneficial. Another advantage, compared with systems that maintain wounds with vertical sides, is the ease with which an oblique approach can be used. The mechanical advantage has 3 benefits. First, bulky external mechanisms for retraction are avoided, which improves access. Second, numerous blade lengths are unnecessary, reducing inventory. Third, radiolucent polymers can be used with "snap-fit" properties. The improved stability over conventional systems reduces the need for skilled assistance and avoids surgeon frustration after retraction migration. Over a 3-year period, 100 anterior cervical operations have been performed. Anecdotally, operations are quicker mainly because the retractors do not slip. Prospective clinical studies with independent evaluation are underway.

Electronic gaming as pain distraction

PubMed Central

Jameson, Eleanor; Trevena, Judy; Swain, Nic

2011-01-01

The current study investigated whether active distraction reduces participants’ experience of pain more than passive distraction during a cold pressor task. In the first experiment, 60 participants were asked to submerge their hand in cold (2°C) water for as long as they could tolerate. They did this with no distraction, and then with active (electronic gaming system) and passive (television) distraction, in randomly assigned order. Tolerance time, pain intensity ratings and task absorption ratings were measured for each condition. A second experiment attempted to control for participants’ expectations about the effects of distraction on pain. Forty participants underwent the same experimental procedure, but were given verbal suggestions about the effects of distraction by the experimenter before each distraction condition. Participants in both experiments had a significantly higher pain tolerance and reported less pain with the active distraction compared with passive or no distraction. Participants reported being more absorbed, and were significantly more willing to do the task again when they had the active distraction compared with both passive distraction and no distraction. They also had more enjoyment, less anxiety and greater reduction in pain with active distraction than with passive distraction. There was no effect of suggestion. These experiments offer further support for the use of electronic games as a method of pain control. PMID:21369538

Electronic gaming as pain distraction.

PubMed

Jameson, Eleanor; Trevena, Judy; Swain, Nic

2011-01-01

The current study investigated whether active distraction reduces participants' experience of pain more than passive distraction during a cold pressor task. In the first experiment, 60 participants were asked to submerge their hand in cold (2°C) water for as long as they could tolerate. They did this with no distraction, and then with active (electronic gaming system) and passive (television) distraction, in randomly assigned order. Tolerance time, pain intensity ratings and task absorption ratings were measured for each condition. A second experiment attempted to control for participants' expectations about the effects of distraction on pain. Forty participants underwent the same experimental procedure, but were given verbal suggestions about the effects of distraction by the experimenter before each distraction condition. Participants in both experiments had a significantly higher pain tolerance and reported less pain with the active distraction compared with passive or no distraction. Participants reported being more absorbed, and were significantly more willing to do the task again when they had the active distraction compared with both passive distraction and no distraction. They also had more enjoyment, less anxiety and greater reduction in pain with active distraction than with passive distraction. There was no effect of suggestion. These experiments offer further support for the use of electronic games as a method of pain control.

Femoral Reconstruction Using External Fixation

PubMed Central

Palatnik, Yevgeniy; Rozbruch, S. Robert

2011-01-01

Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur. Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD), limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups. Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA) for the entire group as well as the subgroups. Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction. PMID:21991425

Using naturalistic driving study data to investigate the impact of driver distraction on driver's brake reaction time in freeway rear-end events in car-following situation.

PubMed

Gao, Jingru; Davis, Gary A

2017-12-01

The rear-end crash is one of the most common freeway crash types, and driver distraction is often cited as a leading cause of rear-end crashes. Previous research indicates that driver distraction could have negative effects on driving performance, but the specific association between driver distraction and crash risk is still not fully revealed. This study sought to understand the mechanism by which driver distraction, defined as secondary task distraction, could influence crash risk, as indicated by a driver's reaction time, in freeway car-following situations. A statistical analysis, exploring the causal model structure regarding drivers' distraction impacts on reaction times, was conducted. Distraction duration, distraction scenario, and secondary task type were chosen as distraction-related factors. Besides, exogenous factors including weather, visual obstruction, lighting condition, traffic density, and intersection presence and endogenous factors including driver age and gender were considered. There was an association between driver distraction and reaction time in the sample freeway rear-end events from SHRP 2 NDS database. Distraction duration, the distracted status when a leader braked, and secondary task type were related to reaction time, while all other factors showed no significant effect on reaction time. The analysis showed that driver distraction duration is the primary direct cause of the increase in reaction time, with other factors having indirect effects mediated by distraction duration. Longer distraction duration, the distracted status when a leader braked, and engaging in auditory-visual-manual secondary task tended to result in longer reaction times. Given drivers will be distracted occasionally, countermeasures which shorten distraction duration or avoid distraction presence while a leader vehicle brakes are worth considering. This study helps better understand the mechanism of freeway rear-end events in car-following situations, and provides a methodology that can be adopted to study the association between driver behavior and driving features. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Effects of individual differences on the efficacy of different distracters during visual sexual stimulation in women.

PubMed

Roberts, Verena M; Prause, Nicole

2012-02-01

Distractions from sexual cues have been shown to decrease the sexual response, but it is unclear how distracters decrease sexual response. Individual differences may modulate the efficacy of distracters. Forty women viewed three sexual films while their labial temperature and continuous self-reported sexual arousal were monitored. One sexual film had simultaneous verbal distracters concerning dissatisfaction with one's physical appearance (higher salience distracter), a second had distracters concerning daily chores (lower salience distracter), and the third sexual film had no distracters. Participant's reporting greater relationship satisfaction and more communication with their partner about their own physical appearance were expected to decrease the efficacy (increased sexual arousal) of the distracters concerning physical appearance. Contrary to expectations, women who received less feedback about their body from their partners reported less sexual arousal during a sexual film with body distracters than a sexual film with general distracters or a sexual film with no distracters. All women exhibited lower labial temperature in Minutes 2 and 3 of the sexual film with body image distracters as compared to the other two sexual films. Possible explanations explored include self-verification theory and individual differences in the indicators that women consider when rating their sexual arousal.

Measurement of torque during mandibular distraction.

PubMed

Burstein, Fernando D; Lukas, Saylan; Forsthoffer, Dina

2008-05-01

In a prospective study, 26 patients aged 9 days to 12 years old underwent mandibular distraction. There were 18 bilateral and 8 unilateral distractions performed. Five patients had previous distraction. Torque measurements were performed during the distraction process. A modest linear increase in torque was noted during the distraction process. Older patients required more torque to achieve the same distraction length as younger patients. The results of this study suggest that distraction forces are relatively modest, which may allow for greater freedom of distractor design.

Mechanics of external fixation device of spine: reducing the mounting stress

NASA Astrophysics Data System (ADS)

Piven, V. V.; Lyulin, S. V.; Kovalenko, P. I.; Mushtaeva, Yu A.

2018-03-01

During the installation of the external fixation device on the spine, there is an occurrence of mounting stress due to misalignment of the rod-screws. To determine the magnitude of the mounting stresses, mathematical dependencies are sometimes used. The proposed technical solution is to reduce stress in the external fixation device.

21 CFR 884.2720 - External uterine contraction monitor and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External uterine contraction monitor and accessories. 884.2720 Section 884.2720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Monitoring Devices § 884.2720 External...

21 CFR 890.5575 - Powered external limb overload warning device.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Powered external limb overload warning device. 890.5575 Section 890.5575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890...

21 CFR 890.5575 - Powered external limb overload warning device.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Powered external limb overload warning device. 890.5575 Section 890.5575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890...

21 CFR 890.5575 - Powered external limb overload warning device.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Powered external limb overload warning device. 890.5575 Section 890.5575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890...

21 CFR 890.5575 - Powered external limb overload warning device.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Powered external limb overload warning device. 890.5575 Section 890.5575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890...

21 CFR 890.5575 - Powered external limb overload warning device.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Powered external limb overload warning device. 890.5575 Section 890.5575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890...

Reward-prospect interacts with trial-by-trial preparation for potential distraction

PubMed Central

Marini, Francesco; van den Berg, Berry; Woldorff, Marty G.

2015-01-01

When attending for impending visual stimuli, cognitive systems prepare to identify relevant information while ignoring irrelevant, potentially distracting input. Recent work (Marini et al., 2013) showed that a supramodal distracter-filtering mechanism is invoked in blocked designs involving expectation of possible distracter stimuli, although this entails a cost (distraction-filtering cost) on speeded performance when distracters are expected but not presented. Here we used an arrow-flanker task to study whether an analogous cost, potentially reflecting the recruitment of a specific distraction-filtering mechanism, occurs dynamically when potential distraction is cued trial-to-trial (cued distracter-expectation cost). In order to promote the maximal utilization of cue information by participants, in some experimental conditions the cue also signaled the possibility of earning a monetary reward for fast and accurate performance. This design also allowed us to investigate the interplay between anticipation for distracters and anticipation of reward, which is known to engender attentional preparation. Only in reward contexts did participants show a cued distracter-expectation cost, which was larger with higher reward prospect and when anticipation for both distracters and reward were manipulated trial-to-trial. Thus, these results indicate that reward prospect interacts with the distracter expectation during trial-by-trial preparatory processes for potential distraction. These findings highlight how reward guides cue-driven attentional preparation. PMID:26180506

Reward-prospect interacts with trial-by-trial preparation for potential distraction.

PubMed

Marini, Francesco; van den Berg, Berry; Woldorff, Marty G

2015-02-01

When attending for impending visual stimuli, cognitive systems prepare to identify relevant information while ignoring irrelevant, potentially distracting input. Recent work (Marini et al., 2013) showed that a supramodal distracter-filtering mechanism is invoked in blocked designs involving expectation of possible distracter stimuli, although this entails a cost ( distraction-filtering cost ) on speeded performance when distracters are expected but not presented. Here we used an arrow-flanker task to study whether an analogous cost, potentially reflecting the recruitment of a specific distraction-filtering mechanism, occurs dynamically when potential distraction is cued trial-to-trial ( cued distracter-expectation cost ). In order to promote the maximal utilization of cue information by participants, in some experimental conditions the cue also signaled the possibility of earning a monetary reward for fast and accurate performance. This design also allowed us to investigate the interplay between anticipation for distracters and anticipation of reward, which is known to engender attentional preparation. Only in reward contexts did participants show a cued distracter-expectation cost, which was larger with higher reward prospect and when anticipation for both distracters and reward were manipulated trial-to-trial. Thus, these results indicate that reward prospect interacts with the distracter expectation during trial-by-trial preparatory processes for potential distraction. These findings highlight how reward guides cue-driven attentional preparation.

Prevalence of and factors associated with distraction among public transit bus drivers

PubMed Central

Griffin, Russell; Huisingh, Carrie; McGwin, Gerald

2015-01-01

Objective Recent research has suggested that driver distraction is a major cause of driving performance impairment and motor vehicle collisions. Research on the topic has focused on passenger vehicles, with studies suggesting that drivers may be distracted nearly 33% of the time spent driving. To date, no study has examined the prevalence of distraction specifically among public transit bus drivers. Methods Over a three-month period, trained investigators observed and recorded distraction behaviors of bus drivers. Distraction prevalence was compared by route characteristics (e.g., geographic area, travel speed) using chi-square test. A general estimating equation logistic regression was used to estimate p-values for distraction prevalence by driver demographics. Results Overall, there was a 39% prevalence of distraction. The most prevalent distractions were due to interactions with another passenger. Distractions were more prevalent among drivers <30 years of age or ≥50 years of age, on city streets or highways (relative to residential streets), and when there were more than 20 passengers. Distractions were the least prevalent in suburban areas, with the highest prevalence observed in city centers and rural areas. Conclusions Driver distraction is a common problem for public transit bus drivers, mainly due to other passengers. Drivers should be educated on the hazards of distracted driving and on ways to avoid distraction. PMID:24433192

Transportation-Related Safety Behaviors in Top-Grossing Children's Movies from 2008 to 2013.

PubMed

Boppana, Shilpa; Shen, Jiabin; Schwebel, David C

2016-05-01

Children regularly imitate behavior from movies. The authors assessed injury risk behaviors in top-grossing children's films. The 5 top-grossing G- or PG-rated movies annually from 2008 to 2013 were included, including animated movies and those set in the past/future. Researchers coded transportation scenes for risk taking in 3 domains: protection/equipment, unsafe behaviors, and distraction/attention. Safe and risky behaviors were recorded across the 3 domains. With regard to protection and equipment, 20% of motor vehicle scenes showed characters riding without seat belts and 27% of scenes with motorcycles showed characters riding without helmets. Eighty-nine percent of scenes with horses showed riders without helmets and 67% of boat operators failed to wear personal flotation devices. The most common unsafe behaviors were speeding and unsafe street-crossing. Twenty-one percent of scenes with motor vehicles showed drivers speeding and 90% of pedestrians in films failed to wait for signal changes. Distracted and inattentive behaviors were rare, with distracted driving of motor vehicles occurring in only approximately 2% of total driving scenes. Although many safe transportation behaviors were portrayed, the film industry continues to depict unsafe behaviors in movies designed for pediatric audiences. There is a need for the film industry to continue to balance entertainment and art with modeling of safe behavior for children.

Spring-mediated distraction enterogenesis in-continuity.

PubMed

Huynh, Nhan; Rouch, Joshua D; Scott, Andrew; Chiang, Elvin; Wu, Benjamin M; Shekherdimian, Shant; Dunn, James C Y

2016-12-01

Distraction enterogenesis has been investigated as a novel treatment for patients with short bowel syndrome (SBS) but has been limited by loss of intestinal length during restoration and need for multiple bowel surgeries. The feasibility of in-continuity, spring-mediated intestinal lengthening has yet to be demonstrated. Juvenile mini-Yucatan pigs underwent in-continuity placement of polycaprolactone (PCL) degradable springs within jejunum. Methods used to anchor the spring ends to the intestine included full-thickness sutures and a high-friction surface spring. Spring constant (k) was 6-15N/m. Bowel was examined for length and presence of spring at 1 to 4weeks. Animals tolerated in-continuity lengthening without bowel obstruction for up to 29days. In-continuity jejunum with springs demonstrated intestinal lengthening by 1.47-fold ±0.11. Five springs had detached prematurely, and lengthening could not be assessed. Histologically, in-continuity jejunum showed significantly increased crypt depth and muscularis thickness in comparison to normal jejunum. Self-expanding endoluminal springs placed in continuity could lengthen intestine without obstruction in a porcine model. This is the first study showing safety and efficacy of a self-expanding endoluminal device for distraction enterogenesis. This is proof-of-concept that in-continuity spring lengthening is feasible and demonstrates its therapeutic potential in SBS. Level 3. Copyright © 2016 Elsevier Inc. All rights reserved.

[Effects of maxillary distraction osteogenesis on the velopharyngeal configuration of cleft palate patients].

PubMed

Wang, Xiao-xia; Wang, Xing; Yi, Biao; Li, Zi-li; Liang, Cheng

2005-12-18

To study the effects of internal maxillary distraction osteogenesis(DO) on the velopharyngeal configuration of cleft palate patients. Ten patients with severe maxillary hypoplasia secondary to cleft lip and palate patients (7 males and 3 females, average age 20.1 years old) had undertaken high step LeFort I osteotomy, and internal maxillary distraction devices were applied to advance the maxilla. Before surgery, when DO was completed and 6 months after DO was completed, oriented lateral cephalograms at rest position of each patient were taken, and 6 measure indexes of velopharyngeal configuration were collected and analyzed. All patients had successfully accomplished maxillary DO and the maxilla had been averagely advanced 11.3 mm. PNS-PhW, C-PhW, UL and ANS-PNS-T had all significantly increased, and UD had significantly decreased when DO was completed and 6 months after DO was completed as compared with pre-surgery. No significant linear correlation was found between maxilla advancement distance and velopharyngeal configuration changes. Correction of maxillary hypoplasia secondary to cleft palate surgery by using internal maxillary DO can increase the velopharyngeal cavity depth, and may impair velopharyngeal competence, but the compensatory changes of velopharyngeal soft tissue can alleviate this impairment to certain extent.

Medical Devices; General Hospital and Personal Use Devices; Classification of the Image Processing Device for Estimation of External Blood Loss. Final order.

PubMed

2017-12-20

The Food and Drug Administration (FDA or we) is classifying the image processing device for estimation of external blood loss into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the image processing device for estimation of external blood loss' classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.

Cosmetic lower limb lengthening by Ilizarov apparatus: what are the risks?

PubMed

Novikov, Konstantin I; Subramanyam, Koushik N; Muradisinov, Serghei O; Novikova, Olga S; Kolesnikova, Elina S

2014-11-01

Compelled by the psychosocial implications of short stature, patients with short stature are increasingly undergoing distraction osteogenesis for cosmetic limb lengthening. To the degree that this is true, evaluation of the risks and benefits of this treatment are very important, but to date, there are few studies reporting on using distraction osteogenesis for this indication. We reviewed a group of patients undergoing cosmetic lower-extremity lengthening in terms of (1) soft tissue challenges, (2) bone-related complications, and (3) functional and subjective clinical outcomes. The study was retrospective by reviewing data from medical records and radiographs. Between 1983 and 2006, we treated 138 somatically normal patients with bilateral lower-limb distraction osteogenesis for cosmetic purposes at our center using an Ilizarov external fixator, of whom 131 (95%; 65 males, 66 females) had complete clinical and radiographic data a minimum of 1 year after treatment (mean, 6 years; range, 1-14 years) and were reviewed for this report. The mean age of these patients was 25 years (range, 14-68 years) and their mean preoperative height was 159 cm (range, 130-174 cm). One hundred twenty-four (95%) patients had lengthening of the tibia alone, of which 66 (53%) were monofocal and 58 (47%) were bifocal. Six patients (4.58%) had crossed contralateral lengthening of the femur and tibia and one patient (0.76%) had bilateral lengthening of the femur. The mean height gained was 6.9 cm (range, 2-13 cm), 7.3 cm (range, 3.5-13 cm) in males and 6.5 cm (range, 2-13 cm) in females. The mean lengthening, maturation, and external fixator indexes were 12 days/cm (range, 4.3-24 days/cm), 19 days/cm (range, 5.2-63 days/cm), and 31 days/cm (range, 12-78 days/cm), respectively. Forty-eight patients (37%) had 59 complications related to treatment. Thirty-seven were soft tissue related (28%), of which 17 (46%) needed reinterventions, and 22 were bone related (17%), of which 16 (73%) needed reinterventions. At final followup, the outcome was excellent for 72 patients (55%), good for 52 (40%), satisfactory for six (4.58%), and poor for one (0.77%). One hundred thirty of 131 patients subjectively felt satisfied and had improved self-esteem. Distraction osteogenesis using the Ilizarov external fixator is an option for carefully selected motivated patients with awareness of this technique. Soft tissue and bone-related complications including those that necessitate reinterventions should be expected during the course of treatment, although most can be managed without permanent sequelae or disability. Future studies with more robust methods will need to determine whether the risks and benefits of this procedure are well balanced. Preoperative counseling, considering the ethical questions this procedure can raise, is of paramount importance for the patient to weigh the risk versus anticipated benefits. Studies from other centers will be important as we move forward. Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

21 CFR 884.2720 - External uterine contraction monitor and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External uterine contraction monitor and... Gynecological Monitoring Devices § 884.2720 External uterine contraction monitor and accessories. (a) Identification. An external uterine contraction monitor (i.e., the tokodynamometer) is a device used to monitor...

Orchestrating Proactive and Reactive Mechanisms for Filtering Distracting Information: Brain-Behavior Relationships Revealed by a Mixed-Design fMRI Study

PubMed Central

Marini, Francesco; Demeter, Elise; Roberts, Kenneth C.; Chelazzi, Leonardo

2016-01-01

Given the information overload often imparted to human cognitive-processing systems, suppression of irrelevant and distracting information is essential for successful behavior. Using a hybrid block/event-related fMRI design, we characterized proactive and reactive brain mechanisms for filtering distracting stimuli. Participants performed a flanker task, discriminating the direction of a target arrow in the presence versus absence of congruent or incongruent flanking distracting arrows during either Pure blocks (distracters always absent) or Mixed blocks (distracters on 80% of trials). Each Mixed block had either 20% or 60% incongruent trials. Activations in the dorsal frontoparietal attention network during Mixed versus Pure blocks evidenced proactive (blockwise) recruitment of a distraction-filtering mechanism. Sustained activations in right middle frontal gyrus during 60% Incongruent blocks correlated positively with behavioral indices of distraction-filtering (slowing when distracters might occur) and negatively with distraction-related behavioral costs (incongruent vs congruent trials), suggesting a role in coordinating proactive filtering of potential distracters. Event-related analyses showed that incongruent trials elicited greater reactive activations in 20% (vs 60%) Incongruent blocks for counteracting distraction and conflict, including in the insula and anterior cingulate. Context-related effects in occipitoparietal cortex consisted of greater target-evoked activations for distracter-absent trials (central-target-only) in Mixed versus Pure blocks, suggesting enhanced attentional engagement. Functional-localizer analyses in V1/V2/V3 revealed less distracter-processing activity in 60% (vs 20%) Incongruent blocks, presumably reflecting tonic suppression by proactive filtering mechanisms. These results delineate brain mechanisms underlying proactive and reactive filtering of distraction and conflict, and how they are orchestrated depending on distraction probability, thereby aiding task performance. SIGNIFICANCE STATEMENT Irrelevant stimuli distract people and impair their attentional performance. Here, we studied how the brain deals with distracting stimuli using a hybrid block/event-related fMRI design and a task that varied the probability of the occurrence of such distracting stimuli. The results suggest that when distraction is likely, a region in right frontal cortex proactively implements attentional control mechanisms to help filter out any distracting stimuli that might occur. In contrast, when distracting input occurs infrequently, this region is more reactively engaged to help limit the negative consequences of the distracters on behavioral performance. Our results thus help illuminate how the brain flexibly responds under differing attentional demands to engender effective behavior. PMID:26791226

Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation.

PubMed

Chan, C K; Saw, A; Kwan, M K; Karina, R

2009-04-01

To compare infection rates associated with 2 dressing solutions for metal-skin interfaces. 60 patients who underwent distraction osteogenesis with external fixators were equally randomised into 2 dressing solution groups (diluted povidone-iodine vs. saline). Fixations were attained using either rigid stainless steel 5-mm diameter half pins or smooth stainless steel 1.8-mm diameter wires. Half-pin fixation had one metal-skin interface, whereas wire fixation had 2 interfaces. Patients were followed up every 2 weeks for 6 months. Of all 788 metal-skin interfaces, 143 (18%) were infected: 72 (19%) of 371 in the diluted povidone-iodine group and 71 (17%) of 417 in the saline group. Dressing solution and patient age did not significantly affect infection rates. Half-pin fixation was more likely to become infected than wire fixation (25% vs 15%). Saline is as effective as diluted povidone-iodine as a dressing solution for metal-skin interfaces of external fixators. Saline is recommended in view of its easy availability and lower costs.

Perceived Discrimination, Coping Strategies, and Mexican Origin Adolescents’ Internalizing and Externalizing Behaviors: Examining the Moderating Role of Gender and Cultural Orientation

PubMed Central

Brittian, Aerika S.; Toomey, Russell B.; Gonzales, Nancy A.; Dumka, Larry E.

2013-01-01

The literature identifying effective coping strategies related to perceived discrimination has yielded mixed findings, suggesting that recommendations for effective coping may vary by individual and group differences. The current study examined the influence of perceived discrimination and coping strategies on Mexican origin adolescents’ later internalizing symptoms and externalizing behaviors, and assessed the moderating roles of gender and cultural orientation. Participants included 189 adolescents (46% male, 54% female) interviewed at 7th and 8th grade. Results suggested that the associations between perceived discrimination and internalizing symptoms were buffered by distraction coping among youth that were low on Anglo orientation but not among youth high on Anglo orientation. In addition, the associations between perceived discrimination and externalizing behaviors were buffered by social support seeking, but only among youth that were low on Mexican orientation. Directions for future research and application of the current research are discussed. PMID:23833550

The Effects of Varying Contextual Demands on Age-related Positive Gaze Preferences

PubMed Central

Noh, Soo Rim; Isaacowitz, Derek M.

2015-01-01

Despite many studies on the age-related positivity effect and its role in visual attention, discrepancies remain regarding whether one’s full attention is required for age-related differences to emerge. The present study took a new approach to this question by varying the contextual demands of emotion processing. This was done by adding perceptual distractions, such as visual and auditory noise, that could disrupt attentional control. Younger and older participants viewed pairs of happy–neutral and fearful–neutral faces while their eye movements were recorded. Facial stimuli were shown either without noise, embedded in a background of visual noise (low, medium, or high), or with simultaneous auditory babble. Older adults showed positive gaze preferences, looking toward happy faces and away from fearful faces; however, their gaze preferences tended to be influenced by the level of visual noise. Specifically, the tendency to look away from fearful faces was not present in conditions with low and medium levels of visual noise, but was present where there were high levels of visual noise. It is important to note, however, that in the high-visual-noise condition, external cues were present to facilitate the processing of emotional information. In addition, older adults’ positive gaze preferences disappeared or were reduced when they first viewed emotional faces within a distracting context. The current results indicate that positive gaze preferences may be less likely to occur in distracting contexts that disrupt control of visual attention. PMID:26030774

The effects of varying contextual demands on age-related positive gaze preferences.

PubMed

Noh, Soo Rim; Isaacowitz, Derek M

2015-06-01

Despite many studies on the age-related positivity effect and its role in visual attention, discrepancies remain regarding whether full attention is required for age-related differences to emerge. The present study took a new approach to this question by varying the contextual demands of emotion processing. This was done by adding perceptual distractions, such as visual and auditory noise, that could disrupt attentional control. Younger and older participants viewed pairs of happy-neutral and fearful-neutral faces while their eye movements were recorded. Facial stimuli were shown either without noise, embedded in a background of visual noise (low, medium, or high), or with simultaneous auditory babble. Older adults showed positive gaze preferences, looking toward happy faces and away from fearful faces; however, their gaze preferences tended to be influenced by the level of visual noise. Specifically, the tendency to look away from fearful faces was not present in conditions with low and medium levels of visual noise but was present when there were high levels of visual noise. It is important to note, however, that in the high-visual-noise condition, external cues were present to facilitate the processing of emotional information. In addition, older adults' positive gaze preferences disappeared or were reduced when they first viewed emotional faces within a distracting context. The current results indicate that positive gaze preferences may be less likely to occur in distracting contexts that disrupt control of visual attention. (c) 2015 APA, all rights reserved.

Factors Affecting the Nonlinear Force Versus Distraction Height Curves in an In Vitro C5-C6 Anterior Cervical Distraction Model.

PubMed

Wen, Junxiang; Xu, Jianwei; Li, Lijun; Yang, Mingjie; Pan, Jie; Chen, Deyu; Jia, Lianshun; Tan, Jun

2017-06-01

In vitro biomechanical study of cervical intervertebral distraction. To investigate the forces required for distraction to different heights in an in vitro C5-C6 anterior cervical distraction model, focusing on the influence of the intervertebral disk, posterior longitudinal ligament (PLL), and ligamentum flavum (LF). No previous studies have reported on the forces required for distraction to various heights or the factors resisting distraction in anterior cervical discectomy and fusion. Anterior cervical distraction at C5-C6 was performed in 6 cadaveric specimens using a biomechanical testing machine, under 4 conditions: A, before disk removal; B, after disk removal; C, after disk and PLL removal; and D, after disk and PLL removal and cutting of the LF. Distraction was performed from 0 to 10 mm at a constant velocity (5 mm/min). Force and distraction height were recorded automatically. The force required increased with distraction height under all 4 conditions. There was a sudden increase in force required at 6-7 mm under conditions B and C, but not D. Under condition A, distraction to 5 mm required a force of 268.3±38.87 N. Under conditions B and C, distraction to 6 mm required <15 N, and further distraction required dramatically increased force, with distraction to 10 mm requiring 115.4±10.67 and 68.4±9.67 N, respectively. Under condition D, no marked increase in force was recorded. Distraction of the intervertebral space was much easier after disk removal. An intact LF caused a sudden marked increase in the force required for distraction, possibly indicating the point at which the LF was fully stretched. This increase in resistance may help to determine the optimal distraction height to avoid stress to the endplate spacer.

Development of a Remodeled Caspar Retractor and Its Application in the Measurement of Distractive Resistance in an In Vitro Anterior Cervical Distraction Model.

PubMed

Wen, Junxiang; Xu, Jianwei; Li, Lijun; Yang, Mingjie; Pan, Jie; Chen, Deyu; Jia, Lianshun; Tan, Jun

2017-06-01

In vitro biomechanical study of the cervical intervertebral distraction using a remodeled Caspar retractor. To investigate the torques required for distraction to different heights in an in vitro C3-C4 anterior cervical distraction model using a remodeled Caspar retractor, focusing on the influence of the intervertebral disk, posterior longitudinal ligament (PLL), and ligamentum flavum (LF). No previous studies have reported on the torques required for distraction to various heights or the factors resisting distraction in anterior cervical discectomy and fusion. Anterior cervical distractions at C3-C4 was performed in 6 cadaveric specimens using a remodeled Caspar retractor, under 4 conditions: A, before disk removal; B, after disk removal; C, after disk and PLL removal; and D, after disk and PLL removal and cutting of the LF. Distraction was performed for 5 teeth, and distractive torque of each tooth was recorded. The torque increased with distraction height under all conditions. There was a sudden increase in torque at the fourth tooth under conditions B and C, but not D. Under condition A, distraction to the third tooth required 84.8±13.3 cN m. Under conditions B and C, distraction to the third tooth required <13 cN m, and further distraction required dramatically increased torque. Under condition D, no marked increase in torque was recorded. Distraction of the intervertebral space was much easier after disk removal. An intact LF caused a sudden marked increase in the force required for distraction, possibly indicating the point at which the LF was fully stretched. This increase in resistance may help to determine the optimal distraction height to avoid excessive stress to the endplate spacer. The remodeled Caspar retractor in the present study may provide a feasible and convenient method for intraoperative measurement of distractive resistance.

Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis: a prospective randomized controlled trial.

PubMed

Saltzman, Charles L; Hillis, Stephen L; Stolley, Mary P; Anderson, Donald D; Amendola, Annunziato

2012-06-06

Initial reports have shown the efficacy of fixed distraction for the treatment of ankle osteoarthritis. We hypothesized that allowing ankle motion during distraction would result in significant improvements in outcomes compared with distraction without ankle motion. We conducted a prospective randomized controlled trial comparing the outcomes for patients with advanced ankle osteoarthritis who were managed with anterior osteophyte removal and either (1) fixed ankle distraction or (2) ankle distraction permitting joint motion. Thirty-six patients were randomized to treatment with either fixed distraction or distraction with motion. The patients were followed for twenty-four months after frame removal. The Ankle Osteoarthritis Scale (AOS) was the main outcome variable. Two years after frame removal, subjects in both groups showed significant improvement compared with the status before treatment (p < 0.02 for both groups). The motion-distraction group had significantly better AOS scores than the fixed-distraction group at twenty-six, fifty-two, and 104 weeks after frame removal (p < 0.01 at each time point). At 104 weeks, the motion-distraction group had an overall mean improvement of 56.6% in the AOS score, whereas the fixed-distraction group had a mean improvement of 22.9% (p < 0.01). Distraction improved the patient-reported outcomes of treatment of ankle osteoarthritis. Adding ankle motion to distraction showed an early and sustained beneficial effect on outcome.

Treatment outcome and long-term stability of skeletal changes following maxillary distraction in adult subjects of cleft lip and palate

PubMed Central

Singh, Satinder Pal; Jena, Ashok Kumar; Rattan, Vidya; Utreja, Ashok Kumar

2012-01-01

Aim: To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Materials and Methods: Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 months (mean 25.5 ± 1.94 months) after distraction osteogenesis were used for the evaluation of treatment outcome and long-term stability of the skeletal changes. Descriptive analysis, ANOVA, and post-hoc test were used, and P-value 0.05 was considered as a statistically significant level. Results: Maxillary distraction resulted in significant advancement of maxilla (P<0.001). Counterclockwise rotation of the palatal plane took place after maxillary distraction. The position of the mandible and facial heights were stable during distraction. During the first 6 months of the post-distraction period, the maxilla showed relapse of approximately 30%. However, after 6 months post distraction, the relapse was very negligible. Conclusions: Successful advancement of maxilla was achieved by distraction osteogenesis in adult subjects with cleft lip and palate. Most of the relapse occurred during the first 6 months of post-distraction period, and after that the outcomes were stable. PMID:22919221

Treatment outcome and long-term stability of skeletal changes following maxillary distraction in adult subjects of cleft lip and palate.

PubMed

Singh, Satinder Pal; Jena, Ashok Kumar; Rattan, Vidya; Utreja, Ashok Kumar

2012-04-01

To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 months (mean 25.5 ± 1.94 months) after distraction osteogenesis were used for the evaluation of treatment outcome and long-term stability of the skeletal changes. Descriptive analysis, ANOVA, and post-hoc test were used, and P-value 0.05 was considered as a statistically significant level. Maxillary distraction resulted in significant advancement of maxilla (P<0.001). Counterclockwise rotation of the palatal plane took place after maxillary distraction. The position of the mandible and facial heights were stable during distraction. During the first 6 months of the post-distraction period, the maxilla showed relapse of approximately 30%. However, after 6 months post distraction, the relapse was very negligible. Successful advancement of maxilla was achieved by distraction osteogenesis in adult subjects with cleft lip and palate. Most of the relapse occurred during the first 6 months of post-distraction period, and after that the outcomes were stable.

Distractions N' Driving: video game simulation educates young drivers on the dangers of texting while driving.

PubMed

Saqer, Haneen; de Visser, Ewart; Strohl, Jonathan; Parasuraman, Raja

2012-01-01

The proliferation of portable communication and entertainment devices has introduced new dangers to the driving environment, particularly for young and inexperienced drivers. Graduate students from George Mason University illustrate a powerful, practical, and cost-effective program that has been successful in educating these drivers on the dangers of texting while driving, which can easily be adapted and implemented in other communities.

A lower border augmentation technique to allow implant placement after a bilateral mandibular fracture as a complication of vertical distraction osteogenesis: a case report.

PubMed

Perdijk, F B T; Meijer, G J; Soehardi, A; Koole, R

2013-07-01

As with other techniques, vertical distraction osteogenesis (VDO) can also induce complications. The case of a patient with a residual alveolar ridge in the symphyseal area of 8 mm is presented. After performing VDO, the patient returned at 1-day postoperatively complaining of pain and dislocation of the distractor device, due to a fracture of the lower mandibular segment on the right side. After removal of the distractor device and application of osteosynthesis plates, the patient returned 2 weeks later due to a second fracture of the lower segment, yet on the left side. After removing the osteosynthesis material, stabilization of the mandible was achieved with an acrylic splint, which was fixated with peri-mandibular wiring. Finally, reconstruction was accomplished by lower border onlay grafting, limited to the symphyseal area, in preparation for implant insertion. Ultimately, after a healing period of 5 months, two endosseous implants were installed. The patient's function has remained satisfactory for 3 years. Reinforcement of the extreme resorbed edentulous mandible after fracture healing by lower border bone augmentation can be a reliable method to allow implant installation in a second stage. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The costly filtering of potential distraction: evidence for a supramodal mechanism.

PubMed

Marini, Francesco; Chelazzi, Leonardo; Maravita, Angelo

2013-08-01

When dealing with significant sensory stimuli, performance can be hampered by distracting events. Attention mechanisms lessen such negative effects, enabling selection of relevant information while blocking potential distraction. Recent work shows that preparatory brain activity, occurring before a critical stimulus, may reflect mechanisms of attentional control aimed to filter upcoming distracters. However, it is unknown whether the engagement of these filtering mechanisms to counteract distraction in itself taxes cognitive-brain systems, leading to performance costs. Here we address this question and, specifically, seek the behavioral signature of a mechanism for the filtering of potential distraction within and between sensory modalities. We show that, in potentially distracting contexts, a filtering mechanism is engaged to cope with forthcoming distraction, causing a dramatic behavioral cost in no-distracter trials during a speeded tactile discrimination task. We thus demonstrate an impaired processing caused by a potential, yet absent, distracter. This effect generalizes across different sensory modalities, such as vision and audition, and across different manipulations of the context, such as the distracter's sensory modality and pertinence to the task. Moreover, activation of the filtering mechanism relies on both strategic and reactive processes, as shown by its dynamic dependence on probabilistic and cross-trial contingencies. Crucially, across participants, the observed strategic cost is inversely related to the interference exerted by a distracter on distracter-present trials. These results attest to a mechanism for the monitoring and filtering of potential distraction in the human brain. Although its activation is indisputably beneficial when distraction occurs, it leads to robust costs when distraction is actually expected but currently absent. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Effects of C5/C6 Intervertebral Space Distraction Height on Pressure on the Adjacent Intervertebral Disks and Articular Processes and Cervical Vertebrae Range of Motion.

PubMed

Lu, Tingsheng; Luo, Chunshan; Ouyang, Beiping; Chen, Qiling; Deng, Zhongliang

2018-04-25

BACKGROUND This study aimed to investigate the association between range of motion of the cervical vertebrae and various C5/C6 intervertebral space distraction heights. MATERIAL AND METHODS The cervical vertebrae from 6 fresh adult human cadavers were used to prepare the models. Changes in C4/C5 and C6/C7 intervertebral disk pressures, articular process pressure, and range of motion of the cervical vertebrae before and after the distraction of the C5/C6 intervertebral space at benchmark heights of 100%, 120%, 140%, and 160% were tested under different exercise loads. RESULTS The pressure on the adjacent intervertebral disks was highest with the standing upright position before distraction, varied with different positions of the specimens and distraction heights after distraction, and was closest to that before distraction at a distraction height of 120% (P<0.05). The pressure of the adjacent articular processes was highest with left and right rotations before distraction, varied with different positions of the specimens and distraction heights after distraction, and was lowest under the same exercise load with different positions at a distraction height of 120% (P<0.05). The ranges of motion of the cervical vertebrae and intervertebral disks were largest without distraction and at a distraction height of 120% after distraction, respectively (P<0.05). CONCLUSIONS When removing the C5/C6 intervertebral disk and implanting an intervertebral bone graft, a benchmark height of 120% had little influence on the pressure of the adjacent intervertebral disks and articular processes and range of motion of the cervical vertebrae and is therefore an appropriate intervertebral space distraction height.

Effects of C5/C6 Intervertebral Space Distraction Height on Pressure on the Adjacent Intervertebral Disks and Articular Processes and Cervical Vertebrae Range of Motion

PubMed Central

Lu, Tingsheng; Luo, Chunshan; Ouyang, Beiping; Chen, Qiling

2018-01-01

Background This study aimed to investigate the association between range of motion of the cervical vertebrae and various C5/C6 intervertebral space distraction heights. Material/Methods The cervical vertebrae from 6 fresh adult human cadavers were used to prepare the models. Changes in C4/C5 and C6/C7 intervertebral disk pressures, articular process pressure, and range of motion of the cervical vertebrae before and after the distraction of the C5/C6 intervertebral space at benchmark heights of 100%, 120%, 140%, and 160% were tested under different exercise loads. Results The pressure on the adjacent intervertebral disks was highest with the standing upright position before distraction, varied with different positions of the specimens and distraction heights after distraction, and was closest to that before distraction at a distraction height of 120% (P<0.05). The pressure of the adjacent articular processes was highest with left and right rotations before distraction, varied with different positions of the specimens and distraction heights after distraction, and was lowest under the same exercise load with different positions at a distraction height of 120% (P<0.05). The ranges of motion of the cervical vertebrae and intervertebral disks were largest without distraction and at a distraction height of 120% after distraction, respectively (P<0.05). Conclusions When removing the C5/C6 intervertebral disk and implanting an intervertebral bone graft, a benchmark height of 120% had little influence on the pressure of the adjacent intervertebral disks and articular processes and range of motion of the cervical vertebrae and is therefore an appropriate intervertebral space distraction height. PMID:29693646

Videogame distraction using virtual reality technology for children experiencing cold pressor pain: the role of cognitive processing.

PubMed

Law, Emily F; Dahlquist, Lynnda M; Sil, Soumitri; Weiss, Karen E; Herbert, Linda Jones; Wohlheiter, Karen; Horn, Susan Berrin

2011-01-01

This study examined whether increasing the demand for central cognitive processing involved in a distraction task, by involving the child in ongoing, effortful interaction with the distraction stimulus, would increase children's tolerance for cold pressor pain. Seventy-nine children ages 6-15 years underwent a baseline cold pressor trial followed by two cold pressor trials in which they received interactive distraction (i.e., used voice commands to play a videogame) or passive distraction (in which they merely watched the output from the same videogame segment) in counterbalanced order. Both distraction conditions were presented via a virtual reality-type helmet. As expected, children demonstrated significant improvement in pain tolerance during distraction relative to baseline. Children showed the greatest improvement during the interactive distraction task. The effects of distraction on children's cold pressor pain tolerance are significantly enhanced when the distraction task also includes greater demands for central cognitive processing.

Interactive versus passive distraction for acute pain management in young children: the role of selective attention and development.

PubMed

Wohlheiter, Karen A; Dahlquist, Lynnda M

2013-03-01

To examine whether age and developmental differences in selective attention influence young children's differential responses to interactive and passive distraction. 65 3- to 6-year-old children underwent three cold-pressor trials while receiving no intervention, playing a video game (interactive distraction), or watching a video game (passive distraction). In addition, children completed a test of selective attention, and parents completed ratings of attention. Consistent with neurocognitive models of pain, children benefited more from interactive distraction than from passive distraction. Although older children demonstrated superior pain tolerance overall, age and selective attention skills did not moderate children's responses to the distraction intervention. These findings suggest that younger preschoolers can benefit from interactive distraction to manage acute pain, provided that the distraction activity is developmentally appropriate. Research is needed to determine whether developmental issues are more important moderators of children's responses to distraction when faced with more challenging task demands.

Cervical external immobilization devices: evaluation of magnetic resonance imaging issues at 3.0 Tesla.

PubMed

Diaz, Francis L; Tweardy, Lisa; Shellock, Frank G

2010-02-15

Laboratory investigation, ex vivo. Currently, no studies have addressed the magnetic resonance imaging (MRI) issues for cervical external immobilization devices at 3-Tesla. Under certain conditions significant heating may occur, resulting in patient burns. Furthermore, artifacts can be substantial and prevent the diagnostic use of MRI. Therefore, the objective of this investigation was to evaluate MRI issues for 4 different cervical external immobilization devices at 3-Tesla. Excessive heating and substantial artifacts are 2 potential complications associated with performing MRI at 3-Tesla in patients with cervical external immobilization devices. Using ex vivo testing techniques, MRI-related heating and artifacts were evaluated for 4 different cervical devices during MRI at 3-Tesla. Four cervical external immobilization devices (Generation 80, Resolve Ring and Superstructure, Resolve Ring and Jerome Vest/Jerome Superstructure, and the V1 Halo System; Ossur Americas, Aliso Viejo, CA) underwent MRI testing at 3-Tesla. All devices were made from nonmetallic or nonmagnetic materials. Heating was determined using a gelled-saline-filled skull phantom with fluoroptic thermometry probes attached to the skull pins. MRI was performed at 3-Tesla, using a high level of RF energy. Artifacts were assessed at 3-Tesla, using standard cervical imaging techniques. The Generation 80 and V1 Halo devices exhibited substantial temperature rises (11.6 degrees C and 8.5 degrees C, respectively), with "sparking" evident for the Generation 80 during the MRI procedure. Artifacts were problematic for these devices, as well. By comparison, the 2 Resolve Ring-based cervical external immobilization devices showed little or no heating (< or = 0.6 degrees C) and the artifacts were acceptable for diagnostic MRI examinations. The low degree of heating and minor artifacts associated with the Resolve-based cervical external immobilization devices indicated that these products are safe for patients undergoing MRI at 3-Tesla.

A Human–Robot Interaction Perspective on Assistive and Rehabilitation Robotics

PubMed Central

Beckerle, Philipp; Salvietti, Gionata; Unal, Ramazan; Prattichizzo, Domenico; Rossi, Simone; Castellini, Claudio; Hirche, Sandra; Endo, Satoshi; Amor, Heni Ben; Ciocarlie, Matei; Mastrogiovanni, Fulvio; Argall, Brenna D.; Bianchi, Matteo

2017-01-01

Assistive and rehabilitation devices are a promising and challenging field of recent robotics research. Motivated by societal needs such as aging populations, such devices can support motor functionality and subject training. The design, control, sensing, and assessment of the devices become more sophisticated due to a human in the loop. This paper gives a human–robot interaction perspective on current issues and opportunities in the field. On the topic of control and machine learning, approaches that support but do not distract subjects are reviewed. Options to provide sensory user feedback that are currently missing from robotic devices are outlined. Parallels between device acceptance and affective computing are made. Furthermore, requirements for functional assessment protocols that relate to real-world tasks are discussed. In all topic areas, the design of human-oriented frameworks and methods is dominated by challenges related to the close interaction between the human and robotic device. This paper discusses the aforementioned aspects in order to open up new perspectives for future robotic solutions. PMID:28588473

A Human-Robot Interaction Perspective on Assistive and Rehabilitation Robotics.

PubMed

Beckerle, Philipp; Salvietti, Gionata; Unal, Ramazan; Prattichizzo, Domenico; Rossi, Simone; Castellini, Claudio; Hirche, Sandra; Endo, Satoshi; Amor, Heni Ben; Ciocarlie, Matei; Mastrogiovanni, Fulvio; Argall, Brenna D; Bianchi, Matteo

2017-01-01

Assistive and rehabilitation devices are a promising and challenging field of recent robotics research. Motivated by societal needs such as aging populations, such devices can support motor functionality and subject training. The design, control, sensing, and assessment of the devices become more sophisticated due to a human in the loop. This paper gives a human-robot interaction perspective on current issues and opportunities in the field. On the topic of control and machine learning, approaches that support but do not distract subjects are reviewed. Options to provide sensory user feedback that are currently missing from robotic devices are outlined. Parallels between device acceptance and affective computing are made. Furthermore, requirements for functional assessment protocols that relate to real-world tasks are discussed. In all topic areas, the design of human-oriented frameworks and methods is dominated by challenges related to the close interaction between the human and robotic device. This paper discusses the aforementioned aspects in order to open up new perspectives for future robotic solutions.

Long-term follow-up of large maxillary advancements with distraction osteogenesis in growing and non-growing cleft lip and palate patients.

PubMed

Meazzini, Maria Costanza; Basile, Valentina; Mazzoleni, Fabio; Bozzetti, Alberto; Brusati, Roberto

2015-01-01

Maxillary distraction osteogenesis (DO) in cleft lip and palate patients has been described by several authors, but most studies have a relatively short follow-up and do not clearly separate growing patients from non-growing patients. The records of 22 consecutive patients affected by cleft lip and palate, who underwent Le Fort I osteotomy and maxillary distraction with a rigid external distractor (RED), were reviewed. The sample was subdivided into a growing and a non-growing group. All patients had pre-DO cephalometric records, immediately post DO, 12 months post DO and long-term records with a long-term follow-up of >5 years (range 5-13 years). As a control sample for the growing group, cleft children with a negative overjet not subjected to distraction or any protraction treatment during growth were followed up until the completion of growth. The average maxillary advancement in the growing group was 22.2 ± 5.5 mm (range: 15-32 mm); in the non-growing group, it was 17.7 ± 6.6 mm (range: 6-25 mm). Excellent post-surgical stability was recorded in the adult sample. On the other hand, growing children had an average 16% relapse in the first year post DO and an additional 26% relapse in the long-term follow-up. This study seems to point out that early Le Fort I DO allows for the correction of very severe deformities. It is followed by a relatively high amount of true skeletal relapse in children with cleft lip and palate. Prognosis should be discussed in depth with the family and true aesthetic and psychological needs assessed. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Evaluating Robotic Surgical Skills Performance Under Distractive Environment Using Objective and Subjective Measures.

PubMed

Suh, Irene H; LaGrange, Chad A; Oleynikov, Dmitry; Siu, Ka-Chun

2016-02-01

Distractions are recognized as a significant factor affecting performance in safety critical domains. Although operating rooms are generally full of distractions, the effect of distractions on robot-assisted surgical (RAS) performance is unclear. Our aim was to investigate the effect of distractions on RAS performance using both objective and subjective measures. Fifteen participants performed a knot-tying task using the da Vinci Surgical System and were exposed to 3 distractions: (1) passive distraction entailed listening to noise with a constant heart rate, (2) active distraction included listening to noise and acknowledging a change of random heart rate from 60 to 120 bpm, and (3) interactive distraction consisted of answering math questions. The objective kinematics of the surgical instrument tips were used to evaluate performance. Electromyography (EMG) of the forearm and hand muscles of the participants were collected. The median EMG frequency (EMG(fmed)) and the EMG envelope (EMG(env)) were analyzed. NASA Task Load Index and Fundamentals of Laparoscopic Surgery score were used to evaluate the subjective performance. One-way repeated analysis of variance was applied to examine the effects of distraction on skills performance. Spearman's correlations were conducted to compare objective and subjective measures. Significant distraction effect was found for all objective kinematics measures (P < .05). There were significant distraction effects for EMG measures (EMG(env), P < .004; EMG(fmed), P = .031). Significant distraction effects were also found for subjective measurements. Distraction impairs surgical skills performance and increases muscle work. Understanding how the surgeons cope with distractions is important in developing surgical education. © The Author(s) 2015.

Dynamics of Driver Distraction: The process of engaging and disengaging

PubMed Central

Lee, John D.

2014-01-01

Driver distraction research has a long history, spanning nearly 50 years, but intensifying over the last decade. The dominant paradigm guiding this research defines distraction in terms of excessive workload and limited attentional resources. This approach largely ignores how drivers come to engage in these tasks and under what conditions they engage and disengage from driving—the dynamics of distraction. The dynamics of distraction identifies breakdowns of interruption management as an important contributor to distraction, leading to describe distraction in terms of failures of task timing, switching, and prioritization. The dynamics of distraction also identifies disengagement in driving (e.g., mind wandering) as a substantial challenge that secondary tasks might exacerbate or mitigate. Increasing vehicle automation accentuates the need to consider these dynamics of distraction. Automation offers drivers more opportunity to engage in distractions and disengage from driving, and can surprise drivers by unexpectedly requiring drivers to quickly re-engage in driving—placing greater importance of interruption management expertise. This review describes distraction in terms of breakdowns in interruption management and problems of engagement, and summarizes how contingency, conditioning, and consequence traps lead to problems of engaging and disengaging in driving and distractions. PMID:24776224

Gender differences in the content of cognitive distraction during sex.

PubMed

Meana, Marta; Nunnink, Sarah E

2006-02-01

This study compared 220 college men and 237 college women on two types of self-reported cognitive distraction during sex, performance- and appearance-based. Affect, psychological distress, sexual knowledge, attitudes, fantasies, experiences, body image, satisfaction, and sexual function were assessed with the Derogatis Sexual Functioning Inventory and the Sexual History Form to determine associations with distraction. Between-gender analyses revealed that women reported higher levels of overall and appearance-based distraction than did men, but similar levels of performance-based distraction. Within-gender analyses revealed that women reported as much of one type of distraction as the other, while men reported more performance- than appearance-based distraction. In women, appearance-based distraction was predicted by negative body image, psychological distress, and not being in a relationship, while performance-based distraction was predicted by negative body image, psychological distress, and sexual dissatisfaction. In men, appearance-based distraction was predicted by negative body image, sexual dissatisfaction and not being in a relationship, while performance-based distraction was predicted by negative body image and sexual dissatisfaction. Investigating the content of cognitive distraction may be useful in understanding gender differences in sexual experience and in refining cognitive components of sex therapy.

External shading devices for energy efficient building

NASA Astrophysics Data System (ADS)

Shahdan, M. S.; Ahmad, S. S.; Hussin, M. A.

2018-02-01

External shading devices on a building façade is an important passive design strategy as they reduce solar radiation. Although studies have proven the benefits of external shading devices, many are designed solely for aesthetic purposes without fully considering its high potential to reduce solar radiation and glare. Furthermore, explorations into shading devices by the design team are mostly left too late in the design development phases. Hence, the paper looks into the effectiveness of external shading devices on a building towards more energy efficient building. The study aims to analyse the effects of various configurations of external shading devices towards the energy consumption of a case study building based on computer simulations. This study uses Building Information Modelling (BIM) through Autodesk Revit software as simulation tool. The constant variables for the simulation are the orientation of the building, types of glazing used by the building and the internal loads of the building. Whereas, the manipulated variable is the types of shading device used. The data were sorted according to the categories and translated into a chart. Analysis of the findings indicate that shading devices with different configurations show significant results in the energy consumption and the best configuration is the egg-crate shading devices. The study recommends that the consideration for shading device as a passive design strategy needs to be developed at the early stage of the building design.

Bone-borne distractor versus tooth-borne distractor for orthodontic distraction after surgical maxillary expansion: The patient's point of view.

PubMed

Garreau, Emilie; Bouscaillou, Julie; Rattier, Simon; Ferri, Joël; Raoul, Gwenaël

2016-06-01

Orthodontic distraction after surgical maxillary expansion is a mode of treatment regularly used in the context of transverse maxillary constriction. There is, however, no consensus in the literature as to the type of distractor (bone-borne or tooth-borne) that should be used. This retrospective study compared orthodontic distraction using a bone-borne or a tooth-borne distractor from the point of view of tolerance, ease of use and overall patient satisfaction, by means of a questionnaire completed by patients undergoing maxillary expansion surgery in the Stomatology and Maxillofacial Surgery Department of Lille University Hospital between January 2013 and March 2015. The efficacy of the two distractors was also assessed. Thirty-two patients were included: 10 in the bone-borne distractor group and 22 in the tooth-borne group. Sixty percent of patients questioned found the bone-borne distractor easy to use compared with 32% for the tooth-borne distractor (P=0.167). Tolerance was noted to be comparable and acceptable by the two groups. The overall satisfaction rate was high for both groups at over 90%, and was correlated with ease of use and clear information. The average space gain between the first molars was 11.1mm with the bone-borne device and 10.7mm for the tooth-borne appliance. The use of a bone-borne distractor for orthodontic distraction after maxillary expansion surgery appears to be an effective, simple and well-tolerated alternative to the use of a tooth-borne distractor. According to patients, this distractor also appears easier to use than the traditional Hyrax-type distractor. This ease of use is correlated with overall satisfaction. Copyright © 2016. Published by Elsevier Masson SAS.

Effect of virtual reality on adolescent pain during burn wound care.

PubMed

Jeffs, Debra; Dorman, Dona; Brown, Susan; Files, Amber; Graves, Tamara; Kirk, Elizabeth; Meredith-Neve, Sandra; Sanders, Janise; White, Benjamin; Swearingen, Christopher J

2014-01-01

The objective of this study was to compare the effect of virtual reality to passive distraction and standard care on burn treatment pain in adolescents.This single-blinded, randomized controlled study enrolled 30 adolescents who were 10 to 17 years of age from the burn clinic of a large children's hospital. After providing informed consent/assent, these participants were randomly assigned to one of three groups during wound care: standard care, passive distraction watching a movie, or virtual reality (VR) using a tripod-arm device rather than an immersive helmet. Before wound care, participants completed the Spielberger's State-Trait Anxiety Inventory for Children and Pre-Procedure Questionnaire while blinded to group assignment. A total of 28 participants completed the study and rated treatment pain after wound care by using the Adolescent Pediatric Pain Tool and completed a Post-Procedure Questionnaire. The VR group reported less pain during wound care than either the passive distraction or standard care group as determined by multivariable linear regression adjusted for age, sex, preprocedure pain, state anxiety, opiate use, and treatment length. The VR group was the only group to have an estimated decrease in pain perception from baseline preprocedure pain to procedural pain reported. Adolescents pretreated with opiate analgesics and female adolescents reported more pain during wound care.This between-subjects clinical study provides further support for VR, even without requiring wearing of an immersive helmet, in lessening burn wound care pain in adolescents. Passive distraction by watching a movie may be less effective in reducing treatment pain. Additional between-subjects randomized controlled trials with larger samples of children and during other healthcare treatments may further support VR's effectiveness in pediatric procedural pain management.

Motion Versus Fixed Distraction of the Joint in the Treatment of Ankle Osteoarthritis

PubMed Central

Saltzman, Charles L.; Hillis, Stephen L.; Stolley, Mary P.; Anderson, Donald D.; Amendola, Annunziato

2012-01-01

Background: Initial reports have shown the efficacy of fixed distraction for the treatment of ankle osteoarthritis. We hypothesized that allowing ankle motion during distraction would result in significant improvements in outcomes compared with distraction without ankle motion. Methods: We conducted a prospective randomized controlled trial comparing the outcomes for patients with advanced ankle osteoarthritis who were managed with anterior osteophyte removal and either (1) fixed ankle distraction or (2) ankle distraction permitting joint motion. Thirty-six patients were randomized to treatment with either fixed distraction or distraction with motion. The patients were followed for twenty-four months after frame removal. The Ankle Osteoarthritis Scale (AOS) was the main outcome variable. Results: Two years after frame removal, subjects in both groups showed significant improvement compared with the status before treatment (p < 0.02 for both groups). The motion-distraction group had significantly better AOS scores than the fixed-distraction group at twenty-six, fifty-two, and 104 weeks after frame removal (p < 0.01 at each time point). At 104 weeks, the motion-distraction group had an overall mean improvement of 56.6% in the AOS score, whereas the fixed-distraction group had a mean improvement of 22.9% (p < 0.01). Conclusion: Distraction improved the patient-reported outcomes of treatment of ankle osteoarthritis. Adding ankle motion to distraction showed an early and sustained beneficial effect on outcome. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. PMID:22637202

Treatment of close-range, low-velocity gunshot fractures of tibia and femur diaphysis with consecutive compression-distraction technique: a report of 11 cases.

PubMed

Ateşalp, A Sabri; Kömürcü, Mahmut; Demiralp, Bahtiyar; Bek, Dogan; Oğuz, Erbil; Yanmiş, Ibrahim

2004-01-01

Lower extremity injuries secondary to close-range, low-velocity gunshot wounds are frequently seen in both civilian and military populations. A close-range, low-velocity injury produces high energy and often results in comminuted and complicated fractures with significant morbidity. In this study, four femoral, four tibial, and three combined tibia and fibular comminuted diaphyseal fractures secondary to close-range, low-velocity gunshot wounds in 11 military personnel were treated with debridement followed by compression-distraction lengthening using a circular external fixator frame. Fracture union was obtained in all without significant major complications. Fracture consolidation occurred at a mean of 3.5 months. At follow-up of 46.8 months, there were no delayed unions, nonunions, or malunions. Minor complications included four pin-tract infections and knee flexion limitation in two femur fractures. Osteomyelitis and deep soft tissue infection were not observed. This technique provided an alternative to casting, open reduction internal fixation, or intermedullary fixation with an acceptable complication rate.

Reflections of Distraction in Memory: Transfer of Previous Distraction Improves Recall in Younger and Older Adults

PubMed Central

Thomas, Ruthann C.; Hasher, Lynn

2012-01-01

Three studies explored whether younger and older adults’ free recall performance can benefit from prior exposure to distraction that becomes relevant in a memory task. Participants initially read stories that included distracting text. Later, they studied a list of words for free recall, with half of the list consisting of previously distracting words. When the memory task was indirect in its use of distraction (Study 1), only older adults showed transfer, with better recall of previously distracting compared with new words, which increased their recall to match that of younger adults. However, younger adults showed transfer when cued about the relevance of previous distraction both before studying the words (Study 2) and before recalling the words (Study 3) in the memory test. Results suggest that both younger and older adults encode distraction, but younger adults require explicit cueing to use their knowledge of distraction. In contrast, older adults transfer knowledge of distraction in both explicitly cued and indirect memory tasks. Results are discussed in terms of age differences in inhibition and source-constrained retrieval. PMID:21843024

Reflections of distraction in memory: transfer of previous distraction improves recall in younger and older adults.

PubMed

Thomas, Ruthann C; Hasher, Lynn

2012-01-01

Three studies explored whether younger and older adults' free recall performance can benefit from prior exposure to distraction that becomes relevant in a memory task. Participants initially read stories that included distracting text. Later, they studied a list of words for free recall, with half of the list consisting of previously distracting words. When the memory task was indirect in its use of distraction (Study 1), only older adults showed transfer, with better recall of previously distracting compared with new words, which increased their recall to match that of younger adults. However, younger adults showed transfer when cued about the relevance of previous distraction both before studying the words (Study 2) and before recalling the words (Study 3) in the memory test. Results suggest that both younger and older adults encode distraction, but younger adults require explicit cueing to use their knowledge of distraction. In contrast, older adults transfer knowledge of distraction in both explicitly cued and indirect memory tasks. Results are discussed in terms of age differences in inhibition and source-constrained retrieval.

Effects of mobile phone distraction on pedestrians' crossing behavior and visual attention allocation at a signalized intersection: An outdoor experimental study.

PubMed

Jiang, Kang; Ling, Feiyang; Feng, Zhongxiang; Ma, Changxi; Kumfer, Wesley; Shao, Chen; Wang, Kun

2018-06-01

With the rapid growth in mobile phone use worldwide, traffic safety experts have begun to consider the impact of mobile phone distractions on pedestrian crossing safety. This study sought to investigate how mobile phone distractions (music distraction, phone conversation distraction and text distraction) affect the behavior of pedestrians while they are crossing the street. An outdoor-environment experiment was conducted among 28 college student pedestrians. Two HD videos and an eye tracker were employed to record and analyze crossing behavior and visual attention allocation. The results of the research showed that the three mobile phone distractions cause different levels of impairment to pedestrians' crossing performance, with the greatest effect from text distraction, followed by phone conversation distraction and music distraction. Pedestrians distracted by music initiate crossing later, have increased pupil diameter, and reduce their scanning frequency, fixation points and fixation times toward traffic signal area priorities. In addition to the above effects, pedestrians distracted by phone conversation cross the street more slowly, direct fewer fixation points to the right traffic area, and spend less fixation time and lower average fixation duration on the left traffic area. Moreover, pedestrians distracted by texting look left and right less often and switch, distribute and maintain less visual attention on the traffic environment. These findings may inform researchers, policy makers, and pedestrians. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effects of distraction on memory and cognition: a commentary.

PubMed

Craik, Fergus I M

2014-01-01

This commentary is a review of the findings and ideas reported in the preceding nine articles on the effects of distraction on aspects of cognitive performance. The articles themselves deal with the disruptive effects of distraction on recall of words, objects and events, also on visual processing, category formation and other cognitive tasks. The commentary assesses the part played by "domain-general" suppression of distracting information and the "domain-specific" competition arising when tasks and distraction involve very similar material. Some forms of distraction are meaningfully relevant to the ongoing task, and Treisman's (1964) model of selective attention is invoked to provide an account of findings in this area. Finally, individual differences to vulnerability to distraction are discussed; older adults are particularly affected by distracting stimuli although the failure to repress distraction can sometimes prove beneficial to later cognitive performance.

Videogame Distraction using Virtual Reality Technology for Children Experiencing Cold Pressor Pain: The Role of Cognitive Processing

PubMed Central

Law, Emily F.; Sil, Soumitri; Weiss, Karen E.; Herbert, Linda Jones; Wohlheiter, Karen; Horn, Susan Berrin

2011-01-01

Objective This study examined whether increasing the demand for central cognitive processing involved in a distraction task, by involving the child in ongoing, effortful interaction with the distraction stimulus, would increase children's tolerance for cold pressor pain. Methods Seventy-nine children ages 6–15 years underwent a baseline cold pressor trial followed by two cold pressor trials in which they received interactive distraction (i.e., used voice commands to play a videogame) or passive distraction (in which they merely watched the output from the same videogame segment) in counterbalanced order. Both distraction conditions were presented via a virtual reality-type helmet. Results As expected, children demonstrated significant improvement in pain tolerance during distraction relative to baseline. Children showed the greatest improvement during the interactive distraction task. Conclusion The effects of distraction on children's cold pressor pain tolerance are significantly enhanced when the distraction task also includes greater demands for central cognitive processing. PMID:20656761

Mechanisms behind distracted driving behavior: The role of age and executive function in the engagement of distracted driving

PubMed Central

Pope, Caitlin Northcutt; Bell, Tyler Reed; Stavrinos, Despina

2016-01-01

Performing secondary tasks, such as texting while driving, is associated with an increased risk of motor vehicle collisions (MVCs). While cognitive processes, such as executive function, are involved in driving, little is known about the relationship between executive control and willingness to engage in distracted driving. This study investigated the relationship between age, behavioral manifestations of executive function, and self-reported distracted driving behaviors. Executive difficulty (assessed with the BRIEF-A) as well as demographics (age and gender) was considered as possible predictors of engagement in distracted driving behaviors. Fifty-nine young, middle, and older adults self-reported executive difficulty and weekly engagement in distracted driving behaviors. Results revealed that while partially accounted for by age, global executive difficulty was uniquely related to engagement in distracted driving behaviors. Older age was associated with fewer weekly self-reported distracted driving behaviors while higher self-reported executive difficulty was associated with more frequent weekly engagement in distracted behavior. No significant differences were found between young and middle-aged adults on distracted driving behaviors. Findings conclude that distracted driving is a ubiquitous phenomenon evident in drivers of all ages. Possible mechanisms underlying distracted driving behavior could potentially be related to deficits in executive function. PMID:27716494

Mechanisms behind distracted driving behavior: The role of age and executive function in the engagement of distracted driving.

PubMed

Pope, Caitlin Northcutt; Bell, Tyler Reed; Stavrinos, Despina

2017-01-01

Performing secondary tasks, such as texting while driving, is associated with an increased risk of motor vehicle collisions (MVCs). While cognitive processes, such as executive function, are involved in driving, little is known about the relationship between executive control and willingness to engage in distracted driving. This study investigated the relationship between age, behavioral manifestations of executive function, and self-reported distracted driving behaviors. Executive difficulty (assessed with the BRIEF-A) as well as demographics (age and gender) was considered as possible predictors of engagement in distracted driving behaviors. Fifty-nine young, middle, and older adults self-reported executive difficulty and weekly engagement in distracted driving behaviors. Results revealed that while partially accounted for by age, global executive difficulty was uniquely related to engagement in distracted driving behaviors. Older age was associated with fewer weekly self-reported distracted driving behaviors while higher self-reported executive difficulty was associated with more frequent weekly engagement in distracted behavior. No significant differences were found between young and middle-aged adults on distracted driving behaviors. Findings conclude that distracted driving is a ubiquitous phenomenon evident in drivers of all ages. Possible mechanisms underlying distracted driving behavior could potentially be related to deficits in executive function. Copyright © 2016 Elsevier Ltd. All rights reserved.

Numerical investigations of MRI RF field induced heating for external fixation devices

PubMed Central

2013-01-01

Background The magnetic resonance imaging (MRI) radio frequency (RF) field induced heating on external fixation devices can be very high in the vicinity of device screws. Such induced RF heating is related to device constructs, device placements, as well as the device insertion depth into human subjects. In this study, computational modeling is performed to determine factors associated with such induced heating. Methods Numerical modeling, based on the finite-difference time-domain (FDTD) method, is used to evaluate the temperature rises near external device screw tips inside the ASTM phantom for both 1.5-T and 3-T MRI systems. The modeling approach consists of 1) the development of RF coils for 1.5-T and 3-T, 2) the electromagnetic simulations of energy deposition near the screw tips of external fixation devices, and 3) the thermal simulations of temperature rises near the tips of these devices. Results It is found that changing insertion depth and screw spacing could largely affect the heating of these devices. In 1.5-T MRI system, smaller insertion depth and larger pin spacing will lead to higher temperature rise. However, for 3-T MRI system, the relation is not very clear when insertion depth is larger than 5 cm or when pin spacing became larger than 20 cm. The effect of connection bar material on device heating is also studied and the heating mechanism of the device is analysed. Conclusions Numerical simulation is used to study RF heating for external fixation devices in both 1.5-T and 3-T MRI coils. Typically, shallower insertion depth and larger pin spacing with conductive bar lead to higher RF heating. The heating mechanism is explained using induced current along the device and power decay inside ASTM phantom. PMID:23394173

Young and Older Adults' Reading of Distracters

ERIC Educational Resources Information Center

Kemper, Susan; Mcdowd, Joan; Metcalf, Kim; Liu, Chiung-Ju

2008-01-01

Eye-tracking technology was employed to examine young and older adults' performance in the reading with distraction paradigm. Distracters of 1, 2, and 4 words that formed meaningful phrases were used. There were marked age differences in fixation patterns. Young adults' fixations to the distracters and targets increased with distracter length.…

Early results of a simple distraction dynamic external fixator in management of comminuted intra-articular fractures of base of middle phalanx.

PubMed

Mansha, Muhammad; Miranda, Sanjay

2013-12-01

Treatment for comminuted fracture dislocations of the proximal interphalangeal joint (pilon injuries) remains a challenge. We present our short term results of twelve pilon fracture dislocations treated by closed reduction and application of a distraction dynamic external fixator. The aim of the study was to assess the clinical outcomes and compare them to the original description by Hynes and Giddins. A cohort of 12 consecutive patients with pilon fracture of the proximal interphalangeal joint (comminuted fracture of the base of middle phalanx, longitudinally unstable with joint subluxation), were treated with this method over the study period. Data was collected by an independent observer at last follow-up appointment in the clinic. The outcome measures recorded were; level of residual pain, arc of motion, X-ray appearance, return to work and satisfaction with the procedure. The study group comprises of 7 male and 5 female patients at a mean age of 38.1 years (range 21-70 years). The average range of movement achieved was 13-87° at a mean follow-up of 16.4 weeks (Range 12-42 weeks). Early return to work, good pain relief and high level of patient satisfaction were achieved. No serious complication was noted during this period. We used the construct with slight modification of the original description and we feel this modification may help to reduce the pin site infection. We found the results reproducible and based on our experience we recommend this technique to treat these complex intra-articular fractures of base of middle phalanx.

Does attention capacity moderate the effect of driver distraction in older drivers?

PubMed

Cuenen, Ariane; Jongen, Ellen M M; Brijs, Tom; Brijs, Kris; Lutin, Mark; Van Vlierden, Karin; Wets, Geert

2015-04-01

With age, a decline in attention capacity may occur and this may impact driving performance especially while distracted. Although the effect of distraction on driving performance of older drivers has been investigated, the moderating effect of attention capacity on driving performance during distraction has not been investigated yet. Therefore, the aim was to investigate whether attention capacity has a moderating effect on older drivers' driving performance during visual distraction (experiment 1) and cognitive distraction (experiment 2). In a fixed-based driving simulator, older drivers completed a driving task without and with visual distraction (experiment 1, N=17, mean age 78 years) or cognitive distraction (experiment 2, N=35, mean age 76 years). Several specific driving measures of varying complexity (i.e., speed, lane keeping, following distance, braking behavior, and crashes) were investigated. In addition to these objective driving measures, subjective measures of workload and driving performance were also included. In experiment 1, crash occurrence increased with visual distraction and was negatively related to attention capacity. In experiment 2, complete stops at stop signs decreased, initiation of braking at pedestrian crossings was later, and crash occurrence increased with cognitive distraction. Interestingly, for a measure of lane keeping (i.e., standard deviation of lateral lane position (SDLP)), effects of both types of distraction were moderated by attention capacity. Despite the decrease of driving performance with distraction, participants estimated their driving performance during distraction as good. These results imply that attention capacity is important for driving. Driver assessment and training programs might therefore focus on attention capacity. Nonetheless, it is crucial to eliminate driver distraction as much as possible given the deterioration of performance on several driving measures in those with low and high attention capacity. Copyright © 2015 Elsevier Ltd. All rights reserved.

Interactive versus Passive Distraction and Parent Psychoeducation as Pain Management Techniques during Paediatric Venepuncture - A Randomized Controlled Trial.

PubMed

Newell, Anna; Keane, Jennifer; McGuire, Brian E; Heary, Caroline; McDarby, Vincent; Dudley, Bernie; Moran, Josh; Francis, Kady; Caes, Line

2018-05-10

The aim of the current research was to compare the relative efficacy of interactive and passive distraction, with or without parental psychoeducation, on child pain and distress during a venepuncture. We also compared the effect of parental psychoeducation on parental distress, knowledge of distraction strategies and engagement in distraction. This cross-sectional study included 213 children scheduled for a venepuncture, and one of their parents, who were randomly allocated to one of four conditions; interactive distraction, passive distraction, interactive distraction with parent psychoeducation and passive distraction with parent psychoeducation. ANCOVA's were used to investigate the impact of distraction type and the use of parent psychoeducation on child and parent pain related outcome variables. Statistical analyses revealed no significant differences between groups for child-reported pain and distress. The parents of children who received interactive distraction reported significantly higher levels of distress than the parents of children who received passive distraction. Parents who received parent psychoeducation had a significantly higher level of knowledge than parents who did not receive psychoeducation, but did not engage in more effective pain management behaviour. The results indicated that distraction type did not have a significantly different influence on child pain-related outcome variables. In addition, while psychoeducation was demonstrated to be effective in increasing parental knowledge, it was not sufficient to change parental behaviour.

Impaired laparoscopic performance of novice surgeons due to phone call distraction: a single-centre, prospective study.

PubMed

Yang, Cui; Heinze, Julia; Helmert, Jens; Weitz, Juergen; Reissfelder, Christoph; Mees, Soeren Torge

2017-12-01

Distractions such as phone calls during laparoscopic surgery play an important role in many operating rooms. The aim of this single-centre, prospective study was to assess if laparoscopic performance is impaired by intraoperative phone calls in novice surgeons. From October 2015 to June 2016, 30 novice surgeons (medical students) underwent a laparoscopic surgery training curriculum including two validated tasks (peg transfer, precision cutting) until achieving a defined level of proficiency. For testing, participants were required to perform these tasks under three conditions: no distraction (control) and two standardised distractions in terms of phone calls requiring response (mild and strong distraction). Task performance was evaluated by analysing time and accuracy of the tasks and response of the phone call. In peg transfer (easy task), mild distraction did not worsen the performance significantly, while strong distraction was linked to error and inefficiency with significantly deteriorated performance (P < 0.05). Precision cutting (difficult task) was not slowed down by mild distraction, but surgical and cognitive errors were significantly increased when participants were distracted (P < 0.05). Compared to mild distraction, participants reported a more severe subjective disturbance when they were diverted by strong distraction (P < 0.05). Our data reveals that phone call distractions result in impaired laparoscopic performance under certain circumstances. To ensure patient safety, phone calls should be avoided as far as possible in operating rooms.

Stress in Lumbar Intervertebral Discs during Distraction

PubMed Central

Gay, Ralph E.; Ilharreborde, Brice; Zhao, Kristin D.; Berglund, Lawrence J.; Bronfort, Gert; An, Kai-Nan

2008-01-01

BACKGROUND CONTEXT The intervertebral disc is a common source of low back pain. Prospective studies suggest that treatments that intermittently distract the disc might be beneficial for chronic low back pain. Although the potential exists for distraction therapies to affect the disc biomechanically their effect on intradiscal stress is debated. PURPOSE To determine if distraction alone, distraction combined with flexion or distraction combined with extension can reduce nucleus pulposus pressure and posterior anulus compressive stress in cadaveric lumbar discs compared to simulated standing or lying. STUDY DESIGN Laboratory study using single cadaveric motion segments. OUTCOME MEASURES Strain gauge measures of nucleus pulposus pressure and compressive stress in the anterior and posterior annulus fibrosus METHODS Intradiscal stress profilometry was performed on 15 motion segments during 5 simulated conditions: standing, lying, and 3 distracted conditions. Disc degeneration was graded by inspection from 1 (normal) to 4 (severe degeneration). RESULTS All distraction conditions markedly reduced nucleus pressure compared to either simulated standing or lying. There was no difference between distraction with flexion and distraction with extension in regard to posterior annulus compressive stress. Discs with little or no degeneration appeared to distributed compressive stress differently than those with moderate or severe degeneration. CONCLUSIONS Distraction appears to predictably reduce nucleus pulposus pressure. The effect of distraction therapy on the distribution of compressive stress may be dependent in part on the health of the disc. PMID:17981092

Combination therapy with intra-articular injection of mesenchymal stem cells and articulated joint distraction for repair of a chronic osteochondral defect in the rabbit.

PubMed

Harada, Yohei; Nakasa, Tomoyuki; Mahmoud, Elhussein Elbadry; Kamei, Goki; Adachi, Nobuo; Deie, Masataka; Ochi, Mitsuo

2015-10-01

The present study investigated intra-articular injection of bone-marrow-derived mesenchymal stem cells (MSCs) combined with articulated joint distraction as treatment for osteochondral defects. Large osteochondral defects were created in the weight-bearing area of the medial femoral condyle in rabbit knees. Four weeks after defect creation, rabbits were divided into six groups: control group, MSC group, distraction group, distraction + MSC group, temporary distraction group, and temporary distraction + MSC group. Groups with MSC received intra-articular injection of MSCs. Groups with distraction underwent articulated distraction arthroplasty. Groups with temporary distraction discontinued the distraction after 4 weeks. The rabbits were euthanized at 4, 8, and 12 weeks after treatment except temporary distraction groups which were euthanized at only 12 weeks. Histological scores in the distraction + MSC group were significantly better than in the control, MSC group or distraction group at 4 and 8 weeks, but showed no further improvement. At 12 weeks, the temporary distraction + MSC group showed the best results, demonstrating hyaline cartilage repair with regeneration of the osteochondral junction. In conclusion, joint distraction with intra-articular injection of MSCs promotes early cartilage repair, and compressive loading of the repair tissue after temporary distraction stimulates articular cartilage regeneration. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

The role of driver distraction in crashes: an analysis of 1995-1999 Crashworthiness Data System Data.

PubMed

Stutts, J C; Reinfurt, D W; Rodgman, E A

2001-01-01

Five years (1995-1999) of national Crashworthiness Data System (CDS) data are analyzed to determine the role of driver distraction in traffic crashes and the specific sources of this distraction. Results show that 8.3 percent of the drivers were distracted at the time of their crash; after adjustment for the large percentage of drivers with unknown distraction status, the percentage rose to 12.9 percent. The most frequently cited sources of driver distraction were persons, objects or events outside the vehicle (29.4% of distracted drivers), adjusting the radio, tape or CD player (11.4%), and other occupants in the vehicle (10.9%). Other specific distractions (moving objects in vehicle, other objects brought into vehicle, adjusting vehicle or climate controls, eating and drinking, cell phones, and smoking) were each cited in only one to four percent of the cases. The likelihood of being distracted and the source of distraction varied by driver age but not by gender. Results are discussed in light of the limitations inherent in the CDS and other crash data, and the need for expanded data collection initiatives.

Background music as a risk factor for distraction among young-novice drivers.

PubMed

Brodsky, Warren; Slor, Zack

2013-10-01

There are countless beliefs about the power of music during driving. The last thing one would think about is: how safe is it to listen or sing to music? Unfortunately, collisions linked to music devices have been known for some time; adjusting the radio controls, swapping tape-cassettes and compact-discs, or searching through MP3 files, are all forms of distraction that can result in a near-crash or crash. While the decrement of vehicular performance can also occur from capacity interference to central attention, whether or not music listening is a contributing factor to distraction is relatively unknown. The current study explored the effects of driver-preferred music on driver behavior. 85 young-novice drivers completed six trips in an instrumented Learners Vehicle. The study found that all participants committed at-least 3 driver deficiencies; 27 needed a verbal warning/command and 17 required a steering or braking intervention to prevent an accident. While there were elevated positive moods and enjoyment for trips with driver-preferred music, this background also produced the most frequent severe driver miscalculations and inaccuracies, violations, and aggressive driving. However, trips with music structurally designed to generate moderate levels of perceptual complexity, improved driver behavior and increased driver safety. The study is the first within-subjects on-road high-dose double-exposure clinical-trial investigation of musical stimuli on driver behavior. Copyright © 2013 Elsevier Ltd. All rights reserved.

Undergraduate nurses' preferred use of mobile devices in healthcare settings.

PubMed

Mather, Carey; Cummings, Elizabeth; Allen, Penny

2015-01-01

The growth of digital technology has created challenges for appropriate and safe use of mobile or portable devices in healthcare environments. There is perceived risk that the use of mobile technology for learning may distract from provision of patient care if used by undergraduate students during work-integrated learning. This paper reports on a study that aimed to identify differences in preferred behavior of student nurses in their use of mobile technology during and away from the clinical practice environment. A previously validated online survey was administered to students during a period of work integrated learning in a range of healthcare settings in two Australian states. Respondents agreed that mobile devices could be beneficial to patient care. Overall, students proposed they would use mobile devices for accessing information, during work integrated learning, less than when away from the workplace. The development of policy to guide the use of mobile devices, in situ, is important to the provision of safe and competent care and improved health outcomes for patients.

Normalizing memory recall in fibromyalgia with rehearsal: a distraction-counteracting effect.

PubMed

Leavitt, Frank; Katz, Robert S

2009-06-15

To examine the impact of distraction on the retention of rehearsed information in patients with fibromyalgia syndrome (FMS). Data refer to the neurocognitive examination of 134 patients (91 with FMS and 43 control subjects) presenting with memory loss. Four neurocognitive measures free of distraction, along with 2 measures with added distraction, were completed. Differences in the retention of rehearsed and unrehearsed information with a source of distraction present were calculated. Patients with FMS showed normal cognitive functioning on verbal memory tests free of distraction. Adding a source of distraction caused unrefreshed information to be lost at a disproportionate rate in patients with FMS. Over 87% of patients with FMS scored in the impaired range on a task of unrehearsed verbal memory. Adding a source of distraction to well-rehearsed information produced a normal rate of recall in FMS. Rehearsal mechanisms are intact in patients with FMS and play beneficial roles in managing interference from a source of distraction. In the absence of rehearsal, a source of distraction added to unrefreshed information signals a remarkable level of cognitive deficit in FMS that goes undetected by conventionally relied-upon neurocognitive measures. We present a theory to promote understanding of the cognitive deficit of people with FMS based on reduced speed of lexical activation and poor recall after distraction.

Systematic Review and Meta-Analysis of Distraction and Hypnosis for Needle-Related Pain and Distress in Children and Adolescents

PubMed Central

Noel, Melanie; Parker, Jennifer A.; Chambers, Christine T.; Uman, Lindsay S.; Kisely, Steve R.; McGrath, Patrick J.

2014-01-01

Objective To systematically review the evidence (and quality) for distraction and hypnosis for needle-related pain and distress in children and adolescents. To explore the effects of distraction characteristics (e.g., adult involvement, type of distracter), child age, and study risk of bias on treatment efficacy. Methods 26 distraction and 7 hypnosis trials were included and self-report, observer-report, and behavioral pain intensity and distress examined. Distraction studies were coded for 4 intervention characteristics, and all studies coded for child age and study risk of bias. Results Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however. Characteristics of distraction interventions, child age, and study risk of bias showed some influence on treatment efficacy. Conclusions Distraction and hypnosis are efficacious in reducing needle-related pain and distress in children. The quality of trials in this area needs to be improved. PMID:24891439

Sharing the responsibility for driver distraction across road transport systems: a systems approach to the management of distracted driving.

PubMed

Young, Kristie L; Salmon, Paul M

2015-01-01

Distracted driving is acknowledged universally as a large and growing road safety problem. Compounding the problem is that distracted driving is a complex, multifaceted issue influenced by a multitude of factors, organisations and individuals. As such, management of the problem is not straightforward. Numerous countermeasures have been developed and implemented across the globe. The vast majority of these measures have derived from the traditional reductionist, driver-centric approach to distraction and have failed to fully reflect the complex mix of actors and components that give rise to drivers becoming distracted. An alternative approach that is gaining momentum in road safety is the systems approach, which considers all components of the system and their interactions as an integrated whole. In this paper, we review the current knowledge base on driver distraction and argue that the systems approach is not currently being realised in practice. Adopting a more holistic, systems approach to distracted driving will not only improve existing knowledge and interventions from the traditional approach, but will enhance our understanding and management of distraction by considering the complex relationships and interactions of the multiple actors and the myriad sources, enablers and interventions that make up the distracted driving system. It is only by recognising and understanding how all of the system components work together to enable distraction to occur, that we can start to work on solutions to help mitigate the occurrence and consequences of distracted driving. Copyright © 2014 Elsevier Ltd. All rights reserved.

Audible radiation monitor

DOEpatents

Odell, Daniel M. C.

1993-01-01

A method and apparatus for monitoring ionizing radiation comprising radiation detectors in electrical connection with an isotopic analyzer and a device for producing chords to which each isotope is mapped so that the device produces a unique chord for each isotope. Preferably the chords are pleasing to the ear, except for chords representing unexpected isotopes, and are louder or softer depending on the level of radioactivity produced by each isotope, and musical instrument voices may be simulated in producing the chords as an aid to distinguishing similar-sounding chords. Because of the representation by chords, information regarding the level and composition of the radiation in an area can be conveyed to workers in that area more effectively and yet without distracting them.

Reconstruction of Canine Mandibular Bone Defects Using a Bone Transport Reconstruction Plate

PubMed Central

Elsalanty, Mohammed E.; Zakhary, Ibrahim; Akeel, Sara; Benson, Byron; Mulone, Timothy; Triplett, Gilbert R.; Opperman, Lynne A.

2010-01-01

Objectives Reconstruction of mandibular segmental bone defects is a challenging task. This study tests a new device used for reconstructing mandibular defects based on the principle of bone transport distraction osteogenesis. Methods Thirteen beagle dogs were divided into control and experimental groups. In all animals, a 3 cm defect was created on one side of the mandible. In eight control animals, the defect was stabilized with a reconstruction plate without further reconstruction and the animals were sacrificed two to three months after surgery. The remaining five animals were reconstructed with a bone transport reconstruction plate (BTRP), comprising a reconstruction plate with attached intraoral transport unit, and were sacrificed after one month of consolidation. Results Clinical evaluation, cone-beam CT densitometry, three-dimensional histomorphometry, and docking site histology revealed significant new bone formation within the defect in the distracted group. Conclusion The physical dimensions and architectural parameters of the new bone were comparable to the contralateral normal bone. Bone union at the docking site remains a problem. PMID:19770704

Repair of segmental bone defects in the maxilla by transport disc distraction osteogenesis: Clinical experience with a new device

PubMed Central

Boonzaier, James; Vicatos, George; Hendricks, Rushdi

2015-01-01

The bones of the maxillary complex are vital for normal oro-nasal function and facial cosmetics. Maxillary tumor excision results in large defects that commonly include segments of the alveolar and palatine processes, compromising eating, speech and facial appearance. Unlike the conventional approach to maxillary defect repair by vascularized bone grafting, transport disc distraction osteogenesis (TDDO) stimulates new bone by separating the healing callus, and stimulates growth of surrounding soft tissues as well. Bone formed in this way closely mimics the parent bone in form and internal structure, producing a superior anatomical, functional and cosmetic result. Historically, TDDO has been successfully used to close small horizontal cleft defects in the maxilla, not exceeding 25 mm. Fujioka et al. reported in 2012 that “no bone transporter corresponding to the (large) size of the oro-antral fistula is marketed. The authors report the successful treatment of 4 cases involving alveolar defects of between 25 mm and 80 mm in length. PMID:26389041

The role of alcohol use on recent trends in distracted driving.

PubMed

Wilson, Fernando A; Stimpson, Jim P; Tibbits, Melissa K

2013-11-01

Distracted driving is now an increasingly deadly threat to road safety. We provide evidence that intoxicated driving is increasingly responsible for recent increases in fatalities from distracted driving crashes. This study describes trends in deaths on U.S. public roads caused by alcohol-involved and distracted drivers using the Fatality Analysis Reporting System (FARS)-a census of fatal crashes on U.S. public roads. Fatality rates per vehicle-miles traveled are calculated using data from the Federal Highway Administration. Alcohol-involved drivers who are simultaneously distracted were responsible for 1750 deaths in 2009, an increase of more than 63% from 2005 when there were 1072 deaths. Alcohol use while driving is increasingly responsible for a growing number of fatalities from distracted driving, accounting for 32% of deaths from distracted driving in 2009 versus 24% in 2005. The fatality rate from these crashes increased from 35.9 to 59.2 deaths per 100 billion vehicle-miles traveled after 2005. Alcohol use is quickly increasing as an important factor behind distracted driving fatalities. This has implications for policies combating distracted driving that do not address the role of alcohol use in distracted driving. Copyright © 2013 Elsevier Ltd. All rights reserved.

Arthroscopic Talar Dome Access Using a Standard Versus Wire-Based Traction Method for Ankle Joint Distraction.

PubMed

Barg, Alexej; Saltzman, Charles L; Beals, Timothy C; Bachus, Kent N; Blankenhorn, Brad D; Nickisch, Florian

2016-07-01

To evaluate the accessibility of the talar dome through anterior and posterior portals for ankle arthroscopy with the standard noninvasive distraction versus wire-based longitudinal distraction using a tensioned wire placed transversely through the calcaneal tuberosity. Seven matched pairs of thigh-to-foot specimens underwent ankle arthroscopy with 1 of 2 methods of distraction: a standard noninvasive strapping technique or a calcaneal tuberosity wire-based technique. The order of the arthroscopic approach and use of a distraction method was randomly determined. The areas accessed from both 2-portal anterior and 2-portal posterior approaches were determined by using a molded translucent grid. The mean talar surface accessible by anterior ankle arthroscopy was comparable with noninvasive versus calcaneal wire distraction with 57.8% ± 17.2% (range, 32.9% to 75.7%) versus 61.5% ± 15.2% (range, 38.5% to 79.1%) of the talar dome, respectively (P = .590). The use of calcaneal wire distraction significantly improved posterior talar dome accessibility compared with noninvasive distraction, with 56.4% ± 20.0% (range, 14.4% to 78.0%) versus 39.8% ± 14.9% (range, 20.0% to 57.6%) of the talar dome, respectively (P = .031). Under the conditions studied, our cadaveric model showed equivalent talar dome access with 2-portal anterior arthroscopy of calcaneal wire-based distraction versus noninvasive strap distraction, but improved access for 2-portal posterior arthroscopy with calcaneal wire-based distraction versus noninvasive strap distraction. The posterior 40% of the talar dome is difficult to access via anterior ankle arthroscopy. Posterior calcaneal tuberosity wire-based longitudinal distraction improved arthroscopic access to the centro-posterior talar dome with a posterior arthroscopic approach. Published by Elsevier Inc.

Potential distractions and unsafe driving behaviors among drivers of 1- to 12-year-old children.

PubMed

Macy, Michelle L; Carter, Patrick M; Bingham, C Raymond; Cunningham, Rebecca M; Freed, Gary L

2014-01-01

Driver distraction has been identified as a threat to individual drivers and public health. Motor vehicle collisions remain a leading cause of death for children, yet little is known about distractions among drivers of children. This study sought to characterize potential distractions among drivers of children. A 2-site, cross-sectional, computerized survey of child passenger safety practices was conducted among adult drivers of 1- to 12-year-old children who presented for emergency care between October 2011 to May 2012. Drivers indicated the frequency with which they engaged in 10 potential distractions in the past month while driving with their child. Distractions were grouped in 4 categories: (1) nondriving, (2) cellular phone, (3) child, and (4) directions. Information about other unsafe driving behaviors and sociodemographic characteristics was collected. Nearly 90% of eligible parents participated. Analysis included 570 drivers (92.2%). Non-driving-related and cellular phone-related distractions were disclosed by >75% of participants. Fewer participants disclosed child (71.2%) and directions-related distractions (51.9%). Child age was associated with each distraction category. Cellular phone-related distractions were associated with the child riding daily in the family car, non-Hispanic white, and higher education. Parents admitting to drowsy driving and being pulled over for speeding had over 2 times higher odds of disclosing distractions from each category. Distracted driving activities are common among drivers of child passengers and are associated with other unsafe driving behaviors. Child passenger safety may be improved by preventing crash events through the reduction or elimination of distractions among drivers of child passengers. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Potential Distractions and Unsafe Driving Behaviors Among Drivers of 1- to 12-year-old Children

PubMed Central

Macy, Michelle L.; Carter, Patrick M.; Bingham, C. Raymond; Cunningham, Rebecca M.; Freed, Gary L.

2014-01-01

Objective Driver distraction has been identified as a threat to individual drivers and public health. Motor vehicle collisions remain a leading cause of death for children yet little is known about distractions among drivers of children. This study sought to characterize potential distractions among drivers of children. Methods A two-site, cross-sectional, computerized survey of child passenger safety practices was conducted among adult drivers of 1- to 12-year-old children who presented for emergency care between October 2011-May 2012. Drivers indicated the frequency with which they engaged in ten potential distractions in the past month while driving with their child. Distractions were grouped in four categories: 1) non-driving, 2) cellular phone, 3) child, 4) directions. Information about other unsafe driving behaviors and sociodemographic characteristics was collected. Results Nearly 90% of eligible parents participated. Analysis included 570 (92.2%) drivers. Non-driving and cellular phone-related distractions were disclosed by >75% of participants. Fewer participants disclosed child (71.2%) and directions-related distractions (51.9%). Child age was associated with each distraction category. Cellular phone-related distractions were associated with the child riding daily in the family car, non-Hispanic white and other race/ethnicity, and higher education. Parents admitting to drowsy driving and being pulled over for speeding had over two-times higher odds of disclosing distractions from each category. Conclusions Distracted driving activities are common among drivers of child passengers and associated with other unsafe driving behaviors. Child passenger safety may be improved by preventing crash events through the reduction or elimination of distractions among drivers of child passengers. PMID:24767781

21 CFR 890.3410 - External limb orthotic component.

Code of Federal Regulations, 2013 CFR

2013-04-01

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21 CFR 890.3420 - External limb prosthetic component.

Code of Federal Regulations, 2013 CFR

2013-04-01

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21 CFR 890.3410 - External limb orthotic component.

Code of Federal Regulations, 2010 CFR

2010-04-01

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21 CFR 890.3410 - External limb orthotic component.

Code of Federal Regulations, 2011 CFR

2011-04-01

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21 CFR 890.3410 - External limb orthotic component.

Code of Federal Regulations, 2012 CFR

2012-04-01

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21 CFR 890.3410 - External limb orthotic component.

Code of Federal Regulations, 2014 CFR

2014-04-01

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21 CFR 890.3420 - External limb prosthetic component.

Code of Federal Regulations, 2012 CFR

2012-04-01

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21 CFR 890.3420 - External limb prosthetic component.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External limb prosthetic component. 890.3420 Section 890.3420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3420...

21 CFR 890.3420 - External limb prosthetic component.

Code of Federal Regulations, 2014 CFR

2014-04-01

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21 CFR 890.3420 - External limb prosthetic component.

Code of Federal Regulations, 2011 CFR

2011-04-01

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21 CFR 878.3800 - External aesthetic restoration prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

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21 CFR 878.3800 - External aesthetic restoration prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

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