The utility of pulse volume waveforms in the identification of lower limb arterial insufficiency

Background: The ankle brachial index is widely used for non-invasive assessment of lower limb arterial status, but has recognised limitations. The most significant limitation involves arterial calcification, which results in artefactually raised occlusion pressures and uninformative ankle brachial indices. Hypothesis: Analysis of the pulse volume waveform is useful for identification of lower limb arterial insufficiency in the presence of arterial calcification. Method: Individuals (n = 1101) registered at a Welsh general practice were invited to undergo cardiovascular risk assessment. The ankle brachial index was measured using an automated device utilising volume plethysmography and the traditional Doppler ultrasound method. Results: Eight percent of participants (30/368) had an ankle brachial index *1.3, suggesting possible arterial calcification; consideration of the pulse volume waveform in these cases identified possible mild peripheral arterial disease in three cases (10%). Furthermore, in one case, the ankle brachial indices were within the normal range, but the pulse volume waveforms suggested a moderate degree of arterial insufficiency; this participant was subsequently diagnosed with bilateral superficial femoral artery stenoses and treated accordingly. Conclusion: Pulse volume waveforms can be easily utilised as an adjunct to ankle brachial index measurement to identify patients who may benefit from further vascular assessment and interventio

Inconsistency of threat level in soft armour standards, correlation of experimental tests to bullet X-ray 3D images

Fundamental to any ballistic armour standard is the reference projectile that is to be defeated. Typically, for certification, consistency of bullet geometry is assumed. Therefore, practical variations in bullet jacket dimensions can have far reaching consequences. Traditionally, internal dimensions have been analysed by physically sectioning bullets – an approach which rules out any subsequent ballistic assessment. The use of a non-destructive X-ray Computed Tomography (CT) method was demonstrated in [1]. Now, the authors apply this technique to correlate bullet impact response to jacket thickness variations. A set of 20 bullets (9 mm DM 11) was selected to analyse both intra and inter bullet variations using an image based analysis method to map the jacket thickness and measure the centre of gravity. Thickness variations of the order of 200μm were found commonly across all the bullets along the length and an angular variation of up to 50μm was found in a few bullets. The bullets were subsequently impacted against a rigid flat plate and re-scanned. The results of the experiments are shown and compared to the un-deformed bullet jacket thickness variations. The conclusions are relevant for future soft armour standards and provide important data for numerical model correlation and development

Data assmilation tests using NISE10 Storm Surge Model

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Leading, Energizing, and Developing Staff Through Times of Change

The nature of library work is changing. New technology, user preferences, tighter budgets, and new expectations have meant that libraries have altered and adapted the way they provide resources and services. While these changes have brought many benefits to library users, innovations in how libraries provide resources and services often have long-term implications on the skills needed from librarians and staff. Now more than ever, it\u27s important to communicate to staff about the future of their work and their roles in the library, and to provide them with the development and training they need to transition into new roles. Where do you see yourself in the next five years? is no longer applicable to just those looking to move up in the profession, but also to those individuals who wish to grow within in their current position. Takeaways: 1) Participants will be able to identify the challenges managers face when communicating with staff about the future of their work and their role in the library. 2) Participants will be able to describe the methods for conveying vision and change to staff. 3) Participants will be able to identify resources they can use to help staff transition to new roles in the library

Using intervention mapping to develop and adapt a secondary stroke prevention program in Veterans Health Administration medical centers

Secondary stroke prevention is championed by the stroke guidelines; however, it is rarely systematically delivered. We sought to develop a locally tailored, evidence-based secondary stroke prevention program. The purpose of this paper was to apply intervention mapping (IM) to develop our locally tailored stroke prevention program and implementation plan. We completed a needs assessment and the five Steps of IM. The needs assessment included semi-structured interviews of 45 providers; 26 in Indianapolis and 19 in Houston. We queried frontline clinical providers of stroke care using structured interviews on the following topics: current provider practices in secondary stroke risk factor management; barriers and needs to support risk factor management; and suggestions on how to enhance secondary stroke risk factor management throughout the continuum of care. We then describe how we incorporated each of the five Steps of IM to develop locally tailored programs at two sites that will be evaluated through surveys for patient outcomes, and medical records chart abstraction for processes of care

The utility of pulse volume waveforms in the identification of lower limb arterial insufficiency

Background: The ankle brachial index is widely used for non-invasive assessment of lower limb arterial status, but has recognised limitations. The most significant limitation involves arterial calcification, which results in artefactually raised occlusion pressures and uninformative ankle brachial indices. Hypothesis: Analysis of the pulse volume waveform is useful for identification of lower limb arterial insufficiency in the presence of arterial calcification. Method: Individuals (n = 1101) registered at a Welsh general practice were invited to undergo cardiovascular risk assessment. The ankle brachial index was measured using an automated device utilising volume plethysmography and the traditional Doppler ultrasound method. Results: Eight percent of participants (30/368) had an ankle brachial index *1.3, suggesting possible arterial calcification; consideration of the pulse volume waveform in these cases identified possible mild peripheral arterial disease in three cases (10%). Furthermore, in one case, the ankle brachial indices were within the normal range, but the pulse volume waveforms suggested a moderate degree of arterial insufficiency; this participant was subsequently diagnosed with bilateral superficial femoral artery stenoses and treated accordingly. Conclusion: Pulse volume waveforms can be easily utilised as an adjunct to ankle brachial index measurement to identify patients who may benefit from further vascular assessment and interventio

Person-centered Outcomes in Culturally and Diverse Contexts: International Application of the ICF

This session is developed by, and presenters invited by, Cultural and Linguistic Considerations Across the Discipline. This session was developed by the Convention Program Committee to increase SLPs’ awareness regarding research and clinical applications of the International Classification of Functioning, Disability and Health (ICF) across pediatric and adult populations around the world. Discussants provide perspectives from Australia, Brazil, Canada, Jamaica, and the United States