Risk factor analysis for fast track protocol failure

Background: The introduction of fast-track treatment procedures following cardiac surgery has significantly shortened hospitalisation times in intensive care units (ICU). Readmission to intensive care units is generally considered a negative quality criterion. The aim of this retrospective study is to statistically analyse risk factors and predictors for re-admission to the ICU after a fast-track patient management program. Methods: 229 operated patients (67 ± 11 years, 75% male, BMI 27 ± 3, 6/2010-5/2011) with use of extracorporeal circulation (70 ± 31 min aortic crossclamping, CABG 62%) were selected for a preoperative fast-track procedure (transfer on the day of surgery to an intermediate care (IMC) unit, stable circulatory conditions, extubated). A uni- and multivariate analysis were performed to identify independent predictors for re-admission to the ICU. Results: Over the 11-month study period, 36% of all preoperatively declared fast-track patients could not be transferred to an IMC unit on the day of surgery (n = 77) or had to be readmitted to the ICU after the first postoperative day (n = 4). Readmission or ICU stay signifies a dramatic worsening of the patient outcome (mortality 0/10%, mean hospital stay 10.3 ± 2.5/16.5 ± 16.3, mean transfusion rate 1.4 ± 1,7/5.3 ± 9.1). Predicators for failure of the fast-track procedure are a preoperative ASA class > 3, NYHA class > III and an operation time >267 min ± 74. The significant risk factors for a major postoperative event (= low cardiac output and/or mortality and/or renal failure and/or re-thoracotomy and/or septic shock and/or wound healing disturbances and/or stroke) are a poor EF (OR 2.7 CI 95% 0.98-7.6) and the described ICU readmission (OR 0.14 CI95% 0.05-0.36). Conclusion: Re-admission to the ICU or failure to transfer patients to the IMC is associated with a high loss of patient outcome. The ASA > 3, NYHA class > 3 and operation time >267 minutes are independent predictors of fast track protocol failure

Experimental verification of the Heisenberg uncertainty principle for hot fullerene molecules

The Heisenberg uncertainty principle for material objects is an essential corner stone of quantum mechanics and clearly visualizes the wave nature of matter. Here we report a demonstration of the Heisenberg uncertainty principle for the most massive, complex and hottest single object so far, the fullerene molecule C70 at a temperature of 900 K. We find a good quantitative agreement with the theoretical expectation: dx * dp = h, where dx is the width of the restricting slit, dp is the momentum transfer required to deflect the fullerene to the first interference minimum and h is Planck's quantum of action.Comment: 4 pages, 4 figure

CONTRIBUTIONS TO CLUB VELOCITY IN GOLF SWINGS TO SUBMAXIMAL AND MAXIMAL SHOT DISTANCES

The contribution of joint rotations to endpoint velocity was investigated in golf shots to submaximal and maximal shot distances using a 41degrees of freedom (DOF) kinematic model. A subset of 16 DOFs was found to explain 97%-99% of endpoint velocity regulation at club–ball contact. The largest contributors, for both groups at every shot condition, were pelvis and torso twist rotation among the most proximal DOFs, elbow pronation/supination and wrist flexion/extension among DOFs in the left arm, and shoulder internal/external rotation and wrist flexion/extension among DOFs in the right arm. The contributions from pelvis obliquity, left wrist flexion/extension, left wrist ulnar/radial deviation and right shoulder flexion/extension differed significantly between the advanced and intermediate group

Effects of post activation potentiation on electromechanical delay

Electromechanical delay (EMD) presumably depends upon both contractile and tensile factors. It has recently been used as an indirect measure of muscle tendon stiffness to study adaptations to stretching and training. The aim of the present study was to investigate whether contractile properties induced by a 6 s maximum voluntary isometric contraction (MVIC) could affect EMD without altering passive muscle tendon stiffness or stiffness index. Plantar flexor twitches were evoked via electrical stimulation of the tibial nerve in eight highly trained male sprinters before and after a 6 s MVIC in passive isometric or passively shortening or lengthening muscles. For each twitch, EMD, twitch contractile properties and SOLM-Wave were measured. Passive muscle tendon stiffness was measured from the slope of the relation between torque and ankle angle during controlled passive dorsal flexion and stiffness index by curve-fitting the torque angle data using a second-order polynomial function. EMD did not differ between isometric, lengthening or shortening movements. EMD was reduced by up to 11.56 ± 5.64% immediately after the MVIC and stayed depressed for up to 60 s after conditioning. Peak twitch torque and rate of torque development were potentiated by up to 119.41 ± 37.15% and 116.06 ± 37.39%, respectively. Rising time was reduced by up to 14.46 ± 7.22%. No significant changes occurred in passive muscle tendon stiffness or stiffness index. Using a conditioning MVIC, it was shown that there was an acute enhancement of contractile muscle properties as well as a significant reduction in EMD with no corresponding changes in stiffness. Therefore, caution should be taken when using and interpreting EMD as a proxy for muscle tendon stiffness.info:eu-repo/semantics/publishedVersio

The wave nature of biomolecules and fluorofullerenes

We demonstrate quantum interference for tetraphenylporphyrin, the first biomolecule exhibiting wave nature, and for the fluorofullerene C60F48 using a near-field Talbot-Lau interferometer. For the porphyrins, which are distinguished by their low symmetry and their abundant occurence in organic systems, we find the theoretically expected maximal interference contrast and its expected dependence on the de Broglie wavelength. For C60F48 the observed fringe visibility is below the expected value, but the high contrast still provides good evidence for the quantum character of the observed fringe pattern. The fluorofullerenes therefore set the new mark in complexity and mass (1632 amu) for de Broglie wave experiments, exceeding the previous mass record by a factor of two.Comment: 5 pages, 4 figure

Does a specific MR imaging protocol with a supine-lying subject replicate tarsal kinematics seen during upright standing?

Magnetic resonance (MR) imaging is becoming increasingly important in the study of foot biomechanics. Specific devices have been constructed to load and position the foot while the subject is lying supine in the scanner. The present study examines the efficacy of such a newly developed device in replicating tarsal kinematics seen during the more commonly studied standing loading conditions. The results showed that although knee flexion and the externally applied load were carefully controlled, subtalar and talo-navicular joint rotations while lying during MR imaging and when standing (measured opto-electrically with markers attached to intracortical pins) did not match, nor were they systematically shifted. Thus, the proposed MR protocol cannot replicate tarsal kinematics seen during upright standing. It is concluded that specific foot loading conditions have to be considered when tarsal kinematics are evaluated. Improved replication of tarsal kinematics in different postures should comprehensively consider muscle activity, a fixed hip position, and a well-defined point of load applicatio

Motion of the rearfoot, ankle and subtalar joints and ankle moments when wearing lateral wedge insoles – results from bone anchored markers

ISSN:1757-114

Collisional decoherence observed in matter wave interferometry

We study the loss of spatial coherence in the extended wave function of fullerenes due to collisions with background gases. From the gradual suppression of quantum interference with increasing gas pressure we are able to support quantitatively both the predictions of decoherence theory and our picture of the interaction process. We thus explore the practical limits of matter wave interferometry at finite gas pressures and estimate the required experimental vacuum conditions for interferometry with even larger objects.Comment: 4 pages, 3 figure

Diffraction of complex molecules by structures made of light

We demonstrate that structures made of light can be used to coherently control the motion of complex molecules. In particular, we show diffraction of the fullerenes C60 and C70 at a thin grating based on a standing light wave. We prove experimentally that the principles of this effect, well known from atom optics, can be successfully extended to massive and large molecules which are internally in a thermodynamic mixed state and which do not exhibit narrow optical resonances. Our results will be important for the observation of quantum interference with even larger and more complex objects.Comment: 4 pages, 3 figure

Decoherence of matter waves by thermal emission of radiation

Emergent quantum technologies have led to increasing interest in decoherence - the processes that limit the appearance of quantum effects and turn them into classical phenomena. One important cause of decoherence is the interaction of a quantum system with its environment, which 'entangles' the two and distributes the quantum coherence over so many degrees of freedom as to render it unobservable. Decoherence theory has been complemented by experiments using matter waves coupled to external photons or molecules, and by investigations using coherent photon states, trapped ions and electron interferometers. Large molecules are particularly suitable for the investigation of the quantum-classical transition because they can store much energy in numerous internal degrees of freedom; the internal energy can be converted into thermal radiation and thus induce decoherence. Here we report matter wave interferometer experiments in which C70 molecules lose their quantum behaviour by thermal emission of radiation. We find good quantitative agreement between our experimental observations and microscopic decoherence theory. Decoherence by emission of thermal radiation is a general mechanism that should be relevant to all macroscopic bodies.Comment: 5 pages, 4 figure