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Sample records for extended criteria cardiac

  1. Micromolded Gelatin Hydrogels for Extended Culture of Engineered Cardiac Tissues

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    McCain, Megan L.; Agarwal, Ashutosh; Nesmith, Haley W.; Nesmith, Alexander P.; Parker, Kevin Kit

    2014-01-01

    Defining the chronic cardiotoxic effects of drugs during preclinical screening is hindered by the relatively short lifetime of functional cardiac tissues in vitro, which are traditionally cultured on synthetic materials that do not recapitulate the cardiac microenvironment. Because collagen is the primary extracellular matrix protein in the heart, we hypothesized that micromolded gelatin hydrogel substrates tuned to mimic the elastic modulus of the heart would extend the lifetime of engineered cardiac tissues by better matching the native chemical and mechanical microenvironment. To measure tissue stress, we used tape casting, micromolding, and laser engraving to fabricate gelatin hydrogel muscular thin film cantilevers. Neonatal rat cardiac myocytes adhered to gelatin hydrogels and formed aligned tissues as defined by the microgrooves. Cardiac tissues could be cultured for over three weeks without declines in contractile stress. Myocytes on gelatin had higher spare respiratory capacity compared to those on fibronectin-coated PDMS, suggesting that improved metabolic function could be contributing to extended culture lifetime. Lastly, human induced pluripotent stem cell-derived cardiac myocytes adhered to micromolded gelatin surfaces and formed aligned tissues that remained functional for four weeks, highlighting their potential for human-relevant chronic studies. PMID:24731714

  2. High-risk donors: extending our criteria in times of organ shortage.

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    Bernhardt, Alexander M; Reichenspurner, Hermann

    2014-10-01

    Increasing waiting lists and declining transplant numbers due to organ shortage are a global problem that needs a multimodal approach to overcome this situation. Extending the criteria for transplantation may be one part of the solution. There are political efforts to increase the donor rate and change the listing criteria and the allocation process. Recently, the cardiac allocation score was introduced enhancing the factor urgency to the allocation process. Marginal donor organs can be accepted using ex-vivo perfusion strategies. Experimental approaches, such as donation after circulatory death and xenotransplantation, need to be further developed to be applied to humans and increase the pool of available transplant organs. Organ shortage needs new approaches to overcome the discrepancy between the number of patients on the wait list and performed heart transplantations, reduce wait list mortality and improve long-term outcomes after transplantation.

  3. Coupling of cardiac electrical activity over extended distances by fibroblasts of cardiac origin.

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    Gaudesius, Giedrius; Miragoli, Michele; Thomas, Stuart P; Rohr, Stephan

    2003-09-05

    Roughly half of the cells of the heart consist of nonmyocardial cells, with fibroblasts representing the predominant cell type. It is well established that individual cardiomyocytes and fibroblasts in culture establish gap junctional communication at the single cell level (short-range interaction). However, it is not known whether such coupling permits activation of cardiac tissue over extended distances (long-range interaction). Long-range interactions may be responsible for electrical synchronization of donor and recipient tissue after heart transplantation and may play a role in arrhythmogenesis. This question was investigated using a novel heterocellular culture model with strands of cardiomyocytes interrupted by cardiac fibroblasts over defined distances. With use of optical recording techniques, it could be shown that impulse propagation along fibroblast inserts was successful over distances up to 300 microm and was characterized by length-dependent local propagation delays ranging from 11 to 68 ms (apparent local "conduction velocities" 4.6+/-1.8 mm/s, n=23). Involvement of mechanical stretch in this phenomenon was excluded by showing that inserts consisting of communication-deficient HeLa cells were incapable of supporting propagation. In contrast, HeLa cells expressing connexin43 permitted impulse conduction over distances as long as 600 microm. Immunocytochemistry showed that fibroblasts and cardiomyocytes expressed connexin43 and connexin45, whereas connexin40 was absent. These results illustrate that fibroblasts of cardiac origin are capable of synchronizing electrical activity of multicellular cardiac tissue over extended distances through electrotonic interactions. This synchronization is accompanied by extremely large local conduction delays, which might contribute to the generation of arrhythmias in fibrotic hearts.

  4. Simulation Methods and Validation Criteria for Modeling Cardiac Ventricular Electrophysiology.

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    Krishnamoorthi, Shankarjee; Perotti, Luigi E; Borgstrom, Nils P; Ajijola, Olujimi A; Frid, Anna; Ponnaluri, Aditya V; Weiss, James N; Qu, Zhilin; Klug, William S; Ennis, Daniel B; Garfinkel, Alan

    2014-01-01

    We describe a sequence of methods to produce a partial differential equation model of the electrical activation of the ventricles. In our framework, we incorporate the anatomy and cardiac microstructure obtained from magnetic resonance imaging and diffusion tensor imaging of a New Zealand White rabbit, the Purkinje structure and the Purkinje-muscle junctions, and an electrophysiologically accurate model of the ventricular myocytes and tissue, which includes transmural and apex-to-base gradients of action potential characteristics. We solve the electrophysiology governing equations using the finite element method and compute both a 6-lead precordial electrocardiogram (ECG) and the activation wavefronts over time. We are particularly concerned with the validation of the various methods used in our model and, in this regard, propose a series of validation criteria that we consider essential. These include producing a physiologically accurate ECG, a correct ventricular activation sequence, and the inducibility of ventricular fibrillation. Among other components, we conclude that a Purkinje geometry with a high density of Purkinje muscle junctions covering the right and left ventricular endocardial surfaces as well as transmural and apex-to-base gradients in action potential characteristics are necessary to produce ECGs and time activation plots that agree with physiological observations.

  5. Simulation Methods and Validation Criteria for Modeling Cardiac Ventricular Electrophysiology.

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    Shankarjee Krishnamoorthi

    Full Text Available We describe a sequence of methods to produce a partial differential equation model of the electrical activation of the ventricles. In our framework, we incorporate the anatomy and cardiac microstructure obtained from magnetic resonance imaging and diffusion tensor imaging of a New Zealand White rabbit, the Purkinje structure and the Purkinje-muscle junctions, and an electrophysiologically accurate model of the ventricular myocytes and tissue, which includes transmural and apex-to-base gradients of action potential characteristics. We solve the electrophysiology governing equations using the finite element method and compute both a 6-lead precordial electrocardiogram (ECG and the activation wavefronts over time. We are particularly concerned with the validation of the various methods used in our model and, in this regard, propose a series of validation criteria that we consider essential. These include producing a physiologically accurate ECG, a correct ventricular activation sequence, and the inducibility of ventricular fibrillation. Among other components, we conclude that a Purkinje geometry with a high density of Purkinje muscle junctions covering the right and left ventricular endocardial surfaces as well as transmural and apex-to-base gradients in action potential characteristics are necessary to produce ECGs and time activation plots that agree with physiological observations.

  6. Extended cardiac rehabilitation for socially vulnerable patients improves attendance and outcome

    DEFF Research Database (Denmark)

    Nielsen, Kirsten Melgaard; Meillier, Lucette Kirsten; Larsen, Mogens Lytken

    2013-01-01

    Patients living alone or having a low socioeconomic status are likely to quit cardiac rehabilitation. We aimed to compare patients being offered extended rehabilitation (ERP) with those being offered standard rehabilitation (SRP) as concerns 1) attendance rates and 2) achievement of treatment goals...

  7. ASCI 2010 appropriateness criteria for cardiac computed tomography: a report of the Asian Society of Cardiovascular Imaging Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging Guideline Working Group.

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    Tsai, I-Chen; Choi, Byoung Wook; Chan, Carmen; Jinzaki, Masahiro; Kitagawa, Kakuya; Yong, Hwan Seok; Yu, Wei

    2010-02-01

    In Asia, the healthcare system, populations and patterns of disease differ from Western countries. The current reports on the criteria for cardiac CT scans, provided by Western professional societies, are not appropriate for Asian cultures. The Asian Society of Cardiovascular Imaging, the only society dedicated to cardiovascular imaging in Asia, formed a Working Group and invited 23 Technical Panel members representing a variety of Asian countries to rate the 51 indications for cardiac CT in clinical practice in Asia. The indications were rated as 'appropriate' (7-9), 'uncertain' (4-6), or 'inappropriate' (1-3) on a scale of 1-9. The median score was used for the final result if there was no disagreement. The final ratings for indications were 33 appropriate, 14 uncertain and 4 inappropriate. And 20 of them are highly agreed (19 appropriate and 1 inappropriate). Specifically, the Asian representatives considered cardiac CT as an appropriate modality for Kawasaki disease and congenital heart diseases in follow up and in symptomatic patients. In addition, except for some specified conditions, cardiac CT was considered to be an appropriate modality for one-stop shop ischemic heart disease evaluation due to its general appropriateness in coronary, structure and function evaluation. This report is expected to have a significant impact on the clinical practice, research and reimbursement policy in Asia.

  8. Comparison of Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD) relating to cardiac arrest calls.

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    Hardeland, Camilla; Olasveengen, Theresa M; Lawrence, Rob; Garrison, Danny; Lorem, Tonje; Farstad, Gunnar; Wik, Lars

    2014-05-01

    Prompt emergency medical service (EMS) system activation with rapid delivery of pre-hospital treatment is essential for patients suffering out-of-hospital cardiac arrest (OHCA). The two most commonly used dispatch tools are Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD). We compared cardiac arrest call processing using these two dispatch tools in two different dispatch centres. Observational study of adult EMS confirmed (non-EMS witnessed) OHCA calls during one year in Richmond, USA (MPD) and Oslo, Norway (CBD). Patients receiving CPR prior to call, interrupted calls or calls where the caller did not have access to the patients were excluded from analysis. Dispatch logs, ambulance records and digitalized dispatcher and caller voice recordings were compared. The MPDS-site processed 182 cardiac arrest calls and the CBD-site 232, of which 100 and 140 calls met the inclusion criteria, respectively. The recognition of cardiac arrest was not different in the MPD and CBD systems; 82% vs. 77% (p=0.42), and pre-EMS arrival CPR instructions were offered to 81% vs. 74% (p=0.22) of callers, respectively. Time to ambulance dispatch was median (95% confidence interval) 15 (13, 17) vs. 33 (29, 36) seconds (pCBD systems, respectively (p=0.05). Pre-arrival CPR instructions were offered faster and more frequently in the CBD system, but in both systems chest compressions were delayed 3-4min. Earlier recognition of cardiac arrest and improved CPR instructions may facilitate earlier lay rescuer CPR. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Safety criteria for contrast administration in computed tomography cardiac angiography: perception of nursing

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    Laura Vargas Acauan

    2015-09-01

    Full Text Available Objective: to understand the perception of the nursing team about the safety criteria adopted in the use and administration of iodinated contrast media on computed tomography cardiac angiography. Methods: a descriptive study with a qualitative approach. The data were produced using the semi-structured interview with twelve participants from two diagnostic imaging centers. Results: two thematic categories emerged from the analysis: safe practices in the use and administration of iodinated contrast media and use of light technologies for safe care in the use of iodinated contrast media. Conclusion: it was surmised that safety criteria linked by light and hard technologies are used, but not standardized. To promote effective and quality care focused on patient safety, protocols and guidelines should be established to overcome possible barriers unsafe.

  10. 2017 multimodality appropriate use criteria for noninvasive cardiac imaging: Export consensus of the Asian society of cardiovascular imaging

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    Beck, Kyong Min Sarah [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Kim, Jeong A [Dept. of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of); Choe, Yeon Hyeon [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); and others

    2017-11-15

    In 2010, the Asian Society of Cardiovascular Imaging (ASCI) provided recommendations for cardiac CT and MRI, and this document reflects an update of the 2010 ASCI appropriate use criteria (AUC). In 2016, the ASCI formed a new working group for revision of AUC for noninvasive cardiac imaging. A major change that we made in this document is the rating of various noninvasive tests (exercise electrocardiogram, echocardiography, positron emission tomography, single-photon emission computed tomography, radionuclide imaging, cardiac magnetic resonance, and cardiac computed tomography/angiography), compared side by side for their applications in various clinical scenarios. Ninety-five clinical scenarios were developed from eight selected pre-existing guidelines and classified into four sections as follows: 1) detection of coronary artery disease, symptomatic or asymptomatic; 2) cardiac evaluation in various clinical scenarios; 3) use of imaging modality according to prior testing; and 4) evaluation of cardiac structure and function. The clinical scenarios were scored by a separate rating committee on a scale of 1–9 to designate appropriate use, uncertain use, or inappropriate use according to a modified Delphi method. Overall, the AUC ratings for CT were higher than those of previous guidelines. These new AUC provide guidance for clinicians choosing among available testing modalities for various cardiac diseases and are also unique, given that most previous AUC for noninvasive imaging include only one imaging technique. As cardiac imaging is multimodal in nature, we believe that these AUC will be more useful for clinical decision making.

  11. ASCI 2010 appropriateness criteria for cardiac magnetic resonance imaging: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group.

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    Kitagawa, Kakuya; Choi, Byoung Wook; Chan, Carmen; Jinzaki, Masahiro; Tsai, I-Chen; Yong, Hwan Seok; Yu, Wei

    2010-12-01

    There has been a growing need for standard Asian population guidelines for cardiac CT and cardiac MR due to differences in culture, healthcare system, ethnicity and disease prevalence. The Asian Society of Cardiovascular Imaging, as the only society dedicated to cardiovascular imaging in Asia, formed a cardiac CT and cardiac MR guideline working group in order to help Asian practitioners to establish cardiac CT and cardiac MR services. In this ASCI cardiac MR appropriateness criteria report, 23 Technical Panel members representing various Asian countries were invited to rate 50 indications that can frequently be encountered in clinical practice in Asia. Indications were rated on a scale of 1-9 to be categorized into 'appropriate' (7-9), 'uncertain' (4-6), or 'inappropriate' (1-3). According to median scores of the 23 members, the final ratings for indications were 24 appropriate, 18 uncertain and 8 inappropriate with 22 'highly-agreed' (19 appropriate and 3 inappropriate) indications. This report is expected to have a significant impact on the cardiac MR practices in many Asian countries by promoting the appropriate use of cardiac MR.

  12. Calcifications of the thoracic aorta on extended non-contrast-enhanced cardiac CT.

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    Damian Craiem

    Full Text Available BACKGROUND: The presence of calcified atherosclerosis in different vascular beds has been associated with a higher risk of mortality. Thoracic aorta calcium (TAC can be assessed from computed tomography (CT scans, originally aimed at coronary artery calcium (CAC assessment. CAC screening improves cardiovascular risk prediction, beyond standard risk assessment, whereas TAC performance remains controversial. However, the curvilinear portion of the thoracic aorta (TA, that includes the aortic arch, is systematically excluded from TAC analysis. We investigated the prevalence and spatial distribution of TAC all along the TA, to see how those segments that remain invisible in standard TA evaluation were affected. METHODS AND RESULTS: A total of 970 patients (77% men underwent extended non-contrast cardiac CT scans including the aortic arch. An automated algorithm was designed to extract the vessel centerline and to estimate the vessel diameter in perpendicular planes. Then, calcifications were quantified using the Agatston score and associated with the corresponding thoracic aorta segment. The aortic arch and the proximal descending aorta, "invisible" in routine CAC screening, appeared as two vulnerable sites concentrating 60% of almost 11000 calcifications. The aortic arch was the most affected segment per cm length. Using the extended measurement method, TAC prevalence doubled from 31% to 64%, meaning that 52% of patients would escape detection with a standard scan. In a stratified analysis for CAC and/or TAC assessment, 111 subjects (46% women were exclusively identified with the enlarged scan. CONCLUSIONS: Calcium screening in the TA revealed that the aortic arch and the proximal descending aorta, hidden in standard TA evaluations, concentrated most of the calcifications. Middle-aged women were more prone to have calcifications in those hidden portions and became candidates for reclassification.

  13. A GIS-based extended fuzzy multi-criteria evaluation for landslide susceptibility mapping.

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    Feizizadeh, Bakhtiar; Shadman Roodposhti, Majid; Jankowski, Piotr; Blaschke, Thomas

    2014-12-01

    Landslide susceptibility mapping (LSM) is making increasing use of GIS-based spatial analysis in combination with multi-criteria evaluation (MCE) methods. We have developed a new multi-criteria decision analysis (MCDA) method for LSM and applied it to the Izeh River basin in south-western Iran. Our method is based on fuzzy membership functions (FMFs) derived from GIS analysis. It makes use of nine causal landslide factors identified by local landslide experts. Fuzzy set theory was first integrated with an analytical hierarchy process (AHP) in order to use pairwise comparisons to compare LSM criteria for ranking purposes. FMFs were then applied in order to determine the criteria weights to be used in the development of a landslide susceptibility map. Finally, a landslide inventory database was used to validate the LSM map by comparing it with known landslides within the study area. Results indicated that the integration of fuzzy set theory with AHP produced significantly improved accuracies and a high level of reliability in the resulting landslide susceptibility map. Approximately 53% of known landslides within our study area fell within zones classified as having "very high susceptibility", with the further 31% falling into zones classified as having "high susceptibility".

  14. Application of appropriate use criteria to cardiac stress testing in the hospital setting: limitations of the criteria and areas for improved practice.

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    Gertz, Zachary M; O'Donnell, William; Raina, Amresh; Litwack, Andrew J; Balderston, Jessica R; Goldberg, Lee R

    2015-01-01

    Imaging cardiac stress test use has risen significantly, leading to the development of appropriate use criteria. Prior studies have suggested the rate of inappropriate testing is 13% to 14%, but inappropriate testing in hospitalized patients has not been well studied. Appropriate use of stress testing in hospitalized patients is not comparable to the ambulatory setting. We studied 459 consecutive patients referred for imaging stress tests (nuclear imaging or stress echocardiography) at a single institution over a 6-month period. Appropriate use was determined by research cardiologists blinded to patient outcomes. Most tests (68%) were in patients with chest pain or possible acute coronary syndrome (ACS). Another 20% were for preoperative evaluation. The rate of inappropriate testing was 13%. Imaging modality did not correlate with appropriate use. Only 2% of the chest pain or possible ACS were inappropriate, compared to 49% of the preoperative exams (P exam (77% of inappropriate tests). Using Thrombolysis in Myocardial Infarction score 0 to define inappropriate testing in the possible ACS cohort might make an additional 27% inappropriate. The rate of inappropriate use of cardiac stress testing with imaging in the inpatient setting is similar to that in the ambulatory setting. However, there is wide variation in inappropriate testing based on the indication for the test. Taking risk into consideration in possible ACS patients could result in a larger number of tests being considered inappropriate. © 2014 Wiley Periodicals, Inc.

  15. Development of an extended framework for emergency response criteria. Interim report for comments

    International Nuclear Information System (INIS)

    2005-01-01

    Experience from response to recent nuclear and radiological emergencies has clearly demonstrated the importance of an efficient response system that includes, among other components, emergency plans, procedures, and internally consistent operational criteria. An analysis of lessons identified from recent responses has shown that a lack of crucial components in the emergency response system could result in major radiological and nonradiological consequences at the national level. One of the reasons for the overwhelming psychological consequences of the Chernobyl and Goiania emergencies was public mistrust of decision-makers, who lost their credibility by frequently changing the criteria for taking action. Moreover, national response arrangements that are incompatible among countries can result in major mistrust by the public. It is considered important to have internationally agreed criteria and guidance for emergency response established in advance of an emergency. Currently there are several IAEA safety standards that contain recommendations for response to radiation emergencies, addressing principles and response criteria. Mindful of the lessons identified from recent emergencies, the IAEA convened in November 2001 a technical committee meeting (TCM) to develop aspects of the technical basis for emergency response to radiation emergencies. At this meeting, the lessons from response to the Chernobyl, Goiania and other emergencies over the past years were examined to identify where revisions were needed to the existing international guidance for response. In particular, the existing international criteria and guidance for taking protective and other actions were examined in the light of these lessons. The objectives of this document are: (1) to propose an extension of existing criteria for undertaking protective and other actions during or following a nuclear or radiological emergency that: addresses the lessons from past emergencies, addresses the recently

  16. Reciprocal Modulation of IK1-INa Extends Excitability in Cardiac Ventricular Cells.

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    Varghese, Anthony

    2016-01-01

    The inwardly rectifying potassium current (I K1 ) and the fast inward sodium current (I Na ) are reciprocally modulated in mammalian ventricular myocytes. An increase in the expression of channels responsible for one of these two currents results in a corresponding increase in expression of the other. These currents are critical in the propagation of action potentials (AP) during the normal functioning of the heart. This study identifies a physiological role for I K1 -I Na reciprocal modulation in ventricular fiber activation thresholds and conduction. Simulations of action potentials in single cells and propagating APs in cardiac fibers were carried out using an existing model of electrical activity in cardiac ventricular myocytes. The conductances, G K1 , of the inwardly rectifying potassium current, and G Na , of the fast inward sodium current were modified independently and in tandem to simulate reciprocal modulation. In single cells, independent modulation of G K1 alone resulted in changes in activation thresholds that were qualitatively similar to those for reciprocal G K1 -G Na modulation and unlike those due to independent modulation of G Na alone, indicating that G K1 determines the cellular activation threshold. On the other hand, the variations in conduction velocity in cardiac cell fibers were similar for independent G Na modulation and for tandem changes in G K1 -G Na , suggesting that G Na is primarily responsible for setting tissue AP conduction velocity. Conduction velocity dependence on G K1 -G Na is significantly affected by the intercellular gap junction conductance. While the effects on the passive fiber space constant due to changes in both G K1 and the intercellular gap junction conductance, G gj , were in line with linear cable theory predictions, both conductances had surprisingly large effects on fiber activation thresholds. Independent modulation of G K1 rendered cardiac fibers inexcitable at higher levels of G K1 whereas tandem G K1 -G Na

  17. Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages

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    Rummel, Christian; Basciani, Reto; Nirkko, Arto; Schroth, Gerhard; Stucki, Monika; Reineke, David; Eberle, Balthasar; Kaiser, Heiko A.

    2018-01-01

    Stroke due to hypoperfusion or emboli is a devastating adverse event of cardiac surgery, but early detection and treatment could protect patients from an unfavorable postoperative course. Hypoperfusion and emboli can be detected with transcranial Doppler of the middle cerebral artery (MCA). The measured blood flow velocity correlates with cerebral oxygenation determined clinically by near-infrared spectroscopy (NIRS) of the frontal cortex. We tested the potential advantage of a spatially extended NIRS in detecting critical events in three cardiac surgery patients with a whole-head fiber holder of the FOIRE-3000 continuous-wave NIRS system. Principle components analysis was performed to differentiate between global and localized hypoperfusion or ischemic territories of the middle and anterior cerebral arteries. In one patient, we detected a critical hypoperfusion of the right MCA, which was not apparent in the frontal channels but was accompanied by intra- and postoperative neurological correlates of ischemia. We conclude that spatially extended NIRS of temporal and parietal vascular territories could improve the detection of critically low cerebral perfusion. Even in severe hemispheric stroke, NIRS of the frontal lobe may remain normal because the anterior cerebral artery can be supplied by the contralateral side directly or via the anterior communicating artery.

  18. Diagnostic Yield of Extended Cardiac Patch Monitoring in Patients with Stroke or TIA

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    Christie E Tung

    2015-01-01

    Full Text Available Background: It is important to evaluate patients with TIA or stroke for atrial fibrillation (AF because the detection of AF changes the recommended anti-thrombotic regimen from treatment with an antiplatelet agent to oral anticoagulation. This study describes the diagnostic yield of a patch-based, single-use, and water-resistant 14-day continuous cardiac rhythm monitor (ZIO Patch in patients with stroke or TIA.Methods: We obtained data from the manufacturer and servicer of the ZIO Patch (iRhythm Technologies. Patients who were monitored between January 2012 and June 2013 and whose indication for monitoring was TIA or stroke were included. The duration of monitoring, the number and type of arrhythmias, and the time to first arrhythmia were documented. Results: 1,171 monitoring reports were analyzed. The mean monitor wear time was 10.9 days and the median wear time was 13.0 days (interquartile range 7.2-14.0. The median analyzable time relative to the total wear time was 98.7% (IQR 96.0-99.5%. AF was present in 5.0% of all reports. The mean duration before the first episode of paroxysmal AF (PAF was 1.5 days and the median duration was 0.4 days. 14.3% of first PAF episodes occurred after 48 hours. The mean PAF burden was 12.7% of the total monitoring duration. Conclusion: Excellent quality of the recordings and very good patient compliance coupled with a substantial proportion of AF detection beyond the first 48 hours of monitoring suggest that the cardiac patch is superior to conventional 48-hour Holter monitors for AF detection in patients with stroke or TIA.

  19. Combined ECG, Echocardiographic, and Biomarker Criteria for Diagnosing Acute Myocardial Infarction in Out-of-Hospital Cardiac Arrest Patients.

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    Lee, Sang-Eun; Uhm, Jae-Sun; Kim, Jong-Youn; Pak, Hui-Nam; Lee, Moon-Hyoung; Joung, Boyoung

    2015-07-01

    Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated. Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD. We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy. In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.

  20. Predictors and outcomes of cardiac resynchronization therapy extended to the second generator.

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    Li, Xuping; Yang, Dachun; Kusumoto, Fred; Shen, Win-Kuang; Mulpuru, Siva; Zhou, Shenghua; Liang, Jinjun; Wu, Gang; Yang, Mei; Liu, Jin-Qu; Friedman, Paul A; Cha, Yong-Mei

    2017-12-01

    A proportion of patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) live to receive a second generator. Controversy exists on whether an implantable cardioverter-defibrillator (ICD) should be offered to patients who have normalized or near-normalized left ventricular ejection fraction (LVEF) at the time of generator replacement (GR). The purpose of this study was to evaluate incidence of appropriate ICD therapy after CRT-D GR. This series involved 1026 consecutive patients who underwent CRT-D implant between January 1, 2002 and December 31, 2012. Echocardiography was assessed before the initial device implant and before GR. ICDs were monitored at our device clinic in person or remotely, or both. Of the cohort, 227 patients (22.1%) underwent CRT-D GR at our institution. Approximately 48% of the patients who received new CRT-D generators were no longer meeting the guidelines indication for ICD use at the time of GR. These patients received subsequent appropriate ICD therapies at a significantly lower rate than those with LVEF generator after GR. Improvement in LVEF after CRT-D GR is associated with significantly reduced incidence of appropriate ICD therapy. Ventricular arrhythmia is less likely to develop with normalized LVEF in nonischemic cardiomyopathy. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  1. Prospective follow-up cardiac evaluation of children with Kawasaki disease in Northern India using the Japanese echocardiography criteria.

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    Kothur, Kavitha; Singh, Surjit; Sharma, Yashpaul; Mittal, B R

    2007-11-01

    There is no information available on the follow-up of children with Kawasaki disease (KD) in developing countries. This prospective study was undertaken to evaluate the cardiac abnormalities in a cohort of children with KD from a tertiary care centre in Northern India. Twenty children with diagnoses of KD and followed-up for at least 3 months in the Pediatric Rheumatology and Immunology Clinic of the Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh were evaluated between July 2002 to January 2006. Age of onset of disease ranged from 12 months to 10 years. The male: female ratio was 4:1. All patients had received intravenous immunoglobulin (IVIG) administration in the acute stage. Chest radiography showed no abnormalities in the 15 patients in whom it was done. Electrocardiographic abnormalities were seen in 3 patients in the form of T wave inversion in 3, ST segment changes in 2, and prolonged PR interval in 1 patient which normalized on follow-up. The mean time interval between the diagnosis of KD and first follow-up echocardiography was 7.9 +/- 3.5 months (range 4.4-11.4 months), which was repeated at 1 year and 2 years follow-up in patients who had abnormal findings. When we analyzed coronary artery diameters using Japanese Ministry of Health criteria, none of our patients could qualify for a diagnosis of coronary aneurysm. However, 3 had coronary artery diameters more than + 2 SD when the body surface area adjusted coronary dimensions were used. One of our patients also had increased left ventricular dimensions but also had normal ejection fraction and shortening fraction, and there were no regional wall motion abnormalities. Mitral valve was thickened in 2 patients and trivial mitral regurgitation was noticed in 1 patient. Repeat echocardiography done 1 year and 2 years later on follow-up, showed persistence of thickening of the mitral valve leaflet in one of these but there was no regurgitation. None of

  2. Hypothermic oxygenated machine perfusion (HOPE) for orthotopic liver transplantation of human liver allografts from extended criteria donors (ECD) in donation after brain death (DBD): a prospective multicentre randomised controlled trial (HOPE ECD-DBD)

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    Czigany, Zoltan; Schöning, Wenzel; Ulmer, Tom Florian; Bednarsch, Jan; Amygdalos, Iakovos; Cramer, Thorsten; Rogiers, Xavier; Popescu, Irinel; Botea, Florin; Froněk, Jiří; Kroy, Daniela; Koch, Alexander; Tacke, Frank; Trautwein, Christian; Tolba, Rene H; Hein, Marc; Koek, Ger H; Dejong, Cornelis H C; Neumann, Ulf Peter; Lurje, Georg

    2017-01-01

    Introduction Orthotopic liver transplantation (OLT) has emerged as the mainstay of treatment for end-stage liver disease. In an attempt to improve the availability of donor allografts and reduce waiting list mortality, graft acceptance criteria were extended increasingly over the decades. The use of extended criteria donor (ECD) allografts is associated with a higher incidence of primary graft non-function and/or delayed graft function. As such, several strategies have been developed aiming at reconditioning poor quality ECD liver allografts. Hypothermic oxygenated machine perfusion (HOPE) has been successfully tested in preclinical experiments and in few clinical series of donation after cardiac death OLT. Methods and analysis HOPE ECD-DBD is an investigator-initiated, open-label, phase-II, prospective multicentre randomised controlled trial on the effects of HOPE on ECD allografts in donation after brain death (DBD) OLT. Human whole organ liver grafts will be submitted to 1–2 hours of HOPE (n=23) via the portal vein before implantation and are going to be compared with a control group (n=23) of patients transplanted after conventional cold storage. Primary (peak and Δ peak alanine aminotransferase within 7 days) and secondary (aspartate aminotransferase, bilirubin and international normalised ratio, postoperative complications, early allograft dysfunction, duration of hospital and intensive care unit stay, 1-year patient and graft survival) endpoints will be analysed within a 12-month follow-up. Extent of ischaemia–reperfusion (I/R) injury will be assessed using liver tissue, perfusate, bile and serum samples taken during the perioperative phase of OLT. Ethics and dissemination The study was approved by the institutional review board of the RWTH Aachen University, Aachen, Germany (EK 049/17). The current paper represent the pre-results phase. First results are expected in 2018. Trial registration number NCT03124641. PMID:29018070

  3. An Extended Step-Wise Weight Assessment Ratio Analysis with Symmetric Interval Type-2 Fuzzy Sets for Determining the Subjective Weights of Criteria in Multi-Criteria Decision-Making Problems

    Directory of Open Access Journals (Sweden)

    Mehdi Keshavarz-Ghorabaee

    2018-03-01

    Full Text Available Determination of subjective weights, which are based on the opinions and preferences of decision-makers, is one of the most important matters in the process of multi-criteria decision-making (MCDM. Step-wise Weight Assessment Ratio Analysis (SWARA is an efficient method for obtaining the subjective weights of criteria in the MCDM problems. On the other hand, decision-makers may express their opinions with a degree of uncertainty. Using the symmetric interval type-2 fuzzy sets enables us to not only capture the uncertainty of information flexibly but also to perform computations simply. In this paper, we propose an extended SWARA method with symmetric interval type-2 fuzzy sets to determine the weights of criteria based on the opinions of a group of decision-makers. The weights determined by the proposed approach involve the uncertainty of decision-makers’ preferences and the symmetric form of the weights makes them more interpretable. To show the procedure of the proposed approach, it is used to determine the importance of intellectual capital dimensions and components in a company. The results show that the proposed approach is efficient in determining the subjective weights of criteria and capturing the uncertainty of information.

  4. Optimal Siting of Charging Stations for Electric Vehicles Based on Fuzzy Delphi and Hybrid Multi-Criteria Decision Making Approaches from an Extended Sustainability Perspective

    Directory of Open Access Journals (Sweden)

    Huiru Zhao

    2016-04-01

    Full Text Available Optimal siting of electric vehicle charging stations (EVCSs is crucial to the sustainable development of electric vehicle systems. Considering the defects of previous heuristic optimization models in tackling subjective factors, this paper employs a multi-criteria decision-making (MCDM framework to address the issue of EVCS siting. The initial criteria for optimal EVCS siting are selected from extended sustainability theory, and the vital sub-criteria are further determined by using a fuzzy Delphi method (FDM, which consists of four pillars: economy, society, environment and technology perspectives. To tolerate vagueness and ambiguity of subjective factors and human judgment, a fuzzy Grey relation analysis (GRA-VIKOR method is employed to determine the optimal EVCS site, which also improves the conventional aggregating function of fuzzy Vlsekriterijumska Optimizacijia I Kompromisno Resenje (VIKOR. Moreover, to integrate the subjective opinions as well as objective information, experts’ ratings and Shannon entropy method are employed to determine combination weights. Then, the applicability of proposed framework is demonstrated by an empirical study of five EVCS site alternatives in Tianjin. The results show that A3 is selected as the optimal site for EVCS, and sub-criteria affiliated with environment obtain much more attentions than that of other sub-criteria. Moreover, sensitivity analysis indicates the selection results remains stable no matter how sub-criteria weights are changed, which verifies the robustness and effectiveness of proposed model and evaluation results. This study provides a comprehensive and effective method for optimal siting of EVCS and also innovates the weights determination and distance calculation for conventional fuzzy VIKOR.

  5. The Anglo-Scandinavian Cardiac Outcomes Trial lipid lowering arm: extended observations 2 years after trial closure

    DEFF Research Database (Denmark)

    Sever, Peter S; Poulter, Neil R; Dahlof, Bjorn

    2008-01-01

    Aims To determine the cardiovascular benefits in those originally assigned atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-2.2 years after closure of the lipid-lowering arm of the trial (ASCOT-LLA). Methods and results The Blood Pressure Lowering Arm of the ASCOT trial (ASCOT...... essentially unchanged and in the case of all cause mortality, the risk reduction of 15% now achieved borderline statistical significance (P = 0.02). Conclusion Carry-over benefits from those originally assigned atorvastatin but no longer taking the drug may account for unchanged relative risk reductions...

  6. Extended criteria and predictors in college admission: Exploring the structure of study success and investigating the validity of domain knowledge

    Directory of Open Access Journals (Sweden)

    OLGA KUNINA

    2007-06-01

    Full Text Available The utility of aptitude tests and intelligence measures in the prediction of the success in college is one of the empirically best supported results in ability research. However, the structure of the criterion “study success” has not been appropriately investigated so far. Moreover, it remains unclear which aspect of intelligence – fluid intelligence or crystallized intelligence – has the major impact on the prediction. In three studies we have investigated the dimensionality of the criterion achievements as well as the relative contributions of competing ability predictors. In the first study, the dimensionality of college grades was explored in a sample of 629 alumni. A measurement model with two correlated latent factors distinguishing undergraduate college grades on the one hand from graduate college grades on the other hand had the best fit to the data. In the second study, a group of 179 graduate students completed a Psychology knowledge test and provided available college grades in undergraduate studies. A model separating a general latent factor for Psychology knowledge from a nested method factor for college grades, and a second nested factor for “experimental orientation” had the best fit to the data. In the third study the predictive power of domain specific knowledge tests in Mathematics, English, and Biology was investigated. A sample of 387 undergraduate students in this prospective study additionally completed a compilation of fluid intelligence tests. The results of this study indicate as expected that: a ability measures are incrementally predictive over school grades in predicting exam grades; and b that knowledge tests from relevant domains were incrementally predictive over fluid intelligence. The results of these studies suggest that criteria for college admission tests deserve and warrant more attention, and that domain specific ability indicators can contribute to the predictive validity of established

  7. The Relations of the Minor with the Parents and Extended Family. Assessing the Best Interest of the Child. Criteria of Assessment

    Directory of Open Access Journals (Sweden)

    Andreea Draghici

    2010-06-01

    Full Text Available Without any doubt, the most important principle which governing the child protection is the principle of best interests of the child. Besides, the protection of this interest is the stated purpose of all the international conventions and the domestic legislation. Despite this, of his importance, the principle is only observed, without content or to enjoy some conceptualization, the criteria assessing being left to the discretion of the court and the competent authorities. It was supported in the literature that the establishmentof an invariable content for all issues incident to the child protection might not be possible through the light of variety situations can find each child. In this way, the present study identifies a priority order of those assessing criteria in the matter of the child relations with parents and extended family. As the exertion of the parental rights and obligations must be governed by the same principle, the identification of those criteria isrealized analyzing the internal case law in this field and ECHR jurisprudence. The papers originality consist in the fact that the research tries to establish the content of this principle, without straightening the action area of the competent decisional authorities (public authorities, judges, the conclusion of this study beingaddressed also to the doctrinaires, also to the practicants.

  8. Cardiac cone-beam CT

    International Nuclear Information System (INIS)

    Manzke, Robert

    2005-01-01

    This doctoral thesis addresses imaging of the heart with retrospectively gated helical cone-beam computed tomography (CT). A thorough review of the CT reconstruction literature is presented in combination with a historic overview of cardiac CT imaging and a brief introduction to other cardiac imaging modalities. The thesis includes a comprehensive chapter about the theory of CT reconstruction, familiarizing the reader with the problem of cone-beam reconstruction. The anatomic and dynamic properties of the heart are outlined and techniques to derive the gating information are reviewed. With the extended cardiac reconstruction (ECR) framework, a new approach is presented for the heart-rate-adaptive gated helical cardiac cone-beam CT reconstruction. Reconstruction assessment criteria such as the temporal resolution, the homogeneity in terms of the cardiac phase, and the smoothness at cycle-to-cycle transitions are developed. Several reconstruction optimization approaches are described: An approach for the heart-rate-adaptive optimization of the temporal resolution is presented. Streak artifacts at cycle-to-cycle transitions can be minimized by using an improved cardiac weighting scheme. The optimal quiescent cardiac phase for the reconstruction can be determined automatically with the motion map technique. Results for all optimization procedures applied to ECR are presented and discussed based on patient and phantom data. The ECR algorithm is analyzed for larger detector arrays of future cone-beam systems throughout an extensive simulation study based on a four-dimensional cardiac CT phantom. The results of the scientific work are summarized and an outlook proposing future directions is given. The presented thesis is available for public download at www.cardiac-ct.net

  9. Assessment of the diagnostic accuracy of 18F-FDG PET/CT in prosthetic infective endocarditis and cardiac implantable electronic device infection: comparison of different interpretation criteria

    International Nuclear Information System (INIS)

    Jimenez-Ballve, Ana; Jesus Perez-Castejon, Maria; Carreras-Delgado, Jose L.; Delgado-Bolton, Roberto C.; Sanchez-Enrique, Cristina; Vilacosta, Isidre; Vivas, David; Olmos, Carmen; Ferrer, Manuel E.F.

    2016-01-01

    The diagnosis of prosthetic valve (PV) infective endocarditis (IE) and infection of cardiac implantable electronic devices (CIEDs) remains challenging. The aim of this study was to assess the usefulness of 18 F-FDG PET/CT in these patients and analyse the interpretation criteria. We included 41 patients suspected of having IE by the Duke criteria who underwent 18 F-FDG PET/CT. The criteria applied for classifying the findings as positive/negative for IE were: (a) visual analysis of only PET images with attenuation-correction (AC PET images); (b) visual analysis of both AC PET images and PET images without AC (NAC PET images); (c) qualitative analysis of NAC PET images; and (d) semiquantitative analysis of AC PET images. 18 F-FDG PET/CT was considered positive for IE independently of the intensity and distribution of FDG uptake. The gold standard was the Duke pathological criteria (if tissue was available) or the decision of an endocarditis expert team after a minimum 4 months follow-up. We studied 62 areas with suspicion of IE, 28 areas (45 %) showing definite IE and 34 (55 %) showing possible IE. Visual analysis of only AC PET images showed poor diagnostic accuracy (sensitivity 20 %, specificity 57 %). Visual analysis of both AC PET and NAC PET images showed excellent sensitivity (100 %) and intermediate specificity (73 %), focal uptake being more frequently associated with IE. The accuracy of qualitative analysis of NAC PET images depended on the threshold: the maximum sensitivity, specificity and accuracy achieved were 88 %, 80 %, 84 %, respectively. In the semiquantitative analysis of AC PET images, SUVmax was higher in areas of confirmed IE than in those without IE (∇SUVmax 2.2, p < 0.001). When FDG uptake was twice that in the liver, IE was always confirmed, and SUVmax 5.5 was the optimal threshold for IE diagnosis using ROC curve analysis (area under the curve 0.71). The value of 18 F-FDG PET/CT in the diagnosis of suspected IE of PVs and CIEDs is highly

  10. Comparison of the Between the Flags calling criteria to the MEWS, NEWS and the electronic Cardiac Arrest Risk Triage (eCART) score for the identification of deteriorating ward patients.

    Science.gov (United States)

    Green, Malcolm; Lander, Harvey; Snyder, Ashley; Hudson, Paul; Churpek, Matthew; Edelson, Dana

    2018-02-01

    Traditionally, paper based observation charts have been used to identify deteriorating patients, with emerging recent electronic medical records allowing electronic algorithms to risk stratify and help direct the response to deterioration. We sought to compare the Between the Flags (BTF) calling criteria to the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS) and electronic Cardiac Arrest Risk Triage (eCART) score. Multicenter retrospective analysis of electronic health record data from all patients admitted to five US hospitals from November 2008-August 2013. Cardiac arrest, ICU transfer or death within 24h of a score RESULTS: Overall accuracy was highest for eCART, with an AUC of 0.801 (95% CI 0.799-0.802), followed by NEWS, MEWS and BTF respectively (0.718 [0.716-0.720]; 0.698 [0.696-0.700]; 0.663 [0.661-0.664]). BTF criteria had a high risk (Red Zone) specificity of 95.0% and a moderate risk (Yellow Zone) specificity of 27.5%, which corresponded to MEWS thresholds of >=4 and >=2, NEWS thresholds of >=5 and >=2, and eCART thresholds of >=12 and >=4, respectively. At those thresholds, eCART caught 22 more adverse events per 10,000 patients than BTF using the moderate risk criteria and 13 more using high risk criteria, while MEWS and NEWS identified the same or fewer. An electronically generated eCART score was more accurate than commonly used paper based observation tools for predicting the composite outcome of in-hospital cardiac arrest, ICU transfer and death within 24h of observation. The outcomes of this analysis lend weight for a move towards an algorithm based electronic risk identification tool for deteriorating patients to ensure earlier detection and prevent adverse events in the hospital. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Côte D’Ivoire; Fifth Review Under the Three-Year Arrangement Under the Extended Credit Facility and Requests for Modification of Performance Criteria and Extension of the Current Arrangement

    OpenAIRE

    International Monetary Fund

    2014-01-01

    This paper discusses Côte d’Ivoire’s Fifth Review Under the Three-Year Arrangement Under the Extended Credit Facility (ECF) and Requests for Modification of Performance Criteria (PC) and Extension of the Current Arrangement. Program performance has been strong. All end-December PCs and all but one indicative target were met. On the downside, fiscal discipline and structural reform momentum could be adversely affected during the run-up to the October 2015 presidential elections. The IMF staff ...

  12. [ The new 2010 Ghent criteria for the indication to surgical treatment of patients affected by Marfan syndrome. Experience of a single cardiac surgery center].

    Science.gov (United States)

    Grego, Susanna; Nardi, Paolo; Gislao, Valentina; Nicolò, Francesca; D'Annolfo, Antonella; Marcucci, Rosaria; Bovio, Emanuele; Versaci, Francesco; Chiariello, Luigi

    2013-01-01

    The diagnosis and surgical treatment of patients with Marfan syndrome remain controversial. It is of utmost importance to identify patients at risk for acute aortic events to establish the correct surgical timing and the appropriate surgical treatment. From May 2008 to December 2012, 500 patients were screened at the Marfan Presidium of the Tor Vergata University Hospital of Rome (Italy). Patients were evaluated by a cardiac surgeon, including echocardiographic, orthopedic, ophthalmologic and dental examinations. All patients received genetic counseling, and genetic sampling was performed if appropriate. The diagnosis of Marfan syndrome was confirmed in 146 patients (29.2%). Fifty-four patients (37%) underwent cardiac surgery on the aortic root, 4 patients had surgery on the mitral valve, 13 patients had combined surgery; 11 cases were emergent surgery for acute aortic dissection. Twenty-eight patients (52%) were operated on at our Division: 13 underwent valve-sparing aortic root replacement (David procedure), 1 underwent Yacoub remodeling procedure and 14 underwent Bentall procedure. Following the establishment of the Marfan Center, the David aortic valve-sparing operation was the most frequently performed procedure compared to the previous period of surgical activity (63 vs 22%, psyndromes. Early surgical treatment is recommended in these patients to achieve optimal results of valve-sparing procedures and life-saving management, especially for patients who live far away from a cardiac surgery center.

  13. Extended-spectrum cephalosporins and the inoculum effect in tests with CTX-M-type extended-spectrum β-lactamase-producing Escherichia coli: potential clinical implications of the revised CLSI interpretive criteria.

    Science.gov (United States)

    Kang, Cheol-In; Cha, Min Kyeong; Kim, So Hyun; Wi, Yu Mi; Chung, Doo Ryeon; Peck, Kyong Ran; Lee, Nam Yong; Song, Jae-Hoon

    2014-05-01

    Based on the new recommendations of the Clinical and Laboratory Standards Institute (CLSI), the revised cephalosporin breakpoints may result in many CTX-M-producing Escherichia coli being reported as susceptible to ceftazidime. We determined the activity of ceftazidime and other parenteral β-lactam agents in standard- and high-inoculum minimum inhibitory concentration (MIC) tests against CTX-M-producing E. coli isolates. Antimicrobial susceptibility was determined using a broth microdilution MIC method with inocula that differed 100-fold in density. An inoculum effect was defined as an eight-fold or greater increase in MIC on testing with the higher inoculum. When the revised CLSI ceftazidime breakpoint of 4 μg/mL was applied, 34 (34.3%) of the 99 CTX-M-producers tested were susceptible. More specifically, for 42 CTX-M-14-producing E. coli isolates, 32 (76.2%) were susceptible at 4 μg/mL. Cefotaxime, ceftazidime, cefepime and piperacillin/tazobactam were found to be associated with inoculum effects in 100% of the evaluable tests for extended-spectrum β-lactamase-producing E. coli isolates. The MIC(50) (MIC required to inhibit 50% of isolates) of ceftazidime was 16 μg/mL in the standard-inoculum tests and >512 μg/mL in the high-inoculum tests. In the high-inoculum tests including isolates encoding CTX-M-14, ceftazidime was dramatically affected, with susceptibility decreasing from 82.1% of isolates inhibited at 4 μg/mL in the standard-inoculum tests to 0% at high inoculum. Although further studies may demonstrate that ceftazidime has a role in the treatment of infections caused by these organisms, we suggest that until more data become available, clinicians should be cautious about treating serious CTX-M-producing E. coli infections with ceftazidime or cefepime. Copyright © 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  14. Cardiac Involvement is Underdiagnosed in Patients with Biopsy-Proven Systemic AL Amyloidosis

    Directory of Open Access Journals (Sweden)

    Haoyi Zheng

    2016-01-01

    Diagnosis of cardiac amyloidosis based on presence of heart failure symptoms led to underdiagnosis of cardiac involvement defined by the NCCN criteria. Guideline recommended assessment of cardiac involvement and cardiac response to treatment was not routinely implemented in our cohort.

  15. Assessment of the diagnostic accuracy of {sup 18}F-FDG PET/CT in prosthetic infective endocarditis and cardiac implantable electronic device infection: comparison of different interpretation criteria

    Energy Technology Data Exchange (ETDEWEB)

    Jimenez-Ballve, Ana; Jesus Perez-Castejon, Maria; Carreras-Delgado, Jose L. [Clinico San Carlos University Hospital, San Carlos Health Research Institute (IdISSC), Complutense University of Madrid, Department of Nuclear Medicine, Madrid (Spain); Delgado-Bolton, Roberto C. [Clinico San Carlos University Hospital, San Carlos Health Research Institute (IdISSC), Complutense University of Madrid, Department of Nuclear Medicine, Madrid (Spain); San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, La Rioja (Spain); Sanchez-Enrique, Cristina; Vilacosta, Isidre; Vivas, David; Olmos, Carmen [Clinico San Carlos University Hospital, Department of Cardiology, Madrid (Spain); Ferrer, Manuel E.F. [Clinico San Carlos University Hospital, Research Unit, Madrid (Spain)

    2016-12-15

    The diagnosis of prosthetic valve (PV) infective endocarditis (IE) and infection of cardiac implantable electronic devices (CIEDs) remains challenging. The aim of this study was to assess the usefulness of {sup 18}F-FDG PET/CT in these patients and analyse the interpretation criteria. We included 41 patients suspected of having IE by the Duke criteria who underwent {sup 18}F-FDG PET/CT. The criteria applied for classifying the findings as positive/negative for IE were: (a) visual analysis of only PET images with attenuation-correction (AC PET images); (b) visual analysis of both AC PET images and PET images without AC (NAC PET images); (c) qualitative analysis of NAC PET images; and (d) semiquantitative analysis of AC PET images. {sup 18}F-FDG PET/CT was considered positive for IE independently of the intensity and distribution of FDG uptake. The gold standard was the Duke pathological criteria (if tissue was available) or the decision of an endocarditis expert team after a minimum 4 months follow-up. We studied 62 areas with suspicion of IE, 28 areas (45 %) showing definite IE and 34 (55 %) showing possible IE. Visual analysis of only AC PET images showed poor diagnostic accuracy (sensitivity 20 %, specificity 57 %). Visual analysis of both AC PET and NAC PET images showed excellent sensitivity (100 %) and intermediate specificity (73 %), focal uptake being more frequently associated with IE. The accuracy of qualitative analysis of NAC PET images depended on the threshold: the maximum sensitivity, specificity and accuracy achieved were 88 %, 80 %, 84 %, respectively. In the semiquantitative analysis of AC PET images, SUVmax was higher in areas of confirmed IE than in those without IE (∇SUVmax 2.2, p < 0.001). When FDG uptake was twice that in the liver, IE was always confirmed, and SUVmax 5.5 was the optimal threshold for IE diagnosis using ROC curve analysis (area under the curve 0.71). The value of {sup 18}F-FDG PET/CT in the diagnosis of suspected IE of PVs

  16. Cardiac pacemaker

    International Nuclear Information System (INIS)

    Kolenik, S.A.

    1976-01-01

    The construction of a cardiac pacemaker is described which is characterized by particularly small dimensions, small weight and long life duration. The weight is under 100g, the specific weight under 1.7. Mass inertia forces which occur through acceleration and retardation processes, thus remain below the threshold values, above which one would have to reckon with considerable damaging of the surrounding body tissue. The maintaining of small size and slight weight is achieved by using an oscillator on COSMOS basis, where by considerably lower energy consumption, amongst others the lifetimes of the batteries used - a lithium anode with thionyl chloride electrolyte - is extended to over 5 years. The reliability can be increased by the use of 2 or more batteries. The designed dimension are 20x60x60 mm 3 . (ORU/LH) [de

  17. Socially differentiated cardiac rehabilitation

    DEFF Research Database (Denmark)

    Meillier, Lucette Kirsten; Nielsen, Kirsten Melgaard; Larsen, Finn Breinholt

    2012-01-01

    cardiac rehabilitation programme. Methods: From 1 September 2002 to 31 December 2005, 388 first-incidence MI patients ≤75 years were hospitalised. Register check for newly hospitalised MI patients, screening interview, and systematic referral were conducted by a project nurse. Patients were referred...... to a standard rehabilitation programme (SRP). If patients were identified as socially vulnerable, they were offered an extended version of the rehabilitation programme (ERP). Excluded patients were offered home visits by a cardiac nurse. Concordance principles were used in the individualised programme elements......Aim: The comprehensive cardiac rehabilitation (CR) programme after myocardial infarction (MI) improves quality of life and results in reduced cardiac mortality and recurrence of MI. Hospitals worldwide face problems with low participation rates in rehabilitation programmes. Inequality...

  18. Cardiac rehabilitation

    Science.gov (United States)

    ... rehab; Heart failure - cardiac rehab References Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: ... of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed ...

  19. Cardiac resynchronisation therapy and the role of optimal device utilisation

    NARCIS (Netherlands)

    Buck, S.; Maass, A. H.; van Veldhuisen, D. J.; Van Gelder, I. C.

    Despite established selection criteria, 30 to 40% of patients do not respond to cardiac resynchronisation therapy. By optimising programming of the device response to cardiac resynchronisation, therapy can be improved. (Neth Heart J 2009;17:354-7.)

  20. Cardiac Dysautonomia in Huntington's Disease.

    Science.gov (United States)

    Abildtrup, Mads; Shattock, Michael

    2013-01-01

    Huntington's disease is a fatal, hereditary, neurodegenerative disorder best known for its clinical triad of progressive motor impairment, cognitive deficits and psychiatric disturbances. Although a disease of the central nervous system, mortality surveys indicate that heart disease is a leading cause of death. The nature of such cardiac abnormalities remains unknown. Clinical findings indicate a high prevalence of autonomic nervous system dysfunction - dysautonomia - which may be a result of pathology of the central autonomic network. Dysautonomia can have profound effects on cardiac health, and pronounced autonomic dysfunction can be associated with neurogenic arrhythmias and sudden cardiac death. Significant advances in the knowledge of neural mechanisms in cardiac disease have recently been made which further aid our understanding of cardiac mortality in Huntington's disease. Even so, despite the evidence of aberrant autonomic activity the potential cardiac consequences of autonomic dysfunction have been somewhat ignored. In fact, underlying cardiac abnormalities such as arrhythmias have been part of the exclusion criteria in clinical autonomic Huntington's disease research. A comprehensive analysis of cardiac function in Huntington's disease patients is warranted. Further experimental and clinical studies are needed to clarify how the autonomic nervous system is controlled and regulated in higher, central areas of the brain - and how these regions may be altered in neurological pathology, such as Huntington's disease. Ultimately, research will hopefully result in an improvement of management with the aim of preventing early death in Huntington's disease from cardiac causes.

  1. Criteria CSR

    OpenAIRE

    Vovk, V.; Zateyshikova, O.

    2014-01-01

    In the article the theoretical aspects regarding criteria for assessing CSR proposed by A. Carroll, including: economic, legal, ethical, philanthropic. Based on this, it is proposed to characterize these criteria with respect to the interested parties (stakeholders), including: investors, shareholders suppliers, customers, employees, society and the state. This will make a qualitative assessment of the presence and depth using social responsibility in the company, as well as determine the ext...

  2. Sudden Cardiac Death in Children. Part 2

    Directory of Open Access Journals (Sweden)

    Ye.V. Pshenichnaya

    2013-03-01

    Full Text Available This article deals with the dysplastic changes in musculo-valve structures of the heart, arrhythmias and conduction disorders, associated with a risk of sudden cardiac death. The diagnostic criteria for sudden cardiac death, the events of cardio-pulmonary resuscitation, prevention of life-threatening conditions in children are provided.

  3. Extended Emotions

    DEFF Research Database (Denmark)

    Krueger, Joel; Szanto, Thomas

    2016-01-01

    Until recently, philosophers and psychologists conceived of emotions as brain- and body-bound affairs. But researchers have started to challenge this internalist and individualist orthodoxy. A rapidly growing body of work suggests that some emotions incorporate external resources and thus extend...... beyond the neurophysiological confines of organisms; some even argue that emotions can be socially extended and shared by multiple agents. Call this the extended emotions thesis (ExE). In this article, we consider different ways of understanding ExE in philosophy, psychology, and the cognitive sciences....... First, we outline the background of the debate and discuss different argumentative strategies for ExE. In particular, we distinguish ExE from cognate but more moderate claims about the embodied and situated nature of cognition and emotion (Section 1). We then dwell upon two dimensions of ExE: emotions...

  4. Extended thermodynamics

    CERN Document Server

    Müller, Ingo

    1993-01-01

    Physicists firmly believe that the differential equations of nature should be hyperbolic so as to exclude action at a distance; yet the equations of irreversible thermodynamics - those of Navier-Stokes and Fourier - are parabolic. This incompatibility between the expectation of physicists and the classical laws of thermodynamics has prompted the formulation of extended thermodynamics. After describing the motifs and early evolution of this new branch of irreversible thermodynamics, the authors apply the theory to mon-atomic gases, mixtures of gases, relativistic gases, and "gases" of phonons and photons. The discussion brings into perspective the various phenomena called second sound, such as heat propagation, propagation of shear stress and concentration, and the second sound in liquid helium. The formal mathematical structure of extended thermodynamics is exposed and the theory is shown to be fully compatible with the kinetic theory of gases. The study closes with the testing of extended thermodynamics thro...

  5. Extended ERP

    OpenAIRE

    Müssigmann, Nikolaus

    2005-01-01

    Extended ERP : dynamic strategic supply network development / A. Albani, N. Müssigmann, K. Turowski. - In: ICESAcc 2005 - Second International Conference on Enterprise Systems and Accounting / C. J. Stefanou. - Thessaloniki : Labor. of Enterprise Resources Dep. of Accounting, 2005. - 1 CD-ROM

  6. Cardiac Rehabilitation

    Science.gov (United States)

    ... may also do muscle-strengthening exercises, such as lifting weights or other resistance training exercises, two or three ... health concerns. Education about nutrition, lifestyle and healthy weight ... the most benefits from cardiac rehabilitation, make sure your exercise and ...

  7. Cardiac MRI

    Science.gov (United States)

    ... such as coronary heart disease, heart valve problems, pericarditis, cardiac tumors, or damage from a heart attack. ... Palpitations Heart Valve Disease Implantable Cardioverter Defibrillators Pacemakers Pericarditis Stress Testing RELATED NEWS April 26, 2013 | News ...

  8. Comparing Methods for Cardiac Output

    DEFF Research Database (Denmark)

    Graeser, Karin; Zemtsovski, Mikhail; Kofoed, Klaus F

    2018-01-01

    tomography (CT) angiography. Sixty-two patients, scheduled for elective heart surgery, were included; 1 was subsequently excluded for logistic reasons. Inclusion criteria were coronary artery bypass surgery (N = 42) and aortic valve replacement (N = 19). Exclusion criteria were chronic atrial fibrillation...... of the left ventricular outflow tract. METHODS: The primary aim was a systematic comparison of CO with Doppler-derived 3D TEE and CO by thermodilution in a broad population of patients undergoing cardiac surgery. A subanalysis was performed comparing cross-sectional area by TEE with cardiac computed......, left ventricular ejection fraction below 0.40 and intracardiac shunts. Nineteen randomly selected patients had a cardiac CT the day before surgery. All images were stored for blinded post hoc analyses, and Bland-Altman plots were used to assess agreement between measurement methods, defined as the bias...

  9. Cardiac Angiosarcoma

    Directory of Open Access Journals (Sweden)

    Monique Esteves Cardoso

    2011-01-01

    Full Text Available Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis.

  10. Cardiac Angiosarcoma

    OpenAIRE

    Cardoso, Monique Esteves; Canale, Leonardo Secchin; Ramos, Rosana Grandelle; Salvador Junior, Edson da Silva; Lachtermacher, Stephan

    2011-01-01

    Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis.

  11. Cardiac Angiosarcoma

    Science.gov (United States)

    Cardoso, Monique Esteves; Canale, Leonardo Secchin; Ramos, Rosana Grandelle; Salvador Junior, Edson da Silva; Lachtermacher, Stephan

    2011-01-01

    Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis. PMID:24826214

  12. Fourth Recurrence of Cardiac Myxoma in a Patient with the Carney Complex

    Directory of Open Access Journals (Sweden)

    O Young Kwon

    2016-04-01

    Full Text Available Although cardiac myxoma is the most commonly encountered benign cardiac tumor in cardiac surgery practice, recurrent cardiac myxoma is very rare, is most commonly related to the Carney complex, and usually requires multiple cardiac operations with specific requirements in terms of perioperative management. In this report, we describe a patient who experienced the fourth recurrence of cardiac myxoma and review the diagnostic criteria of the Carney complex. This is the first report of such a case in Korea.

  13. Extending Puppet

    CERN Document Server

    Franceschi, Alessandro

    2014-01-01

    This book is a clear, detailed and practical guide to learn about designing and deploying you puppet architecture, with informative examples to highlight and explain concepts in a focused manner. This book is designed for users who already have good experience with Puppet, and will surprise experienced users with innovative topics that explore how to design, implement, adapt, and deploy a Puppet architecture. The key to extending Puppet is the development of types and providers, for which you must be familiar with Ruby.

  14. Multicenter Cohort Study of In-Hospital Pediatric Cardiac Arrest

    Science.gov (United States)

    Meert, Kathleen L.; Donaldson, Amy; Nadkarni, Vinay; Tieves, Kelly S.; Schleien, Charles L.; Brilli, Richard J.; Clark, Robert S. B.; Shaffner, D. H.; Levy, Fiona; Statler, Kimberly; Dalton, H.J.; van der Jagt, Elise W.; Hackbarth, Richard; Pretzlaff, Robert; Hernan, Lynn; Dean, J. Michael; Moler, Frank W.

    2009-01-01

    Objectives (1) Describe the clinical characteristics, hospital courses and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network (PECARN) who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and (2) identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest. Design Retrospective cohort study. Setting Fifteen children’s hospitals associated with PECARN. Patients Patients between one day and 18 years of age who had cardiopulmonary resuscitation (CPR) and received chest compressions for >1 minute, and had a return of circulation for >20 minutes. Interventions None. Measurements and Main Results A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurological outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender and first documented cardiac arrest rhythm, variables available prior to and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube prior to the arrest, and the use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included post-operative CPR. Extending the time frame to include variables available prior to, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness. Conclusions Many factors are associated with hospital mortality among children after in

  15. Cardiac echinococcosis

    Directory of Open Access Journals (Sweden)

    Ivanović-Krstić Branislava A.

    2002-01-01

    Full Text Available Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiograpic examination revealed a round tumor (5.8 x 4 cm in the right ventricular free wall and two smaller cysts behind that tumor. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

  16. In-pile investigations at the PHEBUS facility of the behavior of PWR-type fuel bundles in typical L.B. loca transients extended to and beyond the limits of ECCS criteria

    International Nuclear Information System (INIS)

    Duco, J.; Reocreux, M.; Tattegrain, A.; Berna, P.; Legrand, B.; Trotabas, M.

    1984-11-01

    An in-pile investigation is currently carried out at the PHEBUS facility of the behavior of .8m active height, 25-rod PWR-type fuel bundles during simulated large-break LOCA (L.B. LOCA) reactor transients. A first series of six tests using pressurized rods is to be completed by the end of 1984, relative to a conservatively calculated 2-peak cladding temperature transient at the hot point, as considered in the French 900 MW(e) PWR standard safety report. The severity of such a transient has been increased in the tests so as to check the bundle behavior at the limits of the first two NRC ECCS criteria, which were, in fact, locally exceeded in one test. Three of the tests are reported on hereunder. Short coplanar cladding balloonings were observed at the hot point level, which resulted in maximum flow blockage ratios of about 50%. Severe cladding embrittlement against thermal shock and subsequent handling was observed in the test where the criteria were exceeded. Prediction of the overall thermal-hydraulic behavior in the bundle was good, using the RELAP 4 MOD 6 code. Cladding strains are generally overevaluated by codes such as FRAPT 4 or CUPIDON, which currently do not take into account azimuthal cladding temperature gradients. Other L.B. LOCA test series are envisaged from 1986 on, based on transients calculated with ''physical'' models

  17. [Cardiac amyloidosis].

    Science.gov (United States)

    Boussabah, Elhem; Zakhama, Lilia; Ksontini, Iméne; Ibn Elhadj, Zied; Boukhris, Besma; Naffeti, Sana; Thameur, Moez; Ben Youssef, Soraya

    2008-09-01

    PREREQUIS: Amyloidosis is a rare infiltrative disease characterized by multiple clinical features. Various organs are involved and the cardiovascular system is a common target of amyloidosis. Cardiac involvement may occur with or without clinical manifestations and is considered as a major prognostic factor. To analyze the clinical features of cardiac involvement, to review actual knowledgement concerning echocardiographic diagnostic and to evaluate recent advances in treatment of the disease. An electronic search of the relevant literature was carried out using Medline and Pubmed. Keys words used for the final search were amyloidosis, cardiopathy and echocardiography. We considered for analysis reviews, studies and articles between 1990 and 2007. Amyloidosis represents 5 to 10% of non ischemic cardiomyoparhies. Cardiac involvement is the first cause of restrictive cardiomyopathy witch must be evoked in front of every inexplained cardiopathy after the age of forty. The amyloid nature of cardiopathy is suggered if some manifestations were associated as a peripheric neuropathy, a carpal tunnel sydrome and proteinuria > 3g/day. Echocardiography shows dilated atria, a granular sparkling appearance of myocardium, diastolic dysfunction and thickened left ventricle contrasting with a low electric voltage. The proof of amyloidosis is brought by an extra-cardiac biopsy, the indications of endomyocardial biopsy are very limited. The identification of the amyloid nature of cardiopathy has an direct therapeutic implication: it indicates the use of digitalis, calcium channel blockers and beta-blockers. Today the treatment of amyloidosis remains very unsatisfactory especially in the cardiac involvement. An early diagnosis before the cardiac damage may facilitate therapy and improve prognosis.

  18. Consciousness extended

    DEFF Research Database (Denmark)

    Carrara-Augustenborg, Claudia

    2012-01-01

    There is no consensus yet regarding a conceptualization of consciousness able to accommodate all the features of such complex phenomenon. Different theoretical and empirical models lend strength to both the occurrence of a non-accessible informational broadcast, and to the mobilization of specific...... brain areas responsible for the emergence of the individual´s explicit and variable access to given segments of such broadcast. Rather than advocating one model over others, this chapter proposes to broaden the conceptualization of consciousness by letting it embrace both mechanisms. Within...... such extended framework, I propose conceptual and functional distinctions between consciousness (global broadcast of information), awareness (individual´s ability to access the content of such broadcast) and unconsciousness (focally isolated neural activations). My hypothesis is that a demarcation in terms...

  19. Extending Experiences

    DEFF Research Database (Denmark)

    A computer game's player is experiencing not only the game as a designer-made artefact, but also a multitude of social and cultural practices and contexts of both computer game play and everyday life. As a truly multidisciplinary anthology, Extending Experiences sheds new light on the mesh...... of possibilities and influences the player engages with. Part one, Experiential Structures of Play, considers some of the key concepts commonly used to address the experience of a computer game player. The second part, Bordering Play, discusses conceptual and practical overlaps of games and everyday life...... and the impacts of setting up, crossing and breaking the boundaries of game and non-game. Part three, Interfaces of Play, looks at games as technological and historical artefacts and commodities. The fourth part, Beyond Design, introduces new models for the practical and theoretical dimensions of game design....

  20. Cardiac Pacemakers

    International Nuclear Information System (INIS)

    Fiandra, O.; Espasandin, W.; Fiandra, H.

    1984-01-01

    A complete survey of physiological biophysical,clinical and engineering aspects of cardiac facing,including the history and an assessment of possible future developments.Among the topics studied are: pacemakers, energy search, heart stimulating with pacemakers ,mathematical aspects of the electric cardio stimulation chronic, pacemaker implants,proceeding,treatment and control

  1. Approach to cardiac resyncronization therapy

    DEFF Research Database (Denmark)

    Dobreanu, Dan; Dagres, Nikolaos; Svendsen, Jesper Hastrup

    2012-01-01

    and completed the questions. Thirty-two per cent of the responding centres always use CRT in heart failure (HF) patients with New York Heart Association functional class II and QRS width >120 ms, and 55% of the responding centres demand additional criteria when indicating CRT, most often QRS width >150 ms (49......%) and echocardiographic criteria of asynchrony (34%). Only 10% of centres indicate CRT in all HF patients with QRS >120 ms and right bundle branch block, and 51% demand additional criteria, most frequently echocardiographic asynchrony parameters. The vast majority of centres also indicate CRT in patients with atrial...... fibrillation and standard criteria for CRT. In 24% of the centres, biventricular pacemaker (CRT-P) is implanted in all situations, unless there is an indication for secondary prevention of sudden cardiac death, while 10% always choose to implant a biventricular defibrillator (CRT-D). There are no clear...

  2. Cardiac conduction system

    Science.gov (United States)

    The cardiac conduction system is a group of specialized cardiac muscle cells in the walls of the heart that send signals to the ... contract. The main components of the cardiac conduction system are the SA node, AV node, bundle of ...

  3. Inhalation of Simulated Smog Atmospheres Affects Cardiac Function in Mice

    Science.gov (United States)

    The health effects of individual criteria air pollutants have been well investigated. However, little is known about the health effects of air pollutant mixtures that more realistically represent environmental exposures. The present study was designed to evaluate the cardiac eff...

  4. Development of Models for Regional Cardiac Surgery Centers

    Directory of Open Access Journals (Sweden)

    Choon Seon Park

    2016-12-01

    Full Text Available Background: This study aimed to develop the models for regional cardiac surgery centers, which take regional characteristics into consideration, as a policy measure that could alleviate the concentration of cardiac surgery in the metropolitan area and enhance the accessibility for patients who reside in the regions. Methods: To develop the models and set standards for the necessary personnel and facilities for the initial management plan, we held workshops, debates, and conference meetings with various experts. Results: After partitioning the plan into two parts (the operational autonomy and the functional comprehensiveness, three models were developed: the ‘independent regional cardiac surgery center’ model, the ‘satellite cardiac surgery center within hospitals’ model, and the ‘extended cardiac surgery department within hospitals’ model. Proposals on personnel and facility management for each of the models were also presented. A regional cardiac surgery center model that could be applied to each treatment area was proposed, which was developed based on the anticipated demand for cardiac surgery. The independent model or the satellite model was proposed for Chungcheong, Jeolla, North Gyeongsang, and South Gyeongsang area, where more than 500 cardiac surgeries are performed annually. The extended model was proposed as most effective for the Gangwon and Jeju area, where more than 200 cardiac surgeries are performed annually. Conclusion: The operation of regional cardiac surgery centers with high caliber professionals and quality resources such as optimal equipment and facility size, should enhance regional healthcare accessibility and the quality of cardiac surgery in South Korea.

  5. Dual kidney transplantation with organs from extended criteria cadaveric donors.

    LENUS (Irish Health Repository)

    D'Arcy, Frank T

    2009-10-01

    The critical shortage of kidneys available for transplantation has led to alternate strategies to expand the pool. Transplantation of the 2 kidneys into a single recipient using organs suboptimal for single kidney transplantation was suggested. We assessed results in 24 grafts allocated for dual kidney transplantation vs those in a control group of 44 designated for single kidney transplantation. Each group underwent pretransplant biopsy and recipients were age matched.

  6. Context-Sensitive Sharedness Criteria for Teamwork (Extended Abstract)

    NARCIS (Netherlands)

    Harbers, M.; Jonker, C.M.; Van Riemsdijk, M.B.

    2014-01-01

    Teamwork between humans and intelligent systems gains importance with the maturing of agent and robot technology. In the social sciences, sharedness of mental models is used to explain and understand teamwork. To use this concept for developing teams that include agents, we propose contextsensitive

  7. Expanded cardiac rehabilitation reduces cardiac events over five years.

    Science.gov (United States)

    Redfern, Julie

    2011-01-01

    In people with coronary artery disease, does an expanded cardiac rehabilitation program reduce cardiac deaths, myocardial infarctions, and hospital admissions due to cardiovascular disease? Randomised, controlled trial with intention-to-treat analysis. A University hospital in Sweden. People aged less than 75 years who had had a recent myocardial infarction or coronary artery bypass grafts were eligible to participate. Severe co-morbidities were exclusion criteria. Randomisation of 224 participants allocated 111 to undergo expanded cardiac rehabilitation and 113 to a control group. Both groups received standard cardiac rehabilitation, including physical training, education, group and individual counselling, and support to cease smoking. All participants received appropriate preventive medications. In addition, the intervention group received 20 group sessions of stress management, 3 sessions of cooking and diet counselling by a dietician, and a 5-day stay at a 'patient hotel' with several activities including physical training and information. Although other outcomes were reported at the conclusion of 1-year follow-up, the outcomes at the 5-year follow-up were rates of cardiac events: cardiovascular death, acute myocardial infarction, and readmission to a hospital due to other cardiovascular causes. All participants were followed up via national registers of health and mortality. During the 5-year follow-up, 53 (48%) participants in the expanded cardiac rehabilitation group and 68 (60%) participants in the control group had a cardiac event (hazard ratio 0.69, 95% CI 0.48 to 0.99). This difference was mainly due to only 12 (11%) participants having non-fatal myocardial infarctions in the treatment group versus 23 (20%) in the control group (hazard ratio 0.47, 95% CI 0.21 to 0.97). The number of hospitalisations and the number of days of hospitalisation were both significantly fewer in the treatment group than in the control group. Expanded cardiac rehabilitation

  8. Air medical transport of cardiac patients.

    Science.gov (United States)

    Essebag, Vidal; Halabi, Abdul R; Churchill-Smith, Michael; Lutchmedial, Sohrab

    2003-11-01

    The air medical transport of cardiac patients is a rapidly expanding practice. For various medical, social, and economic indications, patients are being flown longer distances at commercial altitudes, including international and intercontinental flights. There are data supporting the use of short-distance helicopter flights early in the course of a cardiac event for patients needing emergent transfer for percutaneous coronary intervention or aortocoronary bypass. When considering elective long-distance air medical transport of cardiac patients for social or economic reasons, it is necessary to weigh the benefits against the potential risks of flight. A few recent studies suggest that long-distance air medical transport is safe under certain circumstances. Current guidelines for air travel after myocardial infarction do not address the use of medical escorts or air ambulances equipped with intensive care facilities. Further research using larger prospective studies is needed to better define criteria for safe long-distance air medical transport of cardiac patients.

  9. Cardiac regeneration therapy: connections to cardiac physiology.

    Science.gov (United States)

    Takehara, Naofumi; Matsubara, Hiroaki

    2011-12-01

    Without heart transplantation, a large number of patients with failing hearts worldwide face poor outcomes. By means of cardiomyocyte regeneration, cardiac regeneration therapy is emerging with great promise as a means for restoring loss of cardiac function. However, the limited success of clinical trials using bone marrow-derived cells and myoblasts with heterogeneous constituents, transplanted at a wide range of cell doses, has led to disagreement on the efficacy of cell therapy. It is therefore essential to reevaluate the evidence for the efficacy of cell-based cardiac regeneration therapy, focusing on targets, materials, and methodologies. Meanwhile, the revolutionary innovation of cardiac regeneration therapy is sorely needed to help the millions of people who suffer heart failure from acquired loss of cardiomyocytes. Cardiac regeneration has been used only in limited species or as a developing process in the rodent heart; now, the possibility of cardiomyocyte turnover in the human heart is being revisited. In the pursuit of this concept, the use of cardiac stem/progenitor stem cells in the cardiac niche must be focused to usher in a second era of cardiac regeneration therapy for the severely injured heart. In addition, tissue engineering and cellular reprogramming will advance the next era of treatment that will enable current cell-based therapy to progress to "real" cardiac regeneration therapy. Although many barriers remain, the prevention of refractory heart failure through cardiac regeneration is now becoming a realistic possibility.

  10. [Cardiac rehabilitation: current status and future challenges].

    Science.gov (United States)

    Hahmann, H W

    2012-02-01

    The goal of cardiac rehabilitation is to support heart patients using a multidisciplinary team in order to obtain the best possible physical and mental health and achieve long-term social reintegration. In addition to improving physical fitness, cardiac rehabilitation restores self-confidence, thus better equipping patients to deal with mental illness and improving their social reintegration ("participation"). Once the causes of disease have been identified and treated as effectively as possible, drug and lifestyle changes form the focus of cardiac rehabilitation measures. In particular diseases, rehabilitation offers the opportunity for targeted educational courses for diabetics or drug dose escalation, as well as special training for heart failure patients. A nationwide network of outpatient heart groups is available for targeted follow-up. Cardiac patients predominantly rehabilitated in follow-up rehabilitation are older and have greater morbidity than in the past; moreover, they generally come out of acute clinical care earlier and are discharged from hospital more quickly. The proportion of severely ill and multimorbid patients presents a diagnostic and therapeutic challenge in cardiac rehabilitation, although cardiac rehabilitation was not initially conceived for this patient group. The benefit of cardiac rehabilitation has been a well documented reduction in morbidity and mortality. However, hurdles remain, partly due to the patients themselves, partly due to the health insurers. Some insurance providers still refuse rehabilitation for non-ST-segment elevation infarction. In principle rehabilitation can be carried out in an inpatient or an outpatient setting. Specific allocation criteria have not yet been established, but the structure and process quality of outpatient rehabilitation should correspond to that of the inpatient setting. The choice between the two settings should be based on pragmatic criteria. Both settings should be possible for an individual

  11. Lung Transplantation From Donors After Previous Cardiac Surgery: Ideal Graft in Marginal Donor?

    Science.gov (United States)

    Palleschi, A; Mendogni, P; Tosi, D; Montoli, M; Carrinola, R; Mariolo, A V; Briganti, F; Nosotti, M

    2017-05-01

    Lung transplantation is a limited by donor pool shortage. Despite the efforts to extend the graft acceptability with recurrent donor criteria reformulations, previous cardiothoracic surgery is still considered a contraindication. A donor who underwent cardiac surgery could potentially provide an ideal lung but high intraoperative risks and intrinsic technical challenges are expected during the graft harvesting. The purpose of this study is to present our dedicated protocol and four clinical cases of successful lung procurements from donors who had a previous major cardiac surgery. One donor had ascending aortic root (AAR) substitution, another had mitral valve substitution, and two had coronary artery bypass surgery. The others' eligibility criteria for organ allocation, such as ABO compatibility, PaO 2 /FiO 2 ratio, absence of aspiration, or sepsis were respected. In one of the cases with previous coronary bypass grafting, the donor had a veno-arterial extracorporeal membrane oxygenation support. Consequently, the grafts required an ex vivo lung perfusion evaluation. We report the technical details of procurement and postoperative courses of recipients. All procurements were uneventful, without lung damage or waste of abdominal organs related to catastrophic intraoperative events. All recipients had a successful clinical outcome. We believe that successful transplantation is achievable even in a complicated setting, such as cases involving donors with previous cardiac surgery frequently are. Facing lung donor shortage, we strongly support any effort to avoid the loss of possible acceptable lungs. In particular, previous major cardiac surgery does not strictly imply a poor quality of lungs as well as unsustainable graft procurement. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Response to cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Schiffer, Angélique A; Widdershoven, Jos W

    2009-01-01

    Cardiac resynchronization therapy (CRT) is a promising treatment for a subgroup of patients with advanced congestive heart failure and a prolonged QRS interval. Despite the majority of patients benefiting from CRT, 10-40% of patients do not respond to this treatment and are labeled as nonresponders....... Given that there is a lack of consensus on how to define response to CRT, the purpose of this viewpoint is to discuss currently used definitions and their shortcomings, and to provide recommendations as to how an expansion of the criteria for CRT response may be useful to clinicians....

  13. Silicone chain extender

    DEFF Research Database (Denmark)

    2015-01-01

    The present invention relates to a silicone chain extender, more particularly a chain extender for silicone polymers and copolymers, to a chain extended silicone polymer or copolymer and to a functionalized chain extended silicone polymer or copolymer, to a method for the preparation thereof...

  14. SU-F-T-405: Development of a Rapid Cardiac Contouring Tool Using Landmark-Driven Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Pelletier, C; Jung, J [East Carolina University Greenville, NC (United States); Mosher, E; Lee, C [National Cancer Institute, Rockville, MD (United States); Lee, C [University of Michigan, Ann Arbor, MI (United States)

    2016-06-15

    Purpose: This study aims to develop a tool to rapidly delineate cardiac substructures for use in dosimetry for large-scale clinical trial or epidemiological investigations. The goal is to produce a system that can semi-automatically delineate nine cardiac structures to a reasonable accuracy within a couple of minutes. Methods: The cardiac contouring tool employs a Most Similar Atlas method, where a selection criterion is used to pre-select the most similar model to the patient from a library of pre-defined atlases. Sixty contrast-enhanced cardiac computed tomography angiography (CTA) scans (30 male and 30 female) were manually contoured to serve as the atlas library. For each CTA 12 structures were delineated. Kabsch algorithm was used to compute the optimum rotation and translation matrices between the patient and atlas. Minimum root mean squared distance between the patient and atlas after transformation was used to select the most-similar atlas. An initial study using 10 CTA sets was performed to assess system feasibility. Leave-one patient out method was performed, and fit criteria were calculated to evaluate the fit accuracy compared to manual contours. Results: For the pilot study, mean dice indices of .895 were achieved for the whole heart, .867 for the ventricles, and .802 for the atria. In addition, mean distance was measured via the chord length distribution (CLD) between ground truth and the atlas structures for the four coronary arteries. The mean CLD for all coronary arteries was below 14mm, with the left circumflex artery showing the best agreement (7.08mm). Conclusion: The cardiac contouring tool is able to delineate cardiac structures with reasonable accuracy in less than 90 seconds. Pilot data indicates that the system is able to delineate the whole heart and ventricles within a reasonable accuracy using even a limited library. We are extending the atlas sets to 60 adult males and females in total.

  15. SU-F-T-405: Development of a Rapid Cardiac Contouring Tool Using Landmark-Driven Modeling

    International Nuclear Information System (INIS)

    Pelletier, C; Jung, J; Mosher, E; Lee, C; Lee, C

    2016-01-01

    Purpose: This study aims to develop a tool to rapidly delineate cardiac substructures for use in dosimetry for large-scale clinical trial or epidemiological investigations. The goal is to produce a system that can semi-automatically delineate nine cardiac structures to a reasonable accuracy within a couple of minutes. Methods: The cardiac contouring tool employs a Most Similar Atlas method, where a selection criterion is used to pre-select the most similar model to the patient from a library of pre-defined atlases. Sixty contrast-enhanced cardiac computed tomography angiography (CTA) scans (30 male and 30 female) were manually contoured to serve as the atlas library. For each CTA 12 structures were delineated. Kabsch algorithm was used to compute the optimum rotation and translation matrices between the patient and atlas. Minimum root mean squared distance between the patient and atlas after transformation was used to select the most-similar atlas. An initial study using 10 CTA sets was performed to assess system feasibility. Leave-one patient out method was performed, and fit criteria were calculated to evaluate the fit accuracy compared to manual contours. Results: For the pilot study, mean dice indices of .895 were achieved for the whole heart, .867 for the ventricles, and .802 for the atria. In addition, mean distance was measured via the chord length distribution (CLD) between ground truth and the atlas structures for the four coronary arteries. The mean CLD for all coronary arteries was below 14mm, with the left circumflex artery showing the best agreement (7.08mm). Conclusion: The cardiac contouring tool is able to delineate cardiac structures with reasonable accuracy in less than 90 seconds. Pilot data indicates that the system is able to delineate the whole heart and ventricles within a reasonable accuracy using even a limited library. We are extending the atlas sets to 60 adult males and females in total.

  16. Cardiac sodium channelopathies

    NARCIS (Netherlands)

    Amin, A.S.; Asghari-Roodsari, A.; Tan, H.L.

    2010-01-01

    Cardiac sodium channel are protein complexes that are expressed in the sarcolemma of cardiomyocytes to carry a large inward depolarizing current (I-Na) during phase 0 of the cardiac action potential. The importance of I-Na for normal cardiac electrical activity is reflected by the high incidence of

  17. Cardiac gated ventilation

    Science.gov (United States)

    Hanson, C. William, III; Hoffman, Eric A.

    1995-05-01

    There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. We evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50msec scan aperture. Multislice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. We observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a nonfailing model of the heart.

  18. Report From the American Society of Transplantation Conference on Donor Heart Selection in Adult Cardiac Transplantation in the United States.

    Science.gov (United States)

    Kobashigawa, J; Khush, K; Colvin, M; Acker, M; Van Bakel, A; Eisen, H; Naka, Y; Patel, J; Baran, D A; Daun, T; Luu, M; Olymbios, M; Rogers, J; Jeevanandam, V; Esmailian, F; Pagani, F D; Lima, B; Stehlik, J

    2017-10-01

    Cardiac transplantation remains the only definitive treatment for end-stage heart failure. Transplantation rates are limited by a shortage of donor hearts. This shortage is magnified because many hearts are discarded because of strict selection criteria and concern for regulatory reprimand for less-than-optimal posttransplant outcomes. There is no standardized approach to donor selection despite proposals to liberalize acceptance criteria. A donor heart selection conference was organized to facilitate discussion and generate ideas for future research. The event was attended by 66 participants from 41 centers with considerable experience in cardiac donor selection. There were state-of-the-art presentations on donor selection, with subsequent breakout sessions on standardizing the process and increasing utilization of donor hearts. Participants debated misconceptions and established agreement on donor and recipient risk factors for donor selection and identified the components necessary for a future donor risk score. Ideas for future initiatives include modification of regulatory practices to consider extended criteria donors when evaluating outcomes and prospective studies aimed at identifying the factors leading to nonacceptance of available donor hearts. With agreement on the most important donor and recipient risk factors, it is anticipated that a consistent approach to donor selection will improve rates of heart transplantation. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  19. Extended Enterprise performance Management

    NARCIS (Netherlands)

    Bobbink, Maria Lammerdina; Hartmann, Andreas

    2014-01-01

    The allegiance of partnering organisations and their employees to an Extended Enterprise performance is its proverbial sword of Damocles. Literature on Extended Enterprises focuses on collaboration, inter-organizational integration and learning to avoid diminishing or missing allegiance becoming an

  20. Syndrome of extended shadow

    International Nuclear Information System (INIS)

    Ginzburg, M.A.

    1987-01-01

    Syndrome of extended shadow is characterized by large (more than one lobe) or total shadow of the lung area. A detailed roentgenological characteristic and intrasyndrome differential diagnosis of extended shadows is given. Ethiology, pathogenesis and pathomorphology as well as clinical picture and methods of investigation of extended shadows are discussed

  1. Perspectives on extended Deterrence

    International Nuclear Information System (INIS)

    Tertrais, Bruno; Yost, David S.; Bunn, Elaine; Lee, Seok-soo; Levite, Ariel e.; Russell, James A.; Hokayem, Emile; Kibaroglu, Mustafa; Schulte, Paul; Thraenert, Oliver; Kulesa, Lukasz

    2010-05-01

    In November 2009, the Foundation for Strategic Research (Fondation pour la recherche strategique, FRS) convened a workshop on 'The Future of extended Deterrence', which included the participation of some of the best experts of this topic, from the United States, Europe, the Middle East and East Asia, as well as French and NATO officials. This document brings together the papers prepared for this seminar. Several of them were updated after the publication in April 2010 of the US Nuclear Posture Review. The seminar was organized with the support of the French Atomic energy Commission (Commissariat a l'energie atomique - CEA). Content: 1 - The future of extended deterrence: a brainstorming paper (Bruno Tertrais); 2 - US extended deterrence in NATO and North-East Asia (David S. Yost); 3 - The future of US extended deterrence (Elaine Bunn); 4 - The future of extended deterrence: a South Korean perspective (Seok-soo Lee); 5 - Reflections on extended deterrence in the Middle East (Ariel e. Levite); 6 - extended deterrence, security guarantees and nuclear weapons: US strategic and policy conundrums in the Gulf (James A. Russell); 7 - extended deterrence in the Gulf: a bridge too far? (Emile Hokayem); 8 - The future of extended deterrence: the case of Turkey (Mustafa Kibaroglu); 9 - The future of extended deterrence: a UK view (Paul Schulte); 10 - NATO and extended deterrence (Oliver Thraenert); 11 - extended deterrence and assurance in Central Europe (Lukasz Kulesa)

  2. Cardiac arrhythmias associated with spinal cord injury

    DEFF Research Database (Denmark)

    Hector, Sven Magnus; Biering-Sørensen, Tor; Krassioukov, Andrei

    2013-01-01

    CONTEXT/OBJECTIVES: To review the current literature to reveal the incidence of cardiac arrhythmias and its relation to spinal cord injury (SCI). METHODS: Data source: MEDLINE database, 304 hits, and 32 articles were found to be relevant. The relevant articles all met the inclusion criteria: (1......) contained original data (2) on cardiac arrhythmias (3) in humans with (4) traumatic SCI. RESULTS: In the acute phase of SCI (1-14 days after injury) more cranial as well as more severe injuries seemed to increase the incidence of bradycardia. Articles not covering the first 14 days after injury, thus...... as during procedures such as penile vibro-stimulation and tracheal suction. These episodes of bradycardia were seen more often in individuals with cervical injuries. Longitudinal studies with continuous electrocardiogram recordings are needed to uncover the true relation between cardiac arrhythmias and SCI....

  3. Stimulating endogenous cardiac regeneration

    Directory of Open Access Journals (Sweden)

    Amanda eFinan

    2015-09-01

    Full Text Available The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration,a combination of these approaches couldameliorate the overall repair process to incorporate the participation ofmultiple cell players.

  4. Cardiac sodium channelopathies.

    Science.gov (United States)

    Amin, Ahmad S; Asghari-Roodsari, Alaleh; Tan, Hanno L

    2010-07-01

    Cardiac sodium channel are protein complexes that are expressed in the sarcolemma of cardiomyocytes to carry a large inward depolarizing current (INa) during phase 0 of the cardiac action potential. The importance of INa for normal cardiac electrical activity is reflected by the high incidence of arrhythmias in cardiac sodium channelopathies, i.e., arrhythmogenic diseases in patients with mutations in SCN5A, the gene responsible for the pore-forming ion-conducting alpha-subunit, or in genes that encode the ancillary beta-subunits or regulatory proteins of the cardiac sodium channel. While clinical and genetic studies have laid the foundation for our understanding of cardiac sodium channelopathies by establishing links between arrhythmogenic diseases and mutations in genes that encode various subunits of the cardiac sodium channel, biophysical studies (particularly in heterologous expression systems and transgenic mouse models) have provided insights into the mechanisms by which INa dysfunction causes disease in such channelopathies. It is now recognized that mutations that increase INa delay cardiac repolarization, prolong action potential duration, and cause long QT syndrome, while mutations that reduce INa decrease cardiac excitability, reduce electrical conduction velocity, and induce Brugada syndrome, progressive cardiac conduction disease, sick sinus syndrome, or combinations thereof. Recently, mutation-induced INa dysfunction was also linked to dilated cardiomyopathy, atrial fibrillation, and sudden infant death syndrome. This review describes the structure and function of the cardiac sodium channel and its various subunits, summarizes major cardiac sodium channelopathies and the current knowledge concerning their genetic background and underlying molecular mechanisms, and discusses recent advances in the discovery of mutation-specific therapies in the management of these channelopathies.

  5. Hyperplastic Cardiac Sarcoma Recurrence

    Directory of Open Access Journals (Sweden)

    Masood A. Shariff

    2015-01-01

    Full Text Available Primary cardiac sarcomas are rare tumors with a median survival of 6–12 months. Data suggest that an aggressive multidisciplinary approach may improve patient outcome. We present the case of a male who underwent resection of cardiac sarcoma three times from the age of 32 to 34. This report discusses the malignant nature of cardiac sarcoma and the importance of postoperative multidisciplinary care.

  6. Criteria for intraventricular conduction disturbances and pre-excitation

    NARCIS (Netherlands)

    Willems, J.L.; Robles de Medina, E.O.; Bernard, R.; Coumel, Ph.; Fisch, Ch.; Mazur, N.A.; Meijler, F.L.; Mogensen, L.; Moret, P.; Pisa, Z.; Rautaharju, P.M.; Surawicz, B.; Watanabe, Y.; Wellens, H.J.J.; WHO/ISFC Task Force ad hoc

    1985-01-01

    In an effort to standardize terminology and criteria for clinical electrocardiography, and as a follow-up of its work on definitions of terms related to cardiac rhythm, an Ad Hoc Working Group established by the World Health Organization and the International Society and Federation of Cardiology

  7. Giant cardiac myxoma.

    Science.gov (United States)

    Barlis, Peter; Lim, Eu Jin; Gow, Paul J; Seevanayagam, Siven; Calafiore, Paul; Chan, Robert K

    2007-10-01

    Although cardiac myxomas remain an uncommon group of malignancies, they are the most common form of primary cardiac tumour. Clinical presentations can be varied with local cardiac haemodynamic consequences, valvular insufficiency or even embolic phenomena. We present a case of a 46-year-old man with chronic abdominal pain and discuss a number of diagnostic challenges that were confronted up until a definitive diagnosis of cardiac myxoma was made. The resultant outcome was excellent with the patient achieving complete recovery from long term disabling symptoms.

  8. Cardiac event monitors

    Science.gov (United States)

    ... ECG) - ambulatory; Continuous electrocardiograms (EKGs); Holter monitors; Transtelephonic event monitors ... attached. You can carry or wear a cardiac event monitor up to 30 days. You carry the ...

  9. [Extracorporeal life support for treating cardiac arrest].

    Science.gov (United States)

    Lehot, Jean-Jacques; Long-Him-Nam, Nelly; Bastien, Olivier

    2011-12-01

    Percutaneous extracorporeal life support (ECLS) is now widespread for treating acute cardiac failure. ECLS has been used for treating in-hospital and out of hospital cardiac arrests. A systematic review of literature was performed in order to assess the results. Nine studies of in-hospital cardiac arrests were published between 2003 and January 31, 2011. They included 724 patients, 208 of which survived without significant neurological sequelae (28.7 %). In the other patients, the initial disease and the consequences of low flow brought multiorgan failure, or ECLS resulted in haemorrhage and ischaemia. Low flow lasted between 42 and 105 min (mean 54min). ECLS was used after out of hospital cardiac arrests in 3 studies published between 2008 and January 31, 2011. They included 110 patients of which only 6 survived (4.4 %) despite strict inclusion criteria. Low flow lasted between 60 and 120 min (mean 98 min.) According to these results the use of ECLS should be encouraged after in-hospital cardiac arrest and training in cardiorespiratory resuscitation should be improved in global population and health professionals.

  10. Extended icosahedral structures

    CERN Document Server

    Jaric, Marko V

    1989-01-01

    Extended Icosahedral Structures discusses the concepts about crystal structures with extended icosahedral symmetry. This book is organized into six chapters that focus on actual modeling of extended icosahedral crystal structures. This text first presents a tiling approach to the modeling of icosahedral quasiperiodic crystals. It then describes the models for icosahedral alloys based on random connections between icosahedral units, with particular emphasis on diffraction properties. Other chapters examine the glassy structures with only icosahedral orientational order and the extent of tra

  11. Extending Database Integration Technology

    National Research Council Canada - National Science Library

    Buneman, Peter

    1999-01-01

    Formal approaches to the semantics of databases and database languages can have immediate and practical consequences in extending database integration technologies to include a vastly greater range...

  12. Biological Water Quality Criteria

    Science.gov (United States)

    Page contains links to Technical Documents pertaining to Biological Water Quality Criteria, including, technical assistance documents for states, tribes and territories, program overviews, and case studies.

  13. Extraction of fetal electrocardiogram (ECG) by extended state ...

    Indian Academy of Sciences (India)

    Fetal electrocardiogram (ECG) gives information about the health status of fetus and so, an early diagnosis of any cardiac defect before delivery increases the effectiveness of appropriate treatment. In this paper, authors investigate the use of adaptive neuro-fuzzy inference system (ANFIS) with extended Kalman filter for fetal ...

  14. Helical cardiac cone beam reconstruction using retrospective ECG gating

    International Nuclear Information System (INIS)

    Grass, M; Manzke, R; Nielsen, T; Koken, P; Proksa, R; Natanzon, M; Shechter, G

    2003-01-01

    In modern computer tomography (CT) systems, the fast rotating gantry and the increased detector width enable 3D imaging of the heart. Cardiac volume CT has a high potential for non-invasive coronary angiography with high spatial resolution and short scan time. Due to the increased detector width, true cone beam reconstruction methods are needed instead of adapted 2D reconstruction schemes. In this paper, the extended cardiac reconstruction method is introduced. It integrates the idea of retrospectively gated cardiac reconstruction for helical data acquisition into a cone beam reconstruction framework. It leads to an efficient and flexible algorithmic scheme for the reconstruction of single- and multi-phase cardiac volume datasets. The method automatically adapts the number of cardiac cycles used for the reconstruction. The cone beam geometry is fully taken into account during the reconstruction process. Within this paper, results are presented on patient datasets which have been acquired using a 16-slice cone beam CT system

  15. Cardiac resynchronization therapy and automatic implantable cardiac defibrillators in the treatment of heart failure: a review article.

    Science.gov (United States)

    Vesty, Jill; Rasmusson, Kismet D; Hall, Jill; Schmitz, Sandy; Brush, Sally

    2004-10-01

    To review the use of cardiac resynchronization therapy (CRT) and automatic implantable cardiac defibrillators (AICDs) in heart failure (HF) patients. Selected scientific literature. New developments in device therapy for HF patients are helping to decrease morbidity and mortality in this challenging patient population. CRT improves left ventricular (LV) ejection fraction, quality of life, 6-min walk distances, and New York Heart Association scores in select patients. AICDs can prevent sudden cardiac death in those who have LV dysfunction and are at risk for ventricular arrhythmias. Cardiac devices are now becoming a standard of care for those with HF who meet certain criteria. Despite advances in medical therapy for treating LV dysfunction, newly diagnosed patients face a 50% mortality rate in 5 years. The natural history of HF leads to continual deterioration of function unless adverse cardiac remodeling is reversed. Until recently, the only means for improving symptoms and cardiac function has been through the optimization of standard medicines that are indicated for LV dysfunction, such as angiotensin-converting enzyme inhibitors and beta-blockers. However, not all patients benefit from medical management alone. Cardiac devices may now be considered when significant symptoms persist after standard medicines are optimized. When practitioners use a multiple-modality approach, careful patient selection based on the inclusion criteria used in the trials outlined in this article will likely lead to improved management of those with LV dysfunction.

  16. Simulation data mapping in virtual cardiac model.

    Science.gov (United States)

    Jiquan, Liu; Jingyi, Feng; Duan, Huilong; Siping, Chen

    2004-01-01

    Although 3D heart and torso model with realistic geometry are basis of simulation computation in LFX virtual cardiac model, the simulation results are mostly output in 2D format. To solve such a problem and enhance the virtual reality of LFX virtual cardiac model, the methods of voxel mapping and vertex project mapping were presented. With these methods, excitation isochrone map (EIM) was mapped from heart model with realistic geometry to real visible man heart model, and body surface potential map (BSPM) was mapped from torso model with realistic geometry to real visible man body surface. By visualizing in the 4Dview, which is a real-time 3D medical image visualization platform, the visualization results of EIM and BSPM simulation data before and after mapping were also provided. According to the visualization results, the output format of EIM and BSPM simulation data of LFX virtual cardiac model were extended from 2D to 4D (spatio-temporal) and from cardiac model with realistic geometry to real cardiac model, and more realistic and effective simulation was achieved.

  17. Safety in cardiac surgery

    NARCIS (Netherlands)

    Siregar, S.

    2013-01-01

    The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for

  18. [Advances in cardiac pacing].

    Science.gov (United States)

    de Carranza, María-José Sancho-Tello; Fidalgo-Andrés, María Luisa; Ferrer, José Martínez; Mateas, Francisco Ruiz

    2012-01-01

    This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  19. Acebutolol in Cardiac Arrhythmias

    African Journals Online (AJOL)

    1974-04-20

    Apr 20, 1974 ... the cardiac output at rest and on exercise is not altered by the administration of acebutolol, and in patients with coronary artery disease, intravenous acebutolol produces a small fall in cardiac index, stroke index and in the parameters which are used to measure left ventricular. contractilityYo. We have used ...

  20. Cardiac Catheterization (For Kids)

    Science.gov (United States)

    ... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... Educators Search English Español Cardiac Catheterization KidsHealth / For Kids / Cardiac Catheterization What's in this article? What Is ...

  1. Extended Life Coolant Testing

    Science.gov (United States)

    2016-06-06

    military vehicles. Newer vehicles come factory- filled with ELC, while the Army continues to use traditional supplemental coolant additives (SCA)-based...UNCLASSIFIED TABLE OF CONTENTS EXTENDED LIFE COOLANT TESTING INTERIM REPORT TFLRF No. 478 by Gregory A. T. Hansen Edwin A...longer needed. Do not return it to the originator. UNCLASSIFIED UNCLASSIFIED EXTENDED LIFE COOLANT TESTING INTERIM REPORT TFLRF No

  2. Extended Theories of Gravitation

    Directory of Open Access Journals (Sweden)

    Fatibene Lorenzo

    2013-09-01

    Full Text Available Extended theories of gravitation are naturally singled out by an analysis inspired by the Ehelers-Pirani-Schild framework. In this framework the structure of spacetime is described by a Weyl geometry which is enforced by dynamics. Standard General Relativity is just one possible theory within the class of extended theories of gravitation. Also all Palatini f(R theories are shown to be extended theories of gravitation. This more general setting allows a more general interpretation scheme and more general possible couplings between gravity and matter. The definitions and constructions of extended theories will be reviewed. A general interpretation scheme will be considered for extended theories and some examples will be considered.

  3. Dual Criteria Decisions

    DEFF Research Database (Denmark)

    Andersen, Steffen; Harrison, Glenn W.; Lau, Morten Igel

    2014-01-01

    The most popular models of decision making use a single criterion to evaluate projects or lotteries. However, decision makers may actually consider multiple criteria when evaluating projects. We consider a dual criteria model from psychology. This model integrates the familiar tradeoffs between...

  4. Mathematical cardiac electrophysiology

    CERN Document Server

    Colli Franzone, Piero; Scacchi, Simone

    2014-01-01

    This book covers the main mathematical and numerical models in computational electrocardiology, ranging from microscopic membrane models of cardiac ionic channels to macroscopic bidomain, monodomain, eikonal models and cardiac source representations. These advanced multiscale and nonlinear models describe the cardiac bioelectrical activity from the cell level to the body surface and are employed in both the direct and inverse problems of electrocardiology. The book also covers advanced numerical techniques needed to efficiently carry out large-scale cardiac simulations, including time and space discretizations, decoupling and operator splitting techniques, parallel finite element solvers. These techniques are employed in 3D cardiac simulations illustrating the excitation mechanisms, the anisotropic effects on excitation and repolarization wavefronts, the morphology of electrograms in normal and pathological tissue and some reentry phenomena. The overall aim of the book is to present rigorously the mathematica...

  5. Biomaterials for cardiac regeneration

    CERN Document Server

    Ruel, Marc

    2015-01-01

    This book offers readers a comprehensive biomaterials-based approach to achieving clinically successful, functionally integrated vasculogenesis and myogenesis in the heart. Coverage is multidisciplinary, including the role of extracellular matrices in cardiac development, whole-heart tissue engineering, imaging the mechanisms and effects of biomaterial-based cardiac regeneration, and autologous bioengineered heart valves. Bringing current knowledge together into a single volume, this book provides a compendium to students and new researchers in the field and constitutes a platform to allow for future developments and collaborative approaches in biomaterials-based regenerative medicine, even beyond cardiac applications. This book also: Provides a valuable overview of the engineering of biomaterials for cardiac regeneration, including coverage of combined biomaterials and stem cells, as well as extracellular matrices Presents readers with multidisciplinary coverage of biomaterials for cardiac repair, including ...

  6. Sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Neeraj Parakh

    2015-01-01

    Full Text Available Sudden cardiac death is one of the most common cause of mortality worldwide. Despite significant advances in the medical science, there is little improvement in the sudden cardiac death related mortality. Coronary artery disease is the most common etiology behind sudden cardiac death, in the above 40 years population. Even in the apparently healthy population, there is a small percentage of patients dying from sudden cardiac death. Given the large denominator, this small percentage contributes to the largest burden of sudden cardiac death. Identification of this at risk group among the apparently healthy individual is a great challenge for the medical fraternity. This article looks into the causes and methods of preventing SCD and at some of the Indian data. Details of Brugada syndrome, Long QT syndrome, Genetics of SCD are discussed. Recent guidelines on many of these causes are summarised.

  7. Extended family medicine training

    Science.gov (United States)

    Slade, Steve; Ross, Shelley; Lawrence, Kathrine; Archibald, Douglas; Mackay, Maria Palacios; Oandasan, Ivy F.

    2016-01-01

    Abstract Objective To examine trends in family medicine training at a time when substantial pedagogic change is under way, focusing on factors that relate to extended family medicine training. Design Aggregate-level secondary data analysis based on the Canadian Post-MD Education Registry. Setting Canada. Participants All Canadian citizens and permanent residents who were registered in postgraduate family medicine training programs within Canadian faculties of medicine from 1995 to 2013. Main outcome measures Number and proportion of family medicine residents exiting 2-year and extended (third-year and above) family medicine training programs, as well as the types and numbers of extended training programs offered in 2015. Results The proportion of family medicine trainees pursuing extended training almost doubled during the study period, going from 10.9% in 1995 to 21.1% in 2013. Men and Canadian medical graduates were more likely to take extended family medicine training. Among the 5 most recent family medicine exit cohorts (from 2009 to 2013), 25.9% of men completed extended training programs compared with 18.3% of women, and 23.1% of Canadian medical graduates completed extended training compared with 13.6% of international medical graduates. Family medicine programs vary substantially with respect to the proportion of their trainees who undertake extended training, ranging from a low of 12.3% to a high of 35.1% among trainees exiting from 2011 to 2013. Conclusion New initiatives, such as the Triple C Competency-based Curriculum, CanMEDS–Family Medicine, and Certificates of Added Competence, have emerged as part of family medicine education and credentialing. In acknowledgment of the potential effect of these initiatives, it is important that future research examine how pedagogic change and, in particular, extended training shapes the care family physicians offer their patients. As part of that research it will be important to measure the breadth and uptake of

  8. Green Supplier Selection Criteria

    DEFF Research Database (Denmark)

    Nielsen, Izabela Ewa; Banaeian, Narges; Golinska, Paulina

    2014-01-01

    to determine prevalent general and environmental supplier selection criteria and develop a framework which can help decision makers to determine and prioritize suitable green supplier selection criteria (general and environmental). In this research we considered several parameters (evaluation objectives......) to establish suitable criteria for GSS such as their production type, requirements, policy and objectives instead of applying common criteria. At first a comprehensive and deep review on prevalent and green supplier selection literatures performed. Then several evaluation objectives defined to assess the green......Green supplier selection (GSS) criteria arise from an organization inclination to respond to any existing trends in environmental issues related to business management and processes, so GSS is integrating environmental thinking into conventional supplier selection. This research is designed...

  9. Redefining design criteria for Pu-238 gloveboxes

    International Nuclear Information System (INIS)

    Acosta, S.V.

    1998-01-01

    Enclosures for confinement of special nuclear materials (SNM) have evolved into the design of gloveboxes. During the early stages of glovebox technology, established practices and process operation requirements defined design criteria. Proven boxes that performed and met or exceeded process requirements in one group or area, often could not be duplicated in other areas or processes, and till achieve the same success. Changes in materials, fabrication and installation methods often only met immediate design criteria. Standardization of design criteria took a big step during creation of ''Special-Nuclear Materials R and D Laboratory Project, Glovebox standards''. The standards defined design criteria for every type of process equipment in its most general form. Los Alamos National Laboratory (LANL) then and now has had great success with Pu-238 processing. However with ever changing Environment Safety and Health (ES and H) requirements and Ta-55 Facility Configuration Management, current design criteria are forced to explore alternative methods of glovebox design fabrication and installation. Pu-238 fuel processing operations in the Power Source Technologies Group have pushed the limitations of current design criteria. More than half of Pu-238 gloveboxes are being retrofitted or replaced to perform the specific fuel process operations. Pu-238 glovebox design criteria are headed toward process designed single use glovebox and supporting line gloveboxes. Gloveboxes that will house equipment and processes will support TA-55 Pu-238 fuel processing needs into the next century and extend glovebox expected design life

  10. The Extended Enterprise concept

    DEFF Research Database (Denmark)

    Larsen, Lars Bjørn; Vesterager, Johan; Gobbi, Chiara

    1999-01-01

    This paper provides an overview of the work that has been done regarding the Extended Enterprise concept in the Common Concept team of Globeman 21 including references to results deliverables concerning the development of the Extended Enterprise concept. The first section presents the basic concept...... picture from Globeman21, which illustrates the Globeman21 way of realising the Extended Enterprise concept. The second section presents the Globeman21 EE concept in a life cycle perspective, which to a large extent is based on the thoughts and ideas behind GERAM (ISO/DIS 15704)....

  11. Cardiac involvement in patients with Becker muscular dystrophy: new diagnostic and pathophysiological insights by a CMR approach

    Directory of Open Access Journals (Sweden)

    Thiene Gaetano

    2008-11-01

    Full Text Available Abstract Background Becker-Kiener muscular dystrophy (BMD represents an X-linked genetic disease associated with myocardial involvement potentially resulting in dilated cardiomyopathy (DCM. Early diagnosis of cardiac involvement may permit earlier institution of heart failure treatment and extend life span in these patients. Both echocardiography and nuclear imaging methods are capable of detecting later stages of cardiac involvement characterised by wall motion abnormalities. Cardiovascular magnetic resonance (CMR has the potential to detect cardiac involvement by depicting early scar formation that may appear before onset of wall motion abnormalities. Methods In a prospective two-center-study, 15 male patients with BMD (median age 37 years; range 11 years to 56 years underwent comprehensive neurological and cardiac evaluations including physical examination, echocardiography and CMR. A 16-segment model was applied for evaluation of regional wall motion abnormalities (rWMA. The CMR study included late gadolinium enhancement (LGE imaging with quantification of myocardial damage. Results Abnormal echocardiographic results were found in eight of 15 (53.3% patients with all of them demonstrating reduced left ventricular ejection fraction (LVEF and rWMA. CMR revealed abnormal findings in 12 of 15 (80.0% patients (p = 0.04 with 10 (66.6% having reduced LVEF (p = 0.16 and 9 (64.3% demonstrating rWMA (p = 0.38. Myocardial damage as assessed by LGE-imaging was detected in 11 of 15 (73.3% patients with a median myocardial damage extent of 13.0% (range 0 to 38.0%, an age-related increase and a typical subepicardial distribution pattern in the inferolateral wall. Ten patients (66.7% were in need of medical heart failure therapy based on CMR results. However, only 4 patients (26.7% were already taking medication based on clinical criteria (p = 0.009. Conclusion Cardiac involvement in patients with BMD is underdiagnosed by echocardiographic methods resulting

  12. Imaging for cardiac electrophysiology

    Directory of Open Access Journals (Sweden)

    Benoit Desjardins

    2016-11-01

    Full Text Available Clinical cardiac electrophysiology is the study of the origin and treatment of arrhythmia. There has been considerable recent development in this field, where imaging has had a transformational impact. In this invited review, we offer a global overview of the most important developments in the use of imaging in cardiac electrophysiology. We first describe the radiological imaging modalities involved in cardiac electrophysiology, to assess cardiac anatomy, function and scar. We then introduce an imaging modality with which readers are probably unfamiliar (electroanatomical mapping [EAM], but which is routinely used by electrophysiologists to plan and guide cardiac mapping and cardiac ablation therapy by catheter, a therapy which can reduce or even cure arrhythmia. We identify the limitations of EAM and describe how radiological imaging modalities can complement this technique. We then describe and illustrate how imaging has helped the diagnosis of arrhythmogenic conditions, and how imaging is used to plan and guide clinical cardiac electrophysiologic procedures and assess their results and complications. We focus on the two most common arrhythmias for which imaging has the greatest impact: atrial fibrillation and ventricular tachycardia.

  13. Cardiac tumors: echo assessment

    Directory of Open Access Journals (Sweden)

    Rekha Mankad MD

    2016-12-01

    Full Text Available Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series. They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1 thrombus or vegetations are the most likely etiology, (2 cardiac tumors are mostly secondary and (3 primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

  14. Building Extended Families

    Science.gov (United States)

    McKain, Barbara; McKain, Michael

    1970-01-01

    Discusses need for dissolution of the couple" relationship with substitution of the extended family which would permit each member to maintain individuality and to function on own merit. Suggests group living as preferable alternative. (CJ)

  15. Extending mine life

    International Nuclear Information System (INIS)

    Anon.

    1984-01-01

    Mine layouts, new machines and techniques, research into problem areas of ground control and so on, are highlighted in this report on extending mine life. The main resources taken into account are coal mining, uranium mining, molybdenum and gold mining

  16. Rational extended thermodynamics

    CERN Document Server

    Müller, Ingo

    1998-01-01

    Ordinary thermodynamics provides reliable results when the thermodynamic fields are smooth, in the sense that there are no steep gradients and no rapid changes. In fluids and gases this is the domain of the equations of Navier-Stokes and Fourier. Extended thermodynamics becomes relevant for rapidly varying and strongly inhomogeneous processes. Thus the propagation of high­ frequency waves, and the shape of shock waves, and the regression of small-scale fluctuation are governed by extended thermodynamics. The field equations of ordinary thermodynamics are parabolic while extended thermodynamics is governed by hyperbolic systems. The main ingredients of extended thermodynamics are • field equations of balance type, • constitutive quantities depending on the present local state and • entropy as a concave function of the state variables. This set of assumptions leads to first order quasi-linear symmetric hyperbolic systems of field equations; it guarantees the well-posedness of initial value problems and f...

  17. Water Quality Criteria

    Science.gov (United States)

    EPA develops water quality criteria based on the latest scientific knowledge to protect human health and aquatic life. This information serves as guidance to states and tribes in adopting water quality standards.

  18. Aquatic Life Criteria - Atrazine

    Science.gov (United States)

    Documents pertaining to Acute and Chronic Ambient Water Quality Aquatic Life Criteria for Atrazine (Freshwater and Salt Water). This document contains the safe levels of Atrazine in water that should protect to the majority of species.

  19. Aquatic Life Criteria - Copper

    Science.gov (United States)

    Documents pertain to Aquatic Life Ambient Water Quality criteria for Copper (2007 Freshwater, 2016 Estuarine/marine). These documents contain the safe levels of Copper in water that should protect to the majority of species.

  20. Aquatic Life Criteria - Ammonia

    Science.gov (United States)

    Documents related to EPA's final 2013 Aquatic Life Ambient Water Quality Criteria for Ammonia (Freshwater). These documents pertain to the safe levels of Ammonia in water that should protect to the majority of species.

  1. Criteria Air Emissions Trends

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Air Emissions Trends site provides national trends of criteria pollutant and precursor emissions data based on the the National Emissions Inventory (NEI) from...

  2. Multimodal freight investment criteria.

    Science.gov (United States)

    2010-07-01

    Literature was reviewed on multi-modal investment criteria for freight projects, examining measures and techniques for quantifying project benefits and costs, as well as ways to describe the economic importance of freight transportation. : A limited ...

  3. Aquatic Life Criteria - Cadmium

    Science.gov (United States)

    Documents pertaining to 2016 Acute and Chronic Aquatic Life Ambient Water Quality Criteria for Cadmium (Freshwater, Estuarine/marine). These documents contain the safe levels of Cadmium in water that should protect to the majority of species.

  4. Endothelial dysfunction after non-cardiac surgery

    DEFF Research Database (Denmark)

    Søndergaard, E S; Fonnes, S; Gögenur, I

    2015-01-01

    BACKGROUND: More than 50% of patients with increased troponin levels after non-cardiac surgery have an impaired endothelial function pre-operatively. Non-invasive markers of endothelial function have been developed for the assessment of endothelial dysfunction. The aim of this paper was to system......BACKGROUND: More than 50% of patients with increased troponin levels after non-cardiac surgery have an impaired endothelial function pre-operatively. Non-invasive markers of endothelial function have been developed for the assessment of endothelial dysfunction. The aim of this paper...... was to systematically review the literature to evaluate the association between non-cardiac surgery and non-invasive markers of endothelial function. METHODS: A systematic search was conducted in MEDLINE, EMBASE and Cochrane Library Database according to the PRISMA guidelines. Endothelial dysfunction was described only...... with non-invasive measurements done both pre- and post-operatively and published in English. All types of non-cardiac surgery and both men and women of all ages were included. RESULTS: We found 1722 eligible studies in our search, and of these, five studies fulfilled our inclusion and exclusion criteria...

  5. Cardiac Procedures and Surgeries

    Science.gov (United States)

    ... the Procedure Does A stent is a wire mesh tube used to prop open an artery during ... a Heart Attack • Heart Attack Tools & Resources • Support Network Heart Attack Tools & Resources My Cardiac Coach What ...

  6. Defining the Cardiac Fibroblast

    Science.gov (United States)

    Ivey, Malina J.; Tallquist, Michelle D.

    2017-01-01

    Cardiac fibrosis remains an important health concern, but the study of fibroblast biology has been hindered by a lack of effective means for identifying and tracking fibroblasts. Recent advances in fibroblast-specific lineage tags and reporters have permitted a better understanding of these cells. After injury multiple cell types have been implicated as the source for extracellular matrix producing cells, but emerging studies suggest that resident cardiac fibroblasts contribute substantially to the remodeling process. In this review, we discuss recent findings regarding cardiac fibroblast origin and identity. Our understanding of cardiac fibroblast biology and fibrosis is still developing and will expand profoundly in the next few years, with many of the recent findings regarding fibroblast gene expression and behavior laying down the groundwork for interpreting the purpose and utility of these cells before and after injury. PMID:27746422

  7. Cardiac Catheterization (For Parents)

    Science.gov (United States)

    ... cases, the doctor might call for a cardiac magnetic resonance imaging (MRI) scan or a CAT scan . ... first couple of days. This means no heavy lifting (more than 10 pounds) and no sports. After ...

  8. Cardiac Catheterization (For Teens)

    Science.gov (United States)

    ... doctor may also call for a cardiac MRI (magnetic resonance imaging) scan or a CT (computerized tomography) ... first couple of days. This means no heavy lifting (nothing over 10 pounds) and no sports. After ...

  9. Effect of donor age on long-term survival following cardiac transplantation.

    Science.gov (United States)

    Topkara, Veli K; Cheema, Faisal H; Kesavaramanujam, Satish; Mercando, Michelle L; Forster, Catherine S; Argenziano, Michael; Esrig, Barry C; Oz, Mehmet C; Naka, Yoshifumi

    2006-01-01

    The current shortage of donor hearts has forced the criteria of organ procurement to be extended, leading to increased use of older donor hearts to bridge the gap between demand and availability. Our objective was to analyze the effect of donor age on outcomes after cardiac transplantation. We retrospectively studied 864 patients who underwent cardiac transplantation at New York Presbyterian Hospital - Columbia University between 1992 and 2002. Patients were divided into two groups; donor age or =40 years (Group B, n = 264). Characteristics including gender, body mass index, and cytomegalovirus (CMV) status were significantly different between the two donor age groups. Race, CMV status, toxoplasmosis status, left ventricular assist device prior to transplant, diabetes mellitus, and retransplantation were similar in both the recipient groups, while age, gender, and BMI were different. Early mortality was lower in Group A, 5%, versus 9.5% in Group B. Multivariate analysis revealed recipient female gender (odd ratio (OR) = 1.71), retransplantation (OR = 1.63), and increased donor age (OR = 1.02) as significant predictors of poor survival in the recipient population. Actuarial survival at 1 year (86.7% vs 81%), 5 years (75% vs 65%), and 10 years (56% vs 42%) was significantly different as well with a log rank p = 0.002. These findings suggest that increased donor age is an independent predictor of long-term survival. However, the shortage of organs makes it difficult to follow strict guidelines when placing hearts; therefore, decisions need to be made on a relative basis.

  10. Cardiac biomarkers in Neonatology

    OpenAIRE

    Vijlbrief, D.C.

    2015-01-01

    In this thesis, the role for cardiac biomarkers in neonatology was investigated. Several clinically relevant results were reported. In term and preterm infants, hypoxia and subsequent adaptation play an important role in cardiac biomarker elevation. The elevated natriuretic peptides are indicative of abnormal function; elevated troponins are suggestive for cardiomyocyte damage. This methodology makes these biomarkers of additional value in the treatment of newborn infants, separate or as a co...

  11. Cardiac imaging in adults

    International Nuclear Information System (INIS)

    Jaffe, C.C.

    1987-01-01

    This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority

  12. Cardiac imaging in adults

    Energy Technology Data Exchange (ETDEWEB)

    Jaffe, C.C.

    1987-01-01

    This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority.

  13. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  14. Cardiac resynchronization therapy : advances in optimal patient selection

    NARCIS (Netherlands)

    Bleeker, Gabe Berend

    2007-01-01

    Despite the impressive results of cardiac resynchronization theraphy (CRT) in recent large randomized trials a consistent number of patients fails to improve following CRT implantation when the established CRT selection criteria (NYHA class III-IV heart failure, LV ejection fraction ≤35 % and QRS

  15. Extending quantum mechanics entails extending special relativity

    International Nuclear Information System (INIS)

    Aravinda, S; Srikanth, R

    2016-01-01

    The complementarity between signaling and randomness in any communicated resource that can simulate singlet statistics is generalized by relaxing the assumption of free will in the choice of measurement settings. We show how to construct an ontological extension for quantum mechanics (QMs) through the oblivious embedding of a sound simulation protocol in a Newtonian spacetime. Minkowski or other intermediate spacetimes are ruled out as the locus of the embedding by virtue of hidden influence inequalities. The complementarity transferred from a simulation to the extension unifies a number of results about quantum non-locality, and implies that special relativity has a different significance for the ontological model and for the operational theory it reproduces. Only the latter, being experimentally accessible, is required to be Lorentz covariant. There may be certain Lorentz non-covariant elements at the ontological level, but they will be inaccessible at the operational level in a valid extension. Certain arguments against the extendability of QM, due to Conway and Kochen (2009) and Colbeck and Renner (2012), are attributed to their assumption that the spacetime at the ontological level has Minkowski causal structure. (paper)

  16. Predictive Models for Normal Fetal Cardiac Structures.

    Science.gov (United States)

    Krishnan, Anita; Pike, Jodi I; McCarter, Robert; Fulgium, Amanda L; Wilson, Emmanuel; Donofrio, Mary T; Sable, Craig A

    2016-12-01

    Clinicians rely on age- and size-specific measures of cardiac structures to diagnose cardiac disease. No universally accepted normative data exist for fetal cardiac structures, and most fetal cardiac centers do not use the same standards. The aim of this study was to derive predictive models for Z scores for 13 commonly evaluated fetal cardiac structures using a large heterogeneous population of fetuses without structural cardiac defects. The study used archived normal fetal echocardiograms in representative fetuses aged 12 to 39 weeks. Thirteen cardiac dimensions were remeasured by a blinded echocardiographer from digitally stored clips. Studies with inadequate imaging views were excluded. Regression models were developed to relate each dimension to estimated gestational age (EGA) by dates, biparietal diameter, femur length, and estimated fetal weight by the Hadlock formula. Dimension outcomes were transformed (e.g., using the logarithm or square root) as necessary to meet the normality assumption. Higher order terms, quadratic or cubic, were added as needed to improve model fit. Information criteria and adjusted R 2 values were used to guide final model selection. Each Z-score equation is based on measurements derived from 296 to 414 unique fetuses. EGA yielded the best predictive model for the majority of dimensions; adjusted R 2 values ranged from 0.72 to 0.893. However, each of the other highly correlated (r > 0.94) biometric parameters was an acceptable surrogate for EGA. In most cases, the best fitting model included squared and cubic terms to introduce curvilinearity. For each dimension, models based on EGA provided the best fit for determining normal measurements of fetal cardiac structures. Nevertheless, other biometric parameters, including femur length, biparietal diameter, and estimated fetal weight provided results that were nearly as good. Comprehensive Z-score results are available on the basis of highly predictive models derived from gestational

  17. Cardiac Findings in Congenital Nephrotic Syndrome

    Directory of Open Access Journals (Sweden)

    Shamsi Ghaffari

    2011-08-01

    Full Text Available Introduction: Congenital nephrotic syndrome is a severe debilitating problem associated with extra renal manifestation such as diverse cardiac findings. Methods: During four years 6 cases diagnosed as congenital nephritic syndrome in base of definitive criteria their documents reviewed and echocardiographic evaluation has been done for all with or with-out cardiac sign or symptoms, results gathered and expressed as incidence. Results: All cases have some grades of structural or functional defects from simple form like as tricus-pid regurgitation to complex defects. It may be run in consecutively in siblings of a family from non consanguine parents. Conclusion: Pulmonary stenosis may occur in all parts subvalvualr, valvular and peripheral parts of pulmonary artery, left ventricular hypertrophy and mitral regurgitation observed in some, moderate tricuspid regurgitation observed in half of cases due to pulmonary hypertension or right ventricular hypertrophy due to pulmonary stenosis.

  18. Cardiac Findings in Congenital Nephrotic Syndrome

    Science.gov (United States)

    Malaki, Majid; Ghaffari, Shamsi; Ghaffari, Samad; Rastkar, Bahaman; Goldust, Mohammad; Malaki, Pouya; Sahar, Behnam

    2011-01-01

    Introduction Congenital nephrotic syndrome is a severe debilitating problem associated with extra renal manifestation such as diverse cardiac findings. Methods During four years, 6 cases diagnosed as congenital nephritic syndrome in base of definitive criteria their documents reviewed and echocardiographic evaluation has been done for all with or without cardiac sign or symptoms, results gathered and expressed as incidence. Results All cases have some grades of structural or functional defects from simple form like as tricuspid regurgitation to complex defects. It may be run in consecutively in siblings of a family from non consanguine parents. Conclusion Pulmonary stenosis may occur in all parts subvalvualr, valvular and peripheral parts of pulmonary artery, left ventricular hypertrophy and mitral regurgitation observed in some, moderate tricuspid regurgitation observed in half of cases due to pulmonary hypertension or right ventricular hypertrophy due to pulmonary stenosis. PMID:24250960

  19. Home-based versus centre-based cardiac rehabilitation.

    Science.gov (United States)

    Taylor, Rod S; Dalal, Hayes; Jolly, Kate; Moxham, Tiffany; Zawada, Anna

    2010-01-20

    The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Traditionally centre-based cardiac rehabilitation (CR) programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. To determine the effectiveness of home-based cardiac rehabilitation programmes compared with supervised centre-based cardiac rehabilitation on mortality and morbidity, health-related quality of life and modifiable cardiac risk factors in patients with coronary heart disease. We updated the search of a previous review by searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2007, Issue 4), MEDLINE, EMBASE and CINAHL from 2001 to January 2008. We checked reference lists and sought advice from experts. No language restrictions were applied. Randomised controlled trials (RCTs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes, in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. Studies were selected independently by two reviewers, and data extracted by a single reviewer and checked by a second one. Authors were contacted where possible to obtain missing information. Twelve studies (1,938 participants) met the inclusion criteria. The majority of studies recruited a lower risk patient following an acute myocardial infarction (MI) and revascularisation. There was no difference in outcomes of home- versus centre-based cardiac rehabilitation in mortality risk ratio (RR) was1.31 (95% confidence interval (C) 0.65 to 2.66), cardiac events, exercise capacity standardised mean difference (SMD) -0.11 (95% CI -0.35 to 0.13), as well as in modifiable risk factors (systolic blood pressure; diastolic blood pressure; total cholesterol

  20. Summarized water quality criteria

    International Nuclear Information System (INIS)

    Kempster, P.L.; Hattingh, W.H.J.; Van Vliet, H.R.

    1980-08-01

    The available world literature from 27 sources on existing water quality criteria are summarized for the 15 main uses of water. The minimum, median and maximum specified values for 96 different determinands are included. Under each water use the criteria are grouped according to the functional significance of the determinands e.g. aesthetic/physical effects, high toxic potential, low toxic potential etc. A synopsis is included summarizing salient facts for each determinand such as the conditions under which it is toxic and its relationship to other determinands. The significance of the criteria is briefly discussed and the importance of considering functional interactions between determinands emphasized in evaluating the potential for toxic or beneficial effects. From the source literature it appears that the toxic potential, in addition to being determined by concentration, is also affected by the origin of the substance concerned, i.e. whether from natural sources or from anthropogenic pollution

  1. An Extended Duopoly Game.

    Science.gov (United States)

    Eckalbar, John C.

    2002-01-01

    Illustrates how principles and intermediate microeconomic students can gain an understanding for strategic price setting by playing a relatively large oligopoly game. Explains that the game extends to a continuous price space and outlines appropriate applications. Offers the Mathematica code to instructors so that the assumptions of the game can…

  2. Extending Critical Performativity

    DEFF Research Database (Denmark)

    Spicer, André; Alvesson, Mats; Kärreman, Dan

    2016-01-01

    from an undue focus on intra-academic debates; engage in author-itarian theoretical policing; feign relevance through symbolic radicalism; and repackage common sense. We take these critiques as an opportunity to offer an extended model of critical performativity that involves focusing on issues...

  3. Parameterization of extended systems

    DEFF Research Database (Denmark)

    Niemann, Hans Henrik

    2006-01-01

    The YJBK parameterization (of all stabilizing controllers) is extended to handle systems with additional sensors and/or actuators. It is shown that the closed loop transfer function is still an affine function in the YJBK parameters in the nominal case. Further, some closed-loop stability results...

  4. Poster Session- Extended Abstracts

    Science.gov (United States)

    Jack D. Alexander III; Jean Findley; Brenda K. Kury; Jan L. Beyers; Douglas S. Cram; Terrell T. Baker; Jon C. Boren; Carl Edminster; Sue A. Ferguson; Steven McKay; David Nagel; Trent Piepho; Miriam Rorig; Casey Anderson; Jeanne Hoadley; Paulette L. Ford; Mark C. Andersen; Ed L. Fredrickson; Joe Truett; Gary W. Roemer; Brenda K. Kury; Jennifer Vollmer; Christine L. May; Danny C. Lee; James P. Menakis; Robert E. Keane; Zhi-Liang Zhu; Carol Miller; Brett Davis; Katharine Gray; Ken Mix; William P. Kuvlesky Jr.; D. Lynn Drawe; Marcia G. Narog; Roger D. Ottmar; Robert E. Vihnanek; Clinton S. Wright; Timothy E. Paysen; Burton K. Pendleton; Rosemary L. Pendleton; Carleton S. White; John Rogan; Doug Stow; Janet Franklin; Jennifer Miller; Lisa Levien; Chris Fischer; Emma Underwood; Robert Klinger; Peggy Moore; Clinton S. Wright

    2008-01-01

    Titles found within Poster Session-Extended Abstracts include:Assessment of emergency fire rehabilitation of four fires from the 2000 fire season on the Vale, Oregon, BLM district: review of the density sampling materials and methods: p. 329 Growth of regreen, seeded for erosion control, in the...

  5. Cardiac radiology: centenary review.

    Science.gov (United States)

    de Roos, Albert; Higgins, Charles B

    2014-11-01

    During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.

  6. Radiological design criteria

    International Nuclear Information System (INIS)

    Selby, J.M.; Andersen, B.V.; Carter, L.A.; Waite, D.A.

    1977-01-01

    Many new nuclear facilities are unsatisfactory from a radiation protection point of view, particularly when striving to maintain occupational exposure as low as practicable 'ALAP'. Radiation protection is achieved through physical protective features supplemented by administrative controls. Adequate physical protective feature should be achieved during construction so that supplemental administrative controls may be kept simple and workable. Many nuclear facilities fall short of adequate physical protective features, thus, remedial and sometimes awkward administrative procedures are required to safely conduct work. In reviewing the various handbooks, reports and regulations which deal with radiation protection, it may be noted that there is minimal radiological design guidance for application to nuclear facilities. A set of criteria or codes covering functional areas rather than specific nuclear facility types is badly needed. The following are suggested as functional areas to be considered: characterization of the Facility; siting and access; design exposure limits; layout (people and materials flow); ventilation and effluent control; radiation protection facilities and systems. The application of such radiological design criteria early in the design process would provide some assurance that nuclear facilities will be safe, flexible, and efficient with a minimum of costly retrofitting or administrative restrictions. Criteria which we have found helpful in these functional areas is discussed together with justification for adoption of such criteria and identification of problems which still require solution

  7. Comments on confinement criteria

    International Nuclear Information System (INIS)

    Kurak, V.; Schroer, B.; Swieca, J.A.

    1977-01-01

    For a QED 2 model with SU(n) flavour, the nature of the physical states space is more subtle than one expects on the basis of the loop criterion for confinement. One may have colour confinement without confinement of the fundamental flavour representation. Attempts to formulate confinement criteria in which the quark fields play a more fundamental role are discussed [pt

  8. Initial Efficacy of a Cardiac Rehabilitation Transition Program: Cardiac TRUST

    OpenAIRE

    Dolansky, Mary A.; Zullo, Melissa; Boxer, Rebecca; Moore, Shirley M.

    2011-01-01

    Patients recovering from cardiac events are increasingly using postacute care, such as home health care and skilled nursing facility services. The purpose of this pilot study was to test the initial efficacy, feasibility, and safety of a specially designed postacute care transitional rehabilitation intervention for cardiac patients. Cardiac Transitional Rehabilitation Using Self- Management Techniques (Cardiac TRUST) is a family-focused intervention that includes progressive low-intensity wal...

  9. Pediatric cardiac postoperative care

    Directory of Open Access Journals (Sweden)

    Auler Jr. José Otávio Costa

    2002-01-01

    Full Text Available The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

  10. Comprehensive cardiac rehabilitation

    DEFF Research Database (Denmark)

    Kruse, Marie; Hochstrasser, Stefan; Zwisler, Ann-Dorthe O

    2006-01-01

    OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed...... for the situation at hand. Due to challenging circumstances, the cost assessment turned out to be ex-post and top-down. RESULTS: Cost per treatment sequence is estimated to be approximately euro 976, whereas the incremental cost (compared with usual care) is approximately euro 682. The cost estimate is uncertain...... and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective....

  11. Extended Irreversible Thermodynamics

    CERN Document Server

    Jou, David

    2010-01-01

    This is the 4th edition of the highly acclaimed monograph on Extended Irreversible Thermodynamics, a theory that goes beyond the classical theory of irreversible processes. In contrast to the classical approach, the basic variables describing the system are complemented by non-equilibrium quantities. The claims made for extended thermodynamics are confirmed by the kinetic theory of gases and statistical mechanics. The book covers a wide spectrum of applications, and also contains a thorough discussion of the foundations and the scope of the current theories on non-equilibrium thermodynamics. For this new edition, the authors critically revised existing material while taking into account the most recent developments in fast moving fields such as heat transport in micro- and nanosystems or fast solidification fronts in materials sciences. Several fundamental chapters have been revisited emphasizing physics and applications over mathematical derivations. Also, fundamental questions on the definition of non-equil...

  12. The dialogically extended mind

    DEFF Research Database (Denmark)

    Fusaroli, Riccardo; Gangopadhyay, Nivedita; Tylén, Kristian

    2014-01-01

    , we argue that language enhances our cognitive capabilities in a much more radical way: The skilful engagement of public material symbols facilitates evolutionarily unprecedented modes of collective perception, action and reasoning (interpersonal synergies) creating dialogically extended minds. We...... relate our approach to other ideas about collective minds and review a number of empirical studies to identify the mechanisms enabling the constitution of interpersonal cognitive systems....

  13. Extended quantum mechanics

    International Nuclear Information System (INIS)

    Pavel Bona

    2000-01-01

    The work can be considered as an essay on mathematical and conceptual structure of nonrelativistic quantum mechanics which is related here to some other (more general, but also to more special and 'approximative') theories. Quantum mechanics is here primarily reformulated in an equivalent form of a Poisson system on the phase space consisting of density matrices, where the 'observables', as well as 'symmetry generators' are represented by a specific type of real valued (densely defined) functions, namely the usual quantum expectations of corresponding selfjoint operators. It is shown in this paper that inclusion of additional ('nonlinear') symmetry generators (i. e. 'Hamiltonians') into this reformulation of (linear) quantum mechanics leads to a considerable extension of the theory: two kinds of quantum 'mixed states' should be distinguished, and operator - valued functions of density matrices should be used in the role of 'nonlinear observables'. A general framework for physical theories is obtained in this way: By different choices of the sets of 'nonlinear observables' we obtain, as special cases, e.g. classical mechanics on homogeneous spaces of kinematical symmetry groups, standard (linear) quantum mechanics, or nonlinear extensions of quantum mechanics; also various 'quasiclassical approximations' to quantum mechanics are all sub theories of the presented extension of quantum mechanics - a version of the extended quantum mechanics. A general interpretation scheme of extended quantum mechanics extending the usual statistical interpretation of quantum mechanics is also proposed. Eventually, extended quantum mechanics is shown to be (included into) a C * -algebraic (hence linear) quantum theory. Mathematical formulation of these theories is presented. The presentation includes an analysis of problems connected with differentiation on infinite-dimensional manifolds, as well as a solution of some problems connected with the work with only densely defined unbounded

  14. Cardiac optogenetics : using light to monitor cardiac physiology

    NARCIS (Netherlands)

    Koopman, Charlotte D.|info:eu-repo/dai/nl/41375491X; Zimmermann, Wolfram-Hubertus; Knöpfel, Thomas; de Boer, Teun P.|info:eu-repo/dai/nl/30481878X

    2017-01-01

    Our current understanding of cardiac excitation and its coupling to contraction is largely based on ex vivo studies utilising fluorescent organic dyes to assess cardiac action potentials and signal transduction. Recent advances in optogenetic sensors open exciting new possibilities for cardiac

  15. Cardiac output measurement

    Directory of Open Access Journals (Sweden)

    Andreja Möller Petrun

    2014-02-01

    Full Text Available In recent years, developments in the measuring of cardiac output and other haemodynamic variables are focused on the so-called minimally invasive methods. The aim of these methods is to simplify the management of high-risk and haemodynamically unstable patients. Due to the need of invasive approach and the possibility of serious complications the use of pulmonary artery catheter has decreased. This article describes the methods for measuring cardiac output, which are based on volume measurement (Fick method, indicator dilution method, pulse wave analysis, Doppler effect, and electrical bioimpedance.

  16. Quantitative cardiac computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Thelen, M.; Dueber, C.; Wolff, P.; Erbel, R.; Hoffmann, T.

    1985-06-01

    The scope and limitations of quantitative cardiac CT have been evaluated in a series of experimental and clinical studies. The left ventricular muscle mass was estimated by computed tomography in 19 dogs (using volumetric methods, measurements in two axes and planes and reference volume). There was good correlation with anatomical findings. The enddiastolic volume of the left ventricle was estimated in 22 patients with cardiomyopathies; using angiography as a reference, CT led to systematic under-estimation. It is also shown that ECG-triggered magnetic resonance tomography results in improved visualisation and may be expected to improve measurements of cardiac morphology.

  17. Mechanisms of Cardiac Regeneration

    Science.gov (United States)

    Uygur, Aysu; Lee, Richard T.

    2016-01-01

    Adult humans fail to regenerate their hearts following injury, and this failure to regenerate myocardium is a leading cause of heart failure and death worldwide. Although all adult mammals appear to lack significant cardiac regeneration potential, some vertebrates can regenerate myocardium throughout life. In addition, new studies indicate that mammals have cardiac regeneration potential during development and very soon after birth. The mechanisms of heart regeneration among model organisms, including neonatal mice, appear remarkably similar. Orchestrated waves of inflammation, matrix deposition and remodeling, and cardiomyocyte proliferation are commonly seen in heart regeneration models. Understanding why adult mammals develop extensive scarring instead of regeneration is a crucial goal for regenerative biology. PMID:26906733

  18. Human Systems Design Criteria

    DEFF Research Database (Denmark)

    Rasmussen, Jens

    1982-01-01

    This paper deals with the problem of designing more humanised computer systems. This problem can be formally described as the need for defining human design criteria, which — if used in the design process - will secure that the systems designed get the relevant qualities. That is not only...... the necessary functional qualities but also the needed human qualities. The author's main argument is, that the design process should be a dialectical synthesis of the two points of view: Man as a System Component, and System as Man's Environment. Based on a man's presentation of the state of the art a set...... of design criteria is suggested and their relevance discussed. The point is to focus on the operator rather than on the computer. The crucial question is not to program the computer to work on its own conditions, but to “program” the operator to function on human conditions....

  19. Intelligent intefrace design criteria

    International Nuclear Information System (INIS)

    Sicard, Y.; Siebert, S.; Thebault, M.H.

    1990-01-01

    Optimum adequation between control means and the capacities of the teams of operators is sought for to achieve computerization of control and monitoring interfaces. Observation of the diagnosis activity of populations of operators in incident situations on a simulator enables design criteria well-suited to the characteristics of the detection, interpretation of symptoms and incident location tasks to be defined. A software tool based on a qualitative approach enables the design process to be systematized

  20. System for the diagnosis and monitoring of coronary artery disease, acute coronary syndromes, cardiomyopathy and other cardiac conditions

    Science.gov (United States)

    Schlegel, Todd T. (Inventor); Arenare, Brian (Inventor)

    2008-01-01

    Cardiac electrical data are received from a patient, manipulated to determine various useful aspects of the ECG signal, and displayed and stored in a useful form using a computer. The computer monitor displays various useful information, and in particular graphically displays various permutations of reduced amplitude zones and kurtosis that increase the rapidity and accuracy of cardiac diagnoses. New criteria for reduced amplitude zones are defined that enhance the sensitivity and specificity for detecting cardiac abnormalities.

  1. Côte d'Ivoire; Second Review Under the Three-Year Arrangement Under the Extended Credit Facility, Request for Waivers of Nonobservance of Performance Criteria, and Financing Assurances Review: Staff Report; Staff Statement; Press Release on the Executive Board Discussion; and Statement by the Executive Director for Côte d'Ivoire

    OpenAIRE

    International Monetary Fund

    2010-01-01

    Economic activity strengthened in Côte d’Ivoire in 2009, but it is expected to decelerate. Financial performance under the Extended Credit Facility-supported program was broadly satisfactory. Good progress was made in restructuring external debt. The program is in line with the agreed reform goals, but reflects the constraints imposed by the pre-election political situation. Tight expenditure management remains critical for the success of the program. Structural reforms are essential to stren...

  2. Neonatal cardiac emergencies

    African Journals Online (AJOL)

    Neonatal cardiac emergencies. The neonatal period is one that fills many generalists with fear – this article will help to dispel these concerns. George A Comitis, MB ChB, DCH (SA), DA (SA), FCPaed (SA), Cert Cardiology (SA) Paed. Consultant, Paediatric Cardiology Service of the Western Cape, Red Cross War Memorial ...

  3. Nonexercise cardiac stress testing

    International Nuclear Information System (INIS)

    Vacek, J.L.; Baldwin, T.

    1989-01-01

    Many patients who require evaluation for coronary artery disease are unable to undergo exercise stress testing because of physiologic or psychological limitations. Drs Vacek and Baldwin describe three alternative methods for assessment of cardiac function in these patients, all of which have high levels of diagnostic sensitivity and specificity. 23 references

  4. Cardiac magnetic resonance imaging

    African Journals Online (AJOL)

    2011-03-06

    Mar 6, 2011 ... Bruce Spottiswoode has a BSc in Electrical Engineering from the University of the Witwatersrand and a PhD in Biomedical Engineering on cardiac MRI from the. University of Cape Town. He has worked on developing electronics for the CSIR, on MRI image reconstruction for Siemens, and on X-ray imaging ...

  5. Sudden cardiac death

    DEFF Research Database (Denmark)

    Hougen, H P; Valenzuela, Antonio Jesus Sanchez; Lachica, E

    1992-01-01

    The study deals with the comparison of morphological, histochemical and biochemical methods applied to the detection of myocardial infarction in 150 medico-legal autopsies performed at the Institute of Forensic Pathology in Copenhagen. The study also included an NBT (formazan) test of cardiac cross...

  6. Cardiac magnetic resonance imaging

    African Journals Online (AJOL)

    2011-03-06

    Mar 6, 2011 ... Cardiac magnetic resonance imaging. Cardiovascular magnetic resonance imaging is becoming a routine diagnostic technique. BRUCE s sPOTTiswOOdE, PhD. MRC/UCT Medical Imaging Research Unit, University of Cape Town, and Division of Radiology, Stellenbosch University. Bruce Spottiswoode ...

  7. Post cardiac injury syndrome

    DEFF Research Database (Denmark)

    Nielsen, S L; Nielsen, F E

    1991-01-01

    The post-pericardiotomy syndrome is a symptom complex which is similar in many respects to the post-myocardial infarction syndrome and these are summarized under the diagnosis of the Post Cardiac Injury Syndrome (PCIS). This condition, which is observed most frequently after open heart surgery...

  8. Estimated venous return surface and cardiac output curve precisely predicts new hemodynamics after volume change.

    Science.gov (United States)

    Sugimachi, Masaru; Sunagawa, Kenji; Uemura, Kazunori; Kamiya, Atsunori; Shimizu, Shuji; Inagaki, Masashi; Shishido, Toshiaki

    2010-01-01

    In our extended Guyton's model, the ability of heart to pump blood is characterized by a cardiac output curve and the ability of vasculature to pool blood by a venous return surface. These intersect in a three-dimensional coordinate system at the operating right atrial pressure, left atrial pressure, and cardiac output. The baseline cardiac output curve and venous return surface and their changes after volume change would predict new hemodynamics. The invasive methods needed to precisely characterize cardiac output curve and venous return surface led us to aim at estimating cardiac output curve and venous return surface from a single hemodynamic measurement. Using the average values for two logarithmic function parameters, and for two slopes of a surface, we were able to estimate cardiac output curve and venous return surface. The estimated curve and surface predicted new hemodynamics after volume change precisely.

  9. Extended Testability Analysis Tool

    Science.gov (United States)

    Melcher, Kevin; Maul, William A.; Fulton, Christopher

    2012-01-01

    The Extended Testability Analysis (ETA) Tool is a software application that supports fault management (FM) by performing testability analyses on the fault propagation model of a given system. Fault management includes the prevention of faults through robust design margins and quality assurance methods, or the mitigation of system failures. Fault management requires an understanding of the system design and operation, potential failure mechanisms within the system, and the propagation of those potential failures through the system. The purpose of the ETA Tool software is to process the testability analysis results from a commercial software program called TEAMS Designer in order to provide a detailed set of diagnostic assessment reports. The ETA Tool is a command-line process with several user-selectable report output options. The ETA Tool also extends the COTS testability analysis and enables variation studies with sensor sensitivity impacts on system diagnostics and component isolation using a single testability output. The ETA Tool can also provide extended analyses from a single set of testability output files. The following analysis reports are available to the user: (1) the Detectability Report provides a breakdown of how each tested failure mode was detected, (2) the Test Utilization Report identifies all the failure modes that each test detects, (3) the Failure Mode Isolation Report demonstrates the system s ability to discriminate between failure modes, (4) the Component Isolation Report demonstrates the system s ability to discriminate between failure modes relative to the components containing the failure modes, (5) the Sensor Sensor Sensitivity Analysis Report shows the diagnostic impact due to loss of sensor information, and (6) the Effect Mapping Report identifies failure modes that result in specified system-level effects.

  10. Identifying cardiac syncope based on clinical history: a literature-based model tested in four independent datasets

    NARCIS (Netherlands)

    Berecki-Gisolf, Janneke; Sheldon, Aaron; Wieling, Wouter; van Dijk, Nynke; Costantino, Giorgio; Furlan, Raffaello; Shen, Win-Kuang; Sheldon, Robert

    2013-01-01

    We aimed to develop and test a literature-based model for symptoms that associate with cardiac causes of syncope. Seven studies (the derivation sample) reporting ≥2 predictors of cardiac syncope were identified (4 Italian, 1 Swiss, 1 Canadian, and 1 from the United States). From these, 10 criteria

  11. Classical extended superconformal symmetries

    International Nuclear Information System (INIS)

    Viswanathan, R.R.

    1990-10-01

    Super-covariant differential operators are defined in two dimensions which map supersymmetry doublets to other doublets. The possibility of constructing a closed algebra among the fields appearing in such operators is explored. Such an algebra exists for Grassmann-odd differential operators. A representation for these operators in terms of free-field doublets is constructed. An explicit closed algebra involving fields of spin 2 and 5/2, in addition to the stress tensor and the supersymmetry generator, is constructed from such a free-field representation as an example of a non-linear extended superconformal algebra. (author). 9 refs

  12. Patient selection criteria for outpatient joint arthroplasty.

    Science.gov (United States)

    Kort, Nanne P; Bemelmans, Yoeri F L; van der Kuy, P Hugo M; Jansen, Jacqueline; Schotanus, Martijn G M

    2017-09-01

    General consensus of patient selection criteria for outpatient joint arthroplasty is lacking, which is paramount to prevent prolonged hospital stay, adverse events and/or readmissions. This review highlights patient selection criteria for OJA based on the current literature and expert opinion. A search of the English and International electronic healthcare databases including MEDLINE/PubMed, EMBASE, AMED and the Cochrane library was performed in November 2015 to include studies published during the last 10 years. Furthermore, a survey of physicians from different specialties was performed. Fourteen studies described results regarding outpatient joint arthroplasty. Studies on outpatient hip and/or knee arthroplasty resulted in similar outcome in preselected patients. Patients who are able and willing to participate, with a low ASA classification (II), bleeding disorders, poorly controlled and/or severe cardiac (e.g. heart failure, arrhythmia) or pulmonary (e.g. embolism, respiratory failure) comorbidities, uncontrolled DM (type I or II), a high BMI (>30 m 2 /kg), chronic opioid consumption, functional neurological impairments, dependent functional status, chronic/end-stage renal disease and/or reduced preoperative cognitive capacity should be excluded from outpatient joint arthroplasty. The expert opinion-based selection criteria were comparable to literature with a further extension of exclusion for patients with practical issue's, urologic medical history and/or severe mobility disorders. Based on the current literature, the presented patient selection criteria provide a basis for outpatient joint arthroplasty and can be useful when selecting patients. Together with a change in mindset, a multidisciplinary approach and literature-based protocols, outpatient joint arthroplasty can be applied in daily orthopaedic practice while ensuring patients' safety. Clinical review, Level III.

  13. Maternal cardiac metabolism in pregnancy

    Science.gov (United States)

    Liu, Laura X.; Arany, Zolt

    2014-01-01

    Pregnancy causes dramatic physiological changes in the expectant mother. The placenta, mostly foetal in origin, invades maternal uterine tissue early in pregnancy and unleashes a barrage of hormones and other factors. This foetal ‘invasion’ profoundly reprogrammes maternal physiology, affecting nearly every organ, including the heart and its metabolism. We briefly review here maternal systemic metabolic changes during pregnancy and cardiac metabolism in general. We then discuss changes in cardiac haemodynamic during pregnancy and review what is known about maternal cardiac metabolism during pregnancy. Lastly, we discuss cardiac diseases during pregnancy, including peripartum cardiomyopathy, and the potential contribution of aberrant cardiac metabolism to disease aetiology. PMID:24448314

  14. Web site Evaluation Criteria

    Directory of Open Access Journals (Sweden)

    Mojdgan binesh

    2008-07-01

    Full Text Available The ever-increasing evolution of the Internet and the growing number of the resources accessible through this medium, has turned the issue of resource evaluation of the internet-based information into a controversial and cogent issue. By nature, the internet milieu is uncontrollable. It concomitantly contains both verifiable and unverifiable information. Thus it behooves the internet users to develop resource evaluation and critical thinking skills in order to discern appropriate quality resources. Through review and comparison of the available checklists, the present paper endeavors to offer criteria for website evaluation

  15. The pathogenesis of cardiac fibrosis.

    Science.gov (United States)

    Kong, Ping; Christia, Panagiota; Frangogiannis, Nikolaos G

    2014-02-01

    Cardiac fibrosis is characterized by net accumulation of extracellular matrix proteins in the cardiac interstitium, and contributes to both systolic and diastolic dysfunction in many cardiac pathophysiologic conditions. This review discusses the cellular effectors and molecular pathways implicated in the pathogenesis of cardiac fibrosis. Although activated myofibroblasts are the main effector cells in the fibrotic heart, monocytes/macrophages, lymphocytes, mast cells, vascular cells and cardiomyocytes may also contribute to the fibrotic response by secreting key fibrogenic mediators. Inflammatory cytokines and chemokines, reactive oxygen species, mast cell-derived proteases, endothelin-1, the renin/angiotensin/aldosterone system, matricellular proteins, and growth factors (such as TGF-β and PDGF) are some of the best-studied mediators implicated in cardiac fibrosis. Both experimental and clinical evidence suggests that cardiac fibrotic alterations may be reversible. Understanding the mechanisms responsible for initiation, progression, and resolution of cardiac fibrosis is crucial to design anti-fibrotic treatment strategies for patients with heart disease.

  16. Improvement of cardiac screening in amateur athletes.

    Science.gov (United States)

    Schmied, Christian M

    2015-01-01

    Although not performing on a professional level, amateur athletes, nevertheless, are participating in competitive sports and thus underlie a relevant risk for exercise-related SCD which implicates the need for an adequate pre-competition cardiac screening. As many amateur athletes belong to the category of "older" individuals, particularly CAD among male athletes with risk factors has to be targeted by the screening. However, the detection of clinically silent underlying coronary heart disease is challenging and cannot be accurately achieved by a standard screening provided to young athletes (history, clinical status, ECG). An extended work-up, at least, mandates the detection of cholesterol levels to estimate the individual cardiovascular risk. The fact that only less than 10% of Swiss amateur athletes have undergone cardiac screening led to various promising approaches to improve the awareness of the issue. Exemplarily, we successfully invented an "on-site" prevention campaign that positively influenced the attitude of the athletes towards cardiac screening. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Lunar Prospector Extended Mission

    Science.gov (United States)

    Folta, David; Beckman, Mark; Lozier, David; Galal, Ken

    1999-01-01

    The National Aeronautics and Space Administration (NASA) selected Lunar Prospector (LP) as one of the discovery missions to conduct solar system exploration science investigations. The mission is NASA's first lunar voyage to investigate key science objectives since Apollo and was launched in January 1998. In keeping with discovery program requirements to reduce total mission cost and utilize new technology, Lunar Prospector's mission design and control focused on the use of innovative and proven trajectory analysis programs. As part of this effort, the Ames Research Center and the Goddard Space Flight Center have become partners in the Lunar Prospector trajectory team to provide the trajectory analysis, maneuver planning, orbit determination support, and product generation. At the end of 1998, Lunar Prospector completed its one-year primary mission at 100 km altitude above the lunar surface. On December 19, 1998, Lunar Prospector entered the extended mission phase. Initially the mission orbit was lowered from 100 km to a mean altitude of 40 km. The altitude of Lunar Prospector varied between 25 and 55 km above the mean lunar geode due to lunar potential effects. After one month, the lunar potential model was updated based upon the new tracking data at 40 km. On January 29, 1999, the altitude was lowered again to a mean altitude of 30 km. This altitude varies between 12 and 48 km above the mean lunar geode. Since the minimum altitude is very close to the mean geode, various approaches were employed to get accurate lunar surface elevation including Clementine altimetry and line of sight analysis. Based upon the best available terrain maps, Lunar Prospector will reach altitudes of 8 km above lunar mountains in the southern polar and far side regions. This extended mission phase of six months will enable LP to obtain science data up to 3 orders of magnitude better than at the mission orbit. This paper details the trajectory design and orbit determination planning and

  18. The remote exercise monitoring trial for exercise-based cardiac rehabilitation (REMOTE-CR): a randomised controlled trial protocol

    OpenAIRE

    Maddison, Ralph; Rawstorn, Jonathan C; Rolleston, Anna; Whittaker, Robyn; Stewart, Ralph; Benatar, Jocelyne; Warren, Ian; Jiang, Yannan; Gant, Nicholas

    2014-01-01

    Background Exercise is an essential component of contemporary cardiac rehabilitation programs for the secondary prevention of coronary heart disease. Despite the benefits associated with regular exercise, adherence with supervised exercise-based cardiac rehabilitation remains low. Increasingly powerful mobile technologies, such as smartphones and wireless physiological sensors, may extend the capability of exercise-based cardiac rehabilitation by enabling real-time exercise monitoring for tho...

  19. Extended biorthogonal matrix polynomials

    Directory of Open Access Journals (Sweden)

    Ayman Shehata

    2017-01-01

    Full Text Available The pair of biorthogonal matrix polynomials for commutative matrices were first introduced by Varma and Tasdelen in [22]. The main aim of this paper is to extend the properties of the pair of biorthogonal matrix polynomials of Varma and Tasdelen and certain generating matrix functions, finite series, some matrix recurrence relations, several important properties of matrix differential recurrence relations, biorthogonality relations and matrix differential equation for the pair of biorthogonal matrix polynomials J(A,B n (x, k and K(A,B n (x, k are discussed. For the matrix polynomials J(A,B n (x, k, various families of bilinear and bilateral generating matrix functions are constructed in the sequel.

  20. Extending rational maps

    Science.gov (United States)

    Martin, Gaven J.

    We investigate when a rational endomorphism of the Riemann sphere overline{C} extends to a mapping of the upper half-space {H3 which is rational with respect to some measurable conformal structure. Such an extension has the property that it and all its iterates have uniformly bounded distortion. Such maps are called uniformly quasiregular. We show that, in the space of rational mappings of degree d , such an extension is possible in the structurally stable component where there is a single (attracting) component of the Fatou set and the Julia set is a Cantor set. We show that generally outside of this set no such extension is possible. In particular, polynomials can never admit such an extension.

  1. Extending juvenility in grasses

    Energy Technology Data Exchange (ETDEWEB)

    Kaeppler, Shawn; de Leon Gatti, Natalia; Foerster, Jillian

    2017-04-11

    The present invention relates to compositions and methods for modulating the juvenile to adult developmental growth transition in plants, such as grasses (e.g. maize). In particular, the invention provides methods for enhancing agronomic properties in plants by modulating expression of GRMZM2G362718, GRMZM2G096016, or homologs thereof. Modulation of expression of one or more additional genes which affect juvenile to adult developmental growth transition such as Glossy15 or Cg1, in conjunction with such modulation of expression is also contemplated. Nucleic acid constructs for down-regulation of GRMZM2G362718 and/or GRMZM2G096016 are also contemplated, as are transgenic plants and products produced there from, that demonstrate altered, such as extended juvenile growth, and display associated phenotypes such as enhanced yield, improved digestibility, and increased disease resistance. Plants described herein may be used, for example, as improved forage or feed crops or in biofuel production.

  2. Extended Poisson Exponential Distribution

    Directory of Open Access Journals (Sweden)

    Anum Fatima

    2015-09-01

    Full Text Available A new mixture of Modified Exponential (ME and Poisson distribution has been introduced in this paper. Taking the Maximum of Modified Exponential random variable when the sample size follows a zero truncated Poisson distribution we have derived the new distribution, named as Extended Poisson Exponential distribution. This distribution possesses increasing and decreasing failure rates. The Poisson-Exponential, Modified Exponential and Exponential distributions are special cases of this distribution. We have also investigated some mathematical properties of the distribution along with Information entropies and Order statistics of the distribution. The estimation of parameters has been obtained using the Maximum Likelihood Estimation procedure. Finally we have illustrated a real data application of our distribution.

  3. Extending over time

    DEFF Research Database (Denmark)

    Christensen, Tanya Karoli; Jensen, Torben Juel; Christensen, Marie Herget

    Studies of general extenders (GEs), such as Eng. and stuff like that, or something, typically find that it is a feature of youth speech, sometimes correlated with sex and class (e.g. Dubois 1992, Stubbe and Holmes 1995, Cheshire 2007, Tagliamonte and Denis 2010, Pichler and Levey 2011), but only...... including pronoun headed phrases, e.g. og (alt) det der ‘and (all) that there’, and clausal variants, e.g. og jeg ved ikke hvad ‘and I don’t know what’. The results indicate that Danish GEs in general are already gram-maticalized to a large extent. Regarding social factors, our data support the general...... finding that GEs are more frequent in youth speech. Adolescents have the highest relative frequency of GEs, and speakers tend to decrease their GE use during their life span, whilst participating in community changes regarding the use of the different GE types. Furthermore, the results suggest...

  4. Cardiac fusion and complex congenital cardiac defects in thoracopagus twins: diagnostic value of cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Park, Jeong-Jun [University of Ulsan College of Medicine, Asan Medical Center, Department of Pediatric Cardiac Surgery, Seoul (Korea, Republic of); Kim, Ellen Ai-Rhan [University of Ulsan College of Medicine, Asan Medical Center, Division of Neonatology, Department of Pediatrics, Seoul (Korea, Republic of); Won, Hye-Sung [University of Ulsan College of Medicine, Asan Medical Center, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of)

    2014-09-15

    Most thoracopagus twins present with cardiac fusion and associated congenital cardiac defects, and assessment of this anatomy is of critical importance in determining patient care and outcome. Cardiac CT with electrocardiographic triggering provides an accurate and quick morphological assessment of both intracardiac and extracardiac structures in newborns, making it the best imaging modality to assess thoracopagus twins during the neonatal period. In this case report, we highlight the diagnostic value of cardiac CT in thoracopagus twins with an interatrial channel and complex congenital cardiac defects. (orig.)

  5. Safety and reliability criteria

    International Nuclear Information System (INIS)

    O'Neil, R.

    1978-01-01

    Nuclear power plants and, in particular, reactor pressure boundary components have unique reliability requirements, in that usually no significant redundancy is possible, and a single failure can give rise to possible widespread core damage and fission product release. Reliability may be required for availability or safety reasons, but in the case of the pressure boundary and certain other systems safety may dominate. Possible Safety and Reliability (S and R) criteria are proposed which would produce acceptable reactor design. Without some S and R requirement the designer has no way of knowing how far he must go in analysing his system or component, or whether his proposed solution is likely to gain acceptance. The paper shows how reliability targets for given components and systems can be individually considered against the derived S and R criteria at the design and construction stage. Since in the case of nuclear pressure boundary components there is often very little direct experience on which to base reliability studies, relevant non-nuclear experience is examined. (author)

  6. Fetal cardiac assessment

    International Nuclear Information System (INIS)

    Greene, K.R.

    1983-01-01

    The better understanding of fetal cardiovascular physiology coupled with improved technology for non-invasive study of the fetus now enable much more detailed assessment of fetal cardiac status than by heart rate alone. Even the latter, relatively simple, measurement contains much more information than was previously realized. It is also increasingly clear that no single measurement will provide the answer to all clinical dilemmas either on cardiac function or the welfare of the fetus as a whole. There are obvious clinical advantages in measuring several variables from one signal and the measurement of heart rate, heart rate variation and waveform from the ECG in labour is a potentially useful combination. Systolic time intervals or flow measurements could easily be added or used separately by combining real-time and Doppler ultrasound probes

  7. Cardiac nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Gerson, M.C.

    1987-01-01

    The book begins with a review of the radionuclide methods available for evaluating cardiac perfusion and function. The authors discuss planar and tomographic thallium myocardial imaging, first-pass and equilibrium radionuclide angiography, and imaging with infarct-avid tracers. Several common but more specialized procedures are then reviewed: nonogemetric measurement of left ventricular volume, phase (Fourier) analysis, stroke volume ratio, right ventricular function, and diastolic function. A separate chapter is devoted to drug interventions and in particular the use of radionuclide ventriculography to monitor doxorubicin toxicity and therapy of congestive heart failure. The subsequent chapters provide a comprehensive guide to test selection, accuracy, and results in acute myocardial infarction, in postmyocardial infarction, in chronic coronary artery disease, before and after medical or surgical revascularization, in valvular heart disease, in cardiomyopathies, and in cardiac trauma.

  8. [Permanent cardiac pacing. Present possibilities and perspectives].

    Science.gov (United States)

    Novák, M

    1996-06-12

    Cardiac pacing is reckoned to be one of the most successful branches of medicine in the second half of the 20th century. Indications for single chamber ventricular pacing are getting gradually restricted. This early pacing mode, which was used in 1958 for the first time, has been recently replaced from modern modes: for atrial, dual chamber and rate adaptive ones. Not only these most recent methods prevent from bradycardia but they also meet demands of modern cardiac pacing, i.e. to restore the synchronization of the atriums and the ventricles and to restore the frequency response. So-called physiological pacing improves both the well-being and the survival of patients and it has also extended pacing indications to the non-arrhythmic ones: first and foremost to the cardiomyopathies. It is dual chamber pacing, the artificial biosensors, various kinds of counters and monitoring functions that enhance the energy consumption. Both low-threshold pacing leads and an automatic adjustment of the pulse energy are helpful in extending the longevity of tiny lithium-powered pacemakers of these days. Current dual chamber rate responsive devices represent an important first step towards a fully automatic smart pacemaker of the future. Such an intelligent pulse generator with several sensors will be operating in the DDDR mode checking automatically the pacing threshold and switching its pacing mode according to pathophysiological requirements.

  9. National Recommended Water Quality Criteria

    Data.gov (United States)

    U.S. Environmental Protection Agency — The National Recommended Water Quality Criteria is a compilation of national recommended water quality criteria for the protection of aquatic life and human health...

  10. Laser Safety Inspection Criteria

    International Nuclear Information System (INIS)

    Barat, K

    2005-01-01

    A responsibility of the Laser Safety Officer (LSO) is to perform laser safety audits. The American National Standard Z136.1 Safe use of Lasers references this requirement in several sections: (1) Section 1.3.2 LSO Specific Responsibilities states under Hazard Evaluation, ''The LSO shall be responsible for hazards evaluation of laser work areas''; (2) Section 1.3.2.8, Safety Features Audits, ''The LSO shall ensure that the safety features of the laser installation facilities and laser equipment are audited periodically to assure proper operation''; and (3) Appendix D, under Survey and Inspections, it states, ''the LSO will survey by inspection, as considered necessary, all areas where laser equipment is used''. Therefore, for facilities using Class 3B and or Class 4 lasers, audits for laser safety compliance are expected to be conducted. The composition, frequency and rigueur of that inspection/audit rests in the hands of the LSO. A common practice for institutions is to develop laser audit checklists or survey forms. In many institutions, a sole Laser Safety Officer (LSO) or a number of Deputy LSO's perform these audits. For that matter, there are institutions that request users to perform a self-assessment audit. Many items on the common audit list and the associated findings are subjective because they are based on the experience and interest of the LSO or auditor in particular items on the checklist. Beam block usage is an example; to one set of eyes a particular arrangement might be completely adequate, while to another the installation may be inadequate. In order to provide more consistency, the National Ignition Facility Directorate at Lawrence Livermore National Laboratory (NIF-LLNL) has established criteria for a number of items found on the typical laser safety audit form. These criteria are distributed to laser users, and they serve two broad purposes: first, it gives the user an expectation of what will be reviewed by an auditor, and second, it is an

  11. Molecular nuclear cardiac imaging

    International Nuclear Information System (INIS)

    Lee, Dong Soo; Paeng, Jin Chul

    2004-01-01

    Molecular nuclear cardiac imaging has included Tc-99m Annexin imaging to visualize myocardial apoptosis, but is now usually associated with gene therapy and cell-based therapy. Cardiac gene therapy was not successful so far but cardiac reporter gene imaging was made possible using HSV-TK (herpes simplex virus thymidine kinase) and F-18 FHBG (fluoro-hydroxymethylbutyl guanine) or I-124 FIAU (fluoro-deoxyiodo-arabino-furanosyluracil). Gene delivery was performed by needle injection with or without catheter guidance. TK expression did not last longer than 2 weeks in myocardium. Cell-based therapy of ischemic heart or failing heart looks promising, but biodistribution and differentiation of transplanted cells are not known. Reporter genes can be transfected to the stem/progenitor cells and cells containing these genes can be transplanted to the recipients using catheter-based purging or injection. Repeated imaging should be available and if promoter are varied to let express reporter transgenes, cellular (trans)differentiation can be studied. NIS (sodium iodide symporter) or D2R receptor genes are promising in this aspect

  12. INTEGRATED METHODOLOGY FOR PRODUCT PLANNING USING MULTI CRITERIA ANALYSIS

    Directory of Open Access Journals (Sweden)

    Tarun Soota

    2016-09-01

    Full Text Available Integrated approach to multi-criteria decision problems is proposed using quality function deployment and analytical network process. The objective of the work is to rationalize and improve the method of analyzing and interpreting customer needs and technical requirements. The methodology is used to determine, prioritize engineering requirements based on customer needs for development of best product. Framework allows decision maker to decompose a complex problem in a hierarchical structure to show relationship between objective and criteria. Multi-criteria decision modeling is used for extending the hierarchy process to both dependence and feedback. A case study on bikes is presented for the proposed model.

  13. Sample quality criteria.

    Science.gov (United States)

    Ramsey, Charles A; Wagner, Claas

    2015-01-01

    The concept of Sample Quality Criteria (SQC) is the initial step in the scientific approach to representative sampling. It includes the establishment of sampling objectives, Decision Unit (DU), and confidence. Once fully defined, these criteria serve as input, in addition to material properties, to the Theory of Sampling for developing a representative sampling protocol. The first component of the SQC establishes these questions: What is the analyte(s) of concern? What is the concentration level of interest of the analyte(s)? How will inference(s) be made from the analytical data to the DU? The second component of the SQC establishes the DU, i.e., the scale at which decisions are to be made. On a large scale, a DU could be a ship or rail car; examples for small-scale DUs are individual beans, seeds, or kernels. A well-defined DU is critical because it defines the spatial and temporal boundaries of sample collection. SQC are not limited to a single DU; they can also include multiple DUs. The third SQC component, the confidence, establishes the desired probability that a correct inference (decision) can be made. The confidence level should typically correlate to the potential consequences of an incorrect decision (e.g., health or economic). The magnitude of combined errors in the sampling, sample processing and analytical protocols determines the likelihood of an incorrect decision. Thus, controlling error to a greater extent increases the probability of a correct decision. The required confidence level directly affects the sampling effort and QC measures.

  14. Laser Safety Inspection Criteria

    International Nuclear Information System (INIS)

    Barat, K.

    2005-01-01

    A responsibility of the Laser Safety Officer (LSO) is to perform laser audits. The American National Standard Z136.1 Safe Use of Lasers references this requirement through several sections. One such reference is Section 1.3.2.8, Safety Features Audits, ''The LSO shall ensure that the safety features of the laser installation facilities and laser equipment are audited periodically to assure proper operation''. The composition, frequency and rigor of that inspection/audit rests in the hands of the LSO. A common practice for institutions is to develop laser audit checklists or survey forms It is common for audit findings from one inspector or inspection to the next to vary even when reviewing the same material. How often has one heard a comment, ''well this area has been inspected several times over the years and no one ever said this or that was a problem before''. A great number of audit items, and therefore findings, are subjective because they are based on the experience and interest of the auditor to particular items on the checklist. Beam block usage, to one set of eyes might be completely adequate, while to another, inadequate. In order to provide consistency, the Laser Safety Office of the National Ignition Facility Directorate has established criteria for a number of items found on the typical laser safety audit form. The criteria are distributed to laser users. It serves two broad purposes; first, it gives the user an expectation of what will be reviewed by an auditor. Second, it is an opportunity to explain audit items to the laser user and thus the reasons for some of these items, such as labelling of beam blocks

  15. Extended lactation in dairy cows

    DEFF Research Database (Denmark)

    Sorensen, Annette; Muir, D. Donald; Knight, Christopher Harold

    2008-01-01

    Twelve spring-calving and twelve winter-calving cows were managed for extended lactation cycles of 18-months duration, with the former group then completing a second extended lactation. Half of the cows were fed according to standard management practice for the herd; the other half received suppl...... interventions, the results lend support to the economic arguments in favour of extended lactation cycles. The likely welfare benefits of extended lactation are also discussed....

  16. PREVALENCE OF CARDIAC ABNORMALITIES IN PATIENTS WITH HIV IN THANJAVUR MEDICAL COLLEGE AND HOSPITAL, THANJAVUR

    Directory of Open Access Journals (Sweden)

    C. Sundararajan

    2017-08-01

    Full Text Available BACKGROUND HIV infection has become a global pandemic with more than 36 million people infected throughout the world. HIV related cardiac involvement has been reported with increasing frequency in recent years. The above study was undertaken to study the prevalence of cardiac abnormalities in HIV infected individuals and to correlate the cardiac abnormalities with stage of infection. MATERIALS AND METHODS We have conducted a cross-sectional study in the Department of Internal Medicine, Thanjavur Medical College and Hospital on the prevalence of cardiac manifestations among the parents living with HIV/ AIDS on ART. The duration of study was for a period of 6 months, August 2016 to January 2017. A total of 100 patients who were seropositive and who fit the inclusion criteria were chosen and an attempt was made out to find the prevalence of cardiac manifestations among them. All patients diagnosed to have HIV infection/ AIDS after ELISA test being positive were included in the study. RESULTS In our study among 100 patients, 30 patients (32.60% had cardiac abnormalities either in the form of ECG or Echocardiography abnormality. It is observed that 1 patient out of 13 patients (7.69% in Stage I, 7 patients out of 27 (25.92% patients in Stage II, 11 patients out of 33 (33.33% patients in Stage III and 11 patients out of 27 (40.74% patients in Stage IV had cardiac abnormalities. There was a statistically significant correlation between cardiac abnormalities and CD4 count (P value was 0.02. As the stage of infection increases, the cardiac abnormalities increase proportionally. Cardiac abnormalities are directly proportional to the stage of infection. CONCLUSION Prevalence of cardiac abnormalities was 32.60% in our study. Diastolic dysfunction was the most common echocardiographic abnormality. Poor progression of R waves was the most common electrocardiographic abnormality. Cardiac abnormalities specifically correlated with stage of infection. People

  17. Criteria for Assessing Naturalistic Inquiries as Reports.

    Science.gov (United States)

    Lincoln, Yvonna S.; Guba, Egon G.

    Research on the assessment of naturalistic inquiries is reviewed, and criteria for assessment are outlined. Criteria reviewed include early foundational and non-foundational criteria, trustworthiness criteria, axiomatic criteria, rhetorical criteria, action criteria, and application/transferability criteria. Case studies that are reports of…

  18. (MAR) calculation of extended spectrum β- lactamase (ESBL)

    African Journals Online (AJOL)

    The aim of this study was to check for the antibiotic susceptibility pattern and multiple antibiotic resistances (MAR) of extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella species. All methods used in this study were according to the standard criteria of NCCLs. It was shown that there was high ...

  19. Decision criteria in PSA applications

    International Nuclear Information System (INIS)

    Holmberg, J.E.; Pulkkinen, U.; Rosqvist, T.; Simola, K.

    2001-11-01

    Along with the adoption of risk informed decision making principles, the need for formal probabilistic decision rule or criteria has been risen. However, there are many practical and theoretical problems in the application of probabilistic criteria. One has to think what is the proper way to apply probabilistic rules together with deterministic ones and how the criteria are weighted with respect to each other. In this report, we approach the above questions from the decision theoretic point of view. We give a short review of the most well known probabilistic criteria, and discuss examples of their use. We present a decision analytic framework for evaluating the criteria, and we analyse how the different criteria behave under incompleteness or uncertainty of the PSA model. As the conclusion of our analysis we give recommendations on the application of the criteria in different decision situations. (au)

  20. Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope.

    Science.gov (United States)

    Miyake, Christina Y; Motonaga, Kara S; Fischer-Colbrie, Megan E; Chen, Liyuan; Hanisch, Debra G; Balise, Raymond R; Kim, Jeffrey J; Dubin, Anne M

    2016-06-01

    This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes. Study design We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded. A total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis. Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.

  1. Blunt and Penetrating Cardiac Trauma.

    Science.gov (United States)

    Bellister, Seth A; Dennis, Bradley M; Guillamondegui, Oscar D

    2017-10-01

    Patients with traumatic cardiac injuries can present with wide variability in their severity of illness. The most severe will present in cardiac arrest, whereas the most benign may be altogether asymptomatic; most will fall somewhere in between. Management of cardiac injuries largely depends on mechanism of injury and patient physiology. Understanding the spectrum of injuries and their associated manifestations can help providers react more quickly and initiate potentially life-saving therapies more efficiently when time is critical. This article discusses the workup and management of both blunt and penetrating cardiac injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. CDTI target selection criteria

    Science.gov (United States)

    Britt, C. L.; Davis, C. M.; Jackson, C. B.; Mcclellan, V. A.

    1984-01-01

    A Cockpit Display of Traffic Information (CDTI) is a cockpit instrument which provides information to the aircrew on the relative location of aircraft traffic in the vicinity of their aircraft (township). In addition, the CDTI may provide information to assist in navigation and in aircraft control. It is usually anticipated that the CDTI will be integrated with a horizontal situation indicator used for navigational purposes and/or with a weather radar display. In this study, several sets of aircraft traffic data are analyzed to determine statistics on the number of targets that will be displayed on a CDTI using various target selection criteria. Traffic data were obtained from an Atlanta Terminal Area Simulation and from radar tapes recorded at the Atlanta and Miami terminal areas. Results are given in the form of plots showing the average percentage of time (or probability) that an aircraft equipped with a CDTI would observe from 0 to 10 other aircraft on the display for range settings on the CDTI up to 30 n. mi. and using various target discrimination techniques.

  3. ACR appropriateness criteria jaundice.

    Science.gov (United States)

    Lalani, Tasneem; Couto, Corey A; Rosen, Max P; Baker, Mark E; Blake, Michael A; Cash, Brooks D; Fidler, Jeff L; Greene, Frederick L; Hindman, Nicole M; Katz, Douglas S; Kaur, Harmeet; Miller, Frank H; Qayyum, Aliya; Small, William C; Sudakoff, Gary S; Yaghmai, Vahid; Yarmish, Gail M; Yee, Judy

    2013-06-01

    A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. When mechanical obstruction is absent, additional imaging can evaluate liver parenchyma for fat and iron deposition and help direct biopsy in cases where underlying parenchymal disease or mass is found. Imaging techniques are reviewed for the following clinical scenarios: (1) the patient with painful jaundice, (2) the patient with painless jaundice, and (3) the patient with a nonmechanical cause for jaundice. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  4. Criteria of site assessment

    International Nuclear Information System (INIS)

    Gibbs, P.; Fuchs, H.

    1975-01-01

    The criteria which lead to the choice of a particular site for a nuclear power station are in general very similar to those which would apply to any other type of power station. The principal differences derive from the simpler transport problems for the fuel compared with, say, solid fuel and the special safety considerations which attach to nuclear reactors. The search for a suitable site obviously starts by considering where the power is needed, i.e. where the load centers are and also the existing transmission network which may help to bring the power from a more remote site to the load centers. This economic incentive to put the plant close to loads conflicts directly with the nuclear safety argument which favours more remote siting, and part of the problem of site selection is to reconcile these two matters. In addition, there are many other important matters which will be considered later concerning the adequacy of cooling water supplies, foundation conditions, etc., all of which must be examined in considerable detail. (orig./TK) [de

  5. FHR Generic Design Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Flanagan, G.F.; Holcomb, D.E.; Cetiner, S.M.

    2012-06-15

    The purpose of this document is to provide an initial, focused reference to the safety characteristics of and a licensing approach for Fluoride-Salt-Cooled High-Temperature Reactors (FHRs). The document does not contain details of particular reactor designs nor does it attempt to identify or classify either design basis or beyond design basis accidents. Further, this document is an initial attempt by a small set of subject matter experts to document the safety and licensing characteristics of FHRs for a larger audience. The document is intended to help in setting the safety and licensing research, development, and demonstration path forward. Input from a wider audience, further technical developments, and additional study will be required to develop a consensus position on the safety and licensing characteristics of FHRs. This document begins with a brief overview of the attributes of FHRs and then a general description of their anticipated safety performance. Following this, an overview of the US nuclear power plant approval process is provided that includes both test and power reactors, as well as the role of safety standards in the approval process. The document next describes a General Design Criteria (GDC)–based approach to licensing an FHR and provides an initial draft set of FHR GDCs. The document concludes with a description of a path forward toward developing an FHR safety standard that can support both a test and power reactor licensing process.

  6. FHR Generic Design Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Flanagan, George F [ORNL; Holcomb, David Eugene [ORNL; Cetiner, Sacit M [ORNL

    2012-06-01

    The purpose of this document is to provide an initial, focused reference to the safety characteristics of and a licensing approach for Fluoride-Salt-Cooled High-Temperature Reactors (FHRs). The document does not contain details of particular reactor designs nor does it attempt to identify or classify either design basis or beyond design basis accidents. Further, this document is an initial attempt by a small set of subject matter experts to document the safety and licensing characteristics of FHRs for a larger audience. The document is intended to help in setting the safety and licensing research, development, and demonstration path forward. Input from a wider audience, further technical developments, and additional study will be required to develop a consensus position on the safety and licensing characteristics of FHRs. This document begins with a brief overview of the attributes of FHRs and then a general description of their anticipated safety performance. Following this, an overview of the US nuclear power plant approval process is provided that includes both test and power reactors, as well as the role of safety standards in the approval process. The document next describes a General Design Criteria (GDC) - based approach to licensing an FHR and provides an initial draft set of FHR GDCs. The document concludes with a description of a path forward toward developing an FHR safety standard that can support both a test and power reactor licensing process.

  7. Criteria for performance evaluation

    Directory of Open Access Journals (Sweden)

    David J. Weiss

    2009-03-01

    Full Text Available Using a cognitive task (mental calculation and a perceptual-motor task (stylized golf putting, we examined differential proficiency using the CWS index and several other quantitative measures of performance. The CWS index (Weiss and Shanteau, 2003 is a coherence criterion that looks only at internal properties of the data without incorporating an external standard. In Experiment 1, college students (n = 20 carried out 2- and 3-digit addition and multiplication problems under time pressure. In Experiment 2, experienced golfers (n = 12, also college students, putted toward a target from nine different locations. Within each experiment, we analyzed the same responses using different methods. For the arithmetic tasks, accuracy information (mean absolute deviation from the correct answer, MAD using a coherence criterion was available; for golf, accuracy information using a correspondence criterion (mean deviation from the target, also MAD was available. We ranked the performances of the participants according to each measure, then compared the orders using Spearman's rextsubscript{s}. For mental calculation, the CWS order correlated moderately (rextsubscript{s} =.46 with that of MAD. However, a different coherence criterion, degree of model fit, did not correlate with either CWS or accuracy. For putting, the ranking generated by CWS correlated .68 with that generated by MAD. Consensual answers were also available for both experiments, and the rankings they generated correlated highly with those of MAD. The coherence vs. correspondence distinction did not map well onto criteria for performance evaluation.

  8. Student Responses to Criteria-Referenced Self-Assessment

    Science.gov (United States)

    Andrade, Heidi; Du, Ying

    2007-01-01

    This paper reports on a study of undergraduate students' experiences with criteria-referenced self-assessment. Fourteen students who had taken a course involving self-assessment were interviewed in focus groups segregated by gender. The findings suggest that students had positive attitudes toward self-assessment after extended practice; felt they…

  9. Antifibrinolytics in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Achal Dhir

    2013-01-01

    Full Text Available Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA or epsilon amino caproic acid (EACA. While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances.

  10. Exercise-related cardiac arrest in cardiac rehabilitation - The ...

    African Journals Online (AJOL)

    Prescribed physical activity plays a major role in the rehabilitation of patients with coronary artery disease, and as with any other form of treatment its benefits must be weighed against its possible risks. This study attempted to establish the safety of cardiac rehabilitation as a medical intervention at the Johannesburg Cardiac ...

  11. Hypertension and cardiac arrhythmias

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Coca, Antonio; Kahan, Thomas

    2017-01-01

    Hypertension (HTN) is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease (CAD), stroke, peripheral artery disease and chronic renal failure. Hypertensive heart disease can manifest as many types of cardiac arrhythmias, most commonly being atrial fibrillation......) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit of comprehensively reviewing the available evidence...

  12. CSI cardiac prevent 2015

    Directory of Open Access Journals (Sweden)

    S Ramakrishnan

    2015-01-01

    Full Text Available The CSI Cardiac Prevent 2015 was held at Hotel Taj Palace, New Delhi, on September 25-27, 2015. The major challenge was to create interest among cardiologists and physicians on preventive cardiology, a neglected area. The theme of the conference was "Innovations in Heart Disease Prevention.′′ This conference included "CSI at WHF Roadmap Workshop, Inauguration Ceremony, scientific program, plenary sessions, Nursing/Dietician track, Industry Exhibition, Social Events," Great India blood pressure Survey, and CSI Smart Heart App. A total of 848 delegates/faculties attended this conference against a total of 1140 people registered for the meeting.

  13. Single ventricle cardiac defect

    International Nuclear Information System (INIS)

    Eren, B.; Turkmen, N.; Fedakar, R.; Cetin, V.

    2010-01-01

    Single ventricle heart is defined as a rare cardiac abnormality with a single ventricle chamber involving diverse functional and physiological defects. Our case is of a ten month-old baby boy who died shortly after admission to the hospital due to vomiting and diarrhoea. Autopsy findings revealed cyanosis of finger nails and ears. Internal examination revealed; large heart, weighing 60 grams, single ventricle, without a septum and upper membranous part. Single ventricle is a rare pathology, hence, this paper aims to discuss this case from a medico-legal point of view. (author)

  14. Validation of an automatic diagnosis of strict left bundle branch block criteria using 12-lead electrocardiograms

    DEFF Research Database (Denmark)

    Xia, Xiaojuan; Ruwald, Anne-Christine; Ruwald, Martin H

    2017-01-01

    AIMS: Strict left bundle branch block (LBBB) criteria were recently proposed to identify LBBB patients to benefit most from cardiac resynchronization therapy (CRT). The aim of our study was to automate identification of strict LBBB in order to facilitate its broader application. METHODS: We devel...

  15. Measure of synchrony in the activity of intrinsic cardiac neurons

    International Nuclear Information System (INIS)

    Longpré, Jean-Philippe; Salavatian, Siamak; Jacquemet, Vincent; Beaumont, Eric; Armour, J Andrew; Ardell, Jeffrey L

    2014-01-01

    Recent multielectrode array recordings in ganglionated plexi of canine atria have opened the way to the study of population dynamics of intrinsic cardiac neurons. These data provide critical insights into the role of local processing that these ganglia play in the regulation of cardiac function. Low firing rates, marked non-stationarity, interplay with the cardiovascular and pulmonary systems and artifacts generated by myocardial activity create new constraints not present in brain recordings for which almost all neuronal analysis techniques have been developed. We adapted and extended the jitter-based synchrony index (SI) to (1) provide a robust and computationally efficient tool for assessing the level and statistical significance of SI between cardiac neurons, (2) estimate the bias on SI resulting from neuronal activity possibly hidden in myocardial artifacts, (3) quantify the synchrony or anti-synchrony between neuronal activity and the phase in the cardiac and respiratory cycles. The method was validated on firing time series from a total of 98 individual neurons identified in 8 dog experiments. SI ranged from −0.14 to 0.66, with 23 pairs of neurons with SI > 0.1. The estimated bias due to artifacts was typically <1%. Strongly cardiovascular- and pulmonary-related neurons (SI > 0.5) were found. Results support the use of jitter-based SI in the context of intrinsic cardiac neurons. (paper)

  16. Azelnidipine protects myocardium in hyperglycemia-induced cardiac damage

    Directory of Open Access Journals (Sweden)

    Puranik Amrutesh S

    2010-12-01

    Full Text Available Abstract Background Azelnidipine (AZL, a long-acting dihydropyridine-based calcium antagonist, has been recently approved and used for treating ischemic heart disease and cardiac remodeling after myocardial infarction, however, its effect on hyperglycemia-induced cardiac damage has not been studied. Methods This study examined the effect of AZL on circulating markers of cardiac damage, altered lipid and cytokines profile and markers of oxidative stress including homocysteine in diabetic rats. Results STZ induced diabetes caused a significant increase in blood glucose levels. It also resulted in an increase in the levels of homocysteine and cardiac damage markers, like Troponin-1, CK-MB, CK-NAC, uric acid, LDH and alkaline phosphatase. Moreover, there was an increase in the levels of proinflammatory cytokines like TNF-α, IFN-γ, and TGF-β and decrease in the levels of IL-4 and IL-10. Additionally, there was increase in the levels of cholesterol, triglycerides, LDL, VLDL and a decrease in HDL in these animals. There was an altered antioxidant enzyme profile which resulted in a notable increase in the levels of oxidative stress markers like lipid peroxides, nitric oxide and carbonylated proteins. Compared with the untreated diabetic rats, AZL treatment significantly reduced the levels of troponin-1 (P Conclusion Our results indicate that AZL treatment can reduce the risk of hyperglycemia induced metabolic disorders and its role can be further extended to explore its therapeutic potential in diabetic patients with cardiac complications.

  17. Multi-Criteria Recommender Systems

    Science.gov (United States)

    Adomavicius, Gediminas; Manouselis, Nikos; Kwon, Youngok

    This chapter aims to provide an overview of the class of multi-criteria recommender systems. First, it defines the recommendation problem as a multicriteria decision making (MCDM) problem, and reviews MCDM methods and techniques that can support the implementation of multi-criteria recommenders. Then, it focuses on the category of multi-criteria rating recommenders - techniques that provide recommendations by modelling a user's utility for an item as a vector of ratings along several criteria. A review of current algorithms that use multi-criteria ratings for calculating predictions and generating recommendations is provided. Finally, the chapter concludes with a discussion on open issues and future challenges for the class of multi-criteria rating recommenders.

  18. Cardiac sarcoplasmic reticulum

    International Nuclear Information System (INIS)

    Jacobson, M.S.; Ambudkar, I.S.; Young, E.P.; Naseem, S.M.; Heald, F.P.; Shamoo, A.E.

    1985-01-01

    The effect on the cardiac sarcoplasmic reticulum of an atherogenic (1% cholesterol) diet fed during the neonatal vs the juvenile period of life was studied in Yorkshire swine. Male piglets were randomly assigned at birth to 1 of 4 groups: group I (control), group II (lactation feeding), group III (juvenile period feeding) and group IV (lactation and juvenile feeding). All animals were killed at 55 weeks of age and cardiac sarcoplasmic reticulum (SR) isolated for assay of calcium uptake, Ca 2+ -Mg 2+ ATPase activity, and lipid analysis by thin-layer chromatography and gas chromatography. The amount of cholesterol/mg SR protein and the cholesterol/phospholipid ratio were higher in the animals fed during lactation (groups II and IV) and lower in those fed only during the juvenile period (group III). Phospholipid fatty acid patterns as measured by gas chromatography were unaltered in any group. Calcium uptake was markedly diminished in all experimental conditions: group II 47%, group III 65% and group IV 96%. Compared to the observed changes in calcium transport, the ATP hydrolytic activity was relatively less affected. Only in group IV a significant decrease (41%) was seen. Groups II and III show no change in ATP hydrolytic activity. The decrease in calcium uptake and altered cholesterol/phospholipid ratio without effect on ATP hydrolytic activity is consistent with an uncoupling of calcium transport related to the atherogenic diet in early life. (author)

  19. Health Instruction Packages: Cardiac Anatomy.

    Science.gov (United States)

    Phillips, Gwen; And Others

    Text, illustrations, and exercises are utilized in these five learning modules to instruct nurses, students, and other health care professionals in cardiac anatomy and functions and in fundamental electrocardiographic techniques. The first module, "Cardiac Anatomy and Physiology: A Review" by Gwen Phillips, teaches the learner to draw…

  20. Pediatric Cardiac Surgery In Eritrea.

    African Journals Online (AJOL)

    The teams consisted of volunteer physicians from Germany, Italy and Switzerland including cardiac surgeons, pediatric cardiologists, cardiac anesthesiologists, pediatric intensivists, perfusionists, and other nursing staff. Each mission has routinely included at least 18 health professionals of different category to maximize the.

  1. Diagnostic value of cardiac cineangiography

    International Nuclear Information System (INIS)

    Han, Man Chung; Yeon, Kyung Mo; Im, Chung Gie; Yoo, Shi Joon

    1979-01-01

    Cineangiography is essential and excellent tool for evaluation of anatomy and pathophysiology of heart disease. 114 cases of cardiac cineangiography were analyzed. The following conditions are easily interpreted and diagnosed accurately by cineangiography. 1. Valvular insufficiency, especially small amount. 2. Valve motion, shape analysis. 3. Detection of shunt. 4. Ventricle wall movement. 5. Complexed congenita cardiac anomaly. 6. Coronary artery stenosis.

  2. The Danish Cardiac Rehabilitation Database

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne

    2016-01-01

    AIM OF DATABASE: The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). STUDY POPULATION: Hospitalized patients with CHD with stenosis on coronary angiography treated with percutane...

  3. Neuromuscular diseases after cardiac transplantation

    NARCIS (Netherlands)

    Mateen, Farrah J.; van de Beek, Diederik; Kremers, Walter K.; Daly, Richard C.; Edwards, Brooks S.; McGregor, Christopher G. A.; Wijdicks, Eelco F. M.

    2009-01-01

    BACKGROUND: Cardiac transplantation is a therapeutic option in end-stage heart failure. Peripheral nervous system (PNS) disease is known to occur in cardiac transplant recipients but has not been fully characterized. METHODS: This retrospective cohort review reports the PNS-related concerns of 313

  4. Cardiac arrest – cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Basri Lenjani

    2014-01-01

    Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

  5. Effects of Caloric Restriction on Cardiac Oxidative Stress and Mitochondrial Bioenergetics: Potential Role of Cardiac Sirtuins

    Directory of Open Access Journals (Sweden)

    Ken Shinmura

    2013-01-01

    Full Text Available The biology of aging has not been fully clarified, but the free radical theory of aging is one of the strongest aging theories proposed to date. The free radical theory has been expanded to the oxidative stress theory, in which mitochondria play a central role in the development of the aging process because of their critical roles in bioenergetics, oxidant production, and regulation of cell death. A decline in cardiac mitochondrial function associated with the accumulation of oxidative damage might be responsible, at least in part, for the decline in cardiac performance with age. In contrast, lifelong caloric restriction can attenuate functional decline with age, delay the onset of morbidity, and extend lifespan in various species. The effect of caloric restriction appears to be related to a reduction in cellular damage induced by reactive oxygen species. There is increasing evidence that sirtuins play an essential role in the reduction of mitochondrial oxidative stress during caloric restriction. We speculate that cardiac sirtuins attenuate the accumulation of oxidative damage associated with age by modifying specific mitochondrial proteins posttranscriptionally. Therefore, the distinct role of each sirtuin in the heart subjected to caloric restriction should be clarified to translate sirtuin biology into clinical practice.

  6. Fibromyalgia diagnosis and diagnostic criteria.

    Science.gov (United States)

    Wolfe, Frederick; Häuser, Winfried

    2011-11-01

    Abstract Criteria for fibromyalgia developed from the conceptualization and hypotheses of Smythe and Moldofsky in 1977 and gradually evolved to a set of classification criteria endorsed by the American College of Rheumatology that emphasized tender points and widespread pain, measures of decreased pain threshold. In 2010, American College of Rheumatology fibromyalgia diagnostic criteria were published that abandoned the tender point count and placed increased emphasis of patient symptoms. The 2010 criteria also contained severity scales and offered physicians the opportunity to assess polysymptomatic distress on a continuous scale. This enabled physicians who were opposed to the idea of fibromyalgia to also assess and diagnose patients using an alternative nomenclature.

  7. Irreducibility conditions for extended superfields

    International Nuclear Information System (INIS)

    Sokatchev, E.

    1981-05-01

    The irreducible supermultiplets contained in an extended superfield are presented as sets of covariant derivatives of the superfield. Differential irreducibility constraints are easily obtained from this decomposition. (author)

  8. Combining the IADPSG criteria with the WHO diagnostic criteria for ...

    African Journals Online (AJOL)

    Five pregnancy outcomes were observed, namely, pre‑eclampsia, shoulder dystocia or birth injury, birth weight ≥4.0 kg, clinical neonatal hypoglycaemia and birth asphyxia. Results: Twenty‑eight participants (21.5%) had GDM by the IADPSG criteria (GDMIADPSG) and 21 (16.2%) women had GDM by the WHO criteria ...

  9. Cardiac changes in anorexia nervosa.

    Science.gov (United States)

    Spaulding-Barclay, Michael A; Stern, Jessica; Mehler, Philip S

    2016-04-01

    Introduction Anorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterise this illness. It has the highest mortality rate of any psychiatric disorder. A large portion of deaths are attributable to the cardiac abnormalities that ensue as a result of the malnutrition associated with anorexia nervosa. In this review, the cardiac complications of anorexia nervosa will be discussed. A comprehensive literature review on cardiac changes in anorexia nervosa was carried out. There are structural, functional, and rhythm-type changes that occur in patients with anorexia nervosa. These become progressively significant as ongoing weight loss occurs. Cardiac changes are inherent to anorexia nervosa and they become more life-threatening and serious as the anorexia nervosa becomes increasingly severe. Weight restoration and attention to these cardiac changes are crucial for a successful treatment outcome.

  10. [Maternal cardiac arrhythmias in pregnancy].

    Science.gov (United States)

    Swiatkowska-Freund, Małgorzata; Ciach, Katarzyna; Kowalewska-Włas, Agnieszka; Preis, Krzysztof

    2005-12-01

    Perinatal care of women with cardiac arrhythmias is very important for every obstetrician. Maternal heart disease complicates 0.2 to 4% of pregnancies. The purpose of this study was to analyze the course of pregnancy, delivery and postpartum period pregnant women with cardiac arrhythmias We analyzed 14 pregnant women with cardiac arrhythmias. hospitalized in the Department of Obstetrics of Medical University of Gdańsk, 1998-2003. Time of delivery, weight and length of neonates in patients with cardiac arrhythmias was presented. Delivery and postpartum period were uncomplicated in all the patients and no stimulation was used. In two women with congenital complete atrio-ventricular block dicavital heart stimulator was applied. All patients and infants were discharged from hospital in good condition. We found no cardiological complications during pregnancy in patients with cardiac arrhythmias.

  11. Cardiac asystole in partial seizures.

    Science.gov (United States)

    Scott, C A; Fish, D R

    2000-06-01

    Literature review shows many anecdotal case reports of cardiac asystole in ictal recordings of partial seizures. We have reviewed our data from the last five years, of patients who are being assessed for epilepsy surgery and found 2 out of more than 1,500 complex partial seizures, recorded in 589 consecutive patients, showing a significant period of asystole (13 and 15 seconds). Our previous studies of cardiac and respiratory parameters during partial seizures showed that a central apnoea occurred in 39%. It is probable that sudden death during seizures is due to the interaction of both cardiac and respiratory irregularities. Although rare (occurrence cardiac asystole occurring in an epilepsy monitoring unit highlights the need for resuscitation equipment to be readily available and for trained nursing staff. Furthermore, it is important to recognize that the semiology of seizures may be affected by the consequences of secondary cardiac asystole.

  12. Cardiac resynchronization therapy or atrio-biventricular pacing-what should it be called?

    Science.gov (United States)

    Cleland, John G F; Nasir, Mansour; Tageldien, Ahmed

    2007-02-01

    Reduced cardiac efficiency caused by suboptimal synchronization of the heart's normal contraction might contribute to the development of or exacerbate heart failure. Conceptually and in practice cardiac dyssynchrony is complex. Recent studies have shown that atrio-biventricular pacing can improve cardiac synchrony in many patients and improve cardiac function, symptoms and exercise capacity, and reduce morbidity and mortality substantially. Randomized controlled trials, however, indicate that the severity of cardiac dyssynchrony, as conventionally measured, is a poor guide to treatment benefit and that correction of dyssynchrony accounts for only part of the benefit of atrio-biventricular pacing. Although some of the benefits of atrio-biventricular pacing might be mediated by cardiac resynchronization, much of the benefit could be mediated by mechanisms that are as yet unknown. Withholding atrio-biventricular pacing in patients who do not exhibit cardiac dyssynchrony on imaging but otherwise fulfil the entry criteria used in randomized controlled trials of this therapy could be unwise. Here, we examine the evidence that cardiac resynchronization is indeed the mechanism by which atrio-biventricular pacing exerts its effects.

  13. The Metabolic Syndrome and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study.

    Science.gov (United States)

    Hess, Paul L; Al-Khalidi, Hussein R; Friedman, Daniel J; Mulder, Hillary; Kucharska-Newton, Anna; Rosamond, Wayne R; Lopes, Renato D; Gersh, Bernard J; Mark, Daniel B; Curtis, Lesley H; Post, Wendy S; Prineas, Ronald J; Sotoodehnia, Nona; Al-Khatib, Sana M

    2017-08-23

    Prior studies have demonstrated a link between the metabolic syndrome and increased risk of cardiovascular mortality. Whether the metabolic syndrome is associated with sudden cardiac death is uncertain. We characterized the relationship between sudden cardiac death and metabolic syndrome status among participants of the ARIC (Atherosclerosis Risk in Communities) Study (1987-2012) free of prevalent coronary heart disease or heart failure. Among 13 168 participants, 357 (2.7%) sudden cardiac deaths occurred during a median follow-up of 23.6 years. Participants with the metabolic syndrome (n=4444) had a higher cumulative incidence of sudden cardiac death than those without it (n=8724) (4.1% versus 2.3%, P metabolic syndrome, the metabolic syndrome was independently associated with sudden cardiac death (hazard ratio, 1.70, 95% confidence interval, 1.37-2.12, P metabolic syndrome criteria components. The risk of sudden cardiac death varied according to the number of metabolic syndrome components (hazard ratio 1.31 per additional component of the metabolic syndrome, 95% confidence interval, 1.19-1.44, P metabolic syndrome was associated with a significantly increased risk of sudden cardiac death irrespective of sex or race. The risk of sudden cardiac death was proportional to the number of metabolic syndrome components. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  14. UO3 deactivation end point criteria

    Energy Technology Data Exchange (ETDEWEB)

    Stefanski, L.D.

    1994-10-01

    The UO{sub 3} Deactivation End Point Criteria are necessary to facilitate the transfer of the UO{sub 3} Facility from the Office of Facility Transition and Management (EM-60) to the office of Environmental Restoration (EM-40). The criteria were derived from a logical process for determining end points for the systems and spaces at the UO{sub 3}, Facility based on the objectives, tasks, and expected future uses pertinent to that system or space. Furthermore, the established criteria meets the intent and supports the draft guidance for acceptance criteria prepared by EM-40, {open_quotes}U.S. Department of Energy office of Environmental Restoration (EM-40) Decontamination and Decommissioning Guidance Document (Draft).{close_quotes} For the UO{sub 3} Facility, the overall objective of deactivation is to achieve a safe, stable and environmentally sound condition, suitable for an extended period, as quickly and economically as possible. Once deactivated, the facility is kept in its stable condition by means of a methodical surveillance and maintenance (S&M) program, pending ultimate decontamination and decommissioning (D&D). Deactivation work involves a range of tasks, such as removal of hazardous material, elimination or shielding of radiation fields, partial decontamination to permit access for inspection, installation of monitors and alarms, etc. it is important that the end point of each of these tasks be established clearly and in advance, for the following reasons: (1) End points must be such that the central element of the deactivation objective - to achieve stability - is unquestionably achieved. (2) Much of the deactivation work involves worker exposure to radiation or dangerous materials. This can be minimized by avoiding unnecessary work. (3) Each task is, in effect, competing for resources with other deactivation tasks and other facilities. By assuring that each task is appropriately bounded, DOE`s overall resources can be used most fully and effectively.

  15. UO3 deactivation end point criteria

    International Nuclear Information System (INIS)

    Stefanski, L.D.

    1994-01-01

    The UO 3 Deactivation End Point Criteria are necessary to facilitate the transfer of the UO 3 Facility from the Office of Facility Transition and Management (EM-60) to the office of Environmental Restoration (EM-40). The criteria were derived from a logical process for determining end points for the systems and spaces at the UO 3 , Facility based on the objectives, tasks, and expected future uses pertinent to that system or space. Furthermore, the established criteria meets the intent and supports the draft guidance for acceptance criteria prepared by EM-40, open-quotes U.S. Department of Energy office of Environmental Restoration (EM-40) Decontamination and Decommissioning Guidance Document (Draft).close quotes For the UO 3 Facility, the overall objective of deactivation is to achieve a safe, stable and environmentally sound condition, suitable for an extended period, as quickly and economically as possible. Once deactivated, the facility is kept in its stable condition by means of a methodical surveillance and maintenance (S ampersand M) program, pending ultimate decontamination and decommissioning (D ampersand D). Deactivation work involves a range of tasks, such as removal of hazardous material, elimination or shielding of radiation fields, partial decontamination to permit access for inspection, installation of monitors and alarms, etc. it is important that the end point of each of these tasks be established clearly and in advance, for the following reasons: (1) End points must be such that the central element of the deactivation objective - to achieve stability - is unquestionably achieved. (2) Much of the deactivation work involves worker exposure to radiation or dangerous materials. This can be minimized by avoiding unnecessary work. (3) Each task is, in effect, competing for resources with other deactivation tasks and other facilities. By assuring that each task is appropriately bounded, DOE's overall resources can be used most fully and effectively

  16. On core stability and extendability

    OpenAIRE

    Shellshear, Evan

    2007-01-01

    This paper investigates conditions under which the core of a TU cooperative game is stable. In particular the author extends the idea of extendability to find new conditions under which the core is stable. It is also shown that these new conditions are not necessary for core stability.

  17. Extending cosmology: the metric approach

    OpenAIRE

    Mendoza, S.

    2012-01-01

    Comment: 2012, Extending Cosmology: The Metric Approach, Open Questions in Cosmology; Review article for an Intech "Open questions in cosmology" book chapter (19 pages, 3 figures). Available from: http://www.intechopen.com/books/open-questions-in-cosmology/extending-cosmology-the-metric-approach

  18. Principles and Criteria for Design

    DEFF Research Database (Denmark)

    Beghin, D.; Cervetto, D.; Hansen, Peter Friis

    1997-01-01

    The mandate of ISSC Committee IV.1 on principles and Criteria for Design is to report on the following:The ongoing concern for quantification of general economic and safety criteria for marine structures and for the development of appropriate principles for rational life cycle design using...

  19. AFRICAN PERSONALITY ASSESSMENT CRITERIA: YORUBA ...

    African Journals Online (AJOL)

    This analysis presents personality assessment criteria often used by the Yoruba as psychological tools to position an individual on the social responsibility scale and also to determine the norm compliant level of the Yoruba person. The study focused on four core criteria upon which such assessment is anchored, namely, ...

  20. Criteria for controlled atmosphere chambers

    International Nuclear Information System (INIS)

    Robinson, J.N.

    1980-03-01

    The criteria for design, construction, and operation of controlled atmosphere chambers intended for service at ORNL are presented. Classification of chambers, materials for construction, design criteria, design, controlled atmosphere chamber systems, and operating procedures are presented. ORNL Safety Manual Procedure 2.1; ORNL Health Physics Procedure Manual Appendix A-7; and Design of Viewing Windows are included in 3 appendices

  1. Mathematics Teachers' Criteria of Dimension

    Science.gov (United States)

    Ural, Alattin

    2014-01-01

    The aim of the study is to determine mathematics teachers' decisions about dimensions of the geometric figures, criteria of dimension and consistency of decision-criteria. The research is a qualitative research and the model applied in the study is descriptive method on the basis of general scanning model. 15 mathematics teachers attended the…

  2. Diagnostic criteria for vascular dementia

    NARCIS (Netherlands)

    Scheltens, P.; Hijdra, A. H.

    1998-01-01

    The term vascular dementia implies the presence of a clinical syndrome (dementia) caused by, or at least assumed to be caused by, a specific disorder (cerebrovascular disease). In this review, the various sets of criteria used to define vascular dementia are outlined. The various sets of criteria

  3. MHD-ETF design criteria

    Energy Technology Data Exchange (ETDEWEB)

    Retallick, F.D.

    1978-04-01

    This document establishes criteria to be utilized for the design of a pilot-scale (150 to 300 MW thermal) open cycle, coal-fired MHD/steam plant. Criteria for this Engineering Test Facility (ETF) are presented relative to plant siting, plant engineering and operations, MHD-ETF testing, costing and scheduling.

  4. New criteria to identify spectrum

    DEFF Research Database (Denmark)

    Jensen, Arne; Krishna, M.

    In this paper we give some new criteria for identifying the components of a probability measure, in its Lebesgue decomposition. This enables us to give new criteria to identify spectral types of self adjoint operators on Hilbert spaces, especially those of interest....

  5. New criteria to identify spectrum

    DEFF Research Database (Denmark)

    Jensen, Arne; Krishna, M.

    2005-01-01

    In this paper we give some new criteria for identifying the components of a probability measure, in its Lebesgue decomposition. This enables us to give new criteria to identify spectral types of self-adjoint operators on Hilbert spaces, especially those of interest....

  6. Cardiac potassium channel subtypes

    DEFF Research Database (Denmark)

    Schmitt, Nicole; Grunnet, Morten; Olesen, Søren-Peter

    2014-01-01

    . The underlying posttranscriptional and posttranslational remodeling of the individual K(+) channels changes their activity and significance relative to each other, and they must be viewed together to understand their role in keeping a stable heart rhythm, also under menacing conditions like attacks of reentry......About 10 distinct potassium channels in the heart are involved in shaping the action potential. Some of the K(+) channels are primarily responsible for early repolarization, whereas others drive late repolarization and still others are open throughout the cardiac cycle. Three main K(+) channels...... that they could constitute targets for new pharmacological treatment of atrial fibrillation. The interplay between the different K(+) channel subtypes in both atria and ventricle is dynamic, and a significant up- and downregulation occurs in disease states such as atrial fibrillation or heart failure...

  7. Cardiac Rehabilitation Series: Canada

    Science.gov (United States)

    Grace, Sherry L.; Bennett, Stephanie; Ardern, Chris I.; Clark, Alexander

    2015-01-01

    Cardiovascular disease is among the leading causes of mortality and morbidity in Canada. Cardiac rehabilitation (CR) has a long robust history here, and there are established clinical practice guidelines. While the effectiveness of CR in the Canadian context is clear, only 34% of eligible patients participate, and strategies to increase access for under-represented groups (e.g., women, ethnic minority groups) are not yet universally applied. Identified CR barriers include lack of referral and physician recommendation, travel and distance, and low perceived need. Indeed there is now a national policy position recommending systematic inpatient referral to CR in Canada. Recent development of 30 CR Quality Indicators and the burgeoning national CR registry will enable further measurement and improvement of the quality of CR care in Canada. Finally, the Canadian Association of CR is one of the founding members of the International Council of Cardiovascular Prevention and Rehabilitation, to promote CR globally. PMID:24607018

  8. Hypertension and cardiac arrhythmias

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Coca, Antonio; Kahan, Thomas

    2017-01-01

    Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both...... supraventricular and ventricular arrhythmias may occur in hypertensive patients, especially in those with left ventricular hypertrophy (LVH) or HF. Also, some of the antihypertensive drugs commonly used to reduce blood pressure, such as thiazide diuretics, may result in electrolyte abnormalities (e.g. hypokalaemia......, hypomagnesemia), further contributing to arrhythmias, whereas effective control of blood pressure may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between hypertension and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society...

  9. Extended Active Disturbance Rejection Controller

    Science.gov (United States)

    Gao, Zhiqiang (Inventor); Tian, Gang (Inventor)

    2016-01-01

    Multiple designs, systems, methods and processes for controlling a system or plant using an extended active disturbance rejection control (ADRC) based controller are presented. The extended ADRC controller accepts sensor information from the plant. The sensor information is used in conjunction with an extended state observer in combination with a predictor that estimates and predicts the current state of the plant and a co-joined estimate of the system disturbances and system dynamics. The extended state observer estimates and predictions are used in conjunction with a control law that generates an input to the system based in part on the extended state observer estimates and predictions as well as a desired trajectory for the plant to follow.

  10. 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

  11. [Diagnostic criteria in acute neuromyelitis].

    Science.gov (United States)

    Panea, Cristina; Petrescu, Simona; Monica, Pop; Voinea, Liliana; Dascălu, Ana-Maria; Nicolae, Miruna; Ungureanu, E; Panca, Aida; Grădinaru, Sânziana

    2007-01-01

    Neuromyelitis optica, also known as Devic disease, was identified in the 19th century, is one of the inflammatory idiopathic demyelinating diseases of the central nervous system, often mistaken for severe multiple sclerosis. In 1999 it had been proposed diagnostic criteria for neuromyelitis optica, but in 2006 these criteria were revised by Dean Wingerchuck. These criteria are 99% sensitive and 90% specific for differentiating neuromyelitis optica from multiple sclerosis that present with optic neuritis or a myelitis syndrome. In the following article we present clinical, spinal and cerebral MR imaging, serological and aspects of cerebrospinal fluid examination features of neuromyelitis optica and the revised criteria of neuromyelitis optica established in 2006. The recently identified serum antibody biomarker: neuromyelitis optica immunoglobulin G (NMO Ig G), which target aquaporin 4 water channel, distinguish neuromyelitis optica from multiple sclerosis, is one of the revised criteria of neuromyelitis optica.

  12. User perspectives on relevance criteria

    DEFF Research Database (Denmark)

    Maglaughlin, Kelly L.; Sonnenwald, Diane H.

    2002-01-01

    , partially relevant, or not relevant to their information need; and explained their decisions in an interview. Analysis revealed 29 criteria, discussed positively and negatively, that were used by the participants when selecting passages that contributed or detracted from a document's relevance...... implications for relevance feedback in information retrieval systems, suggesting that systems accept and utilize multiple positive and negative relevance criteria from users. Systems designers may want to focus on supporting content criteria followed by full text criteria as these may provide the greatest cost....... These criteria can be grouped into six categories: abstract (e.g., citability, informativeness), author (e.g., novelty, discipline, affiliation, perceived status), content (e.g., accuracy/validity, background, novelty, contrast, depth/scope, domain, citations, links, relevant to other interests, rarity, subject...

  13. Failure Criteria for Reinforced Materials

    DEFF Research Database (Denmark)

    Rathkjen, Arne

    Failure of materials is often characterized as ductile yielding, brittle fracture, creep rupture, etc., and different criteria given in terms of different parameters have been used to describe different types of failure. Only criteria expressing failure in terms of stress are considered in what...... follows. The reinforcement here consists of long bars or fibres and complete bond between matrix and reinforcement is assumed so that no problems arising from incomplete transfer of adhesive and frictional forces are discussed. During loading, the reinforcement may yield, but total failure does not take...... certain restrictions on the form of the failure criteria for anisotropic materials. In section 2, some failure criteria for homogenous materials are reviewed. Both isotropic and anisotropic materials are described, and in particular the constraints imposed on the criteria from the symmetries orthotropy...

  14. Mediastinitis after cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Noedir A. G. Stolf

    2000-05-01

    Full Text Available OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6% of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years and 10 (83.3% patients were males. Seven (58.3% patients showed sternal stability on palpation, 4 (33.3% patients had pleural empyema, and 2 (16.7% patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7% patients. Staphylococcus epidermidis was identified in 2 (16.7% patients, Enterococcus faecalis in 1 (8.3% patient, and the cause of mediastinitis could not be determined in 1 (8.3% patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7% patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3% patient. Out of this series, 5 (41.7% patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3% patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

  15. The use of probabilistic safety assessment in the relicensing of nuclear power plants for extended lifetimes

    International Nuclear Information System (INIS)

    1990-02-01

    This document gives guidance in the major ways PSAs can be used for NPP life extension applications utilizing given PSA criteria. It also covers the specific steps for using presently available PSA models, data and criteria to assist life extension decision making and the research that could be carried out to extend the applicability of PSAs in this field. Refs, figs and tabs

  16. Cardiac syncope in pediatric patients.

    Science.gov (United States)

    Massin, Martial M; Malekzadeh-Milani, Sophie; Benatar, Avram

    2007-02-01

    To assess the epidemiology of cardiac syncope in children and evaluate the guidelines on its management. We analyzed the etiology to syncope and diagnostic workup in consecutive pediatric patients presenting with syncope in our emergency departments or cardiac outpatient clinics between 1997 and 2005, and who were subsequently diagnosed as having cardiac syncope. A primary cardiac cause was identified in 11 syncopal patients presenting to the emergency room and 14 patients to the cardiac clinic: supraventricular tachyarrhythmia in 9, ventricular tachyarrhythmia in 10, pacemaker dysfunction in 2, and isolated cases of sick sinus syndrome, hypoxic spell, hypertrophic cardiomyopathy, and primary pulmonary hypertension. Some elements suggested potential cardiac disease as a cause of syncope in all cases. The resting electrocardiogram and the echocardiogram were interpreted as positive and relevant to the diagnosis in 17 and 3 patients, respectively. Exercise electrocardiogram and Holter recording provided diagnostic information previously not seen on the resting electrocardiogram in six and three patients, respectively. Three children have died and one child has neurological sequelae following resuscitation. Our data support the premise that careful history taking with special focus on the events leading up to syncope, as well as a complete physical examination, can guide practitioners in discerning which syncopal children need further cardiac investigations. Copyright (c) 2007 Wiley Periodicals, Inc.

  17. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore

    2011-11-01

    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  18. Fetal cardiac rhabdomyoma: case report

    Directory of Open Access Journals (Sweden)

    Seyed Mostafa Ghavami

    2016-07-01

    Full Text Available Background: The primary manifestation of cardiac tumors in embryonic period is a very rare condition. Cardiac rhabdomyomas most frequently arise in the ventricular myocardium, they may also occur in the atria and the epicardial surface. In spite of its benign nature, the critical location of the tumor inside the heart can lead to lethal arrhythmias and chamber obstruction. Multiple rhabdomyomas are strongly associated with tuberous sclerosis which is associated with mental retardation and epilepsy of variable severity. Ultrasonography as a part of routine prenatal screening, is the best method for the diagnosis of cardiac rhabdomyomas. In the review of articles published in Iran, fetal cardiac rhabdomyoma was not reported. Case presentation: We report a case of cardiac rhabdomyoma on a 24-year-old gravid 1, referred to Day Medical Imaging Center for routine evaluation of fetal abnormalities at 31 weeks of her gestational age. Ultrasonographic examination displayed a homogenous echogenic mass (13×9mm, originating from the left ventricle of the fetal heart. It was a normal pregnancy without any specific complications. Other organs of the fetus were found normal and no cardiac abnormalities were appeared. No Pericardial fluid effusion was found. The parents did not have consanguineous marriage. They did not also have any specific disease such as tuberous sclerosis. Conclusion: The clinical features of cardiac rhabdomyomas vary widely, depending on the location, size, and number of tumors in the heart. Although cardiac rhabdomyoma is a benign tumor in many affected fetuses, an early prenatal diagnosis of the tumor is of great significance in making efficient planning and providing adequate follow up visits of the patients and the complications such as, heart failure and outlet obstruction of cardiac chambers.

  19. Acupuncture therapy related cardiac injury.

    Science.gov (United States)

    Li, Xue-feng; Wang, Xian

    2013-12-01

    Cardiac injury is the most serious adverse event in acupuncture therapy. The causes include needling chest points near the heart, the cardiac enlargement and pericardial effusion that will enlarge the projected area on the body surface and make the proper depth of needling shorter, and the incorrect needling method of the points. Therefore, acupuncture practitioners must be familiar with the points of the heart projected area on the chest and the correct needling methods in order to reduce the risk of acupuncture therapy related cardiac injury.

  20. Analysing and Comparing Encodability Criteria

    Directory of Open Access Journals (Sweden)

    Kirstin Peters

    2015-08-01

    Full Text Available Encodings or the proof of their absence are the main way to compare process calculi. To analyse the quality of encodings and to rule out trivial or meaningless encodings, they are augmented with quality criteria. There exists a bunch of different criteria and different variants of criteria in order to reason in different settings. This leads to incomparable results. Moreover it is not always clear whether the criteria used to obtain a result in a particular setting do indeed fit to this setting. We show how to formally reason about and compare encodability criteria by mapping them on requirements on a relation between source and target terms that is induced by the encoding function. In particular we analyse the common criteria full abstraction, operational correspondence, divergence reflection, success sensitiveness, and respect of barbs; e.g. we analyse the exact nature of the simulation relation (coupled simulation versus bisimulation that is induced by different variants of operational correspondence. This way we reduce the problem of analysing or comparing encodability criteria to the better understood problem of comparing relations on processes.

  1. Inverse correlation between cardiac injury and cardiac anxiety: A potential role for communication

    NARCIS (Netherlands)

    van Beek, M.H.C.T.; Voshaar, R.C.O.; van Deelen, F.M.; van Balkom, A.J.L.M.; Pop, G.; Speckens, A.E.M.

    2014-01-01

    Objective: General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. Methods: We assessed cardiac anxiety in 237 patients

  2. Inverse Correlation Between Cardiac Injury and Cardiac Anxiety A Potential Role for Communication

    NARCIS (Netherlands)

    van Beek, Maria H. C. T.; Oude Voshaar, Richard; van Deelen, Femke M.; van Balkom, Anton J. L. M.; Pop, Gheorghe; Speckens, Anne E. M.

    2014-01-01

    Objective: General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. Methods: We assessed cardiac anxiety in 237 patients

  3. Inverse correlation between cardiac injury and cardiac anxiety: a potential role for communication

    NARCIS (Netherlands)

    Beek, M.H.C.T. van; Oude Voshaar, R.C.; Deelen, F.M. van; Balkom, A.J.L.M. van; Pop, G.A.; Speckens, A.E.M.

    2014-01-01

    OBJECTIVE: General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. METHODS: We assessed cardiac anxiety in 237 patients

  4. Extended asymptotic functions - some examples

    International Nuclear Information System (INIS)

    Todorov, T.D.

    1981-01-01

    Several examples of extended asymptotic functions of two variables are given. This type of asymptotic functions has been introduced as an extension of continuous ordinary functions. The presented examples are realizations of some Schwartz distributions delta(x), THETA(x), P(1/xsup(n)) and can be multiplied in the class of the asymptotic functions as opposed to the theory of Schwartz distributions. The examples illustrate the method of construction of extended asymptotic functions similar to the distributions. The set formed by the extended asymptotic functions is also considered. It is shown, that this set is not closed with respect to addition and multiplication

  5. Cosmological dynamics of extended chameleons

    Energy Technology Data Exchange (ETDEWEB)

    Tamanini, Nicola [Institut de Physique Théorique, CEA-Saclay, CNRS UMR 3681, Université Paris-Saclay, F-91191 Gif-sur-Yvette (France); Wright, Matthew, E-mail: nicola.tamanini@cea.fr, E-mail: matthew.wright.13@ucl.ac.uk [Department of Mathematics, University College London, Gower Street, London, WC1E 6BT (United Kingdom)

    2016-04-01

    We investigate the cosmological dynamics of the recently proposed extended chameleon models at both background and linear perturbation levels. Dynamical systems techniques are employed to fully characterize the evolution of the universe at the largest distances, while structure formation is analysed at sub-horizon scales within the quasi-static approximation. The late time dynamical transition from dark matter to dark energy domination can be well described by almost all extended chameleon models considered, with no deviations from ΛCDM results at both background and perturbation levels. The results obtained in this work confirm the cosmological viability of extended chameleons as alternative dark energy models.

  6. Cosmological dynamics of extended chameleons

    International Nuclear Information System (INIS)

    Tamanini, Nicola; Wright, Matthew

    2016-01-01

    We investigate the cosmological dynamics of the recently proposed extended chameleon models at both background and linear perturbation levels. Dynamical systems techniques are employed to fully characterize the evolution of the universe at the largest distances, while structure formation is analysed at sub-horizon scales within the quasi-static approximation. The late time dynamical transition from dark matter to dark energy domination can be well described by almost all extended chameleon models considered, with no deviations from ΛCDM results at both background and perturbation levels. The results obtained in this work confirm the cosmological viability of extended chameleons as alternative dark energy models.

  7. Low clinical penetrance in causal mutation carriers for cardiac channelopathies.

    Science.gov (United States)

    Jiménez-Jáimez, Juan; Álvarez, Miguel; Algarra, María; Macías Ruíz, Rosa; Peñas, Rocío; Valverde, Francisca; Tortajada, Gustavo; Lorente, Jose Antonio; Melgares, Rafael; Tercedor, Luis

    2013-04-01

    Cardiac channelopathies are genetic alterations that can cause sudden death. Long QT syndrome and Brugada syndrome are 2 such conditions. Both are diagnosed according to previously published criteria. Our objective was to determine the sensitivity of these criteria in a consecutive series of patients carrying the mutations that cause them. We enrolled 15 families and 31 causal mutation carriers with a high pathogenic probability of having long QT syndrome and Brugada syndrome. We conducted clinical and electrocardiographic studies to analyze the extent to which these patients fulfilled the diagnostic criteria. Statistical analysis was with SPSS 17.0. Some 48.3% of the subjects met the criteria indicating a high probability of long QT syndrome or Brugada syndrome. Among those with the mutation for long QT syndrome, only 10 out of 21 had a Schwartz index score ≥ 4. Both the median Schwartz score and the cQT interval were lower in relatives than in probands. Of those with the mutation for Brugada syndrome, 60% failed to meet current diagnostic criteria, which were more frequently fulfilled in relatives. Pharmacological tests with epinephrine and flecainide helped establish the diagnosis in 2 mutation carriers with negative phenotype. Current diagnostic criteria for long QT syndrome and Brugada syndrome had low sensitivity in our sample of genetic carriers. Genetic tests supported by pharmacological tests can increase diagnostic sensitivity, especially in asymptomatic relatives. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  8. Robotic Applications in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alan P. Kypson

    2008-11-01

    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

  9. Understanding traumatic blunt cardiac injury.

    Science.gov (United States)

    El-Menyar, Ayman; Al Thani, Hassan; Zarour, Ahmad; Latifi, Rifat

    2012-01-01

    Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI) are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

  10. Understanding traumatic blunt cardiac injury

    Directory of Open Access Journals (Sweden)

    Ayman El-Menyar

    2012-01-01

    Full Text Available Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

  11. Recent developments in cardiac pacing.

    Science.gov (United States)

    Rodak, D J

    1995-10-01

    Indications for cardiac pacing continue to expand. Pacing to improve functional capacity, which is now common, relies on careful patient selection and technical improvements, such as complex software algorithms and diagnostic capabilities.

  12. Quasi-extended asymptotic functions

    International Nuclear Information System (INIS)

    Todorov, T.D.

    1979-01-01

    The class F of ''quasi-extended asymptotic functions'' is introduced. It contains all extended asymptotic functions as well as some new asymptotic functions very similar to the Schwartz distributions. On the other hand, every two quasiextended asymptotic functions can be multiplied as opposed to the Schwartz distributions; in particular, the square delta 2 of an asymptotic function delta similar to Dirac's delta-function, is constructed as an example

  13. Topological defects in extended inflation

    International Nuclear Information System (INIS)

    Copeland, E.J.; Kolb, E.W.; Chicago Univ., IL; Liddle, A.R.

    1990-04-01

    We consider the production of topological defects, especially cosmic strings, in extended inflation models. In extended inflation, the Universe passes through a first-order phase transition via bubble percolation, which naturally allows defects to form at the end of inflation. The correlation length, which determines the number density of the defects, is related to the mean size of bubbles when they collide. This mechanism allows a natural combination of inflation and large-scale structure via cosmic strings. 18 refs

  14. Some problems with extended inflation

    International Nuclear Information System (INIS)

    Weinberg, E.J.

    1989-01-01

    The recently proposed extended inflation scenario is examined. Upper bounds on the Brans-Dicke parameter ω are obtained by requiring that the recovery from the supercooled regime be such that the presently observed Universe could have emerged. These bounds are well below the present-day experimental limits, implying that one must use models which have a potential to fix the present value of the Brans-Dicke-like scalar field. The implications for extended inflation in such models are discussed

  15. Topological defects in extended inflation

    International Nuclear Information System (INIS)

    Copeland, E.J.; Kolb, E.W.; Liddle, A.R.

    1990-01-01

    We consider the production of topological defects, especially cosmic strings, in extended-inflation models. In extended inflation, the Universe passes through a first-order phase transition via bubble percolation, which naturally allows defects to form at the end of inflation. The correlation length, which determines the number density of the defects, is related to the mean size of the bubbles when they collide. This mechanism allows a natural combination of inflation and large-scale structure via cosmic strings

  16. Aquatic Life Criteria - Tributyltin (TBT)

    Science.gov (United States)

    Documents pertaining to 2004 Final Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Tributyltin (TBT) for freshwater and saltwater. These documents include the safe levels of TBT that should protect the majority of species.

  17. Aquatic Life Criteria - Cadmium Documents

    Science.gov (United States)

    Documents pertaining to 2016 Acute and Chronic Aquatic Life Ambient Water Quality Criteria for Cadmium (Freshwater, Estuarine/marine). These documents contain the safe levels of Cadmium in water that should protect the majority of species.

  18. Extended likelihood inference in reliability

    International Nuclear Information System (INIS)

    Martz, H.F. Jr.; Beckman, R.J.; Waller, R.A.

    1978-10-01

    Extended likelihood methods of inference are developed in which subjective information in the form of a prior distribution is combined with sampling results by means of an extended likelihood function. The extended likelihood function is standardized for use in obtaining extended likelihood intervals. Extended likelihood intervals are derived for the mean of a normal distribution with known variance, the failure-rate of an exponential distribution, and the parameter of a binomial distribution. Extended second-order likelihood methods are developed and used to solve several prediction problems associated with the exponential and binomial distributions. In particular, such quantities as the next failure-time, the number of failures in a given time period, and the time required to observe a given number of failures are predicted for the exponential model with a gamma prior distribution on the failure-rate. In addition, six types of life testing experiments are considered. For the binomial model with a beta prior distribution on the probability of nonsurvival, methods are obtained for predicting the number of nonsurvivors in a given sample size and for predicting the required sample size for observing a specified number of nonsurvivors. Examples illustrate each of the methods developed. Finally, comparisons are made with Bayesian intervals in those cases where these are known to exist

  19. Extender for securing a closure

    Science.gov (United States)

    Thomas, II, Patrick A.

    2012-10-02

    An apparatus for securing a closure such as door or a window that opens and closes by movement relative to a fixed structure such as a wall or a floor. Many embodiments provide a device for relocating a padlock from its normal location where it secures a fastener (such as a hasp) to a location for the padlock that is more accessible for locking and unlocking the padlock. Typically an extender is provided, where the extender has a hook at a first end that is disposed through the eye of the staple of the hasp, and at an opposing second end the extender has an annulus, such as a hole in the extender or a loop or ring affixed to the extender. The shackle of the padlock may be disposed through the annulus and may be disposed through the eye of a second staple to secure the door or window in a closed or open position. Some embodiments employ a rigid sheath to enclose at least a portion of the extender. Typically the rigid sheath has an open state where the hook is exposed outside the sheath and a closed state where the hook is disposed within the sheath.

  20. Cardiac Regeneration and Stem Cells.

    Science.gov (United States)

    Zhang, Yiqiang; Mignone, John; MacLellan, W Robb

    2015-10-01

    After decades of believing the heart loses the ability to regenerate soon after birth, numerous studies are now reporting that the adult heart may indeed be capable of regeneration, although the magnitude of new cardiac myocyte formation varies greatly. While this debate has energized the field of cardiac regeneration and led to a dramatic increase in our understanding of cardiac growth and repair, it has left much confusion in the field as to the prospects of regenerating the heart. Studies applying modern techniques of genetic lineage tracing and carbon-14 dating have begun to establish limits on the amount of endogenous regeneration after cardiac injury, but the underlying cellular mechanisms of this regeneration remained unclear. These same studies have also revealed an astonishing capacity for cardiac repair early in life that is largely lost with adult differentiation and maturation. Regardless, this renewed focus on cardiac regeneration as a therapeutic goal holds great promise as a novel strategy to address the leading cause of death in the developed world. Copyright © 2015 the American Physiological Society.

  1. Cardiac misconceptions in healthcare workers.

    Science.gov (United States)

    Angus, Neil; Patience, Fiona; Maclean, Elizabeth; Corrigall, Helen; Bradbury, Ian; Thompson, David R; Atherton, Iain; Leslie, Stephen J

    2012-12-01

    Cardiac misconceptions are common and may have a detrimental effect on patients. Such misconceptions may be introduced or reinforced by vague and inconsistent advice from healthcare staff and can adversely affect health outcomes. To assess whether level of cardiac misconceptions significantly differs between groups of healthcare staff based on occupation. The 22-item York cardiac beliefs questionnaire (YCBQ) was administered to a convenience sample of healthcare staff (n = 263) in direct contact with cardiac patients. Data was also collected on the occupation of healthcare staff and years worked. Medical staff had the lowest mean score (17.5, CI 15.6-19.4), indicating fewest misconceptions, and unqualified healthcare workers had the highest mean score (32.1, CI 28.4-35.7). Analysis by ANOVA indicated differences between staff groups to be statistically significant (F = 17.66, p misconception score (Pearson's r = - 0.243, p misconceptions in different groups of healthcare staff. Education to correct cardiac misconceptions should be particularly targeted at unqualified healthcare staff. The importance of maintaining appropriate ratios of qualified to unqualified healthcare staff in the care of cardiac patients is supported by this study.

  2. FGF21 and cardiac physiopathology

    Directory of Open Access Journals (Sweden)

    Anna ePlanavila

    2015-08-01

    Full Text Available The heart is not traditionally considered either a target or a site of fibroblast growth factor-21 (FGF21 production. However, recent findings indicate that FGF21 can act as a cardiomyokine; that is, it is produced by cardiac cells at significant levels and acts in an autocrine manner on the heart itself. The heart is sensitive to the effects of FGF21, both systemic and locally generated, owing to the expression in cardiomyocytes of β-Klotho, the key co-receptor known to confer specific responsiveness to FGF21 action. FGF21 has been demonstrated to protect against cardiac hypertrophy, cardiac inflammation, and oxidative stress. FGF21 expression in the heart is induced in response to cardiac insults, such as experimental cardiac hypertrophy and myocardial infarction in rodents, as well as in failing human hearts. Intracellular mechanisms involving PPARα and Sirt1 mediate transcriptional regulation of the FGF21 gene in response to exogenous stimuli. In humans, circulating FGF21 levels are elevated in coronary heart disease and atherosclerosis, and are associated with a higher risk of cardiovascular events in patients with type 2 diabetes. These findings provide new insights into the role of FGF21 in the heart and may offer potential therapeutic strategies for cardiac disease.

  3. Cardiac involvement in myotonic dystrophy

    DEFF Research Database (Denmark)

    Lund, Marie; Diaz, Lars Jorge; Ranthe, Mattis Flyvholm

    2014-01-01

    genetic testing for DM1. Information on incident cardiac diseases was obtained from the NPR. We estimated standardized incidence ratios (SIRs) of cardiac disease compared with the background population, overall and according to selected diagnostic subgroups (cardiomyopathy, heart failure, conduction...... disorders, arrhythmias, and device implantation). In the DM cohort, SIR for any cardiac disease was 3.42 [95% confidence interval (CI) 3.01-3.86]; for a cardiac disease belonging to the selected subgroups 6.91 (95% CI: 5.93-8.01) and for other cardiac disease 2.59 (95% CI: 2.03-3.25). For a cardiac disease...... belonging to the selected subgroups, the risk was particularly high in the first year after DM diagnosis [SIR 15.4 (95% CI: 10.9-21.3)] but remained significantly elevated in subsequent years [SIR 6.07 (95% CI: 5.11-7.16]). The risk was higher in young cohort members [e.g. 20-39 years: SIR 18.1 (95% CI: 12...

  4. Reliability criteria for voltage stability

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Carson W.; Silverstein, Brian L. [Bonneville Power Administration, Portland, OR (United States)

    1994-12-31

    In face of costs pressures, there is need to allocate scare resources more effectively in order to achieve voltage stability. This naturally leads to development of probabilistic criteria and notions of rick management. In this paper it is presented a discussion about criteria for long term voltage stability limited to the case in which the time frames are topically several minutes. (author) 14 refs., 1 fig.

  5. Toxic chemical risk acceptance criteria

    International Nuclear Information System (INIS)

    Craig, D.K.; Davis, J.; Lee, L.; Lein, P.; Omberg, S.

    1992-01-01

    This paper presents recommendations of a subcommittee of the Westinghouse M ampersand 0 Nuclear Facility Safety Committee concerning toxic chemical risk acceptance criteria. Two sets of criteria have been developed, one for use in the hazard classification of facilities, and the second for use in comparing risks in DOE non-reactor nuclear facility Safety Analysis Reports. The Emergency Response Planning Guideline (ERPG) values are intended to provide estimates of concentration ranges for specific chemicals above which exposure would be expected to lead to adverse heath effects of increasing severity for ERPG-1, -2, and -3s. The subcommittee recommends that criteria for hazard class or risk range be based on ERPGs for all chemicals. Probability-based Incremental Cancer Risk (ICR) criteria are recommended for additional analyses of risks from all known or suspected human carcinogens. Criteria are given for both on-site and off-site exposure. The subcommittee also recommends that the 5-minute peak concentration be compared with the relevant criterion with no adjustment for exposure time. Since ERPGs are available for only a limited number of chemicals, the subcommittee has developed a proposed hierarchy of concentration limit parameters for the different criteria

  6. Sudden Cardiac Death

    DEFF Research Database (Denmark)

    Risgaard, Bjarke; Winkel, Bo Gregers; Jabbari, Reza

    2017-01-01

    Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how....... Autopsy was performed in 55%. Overall, 58% of SCD cases (n = 786) received at least 1 drug within 90 days before death. The most common drugs were analgesic drugs (n = 239; 18%), antihypertensive drugs (n = 234; 17%), and antibiotic drugs (n = 218; 16%). After multivariable adjustment, prescription...... of “brugadogenic” drugs or >1 QT-prolonging drug was associated with an increased risk of SADS compared with explained SCD (odds ratio: 2.16 [95% confidence interval: 1.12 to 4.17] and 2.91 [95% confidence interval: 1.46 to 5.81], respectively). Conclusions Pharmacotherapy was identified in 58% of the SCD cases...

  7. Cardiac output during exercise

    DEFF Research Database (Denmark)

    Siebenmann, C; Rasmussen, P.; Sørensen, H.

    2015-01-01

    Several techniques assessing cardiac output (Q) during exercise are available. The extent to which the measurements obtained from each respective technique compares to one another, however, is unclear. We quantified Q simultaneously using four methods: the Fick method with blood obtained from...... the right atrium (Q(Fick-M)), Innocor (inert gas rebreathing; Q(Inn)), Physioflow (impedance cardiography; Q(Phys)), and Nexfin (pulse contour analysis; Q(Pulse)) in 12 male subjects during incremental cycling exercise to exhaustion in normoxia and hypoxia (FiO2  = 12%). While all four methods reported...... a progressive increase in Q with exercise intensity, the slopes of the Q/oxygen uptake (VO2) relationship differed by up to 50% between methods in both normoxia [4.9 ± 0.3, 3.9 ± 0.2, 6.0 ± 0.4, 4.8 ± 0.2 L/min per L/min (mean ± SE) for Q(Fick-M), Q(Inn), QP hys and Q(Pulse), respectively; P = 0...

  8. Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT

    DEFF Research Database (Denmark)

    Perkiomaki, Juha S; Ruwald, Anne-Christine; Kutyifa, Valentina

    2015-01-01

    AIMS: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify...... the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. METHODS AND RESULTS: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known...... causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P

  9. Modern Perspectives on Numerical Modeling of Cardiac Pacemaker Cell

    Science.gov (United States)

    Maltsev, Victor A.; Yaniv, Yael; Maltsev, Anna V.; Stern, Michael D.; Lakatta, Edward G.

    2015-01-01

    Cardiac pacemaking is a complex phenomenon that is still not completely understood. Together with experimental studies, numerical modeling has been traditionally used to acquire mechanistic insights in this research area. This review summarizes the present state of numerical modeling of the cardiac pacemaker, including approaches to resolve present paradoxes and controversies. Specifically we discuss the requirement for realistic modeling to consider symmetrical importance of both intracellular and cell membrane processes (within a recent “coupled-clock” theory). Promising future developments of the complex pacemaker system models include the introduction of local calcium control, mitochondria function, and biochemical regulation of protein phosphorylation and cAMP production. Modern numerical and theoretical methods such as multi-parameter sensitivity analyses within extended populations of models and bifurcation analyses are also important for the definition of the most realistic parameters that describe a robust, yet simultaneously flexible operation of the coupled-clock pacemaker cell system. The systems approach to exploring cardiac pacemaker function will guide development of new therapies, such as biological pacemakers for treating insufficient cardiac pacemaker function that becomes especially prevalent with advancing age. PMID:24748434

  10. Assessment of inpatient multimodal cardiac imaging appropriateness at large academic medical centers.

    Science.gov (United States)

    Remfry, Andrew; Abrams, Howard; Dudzinski, David M; Weiner, Rory B; Bhatia, R Sacha

    2015-11-14

    Responding to concerns regarding the growth of cardiac testing, the American College of Cardiology Foundation (ACCF) published Appropriate Use Criteria (AUC) for various cardiac imaging modalities. Single modality cardiac imaging appropriateness has been reported but there have been no studies assessing the appropriateness of multiple imaging modalities in an inpatient environment. A retrospective study of the appropriateness of cardiac tests ordered by the inpatient General Internal Medicine (GIM) and Cardiology services at three Canadian academic hospitals was conducted over two one-month periods. Cardiac tests characterized were transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), single-photon emission tomography myocardial perfusion imaging (SPECT), and diagnostic cardiac catheterization. Overall, 553 tests were assessed, of which 99.8% were classifiable by AUC. 91% of all studies were categorized as appropriate, 4% may be appropriate and 5% were rarely appropriate. There were high rates of appropriate use of all modalities by GIM and Cardiology throughout. Significantly more appropriate diagnostic catheterizations were ordered by Cardiology than GIM (93% vs. 82%, p = imaging modalities in this multi-centered study on Cardiology and GIM inpatients in the acute care setting. The rate of appropriate ordering was high across all imaging modalities. We recommend further work towards improving appropriate utilization of cardiac imaging resources focus on the out-patient setting.

  11. Optimizing clinical thresholds for PTSD: Extending the DSM-5 preschool criteria to school-age children

    Directory of Open Access Journals (Sweden)

    BreAnne A. Danzi

    2017-01-01

    Full Text Available Antecedentes/Objetivo: Examinar el uso los criterios preescolares del DSM-5 para diagnosticar el trastorno de estrés postraumático (TEPT en ni ̃ nos de edad escolar (7-11 a ̃ nos. Método: Ni ̃ nos expuestos al huracán Ike ( N = 327 fueron evaluados respecto a los síntomas de TEPT, ocho meses después del desastre. Resultados: Aproximadamente el doble de ni ̃ nos fueron diagnosticados con TEPT usando los criterios preescolares del DSM-5 comparado a los de adultos. Los criterios preescolares identificaron todos los ni ̃ nos diagnosticados usando los criterios de adultos y muchos más. Aunque los ni ̃ nos que cumplieron ambos criterios reportaron el mayor deterioro funcional, los ni ̃ nos identificados solamente por los criterios preescolares reportaron más deterioro que los ni ̃ nos no diagnosticados. El efecto de incluir el deterioro en los criterios diagnósticos fue más intenso para los criterios preescolares. Además, el TEPT definido por los criterios preescolares fue asociado significativamente con más factores de riesgo que TEPT definido por los criterios de adultos. El ajuste del modelo fue similar en ambos conjuntos de criterios. Conclusión: Los criterios preescolares pueden ser útiles para detectar el riesgo de TEPT en ni ̃ nos de edad escolar. Se necesitan más investigaciones para optimizar los criterios de TEPT de acuerdo al nivel de desarrollo para los ni ̃ nos en edad escolar.

  12. Social Advertising Quality: Assessment Criteria

    Directory of Open Access Journals (Sweden)

    S. B. Kalmykov

    2017-01-01

    Full Text Available Purpose: the The purpose of the publication is development of existing criterial assessment in social advertising sphere. The next objectives are provided for its achievement: to establish research methodology, to develop the author’s version of necessary notional apparatus and conceptual generalization, to determine the elements of social advertising quality, to establish the factors of its quality, to conduct the systematization of existing criteria and measuring instruments of quality assessment, to form new criteria of social advertising quality, to apply received results for development of criterial assessment to determine the further research perspectives. Methods: the methodology of research of management of social advertising interaction with target audience, which has dynamic procedural character with use of sociological knowledge multivariate paradigmatic status, has been proposed. Results: the primary received results: the multivariate paradigmatic research basis with use of works of famous domestic and foreign scientists in sociology, qualimetry and management spheres; the definitions of social advertising, its quality, sociological quality provision system, target audience behavior model during social advertising interaction are offered; the quality factors with three groups by level of effect on consumer are established; the systematization of existing quality and its measure instruments assessment criteria by detected social advertising quality elements are conducted; the two new criteria and its management quality assessment measuring instruments in social advertising sphere are developed; the one of the common groups of production quality criteria – adaptability with considering of new management quality criteria and conducted systematization of existing social advertising creative quality assessment criteria development; the perspective of further perfection of quality criterial assessment based on social advertising

  13. Home-based versus centre-based cardiac rehabilitation.

    Science.gov (United States)

    Anderson, Lindsey; Sharp, Georgina A; Norton, Rebecca J; Dalal, Hasnain; Dean, Sarah G; Jolly, Kate; Cowie, Aynsley; Zawada, Anna; Taylor, Rod S

    2017-06-30

    Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015. To compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. We included randomised controlled trials, including parallel group, cross-over or quasi-randomised designs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. Two review authors independently screened all identified references for inclusion based on pre-defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created. We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial

  14. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions

    Science.gov (United States)

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh

    2016-01-01

    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices. PMID:27610118

  15. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions.

    Science.gov (United States)

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh

    2016-06-01

    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices.

  16. Controlling criteria for radiation exposure of astronauts and space workers

    International Nuclear Information System (INIS)

    Katoh, Kazuaki

    1989-01-01

    Space workers likely to suffer from radiation exposure in the outer space are currently limited to the U.S. and Soviet Union, and only a small amount of data and information is available concerning the techniques and criteria for control of radiation exposure in this field. Criteria used in the Soviet Union are described first. The criteria (TRS-75), called the Radiation Safety Criteria for Space Navigation, are tentative ones set up in 1975. They are based on risk assessment. The standard radiation levels are established based on unit flight time: 50rem for 1 month, 80rem for 3 months, 110rem for 6 months and 150rem for 12 months. These are largely different from the emergency exposure limit of 100mSv (10rem) specified in a Japanese law, and the standard annual exposure value of 50mSv (5rem) for workers in nuclear power plants at normal times. For the U.S., J.A. Angelo, Jr., presented a paper titled 'Radiation Protection Issues and Techniques concerning Extended Manned Space Missions' at an IAEA meeting held in 1988. Though the criteria shown in the paper are not formal ones at the national level, similar criteria are expected to be adopted by the nation in the near future. The exposure limits recommended in the paper include a depth dose of 1-4Sv for the whole life span of a worker. (Nogami, K.)

  17. Cardiac-resynchronization therapy in patients with systolic heart failure and QRS interval ≤130 ms: insights from a meta-analysis.

    Science.gov (United States)

    Shah, Rachit M; Patel, Dhavalkumar; Molnar, Janos; Ellenbogen, Kenneth A; Koneru, Jayanthi N

    2015-02-01

    Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in patients with chronic systolic heart failure (SHF) and a wide QRS complex. It is unclear whether the same benefit extends to patients with QRS duration (QRSd) cardiac defibrillator (ICD) therapy in patients with SHF (ejection fraction heart failure, systolic dysfunction, dyssynchrony, left ventricular remodelling, readmission, mortality, survival, and various combinations of these terms. We studied the trends of overall mortality, SHF mortality, and hospitalizations due to SHF between the two groups. Heterogeneity of the studies was analysed by Q statistic. A fixed-effect model was used to compute the relative risk (RR) of mortality due to SHF, while a random-effects model was used to compare hospitalization due to SHF. Out of a total of 12 100 citations, four RCTs comparing CRTD vs. ICD therapy in patients with SHF and QRS ≤130 ms fulfilled the inclusion criteria. The median follow-up was 12 months and the cumulative number of patients was 1177. Relative Risk for all-cause mortality in patients treated with CRTD was 1.66 with a 95% CI of 1.096-2.515 (P = 0.017) while for SHF mortality was 1.29 with 95% CI of 0.68-2.45 (P = 0.42). Relative risk for HF hospitalization in patients treated with CRTD was 0.94 with 95% CI of 0.50-1.74 (P = 0.84) in comparison to the ICD group. Cardiac-resynchronization therapy defibrillator has no impact on SHF mortality and SHF hospitalization in patients with systolic HF with QRS duration ≤130 ms and is associated with higher all-cause mortality in comparison with ICD therapy. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  18. Cardiac output monitoring

    Directory of Open Access Journals (Sweden)

    Mathews Lailu

    2008-01-01

    Full Text Available Minimally invasive and non-invasive methods of estimation of cardiac output (CO were developed to overcome the limitations of invasive nature of pulmonary artery catheterization (PAC and direct Fick method used for the measurement of stroke volume (SV. The important minimally invasive techniques available are: oesophageal Doppler monitoring (ODM, the derivative Fick method (using partial carbon dioxide (CO 2 breathing, transpulmonary thermodilution, lithium indicator dilution, pulse contour and pulse power analysis. Impedance cardiography is probably the only non-invasive technique in true sense. It provides information about haemodynamic status without the risk, cost and skill associated with the other invasive or minimally invasive techniques. It is important to understand what is really being measured and what assumptions and calculations have been incorporated with respect to a monitoring device. Understanding the basic principles of the above techniques as well as their advantages and limitations may be useful. In addition, the clinical validation of new techniques is necessary to convince that these new tools provide reliable measurements. In this review the physics behind the working of ODM, partial CO 2 breathing, transpulmonary thermodilution and lithium dilution techniques are dealt with. The physical and the physiological aspects underlying the pulse contour and pulse power analyses, various pulse contour techniques, their development, advantages and limitations are also covered. The principle of thoracic bioimpedance along with computation of CO from changes in thoracic impedance is explained. The purpose of the review is to help us minimize the dogmatic nature of practice favouring one technique or the other.

  19. Primary Cardiac Lymphoma

    Directory of Open Access Journals (Sweden)

    Shu-Ching Hsueh

    2006-04-01

    Full Text Available Primary cardiac lymphoma (PCL has rarely been reported in Chinese populations. PCL mostly occurs in the right atrium. The clinical manifestations may be variable and are attributed to its location, the presence of congestive heart failure, pericardial effusion, arrhythmia, and cardiomegaly. The prognosis is usually poor because it is usually found too late and therefore, clinicians should be aware of PCL. Imaging examinations are the best methods for initial diagnosis and include echocardiography, computed tomography (CT scan, magnetic resonance imaging (MRI, and radioisotope scan. However, the final diagnosis is made by pathology, such as cytologic examination of the effusive fluid and tissue biopsy. Because the tumors are difficult to resect, the main treatment for the disease is chemotherapy, which can be successful. Here, we report a 58-year-old man who had a tumor measuring 8 × 5 cm in the right atrium. By clinical staging, including chest X-ray, echocardiography, CT scan of the abdomen, MRI of the heart, whole body tumor Gallium scan, and gastrointestinal series, no metastatic lesion or involvement was found in other parts of the body. Pathologic findings including cytology of pericardial effusion and heart tumor biopsy revealed the case as a diffuse large B-cell lymphoma. After chemotherapy with COP (cyclophosphamide + vincristine + prednisone and CHOPBE (COP + doxorubicin + bleomycin + etoposide regimens, the intracardiac tumor had disappeared, but the patient survived for 12 months in total, despite additional radiotherapy over the pericardial lesions. It was presumed that because the tumor was very large and involved all 3 layers of the heart, it did not respond as well to the therapy as expected.

  20. Novel Approaches for the Use of Cardiac/Coronary Computed Tomography Angiography

    Directory of Open Access Journals (Sweden)

    Hadi Mirhedayati Roudsari, MD

    2016-12-01

    Full Text Available Recent developments in the novel imaging technology of cardiac computed tomography (CT not only permit detailed assessment of cardiac anatomy but also provide insight into cardiovascular physiology. Foremost, coronary CT angiography (CCTA enables direct noninvasive examination of both coronary artery stenoses and atherosclerotic plaque characteristics. Calculation of computational fluid dynamics by cardiac CT allows the noninvasive estimation of fractional flow reserve, which increases the diagnostic accuracy for detection of hemodynamically significant coronary artery disease. In addition, a combination of myocardial CT perfusion and CCTA can provide simultaneous anatomical and functional assessment of coronary artery disease. Finally, detailed anatomical evaluation of atrial, ventricular, and valvular anatomy provides diagnostic information and guidance for procedural planning, such as for transcatheter aortic valve replacement. The clinical applications of cardiac CT will be extended with the development of these novel modalities.

  1. Hydraulic Design Criteria for Spacer Grids of Nuclear Fuel Element

    International Nuclear Information System (INIS)

    Juanico, Luis; Brasnarof, Daniel

    2000-01-01

    In this paper a hydraulic model for calculating the pressure drop on the CARA spacer grids is extended.This model is validated and feedback from experimental hydraulic test performed in a low pressure loop.The importance of the spacer grid geometric parameter (that is, its thickness and length, the number and kind of their fix spacer), developing hydraulic design criteria for spacer grid on fuel element

  2. Exercise-based cardiac rehabilitation in cardiac resynchronization therapy recipients: A primer for practicing clinicians.

    Science.gov (United States)

    Ambrosetti, Marco; Sarzi Braga, Simona; Giada, Franco; Pedretti, Roberto F E

    2017-11-30

    Cardiac resynchronization therapy (CRT) is a therapeutic option of increasing importance for chronic heart failure (CHF) and criteria for implantation now concern a large amount of patient populations. As a consequence, subjects with ongoing CRT (or immediately after CRT implantation) are more often referred to Cardiac Rehabilitation (CR) programmes, and it has been recently estimated that about one third of CHF patients attending CR in Italy currently have this kind of device. The presence of CRT represents a modulating factor for exercise prescription and monitoring, since CRT patients may be considered per se as a target group for CR. Exercise therapy (ET) increases benefits from CRT on functional capacity, and recent evidence suggests an adjuvant role of ET in improving cardiovascular prognosis also. Both aerobic endurance and resistance training activities may involve CHF patients with CRT, while the potential role of aerobic interval training needs more studies and evidence. Prescription of an ET program should be associated with information regarding device programming and possible limiting factors associated with pacing therapy, tailoring of the basic principles of ET (in terms of type of exercise, intensity and program duration) in this patient group is mandatory.

  3. Reactor tank UT acceptance criteria

    International Nuclear Information System (INIS)

    Daugherty, W.L.

    1990-01-01

    The SRS reactor tanks are constructed of type 304 stainless steel, with 0.5 inch thick walls. An ultrasonic (UT) in-service inspection program has been developed for examination of these tanks, in accordance with the ISI Plan for the Savannah River Production Reactors Process Water System (DPSTM-88-100-1). Prior to initiation of these inspections, criteria for the disposition of any indications that might be found are required. A working group has been formed to review available information on the SRS reactor tanks and develop acceptance criteria. This working group includes nationally recognized experts in the nuclear industry. The working group has met three times and produced three documents describing the proposed acceptance criteria, the technical basis for the criteria and a proposed initial sampling plan. This report transmits these three documents, which were prepared in accordance with the technical task plan and quality assurance plan for this task, task 88-001-A- 1. In addition, this report summarizes the acceptance criteria and proposed sampling plan, and provides further interpretation of the intent of these three documents where necessary

  4. Extended Year, Extended Contracts: Increasing Teacher Salary Options.

    Science.gov (United States)

    Gandara, Patricia

    1992-01-01

    Reports on an attempt to raise teacher salaries through an extended contract made possible through year-round school schedules. Teacher satisfaction with the 1987 experiment in three California schools (the Orchard Plan) has been high. Elements that have contributed to job satisfaction are discussed. (SLD)

  5. Extended cognition in science communication.

    Science.gov (United States)

    Ludwig, David

    2014-11-01

    The aim of this article is to propose a methodological externalism that takes knowledge about science to be partly constituted by the environment. My starting point is the debate about extended cognition in contemporary philosophy and cognitive science. Externalists claim that human cognition extends beyond the brain and can be partly constituted by external devices. First, I show that most studies of public knowledge about science are based on an internalist framework that excludes the environment we usually utilize to make sense of science and does not allow the possibility of extended knowledge. In a second step, I argue that science communication studies should adopt a methodological externalism and accept that knowledge about science can be partly realized by external information resources such as Wikipedia. © The Author(s) 2013.

  6. Shear rheology of extended nanoparticles

    Science.gov (United States)

    Petersen, Matt K.; Lane, J. Matthew D.; Grest, Gary S.

    2010-07-01

    Nonequilibrium molecular-dynamics simulations are presented for the shear rheology of suspensions of extended “jack”-shaped nanoparticles in an explicit solvent. The shear viscosity is measured for two jack-shaped nanoparticle suspensions for volume fractions from 0.01 to 0.15 and compared to spherical nanoparticles of the same mass. Large differences, in some cases, orders of magnitude, are observed for both the equilibrium viscosity and diffusion constant as the shape of the nanoparticle is varied. The source of enhanced viscosity is the very large effective volume swept out by these extended nanoparticles which allows them to become highly entangled even at low volume fraction.

  7. Effective operators and extended symmetry

    CERN Document Server

    Frère, J M; Moreno, J M; Orloff, J

    1994-01-01

    In this note we expand on our previous study of the implications of LEP1 results for future colliders. We extend the effective operator-based analysis of De R\\'ujula et al. to a larger symmetry group, and show at which cost their expectations can be relaxed. Of particular interest to experiment is a rephrasing of our previous results in terms of the Renard et al. parametrization for the gauge boson self-couplings (slightly extended to include $\\delta g_{\\gamma}$). We suggest the use of a ($\\delta g_{\\gamma}$, $\\delta g_{Z}$) plot to confront the expectations of various models.

  8. Adjustable extender for instrument module

    International Nuclear Information System (INIS)

    Sevec, J.B.; Stein, A.D.

    1975-01-01

    A blank extender module used to mount an instrument module in front of its console for repair or test purposes has been equipped with a rotatable mount and means for locking the mount at various angles of rotation for easy accessibility. The rotatable mount includes a horizontal conduit supported by bearings within the blank module. The conduit is spring-biased in a retracted position within the blank module and in this position a small gear mounted on the conduit periphery is locked by a fixed pawl. The conduit and instrument mount can be pulled into an extended position with the gear clearing the pawl to permit rotation and adjustment of the instrument

  9. Exclusion Bounds for Extended Anyons

    Science.gov (United States)

    Larson, Simon; Lundholm, Douglas

    2018-01-01

    We introduce a rigorous approach to the many-body spectral theory of extended anyons, that is quantum particles confined to two dimensions that interact via attached magnetic fluxes of finite extent. Our main results are many-body magnetic Hardy inequalities and local exclusion principles for these particles, leading to estimates for the ground-state energy of the anyon gas over the full range of the parameters. This brings out further non-trivial aspects in the dependence on the anyonic statistics parameter, and also gives improvements in the ideal (non-extended) case.

  10. Common criteria for usability review.

    Science.gov (United States)

    Nassar, Victor

    2012-01-01

    The propose of this paper is to present a literature review, in a grouping of common criteria for usability approaches of Bastien and Scapin (1993), Nielsen (1994), Shnneiderman(1998), Dix et al (1998), Preece et al (2005) and ISO 9241-110 (2006). After establishment of prerequisites for knowledge of the general characteristics of the users who will use the system, are defined and explained the criteria in common: consistency, user control, ease of learning, flexibility, errors management, reduction of excess and visibility system status. Although there is no determination as to which criteria should be considered when developing an interface and each author presents some specificity in their approach, it is observed that there is equivalence in the measures adopted usability.

  11. Combining the IADPSG criteria with the WHO diagnostic criteria for ...

    African Journals Online (AJOL)

    Background: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, yet there are no universally accepted diagnostic ... pregnancy outcome than a diagnosis that meets only WHO or IADPSG criteria. Key words: .... GDM, hypertensive disorder, maternal age, maternal obesity, family history of ...

  12. Combining the IADPSG criteria with the WHO diagnostic criteria for ...

    African Journals Online (AJOL)

    glucose, 1‑hour and 2‑hour serum glucose. Serum glucose was analysed on the Roche/Hitachi 902 automatic analyzer. The women were classified as gestational diabetics and non‑gestational diabetic according to the WHO and IADPSG diagnostic criteria. Five pregnancy outcome parameters were observed during the ...

  13. Design criteria for advanced reactors

    International Nuclear Information System (INIS)

    Dennielou, Y.

    1991-01-01

    Design criteria for advanced reactors are discussed, including safety aspects, site selection, problems related to maintenance and possibility of repairing or replacing structures or components of a nuclear power plant, the human factor considerations. Bearing in mind that some of these criteria are the subject of consensus at international level, the author suggests to establish a table of different operator requirements, to prepare a dossier on the comparison of input data for probabilistic risk analysis, to take into consideration the means to control a severe accident from the very start of the design

  14. Decision modeling and acceptance criteria

    DEFF Research Database (Denmark)

    Ditlevsen, Ove Dalager

    2003-01-01

    formulation of decision criteria and public acceptance criteria connected to risk analysis of technical operations that may endanger human life and property. Public restrictions on the decisions concerning the design, construction and managing of the technical operation have in the past been imposed......, the owner that tries to optimize the net gain of the operation, and the public that has somewhat different preferences than the owner, but also strong interests in the success of the owner. The principles of rational decision are needed for appreciation of the problem. Recognizing that there is an insurance...

  15. Extended replacement of the thoracic aorta.

    Science.gov (United States)

    Hino, Yutaka; Okada, Kenji; Oka, Takanori; Inoue, Takeshi; Tanaka, Akiko; Omura, Atsushi; Kano, Hiroya; Okita, Yutaka

    2013-01-01

    We present our experience of total aortic arch replacement. Twenty-nine patients (21 males and 8 females; mean age 63.3 ± 13.3 years) with extended thoracic aortic aneurysms underwent graft replacement. The pathology of the diseased aorta was non-dissecting aneurysm in 11 patients, including one aortitis and aortic dissection in 18 patients (acute type A: one, chronic type A: 11, chronic type B: six). Five patients had Marfan syndrome. In their previous operation, two patients had undergone the Bentall procedure, three had endovascular stenting, one had aortic root replacement with valve sparing and 12 had hemi-arch replacement for acute type A dissection. Approaches to the aneurysm were as follows: posterolateral thoracotomy with rib-cross incision in 16, posterolateral thoracotomy extended to the retroperitoneal abdominal aorta in seven, mid-sternotomy and left pleurotomy in three, anterolateral thoracotomy with partial lower sternotomy in two and clam-shell incision in one patient. Extension of aortic replacement was performed from the aortic root to the descending aorta in 4, from the ascending aorta to the descending aorta in 17 and from the ascending to the abdominal aorta in eight patients. Arterial inflow for cardiopulmonary bypass consisted of the femoral artery in 15 patients, ascending aorta and femoral artery in seven, descending or abdominal aorta in five and ascending aorta in two. Venous drainage site was the femoral vein in 10, pulmonary artery in eight, right atrium in five, femoral artery with right atrium/pulmonary artery in four and pulmonary artery with right atrium in two patients. The operative mortality, 30-day mortality and hospital mortality was one (cardiac arrest due to aneurysm rupture), one (rupture of infected aneurysm) and one (brain contusion), respectively. Late mortality occurred in three patients due to pneumonia, ruptured residual aneurysm and intracranial bleeding. Actuarial survival at 5 years after the operations was 80.6

  16. 7 CFR 1570.20 - Criteria.

    Science.gov (United States)

    2010-01-01

    ... Criteria § 1570.20 Criteria. The criteria considered by FAS in reviewing proposals for SOAP and COAP... initiatives will make toward realizing U.S. agricultural export goals and, in particular, in developing...

  17. Ethnic Differences in Genetic Ion Channelopathies Associated with Sudden Cardiac Death: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Kong, Tim; Feulefack, Joseph; Ruether, Kim; Shen, Fan; Zheng, Wang; Chen, Xing-Zhen; Sergi, Consolato

    2017-08-01

    Reports of allele frequencies encoding ion channel, or their interacting proteins associated with sudden cardiac death among different ethnic groups have been inconsistent. Here, we aimed to characterize the distribution of these genes and their alleles among various ethnicities through meta-analysis. We conducted a systematic review and meta-analysis to assess the mean allele frequencies of channelopathy genes SCN5A, NOS1AP, KCNH2, KCNE1 , and KCNQ1 among the Black, Caucasian, Asian, and Hispanic ethnicities. Searches in PubMed, Google Scholar, and Web of Science resulted in 18 reports published before July 2015 that met the eligible criteria. Allele frequencies were averaged by weight, and pooled values were calculated by inverse variance. Fixed-effects and random-effects models were used to pool effect sizes within each study and across different studies, respectively. Moreover, to extend our findings, we used sequenced genomic data from the Exome Aggregation Consortium to compare allele frequencies between different ethnicities. Meta-analysis of published studies supports that Asians had the highest overall mean allele frequencies of NOS1AP (0.36%, 95% CI: 0.30, 0.43; P <0.001), and SCN5A frequencies (0.17%, 95% CI: 0.07, 0.27, P =0.001), and whereas Caucasians had the highest KCNH2 frequency (0.21%, 95% CI: 0.16, 0.25; P <0.001), and Hispanics the highest KCNQ1 frequency (0.16%). Analysis of the Exome Aggregation Consortium also provided consistent data in agreement the meta-analysis. Overall, Asians carried the most alleles of genes associated with sudden cardiac death. The meta-analysis reveals significant differences in allele distribution of channelopathy-associated genes among different ethnic groups. © 2017 by the Association of Clinical Scientists, Inc.

  18. Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    Chun Sung Byun

    Full Text Available Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.

  19. Applying and extending Oracle Spatial

    CERN Document Server

    Simon Gerard Greener, Siva Ravada

    2013-01-01

    This book is an advanced practical guide to applying and extending Oracle Spatial.This book is for existing users of Oracle and Oracle Spatial who have, at a minimum, basic operational experience of using Oracle or an equivalent database. Advanced skills are not required.

  20. Ghosts in extended quasidilaton theories

    Science.gov (United States)

    Golovnev, Alexey; Trukhin, Aleksandr

    2017-11-01

    We report on our independent investigations of the puzzle of cosmological perturbations in extended quasidilaton. We confirm the claims of presence of the Boulware-Deser ghost. We use both the language of cosmological perturbations with broken diffeomorphisms and the Stückelberg approach.

  1. Extended memory management under RTOS

    Science.gov (United States)

    Plummer, M.

    1981-01-01

    A technique for extended memory management in ROLM 1666 computers using FORTRAN is presented. A general software system is described for which the technique can be ideally applied. The memory manager interface with the system is described. The protocols by which the manager is invoked are presented, as well as the methods used by the manager.

  2. Extended duration orbiter (EDO) insignia

    Science.gov (United States)

    1990-01-01

    Extended duration orbiter (EDO) insignia incorporates a space shuttle orbiter with payload bay doors (PLBDs) open and a spacelab module inside. Trailing the orbiter are the initials EDO. The EDO-modified Columbia, Orbiter Vehicle (OV) 102, will be flown for the first EDO mission, STS-50.

  3. Extended Duration Orbiter Medical Project

    Science.gov (United States)

    Leach, C. S.; Pool, S. L.; Sawin, C. F.; Nicogossian, A. E.

    1990-01-01

    The Extended Duration Orbiter (EDO) program addresses a need for more time to perform experiments and other tasks during Space Shuttle missions. As a part of this program, the Extended Duration Orbiter Medical Project (EDOMP) has been instituted to obtain information about physiologic effects of extending mission duration and the effectiveness of countermeasures against factors that might compromise crew health, safety, or performance on extended-duration missions. Only those investigations that address and characterize operational problems, develop countermeasures, or evaluate the effectiveness of countermeasures will be pursued. The EDOMP investigations will include flight-associated Detailed Supplementary Objectives as well as ground-based studies simulating the influence of microgravity. Investigator teams have been formed in the following areas: biomedical physiology, cardiovascular and fluid/electrolyte physiology, environmental health, muscle and exercise physiology, and neurophysiology. Major operational questions must be answered in each of these areas, and investigations have been designed to answer them. The EDO program will proceed only after countermeasures have been shown to be effective in preventing or mitigating the adverse changes they have been designed to attenuate. The program is underway and will continue on each Shuttle flight as the manifest builds toward a 16-day orbital flight.

  4. Extended unemployment and UI benefits

    OpenAIRE

    Robert G. Valletta; Katherine Kuang

    2010-01-01

    During the current labor market downturn, unemployment duration has reached levels well above its previous highs. Analysis of unemployment data suggests that extended unemployment insurance benefits have not been important factors in the increase in the duration of unemployment or in the elevated unemployment rate.

  5. Engage, Enhance, and Extend Learning!

    Science.gov (United States)

    Keren-Kolb, Liz

    2013-01-01

    Educators often say that technology is more than a gimmick or add-on, and that it should engage, enhance, or extend learning in ways that traditional tools do not. Yet they seldom stop to define these terms, and they can be confusing, especially for teachers and preservice teachers. Recently, while collaborating on an English language arts and…

  6. ACR appropriateness criteria blunt chest trauma.

    Science.gov (United States)

    Chung, Jonathan H; Cox, Christian W; Mohammed, Tan-Lucien H; Kirsch, Jacobo; Brown, Kathleen; Dyer, Debra Sue; Ginsburg, Mark E; Heitkamp, Darel E; Kanne, Jeffrey P; Kazerooni, Ella A; Ketai, Loren H; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D

    2014-04-01

    Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  7. Perioperative Rosuvastatin in Cardiac Surgery.

    Science.gov (United States)

    Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael; Chen, Zhengming; Collins, Rory; Casadei, Barbara

    2016-05-05

    Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (PSTICS ClinicalTrials.gov number, NCT01573143.).

  8. Exercise-induced cardiac remodeling.

    Science.gov (United States)

    Weiner, Rory B; Baggish, Aaron L

    2012-01-01

    Early investigations in the late 1890s and early 1900s documented cardiac enlargement in athletes with above-normal exercise capacity and no evidence of cardiovascular disease. Such findings have been reported for more than a century and continue to intrigue scientists and clinicians. It is well recognized that repetitive participation in vigorous physical exercise results in significant changes in myocardial structure and function. This process, termed exercise-induced cardiac remodeling (EICR), is characterized by structural cardiac changes including left ventricular hypertrophy with sport-specific geometry (eccentric vs concentric). Associated alterations in both systolic and diastolic functions are emerging as recognized components of EICR. The increasing popularity of recreational exercise and competitive athletics has led to a growing number of individuals exhibiting these findings in routine clinical practice. This review will provide an overview of EICR in athletes. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Out-of-hospital Cardiac Arrest (OHCA) Biomarkers

    Science.gov (United States)

    2017-12-21

    Neurological Outcome; Cardiac Arrest; Out-Of-Hospital Cardiac Arrest; Brain Anoxia Ischemia; Hypoxia, Brain; Hypoxia-Ischemia, Brain; Cardiac Arrest With Successful Resuscitation; Cardiac Arrest, Out-Of-Hospital; Brain Injuries

  10. An airline cardiac arrest program.

    Science.gov (United States)

    O'Rourke, M F; Donaldson, E; Geddes, J S

    1997-11-04

    As many as 1000 lives are lost annually from cardiac arrest in commercial aircraft. Ventricular fibrillation (VF), the most common mechanism, can be treated effectively only with prompt defibrillation, whereas the current policy of most airlines is to continue cardiopulmonary resuscitation pending aircraft diversion. The objective of this study was to assess the impact of making semiautomatic external defibrillators (AEDs) available for use on airline passengers with cardiac arrest. AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation. Supervision was provided by medical volunteers or (remotely) by airline physicians. During a 64-month period, AEDs were used on 109 occasions: 63 times for monitoring an acutely ill passenger and 46 times for cardiac arrest. Twenty-seven episodes of cardiac arrest occurred in aircraft, often (11 of 27 [41%]) unwitnessed, and they were usually (21 of 27 [78%]) associated with asystole or pulseless idioventricular rhythm. All 19 arrests in terminals were witnessed; VF was present in 17 (89%). Overall, defibrillation was initially successful in 21 of 23 cases (91%). Long-term survival from VF was achieved in 26% (2 of 6 in aircraft and 4 of 17 in terminals). The ability to monitor cardiac rhythm aided decisions on diversion, which was avoided in most passengers with asystole or idioventricular rhythm. AEDs in aircraft and terminals, with appropriate crew training, are helpful in the management of cardiac emergencies. Survival from VF is practicable and is comparable with the most effective prehospital ambulance emergency services. Costly aircraft diversions can be avoided in clearly futile situations, enhancing the cost-effectiveness of the program.

  11. Cardiac index in atrio- and interventricular delay optimized cardiac resynchronization therapy and cardiac contractility modulation

    Directory of Open Access Journals (Sweden)

    Tumampos J.

    2015-09-01

    Full Text Available Cardiac resynchronization therapy (CRT is an established therapy for heart failure patients and improves quality of life in patients with sinus rhythm, reduced left ventricular ejection fraction (LVEF, left bundle branch block and wide QRS duration. Since approximately sixty percent of heart failure patients have a normal QRS duration they do not benefit or respond to the CRT. Cardiac contractility modulation (CCM releases nonexcitatoy impulses during the absolute refractory period in order to enhance the strength of the left ventricular contraction. The aim of the investigation was to evaluate differences in cardiac index between optimized and nonoptimized CRT and CCM devices versus standard values. Impedance cardiography, a noninvasive method was used to measure cardiac index (CI, a useful parameter which describes the blood volume during one minutes heart pumps related to the body surface. CRT patients indicate an increase of 39.74 percent and CCM patients an improvement of 21.89 percent more cardiac index with an optimized device.

  12. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome

    NARCIS (Netherlands)

    Harden, R.N.; Bruehl, S.; Perez, R.S.G.M.; Birklein, F.; Marinus, J.; Maihofner, C.; Lubenow, T.; Buvanendran, A.; Mackey, S.; Graciosa, J.; Mogilevski, M.; Ramsden, C.; Chont, M.; Vatine, J.J.

    2010-01-01

    Current IASP diagnostic criteria for CRPS have low specificity, potentially leading to overdiagnosis. This validation study compared current IASP diagnostic criteria for CRPS to proposed new diagnostic criteria (the "Budapest Criteria") regarding diagnostic accuracy. Structured evaluations of

  13. Hypokalemia and sudden cardiac death

    DEFF Research Database (Denmark)

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient......, drugs with a proven significant positive effect on mortality and morbidity rates in heart failure patients all increase plasma potassium concentration. Thus, it may prove beneficial to pay more attention to hypokalemia and to maintain plasma potassium levels in the upper normal range. The more at risk...... of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis....

  14. Risk based seismic design criteria

    International Nuclear Information System (INIS)

    Kennedy, R.P.

    1999-01-01

    In order to develop a risk based seismic design criteria the following four issues must be addressed: (1) What target annual probability of seismic induced unacceptable performance is acceptable? (2) What minimum seismic margin is acceptable? (3) Given the decisions made under Issues 1 and 2, at what annual frequency of exceedance should the safe-shutdown-earthquake (SSE) ground motion be defined? (4) What seismic design criteria should be established to reasonably achieve the seismic margin defined under Issue 2? The first issue is purely a policy decision and is not addressed in this paper. Each of the other three issues are addressed. Issues 2 and 3 are integrally tied together so that a very large number of possible combinations of responses to these two issues can be used to achieve the target goal defined under Issue 1. Section 2 lays out a combined approach to these two issues and presents three potentially attractive combined resolutions of these two issues which reasonably achieves the target goal. The remainder of the paper discusses an approach which can be used to develop seismic design criteria aimed at achieving the desired seismic margin defined in resolution of Issue 2. Suggestions for revising existing seismic design criteria to more consistently achieve the desired seismic margin are presented. (orig.)

  15. Measuring Cardiac Output during Cardiopulmonary Exercise Testing.

    Science.gov (United States)

    Vignati, Carlo; Cattadori, Gaia

    2017-07-01

    Cardiac output is a key parameter in the assessment of cardiac function, and its measurement is fundamental to the diagnosis, treatment, and prognostic evaluation of all heart diseases. Until recently, cardiac output determination during exercise had been only possible through invasive methods, which were not practical in the clinical setting. Because [Formula: see text]o 2 is cardiac output times arteriovenous content difference, evaluation of cardiac output is usually included in its measurement. Because of the difficulty of directly measuring peak exercise cardiac output, indirect surrogate parameters have been proposed, but with only modest clinical usefulness. Direct measurement of cardiac output can now be made by several noninvasive techniques, such as rebreathing inert gases, impedance cardiology, thoracic bioreactance, estimated continuous cardiac output technology, and transthoracic echocardiography coupled to cardiopulmonary exercise testing, which allow more definitive results and better understanding of the underlying physiopathology.

  16. Complications after cardiac implantable electronic device implantations

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard

    2014-01-01

    Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient...

  17. Cardiac symptoms before sudden cardiac death caused by hypertrophic cardiomyopathy

    DEFF Research Database (Denmark)

    Lynge, Thomas Hadberg; Risgaard, Bjarke; Jabbari, Reza

    2016-01-01

    AIMS: Hypertrophic cardiomyopathy (HCM) is a frequent cause of sudden cardiac death (SCD) among the young (SCDY). The aim of this study was to characterize symptoms before SCDY due to HCM. METHODS AND RESULTS: Through review of all death certificates, we identified all SCDs in Danes aged 1-35 years...

  18. Evaluating Dependence Criteria for Caffeine.

    Science.gov (United States)

    Striley, Catherine L W; Griffiths, Roland R; Cottler, Linda B

    2011-12-01

    Background: Although caffeine is the most widely used mood-altering drug in the world, few studies have operationalized and characterized Diagnostic and Statistical Manual IV (DSM-IV) substance dependence criteria applied to caffeine. Methods: As a part of a nosological study of substance use disorders funded by the National Institute on Drug Abuse, we assessed caffeine use and dependence symptoms among high school and college students, drug treatment patients, and pain clinic patients who reported caffeine use in the last 7 days and also reported use of alcohol, nicotine, or illicit drugs within the past year ( n =167). Results: Thirty-five percent met the criteria for dependence when all seven of the adopted DSM dependence criteria were used. Rates of endorsement of several of the most applicable diagnostic criteria were as follows: 26% withdrawal, 23% desire to cut down or control use, and 44% continued use despite harm. In addition, 34% endorsed craving, 26% said they needed caffeine to function, and 10% indicated that they talked to a physician or counselor about problems experienced with caffeine. There was a trend towards increased caffeine dependence among those dependent on nicotine or alcohol. Within a subgroup that had used caffeine, alcohol, and nicotine in the past year, 28% fulfilled criteria for caffeine dependence compared to 50% for alcohol and 80% for nicotine. Conclusion: The present study adds to a growing literature suggesting the reliability, validity, and clinical utility of the caffeine dependence diagnosis. Recognition of caffeine dependence in the DSM-V may be clinically useful.

  19. Cardiac device infections: definition, classification, differential diagnosis, and management.

    Science.gov (United States)

    Polewczyk, Anna; Janion, Marianna; Kutarski, Andrzej

    2016-04-13

    Cardiac device infections (CDIs) continue to be a serious clinical problem, with varying terminology and different classifications constituting one of the major diagnostic and therapeutic challenges in routine clinical practice. The problem invariably arises during an attempt to estimate the extent of the infection, which in consequence determines the choice of treatment strategy (duration of antibiotic therapy). The most serious form of CDI is lead-related infective endocarditis (LRIE). There are no clearly established diagnostic criteria for this disease; the available Duke University criteria are difficult to apply in patients with a suspicion of LRIE because of low sensitivity. As the treatment of LRIE is expensive and troublesome, there is a tendency to underdiagnose this condition and seek any intermediary forms between local pocket infection and definite LRIE. The present review includes suggestions for the systematization of CDIs with a clear definition of LRIE as a separate and most severe entity among CDIs.

  20. Role of the Lebanese family caregivers in cardiac self-care: a collective approach.

    Science.gov (United States)

    Dumit, Nuhad Y; Abboud, Sarah; Massouh, Angela; Magilvy, Joan K

    2015-11-01

    The purpose of this study was to explore perceptions of cardiac self-care among Lebanese family caregivers of cardiac patients. The specific aims were to describe the cultural context of cardiac care-giving in Lebanon and to explore the roles of family caregivers in enhancing self-care practices in patients with cardiac diseases. The role of family caregivers in Lebanon, a country in the Middle East, is assumed to extend beyond care-giving to making decisions on behalf of the patient and assuming responsibility for patient care. To date, there has been no study done to empirically validate this impression. The design of the study is qualitative descriptive that used semi-structured individual interviews with family caregivers of Lebanese cardiac patients. Thirteen family caregivers of cardiac patients were recruited from a referral medical centre in Lebanon. The participants were designated by their patients and interviewed in a place of their choice. One overarching and three themes emerged from data analysis describing roles of family care givers in cardiac self-care. The overarching theme was: Family caregivers of Lebanese cardiac patients were unfamiliar with the term, concept and meaning of Self-Care. The moral and emotional duty to care for the family member stemmed from obligation and responsibility towards patients (theme I). Interdependent care (theme II) between cardiac patients and their families emerged as a significant cultural role. Family members play multiple supportive roles in care-giving namely emotional, informational and instrumental role (theme III). In this study, family caregiver role is shown to be based in the sense of obligation and duty towards the sick family member who collectively provide different types of supportive care. Nurses have to give significant importance to the family caregiver role as an integral part of any culturally sensitive patient/family intervention. © 2015 John Wiley & Sons Ltd.

  1. Metabolic syndrome and left ventricular function: Is the number of criteria actually important?

    Science.gov (United States)

    Tadic, Marijana; Ivanovic, Branislava; Kostic, Nada; Simic, Dragan; Matic, Danica; Celic, Vera

    2012-01-01

    Summary Background Metabolic syndrome (MS) is a clustering of cardiovascular risk factors responsible for the development of target organ damage. The aim of this study was to determine the effect of the increasing number of MS risk factors on left ventricular function assessed by noninvasive methods. Material/Methods The study included 204 subjects with MS and 76 controls with no MS risk factors. MS was defined by the presence of 3 or more of ATP-NCEP III criteria. MS subjects were grouped according to the number of criteria they fulfilled: 3 criteria (n=91), 4 criteria (n=65) and 5 criteria (n=48). All subjects underwent laboratory blood tests, complete 2-dimensional, pulse and tissue Doppler echocardiography. Echocardiography was used to assess systolic (LVEF, sseptal), diastolic function, by pulse-wave Doppler (E/A ratio) and tissue Doppler imaging (E/e′average), and global left ventricular function (Tei index). Appropriate time intervals for the estimation of the Tei index were obtained by tissue Doppler. Results Transmitral E/A ratio decreased significantly and progressively from the 3 criteria to the 5 criteria group (0.82±0.25 vs. 0.79±0.24 vs. 0.67±0.14, p<0.001). The transmitral E/E′average ratio was significantly and gradually increased from the 3 criteria to the 5 criteria group (7.76±1.81 vs. 9.44±2.35 vs. 10.82±2.56, p<0.001). The left ventricle Tei index progressively increased from the 3 criteria to the 5 criteria group (0.43±0.11 vs. 0.48±0.10 vs. 0.54±0.12, p<0.001). Conclusions The increasing number of MS criteria is associated with cardiac diastolic dysfunction. PMID:22534707

  2. Lung procurement for transplantation: new criteria for lung donor selection.

    Science.gov (United States)

    Moretti, M P; Betto, C; Gambacorta, M; Vesconi, S; Scalamogna, M; Benazzi, E; Ravini, M

    2010-05-01

    In Italy, like everywhere in the world, the organ shortage for transplantation is a real problem. It is well known that lung donors (LD) are particularly difficult to procure and that management of the organ do not care during the diagnosis of cerebral death represents a difficult challenge. In this context, the salvage of the so-called "marginal donors" may increase the pool of donors, favoring organ retrieval. To increase lung procurement, the intensivist must recognize "marginal donors," optimizing organ selection and function. The aim of our study was to review LD procured in 2008, as identified by the unrestricted criteria, of the Nord Italian Transplant program Center (NITp). Particularly, the age and habits of donors and the presence of a parenchyma contusion were not sufficient per se to exclude donation. We revisited lung ventilation and monitoring modalities during cerebral death before retrieval. In 2008, the application of enlarged criteria for LD enabled us to collect 21 LD, namely 33% of all cerebral deaths, versus 13% in 2007. Seeking to maintain good gas exchange and lung function, we implemented a safe ventilation program avoided high peak pressures, and fluid therapy properly guided by the cardiac index and extravascular lung water index monitoring. Specific actions to improve LD procurement may help cope with the organ-donor shortage. Although our series was small, our results were encouraging; they underline the necessity to continuously review donor criteria and care, allowing good donor/recipient matching. Copyright (c) 2010. Published by Elsevier Inc.

  3. Genetic testing for inheritable cardiac channelopathies.

    Science.gov (United States)

    Szepesváry, Eszter; Kaski, Juan Pablo

    2016-05-01

    Cardiac channelopathies are linked to an increased risk of ventricular arrhythmia and sudden death. This article reviews the clinical characteristics and genetic basis of common cardiac ion-channel diseases, highlights some genotype-phenotype correlations, and summarizes genetic testing for inheritable cardiac channelopathies.

  4. Regulation of Cardiac Hypertrophy: the nuclear option

    NARCIS (Netherlands)

    D.W.D. Kuster (Diederik)

    2011-01-01

    textabstractCardiac hypertrophy is the response of the heart to an increased workload. After myocardial infarction (MI) the surviving muscle tissue has to work harder to maintain cardiac output. This sustained increase in workload leads to cardiac hypertrophy. Despite its apparent appropriateness,

  5. Childhood cancer survivors: cardiac disease & social outcomes

    NARCIS (Netherlands)

    Feijen, E.A.M.

    2015-01-01

    The thesis is divided in two parts; Cardiac health problems and healthcare consumption & social outcomes in CCS. The general aims of part 1 creates optimal conditions for the evaluation of cardiac events in 5-year childhood cancer survivors, evaluation of the long term risk of cardiac events, and to

  6. Regional variations in baseline characteristics of cardiac rhythm device recipients: The PANORAMA observational cohort study.

    Science.gov (United States)

    Al Kandari, Fawziah; Erglis, Andrejs; Sweidan, Raed; Dannheimer, Ingrid; Sepsi, Milan; Bénézet, Juan; Padour, Michal; Naik, Ajay; Escudero, Jaime; West, Teena; Holbrook, Reece; Lorgat, Faizel

    2014-09-01

    The PANORAMA study was designed to collect concurrent data on subjects from different worldwide regions implanted with CRM devices. In this prospective, multi-center study, we analyzed baseline data on 8586 subjects implanted with CRM devices with no additional selection criteria (66% pacemaker (IPG), 16% implantable cardiac defibrillators (ICD), 17% cardiac resynchronization therapy (CRT) and CRM devices from a range of geographies that are not typically reported in literature. We found significant variations in clinical characteristics and implant practices. Long term follow-up data will help evaluate if these variations require adjustments to outcome expectations.

  7. Dual AV Nodal Nonreentrant Tachycardia Resulting in Inappropriate ICD Therapy in a Patient with Cardiac Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Ankur A. Karnik, MD

    2014-01-01

    Full Text Available Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT occurs due to concurrent antegrade conduction over fast and slow atrioventricular nodal pathways and is treated by slow pathway modification. We describe a unique case of a patient with cardiac sarcoidosis who received inappropriate ICD shocks for DAVNNT. Atrial and ventricular device electrograms satisfied both rate and V>A criteria for ventricular tachycardia. We postulate that alterations in refractoriness and conduction as is seen in cardiac sarcoidosis (CS may have contributed to occurrence of DAVNNT.

  8. Departies: conceptualizing extended youth parties

    DEFF Research Database (Denmark)

    Fjær, Eivind Grip; Tutenges, Sébastien

    2017-01-01

    Every year, millions of young people travel away from home to party for days or weeks on end in permissive environments, such as music festivals, dance parties, and nightlife resorts. The studies that have been conducted on these extended youth parties have focused primarily on specific risk......-taking behaviors, such as drug use and violence. Here, we scrutinize the research on extended youth parties to identify general changes that young people undergo at these events. We call these celebrations departies, because they center on the organization and facilitation of momentary departures from...... immoral; (4) stylistically, by altering their stylistic expressions through dress, demeanor, and consumption; and (5) experientially, because the parties generate mood and mind alterations. These are overlapping and intertwined elements, the combination of which amounts to a distinct type of youth party...

  9. Non-invasive extending prosthesis

    OpenAIRE

    Meswania, Jayantilal Mohanlal

    2006-01-01

    Most sarcomas of the bone occur in patients of a relatively young age including skeletally immature patients. Approximately 50 child sarcomas are treated with limb salvage surgery per year in the United Kingdom. These children need an extendible implant that can be lengthened periodically to keep pace with the growth in the opposite limb. Surgically, invasive devices have been used for the past thirty years with intrinsic problems of infection and long-term recurrent trauma to the patient. To...

  10. Black holes from extended inflation

    International Nuclear Information System (INIS)

    Hsu, S.D.H.; Lawrence Berkeley Lab., CA

    1990-01-01

    It is argued that models of extended inflation, in which modified Einstein gravity allows a graceful exit from the false vacuum, lead to copious production of black holes. The critical temperature of the inflationary phase transition must be >10 8 GeV in order to avoid severe cosmological problems in a universe dominated by black holes. We speculate on the possibility that the interiors of false vacuum regions evolve into baby universes. (orig.)

  11. Locating and extending livelihoods research

    DEFF Research Database (Denmark)

    Prowse, Martin

    2008-01-01

    Much poverty and development research is not explicit about its methodology or philosophical foundations. Based on the extended case method of Burawoy and the epistemological standpoint of critical realism, this paper discusses a methodological approach for reflexive inductive livelihoods researc...... that overcomes the unproductive social science dualism of positivism and social constructivism. The approach is linked to a conceptual framework and a menu of research methods that can be sequenced and iterated in light of research questions....

  12. Extended producer responsibility in oligopoly

    OpenAIRE

    Hiroaki Ino

    2007-01-01

    I investigate the optimal environmental tax under a policy based on extended producer responsibility (EPR) in oligopoly markets. I introduce the recycling market and explicitly consider how these policies affect the incentive for recycling. I derive the optimal tax rule, which depends on the weighted sum of the markup in the product market and the markdown in the recycling market. In contrast to the existing works that emphasize that the optimal tax rate is lower than the marginal external da...

  13. Current Perspectives in Cardiac Laterality

    Directory of Open Access Journals (Sweden)

    Marina Campione

    2016-12-01

    Full Text Available The heart is the first organ to break symmetry in the developing embryo and onset of dextral looping is the first indication of this event. Looping is a complex process that progresses concomitantly to cardiac chamber differentiation and ultimately leads to the alignment of the cardiac regions in their final topology. Generation of cardiac asymmetry is crucial to ensuring proper form and consequent functionality of the heart, and therefore it is a highly regulated process. It has long been known that molecular left/right signals originate far before morphological asymmetry and therefore can direct it. The use of several animal models has led to the characterization of a complex regulatory network, which invariably converges on the Tgf-β signaling molecule Nodal and its downstream target, the homeobox transcription factor Pitx2. Here, we review current data on the cellular and molecular bases of cardiac looping and laterality, and discuss the contribution of Nodal and Pitx2 to these processes. A special emphasis will be given to the morphogenetic role of Pitx2 and to its modulation of transcriptional and functional properties, which have also linked laterality to atrial fibrillation.

  14. The cardiac patient in Ramadan

    Science.gov (United States)

    Chamsi-Pasha, Majed; Chamsi-Pasha, Hassan

    2016-01-01

    Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting. PMID:27144139

  15. [Acute cardiac failure in pheochromocytoma.

    DEFF Research Database (Denmark)

    Jønler, Morten; Munk, Kim

    2008-01-01

    Pheochromocytoma (P) is an endocrine catecholamine-secreting tumor. Classical symptoms like hypertension, attacks of sweating, palpitations, headache and palor are related to catecholamine discharge. We provide a case of P in a 71 year-old man presenting with acute cardiac failure, severe reduction...

  16. Lentiginosis, Deafness and Cardiac Abnormalities*

    African Journals Online (AJOL)

    1973-01-06

    Jan 6, 1973 ... death. The familia:l form is milder. The cardiac lesion commonly consists of hypertrophic obstructive cardiomyopathy of either ventricle or abnor- malities of the ECG.' The obstructive lesion may be pro- gressive ... that the more severe cases would be unable to bear child- ren, even if they lived long enough.

  17. Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.

    LENUS (Irish Health Repository)

    O'Donnell, David H

    2012-02-01

    OBJECTIVE: This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. CONCLUSION: Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.

  18. Epidemiology of pediatric cardiac injuries: a National Trauma Data Bank analysis.

    Science.gov (United States)

    Kaptein, Yvonne E; Talving, Peep; Konstantinidis, Agathoklis; Lam, Lydia; Inaba, Kenji; Plurad, David; Demetriades, Demetrios

    2011-08-01

    Few studies of pediatric cardiac injuries have been conducted in large cohorts. We, therefore, investigated the epidemiology of these injuries in the United States. We identified patients with traumatic cardiac injury from the National Trauma Data Bank, using the International Classification of Diseases, Ninth Revision, codes. Demographic data, clinical data, and inhospital outcomes were compared among 5 age groups. A logistic regression model was used to determine adjusted mortality among these groups. Six hundred twenty-six patients met criteria. Fifty-nine percent sustained cardiac contusion; 36%, laceration. Penetrating injuries proved more severe than blunt, having lower average Glasgow Coma Scale (6.8 vs 8.7) and higher percentage of patients with Glasgow Coma Scale of 8 or lower (68% vs 53%). Associated injuries occurred in 484 (77%), most common being lung injuries (46%), hemopneumothorax (37%), and rib fractures (26%). Eleven percent underwent laparotomy; 9%, thoracotomy; 2%, craniotomy/craniectomy; and 0.2%, sternotomy. Complications occurred in 80 (13%), most common being cardiac arrest (4%). Firearm injuries result in the highest mortality rate (76%), compared with other mechanisms (26%-31%). Crude mortality in different age strata showed significant differences that were lost after adjustment for confounding variables. The predominant cardiac injury was blunt (65%; 35% sustained penetrating insults), frequently paired with contusion. Pediatric cardiac injury is associated with excessive inhospital mortality (40%), with no age-related difference in adjusted mortality. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. SELECTING A LOGISTICS SERVICE PROVIDER: A DEFINITION OF CRITERIA THAT CONSIDER THE REQUIREMENTS OF AN EXTERNAL COMPETITIVE ENVIRONMENT

    Directory of Open Access Journals (Sweden)

    Patricija BAJEC

    2017-12-01

    Full Text Available A large number of criteria, the very diverse use of terminology and different classifications of criteria used to select a logistics service provider (LSP reflect the lack of consensus in defining criteria. Moreover, whether the criteria are consistent with external requirements has not been analysed, which are vitally important for the success and competitiveness of the supply chain. This paper therefore presents a carefully prepared and evaluated classification system of criteria aligned with the requirements of the external environment. A multi-stage methodological approach was used. Selection criteria obtained from the systematic review of literature were first carefully analysed to find potential shortcomings. After that, a cluster method was used to reduce the number of criteria and to aggregate similar criteria. A Pareto analysis (75/25 rule was further used to rank the criteria according to their frequency of use and consequently according to importance. The obtained categories of criteria (vitally important criteria (C1, very important criteria (C2, important criteria (C3 and less important criteria (C4, using the AHP method, were compared by the experts to define their weights. This paper summarizes and extends the recent literature through a six-step methodological approach and proposes a new classification system of selection criteria.

  20. 40 CFR 258.24 - Air criteria.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Air criteria. 258.24 Section 258.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Operating Criteria § 258.24 Air criteria. (a) Owners or operators of all MSWLFs must ensure that the units not violate any...

  1. 46 CFR 385.51 - Criteria: Projects.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Criteria: Projects. 385.51 Section 385.51 Shipping... COOPERATIVE AGREEMENTS REGULATIONS Criteria for Award § 385.51 Criteria: Projects. The criteria to be used by MarAd in evaluating all projects prior to award of a grant or cooperative agreement are as follows: (a...

  2. Reflexive criteria of sociological research

    Directory of Open Access Journals (Sweden)

    R T Ubaydullaeva

    2014-12-01

    Full Text Available The article is devoted to the sociological criteria of explaining the way of thinking and actions of subjects, their spiritual and moral positions and intellectual forces that form the laws of social life. The author seeks to adapt such categories as ‘meaning of life’, ‘human dignity’, ‘rationality’ etc. for the purposes of sociological analysis by methodological construction of some real life dichotomies such as ‘subjective meaning and social function’, ‘the real and the ideal’, ‘the demanded and the excluded’. Thus, the author studies economic, political and technical processes in terms of both positivity and negativity of social interaction and states that given the increasing differentiation of the society and the contradictory trends of social development the reflexive criteria that take into account the socio-cultural nature of the man help to find one’s own model of development.

  3. Prioritizing Zakat Core Principles Criteria

    Directory of Open Access Journals (Sweden)

    Aam Slamet Rusydiana

    2017-06-01

    Full Text Available Prioriting Zakat Core Principles CriteriaZakat Institution (OPZ is the intermediary organizations based on social. The entire of operating expense is taken from the zakat and infaq funds collected. The Zakat Core Principles are a starting point for the frameworks and standards of zakat-based governance best practices. The Zakat Core Principles is mainly aimed to improve the quality of the zakat systems by identifying such weaknesses in the existing of supervision and regulation. This study try to prioritize the Principles of ZCP and also the essential criteria from each level using Analytic Hierarchy Process (AHP.There are five core principles of charity principle, consisting of: regulation, supervision, collection and disbursement management, risk management, and audit and transparency. From these principles, the main priority is regulation following with audit and transparency.DOI: 10.15408/ess.v7i2.5275

  4. Four Criteria for Design Theories

    Directory of Open Access Journals (Sweden)

    Peter Hodges

    Full Text Available The goal of this paper is to demonstrate that the adoption of the four criteria we outline will strengthen future design theories and encourage existing design theories to expand or reconfigure in useful directions. We propose four criteria for design theory creation and evaluation. These are (1 the theory should have substantial design applications, and be applicable to any topic; (2 the theory should use propositions—if-then language—as a way of describing, explaining, and predicting actual and existing aspects of designing; (3 where appropriate, a new theory should accept and adopt propositions and language contained in other design theories; and (4 the theory should accommodate, or at least acknowledge, generative activity. We are not proposing a new general design theory—this paper outlines a strong approach to studying and building theory. Please also note that this essay does not pretend to exhaust a topic that has been discussed for at least the last 50 years.

  5. Evaluating Dependence Criteria for Caffeine

    OpenAIRE

    Striley, Catherine L.W.; Griffiths, Roland R.; Cottler, Linda B.

    2011-01-01

    Background: Although caffeine is the most widely used mood-altering drug in the world, few studies have operationalized and characterized Diagnostic and Statistical Manual IV (DSM-IV) substance dependence criteria applied to caffeine. Methods: As a part of a nosological study of substance use disorders funded by the National Institute on Drug Abuse, we assessed caffeine use and dependence symptoms among high school and college students, drug treatment patients, and pain clinic patients who re...

  6. Good Criteria for Supply Chain Performance Measurement

    Directory of Open Access Journals (Sweden)

    Elisa Kusrini

    2014-03-01

    conducted by distributing questionnaires to supply chain actors from different industry fields (both manufacturing and services in Indonesia using random sampling techniques. Data analysis using pairwise comparisons with an analytical Hierarchy Process model showed that efficient criteria were more important than effective criteria. Efficient criteria consisted of three sub-criteria: the amount of data is not too much and low cost and output is presented in a simple form. Effective criteria consisted of the criteria in the order of importance as follows: clarity, validity, comprehensiveness, responsiveness and dynamics. Further research is needed for developing a model that meets these criteria

  7. Repository operational criteria comparative analysis

    Energy Technology Data Exchange (ETDEWEB)

    Hageman, J.P.; Chowdhury, A.H. [Southwest Research Inst., San Antonio, TX (United States). Center for Nuclear Waste Regulatory Analyses

    1994-06-01

    The objective of the ``Repository Operational Criteria (ROC) Feasibility Studies`` (or ROC task) was to conduct comprehensive and integrated analyses of repository design, construction, and operations criteria in 10 CFR Part 60 regulations considering the interfaces among the components of the regulations and impacts of any potential changes to those regulations. The ROC task addresses regulatory criteria and uncertainties related to the preclosure aspects of the geologic repository. Those parts of 10 CFR Part 60 that require routine guidance or minor changes to the rule were addressed in Hageman and Chowdhury, 1992. The ROC task shows a possible need for further regulatory clarity, by major changes to the rule, related to the design bases and siting of a geologic repository operations area and radiological emergency planning in order to assure defense-in-depth. The analyses, presented in this report, resulted in the development and refinement of regulatory concepts and their supporting rationale for recommendations for potential major changes to 10 CFR Pan 0 regulations.

  8. Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy

    Directory of Open Access Journals (Sweden)

    Lidija Poposka

    2018-02-01

    Full Text Available INTRODUCTION: Although strict selection criteria are used to select patients for cardiac resynchronisation therapy, up to 30% of patients do not have a positive clinical response. PATIENTS: A total of 102 consecutive patients who had biventricular pacemaker/defibrillator (CRT-P or CRT-D implanted were enrolled in this prospective observational study. RESULTS: During the average follow-up period of 24.3 months 5 patients died and 17 (16.7% patients were hospitalised with the symptoms of heart failure; 75 (73.5% patients were responders based on the previously defined criteria. Responders in the group of LBBB patients kept the significant difference in a computed variable (S1 + R6 - (S6 + R1 and R6/S6 ratio. Responders in non-LBBB patients kept the significant difference only in the height of R waves in V6. The R6/S6 ratio tended to be higher, but it did not reach a statistical significance. CONCLUSION: None of the tested ECG parameters stands out as an independent predictor of response to cardiac resynchronisation therapy, but some of them were different in responder-compared to the non-responder group. The amplitude of R wave in V6, higher R/S ratio in V6 and higher computed variable (S1 + R6 - (S6 + R1 may predict the likelihood of response to CRT therapy in both LBBB-patients and non-LBBB patients.

  9. Incremental value of anemia in cardiac surgical risk prediction with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II model.

    Science.gov (United States)

    Scrascia, Giuseppe; Guida, Pietro; Caparrotti, Sergio Maria; Capone, Giuseppe; Contini, Marco; Cassese, Mauro; Fanelli, Vitantonio; Martinelli, Gianluca; Mazzei, Valerio; Zaccaria, Salvatore; Paparella, Domenico

    2014-09-01

    Anemia is a risk factor for adverse events after cardiac operations. We evaluated the incremental value of preoperative anemia over the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II to predict hospital death after cardiac operations. Data for 4,594 consecutive adults (1,548 women [33.7%]), aged 67 ± 11 years, who underwent cardiac operations from January 2011 to July 2013 were extracted from the Regional Cardiac Surgery Registry of Puglia. The last preoperative hemoglobin value was used, according to World Health Organization criteria, to classify anemia as mild (hemoglobin 11.0 to 12.9 g/dL in men and 11.0 to 11.9 g/dL in women) in 1,021 patients (22.2%) and as moderate to severe (hemoglobin anemia, with model discrimination quantified by C statistic and risk classification by the use of net reclassification improvement (NRI). Overall expected and observed mortality rates were 4.4% and 5.9%. Anemia was significantly associated with a mortality rate of 3.4% in patients without anemia, 7.7% in mild anemia, and 15.7% in moderate to severe anemia (p anemia was analyzed with EuroSCORE II, the model improved in discrimination (C statistic = 0.852 vs 0.860; p = 0.007) and reclassification (category free-NRI, 0.592; p anemia has strong association with operative death in cardiac surgical patients. Anemia provides significant incremental value over the EuroSCORE II and should be considered for assessment of cardiac surgical risk. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. How Turkey Meets MPOWER Criteria?

    Directory of Open Access Journals (Sweden)

    Nazmi Bilir

    2013-02-01

    Full Text Available In 2003 World Health Assembly adopted an international treaty on tobacco control; FCTC, Framework Convention on Tobacco Control. Five year later World Health Organization (WHO declared the six effective approach for tobacco control, under the name of MPOWER. In the following years, WHO evaluated the level of implementation of MPOWER criteria in the countries. In this article, how Turkey implemented these six criteria will be discussed. Monitor tobacco use and prevention policies: Monitoring of tobacco use prevalence has been successfully monitored in Turkey through Global Adult Tobacco Survey, Global Youth Tobacco Survey and Health Professionals Tobacco Use Survey. Nevertheless, monitoring of tobacco industry activities was not successfully implemented. Protect people from tobacco smoke: Smoking was banned in most of the indoor public places in Turkey since 1996, and Turkey became a complete smoke-free country by the exposion of smoke-free places including the hospitality workplaces in 2008. Offer help to quit tobacco use: Although smoking cessation services has been a bit late in Turkey, availability of smoking cessation drugs and the establishment of free quitline services made Turkey successful in this regard. Warn about the dangers of tobacco: Since 1996, all TV channels have a duty of broadcasting programs on harms of tobacco use, not less than 90 minutes in a month and it has been implemented successfully. Additionally written messages indicating harms of tobacco has been printed on the packs since 1988 and pictures was added in 2010. But since the average surface area covered by the messages in less than 50% of the total surface of the pack, Turkey was not regarded as to meet the requirement. Enforce bans on tobacco advertising, promotion and sponsorship: All kinds of tobacco advertisement and promotion was banned by the Law in 1996. But the tobacco products was not in closed boxes at the sales points. Turkey was not found as successful

  11. Cardiac GPCR-Mediated EGFR Transactivation: Impact and Therapeutic Implications.

    Science.gov (United States)

    Grisanti, Laurel A; Guo, Shuchi; Tilley, Douglas G

    2017-07-01

    G protein-coupled receptors (GPCRs) remain primary therapeutic targets for numerous cardiovascular disorders, including heart failure (HF), because of their influence on cardiac remodeling in response to elevated neurohormone signaling. GPCR blockers have proven to be beneficial in the treatment of HF by reducing chronic G protein activation and cardiac remodeling, thereby extending the lifespan of patients with HF. Unfortunately, this effect does not persist indefinitely, thus next-generation therapeutics aim to selectively block harmful GPCR-mediated pathways while simultaneously promoting beneficial signaling. Transactivation of epidermal growth factor receptor (EGFR) has been shown to be mediated by an expanding repertoire of GPCRs in the heart, and promotes cardiomyocyte survival, thus may offer a new avenue of HF therapeutics. However, GPCR-dependent EGFR transactivation has also been shown to regulate cardiac hypertrophy and fibrosis by different GPCRs and through distinct molecular mechanisms. Here, we discuss the mechanisms and impact of GPCR-mediated EGFR transactivation in the heart, focusing on angiotensin II, urotensin II, and β-adrenergic receptor systems, and highlight areas of research that will help us to determine whether this pathway can be engaged as future therapeutic strategy.

  12. Entropy Rate Maps of Complex Excitable Dynamics in Cardiac Monolayers

    Directory of Open Access Journals (Sweden)

    Alexander Schlemmer

    2015-02-01

    Full Text Available The characterization of spatiotemporal complexity remains a challenging task. This holds in particular for the analysis of data from fluorescence imaging (optical mapping, which allows for the measurement of membrane potential and intracellular calcium at high spatial and temporal resolutions and, therefore, allows for an investigation of cardiac dynamics. Dominant frequency maps and the analysis of phase singularities are frequently used for this type of excitable media. These methods address some important aspects of cardiac dynamics; however, they only consider very specific properties of excitable media. To extend the scope of the analysis, we present a measure based on entropy rates for determining spatiotemporal complexity patterns of excitable media. Simulated data generated by the Aliev–Panfilov model and the cubic Barkley model are used to validate this method. Then, we apply it to optical mapping data from monolayers of cardiac cells from chicken embryos and compare our findings with dominant frequency maps and the analysis of phase singularities. The studies indicate that entropy rate maps provide additional information about local complexity, the origins of wave breakup and the development of patterns governing unstable wave propagation.

  13. Using a Combined Platform of Swarm Intelligence Algorithms and GIS to Provide Land Suitability Maps for Locating Cardiac Rehabilitation Defibrillators.

    Science.gov (United States)

    Kaffash-Charandabi, Neda; Sadeghi-Niaraki, Abolghasem; Park, Dong-Kyun

    2015-08-01

    Cardiac arrest is a condition in which the heart is completely stopped and is not pumping any blood. Although most cardiac arrest cases are reported from homes or hospitals, about 20% occur in public areas. Therefore, these areas need to be investigated in terms of cardiac arrest incidence so that places of high incidence can be identified and cardiac rehabilitation defibrillators installed there. In order to investigate a study area in Petersburg, Pennsylvania State, and to determine appropriate places for installing defibrillators with 5-year period data, swarm intelligence algorithms were used. Moreover, the location of the defibrillators was determined based on the following five evaluation criteria: land use, altitude of the area, economic conditions, distance from hospitals and approximate areas of reported cases of cardiac arrest for public places that were created in geospatial information system (GIS). The A-P HADEL algorithm results were more precise about 27.36%. The validation results indicated a wider coverage of real values and the verification results confirmed the faster and more exact optimization of the cost function in the PSO method. The study findings emphasize the necessity of applying optimal optimization methods along with GIS and precise selection of criteria in the selection of optimal locations for installing medical facilities because the selected algorithm and criteria dramatically affect the final responses. Meanwhile, providing land suitability maps for installing facilities across hot and risky spots has the potential to save many lives.

  14. Coronary ostial involvement in acute aortic dissection: detection with 64-slice cardiac CT.

    LENUS (Irish Health Repository)

    Ryan, E Ronan

    2012-02-01

    A 41-year-old man collapsed after lifting weights at a gym. Following admission to the emergency department, a 64-slice cardiac computed tomography (CT) revealed a Stanford Type A aortic dissection arising from a previous coarctation repair. Multiphasic reconstructions demonstrated an unstable, highly mobile aortic dissection flap that extended proximally to involve the right coronary artery ostium. Our case is an example of the application of electrocardiogram-gated cardiac CT in directly visualizing involvement of the coronary ostia in acute aortic dissection, which may influence surgical management.

  15. Perioperative THR-184 and AKI after Cardiac Surgery.

    Science.gov (United States)

    Himmelfarb, Jonathan; Chertow, Glenn M; McCullough, Peter A; Mesana, Thierry; Shaw, Andrew D; Sundt, Thoralf M; Brown, Craig; Cortville, David; Dagenais, François; de Varennes, Benoit; Fontes, Manuel; Rossert, Jerome; Tardif, Jean-Claude

    2018-02-01

    AKI after cardiac surgery is associated with mortality, prolonged hospital length of stay, use of dialysis, and subsequent CKD. We evaluated the effects of THR-184, a bone morphogenetic protein-7 agonist, in patients at high risk for AKI after cardiac surgery. We conducted a randomized, double-blind, placebo-controlled, multidose comparison of the safety and efficacy of perioperative THR-184 using a two-stage seamless adaptive design in 452 patients between 18 and 85 years of age who were scheduled for nonemergent cardiac surgery requiring cardiopulmonary bypass and had recognized risk factors for AKI. The primary efficacy end point was the proportion of patients who developed AKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The proportion of patients who developed AKI within 7 days of surgery was similar in THR-184 treatment groups and placebo groups (range, 74%-79%; P =0.43). Prespecified secondary end point analysis did not show significant differences in the severity of AKI stage ( P =0.53) or the total duration of AKI ( P =0.44). A composite of death, dialysis, or sustained impaired renal function by day 30 after surgery did not differ between groups (range, 11%-20%; P =0.46). Safety-related outcomes were similar across all treatment groups. In conclusion, compared with placebo, administration of perioperative THR-184 through a range of dose exposures failed to reduce the incidence, severity, or duration of AKI after cardiac surgery in high-risk patients. Copyright © 2018 by the American Society of Nephrology.

  16. Outcome from paediatric cardiac arrest associated with trauma.

    Science.gov (United States)

    Crewdson, K; Lockey, D; Davies, G

    2007-10-01

    To examine survival rates for paediatric trauma patients requiring cardiopulmonary resuscitation (CPR) in the pre-hospital setting, and to identify characteristics that may be associated with survival. Ten-year retrospective trauma database review. An urban physician-led pre-hospital trauma service serving a population of approximately 7.5 million, in the United Kingdom. Eighty paediatric trauma patients (15 years or less) who received pre-hospital resuscitation following cardiorespiratory arrest between July 1994 and June 2004. Pre-hospital cardiopulmonary resuscitation. Survival to hospital discharge. Eighty children met inclusion criteria for the study. Nineteen (23.8%) were discharged alive from the emergency department and seven children (8.75%) survived to hospital discharge. Of the seven survivors, one had spinal cord injury. Two suffered asphyxial injury associated with blunt trauma and three sustained hypoxic insults following drowning or burns/smoke inhalation. In one patient with known congenital cardiac disease the cause of cardiac arrest was likely to have been medical. This study confirms the poor outcome for children requiring pre-hospital CPR following trauma. However, the results are better in this physician-attended group than in other studies where physicians were not present. They also suggest that cardiac arrest associated with trauma in children has a better outcome than in adults. In common with adults treated in this system, those patients with hypovolaemic cardiac arrest did not survive (Ann Emerg Med 2006;48:240-4). A large proportion of the survivors suffered hypoxic or asphyxial injuries. Targeted aggressive out-of-hospital resuscitation in certain patient groups can produce good outcomes.

  17. Adverse drug reactions in therapeutic hypothermia after cardiac arrest.

    Science.gov (United States)

    Witcher, Robert; Dzierba, Amy L; Kim, Catherine; Smithburger, Pamela L; Kane-Gill, Sandra L

    2017-03-01

    Therapeutic hypothermia (TH) improves survival and neurologic function in comatose survivors of cardiac arrest. Many medications used to support TH have altered pharmacokinetics and pharmacodynamics during this treatment. It is unknown if or at what frequency the medications used during TH cause adverse drug reactions (ADRs). A retrospective chart review was conducted for patients admitted to an intensive care unit (ICU) after cardiac arrest and treated with TH from January 2009 to June 2012 at two urban, university-affiliated, tertiary-care medical centres. Medications commonly used during TH were screened for association with significant ADRs (grade 3 or greater per Common Terminology Criteria for Adverse Events) using three published ADR detection instruments. A total of 229 patients were included, the majority being males with median age of 62 presenting with an out-of-hospital cardiac arrest in pulseless electrical activity or asystole. The most common comorbidities were hypertension, coronary artery disease, and diabetes mellitus. There were 670 possible ADRs and 69 probable ADRs identified. Of the 670 possible ADRs, propofol, fentanyl, and acetaminophen were the most common drugs associated with ADRs. Whereas fentanyl, insulin, and propofol were the most common drugs associated with a probable ADR. Patients were managed with TH for a median of 22 hours, with 38% of patients surviving to hospital discharge. Patients undergoing TH after cardiac arrest frequently experience possible adverse reactions associated with medications and the corresponding laboratory abnormalities are significant. There is a need for judicious use and close monitoring of drugs in the setting of TH until recommendations for dose adjustments are available to help prevent ADRs.

  18. Delirium after cardiac surgery: incidence and risk factors.

    Science.gov (United States)

    Smulter, Nina; Lingehall, Helena Claesson; Gustafson, Yngve; Olofsson, Birgitta; Engström, Karl Gunnar

    2013-11-01

    Delirium after cardiac surgery is a problem with consequences for patients and healthcare. Preventive strategies from known risk factors may reduce the incidence and severity of delirium. The present aim was to explore risk factors behind delirium in older patients undergoing cardiac surgery with cardiopulmonary bypass. Patients (≥70 years) scheduled for routine cardiac surgery were included (n = 142). The patients were assessed and monitored pre-/postoperatively, and delirium was diagnosed from repeated assessments with the Mini-Mental State Examination and the Organic Brain Syndrome Scale, using the DSM-IV-TR criteria. Variables were analysed by uni-/multivariable logistic regression, including both preoperative variables (predisposing) and those extracted during surgery and in the early postoperative period (precipitating). Delirium was diagnosed in 78 patients (54.9%). Delirium was independently associated with both predisposing and precipitating factors (P-value, odds ratio, upper/lower confidence interval): age (0.036, 1.1, 1.0/1.2), diabetes (0.032, 3.5, 1.1/11.0), gastritis/ulcer problems (0.050, 4.0, 1.0/16.1), volume load during operation (0.001, 2.8, 1.5/5.1), ventilator time in ICU (0.042, 1.2, 1.0/1.4), highest temperature recorded in ICU (0.044, 2.2, 1.0/4.8) and sodium concentration in ICU (0.038, 1.2, 1.0/1.4). Delirium was common among older patients undergoing cardiac surgery. Both predisposing and precipitating factors contributed to delirium. When combined, the predictive strength of the model improved. Preventive strategies may be considered, in particular among the precipitating factors. Of interest, delirium was strongly associated with an increased volume load during surgery.

  19. Cardiac troponin: an emerging cardiac biomarker in animal health

    Directory of Open Access Journals (Sweden)

    Vishal V. Undhad

    Full Text Available Analysis of cardiac troponin I (cTn I and T (cTnT are considered the “gold standard” for the non-invasive diagnosis of myocardial injury in human and animals. It has replaced traditionally used cardiac biomarkers such as myoglobin, lactate dehydrogenase (LDH, creatine kinase (CK and CK-MB due to its high sensitivity and specificity for the detection of myocardial injury. Cardiac troponins are proteins that control the calcium-mediated interaction between actin and myosin, allowing contraction at the sarcomere level. Concentration of the cTn can be correlated microscopic lesion and loss of immunolabeling in myocardium damage. Troponin concentration remains elevated in blood for 1-2wks so that wide window is available for diagnosis of myocardial damage. The cTn test has >95% specificity and sensitivity and test is less time consuming (10 to 15 minutes and less costly (INR 200 to INR 500. [Vet. World 2012; 5(8.000: 508-511

  20. Guidance for Decision Making based on Extended PSA. Volume 1 - Summary report

    International Nuclear Information System (INIS)

    Loeffler, H.; Kumar, M.; Raimond, E.

    2016-01-01

    This report of ASAMPSA-E project is a summary report of the WP30 activities which were intended to develop guidance on decision-making process based on extended PSA results, when the PSA scope has been extended to all sources of radioactivity, all internal and relevant external events. It summarizes the ASAMPSA-E recommendations on: - the lessons of Fukushima Dai-ichi accident for PSA, - the risk metrics, - the method for identifying Initiating Events and Hazards for an Extended PSA (screening), - the link between extended PSA and the defense-in-depth concept. The report then provides some general considerations on application of extended PSA results, criteria that can be applied and also some difficulties inherent to the status of extended PSAs. (authors)

  1. Cardiac rhythm, St-t wave-forms, and common electrocardiographic variants among healthy Nigerian children

    Directory of Open Access Journals (Sweden)

    Ibrahim Aliyu

    2016-01-01

    Full Text Available Background: The cardiac rhythm depends on the source and mode of spread of the generated impulse. ST-T segment represents the repolarization phase of the action potential. Racial variability has been established in the morphology of the ST segment among the adult population and four waveforms has been described among Nigerian adults which are different from that of Caucasian adults; therefore, there may be differences among the pediatric population. Materials and Methods: This study was a further review of the electrocardiograph (ECG of 650 apparently healthy primary school children aged 5-15 years, in Kano metropolis. Twelve-lead ECG was recorded, and interpretation was manually done. The subjects were categorized into three age groups namely 5-7, 8-11, and 12-15 years, respectively. The ST segment morphology was classified using Araoye′s criteria. Results: Early repolarization changes were recorded in the 12-15 years age-group. The presence of ECG variants such as T-wave inversion in precordial leads V 1 -V 3 was reported and left axis deviation was documented in 0.4% of the 5-7 years age-group. Type I morphology was common in leads I, II, aVF, V 5 , V 6 . Type II morphology was common in leads I, II, V 4 R, V 5 , V 6 , while Type III morphology was common in leads V 4 R, V 5 , V 6 but Type IV morphology was seen mostly in V 1 . Conclusion: ST-segment elevation in the right precordial leads is a common finding in the pediatric ECG among Nigerian children; furthermore, T-wave inversion is also common in the right precordial leads and may extend way beyond precordial lead V 2 unlike in Caucasians.

  2. [Cardiac catheterization and pulmonary vasoreactivity testing in children with idiopathic pulmonary arterial hypertension].

    Science.gov (United States)

    Zhang, Chen; Li, Qiangqiang; Liu, Tianyang; Gu, Hong

    2014-06-01

    As an important method of hemodynamic assessment in idiopathic pulmonary arterial hypertension (IPAH), cardiac catheterization combined with pulmonary vasoreactivity testing remains with limited experience in children, and the acute pulmonary vasodilator agents as well as response criteria for vasoreactivity testing remain controversial. The aim of this study was to investigate the clinical importance, agent selection, and responder definition of cardiac catheterization combined with pulmonary vasoreactivity testing in pediatric IPAH. The patients admitted to Department of Pediatric Cardiology of Beijing Anzhen Hospital between April 2009 and September 2013 with suspected IPAH, under 18 years of age, with WHO functional class II or III, were enrolled. All the patients were arranged to receive left and right heart catheterization and pulmonary vasoreactivity testing with inhalation of pure oxygen and iloprost (PGI2) respectively. Hemodynamic changes were analyzed, and two criteria, the European Society of Cardiology recommendation criteria (Sitbon criteria) and traditional application criteria (Barst criteria), were used to evaluate the test results. Thirty-nine cases of children with suspected IPAH underwent cardiac catheterization. In 4 patients IPAH was excluded; 4 patients developed pulmonary hypertension crisis. The other 31 patients received standard cardiac catheterization and pulmonary vasoreactivity testing. Baseline mean pulmonary artery pressure (mPAP) was (66 ± 16) mmHg (1 mmHg = 0.133 kPa), and pulmonary vascular resistance index (PVRI) (17 ± 8) Wood U · m². After inhalation of pure oxygen, mPAP fell to (59 ± 16) mmHg, and PVRI to (14 ± 8) Wood U · m² (t = 4.88 and 4.56, both P hypertension crisis is an important complication of cardiac catheterization in pediatric IPAH. Younger age, general anesthesia, crisis history, and poor heart function are important risk factors for pulmonary hypertension crisis. PGI2 is a relatively ideal agent for

  3. Extended inflation with induced gravity

    International Nuclear Information System (INIS)

    Accetta, F.S.; Trester, J.J.; Department of Physics, Yale University, New Haven, Connecticut 06520)

    1989-01-01

    We consider a recently proposed extended model of inflation which improves upon the original old inflation scenario by achieving a graceful exit from the false-vacuum phase. In this paper extended inflation is generalized to include a potential V(phi) for the Brans-Dicke-type field phi. We find that whereas a graceful exit can still be had, the inclusion of a potential places constraints on the percolation time scale for exiting the inflationary phase. Additional constraints on V(phi) and the false-vacuum energy density rho /sub F/ from density and gravitational-wave perturbations are discussed. For initially small values of phi the false vacuum undergoes power-law inflation, while for initially large values of phi the expansion is exponential. Within true-vacuum regions slow-rolling inflation can occur. As a result, this model generically leads to multiple episodes of inflation. We discuss the significance these multiple episodes of inflation may have on the formation of large-scale structure and the production of voids

  4. Quality criteria for landscape visualisation

    International Nuclear Information System (INIS)

    Waldi, H.-P.; Witt, U. de

    1996-01-01

    The rapid expansion of wind energy utilisation in Western Europe can strain the limits of social acceptance with citizens living in wind development areas. One of the problems wind farm engineers and local authorities face is the visual impact of wind turbines. To determine the influence on the landscape visualisations of wind farms photorealistic compositions are used. In many cases it is part of the planning procedure. The quality of this visualization can strongly influence the success of the permission procedure. We will give criteria which can give help to reduce the possibility of unwanted manipulations. (author)

  5. Training review criteria and procedures

    International Nuclear Information System (INIS)

    1993-01-01

    This document provides direction to NRC personnel for reviewing training programs at nuclear power plants to verify compliance with the requirements of 10 CFR 50. 120 and 10 CFR 55 as applicable. It describes the process for evaluating the effectiveness of training programs, provides aids for collection of information during interviews and observations, and provides criteria for evaluating the implementation of a systems approach to training. This document is not intended to have the effect of a regulation, it establishes no binding requirements or interpretations of NRC regulations. It is intended as guidance only

  6. Sudden cardiac death in athletes

    Directory of Open Access Journals (Sweden)

    Fábio Camilo Pellegrino dos Santos

    2012-11-01

    Full Text Available ABSTRACT The most accepted definition of sudden cardiac death nowadays is an unexplained death occurred suddenly within one hour of symptom onset. If it was not witnessed, individuals need to had been observed for at least 24 hours before the event and should be discarded the possibility of non cardiac causes of sudden death, pulmonary embolism or extensive malignancy. The term athlete refers to individuals of any age who participate in collective or individual regular physical activity, as well as physical training program for regular competitions. The sudden death of a young athlete, whether amateur or professional, especially during competitions, is always dramatic, with strong negative social impact and in the media. The fact that sports are recommended as a formula for longevity and quality of life makes these events a cause for concern in sports and society in general.

  7. Massage therapy after cardiac surgery.

    Science.gov (United States)

    Wang, Amy T; Sundt, Thoralf M; Cutshall, Susanne M; Bauer, Brent A

    2010-01-01

    Cardiac surgery presents a life-saving and life-enhancing opportunity to hundreds of thousands of patients each year in the United States. However, many patients face significant challenges during the postoperative period, including pain, anxiety, and tension. Mounting evidence demonstrates that such challenges can impair immune function and slow wound healing, in addition to causing suffering for the patient. Finding new approaches to mitigate these challenges is necessary if patients are to experience the full benefits of surgery. Massage therapy is a therapy that has significant evidence to support its role in meeting these needs. This paper looks at the data surrounding the use of massage therapy in cardiac surgery patients, with a special focus on the experience at Mayo Clinic. Copyright © 2010 Elsevier Inc. All rights reserved.

  8. Cardiac blood pool emission tomography

    International Nuclear Information System (INIS)

    Itti, R.; Philippe, L.; Lorgeron, J.M.; Charbonnier, B.; Raynaud, P.; Brochier, M.

    1983-01-01

    After blood pool labeling using technetium-99m, a series of cardiac pictures is acquired during the rotation of a gamma-camera about the patient. Computer processing leads to reconstruction of various tomographic slices from the original planar projection. Electrocardiographic gating selects the different phases of the cardiac cycle. Individual slices through the left ventricular region are added in order to provide ''thick'' slices on which global and regional parameters of the left ventricular function can be determined. Due to the proportionality existing between count rates and labeled blood volumes, any geometrical model can be avoided. The delineation of regions of interest for count integration is made easier due to the absence of superimposition of structures; no correction for background is necessary. Tomography thus appears to be more consistent and more accurate than the classical methods using planar projections. In addition, right ventricular morphological and kinetic studies can be performed in the same conditions as for the left ventricle [fr

  9. Impact of interventricular lead distance and the decrease in septal-to-lateral delay on response to cardiac resynchronization therapy

    NARCIS (Netherlands)

    Buck, Sandra; Maass, Alexander H.; Nieuwland, Wybe; Anthonio, Rutger L.; Van Veldhuisen, Dirk J.; Van Gelder, Isabelle C.

    2008-01-01

    Aims To investigate the influence of interlead distance and lead positioning on success of cardiac resynchronization therapy (CRT) in patients with advanced chronic heart failure and electrical dyssynchrony. Despite application of established selection criteria, 20-40% of the patients do not respond

  10. Cardiac surgery in the parturient.

    Science.gov (United States)

    Chandrasekhar, Shobana; Cook, Christopher R; Collard, Charles D

    2009-03-01

    Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.

  11. The paediatrician and cardiac auscultation

    OpenAIRE

    Roy, Douglas L

    2003-01-01

    The cardiac auscultation (CA) skills of paediatric residents and office-based paediatricians have recently been shown to be suboptimal. CA is known to have a high degree of specificity and sensitivity, and is inexpensive. New teaching aids and availability of surrogate patient heart sounds and murmurs now allow most physicians to acquire CA skills. These teaching aids should be available in all medical schools and in all postgraduate paediatric training programs. While the relationship betwee...

  12. Neurological Complications of Cardiac Surgery

    OpenAIRE

    Gottesman, Rebecca F.; McKhann, Guy M.; Hogue, Charles W.

    2008-01-01

    Neurological injury resulting from cardiac surgery has a range of manifestations from focal neurological deficit to encephalopathy or coma. As the safety of drug-eluting stents comes into question, more patients will likely undergo coronary artery bypass graft surgery. These projections, along with the growing proportions of elderly patients and those with comorbidities, portend the potential for rising rates of perioperative neurological complications. The risk for neurological injury may be...

  13. Clinical application of cardiac SPECT

    International Nuclear Information System (INIS)

    Nishimura, Shigeyuki

    1999-01-01

    Single-photon emission computed tomography (SPECT) has replaced planar imaging techniques for myocardial scintigraphy. Thallium-201 was the dominant agent employed for myocardial perfusion imaging. Today new technetium-99m labelled radionuclides have been used as excellent alternatives to 201 Tl for detection of coronary artery disease, prognostification, and even assessment of myocardial viability. Pharmacologic stress imaging using either dipyridamole, adenosine or dobutamine is a substitute for exercise stress. Accurate determination of myocardial viability is vitally important for clinical decision making for patients with LV dysfunction who will most benefit from revascularization. Stunned and hibernated myocardium may result in profound regional LTV dysfunction in absence of necrosis. The various approach such as stress-redistribution-reinjection imaging, rest-redistribution imaging and stress-redistribution-24 hours delayed imaging has been utilized to assess myocardial viability with 201 Tl. Quantitative assessment of 99m Tc MIBI uptake reflect the degree of viability. 123 I-Metaiodobenzylguanidine (MIBG), an analog of norepinephrine, has been used for scintigraphic assessment of regional cardiac adrenergic innervation. Cardiac sympathetic denervation, assessed by 123 I-MIBG, due to ischemia in non-Q myocardial infarction and unstable angina has been shown. Quantitative cardiac MIBG scintigram was shown to have prognostic value in patients with severe congestive heart failure. 23 I-BMIPP (ρ-methyl-iodophenyl pentadecanoic acid) has been used to assess myocardial fatty acid utilization. BMIPP has the memory function of ischemia in unstable angina, since decreased BMIPP uptake persists several days after ischemic episode. Nuclear cardiology in Japan has experienced an expansion in the techniques including use of new radionuclides, 99m Tc perfusion agents, 123 I-MIBG and 23 I-BMIPP and in associated clinical application to the various cardiac diseases

  14. Clinical application of cardiac SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Shigeyuki [Yokohama Rosai Hospital (Japan)

    1999-07-01

    Single-photon emission computed tomography (SPECT) has replaced planar imaging techniques for myocardial scintigraphy. Thallium-201 was the dominant agent employed for myocardial perfusion imaging. Today new technetium-99m labelled radionuclides have been used as excellent alternatives to {sup 201}Tl for detection of coronary artery disease, prognostification, and even assessment of myocardial viability. Pharmacologic stress imaging using either dipyridamole, adenosine or dobutamine is a substitute for exercise stress. Accurate determination of myocardial viability is vitally important for clinical decision making for patients with LV dysfunction who will most benefit from revascularization. Stunned and hibernated myocardium may result in profound regional LTV dysfunction in absence of necrosis. The various approach such as stress-redistribution-reinjection imaging, rest-redistribution imaging and stress-redistribution-24 hours delayed imaging has been utilized to assess myocardial viability with {sup 201}Tl. Quantitative assessment of {sup 99m}Tc MIBI uptake reflect the degree of viability. {sup 123}I-Metaiodobenzylguanidine (MIBG), an analog of norepinephrine, has been used for scintigraphic assessment of regional cardiac adrenergic innervation. Cardiac sympathetic denervation, assessed by {sup 123}I-MIBG, due to ischemia in non-Q myocardial infarction and unstable angina has been shown. Quantitative cardiac MIBG scintigram was shown to have prognostic value in patients with severe congestive heart failure. {sup 23}I-BMIPP ({rho}-methyl-iodophenyl pentadecanoic acid) has been used to assess myocardial fatty acid utilization. BMIPP has the memory function of ischemia in unstable angina, since decreased BMIPP uptake persists several days after ischemic episode. Nuclear cardiology in Japan has experienced an expansion in the techniques including use of new radionuclides, {sup 99m}Tc perfusion agents, {sup 123}I-MIBG and {sup 23}I-BMIPP and in associated clinical

  15. Gene Therapy in Cardiac Arrhythmias

    OpenAIRE

    Praveen, S.V; Francis, Johnson; Venugopal, K

    2006-01-01

    Gene therapy has progressed from a dream to a bedside reality in quite a few human diseases. From its first application in adenosine deaminase deficiency, through the years, its application has evolved to vascular angiogenesis and cardiac arrhythmias. Gene based biological pacemakers using viral vectors or mesenchymal cells tested in animal models hold much promise. Induction of pacemaker activity within the left bundle branch can provide stable heart rates. Genetic modification of the AV...

  16. Pregnancy as a cardiac stress model

    Science.gov (United States)

    Chung, Eunhee; Leinwand, Leslie A.

    2014-01-01

    Cardiac hypertrophy occurs during pregnancy as a consequence of both volume overload and hormonal changes. Both pregnancy- and exercise-induced cardiac hypertrophy are generally thought to be similar and physiological. Despite the fact that there are shared transcriptional responses in both forms of cardiac adaptation, pregnancy results in a distinct signature of gene expression in the heart. In some cases, however, pregnancy can induce adverse cardiac events in previously healthy women without any known cardiovascular disease. Peripartum cardiomyopathy is the leading cause of non-obstetric mortality during pregnancy. To understand how pregnancy can cause heart disease, it is first important to understand cardiac adaptation during normal pregnancy. This review provides an overview of the cardiac consequences of pregnancy, including haemodynamic, functional, structural, and morphological adaptations, as well as molecular phenotypes. In addition, this review describes the signalling pathways responsible for pregnancy-induced cardiac hypertrophy and angiogenesis. We also compare and contrast cardiac adaptation in response to disease, exercise, and pregnancy. The comparisons of these settings of cardiac hypertrophy provide insight into pregnancy-associated cardiac adaptation. PMID:24448313

  17. Neurological complications of cardiac surgery.

    Science.gov (United States)

    Gottesman, Rebecca F; McKhann, Guy M; Hogue, Charles W

    2008-11-01

    Neurological injury resulting from cardiac surgery has a range of manifestations from focal neurological deficit to encephalopathy or coma. As the safety of drug-eluting stents comes into question, more patients will likely undergo coronary artery bypass graft surgery. These projections, along with the growing proportions of elderly patients and those with comorbidities, portend the potential for rising rates of perioperative neurological complications. The risk for neurological injury may be determined by the type of procedure, by patient-specific characteristics, and by the extent of cerebral embolization and hypoperfusion during and after surgery. Changes in surgical techniques, including the use of off-pump surgery, have not decreased rates of brain injury from cardiac surgery. When appropriate, modern neuroimaging techniques should be used in postoperative patients to confirm diagnosis, to provide information on potential etiology, to direct appropriate therapy, and to help in prognostication. Management of postoperative medications and early use of rehabilitation services is a recommended strategy to optimize the recovery for individuals with neurological injury after cardiac surgery.

  18. Cardiac MRI in restrictive cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, A. [Department of Cardiovascular Radiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi (India); Singh Gulati, G., E-mail: gulatigurpreet@rediffmail.com [Department of Cardiovascular Radiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi (India); Seth, S. [Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi (India); Sharma, S. [Department of Cardiovascular Radiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi (India)

    2012-02-15

    Restrictive cardiomyopathy (RCM) is a specific group of heart muscle disorders characterized by inadequate ventricular relaxation during diastole. This leads to diastolic dysfunction with relative preservation of systolic function. Although short axis systolic function is usually preserved in RCM, the long axis systolic function may be severely impaired. Confirmation of diagnosis and information regarding aetiology, extent of myocardial damage, and response to treatment requires imaging. Importantly, differentiation from constrictive pericarditis (CCP) is needed, as only the latter is managed surgically. Echocardiography is the initial cardiac imaging technique but cannot reliably suggest a tissue diagnosis; although recent advances, especially tissue Doppler imaging and spectral tracking, have improved its ability to differentiate RCM from CCP. Cardiac catheterization is the reference standard, but is invasive, two-dimensional, and does not aid myocardial characterization. Cardiac magnetic resonance (CMR) is a versatile technique providing anatomical, morphological and functional information. In recent years, it has been shown to provide important information regarding disease mechanisms, and also been found useful to guide treatment, assess its outcome and predict patient prognosis. This review describes the CMR features of RCM, appearances in various diseases, its overall role in patient management, and how it compares with other imaging techniques.

  19. Topics in Extended Dynamical Systems

    Science.gov (United States)

    Bhagavatula, Ravi S.

    This thesis consists of three chapters. Each chapter is self-contained and is devoted to the investigation of a particular topic in extended dynamical systems. In the first chapter, an approach based on Langevin equations is implemented to understand the non-Gaussian nature of the probability distribution function (PDF) of local diffusive variables in extended dynamical systems, e.g., a passive scalar advected by turbulent velocity fluctuations. Two mechanisms are proposed for the origin of non-Gaussian tails: One relies on the nature of temporal correlations of the fluctuations that couple additively to the diffusive field, leading to exponential and stretched exponential tails in the PDF; the other depends on multiplicative coupling between the diffusive field and the fluctuations, producing algebraic tails in the PDF. The mechanisms are illustrated using models for a passive scalar and also a current driven Josephson junction array. This study indicates that shapes of local PDFs in turbulent states are non-universal and crucially depend on local couplings and time scales. The second chapter establishes the existence of a class of locally conserving chaotic (deterministic) systems that exhibit Generic Scale Invariance--algebraic decay of spatial and temporal correlations without tuning parameters. This study also reveals the similarity between noise and chaos in extended systems as far as long-wavelength and long -time behavior is concerned. Specifically, a two dimensional coupled-map lattice model with a conserved density is numerically shown to exhibit, in agreement with heuristic arguments, algebraic decay of spatio-temporal correlations in chaotic states with simple predictable exponents. The third chapter investigates scaling behavior of earthquakes in seismic zone models in which an earthquake is modeled by a quasi-static description that ignores short -time dynamics during an earthquake. The models incorporate the essential feature of long-ranged stress

  20. Recalls of cardiac implants in the last decade: what lessons can we learn?

    Directory of Open Access Journals (Sweden)

    Shixuan Zhang

    Full Text Available Due to an ageing population and demographic changes worldwide, a higher prevalence of heart disease is forecasted, which causes an even higher demand for cardiac implants in future. The increasing high incidence of clinical adverse events attributed especially to high-risk medical devices has led an advocated change from many stakeholders. This holds especially true for devices like cardiac implants, with their high-risk nature and high complication rates associated with considerable mortality, due to their frequent use in older populations with frequent co-morbidities. To ensure patients' safety, the objective of this study is to analyze different cardiac implants recall reasons and different recall systems, based on an overview of the recalls of cardiac implant medical devices in the last decade. On the basis of the results from this structured analysis, this study provides recommendations on how to avoid such recalls from a manufacturer perspective, as well as how to timely react to an adverse event from a post-surveillance system perspective.A systematic search of cardiac implant recalls information has been performed in the PubMed, ScienceDirect and Scopus databases, as well as data sources in regulatory authorities from 193 UN Member States. Data has been extracted for the years 2004-2014 with the following criteria applied: cardiac implant medical device recalls and reasons for recall, associated harm or risk to patients. From the data sources described above, eleven regulatory authorities and 103 recall reports have been included in this study. The largest cardiac implant categories include ICDs 40.8%, pacemakers 14.5% and stents 14.5%. Regarding the recall reasons, the majority of reports were related to device battery problems (33.0% and incorrect therapy delivery (31.1%. From a total of 103 recall reports, five reported death and serious injuries. Our review highlights weaknesses in the current cardiac implant recall system, including

  1. Nuclear reactor philosophy and criteria

    International Nuclear Information System (INIS)

    Atchison, R.J.

    1979-07-01

    Nuclear power plant safety criteria and principles developed in Canada are directed towards minimizing the chance of failure of the fuel and preventing or reducing to an acceptably low level the escape of fission products should fuel failure occur. Safety criteria and practices are set forth in the Reactor Siting Guide, which is based upon the concept of defence in depth. The Guide specifies that design and construction shall follow the best applicable code, standard or practice; the total of all serious process system failures shall not exceed one in three years; special safety systems are to be physically and functionally separate from process systems and each other; and safety systems shall be testable, with unavailability less than 10 - 3 . Doses to the most exposed member of the public due to normal operation, serious process failures, and dual failures are specified. Licensees are also required to consider the effects of extreme conditions due to airplane crashes, explosions, turbine disintegration, pipe burst, and natural disasters. Safety requirements are changing as nuclear power plant designs evolve and in response to social and economic pressures

  2. Donor selection criteria and procurement

    International Nuclear Information System (INIS)

    Agcaoili, N.R.

    1999-01-01

    Donor selection is one of the most important aspects of tissue banking practice. Without a good donor selection criteria, the results of any effort of trying to preserve tissues will have disastrous outcome for the recipient of these tissues. While with a very good and strict donor selection the Tissue Bank can guarantee safe and effective tissue allografts. There are significant aspects in the history and physical examination of the donor that must be emphasized. A donor exclusion criteria has also been formulated together with a list of all the needed laboratory examinations to eliminate possible diseases that may be transferred from the donor. The methods of procurement of tissue allografts from living and cadaver donors will be described. The limitations and advantages of each will be taken.There are also special restrictions that are important in the practice of removing the tissues from the donors. All the necessary equipment should be ready and the potential risk on the personnel should be known to all doing Tissue Banking

  3. Preoperative renin-angiotensin system inhibitors protect renal function in aging patients undergoing cardiac surgery.

    Science.gov (United States)

    Barodka, Viachaslau; Silvestry, Scott; Zhao, Ning; Jiao, Xiangyin; Whellan, David J; Diehl, James; Sun, Jian-Zhong

    2011-05-15

    Renal failure (RF) represents a major postoperative complication for elderly patients undergoing cardiac surgery. This observational cohort study examines effects of preoperative use of renin-angiotensin system (RAS) inhibitors on postoperative renal failure in aging patients undergoing cardiac surgery. We retrospectively analyzed a cohort of 1287 patients who underwent cardiac surgery at this institution (2003-2007). The patients included were ≥65 years old, scheduled for elective cardiac surgery, and without preexisting RF (defined by the criteria of the Society of Thoracic Surgeons as described in Method). Of all patients evaluated, 346 patients met the inclusion criteria and were divided into two groups: using (n = 122) or not using (n = 224) preoperative RAS inhibitors. A comparison of the two groups showed no significant differences in baseline parameters, including creatinine clearance, body mass index, history of diabetes and smoking, preoperative medicines (except that more patients with RAS inhibitors had a history of hypertension or congestive heart failure, fewer RAS inhibitor patients had chronic lung disease), in intraoperative perfusion and aortic cross-clamp time, and in postoperative complications and 30-d mortality. Multivariate logistic regression analysis demonstrated, however, that preoperative RAS inhibitors significantly and independently reduced the incidence of postoperative RF in the patients undergoing cardiac surgery compared with those not taking RAS inhibitors: 1.6% versus 7.6%, yielding an odds ratio of 0.19 (95 % CI 0.04-0.84, P = 0.029). Preoperative RAS inhibitors may have significant renoprotective effects for aging patients undergoing elective cardiac surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Extended uncertainty from first principles

    Energy Technology Data Exchange (ETDEWEB)

    Costa Filho, Raimundo N., E-mail: rai@fisica.ufc.br [Departamento de Física, Universidade Federal do Ceará, Caixa Postal 6030, Campus do Pici, 60455-760 Fortaleza, Ceará (Brazil); Braga, João P.M., E-mail: philipe@fisica.ufc.br [Instituto de Ciências Exatas e da Natureza-ICEN, Universidade da Integração Internacional da Lusofonia Afro-Brasileira-UNILAB, Campus dos Palmares, 62785-000 Acarape, Ceará (Brazil); Lira, Jorge H.S., E-mail: jorge.lira@mat.ufc.br [Departamento de Matemática, Universidade Federal do Ceará, Caixa Postal 6030, Campus do Pici, 60455-760 Fortaleza, Ceará (Brazil); Andrade, José S., E-mail: soares@fisica.ufc.br [Departamento de Física, Universidade Federal do Ceará, Caixa Postal 6030, Campus do Pici, 60455-760 Fortaleza, Ceará (Brazil)

    2016-04-10

    A translation operator acting in a space with a diagonal metric is introduced to describe the motion of a particle in a quantum system. We show that the momentum operator and, as a consequence, the uncertainty relation now depend on the metric. It is also shown that, for any metric expanded up to second order, this formalism naturally leads to an extended uncertainty principle (EUP) with a minimum momentum dispersion. The Ehrenfest theorem is modified to include an additional term related to a tidal force arriving from the space curvature introduced by the metric. For one-dimensional systems, we show how to map a harmonic potential to an effective potential in Euclidean space using different metrics.

  5. Learning Extended Finite State Machines

    Science.gov (United States)

    Cassel, Sofia; Howar, Falk; Jonsson, Bengt; Steffen, Bernhard

    2014-01-01

    We present an active learning algorithm for inferring extended finite state machines (EFSM)s, combining data flow and control behavior. Key to our learning technique is a novel learning model based on so-called tree queries. The learning algorithm uses the tree queries to infer symbolic data constraints on parameters, e.g., sequence numbers, time stamps, identifiers, or even simple arithmetic. We describe sufficient conditions for the properties that the symbolic constraints provided by a tree query in general must have to be usable in our learning model. We have evaluated our algorithm in a black-box scenario, where tree queries are realized through (black-box) testing. Our case studies include connection establishment in TCP and a priority queue from the Java Class Library.

  6. Harmonic superspaces of extended supersymmetry

    International Nuclear Information System (INIS)

    Ivanov, E.; Kalitzin, S.; Nguyen Ai Viet; Ogievetsky, V.

    1984-01-01

    The main technical apparatus of the harmonic superspace approach to extended SUSY, the calculus of harmonic variables on homogeneous spaces of the SUSY automorphism groups, is presented in detail for N=2, 3, 4. The basic harmonics for the coset manifolds G/H with G=SU(2), H=U(1); G=SU(3), H=SU(2)xU(1) and H=U(1)xU(1); G=SU(4), H=SU(3)xU(1), H=SU(2)xSU(2)xU(1), H=SU(2)xU(1)xU(1) and H=U(1)xU(1)xU(1); G=USp(2), H=SU(2)xSU(2), H=SU(2)xU(1) and H=U(1)xU(1) are tabulated a number of useful relations among them

  7. Extended mission life support systems

    Science.gov (United States)

    Quattrone, P. D.

    1985-01-01

    Extended manned space missions which include interplanetary missions require regenerative life support systems. Manned mission life support considerations are placed in perspective and previous manned space life support system technology, activities and accomplishments in current supporting research and technology (SR&T) programs are reviewed. The life support subsystem/system technologies required for an enhanced duration orbiter (EDO) and a space operations center (SOC), regenerative life support functions and technology required for manned interplanetary flight vehicles, and future development requirements are outlined. The Space Shuttle Orbiters (space transportation system) is space cabin atmosphere is maintained at Earth ambient pressure of 14.7 psia (20% O2 and 80% N2). The early Shuttle flights will be seven-day flights, and the life support system flight hardware will still utilize expendables.

  8. Extended uncertainty from first principles

    International Nuclear Information System (INIS)

    Costa Filho, Raimundo N.; Braga, João P.M.; Lira, Jorge H.S.; Andrade, José S.

    2016-01-01

    A translation operator acting in a space with a diagonal metric is introduced to describe the motion of a particle in a quantum system. We show that the momentum operator and, as a consequence, the uncertainty relation now depend on the metric. It is also shown that, for any metric expanded up to second order, this formalism naturally leads to an extended uncertainty principle (EUP) with a minimum momentum dispersion. The Ehrenfest theorem is modified to include an additional term related to a tidal force arriving from the space curvature introduced by the metric. For one-dimensional systems, we show how to map a harmonic potential to an effective potential in Euclidean space using different metrics.

  9. Hamiltonian dynamics of extended objects

    International Nuclear Information System (INIS)

    Capovilla, R; Guven, J; Rojas, E

    2004-01-01

    We consider relativistic extended objects described by a reparametrization-invariant local action that depends on the extrinsic curvature of the worldvolume swept out by the object as it evolves. We provide a Hamiltonian formulation of the dynamics of such higher derivative models which is motivated by the ADM formulation of general relativity. The canonical momenta are identified by looking at boundary behaviour under small deformations of the action; the relationship between the momentum conjugate to the embedding functions and the conserved momentum density is established. The canonical Hamiltonian is constructed explicitly; the constraints on the phase space, both primary and secondary, are identified and the role they play in the theory is described. The multipliers implementing the primary constraints are identified in terms of the ADM lapse and shift variables and Hamilton's equations are shown to be consistent with the Euler-Lagrange equations

  10. Hamiltonian dynamics of extended objects

    Energy Technology Data Exchange (ETDEWEB)

    Capovilla, R [Departamento de FIsica, Centro de Investigacion y de Estudios Avanzados del IPN, Apdo Postal 14-740, 07000 Mexico, DF (Mexico); Guven, J [School of Theoretical Physics, Dublin Institute for Advanced Studies, 10 Burlington Road, Dublin 4 (Ireland); Rojas, E [Instituto de Ciencias Nucleares, Universidad Nacional Autonoma de Mexico, Apdo Postal 70-543, 04510 Mexico, DF (Mexico)

    2004-12-07

    We consider relativistic extended objects described by a reparametrization-invariant local action that depends on the extrinsic curvature of the worldvolume swept out by the object as it evolves. We provide a Hamiltonian formulation of the dynamics of such higher derivative models which is motivated by the ADM formulation of general relativity. The canonical momenta are identified by looking at boundary behaviour under small deformations of the action; the relationship between the momentum conjugate to the embedding functions and the conserved momentum density is established. The canonical Hamiltonian is constructed explicitly; the constraints on the phase space, both primary and secondary, are identified and the role they play in the theory is described. The multipliers implementing the primary constraints are identified in terms of the ADM lapse and shift variables and Hamilton's equations are shown to be consistent with the Euler-Lagrange equations.

  11. Proposed Diagnostic Criteria for Smartphone Addiction.

    Science.gov (United States)

    Lin, Yu-Hsuan; Chiang, Chih-Lin; Lin, Po-Hsien; Chang, Li-Ren; Ko, Chih-Hung; Lee, Yang-Han; Lin, Sheng-Hsuan

    2016-01-01

    Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria. We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist's structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists' clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy. Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1) six symptom criteria, (2) four functional impairment criteria and (3) exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%), while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use. The diagnostic criteria of smartphone addiction demonstrated the core symptoms "impaired control" paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment.

  12. The Extended Virgo Cluster Catalog

    Science.gov (United States)

    Rey, Soo-Chang

    2015-08-01

    We present a new catalog of galaxies in the wider region of the Virgo cluster, based on the Sloan Digital Sky Survey (SDSS) Data Release 7. The Extended Virgo Cluster Catalog (EVCC) covers an area of 725 deg2 or 60.1 Mpc2. It is 5.2 times larger than the footprint of the classical Virgo Cluster Catalog (VCC) and reaches out to 3.5 times the virial radius of the Virgo cluster. We selected 1324 spectroscopically targeted galaxies with radial velocities less than 3000 km s-1. In addition, 265 galaxies that have been overlooked in the SDSS spectroscopic survey but have available redshifts in the NASA Extragalactic Database are also included. Our selection process secured a total of 1589 galaxies, 676 of which are not included in the VCC. The certain and possible cluster members are defined by means of redshift comparison with a cluster infall model. We employed two independent and complementary galaxy classification schemes: the traditional morphological classification based on the visual inspection of optical images and a characterization of galaxies from their spectroscopic features. SDSS u, g, r, i, and z passband photometry of all EVCC galaxies was performed using Source Extractor. We compare the EVCC galaxies with the VCC in terms of morphology, spatial distribution, and luminosity function. The EVCC defines a comprehensive galaxy sample covering a wider range in galaxy density that is significantly different from the inner region of the Virgo cluster. It will be the foundation for forthcoming galaxy evolution studies in the extended Virgo cluster region, complementing ongoing and planned Virgo cluster surveys at various wavelengths.

  13. Oral hydromorphone extended-release.

    Science.gov (United States)

    Guay, David R P

    2010-12-01

    To review the chemistry, pharmacodynamics, pharmacokinetics, efficacy, tolerability, dosing, and role of the Osmotic-controlled Release Oral delivery System (OROS) hydromorphone extended-release (ER) tablets. A MEDLINE/PUBMED search (1986-August 2010) was conducted to identify studies in the English language, with additional references being obtained from their bibliographies. All studies of hydromorphone ER were reviewed. This is the second long-acting hydromorphone formulation to receive approval by the Food and Drug Administration (a twice-daily formulation was approved in September 2004, but was subsequently withdrawn in July 2005). Hydromorphone is a semi-synthetic mu-opioid receptor agonist structurally similar to morphine, hydrocodone, and oxymorphone. OROS ER technology allows once-daily dosing. Clinical trials have focused on the convertibility of (an) other opioid(s) to hydromorphone ER in chronic malignant and nonmalignant pain. This product displays the expected opioid side effects, being comparable to oxycodone controlled-release. Coadministration with ethanol does not produce the degree of "dose-dumping" seen with the former hydromorphone twice-daily product or oxymorphone ER. Hydromorphone ER is indicated for the management of moderate-to-severe pain in opioidtolerant patients requiring continuous, around-the-clock opioid analgesia for an extended period of time. Dosage adjustment is recommended in patients with moderate hepatic impairment (Child-Pugh class B) and moderate renal impairment (creatinine clearance of 30-60 mL/min). Hydromorphone ER is the newest oral opioid to enter a crowded marketplace now totaling 15 different Schedule 2 opioids (including tapentadol), and tramadol, available in oral, parenteral, rectal, transdermal, transmucosal, and intranasal formulations. It does not appear to have any unique assets or liabilities and should be considered as one of many oral opioids available for the management of persistent pain of moderate

  14. THE EXTENDED VIRGO CLUSTER CATALOG

    International Nuclear Information System (INIS)

    Kim, Suk; Rey, Soo-Chang; Lee, Youngdae; Chung, Jiwon; Pak, Mina; Yi, Wonhyeong; Lee, Woong; Jerjen, Helmut; Lisker, Thorsten; Sung, Eon-Chang

    2014-01-01

    We present a new catalog of galaxies in the wider region of the Virgo cluster, based on the Sloan Digital Sky Survey (SDSS) Data Release 7. The Extended Virgo Cluster Catalog (EVCC) covers an area of 725 deg 2 or 60.1 Mpc 2 . It is 5.2 times larger than the footprint of the classical Virgo Cluster Catalog (VCC) and reaches out to 3.5 times the virial radius of the Virgo cluster. We selected 1324 spectroscopically targeted galaxies with radial velocities less than 3000 km s –1 . In addition, 265 galaxies that have been overlooked in the SDSS spectroscopic survey but have available redshifts in the NASA Extragalactic Database are also included. Our selection process secured a total of 1589 galaxies, 676 of which are not included in the VCC. The certain and possible cluster members are defined by means of redshift comparison with a cluster infall model. We employed two independent and complementary galaxy classification schemes: the traditional morphological classification based on the visual inspection of optical images and a characterization of galaxies from their spectroscopic features. SDSS u, g, r, i, and z passband photometry of all EVCC galaxies was performed using Source Extractor. We compare the EVCC galaxies with the VCC in terms of morphology, spatial distribution, and luminosity function. The EVCC defines a comprehensive galaxy sample covering a wider range in galaxy density that is significantly different from the inner region of the Virgo cluster. It will be the foundation for forthcoming galaxy evolution studies in the extended Virgo cluster region, complementing ongoing and planned Virgo cluster surveys at various wavelengths

  15. Extended Power Up-rates

    International Nuclear Information System (INIS)

    Jon Ball

    2006-01-01

    Full text of publication follows: Nuclear energy is a reliable and cost-competitive global source of power. With rising oil and gas prices, nuclear continues to provide economic and environmental benefits. Extended Power Up-rate (EPU) provides a means for existing nuclear assets to generate increased power and substantially reduce electrical generation costs. GE Energy's Nuclear Business is the global leader in boiling water reactor (BWR) technology. The experience-base of plants that have successfully achieved EPU includes Spain, Switzerland, Sweden, Germany and the United States. The GE experience-base includes fourteen BWRs with over fifty-eight reactor-years of operating experience at EPU conditions. Other than the expected plant modifications needed to accommodate higher steam flows, flow-induced vibration (FIV) has been identified as the major area of concern when up-rating. Two plants have experienced damage to their steam dryers that has lead to an extensive program to improve the understanding of the effects of up-rates. This program includes extensive in-plant data collection, the development of a scale model test facility to study components susceptible to FIV and improvements in analytical techniques for evaluating loading on reactor internals. As global energy demands increase, oil and gas prices escalate, and environmental concerns over greenhouse effects challenge us to find environmentally friendly sources of energy, Nuclear is the most viable and economical source of power in the world. With a focused effort on plant reliability, existing plants can undergo Extended Power Up-rate, and continue to meet the ever-increasing energy demands in the world. (author)

  16. THE EXTENDED VIRGO CLUSTER CATALOG

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Suk; Rey, Soo-Chang; Lee, Youngdae; Chung, Jiwon; Pak, Mina; Yi, Wonhyeong; Lee, Woong [Department of Astronomy and Space Science, Chungnam National University, 99 Daehak-ro, Daejeon 305-764 (Korea, Republic of); Jerjen, Helmut [Research School of Astronomy and Astrophysics, The Australian National University, Cotter Road, Weston, ACT 2611 (Australia); Lisker, Thorsten [Astronomisches Rechen-Institut, Zentrum für Astronomie der Universität Heidelberg (ZAH), Mönchhofstraße 12-14, D-69120 Heidelberg (Germany); Sung, Eon-Chang [Korea Astronomy and Space Science institute, 776 Daedeokdae-ro, Daejeon 305-348 (Korea, Republic of)

    2015-01-01

    We present a new catalog of galaxies in the wider region of the Virgo cluster, based on the Sloan Digital Sky Survey (SDSS) Data Release 7. The Extended Virgo Cluster Catalog (EVCC) covers an area of 725 deg{sup 2} or 60.1 Mpc{sup 2}. It is 5.2 times larger than the footprint of the classical Virgo Cluster Catalog (VCC) and reaches out to 3.5 times the virial radius of the Virgo cluster. We selected 1324 spectroscopically targeted galaxies with radial velocities less than 3000 km s{sup –1}. In addition, 265 galaxies that have been overlooked in the SDSS spectroscopic survey but have available redshifts in the NASA Extragalactic Database are also included. Our selection process secured a total of 1589 galaxies, 676 of which are not included in the VCC. The certain and possible cluster members are defined by means of redshift comparison with a cluster infall model. We employed two independent and complementary galaxy classification schemes: the traditional morphological classification based on the visual inspection of optical images and a characterization of galaxies from their spectroscopic features. SDSS u, g, r, i, and z passband photometry of all EVCC galaxies was performed using Source Extractor. We compare the EVCC galaxies with the VCC in terms of morphology, spatial distribution, and luminosity function. The EVCC defines a comprehensive galaxy sample covering a wider range in galaxy density that is significantly different from the inner region of the Virgo cluster. It will be the foundation for forthcoming galaxy evolution studies in the extended Virgo cluster region, complementing ongoing and planned Virgo cluster surveys at various wavelengths.

  17. Clinical Trials in Cardiac Arrest and Subarachnoid Hemorrhage: Lessons from the Past and Ideas for the Future

    Directory of Open Access Journals (Sweden)

    Jennifer A. Frontera

    2013-01-01

    Full Text Available Introduction. Elevated intracranial pressure that occurs at the time of cerebral aneurysm rupture can lead to inadequate cerebral blood flow, which may mimic the brain injury cascade that occurs after cardiac arrest. Insights from clinical trials in cardiac arrest may provide direction for future early brain injury research after subarachnoid hemorrhage (SAH. Methods. A search of PubMed from 1980 to 2012 and clinicaltrials.gov was conducted to identify published and ongoing randomized clinical trials in aneurysmal SAH and cardiac arrest patients. Only English, adult, human studies with primary or secondary mortality or neurological outcomes were included. Results. A total of 142 trials (82 SAH, 60 cardiac arrest met the review criteria (103 published, 39 ongoing. The majority of both published and ongoing SAH trials focus on delayed secondary insults after SAH (70%, while 100% of cardiac arrest trials tested interventions within the first few hours of ictus. No SAH trials addressing treatment of early brain injury were identified. Twenty-nine percent of SAH and 13% of cardiac arrest trials showed outcome benefit, though there is no overlap mechanistically. Conclusions. Clinical trials in SAH assessing acute brain injury are warranted and successful interventions identified by the cardiac arrest literature may be reasonable targets of the study.

  18. SELECTION CRITERIA FOR LIVER DONATION - A REVIEW

    NARCIS (Netherlands)

    PRUIM, J; KLOMPMAKER, IJ; HAAGSMA, EB; BIJLEVELD, CMA; SLOOFF, MJH

    An overview of the criteria that are currently being used for the selection of liver donors is presented. The validity of the different criteria is discussed. The potential benefits of introducing other modalities is dealt with.

  19. Mast Cells: Key Contributors to Cardiac Fibrosis

    Directory of Open Access Journals (Sweden)

    Scott P. Levick

    2018-01-01

    Full Text Available Historically, increased numbers of mast cells have been associated with fibrosis in numerous cardiac pathologies, implicating mast cells in the development of cardiac fibrosis. Subsequently, several approaches have been utilised to demonstrate a causal role for mast cells in animal models of cardiac fibrosis including mast cell stabilising compounds, rodents deficient in mast cells, and inhibition of the actions of mast cell-specific proteases such as chymase and tryptase. Whilst most evidence supports a pro-fibrotic role for mast cells, there is evidence that in some settings these cells can oppose fibrosis. A major gap in our current understanding of cardiac mast cell function is identification of the stimuli that activate these cells causing them to promote a pro-fibrotic environment. This review will present the evidence linking mast cells to cardiac fibrosis, as well as discuss the major questions that remain in understanding how mast cells contribute to cardiac fibrosis.

  20. Service and business model for technology enabled and home-based cardiac rehabilitation programs.

    Science.gov (United States)

    Sarela, Antti; Whittaker, Frank; Korhonen, Ilkka

    2009-01-01

    Cardiac rehabilitation programs are comprehensive life-style programs aimed at preventing recurrence of a cardiac event. However, the current programs have globally significantly low levels of uptake. Home-based model can be a viable alternative to hospital-based programs. We developed and analysed a service and business model for home based cardiac rehabilitation based on personal mentoring using mobile phones and web services. We analysed the different organizational and economical aspects of setting up and running the home based program and propose a potential business model for a sustainable and viable service. The model can be extended to management of other chronic conditions to enable transition from hospital and care centre based treatments to sustainable home-based care.

  1. Cardiac tamponade: contrast reflux as an indicator of cardiac chamber equalization

    Directory of Open Access Journals (Sweden)

    Nauta Foeke Jacob

    2012-05-01

    Full Text Available Abstract Background Traumatic hemopericardium remains a rare entity; it does however commonly cause cardiac tamponade which remains a major cause of death in traumatic blunt cardiac injury. Objectives We present a case of blunt chest trauma complicated by cardiac tamponade causing cardiac chamber equalization revealed by reflux of contrast. Case report A 29-year-old unidentified male suffered blunt chest trauma in a motor vehicle collision. Computed tomography (CT demonstrated a periaortic hematoma and hemopericardium. Significant contrast reflux was seen in the inferior vena cava and hepatic veins suggesting a change in cardiac chamber pressures. After intensive treatment including cardiac massage this patient expired of cardiac arrest. Conclusion Reflux of contrast on CT imaging can be an indicator of traumatic cardiac tamponade.

  2. Cardiac-specific ablation of glutaredoxin 3 leads to cardiac hypertrophy and heart failure

    Science.gov (United States)

    Experimental and clinical investigations have demonstrated that reactive oxygen species (ROS) production is increased during cardiac hypertrophy and heart failure. Excess ROS can directly impair cardiac contraction through modification of Ca2+ handling proteins or activate multiple effectors and sig...

  3. Sensing Cardiac Electrical Activity With a Cardiac Myocyte--Targeted Optogenetic Voltage Indicator

    NARCIS (Netherlands)

    Chang Liao, Mei-Ling; de Boer, Teun P|info:eu-repo/dai/nl/30481878X; Mutoh, Hiroki; Raad, Nour; Richter, Claudia; Wagner, Eva; Downie, Bryan R; Unsöld, Bernhard; Arooj, Iqra; Streckfuss-Bömeke, Katrin; Döker, Stephan; Luther, Stefan; Guan, Kaomei; Wagner, Stefan; Lehnart, Stephan E; Maier, Lars S; Stühmer, Walter; Wettwer, Erich; van Veen, Toon|info:eu-repo/dai/nl/229701310; Morlock, Michael M; Knöpfel, Thomas; Zimmermann, Wolfram-Hubertus

    2015-01-01

    RATIONALE: Monitoring and controlling cardiac myocyte activity with optogenetic tools offer exciting possibilities for fundamental and translational cardiovascular research. Genetically encoded voltage indicators may be particularly attractive for minimal invasive and repeated assessments of cardiac

  4. Resin selection criteria for tough composite structures

    Science.gov (United States)

    Chamis, C. C.; Smith, G. T.

    1983-01-01

    Resin selection criteria are derived using a structured methodology consisting of an upward integrated mechanistic theory and its inverse (top-down structured theory). These criteria are expressed in a "criteria selection space" which are used to identify resin bulk properties for improved composite "toughness". The resin selection criteria correlate with a variety of experimental data including laminate strength, elevated temperature effects and impact resistance.

  5. Criteria for onsite transfers of radioactive material

    International Nuclear Information System (INIS)

    Opperman, E.K.; Jackson, E.J.; Eggers, A.G.

    1992-01-01

    A general description of the requirements for making onsite transfers of radioactive material is provided in Chapter 2, along with the required sequencey of activities. Various criteria for package use are identified in Chapters 3-13. These criteria provide protection against undue radiation exposure. Package shielding, containment, and surface contamination requirements are established. Criteria for providing criticality safety are enumerated in Chapter 6. Criteria for providing hazards information are established in Chapter 13. A glossary is provided

  6. Proposed Diagnostic Criteria for Smartphone Addiction

    OpenAIRE

    Lin, Yu-Hsuan; Chiang, Chih-Lin; Lin, Po-Hsien; Chang, Li-Ren; Ko, Chih-Hung; Lee, Yang-Han; Lin, Sheng-Hsuan

    2016-01-01

    Background Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria. Methods We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each parti...

  7. Complexity analysis of experimental cardiac arrhythmia

    OpenAIRE

    Xu, Binbin; Binczak, Stéphane; Jacquir, Sabir; Pont, Oriol; Yahia, Hussein

    2014-01-01

    International audience; To study the cardiac arrhythmia, an in vitro experimental model and Multielectrodes Array (MEA) are used. This platform serves as an intermediary of the electrical activities of cardiac cells and the signal processing / dynamics analysis. Through it the extracellular potential of cardiac cells is acquired, allowing a real-time monitoring / analyzing. Since MEA has 60 electrodes / channels dispatched in a rectangular region, it allows real-time monitoring and signal acq...

  8. 49 CFR 80.15 - Selection criteria.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Selection criteria. 80.15 Section 80.15... § 80.15 Selection criteria. (a) The Secretary shall assign weights as indicated to the following eight selection criteria in evaluating and selecting among eligible projects to receive credit assistance: (1) The...

  9. 28 CFR 34.3 - Selection criteria.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Selection criteria. 34.3 Section 34.3....3 Selection criteria. (a) All individual project applications will, at a minimum, be subject to review based on the extent to which they meet the following general selection criteria: (1) The problem...

  10. 40 CFR 258.40 - Design criteria.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Design criteria. 258.40 Section 258.40... SOLID WASTE LANDFILLS Design Criteria § 258.40 Design criteria. (a) New MSWLF units and lateral... State or as specified in § 258.40(e) for unapproved States. The design must ensure that the...

  11. 30 CFR 104.3 - Pattern criteria.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Pattern criteria. 104.3 Section 104.3 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR PATTERN OF VIOLATIONS PATTERN OF VIOLATIONS § 104.3 Pattern criteria. (a) The criteria of this section shall be used to identify those mines...

  12. 45 CFR 1634.9 - Selection criteria.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Selection criteria. 1634.9 Section 1634.9 Public... FOR GRANTS AND CONTRACTS § 1634.9 Selection criteria. (a) The criteria to be used to select among... key staff; (6) The applicant's knowledge of the various components of the legal services delivery...

  13. Penetrating cardiac injury following sewing needle ingestion.

    Science.gov (United States)

    Sobnach, Sanju; Castillo, Franco; Blanco Vinent, René; Kahn, Delawir; Bhyat, Ahmed

    2011-07-01

    Penetrating cardiac injuries are common in South Africa. Reports describing traumatic lesions to the heart caused by caudo-cranial migration of ingested foreign bodies are however extremely rare. Delayed presentation and intervention are associated with poor outcome in these patients; cardiac tamponade remains the most serious complication. We present the case of a 19 year-old man who sustained a left ventricular injury after intentionally swallowing eight sewing needles. The impacted needle was removed through a median sternotomy and the patient recovered uneventfully. Copyright © 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier B.V. All rights reserved.

  14. The use of economic criteria in providing a basis for safe reactor operation

    International Nuclear Information System (INIS)

    Graham, J.

    1989-01-01

    Probabilistic criteria based upon an acceptance measure of protection for owner investment can complete the range of design probabilistic criteria between those set by acceptance public safety and those set by acceptable reliability in plant operation. Criteria which address the protection of owner investment have the benefit of lowering risk in adjacent risk regions by providing greater reliability in operation as well as less risk to the safety of the public and the environment. Such investment protection criteria are currently being used to extend plant life but they could also be used very beneficially as part of the initial design process. In this paper trial criteria are suggested which address the risk of extended plant shutdown with the resultant necessity to purchase replacement power, and the risk of replacement of expensive plant components. Additional financial assessment is required to ensure that there is a proper correlation between acceptable measures of owner-investment protection and the levels of probabilistic defence suggested, but the trial criteria proposed can be used as important practical design criteria

  15. Donation after cardiac death: is a "paradigm shift" feasible in Italy?

    Science.gov (United States)

    Fanelli, V; Geraci, P M; Mascia, L

    2013-05-01

    Donation after cardiac death (DCD) is one of the growing strategies to overcome the problem of organ shortage. Cardiac death is defined as "irreversible cessation of circulatory and respiratory function"; the time interval to define irreversibility of cardiac death, the peculiarity of consent, and the framework of end-of-life decision making are the most compelling ethical issues which have been raised with DCD. National protocols that balance medical, ethical, and social issues are mandatory to guide transplant care professionals. In Italy, the 20 min cardiac arrest demonstrated by continuous electrocardiography recording is the time interval necessary for death diagnosis based on cardiopulmonary criteria. This time negatively affects donation after cardiac death because warm ischemic time (WIT) - the most important predictor of grafts' poor outcome - is prolonged. However, this time seems to be prudential to define the irreversibility of death and to respect the "dead donor rule", as established by the National Committee of Bioethics. National reference protocols regulating DCD practice are therefore a compelling issue.

  16. Effects of the july 1997 floods in the Czech Republic on cardiac mortality.

    Science.gov (United States)

    Obrová, Jana; Sovová, Eliška; Ivanová, Kateřina; Táborský, Miloš; Loyka, Svatopluk

    2014-12-01

    An excess of deaths from cardiac causes are reported after many natural disasters. Despite the fact that floods are the most common and most destructive natural disaster worldwide, little is known about their effect on human health. We analyzed the influence of the greatest floods in the Czech Republic on cardiac mortality in the affected area. This was a retrospective case-control study. We analyzed persons whose autopsies proved they had died of cardiac causes during the month of the flood, 2 months before the flood, 1 month after the flood, and during the same period in the 3 previous years. A total of 207 of 985 autopsy reports met the criteria for inclusion in the study. There were no significant differences in the proportions of men and women (P=0.819) or in age (P=0.577). During the month of the flood, an increase in cardiac mortality was observed; however, the increase was not statistically significant (P=0.088). According to our findings, the 1997 Central European flood did not significantly affect cardiac mortality.

  17. Electrocardiographic Characteristics of Potential Organ Donors and Associations with Cardiac Allograft Utilization

    Science.gov (United States)

    Khush, Kiran K.; Menza, Rebecca; Nguyen, John; Goldstein, Benjamin A.; Zaroff, Jonathan G.; Drew, Barbara J.

    2012-01-01

    Background Current regulations require that all cardiac allograft offers for transplantation must include an interpreted 12-lead electrocardiogram (ECG). However, little is known about the expected ECG findings in potential organ donors, or the clinical significance of any identified abnormalities in terms of cardiac allograft function and suitability for transplantation. Methods and Results A single experienced reviewer interpreted the first ECG obtained after brainstem herniation in 980 potential organ donors managed by the California Transplant Donor Network from 2002-2007. ECG abnormalities were summarized, and associations between specific ECG findings and cardiac allograft utilization for transplantation were studied. ECG abnormalities were present in 51% of all cases reviewed. The most common abnormalities included voltage criteria for left ventricular hypertrophy (LVH), prolongation of the corrected QT interval (QTc), and repolarization changes (ST/T wave abnormalities). Fifty seven percent of potential cardiac allografts in this cohort were accepted for transplantation. LVH on ECG was a strong predictor of allograft non-utilization. No significant associations were seen between QTc prolongation, repolarization changes and allograft utilization for transplantation, after adjusting for donor clinical variables and echocardiographic findings. Conclusions We have performed the first comprehensive study of ECG findings in potential donors for cardiac transplantation. Many of the common ECG abnormalities seen in organ donors may result from the heightened state of sympathetic activation that occurs after brainstem herniation, and are not associated with allograft utilization for transplantation. PMID:22615333

  18. Thai nursing students' experiences when attending real life situations involving cardiac life support: A Phenomenological study.

    Science.gov (United States)

    Matchim, Yaowarat; Kongsuwan, Waraporn

    2015-12-01

    During the last few years, manikin simulations have been used for cardiac life support training procedures in medical and nursing education. However, some nursing students have experienced attending real events involving cardiac life support during their clinical practice. This study aims to describe the meaning of experience of Thai nursing students when attending real situations of cardiac life support. A hermeneutic phenomenological study was used. Third and fourth year bachelor of nursing students at a university in the southern region of Thailand who had the experience of attending real situation of cardiac life support were purposely selected as the informants. The data were generated from individual in-depth interviews with eighteen nursing students. Van Manen's approach was used to analyze the data. Trustworthiness was established using the criteria set out by Lincoln and Guba. Essential themes situated in the context of the four existential grounds of body, time, space, and relation emerged. These were: being worried and fearful while desiring to participate in cardiac life support procedures; enhancing self value; knowing each moment is meaningful for one's life; having time to understand the reality of life; being in a small corner; appreciating such opportunities and the encouragement given by nurses and the healthcare team; and feeling empathy. Besides learning in classrooms and practicing in labs, experiencing real situations is beneficial for nursing students in learning cardiac life support. This study provides information that can be used for clinical teaching management in the topics relating to cardiac life support. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Prevalence of 22q11.2 microdeletion in 146 patients with cardiac malformation in a referral hospital of North India

    OpenAIRE

    Halder, Ashutosh; Jain, Manish; Chaudhary, Isha; Kabra, Madhulika

    2010-01-01

    Abstract Background The 22q11.2 microdeletion syndrome is a common condition that is associated with cardiac as well as extra-cardiac manifestations. Its prevalence and manifestations from north India has not been reported. This study was designed to determine the prevalence and ability of clinical criteria to predict 22q11.2 microdeletion. Methods A total of 146 cases of cardiac malformation requiring tertiary care at a teaching hospital were prospectively screened for 22q11.2 microdeletion ...

  20. The need for cardiac follow-up in adults with mild congenital cardiac disease

    NARCIS (Netherlands)

    Kamphuis, Mascha; Vliegen, Hubert W.; Vogels, Ton; Zwinderman, Koos H.; van der Wall, Ernst E.; Verloove-Vanhorick, S. Pauline; Ottenkamp, Jaap

    2002-01-01

    To discuss the need for continuing cardiac surveillance in adults with hemodynamically insignificant congenital cardiac disease. In 82 patients with mild congenital cardiac malformations, aged from 17 to 32 years, we investigated the subjective health status, the health-related quality of life, any

  1. Evolving interpretation of the athlete's electrocardiogram: from European Society of Cardiology and Stanford criteria, to Seattle criteria and beyond.

    Science.gov (United States)

    Zorzi, Alessandro; ElMaghawry, Mohamed; Corrado, Domenico

    2015-01-01

    Electrocardiographic (ECG) pre-participation screening can prevent sudden cardiac death in the athletes by early diagnosis and disqualification of affected individuals. Interpretation of the athlete's ECG should be based on specific criteria, because ECG changes that would be considered abnormal in the untrained population may develop in trained athletes as a physiologic and benign consequence of the heart's adaptation to exercise. In 2010, a stem document from the Section of Sports Cardiology of the European Society of Cardiology (ESC) proposed to classify the athlete's ECG changes according to the prevalence, relation to exercise training, association with an increased risk of cardiovascular disease and need for further investigations into two groups: "common and training-related" (Group 1) and "uncommon and training-unrelated" (Group 2). Over the last years, several efforts have been made to refine the ESC criteria for interpretation of the athlete's ECG in order to improve specificity maintaining good sensitivity, especially among elite and Afro-Caribbean athletes, which show the highest rate of false positives Group 2 ECG abnormalities. However, the balance between improvement in specificity and loss of sensitivity should be evaluated keeping in mind that the primary aim of the screening program is to save the athlete's lives rather than money. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. A quantum extended Kalman filter

    International Nuclear Information System (INIS)

    Emzir, Muhammad F; Woolley, Matthew J; Petersen, Ian R

    2017-01-01

    In quantum physics, a stochastic master equation (SME) estimates the state (density operator) of a quantum system in the Schrödinger picture based on a record of measurements made on the system. In the Heisenberg picture, the SME is a quantum filter. For a linear quantum system subject to linear measurements and Gaussian noise, the dynamics may be described by quantum stochastic differential equations (QSDEs), also known as quantum Langevin equations, and the quantum filter reduces to a so-called quantum Kalman filter. In this article, we introduce a quantum extended Kalman filter (quantum EKF), which applies a commutative approximation and a time-varying linearization to systems of nonlinear QSDEs. We will show that there are conditions under which a filter similar to a classical EKF can be implemented for quantum systems. The boundedness of estimation errors and the filtering problem with ‘state-dependent’ covariances for process and measurement noises are also discussed. We demonstrate the effectiveness of the quantum EKF by applying it to systems that involve multiple modes, nonlinear Hamiltonians, and simultaneous jump-diffusive measurements. (paper)

  3. The Extended Mission Rover (EMR)

    Science.gov (United States)

    Shields, W.; Halecki, Anthony; Chung, Manh; Clarke, Ken; Frankle, Kevin; Kassemkhani, Fariba; Kuhlhoff, John; Lenzini, Josh; Lobdell, David; Morgan, Sam

    A key component in ensuring America's status as a leader in the global community is its active pursuit of space exploration. On the twentieth anniversary of Apollo 11, President George Bush challenged the nation to place a man on the moon permanently and to conduct human exploration of Mars in the 21st century. The students of the FAMU/FSU College of Engineering hope to make a significant contribution to this challenge, America's Space Exploration Initiative (SEI), with their participation in the NASA/USRA Advanced Design Program. The project selected by the 1991/1992 Aerospace Design group is the design of an Extended Mission Rover (EMR) for use on the lunar surface. This vehicle will serve as a mobile base to provide future astronauts with a 'shirt-sleeve' living and working environment. Some of the proposed missions are planetary surface exploration, construction and maintenance, hardware setup, and in situ resource experimentation. This vehicle will be put into use in the 2010-2030 time frame.

  4. Extended attention span training system

    Science.gov (United States)

    Pope, Alan T.; Bogart, Edward H.

    1991-01-01

    Attention Deficit Disorder (ADD) is a behavioral disorder characterized by the inability to sustain attention long enough to perform activities such as schoolwork or organized play. Treatments for this disorder include medication and brainwave biofeedback training. Brainwave biofeedback training systems feed back information to the trainee showing him how well he is producing the brainwave pattern that indicates attention. The Extended Attention Span Training (EAST) system takes the concept a step further by making a video game more difficult as the player's brainwaves indicate that attention is waning. The trainee can succeed at the game only by maintaining an adequate level of attention. The EAST system is a modification of a biocybernetic system that is currently being used to assess the extent to which automated flight management systems maintain pilot engagement. This biocybernetic system is a product of a program aimed at developing methods to evaluate automated flight deck designs for compatibility with human capabilities. The EAST technology can make a contribution in the fields of medical neuropsychology and neurology, where the emphasis is on cautious, conservative treatment of youngsters with attention disorders.

  5. Pythagorean fuzzy analytic hierarchy process to multi-criteria decision making

    Science.gov (United States)

    Mohd, Wan Rosanisah Wan; Abdullah, Lazim

    2017-11-01

    A numerous approaches have been proposed in the literature to determine the criteria of weight. The weight of criteria is very significant in the process of decision making. One of the outstanding approaches that used to determine weight of criteria is analytic hierarchy process (AHP). This method involves decision makers (DMs) to evaluate the decision to form the pair-wise comparison between criteria and alternatives. In classical AHP, the linguistic variable of pairwise comparison is presented in terms of crisp value. However, this method is not appropriate to present the real situation of the problems because it involved the uncertainty in linguistic judgment. For this reason, AHP has been extended by incorporating the Pythagorean fuzzy sets. In addition, no one has found in the literature proposed how to determine the weight of criteria using AHP under Pythagorean fuzzy sets. In order to solve the MCDM problem, the Pythagorean fuzzy analytic hierarchy process is proposed to determine the criteria weight of the evaluation criteria. Using the linguistic variables, pairwise comparison for evaluation criteria are made to the weights of criteria using Pythagorean fuzzy numbers (PFNs). The proposed method is implemented in the evaluation problem in order to demonstrate its applicability. This study shows that the proposed method provides us with a useful way and a new direction in solving MCDM problems with Pythagorean fuzzy context.

  6. Sudden cardiac death in young athletes

    Directory of Open Access Journals (Sweden)

    Östman-Smith I

    2011-07-01

    Full Text Available Ingegerd Östman-SmithDivision of Paediatric Cardiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, SwedenAbstract: Athletic activity is associated with an increased risk of sudden death for individuals with some congenital or acquired heart disorders. This review considers in particular the causes of death affecting athletes below 35 years of age. In this age group the largest proportion of deaths are caused by diseases with autosomal dominant inheritance such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT-syndrome, and Marfan’s syndrome. A policy of early cascade-screening of all first-degree relatives of patients with these disorders will therefore detect a substantial number of individuals at risk. A strictly regulated system with preparticipation screening of all athletes following a protocol pioneered in Italy, including school-age children, can also detect cases caused by sporadic new mutations and has been shown to reduce excess mortality among athletes substantially. Recommendations for screening procedure are reviewed. It is concluded that ECG screening ought to be part of preparticipation screening, but using criteria that do not cause too many false positives among athletes. One such suggested protocol will show positive in approximately 5% of screened individuals, among whom many will be screened for these diseases. On this point further research is needed to define what kind of false-positive and false-negative rate these new criteria result in. A less formal system based on cascade-screening of relatives, education of coaches about suspicious symptoms, and preparticipation questionnaires used by athletic clubs, has been associated over time with a sizeable reduction in sudden cardiac deaths among Swedish athletes, and thus appears to be worth implementing even for junior athletes not recommended for formal preparticipation screening. It is strongly argued

  7. Cardiac disorders with psychosomatic background

    Directory of Open Access Journals (Sweden)

    Ada Bielejewska

    2017-12-01

    Full Text Available Psychosomatic disorders can be described as psychosocial-derived organic disorders. The influence of depression, sleep disorders, quality of life, addictions, work environment, family situation, and stress on atrial fibrillation, palpitations, syncope, chest pain, coronary heart disease, and heart failure has been analysed in this paper. The correlation between psychosomatic disorders and the cardiovascular system has been shown. It allows us to conclude that an attending physician, while taking medical history of cardiac patients, should take into consideration factors that may have a negative impact on their mental health, which can be risk factors in the development or aggravation of an already present cardiovascular disease.

  8. Respiratory gating in cardiac PET

    DEFF Research Database (Denmark)

    Lassen, Martin Lyngby; Rasmussen, Thomas; Christensen, Thomas E

    2017-01-01

    BACKGROUND: Respiratory motion due to breathing during cardiac positron emission tomography (PET) results in spatial blurring and erroneous tracer quantification. Respiratory gating might represent a solution by dividing the PET coincidence dataset into smaller respiratory phase subsets. The aim...... stress (82)RB-PET. Respiratory rates and depths were measured by a respiratory gating system in addition to registering actual respiratory rates. Patients undergoing adenosine stress showed a decrease in measured respiratory rate from initial to later scan phase measurements [12.4 (±5.7) vs 5.6 (±4.......7) min(-1), P PET...

  9. FGF21 and Cardiac Physiopathology

    OpenAIRE

    Planavila, Anna; Redondo-Angulo, Ibon; Villarroya, Francesc

    2015-01-01

    The heart is not traditionally considered either a target or a site of fibroblast growth factor-21 (FGF21) production. However, recent findings indicate that FGF21 can act as a cardiomyokine; that is, it is produced by cardiac cells at significant levels and acts in an autocrine manner on the heart itself. The heart is sensitive to the effects of FGF21, both systemic and locally generated, owing to the expression in cardiomyocytes of β-Klotho, the key co-receptor known to confer specific resp...

  10. Cardiac leiomyosarcoma, a case report

    DEFF Research Database (Denmark)

    Andersen, Rikke; Kristensen, Bjarne W; Gill, Sabine

    2013-01-01

    In this case report we present the history of a patient admitted with recurrent pulmonary edema. Transesophageal chocardiography showed a tumour in the left atrium, occluding the ostium of the mitral valve and mimicking intermittent mitral stenosis. Cardiac surgery followed by pathological...... examination revealed that the tumour was a leiomyosarcoma. Images from the echocardiography as well as the pathological findings are shown and discussed. The present case report illustrates that atrial tumors comprise also sarcomas, suggesting the use of careful, rapid diagnostic procedures and treatment...

  11. [Cardiac effects of radiation therapy].

    Science.gov (United States)

    Tuohinen, Suvi; Turpeinen, Anu; Skyttä, Tanja; Kellokumpu-Lehtinen, Pirkko-Liisa

    2015-01-01

    Because of increased life-expentancy cancer patients having undergone radiation therapy nowadays live longer, and late-appearing adverse effects are therefore playing a more significant role. Radiation therapy given to the chest is known to approximately double the risk of heart disease, the cumulative total radiation dose being the most important risk-increasing factor. The most significant adverse effects appear only years after the treatment. The mortality from late manifestations reduces the total benefit of radiation therapy. Patients with radiation therapy due to a cancer of the left breast or Hodgkin's lymphoma are particularly susceptible to cardiac effects. A safe radiation dose is not known.

  12. Heart Attack or Sudden Cardiac Arrest: How Are They Different?

    Science.gov (United States)

    ... Attack or Sudden Cardiac Arrest: How Are They Different? Updated:Mar 15,2018 People often use these ... The heart attack symptoms in women can be different than men. What is cardiac arrest? Sudden cardiac ...

  13. Extended genomes: symbiosis and evolution.

    Science.gov (United States)

    Hurst, Gregory D D

    2017-10-06

    Many aspects of an individual's biology derive from its interaction with symbiotic microbes, which further define many aspects of the ecology and evolution of the host species. The centrality of microbes in the function of individual organisms has given rise to the concept of the holobiont-that an individual's biology is best understood as a composite of the 'host organism' and symbionts within. This concept has been further elaborated to posit the holobiont as a unit of selection. In this review, I critically examine whether it is useful to consider holobionts as a unit of selection. I argue that microbial heredity-the direct passage of microbes from parent to offspring-is a key factor determining the degree to which the holobiont can usefully be considered a level of selection. Where direct vertical transmission (VT) is common, microbes form part of extended genomes whose dynamics can be modelled with simple population genetics, but that nevertheless have subtle quantitative distinctions from the classic mutation/selection model for nuclear genes. Without direct VT, the correlation between microbial fitness and host individual fitness erodes, and microbe fitness becomes associated with host survival only (rather than reproduction). Furthermore, turnover of microbes within a host may lessen associations between microbial fitness with host survival, and in polymicrobial communities, microbial fitness may derive largely from the ability to outcompete other microbes, to avoid host immune clearance and to minimize mortality through phage infection. These competing selection pressures make holobiont fitness a very minor consideration in determining symbiont evolution. Nevertheless, the importance of non-heritable microbes in organismal function is undoubted-and as such the evolutionary and ecological processes giving rise to variation and evolution of the microbes within and between host individuals represent a key research area in biology.

  14. Low-dose 4D cardiac imaging in small animals using dual source micro-CT

    Science.gov (United States)

    Holbrook, M.; Clark, D. P.; Badea, C. T.

    2018-01-01

    Micro-CT is widely used in preclinical studies, generating substantial interest in extending its capabilities in functional imaging applications such as blood perfusion and cardiac function. However, imaging cardiac structure and function in mice is challenging due to their small size and rapid heart rate. To overcome these challenges, we propose and compare improvements on two strategies for cardiac gating in dual-source, preclinical micro-CT: fast prospective gating (PG) and uncorrelated retrospective gating (RG). These sampling strategies combined with a sophisticated iterative image reconstruction algorithm provide faster acquisitions and high image quality in low-dose 4D (i.e. 3D  +  Time) cardiac micro-CT. Fast PG is performed under continuous subject rotation which results in interleaved projection angles between cardiac phases. Thus, fast PG provides a well-sampled temporal average image for use as a prior in iterative reconstruction. Uncorrelated RG incorporates random delays during sampling to prevent correlations between heart rate and sampling rate. We have performed both simulations and animal studies to validate these new sampling protocols. Sampling times for 1000 projections using fast PG and RG were 2 and 3 min, respectively, and the total dose was 170 mGy each. Reconstructions were performed using a 4D iterative reconstruction technique based on the split Bregman method. To examine undersampling robustness, subsets of 500 and 250 projections were also used for reconstruction. Both sampling strategies in conjunction with our iterative reconstruction method are capable of resolving cardiac phases and provide high image quality. In general, for equal numbers of projections, fast PG shows fewer errors than RG and is more robust to undersampling. Our results indicate that only 1000-projection based reconstruction with fast PG satisfies a 5% error criterion in left ventricular volume estimation. These methods promise low-dose imaging with a

  15. Compressed sensing reconstruction of cardiac cine MRI using golden angle spiral trajectories.

    Science.gov (United States)

    Tolouee, Azar; Alirezaie, Javad; Babyn, Paul

    2015-11-01

    In dynamic cardiac cine Magnetic Resonance Imaging (MRI), the spatiotemporal resolution is limited by the low imaging speed. Compressed sensing (CS) theory has been applied to improve the imaging speed and thus the spatiotemporal resolution. The purpose of this paper is to improve CS reconstruction of under sampled data by exploiting spatiotemporal sparsity and efficient spiral trajectories. We extend k-t sparse algorithm to spiral trajectories to achieve high spatio temporal resolutions in cardiac cine imaging. We have exploited spatiotemporal sparsity of cardiac cine MRI by applying a 2D+time wavelet-Fourier transform. For efficient coverage of k-space, we have used a modified version of multi shot (interleaved) spirals trajectories. In order to reduce incoherent aliasing artifact, we use different random undersampling pattern for each temporal frame. Finally, we have used nonuniform fast Fourier transform (NUFFT) algorithm to reconstruct the image from the non-uniformly acquired samples. The proposed approach was tested in simulated and cardiac cine MRI data. Results show that higher acceleration factors with improved image quality can be obtained with the proposed approach in comparison to the existing state-of-the-art method. The flexibility of the introduced method should allow it to be used not only for the challenging case of cardiac imaging, but also for other patient motion where the patient moves or breathes during acquisition. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Pro (With Caution): Extended oncologic indications in liver transplantation.

    Science.gov (United States)

    Mazzaferro, Vincenzo; Battiston, Carlo; Sposito, Carlo

    2018-01-01

    The success of liver transplantation (LT) in curing cancer (particularly hepatocellular carcinoma and hepatic metastases from neuroendocrine tumors) is based on the augmented oncologic potentials of the total hepatectomy and on restrictive criteria applied to patient selection. Consensus on the grade of expansion of conventional limits and implementation of alternative indications to LT (cholangiocarcinoma and metastases from colorectal cancer) has not been reached. On top of regional/local conditions for wait-list dynamics and organ availability, expanded cancer indications for LT should be explored with caution. Prospective investigations should rely on staging protocols predicting the exclusive hepatic location of cancer; restrictions on clinical conditions, tumor biology, and molecular profile, including the response to neoadjuvant therapies; confirmed tumor nonresectability with curative intent; sufficient life span of the transplant candidates to assess survival and transplant benefit; and use of marginal and extended criteria donors. In conclusion, the arguments supporting moderately loosened criteria for cancer seem more valid today than in the past. Transplant oncology is likely to represent a leading field in the near future, also because comorbidities and transplant-related causes of death are better managed and often eliminated. Liver Transplantation 24 98-103 2018 AASLD. © 2017 by the American Association for the Study of Liver Diseases.

  17. Heat exchanger staybolt acceptance criteria

    International Nuclear Information System (INIS)

    Lam, P.S.; Sindelar, R.L.; Barnes, D.M.

    1992-02-01

    The structural integrity demonstration of the primary coolant piping system includes evaluating the structural capacity of each component against a large break or equivalent Double-Ended Guillotine Break. A large break at the inlet or outlet heads of the heat exchangers would occur if the restraint members of the heads become inactive. The structural integrity of the heads is demonstrated by showing the redundant capacity of the staybolts to restrain the head at design conditions and under seismic loadings. The Savannah River Site heat exchanger head is attached to the tubesheet by 84 staybolts. Access to the staybolts is limited due to a welded seal cap over the staybolts. An ultrasonic testing (UT) inspection technique to provide an in-situ examination of the staybolts has recently been developed at SRS. Examination of the staybolts will be performed to ensure their service condition and configuration is within acceptance limits. An acceptance criteria methodology has been developed to disposition flaws reported in the staybolt inspections while ensuring adequate restraint capacity of the staybolts to maintain integrity of the heat exchanger heads against collapse. The methodology includes an approach for the baseline and periodic inspections of the staybolts. The heat exchanger head is analyzed with a three-dimensional finite element model. The restraint provided by the staybolts is evaluated for several postulated cases of inactive or missing staybolts. Evaluation of specific, inactive staybolt configurations based on the UT results can be performed with the finite element model and fracture methodology in this report

  18. Investigation of Sustainable Housing Criteria

    Directory of Open Access Journals (Sweden)

    roshanfekr Somayeh

    2016-01-01

    Full Text Available Recently, much attention has been paid to sustainable development in cities. The quality of human life is directly related to environmental quality. Because many people live in cities as a place of social, economic and cultural relationships, certain issues such as environmental crises, energy, air and noise pollution and traffic jams are some of the factors that can alter the quality of human life. Therefore, in order to improve the quality of human life, attention to sustainable development (or sustainability in cities is proposed. Sustainable building has a comprehensive significance that begins with the conception of negative and positive impacts on the environment. Several descriptions of sustainable or green buildings have been created; however, they all pursue one goal, which is to create sustainable urban developments and protection of the environment. The quality of indoor environments, materials, and energy consumption, water usage, the impact of building construction processes and building maintenance are some of the factors that affect the environment and sustainability. Sustainable building is an attempt to relieve the minus impacts on the environment that occur during a building’s lifetime. This research investigates the important factors that have relevance to green buildings and introduces several criteria of sustainable housing.

  19. Admission Criteria for MBA Programs

    Directory of Open Access Journals (Sweden)

    Silvana Dakduk

    2016-11-01

    Full Text Available This paper reports a review of studies on admission criteria for MBA programs. The method consisted in a literary review based on a systematic search in international databases (Emerald, ABI/INFORM Global, ProQuest Education Journals, ProQuest European Business, ProQuest Science Journal, ProQuest Research Library, ProQuest Psychology Journals, ProQuest Social Science Journals and Business Source Complete of studies published from January 1990 to December 2013, which explore the academic performance of students or graduates of MBA programs. A quantitative review was performed. Results show that most researchers studied relations between GMAT (Graduate Management Admission Test and UGPA (Undergraduate Grade Point Average as predictors of GGPA (Graduate Grade Point Average. On the other hand, work experience and personal traits (such as personality, motivation, learning strategies, self-efficacy beliefs and achievement expectations and their relation with GGPA had been less studied, and results are not consistent enough to consider them valid predictors of student performance at this time.

  20. Oscillation Criteria of First Order Neutral Delay Differential Equations with Variable Coefficients

    Directory of Open Access Journals (Sweden)

    Fatima N. Ahmed

    2013-01-01

    Full Text Available Some new oscillation criteria are given for first order neutral delay differential equations with variable coefficients. Our results generalize and extend some of the well-known results in the literature. Some examples are considered to illustrate the main results.

  1. Cardiac angiosarcoma: an unexpected diagnosis

    Directory of Open Access Journals (Sweden)

    Milton Roberto Furst Crenitte

    2014-09-01

    Full Text Available Cardiac angiosarcoma is a rare entity. The incidence through autopsy findings ranges between 0.001% and 0.03%. The disease usually presents with non-specific symptoms, although asymptomatic cases are frequent; therefore, diagnosis is unexpected and consequently delayed. The authors report the case of a middle-aged man with a recent onset cough and dyspnea. He sought medical care several times without receiving a definite diagnosis until a plain chest radiography was taken showing a mediastinal enlargement, which was the reason why he was hospitalized for clinical investigation. During the diagnostic workup, an echodopplercardiogram and a thoracic computed tomography were performed, showing a heterogeneous soft-tissue mass infiltrating the pericardium and the anterior atrial wall. Multiple and scattered pulmonary nodules were also present. A pulmonary nodule was biopsied, which revealed an angiosarcoma. The clinical features added to the radiological and histological findings permitted the diagnosis of right atrial angiosarcoma. The authors highlight the unexpected pattern in the presentation of cardiac tumors.

  2. Hemodynamics driven cardiac valve morphogenesis.

    Science.gov (United States)

    Steed, Emily; Boselli, Francesco; Vermot, Julien

    2016-07-01

    Mechanical forces are instrumental to cardiovascular development and physiology. The heart beats approximately 2.6 billion times in a human lifetime and heart valves ensure that these contractions result in an efficient, unidirectional flow of the blood. Composed of endocardial cells (EdCs) and extracellular matrix (ECM), cardiac valves are among the most mechanically challenged structures of the body both during and after their development. Understanding how hemodynamic forces modulate cardiovascular function and morphogenesis is key to unraveling the relationship between normal and pathological cardiovascular development and physiology. Most valve diseases have their origins in embryogenesis, either as signs of abnormal developmental processes or the aberrant re-expression of fetal gene programs normally quiescent in adulthood. Here we review recent discoveries in the mechanobiology of cardiac valve development and introduce the latest technologies being developed in the zebrafish, including live cell imaging and optical technologies, as well as modeling approaches that are currently transforming this field. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel. Copyright © 2015. Published by Elsevier B.V.

  3. Cardiac arrhythmia detection using photoplethysmography.

    Science.gov (United States)

    Paradkar, Neeraj; Chowdhury, Shubhajit Roy

    2017-07-01

    Cardiovascular Diseases (CVDs) cause a very large number of casualties around the world every year and cardiac arrhythmias contribute to significant proportion of CVD related deaths. Bedside cardiac activity monitors in hospitals are based on electrocardiogram (ECG) processing and are known to produce too many false alarms. Moving beyond bedside care, ECG is not very suitable for use in wearable devices. Photoplethysmography (PPG) on the other hand provides an inexpensive and more wearable device-friendly alternative. This work presents a technique to detect life threatening arrhythmias using only PPG waveforms. PhysioNet Challenge 2015 data is used to detect five types of arrhythmias namely, tachycardia, bradycardia, asystole, ventricular tachycardia and ventricular fibrillation. A novel technique is employed to assign pulse quality index to every PPG pulse and highest quality portion of the signal is used for detection. Results indicate that PPG provides a viable alternative for conventional ECG based detection. An overall true positive rate (TPR) of 93% was achieved with true negative rate (TNR) of 53.78% suggesting that PPG is a viable option for arrhythmia detection.

  4. Sudden Cardiac Death in Children. Part 1

    Directory of Open Access Journals (Sweden)

    Ye.V. Pshenichnaya

    2013-02-01

    Full Text Available This article presents the prevalence, terminology, classification of sudden cardiac death. A description of congenital structural heart diseases associated with a risk of sudden cardiac death is given. The issues of etiology and pathogenesis of life-threatening conditions are described in detail.

  5. MicroRNAs in cardiac arrhythmia

    DEFF Research Database (Denmark)

    Hedley, Paula L; Carlsen, Anting L; Christiansen, Kasper M

    2014-01-01

    Long QT syndrome (LQTS) is a genetic cardiac condition associated with prolonged ventricular repolarization, primarily a result of perturbations in cardiac ion channels, which predisposes individuals to life-threatening arrhythmias. Using DNA screening and sequencing methods, over 700 different L...

  6. Cardiac arrhythmias in adult patients with asthma

    DEFF Research Database (Denmark)

    Warnier, Miriam J; Rutten, Frans H; Kors, Jan A

    2012-01-01

    OBJECTIVE: The pathogenesis of cardiac arrhythmias in asthma patients has not been fully elucidated. Adverse drug effects, particularly those of β2-mimetics, may play a role. The aim of this study was to determine whether asthma is associated with the risk of cardiac arrhythmias...

  7. Cardiac MRI of the athlete's heart

    NARCIS (Netherlands)

    Prakken, N.H.J.

    2010-01-01

    The increase in pre-participation cardiovascular screening using the Lausanne protocol will ultimately lead to an increased use of cardiac MRI and MDCT in the cardiovascular work-up of athletes. The role of cardiac MRI is well established in the evaluation of cardiomyopathies, myocarditis, aortic

  8. Athletes at Risk for Sudden Cardiac Death

    Science.gov (United States)

    Subasic, Kim

    2010-01-01

    High school athletes represent the largest group of individuals affected by sudden cardiac death, with an estimated incidence of once or twice per week. Structural cardiovascular abnormalities are the most frequent cause of sudden cardiac death. Athletes participating in basketball, football, track, soccer, baseball, and swimming were found to…

  9. Fetal Primary Cardiac Tumors During Perinatal Period

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2017-06-01

    Full Text Available Fetal primary cardiac tumors are rare, but they may cause complications, which are sometimes life threatening, including arrhythmias, hydrops fetalis, ventricular outflow/inflow obstruction, cardiac failure, and even sudden death. Among fetal primary cardiac tumors, rhabdomyomas are most common, followed by teratomas, fibromas, hemangiomas, and myxomas. Everolimus, a mammalian target of rapamycin inhibitor, has been reported to be an effective drug to cause tumor remission in three neonates with multiple cardiac rhabdomyomas. Neonatal cardiac surgery for the resection of primary cardiac tumors found by fetal echocardiography has been reported sporadically. However, open fetal surgery for pericardial teratoma resection, which was performed successfully via a fetal median sternotomy in one case report, could be a promising intervention to rescue these patients with large pericardial effusions. These recent achievements undoubtedly encourage further development in early management of fetal cardiac tumors. Owing to the rarity of fetal primary cardiac tumors, relevant information in terms of prenatal diagnosis, treatment, and prognosis remains to be clarified.

  10. Corticosteroids in cardiac surgery: a continuing controversy

    NARCIS (Netherlands)

    Dieleman, J.M.

    2015-01-01

    Cardiac surgery leads to significant improvements in symptoms of cardiac disease and quality of life, but is still associated with a substantial risk of adverse events and postoperative disability. The perioperative systemic inflammatory response syndrome (SIRS) likely plays a role in the

  11. Acute cardiac failure in neuroleptic malignant syndrome.

    LENUS (Irish Health Repository)

    Sparrow, Patrick

    2012-02-03

    We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.

  12. Stem cell sources for cardiac regeneration

    NARCIS (Netherlands)

    Roccio, M.; Goumans, M. J.; Sluijter, J. P. G.; Doevendans, P. A.

    Cell-based cardiac repair has the ambitious aim to replace the malfunctioning cardiac muscle developed after myocardial infarction, with new contractile cardiomyocytes and vessels. Different stem cell populations have been intensively studied in the last decade as a potential source of new

  13. Is fetal cardiac function gender dependent?

    NARCIS (Netherlands)

    Clur, S. A. B.; Oude Rengerink, K.; Mol, B. W.; Ottenkamp, J.; Bilardo, C. M.

    2011-01-01

    An increased nuchal translucency (NT) is more common in males. A delayed diastolic cardiac function maturation has been proposed to explain this and the reported gender-related differences in ductus venosus (DV) flow. To investigate gender-related differences in fetal cardiac function. One hundred

  14. Is fetal cardiac function gender dependent?

    NARCIS (Netherlands)

    Clur, S. A. B.; Rengerink, K. Oude; Mol, B. W.; Ottenkamp, J.; Bilardo, C. M.

    Introduction An increased nuchal translucency (NT) is more common in males. A delayed diastolic cardiac function maturation has been proposed to explain this and the reported gender-related differences in ductus venosus (DV) flow. Objective To investigate gender-related differences in fetal cardiac

  15. Cyanide poisoning and cardiac disorders: 161 cases.

    Science.gov (United States)

    Fortin, Jean-Luc; Desmettre, Thibault; Manzon, Cyril; Judic-Peureux, Virginie; Peugeot-Mortier, Caroline; Giocanti, Jean-Pascal; Hachelaf, Mohamed; Grangeon, Marie; Hostalek, Ulrike; Crouzet, Julien; Capellier, Gilles

    2010-05-01

    Inhalation of hydrogen cyanide from smoke in structural fires is common, but cardiovascular function in these patients is poorly documented. The objective was to study the cardiac complications of cyanide poisoning in patients who received early administration of a cyanide antidote, hydroxocobalamin (Cyanokit; Merck KGaA, Darmstadt, Germany [in the United States, marketed by Meridian Medical Technologies, Bristol, TN]). The medical records of 161 fire survivors with suspected or confirmed cyanide poisoning were reviewed in an open, multicenter, retrospective review of cases from the Emergency Medical Assistance Unit (Service d'Aide Médical d'Urgence) in France. Cardiac arrest (61/161, 58 asystole, 3 ventricular fibrillation), cardiac rhythm disorders (57/161, 56 supraventricular tachycardia), repolarization disorders (12/161), and intracardiac conduction disorders (5/161) were observed. Of the total 161 patients studied, 26 displayed no cardiac disorder. All patients were given an initial dose of 5 g of hydroxocobalamin. Non-responders received a second dose of 5 g of hydroxocobalamin. Of the patients initially in cardiac arrest, 30 died at the scene, 24 died in hospital, and 5 survived without cardiovascular sequelae. Cardiac disorders improved with increasing doses of hydroxocobalamin, and higher doses of the antidote seem to be associated with a superior outcome in patients with initial cardiac arrest. Cardiac complications are common in cyanide poisoning in fire survivors. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  16. Ultrasound Imaging in Teaching Cardiac Physiology

    Science.gov (United States)

    Johnson, Christopher D.; Montgomery, Laura E. A.; Quinn, Joe G.; Roe, Sean M.; Stewart, Michael T.; Tansey, Etain A.

    2016-01-01

    This laboratory session provides hands-on experience for students to visualize the beating human heart with ultrasound imaging. Simple views are obtained from which students can directly measure important cardiac dimensions in systole and diastole. This allows students to derive, from first principles, important measures of cardiac function, such…

  17. Cardiac spindle cell hemangioma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ju Young; Lee, In Jae; Min, Kwang Sun; Jeon, Eui Yong; Lee, Yul; Bae, Sang Hoon [Hallym University College of Medicine, Anyang (Korea, Republic of)

    2007-04-15

    Spindle cell hemangioma is an uncommon vascular lesion histologically resembling a cavernous hemangioma and Kaposi's sarcoma with a predilection for the extremities. There are no radiologic reports concerning cardiac spindle cell hemangioma in the current literature. We report here a case of cardiac spindle cell hemangioma.

  18. Tannin, oxalate, saponin, cyanogenic and cardiac glycosides ...

    African Journals Online (AJOL)

    Two species of cola, Cola nitida and Cola acuminate, were investigated for their possible relative contents of the secondary plant products:- tannin, oxalate, saponin, cyanogenic and cardiac glycosides. The two cola species gave low levels of tannin and oxalate but very high levels of cyanogenic and cardiac glycosides as ...

  19. Proposed Diagnostic Criteria for Smartphone Addiction.

    Directory of Open Access Journals (Sweden)

    Yu-Hsuan Lin

    Full Text Available Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria.We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist's structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists' clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy.Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1 six symptom criteria, (2 four functional impairment criteria and (3 exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%, while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use.The diagnostic criteria of smartphone addiction demonstrated the core symptoms "impaired control" paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment.

  20. Proposed Diagnostic Criteria for Smartphone Addiction

    Science.gov (United States)

    Lin, Yu-Hsuan; Chiang, Chih-Lin; Lin, Po-Hsien; Chang, Li-Ren; Ko, Chih-Hung; Lee, Yang-Han

    2016-01-01

    Background Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria. Methods We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist’s structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists’ clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy. Results Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1) six symptom criteria, (2) four functional impairment criteria and (3) exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%), while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use. Conclusion The diagnostic criteria of smartphone addiction demonstrated the core symptoms “impaired control” paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment. PMID:27846211

  1. Cardiac cachexia and muscle wasting: definition, physiopathology, and clinical consequences

    Directory of Open Access Journals (Sweden)

    Okoshi MP

    2014-11-01

    Full Text Available Marina P Okoshi,1 Fernando G Romeiro,1 Paula F Martinez,1,2 Silvio A Oliveira Jr,1,2 Bertha F Polegato,1 Katashi Okoshi11Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil; 2School of Physiotherapy, Federal University of Mato Grosso do Sul, Campo Grande, BrazilAbstract: Cachexia and muscle wasting are frequently observed in heart failure patients. Cachexia is a predictor of reduced survival, independent of important parameters such as age, heart failure functional class, and functional capacity. Muscle and fat wasting can also predict adverse outcome during cardiac failure. Only more recently were these conditions defined in International Consensus. Considering that heart failure is an inflammatory disease, cardiac cachexia has been diagnosed by finding a body weight loss >5%, in the absence of other diseases and independent of other criteria. Muscle wasting has been defined as lean appendicular mass corrected for height squared of 2 standard deviations or more below the mean for healthy individuals between 20 years and 30 years old from the same ethnic group. The etiology of heart failure-associated cachexia and muscle wasting is multifactorial, and the underlying physiopathological mechanisms are not completely understood. The most important factors are reduced food intake, gastrointestinal alterations, immunological activation, neurohormonal abnormalities, and an imbalance between anabolic and catabolic processes. Cachexia and muscle wasting have clinical consequences in several organs and systems including the gastrointestinal and erythropoietic systems, and the heart, previously affected by the primary disease. We hope that a better understanding of the mechanisms involved in their physiopathology will allow the development of pharmacological and nonpharmacological therapies to effectively prevent and treat heart failure-induced cachexia and muscle wasting before significant body

  2. FET-biosensor for cardiac troponin biomarker

    Science.gov (United States)

    Arshad, Mohd Khairuddin Md; Faris Mohamad Fathil, Mohamad; Hashim, Uda

    2017-11-01

    Acute myocardial infarction or myocardial infarction (MI) is a major health problem, due to diminished flow of blood to the heart, leads to higher rates of mortality and morbidity. The most specific markers for cardiac injury are cardiac troponin I (cTnI) and cardiac troponin T (cTnT) which have been considered as `gold standard'. Due to higher specificity, determination of the level of cardiac troponins became a predominant indicator for MI. Currently, field-effect transistor (FET)-based biosensors have been main interest to be implemented in portable sensors with the ultimate application in point-of-care testing (POCT). In this paper, we review on the FET-based biosensor based on its principle of operation, integration with nanomaterial, surface functionalization as well as immobilization, and the introduction of additional gate (for ambipolar conduction) on the device architecture for the detection of cardiac troponin I (cTnI) biomarker.

  3. Cardiac fluid dynamics meets deformation imaging.

    Science.gov (United States)

    Dal Ferro, Matteo; Stolfo, Davide; De Paris, Valerio; Lesizza, Pierluigi; Korcova, Renata; Collia, Dario; Tonti, Giovanni; Sinagra, Gianfranco; Pedrizzetti, Gianni

    2018-02-20

    Cardiac function is about creating and sustaining blood in motion. This is achieved through a proper sequence of myocardial deformation whose final goal is that of creating flow. Deformation imaging provided valuable contributions to understanding cardiac mechanics; more recently, several studies evidenced the existence of an intimate relationship between cardiac function and intra-ventricular fluid dynamics. This paper summarizes the recent advances in cardiac flow evaluations, highlighting its relationship with heart wall mechanics assessed through the newest techniques of deformation imaging and finally providing an opinion of the most promising clinical perspectives of this emerging field. It will be shown how fluid dynamics can integrate volumetric and deformation assessments to provide a further level of knowledge of cardiac mechanics.

  4. FET-biosensor for cardiac troponin biomarker

    Directory of Open Access Journals (Sweden)

    Md Arshad Mohd Khairuddin

    2017-01-01

    Full Text Available Acute myocardial infarction or myocardial infarction (MI is a major health problem, due to diminished flow of blood to the heart, leads to higher rates of mortality and morbidity. The most specific markers for cardiac injury are cardiac troponin I (cTnI and cardiac troponin T (cTnT which have been considered as ‘gold standard’. Due to higher specificity, determination of the level of cardiac troponins became a predominant indicator for MI. Currently, field-effect transistor (FET-based biosensors have been main interest to be implemented in portable sensors with the ultimate application in point-of-care testing (POCT. In this paper, we review on the FET-based biosensor based on its principle of operation, integration with nanomaterial, surface functionalization as well as immobilization, and the introduction of additional gate (for ambipolar conduction on the device architecture for the detection of cardiac troponin I (cTnI biomarker.

  5. Cost Implications of Using Different ECG Criteria for Screening Young Athletes in the United Kingdom.

    Science.gov (United States)

    Dhutia, Harshil; Malhotra, Aneil; Gabus, Vincent; Merghani, Ahmed; Finocchiaro, Gherardo; Millar, Lynne; Narain, Rajay; Papadakis, Michael; Naci, Huseyin; Tome, Maite; Sharma, Sanjay

    2016-08-16

    High false-positive rates and cost of additional investigations are an obstacle to electrocardiographic (ECG) screening of young athletes for cardiac disease. However, ECG screening costs have never been systematically assessed in a large cohort of athletes. This study investigated the costs of ECG screening in athletes according to the 2010 European Society of Cardiology (ESC) recommendations and the Seattle and refined interpretation criteria. Between 2011 and 2014, 4,925 previously unscreened athletes aged 14 to 35 years were prospectively evaluated with history, physical examination, and ECG (interpreted with the 2010 ESC recommendations). Athletes with abnormal results underwent secondary investigations, the costs of which were based on U.K. National Health Service Tariffs. The impact on cost after applying the Seattle and refined criteria was evaluated retrospectively. Overall, 1,072 (21.8%) athletes had an abnormal ECG on the basis of 2010 ESC recommendations; 11.2% required echocardiography, 1.7% exercise stress test, 1.2% Holter, 1.2% cardiac magnetic resonance imaging, and 0.4% other tests. The Seattle and refined criteria reduced the number of positive ECGs to 6.0% and 4.3%, respectively. Fifteen (0.3%) athletes were diagnosed with potentially serious cardiac disease using all 3 criteria. The overall cost of de novo screening using 2010 ESC recommendations was $539,888 ($110 per athlete and $35,993 per serious diagnosis). The Seattle and refined criteria reduced the cost to $92 and $87 per athlete screened and $30,251 and $28,510 per serious diagnosis, respectively. Contemporary ECG interpretation criteria decrease costs for de novo screening of athletes, which may be cost permissive for some sporting organizations. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Association between dental caries and out-of-hospital cardiac arrests of cardiac origin in Japan.

    Science.gov (United States)

    Suematsu, Yasunori; Miura, Shin-Ichiro; Zhang, Bo; Uehara, Yoshinari; Ogawa, Masahiro; Yonemoto, Naohiro; Nonogi, Hiroshi; Nagao, Ken; Kimura, Takeshi; Saku, Keijiro

    2016-04-01

    Oral infection contributes to atherosclerosis and coronary heart disease. We hypothesized that dental caries may be associated with out-of-hospital cardiac arrests (OHCA) of cardiac origin, but not non-cardiac origin. We compared the age-adjusted incidence of OHCA (785,591 cases of OHCA: 55.4% of cardiac origin and 44.6% of non-cardiac origin) to the age-adjusted prevalence of dental caries between 2005 and 2011 in the 47 prefectures of Japan. In both the total population and males over 65 years, the number of cases of dental caries was significantly associated with the number of OHCA of total and cardiac origin from 2005 to 2011, but not those of non-cardiac origin. In the total population, the age-adjusted prevalence of dental caries was not significantly associated with the age-adjusted incidence of OHCA (total OHCA: r correlation coefficient=0.22, p=0.14; OHCA of cardiac origin: r=0.25, p=0.09; OHCA of non-cardiac origin: r=-0.002, p=0.99). Among male patients over 65 years, the age-adjusted prevalence of dental caries was significantly associated with OHCA of total and cardiac origin, but not non-cardiac origin (total OHCA: r=0.47, p<0.001; OHCA of cardiac origin: r=0.37, p=0.01; OHCA of non-cardiac origin: r=0.28, p=0.054). While oral hygiene is important in all age groups, it may be particularly associated with OHCAs of cardiac origin in males over 65 years. Copyright © 2015. Published by Elsevier Ltd.

  7. Design and synthesis of compounds that extend yeast replicative lifespan

    Science.gov (United States)

    Yang, Hongying; Baur, Joseph A.; Chen, Allen; Miller, Christine; Sinclair, David A.

    2011-01-01

    Summary This past decade has seen the identification of numerous conserved genes that extend lifespan in diverse species, yet the number of compounds that extend lifespan is relatively small. A class of compounds called STACs, which were identified as activators of Sir2/SIRT1 NAD+-dependent deacetylases, extend the lifespans of multiple species in a Sir2-dependent manner and can delay the onset of age-related diseases such as cancer, diabetes and neurodegeneration in model organisms. Plant-derived STACs such as fisetin and resveratrol have several liabilities, including poor stability and relatively low potency as SIRT1 activators. To develop improved STACs, stilbene derivatives with modifications at the 4′ position of the B ring were synthesized using a Horner-Emmons-based synthetic route or by hydrolyzing deoxyrhapontin. Here, we describe synthetic STACs with lower toxicity toward human cells, and higher potency with respect to SIRT1 activation and lifespan extension in Saccharomyces cerevisiae. These studies show that it is possible to improve upon naturally occurring STACs based on a number of criteria including lifespan extension. PMID:17156081

  8. An Interoperable System toward Cardiac Risk Stratification from ECG Monitoring

    Science.gov (United States)

    Mora-Jiménez, Inmaculada; Ramos-López, Javier; Quintanilla Fernández, Teresa; García-García, Antonio; Díez-Mazuela, Daniel; García-Alberola, Arcadi

    2018-01-01

    Many indices have been proposed for cardiovascular risk stratification from electrocardiogram signal processing, still with limited use in clinical practice. We created a system integrating the clinical definition of cardiac risk subdomains from ECGs and the use of diverse signal processing techniques. Three subdomains were defined from the joint analysis of the technical and clinical viewpoints. One subdomain was devoted to demographic and clinical data. The other two subdomains were intended to obtain widely defined risk indices from ECG monitoring: a simple-domain (heart rate turbulence (HRT)), and a complex-domain (heart rate variability (HRV)). Data provided by the three subdomains allowed for the generation of alerts with different intensity and nature, as well as for the grouping and scrutinization of patients according to the established processing and risk-thresholding criteria. The implemented system was tested by connecting data from real-world in-hospital electronic health records and ECG monitoring by considering standards for syntactic (HL7 messages) and semantic interoperability (archetypes based on CEN/ISO EN13606 and SNOMED-CT). The system was able to provide risk indices and to generate alerts in the health records to support decision-making. Overall, the system allows for the agile interaction of research and clinical practice in the Holter-ECG-based cardiac risk domain. PMID:29494497

  9. An Interoperable System toward Cardiac Risk Stratification from ECG Monitoring

    Directory of Open Access Journals (Sweden)

    Cristina Soguero-Ruiz

    2018-03-01

    Full Text Available Many indices have been proposed for cardiovascular risk stratification from electrocardiogram signal processing, still with limited use in clinical practice. We created a system integrating the clinical definition of cardiac risk subdomains from ECGs and the use of diverse signal processing techniques. Three subdomains were defined from the joint analysis of the technical and clinical viewpoints. One subdomain was devoted to demographic and clinical data. The other two subdomains were intended to obtain widely defined risk indices from ECG monitoring: a simple-domain (heart rate turbulence (HRT, and a complex-domain (heart rate variability (HRV. Data provided by the three subdomains allowed for the generation of alerts with different intensity and nature, as well as for the grouping and scrutinization of patients according to the established processing and risk-thresholding criteria. The implemented system was tested by connecting data from real-world in-hospital electronic health records and ECG monitoring by considering standards for syntactic (HL7 messages and semantic interoperability (archetypes based on CEN/ISO EN13606 and SNOMED-CT. The system was able to provide risk indices and to generate alerts in the health records to support decision-making. Overall, the system allows for the agile interaction of research and clinical practice in the Holter-ECG-based cardiac risk domain.

  10. Major Cardiac Events After Non-cardiac Surgery.

    Science.gov (United States)

    Sousa, Gabriela; Lopes, Ana; Reis, Pedro; Carvalho, Vasco; Santos, Alice; Abelha, Fernando José

    2016-08-01

    Postoperative cardiovascular complications might be difficult to assess and are known to be associated with longer hospital stay and increased costs as well as higher morbidity and mortality rates. The aim of this study was to evaluate the predictors for major cardiac events (MCE) after non-cardiac surgery. The study included 4398 patients who were admitted to the Surgical Intensive Care Unit between January 1, 2006 and July 19, 2013. Acute physiology and chronic health evaluation II score and simplified acute physiology score (SAPS II) were calculated, and all variables entered as parameters were evaluated independently. Multivariate logistic regression analysis was performed to assess the independent factors for MCE. A total of 107 people experienced MCE. The independent predictors for postoperative MCE were higher fraction of inspired oxygen (FiO2) (odds ratio [OR] 38.97; 95 % confidence interval [CI] 10.81-140.36), history of ischemic heart disease (OR 3.38; 95 % CI 2.12-5.39), history of congestive heart disease (OR 2.39; 95 % CI 1.49-3.85), history of insulin therapy for diabetes (OR 2.93; 95 % CI 1.66-5.19), and increased SAPS II (OR 1.03; 95 % CI 1.01-1.05). Having a MCE was associated with a longer length of stay in the surgical intensive care unit (OR 1.01, 95 % CI 1.00-1.01). FiO2, ischemic heart disease, congestive heart disease, insulin therapy for diabetes, SAPS II, and length of stay in the surgical intensive care unit were independent predictors for MCE.

  11. AAPT Diagnostic Criteria for Central Neuropathic Pain

    DEFF Research Database (Denmark)

    Widerstrom-Noga, Eva; Loeser, John D.; Jensen, Troels Staehelin

    2017-01-01

    ) initiative, invited a working group to develop diagnostic criteria for central neuropathic pain. The criteria for central neuropathic pain that were developed expand upon existing criteria for neuropathic pain and the International Classification of Diseases 11th Revision draft criteria to ensure consistency......: The AAPT chronic central neuropathic pain taxonomy provides a classification for central pain associated with spinal cord injury, stroke, and multiple sclerosis. The diagnostic criteria are organized according to the AAPT multidimensional framework, specifically: 1) core diagnostic criteria, 2) common......Central neuropathic pain, which is pain caused by a lesion or disease of the central somatosensory nervous system, is a serious consequence of spinal cord injury, stroke, multiple sclerosis, and other conditions affecting the central nervous system. A collaborative effort between the Analgesic...

  12. Exercise-based cardiac rehabilitation for coronary heart disease

    Science.gov (United States)

    Heran, Balraj S; Chen, Jenny MH; Ebrahim, Shah; Moxham, Tiffany; Oldridge, Neil; Rees, Karen; Thompson, David R; Taylor, Rod S

    2014-01-01

    Background The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise-based cardiac rehabilitation aims to restore patients with heart disease to health. Objectives To determine the effectiveness of exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health-related quality of life of patients with CHD. Search methods RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009). Selection criteria Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography. Data collection and analysis Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information. Main results This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise-based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow-up) exercise-based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow-up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta-analysis was not undertaken for health-related quality of life. In seven out of 10 trials reporting health

  13. [Primary childhood vasculitis new classification criteria

    DEFF Research Database (Denmark)

    Herlin, T.; Nielsen, Susan

    2008-01-01

    Primary vasculitis is seen in both adults and children, but some of the diseases like Kawasaki disease occur primarily in children. The Chapel Hill Classification Criteria for primary vasculitis refers to the size of vessels but has not been validated in children. Recently, new criteria for the c......Primary vasculitis is seen in both adults and children, but some of the diseases like Kawasaki disease occur primarily in children. The Chapel Hill Classification Criteria for primary vasculitis refers to the size of vessels but has not been validated in children. Recently, new criteria...

  14. News: Good chemical manufacturing process criteria

    Science.gov (United States)

    This news column covers topics relating to manufacturing criteria, machine to machine technology, novel process windows, green chemistry indices, business resilience, immobilized enzymes, and Bt crops.

  15. 2012 Provisional classification criteria for polymyalgia rheumatica

    DEFF Research Database (Denmark)

    Dasgupta, Bhaskar; Cimmino, Marco A; Kremers, Hilal Maradit

    2012-01-01

    The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR compa......The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non...

  16. NWTS program criteria for mined geologic disposal of nuclear wasite: site performance criteria

    Energy Technology Data Exchange (ETDEWEB)

    None

    1981-02-01

    This report states ten criteria governing the suitability of sites for mined geologic disposal of high-level radioactive waste. The Department of Energy will use these criteria in its search for sites and will reevaluate their use when the Nuclear Regulatory Commission issues radioactive waste repository rules. These criteria encompass site geometry, geohydrology, geochemistry, geologic characteristics, tectonic environment, human intrusion, surface characteristics, environment, and potential socioeconomic impacts. The contents of this document include background discussion, site performance criteria, and appendices. The background section describes the waste disposal system, the application of the site criteria, and applicable criteria from NWTS-33(1) - Program Objectives, Functional Requirements and System Performance Criteria. Appendix A, entitled Comparison with Other Siting Criteria compares the NWTS criteria with those recommended by other agencies. Appendix B contains DOE responses to public comments received on the January 1980 draft of this document. Appendix C is a glossary.

  17. NWTS program criteria for mined geologic disposal of nuclear wasite: site performance criteria

    International Nuclear Information System (INIS)

    1981-02-01

    This report states ten criteria governing the suitability of sites for mined geologic disposal of high-level radioactive waste. The Department of Energy will use these criteria in its search for sites and will reevaluate their use when the Nuclear Regulatory Commission issues radioactive waste repository rules. These criteria encompass site geometry, geohydrology, geochemistry, geologic characteristics, tectonic environment, human intrusion, surface characteristics, environment, and potential socioeconomic impacts. The contents of this document include background discussion, site performance criteria, and appendices. The background section describes the waste disposal system, the application of the site criteria, and applicable criteria from NWTS-33(1) - Program Objectives, Functional Requirements and System Performance Criteria. Appendix A, entitled Comparison with Other Siting Criteria compares the NWTS criteria with those recommended by other agencies. Appendix B contains DOE responses to public comments received on the January 1980 draft of this document. Appendix C is a glossary

  18. Enterocyte Damage: A Piece in the Puzzle of Post-Cardiac Arrest Syndrome.

    Science.gov (United States)

    Piton, Gaël; Belin, Nicolas; Barrot, Loïc; Belon, François; Cypriani, Benoit; Navellou, Jean-Christophe; Capellier, Gilles

    2015-11-01

    Cardiac arrest is considered to be a cause of small bowel ischemia, but the consequences of cardiac arrest on the human small bowel have been rarely studied. Plasma citrulline concentration is a marker of functional enterocyte mass, and plasma intestinal fatty acid-binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to measure enterocyte biomarkers after cardiac arrest and to study the prognostic value of biomarker abnormalities. This is a prospective, observational, single-center study of patients admitted to the intensive care unit (ICU) for cardiac arrest, evaluating plasma citrulline and I-FABP concentrations at admission and after 24  h and variables according to the Utstein criteria. Variables according to 28-day Cerebral Performance Category score of 1 to 2 (good neurological outcome) versus 3 to 5 (poor neurological outcome) were compared. Sixty-nine patients with cardiac arrest of both cardiac and hypoxic origin were included. At ICU admission, plasma citrulline concentration was low in 65% and plasma I-FABP was elevated in 82% of the patients. After 24  h, plasma citrulline was low in 82% and I-FABP was normal in 60% of the patients. Patients with a poor neurological outcome had a lower plasma citrulline concentration and a higher I-FABP concentration at ICU admission. By multivariate analysis, plasma citrulline levels of 13.1  μmol L or less and I-FABP more than 260  pg mL were independently associated with a poor neurological outcome (odds ratio, 21.9 [2.2-215], and odds ratio, 13.6 [1.4-129], respectively). Cardiac arrest resuscitation is associated with evidence of small bowel mucosal damage in most patients, with a short and intense I-FABP elevation at admission and a decrease in citrulline concentration during the first day. In this study, low plasma citrulline and high I-FABP concentrations at ICU admission were predictive of a poor neurological outcome. This study confirms that cardiac arrest is a model of

  19. Descartes, Cardiac Heat, and Alchemy.

    Science.gov (United States)

    Heitsch, Dorothea

    2016-11-01

    René Descartes (1596-1650) insisted on a heat and light theory to explain cardiac movement, and used concepts such as distillation of the vital spirits, fermentation in the digestive process, and fermentation in the circulation of the blood. I argue that his theory of the body as a heat-exchange system was based on alchemical and natural philosophical notions of fire and light expounded by precursors and contemporaries who included Jean D'Espagnet, Jean Fernel, Jan Baptist van Helmont, and Andreas Libavius. Descartes endeavoured to mechanise their approaches, creating a theory in which fire and heat, a legacy from thermal explanations of physiology, were transformed into alchemical fire, and then into mechanistic or physicalist heat.

  20. Multiscale measurement of cardiac energetics.

    Science.gov (United States)

    Goo, Soyeon; Pham, Toan; Han, Jun-Chiew; Nielsen, Poul; Taberner, Andrew; Hickey, Anthony; Loiselle, Denis

    2013-09-01

    Herein we describe our laboratories' experimental methods for interrogating cardiac energetics at the organ (whole heart), tissue (trabecula) and perforated fibre (mitochondrial) levels. In whole heart and trabecula experiments, we focus on measuring pressure-volume (force-length) work and oxygen consumption (heat production) from which mechanical efficiency is derived. In both preparations (i.e. across scales differing by three orders of magnitude) we find efficiency values of 10%-15%. Mitochondrial experiments invoke a trio of titration protocols to yield information on oxygen consumption, ATP flux, membrane potential, electron leak and reactive oxygen species production, the latter two of which index energy transfer inefficiencies. Copyright © 2013 Wiley Publishing Asia Pty Ltd.