Assessment of left ventricular diastolic function by MR: why, how and when

Cardiovascular magnetic resonance (CMR), a valuable non-invasive technique for the evaluation of the cardiovascular system, has already been accepted as the "gold standard" for the assessment of systolic function. The assessment of diastolic function is important not only for diagnosis purposes, but also in terms of prognosis. ECG-triggering phase-contrast (PC) CMR allows the routine assessment of diastolic function by measuring the transmitral and pulmonary venous flow with high accuracy and reproducibility, using morphological and quantitative parameters similar to those obtained by transthoracic echocardiography, which are so familiar to general cardiologists. Therefore, the increasing role of CMR in the assessment of the cardiovascular system requires a greater awareness and knowledge of this condition by radiologists. The aim of this study is to review the main mechanisms and common causes of left ventricle diastolic dysfunction, provide a practical approach for the assessment of LV diastolic function and illustrate the different degrees of diastolic dysfunction

Public Health England's recovery tools: potential teaching resources?

The file attached to this record is the author's final peer reviewed version.Training to combat chemical and radiation accidents, incidents or attacks is critical for health professionals due to recent events involving these hazards or their use as unconventional weapons, such as the use of the nerve agent novichok in Salisbury, UK. Health professionals need to have appropriate knowledge and skills to effectively respond to future events involving any of these substances, which requires a rapid and coordinated response from different professionals to protect the environment and minimise the number of people exposed and reduce morbidity and mortality. However, despite chemical and radiation incidents becoming increasingly prevalent, literature reviews have shown that there is a lack of teaching of appropriate competences to face future crises in Europe, particularly amongst clinicians and other health professionals that would be part of the initial response. Thus, De Montfort University (DMU, UK) in collaboration with different academics from the University of Alcalá (Spain) and researchers from Public Health England (PHE) with comprehensive experience in environmental decontamination and restoration, have created a short training course for providing undergraduate/postgraduate students with basic skills to respond to chemical incidents, basic skills that are based on the major competences recently identified by the European Commission [1]. This novel training has been tested with students from different backgrounds in various European universities, recording high degrees of acquisition of the various basic competences that we developed to initially respond to chemical events [2]. To develop the practical part of this chemical training, we have incorporated the novel guidance and methodology developed by PHE to successfully tailor a protection and recovery response to any incident involving chemical substances, which is available in the “UK Recovery Handbook for Chemical Incidents” [3] and its web-based tools: “Chemical Recovery Navigation Tool” (CRNT, [4]) and “Chemical Recovery Record Form” (CRRF, [5]). These innovative resources aid the user to select effective protection, decontamination and restoration techniques or strategies from a pool of up-to-date options applicable to different environments according to the physicochemical properties of the chemical(s) involved and the area affected. The CRNT is accompanied by the CRRF, which facilitates collection and analysis of the necessary data to inform decisions, and an e-learning resource named “Chemical Recovery: Background” (CRB, [6]), which could facilitate the learning of environmental decontamination and restoration. We are currently developing a short training course to cover minor radiation incidents; this radiation training will follow the same methods used to develop the chemical training, but with the specific PHE recovery tools to tackle such events, specifically the “UK Recovery Handbooks for Radiation Incidents” [7] and its associated web-based tools “Radiation Recovery Navigation Tool” (Rad RNT, [8]), one for each environment: food production systems, inhabited areas and drinking water supplies. This communication will explore the use of the PHE’s Recovery Navigation Tools as potential resources to facilitate the acquisition of basic knowledge to tailor protection and recovery interventions for minor chemical and radiation incidents to protect the public

Design and fabrication of a microsystem to handle biological objects

Biological particle microhandling is a common operation in medicine and microbiology, and a lot of research work has been addressed to develop faster, cheaper and more efficient manipulation techniques. In this way, microsystem technologies play an important role because they can be used to fabricate microparticle manipulators. This paper describes the design and fabrication of a microsystem to handle biological objects, based on the dielectrophoretic effects. The development of the right technological option among the possibilities at disposal is also discussed. The proposed design, a whole microsystem including electrical, optical and fluidic interfaces, was developed employing gold and platinum metals, silicon micromachining, and photoresin patterning techniques. Furthermore, the structure of the utilized microelectrode arrays, as well as the resulting microchip are also reported

Spatially resolved integral field spectroscopy of the ionized gas in IZw18

We present a detailed 2D study of the ionized ISM of IZw18 using new PMAS-IFU optical observations. IZw18 is a high-ionization galaxy which is among the most metal-poor starbursts in the local Universe. This makes IZw18 a local benchmark for understanding the properties most closely resembling those prevailing at distant starbursts. Our IFU-aperture (~ 1.4 kpc x 1.4 kpc) samples the entire IZw18 main body and an extended region of its ionized gas. Maps of relevant emission lines and emission line ratios show that higher-excitation gas is preferentially located close to the NW knot and thereabouts. We detect a Wolf-Rayet feature near the NW knot. We derive spatially resolved and integrated physical-chemical properties for the ionized gas in IZw18. We find no dependence between the metallicity-indicator R23 and the ionization parameter (as traced by [OIII]/[OII]) across IZw18. Over ~ 0.30 kpc^2, using the [OIII]4363 line, we compute Te[OIII] values (~ 15000 - 25000 K), and oxygen abundances are derived from the direct determinations of Te[OIII]. More than 70% of the higher-Te[OIII] (> 22000 K) spaxels are HeII4686-emitting spaxels too. From a statistical analysis, we study the presence of variations in the ISM physical-chemical properties. A galaxy-wide homogeneity, across hundreds of parsecs, is seen in O/H. Based on spaxel-by-spaxel measurements, the error-weighted mean of 12 + log(O/H) = 7.11 +/- 0.01 is taken as the representative O/H for IZw18. Aperture effects on the derivation of O/H are discussed. Using our IFU data we obtain, for the first time, the IZw18 integrated spectrum.Comment: Accepted for publication in MNRAS, 13 pages, 10 figures, 4 table

Fluid geochemistry and seismic activityin the period 1998-2002 at Turrialba Volcano (Costa Rica)

Turrialba Volcano, located in Central-Southern Costa Rica, has been characterized, since the last period of eruptive activity in 1884-1886, by a weak and discontinuous fumarolic activity in the western area of its summit. During the 1998-2002 period, fumaroles discharging from central and West craters were collected for chemical analyses of major and trace gas compounds, 13C/12C in CO2 and 18O/16O and D/H (in one fumarolic condensate), isotopic ratios. Geophysical measurements (seismic activity and ground deformation), monitored in the same period, were compared to geochemical data to define the status of the volcanic system. Chemical and isotopic characteristics of fumaroles of Turrialba Volcano seem to be related to interaction processes between a magmatic source and a shallower hydrothermal aquifer. Since February 1997, seismicity at Turrialba Volcano gradually increased, while since August 2001 new fumaroles start to discharge from a new fracture system located in the area between central and West craters. Since September 2001, strong compositional changes of gas discharges have been recorded at central crater. These occurrences are possibly due to variations in the permeability of the conduit system feeding the fumaroles. Heat pulse episodes from a magmatic source have possibly caused the increase of vapour pressure at depth and, consequently, favoured the uprising of the magmatic fluids toward the surface. The observed evolution of chemical and physical parameters suggests that to forecast a possible renewal of the volcanic activity in the near future a full program of both geochemical and geophysical surveillance must be provided at Turrialba Volcano

A User Centered Design Approach for Patient Interfaces to a Diabetes IT Platform

Improving patient self-management can have a greater impact than improving any clinical treatment (WHO). We propose here a systematic and comprehensive user centered design approach for delivering a technological platform for diabetes disease management. The system was developed under the METABO research project framework, involving patients from 3 different clinical centers in Parma, Modena and Madrid

Morphological and geochemical features of crater lakes in Costa Rica: an overview.

This paper describes the compositional and morphological features of the crater lakes found in the volcanoes of Rincón de La Vieja, Poás, Irazú, Congo and Tenorio volcanoes (Costa Rica). As evidenced by the distribution of the water and dissolved gas chemistry along vertical profiles, the different fluid sources feeding the lakes reflect the present status of each of the volcanic systems. The chemical features of the Caliente (Poás volcano) and Rincón crater (Rincón de la Vieja volcano) lakes are mainly dependent on i) inputs of magmatic fluids from sub-lacustrine fumaroles and ii) water-rock interaction processes. Conversely, the Irazú lake is mainly affected by the presence of CO2(H2S)-rich fluids discharged from a hydrothermal system, which masked possible magmatic fluid contributions. Rainfall and organic activity are the main factors responsible for the chemical composition of Hule, Botos, Congo and Tenorio lakes. The chemical and isotopic water composition of Botos, Irazú and Hule lakes have displayed no significant variations along the vertical profiles. In contrast, Caliente lake shows a distinctive chemical stratification, mainly involving F-, Cl- and SO4 2-. The behaviour of these compounds seems to be governed by both dissolution of highly acidic species, i.e. HF, HCl and SO2 released from the magmatic environment, and microbial activity. Despite the significant increases with depth of dissolved CO2 at Caliente and Irazú lakes, the hazard for Nyos-type gas eruptions can be considered negligible, since i) the water volumes are too small and ii) the convective heat transfer limits the CO2 recharge rate. The relatively high concentrations of dissolved CO2 measured at the maximum depth of the Hule lake are likely produced by both degradation of organic material and degassing from a deep source. The sporadic episodes of fish deaths recently observed in this lake can be associated with lake overturn processes that have favoured the rise up to the lake surface of deep, oxygen-depleted waters.Journal of limnolog

Portuguese Consensus and Recommendations for Acquired Coagulopathic Bleeding Management (CCBM)

We aimed to determine how Portuguese physicians handle major bleeding. We also aim to establish global diagnostic and therapeutic recommendations to be followed in clinical practice by using a step-wise approach of evidence generation. This study followed a three-step process: a steering committee desk review, a Delphi technique, an expert panel meeting. A modified 3-round Delphi including 31 statements was performed. Questions were answered in a five-point Likert-type scale. Consensus threshold was established as a percentage of agreement among participants >= 90% in the first round, and >= 85% in the second and third rounds. The level of consensus achieved by panelists was discussed with the scientific committee (January-2020). Fifty-one physicians participated in the study (compliance rate >90%). Analyzing the three rounds, consensus was reached on 20 items (64.5%) in the first, 4/11 items (36.4%) in the second and 6/7 items (85.7%) in the third. One statement about administration of clotting factor concentrates for bleeding control did not reach consensus. A high level of consensus was reached toward the need for implementing Patient Blood Management strategies in Portuguese hospitals, reduce exposure to allogeneic blood components, to use goal directed therapies for acquired bleeding management, and the need for evaluating blood transfusion indirect costs. A final version with 12 recommendations was built, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Our results provide critically appraised and updated evidence on bleeding coagulopathies management in Portugal. Additional studies, mainly about indirect costs of blood transfusion, are needed