Sensors for Rate Responsive Pacing

Advances in pacemaker technology in the 1980s have generated a wide variety of complex multiprogrammable pacemakers and pacing modes. The aim of the present review is to address the different rate responsive pacing modalities presently available in respect to physiological situations and pathological conditions. Rate adaptive pacing has been shown to improve exercise capacity in patients with chronotropic incompetence. A number of activity and metabolic sensors have been proposed and used for rate control. However, all sensors used to optimize pacing rate metabolic demands show typical limitations. To overcome these weaknesses the use of two sensors has been proposed. Indeed an unspecific but fast reacting sensor is combined with a more specific but slower metabolic one. Clinical studies have demonstrated that this methodology is suitable to reproduce normal sinus behavior during different types and loads of exercise. Sensor combinations require adequate sensor blending and cross checking possibly controlled by automatic algorithms for sensors optimization and simplicity of programming. Assessment and possibly deactivation of some automatic functions should be also possible to maximize benefits from the dual sensor system in particular conditions. This is of special relevance in patient whose myocardial contractility is limited such as in subjects with implantable defibrillators and biventricular pacemakers. The concept of closed loop pacing, implementing a negative feedback relating pacing rate and the control signal, will provide new opportunities to optimize dual-sensors system and deserves further investigation. The integration of rate adaptive pacing into defibrillators is the natural consequence of technical evolution

Early Outcomes of Out-of-Hospital Cardiac Arrest after Early Defibrillation: a 24 Months Retrospective Analysis

Introduction: Cardiovascular disease remains the most common cause of death in the United States and most other Western nations. Among these deaths, sudden, out-of-hospital cardiac arrest claims approximately 1000 lives each day in the United States alone. Most of these cardiac arrests are due to ventricular fibrillation. Though highly reversible with the rapid application of a defibrillator, ventricular fibrillation is otherwise fatal within minutes, even when cardiopulmonary resuscitation is provided immediately. The overall survival rate in the United States is estimated to be less than 5 percent. Recent developments in automated-external-defibrillator technology have provided a means of increasing the rate of prompt defibrillation after out-of-hospital cardiac arrest. After minimal training, nonmedical personnel (e.g., flight attendants and casino workers) are also able to use defibrillators in the workplace, with lifesaving effects. Nonetheless, such programs have involved designated personnel whose job description includes assisting persons who have had sudden cardiac arrest. Data are still lacking on the success of programs in which automated external defibrillators have been installed in public places to be used by persons who have no specific training or duty to act. Materials and Methods: All patients who had an out-of-hospital cardiac arrest between January 2003 and December 2004 and who received early defibrillation for ventricular fibrillation were included. We conducted a 24 months retrospective population-based analysis of the outcome in our population. Results: Over a 24 month period, 446 people had non–traumatic cardiac arrest, and in all of them it was observed to be ventricular fibrillation. In a very few cases, the defibrillator operators were good Samaritans, acting voluntarily. Eighty-nine patients (about 19%) with ventricular fibrillation were successfully resuscitated, including eighteen who regained consciousness before hospital admission. Conclusion: Automated external defibrillators deployed in readily accessible, well-marked areas, are really very effective in assisting patients with cardiac arrest. However, it's quite true that, in the cases of survivors, most of our users had good prior training in the use of these devices

Pacemaker Prevention Therapy in Drug–refractory Paroxysmal Atrial Fibrillation: Reliability of Diagnostics and Effectiveness of Prevention Pacing Therapy in Vitatron™ Selection® device

Introduction. Atrial fibrillation (AF), the most common and rising disorder of cardiac rhythm, is quite difficult to control and/or to treat. Non pharmacological therapies for AF may involve the use of dedicated pacing algorithms to detect and prevent atrial arrhythmia that could be a trigger for AF onset. Selection 900E/AF2.0 Vitatron DDDRP pacemaker (1) keeps an atrial arrhythmia diary thus providing detailed onset reports of arrhythmias of interest, (2) provides us data about the number of premature atrial contractions (PACs) and (3) plots heart rate in the 5 minutes preceding the detection of an atrial arrhythmia. Moreover, this device applies four dedicated pacing therapies to reduce the incidence of atrial arrhythmia and AF events. Aim of the Study. To analyze the reliability to record atrial arrhythmias and evaluate effectiveness of its AF preventive pacing therapies. Material and Methods. We enrolled 15 patients (9 males and 6 females, mean age of 71±5 years, NYHA class I–II), with a DDDRP pacemaker implanted for a “bradycardia–tachycardia” syndrome, with advanced atrioventricular conduction disturbances. We compared the number and duration of AF episodes’ stored in the device with a contemporaneous 24h Holter monitoring. After that, we switched on the atrial arrhythmias detecting algorithms, starting from an atrial rate over 180 beats per minute for at least 6 ventricular cycles, and ending with at least 10 ventricular cycles in sinus rhythm. Thereafter, in order to evaluate the possible reduction in PACs number and in number and duration of AF episodes, we tailored all the four pacing preventive algorithms. Patients were followed for 24±8 months (from 20 to 32 months). Results. All 59 atrial arrhythmia episodes occurred in the first part of this trial, were correctly recorded by both systems, with a correlation coefficient (r) of 0.96. During the follow–up, we observed a significant reduction not only in PACs number (from 83±12/day to 2.3±0.8/day) but also in AF episodes (from 46±7/day to 0.12±0.03/day) and AF burden (from 93%±6% to 0.3%±0.06%). An increase in atrial pacing percentages (from 3%±0.5% to 97%±3%) was also contemporaneously observed. Conclusion. In this pacemaker, detection of atrial arrhythmia episodes is highly reliable, thus making available an appropriate monitoring of heart rhythm, mainly suitable in AF asymptomatic patients. Moreover, the significant reduction of atrial arrhythmia episodes indicates that this might represent a suitable therapeutic option for an effective preventive therapy of AF in paced brady–tachy patients

Serialized Asynchronous Links for NoC

This paper proposes an asynchronous serialized link for NoC that can achieve the same levels of performance in terms of flits per second as a synchronous link but with a reduced number of wires in the point to point switch links and reduced power consumption. This is achieved by employing serialization in the asynchronous domain as opposed to synchronous to facilitate the removal of global clocking on the serial links. Based on transistor level simulations using 0.12 ?m foundry models it has been shown that it is possible to achieve the same level of performance as synchronous but with 75% reduction in wires and 65% reduction in power for a 300 MFlit/s link with 8 buffers with a switch clock speed of 300 MHz. Furthermore the paper presents the design requirements arising from interfacing switches of synchronous NoC and asynchronous serial links

B→K∗ℓ+ℓ−B\to K^* \ell^+ \ell^- decays at large recoil in the Standard Model: a theoretical reappraisal

We critically reassess the theoretical uncertainties in the Standard Model calculation of the $B \to K^* \ell^+ \ell^-$ observables, focusing on the low $q^2$ region. We point out that even optimized observables are affected by sizable uncertainties, since hadronic contributions generated by current-current operators with charm are difficult to estimate, especially for $q^2 \sim 4 m_c^2\simeq 6.8$ GeV$^2$. We perform a detailed numerical analysis and present both predictions and results from the fit obtained using most recent data. We find that non-factorizable power corrections of the expected order of magnitude are sufficient to give a good description of current experimental data within the Standard Model. We discuss in detail the $q^2$ dependence of the corrections and their possible interpretation as shifts of the Standard Model Wilson coefficients.Comment: 33 pages, 7 figures, 11 tables. v2: fixed numerical error in S4 and typos; added discussion of the impact of future measurements; conclusions unchange

On Flavourful Easter eggs for New Physics hunger and Lepton Flavour Universality violation

Within the standard approach of effective field theory of weak interactions for $\Delta B = 1$ transitions, we look for possibly unexpected subtle New Physics effects, here dubbed "flavourful Easter eggs". We perform a Bayesian global fit using the publicly available HEPfit package, taking into account state-of-the-art experimental information concerning these processes, including the suggestive measurements from LHCb of $R_{K}$ and $R_{K^{*}}$, the latter available only very recently. We parametrize New Physics contributions to $b \to s$ transitions in terms of shifts of Wilson coefficients of the electromagnetic dipole and semi-leptonic operators, assuming CP-conserving effects, but allowing in general for violation of lepton flavour universality. We show how optimistic/conservative hadronic estimates can impact quantitatively the size of New Physics extracted from the fit. With a conservative approach to hadronic uncertainties we find nonzero New Physics contributions to Wilson coefficients at the level of $\sim 3\sigma$, depending on the model chosen. Furthermore, given the interplay between hadronic contributions and New Physics effects in the leptonic vector current, a scenario with nonstandard leptonic axial currents is comparable to the more widely advocated one with New Physics in the leptonic vector current.Comment: 27 pages, 6 figures and 5 tables. v2: numerical results and plots replaced with higher statistics MC runs, references added. v3: final version to appear in EPJ

Sensory analysis and consumer acceptance of 140 high-quality extra virgin olive oils

Background: Sensory analysis is a crucial tool for evaluating the quality of extra virgin olive oils. One aim of such an investigation is to verify if the sensory attributes themselves – which are strictly related to volatile and phenolic compounds – may permit the discrimination of high-quality products obtained by olives of different cultivars and/or grown in various regions. Moreover, a crucial topic is to investigate the interdependency between relevant parameters etermining consumer acceptance and objective sensory characteristics evaluated by the panel test. Results: By statistically analysing the sensory results, a grouping – but not discriminatory – effect was shown for some cultivars and some producing areas. The preference map shows that the most appreciated samples by consumers were situated in the direction of the ‘ripe fruity’ and ‘sweet’ axis and opposite to the ‘bitter’ and ‘other attributes’ (pungent, green fruity, freshly cut grass, green tomato, harmony, persistency) axis. Conclusion: Extra virgin olive oils produced from olives of the same cultivars and grown in the same areas shared similar sensorial attributes. Some differences in terms of expectation and interpretation of sensory characteristics of extra virgin olive oils might be present for consumers and panellists: most of the consumers appear unfamiliar with positive sensorial attributes, such as bitterness and pungency

Sensory Analysis of Virgin Olive Oil

Virgin olive oil (VOO) is the supernatant of the fresh juice obtained from olives by crushing, pressure and centrifugation, without additional refining. Its flavour is characteristic and is markedly different from those of other edible fats and oils. The combined effect of odour (directly via the nose or indirectly through a retronasal path, via the mouth), taste and chemical responses (as pungency) gives rise to the sensation generally perceived as “flavour”. Sensory analysis is an essential technique to characterize food and investigate consumer preferences. International cooperative studies, supported by the International Olive Oil Council (IOOC) have provided a sensory codified methodology for VOOs, known as the “COI Panel test”. Such an approach is based on the judgments of a panel of assessors, conducted by a panel leader, who has sufficient knowledge and skills to prepare sessions of sensory analysis, motivate judgement, process data, interpret results and draft the report. The panel generally consists of a group of 8 to 12 persons, selected and trained to identify and measure the intensity of the different positive and negative sensations perceived. Sensory assessment is carried out according to codified rules, in a specific tasting room, using controlled conditions to minimize external influences, using a proper tasting glass and adopting both a specific vocabulary and a profile sheet that includes positive and negative sensory attributes (Dec-23/98-V/2010). Collection of the results and statistical elaboration must be standardized (EEC Reg. 2568/91, EC Reg. 640/08). The colour of VOO, which is not significantly related to its quality, may produce expectations and interferences in the flavour perception phase. In order to eliminate any prejudices that may affect the smelling and tasting phases, panelists use a dark-coloured (blue or amber-coloured) tasting glass. Many chemical parameters and sensory analyses (EEC Reg. 2568/91 and EC Reg. 640/08), with the latter carried out by both olfactory and gustatory assessments, can classify oils in different quality categories (extra virgin, virgin, lampant). Extra virgin olive oil (EVOO) extracted from fresh and healthy olive fruits (Olea europaea L.), properly processed and adequately stored, is characterized by an unique and measurable combination of aroma and taste. Moreover, the category of EVOO should not show any defects (e.g. fusty, musty, winey, metallic, rancid) that can originate from incorrect production or storage procedures. Positive or negative sensory descriptors of VOO have been related to volatile and phenol profiles, which are responsible for aroma and taste, respectively. The characteristic taste of VOO, and in particular some positive attributes such as bitterness and pungency that are related to important health benefits, is not completely understood or appreciated by consumers. In this respect, it is interesting to consider the degree of acceptability of VOO in several countries based on literature data. In this way, it is possible to lay the foundations for correct instruction of the sensory characteristics of EVOO. The main chemical, biochemical and technological processes responsible for the positive and negative (defects) descriptors of VOO are summarized in this chapter. An overview on the sensory methodologies proposed, applied and modified during the last 20 years is also presented

Sensory Wheel and Lexicon for the Description of Cold-Pressed Hemp Seed Oil

: Cold-pressed hemp seed oil (CP-HSO) has become available on the market and is gaining popularity mainly for its appeal and nutritional profile. The sensory quality largely depends on seed quality and processing as well as oil storage conditions. Given the "native" nature of the product, obtained by cold-pressing, the development of a standardized methodology to evaluate and describe the sensory quality of HSOs is of the utmost importance. To this aim, 16 commercial HSOs were evaluated, covering the main differences in brands and sales channels. A trained panel developed a vocabulary to describe the HSO profile consisting of 44 attributes, and a practical sensory wheel was proposed to classify attributes in different clusters and according to sensory modality. A sensory profile sheet was developed including two color descriptors (yellow, green), seven main positive (sunflower/pumpkin seeds, nutty, toasted nutty, hay, sweet, bitter, and pungent), several secondary positive (herbs, coffee, tobacco, etc.), four main defects (rancid, paint, burnt, and fish), and other secondary negative descriptors (boiled vegetables, cucumber, etc.). Subsequently, specific training of the panelists was carried out, and a satisfactory performance level was reached. This study represents the first attempt to standardize the sensory quality and terminology of HSO