Fast detection of venous air embolism in Doppler heart sound using the wavelet transform

The introduction of air bubbles into the systemic circulation can result in significant morbidity. Real-time monitoring of continuous heart sound in patients detected by precordial Doppler ultrasound is, thus, vital for early detection of venous air embolism (VAE) during surgery. In this study, the multiscale feature of wavelet transforms (WT's) is exploited to examine the embolic Doppler heart sound (DHS) during intravenous air injections in dogs. As both humans and dogs share similar physiological conditions, the authors' methods and results for dogs are expected to be applicable to humans. The WT of DHS at scale 2 j(j=1,2) selectively magnified the power of embolic, but not the normal, heart sound. Statistically, the enhanced embolic power was found to be sensitive (P<0.01 at 0.01 ml of injected air) and correlated significantly (P<0.0005, τ=0.83) with the volume of injected air from 0.01 to 0.10 ml. A fast detection algorithm of O(N) complexity with unit complexity constant for VAE was developed (processing speed=8 ms per heartbeat), which confirmed the feasibility of real-time processing for both humans and dogs.published_or_final_versio

Volume Estimation by Wavelet Transform of Doppler Heart Sound During Venous Air-Embolism in Dogs

The Doppler heart sound signals detected by the precordial Doppler ultrasound method under simulated sub clinical and clinically significant venous air embolism were studied in anesthetized dogs. Signal processing using wavelet transform enhanced the contrast of embolic to normal signal, facilitating automatic detection and extraction of embolic signal simply by thresholding. Linear relationship of good correlation coefficient was obtained in log-log scale between the subclinical volume of injected air and the corresponding embolic signal power in all dogs. The calibration curve was found to be good estimate of the volume of embolic air during simulated clinically significant venous air embolism. Hence, we overcame the need of constant human attention for detecting venous air embolism and the lack of quantitative information on the volume of embolic air in the traditional precordial Doppler ultrasound method by the present approach.published_or_final_versio

Prolonged myoclonus after a single bolus dose of propofol

Propofol is a commonly used anaesthetic agent and is rarely associated with seizure-like phenomena. This case report presents a young woman with seizure-like phenomena lasting more than 4 weeks after a single dose of propofol. The underlying pathophysiology of this condition is poorly understood but a psychological component is possible in this case. © 2009 The Authors.postprin

Detection and quantification of venous air embolism by wavelet analysis of Doppler heart sound

The wavelet analysis of the Doppler heart sound detected under controlled venous air embolism at sub-clinically and clinically significant volumes was studied in anaesthetized dogs. Signal processing with wavelet enhances the Dower of embolic signal and facilitates the simple detection and extraction of embolic heart beats by thresholding. The cumulative power of the extracted embolic heart beats is found to be linearly related to the volume of embolic air on the log-log scale, suggesting that it is feasible to estimate clinically significant volume of embolic air in human subjects by linearly extrapolating from sub-clinical embolic volumes.published_or_final_versio

A real-time monitor using wavelet analysis of the Doppler heart sound for the detection of venous air embolism

A fast detection algorithm for venous air embolism (VAE) was developed and implemented as a real-time monitor for detecting embolic heart sound and estimating embolic air volume. Its performance was evaluated under bolus injection of sub-clinical (0.0l to 0.80 ml) and continuous infusion of clinically significant (0.80 to 9.60 ml) air volumes in anaesthetized dogs. The clinically significant air emboli could be estimated based on the calibration curve obtained during sub-clinical VAE for a subject. The monitor also kept track of the cumulative embolic air volumes and alerted the anaesthetists once a predefined clinically significant embolic air volume was reached. As both humans and dogs share similar physiological conditions, our monitor for dogs are expected to be applicable to humans.published_or_final_versio

Higher media multi-tasking activity is associated with smaller gray-matter density in the anterior cingulate cortex

Media multitasking, or the concurrent consumption of multiple media forms, is increasingly prevalent in today’s society and has been associated with negative psychosocial and cognitive impacts. Individuals who engage in heavier media-multitasking are found to perform worse on cognitive control tasks and exhibit more socio-emotional difficulties. However, the neural processes associated with media multi-tasking remain unexplored. The present study investigated relationships between media multitasking activity and brain structure. Research has demonstrated that brain structure can be altered upon prolonged exposure to novel environments and experience. Thus, we expected differential engagements in media multitasking to correlate with brain structure variability. This was confirmed via Voxel-Based Morphometry (VBM) analyses: Individuals with higher Media Multitasking Index (MMI) scores had smaller gray matter density in the anterior cingulate cortex (ACC). Functional connectivity between this ACC region and the precuneus was negatively associated with MMI. Our findings suggest a possible structural correlate for the observed decreased cognitive control performance and socio-emotional regulation in heavy media-multitaskers. While the cross-sectional nature of our study does not allow us to specify the direction of causality, our results brought to light novel associations between individual media multitasking behaviors and ACC structure differences

Online detection and quantification of epidemics

<p>Abstract</p> <p>Background</p> <p>Time series data are increasingly available in health care, especially for the purpose of disease surveillance. The analysis of such data has long used periodic regression models to detect outbreaks and estimate epidemic burdens. However, implementation of the method may be difficult due to lack of statistical expertise. No dedicated tool is available to perform and guide analyses.</p> <p>Results</p> <p>We developed an online computer application allowing analysis of epidemiologic time series. The system is available online at <url>http://www.u707.jussieu.fr/periodic_regression/</url>. The data is assumed to consist of a periodic baseline level and irregularly occurring epidemics. The program allows estimating the periodic baseline level and associated upper forecast limit. The latter defines a threshold for epidemic detection. The burden of an epidemic is defined as the cumulated signal in excess of the baseline estimate. The user is guided through the necessary choices for analysis. We illustrate the usage of the online epidemic analysis tool with two examples: the retrospective detection and quantification of excess pneumonia and influenza (P&I) mortality, and the prospective surveillance of gastrointestinal disease (diarrhoea).</p> <p>Conclusion</p> <p>The online application allows easy detection of special events in an epidemiologic time series and quantification of excess mortality/morbidity as a change from baseline. It should be a valuable tool for field and public health practitioners.</p

Effect of simulated microgravity on the virulence properties of the opportunistic bacterial pathogen Staphylococcus aureus

Extended manned space flight will result in a diminution of immune status and cause profound changes in the human bacterial microbiota, leading to increased risk of infection. Experiments conducted during short-term flight suggest that growth in microgravity leads to increases in bacterial antibiotic resistance and to cell wall changes. Growth under low-shear modelled microgravity (LSMMG) indicated that a reduced gravitational field acts as an environmental signal for expression of enhanced bacterial virulence in Gram-negative pathogens. We examined the effect of simulated microgravity on parameters of virulence in clinical isolates of Staphylococcus aureus. Three strains were grown under LSMMG in a High Aspect Ratio Vessel and compared with cells grown under normal gravity (NG) in the same vessel. There were no significant differences in the antibiotic susceptibility, growth rate or morphology of staphylococci grown under LSMMG compared to NG. LSMMG-induced reductions in synthesis of the pigment staphyloxanthin were noted. Strains secreted less protein under LSMMG and reductions in haemolysin secretion were found. Reduced expression of the major virulence determinant "-toxin in the microgravity environment was found by gene amplification. Thus, in contrast to published data on Gram-negative pathogens, simulated microgravity reduces the expression of key virulence determinants of S. aureus

The do's, don't and don't knows of supporting transition to more independent practice

Introduction: Transitions are traditionally viewed as challenging for clinicians. Throughout medical career pathways, clinicians need to successfully navigate successive transitions as they become progressively more independent practitioners. In these guidelines, we aim to synthesize the evidence from the literature to provide guidance for supporting clinicians in their development of independence, and highlight areas for further research. Methods: Drawing upon D3 method guidance, four key themes universal to medical career transitions and progressive independence were identified by all authors through discussion and consensus from our own experience and expertise: workplace learning, independence and responsibility, mentoring and coaching, and patient perspectives. A scoping review of the literature was conducted using Medline database searches in addition to the authors’ personal archives and reference snowballing searches. Results: 387 articles were identified and screened. 210 were excluded as not relevant to medical transitions (50 at title screen; 160 at abstract screen). 177 full-text articles were assessed for eligibility; a further 107 were rejected (97 did not include career transitions in their study design; 10 were review articles; the primary references of these were screened for inclusion). 70 articles were included of which 60 provided extractable data for the final qualitative synthesis. Across the four key themes, seven do’s, two don’ts and seven don’t knows were identified, and the strength of evidence was graded for each of these recommendations. Conclusion: The two strongest messages arising from current literature are first, transitions should not be viewed as one moment in time: career trajectories are a continuum with valuable opportunities for personal and professional development throughout. Second, learning needs to be embedded in practice and learners provided with authentic and meaningful learning opportunities. In this paper, we propose evidence-based guidelines aimed at facilitating such transitions through the fostering of progressive independence

Estimating adjusted prevalence ratio in clustered cross-sectional epidemiological data

BACKGROUND: Many epidemiologic studies report the odds ratio as a measure of association for cross-sectional studies with common outcomes. In such cases, the prevalence ratios may not be inferred from the estimated odds ratios. This paper overviews the most commonly used procedures to obtain adjusted prevalence ratios and extends the discussion to the analysis of clustered cross-sectional studies. METHODS: Prevalence ratios(PR) were estimated using logistic models with random effects. Their 95% confidence intervals were obtained using delta method and clustered bootstrap. The performance of these approaches was evaluated through simulation studies. Using data from two studies with health-related outcomes in children, we discuss the interpretation of the measures of association and their implications. RESULTS: The results from data analysis highlighted major differences between estimated OR and PR. Results from simulation studies indicate an improved performance of delta method compared to bootstrap when there are small number of clusters. CONCLUSION: We recommend the use of logistic model with random effects for analysis of clustered data. The choice of method to estimate confidence intervals for PR (delta or bootstrap method) should be based on study design