Implementing Purpose T: a new and innovative approach for assessing pressure damage

The comprehensive insight, provides robust evidence to support the continued use of PURPOSE-T as a suitable, sustainable and potentially cost saving replacement for Waterlow as standard practice across the Trus

Modeling and interpretation of the bioelectrical impedance signal for the determination of the local arterial stiffness

Purpose: Stiffness of the large arteries (e.g., aorta) plays an important role in the pathogenesis of cardiovascular diseases. To date, the reference method for the determination of regional arterial stiffness is the measurement of the carotid-femoral pulse wave velocity (PWV) by tonometric techniques. However, this method suffers from several drawbacks and it remains limited in clinical routine.Methods: In the present study, the authors propose a new method based on the analysis of bioelectrical impedance (BI) signals for the determination of the local arterial stiffness. They show, from a theoretical model, a novel interpretation of the BI signals and they establish the relationship between the variations in the BI signal and the kinetic energy of the blood flow in large arteries. From this model, BI signals are simulated in the thigh and compared to experimental BI data. Finally, from the model, they propose a new index ( Ira ) related to the properties of the large artery for the determination of the local arterial stiffness. Results: The results show a good correlation between the simulated and the experimental BI signals. The same variations for both of them with different characteristics for rigid and elasticarteries can be observed. The measurement of the Ira index on 20 subjects at rest (mean age of 44 ± 16 yr ) for the determination of the local aortic stiffness presents a significant correlation with the PWV reference method ( R 2 = 0.77 ; P < 0.0001 with the Spearman correlation coefficient and Ira = 4.25 * PWV + 23.54 ). Conclusions: All the results suggest that the theoretical model and the new index could give a reliable estimate of local arterial stiffness

Time and Spatial Invariance of Impedance Signals in Limbs of Healthy Subjects by Time–Frequency Analysis

The bioelectric impedance technique is a non-invasive method that provides the analysis of blood volume changes in the arteries. This is made possible by an interpretation of the impedance signal variations. In this paper, time and spatial variations of such impedance signals are studied on recordings made on limbs of 15 healthy subjects at rest. For that purpose, the scalogram of each signal has been computed and quantitative measures based on energies were determined. The results show that the signals are statistically time invariant on three anatomical segments of the limbs: pelvis, thigh and calf. p Value varies between 0.20 and 0.52 for the absolute energies computed on scalograms of signals recorded at 5 min intervals. Moreover, the analysis made on the two legs of each subject shows that the signals are spatial invariant on the three anatomical segments. p Value varies between 0.0785 and 1.000 for the absolute energies computed on the scalograms of signals recorded simultaneously on the two legs. These conclusions will therefore help the clinicians in studying the temporal variations of physiological parameters on limbs with the impedance technique. Moreover, the results on the spatial invariance make possible the comparisons of these parameters with those given by other acquisition techniques

Measurement of the local aortic stiffness by a non-invasive bioelectrical impedance technique

Aortic stiffness measurement is well recognized as an independent predictor of cardiovascular mortality and morbidity. Recently, a simple method has been proposed for the evaluation of the local aortic stiffness (AoStiff) using a non-invasive bioelectrical impedance (BI) technique. This approach relies on a novel interpretation of the arterial stiffness where AoStiff is computed from the measurement of two new BI variables: (1) the local aortic flow resistance (AoRes) exerted by the drag forces onto the flow; (2) the local aortic wall distensibility (AoDist). Herein, we propose to detail and compare these three indices with the reference pulse wave velocity (PWV) measurement and the direct assessment of the aortic drag forces (DF) and distensibility (DS) obtained by the magnetic resonance imaging technique. Our results show a significant correlation between AoStiff and PWV (r = 0.79; P < 0.0001; 120 patients at rest; mean age 44 ± 16 years), and also between AoRes and DF (r = 0.95; P = 0.0011) and between AoDist and DS (r = 0.93; P = 0.0022) on eight patients at rest (mean age 52 ± 19 years). These first results suggest that local aortic stiffness can be explored reliably by the BI technique

SOST Inhibits Prostate Cancer Invasion.

Inhibitors of Wnt signaling have been shown to be involved in prostate cancer (PC) metastasis; however the role of Sclerostin (Sost) has not yet been explored. Here we show that elevated Wnt signaling derived from Sost deficient osteoblasts promotes PC invasion, while rhSOST has an inhibitory effect. In contrast, rhDKK1 promotes PC elongation and filopodia formation, morphological changes characteristic of an invasive phenotype. Furthermore, rhDKK1 was found to activate canonical Wnt signaling in PC3 cells, suggesting that SOST and DKK1 have opposing roles on Wnt signaling in this context. Gene expression analysis of PC3 cells co-cultured with OBs exhibiting varying amounts of Wnt signaling identified CRIM1 as one of the transcripts upregulated under highly invasive conditions. We found CRIM1 overexpression to also promote cell-invasion. These findings suggest that bone-derived Wnt signaling may enhance PC tropism by promoting CRIM1 expression and facilitating cancer cell invasion and adhesion to bone. We concluded that SOST and DKK1 have opposing effects on PC3 cell invasion and that bone-derived Wnt signaling positively contributes to the invasive phenotypes of PC3 cells by activating CRIM1 expression and facilitating PC-OB physical interaction. As such, we investigated the effects of high concentrations of SOST in vivo. We found that PC3-cells overexpressing SOST injected via the tail vein in NSG mice did not readily metastasize, and those injected intrafemorally had significantly reduced osteolysis, suggesting that targeting the molecular bone environment may influence bone metastatic prognosis in clinical settings

Participatory approaches to housing management

In the past, housing problems have been considered largely in terms of quantitative factors. Increasingly they are seen as resulting from the underlying philosophy of public provision. For many, owner-occupation is the ultimate in the housing "ladder", however there are around 8 million local authority tenants in Britain who, for one reason or another, remain in the public sector. These tenants have, for long, been subjected to insensitive and authoritarian housing management. Many wait weeks and months for "the council" to do essential repairs. In addition they are often regulated by one sided tenancy agreements which imply that, left to their own devices, tenants are irresponsible, anti-social people. This dissertation is written with the belief that tenants should be given opportunities to significantly control aspects of their environment. Through personal involvement in a local housing association, it is interesting to examine consumer participation in a setting which lies outwith the more conventional public housing sector. The breakdown of the dissertation is as follows: Chapter 1: provides a general introduction to the concept of tenant participation. Chapter 2: considers the theoretical background to the debate on Democracy and Participation. It draws upon works of the "classical" and more contemporary theorists. Its objective is to provide a general context within which to examine the later case study material

Power-law scaling behaviour of impedance signal time series of healthy subjects at rest

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