Multiple mechanisms of spiral wave breakup in a model of cardiac electrical activity

It has become widely accepted that the most dangerous cardiac arrhythmias are due to re- entrant waves, i.e., electrical wave(s) that re-circulate repeatedly throughout the tissue at a higher frequency than the waves produced by the heart's natural pacemaker (sinoatrial node). However, the complicated structure of cardiac tissue, as well as the complex ionic currents in the cell, has made it extremely difficult to pinpoint the detailed mechanisms of these life-threatening reentrant arrhythmias. A simplified ionic model of the cardiac action potential (AP), which can be fitted to a wide variety of experimentally and numerically obtained mesoscopic characteristics of cardiac tissue such as AP shape and restitution of AP duration and conduction velocity, is used to explain many different mechanisms of spiral wave breakup which in principle can occur in cardiac tissue. Some, but not all, of these mechanisms have been observed before using other models; therefore, the purpose of this paper is to demonstrate them using just one framework model and to explain the different parameter regimes or physiological properties necessary for each mechanism (such as high or low excitability, corresponding to normal or ischemic tissue, spiral tip trajectory types, and tissue structures such as rotational anisotropy and periodic boundary conditions). Each mechanism is compared with data from other ionic models or experiments to illustrate that they are not model-specific phenomena. The fact that many different breakup mechanisms exist has important implications for antiarrhythmic drug design and for comparisons of fibrillation experiments using different species, electromechanical uncoupling drugs, and initiation protocols.Comment: 128 pages, 42 figures (29 color, 13 b&w

ACHIEVING EFFICIENCY AND EQUITY IN IRRIGATION MANAGEMENT: AN OPTIMIZATION MODEL OF THE EL ANGEL WATERSHED, CARCHI, ECUADOR

The objective of this paper is to address the problems of inefficiency and inequity in water allocation in the El Angel watershed, located in Ecuador's Sierra region. Water is captured in a high-altitude region of the watershed and distributed downstream to producers in four elevation-defined zones via a system of canals. Upstream and downstream producers face radically different conditions with respect to climate and terrain. A mathematical programming model was created to study the consequences of addressing chronic water scarcity problems in the watershed by shifting water resources between the four zones. The model captures the nature of water use by humans, crops and dual purpose cattle. Its objective function maximizes producer welfare as measured by aggregate gross margin, subject to limited supplies of land, labor and water. Five water allocation scenarios are evaluated with respect to efficiency in land and water use and equity in income distribution. Results reveal that although water is the primary constrained resource downstream, in the upstream zones, land is far more scarce. The current distribution of water rights does not consider these differences and therefore is neither efficient nor equitable. Improvements in efficiency (resource use) and equity (income distribution) are associated with (1) a shift of water to the lower zone, and (2) the use of lower levels of irrigation intensity upstream. Furthermore, the scenarios that result in the most efficient use of resources also bring the greatest degree of equity in income distribution, indicating that these may be complementary, not conflicting, goals.Mathematical programming, water allocation, efficiency, equity, Resource /Energy Economics and Policy,

Looking for Distributed Star Formation in L1630: A Near-infrared (J, H, K) Survey

We have carried out a simultaneous, multi-band (J, H, K) survey over an area of 1320 arcmin^2 in the L1630 region, concentrating on the region away from the dense molecular cores and with modest visual extinctions (\leq 10 mag). Previous studies found that star formation in L1630 occurs mainly in four localized clusters, which in turn are associated with the four most massive molecular cores (Lada et al. 1991; Lada 1992). The goal of this study is to look for a distributed population of pre-main-sequence stars in the outlying areas outside the known star-forming cores. More than 60% of the pre-main-sequence stars in the active star forming regions of NGC 2024 and NGC 2023 show a near-infrared excess in the color-color diagram. In the outlying areas of L1630, excluding the known star forming regions, we found that among 510 infrared sources with the near-infrared colors ((J-H) and (H-K)) determined and photometric uncertainty at K better than 0.10 mag, the fraction of the sources with a near-infrared excess is 3%--8%; the surface density of the sources with a near-infrared excess is less than half of that found in the distributed population in L1641, and 1/20 of that in the young cluster NGC 2023. This extremely low fraction and low surface density of sources with a near-infrared excess strongly indicates that recent star formation activity has been very low in the outlying region of L1630. The sources without a near-infrared excess could be either background/foreground field stars, or associated with the cloud, but formed a long time ago (more than 2 Myrs). Our results are consistent with McKee's model of photoionization-regulated star formation.Comment: 30 pages, 10 figures To appear in ApJ Oct 1997, Vol 48

18F-FDG Uptake on PET/CT in Symptomatic versus Asymptomatic Carotid Disease: a Meta-Analysis.

INTRODUCTION: The role of positron emission tomography (PET)/computed tomography (CT) in the determination of inflammation in arterial disease is not well defined. This can provide information about arterial wall inflammation in atherosclerotic disease, and may give insight into plaque stability. The aim of this review was to perform a meta-analysis of PET/CT with 18F-FDG (fluorodeoxyglucose) uptake in symptomatic and asymptomatic carotid artery disease. METHODS: This was a systematic review, following PRISMA guidelines, which interrogated the MEDLINE database from January 2001 to May 2017. The search combined the terms, "inflammation", "FDG", and "stroke". The search criteria included all types of studies, with a primary outcome of the degree of arterial vascular inflammation determined by 18F-FDG uptake. Analysis involved an inverse weighted variance estimate of pooled data, using a random effects model. RESULTS: A total of 14 articles (539 patients) were included in the meta-analysis. Comparing carotid artery 18F-FDG uptake in symptomatic versus asymptomatic disease yielded a standard mean difference of 0.94 (95% CI 0.58-1.130; p < .0001; I2 = 65%). CONCLUSIONS: PET/CT using 18F-FDG can demonstrate carotid plaque inflammation, and is a marker of symptomatic disease. Further studies are required to understand the clinical implication of PET/CT as a risk prediction tool

Detection of Unknown Pregnancy With Complications Using Point-of-Care Ultrasound.

Eclampsia, a condition diagnosed in pre-eclamptic patients who experience seizures, can lead to maternal and fetal death if not treated early. The present case discusses the clinical management of an 18-year-old female who presented to the emergency department (ED) after a generalized tonic-clonic seizure. A physical examination revealed that she was also hypertensive. Based on these symptoms which required urgency due to the patient\u27s instability, and the suspicion that the patient could be pregnant, point-of-care ultrasound (POCUS) was performed. In this case, a POCUS was a faster more accessible modality than a urine or serum human chorionic gonadotropin test. Although the patient denied that she was pregnant, POCUS identified that she was approximately 22-24 weeks pregnant. The patient was promptly diagnosed with eclampsia and given medication to control her blood pressure and seizures. This case highlights the benefits of using POCUS in the ED to expedite clinical decisions by identifying the etiology of a patient\u27s condition and lends itself to the discussion of its utility in a critically ill pregnant woman. It also serves to reinforce the importance of keeping eclampsia as part of an emergency physician\u27s differential when confronted with a potentially pregnant patient with relevant symptoms