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Detecting heart and respiratory rates is an essential means of providing emergency medical care. Current methods of detecting such signals include the widely used electrocardiography (ECG) method. Other more manual methods of heart and respiratory rate estimation require a practitioner to constantly observe the patient. These methods are time consuming and detract valuable time from emergency medical care. This thesis presents a novel, hands off, heart and respiratory monitor (HARMONI). It uses pressure transducers and medical tubing placed on a person's chest. The tubing is plugged off at one end, and then attached to a pressure transducer at the other end. The transducer sees spikes in voltage whenever the pressure inside the tubing changes. Heart and respiratory rates both cause expansion in the chest, increasing the pressure in the tubing, and causing the transducer to see a change in voltage. The method was first validated, and then tested in a simulated environment. Finally, the device was transformed in to a full system prototype. Human tests were conducted to correlate the signal with that of an industry standard ECG device. This thesis explains how heart and respiratory rates can be derived using signal processing techniques and a simple non-invasive sensor. This device is a rapidly deployable tool that has the potential to save lives specifically in mass casualty situations. It would be a force multiplier, allowing a single responder to monitor multiple casualties, saving time and lives. / Master of Science

Yes / Lung cancer remains a major cause of preventable death and early diagnosis is critical to improving survival chances. The chest X-ray (CXR) remains the most common initial investigation, but clinical pathways need to support timely diagnosis through, where necessary, escalation of abnormal findings to ensure priority reporting and early CT scan. This single-centre study included a retrospective evaluation of a rapid lung cancer CXR pathway in its first year of operation (May 2018-April 2019). The pathway was initially designed for primary care referrals but could also be used for any CXR demonstrating abnormal findings. A parallel cross-sectional survey of radiographers explored their understanding, adherence and concerns regarding their role in the pathway operation. Primary care referrals on the rapid diagnostic pathway were low (n = 51/21,980; 0.2%), with 11 (21.6%) requiring a CT scan. A further 333 primary care CXR were escalated by the examining radiographer, with 100 (30.0%) undergoing a CT scan. Overall, 64 of the CT scans (57.7%) were abnormal or demonstrated suspicious findings warranting further investigation. There were 39 confirmed primary lung carcinomas, most with advanced disease. Survey responses showed that most radiographers were familiar with the pathway but some expressed concerns regarding their responsibilities and limited knowledge of CXR pathologies. This baseline evaluation of the rapid lung cancer pathway demonstrated poor referral rates from primary care and identified the need for improved engagement. Radiographer escalation of abnormal findings is an effective adjunct but underlines the need for appropriate awareness, training, and ongoing support. Engagement of the multiprofessional team is critical in new pathway implementation. Rapid diagnostic pathways can enable early diagnosis and the radiographer has a key role to play in their success.

No / Chest radiography is one of the most commonly performed radiographic examinations worldwide. Routinely acquired in the erect posteroanterior (PA) position, a chest radiograph displays substantial amounts of medical information when accurate patient positioning is achieved. However, a rotated PA chest radiograph has reduced diagnostic quality and appearances may mask or mimic chest pathology. Radiographic assessment of patient rotation around the sagittal plane has traditionally been undertaken by assessing the distance between the medial end of the clavicles and a line drawn through the spinous processes at the level of the clavicles. This approach continues to be advocated in radiographic technique textbooks internationally although no identified author has provided criteria to determine when a rotated PA chest radiograph should be repeated; determined the relationship between perceived clavicle to spinous process distance and actual degree of patient rotation; or considered the impact of body morphology, in particular the anteroposterior thoracic diameter, on radiographic appearances of rotation. Objectives To determine the impact of anteroposterior chest diameter on radiographic appearances of sagittal rotation on PA chest radiographs. Design Experimental study. Methods and Settings Sixty computed tomography thorax examinations, stratified for gender, were reviewed and data aggregated to determine average anteroposterior (AP) thoracic dimensions. A bespoke experimental unit was constructed specifically to enable testing of the impact of sagittal rotation on radiographic appearances. The experimental unit was situated within a calibrated circular frame enabling 360° rotation at 1° intervals around a central rotational point. The experimental unit components were varied in 1 cm intervals from 9 cm to 15 cm around the central rotation point to reflect varying AP chest diameters. At each interval, images were acquired at 0, 2, 5, 7, 10, and 15° sagittal rotation using a horizontal central ray, consistent centring point, and a source-image distance of 180 cm. Results A clear linear relationship between AP thoracic diameter and the radiographic appearances of sagittal rotation was noted. Considering significant rotation to be when the medial end of clavicle overlaps the spinous process on the radiographic image, this appearance occurred at a much smaller degree of rotation on wide AP thoracic diameters (15 cm, 5°) than narrower AP thoracic diameters (9 cm, 10°). Conclusions The routine application of the distance between the medial end of the clavicles and a line drawn through the spinous processes at the level of the clavicles as a method of assessing degree of sagittal rotation, diagnostic image quality, and need for repeat is flawed. Persistence in the application of this approach without cognisance of the impact of body morphology on radiographic appearances will result in persons with large AP thoracic diameters being more likely to have a PA chest radiograph repeated for a specified degree of rotation than persons with smaller AP thoracic diameters.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xi, 61 leaves, Annexures A-E, 1-5 / Research is more than merely an academic exercise. It is a key ingredient in establishing chiropractic’s role in an evolving health care system (Dallas, 1997). Very little is known about the changes in the chiropractic patient population over time (Hartvigsen et al. 2003). Despite the widespread use of chiropractic, good descriptive data on chiropractors and their patients are limited (Coulter and Shekelle, 2005). Few studies have been reported which deal specifically with patients attending chiropractic teaching clinics (Nyiendo and Olsen, 1988). A teaching clinic is an outpatient clinic that provides health care for patients, as opposed to inpatients treated in a hospital. Teaching clinics are traditionally operated by educational institutes and provide free or low-cost services to patients (http://en.wikipedia.org/wiki/Teaching_clinic). In April 1994 the chiropractic day clinic was officially opened at the former Technikon Natal (now the Durban University of Technology). Thousands of patients have been treated at this clinic over this twelve year period. In 1994, Elga Renate Drews, conducted research aimed at identifying characteristics of chiropractic patients and their complaints at the chiropractic teaching clinic at Technikon Natal and private practices in South Africa. This survey was conducted from February 1994 to the end of April 1994. 162 Patients were involved in this study. A survey was completed which included the patient’s age, gender, occupation, presenting condition, duration of complaint, previous treatment, referral, severity, quality of pain and their disability. A comparison was made between patients seen in private practice and at the teaching clinic. It was found that generally both populations were very similar, with the exception of the patients’ age and occupation. No other research investigating patient characteristics has been undertaken at Durban University of Technology chiropractic day clinic after 1994. Furthermore, in the study conducted by Drews no mention was made of the type of treatment that was given to patients either in private practice or at the teaching clinic. Although the first successful chiropractic adjustment recorded was in the thoracic spine by Dr. D.D. Palmer, research since then has focused on the lumbar spine (Di Fabio, 1992). In reviewing literature relating to the thoracic spine, it is apparent that in comparison to the cervical and lumbar regions, the thoracic spine has been neglected (Edmonston and Singer, 1997). In South Africa there remains a paucity of information on the types of thoracic conditions chiropractors treat and the management protocols. The present research aimed to shed light on this aspect by collecting data from one of only two chiropractic teaching clinics in South Africa, namely the Durban University of Technology chiropractic day clinic. The purpose of this research was to investigate the age, gender, occupation (whether of a sedentary or non-sedentary nature), prevalence of pain, presenting complaints, common conditions treated and common management protocols of patients who presented with thoracic pain to the Durban University of Technology Chiropractic Day Clinic.

Healthcare organizations are responding to changes in reimbursements by redesigning and re-evaluating existing programs to improve patient outcomes. .One such intervention at the project setting was the re-evaluation of the treatment of patients with low risk for chest pain and implementing a cardiology nurse practitioner (NP) service focusing on the reduction of length of stay (LOS) with the goal of improving patient outcomes. The purpose of this doctor of nursing practice project was to evaluate the effectiveness of a nurse practitioner-led service on the reduction of LOS of patients with low risk for chest pain. An established evidenced-based guideline developed by the American Heart Association for the treatment of patients with low risk for chest pain was adopted by the NP service. The project was guided by both the Donabedian model of quality care and the Aday and Anderson theory of access to medical care. The project design proposal is a comparative study using retrospective data obtained from the medical records of LOS pre- and post-implementation of the project. Implications for social change include improvement in patient care on a national level, not only for patients with low risk for chest pain, but also for patients with other chronic diseases. Streamlining care will improve the financial standing of hospitals as well as provide care that is equal and equitable regardless of race or financial status. The findings of this project have strengthened the role of the APN globally as a social advocate for change, actively participating in designing and implementing programs to improve patients' outcomes.

Chest compressions during cardiopulmonary resuscitation (CPR) may be associated with iatrogenic chest wall injuries. The extent to which these CPR-associated chest wall injuries contribute to a delay in the respiratory recovery of cardiac arrest survivors has not been sufficiently explored. In a single-center retrospective cohort study, surviving intensive care unit (ICU) patients, who had undergone CPR due to medical reasons between 1 January 2018 and 30 June 2019, were analyzed regarding CPR-associated chest wall injuries, detected by chest radiography and computed tomography. Among 109 included patients, 38 (34.8%) presented with chest wall injuries, including 10 (9.2%) with flail chest. The multivariable logistic regression analysis identified flail chest to be independently associated with the need for tracheostomy (OR 15.5; 95% CI 2.77–86.27; p = 0.002). The linear regression analysis identified pneumonia (β 11.34; 95% CI 6.70–15.99; p < 0.001) and the presence of rib fractures (β 5.97; 95% CI 1.01–10.93; p = 0.019) to be associated with an increase in the length of ICU stay, whereas flail chest (β 10.45; 95% CI 3.57–17.33; p = 0.003) and pneumonia (β 6.12; 95% CI 0.94–11.31; p = 0.021) were associated with a prolonged duration of mechanical ventilation. Four patients with flail chest underwent surgical rib stabilization and were successfully weaned from the ventilator. The results of this study suggest that CPR-associated chest wall injuries, flail chest in particular, may impair the respiratory recovery of cardiac arrest survivors in the ICU. A multidisciplinary assessment may help to identify patients who could benefit from a surgical treatment approach.

In recent years, image segmentation by using deep neural networks has made great progress. However, reaching a good result by training with a small amount of data remains to be a challenge. To find a good way to improve the accuracy of segmentation with limited datasets, we implemented a new automatic chest radiographs segmentation experiment based on preliminary works by Chunliang using deep learning neural network combined with shape context information. When the process was conducted, the datasets were put into origin U-net at first. After the preliminary process, the segmented images were then repaired through a new network with shape context information. In this experiment, we created a new network structure by rebuilding the U-net into a 2-input structure and refined the processing pipeline step. In this proposed pipeline, the datasets and shape context were trained together through the new network model by iteration. The proposed method was evaluated on 247 posterior-anterior chest radiographs of public datasets and n-folds cross-validation was also used. The outcome shows that compared to origin U-net, the proposed pipeline reaches higher accuracy when trained with limited datasets. Here the "limited" datasets refer to 1-20 images in the medical image field. A better outcome with higher accuracy can be reached if the second structure is further refined and shape context generator's parameter is fine-tuned in the future. / Under de senaste åren har bildsegmentering med hjälp av djupa neurala nätverk gjort stora framsteg. Att nå ett bra resultat med träning med en liten mängd data kvarstår emellertid som en utmaning. För att hitta ett bra sätt att förbättra noggrannheten i segmenteringen med begränsade datamängder så implementerade vi en ny segmentering för automatiska röntgenbilder av bröstkorgsdiagram baserat på tidigare forskning av Chunliang. Detta tillvägagångssätt använder djupt lärande neurala nätverk kombinerat med "shape context" information. I detta experiment skapade vi en ny nätverkstruktur genom omkonfiguration av U-nätverket till en 2-inputstruktur och förfinade pipeline processeringssteget där bilden och "shape contexten" var tränade tillsammans genom den nya nätverksmodellen genom iteration.Den föreslagna metoden utvärderades på dataset med 247 bröströntgenfotografier, och n-faldig korsvalidering användes för utvärdering. Resultatet visar att den föreslagna pipelinen jämfört med ursprungs U-nätverket når högre noggrannhet när de tränas med begränsade datamängder. De "begränsade" dataseten här hänvisar till 1-20 bilder inom det medicinska fältet. Ett bättre resultat med högre noggrannhet kan nås om den andra strukturen förfinas ytterligare och "shape context-generatorns" parameter finjusteras.

The purpose of the work reported within this thesis was to design and implement a series of tests which better replicate the impact conditions experienced during a game, and allow for quantitative measurements of performance of various items of personal protection equipment (PPE). The sports of cricket and taekwondo were used as case studies. The aim was to improve on existing testing protocols making them more representative of real life, an approach that has not been previously attempted in the literature and so required design of multiple items of novel equipment. A representative cricket impact test was developed utilizing a ball canon firing a cricket ball mass at an equivalent bowling velocity of 31 m/s (70 mph) and a novel, freely suspended force acquisition system with embedded accelerometers from which the transmitted force values could be derived. Throughout the testing secondary variables of coefficient of restitution (COR), deformation and contact time were measured from high speed video footage to give further insight into the impact mechanics of the three tested leg guards. Contact times were in the range of 3 ms - 4 ms, COR between 0.38 - 0.50 and deformation between 45 mm - 52 mm. These results were compared against other benchmark tests to establish how close the representative test was to an actual human related ball-pad impact and to estimate human tolerance levels to impact. A rig to mimic a human on human kicking impact in taekwondo was designed to measure performance of the piece of body protection equipment used in training and competition, commonly referred to as a hogu. Primarily a mechanical simulator was designed to replicate the speed and mass of a human leg impacting during a roundhouse kick. A force acquisition system was manufactured, capable of integrating with the kicking robot functioning, with a human torso sized and shaped anvil, using a similar accelerometer based system of force measurement as that introduced in the cricket testing. This test was then used to measure performance levels of nine off-the-shelf hogus and protective training pads. Using transmitted peak force and time to peak force (TTPF) as indicators of protection, these values were found to range from between 0.5 kN 7.5 kN and 9 ms - 23 ms across the pads indicating a major difference in the protection provided.

Background: Pectus excavatum is the most common deformation of the chest, affecting mainly boys. The etiology is unclear. Objective: The aim of this study is to characterize the patients with pectus excavatum and clarify changes of posture after surgical correction by Nuss. Method: 19 patients (17.3 ± 1.9 years) with pectus excavatum chest deformity were tested a day before and 6 months after surgical correction of the chest according to Nuss. Testing included: clinical examination of range of motion in the shoulder and hip joint, range of motion of the spine Thomayer test, Shober and Stibor distances, as well as paraclinic test mCTSIB on Balance Master ® System and the questionnaire method by means of Pectus Excavatum Evaluation Questionnaire. Statistical significance was determined at 0.05. Results and Discussion: The results show that the correction of the chest has a significant influence on the evaluation of and satisfaction with appearance, increases range of motion of shoulder joints and spine, and positively affects postural stability and balance. Conclusion: A simple and non-invasive tests have shown that the effect of correction of the chest is not just a cosmetic nature and can be an incentive to continue to study this issue.