Contrast echocardiography

Contrast echocardiografie is onderzoek waarbij gebruik gemaakt wordt van een ingespoten stof die andere akoestische eigenschappen heeft dan bloed om de bloedstroom op het beeldscherm zichtbaar te maken. Bijna alle intraveneuze inspuitingen bevatten zeer kleine hoeveelheden lucht en kunnen dus als echo contrast middel gebruikt worden. Kleine hoeveelheden steriel koolzuur kunnen aan de oplossing worden toegevoegd en verhogen het echo contrast effect. Zeer kleine gasbellen passeren gewoonlijk niet door capillairen. Dit gebeurt wel wanneer men in de pulmonale "wedge" positie inspuit zodat zij in de linker kant van het hart aankomen. Het mechanisme van deze transmissie van gasbellen werd onderzocht in dierexperimenteel onderzoek met behulp van verschillende agentia. Er zijn veel belangrijke klinische vraagstellingen waarbij contrast echocardiografie nuttige informatie kan geven: structuur identificatie, het aantonen of uitsiuiten van intracardiale of intrapulmonale rechts-links shunts, de diagnose van congenitale hartziekten, en de diagnose van tricuspidalls insufficientie. Wij hebben aangetoond dat postoperatieve shunts nog aanwezig kunnen zijn lang na succesvolle sluiting van interatriale communicaties. De toekomstmogelijkheden voor contrast echocardiografie zijn indrukwekkend. Theoretisch is het mogelijk dat de graad van doorstroming van het myocard, het hartminuutvo!ume, de grootte van een shunt, en zelfs de intracardiale druk gemeten kunnen worden met behulp van speciaal ontworpen microbellen

Cardiac catheterization under echocardiographic control in a pregnant woman

A 22 year old woman had signs of rheumatic mitral and aortic valve disease early in pregnancy. Cardiac catheterization was performed during her third month of pregnancy under two-dimensional echocardiographic control without the use of ionizing radiation. Severe mitral stenosis with mild aortic stenosis was found. Five cubic centimeters of 5 percent dextrose in water were injected by hand to obtain left ventriculograms and supravalvular aortograms of sufficient quality to diagnose valvular regurgitation. The use of "echo-catheterization" may have significant advantages in selected clinical situations

Videodensitometric processing of contrast two-dimensional echocardiographic data

We developed a computer program to analyze videodensity changes due to contrast appearance within a given operator-designated rectangle using two-dimensional echocardiograms previously recorded on videotape. Videodensity curves have been obtained from two-dimensional echocardiographic recordings in 14 patients after a total of 32 injections of 5% dextrose solution into the left ventricle during cardiac catheterization. The resulting videodensity vs time curves have some characteristics of indicator-dilution curves. The decay phase of these curves is largely mono-exponential. Potential clinical applications of this technique in measurement of ejection fraction, cardiac output and shunt quantification are discussed, as well as some potential limitations

Electron-Phonon Dynamics in an Ensemble of Nearly Isolated Nanoparticles

We investigate the electron population dynamics in an ensemble of nearly isolated insulating nanoparticles, each nanoparticle modeled as an electronic two-level system coupled to a single vibrational mode. We find that at short times the ensemble-averaged excited-state population oscillates but has a decaying envelope. At long times, the oscillations become purely sinusoidal about a ``plateau'' population, with a frequency determined by the electron-phonon interaction strength, and with an envelope that decays algebraically as t^-{1/2} We use this theory to predict electron-phonon dynamics in an ensemble of Y_2 O_3 nanoparticles.Comment: 11 pages, 3 figure

Transmission of ultrasonic contrast through the lungs

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Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism.

In this article we use the example of race/ethnic inequalities in severe mental illness to demonstrate the utility of a novel integrative approach to theorising the role of racism in generating inequality. Ethnic minority people in the UK are at much greater risk than White British people of being diagnosed with a severe - psychosis related - mental illness, and this is particularly the case for those with Black Caribbean or Black African origins. There is entrenched dispute about how we might understand the drivers of this inequality. To address this dispute we build on, and to a certain extent refine, established approaches to theorising structural and institutional racism, and integrate this within a theoretical framework that also incorporates racist/discriminatory interactions (interpersonal racism). We argue that this provides a conceptually robust and thorough analysis of the role of inter-related dimensions of racism in shaping risks of severe mental illness, access to care, and policy and practice responses. This analysis carries implications for a broader, but integrated, understanding of the fundamental drives of race/ethnic inequalities in health and for an anti-racism public health agenda

The population history of northeastern Siberia since the Pleistocene

FGW – Publications without University Leiden contractDescriptive and Comparative Linguistic

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

OPTICAL DEPHASING OF Pr3+ IONS BY NONEQUILIBRIUM PHONONS IN LaF3 AND YAlO3

We describe a new effect, phonon-induced coherence loss (PICOLO), whereby a monoenergetic nonequilibrium phonon distribution is responsible for the loss of optical coherence. The interaction of these phonons with the ions is monitored with the free induction decay or photon echo. We show how PICOLO can be used to study the electron-phonon interaction and the dynamics of phonons