Ultrasonic Mapping Needle

When gaining access to a vein or organ for the purpose of ablation or other reasons, the common procedural method of entry is to use the Seldinger technique. This has been the standard entry procedure since its introduction in 1953, and the technique has not been modified during this time. While effective, it is prone to complication as it relies solely on the operator\u27s precision and experience. It is our task and goal to develop a modifying kit for this procedure that would aid the operator in this process. It would make use of mapping technology and standard products used in hospitals and Arrhythmia Centers, including ultrasound and magnetic cardiovascular mapping systems, as well as hypodermic needles and catheters. Ultimately this product will focus on minimizing the time, complexity, and overall complications currently associated with this procedure. This report outlines the ideation process and explains how we came to our concept design. Our concept design comprises of two main components— a handle and tunneller. The handle guides and orients the ultrasound catheter. The tunneller will secure the mapping catheter and guide the needle to the desired spot of insertion. Following approval of the concept design and direction, we moved towards 3-D modeling, prototyping, and testing. This led to the final design of the handle, which comprises of a ultrasound head, handle, and Tuohy-Borst mechanism. The tunneller final design consists of a needle insert, needle shaft, and a Touhy-Borst/Luer Lock mechanism. We outline any changes made from concept design to our final design and describe the final assembly of this project along with manufacturing cost and the next steps to get this project into production

Evidence for behavioural interventions addressing condom use fit and feel issues to improve condom use : A Systematic Review

© CSIRO 2019. Open Access Article (CC BY-NC-ND)Continuing high rates of sexually transmissible infections (STIs) in many countries highlight the need to identify effective behavioural interventions. Consistent and correct use of male condoms is a key strategy for the prevention of STIs. However, some men report problems with condom fit (e.g. the size and shape of the condom) and feel (e.g. tightness, irritation, sensitivity), which inhibits their use. We conducted a systematic review to identify existing interventions addressing condom use fit and feel problems. We searched electronic databases for peer-reviewed articles and searched reference lists of retrieved studies. Five studies met the inclusion criteria. These were generally small-scale pilot studies evaluating behavioural interventions to promote safer sex with men aged under 30 years, addressing, among other things, barriers to condom use relating to fit and feel. There were significant increases in the reported use of condoms, including condom use with no errors and problems. Improvements in some condom use mediators were reported, such as condom use self-efficacy, knowledge, intentions and condom use experience. There were mixed findings in terms of the ability of interventions to reduce STI acquisition. Behavioural interventions addressing condom fit and feel are promising in terms of effectiveness but require further evaluation.Peer reviewe

Identifying Neurotransmitter Spill-over in Hippocampal Field Recordings

A model of synaptic and extra-synaptic excitatory signaling in the hippocampus is presented. The model is used to analytically evaluate the potential contributions of homosynaptic and heterosynaptic glutamate spill-over to receptor signaling during an electrophysiological experiment in which glutamate transporters are pharmacologically blocked. Inhibition of glutamate uptake selectively prolongs the decay kinetics of the second field excitatory postsynaptic potential evoked by paired pulse stimulation of Schaffer collateral axons in area CA1. The model includes AMPA and NMDA glutamate receptors, and the removal of glutamate by transporters and diffusion. We establish analytically that the prolongation cannot be caused by local effects, i.e., the transporters acting within or near the synapse. In contrast, a time profile of glutamate consistent with spill-over from adjacent synapses can explain the effect. The different reaction kinetics of AMPA and NMDA receptors have a significant role in reproducing the experimental results, as explained by analysis of the ODEs governing the reactions

Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women.

Background Male condoms are effective in preventing common sexually transmitted infections (STIs) and unintended pregnancy, if used correctly and consistently. However, condom use errors and problems are common and young people report negative experiences, such as reduced pleasure. The Kinsey Institute Home-Based Exercises for Responsible Sex (KIHERS) is a novel condom promotion intervention for young women, which aims to reduce condom errors and problems, increase self-efficacy and improve attitudes towards condoms, using a pleasure-focussed approach. The study objective was to test the operability, viability and acceptability of an adapted version of the KIHERS intervention with young women aged 16–25 years in the United Kingdom (UK) (Home-Based Exercises for Responsible Sex-UK (HERS-UK). Methods A repeated-measures single-arm design was used, with a baseline (T1) and two follow-up assessments (T2 and T3), conducted 4 weeks and 8 weeks post intervention over a 3-month period. Participants were provided a condom kit containing different condoms and lubricants and were asked to experiment with condoms alone using a dildo and/or with a sexual partner. Ten process evaluation interviews were conducted post intervention. Results Fifty-five young women received the intervention; 36 (65%) completed T2 and 33 (60%) completed T3. Condom use errors and problems decreased, self-efficacy increased and attitudes towards condoms improved significantly. The proportion of participants who reported using a condom for intercourse in the past 4 weeks increased from T1 (20; 47%) to T2 (27; 87%) and T3 (23; 77%) and using lubricant with a condom for intercourse increased from T1 (6; 30%) to T2 (13; 48%)) and T3 (16; 70%). However, motivation to use condoms did not change. Cronbach’s alpha scores indicated good internal consistency of measures used. Qualitative data provided strong evidence for the acceptability of the intervention. Conclusions HERS-UK was implemented as intended and the recruitment strategy was successful within a college/university setting. This feasibility study provided an early indication of the potential effectiveness and acceptability of the intervention, and the benefits of using a pleasure-focussed approach with young women. Measures used captured change in outcome variables and were deemed fit for purpose. Future research should explore cost-effectiveness of this intervention, in a large-scale controlled trial using a diverse sample and targeting young women most at risk of STIs

Which people are most affected by changes to data linkage methodology? An exploration of patient, organisational and spatiotemporal characteristics in administrative hospital data in England

Objectives In 2021, NHS Digital changed the process used to link records belonging to the same person across and within data collections. Our objectives were to identify patient, organisational and spatiotemporal characteristics associated with records impacted by this change and the implications for researchers using this data. Methods We used an observational cohort study of patients, aged 55 or less, with a secondary care contact recorded in any of the NHS Digital (now part of NHS England) curated Hospital Episode Statistics (HES) datasets between April 1997 and March 2021. We compared clusters of records assigned to each patient using the HES ID (old methodology using a three-step deterministic algorithm) and the Person ID (new methodology using a master patient spine). We used multivariable logistic regression to identify patient, organisational and spatiotemporal (such as area-level deprivation and year of first contact) characteristics associated with patients whose cluster had changed. Results Of 88 million hospital records in 2019, there were 18,968,711 distinct HES IDs and 18,717,142 distinct TPIs. Of the 12,701,169 HES IDs with more than one record, 145,948 (1.1%) were split into multiple Person IDs. Of the 12,999,671 Person IDs with more than one record, 483,091 (3.7%) were associated with two or more merged HES IDs. We will present an analysis using data covering the period April 1997 to March 2021 - 1.25 billion records - and present the characteristics associated with changes between linkage methods. Conclusion Our findings indicate that this change consolidated clusters, resulting in fewer distinct individuals in the data. Our findings will inform researchers about which groups of individuals are most likely to be affected by changes to linkage methodology. This is vital for understanding potential sources of bias due to linkage error

Cross-Sectional and Prospective associations of Rest-Activity Rhythms With Body Mass index in Older Men: a Novel analysis Using Harmonic Hidden Markov Models

Growing evidence supports a role for rest-activity rhythms (RARs) in metabolic health. Epidemiological studies in adolescents and young adults showed that RAR characteristics consistent with weakened rhythmicity were associated with obesity. However, studies in older adults are lacking. The objective of this study was to examine the cross-sectional and prospective associations between RAR and obesity in older men using the Harmonic Hidden Markov Model (HHMM), a novel analytical approach with several advantages over conventional methods for characterizing RAR. The analysis included nearly 3,000 participants in the Osteoporotic Fractures in Men study with 5-day 24-h actigraphy data. The strength of RAR was measured by rhythmic index (RI), a scaled value between 0 and 1 with higher values indicating better RAR. Multiple linear and logistic regression adjusting for multiple confounders were performed to examine the RI in relation to body mass index (BMI) and obesity status at baseline and after ~3.5 years of follow-up. We showed that the HHMM can derive both meaningful visual profile and quantifier of RAR. A lower RI was associated with higher BMI and obesity at baseline, and an elevated likelihood for developing obesity over follow-up. Specifically, when compared with men in the highest quartile of RI, those in the lowest quartile on average had a higher BMI (β [95% confidence interval (CI)], 1.76 [1.39, 2.13]) and were more likely to be obese at baseline (odds ratio (OR) [95% CI], 2.63 [2.03, 3.43]). Moreover, among nonobese men at baseline, those in the lowest quartile of RI were 2.06 times (OR [95% CI], 2.06 [1.02, 4.27]) more likely to develop obesity over follow-up when compared with those in the highest quartile. In conclusion, our study demonstrated the utility of HHMM in characterizing RAR and showed that rhythmicity strength was associated with BMI and risk of obesity in older men

Enhancing condom use experiences among young men to improve correct and consistent condom use:Feasibility of a Home-Based Intervention Strategy (HIS-UK)

Background: Condoms remain the main protection against sexually transmitted infections (STIs) when used correctly and consistently. Yet, there are many reported barriers to their use such as negative attitudes, reduced sexual pleasure, fit-and-feel problems and erection difficulties. The UK Home-Based Intervention Strategy (HIS-UK) is a behaviour change condom promotion intervention for use among young men (aged 16-25 years) designed to increase condom use by enhancing enjoyment of condom-protected intercourse. The objective of this feasibility study was to test HIS-UK for viability, operability and acceptability. Along with an assessment of the recruitment strategy and adherence to the intervention protocol, the study tested the reliability and suitability of a series of behavioural and condom use outcome measures to assess condom use attitudes, motivations, self-efficacy, use experience, errors and problems, and fit-and-feel.Methods: The HIS-UK intervention and associated assessment instruments were tested for feasibility using a single-arm, repeated measures design with baseline measurement and two follow-up measurements over three months. A three-month target of 50 young men completing the baseline questionnaire was set. Twenty process and acceptability evaluation interviews with participants and health promotion professionals were conducted post trial. Results: Of the 61 young men who registered for the study, 57 completed the baseline questionnaire and 33 met with the study researcher to receive the HIS-UK condom kit. Twenty-one young men remained for the duration of the study (64% retention). The Cronbach’s alpha scores for the condom use outcome measures were 0.84 Attitudes, 0.78 Self-efficacy, 0.83 Use experience, 0.69 Errors and problems, and 0.75 Fit-and-feel. Participant and health professional feedback indicated strong acceptability of the intervention. Conclusions: The feasibility study demonstrated that our recruitment strategy was appropriate and the target sample size was achieved. Adherence was favourable when compared to other similar studies. The condom use measures tested proved to be fit-for-purpose with good internal consistency. Some further development and subsequent piloting of HIS-UK is required prior to a full randomised-controlled trial, including the feasibility of collecting STI biomarkers, and assessment of participant acceptance of randomisation.Trial Registration: Research registry, RR2315, 27th March 2017 (retrospectively registered)<br/

Effect of Combination Folic Acid, Vitamin B6 , and Vitamin B12 Supplementation on Fracture Risk in Women: A Randomized, Controlled Trial.

Epidemiologic studies have demonstrated an association of elevated plasma homocysteine levels with greater bone resorption and fracture risk. Vitamins B12 , B6 , and folic acid are cofactors in homocysteine metabolism, and supplementation with B vitamins is effective in lowering homocysteine levels in humans. However, randomized trials of supplemental B vitamins for reduction of fracture risk have been limited. Therefore, we performed an ancillary study to the Women's Antioxidant and Folic Acid Cardiovascular Study (WAFACS), a large randomized trial of women with preexisting cardiovascular disease or three or more coronary risk factors, to test whether a daily B vitamin intervention including folic acid (2.5 mg/day), vitamin B6 (50 mg/day), and vitamin B12 (1 mg/day) reduces nonspine fracture risk over 7.3 years of treatment and follow-up. Among 4810 women, we confirmed 349 nonspine fracture cases by centralized review of medical records. In a substudy of 300 women (150 in treatment group and 150 controls) with paired plasma samples at randomization and follow-up (7.3 years later), we measured two bone turnover markers, including C-terminal cross-linking telopeptide of type I collagen (CTX) and intact type I procollagen N-propeptide (P1NP). In Cox proportional hazards models based on intention-to-treat, we found no significant effects of B vitamin supplementation on nonspine fracture risk (relative hazard = 1.08; 95% confidence interval, 0.88 to 1.34). In a nested case-cohort analysis, there were no significant effects of B vitamins on fracture risk among women with elevated plasma homocysteine levels, or low levels of vitamins B12 or B6 , or folate at baseline. Furthermore, treatment with B vitamins had no effect on change in markers of bone turnover. We found no evidence that daily supplementation with B vitamins reduces fracture risk or rates of bone metabolism in middle-aged and older women at high risk of cardiovascular disease. © 2017 American Society for Bone and Mineral Research