Fibre optic intravascular measurements of blood flow: A review

Fibre optic sensors are well suited to measuring fluid flow in many contexts, and recently there has been burgeoning interest in their application to direct, invasive measurement of blood flow within human vasculature. Depending on the sensing method used and assumptions made, these intravascular measurements of blood flow can provide information about local blood velocity, volumetric flow, and flow-derived parameters. Fibre optic sensors can be readily integrated into medical devices, which are positioned into arteries and veins to obtain measurements that are inaccessible or cumbersome using non-invasive imaging modalities. Measurements of flow within coronary arteries is a particularly promising application of fibre optic sensing; recent studies have demonstrated the clinical utility of certain flow-based parameters, such as the coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). In this review, research and development of fibre optic flow sensors relevant to intravascular flow measurements are reviewed, with a particular focus on biomedical clinical translation

Electrophysiological effects of nicotinic and electrical stimulation of intrinsic cardiac ganglia in the absence of extrinsic autonomic nerves in the rabbit heart

BackgroundThe intrinsic cardiac nervous system is a rich network of cardiac nerves that converge to form distinct ganglia and extend across the heart and is capable of influencing cardiac function.ObjectiveThe goals of this study were to provide a complete picture of the neurotransmitter/neuromodulator profile of the rabbit intrinsic cardiac nervous system and to determine the influence of spatially divergent ganglia on cardiac electrophysiology.MethodsNicotinic or electrical stimulation was applied at discrete sites of the intrinsic cardiac nerve plexus in the Langendorff-perfused rabbit heart. Functional effects on sinus rate and atrioventricular conduction were measured. Immunohistochemistry for choline acetyltransferase (ChAT), tyrosine hydroxylase, and/or neuronal nitric oxide synthase (nNOS) was performed using whole mount preparations.ResultsStimulation within all ganglia produced either bradycardia, tachycardia, or a biphasic brady-tachycardia. Electrical stimulation of the right atrial and right neuronal cluster regions produced the largest chronotropic responses. Significant prolongation of atrioventricular conduction was predominant at the pulmonary vein-caudal vein region. Neurons immunoreactive (IR) only for ChAT, tyrosine hydroxylase, or nNOS were consistently located within the limits of the hilum and at the roots of the right cranial and right pulmonary veins. ChAT-IR neurons were most abundant (1946 ± 668 neurons). Neurons IR only for nNOS were distributed within ganglia.ConclusionStimulation of intrinsic ganglia, shown to be of phenotypic complexity but predominantly of cholinergic nature, indicates that clusters of neurons are capable of independent selective effects on cardiac electrophysiology, therefore providing a potential therapeutic target for the prevention and treatment of cardiac disease

Safety of direct oral anticoagulants in patients with hereditary hemorrhagic telangiectasia

Background: Hereditary haemorrhagic telangiectasia (HHT) is a rare vascular dysplasia resulting in visceral arteriovenous malformations and smaller mucocutaneous telangiectasia. Most patients experience recurrent nosebleeds and become anaemic without iron supplementation. However, thousands may require anticoagulation for conditions such as venous thromboembolismand/or atrial fibrillation. Over decades,tolerance data has been publishedfor almost 200HHT-affected usersof warfarinand heparins, but there are no publisheddata forthe newer direct oralanticoagulants(DOACs)in HHT. Methods: To provide such data, aretrospective audit was conducted across the eight HHT centres of the European Reference Network for Rare Vascular Disorders (VASCERN),in Denmark, France, Germany, Italy, Netherlands and UK. Results: Although HHT Centreshad not specifically recommended the use of DOACs, 32treatment episodes had been initiated by other cliniciansin 28patients reviewed at the centres, at median age 65years(range 30-84). Indications were for atrial fibrillation (16 treatment episodes) and venous thromboembolism (16 episodes).The 32 treatment episodes used Apixaban (n=15), Rivaroxaban (n=14), and Dabigatran (n=3). HHT nosebleeds increased in severity in 24/32 treatment episodes (75%), leading to treatment discontinuation in 11 (34.4%). Treatment discontinuation was required for 4/15(26.7%) Apixabanepisodes and 7/14 (50%)Rivaroxaban episodes.By a 4 point scale of increasing severity,there was a trend for Rivaroxaban to be associated with a greaterbleeding riskboth including and excluding patients who had used more than one agent (age-adjusted coefficients 0.61 (95% confidence intervals 0.11, 1.20) and 0.74 (95% confidence intervals 0.12, 1.36) respectively. Associationswere maintained after adjustment for genderand treatment indication. Extreme haemorrhagic responses, worse thananything experienced previously, with individual nosebleedslasting hours requiring hospital admissions, blood transfusions and in all cases treatment discontinuation, occurred in5/14(35.7%) Rivaroxabanepisodes compared to 3/15(20%) Apixabanepisodes and published rates of ~5% for warfarin and heparin. Conclusions: Currently, conventional heparin and warfarin remain first choice anticoagulantsin HHT. If newer anticoagulants are considered,although study numbers are small, at this stage Apixaban appearsto be associated with lesser bleeding riskthan Rivaroxaban

European Reference Network for Rare Vascular Diseases (VASCERN) position statement on cerebral screening in adults and children with hereditary haemorrhagic telangiectasia (HHT)

Hereditary haemorrhagic telangiectasia (HHT) is a multisystemic vascular dysplasia inherited as an autosomal dominant trait. Approximately 10 % of patients have cerebral vascular malformations, a proportion being cerebral arteriovenous malformations (AVMs) and fistulae that may lead to potentially devastating consequences in case of rupture. On the other hand, detection and treatment related-risks are not negligible, and immediate. While successful treatment can be undertaken in individual cases, current data do not support the treatment of unruptured AVMs, which also present a low risk of bleeding in HHT patients. Screening for these AVMs is therefore controversial. Structured discussions, distinctions of different cerebrovascular abnormalities commonly grouped into an "AVM"bracket, and clear guidance by neurosurgical and neurointerventional radiology colleagues enabled the European Reference Network for Rare Vascular Disorders (VASCERN-HHT) to develop the following agreed Position Statement on cerebral screening: 1) First, we emphasise that neurological symptoms suggestive of cerebral AVMs in HHT patients should be investigated as in general neurological and emergency care practice. Similarly, if an AVM is found accidentally, management approaches should rely on expert discussions on a case-by-case basis and individual risk-benefit evaluation of all therapeutic possibilities for a specific lesion. 2) The current evidence base does not favour the treatment of unruptured cerebral AVMs, and therefore cannot be used to support widespread screening of asymptomatic HHT patients. 3) Individual situations encompass a wide range of personal, cultural and clinical states. In order to enable informed patient choice, and avoid conflicting advice, particularly arising from non-neurovascular interpretations of the evidence base, we suggest that all HHT patients should have the opportunity to discuss knowingly brain screening issues with their healthcare provider. 4) Any screening discussions in asymptomatic individuals should be preceded by informed pre-test review of the latest evidence regarding preventative and therapeutic efficacies of any interventions. The possibility of harm due to detection of, or intervention on, a vascular malformation that would not have necessarily caused any consequence in later life should be stated explicitly. We consider this nuanced Position Statement provides a helpful, evidence-based framework for informed discussions between healthcare providers and patients in an emotionally charged area

Design of a series visco-elastic actuator for multi-purpose rehabilitation haptic device

<p>Abstract</p> <p>Background</p> <p>Variable structure parallel mechanisms, actuated with low-cost motors with serially added elasticity (series elastic actuator - SEA), has considerable potential in rehabilitation robotics. However, reflected masses of a SEA and variable structure parallel mechanism linked with a compliant actuator result in a potentially unstable coupled mechanical oscillator, which has not been addressed in previous studies.</p> <p>Methods</p> <p>The aim of this paper was to investigate through simulation, experimentation and theoretical analysis the necessary conditions that guarantee stability and passivity of a haptic device (based on a variable structure parallel mechanism driven by SEA actuators) when in contact with a human. We have analyzed an equivalent mechanical system where a dissipative element, a mechanical damper was placed in parallel to a spring in SEA.</p> <p>Results</p> <p>The theoretical analysis yielded necessary conditions relating the damping coefficient, spring stiffness, both reflected masses, controller's gain and desired virtual impedance that needs to be fulfilled in order to obtain stable and passive behavior of the device when in contact with a human. The validity of the derived passivity conditions were confirmed in simulations and experimentally.</p> <p>Conclusions</p> <p>These results show that by properly designing variable structure parallel mechanisms actuated with SEA, versatile and affordable rehabilitation robotic devices can be conceived, which may facilitate their wide spread use in clinical and home environments.</p

Brief Online Self-help Exercises for Postnatal Women to Improve Mood: A Pilot Study

OBJECTIVES: Giving birth and adjusting to a new baby can be difficult and stressful for new mothers. Negative mood may occur during this time and can affect women, their parenting and the infant's development. This pilot study evaluated a brief online self-help intervention designed to promote positive mood in mothers of babies and toddlers. METHODS: Women in the UK who had given birth within the previous 18 months were randomly allocated to the online self-help intervention (n = 40) or active comparison group exercise (n = 40) which was matched for time and structure. Mood was measured before and after the intervention. Acceptability was examined at the end of the trial. RESULTS: The self-help intervention was acceptable to the majority of women and significantly increased positive mood compared to the comparison condition. This effect persisted after controlling for self-esteem, anxiety and depression. These results suggest that a simple self-help intervention focused on changing beliefs about oneself as a mother can have an immediate impact on women's mood. CONCLUSIONS FOR PRACTICE: Further research is need to see whether these improvements continue long-term and what processes underlie these improvements

Emerging school sport development policy, practice and governance in England: Big Society, autonomy and decentralisation

International interest in developing mass sports participation through systems of school and community sports development has become a growing field of public leisure policy interest. This research paper considers the policy change from School Sport Partnerships to the new 2012 School Games model of networked partnerships to establish characteristics of the changes in governance modes and implications from practice in England. The research project is based on a regional case study drawing upon indepth,face-to-face interviews with key public policy stakeholders to inform an analysis of change. Initial findings indicate that the emergent networks are characterised by more networked-based mode of governance than previous hierarchical models present under UK New Labour. The study also shows the fragility of a reliance on partnership structures and the potential implications for incongruence in delivering policy outcomes and improving access to physical activity and school sport opportunities

Efeito da adição de sulfato de amônio sobre a produção de ácido succínico durante a fermentação alcoólica

Succinic acid production by yeasts during alcoholic fermentation of cane molasse supplemented with 25, 50 and 100 ppm of nitrogen in the form of ammonium sulfate was determined by gas-liquid chromatography. Ethanol production was not effected by the different levels of nitrogen, but there was a significant reduction in the content of succinic acid which was inversely related with the ammonium sulfate concentration in the medium.A produção de ácido succínico por leveduras durante a fermentação alcoólica de mosto de melaço suplementado com 25, 50 e 100 ppm de nitrogênio na forma de sulfato de amônio foi determinada por cromatografia em fase gasosa. A adição de nitrogênio amoniacal não afetou significativamente a produção de álcool etílico. Houve redução significativa no teor de ácido succínico com o aumento da quantidade de nitrogênio adicionada

Understanding governmental activism

This article seeks to understand an understudied phenomenon: governmental players joining forces with non-governmental players in contentious actions against policies they want to prevent or redress. This behaviour, which we call ‘governmental activism’, problematizes important assumptions in the social movement literature on state–SMO dichotomies and on seeing ‘the state’ as a homogeneous and unified actor that solely provides the context for SMO activities. Governmental activism also problematizes assumptions on cooperation and ‘new’ modes of coordination in the governance literature. To understand governmental activism, we build on the strategic interaction perspective from social movement studies and on third-phase institutionalism from political science. In our analysis, we show the particulars of governmental activism. Our arguments are illustrated by empirical material on a case of municipal amalgamation in the Netherlands

Level models of continuing professional development evaluation: a grounded review and critique

Continuing professional development (CPD) evaluation in education has been heavily influenced by ‘level models’, deriving from the work of Kirkpatrick and Guskey in particular, which attempt to trace the processes through which CPD interventions achieve outcomes. This paper considers the strengths and limitations of such models, and in particular the degree to which they are able to do justice to the complexity of CPD and its effects. After placing level models within the broader context of debates about CPD evaluation, the paper reports our experience of developing such models heuristically for our own evaluation practice. It then draws on positivist, realist and constructivist traditions to consider some more fundamental ontological and epistemological questions to which they give rise. The paper concludes that level models can be used in a number of ways and with differing emphases, and that choices made about their use will need to reflect both theoretical choices and practical considerations