Velocity measurements and flow patterns within the hinge region of a Medtronic Parallel bileaflet mechanical valve with clear housing.

Science.gov (United States)

Ellis, J T; Healy, T M; Fontaine, A A; Saxena, R; Yoganathan, A P

1996-11-01

During recent clinical trials the Medtronic Parallel bileaflet mechanical heart valve was found to have an unacceptable number of valves with thrombus formation when implanted in the mitral position. Thrombi were observed in the hinge region and also in the upstream portion of the valve housing in the vicinity of the hinge. It was hypothesized that the flow conditions inside the hinge may have contributed to the thrombus formation. In order to investigate the flow structures within the hinge, laser Doppler anemometry (LDA) measurements were conducted in both steady and pulsatile flow at approximately 70 predetermined sites within the hinge region of a 27 mm Medtronic Parallel mitral valve with transparent housing. The pulsatile flow velocity measurements were animated in time using a graphical software package to visualize the hinge flow field throughout the cardiac cycle. The LDA measurements revealed that mean forward flow velocities through the hinge region were on the order of 0.10-0.20 m/s. In the inflow channel, a large vortical structure was present during diastole. Upon valve closure, peak reverse velocity reached 3 m/s close to the housing wall in the inflow channel. This area also experienced high turbulent shear stresses (> 6000 dynes/cm2) during the leakage flow phase. A disturbed, vortical flow was again present in the inflow channel after valve closure, while slightly above the leaflet peg and relief the flow was essentially stagnant. The high turbulent stresses near the top of the inflow channel, combined with a persistent vortex, implicate the inflow channel of the hinge as a likely region of thrombus formation. This experimental investigation revealed zones of flow stagnation in the inflow region of the hinge throughout the cardiac cycle and elevated turbulent shear stress levels in the inflow region during the leakage flow phase. These fluid mechanic phenomena are most likely a direct result of the complex geometry of the hinge of this valve

Modeling the Error of the Medtronic Paradigm Veo Enlite Glucose Sensor.

Science.gov (United States)

Biagi, Lyvia; Ramkissoon, Charrise M; Facchinetti, Andrea; Leal, Yenny; Vehi, Josep

2017-06-12

Continuous glucose monitors (CGMs) are prone to inaccuracy due to time lags, sensor drift, calibration errors, and measurement noise. The aim of this study is to derive the model of the error of the second generation Medtronic Paradigm Veo Enlite (ENL) sensor and compare it with the Dexcom SEVEN PLUS (7P), G4 PLATINUM (G4P), and advanced G4 for Artificial Pancreas studies (G4AP) systems. An enhanced methodology to a previously employed technique was utilized to dissect the sensor error into several components. The dataset used included 37 inpatient sessions in 10 subjects with type 1 diabetes (T1D), in which CGMs were worn in parallel and blood glucose (BG) samples were analyzed every 15 ± 5 min Calibration error and sensor drift of the ENL sensor was best described by a linear relationship related to the gain and offset. The mean time lag estimated by the model is 9.4 ± 6.5 min. The overall average mean absolute relative difference (MARD) of the ENL sensor was 11.68 ± 5.07% Calibration error had the highest contribution to total error in the ENL sensor. This was also reported in the 7P, G4P, and G4AP. The model of the ENL sensor error will be useful to test the in silico performance of CGM-based applications, i.e., the artificial pancreas, employing this kind of sensor.

Percutaneous implantation of the CoreValve aortic valve prosthesis in patients at high risk or rejected for surgical valve replacement: Clinical evaluation and feasibility of the procedure in the first 30 patients in the AMC-UvA

NARCIS (Netherlands)

Baan, J.; Yong, Z. Y.; Koch, K. T.; Henriques, J. P. S.; Bouma, B. J.; de Hert, S. G.; van der Meulen, J.; Tijssen, J. G. P.; Piek, J. J.; de Mol, B. A. J. M.

2010-01-01

Objective. To report the feasibility, safety and efficacy of percutaneous aortic valve implantation (PAVI) with the CoreValve self-expanding aortic valve bioprosthesis in elderly patients with aortic valve stenosis who are rejected for surgery or have a high surgical risk.Methods. PAVI using the

Transcatheter Aortic Valve Replacement With Early- and New-Generation Devices in Bicuspid Aortic Valve Stenosis

DEFF Research Database (Denmark)

Yoon, Sung Han; Lefèvre, Thierry; Ahn, Jung Ming

2016-01-01

Background Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). Particularly, limited data exist comparing the results of TAVR with new-generation devices versus early-generation devices.  Objectives...... This study sought to evaluate the clinical outcomes of TAVR for bicuspid AS with early- and new-generation devices.  Methods The Bicuspid TAVR Registry is an international multicenter study enrolling consecutive patients with bicuspid AS undergoing TAVR between April 2005 and May 2015.  Results Of 301...... patients, 199 patients (71.1%) were treated with early-generation devices (Sapien XT [Edwards Lifesciences Corporation, Irvine, California]: n = 87; CoreValve [Medtronic, Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices (Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus...

Hemodynamics in the Valsalva sinuses after transcatheter aortic valve implantation (TAVI).

Science.gov (United States)

Ducci, Andrea; Tzamtzis, Spyridon; Mullen, Michael J; Burriesci, Gaetano

2013-09-01

The study aim was to assess, in vitro, the hemodynamic modifications produced by transcatheter valves in the Valsalva sinuses, by mean of phase-resolved particle image velocimetry (PIV) measurements. Flow measurements were performed on a glass mock aortic root that included three polymeric valve leaflets, before and after the implantation of a Medtronic CoreValve device and of an Edwards SAPIEN valve. All experiments were carried out in a hydro-mechanical cardiovascular pulse duplicator system (Vivitro Superpump System SP3891) that reproduced physiologically equivalent pressures and flow rates conforming to the requirements of the standard ISO 5840:2005. The flow dynamics, before and after implantation of the two prosthetic devices, was characterized on the basis of phase-resolved velocity field and viscous shear rate measurements. Direct comparison indicated that both transcatheter valves determined a significant variation of flow during the early stages of valve opening and during valve closure. In general, the presence of the two valve implants significantly reduced the flow activity in the Valsalva sinuses, promoting regions of stagnation at their base. The reduction in flow in the Valsalva sinuses could be associated with the higher incidence of ischemic events reported after transcatheter heart valve implantation.

Long-Term Health Benefit of Transcatheter Aortic Valve Replacement in Patients With Chronic Lung Disease.

Science.gov (United States)

Crestanello, Juan A; Popma, Jeffrey J; Adams, David H; Deeb, G Michael; Mumtaz, Mubashir; George, Barry; Huang, Jian; Reardon, Michael J

2017-11-27

This study sought to characterize the long-term effect of chronic lung disease (CLD) on mortality, clinical outcomes, quality of life, and health benefits after transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis. The long-term effect of CLD after TAVR is unknown. Prevalence and severity of CLD was determined at baseline in high- and extreme-risk patients with aortic stenosis from the CoreValve US Pivotal Trial. Clinical outcomes and health status were assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS). A favorable health benefit was defined as alive with a KCCQ-OS ≥60 and stability (CLD was present in 55% (20% mild, 13% moderate, 22% severe) of the 1,030 patients studied. All-cause mortality was higher in patients with moderate and severe CLD at 1 year (19.6% mild, 28.1% moderate, 26.9% severe CLD vs. 19.2% non-CLD; p = 0.030) and 3 years (44.8% mild, 53.0% moderate, 51.9% severe vs. 37.7% non-CLD; p CLD at 1 and 3 years. All patients had a nearly 20-point improvement in KCCQ-OS at 1 and 3 years. However, only 43.3% of patients with CLD had a favorable health benefit at 1 year and 22.5% at 3 years. Moderate and severe CLD increases 1- and 3-year mortality after TAVR. Although functional status and quality of life were improved in CLD at 1 and 3 years after TAVR, a favorable health benefit was only achieved in selected patients. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

CT-angiography-based evaluation of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI)-predictive value and optimal thresholds for major anatomic parameters.

Science.gov (United States)

Schwarz, Florian; Lange, Philipp; Zinsser, Dominik; Greif, Martin; Boekstegers, Peter; Schmitz, Christoph; Reiser, Maximilian F; Kupatt, Christian; Becker, Hans C

2014-01-01

To evaluate the predictive value of CT-derived measurements of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI) and to calculate optimal cutoff values for the selection of various prosthesis sizes. The local IRB waived approval for this single-center retrospective analysis. Of 441 consecutive TAVI-patients, 90 were excluded (death within 30 days: 13; more than mild aortic regurgitation: 10; other reasons: 67). In the remaining 351 patients, the CoreValve (Medtronic) and the Edwards Sapien XT valve (Edwards Lifesciences) were implanted in 235 and 116 patients. Optimal prosthesis size was determined during TAVI by inflation of a balloon catheter at the aortic annulus. All patients had undergone CT-angiography of the heart or body trunk prior to TAVI. Using these datasets, the diameter of the long and short axis as well as the circumference and the area of the aortic annulus were measured. Multi-Class Receiver-Operator-Curve analyses were used to determine the predictive value of all variables and to define optimal cutoff-values. Differences between patients who underwent implantation of the small, medium or large prosthesis were significant for all except the large vs. medium CoreValve (all p'sprosthesis size for both manufacturers (multi-class AUC's: 0.80, 0.88, 0.91, 0.88, 0.88, 0.89). Using the calculated optimal cutoff-values, prosthesis size is predicted correctly in 85% of cases. CT-based aortic root measurements permit excellent prediction of the prosthesis size considered optimal during TAVI.

CT-angiography-based evaluation of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI-predictive value and optimal thresholds for major anatomic parameters.

Directory of Open Access Journals (Sweden)

Florian Schwarz

Full Text Available BACKGROUND/OBJECTIVES: To evaluate the predictive value of CT-derived measurements of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI and to calculate optimal cutoff values for the selection of various prosthesis sizes. METHODS: The local IRB waived approval for this single-center retrospective analysis. Of 441 consecutive TAVI-patients, 90 were excluded (death within 30 days: 13; more than mild aortic regurgitation: 10; other reasons: 67. In the remaining 351 patients, the CoreValve (Medtronic and the Edwards Sapien XT valve (Edwards Lifesciences were implanted in 235 and 116 patients. Optimal prosthesis size was determined during TAVI by inflation of a balloon catheter at the aortic annulus. All patients had undergone CT-angiography of the heart or body trunk prior to TAVI. Using these datasets, the diameter of the long and short axis as well as the circumference and the area of the aortic annulus were measured. Multi-Class Receiver-Operator-Curve analyses were used to determine the predictive value of all variables and to define optimal cutoff-values. RESULTS: Differences between patients who underwent implantation of the small, medium or large prosthesis were significant for all except the large vs. medium CoreValve (all p's<0.05. Furthermore, mean diameter, annulus area and circumference had equally high predictive value for prosthesis size for both manufacturers (multi-class AUC's: 0.80, 0.88, 0.91, 0.88, 0.88, 0.89. Using the calculated optimal cutoff-values, prosthesis size is predicted correctly in 85% of cases. CONCLUSION: CT-based aortic root measurements permit excellent prediction of the prosthesis size considered optimal during TAVI.

Evaluation of subcutaneous glucose monitoring systems under routine environmental conditions in patients with type 1 diabetes.

Science.gov (United States)

Aberer, Felix; Hajnsek, Martin; Rumpler, Markus; Zenz, Sabine; Baumann, Petra M; Elsayed, Hesham; Puffing, Adelheid; Treiber, Gerlies; Pieber, Thomas R; Sourij, Harald; Mader, Julia K

2017-07-01

Continuous and flash glucose monitoring (GM) systems have been established in diabetes care. We compared the sensor performance of 3 commercially available GM systems. A total of 12 patients with type 1 diabetes were included in a single-centre, open-label study in which the sensor performance of the Abbott FreeStyle libre (Abbott), Dexcom G4 Platinum (Dexcom) and Medtronic MiniMed 640G (Medtronic) systems over 12 hours was compared during mimicked real-life conditions (meals, exercise, hypo- and hyperglycaemia). Sensor performance was determined by fulfilment of ISO 15197:2013 criteria, calculating mean absolute relative difference (MARD), and was also illustrated using Parkes error grid and Bland-Altman plots. Sensor performance during changes in metabolic variables (lactate, betahydroxybutyrate, glucagon, non-esterified-fatty-acids) was determined by Spearman's rank correlation coefficient testing. The systems fulfilled ISO 15197:2013 criteria by 73.2% (Abbott), 56.1% (Dexcom) and 52.0% (Medtronic). The MARDs ± standard deviation in the entire glycaemic range were 13.2% ± 10.9% (Abbott), 16.8% ± 12.3% (Dexcom) and 21.4% ± 17.6% (Medtronic), respectively. All sensors performed less accurately during hypoglycaemia and best during hyperglycaemia. We did not observe an influence of metabolic variables on sensor performance. © 2017 John Wiley & Sons Ltd.

Aortic Regurgitation in Patients Undergoing Transcatheter Aortic Valve Replacement With the Self-Expanding CoreValve Versus the Balloon-Expandable SAPIEN XT Valve.

Science.gov (United States)

Kiramijyan, Sarkis; Magalhaes, Marco A; Koifman, Edward; Didier, Romain; Escarcega, Ricardo O; Baker, Nevin C; Negi, Smita I; Minha, Sa'ar; Torguson, Rebecca; Jiaxiang, Gai; Asch, Federico M; Wang, Zuyue; Okubagzi, Petros; Gaglia, Michael A; Ben-Dor, Itsik; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

2016-05-01

The incidence of aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) in a self-expanding and a balloon-expandable system is controversial. This study aimed to examine the incidence and severity of post-TAVR AR with the CoreValve (CV) versus the Edwards XT Valve (XT). Baseline, procedural, and postprocedural inhospital outcomes were compared. The primary end point was the incidence of post-TAVR AR of any severity, assessed with a transthoracic echocardiogram, in the CV versus XT groups. A multivariate logistic regression analysis was completed to evaluate for correlates of the primary end point. The secondary end points included the change in severity of AR at 30-day and 1-year follow-up. A total of 223 consecutive patients (53% men, mean age 82 years) who had transfemoral TAVR with either a CV (n = 119) or XT (n = 104) were evaluated. The rates of post-TAVR AR in the groups were similar, and there was no evidence of more-than-moderate AR in either group. There were significant differences in the rates of intraprocedural balloon postdilation with the CV (17.1%) versus XT valve (5.8%; p = 0.009) and in the rates of intraprocedural implantation of a second valve-in-valve prosthesis with the CV (9.9%) versus XT valve (2.2%; p = 0.036). There were no significant differences in inhospital safety outcomes between the 2 groups. In conclusion, the incidence of post-TAVR AR is similar between the CV and the XT valve when performed by experienced operators using optimal intraprocedural strategies, as deemed appropriate, to mitigate the severity of AR. Copyright © 2016 Elsevier Inc. All rights reserved.

Complications with the MICRA TPS Pacemaker System: Persistent Complete Heart Block and Late Capture Failure.

Science.gov (United States)

Holm, Niels; Müller, Andreas; Zbinden, Rainer

2017-04-01

A Medtronic MICRA transcatheter pacing system (Medtronic, Minneapolis, MN, USA) was implanted in an 86-year-old patient with sick sinus syndrome and left bundle branch block after transfemoral aortic valve implantation. During implantation she developed a persistent complete heart block due to manipulation with the large-bore delivery catheter. Two weeks later, acute pacemaker dysfunction occurred due to massive increase of pacing threshold and impedance without obvious pacemaker dislocation or myocardial perforation. Recurrent capture failure was seen with pacing output set at 5 V/1.0 ms. Hence, microdislocation or fixation of the tines in the right ventricular trabeculae has to be assumed. © 2016 Wiley Periodicals, Inc.

Transcatheter Replacement of Failed Bioprosthetic Valves

DEFF Research Database (Denmark)

Simonato, Matheus; Webb, John; Kornowski, Ran

2016-01-01

postprocedural gradients (mean >= 20 mm Hg). Optimal implantation depths were defined by receiver operating characteristic curve. A total of 292 consecutive patients (age, 78.9 +/- 8.7 years; 60.3% male; 157 CoreValve Evolut and 135 Sapien XT) were evaluated. High implantation was associated with significantly...... lower rates of elevated gradients in comparison with low implantation (CoreValve Evolut, 15% versus 34.2%; P=0.03 and Sapien XT, 18.5% versus 43.5%; P=0.03, respectively). Optimal implantation depths were defined: CoreValve Evolut, 0 to 5 mm; Sapien XT, 0 to 2 mm (0-10% frame height); sensitivities, 91...

Initial clinical experience with the Medtronic Micro Vascular Plug™ in transcatheter occlusion of PDAs in extremely premature infants.

Science.gov (United States)

Sathanandam, Shyam; Justino, Henri; Waller, B Rush; Radtke, Wolfgang; Qureshi, Athar M

2017-05-01

To describe the early multicenter, clinical experience with the Medtronic Micro Vascular Plug™ (MVP) for the occlusion of patent ductus arteriosus (PDA) in premature infants. The MVP is a large diameter plug that can be delivered through a microcatheter for occlusion of abnormal blood vessels. A Retrospective review of PDA embolization procedures performed in two centers using the MVP was performed. Fifteen premature infants underwent attempted PDA occlusion using the MVP. The gestational age and birth weight were 25.6 ± 2.5 weeks and 735 ± 251 g, respectively. The median weight and age at the time of the procedure were 1,210 g (700-3,500 g) and 4.5 weeks (2-12 weeks), respectively. Median procedure and fluoroscopy times were 45 and 6.5 min, respectively. The median radiation and contrast doses were 19.7 mGy and 2.4 mL/kg, respectively. Antegrade occlusion was successfully achieved in 13 patients 2 kg had arterial access and attempted retrograde occlusion; one of which was unsuccessful due to the PDA being short and wide. Complete closure was observed in 13 of 14 successful procedures (93%), with one patient having a small residual shunt that was not seen on follow-up. There were no complications related to the procedure or noted during follow-up (Median 11 months). The MVP is a new, large-diameter vascular embolization device that may be useful for the occlusion of PDA in extremely small, premature infants. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Endoscopic augmentation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease: Multicenter study of the gatekeeper reflux repair system

NARCIS (Netherlands)

Fockens, P.; Bruno, M. J.; Gabbrielli, A.; Odegaard, S.; Hatlebakk, J.; Allescher, H. D.; Rösch, T.; Rhodes, M.; Bastid, C.; Rey, J.; Boyer, J.; Muehldorffer, S.; van den Hombergh, U.; Costamagna, G.

2004-01-01

Background and Study Aims: The safety and effectiveness of the Gatekeeper Reflux Repair System (Medtronic Europe, Tolochenaz, Switzerland) in the treatment of gastroesophageal reflux disease (GERD) was evaluated. This new, reversible treatment modality involves the endoscopic introduction of

Accuracy and reliability of continuous glucose monitoring systems: a head-to-head comparison

NARCIS (Netherlands)

Luijf, Yoeri M.; Mader, Julia K.; Doll, Werner; Pieber, Thomas; Farret, Anne; Place, Jerome; Renard, Eric; Bruttomesso, Daniela; Filippi, Alessio; Avogaro, Angelo; Arnolds, Sabine; Benesch, Carsten; Heinemann, Lutz; DeVries, J. Hans

2013-01-01

This study assessed the accuracy and reliability of three continuous glucose monitoring (CGM) systems. We studied the Animas® (West Chester, PA) Vibe™ with Dexcom® (San Diego, CA) G4™ version A sensor (G4A), the Abbott Diabetes Care (Alameda, CA) Freestyle® Navigator I (NAV), and the Medtronic

Radial Force: An Underestimated Parameter in Oversizing Transcatheter Aortic Valve Replacement Prostheses: In Vitro Analysis with Five Commercialized Valves.

Science.gov (United States)

Egron, Sandrine; Fujita, Buntaro; Gullón, Lucía; Désirée, Pott; Schmitz-Rode, Thomas; Ensminger, Stephan; Steinseifer, Ulrich

2017-09-05

The goal is to inform in depth on transcatheter aortic valve replacement (TAVR) prosthesis mechanical behavior, depending on frame type, design, and size, and how it crucially impacts the oversizing issue in clinical use, and ultimately the procedure outcome. Transcatheter aortic valve replacement is an established therapy for high-risk patients suffering from aortic stenosis, and the indication for TAVR is progressively expanding to intermediate-risk patients. Choosing the optimal oversizing degree is crucial to safely anchor the TAVR valve-which involves limiting the risks for embolism, aortic regurgitation, conductance disturbance, or annulus rupture-and to increase the valve prosthesis performance. The radial force (RF) profiles of five TAVR prostheses were measured in vitro: the CoreValve 23 and 26 (Medtronic, MN), the Acurate neo S (Symetis, Switzerland), and the SAPIEN XT 23 and 26 (Edwards Lifesciences, CA). Measurements were run with the RX Machine equipment (Machine Solutions Inc., AZ), which is used in ISO standard tests for intravascular stents. Test protocols were adapted for TAVR prostheses. With the prostheses RF profiles' results, mechanical behavior differences could be described and discussed in terms of oversizing strategy and clinical impact for all five valves. Besides, crossing the prostheses' RF profiles with their recommended size windows made the assessment of borderline size cases possible and helped analyze the risks when accurate measurement of patient aortic annulus proves difficult. The prostheses' RF profiles bring new support in clinical decision-making for valve type and size in patients.

Transcatheter aortic valve replacement: historical perspectives, current evidence, and future directions.

Science.gov (United States)

Horne, Aaron; Reineck, Elizabeth A; Hasan, Rani K; Resar, Jon R; Chacko, Matthews

2014-10-01

Severe aortic stenosis (AS) results in considerable morbidity and mortality without aortic valve replacement and is expected to increase in prevalence with the aging population. Because AS primarily affects the elderly, many patients with comorbidities are poor candidates for surgical aortic valve replacement (SAVR) and may not be referred. Transcatheter aortic valve replacement (TAVR) has emerged as transformative technology for the management of AS over the past decade. Randomized trials have established the safety and efficacy of TAVR with improved mortality and quality of life compared with medical therapy in inoperable patients, while demonstrating noninferiority and even superiority to SAVR among high-risk operative candidates. However, early studies demonstrated an early penalty of stroke and vascular complications with TAVR as well as increased paravalvular leak as compared with SAVR. Two device platforms have been evaluated and approved for use in the United States: the Edwards SAPIEN and the Medtronic CoreValve. Early studies also suggest cost-effectiveness for TAVR. Ongoing studies are evaluating new iterations of the aforementioned TAVR devices, novel device designs, and applications of TAVR in expanded populations of patients including those with lower risk profiles as well as those with comorbidities that were excluded from early clinical trials. Future improvements in TAVR technology will likely reduce periprocedural and long-term complications. Further studies are needed to confirm device durability over long-term follow-up and explore the applicability of TAVR to broader AS patient populations. Copyright © 2014 Mosby, Inc. All rights reserved.

Automated hybrid closed-loop control with a proportional-integral-derivative based system in adolescents and adults with type 1 diabetes: individualizing settings for optimal performance.

Science.gov (United States)

Ly, Trang T; Weinzimer, Stuart A; Maahs, David M; Sherr, Jennifer L; Roy, Anirban; Grosman, Benyamin; Cantwell, Martin; Kurtz, Natalie; Carria, Lori; Messer, Laurel; von Eyben, Rie; Buckingham, Bruce A

2017-08-01

Automated insulin delivery systems, utilizing a control algorithm to dose insulin based upon subcutaneous continuous glucose sensor values and insulin pump therapy, will soon be available for commercial use. The objective of this study was to determine the preliminary safety and efficacy of initialization parameters with the Medtronic hybrid closed-loop controller by comparing percentage of time in range, 70-180 mg/dL (3.9-10 mmol/L), mean glucose values, as well as percentage of time above and below target range between sensor-augmented pump therapy and hybrid closed-loop, in adults and adolescents with type 1 diabetes. We studied an initial cohort of 9 adults followed by a second cohort of 15 adolescents, using the Medtronic hybrid closed-loop system with the proportional-integral-derivative with insulin feed-back (PID-IFB) algorithm. Hybrid closed-loop was tested in supervised hotel-based studies over 4-5 days. The overall mean percentage of time in range (70-180 mg/dL, 3.9-10 mmol/L) during hybrid closed-loop was 71.8% in the adult cohort and 69.8% in the adolescent cohort. The overall percentage of time spent under 70 mg/dL (3.9 mmol/L) was 2.0% in the adult cohort and 2.5% in the adolescent cohort. Mean glucose values were 152 mg/dL (8.4 mmol/L) in the adult cohort and 153 mg/dL (8.5 mmol/L) in the adolescent cohort. Closed-loop control using the Medtronic hybrid closed-loop system enables adaptive, real-time basal rate modulation. Initializing hybrid closed-loop in clinical practice will involve individualizing initiation parameters to optimize overall glucose control. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Direct transcatheter aortic valve implantation with self-expandable bioprosthesis: Feasibility and safety

Energy Technology Data Exchange (ETDEWEB)

Fiorina, Claudia, E-mail: clafiorina@yahoo.it [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Maffeo, Diego; Curello, Salvatore [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Lipartiti, Felicia [Division of Cardiology, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Chizzola, Giuliano [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy); D' Aloia, Antonio [Division of Cardiology, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Adamo, Marianna [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Mastropierro, Rosy [Division of Cardiothoracic Anestesiology, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Gavazzi, Emanuele [Department of Radiology, University of Brescia, Spedali Civili, Brescia (Italy); Ciccarese, Camilla; Chiari, Ermanna [Division of Cardiology, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Ettori, Federica [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy)

2014-06-15

Background: Balloon valvuloplasty has been considered a mandatory step of the transcatheter aortic valve implantation (TAVI), although it is not without risk. The aim of this work was to evaluate the feasibility and safety of TAVI performed without pre-dilation (direct TAVI) of the stenosed aortic valve. Material and Methods: Between June 2012 and June 2013, 55 consecutive TAVI performed without pre-dilation at our institution using the self-expandable CoreValve prosthesis (Medtronic, Minneapolis, MN) were analyzed and compared with 45 pre-dilated TAVI performed the previous year. Inclusion criteria were a symptomatic and severe aortic stenosis. Exclusion criteria were defined as presence of pure aortic regurgitation, degenerated surgical bioprosthesis or bicuspid aortic valve and prior procedure of balloon aortic valvuloplasty performed as a bridge to TAVI. Results: High-burden calcification in the device landing zone, assessed by CT scan, was found in most of the patients. The valve size implanted was similar in both groups. Device success was higher in direct TAVI (85% vs. 64%, p = 0.014), mostly driven by a significant lower incidence of paravalvular leak (PVL ≥2; 9% vs. 33%, p = 0.02). Safety combined end point at 30 days was similar in both groups. Conclusion: Compared to TAVI with pre-dilation, direct TAVI is feasible regardless of the presence of bulky calcified aortic valve and the valve size implanted. Device success was higher in direct TAVI, mostly driven by a lower incidence of paravalvular leak. Safety at 30 days was similar in two groups.

Early Performance and Safety of the Micra Transcatheter Pacemaker in Pigs.

Science.gov (United States)

Bonner, Matthew; Eggen, Michael; Haddad, Tarek; Sheldon, Todd; Williams, Eric

2015-11-01

The Micra® Transcatheter Pacing System (TPS; Medtronic Inc., Minneapolis, MN, USA) is a miniaturized single-chamber pacemaker system that is delivered via catheter through the femoral vein. In this study, the electrical performance was compared between the TPS and a traditional leaded pacemaker. In addition, the safety profile of the two systems was compared by thorough monitoring for a number of adverse events. The TPS was implanted in the right ventricular apex of 10 Yucatan mini pigs and a Medtronic single-lead pacemaker (SLP) was implanted in the right ventricular apex of another 10 pigs and connected to a traditional pacemaker. The electrical performance of all devices was monitored for 12 weeks. The safety profile of each system was characterized using x-ray, computed tomography, ultrasound, blood work, and necropsy to monitor for a variety of adverse events. At implant the mean pacing thresholds were 0.58 ± 0.17 V @0.24 ms and 0.75 ± 0.29 V @0.21 ms for the TPS and the SLP respectively. After 12 weeks, mean thresholds were 0.94 ± 0.46 V and 1.85 ± 0.75 V (P pacemaker system. © 2015 Medtronic PLC. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc.

Analysis of cytokine profile and growth factors in platelet-rich plasma obtained by open systems and commercial columns.

Science.gov (United States)

Pochini, Alberto de Castro; Antonioli, Eliane; Bucci, Daniella Zanetti; Sardinha, Luiz Roberto; Andreoli, Carlos Vicente; Ferretti, Mario; Ejnisman, Benno; Goldberg, Anna Carla; Cohen, Moisés

2016-01-01

To evaluate growth factors and cytokines in samples of platelet-rich plasma obtained by three different centrifugation methods. Peripheral blood of six individuals with no hematological diseases, aged 18 to 68 years, was drawn to obtain platelet-rich plasma, using the open method and commercial columns by Medtronic and Biomet. The products obtained with the different types of centrifugation were submitted to laboratory analysis, including pro-inflammatory cytokines and chemokines by flow cytometry assays, the concentration of fibroblast growth factors-2 (FGF-2) and transforming growth factor-beta1 (TGF-β1). The diverse separation methods generated systematically different profiles regarding number of platelets and leukocytes. The Medtronic system yielded a product with the highest concentration of platelets, and the open method, with the lowest concentration of platelets. The results of cytokine analysis showed that the different types of centrifugation yielded products with high concentrations of interleukin 8, interleukin 1β. The open system resulted in a product with high levels of interleukin 6. Other cytokines and chemokines measured were similar between systems. The product obtained with the open method showed higher levels of TGF-β1 in relation to other systems and low FGF-2 levels. The formed elements, growth factors and cytokines in samples of platelet-rich plasma varied according to the centrifugation technique used. Avaliar fatores de crescimento e citocinas em amostras de plasma rico em plaquetas obtidas por três diferentes métodos de centrifugação. Foi coletado sangue periférico de seis indivíduos, sem doença hematológica, com idades entre 18 e 68 anos, para obtenção de plasma rico em plaquetas, utilizando o método aberto e sistemas comerciais das empresas Medtronic e Biomet. Os produtos obtidos com os diferentes tipos de centrifugação foram submetidos às análises laboratoriais, incluindo citocinas próinflamatórias e quimiocinas

Catheter Ablation of Focal Atrial Tachycardia Using Remote Magnetic Navigation.

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Webster, Mark; Pasupati, Sanjeevan; Lever, Nigel; Stiles, Martin

2018-05-01

This first-in-human study evaluated the safety and technical feasibility of the Tempo temporary cardiac pacing lead (BioTrace Medical), which includes a novel fixation mechanism and soft tip. Complications of temporary pacing leads include dislodgment, arrhythmias, and ventricular perforation. Temporary pacing applications have increased with transcatheter aortic valve replacement (TAVR) growth, for rapid pacing during balloon valvuloplasty (BAV) and valve deployment, and for periprocedural bradyarrhythmia support. Eligible patients required temporary pacing for TAVR, BAV, or electrophysiology (EP) procedures. Transthoracic echocardiograms were obtained at baseline and 24 hours after lead removal. Safety was defined as freedom from pericardial effusion requiring intervention or evidence of tamponade. Technical feasibility involved successful intracardiac delivery and pace capture. Additional evaluations included pacing threshold (PCT), rapid pacing, dislodgment, or sustained ventricular arrhythmias. Follow-up was to 30 days. Twenty-five patients (60% female; mean age, 64 ± 19 years) underwent 13 TAVRs (7 Sapien 3 valves [Edwards Lifesciences], 4 CoreValves [Medtronic], and 2 Lotus valves [Boston Scientific]), 11 EP procedures, and 1 BAV at two New Zealand centers from January 2016 to June 2016. Safety was met in all patients, with no device-related adverse events. Technical feasibility was achieved in 23 cases (92%); 2 patients had unsuitable anatomy. No patient had lead dislodgment or sustained ventricular arrhythmias, and the final procedural PCT was 0.7 ± 0.5 mA. Rapid pacing was successful in all cases. Five patients had successful postprocedural use up to 5 days. This first-in-human study demonstrates the safety and technical feasibility of the Tempo lead, providing stable periprocedural temporary pacing support.

Incidence, feasibility and outcome of percutaneous coronary intervention after transcatheter aortic valve implantation with a self-expanding prosthesis. Results from a single center experience.

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Allali, Abdelhakim; El-Mawardy, Mohamed; Schwarz, Bettina; Sato, Takao; Geist, Volker; Toelg, Ralph; Richardt, Gert; Abdel-Wahab, Mohamed

2016-09-01

Percutaneous coronary intervention (PCI) after transcatheter aortic valve implantation (TAVI) can become technically challenging after implantation of the self-expanding Medtronic CoreValve (MCV) device, which completely covers the aortic root. The aim of this study was to report on the incidence, feasibility and outcome of PCI after TAVI with the MCV device. Between 2007 and 2014, all patients subjected to PCI after MCV implantation in a single-center institutional TAVI database were retrospectively identified. Clinical, angiographic and procedural characteristics were reviewed and analyzed. We identified a total of 17 patients (5.7%) treated with 24 PCI procedures for 29 lesions at a median of 17.7months (range 1-72) after MCV implantation. The mean age was 79.7±6.8years and the mean logistic EuroSCORE was 30.3%±18.9%. Nine procedures were performed for patients with acute coronary syndrome. 89.6% of the treated lesions were of type B2/C and 79.3% were de novo ones. A median of one guiding catheter was necessary to intubate the target coronary ostium (range 1-10) and 95% of the lesions on the left coronary artery were treated through a Judkins catheter. In one primary PCI for STEMI the intubation of the right coronary ostium was not successful. Final procedural success was obtained in 95.8%, and peri-procedural death occurred in one patient. The need for PCI after MCV is not uncommon and is mostly related to coronary artery disease progression. PCI after MCV is usually feasible and safe, but coronary intubation in an emergency setting can be challenging. Copyright © 2016 Elsevier Inc. All rights reserved.

Is valve choice a significant determinant of paravalular leak post-transcatheter aortic valve implantation? A systematic review and meta-analysis.

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O'Sullivan, Katie E; Gough, Aideen; Segurado, Ricardo; Barry, Mitchel; Sugrue, Declan; Hurley, John

2014-05-01

Paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) is associated with poor survival. The two main valve delivery systems used to date differ significantly in both structure and deployment technique. The primary objective of this study was to perform a systematic review and meta-analysis of studies identifying PVR in patients post-TAVI using Medtronic CoreValve (MCV) and Edward Sapien (ES) valves in order to identify whether a significant difference exists between valve types. The secondary objective was to identify additional factors predisposing to PVR to provide an overview of the other associated considerations. A systematic review and meta-analysis of the current literature to identify PVR rate in patients with MCV and ES valves was performed. We also sought to examine other factors predisposing to PVR. A total of 5910 patients were identified from 9 studies. PVR rates for MCV and ES were analysed. MCV was associated with a higher PVR rate of 15.75% [95% confidence interval (CI) 12.48-19.32] compared with ES 3.93% [95% CI 1.05-8.38]. We separately reviewed predisposing factors associated with PVR. A formal comparison of the MCV and ES valve leakage rates by mixed-effects meta-regression with a fixed-effect moderator variable for valve type (MCV or ES) suggested a statistically significant difference in leakage rate between the two valve types (P = 0.0002). Unfavourable anatomical and pathological factors as well as valve choice have an impact on rates of PVR. Additionally, certain anatomical features dictate valve choice. A direct comparison of all the predisposing factors at this time is not possible and will require prospective multivariate analysis. There is, however, a significant difference in the PVR rates between valves based on the published observational data available to date. The ES valve associated with a lower incidence of PVR overall; therefore, we conclude that valve choice is indeed a significant

75 FR 4407 - The Neurological Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting

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2010-01-27

... enough to provide timely notice. Therefore, you should always check the agency's Web site and call the... premarket approval application for the Deep Brain Stimulation System for Epilepsy sponsored by Medtronic...

The effect of endograft device on patient outcomes in endovascular repair of ruptured abdominal aortic aneurysms.

Science.gov (United States)

Kansal, Vinay; Nagpal, Sudhir; Jetty, Prasad

2017-12-01

Objective Endovascular aneurysm repair for ruptured abdominal aortic aneurysm is being increasingly applied as the intervention of choice. The purpose of this study was to determine whether survival and reintervention rates after ruptured abdominal aortic aneurysm vary between endograft devices. Methods This cohort study identified all ruptured abdominal aortic aneurysms performed at The Ottawa Hospital from January 1999 to May 2015. Data collected included patient demographics, stability index at presentation, adherence to device instructions for use, endoleaks, reinterventions, and mortality. Kruskal-Wallis test was used to compare outcomes between groups. Mortality outcomes were assessed using Kaplan-Meier survival analysis, and multivariate Cox regression modeling. Results One thousand sixty endovascular aneurysm repairs were performed using nine unique devices. Ninety-six ruptured abdominal aortic aneurysms were performed using three devices: Cook Zenith ( n = 46), Medtronic Endurant ( n = 33), and Medtronic Talent ( n = 17). The percent of patients presented in unstable or extremis condition was 30.2, which did not differ between devices. Overall 30-day mortality was 18.8%, and was not statistically different between devices ( p = 0.16), although Medtronic Talent had markedly higher mortality (35.3%) than Cook Zenith (15.2%) and Medtronic Endurant (15.2%). AUI configuration was associated with increased 30-day mortality (33.3% vs. 12.1%, p = 0.02). Long-term mortality and graft-related reintervention rates at 30 days and 5 years were similar between devices. Instructions for use adherence was similar across devices, but differed between the ruptured abdominal aortic aneurysm and elective endovascular aneurysm repair cohorts (47.7% vs. 79.0%, p 30 days post-endovascular aneurysm repair ( p = 0.01). Type 1 endoleak rates differed significantly across devices (Cook Zenith 0.0%, Medtronic Endurant 18.2%, Medtronic Talent 17.6%, p = 0

Application of the Continuous-Discrete Extended Kalman Filter for Fault Detection in Continuous Glucose Monitors for Type 1 Diabetes

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Mahmoudi, Zeinab; Boiroux, Dimitri; Hagdrup, Morten

2016-01-01

The purpose of this study is the online detection of faults and anomalies of a continuous glucose monitor (CGM). We simulated a type 1 diabetes patient using the Medtronic virtual patient model. The model is a system of stochastic differential equations and includes insulin pharmacokinetics...

Mid- to long-term outcome comparison of the Medtronic Hancock II and bi-leaflet mechanical aortic valve replacement in patients younger than 60 years of age: a propensity-matched analysis.

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Wang, Yin; Chen, Si; Shi, Jiawei; Li, Geng; Dong, Nianguo

2016-03-01

This study aims to compare mid-long-term clinical outcomes between patients younger than 60 years of age undergoing bioprosthetic and mechanical aortic valve replacement. From January 2002 to December 2009, patients younger than 60 years of age who received Medtronic Hancock II porcine bioprostheses were selected and compared with those who received mechanical bi-leaflet valves in the aortic position. A stepwise logistic regression propensity score identified a subset of 112 evenly matched patient-pairs. Mid-long-term outcomes of survival, valve-related reoperations, thromboembolic events and bleeding events were assessed. The follow-up was only 95.1% complete. Fourteen measurable variables were statistically similar for the matched cohort. Postoperative in-hospital mortality was 3.6% (bioprosthetic valves) and 2.7% (mechanical valves) (P = 0.700). Survival at 5 and 10 years was 96.3 and 88.7% for patients receiving bioprosthetic valve replacement versus 96.3 and 87.9% for patients receiving mechanical valve replacement (P = 0.860), respectively. At 5 and 10 years after operations, freedom from valve-related reoperation was 97.2 and 94.8% for patients receiving mechanical valve replacement, and 96.3 and 90.2% for patients receiving bioprosthetic valve replacement (P = 0.296), respectively. There was no difference between freedom from thromboembolic events (P = 0.528) and bleeding events (P = 0.128) between the matched groups during the postoperative 10 years. In patients younger than 60 years of age undergoing aortic valve replacement, mid-long-term survival rate was similar for patients receiving bioprosthetic versus mechanical valve replacement. Bioprosthetic valves were associated with a trend for a lower risk of anticoagulation treatment and did not have significantly greater likelihood of a reoperation. These findings suggest that a bioprosthetic valve may be a reasonable choice for AVR in patients younger than 60 years of age. © The Author 2015. Published by

Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices

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Ladd Mark E

2010-10-01

Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve® including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve® prosthesis as an initial step towards real-time CMR-guided TAVI. Methods The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T1-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding. Results CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences. Conclusions The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement

Transcatheter aortic-valve replacement with a self-expanding prosthesis.

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Adams, David H; Popma, Jeffrey J; Reardon, Michael J; Yakubov, Steven J; Coselli, Joseph S; Deeb, G Michael; Gleason, Thomas G; Buchbinder, Maurice; Hermiller, James; Kleiman, Neal S; Chetcuti, Stan; Heiser, John; Merhi, William; Zorn, George; Tadros, Peter; Robinson, Newell; Petrossian, George; Hughes, G Chad; Harrison, J Kevin; Conte, John; Maini, Brijeshwar; Mumtaz, Mubashir; Chenoweth, Sharla; Oh, Jae K

2014-05-08

We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to surgical aortic-valve replacement (surgical group). The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing. A total of 795 patients underwent randomization at 45 centers in the United States. In the as-treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority). The results were similar in the intention-to-treat analysis. In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life. Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke. In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement. (Funded by Medtronic; U.S. CoreValve High Risk Study ClinicalTrials.gov number, NCT01240902.).

Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

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Leonardo Sinnott Silva

2015-01-01

Full Text Available Abstract Background: Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI remains a challenge. Objectives: To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. Methods: The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI, EuroSCORE II (ESII, Society of Thoracic Surgeons (STS score, Ambler score (AS and Guaragna score (GS. The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test and discrimination [area under the receiver–operating characteristic curve (AUC]. Results: The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI: 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42 for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16 for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68 for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64 for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05. Conclusions: In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.

Integration of intraoperative stereovision imaging for brain shift visualization during image-guided cranial procedures

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Schaewe, Timothy J.; Fan, Xiaoyao; Ji, Songbai; Roberts, David W.; Paulsen, Keith D.; Simon, David A.

2014-03-01

Dartmouth and Medtronic Navigation have established an academic-industrial partnership to develop, validate, and evaluate a multi-modality neurosurgical image-guidance platform for brain tumor resection surgery that is capable of updating the spatial relationships between preoperative images and the current surgical field. A stereovision system has been developed and optimized for intraoperative use through integration with a surgical microscope and an image-guided surgery system. The microscope optics and stereovision CCD sensors are localized relative to the surgical field using optical tracking and can efficiently acquire stereo image pairs from which a localized 3D profile of the exposed surface is reconstructed. This paper reports the first demonstration of intraoperative acquisition, reconstruction and visualization of 3D stereovision surface data in the context of an industry-standard image-guided surgery system. The integrated system is capable of computing and presenting a stereovision-based update of the exposed cortical surface in less than one minute. Alternative methods for visualization of high-resolution, texture-mapped stereovision surface data are also investigated with the objective of determining the technical feasibility of direct incorporation of intraoperative stereo imaging into future iterations of Medtronic's navigation platform.

Reproducibility and reliability of hypoglycaemic episodes recorded with Continuous Glucose Monitoring System (CGMS) in daily life

DEFF Research Database (Denmark)

Høi-Hansen, T; Pedersen-Bjergaard, U; Thorsteinsson, B

2005-01-01

AIM: Continuous glucose monitoring may reveal episodes of unrecognized hypoglycaemia. We evaluated reproducibility and reliability of hypoglycaemic episodes recorded in daily life by the Medtronic MiniMed Continuous Glucose Monitoring System (CGMS). METHODS: Twenty-nine adult patients with Type 1...... data were recalibrated generating four different CGMS data sets [left-A (left side of abdomen, calibration set A), left-B, right-A and right-B]. Agreement between CGMS data sets was evaluated during hypoglycaemic events, comparing CGMS readings = 2.2 mmol/l with nadir values from corresponding CGMS...... data sets. CGMS readings were also compared with independent self-monitored blood glucose (SMBG) values. RESULTS: With hypoglycaemia (CGMS readings = 2.2 mmol/l) in calibration set left-A, values below 3.5 mmol/l were present in 99% (95% CI: 95-100%) of samples in left-B, 91% (95% CI: 84...

Clinical performance of different DF-4 implantable cardioverter defibrillator leads.

Science.gov (United States)

Sarrazin, Jean-François; Philippon, François; Sellier, Romain; André, Philippe; O'Hara, Gilles; Molin, Franck; Nault, Isabelle; Blier, Louis; Champagne, Jean

2018-06-01

Implantable cardioverter-defibrillator (ICD) DF-4 connectors have been introduced to facilitate defibrillator lead connection and to reduce the size of device header. There are limited data regarding the overall performance of those leads and no comparison between different ICD DF-4 leads. This is a cohort study of consecutive patients implanted with ICD DF-4 lead system at one University Centre between October 2010 and February 2015. A historical control group of patients with ICD DF-1 lead implantation was used for comparison. The following ICD DF-4 leads were evaluated: St. Jude Medical Durata 7122Q (St. Jude Medical, St. Paul, MN, USA), Medtronic Sprint Quattro Secure 6935 M (Medtronic Inc., Minneapolis, MN, USA), Boston Scientific Endotak Reliance 4-Site 0293 (Boston Scientific, Marlborough, MA, USA), and Boston Scientific Reliance 4-Front 0693. This study evaluated the acute and mid-term performances of those leads as well as complications. A total of 812 patients (age 63 ± 12 years, 80% male, left ventricular ejection fraction 31 ± 12%) underwent implantation of an ICD DF-4 lead. Acute and follow-up R-wave sensing and threshold were excellent. Compared to implantation, intrinsic R waves were higher at follow-up for Boston Scientific and Medtronic leads, and pacing lead impedances were lower for all leads at first follow-up (P < 0.001). The number of lead dislodgement or failure was similar between all leads. The estimated lead survival rates at 3 years were 95.6% for Boston Scientific Endotak 4-Site, 97.1% for Boston Scientific 4-Front, 97.7% for Medtronic Sprint Quattro, and 97.5% for St. Jude Durata (P  =  0.553). All ICD DF-4 leads had excellent acute and mid-term electrical performances. Longer follow-up will be necessary to confirm their sustained performance. © 2018 Wiley Periodicals, Inc.

Smart meters and routers radiofrequency disturbances study with pacemakers and implantable cardiac defibrillators.

Science.gov (United States)

Ostiguy, Geneviève; Black, Tom; Bluteau, Louis-Jean; Dupont, Louis; Dyrda, Katia; Girard, Guillaume; Nguyen, Duc-Hai; Plante, Michel; Thibault, Bernard

2013-11-01

There is no scientific literature that examines radiofrequency (RF) interference from Smart Meters with cardiac implantable electronic devices (CIEDs). The objective of this in vitro study was to assess any potential interference with Medtronic CIEDs (Medtronic Inc., Minneapolis, MN, USA). In the Quebec testing, five models of Medtronic CIEDs were placed in an acrylic cylinder filled with a saline solution and faced a Landis+Gyr Smart Meter or Router (Landis+Gyr AG, Zug, Switzerland). The distance between CIEDs and the meter casing or router antenna was 10 cm. The Meter's normal operating conditions were modified to artificially set the number of impulsions at an abnormally high level (one, two, and three impulses per second). Each scenario was repeated one to five times, for 1 minute each. In the U.S. testing, 6 cm and 15 cm (∼2.25' and ∼6') separated the six models of Medtronic CIEDs from the Schlumberger Smart Meter (Itron Inc., Liberty Lake, WA, USA), which generally sent out a 96-bit Standard Consumption Message over 3 seconds. The transmission varied in frequencies along with the interval between cycles. A total of 6,966 RF transmissions were completed during the 34 tests conducted in Quebec. In the United States, the CIED was exposed to the meter for 10 minutes to provide a minimum of 200 completed RF transmissions. No interference was observed in worst-case scenarios (testing of meters and CIEDs at their performance limits). Landis+Gyr Smart Meters/Routers and Schlumberger Smart Meters do not interfere with the functioning of the Medtronic CIEDs tested, when placed, respectively, 10 cm and 6 cm and 15 cm apart. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

Sensor-Augmented Pump-Based Customized Mathematical Model for Type 1 Diabetes.

Science.gov (United States)

Grosman, Benyamin; Wu, Di; Miller, Diana; Lintereur, Louis; Roy, Anirban; Parikh, Neha; Kaufman, Francine R

2018-03-01

Simulations using mathematical models are important for studying, developing, and improving therapies for people with type 1 diabetes. The Medtronic CareLink ® database was used to create virtual patients with a variety of inter-insulin sensitivities, meal absorption rates, pharmacokinetics, age, and gender. In addition, intra-insulin sensitivities of the virtual patients change over a 24-h cycle. A total of 2087 virtual patients were developed. The time percentage between 70 and 180 mg/dL of the CareLink uploads and the simulated virtual patients was 72.4% (18.6) and 74.1% (16.9), respectively. The time percentage 18 years) and 90 adult (>28 years) virtual patients, respectively. The Medtronic CareLink database was utilized to generate a large number of virtual patients with a variety of insulin sensitivities, pharmacokinetics, and meal absorption rates. This new simulation model can be potentially used to evaluate and prognosticate the outcomes of studies of artificial pancreas algorithms and systems.

Implante por cateter de bioprótese valvar para tratamento da estenose aórtica: experiência de três anos

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Fabio Sandoli de Brito Junior

2012-08-01

Full Text Available FUNDAMENTO: O implante por cateter de bioprótese valvar aórtica é uma nova modalidade de tratamento para portadores de estenose aórtica inoperáveis ou de alto risco cirúrgico. Objetivo: Relatar a experiência de três anos do implante por cateter da bioprótese CoreValve. MÉTODOS: Entre janeiro de 2008 e janeiro de 2011, 35 pacientes com estenose aórtica (33 casos ou disfunção de bioprótese valvar aórtica (dois casos de alto risco cirúrgico foram submetidos ao implante da bioprótese CoreValve. RESULTADOS: A média de idade dos pacientes foi 81,5 ± 9 anos, e 80% apresentavam-se em classe funcional III ou IV de insuficiência cardíaca. O EuroScore foi 18,4 ± 14,3% e o STS 14,5 ± 11,6%. Obteve-se sucesso do implante em 34 (97,1% pacientes. Após a intervenção houve redução do gradiente transvalvar de 84,9 ± 22 para 22,5 ± 9,5 mmHg e 87,1% dos pacientes evoluíram em classe funcional I ou II. A mortalidade aos 30 dias e no seguimento médio de 400 ± 298 dias foi, respectivamente, de 11,4% e 31,4%. A ocorrência de complicações hemorrágicas com risco de morte foi o único preditor independente de mortalidade cardiovascular. Acidente vascular cerebral ocorreu em 5,7% dos pacientes. Marca-passo permanente foi necessário em 32,1% dos casos no primeiro mês após o procedimento. CONCLUSÃO: O implante por cateter de bioprótese valvar aórtica é um procedimento seguro e eficaz para ser empregado em portadores de estenose aórtica de alto risco cirúrgico. O dispositivo CoreValve é eficaz no médio-prazo, em seguimento de até três anos.

Battery longevity in cardiac resynchronization therapy implantable cardioverter defibrillators.

Science.gov (United States)

Alam, Mian Bilal; Munir, Muhammad Bilal; Rattan, Rohit; Flanigan, Susan; Adelstein, Evan; Jain, Sandeep; Saba, Samir

2014-02-01

Cardiac resynchronization therapy (CRT) implantable cardioverter defibrillators (ICDs) deliver high burden ventricular pacing to heart failure patients, which has a significant effect on battery longevity. The aim of this study was to investigate whether battery longevity is comparable for CRT-ICDs from different manufacturers in a contemporary cohort of patients. All the CRT-ICDs implanted at our institution from 1 January 2008 to 31 December 2010 were included in this analysis. Baseline demographic and clinical data were collected on all patients using the electronic medical record. Detailed device information was collected on all patients from scanned device printouts obtained during routine follow-up. The primary endpoint was device replacement for battery reaching the elective replacement indicator (ERI). A total of 646 patients (age 69 ± 13 years), implanted with CRT-ICDs (Boston Scientific 173, Medtronic 416, and St Jude Medical 57) were included in this analysis. During 2.7 ± 1.5 years follow-up, 113 (17%) devices had reached ERI (Boston scientific 4%, Medtronic 25%, and St Jude Medical 7%, P battery was significantly worse for Medtronic devices compared with devices from other manufacturers (94% for Boston scientific, 67% for Medtronic, and 92% for St Jude Medical, P battery longevity by manufacturer was independent of pacing burden, lead parameters, and burden of ICD therapy. There are significant discrepancies in CRT-ICD battery longevity by manufacturer. These data have important implications on clinical practice and patient outcomes.

Endoscopic trans-nasal approach for biopsy of orbital tumors using image-guided neuro-navigation system

International Nuclear Information System (INIS)

Sieskiewicz, A.; Mariak, Z.; Rogowski, M.; Lyson, T.

2008-01-01

Histopathological diagnosis of intraorbital tumors is of crucial value for planning further therapy. The aim of the study was to explore clinical utility of image-guided endoscopy for biopsy of orbital tumors. Trans-nasal endoscopic biopsy of intraorbital mass lesions was performed in 6 patients using a neuro-navigation system (Medtronic Stealth Station Treon plus). The CT and MRI 1 mm slice images were fused by the system in order to visualise both bony and soft tissue structures. The anatomic fiducial registration protocol was used during the procedure. All lesions were precisely localised and the biopsies could be taken from the representative part of the pathological mass. None of the patients developed aggravation of ocular symptoms after the procedure. The operative corridor as well as the size of orbital wall fenestration could be limited to a minimum. The accuracy of neuro-navigation remained high and stable during the entire procedure. The image-guided neuro-navigation system facilitated endoscopic localisation and biopsy of intraorbital tumors and contributed to the reduction of surgical trauma during the procedure. The technique was particularly useful in small, medially located, retrobulbar tumors and in unclear situations when the structure of the lesion resembled surrounding intraorbital tissue. (author)

Aortic root geometry in aortic stenosis patients (a SEAS substudy)

DEFF Research Database (Denmark)

Bahlmann, Edda; Nienaber, Christoph A; Cramariuc, Dana

2011-01-01

-specified requirements for the aortic root geometry for current available prostheses, CoreValve and Edwards-Sapien. The ratio of sinus of Valsalva height to sinus width was 1:2. In multivariate linear regression analysis, larger sinus of Valsalva height was associated with older age, larger sinus of Valsalva diameter......, lower ejection fraction and smaller supracoronary diameter (multiple R(2) = 0.19, PSapien prosthesis in 66.9%. Overall, annular dimension feasible for TAVI using any available prosthesis was found...

Optimized programming algorithm for cylindrical and directional deep brain stimulation electrodes.

Science.gov (United States)

Anderson, Daria Nesterovich; Osting, Braxton; Vorwerk, Johannes; Dorval, Alan D; Butson, Christopher R

2018-04-01

Deep brain stimulation (DBS) is a growing treatment option for movement and psychiatric disorders. As DBS technology moves toward directional leads with increased numbers of smaller electrode contacts, trial-and-error methods of manual DBS programming are becoming too time-consuming for clinical feasibility. We propose an algorithm to automate DBS programming in near real-time for a wide range of DBS lead designs. Magnetic resonance imaging and diffusion tensor imaging are used to build finite element models that include anisotropic conductivity. The algorithm maximizes activation of target tissue and utilizes the Hessian matrix of the electric potential to approximate activation of neurons in all directions. We demonstrate our algorithm's ability in an example programming case that targets the subthalamic nucleus (STN) for the treatment of Parkinson's disease for three lead designs: the Medtronic 3389 (four cylindrical contacts), the direct STNAcute (two cylindrical contacts, six directional contacts), and the Medtronic-Sapiens lead (40 directional contacts). The optimization algorithm returns patient-specific contact configurations in near real-time-less than 10 s for even the most complex leads. When the lead was placed centrally in the target STN, the directional leads were able to activate over 50% of the region, whereas the Medtronic 3389 could activate only 40%. When the lead was placed 2 mm lateral to the target, the directional leads performed as well as they did in the central position, but the Medtronic 3389 activated only 2.9% of the STN. This DBS programming algorithm can be applied to cylindrical electrodes as well as novel directional leads that are too complex with modern technology to be manually programmed. This algorithm may reduce clinical programming time and encourage the use of directional leads, since they activate a larger volume of the target area than cylindrical electrodes in central and off-target lead placements.

Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation

DEFF Research Database (Denmark)

De Backer, Ole; Arnous, Samer; Sandholt, Benjamin

2015-01-01

Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI......-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48...... were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn...

Sacral Neuromodulation

DEFF Research Database (Denmark)

Matzel, Klaus E; Chartier-Kastler, Emmanuel; Knowles, Charles H

2017-01-01

INTRODUCTION: Sacral neuromodulation (SNM) (sacral nerve stimulation SNS) has become an established therapy for functional disorders of the pelvic organs. Despite its overall success, the therapy fails in a proportion of patients. This may be partially due to inadequate electrode placement...... with suboptimal coupling of the electrode and nerve. Based on these assumptions the technique of sacral spinal neuromodulation has been redefined. All descriptions relate to the only currently available system licensed for all pelvic indications (Medtronic Interstim(®) ). METHOD: An international...

Transcatheter valve-in-valve implantation due to severe aortic regurgitation in a degenerated aortic homograft

DEFF Research Database (Denmark)

Olsen, Lene Kjaer; Engstrøm, Thomas; Søndergaard, Lars

2009-01-01

Transcatheter aortic valve implantation (TAVI) in severe aortic stenosis has proven to be a feasible and effective treatment modality for inoperable patients. Until now, neither aortic regurgitation nor degenerated bioprostheses has been an indication for TAVI. However, this article reports...... a successful valve-in-valve implantation of a CoreValve aortic valve prosthesis through the right subclavian artery in a case of severe aortic regurgitation within a degenerated aortic homograft. The case exemplifies the possibilities of expanding the indications for TAVI, as well as other vascular access...

233. Explante emergente de una corevalve por leak grave objetivo

Directory of Open Access Journals (Sweden)

F. Gomera

2012-04-01

Conclusiones: La implantación de TAVI está demostrando ser una buena opción para el tratamiento de la estenosis aórtica grave no susceptible de sustitución quirúrgica. Sin embargo, está terapia aún está lejos de estar libre de complicaciones que requieran cirugía urgente de rescate.

Stability of miniature electromagnetic tracking systems

International Nuclear Information System (INIS)

Schicho, Kurt; Figl, Michael; Donat, Markus; Birkfellner, Wolfgang; Seemann, Rudolf; Wagner, Arne; Bergmann, Helmar; Ewers, Rolf

2005-01-01

This study aims at a comparative evaluation of two recently introduced electromagnetic tracking systems under reproducible simulated operating-room (OR) conditions: the recently launched Medtronic StealthStation TM Treon-EM TM and the NDI Aurora TM . We investigate if and to what extent these systems provide improved performance and stability in the presence of surgical instruments as possible sources of distortions compared with earlier reports on electromagnetic tracking technology. To investigate possible distortions under pseudo-realistic OR conditions, a large Langenbeck hook, a dental drill with its handle and an ultrasonic (US) scanhead are fixed on a special measurement rack at variable distances from the navigation sensor. The position measurements made by the Treon-EM TM were least affected by the presence of the instruments. The lengths of the mean deviation vectors were 0.21 mm for the Langenbeck hook, 0.23 mm for the drill with handle and 0.56 mm for the US scanhead. The Aurora TM was influenced by the three sources of distortion to a higher degree. A mean deviation vector of 1.44 mm length was observed in the vicinity of the Langenbeck hook, 0.53 mm length with the drill and 2.37 mm due to the US scanhead. The maximum of the root mean squared error (RMSE) for all coordinates in the presence of the Langenbeck hook was 0.3 mm for the Treon TM and 2.1 mm for the Aurora TM ; the drill caused a maximum RMSE of 0.2 mm with the Treon TM and 1.2 mm with the Aurora TM . In the presence of the US scanhead, the maximum RMSE was 1.4 mm for the Treon TM and 5.1 mm for the Aurora TM . The new generation of electromagnetic tracking systems has significantly improved compared to common systems that were available in the middle of the 1990s and has reached a high level of technical development. We conclude that, in general, both systems are suitable for routine clinical application

Evaluation of an open access software for calculating glucose variability parameters of a continuous glucose monitoring system applied at pediatric intensive care unit.

Science.gov (United States)

Marics, Gábor; Lendvai, Zsófia; Lódi, Csaba; Koncz, Levente; Zakariás, Dávid; Schuster, György; Mikos, Borbála; Hermann, Csaba; Szabó, Attila J; Tóth-Heyn, Péter

2015-04-24

Continuous Glucose Monitoring (CGM) has become an increasingly investigated tool, especially with regards to monitoring of diabetic and critical care patients. The continuous glucose data allows the calculation of several glucose variability parameters, however, without specific application the interpretation of the results is time-consuming, utilizing extreme efforts. Our aim was to create an open access software [Glycemic Variability Analyzer Program (GVAP)], readily available to calculate the most common parameters of the glucose variability and to test its usability. The GVAP was developed in MATLAB® 2010b environment. The calculated parameters were the following: average area above/below the target range (Avg. AUC-H/L); Percentage Spent Above/Below the Target Range (PATR/PBTR); Continuous Overall Net Glycemic Action (CONGA); Mean of Daily Differences (MODD); Mean Amplitude of Glycemic Excursions (MAGE). For verification purposes we selected 14 CGM curves of pediatric critical care patients. Medtronic® Guardian® Real-Time with Enlite® sensor was used. The reference values were obtained from Medtronic®(')s own software for Avg. AUC-H/L and PATR/PBTR, from GlyCulator for MODD and CONGA, and using manual calculation for MAGE. The Pearson and Spearman correlation coefficients were above 0.99 for all parameters. The initial execution took 30 minutes, for further analysis with the Windows® Standalone Application approximately 1 minute was needed. The GVAP is a reliable open access program for analyzing different glycemic variability parameters, hence it could be a useful tool for the study of glycemic control among critically ill patients.

Implantable loop recorders for assessment of syncope: increased diagnostic yield and less adverse outcomes with the latest generation devices.

Science.gov (United States)

Bartoletti, A; Bocconcelli, P; De Santo, T; Ghidini Ottonelli, A; Giuli, S; Massa, R; Svetlich, C; Tarsi, G; Corbucci, G; Tronconi, F; Vitale, E

2013-08-01

Aim of the study was to compare the diagnostic yield of implantable loop recorders (ILR) of two successive generations for the assessment of syncope. Data on patients who had undergone ILR implantation for unexplained syncope in four Italian public hospitals were retrospectively acquired from the Medtronic Clinical Service database. After implantation, routine follow-up examinations were performed every 90 days, while urgent examinations were carried out in the event of syncope recurrence. The following findings were regarded as diagnostic: ECG documentation of a syncope recurrence; documentation of any of the arrhythmias listed by the current guidelines as diagnostic findings even if asymptomatic. Between November 2002 and March 2010, 107 patients received an ILR (40 Medtronic Reveal® Plus; 67 Medtronic Reveal® DX/XT) and underwent at least one follow-up examination. Diagnoses were made in 7 (17.5%) and 24 (35.8%) (P=0.043) patients, with a median time of 228 and 65 days, respectively. Three (42.9%) and 21 (87.5%) (P=0.029) diagnoses were based on automatically detected events, while adverse outcomes occurred in 6 and in 1 (P=0.01) patients, respectively. Our results show that the new-generation device offer a higher diagnostic yield, mainly as a result of its improved automatic detection function, and is associated with fewer adverse outcomes.

Clinical safety of magnetic resonance imaging in patients with implanted SynchroMed EL infusion pumps

International Nuclear Information System (INIS)

Diehn, Felix E.; Wood, Christopher P.; Watson, Robert E.; Hunt, Christopher H.; Mauck, William D.; Burke, Michelle M.

2011-01-01

Patients with implanted SynchroMed spinal infusion pumps (Medtronic, Inc., Minneapolis, MN) routinely undergo magnetic resonance imaging at our institution. In August 2008, Medtronic issued an urgent medical device correction report regarding several pumps. Because of the rare potential ''for a delay in the return of proper drug infusion'' and ''for a delay in the logging of motor stall events,'' ''a patient's pump must be interrogated after MRI exposure in order to confirm proper pump functionality.'' This is particularly important in patients receiving intrathecal baclofen, for whom a delay in return of proper pump infusion could lead to life-threatening baclofen withdrawal syndrome. The objective of this report is to present our experience and protocol of performing magnetic resonance imaging in patients with implanted SynchroMed EL pumps. We retrospectively reviewed records of 86 patients with implanted SynchroMed EL spinal infusion pumps who underwent 112 examinations on 1.5-T magnetic resonance imaging scanners from September 1, 1998 to July 7, 2004. No SynchroMed EL pumps were damaged by magnetic resonance imaging, and the programmable settings remained unchanged in all patients. Our data suggest that SynchroMed EL pump malfunction is indeed rare after routine clinical 1.5-T magnetic resonance imaging examinations. However, based on the Medtronic correction report, we perform pump interrogation before and after imaging. (orig.)

Clinical safety of magnetic resonance imaging in patients with implanted SynchroMed EL infusion pumps

Energy Technology Data Exchange (ETDEWEB)

Diehn, Felix E.; Wood, Christopher P.; Watson, Robert E.; Hunt, Christopher H. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Mauck, William D. [Mayo Clinic, Department of Anesthesiology, Rochester, MN (United States); Burke, Michelle M. [Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN (United States)

2011-02-15

Patients with implanted SynchroMed spinal infusion pumps (Medtronic, Inc., Minneapolis, MN) routinely undergo magnetic resonance imaging at our institution. In August 2008, Medtronic issued an urgent medical device correction report regarding several pumps. Because of the rare potential ''for a delay in the return of proper drug infusion'' and ''for a delay in the logging of motor stall events,'' ''a patient's pump must be interrogated after MRI exposure in order to confirm proper pump functionality.'' This is particularly important in patients receiving intrathecal baclofen, for whom a delay in return of proper pump infusion could lead to life-threatening baclofen withdrawal syndrome. The objective of this report is to present our experience and protocol of performing magnetic resonance imaging in patients with implanted SynchroMed EL pumps. We retrospectively reviewed records of 86 patients with implanted SynchroMed EL spinal infusion pumps who underwent 112 examinations on 1.5-T magnetic resonance imaging scanners from September 1, 1998 to July 7, 2004. No SynchroMed EL pumps were damaged by magnetic resonance imaging, and the programmable settings remained unchanged in all patients. Our data suggest that SynchroMed EL pump malfunction is indeed rare after routine clinical 1.5-T magnetic resonance imaging examinations. However, based on the Medtronic correction report, we perform pump interrogation before and after imaging. (orig.)

75 FR 52472 - Spectrum Requirements for Advanced Medical Technologies

Science.gov (United States)

2010-08-26

... medical devices. Under this framework, the rules for MedRadio service incorporates the MICS ``core'' band... Requirements for Advanced Medical Technologies AGENCY: Federal Communications Commission. ACTION: Final rule.... (Medtronic) regarding rules for the Medical Device Radiocommunication (MedRadio) service. The Commission...

Runaway pacemaker: a forgotten phenomenon?

Science.gov (United States)

Ortega, Daniel F; Sammartino, M Victoria; Pellegrino, Graciela M M; Barja, Luis D; Albina, Gaston; Segura, Eliseo V; Balado, Roberto; Laiño, Ruben; Giniger, Alberto G

2005-11-01

Runaway is an uncommon pacemaker dysfunction, characterized by fast and erratic spikes at non-physiological rates. This infrequent but potentially lethal failure mode may be related to low battery voltage. Four single chamber pacemaker patients were analyzed (Medtronic Minix ST 8330, Minneapolis, MN, had been implanted in two patients and two CPI Triumph VR 1124, St Paul, MN, in the other two). They had been admitted because of presyncopal episodes. Typical high rate stimuli at 2000 ppm alternating with pacing at 60-65 ppm were recorded in all ECGs. Lead system tests were normal. The pulse generators had to be replaced.

Correlation between glycemic variability and gastroesophageal reflux in adolescentswith type 1 diabetes mellitus

Directory of Open Access Journals (Sweden)

I L Alimova

2013-03-01

Full Text Available Aims. To estimate an impact of glycemic variability on the development of gastroesophageal reflux disease (GERD in adolescents with type 1 diabetes mellitus (T1DM. Materials and methods. We enrolled 33 patients with T1DM aged from 12 to 17 years. 24-h pH-monitoring was performed with ?Gas- troskan 24? system (Istok-Sistema, Fryazino; 24-h continuous glucose monitoring utilized CGMS MMT-7310 (Medtronic Minimed, USA with subsequent night-time analysis. Results. As compared to stable night-time glycemia controls (SD 2.0 mmol/L showed longer period of esophageal acidification (17% [2?58]; p

Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: a comparison between the first- and second-generation balloon

NARCIS (Netherlands)

Casado-Arroyo, R.; Chierchia, G.B.; Conte, G.; Levinstein, M.; Sieira, J.; Rodriguez-Manero, M.; Giovanni, G.; Baltogiannis, Y.; Wauters, K.; Asmundis, C. de; Sarkozy, A.; Brugada, P.

2013-01-01

BACKGROUND: Phrenic nerve palsy (PNP) is the most frequently observed complication during cryoballoon ablation (CB; Arctic Front, Medtronic, MN) occurring in roughly 7%-9% of the cases. The new second-generation cryoballoon ablation Arctic Front Advance (CB-A) (Arctic Front) has recently been

Case report and review of the literature total endovascular repair of acute ascending aortic rupture: a case report and review of the literature.

Science.gov (United States)

McCallum, John C; Limmer, Karl K; Perricone, Anthony; Bandyk, Dennis; Kansal, Nikhil

2013-07-01

Thoracic aortic endografting has been successfully implemented to treat aneurysmal disease of the distal aortic arch and descending thoracic aorta. Although there are reports of ascending aortic endovascular interventions, the total endovascular repair of a ruptured ascending aorta secondary to a Type A dissection has not been described. We report the case of a 77-year-old patient who presented with a ruptured ascending aortic aneurysm secondary to degeneration of a Stanford type A aortic dissection. His surgical history was significant for orthotropic heart transplant 19 years prior. The dissection, aneurysm, and rupture occurred in the native aorta distal to the ascending aortic suture line. At presentation, he was hemodynamically unstable with a right hemothorax. We placed 3 Medtronic Talent Thoracic Stent Graft devices (Medtronic Inc, Minneapolis, MN) across the suture line in the ascending aorta, excluding the rupture. The patient survived and has been followed to 25 months.

Incidence and impact of prosthesis-patient mismatch after transcatheter aortic valve implantation.

Science.gov (United States)

Bleiziffer, Sabine; Hettich, Ina; Hutter, Andrea; Wagner, Anke; Deutsch, Marcus-André; Piazza, Nicolo; Lange, Rüdiger

2013-05-01

The study aim was to investigate the incidence of patient-prosthesis mismatch (PPM) with new catheter valves, and its influence on the patients' clinical state. At present, few echocardiographic data are available on the incidence and impact of PPM with the CoreValve and Sapien prostheses for transcatheter aortic valve implantation (TAVI). The reliability of effective orifice area (EOA) measurements was assured by awaiting an interval of six months after TAVI. Of 256 survivors after TAVI, 149 complete echocardiographic data sets were available for the assessment of the indexed EOA (iEOA). In total, 106 CoreValve prostheses and 43 Sapien prostheses were implanted in this high-risk cohort (mean age 81 +/- 6 years, mean logistic EuroSCORE 20 +/- 13%). The overall incidence of PPM (iEOA body surface area were more likely to develop PPM (p = 0.001), while the prosthesis type, native annulus diameter, preoperative EOA, gender and prosthesis size had no influence. The mean aortic gradient was significantly higher in patients with PPM. A reduction in the left ventricular end-diastolic diameter was seen in all patients, without significant differences between groups. There were no differences in postoperative NYHA class or self-assessed health state between patients with or without PPM. PPM was common after TAVI in the presented cohort, presumably because the native calcium masses narrow the outflow area available for blood flow. As expected for low gradients, there was no impairment of left ventricular dimension regression or clinical state of the patients, even if severe PPM was present. Based on the presented data, it is assumed that PPM might be less relevant in TAVI patients.

Effect of steroid eluting versus conventional electrodes on propafenone induced rise in chronic ventricular pacing threshold.

Science.gov (United States)

Cornacchia, D; Fabbri, M; Maresta, A; Nigro, P; Sorrentino, F; Puglisi, A; Ricci, R; Peraldo, C; Fazzari, M; Pistis, G

1993-12-01

The aim of this study was to evaluate chronic ventricular pacing threshold increase after oral propafenone therapy. Eighty-three patients affected by advanced atrioventricular block and sick sinus syndrome were studied at least 3 months after pacemaker implantation, before and after oral propafenone therapy (450-900 mg/day based on body weight). The patients were subdivided into three groups according to the type of unipolar electrode that was implanted: group I (41 patients) Medtronic CapSure 4003, group II (30 patients) Medtronic Target Tip 4011, and group III (12 patients) Osypka Vy screw-in lead. In all cases a Medtronic unipolar pacemaker was implanted: 30 Minix, 23 Activitrax, 14 Elite, 12 Legend, and 4 Pasys. Propafenone blood level was measured in 75 patients 3-5 hours after propafenone administration. The pacing autothreshold was measured at 0.8 V, 1.6 V, and 2.5 V by reducing pulse width. At the three different outputs before and after propafenone, threshold increments were significantly lower in group I in comparison with group II and group III (propafenone ranging from < 0.001 to < 0.05). No significant difference was found in pacing impedance or in propafenone plasma concentration in the three groups. Strength-duration curves were drawn for each group at baseline and after propafenone administration. Before propafenone, in group I, the knee was markedly shifted to the left and downward as compared to the classic curve, so that the steep part was predominant; in group II and group III this shift was progressively less evident.(ABSTRACT TRUNCATED AT 250 WORDS)

77 FR 49046 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

Science.gov (United States)

2012-08-15

..., Inc. (``MA''), MBIA, Inc. (``MBI''), Medtronic, Inc. (``MDT''), Nike, Inc. (``NKE''), Pepsico, Inc... , Inc. (``AMZN''), ConocoPhillips (``COP''), ProShares QQQ Trust Series 1 (``QQQ''), Sprint Corporation (``S''), ProShares UltraShort S&P 500 (``SDS''), Sirius XM Radio, Inc. (``SIRI''), ProShares Ultra S&P...

Cavitation behavior observed in three monoleaflet mechanical heart valves under accelerated testing conditions.

Science.gov (United States)

Lo, Chi-Wen; Liu, Jia-Shing; Li, Chi-Pei; Lu, Po-Chien; Hwang, Ned H

2008-01-01

Accelerated testing provides a substantial amount of data on mechanical heart valve durability in a short period of time, but such conditions may not accurately reflect in vivo performance. Cavitation, which occurs during mechanical heart valve closure when local flow field pressure decreases below vapor pressure, is thought to play a role in valve damage under accelerated conditions. The underlying flow dynamics and mechanisms behind cavitation bubble formation are poorly understood. Under physiologic conditions, random perivalvular cavitation is difficult to capture. We applied accelerated testing at a pulse rate of 600 bpm and transvalvular pressure of 120 mm Hg, with synchronized videographs and high-frequency pressure measurements, to study cavitation of the Medtronic Hall Standard (MHS), Medtronic Hall D-16 (MHD), and Omni Carbon (OC) valves. Results showed cavitation bubbles between 340 and 360 micros after leaflet/housing impact of the MHS, MHD, and OC valves, intensified by significant leaflet rebound. Squeeze flow, Venturi, and water hammer effects each contributed to cavitation, depending on valve design.

Endovascular repair of an innominate artery pseudoaneurysm using the Valiant Mona LSA branched graft device

Directory of Open Access Journals (Sweden)

Josh A. Sibille, MD

2017-03-01

Full Text Available A 60-year-old woman involved in a motor vehicle collision presented with a traumatic pseudoaneurysm of the innominate artery origin in addition to multiple concomitant injuries. She was classified as a high-risk candidate for open repair. An experimental thoracic branched graft device was used for coverage of the injury with the addition of a right carotid-to-left carotid-to-left subclavian artery bypass. Follow-up imaging showed resolution of the pseudoaneurysm and patency of her bypass grafts. This is the first described use of the Mona LSA Branch Thoracic Stent Graft System (Medtronic, Minneapolis, Minn in the innominate artery.

Acurácia, utilidade e complicações da monitorização subcutânea contínua da glicose (CGMS em pacientes pediátricos com diabetes tipo 1 Accuracy, utility and complications of continuous glucose monitoring system (CGMS in pediatric patients with type 1 diabetes

Directory of Open Access Journals (Sweden)

Frederico F. R. Maia

2005-08-01

Full Text Available OBJETIVO: Avaliar a acurácia, utilidade e complicações da monitorização subcutânea contínua da glicemia em crianças e adolescentes com diabetes melito tipo 1 (DM1. MÉTODOS: Foram estudados retrospectivamente 16 pacientes (16,12±4,41 anos, submetidos à monitorização subcutânea contínua da glicemia (Medtronic; Northridge, CA, EUA por 72 horas. Foram analisados os valores de glicemia capilar média e pelo sensor monitorização subcutânea contínua da glicemia; excursões glicêmicas (monitorização subcutânea contínua da glicemia versus. glicemia capilar; hiperglicemia pós-prandial (OBJECTIVE: To evaluate the accuracy, utility and complications of continuous glucose monitoring system in children and adolescents with type 1 diabetes. METHODS: This retrospective study assessed 16 type 1 diabetic patients (16.12±4.41 years submitted to continuous glucose monitoring system (Medtronic; Northridge, CA for 72 hours. The following parameters were analyzed: mean capillary glucose level and mean glucose value measured by the continuous glucose monitoring system; glucose excursions (continuous glucose monitoring system vs. capillary glucose measurement, postprandial hyperglycemia (NR < 140 mg/dl, nocturnal hypoglycemia, complications (trauma, local infection, disconnection and therapeutic management after continuous glucose monitoring. A1c levels were measured at the beginning and after 3 months of the study. RESULTS: The mean capillary glucose values were 214.3±66.5 mg/dl vs. 207.6±54.6 mg/dl by continuous glucose monitoring system, with a significant correlation (p = 0.001. The correlation coefficient and mean absolute error were 0.86±0.21 and 12.6% of the median, respectively. The continuous glucose monitoring system was significantly more efficient in detecting glucose excursion than fingerstick capillary blood sampling (p = 0.04; W = 74, and postprandial hyperglycemia was identified in 60% of type 1 diabetic patients with a

Transcatheter aortic valve-in-valve treatment of degenerative stentless supra-annular Freedom Solo valves: A single centre experience.

Science.gov (United States)

Cockburn, James; Dooley, Maureen; Parker, Jessica; Hill, Andrew; Hutchinson, Nevil; de Belder, Adam; Trivedi, Uday; Hildick-Smith, David

2017-02-15

Redo surgery for degenerative bioprosthetic aortic valves is associated with significant morbidity and mortality. Report results of valve-in-valve therapy (ViV-TAVI) in failed supra-annular stentless Freedom Solo (FS) bioprostheses, which are the highest risk for coronary occlusion. Six patients with FS valves (mean age 78.5 years, 50% males). Five had valvular restenosis (peak gradient 87.2 mm Hg, valve area 0.63 cm 2 ), one had severe regurgitation (AR). Median time to failure was 7 years. Patients were high risk (mean STS/Logistic EuroScore 10.6 15.8, respectively). FS valves ranged from 21 to 25 mm. Successful ViV-TAVI was achieved in 4/6 patients (67%). Of the unsuccessful cases, (patient 1 and 2 of series) patient 1 underwent BAV with simultaneous aortography which revealed left main stem occlusion. The procedure was stopped and the patient went forward for repeat surgery. Patient 2 underwent successful ViV-TAVI with a 26-mm CoreValve with a guide catheter in the left main, but on removal coronary obstruction occurred, necessitating valve snaring into the aorta. Among the successful cases, (patients 3, 4, 5, 6) the TAVIs used were CoreValve Evolut R 23 mm (n = 3), and Lotus 23 mm (n = 1). In the successful cases the peak gradient fell from 83.0 to 38.3 mm Hg. No patient was left with >1+ AR. One patient had a stroke on Day 2, with full neurological recovery. Two patients underwent semi-elective pacing for LBBB and PR >280 ms. ViV-TAVI in stentless Freedom Solo valves is high risk. The risk of coronary occlusion is high. The smallest possible prosthesis (1:1 sizing) should be used, and strategies to protect the coronary vessels must be considered. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Beyond the five-year horizon: long-term outcome of high-risk and inoperable patients undergoing TAVR with first-generation devices.

Science.gov (United States)

Deutsch, Marcus-André; Erlebach, Magdalena; Burri, Melchior; Hapfelmeier, Alexander; Witt, Olivia Ganga; Ziegelmueller, Johannes Amadeus; Wottke, Michael; Ruge, Hendrik; Krane, Markus; Piazza, Nicolo; Bleiziffer, Sabine; Lange, Rüdiger

2018-05-20

We sought to determine the long-term outcome of high-risk patients who underwent transcatheter aortic valve replacement (TAVR) with first-generation devices with a focus on the identification of predictors for mortality and valve durability. Consecutive patients in our prospective single-centre registry undergoing TAVR with first-generation devices (n=214 CoreValve; n=86 SAPIEN) between 06/2007 and 07/2009 were retrospectively analysed (n=300, mean age 81.43±6.55 years, mean STS score 6.5±4.5%). Kaplan-Meier estimates of survival and the Cox proportional hazards model were used to identify independent predictors of all-cause-mortality. At 1, 5, and 7 years, estimated survival rates were 76.0%, 40.2%, and 23.2%, respectively. Age-adjusted baseline predictors of mortality included atrial fibrillation, impaired kidney function, peripheral artery disease, and mitral regurgitation (≥moderate). Baseline risk-adjusted procedure-related predictors for all-cause mortality included acute kidney injury, neurological events, major vascular complications, and major/life-threatening bleeding. At both five and six years, 78.2% of surviving patients were in NYHA Class I or II. PVL was ≤mild in the majority of patients at discharge and throughout follow-up. At seven years, the overall crude cumulative incidence of structural valve deterioration according to the 2017 EAPCI/ESC/EACTS definition was 14.9% (CoreValve 11.8% vs. SAPIEN 22.6%; p=0.01). Seven years after TAVR, 23.2% of high-risk patients were still alive. Independent predictors of all-cause mortality included both patient- and procedure-related factors. With a cumulative incidence of 14.9% at seven years, there is some suggestion that SVD post TAVR may become increasingly relevant during longer-term follow-up.

An in vitro investigation of the retrograde flow fields of two bileaflet mechanical heart valves.

Science.gov (United States)

Ellis, J T; Healy, T M; Fontaine, A A; Weston, M W; Jarret, C A; Saxena, R; Yoganathan, A P

1996-11-01

Fluid stresses occurring in retrograde flow fields during valve closure may play a significant role in thrombogenesis. The squeeze flow and regurgitant jets can cause damage to formed blood elements due to high levels of turbulent shear stress. The aim of this study was to characterize in detail the spatial structure and temporal behavior of the retrograde flow fields of the St. Jude Medical and Medtronic Parallel bileaflet mechanical heart valves. Three-component, coincident laser Doppler anemometry (LDA) velocity measurements were obtained facilitating the determination of the full Reynolds stress tensor and the principal stresses in the valve flow fields. The experiments were performed in the Georgia Tech aortic flow chamber under physiologic pulsatile flow conditions. Data were collected over several hundred cardiac cycles for subsequent phase window averaging and generation of mean velocity and turbulence statistics over 20 ms intervals. A region approximately 8 mm x 10 mm was mapped 1.0 mm upstream of one hinge of each valve with an incremental resolution of 0.13-0.25 mm. Animation of the data allowed the visualization of the flow fields and a quantitative display of mean velocity and turbulent stress values. In the St. Jude Medical squeeze flow, the peak turbulent shear stress was 800 dynes/cm2 and the peak reverse velocity was 0.60 m/s. In the Medtronic Parallel squeeze flow, the peak turbulent shear stress was 1,000 dynes/cm2 and the peak velocity 0.70 m/s. The leakage jet fields of the two valves were very different: in the case of the St. Jude Medical valve, turbulent shear stresses reached 1,800 dynes/cm2 and peak jet velocity was 0.80 m/s; in the case of the Medtronic Parallel valve, turbulent shear stresses reached 3,690 dynes/cm2 and the peak jet velocity was 1.9 m/s. The retrograde flow fields of these two bileaflet mechanical heart valves appear to be design-dependent. The elevated turbulent shear stresses generated by both valve designs may

Best practices in early phase medical device development: Engineering, prototyping, and the beginnings of a quality management system.

Science.gov (United States)

Fearis, Kristy; Petrie, Aidan

2017-03-01

Kristy Fearis is the founder and president of KPConsulting. She has held various positions in the medical device and research industry. She has led programs for medical industry leaders Medtronic, Edward Lifesciences, and Kimberly-Clark Healthcare to develop and commercialize Class II and III devices. Although a true quality management systems specialist at heart, Kristy has a passion for effectively and efficiently applying quality systems principles to early stage development to maximize benefit while minimizing impact on resources and time to market. Kristy works with both precommercial and commercial companies to build and implement quality systems that are "right sized" and support both an effective business model and high product quality. Aidan Petrie is the cofounder and chief innovation officer of Ximedica. Aidan drives innovation in Ximedica's core markets of medical device development and consumer healthcare. With a focus on human-centered design, usability, technical innovation and industrial design, Aidan has helped bring hundreds of products to market. Ranging from simple drug compliance aids to wearable therapeutics, home monitoring products, and complex surgical systems, Aidan challenges his teams to rethink the role design plays in the success of each product. Covering topics around usability, sensor and wearable technology, and current trends in medical design and development, Aidan is a sought-after industry speaker and widely published author. In addition to his role at Ximedica, Aidan advises multiple startups in the healthcare space and has interests in a number of related companies. He sits on the Board of MassArt and teaches and lectures at the Rhode Island School of Design, Massachusetts Institute of Technology, the Harvard iLab, and others. Aidan holds an undergraduate degree from Central St Martins in product design/engineering and a Masters in industrial design from the Rhode Island School of Design. Copyright © 2016 Elsevier Inc. All

Technician-Supported Remote Interrogation of CIEDs: Initial Use in US Emergency Departments and Perioperative Areas.

Science.gov (United States)

Ahmed, Imdad; Patel, Amisha S; Balgaard, Timothy J; Rosenfeld, Lynda E

2016-03-01

Interrogation/interpretation of cardiac implantable electronic devices (CIEDs) is frequently required in the emergency department (ED) or perioperative areas (OR) where resources to do this are often not available. CareLink Express (CLE; Medtronic, plc, Mounds View, MN, USA) is a technician-supported real-time remote interrogation system for Medtronic CIEDs. Using data from 136 US locations, this retrospective study was designed to assess CLE efficiency compared to traditional device management, and examine its findings. All 7,044 US CLE transmissions from the ED and OR (January 2012-October 2014) were compared to 217 traditional requests where CIED interrogations/interpretations were performed by calling industry representatives to these sites. CLE reduced the time to device interrogation/interpretation by 78%: 100 ± 140-22 ± 14 minutes, P < 0.0001, improving response time and consistency; ED: 82 ± 103-23 ± 18 minutes, P, ≤ 0.01; OR: 127 ± 181-17 ± 10 minutes, P < 0.0001. Actionable events (AE) (arrhythmia, device/lead abnormalities) were infrequent: 9.1% overall (ED: 9.9%; OR: 4.1%). Only 6.5% of patients with syncope/presyncope and 13.6% with a perceived shock had AE. AEs were more common in those with suspected device problems (30.4%) or audible alerts (52.6%). They were more likely in patients not enrolled in long-term remote monitoring (23.9% vs 8.2%, P < 0.0001) and in those with older CIED systems (7.4% in year 1 vs 31.0% after 10 years). The many patients with CIEDs, and the ability to quickly identify the minority with high-risk AE from the no/low-risk majority, strongly support CLE use in the ED and OR, sites which are expensive and prioritize efficiency. © 2015 Wiley Periodicals, Inc.

Wenckebach upper rate response in single chamber pacemaker.

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Barold, S S

2000-07-01

The Medtronic Minix pacemaker during normal function in the VVT mode was found to exhibit a Wenckenbach upper rate response similar to that of dual chamber devices. This behavior occurred only when the upper rate interval was longer than the pacemaker refractory period. In a single chamber device this response may simulate pacemaker malfunction.

Selective interference with pacemaker activity by electrical dental devices.

Science.gov (United States)

Miller, C S; Leonelli, F M; Latham, E

1998-01-01

We sought to determine whether electromagnetic interference with cardiac pacemakers occurs during the operation of contemporary electrical dental equipment. Fourteen electrical dental devices were tested in vitro for their ability to interfere with the function of two Medtronics cardiac pacemakers (one a dual-chamber, bipolar Thera 7942 pacemaker, the other a single-chamber, unipolar Minix 8340 pacemaker). Atrial and ventricular pacemaker output and electrocardiographic activity were monitored by means of telemetry with the use of a Medtronics 9760/90 programmer. Atrial and ventricular pacing were inhibited by electromagnetic interference produced by the electrosurgical unit up to a distance of 10 cm, by the ultrasonic bath cleaner up to 30 cm, and by the magnetorestrictive ultrasonic scalers up to 37.5 cm. In contrast, operation of the amalgamator, electric pulp tester, composite curing light, dental handpieces, electric toothbrush, microwave oven, dental chair and light, ENAC ultrasonic instrument, radiography unit, and sonic scaler did not alter pacing rate or rhythm. These results suggest that certain electrosurgical and ultrasonic instruments may produce deleterious effects in medically fragile patients with cardiac pacemakers.

Pannus Formation Leads to Valve Malfunction in the Tricuspid Position 19 Years after Triple Valve Replacement.

Science.gov (United States)

Alskaf, Ebraham; McConkey, Hannah; Laskar, Nabila; Kardos, Attila

2016-06-20

The Medtronic ATS Open Pivot mechanical valve has been successfully used in heart valve surgery for more than two decades. We present the case of a patient who, 19 years following a tricuspid valve replacement with an ATS prosthesis as part of a triple valve operation following infective endocarditis, developed severe tricuspid regurgitation due to pannus formation.

Clinical experience in extended cardiac monitoring with the SEEQ™ satellite wireless system

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Diego Vanegas-Cadavid

2018-05-01

Full Text Available Objectives: To present the clinical experience with a new extended (for 15 days, wireless, and satellite cardiac monitoring system in a group of patients with suspicion of cardiac arrhythmia. Method: The study included a cohort of 100 patients seen in the Cardiovascular Electrophysiology Unit of a reference hospital. They were suspected of having a cardiac arrhythmia, with no electrocardiographic diagnosis of the cause, despite previous examinations. They were subjected to SEEQ-type (Medtronic external cardiac monitoring for 15 days, with the outcomes recorded. Results: Of the total of 100 subjects studied, 51% were male, and the median age was 60 years (range: 5 - 91 years. The main symptoms were palpitation, and the most prevalent comorbidity was arterial hypertension (47%. Almost all (98% of them had a previous Holter study, and 46% had two studies, which were inconclusive in explaining the symptoms. The SEEQ monitoring recorded a significant electrocardiographic abnormality in 22% of the patients. A pacemaker implant was the treatment most applied and atrial fibrillation was the most frequent arrhythmia in 50% of the positive findings. There was a higher and significant percentage of positive diagnoses in males. Conclusions: External, satellite, wireless cardiac monitoring extended for 15 days, is a novel tool that can increase the probability of documenting a clinically significant electrocardiographic abnormality in those patients who suffer recurrent cardiovascular symptoms. Resumen: Objetivos: Dar a conocer la experiencia clínica con un nuevo sistema de monitorización cardiaca extendida (por 15 días, inalámbrica y satelital en un grupo de pacientes con sospecha de arritmias cardíacas. Metodología: Cohorte de 100 pacientes atendidos en la unidad de Electrofisiología cardiovascular de un centro de referencia, con sospecha de arritmia cardíaca, sin diagnóstico electrocardiográfico causal, a pesar de exámenes previos. Se les aplic

A new laryngeal mask supraglottic airway device with integrated balloon line: a descriptive and comparative bench study

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Zhou YH

2016-11-01

Full Text Available YingHai Zhou,1 Korinne Jew2 1Research & Development, Patient Monitoring & Recovery, Medtronic Technology Center, Shanghai, People’s Republic of China; 2Medical Affairs, Minimally Invasive Therapies Group, Medtronic, Boulder, CO, USA Abstract: Laryngeal masks are invasive devices for airway management placed in the supraglottic position. The Shiley™ laryngeal mask (Shiley™ LM features an integrated inflation tube and airway shaft to facilitate product insertion and reduce the chance of tube occlusion when patients bite down. This study compared the Shiley LM to two other disposable laryngeal mask devices, the Ambu® AuraStraight™ and the LMA Unique™. Overall device design, tensile strength, flexibility of various structures, and sealing performance were measured. The Shiley LM is structurally stronger and its shaft is more resistant to compression than the other devices. The Shiley LM is generally less flexible than the other devices, but this relationship varies with device size. Sealing performance of the devices was similar in a bench assay. The results of this bench study demonstrate that the new Shiley LM resembles other commercially available laryngeal mask devices, though it exhibits greater tensile strength and lower flexibility. Keywords: laryngeal mask, supraglottic airway, supralaryngeal device

69. Explante de válvula aórtica transca téter corevalve

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J.R. González Rodríguez

2010-01-01

Conclusiones: El implante de válvulas aórticas transcatéter no es una técnica exenta de complicaciones. Los diferentes modelos y accesos para implantarlas hace necesaria la colaboración de equipos multidisciplinarios en quirófanos híbridos.

Penetrating Stab Wound of the Right Ventricle

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Onursal Buğra

2010-04-01

Full Text Available 18 years old male patient was admitted to our emergency unit with a penetrating stab wound to the right ventricle. A stab wound to the right ventricle was found to be 3 cm in diameter. The bleeding was controlled by insertion of a Foley catheter and inflation of the balloon. The stab wound had transected distal acute marginal side ofthe right coronary artery. A successful repair was performed with the use of a foley catheter and application of the Medtronic Octopus Tissue Stabilization System. The wound was closed with pledgeted mattress sutures. The distal acute marginal side of the right coronary artery was ligated. In this presentation, the surgical intervention method was reported and followed by a discussion of emergency surgical procedures of the heart.

Commercial Parts Technology Qualification Processes

Science.gov (United States)

Cooper, Mark S.

2013-01-01

Many high-reliability systems, including space systems, use selected commercial parts (including Plastic Encapsulated Microelectronics or PEMs) for unique functionality, small size, low weight, high mechanical shock resistance, and other factors. Predominantly this usage is subjected to certain 100% tests (typically called screens) and certain destructive tests usually (but not always) performed on the flight lot (typically called qualification tests). Frequently used approaches include those documented in EEE-INST-002 and JPL DocID62212 (which are sometimes modified by the particular aerospace space systems manufacturer). In this study, approaches from these documents and several space systems manufacturers are compared to approaches from a launch systems manufacturer (SpaceX), an implantable medical electronics manufacturer (Medtronics), and a high-reliability transport system process (automotive systems). In the conclusions section, these processes are outlined for all of these cases and presented in tabular form. Then some simple comparisons are made. In this introduction section, the PEM technology qualification process is described, as documented in EEE-INST-002 (written by the Goddard Space Flight Center, GSFC), as well as the somewhat modified approach employed at the Jet Propulsion Laboratory (JPL). Approaches used at several major NASA contractors are also described

Impact of polymer formulations on neointimal proliferation after zotarolimus-eluting stent with different polymers: insights from the RESOLUTE trial.

Science.gov (United States)

Waseda, Katsuhisa; Ako, Junya; Yamasaki, Masao; Koizumi, Tomomi; Sakurai, Ryota; Hongo, Yoichiro; Koo, Bon-Kwon; Ormiston, John; Worthley, Stephen G; Whitbourn, Robert J; Walters, Darren L; Meredith, Ian T; Fitzgerald, Peter J; Honda, Yasuhiro

2011-06-01

Polymer formulation may affect the efficacy of drug-eluting stents. Resolute, Endeavor, and ZoMaxx are zotarolimus-eluting stents with different stent platforms and different polymer coatings and have been tested in clinical trials. The aim of this analysis was to compare the efficacy of zotarolimus-eluting stents with different polymers. Data were obtained from the first-in man trial or first randomized trials of each stent, The Clinical RESpOnse EvaLUation of the MedTronic Endeavor CR ABT-578 Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions (RESOLUTE), Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions (ENDEAVOR II), and ZoMaxx I trials. Follow-up intravascular ultrasound analyses (8 to 9 months of follow-up) were possible in 353 patients (Resolute: 88, Endeavor: 98, ZoMaxx: 82, Driver: 85). Volume index (volume/stent length) was obtained for vessel, stent, lumen, peristent plaque, and neointima. Cross-sectional narrowing was defined as neointimal area divided by stent area (%). Neointima-free frame ratio was calculated as the number of frames without intravascular ultrasound-detectable neointima divided by the total number of frames within the stent. At baseline, vessel, lumen, and peristent plaque volume index were not significantly different among the 4 stent groups. At follow-up, percent neointimal obstruction was significantly lower in Resolute compared with Endeavor, ZoMaxx, and Driver (Resolute: 3.7±4.0, Endeavor: 17.5±10.1, ZoMaxx: 14.6±8.1, Driver: 29.4±17.2%; Ppolymer used in Resolute independently correlated with neointimal suppression among 3 zotarolimus-eluting stents. The different polymer formulations significantly affect the relative amount of neointima for zotarolimus-eluting stents. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00248079.

Rapid and Minimally Traumatic Replacement of Stimulator Extension Cables: Technical Note on a Novel Use for Sternal Wire.

Science.gov (United States)

Henderson, Fraser; Takacs, Istvan

2017-01-01

Troubleshooting of deep brain stimulators (DBSs, Activa SC/PC/RC Medtronic PLC, Minneapolis, Minnesota, USA) sometimes results in a decision to replace a tunneled stretch-coil extension cable. We present a simple technique to accomplish this atraumatically without a tunneling tool. In the treatment of patients with a DBS, complication avoidance and efficiency of operative time are paramount. We sought to find the safest, most effective, and fastest method of performing the conceptually simple yet technically nuanced act of replacing lead extension cables. We connected #6 (8.0 metric) surgical steel 18″ (45-cm) monofilament (Ethicon US, LLC, Somerville, New Jersey, USA), also known as #6 sternal wire, in line with DBS extension cables (Medtronic DBS Extension 37086-60) in novel fashion to overcome intraprocedural hurdles encountered during the past decade in a busy functional neurosurgery service. Patients tolerate the procedure well and return home shortly after recovery with no complications. A less expensive and faster technique for passing pulse generator extension cables may be the use of a sternal wire. Using the described technique, pulse generators may be quickly and safely adjusted from side to side and site to site as the clinical situation dictates. Copyright © 2016 Elsevier Inc. All rights reserved.

Space Maintenance and New Bone Formation with Polyurethane Biocomposites in a Canine Saddle Defect

Science.gov (United States)

2014-05-01

Vanderbilt University, Nashville, TN 2. Medtronic Spinal and Biologics, Memphis, TN 3. US Army Institute of Surgical Research, Fort Sam Houston, TX...and 15% hydroxyapatite (HA) that is similar in mineral content to natural bone.3 45S5 Bioactive glass (BG) is a resorbable material that has been... used effectively in a variety of bone regeneration applications.4 In the present study, we investigated the ability of injectable PUR/MG and PUR/BG

Finite difference time domain (FDTD) modeling of implanted deep brain stimulation electrodes and brain tissue.

Science.gov (United States)

Gabran, S R I; Saad, J H; Salama, M M A; Mansour, R R

2009-01-01

This paper demonstrates the electromagnetic modeling and simulation of an implanted Medtronic deep brain stimulation (DBS) electrode using finite difference time domain (FDTD). The model is developed using Empire XCcel and represents the electrode surrounded with brain tissue assuming homogenous and isotropic medium. The model is created to study the parameters influencing the electric field distribution within the tissue in order to provide reference and benchmarking data for DBS and intra-cortical electrode development.

Short- and long-term need for permanent pacemaker after transcatheter implantation of the Edwards Sapien aortic valve prosthesis.

Science.gov (United States)

Moreno, Raúl; Calvo, Luis; Sánchez-Recalde, Angel; Galeote, Guillermo; Jiménez-Valero, Santiago; López, Teresa; Plaza, Ignacio; González-Davia, Rosa; Ramírez, Ulises; Mesa, Jose Maria; Moreno-Gomez, Isidro; López-Sendón, José-Luis

2015-11-01

A permanent pacemaker is frequently needed after transcatheter aortic valve implantation, but the available data are mainly on the CoreValve system. To evaluate the need for new permanent pacemaker after implantation of the Edwards Sapien device, as well as related factors. We included the first 100 patients treated with the Edwards Sapien device at our institution. Of these, 12 had a permanent pacemaker before the procedure, and thus our study population was the remaining 88 patients. A permanent pacemaker was indicated in eight patients (9.1%) during hospitalization or at 30 days. After discharge, another four patients needed a pacemaker (at 42 days and three, 18, and 30 months). Two variables were associated with the need for pacemaker during hospitalization: previous dialysis (13% vs. 1%, p=0.042) and complete right bundle branch block before the procedure (25% vs. 5%, p=0.032). More than one month after the procedure, the characteristics associated with the need for pacemaker were plasma creatinine level (2.5±1.7 vs. 1.3±0.6 mg/dl, p=0.001) and previous myocardial infarction (50% vs. 10%, p=0.013). The rate of pacemaker implantation with the Edwards Sapien device was 9.1%. Right bundle branch block and dialysis were associated with this complication.

Steroid therapy and conduction disturbances after transcatheter aortic valve implantation.

Science.gov (United States)

Havakuk, Ofer; Konigstein, Maayan; Ben Assa, Eyal; Arbel, Yaron; Abramowitz, Yigal; Halkin, Amir; Bazan, Samuel; Shmilovich, Haim; Keren, Gad; Finkelstein, Ariel; Banai, Shmuel

2016-10-01

Direct mechanical compression of the frame struts on the adjacent bundle branch with local inflammatory reaction might cause conduction system disturbances and need for pacemaker implantation following transcatheter aortic valve implantation (TAVI). We assessed the impact of preprocedural anti-inflammatory steroid therapy on the occurrence of conduction disturbances following TAVI. From a cohort of 324 patients who underwent transfemoral TAVI, 39 (12%) were pretreated with steroids because of iodine allergy (n=29) or active obstructive pulmonary disease (n=10). We compared the rate of occurrence of new conduction disturbances and pacemaker implantation between TAVI patients with (n=39) and without (n=285) steroid treatment, using Cox logistic regression estimates and proportional hazards models. The overall occurrence of new conduction defects and the need for new pacemaker implantation were similar among steroid and non-steroid-treated patients (38.4% vs 37.5% and 25.6% vs 25.3%, respectively). New conduction disturbances were more prevalent in patients treated with CoreValve prosthesis, low implantation, and smaller aortic annulus diameter (P<.001, P<.001, and P=.006, respectively). Thirty-day mortality and complication rates were similar between the groups. Although safe, steroid treatment prior to TAVI failed to reduce the incidence of new conduction defects and the need for pacemaker implantation. © 2016 John Wiley & Sons Ltd.

Implante por cateter de bioprótese valvar para tratamento da estenose aórtica: experiência de três anos Transcatheter bioprosthesis implantation for the treatment of aortic stenosis: three-year experience

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Fabio Sandoli de Brito Junior

2012-08-01

Full Text Available FUNDAMENTO: O implante por cateter de bioprótese valvar aórtica é uma nova modalidade de tratamento para portadores de estenose aórtica inoperáveis ou de alto risco cirúrgico. Objetivo: Relatar a experiência de três anos do implante por cateter da bioprótese CoreValve. MÉTODOS: Entre janeiro de 2008 e janeiro de 2011, 35 pacientes com estenose aórtica (33 casos ou disfunção de bioprótese valvar aórtica (dois casos de alto risco cirúrgico foram submetidos ao implante da bioprótese CoreValve. RESULTADOS: A média de idade dos pacientes foi 81,5 ± 9 anos, e 80% apresentavam-se em classe funcional III ou IV de insuficiência cardíaca. O EuroScore foi 18,4 ± 14,3% e o STS 14,5 ± 11,6%. Obteve-se sucesso do implante em 34 (97,1% pacientes. Após a intervenção houve redução do gradiente transvalvar de 84,9 ± 22 para 22,5 ± 9,5 mmHg e 87,1% dos pacientes evoluíram em classe funcional I ou II. A mortalidade aos 30 dias e no seguimento médio de 400 ± 298 dias foi, respectivamente, de 11,4% e 31,4%. A ocorrência de complicações hemorrágicas com risco de morte foi o único preditor independente de mortalidade cardiovascular. Acidente vascular cerebral ocorreu em 5,7% dos pacientes. Marca-passo permanente foi necessário em 32,1% dos casos no primeiro mês após o procedimento. CONCLUSÃO: O implante por cateter de bioprótese valvar aórtica é um procedimento seguro e eficaz para ser empregado em portadores de estenose aórtica de alto risco cirúrgico. O dispositivo CoreValve é eficaz no médio-prazo, em seguimento de até três anos.BACKGROUND: Transcatheter aortic bioprosthesis implantation is a new treatment modality for patients with aortic stenosis who are inoperable or at high surgical risk. OBJECTIVE: To report the three-year experience with transcatheter CoreValve® bioprosthesis implantation. METHODS: From January 2008 to January 2011, 35 patients with aortic stenosis (33 or aortic valve bioprosthesis

Late graft explants in endovascular aneurysm repair.

Science.gov (United States)

Turney, Eric J; Steenberge, Sean P; Lyden, Sean P; Eagleton, Matthew J; Srivastava, Sunita D; Sarac, Timur P; Kelso, Rebecca L; Clair, Daniel G

2014-04-01

With more than a decade of use of endovascular aneurysm repair (EVAR), we expect to see a rise in the number of failing endografts. We review a single-center experience with EVAR explants to identify patterns of presentation and understand operative outcomes that may alter clinical management. A retrospective analysis of EVARs requiring late explants, >1 month after implant, was performed. Patient demographics, type of graft, duration of implant, reason for removal, operative technique, length of stay, complications, and in-hospital and late mortality were reviewed. During 1999 to 2012, 100 patients (91% men) required EVAR explant, of which 61 were placed at another institution. The average age was 75 years (range, 50-93 years). The median length of time since implantation was 41 months (range, 1-144 months). Explanted grafts included 25 AneuRx (Medtronic, Minneapolis, Minn), 25 Excluder (W. L. Gore & Associates, Flagstaff, Ariz), 17 Zenith (Cook Medical, Bloomington, Ind), 15 Talent (Medtronic), 10 Ancure (Guidant, Indianapolis, Ind), 4 Powerlink (Endologix, Irvine, Calif), 1 Endurant (Medtronic), 1 Quantum LP (Cordis, Miami Lakes, Fla), 1 Aorta Uni Iliac Rupture Graft (Cook Medical, Bloomington, Ind), and 1 homemade tube graft. Overall 30-day mortality was 17%, with an elective case mortality of 9.9%, nonelective case mortality of 37%, and 56% mortality for ruptures. Endoleak was the most common indication for explant, with one or more endoleaks present in 82% (type I, 40%; II, 30%; III, 22%; endotension, 6%; multiple, 16%). Other reasons for explant included infection (13%), acute thrombosis (4%), and claudication (1%). In the first 12 months, 23 patients required explants, with type I endoleak (48%) and infection (35%) the most frequent indication. Conversely, 22 patients required explants after 5 years, with type I (36%) and type III (32%) endoleak responsible for most indications. The rate of EVAR late explants has increased during the past decade at our

Outcomes of Endovascular Aneurysm Repair using the Ovation Stent Graft System in Adverse Anatomy.

Science.gov (United States)

Greaves, Nicholas S; Moore, Aiden; Seriki, Dare; Ghosh, Jonathan

2018-04-01

The aim was the evaluation of mid-term efficacy and safety outcome measures for the Ovation (Endologix, Santa Rosa, CA, USA) stent graft system in the management of infrarenal abdominal aortic aneurysms (iAAA) with adverse anatomy. A retrospective observational study of all patients undergoing elective iAAA repair was carried out from 2012 to 2017 using Ovation Prime or iX stent grafts with a minimum of 3 months follow-up at a single UK vascular centre. Post-operative surveillance involved computed tomography scans at 3 months and 1 year, with duplex ultrasound yearly thereafter. Outcome measures were established with retrospective analysis of pre- and post-operative imaging, and included peri-operative mortality, major adverse events, limb complications, aneurysm diameter change, and endoleak rates. All patients were within Ovation instructions for use (IFU), and assessment was made to determine whether aneurysms had anatomical features considered adverse for other commonly used stent graft platforms. Ovation stent grafts were implanted in 52 patients (79% male, mean age 75.7 years) with a mean aneurysm diameter of 62.5 mm (range 55-107 mm). There was 100% technical deployment success. The 30 day mortality was 0% and there was no aneurysm related mortality during follow-up (median 24 months, range 3-48 months). There were no type I or III endoleaks, but 19% developed type II endoleaks with one patient requiring re-intervention. No iliac limb occlusions were identified but one case required relining for limb kinking. All 52 cases were within the IFU for Ovation but only 12% met the IFU criteria for the Cook and Medtronic devices. The mid-term experience with Ovation demonstrates safe, durable treatment of iAAAs, including those with unfavourable anatomy, frequently off IFU for other commonly used devices. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Resultados del recambio valvular pulmonar según el tipo de prótesis implantada

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María García Vieites

2017-05-01

Conclusiones: El RVP en nuestra serie se ha asociado a una baja tasa de mortalidad perioperatoria. Cuando comparamos según el tipo de prótesis, la prótesis Medtronic Freestyle presentó un mayor gradiente inicial y en el grupo Sorin Soprano se observa una degeneración protésica superior a la esperada. Sin embargo, será necesario más seguimiento para definir el comportamiento de la prótesis Carpentier Edwards.

Outcomes for the Commercial Use of Self-Expanding Prostheses in Transcatheter Aortic Valve Replacement: A Report From the STS/ACC TVT Registry.

Science.gov (United States)

Sorajja, Paul; Kodali, Susheel; Reardon, Michael J; Szeto, Wilson Y; Chetcuti, Stanley J; Hermiller, James; Chenoweth, Sharla; Adams, David H; Popma, Jeffrey J

2017-10-23

The authors sought to compare the outcomes of commercial transcatheter aortic valve replacement (TAVR) with the repositionable Evolut R platform to those observed with the CoreValve device in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry. TAVR continues to evolve, with rapid adoption of iterative changes for commercial practice. Insight into the outcomes of this adoption is needed. Patients in the TVT Registry who had TAVR using a 23-, 26-, or 29-mm self-expanding prosthesis were enrolled. Site-reported events for procedural, in-hospital, and 30-day outcomes were examined. Between January 2014 and April 2016, 9,616 patients underwent TAVR with a self-expanding prosthesis with data entered in the TVT Registry. Compared with patients treated with CoreValve TAVR, those who received Evolut R TAVR had a lower STS-PROM score (8.0 ± 5.4% vs. 8.7 ± 5.3%; p < 0.001), more iliofemoral access (91.6% vs. 89.2%; p < 0.001), and more frequently had conscious sedation (27.4% vs. 12.7%; p < 0.001). With Evolut R TAVR, there was less need for a second prosthesis (2.2% vs. 4.5%; p < 0.001), less device migration (0.2% vs. 0.6%; p = 0.01), a lower incidence of moderate/severe paravalvular regurgitation (post-procedure, 4.4% vs. 6.2%; p < 0.001), and shorter median hospital stay (4.0 vs. 5.0 days; p < 0.001). Patients treated with Evolut R TAVR had greater device success (96.3% vs. 94.9%; p = 0.001). At 30 days, Evolut R patients had both lower mortality (3.7% vs. 5.3%; p < 0.001) and less need for a pacemaker (18.3% vs. 20.1%; p = 0.03). Commercial adoption of the Evolut R platform is associated with significant improvements in acute outcomes for patients undergoing TAVR for aortic stenosis. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Interference of apex locator, pulp tester and diathermy on pacemaker function

OpenAIRE

Narayanan Sriman; V Prabhakar; J S Bhuvaneswaran; N Subha

2015-01-01

Aim: The purpose of this study was to evaluate the effects of three electronic apex locators (EAL), electric pulp tester (EPT) and diathermy on pacemaker function in vitro. Materials and Methods: Three EALs: Root ZX (J. Morita Co., Tustin, CA, U.S.A.), Propex (Dentsply), Mini Apex locator (SybronEndo, Anaheim, CA, USA), EPT (Parkell pulp vitality tester Farmingdale, NY, USA) and Diathermy (Neomed 250 B) were tested for any interference with one pacemaker (A medtronic kappa KVDD901-serial ...

Use of a real time continuous glucose monitoring system as an educational tool for patients with gestational diabetes.

Science.gov (United States)

Alfadhli, Eman; Osman, Eman; Basri, Taghreed

2016-01-01

Women with gestational diabetes mellitus (GDM) are required to control their blood glucose shortly after GDM diagnosis to minimize adverse pregnancy outcomes. A real time-continuous glucose monitoring system (RT-CGMS) provides the patient with continuous information about the alterations in levels of the blood glucose. This visibility may empower the patient to modify her lifestyle and engage in therapeutic management. The aim of this study was to determine whether a single application of RT-CGMS to pregnant women shortly after GDM diagnosis is useful as an educational and motivational tool. This study was a prospective open label randomized controlled study conducted at Maternity and Children Hospital, Medina, Saudi Arabia. A total of 130 pregnant women with GDM were randomised to either blood glucose self-monitor alone (SMBG group) (n = 62) or in addition to SMBG, patients wore a Guardian(®) REAL-Time Continuous Glucose Monitoring System (Medtronic MiniMed) once for 3-7 days, within 2 weeks of GDM diagnosis (RT-CGMS group) (n = 68). The primary outcomes were maternal glycemic control and pregnancy outcomes. Secondary outcomes were the changes in parameters of glucose variability, which includes mean sensor readings, standard deviation (SD) of blood glucose, and area under the curve for hyper and hypoglycaemia at the end of the RT-CGMS application. HbA1c, mean fasting and postprandial glucose levels were similar in both groups at the end of the pregnancy. Pregnancy outcomes were comparable. However, there was significant improvement in the parameters of glucose variability on the last day of sensor application; both mean glucose and the SD of mean glycaemia were reduced significantly; P = 0.016 and P = 0.034, respectively. The area under the curve for hyper and hypoglycaemia were improved, however, the results were not statistically significant. Although a single application of RT-CGMS shortly after GDM diagnosis is helpful as an educational tool, it

Awake craniotomy using electromagnetic navigation technology without rigid pin fixation.

Science.gov (United States)

Morsy, Ahmed A; Ng, Wai Hoe

2015-11-01

We report our institutional experience using an electromagnetic navigation system, without rigid head fixation, for awake craniotomy patients. The StealthStation® S7 AxiEM™ navigation system (Medtronic, Inc.) was used for this technique. Detailed preoperative clinical and neuropsychological evaluations, patient education and contrast-enhanced MRI (thickness 1.5mm) were performed for each patient. The AxiEM Mobile Emitter was typically placed in a holder, which was mounted to the operating room table, and a non-invasive patient tracker was used as the patient reference device. A monitored conscious sedation technique was used in all awake craniotomy patients, and the AxiEM Navigation Pointer was used for navigation during the procedure. This offers the same accuracy as optical navigation, but without head pin fixation or interference with intraoperative neurophysiological techniques and surgical instruments. The application of the electromagnetic neuronavigation technology without rigid head fixation during an awake craniotomy is accurate, and offers superior patient comfort. It is recommended as an effective adjunctive technique for the conduct of awake surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system.

Science.gov (United States)

Jones, Susan M; Quarry, Jill L; Caldwell-McMillan, Molly; Mauger, David T; Gabbay, Robert A

2005-04-01

We attempted to identify an optimal insulin pump meal bolus by comparing postprandial sensor glucose values following three methods of insulin pump meal bolusing for a consistent pizza meal. Twenty-four patients with type 1 diabetes participated in a study to compare postprandial glucose values following three meal bolus regimens for a consistent evening pizza meal. Each participant utilized the following insulin lispro regimens on consecutive evenings, and glucose values were tracked by the Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed, Northridge, CA): (a) single-wave bolus (100% of insulin given immediately); (b) 4-h dual-wave bolus (50% of insulin given immediately and 50% given over a 4-h period); and (c) 8-h dual-wave bolus (50% of insulin given immediately and 50% given over a 8-h period). Total insulin bolus amount was kept constant for each pizza meal. Divergence in blood glucose among the regimens was greatest at 8-12 h. The 8-h dual-wave bolus provided the best glycemic control and lowest mean glucose values (singlewave bolus, 133 mg/dL; 4-h dual-wave bolus, 145 mg/dL; 8-h dual-wave bolus, 104 mg/dL), leading to a difference in mean glucose of 29 mg/dL for the single-wave bolus versus the 8-h dual-wave bolus and 42 mg/dL for the 4-h dual-wave bolus versus the 8-h dual-wave bolus. The lower mean glucose in the 8-h dual-wave bolus was not associated with any increased incidence of hypoglycemia. Use of a dual-wave bolus extended over an 8-h period following a pizza meal provided significantly less postprandial hyperglycemia in the late postprandial period (8-12 h) with no increased risk of hypoglycemia.

Differential clinical outcomes after 1 year versus 5 years in a randomised comparison of zotarolimus-eluting and sirolimus-eluting coronary stents (the SORT OUT III study)

DEFF Research Database (Denmark)

Maeng, Michael; Tilsted, Hans Henrik; Jensen, Lisette Okkels

2014-01-01

received two different types of drug-eluting stents. METHODS: We undertook this multicentre, open-label, randomised superiority trial at five percutaneous coronary intervention centres in Denmark. We randomly allocated 2332 eligible adult patients (≥18 years of age) with an indication for drug......-eluting stent implantation to the zotarolimus-eluting Endeavor Sprint stent (Medtronic, Santa Rosa, CA, USA) or the sirolimus-eluting Cypher Select Plus stent (Cordis, Johnson & Johnson, Warren, NJ, USA). Randomisation of participants was achieved by computer-generated block randomisation and a telephone...

Glucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery System in Adolescents and Adults with Type 1 Diabetes.

Science.gov (United States)

Garg, Satish K; Weinzimer, Stuart A; Tamborlane, William V; Buckingham, Bruce A; Bode, Bruce W; Bailey, Timothy S; Brazg, Ronald L; Ilany, Jacob; Slover, Robert H; Anderson, Stacey M; Bergenstal, Richard M; Grosman, Benyamin; Roy, Anirban; Cordero, Toni L; Shin, John; Lee, Scott W; Kaufman, Francine R

2017-03-01

The safety and effectiveness of the in-home use of a hybrid closed-loop (HCL) system that automatically increases, decreases, and suspends insulin delivery in response to continuous glucose monitoring were investigated. Adolescents (n = 30, ages 14-21 years) and adults (n = 94, ages 22-75 years) with type 1 diabetes participated in a multicenter (nine sites in the United States, one site in Israel) pivotal trial. The Medtronic MiniMed ® 670G system was used during a 2-week run-in phase without HCL control, or Auto Mode, enabled (Manual Mode) and, thereafter, with Auto Mode enabled during a 3-month study phase. A supervised hotel stay (6 days/5 nights) that included a 24-h frequent blood sample testing with a reference measurement (i-STAT) occurred during the study phase. Adolescents (mean ± standard deviation [SD] 16.5 ± 2.29 years of age and 7.7 ± 4.15 years of diabetes) used the system for a median 75.8% (interquartile range [IQR] 68.0%-88.4%) of the time (2977 patient-days). Adults (mean ± SD 44.6 ± 12.79 years of age and 26.4 ± 12.43 years of diabetes) used the system for a median 88.0% (IQR 77.6%-92.7%) of the time (9412 patient-days). From baseline run-in to the end of study phase, adolescent and adult HbA 1c levels decreased from 7.7% ± 0.8% to 7.1% ± 0.6% (P hotel stay, the proportion of in-target i-STAT ® blood glucose values was 67.4% ± 27.7% compared to SG values of 72.0% ± 11.6% for adolescents and 74.2% ± 17.5% compared to 76.9% ± 8.3% for adults. There were no severe hypoglycemic or diabetic ketoacidosis events in either cohort. HCL therapy was safe during in-home use by adolescents and adults and the study phase demonstrated increased time in target, and reductions in HbA 1c, hyperglycemia and hypoglycemia, compared to baseline. Clinicaltrials.gov identifier: NCT02463097.

Intrathecal catheter-syringe adaptor for short-term intrathecal analgesia with an externalized pump: a case report.

Science.gov (United States)

Wilkes, Denise; Cook, Michael; Solanki, Daneshvari

2010-01-01

In most patients, cancer pain is effectively treated with conservative medical management consisting of oral and/or transdermal analgesics. Cancer patients tend to fail conservative medical management near the end of their life expectancy, thus requiring alternative routes of analgesia such as intravenous, epidural, or intrathecal. The intrathecal route provides the most effective analgesia due to the close proximity of the opioid receptors in the spinal cord. Though there are many techniques that exist for intrathecal drug delivery, complications can limit effectiveness such as infection, bleeding, cerebrospinal fluid (CSF) leaks, post-dural puncture headaches (PDPH), pump and/or catheter malfunctions, or limitations of technical expertise. Therefore, an important goal in palliative cancer pain therapy is to use equipment that is going to have the fewest number of complications and will be the most familiar to the health care providers. We describe the combination of the Medtronic Indura 1P catheter, which has the least catheter-related complications and can be used with any external drug infusion pump. These are regular infusion pumps that the health care workers are familiar with so they can provide excellent and efficient service to the patient. In an operating room, the intrathecal catheter was placed using sterile technique under fluoroscopic guidance. The epidural space was identified with loss of resistance technique. Then the introducer needle (supplied in the Indura 1P catheter kit) was advanced until free-flowing CSF was obtained. The spinal catheter was advanced into the intrathecal space through the introducer needle to lumbar 2-3 level. The catheter was tunneled subcutaneously 10 cm lateral to the catheter exit site. A syringe filling device was inserted into the catheter opening and was secured with silk suture. A luer lock syringe was attached to the syringe filling device and CSF was aspirated. The syringe filling device was capped and later

Response of Balloon-Expandable Endoprosthetic Metallic Stents Subjected to Over-Expansion In Vitro

International Nuclear Information System (INIS)

Montague, B. J.; Kakimoto, W. M.; Arepally, A.; Razavi, M.; Dake, M. D.; Hofmann, L. V.

2004-01-01

We attempted to evaluate the in vitro behavior and performance of balloon-expandable endoprosthetic metallic stents subjected to over-expansion (OE). Seventy-two balloon-expandable endoprosthetic stents, representing 22 models from six manufacturers, were over- expanded in vitro. Stents were initially expanded to their maximum manufacturer- recommended diameter and then over-expanded incrementally to their endpoints. Endpoints for OE were either stent disarticulation or an inability to undergo further expansion despite balloon insufflation to maximum burst pressure. Measurements of stent dimensions were recorded at each overexpanded diameter and comparisons were made to manufacturer's specifications. A total of 288 balloon-driven expansions were performed on 72 stents. Sixteen stents were expanded to large diameters (≥ 16 mm), 20 stents underwent OE of 50% or greater. One model tended to disarticulate after OE greater than 50%. There were five models that had a tendency to disarticulate after minimal OE. Five models were resistant to OE (25% or less OE) but did not disarticulate. Nearly all stents showed some degree of foreshortening with OE, while 36 stents underwent foreshortening of 30% or more. Models that are not recommended for OE include Intrastent, Intrastent DoubleStrut, NIR Royale and Omniflex. Good candidates for OE include Intrastent DoubleStrut LD, Palmaz large, Medtronic Extra Support Biliary Plus and Medtronic Flexible Biliary. Palmaz XL remains the only model available for expansion from 20 to 28 mm in diameter. For the remaining stents, OE is possible, however, caution should be used

Bubble formation occurs in insulin pumps in response to changes in ambient temperature and atmospheric pressure but not as a result of vibration.

Science.gov (United States)

Lopez, Prudence E; King, Bruce R; Goss, Peter W; Chockalingam, Ganesh

2014-01-01

Bubble formation in insulin pump giving sets is a common problem. We studied change in temperature, change in atmospheric pressure, and vibration as potential mechanisms of bubble formation. 5 Animas 2020 pumps with 2 mL cartridges and Inset II infusion systems, 5 Medtronic Paradigm pumps with 1.8 mL cartridge and Quickset and 3 Roche Accu-chek pumps with 3.15 mL cartridges were used. Temperature study: insulin pumps were exposed to a temperature change from 4°C to 37°C. Pressure study: insulin pumps were taken to an altitude of 300 m. Vibration study: insulin pumps were vigorously shaken. All were observed for bubble formation. Bubble formation was observed with changes in temperature and atmospheric pressure. Bubble formation did not occur with vibration. Changes in insulin temperature and atmospheric pressure are common and may result in bubble formation. Vibration may distribute bubbles but does not cause bubble formation.

Navigation accuracy comparing non-covered frame and use of plastic sterile drapes to cover the reference frame in 3D acquisition.

Science.gov (United States)

Corenman, Donald S; Strauch, Eric L; Dornan, Grant J; Otterstrom, Eric; Zalepa King, Lisa

2017-09-01

Advancements in surgical navigation technology coupled with 3-dimensional (3D) radiographic data have significantly enhanced the accuracy and efficiency of spinal fusion implant placement. Increased usage of such technology has led to rising concerns regarding maintenance of the sterile field, as makeshift drape systems are fraught with breaches thus presenting increased risk of surgical site infections (SSIs). A clinical need exists for a sterile draping solution with these techniques. Our objective was to quantify expected accuracy error associated with 2MM and 4MM thickness Sterile-Z Patient Drape ® using Medtronic O-Arm ® Surgical Imaging with StealthStation ® S7 ® Navigation System. Camera distance to reference frame was investigated for contribution to accuracy error. A testing jig was placed on the radiolucent table and the Medtronic passive reference frame was attached to jig. The StealthStation ® S7 ® navigation camera was placed at various distances from testing jig and the geometry error of reference frame was captured for three different drape configurations: no drape, 2MM drape and 4MM drape. The O-Arm ® gantry location and StealthStation ® S7 ® camera position was maintained and seven 3D acquisitions for each of drape configurations were measured. Data was analyzed by a two-factor analysis of variance (ANOVA) and Bonferroni comparisons were used to assess the independent effects of camera angle and drape on accuracy error. Median (and maximum) measurement accuracy error was higher for the 2MM than for the 4MM drape for each camera distance. The most extreme error observed (4.6 mm) occurred when using the 2MM and the 'far' camera distance. The 4MM drape was found to induce an accuracy error of 0.11 mm (95% confidence interval, 0.06-0.15; P<0.001) relative to the no drape testing, regardless of camera distance. Medium camera distance produced lower accuracy error than either the close (additional 0.08 mm error; 95% CI, 0-0.15; P=0.035) or far

Image guided surgery for petrous apex lesions

International Nuclear Information System (INIS)

Van Havenbergh, T.; De Ridder, D.; Verlooy, J.; Koekelkoren, E.; Van De Heyning, P.

2003-01-01

To evaluate whether computer-assisted frameless stereotactic navigation in the temporal bone provides sufficient clinical application accuracy and thus a useful tool in temporal bone surgery. Two patients with petrous apex cholesterol granuloma were operated on by an epidural middle fossa approach using a Stealth/MedtronicTM neuronavigation system. Based an literature data optimal skin fiducial placement and registration methods were used. Intra-operative accuracy was checked using three precise anatomical landmarks. Drilling of the petrotis apex bone was guided by neuronavigation. Postoperative Computed Tomography (CT) images were fused with the preoperative CT and planning. The application of image-guidance in temporal bone surgery causes no additional burden to the patient nor prolongs the operating time. The accuracy measured at the anatomical landmarks was under 2,0 mm. This is confirmed by evaluation of bone removal through image fusion of pre- and postoperative CT scan. The clinical application of a neuronavigation system during petrous apex surgery can be regarded as useful. Using all available data on registration methods it seems possible to obtain intra-operative application accuracies of < 2,0 mm. Additional cadaver work is being performed to support these data. (author)

Insulin Pump Malfunction During Hospitalization: Two Case Reports.

Science.gov (United States)

Faulds, Eileen R; Wyne, Kathleen L; Buschur, Elizabeth O; McDaniel, Jodi; Dungan, Kathleen

2016-06-01

Insulin pump malfunctions and failures continue to occur; however, more severe malfunctions such as the "runaway pump" phenomenon are rarely reported. This article describes two cases of pump malfunction in which pump users appear to have received an unsolicited bolus of insulin resulting in severe episodes of hypoglycemia during hospitalization. Both cases of insulin pump malfunction occurred in the inpatient setting at a large academic medical center in the United States. An analysis of the corresponding insulin pump downloads was performed. The Food and Drug Administration's (FDA's) Manufacturer and User Facility Device Experience (MAUDE) database was searched for similar cases involving Medtronic (Northridge, CA) insulin pumps using the terms "pump," "infusion," "insulin AND malfunction AND Medtronic." The two cases described show remarkable similarities, each demonstrating a severe hypoglycemic event preceded by an infusion site change followed by an alarm. In both cases a rapid spraying of insulin was reported. The insulin pump downloads validated much of the patients' and medical staff's descriptions of events. The FDA's MAUDE database search revealed 425 cases meeting our search term criteria. All cases were reviewed. Seven cases were identified involving independent movement of the reservoir piston. The cases detailed are the first to describe an insulin pump malfunction of this nature in the hospital setting involving unsolicited insulin boluses leading to severe hypoglycemia. The cases are particularly compelling in that they were witnessed by medical personnel. Providers and patients should receive instruction education on the recognition and management of insulin pump malfunction.

Study design and rationale of the 'Balloon-Expandable Cobalt Chromium SCUBA Stent versus Self-Expandable COMPLETE-SE Nitinol Stent for the Atherosclerotic ILIAC Arterial Disease (SENS-ILIAC Trial) Trial': study protocol for a randomized controlled trial.

Science.gov (United States)

Choi, Woong Gil; Rha, Seung Woon; Choi, Cheol Ung; Kim, Eung Ju; Oh, Dong Joo; Cho, Yoon Hyung; Park, Sang Ho; Lee, Seung Jin; Hur, Ae Yong; Ko, Young Guk; Park, Sang Min; Kim, Ki Chang; Kim, Joo Han; Kim, Min Woong; Kim, Sang Min; Bae, Jang Ho; Bong, Jung Min; Kang, Won Yu; Seo, Jae Bin; Jung, Woo Yong; Cho, Jang Hyun; Kim, Do Hoi; Ahn, Ji Hoon; Kim, Soo Hyun; Jang, Ji Yong

2016-06-25

The self-expandable COMPLETE™ stent (Medtronic) has greater elasticity, allowing it to regain its shape after the compression force reduces, and has higher trackability, thus is easier to maneuver through tortuous vessels, whereas the balloon-expandable SCUBA™ stent (Medtronic) has higher radial stiffness and can afford more accurate placement without geographic miss, which is important in aortoiliac bifurcation lesions. To date, there have been no randomized control trials comparing efficacy and safety between the self-expanding stent and balloon-expandable stent in advanced atherosclerotic iliac artery disease. The purpose of our study is to examine primary patency (efficacy) and incidence of stent fracture and geographic miss (safety) between two different major representative stents, the self-expanding nitinol stent (COMPLETE-SE™) and the balloon-expanding cobalt-chromium stent (SCUBA™), in stenotic or occlusive iliac arterial lesions. This trial is designed as a prospective, randomized, multicenter trial to demonstrate a noninferiority of SCUBA™ stent to COMPLETE-SE™ stent following balloon angioplasty in iliac arterial lesions, and a total of 280 patients will be enrolled. The primary end point of this study is the rate of primary patency in the treated segment at 12 months after intervention as determined by catheter angiography, computed tomography angiography, or duplex ultrasound. The SENS-ILIAC trial will give powerful insight into whether the stent choice according to deployment mechanics would impact stent patency, geographic miss, or stent fracture in patients undergoing stent implantation in iliac artery lesions. National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier: NCT01834495 ), registration date: May 8, 2012.

Guide to preemption of state-law claims against Class III PMA medical devices.

Science.gov (United States)

Whitney, Daniel W

2010-01-01

There is a perception that the express preemption holding of the Supreme Court in Riegel v. Medtronic, 552 U.S. 312(2008), immunizes medical device manufacturers from common law personal injury actions involving Class III devices that received FDA clearance under a premarket approval application (PMA). In the aftermath of Riegel, many lawsuits involving Class III PMA devices have been dismissed by district courts applying the new heightened pleading standard of Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007). Other lawsuits involving Class III PMA devices premised on fraud-on-FDA have been dismissed based on the implied preemption holding of the Supreme Court in Buckman v. Plaintiffs' Legal Comm., 531 U.S. 341 (2001). When these decisions are carefully analyzed together with Medtronic, Inc. v. Lohr, 518 U.S. 470 (1996), which found no preemption regarding a Class III device receiving FDA clearance through the 510(k) mechanism, it is apparent that the preemption defense does not apply universally to Class III PMA devices. The overall methodology for framing a non-preempted claim is to first identify conduct which violated the PMA or other specific requirements related to safety or efficacy. If such conduct can also be stated in terms of a breach of a parallel common law duty (e.g, failure to warn under strict liability or negligence, manufacturing defect or breach of warranty), then it would appear the claim is not preempted. Alternatively, regardless of a specific violation, common law remedies are not preempted by general CGMP requirements.

Heterotopic ossification associated with myelopathy following cervical disc prosthesis implantation.

Science.gov (United States)

Wenger, Markus; Markwalder, Thomas-Marc

2016-04-01

This case report presents a 37-year-old man with clinical signs of myelopathy almost 9 years after implantation of a Bryan disc prosthesis (Medtronic Sofamor Danek, Memphis, TN, USA) for C5/C6 soft disc herniation. As demonstrated on MRI and CT scan, spinal cord compression was caused by bony spurs due to heterotopic ossification posterior to the still moving prosthesis. The device, as well as the ectopic bone deposits, had to be removed because of myelopathy and its imminent aggravation. Conversion to anterior spondylodesis was performed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Model Identification using Continuous Glucose Monitoring Data for Type 1 Diabetes

DEFF Research Database (Denmark)

Boiroux, Dimitri; Hagdrup, Morten; Mahmoudi, Zeinab

2016-01-01

This paper addresses model identification of continuous-discrete nonlinear models for people with type 1 diabetes using sampled data from a continuous glucose monitor (CGM). We compare five identification techniques: least squares, weighted least squares, Huber regression, maximum likelihood...... with extended Kalman filter and maximum likelihood with unscented Kalman filter. We perform the identification on a 24-hour simulation of a stochastic differential equation (SDE) version of the Medtronic Virtual Patient (MVP) model including process and output noise. We compare the fits with the actual CGM......, such as parameter tracking, population modeling and handling of outliers....

Medida do fluxo intraoperatório com fluxômetro TTFM nos enxertos coronários: resultados de amostra nacional

OpenAIRE

Succi,José Ernesto; Gerola,Luis Roberto; Succi,Guilherme de Menezes; Kim,Hyong Chun; Paredes,Jorge Edwin Morocho; Bufollo,Enio

2012-01-01

OBJETIVO: Avaliar a perviedade dos enxertos no intraoperatório e identificar enxertos com risco de oclusão precoce. MÉTODOS: Cinquenta e quatro pacientes foram submetidos à revascularização do miocárdio e foi utilizado o fluxômetro (Medtronic Medi-Stim) que utiliza o método de tempo de trânsito (TTFM) para avaliação do fluxo nos enxertos. Três pacientes tinham lesão de tronco de artéria coronária esquerda e 48 apresentavam função ventricular normal ou pouco comprometida. RESULTADOS: A mortali...

Medida do fluxo intraoperatório com fluxômetro TTFM nos enxertos coronários: resultados de amostra nacional Intraoperative coronary grafts flow measurement using the TTFM flowmeter: results from a domestic sample

OpenAIRE

José Ernesto Succi; Luis Roberto Gerola; Guilherme de Menezes Succi; Hyong Chun Kim; Jorge Edwin Morocho Paredes; Enio Bufollo

2012-01-01

OBJETIVO: Avaliar a perviedade dos enxertos no intraoperatório e identificar enxertos com risco de oclusão precoce. MÉTODOS: Cinquenta e quatro pacientes foram submetidos à revascularização do miocárdio e foi utilizado o fluxômetro (Medtronic Medi-Stim) que utiliza o método de tempo de trânsito (TTFM) para avaliação do fluxo nos enxertos. Três pacientes tinham lesão de tronco de artéria coronária esquerda e 48 apresentavam função ventricular normal ou pouco comprometida. RESULTADOS: A mortali...

Prosthetic Valve Endocarditis - Successful Management With Antimicrobial Treatment

Directory of Open Access Journals (Sweden)

Ashokan Nambiar C

2015-07-01

Full Text Available Middle aged male was admitted with high fever, rigor and chills of 2 days duration. He was seen in the clinic two years back for syncope. He gave history of Mitral (Starr-Edward and Aortic (Medtronic valve replacement ten years earlier from another center and was on regular anticoagulation with dose-adjusted acenocoumarol. On evaluation he had normal prosthetic valve function by trans-thoracic echo, but Holter monitoring showed Paroxysmal Atrial Fibrillation. He had mild wall motion abnormalities and left ventricular dysfunction suggestive of coronary artery disease also and was put on additional Metoprolol.

Directory of Open Access Journals (Sweden)

Matheus Fernandes de Oliveira

2013-04-01

Full Text Available Idiopathic normal pressure hydrocephalus (iNPH is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient.Methods:In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic valve, following a protocol based on a positive Tap Test. Results:We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies.Conclusions:The Strata® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH.A hidrocefalia de pressão normal idiopática (iNPH é caracterizada por alterações na marcha, demência e/ou incontinência urinária, além de dilatação dos ventrículos com pressão normal de abertura no líquido cefalorraquidiano. A cirurgia de derivação é o principal tratamento da iNHP. São recomendadas válvulas programáveis, pois a pressão de drenagem pode ser alterada. Embora as válvulas programáveis sejam utilizadas, não há protocolos para atingir a pressão adequada de cada paciente. Métodos: Neste estudo, relatamos nossa experiência com 24 pacientes com iNPH que usaram a válvula Strata® (Medtronic, seguindo protocolo baseado em um Tap test positivo.Resultados:Observamos melhora em 20 pacientes e estabilidade ou piora em 4. Ocorreram complicações em cinco pacientes, tendo um deles falecido. Houve importante melhora clínica, e as complicações ocorreram em taxa mais baixa do que as relatadas em outros estudos.Conclusões:A v

Estimating the effective radiation dose imparted to patients by intraoperative cone-beam computed tomography in thoracolumbar spinal surgery.

Science.gov (United States)

Lange, Jeffrey; Karellas, Andrew; Street, John; Eck, Jason C; Lapinsky, Anthony; Connolly, Patrick J; Dipaola, Christian P

2013-03-01

Observational. To estimate the radiation dose imparted to patients during typical thoracolumbar spinal surgical scenarios. Minimally invasive techniques continue to become more common in spine surgery. Computer-assisted navigation systems coupled with intraoperative cone-beam computed tomography (CT) represent one such method used to aid in instrumented spinal procedures. Some studies indicate that cone-beam CT technology delivers a relatively low dose of radiation to patients compared with other x-ray-based imaging modalities. The goal of this study was to estimate the radiation exposure to the patient imparted during typical posterior thoracolumbar instrumented spinal procedures, using intraoperative cone-beam CT and to place these values in the context of standard CT doses. Cone-beam CT scans were obtained using Medtronic O-arm (Medtronic, Minneapolis, MN). Thermoluminescence dosimeters were placed in a linear array on a foam-plastic thoracolumbar spine model centered above the radiation source for O-arm presets of lumbar scans for small or large patients. In-air dosimeter measurements were converted to skin surface measurements, using published conversion factors. Dose-length product was calculated from these values. Effective dose was estimated using published effective dose to dose-length product conversion factors. Calculated dosages for many full-length procedures using the small-patient setting fell within the range of published effective doses of abdominal CT scans (1-31 mSv). Calculated dosages for many full-length procedures using the large-patient setting fell within the range of published effective doses of abdominal CT scans when the number of scans did not exceed 3. We have demonstrated that single cone-beam CT scans and most full-length posterior instrumented spinal procedures using O-arm in standard mode would likely impart a radiation dose within the range of those imparted by a single standard CT scan of the abdomen. Radiation dose increases

Flow visualization of a monoleaflet and bileaflet mechanical heart valve in a pneumatic ventricular assist device using a PIV system.

Science.gov (United States)

Lee, Hwansung; Tatsumi, Eisuke; Taenaka, Yoshiyuki

2010-01-01

Our group is developing a new type of pulsatile pneumatic ventricular assist device (PVAD) that uses the Medtronic Hall tilting disc valve (M-H valve). Although tilting disc valves have good washout effect inside the blood pump, they are no longer in common clinical use and may be difficult to obtain in the future. To investigate the stability of the Sorin Bicarbon valve (S-B valve) in our PVAD, we constructed a model pump made of an acrylic resin with the same configuration as our PVAD and attempted to compare the flow visualization upstream and downstream of the outlet position valve between the M-H valve and the S-B valve using a particle image velocimetry (PIV) method. The outlet S-B valve had faster closure than the M-H valve. The maximum flow velocity was greater than with the M-H valve. The maximum Reynolds shear stress (RSS) of the M-H valve reached 150 N/m(2) and that of the S-B valve reached 300 N/m(2) upstream during the end-systolic and early-diastolic phases. In both valves, the maximum RSS upstream of the valve was higher than downstream of the valve because of the regurgitation flow during valve closure. In addition, the maximum viscous shear stress reached above 2 N/m(2), which occupied only about 1%-1.5% of the maximum RSS.

Pacing-induced chronic atrial fibrillation impairs sinus node function in dogs. Electrophysiological remodeling.

Science.gov (United States)

Elvan, A; Wylie, K; Zipes, D P

1996-12-01

We assessed the effects of pacing-induced chronic atrial fibrillation (AF) on sinus node function, intra-atrial conduction, and atrial refractoriness. In 15 mongrel dogs (20 to 30 kg), AV nodal block was produced by radiofrequency catheter ablation, and a ventricular-inhibited (VVI) pacemaker (Minix 8330, Medtronic) was implanted and programmed to pace at 80 pulses per minute. In 11 of these dogs, right atrial endocardial pacing leads were connected to a pulse generator (Itrel 7432, Medtronic) and set at a rate of 20 Hz to induce AF. Corrected sinus node recovery time, P-wave duration, 24-hour Holter ECG to assess AF duration, maximal heart rate in response to isoproterenol (10 micrograms/min), intrinsic heart rate after administration of atropine (0.04 mg/kg) and propranolol (0.1 mg/kg), and atrial effective refractory periods (ERPs) were obtained at baseline (EPS-1) and after 2 to 6 weeks (EPS-2) of VVI pacing alone (n = 4) or VVI pacing and rapid atrial pacing (n = 11). At EPS-2, corrected sinus node recovery time and P-wave duration were prolonged, maximal heart rate and intrinsic heart rate were decreased, atrial ERPs were shortened, and the duration of AF was increased significantly compared with EPS-1. These changes partially reversed toward baseline 1 week after conversion to sinus rhythm. Sinus node function and AF inducibility observed in the control dogs that underwent ventricular pacing alone (n = 4) did not change. Pacing-induced chronic AF induces sinus node dysfunction, prolongs intra-atrial conduction time, shortens atrial refractoriness, and perpetuates AF, changes that reverse gradually after termination of AF.

A randomized, placebo-controlled trial of repetitive spinal magnetic stimulation in lumbosacral spondylotic pain.

Science.gov (United States)

Lo, Yew L; Fook-Chong, Stephanie; Huerto, Antonio P; George, Jane M

2011-07-01

Lumbar spondylosis is a degenerative disorder of the spine, whereby pain is a prominent feature that poses therapeutic challenges even after surgical intervention. There are no randomized, placebo-controlled studies utilizing repetitive spinal magnetic stimulation (SMS) in pain associated with lumbar spondylosis. In this study, we utilize SMS technique for patients with this condition in a pilot clinical trial. We randomized 20 patients into SMS treatment or placebo arms. All patients must have clinical and radiological evidence of lumbar spondylosis. Patients should present with pain in the lumbar region, localized or radiating down the lower limbs in a radicular distribution. SMS was delivered with a Medtronic R30 repetitive magnetic stimulator (Medtronic Corporation, Skovlunde, Denmark) connected to a C-B60 figure of eight coil capable of delivering a maximum output of 2 Tesla per pulse. The coil measured 90 mm in each wing and was centered over the surface landmark corresponding to the cauda equina region. The coil was placed flat over the back with the handle pointing cranially. Each patient on active treatment received 200 trains of five pulses delivered at 10 Hz, at an interval of 5 seconds between each train. "Sham" SMS was delivered with the coil angled vertically and one of the wing edges in contact with the stimulation point. All patients tolerated the procedure well and no side effects of SMS were reported. In the treatment arm, SMS had resulted in significant pain reduction immediately and at Day 4 after treatment (P lumbar spondylosis in a randomized, double-blind, placebo-controlled setting. The novel findings support the potential of this technique for future studies pertaining to neuropathic pain. Wiley Periodicals, Inc.

Effect of insulin catheter wear-time on subcutaneous adipose tissue blood flow and insulin absorption in humans

DEFF Research Database (Denmark)

Clausen, Trine Schnedler; Kaastrup, Peter; Stallknecht, Bente

2009-01-01

blood flow (ATBF) and absorption of the rapid-acting insulin analog insulin aspart over a period of 4 days. METHODS: Teflon insulin catheters (Medtronic, Minneapolis, MN) were inserted into the abdominal SAT of 10 healthy men without diabetes (mean +/- SEM age, 23.0 +/- 1.1 years; body mass index, 22...... +/- 3 min on day 0 to 45 +/- 4 min on day 4 (P = 0.019). Neither peak plasma concentration nor area under the curve of insulin aspart changed significantly. CONCLUSIONS: Insertion of a Teflon insulin catheter into the SAT results in increased ATBF and faster absorption of insulin aspart in a period of 4...

Manual Intracardiac Electrogram Method Is Accurate Alternative to Echocardiography for Atrioventricular and Interventricular Optimization in Cardiac Resynchronization Therapy.

Science.gov (United States)

Pezo Nikolić, Borka; Lovrić, Daniel; Ljubas Maček, Jana; Rešković Lukšić, Vlatka; Matasić, Richard; Šeparović Hanževački, Jadranka

2017-12-01

Some manufacturers do not provide automated intracardiac electrogram method (IEGM) systems for atrioventricular (AV) and interventricular (VV) delay optimization in cardiac resynchronization therapy (CRT). We aimed to evaluate the accuracy of manual IEGM method in 48 patients previously implanted with Medtronic Syncra CRT. All patients underwent standard device interrogation followed by CRT optimization by IEGM method and by echocardiography one month after implantation. The patient mean age was 60.7±11.8 years and there were 33 (68.8%) males. After CRT implantation, the left ventricular ejection fraction increased from 28.0±7.9% to 39.1±11.0% (p<0.001). Optimal aortic flow Velocity Time Integral (aVTI) was obtained when VV was set to 20-50 ms left ventricular pre-activation. There was a strong correlation between VV values determined by echocardiography and IEGM (R=0.823, p<0.001). We found no significant difference in AV, VV and aVTI values between echocardiography and IEGM method. However, IEGM was significantly less time-consuming than echocardiography [20 (10-28) vs. 40 (35-60) minutes, p<0.001]. Manual IEGM method may be good alternative to echocardiography and automated IEGM method. It also emphasizes the need for implementation of automated IEGM systems in as many CRT devices as possible.

Manejo anestésico e complicações no implante percutâneo de válvula aórtica Manejo anestésico y complicaciones en el implante percutáneo de válvula aórtica Anesthetic management and complications of percutaneous aortic valve implantation

Directory of Open Access Journals (Sweden)

Tailur Alberto Grando

2013-06-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A estenose aórtica (EA grave é uma doença prevalente e de grande mortalidade. Nos pacientes idosos com outras comorbidades o implante valvar percutâneo é uma opção. OBJETIVOS: Descrever o manejo anestésico e as complicações com anestesia geral. MÉTODO: Série de casos com seguimento de 30 dias e 24 meses após o implante do dispositivo CoreValve feito no Instituto de Cardiologia/Fundação Universitária de Cardiologia entre dezembro de 2008 e janeiro de 2012. Os pacientes foram submetidos à anestesia geral monitorada com pressão arterial média (PAM, eletrocardiograma (ECG, oximetria, capnografia, ecocardiograma transesofágico, termometria e marcapasso transvenoso. RESULTADOS: Foram submetidos com sucesso ao implante valvular 28 pacientes, com idade média de 82,46 anos, EuroScore médio de 20,98%, classe funcional III/IV. Nove pacientes necessitaram de implante de marcapasso definitivo. No seguimento dos pacientes houve dois óbitos, um no transoperatório por perfuração do VE e um no terceiro dia por causa desconhecida. Em 24 meses um paciente faleceu com diagnóstico de mieloma múltiplo. A técnica anestésica mostrou-se segura. CONCLUSÃO: A experiência inicial com implante valvular aórtico percutâneo sob anestesia geral tem se mostrado segura e eficaz sem complicações anestésicas importantes para esse procedimento.JUSTIFICATIVA Y OBJETIVOS: La estenosis aórtica (EA grave es una enfermedad prevalente y de gran mortalidad. En los pacientes ancianos con otras comorbilidades, el implante valvular percutáneo es una opción. OBJETIVOS: Describir el manejo anestésico y las complicaciones con la anestesia general. MÉTODO: Serie de casos con seguimiento de 30 días y 24 meses después del implante del dispositivo CoreValve hecho en el Instituto de Cardiología/Fundación Universitaria de Cardiología entre diciembre de 2008 y enero de 2012. Los pacientes fueron sometidos a la anestesia general

Real-world geographic variations in the use of cardiac implantable electronic devices - The PANORAMA 2 observational cohort study.

Science.gov (United States)

Bastian, Dirk; Ebrahim, Iftikhar O; Chen, Ju-Yi; Chen, Mien-Cheng; Huang, Dejia; Huang, Jin-Long; Kuznetsov, Vadim A; Maus, Bärbel; Naik, Ajay M; Verhees, Koen J P; Fagih, Ahmed R Al

2018-06-13

Currently, several geographies around the world remain underrepresented in medical device trials. The PANORAMA 2 study was designed to assess contemporary region-specific differences in clinical practice patterns of patients with cardiac implantable electronic devices (CIEDs). In this prospective, multicenter, observational, multi-national study, baseline and implant data of 4,706 patients receiving Medtronic CIEDs (either de novo device implants, replacements, or upgrades) were analyzed, consisting of: 54% implantable pulse generators (IPGs), 20.3% implantable cardiac defibrillators (ICDs), 15% cardiac resynchronization therapy defibrillators (CRT-Ds), 5.1% cardiac resynchronization therapy pacemakers (CRT-Ps), from 117 hospitals in 23 countries across 4 geographical regions between 2012 and 2016. For all device types, in all regions, there were less females than males enrolled, and women were less likely to have ischemic cardiomyopathy. Implant procedure duration differed significantly across the geographies for all device types. Subjects from emerging countries, women and older patients were less likely to receive a magnetic resonance imaging (MRI)-compatible device. Defibrillation testing differed significantly between the regions. European patients had the highest rates of atrial fibrillation (AF), and the lowest number of implanted single-chamber IPGs. Evaluation of stroke history suggested that the general embolic risk is more strongly associated with stroke than AF. We provide comprehensive descriptive data on patients receiving Medtronic CIEDs from several geographies, some of which are understudied in randomized controlled trials (RCTs). We found significant variations in patient characteristics. Several medical decisions appear to be affected by socioeconomic factors. Long-term follow-up data will help evaluate if these variations require adjustments to outcome expectations. This article is protected by copyright. All rights reserved. This article is

Renal denervation in treatment-resistant essential hypertension. A randomized, SHAM-controlled, double-blinded 24-h blood pressure-based trial.

Science.gov (United States)

Mathiassen, Ole N; Vase, Henrik; Bech, Jesper N; Christensen, Kent L; Buus, Niels H; Schroeder, Anne P; Lederballe, Ole; Rickers, Hans; Kampmann, Ulla; Poulsen, Per L; Hansen, Klavs W; Btker, Hans E; Peters, Christian D; Engholm, Morten; Bertelsen, Jannik B; Lassen, Jens F; Langfeldt, Sten; Andersen, Gratien; Pedersen, Erling B; Kaltoft, Anne

2016-08-01

Renal denervation (RDN), treating resistant hypertension, has, in open trial design, been shown to lower blood pressure (BP) dramatically, but this was primarily with respect to office BP. We conducted a SHAM-controlled, double-blind, randomized, single-center trial to establish efficacy data based on 24-h ambulatory BP measurements (ABPM). Inclusion criteria were daytime systolic ABPM at least 145 mmHg following 1 month of stable medication and 2 weeks of compliance registration. All RDN procedures were carried out by an experienced operator using the unipolar Medtronic Flex catheter (Medtronic, Santa Rosa, California, USA). We randomized 69 patients with treatment-resistant hypertension to RDN (n = 36) or SHAM (n = 33). Groups were well balanced at baseline. Mean baseline daytime systolic ABPM was 159 ± 12 mmHg (RDN) and 159 ± 14 mmHg (SHAM). Groups had similar reductions in daytime systolic ABPM compared with baseline at 3 months [-6.2 ± 18.8 mmHg (RDN) vs. -6.0 ± 13.5 mmHg (SHAM)] and at 6 months [-6.1 ± 18.9 mmHg (RDN) vs. -4.3 ± 15.1 mmHg (SHAM)]. Mean usage of antihypertensive medication (daily defined doses) at 3 months was equal [6.8 ± 2.7 (RDN) vs. 7.0 ± 2.5 (SHAM)].RDN performed at a single center and by a high-volume operator reduced ABPM to the same level as SHAM treatment and thus confirms the result of the HTN3 trial. Further, clinical use of RDN for treatment of resistant hypertension should await positive results from double-blinded, SHAM-controlled trials with multipolar ablation catheters or novel denervation techniques.

Retrograde type A dissection following hybrid supra-aortic endovascular surgery in high-risk patients unfit for conventional open repair.

Science.gov (United States)

Yip, Hon C; Chan, Yiu C; Qing, Kai X; Cheng, Stephen W

2018-04-01

Hybrid procedures with combined open extra-anatomical supra-aortic bypasses and endovascular surgery are less invasive for patients with complex aortic arch pathology. The aim of this paper is to report patients who developed retrograde type A aortic dissection following initially successful hybrid endovascular treatment. Retrospective review of prospectively collected computerized departmental database. All patients with supra-aortic hybrid endovascular surgery and post-procedure retrograde type A dissection were identified. Patient demographics, comorbid conditions, perioperative parameters, procedural details and post-operative complications were collected. From May 2005 to July 2014, 163 patients underwent thoracic aortic endovascular procedures at our institution. From the 46 patients who had supra-aortic hybrid endovascular repair, six patients (6/46, 13% of all supra-aortic hybrid cases, 3 males) developed retrograde type A aortic dissection. All were elective cases, with 3 chronic dissecting aneurysms and 3 atherosclerotic aneurysms. All had one-stage hybrid procedures: 2 patients had carotid-carotid bypass grafts, one had carotid-carotid-left subclavian bypass graft, and 3 had bypass grafts from ascending aorta to innominate artery and left carotid artery. Five patients had Cook Zenith thoracic stent-grafts (Cook Medical, Bloomington, IN, USA), and one had Medtronic Valiant stent-grafts (Medtronic Vascular Inc, Santa Rosa, CA, USA). The retrograde type A dissection occurred with sudden symptoms at day 5, 6, 10, 20, 105 and 128, respectively. There were 3 immediate fatalities and 2 patients treated conservatively deemed unfit for reintervention (one died of pneumonia at 9 months, and one remained alive at 7 months post-complication). One patient underwent successful emergency open surgery and survived. Supra-aortic hybrid procedures in treating aortic arch pathology may be at risk of developing retrograde type A dissection. This post-operative complication

In-wire measurement of the neutron dose rate on patients with 238Pu pacemakers implanted

International Nuclear Information System (INIS)

Piesch, E.; Burgkhardt, B.; Kollmeier, W.

1975-01-01

In-vivo measurements of the neutron dose on Medtronic pacemakers have been performed by using a proportional counter and a scintillation counter. The paper discusses the technique of free air and phantom calibration and the method of in-vivo measurement of the neutron fluence and the estimation of the dose equivalent. The neutron dose equivalent rate measured on seven patients with 238 Pu pacemakers implanted were found to be (5.6+-0.1) mRem/h at the surface of the pacemaker in 1.25 cm distance from the center of the source corresponding to a neutron emission rate of 940 ns -1 . The results are in good agreement with results of other methods reported by different authors. (Auth.)

Percutaneous valved stent repair of a failed homograft: implications for the Ross procedure.

Science.gov (United States)

Pretorius, Victor; Jones, Alan; Taylor, Dylan; Coe, Yashu; Ross, David B

2008-08-01

A case of percutaneous pulmonary valve implantation following a failed homograft in the pulmonary position is reported. A 16-year-old boy developed infective endocarditis of his pulmonary homograft, which was implanted four years earlier during a Ross procedure for congenital aortic stenosis. Following successful medical therapy, the boy was symptomatic due to pulmonary stenosis and regurgitation. A 22 mm Melody valve (Medtronic, USA) was successfully implanted percutaneously. His symptoms resolved and he was discharged home one day after the procedure. Echocardiography at the six-month follow-up demonstrated a normally functioning pulmonary valve. Percutaneous pulmonary valve replacement may make the Ross procedure a more attractive option for patients with aortic stenosis, particularly in the pediatric population.

[Safety and short-term efficacy of renal sympathetic denervation in the treatment of resistant hypertension].

Science.gov (United States)

Jiang, Xiong-jing; Liang, Tuo; Dong, Hui; Peng, Meng; Ma, Wen-jun; Guan, Ting; Zhang, Hui-min; Bian, Jin; Xu, Bo; Gao, Run-lin

2012-12-11

Transcatheter renal sympathetic denervation (RDN) is a novel technology/therapy in treating resistant hypertension. The present study aims to evaluate the safety and short-term efficacy of RDN for the treatment of resistant hypertension in a Chinese population. This prospective single-center pilot study was the first one conducted in China with Medtronic Ardian Symplicity Catheter System. Eight patients (6 males and 2 females) with resistant hypertension underwent RDN at our hospital from February to April 2012. All patients were followed up at one month and three months post-RDN. Blood pressure, use of antihypertensive medications, renal function and complications were recorded and analyzed. At one month and three months post-RDN, 24-hour ambulatory blood pressure monitoring showed mean systolic blood pressure and diastolic blood pressure decreased 10 (0 - 18) 13 (3 - 19) and 8 (-2 - 15), 9 (2 - 16) mm Hg throughout 24 hours respectively (P renal function (P > 0.05). No complications were observed. The preliminary results revealed that RDN was safe and effective for the treatment of resistant hypertension in the Chinese population during a 3-month follow-up. Further large and long-term studies are warranted.

The effect of therapeutic x-radiation on a sample of pacemaker generators

International Nuclear Information System (INIS)

Maxted, K.J.

1984-01-01

Tests were made on nineteen generators, comprising seventeen types from five manufacturers and including four programmable units, and x-ray energies of about 4 MeV. The bipolar generators suffered no measureable damage and radiotherapy patients using these would appear not to be exposed to any hazard. Nor were any of the generators using entirely CMOS circuitry, including the programmable types, affected. Generators using hybrid bipolar and CMOS circuitry were damaged by radiation exposure, the majority of these being Medtronic pacemakers. Transient recovery of function followed by total failure suggested that even a transient loss of function must be regarded as a precursor to permanent damage. This transient effect indicates that it is most likely the CMOS circuit element that is affected. (U.K.)

An industry update: the latest developments in Therapeutic delivery.

Science.gov (United States)

Steinbach, Oliver C

2018-05-01

The present industry update covers the period of 1 January-31 January 2018, with information sourced from company press releases, regulatory and patent agencies as well as scientific literature. Several public offerings (Gecko, Insmed), licensing (Foresee) and commercialization agreements (Alnylam, Collegium Pharmaceutical) as well as patent filings (Elute) continue to prove the sustained investments in the drug delivery market. In increasing numbers, more effective ways to deliver the active ingredient to the right location and the right dose through devices (Boehringer Ingelheim's Respimat, Medtronics' SynchroMedII) or improved compound properties through formulation (Aquestive Therapeutics' PharmFilm, Noven Pharmaceuticals' transdermal patch) are reaching the market. Furthering biologics and gene delivery (Avacta, Bracco) proves that novel drug delivery technologies are successfully addressing more challenging drug formats.

Glucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery System in Adolescents and Adults with Type 1 Diabetes

Science.gov (United States)

Weinzimer, Stuart A.; Tamborlane, William V.; Buckingham, Bruce A.; Bode, Bruce W.; Bailey, Timothy S.; Brazg, Ronald L.; Ilany, Jacob; Slover, Robert H.; Anderson, Stacey M.; Bergenstal, Richard M.; Grosman, Benyamin; Roy, Anirban; Cordero, Toni L.; Shin, John; Lee, Scott W.; Kaufman, Francine R.

2017-01-01

Abstract Background: The safety and effectiveness of the in-home use of a hybrid closed-loop (HCL) system that automatically increases, decreases, and suspends insulin delivery in response to continuous glucose monitoring were investigated. Methods: Adolescents (n = 30, ages 14–21 years) and adults (n = 94, ages 22–75 years) with type 1 diabetes participated in a multicenter (nine sites in the United States, one site in Israel) pivotal trial. The Medtronic MiniMed® 670G system was used during a 2-week run-in phase without HCL control, or Auto Mode, enabled (Manual Mode) and, thereafter, with Auto Mode enabled during a 3-month study phase. A supervised hotel stay (6 days/5 nights) that included a 24-h frequent blood sample testing with a reference measurement (i-STAT) occurred during the study phase. Results: Adolescents (mean ± standard deviation [SD] 16.5 ± 2.29 years of age and 7.7 ± 4.15 years of diabetes) used the system for a median 75.8% (interquartile range [IQR] 68.0%–88.4%) of the time (2977 patient-days). Adults (mean ± SD 44.6 ± 12.79 years of age and 26.4 ± 12.43 years of diabetes) used the system for a median 88.0% (IQR 77.6%–92.7%) of the time (9412 patient-days). From baseline run-in to the end of study phase, adolescent and adult HbA1c levels decreased from 7.7% ± 0.8% to 7.1% ± 0.6% (P Wilcoxon signed-rank test), respectively. The proportion of overall in-target (71–180 mg/dL) sensor glucose (SG) values increased from 60.4% ± 10.9% to 67.2% ± 8.2% (P < 0.001) in adolescents and from 68.8% ± 11.9% to 73.8% ± 8.4% (P < 0.001) in adults. During the hotel stay, the proportion of in-target i-STAT® blood glucose values was 67.4% ± 27.7% compared to SG values of 72.0% ± 11.6% for adolescents and 74.2% ± 17.5% compared to 76.9% ± 8.3% for adults. There were no severe hypoglycemic or diabetic ketoacidosis events in either cohort. Conclusions: HCL

Anesthetic Management and Complications of Percutaneous Aortic Valve Implantation

Directory of Open Access Journals (Sweden)

Tailur Alberto Grando

2013-05-01

Full Text Available Background and objective: Aortic stenosis is a highly prevalent and life-threatening disease. In elderly patients with comorbidities, percutaneous valve implantation is an option. The aim of the study was to describe the anesthetic management and complications of general anesthesia Method: Case series with 30-day and 24-month follow-ups after implantation of the CoreValve device performed at the Institute of Cardiology/University Foundation of Cardiology between December 2008 and January 2012. The patients underwent general anesthesia monitored with mean arterial pressure (PAM, electrocardiogram (ECG, pulse oximetry, capnography, transesophageal echocardiography, thermometry, and transvenous pacemaker. Results: Twenty-eight patients, mean age 82.46 years, 20.98% mean EuroSCORE, functional class III/IV, successfully underwent valve implantation. Nine patients required permanent pacemaker implantation. During follow-up, two patients died: one during surgery due to LV perforation and the other on the third day of unknown causes. At 24 months, one patient diagnosed with multiple myeloma died. This anesthetic technique proved to be safe. Conclusion: The initial experience with percutaneous aortic valve implantation under general anesthesia has proven to be safe and effective, with no significant anesthetic complications during this procedure. Keywords: Aesthesia, General, Cardiac Surgical Procedures, Aortic Valve Stenosis, Aged.

Chronic cortical and electromyographic recordings from a fully implantable device: preclinical experience in a nonhuman primate

Science.gov (United States)

Ryapolova-Webb, Elena; Afshar, Pedram; Stanslaski, Scott; Denison, Tim; de Hemptinne, Coralie; Bankiewicz, Krystof; Starr, Philip A.

2014-02-01

Objective. Analysis of intra- and perioperatively recorded cortical and basal ganglia local field potentials in human movement disorders has provided great insight into the pathophysiology of diseases such as Parkinson's, dystonia, and essential tremor. However, in order to better understand the network abnormalities and effects of chronic therapeutic stimulation in these disorders, long-term recording from a fully implantable data collection system is needed. Approach. A fully implantable investigational data collection system, the Activa® PC + S neurostimulator (Medtronic, Inc., Minneapolis, MN), has been developed for human use. Here, we tested its utility for extended intracranial recording in the motor system of a nonhuman primate. The system was attached to two quadripolar paddle arrays: one covering sensorimotor cortex, and one covering a proximal forelimb muscle, to study simultaneous cortical field potentials and electromyography during spontaneous transitions from rest to movement. Main results. Over 24 months of recording, movement-related changes in physiologically relevant frequency bands were readily detected, including beta and gamma signals at approximately 2.5 μV/\\sqrtHz and 0.7 μV/\\sqrt{Hz}, respectively. The system architecture allowed for flexible recording configurations and algorithm triggered data recording. In the course of physiological analyses, sensing artifacts were observed (˜1 μVrms stationary tones at fixed frequency), which were mitigated either with post-processing or algorithm design and did not impact the scientific conclusions. Histological examination revealed no underlying tissue damage; however, a fibrous capsule had developed around the paddles, demonstrating a potential mechanism for the observed signal amplitude reduction. Significance. This study establishes the usefulness of this system in measuring chronic brain and muscle signals. Use of this system may potentially be valuable in human trials of chronic brain

[POL-PAVTI--Polish report on transcatheter pulmonary artery valve implantation of Melody-Medtronic prosthesis in the first 14 patients in Poland].

Science.gov (United States)

Ruzyłło, Witold; Demkow, Marcin; Włodarska, Elzbieta K; Kowalski, Mirosław; Spiewak, Mateusz; Siudalska, Hanna; Wolski, Piotr; Miśko, Jolanta; Hoffman, Piotr; Kusa, Jacek; Szkutnik, Małgorzata; Białkowski, Jacek; Fiszer, Roland; Urbańska, Ewa; Sondergaard, Lars

2009-10-01

To assess the early results of the pulmonary artery valve transcatheter implantation (PAVTI) in pts included into POL-PAVTI registry. Detailed medical and economic analyses were performed. Pulmonary artery valve implantation was performed in 14 pts (9 men), aged 16-31 (mean 24.6 +/- 4.8) years, with pulmonary homograft dysfunction after total repair of tetralogy of Fallot (4 pts), pulmonary atresia (2 pts), pulmonary stenosis (1 pt), common arterial trunk type I (1 pt), Ross procedure (3 pts) and TGA - Rastelli operation (3 pts). Eleven pts underwent in the past 2-5 surgical or/and catheter interventions. Indication for PAVTI was based on clinical evaluation and echocardiographic studies. Assessment of morphological and functional features of the right ventricle (RV) and homograft with the use of cardiac magnetic resonance (CMR) was performed in 10 cases. Pulmonary stenosis (max. pulmonary gradient 32-119, mean 72 +/- 28 mmHg) was observed in 13 pts and/or significant pulmonary regurgitation in 10 pts. The procedure was performed in general anesthesia. The deployment of a valved stent in the pulmonary valve position was preceded by a metal stent implantation. Results were evaluated by echocardiography two days after the procedure and one month later. Four patients were evaluated 6 months after procedure. Time of the procedure varied 60-190 (mean 127 +/- 35) min, time of fluoroscopy ranged 12-31 (mean 21 +/- 11) min. PAVTI was successfully performed in all pts without serious complications. Patients were discharged from the hospital 48-293 (mean 120 +/- 71) h after procedure. Significant reduction of pulmonary gradient after the procedure assessed by echocardiography was observed on the second day (20-60, mean 38 +/- 12 mmHg, p < 0.0001) and one month (19-52, mean 34 +/- 9 mmHg, p < 0.0001). Mild pulmonary regurgitation was observed in 2 pts. In 5 pts evaluated 6 months after procedure haemodynamic parameters were unchanged; no late complications were observed. Average cost of the procedure including a price of the valve (82 000 PLN) was 98 000 PLN. Pulmonary artery valve transvascular implantation is an effective and safe method of non-surgical treatment for patients with homograft dysfunction. Cost-effectiveness is approvable.

Selective vibration sensing: a new concept for activity-sensing rate-responsive pacing.

Science.gov (United States)

Lau, C P; Stott, J R; Toff, W D; Zetlein, M B; Ward, D E; Camm, A J

1988-09-01

A clinically available model of an activity-sensing, rate-responsive pacemaker (Activitrax, Medtronic) utilizes body vibration during exercise as an indicator of the need for a rate increase. Although having the advantage of rapid onset of rate response, this system lacks specificity and the rate response does not closely correlate with the level of exertion. In addition, this pacemaker is susceptible to the effects of extraneous vibration. In this study involving 20 normal subjects fitted with an external Activitrax pacemaker, the rate responses to a variety of exercises were studied and were compared with the corresponding sinus rates. The vibration generated at the level of the pacemaker was also measured by accelerometers in three axes. Only a fair correlation (r = 0.51) was achieved between the pacemaker rate and the sinus rate. The total root mean square value of acceleration in either the anteroposterior or the vertical axes was found to have a better correlation (r = 0.8). As the main accelerations during physical activities were in the lower frequency range (0.1-4 Hz), a low-pass filter was used to reduce the influence of extraneous vibration. Selective sensing of the acceleration level may be usefully implemented in an algorithm for activity pacing.

Shielded battery syndrome: a new hardware complication of deep brain stimulation.

Science.gov (United States)

Chelvarajah, Ramesh; Lumsden, Daniel; Kaminska, Margaret; Samuel, Michael; Hulse, Natasha; Selway, Richard P; Lin, Jean-Pierre; Ashkan, Keyoumars

2012-01-01

Deep brain stimulation hardware is constantly advancing. The last few years have seen the introduction of rechargeable cell technology into the implanted pulse generator design, allowing for longer battery life and fewer replacement operations. The Medtronic® system requires an additional pocket adaptor when revising a non-rechargeable battery such as their Kinetra® to their rechargeable Activa® RC. This additional hardware item can, if it migrates superficially, become an impediment to the recharging of the battery and negate the intended technological advance. To report the emergence of the 'shielded battery syndrome', which has not been previously described. We reviewed our deep brain stimulation database to identify cases of recharging difficulties reported by patients with Activa RC implanted pulse generators. Two cases of shielded battery syndrome were identified. The first required surgery to reposition the adaptor to the deep aspect of the subcutaneous pocket. In the second case, it was possible to perform external manual manipulation to restore the adaptor to its original position deep to the battery. We describe strategies to minimise the occurrence of the shielded battery syndrome and advise vigilance in all patients who experience difficulty with recharging after replacement surgery of this type for the implanted pulse generator. Copyright © 2012 S. Karger AG, Basel.

Mechanisms of mechanical heart valve cavitation: investigation using a tilting disk valve model.

Science.gov (United States)

He, Z; Xi, B; Zhu, K; Hwang, N H

2001-09-01

The induction of mechanical heart valve (MHV) cavitation was investigated using a 27 mm Medtronic Hall (MH27) tilting disk valve. The MH27 valve was mounted in the mitral position of a simulating pulse flow system, and stroboscopic lighting used to visualize cavitation bubbles on the occluder inflow surface at the instant of valve closure. MHV cavitation was monitored using a digital camera with 0.04 mm/pixel resolution sufficient to render the tiny bubbles clearly visible on the computer monitor screen. Cavitation on MH27 valve was classified as five types according to the time, site and shape of the cavitation bubbles. Valve cavitation occurred at the instant of occluder impact with the valve seat at closing. The impact motion was subdivided into three temporal phases: (i) squeezing flow; (ii) elastic collision; and (iii) leaflet rebound. MHV cavitation caused by vortices was found to be initiated by the squeezing jet and/or by the transvalvular leakage jets. By using a tension wave which swept across the occluder surface immediately upon elastic impact, nuclei in the vortex core were expanded to form cavitation bubbles. Analysis of the shape and location of the cavitation bubbles permitted a better understanding of MHV cavitation mechanisms, based on the fluid dynamics of jet vortex and tension wave propagations.

An Ensemble Nonlinear Model Predictive Control Algorithm in an Artificial Pancreas for People with Type 1 Diabetes

DEFF Research Database (Denmark)

Boiroux, Dimitri; Hagdrup, Morten; Mahmoudi, Zeinab

2016-01-01

patients with different physiological parameters and a time-varying insulin sensitivity using the Medtronic Virtual Patient (MVP) model. We augment the MVP model with stochastic diffusion terms, time-varying insulin sensitivity and noise-corrupted CGM measurements. We consider meal challenges where......This paper presents a novel ensemble nonlinear model predictive control (NMPC) algorithm for glucose regulation in type 1 diabetes. In this approach, we consider a number of scenarios describing different uncertainties, for instance meals or metabolic variations. We simulate a population of 9...... the uncertainty in meal size is ±50%. Numerical results show that the ensemble NMPC reduces the risk of hypoglycemia compared to standard NMPC in the case where the meal size is overestimated or correctly estimated at the expense of a slightly increased number of hyperglycemia. Therefore, ensemble MPC...

Preoperative DTI and probabilistic tractography in an amputee with deep brain stimulation for lower limb stump pain.

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Owen, S L F; Heath, J; Kringelbach, M L; Stein, J F; Aziz, T Z

2007-10-01

This study aimed to find out whether preoperative diffusion tensor imaging (DTI) and probabilistic tractography could help with surgical planning for deep brain stimulation in the periaqueductal/periventricular grey area (PAG/PVG) in a patient with lower leg stump pain. A preoperative DTI was obtained from the patient, who then received DBS surgery in the PAG/PVG area with good pain relief. The postoperative MRI scan showing electrode placement was used to calculate four seed areas to represent the contacts on the Medtronic 3387 electrode. Probabilistic tractography was then performed from the pre-operative DTI image. Tracts were seen to connect to many areas within the pain network from the four different contacts. These initial findings suggest that preoperative DTI scanning and probabilistic tractography may be able to assist surgical planning in the future.

Cryoballoon Ablation for Atrial Fibrillation

Directory of Open Access Journals (Sweden)

Jason G. Andrade, MD

2012-03-01

Full Text Available Focal point-by-point radiofrequency catheter ablation has shown considerable success in the treatment of paroxysmal atrial fibrillation. However, it is not without limitations. Recent clinical and preclinical studies have demonstrated that cryothermal ablation using a balloon catheter (Artic Front©, Medtronic CryoCath LP provides an effective alternative strategy to treating atrial fibrillation. The objective of this article is to review efficacy and safety data surrounding cryoballoon ablation for paroxysmal and persistent atrial fibrillation. In addition, a practical step-by-step approach to cryoballoon ablation is presented, while highlighting relevant literature regarding: 1 the rationale for adjunctive imaging, 2 selection of an appropriate cryoballoon size, 3 predictors of efficacy, 4 advanced trouble-shooting techniques, and 5 strategies to reduce procedural complications, such as phrenic nerve palsy.

P16.17 Usefulness of neuronavigator-guided fence-post method for malignant glioma resection

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Murase, S.; Yamashita, K.

2017-01-01

Abstract For the resection of malignant glioma, it is necessary to remove the tumor as much as possible and to avoid the expression of new neurological deficit. For this purpose, we adopted neuronavigator-guided fence-post method for malignant glioma resection in 2015. In this presentation, we will introduce this method and evaluate the usefulness of this method. Method:On one or two day before the surgery, fence-post plan is laid according to the MR images on neuronavigator system(StealthStation S7, Medtronic). Usually four fence-post are planned to involve all part of enhanced lesion of the tumor. If the tumor is located close to the pyramidal tracts, MR tractography image is also integrated in the navigator system, and fence-post are planned to avoid damaging the pyramidal tracts. During the surgery, after the craniotomy each fence-post catheter is placed according to the navigator guidance before the dural incision to avoid the influence of brain shift. After the dural incision, four planes created by adjacent each fence-post catheter are resected and the tumor is removed. Result: We will present typical three cases. Two cases of glioblastoma and one case of anaplastic oligodendroglioma case are presented. In all three cases, the tumor were located in the left frontal lobe and the tumor were gross totally removed without new neurological deficit with this method. CONCLUSION: Neuronavigator-guided fence-post method is very useful for the resection of malignant glioma.

The impact of fMRI on multimodal navigation in surgery of cerebral lesions: four years clinical experience

International Nuclear Information System (INIS)

Wurm, Gabriele; Schnizer, Mathilde; Fellner, Claudia

2008-01-01

Neuronavigation with display of intraoperative structures, instrument locations, orientation and relationships to nearby structures can increase anatomic precision while enhancing the surgeon's confidence and his/her perception of safety. Combination of neuronavigation with functional imaging provides multimodal guidance for surgery of cerebral lesions. We evaluated the impact of functional MRI (fMRI) on surgical decision making and outcome. A neuronavigational device (StealthStation (tm), Medtronic Inc.) was used as platform to merge fMRI data with anatomic images, and to implement intraoperative multimodal guidance. In a 52-month period, where 977 surgical procedures were performed with the aid of neuronavigation, 88 patients underwent image-guided procedures using multimodal guidance. Patient, surgical and outcome data of this series was prospectively collected. Evaluation of 88 procedures on cerebral lesions in complex regions where fMRI data were integrated using the navigation system demonstrated that the additional information was presented in a user-friendly way. Computer assisted fMRI integration was found to be especially helpful in planning the best approach, in assessing alternative approaches, and in defining the extent of the surgical exposure. Furthermore, the surgeons found it more effective to interpret fMRI information when shown in a navigation system as compared to the traditional display on a light board or monitor. Multimodal navigation enhanced by fMRI was judged useful for optimization of surgery of cerebral lesions, especially in and around eloquent regions by experienced neurosurgeons. (orig.)

Impact of operator experience and training strategy on procedural outcomes with leadless pacing: Insights from the Micra Transcatheter Pacing Study.

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El-Chami, Mikhael; Kowal, Robert C; Soejima, Kyoko; Ritter, Philippe; Duray, Gabor Z; Neuzil, Petr; Mont, Lluis; Kypta, Alexander; Sagi, Venkata; Hudnall, John Harrison; Stromberg, Kurt; Reynolds, Dwight

2017-07-01

Leadless pacemaker systems have been designed to avoid the need for a pocket and transvenous lead. However, delivery of this therapy requires a new catheter-based procedure. This study evaluates the role of operator experience and different training strategies on procedural outcomes. A total of 726 patients underwent implant attempt with the Micra transcatheter pacing system (TPS; Medtronic, Minneapolis, MN, USA) by 94 operators trained in a teaching laboratory using a simulator, cadaver, and large animal models (lab training) or locally at the hospital with simulator/demo model and proctorship (hospital training). Procedure success, procedure duration, fluoroscopy time, and safety outcomes were compared between training methods and experience (implant case number). The Micra TPS procedure was successful in 99.2% of attempts and did not differ between the 55 operators trained in the lab setting and the 39 operators trained locally at the hospital (P = 0.189). Implant case number was also not a determinant of procedural success (P = 0.456). Each operator performed between one and 55 procedures. Procedure time and fluoroscopy duration decreased by 2.0% (P = 0.002) and 3.2% (P safety outcomes by training method. Among a large group of operators, implantation success was high regardless of experience. While procedure duration and fluoroscopy times decreased with implant number, complications were low and not associated with case number. Procedure and safety outcomes were similar between distinct training methodologies. © 2017 Wiley Periodicals, Inc.

Intraoperative coronary grafts flow measurement using the TTFM flowmeter: results from a domestic sample.

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Succi, José Ernesto; Gerola, Luis Roberto; Succi, Guilherme de Menezes; Kim, Hyong Chun; Paredes, Jorge Edwin Morocho; Bufollo, Enio

2012-01-01

To evaluate intraoperative graft patency and identify grafts under risk of early occlusion. Fifty four patients were submitted to coronary artery bypass surgery and the graft flow was assessed by the Flowmeter (Medtronic Medistim), which utilizes the TTFM method. Three patients had left main disease and 48 had normal or mildly reduced left ventricular function. In hospital mortality was 3.7% (two patients), one for mesenteric thrombosis and one due to cardiogenic chock. Seventeen patients (34%) were submitted to off pump CABG. Arterial Graft flow measures ranged from 8 to 106 ml/min (average 31.14 ml/min), and venous grafts flow ranged from 9 to 149 ml/min (average 50.42 ml/min). Flowmeter use represents higher safety both for patients and surgeons. Even under legal aspects, the documentation provided by the device can avoid future questionings.

Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure

DEFF Research Database (Denmark)

Køber, Lars; Thune, Jens J; Nielsen, Jens C

2016-01-01

Background The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due...... to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT). Methods In a randomized, controlled trial, 556 patients with symptomatic systolic heart.......6%) in the control group (P=0.29). Conclusions In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic...

Accuracy evaluation of a new real-time continuous glucose monitoring algorithm in hypoglycemia

DEFF Research Database (Denmark)

Mahmoudi, Zeinab; Jensen, Morten Hasselstrøm; Johansen, Mette Dencker

2014-01-01

UNLABELLED: Abstract Background: The purpose of this study was to evaluate the performance of a new continuous glucose monitoring (CGM) calibration algorithm and to compare it with the Guardian(®) REAL-Time (RT) (Medtronic Diabetes, Northridge, CA) calibration algorithm in hypoglycemia. SUBJECTS...... AND METHODS: CGM data were obtained from 10 type 1 diabetes patients undergoing insulin-induced hypoglycemia. Data were obtained in two separate sessions using the Guardian RT CGM device. Data from the same CGM sensor were calibrated by two different algorithms: the Guardian RT algorithm and a new calibration...... algorithm. The accuracy of the two algorithms was compared using four performance metrics. RESULTS: The median (mean) of absolute relative deviation in the whole range of plasma glucose was 20.2% (32.1%) for the Guardian RT calibration and 17.4% (25.9%) for the new calibration algorithm. The mean (SD...

The changes of the frequency specific impedance of the human body due to the resonance in the kHz range in cancer diagnostics

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Michalak, K. P.; Nawrocka-Bogusz, H.

2011-12-01

The frequency-specific absorption of kHz signals has been postulated for different tissues, trace elements, vitamins, toxins, pathogens, allergens etc. for low-power (μV) signals. An increase in the impedance of the human body is observed only up to the given power of the applied signal. The highest amplification of the given signal being damped by the body makes it possible to determine the intensity of the given process in the body (e.g. amount of the toxin, trace element, intensity of the allergy) being connected with a given frequency spectrum of the signal. The mechanism of frequency-specific absorption can be explained by means of the Quantum Field Theory being applied to the structure of the water. Substantially high coincidence between the frequencies of the rotation of free quasi-excited electrons in coherent domains of water and the frequencies being used in the MORA diagnostics (Med-Tronic GmbH, EN ISO 13485, EN ISO 9001) can be observed. These frequencies are located in the proximity of f = 7kHz · i (i = 1,3,5,7,...). This fact suggests that the coherent domains with the admixtures of the given substances create structure-specific coherent domains that possess frequency-specific absorption spectra. The diagnostic tool called "MORA System diagnosis" was used to investigate 102 patients with different types and stages of cancer. Many signals were observed to be absorbed by many cancer patients, e.g.: 'Cellular defense system', 'Degeneration tendencies', Manganese, Magnesium, Zinc, Selenium, Vitamin E, Glutamine, Glutathione, Cysteine, Candida albicans, Mycosis. The results confirm the role of oxidative stress, immunological system deficiency and mitochondria malfunction in the development of cancer.

Interference of apex locator, pulp tester and diathermy on pacemaker function.

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Sriman, Narayanan; Prabhakar, V; Bhuvaneswaran, J S; Subha, N

2015-01-01

The purpose of this study was to evaluate the effects of three electronic apex locators (EAL), electric pulp tester (EPT) and diathermy on pacemaker function in vitro. Three EALs: Root ZX (J. Morita Co., Tustin, CA, U.S.A.), Propex (Dentsply), Mini Apex locator (SybronEndo, Anaheim, CA, USA), EPT (Parkell pulp vitality tester Farmingdale, NY, USA) and Diathermy (Neomed 250 B) were tested for any interference with one pacemaker (A medtronic kappa KVDD901-serial number: PLE734632S). Directly connecting the pacemaker lead with the EAL/EPT/diathermy operating on a flat bench top, the telemetry wand was held directly over the pacemaker to monitor the pacing pattern for a period of 30 s. Pacemaker activity was continuously recorded on the telemetric programmer and electro gram (EGM) readings examined for pacer inhibition, noise reversion or inappropriate pacemaker pulses. All the three apex locators showed no pacing interference or background noise during its function or at rest. The EGM readings of EPT showed varying levels of background noise in between pacing however, this did not affect the normal pacing pattern and the pacing interval remained constant. EGM readings of diathermy showed an increase in the pacing interval (irregular pacing pattern) followed by complete inhibition of the pacing system. The tested EALs do not interfere with cardiac pacemaker function. The tested EPT showed varying levels of background noise but does not interfere with cardiac pacemaker function. Use of Diathermy interfered with the normal pacing, leading to complete inhibition of the pacing system.

Magnetic resonance imaging-guided focused laser interstitial thermal therapy for subinsular metastatic adenocarcinoma: technical case report.

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Hawasli, Ammar H; Ray, Wilson Z; Murphy, Rory K J; Dacey, Ralph G; Leuthardt, Eric C

2012-06-01

To describe the novel use of the AutoLITT System (Monteris Medical, Winnipeg, Manitoba, Canada) for focused laser interstitial thermal therapy (LITT) with intraoperative magnetic resonance imaging (MRI) and stereotactic image guidance for the treatment of metastatic adenocarcinoma in the left insula. The patient was a 61-year-old right-handed man with a history of metastatic adenocarcinoma of the colon. He had previously undergone resection of multiple lesions, Gamma Knife radiosurgery, and whole-brain radiation. Despite treatment of a left insular tumor, serial imaging revealed that the lesion continued to enlarge. Given the refractory nature of this tumor to radiation and the deep-seated location, the patient elected to undergo LITT treatment. The center of the lesion and entry point on the scalp were identified with STEALTH (Medtronic, Memphis, Tennessee) image-guided navigation. The AXiiiS Stereotactic Miniframe (Monteris Medical) for the LITT system was secured onto the skull, and a trajectory was defined to achieve access to the centroid of the tumor. After a burr hole was made, a gadolinium template probe was inserted into the AXiiiS base. The trajectory was confirmed via an intraoperative MRI, and the LITT probe driver was attached to the base and CO2-cooled, side-firing laser LITT probe. The laser was activated and thermometry images were obtained. Two trajectories, posteromedial and anterolateral, produced satisfactory tumor ablation. LITT with intraoperative MRI and stereotactic image guidance is a newly available, minimally invasive, and therapeutically viable technique for the treatment of deep seated brain tumors.

Measurements of RF Heating during 3.0T MRI of a Pig Implanted with Deep Brain Stimulator

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Gorny, Krzysztof R; Presti, Michael F; Goerss, Stephan J; Hwang, Sun C; Jang, Dong-Pyo; Kim, Inyong; Shu, Yunhong; Favazza, Christopher P; Lee, Kendall H; Bernstein, Matt A

2012-01-01

Purpose To present preliminary, in vivo temperature measurements during MRI of a pig implanted with a deep brain stimulation (DBS) system. Materials and Methods DBS system (Medtronic Inc., Minneapolis, MN) was implanted in the brain of an anesthetized pig. 3.0T MRI was performed with a T/R head coil using the low-SAR GRE EPI and IR-prepped GRE sequences (SAR: 0.42 W/kg and 0.39 W/kg, respectively), and the high-SAR 4-echo RF spin echo (SAR: 2.9 W/kg). Fluoroptic thermometry was used to directly measure RF-related heating at the DBS electrodes, and at the implantable pulse generator (IPG). For reference the measurements were repeated in the same pig at 1.5T and, at both field strengths, in a phantom. Results At 3.0T, the maximal temperature elevations at DBS electrodes were 0.46 °C and 2.3 °C, for the low- and high-SAR sequences, respectively. No heating was observed on the implanted IPG during any of the measurements. Measurements of in-vivo heating differed from those obtained in the phantom. Conclusion The 3.0T MRI using GRE EPI and IR-prepped GRE sequences resulted in local temperature elevations at DBS electrodes of no more than 0.46°C. Although no extrapolation should be made to human exams and much further study will be needed, these preliminary data are encouraging for the future use 3.0T MRI in patients with DBS. PMID:23228310

Measurements of RF heating during 3.0-T MRI of a pig implanted with deep brain stimulator.

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Gorny, Krzysztof R; Presti, Michael F; Goerss, Stephan J; Hwang, Sun C; Jang, Dong-Pyo; Kim, Inyong; Min, Hoon-Ki; Shu, Yunhong; Favazza, Christopher P; Lee, Kendall H; Bernstein, Matt A

2013-06-01

To present preliminary, in vivo temperature measurements during MRI of a pig implanted with a deep brain stimulation (DBS) system. DBS system (Medtronic Inc., Minneapolis, MN) was implanted in the brain of an anesthetized pig. 3.0-T MRI was performed with a T/R head coil using the low-SAR GRE EPI and IR-prepped GRE sequences (SAR: 0.42 and 0.39 W/kg, respectively), and the high-SAR 4-echo RF spin echo (SAR: 2.9 W/kg). Fluoroptic thermometry was used to directly measure RF-related heating at the DBS electrodes, and at the implantable pulse generator (IPG). For reference the measurements were repeated in the same pig at 1.5 T and, at both field strengths, in a phantom. At 3.0T, the maximal temperature elevations at DBS electrodes were 0.46 °C and 2.3 °C, for the low- and high-SAR sequences, respectively. No heating was observed on the implanted IPG during any of the measurements. Measurements of in vivo heating differed from those obtained in the phantom. The 3.0-T MRI using GRE EPI and IR-prepped GRE sequences resulted in local temperature elevations at DBS electrodes of no more than 0.46 °C. Although no extrapolation should be made to human exams and much further study will be needed, these preliminary data are encouraging for the future use 3.0-T MRI in patients with DBS. Copyright © 2013 Elsevier Inc. All rights reserved.

Single-side renal sympathetic denervation to treat malignant refractory hypertension in a solitary kidney patient.

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Ribichini, Flavio; Ferrara, Angela; Pighi, Michele; Pesarini, Gabriele; Gambaro, Alessia; Valvo, Enrico; Lupo, Antonio; Vassanelli, Corrado

2014-12-01

Renal sympathetic denervation (RSD) is emerging as a new therapeutic option for patients with severe hypertension refractory to medical therapy. Patients affected by renovascular or anatomical abnormalities have hitherto been systematically excluded from clinical trials with RSD because of concern about safety and the unknown efficacy of the procedure in this subgroup of patients. We describe the management of a case of RSD in a single-kidney patient with refractory hypertension; the patient had had a previous surgical right nephrectomy for renal cell carcinoma that subsequently required no other oncologic treatment. After multidisciplinary assessment, the patient underwent RSD. The procedure was performed through a 6F femoral access using the Symplicity™ RSD system (Medtronic, Mountain View, CA, USA). Radiofrequency was applied to the renal artery wall in 6 different points under general sedation with midazolam to control back pain caused by the procedure, that was performed without periprocedural complications. The patient was discharged 2 days later after a control of the vascular access site and routine biochemical examinations. The following 9-month follow up showed a significant reduction in blood pressure and stable renal function, without signs of renal damage. Our report confirms the feasibility of RSD in this delicate context, without evident negative effects on kidney function and with a significant reduction in blood pressure. Future studies are needed to fully clarify the value of RSD in single-kidney patients.

Microendoscopic excision of C2 osteoid osteoma: a technical report.

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Kulkarni, Arvind G; Dhruv, Abhilash N; Bassi, Anupreet J

2013-09-01

Case report and description of technique. To describe a microendoscopic posterior approach for excision of an osteoid osteoma of C2. Microendoscopic techniques are widely used in the management of degenerative disorders of the spine. This is the first report of their use in the management of an osteoid osteoma via the posterior approach. A 12-year-old-boy presented with left-sided neck pain of 3-month duration. Investigations revealed an osteoid osteoma of C2 lamina-lateral mass complex. The patient underwent a posterior microendoscopic excision using 18-mm diameter METRx system (Medtronic Sofamor Danek, Memphis, TN) of tubular retractors. A postoperative computed tomographic scan was done and preoperative and postoperative visual analogue scale and Neck Disability Index were evaluated. The patient was periodically followed up for 1 year. The postoperative computed tomographic scan revealed complete excision of the tumor. The visual analogue scale score for neck pain improved from 3/5 (preoperative) to 0/5 (postoperative) and Neck Disability Index from 33.33 (preoperative) to 0 (postoperative) at 1-year follow-up. Microendoscopic techniques can be extended to excise lesions of the spine. It is a safe procedure in experienced hands. The advantages are minimal morbidity, minimal postoperative pain and discomfort, less analgesic dependence, and better cosmesis. The authors recommend this technique for accessible lesions involving the spine.

Editor's Choice - Late Open Surgical Conversion after Endovascular Abdominal Aortic Aneurysm Repair.

Science.gov (United States)

Kansal, Vinay; Nagpal, Sudhir; Jetty, Prasad

2018-02-01

Late open surgical conversion following endovascular aneurysm repair (EVAR) may occur more frequently after performing EVAR in anatomy outside the instructions for use (IFU). This study reviews predictors and outcomes of late open surgical conversion for failed EVAR. This retrospective cohort study reviewed all EVARs performed at the Ottawa Hospital between January 1999 and May 2015. Open surgical conversions >1 month post EVAR were identified. Variables analysed included indication for conversion, pre-intervention AAA anatomy, endovascular device and configuration, operative technique, re-interventions, complications, and death. Of 1060 consecutive EVARs performed, 16 required late open surgical conversion. Endografts implanted were Medtronic Talent (n = 8, 50.0%), Medtronic Endurant (n = 3, 18.8%), Cook Zenith (n = 4, 25.0%), and Terumo Anaconda (n = 1, 6.2%). Eleven grafts were bifurcated (68.8%), five were aorto-uni-iliac (31.2%). The median time to open surgical conversion was 3.1 (IQR 1.0-5.2) years. There was no significant difference in pre-EVAR rupture status (1.4% elective, 2.1% ruptured, p = .54). Indications for conversion included: Type 1 endoleak with sac expansion (n = 4, 25.0%), Type 2 endoleak with expansion (n = 2, 12.5%), migration (n = 3, 18.8%), sac expansion without endoleak (n = 2, 12.5%), graft infection (n = 3, 18.8%), rupture (n = 2, 12.5%). Nine patients (56.2%) underwent stent graft explantation with in situ surgical graft reconstruction, seven had endograft preserving open surgical intervention. The 30 day mortality was 18.8% (n = 3, all of whom having had endograft preservation). Ten patients (62.5%) suffered major in hospital complications. One patient (6.5%) required post-conversion major surgical re-intervention. IFU adherence during initial EVAR was 43.8%, versus 79.0% (p Open surgical conversion following EVAR results in significant morbidity and mortality. IFU adherence of EVARs later requiring open surgical

Medida do fluxo intraoperatório com fluxômetro TTFM nos enxertos coronários: resultados de amostra nacional Intraoperative coronary grafts flow measurement using the TTFM flowmeter: results from a domestic sample

Directory of Open Access Journals (Sweden)

José Ernesto Succi

2012-09-01

Full Text Available OBJETIVO: Avaliar a perviedade dos enxertos no intraoperatório e identificar enxertos com risco de oclusão precoce. MÉTODOS: Cinquenta e quatro pacientes foram submetidos à revascularização do miocárdio e foi utilizado o fluxômetro (Medtronic Medi-Stim que utiliza o método de tempo de trânsito (TTFM para avaliação do fluxo nos enxertos. Três pacientes tinham lesão de tronco de artéria coronária esquerda e 48 apresentavam função ventricular normal ou pouco comprometida. RESULTADOS: A mortalidade hospitalar foi de dois (3,7% pacientes, um por trombose mesentérica e outro por choque cardiogênico. Dezessete (31,4% pacientes foram operados sem circulação extracorpórea (CEC. O fluxo no enxerto arterial variou de 8 a 106 ml/min, com média de 31,14 ml/min, e nos enxertos venosos de 9 a 149 ml/min, com média de 50,42 ml/min. CONCLUSÃO: O fluxômetro representa maior segurança para o cirurgião e para o paciente. Até mesmo sob o aspecto legal essa documentação dos enxertos pérvios evitará questionamentos futuros.OBJECTIVE: To evaluate intraoperative graft patency and identify grafts under risk of early occlusion. METHODS: Fifty four patients were submitted to coronary artery bypass surgery and the graft flow was assessed by the Flowmeter (Medtronic Medistim, which utilizes the TTFM method. Three patients had left main disease and 48 had normal or mildly reduced left ventricular function. RESULTS: In hospital mortality was 3.7% (two patients, one for mesenteric thrombosis and one due to cardiogenic chock. Seventeen patients (34% were submitted to off pump CABG. Arterial Graft flow measures ranged from 8 to 106 ml/min (average 31.14 ml/min, and venous grafts flow ranged from 9 to 149 ml/min (average 50.42 ml/min. CONCLUSION: Flowmeter use represents higher safety both for patients and surgeons. Even under legal aspects, the documentation provided by the device can avoid future questionings.

Evaluating the clinical accuracy of two continuous glucose sensors using continuous glucose-error grid analysis.

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Clarke, William L; Anderson, Stacey; Farhy, Leon; Breton, Marc; Gonder-Frederick, Linda; Cox, Daniel; Kovatchev, Boris

2005-10-01

To compare the clinical accuracy of two different continuous glucose sensors (CGS) during euglycemia and hypoglycemia using continuous glucose-error grid analysis (CG-EGA). FreeStyle Navigator (Abbott Laboratories, Alameda, CA) and MiniMed CGMS (Medtronic, Northridge, CA) CGSs were applied to the abdomens of 16 type 1 diabetic subjects (age 42 +/- 3 years) 12 h before the initiation of the study. Each system was calibrated according to the manufacturer's recommendations. Each subject underwent a hyperinsulinemic-euglycemic clamp (blood glucose goal 110 mg/dl) for 70-210 min followed by a 1-mg.dl(-1).min(-1) controlled reduction in blood glucose toward a nadir of 40 mg/dl. Arterialized blood glucose was determined every 5 min using a Beckman Glucose Analyzer (Fullerton, CA). CGS glucose recordings were matched to the reference blood glucose with 30-s precision, and rates of glucose change were calculated for 5-min intervals. CG-EGA was used to quantify the clinical accuracy of both systems by estimating combined point and rate accuracy of each system in the euglycemic (70-180 mg/dl) and hypoglycemic (<70 mg/dl) ranges. A total of 1,104 data pairs were recorded in the euglycemic range and 250 data pairs in the hypoglycemic range. Overall correlation between CGS and reference glucose was similar for both systems (Navigator, r = 0.84; CGMS, r = 0.79, NS). During euglycemia, both CGS systems had similar clinical accuracy (Navigator zones A + B, 88.8%; CGMS zones A + B, 89.3%, NS). However, during hypoglycemia, the Navigator was significantly more clinically accurate than the CGMS (zones A + B = 82.4 vs. 61.6%, Navigator and CGMS, respectively, P < 0.0005). CG-EGA is a helpful tool for evaluating and comparing the clinical accuracy of CGS systems in different blood glucose ranges. CG-EGA provides accuracy details beyond other methods of evaluation, including correlational analysis and the original EGA.

Big data in wildlife research: remote web-based monitoring of hibernating black bears.

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Laske, Timothy G; Garshelis, David L; Iaizzo, Paul A

2014-12-11

Numerous innovations for the management and collection of "big data" have arisen in the field of medicine, including implantable computers and sensors, wireless data transmission, and web-based repositories for collecting and organizing information. Recently, human clinical devices have been deployed in captive and free-ranging wildlife to aid in the characterization of both normal physiology and the interaction of animals with their environment, including reactions to humans. Although these devices have had a significant impact on the types and quantities of information that can be collected, their utility has been limited by internal memory capacities, the efforts required to extract and analyze information, and by the necessity to handle the animals in order to retrieve stored data. We surgically implanted miniaturized cardiac monitors (1.2 cc, Reveal LINQ™, Medtronic Inc.), a newly developed human clinical system, into hibernating wild American black bears (N = 6). These devices include wireless capabilities, which enabled frequent transmissions of detailed physiological data from bears in their remote den sites to a web-based data storage and management system. Solar and battery powered telemetry stations transmitted detailed physiological data over the cellular network during the winter months. The system provided the transfer of large quantities of data in near-real time. Observations included changes in heart rhythms associated with birthing and caring for cubs, and in all bears, long periods without heart beats (up to 16 seconds) occurred during each respiratory cycle. For the first time, detailed physiological data were successfully transferred from an animal in the wild to a web-based data collection and management system, overcoming previous limitations on the quantities of data that could be transferred. The system provides an opportunity to detect unusual events as they are occurring, enabling investigation of the animal and site shortly

THE PROGNOSIS IN TRANSCATHETER AORTIC VALVE IMPLANTATION

Directory of Open Access Journals (Sweden)

T. E. Imaev

2016-01-01

Full Text Available Aim. To study the effect of transcatheter aortic valve implantation (TAVI, performed by different types of prostheses and various surgical access, on the prognosis of patients with critical aortic stenosis and comorbidities.Material and methods. Patients (n=130 that had consistently performed 80 TAVI by Edwards valve transfemoral (n=50 and transapical (n=30 access, as well as 50 transcatheter aortic valve replacement by CoreValve system were included into the study. Complications including perioperative mortality, total 30-day mortality, as well as post-hospital mortality were registered during aortic valve replacement, immediately after surgery, before the expiry of 30 days. Mean follow-up was 2.2 years (range 0.2 to 5.2 years.Results. Hospital mortality was on average 6.9%. 121 patients had been discharged from the department after the surgery. The number of deaths in the post-hospital period was 14.8%. Valve type and the type of access had no effect on post-hospital mortality. Men died more than 2.5 times often than women, regardless of age. Atrioventricular block, pacemaker implantation, and history of chronic obstructive pulmonary disease were the most significant prognostic factors. An important role of minor stroke and renal failure should be noted. Mortality did not depend on the surgical access or valve type. All parameters characterizing the intervention were significantly associated with mortality, both during and after surgery. The proportion of survivors at the end of the first year of observation using Corvalve system was 86.9%, Edwards valve by transfemoral access - 88% and Edwards valve by transapical access – 85.4% (insignificant differences for all groups, p>0.05. Two-year survival was 77.5%, 82.5% and 82.7%, respectively (also insignificant differences for all groups, p>0.05.Conclusion. TAVI is the method of choice, reasonable alternative approach for surgical valve replacement in patients with high surgical risk, although

Transcatheter aortic-valve implantation with one single minimal contrast media injection.

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Arrigo, Mattia; Maisano, Francesco; Haueis, Sabine; Binder, Ronald K; Taramasso, Maurizio; Nietlispach, Fabian

2015-06-01

Performing transcatheter aortic valve implantation (TAVI) with the use of minimal contrast in patients at high-risk for acute kidney injury (AKI). Contrast-induced nephropathy (CIN) is a major cause of AKI following TAVI and is associated with increased morbidity and mortality. The amount of contrast media used increases the risk for CIN. Computed tomography was omitted during the screening process. For the procedure transfemoral access was default. The self-expanding CoreValve prosthesis was chosen in all patients to minimize the risk of annular rupture in case of oversizing. Valve sizing was based on echocardiography, aortography, calcification on fluoroscopy, as well as weight and height of the patient. A single contrast injection was performed to confirm correct position of the pigtail catheter at the level of the annulus. The pigtail then served as the marker for the device landing zone. Intraprocedural assessment of the implantation result relied on echocardiography and hemodynamics. Five patients with severe aortic stenosis and at high risk for developing CIN were included. Device success was achieved in all patients and no major complications occurred. The median dose of injected contrast media was 8 ml (4-9). All but one patient had improved renal function after the intervention compared to baseline. Our study shows feasibility of performing TAVI with a single minimal contrast media injection, using a self-expandable valve. This technique has the potential to reduce the incidence of CIN. © 2015 Wiley Periodicals, Inc.

Analysis of implantable defibrillator longevity under clinical circumstances: implications for device selection.

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Knops, Paul; Theuns, Dominic A M J; Res, Jan C J; Jordaens, Luc

2009-10-01

Information about implantable cardioverter-defibrillator (ICD) longevity is mostly calculated from measurements under ideal laboratory conditions. However, little information about longevity under clinical circumstances is available. This survey gives an overview on ICD service times and generator replacements in a cohort of consecutive ICD patients. Indications for replacement were classified as a normal end-of-service (EOS), premature EOS, system malfunction, infection and device advisory, or recall actions. From the premature and normal EOS group, longevity from single-chamber (SC), dual-chamber (DC), and cardiac resynchronization therapy defibrillator (CRT-D), rate-responsive (RR) settings, high output (HO) stimulation, and indication for ICD therapy was compared. Differences between brands were compared as well. In a total of 854 patients, 203 ICD replacements (165 patients) were recorded. Premature and normal EOS replacements consisted of 32 SC, 98 DC and 24 CRT-D systems. Longevity was significantly longer in SC systems compared to DC and CRT-D systems (54 +/- 19 vs. 40 +/- 17 and 42 +/- 15 months; P = 0.008). Longevity between non-RR (n = 143) and RR (n = 11) settings was not significantly different (43 +/- 18 vs. 45 +/- 13 months) as it also was not for HO versus non-HO stimulation (43 +/- 19 vs. 46 +/- 17 months). Longevity of ICDs was not significantly different between primary and secondary prevention (42 +/- 19 vs. 44 +/- 18 months). The average longevity on account of a device-based EOS message was 43 +/- 18 months. Average longevity for Biotronik (BIO, n = 72) was 33 +/- 10 months, for ELA Medical (ELA, n = 12) 44 +/- 17 months, for Guidant (GDT, n = 36) 49 +/- 12 months, for Medtronic (MDT, n = 29) 62 +/- 22 months, and for St. Jude Medical (SJM, n = 5) 31 +/- 9 months (P generators had a longer service time compared to DC and CRT-D systems. No influence of indication for ICD therapy and HO stimulation on generator longevity was observed in this

Randomized comparison of renal denervation versus intensified pharmacotherapy including spironolactone in true-resistant hypertension: six-month results from the Prague-15 study.

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Rosa, Ján; Widimský, Petr; Toušek, Petr; Petrák, Ondřej; Čurila, Karol; Waldauf, Petr; Bednář, František; Zelinka, Tomáš; Holaj, Robert; Štrauch, Branislav; Šomlóová, Zuzana; Táborský, Miloš; Václavík, Jan; Kociánová, Eva; Branny, Marian; Nykl, Igor; Jiravský, Otakar; Widimský, Jiří

2015-02-01

This prospective, randomized, open-label multicenter trial evaluated the efficacy of catheter-based renal denervation (Symplicity, Medtronic) versus intensified pharmacological treatment including spironolactone (if tolerated) in patients with true-resistant hypertension. This was confirmed by 24-hour ambulatory blood pressure monitoring after excluding secondary hypertension and confirmation of adherence to therapy by measurement of plasma antihypertensive drug levels before enrollment. One-hundred six patients were randomized to renal denervation (n=52), or intensified pharmacological treatment (n=54) with baseline systolic blood pressure of 159±17 and 155±17 mm Hg and average number of drugs 5.1 and 5.4, respectively. A significant reduction in 24-hour average systolic blood pressure after 6 months (-8.6 [95% cofidence interval: -11.8, -5.3] mm Hg; Pblood pressure (-12.4 [95% cofidence interval: -17.0, -7.8] mm Hg; Pblood pressure comparable with intensified pharmacotherapy. © 2014 American Heart Association, Inc.

Fifty years of pacemaker advancements.

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Steinhaus, David

2008-12-01

A 1957 power blackout in Minnesota prompted C. Walton Lillehei, MD, a pioneer in open heart surgery, to ask Earl Bakken, the co-founder of Medtronic, Inc., to create a battery-operated pacemaker for pediatric patients. That conversation led to the development of the first external battery-operated pacemaker. That first bulky device is far removed from the tiny implantable computers available to heart patients today. Now, the size of two silver dollars stacked on top of one another, a pacemaker is prescribed for a person whose heart beats too slowly or pauses irregularly. Slightly larger devices have more recently evolved from pacing and regulating the heartbeat to being able to provide therapeutic high voltage shocks when needed to stop runaway fast heart rates, recording heart activity, and other physiologic functions, even resynchronizing the heart's chambers-all while providing information on the patient's condition and device performance to the doctor remotely or in the office.

Results of remote follow-up and monitoring in young patients with cardiac implantable electronic devices.

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Silvetti, Massimo S; Saputo, Fabio A; Palmieri, Rosalinda; Placidi, Silvia; Santucci, Lorenzo; Di Mambro, Corrado; Righi, Daniela; Drago, Fabrizio

2016-01-01

Remote monitoring is increasingly used in the follow-up of patients with cardiac implantable electronic devices. Data on paediatric populations are still lacking. The aim of our study was to follow-up young patients both in-hospital and remotely to enhance device surveillance. This is an observational registry collecting data on consecutive patients followed-up with the CareLink system. Inclusion criteria were a Medtronic device implanted and patient's willingness to receive CareLink. Patients were stratified according to age and presence of congenital/structural heart defects (CHD). A total of 221 patients with a device - 200 pacemakers, 19 implantable cardioverter defibrillators, and two loop recorders--were enrolled (median age of 17 years, range 1-40); 58% of patients were younger than 18 years of age and 73% had CHD. During a follow-up of 12 months (range 4-18), 1361 transmissions (8.9% unscheduled) were reviewed by technicians. Time for review was 6 ± 2 minutes (mean ± standard deviation). Missed transmissions were 10.1%. Events were documented in 45% of transmissions, with 2.7% yellow alerts and 0.6% red alerts sent by wireless devices. No significant differences were found in transmission results according to age or presence of CHD. Physicians reviewed 6.3% of transmissions, 29 patients were contacted by phone, and 12 patients underwent unscheduled in-hospital visits. The event recognition with remote monitoring occurred 76 days (range 16-150) earlier than the next scheduled in-office follow-up. Remote follow-up/monitoring with the CareLink system is useful to enhance device surveillance in young patients. The majority of events were not clinically relevant, and the remaining led to timely management of problems.

Continuous glucose monitoring--a study of the Enlite sensor during hypo- and hyperbaric conditions.

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Adolfsson, Peter; Örnhagen, Hans; Eriksson, Bengt M; Cooper, Ken; Jendle, Johan

2012-06-01

The performance and accuracy of the Enlite(™) (Medtronic, Inc., Northridge, CA) sensor may be affected by microbubble formation at the electrode surface during hypo- and hyperbaric conditions. The effects of acute pressure changes and of prewetting of sensors were investigated. On Day 1, 24 sensors were inserted on the right side of the abdomen and back in one healthy individual; 12 were prewetted with saline solution, and 12 were inserted dry. On Day 2, this procedure was repeated on the left side. All sensors were attached to an iPro continuous glucose monitoring (CGM) recorder. Hypobaric and hyperbaric tests were conducted in a pressure chamber, with each test lasting 105 min. Plasma glucose values were obtained at 5-min intervals with a HemoCue(®) (Ängelholm, Sweden) model 201 glucose analyzer for comparison with sensor glucose values. Ninety percent of the CGM systems operated during the tests. The mean absolute relative difference was lower during hyperbaric than hypobaric conditions (6.7% vs. 14.9%, Phypobaric but not during hyperbaric conditions. Clarke Error Grid Analysis showed that 100% of the values were found in the A+B region. No differences were found between prewetted and dry sensors. The Enlite sensor performed adequately during acute pressure changes and was more accurate during hyperbaric than hypobaric conditions. Prewetting the sensors did not improve accuracy. Further studies on type 1 diabetes subjects are needed under various pressure conditions.

Robotic autopositioning of the operating microscope.

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Oppenlander, Mark E; Chowdhry, Shakeel A; Merkl, Brandon; Hattendorf, Guido M; Nakaji, Peter; Spetzler, Robert F

2014-06-01

Use of the operating microscope has become pervasive since its introduction to the neurosurgical world. Neuronavigation fused with the operating microscope has allowed accurate correlation of the focal point of the microscope and its location on the downloaded imaging study. However, the robotic ability of the Pentero microscope has not been utilized to orient the angle of the microscope or to change its focal length to hone in on a predefined target. To report a novel technology that allows automatic positioning of the operating microscope onto a set target and utilization of a planned trajectory, either determined with the StealthStation S7 by using preoperative imaging or intraoperatively with the microscope. By utilizing the current motorized capabilities of the Zeiss OPMI Pentero microscope, a robotic autopositioning feature was developed in collaboration with Surgical Technologies, Medtronic, Inc. (StealthStation S7). The system is currently being tested at the Barrow Neurological Institute. Three options were developed for automatically positioning the microscope: AutoLock Current Point, Align Parallel to Plan, and Point to Plan Target. These options allow the microscope to pivot around the lesion, hover in a set plane parallel to the determined trajectory, or rotate and point to a set target point, respectively. Integration of automatic microscope positioning into the operative workflow has potential to increase operative efficacy and safety. This technology is best suited for precise trajectories and entry points into deep-seated lesions.

Denervation of nerve terminals in renal arteries: one-year follow-up of interventional treatment of arterial hypertension.

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Bartuś, Krzysztof; Sadowski, Jerzy; Kapelak, Bogusław; Litwinowicz, Radosław; Zajdel, Wojciech; Godlewski, Jacek; Bartuś, Magdalena; Zmudka, Krzysztof; Chrapusta, Anna; Konstanty-Kalandyk, Janusz; Węgrzyn, Piotr; Sobotka, Paul A

2014-01-01

Arterial hypertension is the most common cardiovascular system disease, affecting nearly one billion people worldwide. Despite the widespread use of antihypertensive medications, in some groups of patients an optimal blood pressure (BP) cannot be achieved. To assess BP reduction in patients with resistant hypertension after a catheter-based renal sympathetic denervation procedure and to report vascular and kidney safety in one-year follow-up. Twenty eight patients with diagnosed resistant hypertension (median age 52.02 years, range 42-72) underwent percutaneous catheter-based renal denervation of nerve terminals in renal arteries. Arterial angiography and procedure of ablation was performed by Symplicity catheters and generator provided by Ardian (currently Medtronic Inc., USA). Mean BP value before ablation was [mm Hg]: systolic 176.6, diastolic 100.28 and pulse pressure 73.4. After the procedure, reductions in the value of BP were reported [mm Hg]: systolic 154.8/152.54; diastolic 90.2/89.8, pulse pressure 64.66/62.73, respectively in nine-month and one-year follow-up. All results were statistically significant. No complications during one year observation were observed. Percutaneous renal artery ablation procedure effectively reduces systolic BP, diastolic BP, and pulse pressure. No vascular or renal complications in any of the patients were observed. The results of a Polish research group showed no significant differences compared to the results obtained in the international studies Symplicity I and Symplicity II.

Manejo anestésico e complicações no implante percutâneo de válvula aórtica

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Tailur Alberto Grando

2013-06-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A estenose aórtica (EA grave é uma doença prevalente e de grande mortalidade. Nos pacientes idosos com outras comorbidades o implante valvar percutâneo é uma opção. OBJETIVOS: Descrever o manejo anestésico e as complicações com anestesia geral. MÉTODO: Série de casos com seguimento de 30 dias e 24 meses após o implante do dispositivo CoreValve feito no Instituto de Cardiologia/Fundação Universitária de Cardiologia entre dezembro de 2008 e janeiro de 2012. Os pacientes foram submetidos à anestesia geral monitorada com pressão arterial média (PAM, eletrocardiograma (ECG, oximetria, capnografia, ecocardiograma transesofágico, termometria e marcapasso transvenoso. RESULTADOS: Foram submetidos com sucesso ao implante valvular 28 pacientes, com idade média de 82,46 anos, EuroScore médio de 20,98%, classe funcional III/IV. Nove pacientes necessitaram de implante de marcapasso definitivo. No seguimento dos pacientes houve dois óbitos, um no transoperatório por perfuração do VE e um no terceiro dia por causa desconhecida. Em 24 meses um paciente faleceu com diagnóstico de mieloma múltiplo. A técnica anestésica mostrou-se segura. CONCLUSÃO: A experiência inicial com implante valvular aórtico percutâneo sob anestesia geral tem se mostrado segura e eficaz sem complicações anestésicas importantes para esse procedimento.

Local field potential recordings in a non-human primate model of Parkinsons disease using the Activa PC + S neurostimulator

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Connolly, Allison T.; Muralidharan, Abirami; Hendrix, Claudia; Johnson, Luke; Gupta, Rahul; Stanslaski, Scott; Denison, Tim; Baker, Kenneth B.; Vitek, Jerrold L.; Johnson, Matthew D.

2015-12-01

Objective. Using the Medtronic Activa® PC + S system, this study investigated how passive joint manipulation, reaching behavior, and deep brain stimulation (DBS) modulate local field potential (LFP) activity in the subthalamic nucleus (STN) and globus pallidus (GP). Approach. Five non-human primates were implanted unilaterally with one or more DBS leads. LFPs were collected in montage recordings during resting state conditions and during motor tasks that facilitate the expression of parkinsonian motor signs. These recordings were made in the naïve state in one subject, in the parkinsonian state in two subjects, and in both naïve and parkinsonian states in two subjects. Main results. LFPs measured at rest were consistent over time for a given recording location and parkinsonian state in a given subject; however, LFPs were highly variable between subjects, between and within recording locations, and across parkinsonian states. LFPs in both naïve and parkinsonian states across all recorded nuclei contained a spectral peak in the beta band (10-30 Hz). Moreover, the spectral content of recorded LFPs was modulated by passive and active movement of the subjects’ limbs. LFPs recorded during a cued-reaching task displayed task-related beta desynchronization in STN and GP. The bidirectional capabilities of the Activa® PC + S also allowed for recording LFPs while delivering DBS. The therapeutic effect of STN DBS on parkinsonian rigidity outlasted stimulation for 30-60 s, but there was no correlation with beta band power. Significance. This study emphasizes (1) the variability in spontaneous LFPs amongst subjects and (2) the value of using the Activa® PC + S system to record neural data in the context of behavioral tasks that allow one to evaluate a subject’s symptomatology.

Hemolytic performance of a MagLev disposable rotary blood pump (MedTech Dispo): effects of MagLev gap clearance and surface roughness.

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Hoshi, Hideo; Asama, Junichi; Hijikata, Wataru; Hara, Chikara; Shinshi, Tadahiko; Yasuda, Toshitaka; Ohuchi, Katsuhiro; Shimokohbe, Akira; Takatani, Setsuo

2006-12-01

Mechanical shaft seal bearing incorporated in the centrifugal blood pumps contributes to hemolysis and thrombus formation. In addition, the problem of durability and corrosion of mechanical shaft seal bearing has been recently reported from the safety point of view. To amend the shortcomings of the blood-immersed mechanical bearings, a magnetic levitated centrifugal rotary blood pump (MedTech Dispo Model 1; Tokyo Medical and Dental University, Tokyo, Japan) has been developed for extracorporeal disposable application. In this study, the hemolytic performance of the MedTech Dispo Model 1 centrifugal blood pump system was evaluated, with special focus on the narrow blood path clearance at the magnetic bearing between rotor and stator, and on the pump housing surface roughness. A pump flow of 5 L/min against the head pressure of 100 mm Hg for 4 h was included in the hemolytic test conditions. Anticoagulated fresh porcine blood was used as a working fluid. The clearance of blood path at the magnetic bearing was in the range of 100-250 micro m. Pump housing surface roughness was controlled to be around Ra = 0.1-1.5 micro m. The lowest hemolytic results were obtained at the clearance of 250 micro m and with the polished surface (Ra = 0.1 micro m) yielding the normalized index of hemolysis (NIH) of less than 0.001 g/100 L, which was 1/5 of the Biopump BP-80 (Medtronic Inc., Minneapolis, MN, USA, and 1/4 of the BPX-80. In spite of rough surface and narrow blood path, NIH levels were less than clinically acceptable level of 0.005 g/100 L. The noncontact, levitated impeller system is useful to improve pump performance in blood environment.

Local field potential recordings in a non-human primate model of Parkinsons disease using the Activa PC + S neurostimulator

Science.gov (United States)

Connolly, Allison T; Muralidharan, Abirami; Hendrix, Claudia; Johnson, Luke; Gupta, Rahul; Stanslaski, Scott; Denison, Tim; Baker, Kenneth B; Vitek, Jerrold L; Johnson, Matthew D

2016-01-01

Objective Using the Medtronic Activa® PC + S system, this study investigated how passive joint manipulation, reaching behavior, and deep brain stimulation (DBS) modulate local field potential (LFP) activity in the subthalamic nucleus (STN) and globus pallidus (GP). Approach Five non-human primates were implanted unilaterally with one or more DBS leads. LFPs were collected in montage recordings during resting state conditions and during motor tasks that facilitate the expression of parkinsonian motor signs. These recordings were made in the naïve state in one subject, in the parkinsonian state in two subjects, and in both naïve and parkinsonian states in two subjects. Main results LFPs measured at rest were consistent over time for a given recording location and parkinsonian state in a given subject; however, LFPs were highly variable between subjects, between and within recording locations, and across parkinsonian states. LFPs in both naïve and parkinsonian states across all recorded nuclei contained a spectral peak in the beta band (10–30 Hz). Moreover, the spectral content of recorded LFPs was modulated by passive and active movement of the subjects’ limbs. LFPs recorded during a cued-reaching task displayed task-related beta desynchronization in STN and GP. The bidirectional capabilities of the Activa® PC + S also allowed for recording LFPs while delivering DBS. The therapeutic effect of STN DBS on parkinsonian rigidity outlasted stimulation for 30–60 s, but there was no correlation with beta band power. Significance This study emphasizes (1) the variability in spontaneous LFPs amongst subjects and (2) the value of using the Activa® PC + S system to record neural data in the context of behavioral tasks that allow one to evaluate a subject’s symptomatology. PMID:26469737

Direct comparison of coronary bare metal vs. drug-eluting stents: same platform, different mechanics?

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Schmidt, Wolfram; Lanzer, Peter; Behrens, Peter; Brandt-Wunderlich, Christoph; Öner, Alper; Ince, Hüseyin; Schmitz, Klaus-Peter; Grabow, Niels

2018-01-08

Drug-eluting stents (DES) compared to bare metal stents (BMS) have shown superior clinical performance, but are considered less suitable in complex cases. Most studies do not distinguish between DES and BMS with respect to their mechanical performance. The objective was to obtain mechanical parameters for direct comparison of BMS and DES. In vitro bench tests evaluated crimped stent profiles, crossability in stenosis models, elastic recoil, bending stiffness (crimped and expanded), and scaffolding properties. The study included five pairs of BMS and DES each with the same stent platforms (all n = 5; PRO-Kinetic Energy, Orsiro: BIOTRONIK AG, Bülach, Switzerland; MULTI-LINK 8, XIENCE Xpedition: Abbott Vascular, Temecula, CA; REBEL Monorail, Promus PREMIER, Boston Scientific, Marlborough, MA; Integrity, Resolute Integrity, Medtronic, Minneapolis, MN; Kaname, Ultimaster: Terumo Corporation, Tokyo, Japan). Statistical analysis used pooled variance t tests for pairwise comparison of BMS with DES. Crimped profiles in BMS groups ranged from 0.97 ± 0.01 mm (PRO-Kinetic Energy) to 1.13 ± 0.01 mm (Kaname) and in DES groups from 1.02 ± 0.01 mm (Orsiro) to 1.13 ± 0.01 mm (Ultimaster). Crossability was best for low profile stent systems. Elastic recoil ranged from 4.07 ± 0.22% (Orsiro) to 5.87 ± 0.54% (REBEL Monorail) including both BMS and DES. The bending stiffness of crimped and expanded stents showed no systematic differences between BMS and DES neither did the scaffolding. Based on in vitro measurements BMS appear superior to DES in some aspects of mechanical performance, yet the differences are small and not class uniform. The data provide assistance in selecting the optimal system for treatment and assessment of new generations of bioresorbable scaffolds. not applicable.

Use of real time continuous glucose monitoring and intravenous insulin in type 1 diabetic mothers to prevent respiratory distress and hypoglycaemia in infants

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Passaro Patrizia

2008-07-01

Full Text Available Abstract Background Pregnancy in Type 1 diabetic patients is a precarious condition, both for mother and fetus with increased the risk of prematurity and, immediately after delivery with risk of respiratory distress syndrome and hypoglycaemia in newborns. A strict control and monitoring of diabetes throughout pregnancy is important in reducing the impact of the disease on the fetus and newborn. In recent years many new technologies have been introduced to ameliorate diabetes monitoring, where the last is the Real-time Continuous Glucose Monitoring System (RT-CGMS. Methods In the last three years, 72 h continuous glucose monitoring system (RT-CGMS (Medtronic, CA was performed in 18 pregnant women with Type 1 diabetes in two moments of pregnancy: during treatment with betamethasone to prevent respiratory distress and during delivery. In both cases insulin was administered intravenous and the dose was changed on the basis of glycaemia. Results The results present the use of this new technique during two topics moments of pregnancy of type 1 diabetes patients when is very important intensively to monitor diabetes and to obtain the well being of the fetus. No infant experimented hypoglycaemia or respiratory distress syndrome at the moment and in the first hours after the birth. Conclusion We wish to stress the importance reducing glycaemia during administration of betamethasone and during labor. It is conceivable that the scarce attention paid to monitoring glucose levels in diabetic mothers during labor in gynaecological world may be due to the difficulty in glucose monitoring with the devices until now available. Hopefully, our anecdotal account may prompt improvements with RT-CGMS, and may lead to a better approach to the problem, thereby changing the prognosis of infants born to diabetic mothers.

The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilization and Costs: An Economic Analysis From the FIRE AND ICE Trial.

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Chun, K R Julian; Brugada, Josep; Elvan, Arif; Gellér, Laszlo; Busch, Matthias; Barrera, Alberto; Schilling, Richard J; Reynolds, Matthew R; Hokanson, Robert B; Holbrook, Reece; Brown, Benedict; Schlüter, Michael; Kuck, Karl-Heinz

2017-07-27

This study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial. A trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [€], the United Kingdom [£], and the United States [$]). Total payer costs were calculated by applying standard unit costs to hospital stays, using International Classification of Diseases, 10th Revision diagnoses and procedure codes that were mapped to country-specific diagnosis-related groups. Patients (N=750) randomized 1:1 to cryoballoon (n=374) or RFC (n=376) ablation were followed for a mean of 1.5 years. Resource use was lower in the cryoballoon than the RFC group (205 hospitalizations and/or interventions in 122 patients versus 268 events in 154 patients). The cost differences per patient in mean total payer costs during follow-up were €640, £364, and $925 in favor of cryoballoon ablation ( P =0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of €245 000, £140 000, and $355 000. When compared with RFC ablation, cryoballoon ablation was associated with a reduction in resource use and payer costs. In all 3 national healthcare systems analyzed, this reduction resulted in substantial trial period cost savings, primarily attributable to fewer repeat ablations and a reduction in cardiovascular rehospitalizations with cryoballoon ablation. URL: http://www.clinicaltrials.gov. Identifier: NCT01490814. © 2017 The Authors and Medtronic. Published on behalf of the American Heart Association, Inc., by Wiley.

Thalamocortical network activity enables chronic tic detection in humans with Tourette syndrome

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Jonathan B. Shute

2016-01-01

Full Text Available Tourette syndrome (TS is a neuropsychiatric disorder characterized by multiple motor and vocal tics. Deep brain stimulation (DBS is an emerging therapy for severe cases of TS. We studied two patients with TS implanted with bilateral Medtronic Activa PC + S DBS devices, capable of chronic recordings, with depth leads in the thalamic centromedian–parafascicular complex (CM-PF and subdural strips over the precentral gyrus. Low-frequency (1–10 Hz CM-PF activity was observed during tics, as well as modulations in beta rhythms over the motor cortex. Tics were divided into three categories: long complex, complex, and simple. Long complex tics, tics involving multiple body regions and lasting longer than 5 s, were concurrent with a highly detectable thalamocortical signature (average recall [sensitivity] 88.6%, average precision 96.3%. Complex tics were detected with an average recall of 63.9% and precision of 36.6% and simple tics an average recall of 39.3% and precision of 37.9%. The detections were determined using data from both patients.

Effect of cannula shape on aortic wall and flow turbulence: hydrodynamic study during extracorporeal circulation in mock thoracic aorta.

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Minakawa, Masahito; Fukuda, Ikuo; Yamazaki, Junichi; Fukui, Kozo; Yanaoka, Hideki; Inamura, Takao

2007-12-01

This study was designed to analyze flow pattern, velocity, and strain on the aortic wall of a glass aortic model during extracorporeal circulation, and to elucidate the characteristics of flow pattern in four aortic cannulas. Different patterns of large vortices and helical flow were made by each cannula. The high-velocity flow (0.6 m/s) was observed in end-hole cannula, causing high strain rate tensor (0.3~0.4 without unit) on the aortic arch. In dispersion cannula, a decreased strain rate tensor (less than 0.1) was found on the outer curvature of the aortic arch. In Soft-flow cannula (3M Cardiovascular, Ann Arbor, MI, USA), further decreased flow velocity (0.2 m/s) and strain (less than 0.2) were observed. In Select 3D cannula (Medtronic, Inc., Minneapolis, MN, USA), a high strain (0.4~0.5) was observed along the inner curvature of the aortic arch. In conclusion, end-hole cannula should not be used in atherosclerotic aorta. Particular attention should be paid both for selection of cannulas and cannulation site based on this result.

Ventricular, but not atrial, M2-muscarinic receptors increase in the canine pacing-overdrive model of heart failure.

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Wilkinson, M; Giles, A; Armour, J A; Cardinal, R

1996-01-01

To investigate the effects of heart failure induced by chronic rapid ventricular pacing (six weeks) on canine atrial and ventricular muscarinic receptors. Dogs (n = 4) were fitted with a bipolar pacing electrode connected to a Medtronic pacemaker set at 240 stimuli/min. Pacing was maintained for six weeks. Tissue samples obtained from the left atrium and ventral wall of the left ventricle were frozen at -70 degrees C. Control tissue was obtained from normal dogs (n = 6) following anesthesia and thoracotomy. M2-muscarinic receptors were characterized and quantified in tissue micropunches using the hydrophilic ligand [3H] N-methyl-scopolamine (NMS). Cardiac tissue bound [3H] NMS with the specificity of an M2 subtype. Tachycardia-induced heart failure did not affect atrial muscarinic receptors but signify left ventricular myocytes (control 160.0 +/- 10.0 fmol/mg protein versus heart failure 245.0 +/- 25.0 fmol/mg protein; P failure was accompanied by an increase (+ 53%) in ventricular, but not atrial, M2 receptors compared with normal dogs.

Thalamocortical network activity enables chronic tic detection in humans with Tourette syndrome.

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Shute, Jonathan B; Okun, Michael S; Opri, Enrico; Molina, Rene; Rossi, P Justin; Martinez-Ramirez, Daniel; Foote, Kelly D; Gunduz, Aysegul

2016-01-01

Tourette syndrome (TS) is a neuropsychiatric disorder characterized by multiple motor and vocal tics. Deep brain stimulation (DBS) is an emerging therapy for severe cases of TS. We studied two patients with TS implanted with bilateral Medtronic Activa PC + S DBS devices, capable of chronic recordings, with depth leads in the thalamic centromedian-parafascicular complex (CM-PF) and subdural strips over the precentral gyrus. Low-frequency (1-10 Hz) CM-PF activity was observed during tics, as well as modulations in beta rhythms over the motor cortex. Tics were divided into three categories: long complex, complex, and simple. Long complex tics, tics involving multiple body regions and lasting longer than 5 s, were concurrent with a highly detectable thalamocortical signature (average recall [sensitivity] 88.6%, average precision 96.3%). Complex tics were detected with an average recall of 63.9% and precision of 36.6% and simple tics an average recall of 39.3% and precision of 37.9%. The detections were determined using data from both patients.

Velocity and shear stress distribution downstream of mechanical heart valves in pulsatile flow.

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Giersiepen, M; Krause, U; Knott, E; Reul, H; Rau, G

1989-04-01

Ten mechanical valves (TAD 27 mm): Starr-Edwards Silastic Ball, Björk-Shiley Standard, Björk-Shiley Concave-Convex, Björk-Shiley Monostrut, Hall-Kaster (Medtronic-Hall), OmniCarbon, Bicer Val, Sorin, Saint-Jude Medical and Hemex (Duromedics) are investigated in a comparative in vitro study. The velocity and turbulent shear stress profiles of the valves were determined by Laser Doppler anemometry in two different downstream axes within a model aortic root. Depending on the individual valve design, velocity peaks up to 1.5 m/s and turbulent shear stress peaks up to 150 N/m2 were measured during the systolic phase. These shear stress peaks mainly occurred in areas of flow separation and intense momentum exchange. Directly downstream of the valves (measuring axis 0.55.dAorta) turbulent shear stress peaks occurred at peak systole and during the deceleration phase, while in the second measuring axis (1.5.dAorta) turbulence levels were lower. Shear stress levels were high at the borders of the fluid jets. The results are discussed from a fluid-dynamic point of view.

The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

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Stefan Linsler

2016-01-01

Full Text Available Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT and magnetic resonance imaging (MRI. Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System which was registered via intraoperative CT scan (Siemens CT Somatom. Preexisting MRI studies (navigation protocol were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases.

Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study.

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Paul R Roberts

Full Text Available It has been suggested that sudden cardiac death (SCD contributes around 50% of cardiovascular and 27% of all-cause mortality in hemodialysis patients. The true burden of arrhythmias and arrhythmic deaths in this population, however, remains poorly characterised. Cardio Renal Arrhythmia Study in Hemodialysis (CRASH-ILR is a prospective, implantable loop recorder single centre study of 30 established hemodialysis patients and one of the first to provide long-term ambulatory ECG monitoring.30 patients (60% male aged 68±12 years receiving hemodialysis for 45±40 months with varied etiology (diabetes 37%, hypertension 23% and left ventricular ejection fraction (LVEF 55±8% received a Reveal XT implantable loop recorder (Medtronic, USA between August 2011 and October 2014. ECG data from loop recorders were transmitted at each hemodialysis session using a remote monitoring system. Primary outcome was SCD or implantation of a (tachy or bradyarrhythmia controlling device and secondary outcome, the development of arrhythmia necessitating medical intervention.During 379,512 hours of continuous ECG monitoring (mean 12,648±9,024 hours/patient, there were 8 deaths-2 SCD and 6 due to generalised deterioration/sepsis. 5 (20% patients had a primary outcome event (2 SCD, 3 pacemaker implantations for bradyarrhythmia. 10 (33% patients reached an arrhythmic primary or secondary end point. Median event free survival for any arrhythmia was 2.6 years (95% confidence intervals 1.6-3.6 years.The findings confirm the high mortality rate seen in hemodialysis populations and contrary to initial expectations, bradyarrhythmias emerged as a common and potentially significant arrhythmic event.

Phrenic nerve stimulation during neck dissection for advanced thyroid cancer involving level IV: is it worth doing it?

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Duque, Carlos S; Dueñas, Juan P; Marulanda, Marcela; Pérez, Diana; Londoňo, Andres; Roy, Soham; Khadem, Mai Al

2017-03-01

During thyroidectomy and neck dissection surgery for advanced or recurrent metastatic thyroid cancer under intraoperative monitoring, we used the available technology to assess the feasibility of such an intervention to monitor those patients with phrenic nerves at risk. A retrospective review of patients operated on from January 2009 to December 2015 by a single surgeon (CSD) was conducted. Patients who had neck and mediastinal dissection, with or without total thyroidectomy, due to advanced or recurrent metastatic disease to the neck were selected. The procedures were done under intraoperative nerve monitoring using nerve monitoring systems (NIM 2.0 or 3.0; Medtronic, Jacksonville, FL, USA). A total of 19 patients were included in the study, with a mean age of 57.6 years ± 16.3 and a male/female ratio of 10:9. Overall, all patients had an intact phrenic nerve at the conclusion of the surgery. One patient had an aggressive tumor that precluded sacrifice of the left recurrent laryngeal nerve and ipsilateral thoracic duct. The procedure was complicated by a temporary impairment of the diaphragm contraction with intraoperative nerve monitoring as well as a chyle fistula. This was due to the manipulation of the tissue surrounding the phrenic nerve. Intraoperative nerve monitoring of the phrenic nerve offers the surgeon a "potential" method of ensuring phrenic nerve integrity in cases of advanced thyroid cancers with gross level IV metastatic disease. Further prospective studies are needed to assess the risks of this intervention and evaluate the method of recording diaphragm contraction movement.

Evaluation of different diameter arterial tubing and arterial cannulae in simulated neonatal/pediatric cardiopulmonary bypass circuits.

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Wang, Shigang; Rosenthal, Tami; Kunselman, Allen R; Ündar, Akif

2015-01-01

The objective of this study is to evaluate three different diameters of arterial tubing and three diameters of arterial cannulae in terms of pressure drop, and hemodynamic energy delivery in simulated neonatal/pediatric cardiopulmonary bypass (CPB) circuits. The CPB circuit consisted of a Terumo Capiox Baby FX05 oxygenator (Terumo Corporation, Tokyo, Japan), arterial tubing (1/4 in, 3/16 in, or 1/8 in × 150 cm), and a Medtronic Bio-Medicus arterial cannula (8, 10, or 12 Fr; Medtronic, Inc., Minneapolis, MN, USA). The pseudo patient's pressure was maintained at 50 mm Hg. The circuit was primed using lactated Ringer's solution and heparinized packed human red blood cells (hematocrit 30%). Trials were conducted at different flow rates and temperatures (35 and 28°C). Flow and pressure data were collected using a custom-based data acquisition system. Using 8 Fr arterial cannula at 500 mL/min, small diameter arterial tubing generated higher circuit pressure (294.6 ± 0.1 mm Hg [1/8 in], 213.5 ± 0.5 mm Hg [3/16 in], 208.4 ± 0.4 mm Hg [1/4 in] at 35°C) and arterial line pressure drop (158.3 ± 0.1 mm Hg [1/8 in], 79.6 ± 0.1 mm Hg [3/16 in], 62.1 ± 0.1 mm Hg [1/4 in] at 35°C). Using 10 Fr arterial cannula at 1000 mL/min, pre-oxygenator pressures were 266.8 ± 0.2 mm Hg (3/16 in) and 248.0 ± 0.3 mm Hg (1/4 in); arterial line pressure drops were 111.6 ± 0.0 mm Hg (3/16 in) and 74.0 ± 0.1 mm Hg (1/4 in) at 35°C. When using 12 Fr arterial cannula at 1500 mL/min, preoxygenator pressures reached 324.4 ± 0.3 mm Hg (3/16 in) and 302.5 ± 0.4 mm Hg (1/4 in); arterial line pressure drops were 154.0 ± 0.1 mm Hg (3/16 in) and 92.0 ± 0.2 mm Hg (1/4 in) at 35°C. Pressure drops across arterial line tubing were main CPB circuit pressure drops. High flow rate, hypothermia, small diameter arterial tubing. and

Instrumentação interespinhosa na doença degenerativa da coluna lombar: medição da altura do disco no segmento instrumentado Instrumentación interespinosa en la enfermedad degenerativa de la columna lumbar: medición de la altura del disco en el segmento instrumentado Interspinous instrumentation in patients with degenerative lumbar spine disease: disc height measurement on instrumented segment

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José Alberto de Castro Guimarães Consciência

2009-09-01

Full Text Available INTRODUÇÃO: na última década, a instrumentação interespinhosa vem sendo mais frequentemente utilizada. Apesar dos inúmeros artigos publicados em revistas internacionais de reconhecido mérito científico, são escassas as referências à modificação da altura do disco no segmento tratado, secundária àquela instrumentação. OBJECTIVO: quantificar uma eventual modificação da altura discal decorrente da aplicação de instrumentação interespinhosa (DIAM - Cousin-Biotech - Medtronic Sofamor Danek Inc©. MÉTODOS: o autor avalia um grupo de 20 pacientes com patologia degenerativa da coluna lombar e os seguintes critérios de inclusão: idade >40 e 6; Oswestry Disability Index (ODI >30; Zung Depression Rating Scale INTRODUCCIÓN: la instrumentación interespinosa tiene sido empleada con creciente frecuencia en la última década. Pero, apesar de las numerosas publicaciones científicas hechas en jornales científicos de reconocido mérito internacional, se han producido muy escasas referencias a una hipotética modificación de la altura discal dependiente de la técnica. OBJETIVO: cuantificar una eventual modificación de la altura discal inherente a la aplicación de instrumentación interespinosa. MÉTODOS: el autor hace una evaluación de un grupo de 20 pacientes con patología degenerativa de la columna lumbar, y diversos criterios de inclusión, a saber: edad >40 y 6; Oswestry Disability Index >30; Zung Depression Rating Scale INTRODUCTION: the use of interspinous instrumentation has been increasing in the last decade. However, in spite of the numerous papers seen in relevant scientific publications, there are very few references to an eventual disc height variation in the instrumented segment. OBJECTIVE: to certify eventual changes in disk height after interspinous instrumentation (DIAM - Cousin-Biotech - Medtronic Sofamor Danek Inc©. METHODS: the author evaluated 20 patients with degenerative lumbar disease and the following

Experiencia clínica en monitorización cardiaca extendida con el sistema inalámbrico satelital tipo SEEQ

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Diego Vanegas-Cadavid

2018-05-01

Full Text Available Resumen: Objetivos: Dar a conocer la experiencia clínica con un nuevo sistema de monitorización cardiaca extendida (por 15 días, inalámbrica y satelital en un grupo de pacientes con sospecha de arritmias cardíacas. Metodología: Cohorte de 100 pacientes atendidos en la unidad de Electrofisiología cardiovascular de un centro de referencia, con sospecha de arritmia cardíaca, sin diagnóstico electrocardiográfico causal, a pesar de exámenes previos. Se les aplicó una monitorización cardiaca externa tipo SEEQ (Medtronic por 15 días y se registró el desenlace. Resultados: De un total de 100 sujetos estudiados, 51% eran hombres, con mediana de edad de 60 años (rango: 5 - 91 años. El principal síntoma fueron las palpitaciones (42% y la comorbilidad más prevalente la hipertensión arterial (47%; 98% tenían estudio de Holter previo y 46% dos estudios sin resultado conclusivo que explicara los síntomas. La monitorización tipo SEEQ documentó anormalidad electrocardiográfica significativa en 22% de los pacientes. El implante de marcapaso fue el tratamiento más aplicado y la fibrilación auricular fue la arritmia más frecuente en el 50% de los hallazgos positivos. Hubo una proporción mayor y significativa de diagnósticos positivos en el sexo masculino. Conclusiones: La monitorización cardiaca externa inalámbrica, satelital, extendida por 15 días es una herramienta novedosa que incrementa la probabilidad de documentar una anormalidad electrocardiográfica clínicamente significativa en quienes padecen síntomas cardiovasculares recurrentes. Abstract: Objectives: To present the clinical experience with a new extended (for 15 days, wireless, and satellite cardiac monitoring system in a group of patients with suspicion of cardiac arrhythmia. Method: The study included a cohort of 100 patients seen in the Cardiovascular Electrophysiology Unit of a reference hospital. They were suspected of having a cardiac arrhythmia, with no

Estimulação cerebral contínua (DBS talâmica para controle do tremor Deep brain stimulation of VIM thalamic nucleus for tremor control

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José Augusto Nasser

2002-06-01

Full Text Available OBJETIVO: Apresentamos resultados da estimulação contínua do núcleo ventral intermédio (VIM talâmico para o controle do tremor. MÉTODO: Quatro pacientes foram selecionados no período de outubro de 1999 a janeiro de 2001 com tremor incapacitante refratário à farmacoterapia. Dois pacientes apresentavam tremor essencial (TE bilateral e 2 pacientes tremor de repouso por doença de Parkinson (DP, um à direita e outro à esquerda. Após avaliação sistemática, foram submetidos ao implante de eletrodo talâmico, modelo DBS 3387(Medtronic, para estimulação cerebral profunda (ECP com alta frequência, sendo este bilateral nos casos de TE e unilateral nos casos com tremor por DP. RESULTADOS: Os pacientes tiveram seu seguimente clínico até o presente, com média de 12 meses, sendo observada a eficácia da estimulação do núcleo VIM no controle dos disparos das células do tremor. As complicações temporárias do tipo parestesias, disartrias e discreto aumento do tônus foram revertidas após o ajuste dos parâmetros de estimulação. CONCLUSÃO: Os resultados confirmam os achados da literatura, de que a estimulação talâmica é excelente opção terapêutica no tratamento do tremor, havendo possibilidade de estimulação talâmica bilateral simultânea com segurança.PURPOSE: We present our results in 4 patients with tremor, in whom electrodes (uni and bilateral for Deep Brain Stimulation (DBS were implanted in the ventral intermediate nucleus (VIM of the thalamus. METHOD: Four patients with disabling tremor, with drug-resistant spite of optimum therapeutic trials with poor response were referred to do surgery. Two patients had bilateral essential tremor. These patients were implanted with electrodes for DBS 3387 (Medtronic. Two patients had unilateral parkinsonian tremor and they received unilateral implantation of model 3387 DBS. RESULTS: All four patients showed relieve of the tremor symptoms with significant tremor control seen at

Programmable shunts and headphones: Are they safe together?

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Spader, Heather S; Ratanaprasatporn, Linda; Morrison, John F; Grossberg, Jonathan A; Cosgrove, G Rees

2015-10-01

Programmable shunts have a valuable role in the treatment of patients with hydrocephalus, but because a magnet is used to change valve settings, interactions with external magnets may reprogram these shunts. Previous studies have demonstrated the ability of magnetic toys and iPads to erroneously reprogram shunts. Headphones are even more ubiquitous, and they contain an electromagnet for sound projection that sits on the head very close to the shunt valve. This study is the first to look at the magnetic field emissions of headphones and their effect on reprogrammable shunt valves to ascertain whether headphones are safe for patients with these shunts to wear. In this in vitro study of the magnetic properties of headphones and their interactions with 3 different programmable shunts, the authors evaluated Apple earbuds, Beats by Dr. Dre, and Bose QuietComfort Acoustic Noise Cancelling headphones. Each headphone was tested for electromagnetic field emissions using a direct current gaussmeter. The following valves were evaluated: Codman Hakim programmable valve, Medtronic Strata II valve, and Aesculap proGAV. Each valve was tested at distances of 0 to 50 mm (in 5-mm increments) from each headphone. The exposure time at each distance was 1 minute, and 3 trials were performed to confirm results at each valve setting and distance. All 3 headphones generated magnetic fields greater than the respective shunt manufacturer's recommended strength of exposure, but these fields did not persist beyond 5 mm. By 2 cm, the fields levels were below 20 G, well below the Medtronic recommendation of 90 G and the Codman recommendation of 80 G. Because the mechanism for the proGAV is different, there is no recommended gauss level. There was no change in gauss-level emissions by the headphones with changes in frequency and amplitude. Both the Strata and Codman-Hakim valves were reprogrammed by direct contact (distance 0 mm) with the Bose headphones. When a rotation component was added, all

Repeat transcatheter aortic valve implantation using a latest generation balloon-expandable device for treatment of failing transcatheter heart valves.

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Schaefer, Andreas; Treede, Hendrik; Seiffert, Moritz; Deuschl, Florian; Schofer, Niklas; Schneeberger, Yvonne; Blankenberg, Stefan; Reichenspurner, Hermann; Schaefer, Ulrich; Conradi, Lenard

2016-01-15

Paravalvular leakage (PVL) is a known complication of transcatheter aortic valve implantation (TAVI) and is associated with poor outcome. Besides balloon-post-dilatation, valve-in-valve (ViV) procedures can be taken into consideration to control this complication. Herein we present initial experience with use of the latest generation balloon-expandable Edwards Sapien 3® (S3) transcatheter heart valve (THV) for treatment of failing THVs. Between 01/2014 and 12/2014 three patients (two male, age: 71-80 y, log EUROScore I: 11.89 - 32.63) with failing THVs were refered to our institution for further treatment. THV approach with secondary implantation of an S3 was chosen after mutual agreement of the local interdisciplinary heart team at an interval of 533-1119 days from the index procedure. The performed procedures consisted of: S3 in Sapien XT, JenaValve and CoreValve. Successful transfemoral implantation with significant reduction of PVL was achieved in all cases. No intraprocedural complications occurred regarding placement of the S3 with a postprocedural effective orifice area (EOA) of 1.5-2.5 cm(2) and pressure gradients of max/mean 14/6-36/16 mmHg. 30-day mortality was 0%. At the latest follow-up of 90-530 days, all patients are alive and well with satisfactory THV function. Regarding VARC-2 criteria one major bleeding and one TIA was reported. In the instance of moderate or severe aortic regurgitation after TAVI, S3 ViV deployment is an excellent option to reduce residual regurgitation to none or mild. For further assertions concerning functional outcomes long-term results have to be awaited.

Mini-cardiopulmonary bypass impact on blood conservation strategy in coronary artery bypass grafting.

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Abdel Aal, Mohamed; ElNahal, Nezar; Bakir, Bakir Moustafa; Fouda, Mohamed

2011-04-01

Cardiopulmonary bypass (CPB) using a closed circuit system with minimal priming volume can be a solution to ameliorate adverse effects of CPB. We hypothesize that the use of mini-bypass in routine coronary artery bypass grafting (CABG) reduces homologous blood product use and postoperative bleeding. The study is designed to determine the differences in blood loss and transfusion requirements associated with a minimized CPB circuit vs. a standard bypass circuit. From February 2009 to August 2009, 80 patients were prospectively randomized to undergo elective CABG. Group A included 40 patients who had the minimized bypass circuit (Medtronic Resting Heart Circuit). Group B had an equal number of patients who had the standard CPB circuit (Stockert III, SEC.BM). Laboratory parameters for hemoglobin, hematocrit and platelet count were measured at baseline after initiation of CPB and after bypass. Blood usage was controlled by study-specific protocol (transfusion for hemoglobin platelets (1.95±2.95 units vs. 3.23±2.85), and postoperative drainage in 24 hours (531.62±220.12 ml vs. 729±294.9 ml, P<0.05). The hematocrit was 33±5% in group A, and 27±1% in group B. There was statistical differences seen in the mean hemoglobin level which was 10.19±0.65 g/dl in group A, and 9.4±0.68 g/dl in group B. There was statistical difference in the duration of ventilation, length of ICU stay. The requirement of inotropic support was lower in group A. The adoption of mini-bypass significantly reduces morbidity including donor blood usage and postoperative bleeding in routine CABG patients.

Is the failure of SYMPLICITY HTN-3 trial to meet its efficacy endpoint the "end of the road" for renal denervation?

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Epstein, Murray; de Marchena, Eduardo

2015-02-01

Resistant hypertension is a common medical problem that is increasing with the advent of an increasingly older and heavier population. The etiology of resistant hypertension is almost always multifactorial, but the results of numerous studies indicate that renal sympathetic activation is a particularly common cause of resistance to antihypertensive treatment. Consistent with the belief in a pivotal role of renal sympathetic stimulation, there has been a growing interest in renal denervation (RDN) treatment strategies. The long-awaited results of SYMPLICITY HTN-3 study disclosed that the reduction in blood pressure by the SYMPLICITY device did not differ from that in the sham-procedure arm of the study. In the present article, we identify several factors that explain why the study failed to demonstrate any benefit from the intervention. The reasons are multifactorial and include inadequate screening at entry and frequent medication changes during the study. Additional problems include the lack of experience of many operators with the SYMPLICITY device and procedure variability, as attested to by a diminished number of ablation "quadrants." Also a factor was the inability of the first generation Medtronic device to allow four ablations to be performed simultaneously. We recommend that future RDN studies adhere to more rigorous screening procedures, and utilize newer multi-site denervation systems that facilitate four ablations simultaneously. Drug optimization should be achieved by monitoring adherence throughout the study. Nevertheless, we are optimistic about a future role of RDN. To optimize chances of success, increased efforts are necessary to identify the appropriate patients for RDN and investigators must use second and third generation denervation devices and techniques. Copyright © 2015 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Electromagnetic interference of GSM mobile phones with the implantable deep brain stimulator, ITREL-III

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Alesch François

2003-05-01

Full Text Available Abstract Background The purpose was to investigate mobile phone interference with implantable deep brain stimulators by means of 10 different 900 Mega Hertz (MHz and 10 different 1800 MHz GSM (Global System for Mobile Communications mobile phones. Methods All tests were performed in vitro using a phantom especially developed for testing with deep brain stimulators. The phantom was filled with liquid phantom materials simulating brain and muscle tissue. All examinations were carried out inside an anechoic chamber on two implants of the same type of deep brain stimulator: ITREL-III from Medtronic Inc., USA. Results Despite a maximum transmitted peak power of mobile phones of 1 Watt (W at 1800 MHz and 2 W at 900 MHz respectively, no influence on the ITREL-III was found. Neither the shape of the pulse form changed nor did single pulses fail. Tests with increased transmitted power using CW signals and broadband dipoles have shown that inhibition of the ITREL-III occurs at frequency dependent power levels which are below the emissions of GSM mobile phones. The ITREL-III is essentially more sensitive at 1800 MHz than at 900 MHz. Particularly the frequency range around 1500 MHz shows a very low interference threshold. Conclusion These investigations do not indicate a direct risk for ITREL-III patients using the tested GSM phones. Based on the interference levels found with CW signals, which are below the mobile phone emissions, we recommend similar precautions as for patients with cardiac pacemakers: 1. The phone should be used at the ear at the opposite side of the implant and 2. The patient should avoid carrying the phone close to the implant.

Case report: ruptured aortic aneurysm into oesophagus - treatment by covered stent

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Young, N.; Tan, I.; Costa, R.

2002-01-01

Full text: A case report of a 70 year old man acutely presenting with a large descending thoracic aortic aneurysm, ruptured into the adjacent oesophagus. He was treated with an Aneurex covered stent (Medtronics). This patient has a long history of ischaemic heart disease, hypertension and previously treated abdominal aortic aneurysm. After diagnosis by CT, the bleeding was emergency temponaded by insertion of a Sengstaken-Blackmore tube into the oesophagus and inflated to arterial pressure. After stabilisation in ICU, it was decided that open surgery would probably prove fatal, and insertion of a covered thoracic aortic stent was performed in theatre with a femoral artery cut-down. Post-operatively the bleeding from the aortic aneurysm ceased. However, the patient has ongoing problems with large, open oesophageal ulcer with chronic ooze requiring intermittent transfusions, chronic infection with MRSA, requiring long term antibiotics, feeding via feeding gastrostomy tubes. The patient is stable 12 months after presentation. Treatment of this otherwise fatal problem by covered stent has permitted survival benefit. However, there are significant, unresolved issues of oesophageal ulcer and ongoing MRSA infection. Copyright (2002) Blackwell Science Pty Ltd

Evaluation of optimal treatment approach in patients with early recurrence of atrial fibrillation after the first ablation procedure

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В. В. Шабанов

2015-10-01

Full Text Available 182 patients with paroxysmal AF underwent ablation (circumferential pulmonary vein isolation with linear lesions and were monitored with an implantable cardiac monitor (Reveal XT, Medtronic. Patients were randomly assigned to group 1 or group 2. Group 1 patients were treated only with antiarrhythmic drugs for 6 weeks, with no early reablation during the 3-month postablation period. In the case of AF recurrence after the 3-month postablation period, patients underwent reablation. Group 2 patients were treated according to the onset mechanism of AF recurrences, as detected and stored by the implantable cardiac monitor: antiarrhythmic drug therapy, but no reablation if AF was not preceded by triggers; early reablation if premature atrial beats or atrial tachycardias or flutter triggered AF. All patients were followed up for 1 year to assess the sinus rhythm maintenance in each group. On 12-month follow-up examination, 67 patients (76% out of 88 in group 1 and 78 patients (92% out of 89 in group 2 had no AF recurrences (P<0,009 versus group 1. The patients with AF recurrences caused by a trigger mechanism after the first ablation demonstrated high long-term efficacy after early reablation.

Assessing the direct effects of deep brain stimulation using embedded axon models

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Sotiropoulos, Stamatios N.; Steinmetz, Peter N.

2007-06-01

To better understand the spatial extent of the direct effects of deep brain stimulation (DBS) on neurons, we implemented a geometrically realistic finite element electrical model incorporating anisotropic and inhomogenous conductivities. The model included the subthalamic nucleus (STN), substantia nigra (SN), zona incerta (ZI), fields of Forel H2 (FF), internal capsule (IC) and Medtronic 3387/3389 electrode. To quantify the effects of stimulation, we extended previous studies by using multi-compartment axon models with geometry and orientation consistent with anatomical features of the brain regions of interest. Simulation of axonal firing produced a map of relative changes in axonal activation. Voltage-controlled stimulation, with clinically typical parameters at the dorso-lateral STN, caused axon activation up to 4 mm from the target. This activation occurred within the FF, IC, SN and ZI with current intensities close to the average injected during DBS (3 mA). A sensitivity analysis of model parameters (fiber size, fiber orientation, degree of inhomogeneity, degree of anisotropy, electrode configuration) revealed that the FF and IC were consistently activated. Direct activation of axons outside the STN suggests that other brain regions may be involved in the beneficial effects of DBS when treating Parkinsonian symptoms.

The neurophysiology of urinary retention in young women and its treatment by neuromodulation.

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Goodwin, R J; Swinn, M J; Fowler, C J

1998-01-01

Urinary retention occurring in young women as an isolated phenomenon was often thought to be psychogenic in origin. However, in 1988, Fowler et al. described a syndrome in young women in which urinary retention was the predominant feature and in which electromyography (EMG) of the striated urethral sphincter revealed a striking abnormality. This abnormality, it was postulated, would result in an inability of the sphincter to relax and retention would therefore result. Until recently there was no effective treatment for this disorder except management by clean intermittent self-catheterisation. However, preliminary results of neuromodulation using a Medtronic sacral nerve stimulator have been particularly promising in this group of patients. The response is often spectacular; a woman who has not passed urine per urethram for many months or years will frequently find that within a few hours of insertion of the percutaneous nerve evaluation (PNE) lead, she can void quite normally with little or no residual urine. The precise mechanism of action is yet to be defined, but measurements of the latency of anal sphincter contraction on S3 stimulation during PNE are so prolonged that they can only be the result of an afferent-mediated reflex.

Electrical stimulation induces propagated colonic contractions in an experimental model.

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Aellen, S; Wiesel, P H; Gardaz, J-P; Schlageter, V; Bertschi, M; Virag, N; Givel, J-C

2009-02-01

Direct colonic electrical stimulation may prove to be a treatment option for specific motility disorders such as chronic constipation. The aim of this study was to provoke colonic contractions using electrical stimulation delivered from a battery-operated device. Electrodes were inserted into the caecal seromuscular layer of eight anaesthetized pigs. Contractions were induced by a neurostimulator (Medtronic 3625). Caecal motility was measured simultaneously by video image analysis, manometry and a technique assessing colonic transit. Caecal contractions were generated using 8-10 V amplitude, 1000 micros pulse width, 120 Hz frequency for 10-30 s, with an intensity of 7-15 mA. The maximal contraction strength was observed after 20-25 s. Electrical stimulation was followed by a relaxation phase of 1.5-2 min during which contractions propagated orally and aborally over at least 10 cm. Spontaneous and stimulated caecal motility values were significantly different for both intraluminal pressure (mean(s.d.) 332(124) and 463(187) mmHg respectively; P < 0.001, 42 experiments) and movement of contents (1.6(0.9) and 3.9(2.8) mm; P < 0.001, 40 experiments). Electrical stimulation modulated caecal motility, and provoked localized and propagated colonic contractions.

Single freeze per vein strategy with the second-generation cryoballoon for atrial fibrillation: a propensity score-matched study between 180- and 240-s application time in a large cohort of patients.

Science.gov (United States)

De Regibus, Valentina; Abugattas, Juan-Pablo; Iacopino, Saverio; Mugnai, Giacomo; Storti, Cesare; Conte, Giulio; Auricchio, Angelo; Ströker, Erwin; Coutiño, Hugo-Enrique; Takarada, Ken; Salghetti, Francesca; Lusoc, Ian; Capulzini, Lucio; Brugada, Pedro; de Asmundis, Carlo; Chierchia, Gian-Battista

2017-11-02

The single-freeze strategy using the second-generation cryoballoon (CB-A, Arctic Front Advance, Medtronic, Minneapolis, MN, USA) has been reported to be as effective as the recommended double-freeze approach in several single-centre studies. In this retrospective, international, multicentre study, we compare the 3-min single-freeze strategy with the 4-min single-freeze strategy. Four hundred and thirty-two patients having undergone pulmonary vein isolation (PVI) by means of CB-A using a single-freeze strategy were considered for this analysis. A cohort of patients who were treated with a 3-min strategy (Group 1) was compared with a propensity score-matched cohort of patients who underwent a 4-min strategy (Group 2). Pulmonary vein isolation was successfully achieved in all the veins using the 28-mm CB-A. The procedural and fluoroscopy times were lower in Group 1 (67.8 ± 17 vs. 73.8 ± 26.3, P strategies. The procedural and fluoroscopy times were significantly shorter in 3-min per vein strategy. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Disposable MagLev centrifugal blood pump utilizing a cone-shaped impeller.

Science.gov (United States)

Hijikata, Wataru; Sobajima, Hideo; Shinshi, Tadahiko; Nagamine, Yasuyuki; Wada, Suguru; Takatani, Setsuo; Shimokohbe, Akira

2010-08-01

To enhance the durability and reduce the blood trauma of a conventional blood pump with a cone-shaped impeller, a magnetically levitated (MagLev) technology has been applied to the BioPump BPX-80 (Medtronic Biomedicus, Inc., Minneapolis, MN, USA), whose impeller is supported by a mechanical bearing. The MagLev BioPump (MagLev BP), which we have developed, has a cone-shaped impeller, the same as that used in the BPX-80. The suspension and driving system, which is comprised of two degrees of freedom, radial-controlled magnetic bearing, and a simply structured magnetic coupling, eliminates any physical contact between the impeller and the housing. To reduce both oscillation of the impeller and current in the coils, the magnetic bearing system utilizes repetitive and zero-power compensators. In this article, we present the design of the MagLev mechanism, measure the levitational accuracy of the impeller and pressure-flow curves (head-quantity [HQ] characteristics), and describe in vitro experiments designed to measure hemolysis. For the flow-induced hemolysis of the initial design to be reduced, the blood damage index was estimated by using computational fluid dynamics (CFD) analysis. Stable rotation of the impeller in a prototype MagLev BP from 0 to 2750 rpm was obtained, yielding a flow rate of 5 L/min against a head pressure in excess of 250 mm Hg. Because the impeller of the prototype MagLev BP is levitated without contact, the normalized index of hemolysis was 10% less than the equivalent value with the BPX-80. The results of the CFD analysis showed that the shape of the outlet and the width of the fluid clearances have a large effect on blood damage. The prototype MagLev BP satisfied the required HQ characteristics (5 L/min, 250 mm Hg) for extracorporeal circulation support with stable levitation of the impeller and showed an acceptable level of hemolysis. The simulation results of the CFD analysis indicated the possibility of further reducing the blood damage of

Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery.

Science.gov (United States)

Rigante, M; La Rocca, G; Lauretti, L; D'Alessandris, G Q; Mangiola, A; Anile, C; Olivi, A; Paludetti, G

2017-06-01

During the last two decades endoscopic skull base surgery observed a continuous technical and technological development 3D endoscopy and ultra High Definition (HD) endoscopy have provided great advances in terms of visualisation and spatial resolution. Ultra-high definition (UHD) 4K systems, recently introduced in the clinical practice, will shape next steps forward especially in skull base surgery field. Patients were operated on through transnasal transsphenoidal endoscopic approaches performed using Olympus NBI 4K UHD endoscope with a 4 mm 0° Ultra Telescope, 300 W xenon lamp (CLV-S400) predisposed for narrow band imaging (NBI) technology connected through a camera head to a high-quality control unit (OTV-S400 - VISERA 4K UHD) (Olympus Corporation, Tokyo, Japan). Two screens are used, one 31" Monitor - (LMD-X310S) and one main ultra-HD 55" screen optimised for UHD image reproduction (LMD-X550S). In selected cases, we used a navigation system (Stealthstation S7, Medtronic, Minneapolis, MN, US). We evaluated 22 pituitary adenomas (86.3% macroadenomas; 13.7% microadenomas). 50% were not functional (NF), 22.8% GH, 18.2% ACTH, 9% PRL-secreting. Three of 22 were recurrences. In 91% of cases we achieved total removal, while in 9% near total resection. A mean follow-up of 187 days and average length of hospitalisation was 3.09 ± 0.61 days. Surgical duration was 128.18± 30.74 minutes. We experienced only 1 case of intraoperative low flow fistula with no further complications. None of the cases required any post- or intraoperative blood transfusion. The visualisation and high resolution of the operative field provided a very detailed view of all anatomical structures and pathologies allowing an improvement in safety and efficacy of the surgical procedure. The operative time was similar to the standard 2D HD and 3D procedures and the physical strain was also comparable to others in terms of ergonomics and weight. © Copyright by Società Italiana di Otorinolaringologia

[Endovascular radiofrequency denervation of renal arteries as an innovation method of treatment of refractory arterial hypertension. First experience in Russia].

Science.gov (United States)

Danilov, N M; Matchin, Iu G; Chazova, I E

2012-01-01

Excessive activation of the sympathetic nervous system forms the basis of pathogenesis of essential arterial hypertension (AH). The present work was aimed at evaluating efficacy and safety of endovascular radiofrequency denervation of renal arteries in patients with AH refractory AH based on the initial first experience in with using this methodology in the Russian Federation. The interventions were carried out on December 14-15th, 2011 in the first five patients presenting with AH refractory to antihypertensive therapy consisting of three and more drugs in therapeutic doses, one of which was a diuretic. The selection criteria were systolic arterial pressure (SAP) ≥160 mm Hg or ≥150 mm Hg in the presence of type 2 diabetes mellitus. The obligatory conditions for selection were the preserved renal function [glomerular filtration rate (GFR) ≥45 ml/min] and the absence of the secondary form of AH. The procedure of denervation was performed in the conditions of roentgen-operating room using special Medtronic Ardian Simplicity Catheter System™. In all cases we managed to perform bilateral denervation of renal arteries with the radiofrequency effect in not less than 4 zones of each of vessels. Efficacy of each of the effect was registered with due regard for reaching certain temperature and values of impedance. The interventions were not accompanied by the development of any complications either in the area of manipulations or the site of puncture. Neither were there any complications from the side of the cardiovascular or excretory systems of the body. Diurnal monitoring of AP (DMAP) registered a significant decrease in SAP averagely from 174±12 to 145±10 mm Hg three days after the intervention. A persistent antihypertensive effect was confirmed by the DMAP findings one month after denervation - the SAP level averagely amounted to 131±6 mm Hg. Endovascular radiofrequency denervation of renal arteries is a safe and efficient method of treatment of AH resistant

Glucose-lowering effect and glycaemic variability of insulin glargine, insulin detemir and insulin lispro protamine in people with type 1 diabetes.

Science.gov (United States)

Derosa, G; Franzetti, I; Querci, F; Romano, D; D'Angelo, A; Maffioli, P

2015-06-01

To compare, using a continuous glucose monitoring (CGM) system, the effect on glycaemic variability of insulin glargine, detemir and lispro protamine. A total of 49 white people with type 1 diabetes, not well controlled by three times daily insulin lispro, taken for at least 2 months before study and on a stable dose, were enrolled. The study participants were randomized to add insulin glargine, detemir or lispro protamine, once daily, in the evening. We used a CGM system, the iPro Digital Recorder (Medtronic MiniMed, Northridge, CA, USA) for 1 week. Glycaemic control was assessed according to mean blood glucose values, the area under the glucose curve above 3.9 mmol/l (AUC(>3.9)) or above 10.0 mmol/l (AUC(>10.0)), and the percentage of time spent with glucose values >3.9 or >10.0 mmol/l. Intraday glycaemic variability was assessed using standard deviation (s.d.) values, the mean amplitude of glycaemic excursions and continuous overlapping of net glycaemic action. Day-to-day glycaemic variability was assessed using the mean of daily differences. The s.d. was found to be significantly lower with insulin lispro protamine and glargine compared with insulin detemir. AUC(>3.9) was higher and AUC(>10.0) was lower with insulin lispro protamine and glargine compared with detemir. The mean amplitude of glycaemic excursions and continuous overlapping net glycaemic action values were lower with insulin lispro protamine and glargine compared with detemir. In addition, the mean of daily differences was significantly lower with insulin lispro protamine and glargine compared with detemir. Fewer hypoglycaemic events were recorded during the night-time with insulin lispro protamine compared with glargine and detemir. The results suggest that insulin lispro protamine and glargine are more effective than detemir in reducing glycaemic variability and improving glycaemic control in people with type 1 diabetes. Insulin lispro protamine seems to lead to fewer hypoglycaemic

Systems integration (automation system). System integration (automation system)

Energy Technology Data Exchange (ETDEWEB)

Fujii, K; Komori, T; Fukuma, Y; Oikawa, M [Nippon Steal Corp., Tokyo (Japan)

1991-09-26

This paper introduces business activities on an automation systems integration (SI) started by a company in July,1988, and describes the SI concepts. The business activities include, with the CIM (unified production carried out on computers) and AMENITY (living environment) as the mainstays, a single responsibility construction ranging from consultation on structuring optimal systems for processing and assembling industries and intelligent buildings to system design, installation and after-sales services. With an SI standing on users {prime} position taken most importantly, the business starts from a planning and consultation under close coordination. On the conceptual basis of structuring optimal systems using the ompany {prime}s affluent know-hows and tools and adapting and applying with multi-vendors, open networks, centralized and distributed systems, the business is promoted with the accumulated technologies capable of realizing artificial intelligence and neural networks in its background, and supported with highly valuable business results in the past. 10 figs., 1 tab.

Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs.

Science.gov (United States)

Bettinger, Nicolas; Khalique, Omar K; Krepp, Joseph M; Hamid, Nadira B; Bae, David J; Pulerwitz, Todd C; Liao, Ming; Hahn, Rebecca T; Vahl, Torsten P; Nazif, Tamim M; George, Isaac; Leon, Martin B; Einstein, Andrew J; Kodali, Susheel K

The threshold for the optimal computed tomography (CT) number in Hounsfield Units (HU) to quantify aortic valvular calcium on contrast-enhanced scans has not been standardized. Our aim was to find the most accurate threshold to predict paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). 104 patients who underwent TAVR with the CoreValve prosthesis were studied retrospectively. Luminal attenuation (LA) in HU was measured at the level of the aortic annulus. Calcium volume score for the aortic valvular complex was measured using 6 threshold cutoffs (650 HU, 850 HU, LA × 1.25, LA × 1.5, LA+50, LA+100). Receiver-operating characteristic (ROC) analysis was performed to assess the predictive value for > mild PVR (n = 16). Multivariable analysis was performed to determine the accuracy to predict > mild PVR after adjustment for depth and perimeter oversizing. ROC analysis showed lower area under the curve (AUC) values for fixed threshold cutoffs (650 or 850 HU) compared to thresholds relative to LA. The LA+100 threshold had the highest AUC (0.81), and AUC was higher than all studied protocols, other than the LA x 1.25 and LA + 50 protocols, where the difference approached statistical significance (p = 0.05, and 0.068, respectively). Multivariable analysis showed calcium volume determined by the LAx1.25, LAx1.5, LA+50, and LA+ 100 HU protocols to independently predict PVR. Calcium volume scoring thresholds which are relative to LA are more predictive of PVR post-TAVR than those which use fixed cutoffs. A threshold of LA+100 HU had the highest predictive value. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Impact of Annular Size on Outcomes After Surgical or Transcatheter Aortic Valve Replacement.

Science.gov (United States)

Deeb, G Michael; Chetcuti, Stanley J; Yakubov, Steven J; Patel, Himanshu J; Grossman, P Michael; Kleiman, Neal S; Heiser, John; Merhi, William; Zorn, George L; Tadros, Peter N; Petrossian, George; Robinson, Newell; Mumtaz, Mubashir; Gleason, Thomas G; Huang, Jian; Conte, John V; Popma, Jeffrey J; Reardon, Michael J

2018-04-01

This analysis evaluates the relationship of annular size to hemodynamics and the incidence of prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients. The CoreValve US Pivotal High Risk Trial, described previously, compared TAVR using a self-expanding valve with SAVR. Multislice computed tomography was used to categorize TAVR and SAVR subjects according to annular perimeter-derived diameter: large (≥26 mm), medium (23 to <26 mm), and small (<23 mm). Hemodynamics, PPM, and clinical outcomes were assessed. At all postprocedure visits, mean gradients were significantly lower for TAVR compared with SAVR in small and medium size annuli (p < 0.001). Annular size was significantly associated with mean gradient after SAVR, with small annuli having the highest gradients (p < 0.05 at all timepoints); gradients were similar across all annular sizes after TAVR. In subjects receiving SAVR, the frequency of PPM was significantly associated with annular size, with small annuli having the greatest incidence. No difference in PPM incidence by annular sizing was observed with TAVR. In addition, TAVR subjects had significantly less PPM than SAVR subjects in small and medium annuli (p < 0.001), with no difference in the incidence of PPM between TAVR and SAVR in large annuli (p = 0.10). Annular size has a significant effect on hemodynamics and the incidence of PPM in SAVR subjects, not observed in TAVR subjects. With respect to annular size, TAVR results in better hemodynamics and less PPM for annuli less than 26 mm and should be strongly considered when choosing a tissue valve for small and medium size annuli. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Endovascular aneurysm repair simulation can lead to decreased fluoroscopy time and accurately delineate the proximal seal zone.

Science.gov (United States)

Kim, Ann H; Kendrick, Daniel E; Moorehead, Pamela A; Nagavalli, Anil; Miller, Claire P; Liu, Nathaniel T; Wang, John C; Kashyap, Vikram S

2016-07-01

The use of simulators for endovascular aneurysm repair (EVAR) is not widespread. We examined whether simulation could improve procedural variables, including operative time and optimizing proximal seal. For the latter, we compared suprarenal vs infrarenal fixation endografts, right femoral vs left femoral main body access, and increasing angulation of the proximal aortic neck. Computed tomography angiography was obtained from 18 patients who underwent EVAR at a single institution. Patient cases were uploaded to the ANGIO Mentor endovascular simulator (Simbionix, Cleveland, Ohio) allowing for three-dimensional reconstruction and adapted for simulation with suprarenal fixation (Endurant II; Medtronic Inc, Minneapolis, Minn) and infrarenal fixation (C3; W. L. Gore & Associates Inc, Newark, Del) deployment systems. Three EVAR novices and three experienced surgeons performed 18 cases from each side with each device in randomized order (n = 72 simulations/participant). The cases were stratified into three groups according to the degree of infrarenal angulation: 0° to 20°, 21° to 40°, and 41° to 66°. Statistical analysis used paired t-test and one-way analysis of variance. Mean fluoroscopy time for participants decreased by 48.6% (P time decreased by 33.8% (P zone coverage in highly angulated aortic necks was significantly decreased. The infrarenal device resulted in mean aortic neck zone coverage of 91.9%, 89.4%, and 75.4% (P zone coverage. The side of femoral access for the main body did not influence proximal seal zone coverage regardless of infrarenal angulation. Simulation of EVAR leads to decreased fluoroscopy times for novice and experienced operators. Side of femoral access did not affect precision of proximal endograft landing. The angulated aortic neck leads to decreased proximal seal zone coverage regardless of infrarenal or suprarenal fixation devices. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Chronic multisite brain recordings from a totally implantable bidirectional neural interface: experience in 5 patients with Parkinson's disease.

Science.gov (United States)

Swann, Nicole C; de Hemptinne, Coralie; Miocinovic, Svjetlana; Qasim, Salman; Ostrem, Jill L; Galifianakis, Nicholas B; Luciano, Marta San; Wang, Sarah S; Ziman, Nathan; Taylor, Robin; Starr, Philip A

2018-02-01

OBJECTIVE Dysfunction of distributed neural networks underlies many brain disorders. The development of neuromodulation therapies depends on a better understanding of these networks. Invasive human brain recordings have a favorable temporal and spatial resolution for the analysis of network phenomena but have generally been limited to acute intraoperative recording or short-term recording through temporarily externalized leads. Here, the authors describe their initial experience with an investigational, first-generation, totally implantable, bidirectional neural interface that allows both continuous therapeutic stimulation and recording of field potentials at multiple sites in a neural network. METHODS Under a physician-sponsored US Food and Drug Administration investigational device exemption, 5 patients with Parkinson's disease were implanted with the Activa PC+S system (Medtronic Inc.). The device was attached to a quadripolar lead placed in the subdural space over motor cortex, for electrocorticography potential recordings, and to a quadripolar lead in the subthalamic nucleus (STN), for both therapeutic stimulation and recording of local field potentials. Recordings from the brain of each patient were performed at multiple time points over a 1-year period. RESULTS There were no serious surgical complications or interruptions in deep brain stimulation therapy. Signals in both the cortex and the STN were relatively stable over time, despite a gradual increase in electrode impedance. Canonical movement-related changes in specific frequency bands in the motor cortex were identified in most but not all recordings. CONCLUSIONS The acquisition of chronic multisite field potentials in humans is feasible. The device performance characteristics described here may inform the design of the next generation of totally implantable neural interfaces. This research tool provides a platform for translating discoveries in brain network dynamics to improved neurostimulation

Differences in left ventricular remodelling in patients with aortic stenosis treated with transcatheter aortic valve replacement with corevalve prostheses compared to surgery with porcine or bovine biological prostheses

DEFF Research Database (Denmark)

Ngo, Thuc Anh; Hassager, Christian; Thyregod, Hans Gustav Hørsted

2018-01-01

Aims: Patients with severe aortic stenosis (AS) can be considered for treatment with either transcatheter (TAVR) or surgical aortic valve replacement (SAVR). The purpose of this study was to compare left ventricular (LV) remodeling in patients with AS after treatment with TAVR or SAVR. Methods...... were randomized to TAVR and 112 to SAVR. From baseline to 12 months post-procedure, aortic valve area (AVA) increased in both groups, but with a larger increase in the TAVR group (0.65 ± 0.04 cm2 vs. 1.02 ± 0.05 cm2 for SAVR and TAVR group, P regression was more.......0001). Paravalvular leakage (PVL) and pacemaker implantations were more common in patients treated with TAVR, which was associated with an increase in EDV (P regression at 1 year compared with patients undergoing TAVR, which may be due to increasing...

Experiência inicial em málaga (Espanha) com prótese aórtica CoreValve para tratamento de estenose aórtica sintomática grave

OpenAIRE

Hernández-García,José M.; Muñoz García,Antonio J.; Alonso-Briales,Juan H.; Jiménez-Navarro,Manuel F.; Domínguez-Franco,Antonio J.; Rodríguez-Bailón,Isabel; Hernández,Paula; Olalla-Mercadé,Eduardo; Teresa-Galván,Eduardo de

2009-01-01

INTRODUÇÃO: A prevalência de estenose aórtica grave vem crescendo em decorrência do aumento da expectativa de vida. Alguns pacientes não se beneficiam do tratamento cirúrgico por causa das comorbidades associadas. Apresentamos os resultados de nossa experiência no tratamento percutâneo da estenose aórtica. MÉTODO: Estudo prospectivo, realizado entre abril de 2008 e fevereiro de 2009, em que 31 pacientes consecutivos com estenose aórtica grave sintomática e que apresentavam alto risco cirúrgic...

Coupling component systems towards systems of systems

OpenAIRE

Autran , Frédéric; Auzelle , Jean-Philippe; Cattan , Denise; Garnier , Jean-Luc; Luzeaux , Dominique; Mayer , Frédérique; Peyrichon , Marc; Ruault , Jean-René

2008-01-01

International audience; Systems of systems (SoS) are a hot topic in our "fully connected global world". Our aim is not to provide another definition of what SoS are, but rather to focus on the adequacy of reusing standard system architecting techniques within this approach in order to improve performance, fault detection and safety issues in large-scale coupled systems that definitely qualify as SoS, whatever the definition is. A key issue will be to secure the availability of the services pr...

Digital processing data communication systems (bus systems). Digitale Prozessdaten-Kommunikations-Systeme (Bus Systeme)

Energy Technology Data Exchange (ETDEWEB)

Fleck, K

1980-01-01

After an introduction to the technology of digital processing data communication systems there are the following chapters: digital communication of processing data in automation technology, the technology of biserial communication, the implementaiton of a bus system, the data transmission of the TDC-2000 system of Honeywell's and the process bus CS 275 in the automation system TELEPERM M of Siemens AG.

Protecting information in systems of systems

NARCIS (Netherlands)

Trivellato, D.

2012-01-01

Systems of systems are coalitions of autonomous and heterogeneous systems that collaborate to achieve a common goal. The component systems of a system of systems often belong to different security domains, which are governed by different authorities (hereafter called parties). Furthermore, systems

Dose optimisation for intraoperative cone-beam flat-detector CT in paediatric spinal surgery

International Nuclear Information System (INIS)

Petersen, Asger Greval; Eiskjaer, Soeren; Kaspersen, Jon

2012-01-01

During surgery for spinal deformities, accurate placement of pedicle screws may be guided by intraoperative cone-beam flat-detector CT. The purpose of this study was to identify appropriate paediatric imaging protocols aiming to reduce the radiation dose in line with the ALARA principle. Using O-arm registered (Medtronic, Inc.), three paediatric phantoms were employed to measure CTDI w doses with default and lowered exposure settings. Images from 126 scans were evaluated by two spinal surgeons and scores were compared (Kappa statistics). Effective doses were calculated. The recommended new low-dose 3-D spine protocols were then used in 15 children. The lowest acceptable exposure as judged by image quality for intraoperative use was 70 kVp/40 mAs, 70 kVp/80 mAs and 80 kVp/40 mAs for the 1-, 5- and 12-year-old-equivalent phantoms respectively (kappa = 0,70). Optimised dose settings reduced CTDI w doses 89-93%. The effective dose was 0.5 mSv (91-94,5% reduction). The optimised protocols were used clinically without problems. Radiation doses for intraoperative 3-D CT using a cone-beam flat-detector scanner could be reduced at least 89% compared to manufacturer settings and still be used to safely navigate pedicle screws. (orig.)

How does an inventor find an investor or partner? Raising funds to start a company.

Science.gov (United States)

Mazzocchi, Rudy A

2017-05-01

Rudy Mazzocchi has over 25 years of senior executive management, technology and intellectual property development, and financing experience in the medical-technology/biotechnology industries. He serves currently as cofounder/chief executive officer of ELENZA, Inc, an ophthalmology company that has developed an electro-active, autofocusing, implantable lens; executive chairman of Establishment Labs; executive chairman of LAFORGE Optical; and executive chairman of OptiSTENT, Inc. He served previously as managing director of Accuitive Medical Ventures and The Innovation Factory; cofounder/chief executive officer of Image-Guided NEUROLOGICS, acquired by Medtronic in 2005; and founding chief executive officer of MICROVENA Corporation, which became "eV3," acquired by Covidien. He was formerly cofounder/director of Vascular Science, acquired by St Jude Medical in 1996, and cofounder/chairman of CytoGenesis, one of the first United States stem cell companies that was merged with BresaGen and listed on the Australian public exchange. He is the recipient of the Technology Leadership Award, the Businessman of the Year Award, the Ernst & Young Entrepreneur of the Year Award in Healthcare, and Global Entrepreneur of the Year Award. He has also authored more than 70 patents; 2 published, award-winning novels (medical thrillers); and a top-selling business book on entrepreneurism. Copyright © 2016 Elsevier Inc. All rights reserved.

Lumbar lordosis restoration following single-level instrumented fusion comparing 4 commonly used techniques.

Science.gov (United States)

Dimar, John R; Glassman, Steven D; Vemuri, Venu M; Esterberg, Justin L; Howard, Jennifer M; Carreon, Leah Y

2011-11-09

A major sequelae of lumbar fusion is acceleration of adjacent-level degeneration due to decreased lumbar lordosis. We evaluated the effectiveness of 4 common fusion techniques in restoring lordosis: instrumented posterolateral fusion, translumbar interbody fusion, anteroposterior fusion with posterior instrumentation, and anterior interbody fusion with lordotic threaded (LT) cages (Medtronic Sofamor Danek, Memphis, Tennessee). Radiographs were measured preoperatively, immediately postoperatively, and a minimum of 6 months postoperatively. Parameters measured included anterior and posterior disk space height, lumbar lordosis from L3 to S1, and surgical level lordosis.No significant difference in demographics existed among the 4 groups. All preoperative parameters were similar among the 4 groups. Lumbar lordosis at final follow-up showed no difference between the anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cage groups, although the posterolateral fusion group showed a significant loss of lordosis (-10°) (Plordosis and showed maintenance of anterior and posterior disk space height postoperatively compared with the other groups. Instrumented posterolateral fusion produces a greater loss of lordosis compared with anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cages. Maintenance of lordosis and anterior and posterior disk space height is significantly better with anterior interbody fusion with LT cages. Copyright 2011, SLACK Incorporated.

A case of delayed cardiac perforation of active ventricular lead

Directory of Open Access Journals (Sweden)

Hangyuan Guo

2011-12-01

Full Text Available A 65-year-old man was admitted as for one month of repetitive dizziness and one episode of syncope. Electrocardiogram showed sinus bradycardia and his Holter monitoring also showed sinus bradycardia with sinus arrest, sino-atrial block and a longest pause of 4.3 s. Then sick sinus syndrome and Adam-Stokes syndrome were diagnosed. Then a dual chamber pacemaker (Medtronic SDR303 was implanted and the parameters were normal by detection. The patient was discharged 1 week later with suture removed. Then 1.5 month late the patient was presented to hospital once again for sudden onset of chest pain with exacerbation after taking deep breath. Pacemaker programming showed both pacing and sensing abnormality with threshold of?5.0V and resistance of 1200?. Lead perforation was revealed by chest X-ray and confirmed by echocardiogram. Considering the fact that there was high risk to remove ventricular lead, spiral tip of previous ventricular lead was withdrew followed by implantation of a new ventricular active lead to the septum. Previous ventricular lead was maintained. As we know that the complications of lead perforation in the clinic was rare. Here we discuss the clinical management and the possible reasons for cardiac perforation of active ventricular lead.

Temperature measurement on neurological pulse generators during MR scans

Directory of Open Access Journals (Sweden)

Alesch François

2002-09-01

Full Text Available Abstract According to manufacturers of both magnetic resonance imaging (MRI machines, and implantable neurological pulse generators (IPGs, MRI is contraindicated for patients with IPGs. A major argument for this restriction is the risk to induce heat in the leads due to the electromagnetic field, which could be dangerous for the surrounding brain parenchyma. The temperature change on the surface of the case of an ITREL-III (Medtronic Inc., Minneapolis, MN and the lead tip during MRI was determined. An anatomical realistic and a cubic phantom, filled with phantom material mimicking human tissue, and a typical lead configuration were used to imitate a patient who carries an IPG for deep brain stimulation. The measurements were performed in a 1.5 T and a 3.0 T MRI. 2.1°C temperature increases at the lead tip uncovered the lead tip as the most critical part concerning heating problems in IPGs. Temperature increases in other locations were low compared to the one at the lead tip. The measured temperature increase of 2.1°C can not be considered as harmful to the patient. Comparison with the results of other studies revealed the avoidance of loops as a practical method to reduce heating during MRI procedures.

Electromagnetic Interference from Swimming Pool Generator Current Causing Inappropriate ICD Discharges

Directory of Open Access Journals (Sweden)

Edward Samuel Roberto

2017-01-01

Full Text Available Electromagnetic interference (EMI includes any electromagnetic field signal that can be detected by device circuitry, with potentially serious consequences: incorrect sensing, pacing, device mode switching, and defibrillation. This is a unique case of extracardiac EMI by alternating current leakage from a submerged motor used to recycle chlorinated water, resulting in false rhythm detection and inappropriate ICD discharge. A 31-year-old female with arrhythmogenic right ventricular cardiomyopathy and Medtronic dual-chamber ICD placement presented after several inappropriate ICD shocks at the public swimming pool. Patient had never received prior shocks and device was appropriate at all regular follow-ups. Intracardiac electrograms revealed unique, high-frequency signals at exactly 120 msec suggestive of EMI from a strong external source of alternating current. Electrical artifact was incorrectly sensed as a ventricular arrhythmia which resulted in discharge. ICD parameters including sensing, pacing thresholds, and impedance were all normal suggesting against device malfunction. With device failure and intracardiac sources excluded, EMI was therefore strongly suspected. Avoidance of EMI source brought complete resolution with no further inappropriate shocks. After exclusion of intracardiac interference, device malfunction, and abnormal settings, extracardiac etiologies such as EMI must be thoughtfully considered and excluded. Elimination of inappropriate shocks is to “first, do no harm.”

[Mechanical studies of lumbar interbody fusion implants].

Science.gov (United States)

Bader, R J; Steinhauser, E; Rechl, H; Mittelmeier, W; Bertagnoli, R; Gradinger, R

2002-05-01

In addition to autogenous or allogeneic bone grafts, fusion cages composed of metal or plastic are being used increasingly as spacers for interbody fusion of spinal segments. The goal of this study was the mechanical testing of carbon fiber reinforced plastic (CFRP) fusion cages used for anterior lumbar interbody fusion. With a special testing device according to American Society for Testing and Materials (ASTM) standards, the mechanical properties of the implants were determined under four different loading conditions. The implants (UNION cages, Medtronic Sofamor Danek) provide sufficient axial compression, shear, and torsional strength of the implant body. Ultimate axial compression load of the fins is less than the physiological compression loads at the lumbar spine. Therefore by means of an appropriate surgical technique parallel grooves have to be reamed into the endplates of the vertebral bodies according to the fin geometry. Thereby axial compression forces affect the implants body and the fins are protected from damaging loading. Using a supplementary anterior or posterior instrumentation, in vivo failure of the fins as a result of physiological shear and torsional spinal loads is unlikely. Due to specific complications related to autogenous or allogeneic bone grafts, fusion cages made of metal or carbon fiber reinforced plastic are an important alternative implant in interbody fusion.

Denervation (ablation) of nerve terminalis in renal arteries: early results of interventional treatment of arterial hypertension in Poland.

Science.gov (United States)

Bartuś, Krzysztof; Sadowski, Jerzy; Kapelak, Bogusław; Zajdel, Wojciech; Godlewski, Jacek; Bartuś, Stanisław; Bochenek, Maciej; Bartuś, Magdalena; Żmudka, Krzysztof; Sobotka, Paul A

2013-01-01

Arterial hypertension is one of the main causes of cardiovascular disease morbidity and overall mortality. To report the single centre experiences with changes in arterial blood pressure (BP) in patients after intra-arterial application of radiofrequency (RF) energy to cause renal sympathetic efferent and somatic afferent nerve and report vascular and kidney safety in a six month follow up. Twenty-eight patients, with hypertension despite medical therapy (median age 52.02 years, range 42-72 years) consented to therapeutic renal nerve ablation. SIMPLICITY RF catheters and generator provided by Ardian (currently Medtronic Inc., USA) were used to perform renal artery angiography and ablation. The mean BP at baseline, and after one month, three months and six months were measured [mm Hg]: systolic 176.6; 162.3 (p = 0.004); 150.6 (p arterial renal nerve denervation was not associated with either vascular or renal complications out to six months. Nerve ablation of renal arteries led to significant reduction of mean values of arterial systolic, diastolic BP and significant reduction of pulse pressure. The Polish experience is not significantly different compared to that reported in the Symplicity I and Symplicity II international cohorts. The long term durability of this therapy and its application to earlier stages of hypertension or other disease states will require further investigation.

Data Systems vs. Information Systems

OpenAIRE

Amatayakul, Margret K.

1982-01-01

This paper examines the current status of “hospital information systems” with respect to the distinction between data systems and information systems. It is proposed that the systems currently existing are incomplete data dystems resulting in ineffective information systems.

Situation awareness with systems of systems

CERN Document Server

Tretmans, Jan; Borth, Michael

2013-01-01

This book discusses various aspects, challenges, and solutions for developing systems-of-systems for situation awareness, using applications in the domain of maritime safety and security.  Topics include advanced, multi-objective visualization methods for situation awareness, stochastic outlier selection, rule-based anomaly detection, an ontology-based event model for semantic reasoning, new methods for semi-automatic generation of adapters bridging communication gaps, security policies for systems-of-systems, trust assessment, and methods to deal with the dynamics of systems-of-systems in run-time monitoring, testing, and diagnosis. Architectural considerations for designing information-centric systems-of-systems such as situation awareness systems, and an integrated demonstrator implementing many of the investigated aspects, complete the book.

Intelligent Control Systems with an Introduction to System of Systems Engineering

CERN Document Server

Nanayakkara, Thrishantha

2009-01-01

From aeronautics and manufacturing to healthcare and disaster management, systems engineering (SE) focuses on designing applications that ensure performance optimization. This title integrates the fundamentals of artificial intelligence and systems control in a framework applicable to both simple dynamic systems and large-scale system of systems

Upgraded RECOVER system - CASDAC system

International Nuclear Information System (INIS)

Yamamoto, Yoichi; Koyama, Kinji

1992-03-01

The CASDAC (Containment And Surveillance Data Authenticated Communication) system has been developed by JAERI for nuclear safeguards and physical protection of nuclear material. This system was designed and constructed as an upgraded RECOVER system, design concept of which was based on the original RECOVER system and also the TRANSEAVER system. Both of them were developed several years ago as a remote monitoring system for continual verification of security and safeguards status of nuclear material. The system consists of two subsystems, one of them is a Grand Command Center (GCC) subsystem and the other is a facility subsystem. Communication between the two subsystems is controlled through the international telephone line network. Therefore all communication data are encrypted to prevent access by an unauthorized person who may intend to make a falsification, or tapping. The facility subsystem has an appropriate measure that ensure data security and reliable operation under unattended mode of operator. The software of this system is designed so as to be easily used in other different types of computers. This report describes the outline of the CASDAC system and the results of its performance test. This work has been carried out in the framework of Japan Support Programme for Agency Safeguards (JASPAS) as a project, JA-1. (author)

System design specification Brayton Isotope Power System (BIPS) Flight System (FS), and Ground Demonstration System (GDS)

International Nuclear Information System (INIS)

1976-01-01

The system design specification for ground demonstration, development, and flight qualification of a Brayton Isotope Power System (BIPS) is presented. The requirements for both a BIPS conceptual Flight System (FS) and a Ground Demonstration System (GDS) are defined

Miniesternotomia na cirurgia de revascularização miocárdica sem circulação extracorpórea Ministernotomy in off-pump coronary artery bypass surgery

Directory of Open Access Journals (Sweden)

Walter J. Gomes

2005-12-01

Full Text Available OBJETIVO: Os pacientes com lesão isolada da artéria coronária descendente anterior (ADA se beneficiam mais do tratamento cirúrgico do que com intervenção percutânea. Entretanto, com a menor invasividade da intervenção percutânea, a maioria dos pacientes tem sido direcionada para este procedimento. Relatamos a utilização da miniesternotomia inferior como abordagem para o tratamento de pacientes com lesão única de ADA, com anastomose do enxerto de artéria torácica interna esquerda (ATIE, sem uso de circulação extracorpórea (CEC. MÉTODO: Foram estudados 14 pacientes operados consecutivamente utilizando esta técnica, na qual o enxerto de ATIE foi anastomosado à ADA. A idade média dos pacientes foi 56,7±10,1 anos. A incisão cutânea tinha entre 7 e 9 cm e a porção inferior do esterno foi aberta longitudinalmente. A anastomose foi facilitada com o uso de estabilizadores Octopus-3® (Medtronic. RESULTADOS: Todos os pacientes tiveram boa evolução pós-operatória, com alta hospitalar entre 2 e 6 dias de PO (mediana 3 dias. Não houve alteração de ECG ou elevação enzimática neste grupo. Um paciente foi reinternado por infecção de ferida operatória. CONCLUSÃO: A miniesternotomia permite a realização segura do procedimento cirúrgico de revascularização miocárdica da ADA, sem CEC, com benefício em longo-termo do uso da ATIE.OBJECTIVE: Patients with isolated lesions in the proximal left anterior descending artery (LAD have been demonstrated to benefit more from surgical treatment than percutaneous coronary intervention (PCI. However, with the less invasiveness of PCI, the majority of the patients have been referred for this latter procedure. We report herein on the inferior ministernotomy approach for the treatment of patients with single LAD lesions, with off-pump anastomosis of the left internal thoracic artery graft. METHOD: Fourteen patients, consecutively operated on using this technique with the LITA graft

Profiling Systems Using the Defining Characteristics of Systems of Systems (SoS)

Science.gov (United States)

2010-02-01

system exhaust and emissions system gas engine heating and air conditioning system fuel system regenerative braking system safety system...overcome the limitations of these fuzzy scales, measurement scales are often divided into a relatively small number of disjoint categories so that the...precision is not justified. This lack of precision can typically be addressed by breaking the measurement scale into a set of categories , the use of

Superspeed Maglev system Transrapid. System decription

Energy Technology Data Exchange (ETDEWEB)

Miller, L [Thyssen Henschel AG,, Maglev Transportation Technology, Muenchen (Germany)

1996-12-31

The superspeed maglev system Transrapid is a track-bound transportation system for passengern and priority freight transport. The transrapid trainsets are composed of self-sufficient vehicle section coupled together. The superspeed maglev system Transrapid is capable of revenue operation at speeds of 100 to 500 km/h. Besides the description of the system concept and system characteristics safety and availability are discussed. (HW)

Linking Political Systems and War Systems

DEFF Research Database (Denmark)

Harste, Gorm

2009-01-01

Decisive parts of the Western political system have demonstrated a seemingly surprising misinterpretation of military might. As Madelaine Albright has suggested, the mighty perceived themselves as "almighty". Political power seems to have invested in instrumental coercive power relations and found...... military coercion to be the appropriate mean. Using the system theory and the theory of systemic risks displayed by the German sociologist Niklas Luhmann the article demonstrates how military systems due to their own autonomy and autopoiesis do not fit into the idea of political government....... The Clausewitzian ideal of a political system that could continue its power games by means of war was moderated by Clausewitz' own analysis of "friction". How can a political system be so blind towards the possibilities of another system? What are the risks of systemic blind spots? The argument of the paper...

From systems biology to systems biomedicine.

Science.gov (United States)

Antony, Paul M A; Balling, Rudi; Vlassis, Nikos

2012-08-01

Systems Biology is about combining theory, technology, and targeted experiments in a way that drives not only data accumulation but knowledge as well. The challenge in Systems Biomedicine is to furthermore translate mechanistic insights in biological systems to clinical application, with the central aim of improving patients' quality of life. The challenge is to find theoretically well-chosen models for the contextually correct and intelligible representation of multi-scale biological systems. In this review, we discuss the current state of Systems Biology, highlight the emergence of Systems Biomedicine, and highlight some of the topics and views that we think are important for the efficient application of Systems Theory in Biomedicine. Copyright © 2011 Elsevier Ltd. All rights reserved.

Computer System Design System-on-Chip

CERN Document Server

Flynn, Michael J

2011-01-01

The next generation of computer system designers will be less concerned about details of processors and memories, and more concerned about the elements of a system tailored to particular applications. These designers will have a fundamental knowledge of processors and other elements in the system, but the success of their design will depend on the skills in making system-level tradeoffs that optimize the cost, performance and other attributes to meet application requirements. This book provides a new treatment of computer system design, particularly for System-on-Chip (SOC), which addresses th

Future of robotic surgery in urology.

Science.gov (United States)

Rassweiler, Jens J; Autorino, Riccardo; Klein, Jan; Mottrie, Alex; Goezen, Ali Serdar; Stolzenburg, Jens-Uwe; Rha, Koon H; Schurr, Marc; Kaouk, Jihad; Patel, Vipul; Dasgupta, Prokar; Liatsikos, Evangelos

2017-12-01

To provide a comprehensive overview of the current status of the field of robotic systems for urological surgery and discuss future perspectives. A non-systematic literature review was performed using PubMed/Medline search electronic engines. Existing patents for robotic devices were researched using the Google search engine. Findings were also critically analysed taking into account the personal experience of the authors. The relevant patents for the first generation of the da Vinci platform will expire in 2019. New robotic systems are coming onto the stage. These can be classified according to type of console, arrangement of robotic arms, handles and instruments, and other specific features (haptic feedback, eye-tracking). The Telelap ALF-X robot uses an open console with eye-tracking, laparoscopy-like handles with haptic feedback, and arms mounted on separate carts; first clinical trials with this system were reported in 2016. The Medtronic robot provides an open console using three-dimensional high-definition video technology and three arms. The Avatera robot features a closed console with microscope-like oculars, four arms arranged on one cart, and 5-mm instruments with six degrees of freedom. The REVO-I consists of an open console and a four-arm arrangement on one cart; the first experiments with this system were published in 2016. Medicaroid uses a semi-open console and three robot arms attached to the operating table. Clinical trials of the SP 1098-platform using the da Vinci Xi for console-based single-port surgery were reported in 2015. The SPORT robot has been tested in animal experiments for single-port surgery. The SurgiBot represents a bedside solution for single-port surgery providing flexible tube-guided instruments. The Avicenna Roboflex has been developed for robotic flexible ureteroscopy, with promising early clinical results. Several console-based robots for laparoscopic multi- and single-port surgery are expected to come to market within the

The systems integration modeling system

International Nuclear Information System (INIS)

Danker, W.J.; Williams, J.R.

1990-01-01

This paper discusses the systems integration modeling system (SIMS), an analysis tool for the detailed evaluation of the structure and related performance of the Federal Waste Management System (FWMS) and its interface with waste generators. It's use for evaluations in support of system-level decisions as to FWMS configurations, the allocation, sizing, balancing and integration of functions among elements, and the establishment of system-preferred waste selection and sequencing methods and other operating strategies is presented. SIMS includes major analysis submodels which quantify the detailed characteristics of individual waste items, loaded casks and waste packages, simulate the detailed logistics of handling and processing discrete waste items and packages, and perform detailed cost evaluations

System specifications for the NDS Dictionary System

International Nuclear Information System (INIS)

Attree, P.M.; Smith, P.M.

1979-09-01

The NDS Dictionary System is a computerized system for maintaining and distributing the EXFOR dictionaries and for preparing internal versions of these dictionaries for use in the NDS EXFOR System and other NDS systems. This document is an internal manual for the system specifications of the NDS Dictionary System. It includes flow charts, system and program summaries, input and output specifications and file and record descriptions. This manual is updated from time to time when system modifications are made; this is the version of January 1979

Protecting Information in Systems of Systems

NARCIS (Netherlands)

Trivellato, Daniel; Zannone, Nicola; Etalle, Sandro

2011-01-01

Systems of Systems (SoS) are dynamic, distributed coalitions of autonomous and heterogeneous systems that collaborate to achieve a common goal. While offering several advantages in terms of scalability and flexibility, the SoS paradigm has a strong impact on system interoperability and on the

Expert Systems: What Is an Expert System?

Science.gov (United States)

Duval, Beverly K.; Main, Linda

1994-01-01

Describes expert systems and discusses their use in libraries. Highlights include parts of an expert system; expert system shells; an example of how to build an expert system; a bibliography of 34 sources of information on expert systems in libraries; and a list of 10 expert system shells used in libraries. (Contains five references.) (LRW)

Hot Spot Removal System: System description

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-09-01

Hazardous wastes contaminated with radionuclides, chemicals, and explosives exist across the Department of Energy complex and need to be remediated due to environmental concerns. Currently, an opportunity is being developed to dramatically reduce remediation costs and to assist in the acceleration of schedules associated with these wastes by deploying a Hot Spot Removal System. Removing the hot spot from the waste site will remove risk driver(s) and enable another, more cost effective process/option/remedial alternative (i.e., capping) to be applied to the remainder of the site. The Hot Spot Removal System consists of a suite of technologies that will be utilized to locate and remove source terms. Components of the system can also be used in a variety of other cleanup activities. This Hot Spot Removal System Description document presents technologies that were considered for possible inclusion in the Hot Spot Removal System, technologies made available to the Hot Spot Removal System, industrial interest in the Hot Spot Removal System`s subsystems, the schedule required for the Hot Spot Removal System, the evaluation of the relevant technologies, and the recommendations for equipment and technologies as stated in the Plan section.

Hot Spot Removal System: System description

International Nuclear Information System (INIS)

1997-09-01

Hazardous wastes contaminated with radionuclides, chemicals, and explosives exist across the Department of Energy complex and need to be remediated due to environmental concerns. Currently, an opportunity is being developed to dramatically reduce remediation costs and to assist in the acceleration of schedules associated with these wastes by deploying a Hot Spot Removal System. Removing the hot spot from the waste site will remove risk driver(s) and enable another, more cost effective process/option/remedial alternative (i.e., capping) to be applied to the remainder of the site. The Hot Spot Removal System consists of a suite of technologies that will be utilized to locate and remove source terms. Components of the system can also be used in a variety of other cleanup activities. This Hot Spot Removal System Description document presents technologies that were considered for possible inclusion in the Hot Spot Removal System, technologies made available to the Hot Spot Removal System, industrial interest in the Hot Spot Removal System''s subsystems, the schedule required for the Hot Spot Removal System, the evaluation of the relevant technologies, and the recommendations for equipment and technologies as stated in the Plan section

D0 Cryo System Control System Autodialer

Energy Technology Data Exchange (ETDEWEB)

Urbin, J.; /Fermilab

1990-04-17

The DO cryogenic system is controlled by a TI565-PLC based control system. This allows the system to be unmanned when in steady state operation. System experts will need to be contacted when system parameters exceed normal operating points and reach alarm setpoints. The labwide FIRUS system provides one alarm monitor and communication link. An autodialer provides a second and more flexible alarm monitor and communication link. The autodialer monitors contact points in the control system and after receiving indication of an alarm accesses a list of experts which it calls until it receives an acknowledgement. There are several manufacturers and distributors of autodialer systems. This EN explains the search process the DO cryo group used to fmd an autodialer system that fit the cryo system's needs and includes information and specs for the unit we chose.

Microendoscopic lumbar discectomy: Technique and results of 188 cases

Directory of Open Access Journals (Sweden)

Arvind G Kulkarni

2014-01-01

Full Text Available Background: Discectomy performed open or with an operating microscope remains the standard surgical management. Tubular retractor system is being increasingly used. Potential benefits include less muscle and local damage, better cosmesis, decreased pain and operative time and faster recovery after surgery. We have evaluated the outcome of micro endoscopic discectomy (MED utilizing tubular retractors in terms of safety and efficacy of the technique. Materials and Methods: 188 consecutive patients who underwent surgery for herniated disc using the tubular retractors between April 2007 and April 2012 are reported. All patients had a preoperative MRI (Magnetic Resonance Imaging and were operated by a single surgeon with the METRx system (Medtronic, Sofamor-Danek, Memphis, TN using 18 and 16 mm ports. All patients were mobilized as soon as pain subsided and discharged within 24-48 hours post surgery. The results were evaluated by using VAS (Visual Analog Scale 0-5 for back and leg pain and ODI (Oswestry Disability Index. Patients were followed up at intervals of 1 week, 6 weeks, 3 months, 6 months, 12 months and 2 years. Results: The mean age of patients was 46 years (range 16-78 years and the sex ratio was 1.5 males to 1 female. The mean followup was 22 months (range 8-69 months. The mean VAS scale for leg pain improved from 4.14 to 0.76 ( P < 0.05 and the mean VAS scale for back pain improved from 4.1 to 0.9 ( P < 0.05. The mean ODI changed from 59.5 to 22.6 ( P < 0.05. The mean operative time per level was about 50 minutes (range 20-90 minutes. Dural punctures occurred in 11 (5% cases. Average blood loss was 30 ml (range 10-500 ml. A wrong level was identified and later corrected in a case of revision discectomy. Four patients with residual disc-herniation had revision MED and three patients with recurrent disc herniation later underwent fusion. One patient had wound infection which needed a debridement. Conclusion: MED for herniated discs

Networked control of microgrid system of systems

Science.gov (United States)

Mahmoud, Magdi S.; Rahman, Mohamed Saif Ur; AL-Sunni, Fouad M.

2016-08-01

The microgrid has made its mark in distributed generation and has attracted widespread research. However, microgrid is a complex system which needs to be viewed from an intelligent system of systems perspective. In this paper, a network control system of systems is designed for the islanded microgrid system consisting of three distributed generation units as three subsystems supplying a load. The controller stabilises the microgrid system in the presence of communication infractions such as packet dropouts and delays. Simulation results are included to elucidate the effectiveness of the proposed control strategy.

System program for MICRO-CAMAC terminal system

International Nuclear Information System (INIS)

Sasajima, Yoji; Yamada, Takayuki; Yagi, Hideyuki; Ishiguro, Misako

1979-08-01

A JAERI on-line network system was developed and exists for on-line data processing of nuclear instrumentation. As terminal systems for the network system, the one with a Micro -8 micro-computer is used. By modifying the control program for Micro-8 terminal system, a system program has been developed for a MICRO-CAMAC terminal system, which is controlled by a micro-computer framed within the CAMAC Crate Controller. In this report are described software specifications of the MICRO -CAMAC terminal system and its operation method. (author)

System design in an evolving system-of-systems architecture and concept of operations

Science.gov (United States)

Rovekamp, Roger N., Jr.

Proposals for space exploration architectures have increased in complexity and scope. Constituent systems (e.g., rovers, habitats, in-situ resource utilization facilities, transfer vehicles, etc) must meet the needs of these architectures by performing in multiple operational environments and across multiple phases of the architecture's evolution. This thesis proposes an approach for using system-of-systems engineering principles in conjunction with system design methods (e.g., Multi-objective optimization, genetic algorithms, etc) to create system design options that perform effectively at both the system and system-of-systems levels, across multiple concepts of operations, and over multiple architectural phases. The framework is presented by way of an application problem that investigates the design of power systems within a power sharing architecture for use in a human Lunar Surface Exploration Campaign. A computer model has been developed that uses candidate power grid distribution solutions for a notional lunar base. The agent-based model utilizes virtual control agents to manage the interactions of various exploration and infrastructure agents. The philosophy behind the model is based both on lunar power supply strategies proposed in literature, as well as on the author's own approaches for power distribution strategies of future lunar bases. In addition to proposing a framework for system design, further implications of system-of-systems engineering principles are briefly explored, specifically as they relate to producing more robust cross-cultural system-of-systems architecture solutions.

Lighting system with thermal management system

Science.gov (United States)

Arik, Mehmet; Weaver, Stanton; Stecher, Thomas; Seeley, Charles; Kuenzler, Glenn; Wolfe, Jr., Charles; Utturkar, Yogen; Sharma, Rajdeep; Prabhakaran, Satish; Icoz, Tunc

2013-05-07

Lighting systems having unique configurations are provided. For instance, the lighting system may include a light source, a thermal management system and driver electronics, each contained within a housing structure. The light source is configured to provide illumination visible through an opening in the housing structure. The thermal management system is configured to provide an air flow, such as a unidirectional air flow, through the housing structure in order to cool the light source. The driver electronics are configured to provide power to each of the light source and the thermal management system.

Intelligent car guidance system (parking support system); Chiteki sharyo yudo system (chusha shien system)

Energy Technology Data Exchange (ETDEWEB)

NONE

2000-03-01

This system enables a driver to park the car at a predetermined spot without the driver seeing the outside scene. The system shows on a driver seat display the steps that the driver is to follow and thereby supports the driver when visibility is poor, when the parking space is difficult to approach, when the driver is a novice, or when the driver is aged. The system ensures accurate positioning of the car by showing the steering direction and angle, the car speed, and the force of braking to the driver. For this purpose, the system knows the absolute car position by the use of an RFID (Radio Frequency Identification) tag which is a kind of IC (Integrated Circuit) card and D-GPS (Differential-Global Positioning System), grasps the relative car position by the use of a gyroscope, and collects data from plural sensors, which are complementary to each other, such as a car-speed sensor and a steering sensor. (translated by NEDO)

SystemC and systemC-AMS in practice systemC 2.3, 2.2 and systemC-AMS 1.0

CERN Document Server

Banerjee, Amal

2013-01-01

This book describes how engineers can make optimum use of the two industry standard analysis/design tools, SystemC and SystemC-AMS.  The authors use a system-level design approach, emphasizing how SystemC and SystemC-AMS features can be exploited most effectively to analyze/understand a given electronic system and explore the design space. The approach taken by this book enables system engineers to concentrate on only those SystemC/SystemC-AMS features that apply to their particular problem, leading to more efficient design. The presentation includes numerous, realistic and complete examples,

Systems engineering for very large systems

Science.gov (United States)

Lewkowicz, Paul E.

Very large integrated systems have always posed special problems for engineers. Whether they are power generation systems, computer networks or space vehicles, whenever there are multiple interfaces, complex technologies or just demanding customers, the challenges are unique. 'Systems engineering' has evolved as a discipline in order to meet these challenges by providing a structured, top-down design and development methodology for the engineer. This paper attempts to define the general class of problems requiring the complete systems engineering treatment and to show how systems engineering can be utilized to improve customer satisfaction and profit ability. Specifically, this work will focus on a design methodology for the largest of systems, not necessarily in terms of physical size, but in terms of complexity and interconnectivity.

Mapping biological systems to network systems

CERN Document Server

Rathore, Heena

2016-01-01

The book presents the challenges inherent in the paradigm shift of network systems from static to highly dynamic distributed systems – it proposes solutions that the symbiotic nature of biological systems can provide into altering networking systems to adapt to these changes. The author discuss how biological systems – which have the inherent capabilities of evolving, self-organizing, self-repairing and flourishing with time – are inspiring researchers to take opportunities from the biology domain and map them with the problems faced in network domain. The book revolves around the central idea of bio-inspired systems -- it begins by exploring why biology and computer network research are such a natural match. This is followed by presenting a broad overview of biologically inspired research in network systems -- it is classified by the biological field that inspired each topic and by the area of networking in which that topic lies. Each case elucidates how biological concepts have been most successfully ...

Man-systems distributed system for Space Station Freedom

Science.gov (United States)

Lewis, J. L.

1990-01-01

Viewgraphs on man-systems distributed system for Space Station Freedom are presented. Topics addressed include: description of man-systems (definition, requirements, scope, subsystems, and topologies); implementation (approach, tools); man-systems interfaces (system to element and system to system); prime/supporting development relationship; selected accomplishments; and technical challenges.

Systems Biology as an Integrated Platform for Bioinformatics, Systems Synthetic Biology, and Systems Metabolic Engineering

Science.gov (United States)

Chen, Bor-Sen; Wu, Chia-Chou

2013-01-01

Systems biology aims at achieving a system-level understanding of living organisms and applying this knowledge to various fields such as synthetic biology, metabolic engineering, and medicine. System-level understanding of living organisms can be derived from insight into: (i) system structure and the mechanism of biological networks such as gene regulation, protein interactions, signaling, and metabolic pathways; (ii) system dynamics of biological networks, which provides an understanding of stability, robustness, and transduction ability through system identification, and through system analysis methods; (iii) system control methods at different levels of biological networks, which provide an understanding of systematic mechanisms to robustly control system states, minimize malfunctions, and provide potential therapeutic targets in disease treatment; (iv) systematic design methods for the modification and construction of biological networks with desired behaviors, which provide system design principles and system simulations for synthetic biology designs and systems metabolic engineering. This review describes current developments in systems biology, systems synthetic biology, and systems metabolic engineering for engineering and biology researchers. We also discuss challenges and future prospects for systems biology and the concept of systems biology as an integrated platform for bioinformatics, systems synthetic biology, and systems metabolic engineering. PMID:24709875

Systems Biology as an Integrated Platform for Bioinformatics, Systems Synthetic Biology, and Systems Metabolic Engineering

Directory of Open Access Journals (Sweden)

Bor-Sen Chen

2013-10-01

Full Text Available Systems biology aims at achieving a system-level understanding of living organisms and applying this knowledge to various fields such as synthetic biology, metabolic engineering, and medicine. System-level understanding of living organisms can be derived from insight into: (i system structure and the mechanism of biological networks such as gene regulation, protein interactions, signaling, and metabolic pathways; (ii system dynamics of biological networks, which provides an understanding of stability, robustness, and transduction ability through system identification, and through system analysis methods; (iii system control methods at different levels of biological networks, which provide an understanding of systematic mechanisms to robustly control system states, minimize malfunctions, and provide potential therapeutic targets in disease treatment; (iv systematic design methods for the modification and construction of biological networks with desired behaviors, which provide system design principles and system simulations for synthetic biology designs and systems metabolic engineering. This review describes current developments in systems biology, systems synthetic biology, and systems metabolic engineering for engineering and biology researchers. We also discuss challenges and future prospects for systems biology and the concept of systems biology as an integrated platform for bioinformatics, systems synthetic biology, and systems metabolic engineering.

Cascade system using both trough system and dish system for power generation

International Nuclear Information System (INIS)

Zhang, Cheng; Zhang, Yanping; Arauzo, Inmaculada; Gao, Wei; Zou, Chongzhe

2017-01-01

Highlights: • A novel solar cascade system using both trough and dish collectors is proposed. • Heat rejected by the Stirling engines is collected by the condensed water. • The directions to increase the efficiency improvement has been pointed out • Influence of flow type of heating/cooling fluids of Stirling engines is considered. - Abstract: This paper represents a novel solar thermal cascade system using both trough and dish systems for power generation. An effective structure using the condensed fluid of Rankine cycle to cool the Stirling engines to use the heat released by Stirling engines was proposed. The cascade system model with different fluid circuits was developed. The models of some important components of the system, such as dish collector, trough collector and Stirling engine array, are presented with detail explanation in this paper. Corresponding stand-alone systems were also developed for comparison. Simulations were conducted with the models to find out efficiency difference between cascade system and corresponding stand-alone systems. The directions to increase the efficiency difference were also considered. Results show that the cascade system can achieve a higher efficiency with a high solar irradiance (>550 W/m"2). The flow type of fluids between heating and cooling Stirling engine array is also required to concern on designing a cascade system with Stirling engine array.

Hybrid Propulsion Systems for Remotely Piloted Aircraft Systems

Directory of Open Access Journals (Sweden)

Mithun Abdul Sathar Eqbal

2018-03-01

Full Text Available The development of more efficient propulsion systems for aerospace vehicles is essential to achieve key objectives. These objectives are to increase efficiency while reducing the amount of carbon-based emissions. Hybrid electric propulsion (HEP is an ideal means to maintain the energy density of hydrocarbon-based fuels and utilize energy-efficient electric machines. A system that integrates different propulsion systems into a single system, with one being electric, is termed an HEP system. HEP systems have been studied previously and introduced into Land, Water, and Aerial Vehicles. This work presents research into the use of HEP systems in Remotely Piloted Aircraft Systems (RPAS. The systems discussed in this paper are Internal Combustion Engine (ICE–Electric Hybrid systems, ICE–Photovoltaic (PV Hybrid systems, and Fuel-Cell Hybrid systems. The improved performance characteristics in terms of fuel consumption and endurance are discussed.

System Budgets

DEFF Research Database (Denmark)

Jeppesen, Palle

1996-01-01

The lecture note is aimed at introducing system budgets for optical communication systems. It treats optical fiber communication systems (six generations), system design, bandwidth effects, other system impairments and optical amplifiers.......The lecture note is aimed at introducing system budgets for optical communication systems. It treats optical fiber communication systems (six generations), system design, bandwidth effects, other system impairments and optical amplifiers....

Systems Biology, Systems Medicine, Systems Pharmacology: The What and The Why.

Science.gov (United States)

Stéphanou, Angélique; Fanchon, Eric; Innominato, Pasquale F; Ballesta, Annabelle

2018-05-09

Systems biology is today such a widespread discipline that it becomes difficult to propose a clear definition of what it really is. For some, it remains restricted to the genomic field. For many, it designates the integrated approach or the corpus of computational methods employed to handle the vast amount of biological or medical data and investigate the complexity of the living. Although defining systems biology might be difficult, on the other hand its purpose is clear: systems biology, with its emerging subfields systems medicine and systems pharmacology, clearly aims at making sense of complex observations/experimental and clinical datasets to improve our understanding of diseases and their treatments without putting aside the context in which they appear and develop. In this short review, we aim to specifically focus on these new subfields with the new theoretical tools and approaches that were developed in the context of cancer. Systems pharmacology and medicine now give hope for major improvements in cancer therapy, making personalized medicine closer to reality. As we will see, the current challenge is to be able to improve the clinical practice according to the paradigm shift of systems sciences.

A contemporary view of systems engineering. [definition of system and discussion of systems approach

Science.gov (United States)

Miles, R. F., Jr.

1974-01-01

The concept of a 'system' is defined, and the 'systems approach' is discussed. Four contemporary examples of the systems approach are presented: an operations research project, the planning-programming-budgeting system, an information processing system, and aerospace programs.

A security framework for systems of systems

NARCIS (Netherlands)

Trivellato, D.; Zannone, N.; Etalle, S.

2011-01-01

Systems of systems consist of a wide variety of dynamic, distributed coalitions of autonomous and heterogeneous systems that collaborate to achieve a common goal. While offering several advantages in terms of scalability and flexibility, this new paradigm has a strong impact on system

A Security Framework for Systems of Systems

NARCIS (Netherlands)

Trivellato, Daniel; Zannone, Nicola; Etalle, Sandro

2011-01-01

Systems of systems consist of a wide variety of dynamic, distributed coalitions of autonomous and heterogeneous systems that collaborate to achieve a common goal. While offering several advantages in terms of scalability and flexibility, this new paradigm has a strong impact on system

Smart electromechanical systems the central nervous system

CERN Document Server

Kurbanov, Vugar

2017-01-01

This book describes approaches to solving the problems of developing the central nervous system of robots (CNSR) based on smart electromechanical systems (SEMS) modules, principles of construction of the various modules of the central nervous system and variants of mathematical software CNSR in control systems for intelligent robots. It presents the latest advances in theory and practice at the Russian Academy of Sciences. Developers of intelligent robots to solve modern problems in robotics are increasingly addressing the use of the bionic approach to create robots that mimic the complexity and adaptability of biological systems. These have smart electromechanical system (SEMS), which are used in various cyber-physical systems (CPhS), and allow the functions of calculation, control, communications, information storage, monitoring, measurement and control of parameters and environmental parameters to be integrated. The behavior of such systems is based on the information received from the central nervous syst...

Non linear system become linear system

Directory of Open Access Journals (Sweden)

Petre Bucur

2007-01-01

Full Text Available The present paper refers to the theory and the practice of the systems regarding non-linear systems and their applications. We aimed the integration of these systems to elaborate their response as well as to highlight some outstanding features.

Perioperative coagulation management and blood conservation in cardiac surgery: a Canadian Survey.

Science.gov (United States)

Taneja, Ravi; Fernandes, Philip; Marwaha, Gulshan; Cheng, Davy; Bainbridge, Daniel

2008-10-01

To determine which strategies are currently used for (anti)coagulation management and blood conservation during cardiac surgery in Canada. Institutional survey. University hospital. All sites performing cardiac surgery in Canada. None. The response rate was 85%. Anticoagulation with heparin is monitored routinely through the activated coagulation time (ACT). Less than 10% of centers use heparin concentrations (Hepcon HMS, Medtronic), thromboelastography, or other point-of-care tests perioperatively. Eighty percent of centers routinely use tranexamic acid as the primary antifibrinolytic agent; however aprotinin until recently, was used more commonly for patients at increased risk for bleeding. Retrograde autologous prime is commonly used (62%); however, cell savers are uncommon for routine patients undergoing cardiac surgery (29%). Although most hospitals use a hematocrit of 20% to 21% for transfusing red blood cells, more than 50% of intensive care units do not have written guidelines for the administration of protamine, fresh frozen plasma, platelets, or factor VIIa. At least one third of centers do not audit their transfusion practices regularly. The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period.

A Case of a Cardiac Resynchronization Therapy-Defibrillator Exhibiting a Lower and Alternately Variable Basic Rate.

Science.gov (United States)

Iwazaki, Keigo; Kojima, Toshiya; Murasawa, Takahide; Yokota, Jun; Tanimoto, Hikaru; Matsuda, Jun; Fukuma, Nobuaki; Matsubara, Takumi; Shimizu, Yu; Oguri, Gaku; Hasumi, Eriko; Kubo, Hitoshi; Chang, Kyungho; Fujiu, Katsuhito; Komuro, Issei

2018-04-06

A cardiac resynchronization therapy defibrillator (CRT-D) (Medtronic Inc. Protecta XT) was implanted in a 67-year-old man who had cardiac sarcoidosis with extremely low cardiac function. He had ventricular tachycardia which was controlled by catheter ablation, medication and pacing. The programmed mode was DDI, lower rate was 90 beats/minute, paced AV delay was 150 ms, and the noncompetitive atrial pacing (NCAP) function was programmed as 300 ms.After his admission for pneumonia and heart failure, we changed his DDI mode to a DDD mode because he had atrial tachycardia, which led to inadequate bi-ventricular pacing. After a while, there were cycle lengths which were longer than his device setting and alternately varied. We were able to avoid this phenomenon with AV delay of 120 ms and NCAP of 200 ms.NCAP is an algorithm which creates a gap above a certain period after the detection of an atrial signal during the postventricular atrial refractory period of the pacemaker. This is to prevent atrial tachycardia and repetitive non-reentrant ventriculoatrial (VA) synchrony in the presence of retrograde VA conduction. But in this case, NCAP algorithm induced much lower rate than the programmed basic lower rate. This situation produced some arrhythmias and exacerbated symptoms of heart failure. This had to be paid attention to, especially when the device was programmed at high basic heart rate.

Left ventricular mass regression after porcine versus bovine aortic valve replacement: a randomized comparison.

Science.gov (United States)

Suri, Rakesh M; Zehr, Kenton J; Sundt, Thoralf M; Dearani, Joseph A; Daly, Richard C; Oh, Jae K; Schaff, Hartzell V

2009-10-01

It is unclear whether small differences in transprosthetic gradient between porcine and bovine biologic aortic valves translate into improved regression of left ventricular (LV) hypertrophy after aortic valve replacement. We investigated transprosthetic gradient, aortic valve orifice area, and LV mass in patients randomized to aortic valve replacement with either the Medtronic Mosaic (MM) porcine or an Edwards Perimount (EP) bovine pericardial bioprosthesis. One hundred fifty-two patients with aortic valve disease were randomly assigned to receive either the MM (n = 76) or an EP prosthesis. There were 89 men (59%), and the mean age was 76 years. Echocardiograms from preoperative, postoperative, predismissal, and 1-year time points were analyzed. Baseline characteristics and preoperative echocardiograms were similar between the two groups. The median implant size was 23 mm for both. There were no early deaths, and 10 patients (7%) died after dismissal. One hundred seven of 137 patients (78%) had a 1-year echocardiogram, and none required aortic valve reoperation. The mean aortic valve gradient at dismissal was 19.4 mm Hg (MM) versus13.5 mm Hg (EP; p regression of LV mass index (MM, -32.4 g/m(2) versus EP, -27.0 g/m(2); p = 0.40). Greater preoperative LV mass index was the sole independent predictor of greater LV mass regression after surgery (p regression of LV mass during the first year after aortic valve replacement.

Remaining useful life assessment of lithium-ion batteries in implantable medical devices

Science.gov (United States)

Hu, Chao; Ye, Hui; Jain, Gaurav; Schmidt, Craig

2018-01-01

This paper presents a prognostic study on lithium-ion batteries in implantable medical devices, in which a hybrid data-driven/model-based method is employed for remaining useful life assessment. The method is developed on and evaluated against data from two sets of lithium-ion prismatic cells used in implantable applications exhibiting distinct fade performance: 1) eight cells from Medtronic, PLC whose rates of capacity fade appear to be stable and gradually decrease over a 10-year test duration; and 2) eight cells from Manufacturer X whose rates appear to be greater and show sharp increase after some period over a 1.8-year test duration. The hybrid method enables online prediction of remaining useful life for predictive maintenance/control. It consists of two modules: 1) a sparse Bayesian learning module (data-driven) for inferring capacity from charge-related features; and 2) a recursive Bayesian filtering module (model-based) for updating empirical capacity fade models and predicting remaining useful life. A generic particle filter is adopted to implement recursive Bayesian filtering for the cells from the first set, whose capacity fade behavior can be represented by a single fade model; a multiple model particle filter with fixed-lag smoothing is proposed for the cells from the second data set, whose capacity fade behavior switches between multiple fade models.

[Our experience about the use of resorbable plates in the treatment of craniostenosis].

Science.gov (United States)

Grassiot, B; Delabar, V; Szathmari, A; Beuriat, P A; Paulus, C; Mottolese, C

2015-09-01

The use of resorbable plates increases for craniosynostosis surgery. This material, based on polymere (PLA, PGA) can replace steel wire and non resorbable plates. A few studies present surgical results about the use of this material with a long follow-up. We present our ten years experience of using resorbable material for craniosynostosis treatment in children. Between 2002 and 2012, we operated 283 craniosynostosis (98 scaphocephalies, 55 trigonocephalies, 79 plagiocephalies et 51 craniofaciostenoses). Among these surgeries, 211 were realized with resorbable material (plates and screws). Different criteria were observed: the esthetic result, the infection rate, the re-intervention, the bone defects and the inflammatory granuloma. Among the 211 craniosynostosis, we found 62 plagiocephalies, 66 scaphocephalies, 50 trigonocephalies, 33 craniofaciostenoses. All the reconstructions were realized with the same resorbable material (Macropore by Medtronic). The rate of complications was low: one scar infection without participation of material for two patients (0.9%), a pseudo-meningocele for two patients (0.9%), epilepsy for four children (1.8%) and bone defect for 15 (7%). We observed no granuloma for these patients. Our experience of ten years using resorbable material is very satisfactory. This material permits to realize solid and esthetic reconstructions with a low rate of infection without dangerous reaction for children in young age. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Safety of repetitive transcranial magnetic stimulation in patients with implanted cortical electrodes. An ex-vivo study and report of a case.

Science.gov (United States)

Phielipp, Nicolás M; Saha, Utpal; Sankar, Tejas; Yugeta, Akihiro; Chen, Robert

2017-06-01

To evaluate the safety of repetitive transcranial magnetic stimulation (rTMS) in patients with implanted subdural cortical electrodes. We performed ex-vivo experiments to test the temperature, displacement and current induced in the electrodes with single pulse transcranial magnetic stimulation (TMS) from 10 to 100% of stimulator output and tested a typical rTMS protocol used in a clinical setting. We then used rTMS to the motor cortex to treat a patient with refractory post-herpetic neuralgia who had previously been implanted with a subdural motor cortical electrode for pain management. The rTMS protocol consisted of ten sessions of 2000 stimuli at 20Hz and 90% of resting motor threshold. The ex-vivo study showed an increase in the coil temperature of 2°C, a maximum induced charge density of 30.4μC/cm 2 /phase, and no electrode displacement with TMS. There was no serious adverse effect associated with rTMS treatment of the patient. Cortical tremor was observed in the intervals between trains of stimuli during one treatment session. TMS was safe in a patient with implanted Medtronic Resume II electrode (model 3587A) subdural cortical electrode. TMS may be used as a therapeutic, diagnostic or research tool in patients this type of with implanted cortical electrodes. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Effect of Smaller Left Ventricular Capture Threshold Safety Margins to Improve Device Longevity in Recipients of Cardiac Resynchronization-Defibrillation Therapy.

Science.gov (United States)

Steinhaus, Daniel A; Waks, Jonathan W; Collins, Robert; Kleckner, Karen; Kramer, Daniel B; Zimetbaum, Peter J

2015-07-01

Device longevity in cardiac resynchronization therapy (CRT) is affected by the pacing capture threshold (PCT) and programmed pacing amplitude of the left ventricular (LV) pacing lead. The aims of this study were to evaluate the stability of LV pacing thresholds in a nationwide sample of CRT defibrillator recipients and to determine potential longevity improvements associated with a decrease in the LV safety margin while maintaining effective delivery of CRT. CRT defibrillator patients in the Medtronic CareLink database were eligible for inclusion. LV PCT stability was evaluated using ≥2 measurements over a 14-day period. Separately, a random sample of 7,250 patients with programmed right atrial and right ventricular amplitudes ≤2.5 V, LV thresholds ≤ 2.5 V, and LV pacing ≥90% were evaluated to estimate theoretical battery longevity improvement using LV safety margins of 0.5 and 1.5 V. Threshold stability analysis in 43,256 patients demonstrated LV PCT stability of 1 V had the greatest increases in battery life (mean increase 0.86 years, 95% confidence interval 0.85 to 0.87). In conclusion, nearly all CRT defibrillator patients had LV PCT stability <1.0 V. Decreasing the LV safety margin from 1.5 to 0.5 V provided consistent delivery of CRT for most patients and significantly improved battery longevity. Copyright © 2015 Elsevier Inc. All rights reserved.

Atrial therapies reduce atrial arrhythmia burden in defibrillator patients.

Science.gov (United States)

Friedman, P A; Dijkman, B; Warman, E N; Xia, H A; Mehra, R; Stanton, M S; Hammill, S C

2001-08-28

Approximately 25% of patients who receive an implantable cardioverter-defibrillator (ICD) to treat ventricular tachyarrhythmias have documented atrial tachyarrhythmias before implantation. This study assessed the ability of device-based prevention and termination therapies to reduce the burden of spontaneous atrial tachyarrhythmias. Patients with a standard indication for the implantation of an ICD and 2 episodes of atrial tachyarrhythmias in the preceding year received a dual-chamber ICD (Medtronic 7250 Jewel AF) that uses pacing and shock therapies for prevention and/or termination of atrial tachyarrhythmias. In a multicenter trial, patients were randomized to 3-month periods with atrial therapies "on" or "off" and subsequently crossed over. Analysis was performed on the 52 of 269 patients who had episodes of atrial tachyarrhythmia and had >/=30 days of follow-up with atrial therapies on and off. The atrial therapies resulted in a reduction of atrial tachyarrhythmia burden from a mean of 58.5 to 7.8 h/mo. A paired analysis (Wilcoxon signed-rank test) showed that the median difference in burden (1.1 h/mo) was highly significant (P=0.007). When the subgroup of 41 patients treated only with atrial pacing therapies was analyzed, the reduction in burden persisted (P=0.01). In this study, patients with a standard ICD indication and atrial tachyarrhythmias had a significant reduction in atrial tachyarrhythmia burden with use of atrial pacing and shock therapies.

Temperature control at DBS electrodes using a heat sink: experimentally validated FEM model of DBS lead architecture

Science.gov (United States)

Elwassif, Maged M.; Datta, Abhishek; Rahman, Asif; Bikson, Marom

2012-08-01

There is a growing interest in the use of deep brain stimulation (DBS) for the treatment of medically refractory movement disorders and other neurological and psychiatric conditions. The extent of temperature increases around DBS electrodes during normal operation (joule heating and increased metabolic activity) or coupling with an external source (e.g. magnetic resonance imaging) remains poorly understood and methods to mitigate temperature increases are being actively investigated. We developed a heat transfer finite element method (FEM) simulation of DBS incorporating the realistic architecture of Medtronic 3389 leads. The temperature changes were analyzed considering different electrode configurations, stimulation protocols and tissue properties. The heat-transfer model results were then validated using micro-thermocouple measurements during DBS lead stimulation in a saline bath. FEM results indicate that lead design (materials and geometry) may have a central role in controlling temperature rise by conducting heat. We show how modifying lead design can effectively control temperature increases. The robustness of this heat-sink approach over complimentary heat-mitigation technologies follows from several features: (1) it is insensitive to the mechanisms of heating (e.g. nature of magnetic coupling); (2) it does not interfere with device efficacy; and (3) can be practically implemented in a broad range of implanted devices without modifying the normal device operations or the implant procedure.

Epilogue: Systems Approaches and Systems Practice

Science.gov (United States)

Reynolds, Martin; Holwell, Sue

Each of the five systems approaches discussed in this volume: system dynamics (SD), the viable systems model (VSM), strategic options development and analysis (SODA), soft systems methodology (SSM) and critical systems heuristics (CSH) has a pedigree. Not in the sense of the sometimes absurd spectacle of animals paraded at dog shows. Rather, their pedigree derives from their systems foundations, their capacity to evolve and their flexibility in use. None of the five approaches has developed out of use in restricted and controlled contexts of either low or high levels of complicatedness. Neither has any one of them evolved as a consequence of being applied only to situations with either presumed stakeholder agreement on purpose, or courteous disagreement amongst stakeholders, or stakeholder coercion. The compilation is not a celebration of abstract ‘methodologies', but of theoretically robust approaches that have a genuine pedigree in practice.

Systems theory of interconnected port contact systems

NARCIS (Netherlands)

Eberard, D.; Maschke, B.M.; Schaft, A.J. van der

2005-01-01

Port-based network modeling of a large class of complex physical systems leads to dynamical systems known as port-Hamiltonian systems. The key ingredient of any port-Hamiltonian system is a power-conserving interconnection structure (mathematically formalized by the geometric notion of a Dirac

System specifications for the NDS EXFOR System

International Nuclear Information System (INIS)

Attree, P.M.; Smith, P.M.

1979-07-01

EXFOR is the agreed exchange format for the magnetic-tape exchange of nuclear reaction data between national and international nuclear data centres for the benefit of nuclear data users in all countries. The NDS EXFOR System is a computerized system for the storage and retrieval of EXFOR information compiled or received by the IAEA. This document is an internal manual for the system specifications of the NDS EXFOR System. It includes flow charts, system and program summaries, input and output specifications and file and record descriptions. The manual is updated from time to time when system modifications are made

A Systems Thinking Approach to Engineering Challenges of Military Systems-of-Systems

Science.gov (United States)

2016-09-01

as part of organizational thinking , processes and practice; and 2) an adequate SoSE practice supporting environment created and used to enable SoS...UNCLASSIFIED UNCLLASIFIED A Systems Thinking Approach to Engineering Challenges of Military Systems-of-Systems Pin Chen and Mark...their products and outcomes. This report introduces a systems thinking -based approach, SoS thinking , which offers a language and a thoughtful process

Activity System Theory Approach to Healthcare Information System

OpenAIRE

Bai, Guohua

2004-01-01

Healthcare information system is a very complex system and has to be approached from systematic perspectives. This paper presents an Activity System Theory (ATS) approach by integrating system thinking and social psychology. First part of the paper, the activity system theory is presented, especially a recursive model of human activity system is introduced. A project ‘Integrated Mobile Information System for Diabetic Healthcare (IMIS)’ is then used to demonstrate a practical application of th...

Complex Adaptive Systems of Systems (CASOS) engineering environment.

Energy Technology Data Exchange (ETDEWEB)

Detry, Richard Joseph; Linebarger, John Michael; Finley, Patrick D.; Maffitt, S. Louise; Glass, Robert John, Jr.; Beyeler, Walter Eugene; Ames, Arlo Leroy

2012-02-01

Complex Adaptive Systems of Systems, or CASoS, are vastly complex physical-socio-technical systems which we must understand to design a secure future for the nation. The Phoenix initiative implements CASoS Engineering principles combining the bottom up Complex Systems and Complex Adaptive Systems view with the top down Systems Engineering and System-of-Systems view. CASoS Engineering theory and practice must be conducted together to develop a discipline that is grounded in reality, extends our understanding of how CASoS behave and allows us to better control the outcomes. The pull of applications (real world problems) is critical to this effort, as is the articulation of a CASoS Engineering Framework that grounds an engineering approach in the theory of complex adaptive systems of systems. Successful application of the CASoS Engineering Framework requires modeling, simulation and analysis (MS and A) capabilities and the cultivation of a CASoS Engineering Community of Practice through knowledge sharing and facilitation. The CASoS Engineering Environment, itself a complex adaptive system of systems, constitutes the two platforms that provide these capabilities.

Power Systems Integration Laboratory | Energy Systems Integration Facility

Science.gov (United States)

| NREL Power Systems Integration Laboratory Power Systems Integration Laboratory Research in the Energy System Integration Facility's Power Systems Integration Laboratory focuses on the microgrid applications. Photo of engineers testing an inverter in the Power Systems Integration Laboratory

Automatic TLI recognition system. Part 1: System description

Energy Technology Data Exchange (ETDEWEB)

Partin, J.K.; Lassahn, G.D.; Davidson, J.R.

1994-05-01

This report describes an automatic target recognition system for fast screening of large amounts of multi-sensor image data, based on low-cost parallel processors. This system uses image data fusion and gives uncertainty estimates. It is relatively low cost, compact, and transportable. The software is easily enhanced to expand the system`s capabilities, and the hardware is easily expandable to increase the system`s speed. This volume gives a general description of the ATR system.

Systems integration of business systems. Business system ni kanshite

Energy Technology Data Exchange (ETDEWEB)

Furukawa, H [Nippon Steel Corp., Tokyo (Japan)

1991-09-26

System integration (SI) is defined as combining hardwares and softwares as the infrastructures with know-hows for their use comprehensively to respond to high-level needs of users. This paper reports the features of an SI being developed by a company (E Company), its concept on the systematized development methodology, and the conceptual models. With the primary policy placed on creative integration standing on customers positions, the SI concept comprises three parts of models for evaluations as seen from the customers, evaluations as seen from the E Company, and the development object systems to link both parts. The third part is further consisted of several lower hierarchies including a customer controlled system hierarchy (this enables customers to control the system through visualization, for example, and includes three logic models (multiple solution selection, optimal solution under restricted conditions, and numerical solution)). 2 refs., 9 figs.

Fiscal system analysis - contractual systems

International Nuclear Information System (INIS)

Kaiser, M.J.

2006-01-01

Production sharing contracts are one of the most popular forms of contractual system used in petroleum agreements around the world, but the manner in which the fiscal terms and contract parameters impact system measures is complicated and not well understood. The purpose of this paper is to quantify the influence of private and market uncertainty in contractual fiscal systems. A meta-modelling approach is employed that couples the results of a simulation model with regression analysis to construct numerical functionals that quantify the fiscal regime. Relationships are derived that specify how the present value, rate of return, and take statistics vary as a function of the system parameters. The deepwater Girassol field development in Angola is taken as a case study. (author)

System Entropy Measurement of Stochastic Partial Differential Systems

Directory of Open Access Journals (Sweden)

Bor-Sen Chen

2016-03-01

Full Text Available System entropy describes the dispersal of a system’s energy and is an indication of the disorder of a physical system. Several system entropy measurement methods have been developed for dynamic systems. However, most real physical systems are always modeled using stochastic partial differential dynamic equations in the spatio-temporal domain. No efficient method currently exists that can calculate the system entropy of stochastic partial differential systems (SPDSs in consideration of the effects of intrinsic random fluctuation and compartment diffusion. In this study, a novel indirect measurement method is proposed for calculating of system entropy of SPDSs using a Hamilton–Jacobi integral inequality (HJII-constrained optimization method. In other words, we solve a nonlinear HJII-constrained optimization problem for measuring the system entropy of nonlinear stochastic partial differential systems (NSPDSs. To simplify the system entropy measurement of NSPDSs, the global linearization technique and finite difference scheme were employed to approximate the nonlinear stochastic spatial state space system. This allows the nonlinear HJII-constrained optimization problem for the system entropy measurement to be transformed to an equivalent linear matrix inequalities (LMIs-constrained optimization problem, which can be easily solved using the MATLAB LMI-toolbox (MATLAB R2014a, version 8.3. Finally, several examples are presented to illustrate the system entropy measurement of SPDSs.

System specifications for the NDS EXFOR System

Energy Technology Data Exchange (ETDEWEB)

Attree, P M; Smith, P M

1982-06-01

EXFOR is the agreed exchange format for the magnetic-tape exchange of nuclear reaction data between national and international nuclear data centers for the benefit of nuclear data users in all countries. The NDS EXFOR System is a computerized system for the storage and retrieval of EXFOR information compiled or received of the IAEA. This document is an internal manual for the system specifications of the NDS EXFOR System. It includes flow charts, system and program summaries, input and output specifications and file and record descriptions. The manual is updated from time to time when system modifications are made; the first version was issued in July 1979. (author)

Performance of integrated systems of automated roller shade systems and daylight responsive dimming systems

Energy Technology Data Exchange (ETDEWEB)

Park, Byoung-Chul; Choi, An-Seop; Jeong, Jae-Weon [Department of Architectural Engineering, Sejong University, Kunja-Dong, Kwangjin-Gu, Seoul (Korea, Republic of); Lee, Eleanor S. [Building Technologies Department, Lawrence Berkeley National Laboratory, Berkeley, CA (United States)

2011-03-15

Daylight responsive dimming systems have been used in few buildings to date because they require improvements to improve reliability. The key underlying factor contributing to poor performance is the variability of the ratio of the photosensor signal to daylight workplane illuminance in accordance with sun position, sky condition, and fenestration condition. Therefore, this paper describes the integrated systems between automated roller shade systems and daylight responsive dimming systems with an improved closed-loop proportional control algorithm, and the relative performance of the integrated systems and single systems. The concept of the improved closed-loop proportional control algorithm for the integrated systems is to predict the varying correlation of photosensor signal to daylight workplane illuminance according to roller shade height and sky conditions for improvement of the system accuracy. In this study, the performance of the integrated systems with two improved closed-loop proportional control algorithms was compared with that of the current (modified) closed-loop proportional control algorithm. In the results, the average maintenance percentage and the average discrepancies of the target illuminance, as well as the average time under 90% of target illuminance for the integrated systems significantly improved in comparison with the current closed-loop proportional control algorithm for daylight responsive dimming systems as a single system. (author)

Reliability-Based Optimization of Series Systems of Parallel Systems

DEFF Research Database (Denmark)

Enevoldsen, I.; Sørensen, John Dalsgaard

1993-01-01

Reliability-based design of structural systems is considered. In particular, systems where the reliability model is a series system of parallel systems are treated. A sensitivity analysis for this class of problems is presented. Optimization problems with series systems of parallel systems...... optimization of series systems of parallel systems, but it is also efficient in reliability-based optimization of series systems in general....

Cobit system in the audit processes of the systems of computer systems

Directory of Open Access Journals (Sweden)

Julio Jhovany Santacruz Espinoza

2017-12-01

Full Text Available The present research work has been carried out to show the benefits of the use of the COBIT system in the auditing processes of the computer systems, the problem is related to: How does it affect the process of audits in the institutions, use of the COBIT system? The main objective is to identify the incidence of the use of the COBIT system in the auditing process used by computer systems within both public and private organizations; In order to achieve our stated objectives of the research will be developed first with the conceptualization of key terms for an easy understanding of the subject, as a conclusion: we can say the COBIT system allows to identify the methodology by using information from the IT departments, to determine the resources of the (IT Information Technology, specified in the COBIT system, such as files, programs, computer networks, including personnel that use or manipulate the information, with the purpose of providing information that the organization or company requires to achieve its objectives.

Chaos synchronization between Chen system and Genesio system

International Nuclear Information System (INIS)

Wu Xianyong; Guan Zhihong; Wu Zhengping; Li Tao

2007-01-01

This Letter presents two synchronization schemes between two different chaotic systems. Active control synchronization and adaptive synchronization between Chen system and Genesio system are studied, different controllers are designed to synchronize the drive and response systems, active control synchronization is used when system parameters are known; adaptive synchronization is employed when system parameters are unknown or uncertain. Simulation results show the effectiveness of the proposed schemes

Embedded systems design with special arithmetic and number systems

CERN Document Server

Sousa, Leonel; Chang, Chip-Hong

2017-01-01

This book introduces readers to alternative approaches to designing efficient embedded systems using unconventional number systems. The authors describe various systems that can be used for designing efficient embedded and application-specific processors, such as Residue Number System, Logarithmic Number System, Redundant Binary Number System Double-Base Number System, Decimal Floating Point Number System and Continuous Valued Number System. Readers will learn the strategies and trade-offs of using unconventional number systems in application-specific processors and be able to apply and design appropriate arithmetic operations from these number systems to boost the performance of digital systems. • Serves as a single-source reference to designing embedded systems with unconventional number systems • Covers theory as well as implementation on application-specific processors • Explains mathematical concepts in a manner accessible to readers with diverse backgrounds.

Expert systems in process control systems

International Nuclear Information System (INIS)

Wittig, T.

1987-01-01

To illustrate where the fundamental difference between expert systems in classical diagnosis and in industrial control lie, the work of process control instrumentation is used as an example for the job of expert systems. Starting from the general process of problem-solving, two classes of expert systems can be defined accordingly. (orig.) [de

Amotosalen: Allogeneic Cellular Immunotherapies system, INTERCEPT Plasma System, INTERCEPT Platelet System, S 59.

Science.gov (United States)

2003-01-01

Adis CommentsCerus Corporation is developing a variety of pathogen-inactivation systems, based on its Helinx technology. Three of the systems include amotosalen [S 59] as the inactivation compound. Amotosalen is a light-activated, DNA-, RNA-crosslinking psoralen compound, which is used to neutralise pathogens. The systems that utilise amotosalen are called the INTERCEPT Platelet System, the INTERCEPT Plasma System and the Allogeneic Cellular Immunotherapies (ACIT) system. The INTERCEPT Platelet System and INTERCEPT Plasma System are two of the systems that make up Cerus' INTERCEPT Blood Systems. The other system is the INTERCEPT Red Blood Cell System, which contains S 303 as the inactivation compound rather than amotosalen. Cerus' Helinx technology is able to prevent replication of DNA or RNA that is present in pathogens but not in the blood components being treated (e.g. platelets and plasma). When added to the blood components, the inactivation agent (in this case amotosalen) crosses the membrane or cell wall of the pathogen. When activated by light, amotosalen binds to the nucleic acid of the pathogen and prevents replication. This process prevents infection. INTERCEPT Platelet System: Cerus developed its INTERCEPT Platelet System, in collaboration with Baxter Healthcare, for use in blood centres. Platelets are an essential component of the coagulation process and may be required by patients undergoing surgery, cancer chemotherapy, transplantation or with bleeding disorders. The system is made up of an illuminator device, a compound absorption device and a processing kit containing amotosalen. In October 2002, the two companies announced that CE Mark approval had been received for the illuminator device for the INTERCEPT trade mark Blood System. Application of this technology to platelets is the first to be approved. As it is a new technology, the system is currently undergoing process validation in accordance with European Blood Bank GMP requirements. This

Manager's assistant systems for space system planning

Science.gov (United States)

Bewley, William L.; Burnard, Robert; Edwards, Gary E.; Shoop, James

1992-01-01

This paper describes a class of knowledge-based 'assistant' systems for space system planning. Derived from technology produced for the DARPA/USAF Pilot's Associate program, these assistant systems help the human planner by doing the bookkeeping to maintain plan data and executing the procedures and heuristics currently used by the human planner to define, assess, diagnose, and revise plans. Intelligent systems for Space Station Freedom assembly sequence planning and Advanced Launch System modeling will be presented as examples. Ongoing NASA-funded work on a framework supporting the development of such tools will also be described.

Systems of Systems: Scaling Up the Development Process

National Research Council Canada - National Science Library

Humphrey, Watts

2006-01-01

... of massive systems into system-of-systems structures Section 3 points out how large-scale systems development efforts have typically failed because of project-management and not technical problems...

Digital processing data communication systems (bus systems)

International Nuclear Information System (INIS)

Fleck, K.

1980-01-01

After an introduction to the technology of digital processing data communication systems there are the following chapters: digital communication of processing data in automation technology, the technology of biserial communication, the implementaiton of a bus system, the data transmission of the TDC-2000 system of Honeywell's and the process bus CS 275 in the automation system TELEPERM M of Siemens AG. (WB) [de

System-of-Systems Approach for Integrated Energy Systems Modeling and Simulation: Preprint

Energy Technology Data Exchange (ETDEWEB)

Mittal, Saurabh; Ruth, Mark; Pratt, Annabelle; Lunacek, Monte; Krishnamurthy, Dheepak; Jones, Wesley

2015-08-21

Today’s electricity grid is the most complex system ever built—and the future grid is likely to be even more complex because it will incorporate distributed energy resources (DERs) such as wind, solar, and various other sources of generation and energy storage. The complexity is further augmented by the possible evolution to new retail market structures that provide incentives to owners of DERs to support the grid. To understand and test new retail market structures and technologies such as DERs, demand-response equipment, and energy management systems while providing reliable electricity to all customers, an Integrated Energy System Model (IESM) is being developed at NREL. The IESM is composed of a power flow simulator (GridLAB-D), home energy management systems implemented using GAMS/Pyomo, a market layer, and hardware-in-the-loop simulation (testing appliances such as HVAC, dishwasher, etc.). The IESM is a system-of-systems (SoS) simulator wherein the constituent systems are brought together in a virtual testbed. We will describe an SoS approach for developing a distributed simulation environment. We will elaborate on the methodology and the control mechanisms used in the co-simulation illustrated by a case study.

Linear Actuator System for the NASA Docking System

Science.gov (United States)

Dick, Brandon N.; Oesch, Christopher; Rupp, Timothy W.

2017-01-01

The Linear Actuator System (LAS) is a major sub-system within the NASA Docking System (NDS). The NDS Block 1 will be used on the Boeing Crew Space Transportation (CST-100) system to achieve docking with the International Space Station. Critical functions in the Soft Capture aspect of docking are performed by the LAS. This paper describes the general function of the LAS, the system's key requirements and technical challenges, and the development and qualification approach for the system.

Methods, apparatus, and systems for monitoring transmission systems

Science.gov (United States)

Polk, Robert E [Idaho Falls, ID; Svoboda, John M [Idaho Falls, ID; West, Phillip B [Idaho Falls, ID; Heath, Gail L [Iona, ID; Scott, Clark L [Idaho Falls, ID

2010-08-31

A sensing platform for monitoring a transmission system, and method therefor, may include a sensor that senses one or more conditions relating to a condition of the transmission system and/or the condition of an environment around the transmission system. A control system operatively associated with the sensor produces output data based on an output signal produced by the sensor. A transmitter operatively associated with the control system transmits the output data from the control system.

System Engineering of Photonic Systems for Space Application

Science.gov (United States)

Watson, Michael D.; Pryor, Jonathan E.

2014-01-01

The application of photonics in space systems requires tight integration with the spacecraft systems to ensure accurate operation. This requires some detailed and specific system engineering to properly incorporate the photonics into the spacecraft architecture and to guide the spacecraft architecture in supporting the photonics devices. Recent research in product focused, elegant system engineering has led to a system approach which provides a robust approach to this integration. Focusing on the mission application and the integration of the spacecraft system physics incorporation of the photonics can be efficiently and effectively accomplished. This requires a clear understanding of the driving physics properties of the photonics device to ensure proper integration with no unintended consequences. The driving physics considerations in terms of optical performance will be identified for their use in system integration. Keywords: System Engineering, Optical Transfer Function, Optical Physics, Photonics, Image Jitter, Launch Vehicle, System Integration, Organizational Interaction

Systems

International Nuclear Information System (INIS)

Anon.

1980-01-01

Papers in this session describe the concept of mined geologic disposal system and methods for ensuring that the system, when developed, will meet all technical requirements. Also presented in the session are analyses of system parameters, such as cost and nuclear criticality potential, as well as a technical analysis of a requirement that the system permit retrieval of the waste for some period of time. The final paper discusses studies under way to investigate technical alternatives or complements to the mined geologic disposal system. Titles of the presented papers are: (1) Waste Isolation System; (2) Waste Isolation Economics; (3) BWIP Technical Baseline; (4) Criticality Considerations in Geologic Disposal of High-Level Waste; (5) Retrieving Nuclear Wastes from Repository; (6) NWTS Programs for the Evaluation of Technical Alternatives or Complements to Mined Geologic Repositories - Purpose and Objectives

systems

Directory of Open Access Journals (Sweden)

Alexander Leonessa

2000-01-01

Full Text Available A nonlinear robust control-system design framework predicated on a hierarchical switching controller architecture parameterized over a set of moving nominal system equilibria is developed. Specifically, using equilibria-dependent Lyapunov functions, a hierarchical nonlinear robust control strategy is developed that robustly stabilizes a given nonlinear system over a prescribed range of system uncertainty by robustly stabilizing a collection of nonlinear controlled uncertain subsystems. The robust switching nonlinear controller architecture is designed based on a generalized (lower semicontinuous Lyapunov function obtained by minimizing a potential function over a given switching set induced by the parameterized nominal system equilibria. The proposed framework robustly stabilizes a compact positively invariant set of a given nonlinear uncertain dynamical system with structured parametric uncertainty. Finally, the efficacy of the proposed approach is demonstrated on a jet engine propulsion control problem with uncertain pressure-flow map data.

Ventilation systems

International Nuclear Information System (INIS)

Gossler

1980-01-01

The present paper deals with - controlled area ventilation systems - ventilation systems for switchgear-building and control-room - other ventilation systems for safety equipments - service systems for ventilation systems. (orig./RW)

SSDL personel dosimetry system: migration from a client - server system into a web-based system

International Nuclear Information System (INIS)

Maizura Ibrahim; Rosnah Shariff; Ahmad Bazlie Abdul Kadir; John Konsoh Sangau; Mohd Amin Sharifuldin Salleh; Taiman Kadni; Noriah Mod Ali

2007-01-01

Personnel Dosimetry System has been used by the Secondary Standard Dosimetry Laboratory (SSDL), Nuclear Malaysia since ten years ago. The system is a computerized database system with a client-server concept. This system has been used by Film Badge Laboratory, SSDL to record details of clients, calculation of Film Badge dosage, management of radiation workers data's, generating of dosage report, retrieval of statistical reports regarding film badge usage for the purpose of reporting to monitoring bodies such as Atomic Energy Licensing Board (AELB), Ministry of Health and others. But, due to technical problems that frequently occurs, the system is going to be replaced by a newly developed web- based system called e-SSDL. This paper describe the problems that regularly occurs in the previous system, explains how the process of replacing the client-server system with a web-based system is done and the differences between the previous and current system. This paper will also present details architecture of the new system and the new process introduced in processing film badges. (Author)

Real-Time Operating Systems for Multicore Embedded Systems

OpenAIRE

Tomiyama, Hiroyuki; Honda, Shinya; Takada, Hiroaki

2008-01-01

Multicore systems-on-chip have become popular inthe design of embedded systems in order to simultaneously achieve high performance and low power consumption. On the software side, real-time operating systems are necessary in orderto handle growing complexity of embedded software. This paper describes requirements, design principles and implementation techniques for real-time operating systems to be used inasymmetric multicore systems.

EXPERT SYSTEMS

OpenAIRE

Georgiana Marin; Mihai Catalin Andrei

2011-01-01

In recent decades IT and computer systems have evolved rapidly in economic informatics field. The goal is to create user friendly information systems that respond promptly and accurately to requests. Informatics systems evolved into decision assisted systems, and such systems are converted, based on gained experience, in expert systems for creative problem solving that an organization is facing. Expert systems are aimed at rebuilding human reasoning on the expertise obtained from experts, sto...

A master system for power system fault phenomena

Energy Technology Data Exchange (ETDEWEB)

Yoo, Myung Ho; Jang, Sang Ho; Hong, Joon Hee; Min, Wan Ki; Yoo, Chang Hwan [Korea Electric Power Corp. (KEPCO), Taejon (Korea, Republic of). Research Center

1995-12-31

This report includes as follows - Real time digital simulator - Remote measuring, analyzing and reproducing system of power system fault data -Power system reduction method program using EMTP -Test system for protection device. (author). 22 refs., 38 figs.

T-systems and Y-systems in integrable systems

International Nuclear Information System (INIS)

Kuniba, Atsuo; Nakanishi, Tomoki; Suzuki, Junji

2011-01-01

T- and Y-systems are ubiquitous structures in classical and quantum integrable systems. They are difference equations having a variety of aspects related to commuting transfer matrices in solvable lattice models, q-characters of Kirillov-Reshetikhin modules of quantum affine algebras, cluster algebras with coefficients, periodicity conjectures of Zamolodchikov and others, dilogarithm identities in conformal field theory, difference analog of L-operators in KP hierarchy, Stokes phenomena in 1D Schroedinger problem, AdS/CFT correspondence, Toda field equations on discrete spacetime, Laplace sequence in discrete geometry, Fermionic character formulas and combinatorial completeness of Bethe ansatz, Q-system and ideal gas with exclusion statistics, analytic and thermodynamic Bethe ansaetze, quantum transfer matrix method and so forth. This review is a collection of short reviews on these topics which can be read more or less independently. (topical review)

T-systems and Y-systems in integrable systems

Energy Technology Data Exchange (ETDEWEB)

Kuniba, Atsuo [Institute of Physics, University of Tokyo, Komaba, Tokyo 153-8902 (Japan); Nakanishi, Tomoki [Graduate School of Mathematics, Nagoya University, Nagoya 464-8604 (Japan); Suzuki, Junji, E-mail: atsuo@gokutan.c.u-tokyo.ac.jp [Department of Physics, Faculty of Science, Shizuoka University, Ohya 836 (Japan)

2011-03-11

T- and Y-systems are ubiquitous structures in classical and quantum integrable systems. They are difference equations having a variety of aspects related to commuting transfer matrices in solvable lattice models, q-characters of Kirillov-Reshetikhin modules of quantum affine algebras, cluster algebras with coefficients, periodicity conjectures of Zamolodchikov and others, dilogarithm identities in conformal field theory, difference analog of L-operators in KP hierarchy, Stokes phenomena in 1D Schroedinger problem, AdS/CFT correspondence, Toda field equations on discrete spacetime, Laplace sequence in discrete geometry, Fermionic character formulas and combinatorial completeness of Bethe ansatz, Q-system and ideal gas with exclusion statistics, analytic and thermodynamic Bethe ansaetze, quantum transfer matrix method and so forth. This review is a collection of short reviews on these topics which can be read more or less independently. (topical review)

Sail GTS ground system analysis: Avionics system engineering

Science.gov (United States)

Lawton, R. M.

1977-01-01

A comparison of two different concepts for the guidance, navigation and control test set signal ground system is presented. The first is a concept utilizing a ground plate to which crew station, avionics racks, electrical power distribution system, master electrical common connection assembly and marshall mated elements system grounds are connected by 4/0 welding cable. An alternate approach has an aluminum sheet interconnecting the signal ground reference points between the crew station and avionics racks. The comparison analysis quantifies the differences between the two concepts in terms of dc resistance, ac resistance and inductive reactance. These parameters are figures of merit for ground system conductors in that the system with the lowest impedance is the most effective in minimizing noise voltage. Although the welding cable system is probably adequate, the aluminum sheet system provides a higher probability of a successful system design.

Multiple Energy System Analysis of Smart Energy Systems

DEFF Research Database (Denmark)

Thellufsen, Jakob Zinck

2015-01-01

thermal grids and smart gas grids, Smart Energy Systems moves the flexibility away from the fuel as is the case in current energy systems and into the system itself. However, most studies applying a Smart Energy System approach deals with analyses for either single countries or whole continents......To eliminate the use of fossil fuels in the energy sector it is necessary to transition to future 100% renewable energy systems. One approach for this radical change in our energy systems is Smart Energy Systems. With a focus on development and interaction between smart electricity grids, smart......, but it is unclear how regions, municipalities, and communities should deal with these national targets. It is necessary to be able to provide this information since Smart Energy Systems utilize energy resources and initiatives that have strong relations to local authorities and communities, such as onshore wind...

Cooling system for the IFMIF-EVEDA radiofrequency system

International Nuclear Information System (INIS)

Perez Pichel, G. D.

2012-01-01

The IFMIF-EVEDA project consists on an accelerator prototype that will be installed at Rokkasho (Japan). Through CIEMAT, that is responsible of the development of many systems and components. Empresarios Agrupados get the responsibility of the detailed design of the cooling system for the radiofrequency system (RF system) that must feed the accelerator. the RF water cooling systems is the water primary circuit that provides the required water flow (with a certain temperature, pressure and water quality) and also dissipates the necessary thermal power of all the radiofrequency system equipment. (Author) 4 refs.

Tritium system test assembly control system cost estimate

International Nuclear Information System (INIS)

Stutz, R.A.

1979-01-01

The principal objectives of the Tritium Systems Test Assembly (TSTA), which includes the development, demonstration and interfacing of technologies related to the deuterium--tritium fuel cycle for fusion reactor systems, are concisely stated. The various integrated subsystems comprising TSTA and their functions are discussed. Each of the four major subdivisions of TSTA, including the main process system, the environmental and safety systems, supporting systems and the physical plant are briefly discussed. An overview of the Master Data Acquisition and Control System, which will control all functional operation of TSTA, is provided

Site systems engineering: Systems engineering management plan

Energy Technology Data Exchange (ETDEWEB)

Grygiel, M.L. [Westinghouse Hanford Co., Richland, WA (United States)

1996-05-03

The Site Systems Engineering Management Plan (SEMP) is the Westinghouse Hanford Company (WHC) implementation document for the Hanford Site Systems Engineering Policy, (RLPD 430.1) and Systems Engineering Criteria Document and Implementing Directive, (RLID 430.1). These documents define the US Department of Energy (DOE), Richland Operations Office (RL) processes and products to be used at Hanford to implement the systems engineering process at the site level. This SEMP describes the products being provided by the site systems engineering activity in fiscal year (FY) 1996 and the associated schedule. It also includes the procedural approach being taken by the site level systems engineering activity in the development of these products and the intended uses for the products in the integrated planning process in response to the DOE policy and implementing directives. The scope of the systems engineering process is to define a set of activities and products to be used at the site level during FY 1996 or until the successful Project Hanford Management Contractor (PHMC) is onsite as a result of contract award from Request For Proposal DE-RP06-96RL13200. Following installation of the new contractor, a long-term set of systems engineering procedures and products will be defined for management of the Hanford Project. The extent to which each project applies the systems engineering process and the specific tools used are determined by the project`s management.

System safety education focused on system management

Science.gov (United States)

Grose, V. L.

1971-01-01

System safety is defined and characteristics of the system are outlined. Some of the principle characteristics include role of humans in hazard analysis, clear language for input and output, system interdependence, self containment, and parallel analysis of elements.

Modeling Power Systems as Complex Adaptive Systems

Energy Technology Data Exchange (ETDEWEB)

Chassin, David P.; Malard, Joel M.; Posse, Christian; Gangopadhyaya, Asim; Lu, Ning; Katipamula, Srinivas; Mallow, J V.

2004-12-30

Physical analogs have shown considerable promise for understanding the behavior of complex adaptive systems, including macroeconomics, biological systems, social networks, and electric power markets. Many of today's most challenging technical and policy questions can be reduced to a distributed economic control problem. Indeed, economically based control of large-scale systems is founded on the conjecture that the price-based regulation (e.g., auctions, markets) results in an optimal allocation of resources and emergent optimal system control. This report explores the state-of-the-art physical analogs for understanding the behavior of some econophysical systems and deriving stable and robust control strategies for using them. We review and discuss applications of some analytic methods based on a thermodynamic metaphor, according to which the interplay between system entropy and conservation laws gives rise to intuitive and governing global properties of complex systems that cannot be otherwise understood. We apply these methods to the question of how power markets can be expected to behave under a variety of conditions.

Integrated Systems Health Management for Intelligent Systems

Science.gov (United States)

Figueroa, Fernando; Melcher, Kevin

2011-01-01

The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

Systems Measures of Water Distribution System Resilience

Energy Technology Data Exchange (ETDEWEB)

Klise, Katherine A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Murray, Regan [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Walker, La Tonya Nicole [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2015-01-01

Resilience is a concept that is being used increasingly to refer to the capacity of infrastructure systems to be prepared for and able to respond effectively and rapidly to hazardous events. In Section 2 of this report, drinking water hazards, resilience literature, and available resilience tools are presented. Broader definitions, attributes and methods for measuring resilience are presented in Section 3. In Section 4, quantitative systems performance measures for water distribution systems are presented. Finally, in Section 5, the performance measures and their relevance to measuring the resilience of water systems to hazards is discussed along with needed improvements to water distribution system modeling tools.

Instrument air system - Aging impact on system availability

International Nuclear Information System (INIS)

Villaran, M.; Subudhi, M.

1989-01-01

As part of ongoing efforts to understand and manage the effects of aging in nuclear power plants, an aging assessment was performed for the Instrument Air (IA) system, a system that has been the subject of much scrutiny in recent years. Despite its non-safety classification, instrument air has been a factor in a number of potentially serious events. This report presents the results of the assessment and discusses the impact of instrument air system aging on system availability and plant safety. This work was performed for the US Nuclear Regulatory Commission (NRC) as part of the Nuclear Plant Aging Research (NPAR) program. To perform the complex task of analyzing an entire system, the Aging and Life Extension Assessment Program (ALEAP) System Level Plan was developed by Brookhaven National Laboratory and applied successfully in previous system aging studies. The work presented herein was performed using two parallel work paths, as described in the ALEAP plant. One path used deterministic techniques to assess the impact of aging on compressed air system performance, while the second path used probabilistic methods. Results from both paths then were used to characterize aging in the instrument air system. Some conclusions from this work are: compressors, air system valves, and air dryers were found to make up the majority of failures; the effectiveness and quantity of preventive maintenance devoted to a component significantly affected the amount of failures experienced; review of compressed air system designs and studies using a PRA-based system model revealed that the redundancy of key components (compressors, dryers, IA/SA crossconnect valve) was an important factor in system availability; total loss of air events are uncommon

Airport Information Retrieval System (AIRS) System Design

Science.gov (United States)

1974-07-01

This report presents the system design for a prototype air traffic flow control automation system developed for the FAA's Systems Command Center. The design was directed toward the immediate automation of airport data for use in traffic load predicti...

System description of the Basic MRS System for the FY 1990 Systems Integration Program studies

International Nuclear Information System (INIS)

McKee, R.W.; Young, J.R.; Konzek, G.J.

1991-07-01

This document provides both functional and physical descriptions of a conceptual high-level waste management system defined as a Basic MRS System. Its purpose is to provide a basis for required system computer modeling and system studies initiated in FY 1990 under the Systems Integration Program of the Office of Civilian Radioactive Waste Management Office (OCRWM). Two specific systems studies initiated in FY 1990, the Reference System Performance Evaluation and the Aggregate Receipt Rate Study, utilize the information in this document. The Basic MRS System is the current OCRWM reference high-level radioactive wastes repository system concept. It is designed to accept 3000 MTU per year of spent fuel and 400 equivalent MTU per year of high-level wastes. The Basic MRS System includes a storage-only MRS that provides for a limited amount of commercial spent fuel storage capacity prior to acceptance by the geologic repository for disposal. This document contains both functional descriptions of the processes in the waste management system and physical descriptions of the equipment and facilities necessary for performance of those processes. The basic MRS system contains all system components, from the waste storage facilities of the waste generators to the underground facilities for final disposal of the wastes. The major facilities in the system are the waste generator waste storage facilities, an MRS facility that provides interim storage wastes accepted from the waste generators, a repository facility that packages the wastes and then emplaces them in the geologic repository, and the transportation equipment and facilities for transporting the waste between these major facilities

The impact of a low glycemic index (GI) breakfast and snack on daily blood glucose profiles and food intake in young Chinese adult males.

Science.gov (United States)

Kaur, Bhupinder; Ranawana, Viren; Teh, Ai-Ling; Henry, C Jeya K

2015-09-01

Low glycemic index (GI) foods have been suggested to minimize large fluctuations in blood glucose levels and reduce food intake. However, the majority of studies have been conducted on Caucasian populations with limited data on Asians. The objective of this study was to investigate how the provision of a low GI breakfast and afternoon snack affected daily blood glucose profiles and food intake. In a randomized, controlled crossover non blind design, 11 healthy Chinese male adults (body mass index 22.4 ± 1.3 kg m -2 ) attended two sessions where they consumed either a high or low GI breakfast and afternoon snack, and a standardized buffet lunch. Daily changes in glycemic response (GR) were measured using the Medtronic MiniMed (Northridge, CA) iPro™2 continuous glucose monitoring system (CGMS). The GR was further calculated to obtain the incremental area under the curve (IAUC). Glycemic variability was calculated as mean amplitude of glycemic excursion (MAGE) and energy intake (kcal) was measured quantitatively at the buffet lunch. Compared to the high GI intervention, the low GI intervention significantly reduced the GR following breakfast ( p  = 0.02), lunch ( p  = 0.02) and dinner ( p  = 0.05). The low GI treatment showed a reduction in daily AUC ( p  = 0.03). There was a significant reduction in IAUC after a low GI breakfast compared to the high GI breakfast ( p  = 0.03). The low GI breakfast resulted in a significantly lower food intake at lunch and a resulting decreased energy intake of 285 kcal ( p  = 0.02). The MAGE was significantly lower during the entire low GI treatment ( p  = 0.03). Consumption of a low GI breakfast and afternoon snack was capable of attenuating 24-h blood glucose profiles, minimize glycemic excursions and reduce food intake in healthy Asian males. This simple dietary intervention may be an acceptable approach in improving overall glycemia and energy balance in Asians. NCT02340507.

Comparative Dose Accuracy of Durable and Patch Insulin Infusion Pumps

Science.gov (United States)

Jahn, Luis G.; Capurro, Jorge J.; Levy, Brian L.

2013-01-01

Background: As all major insulin pump manufacturers comply with the international infusion pump standard EN 60601-2-24:1998, there may be a general assumption that all pumps are equal in insulin-delivery accuracy. This research investigates single-dose and averaged-dose accuracy of incremental basal deliveries for one patch model and three durable models of insulin pumps. Method: For each pump model, discrete single doses delivered during 0.5 U/h basal rate infusion over a 20 h period were measured using a time-stamped microgravimetric system. Dose accuracy was analyzed by comparing single doses and time-averaged doses to specific accuracy thresholds (±5% to ±30%). Results: The percentage of single doses delivered outside accuracy thresholds of ±5%, ±10%, and ±20% were as follows: Animas OneTouch® Ping® (43.2%, 14.3%, and 1.8%, respectively), Roche Accu-Chek® Combo (50.6%, 24.4%, and 5.5%), Medtronic Paradigm® RevelTM/VeoTM (54.2%, 26.7%, and 6.6%), and Insulet OmniPod® (79.1%, 60.5%, and 34.9%). For 30 min, 1 h, and 2 h averaging windows, the percentage of doses delivered outside a ±15% accuracy were as follows: OneTouch Ping (1.0%, 0.4%, and 0%, respectively), Accu-Chek Combo (4.2%, 3.5%, and 3.1%), Paradigm Revel/Veo (3.9%, 3.1%, and 2.2%), and OmniPod (33.9%, 19.9%, and 10.3%). Conclusions: This technical evaluation demonstrates significant differences in single-dose and averaged-dose accuracy among the insulin pumps tested. Differences in dose accuracy were most evident between the patch pump model and the group of durable pump models. Of the pumps studied, the Animas OneTouch Ping demonstrated the best single-dose and averaged-dose accuracy. Further research on the clinical relevance of these findings is warranted. PMID:23911184

Topographical and functional anatomy of trapezius muscle innervation by spinal accessory nerve and C2 to C4 nerves of cervical plexus.

Science.gov (United States)

Gavid, M; Mayaud, A; Timochenko, A; Asanau, A; Prades, J M

2016-10-01

The aim of this study was to determine the existence and the frequency of communicating branches between the spinal accessory nerve (SAN) and the C2, C3 and C4 roots of the cervical plexus. The present study also aimed to elucidate whether these branches contain motor fibers or not. Dissection of the cervical region was performed on twelve adult cadavers. A powered operating microscope was necessary to dissect the SAN and its branches and also to dissect C2, C3 and C4 nerve branches. In a second step, data from 13 patients who underwent 25 modified neck dissections under trapezius muscle's monitoring were collected. At the end of surgery, intraoperative stimulation on the SAN, C2, C3 and C4 nerve branches was performed. Registered potentials in the three parts of the trapezius muscle, using the NIM Medtronic system, were analyzed. During cadaver dissection, 18 (78 %) communicating branches were identified between the SAN and C2, 11 (48 %) between the SAN and C3, 12 (52 %) between the SAN and C4. Intraoperative stimulation of the SAN and its branch for the trapezius muscle provided a significant electroneurographic response in the three parts of the trapezius muscle in all subjects. Intraoperative stimulation of C3 led to recordable contractions of the trapezius muscle in 5 (20 %) modified neck surgeries, stimulation of C4 led to recordable contractions during 5 (20 %) modified neck dissections. One case of contraction was recorded after intraoperative stimulation of C2 (7 %). Although we were able to identify at least one communicating branch between the SAN and the roots of the cervical plexus in each cadaver dissection, the cervical plexus is not always involved in trapezius motor innervation. Intraoperative electroneurography demonstrated that a motor input from the cervical plexus to the trapezius muscle was provided in only 32 % of cases. Therefore, SAN trunk and C3-C4 roots should be carefully preserved during modified neck dissection to protect

Systems Biology and Health Systems Complexity in;

NARCIS (Netherlands)

Donald Combs, C.; Barham, S.R.; Sloot, P.M.A.

2016-01-01

Systems biology addresses interactions in biological systems at different scales of biological organization, from the molecular to the cellular, organ, organism, societal, and ecosystem levels. This chapter expands on the concept of systems biology, explores its implications for individual patients

Triggering system innovation in agricultural innovation systems

NARCIS (Netherlands)

Turner, James A.; Williams, Tracy; Nicholas, Graeme; Foote, Jeff; Rijswijk, Kelly; Barnard, Tim; Beechener, Sam; Horita, Akiko

2017-01-01

This article describes a process for stimulating engagement among change agents to develop a shared understanding of systemic problems in the agricultural innovation system (AIS), challenge prevalent institutional logics and identify actions they might undertake to stimulate system innovation.

Port contact systems for irreversible thermodynamical systems

NARCIS (Netherlands)

Eberard, D.; Maschke, B.M.; Schaft, A.J. van der

2005-01-01

In this paper we propose a definition of control contact systems, generalizing input-output Hamiltonian systems, to cope with models arising from irreversible Thermodynamics. We exhibit a particular subclass of these systems, called conservative, that leaves invariant some Legendre submanifold (the

Lectures on algebraic system theory: Linear systems over rings

Science.gov (United States)

Kamen, E. W.

1978-01-01

The presentation centers on four classes of systems that can be treated as linear systems over a ring. These are: (1) discrete-time systems over a ring of scalars such as the integers; (2) continuous-time systems containing time delays; (3) large-scale discrete-time systems; and (4) time-varying discrete-time systems.

IDAPS (Image Data Automated Processing System) System Description

Science.gov (United States)

1988-06-24

This document describes the physical configuration and components used in the image processing system referred to as IDAPS (Image Data Automated ... Processing System). This system was developed by the Environmental Research Institute of Michigan (ERIM) for Eglin Air Force Base. The system is designed

A semantic security framework for systems of systems

NARCIS (Netherlands)

Trivellato, Daniel; Zannone, Nicola; Glaundrup, Maurice; Skowronek, Jacek; Etalle, Sandro

2013-01-01

Systems of systems (SoS) are dynamic coalitions of distributed, autonomous and heterogeneous systems that collaborate to achieve a common goal. While offering several advantages in terms of scalability and flexibility, the SoS paradigm has a strong impact on systems interoperability and on the

Thermal Distribution System | Energy Systems Integration Facility | NREL

Science.gov (United States)

Thermal Distribution System Thermal Distribution System The Energy Systems Integration Facility's . Photo of the roof of the Energy Systems Integration Facility. The thermal distribution bus allows low as 10% of its full load level). The 60-ton chiller cools water with continuous thermal control

Seamless integrated network system for wireless communication systems

NARCIS (Netherlands)

Wu, Gang; Mizuno, Mitsuhiko; Hase, Yoshihiro; Havinga, Paul J.M.

2006-01-01

To create a network that connects a plurality of wireless communication systems to create optimal systems for various environments, and that seamlessly integrates the resulting systems together in order to provide more efficient and advanced service in general. A network system that can seamlessly

Seamless integrated network system for wireless communication systems

NARCIS (Netherlands)

Wu, Gang; Mizuno, Mitsuhiko; Hase, Yoshihiro; Havinga, Paul J.M.

2002-01-01

To create a network that connects a plurality of wireless communication systems to create optimal systems for various environments, and that seamlessly integrates the resulting systems together in order to provide more efficient and advanced service in general. A network system that can seamlessly

Modeling learning technology systems as business systems

NARCIS (Netherlands)

Avgeriou, Paris; Retalis, Symeon; Papaspyrou, Nikolaos

2003-01-01

The design of Learning Technology Systems, and the Software Systems that support them, is largely conducted on an intuitive, ad hoc basis, thus resulting in inefficient systems that defectively support the learning process. There is now justifiable, increasing effort in formalizing the engineering

Database management system for large container inspection system

International Nuclear Information System (INIS)

Gao Wenhuan; Li Zheng; Kang Kejun; Song Binshan; Liu Fang

1998-01-01

Large Container Inspection System (LCIS) based on radiation imaging technology is a powerful tool for the Customs to check the contents inside a large container without opening it. The author has discussed a database application system, as a part of Signal and Image System (SIS), for the LCIS. The basic requirements analysis was done first. Then the selections of computer hardware, operating system, and database management system were made according to the technology and market products circumstance. Based on the above considerations, a database application system with central management and distributed operation features has been implemented

Verification and Validation Issues in Systems of Systems

Directory of Open Access Journals (Sweden)

Eric Honour

2013-11-01

Full Text Available The cutting edge in systems development today is in the area of "systems of systems" (SoS large networks of inter-related systems that are developed and managed separately, but that also perform collective activities. Such large systems typically involve constituent systems operating with different life cycles, often with uncoordinated evolution. The result is an ever-changing SoS in which adaptation and evolution replace the older engineering paradigm of "development". This short paper presents key thoughts about verification and validation in this environment. Classic verification and validation methods rely on having (a a basis of proof, in requirements and in operational scenarios, and (b a known system configuration to be proven. However, with constant SoS evolution, management of both requirements and system configurations are problematic. Often, it is impossible to maintain a valid set of requirements for the SoS due to the ongoing changes in the constituent systems. Frequently, it is even difficult to maintain a vision of the SoS operational use as users find new ways to adapt the SoS. These features of the SoS result in significant challenges for system proof. In addition to discussing the issues, the paper also indicates some of the solutions that are currently used to prove the SoS.

Systems Theory and Systems Approach to Leadership

Directory of Open Access Journals (Sweden)

Dr.Sc. Berim Ramosaj

2014-06-01

Full Text Available Systems theory is product of the efforts of many researchers to create an intermediate field of coexistence of all sciences. If not for anything else, because of the magnitude that the use of systemic thinking and systemic approach has taken, it has become undisputed among the theories. Systems theory not only provides a glossary of terms with which researchers from different fields can be understood, but provides a framework for the presentation and interpretation of phenomena and realities. This paper addresses a systematic approach to leadership, as an attempt to dredge leadership and systems theory literature to find the meeting point. Systems approach is not an approach to leadership in terms of a manner of leader’s work, but it’s the leader's determination to factorize in his leadership the external environment and relationships with and among elements. Leader without followers is unable to exercise his leadership and to ensure their conviction he should provide a system, a structure, a purpose, despite the alternative chaos. Systems approach clarifies the thought on the complexity and dynamism of the environment and provides a framework for building ideas. If the general system theory is the skeleton of science (Boulding: 1956, this article aims to replenish it with leadership muscles by prominent authors who have written on systems theory and leadership, as well as through original ideas. In this work analytical methods were used (by analyzing approaches individually as well as synthetic methods (by assaying individual approaches in context of entirety. The work is a critical review of literature as well as a deductive analysis mingled with models proposed by authors through inductive analysis. Meta-analysis has been used to dissect the interaction and interdependence between leadership approaches.

Peripheral Nervous System Manifestations in Systemic Autoimmune Diseases

OpenAIRE

COJOCARU, Inimioara Mihaela; COJOCARU, Manole; SILOSI, Isabela; VRABIE, Camelia Doina

2014-01-01

The peripheral nervous system refers to parts of the nervous system outside the brain and spinal cord. Systemic autoimmune diseases can affect both the central and peripheral nervous systems in a myriad of ways and through a heterogeneous number of mechanisms leading to many different clinical manifestations. As a result, neurological complications of these disorders can result in significant morbidity and mortality. The most common complication of peripheral nervous system (PNS) involvement ...

Multibody Systems

DEFF Research Database (Denmark)

Wagner, Falko Jens

1999-01-01

Multibody Systems is one area, in which methods for solving DAEs are of special interst. This chapter is about multibody systems, why they result in DAE systems and what kind of problems that can arise when dealing with multibody systems and formulating their corresponding DAE system....

Engineering Elegant Systems: Postulates, Principles, and Hypotheses of Systems Engineering

Science.gov (United States)

Watson, Michael D.

2018-01-01

Definition: System Engineering is the engineering discipline which integrates the system functions, system environment, and the engineering disciplines necessary to produce and/or operate an elegant system; Elegant System - A system that is robust in application, fully meeting specified and adumbrated intent, is well structured, and is graceful in operation. Primary Focus: System Design and Integration: Identify system couplings and interactions; Identify system uncertainties and sensitivities; Identify emergent properties; Manage the effectiveness of the system. Engineering Discipline Integration: Manage flow of information for system development and/or operations; Maintain system activities within budget and schedule. Supporting Activities: Process application and execution.

Applying System of Systems Engineering(SoSE) to VIVO?

OpenAIRE

Wang, Jing

2015-01-01

System of systems (SoS) refers to a set of operational and managerial independent systems interacting with each other to provide capabilities which cannot be accomplished by any single system. SoS has its own characteristics and challenges, such as emergent behavior and evolutionary development. This presentation will: Introduce the concepts and characteristics of system of systems (SoS) and system thinking practice. discuss SoS challenges using SoS case studies such as Global Earth Observati...

Systems integration.

Science.gov (United States)

Siemieniuch, C E; Sinclair, M A

2006-01-01

The paper presents a view of systems integration, from an ergonomics/human factors perspective, emphasising the process of systems integration as is carried out by humans. The first section discusses some of the fundamental issues in systems integration, such as the significance of systems boundaries, systems lifecycle and systems entropy, issues arising from complexity, the implications of systems immortality, and so on. The next section outlines various generic processes for executing systems integration, to act as guides for practitioners. These address both the design of the system to be integrated and the preparation of the wider system in which the integration will occur. Then the next section outlines some of the human-specific issues that would need to be addressed in such processes; for example, indeterminacy and incompleteness, the prediction of human reliability, workload issues, extended situation awareness, and knowledge lifecycle management. For all of these, suggestions and further readings are proposed. Finally, the conclusions section reiterates in condensed form the major issues arising from the above.

Formal heterogeneous system modeling with SystemC

DEFF Research Database (Denmark)

Niaki, Seyed Hosein Attarzadeh; Jakobsen, Mikkel Koefoed; Sulonen, Tero

2012-01-01

Electronic System Level (ESL) design of embedded systems proposes raising the abstraction level of the design entry to cope with the increasing complexity of such systems. To exploit the benefits of ESL, design languages should allow specification of models which are a) heterogeneous, to describe...

System description of the Repository-Only System for the FY 1990 systems integration program studies

International Nuclear Information System (INIS)

McKee, R.W.; Young, J.R.; Konzek, G.J.

1991-07-01

This document provides both functional and physical descriptions of a conceptual high-level waste management system defined as a Repository-Only System. Its purpose is to provide a basis for required system computer modeling and system studies initiated in FY 1990 under the Systems Integration Program of the US Department of Energy's (DOE) Office of Civilian Radioactive Waste Management (OCRWM). The Repository-Only System is designed to accept 3000 MTU per year of spent fuel and 400 equivalent MTU per year of high-level wastes disposal in the geologic repository. This document contains both functional descriptions of the processes in the waste management system and physical descriptions of the equipment and facilities necessary for performance of those processes. These descriptions contain the level of detail needed for the projected systems analysis studies. The Repository-Only System contains all system components, from the waste storage facilities of the waste generators to the underground facilities for final disposal of the wastes. The major facilities in the system are the waste generator waste storage facilities, a repository facility that packages the wastes and than emplaces them in the geologic repository, and the transportation equipment and facilities for transporting the wastes between these major facilities. 18 refs., 39 figs

Tank waste remediation system systems engineering management plan

International Nuclear Information System (INIS)

Peck, L.G.

1998-01-01

This Systems Engineering Management Plan (SEMP) describes the Tank Waste Remediation System (TWRS) implementation of the US Department of Energy (DOE) systems engineering policy provided in 97-IMSD-193. The SEMP defines the products, process, organization, and procedures used by the TWRS Project to implement the policy. The SEMP will be used as the basis for tailoring the systems engineering applications to the development of the physical systems and processes necessary to achieve the desired end states of the program. It is a living document that will be revised as necessary to reflect changes in systems engineering guidance as the program evolves. The US Department of Energy-Headquarters has issued program management guidance, DOE Order 430. 1, Life Cycle Asset Management, and associated Good Practice Guides that include substantial systems engineering guidance

JOSHUA system

International Nuclear Information System (INIS)

Honeck, H.C.

1975-04-01

A major computational system called JOSHUA has been under development at the Savannah River Laboratory since 1968. The JOSHUA System has two major parts: the Operating System and the Application System. The Operating System has been in production use since 1970 and provides data management, terminal, and job execution facilities. The Application System uses these facilities in solving problems in reactor physics and engineering. Features of the Application System are the two-dimensional lattice physics and three-dimensional transient reactor physics capabilities, which have been in use since 1971 and 1974, respectively. The capabilities of the JOSHUA System are summarized, and statistics on size, use, and development effort are provided. (U.S.)

Integrating system safety into the basic systems engineering process

Science.gov (United States)

Griswold, J. W.

1971-01-01

The basic elements of a systems engineering process are given along with a detailed description of what the safety system requires from the systems engineering process. Also discussed is the safety that the system provides to other subfunctions of systems engineering.

A behavioral framework for compositionality: linear systems, discrete event systems and hybrid systems

NARCIS (Netherlands)

Anak Agung Julius, A.A.J.; van der Schaft, Arjan

2004-01-01

In this paper we formulate a general framework based on the behavioral approach to dynamical systems, in which various issues regarding interconnection of systems can be addressed. The main part of the framework is that interconnections or compositions of systems can be modelled with interconnection

The Creation of Differential Correction Systems and the Systems of Global Navigation Satellite System Monitoring

National Research Council Canada - National Science Library

Polishchuk, G. M; Kozlov, V. I; Urlichich, Y. M; Dvorkin, V. V; Gvozdev, V. V

2002-01-01

... for the Russian Federation and a system of global navigation satellite system monitoring. These projects are some of the basic ones in the Federal program "Global Navigation System," aimed at maintenance and development of the GLONASS system...

Solar power satellite system; Uchu hatsuden system

Energy Technology Data Exchange (ETDEWEB)

Sasaki, S [Institute of Space and Astronautical Science, Tokyo (Japan)

1995-09-05

The solar power satellite system is a system that converts solar energy into electric energy in the space, transmits power to earth through wireless resort such as microwave and supplies energy of new concept. In order to realize this system it is necessary to have new technologies such as space power transmission at low cost, construction of large space buildings and wireless high power transmission. In this paper, the principles, characteristics and the necessary technology of this system were explained. Besides Japan`s SPS2000 Plan (cooperative research by universities, government agencies and private corporations on the model of solar power satellite) the group of Europe, Russia and the United States has also proposed some ideas concerning the solar power satellite system. As far as the microwave power transmission, which is the key technology for solar power satellite system, is concerned, ground demonstration tests at the level of several tens of kW are discussed in Canada and France. 3 refs., 3 figs.

System Analysis and Risk Assessment (SARA) system

International Nuclear Information System (INIS)

Krantz, E.A.; Russell, K.D.; Stewart, H.D.; Van Siclen, V.S.

1986-01-01

Utilization of Probabilistic Risk Assessment (PRA) related information in the day-to-day operation of plant systems has, in the past, been impracticable due to the size of the computers needed to run PRA codes. This paper discusses a microcomputer-based database system which can greatly enhance the capability of operators or regulators to incorporate PRA methodologies into their routine decision making. This system is called the System Analysis and Risk Assessment (SARA) system. SARA was developed by EG and G Idaho, Inc. at the Idaho National Engineering Laboratory to facilitate the study of frequency and consequence analyses of accident sequences from a large number of light water reactors (LWRs) in this country. This information is being amassed by several studies sponsored by the United States Nuclear Regulatory Commission (USNRC). To meet the need of portability and accessibility, and to perform the variety of calculations necessary, it was felt that a microcomputer-based system would be most suitable

Dynamic Systems Modeling in Educational System Design & Policy

Science.gov (United States)

Groff, Jennifer Sterling

2013-01-01

Over the last several hundred years, local and national educational systems have evolved from relatively simple systems to incredibly complex, interdependent, policy-laden structures, to which many question their value, effectiveness, and direction they are headed. System Dynamics is a field of analysis used to guide policy and system design in…

Optimization of large-scale heterogeneous system-of-systems models.

Energy Technology Data Exchange (ETDEWEB)

Parekh, Ojas; Watson, Jean-Paul; Phillips, Cynthia Ann; Siirola, John; Swiler, Laura Painton; Hough, Patricia Diane (Sandia National Laboratories, Livermore, CA); Lee, Herbert K. H. (University of California, Santa Cruz, Santa Cruz, CA); Hart, William Eugene; Gray, Genetha Anne (Sandia National Laboratories, Livermore, CA); Woodruff, David L. (University of California, Davis, Davis, CA)

2012-01-01

Decision makers increasingly rely on large-scale computational models to simulate and analyze complex man-made systems. For example, computational models of national infrastructures are being used to inform government policy, assess economic and national security risks, evaluate infrastructure interdependencies, and plan for the growth and evolution of infrastructure capabilities. A major challenge for decision makers is the analysis of national-scale models that are composed of interacting systems: effective integration of system models is difficult, there are many parameters to analyze in these systems, and fundamental modeling uncertainties complicate analysis. This project is developing optimization methods to effectively represent and analyze large-scale heterogeneous system of systems (HSoS) models, which have emerged as a promising approach for describing such complex man-made systems. These optimization methods enable decision makers to predict future system behavior, manage system risk, assess tradeoffs between system criteria, and identify critical modeling uncertainties.

System Design of the SWRL Financial System.

Science.gov (United States)

Ikeda, Masumi

To produce various management and accounting reports in order to maintain control of SWRL (Southwest Regional Laboratory) operational and financial activities, a computer-based SWRL financial system was developed. The system design is outlined, and various types of system inputs described. The kinds of management and accounting reports generated…

Test System Impact on System Availability

DEFF Research Database (Denmark)

Pau, L. F.

1987-01-01

The specifications are presented for an imperfect automatic test system (ATS) (test frequency distribution, reliability, false alarm rate, nondetection rate) in order to account for the availability, readiness, mean time between unscheduled repairs (MTBUR), reliability, and maintenance of the sys......The specifications are presented for an imperfect automatic test system (ATS) (test frequency distribution, reliability, false alarm rate, nondetection rate) in order to account for the availability, readiness, mean time between unscheduled repairs (MTBUR), reliability, and maintenance...... of the system subject to monitoring and test. A time-dependent Markov model is presented, and applied in three cases, with examples of numerical results provided for preventive maintenance decisions, design of an automatic test system, buffer testing in computers, and data communications....

Cognitive Systems

DEFF Research Database (Denmark)

The tutorial will discuss the definition of cognitive systems as the possibilities to extend the current systems engineering paradigm in order to perceive, learn, reason and interact robustly in open-ended changing environments. I will also address cognitive systems in a historical perspective...... to be modeled within a limited set of predefined specifications. There will inevitably be a need for robust decisions and behaviors in novel situations that include handling of conflicts and ambiguities based on the capability and knowledge of the artificial cognitive system. Further, there is a need...... in cognitive systems include e.g. personalized information systems, sensor network systems, social dynamics system and Web2.0, and cognitive components analysis. I will use example from our own research and link to other research activities....

What Is Energy Systems Integration? | Energy Systems Integration Facility |

Science.gov (United States)

NREL What Is Energy Systems Integration? What Is Energy Systems Integration? Energy systems integration (ESI) is an approach to solving big energy challenges that explores ways for energy systems to Research Community NREL is a founding member of the International Institute for Energy Systems Integration

MARBLE: A system for executing expert systems in parallel

Science.gov (United States)

Myers, Leonard; Johnson, Coe; Johnson, Dean

1990-01-01

This paper details the MARBLE 2.0 system which provides a parallel environment for cooperating expert systems. The work has been done in conjunction with the development of an intelligent computer-aided design system, ICADS, by the CAD Research Unit of the Design Institute at California Polytechnic State University. MARBLE (Multiple Accessed Rete Blackboard Linked Experts) is a system of C Language Production Systems (CLIPS) expert system tool. A copied blackboard is used for communication between the shells to establish an architecture which supports cooperating expert systems that execute in parallel. The design of MARBLE is simple, but it provides support for a rich variety of configurations, while making it relatively easy to demonstrate the correctness of its parallel execution features. In its most elementary configuration, individual CLIPS expert systems execute on their own processors and communicate with each other through a modified blackboard. Control of the system as a whole, and specifically of writing to the blackboard is provided by one of the CLIPS expert systems, an expert control system.

System dynamics

International Nuclear Information System (INIS)

Kim, Do Hun; Mun, Tae Hun; Kim, Dong Hwan

1999-02-01

This book introduces systems thinking and conceptual tool and modeling tool of dynamics system such as tragedy of single thinking, accessible way of system dynamics, feedback structure and causal loop diagram analysis, basic of system dynamics modeling, causal loop diagram and system dynamics modeling, information delay modeling, discovery and application for policy, modeling of crisis of agricultural and stock breeding products, dynamic model and lesson in ecosystem, development and decadence of cites and innovation of education forward system thinking.

Thermal systems; Systemes thermiques

Energy Technology Data Exchange (ETDEWEB)

Lalot, S. [Valenciennes Univ. et du Hainaut Cambresis, LME, 59 (France); Lecoeuche, S. [Ecole des Mines de Douai, Dept. GIP, 59 - Douai (France)]|[Lille Univ. des Sciences et Technologies, 59 - Villeneuve d' Ascq (France); Ahmad, M.; Sallee, H.; Quenard, D. [CSTB, 38 - Saint Martin d' Heres (France); Bontemps, A. [Universite Joseph Fourier, LEGI/GRETh, 38 - Grenoble (France); Gascoin, N.; Gillard, P.; Bernard, S. [Laboratoire d' Energetique, Explosion, Structure, 18 - Bourges (France); Gascoin, N.; Toure, Y. [Laboratoire Vision et Robotique, 18 - Bourges (France); Daniau, E.; Bouchez, M. [MBDA, 18 - Bourges (France); Dobrovicescu, A.; Stanciu, D. [Bucarest Univ. Polytechnique, Faculte de Genie Mecanique (Romania); Stoian, M. [Reims Univ. Champagne Ardenne, Faculte des Sciences, UTAP/LTM, 51 (France); Bruch, A.; Fourmigue, J.F.; Colasson, S. [CEA Grenoble, Lab. Greth, 38 (France); Bontemps, A. [Universite Joseph Fourier, LEGI/GRETh, 38 - Grenoble (France); Voicu, I.; Mare, T.; Miriel, J. [Institut National des Sciences Appliquees (INSA), LGCGM, IUT, 35 - Rennes (France); Galanis, N. [Sherbrooke Univ., Genie Mecanique, QC (Canada); Nemer, M.; Clodic, D. [Ecole des Mines de Paris, Centre Energetique et Procedes, 75 (France); Lasbet, Y.; Auvity, B.; Castelain, C.; Peerhossaini, H. [Nantes Univ., Ecole Polytechnique, Lab. de Thermocinetiquede Nantes, UMR-CNRS 6607, 44 (France)

2005-07-01

This session about thermal systems gathers 26 articles dealing with: neural model of a compact heat exchanger; experimental study and numerical simulation of the thermal behaviour of test-cells with walls made of a combination of phase change materials and super-insulating materials; hydraulic and thermal modeling of a supercritical fluid with pyrolysis inside a heated channel: pre-dimensioning of an experimental study; energy analysis of the heat recovery devices of a cryogenic system; numerical simulation of the thermo-hydraulic behaviour of a supercritical CO{sub 2} flow inside a vertical tube; mixed convection inside dual-tube exchangers; development of a nodal approach with homogenization for the simulation of the brazing cycle of a heat exchanger; chaotic exchanger for the cooling of low temperature fuel cells; structural optimization of the internal fins of a cylindrical generator; a new experimental approach for the study of the local boiling inside the channels of exchangers with plates and fins; experimental study of the flow regimes of boiling hydrocarbons on a bundle of staggered tubes; energy study of heat recovery exchangers used in Claude-type refrigerating systems; general model of Carnot engine submitted to various operating constraints; the free pistons Stirling cogeneration system; natural gas supplied cogeneration system with polymer membrane fuel cell; influence of the CRN coating on the heat flux inside the tool during the wood unrolling process; transport and mixture of a passive scalar injected inside the wake of a Ahmed body; control of a laser welding-brazing process by infrared thermography; 2D self-adaptative method for contours detection: application to the images of an aniso-thermal jet; exergy and exergy-economical study of an 'Ericsson' engine-based micro-cogeneration system; simplified air-conditioning of telephone switching equipments; parametric study of the 'low-energy' individual dwelling; brief synthesis of

Embedded Systems

Indian Academy of Sciences (India)

Embedded system, micro-con- troller ... Embedded systems differ from general purpose computers in many ... Low cost: As embedded systems are extensively used in con- .... operating systems for the desktop computers where scheduling.

Understanding Patterns for System-of-Systems Integration

DEFF Research Database (Denmark)

Kazman, Rick; Nielsen, Claus Ballegård; Schmid, Klaus

Creating a successful system of systems—one that meets the needs of its stakeholders today and can evolve and scale to sustain those stakeholders into the future—is a very complex engineering challenge. In a system of systems (SoS), one of the biggest challenges is in achieving cooperation and in...

Cold Vacuum Drying (CVD) Facility Vacuum Purge System Chilled Water System Design Description. System 47-4

International Nuclear Information System (INIS)

IRWIN, J.J.

2000-01-01

This system design description (SDD) addresses the Vacuum Purge System Chilled Water (VPSCHW) system. The discussion that follows is limited to the VPSCHW system and its interfaces with associated systems. The reader's attention is directed to Drawings H-1-82162, Cold Vacuum Drying Facility Process Equipment Skid PandID Vacuum System, and H-1-82224, Cold Vacuum Drying Facility Mechanical Utilities Process Chilled Water PandID. Figure 1-1 shows the location and equipment arrangement for the VPSCHW system. The VPSCHW system provides chilled water to the Vacuum Purge System (VPS). The chilled water provides the ability to condense water from the multi-canister overpack (MCO) outlet gases during the MCO vacuum and purge cycles. By condensing water from the MCO purge gas, the VPS can assist in drying the contents of the MCO

Power system protection 2 systems and methods

CERN Document Server

1995-01-01

The worldwide growth in demand for electricity has forced the pace of developments in electrical power system design to meet consumer needs for reliable, secure and cheap supplies. Power system protection, as a technology essential to high quality supply, is widely recognised as a specialism of growing and often critical importance, in which power system needs and technological progress have combined to result in rapid developments in policy and practice in recent years. In the United Kingdom, the need for appropriate training in power system protection was recognised in the early 1960s with t

Degradable Systems: A Survey of Multistate System Theory.

Science.gov (United States)

1982-08-01

and Subtitle) S. TYPE OF REPORT & PERIOD COVERED C. O DEGRADABLE SYSTEMS: A SURVEY OF MULTISTATE TECHNICAL SYSTEM THEORY 6. PERFORMING ORG. REPORT...THIS PAGE(R7,en Date £nt.,.d) AEoS-T- 8- 9 2 0 Degradable Systems: A Survey of Multistate System Theory by 1 2Emad El-Neweihi and Frank Proschan

Holographic representation of space-variant systems: system theory.

Science.gov (United States)

Marks Ii, R J; Krile, T F

1976-09-01

System theory for holographic representation of linear space-variant systems is derived. The utility of the resulting piecewise isoplanatic approximation (PIA) is illustrated by example application to the invariant system, ideal magnifier, and Fourier transformer. A method previously employed to holographically represent a space-variant system, the discrete approximation, is shown to be a special case of the PIA.

General Systems Theory and Instructional Systems Design.

Science.gov (United States)

Salisbury, David F.

1990-01-01

Describes basic concepts in the field of general systems theory (GST) and identifies commonalities that exist between GST and instructional systems design (ISD). Models and diagrams that depict system elements in ISD are presented, and two matrices that show how GST has been used in ISD literature are included. (11 references) (LRW)

Construction of test-bed system of voltage management system to ...

African Journals Online (AJOL)

Construction of test-bed system of voltage management system to apply physical power system. ... Journal of Fundamental and Applied Sciences ... system of voltage management system (VMS) in order to apply physical power system.

Next generation railway system. ; Control system for JR Maglev. Jisedai tetsudo system. ; Rinia shinkansen no seigyo system

Energy Technology Data Exchange (ETDEWEB)

Matsuda, K [Central Japan Railway Company, Nagoya (Japan)

1993-07-10

Aiming at achieving a maglev Shinkansen that links Tokyo with Osaka at a speed of 500 km/h, an experimental maglev line is being constructed in Yamanashi Prefecture. This paper explains a train control system as the main subject. The system mounts superconductive magnets directly on bogies to propel a train using actions of moving magnet fields generated from propulsion coils paved on ground. Because of its mechanism to levitate and guide the train using induction coils superposed on the propulsion coils, no special control device is required for the levitation and guidance. This is a difference from a normal conduction magnet levitation system. Its speed control also differs from the conventional railway systems. It uses a ground primary control system that controls supply currents from substations on the ground, including braking control. One substation controls one train only. Automatic control is made on all controls related to travelling, including a control from train movement start to stops at predetermined positions, scheduled-time operation control, and jerk control. The construction of the experimental line is under steady progress. 5 figs.

78 FR 18252 - Prevailing Rate Systems; North American Industry Classification System Based Federal Wage System...

Science.gov (United States)

2013-03-26

...-AM78 Prevailing Rate Systems; North American Industry Classification System Based Federal Wage System... applicable sections. The Federal Prevailing Rate Advisory Committee, the national labor- management committee... proposing to amend 5 CFR part 532 as follows: PART 532--PREVAILING RATE SYSTEMS 0 1. The authority citation...

Systems engineering simplified

CERN Document Server

Cloutier, Robert; Bone, Mary Alice

2015-01-01

IntroductionOverviewDiscussion of Common TerminologyThe Case for Systems EngineeringA Brief History of Systems EngineeringSystem ExamplesSummaryThe System Life CycleManaging System Development-The Vee ModelSystem ProductionSystem Utilization and SupportSystem Retirement and DisposalOther Systems Engineering Development ModelsSpiral ModelAgile Model for Systems EngineeringSystem of InterestAbstraction and DecompositionIntegrationDeveloping and Managing RequirementsCyclone Requiremen

Expert Systems for auditing management information systems

Directory of Open Access Journals (Sweden)

Gheroghe Popescu

2007-05-01

Full Text Available Expert systems are built with the help of: specialised programming languages or expert system generators (shell. But this structure was reached after tens of years of work and research, because expert systems are nothing but pragmatic capitalisation of the results of research carried out in artificial intelligence and theory of knowledge.

System and method for creating expert systems

Science.gov (United States)

Hughes, Peter M. (Inventor); Luczak, Edward C. (Inventor)

1998-01-01

A system and method provides for the creation of a highly graphical expert system without the need for programming in code. An expert system is created by initially building a data interface, defining appropriate Mission, User-Defined, Inferred, and externally-generated GenSAA (EGG) data variables whose data values will be updated and input into the expert system. Next, rules of the expert system are created by building appropriate conditions of the rules which must be satisfied and then by building appropriate actions of rules which are to be executed upon corresponding conditions being satisfied. Finally, an appropriate user interface is built which can be highly graphical in nature and which can include appropriate message display and/or modification of display characteristics of a graphical display object, to visually alert a user of the expert system of varying data values, upon conditions of a created rule being satisfied. The data interface building, rule building, and user interface building are done in an efficient manner and can be created without the need for programming in code.

Bitcoin System

Directory of Open Access Journals (Sweden)

Jan Lánský

2017-06-01

Full Text Available Cryptocurrency systems are purely digital and decentralized systems that use cryptographic principles to confirm transactions. Bitcoin is the first and also the most widespread cryptocurrency. The aim of this article is to introduce Bitcoin system using a language understandable also to readers without computer science education. This article captures the Bitcoin system from three perspectives: internal structure, network and users. Emphasis is placed on brief and clear definitions (system components and their mutual relationships. A new system view of the stated terms constitutes author’s own contribution.

Waste receiving and processing plant control system; system design description

Energy Technology Data Exchange (ETDEWEB)

LANE, M.P.

1999-02-24

The Plant Control System (PCS) is a heterogeneous computer system composed of numerous sub-systems. The PCS represents every major computer system that is used to support operation of the Waste Receiving and Processing (WRAP) facility. This document, the System Design Description (PCS SDD), includes several chapters and appendices. Each chapter is devoted to a separate PCS sub-system. Typically, each chapter includes an overview description of the system, a list of associated documents related to operation of that system, and a detailed description of relevant system features. Each appendice provides configuration information for selected PCS sub-systems. The appendices are designed as separate sections to assist in maintaining this document due to frequent changes in system configurations. This document is intended to serve as the primary reference for configuration of PCS computer systems. The use of this document is further described in the WRAP System Configuration Management Plan, WMH-350, Section 4.1.

Waste receiving and processing plant control system; system design description

International Nuclear Information System (INIS)

LANE, M.P.

1999-01-01

The Plant Control System (PCS) is a heterogeneous computer system composed of numerous sub-systems. The PCS represents every major computer system that is used to support operation of the Waste Receiving and Processing (WRAP) facility. This document, the System Design Description (PCS SDD), includes several chapters and appendices. Each chapter is devoted to a separate PCS sub-system. Typically, each chapter includes an overview description of the system, a list of associated documents related to operation of that system, and a detailed description of relevant system features. Each appendice provides configuration information for selected PCS sub-systems. The appendices are designed as separate sections to assist in maintaining this document due to frequent changes in system configurations. This document is intended to serve as the primary reference for configuration of PCS computer systems. The use of this document is further described in the WRAP System Configuration Management Plan, WMH-350, Section 4.1

Supporting Space Systems Design via Systems Dependency Analysis Methodology

Science.gov (United States)

Guariniello, Cesare

The increasing size and complexity of space systems and space missions pose severe challenges to space systems engineers. When complex systems and Systems-of-Systems are involved, the behavior of the whole entity is not only due to that of the individual systems involved but also to the interactions and dependencies between the systems. Dependencies can be varied and complex, and designers usually do not perform analysis of the impact of dependencies at the level of complex systems, or this analysis involves excessive computational cost, or occurs at a later stage of the design process, after designers have already set detailed requirements, following a bottom-up approach. While classical systems engineering attempts to integrate the perspectives involved across the variety of engineering disciplines and the objectives of multiple stakeholders, there is still a need for more effective tools and methods capable to identify, analyze and quantify properties of the complex system as a whole and to model explicitly the effect of some of the features that characterize complex systems. This research describes the development and usage of Systems Operational Dependency Analysis and Systems Developmental Dependency Analysis, two methods based on parametric models of the behavior of complex systems, one in the operational domain and one in the developmental domain. The parameters of the developed models have intuitive meaning, are usable with subjective and quantitative data alike, and give direct insight into the causes of observed, and possibly emergent, behavior. The approach proposed in this dissertation combines models of one-to-one dependencies among systems and between systems and capabilities, to analyze and evaluate the impact of failures or delays on the outcome of the whole complex system. The analysis accounts for cascading effects, partial operational failures, multiple failures or delays, and partial developmental dependencies. The user of these methods can

Embedded systems handbook networked embedded systems

CERN Document Server

Zurawski, Richard

2009-01-01

Considered a standard industry resource, the Embedded Systems Handbook provided researchers and technicians with the authoritative information needed to launch a wealth of diverse applications, including those in automotive electronics, industrial automated systems, and building automation and control. Now a new resource is required to report on current developments and provide a technical reference for those looking to move the field forward yet again. Divided into two volumes to accommodate this growth, the Embedded Systems Handbook, Second Edition presents a comprehensive view on this area

Modern system architectures in embedded systems

International Nuclear Information System (INIS)

Korhonen, T.

2012-01-01

Several new technologies are making their way also in embedded systems. In addition to the FPGA technology which has become commonplace, multi-core CPUs and I/O virtualization (the implementation of the tasks of a software hyper-visor in hardware to improve the efficiency) are being introduced to the embedded systems. In this paper we review the trends and discuss how to take advantage of these features in control systems. Some potential application examples like parallelization, data streaming, high-speed data acquisition and virtualization are discussed

Nonlinearity of colloid systems oxyhydrate systems

CERN Document Server

Sucharev, Yuri I

2008-01-01

The present monograph is the first systematic study of the non-linear characteristic of gel oxy-hydrate systems involving d- and f- elements. These are the oxyhydrates of rare-earth elements and oxides - hydroxides of d- elements (zirconium, niobium, titanium, etc.) The non-linearity of these gel systems introduces fundamental peculiarities into their structure and, consequently, their properties. The polymer-conformational diversity of energetically congenial gel fragments, which continu-ously transform under the effect of, for instance, system dissipation heat, is central to the au-thor's hy

Systems of Systems: Scaling up the Development Program

National Research Council Canada - National Science Library

Humphrey, Watts

2006-01-01

... into system-of-systems structures. Section 3 points out how large-scale systems development efforts have typically failed because of project-management and not technical problems, and that the solutions to these problems...

COGNITIVE SYSTEMS. REDEFINING THE COOPERATION BETWEEN MAN AND SYSTEM

Directory of Open Access Journals (Sweden)

Diana-Aderina MOISUC

2016-12-01

Full Text Available Cognitive systems appeared as a response to the real challenges brought by the Big Data phenomenon. It was found that the solutions for solving difficult problems caused by this phenomenon could be brought by using artificial intelligence tools. In this context a convergence between Big Data and Artificial Intelligence happened, which determined the start of a new stage in system development, namely the era of cognitive systems. The potential of these systems is given by the characteristics that differentiate them from other systems. The cognitive systems offered solutions and were used with success in complex projects from the medical and financial sectors. The architecture of cognitive systems is complex. These systems are designed so that they use artificial intelligence tools when processing source content, producing analytical solutions which can be used in the decision process. In this paper base concepts, the characteristics and architecture of cognitive systems, the benefits brought by the development and use of them were presented.

Systems effectiveness

CERN Document Server

Habayeb, A R

1987-01-01

Highlights three principal applications of system effectiveness: hardware system evaluation, organizational development and evaluation, and conflict analysis. The text emphasizes the commonality of the system effectiveness discipline. The first part of the work presents a framework for system effectiveness, partitioning and hierarchy of hardware systems. The second part covers the structure, hierarchy, states, functions and activities of organizations. Contains an extended Appendix on mathematical concepts and also several project suggestions.

Auxiliary systems

International Nuclear Information System (INIS)

Meyer, P.J.

1981-01-01

Systems included under the heading ''Reactor Auxillary Systems'' are those immediately involved with the reactor operation. These include the systems for dosing and letdown of reactor coolant, as well as for the chemical dosing, purification and treatment of the reactor coolant and the cooling system in the controlled area. The ancillary systems are mainly responsible for liquid and gaseous treatment and the waste treatment for final storage. (orig.)

Situation Awareness with Systems of Systems

NARCIS (Netherlands)

Laar, P. van de; Tretmans, J.; Borth, M.

2013-01-01

This book discusses various aspects, challenges, and solutions for developing systems-of-systems for situation awareness, using applications in the domain of maritime safety and security. Topics include advanced, multi-objective visualization methods for situation awareness, stochastic outlier

3S - Systematic, systemic, and systems biology and toxicology.

Science.gov (United States)

Smirnova, Lena; Kleinstreuer, Nicole; Corvi, Raffaella; Levchenko, Andre; Fitzpatrick, Suzanne C; Hartung, Thomas

2018-01-01

A biological system is more than the sum of its parts - it accomplishes many functions via synergy. Deconstructing the system down to the molecular mechanism level necessitates the complement of reconstructing functions on all levels, i.e., in our conceptualization of biology and its perturbations, our experimental models and computer modelling. Toxicology contains the somewhat arbitrary subclass "systemic toxicities"; however, there is no relevant toxic insult or general disease that is not systemic. At least inflammation and repair are involved that require coordinated signaling mechanisms across the organism. However, the more body components involved, the greater the challenge to reca-pitulate such toxicities using non-animal models. Here, the shortcomings of current systemic testing and the development of alternative approaches are summarized. We argue that we need a systematic approach to integrating existing knowledge as exemplified by systematic reviews and other evidence-based approaches. Such knowledge can guide us in modelling these systems using bioengineering and virtual computer models, i.e., via systems biology or systems toxicology approaches. Experimental multi-organ-on-chip and microphysiological systems (MPS) provide a more physiological view of the organism, facilitating more comprehensive coverage of systemic toxicities, i.e., the perturbation on organism level, without using substitute organisms (animals). The next challenge is to establish disease models, i.e., micropathophysiological systems (MPPS), to expand their utility to encompass biomedicine. Combining computational and experimental systems approaches and the chal-lenges of validating them are discussed. The suggested 3S approach promises to leverage 21st century technology and systematic thinking to achieve a paradigm change in studying systemic effects.

Smart power systems and renewable energy system integration

CERN Document Server

2016-01-01

This monograph presents a wider spectrum of researches, developments, and case specific studies in the area of smart power systems and integration of renewable energy systems. The book will be for the benefit of a wider audience including researchers, postgraduate students, practicing engineers, academics, and regulatory policy makers. It covers a wide range of topics from fundamentals, and modelling and simulation aspects of traditional and smart power systems to grid integration of renewables; Micro Grids; challenges in planning and operation of a smart power system; risks, security, and stability in smart operation of a power system; and applied research in energy storage. .

An algebraic method for system reduction of stationary Gaussian systems

NARCIS (Netherlands)

D. Jibetean; J.H. van Schuppen (Jan)

2003-01-01

textabstractSystem identification for a particular approach reduces to system reduction, determining for a system with a high state-space dimension a system of low state-space dimension. For Gaussian systems the problem of system reduction is considered with the divergence rate criterion. The

Open systems dependability dependability engineering for ever-changing systems

CERN Document Server

Tokoro, Mario

2015-01-01

The book describes a fundamentally new approach to software dependability, considering a software system as an ever-changing system due to changes in service objectives, users' requirements, standards and regulations, and to advances in technology. Such a system is viewed as an Open System since its functions, structures, and boundaries are constantly changing. Thus, the approach to dependability is called Open Systems Dependability. The DEOS technology realizes Open Systems Dependability. It puts more emphasis on stakeholders' agreement and accountability achievement for business/service cont

System of Systems Analytic Workbench - 2017

Science.gov (United States)

2017-08-31

Genetic Algorithm and Particle Swarm Optimization with Type-2 Fuzzy Sets for Generating Systems of Systems Architectures. Procedia Computer Science...The application effort involves modeling an existing messaging network to perform real-time situational awareness. The Analytical Workbench’s

System Modeling and Trust Evaluation of Distributed Systems

OpenAIRE

Alhadad , Nagham; Serrano-Alvarado , Patricia; Busnel , Yann; Lamarre , Philippe

2015-01-01

International audience; Nowadays, digital systems are connected through complex architectures. These systems involve persons, physical and digital resources such that we can consider that a system consists of elements from two worlds, the social world and the digital world, and their relations. Users perform activities like chatting, buying, sharing data, etc. Evaluating and choosing appropriate systems involve aspects like functionality, performance, QoS, ease of use, or price. Recently, tru...

Systems thinking.

Science.gov (United States)

Cabrera, Derek; Colosi, Laura; Lobdell, Claire

2008-08-01

Evaluation is one of many fields where "systems thinking" is popular and is said to hold great promise. However, there is disagreement about what constitutes systems thinking. Its meaning is ambiguous, and systems scholars have made diverse and divergent attempts to describe it. Alternative origins include: von Bertalanffy, Aristotle, Lao Tsu or multiple aperiodic "waves." Some scholars describe it as synonymous with systems sciences (i.e., nonlinear dynamics, complexity, chaos). Others view it as taxonomy-a laundry list of systems approaches. Within so much noise, it is often difficult for evaluators to find the systems thinking signal. Recent work in systems thinking describes it as an emergent property of four simple conceptual patterns (rules). For an evaluator to become a "systems thinker", he or she need not spend years learning many methods or nonlinear sciences. Instead, with some practice, one can learn to apply these four simple rules to existing evaluation knowledge with transformative results.

Physical system requirements: Overall system

International Nuclear Information System (INIS)

1992-01-01

The Nuclear Waste Policy Act (NWPA) of 1982 assigned to the Department of Energy (DOE) the responsibility for managing the disposal of spent nuclear fuel and high-level radioactive waste and established the Office of Civilian Radioactive Waste Management (OCRWM) for that purpose. The Secretary of Energy, in his November 1989 report to Congress (DOE/RW-0247), announced three new initiatives for conduct of the Civilian Radioactive Waste Management (CRWM) program. One of these initiatives was to establish improved management structure and procedures. In response, OCRWM performed a management study and the Direct subsequently issued the Management Systems Improvement Strategy (MSIS) on August 10, 1990, calling for a rigorous implementation of systems engineering principles with a special emphasis on functional analysis. This approach establishes a framework for integrating the program management efforts with the technical requirements analysis into a single, unified, and consistent program. The functional analysis approach recognizes that just the facilities and equipment comprising the physical waste management system must perform certain functions, so must certain programmatic and management functions be performed within the program in order to successfully bring the physical system into being

Using system dynamics simulation for assessment of hydropower system safety

Science.gov (United States)

King, L. M.; Simonovic, S. P.; Hartford, D. N. D.

2017-08-01

Hydropower infrastructure systems are complex, high consequence structures which must be operated safely to avoid catastrophic impacts to human life, the environment, and the economy. Dam safety practitioners must have an in-depth understanding of how these systems function under various operating conditions in order to ensure the appropriate measures are taken to reduce system vulnerability. Simulation of system operating conditions allows modelers to investigate system performance from the beginning of an undesirable event to full system recovery. System dynamics simulation facilitates the modeling of dynamic interactions among complex arrangements of system components, providing outputs of system performance that can be used to quantify safety. This paper presents the framework for a modeling approach that can be used to simulate a range of potential operating conditions for a hydropower infrastructure system. Details of the generic hydropower infrastructure system simulation model are provided. A case study is used to evaluate system outcomes in response to a particular earthquake scenario, with two system safety performance measures shown. Results indicate that the simulation model is able to estimate potential measures of system safety which relate to flow conveyance and flow retention. A comparison of operational and upgrade strategies is shown to demonstrate the utility of the model for comparing various operational response strategies, capital upgrade alternatives, and maintenance regimes. Results show that seismic upgrades to the spillway gates provide the largest improvement in system performance for the system and scenario of interest.

System Study: Emergency Power System 1998-2014

Energy Technology Data Exchange (ETDEWEB)

Schroeder, John Alton [Idaho National Lab. (INL), Idaho Falls, ID (United States). Risk Assessment and Management Services Dept.

2015-12-01

This report presents an unreliability evaluation of the emergency power system (EPS) at 104 U.S. commercial nuclear power plants. Demand, run hours, and failure data from fiscal year 1998 through 2014 for selected components were obtained from the Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES). The unreliability results are trended for the most recent 10 year period while yearly estimates for system unreliability are provided for the entire active period. An extremely statistically significant increasing trend was observed for EPS system unreliability for an 8-hour mission. A statistically significant increasing trend was observed for EPS system start-only unreliability.

A Sustainable, Reliable Mission-Systems Architecture that Supports a System of Systems Approach to Space Exploration

Science.gov (United States)

Watson, Steve; Orr, Jim; O'Neil, Graham

2004-01-01

A mission-systems architecture based on a highly modular "systems of systems" infrastructure utilizing open-standards hardware and software interfaces as the enabling technology is absolutely essential for an affordable and sustainable space exploration program. This architecture requires (a) robust communication between heterogeneous systems, (b) high reliability, (c) minimal mission-to-mission reconfiguration, (d) affordable development, system integration, and verification of systems, and (e) minimum sustaining engineering. This paper proposes such an architecture. Lessons learned from the space shuttle program are applied to help define and refine the model.

Conceptual System of Systems Enabling Maritime Dominance in the Littorals

National Research Council Canada - National Science Library

Holmes, Matt

2004-01-01

.... Focusing on only system-of systems (SoS) concepts, we consider a system of only manned platforms, a system of primarily unmanned platforms, and a balanced hybrid system of manned and unmanned platforms...

Airport Information Retrieval System (AIRS) System Support Manual

Science.gov (United States)

1973-01-01

This handbook is a support manual for prototype air traffic flow control automation system developed for the FAA's Systems Command Center. The system is implemented on a time-sharing computer and is designed to provide airport traffic load prediction...

Reliability-Based Optimization of Series Systems of Parallel Systems

DEFF Research Database (Denmark)

Enevoldsen, I.; Sørensen, John Dalsgaard

Reliability-based design of structural systems is considered. Especially systems where the reliability model is a series system of parallel systems are analysed. A sensitivity analysis for this class of problems is presented. Direct and sequential optimization procedures to solve the optimization...

NASA Advanced Exploration Systems: Advancements in Life Support Systems

Science.gov (United States)

Shull, Sarah A.; Schneider, Walter F.

2016-01-01

The NASA Advanced Exploration Systems (AES) Life Support Systems (LSS) project strives to develop reliable, energy-efficient, and low-mass spacecraft systems to provide environmental control and life support systems (ECLSS) critical to enabling long duration human missions beyond low Earth orbit (LEO). Highly reliable, closed-loop life support systems are among the capabilities required for the longer duration human space exploration missions assessed by NASA’s Habitability Architecture Team.

Supervisory Control and Diagnostics System Distributed Operating System

International Nuclear Information System (INIS)

McGoldrick, P.R.

1979-01-01

This paper contains a description of the Supervisory Control and Diagnostics System (SCDS) Distributed Operating System. The SCDS consists of nine 32-bit minicomputers with shared memory. The system's main purpose is to control a large Mirror Fusion Test Facility

Optimization of System Maturity and Equivalent System Mass for Exploration Systems Development Planning

Science.gov (United States)

Magnaye, Romulo; Tan, Weiping; Ramirez-Marquez, Jose; Sauser, Bruce

2010-01-01

The Exploration Systems Mission Directorate of the National Aeronautics and Space Administration (NASA) is currently pursuing the development of the next generation of human spacecraft and exploration systems throughout the Constellation Program. This includes, among others, habitation technologies for supporting lunar and Mars exploration. The key to these systems is the Exploration Life Support (ELS) system that composes several technology development projects related to atmosphere revitalization, water recovery, waste management and habitation. The proper functioning of these technologies is meant to produce sufficient and balanced resources of water, air, and food to maintain a safe and comfortable environment for long-term human habitation and exploration of space.

Measurement system as a subsystem of the quality management system

Directory of Open Access Journals (Sweden)

Ľubica Floreková

2006-12-01

Full Text Available Each measurement system and a control principle must be based on certain facts about the system behaviour (what, operation (how and structure (why. Each system is distributed into subsystems that provide an input for the next subsystem. For each system, start is important the begin, that means system characteristics, collecting of data, its hierarchy and the processes distribution.A measurement system (based on the chapter 8 of the standard ISO 9001:2000 Quality management system, requirements defines the measurement, analysis and improvement for each organization in order to present the products conformity, the quality management system conformity guarantee and for the continuously permanent improvement of effectivity, efficiency and economy of quality management system.

Emergent nested systems a theory of understanding and influencing complex systems as well as case studies in urban systems

CERN Document Server

Walloth, Christian

2016-01-01

This book presents a theory as well as methods to understand and to purposively influence complex systems. It suggests a theory of complex systems as nested systems, i. e. systems that enclose other systems and that are simultaneously enclosed by even other systems. According to the theory presented, each enclosing system emerges through time from the generative activities of the systems they enclose. Systems are nested and often emerge unplanned, and every system of high dynamics is enclosed by a system of slower dynamics. An understanding of systems with faster dynamics, which are always guided by systems of slower dynamics, opens up not only new ways to understanding systems, but also to effectively influence them. The aim and subject of this book is to lay out these thoughts and explain their relevance to the purposive development of complex systems, which are exemplified in case studies from an urban system. The interested reader, who is not required to be familiar with system-theoretical concepts or wit...

Quality management system

Energy Technology Data Exchange (ETDEWEB)

Lee, Mu Sung

2009-08-15

This book deals with ISO9001 quality management system which includes summary of this system such as classification of quality, principle of quality management, and definition, requirement and procedure of quality management system, introduction of ISO9001 system like model of ISO9001 quality management system, ISO certificate system, structure of ISO9001 standard, requirement of ISO9001 quality management system, process approach and documentation of system, propel cases of ISO9001 quality management system.

Quality management system

International Nuclear Information System (INIS)

Lee, Mu Sung

2009-08-01

This book deals with ISO9001 quality management system which includes summary of this system such as classification of quality, principle of quality management, and definition, requirement and procedure of quality management system, introduction of ISO9001 system like model of ISO9001 quality management system, ISO certificate system, structure of ISO9001 standard, requirement of ISO9001 quality management system, process approach and documentation of system, propel cases of ISO9001 quality management system.

Proposing a Process-Oriented Systems Research for Systems Thinking Development

Directory of Open Access Journals (Sweden)

Jae Eon Yu

2017-04-01

Full Text Available This paper discusses systems thinking development from Churchman’s systems ideas related to critical systems practice that appreciates the use of systems methods from sociolinguistic perspectives and poststructuralist thought. Systems research enabled us to understand and reinterpret Churchman’s philosophy and systems approach through the works of Deleuze and Foucault. Based upon the interpretation of Churchman’s philosophy and systems approach, I propose ‘process-oriented systems research’ developed from the use of social appreciative process and Churchman’s metasystem approach. By applying a metasystem approach into practice, I basically appreciate Deleuzian ethics and Foucault’s theory of discourse in order to deal with issues of power and knowledge, and metaethics or moral epistemology, where the meaning of good or bad is discussed. A detailed account of an application of process-oriented systems research is given to demonstrate how I use systems methods to examine the usefulness of the systems research in practice.

Measurement system as a subsystem of the quality management system

OpenAIRE

Ľubica Floreková; Ján Terpák; Marcela Čarnogurská

2006-01-01

Each measurement system and a control principle must be based on certain facts about the system behaviour (what), operation (how) and structure (why). Each system is distributed into subsystems that provide an input for the next subsystem. For each system, start is important the begin, that means system characteristics, collecting of data, its hierarchy and the processes distribution.A measurement system (based on the chapter 8 of the standard ISO 9001:2000 Quality management system, requirem...

Study on Korean Radiological Emergency System-Care System- and National Nuclear Emergency Preparedness System Development

International Nuclear Information System (INIS)

Akhmad Khusyairi; Yudi Pramono

2008-01-01

Care system; Radiological Emergency Supporting System. Environmental radiology level is the main aspect that should be concerned deal with the utilization of nuclear energy. The usage of informational technology in nuclear area gives significant contribution to anticipate and to protect human and environment. Since 1960, South Korea has developed environment monitoring system as the effort to protect the human and environment in the radiological emergency condition. Indonesia has possessed several nuclear installations and planned to build and operate nuclear power plants (PLTN) in the future. Therefore, Indonesia has to prepare the integrated system, technically enables to overcome the radiological emergency. Learning from the practice in South Korea, the system on the radiological emergency should be prepared and applied in Indonesia. However, the government regulation draft on National Radiological Emergency System, under construction, only touches the management aspect, not the technical matters. Consequently, when the regulation is implemented, it will need an additional regulation on technical aspect including the consideration on the system (TSS), the organization of operator and the preparation of human resources development of involved institution. For that purpose, BAPETEN should have a typical independence system in regulatory frame work. (author)

System-level musings about system-level science (Invited)

Science.gov (United States)

Liu, W.

2009-12-01

In teleology, a system has a purpose. In physics, a system has a tendency. For example, a mechanical system has a tendency to lower its potential energy. A thermodynamic system has a tendency to increase its entropy. Therefore, if geospace is seen as a system, what is its tendency? Surprisingly or not, there is no simple answer to this question. Or, to flip the statement, the answer is complex, or complexity. We can understand generally why complexity arises, as the geospace boundary is open to influences from the solar wind and Earth’s atmosphere and components of the system couple to each other in a myriad of ways to make the systemic behavior highly nonlinear. But this still begs the question: What is the system-level approach to geospace science? A reductionist view might assert that as our understanding of a component or subsystem progresses to a certain point, we can couple some together to understand the system on a higher level. However, in practice, a subsystem can almost never been observed in isolation with others. Even if such is possible, there is no guarantee that the subsystem behavior will not change when coupled to others. Hence, there is no guarantee that a subsystem, such as the ring current, has an innate and intrinsic behavior like a hydrogen atom. An absolutist conclusion from this logic can be sobering, as one would have to trace a flash of aurora to the nucleosynthesis in the solar core. The practical answer, however, is more promising; it is a mix of the common sense we call reductionism and awareness that, especially when strongly coupled, subsystems can experience behavioral changes, breakdowns, and catastrophes. If the stock answer to the systemic tendency of geospace is complexity, the objective of the system-level approach to geospace science is to define, measure, and understand this complexity. I will use the example of magnetotail dynamics to illuminate some key points in this talk.

Open System Architecture design for planet surface systems

Science.gov (United States)

Petri, D. A.; Pieniazek, L. A.; Toups, L. D.

1992-01-01

The Open System Architecture is an approach to meeting the needs for flexibility and evolution of the U.S. Space Exploration Initiative program of the manned exploration of the solar system and its permanent settlement. This paper investigates the issues that future activities of the planet exploration program must confront, defines the basic concepts that provide the basis for establishing an Open System Architecture, identifies the appropriate features of such an architecture, and discusses examples of Open System Architectures.

System theory as applied differential geometry. [linear system

Science.gov (United States)

Hermann, R.

1979-01-01

The invariants of input-output systems under the action of the feedback group was examined. The approach used the theory of Lie groups and concepts of modern differential geometry, and illustrated how the latter provides a basis for the discussion of the analytic structure of systems. Finite dimensional linear systems in a single independent variable are considered. Lessons of more general situations (e.g., distributed parameter and multidimensional systems) which are increasingly encountered as technology advances are presented.

Data monitoring system of technical diagnosis system for EAST

International Nuclear Information System (INIS)

Qian Jing; Weng Peide; Chen Zhuomin; Wu Yu; Xi Weibin; Luo Jiarong

2010-01-01

Technical diagnosis system (TDS) is an important subsystem to monitor status parameters of EAST (experimental advanced superconducting tokamak). The upgraded TDS data monitoring system is comprised of management floor, monitoring floor and field floor.. Security protection, malfunction record and analysis are designed to make the system stable, robust and friendly. During the past EAST campaigns, the data monitoring system has been operated reliably and stably. The signal conditioning system and software architecture are described. (authors)

Systems engineering: A formal approach. Part 1: System concepts

Science.gov (United States)

Vanhee, K. M.

1993-03-01

Engineering is the scientific discipline focused on the creation of new artifacts that are supposed to be of some use to our society. Different types of artifacts require different engineering approaches. However, in all these disciplines the development of a new artifact is divided into stages. Three stages can always be recognized: Analysis, Design, and Realization. The book considers only the first two stages of the development process. It focuses on a specific type of artifacts, called discrete dynamic systems. These systems consist of active components of actors that consume and produce passive components or tokens. Three subtypes are studied in more detail: business systems (like a factory or restaurant), information systems (whether automated or not), and automated systems (systems that are controlled by an automated information system). The first subtype is studied by industrial engineers, the last by software engineers and electrical engineers, whereas the second is a battlefield for all three disciplines. The union of these disciplines is called systems engineering.

Systems integration processes for space nuclear electric propulsion systems

International Nuclear Information System (INIS)

Olsen, C.S.; Rice, J.W.; Stanley, M.L.

1991-01-01

The various components and subsystems that comprise a nuclear electric propulsion system should be developed and integrated so that each functions ideally and so that each is properly integrated with the other components and subsystems in the optimum way. This paper discusses how processes similar to those used in the development and intergration of the subsystems that comprise the Multimegawatt Space Nuclear Power System concepts can be and are being efficiently and effectively utilized for these purposes. The processes discussed include the development of functional and operational requirements at the system and subsystem level; the assessment of individual nuclear power supply and thruster concepts and their associated technologies; the conduct of systems integration efforts including the evaluation of the mission benefits for each system; the identification and resolution of concepts development, technology development, and systems integration feasibility issues; subsystem, system, and technology development and integration; and ground and flight subsystem and integrated system testing

Airborne Collision Avoidance System as a Cyber-Physical System

Directory of Open Access Journals (Sweden)

Andrei C. NAE

2015-12-01

Full Text Available In this paper the key concepts of ITS - Intelligent Transport Systems, CPS - Cyber-Physical Systems and SM - Smart Mobility are defined and correlated with the need for ACAS – Airborne Collision Avoidance System, as the last resort safety net and indispensable ingredient in civil aviation. Smart Mobility is addressed from a Cyber Physical-Systems perspective, detailing some of the elements that this entails. Here we consider the Air Transportations System of the future as a Cyber-Physical System and analyze the implications of doing so from different perspectives. The objective is to introduce a 4D collision avoidance shield technology which forms a last resort safety net technology for the next generation air transport (2050 and beyond. The new system will represent a step change over the performance of current technology. As conclusions, the benefits of implementing Transport Cyber-Physical Systems are discussed, as well as what this would require for future deployment.

Photovoltaic systems engineering

CERN Document Server

Messenger, Roger A

2010-01-01

BackgroundPopulation and Energy DemandEnergy UnitsCurrent World Energy Use PatternsExponential GrowthHubbert's Gaussian ModelNet Energy, Btu Economics, and the Test for SustainabilityDirect Conversion of Sunlight to Electricity with PhotovoltaicsThe SunThe Solar SpectrumThe Effect of Atmosphere on SunlightSunlight SpecificsCapturing SunlightIntroduction to PV SystemsThe PV CellThe PV ModuleThe PV ArrayEnergy StoragePV System LoadsPV System AvailabilityAssociated System Electronic ComponentsGeneratorsBalance of System (BOS) ComponentsGrid-Connected Utility-Interactive PV SystemsApplicable Codes and StandardsDesign Considerations for Straight Grid-Connected PV SystemsDesign of a System Based on Desired Annual System PerformanceDesign of a System Based on Available Roof SpaceDesign of a Microinverter-Based SystemDesign of a Nominal 21 kW System that Feeds a Three-Phase Distribution PanelDesign of a Nominal 250 kW SystemSystem Performance MonitoringMechanical ConsiderationsImportant Properties of MaterialsEstabli...

Ternary systems

International Nuclear Information System (INIS)

Kagan, D.N.; Hubberstey, P.; Barker, M.G.

1985-01-01

The paper reviews the experimental and theoretical studies carried out on multicomponent alkali metal systems. Solid-liquid phase equilibria studies are mainly concerned with the systems Na-K-Rb and Na-K-Cs, and data on the liquidus temperatures in these systems are presented. The thermodynamic properties of the ternary Na-K-Cs eutectic system have been determined experimentally, and the enthalpy, heat capacity and excess functions of the alloy are given. An analysis of calculational methods used in determining thermodynamic functions of ternary liquid metals systems is described. Finally, data are tabulated for the density, compressibility, saturated vapour pressure, viscosity and thermal conductivity of the ternary Na-K-Cs eutectic system. (UK)

System Frequency as Information Carrier in AC Power Systems

DEFF Research Database (Denmark)

Douglass, Philip James; Heussen, Kai; You, Shi

2015-01-01

Power generators contain control systems able to regulate system frequency, but the frequency setpoint values are only rarely modified from nominal values. This paper describes design considerations for a communication system from generators to frequency sensitive distributed energy resourc es (FS......-DER) using changes to frequency setpoint values of genera- tors. Signaling discrete system states by generating off-nominal system frequency values can be used as a novel narrowband unidirectional broadcast communications channel. This paper describes two protocols for utilizing off-nominal frequencies...... to carry information: First, a protocol for dispatching blocks of FS- DER that is suitable for systems restricted to relatively slow rates of change of frequency (ROCOF). Second, for systems that allow higher ROCOF values, the feasibility of using power generation resources as a power line communication...

Operating systems

CERN Document Server

Tsichritzis, Dionysios C; Rheinboldt, Werner

1974-01-01

Operating Systems deals with the fundamental concepts and principles that govern the behavior of operating systems. Many issues regarding the structure of operating systems, including the problems of managing processes, processors, and memory, are examined. Various aspects of operating systems are also discussed, from input-output and files to security, protection, reliability, design methods, performance evaluation, and implementation methods.Comprised of 10 chapters, this volume begins with an overview of what constitutes an operating system, followed by a discussion on the definition and pr

Systems design methodology to develop chrysanthemum growing systems

NARCIS (Netherlands)

Blok, C.; Vermeulen, T.

2012-01-01

When chrysanthemum growers change soil for a soilless growing system they aim for labour cost reduction, quality and yield improvement and reduced emissions of nutrients. Because many attempts to come up with a viable soilless system failed, improvements and systemizations of the design process were

Supermarket Refrigeration System - Benchmark for Hybrid System Control

DEFF Research Database (Denmark)

Sloth, Lars Finn; Izadi-Zamanabadi, Roozbeh; Wisniewski, Rafal

2007-01-01

This paper presents a supermarket refrigeration system as a benchmark for development of new ideas and a comparison of methods for hybrid systems' modeling and control. The benchmark features switch dynamics and discrete valued input making it a hybrid system, furthermore the outputs are subjected...

On Mario Bunge's Definition of System and System Boundary

Science.gov (United States)

Cavallo, Andrew M.

2012-01-01

In this short paper we discuss Mario Bunge's definition of system boundary. It is quickly discovered that Bunge's definition of system and system boundary are both deficient. We thus propose new definitions, which (hopefully) improve the situation. Our definition of system boundary works off the same intuition behind Bunge's.

ERP–systems

OpenAIRE

Shustova I.

2016-01-01

In this work, we analyzed the existing ERP–systems of foreign and domestic manufacturers. Popular ERP–systems in the Republic of Belarus were considered. The leading ERP-systems in the domestic market and their features were described in detail. Finally, we described the steps that must be taken to select the most suitable ERP-system for a particular company.

Infinite Particle Systems: Complex Systems III

Directory of Open Access Journals (Sweden)

Editorial Board

2008-06-01

Full Text Available In the years 2002-2005, a group of German and Polish mathematicians worked under a DFG research project No 436 POL 113/98/0-1 entitled "Methods of stochastic analysis in the theory of collective phenomena: Gibbs states and statistical hydrodynamics". The results of their study were summarized at the German-Polish conference, which took place in Poland in October 2005. The venue of the conference was Kazimierz Dolny upon Vistula - a lovely town and a popular place for various cultural, scientific, and even political events of an international significance. The conference was also attended by scientists from France, Italy, Portugal, UK, Ukraine, and USA, which predetermined its international character. Since that time, the conference, entitled "Infinite Particle Systems: Complex Systems" has become an annual international event, attended by leading scientists from Germany, Poland and many other countries. The present volume of the "Condensed Matter Physics" contains proceedings of the conference "Infinite Particle Systems: Complex Systems III", which took place in June 2007.

L-system fractals

CERN Document Server

Mishra, Jibitesh

2007-01-01

The book covers all the fundamental aspects of generating fractals through L-system. Also it provides insight to various researches in this area for generating fractals through L-system approach & estimating dimensions. Also it discusses various applications of L-system fractals. Key Features: - Fractals generated from L-System including hybrid fractals - Dimension calculation for L-system fractals - Images & codes for L-system fractals - Research directions in the area of L-system fractals - Usage of various freely downloadable tools in this area - Fractals generated from L-System including hybrid fractals- Dimension calculation for L-system fractals- Images & codes for L-system fractals- Research directions in the area of L-system fractals- Usage of various freely downloadable tools in this area

Operating System for Runtime Reconfigurable Multiprocessor Systems

Directory of Open Access Journals (Sweden)

Diana Göhringer

2011-01-01

Full Text Available Operating systems traditionally handle the task scheduling of one or more application instances on processor-like hardware architectures. RAMPSoC, a novel runtime adaptive multiprocessor System-on-Chip, exploits the dynamic reconfiguration on FPGAs to generate, start and terminate hardware and software tasks. The hardware tasks have to be transferred to the reconfigurable hardware via a configuration access port. The software tasks can be loaded into the local memory of the respective IP core either via the configuration access port or via the on-chip communication infrastructure (e.g. a Network-on-Chip. Recent-series of Xilinx FPGAs, such as Virtex-5, provide two Internal Configuration Access Ports, which cannot be accessed simultaneously. To prevent conflicts, the access to these ports as well as the hardware resource management needs to be controlled, e.g. by a special-purpose operating system running on an embedded processor. For that purpose and to handle the relations between temporally and spatially scheduled operations, the novel approach of an operating system is of high importance. This special purpose operating system, called CAP-OS (Configuration Access Port-Operating System, which will be presented in this paper, supports the clients using the configuration port with the services of priority-based access scheduling, hardware task mapping and resource management.

Business system: Sustainable development and anticipatory system

Directory of Open Access Journals (Sweden)

Vojko Potočan

2002-01-01

Full Text Available The existence and development of humankind depends mainly upon the co-ordinated operation of all areas and levels of human activity. However, in theory and in practice there is no model of operation, which would provide a harmonized and target oriented development. A partial solution is offered by sustainable development, which tries to define and carry out common goals of mankind with a harmonized implementation of human activities at all levels of its living and behaviour. Companies belong to central institutions of modern society which essentially co–create the sustainability of society. The company’s endeavour by simulation to prepare models of their goals concerning their internal and external environment. On the base of systemic treatment, we can define companies as business system, which can survive in a log-run only on the basis of sustainable development. The business system can also be supported by the application of the anticipatory systems. The anticipatory systems can be, in this sense, understood as an entity of the methodological approach, techniques and modes of work. Their characteristics have, a direct impact on the determination of goals, on the orientation of operation, and hence on the achievement of the business system results.

Ecological and general systems an introduction to systems ecology

CERN Document Server

Odum, Howard T.

1994-01-01

Using an energy systems language that combines energetics, kinetics, information, cybernetics, and simulation, Ecological and General Systems compares models of many fields of science, helping to derive general systems principles. First published as Systems Ecology in 1983, Ecological and General Systems proposes principles of self-organization and the designs that prevail by maximizing power and efficiency. Comparisons to fifty other systems languages are provided. Innovative presentations are given on earth homeostasis (Gaia); the inadequacy of presenting equations without network relationships and energy constraints; the alternative interpretation of high entropy complexity as adaptive structure; basic equations of ecological economics; and the energy basis of scientific hierarchy.

Composite Socio-Technical Systems: A Method for Social Energy Systems

Energy Technology Data Exchange (ETDEWEB)

Zhang, Yingchen [National Renewable Energy Laboratory (NREL), Golden, CO (United States); He, Fulin [Huazhong University of Science & Technology; Hao, Jun [University of Denver; Dai, Xiaoxiao [University of Denver; Zhang, Jun Jason [University of Denver; Wei, Jiaolong [Huazhong University of Science & Technology

2017-12-01

In order to model and study the interactions between social on technical systems, a systemic method, namely the composite socio-technical systems (CSTS), is proposed to incorporate social systems, technical systems and the interaction mechanism between them. A case study on University of Denver (DU) campus grid is presented in paper to demonstrate the application of the proposed method. In the case study, the social system, technical system, and the interaction mechanism are defined and modelled within the framework of CSTS. Distributed and centralized control and management schemes are investigated, respectively, and numerical results verifies the feasibility and performance of the proposed composite system method.

Operating System Security

CERN Document Server

Jaeger, Trent

2008-01-01

Operating systems provide the fundamental mechanisms for securing computer processing. Since the 1960s, operating systems designers have explored how to build "secure" operating systems - operating systems whose mechanisms protect the system against a motivated adversary. Recently, the importance of ensuring such security has become a mainstream issue for all operating systems. In this book, we examine past research that outlines the requirements for a secure operating system and research that implements example systems that aim for such requirements. For system designs that aimed to

Energy Systems Integration News | Energy Systems Integration Facility |

Science.gov (United States)

the Energy Systems Integration Facility as part of NREL's work with SolarCity and the Hawaiian Electric Companies. Photo by Amy Glickson, NREL Welcome to Energy Systems Integration News, NREL's monthly date on the latest energy systems integration (ESI) developments at NREL and worldwide. Have an item

System Architecture Design for Electric Vehicle (EV) Systems

DEFF Research Database (Denmark)

Xu, Zhao; Wu, Qiuwei; Nielsen, Arne Hejde

2010-01-01

The electric vehicle (EV) system should fulfill the energy needs of EVs to meet the EV users’ driving requirements and enable the system service from EVs to support the power system operation with high penetration of renewable energy resources (RES) by providing necessary infrastructures. In orde...

Analyzing Systemic Risk in the Chinese Banking System

NARCIS (Netherlands)

Huang, Qiubin; de Haan, Jakob; Scholtens, Bert

We examine systemic risk in the Chinese banking system by estimating the conditional value at risk (CoVaR), the marginal expected shortfall (MES), the systemic impact index (SII) and the vulnerability index (VI) for 16 listed banks in China. Although these measures show different patterns, our

Systems analysis of a security alarm system

International Nuclear Information System (INIS)

Schiff, A.

1975-01-01

When the Lawrence Livermore Laboratory found that its security alarm system was causing more false alarms and maintenance costs than LLL felt was tolerable, a systems analysis was undertaken to determine what should be done about the situation. This report contains an analysis of security alarm systems in general and ends with a review of the existing Security Alarm Control Console (SACC) and recommendations for its improvement, growth and change. (U.S.)

System Identification, Environmental Modelling, and Control System Design

CERN Document Server

Garnier, Hugues

2012-01-01

System Identification, Environmetric Modelling, and Control Systems Design is dedicated to Professor Peter Young on the occasion of his seventieth birthday. Professor Young has been a pioneer in systems and control, and over the past 45 years he has influenced many developments in this field. This volume is comprised of a collection of contributions by leading experts in system identification, time-series analysis, environmetric modelling and control system design – modern research in topics that reflect important areas of interest in Professor Young’s research career. Recent theoretical developments in and relevant applications of these areas are explored treating the various subjects broadly and in depth. The authoritative and up-to-date research presented here will be of interest to academic researcher in control and disciplines related to environmental research, particularly those to with water systems. The tutorial style in which many of the contributions are composed also makes the book suitable as ...

Human performance modeling for system of systems analytics.

Energy Technology Data Exchange (ETDEWEB)

Dixon, Kevin R.; Lawton, Craig R.; Basilico, Justin Derrick; Longsine, Dennis E. (INTERA, Inc., Austin, TX); Forsythe, James Chris; Gauthier, John Henry; Le, Hai D.

2008-10-01

A Laboratory-Directed Research and Development project was initiated in 2005 to investigate Human Performance Modeling in a System of Systems analytic environment. SAND2006-6569 and SAND2006-7911 document interim results from this effort; this report documents the final results. The problem is difficult because of the number of humans involved in a System of Systems environment and the generally poorly defined nature of the tasks that each human must perform. A two-pronged strategy was followed: one prong was to develop human models using a probability-based method similar to that first developed for relatively well-understood probability based performance modeling; another prong was to investigate more state-of-art human cognition models. The probability-based modeling resulted in a comprehensive addition of human-modeling capability to the existing SoSAT computer program. The cognitive modeling resulted in an increased understanding of what is necessary to incorporate cognition-based models to a System of Systems analytic environment.

Millimeter-scale MEMS enabled autonomous systems: system feasibility and mobility

Science.gov (United States)

Pulskamp, Jeffrey S.

2012-06-01

Millimeter-scale robotic systems based on highly integrated microelectronics and micro-electromechanical systems (MEMS) could offer unique benefits and attributes for small-scale autonomous systems. This extreme scale for robotics will naturally constrain the realizable system capabilities significantly. This paper assesses the feasibility of developing such systems by defining the fundamental design trade spaces between component design variables and system level performance parameters. This permits the development of mobility enabling component technologies within a system relevant context. Feasible ranges of system mass, required aerodynamic power, available battery power, load supported power, flight endurance, and required leg load bearing capability are presented for millimeter-scale platforms. The analysis illustrates the feasibility of developing both flight capable and ground mobile millimeter-scale autonomous systems while highlighting the significant challenges that must be overcome to realize their potential.

NASA's Earth Observing System Data and Information System - EOSDIS

Science.gov (United States)

Ramapriyan, Hampapuram K.

2011-01-01

This slide presentation reviews the work of NASA's Earth Observing System Data and Information System (EOSDIS), a petabyte-scale archive of environmental data that supports global climate change research. The Earth Science Data Systems provide end-to-end capabilities to deliver data and information products to users in support of understanding the Earth system. The presentation contains photographs from space of recent events, (i.e., the effects of the tsunami in Japan, and the wildfires in Australia.) It also includes details of the Data Centers that provide the data to EOSDIS and Science Investigator-led Processing Systems. Information about the Land, Atmosphere Near-real-time Capability for EOS (LANCE) and some of the uses that the system has made possible are reviewed. Also included is information about how to access the data, and evolutionary plans for the future of the system.

Optimum Design Of On Grid Pv System Using Tracking System

Directory of Open Access Journals (Sweden)

Saeed Mansour

2015-05-01

Full Text Available Abstract The fossil fuel is a main issue in the world due to the increase of fossil fuel cost and the depletion of the fossil fuel with continuous increasing demand on electricity. With continuous decrease of PV panels cost it is interesting to consider generation of electricity from PV system. To provide electric energy to a load in a remote area where electric grid utility is not available or connection with grid utility is available there are two approaches of photovoltaic system PV without tracking system Fixed System and PV with tracking systems. The result shows that the energy production by using PV with tracking system generates more energy in comparison with fixed panels system. However the cost per produced KWH is less in case of using fixed panels. This is the backbone in choice between two approaches of photovoltaic system. In this work a system design and cost analysis for two approaches of photovoltaic system are considered.

Preliminary System Design of the SWRL Financial System.

Science.gov (United States)

Ikeda, Masumi

The preliminary system design of the computer-based Southwest Regional Laboratory's (SWRL) Financial System is outlined. The system is designed to produce various management and accounting reports needed to maintain control of SWRL operational and financial activities. Included in the document are descriptions of the various types of system…

System-Awareness for Agent-based Power System Control

DEFF Research Database (Denmark)

Heussen, Kai; Saleem, Arshad; Lind, Morten

2010-01-01

transition. This paper presents a concept for the representation and organization of control- and resource-allocation, enabling computational reasoning and system awareness. The principles are discussed with respect to a recently proposed Subgrid operation concept.......Operational intelligence in electric power systems is focused in a small number of control rooms that coordinate their actions. A clear division of responsibility and a command hierarchy organize system operation. With multi-agent based control systems, this control paradigm may be shifted...... to a more decentralized openaccess collaboration control paradigm. This shift cannot happen at once, but must fit also with current operation principles. In order to establish a scalable and transparent system control architecture, organizing principles have to be identified that allow for a smooth...

Is the system really the solution? Operating costs in hospital systems.

Science.gov (United States)

Burns, Lawton Robert; McCullough, Jeffrey S; Wholey, Douglas R; Kruse, Gregory; Kralovec, Peter; Muller, Ralph

2015-06-01

Hospital system formation has recently accelerated. Executives emphasize scale economies that lower operating costs, a claim unsupported in academic research. Do systems achieve lower costs than freestanding facilities, and, if so, which system types? We test hypotheses about the relationship of cost with membership in systems, larger systems, and centralized and local hub-and-spoke systems. We also test whether these relationships have changed over time. Examining 4,000 U.S. hospitals during 1998 to 2010, we find no evidence that system members exhibit lower costs. However, members of smaller systems are lower cost than larger systems, and hospitals in centralized systems are lower cost than everyone else. There is no evidence that the system's spatial configuration is associated with cost, although national system hospitals exhibit higher costs. Finally, these results hold over time. We conclude that while systems in general may not be the solution to lower costs, some types of systems are. © The Author(s) 2015.

Real-time reactor coolant system pressure/temperature limit system

International Nuclear Information System (INIS)

Newton, D.G.; Schemmel, R.R.; Van Scooter, W.E. Jr.

1991-01-01

This patent describes an system, used in controlling the operating of a nuclear reactor coolant system, which automatically calculates and displays allowable reactor coolant system pressure/temperature limits within the nuclear reactor coolant system based upon real-time inputs. It comprises: means for producing signals representative of real-time operating parameters of the nuclear reactor cooling system; means for developing pressure and temperature limits relating the real-time operating parameters of the nuclear reactor coolant system, for normal and emergency operation thereof; means for processing the signals representative of real-time operating parameters of the nuclear reactor coolant system to perform calculations of a best estimate of signals, check manual inputs against permissible valves and test data acquisition hardware for validity and over/under range; and means for comparing the representative signals with limits for the real-time operating parameters to produce a signal for a real-time display of the pressure and temperature limits and of the real-time operating parameters use an operator in controlling the operation of the nuclear reactor coolant system

SAMS--a systems architecture for developing intelligent health information systems.

Science.gov (United States)

Yılmaz, Özgün; Erdur, Rıza Cenk; Türksever, Mustafa

2013-12-01

In this paper, SAMS, a novel health information system architecture for developing intelligent health information systems is proposed and also some strategies for developing such systems are discussed. The systems fulfilling this architecture will be able to store electronic health records of the patients using OWL ontologies, share patient records among different hospitals and provide physicians expertise to assist them in making decisions. The system is intelligent because it is rule-based, makes use of rule-based reasoning and has the ability to learn and evolve itself. The learning capability is provided by extracting rules from previously given decisions by the physicians and then adding the extracted rules to the system. The proposed system is novel and original in all of these aspects. As a case study, a system is implemented conforming to SAMS architecture for use by dentists in the dental domain. The use of the developed system is described with a scenario. For evaluation, the developed dental information system will be used and tried by a group of dentists. The development of this system proves the applicability of SAMS architecture. By getting decision support from a system derived from this architecture, the cognitive gap between experienced and inexperienced physicians can be compensated. Thus, patient satisfaction can be achieved, inexperienced physicians are supported in decision making and the personnel can improve their knowledge. A physician can diagnose a case, which he/she has never diagnosed before, using this system. With the help of this system, it will be possible to store general domain knowledge in this system and the personnel's need to medical guideline documents will be reduced.

System for Collecting Biosignal Data from Multiple Patient Monitoring Systems.

Science.gov (United States)

Yoon, Dukyong; Lee, Sukhoon; Kim, Tae Young; Ko, JeongGil; Chung, Wou Young; Park, Rae Woong

2017-10-01

Biosignal data include important physiological information. For that reason, many devices and systems have been developed, but there has not been enough consideration of how to collect and integrate raw data from multiple systems. To overcome this limitation, we have developed a system for collecting and integrating biosignal data from two patient monitoring systems. We developed an interface to extract biosignal data from Nihon Kohden and Philips monitoring systems. The Nihon Kohden system has a central server for the temporary storage of raw waveform data, which can be requested using the HL7 protocol. However, the Philips system used in our hospital cannot save raw waveform data. Therefore, our system was connected to monitoring devices using the RS232 protocol. After collection, the data were transformed and stored in a unified format. From September 2016 to August 2017, we collected approximately 117 patient-years of waveform data from 1,268 patients in 79 beds of five intensive care units. Because the two systems use the same data storage format, the application software could be run without compatibility issues. Our system collects biosignal data from different systems in a unified format. The data collected by the system can be used to develop algorithms or applications without the need to consider the source of the data.

Standard diffusive systems are well-posed linear systems

NARCIS (Netherlands)

Matignon, Denis; Zwart, Heiko J.

2004-01-01

The class of well-posed linear systems as introduced by Salamon has become a well-understood class of systems, see e.g. the work of Weiss and the book of Staffans. Many partial partial differential equations with boundary control and point observation can be formulated as a well-posed linear system.

A Ground Systems Template for Remote Sensing Systems

Science.gov (United States)

McClanahan, Timothy P.; Trombka, Jacob I.; Floyd, Samuel R.; Truskowski, Walter; Starr, Richard D.; Clark, Pamela E.; Evans, Larry G.

2002-10-01

Spaceborne remote sensing using gamma and X-ray spectrometers requires particular attention to the design and development of reliable systems. These systems must ensure the scientific requirements of the mission within the challenging technical constraints of operating instrumentation in space. The Near Earth Asteroid Rendezvous (NEAR) spacecraft included X-ray and gamma-ray spectrometers (XGRS), whose mission was to map the elemental chemistry of the 433 Eros asteroid. A remote sensing system template, similar to a blackboard systems approach used in artificial intelligence, was identified in which the spacecraft, instrument, and ground system was designed and developed to monitor and adapt to evolving mission requirements in a complicated operational setting. Systems were developed for ground tracking of instrument calibration, instrument health, data quality, orbital geometry, solar flux as well as models of the asteroid's surface characteristics, requiring an intensive human effort. In the future, missions such as the Autonomous Nano-Technology Swarm (ANTS) program will have to rely heavily on automation to collectively encounter and sample asteroids in the outer asteroid belt. Using similar instrumentation, ANTS will require information similar to data collected by the NEAR X-ray/Gamma-Ray Spectrometer (XGRS) ground system for science and operations management. The NEAR XGRS systems will be studied to identify the equivalent subsystems that may be automated for ANTS. The effort will also investigate the possibility of applying blackboard style approaches to automated decision making required for ANTS.

A ground systems template for remote sensing systems

International Nuclear Information System (INIS)

McClanahan, Timothy P.; Trombka, Jacob I.; Floyd, Samuel R.; Truskowski, Walter; Starr, Richard D.; Clark, Pamela E.; Evans, Larry G.

2002-01-01

Spaceborne remote sensing using gamma and X-ray spectrometers requires particular attention to the design and development of reliable systems. These systems must ensure the scientific requirements of the mission within the challenging technical constraints of operating instrumentation in space. The Near Earth Asteroid Rendezvous (NEAR) spacecraft included X-ray and gamma-ray spectrometers (XGRS), whose mission was to map the elemental chemistry of the 433 Eros asteroid. A remote sensing system template, similar to a blackboard systems approach used in artificial intelligence, was identified in which the spacecraft, instrument, and ground system was designed and developed to monitor and adapt to evolving mission requirements in a complicated operational setting. Systems were developed for ground tracking of instrument calibration, instrument health, data quality, orbital geometry, solar flux as well as models of the asteroid's surface characteristics, requiring an intensive human effort. In the future, missions such as the Autonomous Nano-Technology Swarm (ANTS) program will have to rely heavily on automation to collectively encounter and sample asteroids in the outer asteroid belt. Using similar instrumentation, ANTS will require information similar to data collected by the NEAR X-ray/Gamma-Ray Spectrometer (XGRS) ground system for science and operations management. The NEAR XGRS systems will be studied to identify the equivalent subsystems that may be automated for ANTS. The effort will also investigate the possibility of applying blackboard style approaches to automated decision making required for ANTS

Working with Systems and Thinking Systemically--Disentangling the Crossed Wires

Science.gov (United States)

Fox, Mark

2009-01-01

This article explores two separate traditions that educational psychologists (EPs) in the UK have for working with systems. One of these is "systems work" with organisations such as schools. The other is "systemic thinking" for working with families. Over the years these two traditions, systems work and systemic thinking, have…

Execution Of Systems Integration Principles During Systems Engineering Design

Science.gov (United States)

2016-09-01

application utilized a paper-based approach to systems design. The customer directed utilization of an SE Waterfall process model . These new...regarding requirements, stakeholders, testing, and system boundaries. Additionally, this thesis discusses use of systems architecture frameworks and models ...and the consistent use of model - based systems engineering throughout development. Lastly, it proposes formal methods language for improving models

System solution to improve energy efficiency of HVAC systems

Science.gov (United States)

Chretien, L.; Becerra, R.; Salts, N. P.; Groll, E. A.

2017-08-01

According to recent surveys, heating and air conditioning systems account for over 45% of the total energy usage in US households. Three main types of HVAC systems are available to homeowners: (1) fixed-speed systems, where the compressor cycles on and off to match the cooling load; (2) multi-speed (typically, two-speed) systems, where the compressor can operate at multiple cooling capacities, leading to reduced cycling; and (3) variable-speed systems, where the compressor speed is adjusted to match the cooling load of the household, thereby providing higher efficiency and comfort levels through better temperature and humidity control. While energy consumption could reduce significantly by adopting variable-speed compressor systems, the market penetration has been limited to less than 10% of the total HVAC units and a vast majority of systems installed in new construction remains single speed. A few reasons may explain this phenomenon such as the complexity of the electronic circuitry required to vary compressor speed as well as the associated system cost. This paper outlines a system solution to boost the Seasonal Energy Efficiency Rating (SEER) of a traditional single-speed unit through using a low power electronic converter that allows the compressor to operate at multiple low capacity settings and is disabled at high compressor speeds.

Expert systems

International Nuclear Information System (INIS)

Haldy, P.A.

1988-01-01

The definitions of the terms 'artificial intelligence' and 'expert systems', the methodology, areas of employment and limits of expert systems are discussed. The operation of an expert system is described, especially the presentation and organization of knowledge as well as interference and control. Methods and tools for expert system development are presented and their application in nuclear energy are briefly addressed. 7 figs., 2 tabs., 6 refs

Expert System

DEFF Research Database (Denmark)

Hildebrandt, Thomas Troels; Cattani, Gian Luca

2016-01-01

An expert system is a computer system for inferring knowledge from a knowledge base, typically by using a set of inference rules. When the concept of expert systems was introduced at Stanford University in the early 1970s, the knowledge base was an unstructured set of facts. Today the knowledge b...... for the application of expert systems, but also raises issues regarding privacy and legal liability....

Saphenous vein graft thrombus findings by scanning electron microscopy in a patient with acute myocardial infarction

Energy Technology Data Exchange (ETDEWEB)

Borges, Marcela Dias; Aguillera, André Haraguti [Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP (Brazil); Brilhante, José Joaquim; Caixeta, Adriano [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

2013-07-01

An eighty-year-old male patient with a history of prior (19 years) coronary artery bypass graft surgery was admitted to the hospital with non ST-segment elevation myocardial infarction (NSTEMI). During the hospital stay he was taking acetylsalicylic acid 100mg per day, a loading dose of 600mg clopidogrel, and low molecular weight heparin 1mg/kg twice a day. Twenty-four hours later the patient underwent coronary angiography, which showed a 90% obstruction in the mid portion of the saphenous vein graft to obtuse marginal with signs of degeneration and local thrombus (Figure 1). Thrombus aspiration was performed with a 6-Fr Export{sup ™} catheter (Medtronic, Santa Rosa, CA, USA), which removed small reddish colored fragments. They were fixed in 2,5% glutaraldehyde in a 0.1M sodium cacodilate buffer. The material was processed following the GOTO protocol in which the fragments were washed with osmium tetroxide and titanic acid, after which they were dried in a critical-point device and a golden bath. Scanning electron microscopy and high definition photos (3,000 to 27,221x magnification) were obtained by the FEI Quanta{sup ™} FEG SEM device (FEI Company, Hillsboro, OR, USA). The images showed that the thrombus was rich in activated platelets, with few erythrocytes or inflammatory cells. Many cholesterol crystals were observed (Figures 2 to). The fibrin networks were sparse and thin, which is compatible with a short ischemic time and recent thrombus formation.

Beta oscillations in freely moving Parkinson's subjects are attenuated during deep brain stimulation.

Science.gov (United States)

Quinn, Emma J; Blumenfeld, Zack; Velisar, Anca; Koop, Mandy Miller; Shreve, Lauren A; Trager, Megan H; Hill, Bruce C; Kilbane, Camilla; Henderson, Jaimie M; Brontë-Stewart, Helen

2015-11-01

Investigations into the effect of deep brain stimulation (DBS) on subthalamic (STN) beta (13-30 Hz) oscillations have been performed in the perioperative period with the subject tethered to equipment. Using an embedded sensing neurostimulator, this study investigated whether beta power was similar in different resting postures and during forward walking in freely moving subjects with Parkinson's disease (PD) and whether STN DBS attenuated beta power in a voltage-dependent manner. Subthalamic local field potentials were recorded from the DBS lead, using a sensing neurostimulator (Activa(®) PC+S, Medtronic, Inc., Food and Drug Administration- Investigational Device Exemption (IDE)-, institutional review board-approved) from 15 PD subjects (30 STNs) off medication during lying, sitting, and standing, during forward walking, and during randomized periods of 140 Hz DBS at 0 V, 1 V, and 2.5/3 V. Continuous video, limb angular velocity, and forearm electromyography recordings were synchronized with neural recordings. Data were parsed to avoid any movement or electrical artifact during resting states. Beta power was similar during lying, sitting, and standing (P = 0.077, n = 28) and during forward walking compared with the averaged resting state (P = 0.466, n = 24), although akinetic rigid PD subjects tended to exhibit decreased beta power when walking. Deep brain stimulation at 3 V and at 1 V attenuated beta power compared with 0 V (P closed-loop DBS. © 2015 International Parkinson and Movement Disorder Society.

Renal denervation in moderate treatment-resistant hypertension.

Science.gov (United States)

Ott, Christian; Mahfoud, Felix; Schmid, Axel; Ditting, Tilmann; Sobotka, Paul A; Veelken, Roland; Spies, Aline; Ukena, Christian; Laufs, Ulrich; Uder, Michael; Böhm, Michael; Schmieder, Roland E

2013-11-12

This study sought to investigate the effect of renal denervation (RDN) in patients with treatment-resistant hypertension according to the established definition (Joint National Committee VII and European Society of Hypertension/European Society of Cardiology guidelines), that is, office blood pressure (BP) ≥140/90 mm Hg (with at least three antihypertensive drugs, including a diuretic, in adequate doses) and confirmed by 24-h ambulatory BP monitoring (ABPM). RDN emerged as an innovative interventional antihypertensive therapy. However, so far, only patients with severe hypertension (systolic BP ≥160 mm Hg or ≥150 mm Hg for patients with type 2 diabetes) have been investigated. In this study, there were 54 patients with moderate treatment-resistant hypertension (office BP ≥140/90 mm Hg and who underwent catheter-based RDN using the Symplicity catheter (Medtronic Inc., Mountain View, California). Patients were treated with 5.1 ± 1.4 antihypertensive drugs on average. Office BP was significantly reduced by 13/7 mm Hg 6 months after RDN (systolic: 151 ± 6 mm Hg vs. 138 ± 21 mm Hg, p who underwent ABPM 6 months after treatment, there was a reduction in average 24-h ABPM by 14/7 mm Hg (systolic: 150 ± 16 mm Hg vs. 136 ± 16 mm Hg, p hypertension. (Renal Denervation in Treatment Resistant Hypertension; NCT01687725). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Saphenous vein graft thrombus findings by scanning electron microscopy in a patient with acute myocardial infarction

International Nuclear Information System (INIS)

Borges, Marcela Dias; Aguillera, André Haraguti; Brilhante, José Joaquim; Caixeta, Adriano

2013-01-01

An eighty-year-old male patient with a history of prior (19 years) coronary artery bypass graft surgery was admitted to the hospital with non ST-segment elevation myocardial infarction (NSTEMI). During the hospital stay he was taking acetylsalicylic acid 100mg per day, a loading dose of 600mg clopidogrel, and low molecular weight heparin 1mg/kg twice a day. Twenty-four hours later the patient underwent coronary angiography, which showed a 90% obstruction in the mid portion of the saphenous vein graft to obtuse marginal with signs of degeneration and local thrombus (Figure 1). Thrombus aspiration was performed with a 6-Fr Export"™ catheter (Medtronic, Santa Rosa, CA, USA), which removed small reddish colored fragments. They were fixed in 2,5% glutaraldehyde in a 0.1M sodium cacodilate buffer. The material was processed following the GOTO protocol in which the fragments were washed with osmium tetroxide and titanic acid, after which they were dried in a critical-point device and a golden bath. Scanning electron microscopy and high definition photos (3,000 to 27,221x magnification) were obtained by the FEI Quanta"™ FEG SEM device (FEI Company, Hillsboro, OR, USA). The images showed that the thrombus was rich in activated platelets, with few erythrocytes or inflammatory cells. Many cholesterol crystals were observed (Figures 2 to). The fibrin networks were sparse and thin, which is compatible with a short ischemic time and recent thrombus formation

Traumatic Migration of the Bryan Cervical Disc Arthroplasty.

Science.gov (United States)

Wagner, Scott C; Kang, Daniel G; Helgeson, Melvin D

2016-02-01

Study Design Case study. Objective To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5-C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively.

Exponential increase in postprandial blood-glucose exposure with increasing carbohydrate loads using a linear carbohydrate-to-insulin ratio.

Science.gov (United States)

Marran, K J; Davey, B; Lang, A; Segal, D G

2013-04-10

Postprandial glucose excursions contribute significantly to average blood glucose, glycaemic variability and cardiovascular risk. Carbohydrate counting is a method of insulin dosing that balances carbohydrate load to insulin dose using a fixed ratio. Many patients and current insulin pumps calculate insulin delivery for meals based on a linear carbohydrate-to-insulin relationship. It is our hypothesis that a non-linear relationship exists between the amounts of carbohydrate consumed and the insulin required to cover it. To document blood glucose exposure in response to increasing carbohydrate loads on fixed carbohydrate-to-insulin ratios. Five type 1 diabetic subjects receiving insulin pump therapy with good control were recruited. Morning basal rates and carbohydrate- to-insulin ratios were optimised. A Medtronic glucose sensor was used for 5 days to collect data for area-under-the-curve (AUC) analysis, during which standardised meals of increasing carbohydrate loads were consumed. Increasing carbohydrate loads using a fixed carbohydrate-to-insulin ratio resulted in increasing glucose AUC. The relationship was found to be exponential rather than linear. Late postprandial hypoglycaemia followed carbohydrate loads of >60 g and this was often followed by rebound hyperglycaemia that lasted >6 hours. A non-linear relationship exists between carbohydrates consumed and the insulin required to cover them. This has implications for control of postprandial blood sugars, especially when consuming large carbohydrate loads. Further studies are required to look at the optimal ratios, duration and type of insulin boluses required to cover increasing carbohydrate loads.

Multifunction system

International Nuclear Information System (INIS)

Wauthier, J.; Fiori, R.

1990-01-01

The development, the characteristics and the applications of a multifunction system are presented. The system is used on the RBES laboratory pipes, at Marcoule. The system was developed in order to allow, without time loss, the modification of the circuit function by replacing only one component. The following elements form the multifunction system: a fixed base, which is part of the tube, a removable piece, which is inserted into the base, a cover plate and its locking system. The material, chosen among commercial trade marks, required small modifications in order to be used in the circuit [fr

AutoBayes Program Synthesis System System Internals

Science.gov (United States)

Schumann, Johann Martin

2011-01-01

This lecture combines the theoretical background of schema based program synthesis with the hands-on study of a powerful, open-source program synthesis system (Auto-Bayes). Schema-based program synthesis is a popular approach toward program synthesis. The lecture will provide an introduction into this topic and discuss how this technology can be used to generate customized algorithms. The synthesis of advanced numerical algorithms requires the availability of a powerful symbolic (algebra) system. Its task is to symbolically solve equations, simplify expressions, or to symbolically calculate derivatives (among others) such that the synthesized algorithms become as efficient as possible. We will discuss the use and importance of the symbolic system for synthesis. Any synthesis system is a large and complex piece of code. In this lecture, we will study Autobayes in detail. AutoBayes has been developed at NASA Ames and has been made open source. It takes a compact statistical specification and generates a customized data analysis algorithm (in C/C++) from it. AutoBayes is written in SWI Prolog and many concepts from rewriting, logic, functional, and symbolic programming. We will discuss the system architecture, the schema libary and the extensive support infra-structure. Practical hands-on experiments and exercises will enable the student to get insight into a realistic program synthesis system and provides knowledge to use, modify, and extend Autobayes.

Expert system for nuclear power plant feedwater system diagnosis

International Nuclear Information System (INIS)

Meguro, R.; Kinoshita, Y.; Sato, T.; Yokota, Y.; Yokota, M.

1987-01-01

The Expert System for Nuclear Power Plant Feedwater System Diagnosis has been developed to assist maintenance engineers in nuclear power plants. This system adopts the latest process computer TOSBAC G8050 and the expert system developing tool TDES2, and has a large scale knowledge base which consists of the expert knowledge and experience of engineers in many fields. The man-machine system, which has been developed exclusively for diagnosis, improves the man-machine interface and realizes the graphic displays of diagnostic process and path, stores diagnostic results and searches past reference

Modernization of control system using the digital control system

International Nuclear Information System (INIS)

Carrasco, J. A.; Fernandez, L.; Jimenez, A.

2002-01-01

Nowadays, all plant automation tendencies are based on the use of Digital Control System. In big industrial plants the control systems employed are Distributed Control Systems (DCS). The addition of these systems in nuclear power plants,implies an important adaptation process, because most of them were installed using analog control systems. This paper presents the objectives and the first results obtained, in a modernization project, focused in obtaining an engineering platform for making test and analysis of changes prior to their implementation in a nuclear plant. Modernization, Upgrade, DCS, Automation, Simulation, Training. (Author)

Consultation system for image diagnosis: Report formation support system

International Nuclear Information System (INIS)

Ikeda, M.; Sakuma, S.; Ishigaki, T.; Suzuki, K.; Oikawa, K.

1987-01-01

The authors developed a consultation system for image diagnosis, involving artificial intelligence ideas. In this system, the authors proposed a new report formation support system and implemented it in lymphangiography. This support system starts with the input of image interpretation. The input process is made mainly by selecting items. This system encodes the input findings into the semantic network, which is represented as a directed graph, and it reserves them into the knowledge database in the above structure. Finally, the output (report) is made in the near natural language, which corresponds to the input findings

Software control and system configuration management: A systems-wide approach

Science.gov (United States)

Petersen, K. L.; Flores, C., Jr.

1984-01-01

A comprehensive software control and system configuration management process for flight-crucial digital control systems of advanced aircraft has been developed and refined to insure efficient flight system development and safe flight operations. Because of the highly complex interactions among the hardware, software, and system elements of state-of-the-art digital flight control system designs, a systems-wide approach to configuration control and management has been used. Specific procedures are implemented to govern discrepancy reporting and reconciliation, software and hardware change control, systems verification and validation testing, and formal documentation requirements. An active and knowledgeable configuration control board reviews and approves all flight system configuration modifications and revalidation tests. This flexible process has proved effective during the development and flight testing of several research aircraft and remotely piloted research vehicles with digital flight control systems that ranged from relatively simple to highly complex, integrated mechanizations.

Dual-systems and the development of reasoning: competence-procedural systems.

Science.gov (United States)

Overton, Willis F; Ricco, Robert B

2011-03-01

Dual-system, dual-process, accounts of adult cognitive processing are examined in the context of a self-organizing relational developmental systems approaches to cognitive growth. Contemporary adult dual-process accounts describe a linear architecture of mind entailing two split-off, but interacting systems; a domain general, content-free 'analytic' system (system 2) and a domain specific highly contextualized 'heuristic' system (system 1). In the developmental literature on deductive reasoning, a similar distinction has been made between a domain general competence (reflective, algorithmic) system and a domain specific procedural system. In contrast to the linear accounts offered by empiricist, nativist, and/or evolutionary explanations, the dual competence-procedural developmental perspective argues that the mature systems emerge through developmental transformations as differentiations and intercoordinations of an early relatively undifferentiated action matrix. This development, whose microscopic mechanism is action-in-the-world, is characterized as being embodied, nonlinear, and epigenetic. WIREs Cogni Sci 2011 2 231-237 DOI: 10.1002/wcs.120 For further resources related to this article, please visit the WIREs website. © 2010 John Wiley & Sons, Ltd.

The Norwegian Electric Power System - System Description and Future Developments; Norsk kraftforsyning - dagens system og fremtidig utvikling

Energy Technology Data Exchange (ETDEWEB)

Hagen, Janne Merete; Nystuen, Kjell Olav; Fridheim, Haavard; Rutledal, Frode

2000-09-01

This report presents a description of the present Norwegian electric power system, as well as a discussion of emerging trends and future developments in this system. The report provides the basis for FFI's current vulnerability analysis of the electric power system. Norway's electric power system is getting increasingly complex, due to a large-scale implementation of electronic components and information systems. Workforce reductions and efficiency improvements dominate the development of the electric power sector. Norway is also becoming increasingly dependent on foreign power sources. These trends provide for an entirely different electric power system than just a few years ago. Also, these trends make it virtually impossible to present a ''static'' description of the system. Thus, the report also contains a scenario, describing possible future developments of the system until 2010. (author)

PWR auxiliary systems, safety and emergency systems, accident analysis, operation

International Nuclear Information System (INIS)

Meyer, P.J.

1976-01-01

The author presents a description of PWR auxiliary systems like volume control, boric acid control, coolant purification, -degassing, -storage and -treatment system and waste processing systems. Residual heat removal systems, emergency systems and containment designs are discussed. As an accident analysis the author gives a survey over malfunctions and disturbances in the field of reactor operations. (TK) [de

Prototype of smart office system using based security system

Science.gov (United States)

Prasetyo, T. F.; Zaliluddin, D.; Iqbal, M.

2018-05-01

Creating a new technology in the modern era gives a positive impact on business and industry. Internet of Things (IoT) as a new communication technology is very useful in realizing smart systems such as: smart home, smart office, smart parking and smart city. This study presents a prototype of the smart office system which was designed as a security system based on IoT. Smart office system development method used waterfall model. IoT-based smart office system used platform (project builder) cayenne so that. The data can be accessed and controlled through internet network from long distance. Smart office system used arduino mega 2560 microcontroller as a controller component. In this study, Smart office system is able to detect threats of dangerous objects made from metals, earthquakes, fires, intruders or theft and perform security monitoring outside the building by using raspberry pi cameras on autonomous robots in real time to the security guard.

Integrated Knowledge Based Expert System for Disease Diagnosis System

Science.gov (United States)

Arbaiy, Nureize; Sulaiman, Shafiza Eliza; Hassan, Norlida; Afizah Afip, Zehan

2017-08-01

The role and importance of healthcare systems to improve quality of life and social welfare in a society have been well recognized. Attention should be given to raise awareness and implementing appropriate measures to improve health care. Therefore, a computer based system is developed to serve as an alternative for people to self-diagnose their health status based on given symptoms. This strategy should be emphasized so that people can utilize the information correctly as a reference to enjoy healthier life. Hence, a Web-based Community Center for Healthcare Diagnosis system is developed based on expert system technique. Expert system reasoning technique is employed in the system to enable information about treatment and prevention of the diseases based on given symptoms. At present, three diseases are included which are arthritis, thalassemia and pneumococcal. Sets of rule and fact are managed in the knowledge based system. Web based technology is used as a platform to disseminate the information to users in order for them to optimize the information appropriately. This system will benefit people who wish to increase health awareness and seek expert knowledge on the diseases by performing self-diagnosis for early disease detection.

System for chemical decontamination of nuclear reactor primary systems

International Nuclear Information System (INIS)

Schlonski, J.S.; McGiure, M.F.; Corpora, G.J.

1992-01-01

This patent describes a method of chemically decontaminating a nuclear reactor primary system, having a residual heat removal system with one or more residual heat removal heat exchangers, each having an upstream and a downstream side, at or above ambient pressure. It comprises: injecting decontamination chemicals using an injection means; circulating the injected decontamination chemicals throughout the primary system; directing the circulated decontamination chemicals and process fluids to a means for removing suspended solids and dissolved materials after the circulated chemicals and process fluids have passed through the residual heat removal heat exchanger; decontaminating the process fluids; and feeding the decontaminated process fluids to the injection means. This patent also describes a chemical decontamination system for use at, or above, ambient pressure in a nuclear reactor primary system having a residual heat removal system. It comprises: means for injecting decontamination chemicals into the primary system; means for removing dissolved and suspended materials and decontamination chemicals from the primary system; one or more residual heat removal pumps; means located downstream of one of the residual heat removal heat exchangers; and a return line connecting the means

Systemic darwinism.

Science.gov (United States)

Winther, Rasmus Grønfeldt

2008-08-19

Darwin's 19th century evolutionary theory of descent with modification through natural selection opened up a multidimensional and integrative conceptual space for biology. We explore three dimensions of this space: explanatory pattern, levels of selection, and degree of difference among units of the same type. Each dimension is defined by a respective pair of poles: law and narrative explanation, organismic and hierarchical selection, and variational and essentialist thinking. As a consequence of conceptual debates in the 20th century biological sciences, the poles of each pair came to be seen as mutually exclusive opposites. A significant amount of 21st century research focuses on systems (e.g., genomic, cellular, organismic, and ecological/global). Systemic Darwinism is emerging in this context. It follows a "compositional paradigm" according to which complex systems and their hierarchical networks of parts are the focus of biological investigation. Through the investigation of systems, Systemic Darwinism promises to reintegrate each dimension of Darwin's original logical space. Moreover, this ideally and potentially unified theory of biological ontology coordinates and integrates a plurality of mathematical biological theories (e.g., self-organization/structure, cladistics/history, and evolutionary genetics/function). Integrative Systemic Darwinism requires communal articulation from a plurality of perspectives. Although it is more general than these, it draws on previous advances in Systems Theory, Systems Biology, and Hierarchy Theory. Systemic Darwinism would greatly further bioengineering research and would provide a significantly deeper and more critical understanding of biological reality.

System identification of the Arabidopsis plant circadian system

Science.gov (United States)

Foo, Mathias; Somers, David E.; Kim, Pan-Jun

2015-02-01

The circadian system generates an endogenous oscillatory rhythm that governs the daily activities of organisms in nature. It offers adaptive advantages to organisms through a coordination of their biological functions with the optimal time of day. In this paper, a model of the circadian system in the plant Arabidopsis (species thaliana) is built by using system identification techniques. Prior knowledge about the physical interactions of the genes and the proteins in the plant circadian system is incorporated in the model building exercise. The model is built by using primarily experimentally-verified direct interactions between the genes and the proteins with the available data on mRNA and protein abundances from the circadian system. Our analysis reveals a great performance of the model in predicting the dynamics of the plant circadian system through the effect of diverse internal and external perturbations (gene knockouts and day-length changes). Furthermore, we found that the circadian oscillatory rhythm is robust and does not vary much with the biochemical parameters except those of a light-sensitive protein P and a transcription factor TOC1. In other words, the circadian rhythmic profile is largely a consequence of the network's architecture rather than its particular parameters. Our work suggests that the current experimental knowledge of the gene-to-protein interactions in the plant Arabidopsis, without considering any additional hypothetical interactions, seems to suffice for system-level modeling of the circadian system of this plant and to present an exemplary platform for the control of network dynamics in complex living organisms.

'System-of-systems' approach for interdependent critical infrastructures

International Nuclear Information System (INIS)

Eusgeld, Irene; Nan, Cen; Dietz, Sven

2011-01-01

The study of the interdependencies within critical infrastructures (CI) is a growing field of research as the importance of potential failure propagation among infrastructures may lead to cascades affecting all supply networks. New powerful methods are required to model and describe such 'systems-of-systems' (SoS) as a whole. An overall model is required to provide security and reliability assessment taking into account various kinds of threats and failures. A significant challenge associated with this model may be to create 'what-if' scenarios for the analysis of interdependencies. In this paper the interdependencies between industrial control systems (ICS), in particular SCADA (Supervisory Control and Data Acquisition), and the underlying critical infrastructures to address the vulnerabilities related to the coupling of these systems are analyzed. The modeling alternatives for system-of-systems, integrated versus coupled models, are discussed. An integrated model contains detailed low level models of (sub)systems as well as a high level model, covering all hierarchical levels. On the other hand, a coupled model aggregates different simulated outputs of the low level models as inputs at a higher level. Strengths and weaknesses of both approaches are analyzed and a model architecture for SCADA and the 'system under control' are proposed. Furthermore, the HLA simulation standard is introduced and discussed in this paper as a promising approach to represent interdependencies between infrastructures. To demonstrate the capabilities of the HLA standard for the interdependencies study, an exemplary application and some first results are also briefly presented in this paper.

78 FR 58153 - Prevailing Rate Systems; North American Industry Classification System Based Federal Wage System...

Science.gov (United States)

2013-09-23

... American Industry Classification System Based Federal Wage System Wage Surveys AGENCY: U.S. Office of... in Federal Wage System wage survey industry regulations with the 2012 NAICS revisions published by.... Applicability date: This rule applies for local wage surveys beginning on or after February 21, 2014. FOR...

A coordination model for ultra-large scale systems of systems

Directory of Open Access Journals (Sweden)

Manuela L. Bujorianu

2013-11-01

Full Text Available The ultra large multi-agent systems are becoming increasingly popular due to quick decay of the individual production costs and the potential of speeding up the solving of complex problems. Examples include nano-robots, or systems of nano-satellites for dangerous meteorite detection, or cultures of stem cells for organ regeneration or nerve repair. The topics associated with these systems are usually dealt within the theories of intelligent swarms or biologically inspired computation systems. Stochastic models play an important role and they are based on various formulations of the mechanical statistics. In these cases, the main assumption is that the swarm elements have a simple behaviour and that some average properties can be deduced for the entire swarm. In contrast, complex systems in areas like aeronautics are formed by elements with sophisticated behaviour, which are even autonomous. In situations like this, a new approach to swarm coordination is necessary. We present a stochastic model where the swarm elements are communicating autonomous systems, the coordination is separated from the component autonomous activity and the entire swarm can be abstracted away as a piecewise deterministic Markov process, which constitutes one of the most popular model in stochastic control. Keywords: ultra large multi-agent systems, system of systems, autonomous systems, stochastic hybrid systems.

Multiobjective Collaborative Optimization of Systems of Systems

National Research Council Canada - National Science Library

Wolf, Robert A

2005-01-01

...; in other words an inefficient design of the system of systems. This thesis examines the simultaneous design of several ships using the sea base concept as an example application of a network of ships working together...

Nova control system: goals, architecture, and system design

International Nuclear Information System (INIS)

Suski, G.J.; Duffy, J.M.; Gritton, D.G.; Holloway, F.W.; Krammen, J.R.; Ozarski, R.G.; Severyn, J.R.; Van Arsdall, P.J.

1982-01-01

The control system for the Nova laser must operate reliably in a harsh pulse power environment and satisfy requirements of technical functionality, flexibility, maintainability and operability. It is composed of four fundamental subsystems: Power Conditioning, Alignment, Laser Diagnostics, and Target Diagnostics, together with a fifth, unifying subsystem called Central Controls. The system architecture utilizes a collection of distributed microcomputers, minicomputers, and components interconnected through high speed fiber optic communications systems. The design objectives, development strategy and architecture of the overall control system and each of its four fundamental subsystems are discussed. Specific hardware and software developments in several areas are also covered

Systems Engineering Leadership Development: Advancing Systems Engineering Excellence

Science.gov (United States)

Hall, Phil; Whitfield, Susan

2011-01-01

This slide presentation reviews the Systems Engineering Leadership Development Program, with particular emphasis on the work being done in the development of systems engineers at Marshall Space Flight Center. There exists a lack of individuals with systems engineering expertise, in particular those with strong leadership capabilities, to meet the needs of the Agency's exploration agenda. Therefore there is a emphasis on developing these programs to identify and train systems engineers. The presentation reviews the proposed MSFC program that includes course work, and developmental assignments. The formal developmental programs at the other centers are briefly reviewed, including the Point of Contact (POC)

Development of brake assist system. Summary of hydraulic brake assist system; Brake assist system no kaihatsu. Ekiatsushiki brake assist system no gaiyo

Energy Technology Data Exchange (ETDEWEB)

Hara, M; Ota, M; Shimizu, S [Toyota, Motor Corp., Aichi (Japan)

1997-10-01

We have already developed vacuum-booster-type Brake Assist System that supplies additional braking power when panic braking is recognized. We are convinced that the expansion of Brake Assist System will become more important issue in the future. Therefore we have developed hydraulic Brake Assist System with increasing its controllability and reducing its discomfort. This system have a brake pressure sensor to detect emergency braking operation and an antilock device to supply additional braking power. 8 refs., 11 figs.

Symmetric linear systems - An application of algebraic systems theory