883 research outputs found

    New innovations in interventional cardiac procedures - role of intraprocedural echocardiography

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    The field of interventional cardiac procedures is rapidly growing. Since the “first in men” catheter-based implantation of a biological aortic valve by Cribier, the number of transcatheter based aortic replacements (TAVR) exceeds several thousand implantations per year worldwide. Beside this percutaneous treatment of mitral regurgitation (MitraClip®), closure of the left atrial appendage, and closure of a patent foramen ovale have been developed. Whereas MitraClip® procedures require general anaesthesia, percutaneous closure of the left atrial appendage as well as closure of a patent foramen ovale are usually performed without the help of anaesthesiologists and will therefore not be discussed furthermore. The transapical NeoChord DS 1000 system (NeoChord Inc, USA) is a new treatment option for patients with severe mitral regurgitation and prolapse of the posterior mitral leaflet that can be done off-pump.Keywords: interventional cardiac procedures; new innovation

    Phaseguide assisted liquid lamination for magnetic particle-based assays

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    We have developed a magnetic particle-based assay platform in which functionalised magnetic particles are transferred sequentially through laminated volumes of reagents and washing buffers. Lamination of aqueous liquids is achieved via the use of phaseguide technology; microstructures that control the advancing air–liquid interface of solutions as they enter a microfluidic chamber. This allows manual filling of the device, eliminating the need for external pumping systems, and preparation of the system requires only a few minutes. Here, we apply the platform to two on-chip strategies: (i) a one-step streptavidin–biotin binding assay, and (ii) a two-step C-reactive protein immunoassay. With these, we demonstrate how condensing multiple reaction and washing processes into a single step significantly reduces procedural times, with both assay procedures requiring less than 8 seconds

    HySST: hyper-heuristic search strategies and timetabling

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    9th International Conference on the Practice and Theory of Automated Timetabling, Son, Norway, 28-31 August 201

    Neuromonitoring und Neuroprotektion in der Kardioanästhesie: Bundesweite Umfrage des Arbeitskreises Kardioanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e.V

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    Zusammenfassung: Fragestellung: Primäres Ziel dieser in deutschen kardioanästhesiologischen Abteilungen durchgeführten Umfrage war, die aktuelle Praxis von Neuromonitoring und Neuroprotektion zu erheben. Methodik: Zwischen Oktober 2007 und Januar 2008 wurden hierzu Daten mithilfe eines 26Punkte umfassenden, anonymisierten Fragebogens erhoben. Ermittelt wurden: präoperative Evaluation der hirnversorgenden Arterien, intraoperatives Neuromonitoring, zerebroprotektive Maßnahmen, Perfusionsmanagement während extrakorporaler Zirkulation, postoperative Erhebung des neurologischen Status und Aus-/Weiterbildung im zerebralen Monitoring. Ergebnisse: 55% der Fragebögen wurden mit folgenden Angaben beantwortet: präoperative Duplexsonographie der Hirngefäße in 90% der Kliniken; intraoperatives Neuromonitoring mithilfe der Elektroenzephalographie (EEG; 60%) bei Typ-A-Dissektionen (38,1%), bei elektiven Operationen an der thorakalen bzw. thorakoabdominellen Aorta (34,1% resp. 31,6%) und in der Karotischirurgie (43,2%), weiterhin Einsatz der Nahinfrarotspektroskopie (40%), Ableitung evozierter Potenziale (30%) und transkranielle Dopplersonographie (17,5%). Auch kombinierte Verfahren wurden angewandt. Während Bypass-, Klappen und minimal-invasiven Operationen erfolgt meistens kein Monitoring des Zentralnervensystems. Zur Zerebroprotektion werden die Kühlung des Patienten an Herz-Lungen-Maschine (HLM; 100%), externe Kühlung des Kopfes (65%), Gabe von Kortikosteroiden (58%), Barbituraten (50%) und Antiepileptika (10%) eingesetzt. Als neuroprotektive Anästhesieverfahren gelten Inhalationsanästhesie (32,5%; Favorit: Sevofluran 76,5%) und total intravenöse Anästhesie (20%; Favoriten: Propofol und Barbiturate mit je 46,2%). Standardmäßig kühlen 72,5% der Krankenhäuser die Patienten bei Operationen mit Herz-Kreislauf-Stillstand, 37,5% bei allen Operationen mit HLM. Unter normothermen Bedingungen entspricht in 84,6% der Kliniken der HLM-Fluss dem errechneten Herzzeitvolumen (HZV), der anzustrebende mittlere arterielle Druck (MAP) liegt bei 60-70mmHg (43,9%) bzw. 50-60mmHg (41,5%). Bei einer Körpertemperatur unter 18°C wird der HLM-Fluss unter das errechnete HZV gesenkt (70%), während in 27% der Kliniken normotherme Flussraten gefahren werden. Der bevorzugte MAP unter Hypothermie liegt zwischen 50 und 60mmHg (59%). Intraoperatives Neuromonitoring wird im Narkoseprotokoll (77%) dokumentiert. Postoperativ wird der neurologische Status in 42,5% der Kliniken durch individuelle Einschätzung des Anästhesisten (77,5%) erhoben. Fortbildungen zum Thema Neuromonitoring werden in 32,5% der Kliniken regelmäßig organisiert, in 37,5% dem Arzt selbst überlassen. Schlussfolgerung: Das kardioanästhesiologische Vorgehen in Deutschland ist im Bereich Neuromonitoring und neuroprotektive Therapie nicht standardisiert. Ein "multimodales Neuromonitoring" wäre wünschenswer

    Heuristic generation via parameter tuning for online bin packing

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    Online bin packing requires immediate decisions to be made for placing an incoming item one at a time into bins of fixed capacity without causing any overflow. The goal is to maximise the average bin fullness after placement of a long stream of items. A recent work describes an approach for solving this problem based on a ‘policy matrix’ representation in which each decision option is independently given a value and the highest value option is selected. A policy matrix can also be viewed as a heuristic with many parameters and then the search for a good policy matrix can be treated as a parameter tuning process. In this study, we show that the Irace parameter tuning algorithm produces heuristics which outperform the standard human designed heuristics for various instances of the online bin packing problem

    Design of Industrial Workplaces to relieve Workers when Interacting with Joint-Arm-Robots

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    A comprehensive understanding of the needs of the user is required to design adequate workplace systems in general, but especially in the highly digitised area of industry where operators are interacting with autonomously operating machines. There is little knowledge in design criteria for professionals to enable adequate developments of system design for Human-Machine Interaction, e.g. Human-Robot Collaboration regarding the effects of design decisions to all three levels of Human Factors, i.e. physiological, cognitive and organisational limitations. Moreover, there is little known about objective measurement procedures that evaluate whether the operator subjectively perceives the workplace system design as assistance and improvement. The research presented in the following is affiliated with the scientific discipline of Human Factors Engineering and focuses on the evaluation of Human Factor issues within the digitised industry. Based on broad theoretical and empirical investigations, the results of this research extend our knowledge of adequate Human-Centred Design by providing reliable, powerful design criteria for workplaces where operators interact with machines/collaborate with robots, but also an overall technique, the Objective Workload Detection Method, for evaluation of the effectiveness of design investigation focusing on cognitive stress relief. Through the application of this method within a controlled experiment, the validation of the derived design criteria was confirmed. The study significantly shows how the cognitive workload can be relieved by an assisting environment. This work also gives one best-practice design example of a self-adapting workplace system for hybrid Human-Robot Teams. Following the Human-Centred Design method, the concept of Assisting Industrial Workplace System for Human-Robot Collaboration has been successfully developed as a flexible hybrid unit design. The prototype is related to a real-world scenario from the aerospace industry and the demonstrator was implemented within a laboratory set-up. This work seamlessly applies techniques from interdisciplinary science fields, e.g. Engineering, Neuroscience, Gestalt theory, and Design. Equally, the design criteria and the evaluation method will support professionals from varied disciplines to succeed in the creation process of future system-designs by giving a clear indication of future Human-Centred Design research

    Concept of a Self-Learning Workplace Cell for Worker Assistance While Collaboration with a Robot Within the Self-Adapting-Production-Planning-System

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    For some time, the focus of past research on industrial workplace designs has been the optimization of processes from the technological point of view. Since human workers have to work within this environment the design process must regard Human Factor needs. The operators are under additional stress due to the range of high dynamic processes and due to the integration of robots and autonomous operating machines. There have been few studies on how Human Factors influence the design of workplaces for Human-Robot Collaboration (HRC). Furthermore, a comprehensive, systematic and human-centred design solution for industrial workplaces particularly considering Human Factor needs within HRC is widely uncertain and a specific application with reference to production workplaces is missing. The research findings described in this paper aim the optimization of workplaces for manual production and maintenance processes with respect to the workers within HRC. In order to increase the acceptance of integration of human-robot teams, the concept of the Assisting-Industrial-Workplace-System (AIWS) was developed. As a flexible hybrid cell for HRC integrated into a Self-Adapting-Production-Planning-System (SAPPS) assists the worker while interaction

    Microstructural Shear Localization in Plastic Deformation of Amorphous Solids

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    The shear-transformation-zone (STZ) theory of plastic deformation predicts that sufficiently soft, non-crystalline solids are linearly unstable against forming periodic arrays of microstructural shear bands. A limited nonlinear analysis indicates that this instability may be the mechanism responsible for strain softening in both constant-stress and constant-strain-rate experiments. The analysis presented here pertains only to one-dimensional banding patterns in two-dimensional systems, and only to very low temperatures. It uses the rudimentary form of the STZ theory in which there is only a single kind of zone rather than a distribution of them with a range of transformation rates. Nevertheless, the results are in qualitative agreement with essential features of the available experimental data. The nonlinear theory also implies that harder materials, which do not undergo a microstructural instability, may form isolated shear bands in weak regions or, perhaps, at points of concentrated stress.Comment: 32 pages, 6 figure

    Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography

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    Aims We sought to investigate the additional value of real-time three-dimensional transoesophageal echocardiography (RT 3D TOE)-guided sizing for predicting annuloplasty ring size during mitral valve repair. Methods and results In 53 patients undergoing elective mitral valve repair, an RT 3D TOE was performed pre- and post-operatively. The digitally stored loops were imported into a software for mitral valve assessment. The annuloplasty ring size was predicted by superimposing computer-aided design (CAD) models of annuloplasty rings onto Live 3D zoom loops, measurement of the intercommissural distance, or the height of the anterior mitral leaflet. The surgeon implanted the annuloplasty ring according to the usual surgical technique and was blinded to the echocardiographic measurement results. Pre-operative correlation between the selected ring size with mitral valve assessment and the actual implanted annuloplasty ring size was 0.91. The correlation for measurement of the intercommissural distance was 0.55 and for measurement of the height of the anterior mitral leaflet 0.75. The post-operative correlation with the actual implanted ring size was 0.96 for mitral valve assessment, 0.92 for intercommissural distance, and 0.79 for the anterior mitral leaflet height. Conclusion Superimposition of annuloplasty ring CAD models on the Live 3D zoom loops of the mitral valve using mitral valve assessment is superior to two-dimensional measurements of the intercommissural distance or the height of the anterior mitral leaflet in predicting correct annuloplasty ring size
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