The Effect of Tube Wall Stiffness on the Speed of Waves in Tubes

The heart creates pulsatile flow in the arterial and pulmonary circulations. The vessels that make up these systems are distensible, so part of each pulse of blood fills the increasing volume of these vessels, while the remaining blood continues to flow down the vessel. Once the pulse has passed, and the valves from the heart are closed, the vessels contract under their own elasticity, pushing the “stored” blood further down the system. Thus the flow at the beginning of the aorta varies differently over time to flow further down that vessel. Different vessels in each circulatory system appear to have different wall thicknesses and stiffnesses. Further, some organs like the kidney and the brain would appear to function better under continuous blood flow rather than pulsatile flow. Thus we are interested in how wall stiffness of the vessels affects how much blood is “stored” from each pulse and then pushed on down the system, and how the velocity of the wave is affected by wall stiffness. We wish to understand how the body does supply more uniform flow to some organs than to other parts of the circulation. The distensibility of seven tubes with different wall stiffness and thickness was measured. Meter lengths of the three tubes most sensitive to pressure change were attached to a pump that delivered a pulsatile waveform resembling aortic flow. The flowrate and pressure changes were measured in the proximal and distal part of each tube. The distensibility of each tube was calculated again and found to be slightly larger than in the first experiment, possibly due to the non-steady state situation. As expected, the more stiff the tube the less the volume that can be stored. Of interest are the rate of reduction in storage with wall stiffness, and the rate of change in wave speed

Analyzing Strain in the Ovine Anterior Cruciate Ligament

Osteoarthritis (OA) is the most common joint disorder affecting adults. Relating the mechanics and biology of the knee joint is crucial to understanding the development and progression OA. A key aim of such studies is to determine the structure/function relationship and failure thresholds of the joint tissues, in-vivo. The Anterior Cruciate Ligament (ACL) is of great interest as it is one of the most commonly injured ligaments linked with premature OA. Previous ACL studies have been unable to determine the stresses within the structure, due to absence of reliable methods of measuring the cross-sectional area of the loaded part of the ligament. Purpose: This study aims to evaluate the normal in-vivo stresses within the ACL, by developing a suitable method to measure the loaded area of the ACL. Methods: Ovine stifle joints were used due to morphological and biochemical proximity to human knee joints. Measurements of in-vivo loadings within the ACL were obtained using an instrumented spatial linkage and robotic test system. Two techniques to measure the area of the loaded ACL will be explored: 3D Virtual Reconstruction (3DVR) and Magnetic Resonance Imaging (MRI). 3DVR: The non-loaded part of the ACL was removed. A cloud of points was measured along the surface of the remaining (loaded) part of the ligament and processed to create a 3DVR of the ACL. MRI: Tests (proton density and T2 mapping) will be run on the 9.4T MR to compare structural differences between a loaded and relaxed ligament. Results: 3DVR method produced only a partial surface reconstruction due to the relatively large size of the probe in comparison to the ligament and femorotibial joint space. Differences between loaded and unloaded MRI images will be assessed using a special jig allowing sequential tensioning of the ligament. Conclusions: It was concluded that the partial 3DVR was insufficient to determine the loaded cross- sectional areas along the ligament accurately. The MRI results will be available for examination shortly

Structural Evaluation and Maintenance of Brooks Aqueduct Historic Site

Brooks Aqueduct in Alberta, Canada is one of the largest and most sophisticated reinforced concrete aqueducts in the world. Now a national historic site, Brooks Aqueduct was built in 1914. The structure suffers from cracking and degradation in certain locations. To find out the possible main causes of potential overstress and damage in the different areas of the structure, it was evaluated by site inspections, some laboratory tests and analyzed numerically using Abaqus finite element software. Results of the numerical analysis are compared with the inspection and testing results and conclusions are made about the causes of deterioration and ways to conserve and repair the structure

Dealing with missing data in a multi-question depression scale: a comparison of imputation methods

BACKGROUND: Missing data present a challenge to many research projects. The problem is often pronounced in studies utilizing self-report scales, and literature addressing different strategies for dealing with missing data in such circumstances is scarce. The objective of this study was to compare six different imputation techniques for dealing with missing data in the Zung Self-reported Depression scale (SDS). METHODS: 1580 participants from a surgical outcomes study completed the SDS. The SDS is a 20 question scale that respondents complete by circling a value of 1 to 4 for each question. The sum of the responses is calculated and respondents are classified as exhibiting depressive symptoms when their total score is over 40. Missing values were simulated by randomly selecting questions whose values were then deleted (a missing completely at random simulation). Additionally, a missing at random and missing not at random simulation were completed. Six imputation methods were then considered; 1) multiple imputation, 2) single regression, 3) individual mean, 4) overall mean, 5) participant's preceding response, and 6) random selection of a value from 1 to 4. For each method, the imputed mean SDS score and standard deviation were compared to the population statistics. The Spearman correlation coefficient, percent misclassified and the Kappa statistic were also calculated. RESULTS: When 10% of values are missing, all the imputation methods except random selection produce Kappa statistics greater than 0.80 indicating 'near perfect' agreement. MI produces the most valid imputed values with a high Kappa statistic (0.89), although both single regression and individual mean imputation also produced favorable results. As the percent of missing information increased to 30%, or when unbalanced missing data were introduced, MI maintained a high Kappa statistic. The individual mean and single regression method produced Kappas in the 'substantial agreement' range (0.76 and 0.74 respectively). CONCLUSION: Multiple imputation is the most accurate method for dealing with missing data in most of the missind data scenarios we assessed for the SDS. Imputing the individual's mean is also an appropriate and simple method for dealing with missing data that may be more interpretable to the majority of medical readers. Researchers should consider conducting methodological assessments such as this one when confronted with missing data. The optimal method should balance validity, ease of interpretability for readers, and analysis expertise of the research team

Surfactant protein D inhibits HIV-1 infection of target cells via interference with gp120-CD4 interaction and modulates pro-inflammatory cytokine production

© 2014 Pandit et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Surfactant Protein SP-D, a member of the collectin family, is a pattern recognition protein, secreted by mucosal epithelial cells and has an important role in innate immunity against various pathogens. In this study, we confirm that native human SP-D and a recombinant fragment of human SP-D (rhSP-D) bind to gp120 of HIV-1 and significantly inhibit viral replication in vitro in a calcium and dose-dependent manner. We show, for the first time, that SP-D and rhSP-D act as potent inhibitors of HIV-1 entry in to target cells and block the interaction between CD4 and gp120 in a dose-dependent manner. The rhSP-D-mediated inhibition of viral replication was examined using three clinical isolates of HIV-1 and three target cells: Jurkat T cells, U937 monocytic cells and PBMCs. HIV-1 induced cytokine storm in the three target cells was significantly suppressed by rhSP-D. Phosphorylation of key kinases p38, Erk1/2 and AKT, which contribute to HIV-1 induced immune activation, was significantly reduced in vitro in the presence of rhSP-D. Notably, anti-HIV-1 activity of rhSP-D was retained in the presence of biological fluids such as cervico-vaginal lavage and seminal plasma. Our study illustrates the multi-faceted role of human SPD against HIV-1 and potential of rhSP-D for immunotherapy to inhibit viral entry and immune activation in acute HIV infection. © 2014 Pandit et al.The work (Project no. 2011-16850) was supported by Medical Innovation Fund of Indian Council of Medical Research, New Delhi, India (www.icmr.nic.in/)

Reliability and Validity of the KIPPPI: An Early Detection Tool for Psychosocial Problems in Toddlers

Background: The KIPPPI (Brief Instrument Psychological and Pedagogical Problem Inventory) is a Dutch questionnaire that measures psychosocial and pedagogical problems in 2-year olds and consists of a KIPPPI Total score, Wellbeing scale, Competence scale, and Autonomy scale. This study examined the reliability, validity, screening accuracy and clinical application of the KIPPPI. Methods: Parents of 5959 2-year-old children in the Rotterdam area, the Netherlands, were invited to participate in the study. Parents of 3164 children (53.1% of all invited parents) completed the questionnaire. The internal consistency was evaluated and in subsamples the test-retest reliability and concurrent validity with regard to the Child Behavioral Checklist (CBCL). Discriminative validity was evaluated by comparing scores of parents who worried about their child's upbringing and parent's that did not. Screening accuracy of the KIPPPI was evaluated against the CBCL by calculating the Receiver Operating Characteristic (ROC) curves. The clinical application was evaluated by the relation between KIPPPI scores and the clinical decision made by the child health professionals. Results: Psychometric properties of the KIPPPI Total score, Wellbeing scale, Competence scale and Autonomy scale were respectively: Cronbach's alphas: 0.88, 0.86, 0.83, 0.58. Test-rete

Canadian Valuation of EQ-5D Health States: Preliminary Value Set and Considerations for Future Valuation Studies

Background The EQ-5D is a preference based instrument which provides a description of a respondent's health status, and an empirically derived value for that health state often from a representative sample of the general population. It is commonly used to derive Quality Adjusted Life Year calculations (QALY) in economic evaluations. However, values for health states have been found to differ between countries. The objective of this study was to develop a set of values for the EQ-5D health states for use in Canada. Methods Values for 48 different EQ-5D health states were elicited using the Time Trade Off (TTO) via a web survey in English. A random effect model was fitted to the data to estimate values for all 243 health states of the EQ-5D. Various model specifications were explored. Comparisons with EQ-5D values from the UK and US were made. Sensitivity analysis explored different transformations of values worse than dead, and exclusion criteria of subjects. Results The final model was estimated from the values of 1145 subjects with socio-demographics broadly representative of Canadian general population with the exception of Quebec. This yielded a good fit with observed TTO values, with an overall R2 of 0.403 and a mean absolute error of 0.044. Conclusion A preference-weight algorithm for Canadian studies that include the EQ-5D is developed. The primary limitations regarded the representativeness of the final sample, given the language used (English only), the method of recruitment, and the difficulty in the task. Insights into potential issues for conducting valuation studies in countries as large and diverse as Canada are gained

Patterns of perceived barriers to medical care in older adults: a latent class analysis

<p>Abstract</p> <p>Background</p> <p>This study examined multiple dimensions of healthcare access in order to develop a typology of perceived barriers to healthcare access in community-dwelling elderly. Secondary aims were to define distinct classes of older adults with similar perceived healthcare access barriers and to examine predictors of class membership to identify risk factors for poor healthcare access.</p> <p>Methods</p> <p>A sample of 5,465 community-dwelling elderly was drawn from the 2004 wave of the Wisconsin Longitudinal Study. Perceived barriers to healthcare access were measured using items from the Group Health Association of America Consumer Satisfaction Survey. We used latent class analysis to assess the constellation of items measuring perceived barriers in access and multinomial logistic regression to estimate how risk factors affected the probability of membership in the latent barrier classes.</p> <p>Results</p> <p>Latent class analysis identified four classes of older adults. Class 1 (75% of sample) consisted of individuals with an overall low level of risk for perceived access problems (No Barriers). Class 2 (5%) perceived problems with the availability/accessibility of healthcare providers such as specialists or mental health providers (Availability/Accessibility Barriers). Class 3 (18%) perceived problems with how well their providers' operations arise organized to accommodate their needs and preferences (Accommodation Barriers). Class 4 (2%) perceived problems with all dimension of access (Severe Barriers). Results also revealed that healthcare affordability is a problem shared by members of all three barrier groups, suggesting that older adults with perceived barriers tend to face multiple, co-occurring problems. Compared to those classified into the No Barriers group, those in the Severe Barrier class were more likely to live in a rural county, have no health insurance, have depressive symptomatology, and speech limitations. Those classified into the Availability/Accessibility Barriers group were more likely to live in rural and micropolitan counties, have depressive symptomatology, more chronic conditions, and hearing limitations. Those in the Accommodation group were more likely to have depressive symptomatology and cognitive limitations.</p> <p>Conclusions</p> <p>The current study identified a typology of perceived barriers in healthcare access in older adults. The identified risk factors for membership in perceived barrier classes could potentially assist healthcare organizations and providers with targeting polices and interventions designed to improve access in their most vulnerable older adult populations, particularly those in rural areas, with functional disabilities, or in poor mental health.</p