THE RELATIONSHIP BETWEEN HRV(rMSSD) AND OTHER CARDIOVASCULAR RISKS IN HEALTHY PARTICIPANTS AND PATIENTS WITH CHRONIC HEART FAILURE USING NOVEL INSTRUMENTS

Heart rate variability (HRV) reflects the modulation of cardiac function by autonomic and other physiological regulatory systems. HRV is accepted as a reliable and reproducible technique for assessing autonomic activity. Impaired autonomic function (measured through a reduction in HRV) predicts mortality and is associated with several disease states. Excess adiposity is also associated with higher risk of cardiovascular diseases, type 2 diabetes, cancer and other health disorders. Body composition analysis involves the measurement of adipose tissue and other components such as muscle, bone and minerals in the human body. The relationship between excess adiposity and autonomic dysfunction has also been reported. The present thesis is divided into three parts: (i) validation studies, (ii) control studies and (iii) heart failure studies. The first validation study compares HRV (rMSSD) measured simultaneously with a Polar s810i and Ithlete on an iPod touch, in both healthy and heart failure populations. The second study examines measurement options for body composition by comparing several bioelectrical impedance analysis devices in a healthy population. Four studies were then undertaken with control subjects, assessing differences in gender, ethnicity and lifestyle factors using the devices validated in the previous chapters. Finally, Ithlete software was used with heart failure participants to gauge the feasibility of using the device daily and obtaining user feedback. Ithlete was then used in a cardiac rehabilitation programme to help participants get the most out of the programme, by guiding their exercise to rest ratio. The relationships between HRV, HR and body composition have been explored in this research work and have contributed to the knowledge around how these relationships can be used in healthcare. The benefit of novel devices to measure these relationships in both clinical and healthy populations has also been demonstrated, with an emphasis on low cost devices with good reliability

Active plasmonic devices and optical metamaterials

We studied active near-infrared metamaterials based on phase transition of vanadium oxide thin films, asymmetrically coupled split-ring resonators for narrowing resonance line-widths , field effect modulation of plasmon propagation and 3D single layer, plasmonic negative-index metamaterials

Is it giant cell arteritis? : a retrospective audit on temporal artery biopsy for giant cell arteritis

Background: Giant cell arteritis (GCA) is the commonest of the vasculitides and should form part of the differential diagnosis of a new-onset headache in patients over 50 years with elevated inflammatory markers. Temporal artery biopsy (TAB) is the gold standard for its diagnoses. Aim: The aim of this audit was to determine whether patients referred for a TAB between 2010 and 2015 at Mater Dei Hospital qualified for a diagnosis of GCA and the significance of the TAB result in affecting management of GCA by correlating the clinical profile and biochemical criteria according to the guidelines based on the American College of Rheumatology (ACR) criteria. Results: The percentage of positive TABs in our cohort of 170 patients was 23%. The ESR (sensitivity - 100%) was shown to be a significant factor associated with a positive TAB when compared to CRP (sensitivity 90%). 79.5% of positive TAB results were patients aged between 70-89 years of age, proving age is also a significant factor. New onset headache was the most common complaint (66%). Only 45.9% of patients were started on steroids prior to TAB despite the clinical suspicion of GCA. This increased to 54.1% of patients on steroids after TAB was performed, pending a histology result. Conclusion:Our findings, which are similar to comparing studies, question the practicality of TAB in the clinical diagnosis of GCA. Clinical symptoms, raised ESR and increasing age proved to be significant factors contributing to the clinical diagnosis and management of GCA. Non-invasive ultrasonography can further confirm the diagnosis and is to replace TAB in the near future.peer-reviewe

Relationship Between Body Adiposity and Arterial Stiffness in Young Indian Adults

ABSTRACT Background: Obesity is one of the major cardiovascular risk factors and is linked with arterial stiffness. This study was undertaken to establish the relationship between regional adiposity and arterial stiffness using simple noninvasive techniques. Methods: In total, 181 young Asian Indian adults aged 18–28 years (mean age 21.9 ± 2.2) were measured for adiposity and arterial stiffness. Total body fat percentage was derived from skinfold thickness of various body sites. Body mass index and waist‑hip‑ratio were also measured. Arterial stiffness was measured using a SphygmoCor with a carotid‑radial pulse wave analysis technique. Results: Significant gender differences were observed on anthropometric variables including skinfold thickness (P < 0.05) and all the arterial stiffness variables (P < 0.05) except pulse wave velocity. Systolic pressure, augmentation pressure, augmentation index (AIx), AIx at 75% heart rate, and aortic systolic pressure had statistically significant correlations with all three adiposity variables (P < 0.05). Significant correlations were found in a higher number of variables in the females. Physical activity had negative correlations with arterial stiffness and adiposity variables (P < 0.05). Conclusion: Arterial stiffness measured by carotid‑radial pulse wave analysis is strongly related to adiposity measured from skinfold thickness in females. Females had higher arterial stiffness and adiposity compared with men. These findings could be helpful in future research using noninvasive arterial stiffness measurements

Kawasaki Disease Shock Syndrome vs Classical Kawasaki Disease: A Meta-analysis and Comparison With SARS-CoV-2 Multisystem Inflammatory Syndrome.

BACKGROUND: The emergence of increasing reports worldwide of a severe inflammatory process and shock in pediatric patients resembling Kawasaki disease (KD) and more specifically Kawasaki disease shock syndrome (KDSS), prompted us to explore KDSS in a preamble of a systematic comparison between the two conditions. METHODS: We completed a systematic review of KDSS and performed a meta-analysis comparison between reported KDSS cases and KD controls. RESULTS: A total of ten case-control series were included in the meta-analysis. KDSS patients were older (38.4 ± 30.6 vs. 21.9±19.5 months; P<0.001) compared to standard KD with equal sex distribution and completeness of clinical diagnostic criteria. KDSS present higher CRP (59.4±29.2 mg/dL vs. 20.8±14.8 mg/dL; p<0.001), lower albumin (2.7±0.5 g/dL vs. 3.3±0.5 g/dL; p<0.01), and lower platelets (255±149 109/L vs. 394±132 109/L; p<0.001) but only borderline higher WBC's (p=0.06). Differences in ALT, AST and ESR were non-significant. The odds of IVIG resistance (44.4% vs. 9.6%; (p<0.001) and the hospital length of stay (10.9±5.8 vs. 5.0±3.0 days; p<0.001) were higher in KDSS as were the odds of coronary artery abnormalities (33.9% vs. 8.6%; p<0.001). CONCLUSION: This first meta-analysis on KDSS versus KD represents a basis for future works on KDSS and opens the opportunity for future multicenter studies in the search of causal relationships between presenting elements and the eventual complications of KDSS. The similarities between SARS-CoV-2 multisystem inflammatory syndrome in children (MIS-C) and KDSS open new horizons to the understanding of the etiology and pathophysiology related to KDSS

Acetaminophen ingestion improves repeated sprint cycling performance in females: a randomized crossover trial

The aim of this study is to investigate the effect of acute acetaminophen (ACT) ingestion on eight maximal 30-second cycling bouts, interspersed with two-minute rests. Seven recreationally active females (N=7, 22.8±6.7 years of age, with a stature of 163.4±5.8 cm, and body mass of 58.9±5.9 kg) participated in a placebo-controlled, randomized crossover design. Pain perception, heart rate, and power profiles were analyzed using a time x condition repeated measures ANOVA. Blood lactate after the eighth bout and total work done were analyzed using the paired samples t-test. Participants achieved a significantly greater (p=.007, =.725) peak power output during the ACT trials (402.9±73.8 W, 95% CI=334.6–471.1 W) when compared to the placebo (PLA) trials (378.7±64.6 W, 95% CI=319.0–438.4 W). Supplementation of ACT had no effect on mean power output, blood lactate accumulation, pain perception, or total work done after eight bouts (p>.05). Data presented here suggest females can improve peak power output during repeated Wingate tests with ACT ingestion. It is proposed that the altered afferent feedback may have caused these alterations in power output

Connections: the power of learning together to improve healthcare in the United Kingdoms

An edited collection of chapters from international experts on patient engagement. Chapter 6.Connections: The Power of Learning Together to Improve Healthcare in the United Kingdom. A research review of patient engagement, with consideration of practical techniques to teach and support patient engagement. The voices of patients are strong with pieces written by twelve patients on their experiences of involvement

Silver diffusion bonding and layer transfer of lithium niobate to silicon

A diffusion bonding method has been developed that enables layer transfer of single crystal lithium niobate thin films to silicon substrates. A silver film was deposited onto both the silicon and lithium niobate surfaces prior to bonding, and upon heating, a diffusion bond was formed. Transmission electron microscopy confirms the interface evolution via diffusion bonding which combines interfacial diffusion, power law creep, and growth of (111) silver grains to replace the as-bonded interface by a single polycrystalline silver film. The transferred film composition was the same as bulk lithium niobate