Compact nonlinear model of an implantable electrode array for spinal cord stimulation (SCS)

We describe the construction of a model of the electrode-electrolyte interface and surrounding electrolyte in the case of a platinum-electrode array intended for spinal-cord stimulation (SCS) application. We show that a finite, two dimensional, resistor array provides a satisfactory model of the bulk electrolyte, and we identify the complexity required of that resistor array. The electrode-electrolyte interface is modelled in a fashion suitable for commonly-available, compact simulators using a nonlinear extension of the model of Franks et al. that incorporates diodes and a memristor. The electrode-electrolyte interface model accounts for the nonlinear current-overpotential characteristic and diffusion-limiting effects. We characterise a commercial, implantable, electrode array, fit the model to it, and show that the model successfully predicts subtle operational characteristics

MRI Safe Electrodes for Spinal Cord Stimulation (SCS)

Adding decoy filars and non-therapeutic decoy electrodes to therapeutic filars can divert and dissipate a significant fraction of captured RF energy in a distributed way along the lead. Simulated worst case local SAR values have been reduced by a factor of ten for lead lengths ranging from 200 mm to 1200 mm

Post-peak fracture behavior during direct shear tests of rock joints

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Management of infections pre- and post-liver transplantation: Report of an AISF consensus conference

The burden of infectious diseases both before and after liver transplantation is clearly attributable to the dysfunction of defensive mechanisms of the host, both as a result of cirrhosis, as well as the use of immunosuppressive agents. The present document represents the recommendations of an expert panel commended by the Italian Association for the Study of the Liver (AISF), on the prevention and management of infectious complications excluding hepatitis B, D, C, and HIV in the setting of liver transplantation. Due to a decreased response to vaccinations in cirrhosis as well as within the first six months after transplantation, the best timing for immunization is likely before transplant and early in the course of disease. Before transplantation, a vaccination panel including inactivated as well as live attenuated vaccines is recommended, while oral polio vaccine, Calmette-Guerin's bacillus, and Smallpox are contraindicated, whereas after transplantation, live attenuated vaccines are contraindicated. Before transplant, screening protocols should be divided into different levels according to the likelihood of infection, in order to reduce costs for the National Health Service. Recommended preoperative and postoperative prophylaxis varies according to the pathologic agent to which it is directed (bacterial vs. viral vs. fungal). Timing after transplantation greatly determines the most likely agent involved in post-transplant infections, and specific high-risk categories of patients have been identified that warrant closer surveillance. Clearly, specifically targeted treatment protocols are needed upon diagnosis of infections in both the pre- as well as the post-transplant scenarios, not without considering local microbiology and resistance patterns

Cause of pulse artefacts inherent to the electrodes of neuromodulation implants

The current pulses delivered through platinum electrodes by medical implants to recruit neurones give rise to slowly-decaying voltage tails, called "artefacts''. These tails make measurement of evoked potentials following the pulses very difficult. We present evidence to show that in a typical clinical scenario these tails are mostly caused by concentration gradients of species induced in the electrical double layer adsorbed onto the surface of both stimulating and passive electrodes. A compact model is presented that allows simulation of these artefacts. The model is verified against measurements made in saline. This shows that electrode artefacts are an intrinsic property of the conductive electrodes of a lead

Teaching strategies and gender in higher education instrumental studios

This study investigates instrumental music teaching strategies in higher education settings, in order to identify those employed and their frequency and context of use. An instrument- and gender-balanced sample of 24 lessons from five institutions was analysed using a researcher-designed observational instrument. The results reveal the predominance of teacher demonstration, general directives and praise as most frequent teaching strategies employed in lessons. Gender differences emerged in the teaching approaches: the male teachers gave more general directives and explanations and the female teachers offered more answers and practice discussions; the male students received the most specific teacher criticism despite uniform use of praise. The findings provide new evidence of teaching practices in advanced instrumental studios and raise questions regarding gender issues in music teaching

Measures of Dosage for Spinal-Cord Electrical Stimulation: Review and Proposal

This manuscript proposes an electrical definition of therapeutic dose for spinal cord systems used for the treatment of chronic pain, analogous to the pharmacological definition. Dose-response relationships are fundamental to pharmacology, radiotherapy, and other treatments, but have never been properly established for neuromodulation. This manuscript offers a robust measure of dose, pre-requisite to establishing a reliable and repeatable dose-response relationship. The new definition, enabled by the system transresistance obtained from measurement of evoked action potentials, recognizes the mechanism of action of spinal cord stimulation (SCS), and should improve acceptance of the therapy as compared to pharmacological treatments which are currently used more frequently for the treatment of chronic pain. The new definition suggests methods for personalization and standardization of the dose in SCS, and is potentially generalizable to all neuromodulation therapies in which nervous tissue is excited including sacral nerve stimulation (SNS), vagal nerve stimulation (VNS), and deep-brain stimulation (DBS). Formulas are provided, and applied using patient data. Powerful conclusions are drawn from application of the new measure

Retinal Function in Advanced Multiple Sclerosis

Purpose People with multiple sclerosis (pwMS) experience autoimmunity-mediated inflammation and neurodegeneration throughout the central nervous system. There remains a need for clinically accessible, reliable functional markers of neurodegeneration in MS. Previous research has described changes to electroretinography (ERG)-derived measures of retinal bipolar cell function in pwMS early in the disease course. We, therefore, investigated ERG as a potential outcome measure in individuals with more advanced disease. Methods This cross-sectional observational study included pwMS with Expanded Disability Status Scale (EDSS) scores of ≥3.0 and healthy control (HC) participants who underwent ERG, optical coherence tomography, high- and low-contrast visual acuity measurement, and an ophthalmological examination. ERG findings in MS eyes with and without previous optic neuritis (MS +ON; MS -ON) were compared with those in HC eyes. Effects of EDSS, disease duration, ON, and treatment status on selected ERG outcomes were measured. Additional exploratory analyses assessed potential influences of MS phenotype and disease status (clinically active, radiologically active, and disease progression). Results Delays to two ERG peak times (dark-adapted 3.0 b-wave; light-adapted flicker) were recorded in MS +ON and MS -ON eyes. No influences of EDSS score, disease duration, previous ON, or treatment status were observed. Exploratory analyses were consistent with no effects of MS phenotype or disease status. Conclusions ERG findings are abnormal in individuals with moderate-severe disability caused by MS; however, these findings are not distinct from those observed earlier in the disease course. Although bipolar dysfunction appears to be common in pwMS throughout the disease course, ERG is likely not useful in monitoring or prognostication of MS

Conceptual design of a two stage to orbit spacecraft

This project, undertaken through the Advanced Space Design Program, developed a 'Conceptual Design of a Two Stage To Orbit Spacecraft (TSTO).' The design developed utilizes a combination of air breathing and rocket propulsion systems and is fully reusable, with horizontal takeoff and landing capability. The orbiter is carried in an aerodynamically designed bay in the aft section of the booster vehicle to the staging altitude. This TSTO Spacecraft design meets the requirements of replacing the aging Space Shuttle system with a more easily maintained vehicle with more flexible mission capability

Alterations in ethanol-induced behaviors and consumption in knock-in mice expressing ethanol-resistant NMDA receptors

Ethanol's action on the brain likely reflects altered function of key ion channels such as glutamatergic N-methyl-D-aspartate receptors (NMDARs). In this study, we determined how expression of a mutant GluN1 subunit (F639A) that reduces ethanol inhibition of NMDARs affects ethanol-induced behaviors in mice. Mice homozygous for the F639A allele died prematurely while heterozygous knock-in mice grew and bred normally. Ethanol (44 mM; ∼0.2 g/dl) significantly inhibited NMDA-mediated EPSCs in wild-type mice but had little effect on responses in knock-in mice. Knock-in mice had normal expression of GluN1 and GluN2B protein across different brain regions and a small reduction in levels of GluN2A in medial prefrontal cortex. Ethanol (0.75-2.0 g/kg; IP) increased locomotor activity in wild-type mice but had no effect on knock-in mice while MK-801 enhanced activity to the same extent in both groups. Ethanol (2.0 g/kg) reduced rotarod performance equally in both groups but knock-in mice recovered faster following a higher dose (2.5 g/kg). In the elevated zero maze, knock-in mice had a blunted anxiolytic response to ethanol (1.25 g/kg) as compared to wild-type animals. No differences were noted between wild-type and knock-in mice for ethanol-induced loss of righting reflex, sleep time, hypothermia or ethanol metabolism. Knock-in mice consumed less ethanol than wild-type mice during daily limited-access sessions but drank more in an intermittent 24 h access paradigm with no change in taste reactivity or conditioned taste aversion. Overall, these data support the hypothesis that NMDA receptors are important in regulating a specific constellation of effects following exposure to ethanol. © 2013 den Hartog et al