The Case for Aggressive Treatment of Pulmonary Embolism

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68484/2/10.1177_153857449703100336.pd

Invited commentary

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41285/1/268_2005_Article_BF01658888.pd

In Vivo Evaluation of Vena Caval Filters: Can Function Be Linked to Design Characteristics?

Purpose: To compare the five vena caval filters marketed in the United States and one investigational vena caval filter and to determine whether there is an association between their design and their in vivo function.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42415/1/270-23-6-460_00230460.pd

“Bull's-eye” sign on gadolinium-enhanced magnetic resonance venography determines thrombus presence and age: A preliminary study

AbstractPurpose: Venous thrombosis is associated with a significant inflammatory response, which can be visualized by gadolinium magnetic resonance venography (MRV). Gadolinium extravasates into tissue during inflammation, producing perithrombus enhancement on magnetic resonance scanning. This study determines (1) whether gadolinium enhancement occurs during deep venous thrombosis (DVT); and (2) whether this enhancement changes with time and can therefore establish the age of thrombus.Methods: Patients with a diagnosis of iliofemoral DVT by duplex ultrasound who were referred for MRV to document central thrombus extent were studied. T1 weighted images were obtained before and after gadolinium injection (0.1 mmol/kg); repeat scans were obtained up to 3 months thereafter. At the level of maximum thrombus, measurements of signal intensity were made at the periphery (rim), and the center of the thrombosed vein, as well as the contralateral normal vein, on images after gadolinium enhancement. Rim-center vein signal intensity ratios were then calculated and followed.Results: A total of 39 scans were obtained in 14 patients (eight men, six women). The thrombosed veins were enlarged, with a peripheral rim of enhancement (“bull's-eye” sign). The rim-center ratio for thrombosed veins (2.16 ± 0.18) was different from that of normal veins (0.66 ± 0.10; n = 39; p < 0.001). For all acute studies (≤14 days) the rim-center ratio was 2.38 ± 0.17 (n = 31), whereas for all chronic studies (>14 days) the rim-center ratio was 1.29 ± 0.44 (n = 8; p = 0.001). Among patients who underwent both early and late studies, the rim-center ratio dropped significantly, from 2.33 ± 0.20 acutely to 1.29 ± 0.44 in chronic studies (n = 8; p = 0.03). One patient with active malignancy had a paradoxic increase in rim-center ratio over time and a clinical recurrence of symptoms, suggesting active thrombosis.Conclusions: We conclude that (1) a pattern of peripheral gadolinium enhancement (bull's-eye sign) is seen around acutely thrombosed veins on gadolinium-enhanced MRV, facilitating DVT diagnosis; and (2) the ratio of signal intensity at the rim versus the center of the thrombosed vein may be a good discriminator of acute compared with chronic DVT, which may help direct therapy. (J Vasc Surg 1997;26:809-16.

HCI policy and the smart city

While the idea of the ‘Smart City’ has attracted increasing attention from academia, industry, and government this interest has largely had a technical and technological focus. This paper identifies some of the important political and policy challenges facing the idea, the discourse, of a ‘smart city’ as a means to optimise HCI input into the ‘smart city’ debate. It then addresses that gap by detailing a research project that explored how experts in smart city research and development in the UK context responded to this policy challenge. Experts were asked questions regarding their prior experience with the “smart city”, their understandings of what it means for a city to be smart, and what policy potentials they've recognised in the smart city. The paper analyses and offers a synthesis of the responses collected throughout the research with the current policies concerning various smart city proximity, thereby providing a critical assessment of the values underlying the smart city. The paper aims to explore and present some of the policy possibilities for UK smart cities that are potentially useful for politicians, policy makers, planners, academics, and technology companies. I believe that these perspectives for policy development can be used to inform responsible development, spatially and socially inclusive technologies, and ultimately more resilient and liveable cities