Ontology-driven monitoring of patient's vital signs enabling personalized medical detection and alert

A major challenge related to caring for patients with chronic conditions is the early detection of exacerbations of the disease. Medical personnel should be contacted immediately in order to intervene in time before an acute state is reached, ensuring patient safety. This paper proposes an approach to an ambient intelligence (AmI) framework supporting real-time remote monitoring of patients diagnosed with congestive heart failure (CHF). Its novelty is the integration of: (i) personalized monitoring of the patients health status and risk stage; (ii) intelligent alerting of the dedicated physician through the construction of medical workflows on-the-fly; and (iii) dynamic adaptation of the vital signs' monitoring environment on any available device or smart phone located in close proximity to the physician depending on new medical measurements, additional disease specifications or the failure of the infrastructure. The intelligence lies in the adoption of semantics providing for a personalized and automated emergency alerting that smoothly interacts with the physician, regardless of his location, ensuring timely intervention during an emergency. It is evaluated on a medical emergency scenario, where in the case of exceeded patient thresholds, medical personnel are localized and contacted, presenting ad hoc information on the patient's condition on the most suited device within the physician's reach

Mechanical disruption of the blood-brain barrier following experimental concussion

Although concussion is now recognized as a major health issue, its non-lethal nature has limited characterization of the underlying pathophysiology. In particular, potential neuropathological changes have typically been inferred from non-invasive techniques or post-mortem examinations of severe traumatic brain injury (TBI). Here, we used a swine model of head rotational acceleration based on human concussion to examine blood–brain barrier (BBB) integrity after injury in association with diffuse axonal injury and glial responses. We then determined the potential clinical relevance of the swine concussion findings through comparisons with pathological changes in human severe TBI, where post-mortem examinations are possible. At 6–72 h post-injury in swine, we observed multifocal disruption of the BBB, demonstrated by extravasation of serum proteins, fibrinogen and immunoglobulin-G, in the absence of hemorrhage or other focal pathology. BBB disruption was observed in a stereotyped distribution consistent with biomechanical insult. Specifically, extravasated serum proteins were frequently observed at interfaces between regions of tissue with differing material properties, including the gray–white boundary, periventricular and subpial regions. In addition, there was substantial overlap of BBB disruption with regions of axonal pathology in the white matter. Acute perivascular cellular uptake of blood-borne proteins was observed to be prominent in astrocytes (GFAP-positive) and neurons (MAP-2-positive), but not microglia (IBA1-positive). Parallel examination of human severe TBI revealed similar patterns of serum extravasation and glial uptake of serum proteins, but to a much greater extent than in the swine model, attributed to the higher injury severity. These data suggest that BBB disruption represents a new and important pathological feature of concussion

Towards ubiquitous requirements engineering through recommendations based on context histories

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Aerospace Medicine and Biology: A continuing bibliography with indexes, supplement 145

This bibliography lists 301 reports, articles, and other documents introduced into the NASA scientific and technical information system in August 1975

Residual Deficits Observed In Athletes Following Concussion: Combined Eeg And Cognitive Study

The neurocognitive sequelae of a sport-related concussion and its management are poorly defined. Emerging evidence suggests that the residual deficits can persist one year or more following a brain injury. Detecting and quantifying the residual deficits are vital in making a decision about the treatment plan and may prevent further damage. For example, improper return to play (RTP) decisions in sports such as football have proven to be associated with the further chance of recurring injury, long-term neurophysiological impairments, and worsening of brain functional activity. The reliability of traditional cognitive assessment tools is debatable, and thus attention has turned to assessments based on electroencephalogram (EEG) to evaluate subtle post-concussive alterations. In this study, we calculated neurocognitive deficits in two different datasets. One dataset contains a combination of EEG analysis with three standard post-concussive assessment tools. The data for this dataset were collected for all testing modalities from 21 adolescent athletes (seven concussive and fourteen healthy) in three different trials. Another dataset contains post-concussion eyes closed EEG signal for twenty concussed and twenty age-matched controls. For EEG assessment, along with linear frequency-based features, we introduced a set of time-frequency and nonlinear features for the first time to explore post-concussive deficits. In conjunction with traditional frequency band analysis, we also presented a new individual frequency based approach for EEG assessment. A set of linear, time-frequency and nonlinear EEG markers were found to be significantly different in the concussed group compared to their matched peers in the healthy group. Although EEG analysis exhibited discrepancies, none of the cognitive assessment resulted in significant deficits. Therefore, the evidence from the study highlight that our proposed EEG analysis and markers are more efficient at deciphering post-concussion residual neurocognitive deficits and thus has a potential clinical utility of proper concussion assessment and management. Moreover, a number of studies have clearly demonstrated the feasibility of supervised and unsupervised pattern recognition algorithms to classify patients with various health-related issues. Inspired by these studies, we hypothesized that a set of robust features would accurately differentiate concussed athletes from control athletes. To verify it, features such as power spectral, statistical, wavelet, and other nonlinear features were extracted from the EEG signal and were used as an input to various classification algorithms to classify the concussed individuals. Various techniques were applied to classify control and concussed athletes and the performance of the classifiers was compared to ensure the best accuracy. Finally, an automated approach based on meaningful feature detection and efficient classification algorithm were presented to systematically identify concussed athletes from healthy controls with a reasonable accuracy. Thus, the study provides sufficient evidence that the proposed analysis is useful in evaluating the post-concussion deficits and may be incorporated into clinical assessments for a standard evaluation of athletes after a concussion

A Comparative Study of Intrathecal Ropivacaine with Fentanyl Versus Bupivacaine with Fentanyl for Labour Analgesia

INTRODUCTION: Labor is an extremely painful process. Traditionally a number of techniques have been employed to provide labor analgesia. Epidural analgesia is considered to be the gold standard in labor analgesia. Continuous epidural analgesia is ideal to provide analgesia because of the long duration of labor. Traditionally only high doses of local anesthetics were used. Though they provide excellent pain relief, they produce an unacceptably high level of motor blockade which impairs the parturient’s ability to bear down during labor, resulting in prolonged labor. Lower doses of Bupivacaine (0.04% -0.125%) by themselves are inadequate. The discovery of opioid receptors in spinal analgesia provides an interesting option. Opioid agonists selectively block pain impulses but leave the motor system intact. Doses used for central neuraxial blockade are also very little compared to other parenteral routes and does not result in significant fetal depression. Since opioids and local anesthetics acts at different sites their combination provides a synergistic effect permitting us to use lesser concentrations of both. When used in such low doses their individual side effects are minimized while maximizing the desired effects. Current obstetric practice aims to provide effective pain relief while Efforts to improve epidural analgesia led to Collins and colleagues1 popularizing the combined spinal-epidural technique (CSE) for analgesia in labor. This technique involved an initial Intrathecal injection of opioids (Fentanyl) and Bupivacaine to establish analgesia, and subsequent epidural injections to maintain the analgesia. The doses of drugs involved were such that ambulation in labor was possible. However after the initial Intrathecal injection, motor blockade was present for up to 20 min. Recent research has shown that, in the absence of motor weakness there is no functional impairment of balance in laboring women and therefore ambulation is safe. Ropivacaine is a newer local anaesthetic, which has been shown to cause less motor weakness and less cardio toxicity and is rapidly evolving as local anaesthetic of choice in Labor analgesia as well as in post operative analgesia. The aim of this study was to compare Intrathecal injection of Fentanyl 0.025 mg and Bupivacaine 2.5 mg, with an Intrathecal injection of Fentanyl 0.025 mg and Ropivacaine 2.5 mg as a part of CSE in labor analgesia. Efficacy, sensory and motor blockade and fetal effects were studied in detail. The CSE technique was selected so that the analgesia will be maintained by Epidural route in both the groups even though the study stops short with the comparison of Intrathecal injection of Bupivacaine and Fentanyl with Ropivacaine and Fentanyl. AIM: To compare Intrathecal Bupivacaine and Ropivacaine with Fentanyl in labor analgesia with regard to: 1. Efficacy of pain relief, 2. Effect on fetal and maternal outcomes, 3. Patient comfort and the ease of ambulation during labor, 4. Safety. MATERIALS AND METHODS: This is a prospective, randomized, double blinded, control study. Prior approval was obtained from the ethical committee of Government Stanley Medical College and Hospital and RSRM Lying in Hospital for the study. Fifty parturients who were admitted to the antenatal ward and who requested pain relief during labor were selected for the study. The procedure and complications of regional analgesia was explained to them in detail and written consent was obtained from them. Inclusion criteria: 1 Patients in established labor (cervical dilatation 3-5cms). 2 Patients belonging to ASA I. 3 Only primigravida patients with singleton pregnancy, in full term labor were included in the study. Exclusion criteria: 1. PIH, DM, bleeding disorder or other systemic disorders. 2. Patients who have already received any Opioid drugs or systemic analgesics within prior 24 hours. 3. Any contraindication for central neuraxial techniques. 4. Patients with known allergy to local anaesthetic or other drugs. 5. Patient refusal for regional technique. The patients were randomly divided into two groups of twenty-five each. Group I (Bupivacaine): Received 2.5mg Bupivacaine with 0.025mg Fentanyl (total volume 1 ml) Intrathecally, followed by epidural drugs (0.1% Bupivacaine with 2g/ml Fentanyl) as 5 ml top-ups. At the start of second stage of labor a top-up of 10 ml bolus was used. The top-ups were given only when the patient requested additional pain relief. Group II (Ropivacaine): Received 2.5mg Ropivacaine with 0.025mg Fentanyl (total volume 1 ml) Intrathecally, followed by epidural drugs (0.1% Bupivacaine with 2g/ml Fentanyl) as 5 ml top-ups. At the start of second stage of labor a top-up of 10 ml bolus was used. The top-ups were given only when the patient requested additional pain relief. SUMMARY: In our study both the drugs (Intrathecal Ropivacaine and Bupivacaine with Fentanyl) provided good pain relief while the incidence of motor blockade was significantly less in Ropivacaine group when compared with Bupivacaine group. The two drugs did not influence the outcome of labor such as the duration of labor or the type of delivery. There was no adverse fetal outcome in both the groups. Sensory blockade levels were similar in both the groups. Both the drugs had lesser impact on the haemodynamics. Complications were only few, were minor and easily manageable. CONCLUSION: In our study we conclude that Intrathecal Ropivacaine 2.5mg in combination with Fentanyl 25 micrograms as a part of CSE technique provides rapid and safe analgesia for labor as effective as that achieved by Bupivacaine 2.5mg with significantly less motor blockade. So it is an ideal drug to use for labour analgesia

Zoological species medicine

Externship report done in order to describe and inform about the activities followed during six months externship at three zoological institutions in the United States of America. These externships were performed in order to conclude the sixth and last year of the integrated master in veterinary medicine of the University of Evora, with the main goal of obtaining more knowledge and experience in this area of the veterinary field. From the more varied number of species, to the more complex procedure, by exemplification with a case of preventative medicine in a western lowland gorilla (Gorilla gorilla gorilla), this report provides information about some of the most important and/or interesting aspects of zoological medicine; Resumo: Medicina das Especies Zoologicas Relatório de estágio produzido com o intuito de descrever e dar a conhecer as actividades seguidas e realizadas durante seis meses de estágio em três entidades zoológicas nos Estados Unidos da América. Estes estágios foram realizados de forma a concluir o sexto e último ano do ciclo de estudos do mestrado integrado em medicina veterinária da Universidade de Évora, com o objectivo principal de obter maior conhecimento e experiência nesta área do ramo veterinário. Desde o mais variado número de espécies, até ao procedimento mais complexo, atraves da exemplificacao com um caso de medicina preventiva num gorila-do-ocidente (Gorilla gorilla gorilla), este relatório fornece informação sobre alguns dos aspectos mais importantes e/ou interessantes da medicina zoológica

Accidental awareness during general anaesthesia in obstetric surgery

Accidental awareness during general anaesthesia (AAGA) occurs when a patient becomes unintentionally conscious during general anaesthesia, which may involve unpleasant memories of experiences during surgery. Contributory factors that may increase risk of AAGA coincide in pregnant women undergoing general anaesthesia for childbirth related surgery. Whilst obstetric general anaesthesia has largely been substituted by spinal and epidural (termed neuraxial) anaesthetic techniques, in which a mother can be awake and pain free during childbirth, general anaesthesia is still necessary to facilitate surgery rapidly in emergency situations or for mothers with certain medical conditions. In this thesis I investigate the distinct characteristics of general anaesthesia for pregnant women undergoing surgery for childbirth, whether these characteristics increase risk of AAGA, and changes to obstetric anaesthetic technique occurring in the context of wider anaesthetic developments over time. I provide evidence on the incidence, experiences, risk factors and psychological consequences of AAGA in peripartum women. Challenges to large scale clinical study of AAGA are explored and addressed in the design of a multi-centre, prospective, cross-sectional cohort study of women receiving general anaesthesia for obstetric surgery in 72 hospitals in England. A four-stage process for screening patients using direct questioning, verifying with corroborative detail, adjudicating and classifying descriptions of experiences is described. The interactional nature of research interviews, statistical modelling, psychological factors and the neurophysiology of memory are considered during development of study methodology. Psychological morbidity was assessed for 12 months after surgery. As part of an embedded study, descriptive epidemiology of obstetric patients and general anaesthesia techniques were identified, alongside risk factors for airway complications. A total of 3,115 patients were recruited, 12 of whom had certain/probable or possible AAGA: a prevalence of 0.39% or 1 in 256 (95%CI 149–500) for all obstetric surgery. Distressing experiences were reported by seven (0.22%) patients, paralysis by five (0.16%) and paralysis with pain by two (0.06%). Associations were identified between AAGA and patient risk factors (abnormal body mass index), organisational factors (out-of-hours surgery) and pharmacological factors (use of thiopental during induction of anaesthesia). Contextual factors relating anaesthesia for obstetric patients with AAGA and other anaesthesia complications, including difficult airway management, were evaluated. My study methodology and it’s context, in English public sector hospitals, identified a higher risk of AAGA in obstetric patients than previously detected using other methods and locations. These results have implications for healthcare policy of obstetric anaesthesia, informed consent of patients receiving general anaesthesia and post-natal screening care. I conclude on recommendations to minimise awareness risk for future patients and address the challenge of implementing systemic improvements in obstetric general anaesthesia care and patient safety

Cholinergic Neurotransmission In Partial Limbic Seizures

Partial limbic seizures impair consciousness, but the mechanism of impairment is not known. Most views hold that structures necessary for consciousness are disrupted by overexcitation from spread of seizure activity. Against this view, we hypothesize that partial limbic seizures cause pathological long-range inhibition of cortical activity. Using a rat model for partial limbic seizures, we demonstrate BOLD fMRI signal increases in the hippocampal seizure focus, but decreases in arousal promoting regions such as the thalamus and midbrain tegmentum. Second, direct single unit recordings from cholinergic neurons in two arousal nuclei, the basal forebrain and the pedunculopontine tegmental nuclei, demonstrate suppressed firing during seizures. Finally, using enzyme-based amperometry, we probe levels of the arousal neurotransmitter acetylcholine in the cortex and thalamus and observe decreased cholinergic neurotransmission during seizures. These findings demonstrate that an arousal center is suppressed during partial limbic seizures and suggest that decreased arousal may lead to impaired consciousness