Tissue Tracking Imaging for Identifying the Origin of Idiopathic Ventricular Arrhythmias: A New Role of Cardiac Ultrasound in Electrophysiology

Several strategies for mapping ventricular outflow tract tachycardia have been reported as useful indices for differentiating between those originating from the right and the left side. Recently, tissue tracking imaging (TTI) has been demonstrated as a novel non-invasive modality for identifying the origin of outflow tract tachycardias. Tissue tracking imaging is an ultrasonographic technique that measures the myocardial motion amplitude towards the transducer in each region during systole, identifying regional myocardial displacement on the basis of myocardial velocities using color Doppler myocardial imaging principles. In this technique, the origin of the arrhythmia could be recognized as the site where the earliest color-coded signal (ECCS) appeared on the myocardium at the onset of the systole. In preliminary studies this modality was found to be useful in differentiating out flow tract ventricular tachycardias. ECCS was always found below or at the level of the pulmonary valve in all arrhythmias which could be ablated from the right ventricular outflow tract, while in those where the origin was above the pulmonary valve could be ablated from the left sinus of valsalva. These results indicate that TTI can provide detailed and accurate information on the arrhythmia origin of OT-VT and may be useful for differentiating between an OT-VT originating from the LV epicardium remote from the LSV and that from the LSV. Newer advances in echocardiographic technologies like high resolution, high frame rate real time three dimensional echocardiography with speckle tracking may further improve the precise localization of arrhythmias in the future

Yield stress dependency on the evolution of bubble populations generated in consolidated soft sediments

Retention of hydrogen bubbles within consolidated soft sediments represents an important safety consideration for the management of legacy nuclear wastes due to the potential for acute gas release. Gas retention sufficiently reduced the bulk density of intermediate yield stress (< 800 Pa) sediments for the bed to become buoyant with respect to an aqueous supernatant, potentially inducing Rayleigh-Taylor instabilities. X-ray computed tomography revealed that beds of 7-234 Pa yield stress retained very similar, steady state size distributions of mature bubbles, limited to 9 mm equivalent spherical diameter, for long residence times. This implied a dominant gas release mechanism dictated by the pore to millimeter scale bubble population, not previously identified in such weak sediments and unrelated to the bubbles' buoyant force. At 1112 Pa yield stress, large bubbles of up to 20 mm diameter were observed to grow through induction of lateral cracks, facilitating gas transport to the bed periphery, thereby limiting the maximum void fraction, while non-homogeneous gas generation promoted the formation of low density regions rich with micro-bubbles which similarly provide pathways for gas release

An X-ray Tomography Study of Gas Retention in Nuclear Legacy Waste

The retention and release of flammable gases from corroded Magnox sludge waste at Sellafield, UK and secondary reprocessing waste at Hanford, USA has significant economic and safety implications for decommissioning various nuclear legacy buildings. Magnesium hydroxide is the primary precipitation product from the corrosion of first generation nuclear fuel in the UK, with hydrogen gas produced as a reaction by-product. Depending on the bed microstructure, wettability and shear yield stress behaviour, some consolidated sediments of these corrosion products are able to trap a substantial volume of gas, sufficient in some instances to become buoyant with respect to a water supernatant, resulting in an undesirable upward transfer of radioactive material from the consolidated bed. These phenomena are investigated using the decomposition of hydrogen peroxide to produce oxygen bubbles within magnesium hydroxide soft sediments at laboratory scale. X-ray tomography analysis showed that high strength sediments of 1112 Pa shear yield stress supported much larger bubbles up to 20 mm equivalent spherical diameter than beds in the 7-234 Pa range, which demonstrated almost identical bubble size distributions across the range. The largest retained bubbles became progressively more distorted with increased sediment strength until the lateral cracks consistent with tensile fracture became apparent in the 1112 Pa bed. These cracks significantly limited the capacity for bed swell as gas diffusion along the cracks to the container walls provided a continuous escape route. The capacity for gas retention was also substantially reduced when gas generation was not homogeneous through the bed as localised gas generation promoted the formation of low density pathways, rich with micro-bubbles, which enable gas transport through the bed

On the supranational spell of PISA in policy

BACKGROUND: PISA results appear to have a large impact upon government policy. The phenomenon is growing, with more countries taking part in PISA testing and politicians pointing to PISA results as reasons for their reforms. PURPOSE: The aims of this research were to depict the policy reactions to PISA across a number of jurisdictions, to see whether they exhibited similar patterns and whether the same reforms were evident. SOURCES OF EVIDENCE: We investigated policy and media reactions to the 2009 and 2012 PISA results in six cases: Canada, China (Shanghai), England, France, Norway and Switzerland. Cases were selected to contrast high-performing jurisdictions (Canada, China) with average performers (England, France, Norway and Switzerland). Countries that had already been well reported on in the literature were excluded (Finland, Germany). DESIGN AND METHODS: Policy documents, media reports and academic articles in English, French, Mandarin and Norwegian relating to each of the cases were critically evaluated. RESULTS: A policy reaction of ‘scandalisation’ was evident in four of the six cases; a technique used to motivate change. Five of the six cases showed ‘standards-based reforms’ and two had reforms in line with the ‘ideal-governance’ model. However, these are categorisations: the actual reforms had significant differences across countries. There are chronological problems with the notion that PISA results were causal with regard to policy in some instances. Countries with similar PISA results responded with different policies, reflecting their differing cultural and historical education system trajectories. CONCLUSIONS: The connection between PISA results and policy is not always obvious. The supranational spell of PISA in policy is in the way that PISA results are used as a magic wand in political rhetoric, as though they conjure particular policy choices. This serves as a distraction from the ideological basis for reforms. The same PISA results could motivate a range of different policy solutions

Brain activity and connectivity during poetry composition: Toward a multidimensional model of the creative process

Creativity, a multifaceted construct, can be studied in various ways, for example, investigating phases of the creative process, quality of the creative product, or the impact of expertise. Previous neuroimaging studies have assessed these individually. Believing that each of these interacting features must be examined simultaneously to develop a comprehensive understanding of creative behavior, we examined poetry composition, assessing process, product, and expertise in a single experiment. Distinct activation patterns were associated with generation and revision, two major phases of the creative process. Medial prefrontal cortex (MPFC) was active during both phases, yet responses in dorsolateral prefrontal and parietal executive systems (DLPFC/IPS) were phase‐dependent, indicating that while motivation remains unchanged, cognitive control is attenuated during generation and re‐engaged during revision. Experts showed significantly stronger deactivation of DLPFC/IPS during generation, suggesting that they may more effectively suspend cognitive control. Importantly however, similar overall patterns were observed in both groups, indicating the same cognitive resources are available to experts and novices alike. Quality of poetry, assessed by an independent panel, was associated with divergent connectivity patterns in experts and novices, centered upon MPFC (for technical facility) and DLPFC/IPS (for innovation), suggesting a mechanism by which experts produce higher quality poetry. Crucially, each of these three key features can be understood in the context of a single neurocognitive model characterized by dynamic interactions between medial prefrontal areas regulating motivation, dorsolateral prefrontal, and parietal areas regulating cognitive control and the association of these regions with language, sensorimotor, limbic, and subcortical areas distributed throughout the brain. Hum Brain Mapp 36:3351–3372, 2015. © 2015 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113109/1/hbm22849.pd

Jejunal Perforation following Screening Colonoscopy

Colonoscopy is rarely associated with complications such as colonic perforation. Perforation of the small bowel is extremely rare, especially if the procedure is done without therapeutic interventions. Several factors are associated with this entity. Perforation of the ileum has been reported, but proximal jejunal perforation secondary to rupture of jejunal diverticulum during colonoscopy has not been reported. We present the case of an 88-year-old patient who developed abdominal pain after undergoing colonoscopy without any additional interventions. Urgent exploration revealed perforation of the proximal jejunum secondary to rupture of a jejunal diverticulum. No therapy or biopsies were undertaken during the colonoscopy, which are known predisposing factors

Opportunities for Process Monitoring Techniques at Delayed Access Facilities

Except for specific cases where the International Atomic Energy Agency (IAEA) maintains a continuous presence at a facility (such as the Japanese Rokkasho Reprocessing Plant), there is always a period of time or delay between the moment a State is notified or aware of an upcoming inspection, and the time the inspector actually enters the material balance area or facility. Termed by the authors as “delayed access,” this period of time between inspection notice and inspector entrance to a facility poses a concern. Delayed access also has the potential to reduce the effectiveness of measures applied as part of the Safeguards Approach for a facility (such as short-notice inspections). This report investigates the feasibility of using process monitoring to address safeguards challenges posed by delayed access at a subset of facility types

Physiologically-based pharmacokinetic models for children: Starting to reach maturation?

Developmental changes in children can affect the disposition and clinical effects of a drug, indicating that scaling an adult dose simply down per linear weight can potentially lead to overdosing, especially in very young children. Physiologically-based pharmacokinetic (PBPK) models are compartmental, mathematical models that can be used to predict plasma drug concentrations in pediatric populations and acquire insight into the influence of age-dependent physiological differences on drug disposition. Pediatric PBPK models have generated attention in the last decade, because physiological parameters for model building are increasingly available and regulatory guidelines demand pediatric studies during drug development. Due to efforts from academia, PBPK model developers, pharmaceutical companies and regulatory authorities, examp

The effect of transmucosal 0.2mg/kg Midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

&lt;b&gt;Background:&lt;/b&gt; The project aims were to evaluate the benefit of transmucosal Midazolam 0.2mg/kg pre-medication on anxiety, induction behaviour and psychological morbidity in children undergoing general anaesthesia (GA) extractions. &lt;b&gt;Method:&lt;/b&gt; 179 children aged 5-10 years (mean 6.53 years) participated in this randomised, double blind, placebo controlled trial. Ninety children had Midazolam placed in the buccal pouch. Dental anxiety was recorded pre operatively and 48 hours later using a child reported MCDAS-FIS scale. Behaviour at anaesthetic induction was recorded and psychological morbidity was scored by the parent using the Rutter Scale pre-operatively and again one-week later. Subsequent dental attendance was recorded at one, three and six months after GA. &lt;b&gt;Results:&lt;/b&gt; Whilst levels of mental anxiety did not reduce overall, the most anxious patients demonstrated a reduction in anxiety after receiving midazolam premedicationmay (p=0.01). Neither induction behaviour nor psychological morbidity improved. Irrespective of group, parents reported less hyperactive (p= 0.002) and more prosocial behaviour (p=0.002) after the procedure:;, older children improved most (p=0.048), Post GA Dental attendance was poor and unrelated to after the procedure and unaffected by premedication. &lt;b&gt;Conclusion:&lt;/b&gt; 0.2mg/kg buccal Midazolam provided some evidence for reducing anxiety in the most dentally anxious patients. However, induction behaviour, psychological morbidity and subsequent dental attendance were not found to alter between the premedication groups