Accuracy and reliability of wrist-cuff devices for self-measurement of blood pressure.

Science.gov (United States)

Kikuya, Masahiro; Chonan, Kenichi; Imai, Yutaka; Goto, Eiji; Ishii, Masao

2002-04-01

dorsiflexion was significantly lower than that in palmar extension. In some cases, finger plethysmogram did not disappear during maximum inflation of the wrist-cuff (congruent with 250 mmHg), even in palmar extension and especially in palmar flexion, suggesting incomplete obstruction of radial and/or ulnar arteries during inflation. The results suggest that wrist-cuff devices in the present form are inadequate for self-measurement of blood pressure and, thus, are inadequate for general use or clinical and practical use. However, there is much possibility in wrist-cuff device and the accuracy and reliability of wrist-cuff device are warranted by an improvement of technology.

A blood pressure monitor with robust noise reduction system under linear cuff inflation and deflation.

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Usuda, Takashi; Kobayashi, Naoki; Takeda, Sunao; Kotake, Yoshifumi

2010-01-01

We have developed the non-invasive blood pressure monitor which can measure the blood pressure quickly and robustly. This monitor combines two measurement mode: the linear inflation and the linear deflation. On the inflation mode, we realized a faster measurement with rapid inflation rate. On the deflation mode, we realized a robust noise reduction. When there is neither noise nor arrhythmia, the inflation mode incorporated on this monitor provides precise, quick and comfortable measurement. Once the inflation mode fails to calculate appropriate blood pressure due to body movement or arrhythmia, then the monitor switches automatically to the deflation mode and measure blood pressure by using digital signal processing as wavelet analysis, filter bank, filter combined with FFT and Inverse FFT. The inflation mode succeeded 2440 measurements out of 3099 measurements (79%) in an operating room and a rehabilitation room. The new designed blood pressure monitor provides the fastest measurement for patient with normal circulation and robust measurement for patients with body movement or severe arrhythmia. Also this fast measurement method provides comfortableness for patients.

Effects of cuff inflation and deflation on pulse transit time measured from ECG and multi-wavelength PPG.

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Liu, Jing; Li, Yao; Ding, Xiao-Rong; Dai, Wen-Xuan; Zhang, Yuan-Ting

2015-01-01

Pulse transit time (PTT), which refers to the time it takes a pulse wave to travel between two arterial sites is a promising index for cuff-less blood pressure (BP) estimation, as well as non-invasive assessment of arterial functions. However, it has not been investigated whether PTTs measured from ECG and different wavelength PPG are equally affected by the arterial status. Furthermore, comparison between the changes of different PTTs can provide enlightenment on the hardware implementation of the PTT-based BP estimation method. This work mainly studied the changes of PTTs calculated from electrocardiogram (ECG) and multi-wavelength photoplethysmogram (PPG) after exerting cuff pressure on the upper arm. A four-channel PPG acquisition system was developed to collect the multi-wavelength PPG signals of red, yellow, green and blue light at the fingertip simultaneously. Ten subjects participated in the experiment and their PTTs measured from different PPG and ECG signals before and after exerting cuff pressure were compared. This study found that within one minute after the four-minute cuff inflation and deflation process, the PTT measured from ECG and yellow PPG experienced a significant increase (p0.9) compared with that before exerting cuff pressure. This indicates that PTTs calculated from different wavelength PPG have different recoverability from smooth muscle relaxation. Another interesting finding is that the PTT calculated from ECG and yellow PPG had a strong correlation (|r|>0.7) with the time difference between yellow PPG and other PPG signals, which implies the potential of the time difference between yellow PPG and other PPGs as a complementary to PTT-based model for blood pressure estimation.

Effectiveness of the endotracheal tube cuff on the trachea: physical and mechanical aspects

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Maira Soliani Del Negro

2014-12-01

Full Text Available Introduction: The inflation pressure of the endotracheal tube cuff can cause ischemia of the tracheal mucosa at high pressures; thus, it can cause important tracheal morbidity and tracheal microaspiration of the oropharyngeal secretion, or it can even cause pneumonia associated with mechanical ventilation if the pressure of the cuff is insufficient. Objective: In order to investigate the effectiveness of the RUSCH® 7.5 mm endotracheal tube cuff, this study was designed to investigate the physical and mechanical aspects of the cuff in contact with the trachea. Methods: For this end, we developed an in vitro experimental model to assess the flow of dye (methylene blue by the inflated cuff on the wall of the artificial material. We also designed an in vivo study with 12 Large White pigs under endotracheal intubation. We instilled the same dye in the oral cavity of the animals, and we analyzed the presence or not of leakage in the trachea after the region of the cuff after their deaths (animal sacrifice. All cuffs were inflated at the pressure of 30 cmH2O. Results: We observed the passage of fluids through the cuff in all in vitro and in vivo experimental models. Conclusion: We conclude that, as well as several other cuff models in the literature, the RUSCH® 7.5 mm tube cuffs are also not able to completely seal the trachea and thus prevent aspiration of oropharyngeal secretions. Other prevention measures should be taken.

Cuff inflation to aid nasotracheal intubation using the C-mac ...

African Journals Online (AJOL)

The main thrust of the technique is that cuff inflation of the endotracheal tube is used to lift the endotracheal tube off the posterior pharyngeal wall and thus direct it towards the glottis. The technique was used successfully in 5 consecutive patients needing nasotracheal intubation. Indeed a couple of these patients might have ...

Skin necrosis in a critically ill patient due to a blood pressure cuff

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Devbhandari Mohan

2006-01-01

Full Text Available The non-invasive method of blood pressure measurement is regarded as a safe procedure and the reports of any serious complications are rare. We report a unique case of extensive skin necrosis due to an intermittently inflating blood pressure cuff in a 65-year-old critically ill lady following a third time redo mitral valve surgery. A brief review of the literature on complications associated with noninvasive method of measurement of blood pressure is presented along with possible mechanisms of skin injury and ways to avoid it.

Difficulty with cuff deflation of reinforced tracheal tube caused by inflation line occlusion with silk thread ligation and fixation.

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Gotoh, Sayoko; Sugiyama, Daisuke; Imai, Eriko; Kawamata, Mikito

2015-03-05

A reinforced tracheal tube, ligated with silk threads, was inserted into a tracheostomy orifice and fixed to the skin. The cuff inflation line of the reinforced tracheal tube became occluded. Reinforced 'armoured' tracheal tubes have a spiral of wire embedded into the wall of the tube to give strength and flexibility, and may be sharply bent without compromising the tube lumen. The tracheal cuff attached to the tube is inflated by injecting air through a narrow-diameter tube welded to the outside of the tracheal tube. When a reinforced tracheal tube is ligated and fixed with silk threads, it should be confirmed whether the tracheal tube cuff can be deflated and inflated after fixation. Moreover, because occlusion can be eliminated by removing all silk threads used to ligate a tracheal tube, they should be removed before extubation. 2015 BMJ Publishing Group Ltd.

The influence of participant characteristics on the relationship between cuff pressure and level of blood flow restriction.

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Hunt, Julie E A; Stodart, Clare; Ferguson, Richard A

2016-07-01

Previous investigations to establish factors influencing the blood flow restriction (BFR) stimulus have determined cuff pressures required for complete arterial occlusion, which does not reflect the partial restriction prescribed for this training technique. This study aimed to establish characteristics that should be accounted for when prescribing cuff pressures required for partial BFR. Fifty participants were subjected to incremental blood flow restriction of the upper and lower limbs by proximal pneumatic cuff inflation. Popliteal and brachial artery diameter, blood velocity and blood flow was assessed with Doppler ultrasound. Height, body mass, limb circumference, muscle-bone cross-sectional area, adipose thickness (AT) and arterial blood pressure were measured and used in different models of hierarchical linear regression to predict the pressure at which 60 % BFR (partial occlusion) occurred. Combined analysis revealed a difference in cuff pressures required to elicit 60 % BFR in the popliteal (111 ± 12 mmHg) and brachial arteries (101 ± 12 mmHg). MAP (r = 0.58) and AT (r = -0.45) were the largest independent determinants of lower and upper body partial occlusion pressures. However, greater variance was explained by upper and lower limb regression models composed of DBP and BMI (48 %), and arm AT and DBP (30 %), respectively. Limb circumference has limited impact on the cuff pressure required for partial blood flow restriction which is in contrast to its recognised relationship with complete arterial occlusion. The majority of the variance in partial occlusion pressure remains unexplained by the predictor variables assessed in the present study.

Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport.

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Mann, Catherine; Parkinson, Neil; Bleetman, Anthony

2007-03-01

Helicopters and light (unpressurised) aircraft are used increasingly for the transport of ventilated patients. Most of these patients are ventilated through endotracheal tubes (ETTs), others through laryngeal mask airways (LMAs). The cuffs of both ETTs and LMAs inflate with increases in altitude as barometric pressure decreases (30 mbar/1000 feet). Tracheal mucosa perfusion becomes compromised at a pressure of approximately 30 cm H2O; critical perfusion pressure is 50 cm H2O. The change in dimensions of the inflated cuffs of a size 8 ETT and a size 5 LMA were measured with digital callipers at 1000 feet intervals in the unpressurised cabin of an Agusta 109 helicopter used by the Warwickshire and Northamptonshire Air Ambulance. A linear expansion in cuff dimensions as a function of altitude increase was identified. For ETTs, a formula for removal of air from the cuff with increasing altitude was calculated and is recommended for use in aeromedical transfers. This is 1/17x1.1 = 0.06 ml/1000 foot ascent/ml initial cuff inflation. The data for LMA cuff expansion failed to show significant correlation with altitude change. Further work is required to determine a similar rule of thumb for LMA cuff deflation.

Strategies to prevent ventilation-associated pneumonia: the effect of cuff pressure monitoring techniques and tracheal tube type on aspiration of subglottic secretions: an in-vitro study.

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Carter, Eleanor L; Duguid, Alasdair; Ercole, Ari; Matta, Basil; Burnstein, Rowan M; Veenith, Tonny

2014-03-01

Ventilation-associated pneumonia (VAP) is the commonest nosocomial infection in intensive care. Implementation of a VAP prevention care bundle is a proven method to reduce its incidence. The UK care bundle recommends maintenance of the tracheal tube cuff pressure at 20 to 30  cmH₂O with 4-hourly pressure checks and use of tracheal tubes with subglottic aspiration ports in patients admitted for more than 72  h. To evaluate the effects of tracheal tube type and cuff pressure monitoring technique on leakage of subglottic secretions past the tracheal tube cuff. Bench-top study. Laboratory. A model adult trachea with simulated subglottic secretions was intubated with a tracheal tube with the cuff inflated to 25  cmH₂O. Experiments were conducted using a Portex Profile Soft Seal tracheal tube with three cuff pressure monitoring strategies and using a Portex SACETT tracheal tube with intermittent cuff pressure checks. Rate of simulated secretion leakage past the tracheal tube cuff. Mean ± SD leakage of fluid past the Profile Soft Seal tracheal tube cuff was 2.25 ± 1.49  ml  min⁻¹ with no monitoring of cuff pressure, 2.98 ± 1.63  ml  min⁻¹ with intermittent cuff pressure monitoring and 3.83 ± 2.17  ml  min⁻¹ with continuous cuff pressure monitoring (P aspiration port and aspirating the simulated secretions prior to intermittent cuff pressure checks reduced the leakage rate to 0.50 ± 0.48  ml  min⁻¹ (P aspiration port. Further evaluation of medical device performance is needed in order to design more effective VAP prevention strategies.

Measurement of brachial artery endothelial function using a standard blood pressure cuff

International Nuclear Information System (INIS)

Maltz, Jonathan S; Budinger, Thomas F; Tison, Geoffrey H; Olgin, Jeffrey; Alley, Hugh F; Owens, Christopher D

2015-01-01

The integrity of endothelial function in major arteries (EFMA) is a powerful independent predictor of heart attack and stroke. Existing ultrasound-based non-invasive assessment methods are technically challenging and suitable only for laboratory settings. EFMA, like blood pressure (BP), is both acutely and chronically affected by factors such as lifestyle and medication. Consequently, laboratory-based measurements cannot fully gauge the effects of medical interventions on EFMA. EFMA and BP have, arguably, comparable (but complementary) value in the assessment of cardiovascular health. Widespread deployment of EFMA assessment is thus a desirable clinical goal. To this end, we propose a device based on modifying the measurement protocol of a standard electronic sphygmomanometer. The protocol involves inflating the cuff to sub-diastolic levels to enable recording of the pulse waveform before and after vasodilatory stimulus. The mechanical unloading of the arterial wall provided by the cuff amplifies the distension that occurs with each pulse, which is measured as a pressure variation in the cuff. We show that the height of the rising edge of each pulse is proportional to the change in lumen area between diastole and systole. This allows the effect of vasodilatory stimuli on the artery to be measured with high sensitivity. We compare the proposed cuff flow-mediated dilation (cFMD) method to ultrasound flow-mediated dilation (uFMD). We find significant correlation (r  =  0.55, p  =0.003, N  =  27) between cFMD- and uFMD-based metrics obtained when the release of a 5 min cuff occlusion is employed to induce endothelial stimulus via reactive hyperemia. cFMD is approximately proportional to the square of uFMD, representing a typical increase in sensitivity to vasodilation of 300–600%. This study illustrates the potential for an individual to conveniently measure his/her EFMA by using a low-cost reprogrammed home sphygmomanometer. (paper)

An in vitro comparison of tracheostomy tube cuffs

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Maguire S

2015-04-01

Full Text Available Seamus Maguire,1 Frances Haury,2 Korinne Jew2 1Research and Development, Covidien Respiratory and Monitoring Solutions, Athlone, Ireland; 2Medical Affairs, Covidien Respiratory and Monitoring Solutions, Boulder, CO, USA Introduction: The Shiley™ Flexible adult tracheostomy tube with TaperGuard™ cuff has been designed through its geometry, materials, diameter, and wall thickness to minimize micro-aspiration of fluids past the cuff and to provide an effective air seal in the trachea while also minimizing the risk of excessive contact pressure on the tracheal mucosa. The cuff also has a deflated profile that may allow for easier insertion through the stoma site. This unique design is known as the TaperGuard™ cuff. The purpose of the observational, in vitro study reported here was to compare the TaperGuard™ taper-shaped cuff to a conventional high-volume low-pressure cylindrical-shaped cuff (Shiley™ Disposable Inner Cannula Tracheostomy Tube [DCT] with respect to applied tracheal wall pressure, air and fluid sealing efficacy, and insertion force.Methods: Three sizes of tracheostomy tubes with the two cuff types were placed in appropriately sized tracheal models and lateral wall pressure was measured via pressure-sensing elements on the inner surface. Fluid sealing performance was assessed by inflating the cuffs within the tracheal models (25 cmH2O, instilling water above the cuff, and measuring fluid leakage past the cuff. To measure air leak, tubes were attached to a test lung and ventilator, and leak was calculated by subtracting the average exhaled tidal volume from the average delivered tidal volume. A tensile test machine was used to measure insertion force for each tube with the cuff deflated to simulate clinical insertion through a stoma site.Results: The average pressure exerted on the lateral wall of the model trachea was lower for the taper-shaped cuff than for the cylindrical cuff under all test conditions (P<0.05. The taper

Endotracheal tube cuff pressure management in adult critical care ...

African Journals Online (AJOL)

of respondents performed cuff pressure measurements every 6 - 12 hours; 32% reported ... effectively when performing ETT cuff pressure management, to reduce practice variance, ... questionnaires were distributed to professional nurses working in .... MOV, CPM and the palpation method.3 No advantage of CPM over.

Comparison of endotracheal tube cuff pressure values before and after training seminar.

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Özcan, Ayça Tuba Dumanlı; Döğer, Cihan; But, Abdülkadir; Kutlu, Işık; Aksoy, Şemsi Mustafa

2018-06-01

It is recommended that endotracheal cuff (ETTc) pressure be between 20 and 30 cm H 2 O. In this present study, we intend to observe average cuff pressure values in our clinic and the change in these values after the training seminar. The cuff pressure values of 200 patients intubated following general anesthesia induction in the operating theatre were measured following intubation. One hundred patients whose values were measured before the training seminar held for all physician assistants, and 100 patients whose values were measured after the training seminar were regarded as Group 1 and Group 2, respectively. Cuff pressures of both groups were recorded, and the difference between them was shown. Moreover, cuff pressure values were explored according to the working period of the physician assistants. There was no significant difference between the groups in terms of age, gender and tube diameters. Statistically significant difference was found between cuff pressure values before and after the training (p values decreased, however no statistically significant different was found (p values and potential complications.

[A design and study of a novel electronic device for cuff-pressure monitoring].

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Wang, Shupeng; Li, Wei; Li, Wen; Song, Dejing; Chen, Desheng; Duan, Jun; Li, Chen; Li, Gang

2017-06-01

To design a novel electronic device for measuring the pressure in the cuff of the artificial airway; and to study the advantage of this device on continuous and intermittent cuff pressure monitoring. (1) a portable electronic device for cuff pressure measurement was invented, which could turn pressure signal into electrical signal through a pressure transducer. Meantime, it was possible to avoid pressure leak from the joint and the inside of the apparatus by modified Luer taper and sophisticated design. If the cuff pressure was out of the normal range, the apparatus could release a sound and light alarm. (2) Six traditional mechanical manometers were used to determine the cuff pressure in 6 tracheal tubes. The cuff pressure was maintain at 30 cmH 2 O (1 cmH 2 O = 0.098 kPa) by the manometer first, and repeated every 30 seconds for 4 times. (3) Study of continuous cuff pressure monitoring: We used a random number generator to randomize 6 tracheal tubes, 6 mechanical manometers and 6 our products by number 1-6, which has the same number of a group. Every group was further randomized into two balanced groups, one group used the mechanical manometer first, and the other used our product first. The baseline pressure was 30 cmH 2 O, measurement was performed every 4 hours for 6 times. When traditional mechanical manometer was used for cuff pressure monitoring, cuff pressure was decreased by an average of 2.9 cmH 2 O for each measurement (F = 728.2, P = 0.000). In study of continually monitoring, at each monitoring point, the pressure measured by electronic manometer was higher than the mechanical manometer. All the pressures measured by mechanical manometer were dropped below 20 cmH 2 O at 8th hour, and there was no pressure decrease below 20 cmH 2 O measured by electronic manometer in 24 hours by contrast. In study of intermittent monitoring, the same result was found. The pressure was dropped significantly with time when measured by mechanical manometer (F = 61.795, P

Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need

DEFF Research Database (Denmark)

Rokamp, K.Z.; Secher, N.H.; Møller, Ann

2010-01-01

ABSTRACT: BACKGROUND: To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. METHOD: In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without...... the use of nitrous oxide) were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. RESULTS: In the 119 patients provided with a tracheal tube, the median cuff pressure was 30 (range 8 - 100) cm H2O and the pressure exceeded 30 cm H2O (upper recommended level) for 54...... patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121) cm H2O and above 60 cm H2O (upper recommended level) for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O). There was no association between cuff pressure...

Improper tube fixation causing a leaky cuff

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Gupta Babita

2010-01-01

Full Text Available Leaking endotracheal tube cuffs are common problems in intensive care units. We report a case wherein the inflation tube was damaged by the adhesive plaster used for tube fixation and resulted in leaking endotracheal tube cuff. We also give some suggestions regarding the tube fixation and some remedial measures for damaged inflation system.

Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access.

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Nelson, Drew; Jeanmonod, Rebecca; Jeanmonod, Donald

2014-07-01

Ten percent of the time, peripheral intravenous access (PIV) is not obtained in 2 attempts in the emergency department. Typically, a tourniquet is used to dilate the target vein; but recent research showed that a blood pressure (BP) cuff improves dilation, which may translate to increased PIV success. We sought to determine if there is improved success in obtaining ultrasound-guided PIV using a BP cuff vs a tourniquet in "difficult stick" patients. This is a prospective, randomized, single-blinded trial. Adult patients requiring PIV with at least 2 prior failed attempts were enrolled. Patients were assigned to tourniquet or BP cuff for target vein dilation randomly. Nurses prepared the patient for PIV attempt by either placing a BP cuff inflated to 150 mm Hg or placing a tourniquet on the chosen extremity. The extremity was draped to blind the physician to assignment. Physicians then attempted ultrasound-guided PIV. Failures were defined as IVs requiring greater than 3 ultrasound-guided attempts or 30 minutes, or patient intolerance. If failure occurred, the physician was unblinded; and the patient could be crossed over and reattempted. Thirty-eight patients were enrolled. The success rate for the tourniquet group (n = 17) and BP cuff group (n = 21) was 82.4% and 47.6%, respectively (P = .04). There were no differences between groups for vessel depth, diameter, or procedure time. Six in the BP cuff group were crossed over and had successful PIV obtained with tourniquet. Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparison of heart rate variability between resting state and external-cuff-inflation-and-deflation state: a pilot study.

Science.gov (United States)

Ji, Lizhen; Liu, Chengyu; Li, Peng; Wang, Xinpei; Yan, Chang; Liu, Changchun

2015-10-01

Heart rate variability (HRV) has been widely used in clinical research to provide an insight into the autonomic control of the cardiovascular system. Measurement of HRV is generally performed under a relaxed resting state. The effects of other conditions on HRV measurement, such as running, mountaineering, head-up tilt, etc, have also been investigated. This study aimed to explore whether an inflation-and-deflation process applied to a unilateral upper arm cuff would influence the HRV measurement. Fifty healthy young volunteers aged between 21 and 30 were enrolled in this study. Electrocardiogram (ECG) signals were recorded for each subject over a five minute resting state followed by a five minute external-cuff-inflation-and-deflation state (ECID state). A one minute gap was scheduled between the two measurements. Consecutive RR intervals in the ECG were extracted automatically to form the HRV data for each of the two states. Time domain (SDNN, RMSSD and PNN50), frequency domain (LFn, HFn and LF/HF) and nonlinear (VLI, VAI and SampEn) HRV indices were analyzed and compared between the two states. In addition, the effects of mean artery pressure (MAP) and heart rate (HR) on the aforementioned HRV indices were assessed for the two states, respectively, by Pearson correlation analysis. The results showed no significant difference in all aforementioned HRV indices between the resting and the ECID states (all p  >  0.05). The corresponding HRV indices had significant positive correlation (all p    0.05) for either state. Besides, none of the indices showed HR-related change (all p  >  0.05) for either state except the index of VLI in the resting state. To conclude, this pilot study suggested that the applied ECID process hardly influenced those commonly used HRV indices. It would thus be applicable to simultaneously measure both blood pressure and HRV indices in clinical practice.

Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry

DEFF Research Database (Denmark)

Graven-Nielsen, Thomas; Vaegter, Henrik Bjarke; Finocchietti, Sara

2015-01-01

) conditioned pain modulation (CPM) assessed by cuff algometry. The influences of age and gender were evaluated. On two different days, cuff pain threshold (cPPT), cuff pain tolerance (cPTT), and temporal summation of pain (TSP) by visual analogue scale scores to 10 repeated cuff stimulations at cPTT intensity......, as well as pressure pain threshold (PPT) with handheld pressure algometry were assessed in 136 healthy subjects. In one session cuff pain sensitivity was also assessed before and after the cold-pressor induced CPM. Good to excellent intraclass correlations (ICCs: 0.60 - 0.90) were demonstrated for manual.......05). TSP were increased in women compared with men (PCPM demonstrated as increased cPPT, cPTT and reduced TSP (P

Occlusion cuff for routine measurement of digital blood pressure and blood flow

DEFF Research Database (Denmark)

Lassen, N A; Krähenbühl, B; Hirai, M

1977-01-01

A miniaturized blood pressure cuff made of plastic material and applicable to fingers and toes is described. The cuff was compared to rubber cuffs and to bladder-free cuffs. It was found to be more reliable than the former type and much easier to use than the latter type. It is recommended for us...

Evaluation of indirect blood pressure monitoring in awake and anesthetized red-tailed hawks (Buteo jamaicensis): effects of cuff size, cuff placement, and monitoring equipment.

Science.gov (United States)

Zehnder, Ashley M; Hawkins, Michelle G; Pascoe, Peter J; Kass, Philip H

2009-09-01

To compare Doppler and oscillometric methods of indirect arterial blood pressure (IBP) with direct arterial measurements in anesthetized and awake red-tailed hawks. Prospective, randomized, blinded study. Six, sex unknown, adult red-tailed hawks. Birds were anesthetized and IBP measurements were obtained by oscillometry (IBP-O) and Doppler (IBP-D) on the pectoral and pelvic limbs using three cuffs of different width based on limb circumference: cuff 1 (20-30% of circumference), cuff 2 (30-40%), and cuff 3 (40-50%). Direct arterial pressure measurements were obtained from the contralateral superficial ulnar artery. Indirect blood pressure measurements were compared to direct systolic arterial pressure (SAP) and mean arterial pressure (MAP) during normotension and induced states of hypotension and hypertension. Measurements were also obtained in awake, restrained birds. Three-way anova, linear regression and Bland-Altman analyses were used to evaluate the IBP-D data. Results are reported as mean bias (95% confidence intervals). The IBP-O monitor reported errors during 54% of the measurements. Indirect blood pressure Doppler measurements were most accurate with cuff 3 and were comparable to MAP with a bias of 2 (-9, 13 mmHg). However, this cuff consistently underestimated SAP with a bias of 33 (19, 48 mmHg). Variability in the readings within and among birds was high. There was no significant difference between sites of cuff placement. Awake birds had SAP, MAP and diastolic arterial pressure that were 56, 43, and 38 mmHg higher than anesthetized birds. Indirect blood pressure (oscillometric) measurements were unreliable in red-tailed hawks. Indirect blood pressure (Doppler) measurements were closer to MAP measurements than SAP measurements. There was slightly better agreement with the use of cuff 3 on either the pectoral or pelvic limbs. Awake, restrained birds have significantly higher arterial pressures than those under sevoflurane anesthesia.

Tail-Cuff Technique and Its Influence on Central Blood Pressure in the Mouse.

Science.gov (United States)

Wilde, Elena; Aubdool, Aisah A; Thakore, Pratish; Baldissera, Lineu; Alawi, Khadija M; Keeble, Julie; Nandi, Manasi; Brain, Susan D

2017-06-27

Reliable measurement of blood pressure in conscious mice is essential in cardiovascular research. Telemetry, the "gold-standard" technique, is invasive and expensive and therefore tail-cuff, a noninvasive alternative, is widely used. However, tail-cuff requires handling and restraint during measurement, which may cause stress affecting blood pressure and undermining reliability of the results. C57Bl/6J mice were implanted with radio-telemetry probes to investigate the effects of the steps of the tail-cuff technique on central blood pressure, heart rate, and temperature. This included comparison of handling techniques, operator's sex, habituation, and influence of hypertension induced by angiotensin II. Direct comparison of measurements obtained by telemetry and tail-cuff were made in the same mouse. The results revealed significant increases in central blood pressure, heart rate, and core body temperature from baseline following handling interventions without significant difference among the different handling technique, habituation, or sex of the investigator. Restraint induced the largest and sustained increase in cardiovascular parameters and temperature. The tail-cuff readings significantly underestimated those from simultaneous telemetry recordings; however, "nonsimultaneous" telemetry, obtained in undisturbed mice, were similar to tail-cuff readings obtained in undisturbed mice on the same day. This study reveals that the tail-cuff technique underestimates the core blood pressure changes that occur simultaneously during the restraint and measurement phases. However, the measurements between the 2 techniques are similar when tail-cuff readings are compared with telemetry readings in the nondisturbed mice. The differences between the simultaneous recordings by the 2 techniques should be recognized by researchers. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Acquired tracheoesophageal fistula due to high intracuff pressure

Directory of Open Access Journals (Sweden)

Hameed Akmal

2008-01-01

Full Text Available High-compliance endotracheal tube cuffs are used to prevent gas leak and also pulmonary aspiration in mechanically ventilated patients. However, the use of the usual cuff inflation volumes may cause tracheal damage and lead to tracheoesophageal fistula. Tracheostomy tube cuffs seal against the tracheal wall and prevent leakage of air around the tube, assuring that the tidal volume is delivered to the lungs. In the past, high-pressure cuffs were used, but these contributed to tracheal injury and have been replaced by high-volume, low-pressure cuffs. For long-term applications, some newer tubes have low-profile (tight to shaft cuffs that facilitate the tracheostomy tube changes by eliminating the lip that forms when standard cuffs are deflated.

MEASUREMENT OF ENDOTRACHEAL TUBE CUFF PRESSURE IN MECHANICALLYVENTILATED PATIENTS ON ARRIVAL TO INTENSIVE CARE UNIT - A CROSS-SECTIONAL STUDY

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Arun Kumar Ajjappa

2017-04-01

Full Text Available BACKGROUND The monitoring of Endotracheal Tube (ETT cuff pressure in intubated patients on arrival to intensive care unit is very essential. The cuff pressure must be within an optimal range of 20-30cm H2O ensuring ventilation with no complications related to cuff overinflation and underinflation. This can be measured with a cuff pressure manometer. The aim of the study is to measure the endotracheal tube cuff pressure in patients on arrival to intensive care unit and to identify prevalence of endotracheal cuff underinflation and overinflation. MATERIALS AND METHODS A cross-sectional study was done on mechanically-ventilated patients who were intubated in casualty (emergency department on arrival to intensive care unit in S.S. Institute of Medical Sciences and Research Centre, Davangere. About 50 critically-ill patients intubated with a high volume, low pressure endotracheal tube were included in the study. An analogue manometer was used to measure the endotracheal tube cuff pressure. It was compared with the recommended level. The settings of mechanical ventilation, endotracheal tube size and peak airway pressure were recorded. RESULTS It was found that the mean cuff pressure was 64.10 cm of H2O with a standard deviation of 32.049. Of the measured cuff pressures, only 2% had pressures within an optimal range (20-30cm of H2O. 88% had cuff pressures more than 30cm of H2O. The mean peak airway pressure found to be 20.50cm of H2O with a Standard Deviation (SD of 5.064. CONCLUSION This study is done to emphasise the importance of cuff pressure measurement in all mechanically-ventilated patients as cuff pressure is found to be high in most of the patients admitted to intensive care unit. Complications of overinflation and underinflation can only be prevented if the acceptable cuff pressures are achieved.

Tracheal cuff pressure monitoring in the ICU: a literature review and survey of current practice in Queensland.

Science.gov (United States)

Talekar, C R; Udy, A A; Boots, R J; Lipman, J; Cook, D

2014-11-01

The application of tracheal cuff pressure monitoring is likely to vary between institutions. The aim of this study was therefore to review current evidence concerning this intervention in the intensive care unit (ICU) and to appraise regional practice by performing a state-wide survey. Publications for review were identified through searches of PubMed, EMBASE and Cochrane (1977 to 2014). All studies in English relevant to critical care and with complete data were included. Survey questions were developed by small-group consensus. Public and private ICUs across Queensland were contacted, with responses obtained from a representative member of the medical or nursing staff. Existing literature suggests significant variability in tracheal cuff pressure monitoring in the ICU, particularly in the applied technique, frequency of assessment and optimal intra-cuff pressures. Twenty-nine respondents completed the survey, representing 80.5% (29/36) of ICUs in Queensland. Twenty-eight out of twenty-nine respondents reported routinely monitoring tracheal cuff function, primarily employing cuff pressure measurement (26/28). Target cuff pressures varied, with 3/26 respondents aiming for 10 to 20 cmH2O, 10/26 for 21 to 25 cmH2O, and 13/26 for 26 to 30 cmH2O. Fifteen out of twenty-nine reported they had no current guideline or protocol for tracheal cuff management and only 16/29 indicated there was a dedicated area in the clinical record for reporting cuff intervention. Our results indicate that many ICUs across Queensland routinely measure tracheal cuff function, with most utilising pressure monitoring devices. Consistent with existing literature, the optimum cuff pressure remains uncertain. Most, however, considered that this should be a routine part of ICU care.

Automated Control of Endotracheal Tube Cuff Pressure during Simulated Flight

Science.gov (United States)

2016-06-21

accomplished in the intensive care unit (ICU) with stand-alone devices as well as those integral to a ventilator [13,14]. We hypothesized that closed loop ... Administration approved automatic cuff pressure adjustment devices (Intellicuff, Hamilton Medical , Reno, NV; Pyton, ARM Medical , Bristol, CT; Cuff Sentry, Outcome...711th Human Performance Wing U.S. Air Force School of Aerospace Medicine Int’l Expeditionary Educ & Training Dept Air Force Expeditionary Medical

The penile cuff test: A clinically useful non-invasive urodynamic investigation to diagnose men with lower urinary tract symptoms

Directory of Open Access Journals (Sweden)

Christopher Harding

2009-01-01

Full Text Available Objectives: To summarize the development of a novel non-invasive test to categorize voiding dysfunction in men complaining of lower urinary tract symptoms (LUTS - the penile cuff test. Methods: The test involves the controlled inflation of a penile cuff during micturition to interrupt voiding and hence estimate isovolumetric bladder pressure (p ves.isv . The validity, reliability, and clinical usefulness of the test were determined in a number of studies in men with LUTS. Results: The penile cuff test can be successfully performed in over 90% of men with LUTS. The reading of cuff pressure at flow interruption (p cuff.int gives a valid and reliable estimate of invasively-measured p ves.isv and when combined with the reading for maximum flow rate obtained during the test (Q max produces an accurate categorization of bladder outlet obstruction (BOO. Use of this categorization prior to treatment allows improved prediction of outcome from prostatectomy. Conclusion: The penile cuff test fulfils the criteria as a useful clinical measurement technique applicable to the diagnosis and treatment planning of men with LUTS.

Optimizing pressurized contact area in rotator cuff repair: the diamondback repair.

Science.gov (United States)

Burkhart, Stephen S; Denard, Patrick J; Obopilwe, Elifho; Mazzocca, Augustus D

2012-02-01

The purpose of this study was to compare tendon-bone footprint contact area over time under physiologic loads for 4 different rotator cuff repair techniques: single row (SR), triangle double row (DR), chain-link double row (CL), and diamondback double row (DBK). A supraspinatus tear was created in 28 human cadavers. Tears were fixed with 1 of 4 constructs: SR, DR, CL, or DBK. Immediate post-repair measurements of pressurized contact area were taken in neutral rotation and 0° of abduction. After a static tensile load, pressurized contact area was observed over a 160-minute period after repair. Cyclic loading was then performed. The DBK repair had the highest pressurized contact area initially, as well as the highest pressurized contact area and lowest percentage decrease in pressurized contact area after 160 minutes of testing. The DBK repair had significantly larger initial pressurized contact than CL (P = .003) and SR (P = .004) but not DR (P = .06). The DBK technique was the only technique that produced a pressurized contact area that exceeded the native footprint both at initial repair (P = .01) and after 160 minutes of testing (P = .01). DBK had a significantly larger mean pressurized contact area than all the repairs after 160 minutes of testing (P = .01). DBK had a significantly larger post-cyclic loading pressurized contact area than CL (P = .01) and SR (P = .004) but not DR (P = .07). This study showed that a diamondback repair (a modification of the transosseous repair) can significantly increase the rotator cuff pressurized contact area in comparison with other standard rotator cuff repair constructs when there is sufficient tendon mobility to perform a double-row repair without excessive tension on the repair site. The persistent pressurized contact area of a DBK repair may be desirable to enhance healing potential when there is sufficient tendon mobility to perform a double-row repair, particularly for large or massive rotator cuff tears where it is

Combined electric and pressure cuff pain stimuli for assessing conditioning pain modulation (CPM).

Science.gov (United States)

Tsukamoto, M; Petersen, K K; Mørch, C D; Arendt-Nielsen, L

2017-12-29

Aims Traditionally, conditioning pain modulation (CPM) can be assessed by applying a test stimulus (TS) before and after application of a conditioning stimulus (CS), which is normally applied extra-segmental. Currently, no studies have attempted to apply the TS and CS to the same site using different stimuli modalities. The aim of this study was to evaluate electrical TS and cuff pressure CS applied to the same experimental site for studying CPM. Methods 20 male volunteers participated in this study, which consisted of stimulations applied by a cuff-algometer (NociTech and Aalborg University, Denmark) and current stimulator (Digitimer DS5, UK), through two Ag/AgCl electrodes (Ambu® Neuroline 700, Denmark). The cuff was wrapped around the lower leg and stimulation electrodes were placed under the cuff and to the same location on the contralateral leg. Electrical TS were applied to the non-dominant leg with or without cuff pressure CS on the dominant (CS1) or the same (non-dominant) leg (CS2, electrode under cuff). The subjects were instructed to rate the electrical evoked pain intensity on a 10-cm continuous visual analog scale (VAS, "0" represented "no pain", and "10" represented "maximal pain"). The pain detection threshold (PDT) was defined as "1" on the VAS scale. Results There was no significant deference in PDT for neither CS1 nor CS2. A median split subanalysis on CPM-responders versus CPM-nonresponders to the TS + CS1 combination. Using this grouping, there was significant increase in PDT when comparing TS to TS + CS1 or TS + CS2 (4.0 mA vs 5.6 mA; P CPM can be evoked in a subgroup of subjects by applying the electrical test stimulus and cuff pressure conditioning stimuli to the same experimental site.

Load and inflation pressure effects on soil compaction of forwarder tires

Science.gov (United States)

Tim McDonald; Tom Way; Bjorn Lofgren; Fernando Seixas; Mats Landstrom

1996-01-01

A standard forwarder tire (600/55-26.5) was tested to determine its range of soil compaction with various inflation pressures and dynamic loads. Past research has shown that compaction of heavier equipment can be somewhat mitigated by operating with lower inflation pressures. Results indicated a significant effect of both load and inflation pressure on bulk density,...

Cuff size influences blood pressure measurement in obese children and adolescents

DEFF Research Database (Denmark)

Muhamed, P. K.; Olsen, M. H.; Holm, Jens-Christian

2016-01-01

Introduction: Recently, we established that a group ofobese children and adolescents had a higher blood pressure(BP) than a healthy control group. In the present study, weinvestigate whether the higher BP in the obese group wasinfluenced by BP cuff sizes.Methods: A total of 104 obese patients aged...... sizes had a significant impact on BP measurements.Despite the influence of cuff size, multiple regressionanalyses revealed that systolic BP was 68 mmHg higherand diastolic BP 32 mmHg higher in the obese groupthan in the control group. A step function, i.e. a sudden fallin BP, was seen at the point...... of switching from small to mediumcuff size in the control group, which suggests that systolicBP was overestimated when using small cuff size andunderestimated when using medium cuff size in subjectswith an AC near 23 cm.Conclusions: BP was higher in the obese group than inthe control group although BP...

Vapor pressure measured with inflatable plastic bag

Science.gov (United States)

1965-01-01

Deflated plastic bag in a vacuum chamber measures initial low vapor pressures of materials. The bag captures the test sample vapors and visual observation of the vapor-inflated bag under increasing external pressures yields pertinent data.

Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies.

Science.gov (United States)

Mariyaselvam, Maryanne Z; Marsh, Lucy L; Bamford, Sarah; Smith, Ann; Wise, Matt P; Williams, David W

2017-03-04

Aspiration of subglottic secretions past the endotracheal tube (ETT) cuff is a prerequisite for developing ventilator-associated pneumonia (VAP). Subglottic secretion drainage (SSD) ETTs reduce aspiration of subglottic secretions and have demonstrated lower VAP rates. We compared the performance of seven SSD ETTs against a non-SSD ETT in preventing aspiration below inflated cuffs. ETTs were positioned vertically in 2 cm diameter cylinders. Four ml of a standard microbial suspension was added above inflated cuffs. After 1 h, aspiration was measured and ETTs demonstrating no leakage were subjected to rotational movement and evaluation over 24 h. Collected aspirated fluid was used to inoculate agar media and incubated aerobically at 37 °C for 24 h. The aspiration rate, volume and number of microorganisms that leaked past the cuff was measured. Experiments were repeated (×10) for each type of ETT, with new ETTs used for each repeat. Best performing ETTs were then tested in five different cylinder diameters (1.6, 1.8, 2.0, 2.2 and 2.4 cm). Experiments were repeated as above using sterile water. Volume and time taken for aspiration past the cuff was measured. Experiments were repeated (×10) for each type of ETT. Results were analysed using non-parametric tests for repeated measures. The PneuX ETT prevented aspiration past the cuff in all experiments. All other ETTs allowed aspiration, with considerable variability in performance. The PneuX ETT was statistically superior in reducing aspiration compared to the SealGuard (p aspiration across the range of diameters compared to the SealGuard (p aspiration, relating to cuff material and design. Variability in performance was likely due to the random manner in which involutional folds form in the inflated ETT cuff. The PneuX ETT was the only ETT able to consistently prevent aspiration past the cuff in all experiments.

Cuff deflation: rehabilitation in critical care.

Science.gov (United States)

Bach, John R; Gonçalves, Miguel R; Rodriguez, Pedro Landete; Saporito, Louis; Soares, Luisa

2014-08-01

This is a case series of rehabilitation failures that resulted in severe reactive depression from patients unnecessarily bereft of verbal communication by being left to breathe or be ventilated via tracheostomy tubes, with or without inflated cuffs, for months to years.

Peripheral arterial volume distensibility: significant differences with age and blood pressure measured using an applied external pressure

International Nuclear Information System (INIS)

Zheng, Dingchang; Murray, Alan

2011-01-01

A new arterial distensibility measurement technique was assessed in 100 healthy normotensive subjects. Arterial transmural pressures on the whole right arm were reduced with a 50 cm long cuff inflated to 10, 20, 30 and 40 mmHg. The electrocardiogram, and finger and ear photoplethysmograms were recorded simultaneously. Arm pulse propagation time, pulse wave velocity (PWV) and arterial volume distensibility were determined. With a 40 mmHg reduction in transmural pressure, arm pulse propagation time increased from 61 to 83 ms, PWV decreased from 12 to 8 m s −1 and arterial distensibility increased from 0.102% to 0.232% per mmHg (all P < 0.0001). At all cuff pressures, arterial distensibility was significantly related to resting mean arterial pressure (MAP), diastolic blood pressure (DBP) and age, and for systolic blood pressure at 30 and 40 mmHg (all P < 0.05). At 40 mmHg cuff pressure, arterial distensibility fell by 54% for a MAP increase from 75 to 105 mmHg, 57% for a DBP increase from 60 to 90 mmHg and 47% for an age increase from 20 to 70 years. These changes were more than double than those without cuff pressure. Our technique showed that systemic volume distensibility of the peripheral arm artery reduced with age, with a greater effect at higher external and lower transmural pressures

In vitro protocol for validating interface pressure sensors for therapeutic compression garments: Importance of sphygmomanometer placement and initial cuff diameter

Directory of Open Access Journals (Sweden)

Inhwa Jung

2018-02-01

Full Text Available An optimal protocol is needed to validate the performance of future interface pressure sensors for compression garments when using a sphygmomanometer. PicoPress® was used on a rigid plastic cylinder (r=4 cm. An FDA-cleared aneroid sphygmomanometer was used to apply pressures from 10-60 mmHg with a diameter of 8 cm or 12 cm placed either beneath the sphygmomanometer’s airbag or fabric cuff. A two-tail t-test was performed (P<0.05 for significance for all applied pressures. PicoPress® outputs vary with sensor placement (airbag vs fabric cuff and the initial cuff diameter. Sensor placement overlying the sphygmomanometer’s fabric cuff compared to the airbag led to significantly higher pressures (37%-135% depending on the cuff diameter size. These differences were nearly all statistically significant (P<0.05. Validation of new interface pressure sensors deploying a sphygmomanometer for calibration should specify the location of sensor placement location and initial diameter with a preference for placement under the airbag.

Effect of standard cuff on blood pressure readings in patients with obese arms. How frequent are arms of a 'large circumference'?

Science.gov (United States)

Fonseca-Reyes, Salvador; de Alba-García, Javier García; Parra-Carrillo, José Z; Paczka-Zapata, José Antonio

2003-06-01

To measure the effect on blood pressure readings when a standard cuff is used on patients with arms of a large circumference, and to determine the frequency of arms of a large circumference. Blood pressures were taken in 120 subjects with an arm circumference greater than 33 cm. Also, the arm circumference was determined in 244 patients from a family health unit, and in 216 patients from a hypertension clinic. A mercury sphygmomanometer and two different cuff sizes were used in a random sequence; therefore, 60 patients' blood pressure were first measured with a large cuff, followed by a standard cuff; the opposite sequence was then applied for another 60 patients. With the obtained values and using a regression analysis, the difference in blood pressure overestimation was calculated. Arm circumference measurement percentages were used to determine the frequency of arms of a large circumference. Both systolic and diastolic blood pressures were significantly greater when the standard cuff was used. For every 5 cm increase in arm circumference, starting at 35 cm, a 2-5 mmHg increase in systolic blood pressure, and a 1-3 mmHg increase in diastolic blood pressure was observed. The prevalence of arms with a large circumference in the family medicine unit and hypertension clinic was 42% and 41.8%, respectively. There is an overestimation of blood pressure when a standard cuff is used in obese subjects. The high prevalence of these individuals in our environment, both in the hypertensive and normotensive population, makes it necessary to have on hand different sizes of cuffs for taking blood pressure in order to avoid incorrect decisions.

Evaluation of footprint contact area and pressure using a triple-row modification of the suture-bridge technique for rotator cuff repair.

Science.gov (United States)

Ostrander, Roger V; McKinney, Bart I

2012-10-01

Studies suggest that arthroscopic repair techniques may have high recurrence rates for larger rotator cuff tears. A more anatomic repair may improve the success rate when performing arthroscopic rotator cuff repair. We hypothesized that a triple-row modification of the suture-bridge technique for rotator cuff repair would result in significantly more footprint contact area and pressure between the rotator cuff and the humeral tuberosity. Eighteen ovine infraspinatus tendons were repaired using 1 of 3 simulated arthroscopic techniques: a double-row repair, the suture-bridge technique, and a triple-row repair. The triple-row repair technique is a modification of the suture-bridge technique that uses an additional reducing anchor between the medial and lateral rows. Six samples were tested per group. Pressure-indicating film was used to measure the footprint contact area and pressure after each repair. The triple-row repair resulted in significantly more rotator cuff footprint contact area and contact pressure compared with the double-row technique and the standard suture-bridge technique. No statistical difference in contact area or contact pressure was found between the double-row technique and the suture-bridge technique. The triple-row technique for rotator cuff repair results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. This more anatomic repair may improve the healing rate when performing arthroscopic rotator cuff repair. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Development and Validation of a Novel Cuff-Less Blood Pressure Monitoring Device

Directory of Open Access Journals (Sweden)

Naoki Watanabe, MD

2017-12-01

Full Text Available Ordinary cuff-based blood pressure–monitoring devices remain a technical limitation that disturbs activities of daily life. Here we report a novel system for the cuff-less blood pressure estimation (CLB that requires only 1 sensor for photoplethysmography. The present study is the first report to validate and assess the clinical application of the CLB in accordance with the latest wearable device standard (issued by the Institute of Electrical and Electronics Engineers, standard 1708-2014. Our CLB is expected to offer a flexible and wearable device that permits blood pressure monitoring in more continuous and stress-free settings.

Differences and effects of medium and large adult cuffs on blood pressure readings in individuals with muscular arms.

Science.gov (United States)

Fonseca-Reyes, Salvador; Fajardo-Flores, Ismael; Montes-Casillas, Mayra; Forsyth-Macquarrie, Avril

2009-08-01

This study analyzed systolic and diastolic blood pressure (SBP and DBP) reading differences in individuals with muscular arms, using medium and large adult cuffs. Resting blood pressures (BPs) were measured in bodybuilders competing at the Mexican National Bodybuilding and Fitness Championship. The means of two bilateral simultaneous arm BP measurements were obtained using two different cuff sizes, 12 cm (medium adult) and 16 cm (large adult). A total of 193 bodybuilders completed the measurements. With an arm circumference greater than 33 cm, the SBP and DBP average taken with the medium adult cuff was higher than that obtained with the large adult cuff, 8.2+/-10.6 and 1.6+/-7.4 mmHg, respectively; however, a significant difference was observed only with the SBP. With the medium adult cuff, 48 of 144 individuals showed SBP at least 140 mmHg, whereas with the large adult cuff there were only 17 of 144 individuals. In those participants with an arm circumference less than 33 cm, the BP was nonsignificantly lower with the large cuff, -4.24+/-9.2 and -2.24+/-5.4 mmHg for the SBP and DBP, respectively. Incorrect cuffing of a muscular arm leads to significant errors in the measurement of SBP and DBP, similar to that observed in miscuffing of nonmuscular arms.

Automatic noninvasive measurement of systolic blood pressure using photoplethysmography

Directory of Open Access Journals (Sweden)

Glik Zehava

2009-10-01

Full Text Available Abstract Background Automatic measurement of arterial blood pressure is important, but the available commercial automatic blood pressure meters, mostly based on oscillometry, are of low accuracy. Methods In this study, we present a cuff-based technique for automatic measurement of systolic blood pressure, based on photoplethysmographic signals measured simultaneously in fingers of both hands. After inflating the pressure cuff to a level above systolic blood pressure in a relatively slow rate, it is slowly deflated. The cuff pressure for which the photoplethysmographic signal reappeared during the deflation of the pressure-cuff was taken as the systolic blood pressure. The algorithm for the detection of the photoplethysmographic signal involves: (1 determination of the time-segments in which the photoplethysmographic signal distal to the cuff is expected to appear, utilizing the photoplethysmographic signal in the free hand, and (2 discrimination between random fluctuations and photoplethysmographic pattern. The detected pulses in the time-segments were identified as photoplethysmographic pulses if they met two criteria, based on the pulse waveform and on the correlation between the signal in each segment and the signal in the two neighboring segments. Results Comparison of the photoplethysmographic-based automatic technique to sphygmomanometry, the reference standard, shows that the standard deviation of their differences was 3.7 mmHg. For subjects with systolic blood pressure above 130 mmHg the standard deviation was even lower, 2.9 mmHg. These values are much lower than the 8 mmHg value imposed by AAMI standard for automatic blood pressure meters. Conclusion The photoplethysmographic-based technique for automatic measurement of systolic blood pressure, and the algorithm which was presented in this study, seems to be accurate.

Should blood pressure be measured with the cuff on a bare arm?

NARCIS (Netherlands)

Thien, T.; Keltjens, E.B.; Lenders, J.W.M.; Deinum, J.

2015-01-01

OBJECTIVE: To establish whether the results of blood pressure (BP) measurements are affected by wearing clothing underneath the BP cuff during measurement. METHODS: Normotensive and hypertensive patients (n=133; 65 men) of an outpatient clinic participated in this study. BP was measured according to

Improvement of wheel skidder tractive performance by tire inflation pressure and tire chains

OpenAIRE

Stoilov, Stanimir

2007-01-01

The motion resistance ratio, gross traction ratio and net traction ratio of a wheel cable skidder were determined and mathematical models derived for three tire inflation pressure values with or without tire chains on forest road in mountainous conditions. The motion resistance ratio increases with the increase of tire inflation pressure. On the contrary, the gross traction ratio increases with the decrease of tire inflation pressure. However, when the tires are equipped with tire chains t...

Data describing the flow-mediated vasodilation responses and blood pressure in young adult humans after a single dose of oral edible emu oil

Directory of Open Access Journals (Sweden)

Tadayoshi Miyashita

2018-04-01

Full Text Available The data provided herein include flow-mediated vasodilation responses, represented by changes in arterial diameter, and blood pressure in young adults after a single oral dose of edible emu oil or placebo (cross-over design. Ten healthy men and 10 healthy women participated. Increased blood flow in the antebrachial region was induced by inflating a pressure cuff and subsequently releasing the pressure by deflating the cuff. After the release, the arterial diameter was continuously monitored for 110 sec using ultrasonic diagnostic equipment. The changes in the arterial diameter from 20 to 110 sec post-cuff deflation are described in line graphs and tables. In addition, systolic and diastolic blood pressure data are provided in a table.

Endotracheal Tube Cuff Management at Altitude

Science.gov (United States)

2014-02-05

the volume of saliva, if any, leaking around ETT cuffs. To simulate the clinical environment, four transport ventilators (Model 731, Impact...ETT. Table 1. Changes in ETT Cuff Pressure during the Study Method Sea Level (Baseline)a 8,000 fta Sea Level (Post-Flight)a 7.5 mm 8.0 mm...threshold typically required to prevent aspiration of secretions around the cuff. These findings have important clinical implications, as cuff

Muscle injury induced beneath and distal to a pneumatic tourniquet: A quantitative animal study of effects of tourniquet pressure and duration

Energy Technology Data Exchange (ETDEWEB)

Pedowitz, R.A.; Gershuni, D.H.; Schmidt, A.H.; Friden, J.; Rydevik, B.L.; Hargens, A.R. (Division of Orthopaedics and Rehabilitation, University of California, San Diego (United States))

1991-07-01

Previous recommendations regarding the safe period of tourniquet hemostasis were based largely on studies of ischemia distal to the tourniquet. This study quantitatively analyzed skeletal muscle injury induced beneath and distal to a pneumatic tourniquet applied to the hindlimbs of rabbits for 1, 2, or 4 hours with a cuff inflation pressure of 125, 200, or 350 mm Hg. Technetium Tc 99m pyrophosphate incorporation after systemic injection (Tc 99 uptake) and correlative histology were used to evaluate tissue damage 2 days after tourniquet application. Compared with the contralateral control limbs, compression and ischemia induced statistically significant increases in Tc 99 uptake in the thigh and leg regions of all groups. Pyrophosphate incorporation was significantly greater in the thigh region than in the leg region after 2 hours of compression in the 200 and 350 mm Hg pressure groups and following 4 hours of compression in all pressure groups. Focal and regional fiber necrosis and degeneration were observed in thigh muscles after 2 hours of tourniquet compression. Two hours of continuous tourniquet application at clinically relevant cuff inflation pressures induced significant skeletal muscle necrosis beneath the tourniquet. Use of the lowest possible inflation pressure for a limited duration should minimize the degree of tissue injury caused by tourniquet application.

Muscle injury induced beneath and distal to a pneumatic tourniquet: a quantitative animal study of effects of tourniquet pressure and duration.

Science.gov (United States)

Pedowitz, R A; Gershuni, D H; Schmidt, A H; Fridén, J; Rydevik, B L; Hargens, A R

1991-07-01

Previous recommendations regarding the "safe" period of tourniquet hemostasis were based largely on studies of ischemia distal to the tourniquet. This study quantitatively analyzed skeletal muscle injury induced beneath and distal to a pneumatic tourniquet applied to the hindlimbs of rabbits for 1, 2, or 4 hours with a cuff inflation pressure of 125, 200, or 350 mm Hg. Technetium Tc 99m pyrophosphate incorporation after systemic injection (Tc 99 uptake) and correlative histology were used to evaluate tissue damage 2 days after tourniquet application. Compared with the contralateral control limbs, compression and ischemia induced statistically significant increases in Tc 99 uptake in the thigh and leg regions of all groups. Pyrophosphate incorporation was significantly greater in the thigh region than in the leg region after 2 hours of compression in the 200 and 350 mm Hg pressure groups and following 4 hours of compression in all pressure groups. Focal and regional fiber necrosis and degeneration were observed in thigh muscles after 2 hours of tourniquet compression. Two hours of continuous tourniquet application at clinically relevant cuff inflation pressures induced significant skeletal muscle necrosis beneath the tourniquet. Use of the lowest possible inflation pressure for a limited duration should minimize the degree of tissue injury caused by tourniquet application.

Muscle injury induced beneath and distal to a pneumatic tourniquet: A quantitative animal study of effects of tourniquet pressure and duration

International Nuclear Information System (INIS)

Pedowitz, R.A.; Gershuni, D.H.; Schmidt, A.H.; Friden, J.; Rydevik, B.L.; Hargens, A.R.

1991-01-01

Previous recommendations regarding the safe period of tourniquet hemostasis were based largely on studies of ischemia distal to the tourniquet. This study quantitatively analyzed skeletal muscle injury induced beneath and distal to a pneumatic tourniquet applied to the hindlimbs of rabbits for 1, 2, or 4 hours with a cuff inflation pressure of 125, 200, or 350 mm Hg. Technetium Tc 99m pyrophosphate incorporation after systemic injection (Tc 99 uptake) and correlative histology were used to evaluate tissue damage 2 days after tourniquet application. Compared with the contralateral control limbs, compression and ischemia induced statistically significant increases in Tc 99 uptake in the thigh and leg regions of all groups. Pyrophosphate incorporation was significantly greater in the thigh region than in the leg region after 2 hours of compression in the 200 and 350 mm Hg pressure groups and following 4 hours of compression in all pressure groups. Focal and regional fiber necrosis and degeneration were observed in thigh muscles after 2 hours of tourniquet compression. Two hours of continuous tourniquet application at clinically relevant cuff inflation pressures induced significant skeletal muscle necrosis beneath the tourniquet. Use of the lowest possible inflation pressure for a limited duration should minimize the degree of tissue injury caused by tourniquet application

Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.

Directory of Open Access Journals (Sweden)

Ata Mahmoodpoor

2013-07-01

Full Text Available Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV ETT, Polyurethane (PU cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34% in group PVC, 8 (25% in Sealguard and 7 (21% in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.

Regional respiratory inflation and deflation pressure-volume curves determined by electrical impedance tomography.

Science.gov (United States)

Frerichs, I; Dargaville, P A; Rimensberger, P C

2013-06-01

Measurement of regional lung volume changes during a quasi-static pressure-volume (PV) manoeuvre using electrical impedance tomography (EIT) could be used to assess regional respiratory system mechanics and to determine optimal ventilator settings in individual patients. Using this approach, we studied regional respiratory system mechanics in healthy and lung-injured animals, before and after surfactant administration during inflation and deflation PV manoeuvres. The comparison of the EIT-derived regional PV curves in ventral, middle and dorsal regions of the right and left lungs showed not only different amounts of hysteresis in these regions but also marked differences among different landmark pressures calculated on the inflation and deflation limbs of the curves. Regional pressures at maximum compliance as well as the lower and upper pressures of maximum compliance change differed between the inflation and deflation and increased from ventral to dorsal regions in all lung conditions. All these pressure values increased in the injured and decreased in the surfactant treated lungs. Examination of regional respiratory system mechanics using EIT enables the assessment of spatial and temporal heterogeneities in the ventilation distribution. Characteristic landmarks on the inflation and especially on the deflation limb of regional PV curves may become useful measures for guiding mechanical ventilation.

Pavement damaging effects from dual tyre configurations of heavy vehicles with tyre inflation pressure differentials

CSIR Research Space (South Africa)

De Beer, M

2015-08-16

Full Text Available inflation pressure data in addition to tyre loading resulted in a rough empirical estimate of tyre inflation pressure directly from SIM contact stress measurements. In an ideal world, an instrument such as the SIM could be invaluable in not only capturing...

Pavement damaging effects from dual tyre configurations of heavy vehicles with tyre inflation pressure differentials

CSIR Research Space (South Africa)

De Beer, M

2015-08-01

Full Text Available inflation pressure data in addition to tyre loading resulted in a rough empirical estimate of tyre inflation pressure directly from SIM contact stress measurements. In an ideal world, an instrument such as the SIM could be invaluable in not only capturing...

Inner ocular blood flow responses to an acute decrease in blood pressure in resting humans

International Nuclear Information System (INIS)

Ikemura, Tsukasa; Kashima, Hideaki; Yamaguchi, Yuji; Miyaji, Akane; Hayashi, Naoyuki

2015-01-01

Whether inner ocular vessels have an autoregulatory response to acute fluctuations in blood pressure is unclear. We tried to examine the validity of acute hypotension elicited by thigh-cuff release as to assess the dynamic autoregulation in the ocular circulation. Blood flow velocity in the superior nasal and inferior temporal retinal arterioles, and in the retinal and choroidal vasculature were measured with the aid of laser speckle flowgraphy before and immediately after an acute decrease in blood pressure in 20 healthy subjects. Acute hypotension was induced by a rapid release of bilateral thigh occlusion cuffs that had been inflated to 220 mmHg for 2 min. The ratio of the relative change in retinal and choroidal blood flow velocity to the relative change in mean arterial blood pressure (MAP) was calculated. Immediately after cuff release, the MAP and blood flows in the all ocular target vessels decreased significantly from the baseline values obtained before thigh-cuff release. The ratio of the relative change in inner ocular blood flow velocity to that in the MAP exceeded 1% / %mmHg. An explicit dynamic autoregulation in inner ocular vessels cannot be demonstrated in response to an acute hypotension induced by the thigh-cuff release technique. (paper)

[A comparative study between inflation and deflation pressure-volume curve in determining the optimal positive end-expiratory pressure].

Science.gov (United States)

Gang, Li; Sun, Xiao-yi; Xu, Jin-quan; Zhang, Xin-li; Kou, Lu-xin; Jiang, Zhi-hong; Zhang, Lei

2012-02-01

To determine the optimal positive end-expiratory pressure (PEEP) according to inflation and deflation pressure-volume curve (P-V curve) in patients with acute respiratory distress syndrome (ARDS). ARDS models were reproduced in 20 dogs, and they were randomly divided into two groups. In both groups, Levenberg-Marquardt iterative algorithm was employed using software to explore parameters fitting with Boltzmann formula, by which the real inflection point of pressure (Pinf d) in deflation limb or lower inflection point pressure (PLip) in inflation limb on P-V curve were defined. For the control group (inflation curve) P-V curve of PLip + 2 cm H(2)O [1 cm H(2)O = 0.098 kPa] was applied as the best PEEP value. In the experimental group (deflation curve) the Pinf d was taken as the best PEEP value. The heart rate (HR), blood pressure (BP), fingertip pulse oxygen saturation [SpO(2)], static lung compliance (Cst), arterial partial pressure of oxygen [PaO(2)] and arterial partial pressure of carbon dioxide [PaCO(2)] were monitored at 0, 2, 6, 12, 24 and 48 hours. Oxygenation index increased significantly both in control and experimental groups. In experimental group, oxygenation index (mm Hg, 1 mm Hg = 0.133 kPa) of 12, 24 and 48 hours was respectively significantly higher than that of the control group (12 hours: 177.63 ± 8.94 vs. 165.60 ± 8.90, 24 hours: 194.19 ± 10.67 vs. 168.70 ± 10.60, 48 hours: 203.15 ± 13.21 vs. 171.26 ± 9.21, all P deflation P-V curve was better than that of inflation curve.

Smartphone-based Continuous Blood Pressure Measurement Using Pulse Transit Time.

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Gholamhosseini, Hamid; Meintjes, Andries; Baig, Mirza; Linden, Maria

2016-01-01

The increasing availability of low cost and easy to use personalized medical monitoring devices has opened the door for new and innovative methods of health monitoring to emerge. Cuff-less and continuous methods of measuring blood pressure are particularly attractive as blood pressure is one of the most important measurements of long term cardiovascular health. Current methods of noninvasive blood pressure measurement are based on inflation and deflation of a cuff with some effects on arteries where blood pressure is being measured. This inflation can also cause patient discomfort and alter the measurement results. In this work, a mobile application was developed to collate the PhotoPlethysmoGramm (PPG) waveform provided by a pulse oximeter and the electrocardiogram (ECG) for calculating the pulse transit time. This information is then indirectly related to the user's systolic blood pressure. The developed application successfully connects to the PPG and ECG monitoring devices using Bluetooth wireless connection and stores the data onto an online server. The pulse transit time is estimated in real time and the user's systolic blood pressure can be estimated after the system has been calibrated. The synchronization between the two devices was found to pose a challenge to this method of continuous blood pressure monitoring. However, the implemented continuous blood pressure monitoring system effectively serves as a proof of concept. This combined with the massive benefits that an accurate and robust continuous blood pressure monitoring system would provide indicates that it is certainly worthwhile to further develop this system.

Short-term pressure induced suppression of the short-latency response: a new methodology for investigating stretch reflexes

DEFF Research Database (Denmark)

Leukel, Christian; Lundbye-Jensen, Jesper; Gruber, Markus

2009-01-01

During experiments involving ischemic nerve block, we noticed that the short-latency response (SLR) of evoked stretches in m. soleus decreased immediately following inflation of a pneumatic cuff surrounding the lower leg. The present study aimed to investigate this short-term effect of pressure......) were recorded. Additionally, stretches were applied with different velocities and amplitudes. Finally, the SLR was investigated during hopping and in two protocols that modified the ability of the muscle-tendon complex distal to the cuff to stretch. All measurements were performed with deflated...

Changes in extracellular muscle volume affect heart rate and blood pressure responses to static exercise

Science.gov (United States)

Baum, K.; Essfeld, D.; Stegemann, J.

To investigate the effect of μg-induced peripheral extracellular fluid reductions on heart rate and blood pressure during isometric exercise, six healthy male subjects performed three calf ergometer test with different extracellular volumes of working muscles. In all tests, body positions during exercise were identical (supine with the knee joint flexed to 900). After a pre-exercise period of 25 min, during which calf volumes were manipulated, subjects had to counteract an external force of 180 N for 5 min. During the pre-exercise period three different protocols were applied. Test A: Subjects rested in the exercise position; test B: Body position was the same as in A but calf volume was increased by venous congestion (cuffs inflated to 80 mm Hg); test C: Calf volumes were decreased by a negative hydrostatic pressure (calves about 40 cm above heart level with the subjects supine). To clamp the changed calf volumes in tests B and C, cuffs were inflated to 300 mm Hg 5 min before the onset of exercise. This occlusion was maintained until termination of exercise. Compared to tests A and B, the reduced volume of test C led to significant increases in heart rate and blood pressure during exercise. Oxygen uptake did not exceed resting levels in B and C until cuffs were deflated, indicating that exclusively calf muscles contributed to the neurogenic peripheral drive. It is concluded that changes in extracellular muscle volume have to be taken into account when comparing heart rate and blood pressure during lg- and μg- exercise.

Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial.

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Dat, Vu Quoc; Geskus, Ronald B; Wolbers, Marcel; Loan, Huynh Thi; Yen, Lam Minh; Binh, Nguyen Thien; Chien, Le Thanh; Mai, Nguyen Thi Hoang; Phu, Nguyen Hoan; Lan, Nguyen Phu Huong; Hao, Nguyen Van; Long, Hoang Bao; Thuy, Tran Phuong; Kinh, Nguyen Van; Trung, Nguyen Vu; Phu, Vu Dinh; Cap, Nguyen Trung; Trinh, Dao Tuyet; Campbell, James; Kestelyn, Evelyne; Wertheim, Heiman F L; Wyncoll, Duncan; Thwaites, Guy Edward; van Doorn, H Rogier; Thwaites, C Louise; Nadjm, Behzad

2018-04-04

Ventilator-associated respiratory infection (VARI) comprises ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). Although their diagnostic criteria vary, together these are the most common hospital-acquired infections in intensive care units (ICUs) worldwide, responsible for a large proportion of antibiotic use within ICUs. Evidence-based strategies for the prevention of VARI in resource-limited settings are lacking. Preventing the leakage of oropharyngeal secretions into the lung using continuous endotracheal cuff pressure control is a promising strategy. The aim of this study is to investigate the efficacy of automated, continuous endotracheal cuff pressure control in preventing the development of VARI and reducing antibiotic use in ICUs in Vietnam. This is an open-label randomised controlled multicentre trial. We will enrol 600 adult patients intubated for ≤ 24 h at the time of enrolment. Eligible patients will be stratified according to admission diagnosis (180 tetanus, 420 non-tetanus) and site and will be randomised in a 1:1 ratio to receive either (1) automated, continuous control of endotracheal cuff pressure or (2) intermittent measurement and control of endotracheal cuff pressure using a manual cuff pressure meter. The primary outcome is the occurrence of VARI, defined as either VAP or VAT during the ICU admission up to a maximum of 90 days after randomisation. Patients in both groups who are at risk for VARI will receive a standardised battery of investigations if their treating physician feels a new infection has occurred, the results of which will be used by an endpoint review committee, blinded to the allocated arm and independent of patient care, to determine the primary outcome. All enrolled patients will be followed for mortality and endotracheal tube cuff-related complications at 28 days and 90 days after randomisation. Other secondary outcomes include antibiotic use; days ventilated, in ICU and in hospital

Continuous cuff-less blood pressure monitoring based on the pulse arrival time approach: the impact of posture.

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Muehlsteff, J; Aubert, X A; Morren, G

2008-01-01

There is an unmet need for cuff-less blood pressure (BP) monitoring especially, in personal healthcare applications. The pulse arrival time (PAT) approach might offer a suitable solution to enable comfortable BP monitoring even at beat-level. However, the methodology is based on hemodynamic surrogate measures, which are sensitive to patient activities such as posture changes, not necessarily related to blood pressure variations. In this paper, we analyze the impact of posture on the PAT measure and related hemodynamic parameters such as the pre-ejection period in well-defined procedures. Additionally, the PAT of a monitored subject is investigated in an unsupervised scenario illustrating the complexity of such a measurement. Our results show the failure of blood pressure inference based on simple calibration strategies using the PAT measure only. We discuss opportunities to compensate for the observed effects towards the realization of wearable cuff-less blood pressure monitoring. These findings emphasize the importance of accessing context information in personal healthcare applications, where vital sign monitoring is typically unsupervised.

Analysis of dynamic autoregulation assessed by the cuff deflation method.

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Hlatky, Roman; Valadka, Alex B; Robertson, Claudia S

2006-01-01

Dynamic testing of cerebral pressure autoregulation is more practical than static testing for critically ill patients. The process of cuff deflation is innocuous in the normal subject, but the systemic and cerebral effects of cuff deflation in severely head-injured patients have not been studied. The purposes of this study were to examine the physiological effects of cuff deflation and to study their impact on the calculation of autoregulatory index (ARI). In 24 severely head-injured patients, 388 thigh cuff deflations were analyzed. The physiological parameters were recorded before, during, and after a transient decrease in blood pressure. Autoregulation was graded by generating an ARI value from 0 to 9. Mean arterial blood pressure (MAP) dropped rapidly during the first 2-3 seconds, but the nadir MAP was not reached until 8 +/- 7 seconds after the cuff deflation. MAP decreased by an average value of 19 +/- 5 mmHg. Initially the tracings for MAP and cerebral perfusion pressure (CPP) were nearly identical, but after 30 seconds, variable increases in intracranial pressure caused some differences between the MAP and CPP curves. The difference between the ARI values calculated twice using MAP as well as CPP was zero for 70% of left-sided studies and 73% for right-sided studies and less than or equal to 1 for 93% of left- and 95% of right-sided cuff deflations. Transient and relatively minor perturbations were detected in systemic physiology induced by dynamic testing of cerebral pressure autoregulation. Furthermore, this study confirms that the early changes in MAP and CPP after cuff deflation are nearly identical. MAP can substitute for CPP in the calculation of ARI even in the severely brain-injured patient.

How important is the recommended slow cuff pressure deflation rate for blood pressure measurement?

Science.gov (United States)

Zheng, Dingchang; Amoore, John N; Mieke, Stephan; Murray, Alan

2011-10-01

Cuff pressure deflation rate influences blood pressure (BP) measurement. However, there is little quantitative clinical evidence on its effect. Oscillometric pulses recorded from 75 subjects at the recommended deflation rate of 2-3 mmHg per second were analyzed. Some pulses were removed to realize six faster rates (2-7 times faster than the original). Systolic, diastolic, and mean arterial blood pressures (SBP, DBP, MAP) were determined from the original and six reconstructed oscillometric waveforms. Manual measurement was based on the appearance of oscillometric pulse peaks, and automatic measurement on two model envelopes (linear and polynomial) fitted to the sequence of oscillometric pulse amplitudes. The effects of deflation rate on BP determination and within-subject BP variability were analyzed. For SBP and DBP determined from the manual measurement, different deflation rates resulted in significant changes (both p deflation rate effect (all p > 0.3). Faster deflation increased the within-subject BP variability (all p deflation rate, and for the automatic model-based techniques, the deflation rate had little effect.

Multi-stage versus single-stage inflation and deflation cycle for alternating low pressure air mattresses to prevent pressure ulcers in hospitalised patients: a randomised-controlled clinical trial.

Science.gov (United States)

Demarré, L; Beeckman, D; Vanderwee, K; Defloor, T; Grypdonck, M; Verhaeghe, S

2012-04-01

The duration and the amount of pressure and shear must be reduced in order to minimize the risk of pressure ulcer development. Alternating low pressure air mattresses with multi-stage inflation and deflation cycle of the air cells have been developed to relieve pressure by sequentially inflating and deflating the air cells. Evidence about the effectiveness of this type of mattress in clinical practice is lacking. This study aimed to compare the effectiveness of an alternating low pressure air mattress that has a standard single-stage inflation and deflation cycle of the air cells with an alternating low pressure air mattress with multi-stage inflation and deflation cycle of the air cells. A randomised controlled trial was performed in a convenience sample of 25 wards in five hospitals in Belgium. In total, 610 patients were included and randomly assigned to the experimental group (n=298) or the control group (n=312). In the experimental group, patients were allocated to an alternating low pressure air mattress with multi-stage inflation and deflation cycle of the air cells. In the control group, patients were allocated to an alternating low pressure air mattress with a standard single-stage inflation and deflation cycle of the air cells. The outcome was defined as cumulative pressure ulcer incidence (Grade II-IV). An intention-to-treat analysis was performed. There was no significant difference in cumulative pressure ulcer incidence (Grade II-IV) between both groups (Exp.=5.7%, Contr.=5.8%, p=0.97). When patients developed a pressure ulcer, the median time was 5.0 days in the experimental group (IQR=3.0-8.5) and 8.0 days in the control group (IQR=3.0-8.5) (Mann-Whitney U-test=113, p=0.182). The probability to remain pressure ulcer free during the observation period in this trial did not differ significantly between the experimental group and the control group (log-rank χ(2)=0.013, df=1, p=0.911). An alternating low pressure air mattress with multi-stage inflation

Assessing endothelial function and providing calibrated UFMD data using a blood pressure cuff

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Maltz, Jonathan S.

2017-08-22

Methods and apparatus are provided for assessing endothelial function in a mammal. In certain embodiments the methods involve using a cuff to apply pressure to an artery in a subject to determine a plurality of baseline values for a parameter related to endothelial function as a function of applied pressure (P.sub.m); b) applying a stimulus to the subject; and applying external pressure P.sub.m to the artery to determine a plurality of stimulus-effected values for the parameter related to endothelial function as a function of applied pressure (P.sub.m); where the baseline values are determined from measurements made when said mammal is not substantially effected by said stimulus and differences in said baseline values and said stimulus-effected values provide a measure of endothelial function in said mammal.

Validity and reliability of central blood pressure estimated by upper arm oscillometric cuff pressure.

Science.gov (United States)

Climie, Rachel E D; Schultz, Martin G; Nikolic, Sonja B; Ahuja, Kiran D K; Fell, James W; Sharman, James E

2012-04-01

Noninvasive central blood pressure (BP) independently predicts mortality, but current methods are operator-dependent, requiring skill to obtain quality recordings. The aims of this study were first, to determine the validity of an automatic, upper arm oscillometric cuff method for estimating central BP (O(CBP)) by comparison with the noninvasive reference standard of radial tonometry (T(CBP)). Second, we determined the intratest and intertest reliability of O(CBP). To assess validity, central BP was estimated by O(CBP) (Pulsecor R6.5B monitor) and compared with T(CBP) (SphygmoCor) in 47 participants free from cardiovascular disease (aged 57 ± 9 years) in supine, seated, and standing positions. Brachial mean arterial pressure (MAP) and diastolic BP (DBP) from the O(CBP) device were used to calibrate in both devices. Duplicate measures were recorded in each position on the same day to assess intratest reliability, and participants returned within 10 ± 7 days for repeat measurements to assess intertest reliability. There was a strong intraclass correlation (ICC = 0.987, P difference (1.2 ± 2.2 mm Hg) for central systolic BP (SBP) determined by O(CBP) compared with T(CBP). Ninety-six percent of all comparisons (n = 495 acceptable recordings) were within 5 mm Hg. With respect to reliability, there were strong correlations but higher limits of agreement for the intratest (ICC = 0.975, P difference 0.6 ± 4.5 mm Hg) and intertest (ICC = 0.895, P difference 4.3 ± 8.0 mm Hg) comparisons. Estimation of central SBP using cuff oscillometry is comparable to radial tonometry and has good reproducibility. As a noninvasive, relatively operator-independent method, O(CBP) may be as useful as T(CBP) for estimating central BP in clinical practice.

Massive aspiration past the tracheal tube cuff caused by closed tracheal suction system.

Science.gov (United States)

Dave, Mital H; Frotzler, Angela; Madjdpour, Caveh; Koepfer, Nelly; Weiss, Markus

2011-01-01

Aspiration past the tracheal tube cuff has been recognized to be a risk factor for the development of ventilator-associated pneumonia (VAP). This study investigated the effect of closed tracheal suctioning on aspiration of fluid past the tracheal tube cuff in an in vitro benchtop model. High-volume low pressure tube cuffs of 7.5 mm internal diameter (ID) were placed in a 22 mm ID artificial trachea connected to a test lung. Positive pressure ventilation (PPV) with 15 cm H₂O peak inspiratory pressure and 5 cm H₂O positive end-expiratory pressure (PEEP) was used. A closed tracheal suction system (CTSS) catheter (size 14Fr) was attached to the tracheal tube and suction was performed for 5, 10, 15, or 20 seconds under 200 or 300 cm H₂O suction pressures. Amount of fluid (mL) aspirated along the tube cuff and the airway pressure changes were recorded for each suction procedure. Fluid aspiration during different suction conditions was compared using Kruskal-Wallis and Mann-Whitney test (Bonferroni correction [α = .01]). During 10, 15, and 20 seconds suction, airway pressure consistently dropped down to -8 to -13 cm H₂O (P aspiration was never observed under PPV + PEEP but occurred always during suctioning. Aspiration along the tube cuff was higher with -300 cm H₂O than with -200 cm H₂O suction pressure (P aspiration of fluid occurs along the tracheal tube cuff during suction with the closed tracheal suction system. © SAGE Publications 2011.

Respiratory system model for quasistatic pulmonary pressure-volume (P-V) curve: inflation-deflation loop analyses.

Science.gov (United States)

Amini, R; Narusawa, U

2008-06-01

A respiratory system model (RSM) is developed for the deflation process of a quasistatic pressure-volume (P-V) curve, following the model for the inflation process reported earlier. In the RSM of both the inflation and the deflation limb, a respiratory system consists of a large population of basic alveolar elements, each consisting of a piston-spring-cylinder subsystem. A normal distribution of the basic elements is derived from Boltzmann statistical model with the alveolar closing (opening) pressure as the distribution parameter for the deflation (inflation) process. An error minimization by the method of least squares applied to existing P-V loop data from two different data sources confirms that a simultaneous inflation-deflation analysis is required for an accurate determination of RSM parameters. Commonly used terms such as lower inflection point, upper inflection point, and compliance are examined based on the P-V equations, on the distribution function, as well as on the geometric and physical properties of the basic alveolar element.

Cuff-less PPG based continuous blood pressure monitoring: a smartphone based approach.

Science.gov (United States)

Gaurav, Aman; Maheedhar, Maram; Tiwari, Vijay N; Narayanan, Rangavittal

2016-08-01

Cuff-less estimation of systolic (SBP) and diastolic (DBP) blood pressure is an efficient approach for non-invasive and continuous monitoring of an individual's vitals. Although pulse transit time (PTT) based approaches have been successful in estimating the systolic and diastolic blood pressures to a reasonable degree of accuracy, there is still scope for improvement in terms of accuracies. Moreover, PTT approach requires data from sensors placed at two different locations along with individual calibration of physiological parameters for deriving correct estimation of systolic and diastolic blood pressure (BP) and hence is not suitable for smartphone deployment. Heart Rate Variability is one of the extensively used non-invasive parameters to assess cardiovascular autonomic nervous system and is known to be associated with SBP and DBP indirectly. In this work, we propose a novel method to extract a comprehensive set of features by combining PPG signal based and Heart Rate Variability (HRV) related features using a single PPG sensor. Further, these features are fed into a DBP feedback based combinatorial neural network model to arrive at a common weighted average output of DBP and subsequently SBP. Our results show that using this current approach, an accuracy of ±6.8 mmHg for SBP and ±4.7 mmHg for DBP is achievable on 1,750,000 pulses extracted from a public database (comprising 3000 people). Since most of the smartphones are now equipped with PPG sensor, a mobile based cuff-less BP estimation will enable the user to monitor their BP as a vital parameter on demand. This will open new avenues towards development of pervasive and continuous BP monitoring systems leading to an early detection and prevention of cardiovascular diseases.

An affordable cuff-less blood pressure estimation solution.

Science.gov (United States)

Jain, Monika; Kumar, Niranjan; Deb, Sujay

2016-08-01

This paper presents a cuff-less hypertension pre-screening device that non-invasively monitors the Blood Pressure (BP) and Heart Rate (HR) continuously. The proposed device simultaneously records two clinically significant and highly correlated biomedical signals, viz., Electrocardiogram (ECG) and Photoplethysmogram (PPG). The device provides a common data acquisition platform that can interface with PC/laptop, Smart phone/tablet and Raspberry-pi etc. The hardware stores and processes the recorded ECG and PPG in order to extract the real-time BP and HR using kernel regression approach. The BP and HR estimation error is measured in terms of normalized mean square error, Error Standard Deviation (ESD) and Mean Absolute Error (MAE), with respect to a clinically proven digital BP monitor (OMRON HBP1300). The computed error falls under the maximum standard allowable error mentioned by Association for the Advancement of Medical Instrumentation; MAE cost home and clinic bases solution for continuous health monitoring.

Effects of reperfusion intervals on skeletal muscle injury beneath and distal to a pneumatic tourniquet.

Science.gov (United States)

Pedowitz, R A; Gershuni, D H; Fridén, J; Garfin, S R; Rydevik, B L; Hargens, A R

1992-03-01

To date there have been no experimental studies specifically directed at effects of reperfusion intervals on skeletal muscle injury beneath the tourniquet. 99mTechnetium pyrophosphate (Tc 99) incorporation and correlative histology were used to assess injury 2 days after tourniquet application in muscles beneath (thigh) and distal (leg) to the cuff. Tourniquets were applied to rabbit hindlimbs for a total of either 2 or 4 hours. In the 4-hour series, tourniquet compression (either 125 mm Hg or 350 mm Hg cuff inflation pressure) was either continuous or interrupted by 10-minute reperfusion intervals after 2 hours or after every hour of cuff inflation. In the 2-hour series, tourniquet compression (350 mm Hg) was either continuous or interrupted by 10-minute reperfusion intervals after 2 hours or after every hour of cuff inflation. In the 2-hour series, tourniquet compression (350 mm Hg) was either continuous or interrupted by a 10-minute reperfusion interval after 1 hour. Pyrophosphate incorporation (Tc 99 uptake) was significantly greater in the thigh region than in the leg region in all of the 4-hour tourniquet groups. Tc 99 uptake was significantly reduced by reperfusion after each hour of cuff inflation. With 350 mm Hg tourniquet pressure, a reperfusion interval after 2 hours of cuff inflation tended to exacerbate tourniquet compression injury. Reperfusion intervals did not significantly affect Tc 99 uptake in the leg region of these groups. With a 2-hour tourniquet time, Tc 99 uptake in the thigh was significantly decreased by reperfusion after 1 hour of cuff inflation. Previous clinical recommendations, based on serum creatine phosphokinase abnormalities after experimental tourniquet ischemia, probably reflected tourniquet compression injury. Hourly reperfusion limits skeletal muscle injury during extended periods of tourniquet use.

A Respiratory Marker Derived From Left Vagus Nerve Signals Recorded With Implantable Cuff Electrodes.

Science.gov (United States)

Sevcencu, Cristian; Nielsen, Thomas N; Kjaergaard, Benedict; Struijk, Johannes J

2018-04-01

Left vagus nerve (LVN) stimulation (LVNS) has been tested for lowering the blood pressure (BP) in patients with resistant hypertension (RH). Whereas, closed-loop LVNS (CL-LVNS) driven by a BP marker may be superior to open-loop LVNS, there are situations (e.g., exercising) when hypertension is normal. Therefore, an ideal anti-RH CL-LVNS system requires a variable to avoid stimulation in such conditions, for example, a respiratory marker ideally extracted from the LVN. As the LVN conducts respiratory signals, this study aimed to investigate if such signals can be recorded using implantable means and if a marker to monitor respiration could be derived from such recordings. The experiments were performed in 14 anesthetized pigs. Five pigs were subjected to changes of the respiratory frequency and nine to changes of the respiratory volume. The LVN electroneurogram (VENG) was recorded using two cuff electrodes and the respiratory cycles (RC) using a pressure transducer. To separate the afferent and efferent VENGs, vagotomy was performed between the cuffs in the first group of pigs. The VENG was squared to derive respiration-related neural profiles (RnPs) and their correlation with the RCs was investigated in regard to timing and magnitude parameters derived from the two waveforms. The RnPs were morphologically similar with the RCs and the average RnPs represented accurate copies of the average RCs. Consequently, the lung inflation/deflation RC and RnP components had the same duration, the respiratory frequency changes affected in the same way both waveforms and the RnP amplitude increased linearly with the lung inflation in all tested pigs (R 2 values between 0.85 and 0.99). The RnPs comprise information regarding the timing and magnitude of the respiratory parameters. As those LVN profiles were derived using implantable means, this study indicates that the RnPs could serve as respiratory markers in implantable systems. © 2017 International Neuromodulation Society.

Validation of the Welch Allyn SureBP (inflation) and StepBP (deflation) algorithms by AAMI standard testing and BHS data analysis.

Science.gov (United States)

Alpert, Bruce S

2011-04-01

We evaluated two new Welch Allyn automated blood pressure (BP) algorithms. The first, SureBP, estimates BP during cuff inflation; the second, StepBP, does so during deflation. We followed the American National Standards Institute/Association for the Advancement of Medical Instrumentation SP10:2006 standard for testing and data analysis. The data were also analyzed using the British Hypertension Society analysis strategy. We tested children, adolescents, and adults. The requirements of the American National Standards Institute/Association for the Advancement of Medical Instrumentation SP10:2006 standard were fulfilled with respect to BP levels, arm sizes, and ages. Association for the Advancement of Medical Instrumentation SP10 Method 1 data analysis was used. The mean±standard deviation for the device readings compared with auscultation by paired, trained, blinded observers in the SureBP mode were -2.14±7.44 mmHg for systolic BP (SBP) and -0.55±5.98 mmHg for diastolic BP (DBP). In the StepBP mode, the differences were -3.61±6.30 mmHg for SBP and -2.03±5.30 mmHg for DBP. Both algorithms achieved an A grade for both SBP and DBP by British Hypertension Society analysis. The SureBP inflation-based algorithm will be available in many new-generation Welch Allyn monitors. Its use will reduce the time it takes to estimate BP in critical patient care circumstances. The device will not need to inflate to excessive suprasystolic BPs to obtain the SBP values. Deflation is rapid once SBP has been determined, thus reducing the total time of cuff inflation and reducing patient discomfort. If the SureBP fails to obtain a BP value, the StepBP algorithm is activated to estimate BP by traditional deflation methodology.

Skin perfusion pressure measured with a photo sensor in an air-filled plastic balloon: validity and reproducibility on the lower leg in normal subjects and patients suspected of obliterative arterial disease

DEFF Research Database (Denmark)

Nielsen, Steen Levin; Nielsen, Anne Lerberg; Vind, Susanne Haase

2011-01-01

An inflatable small plastic bag including a photo sensor was constructed for measurement of skin perfusion pressure avoiding the rim of the photo sensor over bony and tendineous surfaces of the tibia below the knee, at the ankle, and on the dorsal forefoot. Compression was obtained using a conical...... blood pressure cuff with continuous decrease from suprasystolic arm pressure. The validity of skin perfusion pressure with the new device was compared to that of isotope washout below the knee in normal subjects and in patients with an ischemic forefoot with acceptable agreement. The method had a high...... reproducibility within and between days in normal subjects. Compared to systolic arterial pressure measured using a strain gauge with a cuff on the ankle in normal subjects and patients with intermittent claudication the new device showed blood pressure in the skin closer to the diastolic pressure. The new...

Inflation of a Polymeric Menbrane

DEFF Research Database (Denmark)

Kristensen, Susanne B.; Larsen, Johannes R.; Hassager, Ole

1998-01-01

We consider an axisymmetric polymeric membrane inflated by a uniform pressure difference acting across the membrane.......We consider an axisymmetric polymeric membrane inflated by a uniform pressure difference acting across the membrane....

Validity and Usefulness of `Wearable Blood Pressure Sensing' for Detection of Inappropriate Short-Term Blood Pressure Variability in the Elderly

Science.gov (United States)

Iijima, Katsuya; Kameyama, Yumi; Akishita, Masahiro; Ouchi, Yasuyoshi; Yanagimoto, Shintaro; Imai, Yasushi; Yahagi, Naoki; Lopez, Guillaume; Shuzo, Masaki; Yamada, Ichiro

An increase in short-term blood pressure (BP) variability is a characteristic feature in the elderly. It makes the management of hemodynamics more difficult, because it is frequently seen disturbed baro-reflex function and increased arterial stiffness, leading to isolated systolic hypertension. Large BP variability aggravates hypertensive target organ damage and is an independent risk factor for the cardiovascular (CV) events in elderly hypertensive patients. Therefore, appropriate control in BP is indispensable to manage lifestyle-related diseases and to prevent subsequent CV events. In addition, accumulating recent reports show that excessive BP variability is also associated with a decline in cognitive function and fall in the elderly. In the clinical settings, we usually evaluate their health condition, mainly with single point BP measurement using cuff inflation. However, unfortunately we are not able to find the close changes in BP by the traditional way. Here, we can show our advantageous approach of continuous BP monitoring using newly developing device `wearable BP sensing' without a cuff stress in the elderly. The new device could reflect systolic BP and its detailed changes, in consistent with cuff-based BP measurement. Our new challenge suggests new possibility of its clinical application with high accuracy.

A novel multi-wavelength procedure for blood pressure estimation using opto-physiological sensor at peripheral arteries and capillaries

Science.gov (United States)

Scardulla, Francesco; Hu, Sijung; D'Acquisto, Leonardo; Pasta, Salvatore; Barrett, Laura; Blanos, Panagiotis; Yan, Liangwen

2018-02-01

In this study, the Carelight multi-wavelength opto-electronic patch sensor (OEPS) was adopted to assess the effectiveness of a new approach for estimating the systolic blood pressure (SBP) through the changes in the morphology of the OEPS signal. Specifically, the SBP was estimated by changing the pressure exerted on an inflatable cuff placed around the left upper arm. Pressure acquisitions were performed both with gold standard (i.e. electronic sphygmomanometer), and Carelight sensor (experimental procedure), on subjects from a multiethnic cohort (aged 28 +/- 7). The OEPS sensor was applied together with a manual inflatable cuff, going slightly above the level of the SBP with increases of +10mmHg and subsequently deflated by 10mmHg until reaching full deflation. The OEPS signals were captured using four wavelength illumination sources (i.e., green 525 nm, orange 595 nm, red 650 nm and IR 870 nm) on three different measuring sites, namely forefinger, radial artery and wrist. The implemented algorithm provides information on the instant when the SBP was reached and the signal is lost since the vessel is completely blocked. Similarly, it detected the signal resumption when the external pressure dropped below the SBP. The findings demonstrated a good correlation between the variation of the pressure and the corresponding OEPS signal with the most accurate result achieved in the fingertip among all wavelengths, with a temporal identification error of 8.07 %. Further studies will improve the clinical relevance on a cohort of patients diagnosed with hyper- or hypotension, in order to develop a wearable blood-pressure device.

Current Biomechanical Concepts for Rotator Cuff Repair

Science.gov (United States)

2013-01-01

For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed. PMID:23730471

EVALUATION OF THE BLOOD PRESSURE MEASURING KNOWLEDGE OF THE NURSES WHO ARE WORKING IN A MEDICAL FACULTY HOSPITAL

Directory of Open Access Journals (Sweden)

Tahir Kemal SAHIN

2006-02-01

Full Text Available Objective: The aim of this study is to determine the right knowledge of blood pressure measurement of the nurses who working in clinics. Materials and Method: 103 nurses who are working in Meram Medical Faculty Hospital were included to this descriptive study. Sampling method was stratified proportional random sampling method, with strata for the number of nurses at clinics. A questionnaire, which was formed of some questions about standard measuring methods of blood pressure, was applied to the nurses. Results: It was determined that 55.3% to 98.1% of the nurses answered the most of the questions correctly. But, they gave different answers to the questions about choosing the arm for measurement, inflation level of the cuff, deflation speed and how many measurements should be done for true result. It was found that the female nurses had much more knowledge about the tension of wrapping the cuff around the arm and the correct positioning of the stethescope than the male ones. Oppositely, the male nurses had higher correct answer rate about deflation of the cuff than the female nurses. Conclusion: It was concluded that the knowledge of blood pressure measurement of the nurses was partly insufficient. Periodical educational studies should be done for the nurses to complete the blood pressure measurement knowledge of them. [TAF Prev Med Bull 2006; 5(1.000: 8-18

Computerized Cuff Pressure Algometry as Guidance for Circumferential Tissue Compression for Wearable Soft Robotic Applications: A Systematic Review.

Science.gov (United States)

Kermavnar, Tjaša; Power, Valerie; de Eyto, Adam; O'Sullivan, Leonard W

2018-02-01

In this article, we review the literature on quantitative sensory testing of deep somatic pain by means of computerized cuff pressure algometry (CPA) in search of pressure-related safety guidelines for wearable soft exoskeleton and robotics design. Most pressure-related safety thresholds to date are based on interface pressures and skin perfusion, although clinical research suggests the deep somatic tissues to be the most sensitive to excessive loading. With CPA, pain is induced in deeper layers of soft tissue at the limbs. The results indicate that circumferential compression leads to discomfort at ∼16-34 kPa, becomes painful at ∼20-27 kPa, and can become unbearable even below 40 kPa.

Effect of viscous pressure on warm inflation driven by motion of D3 branes in the background of D5 branes

International Nuclear Information System (INIS)

Deshamukhya, Atri

2014-01-01

From a thermodynamic viewpoint, there are two dynamical realizations of inflation. In the standard inflation scenario known as super-cooled inflation, radiation is red-shifted during expansion and a vacuum dominated universe is the result of this exponential expansion. A subsequent reheating mechanism is therefore needed to come back to, the radiation dominated era. Warm inflation, the other thermodynamic alternative, presents the attractive feature that it avoids the reheating period. In these kind of models dissipative effects are important during the inflationary period, so that radiation production occurs concurrently together with the inflationary expansion. In warm inflation models in general, inflation decay products are considered as massless particles (or radiation). Existence of massive particles in the inflationary fluid model may alter the dynamics of the inflationary universe models by modification of the fluid pressure. Decay of the massive particles within the fluid which can be considered as a result of 'bulk viscous pressure' is an entropy-producing scalar phenomenon. This bulk viscous pressure term can be written as Π = -3ζH, where H is Hubble parameter and ζ is coefficient of bulk viscosity. Second law of thermodynamics demands this co-efficient to be positive and it in general depends on the energy density of the fluid. Inflationary scenario driven by the radiation field of separation between a D3 and a stake of D5 branes in presence of thermal bath has been studied. We wish to see the effect of inclusion of such a viscous pressure term in equation of motion of the inflation of the perturbative spectrum in this piece of work. (author)

Use of the nine-step inflation/deflation test and resting middle-ear pressure range as predictors of middle-ear barotrauma in aircrew members.

Science.gov (United States)

Hussein, A; Abousetta, A

2014-07-01

To explore the role of the nine-step inflation/deflation tympanometric test and resting middle-ear pressure range as predictors of barotrauma in aircrew members. A prospective, non-randomised study was conducted on 100 aircrew members. Resting middle-ear pressure was measured and the nine-step inflation/deflation test performed on all subjects before flights. Subjects were allocated to two groups according to resting middle-ear pressure range (group A, within the range of +26 to +100 and -26 to -100 mmH2O; group B, -25 to +25 mmH2O). All aircrew members were assessed after flights regarding the presence and the grade of barotrauma. In both groups, the sensitivity and specificity values of the entire post-inflation/deflation test were close to those of the post-deflation part of the test. The post-deflation test had a higher negative predictive value than the post-inflation test. Ears with resting middle-ear pressure lower than -55 mmH2O experienced barotrauma, regardless of good or poor post-inflation or post-deflation test results. In an aircrew member, a resting middle-ear pressure within the range of -55 and +50 mmH2O, together with good post-deflation test results, are considered reliable predictors for fitness to fly.

Dual-chamber inflatable oil boom

International Nuclear Information System (INIS)

Blair, R.M.; Tedeschi, E.T.

1993-01-01

An elongated floating material containment boom section is described having a normally vertical ballasted skirt depending from flotation means, and convertible from a flattened collapsed condition to a deployable condition wherein buoyancy chamber means extending along the upper edge of said skirt are inflated to expanded buoyant configuration, including: a gas-impervious sleeve extending along the upper edge of said normally vertical skirt forming a first outer collapsible and inflatable flotation chamber, a first inflation valve connecting the interior of said sleeve with the ambient atmosphere, through which gas under pressure may be introduced into said sleeve to inflate said first buoyant outer flotation chamber, elongated gas-impervious tube means positioned inside said outer flotation chamber and forming second collapsible and inflatable internal flotation bladder chamber means, second inflation valve means connecting the interior of said bladder means through said outer flotation chamber to the ambient atmosphere through which gas under pressure may be introduced into said bladder means to inflate it forming said second flotation chamber means inside said outer flotation chamber

A novel stent inflation protocol improves long-term outcomes compared with rapid inflation/deflation deployment method.

Science.gov (United States)

Vallurupalli, Srikanth; Kasula, Srikanth; Kumar Agarwal, Shiv; Pothineni, Naga Venkata K; Abualsuod, Amjad; Hakeem, Abdul; Ahmed, Zubair; Uretsky, Barry F

2017-08-01

High-pressure inflation for coronary stent deployment is universally performed. However, the duration of inflation is variable and does not take into account differences in lesion compliance. We developed a standardized "pressure optimization protocol" (POP) using inflation pressure stability rather than an arbitrary inflation time or angiographic balloon appearance for stent deployment. Whether this approach improves long-term outcomes is unknown. 792 patients who underwent PCI using either rapid inflation/deflation (n = 376) or POP (n = 416) between January 2009 and March 2014 were included. Exclusion criteria included PCI for acute myocardial infarction, in-stent restenosis, chronic total occlusion, left main, and saphenous vein graft lesions. Primary endpoint was target vessel failure [TVF = combined end point of target vessel revascularization (TVR), myocardial infarction, and cardiac death]. Outcomes were analyzed in the entire cohort and in a propensity analysis. Stent implantation using POP with a median follow-up of 1317 days was associated with lower TVF compared with rapid inflation/deflation (10.1 vs. 17.8%, P inflation/deflation (10 vs. 18%, P < 0.0001). Stent deployment using POP led to reduced TVF compared to rapid I/D. These results recommend this method to improve long-term outcomes. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Analysis of the incidence of postintubation injuries in patients intubated in the prehospital or early hospital conditions of the hospital emergency department and the intensive care unit

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Cierniak M

2015-10-01

Full Text Available Marcin Cierniak,1 Dariusz Timler,1 Renata Sobczak,1 Andrzej Wieczorek,2 Przemyslaw Sekalski,3 Natalia Borkowska,2 Tomasz Gaszynski1 1Department of Emergency Medicine and Disaster Medicine, Barlicki University Hospital, 2Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 3Department of Microelectronics and Computer Science, IT Centre, Lodz University of Technology, Lodz, Poland Background: Intubation is still one of the best methods to secure the airway. In the case of prehospital or early hospital conditions when factors such as urgency, stress, or inaccuracy of the undertaken activities are involved, the risk of causing complications, for instance, edema or postintubation injuries, increases, especially while dealing with a difficult intubation. The risk of improper inflation of the endotracheal tube cuff also increases, which is considered in this study.Objective: The aim of this study was to evaluate the prevalence of postintubation complications, such as postintubation injuries or edema, in a research sample, and to examine whether such complications occur more often, for example, while using a guidewire. In this study, we also evaluated the injuries associated with the inflation of the endotracheal tube cuff.Materials and methods: This study was performed on a group of 153 patients intubated in prehospital conditions. The tests were carried out in three clinical sites that received patients from prehospital care. Postintubation injuries were revealed and photographed using videolaryngoscope, such as the C-MAC and the McGrath series 5. The endotracheal tube cuff pressure was measured using a pressure gage manual (VBM Medizintechnik GmbH. The quantitative analyses of differences between incidence of variables were assessed using χ2 test for P<0.05. Analyses have been carried out using the Statistica software.Results: In the group of 153 patients, postintubation injuries occurred in 17% of cases. The dependency

Rotator cuff exercises

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... 25560729 . Read More Frozen shoulder Rotator cuff problems Rotator cuff repair Shoulder arthroscopy Shoulder CT scan Shoulder MRI scan Shoulder pain Patient Instructions Rotator cuff - self-care Shoulder surgery - discharge Using your ...

What Drives China's Food-Price Inflation and How does It Affect the Aggregate Inflation?

OpenAIRE

Wenlang Zhang; Daniel Law

2010-01-01

It is typically argued that China's food-price inflation has been mainly driven by supply-side shocks including natural disasters. Our research, however, shows that demand pressures have played a more important role from a medium-term perspective. This suggests surging food prices may call for policy reactions even if non-food-price inflation is tame. Meanwhile, we find food-price inflation has not generated significant second-round effects on non-food-price inflation. In particular, while fo...

An Improved Optimal Slip Ratio Prediction considering Tyre Inflation Pressure Changes

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Guoxing Li

2015-01-01

Full Text Available The prediction of optimal slip ratio is crucial to vehicle control systems. Many studies have verified there is a definitive impact of tyre pressure change on the optimal slip ratio. However, the existing method of optimal slip ratio prediction has not taken into account the influence of tyre pressure changes. By introducing a second-order factor, an improved optimal slip ratio prediction considering tyre inflation pressure is proposed in this paper. In order to verify and evaluate the performance of the improved prediction, a cosimulation platform is developed by using MATLAB/Simulink and CarSim software packages, achieving a comprehensive simulation study of vehicle braking performance cooperated with an ABS controller. The simulation results show that the braking distances and braking time under different tyre pressures and initial braking speeds are effectively shortened with the improved prediction of optimal slip ratio. When the tyre pressure is slightly lower than the nominal pressure, the difference of braking performances between original optimal slip ratio and improved optimal slip ratio is the most obvious.

Fast or Slow Rescue Ventilations: A Predictive Model of Gastric Inflation.

Science.gov (United States)

Fitz-Clarke, John R

2018-05-01

Rescue ventilations are given during respiratory and cardiac arrest. Tidal volume must assure oxygen delivery; however, excessive pressure applied to an unprotected airway can cause gastric inflation, regurgitation, and pulmonary aspiration. The optimal technique provides mouth pressure and breath duration that minimize gastric inflation. It remains unclear if breath delivery should be fast or slow, and how inflation time affects the division of gas flow between the lungs and esophagus. A physiological model was used to predict and compare rates of gastric inflation and to determine ideal ventilation duration. Gas flow equations were based on standard pulmonary physiology. Gastric inflation was assumed to occur whenever mouth pressure exceeded lower esophageal sphincter pressure. Mouth pressure profiles that approximated mouth-to-mouth ventilation and bag-valve-mask ventilation were investigated. Target tidal volumes were set to 0.6 and 1.0 L. Compliance and airway resistance were varied. Rapid breaths shorter than 1 s required high mouth pressures, up to 25 cm H 2 O to achieve the target lung volume, which thus promotes gastric inflation. Slow breaths longer than 1 s permitted lower mouth pressures but increased time over which airway pressure exceeded lower esophageal sphincter pressure. The gastric volume increased with breath durations that exceeded 1 s for both mouth pressure profiles. Breath duration of ∼1.0 s caused the least gastric inflation in most scenarios. Very low esophageal sphincter pressure favored a shift toward 0.5 s. High resistance and low compliance each increased gastric inflation and altered ideal breath times. The model illustrated a general theory of optimal rescue ventilation. Breath duration with an unprotected airway should be 1 s to minimize gastric inflation. Short pressure-driven and long duration-driven gastric inflation regimens provide a unifying explanation for results in past studies. Copyright © 2018 by Daedalus Enterprises.

Does the Position or Contact Pressure of the Stethoscope Make Any Difference to Clinical Blood Pressure Measurements

Science.gov (United States)

Pan, Fan; Zheng, Dingchang; He, Peiyu; Murray, Alan

2014-01-01

Abstract This study aimed to investigate the effect of stethoscope position and contact pressure on auscultatory blood pressure (BP) measurement. Thirty healthy subjects were studied. Two identical stethoscopes (one under the cuff, the other outside the cuff) were used to simultaneously and digitally record 2 channels of Korotkoff sounds during linear cuff pressure deflation. For each subject, 3 measurements with different contact pressures (0, 50, and 100 mm Hg) on the stethoscope outside the cuff were each recorded at 3 repeat sessions. The Korotkoff sounds were replayed twice on separate days to each of 2 experienced listeners to determine systolic and diastolic BPs (SBP and DBP). Variance analysis was performed to study the measurement repeatability and the effect of stethoscope position and contact pressure on BPs. There was no significant BP difference between the 3 repeat sessions, between the 2 determinations from each listener, between the 2 listeners and between the 3 stethoscope contact pressures (all P > 0.06). There was no significant SBP difference between the 2 stethoscope positions at the 2 lower stethoscope pressures (P = 0.23 and 0.45), but there was a small (0.4 mm Hg, clinically unimportant) significant difference (P = 0.005) at the highest stethoscope pressure. The key result was that, DBP from the stethoscope under the cuff was significantly lower than that from outside the cuff by 2.8 mm Hg (P stethoscope outside the cuff, tends to give a higher DBP than the true intra-arterial pressure, this study could suggest that the stethoscope position under the cuff, and closer to the arterial occlusion, might yield measurements closer to the actual invasive DBP. PMID:25546675

Skin perfusion pressure measured with a photo sensor in an air-filled plastic balloon: validity and reproducibility on the lower leg in normal subjects and patients suspected of obliterative arterial disease

International Nuclear Information System (INIS)

Nielsen, Steen Levin; Nielsen, Anne Lerberg; Vind, Susanne Haase; Thomassen, Anders

2011-01-01

An inflatable small plastic bag including a photo sensor was constructed for measurement of skin perfusion pressure avoiding the rim of the photo sensor over bony and tendineous surfaces of the tibia below the knee, at the ankle, and on the dorsal forefoot. Compression was obtained using a conical blood pressure cuff with continuous decrease from suprasystolic arm pressure. The validity of skin perfusion pressure with the new device was compared to that of isotope washout below the knee in normal subjects and in patients with an ischemic forefoot with acceptable agreement. The method had a high reproducibility within and between days in normal subjects. Compared to systolic arterial pressure measured using a strain gauge with a cuff on the ankle in normal subjects and patients with intermittent claudication the new device showed blood pressure in the skin closer to the diastolic pressure. The new pressure device thus had acceptable validity and reproducibility for estimation of the skin perfusion pressure and can be used on bony and tendineous sites on the lower limb in regions where critical wound healing is frequent, e.g. ankle and forefoot

Artificial urinary sphincter revision for urethral atrophy: comparing single cuff downsizing and tandem cuff placement

Directory of Open Access Journals (Sweden)

Brian J. Linder

Full Text Available ABSTRACT Objective To compare outcomes for single urethral cuff downsizing versus tandem cuff placement during artificial urinary sphincter (AUS revision for urethral atrophy. Materials and Methods We identified 1778 AUS surgeries performed at our institution from 1990-2014. Of these, 406 were first AUS revisions, including 69 revisions for urethral atrophy. Multiple clinical and surgical variables were evaluated for potential association with device outcomes following revision, including surgical revision strategy (downsizing a single urethral cuff versus placing tandem urethral cuffs. Results Of the 69 revision surgeries for urethral atrophy at our institution, 56 (82% were tandem cuff placements, 12 (18% were single cuff downsizings and one was relocation of a single cuff. When comparing tandem cuff placements and single cuff downsizings, the cohorts were similar with regard to age (p=0.98, body-mass index (p=0.95, prior pelvic radiation exposure (p=0.73 and length of follow-up (p=0.12. Notably, there was no difference in 3-year overall device survival compared between single cuff and tandem cuff revisions (60% versus 76%, p=0.94. Likewise, no significant difference was identified for tandem cuff placement (ref. single cuff when evaluating the risk of any tertiary surgery (HR 0.95, 95% CI 0.32-4.12, p=0.94 or urethral erosion/device infection following revision (HR 0.79, 95% CI 0.20-5.22, p=0.77. Conclusions There was no significant difference in overall device survival in patients undergoing single cuff downsizing or tandem cuff placement during AUS revision for urethral atrophy.

Does the position or contact pressure of the stethoscope make any difference to clinical blood pressure measurements: an observational study.

Science.gov (United States)

Pan, Fan; Zheng, Dingchang; He, Peiyu; Murray, Alan

2014-12-01

This study aimed to investigate the effect of stethoscope position and contact pressure on auscultatory blood pressure (BP) measurement. Thirty healthy subjects were studied. Two identical stethoscopes (one under the cuff, the other outside the cuff) were used to simultaneously and digitally record 2 channels of Korotkoff sounds during linear cuff pressure deflation. For each subject, 3 measurements with different contact pressures (0, 50, and 100 mm Hg) on the stethoscope outside the cuff were each recorded at 3 repeat sessions. The Korotkoff sounds were replayed twice on separate days to each of 2 experienced listeners to determine systolic and diastolic BPs (SBP and DBP). Variance analysis was performed to study the measurement repeatability and the effect of stethoscope position and contact pressure on BPs. There was no significant BP difference between the 3 repeat sessions, between the 2 determinations from each listener, between the 2 listeners and between the 3 stethoscope contact pressures (all P > 0.06). There was no significant SBP difference between the 2 stethoscope positions at the 2 lower stethoscope pressures (P = 0.23 and 0.45), but there was a small (0.4 mm Hg, clinically unimportant) significant difference (P = 0.005) at the highest stethoscope pressure. The key result was that, DBP from the stethoscope under the cuff was significantly lower than that from outside the cuff by 2.8 mm Hg (P stethoscope outside the cuff, tends to give a higher DBP than the true intra-arterial pressure, this study could suggest that the stethoscope position under the cuff, and closer to the arterial occlusion, might yield measurements closer to the actual invasive DBP.

Fabrication and performance analysis of a DEA cuff designed for dry-suit applications

International Nuclear Information System (INIS)

Ahmadi, S; Camacho Mattos, A; Barbazza, A; Soleimani, M; Boscariol, P; Menon, C

2013-01-01

A method for manufacturing a cylindrical dielectric elastomer actuator (DEA) is presented. The cylindrical DEA can be used in fabricating the cuff area of dry-suits where the garment is very tight and wearing the suit is difficult. When electrically actuated, the DEA expands radially and the suit can be worn more comfortably. In order to study the performance of the DEA, a customized testing setup was designed, and silicone-made cuff samples with different material stiffnesses were tested. Analytical and FEM modeling were considered to evaluate the experimental output. The results revealed that although the stiffness of the DEA material has a direct relationship with the radial constrictive pressure caused by mechanically stretching the DEA, it has a minor effect on the actuation pressure. It was also found that stacking multiple layers of the DEA to fabricate a laminated structure enabled the attainment of a desired variation of pressure required for the implementation of an electrically tunable cuff. (paper)

[Rotator cuff tear athropathy prevalence].

Science.gov (United States)

Guerra-Soriano, F; Encalada-Díaz, M I; Ruiz-Suárez, M; Valero-González, F S

2017-01-01

Glenohumeral arthritis secondary to massive rotator cuff tear presents with a superior displacement and femoralization of the humeral head with coracoacromial arch acetabularization. The purpose of this study was to establish prevalence of rotator cuff tear artropathy (CTA) at our institution. Four hundred electronic records were reviewed from which we identified 136 patients with rotator cuff tears. A second group was composed with patients with massive cuff tears that were analized and staged by the Seebauer cuff tear arthropathy classification. Thirty four patients with massive rotator cuff tears were identified, 8 male and 26 female (age 60.1 ± 10.26 years). Massive rotator cuff tear prevalence was 25%. CTA prevalence found in the rotator cuff group was 19 and 76% in the massive cuff tears group. Patients were staged according to the classification with 32% in stage 1a, 11% 1b, 32% 2a and 0% 2b. CTA prevalence in patients with rotator cuff tears and massive cuff tears is higher than the one reported in American population. We consider that a revision of the Seebauer classification to be appropriate to determine its reliability.

Efeitos da pressão limite (25 cmH2O e mínima de “selo” do balonete de tubos traqueais sobre a mucosa traqueal do cão Efectos de la presión limite (25 cmH2O y mínima de “sello” del balón de tubos traquéales sobre la mucosa traqueal del can Effects of tracheal tube cuff limit pressure (25 cmH2O and “seal” pressure on tracheal mucosa of dogs

Directory of Open Access Journals (Sweden)

Emanuel Celice Castilho

2003-12-01

ón del tubo traqueal insuflado con volumen de aire suficiente para obtener presión de “sello” o con la presión limite de 25 cmH2O, abajo de la presión crítica de 30 cm de agua para producción de lesión de la mucosa traqueal. MÉTODO: Diez y seis canes fueron sometidos a anestesia venosa y ventilación artificial. Los canes fueron distribuidos aleatoriamente en dos grupos de acuerdo con la presión en el balón del tubo traqueal (Portex Blue-Line, Inglaterra: Gsello (n = 8 balón con presión mínima de “sello” para impedir vaciamiento de aire durante la respiración artificial; G25 (n = 8 balón insuflado hasta la obtención de la presión de 25 cmH2O. La medida de la presión del balón fue realizada por medio de manómetro digital en el inicio (control y después de 60, 120 y 180 minutos. Después del sacrificio de los canes, fueron hechas biopsias en las áreas de la mucosa traqueal adyacentes al balón y al tubo traqueal para análisis de microscopio electrónico de barredura (MEV. RESULTADOS: La presión media del balón en G25 se mantuvo entre 24,8 y 25 cmH2O y en Gsello entre 11,9 y 12,5 cmH2O durante el experimento. Las alteraciones a la MEV fueron pequeñas y no significantemente diferentes en los grupos (p > 0,30, pero ocurrieron lesiones más intensas en las áreas de contacto de la mucosa traqueal con el balón del tubo traqueal, en los dos grupos, en relación a las áreas de la mucosa adyacentes o no al tubo traqueal (p BACKGROUND AND OBJECTIVES: Injuries of tracheal mucosa in contact with tracheal tube cuff is a function of cuff pressure and exposure time. This study aimed at analyzing injuries of tracheal mucosa in contact with tracheal tube cuff inflated to reach “seal” pressure or limit 25 cmH2O pressure, below critical 30 cmH2O, to prevent tracheal damage. METHODS: This study involved 16 dogs submitted to intravenous anesthesia and artificial ventilation. Dogs were randomly distributed into two experimental groups according to

Rotator cuff - self-care

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000358.htm Rotator cuff - self-care To use the sharing features on ... and shoulder exercises may help ease your symptoms. Rotator Cuff Problems Common rotator cuff problems include: Tendinitis , which ...

Inflation and Instability of a Polymeric Membrane

DEFF Research Database (Denmark)

Hassager, Ole; Kristensen, Susanne Brogaard; Larsen, Johannes Ruben

1999-01-01

We consider an axisymmetric polymeric membrane inflated by a uniform pressure difference acting across the membrane. The polymeric material is described by an arbitrary combination of a viscoelastic and a purely viscous component to the stress. Some viscoelastic materials described by a Mooney......-Rivlin model show a monotone increasing pressure during inflation of a spherical membrane. These materials develop a homogeneous membrane thickness in agreement with the Considere-Pearson condition. Molecularly based models such as the neo-Hookean, Doi-Edwards or Tom-Pom model show a pressure maximum when...... inflated. Membranes described by these models develop a local thinning of the membrane which may lead to bursting in finite time. (C) 1999 Elsevier Science B.V. All rights reserved....

Modelling effects of tyre inflation pressure on the stress distribution near the soil-tyre interface

DEFF Research Database (Denmark)

Schjønning, Per; Lamandé, Mathieu; Tøgersen, Frede A

2008-01-01

stress in the contact area for two radial-ply agricultural trailer tyres (650/65R30.5 and 800/50R34) loaded with 60 kN. The study took place on a sandy soil at a water content slightly less than field capacity. We tested the effect of three different inflation pressures (50, 100 and 240 k......Pa) in a randomised block design with three replicates. The vertical stress was measured with load cells located in 0.1 m soil depth. The vertical stress data were used also for identifying the soil area in contact with the tyre, i.e. the tyre footprint. A model (named FRIDA) is proposed that describes the tyre...... footprint by a super ellipse and the stress distribution by a combined exponential (perpendicular to the driving direction) and power-law (along the driving direction) function. The contact area doubled when the inflation pressure was reduced from 240 to 50 kPa. For both tyres, the measured peak stress...

Computer-controlled pneumatic pressure algometry--a new technique for quantitative sensory testing.

Science.gov (United States)

Polianskis, R; Graven-Nielsen, T; Arendt-Nielsen, L

2001-01-01

Hand-held pressure algometry usually assesses pressure-pain detection thresholds and provides little information on pressure-pain stimulus-response function. In this article, a cuff pressure algometry for advanced pressure-pain function evaluation is proposed. The experimental set-up consisted of a pneumatic tourniquet cuff, a computer-controlled air compressor and an electronic visual analogue scale (VAS) for constant pain intensity rating. Twelve healthy volunteers were included in the study. In the first part, hand-held algometry and cuff algometry were performed over the gastrocnemius muscle with constant compression rate. In the second part, the cuff algometry was performed with different compression rates to evaluate the influence of the compression rate on pain thresholds and other psychophysical data. Pressure-pain detection threshold (PDT), pain tolerance threshold (PTT), pain intensity, PDT-PTT time and other psychophysical variables were evaluated.Pressure-pain detection thresholds recorded over the gastrocnemius muscle with a hand-held and with a cuff algometer, were 482 +/- 19 kPa and 26 +/- 1.6 kPa, respectively. Pressure and pain intensities were correlated during cuff algometry. During increasing cuff compression, the subjective pain tolerance limit on VAS was 5.6 +/- 0.95 cm. There was a direct correlation between the number of compressions, the compression rate and pain thresholds. The cuff algometry technique is appropriate for pressure-pain stimulus-response studies. Cuff algometry allowed quantification of psychophysical response to the change of stimulus configuration. Copyright 2001 European Federation of Chapters of the International Association for the Study of Pain.

Inflation targeting and core inflation

OpenAIRE

Julie Smith

2005-01-01

This paper examines the interaction of core inflation and inflation targeting as a monetary policy regime. Interest in core inflation has grown because of inflation targeting. Core inflation is defined in numerous ways giving rise to many potential measures; this paper defines core inflation as the best forecaster of inflation. A cross-country study finds before the start of inflation targeting, but not after, core inflation differs between non-inflation targeters and inflation targeters. Thr...

The optimum tension for bridging sutures in transosseous-equivalent rotator cuff repair: a cadaveric biomechanical study.

Science.gov (United States)

Park, Ji Soon; McGarry, Michelle H; Campbell, Sean T; Seo, Hyuk Jun; Lee, Yeon Soo; Kim, Sae Hoon; Lee, Thay Q; Oh, Joo Han

2015-09-01

Transosseous-equivalent (TOE) rotator cuff repair can increase contact area and contact pressure between the repaired cuff tendon and bony footprint and can show higher ultimate loads to failure and smaller gap formation compared with other repair techniques. However, it has been suggested that medial rotator cuff failure after TOE repair may result from increased bridging suture tension. To determine optimum bridging suture tension in TOE repair by evaluating footprint contact and construct failure characteristics at different tensions. Controlled laboratory study. A total of 18 fresh-frozen cadaveric shoulders, randomly divided into 3 groups, were constructed with a TOE configuration using the same medial suture anchor and placing a Tekscan sensing pad between the repaired rotator cuff tendon and footprint. Nine of the 18 shoulders were used to measure footprint contact characteristics. With use of the Tekscan measurement system, the contact pressure and area between the rotator cuff tendon and greater tuberosity were quantified for bridging suture tensions of 60, 90, and 120 N with glenohumeral abduction angles of 0° and 30° and humeral rotation angles of 30° (internal), 0°, and 30° (external). TOE constructs of all 18 shoulders then underwent construct failure testing (cyclic loading and load to failure) to determine the yield load, ultimate load, stiffness, hysteresis, strain, and failure mode at 60 and 120 N of tension. As bridging suture tension increased, contact force, contact pressure, and peak pressure increased significantly at all positions (P .05 for all). Increasing bridging suture tension to over 90 N did not improve contact area but did increase contact force and pressure. Bridging suture tension did not significantly affect ultimate failure loads. Considering the risks of overtensioning bridging sutures, it may be clinically more beneficial to keep bridging suture tension below 90 N. © 2015 The Author(s).

Large inflated-antenna system

Science.gov (United States)

Hinson, W. F.; Keafer, L. S.

1984-01-01

It is proposed that for inflatable antenna systems, technology feasibility can be demonstrated and parametric design and scalability (scale factor 10 to 20) can be validated with an experiment using a 16-m-diameter antenna attached to the Shuttle. The antenna configuration consists of a thin film cone and paraboloid held to proper shape by internal pressure and a self-rigidizing torus. The cone and paraboloid would be made using pie-shaped gores with the paraboloid being coated with aluminum to provide reflectivity. The torus would be constructed using an aluminum polyester composite that when inflated would erect to a smooth shell that can withstand loads without internal pressure.

Observation of the pulse oximeter trace to estimate systolic blood ...

African Journals Online (AJOL)

Background: The estimation of systolic blood pressure by disappearance and reappearance of the pulse oximeter trace during cuff inflation and deflation was compared with non-invasive blood pressure (NIBP) measurement, across the range of body mass index (BMI), during spinal anaesthesia for Caesarean section.

Identification of the characteristics of motorcycle and scooter tyres in the presence of large variations in inflation pressure

Science.gov (United States)

Cossalter, V.; Doria, A.; Giolo, E.; Taraborrelli, L.; Massaro, M.

2014-10-01

Stability and safety of road vehicles are largely affected by tyre properties. Single-track vehicles are characterised by weakly damped modes of vibration (weave and wobble) and therefore this phenomenon is even more important. This article focuses on the study of both steady-state and transient properties of motorcycle and scooter tyres in the presence of very low and very high inflation pressures. The steady-state properties are defined as lateral forces (side-slip and camber forces) and yaw torques (self-aligning and twisting). The transient properties are described in terms of relaxation length, which represents the distance needed to reach a certain percentage of the steady-state value of the tyre force. Experimental tests are carried out on a specific rotating disk machine. Three sets of tyres are analysed. Steady-state properties are measured by increasing step by step the values of camber and side-slip angles. Transient properties are studied carrying out tests with harmonic side-slip excitation and measuring the phase lag between the excitation (input) and the tyre force (output). Experimental results show important variations in tyre properties with inflation pressure with general trends of all the tested tyres and particular features related to the tyre's geometry. After the analysis and discussion of experimental results, the measured data are fitted by means of a specific version of the Magic Formula. The dependence of the Magic Formula's coefficients on inflation pressure is analysed and interpolation curves are given.

Contact area and pressure in suture bridge rotator cuff repair using knotless lateral anchors.

Science.gov (United States)

Tompkins, Marc; Monchik, Keith O; Plante, Matthew J; Fleming, Braden C; Fadale, Paul D

2011-10-01

To evaluate whether the use of knotless lateral anchors in a suture bridge construct produces better contact area and pressure parameters than a suture bridge construct with standard lateral anchors that require knots or a double-row repair. The hypothesis was that knotless lateral anchors would produce better contact area and pressure parameters than the other two constructs. A total of fifteen matched pairs of cadaveric shoulders were divided into three groups. In Group 1, a suture bridge using knotless anchors for the lateral row was performed on five shoulders. A suture bridge using standard lateral row anchors that require knots was performed on the contralateral shoulders. In Group 2, suture bridge with knotless lateral row anchors was compared with double-row repair. In Group 3, suture bridge using standard lateral row anchors was compared with double-row repair. The contact conditions of the rotator cuff footprint were measured using pressure-sensitive film. There were no statistically significant differences between any of the techniques regarding contact area F(2, 15.7) = 3.09, P = 0.07 or mean contact pressure F(2, 15.1) = 2.35, P = 0.12. A post hoc power analysis suggests differences between techniques are likely less than 91-113 mm(2) for area and 0.071-0.089 N for pressure. The use of knotless anchors in the lateral row of a suture bridge repair did not increase the footprint contact area or contact pressure when compared to a suture bridge repair requiring knots laterally or to a double-row repair.

Rotator cuff tear: A detailed update

Directory of Open Access Journals (Sweden)

Vivek Pandey

2015-01-01

Full Text Available Rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Although the exact pathogenesis is controversial, a combination of intrinsic factors proposed by Codman and extrinsic factors theorized by Neer is likely responsible for most rotator cuff tears. Magnetic resonance imaging remains the gold standard for the diagnosis of rotator cuff tears, but the emergence of ultrasound has revolutionized the diagnostic capability. Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. Appropriate knowledge of pathology and healing pattern of cuff, strong and biological repair techniques, better suture anchors, and gradual rehabilitation of postcuff repair have led to good to excellent outcome after repair. As the healing of degenerative cuff tear remains unpredictable, the role of biological agents such as platelet-rich plasma and stem cells for postcuff repair augmentation is still under evaluation. The role of scaffolds in massive cuff tear is also being probed.

Symmetry and inflation

International Nuclear Information System (INIS)

Chimento, Luis P.

2002-01-01

We find the group of symmetry transformations under which the Einstein equations for the spatially flat Friedmann-Robertson-Walker universe are form invariant. They relate the energy density and the pressure of the fluid to the expansion rate. We show that inflation can be obtained from nonaccelerated scenarios by a symmetry transformation. We derive the transformation rule for the spectrum and spectral index of the curvature perturbations. Finally, the group is extended to investigate inflation in the anisotropic Bianchi type-I spacetime and the brane-world cosmology

Arterial blood oxygen saturation during blood pressure cuff-induced hypoperfusion

International Nuclear Information System (INIS)

Kyriacou, P A; Shafqat, K; Pal, S K

2007-01-01

Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO 2 ) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Pulse oximeters estimate arterial oxygen saturation by shining light at two different wavelengths, red and infrared, through vascular tissue. In this method the ac pulsatile photoplethysmographic (PPG) signal associated with cardiac contraction is assumed to be attributable solely to the arterial blood component. The amplitudes of the red and infrared ac PPG signals are sensitive to changes in arterial oxygen saturation because of differences in the light absorption of oxygenated and deoxygenated haemoglobin at these two wavelengths. From the ratios of these amplitudes, and the corresponding dc photoplethysmographic components, arterial blood oxygen saturation (SpO 2 ) is estimated. Hence, the technique of pulse oximetry relies on the presence of adequate peripheral arterial pulsations, which are detected as photoplethysmographic (PPG) signals. The aim of this study was to investigate the effect of pressure cuff-induced hypoperfusion on photoplethysmographic signals and arterial blood oxygen saturation using a custom made finger blood oxygen saturation PPG/SpO 2 sensor and a commercial finger pulse oximeter. Blood oxygen saturation values from the custom oxygen saturation sensor and a commercial finger oxygen saturation sensor were recorded from 14 healthy volunteers at various induced brachial pressures. Both pulse

Arterial blood oxygen saturation during blood pressure cuff-induced hypoperfusion

Science.gov (United States)

Kyriacou, P. A.; Shafqat, K.; Pal, S. K.

2007-10-01

Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO2) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Pulse oximeters estimate arterial oxygen saturation by shining light at two different wavelengths, red and infrared, through vascular tissue. In this method the ac pulsatile photoplethysmographic (PPG) signal associated with cardiac contraction is assumed to be attributable solely to the arterial blood component. The amplitudes of the red and infrared ac PPG signals are sensitive to changes in arterial oxygen saturation because of differences in the light absorption of oxygenated and deoxygenated haemoglobin at these two wavelengths. From the ratios of these amplitudes, and the corresponding dc photoplethysmographic components, arterial blood oxygen saturation (SpO2) is estimated. Hence, the technique of pulse oximetry relies on the presence of adequate peripheral arterial pulsations, which are detected as photoplethysmographic (PPG) signals. The aim of this study was to investigate the effect of pressure cuff-induced hypoperfusion on photoplethysmographic signals and arterial blood oxygen saturation using a custom made finger blood oxygen saturation PPG/SpO2 sensor and a commercial finger pulse oximeter. Blood oxygen saturation values from the custom oxygen saturation sensor and a commercial finger oxygen saturation sensor were recorded from 14 healthy volunteers at various induced brachial pressures. Both pulse

Inflation and Instability of a Polymeric Membrane

DEFF Research Database (Denmark)

Neergaard, Jesper; Hassager, Ole

1999-01-01

We consider an axisymmetric polymeric membrane inflated by a uniform pressure difference acting across the membrane. The polymeric materialis described by an arbitrary combination of a viscoelastic and a purely viscous component to the stress. Some viscoelastic materials described by a Mooney......-Rivlin model show a monotone increasingpressure during inflation of a spherical membrane. These materials develop a homogeneous membrane thickness in agreement with the Considere-Pearson condition. Molecularly based models such as the neo-Hookean, Doi-Edwards or Tom-Pom model show a pressure maximum when...... inflated. Membranesdescribed by these models develop a local thinning of the membrane which may lead to bursting in finite time....

Which cuff should I use? Indirect blood pressure measurement for the diagnosis of hypertension in patients with obesity: a diagnostic accuracy review.

Science.gov (United States)

Irving, Greg; Holden, John; Stevens, Richard; McManus, Richard J

2016-11-03

To determine the diagnostic accuracy of different methods of blood pressure (BP) measurement compared with reference standards for the diagnosis of hypertension in patients with obesity with a large arm circumference. Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Bland-Altman analyses where individual patient data were available. Methodological quality appraised using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS2) criteria. MEDLINE, EMBASE, Cochrane, DARE, Medion and Trip databases were searched. Cross-sectional, randomised and cohort studies of diagnostic test accuracy that compared any non-invasive BP tests (upper arm, forearm, wrist, finger) with an appropriate reference standard (invasive BP, correctly fitting upper arm cuff, ambulatory BP monitoring) in primary care were included. 4037 potentially relevant papers were identified. 20 studies involving 26 different comparisons met the inclusion criteria. Individual patient data were available from 4 studies. No studies satisfied all QUADAS2 criteria. Compared with the reference test of invasive BP, a correctly fitting upper arm BP cuff had a sensitivity of 0.87 (0.79 to 0.93) and a specificity of 0.85 (0.64 to 0.95); insufficient evidence was available for other comparisons to invasive BP. Compared with the reference test of a correctly fitting upper arm cuff, BP measurement at the wrist had a sensitivity of 0.92 (0.64 to 0.99) and a specificity of 0.92 (0.85 to 0.87). Measurement with an incorrectly fitting standard cuff had a sensitivity of 0.73 (0.67 to 0.78) and a specificity of 0.76 (0.69 to 0.82). Measurement at the forearm had a sensitivity of 0.84 (0.71 to 0.92) and a specificity 0.75 of (0.66 to 0.83). Bland-Altman analysis of individual patient data from 3 studies comparing wrist and upper arm BP showed a mean difference of 0.46 mm Hg for systolic BP measurement and 2.2 mm Hg for diastolic BP measurement. BP measurement

Vaginal Cuff Dehiscence with Small Bowel Evisceration 14 Months after Total Abdominal Hysterectomy

Directory of Open Access Journals (Sweden)

Nida Jareemit, M.D.

2017-11-01

Full Text Available Introduction: Vaginal cuff dehiscence is a rare complication following hysterectomy. The condition coexisting with intraabdominal organ evisceration occurs even rarer. Nevertheless this should not be neglected owing to high morbidity and mortality. Case presentation: The reported case is a 48-year-old widow presenting with vaginal cuff dehiscence and small bowel evisceration after undergoing a total abdominal hysterectomy (TAH in the past 14 months due to myoma uteri. She denied having a history of sexual intercourse after the operation. The exposed bowel, 60 cm in length, appeared viable and no peritoneal sign was observed. There was a vaginal cuff defect approximately 3 cm in length. An exploratory laparotomy was then carried out. Eviscerated bowel was reduced back in the abdominal cavity and the vaginal cuff defect was repaired. No complications such as recurrent dehiscence were observed during one year follow-up. Conclusion: To minimize the incidence of vaginal cuff dehiscence after hysterectomy, surgical techniques should be of concern. Patient instructions, including delaying sexual intercourse and avoiding all possible causes of increased intra-abdominal pressure should be provided postoperatively.

Delaminated rotator cuff tear: extension of delamination and cuff integrity after arthroscopic rotator cuff repair.

Science.gov (United States)

Gwak, Heui-Chul; Kim, Chang-Wan; Kim, Jung-Han; Choo, Hye-Jeung; Sagong, Seung-Yeob; Shin, John

2015-05-01

The purpose of this study was to evaluate the extension of delamination and the cuff integrity after arthroscopic repair of delaminated rotator cuff tears. Sixty-five patients with delaminated rotator cuff tears were retrospectively reviewed. The delaminated tears were divided into full-thickness delaminated tears and partial-thickness delaminated tears. To evaluate the medial extension, we calculated the coronal size of the delaminated portion. To evaluate the posterior extension, we checked the tendon involved. Cuff integrity was evaluated by computed tomography arthrography. The mean medial extension in the full-thickness and partial-thickness delaminated tears was 18.1 ± 6.0 mm and 22.7 ± 6.3 mm, respectively (P = .0084). The posterior extension into the supraspinatus and the infraspinatus was 36.9% and 32.3%, respectively, in the full-thickness delaminated tears, and it was 27.7% and 3.1%, respectively, in the partial-thickness delaminated tears (P = .0043). With regard to cuff integrity, 35 cases of anatomic healing, 10 cases of partial healing defects, and 17 cases of retear were detected. Among the patients with retear and partial healing of the defect, all the partially healed defects showed delamination. Three retear patients showed delamination, and 14 retear patients did not show delamination; the difference was statistically significant (P = .0001). The full-thickness delaminated tears showed less medial extension and more posterior extension than the partial-thickness delaminated tears. Delamination did not develop in retear patients, but delamination was common in the patients with partially healed defects. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A case of laparoscopy-assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy

Directory of Open Access Journals (Sweden)

Tomoatsu Jimi

Full Text Available Introduction: Vaginal cuff dehiscence after hysterectomy is a rare complication and occurs in less than 1% of patients. It can present with serious complications, such as bowel evisceration and peritonitis. Presentation of case: A 51-year-old multigravida Korean woman underwent total laparoscopic hysterectomy for leiomyoma. Six months later, she reported lower abdominal pain and vaginal bleeding. Physical examination revealed rebound tenderness in the lower abdomen, and pelvic examination showed a small amount of vaginal bleeding with an evisceration of the small intestine through the vagina that exhibited healthy peristalsis. The eviscerated bowel, which seemed to be a part of the ileum, was carefully manually reduced transvaginally into the abdominal cavity. Laparoscopic observation revealed adhesions between the omentum, small intestine, and the peritoneum. Specifically, the small intestine was adhered around the vaginal cuff. An abdominal abscess was found in the left lower abdominal cavity. An adhesiotomy was performed and the abdominal abscess was removed and irrigated. Complete separation of the anterior and posterior vaginal cuff edges was obtained. The vaginal cuff was closed with interrupted 0-polydioxanone absorbable sutures without bowel injury. A 6-month follow-up examination revealed complete healing of the vaginal cuff. Discussion: In this case, we were able to make use of both laparoscopic and transvaginal methods to perform a successful repair with a minimally invasive and safe technique. Conclusion: Laparoscopically assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy was found to be effective, safe, and minimally invasive. Keywords: Vaginal cuff dehiscence, Vaginal cuff repair, Vaginal cuff evisceration, Laparoscopic hysterectomy, Complication

Cardiovascular responses to military antishock trouser inflation during standing arm exercise.

Science.gov (United States)

Ng, A V; Hanson, P; Aaron, E A; Demment, R B; Conviser, J M; Nagle, F J

1987-09-01

Military antishock trousers (MAST) inflated to 50 mmHg were used with 12 healthy males (mean age 28 +/- 1 yr) to determine the effects of lower-body positive pressure on cardiac output (Q), stroke volume (SV), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), total peripheral resistance (TPR), and O2 uptake (VO2) during graded arm-cranking exercise. Subjects were studied while standing at rest and at 25, 50, and 75% of maximal arm-cranking VO2. At each level, rest or work was continued for 6 min with MAST inflated and for 6 min with MAST deflated. Order of inflation and deflation was alternated at each experimental rest or exercise level. Measurements were obtained during the last 2 min at each level. Repeated-measures analysis of variance revealed significant increases (P less than 0.001) in Q, SV, and MABP and a consistent decrease in HR with MAST inflation. There was no apparent change in Q/VO2 between inflated and control conditions. There was no effect of MAST inflation on VO2 or TPR. MAST inflation counteracts the gravitational effect of venous return in upright exercise, restoring central blood volume and thereby increasing Q and MABP from control. HR is decreased consequent to increased MABP through arterial baroreflexes. The associated decrease in TPR is not observed, being offset by the mechanical compression of leg vasculature with MAST inflation.

Pulse Oximeter Derived Blood Pressure Measurement in Patients With a Continuous Flow Left Ventricular Assist Device.

Science.gov (United States)

Hellman, Yaron; Malik, Adnan S; Lane, Kathleen A; Shen, Changyu; Wang, I-Wen; Wozniak, Thomas C; Hashmi, Zubair A; Munson, Sarah D; Pickrell, Jeanette; Caccamo, Marco A; Gradus-Pizlo, Irmina; Hadi, Azam

2017-05-01

Currently, blood pressure (BP) measurement is obtained noninvasively in patients with continuous flow left ventricular assist device (LVAD) by placing a Doppler probe over the brachial or radial artery with inflation and deflation of a manual BP cuff. We hypothesized that replacing the Doppler probe with a finger-based pulse oximeter can yield BP measurements similar to the Doppler derived mean arterial pressure (MAP). We conducted a prospective study consisting of patients with contemporary continuous flow LVADs. In a small pilot phase I inpatient study, we compared direct arterial line measurements with an automated blood pressure (ABP) cuff, Doppler and pulse oximeter derived MAP. Our main phase II study included LVAD outpatients with a comparison between Doppler, ABP, and pulse oximeter derived MAP. A total of five phase I and 36 phase II patients were recruited during February-June 2014. In phase I, the average MAP measured by pulse oximeter was closer to arterial line MAP rather than Doppler (P = 0.06) or ABP (P < 0.01). In phase II, pulse oximeter MAP (96.6 mm Hg) was significantly closer to Doppler MAP (96.5 mm Hg) when compared to ABP (82.1 mm Hg) (P = 0.0001). Pulse oximeter derived blood pressure measurement may be as reliable as Doppler in patients with continuous flow LVADs. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Blood pressure measurement in obese patients: comparison between upper arm and forearm measurements.

Science.gov (United States)

Pierin, Angela M G; Alavarce, Débora C; Gusmão, Josiane L; Halpern, Alfredo; Mion, Décio

2004-06-01

It is well known that blood pressure measurement with a standard 12-13 cm wide cuff is erroneous for large arms. To compare arm blood pressure measurements with an appropriate cuff and forearm blood pressure measurements (BPM) with a standard cuff, and both measurements by the Photopletismography (Finapres) method. One hundred and twenty-nine obese patients were studied (body mass index=40+/-7 kg/m2). The patients had three arm BPM taken by an automatic oscillometric device using an appropriate cuff and three forearm BPM with a standard cuff in the sitting position after a five-minute rest. Data were analysed by the analysis of variance. The correction values were obtained by the linear regression test. Systolic and diastolic arm BPM with an appropriate cuff were significantly lower (pforearm BPM with a standard cuff. The measurements obtained by Finapres were significantly lower (pforearm systolic and diastolic blood pressures and upper arm diastolic blood pressure. The equation to correct BPM in forearm in obese patients with arm circumference between 32-44 cm was: systolic BPM=33.2+/-0.68 x systolic forearm BPM, and diastolic BPM=25.2+0.59 x forearm diastolic BPM. This study showed that forearm blood pressure measurement overestimates the values of arm blood pressure measurement. In addition, it is possible to correct forearm BPM with an equation.

Leakage rate from LOCA-aged inflatable airlock seals Pickering NGS 'B' personnel doors

International Nuclear Information System (INIS)

Fayle, G.W.; Cordingley, D.C.

1985-01-01

In order to demonstrate to the Atomic Energy Control Board that an air-lock inflatable seal will function after a LOCA exposure, an inflatable seal intended for personnel doors at the Pickering NGS 'B' was exposed to the thermal/moisture conditions of the LOCA requirement. While attending to determine the post-LOCA leakage rate it was found that additional leaks developed during each post-LOCA inflation/deflation cycle. The seal had been significantly and irreparably deteriorated by the LOCA exposure. The test has demonstrated that this type of LOCA exposed seal should not be expected to withstand either additional pressure above 207 kPa or additional inflation/deflation cycling. A higher inflation pressure and/or cycling will reduce the likelihood of a post-LOCA seal retaining an inflation pressure sufficient to prevent leakage across the seal

Arterial blood oxygen saturation during blood pressure cuff-induced hypoperfusion

Energy Technology Data Exchange (ETDEWEB)

Kyriacou, P A [School of Engineering and Mathematical Sciences, City University, London EC1V 0HB (United Kingdom); Shafqat, K [School of Engineering and Mathematical Sciences, City University, London EC1V 0HB (United Kingdom); Pal, S K [St Andrew' s Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, CM1 7ET (United Kingdom)

2007-10-15

Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO{sub 2}) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Pulse oximeters estimate arterial oxygen saturation by shining light at two different wavelengths, red and infrared, through vascular tissue. In this method the ac pulsatile photoplethysmographic (PPG) signal associated with cardiac contraction is assumed to be attributable solely to the arterial blood component. The amplitudes of the red and infrared ac PPG signals are sensitive to changes in arterial oxygen saturation because of differences in the light absorption of oxygenated and deoxygenated haemoglobin at these two wavelengths. From the ratios of these amplitudes, and the corresponding dc photoplethysmographic components, arterial blood oxygen saturation (SpO{sub 2}) is estimated. Hence, the technique of pulse oximetry relies on the presence of adequate peripheral arterial pulsations, which are detected as photoplethysmographic (PPG) signals. The aim of this study was to investigate the effect of pressure cuff-induced hypoperfusion on photoplethysmographic signals and arterial blood oxygen saturation using a custom made finger blood oxygen saturation PPG/SpO{sub 2} sensor and a commercial finger pulse oximeter. Blood oxygen saturation values from the custom oxygen saturation sensor and a commercial finger oxygen saturation sensor were recorded from 14 healthy volunteers at various induced brachial pressures

Blood pressure measurement of all five fingers by strain gauge plethysmography

DEFF Research Database (Denmark)

Hirai, M; Nielsen, S L; Lassen, N A

1976-01-01

of the other fingers was measured using a 24-mm-wide cuff. Blood pressure at the proximal phalanx was higher than that at the intermediate phalanx in all fingers except finger V. The difference of blood pressure values corresponded well with circumference of the finger. In 15 normal subjects, blood pressure...... at the proximal phalanx was compared in fingers I, III, IV, and V, using 16, 20, 24 and 24 mm wide cuffs. Finger blood pressure was closest to arm systolic blood pressure when a 24-mm or 27-mm-wide cuff was used in fingers I, III, and IV, and with a 20-mm-wide cuff in finger V. As the standard deviation......The aim of the present paper was to study the methodological problems involved in measuring systolic blood pressure in all five fingers by the strain gauge technique. In 24 normal subjects, blood pressure at the proximal phalanx of finger I and both at the proximal and the intermediate phalanx...

Inflation and Inflation Uncertainty in Turkey

OpenAIRE

dogru, bulent

2014-01-01

Abstract: In this study, the relationship between inflation and inflation uncertainty is analyzed using Granger causality tests with annual inflation series covering the time period 1923 to 2012 for Turkish Economy. Inflation uncertainty is measured by Exponential Generalized Autoregressive Conditional Heteroskedastic model. Econometric findings suggest that although in long run the Friedman's hypothesis that high inflation increases inflation ...

Rotator cuff disease

International Nuclear Information System (INIS)

Ziatkin, M.B.; Iannotti, J.P.; Roberts, M.; Dalinka, M.K.; Esterhai, J.L.; Kressel, H.Y.; Lenkinski, R.E.

1988-01-01

A dual-surface-coil array in a Helmholtz configuration was used to evaluate th rotator cuff in ten normal volunteers and 44 patients. Studies were performed with a General Electric 1.5-T MR imager. Thirty-two patients underwent surgery, 25 of whom also underwent arthrography. In comparison with surgery, MR imaging was more sensitive than arthrography for rotator cuff tears (91% vs 71%). The specificity and accuracy of MR imaging were 88% and 91%. The accuracy increased with use of an MR grading system. MR findings correlated with surgical findings with regard to the size and site of tears. MR findings of cuff tears were studied with multivariate analysis. Correlation was also found between a clinical score, the MR grade, and the clinical outcome

Cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

DEFF Research Database (Denmark)

Sloth, Astrid D; Schmidt, Michael R; Munk, Kim

2016-01-01

AIMS: Remote ischaemic conditioning seems to improve long-term clinical outcomes in patients undergoing primary percutaneous coronary intervention. Remote ischaemic conditioning can be applied with cycles of alternating inflation and deflation of a blood-pressure cuff. We evaluated the cost...

Ultrasound determination of rotator cuff tear repairability

Science.gov (United States)

Tse, Andrew K; Lam, Patrick H; Walton, Judie R; Hackett, Lisa

2015-01-01

Background Rotator cuff repair aims to reattach the torn tendon to the greater tuberosity footprint with suture anchors. The present study aimed to assess the diagnostic accuracy of ultrasound in predicting rotator cuff tear repairability and to assess which sonographic and pre-operative features are strongest in predicting repairability. Methods The study was a retrospective analysis of measurements made prospectively in a cohort of 373 patients who had ultrasounds of their shoulder and underwent rotator cuff repair. Measurements of rotator cuff tear size and muscle atrophy were made pre-operatively by ultrasound to enable prediction of rotator cuff repairability. Tears were classified following ultrasound as repairable or irreparable, and were correlated with intra-operative repairability. Results Ultrasound assessment of rotator cuff tear repairability has a sensitivity of 86% (p tear size (p tear size ≥4 cm2 or anteroposterior tear length ≥25 mm indicated an irreparable rotator cuff tear. Conclusions Ultrasound assessment is accurate in predicting rotator cuff tear repairability. Tear size or anteroposterior tear length and age were the best predictors of repairability. PMID:27582996

Exchange rate regimes and inflation: Evidence from India.

OpenAIRE

Mohanty, Biswajit; Bhanumurthy, N.R.

2014-01-01

Exchange rate stability is crucial for inflation management as a stable rate is expected to reduce domestic inflation pressures through a `policy discipline effect'- restricting money supply growth, and a `credibility effect'- inducing higher money demand and reduced velocity of money. Alternatively, the impossibility trillema predicts that in the presence of an open capital account, a stable exchange rate may lead to lack of control on monetary policy and, hence, higher inflation. Using a mo...

Verification and Validation of an Innovative Inflatable Structure, Phase II

Data.gov (United States)

National Aeronautics and Space Administration — An inflatable habitat is a pressure vessel with flexible shell. Notable features such as low weight, large inflated operational volume, and small pre-deployment...

Proteomics perspectives in rotator cuff research

DEFF Research Database (Denmark)

Sejersen, Maria Hee Jung; Frost, Poul; Hansen, Torben Bæk

2015-01-01

Background Rotator cuff tendinopathy including tears is a cause of significant morbidity. The molecular pathogenesis of the disorder is largely unknown. This review aimed to present an overview of the literature on gene expression and protein composition in human rotator cuff tendinopathy and other...... studies on objectively quantified differential gene expression and/or protein composition in human rotator cuff tendinopathy and other tendinopathies as compared to control tissue. Results We identified 2199 studies, of which 54 were included; 25 studies focussed on rotator cuff or biceps tendinopathy......, which only allowed simultaneous quantification of a limited number of prespecified mRNA molecules or proteins, several proteins appeared to be differentially expressed/represented in rotator cuff tendinopathy and other tendinopathies. No proteomics studies fulfilled our inclusion criteria, although...

Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears.

Science.gov (United States)

Makhni, Eric C; Swart, Eric; Steinhaus, Michael E; Mather, Richard C; Levine, William N; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N

2016-09-01

To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these

Multicentre randomised controlled trial to investigate the usefulness of continuous pneumatic regulation of tracheal cuff pressure for reducing ventilator-associated pneumonia in mechanically ventilated severe trauma patients: the AGATE study protocol.

Science.gov (United States)

Marjanovic, Nicolas; Frasca, Denis; Asehnoune, Karim; Paugam, Catherine; Lasocki, Sigismond; Ichai, Carole; Lefrant, Jean-Yves; Leone, Marc; Dahyot-Fizelier, Claire; Pottecher, Julien; Falcon, Dominique; Veber, Benoit; Constantin, Jean-Michel; Seguin, Sabrina; Guénézan, Jérémy; Mimoz, Olivier

2017-08-07

Severe trauma represents the leading cause of mortality worldwide. While 80% of deaths occur within the first 24 hours after trauma, 20% occur later and are mainly due to healthcare-associated infections, including ventilator-associated pneumonia (VAP). Preventing underinflation of the tracheal cuff is recommended to reduce microaspiration, which plays a major role in the pathogenesis of VAP. Automatic devices facilitate the regulation of tracheal cuff pressure, and their implementation has the potential to reduce VAP. The objective of this work is to determine whether continuous regulation of tracheal cuff pressure using a pneumatic device reduces the incidence of VAP compared with intermittent control in severe trauma patients. This multicentre randomised controlled and open-label trial will include patients suffering from severe trauma who are admitted within the first 24 hours, who require invasive mechanical ventilation to longer than 48 hours. Their tracheal cuff pressure will be monitored either once every 8 hours (control group) or continuously using a pneumatic device (intervention group). The primary end point is the proportion of patients that develop VAP in the intensive care unit (ICU) at day 28. The secondary end points include the proportion of patients that develop VAP in the ICU, early (≤7 days) or late (>7 days) VAP, time until the first VAP diagnosis, the number of ventilator-free days and antibiotic-free days, the length of stay in the ICU, the proportion of patients with ventilator-associated events and that die during their ICU stay. This protocol has been approved by the ethics committee of Poitiers University Hospital, and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Clinical Trials NCT02534974. © Article author(s) (or

Helium induces preconditioning in human endothelium in vivo

NARCIS (Netherlands)

Smit, Kirsten F.; Oei, Gezina T. M. L.; Brevoord, Daniel; Stroes, Erik S.; Nieuwland, Rienk; Schlack, Wolfgang S.; Hollmann, Markus W.; Weber, Nina C.; Preckel, Benedikt

2013-01-01

Helium protects myocardium by inducing preconditioning in animals. We investigated whether human endothelium is preconditioned by helium inhalation in vivo. Forearm ischemia-reperfusion (I/R) in healthy volunteers (each group n = 10) was performed by inflating a blood pressure cuff for 20 min.

On cuff imbalance and tripolar ENG amplifier configurations.

Science.gov (United States)

Triantis, Iasonas F; Demosthenous, Andreas; Donaldson, Nick

2005-02-01

Electroneurogram (ENG) recording techniques benefit from the use of tripolar cuffs because they assist in reducing interference from sources outside the cuff. However, in practice the performance of ENG amplifier configurations, such as the quasi-tripole and the true-tripole, has been widely reported to be degraded due to the departure of the tripolar cuff from ideal behavior. This paper establishes the presence of cuff imbalance and investigates its relationship to cuff asymmetry, cuff end-effects and interference source proximity. The paper also presents a comparison of the aforementioned amplifier configurations with a new alternative, termed the adaptive-tripole, developed to automatically compensate for cuff imbalance. The output signal-to-interference ratio of the three amplifier configurations were compared in vivo for two interference signals (stimulus artifact and M-wave) superimposed on compound action potentials. The experiments showed (for the first time) that the two interference signals result in different cuff imbalance values. Nevertheless, even with two distinct cuff imbalances present, the adaptive-tripole performed better than the other two systems in 61.9% of the trials.

MRI of the rotator cuff and internal derangement

Energy Technology Data Exchange (ETDEWEB)

Opsha, Oleg [Department of Radiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219 (United States)], E-mail: oopsha@hotmail.com; Malik, Archana [Department of Radiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219 (United States)], E-mail: dr.armal@gmail.com; Baltazar, Romulo [Department of Radiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219 (United States)], E-mail: rbaltazar@gmail.com; Primakov, Denis [Department of Radiology, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030 (United States)], E-mail: dgprim@yahoo.com; Beltran, Salvador [Dr. Ramon Marti, 2 Albons, Ginrona 17136 (Spain); Miller, Theodore T. [Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 (United States)], E-mail: MillerTT@hss.edu; Beltran, Javier [Department of Radiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219 (United States)], E-mail: jbeltran46@msn.com

2008-10-15

Disease to the rotator cuff is the most common cause of shoulder pain and dysfunction in adults. This group of muscles performs multiple functions and is often stressed during various activities. The anatomy and physiology of the rotator cuff is complex and interconnected to other muscle groups in the shoulder. One must take the anatomic status of the rotator cuff tendons into account when planning the treatment of the rotator cuff injury. Diagnostic imaging of the rotator cuff, performed by MRI, provides valuable information about the nature of the injury. In this article, we will review the various types and causes of rotator cuff injuries, normal MR anatomy, function, patho-anatomy, and the biomechanics of the rotator cuff. We will also review shoulder impingement syndromes.

MRI of the rotator cuff and internal derangement

International Nuclear Information System (INIS)

Opsha, Oleg; Malik, Archana; Baltazar, Romulo; Primakov, Denis; Beltran, Salvador; Miller, Theodore T.; Beltran, Javier

2008-01-01

Disease to the rotator cuff is the most common cause of shoulder pain and dysfunction in adults. This group of muscles performs multiple functions and is often stressed during various activities. The anatomy and physiology of the rotator cuff is complex and interconnected to other muscle groups in the shoulder. One must take the anatomic status of the rotator cuff tendons into account when planning the treatment of the rotator cuff injury. Diagnostic imaging of the rotator cuff, performed by MRI, provides valuable information about the nature of the injury. In this article, we will review the various types and causes of rotator cuff injuries, normal MR anatomy, function, patho-anatomy, and the biomechanics of the rotator cuff. We will also review shoulder impingement syndromes

Exercise increases pressure pain tolerance but not pressure and heat pain thresholds in healthy young men

DEFF Research Database (Denmark)

Vaegter, H. B.; Bement, M. Hoeger; Madsen, A. B.

2017-01-01

BACKGROUND: Exercise causes an acute decrease in the pain sensitivity known as exercise-induced hypoalgesia (EIH), but the specificity to certain pain modalities remains unknown. This study aimed to compare the effect of isometric exercise on the heat and pressure pain sensitivity. METHODS...... and counterbalanced order. Cuff pressure pain threshold (cPPT) and pain tolerance (cPTT) were assessed on the ipsilateral lower leg by computer-controlled cuff algometry. Heat pain threshold (HPT) was recorded on the ipsilateral foot by a computer-controlled thermal stimulator. RESULTS: Cuff pressure pain tolerance...... to the understanding of how isometric exercise influences pain perception, which is necessary to optimize the clinical utility of exercise in management of chronic pain. SIGNIFICANCE: The effect of isometric exercise on pain tolerance may be relevant for patients in chronic musculoskeletal pain as a pain...

US detection of rotator cuff tear

International Nuclear Information System (INIS)

Soble, M.G.; Guay, R.C.; Kaye, A.D.

1988-01-01

Between June 1986 and April 1988, 75 patients suspected of having a tear of the rotator cuff underwent shoulder sonography and arthrography. Compared with anthrography, US demonstrated 92% of rotor cuff tears, with a specificity of 84% and a negative predictive value of 95%. In 30 patients who underwent surgery for a rotator cuff tear or other soft-tissue abnormality, sonography demonstrated a sensitivity of 93% and specificity of 73%, while arthrography demonstrated a sensitivity of 87% and specificity of 100%. The above data indicate that US is a useful, noninvasive screening procedure for patients suspected of having rotator cuff injury

The role of pectoralis major and latissimus dorsi muscles in a biomechanical model of massive rotator cuff tear.

Science.gov (United States)

Campbell, Sean T; Ecklund, Kier J; Chu, Eileen H; McGarry, Michelle H; Gupta, Ranjan; Lee, Thay Q

2014-08-01

Superior migration of the humeral head after massive rotator cuff tear (mRCT) is thought to lead to cuff tear arthropathy. Previous biomechanical studies have demonstrated the ability of the pectoralis major and latissimus dorsi (PM/LD) muscles to resist this migration. This study examined the role of PM/LD muscles on glenohumeral joint forces and acromiohumeral contact pressures in a mRCT model. Six cadaveric shoulders were tested using a custom shoulder-testing system. Muscle insertions of the rotator cuff, deltoid, and PM/LD were preserved and used for muscle loading. Specimens were tested in 3 different humeral rotation positions at 0° abduction and 2 rotation positions at 60° abduction. Testing was performed for intact specimens, after supraspinatus removal, and after supraspinatus/infraspinatus/teres minor removal. PM/LD were loaded or unloaded to determine their effect. Humeral head kinematics, glenohumeral joint forces, and acromiohumeral contact area and pressure were measured. For the mRCT condition at 0° abduction, unloading the PM/LD resulted in superior shift of the humeral head. Acromiohumeral contact pressures were undetectable when the PM/LD were loaded but increased significantly after PM/LD unloading. After mRCT, superior joint forces were increased and compressive forces were decreased compared with intact; loading the PM/LD resolved these abnormal forces in some testing conditions. In mRCT, the PM and LD muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures. Strengthening or neuromuscular training of this musculature, or both, may delay the progression to cuff tear arthropathy. Published by Mosby, Inc.

The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears.

Science.gov (United States)

Rothrauff, Benjamin B; Pauyo, Thierry; Debski, Richard E; Rodosky, Mark W; Tuan, Rocky S; Musahl, Volker

2017-08-01

The torn rotator cuff remains a persistent orthopedic challenge, with poor outcomes disproportionately associated with chronic, massive tears. Degenerative changes in the tissues that comprise the rotator cuff organ, including muscle, tendon, and bone, contribute to the poor healing capacity of chronic tears, resulting in poor function and an increased risk for repair failure. Tissue engineering strategies to augment rotator cuff repair have been developed in an effort to improve rotator cuff healing and have focused on three principal aims: (1) immediate mechanical augmentation of the surgical repair, (2) restoration of muscle quality and contractility, and (3) regeneration of native enthesis structure. Work in these areas will be reviewed in sequence, highlighting the relevant pathophysiology, developmental biology, and biomechanics, which must be considered when designing therapeutic applications. While the independent use of these strategies has shown promise, synergistic benefits may emerge from their combined application given the interdependence of the tissues that constitute the rotator cuff organ. Furthermore, controlled mobilization of augmented rotator cuff repairs during postoperative rehabilitation may provide mechanotransductive cues capable of guiding tissue regeneration and restoration of rotator cuff function. Present challenges and future possibilities will be identified, which if realized, may provide solutions to the vexing condition of chronic massive rotator cuff tears.

Deep Vein Thrombosis

Science.gov (United States)

... changes can include dermatitis, skin discoloration, scarring and ulcers. This condition is called “post-thrombotic syndrome.” Stocking and devices that use air pressure to inflate long leg cuffs are also used for the prevention of DVT. Some health care providers may recommend ...

Verification and Validation of an Innovative Inflatable Structure Design, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — An inflatable habitat is a pressure vessel with flexible shell. Notable features such as low weight, large inflated operational volume, and small pre-deployment...

[Microcirculation of the nasal mucosa during use of balloon tamponade].

Science.gov (United States)

Klinger, M; Siegert, R

1997-03-01

Nasal packings are commonly accepted in the treatment of severe epistaxis. Cuffed catheters are known to cause damage to the nasal mucosa most likely by interfering with tissue perfusion. In this study the effect of different pressure levels on local perfusion of septal mucosa is investigated. In 15 healthy subjects the blood flow in septal mucosa was measured by laser doppler flowmetry by positioning a cuffed epistaxis catheter into the nasal cavity with a laser probe attached to it. Increasing pressure was administered by injecting saline solution while continuously recording intraluminal pressure, perfusion, and filling volume. The local pressure affecting the septal mucosa at the moment of stalling perfusion was determined by subtracting the extranasal cuff pressure from the current intranasal cuff pressure at same inflation volumes. Microcirculation of the septal mucosa stopped when the local pressure exceeded a value of Pmean = 42 mmHg. Individual variations (n = 15) were small (s = 9 mmHg). The intraluminal cuff pressure was measured to be about ten times higher due to the retraction force of the cuff. Spontaneous oscillations of the blood flow were reduced with increasing pressure to the blood vessels. Filling volumes up to 3.2 ml were sufficient to stop perfusion. Cuffed nasal packings stop the blood flow in nasal mucosa even at low local pressures. Depending on the material characteristics of different cuffs the pressure to dilate the cuff may, however, be several times higher than the actual local pressure. This effect may cause problems in the proper use of cuffed catheters. Laser doppler flowmetry proved to be helpful in determining reproducible perfusion values.

Clinical indicators associated with successful tracheostomy cuff deflation.

Science.gov (United States)

Pryor, Lee N; Ward, Elizabeth C; Cornwell, Petrea L; O'Connor, Stephanie N; Chapman, Marianne J

2016-08-01

Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown. The study aims were to identify (1) the proportion of patients tolerating continuous cuff deflation at first attempt; (2) the clinical observations associated with cuff deflation success or failure, including volume of above cuff secretions and (3) the predictive capacity of these observations within a heterogeneous cohort. A retrospective review of 113 acutely tracheostomised patients with a subglottic suction tube in situ was conducted. Ninety-five percent of patients (n=107) achieved continuous cuff deflation on the first attempt. The clinical observations recorded as present in the 24h preceding cuff deflation included: (1) medical stability, (2) respiratory stability, (3) fraction of inspired oxygen ≤0.4, (4) tracheal suction ≤1-2 hourly, (5) sputum thin and easy to suction, (6) sputum clear or white, (7) ≥moderate cough strength, (8) above cuff secretions ≤1ml per hour and (9) alertness≥eyes open to voice. Using the presence of all 9 indicators as predictors of successful cuff deflation tolerance, specificity and positive predictive value were 100%, although sensitivity was only 77% and negative predictive value 19%. Refinement to a set of 3 clinically driven criteria (medical and respiratory stability, above cuff secretions ≤1ml/h) provided high specificity (100%), sensitivity (95%), positive predictive value (100%) and an improved negative predictive value (55%). Key criteria can help guide clinical decision-making on patient readiness for cuff deflation. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Injection Therapies for Rotator Cuff Disease.

Science.gov (United States)

Lin, Kenneth M; Wang, Dean; Dines, Joshua S

2018-04-01

Rotator cuff disease affects a large proportion of the overall population and encompasses a wide spectrum of pathologies, including subacromial impingement, rotator cuff tendinopathy or tear, and calcific tendinitis. Various injection therapies have been used for the treatment of rotator cuff disease, including corticosteroid, prolotherapy, platelet-rich plasma, stem cells, and ultrasound-guided barbotage for calcific tendinitis. However, the existing evidence for these therapies remains controversial or sparse. Ultimately, improved understanding of the underlying structural and compositional deficiencies of the injured rotator cuff tissue is needed to identify the biological needs that can potentially be targeted with injection therapies. Copyright © 2017 Elsevier Inc. All rights reserved.

Rotator Cuff Injuries - Multiple Languages

Science.gov (United States)

... Are Here: Home → Multiple Languages → All Health Topics → Rotator Cuff Injuries URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Rotator Cuff Injuries - Multiple Languages To use the sharing features ...

Can an electronic device with a single cuff be accurate in a wide range of arm size? Validation of the Visomat Comfort 20/40 device for home blood pressure monitoring.

Science.gov (United States)

Stergiou, G S; Tzamouranis, D; Nasothimiou, E G; Protogerou, A D

2008-11-01

An appropriate cuff according to the individual's arm circumference is recommended with all blood pressure (BP) monitors. An electronic device for home monitoring has been developed (Visomat Comfort 20/40) that estimates the individual's arm circumference by measuring the cuff filing volume and makes an adjustment of measured BP taking into account the estimated arm circumference. Thus the manufacturer recommends the use of a single cuff for arm circumference 23-43 cm. The device accuracy was assessed using the European Society of Hypertension International Protocol. Simultaneous BP measurements were obtained in 33 adults by two observers (connected mercury sphygmomanometers) four times, sequentially with three measurements taken using the tested device. Absolute device-observer BP differences were classified into difference differences differences difference (systolic/diastolic) was 3.7 +/- 5.6/-1.5 +/- 4.7 mm Hg (4.7 +/- 4.9/ - 1.7 +/- 4.3 in arm circumference 23-29 cm [39 readings] and 3.1 +/- 5.9/-1.4 +/- 5.0 in arm 30-34 cm [60 readings], P=NS). In conclusion, the device fulfils the International Protocol requirements and can be recommended for clinical use. Interestingly, the device was accurate using a single cuff in a wide range of arm circumference (23-34 cm). This study provides no information about the device accuracy in larger arms.

Pressure Relief, Visco-Elastic Foam with Inflated Air? A Pilot Study in a Dutch Nursing Home

Directory of Open Access Journals (Sweden)

Martin Van Leen

2015-02-01

Full Text Available Objective: There is still little evidence regarding the type of mattress that is the best for preventing pressure ulcers (PUs. In a Dutch nursing home, a new type of overlay mattress (air inflated visco-elastic foam was tested to analyze the opportunity for replacement of the normally used static air overlay mattress in its three-step PU prevention protocol In this small pilot the outcome measures were: healing of a category one pressure ulcer, new development or deterioration of a category one PU and need for repositioning. Methods: We included 20 nursing home residents with a new category one pressure ulcer, existing for no longer than 48 h following a consecutive sampling technic. All residents were staying for more than 30 days in the nursing home and were lying on a visco-elastic foam mattress without repositioning (step one of the 3-step protocol at the start of the pilot study. They had not suffered from a PU in the month before. The intervention involved use of an air inflated foam overlay instead of a static air overlay (normally step 2 of the 3-step protocol. At the start; the following data were registered: age; gender; main diagnosis and presence of incontinence. Thereafter; all participating residents were checked weekly for PU healing tendency; deterioration of PUs; new PUs and need of repositioning. Only when residents showed still a category one PU after 48 h or deterioration of an existing pressure ulcer or if there was development of a new pressure ulcer, repositioning was put into practice (step 3 of the PU protocol. All residents participated during 8 weeks. Results: Seven residents developed a new pressure ulcer category one and still had a category one pressure ulcer at the end of the study period. One resident developed a pressure ulcer category 2. Fifteen residents needed repositioning from one week after start of the study until the end of the study. Conclusions: Overall 40% of the residents developed a pressure ulcer

Occult Interpositional Rotator Cuff - an Extremely Rare Case of Traumatic Rotator Cuff Tear

Energy Technology Data Exchange (ETDEWEB)

Su, Wei Ren; Jou, I Ming [National Cheng Kung University Hospital, Tainan (China); Lin, Cheng Li [Show-Chwan Memorial Hospital, Changhua (China); Chih, Wei Hsing [Chia-Yi Christian Hospital, Chiayi (China)

2012-01-15

Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed.

Influence of short-term blood pressure variability on blood pressure determinations

NARCIS (Netherlands)

Bos, W. J.; van Goudoever, J.; van Montfrans, G. A.; Wesseling, K. H.

1992-01-01

To evaluate the effect of blood pressure variability on Riva Rocci Korotkoff blood pressure determinations, we studied the intra-arterial pressure during Riva Rocci Korotkoff determinations in 25 patients. In 50 measurements with a cuff deflation rate of 2.5 mm Hg/sec, the systolic intra-arterial

NMR of the rotator cuff. An update

International Nuclear Information System (INIS)

Kreitner, Karl-Friedrich; Maehringer-Kunz, Aline

2016-01-01

The rotator cuff consists of the tendons of the supscapularis, supraspinatus, infraspinatus and teres minor muscles. This group of muscles performs multiple functions and is often stressed during various activities. This explains, why rotator cuff disease is common and the most often cause of shoulder pain and dysfunction in adults. MR imaging still is the most important imaging modality in assessment of rotator cuff disease. It enables the radiologist to make an accurate diagnosis, the basis for an appropriate management. In this article, current concepts with regard to anatomy and imaging diagnosis will be reviewed. The discussion of the complex anatomy is followed by normal and pathologic MR imaging appearances of the rotator cuff including tendinopathy and tearing, and concluding with a review of the postoperative cuff.

Rotator cuff tear measurement by arthropneumotomography

International Nuclear Information System (INIS)

Kilcoyne, R.F.; Matsen, F.A. III

1983-01-01

Five years of experience with a method of shoulder arthrography using upright tomography in cases of suspected or known rotator cuff tears has demonstrated its effectiveness. The value of the procedure lies in its ability to demonstrate the size of the cuff tear and the thickness of the remaining cuff tissue. This information provides the surgeon with a preoperative estimate of the difficulty of the repair and the prognosis for a good functional recovery. In 33 cases, there was good correlation between the upright thin-section tomogram findings and the surgical results. The tomograms provided better information about the size of the tear and the quality of the remaining cuff than did plain arthrograms

Automotive airbag inflator analysis using the measured properties of modern propellants

KAUST Repository

Seo, Young D.

2011-04-01

An airbag is composed of a housing assembly, door assembly, cushion assembly, and an inflator. The inflator is an essential part that generates gas for the airbag. When an airbag is activated, it effectively absorbs the crash energy of the passenger by inflating a cushion. In the present study, tank tests were performed with newly synthesized propellants with various compositions, and the results are compared with the numerical results. In the simulation of the inflator, a zonal model has been adopted which consisted of four zones of flow regions: combustion chamber, filter, gas plenum, and discharge tank. Each zone was described by the conservation equations with specified constitutive relations for gas. The pressure and temperature of each zone of the inflator were calculated and analyzed, and the results were compared with the tank test data. The similarity of the pressure curve and closed bomb calculation show that the modeled results are well correlated with the experimental data. © 2011 Elsevier Ltd All rights reserved.

The impact of arm circumference on noninvasive oscillometric blood pressure referenced with intra-aortic blood pressure.

Science.gov (United States)

Shangguan, Qing; Wu, Yanqing; Xu, Jinsong; Su, Hai; Li, Juxiang; Hong, Kui; Cheng, Xiaoshu

2015-12-01

To investigate the influence of arm circumference (AC) on the brachial blood pressure (BP) measured with an adult cuff. This study included 208 patients (150 men, 61.0±8.0 years) for coronary angiography. Intra-aortic BP and noninvasive right brachial oscillometric BP (noninvasive BP) were measured simultaneously before coronary angiography. The noninvasive BP was measured using an electronic oscillometric device with an adult cuff (12×22 cm). The mid-ACs were measured. Thus, proper cuff-arm (≤26 cm) and small cuff (>26 cm) groups were created. The difference in intra-aortic and noninvasive BP was calculated as BPi-n. The correlation coefficients (r) between noninvasive and invasive systolic blood pressure (SBP), mean artery pressure, and diastolic blood pressure (DBP) were 0.88, 0.76, and 0.58, respectively. The SBPi-n was higher (7.9±1.6 vs. 5.2±1.1 mmHg), but the DBPi-n (3.9±1.4 vs. 6.1±1.0 mmHg, P26 cm. Among the four subgroups divided by 20-23, 24-26, 27-30, and 31-37 cm of AC, as the AC increased, the SBPi-n increased, but DBP decreased, resulting in noninvasive SBP 4.6 mmHg higher and noninvasive DBP 4.6 mmHg lower in the 31-37 cm group in comparison with the 20-23 cm group. When an adult cuff was used, the noninvasive oscillometric SBP was overestimated, but DBP was underestimated in the individuals with large arms against the intra-aortic BP.

A Comparison and Calibration of a Wrist-Worn Blood Pressure Monitor for Patient Management: Assessing the Reliability of Innovative Blood Pressure Devices

Science.gov (United States)

Melville, Sarah; Teskey, Robert; Philip, Shona; Simpson, Jeremy A; Lutchmedial, Sohrab

2018-01-01

Background Clinical guidelines recommend monitoring of blood pressure at home using an automatic blood pressure device for the management of hypertension. Devices are not often calibrated against direct blood pressure measures, leaving health care providers and patients with less reliable information than is possible with current technology. Rigorous assessments of medical devices are necessary for establishing clinical utility. Objective The purpose of our study was 2-fold: (1) to assess the validity and perform iterative calibration of indirect blood pressure measurements by a noninvasive wrist cuff blood pressure device in direct comparison with simultaneously recorded peripheral and central intra-arterial blood pressure measurements and (2) to assess the validity of the measurements thereafter of the noninvasive wrist cuff blood pressure device in comparison with measurements by a noninvasive upper arm blood pressure device to the Canadian hypertension guidelines. Methods The cloud-based blood pressure algorithms for an oscillometric wrist cuff device were iteratively calibrated to direct pressure measures in 20 consented patient participants. We then assessed measurement validity of the device, using Bland-Altman analysis during routine cardiovascular catheterization. Results The precalibrated absolute mean difference between direct intra-arterial to wrist cuff pressure measurements were 10.8 (SD 9.7) for systolic and 16.1 (SD 6.3) for diastolic. The postcalibrated absolute mean difference was 7.2 (SD 5.1) for systolic and 4.3 (SD 3.3) for diastolic pressures. This is an improvement in accuracy of 33% systolic and 73% diastolic with a 48% reduction in the variability for both measures. Furthermore, the wrist cuff device demonstrated similar sensitivity in measuring high blood pressure compared with the direct intra-arterial method. The device, when calibrated to direct aortic pressures, demonstrated the potential to reduce a treatment gap in high blood

Dual long memory of inflation and test of the relationship between inflation and inflation uncertainty

OpenAIRE

LIU Jinquan; ZHENG Tingguo; SUI Jianli

2008-01-01

This paper uses the ARFIMA-FIGARCH model to investigate the China¡¯s monthly inflation rate from January 1983 to October 2005. It is found that both first moment and second moment of inflation have remarkable long memory, indicating the existence of long memory properties in both inflation level and inflation uncertainty. By the Granger-causality test on inflation rate and inflation uncertainty, it is shown that the inflation level affects the inflation uncertainty and so supports Friedman hy...

Differences in blood pressure measurements in the forearm and upper arm of obese otherwise healthy first year medical students

Directory of Open Access Journals (Sweden)

Suganthi V, Navin Rajaratnam, Suzanne Maria D’cruz

2014-07-01

Full Text Available Background: The prevalence of obesity is increasing in Indian youth and obesity is associated with complications like systemic hypertension. Often, due to the non-availability of appropriate sized cuffs, standard cuff bladders are used to measure blood pressure in the forearms of obese young adults. Aim: To compare the upper arm arterial blood pressure measured using an appropriate cuff with the forearm arterial blood pressure measured using a standard cuff and conventional sphygmomanometry in obese otherwise healthy first year medical students. Materials and Methods: Blood pressure was measured in 27 obese otherwise healthy first year medical students after five minutes of rest using a mercury sphygmomanometer with the subjects seated and the arm and forearm at heart level, using an appropriate sized cuff for the upper arm according to American Heart Association standards and a standard cuff for the fore arm. Results: A statistically significant difference in both systolic [t-test (paired = -6.921; df = 26; sig = .000 (2- tailed] and diastolic blood pressure [t-test (paired = -8.508; df = 26; sig = .000 (2- tailed] was found, with the blood pressure readings being higher in the forearm. The correlations between upper arm and forearm systolic and diastolic blood pressure were 0.785 (p = .000 and 0.870 (p = .000. Conclusion: Both systolic and diastolic blood pressure measurements were significantly higher in the forearm. Further studies with larger sample size should be conducted to confirm that forearm blood pressure measurements using standard cuff bladders cannot be considered equal to upper arm measurements made using an appropriate sized cuff in all young obese individuals

Examination of rotator cuff re-tear

International Nuclear Information System (INIS)

Kitahara, Hiroyuki; Yabe, Yoshihiro; Norimatsu, Takahiro; Adachi, Shinji; Sera, Keisuke

2010-01-01

The six-month post-operative re-tear rate in 72 arthroscopic rotator cuff repair cases was 16.3% by MRI. The re-tear rate of massive tears was 50%. We investigated the details of the re-tears by MRI and arthroscopic findings. High re-tear rates were connected with cuff tear size and fatty degeneration of muscle belly. Cases with poor cuff quality in arthroscopically showed high re-tear rate. These results suggest that surgery operation should be performed as soon as possible after diagnosis of cuff tear to obtain good results. Cases with damage of long head of the biceps (LHB) are likely to develop impingement causes of re-tears. Some type of rehabilitation is required to avoid impingement in such cases. (author)

Signal quality measures for unsupervised blood pressure measurement

International Nuclear Information System (INIS)

Abdul Sukor, J; Redmond, S J; Lovell, N H; Chan, G S H

2012-01-01

Accurate systolic and diastolic pressure estimation, using automated blood pressure measurement, is difficult to achieve when the transduced signals are contaminated with noise or interference, such as movement artifact. This study presents an algorithm for automated signal quality assessment in blood pressure measurement by determining the feasibility of accurately detecting systolic and diastolic pressures when corrupted with various levels of movement artifact. The performance of the proposed algorithm is compared to a manually annotated reference scoring (RS). Based on visual representations and audible playback of Korotkoff sounds, the creation of the RS involved two experts identifying sections of the recorded sounds and annotating sections of noise contamination. The experts determined the systolic and diastolic pressure in 100 recorded Korotkoff sound recordings, using a simultaneous electrocardiograph as a reference signal. The recorded Korotkoff sounds were acquired from 25 healthy subjects (16 men and 9 women) with a total of four measurements per subject. Two of these measurements contained purposely induced noise artifact caused by subject movement. Morphological changes in the cuff pressure signal and the width of the Korotkoff pulse were extracted features which were believed to be correlated with the noise presence in the recorded Korotkoff sounds. Verification of reliable Korotkoff pulses was also performed using extracted features from the oscillometric waveform as recorded from the inflatable cuff. The time between an identified noise section and a verified Korotkoff pulse was the key feature used to determine the validity of possible systolic and diastolic pressures in noise contaminated Korotkoff sounds. The performance of the algorithm was assessed based on the ability to: verify if a signal was contaminated with any noise; the accuracy, sensitivity and specificity of this noise classification, and the systolic and diastolic pressure

Arthroscopic undersurface rotator cuff repair versus conventional arthroscopic double-row rotator cuff repair - Comparable results at 2-year follow-up.

Science.gov (United States)

Ang, Benjamin Fu Hong; Chen, Jerry Yongqiang; Yeo, William; Lie, Denny Tijauw Tjoen; Chang, Paul Chee Cheng

2018-01-01

The aim of our study is to compare the improvement in clinical outcomes after conventional arthroscopic double-row rotator cuff repair and arthroscopic undersurface rotator cuff repair. A consecutive series of 120 patients who underwent arthroscopic rotator cuff repair was analysed. Sixty-one patients underwent conventional double-row rotator cuff repair and 59 patients underwent undersurface rotator cuff repair. Several clinical outcomes, including numerical pain rating scale (NPRS), constant shoulder score (CSS), Oxford shoulder score (OSS) and University of California Los Angeles shoulder score (UCLASS), were prospectively recorded by a trained healthcare professional preoperatively and at 3, 6, 12 and 24 months after surgery. Comparing both groups, there were no differences in age, gender and preoperative NPRS, CSS, OSS and UCLASS. However, the tear size was 0.7 ± 0.2 (95% confidence interval (CI) 0.3-1.1) cm larger in the conventional group ( p = 0.002). There was no difference in the improvement of NPRS, CSS, OSS and UCLASS at all time points of follow-up, that is, at 3, 6, 12 and 24 months after surgery. The duration of operation was shorter by 35 ± 3 (95% CI 28-42) min in the undersurface group ( p rotator cuff repair and conventional arthroscopic double-row rotator cuff repair showed marked improvements in clinical scores when compared preoperatively, and there was no difference in improvements between both groups. Arthroscopic undersurface rotator cuff repair is a faster technique compared to the conventional arthroscopic double-row rotator cuff repair.

Inflation persistence in African countries: Does inflation targeting matter?

OpenAIRE

Phiri, Andrew

2016-01-01

This study investigates inflation persistence in annual CPI inflation collected between 1994 and 2014 for 46 African countries. We group these countries into panels according to whether they are inflation targeters or not and conduct estimations for pre and post inflation targeting periods. Interestingly enough, we find that inflation persistence was much higher for inflation targeters in periods before adopting their inflation targeting regimes and inflation persistence dropped by 40 percent...

Dynamic Characterization of an Inflatable Concentrator for Solar Thermal Propulsion

Science.gov (United States)

Leigh, Larry; Hamidzadeh, Hamid; Tinker, Michael L.; Rodriguez, Pedro I. (Technical Monitor)

2001-01-01

An inflatable structural system that is a technology demonstrator for solar thermal propulsion and other applications is characterized for structural dynamic behavior both experimentally and computationally. The inflatable structure is a pressurized assembly developed for use in orbit to support a Fresnel lens or inflatable lenticular element for focusing sunlight into a solar thermal rocket engine. When the engine temperature reaches a pre-set level, the propellant is injected into the engine, absorbs heat from an exchanger, and is expanded through the nozzle to produce thrust. The inflatable structure is a passively adaptive system in that a regulator and relief valve are utilized to maintain pressure within design limits during the full range of orbital conditions. Modeling and test activities are complicated by the fact that the polyimide film material used for construction of the inflatable is nonlinear, with modulus varying as a function of frequency, temperature, and level of excitation. Modal vibration testing and finite element modeling are described in detail in this paper. The test database is used for validation and modification of the model. This work is highly significant because of the current interest in inflatable structures for space application, and because of the difficulty in accurately modeling such systems.

Composition of Muscle Fiber Types in Rat Rotator Cuff Muscles.

Science.gov (United States)

Rui, Yongjun; Pan, Feng; Mi, Jingyi

2016-10-01

The rat is a suitable model to study human rotator cuff pathology owing to the similarities in morphological anatomy structure. However, few studies have reported the composition muscle fiber types of rotator cuff muscles in the rat. In this study, the myosin heavy chain (MyHC) isoforms were stained by immunofluorescence to show the muscle fiber types composition and distribution in rotator cuff muscles of the rat. It was found that rotator cuff muscles in the rat were of mixed fiber type composition. The majority of rotator cuff fibers labeled positively for MyHCII. Moreover, the rat rotator cuff muscles contained hybrid fibers. So, compared with human rotator cuff muscles composed partly of slow-twitch fibers, the majority of fast-twitch fibers in rat rotator cuff muscles should be considered when the rat model study focus on the pathological process of rotator cuff muscles after injury. Gaining greater insight into muscle fiber types in rotator cuff muscles of the rat may contribute to elucidate the mechanism of pathological change in rotator cuff muscles-related diseases. Anat Rec, 299:1397-1401, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Investigation of the Effects of Tire Inflation Pressure and Forward Speed of Driven Wheel on Horizontal Impact of Passing Rectangular Obstacle

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H Mohammadzadeh

2013-09-01

Full Text Available The tire-mechanics models have been developed for the study of wheel movement on the road or soil surface while these models are unlikely to describe the motion of wheels on uneven surfaces. Due to dynamical complexity of this phenomena and the importance of this subject for farm conditions and the wheel carrier devices, the present research aimed to investigate the effects of several parameters on the wheel passing the obstacle. The experiments were carried out using single wheel tester in soil bin condition. The results indicated a relatively linear relationship between the impact force applied on tire and forward speed of wheel and also the height of rectangular obstacle. The effect of inflation pressure was inversed in the range of complete formed tire’s body on impact force and in low levels of tire inflation pressure; tire’s body damps the maximum impact forces. The medium levels of pressure (about 150-200 kPa resulted in less horizontal force that applied on the wheel for different levels of forward speed and obstacle’s height. Tractive force for passing obstacle was increased by raising forward speed and the obstacle’s height.

Partial Thickness Rotator Cuff Tears: Current Concepts

Science.gov (United States)

Matthewson, Graeme; Beach, Cara J.; Nelson, Atiba A.; Woodmass, Jarret M.; Ono, Yohei; Boorman, Richard S.; Lo, Ian K. Y.; Thornton, Gail M.

2015-01-01

Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized. PMID:26171251

Partial Thickness Rotator Cuff Tears: Current Concepts

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Graeme Matthewson

2015-01-01

Full Text Available Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized.

Passive contribution of the rotator cuff to abduction and joint stability.

Science.gov (United States)

Tétreault, Patrice; Levasseur, Annie; Lin, Jenny C; de Guise, Jacques; Nuño, Natalia; Hagemeister, Nicola

2011-11-01

The purpose of this study is to compare shoulder joint biomechanics during abduction with and without intact non-functioning rotator cuff tissue. A cadaver model was devised to simulate the clinical findings seen in patients with a massive cuff tear. Eight full upper limb shoulder specimens were studied. Initially, the rotator cuff tendons were left intact, representing a non-functional rotator cuff, as seen in suprascapular nerve paralysis or in cuff repair with a patch. Subsequently, a massive rotator cuff tear was re-created. Three-dimensional kinematics and force requirements for shoulder abduction were analyzed for each condition using ten abduction cycles in the plane of the scapula. Mediolateral displacements of the glenohumeral rotation center (GHRC) during abduction with an intact non-functioning cuff were minimal, but massive cuff tear resulted in significant lateral displacement of the GHRC (p non-functional cuff (p requirements were significantly less with an intact non-functioning cuff than with massive cuff tear (p requirement for abduction from 5 to 30° as compared with the results following a massive rotator cuff tear. This provides insight into the potential biomechanical effect of repairing massive rotator cuff tears with a biological or synthetic "patch," which is a new treatment for massive cuff tear.

Effect of antigravity suit inflation on cardiovascular, PRA, and PVP responses in humans.

Science.gov (United States)

Kravik, S E; Keil, L C; Geelen, G; Wade, C E; Barnes, P R; Spaul, W A; Elder, C A; Greenleaf, J E

1986-08-01

Blood pressure, pulse rate (PR), serum osmolality and electrolytes, as well as plasma vasopressin (PVP) and plasma renin activity (PRA), were measured in five men and two women [mean age 38.6 +/- 3.9 (SE) yr] before, during, and after inflation of an antigravity suit that covered the legs and abdomen. After 24 h of fluid deprivation the subjects stood quietly for 3 h: the 1st h without inflation, the 2nd with inflation to 60 Torr, and the 3rd without inflation. A similar control noninflation experiment was conducted 10 mo after the inflation experiment using five of the seven subjects except that the suit was not inflated during the 3-h period. Mean arterial pressure increased by 14 +/- 4 (SE) Torr (P less than 0.05) with inflation and decreased by 15 +/- 5 Torr (P less than 0.05) after deflation. Pulse pressure (PP) increased by 7 +/- 2 Torr (P less than 0.05) with inflation and PR decreased by 11 +/- 5 beats/min (P less than 0.05); PP and PR returned to preinflation levels after deflation. Plasma volume decreased by 6.1 +/- 1.5% and 5.3 +/- 1.6% (P less than 0.05) during hours 1 and 3, respectively, and returned to base line during inflation. Inflation decreased PVP from 6.8 +/- 1.1 to 5.6 +/- 1.4 pg/ml (P less than 0.05) and abolished the significant rise in PRA during hour 1. Both PVP and PRA increased significantly after deflation: delta = 18.0 +/- 5.1 pg/ml and 4.34 +/- 1.71 ng angiotensin I X ml-1 X h-1, respectively. Serum osmolality and Na+ and K+ concentrations were unchanged during the 3 h of standing.(ABSTRACT TRUNCATED AT 250 WORDS)

Accurate blood pressure recording: is it difficult?

Science.gov (United States)

Bhalla, A; Singh, R; D'cruz, S; Lehl, S S; Sachdev, A

2005-11-01

Blood pressure (BP) measurement is a routine procedure but errors are frequently committed during BP recording. AIMS AND SETTINGS: The aim of the study was to look at the prevalent practices in the institute regarding BP recording. The study was conducted in the Medicine Department at Government Medical College, Chandigarh, a teaching institute for MBBS students. A prospective, observational study was performed amongst the 80 doctors in a tertiary care hospital. All of them were observed by a single observer during the act of BP recording. The observer was well versed with the guidelines issued by British Hypertension Society (BHS) and the deviations from the standard set of guidelines issued by BHS were noted. The errors were defined as deviations from these guidelines. The results were recorded as percentage of doctors committing these errors. In our study, 90% used mercury type sphygmomanometer. Zero error of the apparatus, hand dominance was not noted by any one. Every one used the standard BP cuff for recording BP. 70% of them did not let the patient rest before recording BP. 80% did not remove the clothing from the arm. None of them recorded BP in both arms. In out patient setting, 80% recorded blood pressure in sitting position and 14% in supine position. In all the patients where BP was recorded in sitting position BP apparatus was below the level of heart and 20% did not have their arm supported. 60% did not use palpatory method for noticing systolic BP and 70% did not raise pressure 30-40 mm Hg above the systolic level before checking the BP by auscultation. 80% lowered the BP at a rate of more than 2 mm/s and 60% rounded off the BP to nearest 5-10 mm Hg. 70% recorded BP only once and 90% of the rest re inflated the cuff without completely deflating and allowing rest before a second reading was obtained. The practice of recording BP in our hospital varies from the standard guidelines issued by the BHS.

[Determination of arm circumference for correct measurement of blood pressure. Results of an intervention study].

Science.gov (United States)

Oliveras Puig, A; Dalfó-Pibernat, A; Jdid Rosàs, N; Mayor Isaac, E; Pérez-Romero, L; Gibert Llorach, E; Dalfó-Baqué, A

2015-01-01

To assess the effectiveness of an intervention to promote standardized arm circumference measurement as way to choose appropriate cuff size to measure blood pressure. A before-after intervention study was performed in a basic health care area in Barcelona. Doctors, nurses and pharmacy staff participated by filling out an anonymous self-administered questionnaire pre- and post-intervention (3m). Variables included: demographics, type of professional, years since they finished their studies, availability of different cuff sizes, if arm circumference measurement were obtained or not, knowledge about the cutoff values for each cuff size and type of blood pressure monitor. The written results were given to the participants and presented in sessions. Pre- and post-intervention: 74.3 and 67.3% answered the questionnaires (P=ns), respectively. Determination of arm circumference varied from 1.3 to 19.1% (P=.009). A total of 37.3% and 44.1% declared that they had 2 or more available cuff sizes (P=ns). Knowledge about the correct measurement of the cuffs was 2.7 to 33.8% regarding the standard cuff size (P=.0198) and 0 to 23.5% for obese subjects (P<.05). When more than one cuff was available, reasons for the choice went from: «making a rough guess» or «when velcro stops sticking» before and after the intervention. All blood pressure devices in our primary health care center were electronic and automatic as were those of the 9 pharmacies. The intervention increased the determination of arm circumference prior to the reading of the blood pressure and the knowledge about the cutoff interval for standard and obese cuff size after intervention. There was greater availability of different sized cuffs. Despite this, the choice of the appropriate cuff size was not made based on arm circumference. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

The impact of arm position and pulse pressure on the validation of a wrist-cuff blood pressure measurement device in a high risk population

Directory of Open Access Journals (Sweden)

Ali Reza Khoshdel

2010-03-01

Full Text Available Ali Reza Khoshdel1,2, Shane Carney2, Alastair Gillies21Faculty of Medicine, Aja University of Medical Science, Tehran, Iran; 2John Hunter Hospital, Faculty of Health, The University of Newcastle, Newcastle, NS W, AustraliaAbstract: Despite the increasing popularity of blood pressure (BP wrist monitors for self-BP measurement at home, device validation and the effect of arm position remains an issue. This study focused on the validation of the Omron HEM-609 wrist BP device, including an evaluation of the impact of arm position and pulse pressure on BP measurement validation. Fifty patients at high risk for cardiovascular disease were selected (age 65 ± 10 years. Each patient had two measurements with a mercury sphygmomanometer and three measurements with the wrist BP device (wrist at the heart level while the horizontal arm supported [HORIZONTAL], hand supported on the opposite shoulder [SHOULDER], and elbow placed on a desk [DESK], in random order. The achieved systolic BP (SBP and diastolic BP (DBP wrist-cuff readings were compared to the mercury device and the frequencies of the readings within 5, 10, and 15 mmHg of the gold standard were computed and compared with the British Hypertension Society (BHS and Association for the Advancement of Medical Instrumentation (AAMI protocols. The results showed while SBP readings with HORIZONTAL and SHOULDER positions were significantly different from the mercury device (mean difference = 7.1 and 13.3 mmHg, respectively; P < 0.05, the DESK position created the closest reading to mercury (mean difference = 3.8, P > 0.1. Approximately 71% of SBP readings with the DESK position were within ±10 mmHg, whereas it was 62.5% and 34% for HORIZONTAL and SHOULDER positions, respectively. Wrist DBP attained category D with BHS criteria with all three arm positions. Bland–Altman plots illustrated that the wrist monitor systematically underestimated SBP and DBP values. However a reading adjustment of 5 and 10 mm

Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear

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Paulo Moraes Agnollitto

2016-02-01

Full Text Available Abstract The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma.

The Relationship Between Shoulder Stiffness and Rotator Cuff Healing: A Study of 1,533 Consecutive Arthroscopic Rotator Cuff Repairs.

Science.gov (United States)

McNamara, William J; Lam, Patrick H; Murrell, George A C

2016-11-16

Retear and stiffness are not uncommon outcomes of rotator cuff repair. The purpose of this study was to evaluate the relationship between rotator cuff repair healing and shoulder stiffness. A total of 1,533 consecutive shoulders had an arthroscopic rotator cuff repair by a single surgeon. Patients assessed their shoulder stiffness using a Likert scale preoperatively and at 1, 6, 12, and 24 weeks (6 months) postoperatively, and examiners evaluated passive range of motion preoperatively and at 6, 12, and 24 weeks postoperatively. Repair integrity was determined by ultrasound evaluation at 6 months. After rotator cuff repair, there was an overall significant loss of patient-ranked and examiner-assessed shoulder motion at 6 weeks compared with preoperative measurements (p rotator cuff integrity at 6 months postoperatively (r = 0.11 to 0.18; p rotation at 6 weeks postoperatively was 7%, while the retear rate of patients with >20° of external rotation at 6 weeks was 15% (p rotator cuff repair was more likely to heal. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Wirelessly Controllable Inflated Electroactive Polymer (EAP) Reflectors

Science.gov (United States)

Bao, Xiaoqi; Bar-Cohen, Yoseph; Chang, Zensheu; Sherrit, Stewart; Badescu, Mircea

2005-01-01

Inflatable membrane reflectors are attractive for deployable, large aperture, lightweight optical and microwave systems in micro-gravity space environment. However, any fabrication flaw or temperature variation may results in significant aberration of the surface. Even for a perfectly fabricated inflatable membrane mirror with uniform thickness, theory shows it will form a Hencky curve surface but a desired parabolic or spherical surface. Precision control of the surfaceshape of extremely flexible membrane structures is a critical challenge for the success of this technology. Wirelessly controllable inflated reflectors made of electroactive polymers (EAP) are proposed in this paper. A finite element model was configured to predict the behavior of the inflatable EAP membranes under pre-strains, pressures and distributed electric charges on the surface. To explore the controllability of the inflatable EAP reflectors, an iteration algorism was developed to find the required electric actuation for correcting the aberration of the Hencky curve to the desired parabolic curve. The correction capability of the reflectors with available EAP materials was explored numerically and is presented in this paper.

Effectiveness of MRI in rotator cuff injury

International Nuclear Information System (INIS)

Ohazama, Yuka

1992-01-01

To investigate the potential role of MR imaging in rotator cuf disorders, normal volunteers and patients with suspected rotator cuff injury were evaluated with a low field permanent magnet unit which had a wide gantry. MR findings of the patients were also compared with arthrography, subcromial bursography and operative findings. To establish optimal imaging technique and normal MR anatomy, 100 normal volunteers were examined. On proton density images, signal intensity of the rotator cuff tendon was low and homogenous, and that of rotator cuff muscles was intermediate. On T2 weighted images, signal intensity of muscles and tendon was decreased and that of joint effusion became brighter. In 38 patients with suspected rotator cuff injury, the signal intensity of the rotator cuff was increased to various degrees. In 21 of them, surgical correction was performed and 17 patients were followed with conservative treatment. MR imaging showed abnormalities in all 38 patients. Arthrography and bursography showed abnormalities in 28 out of 38 patients and 3 of 13 patients respectively. In 21 patients who underwent surgery, tear of the rotator cuff was confirmed, and discrepancies in MR and operative findings existed in 8 patients. In 2 patients, no tear was found in the other examinations, and it was suspected to be horizontal tear or degeneration in the substance of the muscle. MR imaging contributes to diagnosis and treatment planning in patients with suspected rotator cuff injury. (author)

THE PROSPECT OF INFLATION TARGETING IN KAZAKHSTAN

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Zhandos Ybrayev

2017-02-01

Full Text Available Over the last two decades, there has been a significant increase in the number of countries that began to pursue an Inflation Targeting monetary policy framework. Since the collapse of the Soviet Union, each of the fifteen newly created independent countries started to develop and run their own autonomous monetary policies. Kazakhstan announced the implementation of an Inflation Targeting policy in August 2015. At the same time, a number of researches show that Inflation Targeting might not work as well for developing countries as it does for developed ones due to certain fundamental differences and preconditions that must be met before the implementation phase. Thus, this paper discusses the case of Kazakhstan as a typical emerging market economy example, examines its ability to respond to various external shocks and identifies the main transmission channels in order to contribute to the knowledge in this particular area. Identification assumptions generate contemporaneous monetary shocks on domestic inflation behavior, which also take into account various features of the small open economy as well as indicate different important transitory and persistent effects. The results show, based on the interpretation of impulse response functions, a positive interest rate shock has an uncertain inflationary impact, which raises questions about the effectiveness of interest rate manipulation in keeping inflation within the given band. In addition, a positive exchange rate shock leads to a stronger upward pressure in inflation rates. Finally, inflation inertia explains a substantial increase in future inflation rates.

Do inflation-linked bonds contain information about future inflation?

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José Valentim Machado Vicente

2013-06-01

Full Text Available There is a widespread belief that inflation-linked bonds are a direct source of information about inflation expectations. In this paper we address this issue by analyzing the relationship between break-even inflation (the difference between nominal and real yields and future inflation. The dataset is extracted from Brazilian Treasury bonds covering the period from April 2005 to April 2011. We find that break-even inflation is an unbiased forecast only of the 3-month and 6-month ahead inflation. For medium horizons (12 and 18 months, break-even inflation has weak explanatory power of future inflation. Over long horizons (24 and 30 months, we report a significant, but counterintuitive, negative relationship between the break-even and realized inflation rates.

Large/Massive Tears, Fatty Infiltration, and Rotator Cuff Muscle Atrophy: A Review Article With Management Options Specific to These Types of Cuff Deficiencies

OpenAIRE

Gandhi Nathan Solayar; Bradley Seeto; Darren Chen; Samuel Mac Dessi

2016-01-01

Context There are many studies in the literature looking into factors affecting outcomes in rotator cuff surgery. The aetiology of rotator cuff deficiency is often multi-factorial and there are many facets towards successful management in this often debilitating condition. Evidence Acquisition We performed a literature search of MEDLINE and Embase databases using the terms large rotator cuff tears, fatty infiltration rotator cuff,...

Inflation and Inflation Uncertainty Revisited: Evidence from Egypt

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Mesbah Fathy Sharaf

2015-07-01

Full Text Available The welfare costs of inflation and inflation uncertainty are well documented in the literature and empirical evidence on the link between the two is sparse in the case of Egypt. This paper investigates the causal relationship between inflation and inflation uncertainty in Egypt using monthly time series data during the period January 1974–April 2015. To endogenously control for any potential structural breaks in the inflation time series, Zivot and Andrews (2002 and Clemente–Montanes–Reyes (1998 unit root tests are used. The inflation–inflation uncertainty relation is modeled by the standard two-step approach as well as simultaneously using various versions of the GARCH-M model to control for any potential feedback effects. The analyses explicitly control for the effect of the Economic Reform and Structural Adjustment Program (ERSAP undertaken by the Egyptian government in the early 1990s, which affected inflation rate and its associated volatility. Results show a high degree of inflation–volatility persistence in the response to inflationary shocks. Granger-causality test along with symmetric and asymmetric GARCH-M models indicate a statistically significant bi-directional positive relationship between inflation and inflation uncertainty, supporting both the Friedman–Ball and the Cukierman–Meltzer hypotheses. The findings are robust to the various estimation methods and model specifications. The findings of this paper support the view of adopting inflation-targeting policy in Egypt, after fulfilling its preconditions, to reduce the welfare cost of inflation and its related uncertainties. Monetary authorities in Egypt should enhance the credibility of monetary policy and attempt to reduce inflation uncertainty, which will help lower inflation rates.

Influences of inflation rate and duration on vasodilatory effect by intermittent pneumatic compression in distant skeletal muscle.

Science.gov (United States)

Liu, K; Chen, L E; Seaber, A V; Urbaniak, J R

1999-05-01

Previous study has demonstrated that application of intermittent pneumatic compression on legs can cause vasodilation in distant skeletal muscle at the microcirculation level. This study evaluated the influence of inflation rate and peak-pressure duration on the vasodilatory effects of intermittent pneumatic compression. The cremaster muscles of 50 male rats were exposed and divided into five groups of 10 each. A specially designed intermittent pneumatic-compression device was applied in a medial-lateral fashion to both legs of all rats for 60 minutes, with an inflation rate and peak-pressure duration of 0.5 and 5 seconds, respectively, in group A, 5 and 0 seconds in group B, 5 and 5 seconds in group C, 10 and 0 seconds in group D, and 10 and 5 seconds in group E. Diameters of arterial segments were measured in vessels of three size categories (10-20, 21-40, and 41-70 microm) for 120 minutes. The results showed that the greatest increase in diameter was produced by intermittent pneumatic compression with the shortest inflation rate (0.5 seconds). A moderate increase resulted from compression with an inflation rate of 5 seconds, and no effective vasodilation occurred during compression with the longest inflation rate (10 seconds). When the groups with different inflation rates but the same peak-pressure duration were compared, there was a significant difference between any two groups among groups A, C, and E and between groups B and D. When the groups with different peak-pressure durations but the same inflation rate were compared, compression with a peak-pressure duration of 5 seconds caused a generally similar degree of diameter change as did compression without inflation at peak pressure. The findings suggest that inflation rate plays an important role in the modulation of distant microcirculation induced by intermittent pneumatic compression whereas peak-pressure duration does not significantly influence the vasodilatory effects of the compression. This may be

Inflation from field theory and string theory perspectives. Matter inflation and slow-walking inflation

International Nuclear Information System (INIS)

Halter, Sebastian

2012-01-01

This thesis is concerned with aspects of inflation both from a field theory and a string theory perspective. It aims at exploring new approaches to address the problem of moduli destabilization and the η-problem and to realize inflation in the matter sector. The first part is devoted to studying models of inflation in the framework of four-dimensional N=1 supergravity. We begin with investigating a new proposal to solve the problem of moduli destabilization, which seems to force us to choose between low-energy supersymmetry and high-scale inflation. This new approach is based on a particular way to couple the modulus to the F-term driving inflation. Using chaotic inflation with a shift symmetry as an example, we show that we can successfully combine low-energy supersymmetry and high-scale inflation. We construct a class of inflation models in N=1 supergravity where the inflaton resides in gauge non-singlet matter fields. These are extensions of a special class of hybrid inflation models, so-called tribrid inflation, where the η-problem can be solved by a Heisenberg symmetry. Compared to previously studied models, we have generalized our models with some inspiration from string theory. We investigate moduli stabilization during inflation and identify situations in which the inflaton slope is dominated by radiative corrections. We outline under which conditions this class of matter inflation models could be embedded into heterotic orbifold compactifications. In doing so, we suggest a new mechanism to stabilize some Kaehler moduli by F-terms for matter fields. In the second part, we consider models of warped D-brane inflation on a family of ten-dimensional supergravity backgrounds. We consider inflation along the radial direction near the tip of the warped throat and show that generically an inflection point arises for the inflaton potential, which is related to an inflection point of the dilaton profile. A universal scaling behaviour with the parameters of the

Inflation from field theory and string theory perspectives. Matter inflation and slow-walking inflation

Energy Technology Data Exchange (ETDEWEB)

Halter, Sebastian

2012-07-09

This thesis is concerned with aspects of inflation both from a field theory and a string theory perspective. It aims at exploring new approaches to address the problem of moduli destabilization and the η-problem and to realize inflation in the matter sector. The first part is devoted to studying models of inflation in the framework of four-dimensional N=1 supergravity. We begin with investigating a new proposal to solve the problem of moduli destabilization, which seems to force us to choose between low-energy supersymmetry and high-scale inflation. This new approach is based on a particular way to couple the modulus to the F-term driving inflation. Using chaotic inflation with a shift symmetry as an example, we show that we can successfully combine low-energy supersymmetry and high-scale inflation. We construct a class of inflation models in N=1 supergravity where the inflaton resides in gauge non-singlet matter fields. These are extensions of a special class of hybrid inflation models, so-called tribrid inflation, where the η-problem can be solved by a Heisenberg symmetry. Compared to previously studied models, we have generalized our models with some inspiration from string theory. We investigate moduli stabilization during inflation and identify situations in which the inflaton slope is dominated by radiative corrections. We outline under which conditions this class of matter inflation models could be embedded into heterotic orbifold compactifications. In doing so, we suggest a new mechanism to stabilize some Kaehler moduli by F-terms for matter fields. In the second part, we consider models of warped D-brane inflation on a family of ten-dimensional supergravity backgrounds. We consider inflation along the radial direction near the tip of the warped throat and show that generically an inflection point arises for the inflaton potential, which is related to an inflection point of the dilaton profile. A universal scaling behaviour with the parameters of the

Volumetric evaluation of the rotator cuff musculature in massive rotator cuff tears with pseudoparalysis.

Science.gov (United States)

Rhee, Yong Girl; Cho, Nam Su; Song, Jong Hoon; Park, Jung Gwan; Kim, Tae Yong

2017-09-01

If the balance of the rotator cuff force couple is disrupted, pseudoparalysis may occur, but the exact mechanism remains unknown. This study investigated the effect of rotator cuff force couple disruption on active range of motion in massive rotator cuff tear (mRCT) by rotator cuff muscle volume analysis. The study included 53 patients with irreparable mRCT: 22 in the nonpseudoparalysis group and 31 in the pseudoparalysis group. The volumes of the subscapularis (SBS), infraspinatus (ISP), and teres minor (TM) muscles were measured using magnetic resonance imaging (MRI), and the ratios of each muscle volume to the anatomic external rotator (aER) volume were calculated. A control group of 25 individuals with normal rotator cuffs was included. Anterior-to-posterior cuff muscle volume ratio (SBS/ISP + TM) was imbalanced in both mRCT groups (1.383 nonpseudoparalysis and 1.302 pseudoparalysis). Between the 2 groups, the ISP/aER ratio (0.277 vs. 0.249) and the inferior SBS/aER ratio (0.426 vs. 0.390) were significantly decreased in the pseudoparalysis group (P= .022 and P= .040, respectively). However, neither the TM/aER ratio (0.357 vs. 0.376) nor the superior SBS/aER ratio (0.452 vs. 0.424) showed a significant difference between the two groups (P= .749 and P= .068, respectively). If the inferior SBS was torn, a high frequency of pseudoparalysis was noted (81.0%, P= .010). The disruption of transverse force couple was noted in both irreparable mRCT groups, although no significant difference was found between the nonpseudoparalysis and pseudoparalysis groups. ISP and inferior SBS muscle volumes showed a significant decrease in pseudoparalysis group and, therefore, were considered to greatly influence the loss of active motion in mRCT. The TM did not exert significant effect on the incidence of pseudoparalysis. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Inflation, its Volatility and the Inflation-Growth Tradeoff in India

OpenAIRE

Raghbendra Jha; Varsha S. Kulkarni

2013-01-01

This paper amends the New Keynesian Phillips curve model to include inflation volatility. It provides results on the determinants of inflation volatility and expected inflation volatility for OLS and ARDL(1,1) models and for change in inflation volatility and change in expected inflation volatility using ECM models. Output gap affects change in expected inflation volatility alone (in the ECM model) and not in the other models. Major determinants of inflation volatility and expected inflation ...

Rotator Cuff Repair in Adolescent Athletes.

Science.gov (United States)

Azzam, Michael G; Dugas, Jeffrey R; Andrews, James R; Goldstein, Samuel R; Emblom, Benton A; Cain, E Lyle

2018-04-01

Rotator cuff tears are rare injuries in adolescents but cause significant morbidity if unrecognized. Previous literature on rotator cuff repairs in adolescents is limited to small case series, with few data to guide treatment. Adolescent patients would have excellent functional outcome scores and return to the same level of sports participation after rotator cuff repair but would have some difficulty with returning to overhead sports. Case series; Level of evidence 4. A retrospective search of the practice's billing records identified all patients participating in at least 1 sport who underwent rotator cuff repair between 2006 and 2014 with an age Rotator Cuff Index. Thirty-two consecutive adolescent athletes (28 boys and 4 girls) with a mean age of 16.1 years (range, 13.2-17.9 years) met inclusion criteria. Twenty-nine patients (91%) had a traumatic event, and 27 of these patients (93%) had no symptoms before the trauma. The most common single tendon injury was to the supraspinatus (21 patients, 66%), of which 2 were complete tendon tears, 1 was a bony avulsion of the tendon, and 18 were high-grade partial tears. Fourteen patients (56%) underwent single-row repair of their rotator cuff tear, and 11 (44%) underwent double-row repair. All subscapularis injuries were repaired in open fashion, while all other tears were repaired arthroscopically. Twenty-seven patients (84%) completed the outcome questionnaires at a mean 6.2 years after surgery (range, 2-10 years). The mean ASES score was 93 (range, 65-100; SD = 9); mean Western Ontario Rotator Cuff Index, 89% (range, 60%-100%; SD = 13%); and mean numeric pain rating, 0.3 (range, 0-3; SD = 0.8). Overall, 25 patients (93%) returned to the same level of play or higher. Among overhead athletes, 13 (93%) were able to return to the same level of play, but 8 (57%) were forced to change positions. There were no surgical complications, but 2 patients did undergo a subsequent operation. Surgical repair of high-grade partial

Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs.

Science.gov (United States)

Le, Brian T N; Wu, Xiao L; Lam, Patrick H; Murrell, George A C

2014-05-01

The rate of retears after rotator cuff repair varies from 11% to 94%. A retear is associated with poorer subjective and objective clinical outcomes than intact repair. This study was designed to determine which preoperative and/or intraoperative factors held the greatest association with retears after arthroscopic rotator cuff repair. Cohort study; Level of evidence, 3. This study retrospectively evaluated 1000 consecutive patients who had undergone a primary rotator cuff repair by a single surgeon using an arthroscopic inverted-mattress knotless technique and who had undergone an ultrasound evaluation 6 months after surgery to assess repair integrity. Exclusion criteria included previous rotator cuff repair on the same shoulder, incomplete repair, and repair using a synthetic polytetrafluoroethylene patch. All patients had completed the modified L'Insalata Questionnaire and underwent a clinical examination before surgery. Measurements of tear size, tear thickness, associated shoulder injury, tissue quality, and tendon mobility were recorded intraoperatively. The overall retear rate at 6 months after surgery was 17%. Retears occurred in 27% of full-thickness tears and 5% of partial-thickness tears (P < .0001). The best independent predictors of retears were anteroposterior tear length (correlation coefficient r = 0.41, P < .0001), tear size area (r = 0.40, P < .0001), mediolateral tear length (r = 0.34, P < .0001), tear thickness (r = 0.29, P < .0001), age at surgery (r = 0.27, P < .0001), and operative time (r = 0.18, P < .0001). These factors produced a predictive model for retears: logit P = (0.039 × age at surgery in years) + (0.027 × tear thickness in %) + (1 × anteroposterior tear length in cm) + (0.76 × mediolateral tear length in cm) - (0.17 × tear size area in cm(2)) + (0.018 × operative time in minutes) -9.7. Logit P can be transformed into P, which is the chance of retears at 6 months after surgery. A rotator cuff retear is a multifactorial process

Metal artefacts severely hamper magnetic resonance imaging of the rotator cuff tendons after rotator cuff repair with titanium suture anchors.

Science.gov (United States)

Schröder, Femke F; Huis In't Veld, Rianne; den Otter, Lydia A; van Raak, Sjoerd M; Ten Haken, Bennie; Vochteloo, Anne J H

2018-04-01

The rate of retear after rotator cuff surgery is 17%. Magnetic resonance imaging (MRI) scans are used for confirmative diagnosis of retear. However, because of the presence of titanium suture anchors, metal artefacts on the MRI are common. The present study evaluated the diagnostic value of MRI after rotator cuff tendon surgery with respect to assessing the integrity as well as the degeneration and atrophy of the rotator cuff tendons when titanium anchors are in place. Twenty patients who underwent revision surgery of the rotator cuff as a result of a clinically suspected retear between 2013 and 2015 were included. The MRI scans of these patients were retrospectively analyzed by four specialized shoulder surgeons and compared with intra-operative findings (gold standard). Sensitivity and interobserver agreement among the surgeons in assessing retears as well as the Goutallier and Warner classification were examined. In 36% (range 15% to 50%) of the pre-operative MRI scans, the observers could not review the rotator cuff tendons. When the rotator cuff tendons were assessable, a diagnostic accuracy with a mean sensitivity of 0.84 (0.70 to 1.0) across the surgeons was found, with poor interobserver agreement (kappa = 0.12). Metal artefacts prevented accurate diagnosis from MRI scans of rotator cuff retear in 36% of the patients studied.

Analysis of failed rotator cuff repair – Retrospective survey of revisions after open rotator cuff repair

Directory of Open Access Journals (Sweden)

Rupert Schupfner

2017-07-01

Full Text Available Background Rotator cuff defects are frequently occurring shoulder pathologies associated with pain and movement impairment. Aims The aim of the study was to analyse the pathologies that lead to operative revisions after primary open rotator cuff repair. Methods In 216 patients who underwent primary rotator cuff repair and later required operative revision between 1996 to 2005, pathologies found intraoperatively during the primary operation and during revision surgery were collected, analysed and compared. Results The average age at the time of revision surgery was 54.3 years. The right shoulder (61.6 per cent was more often affected than the left, males (63.4 per cent more often than females. At primary operation – apart from rotator cuff repair – there were the following surgical procedures performed: 190 acromioplasty, 86 Acromiclavicular joint resections, 68 tenodesis, 40 adhesiolysis and 1 tenotomy. If an ACJ-resection had been performed in the primary operation, ACJ-problems were rare in revision surgery (p<0.01. Primary gleno-humeral adhesions were associated with a significant rise in re-tearing rate (p=0.049. Primary absence of adhesions went along with a significant lower rate of adhesions found at revision (p=0.018. Primary performed acromioplasty had no influence on re-tearing rate (p=0.408 or on the rate of subacromial impingement at revision surgery (p=0.709. Conclusion To avoid operative revision after rotator cuff repair relevant copathologies of the shoulder have to be identified before or during operation and treated accordingly. Therefore, even during open rotator cuff repair, the surgeon should initially start with arthroscopy of the shoulder joint and subacromial space to recognise co-pathologies.

Towards a formal link between inflation perceptions and inflation ...

African Journals Online (AJOL)

This paper reports the finding of a survey of inflation perceptions and inflation expectations in South Africa undertaken in 2014. This survey posed questions on perceptions of past inflation (historic inflation) and expectations of future inflation to the same respondents and determined linkages between historic views and ...

Arthroscintigraphy in suspected rotator cuff rupture

International Nuclear Information System (INIS)

Gratz, S.; Behr, T.; Becker, W.; Koester, G.; Vosshenrich, R.; Grabbe, E.

1998-01-01

Aim: In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n=20), contrast arthrography (n=20) and arthroscopy (n=10) of the shoulder joint. Methods: After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 μCi/5 ml). The application was performed either in direct combination with contrast arthrography (n=10) or ultrasound conducted mixed with a local anesthetic (n=10). Findings at arthroscopical surgery (n=10) were used as the gold standard. Results: In case of complete rotator cuff rupture (n=5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistant. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. Conclusion: Arthroscinitgraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures. (orig.) [de

Effect of tamoxifen on fatty degeneration and atrophy of rotator cuff muscles in chronic rotator cuff tear: An animal model study.

Science.gov (United States)

Cho, Edward; Zhang, Yue; Pruznak, Anne; Kim, H Mike

2015-12-01

Fatty degeneration of the rotator cuff muscles is an irreversible change resulting from chronic rotator cuff tear and is associated with poor clinical outcomes following rotator cuff repair. We evaluated the effect of Tamoxifen, a competitive estrogen receptor inhibitor, on fatty degeneration using a mouse model for chronic rotator cuff tear. Sixteen adult mice were divided into two diet groups (Tamoxifen vs. Regular) and subjected to surgical creation of a large rotator cuff tear and suprascapular nerve transection in their left shoulder with the right shoulder serving as a control. The rotator cuff muscles were harvested at 16 weeks and subjected to histology and RT-PCR for adipogenic and myogenic markers. Histology showed substantially decreased atrophy and endomysial inflammation in Tamoxifen group, but no significant differences in the amount of intramuscular adipocytes and lipid droplets compared to the Regular group. With RT-PCR, the operated shoulders showed significant upregulation of myogenin and PPAR-γ, and downregulation of myostatin compared to the nonsurgical shoulder. No significant differences of gene expression were found between the two diet groups. Our study demonstrated that tamoxifen diet leads to decreased muscle atrophy and inflammatory changes following chronic rotator cuff tear, but has no apparent effect on adipogenesis. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Inflation Volatility and the Inflation-Growth Tradeoff in India

OpenAIRE

Raghbendra Jha; Varsha S. Kulkarni

2012-01-01

This paper amends the New Keynesian Phillips curve model to include inflation volatility and tests the determinants of such volatility for India. It provides results on the determinants of inflation volatility and expected inflation volatility for OLS and ARDL (1,1) models and for change in inflation volatility and change in expected inflation volatility using ECM models. Output gap affects change in expected inflation volatility along (in the ECM model) and not in the other models. Major det...

Recurrent rotator cuff tear: is ultrasound imaging reliable?

Science.gov (United States)

Gilat, Ron; Atoun, Ehud; Cohen, Ornit; Tsvieli, Oren; Rath, Ehud; Lakstein, Dror; Levy, Ofer

2018-02-02

The diagnostic workup of the painful shoulder after rotator cuff repair (RCR) can be quite challenging. The aim of this study was to assess the reliability of ultrasonography (US) for the detection of recurrent rotator cuff tears in patients with shoulder pain after RCR. We hypothesized that US for the diagnosis of recurrent rotator cuff tear after RCR would not prove to be reliable when compared with surgical arthroscopic confirmation (gold standard). In this cohort study (diagnosis), we retrospectively analyzed the data of 39 patients with shoulder pain after arthroscopic RCR who had subsequently undergone US, followed by revision arthroscopy. The rotator cuff was evaluated first using US for the presence of retears. Thereafter, revision arthroscopy was performed, and the diagnosis was either established or disproved. The sensitivity and specificity of US were assessed in reference to revision arthroscopy (gold standard). A rotator cuff retear was indicated by US in 21 patients (54%) and by revision arthroscopy in 26 patients (67%). US showed a sensitivity of 80.8% and specificity of 100% in the diagnosis of rotator cuff retears. Omission of partial rotator cuff retears resulted in a spike in sensitivity to 94.7%, with 100% specificity remaining. US imaging is a highly sensitive and specific test for the detection of recurrent rotator cuff tears, as confirmed by revision arthroscopy, in patients with a painful shoulder after primary RCR. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Eternal hilltop inflation

International Nuclear Information System (INIS)

Barenboim, Gabriela; Park, Wan-Il; Kinney, William H.

2016-01-01

We consider eternal inflation in hilltop-type inflation models, favored by current data, in which the scalar field in inflation rolls off of a local maximum of the potential. Unlike chaotic or plateau-type inflation models, in hilltop inflation the region of field space which supports eternal inflation is finite, and the expansion rate H EI during eternal inflation is almost exactly the same as the expansion rate H * during slow roll inflation. Therefore, in any given Hubble volume, there is a finite and calculable expectation value for the lifetime of the ''eternal'' inflation phase, during which quantum flucutations dominate over classical field evolution. We show that despite this, inflation in hilltop models is nonetheless eternal in the sense that the volume of the spacetime at any finite time is exponentially dominated by regions which continue to inflate. This is true regardless of the energy scale of inflation, and eternal inflation is supported for inflation at arbitrarily low energy scale.

STS-42 MS Readdy conducts blood volume test on OV-103's middeck

Science.gov (United States)

1992-01-01

STS-42 Mission Specialist (MS) William F. Readdy, using intravehicular activity (IVA) foot restraints, studies a checklist as he measures the veins in his lower right leg on the middeck of Discovery, Orbiter Vehicle (OV) 103. Readdy uses an electronic monitor and a pair of large blood pressure cuffs that encircle the thigh and calf. Changes in blood volume are determined by inflating the cuffs which then alters the blood pressure. The tone of the veins was monitored before and during the flight and will be measured following the eight-day mission. Behind Readdy are the forward lockers with combuster analyzer, checklists, communications kit assemblies, and spotmeter attached. At Readdy's left is the sleep station along the starboard wall.

Evaluation of Repair Tension in Arthroscopic Rotator Cuff Repair: Does It Really Matter to the Integrity of the Rotator Cuff?

Science.gov (United States)

Kim, Do Hoon; Jang, Young Hoon; Choi, Young Eun; Lee, Hwa-Ryeong; Kim, Sae Hoon

2016-11-01

Repair tension of a torn rotator cuff can affect healing after repair. However, a measurement of the actual tension during arthroscopic rotator cuff repair is not feasible. The relationship between repair tension and healing of a rotator cuff repair remains unclear. The purpose of this study was to evaluate the effect of repair tension on healing at the repair site. The hypothesis was that repair tension would be a major factor in determining the anatomic outcome of rotator cuff repair. Cohort study; Level of evidence, 2. Arthroscopic rotator cuff repairs (132 patients) for full-thickness rotator cuff tears were analyzed. An intraoperative model was designed for the estimation of repair tension using a tensiometer. Magnetic resonance imaging (MRI) was performed approximately 1 year (mean [±SD], 12.7 ± 3.2 months) postoperatively for the evaluation of healing at the repair site. Multivariable analysis was performed for tear size, amount of retraction, and fatty degeneration (FD) of rotator cuff muscles. The mean repair tension measured during the arthroscopic procedure was 28.5 ± 23.1 N. There was a statistically significant correlation between tension and tear size (Pearson correlation coefficient [PCC], 0.529; P repair tension also showed a significant inverse correlation with healing at the repair site (SCC, 0.195; P = .025). However, when sex, age, tear size, amount of retraction, tendon quality, and FD of rotator cuff muscles were included for multivariable logistic regression analysis, only FD of the infraspinatus showed an association with the anatomic outcome of repair (Exp(B) = 0.596; P = .010). Our intraoperative model for the estimation of rotator cuff repair tension showed an inverse correlation of repair tension with healing at the repair site, suggesting that complete healing is less likely with high-tension repairs. A significant association was observed on MRI between a high level of FD of the infraspinatus and repaired tendon integrity. © 2016

Inflation, inflation uncertainty and output growth in the USA

Science.gov (United States)

Bhar, Ramprasad; Mallik, Girijasankar

2010-12-01

Employing a multivariate EGARCH-M model, this study investigates the effects of inflation uncertainty and growth uncertainty on inflation and output growth in the United States. Our results show that inflation uncertainty has a positive and significant effect on the level of inflation and a negative and significant effect on the output growth. However, output uncertainty has no significant effect on output growth or inflation. The oil price also has a positive and significant effect on inflation. These findings are robust and have been corroborated by use of an impulse response function. These results have important implications for inflation-targeting monetary policy, and the aim of stabilization policy in general.

INFLATE: INFlate Landing Apparatus Technology

Science.gov (United States)

Koryanov, V. V. K.; Da-Poian, V. D. P.

2018-02-01

Our project, named INFLATE (INFlatable Landing Apparatus Technology), aims at reducing space landing risks and constraints and so optimizing space missions (reducing cost, mass, and risk and in the same time improving performance).

Inflation Aversion and the Optimal Inflation Tax

OpenAIRE

Gaowang Wang; Heng-fu Zou

2011-01-01

The optimal inflation tax is reexamined in the framework of dynamic second best economy populated by individuals with inflation aversion. A simple formula for the optimal inflation rate is derived. Different from the literature, it is shown that if the marginal excess burden of other distorting taxes approaches zero, Friedman's rule for optimum quantity of money is not optimal, and the optimal inflation tax is negative; if the marginal excess burden of other taxes is nonzero, the optimal infl...

Rotator cuff ruptures of the shoulder joint, sonography - arthrography

International Nuclear Information System (INIS)

Triebel, H.J.; Wening, V.; Witte, G.; Hamburg Univ.

1986-01-01

47 patients suspected of rutpure of the rotator cuff were sonographed and arthrographed. Rupture of the rotator cuff was diagnosed in 12 cases, both diagnostic methods yielding the same result. In 29 patients sonography and arthrography did not reveal any abnormal findings. Six ruptures evident in sonography were not confirmed by arthrography and were considered false positive. Direct pointers towards rupture of the cuff would be: echoless defects, cuff cannot be visualised fully or in part and irregularities of movement during dynamic examination. Echoless 'cystic' areas in the periarticular soft parts must be considered an indirect pointer. Echorich focal findings in the echopoor cuff represent a differential diagnostic problem and we cannot give a final assessment as yet. Shoulder sonography is justified as a screening method in suspicion of rotator cuff rupture before initiating arthrography. If sonography reveals no abnormal findings, shoulder arthrography need not be performed. (orig.) [de

Superior glenoid inclination and rotator cuff tears.

Science.gov (United States)

Chalmers, Peter N; Beck, Lindsay; Granger, Erin; Henninger, Heath; Tashjian, Robert Z

2018-03-23

The objectives of this study were to determine whether glenoid inclination (1) could be measured accurately on magnetic resonance imaging (MRI) using computed tomography (CT) as a gold standard, (2) could be measured reliably on MRI, and (3) whether it differed between patients with rotator cuff tears and age-matched controls without evidence of rotator cuff tears or glenohumeral osteoarthritis. In this comparative retrospective radiographic study, we measured glenoid inclination on T1 coronal MRI corrected into the plane of the scapula. We determined accuracy by comparison with CT and inter-rater reliability. We compared glenoid inclination between patients with full-thickness rotator cuff tears and patients aged >50 years without evidence of a rotator cuff tear or glenohumeral arthritis. An a priori power analysis determined adequate power to detect a 2° difference in glenoid inclination. (1) In a validation cohort of 37 patients with MRI and CT, the intraclass correlation coefficient was 0.877, with a mean difference of 0° (95% confidence interval, -1° to 1°). (2) For MRI inclination, the inter-rater intraclass correlation coefficient was 0.911. (3) Superior glenoid inclination was 2° higher (range, 1°-4°, P rotator cuff tear group of 192 patients than in the control cohort of 107 patients. Glenoid inclination can be accurately and reliably measured on MRI. Although superior glenoid inclination is statistically greater in those with rotator cuff tears than in patients of similar age without rotator cuff tears or glenohumeral arthritis, the difference is likely below clinical significance. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Flavon inflation

International Nuclear Information System (INIS)

Antusch, S.; King, F.S.; Malinsky, M.; Velasco-Sevilla, L.; Zavala, I.

2008-04-01

We propose an entirely new class of particle physics models of inflation based on the phase transition associated with the spontaneous breaking of family symmetry responsible for the generation of the effective quark and lepton Yukawa couplings. We show that the Higgs fields responsible for the breaking of family symmetry, called flavons, are natural candidates for the inflation field in new inflation, or the waterfall fields in hybrid inflation. This opens up a rich vein of possible inflation models, all linked to the physics of flavour, with interesting cosmological and phenomenological implications. Out of these many possibilities we discuss two examples which realise flavon inflation: a model of new inflation based on the discrete non-Abelian family symmetry group A 4 or Δ 27 , and a model of hybrid inflation embedded in an existing flavour model with a continuous SU(3) family symmetry. With the inflation scale and family symmetry breaking scale below the Grand Unification Theory (GUT) scale, these classes of models are free of the monopole (and similar) problems which are often associated with the GUT phase transition. (author)

Viscous warm inflation: Hamilton-Jacobi formalism

Science.gov (United States)

Akhtari, L.; Mohammadi, A.; Sayar, K.; Saaidi, Kh.

2017-04-01

Using Hamilton-Jacobi formalism, the scenario of warm inflation with viscous pressure is considered. The formalism gives a way of computing the slow-rolling parameter without extra approximation, and it is well-known as a powerful method in cold inflation. The model is studied in detail for three different cases of the dissipation and bulk viscous pressure coefficients. In the first case where both coefficients are taken as constant, it is shown that the case could not portray warm inflationary scenario compatible with observational data even it is possible to restrict the model parameters. For other cases, the results shows that the model could properly predicts the perturbation parameters in which they stay in perfect agreement with Planck data. As a further argument, r -ns and αs -ns are drown that show the acquired result could stand in acceptable area expressing a compatibility with observational data.

Features of the temperature response to a double cuff-occlusion of the upper limbs: remote ischemic preconditioning aspect

Science.gov (United States)

Sagaidachnyi, A. A.; Fomin, A. V.; Mayskov, D. I.; Skripal, A. V.; Usanov, D. A.

2018-04-01

The essence of the phenomenon of ischemic preconditioning is increasing myocardium resistance to long periods of ischemia that occurs after several short ischemia-reperfusion periods. The aim of this pilot study was to determine the temperature and vascular response in double brachial occlusions and to assess the prospects of using this maneuver for remote ischemic preconditioning. Infrared thermography-based measurements were used to assess hemodynamics both left and right hands during the baseline, ischemia and hyperemia periods. Double ischemia with a period of 2 min was implemented by a cuff compression of the brachial artery of the right hand. A study group was constituted of eight men and six women without cardiovascular abnormalities at the age of 22 to 35 years. As a result, we have determined that a temperature and vascular response to ischemia of right hand is accompanied by the vascular reaction of the contralateral left hand, especially after the inflation and deflation of the cuff. These vascular reactions are reproducible, systemic and appear to be at least neurological in nature. An experimental confirmation of the systemic vascular «training effect» after multiple brachial ischemia-reperfusion periods is a subject of further investigations.

Methods and apparatus for field blasting of earth formations using inflatable devices for suspending explosives in boreholes

International Nuclear Information System (INIS)

Fitzgibbon, D.F. Jr.

1991-01-01

This patent describes an inflatable device for supporting a mass of stemming material or explosive material within an uncased borehole formed vertically or essentially vertically in the earth prior to initiation of blasting within the borehole, walls of the borehole being irregular due to drilling of the borehole into the earth. It comprises body means comprising flexible portions of the inflatable device for extending into contact with walls of the borehole and for transferring pressure from an inflating fluid introduced into the inflatable device to the irregular walls of the borehole, the pressure being adequate to provide an essentially vertical force component directed against the stemming material or explosive material supporting the material at a desired location within the borehole, the inflatable device being capable of inflation within the borehole; and means carried by the inflatable device for connection to a source of inflating fluid and through which the inflatable device is filled with the fluid to expand the flexible portions into engagement with the irregular walls of the borehole

The Repaired Rotator Cuff: MRI and Ultrasound Evaluation.

Science.gov (United States)

Lee, Susan C; Williams, Danielle; Endo, Yoshimi

2018-03-01

The purposes of this review were to provide an overview of the current practice of evaluating the postoperative rotator cuff on imaging and to review the salient imaging findings of the normal and abnormal postoperative rotator cuff, as well as of postoperative complications. The repaired rotator cuff frequently appears abnormal on magnetic resonance imaging (MRI) and ultrasound (US). Recent studies have shown that while the tendons typically normalize, they can demonstrate clinically insignificant abnormal imaging appearances for longer than 6 months. Features of capsular thickening or subacromial-subdeltoid bursal thickening and fluid distension were found to decrease substantially in the first 6-month postoperative period. MRI and US were found to be highly comparable in the postoperative assessment of the rotator cuff, although they had a lower sensitivity for partial thickness tears. Imaging evaluation of newer techniques such as patch augmentation and superior capsular reconstruction needs to be further investigated. MRI and US are useful in the postoperative assessment of the rotator cuff, not only for evaluation of the integrity of the rotator cuff, but also for detecting hardware complications and other etiologies of shoulder pain.

Suprascapular Nerve: Is It Important in Cuff Pathology?

Directory of Open Access Journals (Sweden)

Lewis L. Shi

2012-01-01

Full Text Available Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.

Aerial Deployment and Inflation System for Mars Helium Balloons

Science.gov (United States)

Lachenmeler, Tim; Fairbrother, Debora; Shreves, Chris; Hall, Jeffery, L.; Kerzhanovich, Viktor V.; Pauken, Michael T.; Walsh, Gerald J.; White, Christopher V.

2009-01-01

A method is examined for safely deploying and inflating helium balloons for missions at Mars. The key for making it possible to deploy balloons that are light enough to be buoyant in the thin, Martian atmosphere is to mitigate the transient forces on the balloon that might tear it. A fully inflated Mars balloon has a diameter of 10 m, so it must be folded up for the trip to Mars, unfolded upon arrival, and then inflated with helium gas in the atmosphere. Safe entry into the Martian atmosphere requires the use of an aeroshell vehicle, which protects against severe heating and pressure loads associated with the hypersonic entry flight. Drag decelerates the aeroshell to supersonic speeds, then two parachutes deploy to slow the vehicle down to the needed safe speed of 25 to 35 m/s for balloon deployment. The parachute system descent dynamic pressure must be approximately 5 Pa or lower at an altitude of 4 km or more above the surface.

Assessment and treatment strategies for rotator cuff tears

Science.gov (United States)

Al-Hakim, Wisam; Noorani, Ali

2014-01-01

Tears of the rotator cuff are common and becoming an increasingly frequent problem. There is a vast amount of literature on the merits and limitations of the various methods of clinical and radiological assessment of rotator cuff tears. This is also the case with regard to treatment strategies. Certain popular beliefs and principles practiced widely and the basis upon which they are derived may be prone to inaccuracy. We provide an overview of the historical management of rotator cuff tears, as well as an explanation for how and why rotator cuff tears should be managed, and propose a structured methodology for their assessment and treatment. PMID:27582960

MR imaging of rotator cuff tears

International Nuclear Information System (INIS)

Kumagai, Hideo

1992-01-01

A total of 115 patients with clinical symptoms and signs suggesting rotator cuff tears underwent MR imaging with a 1.5-Tesla system. The body coil was used as the receiver coil in 24 patients and a single 10 cm surface coil in 91. Arthrography or MR imaging with intra-articular Gd-DTPA (MR arthrography) was performed in 95 of the 115. T2-weighted images with the body coil showed high signal intensity lesions in rotator cuffs in only seven of the 10 patients who had tears demonstrated by arthrography or MR arthrography. On the other hand, T2-weighted images with the surface coil demonstrated high signal intensity lesions in cuffs in all 27 patients who were diagnosed to have tears by arthrography or MR arthrography. In 12 patietns, T2-wighted images with the surface coil showed high signal intensity lesions in cuffs, while arthrography and MR arthrography did not show tears. Surgery was performed in four of the 12 patients and partial tears were confirmed. A single 10 cm surface coil, 3 mm slice thickness and 2.5 second repetition time seem to account for the fine visualization of cuff tears by the T2-weighted images. These results suggest that T2-weighted images obtained with the surface coil are superior to arthrography and MR arthrography. (author)

The patient inflating valve in anaesthesia and resuscitation breathing systems.

Science.gov (United States)

Fenton, P M; Bell, G

2013-03-01

Patient inflating valves combined with self-inflating bags are known to all anaesthetists as resuscitation devices and are familiar as components of draw-over anaesthesia systems. Their variants are also commonplace in transfer and home ventilators. However, the many variations in structure and function have led to difficulties in their optimal use, definition and classification. After reviewing the relevant literature, we defined a patient inflating valve as a one-way valve that closes an exit port to enable lung inflation, also permitting exhalation and spontaneous breathing, the actions being automatic. We present a new classification based on the mechanism of valve opening/closure; namely elastic recoil of a flexible flap/diaphragm, sliding spindle opened by a spring/magnet or a hollow balloon collapsed by external pressure. The evolution of these valves has been driven by the difficulties documented in critical incidents, which we have used along with information from modern International Organization for Standardization standards to identify 13 ideal properties, the top six of which are non-jamming, automatic, no bypass effect, no rebreathing or air entry at patient end, low resistance, robust and easy to service. The Ambu and the Laerdal valves have remained popular due to their simplicity and reliability. Two new alternatives, the Fenton and Diamedica valves, offer the benefits of location away from the patient while retaining a small functional dead space. They also offer the potential for greater use of hybrid continuous flow/draw-over systems that can operate close to atmospheric pressure. The reliable application of positive end-expiratory pressure/continuous positive airway pressure remains a challenge.

A simple method of injecting tumescent fluid for liposuction

Directory of Open Access Journals (Sweden)

Arindam Sarkar

2011-01-01

Full Text Available Injection of tumescent fluid is essential to obtain a painless and relatively bloodless liposuction. There are many methods of injecting the tumescent fluid like power pumps, syringes and pressure cuffs. Our method consists of applying air pressure within the plastic transfusion fluid bottle by pricking with a wide bore needle and connecting it to a sphygmomanometer balloon pump. By inflation of the balloon pump and thus increasing pressure inside the plastic bottle, the rate and volume of infusion can be controlled. By applying the cuff outside the bottle the visibility inside is impaired and the bottle gets collapsed preventing a continued pressure and thereby impairing both the quantity as well as the rate of infusion. Power pumps are expensive. This method is inexpensive, infused volume of fluid being visible and the rate of infusion controllable.

Inflation perceptions and inflation expectation in South Africa: trends ...

African Journals Online (AJOL)

This paper reports the results of a multinomial analysis of inflation perceptions and inflation expectations in South Africa. Inflation perceptions surveys among South African individuals have been undertaken since 2006. The introduction of these surveys followed on domestic inflation expectation surveys conducted in 2000, ...

Lowering Regional Inflation? Improve Budget Absorption

Directory of Open Access Journals (Sweden)

Vid Adrison

2016-08-01

Full Text Available The subnational government spending in Indonesia exhibit a highly skewed distribution, i.e., it is very low in the first two-quarters and then increases significantly in the last two-quarters. Such explosive pattern poses two disadvantages. First, the regional output will fall below its optimal level as the low government capital expenditure leads to a fewer provision of public goods. Second, a significant increase in government spending in the later quarter pushes the short run aggregate demand to the northeast and creates an inflationary pressure in the following quarters. In this study, we analyze the effect of quarterly regional government expenditure growth on regional inflation during 2010–2014. Using Arellano Bond GMM estimation, we find government expenditure growth leads to higher inflation in the same quarter. A percentage increase in non-capital expenditure spending results in a higher inflation than a percentage increase in capital spending.

Explosive dome eruptions modulated by periodic gas-driven inflation

Science.gov (United States)

Johnson, Jeffrey B.; Lyons, John; Andrews, B. J.; Lees, J.M.

2014-01-01

Volcan Santiaguito (Guatemala) “breathes” with extraordinary regularity as the edifice's conduit system accumulates free gas, which periodically vents to the atmosphere. Periodic pressurization controls explosion timing, which nearly always occurs at peak inflation, as detected with tiltmeters. Tilt cycles in January 2012 reveal regular 26 ± 6 min inflation/deflation cycles corresponding to at least ~101 kg/s of gas fluxing the system. Very long period (VLP) earthquakes presage explosions and occur during cycles when inflation rates are most rapid. VLPs locate ~300 m below the vent and indicate mobilization of volatiles, which ascend at ~50 m/s. Rapid gas ascent feeds pyroclast-laden eruptions lasting several minutes and rising to ~1 km. VLPs are not observed during less rapid inflation episodes; instead, gas vents passively through the conduit producing no infrasound and no explosion. These observations intimate that steady gas exsolution and accumulation in shallow reservoirs may drive inflation cycles at open-vent silicic volcanoes.

Will Preoperative Atrophy and Fatty Degeneration of the Shoulder Muscles Improve after Rotator Cuff Repair in Patients with Massive Rotator Cuff Tears?

Directory of Open Access Journals (Sweden)

Hiroshi Yamaguchi

2012-01-01

Full Text Available Recently, retear rate after repair for massive cuff tear have been improved through devised suture techniques. However, reported retear rate is relevant to preoperative atrophy and fatty degeneration. The purpose of this study was to investigate whether preoperative atrophy and fatty degeneration of rotator cuff muscles improve by successful repair. Twenty-four patients with massive rotator cuff tear were evaluated on the recovery of atrophy and fatty degeneration of supraspinatus and infraspinatus muscle after surgery. Atrophy was classified by the occupation ratio and fatty degeneration by modified Goutallier's classification. Both were assessed on magnetic resonance imaging (MRI before and after the operation. When the cuff was well repaired, improvement of the atrophy and fatty degeneration were observed in a half and a one-fourth of the cases, respectively. In retear cases, however, atrophy and fatty degeneration became worse. Improvement of atrophy and fatty degeneration of the rotator cuff muscles may be expected in the cases with successful achievement of rotator cuff repair for large and massive tear.

Inflation,Inflation Variability, and Output Performance. Venezuela 1951-2002

OpenAIRE

Olivo, Victor

2014-01-01

This paper explores the relationship between the level of inflation, inflation variability, and output performance in the Venezuelan economy for the period 1951-2002. The paper examines the mechanism through which higher inflation translates into lower non-oil real GDP growth. We find empirical evidence that supports Friedman's (1977) contention that higher inflation produces more inflation volatility /uncertainty that leads to relative price variability that in turn, is harmful for the prope...

Student Nurses' Knowledge in Relation to Blood Pressure Measurement by Sphygmomanometry and Auscultation.

Science.gov (United States)

Torrance, Colin; Serginson, Eve

1996-01-01

British nursing students (78 of 93) completed a questionnaire about blood pressure; 90% were not familiar with Korotkoff sounds or auscultary gap; most thought blood pressure was the same in both arms; 63% knew resting was essential before measurement; 59% assessed the arm for cuff size; only 25% thought the cuff should be placed at heart level.…

Degenerative full thickness rotator cuff tears : Towards optimal management

NARCIS (Netherlands)

Lambers Heerspink, Frederik

2016-01-01

The shoulder is one of the most complex joints in the body. Besides a wide range of motion it also has to be stable. The rotator cuff is a major stabiliser of the glenohumoral joint. With increasing age rotator cuff tears are common. Successful treatment is described following surgical (rotator cuff

Multifield consequences for D-brane inflation

International Nuclear Information System (INIS)

Dias, Mafalda; Frazer, Jonathan; Liddle, Andrew R.

2012-01-01

We analyse the multifield behaviour in D-brane inflation when contributions from the bulk are taken into account. For this purpose, we study a large number of realisations of the potential; we find the nature of the inflationary trajectory to be very consistent despite the complex construction. Inflation is always canonical and occurs in the vicinity of an inflection point. Extending the transport method to non-slow-roll and to calculate the running, we obtain distributions for observables. The spectral index is typically blue and the running positive, putting the model under moderate pressure from WMAP7 constraints. The local f NL and tensor-to-scalar ratio are typically unobservably small, though we find approximately 0.5% of realisations to give observably large local f NL . Approximating the potential as sum-separable, we are able to give fully analytic explanations for the trends in observed behaviour. Finally we find the model suffers from the persistence of isocurvature perturbations, which can be expected to cause further evolution of adiabatic perturbations after inflation. We argue this is a typical problem for models of multifield inflation involving inflection points and renders models of this type technically unpredictive without a description of reheating

Regional respiratory inflation and deflation pressure–volume curves determined by electrical impedance tomography

International Nuclear Information System (INIS)

Frerichs, I; Dargaville, P A; Rimensberger, P C

2013-01-01

Measurement of regional lung volume changes during a quasi-static pressure–volume (PV) manoeuvre using electrical impedance tomography (EIT) could be used to assess regional respiratory system mechanics and to determine optimal ventilator settings in individual patients. Using this approach, we studied regional respiratory system mechanics in healthy and lung-injured animals, before and after surfactant administration during inflation and deflation PV manoeuvres. The comparison of the EIT-derived regional PV curves in ventral, middle and dorsal regions of the right and left lungs showed not only different amounts of hysteresis in these regions but also marked differences among different landmark pressures calculated on the inflation and deflation limbs of the curves. Regional pressures at maximum compliance as well as the lower and upper pressures of maximum compliance change differed between the inflation and deflation and increased from ventral to dorsal regions in all lung conditions. All these pressure values increased in the injured and decreased in the surfactant treated lungs. Examination of regional respiratory system mechanics using EIT enables the assessment of spatial and temporal heterogeneities in the ventilation distribution. Characteristic landmarks on the inflation and especially on the deflation limb of regional PV curves may become useful measures for guiding mechanical ventilation. (paper)

Footprint Contact Area and Interface Pressure Comparison Between the Knotless and Knot-Tying Transosseous-Equivalent Technique for Rotator Cuff Repair.

Science.gov (United States)

Kim, Sung-Jae; Kim, Sung-Hwan; Moon, Hyun-Soo; Chun, Yong-Min

2016-01-01

To quantify and compare the footprint contact area and interface pressure on the greater tuberosity between knotless and knot-tying transosseous-equivalent (TOE) repair using pressure-sensitive film. We used 11 pairs of fresh-frozen cadaveric shoulders (22 specimens), in which rotator cuff tears were created before repair. Each pair was randomized to either conventional medial knot-tying TOE repair (group A) or medial knotless TOE repair using the modified Mason-Allen technique (group B). Pressure-sensitive film was used to quantify the pressurized contact area and interface pressure between the greater tuberosity and supraspinatus tendon. The mean pressurized contact area was 33.2 ± 2.5 mm(2) for group A and 28.4 ± 2.4 mm(2) for group B. There was a significant difference between groups (P = .005). Although the overall contact configuration of both groups was similar and showed an M shape, group A showed a greater pressurized configuration around the medial row. The mean interface pressure was 0.20 ± 0.02 MPa for group A and 0.17 ± 0.02 MPa for group B. There was a significant difference between groups (P = .001). Contrary to our hypothesis, in this time-zero study, medial knotless TOE repair using a modified Mason-Allen suture produced a significantly inferior footprint contact area and interface pressure compared with conventional medial knot-tying TOE repair. Even though we found a statistically significant difference between the 2 repair methods, it is still unknown if this statistical difference seen in our study has any clinical and radiologic significance. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Flavon inflation

Energy Technology Data Exchange (ETDEWEB)

Antusch, S. [Max-Planck-Institut fuer Physik (Werner-Heisenberg-Institut), Foehringer Ring 6, D-80805 Muenchen (Germany); King, S.F.; Malinsky, M. [School of Physics and Astronomy, University of Southampton, Southampton, SO17 1BJ (United Kingdom); Velasco-Sevilla, L. [ICTP, Strada Costiera 11, Trieste 34014 (Italy)], E-mail: lvelasco@ictp.it; Zavala, I. [CPT and IPPP, Durham University, South Road, DH1 3LE, Durham (United Kingdom)

2008-08-14

We propose an entirely new class of particle physics models of inflation based on the phase transition associated with the spontaneous breaking of family symmetry responsible for the generation of the effective quark and lepton Yukawa couplings. We show that the Higgs fields responsible for the breaking of family symmetry, called flavons, are natural candidates for the inflaton field in new inflation, or the waterfall fields in hybrid inflation. This opens up a rich vein of possibilities for inflation, all linked to the physics of flavour, with interesting cosmological and phenomenological implications. Out of these, we discuss two examples which realise flavon inflation: a model of new inflation based on the discrete non-Abelian family symmetry group A{sub 4} or {delta}{sub 27}, and a model of hybrid inflation embedded in an existing flavour model with a continuous SU(3) family symmetry. With the inflation scale and family symmetry breaking scale below the Grand Unification Theory (GUT) scale, these classes of models are free of the monopole (and similar) problems which are often associated with the GUT phase transition.

Flavon inflation

International Nuclear Information System (INIS)

Antusch, S.; King, S.F.; Malinsky, M.; Velasco-Sevilla, L.; Zavala, I.

2008-01-01

We propose an entirely new class of particle physics models of inflation based on the phase transition associated with the spontaneous breaking of family symmetry responsible for the generation of the effective quark and lepton Yukawa couplings. We show that the Higgs fields responsible for the breaking of family symmetry, called flavons, are natural candidates for the inflaton field in new inflation, or the waterfall fields in hybrid inflation. This opens up a rich vein of possibilities for inflation, all linked to the physics of flavour, with interesting cosmological and phenomenological implications. Out of these, we discuss two examples which realise flavon inflation: a model of new inflation based on the discrete non-Abelian family symmetry group A 4 or Δ 27 , and a model of hybrid inflation embedded in an existing flavour model with a continuous SU(3) family symmetry. With the inflation scale and family symmetry breaking scale below the Grand Unification Theory (GUT) scale, these classes of models are free of the monopole (and similar) problems which are often associated with the GUT phase transition

Body mass index and blood pressure measurement during pregnancy.

LENUS (Irish Health Repository)

Hogan, Jennifer L

2012-02-01

OBJECTIVE: The accurate measurement of blood pressure requires the use of a large cuff in subjects with a high mid-arm circumference (MAC). This prospective study examined the need for a large cuff during pregnancy and its correlation with maternal obesity. METHODS: Maternal body mass index (BMI), fat mass, and MAC were measured. RESULTS: Of 179 women studied, 15.6% were obese. With a BMI of level 1 obesity, 44% needed a large cuff and with a BMI of level 2 obesity 100% needed a large cuff. CONCLUSION: All women booking for antenatal care should have their MAC measured to avoid the overdiagnosis of pregnancy hypertension.

Soft inflation

Science.gov (United States)

Berkin, Andrew L.; Maeda, Kei-Ichi; Yokoyama, Junichi

1990-01-01

The cosmology resulting from two coupled scalar fields was studied, one which is either a new inflation or chaotic type inflation, and the other which has an exponentially decaying potential. Such a potential may appear in the conformally transformed frame of generalized Einstein theories like the Jordan-Brans-Dicke theory. The constraints necessary for successful inflation are examined. Conventional GUT models such as SU(5) were found to be compatible with new inflation, while restrictions on the self-coupling constant are significantly loosened for chaotic inflation.

21 CFR 868.5800 - Tracheostomy tube and tube cuff.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into a...

Systematics of injuries of the rotator cuff and biceps tendon

International Nuclear Information System (INIS)

Breitenseher, M.J.; Pones, M.; Breitenseher, J.B.

2015-01-01

Injuries of the rotator cuff and the biceps tendon demonstrate different patterns, which can be recognized clinically and radiologically. These patterns are impingement syndrome with additional trauma, isolated trauma of the rotator cuff and shoulder dislocation causing rotator cuff tears. Furthermore, it is clinically crucial to evaluate the extent of a rotator cuff injury. Magnetic resonance imaging (MRI) is the modality of choice to differentiate these patterns. (orig.) [de

Generalized Higgs inflation

Energy Technology Data Exchange (ETDEWEB)

Kamada, Kohei [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); Kobayashi, Tsutomu [Kyoto Univ. (Japan). Hakubi Center; Kyoto Univ. (Japan). Dept. of Physics; Takahashi, Tomo [Saga Univ. (Japan). Dept. of Physics; Yamaguchi, Masahide [Tokyo Institute of Technology (Japan). Dept. of Physics; Yokoyama, Jun' ichi [Tokyo Univ. (JP). Research Center for the Early Universe (RESCEU); Tokyo Univ., Chiba (JP). Inst. for the Physics and Mathematics of the Universe (IPMU)

2012-03-15

We study Higgs inflation in the context of generalized G-inflation, i.e., the most general single-field inflation model with second-order field equations. The four variants of Higgs inflation proposed so far in the literature can be accommodated at one time in our framework. We also propose yet another class of Higgs inflation, the running Einstein inflation model, that can naturally arise from the generalized G-inflation framework. As a result, five Higgs inflation models in all should be discussed on an equal footing. Concise formulas for primordial fluctuations in these generalized Higgs inflation models are provided, which will be helpful to determine which model is favored from the future experiments and observations such as the Large Hadron Collider and the Planck satellite.

Arterial blood pressure measurement and pulse wave analysis—their role in enhancing cardiovascular assessment

International Nuclear Information System (INIS)

Avolio, Alberto P; Butlin, Mark; Walsh, Andrew

2010-01-01

The most common method of clinical measurement of arterial blood pressure is by means of the cuff sphygmomanometer. This instrument has provided fundamental quantitative information on arterial pressure in individual subjects and in populations and facilitated estimation of cardiovascular risk related to levels of blood pressure obtained from the brachial cuff. Although the measurement is taken in a peripheral limb, the values are generally assumed to reflect the pressure throughout the arterial tree in large conduit arteries. Since the arterial pressure pulse becomes modified as it travels away from the heart towards the periphery, this is generally true for mean and diastolic pressure, but not for systolic pressure, and so pulse pressure. The relationship between central and peripheral pulse pressure depends on propagation characteristics of arteries. Hence, while the sphygmomanometer gives values of two single points on the pressure wave (systolic and diastolic pressure), there is additional information that can be obtained from the time-varying pulse waveform that enables an improved quantification of the systolic load on the heart and other central organs. This topical review will assess techniques of pressure measurement that relate to the use of the cuff sphygmomanometer and to the non-invasive registration and analysis of the peripheral and central arterial pressure waveform. Improved assessment of cardiovascular function in relation to treatment and management of high blood pressure will result from future developments in the indirect measurement of arterial blood pressure that involve the conventional cuff sphygmomanometer with the addition of information derived from the peripheral arterial pulse. (topical review)

Arthroscopic rotator cuff repair in elite rugby players

OpenAIRE

Tambe, Amol; Badge, Ravi; Funk, Lennard

2009-01-01

Background: Rugby is an increasingly popular collision sport. A wide spectrum of injuries can be sustained during training and match play. Rotator cuff injury is uncommon in contact sports and there is little published literature on the treatment of rotator cuff tears in rugby players. Aims: We therefore reviewed the results and functional outcomes of arthroscopic rotator cuff repair in elite rugby players. Materials and Methods: Eleven professional rugby players underwent arthroscopic ...

Relationships between rotator cuff tear types and radiographic abnormalities

Energy Technology Data Exchange (ETDEWEB)

Lee, Soo Hyun; Chun, Kyung Ah; Lee Soo Jung; Kang, Min Ho; Yi, Kyung Sik; Zhang, Ying [Dept. of Diagnostic Radiology, College of Medicine, Chungbuk National University, Cheongju (Korea, Republic of)

2014-11-15

To determine relationships between different types of rotator cuff tears and radiographic abnormalities. The shoulder radiographs of 104 patients with an arthroscopically proven rotator cuff tear were compared with similar radiographs of 54 age-matched controls with intact cuffs. Two radiologists independently interpreted all radiographs for; cortical thickening with subcortical sclerosis, subcortical cysts, osteophytes in the humeral greater tuberosity, humeral migration, degenerations of the acromioclavicular and glenohumeral joints, and subacromial spurs. Statistical analysis was performed to determine relationships between each type of rotator cuff tears and radiographic abnormalities. Inter-observer agreements with respect to radiographic findings were analyzed. Humeral migration and degenerative change of the greater tuberosity, including sclerosis, subcortical cysts, and osteophytes, were more associated with full-thickness tears (p < 0.01). Subacromial spurs were more common for full-thickness and bursal-sided tears (p < 0.01). No association was found between degeneration of the acromioclavicular or glenohumeral joint and the presence of a cuff tear. Different types of rotator cuff tears are associated with different radiographic abnormalities.

Relationships between rotator cuff tear types and radiographic abnormalities

International Nuclear Information System (INIS)

Lee, Soo Hyun; Chun, Kyung Ah; Lee Soo Jung; Kang, Min Ho; Yi, Kyung Sik; Zhang, Ying

2014-01-01

To determine relationships between different types of rotator cuff tears and radiographic abnormalities. The shoulder radiographs of 104 patients with an arthroscopically proven rotator cuff tear were compared with similar radiographs of 54 age-matched controls with intact cuffs. Two radiologists independently interpreted all radiographs for; cortical thickening with subcortical sclerosis, subcortical cysts, osteophytes in the humeral greater tuberosity, humeral migration, degenerations of the acromioclavicular and glenohumeral joints, and subacromial spurs. Statistical analysis was performed to determine relationships between each type of rotator cuff tears and radiographic abnormalities. Inter-observer agreements with respect to radiographic findings were analyzed. Humeral migration and degenerative change of the greater tuberosity, including sclerosis, subcortical cysts, and osteophytes, were more associated with full-thickness tears (p < 0.01). Subacromial spurs were more common for full-thickness and bursal-sided tears (p < 0.01). No association was found between degeneration of the acromioclavicular or glenohumeral joint and the presence of a cuff tear. Different types of rotator cuff tears are associated with different radiographic abnormalities.

EFFECT OF INTRACUFF MEDIA-ALKALINISED LIGNOCAINE, SALINE, AND AIR ON ENDOTRACHEAL TUBE INDUCED EMERGENCE PHENOMENA: A RANDOMIZED CONTROLLED STUDY

Directory of Open Access Journals (Sweden)

Indu S

2016-07-01

Full Text Available CONTEXT Emergence from general anaesthesia is associated with post extubation cough, hoarseness, sore throat, and dysphagia, which may affect the smoothness of extubation. Prophylactic interventions have been studied to reduce these tracheal morbidities with varying results. AIMS To compare the efficacy of air, alkalinised lignocaine and saline in maintaining intracuff pressure and reducing postoperative cough (PEC and sore throat (POST. SETTINGS AND DESIGN A randomised controlled study conducted in a teaching hospital. METHODS AND MATERIALS 105 patients scheduled for elective surgeries were randomly allocated into groups of 35 each. The endotracheal tube (ETT cuffs were inflated with air, alkalinised lignocaine, or saline. The intracuff pressure (ICP was initially set to 25-30 cm of H2O; measured every 30 minutes and before extubation; the minimum volume for occlusion (MOV noted. The incidence PEC and POST were monitored. STATISTICAL ANALYSIS Data analysed using Chi-square test, Fisher’s exact test; Bonferroni method allowed multiple comparisons. A p value <0.05 was considered significant. RESULTS Pre-lubricated ETT cuff inflation with liquid media maintained an acceptable ICP. Saline and alkalinised lignocaine were effective in reducing PEC and POST. Alkalinised lignocaine provided smoother extubation and fared better in the early postoperative period. CONCLUSIONS Pre-lubricated ETT cuffs with liquid media reduced PEC and POST. Alkalinised lignocaine showed better profile than saline. Optimum ICP reduces tracheal morbidity.

Inflation Forecast Contracts

OpenAIRE

Gersbach, Hans; Hahn, Volker

2012-01-01

We introduce a new type of incentive contract for central bankers: inflation forecast contracts, which make central bankers’ remunerations contingent on the precision of their inflation forecasts. We show that such contracts enable central bankers to influence inflation expectations more effectively, thus facilitating more successful stabilization of current inflation. Inflation forecast contracts improve the accuracy of inflation forecasts, but have adverse consequences for output. On balanc...

Sustained inflation and incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation in a large porcine model of acute respiratory distress syndrome

Directory of Open Access Journals (Sweden)

Wunder Christian

2006-06-01

Full Text Available Abstract Background To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. Methods Severe lung injury (Ali was induced in 18 healthy pigs (55.3 ± 3.9 kg, mean ± SD by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV: FIO2 = 1.0, PEEP = 5 cmH2O, VT = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV: FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s followed by an incremental mean airway pressure (mPaw trial (steps of 3 cmH2O every 15 minutes were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step. Results The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 ± 100 vs. PCV: 58 ± 15 and TAli: 57 ± 12; p 2-reduction (HFOV: 42 ± 5 vs. PCV: 62 ± 13 and TAli: 55 ± 9; p Ali: 6.1 ± 1 vs. T75: 3.4 ± 0.4; PCV: TAli: 6.7 ± 2.4 vs. T75: 4 ± 0.5; p Conclusion A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

''Old'' locked inflation

International Nuclear Information System (INIS)

Liu, Yang; Piao, Yun-Song; Si, Zong-Guo

2009-01-01

In this paper, we revisit the idea of locked inflation, which does not require a potential satisfying the normal slow-roll condition, but suffers from the problems associated with ''saddle inflation''. We propose a scenario based on locked inflation, however, with an alternative evolution mechanism of the ''waterfall field'' φ. Instead of rolling down along the potential, the φ field will tunnel to end the inflation stage like in old inflation, by which the saddle inflation could be avoided. Further, we study a cascade of old locked inflation, which can be motivated by the string landscape. Our model is based on the consideration of making locked inflation feasible so as to give a working model without slow roll; It also can be seen as an effort to embed the old inflation in string landscape

First-order inflation

International Nuclear Information System (INIS)

Kolb, E.W.

1991-01-01

In the original proposal, inflation occurred in the process of a strongly first-order phase transition. This model was soon demonstrated to be fatally flawed. Subsequent models for inflation involved phase transitions that were second-order, or perhaps weakly first-order; some even involved no phase transition at all. Recently the possibility of inflation during a strongly first-order phase transition has been reviewed. In this talk I will discuss some models for first-order inflation, and emphasize unique signatures that result if inflation is realized in a first-order transition. Before discussing first-order inflation, I will briefly review some of the history of inflation to demonstrate how first-order inflation differs from other models. (orig.)

Impingement syndrome and rotator cuff tears: US findings in 140 patients

International Nuclear Information System (INIS)

Malvestiti, Oreste; Scorsolini, Alessandro; Ratti, Francesco; Ferraris, Giuseppe; Columbaro, Guido; Mariani, Claudio

1997-01-01

The authors investigated the role of rotator cuff impingement in causing tears of supraspinatus and biceps tendons and the comparative reliability of plain radiography and sonography (US). One hundred forty patients with symtoms referrable to the rotator cuff were examined with plain radiography and US of the shoulder. The differential diagnosis must distinguish all these common causes of shoulder dysfunction and cuff problems from other conditions. The authors conclude that US and plain radiography are accurate routine tests of rotator cuff integrity and rotator cuff impingement

Rotator cuff repair using cell sheets derived from human rotator cuff in a rat model.

Science.gov (United States)

Harada, Yoshifumi; Mifune, Yutaka; Inui, Atsuyuki; Sakata, Ryosuke; Muto, Tomoyuki; Takase, Fumiaki; Ueda, Yasuhiro; Kataoka, Takeshi; Kokubu, Takeshi; Kuroda, Ryosuke; Kurosaka, Masahiro

2017-02-01

To achieve biological regeneration of tendon-bone junctions, cell sheets of human rotator-cuff derived cells were used in a rat rotator cuff injury model. Human rotator-cuff derived cells were isolated, and cell sheets were made using temperature-responsive culture plates. Infraspinatus tendons in immunodeficient rats were resected bilaterally at the enthesis. In right shoulders, infraspinatus tendons were repaired by the transosseous method and covered with the cell sheet (sheet group), whereas the left infraspinatus tendons were repaired in the same way without the cell sheet (control group). Histological examinations (safranin-O and fast green staining, isolectin B4, type II collagen, and human-specific CD31) and mRNA expression (vascular endothelial growth factor; VEGF, type II collagen; Col2, and tenomodulin; TeM) were analyzed 4 weeks after surgery. Biomechanical tests were performed at 8 weeks. In the sheet group, proteoglycan at the enthesis with more type II collagen and isolectin B4 positive cells were seen compared with in the control group. Human specific CD31-positive cells were detected only in the sheet group. VEGF and Col2 gene expressions were higher and TeM gene expression was lower in the sheet group than in the control group. In mechanical testing, the sheet group showed a significantly higher ultimate failure load than the control group at 8 weeks. Our results indicated that the rotator-cuff derived cell sheet could promote cartilage regeneration and angiogenesis at the enthesis, with superior mechanical strength compared with the control. Treatment for rotator cuff injury using cell sheets could be a promising strategy for enthesis of tendon tissue engineering. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:289-296, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Inflation Targeting, Between Rhetoric and Reality. The Case of Transition Economies

Directory of Open Access Journals (Sweden)

Laurian Lungu

2007-06-01

Full Text Available The paper examines the inflation targeting regime in the context of transition economies. Recent years have witnessed an increasing number of central banks in these countries moving towards the implementation of inflation targeting regimes. However, the success of such a regime depends largely on the degree to which certain general requirements are met. As experience in a number of transition economies has shown so far, targeting inflation is not an easy task. The ongoing restructuring process in these economies makes the inflation forecasting process more difficult and introduces an additional source of uncertainty in the system. By unequivocally choosing inflation as a nominal anchor the central banks could face potential dilemmas if, for example, exchange rate appreciated too much under the pressure of massive capital inflows. The paper presents the broad framework in which inflation targeting could operate efficiently and attempts to assess the extent to which such a regime, when applied to transition economies, could fit into this framework

Pneumatic antishock garment inflation activates the human sympathetic nervous system by abdominal compression.

Science.gov (United States)

Garvin, Nathan M; Levine, Benjamin D; Raven, Peter B; Pawelczyk, James A

2014-01-01

Pneumatic antishock garments (PASG) have been proposed to exert their blood pressure-raising effect mechanically, i.e. by increasing venous return and vascular resistance of the lower body. We tested whether, alternatively, PASG inflation activates the sympathetic nervous system. Five men and four women wore PASG while mean arterial pressure (MAP), muscle sympathetic nerve activity (MSNA), heart rate and stroke volume were measured. One leg bladder (LEG) and the abdominal bladder (ABD) of the trousers were inflated individually and in combination (ABD+LEG), at 60 or 90 mmHg for 3 min. By the end of 3 min of inflation, conditions that included the ABD region caused significant increases in MAP in a dose-dependent fashion (7 ± 2, 8 ± 3, 14 ± 4 and 13 ± 5 mmHg for ABD60, ABD+LEG60, ABD90 and ABD+LEG90, respectively, P < 0.05). Likewise, inflation that included ABD caused significant increases in total MSNA compared with control values [306 ± 70, 426 ± 98 and 247 ± 79 units for ABD60, ABD90 and ABD+LEG90, respectively, P < 0.05 (units = burst frequency × burst amplitude]. There were no changes in MAP or MSNA in the LEG-alone conditions. The ABD inflation also caused a significant decrease in stroke volume (-11 ± 3 and -10 ± 3 ml per beat in ABD90 and ABD+LEG90, respectively, P < 0.05) with no change in cardiac output. Neither cardiopulmonary receptor deactivation nor mechanical effects can account for a slowly developing rise in both sympathetic activity and blood pressure during ABD inflation. Rather, these data provide direct evidence that PASG inflation activates the sympathetic nervous system secondarily to abdominal, but not leg, compression.

First-order inflation

International Nuclear Information System (INIS)

Kolb, E.W.; Chicago Univ., IL

1990-09-01

In the original proposal, inflation occurred in the process of a strongly first-order phase transition. This model was soon demonstrated to be fatally flawed. Subsequent models for inflation involved phase transitions that were second-order, or perhaps weakly first-order; some even involved no phase transition at all. Recently the possibility of inflation during a strongly first-order phase transition has been revived. In this talk I will discuss some models for first-order inflation, and emphasize unique signatures that result in inflation is realized in a first-order transition. Before discussing first-order inflation, I will briefly review some of the history of inflation to demonstrate how first-order inflation differs from other models. 58 refs., 3 figs

Diagnostic imaging of shoulder rotator cuff lesions

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Nogueira-Barbosa Marcello Henrique

2002-01-01

Full Text Available Shoulder rotator cuff tendon tears were evaluated with ultrasonography (US and magnetic resonance imaging (MRI. Surgical or arthroscopical correlation were available in 25 cases. Overall costs were also considered. Shoulder impingement syndrome diagnosis was done on a clinical basis. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Ultrasound was performed in 22 patients and MRI in 17 of the 25 patients. Sensitivity, specificity and accuracy were 80%, 100% and 90.9% for US and 90%, 100% and 94.12% for MRI, respectively. In 16 cases both US and MRI were obtained and in this subgroup statistical correlation was excellent (p< 0.001. We concluded that both methods are reliable for rotator cuff full thickness tear evaluation. Since US is less expensive, it could be considered as the screening method when rotator cuff integrity is the main question, and when well trained radiologists and high resolution equipment are available.

Biomaterials based strategies for rotator cuff repair.

Science.gov (United States)

Zhao, Song; Su, Wei; Shah, Vishva; Hobson, Divia; Yildirimer, Lara; Yeung, Kelvin W K; Zhao, Jinzhong; Cui, Wenguo; Zhao, Xin

2017-09-01

Tearing of the rotator cuff commonly occurs as among one of the most frequently experienced tendon disorders. While treatment typically involves surgical repair, failure rates to achieve or sustain healing range from 20 to 90%. The insufficient capacity to recover damaged tendon to heal to the bone, especially at the enthesis, is primarily responsible for the failure rates reported. Various types of biomaterials with special structures have been developed to improve tendon-bone healing and tendon regeneration, and have received considerable attention for replacement, reconstruction, or reinforcement of tendon defects. In this review, we first give a brief introduction of the anatomy of the rotator cuff and then discuss various design strategies to augment rotator cuff repair. Furthermore, we highlight current biomaterials used for repair and their clinical applications as well as the limitations in the literature. We conclude this article with challenges and future directions in designing more advanced biomaterials for augmentation of rotator cuff repair. Copyright © 2017 Elsevier B.V. All rights reserved.

Preliminary Results of a Consecutive Series of Large & Massive Rotator Cuff Tears Treated with Arthroscopic Rotator Cuff Repairs Augmented with Extracellular Matrix

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Paolo Consigliere

2017-01-01

Full Text Available Background: Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially in elderly. Augmentation of rotator cuff repairs with extracellular matrix or synthetic patches has gained popularity in recent years with the aim of reducing failure.The aim of this study was to investigate the outcome of rotator cuff repairs augmented with denatured extracellular matrix in a series of patients who underwent arthroscopic rotator cuff repair for large to massive tears.Methods: Ten consecutive patients, undergoing arthroscopic rotator cuff repair with extracellular matrix augment for large and massive tears, were prospectively enrolled into this single surgeon study. All repairs were performed arthroscopically with a double row technique augmented with extracellular matrix. Oxford Shoulder Score, Constant Score and pain visual analogue scale (VAS were used to monitor the shoulder function and outcome pre-operatively and at three, six and 12-month follow-up. Minimum follow up was tree months. Mean follow up was 7 months.Results: Mean Constant score improved from 53 (SD=4 pre-operatively to 75 (SD=11 at final follow up. Mean Oxford score also increased from 30 (SD=8 pre-operatively to 47 (SD=10 at the final follow up. The visual analogue scale (VAS improved from seven out of 10 (SD=2 preoperatively to 0.6 (SD=0.8 at final follow up. Additionally, there was significant improvement at three months mark in Constant score. Conclusion: Arthroscopic repair and augmentation of large and massive rotator cuff tears with extracellular matrix patch has good early outcome.

Pressão de insuflagem dos pneus no desempenho do conjunto trator-grade de discos Tire inflation pressure effects on tractor disc harrow performance

Directory of Open Access Journals (Sweden)

João Manuel Pereira Ramalho Serrano

2008-02-01

Full Text Available O objetivo deste trabalho foi avaliar o efeito da pressão de insuflagem dos pneus nos parâmetros de desempenho do conjunto trator-grade de discos. As pressões avaliadas foram: 100 kPa nos pneus da frente e 70 kPa nos pneus atrás; 140 kPa nos quatro pneus; 190 kPa nos quatro pneus. Os testes de um trator com grades de discos foram desenvolvidos em condições de campo, em solos de textura franca, mobilizados e secos. Os parâmetros de avaliação foram: o patinamento, a velocidade, a capacidade de trabalho, a eficiência energética global e o consumo de combustível por hectare. Entre as situações de pressão de insuflagem dos pneus indicadas pelo fabricante do trator e a pressão de insuflagem indicada pelo fabricante dos pneus, não se verificam diferenças significativas, tanto na capacidade de trabalho como no consumo de combustível por hectare. A utilização de elevadas pressões de insuflagem dos pneus conduz a uma redução da ordem de 3 a 5% na capacidade de trabalho e um aumento significativo entre 10 e 25% do consumo de combustível por hectare, mesmo em condições de boa aderência dos pneus, refletidas no intervalo de 7 a 15% de patinamento registrados.The objective of this work was to evaluate the tire inflation pressure effects on tractor disc harrow performance. The pressures tested were: 100 kPa in front tires and 70 kPa in rear tires; 140 kPa in the tires of both axles; 190 kPa in the tires of both axles. Field tests with disc harrow in secondary tillage were performed under real working conditions, in tilled and dry medium textured soils. The evaluation parameters were: the slip, the actual forward speed, the work capacity, the overall energy efficiency and the fuel consumption per hectare. Concerning the situations of tire inflation pressure specified by the tractor manufacturer and the inflation pressure specified by the tire manufacturer, there were no significant differences, both in work capacity and in fuel

The Societal and Economic Value of Rotator Cuff Repair

Science.gov (United States)

Mather, Richard C.; Koenig, Lane; Acevedo, Daniel; Dall, Timothy M.; Gallo, Paul; Romeo, Anthony; Tongue, John; Williams, Gerald

2013-01-01

Background: Although rotator cuff disease is a common musculoskeletal problem in the United States, the impact of this condition on earnings, missed workdays, and disability payments is largely unknown. This study examines the value of surgical treatment for full-thickness rotator cuff tears from a societal perspective. Methods: A Markov decision model was constructed to estimate lifetime direct and indirect costs associated with surgical and continued nonoperative treatment for symptomatic full-thickness rotator cuff tears. All patients were assumed to have been unresponsive to one six-week trial of nonoperative treatment prior to entering the model. Model assumptions were obtained from the literature and data analysis. We obtained estimates of indirect costs using national survey data and patient-reported outcomes. Four indirect costs were modeled: probability of employment, household income, missed workdays, and disability payments. Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population. Effectiveness was expressed in quality-adjusted life years (QALYs). Results: The age-weighted mean total societal savings from rotator cuff repair compared with nonoperative treatment was $13,771 over a patient’s lifetime. Savings ranged from $77,662 for patients who are thirty to thirty-nine years old to a net cost to society of $11,997 for those who are seventy to seventy-nine years old. In addition, surgical treatment results in an average improvement of 0.62 QALY. Societal savings were highly sensitive to age, with savings being positive at the age of sixty-one years and younger. The estimated lifetime societal savings of the approximately 250,000 rotator cuff repairs performed in the U.S. each year was $3.44 billion. Conclusions: Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of sixty-one years and greater QALYs for all patients. Rotator cuff repair is cost

Validation of the OMRON M7 (HEM-780-E) blood pressure measuring device in a population requiring large cuff use according to the International Protocol of the European Society of Hypertension.

Science.gov (United States)

El Feghali, Ramzi N; Topouchian, Jirar A; Pannier, Bruno M; El Assaad, Hiba A; Asmar, Roland G

2007-06-01

A high percentage of hypertensive patients present an arm circumference of over 32 cm; the use of a large cuff is therefore recommended. Validation studies are usually performed in the general population using a standard-size cuff. The aim of this study was to assess the accuracy of the Omron M7 device in a population with an arm circumference ranging from 32 to 42 cm. A validation study was performed according to the International Protocol of the European Society of Hypertension. This protocol is divided into two phases: the first phase is performed on 15 selected participants (45 pairs of blood-pressure measurements); if the device passes this phase, 18 supplementary participants are included (54 pairs of blood-pressure measurements), making a total number of 33 participants (99 pairs of blood-pressure measurements), on whom the analysis is performed. For each participant, four blood-pressure measurements were performed simultaneously by two trained observers, using mercury sphygmomanometers fitted with a Y tube; the measurements alternated with three by the test device. The difference between the blood-pressure value given by the device and that obtained by the two observers (mean of the two observations) was calculated for each measure. The 99 pairs of blood-pressure differences were classified into three categories (Society of Hypertension protocol. The Omron M7 device passed the first and the second phases of the validation process. The average differences between the two observers were 1.5+/-3.2 and -0.5+/-2.2 mmHg for systolic blood pressure and diastolic blood pressure, and those between the device and the mercury sphygmomanometer were -1.6+/-6.7 for systolic blood pressure and -0.12+/-4.0 mmHg for diastolic blood pressure Readings that differ by less than 5, 10 and 15 mmHg for systolic blood-pressure and diastolic blood-pressure values fulfill the recommendation criteria of the European Society of Hypertension protocol. The Omron M7 (HEM-780-E) device

Conditioned pain modulation is affected by occlusion cuff conditioning stimulus intensity, but not duration.

Science.gov (United States)

Smith, A; Pedler, A

2018-01-01

Various conditioned pain modulation (CPM) methodologies have been used to investigate diffuse noxious inhibitory control pain mechanisms in healthy and clinical populations. Occlusion cuff parameters have been poorly studied. We aimed to investigate whether occlusion cuff intensity and/or duration influenced CPM magnitudes. We also investigated the role of physical activity levels on CPM magnitude. Two studies were performed to investigate the role of intensity and duration of occlusion cuff conditioning stimulus on test stimulus (tibialis anterior pressure pain thresholds). In Study 1, conditioning stimulus intensity of 2/10 or 5/10 (duration CPM magnitude. In Study 1, 27 healthy volunteers (mean ± SD: 24.9 years (±4.5); eight female) demonstrated that an occlusion cuff applied to the upper arm eliciting 5/10 local pain resulted in a significant (mean ± SD: 17% ± 46%) increase in CPM magnitude, when compared to 2/10 intensity (-3% ± 38%, p = 0.026), whereas in Study 2, 25 healthy volunteers (22.5 years (±2.7); 13 female) demonstrated that 3 min of 2/10 CS intensity did not result in a significant change in CPM (p = 0.21). There was no significant relationship between physical activity levels and CPM in either study (p > 0.22). This study demonstrated that an occlusion cuff of 5/10 conditioning stimulus intensity, when compared to 2/10, significantly increased CPM magnitude. Maintaining 2/10 conditioning stimulus for 3 min did not increase CPM magnitude. Dysfunctional conditioned pain modulation (CPM) has been associated with poor health outcomes. Various factors can influence CPM outcomes. The role of occlusion cuff conditioning stimulus intensity and duration has not been previously investigated. Intensity (5/10), but not duration of lower intensity (2/10) conditioning stimulus, affects CPM magnitude. © 2017 European Pain Federation - EFIC®.

Progression from calcifying tendinitis to rotator cuff tear

Energy Technology Data Exchange (ETDEWEB)

Gotoh, Masafumi; Higuchi, Fujio; Suzuki, Ritsu; Yamanaka, Kensuke [Department of Orthopaedic Surgery, Medical Center of Kurume University, 155-1 Kokubu-machi, Kurume City, Fukuoka 839-0862 (Japan)

2003-02-01

This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon without apparent tear. Three months after the first visit, MRI revealed a partial-thickness rotator cuff tear at the site of calcium deposition. Surgical and histologic findings demonstrated that calcium deposition was the cause of cuff rupture. To our knowledge, based on a review of the English literature, this is the first case report in which the progression from calcifying tendinitis to rotator cuff tear has been serially observed. (orig.)

Progression from calcifying tendinitis to rotator cuff tear

International Nuclear Information System (INIS)

Gotoh, Masafumi; Higuchi, Fujio; Suzuki, Ritsu; Yamanaka, Kensuke

2003-01-01

This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon without apparent tear. Three months after the first visit, MRI revealed a partial-thickness rotator cuff tear at the site of calcium deposition. Surgical and histologic findings demonstrated that calcium deposition was the cause of cuff rupture. To our knowledge, based on a review of the English literature, this is the first case report in which the progression from calcifying tendinitis to rotator cuff tear has been serially observed. (orig.)

Single-row versus double-row rotator cuff repair: techniques and outcomes.

Science.gov (United States)

Dines, Joshua S; Bedi, Asheesh; ElAttrache, Neal S; Dines, David M

2010-02-01

Double-row rotator cuff repair techniques incorporate a medial and lateral row of suture anchors in the repair configuration. Biomechanical studies of double-row repair have shown increased load to failure, improved contact areas and pressures, and decreased gap formation at the healing enthesis, findings that have provided impetus for clinical studies comparing single-row with double-row repair. Clinical studies, however, have not yet demonstrated a substantial improvement over single-row repair with regard to either the degree of structural healing or functional outcomes. Although double-row repair may provide an improved mechanical environment for the healing enthesis, several confounding variables have complicated attempts to establish a definitive relationship with improved rates of healing. Appropriately powered rigorous level I studies that directly compare single-row with double-row techniques in matched tear patterns are necessary to further address these questions. These studies are needed to justify the potentially increased implant costs and surgical times associated with double-row rotator cuff repair.

Inflatable Re-Entry Vehicle Experiment (IRVE) Design Overview

Science.gov (United States)

Hughes, Stephen J.; Dillman, Robert A.; Starr, Brett R.; Stephan, Ryan A.; Lindell, Michael C.; Player, Charles J.; Cheatwood, F. McNeil

2005-01-01

integrity when exposed to a relevant dynamic pressure and aerodynamic stability of the inflatable system. Structural integrity and structural response of the inflatable will be verified with photogrammetric measurements of the back side of the aeroshell in flight. Aerodynamic stability as well as drag performance will be verified with on board inertial measurements and radar tracking from multiple ground radar stations. The experiment will yield valuable information about zero-g vacuum deployment dynamics of the flexible inflatable structure with both inertial and photographic measurements. In addition to demonstrating inflatable technology, IRVE will validate structural, aerothermal, and trajectory modeling techniques for the inflatable. Structural response determined from photogrammetrics will validate structural models, skin temperature measurements and additional in-depth temperature measurements will validate material thermal performance models, and on board inertial measurements along with radar tracking from multiple ground radar stations will validate trajectory simulation models.

Multifield consequences for D-brane inflation

Energy Technology Data Exchange (ETDEWEB)

Dias, Mafalda; Frazer, Jonathan; Liddle, Andrew R., E-mail: m.dias@sussex.ac.uk, E-mail: j.frazer@sussex.ac.uk, E-mail: a.liddle@sussex.ac.uk [Astronomy Centre, University of Sussex, Brighton BN1 9QH (United Kingdom)

2012-06-01

We analyse the multifield behaviour in D-brane inflation when contributions from the bulk are taken into account. For this purpose, we study a large number of realisations of the potential; we find the nature of the inflationary trajectory to be very consistent despite the complex construction. Inflation is always canonical and occurs in the vicinity of an inflection point. Extending the transport method to non-slow-roll and to calculate the running, we obtain distributions for observables. The spectral index is typically blue and the running positive, putting the model under moderate pressure from WMAP7 constraints. The local f{sub NL} and tensor-to-scalar ratio are typically unobservably small, though we find approximately 0.5% of realisations to give observably large local f{sub NL}. Approximating the potential as sum-separable, we are able to give fully analytic explanations for the trends in observed behaviour. Finally we find the model suffers from the persistence of isocurvature perturbations, which can be expected to cause further evolution of adiabatic perturbations after inflation. We argue this is a typical problem for models of multifield inflation involving inflection points and renders models of this type technically unpredictive without a description of reheating.

Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure

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Woods TC

2014-06-01

Full Text Available Tom C Woods,4 Michael J Carroll,1 Atiba A Nelson,2 Kristie D More,2 Randa Berdusco,1 Stephen Sohmer,3 Richard S Boorman,1,2 Ian KY Lo1,21Department of Surgery, 2Sport Medicine Centre, University of Calgary, Calgary, AB, Canada; 3Department of Orthopaedics, University of British Columbia, Vancouver, 4St Joseph's Hospital, Comox, BC, CanadaPurpose: The purpose of this study was to evaluate clinical and anatomic outcomes of patients following transtendon rotator-cuff repair of partial articular supraspinatus tendon avulsion (PASTA lesions.Patients and methods: Patients in the senior author's practice who had isolated PASTA lesions treated by transtendon rotator-cuff repair were included (n=8 and retrospectively reviewed. All patients were evaluated preoperatively and at a mean of 21.2 months (±9.7 months postoperatively using standardized clinical evaluation (physical exam, American Shoulder and Elbow Surgeons, and Simple Shoulder Test. All patients underwent postoperative imaging with a magnetic resonance imaging arthrogram.Results: There was a significant improvement in American Shoulder and Elbow Surgeons (42.7±17.5 to 86.9±25.2 and Simple Shoulder Test (4.6±3.2 to 10.1±3.8 scores from pre- to postoperative, respectively. Postoperative imaging demonstrated full-thickness medial cuff tearing in seven patients, and one patient with a persistent partial articular surface defect.Conclusion: Transtendon repair of PASTA lesions may lead to improvements in clinical outcome. However, postoperative imaging demonstrated a high incidence of full-thickness rotator-cuff defects following repair.Keywords: rotator cuff, PASTA lesion, transtendon repair

Release of obstructing rectal cuff following transanal endorectal ...

African Journals Online (AJOL)

symptoms after transanal endorectal pullthrough for ... In both patients, the obstructing symptoms were because of a rectal cuff ... widely adopted for the treatment of Hirschsprung's disease ... The cuff was identified and cut strictly in the midline.

Macroeconomic variables and food price inflation, nonfood price inflation and overall inflation: A case of an emerging market

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Raphael T Mpofu

2017-03-01

Full Text Available The paper analyses the association between certain macroeconomic variables and food price inflation, non-food price inflation and overall inflation in Zimbabwe, and also seeks to determine the level of association between these variables, given food security implications and overall well-being of its citizens. The study reveals that during the 2010 to 2016 period, Zimbabwe experienced stable food prices—annual food price inflation for food and non-alcoholic beverages averaged a relatively low growth rate of 0.12% monthly, while non-food inflation monthly growth rate was 0.09% and overall inflation growth rate was 0.11%. Although inflation from 2010 had been declining, of late, the increase in annual inflation has been underpinned by a rise in non-food inflation. Zimbabwe’s annual inflation remains lower than inflation rates in other countries in the region. Despite the increases lately in overall inflation, it remained below zero in January 2016, mostly driven by the depreciation of the South African rand and declining international oil prices. It should also be noted that domestic demand continued to decline in 2015, leading to the observed decline in both food and non-food prices. While food inflation has remained relatively low, it should be noted that non-food expenditures is significant component of the household budget and the rising prices result often lead to declining purchasing power and force households to make difficult choices in terms of their purchases. The findings of the study are food inflation has a low association with the independent variables under study; Zimbabwe broad money supply, rand-dollar exchange rates and the South Africa food inflation. There is, however, a very strong association between non-food inflation and these independent variables, as well as between overall inflation and the independent variables. Given the mostly rural population and the high level of unemployment in Zimbabwe, it can be surmised that

Technical Note: Does Core Inflation Help Forecast Total Inflation? Evidence from Colombia

OpenAIRE

John Thornton

1998-01-01

In Colombia core and total inflation are both (1) series, and core inflation is cointegrated with total inflation. Granger causality tests using error correction methodology indicate that divergence of total inflation from core inflation is quickly revers

Euro area Inflation as a Predictor of National Inflation Rates

OpenAIRE

Antonella Cavallo; Antonio Ribba

2013-01-01

The stability of inflation differentials is an important condition for the smooth working of a currency area, such as the European Economic and Monetary Union. In the presence of stability, changes in national inflation rates, while holding Euro-area inflation fixed contemporaneously, should be only transitory. If this is the case, the rate of inflation of the whole area can also be interpreted as a predictor, at least in the long run, of the different national inflation rates. However, in th...

Asymptotic behavior of the warm inflation scenario with viscous pressure

International Nuclear Information System (INIS)

Mimoso, Jose P.; Nunes, Ana; Pavon, Diego

2006-01-01

We analyze the dynamics of models of warm inflation with general dissipative effects. We consider phenomenological terms both for the inflaton decay rate and for viscous effects within matter. We provide a classification of the asymptotic behavior of these models and show that the existence of a late-time scaling regime depends not only on an asymptotic behavior of the scalar field potential, but also on an appropriate asymptotic behavior of the inflaton decay rate. There are scaling solutions whenever the latter evolves to become proportional to the Hubble rate of expansion regardless of the steepness of the scalar field exponential potential. We show from thermodynamic arguments that the scaling regime is associated with a power-law dependence of the matter-radiation temperature on the scale factor, which allows a mild variation of the temperature of the matter/radiation fluid. We also show that the late-time contribution of the dissipative terms alleviates the depletion of matter, and increases the duration of inflation

Use of cuff tear arthroplasty head prosthesis for rotator cuff arthropathy treatment in elderly patients with comorbidities.

Science.gov (United States)

Carvalho, Cassiano Diniz; Andreoli, Carlos Vicente; Pochini, Alberto de Castro; Ejnisman, Benno

2016-01-01

To evaluate the clinical and functional behavior of patients undergoing cuff tear arthroplasty at different stages of the disease. Cuff tear arthroplasty hemiarthroplasties were performed in 34 patients with rotator cuff arthropathy and associated comorbidities, classified according to Seebauer. The mean age was 76.3 years, and the sample comprised 23 females (67.6%) and 11 males (32.4%). The mean follow-up period was 21.7 months, and evaluations were performed using the Visual Analog Scale for pain and the Constant scale. There were no statistically significant differences in the mean reduction in the Visual Analog Scale or in the Constant scale increase between the female and male groups. The variation between the pre- and postoperative Visual Analog Scale and Constant scale evaluations was significant. There was also no statistically significant difference between the Seebauer classification groups regarding the mean Visual Analog Scale reduction, or the mean Constant scale increase. Cuff tear arthroplasty shoulder hemiarthroplasty is a good option for rotator cuff arthropathy in patients with comorbidities. Avaliar o comportamento clínico e funcional dos pacientes submetidos à artroplastia do tipo cuff tear arthroplasty para o tratamento da artropatia do manguito rotador em diferentes estágios da afecção. Foram realizadas 34 hemiartroplastias do tipo cuff tear arthroplasty em 34 pacientes com artropatia do manguito rotador e comorbidades associadas, classificadas de acordo com Seebauer. A média de idade foi de 76,3 anos, sendo 23 pacientes do sexo feminino (67,6%) e 11 do sexo masculino (32,4%). O seguimento médio foi de 21,7 meses e a avaliação foi realizada por meio da Escala Visual Analógica da dor e pela escala de Constant. Não houve diferença estatisticamente significante entre os grupos feminino e masculino, tanto nas médias de redução na Escala Visual Analógica quanto nas de aumento na escala de Constant. A variação entre as avalia

Augmentation of Rotator Cuff Repair With Soft Tissue Scaffolds

Science.gov (United States)

Thangarajah, Tanujan; Pendegrass, Catherine J.; Shahbazi, Shirin; Lambert, Simon; Alexander, Susan; Blunn, Gordon W.

2015-01-01

Background Tears of the rotator cuff are one of the most common tendon disorders. Treatment often includes surgical repair, but the rate of failure to gain or maintain healing has been reported to be as high as 94%. This has been substantially attributed to the inadequate capacity of tendon to heal once damaged, particularly to bone at the enthesis. A number of strategies have been developed to improve tendon-bone healing, tendon-tendon healing, and tendon regeneration. Scaffolds have received considerable attention for replacement, reconstruction, or reinforcement of tendon defects but may not possess situation-specific or durable mechanical and biological characteristics. Purpose To provide an overview of the biology of tendon-bone healing and the current scaffolds used to augment rotator cuff repairs. Study Design Systematic review; Level of evidence, 4. Methods A preliminary literature search of MEDLINE and Embase databases was performed using the terms rotator cuff scaffolds, rotator cuff augmentation, allografts for rotator cuff repair, xenografts for rotator cuff repair, and synthetic grafts for rotator cuff repair. Results The search identified 438 unique articles. Of these, 214 articles were irrelevant to the topic and were therefore excluded. This left a total of 224 studies that were suitable for analysis. Conclusion A number of novel biomaterials have been developed into biologically and mechanically favorable scaffolds. Few clinical trials have examined their effect on tendon-bone healing in well-designed, long-term follow-up studies with appropriate control groups. While there is still considerable work to be done before scaffolds are introduced into routine clinical practice, there does appear to be a clear indication for their use as an interpositional graft for large and massive retracted rotator cuff tears and when repairing a poor-quality degenerative tendon. PMID:26665095

Standard sonography and arthrosonography in the study of rotator cuff tears

International Nuclear Information System (INIS)

El-Dalati, Ghassan; Martone, Enrico; Caffarri, Sabrina; Fusaro, Michele; Pozzi Mucelli, Roberto; Castellarin, Gianluca; Ricci, Matteo; Vecchini, Eugenio

2005-01-01

Purpose. The aim of this study was to evaluate the sensitivity of ultrasonography, integrating standard ultrasound and arthrosonography after injecting a saline solution into the glenohumeral cavity in cases of suspected rotator cuff tears. Materials and methods. We respectively examinated 40 patients awaiting shoulder arthroscopy for suspected or diagnosed tears of the rotator cuff. A radiologist, unaware of the pre-operative diagnosis, performed an ultrasound scan on all the patients before and after the injection of saline solution into the glenohumeral cavity. The parameters considered were presence or absence of a rotator cuff injury; type of injury according to Snyder and its extent along the longitudinal and transverse planes; presence or absence of effusion into the articular cavity; subacromial/subdeltoid bursal distension. All the patients underwent arthroscopy either the same day of the day after the ultrasound examination. Results. Standard sonography showed 26 complete rotator cuff tears (type C according to Snyder), 2 partial tears (type B according to Snyder) and 12 intact rotator cuffs. Arthrosonography detected 31 complete rotator cuff tears (type C according to Snyder), 1 partial tear (type B according to Snyder) and 8 intact rotator cuffs. Arthroscopy identified 32 complete rotator cuff tears (type C according to Snyder), 1 partial tear (type B according to Snyder) and 8 intact rotator cuffs. Analysis of the results shows that, taking arthroscopy as the gold standard, the sensitivity of normal sonography is 81.2%, whereas that of arthosonography is 96.8% (p [it

Evaluation of the leakage behavior of inflatable seals subject to severe accident conditions

International Nuclear Information System (INIS)

Parks, M.B.

1989-11-01

Sandia National Laboratories, under the sponsorship of the United States Nuclear Regulatory Commission, is currently developing test validated methods to predict the pressure capacity of light water reactor containment buildings when subjected to postulated severe accident conditions. These conditions are well beyond the design basis. Scale model tests of steel and reinforced concrete containments have been conducted as well as tests of typical containment penetrations. As a part of this effort, a series of tests was recently conducted to determine the leakage behavior of inflatable seals. These seals are used to prevent leakage around personnel and escape lock doors of some containments. The results of the inflatable seals tests are the subject of this report. Inflatable seals were tested at both room temperature and at elevated temperatures representative of postulated severe accident conditions. Both aged (radiation and thermal) and unaged seals were included in the test program. The internal seal pressure at the beginning of each test was varied to cover the range of seal pressures actually used in containments. For each seal pressure level, the external (containment) pressure was increased until significant leakage past the seals was observed. Parameters that were monitored and recorded during the tests were the internal seal pressure, chamber pressure, leakage past the seals, and temperature of the test chamber and fixture to which the seals were attached. 8 refs., 34 figs., 7 tabs

Magnitude of Interfractional Vaginal Cuff Movement: Implications for External Irradiation

International Nuclear Information System (INIS)

Ma, Daniel J.; Michaletz-Lorenz, Martha; Goddu, S. Murty; Grigsby, Perry W.

2012-01-01

Purpose: To quantify the extent of interfractional vaginal cuff movement in patients receiving postoperative irradiation for cervical or endometrial cancer in the absence of bowel/bladder instruction. Methods and Materials: Eleven consecutive patients with cervical or endometrial cancer underwent placement of three gold seed fiducial markers in the vaginal cuff apex as part of standard of care before simulation. Patients subsequently underwent external irradiation and brachytherapy treatment based on institutional guidelines. Daily megavoltage CT imaging was performed during each external radiation treatment fraction. The daily positions of the vaginal apex fiducial markers were subsequently compared with the original position of the fiducial markers on the simulation CT. Composite dose–volume histograms were also created by summing daily target positions. Results: The average (± standard deviation) vaginal cuff movement throughout daily pelvic external radiotherapy when referenced to the simulation position was 16.2 ± 8.3 mm. The maximum vaginal cuff movement for any patient during treatment was 34.5 mm. In the axial plane the mean vaginal cuff movement was 12.9 ± 6.7 mm. The maximum vaginal cuff axial movement was 30.7 mm. In the craniocaudal axis the mean movement was 10.3 ± 7.6 mm, with a maximum movement of 27.0 mm. Probability of cuff excursion outside of the clinical target volume steadily dropped as margin size increased (53%, 26%, 4.2%, and 1.4% for 1.0, 1.5, 2.0, and 2.5 cm, respectively.) However, rectal and bladder doses steadily increased with larger margin sizes. Conclusions: The magnitude of vaginal cuff movement is highly patient specific and can impact target coverage in patients without bowel/bladder instructions at simulation. The use of vaginal cuff fiducials can help identify patients at risk for target volume excursion.

Regenerative Medicine in Rotator Cuff Injuries

Science.gov (United States)

Randelli, Pietro; Ragone, Vincenza; Menon, Alessandra; Cabitza, Paolo; Banfi, Giuseppe

2014-01-01

Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results. Platelet-rich plasma (PRP) is a whole blood fraction which contains several growth factors. Controlled clinical studies using different autologous PRP formulations have provided controversial results. However, favourable structural healing rates have been observed for surgical repair of small and medium rotator cuff tears. Cell-based approaches have also been suggested to enhance tendon healing. Bone marrow is a well known source of mesenchymal stem cells (MSCs). Recently, ex vivo human studies have isolated and cultured distinct populations of MSCs from rotator cuff tendons, long head of the biceps tendon, subacromial bursa, and glenohumeral synovia. Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research. PMID:25184132

Regenerative Medicine in Rotator Cuff Injuries

Directory of Open Access Journals (Sweden)

Pietro Randelli

2014-01-01

Full Text Available Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results. Platelet-rich plasma (PRP is a whole blood fraction which contains several growth factors. Controlled clinical studies using different autologous PRP formulations have provided controversial results. However, favourable structural healing rates have been observed for surgical repair of small and medium rotator cuff tears. Cell-based approaches have also been suggested to enhance tendon healing. Bone marrow is a well known source of mesenchymal stem cells (MSCs. Recently, ex vivo human studies have isolated and cultured distinct populations of MSCs from rotator cuff tendons, long head of the biceps tendon, subacromial bursa, and glenohumeral synovia. Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research.

Warm natural inflation

International Nuclear Information System (INIS)

Mishra, Hiranmaya; Mohanty, Subhendra; Nautiyal, Akhilesh

2013-01-01

In warm inflation models there is the requirement of generating large dissipative couplings of the inflation with radiation, while at the same Âătime, not de-stabilising the flatness of the inflation potential due to radiative corrections. One way to achieve this without fine tuning unrelated couplings is by supersymmetry. In this talk we will discuss warm inflation with Pseudo-Nambu-Goldstone Bosons (PNGB). In this case inflation and other light fields are PNGB. So, the radiative corrections to the potential are suppressed and the thermal Âăcorrections are small as long as the temperature is below the symmetry breaking scale. In such models it is possible to fulfill the contrary requirements of an inflation potential which is stable under radiative corrections and the generation of a large dissipative coupling of the inflation field with other light fields. This warm inflation model with PNGB gives the observed CMB-anisotropy amplitude and spectral index having the symmetry breaking scale at the GUT scale. (author)

Epidemiology, natural history, and indications for treatment of rotator cuff tears.

Science.gov (United States)

Tashjian, Robert Z

2012-10-01

The etiology of rotator cuff disease is likely multifactorial, including age-related degeneration and microtrauma and macrotrauma. The incidence of rotator cuff tears increases with aging with more than half of individuals in their 80s having a rotator cuff tear. Smoking, hypercholesterolemia, and genetics have all been shown to influence the development of rotator cuff tearing. Substantial full-thickness rotator cuff tears, in general, progress and enlarge with time. Pain, or worsening pain, usually signals tear progression in both asymptomatic and symptomatic tears and should warrant further investigation if the tear is treated conservatively. Larger (>1-1.5 cm) symptomatic full-thickness cuff tears have a high rate of tear progression and, therefore, should be considered for earlier surgical repair in younger patients if the tear is reparable and there is limited muscle degeneration to avoid irreversible changes to the cuff, including tear enlargement and degenerative muscle changes. Smaller symptomatic full-thickness tears have been shown to have a slower rate of progression, similar to partial-thickness tears, and can be considered for initial nonoperative treatment due to the limited risk for rapid tear progression. In both small full-thickness tears and partial-thickness tears, increasing pain should alert physicians to obtain further imaging as it can signal tear progression. Natural history data, along with information on factors affecting healing after rotator cuff repair, can help guide surgeons in making appropriate decisions regarding the treatment of rotator cuff tears. The management of rotator cuff tears should be considered in the context of the risks and benefits of operative versus nonoperative treatment. Tear size and acuity, the presence of irreparable changes to the rotator cuff or glenohumeral joint, and patient age should all be considered in making this decision. Initial nonoperative care can be safely undertaken in older patients (>70

Ambulatory heart rate is underestimated when measured by an Ambulatory Blood Pressure device

NARCIS (Netherlands)

Vrijkotte, T.G.M.; de Geus, E.J.C.

1999-01-01

Objective: To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Design: Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous

Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

NARCIS (Netherlands)

Vrijkotte, T. G.; de Geus, E. J.

2001-01-01

To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous electrocardiogram (ECG) recordings

Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

NARCIS (Netherlands)

Vrijkotte, T.G.M.; de Geus, E.J.C.

2001-01-01

Objective: To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Design: Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous

Multiple inflation

International Nuclear Information System (INIS)

Murphy, P.J.

1987-01-01

The Theory of Inflation, namely, that at some point the entropy content of the universe was greatly increased, has much promise. It may solve the puzzles of homogeneity and the creation of structure. However, no particle physics model has yet been found that can successfully drive inflation. The difficulty in satisfying the constraint that the isotropy of the microwave background places on the effective potential of prospective models is immense. In this work we have codified the requirements of such models in a most general form. We have carefully calculated the amounts of inflation the various problems of the Standard Model need for their solution. We have derived a completely model independent upper bond on the inflationary Hubble parameter. We have developed a general notation with which to probe the possibilities of Multiple Inflation. We have shown that only in very unlikely circumstances will any evidence of an earlier inflation, survive the de Sitter period of its successor. In particular, it is demonstrated that it is most unlikely that two bouts of inflation will yield high amplitudes of density perturbations on small scales and low amplitudes on large. We conclude that, while multiple inflation will be of great theoretical interest, it is unlikely to have any observational impact

SECOND ROUND EFFECTS AND PASS-THROUGH OF FOOD PRICES TO INFLATION IN KENYA

Directory of Open Access Journals (Sweden)

Roseline Nyakerario Misati

2015-07-01

Full Text Available In the recent past, the Kenyan economy experienced persistent inflationary pressures, partly attributed to food price spikes. However, the quantitative role of food prices in inflation is not well understood or formally empirically analyzed in Kenya yet food occupies a weight of 36 percent in the consumer price index and contributes a monthly average of over 40 percent to overall inflation. Based on monthly data covering the period 1997-2012, this paper attempts to fill this gap by examining the relationship between food prices and inflation. The study used gap models and Phillips curve approaches to estimate the passthrough effects of food prices to both overall inflation and non-food non-fuel inflation. Based on gap models, the results confirm presence of second round effects from food prices to inflation while estimations of the Phillips curve suggest a domestic food price pass-through of 0.49 to overall inflation and 0.38 to non-food non-fuel inflation. The world food prices pass-through to overall inflation and non-food non-fuel inflation are estimated at 0.09 and 0.08, respectively. Thus this paper recommends usage of headline inflation to estimate trend inflation, enhanced communication to mitigate second round effects and that while monetary policy is very critical in anchoring inflationary expectations, there is mutual gain from a supportive fiscal policy in addressing supply side shocks.

Adaptive inflatable structures for protecting wind turbines against ship collisions

Energy Technology Data Exchange (ETDEWEB)

Graczykowski, C.; Heinonen, J.

2006-09-15

Collisions of small ships are one of main dangers for the offshore wind turbines. Using inflatable structures surrounding the tower on the water level is a possibility of effective protection. Modelling of such structures is based on interaction between solid wall and fluid enclosed inside. Inflatable structures can be adapted to various impact schemes by adjusting initial pressure and controlling release of compressed air by opening piezo-valves. Simulations of ship collision with 2D model of wind turbine tower protected by pneumatic structure are presented in the report. Numerical analysis is performed using ABAQUS/Standard and ABAQUS/Explicit. Performed feasibility study proves that inflatable structures can protect wind turbine tower and ship against serious damages. (orig.)

Interposition vein cuffs.

Science.gov (United States)

Harris, P; Da Silva, T; How, T

1996-01-01

A vein cuff interposed at the distal anastomosis between a prosthetic vascular graft and a recipient infrageniculate artery improves the chances of continued patency of the graft, at least in the short and medium term. The mode of effect appears to be suppression or modification of anastomotic myointimal hyperplasia (MIH). In the event of graft failure the recipient artery and run-off vessels remain free from MIH and their patency is preserved thereby improving the prospects for further vascular reconstruction and limb salvage. The mechanisms by which interposition vein cuffs might modulate MIH are reviewed. Experimental evidence is described to show that the geometry of a cuffed anastomosis promotes a characteristic haemodynamic flow structure with a stable vortex. It is suggested that this vortex exerts greater shear stress upon the wall of the artery than the normal laminar flow observed in conventional anastomoses. High shear stress is known to inhibit MIH.

Flow and volume dependence of rat airway resistance during constant flow inflation and deflation.

Science.gov (United States)

Rubini, Alessandro; Carniel, Emanuele Luigi; Parmagnani, Andrea; Natali, Arturo Nicola

2011-12-01

The aim of this study was to measure the flow and volume dependence of both the ohmic and the viscoelastic pressure dissipations of the normal rat respiratory system separately during inflation and deflation. The study was conducted in the Respiratory Physiology Laboratory in our institution. Measurements were obtained for Seven albino Wistar rats of both sexes by using the flow interruption method during constant flow inflations and deflations. Measurements included anesthesia induction, tracheostomy and positioning of a tracheal cannula, positive pressure ventilation, constant flow respiratory system inflations and deflations at two different volumes and flows. The ohmic resistance exhibited volume and flow dependence, decreasing with lung volume and increasing with flow rate, during both inflation and deflation. The stress relaxation-related viscoelastic resistance also exhibited volume and flow dependence. It decreased with the flow rate at a constant lung volume during both inflation and deflation, but exhibited a different behavior with the lung volume at a constant flow rate (i.e., increased during inflations and decreased during deflations). Thus, stress relaxation in the rat lungs exhibited a hysteretic behavior. The observed flow and volume dependence of respiratory system resistance may be predicted by an equation derived from a model of the respiratory system that consists of two distinct compartments. The equation agrees well with the experimental data and indicates that the loading time is the critical parameter on which stress relaxation depends, during both lung inflation and deflation.

Effect of contacts configuration and location on selective stimulation of cuff electrode.

Science.gov (United States)

Taghipour-Farshi, Hamed; Frounchi, Javad; Ahmadiasl, Nasser; Shahabi, Parviz; Salekzamani, Yaghoub

2015-01-01

Cuff electrodes have been widely used chronically in different clinical applications. Advancements have been made in selective stimulation by using multi-contact cuff electrodes. Steering anodic current is a strategy to increase selectivity by reshaping and localizing electric fields. There are two configurations for contacts to be implemented in cuff, monopolar and tripolar. A cuff electrode with tripolar configuration can restrict the activation to a more localized region within a nerve trunk compared to a cuff with monopolar configuration and improve the selectivity. Anode contacts in tripolar configuration can be made in two structures, "ring" and "dot". In this study, the stimulation capabilities of these two structures were evaluated. The recruitment properties and the selectivity of stimulation were examined by measuring the electric potential produced by stimulation currents. The results of the present study indicated that using dot configuration, the current needed to stimulate fascicles in tripolar topologies would be reduced by 10%. It was also shown that stimulation threshold was increased by moving anode contacts inward the cuff. On the other hand, stimulation threshold was decreased by moving the anode contacts outward the cuff which would decrease selectivity, too. We conclude that dot configuration is a better choice for stimulation. Also, a cuff inward placement of 10% relative to the cuff length was near optimal.

Increased flow sensitivity from gradient recalled echoes and short TRs

International Nuclear Information System (INIS)

Hearshen, D.O.; Froelich, J.W.; Wehrli, F.W.; Haggar, A.M.; Shimakawa, A.

1986-01-01

Time-of-flight effects from flow have been characterized in spin-echo images. ''Paradoxical'' enhancement and flow void are observed. Similar enhancement is seen on GRASS images. With no flow void and gradients existing throughout the volume, spins experiencing radio-frequency pulses will give rise to signals even for fast flow, providing a greater velocity sensitivity. GRASS images were obtained from a volunteer with a blood pressure cuff placed over the right thigh. With the cuff inflated, flow in the popliteal vein results in signal saturation. Increasing TR increases intensity in the popliteal vein relative to other vessels. This suggests a clinical role for the technique in assessment of slow flow

Exercise increases pressure pain tolerance but not pressure and heat pain thresholds in healthy young men.

Science.gov (United States)

Vaegter, H B; Hoeger Bement, M; Madsen, A B; Fridriksson, J; Dasa, M; Graven-Nielsen, T

2017-01-01

Exercise causes an acute decrease in the pain sensitivity known as exercise-induced hypoalgesia (EIH), but the specificity to certain pain modalities remains unknown. This study aimed to compare the effect of isometric exercise on the heat and pressure pain sensitivity. On three different days, 20 healthy young men performed two submaximal isometric knee extensions (30% maximal voluntary contraction in 3 min) and a control condition (quiet rest). Before and immediately after exercise and rest, the sensitivity to heat pain and pressure pain was assessed in randomized and counterbalanced order. Cuff pressure pain threshold (cPPT) and pain tolerance (cPTT) were assessed on the ipsilateral lower leg by computer-controlled cuff algometry. Heat pain threshold (HPT) was recorded on the ipsilateral foot by a computer-controlled thermal stimulator. Cuff pressure pain tolerance was significantly increased after exercise compared with baseline and rest (p  0.77) compared with HPT (intraclass correlation = 0.54). The results indicate that hypoalgesia after submaximal isometric exercise is primarily affecting tolerance of pressure pain compared with the pain threshold. These data contribute to the understanding of how isometric exercise influences pain perception, which is necessary to optimize the clinical utility of exercise in management of chronic pain. The effect of isometric exercise on pain tolerance may be relevant for patients in chronic musculoskeletal pain as a pain-coping strategy. WHAT DOES THIS STUDY ADD?: The results indicate that hypoalgesia after submaximal isometric exercise is primarily affecting tolerance of pressure pain compared with the heat and pressure pain threshold. These data contribute to the understanding of how isometric exercise influences pain perception, which is necessary to optimize the clinical utility of exercise in management of chronic pain. © 2016 European Pain Federation - EFIC®.

Normal isometric strength of rotator cuff muscles in adults

OpenAIRE

Chezar, A.; Berkovitch, Y.; Haddad, M.; Keren, Y.; Soudry, M.; Rosenberg, N.

2013-01-01

Objectives The most prevalent disorders of the shoulder are related to the muscles of rotator cuff. In order to develop a mechanical method for the evaluation of the rotator cuff muscles, we created a database of isometric force generation by the rotator cuff muscles in normal adult population. We hypothesised the existence of variations according to age, gender and dominancy of limb. Methods A total of 400 healthy adult volunteers were tested, classified into groups of 50 men and women for e...

Establishing Maximal Medical Improvement After Arthroscopic Rotator Cuff Repair.

Science.gov (United States)

Zuke, William A; Leroux, Timothy S; Gregory, Bonnie P; Black, Austin; Forsythe, Brian; Romeo, Anthony A; Verma, Nikhil N

2018-03-01

As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. Systematic review. A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1

HIGH-RESOLUTION ULTRASONOGRAPHY OF SHOULDER FOR ROTATOR CUFF TEAR: CORRELATION WITH ARTHROSCOPIC FINDINGS

Directory of Open Access Journals (Sweden)

Vishnumurthy H. Y

2016-09-01

Full Text Available INTRODUCTION Rotator cuff disease is the most common cause of shoulder pain. Ultrasonography being non-invasive, widely available, more cost-effective method and is the first choice in imaging of rotator cuff tears. Arthroscopy of shoulder is considered as the gold standard for diagnosis of rotator cuff tears. Objective of this study was to compare the diagnostic accuracy of high-resolution ultrasonography of shoulder for rotator cuff tears with arthroscopy of shoulder. METHODS Thirty patients clinically suspected to have rotator cuff tear who underwent ultrasonography and arthroscopy of shoulder were included in the study. Duration of study was for two years. All ultrasonography examinations were conducted in ultrasound machine using GE Voluson 730 PRO high frequency (10-12 MHz linear array transducer done by two experienced radiologists. Arthroscopies were done by two experienced shoulder arthroscopic surgeons. RESULTS Age of the patients with rotator cuff tears ranged from 40 to 80 years. 57% were females and 43% were males among the patients who had rotator cuff tears. 71.43% of the rotator cuff tears were found in the dominant arm. 64.28% of patients with rotator cuff tear had given history of fall or trauma to the corresponding shoulder within 6 months prior to presentation. 39.28% of patients who had rotator cuff tears were known diabetics. Supraspinatus tendon was the most commonly affected tendon, followed by infraspinatus and subscapularis tendons. For overall detection of rotator cuff tears, ultrasonography in comparison with the arthroscopy has sensitivity and specificity of 92.85% and 100%. For detection of full thickness rotator cuff tear, its sensitivity and specificity was 94.73% and 100% and for partial thickness rotator cuff tears 76.92% and 100%. Ultrasonography has 100% sensitivity and specificity for detection of supraspinatus full thickness tear. For supraspinatus partial thickness tear, sensitivity and specificity was 88

Study of the suit inflation effect on crew safety during landing using a full-pressure IVA suit for new-generation reentry space vehicles

Science.gov (United States)

Wataru, Suzuki

Recently, manned space capsules have been recognized as beneficial and reasonable human space vehicles again. The Dragon capsule already achieved several significant successes. The Orion capsule is going to be sent to a high-apogee orbit without crews for experimental purposes in September 2014. For such human-rated space capsules, the study of acceleration impacts against the human body during splashdown is essential to ensure the safety of crews. Moreover, it is also known that wearing a full pressure rescue suit significantly increases safety of a crew, compared to wearing a partial pressure suit. This is mainly because it enables the use of a personal life support system independently in addition to that which installed in the space vehicle. However, it is unclear how the inflation of the full pressure suit due to pressurization affects the crew safety during splashdown, especially in the case of the new generation manned space vehicles. Therefore, the purpose of this work is to investigate the effect of the suit inflation on crew safety against acceleration impact during splashdown. For this objective, the displacements of the safety harness in relation with the suit, a human surrogate, and the crew seats during pressurizing the suit in order to determine if the safety and survivability of a crew can be improved by wearing a full pressure suit. For these tests, the DL/H-1 full pressure IVA suit, developed by Pablo de Leon and Gary L. Harris, will be used. These tests use image analysis techniques to determine the displacements. It is expected, as a result of these tests, that wearing a full pressure suit will help to mitigate the impacts and will increase the safety and survivability of a crew during landing since it works as a buffer to mitigate impact forces during splashdown. This work also proposes a future plan for sled test experiments using a sled facility such as the one in use by the Civil Aerospace Medical Institute (CAMI) for experimental validation

Arthroscopic rotator cuff repair in elite rugby players.

Science.gov (United States)

Tambe, Amol; Badge, Ravi; Funk, Lennard

2009-01-01

Rugby is an increasingly popular collision sport. A wide spectrum of injuries can be sustained during training and match play. Rotator cuff injury is uncommon in contact sports and there is little published literature on the treatment of rotator cuff tears in rugby players. We therefore reviewed the results and functional outcomes of arthroscopic rotator cuff repair in elite rugby players. Eleven professional rugby players underwent arthroscopic rotator cuff repair at our hospital over a 2-year period. We collected data on these patients from the operative records. The patients were recalled for outcome scoring and ultrasound scans. There were seven rugby league players and four rugby union players, including six internationals. Their mean age was 25.7 years. All had had a traumatic episode during match play and could not return to the game after the injury. The mean time to surgery was 5 weeks. The mean width of the cuff tear was 1.8 cm. All were full- thickness cuff tears. Associated injuries included two Bankart lesions, one bony Bankart lesion, one posterior labral tear, and two 360 degrees labral tears. The biceps was involved in three cases. Two were debrided and a tenodesis was performed in one. Repair was with suture anchors. Following surgery, all patients underwent a supervised accelerated rehabilitation programme. The final follow-up was at 18 months (range: 6-31 months) post surgery. The Constant scores improved from 44 preoperatively to 99 at the last follow-up. The mean score at 3 months was 95. The Oxford shoulder score improved from 34 to 12, with the mean third month score being 18. The mean time taken to return to full match play at the preinjury level was 4.8 months. There were no complications in any of the patients and postoperative scans in nine patients confirmed that the repairs had healed. We conclude that full-thickness rotator cuff tears in the contact athlete can be addressed successfully by arthroscopic repair, with a rapid return to

What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.

Science.gov (United States)

Boorman, Richard S; More, Kristie D; Hollinshead, Robert M; Wiley, James P; Mohtadi, Nicholas G; Lo, Ian K Y; Brett, Kelly R

2018-03-01

The purpose of this study was to examine 5-year outcomes in a prospective cohort of patients previously enrolled in a nonoperative rotator cuff tear treatment program. Patients with chronic (>3 months), full-thickness rotator cuff tears (demonstrated on imaging) who were referred to 1 of 2 senior shoulder surgeons were enrolled in the study between October 2008 and September 2010. They participated in a comprehensive, nonoperative, home-based treatment program. After 3 months, the outcome in these patients was defined as "successful" or "failed." Patients in the successful group were essentially asymptomatic and did not require surgery. Patients in the failed group were symptomatic and consented to undergo surgical repair. All patients were followed up at 1 year, 2 years, and 5 or more years. At 5 or more years, all patients were contacted for follow-up; the response rate was 84%. Approximately 75% of patients remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100 (SD, 16). Furthermore, between 2 and 5 years, only 3 patients who had previously been defined as having a successful outcome became more symptomatic and underwent surgical rotator cuff repair. Those in whom nonoperative treatment had failed and who underwent surgical repair had a mean rotator cuff quality-of-life index score of 89 (SD, 11) at 5-year follow-up. The operative and nonoperative groups at 5-year follow-up were not significantly different (P = .11). Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Stability of inflation processes with polymer melts

DEFF Research Database (Denmark)

Rasmussen, Henrik Koblitz; Eriksson, Torbjörn Gerhard; Hassager, Ole

2002-01-01

is performed applying a gas pressure into the core of the cylinder, which press the molten plastic cylinder outward. During the inflation the plastic may burst. The occurrence of this burst, or break, puts a limit on the possibility to produce a specified product at some, or all, processing conditions. Here...

Remote inflation as hybrid-like sneutrino/MSSM inflation

International Nuclear Information System (INIS)

Matsuda, Tomohiro

2009-01-01

A new scenario of hybrid-like inflation is considered for sneutrino and MSSM fields. Contrary to the usual hybrid inflation model, the direct coupling between a trigger field and the sneutrino/MSSM inflaton field is not necessary for the scenario. The dissipation and the radiation from the sneutrino/MSSM inflaton can be written explicitly by using the Yukawa couplings. Remote inflation does not require the shift symmetry or cancellation in solving the η problem.

Pseudosmooth tribrid inflation

International Nuclear Information System (INIS)

Antusch, Stefan; Nolde, David; Rehman, Mansoor Ur

2012-01-01

We explore a new class of supersymmetric models of inflation where the inflaton is realised as a combination of a Higgs field and (gauge non-singlet) matter fields, using a ''tribrid'' structure of the superpotential. Inflation is associated with a phase transition around GUT scale energies. The inflationary trajectory already preselects the later vacuum after inflation, which has the advantage of automatically avoiding the production of dangerous topological defects at the end of inflation. While at first sight the models look similar to smooth inflation, they feature a waterfall and are therefore only pseudosmooth. The new class of models offers novel possibilities for realising inflation in close contact with particle physics, for instance with supersymmetric GUTs or with supersymmetric flavour models based on family symmetries

Pseudosmooth tribrid inflation

Science.gov (United States)

Antusch, Stefan; Nolde, David; Rehman, Mansoor Ur

2012-08-01

We explore a new class of supersymmetric models of inflation where the inflaton is realised as a combination of a Higgs field and (gauge non-singlet) matter fields, using a ``tribrid'' structure of the superpotential. Inflation is associated with a phase transition around GUT scale energies. The inflationary trajectory already preselects the later vacuum after inflation, which has the advantage of automatically avoiding the production of dangerous topological defects at the end of inflation. While at first sight the models look similar to smooth inflation, they feature a waterfall and are therefore only pseudosmooth. The new class of models offers novel possibilities for realising inflation in close contact with particle physics, for instance with supersymmetric GUTs or with supersymmetric flavour models based on family symmetries.

Rotator Cuff Disease and Injury--Evaluation and Management.

Science.gov (United States)

Williams, Randy

This presentation considers the incidence, evaluation, and management of rotator cuff disease and injury. Pathogenesis, symptoms, physical findings, treatment (therapeutic and surgical), and prevention are discussed. It is noted that rotator cuff problems, common in athletes, are usually related to an error in training or lack of training. They…

Inflation Protected Investment Strategies

Directory of Open Access Journals (Sweden)

Mirco Mahlstedt

2016-03-01

Full Text Available In this paper, a dynamic inflation-protected investment strategy is presented, which is based on traditional asset classes and Markov-switching models. Different stock market, as well as inflation regimes are identified, and within those regimes, the inflation hedging potential of stocks, bonds, real estate, commodities and gold are investigated. Within each regime, we determine optimal investment portfolios driven by the investment idea of protection from losses due to changing inflation if inflation is rising or high, but decoupling the performance from inflation if inflation is low. The results clearly indicate that these asset classes behave differently in different stock market and inflation regimes. Whereas in the long-run, we agree with the general opinion in the literature that stocks and bonds are a suitable hedge against inflation, we observe for short time horizons that the hedging potential of each asset class, especially of real estate and commodities, depend strongly on the state of the current market environment. Thus, our approach provides a possible explanation for different statements in the literature regarding the inflation hedging properties of these asset classes. A dynamic inflation-protected investment strategy is developed, which combines inflation protection and upside potential. This strategy outperforms standard buy-and-hold strategies, as well as the well-known 1 N -portfolio.

Rotator cuff tendon connections with the rotator cable.

Science.gov (United States)

Rahu, Madis; Kolts, Ivo; Põldoja, Elle; Kask, Kristo

2017-07-01

The literature currently contains no descriptions of the rotator cuff tendons, which also describes in relation to the presence and characteristics of the rotator cable (anatomically known as the ligamentum semicirculare humeri). The aim of the current study was to elucidate the detailed anatomy of the rotator cuff tendons in association with the rotator cable. Anatomic dissection was performed on 21 fresh-frozen shoulder specimens with an average age of 68 years. The rotator cuff tendons were dissected from each other and from the glenohumeral joint capsule, and the superior glenohumeral, coracohumeral, coracoglenoidal and semicircular (rotator cable) ligaments were dissected. Dissection was performed layer by layer and from the bursal side to the joint. All ligaments and tendons were dissected in fine detail. The rotator cable was found in all specimens. It was tightly connected to the supraspinatus (SSP) tendon, which was partly covered by the infraspinatus (ISP) tendon. The posterior insertion area of the rotator cable was located in the region between the middle and inferior facets of the greater tubercle of the humerus insertion areas for the teres minor (TM), and ISP tendons were also present and fibres from the SSP extended through the rotator cable to those areas. The connection between the rotator cable and rotator cuff tendons is tight and confirms the suspension bridge theory for rotator cuff tears in most areas between the SSP tendons and rotator cable. In its posterior insertion area, the rotator cable is a connecting structure between the TM, ISP and SSP tendons. These findings might explain why some patients with relatively large rotator cuff tears can maintain seamless shoulder function.

The "Parachute" Technique: A Simple and Effective Single-Row Procedure to Achieve an Increased Contact Area Between the Cuff-Tendon and Its Footprint.

Science.gov (United States)

Natera, Luis; Consigliere, Paolo; Witney-Lagen, Caroline; Brugera, Juan; Sforza, Giuseppe; Atoun, Ehud; Levy, Ofer

2017-10-01

Many techniques of arthroscopic rotator cuff repair have been described. No significant differences in clinical outcomes or rerupture rates have been observed when comparing single-row with double-row methods. Not all single- and double-row repairs are the same. The details of the technique used are crucial. It has been shown that the suture-tendon interface is the weakest point of the reconstruction. Therefore, the biomechanical properties of rotator cuff repairs might be influenced more by the suture configuration than by the number of anchors or by the number of rows involved. Techniques that secure less amount of tendon over a smaller area of the healing zone might be expected to have higher failure rates. The way the sutures of the "parachute technique" are configured represents a quadruple mattress that increases the contact and pressure between the tendon and its footprint and increases the primary load to failure of the repair. We present a simple and effective single-row technique that involves the biomechanical and biological advantages related to the increased contact area and pressure between the cuff and its footprint.

Evaluation of post-exercise magnetic resonance images of the rotator cuff

International Nuclear Information System (INIS)

Cahoy, P.M.; Orwin, J.F.; Tuite, M.J.

1996-01-01

Objective. To examine the effect of strenuous exercise on the magnetic resonance imaging (MRI) characteristics of the rotator cuff tendon. A second objective was to define an optimal time to image the rotator cuff and possibly eliminate exercise-induced false positives. Design and patients. Five male subjects from 24 to 38 years old with normal rotator cuffs by history, physical examination, and screening MRI underwent a rotator cuff exercise session on the Biodex System 2 (Biodex, Shirley, New York). The exercise sessions were followed by sequential MRI scans of the exercised shoulder. These were performed immediately and at 8 h and 24 h after exercise. Results and conclusions. The rotator cuff tendon and subacromial-subdeltoid bursal signal remained unchanged from the pre-exercise through the 24-h post-exercise scans. The rotator cuff muscle signal was increased in five of five subjects on the immediate post-exercise fat-suppressed T2-weighted images. This signal returned to baseline by the 8-h scan. Positive findings of rotator cuff pathology on MRI after strenuous athletic activity should not be discounted as normal exercise-induced changes. Also, diagnostic MRI scanning may take place after a practice session without an increased risk of false positives. (orig.). With 1 fig

Evaluation of post-exercise magnetic resonance images of the rotator cuff

Energy Technology Data Exchange (ETDEWEB)

Cahoy, P M [Division of Orthopedic Surgery G5/358, University of Wisconsin Hospital and Clinics, Madison, WI (United States); Orwin, J F [Division of Orthopedic Surgery G5/358, University of Wisconsin Hospital and Clinics, Madison, WI (United States); Tuite, M J [Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, WI (United States)

1996-11-01

Objective. To examine the effect of strenuous exercise on the magnetic resonance imaging (MRI) characteristics of the rotator cuff tendon. A second objective was to define an optimal time to image the rotator cuff and possibly eliminate exercise-induced false positives. Design and patients. Five male subjects from 24 to 38 years old with normal rotator cuffs by history, physical examination, and screening MRI underwent a rotator cuff exercise session on the Biodex System 2 (Biodex, Shirley, New York). The exercise sessions were followed by sequential MRI scans of the exercised shoulder. These were performed immediately and at 8 h and 24 h after exercise. Results and conclusions. The rotator cuff tendon and subacromial-subdeltoid bursal signal remained unchanged from the pre-exercise through the 24-h post-exercise scans. The rotator cuff muscle signal was increased in five of five subjects on the immediate post-exercise fat-suppressed T2-weighted images. This signal returned to baseline by the 8-h scan. Positive findings of rotator cuff pathology on MRI after strenuous athletic activity should not be discounted as normal exercise-induced changes. Also, diagnostic MRI scanning may take place after a practice session without an increased risk of false positives. (orig.). With 1 fig.

Magnetic resonance imaging in acute and chronic rotator cuff tears

International Nuclear Information System (INIS)

Buirski, G.

1990-01-01

Magnetic resonance imaging has been assessed in patients with acute rotator cuff tears and normal radiographs (9 cases) and those with chronic tears and changes of cuff arthropathy (9 cases). All images were obtained using a low field strength system (FONAR 0.3 T). Particular attention was placed on the appearances of the tendon and the cuff muscles themselves. Six complete acute tears were clearly identified, but MRI failed to demonstrate two partial tears. Muscle bulk was preserved in all patients in this group. In contrast, all patients with cuff arthropathy had complete tears of the supraspinatus tendon with marked tendon retraction and associated muscle atrophy: These changes precluded primary surgical repair. MRI should be used to assess muscle atrophy preoperatively in those patients with acute tears. When plain radiographs demonstrate cuff arthropathy, the MRI appearances are predictable and primary repair is unlikely to be successful. Further imaging is therefore not indicated. (orig.)

Acromion Index in Korean Population and Its Relationship with Rotator Cuff Tears.

Science.gov (United States)

Kum, Dong Ho; Kim, Jun Ho; Park, Keun Min; Lee, Eun Su; Park, Yong Bok; Yoo, Jae Chul

2017-06-01

Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations. We enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups. The measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups ( p rotator cuff tears in a Korean population.

Pseudosmooth tribrid inflation

Energy Technology Data Exchange (ETDEWEB)

Antusch, Stefan; Nolde, David; Rehman, Mansoor Ur, E-mail: stefan.antusch@unibas.ch, E-mail: david.nolde@unibas.ch, E-mail: mansoor-ur.rehman@unibas.ch [Department of Physics, University of Basel, Klingelbergstr. 82, CH-4056 Basel (Switzerland)

2012-08-01

We explore a new class of supersymmetric models of inflation where the inflaton is realised as a combination of a Higgs field and (gauge non-singlet) matter fields, using a ''tribrid'' structure of the superpotential. Inflation is associated with a phase transition around GUT scale energies. The inflationary trajectory already preselects the later vacuum after inflation, which has the advantage of automatically avoiding the production of dangerous topological defects at the end of inflation. While at first sight the models look similar to smooth inflation, they feature a waterfall and are therefore only pseudosmooth. The new class of models offers novel possibilities for realising inflation in close contact with particle physics, for instance with supersymmetric GUTs or with supersymmetric flavour models based on family symmetries.

Is Inflation in India an Attractor of Inflation in Nepal?

OpenAIRE

Edimon Ginting

2007-01-01

The paper attempts to answer some important questions around the inflationary process in Nepal, particularly the transmission of inflation from India. Because the Nepali currency is pegged to the Indian rupee and the two countries share an open border, price developments in Nepal would be expected to mirror to those in India. The results show that inflation in India and inflation in Nepal tend to converge in the long run. Our estimates indicate that the passthrough of inflation from India to ...

Improved apparatus for predictive diagnosis of rotator cuff disease

Science.gov (United States)

Pillai, Anup; Hall, Brittany N.; Thigpen, Charles A.; Kwartowitz, David M.

2014-03-01

Rotator cuff disease impacts over 50% of the population over 60, with reports of incidence being as high as 90% within this population, causing pain and possible loss of function. The rotator cuff is composed of muscles and tendons that work in tandem to support the shoulder. Heavy use of these muscles can lead to rotator cuff tear, with the most common causes is age-related degeneration or sport injuries, both being a function of overuse. Tears ranges in severity from partial thickness tear to total rupture. Diagnostic techniques are based on physical assessment, detailed patient history, and medical imaging; primarily X-ray, MRI and ultrasonography are the chosen modalities for assessment. The final treatment technique and imaging modality; however, is chosen by the clinician is at their discretion. Ultrasound has been shown to have good accuracy for identification and measurement of full-thickness and partial-thickness rotator cuff tears. In this study, we report on the progress and improvement of our method of transduction and analysis of in situ measurement of rotator cuff biomechanics. We have improved the ability of the clinician to apply a uniform force to the underlying musculotendentious tissues while simultaneously obtaining the ultrasound image. This measurement protocol combined with region of interest (ROI) based image processing will help in developing a predictive diagnostic model for treatment of rotator cuff disease and help the clinicians choose the best treatment technique.

Brachial cuff measurements of blood pressure during passive leg raising for fluid responsiveness prediction.

Science.gov (United States)

Lakhal, K; Ehrmann, S; Benzekri-Lefèvre, D; Runge, I; Legras, A; Dequin, P-F; Mercier, E; Wolff, M; Régnier, B; Boulain, T

2012-05-01

The passive leg raising maneuver (PLR) for fluid responsiveness testing relies on cardiac output (CO) measurements or invasive measurements of arterial pressure (AP) whereas the initial hemodynamic management during shock is often based solely on brachial cuff measurements. We assessed PLR-induced changes in noninvasive oscillometric readings to predict fluid responsiveness. Multicentre interventional study. In ICU sedated patients with circulatory failure, AP (invasive and noninvasive readings) and CO measurements were performed before, during PLR (trunk supine, not modified) and after 500-mL volume expansion. Areas under the ROC curves (AUC) were determined for fluid responsiveness (>10% volume expansion-induced increase in CO) prediction. In 112 patients (19% with arrhythmia), changes in noninvasive systolic AP during PLR (noninvasiveΔ(PLR)SAP) only predicted fluid responsiveness (cutoff 17%, n=21, positive likelihood ratio [LR] of 26 [18-38]), not unresponsiveness. If PLR-induced change in central venous pressure (CVP) was at least of 2 mm Hg (n=60), suggesting that PLR succeeded in altering cardiac preload, noninvasiveΔ(PLR)SAP performance was good: AUC of 0.94 [0.85-0.98], positive and negative LRs of 5.7 [4.6-6.8] and 0.07 [0.009-0.5], respectively, for a cutoff of 9%. Of note, invasive AP-derived indices did not outperform noninvasiveΔ(PLR)SAP. Regardless of CVP (i.e., during "blind PLR"), noninvasiveΔ(PLR)SAP more than 17% reliably identified fluid responders. During "CVP-guided PLR", in case of sufficient change in CVP, noninvasiveΔ(PLR)SAP performed better (cutoff of 9%). These findings, in sedated patients who had already undergone volume expansion and/or catecholamines, have to be verified during the early phase of circulatory failure (before an arterial line and/or a CO measuring device is placed). Copyright © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Pulley lesions in rotator cuff tears: prevalence, etiology, and concomitant pathologies.

Science.gov (United States)

Hawi, Nael; Liodakis, Emmanouil; Garving, Christina; Habermeyer, Peter; Tauber, Mark

2017-08-01

This study aimed to demonstrate the prevalence of lesions in the biceps pulley complex in a representative, consecutive series of rotator cuff tears and rotator cuff interval treatments. We also analyzed associated tear pattern of rotator cuff injuries and superior labrum anterior-posterior (SLAP) lesions. We evaluated the relationships of these lesions to traumatic genesis and the prevalence of pulley lesions in revision cases. This retrospective study analyzed all pre- and intra-operative documentation on arthroscopic rotator cuff reconstructions and isolated pulley lesion treatments performed by a single surgeon over 2 consecutive years. According to Habermeyer et al., we classified cases into four groups, based on the presence of additional or related complete or partial rotator cuff tears, SLAP lesions, trauma, and primary or revision surgery. Among 382 patients with rotator cuff tears, 345 (90.3%) had an injured pulley system; 151 (43.8%) had partial tears of the rotator cuff; out of these, 106 (30.6%) were articular-sided. All of these articular-sided partial tears showed extension into the pulley complex. In 154 cases (44.6%), history of shoulder trauma was associated with the beginning of symptoms. In addition, concomitant SLAP lesions occurred in 25-62% of pulley lesions, correlating with the severity of pulley lesions. Among the 345 cases, there have been 32 (9.3%) revision cases where a pulley lesion was intra-operatively identified and addressed. Pulley complex lesions are present in 90.3% of surgically treated rotator cuff lesions, particularly in articular-sided injuries. In addition, we found a significant relationship between the incidence of SLAP lesions and the severity of pulley lesions. It seems reasonable to assume an important role of pulley system injuries in the pathogenesis of rotator cuff lesions.

Noninvasive measurement of lower extremity muscle oxygen extraction fraction under cuff compression paradigm.

Science.gov (United States)

Wang, Chengyan; Zhang, Rui; Zhang, Xiaodong; Wang, He; Zhao, Kai; Jin, Lixin; Zhang, Jue; Wang, Xiaoying; Fang, Jing

2016-05-01

To demonstrate the feasibility of using a susceptibility-based MRI technique with asymmetric spin-echo (ASE) sequence to assess the lower extremity muscle oxygen extraction fraction (OEF) alternations under cuff compression paradigm. Approved by the local institutional human study committee, nine healthy young volunteers participated in this study. All the ASE scans were conducted using a 3 Tesla clinical MRI scanner during resting state (pre), 1-3 min (post1) and 3-5 min (post2) after a pressure of 50 mmHg above individual systolic blood pressure imposed on the thigh. Moreover, near-infrared spectroscopy (NIRS) measurements were performed on the same day under the same cuff compression protocol to verify the accuracy of this susceptibility-based method. In all volunteers, the mean MRI based OEF in gastrocnemius (GAS) muscle increased significantly from 0.28 ± 0.02 (pre) to 0.31 ± 0.03 (post1, P measured 1-%HbO2 (percentage of deoxyhemoglobin concentration within total hemoglobin) in GAS rose significantly from 0.29 ± 0.03 (pre) to 0.31 ± 0.04 (post1, P measuring skeletal muscle oxygenation. © 2015 Wiley Periodicals, Inc.

Fluxbrane Inflation

CERN Document Server

Hebecker, Arthur; Lust, Dieter; Steinfurt, Stephan; Weigand, Timo

2012-01-01

As a first step towards inflation in genuinely F-theoretic setups, we propose a scenario where the inflaton is the relative position of two 7-branes on holomorphic 4-cycles. Non-supersymmetric gauge flux induces an attractive inter-brane potential. The latter is sufficiently flat in the supergravity regime of large volume moduli. Thus, in contrast to brane-antibrane inflation, fluxbrane inflation does not require warping. We calculate the inflaton potential both in the supergravity approximation and via an open-string one-loop computation on toroidal backgrounds. This leads us to propose a generalisation to genuine Calabi-Yau manifolds. We also comment on competing F-term effects. The end of inflation is marked by the condensation of tachyonic recombination fields between the 7-branes, triggering the formation of a bound state described as a stable extension along the 7-brane divisor. Hence our model fits in the framework of hybrid D-term inflation. We work out the main phenomenological properties of our D-te...

Estimating core inflation : the role of oil price shocks and imported inflation

OpenAIRE

Bjørnland, Hilde Christiane

1997-01-01

This paper calculates core inflation, by imposing long run restrictions on a structural vector autoregression (VAR) model containing the growth rate of output, inflation and oil prices. Core inflation is identified as that component in inflation that has no long run effect on output. No restrictions are placed on the response of output and inflation to the oil price shocks. The analysis is applied to Norway and the United Kingdom, both oil producing OECD countries. A model that ...

Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction

DEFF Research Database (Denmark)

Knudsen, H B; Gelineck, J; Søjbjerg, Jens Ole

1999-01-01

The aim of this study was to investigate tendon integrity after surgical repair of single-tendon rotator cuff lesions. In 31 patients, 31 single-tendon repairs were evaluated. Thirty-one patients were available for clinical assessment and magnetic resonance imaging (MRI) at follow-up. A standard...... series of MR images was obtained for each. The results of functional assessment were scored according to the system of Constant. According to MRI evaluation, 21 (68%) patients had an intact or thinned rotator cuff and 10 (32%) had recurrence of a full-thickness cuff defect at follow-up. Patients...... with an intact or thinned rotator cuff had a median Constant score of 75.5 points; patients with a full-thickness cuff defect had a median score of 62 points. There was no correlation between tendon integrity on postoperative MR images and functional outcome. Patients with intact or thinned cuffs did not have...

Measurements of Intra‐Aortic Balloon Wall Movement During Inflation and Deflation: Effects of Angulation

Science.gov (United States)

Bruti, Gianpaolo; Kolyva, Christina; Pepper, John R.

2015-01-01

Abstract The intra‐aortic balloon pump (IABP) is a ventricular assist device that is used with a broad range of pre‐, intra‐, and postoperative patients undergoing cardiac surgery. Although the clinical efficacy of the IABP is well documented, the question of reduced efficacy when patients are nursed in the semi‐recumbent position remains outstanding. The aim of the present work is therefore to investigate the underlying mechanics responsible for the loss of IABP performance when operated at an angle to the horizontal. Simultaneous recordings of balloon wall movement, providing an estimate of its diameter (D), and fluid pressure were taken at three sites along the intra‐aortic balloon (IAB) at 0 and 45°. Flow rate, used for the calculation of displaced volume, was also recorded distal to the tip of the balloon. An in vitro experimental setup was used, featuring physiological impedances on either side of the IAB ends. IAB inflation at an angle of 45° showed that D increases at the tip of the IAB first, presenting a resistance to the flow displaced away from the tip of the balloon. The duration of inflation decreased by 15.5%, the inflation pressure pulse decreased by 9.6%, and volume decreased by 2.5%. Similarly, changing the position of the balloon from 0 to 45°, the balloon deflation became slower by 35%, deflation pressure pulse decreased by 14.7%, and volume suctioned was decreased by 15.2%. IAB wall movement showed that operating at 45° results in slower deflation compared with 0°. Slow wall movement, and changes in inflation and deflation onsets, result in a decreased volume displacement and pressure pulse generation. Operating the balloon at an angle to the horizontal, which is the preferred nursing position in intensive care units, results in reduced IAB inflation and deflation performance, possibly compromising its clinical benefits. PMID:25959284

Functional outcomes after bilateral arthroscopic rotator cuff repair.

Science.gov (United States)

Aleem, Alexander W; Syed, Usman Ali M; Wascher, Jocelyn; Zoga, Adam C; Close, Koby; Abboud, Joseph A; Cohen, Steven B

2016-10-01

Arthroscopic repair of rotator cuff tears is a common procedure performed by orthopedic surgeons. There is a well-known incidence of up to 35% of bilateral rotator cuff tear disease in patients who have a known unilateral tear. The majority of the literature focuses on outcomes after unilateral surgery. The purpose of this study was to determine if there are clinical differences in shoulders of patients who underwent staged bilateral rotator cuff repairs during their lifetime. A retrospective review of all patients who underwent staged bilateral arthroscopic rotator cuff surgery at our institution was performed. All patients had at least 2 years of follow-up. Clinical outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Rowe measures were obtained. A subset of patients returned for clinical and ultrasound evaluation performed by an independent fellowship-trained musculoskeletal radiologist. Overall, 110 shoulders in 55 patients, representing 68% of all eligible patients, participated. No clinical or statistical difference was found in any outcome measure. ASES scores averaged 86.5 (36.7-100) in the dominant shoulder compared with 89.6 (23.3-100) in the nondominant shoulder (P = .42). Ultrasound was available on 34 shoulders and showed complete healing rate of 88%. The shoulders with retearing of the rotator cuff (12%) demonstrated clinically relevant lower ASES scores (72.5) compared with shoulders with confirmed healed repairs (86.2; P = .2). Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence with excellent healing rates in both shoulders. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Eternal extended inflation and graceful exit from old inflation without Jordan-Brans-Dicke

International Nuclear Information System (INIS)

Linde, A.

1990-01-01

Recently a possible solution to the graceful exit problem of the old inflation was proposed in the context of the Jordan-Brans-Dicke theory (extended inflation). In this paper we will argue that inflation in this theory occurs in a most natural way if it starts near the Planck density, as in the standard version of chaotic inflation. With most natural initial conditions, the inflationary universe in the JBD theory enters the stage of permanent reproduction of new inflationary domains (eternal extended inflation). In order to realize the extended inflation scenario at least two classical scalar fields driving inflation are necessary, as distinct from the simplest versions of new and chaotic inflation. It is shown that in the theory of two scalar fields one can solve the graceful exit problem even without modifying the Einstein gravity theory, due to the possibility that the decay rate of the false vacuum in old inflation depends on the value of the second scalar field and hence on time. (orig.)

Continuous and Cuffless Blood Pressure Monitoring Based on ECG and SpO2 Signals ByUsing Microsoft Visual C Sharp.

Science.gov (United States)

Younessi Heravi, M A; Khalilzadeh, M A; Joharinia, S

2014-03-01

One of the main problems especially in operating room and monitoring devices is measurement of Blood Pressure (BP) by sphygmomanometer cuff. Objective :In this study we designed a new method to measure BP changes continuously for detecting information between cuff inflation times by using vital signals in monitoring devices. This will be achieved by extraction of the time difference between each cardiac cycle and a relative pulse wave. Finger pulse and ECG signals in lead I were recorded by a monitoring device. The output of monitoring device wasinserted in a computer by serial network communication. A software interface (Microsoft Visual C#.NET ) was used to display and process the signals in the computer. Time difference between each cardiac cycle and pulse signal was calculated throughout R wave detection in ECG and peak of pulse signal by the software. The relation between time difference in two waves and BP was determined then the coefficients of equation were obtained in different physical situations. The results of estimating BP were compared with the results of sphygmomanometer method and the error rate was calculated. In this study, 25 subjects participated among them 15 were male and 10 were female. The results showed that BP was linearly related to time difference. Average of coefficient correlation was 0.9±0.03 for systolic and 0.82±0.04 for diastolic blood pressure. The highest error percentage was calculated 8% for male and 11% for female group. Significant difference was observed between the different physical situation and arm movement changes. The relationship between time difference and age was estimated in a linear relationship with a correlation coefficient of 0.76. By determining linear relation values with high accuracy, BP can be measured with insignificant error. Therefore it can be suggested as a new method to measure the blood pressure continuously.

Gauge fields and inflation

Science.gov (United States)

Maleknejad, A.; Sheikh-Jabbari, M. M.; Soda, J.

2013-07-01

small field models also have a potential minimum at φ≠0 which the system falls in at the end of inflation. A typical property of small field models is that a sufficient number of e-folds, requires a sub-Planckian inflaton initial value. For this reason they are called small field models. Natural inflation is an example of this type [12]. Hybrid inflation models: These models involve more than one scalar field while inflation is mainly driven by a single inflaton field ϕ. Inflaton starts from a large value rolling down until it reaches a bifurcation point, ϕ=ϕe, after which the field becomes unstable and undergoes a waterfall transition toward its global minimum. Its prime example is the Linde’s hybrid inflation model with the following potential [13] V(ϕ,χ)={λ}/{4}(+{1}/{2}g2ϕ2χ2+{1}/{2}m2ϕ2. During the initial inflationary phase the potential of the hybrid inflation is effectively described by a single field ϕ while inflation ends by a phase transition triggered by the presence of the second scalar field, the waterfall field χ. In other words, when the effective mass squared of a waterfall field becomes negative, the tachyonic instability makes waterfall field roll down toward the true vacuum state and the inflation suddenly ends.Number of e-folds Ne is given as Ne≃{M4}/{4λm2}ln({ϕ0}/{ϕe}), where ϕe={M}/{g} is the critical value of the inflaton below which, due to tachyonic instability, χ=0 becomes unstable and mχ2 gets negative. K-inflation: This is the prime example of models with non-canonical Kinetic term we discuss here. They are described by the action [14] S=∫d4x√{-g}({R}/{2}+P(φ,X)), where φ is a scalar field and X≔-{1}/{2}(. Here, P plays the rule of the effective pressure, while the energy density is given by ρ=2XP-P. Thus, the slow-roll parameter is given as ɛ={3XP}/{2XP-P}. The characteristic feature of these models is that in general they have a non-trivial sound speed cs2 for the propagation of perturbations (cf. our

Spatiotemporal Aeration and Lung Injury Patterns Are Influenced by the First Inflation Strategy at Birth.

Science.gov (United States)

Tingay, David G; Rajapaksa, Anushi; Zonneveld, C Elroy; Black, Don; Perkins, Elizabeth J; Adler, Andy; Grychtol, Bartłomiej; Lavizzari, Anna; Frerichs, Inéz; Zahra, Valerie A; Davis, Peter G

2016-02-01

Ineffective aeration during the first inflations at birth creates regional aeration and ventilation defects, initiating injurious pathways. This study aimed to compare a sustained first inflation at birth or dynamic end-expiratory supported recruitment during tidal inflations against ventilation without intentional recruitment on gas exchange, lung mechanics, spatiotemporal regional aeration and tidal ventilation, and regional lung injury in preterm lambs. Lambs (127 ± 2 d gestation), instrumented at birth, were ventilated for 60 minutes from birth with either lung-protective positive pressure ventilation (control) or as per control after either an initial 30 seconds of 40 cm H2O sustained inflation (SI) or an initial stepwise end-expiratory pressure recruitment maneuver during tidal inflations (duration 180 s; open lung ventilation [OLV]). At study completion, molecular markers of lung injury were analyzed. The initial use of an OLV maneuver, but not SI, at birth resulted in improved lung compliance, oxygenation, end-expiratory lung volume, and reduced ventilatory needs compared with control, persisting throughout the study. These changes were due to more uniform inter- and intrasubject gravity-dependent spatiotemporal patterns of aeration (measured using electrical impedance tomography). Spatial distribution of tidal ventilation was more stable after either recruitment maneuver. All strategies caused regional lung injury patterns that mirrored associated regional volume states. Irrespective of strategy, spatiotemporal volume loss was consistently associated with up-regulation of early growth response-1 expression. Our results show that mechanical and molecular consequences of lung aeration at birth are not simply related to rapidity of fluid clearance; they are also related to spatiotemporal pressure-volume interactions within the lung during inflation and deflation.

Impact of external pneumatic compression target inflation pressure on transcriptome-wide RNA expression in skeletal muscle.

Science.gov (United States)

Martin, Jeffrey S; Kephart, Wesley C; Haun, Cody T; McCloskey, Anna E; Shake, Joshua J; Mobley, Christopher B; Goodlett, Michael D; Kavazis, Andreas; Pascoe, David D; Zhang, Lee; Roberts, Michael D

2016-11-01

Next-generation RNA sequencing was employed to determine the acute and subchronic impact of peristaltic pulse external pneumatic compression (PEPC) of different target inflation pressures on global gene expression in human vastus lateralis skeletal muscle biopsy samples. Eighteen (N = 18) male participants were randomly assigned to one of the three groups: (1) sham (n = 6), 2) EPC at 30-40 mmHg (LP-EPC; n = 6), and 3) EPC at 70-80 mmHg (MP-EPC; n = 6). One hour treatment with sham/EPC occurred for seven consecutive days. Vastus lateralis skeletal muscle biopsies were performed at baseline (before first treatment; PRE), 1 h following the first treatment (POST1), and 24 h following the last (7th) treatment (POST2). Changes from PRE in gene expression were analyzed via paired comparisons within each group. Genes were filtered to include only those that had an RPKM ≥ 1.0, a fold-change of ≥1.5 and a paired t-test value of <0.01. For the sham condition, two genes at POST1 and one gene at POST2 were significantly altered. For the LP-EPC condition, nine genes were up-regulated and 0 genes were down-regulated at POST1 while 39 genes were up-regulated and one gene down-regulated at POST2. For the MP-EPC condition, two genes were significantly up-regulated and 21 genes were down-regulated at POST1 and 0 genes were altered at POST2. Both LP-EPC and MP-EPC acutely alter skeletal muscle gene expression, though only LP-EPC appeared to affect gene expression with subchronic application. Moreover, the transcriptome response to EPC demonstrated marked heterogeneity (i.e., genes and directionality) with different target inflation pressures. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Double inflation

International Nuclear Information System (INIS)

Silk, J.; Turner, M.S.

1986-04-01

The Zel'dovich spectrum of adiabatic density perturbations is a generic prediction of inflation. There is increasing evidence that when the spectrum is normalized by observational data on small scales, there is not enough power on large scales to account for the observed large-scale structure in the Universe. Decoupling the spectrum on large and small scales could solve this problem. As a means of decoupling the large and small scales we propose double inflation (i.e., two episodes of inflation). In this scenario the spectrum on large scales is determined by the first episode of inflation and those on small scales by a second episode of inflation. We present three models for such a scenario. By nearly saturating the large angular-scale cosmic microwave anisotropy bound, we can easily account for the observed large-scale structure. We take the perturbations on small scales to be very large, deltarho/rho approx. = 0.1 to 0.01, which results in the production of primordial black holes (PBHs), early formation of structure, reionization of the Universe, and a rich array of astrophysical events. The Ω-problem is also addressed by our scenario. Allowing the density perturbations produced by the second episode of inflation to be large also lessens the fine-tuning required in the scalar potential and makes reheating much easier. We briefly speculate on the possibility that the second episode of inflation proceeds through the nucleation of bubbles, which today manifest themselves as empty bubbles whose surfaces are covered with galaxies. 37 refs., 1 fig

Model-based evaluation of the short-circuited tripolar cuff configuration.

Science.gov (United States)

Andreasen, Lotte N S; Struijk, Johannes J

2006-05-01

Recordings of neural information for use as feedback in functional electrical stimulation are often contaminated with interfering signals from muscles and from stimulus pulses. The cuff electrode used for the neural recording can be optimized to improve the S/I ratio. In this work, we evaluate a model of both the nerve signal and the interfering signals recorded by a cuff, and subsequently use this model to study the signal to interference ratio of different cuff designs and to evaluate a recently introduced short-circuited tripolar cuff configuration. The results of the model showed good agreement with results from measurements in rabbits and confirmed the superior performance of the short-circuited tripolar configuration as compared with the traditionally used tripolar configuration.

Current Biomechanical Concepts of Suture Bridge Repair Technique for Rotator Cuff Tear

OpenAIRE

Ming-Long Yeh; Chih-Kai Hong; Wei-Ren Su; I-Ming Jou; Cheng-Li Lin; Chii-Jen Lin

2015-01-01

Rotator cuff tears are one of the most common disorders of the shoulder and can have significant effects on daily activities as a result of pain, loss of motion and strength. The goal of rotator cuff repair is aimed at anatomic restoration of the rotator cuff tendon to reduce pain and improve the joint function. Recently, arthroscopic repair has been widely accepted for treatment of rotator cuff tears due to its equal or better results than those from open repair. In 2006, a...

Free Biceps Tendon Autograft to Augment Arthroscopic Rotator Cuff Repair

OpenAIRE

Obma, Padraic R.

2013-01-01

Arthroscopic rotator cuff repairs have become the standard of treatment for all sizes of tears over the past several years. Current healing rates reported in the literature are quite good, but improving the healing potential of rotator cuff repairs remains a challenging problem. There has been an increase recently in the use of augmentation of rotator cuff repairs with xenografts or synthetics for large and massive tears. Biceps tenodesis is often indicated as part of the treatment plan while...

Natural History of Rotator Cuff Disease and Implications on Management

Science.gov (United States)

Hsu, Jason

2015-01-01

Degenerative rotator cuff disease is commonly associated with ageing and is often asymptomatic. The factors related to tear progression and pain development are just now being defined through longitudinal natural history studies. The majority of studies that follow conservatively treated painful cuff tears or asymptomatic tears that are monitored at regular intervals show slow progression of tear enlargement and muscle degeneration over time. These studies have highlighted greater risks for disease progression for certain variables, such as the presence of a full-thickness tear and involvement of the anterior aspect supraspinatus tendon. Coupling the knowledge of the natural history of degenerative cuff tear progression with variables associated with greater likelihood of successful tendon healing following surgery will allow better refinement of surgical indications for rotator cuff disease. In addition, natural history studies may better define the risks of nonoperative treatment over time. This article will review pertinent literature regarding degenerative rotator cuff disease with emphasis on variables important to defining appropriate initial treatments and refining surgical indications. PMID:26726288

The effect of glenoid cavity depth on rotator cuff tendinitis.

Science.gov (United States)

Malkoc, Melih; Korkmaz, Ozgur; Ormeci, Tugrul; Sever, Cem; Kara, Adna; Mahirogulları, Mahir

2016-03-01

Some of the most important causes of shoulder pain are inflammation and degenerative changes in the rotator cuff (RC). Magnetic resonance imaging (MRI) is a noninvasive and safe imaging modality. MRI can be used for the evaluation of cuff tendinopathy. In this study, we evaluated the relationship between glenoid cavity depth and cuff tendinopathy and we investigated glenoid cavity depth on the pathogenesis of cuff tendinopathy. We retrospectively evaluated 215 patients who underwent MRI. Of these, 60 patients showed cuff tendinopathy (group A) and 54 patients showed no pathology (group B). Glenoid cavity depth was calculated in the coronal and transverse planes. The mean axial depth was 1.7 ± 0.9 and the mean coronal depth 3.8 ± 0.9, for group A. The mean axial depth was 3.5 ± 0.7 and the mean coronal depth 1.5 ± 0.8, for group B. There were significant differences in the axial and coronal depths between the two groups. High coronal and low axial depth of the glenoid cavity can be used to diagnose RC tendinitis.

Ultrasound-Guided Prolotherapy with Polydeoxyribonucleotide for Painful Rotator Cuff Tendinopathy

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Kyoungho Ryu

2018-01-01

Full Text Available Background. Rotator cuff tendinopathy is a primary cause of shoulder pain and dysfunction. Several effective nonsurgical treatment methods have been described for chronic rotator cuff tendinopathy. Prolotherapy with polydeoxyribonucleotide (PDRN, which consists of active deoxyribonucleotide polymers that stimulate tissue repair, is a nonsurgical regenerative injection that may be a viable treatment option. The objective of this study was to assess the efficacy of PDRN in the treatment of chronic rotator cuff tendinopathy. Method. The records of patients with chronic rotator cuff tendinopathy (n=131 were reviewed retrospectively, and the patients treated with PDRN prolotherapy (n=32 were selected. We measured the main outcome of the shoulder pain and disability index score on a numerical rating scale of average shoulder pain. Results. Compared with baseline data, significant improvements in the shoulder pain and disability index and pain visual analog scale scores were demonstrated at one week after the end of treatment, and at one month and three months later. Conclusions. PDRN prolotherapy may improve the conservative treatment of painful rotator cuff tendinopathy for a specific subset of patients.

Knotless double-row SutureBridge rotator cuff repairs have improved self-reinforcement compared with double-row SutureBridge repairs with tied medial knots: a biomechanical study using an ovine model.

Science.gov (United States)

Smith, Geoffrey C S; Bouwmeester, Theresia M; Lam, Patrick H

2017-12-01

In double-row SutureBridge (Arthrex, Naples, FL, USA) rotator cuff repairs, increasing tendon load may generate progressively greater compression forces at the repair footprint (self-reinforcement). SutureBridge rotator cuff repairs using tied horizontal mattress sutures medially may limit this effect compared with a knotless construct. Rotator cuff repairs were performed in 9 pairs of ovine shoulders. One group underwent repair with a double-row SutureBridge construct with tied horizontal medial-row mattress sutures. The other group underwent repair in an identical fashion except that medial-row knots were not tied. Footprint contact pressure was measured at 0° and 20° of abduction under loads of 0 to 60 N. Pull-to-failure tests were then performed. In both repair constructs, each 10-N increase in rotator cuff tensile load led to a significant increase in footprint contact pressure (P row SutureBridge configuration, self-reinforcement is seen in repairs with and without medial-row knots. Self-reinforcement is greater with the knotless technique. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Shouldering the blame for impingement: the rotator cuff continuum ...

African Journals Online (AJOL)

The aim of this article was to summarise recent research on shoulder impingement and rotator cuff pathology. A continuum model of rotator cuff pathology is described, and the challenges of accurate clinical diagnosis, imaging and best management discussed. Keywords: shoulder impingement syndrome, subacromial ...

Inflation targeting and inflation performance : a comparative analysis

NARCIS (Netherlands)

Samarina, Anna; De Haan, Jakob; Terpstra, M.

2014-01-01

This article examines how the impact of inflation targeting on inflation performance depends on the choice of country samples, adoption dates, time periods and methodological approaches. We apply two different estimation methods - difference-in-differences and propensity score matching - for our

Identification of a genetic variant associated with rotator cuff repair healing.

Science.gov (United States)

Tashjian, Robert Z; Granger, Erin K; Zhang, Yue; Teerlink, Craig C; Cannon-Albright, Lisa A

2016-06-01

A familial and genetic predisposition for the development of rotator cuff tearing has been identified. The purpose of this study was to determine if a familial predisposition exists for healing after rotator cuff repair and if the reported significant association with a single-nucleotide polymorphism (SNP) in the ESRRB gene is present in patients who fail to heal. The study recruited 72 patients undergoing arthroscopic rotator cuff repair for a full-thickness posterosuperior tear. Magnetic resonance imaging studies were performed at a minimum of 1 year postoperatively (average, 2.6 years). Healing failures were classified as lateral or medial. Self-reported family history of rotator cuff tearing data and genome-wide genotypes were available. Characteristics of cases with and without a family history of rotator cuff tearing were compared, and a comparison of the frequency of SNP 1758384 (in ESRRB) was performed between patients who healed and those who failed to heal. Of the rotator cuff repairs, 42% failed to heal; 42% of patients reported a family history of rotator cuff tear. Multivariate regression analysis showed a significant association between familiality and overall healing failure (medial and lateral failures) (P = .036) and lateral failures independently (P = .006). An increased risk for the presence of a rare allele for SNP rs17583842 was present in lateral failures compared with those that healed (P = .005). Individuals with a family history of rotator cuff tearing were more likely to have repair failures. Significant association of a SNP variant in the ESRRB gene was also observed with lateral failure. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Accuracy of MR imaging in partial tears of rotator cuff

International Nuclear Information System (INIS)

Eto, Masao; Ito, Nobuyuki; Tomonaga, Tadashi; Harada, Shin'ichi; Rabbi, M.E.; Iwasaki, Katsuro

1997-01-01

MRI is very useful for the diagnosis of the rotator cuff tear However. in case of partial tears it is sometimes controvertible. In this study, we studied the accuracy of MRI in the diagnosis of partial tears. 67 patients who underwent MRI investigation before operation were chosen for this study. There were 61 males and 6 females, ranging from 30 to 80 years (mean: 54.8 years at the time of operation). MRI was performed with 1.5T superconductive system with shoulder surface coil. MPGR T2-weighted images were performed in the coronal oblique and sagittal oblique planes. Complete tears were diagnosed when full thickness high intensity was observed in the rotator cuff, whereas with partial high intensity of the rotator cuff, was considered as partial tears. MRI demonstrated 77.8% sensitivity, 91.4% specificity and 89.6% accuracy in the diagnosis of partial tear. In 8 cases MRI had misinterpretation. In MPGR T2-weighted images, not only the partial tears but the degenerative changes also show high intensity of the rotator cuff. Therefore, it is difficult to differentiate and maybe this is the reason of misinterpretations of partial tears by MRI. MRI provided with useful pre-operative informations of partial tears of the rotator cuff. However, in few cases it is hard to differentiate for the degenerative changes of the rotator cuff. (author)

NMR of the rotator cuff. An update; MRT der Rotatorenmanschette. Ein Update

Energy Technology Data Exchange (ETDEWEB)

Kreitner, Karl-Friedrich; Maehringer-Kunz, Aline [Universitaetsmedizin Mainz (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie

2016-03-15

The rotator cuff consists of the tendons of the supscapularis, supraspinatus, infraspinatus and teres minor muscles. This group of muscles performs multiple functions and is often stressed during various activities. This explains, why rotator cuff disease is common and the most often cause of shoulder pain and dysfunction in adults. MR imaging still is the most important imaging modality in assessment of rotator cuff disease. It enables the radiologist to make an accurate diagnosis, the basis for an appropriate management. In this article, current concepts with regard to anatomy and imaging diagnosis will be reviewed. The discussion of the complex anatomy is followed by normal and pathologic MR imaging appearances of the rotator cuff including tendinopathy and tearing, and concluding with a review of the postoperative cuff.

Eternal extended inflation and graceful exit from old inflation without Jordan-Brans-Dicke

Science.gov (United States)

Linde, Andrei

1990-10-01

Recently a possible solution to the graceful exit problem of the old inflation was proposed in the context of the Jordan-Brans-Dicke theory (extended inflation). In this paper we will argue that inflation in this theory occurs in a most natural way if it starts near the Planck density, as in the standard version of chaotic inflation. With most natural initial conditions, the inflationary universe in the JBD theory enters the stage of permanent reproduction of new inflationary domains (eternal extended inflation). In order to realize the extended inflation scenario at least two classical scalar fields driving inflation are necessary, as distinct from the simplest versions of new and chaotic inflation. It is shown that in the theory of two scalar fields one can solve the graceful exit problem even without modifying the Einstein gravity theory, due to the possibility that the decay rate of the false rate vacuum in old inflation depends on the value of the second scalar field and hence on time. Address after 1 September 1990: Physics Department, Stanford University, Varian Building, Stanford, CA 94305, USA.

Immobilization After Rotator Cuff Repair: What Evidence Do We Have Now?

Science.gov (United States)

Hsu, Jason E; Horneff, John G; Gee, Albert O

2016-01-01

Recurrent tears after rotator cuff repair are common. Postoperative rehabilitation after rotator cuff repair is a modifiable factor controlled by the surgeon that can affect re-tear rates. Some surgeons prefer early mobilization after rotator cuff repair, whereas others prefer a period of immobilization to protect the repair site. The tendon-healing process incorporates biochemical and biomechanical responses to mechanical loading. Healing can be optimized with controlled loading. Complete load removal and chronic overload can be deleterious to the process. Several randomized clinical studies have also characterized the role of postoperative mobilization after rotator cuff repair. Copyright © 2016 Elsevier Inc. All rights reserved.

Quintessential inflation: A unified scenario of inflation and dark energy

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Hossain Wali

2018-01-01

Full Text Available Quintessential inflation unifies inflation and late time acceleration by a single scalar field. Such a scenario, with canonical and non-canonical scalar fields, has been discussed. The scalar field behaves as an inflaton field during inflation and as a quintessence field during late time. Also the predictions of the models has been compared with the recent Planck data.

Numerical Simulation and Experimental Validation of the Inflation Test of Latex Balloons

OpenAIRE

Bustos, Claudio; Herrera, Claudio García; Celentano, Diego; Chen, Daming; Cruchaga, Marcela

2016-01-01

Abstract Experiments and modeling aimed at assessing the mechanical response of latex balloons in the inflation test are presented. To this end, the hyperelastic Yeoh material model is firstly characterized via tensile test and, then, used to numerically simulate via finite elements the stress-strain evolution during the inflation test. The numerical pressure-displacement curves are validated with those obtained experimentally. Moreover, this analysis is extended to a biomedical problem of an...

The global percutaneous shuttling technique tip for arthroscopic rotator cuff repair

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Bryan G. Vopat

2014-05-01

Full Text Available Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthro- scopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author’s practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (P<0.0001. This data supports the use of the GPS technique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique.

Muscle gene expression patterns in human rotator cuff pathology.

Science.gov (United States)

Choo, Alexander; McCarthy, Meagan; Pichika, Rajeswari; Sato, Eugene J; Lieber, Richard L; Schenk, Simon; Lane, John G; Ward, Samuel R

2014-09-17

Rotator cuff pathology is a common source of shoulder pain with variable etiology and pathoanatomical characteristics. Pathological processes of fatty infiltration, muscle atrophy, and fibrosis have all been invoked as causes for poor outcomes after rotator cuff tear repair. The aims of this study were to measure the expression of key genes associated with adipogenesis, myogenesis, and fibrosis in human rotator cuff muscle after injury and to compare the expression among groups of patients with varied severities of rotator cuff pathology. Biopsies of the supraspinatus muscle were obtained arthroscopically from twenty-seven patients in the following operative groups: bursitis (n = 10), tendinopathy (n = 7), full-thickness rotator cuff tear (n = 8), and massive rotator cuff tear (n = 2). Quantitative polymerase chain reaction (qPCR) was performed to characterize gene expression pathways involved in myogenesis, adipogenesis, and fibrosis. Patients with a massive tear demonstrated downregulation of the fibrogenic, adipogenic, and myogenic genes, indicating that the muscle was not in a state of active change and may have difficulty responding to stimuli. Patients with a full-thickness tear showed upregulation of fibrotic and adipogenic genes; at the tissue level, these correspond to the pathologies most detrimental to outcomes of surgical repair. Patients with bursitis or tendinopathy still expressed myogenic genes, indicating that the muscle may be attempting to accommodate the mechanical deficiencies induced by the tendon tear. Gene expression in human rotator cuff muscles varied according to tendon injury severity. Patients with bursitis and tendinopathy appeared to be expressing pro-myogenic genes, whereas patients with a full-thickness tear were expressing genes associated with fatty atrophy and fibrosis. In contrast, patients with a massive tear appeared to have downregulation of all gene programs except inhibition of myogenesis. These data highlight the

Safety and efficacy of a new tourniquet system

Directory of Open Access Journals (Sweden)

Sato Junko

2012-08-01

Full Text Available Abstract Background In upper limb surgery, the pneumatic tourniquet is an essential tool to provide a clean, bloodless surgical field, improving visualization of anatomical structures and preventing iatrogenic failure. Optimal inflation pressure to accomplish these objects without injuring normal tissue and inducing complications is not yet established. Use of the minimum tourniquet pressure necessary to produce a bloodless surgical field is preferable in order to prevent injury to normal tissue. Various methods have been implemented in an effort to lower effective cuff pressure. The purpose of this study is to report clinical experience with a new tourniquet system in which pressure is synchronized with systolic blood pressure (SBP using a vital information monitor. Methods We routinely used the tourniquet system in 120 consecutive upper limb surgeries performed under general anaesthesia in our operating room instead of our clinic. Cuff pressure was automatically regulated to additional 100 mmHg based on the SBP and was renewed every 2.5 minutes intervals. Results An excellent bloodless field was obtained in 119 cases, with the exception of one case of a 44-year-old woman who underwent internal screw fixation of metacarpal fracture. No complications, such as compartment syndrome, deep vein disorder, skin disorder, paresis, or nerve damage, occurred during or after surgery. Conclusions This new tourniquet system, synchronized with SBP, can be varied to correspond with sharp rises or drops in SBP to supply adequate pressure. The system reduces labor needed to deflate and re-inflate to achieve different pressures. It also seemed to contribute to the safety in upper limb surgery, in spite of rare unexpected oozing mid-surgery, by reducing tissue pressure.

Rotator Cuff Injuries.

Science.gov (United States)

Connors, G. Patrick

Many baseball players suffer from shoulder injuries related to the rotator cuff muscles. These injuries may be classified as muscular strain, tendonitis or tenosynovitis, and impingement syndrome. Treatment varies from simple rest to surgery, so it is important to be seen by a physician as soon as possible. In order to prevent these injuries, the…

HIGH-RESOLUTION ULTRASONOGRAPHY OF SHOULDER FOR ROTATOR CUFF TEAR: CORRELATION WITH ARTHROSCOPIC FINDINGS

OpenAIRE

Vishnumurthy H. Y; Jagdeesh K. S; Anand K; Ranoji Mane; Sanath G. Kamte; Fathima Zohra; Banerji B. H; Sathish Servegar

2016-01-01

INTRODUCTION Rotator cuff disease is the most common cause of shoulder pain. Ultrasonography being non-invasive, widely available, more cost-effective method and is the first choice in imaging of rotator cuff tears. Arthroscopy of shoulder is considered as the gold standard for diagnosis of rotator cuff tears. Objective of this study was to compare the diagnostic accuracy of high-resolution ultrasonography of shoulder for rotator cuff tears with arthroscopy of shoulder. METHODS...

Kaehler-driven tribrid inflation

International Nuclear Information System (INIS)

Antusch, Stefan; Nolde, David

2012-01-01

We discuss a new class of tribrid inflation models in supergravity, where the shape of the inflaton potential is dominated by effects from the Kaehler potential. Tribrid inflation is a variant of hybrid inflation which is particularly suited for connecting inflation with particle physics, since the inflaton can be a D-flat combination of charged fields from the matter sector. In models of tribrid inflation studied so far, the inflaton potential was dominated by either loop corrections or by mixing effects with the waterfall field (as in 'pseudosmooth' tribrid inflation). Here we investigate the third possibility, namely that tribrid inflation is dominantly driven by effects from higher-dimensional operators of the Kaehler potential. We specify for which superpotential parameters the new regime is realized and show how it can be experimentally distinguished from the other two (loop-driven and p seudosmooth ) regimes

Towards inflation targeting in Egypt: the relationship between exchange rate and inflation

Directory of Open Access Journals (Sweden)

Aliaa Khodeir

2012-08-01

Full Text Available Since the Egyptian economy has recently moved towards inflation targeting, it became very important to know whether exchange rate movements have serious inflationary implications or not. To investigate this subject, the study aims to analyse the relevance of inflation with the exchange rate by using the Granger-causality test. Two indicators of inflation will be used, the consumer price index (CPI and wholesale price index (WPI. In general, the results show a strong relationship between the two variables in a way that may give support to the application of ‘flexible inflation targeting regime instead of strict inflation targeting regime’.

Problems of rotator cuff re-tear cases. Examination of operative findings

International Nuclear Information System (INIS)

Ishitani, Eiichi; Matsuura, Komei; Shin, Kunichika; Kawamoto, Taisaku; Hosokawa, Akira

2007-01-01

High re-tear rate is reported after rotator cuff repair in large and massive tear cases. Previously, we reported that 15% of patients after rotator cuff repair showed re-tear in MRI findings. In this study, 116 consecutive rotator cuff repaired patients who had been operated arthroscopically since 2003 were evaluated for size, torn site, fixation methods, mobility, and tendon quality. In addition, rehabilitation methods and occupation after revision were also evaluated. There were four patients who underwent re-operation. Rotator cuff repairs by revision surgery failed mechanically due to two reasons: the main factor of failure was suture material breakage in three cases and the second was tendon pulling through sutures in one case. The lack of thread strength was suggested. In addition, it is important to pull cuff stump to greater tubercle without excessive tension. Of re-operated cases, three engaging in manual labor suffered large and massive tear. In two cases, premature return to manual labor suggested cause of re-tear. (author)

Recent Inflation of Kilauea Volcano

Science.gov (United States)

Miklius, A.; Poland, M.; Desmarais, E.; Sutton, A.; Orr, T.; Okubo, P.

2006-12-01

have not decreased during the current inflation. Indeed, gas emission measurements indicate increased outflow, with average sulfur dioxide emissions from the eruption site having almost doubled in 2005. While the eruption is apparently taking up some of the increased supply, at least intermittently, the magma system to Pu`u `O`o is obviously not capable of sustaining the transport of the entire volume; as a result, both the summit and rift zones are being pressurized. Whether the existing magma transport system to the eruption site can evolve in time to handle the increased flux remains to be seen.

Differences in Risk Factors for Rotator Cuff Tears between Elderly Patients and Young Patients.

Science.gov (United States)

Watanabe, Akihisa; Ono, Qana; Nishigami, Tomohiko; Hirooka, Takahiko; Machida, Hirohisa

2018-02-01

It has been unclear whether the risk factors for rotator cuff tears are the same at all ages or differ between young and older populations. In this study, we examined the risk factors for rotator cuff tears using classification and regression tree analysis as methods of nonlinear regression analysis. There were 65 patients in the rotator cuff tears group and 45 patients in the intact rotator cuff group. Classification and regression tree analysis was performed to predict rotator cuff tears. The target factor was rotator cuff tears; explanatory variables were age, sex, trauma, and critical shoulder angle≥35°. In the results of classification and regression tree analysis, the tree was divided at age 64. For patients aged≥64, the tree was divided at trauma. For patients agedrotator cuff tears in this study. However, these risk factors showed different trends according to age group, not a linear relationship.

Comorbidities in rotator cuff disease: a case-control study.

Science.gov (United States)

Titchener, Andrew G; White, Jonathan J E; Hinchliffe, Sally R; Tambe, Amol A; Hubbard, Richard B; Clark, David I

2014-09-01

Rotator cuff disease is a common condition in the general population, but relatively little is known about its associated risk factors. We have undertaken a large case-control study using The Health Improvement Network database to assess and to quantify the relative contributions of some constitutional and environmental risk factors for rotator cuff disease in the community. Our data set included 5000 patients with rotator cuff disease who were individually matched with a single control by age, sex, and general practice (primary care practice). The median age at diagnosis was 55 years (interquartile range, 44-65 years). Multivariate analysis showed that the risk factors associated with rotator cuff disease were Achilles tendinitis (odds ratio [OR] = 1.78), trigger finger (OR = 1.99), lateral epicondylitis (OR = 1.71), and carpal tunnel syndrome (OR = 1.55). Oral corticosteroid therapy (OR = 2.03), oral antidiabetic use (OR = 1.66), insulin use (OR = 1.77), and "overweight" body mass index of 25.1 to 30 (OR = 1.15) were also significantly associated. Current or previous smoking history, body mass index of greater than 30, any alcohol intake, medial epicondylitis, de Quervain syndrome, cubital tunnel syndrome, and rheumatoid arthritis were not found to be associated with rotator cuff disease. We have identified a number of comorbidities and risk factors for rotator cuff disease. These include lateral epicondylitis, carpal tunnel syndrome, trigger finger, Achilles tendinitis, oral corticosteroid use, and diabetes mellitus. The findings should alert the clinician to comorbid pathologic processes and guide future research into the etiology of this condition. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

The Biomechanical Role of Scaffolds in Augmented Rotator Cuff Tendon Repairs

Science.gov (United States)

2012-01-01

The biomechanical role of scaffolds in augmented rotator cuff tendon repairs Amit Aurora, D Enga,b, Jesse A. McCarron, MDc, Antonie J. van den Bogert...used for rotator cuff repair augmentation; however, the appropriate scaffold material properties and/or surgical application techniques for achieving...The model predicts that the biomechanical performance of a rotator cuff repair can be modestly increased by augmenting the repair with a scaffold that

Transparent Inflatable Column Film Dome for Nuclear Stations, Stadiums, and Cities

Directory of Open Access Journals (Sweden)

Alexander Bolonkin

2011-01-01

Full Text Available In a series of previous articles, one of the authors published designs of the AB Dome which can cover a city, important large installations or subregions by a transparent thin film supported by a small additional air overpressure. The AB Dome keeps the outside atmospheric conditions from the interior protecting a city from chemical, bacterial, and radioactive weapons (wastes. The design in this article differs from previous one as this design employs an inflatable columns which does not need an additional pressure (overpressure inside the dome and is cheaper in construction (no powered air pumping station and in operation (no special entrance airlock and permanent pumping expense. When dome is supported by columns, no overpressure is required inside the dome which is important when the dome covers a damaged nuclear reactor. The nuclear reactor may produce radioactive gases and dust, and, as inflatable domes are not typically hermetically sealed, the increased pressure inside the dome can leak out gas and dust into the atmosphere. The suggested design does not have this drawback. Positive pressure gradients expel dust particles—neutral pressure gradients will not. (Negative pressure gradients may even be possible in certain configurations.

Smart blood pressure holter.

Science.gov (United States)

İlhan, İlhan

2018-03-01

In this study, a wireless blood pressure holter that can be used with smart mobile devices was developed. The developed blood pressure holter consists of two parts, which are a smart mobile device and a cuff. The smart mobile device is used as a recording, control and display device through a developed interface, while the cuff was designed to take measurements from the arm. Resistor-Capacitor (RC) and digital filters were used on the cuff that communicates with the smart mobile device via Bluetooth. The blood pressure was estimated using the Simple Hill Climbing Algorithm (HCA). It is possible to measure instantaneous or programmable blood pressure and heart rate values at certain intervals using this holter. The test was conducted with 30 individuals at different ages with the guidance of a specialist health personnel. The results showed that an accuracy at 93.89% and 91.95% rates could be obtained for systolic and diastolic pressure values, respectively, when compared with those obtained using a traditional sphygmomanometer. The accuracy level for the heart rate was measured as 97.66%. Furthermore, this device was tested day and night in the holter mode in terms of working time, the continuity of the Bluetooth connection and the reliability of the measurement results. The test results were evaluated separately in terms of measurement accuracy, working time, the continuity of the Bluetooth connection and the reliability of the measurement results. The measurement accuracy for systolic, diastolic blood pressure and heart rate values was obtained as 93.89%, 91.95% and 97.66%, respectively. The maximum number of measurements which can be conducted with four 1000 mA alkaline batteries at 20 min intervals was found approximately 79 (little more than 24 h). In addition, it was determined that the continuity of the Bluetooth connection and the reliability of the measurement results were automatically achieved through the features in the interface developed for the

Sustained versus intermittent lung inflation for resuscitation of preterm infants: a randomized controlled trial.

Science.gov (United States)

El-Chimi, Mohamed S; Awad, Hisham A; El-Gammasy, Tarek M; El-Farghali, Ola G; Sallam, Mohamed T; Shinkar, Dina M

2017-06-01

To evaluate efficacy and safety of delivery room (DR) sustained lung inflation (SLI) in resuscitation of preterm neonates. Randomized Controlled Trial including 112 preterm infants randomized to either SLI (n = 57) using T-piece resuscitator [maximum three inflations with maximum pressure of 30 cmH 2 O for 15 s followed by continuous positive airway pressure (CPAP) of 5-7 cmH 2 O] or conventional bag/mask inflation (CBMI) (n = 55) using traditional self-inflating bag (maximum pressure of 40 cmH 2 O at a rate of 40-60 per min). Failure was defined as the need for DR or first 72 h intubation. Cord and 2-h post-resuscitation blood samples were collected to measure interleukin (IL)-1β and tumor necrosis factor-α levels before and after intervention. SLI was associated with significantly higher success rate compared to CBMI [75.4 versus 54.5%; p = 0.017], lower need for DR intubation [5.3% versus 23.6%; (X 2  =   7.7; p = 0.005)], higher 5-min-Apgar score (median 8 versus 7; p = 0.018), shorter duration on nasal-CPAP (p = 0.017), and non-significantly different air leak (7% versus 11%; p = 0.3) and bronchopulmonary dysplasia rates among survivors (2% versus 11%; p = 0.09). Post-resuscitation IL-1β plasma levels increased significantly in CBMI (p = 0.009) and not in SLI group. Delivery room SLI is more effective than intermittent bag and mask inflation for improving short-term respiratory outcome in preterm infants, without significant adverse effects.

Advanced Rotator Cuff Tear Score (ARoCuS): a multi-scaled tool for the classification and description of rotator cuff tears.

Science.gov (United States)

Walter, S G; Stadler, T; Thomas, T S; Thomas, W

2018-03-02

To introduce a (semi-)quantitative surgical score for the classification of rotator cuff tears. A total of 146 consecutive patients underwent rotator cuff repair and were assessed using the previously defined Advanced Rotator Cuff Tear Score (ARoCuS) criteria: muscle tendon, size, tissue quality, pattern as well as mobilization of the tear. The data set was split into a training (125 patients) and a testing set (21 patients). The training data set fitted a nonlinear predictive model of the tear score based on the ARoCuS criteria, while the testing data served as control. Based on the scoring results, rotator cuff tears were assigned to one of four categories (ΔV I-IV) and received a stage-adapted treatment. For statistical analysis, mean values ± standard deviation, interclass correlation coefficients (ICC) and kappa values were calculated. Overall, 32 patients were classified as ΔV I, 68 as ΔV II and 37 as ΔV III. Nine patients showed ΔV IV tears. Patients of all ΔV groups improved significantly their Constant scores (p tears in a standardized and reproducible manner.

Galileon inflation

Energy Technology Data Exchange (ETDEWEB)

Burrage, Clare [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); Rham, Claudia de [Univ. de Geneve (Switzerland). Dept. de Physique Theorique; Seery, David [Sussex Univ., Brigthon (United Kingdom). Dept. of Physics and Astronomy; Tolley, Andrew J. [Case Western Reserve Univ., Cleveland, OH (United States). Dept. of Physics

2010-09-15

Galileon inflation is a radiatively stable higher derivative model of inflation. The model is determined by a finite number of relevant operators which are protected by a covariant generalization of the Galileon shift symmetry. We show that the nongaussianity of the primordial density perturbation generated during an epoch of Galileon inflation is a particularly powerful observational probe of these models and that, when the speed of sound is small, f{sub NL} can be larger than the usual result f{sub NL} {proportional_to} C{sup -2}{sub s}. (orig.)

Numerical Simulation and Experimental Validation of the Inflation Test of Latex Balloons

Directory of Open Access Journals (Sweden)

Claudio Bustos

Full Text Available Abstract Experiments and modeling aimed at assessing the mechanical response of latex balloons in the inflation test are presented. To this end, the hyperelastic Yeoh material model is firstly characterized via tensile test and, then, used to numerically simulate via finite elements the stress-strain evolution during the inflation test. The numerical pressure-displacement curves are validated with those obtained experimentally. Moreover, this analysis is extended to a biomedical problem of an eyeball under glaucoma conditions.

Inflation expectations and inflation uncertainty in the Eurozone : Evidence from survey data

NARCIS (Netherlands)

Arnold, I.J.M.; Lemmen, J.J.G.

2006-01-01

This paper uses the European Commission's Consumer Survey to assess whether inflation expectations have converged and whether inflation uncertainty has diminished following the introduction of the Euro in Europe. Consumers' responses to the survey suggest that inflation expectations depend more on

Axisymmetric bifurcations of thick spherical shells under inflation and compression

KAUST Repository

deBotton, G.; Bustamante, R.; Dorfmann, A.

2013-01-01

Incremental equilibrium equations and corresponding boundary conditions for an isotropic, hyperelastic and incompressible material are summarized and then specialized to a form suitable for the analysis of a spherical shell subject to an internal or an external pressure. A thick-walled spherical shell during inflation is analyzed using four different material models. Specifically, one and two terms in the Ogden energy formulation, the Gent model and an I1 formulation recently proposed by Lopez-Pamies. We investigate the existence of local pressure maxima and minima and the dependence of the corresponding stretches on the material model and on shell thickness. These results are then used to investigate axisymmetric bifurcations of the inflated shell. The analysis is extended to determine the behavior of a thick-walled spherical shell subject to an external pressure. We find that the results of the two terms Ogden formulation, the Gent and the Lopez-Pamies models are very similar, for the one term Ogden material we identify additional critical stretches, which have not been reported in the literature before.© 2012 Published by Elsevier Ltd.

Skeletal muscle injury induced by a pneumatic tourniquet: an enzyme- and immunohistochemical study in rabbits.

Science.gov (United States)

Pedowitz, R A; Fridén, J; Thornell, L E

1992-03-01

The pathophysiology of skeletal muscle injury induced by compression beneath pneumatic tourniquets is poorly understood. Tourniquet hemostasis was induced in rabbit hindlimbs for 2 hr with a cuff inflation pressure of either 125 mm Hg (n = 5) or 350 mm Hg (n = 5). Skeletal muscle biopsies, taken 2 days later from tissue beneath and distal to the tourniquet, were frozen and analyzed using enzyme- and immunohistochemical techniques. In the 350 mm Hg tourniquet group, four of 10 thigh muscle samples demonstrated significant regional necrosis (mean 37.3% of the total cross-sectional area). Regional necrosis was not observed in thigh muscles of the 125 mm Hg tourniquet group or in any of the ischemic leg muscles. A topographic pattern of necrosis consistent with the arterial distribution of skeletal muscle suggested pathogenic events during the reperfusion period, such as granulocyte-mediated superoxide radical formation. Extremely large and rounded fibers (histochemically identified as Type IIB fibers) were observed in compressed thigh muscles, indicating differential fiber sensitivity to tourniquet compression and ischemia. The present study demonstrated significant skeletal muscle necrosis after a 2 hr tourniquet applied at a clinically relevant cuff inflation pressure. Recent studies of systemic changes associated with limb "ischemia" should be reassessed in consideration of the confounding effects of tissue compression induced beneath pneumatic tourniquets.

Inflation expectations and inflation uncertainty in the eurozone : Evidence from survey data

NARCIS (Netherlands)

Arnold, I.J.M.; Lemmen, J.J.G.

2008-01-01

This paper uses the European Commission’s Consumer Survey to assess whether inflation expectations have converged and whether inflation uncertainty has diminished following the introduction of the euro in Europe. Consumers’ responses to the survey suggest that inflation expectations depend more on

News on Inflation and the Epidemiology of Inflation Expectations

DEFF Research Database (Denmark)

Pfajfar, Damjan; Santoro, Emiliano

2013-01-01

This paper examines the nexus between news coverage on inflation and households’ inflation expectations. In doing so, we test the epidemiological foundations of the sticky information model (Carroll ). We use both aggregate and household-level data from the Survey Research Center at the University...... of Michigan. We highlight a fundamental disconnection among news on inflation, consumers’ frequency of expectation updating, and the accuracy of their expectations. Our evidence provides at best weak support to the epidemiological framework, as most of the consumers who update their expectations do not revise...

Retrofitting models of inflation

International Nuclear Information System (INIS)

Kain, Ben

2009-01-01

I use the method of retrofitting, developed by Dine, Feng and Silverstein, to generate the scale of inflation dynamically, allowing it to be naturally small. This is a general procedure that may be performed on existing models of supersymmetric inflation. I illustrate this idea on two such models, one an example of F-term inflation and the other an example of D-term inflation.

Ultrasonography and arthrography in rotator cuff lesions: algorithmic approach

Energy Technology Data Exchange (ETDEWEB)

Kim, Eui Jong; Ryu, Kyung Nam; Lee, Sun Wha; Lim, Jae Hoon; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yu, Pil Mun [Dankuk University College of Medicine, Chenona (Korea, Republic of)

1992-11-15

Twenty-six patients with chief complaint of shoulder pain who underwent both ultrasonographic examination and arthrography of the shoulder were analyzed. Ten out of 12 cases with clinical impression of frozen shoulder, showed normal findings on the ultrasonographic examination of the shoulder. Among these ten cases, nine cases showed adhesive capsulitis and one case showed rotator cuff tear on arthrography. Among six cases with the clinical impression of rotator cuff tear, five cases showed rotator cuff tear and one case showed combined calcific tendinitis and adhesive capsulitis on ultrasonographic examination. In arthrography, four cases of rotator cuff tear, one case of calcific tendinitis and biceps tendinitis and one case of normal finding were diagnosed. For the remaining eight cases in the ultrasonographic examination, normal finding or biceps tendinitis were found and for the remaining of the cases in arthrography adhesive capsulitis were found. With the above results, we recommend that the shoulder ultrasonography as the first line diagnostic modality for a patient with chief complaint of shoulder pain.

Ultrasonography and arthrography in rotator cuff lesions: algorithmic approach

International Nuclear Information System (INIS)

Kim, Eui Jong; Ryu, Kyung Nam; Lee, Sun Wha; Lim, Jae Hoon; Rhee, Yong Girl; Yu, Pil Mun

1992-01-01

Twenty-six patients with chief complaint of shoulder pain who underwent both ultrasonographic examination and arthrography of the shoulder were analyzed. Ten out of 12 cases with clinical impression of frozen shoulder, showed normal findings on the ultrasonographic examination of the shoulder. Among these ten cases, nine cases showed adhesive capsulitis and one case showed rotator cuff tear on arthrography. Among six cases with the clinical impression of rotator cuff tear, five cases showed rotator cuff tear and one case showed combined calcific tendinitis and adhesive capsulitis on ultrasonographic examination. In arthrography, four cases of rotator cuff tear, one case of calcific tendinitis and biceps tendinitis and one case of normal finding were diagnosed. For the remaining eight cases in the ultrasonographic examination, normal finding or biceps tendinitis were found and for the remaining of the cases in arthrography adhesive capsulitis were found. With the above results, we recommend that the shoulder ultrasonography as the first line diagnostic modality for a patient with chief complaint of shoulder pain

Structural Testing of a 6m Hypersonic Inflatable Aerodynamic Decelerator System

Science.gov (United States)

Swanson, G. T.; Kazemba, C. D.; Johnson, R. K.; Hughes, S. J.; Calomino, A. M.

2015-01-01

NASA is developing low ballistic coefficient technologies to support the Nations long-term goal of landing humans on Mars. Current entry, decent, and landing technologies are not practical for this class of payloads due to geometric constraints dictated by current and future launch vehicle fairing limitations. Hypersonic Inflatable Aerodynamic Decelerators (HIADs) are being developed to circumvent this limitation and are now considered a leading technology to enable landing of heavy payloads on Mars. At the beginning of 2014, a 6m diameter HIAD inflatable structure with an integrated flexible thermal protection system (TPS) was subjected to a static load test series to verify its structural performance under flight-relevant loads. The inflatable structure was constructed into a 60 degree sphere-cone configuration using nine inflatable torus segments composed of fiber-reinforced thin films. The inflatable tori were joined together using adhesives and high-strength textile woven structural straps. These straps help distribute the load throughout the inflatable structure. The 6m flexible TPS was constructed using multiple layers of high performance materials that are designed to protect the inflatable structure from heat loads that would be seen in flight during atmospheric entry. A custom test fixture was constructed to perform the static load test series. The fixture consisted of a round structural tub with enough height and width to allow for displacement of the HIAD test article as loads were applied. The bottom of the tub rim had an airtight seal with the floor. The rigid centerbody of the HIAD was mounted to a pedestal in the center of the structural tub. Using an impermeable membrane draped over the HIAD test article, an airtight seal was created with the top rim of the static load tub. This seal allowed partial vacuum to be pulled beneath the HIAD resulting in a uniform static pressure load applied to the outer surface. Using this technique, the test article

Scale-invariant extended inflation

International Nuclear Information System (INIS)

Holman, R.; Kolb, E.W.; Vadas, S.L.; Wang, Y.

1991-01-01

We propose a model of extended inflation which makes use of the nonlinear realization of scale invariance involving the dilaton coupled to an inflaton field whose potential admits a metastable ground state. The resulting theory resembles the Jordan-Brans-Dicke version of extended inflation. However, quantum effects, in the form of the conformal anomaly, generate a mass for the dilaton, thus allowing our model to evade the problems of the original version of extended inflation. We show that extended inflation can occur for a wide range of inflaton potentials with no fine-tuning of dimensionless parameters required. Furthermore, we also find that it is quite natural for the extended-inflation period to be followed by an epoch of slow-rollover inflation as the dilaton settles down to the minimum of its induced potential

Measurements of Intra-Aortic Balloon Wall Movement During Inflation and Deflation: Effects of Angulation.

Science.gov (United States)

Bruti, Gianpaolo; Kolyva, Christina; Pepper, John R; Khir, Ashraf W

2015-08-01

The intra-aortic balloon pump (IABP) is a ventricular assist device that is used with a broad range of pre-, intra-, and postoperative patients undergoing cardiac surgery. Although the clinical efficacy of the IABP is well documented, the question of reduced efficacy when patients are nursed in the semi-recumbent position remains outstanding. The aim of the present work is therefore to investigate the underlying mechanics responsible for the loss of IABP performance when operated at an angle to the horizontal. Simultaneous recordings of balloon wall movement, providing an estimate of its diameter (D), and fluid pressure were taken at three sites along the intra-aortic balloon (IAB) at 0 and 45°. Flow rate, used for the calculation of displaced volume, was also recorded distal to the tip of the balloon. An in vitro experimental setup was used, featuring physiological impedances on either side of the IAB ends. IAB inflation at an angle of 45° showed that D increases at the tip of the IAB first, presenting a resistance to the flow displaced away from the tip of the balloon. The duration of inflation decreased by 15.5%, the inflation pressure pulse decreased by 9.6%, and volume decreased by 2.5%. Similarly, changing the position of the balloon from 0 to 45°, the balloon deflation became slower by 35%, deflation pressure pulse decreased by 14.7%, and volume suctioned was decreased by 15.2%. IAB wall movement showed that operating at 45° results in slower deflation compared with 0°. Slow wall movement, and changes in inflation and deflation onsets, result in a decreased volume displacement and pressure pulse generation. Operating the balloon at an angle to the horizontal, which is the preferred nursing position in intensive care units, results in reduced IAB inflation and deflation performance, possibly compromising its clinical benefits. Copyright © 2015 The Authors. Artificial Organs published by Wiley Periodicals, Inc. on behalf of International Center for

Endotracheal tube cufi pressures in adult patients undergoing ...

African Journals Online (AJOL)

obstructing tracheal mucosal blood flow but high enough to form an effective seal when delivering PPV. Tracheal ... the capillary blood pressure supplying the trachea and is followed by ischaemia with inflammation. ... The aim of this study was to determine the ETT cuff pressures of patients receiving general anaesthesia at ...

Preoperative and post-operative sleep quality evaluation in rotator cuff tear patients.

Science.gov (United States)

Serbest, Sancar; Tiftikçi, Uğur; Askın, Aydogan; Yaman, Ferda; Alpua, Murat

2017-07-01

The aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair. Thirty-one patients who underwent rotator cuff repair prospectively completed the Pittsburgh Sleep Quality Index, the Western Ontario Rotator Cuff Index, and the Constant and Murley shoulder scores before surgery and at 6 months after surgery. Preoperative demographic, clinical, and radiologic parameters were also evaluated. The study analysed 31 patients with a median age of 61 years. There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions (p Rotator Cuff Scale and the Constant and Murley shoulder scores (p ˂ 0.001). Sleep disorders are commonly seen in patients with rotator cuff tear, and after repair, there is an increase in the quality of sleep with a parallel improvement in shoulder functions. However, no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality. It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life. IV.

News on Inflation and the Epidemiology of Inflation Expectations

NARCIS (Netherlands)

Pfajfar, D.; Santoro, E.

2012-01-01

Abstract: This paper examines the nexus between news coverage on inflation and households' inflation expectations. In doing so, we test the epidemiological foundations of the sticky information model (Carroll, 2003, 2006). We use both aggregate and household-level data from the Survey Research

Tripolar-cuff deviation from ideal model: assessment by bioelectric field simulations and saline-bath experiments.

Science.gov (United States)

Triantis, Iasonas F; Demosthenous, Andreas

2008-06-01

Ideally, interference in neural measurements due to signals from nearby muscles can be completely eliminated with the use of tripolar cuffs, in combination with appropriate amplifier configurations, such as the quasi-tripole (QT) and the true-tripole (TT). The operation of these amplifiers, is based on the theoretical property of the nerve cuff to produce a linear relationship of potential versus distance along its length, internally, when external potentials appear between its ends. Thus, in principle, electroneurogram (ENG) recordings from an ideal tripolar cuff would be free from electromyogram (EMG) interference generated by nearby muscles. However, in practice the cuff exhibits non-ideal behaviour leading to "cuff imbalance". The main focus of this paper is to investigate the causes of cuff imbalance, to demonstrate that it should be incorporated as a main parameter in the theoretical ENG-recording cuff electrode model. In addition to cuff asymmetry and tissue growth, the proximity of the interference source to the cuff is shown to result in cuff imbalance. The influence of proximity imbalance on the performance of the QT and TT amplifiers is also considered. Proximity imbalance is studied using bioelectric field simulations and saline-bath experiments. Variation is observed with both distance (40 mm and 70 mm was examined) and orientation (0-180 degrees), with the latter causing a more severe effect especially when the source dipole and the cuff are vertical to each other. The simulations and measurements are in close agreement. Tissue growth imbalance and asymmetry imbalance are also investigated in vitro. Finally, the signal-to-interference ratio (SIR; ENG/EMG) of the QT and TT amplifiers is examined in the presence of cuff imbalance. It is shown that proximity imbalance results in their SIR to peak only at certain cuff orientation values. This important finding offers an insight as to why in practice ENG recordings using these amplifiers have been widely

Development of an Inflatable Head/Neck Restraint System for Ejection Seats

Science.gov (United States)

1977-02-28

crewman’s head . It has been observed that low pressures, about 2 psi (1.38 nt/cm2 ) to 4 psi (2.76 nt/cm2 ), create some "spring back" or trampoline ...neck ring Neck injury Head rotation 210 ABSTRACT (Continue on rev’erse side If necessary end identify by block number) 4A ringý-shaped inflatable head ...injuries due to violent forward head rotation at the time of ejection thrust and parachute opening shock. Inflation of the neck ring will,’ be conducted by a

Effectiveness Of Plain Shoulder Radiograph In Detecting Degenerate Rotator Cuff Tears.

Science.gov (United States)

Hussain, Adnan; Muzzammil, Muhammad; Butt, Faisal; Valsamis, Epaminondas Markos; Dwyer, Amitabh J

2018-01-01

Studies have demonstrated radiographic findings of sclerosis and cortical irregularity at the greater tuberosity can suggest a rotator cuff tear. Plain radiographs are the most easily attainable first-line investigations in evaluating shoulder injuries. This study determines the effectiveness in predicting degenerate rotator cuff tears by detecting radiographic changes on shoulder x-rays. Retrospective cross-sectional study with a consecutive series of patients conducted in Hinchingbrooke Hospital, Huntingdon, United Kingdom from January 2015 to June 2017. Anteroposterior shoulder radiographs of 150 symptomatic patients who underwent shoulder arthroscopy were independently analysed by surgeons who were blinded from the arthroscopic results. Patients aged fewer than 30 and over 70 years were excluded. Patients with advanced osteoarthritis and cuff tear arthropathy evident on x-rays were also excluded. Sixty-five patients included in the study had rotator cuff tears on arthroscopy. Radiographic changes were correlated with arthroscopic findings to determine this test's ability to predict degenerate rotator cuff tears. When both cortical irregularity and sclerosis were present on the plain radiograph, these signs had a sensitivity of 78.8% [95% CI 65.7, 87.8%] and specificity 77.4% [95% CI 67.2, 85.0%] with a positive predictive value of 68.3%, using contingency table analysis. The presence of cortical irregularity was found to be a better predictor of a tear as compared to sclerosis. This study concludes that plain radiograph are good modality for initial evaluation of rotator cuff tears and detecting when both cortical irregularity and sclerosis. Consideration of these radiographic findings serves as a useful adjunct in diagnostic workup and can guide subsequent investigations and treatment when evaluating rotator cuff tears of the shoulder.

Evaluation of the Risk Factors for a Rotator Cuff Retear After Repair Surgery.

Science.gov (United States)

Lee, Yeong Seok; Jeong, Jeung Yeol; Park, Chan-Deok; Kang, Seung Gyoon; Yoo, Jae Chul

2017-07-01

A retear is a significant clinical problem after rotator cuff repair. However, no study has evaluated the retear rate with regard to the extent of footprint coverage. To evaluate the preoperative and intraoperative factors for a retear after rotator cuff repair, and to confirm the relationship with the extent of footprint coverage. Cohort study; Level of evidence, 3. Data were retrospectively collected from 693 patients who underwent arthroscopic rotator cuff repair between January 2006 and December 2014. All repairs were classified into 4 types of completeness of repair according to the amount of footprint coverage at the end of surgery. All patients underwent magnetic resonance imaging (MRI) after a mean postoperative duration of 5.4 months. Preoperative demographic data, functional scores, range of motion, and global fatty degeneration on preoperative MRI and intraoperative variables including the tear size, completeness of rotator cuff repair, concomitant subscapularis repair, number of suture anchors used, repair technique (single-row or transosseous-equivalent double-row repair), and surgical duration were evaluated. Furthermore, the factors associated with failure using the single-row technique and transosseous-equivalent double-row technique were analyzed separately. The retear rate was 7.22%. Univariate analysis revealed that rotator cuff retears were affected by age; the presence of inflammatory arthritis; the completeness of rotator cuff repair; the initial tear size; the number of suture anchors; mean operative time; functional visual analog scale scores; Simple Shoulder Test findings; American Shoulder and Elbow Surgeons scores; and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis. Multivariate logistic regression analysis revealed patient age, initial tear size, and fatty degeneration of the supraspinatus as independent risk factors for a rotator cuff retear. Multivariate logistic regression analysis of the single-row group

Vacuum Energy and Inflation: 3. Newtonian Cosmology & GR

Science.gov (United States)

Huggins, Elisha

2013-01-01

This is paper #3 in a series of four papers on "vacuum energy" and inflation. In paper #1 [see EJ1024183] we discussed an example of what we have been calling vacuum energy. It is an energy with negative pressure whose energy density remains constant in an expanding space. We showed that an energy density with these properties exists…

Vacuum Energy and Inflation: 4. An Inflationary Universe

Science.gov (United States)

Huggins, Elisha

2013-01-01

This is the fourth paper in a series of four. The first paper in the series, "Vacuum Energy and Inflation: 1. A Liter of Vacuum Energy" [EJ1024183] discusses an example of vacuum energy. Vacuum energy is explained as an energy with a negative pressure whose energy density remains constant in an expanding space. Paper 2, "Vacuum…

Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors.

Science.gov (United States)

Chung, Seok Won; Oh, Joo Han; Gong, Hyun Sik; Kim, Joon Yub; Kim, Sae Hoon

2011-10-01

The prognostic factors associated with structural outcome after arthroscopic rotator cuff repair have not yet been fully determined. The hypothesis of this study was that bone mineral density (BMD) is an important prognostic factor affecting rotator cuff healing after arthroscopic cuff repair. Cohort study; Level of evidence, 3. Among 408 patients who underwent arthroscopic repair for full-thickness rotator cuff tear between January 2004 and July 2008, 272 patients were included whose postoperative cuff integrity was verified by computed tomography arthrography (CTA) or ultrasonography (USG) and simultaneously who were evaluated by various functional outcome instruments. The mean age at the time of operation was 59.5 ± 7.9 years. Postoperative CTA or USG was performed at a mean 13.0 ± 5.1 months after surgery, and the mean follow-up period was 37.2 ± 10.0 months (range, 24-65 months). The clinical, structural, and surgery-related factors affecting cuff integrity including BMD were analyzed using both univariate and multivariate analysis. Evaluation of postoperative cuff integrity was performed by musculoskeletal radiologists who were unaware of the present study. The failure rate of rotator cuff healing was 22.8% (62 of 272). The failure rate was significantly higher in patients with lower BMD (P cuff healing failure following arthroscopic rotator cuff repair. Bone mineral density, as well as FI of the infraspinatus and amount of retraction, was an independent determining factor affecting postoperative rotator cuff healing. Further studies with prospective, randomized, and controlled design are needed to confirm the relationship between BMD and postoperative rotator cuff healing.

Attractors, universality, and inflation

Science.gov (United States)

Downes, Sean; Dutta, Bhaskar; Sinha, Kuver

2012-11-01

Studies of the initial conditions for inflation have conflicting predictions from exponential suppression to inevitability. At the level of phase space, this conflict arises from the competing intuitions of CPT invariance and thermodynamics. After reviewing this conflict, we enlarge the ensemble beyond phase space to include scalar potential data. We show how this leads to an important contribution from inflection point inflation, enhancing the likelihood of inflation to a power law, 1/Ne3. In the process, we emphasize the attractor dynamics of the gravity-scalar system and the existence of universality classes from inflection point inflation. Finally, we comment on the predictivity of inflation in light of these results.

News on inflation and the epidemiology of inflation expectations

NARCIS (Netherlands)

Pfajfar, D.; Santoro, E.

2013-01-01

This paper examines the nexus between news coverage on inflation and households’ inflation expectations. In doing so, we test the epidemiological foundations of the sticky information model (Carroll 2003, 2006). We use both aggregate and household-level data from the Survey Research Center at the

Quasi-open inflation

CERN Document Server

García-Bellido, J; Montes, X; Garcia-Bellido, Juan; Garriga, Jaume; Montes, Xavier

1998-01-01

We show that a large class of two-field models of single-bubble open inflation do not lead to infinite open universes, as it was previously thought, but to an ensemble of very large but finite inflating `islands'. The reason is that the quantum tunneling responsible for the nucleation of the bubble does not occur simultaneously along both field directions and equal-time hypersurfaces in the open universe are not synchronized with equal-density or fixed-field hypersurfaces. The most probable tunneling trajectory corresponds to a zero value of the inflaton field; large values, necessary for the second period of inflation inside the bubble, only arise as localized fluctuations. The interior of each nucleated bubble will contain an infinite number of such inflating regions of comoving size of order $\\gamma^{-1}$, where $\\gamma$ depends on the parameters of the model. Each one of these islands will be a quasi-open universe. Since the volume of the hyperboloid is infinite, inflating islands with all possible values...

Nutrition Coupled with High-Load Traditional or Low-Load Blood Flow Restricted Exercise During Human Limb Suspension

Science.gov (United States)

Hackney, K. J.; Everett, M.; Ploutz-Snyder, L. L.

2011-01-01

High-load resistance exercise (HRE) and low-load blood flow restricted (BFR) exercise have demonstrated efficacy for attenuating unloading related muscle atrophy and dysfunction. In recreational exercisers, protein consumption immediately before and/or after exercise has been shown to increase the skeletal muscle anabolic response to resistance training. PURPOSE: To compare the skeletal muscle adaptations when chocolate milk intake was coupled with HRE or low-load BFR exercise [3 d/wk] during simulated lower limb weightlessness. METHODS: Eleven subjects were counterbalanced [based on age and gender] to HRE (31 +/- 14 yr, 170 +/- 13 cm, 71 +/- 18 kg, 2M/3W) or low-load BFR exercise (31 +/- 12 yr, 169 +/- 13 cm, 66 +/- 14 kg, 2M/4W) during 30 days of unilateral lower limb suspension (ULLS). Both HRE and BFR completed 3 sets of single leg press and calf raise exercise during ULLS. BFR exercise intensity was 20% of repetition maximum (1RM) with a cuff inflation pressure of 1.3 systolic blood pressure (143 4 mmHg). Cuff pressure was maintained during all 3 sets including rest intervals (90s). HRE intensity was 75% 1RM and was performed without cuff inflation. Immediately (HRE vs. BFR, respectively. Leg press training loads were 44 +/- 7 kg in HRE compared to 11 +/- 1 kg in BFR. Similarly, calf raise training loads were 81 +/- 11 kg in HRE and 16 +/- 1 kg in BFR. Pre to post-ULLS training adaptations in the unloaded leg are shown in the table. CONCLUSION: The preliminary results of this investigation suggest when HRE is optimized for muscle anabolism during unloading muscle size and strength are preserved (or enhanced) at the expense of muscle endurance. In contrast, when BFR exercise is optimized for muscle anabolism during unloading muscle endurance is preserved (or enhanced) at the expense of muscle size and strength

Post-Transurethral Resection of the Prostate Inflation of Pressure-Controlled Endorectal Balloon-Impact on Postoperative Bleeding: A Preliminary Experimental Pilot Study.

Science.gov (United States)

Mohyelden, Khaled; Ibrahim, Hamdy; Abdel-Kader, Osman; Sherief, Mahmoud H; El-Nashar, Ahmed; Shaker, Hosam; Elkoushy, Mohamed A

2016-02-01

To evaluate the impact of rectal balloon (RB) inflation on post-transurethral resection of the prostate (TURP) bleeding in patients with symptomatic benign prostatic hyperplasia. After institutional review board approval, patients who were eligible for TURP were randomized into two equal groups, depending on whether they received postoperative endorectal balloon (RB) (GII) or not (GI). The tip of three-way Foley catheter was fixed to a balloon by a blaster strip to prepare air-tight RB. Postoperatively, the RB was inflated for 15 minutes by a pressure-controlled sphygmomanometer. Perioperative data were compared between both groups, including hemoglobin (Hb) deficit 24-hour postoperatively and at time of discharge. Functional outcomes, anorectal complaints, and adverse events were assessed perioperatively and after 1 and 3 months. Fifty patients were enrolled, including 13 (26%) patients who presented with indwelling urethral catheters. Baseline data and mean resected tissue weight were comparable between both groups, including preoperative Hb (p = 0.17). Immediate postoperative Hb deficit was, comparable between GI and GII patients (0.58 ± 0.18 vs 0.60 ± 0.2, p = 0.56) before RB inflation, respectively. However, compared to GI patients, mean Hb deficit significantly decreased in GII patients 24-hour postoperatively (0.2 ± 0.2 vs 0.7 ± 0.3 g, p = 0.002) and at time of discharge (0.8 ± 0.2 vs 1.3 ± 0.4 g, p = 0.003). GII patients needed significantly less postoperative irrigation (2.1 ± 1.6 vs 8.3 ± 1.8 L, p hematuria or clot retention in either group, while there were no anorectal complaints reported by GII patients. Post-TURP endorectal balloon inflation seems to be simple, safe, and an efficient procedure to reduce postoperative bleeding and irrigation volume. It is significantly associated with shorter catheterization time and hospital stay.

Case Report of Acute Traumatic Rotator Cuff Tear Treatment in Traditional Korean Medicine

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Jeong-Hwan Lee

2011-12-01

Full Text Available Objectives: There is no report on treatment of acute traumatic rotator cuff tear in Traditional Korean Medicine. We reported Traditional Korean Treatment for pain relief and better movement of acute traumatic rotator cuff tear. Methods: Shoulder MRI was used to confirm the diagnosis of tear of rotator cuff. The patient was treated with Traditional Korean Methods (Acupuncture, Herbal medicine, Pharmacopuncture for 6 months. We evaluated the patient through VAS (Visual Analogue Scale, UCLA shoulder scale, ROM (Range of motion and Shoulder MRI. Results: After 6 months of treatment, the patient's VAS was decreased whereas UCLA score and Shoulder ROM were increased. Rotator cuff tear was repaired on Shoulder MRI images. Conclusions: In acute traumatic rotator cuff tear, Korean Traditional Treatment is good method for pain relief and better movement.

A comparison of inflation expectations and inflation credibility in South Africa: results from survey data

Directory of Open Access Journals (Sweden)

Jannie Rossouw

2011-08-01

Full Text Available This paper reports a comparison of South African household inflation expectations and inflation credibility surveys undertaken in 2006 and 2008. It tests for possible feed-through between inflation credibility and inflation expectations. It supplements earlier research that focused only on the 2006 survey results. The comparison shows that inflation expectations differed between different income groups in both 2006 and 2008. Inflation credibility differed between male and female respondents, but this difference did not feed through to inflation expectations. More periodic survey data will be required for developing final conclusions on the possibility of feed-through effects. To this end the structure of credibility surveys should be reconsidered, as a large percentage of respondents indicated that they ‘don’t know’ whether the historic rate of inflation is an accurate indication of price increases.

Inflation rates, rifts, and bands in a pāhoehoe sheet flow

Science.gov (United States)

Hoblitt, Richard P.; Orr, Tim R.; Heliker, Christina; Denlinger, Roger P.; Hon, Ken; Cervelli, Peter F.

2012-01-01

The margins of sheet flows—pāhoehoe lavas emplaced on surfaces sloping Inflation and rift-band formation is probably cyclic, because the pattern we observed suggests episodic or crude cyclic behavior. Furthermore, some inflation rifts contain numerous bands whose spacing and general appearances are remarkably similar. We propose a conceptual model wherein the inferred cyclicity is due to the competition between the fluid pressure in the flow's liquid core and the tensile strength of the viscoelastic layer where it is weakest—in inflation rifts. The viscoelastic layer consists of lava that has cooled to temperatures between 800 and 1070 °C. This layer is the key parameter in our model because, in its absence, rift banding and stepwise changes in the flow height would not occur.

Does the Rotator Cuff Tear Pattern Influence Clinical Outcomes After Surgical Repair?

Science.gov (United States)

Watson, Scott; Allen, Benjamin; Robbins, Chris; Bedi, Asheesh; Gagnier, Joel J; Miller, Bruce

2018-03-01

Limited literature exists regarding the influence of rotator cuff tear morphology on patient outcomes. To determine the effect of rotator cuff tear pattern (crescent, U-shape, L-shape) on patient-reported outcomes after rotator cuff repair. Cohort study; Level of evidence, 3. Patients undergoing arthroscopic repair of known full-thickness rotator cuff tears were observed prospectively at regular intervals from baseline to 1 year. The tear pattern was classified at the time of surgery as crescent, U-shaped, or L-shaped. Primary outcome measures were the Western Ontario Rotator Cuff Index (WORC), the American Shoulder and Elbow Surgeons (ASES), and a visual analog scale (VAS) for pain. The tear pattern was evaluated as the primary predictor while controlling for variables known to affect rotator cuff outcomes. Mixed-methods regression and analysis of variance (ANOVA) were used to examine the effects of tear morphology on patient-reported outcomes after surgical repair from baseline to 1 year. A total of 82 patients were included in the study (53 male, 29 female; mean age, 58 years [range, 41-75 years]). A crescent shape was the most common tear pattern (54%), followed by U-shaped (25%) and L-shaped tears (21%). There were no significant differences in outcome scores between the 3 groups at baseline. All 3 groups showed statistically significant improvement from baseline to 1 year, but analysis failed to show any predictive effect in the change in outcome scores from baseline to 1 year for the WORC, ASES, or VAS when tear pattern was the primary predictor. Further ANOVA also failed to show any significant difference in the change in outcome scores from baseline to 1 year for the WORC ( P = .96), ASES ( P = .71), or VAS ( P = .86). Rotator cuff tear pattern is not a predictor of functional outcomes after arthroscopic rotator cuff repair.

Does a Threshold Inflation Rate Exist? Quantile Inferences for Inflation and Its Variability

OpenAIRE

WenShwo Fang; Stephen M. Miller; Chih-Chuan Yeh

2009-01-01

Using quantile regressions and cross-sectional data from 152 countries, we examine the relationship between inflation and its variability. We consider two measures of inflation – the mean and median – and three different measures of inflation variability – the standard deviation, relative variation, and median deviation. All results from the mean and standard deviation, the mean and relative variation, or the median and the median deviation support both the hypothesis that higher inflation cr...

Effects of asymptomatic rotator cuff pathology on in vivo shoulder motion and clinical outcomes.