A Systems Approach to Health Professional Education Reform

A panel discussion of the findings from recent IOM reports, accreditation progress supporting interprofessional aims and the importance of teams in maximizing value in healthcare

Controversies in the Management of ST Elevation Myocardial Infarction: Thrombin Inhibition.

Anticoagulation is essential in patients with ST elevation myocardial infarction (STEMI) to prevent further thrombosis and to maintain patency of the infarct-related artery after reperfusion. The various anticoagulant medications available for use in patients with STEMI include unfractionated heparin (UFH), low-molecular-weight heparin, fondaparinux, and bivalirudin, a direct thrombin inhibitor. The authors review the current anticoagulation strategies for patients with STEMI undergoing primary percutaneous coronary intervention (PCI), fibrinolysis, or no reperfusion. The authors present the latest evidence and controversies on this topic, with a focus on bivalirudin versus UFH in the setting of primary PCI for STEMI

Design of multi-frequency acoustic kinoforms

Complex diffraction limited acoustic fields can be generated from a single element transducer using inexpensive 3-D printable acoustic kinoforms. This is extremely promising for a number of applications. However, the lack of ability to vary the field limits the potential use of this technology. In this work, this limitation is circumvented using multi-frequency acoustic kinoforms for which different acoustic fields are encoded onto different driving frequencies. An optimisation approach based on random downhill binary search is introduced for the design of the multi-frequency kinoforms. This is applied to two test cases to demonstrate the technique: a kinoform designed to generate the numerals “1,” “2,” and “3” in the same plane but at different driving frequencies, and a kinoform designed to generate 3 sets of eight foci lying on a circle with a driving-frequency-dependent radius. Field measurements from these samples confirmed that multi-frequency acoustic kinoforms can be designed that switch between different arbitrary, pre-designed, acoustic field patterns in the target plane by changing the driving frequenc

Stackable acoustic holograms

Acoustic holograms can be used to form complex distributions of pressure in 3D at MHz frequencies from simple inexpensive ultrasound sources. The generation of such fields is vital to a diverse range of applications in physical acoustics. However, at present, the application of acoustic holograms is severely hindered by the static nature of the resulting fields. In this work, it is shown that by intentionally reducing the diffraction efficiency of each hologram, it is possible to create stackable acoustic holograms that can be repositioned to reconfigure the combined acoustic field. An experimental test-case consisting of two holograms, each designed to generate a distinct distribution of acoustic foci, is used to demonstrate the feasibility of this approach. Field scans taken for four different positions of the two holograms confirm that the individual patterns for each hologram can be arbitrary translated relative to one another. This allows for the generation of a much greater range of fields from a single transducer than could be created using a single hologram

Binary Volume Acoustic Holograms

In recent years, high-resolution additive manufacturing has enabled a diverse range of low-cost methods for ultrasonic wave-front shaping. Acoustic holograms, in particular, allow for the generation of arbitrary diffraction-limited acoustic fields at megahertz frequencies from single-element transducers. These are phase plates that function as direct acoustic analogs to thin optical holograms. In this work, it is shown that, by using multiple polymer three-dimensional (3D) printing, two-material (binary) acoustic analogs to "thick"or volume optical holograms can also be generated. First, an analytic approach for designing a volume hologram that diffracts a set of input fields onto a desired set of output fields is briefly summarized. Next, a greedy-optimization approach based on random downhill binary search able to account for the constraints imposed by the chosen fabrication method is introduced. Finally, an experimental test case designed to diffract the field generated by a 2.54-cm planar lead zirconate titanate (PZT) transducer onto eight distinct patterns dependent on the direction of the incident field is used to validate the approach and the design method. Field scans of the eight target fields demonstrate that acoustic analogs of optical volume holograms can be generated using multipolymer printing and that these allow the multiplexing of distinct fields onto different incident field directions

Single Pulse Illumination of Multi-Layer Photoacoustic Holograms for Patterned Ultrasound Field Generation

A new method for the creation of patterned, focused, optically generated acoustic fields using a single optical pulse is introduced. This utilises multi-layer `holograms' composed of several spatially separate absorbing layers. Each layer is individually patterned so as to focus at a set of targeted points. To create the patterns, a ray-tracing model was implemented to calculate the impulse response of pixels within each absorbing layer to a set of targeted points. An optimisation approach was then used to find the optimal pattern for each layer to create a field evenly focused at each of the target points. The method was validated using both numerical simulations and acoustic field measurements. It was demonstrated that a 3×3 array of acoustic foci could be generated from a 3-layer hologram using a single laser pulse

Control of broadband optically generated ultrasound pulses using binary amplitude holograms

In this work, the use of binary amplitude holography is investigated as a mechanism to focus broadband acoustic pulses generated by high peak-power pulsed lasers. Two algorithms are described for the calculation of the binary holograms; one using ray-tracing, and one using an optimization based on direct binary search. It is shown using numerical simulations that when a binary amplitude hologram is excited by a train of laser pulses at its design frequency, the acoustic field can be focused at a pre-determined distribution of points, including single and multiple focal points, and line and square foci. The numerical results are validated by acoustic field measurements from binary amplitude holograms, excited by a high peak-power laser