Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution

Introduction: Patients under the error-prone and complication-burdened extracorporeal membrane oxygenation (ECMO) are looked after by a highly trained, multidisciplinary team. Simulation-based training (SBT) affords ECMO centers the opportunity to equip practitioners with the technical dexterity required to manage emergencies. The aim of this article is to review ECMO SBT activities and technology followed by a novel solution to current challenges. ECMO simulation: The commonly-used simulation approach is easy-to-build as it requires a functioning ECMO machine and an altered circuit. Complications are simulated through manual circuit manipulations. However, scenario diversity is limited and often lacks physiological and/or mechanical authenticity. It is also expensive to continuously operate due to the consumption of highly specialized equipment. Technological aid: Commercial extensions can be added to enable remote control and to automate circuit manipulation, but do not improve on the realism or cost-effectiveness. A modular ECMO simulator: To address those drawbacks, we are developing a standalone modular ECMO simulator that employs affordable technology for high-fidelity simulation.Peer reviewe

Development of an automated plasmapheresis system for the treatment of sepsis

This thesis was previously held under moratorium from 10/02/2020 to 10/02/2022Background: Sepsis is one of the leading cause of death in ICU. The causes of sepsis could be viral, bacterial, fungal infection, also, and in some instances trauma. When a local response to the infection becomes a systemic response, the immune system becomes chaotic. Cytokines are produced in an uncontrolled way, resulting in a cytokines storm. The immune system enters a hyperactivation status that leads to multiple organ failures. Despite advances in the medical treatment and clinical experience, there is currently no single medication approved for treating sepsis. Thus, removal of the plasma that contains the inflammatory mediators is a potential solution to reduce their effect in the body. Objectives: The aim of this project is to develop a device that is able to separate plasma from whole blood. The device should be able to generate secondary flow to enhance the performance by reducing the formation of cake layer. In addition, the device should be fully automated in order to simplify the technology for the end user. Approach: Design using computer aided design employing different methods for producing secondary flow, investigate the impact of these techniques on formed blood element, by assessment of shear stress. The design was 3D printed to investigate the performance in term of plasma filtration using different membranes with different effective pore area. The next step was to increase the dimension of the rig and test the increase in surface area on flux rate. In addition, an automation system was designed and assembled in order to control the transmembrane pressure, blood pump and plasma replacement pump through feedback from sensors read by a microcontroller. Results: The device was able to separate the plasma from the blood. The polyethersulfone membrane that has higher effective pore size had higher filtration rate. By increasing the size of the rig, the filtration volume increased. Also, the methods used to increase the flux were able to improve the flux rate. The automation system was tested and functioned well. Different flow rates were tested to investigate the performance of the system, and the results demonstrated the relationship between the flow rate and flux rate. In the TMP range 40-50 mmHg, at 260 ml/min flow rate, was the optimum flux rate. The device had the ability to run for 12 hours with a constant flux rate. The device achieved this with little haemolysis (pfHb <4 mg/L).Background: Sepsis is one of the leading cause of death in ICU. The causes of sepsis could be viral, bacterial, fungal infection, also, and in some instances trauma. When a local response to the infection becomes a systemic response, the immune system becomes chaotic. Cytokines are produced in an uncontrolled way, resulting in a cytokines storm. The immune system enters a hyperactivation status that leads to multiple organ failures. Despite advances in the medical treatment and clinical experience, there is currently no single medication approved for treating sepsis. Thus, removal of the plasma that contains the inflammatory mediators is a potential solution to reduce their effect in the body. Objectives: The aim of this project is to develop a device that is able to separate plasma from whole blood. The device should be able to generate secondary flow to enhance the performance by reducing the formation of cake layer. In addition, the device should be fully automated in order to simplify the technology for the end user. Approach: Design using computer aided design employing different methods for producing secondary flow, investigate the impact of these techniques on formed blood element, by assessment of shear stress. The design was 3D printed to investigate the performance in term of plasma filtration using different membranes with different effective pore area. The next step was to increase the dimension of the rig and test the increase in surface area on flux rate. In addition, an automation system was designed and assembled in order to control the transmembrane pressure, blood pump and plasma replacement pump through feedback from sensors read by a microcontroller. Results: The device was able to separate the plasma from the blood. The polyethersulfone membrane that has higher effective pore size had higher filtration rate. By increasing the size of the rig, the filtration volume increased. Also, the methods used to increase the flux were able to improve the flux rate. The automation system was tested and functioned well. Different flow rates were tested to investigate the performance of the system, and the results demonstrated the relationship between the flow rate and flux rate. In the TMP range 40-50 mmHg, at 260 ml/min flow rate, was the optimum flux rate. The device had the ability to run for 12 hours with a constant flux rate. The device achieved this with little haemolysis (pfHb <4 mg/L)

Emerging library technology trends in academic environment - an updated review

Due to a growing significance and applicability of information technologies to an academic institution, it is necessary to acquaint librarians and other information professionals with the technology which can be applied to academic environment since the development of digital competence is an inherent part of every school´s curricula. Emerging library technologies such as Bibliographic Citation Management Software, Instructional System Design Software, Electronic Copyright Management System, Classroom Management Software, Library Automation Software, Electronic Resource Management Software and Integrated Search Software are very impactful as academic libraries move into the creation of digital contents. This paper reviewed the emerging library technology trend especially for academic libraries as well as the need to rethink and re-strategize on how increasing technological changes affect their services. Clear indications on libraries’ need of emerging technology tools to support academic librarians for efficient and effective performance were presented. Recommendations were offered on persistent self-renovation by library professionals in order to stay ahead of technology learning curve

Automated flow rate calculation based on digital analysis of flow convergence proximal to regurgitant orifice

AbstractObjectives. The purpose of the study was to develop and validate an automated method for calculating regurgitant flow rate using color Doppler echocardiography.Background. The proximal flow convergence method is a promising approach to quantitate valvular regurgitation noninvasively because it allows one to calculate regurgitant flow rate and regurgitant orifice area; however, defining the location of the regurgitant orifice is often difficult and can lead to significant error in the calculated flow rates. To overcome this problem we developed an automated algorithm to locate the orifice and calculate flow rate based on the digital Doppler velocity map.Methods. This algorithm compares the observed velocities with the anticipated relative velocities, cos ϑ/μt2. The orifice is localized as the point with maximal correlation between predicted and observed velocity, whereas flow rate is specified as the slope of the regression line. We validated this algorithm in an in vitro model for flow through circular orifices with planar surroundings and a porcine bioprosthesis.Results. For flow through circular orifices, flow rates calculated on individual Doppler maps and on an average of eight velocity maps showed excellent agreement with true flow, with r = 0.977 and ΔQ = −3.7 ± 15.8 cm3/s and r = 0.991 and ΔQ = −4.3 ± 8.5 cm3/s, respectively. Calculated flow rates through the bioprosthesis correlated well but underestimated true flow, with r = 0.97, ΔQ = −10.9 ± 12.5 cm3/s, suggesting flow convergence over an >2π. This systematic underestimation was corrected by assuming an effective convergence angle of 212 δ.Conclusions. This algorithm accurately locates the regurgitant orifice and calculates regurgitant flow rate for circular orifices with planar surroundings. Automated analysis of the proximal flow field is also applicable to more physiologic surfaces surrounding the regurgitant orifice; however, the convergence angle should be adjusted. This automated algorithm should make quantification of regurgitant flow rate and regurgitant orifice area more reproducible and readily available in clinical cardiology practice

Synergistic Model of Cardiac Function with a Heart Assist Device

The breakdown of cardiac self-organization leads to heart diseases and failure, the number one cause of death worldwide. The left ventricular pressure–volume relation plays a key role in the diagnosis and treatment of heart diseases. Lumped-parameter models combined with pressure–volume loop analysis are very effective in simulating clinical scenarios with a view to treatment optimization and outcome prediction. Unfortunately, often invoked in this analysis is the traditional, time-varying elastance concept, in which the ratio of the ventricular pressure to its volume is prescribed by a periodic function of time, instead of being calculated consistently according to the change in feedback mechanisms (e.g., the lack or breakdown of self-organization) in heart diseases. Therefore, the application of the time-varying elastance for the analysis of left ventricular assist device (LVAD)–heart interactions has been questioned. We propose a paradigm shift from the time-varying elastance concept to a synergistic model of cardiac function by integrating the mechanical, electric, and chemical activity on microscale sarcomere and macroscale heart levels and investigating the effect of an axial rotary pump on a failing heart. We show that our synergistic model works better than the time-varying elastance model in reproducing LVAD–heart interactions with sufficient accuracy to describe the left ventricular pressure–volume relation

Optical imaging and spectroscopy for the study of the human brain: status report.

This report is the second part of a comprehensive two-part series aimed at reviewing an extensive and diverse toolkit of novel methods to explore brain health and function. While the first report focused on neurophotonic tools mostly applicable to animal studies, here, we highlight optical spectroscopy and imaging methods relevant to noninvasive human brain studies. We outline current state-of-the-art technologies and software advances, explore the most recent impact of these technologies on neuroscience and clinical applications, identify the areas where innovation is needed, and provide an outlook for the future directions

Advances of Italian Machine Design

This 2028 Special Issue presents recent developments and achievements in the field of Mechanism and Machine Science coming from the Italian community with international collaborations and ranging from theoretical contributions to experimental and practical applications. It contains selected contributions that were accepted for presentation at the Second International Conference of IFToMM Italy, IFIT2018, that has been held in Cassino on 29 and 30 November 2018. This IFIT conference is the second event of a series that was established in 2016 by IFToMM Italy in Vicenza. IFIT was established to bring together researchers, industry professionals and students, from the Italian and the international community in an intimate, collegial and stimulating environment

Optical imaging and spectroscopy for the study of the human brain: status report

This report is the second part of a comprehensive two-part series aimed at reviewing an extensive and diverse toolkit of novel methods to explore brain health and function. While the first report focused on neurophotonic tools mostly applicable to animal studies, here, we highlight optical spectroscopy and imaging methods relevant to noninvasive human brain studies. We outline current state-of-the-art technologies and software advances, explore the most recent impact of these technologies on neuroscience and clinical applications, identify the areas where innovation is needed, and provide an outlook for the future directions

Optical imaging and spectroscopy for the study of the human brain: status report

This report is the second part of a comprehensive two-part series aimed at reviewing an extensive and diverse toolkit of novel methods to explore brain health and function. While the first report focused on neurophotonic tools mostly applicable to animal studies, here, we highlight optical spectroscopy and imaging methods relevant to noninvasive human brain studies. We outline current state-of-the-art technologies and software advances, explore the most recent impact of these technologies on neuroscience and clinical applications, identify the areas where innovation is needed, and provide an outlook for the future directions. Keywords: DCS; NIRS; diffuse optics; functional neuroscience; optical imaging; optical spectroscop